Elizabeth Colledge 
Jacksonville, Florida, United States

Admirers of Andrea del Verrocchio’s painting Tobias and the Angel (circa 1470–1475) may be unaware of the purpose of Tobias’s journey with the archangel Raphael. The Book of Tobit in the Apocrypha posits a story of love and not-so-miraculous healing in seventh century B.C. Nineveh.

Tobit, a devout Hebrew, suffers from a blinding whiteness in his eyes that he attributes to accidental contamination from the droppings of sparrows. Previously, he had left some silver with his relative Gabael in Media and wants to send his son Tobias to redeem it. Tobit hires a kinsman named Azariah (in actuality the archangel Raphael) to accompany Tobias. They depart, and one evening Tobias, bathing his feet in the Tigris River, encounters a large, aggressive fish. Azariah instructs him to capture the fish and remove the liver, heart, and gall bladder, the first two organs as remedies for banishing demons and the third as a salve to anoint eyes blinded by a white film.

Soon afterward, Tobias encounters and marries the widow Sarah, whose previous seven husbands were killed by demons. As instructed by Azariah, Tobias burns the liver and heart of the fish, the smoke of which drives away the demon, enabling Tobias to marry Sarah. Subsequently, Tobias, eager to see his father, returns home with Sarah and Azariah, and rubbing the gall of the fish on his father’s eyes, heals his blindness: “. . . and the white films scaled away from the corners of his eyes; and he saw his son” (possibly the origin of the expression, “The scales fell from his eyes,”). When Tobit attempts to recompense Azariah, the angel reveals himself and ascends into the heavens.¹

Couching through the use of fish bile (from the gall) was a common practice at the time. One theory from the British Journal of Ophthalmology (1995) argues that Tobit had developed cataracts, and in rubbing his eyes, dislocated the lens.² This reinforces an earlier (1931) proponent of this theory.³

A more recent theorist attributes Tobit’s infection and subsequent blindness to a form of conjunctivitis, Chlamydia trachomatis, prevalent in the Middle East in both ancient and recent times. Despite the irritating factors of bile (or perhaps because of it, in homeopathic terms), it remained a treatment for bacterial trachoma in the eye for over two thousand years. Cornelius Celsus, the first-century author of the Roman encyclopedia, recommended goat’s bile for the treatment of trachoma and also gave a detailed description of couching for cataracts. Well into the sixteenth century, the followers of Paracelsus continued to treat trachoma with varieties of bile, even though in general, Galenian Roman medicine had been abandoned. It was not until twentieth-century discoveries of the relationship between bacteria and trachoma and the efficacy of antibiotics that the treatment significantly changed. As recently as 1949, May’s Manual of the Diseases of the Eye prescribed “irritating applications” in the treatment of trachoma.⁴

Modern retrials with bile are unlikely, due to advances in treatment for these conditions. Unplanned couching does sometimes occur through trauma, with cataracts accidentally displaced. The story of Tobit presents a medical narrative with alternate routes: successful lens manipulation of cataracts or effective treatment of bacterial trachoma through the use of an irritant, in this case fish bile.

In Verrocchio’s Tobias and the Angel, Tobias bears the fish suspended from cords in his right hand, while the archangel Raphael carries the organs in a small box. Raphael, whose name comes from the Hebrew “God heals,” served as the guardian angel of healing and medicine, as well as the protector of travelers. The National Gallery of London notes that the painting was reworked by Leonardo da Vinci. Authorities including Oxford art historian Martin Kemp⁵ and David Alan Brown of the National Gallery in Washington⁶ have reinforced this attribution, which makes it a rare extant example of an artwork partially completed by Leonardo.

Tobias and the Angel moves us spiritually and emotionally. As the shape of Tobias’s cloak echoes that of the angel’s wings, their steps fall in synchronization. Linked arms and Tobias’s fingers resting on Raphael’s hand further suggest the bond between them. A little dog trotting alongside humanizes the picture even further. In light of all of this, the story of the curing of Tobit’s blindness with fish bile might be less miraculous and more in accord with contemporary medical practices. As for the burning of the fish heart and liver to drive off demons, science has yet to make a final determination.

References

1. Littman, Robert J. Tobit: The Book of Tobit in Codex Sinaiticus. Leyden-Boston: Brill; 2008.
2. Swan, H.T. “An ancient record of ‘couching’ for cataract.” J R Soc Med. 1995 Apr; 88.
3. Thomson, Ernest and James, R.R. “The blindness of Tobit.” Br J Ophthalmol. 1931 Sep, 15; 9: 516-518.
4. Johnson, Horton A. “Fish bile and cautery: trachoma treatment in art” J R Soc Med. 1998 Jan; 1:30-32.
5. Kemp, Martin. Leonardo: Revised Edition. Oxford: Oxford University Press; 2011. p. 251. ISBN 978-0-19-958335-5.
6. Brown, David Allan. Leonardo da Vinci: Origins of a Genius. New Haven and Yale: Yale University Press; 1998. ISBN 0-300-07246-5.