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The biologic basis of pediatric practice
482
March, 1969 The Journal o[ P E D I A T R I C S
Books
Book reviews P a e d i a t r i e cardiology. E d i t e d b y H a m i s h Watson, M . D . , St. Louis, 1968, T h e C. V. M o s b y C o m p a n y , 996 pages. $36.50. The field of pediatric cardiology, formerly dominated by only three textbooks, has recently become enriched by the addition of several more. This volume is a major addition to the field; it has been compiled by Dr. Watson from the contributions of many experts on both sides of the Atlantic. All aspects of pediatric cardiology are covered, from embryology to the associated social and emotional problems. In addition to congenital heart disease, acquired heart disease and cardiac problems complicating other illnesses are discussed in some detail. An extensive bibliography is placed at the end of each chapter. The book is well illustrated and well written. As indicated in the foreword by Dr. Helen Taussig and in the preface by the author, it has obviously been edited and not just compiled. As with all textbooks, some very new information is not included. For example, cardiac transplantation is not mentioned, and it is stated that ethacrynic acid is not yet commercially available in the United States. However, most of the information and references are as current as is possible in a text. Because of its size, cost, and the detailed nature of its contents, the book would probably be of more value to the pediatric cardiologist than to the general pediatrician. However, despite the number of competing textbooks currently available, this appears to be an excellent addition to the library of any physician interested in the subject of pediatric cardiology. JOSEPH M. OARFUNKEL, M.D. HARRISBURG POLYCLINIC HOSPITAL HARRISBURO~ PA.
T h e biologic basis of p e d i a t r i c p r a c t i c e E d i t e d by R o b e r t E. Cooke, with 163 contributors, N e w York, 1968, T h e Blakiston D i v i s i o n / M c G r a w - H i l l Book Co., 1,739
Vol. 74, No. 3, pp. 482-484
pages. $24.50 (as one volume) or $99.50 (as two volumes). In the past 10 to 20 years there has been the proliferation of a breed of academic pediatricians who have one foot rather solidly planted in a basic science discipline and the other foot equally solidly planted in some necessarily narrow area of clinical pediatrics. Such hybrid individuals are of course not new to pediatrics, but for a variety of reasons their numbers have vastly increased over the past 20 years. The influence which these pediatric scientists or scientific pediatricians have had on modern pediatrics is very great indeed, since by their own work they have pointed out the heavy and direct involvement of clinical pediatrics with the so-called basic sciences. The fundatmental raison d'&re of this new textbook of pediatrics is to codify the multiple interrelationships between pediatrics and the basic sciences upon which it so heavily depends. It presents an image of the modern pediatrician as a scientist who requires a working knowledge of genetics, embryology, biochemistry, physiology, and/or psychology to solve his clinical problems. To this end, Dr. Cooke, who has contributed greatly to the development of many contemporary hybrid pediatric scientists, has assembled a voluminous work to which 163 authors, both within and without pediatrics, have contributed their expertise under the aegis of a distinguished editorial board. The fundamental aim of the book is certainly commendable, although in 1968 it is hardly novel simply because the success of the cross-fertilization of clinical pediatrics with the relevant basic sciences has been so great that few pediatricians could escape the view that basic science is here to stay. The question then is not whether this approach is sound in theory, but how well it can be achieved within the limitations of a textbook. There can be no simple answer to this question, since no single reviewer can adequately address himself critically to all or even an appreciable fraction of the subject matter
Volume 74 Number 3
presented in such a book without greatly exceeding his competence. At best, the reviewer can only sample the book and pass on his impressions and opinions, however fragmentary, to potential readers. The organization of this book differs significantly from more conventional textbooks of pediatrics. Part One, a 94 page section entitled "Sciences fundamental to an understanding of growth and maturation," presents chapters on the cell, heredity, psychology, and sociology. Pat't Two, entitled "Anatomic and functional systems of the child," is a 1,243 page presentation of diseases and disorders of organs and organ systems and superficially resembles the conventional textbook. Part Three, "The total child," presents in 354 pages