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PULMONARY PHYSIOLOGY IN CLINICAL PRACTICE
THE BOOKSHELF I'REVENTIVE SIYOCARUIOLOGY-FUNDAiIENTALS A S D TARGETS. By WILHELAIRAAII.American Lecturt. Series. Springfield, Charles C. Thomas, 1970, 227 pp, 513.30 This is a tlifficult ant1 puzzling hook to review. The reader is not only forced to consider new and controversial theories of the c;trlse of tlegenerative heart disease, but is faced with the prol)lem of tlecipliering r~nr~snally complicated terminology which in itself fornms a forniidable obstacle to accepting these novel theories. To give but two examples, Dr. Raab speaks of "liyposia-induced dysionisnl" and "catecholamine cardiotoxicity-augmenting ant1 electrolyte tieranging element of adrthnolcortical overactivity," in describing initiating factors in ~nytxardialtlysfunction. Nevertheless, when the persevering reader masters the ar~thor's e l a h r a t e verbiage, he is faced with inlportant consitlerations which cannot be easily tlismissed in this challenging t no no graph. It first and foremost challenges tlie one-sided coronary orienteti terminology and pnts eclual stress on factors, other tlwn ischemia, respjnsible for interference with cardiac muscle function in degenerative heart diseaw. Dr. Rash feels that of eclr~al iniportance to coronary flow in disordered cardiac mr~scleIionieostasis are non-vascr~lar factors, such as atlrenocortical and adrenergic over-activity. He develops this theory by discussing tlie oft-reported finding that coronary tliro~nl)osis nlay represent a post-infarction phenomenon rather than the cause of the infarct. The elusiveness of the initi;rtinrr factors in s ~ ~ d t l ec;lrtliac n death. where no infarct is found at autopsy, to some extent bolsters his observations. Atlt1ition;ll challenging and thought-provoking hypotheses artJ tliscussetl, such as: ( 1 ) establishetl congestive heart f;lilurc upsets the nornial circ;ttli;ln rhythm of corticosteroid protluction, which may cause cyclic interference with myocartlial function lei~dingto noch~rnaldyspnea or arrhythmia; ( 2 ) myocardial hypertrophy in sihlations where there is no pressure or volunie overload ( ie, coronary atherosclerosis, acro~negaly,e t c ) may be due to excessive production of growth hormone; ( 3 j focal myocartlial necrosis and "nontxclr~siveinfarcts" may be due to corticoid over-activity. The author deplores the lack of massive practical prophylactic programs ai~netlat degenerative heart disease in the U S . , particularly when this is contrasted with the effort of foreign conntries where there is less heart disease and the population is less "sophisticated". He reiterates his criticism of tlie perpetual atlht~rence to tnatlitional concepts which iniply ;I purely coronary va5cnlar origin of fatal myocardial lesions, while only minimal attention has k e n focnsed on nonvascr~lar c;~rdionietabolic factors, both neurogenic and fiortiarrl L. .!loscocitz, .\l.D. Neu: l'ork City
PCT12\IONARY PHYS1OLOC;Y IN CLINICAL PRACTICE R.I PACE, ( 2 n d e d . ) F. A. Davis, Philadelhy W I L L I A ~ phia, 1970, 184 pp, 64.25 This is a revision of a short synopsis of pulmonary function testing prepared for the clinically oriented reader. The author points o r ~ tthat il majority of patients needing p~~lnionary e v ; ~ l ~ ~ a t ican o n be intelligently tested in a physician's office with a niiniriiurn of eqnipment. He further suggests that the
patient's history and physical findings may be helpful in predicting abnormalities which can only be confirnied by elaborate testing procedures. There are two main deficiencies to the book. Firstly, the author chooses not to discuss the minority of patients who cannot be adequately evaluated with simple equipment. This reviewer would like to know the indications for referring a patient to the large Iaboratory for extensive testing. Certainly the diagnosis of the pulmonary vascular disease with disabling dyspnea can occur with nornial spirometric tests. Secondly, an inordinate amount of space is devoted to the technics and interpretation of spirometry ( 2 5 percent of the book) but little attention is paid to the clinical and pathophysiologic features of pulmonary diseases which aid in the understanding of the reasons for the abnormalities in the tests. Interpretation of pulmonary function tests, as with the electrocardiogram and chest roentgenogram beconies more meaningful when the entire clinical picture is considered. The book should have its widest usefulness for a house officer rotating through a pr~lmonary service and with paramedical personnel such as respiratory therapy and pulmonary laboratory technicians. ,\laruin A. Sackner, M.D. .Iliami Beach, Fla. ASATOSllCAL STUDIES ON T H E SlOTION O F T H E HEART AND BLOOD. By W I L L I AHARVEY. ~~ Translated by Channcey D . Leake, ( 5 t h Ed ), Springfield, Charles C Thomas, 1970, 150 pp, $ 4 5 0 Despite the pivotal importance of Harvey to the history of science, translations of D e .