Book Reviews

CIRCWATORY DYNAMICS. (No. 4, Modern Medical Monographs). Carl J. Wiggers. New York, 1952, Grune & Stratton, Inc. 107 pages.

The application of adequate methods for the measurement of intravascular pressures to the human being has greatly increased the need for understanding of the basic principles of instru- mentation and of the physics of the circulatory system. As might have been predicted by the many cardiologists who are familiar with the contributions of Dr. Wiggers to circulatory physi- ology, this little monograph is concerned almost entirely with intra-arterial and intracardiac pressures. It does not pretend to discuss completely the complex inter-relations of blood flow, blood pressure, resistance, and elasticity throughout the vascular system. Neither does it include specific data on the output and size of the heart. The reader would probably have welcomed a summary of Wiggers’ opinions respecting such additional data. Certainly, this comment reflects in no way on the value of the material which has been included in this monograph, but one may hope that Dr. Wiggers will address himself to the more comprehensive task of expanding this summary into a complete statement on “circulatory dynamics.”

The understanding of the genesis and propagation of the pressure pulses is essential to the cardiologist and to all others who measure blood pressures. Wiggers illustrates most effectively that much more information is actually available in this study than that which is gleaned cur- rently in conventional clinical measurements Inferences from the contours, magnitudes, and propagation of the pressure pulses are remarkable for their accuracy concerning cardiac output, resistance to flow, distensibility of the aortic compression chamber, economy of cardiac effort, etc., even though direct data on blood flow are not available to complete the informational picture. It is indeed fortunate that this is the case since the technology of blood flow measuremenl is relatively not as far advanced in serving clinical needs as that of pressure measurement.

In the reviewer’s opinion, the most interesting and valuable section of the monograph deals with the analysis of ventricular contraction under abnormal conditions. Employing pressure data, Wiggers describes in a pithy clear manner the role of filling, initial tension and length, myocardial contractility, and the sequence of fractionate contractions, in the ventricular per- formance in such conditions as pericardial effusion, hypervolemia, oligemia, arterial hypertension, aortic coarctation, aortic stenosis, pulmonary stenosis, aortic regurgitation, mitral insufficiency, mitral stenosis, and in several arrhythmias. These esamples provide neat exercises for the appli- cation of basic physical principles. ‘I‘he reader will find in this discussion concepts which will aid significantly his practical approach to these frequently encountered conditions.

A.B.H.

ANGIOQUIMOGRAFIA. Ayres de Sousa. Lisboa, 1951, Livraria Portugblia, 240 pages and 173 illustrations (English summary).

This monograph presents a new diagnostic procedure based on the taking of a roentgenky- mogram of the chest after injection of a contrast substance. Using a single or double-slit kymo- graph, the author studied pulmonary circulation time, and the effect of respiration upon venous return, formation of stream lines, and venous pulsations.

The method is not difficult hut requires special knowledge and equipment. Moreover, the use of a contrast substance represents a certain risk for the patient.

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BOOK REVIEWS 475

For the study of pulmonary circulation time, a single-slit kymograph was placed at the base of the cardiac pedicle. Twenty cubic centimeters of solution were injected within two seconds in adults while the films were moving at 2 cm./sec. The arrival of the contrast substance to the superior cava, pulmonary artery, and aorta, was timed in the film.

It is claimed that this method permits an accurate measurement of circulation time from right ventricle to left atrium. In one normal individual, a circulation time of 4.5 seconds from cava to aorta was found. The value of this technique is still not demonstrated even though a good point is made concerning its possible application.

Excellent pictures and diagrams are presented. A. A. L.

CLIXICAL DISORDERS OF THE HEART BE.v~: Samuel Bellet, M.D., Philadelphia, 1953, Lea & Febiger, 373 pp. Pr. $8.50.

This is probably the most complete book on this particular subject in English. As a rule treatises on this phase of cardiology have consisted largely of discussion of the electrocardio- graphic findings. The author in this volume deals with the whole subject. Physiology and pathology are dealt with as well as the etiology, symptoms and physical findings in the various disorders. There is a full electrocardiographic presentation accompanied by many excellent electrocardiograms to illustrate the different conditions. A good discussion of treatment is also given and at the end of the book the drugs most commonly used are discussed in detail. In other words, every phase of the individual disorder is fully presented. There is a large bibli- ography appended, which will aid anyone interested in a particular phase.

The book is well and clearly written and can be highly recommended, not only to the cardi- ologist, but to all those interested in the medical aspects of disease.

J. H. C.

Announcement

The 1954 meeting of THE AMERICAN GOITER 24ssocr~~~o~ will be held at the Somerset Hotel, Boston, Massachusetts, April 29, 30, and May 1, 1954. The program for the three day meeting will consist of papers and discussions dealing with the phvsiologp and diseases of the thyroid gland.