In 1791, arguably the world’s most gifted composer, Wolfgang Amadeus Mozart, died at the very young age of 35. His death was rumored incorrectly to have been caused by poisoning by Antonio Salieri, a court composer in Austria who was jealous of Mozart’s great talent and success. Twenty-two years after Mozart’s death, Salieri, who was then in a mental institution, claimed that he poisoned Mozart, but several years later on his deathbed, he strongly denied having killed Mozart. Today, no serious researchers believe that Mozart was poisoned because his medical history and his symptoms during the week before his death match those of a classic disease that can now be cured.
Symptoms and Diagnosis
At age 35, on Nov. 20, 1791, Mozart developed a high fever, a headache, a rash, and pain and swelling in his arms and legs. He was alert and lucid, but in the second week of his illness, he began vomiting and had diarrhea. His body became swollen with fluid, causing his clothes to squeeze his body. He was too weak to sit up in bed without help, and he complained of severe shortness of breath. Then he died.
Because he had a fever, headache and sore throat, we know he had a infection. Most likely, the red rash was caused by the erythrotoxin produced by a beta strep, group A bacteria, that causes a sore throat and then rheumatic fever. Most adults who die from rheumatic fever have a long history of recurrent attacks because each time they are infected with strep, they develop the same symptoms — fever, sore throat, headache and rash — and they suffer more heart and kidney damage.
Mozart’s Long History of Rheumatic Fever
According to his father, Leopold, Mozart had suffered three attacks of serious upper respiratory infections in childhood. At age six, he developed rheumatic fever, which was most likely a result of his strep infections. Two years later, at age eight, Mozart suffered a sore throat that made him so sick that he stayed in bed for several months. That attack was caused by another strep infection called tonsillitis. He suffered a third bout of rheumatic fever at age ten, in 1766.
At ages 28 and 31, he suffered his fourth and fifth severe prolonged attacks. Each successive infection with beta strep group A bacteria further weakened his heart and kidneys, and the last serious strep infection, at age 35, was more than his body could stand.
A Beta Strep Epidemic in Vienna
In 2008, a group of medical scholars from Amsterdam, Vienna, and London pored through recorded deaths of people in the same age group in Vienna at the time of Mozart’s death, between December 1791 and January 1792, and compared the deaths to those that occurred in the next few winters (Annals of Internal Medicine, 2009, 151:274-278). There had been a marked increase in deaths in people in their 30s in that December and January, the same time that Mozart died. Furthermore, many of the people who died in the same period as Mozart also had severe edema. The researchers concluded that this pointed to a minor epidemic of a rheumatic-fever type of glomerulonephritis, kidney damage from a streptococcal bacterial infection.
Today’s Treatment of Sore Throats
When you have a persistent sore throat, your doctor should do a throat culture. If you have beta strep (“strep throat”), you should receive antibiotics. A child with rheumatic fever may be kept on antibiotics continuously until he or she is 18 years old because every subsequent infection with beta strep can cause further damage to the heart and kidneys.
Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com.