886 AMERICAN JOURNAL OF OPHTHALMOLOGY APRIL, 1967

anatomy and physiology of the extraocular muscles as they relate to the diagnosis and treatment of paralytic strabismus.

In the first part of the volume Hambur­ger discusses the anatomy and physiology of binocular vision and ocular motility and presents, in addition to the classical body of knowledge, the new description of the me­chanics of the extraocular muscles as given by Boeder, the anatomic relationships as de­scribed by Fink, the histologie structure as investigated by Siebeck and Krüger, and the principles of feed-back control of the ocular movements. The chapter is well and concisely written. One feature which was annoying to this reviewer, which might well be corrected in a future edition, was that the papers of a large number of authors, quoted by name in the text, are not listed in the references. This makes it very difficult for the interested reader to refer to the sources.

The section on the methods of examina­tion, also by Hamburger, is quite brief and by no means complete. However, in a subse­quent chapter by Hamburger dealing with the signs and symptoms of paralytic strabis­mus some of the methods of examination are further discussed, as is the diagnosis of the paralysis of individual muscles and groups of muscles.

Also dealing with the methods of exam­ination is a chapter by Mackensen on the tangent screen devised by Harms. The same author has contributed a brief note on elec-tro-oculography. An excellent survey of electromyography is given in a chapter by Huber.

Klara Weingarten reviews the neuro-oph-thalmologic aspects of the extraocular mus­cle palsies, in particular their etiology, and includes a survey of the supranuclear paral­yses. The surgical treatment is presented by Hollwich and Krebs. The authors emphasize that the goal should be to create parallelism of the visual axes in primary position and to enlarge so -far as possible the field of single binocular vision.

In two separate concluding chapters Adel-

stein and Cuppers discuss ocular torticollis, and the differentiation of true sixth nerve paralyses from an apparent sixth nerve par­alysis due to a convergent position of the eyes assumed to block a nystagmus.

The volume does not offer much that is new to the specialist. It is difficult to judge to what extent it might be useful to one who is less well acquainted with the subject. It is, however, of interest to note that the new acquisitions in anatomy and physiology dis­cussed in the first chapter of the book ap­pear, as yet, to have had little effect on the clinical thinking and the handling of pa­tients with paralytic strabismus discussed in subsequent chapters.

Hermann M. Burian

DIE RÖNTGENDIAGNOSTIK DER T R Ä N E N A B L E -

ITENDEN WEGE. By M. Radnót and J. Gall. Budapest, Akademiai Keado, 1966. Cloth-bound, 191 numbered pages, 137 figures, 113 sketches. Price: $11.00.

This very interesting and well-made book, besides presenting useful information, serves to underline one of the dilemmas of medical practice in our time. Modern medi­cine is indissolubly bound to an increasing number of diagnostic procedures. Blood counts, urinalysis, blood chemistry deter­minations, microbiologie cultures, electrocar­diograms and many other procedures, though occasionally used thoughtlessly, are when properly employed part of the solid foundation on which our uniquely effective practice is based. In purely ophthalmic prac­tice relatively common procedures such as tonography are being augmented by elec-troretinography, electro-oculography, visual-evoked-response determinations, monochro­matic ophthalmoscopy, ultrasonography and pupillography. In all of these determinations a common factor is that the aid of a techni­cian is ordinarily employed. The physician, even if he were to possess the skills to per­form these procedures, cannot have the time to give effective patient care unless the exe-

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cution is delegated to others and only inter­pretation is done by him. This results in in­evitable removal of the physician from the scene of the procedure with possible unhap­py consequences. Even more separation of execution from purpose arises when the procedure such as clinical chemistry, electro-cardiography or radiography is done by a technician under the supervision of a physi­cian in another department.

It is perfectly evident from the careful description of technique and the 135 well-reproduced plates that the entire basis for the success of lacrimai contrast radiography is the presence of the interested ophthal­mologist at the actual examination, the in­jection of the contrast medium by him, rely­ing on his experience to avoid soft tissue infiltration. Finally, the ophthalmologist sees the results quickly and knows immediately whether the procedure is informative or re­quires repetition. It is also evident that in­jection of contrast medium by a radiologist followed at some interval by films made by a technician, followed at a much longer in­terval by a report to the ophthalmologist is unlikely to yield useful information on the lacrimai system.

This, then, is the dimension of the di­lemma. To get a useful result, the interested ophthalmologist must perform the examina­tion—not delegate it to a radiologist, a tech­nician or both. The material presented by the authors make credible their claim that in every case in which surgical manipulation of the lacrimai pathways is contemplated radi­ographie examination with, or rarely with­out, contrast medium should be done.

For those interested in details the au­thors' recommended technique is worth not­ing. Because fat-soluble compounds tend to ball up and give false contours, and because of their tendency to remain in tissues for extended periods, they are not considered satisfactory as contrast media. The authors use a solution of water-soluble iodinated or­ganic compound Joduron-B ( es Diodrast) whose viscosity has been increased by the

addition of methyl cellulose. All pus must be washed from the lacrimai sac to allow ade­quate filling. While filling through the lower canaliculus, the upper punctum is partially occluded with a glass rod to allow filling of the upper canaliculus without overflow of contrast medium to the lacus lacrimalis. The chin-nose position is favored for making the picture but other positions are used when appropriate. The Sweet localization tech­nique can also be used to advantage in plac­ing the shadow in relation to the globe. In all cases particular precautions are taken to prevent swallowing and blinking by the pa­tient before the pictures are made.

It would appear that only by paying me­ticulous attention to details such as these can meaningful results be obtained. The individ­ual physician must solve for himself the problem of how much time he can spend ac­quiring and practicing a new technique which gives useful results to only the most motivated practitioner.

Albert M. Potts

MODERN PROBLEMS IN OPHTHALMOLOGY (Volume 4) . Edited by E. B. Straff, Laus­anne. New York, S. Karger AG, 1966. Clothbound, 308 pages, 104 figures, 26 tables. Price: $20.70.

Volume four of this estimable series con­cerns the surgery of retinal vascular dis­eases and the prophylactic treatment of reti­nal detachment. The papers are those re­ported before the third meeting of the Jules Gonin Club, held in Amersfoort, Holland, in 1963.

The Jules Gonin Club is composed of members from both hemispheres who are particularly concerned with retinal disease and its treatment. The first meeting was ap­propriately held in Lausanne in 1959, the second also in Lausanne in 1961, the fourth in Villars-sur Ollon, Switzerland, in 1965, and the fifth in Munich in 1966.

This report opens with a memorial tribute