A Finger for en Eye

Few surgical operations are older than those performed for cataract of the eye. As early as about 2000 B.C., the Code of Hammurabi ordained: "If a physician . . . open a tumor of the eye with a bronze lancet and save [the patient's] sight, he shall have ten shekels of silver ... If a physician open an abscess of the eye with a bronze lancet and the patient lose his eye, the physician shall have his fingers cut off." In his monumental monograph, Surgery of Cataract (Lippincott; $30), New York Ophthalmologist Daniel B. Kirby traces the history of operations for cataract (a clouding of the eye's lens) from these harsh beginnings to such present-day refinements as air-conditioned operating rooms and parallel-beam light.

Sweet Vapors. The half-legendary Indian surgeon Susruta,* says Dr. Kirby, was able to operate successfully for cataract by piercing the eyeball and pushing the clouded lens down out of the light rays' path. This partly restored the patient's sight, though not his power to focus. Susruta also anticipated modern aseptic surgery: his operating room was fumigated with sweet vapors; the surgeon kept his hair and beard short, his nails and hands clean. His patients even seem to have inhaled some kind of anesthetic.

Much of Susruta's knowledge was lost to the world for centuries. Not until the 17th Century was the true position of the lens (directly behind the pupil, with no intervening "cataract space") rediscovered; not until the 18th Century was a whole defective lens removed. Over the centuries, Dr. Kirby found, the number of instruments invented for the removal of cataracts (e.g., a glass tube and a hollow needle to withdraw the cataract by suction; a metal loop to flip it out) rivaled the number of operations performed.

Capsule & All. With growing knowledge and improved technique progress was speeded up. Ways were found to remove a cataract without damaging the rest of the eye and with little danger of recurrence. Surgeons now use either of two methods: removing the hardened gelatinous interior of the lens but leaving in place part of the empty container (a Cellophane-like capsule); or taking out the whole lens, capsule and all.

Few modern patients would be content with the unfocused vision of Susruta's patients (although that is often good enough for getting around the house without falling over chairs). But eye surgeons today would have little to fear under the Hammurabic Code: in 85% to 90% of cases, says Dr. Kirby, simple cataract operations result in the restoration of "good useful vision," and in the others some vision is nearly always regained.

*Scholars trying to fix the date when Susruta flourished can only agree that it was between 700 B.C. and 500 A.D.

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