From which we may deduce the general statement that the drugs that affect the epidermis and epithelial structures specifically will also be our remedies in some of the abnormalities of the nutrition of the lens, and therefore in some forms of cataract.
From the albuminous nature of the lens we may deduce the general statement that substances which in the living body enter into combination with the albumen to form albuminates, will likewise be remedies in certain forms of cataract.
The Aqueous Humor.
The chambers of the eye are bounded posteriorly by the anterior capsule of the lens, and anteriorly by the posterior membrane of the cornea, the so-called membrane of Descemet. The iris dips like a circular curtain into the space so designated. They are occupied by the aqueous humor, which differs but little from water in its physical characters, but it contains a small quantity of some solid matter, chiefly chloride of sodium, dissolved in it.-(Quain.)
It is very probable that the aqueous humor plays a very important part in the nutrition of the lens.
Etiology and Pathology of Cataract.
For this part of our subject a very important work is Des Causes Anatomiques de la Cataracte Spontanee, par Henri Chiray, Paris, 1875.
In general thesis it is maintained that cataract is due to thickening of the blood from the abstraction of a portion of its water.
The principal experiments on this point are those of Kunde and of Kuhnhern made of frogs, cats and dogs, with common salt, the nitrate of soda, and concentrated solutions of sugar, introduced into the digestive tube and under the skin. Under this influence the animals rapidly lose a great quantity of water, they attain to an extreme degree of desiccation, and in a period of time, varying from a few hours to as many days, an opacity of both lenses is seen to develop. Some authors will not recognize these as true cataracts, because they disappear as soon as the abstracted fluid is restored to the economy. But, as Chiray observes, this objection will not hold; for what constitutes, clinically, a cataract, is an opacity of the crystalline, and the just mentioned substances do produce opacities of the crystalline.
So we must say they are analogous, though not indentical. But then the same holds good of all cases of disease, and therefore of cataract.
Chiray also comes to the conclusion that we must consider it as a fact that loss of fluid is a cause of cataract. As examples of this, he reckons the cataracts of the diabetic, and those common to certain trades. Thus glass-blowers, for instance, who work a good part of the day before very hot fires; the vignerons, who work very hard in the full blaze of the sun on their shelterless hill; also a certain number of senile cataracts are to be attributed to this same cause; for we know the vascular changes at this age must necessarily impede the interchange of the fluids between the tissues and the blood-vessels; this is particularly the case with the aged, and those who are withered and emaciated by misery and privation.
Then there is the cataract of ergotism, but how brought about we will not here tarry to discuss, but will briefly revert to the subject presently.
It would lead us too far to enter into the much vexed question of how inflammatory cataract becomes established; it is well discussed in Chiray. According to Ritter and Moers, irritation of the crystalline produces at first subcapsular and capsular lesions that might well be connected with capsular cataract, and these lesions subsequently extend to the crystalline. Clinically, we frequently note that cataractous patients tell us of former inflammations of the eyes.
GERONTOTOXON LENTIS is pretty frequent in the aged; it consists of an equatorial opacity of the lens, with very weak centripetal rays, and having but a very slight tendency to increase. The opacities are due to deposits of fat between the fibres. This is analogous to the arcus senilis of the cornea; and although an opacity of the lens, is nevertheless no cataract in a strict sense.
Choroiditis, and sclero-choroiditis are very frequent causes of cataract.
Chiray (These, 1858) very prettily terms the choroid the placenta of the eye.
The most important part in the nutrition of the eye is undoubtedly played by the aqueous humor, and this fluid is secreted by the choroid, the nourishing membrane of the eye. Hence choroidal lesions must play an important part in the etiology of cataract by primarily altering the nature of the aqueous humor.
Those cataracts that are produced by desiccation are, according to Kolliker, due to the production of vacuoles filled with fluid and situate between the crystalline fibres.
And Chiray remarks,” apropos of this (op. jam cit., p. 7), De plus, on sait que, dans la cataracte dure, au debut, les fibres crystalliniennes s’ isolent, se ratatinent, se decrochent, pour ainsi dire, les unes des autres, et laissent aux points ou correspondent leurs extremites des espaces libres que remplit une substance grumeuse.
