MONDAY, Aug. 17 (HealthDay News) -- It's one of the enduring mysteries of classical music: What -- or who -- killed Mozart at the age of 35 when he was at the height of his creative powers?
Now, there's a new theory: He died of complications of strep throat.
The latest hypothesis lacks the inherent drama of murder by a rival or suicide, which have both been suggested as causes of Mozart's death. But Andrew Steptoe, co-author of a historical diagnosis published Aug. 18 in the Annals of Internal Medicine, said an infection makes the most sense, considering medical records from the time, which was Vienna in 1791.
"We have for the first time analyzed the causes of death that were prevalent over the period during which he died," said Steptoe, an epidemiologist at University College London. "This has given us ideas about what medical problems were widespread at that time, and we have been able to link this with the known facts about Mozart's death."
Wolfgang Amadeus Mozart, considered one of the world's most brilliant composers, died in 1791. "In the months before his death, he was busy and successful, with the 'Magic Flute' playing to packed houses, and a flow of other masterworks, including the clarinet concerto," Steptoe said. "He died after only a brief illness, and was buried with the minimum of fuss in a very modest ceremony."
Had Mozart not died, commissioned works "would surely have resulted in some amazing music, the imagined loss of which is surely a good part of what drives the continual reconsideration of the subject" of his death, said Neal Zaslaw, a Mozart specialist and a professor of music at Cornell University.
A huge gamut of theories have emerged on the subject over the centuries, including foul play (murder by fellow composer Salieri, as suggested in the multiple Oscar-winning movie "Amadeus") and suicide. The list of proposed natural causes is long, including rheumatic fever, an overdose of mercury salts used to treat syphilis, and trichinosis caused by eating improperly heated pork chops, said the new study's co-author, Dr. R.H.C. Zegers, an ophthalmologist at the University of Amsterdam in the Netherlands.
Zegers, Steptoe and Andreas Welgl, from the University of Vienna, examined the records on deaths in Vienna during the month of Mozart's death as well deaths the month before and after. They also compared the records with those of other years to see if they could find anything unusual.
They found many deaths attributed to an accumulation of fluids in the body, which Mozart suffered from as he died. The study authors suspect this was caused by strep throat, which in turn might have been spread in a minor epidemic from a nearby military hospital.
Complications could have led to kidney problems, and bloodletting -- a common treatment at the time -- could have caused another infection, Zegers said.
The authors caution, however, that their diagnosis is tentative. Scarlet fever, they say, is an alternative possibility, but less likely.
Zaslaw, the music professor, has also studied Mozart's death, and he said that it's difficult to reach conclusions because of the lack of reliable documents from the time. Still, he said, the new findings "give us the possibility of reinterpreting those documents in a richer, more nuanced context."
The U.S. National Institute of Allergy and Infectious Diseases has more on strep throat.
SOURCES: Andrew Steptoe, D.Sc., professor, psychology, and deputy head, Department of Epidemiology and Public Health, University College London; R.H.C. Zegers, M.D., Ph.D., ophthalmologist, University of Amsterdam, the Netherlands; Neal Zaslaw, Ph.D., professor, music, Cornell University, Ithaca, N.Y.; Aug. 18, 2009, Annals of Internal Medicine