- Email: [email protected]
Keratoplasty and Tissue Therapy
BOOK REVIEWS
1316
title, and of the two titles to use that which is the more adequate and logical? The term used by the New York State Board of Education appears to cover the subject rather well (vmless "Optical Dis pensing" is preferred) and to be logical in form, whereas the entirely new term "Opticianry" is of somewhat dubious etymology and vague significance. T h e two may of course persist side by side. W h a t ' s in a name? W . H . Crisp.
BOOK
REVIEWS
KERATOPLASTY AND TISSUE T H E R A P Y . By V. P . Filatov. Mos cow, State jjublications of medical literature, 1945. 2,32 pages. 233 illus trations. This book, by the chief of the U k r a n i a n Experimental Institute of Ophthalmology, best known for his pioneer work in keratoplasty and for his recent develop ment of a new method of therapy with preserved animal and plant tissues and their extracts, gathers in a monograph the formerly published data of the Insti tute, and adds the material accumulated during the war in the various military hospitals. W h e n the Institute in Odessa was abandoned because of the Nazi in vasion, the staff of the Institute was as signed to various military hospitals where the doctors had an opportunity to pursue their clinical studies. In 1942, the Insti tute was reopened in Tashkent. The preface to the volume is as reveal ing as some of the technical expositions. As his catechism of faith, Filatov de clares that only optimism and therapeutic activity can lead to progress. H e believes that every organism holds hidden within it potentialities for recovery, if one could but release them. One must therefore never give up the exploration of thera peutic resources, and when forced to ad
mit defeat, one must leave the patient with a hope and expectation of some new discovery, which may bring relief. "Pessi mism at the bedside and in science is fruitless, and not to it belongs the future." This philosophic attitude helps to under stand what otherwise, because of the skepticism incident to accurate scientific evaluation, might appear as an unre strained flight of an unscientific imagina tion. T h e volume actually consists of two monographs, which Filatov combines for the purpose of historical perspective, inasmuch as tissue therapy was the outgrowth of his experience with kerato plasty. The first part, dealing with kerato plasty, reviews in detail the clinical experience based on about 1,000 cases, and the experimental and research data in connection with it. Filatov introduced the use of cadaver cornea into keratoplasty, and through the study of eyes enucleated after successful transplantations, demon strated that the transplant forms a true union with the cornea of the host, and is not merely a scaffold for the ingrowth of corneal elements from the recipient's cornea. It was also shown that the cornea is preserved best without fluids at a tem perature of 3 ° C . ; under these conditions the oxidative processes are continued in the cornea and lens; and despite autoly sis the preserved cornea continues to ex hibit cellular division and growth. T h e descriptions of the indications, the various techniques, and the instrumentation con form to the requirements of a good text book, and 143 satisfactory photographs demonstrate the final results. In the part dealing with tissue and tis sue-extract therapy, Filatov explains in detail the hypothesis which he elaborated, with some support from known biologic and botanical phenomena, to explain the rationale of this new form of therapy which is hailed in a tone of evangelism.
BOOK REVIEWS
1317
The numerous reports which appeared on this subject from the Ul
tion into a sick organism of tissues rich in biogenic stimulants augments its cellular metabolism, and counteracts the inhibiting effect of pathogenic products on the for mation of substances necessary for re covery. T h e unfavorable environment giv ing impetus to the formation of biogenic stimulators comprises variations in tem perature and light, and various chemical agents. This in substance is the theory on which this form of therapy is based. Filatov believes that this type of therapy is in its inception, and that there are many problems yet to be cleared up.
Preserved tissue and tissue-extract therapy is a nonspecific form of therapy, the therapeutic agent being designated as biogenic stimulators, or resistance sub stances, the existence of which is assumed, and the chemical nature of which is still in the process of investigation, the probability being that they are amines. They develop as a result of biochemical reconstruction in all living tissues and plants in response to an unfavorable en vironment, which harasses life but does not extinguish it entirely. They in turn stimulate biologic processes, and it is be lieved that such a phenomenon takes part in the process of evolution. Animal or plant tissues isolated from their organism, and subjected to an unfavorable, but not mortal, environment also undergo bio chemical changes, resulting in the produc tion of these substances. Tissues rich in these substances, introduced into another organism, become stimulants of the phys iologic functions of the host.
