Cataract surgeons, slit lamps and the Basel Eye Clinic

Anyone who passed themselves off as an ophthalmologist in ancient Babylon could make a fortune, as reported in the more than 3,600-year-old Code of Hammurabi. A successful treatment was rewarded with 10 shekels. At that time, a shekel had the purchasing power of 50 kilograms of flour, 360 fish or 2 liters of date syrup. However, the consequences of failure due to medical malpractice were drastic: The doctor’s hands were chopped off. Over the following centuries, ophthalmology retained the reputation of being a somewhat shady profession, as the complexity of the human eye and the inadequate instruments for examining it hindered scientific progress for a long time. The anatomy and functioning of the eye remained unclear until the 18th century, and it was only with the advent of the microscope that it became possible to see details and use the knowledge gained for therapies. Although ancient Indian medicine and many Greek scholars such as Hippocrates were concerned with the anatomy and treatment of the eyes, their findings were based essentially on studies of animal eyes and were hardly transferable to humans. The starling and its piercers This unsatisfactory state of knowledge did not, however, prevent practicing doctors from treating one of the most widespread eye conditions with surgery: cataracts. As early as 140 AD, there was a report of such a surgical procedure being performed by a Greek doctor. In the Middle Ages, extensive theoretical works were written that described observations and findings such as the pupil’s reaction to light or the absorption of light by the retina. At that time, the practical tasks were performed by specialized artisan surgeons, who were also referred to as cataract surgeons and oculists. Dr. Eisenbarth, who was famous in the Middle Ages, performed cataract operations using a special knife to push the cloudy lens into the interior of the eye. The situation at that time is described by the German oculist Georg Bartisch in his 1583 book Ophthalmoduleia: “Eyes should be held in high regard and cataracts should not be allowed to develop. The oculist should be pious, have studied anatomy, have subtle hands and fingers, and be agile on both hands, not greedy for money, not a drunkard, not boastful; such oculists are few and far between.” Friedrich Rintelen, former director of the Basel Eye Hospital, gives us an insight into conditions in Basel at the time in his essay Ophthalmology in Basel during the Baroque Period. Here, too, cataract surgeons were in practice until the 18th century, and the most successful of them enjoyed a high reputation. Towards the end of the 17th century, the city physician of Basel, Bernhard Verzascha, recommended the following eye lotion for the medicinal treatment of cataracts: “Eye-bright spirit, fresh valerian root, fresh bellflower root, fresh vervain and rosemary, nutmeg and cinnamon, fresh rue, fennel and aniseed, fresh eyebright; mix everything together, leave it to stand overnight, distill it on the balneo Mariae and keep it in a well-protected glass. This water can be used both internally and externally.” Rintelen concludes his treatise by stating that ophthalmology in 17th-century Basel and in the first quarter of the 18th century was a very peculiar but typical mixture for the baroque cultural period: ‘The faculty taught outstanding work in the fields of anatomy and physiology and probably also medical-clinical knowledge, which the masters of the faculty taught and had their doctoral students express; we may assume that some skilled surgeons and cataract surgeons were at work. And alongside this, a worryingly primitive, botched therapeutic practice flourishes, worthy of a caustic Molière comedy.’ The Basel Eye Hospital When the founder of the Basel Eye Hospital, Dr. Heinrich Schiess-Gemuseus, a doctor from eastern Switzerland, settled in Basel in 1861, the level of knowledge in the field of ophthalmology had already developed considerably. Schiess, for his part, had extensive ophthalmological knowledge, which he had acquired during his studies in Basel, Wuerzburg, Munich, and Vienna. He specialized in the field of ocular histopathology and published around 60 studies on clinical and histopathological topics during his lifetime. Schiess was also the ophthalmologist to Friedrich Nietzsche and a lecturer in ophthalmology in Basel. It was at the Basel University that the medical professor C. G. Jung had given his first lectures on eye diseases as early as 1823, and it was Jung who encouraged Schiess, a practitioner, to open a clinic exclusively for eye diseases in Basel after his arrival in Basel. However, the municipal hospital and curatorship provided so little support for this project that Schiess only managed to acquire sufficient funds and land for his project with the help of the public. In 1864, Schiess founded the “Sanatorium for Poor Eye-Patients in Basel” with eight beds in a small house at Missionsstrasse 45. Nursing care for the patients was provided by nurses from the Bern Deaconess House.

