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Physiologic therapy in respiratory diseases
BOOK
REVIEWS
In this book, The Mechanism of Abdominal Pain, Dr. Iiinsellazs suggests that mechanism for splanchnic pain does not differ essentially from that for somatic pain. He states that the underlying factors, anatomic and physiologic, are identical as are also the After briefly effective painful stimuli, whether physical (experiment) or pathological. the text proceeds to describe in reviewing the various conceptions of abdominal pain, detail the three pathways, bulbar, thoracolumbar, and sacral, which carry the nerve impulses from the abdominal viscera to the central nervous system. Various succeeding chapters take up visceral sense, referred pain, cutaneous reactions, tenderness and rigidity, adhesions, and the various sections of the alimentary tract. In Chapter fifteen the author refers to the pain of appendicitis as having two components, the visceral and the parietal, and the origin and pathways of these impulses are discussed, repeating to a certain degree the previous analysis (Chapter Six) of cutaneous hyperalgesia in appendicitis. He notes the atypical distribution of pain in the normally placed appendix as well as in the abnormally situated organ, and refers to the importance of the psoas ridge in promoting the remarkable constancy of McBurney’s point.
He raises three points of interest regarding pain arising in the uterus and adnexa: the persistence of pain during labor following presacral neurectomy; again, the pain pro duced by palpation of an inflamed ovary in the pouch of Douglass, especially when overlain by a retroverted uterus. He considers this an expression of direct visceral tenderness since parietal peritoneum does not lie between the affected viscus and the examining finger; and finally, that the pain produced on grasping an inflamed cervix with a vulsellum proves that the apparent insensitivity of the viscera is only relative; that visceral pain may arise not only direct by disordered motor activity, but also through inflammation. In the final chapter he sums up his reasons for belief in direct visceral tenderness as well as for direct visceral pain, concisely summarizing his theories and the proofs as he has found them. PHILIP
F.
WILLIA~~S.
The aim of the book, Physiologic Therapy in Respiratory Diseases, by Dr. Barach,z: as in an earlier text by him on inhalation therapy, is to bring out the principles and pracThe therapeutic use of gas and other tices of physiologic therapy in respiratory disease. measures which have a specific value in counteracting clinical disorders of breathing are discussed. The pathologic physiology of each clinical entity is explained, as well as the physiologically based procedures by which it may be combated. The subject of practical techniques in current use has been thoroughly considered. After a short section on the historical background of the topic, there is an extended presentation on anoxia. This is followed by a concise chapter on each of the various etiologic lesions and their therapy. Of interest to gynecologists and obstetricians should be the chapters on massive colSeventy per cent of the former follow lapse of the lungs and postoperative atelectasis. surgical operation and injury. The treatment recommended is inhalation of from 5 to 7 per cent carbon dioxide and oxygen to stretch the bronchial walls by maximum expansion of the chest in hope of freeing the usual mucous plug, and having it subsequently coughed up. Inhalation of from 50 to 70 per cent oxygen is regarded as useful as generally indicated in the maintenance of respiratory function before and after the carbon dioxide The author discusses the effect of anesthetic agents and the reduction of vital therapy. capacity by the abdomen in producing postoperative atelectasis. The preoperative use of penicillin and hyperventilation is mentioned as well as bronchoscopy, intubation, and aspiration. WThe
(Eng.), ~ISI.
Mechanism
F.R.A.C.S.,
210 pages
and
of
Hon.
Abdominal
Surge?&
1’7 lllustratlons,
Pain.
St. Vincent’,s Australasmn
BY
V.
J.. Kinsella,
Hospital, Medical
Sydcey, Pubhshmg
M.B.,
Ch.M. (Syd.), F.R.C.S., Hon. Surgeon,. Hornsby HosCompany Llmlted, Sydney,
arPhrsiologic Therapy ln Resphdmy Diseases, by Alvan L. Barach. fessor pf Clinical Medicine, Columbia College of Physicians and Surgeons; Physicmn. Presbyterian-Hospital New York, N. Y. Second Edition. 396 tions. J. B. Lippincott Company. Philadelphia, London, Montreal, 1948.
