792 PERCY FRIDEKBERG 



antecedent amblyopias of DeSchweinitz, which become manifest as tran- 

 sient or fluctuating central mist without definite deterioration of visual 

 acuity, and subjective sensations of metamorphopsia, as well as by the good 

 effects of glandular therapy upon the amblyopia, in the form of thyroid, 

 either alone, with anterior lobe or whole gland extract, or in conjunction 

 with mercurial inunctions (DeSchweinitz). Pigmentation of the skin 

 of the lids suggests a complicating disturbance of adrenal function. 



Physiological swelling of the hypophysis in normal pregnancy and 

 consecutive shrinking after delivery are cited by Schirmer in explanation 

 of passing bitemporal hemianopsias during the last period of pregnancy 

 in multiparae and of amblyopia which showed none of the retinal changes 

 (albuminuric, uremic) to which such visual disturbances are generally, 

 and correctly, ascribed. Similar visual disturbances coming on with 

 the menopause, or after operative removal of the ovaries, are in logical 

 accord with the hypothesis of a relative hyperpituitarism as one, at least, 

 of the causative factors. 



Oppenheim described, as tabes pituitaria, a form of locomotor ataxia 

 with degenerative changes in the lumbar cord which he brought into rela- 

 tion with dyspituitarism. Schirmer advances the suggestion that some 

 forms of optic nerve atrophy may, similarly, be due to dyscrinism in pitu- 

 itary disease rather than to mechanical causes or increased intracranial 

 pressure. 



Amaurotic Family Idiocy. The visual disturbances, marked ocular 

 changes, myasthenia, and general debility, with periodic convulsions, and 

 fatal termination form a well known clinical picture. The endocrin im- 

 plications of this and allied cerebroretinal degenerations of infancy may 

 be summed up as indicating an indirect or inherited congenital vulner- 

 ability, on a basis of syphilis or more probably avitaminosis in the mother, 

 of the adrenal elements promoting normal nutrition and metabolism in the 

 central nervous system. This familial toxemia may be associated with 

 lesions in the thymus, adrenals, and thyroid. 



Hereditary Optic Nerve Atrophy. (Leber's Disease.) This condi- 

 tion has been placed by some observers in the group of congenital en- 

 docrin disturbances. The familial grouping, the incidence at puberty, or 

 at the climacteric, the association with various neuropathies, are advanced 

 as suggestive significant facts. Definite changes in the sella, indicating 

 pituitary enlargement, were noted in a series of cases by Zentmayer and 

 others. Optic atrophy in steeple skull or oxycephalus is probably due to 

 synostosis of cranial sutures, notably the sagittal sutures, and consequent 

 mechanical interference with the nutrition of the optic nerve rather than 

 to a direct effect of dyscrinoid heredity factors, although the latter may 

 have some significance in the causation of the original developmental 

 anomaly of the skull itself. 



Adiposis dolorosa is at times associated with amblyopia, and cases are 



