Medical file Gustav Mahler (1860-1911)

1860-1875 Youth (Kaliste and Jihlava)

Year 1866: Migraine (aged 6)

  • 00-00-1866 Jihlava: Migraine since his childhood.

Year 1870: Sour throats (aged 10)

  • 00-00-1870 Jihlava: Sour throats in childhood and as adult.

Year 1875? St Vitus dance (aged 15?)

  • 00-00-1880 Sydenham’s chorea (SC) or chorea minor (historically referred to as Saint Vitus Dance) is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham’s chorea results from childhood infection with Group A beta-haemolytic Streptococcus and is reported to occur in 20–30% of patients with acute rheumatic fever (ARF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of rheumatic fever. Sydenham’s chorea is more common in females than males and most patients are children, below 18 years of age. Adult onset of Sydenham’s chorea is comparatively rare and the majority of the adult cases are associated with exacerbation of chorea following childhood Sydenham’s chorea.

Year 1875: Death in the family (aged 15)

1876-1879 Studentship (Vienna)

Year 1878: Myopia (aged 18)

  • 00-00-1878 Vienna: Near-sightedness, also known as short-sightedness and myopia, is a condition of the eye where light focuses in front of, instead of on, the retina. This causes distant objects to be blurry while close objects appear normal. Other symptoms may include headaches and eye strain. Severe near-sightedness increases the risk of retinal detachment, cataracts, and glaucoma. First photo with glasses dating Year 1878.

Gustav Mahler (1860-1911), signature eyeglasses.

  • Mahler almost certainly used these for reading and not for general vision. They are strong and if Mahler had required them for general vision, he would have had extreme difficulty seeing, and there is no evidence of that.
  • His right eye was about 50 percent weaker than his left eye and had a moderate astigmatism (his left eye had none).
  • The relevant measurements (in diopters) are as follows (“Spherical” is the measurement of the strength of the lens – “+” indicates far-sightedness; “Cylindrical” describes the degree of astigmatism; “Axis” is the direction of that astigmatism):
Right eye+6.50-2.00100
Left eye+4.00

1888-1891 Royal Opera House (Budapest)

Year 1889: Deaths in the family (aged 29)

1892-1897 Municipal Theater (Hamburg)

Year 1897: Abscess in throat (aged 37)

  • 11-06-1897 Vienna: Abscess in the throat is removed. First week high fever. Needs to rest in bed.
  • 30-06-1897 Gries: Bicycle accident.

1898-1907 Vienna Court Opera (Vienna)

Year 1898: Hemorrhoids (aged 38)

  • 06-06-1898 Vienna: First operation on hemorrhoids. Rudolfinerhaus (Dobling district). Mahler takes a leave.

Year 1901: Hemorrhoids (aged 41)

Year 1907: Death of a child (aged 47)

Year 1907: Valvular heart, mitral stenosis, rheumatic valve disease (aged 47)

  • 14-07-1907 Maiernigg: Valvular heart disease disclosed by Dr. Carl Viktor Blumenthal (1868-1947).
  • 18-07-1907 Vienna: According to Alma Mahler’s biography Dr. Friedrich Kovacs (1861-1931) “confirmed the verdict … [and] forbade him to walk uphill, bicycle or swim: indeed he was so blind as to order a course of training to teach him to walk at all; first it was to be five minutes then ten, and so on until as was used to walking; and this for a man … accustomed to violent exercise! And Mahler did as he was told. Watch in hand, he accustomed himself to walking—and forgot the life he had lived up to that fatal hour.” Mrs. Mahler says further that in that winter, “Mahler was so shattered by the verdict on his heart that he spent the greater part of the day in bed … he got up only for rehearsals or for the performance … if he was conducting.” And again, to confirm the suspicion that Mahler was made unduly “heart-concious” by his doctors: “… we avoided strenuous walks owing to the ever-present anxiety about his heart. Once we knew he had valvular disease … we were afraid of everything. He was always stopping on a walk to feel his own pulse; and he often asked me … to listen to his heart and see whether the beat was clear, or rapid, or calm. I had been alarmed for years by the creaking sound his heart made—it was particularly loud at the second beat—and I had always known that it must be diseased … he had a pedometer in his pocket. His steps and pulse-beats were numbered and his life [was] a torment.”
  • 29-08-1907 Vienna: Dr. Franz Hamperl (1866-1920) confirmed according to a letter from Mahler to his wife 30-09-1907: “Dr. Hamperl … found a slight valvular defect, which is entirely compensated, and he makes nothing of the whole affair. He tells me I can certainly carry on my work just as I did before and in general lead a normal life, apart from avoiding over fatigue”.
  • Heart murmur “loud second sound”.
  • Two episodes of cardiac arrhythmia.
  • 03-1908
  • 06-1909
  • 07-1910

1908-1911 Metropolitan Opera House (New York City)

Year 1908: Angina pectoris (1908-1911, aged 48-50)

Year 1909: Fever and tonsilitis (aged 45)

  • 01-1909
  • 06-1909
  • 07-1910
  • 08-1910
  • 09-1910
  • 02-1911

Year 1909: Anxiety (aged 49)

  • 06-1909 At the mere idea of falling ill.

