The Eyes Have It!

I'm having warm thoughts about ophthalmology these days. My spouse has just had a cataract removed, and over the past several weeks we have seen (and been seen by) more different kinds of eye specialists than I imagined possible. The eye is a remarkable structure, and the science of the eye has a long and rich medical, bibliographical, literary history. But as a focus within the history of Islamic medicine, it has a particular status.

The earliest systematic treatise on the eye is attributed to the Islamic scholar and physician Hunayn ibn Ishaq (809-873), who spent much of his storied career translating Greek and Syriac manuscripts, and thus spreading classical influence throughout the Muslim world. His Ten Treatises on the Eye is not, however, one of these translations, but rather among his works of original medical research. It describes the anatomy of the eye in exquisite detail, and discusses treatments for, among other things, cataracts.

But for nearly a thousand years this treatise was lost, although secondary references to it gave scholars some sense of its contents. The great historian of medicine Julius Hirschberg (1843-1925) discovered a Latin manuscript of The Ten Treatises bound into a collection of works by Galen (c.129-200 or 216), and Orientalist Max Meyerhoff (1874-1945), the preeminent student of Arabic medical literature, discovered a (rather corrupt) Arabic version of the text in the Islamic library of Ahmed Taimur Pasha (1872-1940) in Cairo. It was Meyerhoff who managed to produce a full critical edition by comparing the Cairo text with another more complete manuscript in Leningrad.

Max Meyerhoff

Meyerhoff described the growth of the Muslim study of medicine, launched by those like Hunayn ibn Ishaq who began by translating classical manuscripts:

“At the end of the period of translation, the physicians and scientists of the Islamic world stood on a firm foundation of Greek science, increased by a large share of Persian and Indian thought and experience. Their work had been learned but was not very original. From this time on they begin to rely upon their own resources and develop from within. The sciences, particularly medicine, now pass rapidly from the hands of Christians and Sabians into the possession of Muslim scholars, mostly Persians. In medicine, in place of pandects compiled from antique sources, we find imposing encyclopedic works in which the knowledge of former generations is carefully classified and set against that of modern times.” (Meyerhof, Science and Medicine: The Legacy of Islam, 322)

It was clear to Meyerhoff and others that ophthalmology was a respected profession in medieval Islamic society, which was not the case in Galen's Rome, where the 'occulist' was deemed a second class medical professional. The crafting of precise specialized medical instruments for the study of the eye (described in the Ten Treatises) combined with theoretical experimental work, resulted in rapid innovation in the care of the eye. The treatment of cataracts described by Hunayn was aided by the development of instruments such as the 'injection syringe,' a hollow needle invented in the 11th century by Ammar ibn Ali of Mosul, which made possible the extraction by suction of soft cataracts.

Hunays writes about performing surgery for a cataract:

"Then I operated on him with the hollow needle and extracted the cataract; and he saw immediately and did not need to lie, but slept as he liked. Only I bandaged his eye for seven days. With this needle nobody preceded me. I have done many operations with it in Egypt."

Throughout the Middle Ages, Islamic physicians advanced the knowledge and treatment of eye diseases, and treatises by Averroes, Ali ibn Isa al-Kahhal’, Jibrail Bukhtishu and Ibn al-Nafis provided solid ground for the field of ophthalmology. A splendid account by Cyril Elgood details this period of medical science: http://www.amazon.com/Medical-History-Persia-Eastern-Caliphate/dp/1108015883

A Medical History of Persia

But sadly, most of this Islamic scholarship in the field of ophthalmology (from the Greek ὀφθαλμός = eye) was lost to Western physicians, and as a distinct medical specialty in the West, ophthalmology dates its origins only  from the appointment by St Bartholomew's Hospital of the first eye surgeon in 1727, from the founding of the ophthalmological hospital i London (later Moorfields Eye Hospital ) in 1805, and from the founding of the American Ophthalmological Society in 1864. Ten years earlier, in 1854, Hermann von Helmholtz (1821-1894) had (re)invented the ophthalmoscope making direct observation of the interior of the eye again possible..

Moorfields Eye Hospital

The  continuing quest for the treatment of diseases of the eye and the reduction of blindness is a noble and often-overlooked aspect of Islamic history. And our experience over the past several days of a return to eye heath after a routine outpatient operation is a thing for which we are enormously grateful, grateful to the giants of both Muslim and Western medical practice. But we wonder if the ophthalmological science of the Muslim world had not been ignored (and, in most cases, despised) by the West, if the quality of life of generations of our forebears with eye disease would have been vastly improved.

In his 1995 novel  Ensaio sobre a Cegueira (= Essay on Blindness), Portuguese Nobel Prize winner Jose Saramago (1922-2010) describes an epidemic of blindness that seizes an unnamed city. We follow the characters as their social fabric unravels and as they attempt to create new forms of community. Sight and sightlessness become an extended metaphors for the ability to form human connections, and we observe the anxiety, apathy, violence, and despair that attends the loss of sight. Many of the characters are named by their disability: the boy with the squint, the girl with dark glasses, the man with the eye patch.

And throughout the novel we are called to appreciate, as we ourselves do this week after cataract surgery, the various deep meanings of the phrase "I see."