|
|
Richard Zegers, MD
The 1748 painting of Bach by Elias Gottlob Haussmann
The Young Bach
Bach’s only physical problem seems to have been his vision. His eyes had
“naturally bad vision” (Sein von Natur blödes Gesicht), and “this was further
weakened by a lot of studying, sometimes even all night long, especially during
his youth.”
Myopia has been suggested by several authors on the basis of Bach’s appearance
in the Haussmann painting, which shows “the vertical furrows running upward from
the bridge of the nose as well as the narrowed eyes, the result of
myopia.” The word myopia is derived from Greek and means “squeezing.”
However, other refractive errors such as hyperopia and astigmatism can also
cause narrowing of the eyelids.
Myopia is generally preferable to hyperopia, since myopic people have
adequate near vision. For a musician who has not yet matured and is
still mastering his art by extensive note reading and writing, near
vision is essential. This suggests that Bach was probably myopic.
Hyperopia or astigmatism would have been much less compatible with his
daily activities. Furthermore, Bach was at risk for myopia; as he was a
scholastic success (one of the best students in his school, and he even
skipped a year), he performed a lot of near work and he read
considerably.
Bach’s myopia can only have been moderate. With a refractive error of −2 D, his
far point would have been 50 cm. A higher refractive error of, for example, −5 D
would have given Bach difficulty playing the church organ, his favorite
instrument. He used both feet for playing the pedals of the church organ, and
this required leaning back on the seat to free the legs for this action. Bending
forward to read a music score at the church organ while also using both hands at
the keyboard calls for at least one foot on the ground to maintain balance; the
greater the refractive error, the worse this problem would become. Recognizing
faces on the street certainly would have been a problem for a moderately myopic
individual in the era before spectacle correction. Spectacles could have solved
this problem, but the use of spectacles for anything other than reading was not
widespread until a century after Bach’s death. Biographies do not mention the
use of glasses by Bach at all.
Amblyopia is another theoretic possibility, but there is no evidence to support
this. Bilateral amblyopia from severe hyperopia or astigmatism is also a
theoretical possibility, but it would have also impaired near vision. Bilateral
amblyopia due to myopia is exceedingly rare, but some near vision might be
retained.
Bach in his Old Age
It seems that in general Bach was in good health, except in his final
year. Considering the amazing amount of music he wrote, the almost
continuous demand for performances, the care of the 20 children he had
with his 2 successive spouses, his concern for numerous students who
lived in his house, and the vigorous appearance of Bach in his 61st year
in the Haussmann painting, it is most unlikely that he could have
suffered any serious or chronic diseases. Furthermore, biographies
explicitly mention Bach’s strength and healthy constitution: seinen
übrigen noch sehr muntern Seelen—und Leibeskräften (his lively soul—and
body strengths).
The only known period of sickness occurred between 1730 and 1740, when Bach had
to cancel a journey to Halle, Germany, to meet George Frideric Handel, a
contemporary composer who was also born in 1685. Nothing is known about the
nature and duration of this illness. Additional information about Bach’s
physical appearance is given by the Haussmann portrait, which shows that Bach
was obese.
Another striking feature is his narrowed eyelids. A closer look seems
to give the impression of dermatochalasis; this has no serious clinical
implications except that it can sometimes restrict the superior visual field.
Detail of the eyes of Bach according to Haussmann, 1748
According to his contemporary biographies, Bach’s eyesight deteriorated as he
aged. There are many possible explanations for this, with cataract being the
most logical. There are no clues suggesting or excluding other diseases, such as
glaucoma or age-related macular degeneration. It seems unlikely that his vision
deteriorated as a result of a sequela of myopia, because his myopia seems to
have been only mild.
The Operations
During the last year of his life, Bach’s vision became so poor that he decided,
after persuasion by his friends, to have his eyes operated on. Two operations
were performed in 1750 by the traveling English ophthalmiater “Chevalier” John
Taylor (1703 or 1708-1772), who happened to be in Leipzig.
