Did a strep infection bring Mozart's finale?

The cause of Wolfgang Amadeus Mozart's death has been the subject of speculation for centuries. Was he poisoned? Did he have tuberculosis? Perhaps it was trichinosis from undercooked pork?

A study in the Annals of Internal Medicine offers the possibility that Mozart died from a streptococcal infection.

The researchers, who include two devoted Mozart fans and an expert in Viennese demographic history, theorize that the infection led to poststreptococcal glomerulonephritis, nephritic syndrome. Eyewitness accounts of the composer's last illness describe severe edema, malaise and back pain.

The researchers also analyzed causes of death listed in an official registry for the weeks surrounding Mozart's illness and compared them with the previous and following years. The data, overlooked by previous studies, revealed an increase in the number of deaths from edema among young men. The researchers speculate that a minor strep epidemic may have originated in a Vienna military hospital.

While glomerulonephritis is still sometimes seen after strep infections, it is not generally considered life-threatening, but Mozart, of course, had no access to antibiotics.

When Mozart died at age 35 on Dec. 5, 1791, the cause was listed in the register as fever and rash, which raised the possibility that scarlet fever was the cause. However, the rash did not seem to be present throughout Mozart's two-week illness, the researchers found.

The investigation was a labor of love, said lead author Dr. Richard H.C. Zegers, an ophthalmologist at the University of Amsterdam, in the Netherlands. He was inspired by his "love and admiration for the music Mozart left behind, in combination with my interest in his person and medical history." Mozart also inspired Dr. Zegers to name his daughter, Lara Dorinde Amadé.

Dr. Zegers maintains a Web site that includes medical histories and the causes of death of Mozart and Johann Sebastian Bach, about whom Dr. Zegers wrote his doctoral dissertation last year (link).

The study in the Aug. 17 issue of the Annals (link).