Saturday, November 17, 2012

Hadassah Medical Center examines Mozart's medical file

Medical professionals took their seats in the auditorium of the Hadassah Ein Kerem Hospital on November 7th 2012 to attend a case history presentation, a weekly series produced by Professor Yoel Donchin. This specific clinical, historical conference was to focus on Wolfgang Amadeus Mozart, his life, health problems and causes of death.

The conference opened with a lively, fresh and contrasted rendition of the first movement of Mozart’s Piano Sonata in D major for four hands KV381 (1772) performed by cardiologists Dr. Ayelet Shower and Professor Arthur Pollak. Dr. Uzi Izhar, head of the Hadassah Medical Center’s General Thoracic Surgery Unit, gave background information on the composer, starting with his birth in Salzburg in 1756. Mozart’s father, who nurtured his son’s talent throughout his childhood, had been employed as a musician to the Archbishop of Salzburg and was himself a renowned teacher. Mozart’s mother was also highly supportive and caring of the boy. From the content of his letters to her, we know she read music. Of the seven children born to them, only two survived – Wolfgang and his sister Nannerl; she was a child prodigy on the piano and harpsichord. For some three years, their father toured with them by carriage all over Europe, where the two children performed. This remunerative tour greatly improved the Mozart family’s financial situation. In England, a notice publicizing a recital the young Mozart referred to him as a “prodigy of nature”.  Wolfgang played piano and violin and had written his first work – Andante in C – at age five. He never went to school. A sketch on the screen showed the music room in the Mozart House in Salzburg.

At this point, Dr, Izhar began to describe Mozart’s illnesses from age five, beginning with recurring fevers and joint pains which temporarily prevented him from performing. In September 1765, when they were in The Hague, Nannerl became ill with a raging fever, sore throat and loss of consciousness. She was treated by Professor Thomas Schwänke, who diagnosed her as having “pox on the lungs”. Following her recovery, Wolfgang became ill with something similar. His condition deteriorated to the point that his father described him as “all skin and bones”. Within two months, the young boy had recovered and could continue performing. Altogether, Mozart’s first ten years were fraught with throat infections…probably meaning he had an abscess on his tonsils. Medications prescribed him included powders, juices and Indian tamarind water. At age 11, he came down with chicken pox and recovered. At age 16, he was ill with ephagitis. Then his mother died when he was 23. She was 58 and had suffered from chronic fever accompanied by chills, headaches, loss of consciousness, etc. At age 26, Mozart married Constanze Weber, a cousin of Carl von Weber. Wolfgang’s father was unhappy about his choice of a wife, considering his son worthy of someone of a higher social standing. Together Wolfgang and Constanze had six children, but only two reached adulthood – Karl and Franz. Karl became a pianist and composer and Franz was a clerk. Neither of the sons married or brought children into the world, thus putting an end to the Mozart line.

Mozart was described as a thin, pale, short man. Under his wig his hair was blond. He may possibly have been short-sighted. His alcohol consumption was average and he smoked a pipe. He liked pets and kept a dog and a canary. He was born with a deformity of one ear but with good hearing. At age 29, in Vienna, he premiered his Piano Concerto no.20, K466. Altogether, his late 20s in Vienna, during which time he performed and conducted his piano concertos, were Mozart’s happiest and healthiest years. His 30s were characterized by constant complaints of headaches, throat infections, toothache and stomach aches. His sister, five years older than him, was healthy. Constanze, however, was not so healthy. In addition, she and Wolfgang had financial worries. A scene we viewed from one of the Mozart films shows the ill Wolfgang taking ice baths and talking to Constanze about the family’s money problems. In May 1787, Mozart’s father died at the age of 68. In the same year, Wolfgang and Constanze lost another child. Mozart made a number of visits to Prague, completing the latest symphonies – numbers 39, 41 (Jupiter) – and two operas – “The Marriage of Figaro” and “Don Giovanni”.

