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THE sixtieth annual meeting of the Wisconsin State Medical Society was held in Milwaukee on June 29. The following officers were elected for the ensuing year: President, Doctor Levi H. Pelton, of Waupaca; first vicepresident, Doctor Arthur J. Burgess, of Milwaukee; second vicepresident, Doctor William E. Ground, of Superior; third vicepresident, Doctor W. J. Pinkerton, of Prairie du Chien; secretary, Doctor Charles S. Sheldon, of Madison; treasurer, Doctor Sidney S. Hall, of Ripon. The next meeting will be held at Superior.
DOCTOR CHARLES WARREN ALLEN, Professor of Dermatology in the New York Postgraduate Medical School, died of typhoid fever at Gibraltar, on May 31. Doctor Allen had been attending the International Medical Congress, having spoken at the Section on Radiology, and was attacked with his fatal illness while en route home by way of Naples. At Gibraltar his illness became so severe that he was persuaded to discontinue his journey. Doctor Allen was an authority on radiotherapy, and contributed many valuable papers to radiologic literature.
PROGRESSIVE MEDICINE-June, 1906.*
THE second number of Volume VIII is devoted to the following subjects: Hernia, Surgery of the Abdomen exclusive of Hernia, Gynecology, Diseases of the Blood, Deathetic and Metabolic Diseases, Diseases of the Spleen, Thyroid Gland, and Lymphatic System, and Ophthalmology. We have praised the merits of this quarterly visitor so often that it seems unnecessary to say more. But for those who may not be acquainted with the object of "Progressive Medicine" a few words will not be out of place. "Progressive Medicine" is a yearly summary of the world's best literature in all branches of medicine and surgery. It gathers together an extensive bibliography of all the subjects dealt with and presents its matter in such a way that one who has endeavored to keep abreast of the times, feels that great justice has been done the original articles by the reviewer. The knowledge obtained from "Progressive Medicine" is very trustworthy.
In those parts devoted to surgery every new and important method is illustrated by copies of the original illustrations. The cuts are clear in every detail. The book is executed in convenient form. As yet we have no occasion to say aught against this valuable publication.
*By Hobart Amory Hare, M. D. lishers, Philadelphia and New York.
D. M. C.
Lea Brothers & Company, pub-
A TREATISE ON DIAGNOSTIC METHODS OF EXAMINA
THE fact that Sahli's work on diagnosis was not translated into English long before this has been a matter of comment among all who knew the value of the work. Even in the first edition, a very much. smaller volume than the latest, the book had a striking individuality. It not only gave diagnostic methods with fulness and accuracy, but it also gave explanations of the problems involved, physical, chemical, physiological and pathological. From the fulness and soundness of its discussions the work was indispensable to all who wished to go most thoroughly into medical diagnosis.
The large body of medical students, postgraduate as well as undergraduate, are to be congratulated upon the fact that the work is not only available now in English but that it is put forward in the best possible manner. The translation is good. The notes and additions are accurate and discriminating and the mechanical execution of the volume such as we have been made familiar with by the Saunders firm. A successful career can be confidently predicted, and at the same time we may expect that a great impetus will be given to the use of good diagnostic methods by American physicians.
*By Professor Doctor Hermann Sahli. Edited, with additions, by Francis P. Kinnicutt, M. D., and Nathaniel Bowditch Potter, M. D. Authorized Translation from the fourth revised and enlarged German edition. Philadelphia and London: W. B. Saunders & Company,
A COMPEND OF OPERATIVE GYNECOLOGY.* BAINBRIDGE and Meeker have filled a long-felt want by producing a little book of only sixty-six pages which considers all the important gynecologic operations in a terse but comprehensive manner.
The book is intended primarily to serve as an aid to students taking the course in operative gynecology in the New York Postgraduate School. As an illustration of its scope we may cite the description of the Alexander operation. The surgical anatomy receives attention first origin and course of the round ligament, its attachments, and the position of the external ring. Next comes the technic of the operation: the incisions, and what they should accomplish; the method of uncovering and hooking the ligaments; the method of producing proper traction after freeing the ligaments; the cutting away of the slack portion of the ligament and its subsequent anchorage. Materials used. Aftertreatment. Various modifications. Objections to its use.
If, in the next edition, the authors would insert a good cut to illustrate each operation, the value of this book would be almost inestimable. It is a clear-cut rendering and has a field of usefulness because of its comprehensive briefness and convenient size.
D. M. C.
*The Grafton Press, Publishers, New York. Price, $1.00.
THE VISUAL FIELDS AS AN AID TO DIAGNOSIS.
GEORGE SLOCUM, M. D.
DEMONSTRATOR OF OPHTHALMOLOGY IN THE UNIVERSITY OF MICHIGAN.
THE term visual field is employed to designate the sensitiveness of the whole retina to form. It is distinguished from central vision at the macula by the expression, visual acuity, which is symbolized as V. or V. A. Visual acuity is direct or axial perception, while the visual field is the perception of form as characterized by the ability to see two separate points at one and the same time over all sensitive portions of the retina. It is the indirect vision.
The limits of the field of vision have two factors, the anatomical configuration, namely, the eyebrows, lids, lashes, nose, lips, et cetera, and, the limit of retinal sensitiveness at its peripheral portion. The first factor is variable and must often be taken into consideration. The second factor is also variable even in health. Fields are increased in hyperopia and by the action of strychnia, and decreased in myopia. Various ocular, cerebral, and general diseases, some of which may be functional while others are organic, also decrease them.
