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Paul Wittgenstein’s right arm and his phantom: the saga of a famous concert pianist and his amputation Franc¸ois Boller*,1, Julien Bogousslavsky† *Department of Neurology, George Washington University Medical School, Washington, DC, USA † Genolier Swiss Medical Network Neurocenter, clinique Valmont, Glion/Montreux, Switzerland 1 Corresponding author: Fax: +1-202-741-2721, e-mail address: [email protected]
Abstract Reports of postamputation pain and problems linked to phantom limbs have increased in recent years, particularly in relation to war-related amputations. These problems are still poorly understood and are considered rather mysterious, and they are difficult to treat. In addition, they may shed light on brain physiology and neuropsychology. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Several artists have suffered from postamputation complications and this has influenced not only their personal life but also their artistic work. Paul Wittgenstein (1887–1961), a pianist whose right arm was amputated during the First World War, became a famous left-handed concert performer. His case provides insight into Post-World War I musical and political history. More specifically, the impact on the artistic life of this pianist illustrates various postamputation complications, such as phantom limb, stump pain, and especially moving phantom. The phantom movements of his right hand helped him develop the dexterity of his left hand. Wittgenstein played piano works that were written especially for him (the most famous being Ravel’s Concerto for the Left Hand) and composed some of his own. Additionally, several famous composers had previously written for the left hand.
Keywords Phantom limb, stump pain, moving phantom, artistic realization, Paul Wittgenstein, piano music for the left hand
Limb amputation began very early on in the history of medicine, particularly following war injuries. Reports of postamputation pain and problems linked to phantom limbs have increased in recent years (Finger and Hustwit, 2003; Cipriani et al., 2011). Postamputation phenomena are highly relevant to neurologists and Progress in Brain Research, ISSN 0079-6123, http://dx.doi.org/10.1016/bs.pbr.2014.11.011 © 2015 Elsevier B.V. All rights reserved.
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neuroscientists because they are difficult to treat, and also because they may shed light on brain physiology and neuropsychology (Giraux and Sirigu, 2003; Raffin et al., 2012; Wade, 2010). Several writers and artists suffered from postamputation phenomena (Tatu et al, 2014). This chapter focuses on an amputated musician who experienced postamputation phenomena. The pianist Paul Wittgenstein (1887–1961) became a left-handed player after his right arm was amputated during World War I (WWI). The impact on his life and work illustrates the moving phantom phenomenon, a relatively infrequently described postamputation complication. His moving phantom limb contributed to his fame as a left-handed concert pianist. After losing his right arm, Wittgenstein commissioned several piano works and is often associated with lefthand piano music, particularly the Piano Concerto in D-major for Left Hand by Maurice Ravel. However, surprising as it might seem, many piano pieces have been composed for the left hand alone. Among the many composers who have written piano music for the left hand, one finds names such as Bela Bartok, Johannes Brahms, Franz Liszt, Carl Reinecke, Alexander Scriabin, and Camille Saint-Sae¨ns.
1 PAUL WITTGENSTEIN Paul Wittgenstein was born in Vienna in 1887. The family was remarkable in several respects. His father, a tyrannical family patriarch, was Karl Wittgenstein (1847–1913), a steel, banking and arms magnate who had accumulated an enormous fortune. He and his timorous wife, Leopoldine, had nine children. Ludwig, the philosopher, was born 2 years after Paul. The sons of the household had a distressing habit of doing away with themselves (Holt, 2009). Handsome, intelligent, homosexual Rudolf (born in 1881) strolled into a Berlin bar in 1904, asked the piano player to play a sentimental song, then dissolved potassium cyanide into his glass of milk, and died in agony on the spot. Two years earlier, Hans Karl (1877–1902) had disappeared without trace in the course of a canoe expedition of Chesapeake Bay and is thought to have willingly killed himself at sea. He was a shy, ungainly, possibly autistic child with a prodigious gift for mathematics and music. Kurt (1878–1918) became by default the oldest son. His short life illustrates the fact that the family was very conservative and attached to the Monarchy. Unlike his other brothers, Kurt had entrepreneurial spirit and went to the United States in early 1914 to explore investment opportunities for the family business, the beginning of WWI caught him there and he wanted to sail back, but the U.S. authorities apparently prevented him. He then worked for the Austrian Embassy until 1917 when he was finally able to come back and immediately enrolled in the Army. His suicide, which occurred at the Italian front, just as the war was ending, was probably related to the totally unexpected defeat of the Imperial Army by the Italians and perhaps also to a series of mutinies that were occurring within the ranks. The other two boys Paul and Ludwig (1889–1951) were plagued by suicidal impulses throughout their lives. Of the three daughters who survived into adulthood,
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two married; both husbands ended up insane and one died by his own hand. As pointed out in a review of a book on the Wittgenstein family, “even by the morbid standards of late Habsburg Vienna, these are impressive numbers” (Holt, 2009, p. 8). The other feature that marked Paul’s life is that he grew up in an exceptionally artistic environment. The Wittgenstein dwelling often resembled more a conservatory than an ordinary mansion. Prominent musicians frequently visited the household, among them Johannes Brahms, Clara Schumann, Gustav Mahler, and Richard Strauss, with whom the young Paul played duets. His grandmother, Fanny Wittgenstein, was a first cousin of the violinist Joseph Joachim, whom she adopted and took to Leipzig to study with Felix Mendelssohn. The book alluded to above (Waugh, 2008) is a thorough and very well-written account of the rise and fall of the family. It includes several photos of Paul and his relatives. Some of these photos can also be seen in the Web1 Contrary to what one might infer from some idyllic pictures “The House of Wittgenstein” was not a happy family, as narrated, by Waugh and in a New Yorker article (Gottlieb, 2009). Karl, the father, had amassed his colossal wealth through ruthless methods and wanted at all costs to have at least one of his sons to continue his work in business. He went so far as to limit the number of hours his sons, particularly Karl Hans who appeared the most gifted, were allowed to practice the piano. He was bitterly disappointed that none of them took up his incredibly successful trade. Hermine, one of the sisters, commented that this was due to her brothers’ lack of vitality and will for life. We do not know the details of the relationship between Paul the musician and Ludwig the philosopher, but we can infer that they went from acrimonious to nonexistent. Gottlieb quotes an episode in which Paul was practicing on one of the seven grand pianos in one of their mansions. One day, Paul leaped up and shouted at his brother Ludwig in the room next door, “I cannot play when you are in the house, as I feel your skepticism seeping towards me from under the door” (Gottlieb, 2009, p. 71). Ludwig expressed commiseration for his brother’s amputation, but there very few contacts between them after Ludwig left for England in 1929, nor is there any evidence that Ludwig ever attended one of his brother’s concerts. Similarly, we do not know the details of the relationship between Paul and his sisters, but here again, one episode may illustrate them. When Paul returned for the first time to Vienna after the end of World War II, Hermine was there, close to death, but Paul, even though he had been told and even though he stayed in Vienna for an entire week made no attempt to go and see her or the family house. Based also on his relations with other musicians, particularly those who wrote music for him (see below), one can conclude that Paul was far from being a nice and pleasant person. Paul attended middle school in Linz, in the same Institution as Adolph Hitler, but there is no evidence that they even knew each other. He then undertook serious musical studies with prestigious teachers including the Czech-born pianist and
1
Pictures of Paul and his family as well as a genealogical tree can be seen on https://www.google.com/ webhp?sourceid¼chrome-instant&ion¼1&espv¼2&ie¼UTF-8#q¼witgenstein%20family.
