796 PERCY FRIDEKBERG 



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appendix, or prostate ~"s likev/k j dependent more probably on a transported 

 toxin than on any actual metastasis of micro-organisms or of pus cells from 

 the foci of infection. The special relation of these etiological factors 

 to endocrinology lies in their deleterious action on the glands of internal 

 secretion and particularly on the immunizing function of the thyroid. 

 From this point of view special importance attaches to the chronic, in- 

 veterate forms of sepsis or toxemia producing relapsing or low-grade slug- 

 gish uveitis which is notoriously bad prognostically and difficult to treat 

 with any degree of satisfaction either to patient or physician. The virus 

 of syphilis and of tuberculosis, meaning the germ-free but toxic protein, 

 seems to be on a par in this respect with the poison absorbed by the organ- 

 ism from pyorrhea alveolar is, apical abscess, and chronically diseased 

 tonsils. 



The therapeutic implications are interesting and significant, showing 

 without exception that all our remedial agents tend, perhaps by various 

 paths, to a single end, that of stimulating the sympathetic system, depress- 

 ing the irritated vagus, and restoring the depleted thyroid. This applies 

 emphatically to catharsis, irrigation of the lower intestinal tract with 

 subsequent alkalinization. It applies, as well, to restriction of carbo- 

 hydrates and lowered diet, to massage and exercise, to sweats and hot baths. 



The traditional local treatment of iritis by hot applications, instilla- 

 tions of atropin and dionin, and by the abstraction of blood from the im- 

 mediate neighborhood of the globe by leeching, gives logical support to this 

 view. Such local treatment is usually fairly successful in acute attacks 

 of iritis or uveitis in other forms, but frequently fails in the chronic re- 

 lapsing cases. This indicates clearly, I think, that there is in those very 

 cases an organic hormone deficiency to be made good, probably by appro- 

 priate organotherapy, as the mere stimulation of the system is not enough. 

 The source is dried up; a new supply is needed. 



The influence of the thyroid gland has been noted by Dunn, who says 

 that owing to its extreme vascularity, the ciliary body is very responsive 

 to blood changes which often make their appearance some time after the 

 thyroid has become exhausted in its efforts to overcome a toxemia of in- 

 testinal or other origin, and find in the ocular tissues a diminished resis- 

 tance to bacillary infection or protein sensitization. 



Dunn reports a number of remarkable cures from the administra- 

 tion of thyroid extract in iridccyclitis and other deep seated eye affec- 

 tions. The dose of the extract employed by him for children beyond 

 five years of age and for adults is three grains twice daily, and from this 

 dosage he has never seen any ill effects. 



Bordley (Baltimore) has had a fairly large number of similarly good 

 results in the treatment of malignant uveitis with thyroid which he 

 thinks valuable mainly in restoring the defensive biological processes of 



