Does lead take the lead as the best explanation for Beethoven deafness?

Abstract

We read with interest the article by Thomas et al. entitled “Aetiology of Ludwig van Beethoven’s hearing impairment: hypotheses over the past 100 years—a systematic review” discussing the hypotheses proposed over time to explain the hearing loss of the great composer [1]. In our opinion, the discussion about the role of chronic lead intoxication in the clinical course of Beethoven health issues should be clarified. The authors state that few data are available about the prevalence and extent of hearing loss induced by chronic lead exposure, concluding that it is difficult to associate Beethoven’s deafness with a chronic lead intoxication. We agree with the colleagues that lead poisoning is rare and basically studies on large populations are missing. Indeed, this type of poisoning is prevented by modern laws about the use of lead, for examples in varnishes and in beverage. Also, the use in construction is now very limited. This was not the case of the Roman Empire in which the use of lead in the pipes is supposed to be the cause of saturnism in large part of the population of wealthy social classes. Fortunately, we can say that in the last two centuries only limited cases of lead poisoning are documented. In our previous paper [2], we presented a rare case of lead intoxication that we had the chance to visit. The woman presented abdominal symptoms, fatigue, and progressive hearing loss. In the end, the clinical history was oddly similar to the one of Beethoven. Luckily for the woman, the availability of modern techniques and instruments enabled to detect the high levels of lead in the blood, to treat the patients and to regress most of the symptoms. Unfortunately, the hearing loss caused by lead intoxication is not reversible and the woman will have to deal with it for the rest of her life as it happened for Beethoven. Even if the value of a single case should be considered with caution, it should not be ignored because it can confirm the previously presented hypothesis of chronic lead poisoning as the possible cause of hearing loss of the German composer [3]. Notably, the presence of high lead values deep in the bones of Beethoven’s body should be considered as particularly relevant to sustain this hypothesis among others. In the past, multiple theories were considered plausible despite the absence of real data to sustain them; as we pointed out in our paper, also Thomas also reported a series of beliefs that have been proposed over time with no concrete data to support them. If lead poisoning is excluded as the possible explanation of Beethoven’s illness, one should explain what is the reason (other than a chronic assumption) to such amount of lead that can be found in the body and why it did not have an impact on the clinical health status of the great maestro. In our opinion, the simplest way to connect all the available data is a chronic lead intoxication caused by a significant assumption of low-quality wine with the addition of lead in it. Indeed, the course of the hearing loss seems to be in line with the timeline of the consumption of wine throughout his life. Also, his contemporaries reported that in the periods in which Beethoven stopped the assumption of alcohol most of the symptoms reduced; this was not the case of the hearing damage that is not reversible in lead intoxication. This comment refers to the article available online at https:// doi. org/ 10. 1007/ s0040502006467-w.