Mozart and smallpox

• 1. Introduction

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  In October 1767, an 11-year-old Wolfgang Amadeus Mozart began to lose his sight. He was lying in a bed in the northern Moravian city of Olmütz, his cheeks burning red, his hands cold as ice, covered in the pustular rash that announced one of the most feared diseases of the 18th century: smallpox. The boy who had already toured the courts of England, France, and the Imperial capital of Vienna was now fighting for his life. His father Leopold scribbled anxious observations about the boy's pulse and fever. His sister Nannerl would later recall that he could see nothing for nine days. How did the prodigy end up in this condition? Why had his father, just three years earlier, refused to protect him? And what happened when the Mozart family, smallpox survivors, finally returned to Vienna and were greeted by an Empress who had lost three children to the same disease?

• 2. The Disease That Shaped a Century

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  Smallpox in 18th-century Europe was not merely common; historians Ian and Jenifer Glynn described it as the disease Macaulay called "the most terrible of all the ministers of death." In an unvaccinated population, somewhere between 10 and 30 percent of all patients died. The survival rate was especially low for children. Those who lived through the disease did not always emerge unscathed. Blindness was a frequent outcome. And visible on the skin of survivors were conspicuous pits where the large, bulging pustules had been. The 18th century may have been a particularly brutal era for the disease in Europe. Growing cities meant more crowding, which made the virus easier to spread from person to person. The vaccine that would eventually consign smallpox to history was still decades away. Medicine had made only slight progress. A method of inoculation had arrived in Europe from Asia around the second decade of the century, but it was no vaccine. Inoculation used active smallpox virus, taken from the mildest pustules available, to confer immunity. The risk was real and immediate: the inoculated person could die of smallpox as a direct result of the procedure. That risk sat at the center of one of the most consequential decisions Leopold Mozart ever made.

• 3. Leopold's Impossible Dilemma

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  On the 22nd of February 1764, Leopold Mozart wrote a letter to his landlord and friend Lorenz Hagenauer from wherever the family was then staying. The subject was inoculation. "They are trying to persuade me to let my boy be inoculated with smallpox," Leopold wrote. "But as I have expressed sufficiently clearly my aversion to this impertinence they are leaving me in peace." He continued: "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." Mozart biographer Ruth Halliwell places these words in their proper context. From today's vantage point, a parent trusting divine will over medicine looks reckless. But in 1764, the case for inoculation was not firmly established. A parent choosing inoculation was choosing a deliberate act that might kill a child immediately. Choosing to do nothing meant hoping the disease might never arrive, or might arrive in a mild form. Leopold's appeal to religion may have been less a rejection of reason than an attempt to navigate what felt like an impossible dilemma, one with no safe exit on either side.

• 4. Fleeing Vienna

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  The Mozart family left Salzburg for Vienna on the 11th of September 1767. The occasion was promising: the upcoming marriage of the 16-year-old Archduchess Maria Josepha, daughter of Empress Maria Theresa, was set for the 14th of October, and celebrations like that drew visiting musicians and opportunities for income. But Vienna was in the grip of a smallpox outbreak. On the 28th of May that year, Emperor Joseph II had already lost his second wife, also named Maria Josepha, to the disease. The Empress herself had caught it and survived. Then the imperial bride-to-be Maria Josepha contracted smallpox in October and died on the 15th, a day after her scheduled wedding. Sometime in the week before his own illness appeared, the young Wolfgang composed a fragmentary elegy for two sopranos in F major, catalogued as K. Anh.24a/43a, mourning the princess with the words: "Ach, was müssen wir erfahren! Wie? Josepha lebt nicht mehr!" The Mozarts were renting rooms from a goldsmith named Johann Schmalecker, and when all three of Schmalecker's children fell ill with smallpox, Leopold moved immediately. On the 17th of October he took Wolfgang alone and left the house. Six days later, on the 23rd of October, the entire family fled the city entirely.

• 5. Nine Days Without Sight

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  Heading north toward what is now the Czech Republic, the Mozarts stopped first in Brno, then known by its German name Brünn, where Leopold called on Count Franz Anton Schrattenbach, brother of his employer back in Salzburg. Count Schrattenbach offered a concert. Leopold, driven by what he later described as an "inner urge," declined and pressed on. The family reached Olmütz, today called Olomouc, and on the 26th of October, Wolfgang showed his first symptoms. Given the roughly 12-day incubation period of the disease, physicians could calculate that he had already been infected before leaving Vienna. An acquaintance of Leopold's, Count Leopold Anton Podstatsky, was dean of the cathedral and rector of the University in Olmütz. He had known Leopold from an earlier posting in Salzburg. Learning of Wolfgang's condition, Podstatsky insisted the Mozarts move into his home and placed the boy under the care of his personal physician, Dr. Joseph Wolff. Leopold's own letters described his son's cold hands, hot cheeks, irregular pulse, and dry fever. What the letters did not capture was the terrifying symptom Nannerl wrote about in a letter of 1800: Wolfgang could see nothing for nine days, and had to spare his eyes for several weeks after recovering. Ophthalmologist Richard H. C. Zegers later proposed that the vision loss was not true blindness but the result of pustular rash affecting Wolfgang's eyelids. In either case, the boy unable to read or write found a different way to pass his convalescence. He spent the time learning card tricks and fencing.

• 6. Aftermath and the Empress

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  By the 10th of November, Wolfgang was recovering. Then Nannerl caught the disease and was ill for three more weeks. The family spent a total of four months away from Vienna. When they finally returned and were received at the Imperial court on the 19th of January 1768, the Empress Maria Theresa, who had by then lost three children to smallpox, spoke personally with Frau Mozart about the disease. Leopold noted that both children carried pitting on their skin from the former pustules, but that neither was seriously marked. The rest of the Vienna visit did not go smoothly. A chance remark from the Emperor, which Leopold took as a firm commission, led Wolfgang to write the opera La finta semplice. Intrigues among Viennese singers and musicians prevented it from reaching the stage there, and it was only premiered in Salzburg after the family returned on the 5th of January 1769. The Empress, for her part, drew a different lesson from her losses. In 1768, she engaged the Dutch physician Jan Ingenhousz to run a formal inoculation program. Poor parents in Vienna were paid a ducat to have their children inoculated, with the goal of developing a weakened strain of the virus. The program succeeded well enough that inoculations using this strain were then conducted on the imperial family itself, shifting public opinion toward the procedure.

• 7. Vaccination Reaches Salzburg

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  Smallpox returned to the Mozart orbit in 1787, when Nannerl's eldest son Leopold and two of her stepchildren caught the disease in an outbreak in the Salzburg area. All three children survived. The decisive turning point for the disease came in 1796, when Edward Jenner announced the discovery of vaccination: using the related cowpox virus to immunize against smallpox. Vaccination reached Vienna around 1800, spurred by yet another local epidemic. One of the doctors trained in that Vienna campaign, named Doutrepout, carried the practice south to Salzburg, Mozart's native city. According to Ruth Halliwell, popular resistance there was fierce. Both the government and the Roman Catholic Church, previously an opponent of the procedure, took stern measures to promote it. The first member of Mozart's extended family known to have been vaccinated was Johanna Berchtold von Sonnenberg, Nannerl's youngest child, who went by the name Jeannette and was born in 1789. She was vaccinated during the 1802 campaign in Salzburg, three decades after her uncle had lain feverish and sightless in a borrowed house in Olmütz. Smallpox was eventually confirmed as eradicated in 1979, the only human disease so far to have been eliminated entirely.