“Couching, Kepler and charlatans”

The ESCRS Heritage Lecture will take delegates on a journey through the rich and fascinating origins of cataract surgery

Dermot McGrath

Posted: Thursday, September 12, 2019

Professor David Spalton
The renowned British surgeon and former ESCRS President David Spalton will deliver the second ESCRS Heritage Lecture at the 37th Congress of the ESCRS in Paris in September.
Prof Spalton’s lecture will focus on the origins of cataract surgery, taking delegates on a journey through ancient Egypt, classical Greece, ancient Rome and the medieval period right through to the advent of extracapsular surgery in the late 18th Century.
He will reveal the trials, tribulations and triumphs of cataract surgery as practised through the ages, describing a rich tapestry of medical history interwoven with characters such as Hippocrates, Celsus, Galen, Kepler, Rembrandt and many others.
Prof Spalton told Eurotimes that he was honoured to have been asked to deliver the Heritage Lecture at the invitation of the Programme Committee of the ESCRS.
At a time when ophthalmologists tend to focus obsessively on the latest technology, he said that it was important not to lose sight of the historical context that has brought cataract surgery to where it is today.
“I think it’s a very important thing because quite a lot of today’s surgeons do not realise the rich history and the ways things have evolved to get to the point where we are today. We need to appreciate that cataract surgery, like other areas of medicine, was frequently a question of two steps forwards and one step backwards. I think it is timely and interesting and it adds a lot to the enjoyment of ophthalmology to know the history of it,” he said.
As he acknowledges, the early history of cataract surgery is not easy to unravel.
“There are a lot of conflicting accounts in the literature and many of the early descriptions are lost in translation, so it is hard to interpret their meaning with any certainty. However, there is good evidence that ‘couching’ was performed in India in about 600 BC and then came to ancient Greece and Europe around 300 BC through the conquests of Alexander the Great,” Prof Spalton said.
Couching is the oldest traditional technique documented to treat cataract and involves the use of a sharp or blunt instrument to dislocate the cataract lens and push it back into the posterior segment of the eye. The results were hit-and-miss and an estimated half of patients treated by couching ended up blind.
“It wasn’t until the 1600s that people really understood where the lens of the eye was because the early descriptions always put the lens in the centre of the eye – I wonder if this was due to postmortem artefact?” he said. “The early surgeons thought they were removing a dry material between the lens and the iris, which they called hypochyma.”
The ancient Greeks also subscribed to the “extramission’ theory of vision, the idea that light issued from the eyes towards objects, lighting up the world rather like car headlights on a foggy night. Galen thought that the lens was the organ of visual perception, said Prof Spalton, and this idea persisted until the 16th Century.
The famous astronomer Johannes Kepler (1571-1630) was responsible for the truly revolutionary observation that the lens formed an inverted image on the retina.
“Things outside the realm of optics do appear not to have interested him much, saying in the wonderful terminology that the inverted image was corrected ‘within the hollows of the brain by the spirit of the soul’ – so much for neuro ophthalmology!”
Less salubrious characters such as Chevalier John Taylor will also get a mention in his wide-ranging lecture.
“Chevalier Taylor was an itinerant quack who blinded Bach and Handel and who travelled around Europe blinding a lot of people,” said Prof Spalton. “There’s a lovely quote about him which goes: ‘Many elements go to the formation of the complete charlatan – bombast, effrontery, dishonesty, ignorance – all these qualities Taylor showed in perfection.’ It was interesting too to learn that – like myself and Harold Ridley – he also trained at St Thomas’ Hospital.”

The ESCRS Heritage Lecture will take place on Monday 16 September at 10.30 in the Auditorium