How did Mozart die? In 140 ways!

I was going through an article published in the BMJ by Karhausen LR where he describes the different hypotheses put forward to explain the death of Mozart. Karhausen has listed 140 causes proposed to explain the death of Mozart even though he died only once.

Mozart. From BMJ.

In medicine a hypothesis is made by observing the facts, that is, case history and the clinical examination. The hypothesis is then tested by diagnostic tests. If the test results support the hypothesis, it is accepted. If not, it is rejected. Usually there are several competing hypotheses to explain a set of symptoms, termed as differential diagnosis. The final diagnosis is the one which is most favored by the evidence. On the other hand, in historical medicine usually there is no way to test a hypothesis. Surely we can say about the probability of a particular diagnosis but that’s pretty much all that can be said. Hence there arise many competing hypotheses, all vying for the position of final diagnosis.

Karhausen argues that in case of Mozart, the data has been manipulated to fit the hypothesis.

Most of the 27 psychiatric disorders attributed to Mozart result from disregarding or misquoting the criteria that demarcate normal from abnormal behaviour. Some authors upgrade daily worries into paranoid ideas or anxiety neuroses; blues or genuine worries into depression; elation into hypomania; linguistic games into jargonophasia; wit into immature or manic behaviour or into a childish, psychotic other self; the dissonant harmonies of the Haydn quartets into Tourette’s syndrome; and, at the end of his life, a small shuddering into a convulsion.

Much can be said about psychiatric conditions and without any hard evidence it is dependent upon interpretation. Karhausen comments that the psychological assessment of Mozart says much more about the psychobiographers themselves than it does about Mozart.

There is also a thing about the perspective from which different investigators approach. A cardiologist thinks of a heart condition first when he sees a patient whereas a nephrologist thinks about the kidneys when he sees the same patient. A microfungi expert, Schoental suggested Mozart died from mycotoxin poisoning. The neurosurgeon, Drake forwarded subdural hematoma. The cardiologist, Brown, thought of endocarditis whereas Langegger, the psychiatrist, thought of a psychosomatic cause. There is also a theory about Mozart being murdered by the Jews, the Freemasons or the Jesuits.

As the number of competing hypotheses put forward increases, the diseases become more uncommon and rarer. The common diseases had already been proposed, all that remains are increasingly uncommon. The list of diseases proposed to explain the death of Mozart can be used to form a short treatise on medicine. I like posthemorrhagic anemia. So Mozart survived a massive loss of blood, but died from anemia?

Karhausen ends by noting –

It [psychological hypothesis of Mozart’s death] covers the hidden intent to pull an exceptional creator down from his pedestal through some obscure need to cut great artists down to size.

The whole list of causes of Mozart’s death is available here.

Reference:

Karhausen, L. (2010). Mozart's 140 causes of death and 27 mental disorders BMJ, 341 (dec10 1) DOI: 10.1136/bmj.c6789