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Medical and Biological Research in Israel
Volume 81 Number 6
cal fe, which was published in 1958. Essentially, the experience of the New York Lying-In Hospital is presented against the background of selected publications from other centers. Incidentally, the publisher's fly-leaf statement that "'Dr. Mendelson has been responsible for the care of almost four thousand pregnant women afHicted with heart disease" could be true only if he had been in charge of the cardiac clinic since two years before entering medical school. This large number of patients with heart disease brings up the question of diagnosis, for the 3.7 per cent incidence is about three times that reported in other clinics in the same area. Part of the answer to this question is that the Pediatric Cardiac Clinic of the New York Hospital labels as having heart disease every child who has had rheumatic fever and, on very tenuous evidence of rheumatic fever, so labels siblings. Many of the girls in this group eventually come to the Obstetric Cardiac Clinic with the ready-made diagnosis of heart disease and this is reflected in Mendelson's remark, in a recent paper, that "nearly 75 per cent" of his pregnant women with rheumatic heart disease have mitral stenosis. What are the lesions in the other 25 plus per cent? Bland and Jones, in a 20 to 30 year follow-up study of children with rheumatic fever at the Good Samaritan Hospital in Boston, found that only half ever developed signs of valvular lesions. Yet l
Book reviews
1283
dictable hemodynamic burden of pregnancy" appears in the correlation of time of cardiac failure in pregnancy to the peak of plasma volume ur peak of cardiac output. However, Gordon, in reviewing all maternal cardiac deaths in Brooklyn, found no such thing; the times of failure were distributed throughout pregnancy, with the highest incidences in the fourth month. Also ignored is the fact that the increase in blood volume is largely a "dilutional" effect in that plasma volume increases more than red cell mass. The effect of this is to decrease the apparent viscosity of the blood by 15 to 2() per cent and thus offset, partially, the burden upon the heart. In discussing the medical supportive management of pregnant women with heart disease, Mendelson cit her ignores or distorts, denigrates and dismisses papcrs with conclusions that he finds uncongenial. Some startling remarks are made about toxemia of pregnancy. To mention some: it is caused by placental thrombosis and infarction; it is accompanied by hypervolcmia; fluid intake should be restricted; the vast majority of eclamptic fatalities associated with cerebral hcmorrhage have ruptured aneurysms.
Medical and Biological Research in Israel.
ny
Moshe Prywes. 562 pages. New York, 1960, Grone & Stratton, Inc. $8. In the foreword to this remarkable book concerning the accomplishments of medical and biological research in Israel, there is a statement that "Our achievements, all told, have been Illodest." No one reading this book could possibly agree, cspecially when it is found to contain 2,000 references selected from more than 5,000, most of which have been published since thc foundation of thc State of Israel in 19·48. The book shows how well-organized research programs encompassing a whole country can be developed within a decade. The territory 01 ancient Israel has always attracted the attention of European scholars, mainly because of its theological and historical associations, so that the prerequisites were there. Saul Adler, F.R.S., has written a section entitled "Background" and has placed the development of research into three phases, (1) from the beginning of tht' present century to World War I; (2) the malldatory period; (3) the period from the foundation of the State of Israel to thc present time. The mandatory period was important to tIll'
1284
Book reviews
future development of research which matured after the foundation of the state. During this second phase such institutions as the Weizmanll Institute of Science at Rehovot, the Technion at Haifa, and the Hebrew University of Jerusalem were founded, and their places in the world of learning and research are now well established. How the Hebrew University maintained its teaching and research activities after the enforced evacuation from Mt. Scopus is a source of continual admiration to the whole civilized world. Medical and biological education in Israel generally follow the patterns of Western methods and the Israel Medical Association is largely responsible for postgraduate medical education and the organization of symposia and medical conferences. The bulk of the book, however, is divided into the second and third parts, one dealing with regional and applied research and the other with research of general nature. Each part is subdivided into sections which contain short descriptions of the most significant research carried out by individual departments. At the end of each section references are fully and meticulously given. In the regional and applied research part of the book, there are chapters on public health and social medicine, plant sciences as applied to agriculture, animal husbandry, and industrial aspects of biological research. Under the heading of "Research of a General Nature," the first section deals with experimental biology and includes references to such important subjects as genetics, radiology, and cancer research. Botany and zoology also have sections of their own. Interesting and practical information concerning the development of fishing and plant ecology has resulted from research carried out in these departments. The section devoted to experimental and clinical research and medical disciplines covers all the major specialties and obstetrics and gynecology are included. The researches developing from the original Aschheim-Zondek pregnancy test have continued, and indigenous amphibia have been utilized for pregnancy testing. Zondek and his colleagues have made valuable contributions concerning estriol determinations in intrauterine fetal death, cervical mucous arborization, and vaginal smears for the determination of endocrine functions. The high incidence of genital tuberculosis causing female sterility in Israel has led to ex-
Am.
