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The clinical use of digitalis
BOOK
767
REVIEWS
pears illogical to the reviewer since pain in this condition is aggravated by increasing the temperature of the skin, an anticipated result of successful sympathectomy. “Vascular Disorders in Diseases of the Nervous System,’ ’ is The final chapter, clearly written and contains much valuable information. This book constitutes an outstanding volume of explanations of the mechaniSn= value to the physician whose of circulatory disturbances although it seem. u of limited It is chief interests in peripheral vascular diseases are diagnosis and treatment. heartily recommended to every student of vascular diseases, since within its covers are to be found explanations of many of the puzzling phenomena observed in abIt is the sort of work which can be normalities of peripheral arterial circulation. read more than once with pleasure and rpferrpd l-o on numerous occasions with profit. THE
CLINIPAI,
Charles
USE
C. Thomas,
OF DIGITALIS.
By
Drew
Luten,
M.D.,
Rpringfleld,
ill.,
1936,
226 pages.
Those who are familiar with Dr. Luten’s splendid work upon digitalis will be gratified to know that he has written a book upon its clinical use. They will welcome any work bearing his name with eagerness and confidence, nor will they he He begins the preface of this volume with the following sentencr : disappointed. “Not many years ago there were published t,wo classical works on digitalis, each a he refers to the admirable work of Robinso~~ and splendid epitome. ’ ’ Presumably of Cushny, whose books appeared in 1923 and 1995, respectively. It is safe to say that future writers upon this subject must refer to three classical works, for the present volume more than measures up to the high standard of its predecessors. this is primarily a study of the c.linical use of ihe tlrug, As the title indicates, but all relevant experimental work has been include{1 in the discussion of its action. It is essentially a summary of all the important work of the past ten years in this field, interpreted by one of the acknowledged authorities in the light of his own wide Plinical experience. While most of his references are to work of the past decatle, he has not hesitated to make use of important contributions during the preceding qmtrter century, and some of the most. fascinating pages in t.he book are those devoted to the interpretation of cases reported by Withering and by Markenzie. He st,ates that he has made no attempt to harmonize caonflieting opinion, but he has demonstrated convincingly that authoritative opinion is alrrady in harmony upon almost all the essential points. There are too many important chapters to permit comment, upon all of them. There are few physicians, even among those who specialize in diseases of t,he heart, who cannot read the book with profit as well as with great pleasure. To those who have worked in this field, perhaps the most important chapters are those dealing with the effect of digitalis upon the ventricular muscle and with the newer views relating to the level of optimum effect and the doses required to produce it. The author brings forward evidence from many directions in support of the increasingly prevalent ronception that the tachycardia commonly observed in cases of auricular fibrillation with heart failure is a result of the failure rather than a cause of it. “This conception explains the slowing from digitalis as due in large part at least to the beneficial effect whic.11 the drug is known to exert on the ventricular muscle regularly in cases of heart failure, and makes unnecessary the hypothesis that digit,&* To those block depends solely upon a depression of conduction in the A-V tissues.” unfamiliar with recent work upon digitalis, the amount of evidence supporting this view will be surprising. His comments upon the common practice of regarding auric-ular fibrillation in itself as an indication for administration of the drug are forceful and wise. He lends the weight of his authority to the current belief that digitalis increases the efficiency of a failing myocardium by enabling it to perform its work with a smaller expenditure of energy. He properly emphasizes the uselessness of the
768
THE
AMERICAK
ISEART
JOURNAL
drug in cases of toxic, auricular fibrillation without heart failure and in cases of peripheral circulatory failure; he shovv~ clt~arly that it, shoul,l not bc :~dministered lo (‘ases of shock, septicemia, pneumonia, an11 other a&c infections, The sections relating to the therapeutic! zonk of digitalis action and the difieronces in dosxgo r+ C(Ui Wtl for different levels of optimum rffe(*t caxtremely important. il‘C
The
longest chapter in the book is that upon dosage and nlethotl of administraiion: to these important matters the author devote. b sixty-four pagrs, every one of which is important. If every practitionrr c~oultl be required 11) rear1 this one chapter thoughtfully and repeatedly, the improv~!ment in the thelapcutic use of digitalis would be enormous. There is no asp& of its t~herapc~utic or I.~~xin action that is not fully and wisely discussed. The book closes mith a quotation from \Venckebach: “Di I:,italis treatment, is one of t,he most important and serious duties of the general physician; it demands a great deal of skill, power of ohservstion, liPkIn interest, and experience. A long lift: is too short to learn enough about this wonderful drug.” To the writing of this book, Dr. Luten has brought in abundant measure the requisites mentioned by \Venekebach. There is not a page that does not bear witness lo his wide exprrienre, his excellent clinical judgmeni, and his tleep interest,; t,hcre are scores of paragraphs that could have been written only by a wirr. kind, experienced physician whose first, csoncern is for the welfare and ceomfort ol his patients. His Ibook takes its proper place on the shelf with those of (‘usImp amI Robinson as thr latert in a series of . . . splendid crltlcal reviews. Because it is the latest, because it includes so much work that is new and of fundamental importanc.cz, and especially hecause of the author’s distinction, wisdom, and clarity of expression, it, stands, in thr opinion of this reviewer, as the finest work upon digitalis availahlc today.
