Book Review DIE NEUZEITLICHEN BRUSTWAND UND EXTREMIT~TEN-ABLEIT~NGEN IN DER PRAXIS. By Herbert Reindell and Helmut Klepzig, Stuttgart, 1958, Georg Thieme Verlag, 192 pages, 82 illustrations. In view of the present search for new electrocardiographic leads which have less distortion than the conventional leads, one perhaps might expect, from the title, some information about their practical application. However, as stated in the preface by L. Heilmeyer, the main purpose of the book is a condensed presentation of the large “Anglo-American” literature on Wilson’s V-leads (proposed 20 years ago) and Goldberger’s aV-leads (proposed 1.5 years ago); these are critically discussed on the basis of the authors’ own material. Since these leads were introduced into general use in Germany much later, the title may be justified for the average German reader. Actually, the book gives more than that. Vectorcardiographic information is integrated, and also chest leads, in addition to Leads VI-Va, and esophageal leads are considered in the dis- cussion, together, of course, with the standard leads which are still the basis of clinical electrocardiography. The book is fluently written and gives, in a comparatively small volume, up-to-date and adequate information on the clinical use of the 12-lead ECG. Arrhythmias are not included; indeed, the contribution of the V-leads to the differentiation of arrhythmias is small. The book is quite similar to most recent electrocardiographic textbooks. A distinguishing feature is the relatively large space devoted to the normal electrocardiogram (pages 22-52). The recognition of the importance of normal variations is certainly to the credit of the authors, but their treatment of normal variations is open to criticism. The authors present the normal standards for the V-leads from their own material of 100 cardiac normals (“Herzgesunden”) and 40 trained subjects. The composition of the “normal” group (age, body weight, sex) is not given, but it is probably a heterogeneous group, and the specification of absent cardiac pathology suggests that patients with other types of pathology may have been included. “Standards” derived from such groups can, at best, give only a pre- liminary orientation. It cannot be expected that such standards could be reproduced in another group of different composition. Indeed, the authors find that their values differ from those of Sokolov and Friedlander. They suggest that these differences are, in the first place, due to a different nutritional state between theirs and Sokolov’sgroup, which is not supported by actual evidence; most likely, other uncontrolled constitutional factors were more important. Sokolov and Fried- lander’s group was also heterogeneous, and group differences should be expected when two heterogeneous groups are compared. Similarly, the fact that the voltage of deflections in the group of 40 trained subjects was higher than that in the 100 “normal” subjects may be due to a different age or sex composition of the two groups rather than to training. It should be said, however, that the treatment of normal variations is also not adequate in some other recent textbooks of electrocardiography. The book is recommended as a critical evaluation of the present 12-lead electrocardiography, written from a large clinical experience of the authors. It is illustrated by a great number of excellent figures and diagrams. E. S. 478

Die neuzeitlichen brustwand und extremitäten—Ableitungen in der praxis: By Herbert Reindell and Helmut Klepzig, Stuttgart, 1958, Georg Thieme Verlag, 192 pages, 82 illustrations

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Page 1: Die neuzeitlichen brustwand und extremitäten—Ableitungen in der praxis: By Herbert Reindell and Helmut Klepzig, Stuttgart, 1958, Georg Thieme Verlag, 192 pages, 82 illustrations

Book Review

DIE NEUZEITLICHEN BRUSTWAND UND EXTREMIT~TEN-ABLEIT~NGEN IN DER PRAXIS. By Herbert Reindell and Helmut Klepzig, Stuttgart, 1958, Georg Thieme Verlag, 192 pages, 82 illustrations.

In view of the present search for new electrocardiographic leads which have less distortion than the conventional leads, one perhaps might expect, from the title, some information about their practical application. However, as stated in the preface by L. Heilmeyer, the main purpose of the book is a condensed presentation of the large “Anglo-American” literature on Wilson’s V-leads (proposed 20 years ago) and Goldberger’s aV-leads (proposed 1.5 years ago); these are critically discussed on the basis of the authors’ own material. Since these leads were introduced into general use in Germany much later, the title may be justified for the average German reader.

Actually, the book gives more than that. Vectorcardiographic information is integrated, and also chest leads, in addition to Leads VI-Va, and esophageal leads are considered in the dis- cussion, together, of course, with the standard leads which are still the basis of clinical electrocardiography.

The book is fluently written and gives, in a comparatively small volume, up-to-date and adequate information on the clinical use of the 12-lead ECG. Arrhythmias are not included; indeed, the contribution of the V-leads to the differentiation of arrhythmias is small.

The book is quite similar to most recent electrocardiographic textbooks. A distinguishing feature is the relatively large space devoted to the normal electrocardiogram (pages 22-52). The recognition of the importance of normal variations is certainly to the credit of the authors, but their treatment of normal variations is open to criticism.

The authors present the normal standards for the V-leads from their own material of 100 cardiac normals (“Herzgesunden”) and 40 trained subjects. The composition of the “normal” group (age, body weight, sex) is not given, but it is probably a heterogeneous group, and the specification of absent cardiac pathology suggests that patients with other types of pathology may have been included. “Standards” derived from such groups can, at best, give only a pre- liminary orientation. It cannot be expected that such standards could be reproduced in another group of different composition. Indeed, the authors find that their values differ from those of Sokolov and Friedlander. They suggest that these differences are, in the first place, due to a different nutritional state between theirs and Sokolov’sgroup, which is not supported by actual evidence; most likely, other uncontrolled constitutional factors were more important. Sokolov and Fried- lander’s group was also heterogeneous, and group differences should be expected when two heterogeneous groups are compared. Similarly, the fact that the voltage of deflections in the group of 40 trained subjects was higher than that in the 100 “normal” subjects may be due to a different age or sex composition of the two groups rather than to training. It should be said, however, that the treatment of normal variations is also not adequate in some other recent textbooks of electrocardiography.

The book is recommended as a critical evaluation of the present 12-lead electrocardiography, written from a large clinical experience of the authors. It is illustrated by a great number of excellent figures and diagrams.

E. S.

478