DISOKDERS IN RELATION TO THE EYE 771 



marked predisposition of Jews to this affection is significant in view of 

 the emotional history of the race, the prevalence of neuroses (speech- 

 defects, neurasthenia) and of metabolic disorders (diabetes, arthritism) 

 of endocrin origin, or the sudden development of acute glaucoma "under 

 the bandage" after operation (iridectomy) on the fellow eye. 



Pathology. There are certain discrepancies in the theories which lay 

 stress on mechanico-physical factors. Hypermetropia is most common in 

 youthful eyes, yet at this age glaucoma is not only uncommon, it is al- 

 most unknown. Intra-ocular tumors (glioma, sarcoma, of the choroid) 

 may attain large dimensions without increasing intra-ocular tension or 

 causing the dilatation of the pupil which was supposed to bring about the 

 acute attack of glaucoma. It is a question whether increased intra-ocular 

 tension alone is sufficient to paralyze the sphincter pupillae completely 

 and whether there is not some other factor to be considered. It is to be 

 noted that in some cases of increased tension where meiotics fail com- 

 pletely, the same alkaloids, administered in sufficient doses to produce 

 systemic effects and the characteristic physiological reaction, promptly 

 contract the pupil. This would speak against any terminal, mechanical 

 paralysis sufficient to paralyze the nerve endings in the sphincter or the 

 muscle fibers themselves. 



Ocular agioneurotic edema associates with glaucoma logically as well 

 as clinically and Barkan says that it seems too much to suppose, in view 

 of the well recognized causes of certain classes and cases of glaucoma, that 

 all these causes should only be favoring factors to the localized edema 

 which raises the ocular tension. Are hyperopia, old age, stiffening of the 

 sclerotic, relatively disproportionate increase of lens volume, fibrosis of 

 the ligamentum pectinatum, high blood-pressure, arteriosclerosis, and 

 sudden mental excitement, all only secondary to a local acidosis, or only 

 an aid in its appearance in a type case of this kind? For acidosis is 

 common in childhood ; glaucoma, rare ; there is no edema in diabetes, typi- 

 cally acidotic as it is. On the contrary, one finds hypotony in this non- 

 edematous, highly acid state. Finally, the prompt action of meiotics in 

 the case he reports, of angioneurotic intra-ccular edema with glaucoma, 

 is hard to reconcile with the hydrophilic theory. 



These considerations appear to me to lead directly back to an endocrin 

 basis in the pathogenesis of glaucoma. The anatomic factors cited are 

 all predisposing elements, as indeed we recognized before; acidosis is also 

 a link in the chain, but a link merely. 



Symptomatology. The constitutional disturbance is significant, es- 

 pecially the agonizing pain, radiating to a distance from the eye and in- 

 volving the brow, cheek, and teeth ; the severe headache, often associated 

 with nausea; the marked prostration, exhaustion, and anxiety. Pain 

 alone, however severe, in other eye affections never presents this picture, 

 that of an endocrin storm; a picture which not infrequently misleads the 



