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Heart disease
Book Reviews SPATIAL VECTORCARDIOGRAPHY. By George E. Burch, J. A. Abildskov, and James Philadelphia, 1953, Lea b Febiger. Cronvich. Pp. 173, with 121 illustrations.
A.
This volume reproduces an exhibit which was displayed at a meeting of the American Medical Association in 1952, presenting the basic concepts of spatial vectorcardiography and the results of the authors’ clinical investigations in this subject. The resulting style has the virtues of being The authors’ conclusions about concise and of being directed at a general medical audience. technique and clinical applications are clearly stated, and the reasons for their conclusions enumerated in order. Their findings in cases of myocardial infarction and other abnormalities are summarized under the refreshing heading “Impressions” at the end of each chapter. Specialists will disagree in detail with some of the conclusions, but will at the same time appreciate the authors’ unequivocal statement of their opinion. To the question, “What use has vectorcardiography in clinical medicine today?” the Tulane group gives the answer, “We are not sure yet.” On the basis of the evidence available, this is It seems unlikely that cathode-ray spatial vectorcardiogthe only reasonable answer possible. raphy will ever replace conventional scalar electrocardiography, partly for technical reasons, and partly because the two methods are simply different ways of measuring the same phenomena. The recording of vector loops may prove to be a useful supplementary method in some cases, but more information is needed before agreement can be reached even on this point. Dr. Burch and his colleagues emphasize that “Vectorcardiography is not yet suitable for general clinical application. It is still in the experimental stage, its practical clinical applications not yet having may be reasonably expected in the near been demonstrated,” but “. . . practical applications future.” William
R. Milnor
HEART DISEASE. By Paul Dudley White, M.D. Ed. 4. Pp. 1000, with 168 figures; indexed. New York, 1954, The Macmillan Company. Price $12.00. The fourth edition of this classic book meets high expectations. Few medical authors can combine in a textbook scientific accuracy, felicity of expression, thoroughness, and completeness of content as well as White. The general plan of the third edition is followed, although the format is improved greatly. The first part of the book deals with cardiovascular examination, symptoms, and signs. Roentgenology of the heart, ballistocardiography, and electrocardiography are treated briefly but adequately. Perhaps the short discussion on vectorcardiography and the ventricular gradient could have been omitted. The second section deals with the significance, prevalence, causes, and types of heart disease. The chapter on congenital heart disease is well conceived, and the colored diagrams borrowed from Taussig’s book are a distinct aid to the understanding of the abnormal circulation. The whole section is written in the light of recent advances in diagnosis and treatment. Rheumatic heart disease, bacterial endocarditis, cardiovascular syphilis, and the relationship of other infections and infestations to the heart receive appropriate consideration. Hypertensive heart disease is described as the most common and important of all types of heart disease. Between forty and fifty drugs are mentioned as having been used in the treatment of hypertension. Obviously the newer drugs could not be discussed in this edition published in 1951. However, White has great enthusiasm for Smithwick’s operation of sympathectomy.
a50
Volume 1 Number 3
351
BOOK REVIEWS
Coronary heart disease logically includes in one chapter angina pectoris, coronary thrombosis, and myocardiil infarction. A notable omission in this chapter concerns the important and debatable factors that precipitate acute coronary artery occlusion. The relationship of heart disease to pregnancy, anesthesia, surgical operations, alcohol, and smoking receives adequate attention. Part three deals with structural cardiovascular abnormalities. This includes, among others, two important chapters on endocardial and valvular disease, and on pericardial disease, both acute and chronic. The final part is concerned with disorders of cardiovascular function, including congestive This is complete and up to date, with excellent heart failure, and the numerous arrhythmias. illustrations. The whole book is arranged beautifully with interesting historical references and a complete bibliography. This reviewer has never read a medical book with such genuine pleasure. Neil Feeney
CONGENITAL SYPHILIS. By Arnold & Co. Price $10.00.
David
Nabarro.
Pp. 4.54; cloth.
