Book Review

Infective Endocarditis

N Engl J Med 1996; 335:678August 29, 1996

Article

Infective Endocarditis
By Louis Weinstein and John L. Brusch. 359 pp., illustrated. New York, Oxford University Press, 1996. $75. ISBN: 0-19-507395-9

This book is a delectation to be savored by anyone with an interest in infectious disease, cardiology, or the history of medicine. With a half century of passionate involvement in the study and treatment of infective endocarditis, Louis Weinstein's remarkable career brackets the close of the pre-antibiotic era, the advent of modern antimicrobial therapy, and the emergence of antibiotic resistance and immunodeficiency. He and John L. Brusch illuminate the changing face of infective endocarditis from a vantage point shared by few others.

The fascinating first chapter of this book, “The Natural History of Infective Endocarditis Prior to the Availability of Antimicrobial Therapy,” traces the evolution of knowledge about infective endocarditis from an early clinical description in 1723 by Lazare Riviere, through the seminal contributions of Morgagni, Osler, and others, down to the early days of cardiac surgery, when it became thinkable that one might be able to correct some of the damage inflicted on the heart by endocarditis. The second chapter very briefly summarizes the historical development of antimicrobial and surgical therapy of infective endocarditis. These two chapters capture some of the mystery surrounding an affliction that was uniformly fatal until the discovery of penicillin. The next several chapters cover epidemiology, microbiology, pathology, physiology, and clinical correlations in great detail. Each chapter cogently reviews current knowledge, pausing at intervals to identify the historical antecedents of current concepts and practices. Black-and-white photographs, tables, graphs, and line drawings are used sparingly but to good effect.

Chapter 8, “Clinical Manifestations of Native Valve Endocarditis,” is an extraordinarily vivid, formal depiction of a disease process. Its stark, arresting quality brings to mind photographic images from the Civil War. The next two chapters, “Endocarditis in Intravenous Drug Abusers” and “Prosthetic Valve Endocarditis,” are incisive variations on the same theme. They are followed by a very brief chapter on pediatric endocarditis. Subsequent chapters focus on diagnostic issues, medical and surgical management, prophylaxis, and experimental models of endocarditis. Throughout, this book stays closely in touch with a large body of literature. There are, for example, no less than 438 citations in chapter 5, on the microbiology of infective endocarditis.

For the most part, the motif of the scholarly review of the literature serves the authors well. In some sense, however, what remains unknown about a disease influences patient care just as decisively as what is known. One example is the extraordinary difficulty of demonstrating the efficacy of prophylactic measures against infective endocarditis. The struggle to achieve a consensus regarding prophylaxis remains one of the most interesting and instructive stories in contemporary medicine. A possible criticism of this book is that, in a work that so effectively traces the early history of endocarditis, little effort has been made to highlight the remaining areas of controversy, and an excellent opportunity to document and comment upon the evolution of opinion and policy regarding prophylaxis was missed — but perhaps this should be the focus of another book.

Edward B. Seldin, D.M.D., M.D.
Massachusetts General Hospital, Boston, MA 02114