Looking at medical malpractice through Bach’s eyes (Part 1)

1752_DavielJohann Sebastian Bach, the great German composer and musician of the Baroque period, enjoyed good health for most of his life, but died, completely blind, less than four months after undergoing eye operations for what seemed to be cataracts at the hand of a travelling English eye surgeon, John Taylor, who was as well known for his eye surgeries as he was for his womanising and puffery.

Although Bach may have been suffering from Myopia (near sightedness), it was only at an older age that he developed cataracts. In addition, another kind of painful eye disease may have added to his worsening vision to the extent that Bach decided to have his eye operated on by the famous oculist, “Chevalier” John Taylor, who happened to be in Leipzig, Bach’s home town, at the time of his decision. In a biography of Taylor dated 1898, author Henry Jones wrote of Taylor that “…never was the art of Puffing displayed to such perfection…” and that Taylor was “…an instance of how far impudence will carry ignorance.”

Two eye operations were subsequently performed on Bach’s eyes by Taylor in 1750. The first operation that took place between 28 and 31 March 1750 was Taylor’s standard couching procedure, used for treating cataracts by displacing the opaque lens inferiorly into the vitreous, with the second operation performed between 5 and 7 April 1750, resulting from the reappearance of the cataract.

To put Taylor’s treatment of Bach’s cataracts in context one must briefly consider the history of cataract surgery.

Cataracts were very common in antiquity and comes from the Greek word kataráktēs meaning the fall of water and were treated with eye ointments and magic spells by the old Egyptians. The ancient Egyptians were also credited with the first surgical treatment of cataracts by couching the lens into the vitreous cavity as depicted in a wall painting in the tomb of the master builder Ipwy at Thebes (about 1200 BC).

cataract

Couching as method for treatment of cataracts was first described by an ancient Indian surgeon, Maharshi Sushruta in Sushruta Samhita, Uttra Tantra (800 BC) an Indian medical treatise. This method then spread to the western world by Greek travellers coming from India and the Middle East where the first indication of this method being used in the West was found in De Medicinae (29 BC), the work of a Latin encyclopaedist Aulus Cornelius, which also describes the couching operation.

The relatively simplistic method of the couching technique was probably the major reason for it being used as the procedure of choice for thousands of years until 1748 when a French ophthalmologist, Jacques Daviel, performed the first successful cataract extraction surgery whereby the lens could be removed by suction through a hollow instrument on 8 April 1747. This method was already described by the 10th century Persian physician Muhammad ibn Zakariya al-Razi, who attributed it to Antyllus, a 2nd century Greek physician.

The couching procedure was also mentioned in the articles of the Code of Hammurabi (1792-1759 BC), a celebrated codification of the laws that governed Babylonian life. This code contained 282 laws and did law 196 specifically stated that: “If a man put out the eye of another man, his eye shall be put out.” The governance of medical outcomes in this codes give an indication of a highly organised society where medical care was regulated. A number of these laws dealt with issues relating to the eye which is a further indication of the state of ancient ophthalmological knowledge. Penalties stipulated in the code for “medical malpractice” varied with the economic status of the patient.

If a doctor operates…on the eye of a patrician who loses his eye in consequence, his hands shall be cut off.

In the case of a slave, if the surgeon has caused his death the penalty was to replace him by another, and if he made the slave lose his eye, he shall pay half his value.

Subsequently, at the dawn of civilisation approximately 4 000 years ago, the Code of Hammurabi already laid the foundation for the concept of managed medical care and is considered to be the genesis of modern day managed care.

Taylor also performed the ancient method of couching on Bach, notwithstanding the fact that Daviel performed successful cataract extraction surgery three years prior to Taylor operating on Bach. However, Taylor allegedly confessed to blinding hundreds of patients, including the Baroque composer, George Friedrich Händel, whilst working in Switzerland. In an era where the only anaesthetics were alcohol and opiates, Taylor’s postoperative care were questionable at best. He regularly combined couching with local irritation of the eye by repeated incisions and cataplasms with excessive use of dubious methods such as bleeding and covered wounds he made with a bandage that increased the risk of infection and were patients only allowed to remove the bandages after 5 to 6 days when Taylor had already moved on to the next town to operate on new patients. Taylor’s arrival in a new town, which would be publicised prior to his arrival, was always marked by the delivery of along self-promoting speech to draw as big a crowd as possible.

Biographies of Bach indicated that Bach fell ill after the second operation performed by Taylor, experienced painful eyes and was completely blind, which blindness is compatible with most of the possible post-operative complications resulting from the above, especially ones involving inflammation and/or secondary rise of pressure in the eye. Bach never recovered, suffered a burning fever (hitsiges Fieber), which is consistent with infection, and died less than 4 months after the second operation.

Continue to Part 2 >