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Flying Vistas
BOOK NOTICES
"an entirely noncharacteristic exudative or serous iritis." The latter tends to clear and then recur. Such a classification falls into the experience of all ophthalmologists. The former group, fortunately rare, almost invariably progress unfavorably, and the latter group relatively well. In discussion of the various ocular manifestations the author suggests that the solitary patches of choroiditis so frequently seen may be judged tuberculous if other causes can be excluded. Regarding the location of the primary source, evidence seems to point to peribronchial lymph nodes as the most frequent, and X-rays may be moderately helpful in determining this. The relation of the intensity of skin reaction to tuberculosis has little or no bearing on the diagnosis unless strongly positive. Diagnosis must be made from the appearance of the eye and by exclusion of other causes. This opinion is in line with that of most physicians who have used skin tests extensively. Two concepts of the action of tuberculin exist, the older in which allergy was thought to be responsible for immunity, and the newer according to which tuberculin was used "to remove tissue hypersensitivity, to achieve and maintain tissue desensitization, and to allow the littleunderstood forces of immunity free play in the final healing and encapsulation of the lesion." From careful observation over many years at the Wilmer Institute the latter method of treatment by desensitization has proved the better. Therefore prolonged treatment over several years with doses so small as not to produce an obvious reaction is advocated. Lower doses are used when the eye is inflamed and hypersensitive, and higher doses when the eye is quiet. Some of the patients are desensitized so that no reaction is produced to as much as 500 mg. of old tuberculin. The older idea or "perifocal con-
441
cept" involved the production of repeated allergic reactions in the tissue until the eye became quiet, at which time treatment was stopped. A word of caution is given against the use of tuberculin by any method in cases of hypersensitivity. For the past four years this subject of ocular tuberculosis has been studied carefully in a special division of the ophthalmological clinic at Washington University. Many of the findings are confused and contradictory, hence it has not been possible to arrive at many definite conclusions, but a few facts pertinent to this paper stand out clearly and one of these is that there are a certain number of patients with uveal and corneal tuberculosis who unquestionably improve or at least remain unchanged while under tuberculin treatment and who become definitely worse when this treatment is discontinued. These are patients who have taken small doses over a long time. One point should be stressed, that in a certain number of cases of the indefinite type of tubercular ocular lesion tuberculin will do good. Other factors, such as general health care, are essential and just as important as in pulmonary or bone tuberculosis, but the prolonged treatment with low doses of tuberculin may well be employed to supplement them. Lawrence T. Post
BOOK NOTICES FLYING VISTAS. By Isaac H. Jones, M.D. Cloth bound, 12 mo. Illustrated, 255 pages. Philadelphia, J. B. Lippincott Co., 1937. The beginnings of aviation will be of interest to all future generations. There are official records, magazine articles, newspaper clippings of crashes and missing men; but, perhaps, the most broadly interesting account of it will be this tribute of a Chevalier of the Legion of
442
BOOK NOTICES
Honor to his comrade. This book is dedicated to General Theodore Charles Lyster, who first entered a new field of practical research in creating aviation medicine. General Lyster received the Distinguished Service Medal largely for creating the Flight Surgeon. When the aviation service became of supreme importance to the combatants in the World War, General Lyster directed the education of the medical profession .to choose, among the host of applicants, those best fitted for flying; and Isaac H. Jones travelled over the country instructing otolaryngologists in the Barany tests of. equilibrium, to fit for "blind flying." This book is well named, for it gives brief glimpses of this swiftly growing department of human knowledge. The chapter headings are: Flying and the pilot himself; The aviation examinations; The eye; The ear, a dual sense-organ; Blind flying; General medical examinations; The air commutor (suggestions for passengers). Under the heading, Aviation medicine, the background, five chapters are devoted more directly to history. The incidents of which it tells are well illustrated by Dr. Tones's first meeting with General Gorgas: '''It was in his hotel bedroom that I met 'Doctor' Gorgas for the first time. Dr. Lyster and I had just finished writing the A.G.O. 609 (Instructions for standard tests of the aviation examinations). Dr. Gorgas said 'Theo, I need you with me in Washington.' He then turned to me and said: 'Lieutenant, you will take over the work of recruiting for aviation.' " It must be remembered that General Lyster had served with Surgeon-General Gorgas in Panama, and was already entitled to honorable retirement in the Army Medical Corps. This book should be known to the ophthalmologists and otologists of our day. Edward Jackson
METHODIK DES OPTISCHEN RAUMSINNES UND DER AUGENBEWEGUNGEN (Methods of study of the optic sense of space and of ocular movements). By Armin Tschermak-Seysenegg, Prague. Being part 6, no. 10 (conclusion) of section 5 of Handbuch der biologischen Arbeitsmethoden, edited by Dr. Emil Abderhalden. 355 pages, together with table of contents for this volume and some other parts of section 5 of the series. With 88 reproductions in the text. Paper covers. Berlin and Vienna, Urban & Schwarzenberg. Price RM 20.00. This efficient but extremely technical monograph is destined for use by the research worker rather than by the average ophthalmologist. It lays particular stress upon the necessity for clear distinction between objective external space and the subjective sensation and idea of space; between motility and sensitivity; between ocular movements and perspective. Chapter after chapter is devoted to the most detailed consideration of technique and its instrumentarium, from complete fixation of the subject's head and of the direction of gaze, through testing of sensory and motor orientation in space and special methods of testing binocular vision, down to a study of stereoscopy and the technique of examination and analysis of monocular and binocular movements. A satisfactory subject index is appended. Many references to the literature of the subject are given, chiefly as footnotes. The very numerous and wellprinted illustrations are partly taken from other authors and partly original with Tschermak-Seysenegg. W. H. Crisp