M.D., Associate ProAssistant Attending pages with 74 illustra-
Am. J. Obst. & Gynec. March, 1949
620
In discussing asphyxia of the newborn, both antenatal and postnatal, the author refers to the large part this plays in the mortality of the newborn on the first day of life. The causes of asphyxia before delivery are enumerated, and the influence of anesthetic and analgesic agent3 is stressed. The disturbances of the placental circulation are mentioned, and stress is laid on the importance of recognition of intrauterine anoxia, pointing out the significance of both sudden drops and persistent slowing of the fetal heart beat. He suggest3 the therapeutic use under these circumstances during labor of oxygen administration to the mother. The pathology of asphyxia is well described and the author discusses mouth-to-mouth insufflation, inhalation of 5 per cent carbon dioxide and oxygen, and the use of pure oxygen. Infants who finally breathe with any measure are best protected by incubation and 50 per cent oxygen atmosphere for some time after birth. The value of drug treatment of apnea is questioned. The author discusses the mechanics used for resuscitation. The methods of physiologic therapy, including the apparatus for inhalation therapy, the use of pressure and administration of aerosols, is thoroughly gone into, and the techniques of many type3 of instrument3 fully explained. While the volume will be particularly interesting to those dealing with acute and chronic respiratory disease, it should also be of great help to divisions of anesthesiology which today in many hospitals are intimately concerned in the administration of these methods of physiologic therapy. RHILIP
F.
WILLIAhlS.
The three-volume Clinical Laboratory Methods and Diagnosis28 in its fourth edition is an increasingly ambitious attempt to cover all phases of laboratory technique with concise interpretations. It succeeds fairly well in 3,103 pages. The good handiwork of coauthors improves particularly the partially revised section3 on bacteriology, protein metabolism and parenteral protein hydrolysate therapy, toxicology and police crime methods, optical crystallography, parasitology and tropical medicine, Rh factor, antibiotic3 and their assay, and electrocardiography. Up-to-date laboratory information is presented relative to antibiotics, salmonella organisms, virus diseases in general, atypical pneumonia, influenza, vaginal smears, and toxicologic problems. Improvement in procedures such as i ‘blood-phenol level” and ‘ ( protein-bound iodine, ’ ’ although not as yet universally used, should have been noted. A very useful portion of the material is an accurate compilation of techniques selected from personal experience, personal communications, and from the literature. Unfortunately, a good many of the techniques, terms, and references to the literature are principally of only historic interest. Further, there is an unfortunate introduction of commercialism by the tendency to show undue preference for equipment and reagents of certain manufacturers, instead of naming several or all interested firms. The subject matter is well organized and clearly presented. Many intricate facts and theories are simply and logically explained to furnish an easy and adequate working However, the author lapse3 into the history of an isolated knowledge for the uninitiated. case all too frequently to illustrate a point. Of note are certain ambiguous statements, e.g., the inaccurate suggestion that splenectomy is ordinarily useful in leucemia. Nevertheless, there are many minute pearls (such as “short cuts” in technique) available to a semi-experienced and wary physician or technologist. One attraction to this set of book3 is the fact that there is nearly always available a procedure which yields an answer useful to the clinician. Most illustrations are good, e.g., vaginal and bronchial smears, smears of nasal secretion, and the pictures of eolorimetric reactions. The hematologic color plates are fair. Many of the old illustrations are poor and their legends do not state the degree of magnifi. cation. The index is well organized and complete. ~Cllnlcal Laboratory Methods and Diagnosis. BY R. B. H. Gradwohl. M.D.. D.Sc.. F.R.S.T.M. and H. (London). Director of the Gradwohl Laboratories and Gradwohl &boo1 of Laboratory Technique : Pathologist to Christian Hospital ; Director. Research L&oratory, St. Louis Metropolitan Police Department. St. Louis, Missouri. Fourth Bditton. Volumes I and 11, 2284 pages. with 691 illustrations and 51 plates. Volume III, separately indexed, 819 pages, with 420 illustrations and 7 plates. The C. V. Mosby Company, St. Louis, 1948.