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composer Josef Labor (1842–1924). He made his public debut as a pianist in 1913, attracting favorable reviews. Interestingly, some critiques of the time specifically applauded his left-hand technique. In 1914, at the onset of WWI, Paul was drafted into the Austrian army. Soon thereafter, his right arm was injured during a patrol near Zamosc in Poland. He was then taken prisoner by the Russians, and his right arm was amputated. He remained 2 years in a prisoner-of-war camp in Omsk in Siberia. While he was still recovering, he resolved to continue his career using only his left hand. With the help of the Danish Ambassador, he managed to send a letter to his old teacher, Josef Labor, asking for a concerto for the left hand. Labor, who meanwhile had lost his sight, responded quickly, saying he had already started work on such a piece. Following the end of the war, Wittgenstein studied intensely, arranging pieces for the left hand alone and learning the new composition written for him by Labor. Once again, he began to give concerts (Fig. 1). Many reviews were mixed, qualified with comments such as that he played very well “for a man with one arm,” but he persevered. He was certainly a well-known figure within the Vienna society and probably throughout the musical world. He approached more famous composers, asking them to write material for him to perform. In addition to Labor, Benjamin Britten, Paul Hindemith, Alexander Scriabin, Alexandre Tansman, Erich Wolfgang Korngold, Franz Schmidt, Sergei Bortkiewicz, and Richard Strauss all produced pieces for him. In 1929, at his request, Maurice Ravel wrote his Piano Concerto in D-major for the Left Hand, which
FIGURE 1 Paul Wittgenstein ca. 1930.
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was to become more famous than any of the other compositions that Wittgenstein commissioned. Ravel took this commission very seriously, going so far as to enthusiastically study left-hand music, such as the e´tudes of Camille Saint-Sae¨ns. Wittgenstein performed the premiere of the Concerto with Robert Heger (1886–1978) and the Vienna Symphony Orchestra on January 5, 1932. Of note is the fact that its direction had been offered to Arturo Toscanini (1867–1957), who declined, perhaps because of a previous dispute with Ravel. The concert attracted enormous interest, and its recordings can be heard on YouTube2. There were many problems with Wittgenstein’s rendition of Ravel’s music. It was technically inadequate, and some of the jazz-inspired rhythms were poorly rendered, apparently because Wittgenstein had not been inspired by them, as he openly stated. He went so far as to deliberately change parts of the score. As a result, Maurice Ravel was infuriated. Not only did he never again talk to Wittgenstein, but also he threatened to withdraw that magical piece altogether. Fortunately, the French pianist Jacques Fe´vrier (1900–1979) came along and was able to play the Concerto to Ravel’s satisfaction in 1937. At that time, Ravel was already severely aphasic, but he had retained an astonishing ability to recognize and judge music (Cytowic, 1976; Amaducci et al., 2002). The Concerto for the Left Hand is one of the highlights of the contemporary repertoire. Another anecdote deserves to be mentioned. The Concerto begins with double basses softly playing a rather ambiguous harmony. Because the industry was still in its infancy relative to today’s standards, that part was barely audible in contemporary recordings, thus further disheartening Ravel, who probably died convinced that his music would never be rendered as faithfully as he would have liked. Perhaps because he deemed the left-handed version too difficult, before the premiere in 1931, the famous pianist Alfred Cortot (1877–1962) arranged the Concerto to be played for two-hands and orchestra; Ravel strongly disapproved of it and tried to forbid its publication or performance. Cortot ignored this and played his arrangement, which caused Ravel to implore many conductors not to engage Cortot to play his concerto. After Ravel’s death in 1937, Cortot resumed playing his arrangement, and even recorded it with Charles Munch leading the Paris Conservatoire Orchestra. It is less commonly known that Wittgenstein also approached Sergei Prokofiev (1891–1953) and requested a concerto. Prokofiev agreed and wrote the Piano Concerto No. 4 in B-flat Major for the left hand, Op. 53, which was completed in 1931. Wittgenstein did not understand the work, but it is apparently not the case (as has sometimes been claimed) that he explicitly refused to play it. He was stated as declaring, “I am simply not prepared to play it until such time as I appreciate its inner logic.” That time never came, but Wittgenstein and Prokofiev remained on friendly 2 There are several recordings of Paul Wittgenstein playing the Ravel Concerto: https://www.youtube. com/watch?v¼tSxcXdXqLvA. https://www.youtube.com/watch?v¼PnC8DmBJJEw. In these, still photographs showing the composer and the interpreter accompany the recording. Another video shows a few seconds of the artist himself while he plays, accompanied by a comment in German: https://www. youtube.com/watch?v¼FI7tnBmGnq4.