Books Received r
UND
TNERAPJE
DER
HEJsz-I~~~AXKHEJTEX
Vortr&ge fiir Praktische ;irztr. serte und Vcrmehrte Auflage. von Julius Springer, 1936. OVER
~EiSTRWULAIRE
T:NJ)
DJm
GEE.ASSEJi-IiRANKFlEJ'J'EN.
ITon Privattloecnt J)r. 1). Sherf. Pp. 290. Xit .tO TrstahhiltlungcLn.
hkTXASYSTOJ,&N
EN
HAI:E
~A)~‘AlilSh’rlE;.
Dritte TVicbn:
vt,rbesVrrlag
%UPXSi(‘HI:IYT.
T?l
verkrigging van den graad van Doctor in 11c Geneeskundrl aan 11e Hoog~school te Batavia, op Gezag van den Voorzitter &r >‘acultejt, Dr. B. .J. van der Plxtts, tegen de R~denkingen van die Hoogleeraar in de Faculteit der Genrcskunde, Faculteit te Verdedigen op Vrijdag 29 Mei 1936, des Voormiddags 12 Uur. By Paper. G. Wolff and Company. Batavia-C. Cornelis Johannes Storm. Pp. 193. 1936. ELECTRoCARDIoGRAFfA
YRhXICA.
By
Patologia MBdica de la Universidad prenta “ Artes y Letras ” ; Santiago BosNTC;~NKIaroc;ltA~~fA Profesor Carlo?;
ly Albt*rto 2-1; :I2 plates.
CONC~~NTRICA.
Butler.
Pp.
LUiS Herr& Jr. de (.%ili. Pp. de Chili ; 1926.
~~JXd;mtP
Cl. Morrlli. Montevideo.
69.
Iit’
Paper.
lnstituto I!):lti.
la (::~tetJr:t d(% Libreria e Zrrl-
(112 l~atliologi:t
;
CONGENITAS. By Ramon Valdivieso D., Profesor Agregado dc Terapkutica, and Domingo Urrutia 111. hyudante de Clinica MBdiea. Prolog0 de1 Prof. E. Gonzalez Cortes. Pp. 158; 48 illustrations. Paper. 8antiago de Chili : 1936.
CARDIOPATIAS
767
REVIEWS
pears illogical to the reviewer since pain in this condition is aggravated by increasing the temperature of the skin, an anticipated result of successful sympathectomy. “Vascular Disorders in Diseases of the Nervous System,’ ’ is The final chapter, clearly written and contains much valuable information. This book constitutes an outstanding volume of explanations of the mechaniSn= value to the physician whose of circulatory disturbances although it seem. u of limited It is chief interests in peripheral vascular diseases are diagnosis and treatment. heartily recommended to every student of vascular diseases, since within its covers are to be found explanations of many of the puzzling phenomena observed in abIt is the sort of work which can be normalities of peripheral arterial circulation. read more than once with pleasure and rpferrpd l-o on numerous occasions with profit. THE
CLINIPAI,
Charles
USE
C. Thomas,
OF DIGITALIS.
By
Drew
Luten,
M.D.,
Rpringfleld,
ill.,
1936,
226 pages.
Those who are familiar with Dr. Luten’s splendid work upon digitalis will be gratified to know that he has written a book upon its clinical use. They will welcome any work bearing his name with eagerness and confidence, nor will they he He begins the preface of this volume with the following sentencr : disappointed. “Not many years ago there were published t,wo classical works on digitalis, each a he refers to the admirable work of Robinso~~ and splendid epitome. ’ ’ Presumably of Cushny, whose books appeared in 1923 and 1995, respectively. It is safe to say that future writers upon this subject must refer to three classical works, for the present volume more than measures up to the high standard of its predecessors. this is primarily a study of the c.linical use of ihe tlrug, As the title indicates, but all relevant experimental work has been include{1 in the discussion of its action. It is essentially a summary of all the important work of the past ten years in this field, interpreted by one of the acknowledged authorities in the light of his own wide Plinical experience. While most of his references are to work of the past decatle, he has not hesitated to make use of important contributions during the preceding qmtrter century, and some of the most. fascinating pages in t.he book are those devoted to the interpretation of cases reported by Withering and by Markenzie. He st,ates that he has made no attempt to harmonize caonflieting opinion, but he has demonstrated convincingly that authoritative opinion is alrrady in harmony upon almost all the essential points. There are too many important chapters to permit comment, upon all of them. There are few physicians, even among those who specialize in diseases of t,he heart, who cannot read the book with profit as well as with great pleasure. To those who have worked in this field, perhaps the most important chapters are those dealing with the effect of digitalis upon the ventricular muscle and with the newer views relating to the level of optimum effect and the doses required to produce it. The author brings forward evidence from