786 PERCY FRIDENBERG 



Other vagotonic manifestations are an extremely low pulse and a 

 definite increase in urinary activity with copious, pale urine. 



In the female, the attacks often coincide with menstruation, and in 

 many cases were interrupted during pregnancy, and ceased entirely with 

 the menopause. The male climacteric has a similar good effect in gen- 

 erally putting an end to migraine in men. 



The endocrinological implications of headache, migraine, and epi- 

 lepsy are numerous and significant. On the one hand we have the asso- 

 ciation with vagotonia and its relation to spasmophilia. This again refers 

 to acid states, defective calcium metabolism, and their dependence on de- 

 fective thyroid and parathyroid secretion and their causal relation to 

 tetany and rickets. The influence of pituitary gland disturbances in dis- 

 ease and with vascular changes in health incident to digestion, menstrua- 

 tion, pregnancy, and endocrin activation, notably thyroid, thymic, and 

 adrenal, is so striking and important that more detailed notice of it will be 

 taken in the chapter on hypophyseal disorders. 



Cycloplegics in Eye-Strain. It is something more than a coincidence 

 that the alkaloids used in accurate determination and measurement of 

 refraction errors are typically vago-paralysant, and the symptoms of eye- 

 strain are largely vagotonic. This may in part explain certain incon- 

 sistencies and discrepancies in the data of clinical ophthalmology. Thus, 

 the varying effect of correction of ametropia, the disproportionate severity 

 of eye-strain in minimal errors of refraction and muscle imbalance, the 

 excellent effects of atropinization and of correction under full cycloplegia, 

 the adjutant effect on spasmophilic reactions, not only local and ocular 

 but at a distance, from continuation of the belladonna treatment, finally, 

 the marked individual reaction to refraction error, depending on what 

 we are justified in assuming as an endocrin disposition, and manifested 

 often enough as reflex disturbances of various functions, digestive, motor, 

 or cerebral. In this connection I am tempted to review the biological 

 clinics of famous ametropes if I may so call them, published by Gould, 

 some ten or fifteen years ago, in which the life tragedies of various artists 

 and literary men were ascribed to refraction error and its results in eye- 

 strain and reflex neuroses. A knowledge of endocrinology throws an en- 

 tirely new light on this series, and many of the symptoms which Gould 

 considered pathognomonic of myopia or astigmatism are undoubtedly due 

 to typical disturbances of emotion and function on a basis of disturbed 

 internal secretions. Stated briefly, the dyspepsia, nervous instability, 

 hyperacidity, jealousy, insomnia, anxiety and doubt states, excessive 

 inhibition, dizziness, were not due to ametropia, but both were indica- 

 tions of an underlying dyscrinism. 



Ocular Sympathetico-tonia. The clinical data of this condition are 

 not as easily interpreted as those of the opposite state of vagotonia which, 

 as we have seen, is manifested by a variety of, mainly spasmophile, clin- 



