Schubert’s Illness Re-examined
The Musical Times, Jan. 1980 (pp. 15-22)
“Mir kommt’s manchmal vor, als gehörte ich nicht
mehr in diese Welt“
(Franz Schubert, 1828)
Authorities have asserted, and others have accepted, that Schubert contracted syphilis in late 1822 or early 1823, and died of typhoid fever in November 1828, at only 31 years and nine months old. Hans Fröhlich, to cite a recent example, offers typical assurances on both these topics (1978: 156, 319). [fn1: In this article references are shown by date and (where necessary) page number, cited works are listed in chronological order in the bibliography] Yet doubts or dissent have been freely voiced about each diagnosis. Thus Robert Pascall has contended in these pages (1979) that syphilis is only one possibility among others. Specialist medical opinion, conversely (e.g. Kerner, 1963), had already argued that not only the earlier but also the terminal illness was syphilitic in origin. The renaissance of Schubert studies heralded by the revised Deutsch Verzeichnis (2/1978) may make this an opportune moment to offer a factually based compendium of evidence, critique, and some preliminary further research, with the aim of clarifying the problems and eliciting definitive commentary.
The earliest musicological intimation that Schubert was syphilitic came from Otto Erich Deutsch in 1907; a cautiously confirmatory medical opinion followed in due course (Schweisheimer, 1921). The long delay in arriving at that diagnosis has been used as an. argument against it. But the time-lag is explained readily enough by such factors as the social taboo on the topic, the comparative paucity of unequivocal evidence, and the consequent need for careful evaluation of the relevant data. Conversely, the lack of evidence has itself been counted towards confirmation; thus according to Maurice Brown (1958: 127) “the complete absence of contemporary reference, although the trouble was well known to all his friends, suggests that documents ... have been destroyed”. On any assessment, reticence predictably waned with time. Three witnesses in effect asserted (and none ever denied) that Schubert had syphilis. The first acquaintance to speak out was Josef Kenner, in 1858; then the rather unfriendly Wilhelm von Chezy, in 1863; finally the boon companion Franz Schober, in 1868. Their comments can be found in the Deutsch Memoirs (1958: 86, 261, 266 respectively). [fn 2: Hereinafter references to the Memoirs are given in the Form M86, etc.] All three references are rather guarded as well as belated; none is necessarily reliable. But their purport is plain, and unanimous. Of all people, Schober would be best placed to know the truth and to judge it uncensoriously; the words attributed to him clearly imply that Schubert was recklessly promiscuous, and they state in terms that the condition for which he was admitted to hospital was the direct consequence of sexual licence.
The first we hear of any possibly serious illness is from Schubert himself, at the end of February 1823: “the circumstances of my health still do not permit me to go outside the house” (Deutsch Documentary Biography, 270). [fn 3: Hereinafter citations take the form DB270] Deutsch adds, for no stated reason, that this illness seems already to have begun at the new year. Brown, however (1958: 126), places its onset during the late autumn of 1822, again without explanation; and this dating has now become "fact" in some contexts (e.g. Fischer-Dieskau, 1976: 166). Equally contestable is the firm identification of May 1823as the month when Schubert had to spend a short time (Brown, 1958: 130) or perhaps a long time (Deutsch, M267) in hospital. There is certainly a strong tradition, hinted at by Chezy (M261), vouched for by Spaun (M367), announced as attested fact by Kreissle (1865: 316), confirmed by Schober, who further cites a friend of Mayrhofer's as his source (M266), and reaffirmed by Deutsch (DB302), that Die schöne Müllerin D795 was partly composed in hospital. That cycle may indeed have been begun in May 1823; but Schubert was still working on it in November of that year (DB301). It seems then that no-one really knows for sure when Schubert was first taken ill, or precisely why, or when, or where, or for how long he was in hospital.
