Mozart and smallpox

• 1. Smallpox In Eighteenth Century Europe

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  In 1767, the 11-year-old composer Wolfgang Amadeus Mozart was struck by smallpox. Like all smallpox victims, he faced a serious risk of dying, yet he survived the disease. Smallpox in 18th-century Europe was a devastating disease that recurred frequently in epidemics and killed or disfigured millions of people. The 18th century was probably a particularly terrible time for smallpox in Europe because urbanization had increased crowding, making it easier for the disease to spread. Effective protection from smallpox through a vaccine was discovered only at the end of the century. An unvaccinated population could expect something like 10, 30 percent of all patients with smallpox to die. Dying was not easy; smallpox was, as Macaulay wrote, 'the most terrible of all the ministers of death.' Those who survived smallpox did not always survive intact; it frequently inflicted blindness on its survivors. The survival rate was particularly low for children. The physical appearance of the disease was frightening to patients and to their caretakers: the patient's skin became covered with large, bulging pustules, which often left conspicuous pitting on the skin of patients who survived the disease.

• 2. Leopold's Decision Against Inoculation

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  Medicine had made only slight progress against the disease in Mozart's time. Around the second decade of the 18th century the method of inoculation reached European countries. Inoculation offered immunity to smallpox, but the procedure carried a definite risk that the inoculated person could die from smallpox as a result. Thus, many parents felt that they would rather do nothing, risking future smallpox arriving at random, rather than carry out a deliberate act that might well kill their children immediately. As Mozart biographer Ruth Halliwell points out, it is in this context that we must interpret a letter sent by Leopold Mozart on the 22nd of February 1764 to his landlord and friend Lorenz Hagenauer concerning smallpox. They are trying to persuade me to let my boy be inoculated with smallpox. But as I have expressed sufficiently clearly my aversion to this impertinence they are leaving me in peace. Here inoculation is the general fashion. But for my part I leave the matter to the grace of God. It depends on His grace whether He wishes to keep this prodigy of nature in this world in which He placed it or to take it to Himself. The visiting Italian physician Angelo Gatti noted in 1761 that in Paris there were 'more brochures for and against inoculation than inoculations.' His remarks can be seen to be more of appeal to religion to resolve what must have seemed an impossible dilemma.

• 3. The Vienna Outbreak And Family Flight

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  The Mozart family left their home in Salzburg for Vienna on the 11th of September 1767. They had been there before, exhibiting the children's talents, in 1762; by this time they had completed their Grand Tour of Europe, performing in England, France, and elsewhere, and hoped to achieve even greater recognition in the Imperial capital. Unfortunately, there was an outbreak of smallpox in Vienna at the time. On the 28th of May of that year, Emperor Joseph II had lost his second wife Maria Josepha to the disease, and his mother Maria Theresa also caught it. The imperial bride-to-be Maria Josepha caught the disease in October and died of it on the 15th, the day after she had been scheduled to be married. In the following week, presumably before the onset of his illness, the 11-year-old composer wrote an inexplicably cheerful elegy, a fragmentary duet for two sopranos in F major (K. Anh.24a/43a) to an anonymous text: Ach, was müssen wir erfahren! Wie? Josepha lebt nicht mehr! She gives herself to be death's offering in the most beautiful of years. Neither the glow of happy youth nor the ancestral virtue protects her from the cold stretcher. The Mozarts were renting rooms in the home of the goldsmith Johann Schmalecker, located at #3 Weihburggasse. They were horrified when all three of Schmalecker's children came down with smallpox. Alarmed, Leopold first left Schmalacker's house, taking Wolfgang only with him on the 17th of October. Six days later, on the 23rd of October, the entire family fled the city.

• 4. Wolfgang's Illness And Recovery Process

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  They headed north into what today is the Czech Republic, first reaching Brno where they called on Count Franz Anton Schrattenbach. It was there that, on the 26th of October, Wolfgang showed the first symptoms of smallpox. Given the incubation period of the disease, roughly 12 days, it can be ascertained that he had already caught it in Vienna. Leopold consulted an acquaintance, Count Leopold Anton Podstatsky, who insisted that the Mozarts move into his home and placed Mozart under the excellent care of his personal physician, Dr. Joseph Wolff. Leopold later wrote: Wolfgang was complaining of his eyes. I noticed his head was warm, that his cheeks were hot and very red, but that his hands were cold as ice. Moreover, his pulse was not right. So we gave him some black powder and put him to bed. During the night he was rather restless and in the morning he still had the dry fever. A frightening symptom of Wolfgang's illness was an inability to see. In a letter written much later, his sister Nannerl reported: He caught the smallpox, which made him so ill that he could see nothing for nine days and had to spare his eyes for several weeks after his recovery. By the 10th of November, Wolfgang was feeling better, but then Nannerl also contracted smallpox and was ill for three weeks. The Mozart children were thereafter safe from the disease, which confers immunity on its survivors. According to Leopold, both children were pitted in the locations of the former pustules, but neither seriously.

• 5. Empress Maria Theresa's Medical Reforms

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  The experience of losing three of her children to smallpox led Empress Maria Theresa to become a convert to inoculation. In 1768, she engaged the Dutch physician Jan Ingenhousz to conduct an inoculation program. Ingenhousz's program worked first among poor people, with the goal of developing a weakened strain of the disease; poor parents in Vienna were paid a ducat to have their children inoculated. The inoculations performed with this weakened strain on the imperial family were successful, and led to greater public acceptance for the procedure. Smallpox struck the Mozart family again in the next generation: Nannerl's eldest son Leopold and two of her stepchildren caught the disease during an outbreak in the Salzburg area in 1787. All three children survived. The Mozarts eventually returned to Vienna and were received in the Imperial court on the 19th of January 1768. The Empress, who had by now lost three children to smallpox, conversed with Frau Mozart about the disease. The remainder of the trip was not especially successful because the opera La finta simple went unperformed in Vienna due to intrigues.

• 6. The Advent Of Edward Jenner's Vaccine

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  In 1796, the discovery of vaccination, the use of the related cowpox virus to immunize against smallpox, by Edward Jenner revolutionized the ability of medicine to deal with smallpox. Vaccination reached Vienna around 1800, when yet another local epidemic created impetus for its adoption. One of the doctors trained in the Vienna campaign, named Doutrepout, then brought vaccination to Mozart's native city of Salzburg. According to Halliwell, popular resistance was fierce, and both the government and the Roman Catholic Church took stern measures to promote vaccination. The first relative of Mozart's known to have been vaccinated was Johanna Berchtold von Sonnenberg, called Jeannette (1789, 1805), Nannerl's youngest child; she was vaccinated during the 1802 campaign in Salzburg. With vaccination, great progress was made in reducing incidence of the disease, and it was eventually confirmed as eradicated in 1979 by the World Health Organization.