In late 1907 the Austrian painter Gustav Klimt stood at Vienna's railway station, woefully declaring, ‘It's over’ as the train taking Gustav Mahler on his journey ultimately to the USA pulled away. Mahler had just suffered the triple hammer blow of his anti-Semitic ousting from the Vienna Opera, the death of his beloved little daughter, ‘Putzi’, and the news of his potentially fatal heart condition. But it was not over. For his remaining nearly three and a half years, before the train brought him back to die in Vienna, further great music was to come, and in some ways it would be different music. From this vignette, the strong influence of both mental and physical health upon the process of composition is seen. It may be asked how Mahler died and of what disease. We can wonder how he managed at all, as other personal and professional problems overshadowed his remaining life. More questions arise from Mahler's story, as they do from medical accounts of many other great composers. These will be posed, and hopefully answered, within this book. There is, after all, a keen general interest in the influence of ill health upon famous men. The outcome from the meeting of the Big Three at Yalta, so crucial for the world today, might have been very different if Roosevelt had not been close to death. By the same token, this book will consider how prevailing sickness affected both the quality and quantity of composition; was it because of, or in spite of, that illness? The nature of the music and how different Western music would be now if a particular composer had lived longer will be considered. For the person interested in classical composers and their sometimes dreadful deaths, and in the relationship between declining health and creative output, here is an overview.

At the outset it was vital to learn what had already been written on this topic. Not all musical authors have sought medical advice, just as doctors have sometimes neglected musical expertise.