- Email: [email protected]
Your Heart
1962
PSYCHOSOMATICS
Any model of the mind must not be incompatible with present well established physiological findings. It must be capable of stimulating theories that can be tested and must be able to respond to any changes suggested by the test findings. Whether or not the conceptual approaches of this model of the mind will improve the practice of psychotherapy remains to be seen, but appears highly controversial at this time. Joseph Joel Friedman, M.D.
LAENNEC, HIS LIFE AND TIMES. Roger Kervran, M.D. New York: Pergamon Press, 1960, pp. 213, $3.50. In 1961 the correspondence section of several issues of the Journal of the American Medical Association carried letters debating use of a .diaeresis in Laennec's name. It seemed to me that readers could lose sight of the man while concentrating on the letters of his name. Roger Kervran, M.D., loses sight of neither the man nor his name in his good biography of this fellow Breton. Space is devoted to Laennec's concern with his native Breton language of which he was a devoted student. More important for physicians is the thorough study of Laennec's personality and medical contributions. He was an able, ambitious, productive physician, studious and energetic despite a constant battle with poor health that finally overpowered him. He lost the contest with tuberculosis, the bane of fellow countrymen and the illness he investi. gated so carefUlly. How did Laennec appear to his medical colleagues? "He gave clinical lectures in Latin and .. required his pupils to examine patients minutely and to keep careful notes of their observations. He spoke little. The greatest compliment that could be expected from him was 'it will do.' Anything mediocre was mercilessly returned to be done over. He readily accepted discussion with his young entourage. Sometimes his tone was . mocking but he was always indulget and calm. . He had great respect for the patients in his care. 'In order to interrogate nature, it is not permIssible to torture the patient,' he reminded those pupils who, with the fierce ardour of neophytes, made lengthy and tiring examinations." Is there truth in the often repeated story that Laennec's clue to the discovery of mediate auscUltation came from his observations of children playing at tapping opposite ends of a beam? Kervran does not confirm it. But I think it should be of interest to quote Laennec's remarks on the origin of the stethoscope: "I was consulted in 1816 by a young lady who presented the general symptoms of a heart-disease and with whom the application of the hand
81
and percussion gave poor results owing to stoutness. The age and sex of the patient forbidding the type of examination of which I have just spoken (direct auscultation), I remembered a well-known phenomenon of acoustics: if the ear is applied to one end of a beam, a pin prick is most distinctly heard at the other end. I thought that maybe I could make use of this fact in this partiCUlar case. I took some sheets of paper and, rolling them very tightly, I applied one end to the precordial region and placing my ear at the other end, I was as surprised as I was gratified to hear the beating of the heart much more clearly and distinctly than if I had applead my ear directly to the chest. It occurred to me that this means could become a useful method, applicable not only to the study of heart-beats but also to that of all movements that might produce sound in the thoracic cavity. It might, for example, help in the investigation of breathing, voice production, wheeZing, and even pleural or pericardial effusion. . . ." This biography covers Laennec's life broadly in terms of the political and social background of his times, medical associates-great and near great, friends and relatives, Laennec's daily routine, his financial problems, his patients-rich and poor, his work in Paris and his life as a gentleman farmer in Brittany, his supporters and his enemies. Acceptance of Laennec and his findings and his opinions was by no means general. Most doctors working with new ideas and methods can identify themselves easily with his frustrations if not his success. Because of the basic importance of Laennec's work in medicine, Kervran's biography should appeal to physicians regardless of specialty. Jerome M. Schneck, M.D.
