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Vitamin Therapy in Ophthalmology
EDITORIALS gonioscope with an open mind, and more detailed studies should be made of the disease with this newer method. As a re sult of this we may completely revise our conception of the etiology and care of glaucoma. Frederick C. Cordes.
VITAMIN T H E R A P Y IN OPHTHALMOLOGY Elsewhere in this issue are to be found two articles, by careful investigators, on eye diseases due to vitamin deficiency and their treatment with vitamins of various sorts. It is unnecessary here to recall the history of the discovery of the vitamins and the disorders produced by the lack of them in both the animal and man. The subject forms a glorious and fasci nating current chapter in medicine, and every physician is now awake to this in formation, if not from scientific sources, at least from the literature of the drug houses and from the daily press and lay magazines. One can say that there is no deficiency of vitamin awareness, at any rate. It is but natural that in the enthusiastic reception of this knowledge, abuses should have crept in. If the history of any drug or healing agent be investigated, this same abuse at the onset of its appli cation will be found. A search of the medical literature of the past will disclose serious articles in first-rate journals by outstanding men, devoted to astonishing reports of successful therapeutic results in all sorts of conditions from the use of such drugs as quinine, thyroid extract, cocaine, and a host of others including tobacco. The first flush of excitement following the announcement of a thera peutic discovery led naturally to its ap plication to a legion of misunderstood conditions, sometimes with an amazingly good effect; witness, for example, the
1325
value of sulfanilamide in trachoma, often with no effect and occasionally with dis astrous and unanticipated results, as, for example, the cataract formed consequent to the dinitrophenol treatment of obesity. Our knowledge and application of vita min therapy is at present in the state of ferment and flux through which the eval uation of all of the drugs in the phar macopeia have passed. An enthusiastic hunter sees an Indian behind every tree. Any patient with an ocular condition that has so far defied an exact knowledge of its treatment is now being dosed with vitamins that are given locally and gen erally in shotgun mixtures. They have been fanatically prescribed in conditions as far apart as cataract and retinitis pigmentosa, myopia and interstitial keratitis, primary optic atrophy and Mooren's ulcer. For example, unsupported claims are made daily, at least verbally, that cataract can be prevented, a fact most difficult to prove, and not only that, but cured as well by the ingestion of vitamins, either in capsule form under all sorts of confusing trade names, or by the daily consumption of one raw carrot. It is natural that the vitamin craze is wide open to exploitation by the unscrupulous. The only difficulty seems to be that the public is now so well educated that the physician finds that the majority of his patients are already taking vitamins of their own initiative and have been doing so for some time. The only way in which our prejudices can be debunked is by the publication of articles by competent and trustworthy observers who have access to a large amount of clinical and experimental fa cilities. The question, "Is this honest work ?" must be constantly posed. Subtle influences such as the desire to satisfy enthusiastic ambition, or to promote the interests of pharmaceutical benefactors must be searched for and weighed in the
1326
BOOK NOTICES
balance by the reader. The logic of the drug action must be apparent to some extent at any rate. Finally, the test of one's own experience must be made and impressions turned into facts by observa tion. The Journal will always welcome hon est work that will help to solve this and all other ophthalmic problems. Even if later knowledge should disprove ardent claims, the forum will not have been in vain. Derrick Vail.
BOOK NOTICES PERSONAL HYGIENE APPLIED. By Jesse Feiring Williams, M.D., Sc.D. Seventh edition. 165 illustrations, 527 pages. Philadelphia, W. B. Saunders Company, 1941. Price $2.50. The ophthalmologist will be interested to know that the era of preventive medicine is being appreciated by other branches of the medical profession. This author is the professor of physical educa tion in the Teachers' College of Columbia University. The fact that the work has reached the seventh edition shows that educated people outside the medical pro fession begin to appreciate the value of prevention. The work is divided into 16 chapters, of which one is devoted to the Hygiene of the mouth, eye, and ear. In the seven pages devoted to the eye, the distinction is made clear between the eye physician and the optometrist. The im portance of good light and the ways to secure it are emphasized, and the depend ence of general symptoms on eyestrain is brought out. This book is not intended to emphasize and explain the importance of good vision, and especial need for care of the eyes, but it does bring out the importance of personal health, and specify the many
directions in which it may be developed and maintained; and the dangers that threaten its impairment in many direc tions. While it is addressed, and has an appeal, to all educated and thinking per sons, it will be most generally appreciated by members of the medical profession. They will best understand the facts on which it is based, and the value of the health that it is possible for most person', to attain. For doctors who are engaged in special branches of medical practice, it will renew an understanding of the breadth of the field in which those who work for health must observe and exer cise their professional skill. Edward Jackson. EL TRACOMA, REBELDE Y MILENARIO. (Trachoma, stubborn and an cient.) By Antonio Ros. 173 pages without illustrations, diagrams, or ta bles. Published by Editorial Cultura, Mexico, D. F., 1941. This monograph on trachoma com prises a summary review of the subject with about half the text devoted to the historical development of the disease. This section is the most detailed part of the book and maintains an interest throughout its telling. The section on the clinical phases is brief and consequently lacks both sufficient detail and critical comment. . Starting, for example, with adoption of MacCallan's classification, the etiology is then summarily presented with the Halberstadter-Prowazek body accept ed as the incitant, and ending with a com pilation of the surgical and medical methods of treatment. The author recom mends for the management of trachoma the use of aspirin. The drug is used topi cally in the form of drops (0.03 gm. dis solved in 15 gm. of sterile distilled water), or it may be swabbed or pencilled on the conjunctiva as a solution in glycerine (0.3 gm. in 30 gm. of neutral glycerine). It
