154 BOOK REVIEWS

CLASSICS IN ARTERIAL HYPERTENSION. By Arthur Ruskin, M.D., Springfield, Ill., 1956, Charles C Thomas, 3.58 pages. Price $9.50.

This book is composed of selected publications (translated into English where necessary) of investigators whose contributions are milestones in the history of arterial blood pressure.

A brief and amusing introductory chapter deals with pulse-lore, and this is followed by a history of the methods of measuring blood pressure. This begins with the work of Stephen Hales (1733), who measured intravascular pressures in animals much as one measures the cerebrospinal fluid pressure of patients today. There follows the investigations of Poiseuille, who adapted the mercury manometer to the measurement of intravascular pressures; the project was carried out and published while Poiseuille was still a senior medical student in Paris. After dealing with other significant contributions, this section culminates in the 1905 pdblication of Korotkov on the auscultatory method of measuring systolic and diastolic blood pressures as currently employed.

In the chapters entitled “Significance” one encounters the paper of Richard Bright, corre- lating sclerosis of the kidneys with hardness and fullness of the pulse. This paper was published in 1827, one year before that of Poiseuille which dealt with the manometric measurement of in- travascular pressure. On the basis of Bright’s work, hypertension was regarded as being entirely of renal origin, and it was not until the turn of the century that the present concept of primary and secondary hypertension evolved. When one realizes that some seven decades elapsed be- tween the publications of Bright and Poiseuille and the development of the first clinically accep- table sphygmomanometer by Riva-Rocci (1896), one can appreciate the difficulties that faced the mid-nineteenth century clinicians and pathologists in their efforts to unravel the interrela- tionships of hypertension, renal disease, and arteriosclerosis.

The closing chapters are comprised of papers dealing with the etiology of hypertension. The first one is by Tigerstedt and Bergman (1897), and describes their discovery of the pressor activity of renal extracts; the final one, appropriately enough, is Goldblatt’s (1934) treatise on the pro- duction of experimental renal hypertension.

This book will intrigue those whose main concern is the field of hypertension, and will be equally appealing to those interested in the experimental method and clinical observation.

B. A. L.

THE CLINICAL ASPECTS OF ARTERIOSCLEROSIS. By Seymour H. Rinzler, M.D., Springfield, Ill., 1957, Charles C Thomas, 339 pages. Price $8.75.

The author’s principal objective in writing this monograph is to summarize the extensive and widely scattered literature on the clinical aspects of arteriosclerosis for the guidance of the general practitioner who is frequently confronted with such problems.

The term arteriosclerosis is defined in a generic sense to include atheromatosis, atherosclerosis, Monckeberg’s sclerosis, and hyperplastic (involutionary) arteriosclerosis, but almost all the

detailed discussion in the book concerns atherosclerosis, and the terms arteriosclerosis and athero- sclerosis are often used more or less interchangeably throughout the text.

The first chapter, which lists nearly 300 references to the literature, deals with the incidence of arteriosclerosis and summarizes current ideas on the role of various factors in the etiology and

pathogenesis of the condition. This chapter is somewhat disappointing because it is neither long enough to supply the sophisticated reader with a comprehensive summary of all the conflicting points of view, nor short and critical enough to provide authoritative guidance for the reader who is merely searching for a reasonable, provisional attitude which he may use as a guide in clinical

practice, pending clarification of the disputed issues by future research. The next seven chapters are devoted to a discussion of the clinical manifestations, diagnosis,

and treatment of coronary heart disease. Apart from the more liberal use of references to the

literature, this section of the monograph follows the conventional pattern of a chapter on coronary heart disease in a tmtbook of cardiology. Chapters on the treatment of congestive heart failure and on drug therapy of disorders of the heart beat are also included in this section, but, as might have been expected, it was not possible in a monograph on arteriosclerosis to allocate sufficient

Volume 56 Number 1 BOOK REVIEWS 155

space to permit adequate coverage of subjects such as these which have no specific relation to coronary heart disease. In a textbook of cardiology, on the other hand, it is possible to present a single, comprehensive discussion of congestive heart failure, so that in the chapters on individual diseases only those aspects of heart failure which are specific to the disease in question need be mentioned.

Nearly half of the chapter on the cerebral aspects of arteriosclerosis is devoted to a discus- sion and tabulation of the neuroanatomic basis of the symptoms and signs produced by occlusion of individual arteries which supply blood to the brain and spinal cord. Perhaps as a result of the limitations imposed by the title of the monograph, cerebrovascular accidents are discussed with only incidental reference to the role of hypertension and arteriolar sclerosis. This is unfortunate because hypertension plays an important and sometimes dominant role in the great majority of strokes in patients under 60 or 70 years of age. Moreover, the presence of an elevated blood pres- sure is often the most important single factor which influences decisions regarding treatment and prognosis.

The remainder of the book consists of short chapters on the clinical aspects of aortic, pe- ripheral, retinal, renal, and pulmonary arteriosclerosis. In several places in this section limitations of space seem to have made it impossible to present an adequate discussion of points of consider- able importance in everyday practice. For example, the short paragraph which deals with the ophthalmoscopic characteristics of retinal arteriosclerosis with and without hypertension is par- ticularly unsatisfactory and even confusing. On the other hand, in the chapter on arteriosclerosis of the aorta, two pages are devoted to a detailed description of the technique of aortography, a procedure which is rarely performed except by specialists in the field of vascular disease.

In view of the contradictory nature of much of the material which is cited from the literature without critical comment, it is unfortunate that a summary was not given at the end of each chapter in order to permit the author to express his personal evaluation of the consensus of the available evidence. A minor, but rather irritating shortcoming of the book, which is otherwise beautifully printed and illustrated, is the frequency with which errors of spelling and composition have escaped correction by the proofreader.

Dr. Rinzler deserves to be congratulated for having summarized in a single volume such a large cross section of the literature on the clinical aspects of arteriosclerosis, since this material would otherwise have remained scattered throughout a very large number of booksand periodicals dealing with various specific manifestations of the condition. It is this reviewer’s opinion, how- ever, that this monograph is likely to be of a greater value as a source of ready reference for those whose special interests lie in the field of arteriosclerosis than as a practical manual for day-to-day use by the general practitioner.

K. A. E.

ANAESTHESIA (BRITISH MEDICAL BULLETIN). Vol. 14, No. 1, January, 1958. Published by Medical Department, The British Council, London, 72 pages. Price El or $3.25 post free.

Volume 14, Number 1 of this Journal is a symposium containing short, essentially practical articles mainly of interest to the anesthetist, but with papers for those whose study is in cardiology and respiratory function. It contains no very academic papers but is based on the observations

and thinking of experienced men. Professor Whitteridge describes the effects, and consequences, of volatile anesthetics and

other drugs on the sensitivity of the stretch receptors in the lung and those of the carotid and aortic

pressor receptors. Professor Pask details many of the factors governing and relating to COZ

levels in anesthesia and the effects of the variation in mechanical factors on the exchange of gases in the lungs and tissues. He also points out the difficulties in assessing the effects of COz on human

beings by the interpretation of animal experiments.

Lucas, in his article on hypothermia, recalls the stimulus of modern cardiac surgery on the

concept originally used by Bayle and Currie in the eighteenth century. He deals in some detail with the occurrence and treatment of the variety of cardiac arrhythmias which have been found

to occur in this form of therapy.