Failure of the circulation

FAILURE

OF

396 pages,

THE

The

CIfiCULAmON.

Williams

By Tin&y Randolph & Wilkins Company.

Harrison.

Baltimore,

1935,

This book was written by one who, with several associates, has been actively engaged for over a decade in the clinical and experimental study of the mechanism of the failure of the circulation. The structure of the presentation consists in an introduction, five sections of discussion, and a summary. A selected bibliography and author and subject indexes are appended. In the concise historical introduction, the author presents the early history of the knowledge of circulatory failure, bearing particularly on the concepts of “forward failure” and “backmarc? failure” of the circulation (i.e., whether the early and primary derangement of the circulation depends on the inadequate blood supply to the tissues resulting from .&creased cardiac output, or on t,he engorgement of blood behind the failing or diseased portion of the heart). After justified apologies the author introduces the terms and concepts of hypokinetic, hyperkinetic, and dyskinetic syndromes. Whether these terms as representing basic concepts are constructive or entirely justified may be debated. Of the three syndromes, the hyperkinetic and hypokinetic syndromes are discussed in a summary fashion, while t.he dyskinetic syndrome (congestive failure) represents the bulk of the volume. In thi.s part the author analyzes in det,ail the experimental and clinical evidence for and against the He concludes that the forward failure forward and backv,-ard failure theories. theory is not. acceptable, and presents evidence favoring the backward failure theory. In the succeeding ch:rpters, the mechanism of a number of the important phenomena The conclusions of the failure of the circulation is presented in a selective manner. of some of the chapters are reached on the basis of the analysis of the literature, and of others on the basis of rich personal experience. The chapters on dyspnea and on the classification and measureedema are particularly good. The discussions ments of dyspneas, the causes of dyspnea on exertion, the mechanism of orthopnea, paroxysmal dyspnea, and Cheyne-Stokes i respiration are stimulating and reveal valuable information with much originality. The numerous other manifestations of circulatory failure are treated concisely, rather in a clinical descriptive than in an analytical manner. The section on the therapeutic action of digitalis is excellent in describing the mechanism whereby digitalis produces improvement. There is in addition a short section on the failure of the coronary circulation. The style of the book is simple and direct. There is, however, a lack of uniformity in the construction of the chapters. The book serves as an excellent demonClinical observastration of the methods and tools used in clinical sciences today. tions and descriptions are related to results of well-conceived experimental studies, though the ratio of the correlation varies widely in different chapters, depending primarily on whether or not the author has done work on the subject. In arrangement the book is a cross between a monographic presentation and a detailed textbook of specialties. It is a well-focused and excellent presentation of the subject in the light of personal experience and opinion by one who has pondered over the problems. The book is not for the use of the average physician interested in general medicine. Rather it is a reference book for those desiring to be, or considered as, experts in diseases of the heart and the circulation, and for all students who are interested in the functional approach and analysis of clinical phenomena.. 8. w. 254