J.
June, 1961 Obs!. & Gyne c .
tensive research by Halbrecht and his colleagues. Much work has also been done on male sterility, in particular Joel's contributions on aspermia due to obstruction, a staining method of determining the viability of human spermatozoa, and the various aspects of antibiotics on sperm motility. Many important contributions to the American and British literature have been made by Getzowa, Sadowsky, and Laufer concerning the structure of the placenta in particular to the anuclear spaces of placental syncitium. Likewise, the work of Serr, Sadowsky, and Kohn on "nuclear sexing" and their demonstration that the placental septa are of maternal composition have received wide recognition. A new fetal hemoglobin has been described by Halbrecht and Klibansky, and Bromberg's studies on fetal hemoglobin have been published. The rarity of cervical carcinoma in Israel is probably responsible for the paucity of investigation into benign and malignant growths. As is well known, the incidence of cervical cancer in Israel is identical with that of Jewish women in New York, but the reasons remain obscure. Nutritional anemia has been a great problem and is largely accounted for by the mass eXodus of poorly nourished people to Israel. Some important surveys in pregnant women have been carried out, notably by Sadowsky, Izak, and Rachmilewitz, and it was concluded that anemia of pregnancy in Israel probably develops as a consequence of poor nutrition and repeated pregnancies. This work was an enormous undertaking involving the participation of over sixty coIl" tributors under the direction of the editor, Moshe Prywes, and was sponsored and financed by the Hebrew University of Jerusalem and I-Iadassah, the Women's Zionist Organization of America. . 1 Some excellent photographs of the more InpOl·tant research institutions add considerable interest to the book. It is the opinion of the reviewer that all thOSe who made this vast undertaking possible arc (0 be congratulated. Shaw's Textbook of Operative Gynaecology. Edited by John Howkins. Second edition. 4B4 pages, 42B figures. Baltimorc, 1960, Williams & Wilkins Company. $20. The second edition of Shaw's Textbook of operative Gynaecology having been rewritten by
cal fe, which was published in 1958. Essentially, the experience of the New York Lying-In Hospital is presented against the background of selected publications from other centers. Incidentally, the publisher's fly-leaf statement that "'Dr. Mendelson has been responsible for the care of almost four thousand pregnant women afHicted with heart disease" could be true only if he had been in charge of the cardiac clinic since two years before entering medical school. This large number of patients with heart disease brings up the question of diagnosis, for the 3.7 per cent incidence is about three times that reported in other clinics in the same area. Part of the answer to this question is that the Pediatric Cardiac Clinic of the New York Hospital labels as having heart disease every child who has had rheumatic fever and, on very tenuous evidence of rheumatic fever, so labels siblings. Many of the girls in this group eventually come to the Obstetric Cardiac Clinic with the ready-made diagnosis of heart disease and this is reflected in Mendelson's remark, in a recent paper, that "nearly 75 per cent" of his pregnant women with rheumatic heart disease have mitral stenosis. What are the lesions in the other 25 plus per cent? Bland and Jones, in a 20 to 30 year follow-up study of children with rheumatic fever at the Good Samaritan Hospital in Boston, found that only half ever developed signs of valvular lesions. Yet l
Book reviews
1283
dictable hemodynamic burden of pregnancy" appears in the correlation of time of cardiac failure in pregnancy to the peak of plasma volume ur peak of cardiac output. However, Gordon, in reviewing all maternal cardiac deaths in Brooklyn, found no such thing; the times of failure were distributed throughout pregnancy, with the highest incidences in the fourth month. Also ignored is the fact that the increase in blood volume is largely a "dilutional" effect in that plasma volume increases more than red cell mass. The effect of this is to decrease the apparent viscosity of the blood by 15 to 2() per cent and thus offset, partially, the burden upon the heart. In discussing the medical supportive management of pregnant women with heart disease, Mendelson cit her ignores or distorts, denigrates and dismisses papcrs with conclusions that he finds uncongenial. Some startling remarks are made about toxemia of pregnancy. To mention some: it is caused by placental thrombosis and infarction; it is accompanied by hypervolcmia; fluid intake should be restricted; the vast majority of eclamptic fatalities associated with cerebral hcmorrhage have ruptured aneurysms.
