Indirect evidence of cataract surgery in ancient Egypt

Abstract

We believe that the article by Blomstedt1 on cataract surgery in ancient Egypt needs some discussion. The majority of previous publications on this subject, not referenced by Blomstedt, report no direct evidence that cataract surgery was performed in ancient Egypt.2,3 On the other hand, at least some of the references cited in Blomstedt’s paper1 to show the opposite point of view are of low scientific value; for example, the article by Keeler et al. has no references and Osler’s book contains no information about cataract surgery that we could identify. Although there is little or no direct evidence of cataract surgery in ancient Egypt (which does not mean it was not performed), there is some indirect evidence. In 2001, near the Saqqara pyramid complex (built c.2630 BC) about 19 miles south of Cairo, archeologists discovered the tomb of Skar, the chief physician of one of Egypt’s fifth dynasty rulers. Dating back more than 4000 years, this is the oldest known tomb of a Pharaonic surgeon. In the writing on the tomb walls was a hint that surgery had been practiced in ancient Egypt, the first hard evidence of it being performed as early as this. The tomb contained about 30 bronze surgical tools, including several needles having neither hooks nor eyes, used by the ancient Egyptian doctor.4 Nebenchari, the ophthalmologist of pharaoh Amasis, wrote an ophthalmic textbook about 529 BC titled Additional Writings on Treatment of the Diseases of the Eye, by the Great God Toth, Newly Discovered by the Oculist Nebenchari.5 He was sent to cure the Persian king’s 70-year-old mother Cassandane, whose sight deteriorated. He operated on her by “cutting the skin that covers the pupil of the eye” and restored her vision. From the historical accounts, it is not clear whether this procedure represented couching, pterygium surgery, or something else entirely. At the same time, Nebenchari’s rival at Amasis’ court, Pentammon, read this treatise and subsequently operated on the eye of the pharaoh Amasis.5 Again, it cannot be conclusively determined what procedure was performed. Finally, the picture often presented in papers (Figure 1, A) clearly shows a physician with a long, sharp instrument used for an eye operation. We can speculate on the circumstances of this drawing and the length of the instrument, but a very similar image (Figure 1, B) was used in surgery textbooks in the Middle Ages to represent the couching procedure.Figure 1: A: Wall painting in the tomb of the master builder Ipwy at Thebes (about 1200 BC) showing an oculist treating the eye of a workman. B: Illustration of an ocular surgical procedure using a long, sharp instrument. Taken from the late 12th century Anglo-Norman illuminated manuscript entitled Practica Chirurgiae (The Practice of Surgery), also called Chirurgiae Magistri Rogerii (The Surgery of Master Rogerius), by Roger Frugard of Salerno (c.1140–1195) (British Library, London, United Kingdom).In conclusion, although we still lack direct evidence for cataract surgery in ancient Egypt, the indirect evidence suggests that it was possible.