Year 1909: Fatigue and overwork

  • 06-1909
  • 04-1910

Year 1910: Nervous disintegration (aged 50)

  • 07-1910

Year 1910: Strained arm (aged 50)

  • 07-1910 Cramp, an acute pain in a shoulder blade.

Year 1910: Consult Sigmund Freud (1856-1939). Psychoanalysis (aged 50)

Year 1910: Laryngitis (aged 50)

Year 1911: Laryngitis and Endocarditis (aged 50)

Treating Doctors of Medicine Gustav Mahler

  1. Jihlava: Josef Kopfstein
  2. Vienna: Friedrich Kovacs (1861-1931)
  3. Vienna: Julius Hochenegg (1859-1940)
  4. Vienna: Dr. Singer. Mahlers physician. Two Dr. Singers were listed in the medical directory. Gustav Singer (1867-1944), a specialist in intestinal troubles at the Wiener Allgemeines Krankenhaus, seems the more likely of the two to have treated Mahler in 1901.
  5. Vienna: Ludwig Boer (1862-1942) Friend.
  6. Vienna: Franz Hamperl (1866-1920)
  7. Maiernigg: Carl Viktor Blumenthal (1868-1947)
  8. Leiden: Sigmund Freud (1856-1939)
  9. New York: Joseph Fraenkel (1867-1920)
  10. New York: Emanuel Libman (1872-1946)
  11. New York: George Baehr (1887-1978)
  12. Paris: Andre Chantemesse (1851-1919)
  13. Paris: Jean-Joseph Defaut (1852-1929)
  14. Paris/Vienna: Franz Chvostek Jr. (1864-1944)
  15. Vienna: Armin Czinner (1853-1918)
  16. Vienna: Dr Mihalics

Other Doctors of Medicine who knew him

  1. Vienna: Adolf Stenzinger (1868-1915)
  2. Breslau: Albert Neisser (1855-1916)
  3. Vienna: Albert Spiegler (1856-1940)
  4. Vienna: Arthur Schnitzler (1862-1931)
  5. Paris: Georges Clemenceau (1841-1929)
  6. Berlin: Ludwig Achim von Arnim (1781-1831) Previously.
  7. Vienna: Max von Gruber (1853-1927)
  8. Vienna: Richard von Nepalleck (1864-1940)
  9. Berlin: Theodor Billroth (1829-1894)
  10. Vienna: Victor Adler (1852-1918)

Evidence for Rheumatic Heart Disease with Superimposed Subacute Bacterial Endocarditis

  • Mother and possibly siblings had heart disease;
  • St. Vitus dance in his childhood;
  • Frequent sore throats in childhood and as adult;
  • Two episodes of cardiac arrhythmia;
  • 1907: Finding of heart murmur (loud second sound”);
  • 1908-1911: Angina pectoris;
  • 02-1911 to 04-1911: Streptococcal bacteremia found in New York City and Paris;
  • 02-1911 to 05-1911: Intermittent fevers;
  • 03-1911 to 05-1911: Pallor (anemia), weakness;
  • 05-1911: Arthritis, uremia, pneumonia, heart failure.

The most probable diagnosis is rheumatic heart disease with superimposed subacute bacterial Endocarditis. Mahler’s mother and perhaps siblings had “heart disease”, not further defined. Rheumatic heart disease notoriously runs in families. Mahler is said by at least two biographers to have had St. Vitus’ dance in childhood. He had had many bouts of pharyngitis throughout life, some with visible exudate. There were two bouts of sudden weakness and “heart-consciousness” that might have been arrhythmia—the dates are uncertain.

A heart murmur, said to denote a “compensated, slight valvular defect” was discovered when he was 47. The fact that it was virtually asymptomatic before that is entirely consistent with rheumatic valvular disease. The character of the murmur we only know from Alma’s description; the alleged “angina” could have been associated with aortic stenosis or with the pulmonary hypertension of mitral stenosis.

