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In death of Mozart, a chorus of causes

By Daniel J. Wakin (China Daily)
Updated: 2010-09-05 10:04

Direct medical evidence? None. Autopsy?Not performed. Medical records? Corpse?Disappeared.

Yet according to a recent article, researchers have posited at least 118 causes of death for Wolfgang Amadeus Mozart.

Dr. William J. Dawson, a retired surgeon who is the bibliographer for the Performing Arts Medical Association, examined most of the 136 entries in the association's database dedicated to Mozart's death, a list by no

means comprehensive.

"Reviewing the publications on this topic finds many of them to be confusing, complicated, conjectural and contentious," Dr. Dawson wrote in the association's journal, Medical Problems of Performing Artists. His conclusion: controversy will rage on, unabated.

A major scholar on the subject, L.R. Karhausen,a physician in France, came up in 1998 with the figure 118 for the causes of death cited by Dr. Dawson.

Without direct evidence, researchers have had to rely on accounts by Mozart's family and from a description, decades later, by a Viennese doctor who spoke to the physicians who treated Mozart in his final days.

Speculation about an abnormality in the shape of one of Mozart's ears has even led some to suggest that kidney failure was likely, since urinary tract deformities are sometimes

related to ear abnormalities.

The indirect evidence itself rests on a quicksand of changing medical definitions, sometimes mistranslated phrases from original testimonies and leaps forward in medical knowledge.

The outline of Mozart's final illness is clear. He took to his bed on November 20, 1791, after an intense period that produced "The Magic Flute," "La Clemenza di Tito," the Clarinet Concerto, a Masonic cantata and parts of his Requiem. His hands and feet swelled. He grew listless,

suffered vomiting fits and ran a fever.

On the evening of December 4 he took a turn for the worse, and his doctor, Thomas Closset,was summoned from the theater. When he arrived (after the show had ended),he ordered cold compresses applied to Mozart's head. An hour past midnight on December 5, Mozart was dead, at 35.

Closset diagnosed acute miliary fever, miliary being a term used to describe milletsize pustules - effectively, a rash. It was put down as the official cause of death in the records of St.Steohen'sCathedral in Vienna.Mozart's body was buried, without marking, in a common grave, according to the practice of the day for the Viennese middle class,ensuring that no remains that are indisputably his are available for testing.

Dr.Dawson divides the causes of the composer's death into five groups:poisoning,infection,cardiovascular disease,kidney disease and miscellaneous.Bloodletting as a treatment may also have hastened Mozart's demise.The theory that Mozart was poisoned - whether by his colleague Antonio Salieri or by Mozart himself to treat syphilis(an illness long since discounted) - was refuted.In the infection category,rheumatic fever has been a major candidate since a landmark study in 1966

by Carl Bar, a Swiss doctor.Other possible causes include a stroke and congestive heart failure. The most citations found by Dr. Dawson fall under uremia, a buildup of toxins in the blood caused by kidney disease.

"If I had to put two cents on something,it would probably be kidney failure,"Dr.Dawson said.Another major theory, propounded in the 1980s by the researcher

Peter J. Davies, blames Sch?nlein-Henoch syndrome, a rare disorder of the blood vessels. The syndrome caused kidney failure; a brain hemorrhage and pneumonia were the coups de grace, Mr. Davies put forth.

Why does the subject arouse such intense interest? Part of the reason may lie in the close overlay between music and medicine. A high proportion of doctors seem to play instruments; Dr. Dawson is an accomplished

bassoonist.

The very idea that remarkable individuals who gave life so much beauty could be brought down by ordinary physical ailments is inherently fascinating.

"They're immortal and mortal at the same time," said Dr. Jeffrey R. Saffle, a general surgeon and director of the burn-trauma unit at the University of Utah Medical Center. Dr. Saffle co-wrote a survey of the literature regarding the medical histories of prominent composers.

"They're larger-than-life figures from the standpoint of what they created," he said,"but they are very ordinary in terms of their lives and births and deaths."

The New York Times