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Postmortem
with Strings
by
Anita Kunz
What eventually
led to the premature death of Mozart? Centuries after his
demise, an unusual clinical pathology conference was held
in Maryland to diagnose the genius'
death, at
which Professor Faith Fitzgerald presented her peculiar diagnosis.
How unusual was the conference? How did Professor Fitzgerald
conduct the postmortem? The following article will get these
puzzles clear.
Down
on the brick floor of the University of Maryland's Davidge
Hall, a noted professor of medicine is about to perform a
most unusual postmortem. Although this domed amphitheater
with its steeply rising seats has hosted medical lectures
and demonstrations for more than 200 years, today's offering
is exceptional, for the deceased's remains are nowhere in
sight. And at the conclusion of the ,
a string quarter will present a program of 18th-century music.
The occasion is the university's sixth annual historical clinical
conference. Each year the university's medical school invites
a physician to diagnose the mysterious maladies of historical
figures ranging from Edgar Allan Poe to Alexander the Great.
This year's patient is a 35-year-old male who died in Vienna
after a two-week illness. His body was consigned to a common
grave, but his genius still resounds in concert halls the
world over.
"We are disquieted when extraordinary people
die of ordinary things," begins Faith Fitzgerald, an internist
and professor of medicine at the University of California,
Davis School of Medicine. Her introduction sounds a cautionary
note for those who would haste to interpret the synopsis that
follows. At the height of his creative powers, and while enjoying
a spell of good health, the subject fell suddenly and ferociously
ill, succumbing to high fever, headaches, profuse sweating,
and swelling of his hands and feet. Within a few days the
swelling of his hand spread to his whole body—a condition
known as anasarca. The bedridden victim also developed a rash
on his chest and belly; after a week of illness, he complained
of generalized aches and pains and endured bouts of vomiting
and diarrhea. He remained conscious and alert until the night
of December 4, 1791, when he became delirious, lapsed into
a coma, and died just after midnight.
Controversy has surrounded this particular
case history, Fitzgerald explains, because of the deceased's
celebrity status: Wolfgang Amadeus Mozart's death "wouldn't
have been mysterious at all if Wolfgang Amadeus Muller had
died that December night." Strastruck physicians have since
ascribed Mozart's death to more than 100 causes. "Each of
these [diagnoses] is argued with a passion disproportionate
to the data," Fitzgerald points out. "And of course, Mozart
died of
as well as everything else, because every great man dies of
syphilis."
The physicians who attended the sickly composer
weren't much help, either. Their
succor amounted to a blood-letting and a few cold compresses.
No autopsy was performed on the body. According to musicologist
Neal Zaslaw of Cornell University, who sketches a brief Mozart
biography, the death and burial entries in two church registers
list the cause of death as "severe miliary fever," a generic
descriptor at the time for any syndrome marked by a seedlike
rash. Press reports of his passing supplied such colorful
and sinister diagnosis as poisoning, venereal disease, and
dropsy of the heart, the 18th-century term for fluid retention
and severe swelling.
Even some learned men who examined Mozart
as a child had formulated their own opinions about his eventual
demise. "They believed that each individual is born with a
finite store of vital essence which was consumed with the
intensity they perceived in the young Mozart," says Zaslaw,
"and when that essence was likely to be exhausted prematurely,
it leads to an early death."
Thus, overweight imaginations and the sands
of time have turned tragedy into a medical mystery aching
to be solved. That's just the sort of material that appeals
to the school's vice chair of medicine, Philip Mackowiak,
who launched the conference six years ago after reading an
account in a Maryland historical magazine of Edgar Allan Poe's
final days. He hired an actor to play Poe and asked his colleague
Michael Benitez to review the writer's medical history.
The
diagnosis—death by was topped off, appropriately enough, with a monologue from
Poe's story "The Black Cat." The rabies theory
attracted enough attention to become a question on the TV
game show Jeopardy.
Since then, conferees have taken on Alexander
the Great, Beethoven, and the Athenian military and political
leader Pericles. So far, the diagnoses made by Mackowiak's
medics tend to be familiar, if not mundane—and that's part
of what makes the conference not just interesting but useful
to the doctors-in-training who attend. There's a thoroughness
to the historical diagnostic procedure that is sometimes lost
in contemporary clinical practice, says Paul Sehdev, an M.D.
in his final year of training in infectious diseases. "Once
you get past your internship and residency, you tend to make
automatic diagnoses, without going through all the possibilities,"
he says.
It's instructive, too, to watch another physician
work through a case without the benefit of modern technology,
says Sehdev. In Mozart's example, the most compelling symptom—anasarca—has three common causes: liver disease, kidney
disease, and congestive heart failure. Lacking modern lab
techniques, Fitzgerald must use deductive reasoning. Her first
step is to discount liver disease because there was no evidence
of .
Some medical historians have implicated kidney
disease because of Mozart's malformed ear. Ears and kidneys
develop at about the same time in the human embryo; hence,
a malformed ear may indicate problems with the kidneys as
well. But Mozart had no history of , Fitzgerald says. And advanced kidney
disease produces delirium earlier in the course of illness.
So Fitzgerald settles at last on congestive
heart failure, which can cause anasarca if the heart can't
pump enough blood through the kidneys to eliminate fluid-retaining
salts. Heart troubles would be easy to confirm with any one
of the stethoscopes that adorn audience members at Davidge
Hall. "Unfortunately," says Fitzgerald, "Mozart died more
than a quarter of a century before the invention of stethoscopy.
And there was no description of his doctor's leaning an ear
against his heart to listen to it. If I were facing a really
swollen, febrile, rashy, sweaty guy, I might not want to put
my ear on his chest either."
Fitzgerald notes, however, that at the time
of Mozart's death an epidemic of rheumatic fever is said to
have besieged Vienna. Rheumatic
fever is triggered by an invading bacterium that elicits antibodies
from the immune system. The antibodies attack the
bacterium, but they can also attack tissue in a vulnerable
host's own heart, skin, joints, and brain. This reaction can
cause congestive heart failure, Fitzgerald points out, as
well as the rest of Mozart's physical symptoms. And chorea,
the neurological consequence of rheumatic fever, could account
for Mozart's final delirium, as well as the puzzling change
of character that prompted him to drive his pet canary out
of the sickroom days before his passing.
"One
could say that the epidemic was immaterial to his death, that
it was coincidental," she says. "But I think it's
bit of arrogance to dismiss it." Applying the principle of
Occam's razor—which states that the simplest explanation
for a phenomenon is the most probable—Fitzgerald formalizes
her diagnosis: congestive heart failure brought on by rheumatic
fever.
The audience seems calm and deeply satisfied,
as if absorbing a eulogy for a departed friend. Sandwiches
are passed around, the string quartet warms up, and as the
first note is struck, Wolfgang Amadeus Mozart lives again.
(1187 words)
(From Discover, June 1999 )
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