What did Mozart really die from?

European researchers investigating records of deaths in Vienna around the time of Mozart's death at the age of 35 on 5 December 1791 suggest that the composer may have died from a streptococcal throat infection that led to a fatal kidney syndrome.

The study is the work of first author Richard HC Zegers from the University of Amsterdam in the Netherlands and colleagues Andreas Weigl from the University of Vienna in Austria and Andrew Steptoe from University College London in the UK, and is published online in the 18 August issue of the Annals of Internal Medicine.

The early death of Wolfgang Amadeus Mozart has fascinated people all over the world for over 200 years, with some believing he was poisoned by a rival, while others have suggested he died from kidney failure, Henoch-Schönlein purpura (a condition where blood vessels become inflamed), trichinosis (a parasite disease caused by eating raw or undercooked pork), and many other causes.

For the study, Zegers and colleagues examined the official daily register of deaths in Vienna and compared it to what witnesses said at around the time of the composer's death.

They analyzed all deaths recorded in Vienna during the three months from November 1791 to January 1792 and then also during the same three months in 1790 to 1791 and 1792 to 1793.

According to eyewitness accounts at the time, Mozart's body was very swollen before he died, suggesting he had severe edema (swelling caused by excess fluid in bodily tissues).

After analysing the records and comparing them to the eyewitness accounts, the researchers found that:
5,011 adults (3,442 men, 1,569 women) died in total in Vienna over the 3 periods.

The mean age of death for men was 45.5 years (standard deviation SD, 18.5) and for women it was 54.5 years (SD, 19.9).

The most commonly recorded cause of death was tuberculosis (TB) and related conditions.

The second most common was cachexia (wasting syndrome) and malnutrition, and the third most common was edema.

Deaths from edema were significantly higher among younger men the weeks surrounding Mozart's death compared with the same period in preceding and following years.

This minor epidemic may have started in the city's military hospital.
Zegers and colleagues concluded that their analysis was:

"Consistent with Mozart's last illness and death being due to a streptococcal infection leading to an acute nephritic syndrome caused by poststreptococcal glomerulonephritis."

Streptococcal infection is caused by the Streptococcus bacteria of which there are many strains, including some that cause a scarlet fever rash.

In the throat the infection ranges from mild to very severe and can lead to complications such as rheumatic fever and, as the authors suggest in Mozart's case, a rare kidney condition called poststreptococcal glomerulonephritis.

Acute poststreptococcal glomerulonephritis is an inflammation of the glomeruli in the kidneys caused by an immune system reaction to streptococcal infection. The kidney's glomeruli play an essential role in filtering the blood.

Zegers and colleagues also said it was possible that scarlet fever killed Mozart, because it leads to the same kidney complication, but given the evidence from the records they examined, they thought this was less likely.

"The Death of Wolfgang Amadeus Mozart: An Epidemiologic Perspective."
Richard H.C. Zegers, Andreas Weigl, and Andrew Steptoe.
Annals of Internal Medicine Volume 151 Issue 4, Pages 274-278, 18 August 2009.