Ludwig van Beethoven-a psychiatric perspective.

Biographical accounts of famous artists usually try to relate the life story to the works (and vice versa). This gives the work a special "colour", often the context for understanding for today's recipients. This interrelation is complex and often judgmental, sometimes manipulative. Thus, medical (including psychiatric), characterological and psychodynamic assessments and interpretations must be made with great caution. Primary sources may be scanty and diagnostic concepts may have changed (Mozart died of hitzigem Frieselfieber [prickly heat fever]; in Hölderlin's lifetime, schizophrenia or bipolar disorder did not yet "exist"). The attempt at a diagnostic classification often says more about the author and his time than about the artist (for example, the assessment of Robert Schumann's or Friedrich Hölderlin's mental illness). Against this background, elements of Ludwig van Beethoven's biography are presented from a psychiatric perspective. In summary, Beethoven can be diagnosed with an alcohol use disorder. A pronounced hyperthymic temperament is likely to have had a clearly positive influence on the course of the disorder. In particular, no influence of the alcohol use disorder on the musical quality of the work can be proven. A clear episodic course of affective symptoms as in bipolar disorder is not demonstrable. The deafness caused a severe reduction in quality of life.

Will the shepherd be able to play the alpine horn with that huge goiter (XVI century)?

PURPOSE: There are many of the representations in iconography of individuals with goiters reported in the literature. METHODS: The article describe a unique representation of goiter, as observed by the authors in a sculpture in Italy. RESULTS: In a Nativity, in the upper part of the altar of the Church of the Annunciata, Boccioleto (Val Sermenza, Piedmont, Italy), a horn player with a huge goiter, gladdens the Holy Family. Wooden work by Francesco Antonio d'Alberto, 1694. CONCLUSION: This is an appropriate example of the iconography of "real goiter," since in this case the sculptor had the aim of showing person with goiter.

A different aspect of the unexpected death of Mozart at the age of 35 years.

The cause of the early death of Wolfgang Amadeus Mozart (1756-1791) at the age of 35 has been the source of much discussion in the medical community. Investigators attributed to Mozart nearly 150 different medical diagnoses. However, the neurosurgical aspect of the early death of Mozart has yet to be well-analyzed, and this subject was investigated herein. The key words "Mozart" and "Mozart's death" were searched in PubMed as well as the libraries of universities. The main source was the archive and website of Internationale Stiftung MOZARTEUM/Salzburg (www.mozarteum.at) and the cranium stored in the Internationale Stiftung Mozarteum in Salzburg/Austria. The linear fracture of the cranium is important, since it shows the neurosurgical aspect of the early death of Mozart. Mozart's disease was most likely a neurotraumatologic one. His fracture likely occurred several months before his death, as evidenced by signs of healing. Intense headaches and declining musical performance in his last year may have been influenced by intracranial hemorrhage induced by the linear fracture. His final disease therefore may have been chronic postconcussion syndrome depending on chronic calcified epidural hematoma.

[Johann Sebastian Bach's disease and his bizarre english physician]. / La enfermedad de Johann Sebastian Bach y su mediático médico inglés.

Johann Sebastian Bach suffered during the last year of his life of a progressive visual defect despite two operations done by a famous but quite controversial English ocular surgeon of that time. The exact diagnosis of his ocular problems is unclear but cataracts and complicated glaucoma seem the most plausible. A septic complication following the ocular surgery could have weakened Bach's health leading to his death only three months after the last intervention. In this paper diverse less known aspects of Bach's disease and life are reported.

Did Frédéric Chopin Die From Heart Failure?

On October 17, 1849, Poland's greatest composer, Frédéric Chopin (1810-1849) died aged 39. His cause of death remains unknown. An investigation of the documental sources was performed to reconstruct the medical history of the artist. Since his earliest years, his life had been dominated by poor health. Recurrent episodes of cough, fever, headaches, lymphadenopathy- a series of symptoms that may be attributed to viral respiratory infections- manifested in his teens. Later in life, he had chest pain, hemoptysis, hematemesis, neuralgia, and arthralgia. Exhaustion and breathlessness characterized all his adult life. Coughing, choking, and edema of the legs and ankles manifested four months before his death. Several hypotheses ranging from cystic fibrosis to alpha-1 anti-trypsin deficiency and pulmonary tuberculosis have been proposed to explain Chopin's lifelong illness. We suggest that Chopin had dilated cardiomyopathy with consequent heart failure and cirrhosis that caused his death.

