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Clinical cardiology, with special reference to bedside diagnosis
716
AMERICAN
HEART
JOURNAL
for instance, the meaning of (‘left ventricular preponderance of the first type” nor the meaning of (‘a QRS of the Q type.” Having mastered the author’s terminology, however, there will be much to learn from a perusal of these records and the accompanying text for one who has not had much experience in interpreting electrocardiograms. HAROI,D
CLINICAL
CARDIOLOGY,
William Dressler. illustrations.
WITH
Paul
SPECIAL
B.
Hoeber
REFERENCE
Inc.,
TO
New
York,
BEDSIDE
1942,
E.
B.
PARDEE.
DIAGNOSIS:
692
pages,
By
108
This is a well-arranged, readable, complete book and the illustrations are well chosen. It is a clear, concise, ex-cathedra exposition of clinical cardiology. Throughout, the author has accepted the newest viewpoints. This is especially noticeable in his discussion of the pathogenesis of hypertension, of the natural history of rheumatic infections, and of the etiology of aortic stenosis. The book has a very certain, but by the same token limited, appeal, in that it is written for senior students, young graduates, and general practictioners, especially It is too advanced for younger students for use during a post-graduate course. It fails to point out and discuss the and too elementary for advanced students. various aspects of the many problems which still await solution, and, above all, the author has chosen to omit all references to the literature. This is the worst aspect of the book, for every student should, as early as possible, be encouraged to seek the source records for himself. By this omission also the field of cardioThe modern cardiologist might find that the logical history is completely ignored. author overemphasizes physical diagnosis to the detriment of the newer, modern means of diagnosis; the electrceardiograph and the fluoroscope are no longer special instruments, but aids in physical diagnosis aa indispensable as the stethoscope and the sphygmomanometer. One
must decidedly disagree with the author when he says (p.VI) that evaluaelectrocardiographic data has done more harm than good; when that and the complaint might, with the same happens it is due to poor judgment, justification (or lack of it), be lodged against stethoscopy or physical diagnosis; think of the interpretations given to “murmurs.” tion
of
The reviewer also believes that the student for whom this book is meant would like to know, at least briefly, what kymography, phonocardiography, and other modern methods are and what they contribute, even though they are not of fundamental importance. The ex-cathedra method of exposition has led to a number of statements which represent the author’s opinion rather than what is generally accepted. Many of his views on myocardial infarction differ from those of other authorities; he fails to recognize “degenerative heart disease” as an etiological group comparable to infectious heart disease, and his use of the term “angina pectoris” is particularly distressing, in that he does not clearly distinguish between the pain of transitory anoxemia and that of myocardial infarction as suggested by the “nomenclature” (New York Heart Association), but he calls all pain from myocardial ischemia, angina pectoris. A number of statements which quoting his authority. Some seem he says that about 50 per cent disease (p. 235), it is necessary to recruiting office, an office practice,
appear so new and unusual are made without to be suspended in thin air; for instance, when of the extrasystoles actxnqany organic heart state whether he obtained his statistics from a or a hospital ward.
BOOK
717
REVIEWS
Of frank omissions there are not many beyond what may be expected by the limitation of the scope of the book. There are, however, some facts missing which should not be omitted even from an elementary textbook. The author does not mention xanthopia as a sign of overdigitalization; Wenckebach’s periods, oncr mentioned, should be explained; the early combination of digitalis and diuretic3 in congestive failure. The figure giving the incidence of positive serologic reaction? The importance of venous pressure in syphilitic heart disease is not in the book. measurements in the evaluation of cardiac function is not duly emphasized: the found only by a thorough perusal of the discussion of cardiac aneurysm can be text-it should be included in the index. There is no mention of the symptomatic effects of sympathectomy in hypertension, which, though difficult to explain, are real enough to be included in the effects of the operation. These are, after all, minor defects in an excellent book. Outweighing these criticisms is the fart that students were more than usually attracted to the volume. and
On the whole, should prove
the book is a contribution popular with the readers
for
to our whom
didactic cardiological it is meant. JULIUS
literature JENSEN.
