Wednesday, 5 November 2014

Rachmaninov, Marfan’s & Acromegaly

Russian virtuoso pianist, composer, and conductor Sergei Vasilievich Rachmaninov (1873-1943) is perhaps best known for his second, C minor, piano concerto, popularized in the films Brief Encounter (1945) and The Seven Year Itch (1955). The third, D minor, piano concerto was also popularized by David Helfgott, in the film Shine (1996). In his lifetime Rachmaninov's prelude in C sharp minor was so popular as a concert encore that even he grew to hate it. And works such as the Rhapsody on a Theme of Paganini and the Symphonic Dances cemented his popularity. His technical perfection was legendary.

It was said that his large hands were able to span a twelfth (an octave and a half or, for example, a stretch from middle C to high G). However, according to the Guinness Book of Musical records, Rachmaninov could play a left hand chord of C E Flat G C G. It is one thing to play a 12th but another thing to play a 5 finger chord. It is therefore possible that he could play a 13th.

After Rachmaninov's death, the poet Marietta Shaginyan published fifteen of the apparently many letters they had exchanged between her first contacting him in February 1912 and their final meeting in July 1917. Although she had signed her letters simply "Re", Rachmaninov had fairly quickly discovered her identity. The nature of Shaginyan and Rachmaninov's relationship bordered on romantic, but was primarily an intellectual and emotional love. Shaginyan and the poetry she shared with Rachmaninov during their correspondence has been cited as the inspiration for the six songs that make up Rachmaninov's Opus 38. In 1913 she dedicated her first set of published poems, "Orientalia", to him. Sadly Rachmaninov left Russia in 1917, never to return. Their correspondence ceased at that point.

Marietta Shaginyan, portrait by Alexander Deineka,1944

“Looking back on the last eighteen months of our friendship with Rachmaninoff, on Monday, January 18 of 1916 he was playing a big concert in Moscow… The program included The Bells, the Spring cantata, the Third Concerto for piano and orchestra and an encore of the Musical Moment played by a very inspired Rachmaninoff to a raving audience…” Marietta Shaginyan writes in her diary.

Big as he was as a composer, Rachmaninoff was absolutely fantastic as a pianist. His playing was so incredibly demonic, he could make you believe everything he wanted by just playing the instrument… Like, for example, his Musical Moment that was absolutely without any precedence in world musical literature…”

The spring of 1916 was a bad time for him: first, his wife fell seriously ill and then he himself was struck by arthritis in his hand joints which tormented him for the rest of his life. Advised by his doctors to get some treatment in the Caucasus, Rachmaninoff headed to a sanatorium where he was treated like royalty living in a two-room suite complete with a baby grand

Marietta Shaginyan, who was then spending the summer in the Caucasus, came down to see Rachmaninoff and was quick to realize how bad he was. “There were tears welling up in his eyes, his voice was trailing off as he said he was no longer able to work and write on, that he would never be more than just a “well-known pianist and a mediocre composer.”

“If I had always been like this it would have been much easier for me,” he said. “The problem is, I used to be a talented young man who could write just about anything sitting down in the morning and finishing in the evening… I still feel the urge to write music but it seems I’ve lost the knack and will never get it back…”

“His voice was horrible, dead, as is spoken by an old man, his eyes had lost their sparkle, his face was gray and tortured… I was trying my best to express to him my heartfelt sympathy and unwavering faith in his huge talent, to wrap him in my faith to make him feel better. When he calmed down a bit I opened my notebook with poems and we started looking for something he could use in his love songs…”

Diary of Marietta Shaginyan

It is widely thought that Rachmaninov’s hands were a manifestation of Marfan's syndrome, their size and slenderness typical of arachnodactyly. However, Rachmaninov did not clearly exhibit any of the other clinical characteristics typical of Marfan's, such as scoliosis, pectus excavatum, and eye or cardiac complications. Nor did he express any of the clinical effects of any of the rare Marfan-related syndromes. There is no indication that his immediate family had similar hand spans, ruling out familial arachnodactyly. Rachmaninov did not display any signs of digital clubbing or any obvious hypertrophic skin changes associated with the condition.

Rachmaninov may well have been myopic rather than suffering eye complications related to Marfan's Syndrome. In 1907 in Dresden at the age of 34 he suffered disabling eye strain. He wrote that after weeks of intensive proof reading of music "my eyes are quite ruined. In doing any strenuous writing or reading the eyes go misty and the head aches badly." At first glasses were prescribed, but within weeks an ophthalmologist had specifically countermanded this and the successful treatment consisted of eye massage and the avoidance of all reading and writing by artificial light. Possibly related to this eye strain were bouts of a severe, stabbing pain in the right temple that began in Russia before the first world war and increased every year in frequency and severity until in 1921 he spent time in hospital undergoing treatment, but without success. In Russia he had always attributed these pains to eye strain and continual bending over the manuscript while composing. After leaving Russia for the last time in December 1917 he was forced by this trouble to give up composition for three years, and he found relief from it only in his recital work. Both these problems, it has been suggested, were due to difficulties of accommodation and convergence resulting from myopia. Lastly, it would appear from photographs that Rachmaninov did not use reading glasses in his 50’s and early 60’s.