REVIEWS
In this book, The Mechanism of Abdominal Pain, Dr. Iiinsellazs suggests that mechanism for splanchnic pain does not differ essentially from that for somatic pain. He states that the underlying factors, anatomic and physiologic, are identical as are also the After briefly effective painful stimuli, whether physical (experiment) or pathological. the text proceeds to describe in reviewing the various conceptions of abdominal pain, detail the three pathways, bulbar, thoracolumbar, and sacral, which carry the nerve impulses from the abdominal viscera to the central nervous system. Various succeeding chapters take up visceral sense, referred pain, cutaneous reactions, tenderness and rigidity, adhesions, and the various sections of the alimentary tract. In Chapter fifteen the author refers to the pain of appendicitis as having two components, the visceral and the parietal, and the origin and pathways of these impulses are discussed, repeating to a certain degree the previous analysis (Chapter Six) of cutaneous hyperalgesia in appendicitis. He notes the atypical distribution of pain in the normally placed appendix as well as in the abnormally situated organ, and refers to the importance of the psoas ridge in promoting the remarkable constancy of McBurney’s point.
He raises three points of interest regarding pain arising in the uterus and adnexa: the persistence of pain during labor following presacral neurectomy; again, the pain pro duced by palpation of an inflamed ovary in the pouch of Douglass, especially when overlain by a retroverted uterus. He considers this an expression of direct visceral tenderness since parietal peritoneum does not lie between the affected viscus and the examining finger; and finally, that the pain produced on grasping an inflamed cervix with a vulsellum proves that the apparent insensitivity of the viscera is only relative; that visceral pain may arise not only direct by disordered motor activity, but also through inflammation. In the final chapter he sums up his reasons for belief in direct visceral tenderness as well as for direct visceral pain, concisely summarizing his theories and the proofs as he has found them. PHILIP
F.
WILLIA~~S.
The aim of the book, Physiologic Therapy in Respiratory Diseases, by Dr. Barach,z: as in an earlier text by him on inhalation therapy, is to bring out the principles and pracThe therapeutic use of gas and other tices of physiologic therapy in respiratory disease. measures which have a specific value in counteracting clinical disorders of breathing are discussed. The pathologic physiology of each clinical entity is explained, as well as the physiologically based procedures by which it may be combated. The subject of practical techniques in current use has been thoroughly considered. After a short section on the historical background of the topic, there is an extended presentation on anoxia. This is followed by a concise chapter on each of the various etiologic lesions and their therapy. Of interest to gynecologists and obstetricians should be the chapters on massive colSeventy per cent of the former follow lapse of the lungs and postoperative atelectasis. surgical operation and injury. The treatment recommended is inhalation of from 5 to 7 per cent carbon dioxide and oxygen to stretch the bronchial walls by maximum expansion of the chest in hope of freeing the usual mucous plug, and having it subsequently coughed up. Inhalation of from 50 to 70 per cent oxygen is regarded as useful as generally indicated in the maintenance of respiratory function before and after the carbon dioxide The author discusses the effect of anesthetic agents and the reduction of vital therapy. capacity by the abdomen in producing postoperative atelectasis. The preoperative use of penicillin and hyperventilation is mentioned as well as bronchoscopy, intubation, and aspiration. WThe
(Eng.), ~ISI.
Mechanism
F.R.A.C.S.,
210 pages
and
of
Hon.
Abdominal
Surge?&
1’7 lllustratlons,
Pain.
St. Vincent’,s Australasmn
BY
V.
J.. Kinsella,
Hospital, Medical
Sydcey, Pubhshmg
M.B.,
Ch.M. (Syd.), F.R.C.S., Hon. Surgeon,. Hornsby HosCompany Llmlted, Sydney,
arPhrsiologic Therapy ln Resphdmy Diseases, by Alvan L. Barach. fessor pf Clinical Medicine, Columbia College of Physicians and Surgeons; Physicmn. Presbyterian-Hospital New York, N. Y. Second Edition. 396 tions. J. B. Lippincott Company. Philadelphia, London, Montreal, 1948.
