Star stitch
The cataract or Reclinatio lentis ( English : couching ; also scleronyxis with respect to the dislocation of the lens by the sclera pierced Star needle , and depression (the star lens) ) is the Down pushing or depressing the eye lens with a needle into the vitreous on the base of the eyeball and has been a simple surgical method for treating cataracts for thousands of years , which has been used from ancient times to around 1800. In some regions of the Third WorldIn the absence of better treatment options such as modern cataract extraction and medical care , the cataract is still performed today.
Principle of the star stitch
With the star stitch, a so-called "star stitch needle" is stabbed into the eye and the clouded eye lens is pressed to the bottom of the eyeball . After this procedure, also known as Reclinatio Lentis , the light can fall on the retina without any obstacles , the patient can see better, although the lack of refractive power of the lens usually results in a clear overview of around +19.00 diopters .
In addition to reclinatio lentis (English called couching ), cataract surgery also included suctioning out the lens and radical lens extraction.
execution
Over the millennia in which the “star stitch” was performed, the techniques had also changed depending on the anatomical knowledge.
The Okulist (of lat. Oculus , eye '), a augenheilkundlich active in earlier times surgeon (also Starstecher called), and patient sit in Reclinatio lentis , the commonly used method of cataract couching opposite. A helper standing behind the patient grabs his head and presses him firmly against his chest. The Starstecher stands with the Star piercing needle at the limbus side of the iris (Iris) in the eyeball in, moves the sharp tip of the front chamber through the pupil to the rear top and cuts through the zonular fibers . Now he has to grasp the lens above with the needle and press it down to the bottom of the vitreous humor. To prevent the lens from rising again, the surgeon holds it there for a while. After the procedure, a bandage is placed over both eyes to keep the eye still. The lens could, however, rise again after a long time and thus make it impossible for the patient to see again.
Often it was in such oculist to specialized, traveling surgeons offering their services at exhibitions and fairs offering. One of the most famous oculists is Johann Andreas Eisenbarth , whose work is exemplary for the work of such oculists. Traveling around not only widened the range of possible patients, but also protected the surgeon from the reaction of patients who had complications with this surgical method.
Such complications may have been victims of Johann Sebastian Bach and Georg Friedrich Handel , both of whom had been treated by the same oculist John Taylor . Handel did not bring Taylor's healing skills any lasting improvement: he went blind again. Bach died four months after two eye operations without fully recovering in between.
In general, the results of this gross operation were poor and still are today, the rates of inflammation , secondary diseases (glaucoma), recurrences (the lens came back into the facial line ) and complete blindness are still very high.
history
Star stitches were already carried out in pre-Christian times. Star stitches are already known from Babylonian times. Even then, a pointed object was pushed into the glass body. This helped the blind to regain their eyesight, even though as a result of frequent infections, many people subsequently became completely blind and sometimes even died.
References to this type of therapy can also be found in the Codex Hammurapi :
"Section 215: If a doctor has healed a man from a serious wound with a bronze instrument or has opened the spot in a man's eye with the bronze instrument and healed the man's eye, ten shekels of silver are to be paid for him. "
In connection with the high risk of blindness, the decree listed shortly afterwards clarifies why the cataract was mainly performed by wandering healers:
"§ 218: If the doctor treats a free man with a bronze instrument of a serious wound and lets him die, and if he has opened the spot in the man's eye with the bronze instrument but destroyed the man's eye, one becomes his Cut off hands. "
These passages of the Codex Hammurabi around 1700 BC C. prove that the relationship between doctor and patient was already a contractual relationship. But they also show that the Babylonian social system provided for different contractual obligations or sanctions for breaches of contract, depending on the legal status of its members. For example, only two shekels of silver had to be paid for a star engraving on a slave , i.e. only one fifth of the price for the star engraving on his master. The treatment of the slave had to be paid for by his master.
Probably the oldest description of the star engraving in ancient Greece is contained in Ophthalmikós , a textbook of ophthalmology written by doctor Demosthenes Philalethes in the 1st century AD.
Nowadays the star stitch is hardly widespread and only plays a role in a few developing countries. In some countries in Black Africa or in rural areas of India, the star stitch by traditional healers is widespread to this day, whereby not only the poor accessibility to modern eye clinics, but also a traditional distrust of western medicine plays a role. Scientific studies from the early 2000s have shown that traditional cataract stitches have no (long-term) benefit for patients and that complication rates are high.
literature
- Richard Greff : Rembrandt's depictions of Tobias' healing, along with contributions to the history of the star stitch. A cultural-historical study. Stuttgart 1907.
- Klaus Jacob: The star stitch in Ethiopia. In: Clinical monthly sheets for ophthalmology. Vol. 162, No. 3, 1973, ISSN 0023-2165 , pp. 407-411.
- Frank Krogmann: Star operation. In: Werner E. Gerabek u. a. (Ed.): Encyclopedia of medical history. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1356 f.
- Christian Probst : Traveling healers and drug dealers. Medicine from Marktplatz and Landstrasse. Rosenheimer Verlagshaus, Rosenheim 1992, ISBN 3-475-52719-7 .
Web links
Individual evidence
- ↑ Gundolf Keil : "blutken - bloedekijn". Notes on the etiology of the hyposphagma genesis in the 'Pommersfeld Silesian Eye Booklet' (1st third of the 15th century). With an overview of the ophthalmological texts of the German Middle Ages. In: Specialized prose research - Crossing borders. Volume 8/9, 2012/2013, pp. 7–175, here: p. 11 f. with note 41 and note 49, p. 24 with note 167, and p. 65 with note 514.
- ↑ Insuccessful couching on the University of Iowa Health Care Ophthalmology & Visual Sciences website
- ↑ a b M. A. Isawumi, O. U. Kolawole, and M. B. Hassan: Couching Techniques for Cataract Treatment in Osogbo, South West Nigeria. In: Ghana Medical Journal , Vol. 47, No. 2 (June 2013), pp. 64-69 ( PMC 3743109 (free full text)).
- ↑ Gundolf Keil, Karen Aydin: Starstich. In: Mamoun Fansa u. a. (Ed.): Ex oriente lux? Paths to Modern Science. Accompanying volume for the special exhibition [...] in the Augusteum Oldenburg. Mainz / Oldenburg 2009 (= series of publications by the State Museum for Nature and Man. Volume 70), pp. 435–442 and 495–526.
- ^ Christian Probst: Traveling healers and drug dealers. Medicine from Marktplatz and Landstrasse. 1992, p. 39 f.
- ^ Richard H. C. Zegers: The Eyes of Johann Sebastian Bach. In: Archives of Ophthalmology. Vol. 123, No. 10, 2005, ISSN 0093-0326 , pp. 1427-1430, doi : 10.1001 / archopht.123.10.1427 .
- ↑ Wolfgang U. Eckart : History of Medicine , 1st ed. 1990, pp. 19 + 20; 2nd edition 1994, pp. 19 + 20; 3rd edition 1998, pp. 23 + 24; 4th edition 2001, pp. 23 + 24; each Springer Verlag Berlin, Heidelberg, New York.
- ↑ Wolfgang Wegner: Demosthenes Philalethes. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 292 f.
- ↑ Couching. Retrieved October 8, 2019 .