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  • History of Ophthalmology in the Asia Pacific

    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.
    India
    Ayurvedic Anatomical Drawing, c18th Century
    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.






    Couching Needle
    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.

    China
    An aged page from a book. The paper is beige and has a dark brown stain in the top right hand corner. The page has eight lines of small Chinese characters, and there is a drawing of two almond-shaped human eyes in the center of the page.
    Fushi Yanke Shenshi Yaohan, c1644
    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.







    Acupuncture Illustration
    A faded page from a book. The paper is beige and there is a water stain in the top right hand corner. The left half of the page has lines of Chinese characters, and the right side of the page has a drawing of almond-shaped human eyes and five long needles.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.

    Surgical Illustration

    A faded page from a book. In the center of the page, there is a line drawing of a man sitting in a black chair. He has dark hair and is wearing long robes tied across his body. There are lines and Chinese characters labeling parts of his body. There are also lines of Chinese characters along the top and right and left sides of the page.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.
    Role of Buddhism
    A sepia-toned photograph of a statue of the Buddha. The statue is made of stone, and has its hands raised in front of it in a meditative posture. There is a statue of another small figure next to the Buddha, and many smaller figures beneath him.
    Buddha Statue, Rudolf Bock, MD
    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.





    Madhyamaka Buddhism

    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.
    Japan
    A small, round figurine in the shape of a man cutting his toenails. He is ivory-colored, and the details of his hat, eyes, eyeglasses, and kimono have been painted on in black and blue. He bent forward, and is holding his foot in one hand while he holds clippers in the other hand.
    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.






    Majima School

    A faded page from a book. The paper is beige and worn. There is very small text in Japanese characters, and a drawing of one human eye in the center of the page.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.

    Holistic Model

    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.
    Sri Lanka
    A large stone basin with an opening shaped like a human body sits on a stone walkway. It is outside, and there is green grass in the background. Stone pillars or objects can be seen in the far background.
    Vejja Sala Archaeological Site
    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 Ola

    A book with fanned out, accordion style pages sits on a brown surface. The book's cover is made of wood, and has a complicated design and a stone in the center. The pages are rectangular, and are connected together at the bottom to they can fan out. The book has a red and white string attached for carrying it.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.