Aug 18, 2009 -- Two hundred and fifty years after his birth, Wolfgang Amadeus Mozart might be the most known classical music composer, but his legacy is still shadowed by a mysterious death.
Buried in an unmarked grave, without a casket or his widow at the funeral, historians don't know exactly what killed the 35-year-old musical genius Dec. 5, 1791. His remains have been lost to history.
Eyewitness records written a decade after Mozart's death indicate that the composer was extremely swollen during his final days of illness and had back pain. By using that little bit of information, many have theorized about his cause of death -- from poison by the hand of a jealous pupil who was convinced Mozart was having an affair with his wife, to scarlet fever or trichinosis.
But in a new article in the Annals of Internal Medicine, researchers in London, Vienna and Amsterdam are proposing that Mozart actually died from complications of a bad case of strep throat going around a nearby military hospital.
How Details of Mozart's Death Were Buried in a Pauper's Grave
"He was thrown in a pauper's grave and nobody marked it very well," said John Baron, professor of musicology at Tulane University in New Orleans. "Mozart had scarlet fever as a child and his health was never good as a result after that."
"Some of the far-fetched theories are that he was poisoned," said Baron. "But the prevailing theory is that he was in frail health, and it was the middle of winter and he was not taking care of himself."
Mozart's death registry simply lists hitziges Frieselfieber, fever and rash.
Dr. Bruce Goldberger, chief of forensic pathology at the University of Florida in Gainesville, doesn't see a way any of these theories could be proven.
"Without the body, we're left with speculation," said Goldberger. "At this point, I'm not sure a body would help you either."
Yet, historians and Mozart fans may never let it rest.
This week's article took quite a different approach to the mystery of Mozart's death. While other historians attempted to match an infection to Mozart's reported symptoms in his final days, the authors of the new paper decided to document which diseases killed other adults in Vienna during the winters of 1790, 1791, and 1792 and then matched those outbreaks to the Mozart's purported symptoms.
"I think those other theories are trying to explain a very unexpected death," said Andrew Steptoe, co-author on the study and a professor of psychology and epidemiology at University College London.
Mozart Died of Sudden, Unexplained Illness
"It was unusual to die within a couple of weeks of symptoms. Up until that time he seemed to be extremely active," said Steptoe.
By carefully translating and analyzing the death registries kept for the 3,442 men 1,569 women killed by disease in Vienna during those winter years, Steptoe and his colleagues came to the theory that Mozart died of strep complications.
As it turns out, an outbreak of streptococcal infection (like the strep bacteria in a sore throat) killed an inordinate amount of young men in Vienna the winter Mozart died.
Steptoe guessed that Mozart may have caught the infection in a crowd at the Opera House where his "Magic Flute" opera was playing, or at the Masonic lodge where Mozart was a member.
Doctors in those days weren't diagnosing streptococcal infection, or strep, specifically but by the description of swelling, pain in his back and the relatively brief illness, infectious disease specialists and medical forensic experts could easily see a connection.
"Most people who get a strep throat, it heals on its own. In a small percentage, there's always a concern of this happening," said Dr. Gregory Davis, professor of pathology and lab medicine at the University of Kentucky College of Medicine in Lexington.
While most people fighting a strep infection make antibodies to target the harmful bacteria, Davis said some unlucky few might have an immune system that targets the kidneys as well as the bugs. When that happens, the kidneys can start to filter out necessary proteins, which help keep fluid in the blood, along with harmful toxins.
"It's your defense mechanisms going too far," said Davis. In the resulting swelling, Davis said "there are gradations from just a little puffy, from just total puffiness… like the Michelin Man."
Infection that May Have Killed Mozart Could Harm Today
Today doctors have antibiotics to stave off such complications from a bacterial infection. But infectious disease experts warn that strep can be deadly in modern times too.
"Even with antibiotics, patients can die from streptococcal disease," said Dr. Aaron Glatt, chief executive officer and president of New Island Hospital in Bethpage, N.Y.
"With all the antibiotics we have today there is still a mortality associated with it," said Glatt, a member of the Infectious Diseases Society of America.
Still, doctors and the authors of the study themselves don't believe this is the final word on Mozart's cause of death.
"This is all speculation of course, don't take it too seriously," said Steptoe.
"It's one of those things -- it's fun reading, but nobody should take it as absolute fact," said Glatt. "No one should alter Mozart's death certificate here."