Acute-on-chronic subdural hematoma: the death of the famous XIX century soprano Maria Malibran-a study of the sources.

Maria Malibran (1808-1836) is one of the most famous sopranos of the nineteenth century. In 1825, along with her father, the renowned tenor Manuel Garcia, she introduced the Italian opera in America for the first time. The European debut in Paris (1828) definitively crowned her as a star. Thus, she was requested by the most famous European theaters. In July 1836, during an equestrian excursion in London, she fell from her horse dashing her head against the ground, resulting in a state of insensibility. Since that accident, she had suffered from continual headache and nervous attacks, but she continued to work. In September 1836, she attended a music festival in Manchester, but her health rapidly worsened: episodes of nervous attacks, headache, and fainting occurred with higher frequency. At the end of a representation, she was attacked by violent convulsions. In the following days, she was laid in a kind of stupor. Afterward, she died at the age of 28. The hypothesis that prolonged efforts during her performance could have provoked a rebleeding of a pre-existent chronic subdural hematoma should be taken into account as a possible cause of death.

Analyzing of dark past and bright present of neurosurgical history with a picture of musicians.

AIM: Currently, neurosurgery has gone through moments of great renewal, however, in the first half of the 20th century, unwanted outcome after surgical approach had occurred. The aim of this historical overview of a picture of the musicians is to show the development of Neurosurgery in 20 century. METHODS: History of neurosurgery in the first half of the 20th century and the current was investigated through PubMed. A brief tour of some of the major landmarks of contemporary neurosurgery was also made. RESULTS: A musician picture was found which taken in 1928. Two of the musicians suffered neurosurgical disorder, and operated in 1937, both immediately died without gaining conscious at early postoperative period. CONCLUSION: We described the role of neurosurgery in the lives of two famous musicians, George Gershwin and Maurice Ravel. A picture taken 1928, shows the developing of Neurosurgery from first half of 20th century to current.

Playing off the beat: Applying the jazz paradigm to psychotherapy.

A jazz paradigm is applied to traditional psychotherapy practice, illuminating the links between psychotherapy and the Romantic aesthetic tradition, primarily in the centrality of concepts such as attunement. Modernist disruptions of realism during the early 20th century, such as jazz, elaborated dissonant and improvisational artistic impulses that brought new vitality to their art forms. The psychotherapeutic relationship also has potential avenues for multilevel and discrepant communication that open possibilities of freedom. However, the limitations imposed by the single channel nature of comprehended language, compared with the capacity of artistic media to express multiple sensory information simultaneously, remain the most significant obstacle to dimensionalizing the psychotherapeutic dialogue. Psychotherapy may have much to gain from embracing some of the concepts underlying the jazz aesthetic.

[A medical biography of Ludwig van Beethoven]. / Ludwig van Beethoven, el genio de Bonn atormentado por sus enfermedades: su historia médica.

Much emphasis has been given to the deafness of Ludwig van Beethoven and its potential causes. However, when analyzing several symptoms reported by himself throughout his life in many letters and his final illness, a common etiology emerges. This article reports the medical history of this artist, based on authoritative scientific sources.

"Nabucco" by Giuseppe Verdi: A Case of Delirium in an Italian Romantic Opera.

Italian operas can provide relevant information on the medical knowledge during the Romantic Age, especially in the field of neuroscience. One of the most renowned operas, "Nabucco" by Giuseppe Verdi (1813-1901) may provide us with some information on the state of knowledge on neuropsychiatric diseases in the first part of the nineteenth century. The main character of this opera, the Assyrian king Nabucco suffers from delirium. Psychic signs and symptoms attributed to Nabucco in Verdi's opera could have been influenced by a better knowledge of neuropsychiatric diseases in the nineteenth century. Furthermore, the representation of Nabucco's mental illness in the opera could also have been influenced by direct experiences of Verdi himself, who seems to have suffered from recurrent depressive episodes in that period, and for the rest of his life.

[Robert Schumann in the psychiatric hospital in Endenich near Bonn]. / Robert Schumann in der Heil- und Pflegeanstalt Endenich bei Bonn.