The evidence for Endocarditis is presented in non-technical terms in Alma Mahler’s biography. The authors are able to give here an accurate technical recital of this evidence based on the very detailed recollections of Dr George Baehr (1887-1978), formerly Chief of Medicine at Mt. Sinai Hospital, New York, who was in 1911 Fellow in Pathology and Bacteriology in Emanuel Libman (1872-1946)‘s laboratory.

Dr. George Baehr (1887-1978) vivid account, extracted from his personal communication to us, follows: “Sometime in February 1911, Dr. Emanuel Libman (1872-1946) was called in consultation by Mahler’s personal physician, Dr. Joseph Fraenkel (1867-1920), to see the famous composer and director. Apparently Dr. Joseph Fraenkel (1867-1920) had suspected that Mahler’s prolonged fever and physical debility might be due to subacute bacterial Endocarditis and therefore called Emanuel Libman (1872-1946), Chief of the First Medical Service and Associate Director of Laboratories at the Mt. Sinai Hospital, in consultation.

Libman was at that time the outstanding authority on the disease. At the time of the consultation, the Mahlers were occupying a suite of rooms at the old Savoy Plaza Hotel (or it may have been the Plaza) at Fifth Avenue and 59th Street overlooking Central Park. Libman confirmed the diagnosis clinically by finding a loud systolic-presystolic murmur over the precordium characteristic of chronic rheumatic mitral disease, a history of prolonged low grade fever, a palpable spleen, characteristic petechiae on the conjunctivae and skin and slight clubbing of fingers. To confirm the diagnosis bacteriologically, Libman telephoned me to join him at the hotel and bring the paraphernalia and culture media required for a blood culture.

Bipolar disorder

Bipolar disorder, also known as manic depression, is a mental disorder with periods of depression and periods of elevated mood. The elevated mood is significant and is known as mania or hypomania, depending on its severity, or whether symptoms of psychosis are present. During mania, an individual behaves or feels abnormally energetic, happy or irritable. Individuals often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced during manic phases. During periods of depression there may be crying, a negative outlook on life, and poor eye contact with others.The risk of suicide among those with the illness is high at greater than 6 percent over 20 years, while self-harm occurs in 30–40 percent. Other mental health issues such as anxiety disorders and substance use disorder are commonly associated.

The causes are not clearly understood, but both environmental and genetic factors play a role. Many genes of small effect contribute to risk. Environmental factors include a history of childhood abuse, and long-term stress. The condition is divided into bipolar I disorder if there is at least one manic episode and bipolar II disorder if there are at least one hypomanic episode and one major depressive episode. In those with less severe symptoms of a prolonged duration the condition cyclothymic disorder may be diagnosed. If due to drugs or medical problems it is classified separately. Other conditions that may present in a similar manner include attention deficit hyperactivity disorder, personality disorders, schizophrenia, and substance use disorder as well as a number of medical conditions.Medical testing is not required for a diagnosis, though blood tests or medical imaging can be done to rule out other problems.

Treatment commonly includes psychotherapy, as well as medications such as mood stabilizers and antipsychotics.

Risk factors for mental illness include genetic inheritance, such as parents having depression, or a propensity for high neuroticism or “emotional instability”. In depression, parenting risk factors include parental unequal treatment, and there is association with high cannabis use. In schizophrenia and psychosis, risk factors include migration and discrimination, childhood trauma, bereavement or separation in families, and abuse of drugs, including cannabis, and urbanicity.

In anxiety risk factors may include family history (e.g. of anxiety), temperament and attitudes (e.g. pessimism), and parenting factors including parental rejection, lack of parental warmth, high hostility, harsh discipline, high maternal negative affect, anxious childrearing, modelling of dysfunctional and drug-abusing behaviour, and child abuse (emotional, physical and sexual).

Environmental events surrounding pregnancy and birth have also been implicated. Traumatic brain injury may increase the risk of developing certain mental disorders. There have been some tentative inconsistent links found to certain viral infections, to substance misuse, and to general physical health.

Social influences have been found to be important, including abuse, neglect, bullying, social stress, traumatic events and other negative or overwhelming life experiences. For bipolar disorder, stress (such as childhood adversity) is not a specific cause, but does place genetically and biologically vulnerable individuals at risk for a more severe course of illness. The specific risks and pathways to particular disorders are less clear, however. Aspects of the wider community have also been implicated, including employment problems, socioeconomic inequality, lack of social cohesion, problems linked to migration, and features of particular societies and cultures.

Composers with Bipolar Disorder


  •     H = Asylum or psychiatric hospital.
  •     S = Suicide.
  •     SA = Suicide attempt.

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