Baker report, 1968 congressional hearings

Urinalysis:
Grossly amber and clear. Specific gravity: 1.015. pH: 5.5; albumin: negative; glucose: negative; acetone:
negative.
Microscopic:
WBC/HPF - 0-2
RBC/HPF - 0-1
No casts seen. Amorphous urates (moderate amount) present.
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E. Summary of Positive Findings
1. History of chronic alcoholism and heavy smoking.
2. Recent photophobia.
3. Hepatomegaly, with ruddy complexion with malar telangiectasia.
4. Effects of smoking: tobaccco-stained teeth, injected posterior pharynx, and basilar rales.
5. Abnormal liver function studies: Bilirubin elevated in both direct and indirect fractions; elevated
alkaline phosphatase; decreased albumin and elevated globulin (reversed A/G ratio).
F. Discussion and Creditability Score
The subject has definite changes of early alcoholic cirrhosis. At this point in time the toxic effects of his liver pathology
would be expected to be exerting only a mildly adverse influence on overall central nervous system functioning.
Such effects, however, would serve to aggravate any already existing neurological and/or psychological problems.
Creditability Score 75%.
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III. Neuro-ophthalmologic Evaluation
A. "Eye" History
Subject denies previous history of transient blindness, blurred vision, double vision, spots or shadows before his eyes or
protracted pain in his eyes. His last eye evaluation was 20 years ago. This was during high school and was prompted by
headaches when reading. Reading glasses were prescribed at that time and he wore them for approximately eight months
and then discarded them. He denies any eye problems since that time. He states that both his parents wore glasses only for
reading and that none of his siblings wear glasses. He states also that his father developed glaucoma at age 55 and was
required to use eye drops to keep it under control.
There is no history of trauma or infection in the past five years. On questioning, the patient acknowledges a mildly
irritating tearing which he has noticed for six to eight weeks, associated with a slight mistiness of his vision. He also has
been wearing sunglasses on bright days for the same period because the sunlight hurts his eyes.
B. Qualitative Ophthalmologic Examination
Subject is right eye dominant. There is no evidence of structural abnormality, trauma, or ptosis (see photo in Section III C
1). The palpebral fissure is of normal shape and size. The cornea is clear bilaterally but the conjunctivae show a moderate
degree of injection, without discoloration. The sclerae are also clear without abnormal vessels or pigmentation. The iris is
bilaterally brown. The pupils are symmetrically round, equal, and both 4mm. in diameter. They reacted to light sluggishly
and responded to accommodation directly and consensually (see Fig. #l). The extra-ocular muscles function normally.
There is no image separation upon red glass testing. There was no nystagmus either horizontally or vertically.
Funduscopic examination reveals a poor red reflex bilaterally. There are no apparent floaters or other opacities in the
vitreous. The disc shows sharp margins bilaterally but the normal physiologic cupping is absent. There is a pale quality to