What killed Mozart?

For more than two centuries, the music of Wolfgang Amadeus Mozart has endured — as has the speculation about what led to his sudden death at age 35 on Dec. 5, 1791.

Was the wunderkind composer poisoned by a jealous rival? Did he have an intestinal parasite from an undercooked pork chop? Could he have accidentally poisoned himself with mercury used to treat a bout of syphilis?

A report in Tuesday's Annals of Internal Medicine suggests the exalted Austrian composer might have succumbed to something far more commonplace: a streptococcal infection — possibly strep throat — that led to kidney failure.

The researchers looked at death records in Vienna during the months surrounding Mozart's death — November and December 1791 and January 1792, and compared causes of death with the previous and following years.

"We saw that at the time of Mozart's death there was a minor epidemic in deaths involving edema (swelling), which also happened to be the hallmark of Mozart's final disease," said Dr. Richard Zegers of the University of Amsterdam, one of the study's authors.

There was a spike in swelling-related deaths among younger men in Vienna at the time of Mozart's death compared to the other years studied, suggesting a minor epidemic of streptococcal disease, Zegers said.

The cause of death recorded in Vienna's official death register was "fever and rash," though even in Mozart's time those were recognized to be merely symptoms and not an actual disease.

His surviving letters and creative output suggest that he was feeling well in the months before his death and was not suffering from any chronic ailment. Many accounts note that he fell ill not long before he died — suffering from swelling so severe, his sister-in-law recalled three decades later, that the composer was unable to turn in bed.

Others who reported to have been witnesses to Mozart's final days also described swelling, as well as back pain, malaise and rash — all symptoms that indicate Mozart may have died of kidney disease brought on by a strep infection.

"It's not definitive, but it's certainly food for thought," said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center who was not involved in the study.

He said it was not unreasonable to presume that Mozart died from strep complications, based on the information presented, but he pointed out that the authors had scant data to go on.

"Serious streptococcal infections were much more common than they are now and, indeed, they had very serious complications," he said. "This is sure to set off many discussions going forward."

'Jackson died of lethal levels of potent medicines, drugs'

The leaked toxicology report of Michael Jackson claims that the pop star had lethal levels of potent painkillers and drugs in his body at the time of his death, triggering suspicion that it may be a case of homicide.
Jackson was on a diet of deadly cocktail potent enough to have killed a normal person instantly but his body had developed a tolerance due to the longtime use of huge doses, the British newspaper Sun claimed quoting the findings of his preliminary toxicology reports.
Apart from high levels of Demerol, a strong painkiller and heroin substitute Methadone, Jackson's blood tests found high doses of antianxiety drug Xanax, according to the leaked toxicology report submitted to the Los Angeles county coroner's office, the paper said.
Lower levels of powerful anaesthetic drug Propofol was also present in Jackson's body. The medicine is used for surgical operations but according to Jackson's close aides, the pop star, who suffered from insomnia, used the medicine as a sleeping pill.
Another medicine, Dilaudid, which is normally used to numb post-surgery pain was also found in Jackson's body.
Jackson died after collapsing on June 25 just weeks before making his comeback in London and reports have linked his sudden death to the long abuse of prescription drugs.
Coroner's office is yet to release the toxicology report, which will determine the cause of death.
But daily claiming to have access to the report said besides Demerol and Methadone, 50-year old Jackson had taken four more painkillers and anaesthetics plus anti-anxiety pills.
"This is sure to increase pressure on police to establish exactly how one man obtained so many prescription medications — and which doctors were responsible."
"There is increasing talk of manslaughter charges if it can be shown he was given drugs without proper regard for his safety," the daily said claiming to quote a source close to the case.
Police Chief William Bratton added he was waiting for the final toxicology reports to move further in the investigation.
"Based on those, we will have an idea what we are dealing with. Are we dealing with a homicide or are we dealing with accidental overdose?" he said.
"Michael Jackson was a walking drug store when he died — he never stood a chance," the daily added.
"The body can build up extreme tolerances to huge doses of drugs but eventually it overloads and just shuts down. That is what happened to Michael," it said.
In addition to these medicines, there were "therapeutic" levels of Fentanyl, another post-operation painkiller 100 times more potent than morphine, plus prescription painkiller Vicodin, anti-anxiety pills Valium and the sleeping drug Ambien.

'Jackson died of lethal levels of potent medicines, drugs'

