REVIEW OF RECENT BOOKS
Diagnosis of Diseases of the Chest (Vol I) (2nd ed) B y Robert G. Fraser, M.D., and 1. A. Peter Pare, M . D . W. B. Saunders C o m p a n y , Philadelphia, 2977 656 p p , illustrated, $22.50
Reviewed by Alan Marty, M . D . Like Plato with his cave analogy, many of us share a longing to understand intrathoracic truths by viewing mere roentgenographic shadows. Few of us, however, consistently base our roentgenographic diagnosis on so firm an analytic foundation as that presented by Fraser and Pare. Connoisseurs of this classic text may recall the delectable feast of original case material, prepared with synthesizing perception, organizational perfection, and well-chosen documentation. The new edition, as exemplified by this updated first volume, maintains this quality and adds depth. The original two volumes have been expanded to four, and the number of references cited has doubled. Volume 1, covering roentgenographic, pathological, and clinical methods, the normal chest, roentgenographic signs, and congenital anomalies, contains twice as many illustrations and pages as the older, equivalent chapters. To enhance reading ease, all subject headings are offset and more boldface type has been used. Separate bibliographies are placed at the end of each volume. Although the length of this book threatens to relegate it to the reference shelf, the smooth narrative flow and the authors’ inability to be boring could tempt readers to consume it like a best seller. Try the section on acid-base balance-even this topic emerges as enjoyable reading! The authors reexamine commonplace observations with unpretentious erudition: for example, the butterfly pattern of pulmonary edema. Apparently, the greater ventilatory excursion of the lung periphery facilitates edema clearance by the lymphatics, thus
leaving the centrally dense edema to create the butterfly image on the chest roentgenogram. New procedures such as bronchial arteriography for localizing severe hemoptysis are mentioned. Practical pointers abound as well, such as the authors’ technique of making a bedside roentgenogram. They load two films in a single cassette, overpenetrate, and thereby simultaneously obtain proper exposure of both the lung and the mediastinum. Furthermore, Fraser and Par6 fearlessly raise timely issues such as costlbenefit considerations. In this regard, they note a growing disenchantment with bronchography, and they perform only one bronchogram per month now instead of three per week as a decade ago. While celebrating science and rational thinking throughout, the authors unashamedly also point out their (and our) limits of knowledge. For example, miliary tuberculosis shows up on roentgenograms even though the lesions measure below the limit of threshold visibility. Tubular roentgenographic shadows reminiscent of bronchiectasis sometimes appear in histologically normal lungs. These roentgenological enigmas are examined, but left unsolved. Of course, even such a comprehensive text cannot discuss every relevant topic with equal depth. One might quarrel, for example, with the wisdom of allocating two pages to pneumomediastinography while allowing only two sentences for computerized axial tomography. Like the first edition, the second edition continues to emphasize the value of the roentgenogram as a first step in diagnosis. But by integrating clinical, laboratory, pathological, and physiological information into a unified whole, it will continue to function as a bible for all physicians interested in chest disease.