H o w can maximum action of these sub stances be obtained? H o w can they be isolated? There are problems of sterility and stability; there is the possibility of specific stimulants. This, he says, is too big a task for a single investigator and he seeks to interest other workers. T h e techniques for the preparation of the various preserved homologous, heteroge nous, and plant tissues and extracts, and their therapeutic application are described in detail, in the hope that this information will lead to their wider use. Filatov forsees that the hypothesis may not stand the test of future investigations, and may be substituted by another theory based on a more factual foundation. Extensive clinical research may limit the sphere of usefulness of this form of therapy. But, whatever the explanation, he believes that the therapeutic eflfect of preserved tissue has been demonstrated and will remain incontrovertible.
In disease, pathogenic products inhibit the production of substances necessary for regenerative processes; and, on the other hand, the same pathologic process after reaching a certain intensity and duration initiates the development of biogenic stim ulants; the crisis of acute infectious dis eases is interpreted as the indication of a spurt in their appearance. T h e introduc
T h e clinical material subjected to this type of therapy consists chiefly of hope less cases, discharged as such from other ophthalmologic institutions. It is not diffi cult to understand that in such cases even very slight improvement may lead to an exaggerated enthusiasm. During the war the effectiveness of this therapy appears to have been confirmed in the various military hospitals, principally in Mid Asia,
1318
CORRESPONDENCE
where Filatov and his students worked. Regardless of the fate which the future holds for this form of therapy, the pa tience and the deep human sympathy mo tivating the sustained and prolonged ef forts to restore to practically blind people a semblance of vision, adequate perhaps only to enable them to get about unaided, command our respect. T h e language bar rier will make Filatov's book inacces sible to most ophthalmologists, and it is hoped that this review will at least define the pattern of his work. Ray K. Daily.
RESEARCHES ON NORMAL AND DEFECTIVE COLOUR VISION. By W . D. Wright, A.R.C.S., D . S c , with a foreword by L. C. Martin, D . S c , A.R.C.S., D.I.C., St. Louis, C. V. Mos by Co., 1 9 4 7 . Clothbound, 3 8 3 pages, 2 3 3 illustrations. Price, $ 1 0 . 0 0 . This volume is the last word on experi mentation and theory of color vision. It is the result of some 2 0 years of research. L. C. Martin, professor of Technical O p tics in the Imperial College of Science and Technology, London, states, in the fore word, that the fundamental problems of color vision are still unsolved. T h e author w r i t e s : " T h i s book should be regarded first and foremost as a record of experimental data, with theoretical discussion and specu lation occupying a very secondary posi tion." He goes on to express his personal belief that the three-response theory along lines proposed by Young and Helmholtz is probably correct. H e does not, however, wish to ally himself too strongly with any theory as he believes that much work re mains to be done. His opinion is that many exact experiments, the suggestions for which have already been made, should be performed as an aid toward establishing incontrovertible theory. T h e first 4 0 pages are devoted to the
anatomy of the visual organ and the physi ology of visual perception. Each succeed ing chapter is introduced by a paragraph or two outlining the work contained in that chapter and in some cases descriptions of instruments that were used in the experi mental work. Most attention is devoted to the trichro matic system which is discussed exhaus tively. If the mathematical details are passed over briefly by the average reader, much of practical interest to him will be found. Obviously the mathematics and other details are vital to the deeply inter ested student of color vision and to such a person the book is invaluable. It also will serve as a good reference book of the most recent researches in this field. Lawrence T . Post
CORRESPONDENCE Editor, American Journal of Ophthalmology: In the April, 1 9 4 7 , issue of the JOURNAL (page 4 9 1 ) , Dr. S. Rodman Irvine re ported on the J a n u a r y meeting of the Research Study Club of Los Angeles. In his report on my presentation of the sub ject of retinal detachment, he stated that I felt that about 1 0 percent of the de tachments have a hole in the macula area that needs treating. This is a serious mis understanding which, I feel, should be cleared up. I feel that probably one per cent, or at most two percent, of detach ments have a hole in the macula. I feel that many operations for a hole in the macula have been done when there was no hole present. I would appreciate, it very much if this statement could be published to correct the impression createfi by D r . Irvine's excellent resume of the Los Angeles meeting. (Signed) D o h r m a n n Κ. Pischel, San Francisco, California.
