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Geschichte Der Deutschen Ophthalmologischen Gesellschaft
415
BOOK REVIEWS
neurology, and the use of atropine in the treatment of strabismus. Costenbader discusses the principles and techniques of nonsurgical treatment and the clinical course and management of esotropia. Finally, Philip Knapp discusses divergent deviations and their treatment and gives us a sound chapter on the surgical treatment of strabismus. One of the most valuable parts of the book is a verbatim recording of an interesting round-table discussion in which Breinin, ex pert on electromyographic studies of the ocular muscles, takes part. This is delight fully informal and full of meat. It brings out very nicely the fact that even these top flight ophthalmologists don't always agree and that there is still much to be learned. But we have indeed come a long way in the last two decades; thanks to these and other investigators. The book is well edited, co-ordinating the different literary styles of the authors nicely and fluently. But, I warn you that, even so, it is difficult reading, for the subject is com plex, as we all know, and at times the ter minology is confusing, too. You will have to stop many times and go back over what you have just read. But this is most rewarding. I wish I had had this book when I was a resident 35 years ago. EHEU. Derrick Vail.
APPLIED PHYSIOLOGY OF THE EYE. By
H.
Willoughby, M.D., assisted by T. Keith Lyle, M.D. London, 1958, Bailliere, Tindall, and Cox. (Williams and Wilkins Co., Baltimore, exclusive U. S. agents.) 314 pages and index. Price: $9.00. The book consists of 22 chapters covering the subjects usually considered in a textbook on the physiology of the eye. According to the author it was intended as a book "to help those who are working for higher exam inations in ophthalmology." The book is very disappointing and would seem inadequate for its intended purpose.
For example, only two pages are devoted to the physiology of the retina, the remaining eight pages of the chapter containing brief clinical descriptions of the various types of retinopathies. A contemporary physiology of the eye, on the other hand, devotes 15 pages to the physiology of the retina alone. Similarly, in other important phases of physiology, little space is devoted to the sub ject; for example, six pages on the lens, four and a half pages on the vitreous, and six and a half pages on the aqueous. A great deal of the space of the book is devoted to very brief descriptions of some of the clinical af fections of the eye. The book has a place as a simple text for medical students or general practitioners who may be interested in the physiology of the eye. It cannot be recommended for the seri ous student in ophthalmology. Frederick C. Cordes.
GESCHICHTE DER DEUTSCHEN OPHTHALMO-
By Albert Esser. Munich, J. F. Bergmann, 1957. 84 pages, 3 illustrations. Price: not listed. The deutsche ophthalmologische Gesellschaft commissioned Albert Esser to write its history in commemoration of its centen nial. Although this society was formally inagurated on only September 5, 1863, it really was conceived during an informal meeting that took place in Heidelberg from Septem ber 3 to September 5, 1857. This meeting had been planned as a friendly gathering by v. Graefe and Donders to precede the first In ternational Congress of Ophthalmology in Brussels and was attended by 12 ophthal mologists. Donders who had suggested Hei delberg as the meeting place in preference to Berlin, Graefe's choice, did not participate. His suggestion proved to be sound: with the exception of the meetings in Jena (1922), Leipzig (1932), Dresden (1940), and Mu nich (1950) Heidelberg has remained the permanent place of the meetings up to this day. The first small group found the Hotel LOGISCHEN
GESELLSCHAFT.
