Book Reviews

CIRCULATORY DISORDEKS. By Erik Warburg, ed. 6, (Vol. IV of NORDISK LAEREBOG I INTERN MEDICIN), Copenhagen, 19.56, Glydendal, 413 pages.

Scandinavian medical students use as their standard text Nordisk Laerebog i Intern Medicin. This work appears as a series of monographs on the various divisions of internal medicine written by the professors at the Scandinavian medical schools. For many years Professor Erik Warburg has been the author of the volume on cardiology which now appears in its sixth edition.

The approach to the study of heart disease is through pathologic physiology, and the book begins with a general consideration of the factors concerned with heart failure (blood volume, vascular control, blood pressure, etc.). There follows a description of the symptomatology of congestive failure and the methods by which the cardiac patient is examined. Seventy-five pages are devoted to electrocardiography. Vectorcardiography is scarcely mentioned, ballistocardio- graphy not at all.

The “special” part of the book is divided into diseases of the heart and diseases of the arteries. The section on heart disease follows the traditional sequence of congenital heart disease,

coronary artery disease, infectious heart disease, and heart disease in metabolic and endocrine disorders, in deficiency disorders, and in other special conditions. This section also contains brief descriptions of cardiac involvement in unusual conditions, such as leukosis cordis, lymphogranuloma cordis, etc. It ends with a consideration of the cardiac patient in relation to special situations, such as pregnancy, sports, aviation, operation, and with a discussion of digitalis therapy, salt- poor diet, and oxygen therapy.

The section on disease of the arteries begins with a discussion of arterial hypertension in relation to various clinical conditions, including “essential hypertension.” There follows a de- scription of the conditions in which the blood pressure is lowered, and finally, a catalogue of unusual arterial disorders such as Takayashus disease, asthenia crurum paraesthetica et dolorosa, and glomus tumors.

Thus, within less than 400 pages the author has condensed essential information covering the entire field of cardiovascular diseases. The presentation of the material is of necessity brief, and somewhat dogmatic, but it is concise, accurate, and up to date. It is of special interest to the ilmerican cardiologist because it contains a fairly complete coverage of the contributions of Scandinavian workers. But to the American reader it has two drawbacks; it is written in Danish, and it lacks references, which would be helpful especially where the author has drawn upon the Scandinavian literature. Many of these contributions are theses which are not easily found by American readers.

3. J.

ANESTHESIA FOR SURGERY OF THE HEART. By Kenneth K. Keown, M.D., Springfield, Ill., Charles C Thomas, 1956. Price $3.75.

This loo-page monograph offers a concise, well-organized guide for anesthetists in the han- dling of patients undergoing surgery for congenital and acquired heart lesions.

The author takes a broad approach to the subject, and describes the development of anes- thesia for cardiac surgery, the responsibilities of the anesthesiologist in the choice and prepara- tion of the patient, the diagnosis and treatment of cardiac irregularities, the management of com- plications, and the postoperative therapy.

The chapter devoted exclusively to anesthetic management of patients entails only 5 pages, Here, general principles are offered without detail concerning specific problems. Anesthetic

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technics are described in more detail in subsequent chapters devoted to the various individual heart lesions. Dr. Keown’s choice of agents and technics are presented, and reasons for his choice, based on extensive experience, are briefly but adequately stated. In general, they repre- sent widely accepted and well-proved methods.

Many useful tips are included throughout the book, e.g., the use of two cut-down infusions, having two anesthetists for each case, and the continued, direct observation of cardiac action bl- the anesthetist during open-chest surgery.

No discussion is offered concerning hypothermic technics, or the handling of patients during use of by-pass heart-lung apparatus.

Undoubtedly the greatest value of the monograph lies in the 10 short chapters which give a meaty synopsis of each surgical lesion in its relation to anesthesia and surgery. A chart of the defect is shown, with anatomical and catheterization findings. Then symptoms and essential physiological factors are presented, giving the anesthetist insight into the special problems in- volved and warning him of the dangers that may occur during operative correction.

This book serves a real purpose in enabling the reader to familiarize himself quickly and clearly with the general requirements and the individual differences of patients facing cardiac surgery.

K. 31. s.

MITRAL STENOSIS. By Knud Henning Olesen, Copenhagen, 1955, Ejnar Munksgaard, 228 pages. Much of the best medical work coming out of Scandinavia is contained in the theses submitted

by physicians as a requirement for the degree of M. D., which is comparab!e to the Ph. D. degree in medicine, granted by some American universities.

The present thesis is a contribution to our knowledge of the course and prognosis of mitral stenosis. It is an attempt to help establish some “background” knowledge for the physician who is consulted regarding the advisability of operation on stenosed mitral valves.

The author points out that systematic clinical examination of the course of rheumatic heart disease during the older decades has been scarce, and mentions the studies of Willius, De Graff and Lingg, Friedmann, Aastrup, and especially Grant, as the only ones which he could find. Therefore, he proceeded to study the progress of 28.5 patients who had been in a division of the University Hospital of Copenhagen, from 1933 to 1949, and 66 patients from the private tiles of Dr. Erik Warburg. These cases were all submitted to critical analysis, and the author draws such conclu- sions as his material will allow for the various groups. The effect of various factors, such as auricu- lar fibrillation, hemoptysis, and pulmonary infarction, is discussed, but the results are too detailed to be repeated in this review. In summary, it may be stated that of 271 adult patients with isolated mitral stenosis, 40 per cent of the women survived 10 years and 18 per cent 20 years after they were first seen; of the men 29 per cent were alive after 10 years and 8 per cent after 18 years.

Altogether, the book is a notable contribution to the natural history of mitral stenosis and it should be a valuable reference work for all who are interested in factors which influence the prog- nosis of this condition. The book is written in English.

J. J.