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terms. It was the only one of Prokofiev’s complete piano concertos that was never performed during the composer’s lifetime. It was premiered in Berlin on 5 September 1956, played by Siegfried Rapp (who had also lost his right arm while in Russia, but during World War II) and the West Berlin Radio Symphony Orchestra, conducted by Martin Rich. The U.S. premiere was in 1958, by Rudolf Serkin and the Philadelphia Orchestra under Eugene Ormandy. Prokofiev apparently expressed some interest in arranging the concerto for piano, two-hands and orchestra, but never went through with this idea. There are several other instances illustrating Paul Wittgenstein’s arrogance, and his problems with the musicians who wrote works for him. An extreme example can be found in the way he handled a composition written for him by Paul Hindemith (1895–1963). Not only did he reject outright Hindemith’s Piano Music with Orchestra Op. 29 but also he hid the score in his study, and it was not discovered until after his widow’s death in 2002, by which time Hindemith himself had been dead for 39 years. He was able to take this approach because he arbitrarily insisted on exclusive lifetime performing rights for all the pieces written for him. As stated above, several musicians wrote music for the left hand for the purpose of helping amputated pianists (Drozdov et al., 2008). However, many other musicians did that without being asked. The reason for this is not entirely clear. It may be a way to give an occasion to pianists (including themselves) to show off their virtuosity. A life-long smoker, Ravel once joked that he had always intended to write the Concerto for Left-Hand in order to be able to smoke a cigarette with one hand, while playing the piano with the other (Otte et al., 2003). Wittgenstein’s approach to music after his amputation was quite peculiar, as shown in the arrangements and keyboard exercises he wrote. They suggest an attempt to train his left hand to assume the load of two (Howe, 2010). As far as his performance is concerned, he experienced the “moving phantom” phenomenon, a mixture of illusion of movement of the missing limb and of voluntary movement of the stump. This seems to have played a crucial role in the acquisition of his unusual left-handed dexterity. Erna Otten-Attermann, one of his piano students, observed this during the 1930s: I had many occasions to see how involved his right stump was whenever we went over the fingering for a new composition. He told me many times that I should trust his choice of fingering because he felt every finger of his right hand. At times I had to sit very quietly while he would close his eyes and his stump would move constantly in an agitated manner. This was many years after the loss of his arm . . . His finger choice was always the best! Saks (2007, p. 259)
2 LATER EVENTS The Wittgenstein family had converted to Christianity three generations before Paul’s birth on the paternal side and two generations before on the maternal side;
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nonetheless, they were considered Jews under the 1935 Nuremberg laws. Following the rise of the Nazi Party and the annexation of Austria in 1938, Paul tried to persuade his sisters Helene and Hermine to leave Vienna, but they refused. They were viscerally attached to their homes and could not believe such a distinguished family as theirs was in real danger, a pattern all too common in Nazi- and Fascistdominated parts of Europe. Giorgio Bassani’s novel, The Garden of the FinziContini, adapted to the cinema by Vittorio DeSica in 1971, clearly illustrates this pattern. Ludwig, the famous philosopher, had already been living in England for some years, and Margaret (Gretl) was married to an American. Paul himself, who was no longer permitted to perform in public concerts under the Nazis, departed for the United States in 1938. From there, he and Gretl, with some assistance from Ludwig (who acquired British nationality in 1939), managed to use family finances (mostly held in Switzerland) and legal connections to attain non-Jewish status for their sisters. The family’s financial portfolio consisted of properties and other assets. The portion in Germany and occupied lands amounted to a total value of about 6 billion dollars in today’s American money, thus rivaling with the Rothschild for the distinction of being the largest private fortune in Europe. A considerable portion of the family assets was surrendered to the Nazis in return for protection afforded to the two sisters under exceptional interpretations of racial laws, allowing them to continue to live in their family palace in Vienna. Paul Wittgenstein became an American citizen in 1946, and spent the rest of his life in the United States, where he taught as well as played the piano. He had no contact whatsoever with the rest of his family. He died in New York City in 1961, aged 73, of prostate cancer, the same condition that had caused the death of his brother Ludwig. At his funeral, not a word, not a prayer was said. The only sound came from an old gramophone on which someone had put a 78 rpm version of Brahms’ German Requiem.
3 THE PHANTOM LIMB PHENOMENA In the middle of the Sixteenth century, French surgeon Ambroise Pare´ (1510–1590) reported that a patient of his complained of pain in an absent limb, which he viewed as not an adequate reason to stop an amputation to prevent the spread of potentially deadly gangrene (Pare´, 1552). In later years, the phantom limb phenomenon (not yet identified under that name) continued to fascinate physicians and philosophers. As written by Wade (The phenomenon) was used in attempts to incorporate the experiences from missing limbs into the body of existing theories. Most famously Rene´ Descartes (1596–1650) integrated sensations in amputated limbs into his dualist theory of mind and used the phenomenon to support the unity of the mind in comparison to the fragmented nature of the body Wade (2010, p. 493)
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The first direct account from a physician amputee appears to be that of a Scottish doctor, William Porterfield (1696–1771), a vision specialist. His leg was amputated at a young age, and he too felt sensations in the missing limb (Porterfield, 1759; Wade and Finger, 2003). Postamputation phenomena became a subject of greater medical interest during the 19th century (Finger and Hustwit, 2003). In 1830, the Scottish surgeon and anatomist Charles Bell (1774–1842), of “Bell-Magendie’s law” fame described these problems more specifically (Bell, 1830). The term phantom first appeared in the work of Silas Weir Mitchell (1829–1914), one of the founders of neurology in the United States and an important author of popular literature. His experience as a physician during the American Civil War provided a dramatic description of postamputation problems to a vast audience. His first important article on the subject was published anonymously in 1866 in a nonmedical journal, The Atlantic Monthly—A Magazine of Literature, Science, Art and Politics in a short story entitled The Case of George Dedlow. It is written in the first person and is about an American military physician who, after several injuries, had each of his four limbs consecutively amputated. Following the amputation of his two legs, he offered the following description: I got hold of my own identity in a moment or two, and was suddenly aware of a sharp cramp in my left leg. I tried to get at it to rub it with my single arm, but, finding myself too weak, hailed an attendant. “Just rub my left calf ”, said I, “If you please”. Mitchell (1866, p. 2)
