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Detachment of the retina and its treatment
BOOK NOTICES problem for many years thought that something constructive might be ac complished by forming a Teachers' Sec tion. This was accordingly done, and a great deal of time and energy spent by some two dozen men in collecting ma terial and reviewing the subject. This was an essential foundation on which to build. Meetings have been devoted to the presentation of these data to the membership and to pertinent talks. Many excellent suggestions have been made but little action has been taken. Certain points stand out clearly, of which perhaps the most important is the lack of teachers and facilities for giving adequate postgraduate instruction. There is and always will be difference of opinion as to proportioning the train ing between the didactic and the prac tical, but it is possible to outline a satis factory course. However, to be able to offer this to the large number of men seeking it is now impossible. There are vastly too many features vital to this subject to justify opening a discussion of details, but suggestions regarding methods for furthering con sideration of the problem are appropri ate. It is time now for the formulation of some concrete program in graduate in struction. It can be the basic structure only but should be planned to permit of expansion. This can be done only by a representative group of ophthalmolo gists and otolaryngologists. Probably the make-up of this committee should be similar to that of the American Board of Ophthalmology. It should be relative ly small for reasons of efficiency and ex pedition. The existing Boards might serve very well but it is a serious ques tion if the same men should be asked to assume this great burden in addition to that which they now carry in their work as examiners. This graduate problem is exceedingly difficult and its solution will require many years of hard work. Much discus sion and fact finding still remain to be done. The Teachers' Section has been excellent but inadequate. Perhaps a hundred and fifty members were in at tendance at the dinner this year. An
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hour or more was occupied by guest speakers who discussed the broader phases of the subject very interestingly and in a manner similar to that of other speakers in previous years. Then the prepared ideas of half a dozen members were given. Obviously these had been carefully thought out and all deserved long and deliberate discussion with a view to classification, correlation, and the establishment of concrete sugges tions. Unfortunately, after the reading of the last of these the hour was late and no discussion at all was possible. The members must have felt a bit thwarted and gone away thinking that this method of considering the problem was rather futile. To have carried the discussion to a conclusion from the point reached by the speakers was obviously not to be considered for it would have required at least a week of daily sessions to have evaluated the diversity of ideas presented. It is for these reasons that a small representative committee to formulate a plan and present it for consideration by the various national bodies of oph thalmology and otolaryngology is sug gested. It would seem best that this should not be the present Boards of Ophthalmology and of Otolaryngology, primarily because the consideration of this problem should be the sole func tion of this body, otherwise one activity is apt to suffer at the expense of the other, and as already mentioned it is too much to ask of a man that he should contribute as much time as this double duty would require. The board might well, however, be made up of delegates elected from such organizations as are represented on the present Boards of Ophthalmology and of Otolaryngology. Lawrence T. Post.
BOOK NOTICES Detachment of the retina and its treat ment. By F. Terrien, Prosper Veil, and M.-A. Dollfus. 163 pages, with 45 illustrations in the text and 4 plates in colors. Stiff paper covers.
1120
BOOK NOTICES
Masson et Cie, Publishers for the Academie de Medecine, Paris, 1936. Price 40 francs. The authors hesitate to add to the existing literature on the subject, es pecially Gonin's magnificent volume. But they feel that personal experiences at the eye clinic of the Hotel-Dieu and in their daily practice in the past five years may throw light on the subject. They regret the hesitation which leads many colleagues to limit themselves still to subconjunctival injections with loss of valuable time. They have tried all the techniques put forward. The color plates present interesting examples of different types of retinal tear. Chapter one is devoted to a clinical study of retinal detachment, with a brief discussion of premonitory symp toms and modes of onset, and a detailed discussion of the forms of detachment, especially in relation to type of tear, age of detachment, presence of exudate, condition of the vitreous, and etiology. Of the authors' first 150 detachments, 92 had V-shaped tears with flap. Multi plicity of tears in the same eye was found more frequently with perfora tions than with flap tears. Although in case of a visible tear it is desirable to intervene surgically as early as possible, it is advisable to attempt preliminary reapplication of the retina by having the patient completely immo bilized for forty-eight hours, wearing stenopeic spectacles. If the detachment is above, the patient's head should be lower than his feet, without pillow. After the forty-eight-hour interval, lo calization should be carefully under taken in the dark room. A large amount of space is naturally devoted to appraisal of the different surgical techniques and their selection for different types of case. Obliterating thermopuncture is reserved for small single tears, well localized, easily acces sible, and situated in relatively healthy tissue. Diathermy is used for the small round and frequently multiple tears found in degenerated retinas; and also for very extensive tears, large or mul tiple, in which a double diathermic bar