It is to the diagnostic value of the visual fields, more particularly in regard to extraocular and general disease, that I wish to direct your attention, but before doing this a few remarks in regard to the methods of taking visual fields may be of interest.
A simple expedient is that of seating the patient, with one eye covered, directly in front of the examiner, who also must close one eye, his right for the patient's left and vice versa, and then, the patient's other eye fixed on his, he carries an object from without his own field directly in from above, below, without, or within, equally distant from his and the patient's eye and compares the first perception of the object by the patient with his own. This is only a rough approxima
tion but it will determine the presence of marked contractions or of hemiopia. Large scotomata may also be found. The method of taking the fields with a blackboard is open to the objection that as an angle of forty-five degrees is reached the distance of the test object rapidly becomes so great that its mere remoteness serves to render it less distinct. The perimeter is practically much more valuable, and for accuracy, indispensable. The instrument needs no description here.
The size of the test object is important. In general, for white, a square of ten millimeters is satisfactory. Where the vision is low, twenty millimeters is better, and in some cases a white card of ten to fifteen centimeters with a black spot in the center five to ten millimeters in diameter is exceedingly useful for accurate work. In locating scotomata, the test object should not generally exceed one to five millimeters. The examination should be made in good daylight and should be carefully conducted. The more painstaking the examination, the more valuable does the chart become for diagnostic purposes.
The normal limits of the visual fields are approximately in degrees as expressed by the chart: up, fifty; up and out, sixty-five; directly out, ninety; out and down, eighty-five to ninety; down, seventy; down and in, fifty; in, sixty, and up and in, fifty-five, with reference to axial vision.
The color fields are as important for diagnostic purposes as the form, particularly, in their relation to that for white, and to each other. They are arranged from without in, yellow, blue, red, and green in order.
Of much importance also, for diagnosis, is the location, character, and size of the various scotomata. A physiologic scotoma located about fifteen degrees temporally from the axial center marks the physiologic blind spot or optic nerve entrance. It is a negative scotoma, a positive scotoma being one of which the patient is conscious. Scotomata are false when caused by opacities of, or foreign bodies in, the media, and true when caused by defect of the receptive, conductive, or perceptive apparatus. They may be in the central, itermediate, or peripheral zone, and are irregular, concentric, central or paracentral. They are absolute when all perception of light is lost and relative when acuity is diminished. The latter are color scotomata and are more generally for green and red, blue being longest retained and therefore less often lost.
The relation of the color fields to that for white, as said before, is very important. Where they diminish much more rapidly than that for white and central vision is diminished, atrophy or pressure upon the visual paths is usually present. Where the vision is rapidly lowered by subdued light, as in twilight, the so-called hemeralopia, the color fields are greatly restricted and disappear if the fields are taken in such light, while at the same time the form fields are undiminished. Purely functional conditions as in the neuroses, often present contracted fields for white with characteristic change of those for colors. Peripheral defects are divided into concentric contraction, contraction with sector
like defects, and sector defects with the remaining portion of the field normal, or nearly so, the latter often extending nearly to the point of central fixation.
Brief mention only will be made of most of the intraocular conditions causing visual defects. The diagnostic value of these fields is greatly enhanced by associated ophthalmoscopic examination.
The fields are restricted in retinitis pigmentosa, circular detachment of the retina, glaucoma, atrophy, and hysteria, in all of which there is concentric contraction.
Hemiopia or half sight, whether temporal, nasal or transient shows a marked limitation or suppression of one-half of the field.
Central scotomata are found in tobacco or other toxic amblyopias, in retrobulbar neuritis, in embolism of the retinal artery, and in central choroiditis. Scotomata and contractions occur also in papillitis, retinitis and choroiditis. Irregular scotomata are seen in atrophy, choroiditis, coloboma, detached retina, irregular hemorrhages, nephritis, foreign bodies and opacities of the media.
An enlarged blind spot is seen in opaque nerve fibers and in retinal and choroidal coloboma, while retinal hemorrhages may cause irregular scotomata with or without concentric contraction.
In embolism of the retinal artery blindness usually results, but in those cases where the macular branches are given off in the nerve below the embolism, central vision may be retained. Here the field will correspond only to the then unaffected portion of the macula. When the embolism is limited to a retinal branch, a sector defect will appear. Occasionally there is a cilioretinal artery present. When this is the case vision may be preserved only in that portion of the retina supplied by it or it may itself be the seat of the embolism, in which case there would be a large central scotoma corresponding to the area supplied by the cilioretinal artery.
In retinal detachment, the fields will show a marked contraction or sector defect corresponding to the detachment, which, unless recovery takes place, usually increases in size.
The change in retinitis pigmentosa is typical, there being concentric contraction, with marked decrease of the color fields and their complete loss in poor light. Other forms of retinitis, neuroretinitis and choroiditis present marked changes not typical.
When the underlying cause is syphilis the normal field is often restored by appropriate treatment.
Perhaps the most important diagnostic significance of the visual fields in intraocular affection is in glaucoma. In this disease the fields. are usually contracted most nasally, for the nasal field is that which falls on that portion of the retina without the macula and this being farthest from its blood supply, it is therefore most easily affected by the cupping and pressure at the papilla. Associated with this contraction more or less reduction of the visual acuity is seen, which gradually increases as the disease progresses, and at the same time that the con