The History of Ophthalmology
Part 1: The Ancient World
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We humans have been developing eye and vision problems as long as we’ve been here on Earth. Aging was the same problem millennia ago that it is today, and there have always been nearsighted and farsighted people, and eye problems like cataracts, glaucoma, and macular degeneration.
The beginnings of ophthalmology and optics were back in the ancient world, when the complex structures we take for granted as our eyes were very little understood. It took 38 centuries for mankind to take all the steps that have led now to Custom LASIK (Wavefront-Guided LASIK).
Babylon: Payment Based on Merit
Hammurabi was a Babylonian king who inherited the throne from his father about 1800 B.C. Babylon was one of the Mesopotamian city-states. For many years life was peaceful, until Babylon was attacked by a neighboring city-state.
One thing led to another until Hammurabi became king of all Mesopotamia. His total reign was for about 40 years, his son inheriting the kingdom at his death. To consolidate his large kingdom, Hammurabi created and imposed a Code of Law. He had it engraved on a very large stone monument (a stele) which is now in the Louvre Museum in Paris.
The laws give a picture of a highly organized society where medical care was regulated. If an eye surgeon performed a successful operation and saved the patient’s eye or vision, he was to be paid, and the amounts were specified according to how prosperous the patient was. But if the operation caused blindness or death, the surgeon’s hands were to be cut off.
This may have discouraged people from becoming doctors, as in about 450 B.C. Herodotus (a traveling trader and writer) says that Babylon had no doctors. Instead, sick people were put out in the market place and anyone passing by could discuss the illness or injury and recommend a treatment he himself had devised, experienced or heard about. Officially, medicine was practiced by priests, who used incantations and various foul treatments designed to chase demons away.
India: Treating Cataracts
Cataract treatments can be traced back to the fifth century BC in India. There is a Sanskrit manuscript, thought to have been written by a Hindu surgeon called Sushruta. Its title is Sushruta Samhita, meaning Sushruta’s Encyclopedia. One of its sections is about couching. This was a surgery to push the lens out of the visual field, so that the cloudiness of its cataract did not impair vision. A needle was used, or a hard blow to the eye or head. The patient then had no functioning lens (and no glasses or contact lenses of course), but at least had no cataracts in the line of vision.
Egypt: Diagnosis Only
Egyptian medical records were kept on papyri (singular: papyrus) and there are several dating between 1300 and 1600 B.C. Much of the text is devoted to incantations and foul remedies similar to those of Babylon, but some suggests that centuries of empirical observation must have happened. The ancient Egyptians recognized many separate eye diseases such as blepharitis (eyelid infection), cataracts, and pterygium (an abnormal membrane between the cornea and eyelids). But they apparently did not perform any eye surgeries.
Greece: From Supernatural to Natural
As in Babylon and Egypt, early Greek medicine was also dominated by priests and supernatural cures. That was changed by Hippocrates, who lived from 460 to 370 B.C. Plato was about 20 years younger than Hippocrates, and mentions him as "Hippocrates of Kos, the Asclepiad". (Plato was a student of Socrates and teacher of Aristotle, who in turn was a teacher of Alexander the Great).
The Asclepiads were followers of Asclepius, the god of medicine and healing in Greek mythology. You can still visit the large remains of the Aesclepion of Kos, where Hippocrates received his training. An Asclepion was an overnight clinic, or hospital, where people would stay while they underwent treatments.
Instead of basing their diagnoses and treatments on supernatural theories, the Asclepiads studied disease as a natural phenomenon calling for physical remedies rather than incantations. (They did, however, include a patient’s dreams as valid data for treatment planning.) Their knowledge of anatomy was limited by the Greek law which forbade dissection of human bodies.
The Hippocratic oath was written either by Hippocrates or one of his students, and binds a physician to an ethical code. An updated form of it is still taken by some graduating physicians.
The physician Galen, who lived between about 129 and 207 AD) also began his career in an Asclepion. He studied anatomy extensively and wrote detailed texts (including eye anatomy) based on his dissection of monkeys and pigs. Like Greek law, Roman law also forbade human dissection, and Greece was by Galen’s time part of the Roman empire.
Galen later worked as a doctor at a gladiator school, where he treated trauma and wounds which he wrote of as “windows into the body”. This taught him much anatomy, and encouraged him to try innovative surgeries, one of which was cataract surgery. He used a long needle to lever the lens out of the visual field – continued by the Romans as couching .
Galen wrote perhaps as many as 600 treatises, but about two thirds of them were lost, either in the fire which destroyed the library in Alexandria (date is controversial) or in the overall social deterioration which went with the fall of Rome. But translated into Arabic some survived to dominate anatomical knowledge for the following thousand years or so. An example is sixteenth century treatments of strabismus which were based on Galen’s writings about it.
Our term physician comes from a Greek word meaning natural. From Hippocrates’ time onward, medicine was freed from superstition and became a natural science.
History of Ophthalmology Part 2: The Middle Ages: Spectacles
History of Ophthalmology Part 3: Anesthesia and Infection
History of Ophthalmology Part 4: The Nineteenth Century: Seeing the Eye
History of Ophthalmology Part 5: The Twentieth Century: Swift Progress
History of Ophthalmology Part 6: What is a Laser?
History of Ophthalmology Part 7: Leading up to LASIK
History of Ophthalmology Part 8:LASIK Into the Twenty-First Century