58U TJIE AMERI(‘.iS HEART JOURNAL

study in normal people, although it is well known that they may precipitate acute cardiac

failure in patients with heart disease.

Perhaps the most illuminating data for clinicians are the averages obtained on the 51

normal men and 52 normal women, most of whom were young:

AV. RATE FOR BASAL AV. RATE FOR MINIMUM

WAKING HOURS AWAKE SLEEPING HOURS ASLEEP

Men 77.8 61.4 59.4 52.8 Women 83.9 69.9 65.3 57.7

The authors emphasize the importance of obtaining true basal conditions for com-

parative purposes, and they point out the clinical value of measurements made during

sleep, especially in the differential diagnosis of neurocirculatory asthenia. Their de-

tailed studies of the heart rate in cardiac patients are of great interest. The curves of

rates during the different stages of operations should be scrutinized by internists as

well as surgeons. This little book is one that should not be neglected by physicians or physiologists.

The subject matter is well presented and the authors keep a good sense of proportion.

They do not lose sight of the fact that the heart rate is only one of many factors in the circulation. -E. F. Du B.

THE FAILING HEART OF MIDDLE LIFE. By A. S. Hyman and A. E. Parsonnet. The F. 9.

Davis Co., Philadelphia, 1932.

This book, with greater accuracy, might have been entitled “coronary arterial dis-

ease,” inasmuch as five-sixths of the text is devoted to this subject. Of the heart that

fails in middle life as a result of rheumatic, syphilitic, or hypertensive disease, nothing

is said.

It is not made clear for whom the book was written. There are intimations that it

is intended for the practitioner, but if so, it is scarcely justifiable to devote almost a

fourth of its pages to a detailed discussion of electrocardiograms, and another fourth

to an exhaustive presentation of the various theories relating to angina pectoris. The

general approach of the authors is revealed in their statement: “Indeed, the very

approach to the simplest discussion of the angina1 syndrome must carry one over path-

ways of the most intangible and complicated sort, proceeding through a labyrinthine

maze of neurologic, myogenic, and teleologic routes.” In view of this attitude, with

which the present reviewer is not in sympathy, it is not surprising that the chapter on

angina is the longest and most involved in the volume. It is regrettable that their

learned discussion of this type of heart failure should leave the careful reader with

his impressions blurred and confused rather than clarified, for there are many features

of angina that may be described clearly and dogmatically, even though some are still

puzzling.

The book as a whole leaves the impression of being too long; with the exception of

the last chapter, it would have been improved by considerable reduction. In their

apparent desire to leave no topic untouched, the authors have extended their discussions

and descriptions unduly, and in many instances have introduced confusion rather than

clarity. It is by no means clear to the present reviewer, even after several readings,

just what is their conception of myoeardosis. They speak of it as “a designation spell- ing a new approach to the understanding of the earliest manifestations of coronary and

myoeardial insufficiency, ’ ’ and in many places indicate that the term applies to early

changes in the heart. Yet throughout their discussion they speak of early myocardosis, and never of later or advanced myocardosis. The pain of this condition is discussed at

ROOK REVIEWS 581

length, but nowhere is it made clear how it differs from that of true angina1 failure.

One can scarcely believe that they have justified the use of this newer term as a sub

stitute for arteriosclerotic heart disease; with their declaration that the term “myo-

carditis ’ ’ is no longer tenable there can be no serious quarrel.

The book is written interestingly and in many places eloquently, with a happy choice

of words and descriptive phrases, but without sufficient thought of conciseness. The

illustrations are uniformly excellent. The last section, devoted to the medicolegal as-

pects of sudden death from heart disease, is a most valuable addition to a modern text

in this particular field. There is a very complete bibliography containing 1350 ref-

erences, and a complete index. To me it seems a stimulating, thoughtful, and compre-

hensive presentation of an increasingly important subject, but one which will be of

chief value to the cardiologist or the practitioner who has a special interest in diseases

of the heart. H. iK. M.

DIE SOZIALE BEDEUT~NG UND BEERTEILUNG DER KREISLAUFERKRANKUNGEN. By Dr.

med. Franz Griinbaum. Georg Thieme, Leipzig, 1933, pp. 128. (Arhrit und

Gesundheit. Herausgegeben von Prof. Dr. Martineck. Heft 21.)

This small monograph deserves especial notice in the United States, for, as is mani-

fest, it owes its inspiration to phases of interest in the heart diseases which have been

cultivated especially in this country. Doctor Griinbaum has, as a matter of fact, travel-

led about here to be acquainted with the current course of events. The fact that his

book is published in the series “Arbeit und Gesundheit ’ ’ is evidence of the growing con-

cern in Germany with aspects of the heart diseases from the point of view of the public

health. It is, furthermore, not without interest to record the occurrence of the first meeting in Germany of the “ Wissenschaftliche Komitee zur Erf orschung und Bekaemp-

fung der Kreislaufstoerungen” in March, 1933. Leadership in interest in this problem

is a development in which we may take a legitimate pride.

The specific matters which have occupied Doctor Griinbaum are statistics of mor-

tality and morbidity in relation to age. He made comparisons between experience in

the United States and in Germany and studied the relation of etiological moments to

the frequency of the various groups. In arriving at diagnoses, use has been made of the classification of the New York Heart Committee. In their study of functional elas-

sification Griinbaum mentions the effort of Fraenkel and Doll who have attempted a

separation based on the reactivity of patients to the intravenous injection of strophan-

thin. This is a method which requires further consideration but one which surely is liable to serious error. Other criteria are discussed dealing with physical examination and with efficiency-in valvular diseases and in arrhythmias.

The points of view which have received so much attention here in recent years have

clearly awakened a response abroad. The importance of this newer plan of understand- ing the course of events of a disease as it concerns both individuals and communities

will become more apparent when, as the result of sifting ideas in various countries, the effort is finally made to devise a working nomenclature of morbidity. In the develop-

ment of any science, nomenclature or language is obviously fundamental. That this is

being found to be the case in connection with the study of diseases is not unexpected

when experience in other sciences, physical and biological, is recalled. A. E. C.

NOUVEAU TRAITS DE M$DECINE. FASCICULE X, PATHOL~GIE DE L’APPAREIL CIRCULA-

TOIRE (COEUR ET VAISSEAUS) . Vol. I 992 pp., and Vol. II 778 pp., Masson & Cie, Paris, 1933.

This monumental work, planned by Professor Teissier but completed under the di- rection of Professor Lutembacher, is a compilation of most of the facts and many of the

theories pertaining to the circulation. Its high quality may be judged from the names

of the contributors-Lutembacher, Teissier, Prieur, Bordet, Giraud, Coste, Dumas,