Certainly I as a physician I cannot but help but wonder sometimes what the
'real' diagnoses on various well known people are.  There was a wonderful
speculative discussion a few years back about the possible causes of
Alexander the Great's demise in the New England Medical Journal.  The most
convincing argument was that he died of cerebral malaria.

As to Mozart's death, being myself no more of a Mozartian than Adorno, the
famous lines uttered by Glenn Gould come to mind that the real shame was
not that he died he died to early but that he didn't die soon enough!  That
taking it too far but its nice to get a different view on things sometimes,
especially when Mozart has become such a sacred cow that we are not allowed
to listen critically any longer.

Having said that the possibilities as to other diagnoses for Mozart's
death are endless.  To simply say that he died of rheumatic fever would
be oversimplying things.  Rheumatic fever is relatively less likely in a
man aged in his 30's, at least at a primary disorder.  The possibility
of subacute bacterial endocarditis secondary to pre-existing rheumatic
valvular heart disease (usually acquired in childhood causing a lifelong
predisposition to valve infections later in life) is more plausible.  This
can certainly be accompanied by a rash.  The oedema described can be due
to either cardiac failure from valvulopathy and in particular mitral
valvulopathy can cause blood to be coughed up and certainly some patients
talk of 'vomiting' blood when they in fact mean they coughed it up.  Oedema
can also occur when circulating immune complexes from endocarditis get
caught up in the kidneys causing acute renal failure from secondary
infection-related glomerulonephritis.  I recall reading accounts in the
past of blood being passed in the urine, and certainly this would be
consitent with both glomerulonephritis and subacute bacterial endocarditis.

Now all this is pure speculation when for example many of these things
can be caused by that great mimic: tuberculosis.Yes, it can caused
blood to be coughed, vomited, and passed in the urine.  It can even
cause infective endocarditis, with a tuberculous infection on the
valves.  Certainly the nasty rash could be the end product of secondary
complications of any variety of advanced untreated systemic infection,
or the product of profound bone marrow failure from tuberculous infection
of the bone marrow ('thrombocytopenic purpura').

Indeed this makes the point that the end product of various advanced
illness, when allow to run their course untreated could all resemble the
clinical picture presented to us of his final fatal illness, which robbed
the world of what might have been a really great composer.

(Dr) Satoshi Akima
Sydney, Australia