M.D., Associate ProAssistant Attending pages with 74 illustra-
Am. J. Obst. & Gynec. March, 1949
620
In discussing asphyxia of the newborn, both antenatal and postnatal, the author refers to the large part this plays in the mortality of the newborn on the first day of life. The causes of asphyxia before delivery are enumerated, and the influence of anesthetic and analgesic agent3 is stressed. The disturbances of the placental circulation are mentioned, and stress is laid on the importance of recognition of intrauterine anoxia, pointing out the significance of both sudden drops and persistent slowing of the fetal heart beat. He suggest3 the therapeutic use under these circumstances during labor of oxygen administration to the mother. The pathology of asphyxia is well described and the author discusses mouth-to-mouth insufflation, inhalation of 5 per cent carbon dioxide and oxygen, and the use of pure oxygen. Infants who finally breathe with any measure are best protected by incubation and 50 per cent oxygen atmosphere for some time after birth. The value of drug treatment of apnea is questioned. The author discusses the mechanics used for resuscitation. The methods of physiologic therapy, including the apparatus for inhalation therapy, the use of pressure and administration of aerosols, is thoroughly gone into, and the techniques of many type3 of instrument3 fully explained. While the volume will be particularly interesting to those dealing with acute and chronic respiratory disease, it should also be of great help to divisions of anesthesiology which today in many hospitals are intimately concerned in the administration of these methods of physiologic therapy. RHILIP
F.
WILLIAhlS.
The three-volume Clinical Laboratory Methods and Diagnosis28 in its fourth edition is an increasingly ambitious attempt to cover all phases of laboratory technique with concise interpretations. It succeeds fairly well in 3,103 pages. The good handiwork of coauthors improves particularly the partially revised section3 on bacteriology, protein metabolism and parenteral protein hydrolysate therapy, toxicology and police crime methods, optical crystallography, parasitology and tropical medicine, Rh factor, antibiotic3 and their assay, and electrocardiography. Up-to-date laboratory information is presented relative to antibiotics, salmonella organisms, virus diseases in general, atypical pneumonia, influenza, vaginal smears, and toxicologic problems. Improvement in procedures such as i ‘blood-phenol level” and ‘ ( protein-bound iodine, ’ ’ although not as yet universally used, should have been noted. A very useful portion of the material is an accurate compilation of techniques selected from personal experience, personal communications, and from the literature. Unfortunately, a good many of the techniques, terms, and references to the literature are principally of only historic interest. Further, there is an unfortunate introduction of commercialism by the tendency to show undue preference for equipment and reagents of certain manufacturers, instead of naming several or all interested firms. The subject matter is well organized and clearly presented. Many intricate facts and theories are simply and logically explained to furnish an easy and adequate working However, the author lapse3 into the history of an isolated knowledge for the uninitiated. case all too frequently to illustrate a point. Of note are certain ambiguous statements, e.g., the inaccurate suggestion that splenectomy is ordinarily useful in leucemia. Nevertheless, there are many minute pearls (such as “short cuts” in technique) available to a semi-experienced and wary physician or technologist. One attraction to this set of book3 is the fact that there is nearly always available a procedure which yields an answer useful to the clinician. Most illustrations are good, e.g., vaginal and bronchial smears, smears of nasal secretion, and the pictures of eolorimetric reactions. The hematologic color plates are fair. Many of the old illustrations are poor and their legends do not state the degree of magnifi. cation. The index is well organized and complete. ~Cllnlcal Laboratory Methods and Diagnosis. BY R. B. H. Gradwohl. M.D.. D.Sc.. F.R.S.T.M. and H. (London). Director of the Gradwohl Laboratories and Gradwohl &boo1 of Laboratory Technique : Pathologist to Christian Hospital ; Director. Research L&oratory, St. Louis Metropolitan Police Department. St. Louis, Missouri. Fourth Bditton. Volumes I and 11, 2284 pages. with 691 illustrations and 51 plates. Volume III, separately indexed, 819 pages, with 420 illustrations and 7 plates. The C. V. Mosby Company, St. Louis, 1948.