The term “phantom limb” appeared in 1871 in an article, this time bearing Silas Weir Mitchell’s name and published in the Lippincott Magazine (Mitchell, 1871). The scientific version appeared in 1872 in his book, Injuries of the Nerves and their Consequences, with a more detailed medical description of several war amputee cases (Mitchell, 1872). Today, the phantom complex includes three different elements: phantom limb sensation—any sensation in the absent limb, including posture and movement; phantom limb pain—painful sensations in the absent limb; and moving phantoms. Paul Wittgenstein’s plight illustrates all three, and particularly the third one (Nikolajsen and Jensen, 2001). The pathogenesis of phantom limb sensations and the anatomical substrate that underlies the mental representation of the body remain unknown. According to Melzack (1990), corporeal awareness relies on a large neural network in which the somatosensory cortex, posterior parietal lobe, and insula cortex play crucial roles. More recently, functional neuroimaging techniques have enabled us to better understand the pathophysiology of phantom limbs. These studies demonstrate a functional remodeling of the sensory–motor cortical representations of the missing and intact limbs. These neuroplastic changes do not appear to be dependent on the presence of phantom pain. Neuroimaging techniques have also shown structural changes in the corpus callosum of amputees, compatible with the hypothesis that phantom sensations may depend on inhibitory release in the sensorimotor cortex (Flor et al. 1995; MacIver et al., 2008; Simoes et al., 2012). A comprehensive literature review
ARTICLE IN PRESS Acknowledgments
of the in vivo assessment of use-dependant brain structure changes can be found in a recent paper by Draganski et al. (2014). Among the phenomena associated with phantom limbs, impressions of movement (moving phantom) are less commonly reported. These can take the form of involuntary movements that correspond to a type of cramp. Sometimes they “move” the phantom limb into painful positions; they can also manifest as voluntary movements of the stump of the missing limb, as was the case for Wittgenstein. This phenomenon has long been recognized. Charles Bell reported it as early as 1830: I have seen a young gentleman, whose limb I amputated, making the motion with his hands of taking his leg and placing it over his knee after the limb had been removed and the stump for some time healed; so a man who has lost his arm close to the armpit has a perception of that arm changing its position Bell (1830)
Silas Weir Mitchell also reported it in his work in 1872: [The majority of amputees] are able to will a movement, and apparently to themselves execute it more or less effectively. . . The certainty with which these patients describe their [phantom motions], and their confidence as to the place assumed by the parts moved, are truly remarkable. Mitchell (1872)
Phantom limb phenomena and specifically the phenomenon of the moving phantom have inspired considerable research in recent times. Raffin et al. (2012) have shown that amputees can distinguish between motor execution and motor imagery with the phantom limb, and that the former is associated with activity in stump muscles while the latter is not. Furthermore, it is possible to evoke a sensation of touch in the missing limb following illusory visual stimulation, a phenomenon akin to synesthesia (Ramachandran & Rogers-Ramachandran, 1996). The amputees can indeed distinguish between motor execution and motor imagery with the phantom limb, and that the former is associated with activity in stump muscles while the latter is not. Angela Sirigu and her colleagues have suggested that illusory movements induced by artificial visual feedback may restore motor cortex activity, possibly producing a reduction in phantom pain (Giraux & Sirigu, 2003; Mercier & Sirigu, 2009). In conclusion, the checkered history of the Wittgenstein family illustrates some peculiar aspects of life at that time. As for Paul Wittgenstein, his moving phantom right hand probably helped him to become a famous left-handed piano concert player. Above all, Wittgenstein’s amputation caused him to commission some remarkable music that endures as a highlight of the contemporary repertoire.
ACKNOWLEDGMENTS We wish to acknowledge the contribution of Laurent Tatu, who has written extensively on the phantom limb phenomenon. We are particularly grateful to Professor Eckart Altenmueller for
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his useful and scholarly suggestions. Michael Nedo and Johanna Wittgenstein, Paul’s daughter facilitated our access to the Wittgenstein archives and to the figure used in this chapter.
REFERENCES Amaducci, L., Grassi, E., Boller, F., 2002. Maurice Ravel and right-hemisphere musical creativity: influence of disease on his last musical works? Eur. J. Neurol. 9, 75–82. Bell, C., 1830. The Nervous System of the Human Body. Longman, London. Cipriani, G., Picchi, L., Vedovello, M., Nuti, A., Di Fiorino, M., 2011. The phantom and the supernumerary phantom limb: historical review and new case. Neurosci. Bull. 27, 359–365. Cytowic, R.E., 1976. Aphasia in Maurice Ravel. Bull. Los Angel. Neurol. Soc. 41, 109–114. Draganski, B., Kherif, F., Lutti, A., 2014. Computational anatomy for studying use-dependant brain plasticity. Front. Hum. Neurosci. 8, 1–7. Drozdov, I., Kidd, M., Modlin, I.M., 2008. Evolution of one-handed piano compositions. J. Hand Surg. 33, 780–786. Finger, S., Hustwit, M.P., 2003. Five early accounts of phantom limb in context. Neurosurgery 52, 675–686. Flor, H., Elbert, T., Knecht, S., Wienbruch, C., Pantev, C., Birbaumer, N., Larbig, W., Taub, E., 1995. Phantom-limb pain as a perceptual correlate of cortical reorganization following arm amputation. Nature 375 (6531), 482–484. Giraux, P., Sirigu, A., 2003. Illusory movements of the paralyzed limb restore motor cortex activity. NeuroImage 20, S107–S111. Gottlieb, A., 2009. A nervous splendor. The Wittgenstein family had a genius for misery. New Yorker, 70–74. Holt, J., 2009. Suicide Squad. Review of Alexander Waugh’s the House of Wittgenstein. A Family at War. Book Review New York Times March 9, BR 8. Howe, B., 2010. Paul Wittgenstein and the performance of disability. J. Musicol. 27, 135–180. MacIver, M., Loyd, D.M., Kelly, S., Roberts, N., Nurmikko, T., 2008. Phantom limb pain, cortical reorganization and the therapeutic effect of mental imagery. Brain 131, 2181–2191. Melzack, R., 1990. Phantom limb and the concept of neuromatrix. Trends Neurosci. 13, 88–92. Mercier, C., Sirigu, A., 2009. Training with virtual visual feedback to alleviate phantom limb. Neurorehabil. Neural Repair 23, 587–594. Mitchell, S.W., 1866. The Case of George Dedlow. The Atlantic Monthly, vol. XVIII. Ticknor and Fields, Boston, MA, pp. 1–11. Mitchell, S.W., 1871. Phantom Limbs, vol. 8. The Lippincott Magazine, Philadelphia, PA, pp. 563–569. Mitchell, S.W., 1872. Injuries of Nerves and Their Consequences. Lippincott, Philadelphia, PA. Nikolajsen, L., Jensen, T.S., 2001. Phantom limb pain. Br. J. Anaesth. 87, 107–116. Otte, A., De Bondt, P., Van de Wiele, C., Audenaert, K., Dirckx, R.A., 2003. The exceptional brain of Maurice Ravel. Med. Sci. Monit. 9, RA154–RA159. Pare´, A., 1552. De la manie`re de traiter les plaies faites par harquebuses. Arnoult l’Angelie´, Paris.
