What Did the Great Master Bach Die From?

To the Editor:

I am writing to convey some of my opinions related to the reason of death of Johann Sebastian Bach, the great master of Baroque music.

Bach has the typical look of a metabolic syndrome patient in the pictures depicting his later life. He is overweight and his abdominal circumference is rather large. We learn from the memoirs of his second wife, Anna Magdelena,1 that Bach was quite a trencherman. He had a big appetite, particularly for food of animal origin. He enjoyed smoking tobacco and excessively consuming alcoholic beverages. His eating habits and the appearance in his pictures suggest the presence of diabetes. It is said that he was a rather picky, fastidious, and obstinate person. He was also diligent.

His wife's memoirs and many sources mention that he had impaired vision.1, 2, 3, 4 This is why he had eye surgery. Interestingly, some defined the English surgeon, John Taylor, who performed the operation on Bach's eye, as a charlatan and some others believed that he was a famous doctor.3, 4 Bach died from a stroke at the age of 65, about 4 months following the eye surgeries.

It is reported that John Taylor used a large amount of mercury as an antiseptic during the operation, in case of inflammation.3 Moreover, some substances that could be sources of infections were administered postoperatively. After the failure of the first operation, he had a second surgery. During the postoperative period, in addition to drawing blood for treatment, harmful substances in Bach's body were tried to be excreted by administering laxatives.1, 3 Some substances containing mercury were being used as laxatives at that time. His wife argues in her memoirs that some medications were used, the nature of which is unknown.1 Local physicians perhaps also administered mercury preparations to heal the infection in his eye. It is simply impossible to know what these were.

Another interesting point is that John Taylor had operated on George Frideric Handel, which resulted in failure, too.5 He performed the operation in August 1758 and Handel died from a stroke in April 1759, at the age of 74. In fact, Handel was older and had another stroke previously. However, it is an interesting coincidence that just like Bach, he died soon after the eye operation. Perhaps the medications, such as mercury, accelerated the process leading to stroke and death.

Feibel6 suggests that although they never met, these two great masters shared a physical contact through the operations by the same surgeon's hands. I take this hypothesis a little further. Both composers were born in the same year. They were both overweight and had similar appearances. They enjoyed food, smoking, and alcohol. They both experienced eyesight problems and suffered from them at the end of their lives. It is an amazing coincidence that even though unknowingly, John Taylor set up the process leading to their shared destiny and contributed to the similarities between the two.

Mercury is a highly toxic metal depending on its dose and composition. It can enter into the body through the skin, mucosa, gastrointestinal system, or inhalation. Overdosage of mercury has been shown to play a role in hypertension, atherosclerosis, and stroke in several studies.7 Whether mercury had a role in the chronic processes that developed in Bach and led to stroke remains a mystery.

Bach had severe eye and headaches in his last months. He had a stroke in his last days and his temperature was elevated.2, 3, 4 We do not know the exact characteristics of his headache. Could it be possible that chronic hypertension caused the acute attacks? Could severe stress, depression, and use of mercury have triggered the hypertension attacks? Did the fever observed in his last day occur as a result of intracerebral hemorrhage or an infection? These questions are difficult to answer. However, his dying on the last day right after the stroke brings to mind severe intracerebral hemorrhage caused by hypertension. Certainly, a thromboembolic event caused by a major cranial vascular obstruction could have led to his death. All the risk factors for the development of atherosclerosis were present in Bach.

I would like to respectfully memorialize Johann Sebastian Bach, who lived longer than his contemporaries and in the circumstances of that time. His music has added colors to our mere lives throughout the centuries.