Taylor had completed a surgical training in England; he also attended lectures
by Hermann Boerhaave in the Netherlands and learned the art of couching from
Jean Louis Petit in France. After his training, Taylor started practicing in
Switzerland, where he blinded hundreds of patients, he once confessed. During
his working life, he spent most of his time traveling around in a coach painted
all over with eyes and the words qui dat videre dat vivere (giving sight is
giving life). His travels took him over the greater part of Europe and beyond,
to Russia and Persia, where even kings and emperors were among his patients.
More than once he was robbed and almost killed during his travels. Taylor knew a
lot about ophthalmology and left scientific articles in several languages. He
was the first to describe keratoconus, which he also illustrated in a
recognizable way. In the surgical approach to strabismus by means of cutting an
eye muscle, he was ahead of his time. This made Taylor a rare combination of a
man of serious science and a charlatan in daily practice.
Impression of couching in the 18th century, showing the surgeon and a helper to hold the patient tightly, as was necessary in the preanesthetic era (Lorenz Heister, 1718).
Patients in the second half of the 18th century were operated on while seated
upright in a chair and held tightly by a helper, who made sure the patient did
not move at crucial moments in this era without anesthetics being in common use. The only anesthetics were alcohol and opiates. Taylor was known to
use a spatula to press the upper eyelid against the orbital wall, a technique
used by other surgeons as well. By pressing the deep tissues of the superior
orbital quadrants through the upper sulcus with this spatula, it would be
possible to achieve some anesthesia. Parts of the nasociliary nerve or its
branches that form the short posterior ciliary nerves were damaged. These latter
nerves supply sensory innervation to the cornea, iris, and corpus ciliare, and
hence some pain was reduced in these areas. A resultant advantage to this
approach was fixation of the bulbus.
Because Taylor was right-handed, he preferred operating on the left eye of the
seated patient, even if this was the healthy one! Even physicians in his time,
such as Eschenbach, who wrote a whole book about Taylor and his operations,
criticized this approach. Taylor’s habit of covering the wounds he made with a
bandage was also criticized because it increased the risk of infection. Patients
were allowed to remove the bandage only after 5 to 6 days, when Taylor had
already moved on to the next town to operate on new victims. Often he charged
exorbitant amounts of money for these interventions, depending on the wealth of
the patient. If they were not able to pay cash, he also accepted valuables like
gold watches.
The first operation on Bach took place between March 28 and 31, 1750, and the
second one was performed between April 5 and 7. Most likely the first
operation was Taylor’s standard couching procedure, which took him 9 pages to
describe in his book Cataract and Glaucoma (1736). In this operation, an
incision a little larger than 4 mm was positioned about 3.5 mm posterior to the
limbus. With a planoconvex needle, the posterior capsule was opened and followed
by anterior and downward movement of the needle so that the opaque lens was
displaced inferiorly into the vitreous. In the dissertation by Johann Philipp
Schnitzlein dated 1750, this technique of cataract surgery is illustrated by an
artist’s impression.
Ideal method of couching by toppling and pushing down the lens via a posterior (scleral) approach, according to J. P. Schnitzlein in his 1750 dissertation.
About one week after the first operation, Bach had to be operated on again because
of a reappearance of the cataract (wieder aufgetreteten Stahrs). It is
possible that the couching was followed by an anterior displacement of the lens,
pupillary block, and glaucoma.
What exactly took place during the operations will never be known, but Taylor’s
general approach included bloodletting, laxatives, and eyedrops of blood from
slaughtered pigeons, pulverized sugar, or baked salt. He sometimes made
periocular incisions, which then were covered with bandages that incorporated
baked apple or a coin. In cases of serious inflammation, Taylor prescribed large
doses of mercury. This all took place in the preantiseptic era. Many painful
and/or vision-reducing complications could have been induced by these
intraocular operations: uveitis or endophthalmitis, secondary glaucoma,
hemorrhage, retinal detachment, and even (after 4-8 weeks) sympathetic
ophthalmia.
