MOZART'S SUMMER OF MAGICAL THINKING

Vincent P. de Luise M.D.

W.A. Mozart (1756-1791)
The portrait in oil by his brother-in-law Joseph Lange

Wolfgang Amade' Mozart was one of the greatest symphonists in history. Over the course of thirty years of composing, he crafted over 54 symphonies and sinfonias; about forty-one are the canonical compositions, with the last three among the finest ever written.(1)

Mozart composed his 38th symphony, the D Major K.V. 504 ("Prague") in December 1786 and it premiered in that great city on January 19, 1787.  A year and a half would pass before Mozart returned to the symphonic genre. 
Then, seemingly without a specific reason, over the course of six weeks in that magical summer of 1788, Mozart composed not just one, but three magisterial symphonies, his last and greatest in the genre. 
June 26, 1788; 25 July, 1788; 10 August 1788. These are the dates of completion of the three last symphonies. 

For what purpose were they written? For what commission or special event? Why did Mozart decide to write three large-scale and intricate works, masterpieces which stood on the shoulders of Haydn's creations, compositions that opened the door to a new world for the symphonic form?

Mozart rarely wrote music without a specific purpose, just "for the heck of it." The quaint trope of the starving artist living in a garret and composing out of "divine" inspiration is a romantic and Byronic conceit, a false narrative to be sure, yet one that, curiously, is still held onto by some Mozart admirers. 

That myth was not Mozart's reality. Mozart was not a starving artist, certainly not by 1788. He was earning the modern equivalent of at least $ U.S. 100,000 in each of the last three years of his life, compensation that put him in the upper middle class of Viennese society. (2) 
Mozart's creative output did ebb and flow in 1787 and 1788, but by then he had secured financial security with his three operatic Da Ponte collaborations (Le Nozze di Figaro, Don Giovanni and Cosi' fan tutte), piano concerti, had given several Akademies (subscription concerts where he kept the profits), and had a number of talented and wealthy keyboard pupils under his wing (among whom were Barbara Ployer, Josepha von Auernhammer, Thomas Attwood, Johann Nepomuk Hummel, and Prince Karl Lichnowsky, the last of whom would become his patron and then, curiously, a legal adversary in an unpaid debt). Mozart was beginning to see the financial light at the end of the tunnel.(2)

To Mozart scholar and Cornell Professor Neal Zaslaw, Mozart was a "working stiff." He had a spouse and two young children, a large apartment, expensive clothes, a valet and a coach, and a desire to live as an equal to the aristocrats who patronized his concerts, so he needed to work. 
Mozart was one of history's first "freelance" artists. He was not fully employed church nor did he have  a munificent aristocratic patron, as had Handel and Haydn.  To earn an income, Mozart was largely on his own.(3)

That leads us to ask about Mozart’s last three symphonies. There is no record that the symphonies known today as the 39th (Eb major K.V. 543), 40th (g minor K.V. 550) and 41st (C major K.V. 551, nicknamed "Jupiter" by Haydn's employer Johann Peter Salomon in London in the 1790s) were commissioned. 

There is no record of any purpose for which they were composed, and there is scant evidence that they were ever performed during Mozart's lifetime. 

Some musicologists believe that Mozart wrote the symphonies as a whole, for publication purposes, but again, with no proof of performance.

An intriguing statement in one of Mozart's letters implies that he had intended to perform these symphonies at a new casino in Vienna's Spiegelgasse (owned by his friend Philip Otto), and a letter to another colleague, a comment about tickets for a series of concerts at that venue, supports the notion of a planned performance.(4)

In a July 10, 1802 letter by the musician Johann Wenzel to the Leipzig publisher Ambrosius Kuhnel, Wenzel refers to a performance of the g minor symphony (what we no call the 40th) at the home of Baron Gottfried van Swieten, but it was so poorly performed that Mozart had to leave the room! (4)  

Concert programs exist from performances in Dresden, Leipzig, Frankfurt and Vienna in 1789 and 1790 that refer to Mozart symphonies, however without date or key signature. 

An announcement for the 15 October 1790 Frankfurt concert, at which Mozart conducted eine grosse Simphonie (a great Symphony).
The specific symphony remains unknown.