416
BOOK REVIEWS
Schrieder an adequate place. Soon the everincreasing number of participants made it necessary to move to larger quarters like the University Eye Clinic, the auditorium of the university, or some of the larger munici pal buildings. From the very beginning, Graefe was the moving spirit of the organization. It was he who had conceived the idea and had written the by-laws. His overwhelming personality dominated the meetings during his lifetime and has left its imprint to this day. With its foundation in 1863, the ophthalmologische Gesellschaft (the name was changed to deutsche ophthalmologische Gesellschaft only in 1920) not only became the first society of any medical speciality in Germany but also the oldest ophthalmologic organization anywhere, preceding the Ameri can Ophthalmological Society founded in 1864. Its transactions were published in the Monatsblaetter fuer Augenheilkunde, pub lished for the first time also in 1863. A committee of six (one year later in creased to eight )was in charge of all ar rangements until the society became incorpo rated in 1902, when it became necessary to elect a president. The first man so honored was Leber. His successors were Uhthoff, Axenfeld, Wagenmann, Loehlein, Wessely, Lindner, and Thiel. In the entire history of the society, there were only three secretaries: Wilhelm Hess, Wagenmann, and Engelking who is still in office. Although it had originally been planned to hold yearly meetings, it soon proved to be expedient to omit those years which coin cided with an international congress. Ex ceptions were the seventh International Con gress held simultaneously with the ophthalmologische Gesellschaft in Heidelberg in 1888 and the 1950 meeting, the year of the International Congress in London. In time of war and during post-war periods, meet ings had to be dispensed with quite fre quently. Graefe had stressed the international char acter of the organization from the very
beginning. Thanks to the pre-eminence of Donders, this outlook was very much in evi dence during the latter's lifetime. The large number of non-German members, amount ing at times to 38 percent, is eloquent testi mony of the same spirit during the entire history of the group. The change in name from "ophthalmologische Gesellschaft" to "deutsche ophthalmologische Gesellschaft" should not be interpreted as a deviation from this ideal; as Uhthoff expressed it in 1925, the change was adopted as a form of protest against attempts to "boycott and isolate Ger man research and science." The Graefe Medal, the highest award of the society, was bestowed for the first time on Helmholtz in 1886. The original plan had been to make a presentation of the award every 10 years; this plan was not strictly adhered to. Recipients of the medal were Leber, Hering, and Carl Hess (the official ceremony took place after his death). The inflation that followed Warld War I ex hausted the funds of the society and seemed to jeopardize the future of the Greafe Medal. Barkan's generous donation of 250 dollars came to the rescue. Further awards were made to Gullstrand, Gonin (posth.), and Thiel. While the Graefe Medal definitely has an international character, the Graefe Prize is more national in character since it is awarded to the author of an article published in Ger man in the Archiv fuer Ophthalmologic. This prize was originated by Robert v. Welz, a disciple and friend of Graefe, who made the fund available in 1873. Of interest is the Dr. Joseph Schneidervon Welz donation made by Schneider of Milwaukee in 1913. In counterdistinction to the Graefe Prize which is awarded to the author of the best paper published during the preceding three years, this prize was granted to contestants who submitted an original paper with the sole purpose of ob taining this award. Oddly enough, the only applicant was Lindner in 1920. As a result of the post-war inflation this as well as other
BOOK REVIEWS prizes had to be discontinued. At present there remains the Axenfeld Memorial Foun dation and the Uhthoff Foundation in addi tion to the Graefe Prize. Members who have earned special con sideration for their devotion to the society may be made honorary members; honorary members are Wagemann, Loehlein, Stock, and Comberg. It is a pleasure to peruse this small vol ume. Not only does it re-emphasize Graefe's important role in the history of ophthalmol ogy but also his close association with men like Donders, Bowman, and Arlt on a truely international level. His example in this re spect has created a pattern for the inter national relation among ophthalmologists that is predominant to this day. Stefan Van Wien. T H E BLOOD CIRCULATION IN THE RETINA
(Der Blutkreislauf der Netzhaut). By K. Thuranszky (with an introduction by Prof. Dr. F. Kukan). Budapest, Adademai Kiado, 1957. 140 pages, 63 illustrations, bibliography. Price: not listed. K. Thuranszky, a pharmacologist, selected the cat for his investigations because its ret inal blood circulation is rather similar to that in man. Though he concerns himself in his experiments mostly with physiologic and pharmacologic aspects, his conclusions on controversial subjects as well as some highly original research concepts are equally im portant to the ophthalmologist. The ingeni ous experimental arrangements may be quite suitable as the basis for related problems in the field of ophthalmology. Careful immobilization of the animal and its globe and general anesthesia permit re moval of the cornea, the lens, and even the vitreous without distortion of the retina. The objective of a Leitz Ultropak microscope (with vertical illuminator) is provided with a cone-shaped glass rod that can be immersed into the vitreous or, if the latter has been re moved, into normal saline or aqueous filling