The leaked toxicology report of Michael Jackson claims that the pop star had lethal levels of potent painkillers and drugs in his body at the time of his death, triggering suspicion that it may be a case of homicide.
Jackson was on a diet of deadly cocktail potent enough to have killed a normal person instantly but his body had developed a tolerance due to the longtime use of huge doses, the British newspaper Sun claimed quoting the findings of his preliminary toxicology reports.
Apart from high levels of Demerol, a strong painkiller and heroin substitute Methadone, Jackson's blood tests found high doses of antianxiety drug Xanax, according to the leaked toxicology report submitted to the Los Angeles county coroner's office, the paper said.
Lower levels of powerful anaesthetic drug Propofol was also present in Jackson's body. The medicine is used for surgical operations but according to Jackson's close aides, the pop star, who suffered from insomnia, used the medicine as a sleeping pill.
Another medicine, Dilaudid, which is normally used to numb post-surgery pain was also found in Jackson's body.
Jackson died after collapsing on June 25 just weeks before making his comeback in London and reports have linked his sudden death to the long abuse of prescription drugs.
Coroner's office is yet to release the toxicology report, which will determine the cause of death.
But daily claiming to have access to the report said besides Demerol and Methadone, 50-year old Jackson had taken four more painkillers and anaesthetics plus anti-anxiety pills.
"This is sure to increase pressure on police to establish exactly how one man obtained so many prescription medications — and which doctors were responsible."
"There is increasing talk of manslaughter charges if it can be shown he was given drugs without proper regard for his safety," the daily said claiming to quote a source close to the case.
Police Chief William Bratton added he was waiting for the final toxicology reports to move further in the investigation.
"Based on those, we will have an idea what we are dealing with. Are we dealing with a homicide or are we dealing with accidental overdose?" he said.
"Michael Jackson was a walking drug store when he died — he never stood a chance," the daily added.
"The body can build up extreme tolerances to huge doses of drugs but eventually it overloads and just shuts down. That is what happened to Michael," it said.
In addition to these medicines, there were "therapeutic" levels of Fentanyl, another post-operation painkiller 100 times more potent than morphine, plus prescription painkiller Vicodin, anti-anxiety pills Valium and the sleeping drug Ambien.

Jackson's hospital is known for 'raising the dead'

When Michael Jackson went into cardiac arrest, rescuers took him to a place known for bringing the dead back to life. A world-renowned surgeon at the UCLA Medical Center has pioneered a way to revive people that most doctors would have long written off, including a woman whose heart had stopped for 2 1/2 hours.

Tested on a few dozen cardiac arrest patients, 80 percent survived. Usually, more than 80 percent perish.

"They took people who were basically dead, not all that different than Michael Jackson, and saved most of them," said Dr. Lance Becker, an emergency medicine specialist at the University of Pennsylvania and an American Heart Association spokesman.

Could Jackson, too, have been saved?

It's impossible to know. Doctors at the hospital worked on him for an hour. The UCLA expert, cardiothoracic surgeon Dr. Gerald Buckberg, said he was not personally involved in Jackson's treatment, and that too little is known about what preceded it.

"We have no idea when he died versus when he was found," Buckberg said in a telephone interview.

However, the results in other patients show that "the window is wide open to new thinking" about how long people can be successfully resuscitated after their hearts quit beating, Buckberg said. "We can salvage them way beyond the current time frames that are used. We've changed the concept of when the heart is dead permanently."

They call it "the Lazarus syndrome" for the man the Bible says Jesus raised from the dead.

Let's be clear: No one is saying that people long dead without medical attention can be revived. The lucky ones in Buckberg's study received quick help, and the reason they suffered cardiac arrest was known and could be fixed: blocked arteries causing a heart attack, in most cases.

Buckberg's method requires:

_Prompt CPR — rhythmic chest compressions — to maintain blood pressure until the patient gets to a hospital.

_Use of a heart-lung machine to keep blood and oxygen moving through the body while doctors remedy what caused the heart to quiver or stop in the first place, such as a drug overdose or a clogged artery.

_Special procedures and medicines to gradually restore blood and oxygen flow, so a sudden gush does not cause fresh damage.

Without all three elements, patients might suffer brain damage if they survive at all.

"You can save the heart and lose the brain," Buckberg explained.

UCLA and hospitals in Birmingham, Ala.; Ann Arbor, Mich.; and in Germany tested Buckberg's method on 34 patients who had been in cardiac arrest for an average of 72 minutes. All had failed resuscitation methods with standard CPR and defibrillation to try to shock their hearts back to beating.

Only seven died. Only two survivors were left with permanent neurological damage. Results were published in 2006 in the journal Resuscitation.

Dr. Constantine Athanasuleas (pronounced uh-than-uh-SOO'-lee-us), a surgeon at the University of Alabama at Birmingham, treated one man in the study who had been in cardiac arrest for about an hour and a half. The man's wife, a nurse, did CPR until a helicopter brought him to the hospital.

"He was flatlined," with a heart "as still as your dining room table," Athanasuleas said.

Doctors put him on a heart-lung machine, whisked him to the catheterization lab to see if he had artery blockages, then did bypass surgery to detour around them.

"The guy went home and was neurologically perfect" at least two years later, the doctor said.

Buckberg treated a woman who had been in cardiac arrest for 2 1/2 hours.

He would not send her to the operating room until her CPR and blood pressure could be maintained so further treatment could be attempted, he said.

Sadly, the woman survived all this but died several weeks later from an infection.

Buckberg has taken his work further in experiments with pigs in cardiac arrest. He deliberately deprived their brains of blood flow for half an hour, then used his resuscitation techniques to bring them back, with normal or near-normal function. Results presented at a heart association conference last fall stunned many, including Dr. Myron Weisfeldt, a cardiologist and chairman of medicine at Johns Hopkins University School of Medicine.

"He's doing extraordinary things. You almost don't believe the results that he got," Weisfeldt said of Buckberg. "Most of us carry around in our head that if somebody's brain is deprived of blood flow for 10 to 15 minutes that we're just not going to get them back to any useful function. His data suggest it's possible."

Doctors in Japan, Taiwan and elsewhere in Asia have tried approaches similar to Buckberg's with excellent results, said Becker, who is about to try it in Philadelphia.

"It takes training. It takes rethinking" to get doctors to adopt something this new, and funding for bigger studies to prove it works, Buckberg said.

On the Net:

• Heart Association: http://www.americanheart.org
• Journal study: http://repositories.cdlib.org/postprints/1859/