Mozart made a revision of the g minor (40th) symphony a few months after he composed it, to include clarinets and to give new parts for the flutes. Could this revision have been for a performance in a different location in Vienna or elsewhere in Europe? Ever the pragmatist, it is unlikely that Mozart would have rescored the symphony if he had not intended to perform it in a different venue. 

A poster survives announcing that on April 17, 1791, the Tonkunstler Societat presented a program in the Burgtheater of Vienna, conducted by Antonio Salieri. The concert included two works by Mozart: an aria sung by his sister-in-law Aloysia Weber Lange, and a "Grand Symphony." The specific Mozart symphony which Salieri conducted is not mentioned in research by Colin Lawson. (6)  Julian Rushton suggests that the Symphony performed may have been the revised version of the g minor (KV 550) with the inclusion of parts for the clarinets.(7)

But that's it. 

There are no ticket receipts, no written recollections by concert-goers, no reviews in the Viennese newspapers or journals of new compositions by local composers, and no mention of a performance of any of the last three symphonies in any correspondence by Mozart to his friends, nor to his spouse, Constanze, or his sister, Maria Anna (Nannerl). 

Which is all very odd. 

Over 800 letters exist from Mozart to and from his family, colleagues and friends, one of the largest troves of correspondence by any composer. In these letters, Mozart mentions in detail not only his musical triumphs but also quotidian events in his life, such as purchasing a pet starling, or eating pork cutlets "con gusto," on October 6, 1791, eight weeks before he died. Given this extraordinarily detailed chronicle of his life, it is unlikely that Mozart would not have made a reference to one of these symphonies.

Yet nothing. 

Haydn, in his 98th symphony of 1792, seems to have channeled motifs that are found in Mozart's 41st symphony (Jupiter). Could Haydn have heard a performance of Mozart's 41st symphony sometime between 1788 and 1792? 

We do not know.

The late conductor Nikolaus Harnoncourt has offered the possibility that Mozart crafted his last three symphonies as an integral whole, as a final statement on the symphonic genre.

Harnoncourt opined that Mozart composed them without commission, as an “Instrumental Oratorium." Harnoncourt considers the first movement of the 39th symphony the "Prelude" and the last movement of the 41st symphony, the "Finale." He argues that the 39th has no ending, the 40th begins "in the middle of things" and the 41st climaxes with a magisterial fugal coda that is the apotheosis not only of Classical Style but of 18th century music writ large.

This link is to a traversal of Mozart's last three symphonies in seamless continuity, as performed by the Karangala Symphony Orchestra under Peter Gribanov:

                 https://www.youtube.com/watch?v=JtNbSvXbZA8

What is evident is the quality of these three last Mozart symphonies, their assuredness and complexity, their modulation and chromatics, their "knocking on the door" of Romanticism seventeen years before Beethoven would break open that door in 1805 with his Eroica Symphony. 

As regards the 41st symphony, there are melodic antecedents. The last movement's motif is found not only in Mozart's own first symphony (Eb major, KV 16 of 1764), his Missa Brevis in F (KV 192 of 1774), and his 33rd symphony (KV 319 of 1779), it can be heard as far back as the Missa Pangue Lingua of 1515 of Josquin de Prez. 

Mozart had seen the autograph of the Symphony no. 27 in C major by his friend, Michael Haydn, which was written four years earlier than Mozart's Jupiter, and which has the same motif in the finale. In those days, before copyright laws, imitating another composer's melodies was not only not considered plagiarism, it was viewed as a compliment.

The finale of Mozart's Jupiter is an astonishing burst of creativity: the coda is comprised of five separate and intertwined fugal motifs. Johann Sebastian Bach would have been proud:

The fugal coda of Mozart's Symphony no. 41 in C major, 
KV 551 "Jupiter," with its five separate, intertwined motifs.

With his last three symphonies, whether or not they were composed as one integral whole, Mozart has left posterity several of the greatest compositions in the western Canon. 

© 2023 Vincent P. de Luise M.D. 


References"

1. Zaslaw, Neal. Mozart's Symphonies: Context, Performance Practice, Reception. Oxford: Oxford University Press. 1989. 

2. Baumol, William and Baumol, Hilda. On the economics of musical composition in Mozart's Vienna, in, On Mozart,  James Morris, ed. Woodrow Wilson center and Cambridge University Press, 1994.

