4 



NATURE 



\Nov. 2, 1 87 1 



The work of Dr. Allbutt is, however, the first treatise 

 in English that is occupied exclusively with the ophthal- 

 moscopic appearances pres^'nted incises of cerebral disease, 

 or in other words with tha diagnosis of nervous affcclions 

 by the ophthalmoscope. Abroad he has been preceded 

 by M. Boachut, whilst the volumes of the " Archiv fiir 

 Ophthalmologie " are a mine of original memoirs written 

 by the best ophthtlmologists in Germany on the bearings 

 of oph'halnioscopic observations on nervous affections. 

 To tlicsc, of course, Dr. Allbutt mikes frequent reference. 

 In no instance, ho.vever, have we noticed a servile ad- 

 herence to the opinions of others, the statemints he quotes 

 being always checked by his own observations, and 

 every page bearing the stamp of very careful and sound 

 investigation. It is impossible with the limited space here 

 at disposal, and it would perhaps scarcely be interesting 

 to many of our readers, to give what the work really de- 

 serves, a rcsuiiic'&nA discussion of its successive chapters ; 

 but we may here perhaps point out one or two of the prin- 

 cipal points of interest. 



In speaking of the disc of the optic ncive, Dr. Allbutt 

 expresses himself in favour of the view of Galezowski, who 

 is fortified by the observations of Leber, to the effect that 

 the vascularity of the disc is to a great extent independent 

 of that of the retina, and rather forms a part of the vas- 

 cular system of the brain. The importance of this principle 

 in enabling deductions to be drawn respecting the occur- 

 rence of intcrcranial disease is obvious. Proceeding on 

 this hypothesis, Dr. Allbutt points out the changes that 

 ate visible in a large number of different affections. He 

 draws a strong line of distinction between ischasmia 

 and optic neuritis, conditions that have hitherto 

 been almost invaiiably confounded by ophthalmic sur- 

 geons, but of which the former is produced by some 

 cause, often of a mechanical nature, interfering with the 

 return of the blood from the retina, whilst the latter is a 

 true inflammation of the nerve. The diagnosis of the two 

 in their earlier stages is very clearly and correctly laid 

 down. At a later period both conditions pass into white 

 atrophy, and it is not always then easy to pronounce which 

 of the two has previously been present. His views, in 

 regard to changes in the optic disc from intercranial 

 disease, are clearly laid down in the following passage 

 (pp.129, 130)- — "We find optic changes in connection 

 with two kinds of intracranial disease in particular; the 

 one tumour, the other meningitis. When we amlyse 

 the matter one degree further, we ascertain that, although 

 the choked disc (ischemia) and the inflamed nerve may 

 co-exist with either of these kinds of disease, that never- 

 theless the choked disc is far more commonly found in 

 association with tumour and hydrocephalus than the in- 

 flamed nerve. The inflamed nerve, on the other hand, 

 is very commonly found in association with meningitis, 

 and of meningitis not of the surface, nor of parts near 

 any supposed vasomotor centres, but with meningitis 

 near the centre." And with this we are disposed 

 substantially to agree. Dr. Allbutt expresses him- 

 self in very doubtful terms in regard to the existence 

 of tobacco amaurosis, and it certainly is extraordinary 

 that, if really constituting an effect of the use of that 

 leaf, it is not of more frequent occurrence amongst the 

 Germans and Americans, who are much larger consumers 

 than either the French or ourselves. 



Our readers will see that Dr. Allbutt has, if not exactly 

 opened up, at all events vigorously worked at, a new field 1 

 of medical investigation. This field promises when duly 

 cultivated to yield very valuable fruit ; and, we arc sure, 

 the conclusion at which every cindid reader will arrive, 

 after carefully perusing i', will be that no physician should '^ 

 consider he has fully examined any case of cerebral 

 disease unless he has accurately investigated the appear- 

 ances presented by the eye under the ophthalmoscope. 

 It is not to be supposed that Dr. Allbutt has by any means 

 exhausted the subject. Many difficulties lie in the path 

 of the most diligent inquirer. In many instances condi- 

 tions of disease are seen to be present, as to the nature 

 of which only a guess can be formed, and respecting 

 which from forgetfulness or lack of observation on the 

 part of the patient no history can be obtained ; whilst 

 in a multitude of cases the disease is seen only at one stage 

 of its progress, and the physician is unable to ascertain, 

 owing to his losing sight of his patient, the ulterior changes 

 that take place. 



Lastly, in many cases the prejudice of friends (a point 

 to be greatly regretted) prevents the exammation of the 

 eyes after death. The fragmentary character of many of 

 the reports of cases collected by Dr. Allbutt in his appen- 

 dix is pain''ully evident, and leaves many hiatuses to be 

 filled up by future research. We may, however, in con- 

 clusion, thank Dr. Allbutt for having published a work 

 which constitutes an important step in the advancement of 

 medicine, and will certainly form a very valuable guide to 

 the profession at large, nor miy we omit to thank the 

 publishers for the excellent manner in which the book has 

 been issued from the press. H. Power 



OUR BOOK SHELF 



Hardy Flowers: Destriptions of upmards of thirteen 

 hundred of the most ornamental species, and directions 

 for tlicir arran^emefit, culture, H^c. By W. Robinson, 

 F.L.S. (London : F. Warne and Co., 1871.) 

 Mr. RoriNSON is a prolific writer, but his prolificacy (as 

 Webster has ir, if Dr. Ingleby and Dr. Latham will allow 

 us the word) does not degenerate into mere book-making. 

 Like its predecessors, this volume is one of practical 

 utility both to the professional gardener and to the 

 cultivator of flowers for their beauty. Much the greater 

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 the most ornamental hardy flowers, with directions for 

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 or more in accordance with ancient custom, than that of 

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 bulbs are often displaced and injured ; and a sparse de- 

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 darkening of the surface of the upturned earth." After 