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Porterfield, W., 1759. A treatise on the eye. The Manner and Phenomena of Vision, vol. 1. Hamilton and Balfour, Edinburgh. Raffin, E., Giraux, P., Reilly, K.T., 2012. The moving phantom: motor execution or motor imagery. Cortex 48, 746–757. Ramachandran, V.S., Rogers-Ramachandran, D., 1996. Synaesthesia in phantom limbs induced with mirrors. Proc. Biol. Sci. 263, 377–386. Saks, O., 2007. Musicophilia. Tales of Music and the Brain. Alfred Knopf, New York, NY. Simoes, E.L., Bramati, I., Rodrigues, E., Franzoi, A., Moll, J., Lent, R., Tovar-Moll, F., 2012. Functional expansion of sensorimotor representation and structural reorganization of callosal connections in lower limb amputees. J. Neurosci. 32, 3211–3220. Tatu, L., Bogousslavsky, J., Boller, F., 2014. Phantoms in artists: the lost limbs of Blaise Cendrars, Arthur Rimbaud, and Paul Wittgenstein. J. Hist. Neurosci. 23, 1–12. Wade, N.J., 2010. Sensory and perceptual disorders. In: Finger, S., Boller, F., Tyler, K. (Eds.), History of Neurology. In: Handbook of Clinical Neurology, vol. 95. Elsevier, Edinburgh, pp. 489–500. Wade, N.J., Finger, S., 2003. William Porterfield (ca. 1696–1771) and his phantom limb: an overlooked first self-report by a man of medicine. Neurosurgery 52, 1198–1199. Waugh, A., 2008. The House of Wittgenstein. A Family at War. Doubleday, New York, NY.
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Paul Wittgenstein’s right arm and his phantom: the saga of a famous concert pianist and his amputation Franc¸ois Boller*,1, Julien Bogousslavsky† *Department of Neurology, George Washington University Medical School, Washington, DC, USA † Genolier Swiss Medical Network Neurocenter, clinique Valmont, Glion/Montreux, Switzerland 1 Corresponding author: Fax: +1-202-741-2721, e-mail address: [email protected]
Abstract Reports of postamputation pain and problems linked to phantom limbs have increased in recent years, particularly in relation to war-related amputations. These problems are still poorly understood and are considered rather mysterious, and they are difficult to treat. In addition, they may shed light on brain physiology and neuropsychology. Functional neuroimaging techniques now enable us to better understand their pathophysiology and to consider new rehabilitation techniques. Several artists have suffered from postamputation complications and this has influenced not only their personal life but also their artistic work. Paul Wittgenstein (1887–1961), a pianist whose right arm was amputated during the First World War, became a famous left-handed concert performer. His case provides insight into Post-World War I musical and political history. More specifically, the impact on the artistic life of this pianist illustrates various postamputation complications, such as phantom limb, stump pain, and especially moving phantom. The phantom movements of his right hand helped him develop the dexterity of his left hand. Wittgenstein played piano works that were written especially for him (the most famous being Ravel’s Concerto for the Left Hand) and composed some of his own. Additionally, several famous composers had previously written for the left hand.
Keywords Phantom limb, stump pain, moving phantom, artistic realization, Paul Wittgenstein, piano music for the left hand
Limb amputation began very early on in the history of medicine, particularly following war injuries. Reports of postamputation pain and problems linked to phantom limbs have increased in recent years (Finger and Hustwit, 2003; Cipriani et al., 2011). Postamputation phenomena are highly relevant to neurologists and Progress in Brain Research, ISSN 0079-6123, http://dx.doi.org/10.1016/bs.pbr.2014.11.011 © 2015 Elsevier B.V. All rights reserved.
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neuroscientists because they are difficult to treat, and also because they may shed light on brain physiology and neuropsychology (Giraux and Sirigu, 2003; Raffin et al., 2012; Wade, 2010). Several writers and artists suffered from postamputation phenomena (Tatu et al, 2014). This chapter focuses on an amputated musician who experienced postamputation phenomena. The pianist Paul Wittgenstein (1887–1961) became a left-handed player after his right arm was amputated during World War I (WWI). The impact on his life and work illustrates the moving phantom phenomenon, a relatively infrequently described postamputation complication. His moving phantom limb contributed to his fame as a left-handed concert pianist. After losing his right arm, Wittgenstein commissioned several piano works and is often associated with lefthand piano music, particularly the Piano Concerto in D-major for Left Hand by Maurice Ravel. However, surprising as it might seem, many piano pieces have been composed for the left hand alone. Among the many composers who have written piano music for the left hand, one finds names such as Bela Bartok, Johannes Brahms, Franz Liszt, Carl Reinecke, Alexander Scriabin, and Camille Saint-Sae¨ns.
