SURVEY OF OPHTHALMOLOGY VOLUME 50 � NUMBER 5 � SEPTEMBER–OCTOBER 2005

HISTORY OF OPHTHALMOLOGYMICHAEL MARMOR, EDITOR

Superstitions of George BartischDonald L. Blanchard, MD

Casey Eye Institute, Oregon Health Sciences and University, Portland, OR, USA

Abstract. George Bartisch was a 16th century German ophthalmologist who published the firstophthalmology textbook in the vernacular for laymen and non--university-trained practitioners. Histreatments and understanding of diseases rested firmly on Greek tradition, but he also was veryinvolved in the superstitions of the day. This essay looks at the man and his mores. Bartisch believedthat much of the suffering of patients had to do with sins they had committed, and that the devil wasthe active force in the world inflicting this punishment. Often, he believed, witches would carry out thedevil’s hexes, in the form of either hot or cold witchcraft. Bartisch also felt that astrology played a majorrole in the outcome of surgery. Because of that he practiced only during certain astrological signs, andin the proper waxing and waning phases of the moon. He also linked many common problems to sins.For example, presbyopia was presented as due to excessive use of alcohol. Glasses were to be avoidedbecause he felt they destroyed vision in themselves. Despite these superstitions and misconceptions,Bartisch was an honorable professional and his books give insight into the making of a goodophthalmologist. (Surv Ophthalmol 50:490--494, 2005. � 2005 Elsevier Inc. All rights reserved.)

Key words. astrology � Bartisch, George � glasses � Ophthalmodouleia � qualifications �witchcraft

When we consider our ocular heritage, GeorgeBartisch (Fig. 1) stands out as a monumental figure.In 1583 he published Ophthalmodouleia,5,6 which isthe first comprehensive ophthalmology textbookwritten in the vernacular for practitioners and headsof the household taking care of eye disease, ratherthan for the theoretically oriented, academic physi-cians with their Latin texts and disdain for surgery,especially eye surgery. He dedicated his book toAugust, the Duke of Saxony. For this Bartischbecame the court ophthalmologist and was soughtafter for ophthalmic problems by other Europeannobility. Being the court ophthalmologist allowedhim to practice in Dresden more of the time in hislater years. He also received certificates vouching forhis abilities, which allowed him privileged entry into

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� 2005 by Elsevier Inc.All rights reserved.

practice in various cities when he did travel.7,8 Herewe will deal with superstitions he discussed as theyrelate to eye disease.

Bartisch was a great compiler of information,rather than someone who brought out originalideas, and he described the then current super-stitions in detail. He, his patients, and the otherpractitioners who dealt with eye disease at that timeaccepted these superstitions.

In general the distinction between types ofmedical practitioners was less clear-cut at that time.In characterizing different practitioners, Bartischnoted that it was hard to distinguish between anexperienced barber surgeon and a simple barberinvolved in keeping a bathhouse, who did anoccasional bleeding, not to speak of the former rat

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GEORGE BARTISCH 491

catchers and the out and out scoundrels straightfrom behind the plow or just off the manure wagon.All these groups took on the treatment of ophthal-mic conditions, even surgery. Bartisch believed hehad advanced beyond these practitioners and de-scribed himself as an apprenticeship-trained woundsurgeon, lithotomist, and oculist. During much ofhis career he was an itinerant practitioner who hadan especial fondness for treating eye diseases, but hewould pull teeth, give worm medicine, or teacha class on surgical anatomy as the need arose(Fig. 2).

Witchcraft

Superstitions were commonplace and a potentforce throughout society in those days. Bartisch andthe other types of practitioners and their patientsbelieved in them wholeheartedly. Those of mostinterest to Bartisch in his texts though were thesuperstitions that particularly related to medicine.Devils, demons, sorcery, witches, astrology, amulets,hexes, and even the eye-destroying properties ofglasses were all real to Bartisch.

Fig. 1. George Bartisch, front portrait from Kunstbuch,1575.

