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Syphilitic Optic Atrophy
BOOK REVIEWS (Chapter V ) where, after discussing the morbid changes, details regarding the patho genesis of the disease are given. Animal ex perimental pathology is quoted in many places where it will help explain pathologic processes. Most important is the fact that the clinical application and significance of pathologic changes are stressed. T h e illustrations are superb. It is difficult to conceive of their being better either tech nically or in their selection. The illustrations are grouped at the end of each chapter and no reference is made to them in the text, a feature which might have been incorporated to advantage. As a matter of fact, the illus trations out-strip the text occasionally. F o r instance, there is one page showing foreign bodies of cotton fibrils in operative wounds, and one page showing the epithelization of the anterior chamber and implantation cyst, neither of which subjects is mentioned in the associated chapter. None of the illustrations are in color, and, although this is under standable, there are a number of conditions depicted in which color is essential to show the changes. A n y book of composite authorship lacks uniformity of quality, some chapters being better than others. Also, such a work must suffer to some degree from a lack of integra tion. In this book the majority of chapters are excellent, but there naturally exists some repetition, some disagreement in pathologic findings and their interpretation. F o r ex ample, in Chapter I X on extrabulbar dis eases, the anatomy is reviewed and tumors are discussed even though both these items have been included elsewhere in the volume. Criticisms of this book are limited to minor features. T h e r e are included some statements which seem to be the views of individual authors and not those held by many, such as the existence of a vasomotor endophthalmitis and the presence of pigment around the periphery of inactive areas of choroiditis being due to the deposit of phagocytosed melanin rather than to proliferation of the pigment epithelium. Also, where there
1001
is a paucity of pathologic material, such as in the subject of iritis, the author resorts entirely to a clinical description of the dis ease (hypopyon uveitis in Chapter V I ) . There are some omissions. In the chapter on anomalies no mention is made of iris processes, pigmentation of the lamina cribrosa, retinal dysplasia, or intrascleral nerve loops. In the chapter on injuries, retinitis sclopetaria, recession, and inversion of the iris are not mentioned. In the chapter on glaucoma, the cause of narrow-angle glaucoma is given as a vaso motor crisis in the ciliary processes and the question of physiologic pupillary block or bombe is not mentioned. Not cited in that portion dealing with detachment of the retina are vitreous shrink age, retinal contraction after a long-standing detachment, ring schwiele, and the occur rence of secondary holes or breaks in detach ments. There has been a great need for a compre hensive, up-to-date, authoritative, well-illus trated treatise in English on ocular pathol ogy. This is it. T h a n k s are due to many people for making this superb book possible, but it would be amiss not to single out Dr. Jonas S. Friedenwald and M r s . Helenor C. Wilder for an especial nod of appreciation. Algernon B. Reese.
SYPHILITIC
OPTIC
ATROPHY.
By
W.
L.
Bruetsch. Springfield, Illinois, Charles C Thomas. 138 pages. P r i c e : $5.50. This number 142 of the American Lecture Series is concerned primarily with the pathol ogy and pathogenesis of syphilitic optic atrophy although clinical symptoms, treat ment, and prevention are also discussed. After a brief introductory chapter in which it is noted that 10 to 15 percent of blindness is caused by syphilis, the earlier hypotheses are discussed and criticized. This discussion is followed by the author's cases,
1002
BOOK REVIEWS
reported in great detail and illustrated by ex cellent photomicrographs. This material sup ports the conclusion of Leri that syphilitic atrophy of the optic nerves is always due to an interstitial neuritis. The theory of Abadie that the degenera tion is due to vascular spasm from sympa thetic involvement, the theory of Lauber that the cause is retinal hypertension, the theory that optochiasmatic arachnoiditis is the cause, and the theory of vitamin deficiency are all shown not to be in accord with the known facts. The inflammatory process is in the intracranial portion of the optic nerves and in the chiasm and the degeneration of the nerve fibers is secondary to it. Bruetsch bases his conclusions on the examination of the optic pathways of 80 patients, 57 with general paresis or taboparesis, three with tabes dorsalis, and 20 with meningovascular syphilis. The author shows that the clinical findings agree with the microscopic findings that the atrophy begins in the intracranial portions of the optic nerves, chiasm, or both. The first sign of syphilitic optic atrophy may be con striction of the fields for white and color, while the central vision is relatively intact. Treatment with penicillin is advised and the author is of the opinion that intraspinal ad ministration has no advantage and may be dangerous. For prevention, routine repeated examinations of visual fields, fundi, and acuity are advised in every patient with acquired or congenital syphilis. This little book should settle once and for all the question of the nature and cause of syphilitic optic atrophy. It is clearly and logically written, printed on excellent paper with large clear type. It should be in every library. P. Bailey.
Topographic normale et pathologique de ses sensibilites. By A. Dubois-Poulson (with the collaboration of P. Francois, A. Tibi, and Cl. Magis).
L E CHAMP VISUEL.
