Satoshi Akima responds to my post on possible causes of Beethoven's
deafness:

>Having followed this topic with some interest I find myself enticed out
>of my lengthy silence to write as an Internist that the hypothesis of
>SLE (systemic lupus erythematosus) sounds to me too far fetched.  SLE
>is extraordinarily rare in men.

Yes, I know and so does Larkin, the defender of the hypothesis.
Nevertheless he finds enough evidence, he writes, to keep it in mind.

>Bowel problems in general usually are not that prominent a feature of
>the disorder as much as joint pains, fevers, dramatic hair loss (hair
>falling out in large clumps - not just male pattern balding!), skin
>rashes, shortness of breath and pleuritic chest pains.  I am not aware
>of Beethoven having any of these symptoms.

Skin rashes, yes.  Shortness or breath and pleuritic chest pains, maybe.
In his last two years Beethoven suffered from skin problems (particularly
his face) and in preceding years he sometimes complained about his chest
and he even thought that he would die of consumption, like his mother and
brother.  However, the autopsy report doesn't show sick lungs.  On the
contrary.  Joint pains is a difficult one, for Beethoven sometimes also
complained about "rheumatism", but in his days this word was used for
various illnesses that had nothing to do with rheuma.  Dramatic hair loss,
no. Not a sign of this symptom in Beethoven.

>>Also interesting is the publication by Kubba and Young in The Lancet
>>(1996).  Their conclusion is that a diagnosis is not possible, because we
>>don't have enough data.  Their choice for the bowel problems and liver
>>cirrhosis is Crohn's disease.
>
>This one is more plausible.  Crohn's usually causes bloody diarrhea however
>and I am unaware of this being a feature of Beethoven's medical history.
>Liver cirrhosis from associated sclerosing cholangitis is known to occur in
>Crohn's, but is again uncommon for it lead to end stage hepatic cirrhosis.
>This hypothesis posits a rare complications of a relatively uncommon
>disease.

Beethoven often suffered from diarrhoea, though not bloody, as far as we
know.  The fact that -as you write- it's rare when Crohn's disease leads
to end stage liver cirrhosis is a reason to ponder over either another
diagnosis or a second cause that worsened the condition of a maybe already
weak (inborn?) liver.  Lead? Alcohol? Both?

Joyce Maier (mail to: [log in to unmask] or [log in to unmask] or [log in to unmask])
www.ademu.com/Beethoven