Death - with the world at his fingertips

Hadassah University Medical Center doctors explore the death of famed Jewish composer George Gershwin.

Composer George Gershwin (photo credit: Wikimedia Commons)
Composer George Gershwin
(photo credit: Wikimedia Commons)
It isn’t considered ethical for physicians to diagnose the physical or mention disorders of living kings, presidents, prime ministers or their families without examining them. But there is nothing wrong with contemporary doctors using historical reports, pathological specimens and some speculation based on their clinical experience to determine what killed famous people many decades or even centuries ago.
Doctors of yesteryear probably would have given their eyeteeth for magnetic resonance instruments, computerized tomography scanners and other medical technologies we take for granted to diagnose and treat their patients. But in some cases, even if their ailment had been identified at an early stage, some might nevertheless have suffered and died from it.
The great Bavarian-born composer Wolfgang Amadeus Mozart died on December 5, 1791 at the premature age of 35. There has been much speculation by physicians and historians on what did him in, even a rumor that he had been poisoned by a jealous colleague named Antonio Salieri, but this has been disproved because Mozart showed no signs of having ingested toxic substances.
Other suggested causes of his death include trichinosis from consuming undercooked pork, syphilis, rheumatic fever, kidney failure and infection after undergoing bloodletting.
But an epidemiological analysis published a few years ago in the Annals of Internal Medicine suggested that Mozart had been done in by a simple Streptococcus infection untreated before the age of penicillin.
The great composer Ludwig van Beethoven died on March 26, 1827 at the age of 56 after considerable suffering from declining health over several years. Bouts of diarrhea and vomiting by the genius, then deaf, were followed by four minor operations to alleviate the accumulation of liquid in his abdomen. He was tortured by well-meaning doctors who poured hot oil into his ears. An autopsy the day after his death indicated liver disease. His body was even exhumed some four decades later, but a certain diagnosis did not result.
Hadassah University Medical Center retired anesthesiologist and critical care specialist Prof. Yoel Donchin has unusual hobbies – using old movies to teach medicine and investigating the causes of death of famous personalities. “Maestro Donchin” previously held clinical presentations at Hadassah on Mozart and Beethoven, and late last month he opened the new season of clinical presentations for Hadassah staffers by orchestrating a discussion of what caused American Jewish composer George Gershwin’s untimely death.
About 100 doctors, nurses and others took an hour off work to participate. Allergy and immunology specialist Prof. Meir Shalit introduced the “pathological musical clinical presentation” event as coordinator of this year’s series.
It began on the right foot in the second- floor auditorium, as Hadassah cardiologist Dr. Ayelet Shauer played a segment of Gershwin’s mellifluous Rhapsody in Blue, which he composed for solo piano and jazz band in 1924 on a baby grand piano on stage.
Donchin summarized the biography of the great man, who was regarded as one of the most significant US composers in the 20th century who wrote both classical compositions and music for the stage and screen.
Gershwin was born Jacob Gershwine in Brooklyn, New York, on September 26, 1898 – the son of Russian-Jewish immigrants Moishe Gershowitz, who worked as a leather cutter for women’s shoes, and Roza Bruskina, the daughter of a furrier in Vilnius.
Moishe, who changed his name to Morris when he landed on Ellis Island, had decided to leave Russia to avoid compulsory military service. Roza emigrated with her parents to New York due to the growing antisemitic threats in Russia and changed her first name to Rose.
They had a son named Ira who – it turned out – was directly involved for years in George’s soaring musical career. Their parents bought a used upright piano for Ira that was pulled into the window of their tenement apartment via a pulley. George, who had no musical education, took a liking to the instrument and began to play when he was 11 years old. Their younger sister Frances was also musical but gave it up, and their brother Arthur also became a composer for the piano.
Donchin noted that the handsome George became captivated by music when he heard Humoresques, a piano cycle by the Czech composer Antonín Dvorak dating back to 1894. Uninterested in school and ignorant of musical notes, he dropped out of school and went to hear music in bars in Upper Manhattan’s Harlem neighborhood. He began to play music professionally before audiences in nightclubs and elsewhere he was only 15.
He broke his nose in a fight.
“If he had been alive today, he would have been given Ritalin [for attention-deficit hyperactivity disorder]. After entering the world of music, he became a different person and lost his wildness.”
George began as a “song-plugger” in Tin Pan Alley, dominated by musical composers and publishers in New York City a century ago. In 1916, his first published song was titled: “When You Want ‘Em, You Can’t Get ‘Em; When You Have ‘Em, You Don’t Want ‘Em.”
Gradually, as his natural skills as a composer and pianist became finely honed, he also worked as a rehearsal pianist for Broadway singers. In the early ‘20s, he worked on a jazz composition that became his best-known piece, Rhapsody in Blue.
Ira and even George sometimes went to Yiddish theaters. Their collaborations led to many songs for musical plays and movies that he composed and his brother Ira lyricized: “They Can’t Take That Away from Me,” “Oh, Lady Be Good!”, “Embraceable You,” “Someone to Watch Over Me,” “Strike Up the Band” and “Let’s Call the Whole Thing Off.” Most of the music he played was not inscribed on vinyl records but was preserved on punctured piano rolls. He and Ira wrote “Swanee” for fellow-Jewish singer Al Jolson.
