|
|
|
|
No. 70 Music & Medicine |
|
A Rhapsodic Debut George Gershwin was born in New York on 26 September 1898 into a family of Jewish Russian immigrants. He had an older brother, Ira, who later wrote the lyrics to most of Gershwin’s songs. Early on Gershwin showed a talent for the piano and made his public debut on 21 March 1914, playing a tango he had composed himself. He left school at the age of 15 to work as a pianist. For much of his life Gershwin was an extrovert, hard working, and a keen sportsman. He also fell deeply in love several times, but never married or had children. He composed his two most well-known works in his twenties, pieces in which he fused classical music with popular American forms such as ragtime, blues and jazz. Rhapsody in Blue, written in a few weeks in 1924 was an immediate success and made him famous overnight. It was followed in 1927 by An American in Paris, whose purpose Gershwin wrote was ‘to portray the impressions of an American visitor in Paris as he strolls about the city, listens to the various street noises, and absorbs the French atmosphere.’ Porgy and Bess, his first opera, written in 1935, was not well-received at first, but its compelling songs have ensured its place in the 20th-century opera repertoire. Some of these songs are the saddest and most anguished that Gershwin ever wrote, intimations of a sea change in Gershwin’s character and mood. An American in Pain Despite his strong physique, as early as the 1920s, Gershwin was plagued by nausea and stomach complaints. For which no doctor was able to find a cause or cure. However, it was not until 1936 that Gershwin’s friends and colleagues began to notice that this formerly extrovert man was growing increasingly melancholic. He became irritable and started complaining about matters he would previously have ignored. After the concert lapse, however, his private physician, Dr. Zilboorg, gave him a thorough medical examination but could find nothing wrong organically, and Gershwin was diagnosed as suffering from a psychosomatic disorder. Nevertheless, during the first half of 1937, Gershwin began experiencing headaches and dizzy spells, characterized by vertigo and an unpleasant spell. These spells occurred mostly in the morning or when he got nervous before playing a concert or a tennis match. He never lost consciousness. His doctor examined him regularly, but Gershwin still had no discernible neurological deficits, and the diagnosis was always psychogenic. Gershwin was working on his fourth motion picture, The Goldwyn Follies, and his symptoms were explained as ‘a neurotic protest against the artificial world of Hollywood.’ By June, however, he had become noticeably indifferent, apathetic and somewhat slow-witted. His behavior had also become erratic – soon after receiving chocolate as a gift, he powdered it and started to rub it over his body as an ointment. He also complained of motor limitations in his right hand and motor incoordination. Gershwin was admitted to the ‘Cedars of Lebanon’ Hospital in Los Angeles for a thorough investigation. The results of all the tests – blood, X-rays, ECG, neurological – were normal, and Gershwin was discharged with the diagnosis of ‘hysteria.’ Arrangements were now made for a nurse to be with him at all times and he received daily psychoanalytic treatment. All to no avail. His condition worsened. One evening, returning home from a party he sat down on the street with his feet in the gutter, put his head in his hands and complained bitterly that the splitting headache and the stench of burning rubber remained with him almost permanently and were driving him crazy. He dropped his knife when he was eating. Water spilled out of the glass when he tried to drink. A rest cure in a private nursing home was recommended and this seemed to do some good. He complained less about his headaches and played the piano with enjoyment. George Gershwin played his beloved instrument for the last time on the morning of 9 July 1937. That afternoon he collapsed and lost consciousness. He was taken again to the ‘Cedars of Lebanon’ Hospital. In a deep coma, Gershwin did not react to painful stimuli, had small and unequal pupils, and no voluntary movements. He presented with slight right hemiparesis, papilledema with retinal bleeding, and normal blood pressure without a stiff neck. His condition deteriorated and, on 10 July, the tentative diagnosis of a brain tumor was made. Dr. Harvey Cushing, a well-known neurosurgeon was called, and he recommended consultation with Dr. Walter Dandy of the Johns Hopkins Hospital in Baltimore, at the time the most distinguished practicing neurosurgeon in the US. The latter, however was on a cruise. A telegram was sent, but in the meantime, contact had also been made with another neurosurgeon in California, Dr. Howard Nafziger. Although he too was on vacation, he immediately flew in to Los Angeles from Lake Tahoe. At 9 p.m. on 10 July, unable to establish the precise location of the suspected tumor, Rand and Nafziger trepanated Gershwin to undertake ventriculography. They found that both lateral ventricles were displaced far toward the left and, whereas the left lateral ventricle was basically normal in configuration, the right was greatly flattened and the right temporal horn was not filled at all. The intracranial pressure had been very high. There was clearly a tumor in the right temporal region. Gershwin was taken into the operating room. During a procedure lasting 5 hours, Nafziger and Rand found a partially cystic malignant glioma and performed a partial resection. Gershwin, however, did not regain consciousness. His clinical situation worsened and he died on the morning of 11 July. Announcing his death on the radio, the commentator stated: ‘The man who had more notes in his head than he could write down in a hundred years died suddenly today in Hollywood.’ It Ain’t Necessarily So Today the lesion would be called a multiform glioblastoma. These tumors start developing long before there are clinical manifestations of their existence, and the initial symptoms can easily be misdiagnosed. It has been speculated that Gershwin originally had a low-grade astrocytoma in the right temporal lobe that may have provoked the very early epigastric sensations and was certainly responsible for the temporal lobe seizures and olfactory auras. Only in the final phase did it undergo rapid malignant degeneration and turn into a fulminating glioblastoma multiforme. Despite the gradual evolution of his disease, however, Gershwin’s musical productivity until only months before his death remained prodigious. A highly trained artist, the preservation of his left hemisphere musical representation probably explains his preserved musical competence. Words and Music An even more dramatic illustration of the brain’s spatial organization of its various processing functions is provided by the story of the Russian composer Vissarion Shebalin.
