Book Reviews

HEKZ-UND GEFASSERKRANKUNGEN. By R. Volker, Darmstadt, 1957, D. Steinkopff, 166 pages, 106 illustrations.

Over the past decade the author has developed a’combination of methods which permits a more detailed diagnosis of the functional state of peripheral circulation than do the clinical routine methods, but which is simple enough to be used, in the author’s words, by a “geschickte Kran- kenschwester” (skilled nurse). The technique includes photoelectric recording of the pulse and peripheral arterial 02 saturation from the finger cup; continuous recording of CO2 and 02 content of the expired air, together with respiratory volume, by means of an instrument manufactured by Hartmann and Braun; and continuous recording of skin temperature. These methods are used in resting condition, in response to thermal stimuli, and under physiologic stress situations, particularly in hypoxia produced by rebreathing or by breathing a 10 per cent 02/N* mixture. The compact pickup for recording of peripheral circulation and 02 saturation, strapped on the middle finger (Fig. 106), is in some respects an improvement of Matthes’ method. Of these methods, by far the largest space is devoted to the photoelectric recording of the digital volume pulse (pp. 3-l 19). Deformation of the contour was found not only in peripheral vascular disease. but also in cardiac diseases and conditions such as coronary insufficiency and myocardial infarction, decompensation, mitral and aortic valvular defects, auricular fibrillation, etc. In regard to the variety of cardiocirculatory pathology investigated, this is one of the most comprehensive appli- cations of photoelectric plethysmography. The author’s view that any type of cardiac pathology involves also the peripheral circulation is, perhaps, not new, but the detailed objective demon- stration of this functional relationship fills an important gap. While for the functional capacities of a cardiac patient the state of peripheral circulation is undoubtedly important, there is a tendency to some exaggeration. Since impairment of peripheral circulation was found in patients with definite coronary artery disease, the author considers an abnormal pulse tracing in dubious angina pectoris (with normal ECG) as positive evidence for coronary insufficiency. However, the de- formation of the pulse contour, reaction to thermal stimuli, etc., does not appear to be specific for any cardiac condition, and in the absence of statistical evaluation of normal distribution, of incidence of peripheral involvement in cardiac patients, and of correlation between peripheral and cardiac involvement, such diagnostic implication appears to be premature.

As a whole, however, the experience of the author is encouraging and his methods promise to be a valuable supplement to the present clinical routine examination.

E. S.

CARDIO-CHARTING. Universal Method of Recording Heart Auscultation. By Arthur Briskier, M.D., New York, 1957, The Macmillan Company.

The ability to observe accurately and to describe clearly is a skill which every student of medicine must develop. His task is made more difficult than it need be by the various terms used by different authors and teachers to indicate abnormalities in the quality, intensity, and timing of the heart sounds and murmurs.

In this monograph the author aims to increase interest in careful cardiac auscultation and to introduce an internationally acceptable system for recording the findings graphically. The method is a modification of one in common use, whereby a diagram is made to resemble what one believes the phonocardiogram would show. The colors blue and red are used to represent sounds

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