Hektoen International

A Journal of Medical Humanities

Euterpe Deconstructed: Reflections on the health, illness, and legacy of Wolfgang Mozart

Vincent de Luise


Wolfgang Mozart, age 26, by his brother-in-law
Joseph Lange (1782-1789).

Who was Mozart?

Of course, we all know his music. The music! That music, so refined and richly textured, melodic, timeless, ineffably beautiful, and sublime.

But, who was Mozart? Who was the man behind those genius creations? So much has been written and said about Johannes Chrysostomus Wolfgangus Theophilus Mozart, true and vetted, and more than a little hyped, hyperbolic, and apocryphal, that the truth has been hidden. There are so many stories circulating about Mozart that they have their own name: “Mozart myths.” Even the observation that posterity calls him “Amadeus”—when that name was not on his birth certificate nor a name that he used in his lifetime—is part of that myth. (N.B.: He preferred Wolfgang Amade’ Mozart).

Who was Mozart? There are many Mozarts. There is the eighteenth century Mozart, the undiscovered and neglected artistic genius. There is the re-imagined nineteenth century Mozart, the perfect, porcelain musical god on a pedestal. Today, there is the deconstructed twenty-first century Mozart, whose 626 canonical compositions are now as commonly heard on historically-informed, performance-pattern instruments (H.I.P.) as they are by full modern orchestras, the Mozart who is recognized today as western music’s “first freelance” musician, a peerless and foundational composer for so many that came after him. For many listeners, one or another of the above historical Mozart remains their truth, regardless of the truth.

Mozart is certainly known by his music, music at once joyous, yet tinged with sadness. Can anything more be revealed by an examination of Mozart, the man? By examining aspects of his physiognomy, his personality, the written evidence of his chronic illnesses, the proximate cause of his death, or by his legacy and his “effect”? Can this exegesis illuminate more of this most wondrous of stars in the musical firmament?

The observations below are gleaned from the written literature and vetted scholarship. They paint a portrait of a man with all the imperfections and warts of humanity, who at the same time possessed a gift so rare and so extraordinary that its output, that music which is so beloved, has been likened to the foundational melodies and rhythms that emanate from the center of the universe.


What did Mozart look like?

More than any other composer, Mozart’s image remains one of the least certain. An influential German biographer of the early twentieth century, Arthur Schurig, asserted that, “Mozart has been the subject of more portraits having no connection with his actual appearance than any other famous man; and there is no famous man of whom a more worshipful posterity has had a more incorrect physical picture than is generally the case with Mozart.” Can any painter truly capture genius in a portrait? The answer is self-evident.

Mozart by Barbara Kraft, The
posthumous oil of 1819 Gesellschaft
der Musikfreunde, Wien

There are about fourteen vetted and attested portraits of Mozart. Some of these derive from others, so there are actually about ten distinct visual representations of the composer. He had a strong nose and chin, fine blondish hair, a slight esotropia, bilateral exophthalmos, an anomalous external left pinna (but obviously a pristine inner ear, given his absolute pitch and eidetic memory). The Lange portrait (above) and the Kraft posthumous portrait (for which Kraft used the 1781 dalla Croce Mozart family portrait as a reference) were said by Mozart’s sister Maria Anna (Nannerl) and his wife Constanze Weber Mozart Nissen to be the best likenesses.

Descriptions by Mozart’s contemporaries are even more illuminating. Nannerl commented that “my brother was a rather pretty child,” but his looks were permanently disfigured by scars” after a bout of smallpox that both siblings sustained in 1767 (he, age 11; she, age 16). Nannerl went on to describe Mozart in her reminiscences in 1792, a year after his death, as being “small, thin, and pale in color and entirely lacking in any pretensions as to physiognomy and bodily appearance.”

