History of Ophthalmology in the Asia Pacific
Illustration from "Yin Hai Jing Wei," 15th Century
Medical knowledge in the Asia Pacific was largely insular for thousands of years. Starting in the 1400s, European countries began commercial exploration of the world and their influence would end up transforming trade, politics, and medicine throughout the region. Although our exhibit ends with this exploration, traditional medicine in the Asia Pacific is seeing a resurgence as modern governments reinvest in their native models, creating a dialog between Western and traditional practice.
"Ayurvedic Anatomical Drawing," Nepal, 18th Century,
Courtesy of Wellcome Library
Ancient India is believed to have been founded in 3000 BCE. In approximately 1500 BCE the four main Hindu religious texts, or Vedas, are written. The fourth and last of these is the Atharvaveda, which is the source of Ayurvedic medicine - one of the world's oldest systems of medical knowledge. Ayurveda advocates balancing the body's three doshas to maintain good health through medicine and diet. Early texts also discuss poisons, care of children and the elderly, mental health, and surgical technique.
The Sushruta Samhita is the oldest surviving medical text in India to mention eye disease. The original was written in Sanskrit by Maharshi Sushruta in approximately 600 BCE. The book mentions even earlier practitioners and their techniques, documenting the ancient lineage of medicine in India. Most famously, the Sushruta Samhita contains instructions for rhinoplasty and couching of cataracts. This bronze couching needle dating to the Roman Empire likely owes its design to ancient India.
Couching needle illustration
Couching is a surgical procedure that consists of using a needle inserted through the sclera to dislocate the opaque lens or cataract back and into the vitreous of the eye. There the lens remains out of the field of vision. The quality of sight after a couching procedure would have been poor, especially in ancient times before the invention of spectacles. The patient, who endured the surgery without anesthesia, would have done so because limited vision was preferable to blindness. This illustration is from "Ophthalmodouleia: das ist Augendienst," by George Bartisch and dates to 1583. A couching needle is shown in the right hand of George Bartisch (1535-1606). The surgical procedure he performed was nearly identical to that described by Sushruta over 2000 years earlier.
Illustration from "Fushi Yanke Shenshi Yaohan," 1644
Founded in approximately 2000 BCE, China is considered to be the oldest continuous civilization in the world. Although civilizations in Egypt, Mesopotamia (ancient Iraq), and India pre-date China, those places experienced great change in population and culture whereas many prominent elements of ancient China can still be found today such as its language.
China had its own unique medical system. It included the philosophy of Yin and Yang (balance), Qi (energy), the five elements, and the practice of acupuncture. Based on archeological evidence, acupuncture may date as far back as the Neolithic Revolution (c10,000 BCE), however the first written accounts were made during China's Warring States Period (475-221 BCE). Acupuncture is part of a holistic approach to medicine. Chinese medical texts advocated using it along with proper diet and herbal medicine to balance five elements in the body: metal, wood, water, earth, and fire. This illustration from "Fushi Yanke Shenshi Yaohan" (Fu's Precious Book of Ophthalmology) by Fu Renyu, 1644, demonstrates acupuncture points.
A Chinese imperial medical school was established in 624 CE during the T'ang Dynasty. Provincial medical schools were then established 5 years later. Medical education at the time reportedly lasted anywhere from 3 to 7 years and students were required to take an examination. Eye medicine was initially taught alongside ear, nose and throat. An independent department of ophthalmology was finally established during the Song Dynasty (960-1279 CE) - a period of great growth and prosperity in China.
Buddha statute photographed by Rudolf Bock, MD
Role of Buddhism
When Buddhism arose in the 5th Century BCE, it incorporated some Hindu beliefs including the practice of Ayurvedic medicine. Buddhist monks then disseminated their religious and medical knowledge throughout the Asia Pacific via the Silk Road. Evidence of this is particularly strong in the case of couching cataracts which we can trace from India to China to Japan and on. This strong lineage of ophthalmology is one reason the history of medicine in the Asia Pacific is so fascinating.
One example of this flow of ideas can be found in the writings of the Indian monk Acharya Nagarjuna (c150-250 CE). Known as Longshu in China, Nagarjuna is considered the founder of Madhyamaka or Mahayana Buddhism (Middle Path). He was also an Ayurvedic physician. Nagarjuna’s writings were translated into Chinese during the T’ang Dynasty (618-906 CE) and can be found in early Japanese medical texts as well.
Netsuke figurine, 20th Century
In 701 CE, Emperor Monmu (697-707), established a comprehensive legal code in Japan that included standards of medical education and licensure. The oldest surviving medical text to mention eye disease is “Ishinpo,” written by Tanba Yasyori in 984. The book also included the first known description of couching cataracts.
In 1357 CE, early ophthalmology in Japan reached a high point when Seigan (d.1379) founded the Majima School of Ophthalmology and eye hospital. The school would remain open until the 19th Century. Unfortunately for Western scholars, the Majima School and similar institutions in Japan considered their surgical techniques to be “hiden” or secret. No official textbooks were written, but students could hand write scrolls or hidensho as memory devices. The hidensho that have survived to modern times describe mainly diagnostic and non-surgical treatment. This example is "Majima Aammoku Ichibu No Makimono" (The Secret Principles of Part of the Majima SChool of Ophthalmology,) c1600, from the Special Collections Research Center at the University of Chicago Library.
We do know that Japan’s traditional medical system used a holistic model. Physicians understood good health was reliant on a proper diet and several foods were identified for eye health including shellfish, radishes, melon and plum. Not recommended were ginger, garlic, tofu and whale meat.
Vejja Sala photographed by Jochem Wijnands,
Courtesy of Horizons WWP Collection and Age Fotostock
In 247 BCE, King Devanampiyatissa converted to Buddhism on top of Mihintale Mountain in Sri Lanka. The mountain then became a holy place with shrines devoted to the worship of Buddha. Even today, Mihintale mountain attracts Buddhist travelers from all over the world. An archeological site there named Vejja Sala is evidence that Buddhist teachings also brought medical knowledge. Vejja Sala is the oldest surviving archeological site in the world known to have functioned as a hospital. Built in the 9th Century, it likely served both locals and visitors.
Medical knowledge was written down in books called olas. The example at the Museum of Vision was written around 1670 in Sinhala, the language of the Buddhist peoples of Sri Lanka.