Book Review

Respiratory Physiology

N Engl J Med 1996; 335:1692November 28, 1996

Article

Respiratory Physiology
(People and Ideas Series.) Edited by John B. West. 430 pp., illustrated. New York, Oxford University Press (for the American Physiological Society), 1996. $85. ISBN: 0-19-508081-5

This book on people and ideas contains interesting and often amusing information about the founders of respiratory physiology, with a minimum of complicated diagrams and jargon. Its five parts cover morphology, gas exchange and blood flow, mechanics, control of ventilation, and comparative physiology. The chapters vary widely in their scope, some summarizing developments since the ancient Greeks, others starting from World War II; an author occasionally presents a state-of-the-art overview without bothering much about people and ideas. Appropriately, all authors are pioneers who are well equipped to look back: Weibel, Forster, Astrup, Mead, Macklem, to mention only some. A handicap of the book is that it does not highlight the achievements of the authors themselves, and so for people unfamiliar with the role of the authors in respiratory physiology these will remain unclear. There are abundant figures and pictures, including many formal portraits and candid looks into old laboratories where handmade, clumsy-looking equipment is displayed on kitchen tables, with the scientist in full action (such as the “mighty Wurlitzer” of Arthur DuBois and his son, who “used body chambers to the benefit of mankind”).

The best chapters are loaded with anecdotes, such as the one by Staub (“Colin learned that veterinary students at Lyon University in France had to pour 30 and 40 liters of water down the tracheas of two horses in order to kill them. This appears to have been the reason for his choice of the horse for his experiments [on fluid absorption by the lung]”). He concludes several paragraphs with the phrase “and so it goes.” Another fine example is the chapter by Mead, who writes in a highly personal and humorous style. One evening, when Mead and Arthur Otis were to prepare a manuscript, Otis decided to buy a car instead: “a Buick, as I recall. . . . At loose ends, I made my way to the Gaité Burlesque and enjoyed a truly eye-opening performance, which I recall vividly to this day. I doubt that Arthur remembers even the color of his Buick!” This anecdote is followed by an original hypothesis of the normal function of airway smooth muscle. How was the flow-volume plot conceived? “We [Fry and Hyatt] immediately rigged up a spirometer and flow meter in series and started pursuing the idea.” One of the most hilarious passages is one in which Peter Macklem describes experiments by Mead in which huge numbers of Ping-Pong balls and condoms were used in a model to analyze the force balance in the lung parenchyma (“My God, a sexual Gatling gun” exclaimed a surprised visitor).

Several authors stress that respiratory-physiology research groups emerged from the needs of World War II, which forced together scientists with widely different backgrounds. Likewise, some of the important respiratory physiologists from the beginning of the century were engaged in World War I. This war background is used as an explanation of the team spirit among these early research groups, which in the opinion of many authors, contrasts with the present atmosphere (“what a fine, helpful, generous group they were. We shared information without fear and without loss,” says Forster). Many authors close their chapters with similar “those were the days” feelings. However, war is probably not the only reason that our ways changed during the past decades. One only need read the extremely careful and respectful wording used by August Krogh in his paper to spare his teacher Bohr when he refutes his view of active oxygen secretion in the lungs.

The sad thing about a book such as this is that it is not likely to reach those currently involved in modern respiratory research. Reading the various contributions makes one wonder why this sort of research has become increasingly unpopular and why it required a world war to get eminent research groups started. As the editor John West says, “The present swing away from integrative physiology means that a whole generation of young physiologists are largely unaware of these fields. This is unfortunate because many questions remain to be answered. . . . No doubt the pendulum will swing back to find a better balance in the fullness of time.” And so it may go, but one hopes, without another world war.

Johan C. de Jongste, M.D., Ph.D.
Sophia Children's Hospital, 3015 GJ Rotterdam, the Netherlands