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Occupational lung disease
Br. J. Dis. Chest (1977),
71, 303
BOOK REVIEWS Ventilation/Blood
Flow and Gas Exchange
John B. West Oxford : Blackwell Scientific. edition. xii + 113. Price E2.50.
1977.
Third
John West is a gifted teacher and this monograph shows this to be so. His text and diagrams are refined inexorably to unroll a brief, clear and simple explanation of a complex subject. There is no better or more accessible account of gas exchange in the lung than this and it should be read and re-read by all who wish to appreciate, let alone hide behind the jargon of, V/Q inequality. The third edition, largely and wisely unchanged, discusses the mechanism of lung collapse during the breathing of oxygen, and includes references to new methods of estimating inequality, particularly those dependent upon inert gas elimination, developed by Wagner and West and discussed in detail by Wagner (Physd. Rev. 1977, 57, 257-312) in a review that appeared too late to be cited in the monograph. This book is a classic of medical teaching and should be known to all who wish to understand the lung or to write of complex matters simply. D. M. DENISON Occupational W. Keith
Lung Disease C. Morgan
and Anthony
Philadelphia: Saunders. Price not stated.
1975.
Seaton xiv + 391.
The preface states the book is written ‘especially for those engaged in the practice of internal medicine and the subspecialities of respiratory and occupational medicine, it is hoped that it will be of use also to radiologists and pathologists’. This aim is to be achieved by a series of introductory chapters on general topics followed by chapters on individual diseases. The introductory chapters are the weakest of the book. The opening chapter on the history and legal aspects of industrial lung disease is too brief to be helpful and seems superfluous when later chapters discuss the
history of industrial diseases also. The second physiology chapter on basic pulmonary appears too brief for those with any training in the field and too compressed for those without ; the references are particularly unhelpful for the non-physiologist. The third chapter, on dust deposition, is simply unclear; there is no clear explanation of the relationship between particle shape, size and deposition; the reader is left to realize that the majority of the smallest particles will not deposit in the lung at all. The fourth chapter discusses epidemiology. The chapter on pathology is informative but the photomicrographs are poor. The chapter on immunology makes no mention of recent techniques to detect circulating immune complexes which may yield much new information in the next few years. The later chapters on individual diseases are good and give lucid accounts of silicosis, silicate pneumoconioses and asbestosis. The chapter on coalworkers’ pneumoconiosis irritatingly discusses the three possible ways of grading chest radiographs without clearly stating which one is then described in detail. There is no clear account of the recent, important debate on the relationship between emphysema and coalworkers’ pneumoconiosis which has divided British investigators. Later chapters on other pneumoconioses, occupational asthma, industrial bronchitis, byssinosis (in spite of an irrelevant picture of a cotton flower), allergic alveolitis, toxic gases and fumes, infectious diseases, and occupational pulmonary neoplasms are helpful. The index is good. Annoying evidences of poor editing are too common. It seems unnecessary to discuss the radiological determination of lung volume under pulmonary physiology, epidemiology and coalworkers’ pneumoconiosis. There are several discussions on the fate of particles in the lung according to their size; these are not consistent. There is a good book here struggling to get written. Authors divided by the Atlantic have a hard task. With firm decisions on who the book is for, and so the proper balance between the general and specific chapters, and a single
304 final could
Book Reviews editor the second be outstanding.
edition
of
this
P. H.
Pathology
of Disruptive
A. E. Anderson Springfield, xvi + 239.
Ill.: Price
and
Pulmonary Alvan
Charles $18.50.
G. C.
book
WRIGHT
present-day book is generalist
views as to its significance. This therefore strongly recommended to and specialist alike. B. CORFCIN
Emphysema Respiratory
Foraker Thomas.
1976.
