From Julian Lieb:

Re: Small “epidemic” may have killed Mozart (Aug. 17): There is nothing new about the streptococcus theory. It was originally derived from the history of attacks of rheumatic fever, the nephrotic syndrome, and hypertension culminating in a stroke, with the possibility of subacute bacterial endocarditis. For my money, this is pretty close, but the terminal event the embolization of valvular bacterial vegetations to the brain. Rheumatic fever may cause various deformities of the aortic, tricuspid and mitral valves, that may become breeding grounds for pathogens that form the vegetations. The edema, I would bet, was due to congestive heart failure secondary to mitral stenosis and aortic incompetence.

Mozart was manic- depressive (name a great composer that was not), his penury due to manic spending spells. Lithium has potent immunostimulating, antiviral, and antibacterial properties. Would lithium have saved him? Almost certainly, yes. Would it have interfered with his creativity and productivity? Mogens Schou studied 24 creative geniuses taking lithium. 12 reported no impairment, 6 impairment, and 6 enhancement.

As for Don Giovanni, thank goodness M got that in before the strep got him, although some credit must go to Lorenzo da Ponte.

If ever you wish to disseminate the immunostimulating and antimicrobial properties of lithium and antidepressants, such that people take notice, let me know. Relevant not only to strep, but to HIV and HINI as well.

Julian Lieb, M.D.