Decomposing Miozart's Death

(CNN) -- More than two centuries after Wolfang Amadeus Mozart died at age 35 at his home in Vienna, Austria, researchers have concluded that the composer likely died of a streptococcal infection leading to kidney failure.

"What we've done is analyze the death records of the people who died in Vienna in 1791, when Mozart died, as well as 1790 and 1792," said Andrew Steptoe, a professor of psychology in the Epidemiology and Public Health Department of England's University College London.

"What we found was that the major causes of death were tuberculosis, and that older people died of strokes, but in addition to that we found an increase in deaths among young men from conditions related to edema," he told CNN.

Edema -- or swelling -- can result from kidney failure. It can occur all over the body, and there appears to be little doubt that Mozart suffered from it. His sister-in-law recalled that he was so swollen he could not turn in bed.

The authors turned to a variety of sources -- accounts from relatives, a biography, witnesses, friends of witnesses -- to summarize what is known about his final illness: it came on quickly, lasted two weeks, included severe swelling, pain, fever and rash and consciousness until two hours before death.

Apparently his breathing was not affected -- he was reported to have sung parts of his "Requiem" from his death bed.

The researchers then attempted to link those accounts of symptoms with the leading causes of death in Vienna in 1791 and found some clues.

Mozart's official cause of death was listed as fever and rash, though the authors note that the determination probably was not made by a doctor, since doctors knew even then that those were only symptoms rather than a disease.

Looking at the death records, the authors found "a minor epidemic" of deaths involving edema among young men around the time Mozart died.

"Streptococcal infection leading to postinfectious glomerulonephritis is a possible cause of death involving edema under these circumstances," they said.

In other words, a streptococcal infection that impaired the kidneys' ability to remove waste and excess fluids.

Patients with the disorder typically also suffer from headache, anorexia, nausea, vomiting, malaise and back pain, they said.

"The known facts of Mozart's fatal illness, including the features of edema, malaise, and back pain, seem compatible with this diagnosis," they said.

Today, the condition is seen mainly in children 2 to 6 years of age and is easily treated with antibiotics, which were unknown in 1791.

The authors said scarlet fever was unlikely because it typically is accompanied on the first or second day of the illness by a rash that eases in six to nine days. "However, none of the accounts of relatives who looked after Mozart describe the rash that was presumably present when Mozart died, which suggests that it was a late rather than an early symptom," they wrote.

Edema can also be caused by heart conditions and other kidney problems, but in those cases the condition must be chronic before it would cause edema, the authors said. They reasoned that the infection likely was acute because Mozart's output of compositions and his performance schedule were prodigious during the months prior to his death.

They also rejected rheumatic fever, which causes swelling in the joints, because it is seldom fatal in its acute form.

But the authors acknowledged that their data "have serious limitations, so conclusions must be drawn with extreme caution."

The translation of cause of death into modern diagnostic terms is "open to debate, because many causes of death were descriptions of symptoms and signs rather than conclusive diagnoses," they said.

Why does anyone care? "I think people have always been intrigued by Mozart's death, partly because he died so tragically young," Steptoe said, noting that the average man survived well into his 40s at that time. "We wonder about what he might have produced."

The work was applauded by Dr. Kenrad Nelson, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health and a Mozart fan who had nothing to do with the work. "I think this is kind of a clever paper," he told CNN in a telephone interview. "I think it's a credible hypothesis, but I can't think of any way that you could get any more evidence in favor or against it."

But Dr. Stephen L. Gluck, a professor of medicine and kidney expert at the University of California - San Francisco, called the study conclusion "far-fetched."

The disease described by the authors as the likely cause of death would likely have caused the musician's urine to turn dark -- indicative of the presence of blood -- and that was not described, he said.

And the rash, he said, would likely have been dissipated by the time Mozart's kidneys shut down, causing the swelling.

It would have been usual for a man of Mozart's age to get the disease, which is primarily contracted by children, he said.

And for the disease to be fatal would also be atypical, he said, since it's usually self-limiting. "To kill you within two weeks of onset of disease, that's very unusual," he told CNN in a telephone interview.

Gluck, also a Mozart fan, speculated that a viral disease may have caused acute heart failure, which would also have caused swelling.

But he credited the authors for uncovering what appears to have been an outbreak of some type of infectious illness that resulted in edema and death among young men.

"It's tragic that he died so early, but I think it must have been from something else," he said.

-- CNN's Ashleigh Nghiem contributed to this story from London, England.

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