[Extracted, from the Transactions of the College of Philadelphia.] 
Cataract—Dr. Hays made some verbal remarks on this affection, of 
which the following is an abstract. 
Dr. H. said he would offer for the consideration of the Fellows of the 
College some speculations which have lately been occupying his thoughts, 
and which, if well founded, would tend to invalidate a long accepted sur- 
gical precept, and also to elucidate the pathology of cataract. 
There are few doctrines more firmly established, than that cataract is 
not amenable to medical treatment—that its progress can neither be arrested 
nor retarded by therapeutic measures—and that the only means of relief is 
a surgical operation. It certainly-had been too often the speaker’s pain- 
ful task, when applied to by persons affected with incipient cataract and 
who anxiously inquired whether the progress of the disease could not be 
arrested, to be obliged to crush their hopes by the avowal that no such 
means existed, and that they would be obliged to abide their time and then 
trust to an operation for their relief. 
It is difficult, indeed, to conceive how, in the existing state of physio- 
logical science—at all events, up to a recent period—any other opinion 
could be entertained. The -lens is a transparent body inclosed in its cap- 
sule, without any vessels passing into it. How, then, was it possible to 
act on it by medicines ? 
It has been within a few years only that its mode of nutrition was under- 
stood. This is effected, as in some of the lower animals, by osmosis through 
its capsule. 
I was first led to doubt the correctness of the doctrine under notice by 
the experiments of Dr. S. Weir Mitchell,1 of this city, communicated to the 
Biological Society, Oct. 3, 1859, and published in the Am. Jl. Med. Sci., 
for Jan. 1860. In experimenting with frogs by injecting syrup into their 
cuticular sac he found that the lens of the animal became opaque, and what 
was most remarkable that when the animal was replaced in water, after 
some hours the opacity diminished, and, in some instances, the transparency 
of the lens was entirely restored. 
This last circumstance struck me as one which might lead to important 
practical results, and at all events it pointed out the direction in which our 
investigations should be made for that purpose. 
Additional light was soon shed upon this subject by Dr. Hichardson, of 
London, who, after reading Dr. Mitchell’s paper, instituted a number of 
similar experiments, the results of which he communicated to the Medical 
Society of London on the 26th of March and 16th of April, 1860.3 
These experiments confirm Dr. Mitchell’s results and throw much addi- 
tional light on the subject. Dr. Hichardson shows that cataract may be 
produced by the injection into the system not only of cane sugar, but also 
of grape and milk sugar—and likewise of glycerin, alcohol, of solutions of 
chloride of sodium, of acid urate of soda, and of lactate of soda. Death 
was also produced when any of these articles were introduced into the 
system in sufficient quantity. 
Dr. H. concludes from his experiments that “ as the cataractous appear- 
ance is modified by the density of the producing body, and is removable by 
1 On the production of Cataract in Frogs by the administration of sugar. 
2 See Am. Journ. Med. Sci., July, 1860, pp. 257-9. 2 
reversing the conditions which led to it, and as it is producible in a clear 
lens removed from the body, it is a demonstration that the cataract induced 
in the different animals is a purely physical—that is to say, osmotic— 
change.”1 
Dr. Richardson advanced a step beyond this and suggested a practical 
application of this discovery. 
“As a point bearing on the treatment of cataract,” Dr. Richardson 
said, “ that inasmuch as temporary opacity produced by exposure of the 
lens to syrup was removable by an after exposure to water (that is, by 
changing the position of the medium surrounding the lens), it was worthy 
of consideration whether an operation for letting out the aqueous humour 
by a small opening, and refilling the anterior and posterior chambers with 
distilled water, might not lead to removal of the cataractous condition in 
the earliest stages.” 
Soon after this, it was announced that M. Sperino, of Turin, had suc- 
ceeded in curing cataract by repeatedly evacuating the aqueous humour. 
This was to some extent a confirmation of the value of Dr. Richardson’s 
suggestion. M. Sperino was not led to this mode of treating cataract by 
any physiological reasoning, but rather empirically. “He had long derived 
great advantage from the repeated evacuation of the aqueous humour in 
cases of iritis, interlamellar keratitis, severe hypopion, staphyloma of the 
sclerotica, congestion of the choroid and retina (even when attended with 
exudations), opacities of the vitreous humour, and in pseudo-membranous 
deposits in front of the lens. Even in some desperate cases of glaucoma 
attended with commencing cataract, this treatment, useless as regards the 
loss of sight, was of use, a diminution of the opacity of the lens following 
the evacuation.” M. Sperino promises to soon publish a work which will 
contain the results of his treatment of cataract by this method and show 
the kind of cataract to which this operation is applicable. 
M. Sperino’s operation consists in puncturing the cornea and preventing 
the puncture from uniting by introducing at short intervals into it a small 
probe, thus keeping up a drain of the aqueous humour. Mr. Hildige, of 
Dublin, professes to have tried this plan and without success; but he did 
not adopt M. Sperino’s process. On the contrary, he made a fresh punc- 
ture at intervals, and these repeated punctures caused so much irritation and 
inflammation that he was compelled to desist. 
