tive degeneration, but the periphery of the lens finally became partially transparent so as to admit of a bright reflex from the fundus, the central portion taking on a sort of feldspar or spermaceti appearance. In this part of the country (Kansas) where the Osage extending from the iris to the capsule and into the lens. orange hedge is so extensively used for fencing, patients In these cases subsequently atrophy took place. In one frequently come to me with traumatic cataract produced case this atrophy of the lens fibres went into suppura. by the Osage orange thorn having pierced the eye while trimming the hedges. These patients come to us without any marked evidence of an injury except the opaque lens. The thorn, being so sharp and slender, leaves scarcely any visible wound in the lid or tunics of the eye. The thorn rarely, if ever, is left within the eye. CATARACT FROM LUXATION.-The lens is frequently dislocated by traumatism not infrequently without spe. cial cause as in myopia, and occasionally it is partially luxated congenitally, as in ectopia lentis. The lens displaced from its bed even as a congenital defect sooner or later becomes cataractous. FIG. 5-PROF. ALFRED GRAEFE. DIABETIC CATARACT.-Diabetic cataract is one of the forms of secondary cataract and frequently runs a rapid course, especially if it exists in a young person. The prognosis in this form should be guarded, as not infre quently it is associated with lesions of the fundus, such as scotomata due to hemorrhagic patches within the retina. About six per cent of diabetic patients have cataract. SUPPURATIVE CATARACT.-Stellwag and Knapp speak of a peculiar form of cataract which they designate as suppurative cataract, it being connected with panophthalmitis where there is general suppuration going on. The lens swells and large pus-corpuscles are found within the capsule. From the neoplastic deposit, the lens fibres are displaced and warped. Occasionally portions of the lens contain saccules of pus corpuscles. I distinctly remember some cases which might be classi fied under this head, being the result of suppurative iritis caused by la grippe, the suppurative inflammation CAPSULAR CATARACT.-This is in a certain sense a mis-nomer, as an opacity of the capsule rarely, if ever, exists with a transparent lens. The opacity being deposited upon the capsule either from without or within the lens; occasionally, however, the opacity is caused from proliferation of the capsule cells. Capsular cataract is almost invariably limited to the pupillary area or posterior pole. It is frequently seen as a pyramidal eminence extending from the anterior pole; it sometimes exists as an inverted cone at the posterior pole, the apex extending into the vitreous body. PRIMARY CATARACT.-Primary cataract is that form which seems to be independent of any disease or affection of the eye or system; as for example, senile cata ract. SECONDARY CATARCT.-Secondary cataract, as the name suggests, is subsequent to other affections of the eye and is the result of diseases of other parts of this organ. Frequently it follows glaucoma, cyclitis, iritis, choroiditis, or myopia. It may be dependent upon systemic disease, as nephritis. CRETACEOUS CATARACT.-Cretaceous or chalky cataract need not be mistaken for any other form. A portion only of the lens, as a rule, undergoes retrograde metamorphosis from a degeneration of the lenticular substance with deposition of chalky or limy material. The lens shrinks and presents the appearance of a little sac containing these cretaceous deposits. This form of cataract is often associated with ossification of the choroid, detached retina, and other diseases of the fundus and is usually accompanied by a deep anterior chamber; not infrequently by adhesions of the iris to the capsule. MEMBRANOUS CATARACT.-There is always more or less opacity of the capsule or the lens after extraction of cataract; more especially after the section operation in the soft or semi-soft cataract; frequently after linear extraction. This opacity may be confined entirely to the capsule or it may be due in part to opaque lenticular substance retained within the capsule. Frequently the opacity is greater several days or weeks subsequent to the operation than immediately after it. Not infre quently is this form of cataract complicated with iritis and posterior synechia. The opacity may be due to diffraction caused by crenation or wrinkling of the capsule. ETIOLOGY. In considering the etiology let us look more carefully into the minute anatomy of that part of the eye in close proximity to the lens; namely, the ciliary region. Schlemm's canal (csl, Fig. 6) is a circular canal situated at the junction of the cornea with the sclers in front of the ciliary attachment of the iris. Internally and posteriorly, it is bounded by the ligamentum pecti natum iridis (i) and the ciliary muscle (CF); externally and anteriorly, by fibres of the cornea and the sclerotic. The iris (I), or diaphragm of the eye consists of two sets of