Book Reviews

PULMONARY EMPHYSEMA. Edited by Alvan L. Barach, iM.I)., and Hylan A. Bickerman, M.D., Baltimore, 1956, Williams & bl’ilkins Co., 545 pages, illustrated. $10.

This volume was compiled with the assistance of 18 distinguished authors, all of whom have made significant contributions to our knowledge of emphysema within the last 10 years. The very fact that a book of this size can now be compiled on the single subject of pulmonary emphy- sema, testifies to the considerable volume of clinical experimental work which this disease has received in the last 10 years. This book provides an excellent summary of contemporary know!. edge and opinions concerning chronic respiratory disease.

Of the 18 chapters which comprise the volume, 5 are concerned with various aspects of re- spiratory physiology in emphysema, 3 with a discussion of the role of infection in emphysema and with descriptions of senile emphysema and pathogenesis, and the remainder discuss various aspects of the treatment of established pulmonary emphysema. The arrangement of these chapters appears to be rather arbitrary, and the volume would have benefited from a somewhat different arracgement of these sections. The general reader would be well advised not to read the book in the sequence in which the chapters are written, but to read first the sections on respiratory physiology, and then the chapters discussing the physiologic basis of therapeutic procedures. The possible benefit of breathing exercises and of diaphragmatic exercises in emphysema can only be intelligently understood and discussed in relation to the alterations in the mechanics of breathing found in this disease. Yet, the chapter (which is an excellent one) on the mechanics of breathing is placed 17.5 pages after the chapter on diaphragmatic function and breathing exercises.

It is not possible to discuss in detail the individual points of view expressed by the authors of some of the chapters. The sections on treatment are perhaps not sufficiently critical, and the physician who is particularly interested in this disease will look in vain for carefully controlled clinical trials of the theraDeutic procedures advised. As is well known in a condition such as emphysema, the degree of bronchial obstruction may vary considerably from month to month, and perhaps even from day to day, and the therapeutic success of any procedure will depend inevitably on the relative importance of potentially reversible factors in any individual patient. If it be accepted that the main or distinguishing lesion in emphysema is loss of parenchymal lung tissue, which no amount of therapy can yet restore, then the assessment of the value of individual therapeutic procedures depends greatly on the selection of patients and on a number of extraneous factors, all of which must be most carefully rontrolled if reliable conclusions are to be drawn. The sections on therapy in this volume are clearly written by authors who have had considerable practical experience in the maneuvers they recommend, but it is not possible to say yet that a completely convincing case has been made for the therapeutic value of every one of the different measures proposed. From this point of view, a volume of this type, comprehensive though it is, represents an interim stage in the development of our knowledge of this condition. The major puzzle of the etiology of emphysema remains unsolved. The difference in sex incidence is com- pletely unexplained, and, although in the last 10 years we have acquired a great deal of funda- mental physiologic knowledge about the condition when fully established, we have yet to under- stand entirely the relationship of the disease to the changes in the lung that inevitably occur with increasing age. One may look forward to the day when the various therapeutic maneuvers suggested have been tested completely, and in the light of detailed physiologic studies either are found to be valid or are discarded. Llntil that has been done under controlled circumstances, the value of some of the therapeutic procedures advocated in this volume with considerable en- thusiasm will remain a matter of opinion.

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BOOK REVIEWS 479

The whole book has been carefully edited. The standard of figures, diagrams, and x-rays is hi&h. and each chapter has an adcqr q.te bibliography. This volume fills an important gap in the lit:rature on emphysema, in t!rat it provides a readable and up-to-date summary of con- temporary opinions and knowledge. It deserves to be read widely, and it is not too much to sa*, that the knowledge and outlook incorporated within it should be a part of the normal edu- rational background of any physician or surgeon interested in chest disease.

D. V. B.

ATLAS OF CLINICAL ENDOCRINOLOGY. By H. Lisser, M.D., and Roberto F. Escamilla, M.D., St. Louis, 1957, C. V. Mosby Co., 476 pages, 148 plates. Price $18.75.

The authors of the Atlas of Clinical Endocrinology have succeeded in bringing together a vast experience in clinical endocrinology. They have done this by drawing heavily on photographs of patients, on their x-ray investigations, and on the pathologic specimens whenever these were available. In addition, they have reproduced charts depicting the salient laboratory features in the patients and the disease state under discussion. There certainly can be little or no argument about the general divisions of the endocrine disorders discussed, but undoubtedly there will be differences of opinion regarding nomenclature. Such semantic difficulties are not exclusive to clinical or research endocrinology. The appendix which concerns itself with growth and de- velopmental patterns, as well as with behavior manifestations, is invaluable; it is unusual to find these summarized in a short section.

Undoubtedly, this atlas will be of great value to many physicians who have only an occasional opportunity of seeing endocrine problems, as well as to specialists in other fields in which endocrinology may play an ancillary role.

J. C. B.

CORONARY HEART DISEASE. By Milton Plotz, M.D., New York, 1957, Paul B. Hoeber, Inc., 353 pages.

Since coronary heart disease is ubiquitous in Americans, it is entirely fitting that a book should be written concerning it. Dr. Plotz has presented a very complete treatise on the subject. There are 21 chapters, each with an excellent bibliography. It is my belief that Dr. Plotz has been successful in attempting to summarize the present status of coronary heart disease, and that he has done so by writing a carefully organized and easily comprehended book, using nu- merous illustrations and tables.

Although coronary heart disease is extremely common, the symptoms of this disease fre- quently are overlooked or misinterpreted. Accordingly, I believe that this book should be read by medical students, general practitioners, internists, and cardiologists.

J. W. H.

SCHRIFTENREIHE DER ZEITSCHRIFT FUR DIE GESAMTE INNERE MEDIZIN. (Cardiologie IV, Heft 7) Prof. Dr. Theodor Brugsch, Editor, Leipzig, 19.56, Georg Thieme, 192 pages, 43 illustrations.

The volume consists of 5 papers, the first 4 of which are based on a large amount of the experi- mental material of the authors, together with a quite detailed literature review of the various fields. R. Behre studied the important question of objective experimental documentation of subjective cardiovascular symptoms, comparing 102 patients having primarily organic heart disease with 194 patients having primarily functional disorders (pp. 7-84). All methods used were comparatively simple and applicable in a clinical diagnostic laboratory, or even in a phy- sician’s office; they included venous pressure (at rest, during Valsalva, and after mild exercise), vital capacity (rest and exercise), breath holding time, circulation time, Schellong’s functional test (essentially changes of pulse rate and blood pressure in standing and exercise), ECG (rest,