Tchaikovsky's death in October 1893 in St Petersburg, shortly after the première of his sixth symphony, the `Pathétique', is one of the most thoroughly documented deaths of a prominent cultural figure in modern times. He was treated by no fewer than four physicians and surrounded by a group of relatives and friends. The official account of his death was that he died from cholera, possibly by drinking infected water, but almost since the day of his death there have been rumours that it was not accidental. It is alleged by some that Tchaikovsky either committed suicide or was murdered in order to avoid the scandal and disgrace of being unmasked as a homosexual.

Alexander Poznansky is the first Western scholar to have gained access to the Tchaikovsky archives in Klin, Russia. He provides much hitherto unknown documentary material - memoirs, diary entries, letters, and newspaper reports - and adds his own commentary on the status of homosexuality in nineteenth-century Russia and on the various conspiracy theories that have been advanced to account for Tchaikovsky's death. His conclusion is that there is no factual evidence to support the notion that Tchaikovsky's death was caused by anything other than cholera.