fibres, radiating and circular, with a fibrous stroma containing blood vessels, nerves, lymphatics, and pigmentary cells. Anteriorly, the iris is attached to the cornea by the ligamentum pectinatum iridis, which is a continuation of the endothelial layer of the cornea. The radiating fibres of the iris become continuous with those of the ciliary muscle and ciliary processes (Pc), and these processes are principally formed by folds or plaitings of the internal layer of the choroid. The canal of Fontana (Fig. 7) is the triangular space inclosed by the ligamentum iridis, cornea, ciliary mus. cle, and iris. It is crossed by bands of fibres and is a loose cellular network which connects with Schlemm's canal. FIG 7. The ciliary muscle consists of two sets of fibres, meridional (mcı, Fig. 6) and circular (Po). The meridional take their origin from the posterior wall of Schlemm's canal, extend. ing back upon the choroid, while the circular are more intimately connected with the posterior wall of Fontana's spaces, extending back and connecting with the fibres of the ciliary processes and the suspensory ligament. In highly myopic eyes the meridional fibres are strongly developed (Fig. 8); the circular are scarcely to be seen. In the hyperopic eye, the opposite condition prevails (Fig. 9); the meridional fibres are sparse while the circular are highly developed. Immediately posterior to the iris is the crystalline lens in its capsule (C, Fig. 1) supported by the suspensory ligament (NN), vitreous body (D), and ciliary processes (K). The principal arterial blood-supply to the anterior portion of the eye, according to Frey and Satterthwaite, is through the long posterior and anterior ciliary arteries (Fig. 10). The posterior penetrates the sclera in a very oblique course in front of the optic nerve. Passing forward in the outer layer of the choroid to the ciliary muscle, they divide into several branches, penetrating the muscle from opposite sides. These branches, uniting, form a large circle near the periphery of the iris, the circulus arteriosus iridis major (G). The anterior ciliary arteries (F), eight or ten in Dumber, arising from the muscular branches of the ophthalmic artery enter the eye in the region of the ciliary muscle, and unite with the circle just described, assisting in the distribution of the blood to the ciliary body, ciliary ligament and iris. CF ma CD* ср ha va L Lc FIG. 6. From the circulus arteriosus iridis major, a series of acute angles to form larger branches, some of which very important branches is given off to different parts of the eyeball; namely, to the choroid, ciliary processes, and iris. The recurrent branches passing back into the ciliary muscle are very numerous, forming a perfect meshwork through the muscle. The arterial twigs (L) of the ciliary processes are short tubes which enter these bodies from the circulus arteriosus iridis major. After they have traversed the ciliary muscle, each of empty into the venæ vorticos. Others take their exit through schlemm's canal. Some twenty-five or more quite large branches, mostly from the ciliary muscle, leave the eye at this point where they pierce the sclera quite obliquely and upon its surface empty into the ciliary veins (Y); thus we see that this portion of the eye is highly vascular, and that the blood vessels are closely packed, requiring but a slight disturbance in the ana. tomical parts to produce a disturbance in the circula tion, and a derangement of this immediate circulation may change the condition of the aqueous and vitreous bodies, thus affecting the nourishment of the lens. The vessels supplying the iris are all derived from the large circle. They form a wide vascular network Accompanying the blood vessels, there is an equally through the stroma of the iris converging towards the complex structure of nerves ramifying and traversing pupil. Near its margin, they form another vascular this portion of the eye. The ciliary nerves are those of circle, the circulus arteriosus iridis minor (L). From the lenticular ganglion and pass through the ciliary body, this small circle, branches are still further given off ciliary muscle, and iris by Schlemm's canal to the corwhich supply the sphincter of the pupil, and finally nea, many of them terminating in filaments void of merge into the venous radicals. their medullary sheath and finally end in the nucleoli of the epithelial cells of the cornea. The veins of this part are nearly as numerous as the arteries. Crowded closely together they unite at very We know from this complex structure that any slight disturbance sufficient to interfere with the circulation, thus interfering with the circulation, and therefore with induced, perhaps, by over exertion of the ciliary muscle, the nourishment of the lens. as in hyperopia, may affect the nutrition of the lens. The hyperopic eye, from necessity, is constantly exert ing its power of accommodation for distant as well as for near objects, hence its susceptibility. This would suggest one of the main causes