Mozart is said to have suffered a temporary “blindness” as a result of the marked inflammation of his eyes (this could have been from a keratitis (a corneal inflammation) secondary to the Vaccinia virus of smallpox) and developed facial scars. Yet, in 1770, three years after that same smallpox epidemic, the composer Johann Adolph Hasse wrote that “the boy Mozart is handsome, vivacious, graceful, and full of good manners.”

Michael Kelly, the tenor whose vocal talent was much beloved by Mozart and who sang the roles of both Don Basilio and Don Curzio in the premiere of Le Nozze di Figaro (The Marriage of Figaro), famously reminisced in 1826 about Mozart: “He was a remarkably small man, very thin and pale, with a profusion of fine hair, of which he was rather vain. He always received me with kindness and hospitality. He was fond of punch, of which I have seen him take copious draughts. He was kind-hearted and always ready to oblige; but so very particular that when he played, if the slightest noise were made, he left off.”

Thomas Attwood, who was Mozart’s composition student between 1785 and 1787, recalled his teacher being “of cheerful habit, though lacking a strong constitution.” Attwood also remembered that “in consequence of being so much over the table when composing, he (Mozart) was obliged to have an upright desk and stand when he wrote.”

There is evidence that Mozart was small in stature. It has been estimated that he stood about 1.6 meters in height, or five feet, three inches. Mozart himself corroborated this when, as a fourteen-year-old in April 1770, he wrote from Rome to his sister in Salzburg about a visit to St. Peter’s Basilica, stating, “I had the honor of kissing St. Peter’s foot in the church, and having had the misfortune of being so small, I, that same old dunce Wolfgang Mozart, had to be lifted up.”

In 1777, at Mannheim, Mozart first met the Webers, the family of Caecilia and Fridolin, whose four musically talented daughters would figure greatly in his life. Although Mozart later married Constanze Weber, he initially fell in love with her elder sister, Aloysia, who spurned him. In her dotage in the 1830s, Aloysia was asked why she rejected so famous a man as Mozart, to which she replied, “I did not know, you see . . . I only thought . . . well . . . he was such a little man.” Mozart himself may have put it best when he stated, “Mozart magnus, corpore parvus” (“Mozart the great, small in size”).


What ailed Mozart? His health and illnesses

For someone possessed of such remarkable productivity, Mozart was often quite ill. To be sure, his health was in large part a consequence of his era, a function of the endemic diseases and epidemics to which he was inevitably exposed as a result of extensive travels undertaken in childhood. For example, in the fall 1765, while on the grand tour that included the Hague, first Nannerl then Mozart contracted typhoid fever, and both children almost died. He and Nannerl also contracted what has been clinically described as acute rheumatic fever.

There is a large body of literature regarding Mozart’s chronic diseases, much of it conjecture. The following is a partial summary of what Mozart may have contracted during his life, as deduced by a careful reading of the primary medical literature and commentary, in German, of his physicians’ observations, and by the writings of friends and observers: recurrent streptococcal infections, erythema nodosum (a nodular and painful skin disease related to a systemic inflammation), typhus, variola (smallpox), quinsy (tonsillar abscess), recurrent bouts of acute rheumatic fever, and renal (kidney) disease.

The putative recurrent streptococcal illnesses may have led to chronic endocarditis (heart disease) and chronic renal disease, specifically a post-streptococcal glomerulonephritis, which in turn could have led to renal failure. Mozart may also have had antimony over-dosage (he was self-medicating with it), a subdural or extradural hematoma (vide infra), and renal hypertension. There is also the possibility that he had acute trichinosis (Hirschmann Arch Int Med 161:1381-1389, 2001. Indeed, Mozart wrote to Constanze in October 1791 that he had eaten two pork cutlets, “con gusto!”). There is no evidence that Mozart ever took mercury, nor is there any clinical description by his physicians that he had ever contracted syphilis. Indeed, Mozart frequently documented his faithfulness to his wife Constanze and said he would never frequent prostitutes.

