Medicine, Music and Apoplexy

Jun. 26, 2019

Dr. Quest recently brought these two disciplines together in a talk called “The Intersection of Music and Medicine: Maladies of the Great Composers.” It was delivered at a meeting of the Columbia University Vagelos College of Physicians and Surgeons’ Alumni Association, and the audience was a mix of med school alums and invited current students—a group with a variety of perspectives on the evolution of medicine.

Composers of the 1700s and 1800s created fantastic and enduring works, but their lives were shaped by the state of medicine at the time. Some lived fairly long lives: Haydn survived smallpox and suffered his entire life with painful nasal polyps, but he lived to age 77. Bach was composing music almost up until his death from eye surgery complications at age 65. Unfortunately, this surgery was performed by someone who is today thought to have blinded hundreds of individuals. Beethoven, famously, was deaf for much of his career.

Dr. Quest also spoke about Mozart, Schubert and Mendelssohn, all of whom died in their 30s. These composers’ musical achievements were so incredible that they are still remembered hundreds of years later. Yet they died so young that we can’t help but wonder what else they would have achieved had their lives been longer. 

In an effort to find out what many of the great composers died from, modern scholars have pored over contemporary accounts of their final illnesses, along with information about their environments, diets, lifestyles and habits.

By way of example, “medical detectives” have proposed that Schubert’s decline and death at age 31 may have been due to typhoid fever, or to a combination of syphilis and poisoning from the mercury used to treat syphilis. Today, typhoid fever is treated with antibiotics and the intravenous administration of fluid. Without these treatments—unavailable during Schubert’s lifetime—typhoid was fatal in as many as 30 percent of cases. Syphilis is likewise treated with antibiotics; when caught early, it can be completely cured by a single injection. In the 1800s, mercury was the only treatment available, and in some cases the “treatment” was hardly better than the condition itself.

Another condition, apoplexy, the cause of Mendelssohn’s death at age 38, has the ring of a defunct diagnosis. The word does have a specific meaning in medicine today: bleeding into an organ. But in the mid-1800s, the term apoplexy covered a lot of conditions that we recognize (and can more successfully treat) today: subarachnoid hemorrhage (bleeding inside the skull, for example from a burst aneurysm or AVM), ischemic stroke (loss of blood flow to the brain) and even sudden cardiac arrest (as from heart attack). The defining feature of apoplexy was that someone died suddenly, as if he or she had been struck down. At the time, no further medical diagnosis was either possible or useful.

In 1847, Mendelssohn’s sister died of apoplexy just a few months before he did. Both their parents also died of apoplexy, as did one grandfather. Today, doctors would suspect a genetic component to these events. Were they living in the developed world today, Mendelssohn and his sister would both have received detailed scans of the blood flow in their brains. If potentially dangerous aneurysms were found, neurosurgeons would have several treatment options to prevent them from bursting. 

From today’s perspective, medical practitioners of the 1800s were extremely constrained by the available medical understanding and technology. Composers also lived within those constraints, suffering chronic illnesses, loss of sight and early deaths that today would likely be preventable. But even given the very real constraints on their health and lifespans, composers of the period created enduring work that has brought joy and pleasure to generations of music lovers and inspired generations of composers.

Doctors and surgeons over the past 200 years have been busy also, making advances that succeeding generations of doctors and surgeons have eagerly applied and built upon. Extending the knowledge and capability of preceding generations, each new generation of doctors has brought a better chance at a healthier, longer life to new generations of patients. 

So it was fitting that Dr. Quest, an honored mentor of decades’ worth of younger doctors, spoke to both alumni and current medical students. He gave them perspective on change over time in the art of medicine, and on the reverberations of the art of medicine in the lives of artists.

Learn more about Dr. Quest on his bio page.

 

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