Dorland's Illustrated Medical Dictionary, 26th ed

Dorland's Illustrated Medical Dictionary, 26th ed

668 AMERICAN JOURNAL OF OPHTHALMOLOGY MAY, 1982 mechanism of visual transduction more precisely. Although understanding the mechanism of visual tra...

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MAY, 1982

mechanism of visual transduction more precisely. Although understanding the mechanism of visual transduction is an important subject in its own right, the chapter by G. J . Chader and associates on earlyonset inherited retinal degeneration will be of particular interest to clinical ophthalmologists. This work relates studies of retinal metabolism to possible mechanisms of retinal dysplasia in several animal models and shows the clinical implications of understanding visual transduction. The mechanism of visual transduction is a challenging and fascinating subject, clearly one of the central problems in vision science. The contributors to this volume have also made significant contributions to the understanding of visual transduction through their experimental work in the laboratory. Here, they review their own work in the light of more recent experimental information and theoretical concepts. Thus, this is not a book to let sit on the shelf. It is highly recommended for anyone interested in obtaining a thorough overview of current thinking in this field.

editions and as medical books go they are both reasonably priced and a good buy. Neither dictionary can really justify calling itself "illustrated." On the average, you have to turn 3.2 pages in Stedman's before you come to another in-text illustration and 6.1 pages in Dorland's. If you want to see what an illustrated medical dictionary looks like, check Melloni's (Baltimore, Williams and Wilkins, 1979); it has 4.7 clear illustrations on each of 529 pages, but only one-fourth the number of entries. Ever since Dr. Johnson's famous dictionary came out in 1755 every lexicographer has kept his own master citation file showing how words have been used by various writers and speakers in the past. This file is the foundation of any dictionary's scholarly authority. Nowadays the file is handled by a computer, a machine that can also do all the mechanical chores like sorting, alphabetizing, and classifying. One doesn't have to look far beyond the horizon to anticipate the day when we will turn to the computer to look up a word. It is as easy to type the word into the computer as it is to turn to the appropriate page in a dictionary. Each of these two volumes is the modern repJOSEPH F . METCALF resentative of a long line of medical dictionaries—Stedman's goes back to 1833 and Dorland's to 1901—but the series may one day come to an end and be Stedman's Illustrated Medical Dictionary, replaced by a few microchips in your 24th ed. Baltimore, Williams & Wilkins home computer. I don't particularly look Company, 1982. Hardcover, 1,678 forward to that day; I like to riffle through pages, illustrated, thumb-indexed. the pages and stop where something $33.50 catches my eye. It would be harder to browse through a computer file. Dorland's Illustrated Medical Dictionary, 26th ed. Philadelphia, W. B. Saunders Co., 1981. Hardcover, 1,485 pages, illustrated, thumb-indexed. $37.50

Both of these standard medical dictionaries have recently come out with new

Dorland's has slightly larger pages and larger and cleaner type, but it is 20% heavier. The readability of both dictionaries is excellent: symbols, abbreviations, and dictionary shorthand are kept to a minimum. Each dictionary is equipped with a valuable essay on medical etymolo-

VOL. 93, NO. 5




Entry Calassi's pupillary phenomenon Orbicularis phenomenon Paradoxical pupillary phenomenon Piltz-Westphal phenomenon Westphal's phenomenon

Definition Dorland's Westphal-Piltz phenomenon Westphal-Piltz phenomenon Westphal-Piltz phenomenon Westphal-Piltz phenomenon 1. Westphal-Piltz phenomenon 2. Westphal's sign

Westphal-Piltz phenomenon

Westphal's pupillary reflex Westphal-Piltz reflex Gilford's reflex Gifford-Galassi reflex Orbicularis reflex Piltz's sign

Galassi's pupillary phenomenon Orbicularis phenomenon

Paradoxical pupillary phenomenon Westphal's phenomenon Westphal-Piltz phenomenon Westphal's pupillary reflex Westphal-Piltz pupil Gilford's reflex

Orbicularis pupillary reflex

Piltz's sign Westphal's sign

Contraction of the pupil, followed by dilatation after vigorous closing of the lids; caused by tension of the orbicularis muscle Westphal-Piltz reflex Contraction of the pupil associated with closure or attempted closure of the eye Gifford-Galassi reflex Contraction of the pupil when an effort is made to close the lids which are held apart Westphal's pupillary reflex 1. Piltz's attention pupillary reflex 2. Westphal-Piltz phenomenon Stedman's Orbicularis pupillary reflex Unilateral constriction of the pupil when an effort is made to close eyelids forcibly held apart See "reflex" See "sign" 1. Tonic pupil 2. Spasm of orbicularis oculi and pupillary muscles Tonic pupil Mydriatic rigidity; tonic pupil Contraction of the pupils when an attempt is made to close the eyes while the lids are held open Galassi's pupillary phenomenon; contraction followed by dilation of the pupil upon forcible closure of the eyelids, or upon the attempt to close them while they are held apart Tonic pupil 1. Westphal's phenomenon 2. Westphal-Erb's sign

