Transcript

PATTY BAKER

What is a cataract? And how would you perform surgery on it?

RALPH JACKSON

So a cataract is a clouding of the lens. I mean, we still have a big problem with cataract these days, especially in the third world. But cataract could be resolved very straightforwardly. Even though their theories are different to ours, they were able to operate effectively.

So the cataract needle is described. Now, the reason we can identify this instrument as a cataract needle, this is the replica. Here is the original. Very beautiful craftsmanship. That’s what unites all Roman surgical tools. They’re precision instruments, and they’re immaculately designed.

And it matches the description of the texts. Namely, that it should be an instrument of bronze, that it was double ended, that it had an olivary enlargement at one end. This is what Celsus and Paul of Aegina tell us. And the other end was a bronze needle and that the tip was round-pointed. It was sharp but not too sharp. And that allowed the identification of this type of needle in several sets of instruments.

PATTY BAKER

And why a bronze needle for cataract? Is there any theory on that?

RALPH JACKSON

We don’t know why. But they specified bronze which is unusual because, as you know, the needles were usually made of steel or iron. So it’s unusual they specifically asked for the bronze needle.

Well, what they did then was to take that needle and push it into the angle of the eye. Why did they do this? They did it because they regarded the cataract as a suffusion. And they called it suffusio in Latin. And this was supposed to be something that dripped down and fell into the otherwise empty space between the pupil and the lens. So what they thought they were doing was breaking up a suffusion with the tip of the needle. And that's what they did.

PATTY BAKER

Could any doctor perform this surgery, or did it take a specialist?

RALPH JACKSON

No. I think, although in theory, any doctor could, in reality, it was a specialism. And we know from written sources that this was one of the specialist areas. Probably you would have a practitioner train up an apprentice. So basically, the apprentice was very important because he was an assistant.

So let’s think about this. Turn around a little bit. You’ve got to go a little bit lower than me. I’m higher. I'm the practitioner. I need to be ambidextrous. If you’ve got a cataract in your left eye, I need to operate with my left hand, the right eye with my right hand.

The assistant, the apprentice, holds your head very firmly from behind because Celsus tells us a slight movement will result in a big problem as we can imagine. So you’re sitting there. The light is behind me, so it’s shining on your face. The reason this description is very important because you can see that they did everything they possibly could to make the operation work.

Celsus is always very careful about post-operative care so he says once you’ve done that take the needle out carefully. Withdraw it, turning it slightly. Then get a little bit of wool soaked in egg albumin, place that on top of the eye, then an anti-inflammatory medication, and on top of that bandages.

But in fact, cataract surgery rarely has the problem of infection, post-operative infection. It’s an area which is quite good in that respect. Septic infection rarely follows. So they had a good chance of success.

PATTY BAKER

How painful was it?

RALPH JACKSON

Well, in terms of pain, at the turn of the 20th century, 19th into the 20th century, this operation was being done in India. And the word is that it is not particularly painful. There’s discomfort, but there’s not particularly pain. So it’s an operation that had a lot going for it.

I find it absolutely splendid. It’s so ironic that this operation, which was done with a completely flawed theory, was so beneficial and had such a long-lasting effect right through to the 16th, 17th century and onwards. Because they thought-- if they’d known that they were breaking up the lens-- if the practitioners, if Celsus himself had known that the lens was being destroyed, he wouldn’t have done the operation. He’d had been incredulous. So the idea that you would break up a suffusion and move it away was what guided them.

And so the theory was rubbish, but the instrumentation was absolutely superlative. They had everything going for them with the instruments. The instruments could not have been better.