3. Zaslaw, Neal, Mozart as a working stiff.  On Mozart. James Morris ed., Woodrow Wilson Center and Cambridge University Press, 1994 

4. Milada Jonasova: Eine Auffuhrung der g-moll-Sinfonie KV 550 bei Baron van Swieten im Beisein Mozarts", in: Mozart Studien 20, Tutzing 2011, pp. 253-268. An abridged English translation was published in the Newsletter of the Mozart Society of America 16:1 (2012)

5.Mozart's Symphonies 39,40,41 as an Instrumental Oratorium

Nikolaus Harnoncourt, Concentus Music Wien

https://www.amazon.com/Mozart-Symphonies-Nos-39-40/dp/B00IROIE1I

6. Lawson, C. Mozart: Clarinet Concerto, Cambridge: Cambridge University Press, 1996, pg. 27.

7. Rushton, J.  Mozart, Oxford: Oxford University Press, 2009, pg. 210.

BRAHMS and BEETHOVEN in NEW YORK CITY

I was given the privilege and honor again of writing the program notes for tonight's (March 4, 2017) performance by the Weill Cornell Medical College Music and Medicine Orchestra performance of the Brahms violin concerto and Beethoven's fifth symphony at the Peter Jay Sharp Theater at Juilliard, in New York City. Music performed at this level of excellence and sheer musicality gives me great hope for the future of humanity.

Notes on the Program

Vincent P. de Luise M.D. ‘77

Assistant Clinical Professor, Ophthalmology, Yale University                            
Adjunct Assistant Professor, Weill Cornell Medical College

Two masterworks comprise tonight’s program, “warhorses” of the classical music repertoire. How fitting that we will hear Brahms’ violin concerto along with Beethoven’s fifth symphony, as Brahms was proclaimed, by Robert Schumann and subsequently an adoring Viennese public, the successor to Beethoven’s legacy.

Concerto for Violin and Orchestra in D, Op. 77

Johannes Brahms (May 7, 1833 – April 3, 1897)

I. Allegro non troppo II. Adagio III. Allegro giocoso, ma non troppo vivace - Poco piu’ presto

Scored for solo violin, pairs of flutes, oboes, clarinets, bassoons, trumpets, four horns, timpani and strings

It is a commonplace today for music to be a collaborative endeavor. Composers work with lyricists and producers to create songs and smash-hit musicals. Though these relationships were less frequent in the 19th century, Johannes Brahms in particular relied on his virtuosi musical friends, in his violin, cello, and clarinet masterpieces, who served as inspirational muses and editors. 

The Hungarian violinist Joseph Joachim (1831-1907) was one such advisor. When the two first met in 1853, Joachim, though only two years older, was already widely known as a brilliant musician and composer. Brahms, a newcomer to the musical scene, often sought out the violinist's opinion regarding his compositions. It was Joachim who introduced Brahms to Robert and Clara Schumann, in Dusseldorf in 1853; the rest is history, with Robert anointing Brahms as “the next big thing,” and Brahms and Clara remaining intimate musical and personal friends throughout their lives. 

Johannes Brahms at 52,  in 1885

The violin concerto could not have had a more sublime environ for its genesis. Brahms began composing it during a relatively happy period in his life, the summer of 1878, in the Austrian village of Portschach. He had heard so many melodies walking the streets of the town that he once quipped, “one had to be careful not to step on them!” However, Brahms was a pianist, and needed the advice of Joachim the violinist to craft the concerto, writing to him, "You should correct it, not sparing the quality of the composition.... I shall be satisfied if you mark those parts that are difficult, awkward, or impossible to play." In fact, many of its arpeggios were considered “unviolinistic,” which is to say, more pianistic than for a violinist’s technique. 

Joachim contributed greatly to the concerto, scrutinizing every note, offering ideas, revising whole sections with multiple mail exchanges, ensuring that the work was “playable and idiomatic.”

The concerto was premiered at the Gewandhaus in Leipzig (which had earlier been Mendelssohn’s home base) on January 1st 1879, with Joachim as soloist and Brahms himself conducting. Perhaps to cement the relationship between two of von Bulow’s iconic “Three B’s of Music,” (the other "B" being Johann Sebastian Bach), the concert opened with the Beethoven concerto and closed with the Brahms.

