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Test for Abducens Paralysis
81
CORRESPONDENCE
authors here mentioned are not in cluded in the index of authors' names which gives only those whose observa tions and views have been quoted in the text. T h e bibliographies are arranged chronologically; a paragraph being given to each year in which some paper has been published on that particular subject. The book is illustrated chiefly with reproductions of photographs of cases and microscopic sections illustrating the pathology of the conditions de scribed. Of the illustrations, 36 are in colors; and 42 are new, in this edition, having been supplied by cases from the University E y e Clinics at Heidel berg and Prague. They are not col lected on plates away from the text relating to them, but are all printed on the same pages with the letter press relating to the case or condition illus trated. Schreiber's book will be welcome to all German reading ophthalmologists. It well sustains the reputation of the Graefe-Saemisch "Handbook" as the greatest collection of monographs re lating to ophthalmology to be found in any language. E. J . CORRESPONDENCE Test for Abducens Paralysis. To the Editor: While listening to Dr. Giflford's interesting paper at the Mon treal meeting of the Academy, I was re minded of a point in connection with the diagnosis of paralysis of the external rectus muscle in small children that has been of value to me. I did not mention it in discussion because I thought it was probably familiar to the Fellows, but after the session I did speak of it to several to whom it did not seem familiar and a short note of it is probably worth printing. It has occurred to me a number of times in examining a small child with a convergent squint that I was unable to get the patient to turn the eye as de sired, and therefore it was difficult to tell whether or not the condition was the ordinary concomitant squint or a pa ralysis of the external rectus. In such circumstances the function of the muscle can readily be investigated by applying
the caloric test for functional activity of the labyrinth. I f the ear on the side to be tested is douched with either hot or cold water, a lively nystagmus is excited, provided of course that the muscles are capable of functioning. The test is con clusive, easily applied and involves no question of cooperation on the part of the patient. Its limitations are more theoretic than real, for while destruc tion of the labyrinth would invalidate the test, in the cases in which it is desired to apply it for this purpose the labyrinth would rarely happen to be dead. The caloric test and its resultant nystagmus are of course perfectly familiar to every one. It is this particu lar use which can be made of the test that may not be so generally known. E . C. ELLETT.
Memphis, Tenn. Angioma of Orbit. Electrocoagulation. To the Editor: The additional data and remarks re garding the case published last month in the A. J . O . , λ'οΐ. 7, ρ, 946, will add to its interest. An additional pathologic report has been made by Dr. Eugene J . Asnis as follows: Growth in orbit consisting of brownish black irregular masses varying in size one cm. to one and a half cm. Portion of the growth appeared dense and cal careous. HISTOLOGY I N DETAIL: T h e
histologic
picture presented a dense matrix of connective tissue; embedded within were numerous dilated blood vessels. T h e dilated veins varied in size, some being small, others enormously dis tended. Some of the vessels were filled with thrombi, the latter showing various stages of organization and cal cification. While the major portion of the growth is of a simple cavernous angioma type, there are evidences in certain areas of the microscopic field of proliferation of the endothelial cells. DIAGNOSIS : Cavernous angioma show ing tendencies to endothelial prolifer ation. (Cavernous angioendothelioma). In view of the fact that radium has been utilized occasionally in angioma tous degeneration o f the orbital blood vessels, I have asked Dr. W m . L.
CORRESPONDENCE
authors here mentioned are not in cluded in the index of authors' names which gives only those whose observa tions and views have been quoted in the text. T h e bibliographies are arranged chronologically; a paragraph being given to each year in which some paper has been published on that particular subject. The book is illustrated chiefly with reproductions of photographs of cases and microscopic sections illustrating the pathology of the conditions de scribed. Of the illustrations, 36 are in colors; and 42 are new, in this edition, having been supplied by cases from the University E y e Clinics at Heidel berg and Prague. They are not col lected on plates away from the text relating to them, but are all printed on the same pages with the letter press relating to the case or condition illus trated. Schreiber's book will be welcome to all German reading ophthalmologists. It well sustains the reputation of the Graefe-Saemisch "Handbook" as the greatest collection of monographs re lating to ophthalmology to be found in any language. E. J . CORRESPONDENCE Test for Abducens Paralysis. To the Editor: While listening to Dr. Giflford's interesting paper at the Mon treal meeting of the Academy, I was re minded of a point in connection with the diagnosis of paralysis of the external rectus muscle in small children that has been of value to me. I did not mention it in discussion because I thought it was probably familiar to the Fellows, but after the session I did speak of it to several to whom it did not seem familiar and a short note of it is probably worth printing. It has occurred to me a number of times in examining a small child with a convergent squint that I was unable to get the patient to turn the eye as de sired, and therefore it was difficult to tell whether or not the condition was the ordinary concomitant squint or a pa ralysis of the external rectus. In such circumstances the function of the muscle can readily be investigated by applying
the caloric test for functional activity of the labyrinth. I f the ear on the side to be tested is douched with either hot or cold water, a lively nystagmus is excited, provided of course that the muscles are capable of functioning. The test is con clusive, easily applied and involves no question of cooperation on the part of the patient. Its limitations are more theoretic than real, for while destruc tion of the labyrinth would invalidate the test, in the cases in which it is desired to apply it for this purpose the labyrinth would rarely happen to be dead. The caloric test and its resultant nystagmus are of course perfectly familiar to every one. It is this particu lar use which can be made of the test that may not be so generally known. E . C. ELLETT.
Memphis, Tenn. Angioma of Orbit. Electrocoagulation. To the Editor: The additional data and remarks re garding the case published last month in the A. J . O . , λ'οΐ. 7, ρ, 946, will add to its interest. An additional pathologic report has been made by Dr. Eugene J . Asnis as follows: Growth in orbit consisting of brownish black irregular masses varying in size one cm. to one and a half cm. Portion of the growth appeared dense and cal careous. HISTOLOGY I N DETAIL: T h e
histologic
picture presented a dense matrix of connective tissue; embedded within were numerous dilated blood vessels. T h e dilated veins varied in size, some being small, others enormously dis tended. Some of the vessels were filled with thrombi, the latter showing various stages of organization and cal cification. While the major portion of the growth is of a simple cavernous angioma type, there are evidences in certain areas of the microscopic field of proliferation of the endothelial cells. DIAGNOSIS : Cavernous angioma show ing tendencies to endothelial prolifer ation. (Cavernous angioendothelioma). In view of the fact that radium has been utilized occasionally in angioma tous degeneration o f the orbital blood vessels, I have asked Dr. W m . L.