1791, Mozart’s last year, was a year of work at a frenzied pace, causing him emotional crises. In June of that year, he claimed he was in good health. In his visit to Prague in September, some two months prior to his death, he conducted the premiere of one of his most important operas - “The Magic Flute”- at this time also composing his clarinet concerto. On October 14th, in a letter written to his wife Constanze who was sojourning at the spa town of Baden, he wrote that his health was in order, in the same letter, also discussing the future of their son’s education. Only a month later, Mozart fell ill with the malady that would bring about his end. There was no medical record of this. Evidence of his final illness was written years later by Constanze’s sister, Sophie Haibel. In a letter written by Sophie to Georg Nikolaus Nissen, a Danish diplomat who penned a Mozart biography, and who was to become Constanze’s second husband in 1809, she described a chronic illness, seemingly common at the time, that manifested itself in fast developing edema of the whole body accompanied by a pungent smell, general pain, fever and, possibly, a rash. Mozart’s edema became so bad that he was finding it difficult to turn over in bed and Sophie and Constanze sewed a special night shirt to make tending to him easier. Two weeks after taking ill, Mozart’s consciousness began to ebb. Dr. Thomas Franz Closset was called in to examine him; he came by after attending a theatre performance. He bled Mozart and prescribed cold compresses for the composer’s burning forehead. Sophie writes that, shortly after that, Mozart died at home on December 5th 1791, only weeks short of his 36th birthday.  A number of years following Mozart’s death, a doctor in Vienna  - Dr. Eduard Vincent Goldhörner von Lotz - wrote that, at that time, many of the city’s inhabitants had come down with a similar fatal illness. Dr. Closett observed Mozart’s dead body and claimed it was in keeping with the illness. Having examined Mozart before his death, Dr. Closett wrote that the composer’s death had been the result of brain deposit, “deposito alla testa”. The cause of death, as announced by St. Stephan’s Church was “hitziges Frieselfieber” (miliary fever). At that time, the cause of death was not always determined by a doctor but was often decided on by the family according to an account of the person’s death. On the day following his death, Mozart was taken to St. Stephen’s Cathedral. Few people were there to attend his funeral ceremony. On December 7th, he was buried in a common grave, quite an accepted practice in those days. Although his exact burial place is not known in St. Mark’s Cemetery, a monument has been erected there in the composer’s memory.

In the almost 36 years of his life, Mozart had managed to write more than 600 works, as numbered by Ludwig von Köchel. His last and uncompleted work was the Requiem K.626, a liturgical, sacred work for the dead. It was probably commissioned by one of Vienna’s well-known noblemen – Count Franz Walsegg-Stuppach - a music lover, who had requested the work in memory of his late wife. Following Mozart’s death, Constanze wished to find someone to finish the incomplete Requiem. The only person willing to do this was the composer’s student Franz Süssmayr. (Not all music researchers agree on this fact.)

Pediatrician Dr. Yigal Shvil opened his talk by expressing real sorrow at the fact that the genius Wolfgang Amadeus Mozart had left us at age 36, Dr. Shvil asking why he could he have not lived as long as J.S.Bach. There have been many theories regarding cause of death. The first is poisoning….connected to the stranger who visited Mozart constantly for a month to pay him in installments for composing the Requiem and to keep an eye on its progress. Feeling enormously pressured by the task, Mozart told Constanze that he was feeling unwell, that he was “being poisoned” and that he sensed the Requiem would be for his own death. Dr. Shvil mentioned the theory that Aqua Tofana, a substance having neither taste nor smell, used by women for cosmetic purposes, had caused Mozart’s death by poisoning. But that could not have been the case as his handwriting had remained steady. Mozart’s son Karl Thomas was also convinced his father had been poisoned due to the terrible smell emanating from Mozart before his death and, even more so, after his death. He added that, after his death, Mozart’s body did not take on rigor mortis.  Then there is the story of composer and contemporary of Mozart, Antonio Salieri, who, late in life, in a mental hospital, told Beethoven’s secretary that he had poisoned Mozart. However, closer to his own death, Salieri informed Bohemian composer and piano virtuoso Ignaz Moscheles that this had not been the case at all. Dr. Shvil reminded us that Pushkin had written a play on the subject and Rimsky Korsakov, an opera, not to speak of Peter Shaffer's stage play “Amadeus”, premiered in 1979, and Milos Forman's film version of five years later. The only medical professionals in Vienna who had looked after Mozart were Dr. Thomas Franz Closett and his assistant Matthias von Sallaba, but we have no official medical account of Wofgang’s last illness. “Hitziges Frieselfieber” is not a precise medical diagnosis. And how could there be one? The stethoscope was invented by René Laennec only in 1816, and the clinical thermometer had also not existed in Mozart’s time, its accuracy only established in 1920; it then took more time again to determine the normal range of body temperature. So how could they treat Mozart? They used bleeding, cold baths and other remedies of the time. Mozart was a small man, so bleeding him must have been detrimental to his weakened state.  