Joachim famously stated that, "the Germans have four concertos: the greatest, most uncompromising is Beethoven's; Brahms' concerto vies with it in seriousness; the richest, the most seductive was written by Bruch; but the heart's jewel is that by Mendelssohn."  Indeed, Brahms’ concerto melds the nobility and gravitas of Beethoven’s with the lyricism of the Mendelssohn, along with Hungarian folk melodies which had informed Brahms in his halcyon days touring Europe with the violinist Edward Remenyi. Thankfully, Brahms and Joachim were on good terms throughout the composition of the concerto. They later had a falling out over Joachim’s relationship with his (Joachim’s) spouse, but Brahms ultimately patched things up in 1887, writing the double concerto for violin and cello, Op 102.

Brahms’ concerto, like Beethoven’s, is in the violin-friendly key of D major. They also share a top-heavy first movement and, unusually, a timpani accompaniment to the violin’s first entry. The work presents formidable technical challenges for any violinist: wide interval jumps, broken chords, double and triple stops, even quadruple stops, mandating that the violinist play multiple notes simultaneously and rapidly. Though conductor Joseph Hellmesberger (who led the Vienna premiere before a rapturous Viennese audience) acidly described it as not a concerto for, but rather, as “against the violin,” and Wieniawski stated it was “unplayable,” the inherent beauty, elegance and compositional mastery that the concerto displays belie these grumblings.

The musicologist Bernard Jacobsen reminds us that a concerto is, at its essence, a human drama, with contrasting forces from soloist and orchestra. In classical idiom, it uses the musical device of the Baroque ritornello (literally, “a little return”), “.... the orchestra presents the basic material and then the solo instrument comes in and establishes its primacy by varying the orchestral ideas, introducing new ones of its own, and extending the music’s tonal range.” The first movement is heralded by the orchestra’s tonic and dominant chords, combining classical formalism with the richness and warmth that is idiomatic of Brahmsian style. The violin enters with breathtaking virtuosity, stakes its claim, and the forces collide. Of the many cadenzas that have been composed for the first movement (Auer, Busoni, Kreisler, Heifetz, inter alias), the original and most famous one, written by Joachim himself, will be heard this evening. The Adagio, in F major and ternary (ABA) form, begins with one of classical music’s most ravishing melodies: a solo oboe on high, floating a sublime melody, an achingly beautiful theme gently supported by a lovely woodwind choir, which is then taken up and developed by the violin. An unsettled mid-section ebbs and returns to the pastoral theme. The third movement is a sprightly rondo highlighted by “ungarisch” gypsy motifs, ending with a dynamic coda.

Symphony No. 5 in c minor, Op 67

Ludwig van Beethoven (December 17, 1770 – March 26, 1827)

I. Allegro con brio II. Andante con moto III. Scherzo: Allegro IV. Allegro

Scored for pairs of flutes, oboes, clarinets and bassoons, piccolo, contrabassoon, two trumpets, three trombones, four horns, timpani, and strings

Can you imagine being seated in Vienna’s majestic Theater an der Wien on the evening of December 22, 1808, one of the first ever to hear those eight earth-shattering notes:

What did that motif sound like to early nineteenth century ears? Two groups of four notes, each three short and one long, a descending fourth in cut time (2/4), with the half notes held, unmeasured. It certainly wasn’t a melody, but rather some type of pronouncement. An outcry. What an extraordinary experience it must have been! 

The lengthy and under-rehearsed concert was an Akademie subscription event for Beethoven’s own benefit, and he himself conducted it. It was to be the most remarkable night of his life. The concert lasted almost four hours, and included five premieres. Two symphonies were on the program: the Sixth (“Pastoral”) began the concert, and the Fifth was performed in the second half, along with a large swath of the C major Mass. The concert aria, “Ah ! Perfido,” and the fourth piano concerto (with Beethoven himself as soloist) also had their maiden voyages that evening. The marathon concluded with the sublime Choral Fantasia (a “brilliant finale” Beethoven called it), a fascinating work for piano, chorus and orchestra that prefigured the last movement of Beethoven’s magisterial ninth symphony. Some grumbled about the length of the concert and the freezing cold in the unheated hall, yet virtually no one left early.

