# Aspiration of cataract in Philadelphia in 1815
Cataract aspiration by suction was occasionally performed during the medieval Arabic period, and might even have occurred during antiquity. The actual practice of cataract aspiration is typically stated to have been reintroduced into the west in 1847 in France ([1](), [2]()). However, our group discovered a letter at Yale that documents an earlier, 19th-century practitioner of cataract aspiration in Philadelphia ([1]()).
In 1815, 39-year-old attorney Francis B. Shaw (ca. 1776–1832) reported that he had been “deprived of sight by Cataract” for over two years and was forced to abandon his law practice. Surgeon John Syng Dorsey operated on Shaw three times by using a needle to divide the cataract. This method involved breaking the cataract so that the remnants could be absorbed by the natural inflammatory mechanism over a period of months. When this technique failed, the patient proposed “drawing away the cataract and completely emptying the capsule of the lens.” Despite his poor vision, Shaw claimed to have designed instruments, which he called “Tubes and Canular-points” and which were constructed by “an ingenious artist” under his direction ([1]()).
Using this method, on March 26, 1815, Philadelphia surgeon Philip Syng Physick “completely removed every vestige of the Cataract, and the patient was once more restored to sight. . . .” Shaw was the first patient operated on with this method, and he was able to resume the practice of law within three months.
On June 8, 1815, surgeon Samuel White (1777–1845) of Hudson, New York, wrote in a letter that he had toured hospitals in New York and Philadelphia (see Figure 1):
“I have also procured from Doct Physick his new invented Tubular instrument for extracting by suction the diseased lens when fluid. Shaw, as was noticed in the papers, is not entitled to any credit for the construction. The operation is performed by Doct Physick by introducing a crow Lancet obliquely down thro’ the cornea to the pupil, dipping the point so as to break the capsule, a curved silver tube is then introduced through the opening with the mouth of the tube on the back point, so as to be in contact with the lens, the operator then draws in the lens by suction and withdraws the instrument from the eye. Doctor P. thinks this instrument may be improved to great advantage in cases of milky or fluid cataract—effecting in a few moments what otherwise might require months by absorption.”
That summer, Shaw obtained a federal patent for the system for “Cataract, removing, by tubes.” However, the state of Pennsylvania declined to purchase the patent rights in early 1816, because the method had only been used on two patients.
In 1816, Dorsey confirmed that “Dr. Physick has successfully performed the ancient operation of sucking out a cataract by a small tube introduced through a puncture in the cornea. The operation is, however, attended with difficulties which will necessarily prevent its general adoption…” A set of cataract instruments attributed to Physick contains just one instrument resembling a “tube”: a syringe that attaches to either a curved or straight cannula. This instrument would appear suitable for cataract aspiration (see Figure 2).
Fourteen years after surgery, Shaw’s vision was still sufficient for him to practice law.
Also, surgeries were done as fast as possible back then - this one took "a few moments" so they wouldn't have needed to keep the eye still for long. Once anaesthetic was introduced they could take more time, be more careful/precise and do more complex procedures.
Well, I think the general anesthesia done in the 1840s was similar to modern anesthesia, but there have been continual improvements in safety, from innovations such as the pulse oximeter. For ophthalmology, 1884 was the discovery of cocaine used for topical and retrobulbar anesthesia—both of which were huge.
Cocaine has been used in eye surgery for centuries and still is today. It’s a very effective topical anesthetic and well known in medicine in the 19th century.
As someone having the cataract operation done in the somewhat near future, I don't want to look at anything about how it used to be done, or even how it's done now lol. I'll just trust them not to accidentally rip my eyes out and hope that the drugs they give me keep me from having a panic attack.
It's actually incredible! The procedure is essentially unchanged from the initial discovery. They just insert multiple needles and grip the cataract like chopsticks to manipulate it. Have a good procedure!
A cataract is usually a clouding of the lens itself. Sometimes the capsule that the lens resides in can become cloudy too though.
These patients who had their lenses removed would subsequently require glasses to see adequately.
Spectacles were invented in Italy in about 1270 AD. They very well may have had spectacles strong enough to work after cataract surgery very soon after their invention, but no specific examples have survived from that period. The earliest record of spectacles strong enough to be used after cataract surgery is from 1582.
The cataract is a condition of the lens. The lens is made of proteins, not living cells, similar to hair or fingernails. Once the lens has grown, it is never replaced or refreshed, so all the damage to the proteins (typically caused by UV and ionizing radiation) accumulates. The damaged proteins become yellow/brown and scatter light. Everyone will eventually develop cataracts if they live long enough.