But there are at least some factual grounds for a tentative hypothesis of primary syphilis in early 1823. The following collation of expected pathological consequences with recorded biographical data is based on medical sources from the 1820s to the 1970s, and cites all the known documentary references to Schubert's illness. The first manifestation, about a month after infection, would be a genital chancre and swollen lymph nodes in the groin. Sufferers from this highly infective condition were sensibly advised to stay at home. But Schubert was seen out and about in company during early January 1823 (DB261); and his words cited above suggest that he had already been housebound for some time by the end of that February (DB270). So if this were indeed his case, he would be in a state of quarantine imposed by the appearance of a primary lesion at some time between (say) mid-January and mid-February 1823. Within two months, the patient would have fever, malaise, and a generalized rash of pinkish circular spots, 5-10 mm in diameter (Scott, 1978: 99), with a characteristic coppery sheen, on chest, back, abdomen and upper thighs. By 1823, such a history would have been ominously familiar to most doctors and many laymen in western Europe for over 300 years. There could be little doubt of its identity or its gravity. Ex hypothesi, the rash would be manifest no later than mid April 1823. On 8 May 1823, Schubert composed his passionately incoherent poem My Prayer (DB279), which contains such sentiments as “On the road to martyrdom, nearing eternal ruin, my life lies annihilated in the dust, a prey to unheard-of grief. Kill it, and kill me myself; hurl everything now into Lethe, and then, O Great One, allow a pure and powerful existence to thrive”.
This secondary syndrome would have lasted a month or two, and may have been severe enough to warrant hospital treatment. But there would be worse to come. The rash described above is expected to give place to a further eruption of "dome-shaped dull-red papules about the size of a pea" (Scott, 1978), this time appearing on face, scalp and palms as well as trunk and limbs, and tending to break down into smaller spots like acne. This conspicuous development would have appeared, ex hypothesi, by mid July 1823. On 26 July Kupelwieser reports to Schober (DB284): “At Collin's yesterday I heard that Schubert was ill; they say Bradesky brought the news”. By that time Schubert was on holiday in the country, where he was later independently said to have been “seriously ill” (DB296). In August 1823, Beethoven's nephew Karl was writing in the famous conversation book that Schubert was much praised, but was said to have to hide himself (DB288). By mid-August however all the symptoms thus far described would, on the proposed time-scale, have healed or faded, and a latent phase would have supervened. On 14 August 1823 Schubert writes to Schober (DB286): “I correspond busily with Schäffer and remain fairly well. I almost despair of ever becoming entirely well again'. The papular eruption was liable to recur, perhaps more than once. By November 1823 Schubert was back in Vienna, but ill in bed (DB295), with two doctors in attendance. Dr Schäffer had been reinforced, and would soon be replaced, by Dr Bernhardt. The consultants offered the prognosis that Schubert might be quite restored in a month's time. He, more realistically, feared that his road back to health would be an arduous one (DB301). In early December 1823 Johanna Lutz tells her fiancé Kupelwieser that Schubert is fairly well but chafing under a strict regime; “if only he does not do himself harm” is her heartfelt wish (DB304).
Perhaps it was already too late. On 24 December 1823 (according to Deutsch, DB314)Schwind cheerily informs Schober that Schubert is better and will “soon be going about with his own hair again” which had had to be shorn “because of the rash”. A four-volume encyclopedia of therapy later compiled by one of Schubert's own doctors (Rinna, 1833-6) invokes head-shaving as a remedy for only two kinds of scalp condition, namely those causing either scabs or baldness (iii, 165, 206), in the latter case presumably with the intention of stimulating new growth. The papular rash of syphilis was, and is, a possible cause of both conditions (Delarue, 1823: 118; Scott, 1978: 99). The hair loss leaves circular patches, so the shaving could be cosmetic as well as therapeutic (1921: 555). On the face, the lesions may break down to resemble the eruptions of smallpox (Scott, 1978). Sonnleithner's famous description of Schubert (M121) may be relevant here: `His complexion was more fair than dark, but it was inclined to break out into little pimples and was somewhat darker for that reason'. Such an appearance may suggest the markings of smallpox, then very prevalent, and very much the lesser of the two evils. But that was not a recurrent condition; and there is no evidence that Schubert ever suffered from it in adult life. On the contrary; his admission to the City Seminary at 11 years old, in 1808, was conditional on his being “past the danger of smallpox” (DB6). On any diagnosis, scalp epilation because of a rash, especially if that condition was infective, could connote hospital treatment. A modern text-book (1975: 421) gives three to eight months after infection as the time-scale for hair loss, Le. between mid-March and mid-September 1823 on the hypothesis proposed. But Schwind's reference to headshaving, dated by Deutsch at the end of 1823, seems to imply a recent event, perhaps more directly related to a recurrence of the rash, just as Schwind suggests. A November admission to hospital would coincide both with a known period of illness in bed (DB295) and with a known date of work on Die schöne Müllerin, as the tradition requires. Just possibly, the time of admission might, have been later still while remaining compatible with this tradition. Schubert could reasonably have been supposed' to be still engaged on the Mill cycle for another month or so; his variations for flute and piano D802 on the theme of its 18th song, Trockne Blumen, are dated January 1824.