Medical and Biological Research in Israel.
ny
Moshe Prywes. 562 pages. New York, 1960, Grone & Stratton, Inc. $8. In the foreword to this remarkable book concerning the accomplishments of medical and biological research in Israel, there is a statement that "Our achievements, all told, have been Illodest." No one reading this book could possibly agree, cspecially when it is found to contain 2,000 references selected from more than 5,000, most of which have been published since thc foundation of thc State of Israel in 19·48. The book shows how well-organized research programs encompassing a whole country can be developed within a decade. The territory 01 ancient Israel has always attracted the attention of European scholars, mainly because of its theological and historical associations, so that the prerequisites were there. Saul Adler, F.R.S., has written a section entitled "Background" and has placed the development of research into three phases, (1) from the beginning of tht' present century to World War I; (2) the malldatory period; (3) the period from the foundation of the State of Israel to thc present time. The mandatory period was important to tIll'
1284
Book reviews
future development of research which matured after the foundation of the state. During this second phase such institutions as the Weizmanll Institute of Science at Rehovot, the Technion at Haifa, and the Hebrew University of Jerusalem were founded, and their places in the world of learning and research are now well established. How the Hebrew University maintained its teaching and research activities after the enforced evacuation from Mt. Scopus is a source of continual admiration to the whole civilized world. Medical and biological education in Israel generally follow the patterns of Western methods and the Israel Medical Association is largely responsible for postgraduate medical education and the organization of symposia and medical conferences. The bulk of the book, however, is divided into the second and third parts, one dealing with regional and applied research and the other with research of general nature. Each part is subdivided into sections which contain short descriptions of the most significant research carried out by individual departments. At the end of each section references are fully and meticulously given. In the regional and applied research part of the book, there are chapters on public health and social medicine, plant sciences as applied to agriculture, animal husbandry, and industrial aspects of biological research. Under the heading of "Research of a General Nature," the first section deals with experimental biology and includes references to such important subjects as genetics, radiology, and cancer research. Botany and zoology also have sections of their own. Interesting and practical information concerning the development of fishing and plant ecology has resulted from research carried out in these departments. The section devoted to experimental and clinical research and medical disciplines covers all the major specialties and obstetrics and gynecology are included. The researches developing from the original Aschheim-Zondek pregnancy test have continued, and indigenous amphibia have been utilized for pregnancy testing. Zondek and his colleagues have made valuable contributions concerning estriol determinations in intrauterine fetal death, cervical mucous arborization, and vaginal smears for the determination of endocrine functions. The high incidence of genital tuberculosis causing female sterility in Israel has led to ex-
Am.
J.
June, 1961 Obs!. & Gyne c .
tensive research by Halbrecht and his colleagues. Much work has also been done on male sterility, in particular Joel's contributions on aspermia due to obstruction, a staining method of determining the viability of human spermatozoa, and the various aspects of antibiotics on sperm motility. Many important contributions to the American and British literature have been made by Getzowa, Sadowsky, and Laufer concerning the structure of the placenta in particular to the anuclear spaces of placental syncitium. Likewise, the work of Serr, Sadowsky, and Kohn on "nuclear sexing" and their demonstration that the placental septa are of maternal composition have received wide recognition. A new fetal hemoglobin has been described by Halbrecht and Klibansky, and Bromberg's studies on fetal hemoglobin have been published. The rarity of cervical carcinoma in Israel is probably responsible for the paucity of investigation into benign and malignant growths. As is well known, the incidence of cervical cancer in Israel is identical with that of Jewish women in New York, but the reasons remain obscure. Nutritional anemia has been a great problem and is largely accounted for by the mass eXodus of poorly nourished people to Israel. Some important surveys in pregnant women have been carried out, notably by Sadowsky, Izak, and Rachmilewitz, and it was concluded that anemia of pregnancy in Israel probably develops as a consequence of poor nutrition and repeated pregnancies. This work was an enormous undertaking involving the participation of over sixty coIl" tributors under the direction of the editor, Moshe Prywes, and was sponsored and financed by the Hebrew University of Jerusalem and I-Iadassah, the Women's Zionist Organization of America. . 1 Some excellent photographs of the more InpOl·tant research institutions add considerable interest to the book. It is the opinion of the reviewer that all thOSe who made this vast undertaking possible arc (0 be congratulated. Shaw's Textbook of Operative Gynaecology. Edited by John Howkins. Second edition. 4B4 pages, 42B figures. Baltimorc, 1960, Williams & Wilkins Company. $20. The second edition of Shaw's Textbook of operative Gynaecology having been rewritten by