JOHN KEATS (1795-1821) abandoned the profession of medicine in 1817 to pursue a career in poetry. Given the poverty of medical knowledge at the onset of the 19th Century it is doubtful that either Keats’s name or his clinical accomplishments would have become imperishable had he remained with medicine. His poetry, on the other hand, is wondrously imaginative, moves its readers and possesses that quality of insight that compels us to think for and beyond ourselves. Consider these two unadorned lines from one of his odes:

Heard melodies are sweet, but those unheard

Are sweeter.

This enigmatic couplet has been quoted repeatedly, suggesting that sweeter musical invention, as yet dormant, may indeed lie in our future. Or, alternatively, that there is sweeter music now being played in the next village, yet is, for the moment, inaudible to us. But since melody is heard solely through one’s mortal ears (as a violent storm, to a deaf person, is merely lightning, and to a blind one, only thunder), what else could Keats, unencumbered by mortal constraints, be suggesting? To those rare geniuses such as Mozart, a melody of celestial dimension might be incubating silently in some cerebral niche or heard merely by glancing at a printed score; but to the rest of us, there are but two choices: Either we hear something — or there is silence.

And so, could Keats then be hinting of melodic greatness, sweeter melodies, incubating in the domain of silence? Could great melody be confined to that world harboring neither sound nor the written word, a world bereft of formed ideas, of questions, of anything tangibly creative?

What was a Beethoven symphony before Beethoven put it to paper? An ill-formed, soundless melody in his head, perhaps. But before that? Something immaterial in the silence of his thinking, maybe: And one by one, the melodies may have materialized, a variation here, an inverted theme there, a counterpoint melody, a change in the strings, a modified tempo, a touch of pianissimo; and before even that, an awesome silence where genius, through some preternatural alchemy, yielded Beethoven’s gift to the world. Somewhere between a banal Austrian breakfast and a rudimentary construct of a sonata must have been an interval of utter silence bereft of plans, ideas, even unfocussed sketches. Is silence, then, like the celestial ether, filled with intangible substances not measurable by mortal instruments?

Nature abhors a vacuum, said Galileo in 1643, paraphrasing Aristotle’s famous dictum. Silence, the auditory counterpart of a vacuum, is also abhorred by the overwhelming majority of humans. Silence is a void believed to be empty of all things except annoyances and terrible anxieties for most of us, but resourceful possibilities for the rare creative ones. Silence has been called unproductive or sedative or even lifeless except when it is inserted as a seminal pause between words of expressive meaning; and silence, only then, becomes pregnant with meaning solely by its artful juxtaposition to sounds.

A rare individual, perhaps an adherent of one of the religions of South Asia, may find comfort and serenity in silence, regarding it as a benediction rather than a threat or curse. But for many people silence is taken to be a stern form of chastisement, a non-verbal variety of intense criticism. And for still others, silence becomes an anxiety-inducing interval generating unease and sometimes profound angst.

But still there can be an indisputable eloquence in silence. The absence of articulate sound may indicate profound wisdom (“That man’s silence is worth listening to” — Thomas Hardy), a soothing comfort (“And silence like a poultice comes to heal the blows of sound” — Oliver Wendell Holmes Sr.), contemplative remorse (“I have often repented speaking, but never of holding my tongue.” — Xenocrates), scorn (“The cruelest of lies are often told in silence.” — Robert Louis Stevenson), or even compelling humor (“He has occasional flashes of silence that make his conversation perfectly delightful.” — Sydney Smith). Truly, there is an infinitude of silences with subtle gradations of nuance. Silence speaks volumes, possesses a thousand unheard voices, and yields a chorus of many messages.

And how much better the world would be were there more silence instead of imprudent, oral invective or worse, ill-considered, hastily spoken judgment. We return again to music which, much like silence, can convey the infinite and the inexpressible. And in silence, as well as in music, there is the promise of peace.

Stanley M. Aronson, M.D., a weekly contributor, is dean of medicine emeritus, Brown University ( smamd@cox.net).