Conformably with a late 1823 date for the head-shaving, a further bulletin from Schwind at the end of February 1824 (DB330) confirms the predicted new hair growth. Schwind's sharp artistic eye affectionately notes the efflorescence of coiled fuzz in snail-shell spirals, the “Schneckerlanflug” readily recognizable from Schubert portraiture. But this time the patient is said to be very much better, although keeping a 14-day fast indoors. This was presumably at the instance of Dr Bernhardt, with whom, as with Dr Schäffer, Schubert was careful to stay in close touch. Indeed, by early 1824 (DB305, 314, 319, 331, 342, 348) Bernhardt had become an ex officio member of the inner Schubertian circle, in assiduous personal attendance. The grateful patient responded with the dedication “En marque de reconnoissance à Son ami Monsieur I. Bernhardt docteur en médecine” of his Six Grandes Marches D819 for piano duet. This might incidentally suggest that of the two possible dates of composition put forward by the new Deutsch Verzeichnis, 1818 or 1824, the latter is much to be preferred as the actual year in which Schubert felt he had reason for gratitude to his personal physician; and a newly created work would seem apt for a newly restored composer.
For a time, indeed, he believed himself cured. As Schwind told Schober in March 1824 (DB331): “He says that after a few days of the new treatment he felt how his complaint broke up and everything was different'. But he was apparently continuing to observe this new treatment, which is then described. “He still lives one day on panada [bread pulp] and the next on a veal cutlet, indulges in copious tea-drinking, and takes frequent baths.” Another comment on the same regime is (DB343) “very scanty fare, under house arrest”. Within a few years, a contemporary medical journal (1829: lxxix/iii, 18-23) would warn its readers against quack cures for syphilis consisting of “warm baths and purges, hardly any food, and sweatinducing tisanes” in addition to the usual repeated applications of a mercury ointment. Perhaps other ailments were so treated; and of course many other “cures” for syphilis were confidently recommended. All could appear successful, because of the typical relapsing course of the symptoms. Rinna's encyclopedia alone (1833-6) lists more than 100, including a dozen “hunger” or “fasting” cures. But, as his text shows, such cures were hardly ever invoked for any condition other than syphilis, over the previous 40 years. It seems then that if Schubert on medical advice was homebound and fasting, drinking plenty of tea and taking frequent baths, those facts alone would suggest that he was being treated for an actively virulent stage of secondary syphilis, and in particular for those deep-rooted and intractable types of infection which such therapies were expressly designed to eradicate (1833: i, 97 and iii, 143), no doubt by eliminating from the body those “alien substances” or “poisons” (1829, loc cit) which were rightly believed to be invading the tissues, with certainly dire and possibly fatal consequences. Some of these fasting cures (e.g. 1833: ii, 140) are notable for quite detailed and complex time-schedules. It is reported that Schubert was a careful observer of treatment times, and indeed in his last illness kept a pocketwatch beside his bed for that purpose (1865: 452).
But whatever his condition in March 1824, and however it was treated, the cure was short-lived. At the end of that month comes his harrowing cry to Kupelwieser (DB339)
I feel I am the unhappiest, most wretched man in the world. Imagine a man whose health will never be right again and who by despairing about it always makes the matter worse instead of better; imagine a man, I say, whose most auspicious hopes have been brought to nothingness, to whom the joy of love and friendship has nothing to offer but pain at best, whose enthusiasm (at least of the creative kind) for beauty threatens to vanish, and ask yourself - is not this a wretched unhappy man? “Meine Ruh ist hin, mein Herz ist schwer, ich finde sie nimmer und nimmermehr” - so indeed I can now sing every day, for every night when I go to sleep I hope never to wake again, and every morning serves only to remind me of the previous day's misery.