YOUR HEART. A Handbook for Laymen. H. M. Marvin, M.D. Doubleday, Garden City, N. Y. $4.50. This is an excellent book; it is authoritative but not dogmatic, comprehensible but not patronizingly simple, logical but not pat. There is a respect for rhetoric, occasional and pertinent allusion to the classics and always humor and kindliness, all of which result in enjoyable readability. The author is a past president of the American Heart Association and a member of the faculty of Yale Medical School. He has provided this book as a supplement rather than as a substitute for sound medical advice. ). There are so many things that a patient or his family might want to know-the causes, the hereditary and familial implications, the diet,
82
PSYCHOSOMATICS
the course and general prognosis. A good physician will impart much of this information. This book can well prOVide the rest. The author describes the heart, blood vessels and the circulation. There are chapters on irregularities of the beat, rheumatic heart disease, hypertension, congestive failure, angina and myocardial infarction. Almost forty pages are spent in a discussion of the causes of coronary atherosclerosis, presenting the pros and cons of cholesterol, diet, and stress and strain. A similar treatment is given to the problem of anti-coagulants in which there is so much heat if only a little light. Pericarditis, neurocirculatory asthenia, the heart in pregnancy and congenital diseases have their separate chapters. There is a thorough discussion of the problem of overweight, its seriousness, psychological and psychiatric aspects (by Dr. Hilde Bruch), the importance of physical inactivity, the bizarre excuses given by obese people, the principles of weight reduction, and caution about "crash diets." Some choice excerpts by W. H. Sebrell Jr. on "Metabolic Aspects of Obesity-Facts, Fallacies and Fables" conclude this chapter. There are others dealing with the controversial subject of the effects of smoking, the hereditary aspects of heart diseases and common misconceptions. The value as well as the limitations of the electrocardiogram are properly delineated. In the final chapters Dr. MarVin emphasizes the importance of continuing research and there is a dignified and inspiring message about the role of the physician and of Medicine-its nobility, its challenges, its rewards. This book will make a splendid vade-mecum for the many who are affected by heart disease-either directly or indirectly. Samuel L. Swiller, M.D.
THE ANATOMY OF THE NERVOUS SYSTEM. S. W. Ranson, M.D., Ph.D., and S. L. Clark, M.D., Ph.D. W. B. Saunders & Co., Philadelphia, 1959, pp. 622. $9.50. This is the tenth edition of a classic in neuroanatomy. Although this text book is primarily an anatomical one, it will aid the student seeking neurological correlations. It includes 434 illustrations. In Chapter I, the origin and function of the nervous system is outlined. The development of the neural tube in the human embryo is discussed in detail. Subsequent chapters review the gross anatomy of the nervous system, the meninges and blood vessels, the histogenesis of the nervous system, the structure of neurons, the spinal nerves, the autonomic nervous system, the spinal
JANUARy-FEBRUARY
cord, the fiber tracts of the spinal cord, the struc_ ture of the medulla, pons and mesencephalon, the cranial nerves, the cerebellum, diencephalon, cerebral hemispheres, rhinencephalon, and cere. bral cortex. Most valuable are the clinical illustrations (pp. 419-430) and transverse sections of the brain at various levels (449-530). W.D.
THE PSYCHOLOGY OF AGGRESSION. Arnold H. Buss. New York: John Wiley & Sons, Inc., 1961, pp. 307. The book is divided into three parts. In the first part the author distinguishes between aggression, anger and hostility. Frustration and noxious stimuli are classified as the antecedents of aggression. Laboratory experiments and measures of aggressive reaction are discussed. Punishment is presented as the major inhibitor of aggression. Aggression expressed as anger has a cathartic effect. According to the author, there is a paucity of knowledge about bodily changes in human anger. Part two discusses the contribution of projective techniques in eliciting evidence of aggressiveness. The author concludes that the Rorschach and TAT identify the extremes of the aggressive and non-aggressive populations. He then states "that projective techniques have little to offer concerning measurement of aggression that could not be supplied by self-report techniques like inventories." The author reviews the Freudian theory of the death instinct, the reactions of psychoanalysts to it and offers his own behavioral concept that aggressiveness is the habit of attacking. The role of hostility and aggression in relationship to nosological syndromes is briefly indicated. The final part defines prejudice as group membership type of hostility or aggression. Prejudice is learned and is reinforced by habit. Psychological and psychoanalytic articles on aggression in children are reported. The author presents an excellent review of the literature. His reporting is authoritative and superbly summarized. The research student will find many valuable references in this book. There is a heavy bias towards a behavioral investigation in the understanding of aggression. There is a flight from depth material like the Rorschach and psychoanalytic contributions which the author ably presents, but leaves the reader with insufficient closure. Nonetheless, this is a book that should not be ignored in stl'fdies of aggression. Benjamin Kotkov, Ph.D.