These observations throw new light on the pathology of cataract, and 
seem to hold out a hope that remedial means may be discovered of arrest- 
ing the progress of that disease, and, perhaps, even of restoring the trans- 
parency of the lens ; but the physiological law which presides over the 
changes in the lens, and which was to guide us in our search for the means 
of controlling these changes, required to be more clearly determined. 
In conversing, a short time since, with my friend Prof. Jackson on this 
subject, he informed me that experiments similar to those of Dr. Mitchell 
had been previously made by Kunde, and referred me to Claude Bernard’s 
“Legons sur les proprieties physiologiques et les alterations pathologiques 
des liquides de Vorganisme,” for an account of them. 
In M. Bernard’s lecture, delivered on the 11th of Dec. 1857, that emi- 
nent physiologist, to whose experimental researches we are indebted for 
1 It is just to Dr. Mitcliell to say that although he believed that the direct con- 
tact of the sugar with the lens was essential to the production of what he called 
sugar cataract, he recognized the fact that the phenomenon was produced by 
osmotic action. 3 
many advances in physiological science, merely briefly notices Kunde’s 
experiments, without stating when they were made. In that lecture he, 
however, treats of the physiological importance of water to the organism, 
and the doctrines which he there develops seem to me to alford a physiolo- 
gical explanation of the production of cataract and to point out the direc- 
tion in which our investigation for the means of remedying that condition 
should be directed. 
M. Bernard shows that water is an essential component of all living 
organism—it is the necessary vehicle for the materials which enter into the 
double movement of nutrition and excretion—without which life cannot be 
maintained. "Independently of their special properties, the organic fluids,’7 
he says, “are allied by a general character; all owe their first physiological 
importance to the water they contain ; before being useful in consequence 
of the substances which they may hold in solution or in suspension, they 
are first useful as fluids.77 
M. B. states that water constitutes nine-tenths of the whole weight of 
the human body; but the proportion of water to the solid constituents 
varies in the different fluids, being from 80 to 90 per 100 in the blo'od; 98 
to 99 per 100 in the gastric juice; 10 to 80 per 100 in milk, &c. 
Mr. B. next investigates the influence which the quantity of water in the 
organism exercises on physiological phenomena. To do this, he says, “two 
processes present themselves to the experimenter; one consists in detracting 
water from the body, the other in adding water to it. The first is difficult 
to accomplish. Nevertheless, Dr. Kunde has effected This in frogs, and 
observed some singular results.' His process consisted in introducing into 
the intestinal canal of these animals some sulphate of soda or sugar ; en- 
dosmotic action was thus induced which caused a part of the water of the 
blood to flow into the intestine; the blood was thus deprived of a portion 
of its water.77 
“ One of the first results of this experiment was the loss of transparency 
of the crystalline—the animal becoming blind. This result quickly disap- 
peared when the frog was replaced in water. Convulsions also resulted 
from this impoverishment of the blood of its water, very probably from the 
subtraction of the fluids which bathed the nerve, and these convulsions 
disappeared when the water which the system has lost-was restored to it.77 
M. Bernard injected water into the veins of dogs, thus increasing the 
normal proportion of water in the system, and found he could do this to a 
considerable extent, without ill consequences; but so soon as the propor- 
tion of water exceeded certain limits, pathological results followed. Some 
of the secretions were first diminished, and as more water was injected, these 
secretions became entirely suspended, convulsions then supervened, and 
finally death. 
It is thus seen that while the proportion of water to the solid constituents 
of the blood may vary within pretty extensive limits, without injurious con- 
sequences, yet so soon as these limits are transcended, pathological condi- 
tions at once result. 
The only one of these which at present interests us, is the opacity of the 
crystalline lens following the diminution of the proportion of water in the 
blood below its physiological limits. 
Dr. Mitchell supposes that the direct contact of the sugar with the lens 
is essential to the production of the phenomenon in question ; but this is 
disproved by the experiments of Kunde and Richardson, which show that 
other articles that cause excessive exosmosis of the fluids produce the same 4 
phenomenon; and, further, Hepp, who examined a diabetic cataractous lens, 
extracted by Stoeber at the ophthalmological clinic of Strasbourg, could 
not find in it a trace of glucose.1 
Dr. Mitchell states, that the mere abstraction of water from the lens is 
insufficient to cause opacity, because the lens when dried does not become 
opaque. This statement, we believe, requires some qualification, and at 
all events when excessive exosmose from the lens is produced, the superficial 
nucleated cells and lens tubes are as a consequence emptied of their contents, 
and the structure of the lens is thus so altered as to render this body more 
or less opaque. This vacuity the nucleated cells and lens tubes has 
actually been observed by microscopists in the examination of cataractous 
lenses. 
Is this opacity of the lens then the consequence of the impoverishment of 
the fluids of the body of their water, which causes an excessive exosmosis 
of the more fluid contents of the lens, and impairs the nutritive functions of 
that body ? 