Peter G. Davies, M.D., the Melbourne gastroenterologist and Mozart biographer, has posited that Mozart suffered from the manic-depressive disorder cyclothymia (J. Roy. Sc. Med. 1991). The possibility of cyclothymia, quite common in many creative types, would potentially explain some of Mozart’s bursts of extraordinarily intense creativity, such as in the summer of 1788, when he wrote the last three symphonies, his greatest in the genre. These works were composed with no known commission and Mozart never heard them performed except in his imagination. On the other hand, such an explanation must be weighed against several periods of sustained productivity, such as the years 1784 to 1786, when Mozart created an extraordinary number of masterworks in every musical genre. Further complicating Davies’s claim is the more recent and close reading of the primary literature, in the original German, by Lucas Karhausen, who compellingly argues against cyclothymia or any mood disorder.

A distinction should be made between Mozart’s chronic illnesses and the proximate causes of his abrupt and early demise. Davies suggests that Mozart died of the consequences of a cerebral hemorrhage resulting from hypertension secondary to an acute nephritis, possibly from Henoch-Schönlein purpura, a rare disease which can result from streptococcal infection. Mozart was likely severely anemic and already in uremic coma. To compound matters, his physician, Dr. Thomas Franz Closset (one of the best in Vienna), bloodlet him of almost a liter of blood, which only served to worsen the anemia and hasten his death. Karhausen agrees with the possibility of an acute infectious illness but does not rule out acute rheumatic fever, which was also the consensus of the 2000 Delphi panel of physicians at the University of Maryland.

Mozart’s death certificate (there was no autopsy) stated “hitziges Frieselfieber” (“heated miliary fever”), a common clinical diagnosis of that era, but one which is far too non-specific a term on which to opine a diagnosis. It may relate to the inflammatory rash of rheumatic fever, which in turn may have been a result of Mozart’s presumed repeated streptococcal infections. Richard Zegers M.D. (Ann Int. Med. 2009) reviewed the records of 5,011 Viennese adults who died in the two months before and after December 1791, and compared that data to comparable months in 1790 and 1792, finding a much higher than normal rate of death from an epidemic of presumed streptococcal infection in 1791.

In early 1789, and again in 1790, Mozart fell, landing on his left temple, and, as a result, may have sustained a chronic subdural hematoma that also manifested itself as a fracture to his skull (M. Drake, Neurol 1993).

The putative Mozart calvarium in the Mozarteum, Salzburg

There exists a calvarium (a skull that lacks its mandible) in the possession of the Mozarteum in Salzburg, which was exhumed in 1801 by a man named Radschopf, the successor of the grave digger who buried Mozart on December 1791. The condition of the calvarium reflects a trauma like that of a repeated fall and fracture which may be that of Mozart.

However, a forensic examination in 2006, comparing DNA from the calvarial scrapings to the osseous remains of his relatives were inconclusive, largely because none of the DNA matched any of the others. This lack of concurrence may be a result of the gravesites having been disturbed many times over the preceding two hundred years.


Franz Joseph Haydn on Mozart and the author Karoline Pilcher on both

Franz Joseph Haydn recognized Mozart’s genius during his lifetime and before most anyone else. Haydn said as much to Mozart’s father, Leopold, at a February 12, 1785 string quartet party at which the last three of Mozart’s six string quartets dedicate to Haydn were performed. Haydn said: “I tell you before God, and as an honest man, that your son is the greatest composer known to me in person or by name. He has taste, but above all, he has the greatest knowledge of composition.”

After Mozart’s death, Haydn wrote to his friend Michael Puchberg in 1792 that “for some time I was quite beside myself over his death, and could not believe that Providence should so quickly have called away an irreplaceable man into the next world.” Haydn went on to write that “posterity will not see another talent as his in a hundred years.”