sections on growth and development, as well as material dealing with the prenatal, perinatal, and neonatal periods and material on the infant, the preschool and school child, and the adolescent. There is a 50 page Appendix containing a variety of tables of normal values and a comprehensive table of drug dosage which promises to be useful. The book in toto requires nearly 1,800 pages, thereby exceeding the conventional existing textbooks by a substantial margin. The single-volume edition, weighing nearly 10 pounds, is barely portable; fortunately, the book is also available in a two-volume format, each volume of which contains a complete Table of Contents and Index. For the medical student, who seems to be one prime target of this book, this is indeed a formidable work. But the student who reads Part One will be introduced to areas of biology which should serve as an enrichment to his usual experience in pediatrics in the medical school curriculum. Part Two, which occupies about two thirds of the total of the book, resembles the conventional textbook of pediatrics, but throughout many of the sections, each of which is devoted to diseases of an organ or organ system, the emphasis is distinctly different than in conventional books. One example--the section on the cardiovascular system--will serve to illustrate this point. This section begins, as do most of the others in Part Two, with a comprehensive chapter on developmental anatomy and physiology. There follow equally excellent chapters on methods of study and radiology. These three initial chapters, comprising nearly 40 per cent of the total page allotment to the cardiovascular system, are followed by discussions of develop-
Books
483
mental disorders, acquired heart disease, and disorders of the lesser and systemic circulations. For the student or physician wishing, for example, to relate his knowledge of embrology to a given clinical variety of congenital heart disease, there is more than enough textual material here. But a reader intending to get specific details of treatment for an individual patient will likely be disappointed. This is deliberate, since the editorial philosophy of the book is that "systemic disease is presented with particular emphasis on the functional aspects to the neglect of the historical and possibly, at times, the clinical viewpoint." Thus, "modes of therapy are changed so rapidly that only general board principles rather than specific areas are given." Even this editorial philosophy is not always consistently carried out. For example, in the section on cardiovascular diseases, this reviewer could nowhere locate a detailed discussion of even the pathopl}ysiolegy of heart failure in infants, much less a discussion of the principles of treatment. Because of this omission, this reviewer took four consecutive clinical problems on which he was asked to consult and looked each of these up in the book. Three of these--diabetic acidosis, hypernatremic dehydration, and collagen diseases--were excellently presented. But nowhere was there a comparable presentation of the respiratory distress syndrome--a surprising omission in a textbook of pediatrics! Part Three of the book emphasizes developmental processes--physiological, psychological, and social in pediatric patients. To this reviewer it is rather refreshing to find in a textbook of pediatrics a section on the prenatal period, which includes chapters on developmental genetics, physiology of development, principles of teratology, cytogenics, and the placenta. If students could be persuaded to peruse Part Three, they would certainly gain many useful points of view of the pediatric patient as a whole. Any multiauthored book is susceptible to the charge of unevenness of presentation and emphasis. This is unavoidabIe, not only because of varying competence of individual authors but also, as is the case with the present book, because of the uneven relationships between various areas of clinical pediatrics and the relevant areas of basic science. Editors and authors are both aware of the long time usually required to receive manuscripts and the subsequent painful processes of editing, printing, etc. The re-
484
Books
sult, of course, is an inordinately long time lag between the conception of a book and its final publication, and this in turn carries the attendant difficulties of some degree of built-in obsolence. This book is no exception. But despite its faults of unevenness and of the inclusion of some dated information, this work is a laudable attempt to present to the world of pediatrics an image which it much needs. One is unsure how this book will be used and what its relationship to conventional textbooks will be. The book is unlikely to be popular with students as a sole textbook, primarily because the general emphasis of Part Two is not on the "practical and clinical" approach. Whether or not this is a drawback is debatable of course, but it seems to be true. One hopes that the book will be consulted by those who are interested in broadening their knowledge of the functional, anatomical, and/or psychological basis of given disorders and phenomena in pediatric patients, and in this context the work should be extremely useful. ROBERT W . W I N T E R S , M.D. C O L U M B I A - P R E S B Y T E R I A N MEDICAL C E N T E R
