1842 BOOK REVIEWS

with or without detachment. F. C. Cordes reports a study of 81 cases

of optic atrophy in infancy, childhood, and adolescence. Primary atrophy is present in 43 of the 81 cases. The largest single cause of optic atrophy in this group is hydrocephalus (11 cases), neoplastic disease (10 cases). Congenital syphilis is third.

Ludwig von Sallmann and Carmen M. Munoz find intravenously administered cys-teine has a markedly protective action against radiation damage to the lens and hair follicles of rabbits.

W. F. Duggan finds the study of color fields to be of value in determining whether a lesion originates in the choroid or in the retina. In five cases of tumor of the choroid the field defect was larger for a blue than for a red stimulus.

The changes in the eye and orbit following carotid legation as observed by Kenneth C. Swan and John Raaf are (1) relief of di-plopia and bruit, (2) improvement in the exophthalmos, and (3) the development of a slight cyanosis of the retina with edema and cotton-wool spots. The cyanosis, edema, and cotton-wool spots cleared.

According to A. M. Culler, the intraocular complications of leukemia are produced by anemia which produces hemorrhage and ar­terial and venous occlusion which produces other lesions. Thrombocytopenia is the most likely cause of terminal hemorrhage in the fundus.

The theses published are: "The ocular aspects of mycotic infection," by Henry L. Birge; "The use of the Sanborn electro-manometer in the study of pharmacological effects upon the intraocular pressure," by DuPont Guerry, I I I ; "An experimental study of the evaluation of Hydrosulphosol in the treatment of ocular injuries due to chemi­

cal burns," by Robison D. Harley; "The relationship of lenticular changes to mon-golism," by Joseph Igersheimer; "Auto-nomic drugs and their influence on the cho-roidal vessel caliber," by Irving H. Leopold;

"Early wounds in and about the orbit," by Byron Smith.

The contributors to this volume are to be congratulated on their continued curiosity, energy, and enthusiasm.

William M. James.

OCULAR SURGERY. By H. Arruga, M.D. Translated from the third Spanish edition by Michael J. Hogan, M.D., and Luis E. Chaparro, M.D. New York, McGraw-Hill Book Co. Inc., 1952. 936 pages with 1293 illustrations, 127 in color. Price: $36.00. In the preface to the first edition, the au­

thor states that he has followed the rule of describing, along with the techniques that he considers most advantageous, those practiced by the leading personalities in the world of ophthalmic surgery. In the third edition, he has added new techniques and interesting modifications of the old ones. Some original procedures are retained, he says, so that the beginners in ophthalmic surgery may be familiar with the origin of various tech­niques.

The wide knowledge of ophthalmic litera­ture of all lands possessed by Arruga is at­tested by the author's index of nearly 600 names, with references in the text to the writings of most of them.

His vast experience and surgical skill are evident in the clarity and adequacy of text, describing without laborious detail the es­sentials of each operation.

The illustrations are mostly semidiagram-matic, half-tone drawings "highly practical and didactic." They are of sufficient size and accurate detail to enable anyone experienced in ophthalmic surgery to perform the indi­cated procedures with confidence. Both the artist, Mr. Alemany, and the printers, Im-prenta Hispano-Americana, S.A., of Bar­celona, are to be commended most heartily on the excellence of this feature. The author has properly provided such visual instruction so generously that most of the described opera-

BOOK REVIEWS 1843

tive techniques are also pictorially demon­strated.

The chapter on the "Generalities of oph­thalmic surgery" contains some excellent suggestions as to the qualifications and con­duct of the surgeon. One unusual but excel­lent bit of advice is that the nervous surgeon may do well to take a mild sedative, such as a short-acting barbituate, one-half hour be­fore operating, to attain calmness and avoid tremor.

The furnishings of the operating room, the illustrated instruments and dressings dif­fer somewhat from those in use generally in the United States but provide a pattern worthy of study by anyone contemplating setting up or improving the surgical work­shop, tools, and modus operandi.

The section on "Surgery of the eyelids" fills 149 pages with well-illustrated exposi­tion of operations for all the ordinary condi­tions as chalazion, entropion, ectropion, epi-canthus, and so forth. Different methods are presented enabling the surgeon to refresh his memory on the standard procedure that best suits the problem at hand. Likewise many plastic techniques are presented such as the sliding grafts, pedicle flaps, restoration of the canthus, repair of colobomas, and many others. Here the illustrations enable one to visualize the procedure better than any num­ber of words could do. The techniques for the relief of palpebral ptosis include the clas­sic methods of Elschnig, Blaskovicz, Motais, and others, and some of the later procedures, as the modifications of Berke and the Fried-enwald-Guyton suture.

T h "Surgery of the lacrimal apparatus" deals not only with the methods of treating obstruction of the drainage channels but with less common ways of dealing with everted or deformed puncta, absence of tear sac, and so forth. Surgery of the lacrimal gland is treated briefly.