The author Karoline Pilcher was a contemporary of Mozart and Haydn and knew both of them personally. In the 1820s, in her reminiscences, Pilcher writes this about them (translated here from the German):

“Mozart and Haydn, whom I knew well, were men who displayed in their personal intercourse no other outstanding mental ability and almost no sort of intellectual cultivation of a learned or higher education. Everyday character, flat humor and with the first (Mozart) a scantly sensible lifestyle, was all they publicly manifested, and yet, what depths, what worlds of fantasy, harmony, melody and feeling, lay concealed within these modest exteriors! Through what inner revelation came to them this understanding, how they must have seized it, to bring forth such powerful effects, and express in tones, feelings, thoughts, passions, that every ear must feel with them, and be spoken to us as well as from greater depths.”


The Mozart effect

Almost as abundant as the varied speculation about Mozart’s health, illness, and death, is the literature on the neurological, cognitive, and psychophysiological effect of Mozart’s music on the listener. This discussion, originally grounded in rigorous scientific study, has formed the basis of later and popular claims revolving around the so-called “Mozart effect.”

The French otolaryngologist Alfred Tomatis coined the term “Mozart effect” in a 1991 book entitled Pourqoui Mozart? about the concept of auditory processing integration. While examining opera singers who were having trouble reaching and singing certain notes in tune, he discovered that those singers all had a coincident hearing defect in the same frequency as the vocal problem.

This relationship between audition (hearing) and phonation (voicing) was first posited by Tomatis, who stated that “the voice can only reproduce what the ear can hear.” He subsequently focused his audiological research using Mozart’s violin concertos, as well as Gregorian plainchant, at different hearing frequencies, to improve auditory processing. To “retrain the ear,” if you will, of patients who had acquired sensori-neural hearing loss. Among those who gained improvement not only in their hearing as well as in their “voicing” by this technique were the actor Gerard Depardieu, the baritone Benjamin Luxon, and the popular singer Sting (Gordon Sumner).

In 1993, Frances Rauscher, Gordon Shaw, and Katherine Ky,  researchers in the department of neurobiology at the University of California, Irvine, further investigated a “Mozart effect” in an experiment which was published in the October 14, 1993 issue of the scholarly scientific journal Nature under the title Music and Spatial Task Performance.”

Rauscher’s team found that a group of students who were “pre-treated” for ten minutes by listening to the first movement and part of the second movement of Mozart’s two-piano sonata in D major, K. 448, performed better on a spatial-task reasoning Stanford-Binet test than when the same students were pre-treated with a “relaxation tape” or after they had sat in silence for ten minutes prior to testing. (Stanford-Binet testing is a form of IQ test, which measures aspects of verbal and non-verbal reasoning.) In the Rauscher study, the students were given a paper folding and cutting test: a piece of paper is folded several times and then cut. The students had to mentally “unfold” the paper and choose the correct shape from the numerous examples that they were given. These results were temporary, lasting only through the time taken for the experiment (about fifteen minutes) and were specifically related to visual-spatial task reasoning, and not to other measures of intellect. More recent research has both confirmed and contradicted the results of the Rauscher study, among them “Arousal, Mood, and the Mozart Effect,” Psychological Science (2001); “Re-examination of the Effect of Mozart’s Music on Spatial Task Performance,” Journal of Psychology (1997); “‘Brain-Based’ Learning: More Fiction than Fact,” American Educator (2006); and “Prelude or Requiem for the Mozart Effect,” Nature (1996). The music educator Don Campbell was influenced by Tomatis’s work and the results of the Rauscher study and went on to write the best-selling 1997 book The Mozart Effect: Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit. Campbell’s claims went far beyond spatial intelligence improvement to include notions that Mozart’s music improved mental health and cognitive ability. Over the decades, the “Mozart effect,” as put forth in Tomatis’s original work and subsequent misinterpretations of the Rauscher study, has devolved into an assertion that early childhood exposure to classical music (specifically, Mozart’s music) can ipso facto bestow a beneficial effect on mental development, leading to advantages and a range of lifetime achievement.

