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Diseases of the heart and circulation
Book Reviews OF THE HEART Lippincott Company,
DISEASES
AND CIRCULATION. 1005 pages.
By
Paul
Wood,
2nd
Ed.,
Philadelphia,
1956,
J. B.
This book is the British counterpart of Paul White’s “Heart Disease,” and Friedberg’s “Diseases of the Heart” in this country. The acknowledgIt is dedicated to Sir John Parkinson. ments, in the front of the book, read like a Who’s Who of London cardiolcgy. The preface is an extraordinarily well-written epitome of the cardiological advances which have occurred since the first edition of the book (1950), omitting only the advances in knowledge of atherosclerotic processes which, however, are well treated in the text. The book is a fine standard text; cardiological research is now so closely co-ordinated in Britain and in this country that there is very little bias from what an American reader expects. It will, therefore, be as welcome in an American physician’s library as its American counterparts. The scope is about the same, the points of view, and the treatment of the subjects are similar, and it may be fairly stated that it soundly reflects the state and trends of Anglo-Saxon cardiological knowledge at this time. The book is traditionally arranged. It begins with a description of symptoms and signs of heart disease. Then follows the means of cardiac investigation, with a chapter on electrocardiography (one page to ballistocardiography). There are two general chapters on cardiac arrhythmias and congestive heart failure. The rest of the book is a special part dealing, in succession, with congenital, rheumatic, and other forms of heart disease. (Incidentally, “coronary disease” is here listed as “ischaemic heart disease”-while the cause of the trouble is in the arteries, the functional disturbance arises from dysfunction of the myocardium, so that there appears to be a choice Considerable of classification. In common sense, of course, coronary disease is heart disease.) emphasis and space are given to rare forms of heart disease (Chapter XI). In the last pages of the book the author reveals a great insight into the psychic and emotional aspects of cardiology. Considering the great importance which these aspects assume in actually dealing with patients, one must regret that more emphasis has not been given to them in the other sections dealing with treatment. To ments
a reader who may be quoted:
attempts
to assess
the
present
page 264: “The mechanism and even the definition century, and are still a source of controversy.”
state
of cardiology,
of heart
failure
five have
significant been debated
statefor a
page 471: “There is no evidence as yet that rheumatic fever is caused directly by any infective agent. There is still, perhaps, a remote possibility that a virus is responsible, but the known facts are against it. It is now generally believed that rehumatic fever is an abnormal tissue reaction to the products of hemolytic streptococcal infection in a sensitized individual.” page 766: this mechanism” tial or malignant
“There is, as yet, no direct proof that essential hypertension (or any other), and (p. 786) “as yet there is no satisfactory hypertension.”
in man is caused by treatment for essen-
“It is believed that page 703: “The cause of human atheroma remains unknown.” p. 705: it is closely related to disturbances of fat metabolism acting over a long period of time and perhaps also to some alteration in the biophysical properties or biochemical structure of the intima itself.” 638
BOOK
6.39
KEVIEWS
page 638: “Carditis accompanying toxemia of pregnancy is particularly interesting. That there may be some form of cardiopathy is suggested in certain cases by the behavior of the cardiac output which may fail to rise as expected when the venous pressure is high. On the other hand, the lack of response to digitalis shows that the heart is not overloaded. It is probable, therefore, that in certain instances cardiac function is impaired, owing perhaps to biochemical, rather than to structural changes in the heart muscle.” In every one, ignorance of the basic These are the five crucial problems in cardiology. process is profound, and as one scans the literature on these subjects, only that on atherosclerosis suggests that any worth-while progress has been made in our knowledge in recent years, in spire of the colossal expenditures of time, effort, and money which have been made. It would appear that continued research along the lines which are described in this volume would lead largely to refinement of existing knowledge but not to clarification of the crucial problems. Yet, in the quotations which have been made there are suggestions that some new avenues of research ma! be available to cardiology, and that perhaps in the biochemical and biophysical laborator& cardiologists may find the answers to the problems which at present block real progress. Is it possible that those who now are studying myocardial and connective tissue cells under the electron microscopes may some day uncover the facts which the cardiologists need? If that be so, it would seem that authcrs of cardiological texts will then have to shift their emphasis of pre-. entations. iiltogether, the author has the rare gift of being able to cull from an overwhelming literaturt the important data and to present them in a clear and readable form.
J. J, DISEASES OF THE HEART. Saunders
Company,
By Charles 1161 pages.
