2
5 2 0 Vol. 7 3, N o . 6 BKREVIEWS A TEXTBOOK OF GYNECOLOGY. By Arthur Hale Curtis, M.D., Emeritus Professor a n d Chairman o f t h e Department o f Obstetrics a n d Gynecology, Northwestern University Medical School; and John William Huffman, M.D., Associate Professor of Obstetrics a n d Gynecology, Northwestern University Medical School. Sixth Edition- 4 6 6 Illustrations. W. B . Saunders Co., Philadelphia, 1950. $10.00. I n preparing t he sixth edition o f this well-known text Curtis h a s shared t he labors o f revision with John W. Huff- man, known for his contributions t o t h e embryology o f t h e genito-urinary tract. Curtis states i n the introduction t o th e present edition that h e h a d thought i t advisable t o divide the responsibility o f revising t h e text i n collaboration with a junior author actively engaged i n teaching since h e n o longer participates i n university duties. This is a farsighted move fo r i t holds o u t a reasonable assurance f or t h e per- petuation o f a valuable textbook. Curtis' Gynecology is an o ld standby f o r medical students a n d a handy guide f o r t h e busy practitioner and, a s such, needs n o detailed review. O n t h whole i t i s practical i n i ts conception, i t is readable a nd reliably documented. T h e present edition h a s been enriched with additional informa- tion about t h e embryology o f the genito-urinary tract a n d some o f t h e commoner disturbances o f t h e vesicorenal sys- tem. Minor changes appear i n many chapters. T h e chapters o n anatomy, embryology a n d physiology a r e outstanding a n d beautifully illustrated b y T o m Jones. A s fa r as diagnosis a n d treatment a r e concerned there might b e room f or further revision. Certain attitudes a r e strictly o f th e author whose long experience i n t h e practice a nd teaching o f gynecology h a s made h i m rather s e t i n h i s views. In some respects this enhances t h e value o f t h e text because i t allows teachers t o take excep- tion a n d therewith create discussion. However, a broader approach would b e more enlightening t o th e student w h o then could acquaint himself with methods of treatment other than those advocated b y t h e senior author. This i s true i n particular o f t he chapters dealing with t h e rapidly expanding field o f endocrinology, with the study a n d treat- ment o f dysmenorrhea a n d t h e etiology o f cancer. There i s room also f o r a broader discussion o f psychosomatic phe- nomena particularly a this relates t o th e menarche, meno- pause, dysmenorrhea a n d t h e host o f poorly understood pelvic complaints, n ot t o forget t h e approach t o th e han- dling o f cancer patients. Yet, a l l i all, none o f these minor shortcomings detracts from t h e widely recognized value o f this book a s a teaching text a n d a practitioner's guide. Curtis' Gynecology is illustrated elaborately, i n fact, o n e might say, almost extravagantly. F o r instance, t h e mass o f illustrations depicting a variety of surgical corrections o f a ratlrr limited field o f traumatic disturbances i s a fine example o f t h e versatility o f approach t o a surgical problem b u t i t must be bewildering t o t h e young student t o s e e such a n array o f surgical technique without finding adequate explanations i n t h e text to permit h i m t o understand w h y so many different procedures have been devised. This needs correction either through elimination o f some o f t h e less useful methods depicted o r b y offering a more adequate discussion o f their respective applications. Your reviewer h a s watched t h e growth o f this textbook since its first a p - pearance a n d h e h a s noticed that with e ac h edition there i s a growing tendency t o develop i t into a more elaborate handbook o f t he reference type. H e hopes this will n ot come t o pass because handbooks a r e n o t handy texts f o r students. Besides, frequent revisions are o u t o f the question because o f t h e cost, t h e limited market and th e monumental effort required t o keep abreast with t h e progress o f medi- cine. Th e three volumes o f Gynecology edited b y Arthur Curtis years ag o a re a good example o f t e fate of inflexible handbooks. W. B . Saunders Company is known f o r i t s high standard i n publishing medical texts. The sixth edition o f Curtis' Textbook o f Gynecology attests in every respect t o t h e continuance o f this enviable record. In view o f t h e fine printing, t he clear illustrations, high grade paper a n d good binding th e cost of th e book a t $10.00 seems n o t out o f line although students ar e finding i t increasingly difficult t o acquire textbooks a t t h e present high prices. * * * ANGINA PECTORIS AND MYOCARDIAL INFARC- TION-With Special Reference t o t h e Autonomic Nervous System. By Heymen R . Miller, M.D., Formerly Principal Physician a n d Chief, Signal Corps Climatic Research; A t - tending Physician, Sydenham Hospital. Grune & Stratton, New York, 1950. $8.75. This book presents a detailed discussion o f t h e anatomy o f t h e autonomic pathways o f t he heart a n d their role i n t h e distribution o f cardiac pain i n coronary disease a n d myocardial infarction. I n addition, considerable information o n t h e physiology o f t h e autonomic nervous system a n d i ts relation t o t he circulation is presented. I n this respect t h e book i s valuable a s a reference f o r those w ho wish unusu- ally detailed information o n these matters. The remainder o f t h e book considers th e clinical aspects o f t h e subject, including the electrocardiographic findings, a nd t he medical a n d surgical aspects o f treatment. I n t h e reviewer's opinion a large part o f this material i s consider- ably below t h e o f parts o f t h e book, a n d i n some instances greatly detracts from i t s value as a text. T h e section o n t h e electrocardiogram i s entirely inadequate a nd adds little o f value t o t he book. I t i s inferred that there a r e distinguishable differences between t h e electrocardio- gram o f myocardial infarction with coronary occlusion a n d that of myocardial infarction without coronary occlusion, a nd illustrative are presented a s examples which differ only i n t h e degree o f electrocardiographic abnormal- ity. I n the reviewer's opinion such differentiation is unsound a nd n o t based on generally accepted principles o f electro- cardiography. T h e electrocardiogram illustrating acute pul- monary embolism is described a s showing a Q wave i n lead I I I when t h e initial deflection - o f t h e ventricular complex i n this lead i s positive. I n no instance is more than o n e pre- cordial lead included with the electrocardiographic illustra- tions, a nd i n only o n e instance w as t h e site o f t he indifferent electrode noted. T h e section o n the clinical features of myocardial infarc- tion is confused b y t h e author's preoccupation with t he clin- ical differentiation between myocardial infarction "with a n d without coronary occlusion"; a n d t h e illustrative cases pre- sented offer t h e reader no reasonable basis f o r such a differ- entiation. T h e section on treatment is adequate, though i t suffers from th e u s e of proprietary names f o r suggested drugs, t e n o f which were recommended a s hypnotics. This book cannot b e recommended f o r medical students, a n d will have limited u s e a s a reference text b y physicians interested i n heart disease.

