342 E D I T O R I A L S

gators. One observation of special in­terest was made, namely that the ac­tion of iris tissue in blocking scar for­mation in the scleral wound was more complete when the iris tissue was rich in pigment and less complete when the iris was poorly supplied with pigment.

While it is unfortunately true that the relief obtained from any type of fil­tration operation for simple glaucoma may occasionally prove evanescent, yet either the operation of Lagrange or that of Elliot, in combination with iridectomy, or the type of operation as­sociated with the names of Holth and Borthen, if performed early and under proper conditions, offers a distinctly hopeful prognosis. But it is apparently desirable that a not inconsiderable amount of iris tissue should remain in the lips of the wound, a purpose which may be accotnplishcd either by a some­what ragged iridectomy, or more posi­tively by doing an iridencleisis or an iridotasis, or by combining Lagrange's or Elliot's method of sclerectomy with treatment of the iris as in an iri­dencleisis; while in each of these varia­tions it is particularly advisable to make a conjunctival flap which in the first place is sufficiently ample to maintain relationship between the incarcerated uveal tissue and a large subconjunc­tival .space, and which in the second place is not too thin where it lies in contact with the prolapsed iris.

IV. H. Crisp.

ROENTGEN T H E R A P Y FOR B L E P H A R I T I S

Much still remains to be learned with regard to the benefits that may be derived from various forms of radiant energy in the treatment of disease. Sun therapy, natural and artificial, has pro­duced remarkable results as a general constructive factor, and, probably be­cause of this general tonic effect, it has been successfully applied in the treat­ment of many local disorders, includ­ing a large variety of skin infections and dyscrasias. A great deal has been

claimed for infrared radiation, although many physicians believe that heat in its more familiar modes is just as efficaci­ous as when applied by radiation.

In a general way the profound influ­ence of the x-ray and of radium upon the cells of the body is well known, but both of these sources of radiation are known to have powerful destruc­tive effects, and the fact that their em­ployment is not free from danger has undoubtedly interfered with more gen­eral resort to them for therapeutic pur­poses.

As regards the eye, fear of harm to the refractive media and even to the retina has interfered with the use of the x-ray or radium in a number of diseased conditions of the anterior segment. The treatment of cancerous growths, or the removal of misplaced eyelashes, with radium is an example of selective destruction. For miscellaneous local conditions the practicability of radium application is not so great as in the case of the x-ray, and the risks are less readily controlled.

But from time to time important suc­cesses are reported in the use of x-rays for disorders in which stimulation is necessary. In some conditions there is a marked tendency to the formation of new bloodvessels which themselves may prove a source of annoyance rather than of benefit, and it is well to remem­ber that x-radiation has a recognized power of destruction of young blood­vessels. With this in view, x-rays have been tried, with apparent benefit, in an attempt to shorten the period of ex­cessive vascularization after lime burns.

The x-ray is distinctly one of the therapeutic agents to be considered for the stimulation of sluggish corneal ul­cers, and the application of a fraction of an erythema dose often affords much relief from pain in such conditions.

Among the most obstinate disorders with which the ophthalmic physician has to deal is chronic blepharitis. Some cases of blepharitis show a decided tendency to recover when eyestrain is relieved by proper glasses. But there

BOOK NOTICES 343

are many cases of blepharitis in which refractive errors are at least not the only causative factor and in which the obstinacy of the condition is mostly comparable with that of the various types of eczema. In these cases medi­cation seems to afford relatively little relief, or such relief as is obtained proves temporary in character.

Luzsa (Klinische Monatsblätter für Augenheilkunde, 1930, volume 84, January, page 76) found ultraviolet radiation ineffective in the treatment of blepharitis, and he attributes this fail­ure to the fact that ultraviolet rays have very little power of penetration. On the other hand, he has had ex­tremely gratifying results from the use of x-rays. Of thirty-one cases so treated, fourteen were completely cured and nine showed a striking improve­ment. Anumberof the remaining eight cases failed to return to the clinic for repetition of the treatment.

The patients chosen for roentgen treatment were those who had proved most resistant to other forms of therapy over a long period of time. During the course of radiation all other treatment was discontinued.

The effective dose of x-ray was found to be that which produced an actual erythema of the lids. Patients who de­veloped an erythema got well or at least improved, while (with one excep­tion, a very recent cast of blepharitis) those who showed no erythema were not helped. For patients in whom a satisfactory erythema was not produced by the first two doses, a cumulative ef­fect was sought, and if necessary the amount of the individual dose was in­creased. The adequate dose varied in different patients. If the first dose was sufficient to cause an erythema, two treatments at an interval of one week were practically always all that was re­quired.

The first experiments were made with from ten to fifteen percent of the standard skin-erythema dose, but this produced no result. In different subjects the adequate dose was found to vary between twenty and thirty per­

cent of the standard erythema dose. On twenty-two patients a three millimeter aluminum filter was used, and on the other nine the aluminum filter em­ployed was two millimeters thick. The discharge is technically stated as pro­duced with a tension of 109 kilovolts at an intensity of four miliamperes and a focal distance of twenty-three centi­meters for an exposure of twenty minutes through the three millimeter filter, or of sixteen minutes through the two millimeter filter. The eyeball was protected by a layer of glass two millimeters thick, containing fifty per­cent of lead. IV. H. Crisp.

BOOK NOTICES

Stereoskopischer Atlas der äusseren Erkrankungen des Auges nach farbigen Photographien (Stereo­scopic atlas of external diseases of the eye from colored photographs). By Karl Wessely, professor in München. Section 1, plates 1-10. In cardboard case, price 12 ijiarks. Published by J. F. Bergmann, Munich, 1930.

This is the first of a projected series of six such atlases, each to contain ten colored plates of external diseases of the eye. Each plate is a three-color reproduction of an AGFA stercophoto­graph and is designed to be observed through an ordinary stereoscope. The use of a high-powered magnifying stereoscope brings out the grain and de­stroys much of the illusion. This first series illustrates pigmented nevus of the lower lid, circumscribed melanosis of the conjunctiva, recent lime burn, congenital coloboma of the iris, Symblepharon of the lower lid, gonor­rheal conjunctivitis, iris bombé, sarco­ma of the orbit, herpes zoster ophthal­micus, and a far advanced lid carcino­ma. Printed on the back of each plate is a description of the case in German, French, and English, the English trans­lations having been made by Dr. Per­kins of New York.