History Of Ophthalmology

Introduction

Ancient Practices

Ophthalmology has come to be a field of medical science that was separated from the conglomerate of practicing medicine by the early eye studies performed by men of science who kept records of the eyes anatomy, ophthalmic diseases, and treatments. What started out as ancient practice began to grow into more intense studies as man progressed in practicing and examining the human eye in centers of learning within certain civilizations. Human eyes were examined, dissected, and recorded in ancient Egyptian studies 1600 BC-1400 BC. The Ebers papyrus for example gives details of the eye by observers who described the various layers of the eye in terms common to their circle. Such early observers recognized some of the basic differences between the eye diseases affecting sight. The first known concepts of the anatomy of the eye were not truly discovered until early science observers dismissed superstitions and pagan or religious beliefs.

Greco-Roman Influences : Taken to the East

Early history of eye anatomy was recorded and practiced by various civilizations. Progress made by the Greeks in developments of early ophthalmic observation were practiced and recorded at schools of learning in Greece. 354 BC Critobulus extracts an eyeball successfully without facial disfigurement. Many ophthalmic terms from Greece, Rome and others cultures are still used today in Ophthalmology. Early procedures of surgical nature were practiced but treatments were limited. What was taken from the founding ophthalmic works ranging between 280 BC Herophilus Dissection studies of the anatomy of the eye to the works of the Byzantine Alexander of Tralles 550 AD-605 AD was used by Islamic medieval medicine to create documents for their research. This occurred as eastern civilizations invaded towards the west, the medical texts and scrolls of known works of Romans and Greeks such as Aulus Cornelius Celsus 25 BC-50 AD, Pliny the Elder 23 AD - 79AD, Galen 129 AD -216 AD and others from Greco Roman medical centers of learning became apart of the preserved early eye anatomy studies by eastern dominance. Within the Greco-Roman span of 800 years between 200BC TO 600AD the many works in medicine remained in conditions available and legible to scholars; some works traveled with invaders to be housed in center of studies of the eastern origin. The advancement of the Golden Age Islam around the 9th-12th century created a stepping stone into early pre-ophthalmology era that was yet to come in late Medieval Europe.One such preserver of medical knowledge was Hunayn ibn Ishaq born around born in 873 A.D died at age 74 1040A.D.. This Arabic Syriac speaking Christian who studied in Bagdad translated many Greco-Roman and Byzantine texts of medicine into Arabic-Syriac. This occurred through promotion from Abbasid Caliph al-Mamun who favored the brilliance of talented Hunayn. The Caliph placed Hunayn at the “Bayt al Hikmah” known as the House of Wisdom. This institution harbored Greek and other works that could be translated for availability to scholars for the advancement of Islamic Medicine. The Calif allowed Hunayn to travel to Byzantine, Greece, Rome and other countries to extract more knowledge from these founding base cultures of learning. One of his well known works is the “Ten Treatises on Ophthalmology ” the systematic ophthalmic treatment used in medical schools. Eye anatomy was studied and practice but also refined in detail as translations were made and human subjects were used for investigation of eye diseases. Hunayn efforts as translator helped physicians like himself use the works for practice allowing discovery of applied investigations towards the nature of masses , the swelling of eye in relation to corneal ulcers, tumors, and cysts. Cataracts and surgery with post surgical treatment were included in his works. Islamic empire grasp weakened in late 850- 900 A.D. but advances in medicine did not stop, continuing till 1300 A.D. and on.

In Stagnant Europe: Privately Funded Individuals and Monastery Schools

Though little or no advances were made in society from 150a.D. to 1300 A.D. in Europe, privately funded individuals helped to translate Arabic medical documents to Latin through Christian based influences supported by Monasteries and Nobles. During the early Middle Ages of Europe around 1070-1100 A.D. Constantine the African of Arabia took interests in being a Benedict monk and used this advantage of convert along with his fluent abilities in Greek and Arabic to translate many works including the anatomy of the eye into Latin. The Arabic preserved knowledge of the early pre-ophthalmology era became apart of monastery and institutional community of the dark ages, as early Christian monk scholars worked within the early/middle dark ages from 150 A.D. to 1200 A.D.. Their work during this time period of multiple invasions, low birth- high death rates; helped to advance medical knowledge into the early medical era. Early Ophthalmology as a young science began to flourish under the protection of the early church resisting invaders and accepting converts such as Constantine the African. Beginning in between 650 A.D. to 1300 AD Christian monk scholars advanced in countries like France, Spain and Catholic Rome as well as others regions practicing and translating Arabic medical knowledge to Latin.

