Attention called to the frequency of bard cataract in bottle-finishers, who are exposed to the brilliant light and intense heat of a furnace during their working hours. Both eyes are practi cally always affected. The disease be gins early in life and progresses slowly. It usually starts as a posterior polar cortical cataract. The disease can be prevented by wearing dark-blue specta cles. Six cases are reported. Robinson (Brit. Med. Jour., Jan. 24, 1903).
Pathology.—By most recent author ity, cataract is said to be, as a rule, caused by a too-rapid sclerosis and shrinkage of the nucleus. As one of the results, a cessation in the growth of the surrounding lens-fibres takes place. These separate from one another at cer tain places, especially in the area be tween the nucleus and the cortex, and particularly in the equatorial region of the former, producing fissures or cavities that gradually become filled with an albuminous liquid, which coagulates and produces spheroidal bodies known as the spheres of Morgagni. Later, the lens fibres which constitute the walls of the fissures become translucent and un equally swelled, giving rise to large and mostly nucleated vesicles of varying sizes and shapes. After total disintegra tion of these fibres and cells with their remains has fairly well taken place, the epithelium of the lens becomes abnor mally thickened, the most peripheral lens-fibres become vacuolated, and the capsule of the organ becomes abnormally' separated by the pathological process at work. In contrast to this breaking-down of the cortex, the shrunken and hard ened nucleus, as a rule, remains prac tically unchanged.
In the various forms of congenital cataract the course of events may prob ably be traced in this manner: An in flammatory process has attacked the different eyes in varying intensity; tbe ribbon-like opacity which each cornea bears as an evidence of this is most marked in the eyes with most posterior synechke and capsular cataract. Fol lowing the disturbance in nutrition pro duced by the inflammatory attack, the capsular epithelium and lens degenerate, and, in consequence of shrinking proc esses, rupture of the posterior capsule ensiles. The gap is filled up by a, capsu lar cataract, and thence arises an ad hesion of capsule to lens-substance. ln one case witnessed occlusion (lid not take place and the lens-fibres grew out ward. After the inflammatory process had run its course (and it lasted a vari able time in the different cases) lens fibres were developed, the plentifulness and quality of which depended on the condition of the epithelium. E. V. Hip
pel (Von Graefe's Archiv f. Ophtbal., liv, 1, 1902).
Prognosis.—The diagnosis of cataract being once established, it frequently be comes necessary to be able to decide how long it will take for the cataract to be come mature, or what is known as "ripe." This is very difficult, as the rate of progress is extremely variable. Senile cataracts may require years to be come sufficiently opaque and hardened for operative interference, while, on the contrary, in a few rare instances, they have ripened over night. It is gener ally wise, therefore, if the signs of cat aract be discovered in elderly persons not to alarm them by telling them of its existence, as vision may not be seriously disturbed for a long time. Particularly is this so in nervous females in frail health. Under all circumstances, how ever, it is better that the diagnosis be communicated to some responsible friend or relative of the patient. At times, among men especially, those who are harassing themselves with monetary and business affairs, it is best to acquaint them with the nature of the disturbance in order that better hygienic living may be obtained.
As a general rule, cataracts in the young, those due to general dyscrasia, and the secondary forms, all develop rapidly. On the contrary, all forms of opacity which commence in the periphery as narrow radii are slower in extension than those in which there are dot-like and broader opacities.
In reference to the prog,nosis of the result of operative interference for the removal of cataract, numerous factors must be taken into consideration. In many cases it is essential to determine the probable condition of the interior of the eye by means of the so-called candle test. No matter how dense a cataract may be, a patient with a healthy fundus should be able to recognize the position of a candle-light placed in all parts of the visual field while the organ is con stantly directed toward a second candle situated at a central fixation-point. If the moving light be lost at any point in the field, a disturbance of one or more of the ocular tunics may be diagnosed with almost certain precision and the prognosis rendered relatively unfavor able. If all light-perception be lost, op erative procedure would be useless. The condition of the appendages of the eye must be noted, and any disease of them should be carefully treated.