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Cataract surgery – what was it like in 1914?

29/08/2017

In an episode of the acclaimed series Downton Abbey, the cook, Mrs Patmore, is having problems in the kitchen. She puts salt on a dessert instead of sugar. She burns herself regularly. All the while giving kitchen maid Daisy a difficult time. But Mrs Patmore has a secret – she is going blind. She has cataracts, and they are gradually taking away her sight. These days, we take modern cataract surgery for granted – not only will cataract surgery renew the sight of the person, but leading-edge intraocular lenses will improve it.

So, as Mrs Patmore was sent to the famous Moorfields Eye Hospital by Lord Grantham, what would have been the approach towards cataract surgery?

The actual removal of the cloudy lens (the reason why, when untreated, cataracts can cause loss of vision) was first introduced in 1748. However, it wasn’t until the 1960s that technology made it easy not only to remove the cloudy cataract, but replace it with an intraocular lens. Although we don’t have records from Moorfields Eye Hospital in 1914 (and Downton Abbey is, after all, a fictional television series), we can only make assumptions.

*Mrs Patmore was most likely was given an anaesthesia (either cocaine or a nerve block called retrobulbar). Her cloudy lenses would have been removed through a wound, around 6mm (very different from today’s 2mm incision). Copious irrigation using saline or various syringes may have been used to remove the cortex. The wound would be sutured (not necessary today) and Mrs Patmore would remain at the hospital and examined every day for any complications. She would then be given ‘aphakic’ lenses (glasses), and told to expect a recovery period of 6–8 weeks.

In the episode in which Mrs Patmore returns from Moorfields Eye Hospital with her ‘coke bottle’ glasses, she is able to do her job as before. Meanwhile, the rest of the staff are befuddled (and in awe) of a revolutionary new contraption – a telephone. “It’s not a toy!” Butler Carlson says, admonishing the younger staff. Little did he know that one day, it would have a thousand uses (including being a toy). Imagine what they would say if they knew that, one day, a laser could have been used for Mrs Patmore’s cataract surgery. But laser cataract surgery – that’s another story….

*Source: The History of Modern Cataract Surgery by Marvin L. Kwitko and Charles D Kelma

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