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MOZART AND THE GOLDEN KING

By Prof. Talaat I. Farag MD, FRCP, FACP

Both the Austrian musician and composer, Wolfgang Mozart (1756-1791) and King Tutankhamun (1343-1325 B.C.?) have been the topic of debate due to their puzzling health profiles and cause of death. Some even speculate the possibility of homicide!!!

POOR MOZART!! The Austrian composer and genius musician, Wolfgang Leopold Amadeus Mozart (1756-1791), the son of a violinist, died when he was only 35-years-old. Since that time, he has mesmerized listeners and scientists alike with his work and the mysteries around his death. There are many controversies with regards to his health profile and cause of death.  His condition is very much reminiscent of the story of golden King Tut (1343-1325 B.C.?) whose early death raised three speculations: natural death, accidental death and murder theory. The idea of King Tut's murder, which is more than two decades old, was proposed by William MacQuitty in 1978. An honorary MA from Queen University Belfast, fellow of the Royal Geographical Society and the Royal Photographic Society and producer of the film A Night To Remember about the sinking of the Titanic, MacQuitty published his third book about Pharaonic Egypt. The book, published by The Crown Publishers (NY) was entitled Tutankhamen: The Last Journey. MacQuitty proposed for the first time the possibility of the boy-king's assassination and speculated the possible causes for the early death of the young king. Two decades later, Prof Bob Brier from Long Island University (USA) published his book "The Murder of Tutankhamen" GP Putman's Sons, Penguin Putnam Inc in which he supported the murder theory of Tut!! In very much the same way, Mozart has also raised many queries about his health, life and death. The sagas of their health profiles and early deaths continue to puzzle scientists and enthusiasts alike.  

The Saga of "Mozart's Illnesses"   One decade ago, the Dalhousie Society for the History of Medicine organized a symposium entitled, "Medicine in the Age of Mozart" on the bi-century of Mozart's death (1791-1991). The society was founded 25 years ago by the eminent Nova Scotian neurologist Prof. T.J. Murray (also former president of the Association of Canadian Medical Colleges) strived to investigate the often understated history aspects of medical practice. The organizer of this symposium was Dr. Edward Carl Abbott, a distinguished physician, cardiologist and endocrinologist. The symposium, held in 1991, brought together a group of high caliber specialists in an attempt to solve the puzzles of "Mozart's illnesses"! The multidisciplinary team included historians, anthropologists, nephrologists, cardiologists, neurologists, endocrinologists, pathologists, and epidemiologists. The symposium publication outlined thoughts about the alleged illnesses and death of Mozart in twelve articles, four poems and two short stories. The symposium presented the disease profile of the last half of the 18th century. In an era that preceded immunizations and antibiotics, where infectious diseases were very common, Mozart was speculated to have been affected by typhoid, typhus, rheumatic fever, streptococcal infection, scarlet fever, measles, TB, hepatitis, SBE, meningitis and/or trichinosis!!! Not only did the book present the controversies regarding the alleged ailments that may have affected Mozart during his life, it also raised a conspiracy theory as a possible cause of his early death. Interestingly, while the symposium's book (Summer 1993) entitled, "Mozart and Medicine," (edited by Dr. Abbott) and published as a special issue of the Dalhousie Review looked at possible diagnoses for Mozart's condition, the symposium itself focused primarily on the diseases that predominated at the time of Mozart's life. Dr. Mary Wheater helped in the preparation of the symposium papers for publication.

Below, we present some of the views offered in the symposium book regarding Mozart's health profile and cause of death.

Prof. W.F. Bynum the eminent historian discussed medicine in Mozart's Europe and how artists of that time caricatured 18th century medicine and its doctors. He noted the evolution of medicine in the 19th century to a lesion-oriented approach from a symptom-oriented one, with a better understanding and classification of diseases. It is well-known that in Mozart's time, there were a plethora of infectious diseases, no immunizations or antibiotics.

Prof. George E. Ehrlich notes that Mozart lived at an era when more children died than survived. He and his sister were the only two of seven to reach maturity and four of his six children died early. Infectious diseases were of more importance than cancer and heart disease in his era, where most people didn't reach the age when the latter would cause death. He raised several questions "Is it important to diagnose at a distance what ended the life of this paradigm of music? If he was poisoned, it was likely by his medicines not by Salieri or Sussmayr or Hofdemel or other candidates. What he needed was dialysis, what he got was bleeding! We are deprived of the opportunity to try to type his genome because of his unattended burial so that no one knows which might be his skeletal remains."

Prof. K.A. Aterman tried to analyze Mozart as a genius musician and as a human being with a life outside of music. He mentioned that most of Mozart's bibliographies tend to fluctuate between apology and eulogy, reconstructing a complex character and personality with psychoinfantalism and passionate coprolalia. Dr. Aterman raised the question on whether Mozart should have been psychoanalyzed and his letters read by a psycholinguistic? 

Prof. T.J. Murray, the former dean of Dalhousie Medical College (1985-1992), mentioned that "Mozart's unusual personality, borderless energy and rude uninhibited language, naughty habits and vulgar letters might constitute Gilles de la Tourette Syndrome. He also suggest that in his last years, Mozart suffered from recurrent attacks of streptococcal infections with rheumatic heart disease and renal impairment, with multi-organ failure and terminal pneumonia.