His incredible large portfolio of music also included orchestral works such as Piano Concerto in F for piano and orchestra (1925); Dream Sequence/The Melting Pot for chorus and orchestra (1931); Second Rhapsody for piano and orchestra (1931), Cuban Overture for orchestra (1932), a march from Strike Up the Band for orchestra (1934) and Shall We Dance (1937); a movie score, feature-length ballet; his solo piano work Three Preludes (1926); his London musical Primrose (1924); and Broadway musicals Lady, Be Good (1924), Tip-Toes (1925), Tell Me More! (1925), Treasure Girl (1928), Show Girl (1929), Of Thee I Sing (1931) and Let ‘Em Eat Cake (1933). Various Broadway musicals such as Nice Work If You Can Get It were produced decades after his death using his original songs.
He went to France and composed An American in Paris (which almost a quarter of a century later was turned into an award-winning musical film starring Gene Kelly and Leslie Caron.) Gershwin became very rich, the toast of the town in America and in Europe. Among his friends was composer Maurice Ravel.
Ten years after Rhapsody in Blue, Gershwin wrote an unforgettable “folk opera,” Porgy and Bess, based on the novel Porgy by Dubose Heyward. It was not highly acclaimed in Gershwin’s lifetime, but was later hailed as one the greatest American pieces of music in the last century.
The composer never married, said Donchin, but he reputedly had a long affair with composer Kay Swift, whom he frequently consulted about his music. “There was some talk about him fathering a child, but no details are available,” Donchin said.
AFTER BECOMING acclaimed around globe, with the world at his fingers, Gershwin began to feel unwell at the beginning of 1937, Donchin related. He complained of severe headaches, which he thought had been caused by his broken nose, and of constantly smelling “burning rubber.”
His doctor send him to a Russian-born psychiatrist, Gregory Silboorg, but to no avail.
During concerts, Gershwin’s hands hurt, and he felt he couldn’t control them due to tremors. He developed convulsions. His condition declined, and he suddenly went into a coma. A famous American neurosurgeon was sought, but he had already retired and could not do surgery. Gershwin went into a coma at the Cedars of Lebanon Hospital (which in 1961 merged with Mount Sinai Hospital to become Cedars-Sinai Medical Center in Los Angeles). Brain surgery was performed by Dr.
Howard Christian Naffziger, but Gershwin died on July 11, 1937, at the age of 38. The world was shocked. The screen at Hadassah shows a New York concert being halted to suddenly announce Gershwin’s passing.
An autopsy, in which specimens of his brain tissue were taken, was performed by Dr. Isaac Yale Olch, who called the cause of death “spongioblastoma [or glioblastoma] multiforme” (a fast-growing brain tumor composed of spongioblast cells and nearly always fatal).
Gershwin was buried at Westchester Hills Cemetery at Hastings-on-Hudson in Westchester, New York, where his mausoleum is still visited.
In 2001, a New Orleans physician named Dr. Gregory Sloop published an article in the Journal of Medical Biography in which he says that Gershwin died of a pilocytic astrocytoma, not glioblastoma multiforme, a brain tumor that originates from star-shaped cells called astrocytes. Pilocytic astrocytomas are low-grade gliomas – a family of slow-growing tumors that arise from glial cells. Sloop wrote that near the end of his life, Gershwin experienced two strange episodes that were “probably temporal lobe seizures. In one, the composer opened the driver’s-side door of a moving car and tried to push out his chauffeur.
When asked why he did this, Gershwin replied: ‘I don’t know.’ In the second, in response to the gift of a box of chocolates, Gershwin crushed the contents into a mass which he smeared over his body.”
SO WHAT caused Gershwin’s tragic death? Hadassah neurosurgeon Dr. Ido Paldor examined pink-tinted slides from the autopsy and medical reports that have been published.
“He suffered from weakness on his left side that could be from the motor cortex on the right, or the sub-cortex located below the cerebral cortex, the brainstem or the cervical spine on the left.
“There was a good case for a tumor, because of his headaches, especially in the morning.
Malignancies kill faster, in days or weeks. A malignant tumor can be primary or a metastasis [that spreads from other organs]. His tumor was probably malignant, and it probably was primary and not something that spread in the brain,” said Paldor.
“The evidence suggested it was a glioma [a type of tumor that begins in the glial cells of the brain or the spine; they account for about a third of all central nervous system tumors and 80% of all malignant brain tumors in the right hemisphere of the brain]. The actual cause of death could have been a cerebral herniation [very high pressure within the skull when a part of the brain is squeezed across structures inside the skull].”
Hadassah psychiatry Prof. Shahar Arzy recalled the case of a 58-year-old grandmother and mother of five who complained of always being tired and having psychiatric symptoms. But when an MRI was performed, a small frontal lesion was found. A tumor in the brain can cause symptoms that seem psychiatric.
Even a non-lesional inflammation can affect behavior,” Arzy noted. “Neurology and psychiatry involve the same organ.
Trillions of neurons can cause disruptions in cognition, emotions and consciousness, but it is still a mystery that is dealt with by neuropsychiatrists.”
Donchin and his colleagues concluded that while there are different views, Gershwin undoubtedly died of a high-grade, devastating brain tumor. “With all our MRIs and CT and radiation, even today, we can’t really treat it. His life could have been extended maybe for a year. He couldn’t have been cured.”