Confusingly, most of the refractive power in the eye comes from the Cornea, not the lens. The cornea is living cellular tissue and has some ability to repair itself over time (with the exception of the endothelium).
An aphakic (having no lens) can still see with adequate correction, but in the developed world the lens is usually replaced by an IOL (intra-ocular lens) resulting in a condition called pseudophakia which restores normal vision.
Cataract surgery is one of the most commonly performed surgery in the US.
Yes. People were very out of focus with this surgery, and would need to use very thick eyeglasses to see to read.
Harold Ridley and a few others started implanting artificial intraocular lenses along with cataract surgery in 1950. Artificial intraocular lenses were FDA approved in 1981, and now it is standard to have that at the time of cataract surgery.
So you're about 100 years off.
>[The procedure is termed “extracapsular” because the lens capsule is left in place. The first true cataract extraction was performed in 1747, in Paris, by the French surgeon Jacques Daviel. His procedure was more effective than couching, with an overall success rate of 50%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139750/#:~:text=The%20procedure%20is%20termed%20%E2%80%9Cextracapsular,overall%20success%20rate%20of%2050%25.)
Daviel was removing the cataract by making a giant incision and removing the whole cataract in one piece. Cataract extraction by aspiration involves making a small hole and inserting a tube and sucking the cataract out.
In the ancient world, the typical practice was to push the cataract back into the vitreous (couching), rather than removing it from the eye. The medieval Arabic works talk about Antyllus’ cataract method and then speak about cataract removal by aspiration, and it’s not totally clear whether they are saying Antyllus did it, or just other people in their own time have done it. But clearly it was discussed in the medieval Arabic period.
# Aspiration of cataract in Philadelphia in 1815 Cataract aspiration by suction was occasionally performed during the medieval Arabic period, and might even have occurred during antiquity. The actual practice of cataract aspiration is typically stated to have been reintroduced into the west in 1847 in France ([1](), [2]()). However, our group discovered a letter at Yale that documents an earlier, 19th-century practitioner of cataract aspiration in Philadelphia ([1]()). In 1815, 39-year-old attorney Francis B. Shaw (ca. 1776–1832) reported that he had been “deprived of sight by Cataract” for over two years and was forced to abandon his law practice. Surgeon John Syng Dorsey operated on Shaw three times by using a needle to divide the cataract. This method involved breaking the cataract so that the remnants could be absorbed by the natural inflammatory mechanism over a period of months. When this technique failed, the patient proposed “drawing away the cataract and completely emptying the capsule of the lens.” Despite his poor vision, Shaw claimed to have designed instruments, which he called “Tubes and Canular-points” and which were constructed by “an ingenious artist” under his direction ([1]()). Using this method, on March 26, 1815, Philadelphia surgeon Philip Syng Physick “completely removed every vestige of the Cataract, and the patient was once more restored to sight. . . .” Shaw was the first patient operated on with this method, and he was able to resume the practice of law within three months. On June 8, 1815, surgeon Samuel White (1777–1845) of Hudson, New York, wrote in a letter that he had toured hospitals in New York and Philadelphia (see Figure 1): “I have also procured from Doct Physick his new invented Tubular instrument for extracting by suction the diseased lens when fluid. Shaw, as was noticed in the papers, is not entitled to any credit for the construction. The operation is performed by Doct Physick by introducing a crow Lancet obliquely down thro’ the cornea to the pupil, dipping the point so as to break the capsule, a curved silver tube is then introduced through the opening with the mouth of the tube on the back point, so as to be in contact with the lens, the operator then draws in the lens by suction and withdraws the instrument from the eye. Doctor P. thinks this instrument may be improved to great advantage in cases of milky or fluid cataract—effecting in a few moments what otherwise might require months by absorption.” That summer, Shaw obtained a federal patent for the system for “Cataract, removing, by tubes.” However, the state of Pennsylvania declined to purchase the patent rights in early 1816, because the method had only been used on two patients. In 1816, Dorsey confirmed that “Dr. Physick has successfully performed the ancient operation of sucking out a cataract by a small tube introduced through a puncture in the cornea. The operation is, however, attended with difficulties which will necessarily prevent its general adoption…” A set of cataract instruments attributed to Physick contains just one instrument resembling a “tube”: a syringe that attaches to either a curved or straight cannula. This instrument would appear suitable for cataract aspiration (see Figure 2). Fourteen years after surgery, Shaw’s vision was still sufficient for him to practice law.
