Beethoven’s deafness probably began with a “cold in the head” which was neglected.  The inflammatory process then extended to the Eustachian tubes.  When it reached this point it was considered out of the reach of treatment in his time, and for long after.  Even in our own time, in the light of advanced medical science, such a condition is serious and is not always amenable to treatment, some impairment of the hearing frequently occurring even with the best of care and under conditions precluding the thought of a congenital tendency.  The difficulty as revealed by the post-mortem, lay in a thickening of the membrane of the Eustachian tubes.  The office of these tubes is to supply air to the cavity on the inner side of the drum-membrane, known as the middle ear.  As is well known, a passage exists from the outer ear to the drum.  The Eustachian tubes connect the middle ear with the upper portion of the throat from whence the air supply to the middle ear is obtained.  We cannot imagine a drum to be such unless there is air on both sides of the membrane.  Exhaust the air of an ordinary drum, and its resonance would be gone.  A similar condition obtained with Beethoven.  With the closure of the Eustachian tubes the air supply to the middle ear was cut off; the air in the cavity finally became absorbed, and a retraction and thickening of the drum-membrane with consequent inability to transmit sound vibrations followed.

The hypothesis of heredity, sometimes brought forward to account for his deafness, would have more weight had the lesion shown itself in the case of either of his other brothers.  As it is, there is no hint to be found of even a tendency to deafness in any other of the Beethovens, whether Johann, Karl, or the nephew.  In any event a congenital tendency of this kind would have been more likely to develop itself in Karl, the weakling, than in the sturdy Ludwig.

The master’s known impulsiveness and carelessness in matters connected with the preservation of his health, lead to the conclusion that he himself contributed much to his deafness.  He was fond of pure air outside, but sometimes had for a sleeping room an alcove wholly without ventilation, so dark that he had to dress in another room.  We hear much of his practice of taking brisk walks on the ramparts or in the suburbs, in the intervals of his work.  There is at least one instance on record,—­there were probably many such cases,—­of his coming in after a walk, overheated, perspiring, and seating himself before an open window in a draught.  Another hygienic measure which he abused was his custom of frequently bathing his head in cold water while at work, probably to counteract the excessive circulation of the blood in the head brought about by his brain-work.  A chilling of the body, particularly in the neck and the back of the head when overheated is a frequent cause of inflammation of the middle ear.  Von Frimmel calls attention to the dust-storms which are a feature of Vienna.  They were probably worse in Beethoven’s time than now, as but little attention was paid to hygienic measures in those days.  This no doubt aggravated the trouble.