The theory of disease, which Bartisch discussed,was wrapped up with a belief in forces of evil. It wasfelt that the devil was an active force in the world,and the devil had his evil spirits working among thepopulation. The humans who did the devil’s willwere mostly witches, and Bartisch spoke very harshlyabout them. After they had confessed, the govern-mental punishment was for them to be burned atthe stake until their bodies were totally consumed byfire. People were made to watch this, so out of fearthey would not become agents of the devil. Thework of witches was not random. The devil and hisagents especially chose sinful people to work theirsorcery on, and eye disease was thought to be thevirtueless person’s punishment for past sins. Thisunderlying theme pervades Bartisch’s texts eventhough most of the space is taken up with thegeneral medical and surgical treatments. In hisdiscussion of the various eye diseases he frequentlystarted by identifying the type of sin causing thatparticular disease. First the sinful ways needed to bestopped. Then he would use rather standardmedical means to help the patient. These treat-ments were in general the treatments that Galenand other Greek doctors had recommended andhad been used for centuries. If this failed he wouldthen recommend surgery if appropriate.

The form of diseases, which were most clearly dueto a person’s sinful ways and caused by sorcery,could be bizarre in the extreme. Without any prior

Fig. 2. Master demonstrating surgical anatomy.

492 Surv Ophthalmol 50 (5) September--October 2005 BLANCHARD

injury a swelling and drainage would occur, and inthe discharge would be found coals, hair, wood, orpieces of iron in the form of clothes pins and claspsof various types common at that time. These werespontaneously formed in the body of the personunder a hex. Bartisch himself details how he hadseen whole pears and apples extruding frompatients’ orbits (Fig. 3).

Bartisch distinguished two basic forms of witch-craft. These were hot and cold witchcraft. The hotwitchcraft was characterized by an onset thataccompanied a terrifying experience or bad dream.The patient developed a generalized hotness, whichthen centered in the eyes. There were intenseshooting pains, which went on day and night forabout 9 days. Finally the eyes burst and were totallyruined and became as nothing. If this kind ofproblem was identified in its early stages, Bartisch’sfirst treatment would be to have the patientrenounce his sinful ways, then he would use eye-washes made from the heart and liver of a badger,the blood of a unweaned puppy, and deadlynightshade. It is easy to speculate on some beneficial

Fig. 3. Witchcraft with ‘‘pears’’ extruding from orbits. Atupper right, clothes pins supposedly formed in patient’sbodies from witches’ hexes.

effect of the extracted belladonna from the night-shade if a case of hot witchcraft were actually uveitis.A less-fortunate result could be anticipated if the hotwitchcraft were an angle-closure glaucoma attack.

Cold witchcraft began with chills and shivering.There was a roaring in the patient’s head. Thenswelling arose in the upper lids, sometimes to thesize of a fist. The patient felt as if his eyes were goingto fall out of his head. Death could follow.Treatment was with a topical salve made of theheart, liver, and blood of a raven, mixed with magpiefat, bear fat, and rose vinegar.

The wearing of opal or precious sapphire on theskin, and looking at them often, was thought to haveprotective value. Pendants and charms were used toward off evil directly, but also for the carrying ofprotective powders made from angelica root, saf-fron, and fennel. In addition to serving as pro-tection against a wide array of eye diseases, thesependants also were used specifically for the treat-ment of certain diseases. An appropriate set ofingredients was put in the pendant depending onwhat ailment the patient had. These pendants wereoften quite aromatic and merely smelling themfrequently was thought to be beneficial. Somependants even had attachments, one of which alsoserved as a tooth pick. Bartisch’s choice of treat-ments was conservative. He usually chose well-established treatment plans that had been aroundfor centuries.

