- Email: [email protected]
A diagnostic approach to chest diseases
BOOK REVIEWS
307
Dr, Wallace w r i t e s 'tie was an admirable and lucid lecturer, and from tile rostrum, he could continue with even greater authorily, to expound the principles on which his work was based. Here, particularly, he displayed his comprehensive grasp of medical art and science'. It is interesting to read Sir Robert Philip's words on the study of tuberculosis, as quoted by Dr. Wallace--'The study of tuberculosis is well calculated to make a man think regarding tire meaning and course of all disease. In t fie variability of its expression, ill the methods of diagnosis and prognosis and in the far-reaching,question} of prevention and treatment, tuberculosis affords a fine object lesson in medicine. Its teacl'6ng is not Iimited to tuberculosis. It is luminous with principles which give just proportions to lhe facts of disease, and inspire fresh effort towards the realization of the ideals of health'.
The Library, Institute o[" Diseases o[ the ~hesI, Hrnml>tOn, S. 1I'.3.
P, JAMES ~ISIIOP
BOOK
REVIEWS
A Diagnostic Approach to Chest Diseases. G, A, Ln,Ll~c.;ro~ and R. W. JAMPLIS. Williams and Wilkins Company, Baltimore; E. & S. Livingstone, Edinburgh & London. 1965. Pp. 508. s 16/-. The sub-title of thls book is 'Differential Diagnoses based on Roentgenographic Patternns'; and it is founded on the premise that 'an analysis of llle chest roentgenogram is the logical starting point in the differential diagnosis of pulmonary disease'. This is a welcome approach to the subject for those who have succeeded in lorgetting rise teaching of their student days on physical signs in chest disease. The history and physical signs are by no means neglected: they are put into proper perspective in the total diagnostic procedure. The chest x-ray is placed in a text book in the dominant position it occupies in practice. After a relatively brief bnt sensible introduction on I'dstory taking, physical examination and laboratoly tceh.niques, the remainder of the book deals with differential diagnosis of the specific roentgellograpl'dc patterns. This approach owes much to Simon's pioneering work on the rational interpretation of chest x-rays. The final chapter deals with diagnosis of the cause of coughing in the absence of x-ray abnormality. For completeness tl'ds section could have been expanded to include more discussion of chest pain, wheezing and dyspnoea, otber important symptoms often unaccompanied by x-ray abnormalities. The autll.ors' views on the logical basis of diagnosis are convelltiolml ones: tbey ntay not be correct. According to them there are four steps: selecting one or more salient features, listing the diseases that produce these features, selecting additional investigations to differentiate the diseases, selecting the diagnosis that appears most probable from all the accumulated evidence. There is another hypothesis of diagnosis that is at least as probable as the conventional one. The process may begin from the very moment that the clinician first sees the patient. He may then start to form patterns of observatiorts and to select the most probable disease groups for them. further selection ocurring as each new observation is nlade. This process is a continuous one, not. as ill the conventional view, a single operation that must follow the collection of data. If this concept of a continuous operation is correct, to discuss the differential diagrtosis of a single symptom, sign or
308
TUBERCLE
x-ray appearance is merely an intellectual exercise, for it has no relation to the actual mental mechanics of medical practice. However, differences concerning the logic of diagnosis do not detract from the reviewcr's admiration for the book. It is a valuable one, especially for general physicians, for whom it is primarily iiatended.
Progress in Research in Emphysema and Chronic Bronchitis. Vol. 2. Ed. by Roger S. Mitchell. S. Karger, Basel/New York, 1965. Pp. 431. SFr/DM 87. This is a record of the 7th Conference oil Research in Emphysema held at Aspen, Colorado in 1964 and has previously appeared in 'Medicina Thoracalis'. It irtcludes papers on epidemiology, morbid anatomy, alveolar surfactant, the pulmonary circulation, and respiratory physiology. Reviewing such a book is difficult. There are more than 30 individual contributions on a wide variety of subjects. The majority of the work described has been published elsewhere. But tile book brings together much recent research from reports scattered in a large number of differeut journals. It is, therefore, a valuable volume. The subject is large, complex and rapidly developing. It is too complex for easy comprehension. This is not uncommon in any rapidly advancing scienti fie lield. Tile reader may well hope that someone will soon attempt a simple synthesis of the vast scattered array of knowledge, It will have to be a person of unusual analytical abilities and clarity of thought. But such simplification is badly needed to direct future research. There may be at present too much confused thinking and ill-fbunded time-wasting enquiry. This collection of articles will ilIuminate some of the darker areas of the subject, tt will not simplify the whole,
Rontgenatlas zar Fruhdiagnostie Des Bronchasearcinom. VON E. LOBENWEIN WEINEGG.Sprirtger, Berlin, i965. Pp. 97. DM 49. The title of this slim volume is a little misleading, it describes and illustrates tke rad.iographic appearances of bronchial carcinoma. But it is doubtl~l whether "early diagnosis' is applielible in, for instance, a case of obvious lobar collapse. Such appearances, in conjunction with tl~e clinical details elicited by accurate history-taking and examination, would hardly fail to indicate to a competent physician the need for farther investigation. Nevertheless, the book is a competent compilation of common and uncommon x-ray appearances and is well illustrated.