The first “Sanatorium for Poor Eye-Patients in Basel” was opened in 1864 at Missionsstrasse 45 with eight beds.

The need for competent treatment of eye diseases and the possibility of inpatient care was immense, not only in the city of Basel but also in the surrounding areas, leading to the rapid expansion of the eye hospital. In 1877, the main building of the present-day eye hospital on Mittlere Strasse was already in use; at that time, at that time, the clinic had as many as 48 beds, a permanently employed assistant, a head nurse and an administrator. In 1900, the first polyclinic was set up in the garden area, and with the invention of the slit lamp, developed by the Swedish physician Allvar Gullstrand in 1911, the hospital's doctors now also had a modern examination device at their disposal. The slit lamp can be used preventively during a routine examination, but also to diagnose existing complaints. Heinrich Schiess was succeeded by Carl Mellinger, Alfred Vogt, and Anton Brueckner, who took over the post of head physician at the eye hospital between 1896 and 1948. Friedrich Rintelen then ran the hospital for almost 30 years, from 1948 to 1974. During his term of office, the current Eye Clinic and the still-used ward block were built between 1950 and 1953. The new polyclinic building, which currently hosts more than 80,000 consultations a year, was completed in time for the 500th anniversary of the University of Basel in 1960. The polyclinic is the center for outpatient ophthalmological care and for the training of medical staff.

During Rintelen’s term of office, particularly in the 1950s and 1960s, ophthalmology also became highly specialized, which ultimately meant that the diverse subject areas could no longer be covered by a single head physician. Integration and innovation In the 1960s, the first research laboratory of the Eye Clinic was set up, headed by a newly appointed scientist specializing in basic research. Initially, the focus was on research into corneal physiology problems; in the 1980s, this area was abandoned and the focus was now on vitreoretinal surgery. Under Balder Gloor, who was head of the clinic from 1974 to 1985, ophthalmic surgery became a high priority, and with the opening of the new surgical wing in 1980, the number of operations also rose sharply.

In the 1950s the dormitory was rebuilt (view from the garden).

When Josef Flammer took over as director of the clinic, having been its senior consultant from 1987 to 2013, research work changed again, this time towards the physiology and pharmacology of the eye, with a focus on glaucoma. Flammer introduced several teams for basic research, but also for clinical research, and intensified scientific exchange. To this end, contacts with nearby institutes such as the Biozentrum, but also with international partners, were expanded, and in 2006 an additional department for diagnostics, teaching and research was opened at the clinic. The integration into the University Hospital Basel (USB) opened up exciting new perspectives for the Eye Clinic in the field of ​​interdisciplinary cooperation with internal medicine, neurology, and surgery. For example, the USB is the Swiss center for a recently approved gene therapy for the treatment of inherited retinal dystrophy, a rare disease that affects one in 3,000 people in Switzerland and can cause blindness in early adulthood. The gene therapy drug is applied microsurgically under the retina, which requires not only the necessary instruments but also considerable knowledge and skill. On March 10, 2021, a 12-member team from the Department of Ophthalmology successfully performed the first such operation in Switzerland. Another example of the Eye Clinic’s forward-looking approach is its partnership with the Institute for Molecular and Clinical Ophthalmology Basel (IOB), with which the Eye Clinic has been working closely since 2017. Both partners represent a unique innovation chain in ophthalmology – from basic research to patient application. The motto of this translational research is “from bench to bedside,” i.e. from the laboratory to the patient as quickly as possible. Since the IOB was founded, every effort has been made to accommodate both basic researchers and clinicians under the same roof so that they can work hand in hand to gain a better understanding of eye diseases. Today, the management of the Eye Clinic is in the hands of Nicolas Feltgen. A polyclinic is available for patients to provide basic care, with a 24-hour emergency service. In addition, the Eye Clinic offers all specialist ophthalmological consultations. In order to remain at the forefront of medical innovation, the Eye Clinic’s surgical facilities are currently being fully converted to digital microscopy. This will also enable live imaging of the retina during operations. For operations, the clinic can draw on experienced specialists and state-of-the-art technology. If required, a ward is also available in addition to the outpatient area.