1316
title, and of the two titles to use that which is the more adequate and logical? The term used by the New York State Board of Education appears to cover the subject rather well (vmless "Optical Dis pensing" is preferred) and to be logical in form, whereas the entirely new term "Opticianry" is of somewhat dubious etymology and vague significance. T h e two may of course persist side by side. W h a t ' s in a name? W . H . Crisp.
BOOK
REVIEWS
KERATOPLASTY AND TISSUE T H E R A P Y . By V. P . Filatov. Mos cow, State jjublications of medical literature, 1945. 2,32 pages. 233 illus trations. This book, by the chief of the U k r a n i a n Experimental Institute of Ophthalmology, best known for his pioneer work in keratoplasty and for his recent develop ment of a new method of therapy with preserved animal and plant tissues and their extracts, gathers in a monograph the formerly published data of the Insti tute, and adds the material accumulated during the war in the various military hospitals. W h e n the Institute in Odessa was abandoned because of the Nazi in vasion, the staff of the Institute was as signed to various military hospitals where the doctors had an opportunity to pursue their clinical studies. In 1942, the Insti tute was reopened in Tashkent. The preface to the volume is as reveal ing as some of the technical expositions. As his catechism of faith, Filatov de clares that only optimism and therapeutic activity can lead to progress. H e believes that every organism holds hidden within it potentialities for recovery, if one could but release them. One must therefore never give up the exploration of thera peutic resources, and when forced to ad
mit defeat, one must leave the patient with a hope and expectation of some new discovery, which may bring relief. "Pessi mism at the bedside and in science is fruitless, and not to it belongs the future." This philosophic attitude helps to under stand what otherwise, because of the skepticism incident to accurate scientific evaluation, might appear as an unre strained flight of an unscientific imagina tion. T h e volume actually consists of two monographs, which Filatov combines for the purpose of historical perspective, inasmuch as tissue therapy was the outgrowth of his experience with kerato plasty. The first part, dealing with kerato plasty, reviews in detail the clinical experience based on about 1,000 cases, and the experimental and research data in connection with it. Filatov introduced the use of cadaver cornea into keratoplasty, and through the study of eyes enucleated after successful transplantations, demon strated that the transplant forms a true union with the cornea of the host, and is not merely a scaffold for the ingrowth of corneal elements from the recipient's cornea. It was also shown that the cornea is preserved best without fluids at a tem perature of 3 ° C . ; under these conditions the oxidative processes are continued in the cornea and lens; and despite autoly sis the preserved cornea continues to ex hibit cellular division and growth. T h e descriptions of the indications, the various techniques, and the instrumentation con form to the requirements of a good text book, and 143 satisfactory photographs demonstrate the final results. In the part dealing with tissue and tis sue-extract therapy, Filatov explains in detail the hypothesis which he elaborated, with some support from known biologic and botanical phenomena, to explain the rationale of this new form of therapy which is hailed in a tone of evangelism.
BOOK REVIEWS
1317
The numerous reports which appeared on this subject from the Ul
tion into a sick organism of tissues rich in biogenic stimulants augments its cellular metabolism, and counteracts the inhibiting effect of pathogenic products on the for mation of substances necessary for re covery. T h e unfavorable environment giv ing impetus to the formation of biogenic stimulators comprises variations in tem perature and light, and various chemical agents. This in substance is the theory on which this form of therapy is based. Filatov believes that this type of therapy is in its inception, and that there are many problems yet to be cleared up.
Preserved tissue and tissue-extract therapy is a nonspecific form of therapy, the therapeutic agent being designated as biogenic stimulators, or resistance sub stances, the existence of which is assumed, and the chemical nature of which is still in the process of investigation, the probability being that they are amines. They develop as a result of biochemical reconstruction in all living tissues and plants in response to an unfavorable en vironment, which harasses life but does not extinguish it entirely. They in turn stimulate biologic processes, and it is be lieved that such a phenomenon takes part in the process of evolution. Animal or plant tissues isolated from their organism, and subjected to an unfavorable, but not mortal, environment also undergo bio chemical changes, resulting in the produc tion of these substances. Tissues rich in these substances, introduced into another organism, become stimulants of the phys iologic functions of the host.