many directions in support of the increasingly prevalent ronception that the tachycardia commonly observed in cases of auricular fibrillation with heart failure is a result of the failure rather than a cause of it. “This conception explains the slowing from digitalis as due in large part at least to the beneficial effect whic.11 the drug is known to exert on the ventricular muscle regularly in cases of heart failure, and makes unnecessary the hypothesis that digit,&* To those block depends solely upon a depression of conduction in the A-V tissues.” unfamiliar with recent work upon digitalis, the amount of evidence supporting this view will be surprising. His comments upon the common practice of regarding auric-ular fibrillation in itself as an indication for administration of the drug are forceful and wise. He lends the weight of his authority to the current belief that digitalis increases the efficiency of a failing myocardium by enabling it to perform its work with a smaller expenditure of energy. He properly emphasizes the uselessness of the
768
THE
AMERICAK
ISEART
JOURNAL
drug in cases of toxic, auricular fibrillation without heart failure and in cases of peripheral circulatory failure; he shovv~ clt~arly that it, shoul,l not bc :~dministered lo (‘ases of shock, septicemia, pneumonia, an11 other a&c infections, The sections relating to the therapeutic! zonk of digitalis action and the difieronces in dosxgo r+ C(Ui Wtl for different levels of optimum rffe(*t caxtremely important. il‘C
The
longest chapter in the book is that upon dosage and nlethotl of administraiion: to these important matters the author devote. b sixty-four pagrs, every one of which is important. If every practitionrr c~oultl be required 11) rear1 this one chapter thoughtfully and repeatedly, the improv~!ment in the thelapcutic use of digitalis would be enormous. There is no asp& of its t~herapc~utic or I.~~xin action that is not fully and wisely discussed. The book closes mith a quotation from \Venckebach: “Di I:,italis treatment, is one of t,he most important and serious duties of the general physician; it demands a great deal of skill, power of ohservstion, liPkIn interest, and experience. A long lift: is too short to learn enough about this wonderful drug.” To the writing of this book, Dr. Luten has brought in abundant measure the requisites mentioned by \Venekebach. There is not a page that does not bear witness lo his wide exprrienre, his excellent clinical judgmeni, and his tleep interest,; t,hcre are scores of paragraphs that could have been written only by a wirr. kind, experienced physician whose first, csoncern is for the welfare and ceomfort ol his patients. His Ibook takes its proper place on the shelf with those of (‘usImp amI Robinson as thr latert in a series of . . . splendid crltlcal reviews. Because it is the latest, because it includes so much work that is new and of fundamental importanc.cz, and especially hecause of the author’s distinction, wisdom, and clarity of expression, it, stands, in thr opinion of this reviewer, as the finest work upon digitalis availahlc today.
Books Received r
UND
TNERAPJE
DER
HEJsz-I~~~AXKHEJTEX
Vortr&ge fiir Praktische ;irztr. serte und Vcrmehrte Auflage. von Julius Springer, 1936. OVER
~EiSTRWULAIRE
T:NJ)
DJm
GEE.ASSEJi-IiRANKFlEJ'J'EN.
ITon Privattloecnt J)r. 1). Sherf. Pp. 290. Xit .tO TrstahhiltlungcLn.
hkTXASYSTOJ,&N
EN
HAI:E
~A)~‘AlilSh’rlE;.
Dritte TVicbn:
vt,rbesVrrlag
%UPXSi(‘HI:IYT.
T?l
verkrigging van den graad van Doctor in 11c Geneeskundrl aan 11e Hoog~school te Batavia, op Gezag van den Voorzitter &r >‘acultejt, Dr. B. .J. van der Plxtts, tegen de R~denkingen van die Hoogleeraar in de Faculteit der Genrcskunde, Faculteit te Verdedigen op Vrijdag 29 Mei 1936, des Voormiddags 12 Uur. By Paper. G. Wolff and Company. Batavia-C. Cornelis Johannes Storm. Pp. 193. 1936. ELECTRoCARDIoGRAFfA
YRhXICA.
By
Patologia MBdica de la Universidad prenta “ Artes y Letras ” ; Santiago BosNTC;~NKIaroc;ltA~~fA Profesor Carlo?;
ly Albt*rto 2-1; :I2 plates.
CONC~~NTRICA.
Butler.
Pp.
LUiS Herr& Jr. de (.%ili. Pp. de Chili ; 1926.
~~JXd;mtP
Cl. Morrlli. Montevideo.
69.
Iit’
Paper.
lnstituto I!):lti.
la (::~tetJr:t d(% Libreria e Zrrl-
(112 l~atliologi:t
;
CONGENITAS. By Ramon Valdivieso D., Profesor Agregado dc Terapkutica, and Domingo Urrutia 111. hyudante de Clinica MBdiea. Prolog0 de1 Prof. E. Gonzalez Cortes. Pp. 158; 48 illustrations. Paper. 8antiago de Chili : 1936.
CARDIOPATIAS