1 PAUL WITTGENSTEIN Paul Wittgenstein was born in Vienna in 1887. The family was remarkable in several respects. His father, a tyrannical family patriarch, was Karl Wittgenstein (1847–1913), a steel, banking and arms magnate who had accumulated an enormous fortune. He and his timorous wife, Leopoldine, had nine children. Ludwig, the philosopher, was born 2 years after Paul. The sons of the household had a distressing habit of doing away with themselves (Holt, 2009). Handsome, intelligent, homosexual Rudolf (born in 1881) strolled into a Berlin bar in 1904, asked the piano player to play a sentimental song, then dissolved potassium cyanide into his glass of milk, and died in agony on the spot. Two years earlier, Hans Karl (1877–1902) had disappeared without trace in the course of a canoe expedition of Chesapeake Bay and is thought to have willingly killed himself at sea. He was a shy, ungainly, possibly autistic child with a prodigious gift for mathematics and music. Kurt (1878–1918) became by default the oldest son. His short life illustrates the fact that the family was very conservative and attached to the Monarchy. Unlike his other brothers, Kurt had entrepreneurial spirit and went to the United States in early 1914 to explore investment opportunities for the family business, the beginning of WWI caught him there and he wanted to sail back, but the U.S. authorities apparently prevented him. He then worked for the Austrian Embassy until 1917 when he was finally able to come back and immediately enrolled in the Army. His suicide, which occurred at the Italian front, just as the war was ending, was probably related to the totally unexpected defeat of the Imperial Army by the Italians and perhaps also to a series of mutinies that were occurring within the ranks. The other two boys Paul and Ludwig (1889–1951) were plagued by suicidal impulses throughout their lives. Of the three daughters who survived into adulthood,
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two married; both husbands ended up insane and one died by his own hand. As pointed out in a review of a book on the Wittgenstein family, “even by the morbid standards of late Habsburg Vienna, these are impressive numbers” (Holt, 2009, p. 8). The other feature that marked Paul’s life is that he grew up in an exceptionally artistic environment. The Wittgenstein dwelling often resembled more a conservatory than an ordinary mansion. Prominent musicians frequently visited the household, among them Johannes Brahms, Clara Schumann, Gustav Mahler, and Richard Strauss, with whom the young Paul played duets. His grandmother, Fanny Wittgenstein, was a first cousin of the violinist Joseph Joachim, whom she adopted and took to Leipzig to study with Felix Mendelssohn. The book alluded to above (Waugh, 2008) is a thorough and very well-written account of the rise and fall of the family. It includes several photos of Paul and his relatives. Some of these photos can also be seen in the Web1 Contrary to what one might infer from some idyllic pictures “The House of Wittgenstein” was not a happy family, as narrated, by Waugh and in a New Yorker article (Gottlieb, 2009). Karl, the father, had amassed his colossal wealth through ruthless methods and wanted at all costs to have at least one of his sons to continue his work in business. He went so far as to limit the number of hours his sons, particularly Karl Hans who appeared the most gifted, were allowed to practice the piano. He was bitterly disappointed that none of them took up his incredibly successful trade. Hermine, one of the sisters, commented that this was due to her brothers’ lack of vitality and will for life. We do not know the details of the relationship between Paul the musician and Ludwig the philosopher, but we can infer that they went from acrimonious to nonexistent. Gottlieb quotes an episode in which Paul was practicing on one of the seven grand pianos in one of their mansions. One day, Paul leaped up and shouted at his brother Ludwig in the room next door, “I cannot play when you are in the house, as I feel your skepticism seeping towards me from under the door” (Gottlieb, 2009, p. 71). Ludwig expressed commiseration for his brother’s amputation, but there very few contacts between them after Ludwig left for England in 1929, nor is there any evidence that Ludwig ever attended one of his brother’s concerts. Similarly, we do not know the details of the relationship between Paul and his sisters, but here again, one episode may illustrate them. When Paul returned for the first time to Vienna after the end of World War II, Hermine was there, close to death, but Paul, even though he had been told and even though he stayed in Vienna for an entire week made no attempt to go and see her or the family house. Based also on his relations with other musicians, particularly those who wrote music for him (see below), one can conclude that Paul was far from being a nice and pleasant person. Paul attended middle school in Linz, in the same Institution as Adolph Hitler, but there is no evidence that they even knew each other. He then undertook serious musical studies with prestigious teachers including the Czech-born pianist and
1
Pictures of Paul and his family as well as a genealogical tree can be seen on https://www.google.com/ webhp?sourceid¼chrome-instant&ion¼1&espv¼2&ie¼UTF-8#q¼witgenstein%20family.
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composer Josef Labor (1842–1924). He made his public debut as a pianist in 1913, attracting favorable reviews. Interestingly, some critiques of the time specifically applauded his left-hand technique. In 1914, at the onset of WWI, Paul was drafted into the Austrian army. Soon thereafter, his right arm was injured during a patrol near Zamosc in Poland. He was then taken prisoner by the Russians, and his right arm was amputated. He remained 2 years in a prisoner-of-war camp in Omsk in Siberia. While he was still recovering, he resolved to continue his career using only his left hand. With the help of the Danish Ambassador, he managed to send a letter to his old teacher, Josef Labor, asking for a concerto for the left hand. Labor, who meanwhile had lost his sight, responded quickly, saying he had already started work on such a piece. Following the end of the war, Wittgenstein studied intensely, arranging pieces for the left hand alone and learning the new composition written for him by Labor. Once again, he began to give concerts (Fig. 1). Many reviews were mixed, qualified with comments such as that he played very well “for a man with one arm,” but he persevered. He was certainly a well-known figure within the Vienna society and probably throughout the musical world. He approached more famous composers, asking them to write material for him to perform. In addition to Labor, Benjamin Britten, Paul Hindemith, Alexander Scriabin, Alexandre Tansman, Erich Wolfgang Korngold, Franz Schmidt, Sergei Bortkiewicz, and Richard Strauss all produced pieces for him. In 1929, at his request, Maurice Ravel wrote his Piano Concerto in D-major for the Left Hand, which
FIGURE 1 Paul Wittgenstein ca. 1930.
