Coronary heart disease

Book Reviews My Life and Medicine-An Autobiographical Memoir, by Paul Dudley White, MD. Boston, Gambit, 1971, 269 pages, $6.95 The memoirs of Paul Dudley White portray the life history of a great human being-his thoughts, his teaching activities, his contributions to cardiology as a scientific discipline and his lifelong concern for world peace. This history is interwoven into a literary fabric which affords the reader a profitable, stimulating experience. The chronology of personal events never reflects egotism. The qualities of sympathy, determination, insight and profound skill reveal a man who possesses the highest attributes in medicine and in society. Dr. White’s early training by his physician-father, his educational experience at Harvard Medical School and his interests in pediatrics and internal medicine prepared him for the opportunity to study under the world’s greatest cardiologists-Sir James McKenzie, Sir Thomas Lewis, John Parkinson and others in London. In 1914 he returned to Boston and set up an electrocardiographic laboratory in the basement of the Massachusetts General Hospital. Soon thereafter, Dr. White, with Dr. Richard Cabot, began the classification of heart disease according to its origin, thus becoming a pioneer in the concept of preventive cardiology. World War I found him serving in Europe as a medical officer, and he later had a tour of duty in Macedonia, sponsored by the Red Cross. Returning to Boston, he fathered the beginnings of cardiology through practice, teaching and clinical research. He wrote the first American textbook on heart disease in 1929. Dr. White’s interest in the anatomy and physiology of large mammals brought interesting and profitable interludes in his life as he studied the action of the elephant’s heart in Boston, and the heart of the grey whale, both in Alaskan waters and in the Pacific Ocean off the coast of Mexico. During the 1940’s and 1950’s Dr. White pointed to the wider range of normal findings in man, and indicated that no man necessarily conformed to the socalled averages. He especially emphasized the wide variation in normal heart rate, heart size and blood pressure. Following his retirement as an active director of the cardiac laboratory and cardiac clinics at Massachusetts General Hospital, his advice was widely sought and his activities as a consulting cardiologist and world traveler in the interest of the heart and global peace increased markedly. The measure of the man and the physician is seen in his detailed account of President Eisenhower’s heart attack. In the care of the President, his belief that both medical and lay communities should know the details of the illness and the status of the patient at all times established a precedent. He pointed out that recovery from a heart attack is possible and that long years of useful life may follow. The chapter on President Eisenhower’s heart attack should be required reading for all. The increasing incidence of coronary artery disease, especially in the young American, is emphasized. He

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shows that control of the greatest epidemic the world has ever known--coronary artery disease-can be attained by physical fitness, prudent dieting, avoidance of tobacco and the lessening of tension. Throughout the book it becomes unmistakably clear that most of the advances in cardiology were heralded by the mind of Dr. Paul Dudley White. George C. Griffith, MD, FACC La Canada, California

Coronary Heart Disease, edited by H. I. Russek, MD and B. L. Zohman, MD. Philadelphia, J. B. Lippincott, 1971, 502 pages, $20.00

This volume consists of a discussion of the various aspects of coronary artery disease presented at a symposium sponsored by the American College of Cardiology and St. Barnabas Hospital in New York City on December 13 to 15, 1969. The chapters are written by some of the most famous names in American medicine. Discussed are the recent concepts of the anatomy of the coronary arteries with reference to their functional import and the location of obstructive disease of the coronary circulation. Discussion of pathophysiologic and pathogenetic factors is extensive and includes excellent chapters by Gregg on the physiologic factors which determine coronary blood flow and techniques for measurement of the coronary circulation by Gensini and associates. An excellent chapter by Katz considers the effects of ischemia and hypoxia upon the myocardium. Rosenman and Friedman present an informative discussion on the possible role of behavior patterns in proneness and immunity to coronary heart disease. Gudbjarnason and Bing contribute an excellent chapter on the metabolic changes in myocardial infarction. The diagnosis of ischemic heart disease is presented in considerable detail as is the long-term management of ischemic heart disease. The problems encountered in the acute coronary care unit are presented by Grace, Weil, Shubin, Killip, Kuhn and others. An excellent chapter is that on the management of heart block complicating acute myocardial infarction by Dack and Donoso. The surgical treatment for coronary artery disease is presented by Lillehei, Vineberg, Sones, Bailey and associates, with some dissenting opinions by Friedberg. Some of the drawbacks in this volume are those which are frequently inherent in a compilation of data on various subjects by many different authors. These include variation in the emphasis placed on different topics, lack of uniformity of presentation, repetition of certain aspects, and variation in emphasis and methods of presentation of data. In summary, this volume consists of an excellent compilation and review of the recent status of the subject of coronary heart disease and should be in the library of the cardiologist, internist and cardiovascular surgeon. Samuel Bellet, MD, FACC Philadelphia,

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