What were the symptoms of the illness? His hands and feet were swollen but he did not suffer from shortness of breath. He was lucid till his death. He could not move; he suffered from vomiting and fainting. His hearing, however, had remained sensitive, so much so that he had asked that his beloved canary be removed from the room. Mozart’s was an epidemical illness, so common at the time that the doctors could predict when he would die. Could it have been syphilis, widespread in Europe at the time? This would be treated with mercury. Could Mozart have overdosed on mercury? No. He did not show symptoms of mercury poisoning. Did he perhaps suffer from his father Leopold’s complaint of severe perspiring and colitis? It seems not. Mozart complained of having the “taste of death” in his mouth; this can be caused by uremia, the result of kidney failure. Dr. Shvil then listed symptoms of several other diseases, including rheumatic fever, ruling them out one by one. But then, in 1820, at St Bartholomew’s Hospital in London, a student had gone to the dissection room, where there was a patient who had had tuberculosis; the student saw worm spicules in a muscle. The disease caused by this became known as “trichina spira”. This was then forgotten for some 30 years. In 1860, Friedrich Albert von Zenker, a German pathologist and physician, observed the same thing in the muscles of a German waitress from an inn who had died, realizing that others who had eaten at the very public house had also suffered the same fate. He checked the pork sausage they had eaten and found the same larvae. The course of the disease – trichinosis – was that of Mozart’s illness. 44 days before his death, Mozart had written to Constanze that he had eaten delicious pork cutlets at a public house, eating them “to your health”. It had not been to the good of his health! In 1899, there was an epidemic of it in northern Italy; by now, however, the patients could be treated and they recovered. And in 2004,  30 Thai workers in Emek Hefer, Israel, were found to be suffering from trichinosis!

For a moment of relief, a picture of a chocolate Mozart kugel appeared on the screen. Pediatric ophthalmologist Dr. Irene Anteby drew the audience’s attention to the fact that the halved chocolate looked like an eye! She was to speak about Mozart’s eyes, the information for which would be taken from written accounts and from her own scrutinizing of portraits of the composer. Leopold Mozart had written to his wife that Mozart had good eyesight; Constanze also wrote that Mozart had never needed glasses. However, she also wrote that his eyes had been quite large. We then observed two paintings of the seven-year-old Mozart; Dr. Anteby found his eyes quite normal. From another portrait, painted of Mozart at age 21, some questions arise as to the white of the eye, the eyes’ slight protrusion and asymmetry, lid lag, etc. These could be symptoms of certain illnesses. Or were these signs of acute short-sightedness? Probably not. But what about thyroid problems? Hyperthyroidism was ruled out; Mozart’s hand-writing was too steady for that. In a portrait of the composer at age 27, painted by Joseph Lange, there are no signs of any systemic disease. In Doris Stock’s side on drawing of Mozart at 33, one sees a little swelling of the lower eyelid; his collar, however, hides his neck, making it impossible to see signs of thyroid problems. So Dr. Anteby’s answer to Professor Donchin is that Mozart probably suffered neither from poor eyesight nor from eye disease. One cannot rule out slight short-sightedness in one eye or a lazy eye.

Moving from eyes to ears, ear-nose-and-throat surgeon Dr. Michal Kauffman-Yechezkeli took to the platform. She opened by reminding us that Mozart had absolute hearing and more than outstanding musical aptitude. However, many people do not know that he suffered from a deformation of the left ear, causing him much grief; and he did all he could to hide this. Most of the Mozart portraits show his right side and, generally, his ears stayed tucked under his wig. In the biography written by Georg Nikolaus von Nissen, published in 1828, there is a sketch of Mozart’s left ear shown together with a sketch of a normal ear. The very rare deformation has since been termed the “Mozart ear”. Dr. Kauffman spoke of there being only been five cases recorded. The sixth case, as shown on the screen, was is that of a child seen a week ago at the Hadassah Medical Center! The phenomenon is hereditary; Mozart’s younger son suffered from the same deformation. Kauffman concluded by quoting from P.H.Gerber’s 1898 Mozart biography: “It is a peculiar irony that a person, whose inner ear has, so to speak, reached the highest level of development, has a retarded and malformed outer ear”.

Professor Donchin thanked all those who had taken part in the event. He added that Mozart’s reputation had been much harmed: the film “Amadeus” took artistic license in portraying the composer as a clown. Salieri did not write down the Requiem (as shown in the Forman film), nor did he hate Mozart. And Mozart had not been a womanizer. Professor Donchin closed the meeting with the fact that Mozart had been a composer of rare genius with an amazing musical memory and that he had been a superb improviser.

Informed, inspired and well entertained, people quickly left the auditorium to return to today’s reality.

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