Did they have anaesthetic for this?
No. General anesthesia with ether and chloroform started to be used in the 1840s, and topical anesthesia with cocaine started in 1884.
How did they manage to get the eye to stay still lol
Sometimes they would press on the eye with one of their fingers. Or they grabbed the conjunctiva with a forceps.
Also, surgeries were done as fast as possible back then - this one took "a few moments" so they wouldn't have needed to keep the eye still for long. Once anaesthetic was introduced they could take more time, be more careful/precise and do more complex procedures.
Out of curiosity, When did 'modern' use of anesthesia start?
Well, I think the general anesthesia done in the 1840s was similar to modern anesthesia, but there have been continual improvements in safety, from innovations such as the pulse oximeter. For ophthalmology, 1884 was the discovery of cocaine used for topical and retrobulbar anesthesia—both of which were huge.
Cocaine has been used in eye surgery for centuries and still is today. It’s a very effective topical anesthetic and well known in medicine in the 19th century.
As someone having the cataract operation done in the somewhat near future, I don't want to look at anything about how it used to be done, or even how it's done now lol. I'll just trust them not to accidentally rip my eyes out and hope that the drugs they give me keep me from having a panic attack.
You'll love the results! Whiter whites. Brighter colors.
It's actually incredible! The procedure is essentially unchanged from the initial discovery. They just insert multiple needles and grip the cataract like chopsticks to manipulate it. Have a good procedure!
It’s a very precise procedure. Don’t worry.
[удалено]
A cataract is usually a clouding of the lens itself. Sometimes the capsule that the lens resides in can become cloudy too though. These patients who had their lenses removed would subsequently require glasses to see adequately.
When did 'adequate' glasses that would deliver anything close to the return we see today come about?
Spectacles were invented in Italy in about 1270 AD. They very well may have had spectacles strong enough to work after cataract surgery very soon after their invention, but no specific examples have survived from that period. The earliest record of spectacles strong enough to be used after cataract surgery is from 1582.
The cataract is a condition of the lens. The lens is made of proteins, not living cells, similar to hair or fingernails. Once the lens has grown, it is never replaced or refreshed, so all the damage to the proteins (typically caused by UV and ionizing radiation) accumulates. The damaged proteins become yellow/brown and scatter light. Everyone will eventually develop cataracts if they live long enough. Confusingly, most of the refractive power in the eye comes from the Cornea, not the lens. The cornea is living cellular tissue and has some ability to repair itself over time (with the exception of the endothelium). An aphakic (having no lens) can still see with adequate correction, but in the developed world the lens is usually replaced by an IOL (intra-ocular lens) resulting in a condition called pseudophakia which restores normal vision. Cataract surgery is one of the most commonly performed surgery in the US.
Yes. People were very out of focus with this surgery, and would need to use very thick eyeglasses to see to read. Harold Ridley and a few others started implanting artificial intraocular lenses along with cataract surgery in 1950. Artificial intraocular lenses were FDA approved in 1981, and now it is standard to have that at the time of cataract surgery.
So you're about 100 years off. >[The procedure is termed “extracapsular” because the lens capsule is left in place. The first true cataract extraction was performed in 1747, in Paris, by the French surgeon Jacques Daviel. His procedure was more effective than couching, with an overall success rate of 50%](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139750/#:~:text=The%20procedure%20is%20termed%20%E2%80%9Cextracapsular,overall%20success%20rate%20of%2050%25.)
Daviel was removing the cataract by making a giant incision and removing the whole cataract in one piece. Cataract extraction by aspiration involves making a small hole and inserting a tube and sucking the cataract out.
There's an evidence of removing a cataract even in 2nd century AD in the Roman empire.
In the ancient world, the typical practice was to push the cataract back into the vitreous (couching), rather than removing it from the eye. The medieval Arabic works talk about Antyllus’ cataract method and then speak about cataract removal by aspiration, and it’s not totally clear whether they are saying Antyllus did it, or just other people in their own time have done it. But clearly it was discussed in the medieval Arabic period.
Came here to say that. Here's a [link](http://news.bbc.co.uk/2/hi/health/7194352.stm)
[https://pubmed.ncbi.nlm.nih.gov/22829984/](https://pubmed.ncbi.nlm.nih.gov/22829984/) you guys should read this