BACKGROUND: The composer Robert Schumann (1810-1856) spent the last two-and-a-half years of his life in the private psychiatric hospital in Endenich. His medical records emerged in 1991 and were published by Appel in 2006. METHODS: Daily entries by the physicians were analyzed concerning psychopathology and organic signs as well as the illness-related correspondence of the people closest to Schumann. RESULTS: The numerous entries reveal the treatment typical at that time for what was at first considered to be "melancholy with delusions": shielding from stimuli, physical procedures, and a dietary regimen. The feared, actual diagnosis, a "general (incomplete) paralysis," becomes a certainty in the course of the paranoid-hallucinatory symptoms with cerebro-organic characteristics and agitated states, differences in pupil size, and increasing speech disturbances. CONCLUSION: In the medicine of the time, syphilis is just emerging as the suspected cause, and the term "progressive paralysis" is coined as typical for the course. Proof of Treponema pallidum infection was not available until 1905. Nevertheless, the clinical signs strongly refer to the course of neurosyphilis. People close to Robert, in particular his wife Clara and the circle of friends around Brahms and Joachim, cared intensively for him and suffered under the therapeutic isolation. The medical records and disease-related letters contradict the theory that Schumann was disposed of by being put into the psychiatric hospital; they show the concern of all during the unfavorable illness course.

Musical and poetic creativity and epilepsy.

Associations between epilepsy and musical or poetic composition have received little attention. We reviewed the literature on links between poetic and musical skills and epilepsy, limiting this to the Western canon. While several composers were said to have had epilepsy, John Hughes concluded that none of the major classical composers thought to have had epilepsy actually had it. The only composer with epilepsy that we could find was the contemporary composer, Hikari Oe, who has autism and developed epilepsy at age 15years. In his childhood years, his mother found that he had an ability to identify bird sound and keys of songs and began teaching him piano. Hikari is able to compose in his head when his seizures are not severe, but when his seizures worsen, his creativity is lost. Music critics have commented on the simplicity of his musical composition and its monotonous sound. Our failure to find evidence of musical composers with epilepsy finds parallels with poetry where there are virtually no established poets with epilepsy. Those with seizures include Lord George Byron in the setting of terminal illness, Algernon Swinburne who had alcohol-related seizures, Charles Lloyd who had seizures and psychosis, Edward Lear who had childhood onset seizures, and Vachel Lindsay. The possibility that Emily Dickinson had epilepsy is also discussed. It has not been possible to identify great talents with epilepsy who excel in poetic or musical composition. There are few published poets with epilepsy and no great composers. Why is this? Similarities between music and poetry include meter, tone, stress, rhythm, and form, and much poetry is sung with music. It is likely that great musical and poetic compositions demand a greater degree of concentration and memory than is possible in epilepsy, resulting in problems retaining a musical and mathematical structure over time. The lack of association between recognizable neuropsychiatric disorders and these skills is a gateway to understanding facets of the relationship between the brain and creativity. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

'Il Sonnambulo' by Michele Carafa: A Forgotten Romantic Opera with Sleepwalking.

Romantic operas provide a useful tool for historians to understand the perception of some medical disorders that existed during the nineteenth century. Somnambulism was still a mysterious condition during this time, since its pathogenesis was unknown. Hence, it comes as no surprise that somnambulism features in a number of operas, the best known of which are Verdi's 'Macbeth' and Bellini's 'La Sonnambula', both the subject of recent scholarship. Here we examine a more obscure opera in which sleepwalking is depicted. Dating from 1824, 'Il Sonnambulo' by the Italian composer Michele Carafa is based on a libretto by Felice Romani. Although it shares some features with the Verdi and Bellini operas, it also presents original elements. Our analysis of this forgotten opera supports the contention that studying operas can shed light on medical theories and practices, and on how ideas about mind and body disorders were transmitted to the laity in times past.

[Production of accentuated personality traits in baroque opera : Opera buffa Arcifanfano-Re dei matti (1749)]. / Inszenierung von akzentuierten Persönlichkeitszügen in der Barockoper : Opera buffa Arcifanfano - Re dei matti (1749).

BACKGROUND: Madness served primarily as a form of amusement for the spectators in operas of the seventeenth century. This representation was far removed from clinical reality. This circumstance changed in the eighteenth century at the time when tragic madness emerged in numerous operas. MATERIAL AND METHODS: The opera buffa Arcifanfano-Re dei matti (Arcifanfano-King of fools, premiered in 1749 in Venice, text by Carlo Goldoni 1707-1793 and music by Baldassare Galuppi 1706-1785), which continuously enacts a realm of fools and is meant to appear amusing, is riddled with psychopathological abnormalities for which a retrospective diagnosis is methodologically rejected. However, the opera presents many subjects for working out a typology of fools based on outlasting personality traits of the protagonists. The libretto is investigated. A musical analysis is spared. RESULTS: The conceptualized typology of fools in the opera, which is oriented towards the seven main vices or deadly sins serves, in the tradition of moral satire, to critically hold up a mirror to the audience to reflect their own vices by an amusing characterization of the latter. Historically classified, the treatment of fools by means of isolation, custody, locking up in cages as well as authoritarian measures of submission reflects the custom in those days before humanizing the treatment of people with mental illness in the course of the Enlightenment and the French Revolution. CONCLUSION: The opera Arcifanfano is essentially characterized by continuous madness. A typology of the fools can be worked out from the precise depiction of the personalities. A mirror is held up to the spectators in terms of vices, in the tradition of the contemporary baroque opera. At the same time, the opera can be classified psychiatrically and historically as a seismograph of its time when in the seventeenth and eighteenth centuries people with mental illness were isolated and incarcerated.