Dr. Mary Wheater noted that Mozart was always in delicate health. She questioned whether he developed a chronic debilitating disease, drank or overworked himself into an early grave, succumbed to an epidemic fever or was he poisoned accidentally or deliberately? She concludes that "the available information is inadequate for a firm diagnosis. In weighing up the probabilities, one has to assume a more or less typical presentation of disease. Common conditions should be preferred to rarer ones unless there is strong evidence of a rare diagnosis. I suggest that renal disease is the strongest possibility, with renal tuberculosis and post-streptococcal glomerulonephritis vying for first place in the differential. Lower down come rheumatic fever, bacterial endocarditis, Henoch Schonlein syndrome and leukemia."

Prof. Alan J. MacLeod mentioned that it is impossible to test hypotheses advanced regarding Mozart's illnesses and death, "because we search in the dark. The records are the observations of lay people, physicians of varying abilities, modified by transmission from person to person, a process of questionable accuracy." He is inclined to the diagnosis of progressive renal failure and second hypertension. He believes Mozart probably died from an epidemic infectious disease seriously aggravated by horrible medications and blood letting!

Prof. R.N. Anderson mentioned that many have been fascinated with the possibility of deliberate poisoning, although an accidental dose seems a more likely possibility. He discussed Prof. Virgil Brown's, president of the American Heart Association, claim that Mozart had suffered from rheumatic heart disease and almost certainly died of bacterial endocarditis. He mentioned that "the nature of the several illnesses that Mozart suffered from during his lifetime and exact details of the final events will never be fully clarified. However, he almost certainly had rheumatic fever, he probably had rheumatic heart disease and quite possibly died of complications related to these."

Prof. E. Carl Abbott was interested in tracing Mozart's childhood illnesses and his family physicians and their medications. He mentioned that "Mozart's wife, Constanze, has frequently been portrayed as a woman with failings. There are rumors published of her having affairs with her husband's student, Sussmayr." Yet, he denies these rumors of her fidelity mentioning that although Mozart's last son was named Franz Xaver (Sussmayr's names) he appeared to have the same deformity (Mozart's ear) as his presumed father Wolfgang! In 1984, Dr. Abbott published data about Mozart's final illness and putting Grave's Disease as a possibility?

Prof. Philip Welch presented a critical discussion about the inheritance of musical talents and role of "nature or nurture." As a medical geneticist, he presented two pedigrees of Mozart's and Bach's families to better represent the inheritance. A number of Mozart's relatives possessed significant musical abilities. He mentioned, "I echo the comment made by Sir Walter Bodmer at the International Genetics Congress in Washington in 1991; namely, that had Mozart been born in a Bedouin tent, it is likely that he might not have produced the wealth and beauty of the compositions which he achieved; however, if Walter Bodmer (or I) had been born the seventh child to Leopold Mozart, the world would have lacked the creative legacy of Wolfgang Amadeus Mozart."

Mozart's Final Days

Besides the possibility of infectious diseases mentioned above, the symposium also discussed different possible illnesses that may have led to Mozart's death such as: progressive renal failure, heart failure, hepatic failure, malignancy, polycystic kidney, and alcoholic cirrhosis. A homicidal death was also raised, specifically the poisoning theory by either antimony, arsenic, lead, or mercury. Trauma and head injury were also noted as possible death factors. The medical historian, Dr. Abbott mentioned, "of course there can be no absolute certainty of the diagnosis in the absence of a post-mortem examination." Unfortunately, to this day, Mozart's body remains unfound, and the skull claimed to be his was denied by Prof. Murray, first president of The Dalhousie Society for the History of Medicine - "the skull is not that of Mozart as seen in portraits. Its origin is uncertain."

In the absence of the bodily reminents of celebrities, it is unlikely that precise evidence can be found to make any definitive diagnosis, whether in Mozart's case or anyone else. On the contrary, the mummy of King Tut is still present in his tomb (VK 62) in the Valley of Kings. In my recent scientific visit to Cairo, Egypt (October 2001), H.E. Prof. Ismail Sallam, Egyptian Minister of Health and Population, explained to me that DNA studies will be carried out very soon by Egyptian scientists to solve the puzzle of his ailment and death. Many years after their passing, the world still marvels at the lives of both Mozart and King Tut. Over 3300 years later, King Tut's tomb is frequented by thousands of tourists every year, and Mozart's revolutionary compositions continue to be heard across the globe, 210 years after his death! Making an investigation of their lives and deaths a worthy cause.

References:

Abbott, E.C. (1984). "Mozart's Final Illness: Was it Grave's disease?" Cl and Invest Med 7, Suppl. 2: 40. (Abstract).

Abbott,  E.C. (1991). "Patterns of Morbidity and Mortality in the 18th Century: The Case of W.A.Mozart (1756-1791)," Cl and Invest Med, Suppl. 14: A66.

Abbott, E.C. (1993). "Medicine in the Age of Mozart: Introduction," The Dalhousie Review, 73(2): 150-152.

Abbott, E.C. (1993). "The Mozart Family's Physicians and their Treatments," The Dalhousie Review, 73(2): 224-229. 

Mozart's Own Web Site <http://freeweb.digiweb.com/music/wam/01.htm>. This unique website is ostensibly written by Wolfgang Amadeus Mozart himself. The ghostwriter behind the site cleverly recalls Mozart's friends and family, his first violin and his first love - all done in the first person. This web site provides an interesting look at the life of Mozart the musician. This website was mentioned in Sympatico Netlife magazine's January/February 2002 issue.

Prof. Talaat I. Farag MD, FRCP(Edin), FACP is an adjunct professor at Dalhousie University, Halifac, Nova Scotia, CANADA. Email: tfarag@is.dal.ca

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