As a surgeon, one of the most difficult body parts to operate on is the eye. Yet, ocular surgery was one of the most advanced fields of medicine in the ancient world. Eye disease was a disorder with a very high incidence in ancient times, and the urgent need for it fostered the extraordinary skills of ancient ophthalmologists.
For example, ancient Romans often suffered from ingrown eyelashes, or eyelashes that grew inward. The straightforward solution was to remove them: the eyelids were turned out and the disturbing lashes were removed with surgical forceps; a fine iron needle was then heated and inserted into the root of the eyelashes and cauterized to prevent them from growing back.
The removal of eyelashes was child’s play for the experienced Roman surgeon, but the techniques required to remove cataracts were not so simple. As now, cataracts were the most common cause of semi- and total blindness at the time. Removal of cataracts was the only treatment available at the time.
The “Golden Needle Extraction” was an operation performed by ancient Chinese medical practitioners for cataract eye disease. Patients with cataracts were usually able to see again after undergoing this surgery. The fact that this surgery was performed more than a thousand years ago cannot be considered advanced in the history of ophthalmology in the world.
The Roman physician Cornelius? Celsus, who lived during the reign of Emperor Tiberius (14-37 AD), wrote a medical work in which he described in detail a cataract extraction operation. As Celsus emphasizes, careful care was especially needed during the preparation phase. Once the preparations were all in place, the Roman eye surgeons were ready to get to work. Some doctors used sophisticated instruments such as the first-class tools found in the excavations at Montbélé, France. Two needle syringes and three other more common long needles with handles were found in a bronze case, and these extremely well-made needles were placed in syringes of the right thickness to be inserted and withdrawn. This discovery proves that the description of the complex steps of cataract extraction given by the Greek physician Galen in the 2nd century AD is true. By inserting this instrument into the lens and pushing the fine needle out of the syringe, the cataract was able to be broken. Once the needle is withdrawn, the surgeon uses the syringe to aspirate the debris and clean the lens.
Such high-quality instruments are certainly rare, and repeated probing with a probe to fragment the cataract makes the procedure risky unless it is performed by the most experienced surgeon. Celsus himself had recommended a different procedure, simpler but much more daring. The surgeon was able to push the cataractous lens completely out of its original position with an ordinary brass needle: the procedure Celsus described in detail is now called “cataract depression”. The same procedure – using a lancet or needle to push the infected lens downward out of its original position – is still used by physicians today. If infection does not occur, vision can be restored to some degree after surgery. For people with high myopia, the surgery produces excellent results because it helps correct the focal distance between the retina and the cornea.
Where did the Roman surgeons learn this remarkable technique? In Celsus’ writing, this technique seems to have been perfected. However, the Greek doctors, who were at the forefront of Roman medicine in many other respects, did not perform a similar operation at all. Unless they invented the technique themselves, one cannot help but think that the Romans borrowed it from the treasury of Indian medicine. The Indian medical text, the Mythology, probably compiled in the last centuries B.C., contains a section devoted to ophthalmic diseases, four times the length of what Celsus wrote. The wording is much the same when it comes to cataract depression. The book even advises surgeons to use the left hand to puncture the right eye and the right hand to puncture the left eye.
However, it seems that eye surgery was developed by the Babylonians in southern Iraq long before the Romans or Indians, who should probably have been called “sir”. Unfortunately, we have not seen any description of ophthalmology among the Babylonians, except for a famous code of law written by King Hammurabi of Babylon in the 8th century B.C., which mentions such surgery. The codex mentions that the blindness could be cured by “cutting open the nakaputu” with a bronze Lancet. “The meaning of the word “nakaputu” is difficult to translate; one ophthalmologist believes it must mean “cataract. However, this latter translation is more literary: “If a physician saves the life of a nobleman by performing a major operation on him with a bronze Lancet, or saves his eyes by cutting open his eye sockets with a bronze Lancet, he should receive ten shekels of silver coins.” The cure of a patient’s eye was worth five shekels of silver coins from a commoner and two from a slave. It is difficult to imagine what operation the code refers to if it is not the cataract depression described by Celsus almost 2000 years later. The fact that surgical procedures needed to be regulated by law suggests that such procedures must have been quite common at the time. As in the Roman Empire, there were even professional eye surgeons in ancient Babylon. Moreover, being a surgeon, while lucrative, also involved risks. The Code of Hammurabi then established a penalty for failure of such difficult operations: if a surgeon stabbed a nobleman in the eye with a Lancet and destroyed his eyesight, his hand was to be cut off according to the law.