ART IN MEDICINE: MUSICIANS, PHYSICIANS AND

PHYSICIAN-MUSICIAN
JAMES J. CERDA
GAINESVILLE, FL

INTRODUCTION
According to Strohl (1) the profession of medicine and the art of music
have been closely allied since ancient times. Apollo, according to Greek
and Roman mythology, was the god of medicine, music, and poetry. To
Homer, the greatest of poets, go the laurels for his successful use of music
as a therapeutic agent in the field of surgery. It is only now after nearly
3,000 years that music is being used in surgery, though from a rather
different aspect than to check the flow of blood from a wound of Ulysses,
as was originally done. In many operating rooms, classical music is
available at the option of the surgeon and patient prior to and during the
surgical procedure. At the Royal Victoria Hospital in Montreal, music
therapy utilizing a trained music therapist is used in the palliative care
of patients with advanced malignant disease (2). Recently, the Interna-
tional Journal of Arts and Medicine (IJAM) has emerged as an official
peer-review journal to foster and research the therapeutic properties of
music. Their goal is to help improve the management of patients through
musical means by bringing together scientists, musicians, psychologists,
and professionals from other disciplines and backgrounds who have an
interest in music, medicine/music therapy, and related research (3).
Musicians themselves seek medical care because of common and pain-
ful musculoligamentous overuse which can result in pain and loss of
function in muscle groups and ligaments as a result of excessive or
unaccustomed activity. This has been referred to as craft palsy (4).
Probably one of the most famous musicians studied in this fashion was
Gary Graffman, the renowned concert pianist, who was suffering from
mysterious cramping and curling of the fourth and fifth fingers of his
right hand. Examinations included complete musculoskeletal system
evaluation, blood test to rule out immune system dysfunction or circu-
latory problems, conduction studies, videotapes and snapshots of many
performances. It is of interest that 75% of the musician-patients are
pianists, 15% are string players, and the remaining 10% comprise guitar-
ists (steel and classical), woodwind and tuba players, and drummers (5).
The nineteenth century was a period in which the association of
medicine and music was especially great.
The child prodigy, Fritz Kreisler, was born in Vienna in 1875. He won
the grand prix of the Paris Conservatory at the age of 12, and was
228
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awarded the grand prix de Rome at the age of 20. At the completion of a
successful tour of the United States as a concert violinist, he gave up his
beloved music and began the study of medicine, culminating in his being
appointed a medical officer in the Austrian Army. However, music was
his first love and he subsequently abandoned his career in medicine,
returning to his lifelong career as one of the great violin virtuosos of all
time. In 1935 he revealed that a number of compositions he had played
as compositions of old masters were actually his own (6).
Herman Boerhaave (1668-1738) was educated with the hope that he
would follow in the footsteps of his clerical father. He was considered
the greatest clinician and medical educator of his time and was versed in
a number of languages. Truly a Renaissance man, he was a distinguished
chemist, physician, teacher, and practitioner, best known for the descrip-
tion of esophageal rupture (Boerhaave's syndrome). Less known is the
fact that he developed the botanical garden in Leyden and is known as
the first physician to cultivate chamber music (7).
Hector Berlioz was the son of Louis Berlioz, a small-town physician
who had little sympathy for a musical career for Hector. Louis Berlioz
exerted every possible influence in order to direct Hector into a career in
medicine, since not only Louis, but his grandfather and uncle had been
physicians. Fortunately for music, Hector was easily recognized as a
composer and child prodigy. It was fortunate that Bernard Vandiern, a
great composer in his day, perceived Hector's potential. He stated that
Berlioz had "with the sole exception of Mozart, the most stupendous
gifts of the past century." Nevertheless, Berlioz entered medical school
and in 1824 earned his Bachelor of Science degree in medicine. However,
his desire to be a musician was stronger than his forced conscription into
the medical profession. Against the advice of friends and his parents,
(who threatened to cut off his allowance) he attended classes under the
tutelage of Leseur. In fact, it was Leseur who commented after hearing
Berlioz' mass, "You should not be a doctor or a druggist, or anything
else, but a great musician." Stubbornly, his father held that Hector
should continue to be a physician, but did allow him to continue to
pursue his musical ambitions. However, Hector's lifestyle, including
many unsuccessful love affairs, and lack of money were impediments.
Nicolo Paganini recognized Berlioz' phenomenal ability and after the
performance of "Harold" in Italy, paid tribute to Berlioz by getting down
on his knee and congratulating him. It was through Paganini and Baron
de Rothschild that Hector was able to complete "Romeo and Juliet" and,
of course, his magnificent Symphony, "Fantastique," works which estab-
lished him as a great composer (8). Paganini himself may have suffered
from Marfan's syndrome, which probably contributed to his being con-
sidered the greatest violin virtuoso of all time, due to the manual dexterity
230 JAMES J. CERDA
conferred by being born with long fingers and the hyperextensive joints
of Marfan's syndrome (9).