K. Friedberg, Price $18.
M.D.,
2nd Ed.,
Philadelphia,
1956,
u’.
B.
This second edition is, as was the first, the most comprehensive single volume text on diseases of the heart in the English language. It should be readily accessible to all physicians whose province includes cardiology, not only for its wealth of information, literally a one-volume enryclopedia, but also for its references which are virtually a bibliography of significant cardiac literature. Although the double-column page has been introduced, it still has been necessary to enlarge the number of pages by over 100. This increase is due to a new chapter on graphic methods and to recent advances stimulated by the present surgical era. Scarcely any significant phase of cardiology has been omitted. Particularly commendable are many of the sections on medical treatment. Severtheless, the reviewer thinks that the author failed to produce a really great clinical text, which, like a great novel, should create an illusion of reality. The basis for this last opinion is illustrated, implied, and prophesied by the opening chapter Thus, the bald statement, “it has been claimed that cardiac tomography may aid in the differential diagnosis between mitral stenosis and mitral insufficiency,” is obviously a librarious find and has no operational meaning to the reader. More subtle perhaps is the absence of a discussion of reproducibility which is fundamental to the meaning of difference. For instance, there is a lack of a sense of the difficulty in obtaining reproducible electrokymograms as compared to obtaining reproducible electrocardiograms. A pastiche, partly uncontrolled by personal experience, is unavoidable when a single author covers an entire discipline. But to obtain a live book, the author should explicitly differentiate the knowledge gained by personal contact with patients from the information gained from purely verbal sources. Equally impcrtant is the fact that the book opens with a chapter on graphic methods. ‘This implies and prophesies the author’s lack of appreciation of a living person’s complaints and the physician’s mental and physical responses to these complaints. .%fter all, it is a matter of the questions raised by this interaction which forms the reasons for the use of graphic methods. Thus, cardiac hypertrophy (p. 92) is said to be essentially a postmortem diagnosis and is clinically ignored in the chapter on cardiac enlargement; but hypertension is diagnosed (p. 931) by persistent diastolic hypertension and by the contradictory statement, “evidence of left ventricular hypertrophy (roentgenologic and electrocardiographic).” Actually, left ventricular hypertrophy is diagnosed by inspection and palpation, frequently years before electrocardiographic evidence
DISEASES
AND CIRCULATION. 1005 pages.
By
Paul
Wood,
2nd
Ed.,
Philadelphia,
1956,
J. B.
This book is the British counterpart of Paul White’s “Heart Disease,” and Friedberg’s “Diseases of the Heart” in this country. The acknowledgIt is dedicated to Sir John Parkinson. ments, in the front of the book, read like a Who’s Who of London cardiolcgy. The preface is an extraordinarily well-written epitome of the cardiological advances which have occurred since the first edition of the book (1950), omitting only the advances in knowledge of atherosclerotic processes which, however, are well treated in the text. The book is a fine standard text; cardiological research is now so closely co-ordinated in Britain and in this country that there is very little bias from what an American reader expects. It will, therefore, be as welcome in an American physician’s library as its American counterparts. The scope is about the same, the points of view, and the treatment of the subjects are similar, and it may be fairly stated that it soundly reflects the state and trends of Anglo-Saxon cardiological knowledge at this time. The book is traditionally arranged. It begins with a description of symptoms and signs of heart disease. Then follows the means of cardiac investigation, with a chapter on electrocardiography (one page to ballistocardiography). There are two general chapters on cardiac arrhythmias and congestive heart failure. The rest of the book is a special part dealing, in succession, with congenital, rheumatic, and other forms of heart disease. (Incidentally, “coronary disease” is here listed as “ischaemic heart disease”-while the cause of the trouble is in the arteries, the functional disturbance arises from dysfunction of the myocardium, so that there appears to be a choice Considerable of classification. In common sense, of course, coronary disease is heart disease.) emphasis and space are given to rare forms of heart disease (Chapter XI). In the last pages of the book the author reveals a great insight into the psychic and emotional aspects of cardiology. Considering the great importance which these aspects assume in actually dealing with patients, one must regret that more emphasis has not been given to them in the other sections dealing with treatment. To ments
a reader who may be quoted:
attempts
to assess
the
present
page 264: “The mechanism and even the definition century, and are still a source of controversy.”