PSYCHOSOMATICS
Any model of the mind must not be incompatible with present well established physiological findings. It must be capable of stimulating theories that can be tested and must be able to respond to any changes suggested by the test findings. Whether or not the conceptual approaches of this model of the mind will improve the practice of psychotherapy remains to be seen, but appears highly controversial at this time. Joseph Joel Friedman, M.D.
LAENNEC, HIS LIFE AND TIMES. Roger Kervran, M.D. New York: Pergamon Press, 1960, pp. 213, $3.50. In 1961 the correspondence section of several issues of the Journal of the American Medical Association carried letters debating use of a .diaeresis in Laennec's name. It seemed to me that readers could lose sight of the man while concentrating on the letters of his name. Roger Kervran, M.D., loses sight of neither the man nor his name in his good biography of this fellow Breton. Space is devoted to Laennec's concern with his native Breton language of which he was a devoted student. More important for physicians is the thorough study of Laennec's personality and medical contributions. He was an able, ambitious, productive physician, studious and energetic despite a constant battle with poor health that finally overpowered him. He lost the contest with tuberculosis, the bane of fellow countrymen and the illness he investi. gated so carefUlly. How did Laennec appear to his medical colleagues? "He gave clinical lectures in Latin and .. required his pupils to examine patients minutely and to keep careful notes of their observations. He spoke little. The greatest compliment that could be expected from him was 'it will do.' Anything mediocre was mercilessly returned to be done over. He readily accepted discussion with his young entourage. Sometimes his tone was . mocking but he was always indulget and calm. . He had great respect for the patients in his care. 'In order to interrogate nature, it is not permIssible to torture the patient,' he reminded those pupils who, with the fierce ardour of neophytes, made lengthy and tiring examinations." Is there truth in the often repeated story that Laennec's clue to the discovery of mediate auscUltation came from his observations of children playing at tapping opposite ends of a beam? Kervran does not confirm it. But I think it should be of interest to quote Laennec's remarks on the origin of the stethoscope: "I was consulted in 1816 by a young lady who presented the general symptoms of a heart-disease and with whom the application of the hand
81
and percussion gave poor results owing to stoutness. The age and sex of the patient forbidding the type of examination of which I have just spoken (direct auscultation), I remembered a well-known phenomenon of acoustics: if the ear is applied to one end of a beam, a pin prick is most distinctly heard at the other end. I thought that maybe I could make use of this fact in this partiCUlar case. I took some sheets of paper and, rolling them very tightly, I applied one end to the precordial region and placing my ear at the other end, I was as surprised as I was gratified to hear the beating of the heart much more clearly and distinctly than if I had applead my ear directly to the chest. It occurred to me that this means could become a useful method, applicable not only to the study of heart-beats but also to that of all movements that might produce sound in the thoracic cavity. It might, for example, help in the investigation of breathing, voice production, wheeZing, and even pleural or pericardial effusion. . . ." This biography covers Laennec's life broadly in terms of the political and social background of his times, medical associates-great and near great, friends and relatives, Laennec's daily routine, his financial problems, his patients-rich and poor, his work in Paris and his life as a gentleman farmer in Brittany, his supporters and his enemies. Acceptance of Laennec and his findings and his opinions was by no means general. Most doctors working with new ideas and methods can identify themselves easily with his frustrations if not his success. Because of the basic importance of Laennec's work in medicine, Kervran's biography should appeal to physicians regardless of specialty. Jerome M. Schneck, M.D.