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5 2 0 V o l . 7 3 , N o . 6

BKREVIEWS

A TEXTBOOK OF GYNECOLOGY. By Arthur Hale

C u r t i s , M . D . , Emeritus P r o f e s s o r and Chairman o f t h eDepartment o f O b s t e t r i c s and G y n e c o l o g y , N o r t h w e s t e r nU n i v e r s i t y M e d i c a l S c h o o l ; and John W i l l i a m Huffman,M . D . , A s s o c i a t e P r o f e s s o r o f O b s t e t r i c s and G y n e c o l o g y ,Northwestern U n i v e r s i t y Medical S c h o o l . S i x t h E d iti on-4 6 6 I l l u s t r a t i o n s . W. B . Saunders C o . , P h i l a d e l p h i a , 1 9 5 0 .

$ 1 0 . 0 0 .

I n p r e p a r i n g t h e s i x t h e d i t i o n o f t h i s w e l l - k n o w n t e x t

C u r t i s h a s s h a r e d t h e l a b o r s o f r e v i s i o n w i t h J o h n W. H u f f -

m a n , k n o w n f o r h i s c o n t r i b u t i o n s t o t h e e m b r y o l o g y o f t h eg e n i t o - u r i n a r y t r a c t . C u r t i s s t a t e s i n t h e i n t r o d u c t i o n t o t h ep r e s e n t e d i t i o n t h a t h e h a d t h o u g h t i t a d v i s a b l e t o d i v i d et h e r e s p o n s i b i l i t y o f r e v i s i n g t h e t e x t i n c o l l a b o r a t i o n w i t h

a j u n i o r a u t h o r a c t i v e l y e n g a g e d i n t e a c h i n g s i n c e h e n o

l o n g e r p a r t i c i p a t e s i n u n i v e r s i t y d u t i e s . T h i s i s a f a r s i g h t e dm o v e f o r i t h o l d s o u t a r e a s o n a b l e a s s u r a n c e f o r t h e p e r -p e t u a t i o n o f a v a l u a b l e t e x t b o o k .