The authors of this handy book confine their attention to the clinically important disruptive forms of emphysema. Pure dilatation lesions are given little consideration and what is frequently thought to be a complex subject is thereby made to appear refreshingly clear. The disruptive forms of emphysema are classified in the usual way on the basis of acinar architecture (centriacinar, panacinar, paraseptal and irregular) and extrinsic and intrinsic pathogenetic factors are related to each morphological type of disease so far as present-day knowledge permits. In essence the authors consider that disruptive emphysema represents the summation of repeated episodes of alveolar damage which is most frequently inflammatory in nature. Thereafter emphysema is treated as one disease and succeeding chapters deal with the changes in the lung parenchyma, the bronchioles, the bronchi, the heart and the pulmonary blood vessels. Each of these chapters summarizes the normal structure as a basis for comparison with the diseased, describes in detail the various pathological changes, considers the pathogenic and functional implications of these abnormalities, and in common with the earlier chapters ends with a succinct summary. There are 102 figures of mixed quality, 32 tables and a useful list of 218 references. This book will have double appeal. General physicians and pathologists looking for a lucid and concise account of this difficult subject will be pleased to find a comprehensible straightforward presentation. They will also be impressed by the wealth of quantitative data presented and note that much of this represents studies conducted personally by the authors and their colleagues. Specialists in this field on the other hand will already know of these contributions to the subject but will find it extremely valuable to have all these data collected together in one slim volume, with the benefit of a clear statement of the authors’
Failure
M. K. Sykes, Campbell Oxford: edition.
xii
M.
Blackwell + 461.
W.
McNicol
Scientific. Price Ll1.50.
and
E. J. M.
1977.
Second
Since the first edition of this book was published in 1969 there have been many important advances in the management of respiratory failure. Much more is known about the underlying disturbances of pulmonary function, respiratory intensive therapy units are more efficiently organized and there have been major developments not only in therapeutic techniques and the design of equipment but also in the methods used to monitor the response to treatment. The preparation of a new edition after a gap of seven years must therefore have been a daunting task and it is to the authors’ credit that, although a vast amount of new data has had to be assimilated, they have still managed to retain the pragmatic approach to the treatment of respiratory failure which was one of the main reasons why the original book proved so useful and successful. The average reader may find the introductory chapters on respiratory physiology somewhat indigestible, but they are clearly and concisely written and provide an essential scientific background to the basic purpose of the book. The later chapters cover every aspect of practical management in commendable detail. Although the views expressed on the strategy of treating respiratory failure will receive unqualified support, some of the more specific recommendations may be challenged. It is doubtful, for example, if there will be much enthusiasm for the technique of cricothyroid cannulation to stimulate cough or for the suggestion that rigid bronchoscopy and repeated endotracheal intubation for the removal of secretions should be performed under local anaesthesia in conscious patients. Another controversial point is the implication that mechanical ventilation in patients with respiratory paralysis presents no serious problems because
71, 303
BOOK REVIEWS Ventilation/Blood
Flow and Gas Exchange
John B. West Oxford : Blackwell Scientific. edition. xii + 113. Price E2.50.
1977.
Third
John West is a gifted teacher and this monograph shows this to be so. His text and diagrams are refined inexorably to unroll a brief, clear and simple explanation of a complex subject. There is no better or more accessible account of gas exchange in the lung than this and it should be read and re-read by all who wish to appreciate, let alone hide behind the jargon of, V/Q inequality. The third edition, largely and wisely unchanged, discusses the mechanism of lung collapse during the breathing of oxygen, and includes references to new methods of estimating inequality, particularly those dependent upon inert gas elimination, developed by Wagner and West and discussed in detail by Wagner (Physd. Rev. 1977, 57, 257-312) in a review that appeared too late to be cited in the monograph. This book is a classic of medical teaching and should be known to all who wish to understand the lung or to write of complex matters simply. D. M. DENISON Occupational W. Keith
Lung Disease C. Morgan
and Anthony
Philadelphia: Saunders. Price not stated.
1975.
Seaton xiv + 391.
