292 BOOK REVIEWS

Of particular interest to ophthalmologists should be the chapter (XXII) on "Medical eye practitioners." Here the ophthalmologist will learn of the lowly origin of his own specialty, the "itinerant quacksalvers"; and of the opposition of our medical colleagues to our specialty.

If this is not surprising enough, there are the definitions, "an ophthalmologist is a physician certified by the American Board of Ophthalmology"; an oculist is "a phy-sician without special certification who limits his practice to the care of the eyes"; and the E.E.N.T. specialist is "a physician without special certification who limits his practice to the care of the eyes, ears, nose, and throat."

The ophthalmologist will be particularly surprised to find that the reason why op-tometry is not acceptable to him is because of the economic competition involved, in spite of the fact that it is well known that 80 per-cent of the people with visual symptoms see the optometrists, and in spite of the fact that every ophthalmologist is severely over-worked.

There is little consideration given to the idea that the chief reason for objecting to optometrists is that they are not competently trained to recognize ocular diseases and pathologic conditions, thereby exposing the public to exploitation and to the risk of blindness.

Chapter VII, "The title 'doctor' and designations other than optometrist," will likewise prove of interest and deserves careful reading. The following paragraphs are reproduced for your information.

"The prime reason that the optometrists want the doctor degree is that the public expects a person who examines eyes to be a doctor; i.e., the public automatically puts the optometrist in a category with the dentists and physicians. If he uses the title, no questions are asked; if he does not em-ploy the title, he is repeatedly requested to explain why.

"Furthermore, the title has been used for centuries as a means of designating a higher degree of learning in various fields, such as theology, law, and science, as well as in medicine; and, therefore, the title inspires confidence on the part of the public that the holder knows what he is doing. Proper rap-port between the patient and the optometrist is quite essential and it is probably justifi-able to make use of the title to help induce proper rapport."

That this claim is modest is, of course, apparent. Think how much prestige the optometrists would have had if they were all called "Professor." Perhaps they can be persuaded to adopt this title. It would save the ophthalmologist much trouble in ex-plaining to the people and even to his medi-cal students, what the difference between "ophthalmologist" and "optometrist" really is.

The "professor" who plays the piano "downstairs" while the "profession" prac-tices "upstairs" is in a good position to put the customers in a state of proper rapport.

Derrick Vail.

OFFICE TREATMENT OF THE EYE. By Elias Selinger, M.D. Chicago, The Year Book Publishers, 1947. 542 pages, 67 illustra-tions, index, chapter bibliography. Price, $7.75. Dr. Selinger's book was published only

shortly before his untimely death, and is now both a valued legacy to his confreres and a fitting memorial to his memory. The delay in the presentation of this review, for which the JOURNAL apologizes, permits a perspective that shows its high points of quality in bolder relief. The volume, in-tended for the indoctrination of residents in ophthalmology, is still full of novel and valuable hints for the seasoned practitioner. The material is well organized, minutely detailed, and clearly illustrated. Selinger's own contributions, such as the quinine bi-

BOOK REVIEWS 293

sulfate treatment of trachoma and his tech-nique for iontophoresis are lucidly recorded. Much ophthalmic surgery is carefully de-scribed that could be done in a properly equipped office operating room, and, indeed, if the present hospital situation continues, minor surgery and emergency procedures could be handled better with such an ar-rangement.

Certain statements are open to question, such as "in congenital cataracts needling can be performed safely between three and six months of age." It is an error to suggest to glaucoma patients the self-instillation of drops in the lower fornix. Although this method is generally satisfactory for con-junctivitis, it does not insure adequate ab-sorption. Where self-administration of miotics or mydriatics is necessary, the pa-tient should lie supine, bring the dropper above his eye, and let the drop fall on the cornea. In the description of stellate retinopathy, no mention is made of the pseudoalbuminuric retinitis of Leber that follows edema of the macula due to trauma or other cause, while Duke-Elder reserves the term for this particular entity.

Ophthalmic therapy, in spite of its im-portance, has only within recent years re-ceived adequate special attention. American ophthalmology has moved far toward the Hippocratic ideal of making therapy "cer-tain, speedy, and comfortable." Some definite advances are not included in even this latest compilation. Sulfonamide therapy has been improved by administering the most effective representatives in combina-tion—-"triple sulfonamides." Tuberculin testing has become more general through the convenience of the Vollmer patch test. The instillation of histamine phosphate (1:1,000) has helped control episcleritis. The new plastic lenses are more protective than the laminated or tempered variety. As an occlusive contrivance, the rubber suc-tion occluder of Jamieson is superseded by the Bel-occluder.

Although Selinger advocated the conven-tional skin incision for acute dacryocystitis, the operation of Agnew, revived by Ver-hoefr and described in the American Ency-clopedia of Ophthalmology, is far prefer-able. It requires only a preparation similar to that for probing. A keratome, placed anterior to the caruncle, enters the sac and releases the pus. Immediately after, a No. 14 probe, easily passed into the naso-lacrimal duct, secures adequate drainage. For lymphangiectases of the bulbar con-junctiva, Selinger suggests incision, but obliteration by galvanocautery is as easy and more effective.

Because of the author's decease this book is unlikely to be published in a succeeding edition. It is to be hoped that whatever is excellent and permanent will, nevertheless, be perpetuated. James E. Lebensohn.

L E FOND D'OEIL DES HYPERTENDUS ET DES CYANOSES. (The ocular fundus in hyper-tension and vascular congestion.) By Daniel Routier. Paris, Masson et Cie, 1947. 100 pages, 232 figures. Price, 1,350 francs. The author, who is a cardiologist and not

an ophthalmologist, has succeeded in pro-viding us with a valuable book, consisting of his observations over many years of his numerous patients with heart disease and vascular hypertension.

The illustrations are beautiful black and white photographs of the ocular fundus taken with the Nordenson reflex-free camera. They are well chosen. Accompany-ing the plates are fine descriptions of the lesions seen and the interpretation of them from the author's viewpoint.

This approach, seldom encountered by the ophthalmologist, will intrigue him and will yield much information of value to him. Few ophthalmologists are experts in vascu-lar diseases and find the meaning of what they see with the ophthalmoscope difficult,