Extracapsular cataract removal pioneered by Sushruta

Reports that Sushruta practiced couching for cataract removal are incorrect, although Sushruta clearly and unambiguously described extracapsular removal. That Sushruta lived around 600 BC is accepted bymost medical history scholars. His work Sushruta-Samhita (compendium), which is written in Sanskrit in verse form, was discovered in Chinese Turkistan by Hamilton Bower in 1890. The translation of Sushruta-Samhita is based on the Bower manuscript now in the Bodlean Library, Oxford, United Kingdom. Hoernle’s 1997 translation remains incomplete. The first complete translations were by Bhishagratna in 1907 and Singhal et al. in 1972. Bhishagratna, a poet whose epithet was “kaviraj” (king among poets), had no scientific or medical training. Although he accurately translated the relevant verses of Sushruta-Samhita describing the extracapsular procedure, Bhishagratna, not understanding the nuances of eye surgery, concluded his introduction with poetic flourish, “To Sushruta is attributed the glory of discovering the art of cataract-crouching [sic] . . . .” Singhal, who had surgical training in India, UK, and Canada, and qualifications ofMS and FRCS,was a professor of pediatric surgery. He did not draw any erroneous conclusions. The gist of the translation of Sushruta’s verses 51–79 by Bhishagratna and Sighal is that Sushruta accurately described extracapsular cataract removal by piercing the eyewith a pointed instrument, “which is directed to the natural orifice (pupil), the lesion/fault (cataract) should be punctured and scraped with the point of the instrument, and the patient should exhale forcefully after closing the contralateral nostril . . . the instrument should be withdrawn when the patient is able to see.” The eye was then bandaged and the patient lay supine, avoiding coughing or sneezing, for 10 days. Such postoperative care was also practiced worldwide after intracapsular cataract removal until the 1970s and is too elaborate a procedure had Sushruta practiced simple couching. The incorrect attribution of couching to Sushruta by eminent ophthalmologists such as Duke-Elder, Ridley, Trevor-Roper, and Apple was perpetuated because they were probably unaware of Singhal’s

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