“Unfortunately, as far as cataract is concerned, as for lacrimal fistula, surgery has not really shown any improvement in recent times, and it still wavers uncertainly among various means for treating illnesses.
If there is one case in which surgical truth is difficult to discover, and needs to be researched with the same care and scrupulousness as judicial truth, it is without doubt that concerning which method is best for treating cataract and to bring to an end the interminable debates which, still today, divide supporters of extraction and couching (displacement) of the lens. Only after ample information and the most scrupulous enquiry, and new enquiry, actual facts, not opinions, carefully observed and judged honestly, will one be able eventually to decide which of the two methods is preferable, not as an exclusive method, but rather in general. In effect, there will always be circumstances in which, whether extremely small size [of the lens], excessive volume or excessive mobility of the eyeball, extraction is impracticable, and one finds oneself forced to try couching again, albeit reserving it as an exceptional method.
The traditional method of couching achieves so few treatment successes that, during the 17th century, surgeons more or less abandoned treatment to itinerant operators; if one is to believe Raw, it did not restore sight to a hundredth (one in a hundred) of patients.”
“Born in the bosom of the Royal Academy of Surgery, the wholly French method of extraction was welcomed since its birth by more or less universal applause. In vain, some foreign surgeons, Pott among them, remained loyal to the traditional method, or explicitly accorded it preference; the method of extraction favoured in France, as in the rest of Europe, up to the moment that Scarpa, reintroducing Pott’s views, borrowing from him the idea of a bent needle and hook, declared himself in support of the exclusive use of couching. Better knowledge about the mechanism of absorption, through which the displaced lens will disappear, provided Scarpa with a satisfactory explanation, a more effective treatment; the inconvenience associated with extraction grew every day by the failures of couching, becoming more numerous every day; and each [surgeon] invoking the experience and interpretation in his own way, resulting in endless debates about so simple a question with so simple an answer. Only one way is open to provide an escape from this maze of contradictory opinions and to resolve this important point in surgical doctrine. Under the eyes of the Academy, a certain number of patients must be gathered in a convenient place, then operated on comparatively according to the two methods, placing the individuals subjected to operation, as far as possible, in the same circumstances. An academic body alone, the sole interest of which is that of truth, is able to undertake and follow up such an experiment. Even the most able surgeon, and who in exercising his art aims at the truth with the greatest honesty and good faith, would be unable to defend himself against a multitude of prejudices, the existence and power of which he often ignores. Thence, what credibility can one attribute to those men of bad faith, for whom truth is nothing other than fashion acquired by a misrepresentation? And what have we to understand by what they name their ‘successes’ by the use of this or that method?”
Translation by Ulrich Tröhler