The progression of minor eye surgery to a true surgical subspecialty awaited the discovery of anesthesia in the latter part of the 19th century. Prior to that, anatomy (1) and physiology was poorly understood and the only major operation that was routinely practiced was the removal of cataracts in the early 6th century in India (2-5). Barber-surgeons removed cataracts as they traveled the countryside and performed various other procedures including bloodletting, dental extraction, cupping, abscess drainage, and fracture repair. Many patients succumbed to shoddy work and included the famous composer Johann Sebastian Bach, while others lost their sight including George Frideric Handel.

An Explosion in Instrumentation

In 1850, Herman Helmholtz invented the ophthalmoscope (6), enabling him to visualize the retina and Ophthalmology was on its way to becoming a specialized branch of medicine. The growth of technology and an expanding population resulted in the production of many more instruments directed toward the treatment of eye diseases (7,8), and the training of physicians (9,10). Wonderful instruments were made prior to the aseptic era, with some specifically constructed for exhibition and competition at World's Fairs (11-14). Ironically, a great deal of morbidity resulted from the use of these instruments since the medical community had not yet unanimously accepted sterilization procedures.

Artificial Parts

Frequently the best a physician could do following severe disease or wartime injury was to provide a prosthesis to match as closely as possible the missing part. Eyeglasses have been available from the 16^th century and have only recently been replaced by newer surgical techniques (15-17).

1) Optic Tracts by Leonardo da Vinci, (ca 1517)

Da Vinci made these early sketches to relate anatomy and physiology and was the first to demonstrate the relationship between the brain and peripheral nerves. These drawings were primarily for use by other artists.

2-5) Early Cataract Surgery

These early depictions of cataract surgery begin with a 16th century engraving that points out the need of an assistant to hold down the patient in this preanesthetic era. Early instrumentation can be seen in Laurence Heister's "A General System of Surgery" (1743), while the same operation is beautifully illustrated in "Traite Complet de L'Anatomie de L'Homme" (1866-1871), by Bourgery. Another fine illustrated text shown here was written by Joseph Pancoast in 1844, "A Treatise on Operative Surgery".

6) Loring's Ophthalmoscope

This fine latter 19th century ophthalomoscope was made by Luer of Paris, one of the foremost manufacturers of eye instruments at that time.

7-8) Lacrimal and Trial Lens Set

Again French interest in ophthalmology is demonstrated in this lacrimal syringe set made by Charriere/Collin while the extensive trial lens set was made by Nachet a Paris and sold in United States by JW Queen of Philadelphia.

9-10) Ophthalmophantome

Students of ophthalmology used this surrealistic appearing device by operating on animal corneas that were placed in the eye sockets. This particular one was made by Luer and a similar one was advertised by Aubry in his 1900 catalogue "Catalogue Illustre des Instruments de Chirurgie".

11-14) Exhibition Aubry Ophthalmology Set

Aubry made this wonderful surgical set specifically to compete with other manufacturers at World's Fairs during the latter part of the 19th Century. Only the finest materials were used Including tortoise shell handles with nickel and gold plated instruments. The case is brass bound and of the finest burl wood.

15-17) Eye Prostheses

Artificial eyes that were made of finely hand painted glass were imported from Europe until the late 19th century when American instrument makers increased their production. Here are beautiful 18th century silver eyeglasses in a shagreen case, along with a 19th century silver lorgnette that springs open for use. 

1) Optic Tracts, da Vinci

2) Cataract Surgery, (ca 1500)

6) Loring's Ophthalmoscope

8) Trial Lens Set

10) Ophthalmophantome

13) Aubry Set, Open

15) Artificial Eye