We will never know whether Taylor operated on one or both eyes on both
occasions. He may have operated the second time because the result was not quite
as he wished the first time, or he may have operated on the second eye on
another date just as these days we operate on the 2 eyes with an interval.
According to the newspaper Vossische Zeitung (1750, No. 41), Bach was able to
see much better after the first operation, supporting the suggestion of cataract
displacement giving a little or some improved vision. However, the newspaper
might have been influenced by Taylor himself, who had a very well-developed
sense of public relations and who often advertised in local newspapers to
announce his arrival and miraculous operations.
The biographies indicate that Bach was completely blind after the second
operation, and that he felt ill and experienced painful eyes. However,
Forkel stated that Bach’s eyes were painful even before the operations took
place. Since Forkel wrote his biography more than half a century after Bach had
died and gained most of his information indirectly, it seems possible that this
description was erroneous.
The blindness and pain after Taylor’s interventions are compatible with most of
the possible postoperative complications described, especially the ones
concerning inflammation and/or secondary rise of pressure.
Because Bach was “completely blind” after the second operation, it can be
postulated that this was due to operations on both eyes. This is a possibility,
but it is also possible that one eye was already (almost) completely blind
before the operations took place. If this was true about his right eye, he could
indeed have lost vision completely by Taylor’s preference for operating on the
left eye. Furthermore, the expression completely blind used by medical laymen
who wrote his biographies might not have been the interpretation of modern
ophthalmologists.
Bach never recovered fully after the operations. The sources mention a sudden
return of his vision a few days before his death, which was followed by a
stroke. This was followed by hitsiges Fieber (burning fever), leading to his
death on July 28, 1750, at 6:15 PM, in the 66th year of his life, despite the
care of two of the most skillful physicians in Leipzig. Bach died less than 4
months after his final operation.
A sudden, brief, spontaneous return of his vision seems unlikely after a
prolonged period of inflammation and/or elevated intraocular pressure. It may
have been a hallucination or the Charles Bonnet syndrome, in which patients
experience complex visual hallucinations. This syndrome is associated with
impairment or loss of vision due to deafferentation that causes sensory cortex
to exhibit spontaneous independent activity with resultant conscious imagery.
Stroke in those days was a nonspecific term and may have indicated merely that
Bach lost consciousness.
The fever suggests an infection. It is very difficult to make a clear connection
between the operations and the illness that killed him. It seems unlikely that a
postoperative endophthalmitis would have smoldered for 4 months before causing a
fatal sepsis. Certainly the operations, bloodletting, and/or purgatives would
have weakened him and predisposed him to new infections.
It is also worth remembering that the old expression hitsiges Fieber has
been variously translated as “fever as convulsion of the soul” or “fever as
spasm of the blood vessels accompanied by tachycardia.”
Retrato de Bach, recentemente descoberto por Towe (2000) e proposto como autêntico
Bach was buried anonymously, as was Mozart, 3 days after his death, in a grave
without any obvious stone or mark, near the St Johannes Kirche in Leipzig. When
the church was rebuilt in 1894, the alleged mortal remains of Bach were reburied
in the church itself. After this church was heavily bombed during World War II,
the alleged remains were moved to the St Thomas Kirche in Leipzig, where they
still remain.
One can only speculate about the fate of this great composer. The only
inarguable fact is the body of music Bach left us, sounding still as fresh today
as it did the day he put it on paper. Whatever eye diseases Bach might have
suffered during his life, they never stopped him from creating divine music.
ϟ
The Eyes of Johann Sebastian Bach
Richard H. C. Zegers, MD
in
Arch Ophthalmol. 2005;123(10):1427-1430. doi:10.1001/archopht.123.10.1427
https://jamanetwork.com/
19.Fev.2023
Publicado por
MJA
|