Herman Ludwig Ferdinand von Helmholtz (1821-1894) was professor
of physiology at Konigsberg. A physician by training and teacher by
profession, Helmholtz became Germany's foremost physicist, succeeding
to the chair of physics at the University of Berlin. His contributions to
our knowledge of acoustics nearly equaled those he made to physiologic
optics. Among his greatest accomplishments in medicine during nine-
teenth century was the ophthalmoscope invented in 1850. He was a
skilled pianist and musician, having studied the theory of music as
required at that time for a proper musical education. His first paper on
physical acoustics appeared in 1849 and his most famous group of works,
"On the Sensation of Tones as a Physiological Basis for the Theory of
Music," became a fundamental textbook in its field (10).
Theodor Billroth was born on the island of Rugen in 1829. Billroth's
contributions to surgery of the digestive tract gained him international
recognition. It was, however, in music that his ambitions really lay. His
earliest hopes were to study music. Nevertheless, his parents opposed
this career and insisted he study medicine. It was at Zurich that Billroth
met Johannes Brahms where they formed a lifelong friendship. In fact,
virtually all of Brahms' chamber music was played for the first time in
Billroth's home. Leading musicians of Vienna gathered at his home for
evenings of music with Billroth performing on the piano or violin. As if
this were not enough, Billroth wrote extensively and entitled a book,
"Wer ist Musicalich?", attempting to develop a physiologic theory of
music appreciation. Furthermore, he was recognized as a critic of music
and wrote musical reviews for the music magazine, "New Zuricher Zie-
tung" (11).
Aleksandr Borodin was born in St. Petersburg, Russia in 1833. It was
the ambition of his mother that he aspire to become a physician, so at
the age of 15 he was enrolled in the St. Petersburg Academy of Medicine.
Like Billroth, Borodin was able to combine his great interest in science
with his musical avocation. He became a Professor at Petersburg Acad-
emy of Medicine. Borodin became a member of the "Russian Circle of
Five," who had a single mission: to create a national art in their compo-
sition. The group was composed of Balakrieve, a mathematician; Borodin,
a physician; Cui, a professor of fortification in the Engineer's Academy;
Moussorvsky, a military officer; and Rimski-Korsakov, a former naval
cadet (12).
Early in his youth, Albert Schweitzer became a lover of music. He
became a pupil of Eugene Munch, one of Germany's most illustrious
organists. It was under Munch's tutelage that Schweitzer developed as a
great organist and as an outstanding interpreter of Bach. It is of interest
 ART IN MEDICINE 231
to note that the late director of the Boston Symphony Orchestra, Charles
Munch, was the nephew of Eugene Munch. Schweitzer then entered the
University of Strasbourg in 1893 where he studied philosophy, theology,
and music. In 1900 he was ordained a Lutheran minister and began to
write extensively in theology. In 1905 he read a magazine article in which
the president of a Paris missionary society pleaded for workers in Africa.
This was Schweitzer's inspiration to serve as a medical missionary. He
enrolled in the University of Strasbourg to prepare himself for his future
work as a physician in French Equatorial Africa. His work in Africa is
legendary, and led to his winning the Nobel prize. Despite failing health
he continued to give lectures and concerts in many European countries,
using the money to fund his hospitals in Africa (13).
There has also been a considerable interest in musicians and their
diseases. Of great importance was the celebration last year of the bicen-
tennial of Mozart's death at the age of 35. In the United States and
abroad, virtually hundreds of commemorative concerts were given during
1991, "the year of Mozart." The movie, Amadeus, may have won the
Oscar for best movie, but it wins no awards for medical accuracy since it
was probably kidney disease after a lifetime of illness and not his envious
rival court composer Antonio Salieri that ultimately did in the Austrian
wunderkind, christened Johannes Chrysostomus Wolfgangus Theophilus
Mozart (14).
Despite, or perhaps because, of a large amount of medical speculation,
the actual cause of Mozart's death remains somewhat uncertain. It has
been variously attributed to typhoid fever, tuberculosis, and glomerulo-
nephritis. It was Barraut, quoted by Biancolli, who stated that: "Two
factors hastened Mozart's death. The first was a chronic cause dating
from his earliest years and increasing every day. This was simply exces-
sive work, continual fatigue and profound misery. It was at that moment
that the disease which carried him off laid hold of him. If we considered
his rapid emaciation, his difficulty in breathing, his faintings, the swelling
of his legs and hands, paresis, and if we remember that when young he
had scarlatina, we are indeed led to the conclusion "nephritis." Mozart,
in our opinion died of Bright's disease, and if one considers the extreme
weakness when he felt the first attacks of this malady, one can really
understand that the disease only took six months, from July to December,
to exterminate a man who throughout his life had been obliged to fight
in order to have bread to eat" (15). According to Yu (16), Mozart's skull
was acquired by the Mozarteum at Salzburg, where it is presently held.