of cataract. It has been my experience that the hyperopic eye is to a greater per cent cataractous than the emmetropic. If a myope has cataract the disease develops very slowly, extending over a period of many years before its maturity is reached. Diabetes and other systemic diseases cause cataract; diabetes from a deposit of sugar in the lens. The injection of naphthalin in the lower animals will cause cataract. Tobacco is frequently an indirect cause. Cataract has been produced in frogs by the injection of salt or sugar into the blood, giving rise to density of the intra ocular fluids. Cataract frequently depends upon hereditary taints, and is often found in rachitic, syphilitic, or ecrofulous children who are subject to epilepsy and have other The nourishment of the lens being by osmosis through evidences of inherited vitiated systems, such as the sothe intra-ocular lymph streams, any retrograde metamor- called Hutchinson's notched and peg shaped teeth. phosis in the aqueous or vitreous is liable to cause disturbance of nutrition and result in degeneration or cloudiness of the lens. Hence, we may readily see that any disease of these media brought about by a disturb ance of the condition of the uveal tract may affect the nutrition of the lens and result in cataract. Cataract is very frequently secondary to some disease of the uveal tract, and ofttimes we are able to trace it directly from iritis or choroiditis. Nearly all deaf mutes have choroiditis, and these people sooner or later are almost sure to become affected by cataract. In fact, it is a rule that people with choroiditis eventually become cataractous. Consanguinity in some occult way is responsible for this disease. Children of parents of blood relation are frequently cataractous. I have found in several large families every child so afflicted, both eyes being affected. Most of these children were progeny of debauchees of alcohol, of tobacco, or of both, and were of stunted growth. In some of these families the father and mother were first cousins. I recall treating one family consisting of eleven children all of whom had cataract and were also hyperopic, with other complications. I have also a vivid recollection of another family from a neighboring town (the father, a bright, able attorney, and the mother with more than ordinary intellect and remember one patient-a boy of fourteen-with lamel. brilliancy), in which each of the four children were lar cataract, who had complete alopecia, being almost an cataractous with choroiditis, and these children were exact prototype in profile of the face and bald head of absolute mutes; each, however, had had fairly good hearing up to the second or third year when they grad ually became deaf. These children otherwise were bright with mental capacities to be admired. Their father and mother were first cousins. Some months ago I had at my clinic a large family of children all grown and each one cataractous. The father and mother, as in these other families, were first cousins. . While in Berlin, in the year of 1877-78, I noticed that the rabbits kept in the laboratory for vivisection were nearly all blind from cataract. This blindness, as suggested by Prof. Hirschberg, was due to the interbreeding of these animals. FIG. 11.-JONATHAN HUTCHINSON. his grandfather. In this case, the mother attributed the cataract and the bald head to a shock she received while in the first stage of her pregnancy. She related that upon entering the room where her father was sleeping on the bed, she caught sight of his bare head and face which were extremely pale, and she thought he was dead. This so frightened her that she ran screaming from the room. Although there may be a probability of the maternal impression upon the child from this shock of the system having had something todo in the arrest of nutrition to the lens cells and the hair follicles resulting in cataract and alopecia, yet from the fact that the grandfather had cataract I am inclined to believe that these conditions were due more to inheritancy than to the meternal impression. The eating of rye bread which contains ergot has been assigned as a cause of cataract, ergot producing a Cataract occurs most frequently in old age and is constriction of the bloodvessels in the ciliary region, evidently due to an arrest of or mal nutrition; often it is no easier accounted for than gray hair or a wrinkled skin, and is only one of the tissues of the body from age, from vitiated habits, from intemperance, or ex cesses in different directions, from worry, mental hallucinations, etc. Capsular cataract not infrequently follows an attack of iritis from la grippe, the deposit occasionally produc ing a complete opacity of the lens. This deposit may be absorbed, in a measure, after several weeks or months, but almost invariably the vision is more or less impaired. It is often due to an inflammation of the cornea or iris; but it is most frequently the result of ophthalmia neonatorum when we usually find a corres ponding opacity