London,
1954,
Edward
To read this book is to savor of old wine; and like old wine, it is for the connoisseur. Also, like old wine, it is somewhat musty, and contains an inordinate quantity of dregs. It is a book for the physician to read by the firelight of a winter’s evening, and cannot be recommended to the busy student or practitioner avid for accurate and practical knowledge. The author was Medical Officer in charge of the Venereal Diseases Clinic at the Hospital for Sick Children, Great Ormond Street, London, from its inception in 1917 until its closure in 1939. The book is largely based upon the nearly 900 cases of congenital syphilis seen during the It is a historical record of the disease as seen in Britain in twenty-three years of its existence. the prepenicillin era. The keynote of the volume is set by an excellent illustrated chapter on historical aspects. A mighty march of masters, from Paracelsus to Parran, passes in figured review. There follows an adequate discussion of the incidence of congenital syphilis with proper emphasis upon its decline as well as upon the relative lack of reliability of published rates. The author The ensuing chapter on the transmission of the disease is truly anachronistic. exhibits a curiously persistent belief in the nineteenth century theory of paternal transmission. “It is possible for the first infected child to be an instance of paternal transmission, and that the mother is infected by that child (‘choc en retour’).” The metaphysics of maternal germ transmission have been disinterred. “It is possible, too, that the genes of the germ-cells may be so affected by resting or attenuated form of the parasite (or hy an alleged syphilotoxin) that a true hereditary effect upon the offspring may result.” There follows a brief discussion of the general pathology of the disease and of serologic and spinal fluid tests. The important problem of biologic false positive reactors is disposed of in less than a single page of text. The detailed consideration of the symptomatology of congenital syphilis, with numerous illustrative cases from the author’s clinic, is, on the whole, excellent. Particularly to be commended are the discussions, with photographs and radiographs, of cutaneous manifestations, dental A persistent belief in the thoroughly disstigmas, and involvement of the bones and joints. credited Warthin lesion and in the ubiquity of the Treponema pallidurn mars the discussion of “I would go further and suggest that some cardiovascular involvement in congenital syphilis. of the attacks of so-called rheumatic carditis and even chorea may be manifestations of treponemal activity which would benefit by treatment on antisyphilitic lines even though the W. R. be negative.” Consideration of central nervous system involvement is fundamentally sound but not entirely The clinical picture of juvenile paresis adequate. Discussion of pathologic anatomy is sketchy. might well have heen more vividly painted, and concerning its treatment the author states.
A.
This volume reproduces an exhibit which was displayed at a meeting of the American Medical Association in 1952, presenting the basic concepts of spatial vectorcardiography and the results of the authors’ clinical investigations in this subject. The resulting style has the virtues of being The authors’ conclusions about concise and of being directed at a general medical audience. technique and clinical applications are clearly stated, and the reasons for their conclusions enumerated in order. Their findings in cases of myocardial infarction and other abnormalities are summarized under the refreshing heading “Impressions” at the end of each chapter. Specialists will disagree in detail with some of the conclusions, but will at the same time appreciate the authors’ unequivocal statement of their opinion. To the question, “What use has vectorcardiography in clinical medicine today?” the Tulane group gives the answer, “We are not sure yet.” On the basis of the evidence available, this is It seems unlikely that cathode-ray spatial vectorcardiogthe only reasonable answer possible. raphy will ever replace conventional scalar electrocardiography, partly for technical reasons, and partly because the two methods are simply different ways of measuring the same phenomena. The recording of vector loops may prove to be a useful supplementary method in some cases, but more information is needed before agreement can be reached even on this point. Dr. Burch and his colleagues emphasize that “Vectorcardiography is not yet suitable for general clinical application. It is still in the experimental stage, its practical clinical applications not yet having may be reasonably expected in the near been demonstrated,” but “. . . practical applications future.” William
R. Milnor
HEART DISEASE. By Paul Dudley White, M.D. Ed. 4. Pp. 1000, with 168 figures; indexed. New York, 1954, The Macmillan Company. Price $12.00. The fourth edition of this classic book meets high expectations. Few medical authors can combine in a textbook scientific accuracy, felicity of expression, thoroughness, and completeness of content as well as White. The general plan of the third edition is followed, although the format is improved greatly. The first part of the book deals with cardiovascular examination, symptoms, and signs. Roentgenology of the heart, ballistocardiography, and electrocardiography are treated briefly but adequately. Perhaps the short discussion on vectorcardiography and the ventricular gradient could have been omitted. The second section deals with the significance, prevalence, causes, and types of heart disease. The chapter on congenital heart disease is well conceived, and the colored diagrams borrowed from Taussig’s book are a distinct aid to the understanding of the abnormal circulation. The whole section is written in the light of recent advances in diagnosis and treatment. Rheumatic heart disease, bacterial endocarditis, cardiovascular syphilis, and the relationship of other infections and infestations to the heart receive appropriate consideration. Hypertensive heart disease is described as the most common and important of all types of heart disease. Between forty and fifty drugs are mentioned as having been used in the treatment of hypertension. Obviously the newer drugs could not be discussed in this edition published in 1951. However, White has great enthusiasm for Smithwick’s operation of sympathectomy.