This has been interpreted as mere depression or hypochondria; but the quatrain Schubert quotes from his first famous song sounds all too apposite. If he was suffering from syphilis, then the secondary stage of the disease would now be extending and tightening its grip. The sufferer could expect lesions of the mouth and throat (1823: 118; Scott, 1978: 100) with consequent hoarseness or huskiness. Two days after that despairing letter to Kupelwieser, Doblhoff tells Schober (DB342) that “Schubertiads are hardly mentioned any more; Schubert himself cannot sing”. This is glossed by Deutsch as no doubt meaning merely that “his voix de compositeur was not suited to performance”. But that was hardly news to any of the friends, least of all Schober; and Schubert often sang among his own intimate circle. Another expected sign of the secondary stage would be aching pains in the long bones (1823 and 1978, loc cit). In that same letter Doblhoff says that “Schubert still complains of pains in his bones”. A fortnight later, in mid-April 1824, Schubert is still the victim of “pains in his left arm, so that he cannot play the piano at all” (DB343).
Whatever its cause, the chronic course continued its fluctuating cycle-a pattern typical of syphilis (1921: 555). Schubert was said to be “newly rejuvenated” by November 1824 (DB383). But `pains' are still mentioned, though perhaps only figuratively. Whether significantly or not, Schwind's newsletter to Schober in February 1825 refers to a recent period of inactivity (DB401), while Kreissle (1865: 316, 594) reports information from several of the friends that the song Der Einsame D800 was written in hospital in 1825. In the new Verzeichnis that song is assigned, for quite different reasons, to the early part of that year. So perhaps further hospital treatment proved necessary then. By July 1825, however, Schubert looks “well and strong” (DB429); and it is clear from the tone of his own letters that he feels very much better. But by New Year's Eve he is too ill to attend a convivial party (DB502). Perhaps this was also the occasion when he was too ill to see Reissiger, as the latter thought it worth while to report in 1857 (M99). The next contemporary comment has elicited some sharply contradictory opinions, such as the two expressed by Deutsch. In August 1826, Schubert's close friend and collaborator Bauernfeld wrote the cryptic diary-entry (DB548): “Schubert ailing (he needs "young peacocks" like Benv. Cellini)”. The reference is to the latter's Memoirs. In Book 3 chapter 3 of Goethe's translation (1803), the likeliest source, Cellini does indeed say that he had been ill but had recovered after shooting and eating young peacocks. By 1826, Cellini had become the best-attested and most famous of all syphilitics. His own explicit commentary on his infection, its cause, course and supposed cure, is found in Book 1 chapter 11. Deutsch, with all these relevant facts fully available to him, at first found it hard to believe (DB548) that any such allusion was intended. Later, however, (1964: 15) he silently reversed this view to the extent of quoting Bauernfeld's diary-entry as evidence for syphilis.
There is more such evidence. The main symptoms have remained constant over the last 150 years (1823, 1883, 1921, 1975, 1978). The two modern text-books single out six such symptoms that characterize the secondary stage. One is iritis, which can cause pain when light falls on the eye. Schubert was given to screwing up his eyes or eyelids, occasionally according to Chezy (M261) or habitually according to Eckel (M51). But this might of course have been attributable solely to his short-sightedness, as indeed the latter suggests. Two other such symptoms are hair loss and vocal failure, from both of which Schubert may well have suffered. Two more, both of which Schubert had on explicit testimony, are rash on face and scalp, and pain in the bones. The sixth is headache; and we hear about this from Schubert himself in a letter of October 1827 mentioning “my usual headaches” which are “already assailing me again” (DB679). These ominous words are echoed in an 1828 obituary (M10) which selects Schubert's “frequent headaches” for special comment. The headaches of secondary syphilis indicate meningitis, whether sub-acute, as still found in 20% of patients (1975: 421), or acute, if the headaches are severe and protracted (1978: 1329).
