VENOUS PULSATION

blocking the filtration angle. But this form of treatment is manifestly too dangerous for other than experimental work; Lagrange thinks that the escape can be sufficiently limited by encouraging the formation of a band of fibrous tissue on the outside of the sclerotic, round about the region of the filtration angle. If the escape is limited, the tension will rise. Certain cases have been observed by Kummel, Guarino, and Lagrange himself in which glaucoma has followed on extensive scarring of the conjunctiva. Guardino is quoted as expressing the opinion that the high frequency of glaucoma in Egypt is due to the cicatricial state of the limbal conjunctiva in old trachoma. Lagrange adopts a measure which he calls colmatage; it consists in burning the sclerotic deeply, through the conjunctiva, in a number of points-20 or more-arranged in three rows round one half of the limbus; later, if necessary, the other half is treated similarly. This is followed by a series of subconjunctival injections. He produces the notes of a number of cases in which detachment of the retina was cured by these means. As a means of treatment of this disastrous condition, anything that will allow us to raise the intraocular tension deliberately, and to a definite extent, holds out large hopes. The book as a whole is interesting and stimulating; there is much that is controversial in it-some of this has been indicated here-but no one can doubt the sincerity of the author or deny the great debt which the world owes him for his operation of limbal sclerectomy as a means of combating chronic glaucoma. The book loses from the absence of an index.