Remarks Correct Correct Wrong, but it's a long story Correct, see "reflex" Who knows? It could be "spasmus mobilis" of Westphal. "Loss of kpee jerk in tabes dorsalis" (the wrong Westphal) Factually correct, but the last phrase is wrong and should be omitted Could be Correct (except for the implication that it is a unilateral phenomenon) Correct Correct Or Westphal-Piltz reflex Correct Could be Correct Nicely said, but it is a bilateral, not a unilateral pupillary constriction Correctly defined under "reflex" Wrong Close, but misleading Wrong Wrong Correct


Wrong Abolition of patellar reflex (the wrong Westphal again)



gy (Stedman's is old; Dorland's is new), so that the beginning student can look at a word like in-ocul-ate and figure that it probably means to implant a "little eye" in something. If the student looks up the word "inoculate" in either dictionary he will find a dutiful and accurate series of definitions but not a whisper about the "little eye," not a clue that the original concept was to make a graft from one tissue to another and that the word eye is used in the sense of a bud, like the eye of a potato. I'd like to see more word origins and word history slipped in among the bare bones of the definitions. While I was browsing, the term "Westphal-Piltz phenomenon" caught my eye and before I knew it I had chased the concept back and forth through both dictionaries (Table). It is a badly mixed up jumble. Here, as far as I can make out, is what really happened: Harold Gifford was a world-class ophthalmologist who practiced in Omaha, Nebraska, when Omaha was in the wild wild west. In 1895 he pointed out that on attempted eyelid closure the pupils constricted smartly and redilated when the effort ceased. This was, to him, a new observation, but it soon came to light that Galassi had clearly described the phenomenon in 1887. In the meantime, Westphal and Piltz made independent observations of the same eyelid closure pupillary constriction. There followed some exchanges on the matter of priority which Meyerhof ended by pointing out that von Graefe himself had described the phenomenon quite clearly in 1854 and had used the item as filler material in his new journal. Most of the 19th century interest in the eyelid closure reaction resulted from the belief that it was a way of producing a pupillary constriction that was independent of the light and near reactions. But Lowenstein and Loewenfeld have shown that it is nothing more than a near 1









MAY, 1982

response. It is still a phenomenon worth knowing about: when looking for a pupillary light-near dissociation in a patient who is too old or too sick to look at a near object, this technique can produce a surprisingly strong near reaction. All these eponyms should probably be dropped from use but retained in the dictionary. Each entry should direct the reader to the "eyelid-closure pupil constriction" where a more detailed definition could be found. In describing the clinical examination we should say, for example, that "no pupillary constriction could be obtained with near effort or with eyelid closure." Any student who, after a session with his dictionary, trots out the "Galassi-Gifford reflex" as part of his neurologic examination will find that he does not get much encouragement from his teachers. Of what use then are these collections of named signs, syndromes, reflexes, and phenomena? Most of them are not in active use and are chiefly of historical interest. The job of cleaning up these lists is much more difficult than it seems. Dictionary publishing is highly competitive, so most lexicographers are working on a tight budget and cannot afford to hire people with the necessary expertise. This is an opportunity for those of us who care about the medical language we use to make a contribution. Go to your standard medical dictionary, look up those large lists under words like "disease," "test," "sign," "reflex," "syndrome," and "phenomenon." Go through them, paying attention to your own area of expertise. Note what you consider to be error, confusion, or pedantry. Offer your opinion, defend it, and take the trouble to mail your contribution to the publisher. You will probably learn something, as I did, and enjoy yourself besides. H. STANLEY THOMPSON

VOL. 93, NO. 5


REFERENCES 1. Gifford, H.: An orbicularis pupillary reaction. Arch. Ophthalmol. 24:402, 1895. 2. Mingazzini, G.: Ueber das Lidphänomen der Pupille (Galassi). Neurol. Zentralbl. 18:482, 1899. 3. Galassi, C. : Sopra un singulare fenómeno pupillare. Bul. Soc. Lancisiana Ospedali Roma 7:173, 1887. 4. Westphal, A. : Ueber ein bisher nicht beschriebenes Pupillenphänomen. Neurol. Zentralbl. 18:161, 1899, 5. Piltz, J . : Ueber neue Pupillenphänomene. Neurol. Zentralbl. 18:248, 1899.


6. Gifford, H.: The palpebral reaction of the pupil (Galassi). Arch, Ophthalmol. 29:191, 1900. 7. : Über Galassi's Lidschlussreaktion der Pupille. Klin. Monatsbl. Augenheilkd. 14:155, 1902. 8. Meyerhof: Zur Geschichte der "Lidschlussreaction" der Pupille. Berl. Klin. Wochenschr. 39:90, 1902. 9. von Graefe, A. : Notiz über die Behandlung der Mydriasis. Arch. Ophthalmol. 1:315, 1854. 10. Lowenstein, O., and Loewenfeld, I. E.: The pupil. In Davson, H. (ed.): The Eye. New York, Academic Press, 1962, pp. 260 and 261.

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