His life was plagued by minor illness, which had important consequences for his musical career both as a composer and as a performer. Thus, at intervals from his mid-30s, in addition to the eye strain and headaches, he suffered disabling back pain, stiffness of the hands, arthritis, and, for a while, a strange bruising of the finger tips while performing at the piano (a microvascular fragility, it has been speculated as the result of connective tissue disorganisation arising from the syndrome), all of which seriously interfered with his work. The stoical manner in which he faced his final illness makes it unlikely that these were trivial complaints magnified by hypochondria.

Marfan’s Syndrome

A tall, thin build
Long arms, legs, fingers, and toes
Flexible joints
Pectus excavatum and pectus carinatum
Teeth that are too crowded
Flat feet
Stretch marks on the skin that are not related to weight gain or loss
Heart and Blood Vessel Complications
Mitral valve prolapse (MVP)
Eye Complications
Nervous System Complications
Lung Complications

Blurred vision
Enlarged hands, feet & bone overgrowth
Swollen hands & feet
Thick, Course & Oily skin
Skin tags
Enlarged tongue, lips & nose
Dental bite disturbances
Deep voice
Enlarged sinuses
Fatigue & Weakness
Enlarged internal organs
Enlargement of face bones
Abnormal growth of head & face
Coronary artery disease
High blood pressure
Carpel tunnel syndrome

Marfan's Syndrome: Extreme presentation
Development of facies in Acromegaly

Acromegaly has been advanced as an alternative diagnosis for Rachmaninov’s health problems. From photographs of Rachmaninov in the 1920s and his portrait by Konstantin Somov in 1925 (below) at a time when he was recording his four piano concerti, the coarse facial features of acromegaly are not immediately apparent although the Somov portrait is suggestive. However, a case can be made from later photographs.

Portrait of Sergei Rachmaninov (1925)
by Konstantin Somov; oil on canvas.
The State Russian Museum, St. Petersburg, Russia

Yet contrary to rumors of Rachmaninov’s proposed "giantism" of “six and a half feet,” his physical height is documented in repeated U.S. Immigration manifests at Ellis Island as 6'1". However, conductor Eugene Ormandy (who teamed with Rachmaninov in many piano and orchestra performances) recalled in 1979: "He [Rachmaninov] was about six feet-three. I am five feet-five and a half..." Rachmaninov's height would therefore not really be considered a physical deformity or abnormality. However, the presence of "gigantism" is not diagnostic of acromegaly. It is true that childhood pituitary tumours can cause the bones to grow which results in extraordinary limb length, but pituitary tumours & abnormalities which occur after adolescence can cause thickening of bone resulting in enlargement of the head, feet and hands only. A late- onset pituitary tumour would explain Rachmaninov's relatively modest height and change in appearance only in later photographs.

Rachmaninov's repeated bouts of depression are also consistent with a diagnosis of acromegaly. On 27 March 1897, his First Symphony was poorly received in an under-rehearsed performance conducted by an inebriated Aleksandr Glazunov. This event, from which Rachmaninov fled in horror, is said to have triggered his first major episode of depression, which temporarily brought his composing career to a standstill: ‘all my hopes, all belief in myself, had been destroyed.’ It would not be until the latter half of 1900 that he returned to composition, with the help of a hypnotist, Dr Nikolai Dahl, to whom he dedicated his Second Piano Concerto, the second and third movements of which he brilliantly performed in December of that year. His second major bout of depression began during the Second World War, when he was living near Los Angeles, probably related to worries over the safety of one of his daughters and grief over the deaths of relatives and friends in the war.

During a heavy concert schedule in Russia in 1912, he interrupted his schedule because of stiffness in his hands. This may have been due to overuse, although carpal tunnel syndrome or simply swelling and puffiness of the hands associated with acromegaly may have been the cause. In 1942, Rachmaninov made a final revision of his troublesome Fourth Concerto but composed no more new music.

In 1943 Rachmaninov became ill in the middle of a concert tour after a recital in Knoxville, Tennessee, and was admitted to a hospital in Los Angeles with a rapidly progressing melanoma. A little over five weeks later he was dead due to the disease, which is known to be associated with acromegaly. It would be possible to confirm a diagnosis by testing Rachmaninov’s relatives using genetic assay techniques. Rachmaninov had two daughters, a couple of grandchildren and a few other relatives who would be eligible for genetic testing. Up till now such a test has not been performed.

When cancer was diagnosed, he looked at his hands and whispered;
‘My dear hands... Farewell, my poor hands.’

Info: British Medical Journal, J R Soc Med, Voice of Russia.
By North Utsire

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