Later in October 1827, and again in that November, Schubert wrote to cancel his engagements. On the first occasion he explains that he is ill, and in a way which “totally unfits” him for a convivial gathering (Brown, 1958: 280). On the second he says that he cannot after all come for lunch but will appear without fail at half-past seven in the evening (DB686). The tone and timing may suggest that he was purging, perhaps as part of a fasting cure of the kind already described. Finally an incident ascribed to 1827, though first recounted many years later (M265), may be worth recalling in the present context. When it was represented to Schubert that he ought to marry Gusti Grünwedel, who seemed fond of him, he “jumped up and rushed out without his hat, flushing with anger. After half an hour he came back quietly and later related how, distraught, he had run round St Peter's Church, telling himself again and again that no happiness was granted to him on earth”. He must have had very compelling reasons for such strong feelings, from 1824 when (as he told Kupelwieser) love could bring him nothing but pain, to 1827 when (as this sad story shows) marriage was out of the question for him. If he were syphilitic, then common sense as well as routine medical advice (cf 1823: 106) would have convinced him that not only celibacy but complete continence was mandatory.
Of course the isolation and juxtaposition of such data will predictably paint a grey or black picture of sickness and suffering. But Schubert's inner life may thereby stand revealed in its true colours. Such points plot a fluctuating but continuous graph of serious, distressing and often painful illness, warranting assiduous medical attendance and treatment. The doctors' bills alone could have been a substantial burden. That diagnosis is underlined by contemporary testimony from intimate friends. Mayrhofer's memoir (M15) says that by the time of Winterreise D911 (i.e. late 1827) Schubert had been “long and seriously ill”.
Spaun takes up the tale (M138); from that time on “he was a sick man”. Within a year, Schwind would seek to comfort Schober by saying that Schubert was now “free of all his troubles”. “The more I realize what he was”, Schwind feelingly adds, “the more I realize what he suffered' (DB829). According to Spaun, Schubert's music was “conceived in suffering” (M138). Schober's funeral poem (DB827) also refers to “long suffering”. Deutsch finds this “curious”, as the last illness lasted only a few weeks. But that illness seems to have been almost painless; and in any event Schober was surely alluding to his dear friend's tormented life, not his sudden death, the news of which (as Spaun says, M139) “struck home like a thunderbolt”. What could that final fulminant sickness have been?
German sources use the ambiguous term Typhus, which has not only spread confusion in the English-speaking world but may also have proved universally misleading. It could mean either typhus or typhoid fever. Frank Walker (1947) listed a dozen works in English, including Grove's Dictionary (4/1940), in which Schubert was libellously alleged to have succumbed to typhus, a louse-borne plague of infested jails and slums. Walker appealed for the 'correct translation' of Typhus, which he took to be “typhoid fever”. But that is itself a disease of polluted water-supply; and in any event the official cause of Schubert's death (DB823) was not any form of Typhus but Nervenfieber, which is a very different matter. Deutsch's obiter dicta on this topic sound particularly dubious. “It was typhus”, says his English edition firmly; but it was not. “More precisely, in Schubert's case as in his mother's, it was typhus abdominalis” (i.e. typhoid fever). But his mother's death too was certified as Nervenfieber; and the reckless assertion that this “meant nothing else than” typhoid fever (DB24) can readily be refuted by reference to contemporary medical sources. Deutsch himself (1964: 15) later tacitly acknowledged that it could in fact denote a number of different conditions. In the encyclopedia (1833-6) compiled by Ernst Rinna, who was chief among the doctors actually treating Schubert during this last illness, Nervenfieber and Typhus (which includes typhoid fever) are itemized and indexed separately, each in due alphabetical order; the two German terms cannot possibly have been merely synonymous. Already in 1865, Kreissle (452) had made a clear and correct distinction; he says that three days before Schubert's death his doctors feared that the illness was approaching transition into a Nervenfieber. That word denoted a critical impairment of the higher nervous centres, for example by delirium or stupor; and hence, by extension, any condition characterized by such symptoms. There seems to be no evidence at all, and no reason to suppose, that Nervenfieber in Schubert's case, or indeed in his mother's, meant the specific eruptive condition known as typhoid fever. Deutsch compounds this far-reaching fallacy by further asserting (DB823) that the illness lasted its usual “three weeks duration before the crisis”, and that among its contributory factors were “obesity” and “a certain inclination towards alcohol”. All these notions are found in, and presumably derive from, Schweisheimer (1921); but they remain unacknowledged in the later source, and unsubstantiated anywhere. In short, much of the accepted account of Schubert's last illness seems to be without any real foundation in fact or argument.