of the center of the cornea; however, anterior capsular cataract may exist with no perceptible opacity of the cornea. In fetal life or even at birth the lens is nearly spheroidal, the anterior part being in close proximity to the cornea; in other words, the anterior chamber is very shallow and any slight inflamma. tion or swelling of the cornea would bring it into apposition with the lens. Then the exudation deposited upon the capsule arrests the nutrition and results in opacity without necessarily any change in the cornea or lens. "It has for its principal application the employment of the alkaloids in broken doses, exactly measured, in the form of granules. "This mode of employment permits of the adminis tration of the alkaloids in doses, relatively considered, in an absolutely safe and convenient form." The main and leading idea in this system in to give medicine in small and oft repeated doses until the therapeutic effect desired is obtained or its physiological manifested. In the incipiency of nearly all forms of disease there is a certain class of phenomena or symptoms which are almost identical in their manifestations. There is fever, pain, nausea, and a general malaise. When these symptoms are present it is not necessary to wait until the specific form of fever or pathologic condition is well defined, and a diagnosis carefully made before instituting active treatment to restore the disturbed equilibri. um. If the temperature shows a rise above 100°F., attack at once with aconitine, digitaline and strycnine. Clear out the alimentary canal with Seidlits, salts or calomel and podophilin. Relieve pain with codeine, morphine or hyoscimine. Any other symptoms meet as they appear with appropriate remedies. In inflammation of the iris, the exudation is deposited The central idea to be carried out is the aborting or on the capsule within the pupillary area, and when the jugulation of the onsetting fever, whatever may be its pupil is dilated this deposit is confined to the pupillary character, and thus restore the system to its normal space of the capsule. Posterior capsular cataract is condition. This much-desired result can be obtained usually the result of an inflammation of the deeper por. in a very large per cent of cases if seen in their incip. tion of the uveal tract. Occasionally, we find the bya-ient stage. It is this early arrest of disease prior to loid artery or remnants of this vessel attached to the organic change of structure that makes this system so posterior pole of the capsule; again, we may have a so very prominent, and which is one of its chief claims to called capsular cataract from detritus of the lens. superiority. Yet, in those chronic maladies, with their long train of sequences, it holds a useful and important place. The minute dose, the pleasant and agreeable form for administration, makes it a boon to the mother and the invalid. In senile cataract the majority of the eyes except the cataract seem to be perfectly sound eyes, free from any disease, and fortunately, these constitute the large majority of all the different forms of cataract, and when the cataract is removed by a suitable operation, good vision should be gained. [TO BE CONTINUED] Dosimetry. BY S. H. HEADLEE, M.D., ST. JAMES, MO. The number who deny the efficacy of the little ganule of calomel or codeine given at short intervals are not nearly so numerous as a few years ago, yet there are quite a large per cent of those who ought to know better who are yet firm believers, and pin their faith and practice to the crude drugs and big doses, with their invariable accompaniment-nauseous taste and smell. No more refined system of cruelty can be imagined Having been repeatedly twitted by my friends of than that practices upon innocent children and helpless this Association for my leaning toward small and oft invalids by physicians and parents under the old rerepeated doses of medicine, or to what they call a di- gieme. No wonder children turned pale and fled in luted Homeopathy, or possibly a mere stretch of the terror at the bare mention of the doctor, or the threat imagination on my part, I have concluded to give a of opening the family medicine chest. Many times reason for the faith that is in me. This system, denom- and in many cases the remedy was more to be dreaded inated Dosimetric, has of late years assumed considera than the disease. In my own personal observation it ble importance in the medical world, yet there is noth- has been my misfortune to see a useful and well-indiing very new or really startling in its pretentions, it cated remedy not only fail to do good, but produce posonly realizes and gives prominence to old and well-itive injury from being administered in too large a dose. verified facts. It has been defined: The longer I live, and the closer my observation on the "As a medico-therapeutic method based upon physi- effects of medicine upon the human system, the firmer ology and clinical experience. is my belief that the smallest amount that can accom |