588 AMERICAN JOURNAL OF OPHTHALMOLOGY SEPTEMBER, 1966

on stretch, and its effect can be seen in the electrocardiographic tracing."

The fact that traction on the lateral rectus muscle causes EKG changes is well docu­mented. Traction is considered unnecessary in making retrobulbar injections. EKG re­cordings were made in a series of retrobul­bar injections in which the following tech­nique was used. The needle is introduced close to the inferior temporal margin of the orbit and is directed straight back close to the floor of the orbit until the point is be­yond the globe, then directed upward toward the apex of the orbit and into the muscle cone just posterior to the globe where the injection is made. No resistance should be encountered after the orbital septum is pierced. No traction on the lateral rectus muscle was used and no abnormal tracings were recorded.

Walter S. Atkinson

DIAGNOSTIC ULTRASONOGRAPHY

Editor, American Journal of Ophthalmology:

Dr. Gilbert Baum's paper (Am. J. Ophth. 60:493-498 (Sept. 1965) misinterpreted some points concerning an earlier paper of mine (Am. J. Ophth. 57:461-466 (Mar.) 1964).

In contrast to previous publications by Dr. Baum, the article under discussion con­tains neither new experimental or clinical findings nor strong support of the opinions advanced. Moreover, the leading investiga­tors do not differ greatly in their opinions on the value and management of diagnostic ultrasonography, as Dr. Baum and others suggest.

I should like to present a lengthy elabora­tion of these statements, but I feel there have already been too many comments on diag­nostic ultrasonography containing chiefly assumption and opinion, and by far not enough based on scientific experiment and observation.

May I therefore ask those colleagues in­

terested in an elaboration on the above statements to contact me directly, while for publication in T H E JOURNAL, I propose to submit a report on recent results of diag­nostic ultrasonography involving some hun­dred patients.

W. Buschmann Berlin

BOOK REVIEWS VISION : BIOPHYSICS AND BIOCHEMISTRY OF

THE RETINAL PHOTORECEPTORS. By Jer­ome J. Wolken, Ph.D. Springfield, Illi­nois, Charles C Thomas, 1966. Cloth-bound, 193 pages, 104 figures in black and white, 8 tables, references, author and subject indexes. Price: $9.00. As the author clearly states in his preface,

this monograph is a review of his own work on photoreceptors, not a treatise on the ex­tremely large territory of vision in all its as­pects. The work described is of varied inter­est ranging from microspectrophotometry of isolated receptor outer segments through studies on rhodopsin and tissue culture of retinal cells to a discussion of photorecep-tion in the invertebrate eye.

It is in this last field that the author's work is particularly noteworthy. He has re­fused to be daunted by the supposed discon­tinuity between photoreception in the verte­brate and invertebrate, and has gone on to show numerous areas of congruence be­tween the two supposedly different func­tions. If the book serves to call attention of potential researchers to the largely untapped area of research on invertebrate visual pro­cess, it will have done an excellent service to visual science.

Albert M. Potts

RETINAL DETACHMENT SURGERY: DIAG­NOSIS AND TREATMENT. Papers pre­sented at a Post-Graduate Symposium for Nordic Ophthalmologists held at Gothen-

VOL. 62, NO. 3 BOOK REVIEWS 589

burg in December, 1964. Edited by Bength Rosengren. Gothenburg, Sweden, Elanders Boktryckeri Aktiebolag, 1966. Clothbound, 196 pages, 71 figures in black and white, 5 tables, chapter references, index. Price: Sw. Cr. 60 (sewn), 75 (cloth). This book has also been published as a

supplement to Acta Ophthalmologia (Sup­plemental 84). It represents a brief sum­mary of the historical development of reti­nal detachment surgery and the current views in Scandinavia as to the proper man­agement of a patient with a retinal detach­ment. It is well written, easily read and dominated by the thinking of Prof. Rosen­gren who, while relatively unknown in this country, has contributed significantly to our present knowledge of the subject.

The complex origin of a retinal detach­ment is discussed in a review of chorioreti-nal and vitreous factors as a cause of the retinal breaks. In the United States, the subretinal fluid is assumed to be a "vitreous extract," filtering through the break but, in this review, the role of the choroid in the formation of subretinal fluid is emphasized.

In the discussion of ophthalmoscopy, I was surprised to see the discovery of in­direct ophthalmoscopy attributed to Helm-holtz rather than Ruete. While the advan­tages of indirect ophthalmoscopy over direct ophthalmoscopy are emphasized, there is lit­tle or no mention of the value of binocular indirect ophthalmoscopy over the monocular methods. For those of us in this country who daily see the advantages of a stereo­scopic view of the fundus, it is difficult to understand why the Europeans have been so slow to change. At times I feel as though they are dragging their feet in this area as we Americans are so often prone to do. De­spite their unwillingness to take up binocu­lar indirect ophthalmoscopy, considerable emphasis is placed upon binocular mi­croscopy of the vitreous and fundus and I would guess this group, under the influence of Goldmann, is ahead of us in this area.

Scleral depression while mentioned is not emphasized.

In the discussion of surgery, Prof. Ro­sengren gives reference to his classic work on the use of intravitreous air in the man­agement of selected cases (1936) and refers to the original work of Ohm (1911). This technique has had limited popularity in this country and is undoubtedly deserving of much more attention. Another chapter dis­cusses the use of methods of inducing local scleral impression. Proper credit is given to Prof. Custodis for his monumental con­tribution to detachment surgery—the buckle, or as Custodis called it, the plomb (1949). Prof. Rosengren also emphasizes his own ingenious technique of a silver Plomb (1960) which, to my knowledge, has not been taken up in this country.

Selection of surgical procedures, in­cluding the encircling method of Schepens (1957), for specific types of detachments, as well as results at the Gothenburg clinic since 1936 are presented.

While every detachment surgeon will find areas of disagreement, the quality of this symposium makes it a must for each of us.

Edward W. D. Norton

CURRENT THERAPY 1966. Latest approved methods of treatment for the practicing physician. Edited by Howard F. Conn, M.D. Philadelphia, W. B. Saunders Com­pany, 1966. Clothbound, 857 pages, 2 figures in black and white, 58 tables, ap­pendices, index. Price: $13.00. This is the 18th edition of Current Ther­

apy, and it continues to devote itself to the task of bringing concise information on cur­rent therapeutic methods to the practicing physician. It represents the method of ther­apy of the individual author writing each section, who may not be the originator of the regimen which he describes. Much of it is the summation of work of many clini­cians over the years. There are sections dealing with infectious disease, the respira-