Beethoven at 45, in 1815

Extant sketches confirm that Beethoven began working on the fifth symphony as early as 1802, diving deeply into it by 1804, yet frequently interrupting its creation as he switched gears to compose the fourth piano concerto and the Pastoral symphony, and to deal with personal anguish and ailments. He had written his courageous Heiligenstadt Testament to his brothers Carl and Johann, (a letter, like his letters to die unsterbliche Geliebte, “the Immortal Beloved,” that he never sent), in which he admitted, in heartbreaking detail, that he was slowly going deaf. 

In the summer of 1808 he was nursing a nasty finger infection, affecting his piano playing, while the world around him was equally challenging, with Europe enmeshed in the Napoleonic Wars and Vienna in political turmoil. The symphony was commissioned by Count Franz von Oppersdorff, but Beethoven dedicated it to two other aristocrats: Prince Franz Joseph Maximilian von Lobkowitz and Count Andreas Kirillovich Razumovsky.

Debussy famously wrote that “music is the silence between the notes,” a fitting comment with respect to Beethoven’s Fifth, which boldly begins not with sound, but with silence: an eighth note rest ! Silence creates musical tension. That tension leads to expectations that trigger the brain’s neural network emotional response, those musical frissons (“chills down the spine”) that music gives to the listener, catalyzing receptors in the midbrain and forebrain pleasure centers. If we are to believe Beethoven’s amanuensis Anton Schindler (who was prone to hyperbole in re his master’s works), Beethoven himself provided the key to the motif, expressing its essential idea as, "Thus Fate knocks at the door!”

The structure of the first movement is a Manichean struggle between darkness and light, chaos and form, represented in music by the dialectic between minor (c minor) and major (Eb major). Given composition theory within the common-practice era, the keys are related: the symphony’s tonic of c minor (3 flats) is the relative minor of Eb major (also 3 flats). Dynamics, contrasting tempos and harmonies contribute scaffolding and shading. The opening motif is heard repeatedly, incessantly, at times overlapping, modulated to Eb major (the relative major), reprised in ascending and descending forms, even as it also serves as a rhythmic foundation for the other three movements.

The second movement is as soft as the first movement is stormy. In ABAC form, it begins with a syncopated theme from low strings in Ab major (four flats). Woodwinds introduce the second motif, followed by a third theme from violas and cellos. The movement ends with a unison fortissimo, which Donald Francis Tovey likened to “smiling through tears in the minor mode.” 

The third movement is in ternary form: a scherzo and trio. Its brooding, drum-thumping ending proceeds directly into the magisterial fourth movement without a pause, a revolutionary technique for its time. The triumphant finale (with trombones!, another first!) explodes not with the traditional return to the tonic of c minor that began the symphony, but rather in the sunlight of C major. Beethoven, as one might imagine, defended his choice, stating that “Many people say that every minor piece must end in the minor. I disagree! .... Joy must follow sorrow, just as sunshine from rain.”

The first movement’s “dah-dah dah-DAH” rhythm came to represent the letter “V” in Morse code, explaining why the Allies in World War II nicknamed the Fifth, the “Victory” Symphony. As one of the most groundbreaking and transformative compositions in the western canon, it comes as no surprise that the Fifth Symphony is now hurtling forward into interstellar space. Its first movement is one of several compositions embedded into a gold-plated copper disc Golden Record containing music, images, and languages of Earth, sent into space in 1977 with each of the two unmanned Voyager probes; music that is, literally, out of this world ! 

Ars longa!

AN UNLIKELY MUSE

AN UNLIKELY MUSE
Morse Recital Hall, Yale University
Tuesday, February 28, 2017
Vincent P. de Luise, M.D.

The extraordinary story of Johannes Brahms, the clarinetist Richard Muhlfeld and the autumnal beauty that are the Brahms Op 114 Trio, the ineffable quintet Op 115 and the valedictory Op 120 sonatas, were elegantly brought to life this evening in Harry Clarke's wonderfully crafted paean to Brahms and Muhlfeld, "An Unlikely Muse," in Morse Recital Hall at Yale University.

Johannes Brahms in 1885, at 52 years of age

The stellar musicians who performed were clarinetist, David Shifrin, pianist Melvin Chen, the violinist Ani Kafavian, the violist Ettore Causa, Julie Eskar (Danish chamber Symphony) second violin, Ole Akahoshi cello, and the stentorian oratory of narrator, Broadway and TV star, Jack Gilpin, it was an evening of clarinet heaven, for the fortunate 500 in attendance at Morse Recital Hall at Yale.

