DISORDERS IN RELATION TO THE EYE 795 



Subconjunctival hemorrhage or spontaneous ecchymosis is by some 

 to be accepted as an indication of a tendency to ocular hemorrhage, gen- 

 erally of unhealthy blood-vessels, and especially as a danger sign pointing 

 to possible retinal hemorrhage. In advanced age this may be of signifi- 

 cance, but in infancy and youth such hemorrhages may be caused with nor- 

 mal blood-vessels by sudden and excessive increase in pressure with vomit- 

 ing, or with spasmodic coughing (pertussis). 



Lid hemorrhages, particularly the petechial variety as seen in malig- 

 nant enodocarditis and in the systemic hemorrhagic diseases such as pur- 

 pura hemorrhagica and pernicious anemia these, as well as massive 

 orbital hemorrhages, have been seen in infantile scurvy (Barlow's disease). 



The similarity of these conditions to the clinical syndromes due to 

 vitamin deficiency is striking. Like scurvy, of which the deficiency factor 

 is known, there are others like pellagra, and probably purpura rheumatica, 

 in which the vitamin or hormone defect has yet to be found, although there 

 is little doubt of its agency. 



The therapeutic indications of ocular hemorrhages as far as metabolism 

 and the endocrins are concerned coincides completely with the desiderata 

 of treatment of the underlying conditions or of actual organ disease 

 (Bright's, diabetes, cardiac disease) in other parts of the body. 



The prognosis, it should be borne in mind, must consider the special 

 delicacy and vulnerability of the retina, in which respect it is like the 

 brain, and retinal, like cerebral hemorrhages, in their damaging effect 

 on the functional activity of the perceptive elements of which both tissues 

 are so largely made up. 



Ocular hemorrhage, or more particularly retinal, is common in the sec- 

 ondary anemias and, as one would expect, in such systemic conditions as 

 pernicious anemia, leukemia, as well as in certain grave intoxications 

 particularly with the hemocytolytic poison such as rattlesnake poison. 



Most of the observations on intra-ocular hemorrhage date from a period 

 in which little attention was paid to general metabolism or its disorders, 

 and none at all to the internal secretions. A re-survey in the light of our 

 present knowledge of endocrinology would be of great practical value. 



Uveitis. The etiology of inflammations of the iris, ciliary body and 

 choroid is concerned chiefly with syphilis in its various stages, tuber- 

 culosis, gout, rheumatism, gonorrhea, putrefying intestinal accumulations 

 and focal infections. In the light of endocrinological study these factors 

 have an added and a different significance from that of a specific micro- 

 organism, toxin, or protein which happens to localize in the uveal tract 

 and cause infection or inflammation. In acquired lues there is probably 

 an actual invasion of the ocular tissues by the spirochete. In gonorrheal 

 iritis such invasion is highly improbable and the agency of a gonorrheal 



I toxin has been generally accepted in its place. The mode of action of pus 

 iccumulations in the teeth, accessory nasal cavities, tonsils, gall-bladder, 