The preface states the book is written ‘especially for those engaged in the practice of internal medicine and the subspecialities of respiratory and occupational medicine, it is hoped that it will be of use also to radiologists and pathologists’. This aim is to be achieved by a series of introductory chapters on general topics followed by chapters on individual diseases. The introductory chapters are the weakest of the book. The opening chapter on the history and legal aspects of industrial lung disease is too brief to be helpful and seems superfluous when later chapters discuss the
history of industrial diseases also. The second physiology chapter on basic pulmonary appears too brief for those with any training in the field and too compressed for those without ; the references are particularly unhelpful for the non-physiologist. The third chapter, on dust deposition, is simply unclear; there is no clear explanation of the relationship between particle shape, size and deposition; the reader is left to realize that the majority of the smallest particles will not deposit in the lung at all. The fourth chapter discusses epidemiology. The chapter on pathology is informative but the photomicrographs are poor. The chapter on immunology makes no mention of recent techniques to detect circulating immune complexes which may yield much new information in the next few years. The later chapters on individual diseases are good and give lucid accounts of silicosis, silicate pneumoconioses and asbestosis. The chapter on coalworkers’ pneumoconiosis irritatingly discusses the three possible ways of grading chest radiographs without clearly stating which one is then described in detail. There is no clear account of the recent, important debate on the relationship between emphysema and coalworkers’ pneumoconiosis which has divided British investigators. Later chapters on other pneumoconioses, occupational asthma, industrial bronchitis, byssinosis (in spite of an irrelevant picture of a cotton flower), allergic alveolitis, toxic gases and fumes, infectious diseases, and occupational pulmonary neoplasms are helpful. The index is good. Annoying evidences of poor editing are too common. It seems unnecessary to discuss the radiological determination of lung volume under pulmonary physiology, epidemiology and coalworkers’ pneumoconiosis. There are several discussions on the fate of particles in the lung according to their size; these are not consistent. There is a good book here struggling to get written. Authors divided by the Atlantic have a hard task. With firm decisions on who the book is for, and so the proper balance between the general and specific chapters, and a single
304 final could
Book Reviews editor the second be outstanding.
edition
of
this
P. H.
Pathology
of Disruptive
A. E. Anderson Springfield, xvi + 239.
Ill.: Price
and
Pulmonary Alvan
Charles $18.50.
G. C.
book
WRIGHT
present-day book is generalist
views as to its significance. This therefore strongly recommended to and specialist alike. B. CORFCIN
Emphysema Respiratory
Foraker Thomas.
1976.
The authors of this handy book confine their attention to the clinically important disruptive forms of emphysema. Pure dilatation lesions are given little consideration and what is frequently thought to be a complex subject is thereby made to appear refreshingly clear. The disruptive forms of emphysema are classified in the usual way on the basis of acinar architecture (centriacinar, panacinar, paraseptal and irregular) and extrinsic and intrinsic pathogenetic factors are related to each morphological type of disease so far as present-day knowledge permits. In essence the authors consider that disruptive emphysema represents the summation of repeated episodes of alveolar damage which is most frequently inflammatory in nature. Thereafter emphysema is treated as one disease and succeeding chapters deal with the changes in the lung parenchyma, the bronchioles, the bronchi, the heart and the pulmonary blood vessels. Each of these chapters summarizes the normal structure as a basis for comparison with the diseased, describes in detail the various pathological changes, considers the pathogenic and functional implications of these abnormalities, and in common with the earlier chapters ends with a succinct summary. There are 102 figures of mixed quality, 32 tables and a useful list of 218 references. This book will have double appeal. General physicians and pathologists looking for a lucid and concise account of this difficult subject will be pleased to find a comprehensible straightforward presentation. They will also be impressed by the wealth of quantitative data presented and note that much of this represents studies conducted personally by the authors and their colleagues. Specialists in this field on the other hand will already know of these contributions to the subject but will find it extremely valuable to have all these data collected together in one slim volume, with the benefit of a clear statement of the authors’
Failure
M. K. Sykes, Campbell Oxford: edition.
xii
M.
Blackwell + 461.
W.
McNicol
Scientific. Price Ll1.50.
and
E. J. M.
1977.
Second
Since the first edition of this book was published in 1969 there have been many important advances in the management of respiratory failure. Much more is known about the underlying disturbances of pulmonary function, respiratory intensive therapy units are more efficiently organized and there have been major developments not only in therapeutic techniques and the design of equipment but also in the methods used to monitor the response to treatment. The preparation of a new edition after a gap of seven years must therefore have been a daunting task and it is to the authors’ credit that, although a vast amount of new data has had to be assimilated, they have still managed to retain the pragmatic approach to the treatment of respiratory failure which was one of the main reasons why the original book proved so useful and successful. The average reader may find the introductory chapters on respiratory physiology somewhat indigestible, but they are clearly and concisely written and provide an essential scientific background to the basic purpose of the book. The later chapters cover every aspect of practical management in commendable detail. Although the views expressed on the strategy of treating respiratory failure will receive unqualified support, some of the more specific recommendations may be challenged. It is doubtful, for example, if there will be much enthusiasm for the technique of cricothyroid cannulation to stimulate cough or for the suggestion that rigid bronchoscopy and repeated endotracheal intubation for the removal of secretions should be performed under local anaesthesia in conscious patients. Another controversial point is the implication that mechanical ventilation in patients with respiratory paralysis presents no serious problems because