Early Ophthalmology in the early technology era

All science has a prehistoric beginning. When scholars practice and recorded their findings, each evaluation of trial and error began to influence how the next steps would be taken. The equipment used in a treatment is what makes a difference in practice. The more precise and detailed a procedure, the more likely desired results are obtained and new ideas can be practiced with the hope the new treatments can help the ailing or diseased individual. Any progress made during the stagnant social period of the middle ages, came from scholars who practice and recorded on the anatomy of the human being. The first lenses used in ophthalmology were the magnifying glasses invented by presbyopic monks around 1000 A.d. to 1200A.D. , the lens was called a reading stone used to magnify the small letters in scripts. These lenses were replicated and remade in Europe by men like Friar Roger Bacon. Bacon wrote the Opus Majus in 1266 A.D. his quote states, "If anyone examine letters or other minute objects through the medium of crystal or glass or other transparent substance, if it be shaped like the lesser segment of a sphere, with the convex side toward the eye, he will see the letters far better and they will seem larger to him. For this reason such an instrument is useful to all persons and to those with weak eyes for they can see any letter, however small, if magnifier enough". Such discoveries further promoted the early ophthalmic studies in Europe, as seen within the written manuscript of 1289 Traite de con unite de la famille, author di Popozo stated "I am so debilitate-ted-by age that without the glasses known as spectacles, I would no longer be able to read or write. These have recently been invented for the benefit of poor old people whose sight has become weak". Knowledge of the eyes was then passed on to other monks in Pisa near 1300 A.D. who stated "It is not yet twenty years since the art of making spectacles, one of the most useful arts on earth, was discovered I have seen and conversed with the man who made them first". Although the magnification lens is a basic step to enhance what a person can see, it was enough to start up the next step in 15th century medicine, the invention of the simple microscope. Through much difficulty around 1400 to the late 1500's the 20x or 30 x scopes were invented by unknown sources. As these types of microscopes were being invented those allowed by the church and royal power, were able to experiment on cadavers, creating more elaborate and detailed anatomy drawings of the human body. The two studies combined microscopic observation and dissecting observation allowed science to further move to advances in surgery and function of the human body. Now in 1585 Royal surgeon Jacques Guillemeau wrote "Traité des maladies de l’oeil" which in 9 parts focuses on the eye's anatomy and eye diseases this includes muscles , membranes, and interior focuses of the eyes vitreous body and optic nerve damage.

Pioneer Surgeons of the 17th Century

Surgery techniques emerged as anatomy dissection chart were drawn into existence through physicians like Belgium born Andries van Wesel in Latin he is known by the name Andreas Vesalius. His work in the middle 16th century revealed that Galens medieval anatomy studies was based on animal dissections not human cadavers. Among others are surgeons such as Wilhelm Fabricius von Hilden who wrote a large chapter on the eye and performed a exenteratio orbitae due to a tumor his patient had; in detail he explains this procedure with the use of tweezers and a prop for the surgeons arm. In William Cowper's 1698 first edition of The Anatomy of Humane Bodies the anatomy of the eye is included, his work was aided by purchasing the prints by Gerard de Lairesse (1640–1711)from Govard Bidloo publishers. The printing plates had also been previously used in the 1685 book called‘Anatomia Humani Corporis’ by Govard Bidloo 1649 –1713). Many letters of disagreement were written between Cowper and Bidloo, and the reputation of Cowper slightly damaged. As new plates were made and superior drawings released by Cowper, his drawings were recognized by many including the Royal Society, who selected Cowper for fellowship in 1699. For the studies of anatomy can be considered as maps which early surgeons used to guide them in explorations and treatments of not only the body but specific areas of the body such as the eye.

