(If you’d like to catch up, ‘Medicine Macabre – Eyes and Needles – Part 1’ can be found here)
Alas. If the readership of my previous article on eyes is anything to go by, it would appear that there are certain thresholds of squeamishness that even the hardiest of medical history aficionados take issue with. I have apparently discovered your limit. Even my study of Karl Weinhold and his brutal dissection of adorable kittens received more attention, which says much about you all.
It is with this in mind, I must announce that sadly, I have little choice but to… well, continue, yes, continue forth! Let us roam deeper into the wonderful history of brutal and largely ineffective eye surgery. No need to back down now, when we’ve come so far, don’t you think? Onwards!
And you thought I was going to let you off. No such fortune, dears. It is Halloween, after all. If low readership and limited appreciation of gory, blood-soaked prose dictated literary output, a certain Mr Poe would never have stood a chance.
So where were we? Ah yes, cataracts, and the sort-of-but-not-quite proved ancient method of couching, where needles are introduced into the bulb of the eye to gracelessly shove the cataract deep into the base of the orb, eliciting spectacularly varied and inconsistent results.
This grotesque method was the status quo until Jacques Daviel (1696-1762) came along, a Frenchman who, like so many of the barber-surgeon class, strove to elevate the art of ophthalmology to a respectable science and shift it away from itinerant quacks with no formal training. Thanks to his efforts, the 18th century saw significant developments in the understanding of eye disease and surgery. He didn’t make it any less excruciating however.
Previously a proponent of couching, as well as the fabricator of various surgical implements, in 1748 he experienced persistent and limited success whilst operating on a specific patient, master Parisian wig-maker Monsieur Garion. Being an experimental type of fellow, especially when it came to the squishy, most sensitive bits of the human body, Daviel tried an alternate method:
“After making the opening [in the eye] he held it apart by lifting the corneal flap with a small forceps, and with the “needle” introduced it into the posterior chamber of the eye”, the lens was brought out, followed by a small portion of vitreous humor.”
The needle he described was that of a flattened, spatula-like device that allowed him to scoop out both the ‘vitreous humor’ and interior lens. The obstruction now cleared, the perruquier Monsieur Garion was able to see once again, albeit with the aid of a cataract glass, granting Daviel, among many other prestigious accolades, the title of Surgeon-Oculist to Louis XV.
Yet, couching, although largely ineffective was not going to go quietly into the blurry night, and its main proponent came in the form of the fabulously opprobrious personality of John Taylor (1703-1772). As a surgeon, he was certainly not immune to the kind of kind of self-aggrandizement that is commonly associated with the position, indeed, he actively perpetuated it (I myself am immune from such aloof attitudes, of course. It would be outright arrogance to consider oneself the best doctor in a trade comprised mostly of driveling, ignorant, unimaginative, bumbling, moronic saw-bones, now wouldn’t it?).
Allegedly appointed as Chief Oculist to King George III, Taylor’s arrival into the various towns, cities and other stages for his theater-style performances were advertised well in advance, drawing huge crowds. Quite the showman, his mode of transport was that of a coach decorated in large colorful eyes and drawn by 6 black horses, five of which were blind, thanks to Taylor’s personal ministrations upon the poor beasts.
To complete this aesthetic he dressed opulently and elegantly in the finest garb, and gave grand oratorical lectures on his procedures to all who would listen. Ophthalmology was clearly a much sexier occupation in those days, and Taylor took full advantage provided by a rather dubious reputation in his debaucherous pursuits, his prowess at philandering far exceeding his actual acumen with a scalpel.
A dubious reputation? Most definitely. Not only was he reputed to have irreparably blinded hundreds of his patients, it was his manner to perform his great ‘feats’ of ocular miracles on unsuspecting victims and then vamoose with the utmost urgency.
Before the crowds, and with great fanfare and ceremony, Taylor would cut into the eye of the squirming, agonized victim, attempting (without anesthetic, as indeed all these operations lacked) to depress the cataract and lens into the ocular orb. He would then cover both eyes, instructing the patient to leave them as such for seven days, and then swiftly vamoose. By the time the patient recognized the failure, all that remained was the dust from his peculiar carriage. Unbelievably, it was on his highly questionable reputation alone that allowed him to operate – twice – on the legendary composer you might have heard of by the name of Johann Sebastian Bach. Neither surgery worked, and following the last procedure Bach spent what was to be the last four months of his life completely blind.
As an unreliable method, couching clearly had to go, the success rate being both painfully small (heavy emphasis on ‘painful’) and the risk of complications prevalent. The techniques pioneered by Daviel, known as extracapsular cataract extraction (ICCE), were further refined by luminaries such as the aptly named Samuel Sharp (1770-1778), who used his thumb to exert pressure on the eye following the incision, to squeeze the cateracted lens through the hole, and Albrech von Graefe (1828-1870), a German surgeon of similar great talent and surgical dexterity. Graefe invented both his infamous ‘von Graefe incision’, and the knife necessary to perform it.
Graefe’s technique came from a desire to reduce suppuration (pus accumulation following incisions), and yet his method was no less gruesome than previous procedures, alleviated only by the introduction of anesthetic eyedrops in 1884. His procedure involved a lengthy cut, going from ‘9 o’clock’ on the chamber of the eye and sweeping in a upside-down smile-shape to ‘3 o’clock’, before removing the cataract and the lens, the eyelid itself providing some insulation from infection after the operation.
Oh how far we have come. In this year of 1885, we’re still tearing ragged holes in our little peepers in an effort to thwart blindness and decrepitude, occasionally muting the pain, sometimes not.
I’m reminded of a little poem I wrote some time ago:
I’d love to see the world today,
With the wonders it can bring.
Yet I’ve got damned cataracts,
And can’t see a bloody thing.
Yet when doctor comes with scalpel,
My fears are for my life.
I’ll take cataracts any time you ask,
than endure the surgeons knife…
Which reminds me, I really should get my scalpels cleaned.