Wednesday, April 30, 2014

The Eyes of Bach and Handel

This essay was originally written for the  internet website, Only Opera  (www.onlyopera.com)


George Frideric Handel and Johann Sebastian Bach were two towering figures of the Baroque. Coincidently, they shared the same birth year, 1685, were both born in Germany, and only a month apart. Handel’s Messiah is an operatic oratorio, like his operas Giulio Cesare, Rodelinda and Alcina. Johann Sebastian Bach’s b minor Mass is a grand and operatic work of depth, breadth, texture and complexity. But something else united these two Baroque masters. That other bond between these two musical giants was that they both suffered visual loss at the end of their lives, possibly cataracts, and both may have had eye surgery by the same charlatan surgeon who went by the name, The Chevalier John Taylor.
It is the following excerpt from the autobiography of the Chevalier John Taylor that has catalyzed this essay on Bach and Handel and their failing eyesight:

“I have, at Leipsick (Leipzig), seen a celebrated master of music, who had already arrived to his 88th year, and who received his sight by my hands; it is with this very man that the famous Handel was first educated, and with whom I once thought to have had the same success, having all circumstances in his favour, motions of the pupil, and light, &c, but upon drawing the curtain, we found the bottom defective, from a paralytic disorder.” (ref.1)

The “celebrated master of music” was, of course, Johann Sebastian Bach, who was likely 65 and not "in his 88th" year when Taylor met the composer. Handel was not educated by Bach. The two likely never met, although Bach tried several times, was very fond of Handel’s music, and copied some of it out. Taylor did treat Bach, but it is not as clear whether Taylor operated on Handel, although the last clause in the excerpt above makes this writer think that Taylor may have treated Handel, as we shall see.                                                 
                                                 *****
The Chevalier John Taylor was born in 1703, the son of a surgeon of the same name. He studied at St Thomas’ Hospital under Professor William Cheselden.  Taylor decided to specialize in eye diseases, and soon thereafter proclaimed himself an ophthalmiater(a neologism that Taylor  himself coined, to mean  an “eye physician”). He became the self-proclaimed oculist (ophthalmologist) to King George II and the pope. His motto was "in optics, expertissimus!"

The Chevalier John Taylor (1703-1772)
Taylor was an itinerant surgeon, and for the most part, despite his medical training, a charlatan.  He coined the expression, Qui visum visam dator He who gives sight, gives life.He jumbled this correctly written Latin motto into a grammatically garbled, “qui dat videre dat vivere,” and put the quote on the canvas side of his horse-drawn wagon, which was everywhere adorned  with painted eyes, and from which he would bring out the nostrums and elixirs of his charlatan trade and feign to cure the visually impaired.  
Taylor would go from town to town, treating the blind, and if he diagnosed that they had cataracts (a clouding of the crystalline lens with age), he would “couch” the cataracts from patients so afflicted. Then, he would skip town before the almost inevitable consequences of eye surgery at the time (bleeding and infection) came to pass. According to scholarship by Professor Richard Zegers of the University of Amsterdam, the Chevalier Taylor once confessed that when he started practicing in Switzerland after medical school, he “blinded hundreds of patients.” (ref.2) 
Cataract surgery in the 18th century was not the remarkable, world-wide success story that it is today. With incisions smaller than an eighth of an inch, modern-day cataract surgery is a triumph. Cataracts are removed by ultrasonically emulsifying them.  Through the same minute incision, a foldable plastic lens implant is unfolded in the eye to restore and improve eyesight. Cataract surgery is the most commonly performed of all surgeries and, using benefit-risk and outcome metrics, the most successful.
In Taylor’s era, however, there did not exist the finely detailed technology we have now. Back then, oculists waited for cataracts to become mature, or “ripe,” then went inside the eye (without anesthesia!), and, using a small, sharp hook or lance, pushed or depressed (“couched” ) the cataract into the the fluid in the back of the eye called the vitreous humour, and ideally, though not always, out of the pupillary axis, thus allowing light to re-enter. This was now unfocused light which got into the back of the eye and the retina. Thus, the patient still needed glasses (those strong, thick, “coke bottle” glasses) to restore some form of clear vision.
Johann Sebastian Bach (1685-1750)
Johann Sebastian Bach was born in Leipzig in 1685. He became a renowned composer of church and organ music, cantatas and concertos, composing over 1100 works. Apparently, Bach's only infirmity was his vision. 
Bach was said to have had “naturally bad vision… weakened by a lot of study.” (ref.2)
If Bach were nearsighted (myopic), which is likely, it was not very severe, as he was able to sit at the organ for extended periods of time over the course of years and read music without glasses. He also had very narrow eyelids, which has been noted in much of the vetted portraiture (see above).
Because of his failing eyesight, likely due to cataracts, Bach was introduced to the Chevalier John Taylor, who, in 1750, performed two operations on the composer. Bach may have experienced some improvement after the first operation, but it is evident from the newspaper articles of the day, which still exist, that after the second operation (and it is not clear if one or both eyes were operated upon in the second intervention), he became “completely” and bilaterally blind. The adverb “completely” is subject to interpretation, and “complete blindness" to a layperson is not the same thing as “complete” or "total" blindness is to an ophthalmologist. To an ophthalmologist, that would be no light perception.
A few days after the surgery, Bach was not only unable to see, but he became quite ill. He developed what was described as a hitziges Fieber ( a non-specififc term which translates as a “burning fever”). He lingered on for a few months and died on July 28, 1750 at 6:15 PM, at age 66. (ref. 2)
It has been postulated that Bach developed either an eye infection from the surgery, or an increase in intraocular (eye) pressure, and  a subsequent stroke. 
It is not clear that the eye surgery was directly causal to Bach’s demise. As Professor Zegers posits, Bach lived about four months after the eye operation, and an endophthalmitis (an infection of the inner tissues of the eye), if it had gone into the central nervous system to cause a septic meningitis, would not have taken four months to cause a fatal infection, but would have occurred much sooner. (ref.2)
                                               