417
the cavum oculi, thus eliminating surface re flexes. The blood pressure is checked with the equipment designed by J. Balassy: it regis ters graphically the fluctuations of the blood column in a polyethylene tube introduced into the femoral artery. These fluctuations cause an induction current which is ampli fied to actuate an electromagnetic registra tion mechanism. The author uses a clever method to stabilize the blood pressure in the experimental animal with a compressor. At the same time, this arrangement allows for a lowering of the blood pressure. The re sulting slowdown of the circulation in the retinal vessels permits the visualization of individual blood cells. If desired, the circula tion in the retinal vessels can be slowed down without reducing the blood pressure by ap plying clamps to both carotid arteries. An electronic flash bulb permits exposures of 1/5,000 sec. under magnifications up to X150. For histologic examination, the retina is quick-frozen by a mixture of carbon di oxide snow and ether at the desired moment. In a special chapter on the anatomy of the retina of the cat, the author refers to some of his previous investigations that enabled him to prove that, in addition to the narrow capillaries in the central area, there are wider and shorter capillaries in a three to four-mm. zone of the extreme retinal periphery that allow for a blood flow from the arterial to the venous side more or less independent of the central capillary circulation. He calls these vessels "shunt capillaries." He was able to demonstrate conclusively that the caliber of the central capillaries varies to such an extent that, at any given time, only a limited number were wide enough to allow the pas sage of erythrocytes, whereas all other cen tral capillaries contained only plasma. The width of the capillaries varied continuously depending on the retinal metabolism in a given area. He believes that, on the basis of these findings, he can repudiate the idea of the so-called "vasa serosa" described by Cohnheim and Zuntz.
BOOK REVIEWS
neurology, and the use of atropine in the treatment of strabismus. Costenbader discusses the principles and techniques of nonsurgical treatment and the clinical course and management of esotropia. Finally, Philip Knapp discusses divergent deviations and their treatment and gives us a sound chapter on the surgical treatment of strabismus. One of the most valuable parts of the book is a verbatim recording of an interesting round-table discussion in which Breinin, ex pert on electromyographic studies of the ocular muscles, takes part. This is delight fully informal and full of meat. It brings out very nicely the fact that even these top flight ophthalmologists don't always agree and that there is still much to be learned. But we have indeed come a long way in the last two decades; thanks to these and other investigators. The book is well edited, co-ordinating the different literary styles of the authors nicely and fluently. But, I warn you that, even so, it is difficult reading, for the subject is com plex, as we all know, and at times the ter minology is confusing, too. You will have to stop many times and go back over what you have just read. But this is most rewarding. I wish I had had this book when I was a resident 35 years ago. EHEU. Derrick Vail.
APPLIED PHYSIOLOGY OF THE EYE. By
H.
Willoughby, M.D., assisted by T. Keith Lyle, M.D. London, 1958, Bailliere, Tindall, and Cox. (Williams and Wilkins Co., Baltimore, exclusive U. S. agents.) 314 pages and index. Price: $9.00. The book consists of 22 chapters covering the subjects usually considered in a textbook on the physiology of the eye. According to the author it was intended as a book "to help those who are working for higher exam inations in ophthalmology." The book is very disappointing and would seem inadequate for its intended purpose.
For example, only two pages are devoted to the physiology of the retina, the remaining eight pages of the chapter containing brief clinical descriptions of the various types of retinopathies. A contemporary physiology of the eye, on the other hand, devotes 15 pages to the physiology of the retina alone. Similarly, in other important phases of physiology, little space is devoted to the sub ject; for example, six pages on the lens, four and a half pages on the vitreous, and six and a half pages on the aqueous. A great deal of the space of the book is devoted to very brief descriptions of some of the clinical af fections of the eye. The book has a place as a simple text for medical students or general practitioners who may be interested in the physiology of the eye. It cannot be recommended for the seri ous student in ophthalmology. Frederick C. Cordes.