In the first place, the illness at the beginning of November 1828 was seen by eye-witnesses such as Lachner (M196), Spaun (M138) and Bauernfeld (M33), as well as by Schubert's brother Ferdinand (M37), in whose house he spent his last 11 weeks, as the continuation of an existing condition, and not at all as a new or unforeseen development. Already in early September 1828 Schubert was being treated (1865: 449) for giddiness and Blutwallungen (rushes of blood presumably to the head or heart). There is no suggestion however that even these were assessed as novel or alarming symptoms. On the contrary; Spaun explicitly states that Schubert's condition in the last year “aroused no apprehension”(M138), as if some degree of chronic if intermittent illness had come by then to be expected. The prescribed treatment in the last months included long walks (1865: 449) such as the three-day pilgrimage in mid-October to Haydn's grave at Eisenstadt. On that occasion Schubert seems to have been fasting again, or at least partaking of food and drink “most moderately” (M37). Back in Vienna, he sickened yet again. On 31 October 1828 he fancied a fish supper; but at the first morsel he felt as though he had taken poison. Again, this was no novel reaction; Schönstein (M101) had heard similar complaints some years earlier.
But this last incident seemed in retrospect to mark a crisis; from that moment, says his brother Ferdinand, Schubert ate or drank hardly anything except medicines. Yet he was still going for very long walks (M37), again no doubt on medical advice. On or about 4 November he began his celebrated course in counterpoint with Simon Sechter (M107). On or about 9November he is recorded as having spent a convivial evening with Schönstein (M101), and was absent ill from the second counterpoint lesson next day. Soon afterwards he took to his bed. First he wrote to his dear friend Schober (DB819) saying that he was ill and had not eaten or drunk anything for 11 days, and asking for more books to read, preferably by Fenimore Cooper. He was duly sent some, and presumably looked at them; for almost to the last, though very weak and exhausted, he was able to correct proofs and discuss new projects. Some accounts mention sporadic delirium; but it was not continuous or violent until the evening of 17 November. On 19 November, at three o'clock in the afternoon, Schubert died.
This surely cannot be a typical three-week course of typhoid or any other fever-unless one normally spends the first week taking long walks and counterpoint lessons, the second carousing with friends and laying in a stock of adventure stories, and much of the third correcting proofs for some hours each day (M38). This time there was no suggestion of any rash, nor even, until the final stage, of any fever. No-one mentioned any form of Typhus, although that word and the conditions it signified were all too well known in Vienna in those days. There was no comment on the risk of infection; several friends paid lengthy visits, and Ferdinand's family devotedly took turns with the nursing, without any reported ill effects. In the circumstances, the general reproach that Schober stayed away for fear of infection (asserted as a fact by Deutsch, M211) seems unfounded and unfair. Ominous and pathetic though Schubert's description of his plight may sound to us now, it may well have been nothing new then; no doubt Schober had no special cause for real alarm. After all, no-one else had, not even the patient, until the final 48 hours. At other times, visitors and invalid alike disclaimed any special discomfort on his part (M28, M33). Only one source (M10) mentions even transient pain, abdominal or other. There is no hint of drowsiness or coma; on the contrary, insomnia is a trial (M33). There seems to have been no change in Schubert's appearance; on the contrary, Spaun expressly observes that even in the last few days “his condition did not look to me at all serious”, while Schubert himself in extremis is recorded as having said that there was nothing wrong with him except exhaustion (M139). Could such comments conceivably have been made about, let alone by, a dying typhoid fever victim in the terminal stage of a manifestly serious illness with clearly marked and clinically familiar symptoms?
