An Ordinary Death
   Conspiracy Theories Aside, Conference Hears, Rheumatic Fever Killed
   Mozart

   By Fern Shen
   Washington Post Staff Writer
   Saturday, February 12, 2000; Page B01

   BALTIMORE, Feb. 11 - The patient's body was bloated and puffy.  His
   chest was blotched with an angry red rash.  He was projectile vomiting.
   His pet canary so grated on his nerves that he ordered it taken away.

   Hearing an hour-long recitation of these graphic symptoms today, the
   doctors in their white coats chuckled and applauded, some muttering a
   learned "Hmmm" or "Aha!" Then they adjourned to enjoy a box lunch and
   a performance of chamber music, some still heatedly discussing the
   details.

   "Why all the fuss?" asked Faith T.  Fitzgerald, a professor and
   assistant dean at the University of California-Davis School of
   Medicine, who had just outlined the case of the 35-year-old white
   male and diagnosed rheumatic fever.  "Because this is Mozart!"

   And even though rheumatic fever has been among the most widely accepted
   explanations for the romantically early death of the famously precocious
   composer, there still swirls a huge body of speculation, fabrication
   and passion about what took Wolfgang Amadeus Mozart's life in the
   early morning hours of Dec. 5, 1791.

   "There are as many conspiracy theories about his death as there are
   about John F. Kennedy and Martin Luther King. . . .  His death has
   been blamed on his doctors, on [fellow composer Antonio] Salieri, on
   the Masons and on the Jews," said Fitzgerald, who has counted 118
   diseases that have been suggested to explain Mozart's death.

   With a droll style and a penchant for drama, Fitzgerald spoke today
   before nearly 300 staff physicians, classical music aficionados and
   others gathered for the sixth annual clinical pathologic conference
   sponsored by the University of Maryland School of Medicine and the
   VA Healthcare System.

   Previous conferences have explored the psychopathology of Gen. George
   A. Custer and speculated on the deaths of Alexander the Great, Pericles
   and Ludwig van Beethoven.  A theorist's proposal one year that hometown
   writer Edgar Allan Poe may have died of rabies was widely reported
   and caused a brief sensation.

   "Perhaps because we had that actor come in who appears around town
   in the costume and in the character of Poe," mused the conference's
   organizer, Philip A. Mackowiak, professor and vice chair of medicine
   at the school.

   Fitzgerald thinks she understands the fascination with the details
   of famous people's demises: "If we know some secret thing about
   great people, we somehow share their greatness."

   And she knows, she said, that people believe "extraordinary people
   shouldn't die of ordinary things.  It somehow throws the cosmic
   balance out of whack."

   But Fitzgerald's conclusion was that Mozart succumbed to the epidemic
   of rheumatic fever that was sweeping through 18th-century Europe,
   producing fever and rashes and ending in death.  An immune system
   disease that may develop after an infection with streptococcus
   bacteria, rheumatic fever rarely kills today, thanks to antibiotics,
   though it remains a threat in underdeveloped countries.

   Fitzgerald ran through the known details of Mozart's final days,
   which are drawn largely from eyewitness accounts taken years later
   from his wife, Constanze, and her sister Sophie Haibl:

     Mozart's illness began suddenly with fever and headache, as well
     as swelling of the hands and feet, which, over the course of several
     days, progressed to tissue swelling so severe he had difficulty
     turning in bed.  By the second week of his illness, he complained
     of foul taste and was suffering bouts of vomiting and diarrhea.
     On the 14th day of his illness, his condition deteriorated markedly,
     and he began to show signs of delirium.  On the 15th, he died.

   Fitzgerald said she believes rheumatic fever weakened Mozart's heart,
   causing fluid retention and swelling.  His heart was already weakened
   from bouts of childhood rheumatic fever, she said.

   Fitzgerald then examined some of the other diagnoses, "each of which,"
   she said, "has been argued with a passion inversely proportional to
   the evidence."

   Was it a liver failure or kidney disease, perhaps the type known as
   Henoch Schonlein Purpura, one of the strongest competing theories?

   No, says Fitzgerald, because there was no jaundice, as happens with
   liver disease.  Neither, for most of the course of the illness, was
   Mozart delirious, one feature of the uremic toxicity that results
   from severe kidney failure.  And Henoch Schonlein brings bruise-like
   marks, not a rash, Fitzgerald said.

   How about typhoid fever? Unlikely, since Mozart's gastrointestinal
   problems were not severe enough.

   And what of syphilis? That topic sends Fitzgerald off onto a passionate
   riff on the public penchant for attributing the sexually transmitted
   disease to "every great person."

   Finally, there is little or no evidence, Fitzgerald said, for the
   Salieri murder-by-poisoning theory, revived and popularized in the
   1980s by the Peter Shaffer play, "Amadeus," and by the Milos Forman
   film of the same name.

   "Poor Salieri," Fitzgerald intoned, noting that, though he was
   well-regarded in his day, he is remembered today only "for a crime
   it turns out he did not commit!"

   Although Fitzgerald likes to debunk the loopier theories, it's clear
   she finds them all fascinating.

   "Medicine is not just the study of disease.  It's the study of people
   and of their culture, " she said before her talk, applauding the
   intensity of the debate over tiny details of Mozart's death, such as
   the asymmetry of his eyes, the shape of one ear.

   "I think passion is a good thing, as opposed to a silly one.  It
   means people care," she said.  "The death of culture and of really
   good medicine will come when people don't care."

Brad Leissa, M.D.
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