GESCHICHTE DER DEUTSCHEN OPHTHALMO-
By Albert Esser. Munich, J. F. Bergmann, 1957. 84 pages, 3 illustrations. Price: not listed. The deutsche ophthalmologische Gesellschaft commissioned Albert Esser to write its history in commemoration of its centen nial. Although this society was formally inagurated on only September 5, 1863, it really was conceived during an informal meeting that took place in Heidelberg from Septem ber 3 to September 5, 1857. This meeting had been planned as a friendly gathering by v. Graefe and Donders to precede the first In ternational Congress of Ophthalmology in Brussels and was attended by 12 ophthal mologists. Donders who had suggested Hei delberg as the meeting place in preference to Berlin, Graefe's choice, did not participate. His suggestion proved to be sound: with the exception of the meetings in Jena (1922), Leipzig (1932), Dresden (1940), and Mu nich (1950) Heidelberg has remained the permanent place of the meetings up to this day. The first small group found the Hotel LOGISCHEN
GESELLSCHAFT.
416
BOOK REVIEWS
Schrieder an adequate place. Soon the everincreasing number of participants made it necessary to move to larger quarters like the University Eye Clinic, the auditorium of the university, or some of the larger munici pal buildings. From the very beginning, Graefe was the moving spirit of the organization. It was he who had conceived the idea and had written the by-laws. His overwhelming personality dominated the meetings during his lifetime and has left its imprint to this day. With its foundation in 1863, the ophthalmologische Gesellschaft (the name was changed to deutsche ophthalmologische Gesellschaft only in 1920) not only became the first society of any medical speciality in Germany but also the oldest ophthalmologic organization anywhere, preceding the Ameri can Ophthalmological Society founded in 1864. Its transactions were published in the Monatsblaetter fuer Augenheilkunde, pub lished for the first time also in 1863. A committee of six (one year later in creased to eight )was in charge of all ar rangements until the society became incorpo rated in 1902, when it became necessary to elect a president. The first man so honored was Leber. His successors were Uhthoff, Axenfeld, Wagenmann, Loehlein, Wessely, Lindner, and Thiel. In the entire history of the society, there were only three secretaries: Wilhelm Hess, Wagenmann, and Engelking who is still in office. Although it had originally been planned to hold yearly meetings, it soon proved to be expedient to omit those years which coin cided with an international congress. Ex ceptions were the seventh International Con gress held simultaneously with the ophthalmologische Gesellschaft in Heidelberg in 1888 and the 1950 meeting, the year of the International Congress in London. In time of war and during post-war periods, meet ings had to be dispensed with quite fre quently. Graefe had stressed the international char acter of the organization from the very
beginning. Thanks to the pre-eminence of Donders, this outlook was very much in evi dence during the latter's lifetime. The large number of non-German members, amount ing at times to 38 percent, is eloquent testi mony of the same spirit during the entire history of the group. The change in name from "ophthalmologische Gesellschaft" to "deutsche ophthalmologische Gesellschaft" should not be interpreted as a deviation from this ideal; as Uhthoff expressed it in 1925, the change was adopted as a form of protest against attempts to "boycott and isolate Ger man research and science." The Graefe Medal, the highest award of the society, was bestowed for the first time on Helmholtz in 1886. The original plan had been to make a presentation of the award every 10 years; this plan was not strictly adhered to. Recipients of the medal were Leber, Hering, and Carl Hess (the official ceremony took place after his death). The inflation that followed Warld War I ex hausted the funds of the society and seemed to jeopardize the future of the Greafe Medal. Barkan's generous donation of 250 dollars came to the rescue. Further awards were made to Gullstrand, Gonin (posth.), and Thiel. While the Graefe Medal definitely has an international character, the Graefe Prize is more national in character since it is awarded to the author of an article published in Ger man in the Archiv fuer Ophthalmologic. This prize was originated by Robert v. Welz, a disciple and friend of Graefe, who made the fund available in 1873. Of interest is the Dr. Joseph Schneidervon Welz donation made by Schneider of Milwaukee in 1913. In counterdistinction to the Graefe Prize which is awarded to the author of the best paper published during the preceding three years, this prize was granted to contestants who submitted an original paper with the sole purpose of ob taining this award. Oddly enough, the only applicant was Lindner in 1920. As a result of the post-war inflation this as well as other
