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blood-pressure affected the eye after ligature of the external carotid, through anastomotic branches from the internal carotid and through the circle of Willis. Intra-ocular tension responded passively to all variations in general blood-pressure, even when the external carotid was tied or the skull laid freely open. The respiratory and cardiac oscillations were usually clearly represented by the air bubble in the connecting tube, but were not recorded by the manometer. The general curve of the blood-pressure was reproduced in a "damped" form by the intra-ocular manometer, i.c., there was a short latent period of one to two seconds; the changes were slower and he curve flatter. Variations of bloodpressure by mechanical pressure of the aorta, stimulation of the central end of sensory and mixed nerves, the vagus, the cord, or vasometer centre, were accompanied by rise in intraocular tension. Drugs which modify blood-pressure (e.g., adrenalin, nicotine, strychnine, pilocarpin, quinine, amyl nitrite, and large doses of chloroform) have a similar influence over intra-ocular tension. Asphyxia caused increase in blood and intra-ocular pressure, followed by a fall in both pressures.

The authors do not regard the experiments, as performed, to have been influenced by the elasticity of the sclerotic or by active vasomotor changes.


Brown Pusey (Archives of Ophthalmology, March, 1904) found that fresh sheep's eyeballs immersed in solutions of either salt or sugar of the concentration of m/32, m/16, m/8 increased in weight, whilst in similar solutions of concentration m and m/2 they lost weight. From these experiments he concludes that variations in tension may take place under varying osmotic pressures, and may be the explanation of the primary cause of glaucoma.

In carrying out these experiments the author found that the lenses of the eyes placed in m and m/2 solutions of salt

and sugar became cataractous after one and a half to two and a half hours' immersion in the salt solutions, and after twenty-four hours in the sugar solutions. The lenses which became cataractous in the salt solution could be cleared again by putting them in an m/32 solution of salt, or by leaving them in distilled water for some hours.



Ophthalmological Anatomy, with some illustrative cases. By J. HERBERT FISHER, M.B., B.S., F.R.C.S. London : Hodder and Stoughton. 1904.

THIS volume contains an excellent selection of anatomical information concerning the eye and its adnexa. The subject matter is divided into nine chapters. The first four deal with the origins, courses, and distributions of the ocular nerves. The fifth chapter deals with the cutaneous nerves of the head and face and cerebral topography. The sixth deals with ocular muscles and movements; the seventh is concerned with the eyelids and lachrymal apparatus; the eighth is devoted to the ophthalmic blood-vessels and intracranial venous sinuses; and the ninth includes the anatomy of the orbit and the surrounding air cells, and some points in development. It is not to be supposed that this represents the whole field of ophthalmological anatomy, and the author's expressed intention is that it should be a "useful supplement to students' text-books, and prove a practical help to the clinical ophthalmologist."

In this the author has been eminently successful, as the work before us contains a large amount of information which it would be almost impossible for the busy practitioner to acquire and retain in his mind were it not presented to him in so accessible a form. The contents of this book are essentially useful and practical, and the application in practice of many of the points mentioned is demonstrated in the list of illustrative cases described at the end of the book. It is hardly necessary to say that the anatomical and clinical descriptions are tersely and lucidly given, and their correctness is only what we should expect from an author so experienced in anatomical teaching and practical ophthalmology. Ophthalmic surgeons should be much indebted to Mr. Fisher

for supplying them with a valuable book, the information contained in which must be put into use daily by every ophthalmic surgeon in active practice. The publishers are to be congratulated on the excellence of the paper and type, and upon the elegant appearance of the volume.

Enlargement of the Prostate. By C. W. MANSELL MOULLIN. EXTENSIVE as has been the literature on this subject during the last few years, we can still welcome a little book which devotes itself to a review of the condition and the methods of treatment. We have become so accustomed to statistics of suprapubic prostatectomy with records of so many ounces of prostate removed, and the battle of what constitutes the capsule of the prostate, that we are in danger of losing sight of the fact that there are other methods of treatment, and that very often it would be better that we should try these methods, and not act upon the suggestion, "Here is a prostate; let's remove it." The author gives a very good description of its anatomy and development, and attributes modern treatment to a proper understanding of the latter. He shows that the organ is developed independently of the bladder and in connecion with the Wolffian ducts, and that it is not in any way homologous with the uterus; that the utriculus being incorporated with it is a mere accident of growth; that if one vas deferens is not developed, the corresponding half of the prostate remains undeveloped though the testis may be normal.

Another point insisted upon which is important in the consideration of the treatment, is the greater proportion of glandular tissue in the base of the gland as opposed to the apex. This results later in the projection of the adenomatous masses into the bladder, and therefore to a preference on the part of the surgeon for the supra-pubic route.

The author agrees that the enlargement is due to adenomatous masses for the most part, but holds that there is at the same time a true hypertrophy of the stroma, and that in the cortex the fibro-muscular layer increases from the first.

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A most vivid picture is drawn of the symptoms of the enlarged prostate, especially in the later stages, when engorgement is added to hypertrophy, and the evils of cystitis supervene from catheterisation, as they do sooner or later, despite the most stringent precautions.

The chapter on General Treatment is very well worth reading, as is also the Local Treatment. Various methods which the author has found of value are discussed, though McGill's operation-for, after all, it is to McGill that we owe our present position with regard to the supra-pubic removalseems to be rather shortly dismissed.

A point of supreme importance is insisted upon, and that is that prostatectomy should never be performed immediately after an attack of retention of urine, but the operation divided into two stages. First, a supra-pubic drainage until the urine has become clear and sweet, and, what is of much greater importance, the bladder and kidneys have recovered their tone; then the removal. When this is fully realised, the mortality of the operation will improve.

An impartial reader would gain the impression from persal of the book that indirect operations, such as removal of the testis or ligature of the cord, are of more value than the concurrence of opinion among surgeons seems to indicate. These operations, it is claimed, act by in some way removing a nervous influence, and cause an immediate diminution in the size of the corresponding half of the prostate; but if they were even moderately uniformly successful, they would certainly not have been discarded in favour of such a severe procedure in old men as the supra-pubic removal undoubtedly is.

The author does not apparently favour the various perineal operations, nor the urethral ones, though he thinks the method of Bottini, which consists of burning away the obstruction by the galvano-cautery applied through the urethra, is deserving of more popularity than it has obtained. It is a method, however, which can never become popular with surgeons who prefer to see what they are doing.

The illustrations are somewhat few in number, and in this respect the book could be much improved.

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