780 PERCY FRIDEKBERG 



neuroretinitis*) are, as is well known, common in advanced nephritis and 

 usually of unfavorable prognostic significance. The retinal changes are 

 fatty degeneration, hemorrhages with changes in the smaller vessels, and 

 edema. Papilledema is the usual form of the optic-nerve manifestation. 

 Complete blindness without ophthalmoscopic changes, uremic amaurosis, 

 is seen at times with convulsions, vomiting, and coma indicating a grave 

 general disturbance. The rapid appearance and disappearance of this 

 condition indicate that it depends on retention of urea in the blood rather 

 than on the factor of increased intracranial pressure secondary to edema 

 which is the probable cause of papilledema in Bright's disease. 



Syphilis and Tuberculosis. The attenuated virus of lues and of tuber- 

 culosis transmitted to the offspring of the originally infected patient seems 

 to have an actual selective action on the glands of internal secretion. Many 

 and varied forms of nutritional and developmental disturbance and de- 

 generative states may well be attributed to the dyserinism rather than 

 to any survival of the primary disease. In this connection we have in 

 mind primarily the pigment degenerations of the retina and choroid 

 with their characteristic disturbances of visual function. The striking 

 symptom of hemeralopia or night-blindness, which is seen also in many 

 deficiency diseases as a passing condition amenable to vitamin therapy, 

 accentuates the probable correctness of this view. 



Interstitial keratitis is seen in acquired as well as congenital syphilis, 

 and in hereditary form as one of the Hutchinsonian triad of pegged teeth, 

 deafness and keratitis. A clinically almost identical form of keratitis is 

 seen in rickets and some forms of vitamin privation, and Risley and others 

 have noted the good effect of thyroid extract in all forms of interstitial 

 keratitis. In pigmentary chorioretinal disease, probably on a heredito- 

 specific basis, Muncaster used mixed glands in conjunction with cacody- 

 late of soda, with excellent effect. 



The syphilitic inheritance seems to act largely by disturbing the nor- 

 mal functions of the endocrin glands and thus indirectly affecting im- 

 munity, nutrition, metabolism, and development. The diatheses such 

 as rickets, lymphatism or exudative diathesis, or scrofula, all of which 

 are marked by ocular diseases, suggest this origin as one at least of the 

 factors. 



Disorders of the Sexual Apparatus. Numerous affections of the eyes 

 or of vision, particularly in females were formerly attributed to menstrual 

 disturbances, ovarian or uterine disease, and so on. Various neuroses, 

 especially hysteria, were traced to the same source and the ocular symp- 

 toms attributed to an underlying genital affection. The fact that even 

 physiological processes connected with sex development, menstruation, 

 pregnancy, and lactation, as well as the menopause and the male climacteric 

 are closely connected with the internal secretion of the testes, ovary, 

 placenta, and mammary glands, and that these profoundly influence 



