Was Bad Pork an Instrument of Mozart's Death?

New theory offered on composer's early demise

TUESDAY, June 12, 2001 (HealthDayNews) -- Add tainted pork to the list of theories of what -- or who -- killed Wolfgang Amadeus Mozart, whose untimely death in 1791 has spawned a cottage industry of speculation.

A University of Washington professor of medicine dismisses two of the main notions, the evil intentions of envious court composer Antonio Salieri or the fatal effects of an overdose of mercury, then the fashionable-but-unreliable treatment for syphilis. He says the composer loved pork, and suggests that a pork cutlet Mozart enjoyed only 44 days before he fell ill -- a cutlet full of the worms that cause trichinosis -- was his undoing.

But don't give up on the syphilis theory just yet, says another researcher. The composer's symptoms resemble the kidney damage that could result from both the venereal disease and its 18th-century "cure."

"Mozart died young, he died of a short illness that was mysterious, and he died with enough medical description to be able to speculate, but not enough to be certain," says Dr. Jan Hirschmann, assistant chief of medicine at the Puget Sound VA Medical Center. "And it suddenly struck me, even though I had only seen one case in my life, that trichinosis fits the symptoms that had been described by his wife [Constanze], his sister, and his physicians."

Mozart became ill in November 1791 and died in Vienna on Dec. 5, two months shy of his 36th birthday. Reviewing eyewitness descriptions and speculations on the reasons for Mozart's sudden illness, as well as postmortems performed at the time, Hirschmann compared all the theories of how the composer died with symptoms of diseases.

"People have suggested he was poisoned by arsenic, lead or mercury -- that theory has become popularized particularly in the case of Salieri," Hirschmann says. "Some people suggested he died of kidney disease, and others that he died of syphilis. And then people have suggested that he died of acute rheumatic fever -- which is the most popular of the theories. It does cause fever, inflammation and a rash, and it does occur in epidemics."

At the height of his creative powers, and in good health, Mozart suddenly fell ill, complaining of high fever, headaches, profuse sweating and swelling of his hands and feet. He also developed a rash on his chest and belly; after a week of illness, he complained of generalized aches and pains and suffered through bouts of vomiting and diarrhea. He remained conscious and alert until the night of Dec. 4, 1791, when he became delirious, lapsed into a coma, and died just after midnight.

Trichinosis, in which the muscles are attacked by parasitic worms called trichinae, fits all the symptoms, Hirschmann says. "Although the disease was not described until 1860, several outbreaks of the disease in Germany at the time showed that the mortality was high -- 20 to 30 percent. So I went back through all the literature, all the descriptions of his disease from his wife, his sister, and his doctors."

Trichinosis runs a predictable course, with deaths occurring in the second and third weeks, Hirschmann explains. "It causes fever, rashes, and swelling without shortness of breath, all of which match the symptoms Mozart exhibited," he adds.

Only one piece of the puzzle remained. "I didn't know a lot about his diet," Hirschmann explains. Another book with yet another theory led him to the last clue.

"In a letter Mozart was writing to his wife while she was away getting treatment for some leg problem, he was interrupted by a servant bringing in his meal," he continues. "In the letter Mozart says, 'What do I smell? -- pork cutlets! … I eat to your health.' That letter made it clear that he ate meat. And what's even more intriguing is that the incubation of trichinosis is up to 50 days, and it's even conceivable the very pork chops he was describing in that letter were the ones that killed him."

The findings were published in the June 11 issue of the Archives of Internal Medicine.

But Constanze's frequent treatments for a leg problem may provide a much different clue, says Dr. Philip Mackowiak, who directs the University of Maryland's annual Clinicopathologic Conference.

"A lot of people say there's no evidence that Mozart was having extramarital affairs," Mackowiak says. "But he was a musical superstar at the time, an equivalent of our modern-day rock star. And in his last year in Vienna, he was alone a lot of the time because his wife, Constanze, was away in various spas, being treated for varicose veins."

"I think his clinical picture is most consistent with nephritis or inflammation of the kidney," Mackowiak says. "What caused that inflammation becomes total speculation. But I'm mildly attracted to the secondary syphilis diagnosis. First of all, syphilis was a much more severe disease 200 years ago. Secondly, in its secondary phase, it causes a rash and nephritis, which caused the swelling that Mozart appears to have. It doesn't usually cause high fever, but 200 years ago, who knows?"

At the time, fevers were gauged anecdotally instead of with thermometers common today, and doctors simply didn't have the tools to diagnose disease.

What To Do

For more on Mozart, see the Mozart Project. And for more on trichinosis, visit the Centers for Disease Control on Prevention.

For other historical medical mysteries, see these HealthDay stories about Beethoven and Brahms.

SOURCES: Interviews with Jan Hirschmann, M.D., assistant chief of medicine, Puget Sound VA Medical Center, and professor of medicine, University of Washington, both in Seattle, Wash.; Philip A. Mackowiak, M.D., professor and vice chairman of medicine, University of Maryland School of Medicine, Baltimore; June 2001 Archives of Internal Medicine
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