Excerpts from virtually all the mountaintops for the clarinet (the Brahms trio, quintet and sonatas, the Schumann Fantasiestucke, the first Weber Concerto, Schubert's Der Hirt auf dem Felsen and the adagio from the Mozart Concerto) were interwoven within the narrative of how Brahms first met Muhlfeld and how that inspired him to compose again. 
All was magisterially scaled by Shifrin, whose full and centered tone were a result of both his supreme talent and the cocobolo clarinets he played. These clarinets are crafted by Morrie Backun, the Vancouver Instrument maker who is revolutionizing the sound quality and intonation of our instrument.

I have studied, still study, and have performed these clarinet masterpieces, practicing parts of them every day. I know them like the back of my hand (I guess that makes sense because parts of them are now "muscle memory" ). 

Yet,  when chamber music is played by artists of this caliber and talent who share the joy and the intense focus required of Kammermusik at the highest level, the results are blissful . 

Those moments of rapture became manifest not only when Shifrin played, but also when Chen took us to another sound world with excerpts from the intimate Brahms Intermezzi from Op 117, 118 and 119.
And how perfect they were! 

The intermezzi were written chronologically in between the trio, quintet and the two sonatas; they were to be Brahms' valedictory to the piano as well. Brahms dedicated the particularly tender Op. 118 intermezzi to his lifelong love, Clara Schumann, They, like the clarinet works, are emblematic of late Brahms: melody triumphs over dense chromaticism, even with typical Brahms rhythmic instability (stressing the second and third beats of a measure and nit the downbeat), there is always a crystalline clarity and a measured tempo overarching each moment, the music being a distillation of his life, his modernism and at once his faithfulness to a musical vernacular that Mozart and Beethoven would have understood. Not one note is unnecessary. Brahms tells his stories in music with an economy and concision in which what he does not say is as meaningful as what he conveys.

Brahms wrote all this beauty toward the end of his life, coming out of retirement to compose these swansongs, and all because of the rare and sublime Sound World crafted on the clarinet by his inspirational muse, Richard Muhlfeld.

Muhlfeld and Brahms in 1891

https://www.youtube.com/watch?v=gtN1scGYJKA

ART IS A FRACTAL - KNOWLEDGE IS FRACTAL

Art is a Fractal. Knowledge is Fractal.

In the months I have been posting, learning and teaching on Le Connoisseur, it has become evident to me that Art is a Fractal. 
Beauty derives from beauty, Beauty has beauty as its antecedent, and Beauty begets beauty. 
Knowledge is fractal in the sense that it is infinite, ever-exploding into new vistas and horizons, with answers that beget further questions, questions that don't have answers, only more questions.

DANCING TO THE ART WORK

Motor Responses in Viewing Art

We listen to music, and very often,without realizing it, the next thing we know, we are tapping our feet, clapping our hands, and swaying rhythmically to the melody and beat. 

We are dancing to the music!

Why does that happen? How does music do that? What is it about music that not only activates our midbrain and forebrain pleasure center (which I discussed in the last blog post), which are also sensory neural networks, but also our motor cortex?

Can art, the act of simply gazing at and meditating upon a painting, also cause such activity?

It turns out that the answer is yes.

My friend, Suzanne Nalbantian, Professor of comp lit at LIU, edited an extraordinary and important book called The Memory Process: Neuroscientific and Humanistic Perspectives(MIT Press, Cambridge, Mass 2010).

Rogier van der Weyden
The Descent from the Cross
(Prado, Madrid   c.1435)

The first chapter is by Professor David Freedberg, now head of the Warburg Institute in London, and at the time the Pierre Matisse Professor of Art at Columbia University. In the chapter, Freedberg opines about the neural responses to art, including empathy, compassion, and motor cortical responses.

