On April 13, 1752, Jacques Daviel presented before the French Royal Academy of Surgeons a paper entitled, “A new Method of Curing Cataract by Removing the Lens.” The paper’s publication in 1753 laid the ground work for modern cataract surgery and a revolution in ophthalmology.
Born in La Barre in Normandy, Daviel became an apprentice to his surgeon-uncle in Rouen and in 1713 he became a student surgeon in the French Army. When plague struck the South of France, Daviel volunteered in 1719 to go to Marseilles and took his newly married wife with him to a city where half of the 100,000 population died from the epidemic. For his services, he was awarded the Cross of the knights of Saint Roch by the King of France and made a master surgeon by the alderman of Marseilles in 1722. The following year, he became a surgeon at the Hotel Dieu of Marseilles. In 1740, Daviel became a corresponding member of the Royal Academy of Surgery. In 1746, he settled in Paris, where he prospered, and in 1749 was appointed surgeon-oculist to Louis XV. He died in Geneva in 1762. Over his grave in the cemetery of the Grand Saxony Church, just north of Geneva, the ophthalmologists of Switzerland in 1885 fittingly erected a marble headstone with the inscription “Post Tenebras Lux” (Light After Darkness).
At the time of Daviel’s groundbreaking work, couching was the primary means of treating cataracts. The first authentic document on depression or couching of cataracts appears in the writings of Aulus Cornelius Celsus (ca 25 BC—ca 50 BC), which included a complete teaching on the pathology and treatment of condition. Celsus was a Roman encyclopedist, known for his medical work, De Medicina. Couching is believed to have first appeared in India, where it was known to the Indian physician Sushruta in the 6th century BC. At that time, couching was performed with a special a curved needle used to loosen the lens and push the cataract out of the field of vision. The eye would later be soaked with warm butter and then bandaged. However, Celsus' account of cataract and its treatment was indeed the teaching that persisted till the 18th century with hardly any modification.
The operation which Daviel had invented and made public in 1753 consisted of incising the lower part of the cornea exactly at its junction with the sclera. He first made an opening into the anterior chamber at the extreme lower margin of the cornea with a myrtiform or triangular shaped knife, and then, after withdrawing this, he enlarged the incision on both sides with a narrow, blunt pointed, double-edged knife, as far as he could easily, and finally, when the cornea became too much relaxed to continue the incision, he completed it to the extent desired with delicate scissors which were so curved on the flat and edge as to correspond to the curve of the corneo-scleral line. These, of course, were made right and left, and the blade to be introduced into the anterior chamber was blunt pointed.
According to his memoir, the incision was of equal extent on both sides of the cornea, and was carried to a point on each side "a little above the pupil." Having completed the incision he gently lifted up the corneal flap with a small spatula and incised the anterior capsule of the lens with a sharp-edged needle.
After doing this, he carried the spatula between the lens and the iris, "so as to entirely loosen the cataract and facilitate its issue." After the cataract was delivered the corneal flap was then allowed to fall into place. If the cataract happened to be soft and "glairy" or broken into pieces, the remnants were removed with a curette. The pupil might sometimes be disarranged by the passage of the lens, especially if it was large and hard, and it should then be readjusted. The corneal flap being accurately replaced, the eye was gently cleansed and covered with a small compress, over which plasters were applied and the whole was kept in place by a bandage without much pressure.
This translation in brief of Daviel’s paper, by Alvin Hubbel, MD, appeared in the Journal of the American Medical Association in 1902.