BOOK REVIEWS prizes had to be discontinued. At present there remains the Axenfeld Memorial Foun dation and the Uhthoff Foundation in addi tion to the Graefe Prize. Members who have earned special con sideration for their devotion to the society may be made honorary members; honorary members are Wagemann, Loehlein, Stock, and Comberg. It is a pleasure to peruse this small vol ume. Not only does it re-emphasize Graefe's important role in the history of ophthalmol ogy but also his close association with men like Donders, Bowman, and Arlt on a truely international level. His example in this re spect has created a pattern for the inter national relation among ophthalmologists that is predominant to this day. Stefan Van Wien. T H E BLOOD CIRCULATION IN THE RETINA
(Der Blutkreislauf der Netzhaut). By K. Thuranszky (with an introduction by Prof. Dr. F. Kukan). Budapest, Adademai Kiado, 1957. 140 pages, 63 illustrations, bibliography. Price: not listed. K. Thuranszky, a pharmacologist, selected the cat for his investigations because its ret inal blood circulation is rather similar to that in man. Though he concerns himself in his experiments mostly with physiologic and pharmacologic aspects, his conclusions on controversial subjects as well as some highly original research concepts are equally im portant to the ophthalmologist. The ingeni ous experimental arrangements may be quite suitable as the basis for related problems in the field of ophthalmology. Careful immobilization of the animal and its globe and general anesthesia permit re moval of the cornea, the lens, and even the vitreous without distortion of the retina. The objective of a Leitz Ultropak microscope (with vertical illuminator) is provided with a cone-shaped glass rod that can be immersed into the vitreous or, if the latter has been re moved, into normal saline or aqueous filling
417
the cavum oculi, thus eliminating surface re flexes. The blood pressure is checked with the equipment designed by J. Balassy: it regis ters graphically the fluctuations of the blood column in a polyethylene tube introduced into the femoral artery. These fluctuations cause an induction current which is ampli fied to actuate an electromagnetic registra tion mechanism. The author uses a clever method to stabilize the blood pressure in the experimental animal with a compressor. At the same time, this arrangement allows for a lowering of the blood pressure. The re sulting slowdown of the circulation in the retinal vessels permits the visualization of individual blood cells. If desired, the circula tion in the retinal vessels can be slowed down without reducing the blood pressure by ap plying clamps to both carotid arteries. An electronic flash bulb permits exposures of 1/5,000 sec. under magnifications up to X150. For histologic examination, the retina is quick-frozen by a mixture of carbon di oxide snow and ether at the desired moment. In a special chapter on the anatomy of the retina of the cat, the author refers to some of his previous investigations that enabled him to prove that, in addition to the narrow capillaries in the central area, there are wider and shorter capillaries in a three to four-mm. zone of the extreme retinal periphery that allow for a blood flow from the arterial to the venous side more or less independent of the central capillary circulation. He calls these vessels "shunt capillaries." He was able to demonstrate conclusively that the caliber of the central capillaries varies to such an extent that, at any given time, only a limited number were wide enough to allow the pas sage of erythrocytes, whereas all other cen tral capillaries contained only plasma. The width of the capillaries varied continuously depending on the retinal metabolism in a given area. He believes that, on the basis of these findings, he can repudiate the idea of the so-called "vasa serosa" described by Cohnheim and Zuntz.