Georg Frideric Handel (1685-1759)
Georg Frideric Handel was born in Halle, Germany in 1685. After a wondrous tour of Italy between 1705 and 1709, where he became informed by Italian operatic style, he thereafter settled in England, where he continued his employ under George I, who had preceded him to the island kingdom a few years earlier.
In 1751, at the age of 66, and after four decades of extraordinary success in opera and oratorio, Handel began noticing changes in his eyesight. There is no direct documentation that Handel was seen or cared for by the Chevalier John Taylor, apart from Taylor’s own writings (see above). 
It is difficult to know exactly what specific disorder may have caused Handel’s visual loss. Some scholars insist that Handel had cataracts, because there is evidence that he had these putative cataracts “couched” lanced, pushing them out of the central pupillary axis). 
According to the Chevalier Taylor, he performed these procedures on Handel on several occasions. If this is the case, then Handel’s medical history mimicked J.S. Bach’s. Fortunately for Handel, despite unsuccessful surgery to both eyes, he lived a few more years after the operations.
A closer reading of Handel’s personal correspondence makes it clear, however, that the visual loss he sustained was not only initially monocular, but binocular, and his loss of sight in each eye consecutively, was abrupt.
The rapid loss of sight implied in the correspondence implies that Handel may not have suffered from cataracts, since cataracts do not cause sudden visual loss. Therefore, despite the bombastic pronouncements and rodomontade by the Chevalier Taylor that Handel had "cataracts," it is more likely that he sustained a sudden loss of blood, or “stroke”, to the ophthalmic artery of each eye, from an entity called anterior ischemic optic neuropathy (AION).
In closely reading the excerpt from the Chevalier Taylor's diaries, that last clause gives a clue, ".....but upon drawing the curtain, we found the bottom defective, from a paralytic disorder."
"Upon drawing the curtain" is a metaphor to imply that, "upon removing the cataract" (if it existed), Taylor evidently did find that the "bottom" (or "fundus" the back of the eye, where the retina and optic nerve are) was defective,  "from a paralytic disorder." This could have meant the consequences of sudden blood loss or "stroke."
In those days, the concept of  a stroke to a target tissue or organ was not as clearly understood, although the brilliant English physician William Harvey had made great discoveries in that regard a century earlier, in his monumental Du Motu Cordis (On the Motion of the Heart) of 1628.
A sudden loss of blood ("stroke") of the ophthalmic artery, the major blood vessel serving the front or anterior part or head of the optic nerve, causes the tissue in that crucial location  to die (infarct) from lack of blood flow. AION can be associated with other systemic illnesses such as rheumatoid arthritis, and present with headaches, myalgias, arthralgias and anorexia.  Handel's age of 66 years at that time is consistent with case studies of AION, whereas it would be a bit young for someone to have significant visual loss from cataracts. 
It is also of note that AION is more common in those with Scandinavian or German heritage. Handel, born in Germany, fit this demographic risk factor as well. On August 5, 1752, The General Advertiser of London reported: “We hear that George-Frederick Handel, Esq., the celebrated Composer of Musick, was seized a few Days ago with a Paralytick Disorder of the Head, which has deprived him of Sight."
 Statue and Memorial of G.F. Handel  with
"I know my Redeemer Liveth" from Messiah
           by Louis Francois Roubilia         
   Westminister Abbey  unveiled in 1762)
After he lost his vision, Handel's general health inexorably declined through the last eight years of his life. He became more religious, more introspective, and retreated into a cocoon of solitude and silence. Although he still played the organ and acceded to conduct the occasional Messiah, Handel's overall compositional style changed. He went on to complete the oratorio Jephtha in 1752, but that was to be his last work in the genre.  Handel's days as a composer of opera were long past as well; his last opera, Deidamia, premiered in 1741. He died on April 14, 1759, at the age of 74, a justly famous and widely admired cultural icon, having never married. He was buried in Westminster Abbey. He left his estate to his niece, Johanna, and also, as per four separate codicils, to his friends, his servants and several charities.
Posterity has been a most grateful beneficiary of the works of both J.S. Bach and "Mr. Handel." Their rich musical creations are a trove extraordinary in quantity and quality. Despite their visual impairment, Bach and Handel retained a wondrous auditory capacity, through which they conjured and created a sublime musical legacy.

©2014 Vincent P. de Luise MD FACS

1. D.M. Jackson. Bach, Handel and the Chevalier John Taylor, Medical History, 12: 385-393, 1968.

2. R. Zegers, The Eyes of Johann Sebastian Bach, Archives of Ophthalmology, 123: 1427-1430, 2005.

         

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