[Psychological and psychoanalytical issues in Schreker's opera "Die Gezeichneten"]. / Psychologische und psychoanalytische Grundlagen in Schrekers Musikdrama "Die Gezeichneten".

Franz Schrekers opera "Die Gezeichneten" is the artistically answer to Sigmund Freud's psychoanalysis. The proceedings in this drama discuss some principles of psychoanalyses. The figures show typical psychological mechanisms like repression, sublimation or regression and also the typical symptoms of neurosis. During the date of origin of the opera, Freud's method of psychoanalysis becomes well known and a lot of physicians and psychologists begin with their education in it. Themes like the theory of sexuality by Freud were discussed in the Vienna society. The story contains all mechanisms of psychoanalysis and discloses the psychopathology of the society of "fín de siègle" on the end of the 19th century. Franz Schreker's opera is like a forecasting of the nemesis, which in Europe occurs two decades later. The figures of the opera show the central facts of psychoanalysis and their artificial expression in music and performance.

Music, Mechanism, and the "Sonic Turn" in Physical Diagnosis.

The sonic diagnostic techniques of percussion and mediate auscultation advocated by Leopold von Auenbrugger and R. T. H. Laennec developed within larger musical contexts of practice, notation, and epistemology. Earlier, François-Nicolas Marquet proposed a musical notation of pulse that connected felt pulsation with heard music. Though contemporary vitalists rejected Marquet's work, mechanists such as Albrecht von Haller included it into the larger discourse about the physiological manifestations of bodily fluids and fibers. Educated in that mechanistic physiology, Auenbrugger used musical vocabulary to present his work on thoracic percussion; Laennec's musical experience shaped his exploration of the new timbres involved in mediate auscultation.

Nicolò Paganini's hair lock for Signora Chatterton - morphological hair investigations using digital light microscopy.

The famous violin virtuoso Nicolò Paganini (born on 27 October 1782 in Genoa, died on 27 May 1840 in Nice) left us with many puzzles. An interesting aspect is his hair: In the 19th century, hair given away as a token of friendship or romantic love became very popular, and Paganini also seems to have made use of this fad. In 2009, a lock of hair, purportedly that of Paganini, kept in a locked presentation box together with a bilingual autograph inscription saying: "Alla Signora Chatterton avec les compliments de Nicolò Paganini" was bought at an auction. From this hair lock a sample was taken and was investigated morphologically by using digital light microscopy (digital microscope VHX-100, Keyence) in reflected and transmitted light with and without polarization at different magnifications up to 1:5,000. The sample was then compared with a hair sample from the possession of the Paganini family, which had been microscopically examined in 2012 by the co-author of this paper yielding numerous figures with measurement results that had been stored and could be retrieved for direct comparison. The hair sample consisted of ten strands of hair or hair fragments and was investigated with great effort for the following parameters: exogenous hair damage, especially feeding traces caused by parasites, modeling and angulation of hairs, hair thickness, medulla and pigmentation, curling and mercury load on the trace material. After evaluation of all findings not only a non-exclusion of identity can be determined, but due to the broad match of also rare findings there is no reasonable doubt about their identity. In addition, the findings suggest that the studied hair samples are in fact from Paganini's head. The present case of Nicolò Paganini's hair lock is also an excellent starting point for reflections on the probative value of trace hair investigations. This point is also critically discussed in the paper. Finally, this study shows that said lock of hair had probably really been dedicated and given to Eliza Davenport Latham (born on 25 November 1806, died on 9 January 1877), the future wife of the, at that time, best-known and most famous English harpist John Balsir Chatterton (born on 25 November 1804, died on 9 April 1871). Paganini must have met her on his concert tour 1831/32, where he had travelled to Paris, London, the rest of England, Scotland and Ireland.