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Welcome to Episode 206 of That Shakespeare Life, the podcast that takes you behind the curtain and into the real life and history of William Shakespeare.

In a 16th century painting by Casper Stromayr, two men, presumably doctors, are standing behind a table on which a set of surgical instruments are laid out very neatly. In the notes for the painting we discover that some of the instruments are specifically for surgery of the eye. 

Cataract surgery like the one being prepared for in this painting was just becoming widespread in Shakespeare’s lifetime and was performed to remove the pearly film that developed over the surface of the eye. 

In Shakespeare’s The Tempest, Ferdinand uses the phrase “Those are pearls that were his eyes:” Again in Rape of Lucrece, Shakespeare calls attention to pearly eyes when he writes “His eye drops fire, no water thence proceeds; Those round clear pearls of his…” 

Additionally, in both King Lear and Shakespeare’s Henry VI Part II, there are references in the dialogue to specific procedures and even specific diseases of the eye. The novelty of this new surgery, combined with the very public and performative nature of the procedure itself– often being performed in the street on public display– it’s plausible to think William Shakespeare may have been studying up on this new science. Based on the parallels found in Shakespeares plays, some scholars even suggest that William Shakespeare may have read Charles Estienne’s Defence of Contraries, translated from French to English in 1593, or Thomas Cooper’s 1578 medical dictionary that defines “cataractia” as “a disease of the eyes, when a tough humour like a gelly droppeth out.” 

To help us explore the history of cataract surgery as well as the references to the procedure and eye disease we see in Shakespeare’s plays is our guest and professional ophthalmologist, Dr. Chris Lefflfer.

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Dr. Chris Leffler is Opthamologist and professor at Virginia Commonwealth University. He is the author of The history of cataract surgery: from couching to phacoemulsification published in the Annals of Translational in 2020, currently practices ophthalmology at the Virginia Commonwealth University Medical Center, and is Associate Professor in the Department of Ophthalmology at the Virginia Commonwealth University. 

cataract surgery, 1594
Le chirurgie françoise recueillie des antiens médecins et chirurgiens. Avec plusieurs figures des instrumens necesseres pour l'opération manuelle / Par Iacques Guillemeau.. Credit: Wellcome CollectionPublic Domain Mark | Translated from French: The French surgery collected antiens doctors and surgeons. With several figures of the instruments necessary for manual operation / By Iacques Guillemeau.. Credit: Wellcome Collection. Public Domain Mark | Wellcome Images, Public Domain | Source

This week, I'll be asking Chris Leffler about:

  • What were the signs and symptoms used to diagnose cataracts in the 16th century?
  • Did the field of ophthalmology exist in Shakespeare’s lifetime, or what kind of physician was performing these procedures?
  • What was the process of getting cataracts surgery done in the 16th century? Was the patient awake, Was there a special chair or surgical time used, and what was the recovery time like for patients, how did they heal?

Books and Resources Chris Leffler Recommends:

Articles Chris has written on cataract surgery and shares these links to his work:

https://www.researchgate.net/publication/347250937_The_history_of_cataract_surgery_from_couching_to_phacoemulsification

https://www.researchgate.net/publication/350148285_The_First_Cataract_Surgeons_in_the_British_Isles

More resources Cassidy thought you might find useful:

Author Sara Read has been a guest on That Shakespeare Life to talk about John Hall, Shakespeare's Son in Law that was himself a medical professional. Explore that episode here.

Dr. Leffler’s staff page: https://medschool.vcu.edu/expertise/detail.html?ID=1143

The history of cataract surgery, Annals of Translational Medicine: https://atm.amegroups.com/article/view/54993/html

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“Blow, winds, and crack your cheeks! rage! blow!

You cataracts and hurricanoes (sic), spout

Till you have drench'd our steeples, drown'd the cocks!”

— King Lear, Act III Scene 2

cataract surgery images and instruments 1757
Heister, Operation for cataract and eye instruments, 1757 | Public Domain | Source

Cataracts Surgery was performed by a specialist

It was generally doctors or eye specialists that performed cataract surgery in the 16th century. The diagnosis of cataracts was a rougher business than today, because as Chris points out, doctors did not have all the modern equipment we have today.

“[The primary symptom was] not being able to see is the worst symptom. You can see light/dark but not much else. Mild cataracts did have other symptoms, like seeing flies (things swirling around) and in fact that’s not considered cataract today, but they didn’t have really good tools for examining the eye and didn’t have the ability to distinguish between various eye diseases like we can today.”