C u r t i s ' G y n e c o l o g y i s a n o l d s t a n d b y f o r m e d i c a l s t u d e n t s

a n d a h a n d y g u i d e f o r t h e b u s y p r a c t i t i o n e r a n d , a s s u c h ,n e e d s n o d e t a i l e d r e v i e w . On t h e w h o l e i t i s p r a c t i c a l i n i t s

c o n c e p t i o n , i t i s r e a d a b l e a n d r e l i a b l y d o c u m e n t e d . T h e

p r e s e n t e d i t i o n h a s b e e n e n r i c h e d w i t h a d d i t i o n a l i n f o r m a -t i o n a b o u t t h e e m b r y o l o g y o f t h e g e n i t o - u r i n a r y t r a c t a n d

s o m e o f t h e c o m m o n e r d i s t u r b a n c e s o f t h e v e s i c o r e n a l s y s -t e m . M i n o r c h a n g e s a p p e a r i n many c h a p t e r s . T h e c h a p t e r s

o n a n a t o m y , e m b r y o l o g y a n d p h y s i o l o g y a r e o u t s t a n d i n g a n d

b e a u t i f u l l y i l l u s t r a t e d b y To m J o n e s .

A s f a r a s d i a g n o s i s a n d t r e a t m e n t a r e c o n c e r n e d t h e r e

m i g h t b e r o o m f o r f u r t h e r r e v i s i o n . C e r t a i n a t t i t u d e s a r es t r i c t l y t h o s e o f t h e s e n i o r a u t h o r w h o s e l o n g e x p e r i e n c e i nt h e p r a c t i c e a n d t e a c h i n g o f g y n e c o l o g y h a s m a d e h i m

r a t h e r s e t i n h i s v i e w s . I n s o m e r e s p e c t s t h i s e n h a n c e s t h ev a l u e o f t h e t e x t b e c a u s e i t a l l o w s t e a c h e r s t o t a k e e x c e p -t i o n a n d t h e r e w i t h c r e a t e d i s c u s s i o n . H o w e v e r , a b r o a d e r

a p p r o a c h w o u l d b e m o r e e n l i g h t e n i n g t o t h e s t u d e n t w h o

t h e n c o u l d a c q u ai n t h i m s e l f w i t h m e t h o d s o f t r e a t m e n t

o t h e r t h a n t h o s e a d v o c a t e d b y t h e s e n i o r a u t h o r . T h i s i s

t r u e i n p a r t i c u l a r o f t h e c h a p t e r s d e a l i n g w i t h t h e r a p i d l ye x p a n d i n g f i e l d o f e n d o c r i n o l o g y , w i t h t h e s t u d y a n d t r e a t -m e n t o f d y s m e n o r r h e a a n d t h e e t i o l o g y o f c a n c e r . T h e r e i s

r o o m a l s o f o r a b r o a d e r d i s c u s s i o n o f p s y c h o s o m a t i c p h e -

n o m e n a p a r t i c u l a r l y a s t h i s r e l a t e s t o t h e m e n a r c h e , m e n o -

p a u s e , d y s m e n o r r h e a a n d t h e h o s t o f p o o r l y u n d e r s t o o d

p e l v i c c o m p l a i n t s , n o t t o f o r g e t t h e a p p r o a c h t o t h e h a n -d l i n g o f c a n c e r p a t i e n t s . Y e t , a l l i n a l l , n o n e o f t h e s e m i n o r

s h o r t c o m i n g s d e t r a c t s f r o m t h e w i d e l y r e c o g n i z e d v a l u e o ft h i s b o o k a s a t e a c h i n g t e x t a n d a p r a c t i t i o n e r ' s g u i d e .

