Brit. J. Ophthal. (I975) 59, 171 Br J Ophthalmol: first published as 10.1136/bjo.59.3.171 on 1 March 1975. Downloaded from

Cataract performed before 800 B.C.

P. N. ROY, K. S. MEHRA, AND P. J. DESHPANDE* Department of Ophthalmologv and *Department ofShalya Shalalcya, Institute of Medical Sciences, Banaras Hindu University, India

Duke-Elder (I969) pointed out that surgery was produced followed by the gushing ofwatery fluid, then was performed in India by by the couching the 's needle was considered to be in the correct technique long before the Christian era. Sushruta's part of the eye ball, but if this puncture was followed by method, which is described in detail in "Sushruta bleeding, it meant that it was misplaced. Care was taken to avoid blood vessels present in that region. , Uttar ", appears to the modem The tip of the needle was then made to incise the capsule reader to be more akin to extracapsular lens extrac- of the lens. With the needle in this position, the patient was tion than to couching. asked to blow down the nostril, while closing the opposite The medical treatise "" was nares. After this procedure, according to Sushruta, lens written in verse in approximately 8oo years material came out alongside the needle and when the before the birth of Christ. An examination of the patient was able to perceive objects, the needle was relevant verses in their original language discloses the removed.

tollowing points concerning the treatment ofcataract. copyright. Postoperative care Preoperative care A few indigenous (roots and leaves) were ap- The patient was recommended to have an oily massage plied to the eye, with a bandage. The patient was then followed by a kind of heat-bath. instructed to lie flat on his back and avoid any movement, particularly sneezing and coughing. The operated eye was examined daily until the tenth day. If the whitish mass Operative technique appeared again in the pupillary area the same procedure The patient was asked to sit on a high stool, with the had to be repeated. http://bjo.bmj.com/ surgeon stitting in front of him face to face. He was in- structed to look at the surgeon's nose while the operator placed the tip of his little finger on the bony margin of the Summary outer angle of the orbit, holding a sharp-pointed needle The general belief that the technique of cataract (rav Vakra Shalaka) between his thumb, index, and middle finger. The point entered the anterior chamber, at the extraction in India in the Sushruta period (800 B.C.) junction of the medial and lateral two-thirds of the outer was couching is no longer tenable. A study of the portion ofthe white layer (sclera) ofthe eye ball. Ifa sound original text suggests that the method was more on September 26, 2021 by guest. Protected closely allied to the extracapsular extraction of recent Address for reprints: Dr. K. S. Mehra, 4 Medical Enclave, Banaras Hindu University, -221005, India times.

Bibliography DUKE-ELDER, S. (I969) "System of ", vol. I I, p. 249. Kimpton, London "Sushruta Samhita-Uttar Tantra", chap. I7, verses 57-70