Using Rogier's compelling manifesto, The Descent from the Cross (Prado Madrin, c. 1435, shown above) as a point of departure, Freedberg discusses, inter alia, empathy, compassion, and Rizzolati concept of "mirror neurons" as ways by which we humans use not only our receptive cortices - the occipital cortex (V1) and the temporal cortex, to receive information from our sensory system, but also (with the mirror neuron system), our motor cortices. The MIT Press blurb for the book, The Memory Process, reminds us that: 

" The traditional divide between the sciences and the humanities has long been seen in terms of the tension between naturalist and materialist views, on the one hand, and sensitivity to contextual and social constraints, on the other. But this conventional dichotomy collapses in the face of the evidence for the neural bases of empathetic engagement with works of art..... Prefrontal modulation of lower-level cerebral responses offers more flexible and inventive ways of thinking about the relationship between automaticity and experience. Recent research on memory confounds the separation of history and experience from the corporeal and psychological entailments of beholding a visual image, and a work of art in particular. The subject of embodied responses—much discussed in recent years by humanist scholars—now stands at the intersection of several fields within the cognitive neurosciences."

We all know that Music tends to get us moving.

So does viewing Art.

PLEASURE AND REWARD: WANTING, LIKING, AND HEDONIC HOTSPOTS

Vincent P. de Luise MD

What is pleasure?   

Pleasure can mean different things to each of us. Eating ice cream, love-making, meditating, sailing, having a religious experience, or simply lying on a beach, can all engender feelings of pleasure. The ancient Greeks talked of happiness as being a combination of two concepts: hedonia (pleasure) and eudaimonia ("well-being" or "human flourishing" by doing "good work" for others). 

Certain pleasures have been studied neurologically, using a non-invasive brain scan called functional magnetic resonance imaging, or fMRI. An fMRI scan tracks changes in blood flow (hemoglobin) to various brain regions as a result of a specific stimulus. The more hemoglobin (therefore, the more oxygen) to a specific brain site, the more activity. 

A significant body of scientific research has been published evaluating brain responses to four specific pleasurable stimuli: eating dark chocolate, listening to music that causes "frissons" (those thrilling “goosebumps” and “chills up or down the spine”  that one gets to particularly pleasurable music), sexual climax,  and,  for those who unfortunately have a need for them, taking addictive drugs, i.e., drugs like cocaine and heroin, which stimulate the brain’s so-called mu-opioid and cannabinoid systems. All four of these distinct, pleasure-inducing stimuli (chocolate, music, orgasm, addictive drugs) activate the same brain areas, anatomically adjacent to each other in a region called the medial forebrain (MFB). These areas are: 1) the ventral tegmental area (VTA) ( specifically a little blob of neurons in the VTA called the nucleus accumbens); 2) the prefrontal cortex; 3) the anterior cingulate cortex (especially its subgenual area, above the nucelus accumbens (not shown)); and 4)  the amygdala. 

Axial section of brain. From Hartley.com

These four brain areas are part of what cognitive neuroscientists term the Reward/Pleasure system. What we feel as desire and pleasure occurs in this system, also referred to as the Wanting/Liking system.

Four brain areas are part of what cognitive neuroscientists describe as the Reward/ Pleasure System. What we feel as desire and pleasure occurs in this system, which is also referred to as the Wanting/Liking system. This system tells the memory centers in the brain to pay attention to everything associated with that experience, so it can be repeated in the future. 

The Reward/Pleasure system is activated and controlled at the molecular level by chemicals, called neurotransmitters, specifically dopamine, serotonin and oxytocin. Evolutionarily, the Reward/Pleasure system is ancient; dopamine neurons that interconnect behavioral responses to natural rewards have been observed in various species of worms and flies, whose ancestors were around five hundred million years ago.

Pleasure, Reward and the "Happiness Trifecta"

Three neurotransmitters: dopamine, serotonin and oxytocin, mediate every pleasurable moment, including the “giving experience,” so much so that Eva Ritvo M.D., vice-chair of psychiatry at the University of Miami School of Medicine, has termed them the “Happiness Trifecta.” Dr. Ritvo asserts that "giving is a powerful pathway for creating more personal joy and improving health. Any activity that increased the production of these neurotransmitters will cause a boost in mood and cause happiness." Dopamine is connected to motivation, reward and arousal. Serotonin is connected  to memory, learning, sleep and appetite. Oxytocin, nicknamed "the cuddle hormone," has a powerful effect on the brain and the body. "When oxytocin begins to flow, blood pressure decreases, bonding increases, social fears are reduced, and trust and empathy are enhanced” Dr. Ritvo explains. 

