The eighteenth century played a remarkable role in the history of ophthalmology. This was the time, when after several thousands of years the old technique of cataract couching received competition from a new revolutionary surgical concept, lens extraction. The inventor and protagonist of this technique was the Frenchman Jacques Daviel (1693–1762), who received wide acclaim from his contemporaries. In spite of this, numerous ophthalmologists remained faithful to the old technique, well into the nineteenth century. Amongst them was Johann Christian Jüngken (1794–1875), the ophthalmic chairman of the University of Berlin.
Hans-Reinhard Koch is one of the most committed historians of ophthalmology of recent years. He has published the transcription of a fascinating lecture on this subject that was given on 2 March 1791 in the ‘Schwarzer Garten’ (Black Garden), the Zurich guild house of the barbers and surgeons. In this house, barber surgeons and academic physicians convened to discuss latest medical trends. Author of this most interesting work was Johann Conrad Stoll (1766–1836), a Zurich student of Württemberg extraction.
The book published now is a little bibliophilic treasure. It shows the original manuscript pages and the transcribed text side-by-side. A flowingly written introduction presents the family and social background of Stoll, meticulously reconstructed by the editor. The relationship to Justinus Kerner’s circle of romantic poets in Weinsberg is interesting.
The situation of contemporary ophthalmology is also outlined. Striking is the social advancement of the non-academic surgical profession, favoured not only by the surgeons’ importance for the armed forces and their sovereigns, but also by the limited therapeutic efficacy of traditional ‘internal’ medicine, still much influenced by humoral pathology. In spite of a few outstanding physician personalities (eg. Hölderlin’s physician Autenrieth), this was also true for Württemberg. Halle, Jena and Leyden, where more modern approaches were attempted, were far away.
Of course, the transcribed manuscript itself is of special medico-historical interest. It begins with a somewhat long-winded retrospective of the Chirurgus Stoll, rather typical for his time. We understand that in 1791, and in fact even a century earlier, one was well aware of the patho-physiology of the ‘Grauer Star’ (grey cataract). Yet the term ‘Star’ (
$\def \xmlpi #1{}\def \mathsfbi #1{\boldsymbol {\mathsf {#1}}}\let \le =\leqslant \let \leq =\leqslant \let \ge =\geqslant \let \geq =\geqslant \def \Pr {\mathit {Pr}}\def \Fr {\mathit {Fr}}\def \Rey {\mathit {Re}}=$cataract, eye disease) was still not well defined. Other forms of ‘Star’ are mentioned that the present-day reader (even the ophthalmologist) will find difficult to understand. Thus blindness is called ‘Schwarzer Star’ (black cataract), a term also describing a mysterious opacification of the eye, or an unclear inflammatory or post-inflammatory condition. ‘Güner Star’ (green cataract), on the other hand, was an ill-defined disease of the vitreous and/or the iris, eg. an iridocyclitis. Today the term ‘Grüner Star’ is used for glaucoma, a disease unknown and undetectable in Stoll’s day.
The two competing techniques of cataract surgery, depression and extraction, are precisely described and critically compared. This was the ophthalmic subject of the period. It is beneficial that Stoll’s editor is an experienced ophthalmic surgeon himself. Thus, he is able to explain convincingly some of Stoll’s surgical recommendations, eg. when he speaks of ‘exerting a gentle and slow pressure’ (pages 51 of the text and 82 of the introduction). The ophthalmic surgical equipment of Stoll’s time is described in detail. The literature listed by Stoll in 1791 is also most interesting (261–9). Older works, such as Bartischs ‘Augendienst’ of 1583 are quoted as well as the medical observations during a journey of Johann Nepomuk Hunscovsky in 1783. Latin treatises are quoted along with German, French and English publications. Scientific work in 1791 implied quite naturally a retrospective view.
The book introduces the reader to the scientific medical world of the late eighteenth century, covering both the facts and the atmosphere. Whoever is interested in the history of ophthalmology, will be supplied with the sources in a clear, vivid and readable way. And he will learn a lot about the methods and problems of this subject in the days of Goethe.