AMERICAN
HEART
JOURNAL
for instance, the meaning of (‘left ventricular preponderance of the first type” nor the meaning of (‘a QRS of the Q type.” Having mastered the author’s terminology, however, there will be much to learn from a perusal of these records and the accompanying text for one who has not had much experience in interpreting electrocardiograms. HAROI,D
CLINICAL
CARDIOLOGY,
William Dressler. illustrations.
WITH
Paul
SPECIAL
B.
Hoeber
REFERENCE
Inc.,
TO
New
York,
BEDSIDE
1942,
E.
B.
PARDEE.
DIAGNOSIS:
692
pages,
By
108
This is a well-arranged, readable, complete book and the illustrations are well chosen. It is a clear, concise, ex-cathedra exposition of clinical cardiology. Throughout, the author has accepted the newest viewpoints. This is especially noticeable in his discussion of the pathogenesis of hypertension, of the natural history of rheumatic infections, and of the etiology of aortic stenosis. The book has a very certain, but by the same token limited, appeal, in that it is written for senior students, young graduates, and general practictioners, especially It is too advanced for younger students for use during a post-graduate course. It fails to point out and discuss the and too elementary for advanced students. various aspects of the many problems which still await solution, and, above all, the author has chosen to omit all references to the literature. This is the worst aspect of the book, for every student should, as early as possible, be encouraged to seek the source records for himself. By this omission also the field of cardioThe modern cardiologist might find that the logical history is completely ignored. author overemphasizes physical diagnosis to the detriment of the newer, modern means of diagnosis; the electrceardiograph and the fluoroscope are no longer special instruments, but aids in physical diagnosis aa indispensable as the stethoscope and the sphygmomanometer. One
must decidedly disagree with the author when he says (p.VI) that evaluaelectrocardiographic data has done more harm than good; when that and the complaint might, with the same happens it is due to poor judgment, justification (or lack of it), be lodged against stethoscopy or physical diagnosis; think of the interpretations given to “murmurs.” tion
of
The reviewer also believes that the student for whom this book is meant would like to know, at least briefly, what kymography, phonocardiography, and other modern methods are and what they contribute, even though they are not of fundamental importance. The ex-cathedra method of exposition has led to a number of statements which represent the author’s opinion rather than what is generally accepted. Many of his views on myocardial infarction differ from those of other authorities; he fails to recognize “degenerative heart disease” as an etiological group comparable to infectious heart disease, and his use of the term “angina pectoris” is particularly distressing, in that he does not clearly distinguish between the pain of transitory anoxemia and that of myocardial infarction as suggested by the “nomenclature” (New York Heart Association), but he calls all pain from myocardial ischemia, angina pectoris. A number of statements which quoting his authority. Some seem he says that about 50 per cent disease (p. 235), it is necessary to recruiting office, an office practice,
appear so new and unusual are made without to be suspended in thin air; for instance, when of the extrasystoles actxnqany organic heart state whether he obtained his statistics from a or a hospital ward.
BOOK
717
REVIEWS
Of frank omissions there are not many beyond what may be expected by the limitation of the scope of the book. There are, however, some facts missing which should not be omitted even from an elementary textbook. The author does not mention xanthopia as a sign of overdigitalization; Wenckebach’s periods, oncr mentioned, should be explained; the early combination of digitalis and diuretic3 in congestive failure. The figure giving the incidence of positive serologic reaction? The importance of venous pressure in syphilitic heart disease is not in the book. measurements in the evaluation of cardiac function is not duly emphasized: the found only by a thorough perusal of the discussion of cardiac aneurysm can be text-it should be included in the index. There is no mention of the symptomatic effects of sympathectomy in hypertension, which, though difficult to explain, are real enough to be included in the effects of the operation. These are, after all, minor defects in an excellent book. Outweighing these criticisms is the fart that students were more than usually attracted to the volume. and
On the whole, should prove
the book is a contribution popular with the readers
for
to our whom
didactic cardiological it is meant. JULIUS
literature JENSEN.