Astrology

In the 16th century astrology was used extensivelyfor predicting the future and explaining conditionsin human life, and was widely applied to matters ofhealth and disease. The positions of the planets, thesigns of the zodiac and the phases of the moon hada large influence on Bartisch’s practice. He believedthat dreams could be interpreted by reference to theplanets and to astrological signs. This medicalastrology was most important to him for predictinggood results of surgery. He did not do surgery whenthe moon was new, waxing, or full. The best time foreye surgery was under the sign of Libra, withSagittarius and Aquarius only slightly less auspicious.Less good, but acceptable in dire cases, were Virgo,Scorpio, and Pisces. For their own gain, ‘‘vagabondsurgeons’’ disregarded these precautions and wouldoperate any time of the day or year. Bartisch felt thatthis was extremely unwise and that the poor surgicalresults of these vagabonds proved it. For everypatient that the vagabonds treated who turned outwell and happy, there were 10, 20, or more who wereruined. This obviously distressed Bartisch but he

GEORGE BARTISCH 493

realized that he could not expect all patients or allirresponsible practitioners to follow his advice. Hephilosophically added, ‘‘Many heads, thus also manythoughts.’’ It did however turn out that this limitedtime frame available for eye surgery was augmentedby Gemini and Capricorn being good signs for hisother role as a lithotomist operating on bladderstones.3,4 The good signs also conveniently fellduring special fairs in major cities where Bartischliked to set up shop.

Opposition to Glasses

The Duke had a hobby of wood turning, and as hegot older, he could not see detail well. After waitingfor months, his servant brought him glasses fromVenice with solid gold frames. Bartisch stronglyadvised the Duke against wearing the glasses sayingit was a habit that weakened the eyes. He felt that itwas a delusion that presbyopes thought thingslooked larger to them through glasses than withoutglasses. It was natural and absolutely apparent toBartisch that a person should see and recognizethings better without any lenses in front of his eyesthan with lenses. Giving fuel to centuries of jokesabout glasses he said, ‘‘It is much better for a personto preserve two eyes than that a person should havefour eyes.’’ Again he felt that the sinful ways of thepatient entered in to the causes for the decliningvision, and he cited drunkenness as the primaryreason. One can wonder how Bartisch broke thisnews to the Duke. Separate from this superstitionwas Bartisch’s recognition that the dimness of visionalso came with advancing age. As he said, ‘‘In oldchurches are dark windows.’’ Still speaking froma more traditional medical standpoint he men-tioned that excessive reading in dark chamberscontributed to the problem with near vision. Inaddition to abstinence from alcohol, he suggestedgetting out in the sun more and looking at soothinggreen trees at a distance and not looking at fine, upclose things. This would help a person’s faint, dimvision and protect him from the use of glasses. Alsohe recommended deer liver powdered up alongwith cinnamon and sugar. This was to be eaten inthe waxing of the moon. The extra vitamin A mighthave helped a small percentage of these patientswith dim vision.

Once a person had become accustomed toeyeglasses and had ruined his eyes, the treatmentwas an eyewash used during the waning of themoon. It was made of magpie gallbladders, wholeyoung sparrows, hen droppings, and orchids dis-solved in vinegar.

Ophthalmologists’ Qualifications

It is clear that Bartisch was a product of his timewith his superstitions and misconceptions; however,he was very well informed about the medicine ofhis day1,2 and was a dedicated and caring ophthal-mologist. In contrast to many of the itinerantpractitioners, Bartisch personally attended to thepostoperative care of his patients. He changed theireye dressings three times a day during the 12 daysneeded for a proper healing from the surgery forcertain types of cataract. He was also well aware thatsome patients might not survive his surgery, such aswhen he removed a cancerous eye with his sharpenucleation spoon. The enormity of this undertak-ing appalled him and only his faith, that he wasGod’s tool in the course of the patients’ disease,gave him the courage to take on the neededtreatment. He would go to church just prior to thesurgery, often in the company of the patient’srelatives, and say a prayer for the patient.

