A FEW OBSERVATIONS ON THE ETIOLOGY, 
PROGNOSIS AND CURE OF INCIPIENT 
CATARACT WITHOUT OPERA- 
TIVE INTERFERENCE. 
A. R. Baker, M. D„ 
CLEVELAND, O. 
From Transactions 
Ohio State,Medical Society 
1889. 
Press of 
THE WILLIAMS PUBLISHING CO., 
Cleveland, O. A FEW OBSERVATIONS ON THE ETIOLOGY, 
PROGNOSIS AND CURE OF INCIPIENT 
CATARACT WITHOUT OPERA- 
TIVE INTERFERENCE. 
A. R. BAKER, M.D., CLEVELAND, O. 
OBSERVATION I. 
I was consulted by Mrs. S., aged forty-three, in the 
spring of 1884, on account of loss of sight. I found that 
she had a cataract of the left eye almost mature, i. e., 
she could not count fingers and no red reflex could be 
seen from the fundus with the ophthalmoscope; with 
the right eye she could only count fingers with difficulty 
at six inches. I could get a slight reflex from the fundus, 
but was unable to see any of the retinal vessels. 
The history of the case led me to suspect diabetes, and 
upon examining the urine, I found large quantities of 
sugar. I prescribed tablets of iron, arsenic and strych- 
nine and gave the patient a diet list, in which all articles 
of food not marked were positively forbidden. The 
directions were followed very faithfully. The sugar 
diminished in quantity very rapidly and at times disap- 
peared entirely; but what was most remarkable was the 
immediate improvement in vision. In the course of a 
few weeks she was able to read ordinary newspaper print, 
and with the ophthalmoscope I could see the retinal vessels 
distinctly in either eye. 
My note-book contains a memorandum, April 25, 
1885, stating that her vision at that date in left eye was 
(S.) and right eye (S.). For a period of over four INCIPIENT CATARACT. 
2 
years the patient was under my observation. Almost all 
the time there was a little sugar in the urine; at times, 
after some indiscretion in diet or exposure to cold, there 
would be an increase in the amount of sugar excreted, and 
almost simultaneously a decrease in the visual acuteness. 
In September, 1888, Mrs. S. was called into court as 
a witness in a case which involved the title of her home ; 
was kept on the stand all day; on the way home she was 
caught in a shower, had a chill that night and died of 
diabetic coma in less than a week. 
Remarks.-Similar cases are not unknown to ophthal- 
mological literature. Dr. Seegen reports two cases in 
his work on "Diabetes Mellitus." One case was that 
of a man aged thirty-nine, who in July, 1863, noticed that 
his sight began to fail ; this was about six months after 
the first appearance of diabetes. The lenses were cata- 
ractous. Under treatment at Carlsbad, the lenses cleared ; 
the quantity of urine was reduced about one-half, although 
the sugar remained about the same. In the spring of 
1865, the lenses again became opaque. 
The other case was that of a woman aged fifty-five, 
who was first seen in the autumn of 1867, soon after which 
the sight began to fail. She was treated for diabetes in 
February, 1868, and while under treatment the lenses 
became clear again. 
Dr. Tannahill also reports a case of a coal miner who 
was seen while in prison. He had suffered from diabetes 
for eleven months. Both lenses were opaque-the left 
more than the right. He was put on the ordinary dia- 
betic diet, and was given two grains of opium daily. 
While under treatment his sight began to improve ; the. 
opaque lenses gradually cleared, and upon inspection, 
when he was discharged from the prison, no trace of the 
cataract remained. In 1885 Mr. Nettleship reported a 
similar case to the London Ophthalmological Society. A. R. BAKER, M.D. 
3 
OBSERVATION II. 
Mr. O., aged sixty-two, mature cataract of right eye ; 
immature cataract of left; vision (S.) operation of 
linear extraction performed on right eye in October of 
1883; vision after operation, As I usually examine 
the urine as a routine practice in all cataract cases, I did 
so in this, and found quite a large amount of albumen. 
There was a slight hypertrophy of the heart, but no 
valvular disease found. Dietetic and medicinal treatment 
for the albuminuria was instituted, with quite satisfactory 
results. At the end of a year, I was informed by the 
patient by letter, that his sight in left eye had improved 
very much, and that his spectacles were unsatisfactory. 
I saw the case soon afterward, and found that his vision 
had improved to -|-g- (S.) in this, the unoperated eye ; and 
that he had discarded the cataract spectacles and was 
using his old ones, with which he claimed to see better. He 
continued to use a pair of +2.50 D. lenses which I gave him 
until about one year ago (five years), when his sight began 
to fail rapidly in the left eye, and he returned to the use 
of the cataract lenses. About the same time, there was 
a decided increase in the amount of albumen in the urine, 
and at present, the old gentleman is suffering from oedema 
of the feet and legs and other serious results of kidney 
disease. 
Remarks.-I have found albumen in the urine of a large 
percentage of my cataract cases, usually not in large quan- 
tities, and in most cases unsuspected by the patient or 
family physician. But casts and hypertrophy of the 
heart have usually demonstrated the existence of nephritis. 
Deutschman has made the same observation, and believes 
that the coincidence of chronic Bright's disease and cata- 
ract is not accidental, and that "we must recognize a 
nephritic cataract just as we recognize a diabetic cataract, 
the cause in both cases being constitutional." INCIPIENT CATARACT. 
