The Romans carried out cataract ops
By Jane Elliott
Health reporter, BBC News

Think of the Roman legacy to Britain and many things spring to mind - straight roads, under-floor heating, aqueducts and public baths.

But they were also pioneers in the health arena - particularly in the area of eye care, with remedies for various eye conditions such as short-sightedness and conjunctivitis.

Perhaps most surprisingly of all is that the Romans - and others from ancient times, including the Chinese, Indians and Greeks - were also able also to carry out cataract operations.

The Romans were almost certainly the first to do this in Britain.

Surgical skills

Nowadays the procedure can be carried out with the help of ultrasound, but in Roman times technology was rather more basic - needles were inserted into the eye.

The sharp end of the needle was used for surgery and the blunt end heated to cauterise the wound.

Blows to the head were sometimes used to try and dislodge the cataract.

Dr Nick Summerton, GP and advisor to the National Institute of Health and Clinical Excellence (NICE) has written a book "Medicine and Health in Roman Britain".

In it, he details how various medical instruments found in Britain indicate that the Romans carried other advanced procedures, such as head surgery and induced abortions.

"Archaeological finds of eye medicine stamps, representations of eyes together with a sickness report from the Roman fort at Vindolanda suggest that eye diseases were a particular concern within Roman Britain," said Dr Summerton.

"Interestingly the Roman author Celsus described cataract extraction surgery using a specially pointed needle - and possible cataract needles (specilla) have been found in Britain as well as elsewhere in the Roman Empire."

Detailing the procedure Celsus said: "A needle is to be taken, pointed enough to penetrate, yet not too fine, and this is to be inserted straight through the two outer tunics.

"When the (correct) spot is reached, the needle is to be sloped.........and should gently rotate there and little by little."

Dr Summerton explained how eye doctors (oculists) manufactured ointment sticks (collyria) stamped with the ingredients and the name of the eye specialist.

These were used to treat a range of eye problems such as conjunctivitis and other inflammatory or infectious eye condition in addition to short-sightedness.

A large number of the eye remedies contained antiseptics in one form or another.

"The vinegar lotion of Gaius Valerius Amandus (from a stamp found at Biggleswade) or the copper oxide of Aurelius Polychronius (from a stamp found at Kenchester) would have been very effective antiseptics either in treating conjunctivitis or in preventing any scar on the eye becoming infected while it healed."

Excavations provide clues

Dr Summerton has also discovered that religion played an important role in eye care.

"It may be somewhat artificial to seek to rigidly separate out the spiritual from the physical aspects of Romano-British health care," he said.

"At Wroxeter in Shropshire there may have been a particular focus on eye care with the discovery of two collyrium stamps in the names of Tiberius Claudius and Lucillianus together with a case of probable surgical instruments including an eye needle for cataract extraction.

"However, this evidence of 'physical medicine' is complemented by the presence of eye votives (offerings to the Gods).

"In 1967 a piece of sheet-gold in the shape of a pair of eyes was found at the north-west corner of the Baths-Basilica.

"In the same area bronze eyes have been unearthed in addition to numerous eyes carved from wall plaster.

"Wroxeter has also yielded an altar to the Apollo who was considered to have a particular association with eyes."

Dr Alex Ionides, eye surgeon at Moorfield eye hospital said an ancient method for treating cataracts was referred to as "couching".

"A cataract is a clouding of the lens, which loses its transparency and becomes misty and foggy and white," he said.

"The lens is held in place within the eye by multiple radial 'strings' called zonules. These become weaker with age and with cataract formation.

"'Couching' breaks these weakened strings so that the lens is no longer suspended in the correct position and falls away from the pupil, dropping into the back of the eye, allowing light into the eye once more.

"There are different ways of performing couching, one is with a blunt stick to 'knock' the eye hard from the outside, thus dislodging the lens from the zonules by shear blunt force.

"Another form of 'couching' was with a sharp metal probe that would be inserted, without anaesthetic through the edge of the iris, into the eye, and wiggled around to dislodge the cataract from the pupil.

"It wasn't until the 18th century that Daviel in France suggested opening up the eye and removing the cataract.

"This technique met with various success and blinded many people including Handel, who as a result of his cataract surgery, was blind for the last few years of his London life."

Cataract surgery is now the commonest operation performed on the NHS with vastly superior techniques and generally excellent visual outcomes - although no surgery is without some risk.