18th Century Ophthalmology: Couching Progression

During the 18th century surgeons made an effort to practice on patients who had cataracts. The technique of removing the clouded lens was not proven to help the vision of the patient, this procedure was known as Couching. The entire lens including the capsular bag the lens resides in was completed detached and forced to fall into the posterior chamber were it would if successful fall to the bottom of the vitreous humor. The term Cataract itself translates falling water from the Arabic translators who took the original word Hypochalis from the Greeks. The 18th century Ophthalmologist not knowing the true structural composition of the lens of the eye therefore based their assumption of this lens as part of the theory of fluid, In which they believed that the change of the clear lens to an opaque color was cause by effusion of liquid into the lens, in modern Ophthalmology this is partialliy true except that the 18th century observers of the eye had no super microscopes or advanced technology to determine the other factors that cause cataracts as known in modern medicine for example the re-composition of protein bonds. Couching was practiced by many during the 18th century but those who procedures failed were marked as charlatans and quacks. In Great Brittan though not all surgeons were academically trained many of these men were the assistant understudy students to great surgeons of their day such as William Cheselden or Edward Nourse as well as many others. Such men are Samuel Sharp and Percival Pott. Couching did not improve vision. Results were even poorer than the cataract condition itself , though a complete advanced white cataract blocks the vision completed,couching itself did not guarantee that the patient would have better vision post surgery.

The first half of 19 century couching

Most prehistoric medicine was done through experimentation not knowing the results of the post surgery procedure. The risks were higher post operative as were infections which made the patients condition worse or even bring upon the death of the ill fated patient. There were surgeons who did tried to advance the technique of couching; one used Pressure literally popping out the cataract through pupil into the anterior chamber then onto the cheek this is Sharp’s technique. The other technique by Daviel involved an incision to create a flap in the lower half of the cornea as a method of entry to the cataract; there from the anterior chamber he used a surgical spatula and a blunt needle to reduce bleeding; with the aid of other tools to extract the cataract . Daviels advances were due to his planned surgery methods practiced first on corpses. Through his studies he discovered the it was the lens itself that had become opaque. Though his couching took longer the results were noted to be a bit better than the standard couching which involved pushing the lens into the posterior chamber of the eye. This is one thing surgeons know they must complete a series of steps to succeed in surgery but also be ready for unpredictability of complications of the unknown. Plans that involve getting the work done within a reasonable time so that the patients has a greater chance at success towards full recover were still slim in this era.

Second half the 19th century

Though the ophthalmic surgeons of 1700-1900's aimed to advance the treatment eye diseases, many countries not only competed within each other but through sharing information about their surgical techniques; they were able to bring about the development of steps required to obtain the desired results of success. They even borrowed foreign techniques from other regions; with all the new variations from these surgeons, advancement came through sterilization, planned methods of surgery and post op medicinal treatment. When the surgeon Pott promoted a technique that allowed minimum invasion as apart of therapy, he created a mental stepping stone for future surgeons to understand that surgery in a more gentle manner increased post operative healing and lower risks to the patients. Potts states, “an operation attended with less pain, and a less violation of parts, than a firmer one would necessarily require.” Anesthesia was introduced in 1846. Between 1845-1885 and on, many different types of anesthesia were evaluated for eye use. The topical application of a form of cocaine was introduced by Koller in 1884. The Aseptic approach was not well into use but when Lister in 1865 enlisted an aseptic or contamination free method to evade infections or contamination during and after surgery the progressive results were noted by his colleagues in medicine. For when we cure or treat diseases the people gain help and health; those who provide the new advances in instruments, medicines, anesthesia, and procedures benefit as well internally of soul and financially. For there are also those who sacrifice their knowledge for the benefit of mankind, the poor and the unwanted, those who have no heart will also be called doctor just as the kindhearted surgeon; both harvest the keys to treatment and prevention. Towards the end of the 19th century the official volumes on the disease of the Eye and workings of the anatomy of the eye were published. Such are French text in a four volumes called Traité Complet d’Ophthalmologie, 1880-1889 by Louis de Wecker and Edmond, Landoldt, the American version by Norris, Wm. F. & Oliver, Chas. A. called System of Diseases of the Eye was also a four volume system. Other works are Jackson, Edward, Skiascopy and its Practical Applications, 1895,Maddox, Ernest, Tests & Studies of Ocular Muscles, 1898-1935,Ramon y Cajal, Santiago, Die Retina der Wirbelthiere, 1894-1933,Jackson, Edward, Skiascopy and its Practical Applications, 1895 and Fuchs, Ernst, Lehrbuch der Augenheilkunde, 1889–1945, there are also other sources from other countries around the world depending on how far their studies of medicine in the field of the eye progress.

Keywords

history_of_ophthalmology

See Also

References

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