Paris, Masson et Cie., 1952. 1175 pages, 820 figures, four plates in color, bibliog raphy, table of contents. Price: 6,500 francs. The subtitle of this magnificent book dis closes the point of view in studying the visual field that the author considers impor tant. A visual field is the record of a study of the topography of thresholds of perception throughout the visible area, not merely the determination of the peripheral limits beyond which the eye is blind. Adequate interpreta tion of the findings can only be based on ex tensive knowledge of the anatomy and physi ology of the tissues concerned with vision and of the technical methods of gathering data. Without detailed exposition of these principles, a mere atlas of records of fields which were of diagnostic help in patients with various lesions of the eye or the visual tracts would be valueless. The book is divided into two sections. In the first section of 407 pages the physi ology of the visual sensations and the anatomy of structures and their blood supply are discussed. Here the theoretical basis fo.the normal topography of visual sensitivity is discussed—character of stimuli, the idea of threshold, adaption, time factor, the isopters, fusion and flicker perimetry, color perception and thresholds, form sense, the normal scotomas, binocular field, the pupil, the electroretinogram, and the electroence phalogram. In the anatomic portion, the retina, tracts and cortex and their blood sup ply are described and the correspondences between anatomic and perimetric data are evaluated. In the second section the instruments and methods for clinical field taking are described in detail. Many models of perimeters and other instruments are evaluated. The find ings that are associated with lesions in each of the tissues which is important in vision are considered systematically and the clinical significance of characteristic field defects is analyzed. Numerous excellent figures are records of
1001
is a paucity of pathologic material, such as in the subject of iritis, the author resorts entirely to a clinical description of the dis ease (hypopyon uveitis in Chapter V I ) . There are some omissions. In the chapter on anomalies no mention is made of iris processes, pigmentation of the lamina cribrosa, retinal dysplasia, or intrascleral nerve loops. In the chapter on injuries, retinitis sclopetaria, recession, and inversion of the iris are not mentioned. In the chapter on glaucoma, the cause of narrow-angle glaucoma is given as a vaso motor crisis in the ciliary processes and the question of physiologic pupillary block or bombe is not mentioned. Not cited in that portion dealing with detachment of the retina are vitreous shrink age, retinal contraction after a long-standing detachment, ring schwiele, and the occur rence of secondary holes or breaks in detach ments. There has been a great need for a compre hensive, up-to-date, authoritative, well-illus trated treatise in English on ocular pathol ogy. This is it. T h a n k s are due to many people for making this superb book possible, but it would be amiss not to single out Dr. Jonas S. Friedenwald and M r s . Helenor C. Wilder for an especial nod of appreciation. Algernon B. Reese.
SYPHILITIC
OPTIC
ATROPHY.
By
W.
L.
Bruetsch. Springfield, Illinois, Charles C Thomas. 138 pages. P r i c e : $5.50. This number 142 of the American Lecture Series is concerned primarily with the pathol ogy and pathogenesis of syphilitic optic atrophy although clinical symptoms, treat ment, and prevention are also discussed. After a brief introductory chapter in which it is noted that 10 to 15 percent of blindness is caused by syphilis, the earlier hypotheses are discussed and criticized. This discussion is followed by the author's cases,
1002
BOOK REVIEWS
reported in great detail and illustrated by ex cellent photomicrographs. This material sup ports the conclusion of Leri that syphilitic atrophy of the optic nerves is always due to an interstitial neuritis. The theory of Abadie that the degenera tion is due to vascular spasm from sympa thetic involvement, the theory of Lauber that the cause is retinal hypertension, the theory that optochiasmatic arachnoiditis is the cause, and the theory of vitamin deficiency are all shown not to be in accord with the known facts. The inflammatory process is in the intracranial portion of the optic nerves and in the chiasm and the degeneration of the nerve fibers is secondary to it. Bruetsch bases his conclusions on the examination of the optic pathways of 80 patients, 57 with general paresis or taboparesis, three with tabes dorsalis, and 20 with meningovascular syphilis. The author shows that the clinical findings agree with the microscopic findings that the atrophy begins in the intracranial portions of the optic nerves, chiasm, or both. The first sign of syphilitic optic atrophy may be con striction of the fields for white and color, while the central vision is relatively intact. Treatment with penicillin is advised and the author is of the opinion that intraspinal ad ministration has no advantage and may be dangerous. For prevention, routine repeated examinations of visual fields, fundi, and acuity are advised in every patient with acquired or congenital syphilis. This little book should settle once and for all the question of the nature and cause of syphilitic optic atrophy. It is clearly and logically written, printed on excellent paper with large clear type. It should be in every library. P. Bailey.
Topographic normale et pathologique de ses sensibilites. By A. Dubois-Poulson (with the collaboration of P. Francois, A. Tibi, and Cl. Magis).
L E CHAMP VISUEL.
Paris, Masson et Cie., 1952. 1175 pages, 820 figures, four plates in color, bibliog raphy, table of contents. Price: 6,500 francs. The subtitle of this magnificent book dis closes the point of view in studying the visual field that the author considers impor tant. A visual field is the record of a study of the topography of thresholds of perception throughout the visible area, not merely the determination of the peripheral limits beyond which the eye is blind. Adequate interpreta tion of the findings can only be based on ex tensive knowledge of the anatomy and physi ology of the tissues concerned with vision and of the technical methods of gathering data. Without detailed exposition of these principles, a mere atlas of records of fields which were of diagnostic help in patients with various lesions of the eye or the visual tracts would be valueless. The book is divided into two sections. In the first section of 407 pages the physi ology of the visual sensations and the anatomy of structures and their blood supply are discussed. Here the theoretical basis fo.the normal topography of visual sensitivity is discussed—character of stimuli, the idea of threshold, adaption, time factor, the isopters, fusion and flicker perimetry, color perception and thresholds, form sense, the normal scotomas, binocular field, the pupil, the electroretinogram, and the electroence phalogram. In the anatomic portion, the retina, tracts and cortex and their blood sup ply are described and the correspondences between anatomic and perimetric data are evaluated. In the second section the instruments and methods for clinical field taking are described in detail. Many models of perimeters and other instruments are evaluated. The find ings that are associated with lesions in each of the tissues which is important in vision are considered systematically and the clinical significance of characteristic field defects is analyzed. Numerous excellent figures are records of