VITAMIN T H E R A P Y IN OPHTHALMOLOGY Elsewhere in this issue are to be found two articles, by careful investigators, on eye diseases due to vitamin deficiency and their treatment with vitamins of various sorts. It is unnecessary here to recall the history of the discovery of the vitamins and the disorders produced by the lack of them in both the animal and man. The subject forms a glorious and fasci nating current chapter in medicine, and every physician is now awake to this in formation, if not from scientific sources, at least from the literature of the drug houses and from the daily press and lay magazines. One can say that there is no deficiency of vitamin awareness, at any rate. It is but natural that in the enthusiastic reception of this knowledge, abuses should have crept in. If the history of any drug or healing agent be investigated, this same abuse at the onset of its appli cation will be found. A search of the medical literature of the past will disclose serious articles in first-rate journals by outstanding men, devoted to astonishing reports of successful therapeutic results in all sorts of conditions from the use of such drugs as quinine, thyroid extract, cocaine, and a host of others including tobacco. The first flush of excitement following the announcement of a thera peutic discovery led naturally to its ap plication to a legion of misunderstood conditions, sometimes with an amazingly good effect; witness, for example, the
1325
value of sulfanilamide in trachoma, often with no effect and occasionally with dis astrous and unanticipated results, as, for example, the cataract formed consequent to the dinitrophenol treatment of obesity. Our knowledge and application of vita min therapy is at present in the state of ferment and flux through which the eval uation of all of the drugs in the phar macopeia have passed. An enthusiastic hunter sees an Indian behind every tree. Any patient with an ocular condition that has so far defied an exact knowledge of its treatment is now being dosed with vitamins that are given locally and gen erally in shotgun mixtures. They have been fanatically prescribed in conditions as far apart as cataract and retinitis pigmentosa, myopia and interstitial keratitis, primary optic atrophy and Mooren's ulcer. For example, unsupported claims are made daily, at least verbally, that cataract can be prevented, a fact most difficult to prove, and not only that, but cured as well by the ingestion of vitamins, either in capsule form under all sorts of confusing trade names, or by the daily consumption of one raw carrot. It is natural that the vitamin craze is wide open to exploitation by the unscrupulous. The only difficulty seems to be that the public is now so well educated that the physician finds that the majority of his patients are already taking vitamins of their own initiative and have been doing so for some time. The only way in which our prejudices can be debunked is by the publication of articles by competent and trustworthy observers who have access to a large amount of clinical and experimental fa cilities. The question, "Is this honest work ?" must be constantly posed. Subtle influences such as the desire to satisfy enthusiastic ambition, or to promote the interests of pharmaceutical benefactors must be searched for and weighed in the
1326
BOOK NOTICES
balance by the reader. The logic of the drug action must be apparent to some extent at any rate. Finally, the test of one's own experience must be made and impressions turned into facts by observa tion. The Journal will always welcome hon est work that will help to solve this and all other ophthalmic problems. Even if later knowledge should disprove ardent claims, the forum will not have been in vain. Derrick Vail.
BOOK NOTICES PERSONAL HYGIENE APPLIED. By Jesse Feiring Williams, M.D., Sc.D. Seventh edition. 165 illustrations, 527 pages. Philadelphia, W. B. Saunders Company, 1941. Price $2.50. The ophthalmologist will be interested to know that the era of preventive medicine is being appreciated by other branches of the medical profession. This author is the professor of physical educa tion in the Teachers' College of Columbia University. The fact that the work has reached the seventh edition shows that educated people outside the medical pro fession begin to appreciate the value of prevention. The work is divided into 16 chapters, of which one is devoted to the Hygiene of the mouth, eye, and ear. In the seven pages devoted to the eye, the distinction is made clear between the eye physician and the optometrist. The im portance of good light and the ways to secure it are emphasized, and the depend ence of general symptoms on eyestrain is brought out. This book is not intended to emphasize and explain the importance of good vision, and especial need for care of the eyes, but it does bring out the importance of personal health, and specify the many
directions in which it may be developed and maintained; and the dangers that threaten its impairment in many direc tions. While it is addressed, and has an appeal, to all educated and thinking per sons, it will be most generally appreciated by members of the medical profession. They will best understand the facts on which it is based, and the value of the health that it is possible for most person', to attain. For doctors who are engaged in special branches of medical practice, it will renew an understanding of the breadth of the field in which those who work for health must observe and exer cise their professional skill. Edward Jackson. EL TRACOMA, REBELDE Y MILENARIO. (Trachoma, stubborn and an cient.) By Antonio Ros. 173 pages without illustrations, diagrams, or ta bles. Published by Editorial Cultura, Mexico, D. F., 1941. This monograph on trachoma com prises a summary review of the subject with about half the text devoted to the historical development of the disease. This section is the most detailed part of the book and maintains an interest throughout its telling. The section on the clinical phases is brief and consequently lacks both sufficient detail and critical comment. . Starting, for example, with adoption of MacCallan's classification, the etiology is then summarily presented with the Halberstadter-Prowazek body accept ed as the incitant, and ending with a com pilation of the surgical and medical methods of treatment. The author recom mends for the management of trachoma the use of aspirin. The drug is used topi cally in the form of drops (0.03 gm. dis solved in 15 gm. of sterile distilled water), or it may be swabbed or pencilled on the conjunctiva as a solution in glycerine (0.3 gm. in 30 gm. of neutral glycerine). It