mew YORK, N. V. 10032 T h e n e o n a t e with congenital h e a r t disease R i c h a r d Rowe a n d Ali Mehrlzi, Philadelphia, 1968, W. B. Saunders C o m p a n y , 445 pages. $12.50. In pediatric cardiology, emphasis in recent years has shifted to the problems of the newborn and the very young infant. This monograph on the neonate with congenital heart disease brings together for the first time an extensive bibliography and a large personal experience with problems of this age group. As clearly stated in the preface by the authors, "It has not been our aim to make this monograph an encyclopedia containing all possible presentations of congenital heart malformations in newborn infants. Rather it is meant to reflect our experience, with the most regularly en-
The Journal of Pediatrics March 1969
countered malformations and to touch meaningfully on the most important of the rarer malformations." With few exceptions, the authors have resisted the temptation to extend the discussion of the various malformations beyond the early infancy stage. This 445 page book is divided into 5 parts: introduction, the 10 major cardiac malformations, less common disorders (10), rare anomalies (6), and related problems. The format of outlining the presentation of each malformation (definition, pathology, incidence, hemodynamics, ctinical features, radiologic features, electrocardiogram, diagnosis, treatment, prognosis) is very convenient for the reader who is looking for information in a specific area. Experienced cardiologists no doubt will take exception to certain statements, but an attempt to include all exceptions to the general rule would only add to the difficulty in making a clinical diagnosis and would distract the reader from the emphasis on the more frequent findings. Areas i n which information or observation is incomplete are clearly stated. In some instances, such as the pathologic histology, cell growth, and normal standards in the premature and full-term infants, more questions are asked than are answered. For the most part, the diagrams and illustrations are very helpful and clarify the descriptions in the text. However, some of the electrocardiograms are so reduced in size that they are difficult to read, and the photographs of the histologic preparations would have been much clearer in color. I would highly recommend this monograph not only to the pediatric cardiologist but also as a very useful reference to all neonatologists and those pediatricians with an active practice of newborn infants. C. ROBERT E. W E L L S , 2vs ST. C H R I S T O P H E R " S H O S P I T A L FOR C H I L D R E N P H I L A D E L P H I A , PA.
March, 1969 The Journal o[ P E D I A T R I C S
Books
Book reviews P a e d i a t r i e cardiology. E d i t e d b y H a m i s h Watson, M . D . , St. Louis, 1968, T h e C. V. M o s b y C o m p a n y , 996 pages. $36.50. The field of pediatric cardiology, formerly dominated by only three textbooks, has recently become enriched by the addition of several more. This volume is a major addition to the field; it has been compiled by Dr. Watson from the contributions of many experts on both sides of the Atlantic. All aspects of pediatric cardiology are covered, from embryology to the associated social and emotional problems. In addition to congenital heart disease, acquired heart disease and cardiac problems complicating other illnesses are discussed in some detail. An extensive bibliography is placed at the end of each chapter. The book is well illustrated and well written. As indicated in the foreword by Dr. Helen Taussig and in the preface by the author, it has obviously been edited and not just compiled. As with all textbooks, some very new information is not included. For example, cardiac transplantation is not mentioned, and it is stated that ethacrynic acid is not yet commercially available in the United States. However, most of the information and references are as current as is possible in a text. Because of its size, cost, and the detailed nature of its contents, the book would probably be of more value to the pediatric cardiologist than to the general pediatrician. However, despite the number of competing textbooks currently available, this appears to be an excellent addition to the library of any physician interested in the subject of pediatric cardiology. JOSEPH M. OARFUNKEL, M.D. HARRISBURG POLYCLINIC HOSPITAL HARRISBURO~ PA.