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was to become more famous than any of the other compositions that Wittgenstein commissioned. Ravel took this commission very seriously, going so far as to enthusiastically study left-hand music, such as the e´tudes of Camille Saint-Sae¨ns. Wittgenstein performed the premiere of the Concerto with Robert Heger (1886–1978) and the Vienna Symphony Orchestra on January 5, 1932. Of note is the fact that its direction had been offered to Arturo Toscanini (1867–1957), who declined, perhaps because of a previous dispute with Ravel. The concert attracted enormous interest, and its recordings can be heard on YouTube2. There were many problems with Wittgenstein’s rendition of Ravel’s music. It was technically inadequate, and some of the jazz-inspired rhythms were poorly rendered, apparently because Wittgenstein had not been inspired by them, as he openly stated. He went so far as to deliberately change parts of the score. As a result, Maurice Ravel was infuriated. Not only did he never again talk to Wittgenstein, but also he threatened to withdraw that magical piece altogether. Fortunately, the French pianist Jacques Fe´vrier (1900–1979) came along and was able to play the Concerto to Ravel’s satisfaction in 1937. At that time, Ravel was already severely aphasic, but he had retained an astonishing ability to recognize and judge music (Cytowic, 1976; Amaducci et al., 2002). The Concerto for the Left Hand is one of the highlights of the contemporary repertoire. Another anecdote deserves to be mentioned. The Concerto begins with double basses softly playing a rather ambiguous harmony. Because the industry was still in its infancy relative to today’s standards, that part was barely audible in contemporary recordings, thus further disheartening Ravel, who probably died convinced that his music would never be rendered as faithfully as he would have liked. Perhaps because he deemed the left-handed version too difficult, before the premiere in 1931, the famous pianist Alfred Cortot (1877–1962) arranged the Concerto to be played for two-hands and orchestra; Ravel strongly disapproved of it and tried to forbid its publication or performance. Cortot ignored this and played his arrangement, which caused Ravel to implore many conductors not to engage Cortot to play his concerto. After Ravel’s death in 1937, Cortot resumed playing his arrangement, and even recorded it with Charles Munch leading the Paris Conservatoire Orchestra. It is less commonly known that Wittgenstein also approached Sergei Prokofiev (1891–1953) and requested a concerto. Prokofiev agreed and wrote the Piano Concerto No. 4 in B-flat Major for the left hand, Op. 53, which was completed in 1931. Wittgenstein did not understand the work, but it is apparently not the case (as has sometimes been claimed) that he explicitly refused to play it. He was stated as declaring, “I am simply not prepared to play it until such time as I appreciate its inner logic.” That time never came, but Wittgenstein and Prokofiev remained on friendly 2 There are several recordings of Paul Wittgenstein playing the Ravel Concerto: https://www.youtube. com/watch?v¼tSxcXdXqLvA. https://www.youtube.com/watch?v¼PnC8DmBJJEw. In these, still photographs showing the composer and the interpreter accompany the recording. Another video shows a few seconds of the artist himself while he plays, accompanied by a comment in German: https://www. youtube.com/watch?v¼FI7tnBmGnq4.
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terms. It was the only one of Prokofiev’s complete piano concertos that was never performed during the composer’s lifetime. It was premiered in Berlin on 5 September 1956, played by Siegfried Rapp (who had also lost his right arm while in Russia, but during World War II) and the West Berlin Radio Symphony Orchestra, conducted by Martin Rich. The U.S. premiere was in 1958, by Rudolf Serkin and the Philadelphia Orchestra under Eugene Ormandy. Prokofiev apparently expressed some interest in arranging the concerto for piano, two-hands and orchestra, but never went through with this idea. There are several other instances illustrating Paul Wittgenstein’s arrogance, and his problems with the musicians who wrote works for him. An extreme example can be found in the way he handled a composition written for him by Paul Hindemith (1895–1963). Not only did he reject outright Hindemith’s Piano Music with Orchestra Op. 29 but also he hid the score in his study, and it was not discovered until after his widow’s death in 2002, by which time Hindemith himself had been dead for 39 years. He was able to take this approach because he arbitrarily insisted on exclusive lifetime performing rights for all the pieces written for him. As stated above, several musicians wrote music for the left hand for the purpose of helping amputated pianists (Drozdov et al., 2008). However, many other musicians did that without being asked. The reason for this is not entirely clear. It may be a way to give an occasion to pianists (including themselves) to show off their virtuosity. A life-long smoker, Ravel once joked that he had always intended to write the Concerto for Left-Hand in order to be able to smoke a cigarette with one hand, while playing the piano with the other (Otte et al., 2003). Wittgenstein’s approach to music after his amputation was quite peculiar, as shown in the arrangements and keyboard exercises he wrote. They suggest an attempt to train his left hand to assume the load of two (Howe, 2010). As far as his performance is concerned, he experienced the “moving phantom” phenomenon, a mixture of illusion of movement of the missing limb and of voluntary movement of the stump. This seems to have played a crucial role in the acquisition of his unusual left-handed dexterity. Erna Otten-Attermann, one of his piano students, observed this during the 1930s: I had many occasions to see how involved his right stump was whenever we went over the fingering for a new composition. He told me many times that I should trust his choice of fingering because he felt every finger of his right hand. At times I had to sit very quietly while he would close his eyes and his stump would move constantly in an agitated manner. This was many years after the loss of his arm . . . His finger choice was always the best! Saks (2007, p. 259)
2 LATER EVENTS The Wittgenstein family had converted to Christianity three generations before Paul’s birth on the paternal side and two generations before on the maternal side;
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nonetheless, they were considered Jews under the 1935 Nuremberg laws. Following the rise of the Nazi Party and the annexation of Austria in 1938, Paul tried to persuade his sisters Helene and Hermine to leave Vienna, but they refused. They were viscerally attached to their homes and could not believe such a distinguished family as theirs was in real danger, a pattern all too common in Nazi- and Fascistdominated parts of Europe. Giorgio Bassani’s novel, The Garden of the FinziContini, adapted to the cinema by Vittorio DeSica in 1971, clearly illustrates this pattern. Ludwig, the famous philosopher, had already been living in England for some years, and Margaret (Gretl) was married to an American. Paul himself, who was no longer permitted to perform in public concerts under the Nazis, departed for the United States in 1938. From there, he and Gretl, with some assistance from Ludwig (who acquired British nationality in 1939), managed to use family finances (mostly held in Switzerland) and legal connections to attain non-Jewish status for their sisters. The family’s financial portfolio consisted of properties and other assets. The portion in Germany and occupied lands amounted to a total value of about 6 billion dollars in today’s American money, thus rivaling with the Rothschild for the distinction of being the largest private fortune in Europe. A considerable portion of the family assets was surrendered to the Nazis in return for protection afforded to the two sisters under exceptional interpretations of racial laws, allowing them to continue to live in their family palace in Vienna. Paul Wittgenstein became an American citizen in 1946, and spent the rest of his life in the United States, where he taught as well as played the piano. He had no contact whatsoever with the rest of his family. He died in New York City in 1961, aged 73, of prostate cancer, the same condition that had caused the death of his brother Ludwig. At his funeral, not a word, not a prayer was said. The only sound came from an old gramophone on which someone had put a 78 rpm version of Brahms’ German Requiem.
