In his opening address to the Winter Session of the Royal Victoria Hospital, 1945-46, entitled A Synopsis of the History of Ophthalmology, James R. Wheeler, MB, FRCSED, DOMS, wrote:
“The uncertainties of unrecorded history make it impossible to say where the dawn of civilisation began, but the earliest mention of any medical matter is found in an ancient work on law. About 2250 BC, Hammurabi, a king of Babylon, Assyria, promulgated a collection of laws.”
As every history student learns, one of the most famous and enduring of these Hammurabic codes is an eye for an eye, sometimes referred to as the law of retaliation. But it turns out that Hammurabi had more in mind than retaliation – in fact, as Dr. Wheeler wrote, “A considerable number of sections of these laws relate to ophthalmology…” and specifically to compensation for those who successfully performed eye surgery, and recompense from those who did not.
In the case of payment, Hammurabi declared as follows:
215. If a physician make a large incision with an operating knife and cure it, or if he open a tumor (over the eye) with an operating knife, and saves the eye, he shall receive ten shekels in money.
216. If the patient be a freed man, the physician receives five shekels.
217. If the patient be the slave of some one, his owner shall give the physician two shekels.
Not exactly equitable by 21st century standards, but obviously, in 2250 BC, not all eyes were considered equal. Hammurabi was far less generous to eye doctors when they failed:
218. If a physician make a large incision with the operating knife, and kill him, or open a tumor with the operating knife, and cut out the eye, his hands shall be cut off.
The Code was less harsh if the patient was a slave:
219. If a physician make a large incision in the slave of a freed man, and kill him, he shall replace the slave with another slave.
220. If the physician open a tumor with the operating knife, and merely put out the slave’s eye, he shall pay half his value.
Hammurabi may have been looking to his own house; it’s believed by many that he suffered from cataracts, and may have been a candidate for the surgery. Whether he actually underwent surgery, and what the nature of that might have consisted of, is lost to history.
The first technique to treat cataracts wasn’t documented until the 6th century BC. Couching, or the practice of using a sharp instrument to push the cloudy lens to the bottom of the eye, was described by the Hindu surgeon Sushruta, and was later adopted by the Greeks and Romans, as well as the Egyptians, Arabs and Europeans. It was the only method of cataract treatment until the 19th century.
Luckily for physicians and patients alike, eye surgeries – whether for cataracts or other conditions – have become far less dangerous over the course of millennia, while technical and medical advances in treating eye diseases and correcting eyesight have made clarity of vision accessible to nearly everyone.
Despite these dramatic advances, the National Eye Institute, an arm of the National Institutes of Health, estimates that between 2010 and 2050, the number of people affected by the most common eye diseases will double. Thus the contributions of ophthalmologists like our featured specialists and the many across Hampton Roads who were nominated, are more vital than ever – and another reason this community is so fortunate. <