Giving to others triggers a release of oxytocin, which boosts mood and counteracts the stress hormone, cortisol. The higher the level of oxytocin, the more one wants to help others, Interestingly, when oxytocin is boosted, so are dopamine and serotonin. According to Dr. Ritvo, "even small repeated boosts of the Happiness Trifecta will produce a benefit. Donating money or time... are wonderful waus to give. When we step outside of ourselves long enough to help someone else, something wonderful is waiting for us in return: the Happiness Trifecta neurochemicals are all boosted." 

Nerve-nerve cables, called neural networks, interconnect the pleasure centers. These neural networks work electrically, as well as chemically through the neurotransmitters.  When we experience pleasure, we are, in essence, getting a reward.  Pleasure has a lot to do with what cognitive neuroscientists call the Wanting-Liking system in the brain, which is part of the Reward-Pleasure circuit.

Hedonic Hotspots, Enkephalins, Anandamides 

However, things are actually a little more complicated than the Happiness Trifecta of dopamine, serotonin and oxytocin. University of Michigan researchers Morton Kringelbach, Terry Robinson and Kent Berridge have discovered that there are neurochemical differences in our brains between “wanting” something and “liking” it.

The “Wanting” or "Desire" part of the system is largely mediated by dopamine, the same neurotransmitter that is involved in drug addiction with cocaine and heroin. Dopamine, according to Berridge, contributes more to motivation ("Wanting") than to the actual sensation of pleasure ("Liking") itself. 

The "Liking" (or "Pleasure") system in the brain is mediated by neurotransmitters called enkephalins and anandamides. There are specific area in the brain which have dense populations of these neurotransmitters. These areas serve as waystations for "Liking." Berridge calls these loci "hedonic hotspots" ("hedonic" means "pleasant (recall the ancient Greek concept of hedonia and our present-day notions of hedonism).

The enkephalins bind mostly to what are known as opioid (mu-opiod) receptors. The anandamides, in contrast, bind to cannabinoid rceptors. They are termed "cannabinoid" receptors because they are similar to the cannabinoid receptors (molecules which are contained in marijuana).
Interestingly, we humans make our own endogenous opiods and cannabinoids (in much smaller concentrations than if they are taken externally). The anadamide (cannabinoid) receptors are more densely located in the cerebral cortex ("thinking brain") than in the mid-brain limbic system ("subconscious brain").

A bite of chocolate, for example, prompts neurons in these hedonic hotspot areas to release neurotransmitters in the encephalin family,  which are endogenous opioids that are made in our brains. According to Berridge, these enkephalins then interact with receptor proteins that cause the release of anandamide, our brain’s own home-made version of a marijuana cannabinoid. The anandamide, in turn, can interact with other neuronal receptors, producing more enkephalin and intensifying the pleasurable experience.

Two key hedonic hotspots are a specific region in the nucleus accumbens called the medial shell, and another area nearby, the ventral pallidum (different from the ventral tegmentum discussed earlier). 
What does this mean? It means that when we desire or seek pleasure, we release dopamine to get what we want. When we finally get it (sec, drugs, rock and roll, chocolate), we really like it, through the release of enkephalins and anandamides.
It turns out that, among these stimuli, it is music that is particularly exciting to humans, especially music that causes those "chills" down one's spine, the musical frissons. Music is a powerful stimulus of the brain's pleasure center, activating the same neural network receptors as do addictive drugs, sexual climax and dark chocolate. Why would that be? 

What is the role of music in human evolution? Are humans hard-wired for music? Music may have a foundational and evolutionarily adaptive role in our brains. 

That is the topic for a future A Musical Vision essay.

@ 2015,2017 Vincent P. de Luise MD 

Ritvo, E. Psychology Today April 20, 2014.

https://www.psychologytoday.com/blog/vitality/201404/the-neuroscience-giving

Kringelbach, M., and Berridge, K., The Joyful Mind, Scientific American, August 2012

EUTERPE DECONSTRUCTED: REFLECTIONS ON THE HEALTH, ILNESSES AND LEGACY OF WOLFGANG MOZART

This essay was  published in the  Fall 2015 edition of the Hektoen International Journal of Medical Humanities.

Vincent P. de Luise MD

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.

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

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.
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."

References

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.

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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