T h e biologic basis of p e d i a t r i c p r a c t i c e E d i t e d by R o b e r t E. Cooke, with 163 contributors, N e w York, 1968, T h e Blakiston D i v i s i o n / M c G r a w - H i l l Book Co., 1,739
Vol. 74, No. 3, pp. 482-484
pages. $24.50 (as one volume) or $99.50 (as two volumes). In the past 10 to 20 years there has been the proliferation of a breed of academic pediatricians who have one foot rather solidly planted in a basic science discipline and the other foot equally solidly planted in some necessarily narrow area of clinical pediatrics. Such hybrid individuals are of course not new to pediatrics, but for a variety of reasons their numbers have vastly increased over the past 20 years. The influence which these pediatric scientists or scientific pediatricians have had on modern pediatrics is very great indeed, since by their own work they have pointed out the heavy and direct involvement of clinical pediatrics with the so-called basic sciences. The fundatmental raison d'&re of this new textbook of pediatrics is to codify the multiple interrelationships between pediatrics and the basic sciences upon which it so heavily depends. It presents an image of the modern pediatrician as a scientist who requires a working knowledge of genetics, embryology, biochemistry, physiology, and/or psychology to solve his clinical problems. To this end, Dr. Cooke, who has contributed greatly to the development of many contemporary hybrid pediatric scientists, has assembled a voluminous work to which 163 authors, both within and without pediatrics, have contributed their expertise under the aegis of a distinguished editorial board. The fundamental aim of the book is certainly commendable, although in 1968 it is hardly novel simply because the success of the cross-fertilization of clinical pediatrics with the relevant basic sciences has been so great that few pediatricians could escape the view that basic science is here to stay. The question then is not whether this approach is sound in theory, but how well it can be achieved within the limitations of a textbook. There can be no simple answer to this question, since no single reviewer can adequately address himself critically to all or even an appreciable fraction of the subject matter
Volume 74 Number 3
presented in such a book without greatly exceeding his competence. At best, the reviewer can only sample the book and pass on his impressions and opinions, however fragmentary, to potential readers. The organization of this book differs significantly from more conventional textbooks of pediatrics. Part One, a 94 page section entitled "Sciences fundamental to an understanding of growth and maturation," presents chapters on the cell, heredity, psychology, and sociology. Pat't Two, entitled "Anatomic and functional systems of the child," is a 1,243 page presentation of diseases and disorders of organs and organ systems and superficially resembles the conventional textbook. Part Three, "The total child," presents in 354 pages sections on growth and development, as well as material dealing with the prenatal, perinatal, and neonatal periods and material on the infant, the preschool and school child, and the adolescent. There is a 50 page Appendix containing a variety of tables of normal values and a comprehensive table of drug dosage which promises to be useful. The book in toto requires nearly 1,800 pages, thereby exceeding the conventional existing textbooks by a substantial margin. The single-volume edition, weighing nearly 10 pounds, is barely portable; fortunately, the book is also available in a two-volume format, each volume of which contains a complete Table of Contents and Index. For the medical student, who seems to be one prime target of this book, this is indeed a formidable work. But the student who reads Part One will be introduced to areas of biology which should serve as an enrichment to his usual experience in pediatrics in the medical school curriculum. Part Two, which occupies about two thirds of the total of the book, resembles the conventional textbook of pediatrics, but throughout many of the sections, each of which is devoted to diseases of an organ or organ system, the emphasis is distinctly different than in conventional books. One example--the section on the cardiovascular system--will serve to illustrate this point. This section begins, as do most of the others in Part Two, with a comprehensive chapter on developmental anatomy and physiology. There follow equally excellent chapters on methods of study and radiology. These three initial chapters, comprising nearly 40 per cent of the total page allotment to the cardiovascular system, are followed by discussions of develop-
Books
483