Since Bartisch thought of himself as an accom-plished ophthalmologist, he felt called upon todescribe in writing the qualifications and level ofcare required of an ophthalmologist. There was nosubspecialty in ophthalmology then, as we know ittoday, but Bartisch felt the best preparation was todo as he did. That meant serving an apprenticeshipwith a Master in ophthalmology, who generally alsodid hernia and lithotomy surgery. This was trainingbeyond what a barber surgeon had in these areas. Inthose days ophthalmologists often traveled exten-sively. There were established Master ophthalmolo-gists in the larger cities such as Dresden, but thesmaller towns rarely had a permanent ophthalmol-ogist. The itinerant ophthalmologists would go tothe smaller towns and see the people who had beenwithout eye care. Bartisch recommended that thetown fathers meet a prospective practitioner to besure he was worthy to start work in their town. Hefurnished a series of questions for the town boardand indicated who besides the town officials shouldbe there. There was to be a university-trained phy-sician, a wound surgeon, a barber surgeon, a lith-otomist, and if possible a local ophthalmologist. Themakeup of the committee depended on the size ofthe town and which practitioners were available lo-cally. The visiting ophthalmologist was to be quizzedabout his training and was to give the name of hisMaster. The local ophthalmologist was to ask himabout other well-known ophthalmologists in thetown where the visitor trained. This was to doublecheck that the visitor actually had trained there. Theapplicant presented the certificate of completion ofthe apprenticeship. It was appropriate at that timeto bring out patient testimonials and certificates

494 Surv Ophthalmol 50 (5) September--October 2005 BLANCHARD

from other cities. If he was also to practice lithotomy,he was to open his bag and show all the stones hehad removed during his training. They were to becounted to make sure that the number tallied withthe number certified in his papers. Once the townofficials were satisfied with his papers, the examineewas asked first of all, ‘‘What is an ophthalmologist?’’The correct answer was that he is a tool andinstrument for disease-afflicted mankind and a trueservant of nature. General questions about medicaland surgical ophthalmic treatments followed. Bar-tisch supplied the answers too for when a localophthalmologist was not available. The university-trained physician would examine the practitionerabout the medical uses of various herbs. The dex-terity of the ophthalmologist was carefully checked,to prove he was capable of eye surgery, and thena detailed examination of his character followed.This included determining that the applicantbelieved in the standard superstitions as presentedby Bartisch. The applicant was to have been raisedin a devout household and behave in a Christianmanner. An acceptable ophthalmologist was to bechaste and married, as well as sensible and diligent,especially in his art. He should willingly and happilyserve, help, and advise, whether the patient be richor poor. Also he should always tell the truth to thepatients and all mankind, and indicate whether itwas possible or not possible to help, as well aswhether the treatment was safe or unsafe. Noophthalmologist was to be drunken, lazy, morose,impudent, or praise himself as the best. Bartisch

said, however, that God in Heaven lamented therewere few such ophthalmologists to be found at thattime.

Conclusion

It has been over 400 years since Bartisch wroteabout beliefs that we now consider to be thesuperstitions of his day. We can only speculate whathistorians 400 years from now will have to say aboutsome of our own cherished beliefs.

References

1. Bartisch G: Theriac. Translated by D Blanchard, Portland,Oregon, Blanchard’s Books, 2000

2. Bartisch G: Warhafftige.des grossen Theriacks. 16023. Bartisch G: The Art of Lithotomy. Translated by D Blanchard,

Oostende, Belgium, Wayenborgh (in press)4. Bartisch G: Kunstbuch, in Mankiewicz O (ed): Berlin,

Germany, Oscar Coblentz, 19045. Bartisch G: Ophthalmodouleia. Translated by D Blanchard,

Oostende, Belgium, Wayenborgh, 19966. Bartisch G: Ophthalmodouleia. Dresden, Germany, printed

by M Stockel, 15837. Marre E (ed): Georg Bartisch: Augen-und Wundarzt. Dres-

den, Germany, Marre, 19858. Tower P: Notes on the life and work of George Bartisch. Arch

Ophthalmol 56:57--70, 1956

This paper was presented in part at the American Academy ofOphthalmology 2004.

Reprint address: Donald L. Blanchard, 10907 S.E. Azar Drive,Portland, OR, USA 97266.