H o w can maximum action of these sub stances be obtained? H o w can they be isolated? There are problems of sterility and stability; there is the possibility of specific stimulants. This, he says, is too big a task for a single investigator and he seeks to interest other workers. T h e techniques for the preparation of the various preserved homologous, heteroge nous, and plant tissues and extracts, and their therapeutic application are described in detail, in the hope that this information will lead to their wider use. Filatov forsees that the hypothesis may not stand the test of future investigations, and may be substituted by another theory based on a more factual foundation. Extensive clinical research may limit the sphere of usefulness of this form of therapy. But, whatever the explanation, he believes that the therapeutic eflfect of preserved tissue has been demonstrated and will remain incontrovertible.
In disease, pathogenic products inhibit the production of substances necessary for regenerative processes; and, on the other hand, the same pathologic process after reaching a certain intensity and duration initiates the development of biogenic stim ulants; the crisis of acute infectious dis eases is interpreted as the indication of a spurt in their appearance. T h e introduc
T h e clinical material subjected to this type of therapy consists chiefly of hope less cases, discharged as such from other ophthalmologic institutions. It is not diffi cult to understand that in such cases even very slight improvement may lead to an exaggerated enthusiasm. During the war the effectiveness of this therapy appears to have been confirmed in the various military hospitals, principally in Mid Asia,
1318
CORRESPONDENCE
where Filatov and his students worked. Regardless of the fate which the future holds for this form of therapy, the pa tience and the deep human sympathy mo tivating the sustained and prolonged ef forts to restore to practically blind people a semblance of vision, adequate perhaps only to enable them to get about unaided, command our respect. T h e language bar rier will make Filatov's book inacces sible to most ophthalmologists, and it is hoped that this review will at least define the pattern of his work. Ray K. Daily.
RESEARCHES ON NORMAL AND DEFECTIVE COLOUR VISION. By W . D. Wright, A.R.C.S., D . S c , with a foreword by L. C. Martin, D . S c , A.R.C.S., D.I.C., St. Louis, C. V. Mos by Co., 1 9 4 7 . Clothbound, 3 8 3 pages, 2 3 3 illustrations. Price, $ 1 0 . 0 0 . This volume is the last word on experi mentation and theory of color vision. It is the result of some 2 0 years of research. L. C. Martin, professor of Technical O p tics in the Imperial College of Science and Technology, London, states, in the fore word, that the fundamental problems of color vision are still unsolved. T h e author w r i t e s : " T h i s book should be regarded first and foremost as a record of experimental data, with theoretical discussion and specu lation occupying a very secondary posi tion." He goes on to express his personal belief that the three-response theory along lines proposed by Young and Helmholtz is probably correct. H e does not, however, wish to ally himself too strongly with any theory as he believes that much work re mains to be done. His opinion is that many exact experiments, the suggestions for which have already been made, should be performed as an aid toward establishing incontrovertible theory. T h e first 4 0 pages are devoted to the
anatomy of the visual organ and the physi ology of visual perception. Each succeed ing chapter is introduced by a paragraph or two outlining the work contained in that chapter and in some cases descriptions of instruments that were used in the experi mental work. Most attention is devoted to the trichro matic system which is discussed exhaus tively. If the mathematical details are passed over briefly by the average reader, much of practical interest to him will be found. Obviously the mathematics and other details are vital to the deeply inter ested student of color vision and to such a person the book is invaluable. It also will serve as a good reference book of the most recent researches in this field. Lawrence T . Post
CORRESPONDENCE Editor, American Journal of Ophthalmology: In the April, 1 9 4 7 , issue of the JOURNAL (page 4 9 1 ) , Dr. S. Rodman Irvine re ported on the J a n u a r y meeting of the Research Study Club of Los Angeles. In his report on my presentation of the sub ject of retinal detachment, he stated that I felt that about 1 0 percent of the de tachments have a hole in the macula area that needs treating. This is a serious mis understanding which, I feel, should be cleared up. I feel that probably one per cent, or at most two percent, of detach ments have a hole in the macula. I feel that many operations for a hole in the macula have been done when there was no hole present. I would appreciate, it very much if this statement could be published to correct the impression createfi by D r . Irvine's excellent resume of the Los Angeles meeting. (Signed) D o h r m a n n Κ. Pischel, San Francisco, California.