Book Review

Respiratory Medicine

N Engl J Med 1996; 334:1344May 16, 1996

Article

Respiratory Medicine
Second edition. Edited by R.A.L. Brewis, B. Corrin, D.M. Geddes, and G.J. Gibson. 1685 pp. in two volumes, illustrated. Philadelphia, W.B. Saunders, 1995. $180. ISBN: 0-7020-1641-1

Unarguably, the specialties of pulmonary and critical care medicine have come a long way in the past quarter of a century. This progress has depended on the application of bioengineering, physiology, biochemistry, pharmacology, molecular biology, and microbiology to the definition, understanding, and in some cases, effective treatment of acute and chronic disorders of the respiratory system. In recognition of the dependency of this progress on such firmly laid foundations, most authors of specialty textbooks almost appropriate these areas of basic science, rewriting them and focusing them on their own specialties.

This book is no exception. It provides inconsistent and, on occasion, excessive and unfocused coverage of basic material that is better suited for presentation as a monograph. Examples include the chapters on lung metabolism and on humoral and cellular defense mechanisms. Yet, by and large, the discussions of basic science are well done and sharply focused.

This two-volume work is a valuable reference that combines the advantages (depth and expertness) and inevitable disadvantages (inconsistencies and duplications) of a multiauthored book. Able editing appears to have minimized the disadvantages, but they are still in evidence, most clearly in the first volume. For example, part A, which deals with the structure, function, and defense mechanisms of the respiratory tract, has inconsistencies and duplications. These, however, are more obvious to a reviewer, who reads through the book, than to a reader, who focuses on a given topic. Especially laudable are the chapters on the physiologic principles of gas exchange, respiratory function during exercise, and lung injury and repair.

Part B, on diagnostic methods, cuts a wide and lucid swath through an array of established and new techniques. Lagging a bit, perhaps, are the chapters dealing with signs and symptoms and with the mechanisms and characteristics of dyspnea.

The section on principles of treatment (part C) illustrates well the problem of duplications and inconsistencies. The chapter on mechanical ventilation is excellent and applies basic principles in a physiologically sound and clinically useful way. In contrast, the chapter on anesthesia in patients with respiratory disease repeats the earlier discussions of the mechanics of breathing and the principles of gas exchange, instead of building on these discussions in the context of anesthesia.

In the sections that deal with particular diseases and environmental aspects of the respiratory system, this book shines. Of particular merit is the expertly written and beautifully illustrated chapter on adverse environments.

In sum, I highly recommend this reference work to any practitioner or trainee in the specialties of pulmonary and critical care medicine.

Roland H. Ingram, Jr., M.D.
Emory University School of Medicine, Atlanta, GA 30322