However, there a kernel of scientific fact in the studies. There is a feature intrinsic to the music of Mozart (and several other composers) that modifies or enhances brain function (J. Jenkins, Royal Society of Medicine, 2001). Neurologists John Hughes and John Fino subjected to computer analysis eighty-one works by Mozart, sixty-seven of Johann Sebastian Bach, sixty-seven of Johann Christian Bach, and 150 works by fifty-five other composers. These researchers at the University of Illinois found that the music of Mozart as well as that of J. S. and J. C. Bach, but not the music of the other composers, contained a high degree of long-term periodicity. They hypothesized that these specific harmonic patterns and chordal repetitions, found especially in the music of Mozart and J. S. and J. C. Bach (the latter was an influence on the young Mozart) have a function in brain coding: they act to align or “symmetrize” neurons in certain regions of the brain involved with auditory processing and memory (specifically the parietooccipital cortex and right prefrontal cortex) and which can lead to heightened mental capacity and function, even if only temporarily. There is thus neurophysiological evidence for a “Mozart effect” (as well as a “J. C. Bach effect” and a “J. S. Bach effect”). There are fundamental and physiological aspects that underlie the “Mozart effect” and to the music of Mozart in general—the pleasure, felicity, and depth of emotion of his music can provoke and stimulate a heightened intellectual, even spiritual, awareness and rapture. Perhaps the timeless remark that has been ascribed to the Nobel-prize winning physicist Albert Einstein, himself a genius, resounds most compellingly: “Mozart’s music is of such beauty and purity that one feels that he merely found it, that it has always existed as part of the inner beauty of the universe waiting to be revealed.”



  1. Campbell, D. The Mozart Effect: Tapping the Power of Music, 1997.
  2. Davies, P. Mozart in Person: His Character and Health. New York: Praeger, 1989.
  3. Drake, M. “Mozart’s chronic subdural hematoma.” Neurology 1993; 43: 2400-2403.
  4. Fino, J. and J. Hughes. “The Mozart effect: distinctive aspects of the music–a clue to coding?” Clin Electroenceloph 2000; 2, 94-103.
  5. Jenkins, J. “Mozart–portrait and myth.” J Roy Soc Med2006; 99, 288-291.
  6. Karhausen, Lucas. The Bleeding of Mozart. London: Xlibris Pub, 2011.
  7. Eisen, C. and S. Keefe. The Cambridge Mozart Encyclopedia, Cambridge Univiversity Press, 1997.
  8. Rauscher, F., G. Shaw and K. Key. “Music and spatial task performance.” Nature 1993; 365:611.
  9. Spaethling, R. Mozart’s Letters, Mozart’s Life. New York: W. W. Norton, 2005.
  10. Stafford, W. The Mozart Myths: A Critical Reassessment. Stanford: Stanford University Press, 1993.
  11. Tomatis, A. Pourquois Mozart. Paris: Diffusion, Hatchette, 1991.
  12. Zegers, R. “The death of Wolfgang Amadeus Mozart: an epidemiologic perspective.” Ann Int Med 2009; 151: 274-278.



VINCENT P. DE LUISE, MD, FACS, is an assistant clinical professor of ophthalmology at Yale University School of Medicine, and adjunct clinical assistant professor of ophthalmology at Weill Cornell Medical College, where he also serves on the Music and Medicine Initiative Advisory Board. A clarinetist, he was the director of the Connecticut Mozart Festival in the bicentenary year of the composer’s death, is president of the Connecticut Summer Opera Foundation, and writes frequently about music and the arts.


Fall 2015  |  Sections  |  Music Box

One response

  1. Thanks for that interesting contribution! About “Mozart-Effect” I’ve never heard before. To me it seems, that in America the interest in Mozart actually is much more than in Europa.
    Greetings from Kübelstein, Upperfrankonia, Bavaria, Germany.

    Rudolf kuhnlein
    founder and manager of The “Fränkisches Kammerorchester”

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