Thirty-five pages are devoted to "Surgery of the conjunctiva" including numerous operations for pterygium, methods of cover­

ing the cornea with conjunctival flaps, and the repair of symblepharon.

The "Surgery of the cornea" presents many of the more unusual techniques of keratoplasty as well as those approved by the author. Of considerable interest is the discussion of the technique of tattooing of corneal scars, including the use of colors.

The "Surgery of the ir is" describes a sur­prising number of things that may need to be done to the iris usually as part of the treat­ment of other conditions.

The treatise on the "Surgery of the lens" is especially full and covers every phase of that most interesting of all problems of oph­thalmic surgery, the cataract extraction. The classic operation with full Graefe section, including a narrow strip of limbal conjunc­tiva, peripheral iridectomy or two iridot-omies ( A r r u g a ) , intracapsular delivery with forceps and hook is described. Follow­ing this, a great many of the better known and most useful variations of each of the operative steps are given. The use of pre-placed corneal or corneoscleral sutures is mentioned but not stressed. The McLean su­ture, most popular in America, is not men­tioned. The statement is made that iris pro­lapse occurs in two or three percent of cases even when sutures are used.

Other types of cataract extraction, extra-capsular, linear, loop extraction of luxated lenses, even reclination and Ridley's inclu­sion of a plastic lenticulus are described or mentioned.

The discussions of preliminary prepara­tion of the patient, the postoperative care, and the management of complications are full and practical.

Treatment of retinal detachment is com­prehensive and understandable. Much of the material appeared earlier in Arruga 's book on this subject. The techniques of treating the region of the retinal tear are generally those adopted by most American authors. The lucid description and illustrations make it possible for the beginner to obtain a men-

1844 BOOK REVIEWS

tal picture of the procedure which is to be The final 70 pages of text are devoted to followed. the "Surgery of the eyeball," the vitreous,

The section on the "Surgery of glaucoma" the orbit, and finally an essay on the subject devotes little space to the etiologic factors of of intraocular foreign bodies. In this section, the various types of glaucoma. The classic as in all the rest, the later developments are operations and many variations in technique mentioned and many of them described in are clearly presented by description, illustra- detail. The electronic metal locator could be tion, and diagram. The complications and more fully treated. difficulties of each type of procedure are sue- As stated in the translator's preface, "The cinctly discussed. vast experience and surgical skill of Doctor

The chapter on "Surgery of the muscles" Arruga and the unusual quality of the illus-devotes considerable space to the theoretic trations make this book a notable addition to considerations which determine the choice the books already available on the subject." of muscle to be operated and what is to be The book is recommended to everyone who done to it. Then the techniques for produc- aspires to do ophthalmic surgery, or teach it, ing the desired effects are described. The and who needs at times a source where cor-recommendations of many leading figures in rect techniques and indications for operative the field of muscle surgery are given along procedures can be readily and understand-with a great variety of methods of modify- ably reviewed. ing the actions of the ocular muscles. B. Y. Alvis.

O P H T H A L M I C M I N I A T U R E

T H E OPERATION FOR CATARACT

A proper cure begins with a purgative, using my Jerusalem pills, compounded only by me. The formula of these is spurge, half an ounce, hepatic aloes, five ounces, to be ground with sugar of roses. After purgation, at the third hour, the patient should be placed astraddle a bench, as if on horseback. Now be seated on the same bench face to face with the patient, who will keep one eye closed. So begins the operation in the name of our Saviour Jesus Christ.

With one hand raise the upper lid, and with the other hold a silver needle and direct it toward the outer lacrimal region. Then perforate the eye coats, pushing and turning the instrument around with the fingers until you touch the diseased matter, which the Saracens and Arabs call linzaret (but which we call cataract), with the point of the needle and dislodge it from its position in front of the pupil. Then push it well below, holding it there until you have said four pater nosters. Then carefully and slowly turn the needle back to its first position in front of the eye. If the cataract follows the instrument and shows itself in front, you must again depress it, pushing it this time as much as possible toward the ear. Then withdraw the needle in the same manner that it was inserted. And note well that having entered the instrument you must not withdraw it until you are convinced that you have depressed the cataract in the manner just described.

After the operation the patient's eye must be closed, and he should be kept in bed on his back in a shady part of the house. He must not be moved nor allowed to look at a light for eight days, during which period the eye operated on must be dressed with white of egg twice a day and twice during the night. His diet should be soft, fresh eggs with bread. If the patient is young, let him drink water; if old, he may drink a little wine well diluted with water. Many (physicians) allow such patients the meat of chicken, but I prohibit it as being too heavy. That sort of diet causes a rush of blood to the eyes and interferes with natural healing. Finally, after eight or nine days, let the patient make the sign of the Cross and leave his bed. He may now bathe in cold water and so accustom himself to that practice.

Benevenutus Grassus of Jerusalem, De Oculis Eorumque Egritudinibus et Curis,

Translated by Casey A. Wood, 1929