Annals ofthe Rheumatic Diseases 1991; 50: 963-964 963

NOW AND THEN Ann Rheum Dis: first published as 10.1136/ard.50.12.963 on 1 December 1991. Downloaded from

Mozart's death

R Treves

Two centuries ago Wolfgang Mozart His last year, 1791 (punctuated with Titus' died at the age of 35 after 15 days of agony. At Clemency, , and the ); the time this led to rumours of poisoning, was a year of intense activity: On the 6 readily ascribed by certain people to his rival September, at the first performance of Titus' . Reconsideration of the facts, a Clemency, he fell ill during the last act. This did critical analysis of the medical observations of not prevent him from directing the Magic the time, and a review of recent hypotheses Flute on 30 September, and from resuming suggest that the poisoning theory should be afterwards composition of the Requiem between discarded in favour of a diagnosis of inflam- the first week ofOctober and the 20 November- matory rheumatism. the date of his confinement to bed. Mozart suffered several times from infection The last letter written by Mozart is dated 14 of the respiratory tract and from cutaneous October 1791, in which he speaks of his health, rash. which he considered very good. As early as October 1762 (the year in which His final disease lasted for 15 days (20 the minuets and the allegros for harpsichord November-5 December). Nissen,' one of his were composed), at the age of 6, he is said to biographers, describes swelling of hands and have had a 'fit of scarlet fever', which lasted feet, lumbago, vomiting, and severe asthenia, several weeks, and a rash which might have which led to a raging miliary fever. Mozart's been similar to erythema nodosum. Two years contemporaries reported 'hydrops, cutaneous later he had purulent tonsillitis. rash, and arthritis'. In December 1765 (the year in which some With the rough drafts of the Requiem on his symphonies, choruses, and sonatas were com- bed, Mozart explained how this work should be posed) his father, Leopold, spoke of a raging fmiished after his death and died on 5 December, fever from which both Mozart and his sister, at 0 55 am, in the arms of his doctor, Dr http://ard.bmj.com/ Marianne, were suffering after a further attack Thomas Frantz Closset (who had probably of tonsillitis complicated by sinusitis; a coma, diagnosed the raging miliary fever). weight loss, and a mucopurulent oral rash led Mozart's body was taken to St Marx's them to think this was typhoid fever. cemetery, located one hour away from , During the following year Mozart again had and thrown into a common grave. a fever and articular pain, without anyone knowing whether this was arthritis or not. on September 30, 2021 by guest. Protected copyright. In September 1767 (the year during which he Discussion composed Apollo and Hyacinth, and several, The suddenness of the outcome and the tragic concertos and symphonies) Mozart developed end after 15 days of agony might have suggested in Vienna. poisoning. Mozart believed it and blamed 'aqua In 1770 Mozart complained of chilblains. Tofana'. The 'body swelling' raised suspicions On 13 September 1771, at the age of 15 (the for his son Carl Thomas. Furthermore, in 1823 year during which he composed his rival, A Salieri, admitted to being the and Ascania in Alba), Mozart had a severe cold murderer after a suicide attempt and in a fit of and fever. He wrote: 'I am fine, but I cannot delirium. write very much because my fingers hurt by The accusation of guilt made against his dint ofwriting music'. In the same year he again freemason brothers, the doubts of Carl, had bronchitis and, maybe, jaundice. Beethoven's nephew, the questions asked by The following year (during which he com- Carpani, Haydn's biographer, and P Schaffer's posed, among other works, a Sogno di Scipione, play have all helped to foster this suspicion of , and some symphonies), back from poisoning. Italy, his sister tells us that he had been There is no evidence to support such a Clinique de 'seriously ill' but gives no further details. hypothesis, however, especially as E V Guldner Rhumatologie, H6pital Universitaire Between 1774 and 1780 he suffered succes- von Lobes, the court physician and adviser, Dupuytren, sively from a dental infection, pneumonia, and made no mention of this theory in a letter to 2 Avenue Alexis-Carrel, respiratory infections. Carpani, in which he stated: 'during Autumn 87042 Limoges Cedex, At the end of 1790 France Mozart, though claiming (1791), he contracted arheumatico-inflammatory R Treves to be in good health, expressed foreboding of fever, which at the time was nearly general'; this Accepted for publication his imminent death in his farewells to Haydn, is thought to have been complicated by 29 May 1991 aged 58. meningitis. 964 Treves

