794 PERCY FRIDENBERG 



disturbances simulating tuberculosis. In ocular hemorrhages with blood 

 diatheses and deficiency diseases, as purpura, scurvy, look for a dyscrin- 

 ism. Tachycardia, like that in exophthalmic goiter, is seen in scurvy 

 (Hess) with oliguria suggesting the action of atropin and relative lack 

 of pituitrin. 



Vascular disturbances in lids and conjunctiva are common in hyper- 

 thyroidism as well as in angioneurotic states due to acidosis. Wilmer 

 notes the cure of recurrent vitreous hemorrhages in a young man by re-, 

 moval of pyorrhea foci and clearing out intestines. 



Barker is impressed with the importance of constitutional inferiorities 

 of the vascular, the nervous, and the endocrin systems in the pathogenesis 

 of chronic arterial hypertension, and of chronic renal disease. Patients 

 with obesity, diabetes mellitus and gout tend to develop an arteriosclerotic 

 process and many of them also have high blood-pressure. The retinal 

 indications of arteriosclerosis may be observed in a very beautiful picture 

 on ophthalmoscopic examination. The earliest stages consist in a nar- 

 rowing of the reflex or light streak on the smaller arteries and a slight 

 change in color producing the copper-wire appearance noted by many ob- 

 servers. An increased rigidity of the vessel wall is also shown by arteries 

 where they pass over veins in a compression of the underlying vessel with 

 a resulting damming of current and local dilatation of the vein on the 

 proximal side and a narrowing for a short distance on the distal side of 

 the crossing. Irregularities in caliber, particularly of the smaller vessels, 

 are frequent. Tortuosity of arterial twigs is a somewhat later change, 

 as are actual degenerative changes in the vessel wall indicated by grayish 

 patches on or alongside the arteries, showing lime deposits in intima or 

 media. Peri-arteritis is also observed, with a double outlining of the 

 vessel. In all the later stages hemorrhages may be seen, generally from 

 superficial arteries and involving the nerve fiber layer as indicated ophthal- 

 moscopically by their flame or horsetail shape. After repeated hemor- 

 rhages, degenerative changes are found in fatty yellowish spots with blood 

 pigment traces or in bright white points, sometimes confluent to patches, 

 indicating calcification. The significance of renal disease and of diabetes 

 in the causation of retinal hemorrhages and iieuroretinal inflammation 

 is well known, and the f undus changes need not be described in extenso here. 

 These affections and some other factor, such as arteriosclerosis or arthrit- 

 ism, have been noted in the much less frequent but interesting condition 

 of retinitis circinata in which the wreath-shaped arrangement of the 

 confluent degenerative patches in a double bow from optic papilla to 

 macula gives a name to the fundus condition and marked interest to the 

 ophthalmoscopic picture. The origin of these degenerative spots, later 

 areas, from small almost capillary hemorrhages has been noted by the 

 writer and various other observers, one of the first of whom was the late 

 Edward Fridenberg. 