The Nervenfieber must surely, at the very least, have involved some other causative condition. As we have seen, Schweisheimer (1921), echoed by Deutsch (1946),unflatteringly inculpated obesity and alcohol as contributory factors, without offering any evidence. It seems strange that both should have overlooked the possibility of tertiary syphilis, which would be entirely consonant with their own views. Later writers have often invoked the hypothesis that Schubert's constitution was already deeply undermined by that condition. Fasting combined with strenuous exercise might well have further lowered an already enfeebled resistance. There is also an obvious explanation of his persistent feeling of being poisoned, namely that he was being poisoned; his symptoms include some of those attributable to chronic mercurial intoxication, such as insomnia, giddiness and headache (1927: 275). Mercury was then a standard remedy, mainly in the form of an ointment, for example as part of the fasting cures already described. One member of Schubert's last team of doctors had written a book (1821) on the treatment of syphilis by mercurial inunction; an unspecified ointment is included in the itemized list of expenses incurred during the final illness (DB836-7). Medical historians might draw informative inferences from the description and costs of the medicaments then supplied.
Another approach to the problem of causation is afforded by the experience and qualifications of the distinguished doctors who attended Schubert in the last months of his life. Ernst Rinna von Sarenbach (1929-35: iv, 821), though only four years older than his patient, had already been appointed personal medical adviser to the emperor himself. But Schubert's last letter to Schober (DB819) just says “Rinna's treating me”, quite casually, as if the eminent physician were personally well known to them both. A threefold acquaintance could have dated back to 1823; Schubert was then living in the suburb of Rossau, where Rinna was serving as district police doctor; their paths might well have crossed. In November 1828, however, Rinna himself was ill and so had to nominate a deputy. He chose his friend and colleague Josef von Vering, also an outstanding practitioner (1929-35: v, 732), who had begun his career in 1813 as an army doctor in military hospitals and graduated thence to a specialization in syphilis and its treatment, as evidenced by his two books on that subject (1821, 1826). He was later reported as having instantly diagnosed Schubert's case as hopeless because of `advanced decomposition of the blood' (M256). Conceivably, he knew of the deteriorative anaemia that characterizes tertiary syphilis, a stage expected to supervene between three and ten years after infection (1883: 748; 1978: 100). That could also account for the lassitude and exhaustion of which Schubert so frequently complained in 1828 (M33, 38, 139). At least there might well have been some connection between the field of Vering's expertise and his appointment to the case. Deutsch however, denies this manifest possibility, yet again for no stated reason (DB821), whereas Brown firmly asserts it as a probability (1958: 307). The layman can only speculate in matters of medical history; but it comes as little surprise in the circumstances to find a modern medical opinion that disputes the diagnosis of typhoid fever and interprets Schubert's death as the direct and uncomplicated consequence of brain syphilis. For Dr Kerner (1963: 99) the terminal illness suggests “the occlusion of a cerebral artery, whether basal or in the fossa sylvii region”. Among the possible causes of death in the tertiary stage, modern textbooks mention arterial narrowing or occlusion of a major vessel (1975: 681; 1978: 1329), or endarteritis of a main cerebral artery leading to ischaemic stroke. In such a case, fever could be among the symptoms, together with signs of brain damage or disturbance-precisely the syndrome known as Nervenfieber. It may be relevant that Schubert is said to have complained, two days before his death, of `burning in his head' (M328).
What would be the consequences for musical and biographical studies if Schubert were not only mortally ill for his last six years but also aware of the extreme gravity of his condition? Medical text-books of the time would have told him what to expect. Thus according to Dr Delarue (1823: vi) the syphilitic was “voué par sa faute à une mort certaine, précédée des tourments les plus affreux, et presque toujours d'un aspect aussi dégoútant pour lui que pour ceux qui 1'environnent'. If Schubert was indeed sentenced to six years of disgrace, distress and disgust before the final execution, then his mind and work could hardly have failed to be afflicted and modified thereby. For a time he seems to have been stunned into silence; in the summer of 1823 the stream of music dwindled and dried. But then he rallied. As his own diary (in Bauernfeld's transcription, DB336) records in 1824,"pain sharpens the understanding and strengthens the mind", and again “my compositions are made by my understanding of music and by my sorrows”. A feeling of impending doom may well have first inspired his pious poem My Prayer and then gradually undermined his faith in a benevolent deity (DB597). Macdonald's recent study of “volcanic outbursts” in the music (1978) asks whether these can be evidence of psychological disturbance, even of mental instability. The inception of serious illness in late autumn 1822, if that date could be substantiated, might suggest some interrelation between Schubert's health and the form or content of his Unfinished Symphony D759, dated 30 October 1822. Then 1823 would mark a decisive crisis in his music as in his life. On this assessment the two great song-cycles Die schöne Müllerin and Winterreise can be heard as belonging to the same creative period, and at comparable levels of achievement (cf Reed, 1978), the beginning and end of a new though poignantly brief life-cycle. Nor need it be merely sentimental to hear in, for example, the String Quintet D956, just as his friends heard in Winterreise, “some premonition of the approaching end” (Reed, 1972: 245).