4 
I am not aware that any cases are on record in which 
nephritic cataracts entirely disappeared; but it has been 
the observation of everyone that the progress of a cata- 
ract is very uncertain, at times progressing rapidly, at 
other times slowly, and frequently remaining stationary 
for months or years. Is it not quite possible that if the 
general health was carefully interrogated, some other than 
senile changes might be found to explain the origin of 
cataract and enable us to give a prognosis more favorable 
to the patient than inevitable blindness? 
OBSERVATION III. 
Mr. C., in 1884, consulted an oculist for failing vision, 
whose ability to diagnose incipient cataract I could not 
doubt. A preliminary iridectomy was made prior to the 
cataract extraction, which, it was said, would be made in 
the course of a few months at most. 
Mr. C. has now waited five years for this cataract to 
mature, and now, much to his gratification, there is no 
cataract to be seen or evidence that there ever has been 
one. 
OBSERVATION IV. 
Mr. O. D., in 1871, consulted Dr. C. R. Agnew for 
failing vision. Dr. Agnew diagnosed incipient cataract of 
both eyes ; also found quite a high degree of astigmatism 
and vision very much improved by cylindrical glasses after 
dilating the pupils with atropia. Spectacles were ordered, 
and a prescription for atropia given, to be used as long as 
the vision was improved, and when sight had so far 
failed as to be unable to count fingers, he was requested 
to return to New York for an operation. Mr. O. D. 
thinks he can see just as well now as he could eighteen 
years ago. He has used the solution of atropia in his 
eyes every week, and worn the glasses continuously dur- 
ing the entire period. A. R. BAKER, M.D. 
5 
I have had the case under my observation for the past 
six years, and have been unable to detect any change in 
the condition of the lenses during this period. 
Remarks.-Cataract, which is usually a disease of old 
age, characterized by gray hairs and wrinkles, atheroma- 
tous blood-vessels and shrunken muscles, owing to its 
white color has, in the absence of any other plausible ex- 
planation for its existence, been called senile. 
The patient suffering from incipient cataract has been 
assured, from time immemorial, that nothing could be 
done for him, that the disease was a senile one, and as 
inevitable as gray hairs ; and the only consolation offered 
was, that after becoming totally blind, he might undergo 
a delicate and difficult operation, which would probably 
give him partial relief. 
Dr. Risley contributed a valuable paper to a recent 
number of the University Medical Magazine, in which he 
said, "That while opacity of the lense is a disease of 
advanced life, it does not in all probability depend upon 
senile changes, but is originated in local pathological 
states involving the nutrition of the eye itself." 
These local pathological changes he believes to be in 
the choroid, and thinks the changes in the lense and 
vitreous in later life to be due to the same cause as the 
impaired nutrition of the sclera, and the resulting posterior 
staphyloma and consequent myopia in children. He attrib- 
utes the comparative freedom from cataract in early life to 
the yielding of the sclera, which prevents the lense from 
suffering from injurious disturbances of nutrition. In 
support of this theory of the cause of cataract, Dr. Risley 
presents statistics of sixty cases taken consecutively from 
his case-book, in forty of which there was a choroiditis 
noted, and in many of the other twenty the opacity of 
the lense was so far advanced as to prevent a study of the 
fundus oculi. He also reports a number of cases in which 6 
INCIPIENT CATARACT. 
the opacity of the lense remained stationary for many 
years, or even disappeared entirely upon proper treat- 
ment, directed to the choroidal disease. 
CONCLUSION. 
If these observations are accurate, should not our views 
as to the etiology, prognosis and treatment of incipient 
cataract be modified ? If it is true that a large number of 
cataracts are due to general diseases, like diabetes and 
nephritis, and the resulting opacity of the lense may be 
retarded or cured by treatment directed to the general 
disease ; if it is true that a still larger number of cataracts 
are due to local pathological conditions affecting the nu- 
trition of the lense, and the resulting opacity may be 
retarded or cured by treatment directed to the local 
disease, should not our prognosis, as to the cure of 
cataract without operative interference, be more hopeful 
than heretofore ? 
If progressive myopia is a conservative factor which 
protects the lense from undue pressure and resulting dis- 
turbance of nutrition and opacity, the reason why cata- 
ract is a disease of the aged would be satisfactorily ex- 
plained. In fact, I think the wearing of spectacles, in high 
degrees of myopia, as a prophylaxis of cataract, has long 
been a recognized procedure. 
If our reasoning is correct, not only high degrees of 
myopia, predisposed to cataract, but cases of choroidal 
disease which result in myopia in young persons, termi- 
nate in opacity of the lense in older people, and we may, 
therefore, conclude that (i) All cases of eye-strain should 
be removed in early and late life. (2) Cataract is not due 
to senile causes. (3) That it may be classed among 
preventable diseases. (4) That incipient cataract may be, 
by judicious treatment, retarded or even cured entirely. 
(5) That even if treatment does not accomplish this A. R. BAKER, M.D. 
7 
favorable result, it will put the eye in a healthier condi- 
tion, and future operations will be undertaken with greater 
prospects of success. (6) All cases of incipient cataract 
should be referred to some one skilled in the use of the 
ophthalmoscope for examination.