EFFECTS ON THE VISUAL APPARATUS 211 



xerophthalmia, involving cornification and degeneration of the corneal epi- 

 thelium, edema of the substantia propria and progressive leukocytic infiltration. 

 Later the conjunctivitis becomes more severe, with purulent panophthalmia and 

 keratomalacia, leading in extreme stages to corneal perforation and consequent 

 destruction of the eyeball. There are also characteristic lesions in the lacrimal 

 glands, with a disturbance of secretion which may contribute in producing the 

 changes in the eyeball. The conjunctivitis and keratomalacia are associated 

 with bacterial infection. This appears to be secondary to the primary effect 

 of the vitamin deficiency, which produces a specific lowered resistance in the 

 tissues of the visual apparatus. Upon adding vitamin A to the diet, recovery is 

 prompt, excepting in extreme stages with corneal destruction. 



(.4 ) Effects of Total Inanition, or on Water Only 



In the human adult, the earlier observation upon the visual apparatus 

 during malnutrition included conjunctivitis and corneal lesions, evidently 

 corresponding to the disorder now known as xerophthalmia and considered as 

 due to a deficiency of vitamin A. The earlier literature, as reviewed by Cyr, 

 ('69) and Blegvad ('24), will therefore be presented later, in connection with this 

 topic. Bourgeois ('70) noted that the human eyeball retains its volume during 

 starvation. 



Luciani ('89, '90) observed the retina during the 30 day fast of Succi. He 

 found nothing abnormal until the 28th day, when there was a slight narrowing 

 of the visual field and also a slight constriction of the retinal vessels, of 

 doubtful significance. 



In a man who died of starvation, Meyer ('17) noted that the eyes were deeply 

 sunken, the periorbital fat " absolutely depleted" and the eyeballs very soft. 



Numerous observations indicate an increase in certain visual disorders 

 attributed to malnutrition during the recent war period. Thus Seef elder ('19) 

 noted an increase in acute glaucoma, conjunctivitis and keratomalacia (the latter, 

 at least, probably due to partial inanition). Feilchenfeld ('20) concluded that 

 the eye is very sensitive to malnutrition, which during war famine resulted in an 

 increased number of lesions of the eyelids (extensions from facial eczema); 

 retinal hemorrhages and thrombosis of the central vein; apoplexy and glaucoma. 

 The general weakness also causes a marked decrease in the power of accommoda- 

 tion. Pick ('20) likewise noted a marked increase in certain ocular disorders as 

 a result of malnutrition during and since the war. 



Most of these ocular symptoms during famine are probably due chiefly to 

 lack of vitamin A (xerophthalmia) and vitamin C (scurvy), to be considered 

 later, as well as to the lowered resistance with increased susceptibility to infec- 

 tions in general. 



In malnourished and emaciated infants, the corneal ulcerations (kerato- 

 malacia) described by Mackensie ('57), Blessig ('66), von Graefe ('66), Gama 

 Lobo ('66), Teuscher ('67), Tardieu ('80), de Gouva ('83), Thalberg ('83), Kubli 

 ('87), Schiele ('07) and Stolte ('22) doubtless likewise belong chiefly in the 

 category of xerophthalmia, to be considered later. Ohlmuller ('82) recorded for 

 the eyeballs a weight of 5.41 g. in an atrophic infant of 56 days (body weight 



