Styria, the second-largest state in Austria, is characterized by its verdant landscape and rolling wooded hills that earned the region the nickname the Green Mark. Styria, however, is perhaps more famously known for a group of inhabitants who relied on an unconventional way to enhance their complexions, ward off infectious disease, aid digestion, and increase their strength and breathing. From the 13th century until at least the 1950s, some Styrian residents ingested roughly double the lethal dose of arsenic every 2 to 3 days over their lifetime.
Styria became noteworthy in the 19th century when the so-called Styrian defense began to be invoked in the legal system. In cases of suspected arsenic poisoning, attorneys would argue that the deceased was not murdered but was a chronic arsenic consumer who had accidentally self-administered a lethal dose of the element.
The medical community, however, did not change its way of thinking, and members long discounted the claims that arsenic was commonly being ingested in Styria. Until testing became available to prove that Styrian residents were ingesting lethal doses without obvious harm, scientists remained convinced that arsenic was absolutely lethal.
This story is in no way meant to recommend that people consume arsenic. Much has come to light about the nuances of this Styrian habit and its longer-term health consequences. However, this small group of arsenic eaters showed that, under the right conditions (ie, ingesting smaller, less absorbable amounts over time), arsenic may not be universally fatal after all—establishing a new scientific explanation.
In this issue of GT, we hear from glaucoma surgeons who changed their thinking in recent years, sometimes pivoting from approaches that had been in use throughout their careers. As new evidence and personal experience build, the best dogma might be to not be so dogmatic. Maybe some practices that were once considered harmful could be effective under the right conditions. As we continue to expand our knowledge of and options for managing glaucoma surgically, open dialogue about how and why our perspectives evolve is essential to our continued progress. Just stay away from arsenic … at least in large quantities.