A group of French scientists has recently carried out extensive exami-
nations on the skull. Of particular note was the finding of premature
synostosis of the metopic suture, a rare congenital anomaly associated
with a characteristically shaped cranium. When they superimposed im-
232 JAMES J. CERDA
ages of the skull on a contemporary (1778) portrait of Mozart, they
demonstrated that the features of both coincided closely. Given this, Yu
goes on to state that other studies would be intriguing, including positive
identification by DNA fingerprinting, diagnostic molecular analysis, uti-
lizing polymerase chain reaction (PCR), trace metal analyses, and radio-
graphic analyses, to provide evidence for renal osteodystrophy. A com-
plete review of the various theories can be found in an excellent article
by Guillery (17).
The most famous instance of deafness is the case of the composer
Ludwig van Beethoven. Beethoven suffered through a wide variety of
other diseases, including "rheumatism" which may have been gout, and
probably infectious hepatitis. In early 1825 he had a severe attack of
colitis and was glad to have survived it. He wrote the adagio, a minor
quartet as a "hymn of thanksgiving to God" by an "invalid on his
convalescence," which inspired the sonnet:
Bereft of love and wearied out with life,
Too torn to weep, yet wishing to be wept
Upon and loved; beset with sorrows rife,
I lay alone through tortured nights unslept.
And all the world's outside was vilely stenched
By man's insensate brutishness, and stocked
With micro-men for macro-tests. How wrenched
Was my poor heart to see dear peace so mocked!
Thus wrenched I then heard a song above,
Sublime, transcendent music! Starsward soared
This pure abstraction, prayer for peace and love
Transfigured wine from fragile chalice poured
All cares seemed naught when Beethoven could still
Give thanks to God though deaf, alone and ill (18).
His health continued to dissipate and after composing one of his
masterpieces, the string quartet in C sharp minor in 1826, his health
took a sudden turn for the worse, including symptoms such as chills,
fever, and pleuritic pain. He had diarrhea and became jaundiced. After
seeing his physician, Dr. Waruch, he continued to try to keep up his
spirits. Beethoven was said to have looked at his many bottles of pills
and whisper, "Pity-too late!" These were his final words. For two days
he remained in hepatic coma, expiring shortly after 5:00 p.m. on March
26, 1827 (19).
In summary, it would appear that music is an art to which many
physicians are attracted. Whether as performers or as listeners, a consid-
erable number of people in the medical sciences have had some sort of
interest in music. The reason for this affinity between medicine and
music is hard to explain and will continue to be an interesting topic for
 ART IN MEDICINE 233
speculation, and with validation of therapeutic goals through interdisci-
plinary research involving physiology, psychology, and applications of
music and medicine. Organizations such as the International Arts-Med-
ical Association, and the International Society for Music and Medicine
will play important roles. At the University of Florida a working group
has been established called "Art in Medicine (AIM)" a concept which is
not new, but whose application may be new. The purpose of our program
is designed to encourage caring and humanistic communication between
health professionals and patients through art and music and to provide
artists a new dimension to express their art as an integral part of the
healing process. This cooperative effort hopes to:
(1) Improve and increase the practice of humanistic communications
among health professionals toward each other and patients.
(2) Encourage health professionals to find a form of expression
through the arts by exposing the group to local, national and
international figures in the health and science disciplines who are
known for their artistic pursuits in addition to their scientific
professions.
(3) Create awareness in both groups of the symbiotic relationship of
the arts of self expression and human physiology in the prevention
of illness and healing processes by means of seminars conducted
by artists, patients, scientists and experts in such new areas of
scientific exploration as Psychoneuroimmunology and associated
fields.
(4) Form a dedicated group of those artists and scientists to interact
with patients suffering terminal or chronic illness to encourage
them to express through some form of art or art appreciation, their
pain, fear, and hopes in order to provide an approved quality of
life and acceptance of self.
(5) Collect pertinent data relative to the response of patients, artists,
and health professionals involved in the program.
Much needs to be done.

ACKNOWLEDGEMENT
The author wishes to thank Mrs. Patricia R. Vance for expert technical
assistance.

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234 JAMES J. CERDA
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