state
of cardiology,
of heart
failure
five have
significant been debated
statefor a
page 471: “There is no evidence as yet that rheumatic fever is caused directly by any infective agent. There is still, perhaps, a remote possibility that a virus is responsible, but the known facts are against it. It is now generally believed that rehumatic fever is an abnormal tissue reaction to the products of hemolytic streptococcal infection in a sensitized individual.” page 766: this mechanism” tial or malignant
“There is, as yet, no direct proof that essential hypertension (or any other), and (p. 786) “as yet there is no satisfactory hypertension.”
in man is caused by treatment for essen-
“It is believed that page 703: “The cause of human atheroma remains unknown.” p. 705: it is closely related to disturbances of fat metabolism acting over a long period of time and perhaps also to some alteration in the biophysical properties or biochemical structure of the intima itself.” 638
BOOK
6.39
KEVIEWS
page 638: “Carditis accompanying toxemia of pregnancy is particularly interesting. That there may be some form of cardiopathy is suggested in certain cases by the behavior of the cardiac output which may fail to rise as expected when the venous pressure is high. On the other hand, the lack of response to digitalis shows that the heart is not overloaded. It is probable, therefore, that in certain instances cardiac function is impaired, owing perhaps to biochemical, rather than to structural changes in the heart muscle.” In every one, ignorance of the basic These are the five crucial problems in cardiology. process is profound, and as one scans the literature on these subjects, only that on atherosclerosis suggests that any worth-while progress has been made in our knowledge in recent years, in spire of the colossal expenditures of time, effort, and money which have been made. It would appear that continued research along the lines which are described in this volume would lead largely to refinement of existing knowledge but not to clarification of the crucial problems. Yet, in the quotations which have been made there are suggestions that some new avenues of research ma! be available to cardiology, and that perhaps in the biochemical and biophysical laborator& cardiologists may find the answers to the problems which at present block real progress. Is it possible that those who now are studying myocardial and connective tissue cells under the electron microscopes may some day uncover the facts which the cardiologists need? If that be so, it would seem that authcrs of cardiological texts will then have to shift their emphasis of pre-. entations. iiltogether, the author has the rare gift of being able to cull from an overwhelming literaturt the important data and to present them in a clear and readable form.
J. J, DISEASES OF THE HEART. Saunders
Company,
By Charles 1161 pages.
K. Friedberg, Price $18.
M.D.,
2nd Ed.,
Philadelphia,
1956,
u’.
B.
This second edition is, as was the first, the most comprehensive single volume text on diseases of the heart in the English language. It should be readily accessible to all physicians whose province includes cardiology, not only for its wealth of information, literally a one-volume enryclopedia, but also for its references which are virtually a bibliography of significant cardiac literature. Although the double-column page has been introduced, it still has been necessary to enlarge the number of pages by over 100. This increase is due to a new chapter on graphic methods and to recent advances stimulated by the present surgical era. Scarcely any significant phase of cardiology has been omitted. Particularly commendable are many of the sections on medical treatment. Severtheless, the reviewer thinks that the author failed to produce a really great clinical text, which, like a great novel, should create an illusion of reality. The basis for this last opinion is illustrated, implied, and prophesied by the opening chapter Thus, the bald statement, “it has been claimed that cardiac tomography may aid in the differential diagnosis between mitral stenosis and mitral insufficiency,” is obviously a librarious find and has no operational meaning to the reader. More subtle perhaps is the absence of a discussion of reproducibility which is fundamental to the meaning of difference. For instance, there is a lack of a sense of the difficulty in obtaining reproducible electrokymograms as compared to obtaining reproducible electrocardiograms. A pastiche, partly uncontrolled by personal experience, is unavoidable when a single author covers an entire discipline. But to obtain a live book, the author should explicitly differentiate the knowledge gained by personal contact with patients from the information gained from purely verbal sources. Equally impcrtant is the fact that the book opens with a chapter on graphic methods. ‘This implies and prophesies the author’s lack of appreciation of a living person’s complaints and the physician’s mental and physical responses to these complaints. .%fter all, it is a matter of the questions raised by this interaction which forms the reasons for the use of graphic methods. Thus, cardiac hypertrophy (p. 92) is said to be essentially a postmortem diagnosis and is clinically ignored in the chapter on cardiac enlargement; but hypertension is diagnosed (p. 931) by persistent diastolic hypertension and by the contradictory statement, “evidence of left ventricular hypertrophy (roentgenologic and electrocardiographic).” Actually, left ventricular hypertrophy is diagnosed by inspection and palpation, frequently years before electrocardiographic evidence