a doctor who examined Mozart, renal insufficiency, Wegner's disease or

Von Sallab, Ann Rheum Dis: first published as 10.1136/ard.50.12.963 on 1 December 1991. Downloaded from speaks of 'acute miliary fever with head involve- Goodpasture's syndrome? ments', which suggests neurological symptoms. We wonder whether Mozart did not die of an Of course, bleedings only made the composer's infectious endocarditis following three attacks health worse. of acute rheumatic fever. More recently (1966), Carl Bar, a Swiss This last hypothesis seems sound because a dentist, challenged the miliary fever diagnosis study of Mozart's medical history shows a reported by Nissen2; he suggested a relation succession of respiratory tract infections between a rheumatic fever and heart disorders. (bronchitis, pneumonopathy, tonsillitis, sinu- Davies, in 1984, suggested a Sch6nlein-Henoch sitis), in the course of which there were recur- syndrome3: cutaneous streptococcaemia follow- rent articular disorders. In addition, the 'miliary ing an epidemic and chronic glomerulonephritis fever' described by Closset might have been a due to oedema-the neurological disorders symptom of a severe infectious syndrome; the explaining vomiting via an arterial hypertension, word 'miliary' indicating that the composer had a central nervous system abnormality, and what a cutaneous rash. These cutaneous rashes might he presented as a hemiparesia. This hypothesis have been erythema nodosum. The 'swelling' of rheumatoid purpura (or Schonlein-Henoch might have been due to renal impairment. The disease) often occurring after upper respiratory loss of consciousness, the vomiting, the fear of tract ailments, in particular those induced by a assassination, the depressive state sometimes streptococcal infection, is based on strong mentioned could be accounted for by an impair- arguments, but in 1791 renal impairment and ment of the central nervous system, possibly arterial hypertension were unknown to the involving an arterial hypertension complicated scientific community. J Barraud thought by a haematoma. Mozart had died of chronic renal impairment.4 On the other hand, we do not know much In support of the theory of a brain hae- about his possible heart disease: Did he already morrhage, Puech et al put forward the idea of a have a murmur when he was an adolescent? Did calcified extradural haematoma5; a skull thought he have symptoms of heart failure during the to be Mozart's was exhumed in 1801, identified last year ofhis life? Both these questions remain and examined in the Salzburg Mozarteum, unanswered. In 1791 heart diseases were only where the mark of a left temporoparietal identified at necropsy, and their detection in haematoma was found on it. Puech asserts that living subjects was not yet possible; auscultation Mozart probably had moderate craniofacial was discovered only in 1819. dysmorphism (with premature cranial synostosis From his 35 years of life Mozart left us about of the frontal suture), which is confirmed by an 600 works. Death haunted or worried him: the examination of the musician's portraits. This last act of Don Juan (1787), his letters, and his dismorphism might explain the occurrence of feelings indicate that. headaches, particularly those after spring 1790, He possibly died of Bouillaud's disease, the faintness, and the possible epileptic fits. complicated by bacterial infection (as in Osler's This craniostenosis, the cause of an apparent disease). http://ard.bmj.com/ exophthalmos, reproduced in several ofMozart's His genius was inexhaustible: Mozart portraits (those painted by Joseph Lauge in remains eternal and mystical, like his music. 1783, and by Dorothea Stock in 1789), suggested to Sederholm a case of Graves' disease.6 In 1985 G E Ehrlich, considering the same 1 Nissen G N. Biographie W A Mozart's. Heransgeben vom symptoms (arthritis, oedema, fever, oral ulcera- constanze, nittive vom Nissen,friher WittiveMozart. Leipzig:

Britkopf and Hartel, 1928. on September 30, 2021 by guest. Protected copyright. tions, erythema nodosum, impairment of the 2 Robbins Landon H C. 1791: La derniire annee de Mozart. JC central nervous system) suggested two other Lattes, 1990. 3 Davies P J. Mozart's illness and death. J R Soc Med 1983; diagnoses: Still's disease and Behqet's disease 76: 776-85. (ILAR XVIth International Congress of Rheu- 4 Baraud J. A quelle maladie a succombe Mozart? Chron Med 1905; 12: 737. matology, Sydney, 1985). 5 Puech B, Puech P F, Dhellemmes P, Pellerin P, Lepoutre F, Would it not be possible to suggest, taking Tichy G. Did Mozart have a chronic extra dural hematoma? Injury 1989; 20: 327-30. into account the recurrent upper respiratory 6 Sederholm C G. Mozart est-il mort d'un Basedow? Ciba tract and lung disorders and a possible terminal Symposium 1959; 7: 224-8.