This kidney lover enjoys a good mystery, especially a medical mystery. When I heard that my favorite classical composer, Wolfgang Amadeus Mozart, may have died of kidney disease, I knew I had to find out more. His strange illness and death at the age of 35 has intrigued fans and physicians alike for more than 220 years. One avid scholar has tallied more than 118 theories for his cause of death, ranging from poisoning, a blow to the head, heart disease, strep infection to trichonosis from undercooked pork.
Apart from the fact that medical knowledge was limited at the time, there are two significant points that contribute to the confusion and mystery surrounding his death. First, there doesn’t seem to be a good contemporary description of what happened to Mozart in the days before his death. The best information we have comes from a letter by his sister-in-law, Sophie Haibel, penned 34 years after his death. Second, Mozart was buried in a communal grave with four or five other people and only a simple wooden marker, according to the laws of Vienna, which forbade elaborate funerals. Graves were often disturbed to make room for new ones and a few years after Mozart’s death, the sexton of St. Marx’s reportedly dug up the grave and retrieved a sacred relic—Mozart’s skull, which he had previously tagged with a bit of wire around the neck. So, a skull, which may not even be his, is all the physical evidence scientists have been able to study.
I’ve tracked down a portion of Sophie’s letter, translated from German. According to Sophie, when Mozart fell ill on November 20, 1791, she and her sister, Mozart’s wife Costanze, had no idea how sick he was. At some point, (she doesn’t say when) Mozart became so swollen that he couldn’t turn over in bed, and Sophie and Costanze made him a nightgown that opened in the front. Sophie visited Mozart and her sister daily throughout his illness, but mentions no other symptoms until his final days. By December 3, Mozart appeared to feel better and asked Sophie to tell her mother that he was doing well and would visit her soon. Sophie returned the next day to find that he had taken a turn for the worse in the night. Mozart told her, “Ah, it is good that you are here, dear Sophie. You must stay here tonight; you must see me die. I already have the taste of death on my tongue and who will be here to support my dear Costanze if you don’t stay.” He was coherent enough to give instructions to a pupil so that he could finish his Requiem and in fact, the last thing Mozart did was to sing the timpani part of the piece. Mozart was by then burning with fever and after cold compresses were applied to his head, he lost consciousness, never to reawaken. He died December 5, 1791.
In an excellent and comprehensive article, pediatric nephrologist Dr. Edward N. Guillery uses details from Sophie’s account to break down various theories and find out what killed Mozart. (There are so many theories that I can only share the most popular ideas with you here.) Guillery is pretty quick to dismiss a blow to the head. Although the skull, which may or may not be Mozart’s, shows evidence of a healing fracture, such an injury would not have accounted for Mozart’s swelling and fever. Guillery adds that a week before his death, a doctor diagnosed Mozart with heated miliary fever, a nonspecific term describing a fever accompanied by a rash of red bumps. This fever was recorded as the official cause of death.
Rumors of poisoning began soon after Mozart’s death. Even the composer was quoted as saying he had been poisoned with acqua toffana, a slow-acting poison containing arsenic and lead; he reportedly linked the poisoning to the anonymous commission of the Requiem, which he felt he was writing for his own funeral. Poisoning theorists suspect Mozart was drugged by rival musician Antonio Salieri, who went insane later in life. There were accounts that Salieri privately admitted responsiblity for killing Mozart, and even mentioned poisoning him, but in public, he denied guilt. Was the Salieri story mere gossip? Probably. Without proof, Guillery sees no reason to blame the mad Salieri, but it’s a theory that still intrigues. He goes on to describe the symptoms associated with various poisons, including acqua toffana. He reasons that these heavy metals would have ultimately caused kidney failure, but they would have also caused a number of symptoms that Mozart didn’t have, such as mental impairment. A modern doctor has proposed that Mozart may have been poisoned by an antimony compound taken to alleviate depression. Guillery argues that there is no proof that Mozart took the drug, though the symptoms of antimony poisoning are a close match for Mozart’s.
The kidney disease theories are, of course, most interesting to me. According to Guillery, the “taste of death” on Mozart’s tongue may have been the metallic taste associated with the buildup of uremic toxins in the body. While this could be true, Mozart’s statement, when taken in context, sounds more figurative than literal to me. Many experts have proposed a long list of kidney ailments, including glomerulonephritis, though there were no accounts of blood in Mozart’s urine; renal tuberculosis; Henoch Schonlein purpura, a disease marked by purple spots on the body (which again Mozart didn’t have); kidney disease caused by an untreated strep infection; and chronic urinary tract infections. Guillery thinks this last could be a good possibility. Mozart apparently had a slightly deformed left ear, and ear deformities have been linked to kidney/urinary tract anomalies and kidney failure.
In 2009, years after Guillery’s article was written, researchers from the University of Amsterdam provided a convincing case for the strep throat theory. Though rare today, strep bacterial infection in the throat or skin can cause the glomeruli in the kidney to become inflamed, affecting the kidneys’ filtering ability. This can occur one to two weeks after untreated throat infection or three to four weeks after skin infection. One of the symptoms is blood in the urine, which again was not mentioned with Mozart. The University of Amsterdam scientists looked at death records immediately before and after Mozart’s death and found that there were a significant number of deaths involving swelling in young men, which they attribute to “a minor epidemic” of strep. According to a doctor not involved in the study, serious strep infections were more common then and frequently resulted in deadly complications.
It seems quite likely that Mozart died of kidney failure, though what brought him to that endpoint is up for debate. Without enough facts, we’ll never know for sure. Maybe that’s why his death continues to fascinate us. The subject is so wide open that anyone might have a theory. The quest to find out how he died becomes personal, even for physicians and scientists. We all want to know if our theory is the right one—especially if we feel a connection to his music and to the haunting image of his last conscious moments, attempting to share the sounds of the unfinished Requiem playing in his head.
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For more about what may have killed Mozart, take a look at these articles.
Did Mozart Die of Kidney Disease? A Review from the Bicentennial of His Death, Edward N. Guillery, 1992
What Killed Mozart? Study Suggests Strep, Phys.org, August 19, 2009