Couching for cataract and Sino-Indian medical exchange from the sixth to the twelfth century AD

Reimagining India’s national health system (NHS)

In the light of the poor performance of the National Health System as a whole, the article argues the case for the urgent re-imagination and recalibration of the roles of legally approved, health knowledge systems. The article suggests that the analysis of ten years' retrospective clinical data (around 100 million records) from the most reputed Allopathic and Ayurveda clinical establishments may serve as a reliable source of information on the actual performance of different knowledge systems. This strategy for evidence generation, argues the author, is perhaps more realistic than analysis of fragmented clinical and preclinical data from trials and experiments. The article also reviews the quality of evidence and societal performance of western medicine during the last 70 years. The plural health seeking behaviour of millions of citizens, suggest that in the 21st century, a creative, functional, reliable form of integrative healthcare is imperative.

A Family of Early English Oculists (1600-1751), With a Reappraisal of John Thomas Woolhouse (1664-1733/1734)

Introduction:

John Thomas Woolhouse (1666-1733/1734), who practiced in Paris, was part of a family with 5 generations of English oculists. Some historians have derided him as a “charlatan” and have criticized him for adhering to the old notion that a cataract was a membrane anterior to the lens.

Methods:

We reviewed treatises and digital records related to Woolhouse and his family and the handwritten notes of his 1721 lecture series at the Royal Society of Medicine.

Results:

We have identified 5 generations of oculists in Woolhouse’s family, by the names of Atwood, Stepkins, Ivy, and Beaumont. Woolhouse taught students from across Europe. He was one of the early proponents in Europe, inspired by Asian medical practices, to perform paracentesis to release aqueous for a new condition called hydrophthalmia. In Woolhouse’s system, some of these cases probably described angle-closure glaucoma. He was the first to attach the name glaucoma to the palpably hard eye in 1707. He may also have been the first to teach that a soft eye was unlikely to recover vision. Credit for these teachings has traditionally gone to one of his students, Johannes Zacharias Platner, in 1745. Some historians have stated that he proposed iridectomy as a theoretical procedure, which was later performed by Cheselden. In fact, Woolhouse described techniques he had performed which today would be called pupilloplasty, synechiolysis, or pupillary membrane lysis. He was also a pioneer in dacryocystectomy for chronic dacryocystitis and in congenital cataract surgery. His writings from 1716 onward repeatedly (and correctly) stressed that most of the patients with visual disorders required depression of the crystalline lens (for what he called glaucoma), as opposed to removal of an anterior membrane (which he called cataract).

Conclusions:

Woolhouse was a bold ophthalmic innovator and teacher who made major contributions which have lasted to this day. Although he did not admit it, he ultimately adopted much of the evolving understanding of the nature of lens opacities. However, his stubborn refusal to adopt the newer semantics has detracted from a full appreciation of his contributions.

Couching for cataract in China

Couching for cataract is one of the most ancient surgical procedures. Maharshi Sushruta, an ancient Indian surgeon, first described the procedure around 600 BCE in Sushruta Samhita. The procedure, also known as jin pi shu in Mandarin, was introduced to China via the Silk Road during the late West Han Dynasty (206 BCE-9 CE), and it spread throughout China during the Tang Dynasty (618-907 CE). As the procedure was combined with the Chinese concept of acupuncture, jin pi shu was integrated into Chinese medical practice until the founding of the Republic of China in 1911. The government of the Republic of China considered jin pi shu to be unscientific. In 1949, the Communists established the People's Republic of China. Jin pi shu was revitalized by Chairman Mao Zedong (1893-1976), who thought that traditional Chinese medicine, including jin pi shu, was a great treasure. After his death and the opening of China to the external world, many Chinese ophthalmologists pointed out that jin pi shu had relatively high complications and a low success rate, compared to various modern techniques for cataract surgery. This procedure is gradually fading away in China. The use of jin pi shu reflects the history, culture, and political transformation of China.

Cataract surgery in the patient that cannot lie flat

PURPOSE OF REVIEW

At times a patient requiring cataract surgery cannot be positioned flat rendering the case challenging. In addition, sometimes the medical condition that limits the patient's ability to lie supine also carries an increased risk of being placed under general anesthesia making topical anesthesia a safer option. The surgeon must often use ingenuity in positioning in order to carry out a successful surgery. This review will highlight different techniques employed for cataract surgery in a patient that cannot lie supine.

RECENT FINDINGS

There is a small amount of published literature describing techniques of cataract surgery in the patient who cannot lie supine. We hope to highlight the various techniques that have been described in the literature.

SUMMARY

Cataract surgery can become more complex when the patient cannot be positioned with their head flat on the operating table. With creative alterations to normal positioning, successful phacoemulsification can be executed.