C u r t i s ' G y n e c o l o g y i s i l l u s t r a t e d e l a b o r a t e l y , i n f a c t , o n e

m i g h t s a y , a l m o s t e x t r a v a g a n t l y . F o r i n s t a n c e , t h e m a s s o fi l l u s t r a t i o n s d e p i c t i n g a v a r i e t y o f s u r g i c a l c o r r e c t i o n s o f a

r a t l r r l i m i t e d f i e l d o f t r a u m a t i c d i s t u r b a n c e s i s a f i n ee x a m p l e o f t h e v e r s a t i l i t y o f a p p r o a c h t o a s u r g i c a l p r o b l e m

b u t i t m u s t b e b e w i l d e r i n g t o t h e y o u n g s t u d e n t t o s e e s u c h

a n a r r a y o f s u r g i c a l t e c h n i q u e w i t h o u t f i n d i n g a d e q u a t e

e x p l a n a t i o n s i n t h e t e x t t o p e r m i t h i m t o u n d e r s t a n d w h y

s o m a n y d i f f e r e n t p r o c e d u r e s h av e b e e n d e v i s e d . T h i s n e e d s

c o r r e c t i o n e i t h e r t h r o u g h e l i m i n a t i o n o f s o m e o f t h e l e s su s e f u l m e t h o d s d e p i c t e d o r b y o f f e r i n g a m o r e a d e q u a t e

d i s c u s s i o n o f t h e i r r e s p e c t i v e a p p l i c a t i o n s . Y o u r r e v i e w e r

h a s w a t c h e d t h e g r o w t h o f t h i s t e x t b o o k s i n c e i t s f i r s t a p -p e a r a n c e a n d h e h a s n o t i c e d t h a t w i t h e ac h e d i t i o n t h e r e i s

a g r o w i n g t e n d e n c y t o d e v e l o p i t i n t o a m o r e e l a b o r a t eh a n d b o o k o f t h e r e f e r e n c e t y p e . He h o p e s t h i s w i l l n o t

c o m e t o p a s s b e c a u s e h a n d b o o k s a r e n o t h a n d y t e x t s f o rs t u d e n t s . B e s i d e s , f r e q u e n t r e v i s i o n s a r e o u t o f t h e q u e s t i o nb e c a u s e o f t h e c o s t , t h e l i m i t e d m a r k e t a nd t h e m o n u m e n t a l

e f f o r t r e q u i r e d t o k e e p a b r e a s t w i t h t h e p r o g r e s s o f m e d i -

c i n e . T h e t h r e e v o l u m e s o f G y n e c o l o g y e d i t e d b y A r t h u r

C u r t i s y e a r s a g o a r e a g o o d e x a m p l e o f t h e f a t e o f i n f l e x i b l eh a n d b o o k s .

W. B . S a u n d e r s C o m p a n y i s k n o w n f o r i t s h i g h s t a n d a r di n p u b l i s h i n g m e d i c a l t e x t s . T h e s i x t h e d i t i o n o f C u r t i s 'T e x t b o o k o f G y n e c o l o g y a t t e s t s i n e v e r y r e s p e c t t o t h ec o n t i n u a n c e o f t h i s e n v i a b l e r e c o r d . I n v i e w o f t h e f i n ep r i n t i n g , t h e c l e a r i l l u s t r a t i o n s , h i g h g r a d e p a p e r a n d g o o d

b i n d i n g t h e c o s t o f t h e b o o k a t $ 1 0 . 0 0 s e e m s n o t o u t o f l i n ea l t h o u g h s t u d e n t s a r e f i n d i n g i t i n c r e a s i n g l y d i f f i c u l t t oa c q u i r e t e x t b o o k s a t t h e p r e s e n t h i g h p r i c e s .

* * *

ANGINA PECTORIS AND MYOCARDIAL INFARC-TION-With S p e c i a l Reference t o t h e Autono m i c NervousS y s t e m . By Heymen R . M i l l e r , M . D . , F o r m e r l y P r i n c i p a lP h y s i c i a n and C h i e f , S i g n a l Corps C l i m a t i c R e s e a r c h ; At-t e n d i n g P h y s i c i a n , Sydenham H o s p i t a l . Grune & S t r a t t o n ,New Y o r k , 1 9 5 0 . $ 8 . 7 5 .

T h i s b o o k p r e s e n t s a d e t a i l e d d i s c u s s i o n o f t h e a n a t o m y

o f t h e a u t o n o m i c p a t h w a y s o f t h e h e a r t a n d t h e i r r o l e i nt h e d i s t r i b u t i o n o f c a r d i a c p a i n i n c o r o n a r y d i s e a s e a n d

m y o c a r d i a l i n f a r c t i o n . I n a d d i t i o n , c o n s i d e r a b l e i n f o r m a t i o no n t h e p h y s i o l o g y o f t h e a u t o n o m i c n e r v o u s s y s t e m a n d i t sr e l a t i o n t o t h e c i r c u l a t i o n i s p r e s e n t e d . I n t h i s r e s p e c t t h eb o o k i s v a l u a b l e a s a r e f e r e n c e f o r t h o s e w h o w i s h u n u s u -