Shebalin was born in Omsk, Siberia, on 11 June 1902. He first studied at the musical conservatory in Omsk before moving on to the Moscow conservatory where he graduated in 1928 and was made a professor. He took the chair of the Department of Composition in 1941, and by 1942 was the conservatory’s director. Shebalin composed his first symphony as a student. A stream of compositions followed, including an opera performed at the Bolshoi Theater. He did not however escape the political purges of the post-war USSR, and in 1948, the level of his musical complexity attracted official rebuke for its so-called ‘formalism.’ Music without Words On 14 December 1953, Shebalin had his first stroke. This left him with hypesthesia (a diminished sensitivity to stimulation) and partial paralysis of his right hand and face. He also had severe language impairment. However, his condition improved over time and he was able to return to work. During the next six years Shebalin, free of symptoms, continued to compose and perform his duties as the conservatory’s director. However, on 9 October 1959 he had his second stroke, resulting in partial paralysis on the right side of his body. In addition he now suffered from profound aphasia. He could no longer understand language nor could he speak, and even several weeks after the stroke, he could not articulate words successfully. He could not repeat phonemes, and his speech showed severe paraphasia, that is the substitution of one word for another and the unintelligible jumbling of words and sentences. For example, instead of ‘okrepnuts’ [to recover], he would say ‘krepnost okrepnost krepnust okrestno ,’ all of which share a common root, but are meaningless or mean something else. Two months after the stroke, he was able to speak some words and phrases, but in general the paraphasis persisted. His motor speech had partially recovered, but defects in the perception and understanding of speech remained. His comprehension of phrases was very limited. Six months after the stroke and for the next 2 years Shebalin underwent neuropsychological tests and therapy. He was diagnosed with an acoustic (sensory) aphasia and defective kinesthetic organization of motor speech. A year after the stroke there were some improvements: his discrimination of speech sounds was better and his articulatory defects had diminished somewhat. He could name objects, but if three objects were presented to him simultaneously, the naming became confused again. His ability to read was preserved and, to a certain extent, he could still write. Shebalin was clearly aware of what had happened to him, and tried to explain his defects to his physician A.R. Luria: ‘The words do I really hear them? But I am sure not so clear I can’t grasp them Sometimes – yes But I can’t grasp the meaning. I don’t know what it is.’ This defect was particularly obvious when the word was presented in the absence of the object in question. In such cases, he could not grasp the referential meaning of the word. Shebalin’s personality seemed unaffected by the severity of the stroke and despite the severe language impairments, he continued to work. With the assistance of his students he completed compositions he had begun before the stroke and he created many new ones whose quality does not differ significantly from his earlier pieces. Some of his new compositions were performed in his presence on 9 October 1962. His fellow composer Dmitri Shostakovich remarked that ‘the 5th symphony of Shebalin is a brilliant work of elevated emotions, optimism and vitality. This symphony, composed during his illness, is the creation of a great teacher.’ Sadly, this creative activity was not to last. On 30 April 1963, Shebalin succumbed to a third stroke with a cardiac infarct. He died on 29 May 1963. The postmortem revealed massive damage in the temporal and inferior parietal regions, with a hemorrhagic cyst in the left temporoparietal region. Despite his profound aphasia, Shebalin showed remarkable preservation of the receptive and expressive aspects of music, demonstrating the extent to which – in a professional musician at least – the cerebral processing of music and language can be separated. Picture crediti: The photo of V. Shebalin was kindly provided by I. Minakova, with permission from the Shebalin family. |
||||||||||||||
