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It has been pretty clear for a century or so that Austrian court composer Antonio Salieri was in the throes of Alzheimer's disease when at age 73 he "confessed" to murdering the young musical genius Wolfgang Amadeus Mozart. Mozart's untimely death in the late 18th century is generally still considered a mystery. Most present-day physicians don't think he had tuberculosis or rheumatic fever, the two illnesses to which his death is most often ascribed.

British playwright Peter Shaffer's play "Amadeus," of course, lent new credence to the Salieri-poison scenario, but that's mere poetic license, according to a neurologist with a penchant for latter-day diagnoses of history's rich and famous.

Mozart's problem, concluded neurologist Miles E. Drake, was a chronic subdural hematoma, a pool of blood between the membranes that separate the brain and the skull, that was caused by a fall. Doctors treating the symptoms -- weakness, headaches and faintings -- in all probability killed him, or, at the very least, hastened his death with their misguided techniques, mainly involving bloodletting, according to Drake, who teaches at the Ohio State University College of Medicine.

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Ludwig van Beethoven, whose deafness was long believed to have been caused by syphilis or alcoholism, had chronic neurological and gastrointestinal illnesses and probably has gotten a bum rap from post-mortem diagnoses that attribute them all to his lifestyle, experts have concluded. Drake argued that these problems were caused by a rare disorder known as neurosarcoidosis.

Drake, basing his work on advances in the field of neurology in the past two decades, has taken on the medical diagnoses of both Mozart and Beethoven. In articles in recent issues of Neurology, the journal of the American Academy of Neurology, Drake has made cases for new causes of disability and death for these two musical geniuses.

"We neurologists are very vain about our historical and cultural interests," Drake said recently, noting that the academy meetings usually have such presentations. Drake is especially interested in music, so it is no surprise that his historical diagnoses are musically oriented. (He noted with some regret that his favorite composers, Richard Strauss and Richard Wagner, do not require his abilities. "Strauss was healthy as a horse until his kidneys failed when he was 85," Drake said. Wagner was also healthy over his 70 years, he added.)

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Mozart, however, posed a real challenge. A skull exhumed from the common grave in which the poverty-stricken composer was buried has been almost certainly identified as Mozart's through modern forensic techniques, including facial reconstruction. Drake has not seen the skull, but anthropologists examining it have hinted that when they have finished they may make it available to Drake for a hands-on examination.

Meanwhile, detailed scientific descriptions of the skull have led Drake to conclude that in one of several falls Mozart was known to have experienced in 1789 and 1790, the composer fractured his skull. His final illness, before his death in his mid-thirties in 1791, included many neurological symptoms, said Drake, all of which are consistent with the development of the hematoma that can press on the brain and cause all sorts of behavioral and neurological problems.

When it is promptly treated, as occurred when former President Ronald Reagan fell from his horse in 1989 and subsequently developed the same collection of fluid, it generally causes no more trouble. The former president, who had no symptoms, was treated about two months after his fall. Neurosurgeons drilled holes in his skull and siphoned off the fluid.

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No such elegant diagnosis and treatment were available to Mozart, of course, but Drake notes in his article that Mozart's "correspondence and the accounts of his friends and family provide evidence of chronic neuropsychiatric symptoms during the last 18 months of his life, culminating in an incapacitating and then fatal crisis . . . "

Drake also suggests that Mozart's work habits and bumptious, intemperate behavior in 1789 and 1790 could easily have provoked the falls.

Even the 18th-century doctors suspected some sort of brain lesion, but also various inflammatory illnesses for which the conventional treatment of the time was bleeding. Writes Drake, " . . . the treatments could have involved four more units of blood, probably sufficient to produce {fatal} shock in the slightly built composer."

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So much for Mozart.

Drake's diagnosis of Beethoven was based on his symptoms. The timing of Beethoven's onset of deafness did not fit with the usual course of syphilis, said Drake. In syphilis patients, deafness is usually a very late symptom, but Beethoven lived for nearly 30 years after going deaf.

In addition to being deaf, Beethoven toward the end of his life was almost totally blind and had an assortment of gastrointestinal ills, liver and kidney complaints, rheumatic problems, mood disorders and some behavioral problems. Neurosarcoidosis, a disease not even identified in the early 19th century, "could explain many features of Beethoven's medical history and particularly his deafness." Drake said doctors still do not know what causes the disease, but neurosarcoidosis damages multiple organ systems, including the central nervous system.

Drake likes to speculate on what would have happened if Mozart and Beethoven had had modern medicine available to them. He suggests that George Bernard Shaw, in his early days as a prominent music critic, may have been correct that Beethoven's musical thought was influenced by his "giant moods." They might not have been there, had he received today's therapies.

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