a l l y d e t a i l e d i n f o r m a t i o n o n t h e s e m a t t e r s .T h e r e m a i n d e r o f t h e b o o k c o n s i d e r s t h e c l i n i c a l a s p e c t s

o f t h e s u b j e c t , i n c l u d i n g t h e e l e c t r o c a r d i o g r a p h i c f i n d i n g s ,a n d t h e m e d i c a l a n d s u r g i c a l a s p e c t s o f t r e a t m e n t . I n t h er e v i e w e r ' s o p i n i o n a l a r g e p a r t o f t h i s m a t e r i a l i s c o n s i d e r -a b l y b e l o w t h e s t a n d a r d o f o t h e r p a r t s o f t h e b o o k , a n d i ns o m e i n s t a n c e s g r e a t l y d e t r a c t s f r o m i t s v a l u e a s a t e x t .T h e s e c t i o n o n t h e e l e c t r o c a r d i o g r a m i s e n t i r e l y i n a d e q u a t e

a n d a d d s l i t t l e o f v a l u e t o t h e b o o k . I t i s i n f e r r e d t h a t t h e r ea r e d i s t i n g u i s h a b l e d i f f e r e n c e s b e t w e e n t h e e l e c t r o c a r d i o -g r a m o f m y o c a r d i a l i n f a r c t i o n w i t h c o r o n a r y o c c l u s i o n a n d

t h a t o f m y o c a r d i a l i n f a r c t i o n w i t h o u t c o r o n a r y o c c l u s i o n ,a n d i l l u s t r a t i v e t r a c i n g s a r e p r e s e n t e d a s e x a m p l e s w h i c h

d i f f e r o n l y i n t h e d e g r e e o f e l e c t r o c a r d i o g r a p h i c a b n o r m a l -

i t y . I n t h e r e v i e w e r ' s o p i n i o n s u c h d i f f e r e n t i a t i o n i s u n s o u n d

a n d n o t b a s e d o n g e n e r a l l y a c c e p t e d p r i n c i p l e s o f e l e c t r o -c a r d i o g r a p h y . T h e e l e c t r o c a r d i o g r a m i l l u s t r a t i n g a c u t e p u l -m o n a r y e m b o l i s m i s d e s c r i b e d a s s h o w i n g a Q w a v e i n l e a dI I I w h e n t h e i n i t i a l d e f l e c t i o n - o f t h e v e n t r i c u l a r c o m p l e x i nt h i s l e a d i s p o s i t i v e . I n n o i n s t a n c e i s m o r e t h a n o n e p r e -c o r d i a l l e a d i n c l u d e d w i t h t h e e l e c t r o c a r d i o g r a p h i c i l l u s t r a -t i o n s , a n d i n o n l y o n e i n s t a n c e w a s t h e s i t e o f t h e i n d i f f e r e n te l e c t r o d e n o t e d .

T h e s e c t i o n o n t h e c l i n i c a l f e a t u r e s o f m y o c a r d i a l i n f a r c -t i o n i s c o n f u s e d b y t h e a u t h o r ' s p r e o c c u p a t i o n w i t h t h e c l i n -i c a l d i f f e r e n t i a t i o n b e t w e e n m y o c a r d i a l i n f a r c t i o n " w i t h a n d

w i t h o u t c o r o n a r y o c c l u s i o n " ; a n d t h e i l l u s t r a t i v e c a s e s p r e -s e n t e d o f f e r t h e r e a d e r n o r e a s o n a b l e b a s i s f o r s u c h a d i f f e r -e n t i a t i o n .

T h e s e c t i o n o n t r e a t m e n t i s a d e q u a t e , t h o u g h i t s u f f e r sf r o m t h e u s e o f p r o p r i e t a r y n a m e s f o r s u g g e s t e d d r u g s , t e no f w h i c h w e r e r e c o m m e n d e d a s h y p n o t i c s .

T h i s b o o k c a n n o t b e r e c o m m e n d e d f o r m e d i c a l s t u d e n t s ,a n d w i l l h a v e l i m i t e d u s e a s a r e f e r e n c e t e x t b y p h y s i c i a n si n t e r e s t e d i n h e a r t d i s e a s e .