307
Dr, Wallace w r i t e s 'tie was an admirable and lucid lecturer, and from tile rostrum, he could continue with even greater authorily, to expound the principles on which his work was based. Here, particularly, he displayed his comprehensive grasp of medical art and science'. It is interesting to read Sir Robert Philip's words on the study of tuberculosis, as quoted by Dr. Wallace--'The study of tuberculosis is well calculated to make a man think regarding tire meaning and course of all disease. In t fie variability of its expression, ill the methods of diagnosis and prognosis and in the far-reaching,question} of prevention and treatment, tuberculosis affords a fine object lesson in medicine. Its teacl'6ng is not Iimited to tuberculosis. It is luminous with principles which give just proportions to lhe facts of disease, and inspire fresh effort towards the realization of the ideals of health'.
The Library, Institute o[" Diseases o[ the ~hesI, Hrnml>tOn, S. 1I'.3.
P, JAMES ~ISIIOP
BOOK
REVIEWS
A Diagnostic Approach to Chest Diseases. G, A, Ln,Ll~c.;ro~ and R. W. JAMPLIS. Williams and Wilkins Company, Baltimore; E. & S. Livingstone, Edinburgh & London. 1965. Pp. 508. s 16/-. The sub-title of thls book is 'Differential Diagnoses based on Roentgenographic Patternns'; and it is founded on the premise that 'an analysis of llle chest roentgenogram is the logical starting point in the differential diagnosis of pulmonary disease'. This is a welcome approach to the subject for those who have succeeded in lorgetting rise teaching of their student days on physical signs in chest disease. The history and physical signs are by no means neglected: they are put into proper perspective in the total diagnostic procedure. The chest x-ray is placed in a text book in the dominant position it occupies in practice. After a relatively brief bnt sensible introduction on I'dstory taking, physical examination and laboratoly tceh.niques, the remainder of the book deals with differential diagnosis of the specific roentgellograpl'dc patterns. This approach owes much to Simon's pioneering work on the rational interpretation of chest x-rays. The final chapter deals with diagnosis of the cause of coughing in the absence of x-ray abnormality. For completeness tl'ds section could have been expanded to include more discussion of chest pain, wheezing and dyspnoea, otber important symptoms often unaccompanied by x-ray abnormalities. The autll.ors' views on the logical basis of diagnosis are convelltiolml ones: tbey ntay not be correct. According to them there are four steps: selecting one or more salient features, listing the diseases that produce these features, selecting additional investigations to differentiate the diseases, selecting the diagnosis that appears most probable from all the accumulated evidence. There is another hypothesis of diagnosis that is at least as probable as the conventional one. The process may begin from the very moment that the clinician first sees the patient. He may then start to form patterns of observatiorts and to select the most probable disease groups for them. further selection ocurring as each new observation is nlade. This process is a continuous one, not. as ill the conventional view, a single operation that must follow the collection of data. If this concept of a continuous operation is correct, to discuss the differential diagrtosis of a single symptom, sign or
308
TUBERCLE
x-ray appearance is merely an intellectual exercise, for it has no relation to the actual mental mechanics of medical practice. However, differences concerning the logic of diagnosis do not detract from the reviewcr's admiration for the book. It is a valuable one, especially for general physicians, for whom it is primarily iiatended.
Progress in Research in Emphysema and Chronic Bronchitis. Vol. 2. Ed. by Roger S. Mitchell. S. Karger, Basel/New York, 1965. Pp. 431. SFr/DM 87. This is a record of the 7th Conference oil Research in Emphysema held at Aspen, Colorado in 1964 and has previously appeared in 'Medicina Thoracalis'. It irtcludes papers on epidemiology, morbid anatomy, alveolar surfactant, the pulmonary circulation, and respiratory physiology. Reviewing such a book is difficult. There are more than 30 individual contributions on a wide variety of subjects. The majority of the work described has been published elsewhere. But tile book brings together much recent research from reports scattered in a large number of differeut journals. It is, therefore, a valuable volume. The subject is large, complex and rapidly developing. It is too complex for easy comprehension. This is not uncommon in any rapidly advancing scienti fie lield. Tile reader may well hope that someone will soon attempt a simple synthesis of the vast scattered array of knowledge, It will have to be a person of unusual analytical abilities and clarity of thought. But such simplification is badly needed to direct future research. There may be at present too much confused thinking and ill-fbunded time-wasting enquiry. This collection of articles will ilIuminate some of the darker areas of the subject, tt will not simplify the whole,
Rontgenatlas zar Fruhdiagnostie Des Bronchasearcinom. VON E. LOBENWEIN WEINEGG.Sprirtger, Berlin, i965. Pp. 97. DM 49. The title of this slim volume is a little misleading, it describes and illustrates tke rad.iographic appearances of bronchial carcinoma. But it is doubtl~l whether "early diagnosis' is applielible in, for instance, a case of obvious lobar collapse. Such appearances, in conjunction with tl~e clinical details elicited by accurate history-taking and examination, would hardly fail to indicate to a competent physician the need for farther investigation. Nevertheless, the book is a competent compilation of common and uncommon x-ray appearances and is well illustrated.