During Shakespeare's lifetime, cataracts surgery was not known as cataracts. That term would arrive in English later. During the 1580s, a new English term for this surgery developed called “Couching.” Chris explains that the term is thought to have derived from

“…[the] French [term], coucher, to lay down. In the 1500s, around the time of Shakespeare, people began to use the English term “couch” to describe the surgery that had been around since antiquity–using a rod to push the opaque lens out of the field of view so they could see.” 

The procedure, as well as the field of ophthalmology, was just getting its' feet under it in the 16th century. The specialist title of ophthalmologist didn't exist yet. Instead, there were a variety of professionals who could perform this procedure. Chris explains,

“[It] wasn’t always an eye specialist, but it could have been. Occulists. They were people who English language around 1580s is when this term arrives and when doctors start specializing in eyes. Other times it was a general surgeon who could perform this.”


“Those are pearls that were his eyes…”

— Ferdinand, The Tempest, (I.2)

man having cataract surgery performed, 1195

1195, Medieval eye surgery (Starstich); The text / the text “Albule oculorum sic excucuciuntur”, correct Latin / correct Latin “Albulae oculorum sic excutiuntur” (duplication / doubling “cucuci-” instead of / instead “cuti-” (c <=> t) is a typo at the line break /is a writing error at line break) means in German: “The white opacities of the eyes are removed this way.” | British Library MS Sloane 1975, f. 93. (http://www.bl.uk/catalogues/illuminatedmanuscripts/ILLUMIN.ASP?Size=mid&IllID=3113) |Public Domain | Source

Cataracts Surgery Procedure

Cataracts patients can be visually blind, and sometimes having this surgery done was seen as a cure for blindness. Chris explains that the procedure itself was in an infancy that translated to a great deal of failure more often than success, but that there were several instances where people's sight was restored:

Surgery could fail alot, particularly from infections (sterility not observed as closely as we do today). Retinal detachment could also occur, and there were definitely people who had the surgery done successfully and were cured of blindness. It was a primitive type of surgery, and you would wait until the cataract was very severe, but yes there were instances in the early 1600s in England and even at the end of the 1500s, where people did have their sight restored. 

The instruments used to perform cataracts surgery were quite different than what we have today. Chris explains that the severity of cataracts being operated upon was often much more advanced than the point at which modern surgeons would recommend the procedure. Additionally, this surgery was done prior to anesthetic, so the operation was quite different than today. In England, in particular, they weren't using the same approach to cataracts as other countries:

“In antiquity, it was a needle or a rod that was used. It was a single instrument used to penetrate the white part of the eye and push the lens out of the way. They didn’t use an eyelid speculum to hold the eyelids open and sometimes you would have to pus the lens down repeatedly, otherwise you would hold it down quite a while to try and keep it out of the visual axis. In the medieval arabis period there were some eye surgeons who used a lancet to make an incision in the white part of the eye then use a separate rod to pus the lens you to that way, [this approach to the cataracts] surgery moved into India but it wasn’t common in Europe and definitely not in England…”


His eye drops fire, no water thence proceeds; Those round clear pearls of his…”

— William Shakespeare, Rape of Lucrece

16th century image, Casper Stromayr, Surgical instruments laid out on a table, for use in cataract and hernia operations during the mid 1500s
16th century image, Casper Stromayr, Surgical instruments laid out on a table, for use in cataract and hernia operations during the mid 1500s, with two men in 16th century dress standing behind it. Colour facsimile process print after a 16th century manuscript, 1925.| This file comes from Wellcome Images, a website operated by Wellcome Trust, a global charitable foundation based in the United Kingdom. Refer to Wellcome blog post (archive).| Source information:
https://wellcomeimages.org/indexplus/obf_images/5e/b6/4963eee2d56c8ed2b67e1d85dfa6.jpg

Gallery: https://wellcomeimages.org/indexplus/image/V0016465.html
Wellcome Collection gallery (2018-04-03): https://wellcomecollection.org/works/abehxsgy CC-BY-4.0 | Source

Cataracts Surgery Recovery and Healing

Many times the procedure of cataracts surgery was a public affair, often being performed in a chair on a pedestal or otherwise constructed stage. (I've often wondered if there's an association with this practice and the development of the phrase “operating theater” that we have today). Chris explains,

There were a variety of different ways this could happen. Some itinerant practitioners, some performed it on a stage. Trapeze artists and rope walkers and play music, gambling and [had a] medical booth part of a city fair, and other people would go to patients homes or the patient would go to the doctor’s homes. You don’t hear of it happening in hospitals in the 1600s, it wasn’t until the 18th century that you see it happen in hospitals. 

The process of undergoing the cataracts surgery was quite severe. While it's paramount to emphasize the lack of anesthesia while your eyes are being cut upon, that's only where the harshness begins. Chris explains that the patient was often physically restrained and held down for the procedure, often undergoing a lengthy rest period afterwards to recover.

