The Death of Wolfgang Amadeus Mozart: An Epidemiologic Perspective Richard H.C. Zegers, MD, PhD; Andreas Weigl, PhD; and Andrew Steptoe, DSc The early death of the composer Wolfgang Amadeus Mozart on 5 December 1791 has fascinated the world for more than 2 centuries. It has been suggested that his final illness was caused by poisoning, renal failure, Henoch–Scho ¨ nlein purpura, trichinosis, and many other conditions. The official daily register of deaths in Mozart’s Vienna was evaluated to provide an epidemiologic framework into which the observations of contemporary witnesses of his death can be integrated. All recorded deaths in Vienna during November and December 1791 and January 1792 were analyzed, together with the corresponding periods in 1790 to 1791 and 1792 to 1793. The deaths of 5011 adults (3442 men, 1569 women) were recorded over these periods. The mean ages of death were 45.5 years (SD, 18.5) for men and 54.5 years (SD, 19.9) for women. Tuberculosis and related conditions accounted for the highest number of deaths; cachexia and malnutrition ranked second, and edema was the third most common cause. According to eyewitness accounts, the hall- mark of Mozart’s final disease was severe edema. Deaths from edema were markedly increased among younger men in the weeks surrounding Mozart’s death compared with the previous and fol- lowing years. This minor epidemic may have originated in the military hospital. Our analysis is consistent with Mozart’s last illness and death being due to a streptococcal infection leading to an acute nephritic syndrome caused by poststreptococcal glomerulonephritis. Scarlet fever, which represents the same un- derlying disease from an etiologic perspective, is a less likely possibility. Ann Intern Med. 2009;151:274-278. www.annals.org For author affiliations, see end of text. T he composer Wolfgang Amadeus Mozart died at home in Vienna, Austria, on 5 December 1791 at the age of 35 years. One week later, a Berlin newspaper started the rumor that he was poisoned (1), the first of many specula- tions concerning his death (2). Several persons witnessed his last illness, but they mostly wrote down their recollec- tions decades after the event took place. A wide range of possible final illnesses has been postulated over the cen- turies. We present findings from a source that has been overlooked in Mozart research: the daily register of deaths in Vienna. This provides a population framework into which the known facts about Mozart’s last illness can be integrated. THE CIRCUMSTANCES OF MOZART’S DEATH According to contemporaries, Mozart may have been ill during a visit he made to Prague (Czech Republic) in September 1791 (3, 4). However, this illness could not have been very serious, because after Mozart returned to Vienna, he completed the musical score of The Magic Flute (K 620); conducted its premiere and was involved in sev- eral more performances; visited the spa town of Baden (Austria), where his wife Constanze was taking the waters; and conducted his last completed composition, a Masonic cantata at the opening of a new Masonic lodge in Novem- ber 1791 (5). In the same period, he composed the clarinet concerto (K 622) and started writing the score of Requiem (K 626). His last surviving letter, written to Constanze on 14 October 1791, made no mention of any illness or dis- comfort; indeed, it depicts a busy life socializing with the composer Antonio Salieri, eating well, and sleeping well (6). Two days after his last public performance, in the Masonic lodge on 20 November 1791, Mozart took to his bed with the illness that would lead to his death. The most detailed description of this illness was pro- vided by Mozart’s sister-in-law, Sophie Haibel, 33 years later (6). She recalled that Mozart’s body was very swollen, which made him unable to turn in bed; that he was con- scious and in good mental condition until the last day of his life; and that he was attended by the distinguished physician Thomas Franz Closset (1754 to 1813), who or- dered cold compresses for his burning head “after which he lost consciousness and never woke up again.” Haibel states that Mozart died at 12:55 a.m. at home in Vienna on Monday 5 December 1791. Constanze’s second husband, Georg Nikolaus von Nissen (1761 to 1826), wrote an authoritative biography of Mozart that was published in 1828 (4) in which he states that Mozart’s final illness lasted for 2 weeks. During Mozart’s illness, at least 1 venesection seems to have been performed. von Nissen suggests that Mozart’s lifestyle— drinking throughout the day and frequently composing at night—might have contributed to his premature end. von Nissen suggested tuberculosis as the cause of death— but later proposed cerebral inflammation—and indicated that his illness followed a predictable course. von Nissen also states that many people died of the same illness over this period. He confirmed that Mozart worked on Requiem un- til the last day of his life (4), singing some parts to his assistant Franz Su ¨ssmayr (7). See also: Print Key Summary Points ....................... 275 Web-Only Appendix Appendix Table Appendix Figure Conversion of graphics into slides Audio summary Annals of Internal Medicine History of Medicine 274 © 2009 American College of Physicians