YOUR HEART. A Handbook for Laymen. H. M. Marvin, M.D. Doubleday, Garden City, N. Y. $4.50. This is an excellent book; it is authoritative but not dogmatic, comprehensible but not patronizingly simple, logical but not pat. There is a respect for rhetoric, occasional and pertinent allusion to the classics and always humor and kindliness, all of which result in enjoyable readability. The author is a past president of the American Heart Association and a member of the faculty of Yale Medical School. He has provided this book as a supplement rather than as a substitute for sound medical advice. ). There are so many things that a patient or his family might want to know-the causes, the hereditary and familial implications, the diet,
82
PSYCHOSOMATICS
the course and general prognosis. A good physician will impart much of this information. This book can well prOVide the rest. The author describes the heart, blood vessels and the circulation. There are chapters on irregularities of the beat, rheumatic heart disease, hypertension, congestive failure, angina and myocardial infarction. Almost forty pages are spent in a discussion of the causes of coronary atherosclerosis, presenting the pros and cons of cholesterol, diet, and stress and strain. A similar treatment is given to the problem of anti-coagulants in which there is so much heat if only a little light. Pericarditis, neurocirculatory asthenia, the heart in pregnancy and congenital diseases have their separate chapters. There is a thorough discussion of the problem of overweight, its seriousness, psychological and psychiatric aspects (by Dr. Hilde Bruch), the importance of physical inactivity, the bizarre excuses given by obese people, the principles of weight reduction, and caution about "crash diets." Some choice excerpts by W. H. Sebrell Jr. on "Metabolic Aspects of Obesity-Facts, Fallacies and Fables" conclude this chapter. There are others dealing with the controversial subject of the effects of smoking, the hereditary aspects of heart diseases and common misconceptions. The value as well as the limitations of the electrocardiogram are properly delineated. In the final chapters Dr. MarVin emphasizes the importance of continuing research and there is a dignified and inspiring message about the role of the physician and of Medicine-its nobility, its challenges, its rewards. This book will make a splendid vade-mecum for the many who are affected by heart disease-either directly or indirectly. Samuel L. Swiller, M.D.
THE ANATOMY OF THE NERVOUS SYSTEM. S. W. Ranson, M.D., Ph.D., and S. L. Clark, M.D., Ph.D. W. B. Saunders & Co., Philadelphia, 1959, pp. 622. $9.50. This is the tenth edition of a classic in neuroanatomy. Although this text book is primarily an anatomical one, it will aid the student seeking neurological correlations. It includes 434 illustrations. In Chapter I, the origin and function of the nervous system is outlined. The development of the neural tube in the human embryo is discussed in detail. Subsequent chapters review the gross anatomy of the nervous system, the meninges and blood vessels, the histogenesis of the nervous system, the structure of neurons, the spinal nerves, the autonomic nervous system, the spinal
JANUARy-FEBRUARY
cord, the fiber tracts of the spinal cord, the struc_ ture of the medulla, pons and mesencephalon, the cranial nerves, the cerebellum, diencephalon, cerebral hemispheres, rhinencephalon, and cere. bral cortex. Most valuable are the clinical illustrations (pp. 419-430) and transverse sections of the brain at various levels (449-530). W.D.
THE PSYCHOLOGY OF AGGRESSION. Arnold H. Buss. New York: John Wiley & Sons, Inc., 1961, pp. 307. The book is divided into three parts. In the first part the author distinguishes between aggression, anger and hostility. Frustration and noxious stimuli are classified as the antecedents of aggression. Laboratory experiments and measures of aggressive reaction are discussed. Punishment is presented as the major inhibitor of aggression. Aggression expressed as anger has a cathartic effect. According to the author, there is a paucity of knowledge about bodily changes in human anger. Part two discusses the contribution of projective techniques in eliciting evidence of aggressiveness. The author concludes that the Rorschach and TAT identify the extremes of the aggressive and non-aggressive populations. He then states "that projective techniques have little to offer concerning measurement of aggression that could not be supplied by self-report techniques like inventories." The author reviews the Freudian theory of the death instinct, the reactions of psychoanalysts to it and offers his own behavioral concept that aggressiveness is the habit of attacking. The role of hostility and aggression in relationship to nosological syndromes is briefly indicated. The final part defines prejudice as group membership type of hostility or aggression. Prejudice is learned and is reinforced by habit. Psychological and psychoanalytic articles on aggression in children are reported. The author presents an excellent review of the literature. His reporting is authoritative and superbly summarized. The research student will find many valuable references in this book. There is a heavy bias towards a behavioral investigation in the understanding of aggression. There is a flight from depth material like the Rorschach and psychoanalytic contributions which the author ably presents, but leaves the reader with insufficient closure. Nonetheless, this is a book that should not be ignored in stl'fdies of aggression. Benjamin Kotkov, Ph.D.