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zoom RSS モーツァルトの死因は溶連菌感染症

<<   作成日時 : 2009/08/19 00:56   >>

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 有名なミュージシャンについてのスキャンダラスな噂は今と同じくらい18世紀でも不気味だったが、伝わり方は今ほどではなかった。ウォルフガング・アマデウス・モーツァルトは1791年12月5日に死亡し、ベルリンの新聞で毒殺されたと報道されるまでに1週間もかかった。しかし、新たな研究によれば実際の死因はもっと月並みな溶連菌感染だった可能性があるという。
画像 モーツァルトは、9月にプラハへの旅行からウィーンに戻り、「魔笛」のスコアを完成し、その初演を指揮し、彼の妻が水浴に行っていたドイツのバーデンを訪問し、レクイエムを書き始めました。彼は明らかにアクティブで、よい健康状態だった。それから、彼の最後の公演の2日後の11月22日に病気になった。
 毒殺は絶頂期の35才の作曲家を殺した多くの推論のうちの一番であった。死に立ち会った人々が何年も経ってから記録を残していた。彼の義姉妹は、モーツァルトの非常にむくんでしまい、ベッドの中で寝返りもできず、高熱があったことを思い出した(主治医は冷たい湿布を指示した)。彼は意識を失い、12月5日早朝に死んだ。死因は「熱と発疹」として記録された(それは18世紀でも病気ではなく徴候と考えられた)。
 数百年間多くの原因が唱えられた。梅毒、水銀塩治療の影響、リウマチ熱、腎不全につながる血管炎、脱血手技からの感染、生煮えのポークチョップからの旋毛虫病。
 新たな研究の発表があり、疫学的な分析から流行性の溶連菌感染の犠牲者だったとしている。
 18世紀のウィーンでは死亡記録が残されているが、医師ではなく家族や事務員が記したものである。1791年11月から1792年1月の死亡記録を前後の年と比較することでモーツァルトの最終的な病気を探ろうとした。9ヶ月間で18才以上の死者5,011人があり、最も多い原因は、結核、栄養不良、浮腫、胃腸病、脳血管性疾患であった。しかし、他の年に比べて1791-92の冬に、浮腫が若者の間で増大した発生を示した唯一の原因で、伝染病の小さい流行を示唆していた。浮腫はまた腎臓と心臓の一定の慢性疾患と関連するけれども、モーツァルトの病気は突然であった。浮腫に加えて、モーツァルトは不快、背痛、発疹がみられ、連鎖球菌感染のすべての徴候を持っていた。連鎖状球菌は時々急性腎炎を合併するので浮腫の説明がつく。
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What Really Killed Mozart? Maybe Strep
http://www.nytimes.com/2009/08/18/health/18mozart.html
By NICHOLAS BAKALAR
Published: August 17, 2009

Scandalous rumors about popular musicians were just as lurid in the 18th century as they are today, but they moved at a more deliberate pace. Wolfgang Amadeus Mozart died on Dec. 5, 1791, and it took a whole week for a Berlin newspaper to announce that he had been poisoned. The actual cause of death, a new study suggests, may have been more pedestrian: a strep infection.

Mozart had returned to Vienna from a trip to Prague in September, completed the score of “The Magic Flute,” conducted its premiere, visited Baden, Germany, where his wife was taking the waters, and started writing the Requiem. He was evidently active and in good health. Then on Nov. 22, two days after his last public performance, he fell ill.

Poisoning was only the first of many theories about what could have killed the 35-year-old composer at the height of his powers. Although several people witnessed his death, most recorded their recollections many years later. His sister-in-law recalled that Mozart’s body was very swollen, so much so that he was unable to turn in bed, and that he had a high fever, for which the attending physician ordered cold compresses. He lost consciousness and died early on Dec. 5. The cause of death was recorded as “fever and rash,” which even in the 18th century were considered symptoms, not a disease.

Many causes have been suggested over the centuries: syphilis, the effects of treatment with salts of mercury, rheumatic fever, vasculitis leading to renal failure, infection from a bloodletting procedure, trichinosis from eating undercooked pork chops.

Now researchers writing in the Aug. 18 issue of The Annals of Internal Medicine have done an epidemiological analysis that suggests he was a victim of an epidemic streptococcal infection.

“Like those before us, we’ve taken into account all the signs and symptoms,” said Dr. Richard H. C. Zegers, the lead author, “but we also have looked at one of the most logical additional things: what people commonly died from in Vienna at the time of Mozart.”

Deaths were routinely recorded in 18th-century Vienna, but physicians were not required to note a cause, which was usually provided by relatives or the clerk doing the paperwork. These records have survived, and the researchers used them to figure out patterns of death in the months surrounding Mozart’s final illness ― November and December 1791 and January 1792 ― and compare them with the patterns in the same periods of the previous and following years.

The scientists found 5,011 deaths of people 18 and older over the nine months. The most common causes were tuberculosis, malnutrition, edema (swelling of tissue under the skin), gastrointestinal disease and cerebrovascular disease, the blood vessel disorder that leads to stroke. But in the winter of 1791-92, edema was the only cause that showed an increased incidence among younger men compared with the other years, suggesting a small epidemic of infectious disease. Edema is also associated with certain chronic diseases of the kidneys and heart, but Mozart’s sickness was sudden.

In addition to the edema, Mozart had malaise, back pain and a rash, all symptoms of streptococcal infection. Streptococcus is sometimes followed by an acute kidney disease called glomerulonephritis, which would explain the severe swelling.

Dr. Zegers, an ophthalmologist at the University of Amsterdam, said a description of symptoms alone can never be definitive, because many diseases have similar symptoms. He views the added epidemiological information as crucial. “It will take several years, or maybe longer,” he said, “before anyone can come up with a better diagnosis than this one.”

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The Death of Wolfgang Amadeus Mozart: An Epidemiologic Perspective
Richard H.C. Zegers, MD, PhD; Andreas Weigl, PhD; and Andrew Steptoe, DSc
http://www.annals.org/cgi/content/abstract/151/4/270
18 August 2009 | Volume 151 Issue 4 | Pages 274-278

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 hallmark 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 following 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 underlying disease from an etiologic perspective, is a less likely possibility.

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モーツァルトの死因は溶連菌感染症 医師の一分/BIGLOBEウェブリブログ
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