rage, either superficial or perforating, is employed. For macular tears diathermy applied to the macular region has not given the results obtained by Lindner with suprachoroidal injection of caustic potash. A brief final chapter is devoted to the medicolegal aspects of retinal detach ment. W. H. Crisp. Polychromatic plates for color-sense examination. By Dr. E. B. Rabkin, Director of the Ukrainian Prof. Hirshman Memorial Central Oph thalmic Institute. 40 pages to which are added 20 color plates. Cloth bound. Published by State Medical Publishing Board, Kief and Kharkof, U.S.S.R., 1936. Price 30 rubles. The twenty diagnostic plates con tained in this volume were designed by the author. In general, they are along the lines of the Ishihara plates for test ing color vision. But the designs for recognition by the patient consist of numbers and geometric forms (circle, triangle, square). The plates are so planned that it is possible to differen tiate between the principal forms of de fect (protanopia, deuteranopia, protanomaly, and deuteranomaly). Certain numbers or geometric forms are obvi ous to the normal eye, whereas the per son with defective color vision sees other numbers or forms. The experimental basis of these plates and their clinical application were worked out in the experimental oph thalmic clinic of the Institute of Ex perimental Medicine and in the Hirsh man Memorial Central Ophthalmic In stitute. The volume is suitable for use in English-speaking countries or in Rus sia, since the preface and the careful explanation of the principles and appli cation of the tests are printed in both languages. Dr. Rabkin, who is well known to many American colleagues since his vis its to the United States, is to be con gratulated on the effectiveness of de sign of these plates, the printing of which has been most efficiently exe-
1119
hour or more was occupied by guest speakers who discussed the broader phases of the subject very interestingly and in a manner similar to that of other speakers in previous years. Then the prepared ideas of half a dozen members were given. Obviously these had been carefully thought out and all deserved long and deliberate discussion with a view to classification, correlation, and the establishment of concrete sugges tions. Unfortunately, after the reading of the last of these the hour was late and no discussion at all was possible. The members must have felt a bit thwarted and gone away thinking that this method of considering the problem was rather futile. To have carried the discussion to a conclusion from the point reached by the speakers was obviously not to be considered for it would have required at least a week of daily sessions to have evaluated the diversity of ideas presented. It is for these reasons that a small representative committee to formulate a plan and present it for consideration by the various national bodies of oph thalmology and otolaryngology is sug gested. It would seem best that this should not be the present Boards of Ophthalmology and of Otolaryngology, primarily because the consideration of this problem should be the sole func tion of this body, otherwise one activity is apt to suffer at the expense of the other, and as already mentioned it is too much to ask of a man that he should contribute as much time as this double duty would require. The board might well, however, be made up of delegates elected from such organizations as are represented on the present Boards of Ophthalmology and of Otolaryngology. Lawrence T. Post.
BOOK NOTICES Detachment of the retina and its treat ment. By F. Terrien, Prosper Veil, and M.-A. Dollfus. 163 pages, with 45 illustrations in the text and 4 plates in colors. Stiff paper covers.
1120
BOOK NOTICES
Masson et Cie, Publishers for the Academie de Medecine, Paris, 1936. Price 40 francs. The authors hesitate to add to the existing literature on the subject, es pecially Gonin's magnificent volume. But they feel that personal experiences at the eye clinic of the Hotel-Dieu and in their daily practice in the past five years may throw light on the subject. They regret the hesitation which leads many colleagues to limit themselves still to subconjunctival injections with loss of valuable time. They have tried all the techniques put forward. The color plates present interesting examples of different types of retinal tear. Chapter one is devoted to a clinical study of retinal detachment, with a brief discussion of premonitory symp toms and modes of onset, and a detailed discussion of the forms of detachment, especially in relation to type of tear, age of detachment, presence of exudate, condition of the vitreous, and etiology. Of the authors' first 150 detachments, 92 had V-shaped tears with flap. Multi plicity of tears in the same eye was found more frequently with perfora tions than with flap tears. Although in case of a visible tear it is desirable to intervene surgically as early as possible, it is advisable to attempt preliminary reapplication of the retina by having the patient completely immo bilized for forty-eight hours, wearing stenopeic spectacles. If the detachment is above, the patient's head should be lower than his feet, without pillow. After the forty-eight-hour interval, lo calization should be carefully under taken in the dark room. A large amount of space is naturally devoted to appraisal of the different surgical techniques and their selection for different types of case. Obliterating thermopuncture is reserved for small single tears, well localized, easily acces sible, and situated in relatively healthy tissue. Diathermy is used for the small round and frequently multiple tears found in degenerated retinas; and also for very extensive tears, large or mul tiple, in which a double diathermic bar
rage, either superficial or perforating, is employed. For macular tears diathermy applied to the macular region has not given the results obtained by Lindner with suprachoroidal injection of caustic potash. A brief final chapter is devoted to the medicolegal aspects of retinal detach ment. W. H. Crisp. Polychromatic plates for color-sense examination. By Dr. E. B. Rabkin, Director of the Ukrainian Prof. Hirshman Memorial Central Oph thalmic Institute. 40 pages to which are added 20 color plates. Cloth bound. Published by State Medical Publishing Board, Kief and Kharkof, U.S.S.R., 1936. Price 30 rubles. The twenty diagnostic plates con tained in this volume were designed by the author. In general, they are along the lines of the Ishihara plates for test ing color vision. But the designs for recognition by the patient consist of numbers and geometric forms (circle, triangle, square). The plates are so planned that it is possible to differen tiate between the principal forms of de fect (protanopia, deuteranopia, protanomaly, and deuteranomaly). Certain numbers or geometric forms are obvi ous to the normal eye, whereas the per son with defective color vision sees other numbers or forms. The experimental basis of these plates and their clinical application were worked out in the experimental oph thalmic clinic of the Institute of Ex perimental Medicine and in the Hirsh man Memorial Central Ophthalmic In stitute. The volume is suitable for use in English-speaking countries or in Rus sia, since the preface and the careful explanation of the principles and appli cation of the tests are printed in both languages. Dr. Rabkin, who is well known to many American colleagues since his vis its to the United States, is to be con gratulated on the effectiveness of de sign of these plates, the printing of which has been most efficiently exe-