There are a number of facts which seem to lend support to this view. 
Cataract most commonly occurs in advanced life, at which period the 
proportion of fluids to the solids is considerably diminished, and as correctly 
observed by Mr. Dixon, when the lens becomes cataractous in old persons, 
“ the change seems to consist in a process of drying and atrophy of its 
fibres. 
Again, it is now a well-established fact, that cataract is a frequent con- 
sequence of diabetes. Is this not to be explained by the abnormal density 
of the fluids of the system resulting from the excessive excretion of fluid 
by the kidneys ; and if this opacity is not always produced, may it not be 
owing to the water being replaced by the great quantity ingested, uncon- 
trollable thirst being a constant attendant on the disease ? 
M. Bernard states that it is difficult to deprive the organism of its water, 
but he has overlooked the fact that this may be effected by certain medi- 
cines, as croton oil, tartar emetic, and the hydragogue cathartics, and it is 
the constant result of several diseases, as diabetes, malignant cholera, pro- 
fuse serous diarrhoea, leucorrhoea, &c. 
In malignant cholera the exosmose of water into the intestines is enor- 
mous; the blood is so impoverished of its water that it becomes thick 
and dark as molasses. Is opacity of the lens one of the consequences of 
the loss of fluids in this disease ? We are unable to answer this question, 
for we are not aware of any examination of the lens having been made 
after death from this disease. But we have often noticed a dulness and 
loss of transparency of the cornea, preceding death from this affection. 
Artificial cholera may be produced by large doses of croton oil, or by 
repeated doses of emetic tartar, and experiments might be made on animals 
which would determine whether cataract is a consequence of the loss of 
fluid thus occasioned; and we would ask the attention of experimental 
physiologists to the subject. 
Long continued copious serous diarrhoea, profuse leucorrhoea, and other 
exhausting fluid evacuations, impoverish the organism of its fluids, and, if 
our views be correct, must favour the formation of cataract.3 
If it be objected to this that no such result has ever been noticed, let it 
1 Lecorche, Archives Gen., May, 1861, p. 737. 
2 Guide to the Practical Study of Diseases of the Eye, 2d ed., p. 216. 
3 There may be various other obscure diseases, which also alter the normal 
density of some of the fluids, and thus impair osmotic action. 5 
be remembered that it is only within a very few years that the connection 
between diabetes and cataract has been recognized, and that when attention 
shall be directed to this subject a similar connection may be discovered in 
other affections. 
Should further investigations show that the long continued impoverish- 
ment of the blood of its water impairs the osmotic nutritive functions of the 
lens so as to produce opacity of that body, may we not hope that in some of 
such cases, by supplying to the organism its lost water, or by adopting the 
suggestion of Dr. Richardson or the practice of M. Sperino, the nutritive 
actions of the lens may be restored, the progress of the opacity arrested, and 
even, as occurred in the experiments of Kunde, Mitchell, and Richardson, 
that its transparency may be restored. 
In very advanced age, it may not be possible to restore the proportion 
between the fluid and solid constituents of the body, for to do this would 
be to rejuvenate the individual, and senile cataract may therefore be regard- 
ed as beyond our therapeutical resources, as will be also those cases in which 
the affection has advanced to that stage where the lens tubes have become 
broken up and actual structural alterations have taken place. 
Congenital and traumatic cataract must be equally intractable to medical 
treatment, neither resulting primarily from impaired nutrition. The former 
is the consequence of arrest of development; and the latter is produced by 
exudation of lymph on the capsule, the result of inflammatory action. The 
capsule is then, of course, rendered incapable of performing its osmotic 
functions. 
But when cataract occflrs prior to senility—without any obvious cause— 
when the opacity has not far advanced, and especially when the impaired 
nutrition causing the opacity, is the sequel of exhausting evacuations, is it 
unreasonable to hope that the progress of the change in the lens may be 
arrested, and even a retrograde metamorphosis effected ? 
The loss of transparency of the lens almost always commences in the 
layer of nucleated cells which connect the body of the lens to its capsule, 
the anterior marginal cells being first affected—the opacity proceeds in a 
centripetal direction implicating next the superficial softer fibres, and it is 
usually not until a late period that the denser fibres constituting the nu- 
cleus become affected. The mere arrest of the affection in its early stages 
while the nucleus is still clear, would be a great boon to the patient. 
We might dwell further on this subject, for many points remain still to 
be developed, but we abstain for fear of too long trespassing on the patience 
of the Fellows of the college. 
We shall besides have accomplished our object if we have succeeded in 
awakening attention to the subject, and have thrown some light on the 
pathology of cataract—if we have excited the suspicion of our hearers 
that the conviction under which we have long rested of its being beyond 
the therapeutic resources of our art to retard, or in any degree control 
the formation of cataract, may not be well founded, and if we have indicated 
the proper direction in which our researches should be pushed in order to 
discover the means, if such exist, of attaining this very desirable object.