You shake my nerves and rattle my brain . . .

--Jerry Lee Lewis' "Great Balls of Fire"

"Neurology," said Dr. Robert Laureno, "is not frequently the subject of music." He gave a great sigh and, in mock despair, announced that after a diligent search Jerry Lee Lewis was all he could come up with.

Still, said the chairman of the neurology department of the Washington Hospital Center, "Music has the capacity to affect our neurologic circuitry with an intensity that visual or dramatic arts cannot match.

"It can not only put one at ease in the dentist's chair, it can drum up martial spirits in a parade, facilitate romance or produce anxiety in the audience at a circus.

"I doubt," Laureno added, "that the unveiling of a sculpture will ever result in a riot of the proportions which attended the first performance of Stravinsky's 'Rite of Spring' in Paris earlier in this century . . ."

Laureno was speaking to about 150 colleagues at the Hospital Center on how music--either played or heard--can affect human neurological circuitry, and the especial poignancy when neurological disorders afflict the musically talented, and, in fact, stop the music.

In best doctor-ese, the program was introduced as "the interface of neurology and music" and included, as examples, cases in which certain types of music have induced epilepsy. One patient had a seizure when he played a certain hymn on the piano. If he fingered the notes on a silent keyboard, nothing happened. If he hummed or sang the hymn or listened to someone else play it he was safe, as well. But the combination of playing and hearing set him off. Other patients, Laureno said, had seizures brought on only by specific types of music, such as "country or organ music." Church bells in certain frequencies could produce seizures, and one victim on record "only had seizures when listening to the second movement of the Beethoven Fifth Symphony."

Flautists are prone to a disorder caused by pressure neuropathy of the digital nerve "due to prolonged practicing of the flute, and perhaps better known is pianist's cramp . . . now considered to be an organic form of isolated tonic spasm of the wrist." It does not respond well to treatment, he said, and "has terminated the performing careers of several major pianists in this century." Pianist Leon Fleisher has been conducting for some years because of a wrist problem. Concert pianist Gary Graffman gave up performing for teaching because of this sort of right-hand neuropathy.

Maurice Ravel, in a curious way, has proved to the satisfaction of many neurologists that this kind of musico-neurological ill is not a problem of psychological origin--a kind of piano burnout--as many doctors had believed. Ravel's extraordinarily difficult Concerto for the Left Hand in D Major, commissioned by a well-known pianist who lost his right arm in World War I, has been mastered by victims of pianist's cramp. Fleisher's rendition of it, for example, is considered definitive. For Graffman too, it became important. Says Laureno of one unnamed patient who mastered it, "Obviously this man is not cracking under pressure . . . it the cramp is probably almost definitely an organic condition." That is an unusually definite statement for a physician, especially a neurologist, to make.

It is an irony that even today Ravel's music can affect neurologists' thinking because the popular French composer's talent was short-circuited by a neurological accident.

Ravel's case has become a major subject of study because the apparent stroke that jumbled his technical skill but left his musical senses unimpaired has demonstrated some aspects of how the brain's two hemispheres work together.

Today neurologists know that this sort of stroke-induced, so-called aphasia can sometimes heal itself spontaneously or respond to therapy, but while Ravel's own neurologist was away, another neurosurgeon performed an exploratory operation from which Ravel never recovered. He died in 1937.

Dr. Richard Cytowic told the Hospital Center group that Ravel's stroke, "a left temporal hemisphere insult" suffered at the age of 58, left the composer "with a remarkable discrepancy between preserved musical thinking and a loss of musical expression."

"He lost the technical stuff of music," said Cytowic. "He was unable to sight-read at the piano, name the notes, write down notes of music he heard. A result of the stroke's damage to the left side of his brain. But there were indications that the esthetic qualities of music had not escaped him. He could recognize tunes, point out errors, incorrect notes or rhythms. These are right-side brain functions.

"He also spoke frequently of the new music in his head and his frustration at his inability to get it out . . . But he could not translate music either into symbols or performance to get them out. Ravel's new music remained imprisoned in his aphasic mind."

If Beethoven were alive today, the conference was told, he might not be deaf. In any case, it appears the 150-year-old conventional wisdom that attributed his famous deafness to syphilis is almost certainly a bum rap.

Dr. Robert Bunning, rheumatology fellow at the Hospital Center and professional pianist (now appearing at Hogate's), made a persuasive case for Paget's Disease, a relative newcomer among the several diagnoses of Beethoven's deafness put forward over the years. Paget's Disease is a still-mysterious disorder, often involving the sort of gradual, progressive deafness experienced by Beethoven. It is also characterized by a distorted bone structure--bow legs, for example, and a telling malformation of the skull. Beethoven is widely depicted wearing a hat perched on the back of his head--a common occurrence with victims of Paget's. Through his examination of Beethoven's autopsy report and other literature, Bunning established that the state of the composer's organs did not meet the known criteria for the other suggested illnesses, including syphilis.

Much progress has been made now in arresting the progression of Paget's Disease, and today Beethoven's hearing might well have been preserved for many more years. "I don't know," said a music lover with a certain heartlessness, "had he been able to hear he might never have written the Ninth Symphony . . . or the Missa Solemnis."