On ne saurait nier sinon l’identite, au moins la grande analogie entre ces espaces interfibrillaires et les vacuoles qui se forment dans les experiences indiquees.” He then goes on to note, however, the extreme rapidity of the formation of the one and the extreme slowness of the formation of the other. But this difference, I submit, may be more apparent than real.
Thus he admits that certain forms of cataract are, up to a certain point, susceptible of resolution. There are, he says, those slight troubles of the subcapsular epithelial layer that follow irido-choroiditis or traumatism of the crystalline, and also those that occur in the diabetic.
With regard to the cataract of ergotism the fact is admitted. But how does it come about? Some maintain that it is from deperdition of water from the organism.
It has struck me as remarkable that no one seems to have succeeded in curing cataract with ergot; Mons. Ozanam, for instance. Now, it occurs to me that another, and very plausible, explanation of how the ergotic cataract is brought about may clear this point up. We know that ergot produces spasm of muscular fibres; in ergotism we shall, therefore, get spasmodic contraction of the ciliary muscle and of the choroidal vessels, and consequent obstruction in the transportation of the blood to the part involved. Hence Secale would be only homoeopathic to this peculiar variety of cataract, viz., when spasm causes it, and when the spasm still exists.
Production of Cataract from Imbibition of the Aqueous Humor- The following very instructive case of M. Forarini may be found in Chiray (p. 18):
A young laborer was hit with a very small fragment of steel filing, which penetrated into the substance of the capsule of the lens, and this is what was observed: For the space of a mouth this fragment remained quietly lodged in it, without causing the least visual trouble. At the end of this period a small perforation in the capsular cicatrix was observed, and M. Forarini was able to follow, step by step, the development of a cataract from aqueous imbibition. For more than a month the alteration only propagated itself in the peripheral cortical layers. Little by little it extended to the deeper layers, and it was only then that the region surrounding the metallic splinter was seen to be disturbed in its state. The gist of M. Chiray’s work is to prove that cataract is due, very frequently, to atrophy of the choroid and to choroiditis. No one can gainsay his facts, but his reading of them is another matter; to me he seems to have fallen into the usual error of letting a younger brother descend from an elder brother. Just as some persists in saying that English is derived from German, whereas the two language are separate branches of a common stem. So it is, I submit, with choroiditis, atrophy of the choroid, and cataract, neither is from the other, but all have their origin in the general constitutional state.
The most positive knowledge in regard to the etiology of cataract is that resulting from Kunde’s experiment with salt; we know certainly that the lens may become cataractous from a too great loss of fluid.
Speaking anatomically, the lenticular opacities, i.e., cataracts, are different according to whether the nucleus or the cortex is involved. There is a difference between the nucleus and the cortical substance.
First, with regard to the kernel, or nucleus, we see that it becomes hard, dry, and brittle; in color, yellow, rusty, or yellow-brown, but still retaining a certain degree of transparency. If a cataractous nucleus is analyzed it is found that it is composed of concentric layers in which the several fibres cannot be separated from one another. If the nucleus is broken asunder, the fracture surface is found to be irregular. Sometimes the lens fibres have become as if broken, and then an amorphous granular mass is imbedded in it, and this splits it up. The nucleus of the lens becomes broader and thinner the older the individual. In the debris of a cataractous lens there are found particles of fibres, molecules of fat, and cholesterin. The entire. process, therefore, consists in a disintegration of the lenticular substance with chemical changes, the lens at the same time containing less water; in fact, it is atrophy of the lens, starting originally from phakitis. There is at first a proliferation of the capsular epithelial cells, and these new elements drive the lens fibres asunder. Then these neoplastic cells degenerate, and thus render the lens opaque. (Tetzer.)
Burnett was one of the first to speak about vaccination triggering illness. This was discussed in his book, Vaccinosis, published in 1884. He introduced the remedy Bacillinum. He authored twenty books, including the much loved "Fifty Reason for Being a Homeopath." He was the editor of The Homoeopathic World.