Curability of Cataract with medicines.
Its nature, causes, prevention and treatment
The Lens and its Capsule(<>), Structure of the Lens Substance (<>), Nutrition of the Lens (<>), Chemistry of the Lens (<>), Embryology of the Lens and its Capsule (<>), The Aqueous Humor (<>), Etiology and Pathology of Cataract (<>), Production of Cataract from Imbibition of the Aqueous Humor (<>).
THE crystalline lens, or crystalline body, is a doubly convex transparent solid body, with a rounded circumference ; it is inclosed in a capsule, is situated behind the pupil, and in front of the vitreous body.
In Bowman's words, the capsule of the lens, a transparent glass-like membrane closely surrounding the contained body, is hard and brittle, especially in front, but very elastic and permeable to fluid. The anterior surface is in contact with the iris towards the pupil, and recedes from it slightly at the circumference ; the posterior rests closely on the vitreous body. Around the circumference is a space, called the Canal of Petit.
The fore part of the capsule is several times thicker than the back, as far out as 1/6 of an inch from the circumference, where the suspensory ligament joins it ; but beyond that spot it becomes thinner, and it is thinnest behind. In its nature the capsule of the lens resembles the glassy membrane at the back of the cornea, for it is structureless, and remains transparent under the action of acids, alcohol, and boiling water, and when ruptured, the edges roll up with the outer surface innermost.
By “structureless” is meant that our strongest magnifying powers are unable to show any further differentiation. It is very tough and exceedingly elastic.
The histology of the lens is admirably given in Stricker's Manual of Human and Comparative Histology, vol. 3,
It is the work of Professor Babuchin, who was ably assisted by Sernoff. But it is much too elaborate for the present purpose.
Max Tetzer's Compendium der Augenheilkunde, Gruenfeld's third edition, Vienna, 1878, — by the way the best Manual of Ophthalmology extant, — is a mine from which we shall dig a little.
Poor Tetzer was the most genial clinical instructor of his day ( alas ! so short ), and made almost every student feel that he would go in for the eye. He puts the anatomy and histology of the lens thus tersely : The lens, with its posterior surface, fits into the plate-like groove of the vitreous. The connection of the posterior part of the capsule in this groove, is however, very loose, so that the capsule can be readily taken out. Of the greatest importance is the layer of the intracapsular cells, that are very pretty epithelial cells, like mosaic. This epithelium of the capsule, lying on its inner surface, is to be regarded as the matrix of the fibres of the lens. Particularly those cells towards the periphery give rise to the formation of the fibres of the lens. The lens substance has a peculiar shape ; its anterior surface is flatter, the posterior surface more convex. The proportion in the convexity is as ten to six. In the lens we distinguish the nucleus and the cortical substance. The cortical substance is rather softer, somewhat succulent ; the nucleus, on the other hand, is a compact mass.
The cortical substance can be divided into leaves (laminae), but the nucleus cannot be divided into leaves. Towards the equator the cortical substance is most considerable. This depends upon the development of the lens, because the peripheral layers are the youngest, while those layers that surround the nucleus are the oldest. The color of the lens in young individuals is as clear as water ; the older the person the more it becomes metamorphosed, turning yellow, yellow-brown, even rusty-brown.
The fibres of the lens are its most important constituent; they are six-sided prisms, so that on section of a lenticular fibre we get a hexagon. One fibre fits accurately to the other. The ends of the fibres are jagged like a saw, whereby the connection is more intimate. The fibres consist of a membrane, a contained fluid, in which globulin or crystalline was discovered, and of a nucleus, which, however, exists only in the young ; in the older it has already disappeared.
The complicated .arrangement of the fibres themselves will not ‘here come under consideration.
The consistence of the fibres of the lens varies in accordance with the layer in which they are found. The superficial fibres are very soft and delicate, and the nearer the center the more hard and resistant.
The lens has no blood-vessels. With regard to the nutrition of the lens, we consider the capsule as the matrix of the lens. On the inner surface of the capsule there is a layer of epithelial Cells, so that here the further nutrition is carried on through cells. The capsule is, as it were, the basement membrane for the epithelial cells ; these grow and differentiate into lens fibres. Hence the lens proper is the product or fruit of the capsule, and it is this idea that we have found to encourage us in our therapeutical endeavors, more especially when considered in relation with its origin. The nutrition may reach the lens by transudation through the capsule.
The principal chemical constituents are of an albuminous nature ; consisting, in fact, chiefly of globulin, with a certain quantity of albuminate of potash and ordinary seralbumen. Other materials that have been ascertained to enter into the composition of the lens fibres are — a little fat, with traces of cholesterin, about one-half per cent. or ashes, and sixty per cent. of water. The qualitative characters, no doubt, vary with the layer from which the fibres are taken ; for, apart from the fact that the central fibres are more resistant, the nucleus of the lens becomes much harder than the superficial layers under the same reagents ; so that, in fishes, for example, the nucleus remains transparent, hard, and difficult to cut. The cloudiness of the fibres of the lens, and the formation of vacuole in their interior, are occasioned by the action of reagents which withdraw water from them.
