Since 1997, one technique for manual small-incision cataract surgery practiced in Nepal – as well as some Indian states – involves pulling the cataract from the eye with a fishhook (1). But when in history was this type of surgery first performed?
If we include attempts in animals, we might have to go all the way back to 1596. That year, Durante Scacchi of Italy wrote in his Subsidium medicinae that others had used a harp string bent into the shape of a hook, and inserted through a hollow needle to pull cataracts out of the eyes, but when he tried it in animals, he succeeded only in tearing the tunics of the eye and permitting aqueous to escape (2,3).
Next, Thomas Feyens of Louvain mentioned the technique again in 1602 (2,4). The only figure we have of a similar instrument is from the 1695 thesis of Leopold Gosky of Frankfurt, who stated that an itinerant eye surgeon claimed to have received from a fellow surgeon of Riga a needle which, when a spring was pressed, opened like a forceps, and could grasp and extract cataracts (Figure 1) (2,5). Gosky believed a cataract to be a thin film, but he doubted the procedure could work.
If we include attempts in animals, we might have to go all the way back to 1596. That year, Durante Scacchi of Italy wrote in his Subsidium medicinae that others had used a harp string bent into the shape of a hook, and inserted through a hollow needle to pull cataracts out of the eyes, but when he tried it in animals, he succeeded only in tearing the tunics of the eye and permitting aqueous to escape (2,3).
Next, Thomas Feyens of Louvain mentioned the technique again in 1602 (2,4). The only figure we have of a similar instrument is from the 1695 thesis of Leopold Gosky of Frankfurt, who stated that an itinerant eye surgeon claimed to have received from a fellow surgeon of Riga a needle which, when a spring was pressed, opened like a forceps, and could grasp and extract cataracts (Figure 1) (2,5). Gosky believed a cataract to be a thin film, but he doubted the procedure could work.
Johannes Conrad Freytag of Zurich wrote in 1710 that during the 1690s he had drawn visual opacities out of the eye with a hooked needle in at least 3 patients, typically as a secondary procedure following cataract couching (2,6). A 19-year-old born blind was cured by Freytag using conventional cataract couching. After the patient’s vision was restored, he stole from Freytag’s home, and an angry mob grabbed the thief’s feet, dragged him down the stairs, forcing him to hit his head, whereupon he became blind again. Freytag then used the hooked needle to restore the patient’s vision a second time (2,6).
In one case, Freytag operated with the hooked needle on cataracts which developed in both eyes of a 40-year-old woman during childbirth. What is remarkable is that, although one of the hooked-needle extractions was a reoperation, presumably of a thin capsular opacification or retained cortex, the other hooked-needle extraction apparently was in a previously unoperated eye (2,6).
When Freytag’s son, also a surgeon, wrote a thesis in 1721 describing his father’s extractions with the hooked needle, a team of skeptical surgeons insisted that the son demonstrate the surgery to them (2). This demand seems a bit unfair. We don’t expect the children of Nadia Comaneci or Tiger Woods to perform gymnastics or play golf as well as their parents!
While we accept that Freytag could pull out a bit of cortex or capsule with a hook secondarily, we are possibly inclined to doubt that he could extract a complete cataract from the eye with a hook. On the other hand, given the modern surgical experiences described in South Asia (1), maybe Freytag did actually pull off such a feat!
References
- A Anand et al., “Fish hook technique for nucleus management in manual small-incision cataract surgery: An Overview,” Indian Journal of Ophthalmology, 70, 4057.
- CT Leffler et al., “Cataract extraction from anquity through Daviel in 1750,” in CT Leffler (Ed.), A New History of Cataract Surgery, Part 1: From Antiquity through 1750, 377, Wayenborgh: 2024.
- D Scacchi, Subsidium medicinae, 54, Urbini: 1596.
- T Feyens, Thomae Fieni…Libri chirurgici XII, 30, Francofurti-Goezium: 1602.
- LD Gosky, De catararhacta defendente Leopoldo Dieterico Gosky, Frankfurt: 1695.
- J Freytag, “Observationes Chirurgae 1710,” in J. von Muralt, Schrifften von der Wund-Artzney, 729. Thurneysen: 1711.