3 THE PHANTOM LIMB PHENOMENA In the middle of the Sixteenth century, French surgeon Ambroise Pare´ (1510–1590) reported that a patient of his complained of pain in an absent limb, which he viewed as not an adequate reason to stop an amputation to prevent the spread of potentially deadly gangrene (Pare´, 1552). In later years, the phantom limb phenomenon (not yet identified under that name) continued to fascinate physicians and philosophers. As written by Wade (The phenomenon) was used in attempts to incorporate the experiences from missing limbs into the body of existing theories. Most famously Rene´ Descartes (1596–1650) integrated sensations in amputated limbs into his dualist theory of mind and used the phenomenon to support the unity of the mind in comparison to the fragmented nature of the body Wade (2010, p. 493)
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The first direct account from a physician amputee appears to be that of a Scottish doctor, William Porterfield (1696–1771), a vision specialist. His leg was amputated at a young age, and he too felt sensations in the missing limb (Porterfield, 1759; Wade and Finger, 2003). Postamputation phenomena became a subject of greater medical interest during the 19th century (Finger and Hustwit, 2003). In 1830, the Scottish surgeon and anatomist Charles Bell (1774–1842), of “Bell-Magendie’s law” fame described these problems more specifically (Bell, 1830). The term phantom first appeared in the work of Silas Weir Mitchell (1829–1914), one of the founders of neurology in the United States and an important author of popular literature. His experience as a physician during the American Civil War provided a dramatic description of postamputation problems to a vast audience. His first important article on the subject was published anonymously in 1866 in a nonmedical journal, The Atlantic Monthly—A Magazine of Literature, Science, Art and Politics in a short story entitled The Case of George Dedlow. It is written in the first person and is about an American military physician who, after several injuries, had each of his four limbs consecutively amputated. Following the amputation of his two legs, he offered the following description: I got hold of my own identity in a moment or two, and was suddenly aware of a sharp cramp in my left leg. I tried to get at it to rub it with my single arm, but, finding myself too weak, hailed an attendant. “Just rub my left calf ”, said I, “If you please”. Mitchell (1866, p. 2)
The term “phantom limb” appeared in 1871 in an article, this time bearing Silas Weir Mitchell’s name and published in the Lippincott Magazine (Mitchell, 1871). The scientific version appeared in 1872 in his book, Injuries of the Nerves and their Consequences, with a more detailed medical description of several war amputee cases (Mitchell, 1872). Today, the phantom complex includes three different elements: phantom limb sensation—any sensation in the absent limb, including posture and movement; phantom limb pain—painful sensations in the absent limb; and moving phantoms. Paul Wittgenstein’s plight illustrates all three, and particularly the third one (Nikolajsen and Jensen, 2001). The pathogenesis of phantom limb sensations and the anatomical substrate that underlies the mental representation of the body remain unknown. According to Melzack (1990), corporeal awareness relies on a large neural network in which the somatosensory cortex, posterior parietal lobe, and insula cortex play crucial roles. More recently, functional neuroimaging techniques have enabled us to better understand the pathophysiology of phantom limbs. These studies demonstrate a functional remodeling of the sensory–motor cortical representations of the missing and intact limbs. These neuroplastic changes do not appear to be dependent on the presence of phantom pain. Neuroimaging techniques have also shown structural changes in the corpus callosum of amputees, compatible with the hypothesis that phantom sensations may depend on inhibitory release in the sensorimotor cortex (Flor et al. 1995; MacIver et al., 2008; Simoes et al., 2012). A comprehensive literature review
ARTICLE IN PRESS Acknowledgments
of the in vivo assessment of use-dependant brain structure changes can be found in a recent paper by Draganski et al. (2014). Among the phenomena associated with phantom limbs, impressions of movement (moving phantom) are less commonly reported. These can take the form of involuntary movements that correspond to a type of cramp. Sometimes they “move” the phantom limb into painful positions; they can also manifest as voluntary movements of the stump of the missing limb, as was the case for Wittgenstein. This phenomenon has long been recognized. Charles Bell reported it as early as 1830: I have seen a young gentleman, whose limb I amputated, making the motion with his hands of taking his leg and placing it over his knee after the limb had been removed and the stump for some time healed; so a man who has lost his arm close to the armpit has a perception of that arm changing its position Bell (1830)
Silas Weir Mitchell also reported it in his work in 1872: [The majority of amputees] are able to will a movement, and apparently to themselves execute it more or less effectively. . . The certainty with which these patients describe their [phantom motions], and their confidence as to the place assumed by the parts moved, are truly remarkable. Mitchell (1872)
Phantom limb phenomena and specifically the phenomenon of the moving phantom have inspired considerable research in recent times. Raffin et al. (2012) have shown that amputees can distinguish between motor execution and motor imagery with the phantom limb, and that the former is associated with activity in stump muscles while the latter is not. Furthermore, it is possible to evoke a sensation of touch in the missing limb following illusory visual stimulation, a phenomenon akin to synesthesia (Ramachandran & Rogers-Ramachandran, 1996). The amputees can indeed distinguish between motor execution and motor imagery with the phantom limb, and that the former is associated with activity in stump muscles while the latter is not. Angela Sirigu and her colleagues have suggested that illusory movements induced by artificial visual feedback may restore motor cortex activity, possibly producing a reduction in phantom pain (Giraux & Sirigu, 2003; Mercier & Sirigu, 2009). In conclusion, the checkered history of the Wittgenstein family illustrates some peculiar aspects of life at that time. As for Paul Wittgenstein, his moving phantom right hand probably helped him to become a famous left-handed piano concert player. Above all, Wittgenstein’s amputation caused him to commission some remarkable music that endures as a highlight of the contemporary repertoire.
ACKNOWLEDGMENTS We wish to acknowledge the contribution of Laurent Tatu, who has written extensively on the phantom limb phenomenon. We are particularly grateful to Professor Eckart Altenmueller for
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his useful and scholarly suggestions. Michael Nedo and Johanna Wittgenstein, Paul’s daughter facilitated our access to the Wittgenstein archives and to the figure used in this chapter.
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