Probably this explains the modus operandi of sale, sugar, alcohol, and, secondarily, of ergot in the artificial production of cataract.
The development of the crystalline and its coat must, of course, be considered in connection with that of the eye as a whole. Now the eyes -begin to be developed at a very early period, in the form of two hollow processes projecting one from each side of the first primary cerebral vesicle. Each process becomes converted into a flask-shaped vesicle, called the primary optic vesicle, which communicates by a hollow pedicle with the base of the posterior division of the first primary cerebral vesicle.
According to the observations of Remak on the chick, the pedicles, originally separate, come together, and their cavities temporarily communicate, — a condition which may ,explain the formation of the optic commissure. The primary optic vesicle comes into contact at its extremity with the CUTICLE, which somewhat later becomes invaginated at this point, and forms a small pouch pressing inwards on the optic vesicle; the aperture of this pouch becomes constricted and closed, and the pouch is soon converted into a shut sac, within which the contents, subsequently becoming solid, form the lens and its capsule.
After the lens has been thus separated from the CUTICLE the deeper tissue contributes to the formation of the secondary optic vesicle. This is as much of the embryonic development of the eye as we need for the present purpose ; from it we see that the lens and its capsule are differentiated skin. This should be well remembered.
The investigations of Babuchin and of Sernoff lead them to differ but slightly from this in their conclusions.. They say that, as regards the origin of the lens, and the mode of development of its fibres, it is obvious from the direct transition of the anterior epithelial layer of the lens into the posterior fibrous layer, that each fibre of the lens is simply a colossal and greatly elongated epithelial cell, and the history of development shows further that the persistent portions of the body of the lens arise from the EPIDERMOID external layer of the embryo.
The question of the development of the capsule is still open, according to Sernoff, who has long been occupied with its investigation ; in the meantime he would appear to deny both its epidermoid origin, and also that it is the product of the excretion of the epithelial cells and of the fibres of the lens. Babuchin inclines to classify it with the metamorphosed connective tissue formation.
But some light may be thrown on the question of the origin of the capsule of the lens — a very important question, by the way, for gaining a little firm ground for our therapeutic endeavors — by comparing it with the membrane of Descemet.
The capsule of the lens and the membrane of Descemet have many properties in common ; thus portions of either, when treated with reagents (as, for instance, permanganate of potash, or a ten per cent. solution of common salt) will roll inwards like paper that has been long rolled up, and they are both glass-like or hyaline. Hence the opinion of Babuchin, that the capsule of the lens is transparent connective tissue, would seem very probable. According to Rollett, the histogenesis of the cornea requires to be again worked over, especially with the aid of the silver and gold methods of preparation.
But, leaving for the present the origin of the capsule undecided, we are in no doubt of the EPIDERMOID nature of the lens, and also in no doubt of the endothelial nature of the intercapsular cells.
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 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. — (Quoin.)
It is very probable that the aqueous humor plays a very important part in the nutrition of the lens.
For this part of our subject a very important work is Des Causes Anatomiques de la Cataracte Spontanée, par Henri Chiray, Paris, 1875.
In general thesis it is maintained that cataract is due to a 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 hills ; 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, à propos of this (op. jam cit., p.7), De plus, on sait que, dans la cataracte dure, au début, les fibres cristalliniennes s'isolent, se ratatinent, se décrochent, pour ainsi dire, les unes des autres, et laissent aux points ou correspondent leurs extrémités des espaces libres que remplit une substance grumeuse.
On ne saurait nier, sinon l'identité, au moins la grande analogie entre ces espaces interfibrillaires et les vacuoles qui se forment dans les expériences indiquées."
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 cleat-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 apportation 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.
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 month 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 languages 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 Kundp'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.)
I must pass over the various kinds of cataract, except just giving a list of them from Tetzer ; their names are to some extent descriptive of them. They are : Cataracta accreta, aridosiliquata, capsularis, complicata, corticalis, cystica, fluida, glaucomatosa, gypsea, hypermatura, immatura, incipiens, intumescens, lactea, lenticularis, matura, membranacea, Morgagni, nigra, nucleolaris, perinuclearis, polaris, pyramidalis, secundaria, simplex, spuria, traumatica, and zonularis.
It must be obvious that many of these varieties can only be recognized after the cataract has been extracted, so they will help us but very little in a therapeutic sense.
I will revert to the Hahnemannic pathology subsequently.
I have thus stated how I came to believe in the possibility of curing cataract with medicines ; the n I have brought together a certain number of homoeopathic cures of cataract, together with the opinions of some eminent homoeopathic practitioners on the subject ; after this I have given a very short account of the biology of the lens, and added thereto a rough sketch of its characteristics when diseased.
Now I propose to take the reader for a little ramble into the general medical literature of the eye, and see what certain eye-surgeons say on the subject of the medicinal curability of cataract. After that I purpose giving my own further limited experience on the same subject, and then I will conclude with a few observations and remarks on psora as bearing upon it.
My object is to get and to give an all-round view of the subject, so that we may know the ground upon which we stand.
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