The person was sitting on the ground, and perhaps on a pillow, the chairs didn’t have arms but they had a back. There would be an attendant behind the patient holding their head still, and there was no anesthesia,) they didn't’ have it, after the procedure they’d have to lay down for 9 days with a dressing on the eyes of linen and egg white, changed every few day[s]…


“If thou hadst been born blind, thou mightest as well have known all our names as thus to name the several colours we do wear. Sight may distinguish of colours, but suddenly to nominate them all, it is impossible.”

— Duke of Gloucester, Henry VI Part II (II.1)

The engraving illustrates a couplet by Horace (Epistles I.2) Man having his eye removed, 1672
The engraving illustrates a couplet by Horace (Epistles I.2): “Quae laedunt oculos festinas demere: si quid / Est animum, differs tempus curandi in annum” (Those things which harm the eyes you hasten to eliminate. As for those which harm the soul, you postpone the time of cure from year to year). | [Brussels] : [F. Foppens], 1672. | Contributors
Veen, Otto van, 1556-1629. Gomberville, M. Le Roy (Marin Le Roy), sieur de, 1600-1674.
Horace. | The commentary by Marin Le Roy, sieur de Gomberville, may be translated as follows: We see first a wretched man, one of those whom the world calls happy, whose soul is eaten with ulcers, his heart gnawed by all the worms which his crimes form there, and his spirit attacked by all the most uncontrolled passions, but nevertheless refuses the pleasant and unfailing remedies which Time and Wisdom offer to him. He shamelessly brushes off the generosity by which they have deigned to anticipate his prayers, and dismisses them with this arrogant compliment: that if he ever needs their assistance, he will not fail to have them summoned. However, for a slight inflammation which he has in is eye, he calls out impatiently for the help of all the oculists. This little inflammation deprives him of rest, and causing him to forget the great number of possessions that he has acquired for himself by an even greater number of crimes, persuades him that all his happiness is bound up in the cure of his illness. The surgeon also works with all the industry of which he is capable, and promises the willing blind man that he will soon mitigate his pain. In truth the outer eye can be cured, but the more precious vision will not be. It is from an art much more subtle, amd nore divine, than surgery, that we must expect the cure of these delicate senses through which man is truly human. Reference: Wellcome Library no. 16545i | Public Domain | Source: https://wellcomecollection.org/works/qhyev4te

A Scene in Henry VI Part II Inspired by Real Life

In Shakespeare’s Henry VI (Part II, Act II, Scene I), the Duke of Gloucester says: “If thou hadst been born blind, thou mightest as well have known all our names as thus to name the several colours we do wear. Sight may distinguish of colours, but suddenly to nominate them all, it is impossible.” Chris, explains that this line is based on a real story from Shakespeare's history:

“[In a work] published by Thomas Moore in 1529, refers to a story that’s supposedly took place in the 1400s when a beggar said that he was miraculously cured of blindness. The Duke of Gloucester aid that it would be impossible for him to name the colors, having never seen them to learn their names. He had him set in the stocks as punishment. There is a historical origin to the story and when Shakespeare wrote that play 1590-1592, cataract surgery was not really known in England and was considered a miracle to improve the vision in children who had been born blind or in adults who had been born blind …”


“Tis not your inky brows, your black silk hair,

Your bugle eyeballs, nor your cheek of cream,

That can entame my spirits to your worship.”

— Rosalind, As You Like It (III.5)

Images (From bottom right back up to top left):

  1. Operation for Pterygium (a triangular or wedge-shaped growth of conjunctival tissue, which has grown over the surface of the cornea) | Uncertain Date | Source | This file is licensed under the Creative Commons Attribution 4.0 International license.
  2. Woodcuts; Anatomy of the eye; woodcut from Gregor Reisch: Margarita Philosophica, Freiburg 1503 | Public Domain| Wellcome Images Gallery | Source | This file is licensed under the Creative Commons Attribution 4.0 International license.
  3. Woodcut, Operation for Cataract, Unclear Date | Wellcome Images | This file is licensed under the Creative Commons Attribution 4.0 International license.| Source
  4. Woodcut, Operation on the Eye | Wellcome Images | Unclear Date | Source | This file is licensed under the Creative Commons Attribution 4.0 International license.
  5. A monk performs an eye operation on a lay patient, who reclines on a table. Behind him are shelves stocked with various pots and jars of medicine. | Wellcome Images | Unclear Date | Source | This file is licensed under the Creative Commons Attribution 4.0 International license.
  6. A monk performs a delicate eye operation on one of the fellow members of his order, who is held in place by another monk. | Wellcome Images | Unclear Date | Source | This file is licensed under the Creative Commons Attribution 4.0 International license.