mental disorders, acquired heart disease, and disorders of the lesser and systemic circulations. For the student or physician wishing, for example, to relate his knowledge of embrology to a given clinical variety of congenital heart disease, there is more than enough textual material here. But a reader intending to get specific details of treatment for an individual patient will likely be disappointed. This is deliberate, since the editorial philosophy of the book is that "systemic disease is presented with particular emphasis on the functional aspects to the neglect of the historical and possibly, at times, the clinical viewpoint." Thus, "modes of therapy are changed so rapidly that only general board principles rather than specific areas are given." Even this editorial philosophy is not always consistently carried out. For example, in the section on cardiovascular diseases, this reviewer could nowhere locate a detailed discussion of even the pathopl}ysiolegy of heart failure in infants, much less a discussion of the principles of treatment. Because of this omission, this reviewer took four consecutive clinical problems on which he was asked to consult and looked each of these up in the book. Three of these--diabetic acidosis, hypernatremic dehydration, and collagen diseases--were excellently presented. But nowhere was there a comparable presentation of the respiratory distress syndrome--a surprising omission in a textbook of pediatrics! Part Three of the book emphasizes developmental processes--physiological, psychological, and social in pediatric patients. To this reviewer it is rather refreshing to find in a textbook of pediatrics a section on the prenatal period, which includes chapters on developmental genetics, physiology of development, principles of teratology, cytogenics, and the placenta. If students could be persuaded to peruse Part Three, they would certainly gain many useful points of view of the pediatric patient as a whole. Any multiauthored book is susceptible to the charge of unevenness of presentation and emphasis. This is unavoidabIe, not only because of varying competence of individual authors but also, as is the case with the present book, because of the uneven relationships between various areas of clinical pediatrics and the relevant areas of basic science. Editors and authors are both aware of the long time usually required to receive manuscripts and the subsequent painful processes of editing, printing, etc. The re-
484
Books
sult, of course, is an inordinately long time lag between the conception of a book and its final publication, and this in turn carries the attendant difficulties of some degree of built-in obsolence. This book is no exception. But despite its faults of unevenness and of the inclusion of some dated information, this work is a laudable attempt to present to the world of pediatrics an image which it much needs. One is unsure how this book will be used and what its relationship to conventional textbooks will be. The book is unlikely to be popular with students as a sole textbook, primarily because the general emphasis of Part Two is not on the "practical and clinical" approach. Whether or not this is a drawback is debatable of course, but it seems to be true. One hopes that the book will be consulted by those who are interested in broadening their knowledge of the functional, anatomical, and/or psychological basis of given disorders and phenomena in pediatric patients, and in this context the work should be extremely useful. ROBERT W . W I N T E R S , M.D. C O L U M B I A - P R E S B Y T E R I A N MEDICAL C E N T E R
mew YORK, N. V. 10032 T h e n e o n a t e with congenital h e a r t disease R i c h a r d Rowe a n d Ali Mehrlzi, Philadelphia, 1968, W. B. Saunders C o m p a n y , 445 pages. $12.50. In pediatric cardiology, emphasis in recent years has shifted to the problems of the newborn and the very young infant. This monograph on the neonate with congenital heart disease brings together for the first time an extensive bibliography and a large personal experience with problems of this age group. As clearly stated in the preface by the authors, "It has not been our aim to make this monograph an encyclopedia containing all possible presentations of congenital heart malformations in newborn infants. Rather it is meant to reflect our experience, with the most regularly en-
The Journal of Pediatrics March 1969
countered malformations and to touch meaningfully on the most important of the rarer malformations." With few exceptions, the authors have resisted the temptation to extend the discussion of the various malformations beyond the early infancy stage. This 445 page book is divided into 5 parts: introduction, the 10 major cardiac malformations, less common disorders (10), rare anomalies (6), and related problems. The format of outlining the presentation of each malformation (definition, pathology, incidence, hemodynamics, ctinical features, radiologic features, electrocardiogram, diagnosis, treatment, prognosis) is very convenient for the reader who is looking for information in a specific area. Experienced cardiologists no doubt will take exception to certain statements, but an attempt to include all exceptions to the general rule would only add to the difficulty in making a clinical diagnosis and would distract the reader from the emphasis on the more frequent findings. Areas i n which information or observation is incomplete are clearly stated. In some instances, such as the pathologic histology, cell growth, and normal standards in the premature and full-term infants, more questions are asked than are answered. For the most part, the diagrams and illustrations are very helpful and clarify the descriptions in the text. However, some of the electrocardiograms are so reduced in size that they are difficult to read, and the photographs of the histologic preparations would have been much clearer in color. I would highly recommend this monograph not only to the pediatric cardiologist but also as a very useful reference to all neonatologists and those pediatricians with an active practice of newborn infants. C. ROBERT E. W E L L S , 2vs ST. C H R I S T O P H E R " S H O S P I T A L FOR C H I L D R E N P H I L A D E L P H I A , PA.