For Schubert himself surely had just such a premonition. A sense of imminent deracination and dispossession is already manifest in his letters and other writings of 1823-4. A short time before his death he was out walking in the streets of Vienna, on one of those perpetual pilgrimages in search of his lost health, when he met an acquaintance who later reported the striking words, ostensibly uttered in the course of casual conversation (M224): "It often seems to me as though I no longer belonged to this world". Whatever the cause of Schubert's illness, its effects must surely compel enhanced admiration, just as in Schumann's case, for such achievements against such odds.
J. W. von Goethe, trans.: Leben des Cellini (Tübingen, 1803)
J. Vering: Über die Heilart der Lustseuche durch Quecksilber-Einreibungen (Vienna, 1821)
F. Delarue: Tableau de la Syphilis (Paris, 2/1823)
J. Vering: Syphilido-Therapie (Vienna, 1826)
C. Hufeland and E. Osann, ed.: Journal der practischen Arzneykunde (Berlin and Jena, 1829)
E. Rinna von Sarenbach: Repertorium der vorzüglichsten Kurarten, Heilmittel US.W. aus den letzten vier
Jahrzehenten (Vienna, 1833-6)
H. Kreissle von Hellborn: Franz Schubert (Vienna, 1865)
C. Vibert: 'Syphilis', Nouveau dictionnaire de médecine et de chirurgie pratiques, xxxiv (Paris, 1883)
O. E. Deutsch: article in Bühne und Welt, ix (1907), 227
W. Schweisheimer: 'Der kranke Schubert', Zeitschrtft für Musikwissenschaft, iii (1921), 552
A. Kulkow: `Das neurologische Bild der Quecksilbervergiftung', Zentralblatt für die gesamte Neurologie und
Psychiatrie, cxi (1927), 274
A. Hirsch, ed.: Biographisches Lexicon der hervorragendsten Arzte (Berlin, 1929-35)
O. E. Deutsch, ed.: Schubert: a Documentary Biography (London, 1946) [DB]*
F. Walker: 'Schubert's Last Illness', MMR, Ixxvii (1947), 232
O: E. Deutsch, ed.: Schubert: Memoirs by his Friends (London, 1958) [M]*
M. J. E. Brown: Schubert: a Critica! Biagraphy (London, 1958)
D. Kerner: 'Franz Schubert', Krankheiten grosser Musiker (Stuttgart, 1963)
O. E. Deutsch, ed.: Schubert: Zeugnisse seiner Zeitgenossen, Ausgewählte Erinnerungen (Frankfurt, 1964)
J. Reed: Schubert: the Final Years (London, 1972)
P. Besson, W. McDermott, ed.: Textbook of Medicine (Philadelphia, 1975)
D. Fischer-Dieskau: Schubert: a Biographical Study of his Songs (London, 1976)
H. Fröhlich: Schubert (Munich, 1978)
O. E. Deutsch and others: Schubert: Thematisches Verzeichnis seiner Werke (Kassel, 2/1978)
R. Scott, ed.: Textbook of the Practice of Medicine (Oxford, 1978)
J. Reed: 'Die schöne Müllerin Reconsidered', ML, lìx (1978), 411
H. Macdonald: `Schubert's Volcanic Temper', MT, cxix (1978), 949
R. Pascall: review in MT, cxx (1979), 486
* I have cited the English sources for convenience of reference, but have on occasion made my own translation from the original German.
I am much obliged to Dr R. A. Henson, Dr Robert Pascall and John Reed for their stimulating and helpful comments.