\lotn Conlk are not available in abundance. It is t n ~ ethat no one who has access to an adequate medical or public library could fail to find a copy. But some books 1m)m so large that they should be ownedand read-by everyone in the field. Harvey's is such a book. In justifying this statement, I d o not feel any necessity to atld redundant comment on the fnntlamental scientific i~nportance of D e .ilotu Cordis. Before Harvey, it was thought that the blood swished back and forth in the arteries, and separately back and forth in the veins. From this sterile concept t Harvey leapt to the t n ~ t hof the circulation, w i t h o ~ ~which much of nitxiern medicine, and most of our knowledge of cardiovascular disease. wor~ldc n ~ m b l e . Aside, then, from its obvious scientific importance, other reasons should compel all of us to meet Harvey personally, instead of t h r o ~ ~ gthe h interniediary of excerpts and paraphrases and interpretations. To be practical, the book is short: fewer than 140 pages (roughly equivalent to 35 pages in Chest ) . The busy doctor's time is not a factor here; no one can afford not to take the time to read Harvey. Further, he does not wallow in the obscure profundities of seventeenth c e n h ~ r ymedical philosophy. He is a practical Inan who has written a practical book which is, as a result, readable by all. Not only that, Harvey is a conipelling early devotee of the new scientific tnethod, whereby one does not speculate, he tries an experiment; his book will remind all readers of the continuing import of such an attih~de. Finally, Leake's translation is eminently readable. I have not the Latin to comment knowledgeably on the fine points of interpretation, but Leake makes De .\lotu Cordis read well, thus providing a nice bit of icing to the cake. It is a cliclmi. of book reviewing to say that every physician should have and read a Imok. But I say that here, and mean it literally. Charles 6. Rolat~d,'1l.D. Rocl~e.stcr,,\linr~esota
PCT12\IONARY PHYS1OLOC;Y IN CLINICAL PRACTICE R.I PACE, ( 2 n d e d . ) F. A. Davis, Philadelhy W I L L I A ~ phia, 1970, 184 pp, 64.25 This is a revision of a short synopsis of pulmonary function testing prepared for the clinically oriented reader. The author points o r ~ tthat il majority of patients needing p~~lnionary e v ; ~ l ~ ~ a t ican o n be intelligently tested in a physician's office with a niiniriiurn of eqnipment. He further suggests that the
patient's history and physical findings may be helpful in predicting abnormalities which can only be confirnied by elaborate testing procedures. There are two main deficiencies to the book. Firstly, the author chooses not to discuss the minority of patients who cannot be adequately evaluated with simple equipment. This reviewer would like to know the indications for referring a patient to the large Iaboratory for extensive testing. Certainly the diagnosis of the pulmonary vascular disease with disabling dyspnea can occur with nornial spirometric tests. Secondly, an inordinate amount of space is devoted to the technics and interpretation of spirometry ( 2 5 percent of the book) but little attention is paid to the clinical and pathophysiologic features of pulmonary diseases which aid in the understanding of the reasons for the abnormalities in the tests. Interpretation of pulmonary function tests, as with the electrocardiogram and chest roentgenogram beconies more meaningful when the entire clinical picture is considered. The book should have its widest usefulness for a house officer rotating through a pr~lmonary service and with paramedical personnel such as respiratory therapy and pulmonary laboratory technicians. ,\laruin A. Sackner, M.D. .Iliami Beach, Fla. ASATOSllCAL STUDIES ON T H E SlOTION O F T H E HEART AND BLOOD. By W I L L I AHARVEY. ~~ Translated by Channcey D . Leake, ( 5 t h Ed ), Springfield, Charles C Thomas, 1970, 150 pp, $ 4 5 0 Despite the pivotal importance of Harvey to the history of science, translations of D e .\lotn Conlk are not available in abundance. It is t n ~ ethat no one who has access to an adequate medical or public library could fail to find a copy. But some books 1m)m so large that they should be ownedand read-by everyone in the field. Harvey's is such a book. In justifying this statement, I d o not feel any necessity to atld redundant comment on the fnntlamental scientific i~nportance of D e .ilotu Cordis. Before Harvey, it was thought that the blood swished back and forth in the arteries, and separately back and forth in the veins. From this sterile concept t Harvey leapt to the t n ~ t hof the circulation, w i t h o ~ ~which much of nitxiern medicine, and most of our knowledge of cardiovascular disease. wor~ldc n ~ m b l e . Aside, then, from its obvious scientific importance, other reasons should compel all of us to meet Harvey personally, instead of t h r o ~ ~ gthe h interniediary of excerpts and paraphrases and interpretations. To be practical, the book is short: fewer than 140 pages (roughly equivalent to 35 pages in Chest ) . The busy doctor's time is not a factor here; no one can afford not to take the time to read Harvey. Further, he does not wallow in the obscure profundities of seventeenth c e n h ~ r ymedical philosophy. He is a practical Inan who has written a practical book which is, as a result, readable by all. Not only that, Harvey is a conipelling early devotee of the new scientific tnethod, whereby one does not speculate, he tries an experiment; his book will remind all readers of the continuing import of such an attih~de. Finally, Leake's translation is eminently readable. I have not the Latin to comment knowledgeably on the fine points of interpretation, but Leake makes De .\lotu Cordis read well, thus providing a nice bit of icing to the cake. It is a cliclmi. of book reviewing to say that every physician should have and read a Imok. But I say that here, and mean it literally. Charles 6. Rolat~d,'1l.D. Rocl~e.stcr,,\linr~esota