"an entirely noncharacteristic exudative or serous iritis." The latter tends to clear and then recur. Such a classification falls into the experience of all ophthalmologists. The former group, fortunately rare, almost invariably progress unfavorably, and the latter group relatively well. In discussion of the various ocular manifestations the author suggests that the solitary patches of choroiditis so frequently seen may be judged tuberculous if other causes can be excluded. Regarding the location of the primary source, evidence seems to point to peribronchial lymph nodes as the most frequent, and X-rays may be moderately helpful in determining this. The relation of the intensity of skin reaction to tuberculosis has little or no bearing on the diagnosis unless strongly positive. Diagnosis must be made from the appearance of the eye and by exclusion of other causes. This opinion is in line with that of most physicians who have used skin tests extensively. Two concepts of the action of tuberculin exist, the older in which allergy was thought to be responsible for immunity, and the newer according to which tuberculin was used "to remove tissue hypersensitivity, to achieve and maintain tissue desensitization, and to allow the littleunderstood forces of immunity free play in the final healing and encapsulation of the lesion." From careful observation over many years at the Wilmer Institute the latter method of treatment by desensitization has proved the better. Therefore prolonged treatment over several years with doses so small as not to produce an obvious reaction is advocated. Lower doses are used when the eye is inflamed and hypersensitive, and higher doses when the eye is quiet. Some of the patients are desensitized so that no reaction is produced to as much as 500 mg. of old tuberculin. The older idea or "perifocal con-
441
cept" involved the production of repeated allergic reactions in the tissue until the eye became quiet, at which time treatment was stopped. A word of caution is given against the use of tuberculin by any method in cases of hypersensitivity. For the past four years this subject of ocular tuberculosis has been studied carefully in a special division of the ophthalmological clinic at Washington University. Many of the findings are confused and contradictory, hence it has not been possible to arrive at many definite conclusions, but a few facts pertinent to this paper stand out clearly and one of these is that there are a certain number of patients with uveal and corneal tuberculosis who unquestionably improve or at least remain unchanged while under tuberculin treatment and who become definitely worse when this treatment is discontinued. These are patients who have taken small doses over a long time. One point should be stressed, that in a certain number of cases of the indefinite type of tubercular ocular lesion tuberculin will do good. Other factors, such as general health care, are essential and just as important as in pulmonary or bone tuberculosis, but the prolonged treatment with low doses of tuberculin may well be employed to supplement them. Lawrence T. Post
BOOK NOTICES FLYING VISTAS. By Isaac H. Jones, M.D. Cloth bound, 12 mo. Illustrated, 255 pages. Philadelphia, J. B. Lippincott Co., 1937. The beginnings of aviation will be of interest to all future generations. There are official records, magazine articles, newspaper clippings of crashes and missing men; but, perhaps, the most broadly interesting account of it will be this tribute of a Chevalier of the Legion of
442
BOOK NOTICES
Honor to his comrade. This book is dedicated to General Theodore Charles Lyster, who first entered a new field of practical research in creating aviation medicine. General Lyster received the Distinguished Service Medal largely for creating the Flight Surgeon. When the aviation service became of supreme importance to the combatants in the World War, General Lyster directed the education of the medical profession .to choose, among the host of applicants, those best fitted for flying; and Isaac H. Jones travelled over the country instructing otolaryngologists in the Barany tests of. equilibrium, to fit for "blind flying." This book is well named, for it gives brief glimpses of this swiftly growing department of human knowledge. The chapter headings are: Flying and the pilot himself; The aviation examinations; The eye; The ear, a dual sense-organ; Blind flying; General medical examinations; The air commutor (suggestions for passengers). Under the heading, Aviation medicine, the background, five chapters are devoted more directly to history. The incidents of which it tells are well illustrated by Dr. Tones's first meeting with General Gorgas: '''It was in his hotel bedroom that I met 'Doctor' Gorgas for the first time. Dr. Lyster and I had just finished writing the A.G.O. 609 (Instructions for standard tests of the aviation examinations). Dr. Gorgas said 'Theo, I need you with me in Washington.' He then turned to me and said: 'Lieutenant, you will take over the work of recruiting for aviation.' " It must be remembered that General Lyster had served with Surgeon-General Gorgas in Panama, and was already entitled to honorable retirement in the Army Medical Corps. This book should be known to the ophthalmologists and otologists of our day. Edward Jackson
METHODIK DES OPTISCHEN RAUMSINNES UND DER AUGENBEWEGUNGEN (Methods of study of the optic sense of space and of ocular movements). By Armin Tschermak-Seysenegg, Prague. Being part 6, no. 10 (conclusion) of section 5 of Handbuch der biologischen Arbeitsmethoden, edited by Dr. Emil Abderhalden. 355 pages, together with table of contents for this volume and some other parts of section 5 of the series. With 88 reproductions in the text. Paper covers. Berlin and Vienna, Urban & Schwarzenberg. Price RM 20.00. This efficient but extremely technical monograph is destined for use by the research worker rather than by the average ophthalmologist. It lays particular stress upon the necessity for clear distinction between objective external space and the subjective sensation and idea of space; between motility and sensitivity; between ocular movements and perspective. Chapter after chapter is devoted to the most detailed consideration of technique and its instrumentarium, from complete fixation of the subject's head and of the direction of gaze, through testing of sensory and motor orientation in space and special methods of testing binocular vision, down to a study of stereoscopy and the technique of examination and analysis of monocular and binocular movements. A satisfactory subject index is appended. Many references to the literature of the subject are given, chiefly as footnotes. The very numerous and wellprinted illustrations are partly taken from other authors and partly original with Tschermak-Seysenegg. W. H. Crisp