a50
Volume 1 Number 3
351
BOOK REVIEWS
Coronary heart disease logically includes in one chapter angina pectoris, coronary thrombosis, and myocardiil infarction. A notable omission in this chapter concerns the important and debatable factors that precipitate acute coronary artery occlusion. The relationship of heart disease to pregnancy, anesthesia, surgical operations, alcohol, and smoking receives adequate attention. Part three deals with structural cardiovascular abnormalities. This includes, among others, two important chapters on endocardial and valvular disease, and on pericardial disease, both acute and chronic. The final part is concerned with disorders of cardiovascular function, including congestive This is complete and up to date, with excellent heart failure, and the numerous arrhythmias. illustrations. The whole book is arranged beautifully with interesting historical references and a complete bibliography. This reviewer has never read a medical book with such genuine pleasure. Neil Feeney
CONGENITAL SYPHILIS. By Arnold & Co. Price $10.00.
David
Nabarro.
Pp. 4.54; cloth.
London,
1954,
Edward
To read this book is to savor of old wine; and like old wine, it is for the connoisseur. Also, like old wine, it is somewhat musty, and contains an inordinate quantity of dregs. It is a book for the physician to read by the firelight of a winter’s evening, and cannot be recommended to the busy student or practitioner avid for accurate and practical knowledge. The author was Medical Officer in charge of the Venereal Diseases Clinic at the Hospital for Sick Children, Great Ormond Street, London, from its inception in 1917 until its closure in 1939. The book is largely based upon the nearly 900 cases of congenital syphilis seen during the It is a historical record of the disease as seen in Britain in twenty-three years of its existence. the prepenicillin era. The keynote of the volume is set by an excellent illustrated chapter on historical aspects. A mighty march of masters, from Paracelsus to Parran, passes in figured review. There follows an adequate discussion of the incidence of congenital syphilis with proper emphasis upon its decline as well as upon the relative lack of reliability of published rates. The author The ensuing chapter on the transmission of the disease is truly anachronistic. exhibits a curiously persistent belief in the nineteenth century theory of paternal transmission. “It is possible for the first infected child to be an instance of paternal transmission, and that the mother is infected by that child (‘choc en retour’).” The metaphysics of maternal germ transmission have been disinterred. “It is possible, too, that the genes of the germ-cells may be so affected by resting or attenuated form of the parasite (or hy an alleged syphilotoxin) that a true hereditary effect upon the offspring may result.” There follows a brief discussion of the general pathology of the disease and of serologic and spinal fluid tests. The important problem of biologic false positive reactors is disposed of in less than a single page of text. The detailed consideration of the symptomatology of congenital syphilis, with numerous illustrative cases from the author’s clinic, is, on the whole, excellent. Particularly to be commended are the discussions, with photographs and radiographs, of cutaneous manifestations, dental A persistent belief in the thoroughly disstigmas, and involvement of the bones and joints. credited Warthin lesion and in the ubiquity of the Treponema pallidurn mars the discussion of “I would go further and suggest that some cardiovascular involvement in congenital syphilis. of the attacks of so-called rheumatic carditis and even chorea may be manifestations of treponemal activity which would benefit by treatment on antisyphilitic lines even though the W. R. be negative.” Consideration of central nervous system involvement is fundamentally sound but not entirely The clinical picture of juvenile paresis adequate. Discussion of pathologic anatomy is sketchy. might well have heen more vividly painted, and concerning its treatment the author states.