Larry Roberts, University of Maryland School of Medicine
410-706-7590 ([email protected])
Monica Smith, Baltimore VA Medical Center
410-605-7098 ([email protected])
MOZART'S FATE: ANOTHER MEDICAL MYSTERY SOLVED AT THE UM SCHOOL OF MEDICINE AND VA HEALTH CARE SYSTEM CONFERENCE
After more than 200 years of speculation and suspicion, the strange and untimely death of Wolfgang Amadeus Mozart may have finally been explained. The demise of the brilliant and prolific composer-who died in 1791 at the age of 35-is the focus of this year's historical diagnosis conference sponsored by the University of Maryland School of Medicine and the Veterans Affairs (VA) Maryland Health Care System in Baltimore.
"Mozart was probably the victim of an acute case of rheumatic fever," according to the medical detective work of Faith T. Fitzgerald, M.D., internist and professor of medicine at the University of California, Davis. Dr. Fitzgerald will reveal her diagnosis at the sixth annual clinical pathologic conference (CPC) dedicated to notorious case histories of the past.
This year's historical CPC will be held Friday, February 11, 2000, from noon to 2 p.m. in Davidge Hall (522 W. Lombard St.), the oldest medical school building in the country used continuously for medical education. The conference will include a performance of Mozart's music by the Atlantic Quartet.
During a CPC, the case history of an unnamed patient is presented to an experienced clinician for discussion in an academic setting. "This method teaches medical students and residents how to properly diagnose difficult or challenging cases," says Philip A. Mackowiak, M.D., professor and vice chair of medicine at the University of Maryland School of Medicine and director of medical care at the VA Maryland Health Care System.
"Since 1995, we have examined the deaths of Edgar Allan Poe, Alexander the Great, Ludwig van Beethoven, General George A. Custer and Pericles. For the year 2000, we chose Mozart because of his unusual case history and the ongoing debate over what caused his death, " says Dr. Mackowiak.
From kidney failure to liver disease to typhoid fever, many theories have been put forth over the centuries to explain Mozart's death. It has even been suggested that Mozart was poisoned by Italian composer Antonio Salieri, who was portrayed as a jealous rival in the popular play and movie "Amadeus."
"While conspiracy theories make good fiction, there is no historical evidence that Mozart was murdered," says Neal Zaslaw, Ph.D., professor of music at Cornell University, one of the world's leading experts on Mozart's music and life, and CPC speaker. But Mozart's sudden illness and early death seem to have perpetuated the myth.
"Mozart was vigorous and successful right up until the time he fell ill," says Zaslaw. "In the last year of his life Mozart composed two operas, participated in an unbelievable number of performances, and maintained a busy social life."
"Because Mozart was a great and famous man, we tend to look for an extraordinary cause of death," says Dr. Fitzgerald. "In fact, the clues point to an illness that was a common killer in Mozart's time."
Rheumatic fever is an immune system disease that may develop after an infection with the streptococcus bacteria. It is now uncommon in the United States.
"Thanks to antibiotics, rheumatic fever has become a forgotten disease in the U.S.," says Dr. Fitzgerald. "But it continues to be a threat in underdeveloped countries." In 18th century Europe, epidemics were common.
Dr. Fitzgerald made her diagnosis by carefully analyzing the case history, which is based on descriptions written by Mozart's family and physicians. According to those accounts, Mozart was stricken suddenly with a high fever, headaches, a rash, and pain and swelling in his arms and legs.
Mozart remained alert and lucid, but the composer became increasingly agitated as his illness progressed. He had his beloved pet canary removed from his room when the bird's singing began to irritate him. By the second week, Mozart was suffering from repeated episodes of vomiting and diarrhea. His body became so swollen that his clothes no longer fit and he needed assistance to sit up in bed.
Knowing the end was near Mozart gave a colleague instructions on how to complete his final prophetic masterpiece, the Requiem. In the hours before his death, Mozart became delirious and went into a coma. He died 15 days after he became ill, on December 5, 1791.
Dr. Fitzgerald ruled out kidney failure and liver disease, because Mozart's mental faculties remained intact, and there was no sign of jaundice (skin yellowing). Typhoid fever is an unlikely culprit because Mozart's gastrointestinal problems were not severe enough.
Dr. Fitzgerald believes rheumatic fever weakened Mozart's heart, causing fluid retention and the extreme swelling. She says Mozart's heart was probably already weakened by two earlier bouts of rheumatic fever as a child and young man.
"Finally," says Dr. Fitzgerald, "there's Mozart's sudden distaste for the singing of his pet canary. Irritability is a classic symptom of rheumatic fever."
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