642 AMERICAN HEART JOC-RNAL

One can agree with the statement that the differentiation between a large and a small infarct is clinically more important than the differentiation of the infarct location, but hardly with the

criteria advanced for this purpose, which are, in general, based on the somewhat naive concept of a parallelism between the size of the infarct and the extent of electrocardiographic changes.

A small infarct, for instance, is diagnosed when only T-wave changes but no QRS changes occur. It is recognized that myocardial infarct may produce T inversion without QRS changes,

but it is a different matter to diagnose outright an infarct from T changes (often reversible within

a few days) alone. While the transition between infarct and coronary insufficiency is fluid, it seems that the electrocardiographic changes are used mainly to corroborate the clinical impression,

i.e., the author reads into the electrocardiogram what he knows about the patient. With the author’s criteria, it is impossible to differentiate an infarct from coronary insuf-

ficiency, myocarditis, or pericarditis. Hauss suggests that the S-T elevation in acute myocardial

infarction starts on the descending limb of the R wave, and in pericarditis after the S wave, but curiously enough, this pattern is illustrated by a cace of posterior wall infarct and not pericarditis.

Interesting material mostly in the form of individual case reports is presented on the general relationship of myocardial infarct or angina pectoris to environmental and constitutional factors,

and on interaction with other types of pathology. Hypoglycemia, chest injury, allergic reaction, diseases of the intestinal organs, diaphragm, and the vertebrae, psychic trauma, etc., may in the presence of coronary disease be responsible for the development of a myocardial infarction. The

possible mechanisms invclved in such interaction are discussed on the basis of the available esperi- mental material.

That such causal relationships exist is of interest, and therefore the collection of such in-

formation is valuable. However, the presentation is not unbiased and not balanced. While the author goes to some length to show that apparently remote factors may be occasionally in- volved in the production of an infarct, the relationship between coronary disease and blood lipids

is denied in spite of the large and impressive literature, which is essentially ignored (p. 74). The author devotes considerably more space to hypoglycemia than to blood lipids.

In the discussion of prognosis and of complications in myocardial infarction, interesting

material from the {Iniversity Hospital in Frankfurt corroborates the much larger material pub- lished in the American literature on the evaluation of anticoagulant therapy. Of interest is the treatment of shock in infarct with bilateral carotid-sinus block.

One misses a chapter on functional tests (exercise, nnosia, meal) which should have a place

in a book on angina pectoris. The book cannot be recommended as an introduction for a medical student or for the general

practitioner, but the informed cardiologist will find interesting data on some aspects which are often by-passed in the &4merican cardiologic literature. The quality of the illustrations is excel-

lent, and there is a large bibliography of 35 pages. ES.

L)~S'L‘RANSVERSALESCHICHTVEWAFIREN. By -4lfred Gebauer, iU.ID., and Alfred Schanen, RI.D., Stuttgart, 1955, Georg Thieme, 313 pages.

The author states in the foreword that this is the second book devoted to transverse to- mography. (The first was written by Vallebona in Italy.)

This work is technically very beautiful. It is primarily a technical handbook for the use

of x-ray departments. The method is relatively limited in value in the differential diagnosis of heart disease, some forty pages are devoted to the heart and the large blood vessels.

The book can be warmly recommended for the student who wishes to develop this approach

to the study of pathology of the thoracic cavity.

J.J.