BOOK REVIEWS 205

chapters on aspects of upper respiratory tract infections, one on bronchitis and nine on specific aspects of lower respiratory infections including pneumonia. Each chapter stands on its own and the majority are excellent reviews of their topic. There is a welcome uniformity of editorial style throughout. The chapter on streptococcal infection and rheumatic fever seems oddly out of place. The chapter on bronchitis produces some confusion in the management of infection and airways obstruc- tion. There are three separate large pictures of a spirometer that appear rather excessive.

The line drawings are excellent, the few radiographs poor and references, particularly in the AIDS chapter, up to date.

The majority of chapters are excellent, but the selection of subjects, although interesting, appears rather random. It will be a useful reference book, providing the clinician knows that the subject is covered in it. I cannot see many clinicians buying it themselves, but it is a useful addition to any medical library.

J. T. Macfarlane

The Thorax, Parts A and B Eds Charis Roussos and Peter Macklem New York: Marcel Dekker. 1985. 1st edition. Pp. 1544. Price $210.00 (US & Canada); $252.00 (all other countries)

This two-volume magnum opus has been published as part of Claude Lenfant’s series ‘Lung Biology in Health and Disease’, a series of ‘monographs’ whose stated aims are ‘to cover topics of the respiratory process in some detail, reviewing the current state of knowledge, assembling the ideas of the best experts, and exhibiting some vision’. Although by no stretch of the imagination is The Thorax a monograph (there are 40 contributors), it does admirably succeed in the other aims of the series.

The Thorax is published at an opportune moment. The importance of the respiratory muscles and chest wall has been belatedly recognized, and workers are increasingly devoting themselves to this field. It was Rohrer who first made a careful analysis of respiratory

motions, in the 1920s but there was little further interest in the respiratory muscles dur- ing the first half of this century. Thus in 1958 when Moran Campbell wrote his classical monograph (one author!) on the respiratory muscles he was only able to find about 200 relevant references in the world literature. Even then interest progressed only slowly until the last decade. There has now been an explo- sion of activity, ably summarized in this work. Thus The Thorax lists well over 3000 cited authors, most with several or many contributions.

The Thorax is divided into five sections: Pro- perties of striated muscles, Structure and func- tion of the thorax, Applied physiology, The thorax in disease, and Therapeutic approaches. Within these sections are a total of 47 chapters, mostly written by two authors jointly. The credentials of the authors are impeccable and have clearly been chosen appropriately, and with care. Inevitably the style of the chapters varies, but all are authoritative, and detailed. Most have managed a balanced view of their topic, despite occasional scientific vested interest!

Reading this book emphasizes the recent advances as well as highlighting the areas of uncertainty. Our knowledge of how the mus- cles themselves work has been dramatically expanded, particularly by the studies of De Troyer and colleagues. Application of skeletal muscle physiology and mechanics to the res- piratory muscles has been pioneered by Edwards, Moxham and Faulkner. The mech- anics of the chest wall and its inter-relationship with the muscles and lung are described par- ticularly in chapters from the groups in Boston (Mead, Banzett, Loring and others), Montreal (Macklem, Roussos, Milic Emili and others), and Hammersmith (Pride and Gibson). The notion that the respiratory muscles may fatigue as do other muscles has been suggested and demonstrated by the Montreal and the Brompton groups. Despite many advances, there are important unknowns. How can we detect fatigue clinically in the respiratory muscles? When the respiratory muscles are under stress, as in lung diseases such as COPD, would it be better to train the muscles to

206 BR. J. DIS. CHEST: VOL. 81 NO. 2

increase their strength and endurance, or to rest them? Perhaps these opposite strategies should be employed alternately! What are the clinical features and importance of moderate muscle weakness? Are there drugs which importantly improve the strength and endurance of the muscles? The methylxanthines have been advocated as effective by the Montreal and Paris groups, summarized here by Aubier, but other groups, including our own, have failed to find impressive therapeutic effects. The answers to these and many other practical problems are being actively pursued, and these volumes will provide an important base of knowledge for future studies.

This work will rapidly become a standard bible for those of us interested in the respira- tory muscles, and will need to be on the desk of any research fellow in this field. However, the problem with a tome of this type, with 1500 pages, is that it is difficult for the non-devotee

to see the wood for the trees. Whilst detail about almost every aspect of the muscles and chest wall can be found via the excellent indices, and the individual chapters are well summarized, it is hard to achieve a general overview. The average chest physician is likely to find it hard going, and only useful as perhaps an occasional reference. In any case he is unlikely to contemplate purchase, since the price, as usual with this series, is enormous at $250 (for the two volumes). Although the book is well produced and published, with no detec- table misprints, and well reproduced black and white figures, this price seems hard to justify, particularly since the authors are essentially unpaid. Neverthless I would recommend this book strongly for the libraries of any institution with a respiratory interest, and for all labora- tories and individuals with any research inter- est in the field, for whom it is required reading.

Malcolm Green

BOOKS RECEIVED

Brief details of newly published books

Critical reviews of these books may be published in later issues of the British Journal of Diseases of the Chest

Cardiopulmonary Exercise Testing Karl T. Weber & Joseph S. Janicki. Philadelphia: W. B. Saunders Co. (available from Holt- Saunders Ltd, Eastbourne, East Sussex). 1986. 1st edition. Pp. 378. Price f37.50.

Clinics in Oncology, Vol. 4, Small Cell Lung Cancer edited by Stephen G. Spiro. Eastbourne: Holt-Saunders Ltd. 1985. 1st edi- tion. Pp. 193. Price f15.00.

In Vitro Effects of Mineral Dusts Third Interna- tional Workshop NATO AS1 Series; Series G (Ecological Sciences); No. 3 edited by Ernst G. Beck & Jean Bignon. Berlin: Springer-Verlag. 1985. 1st edition. Pp. 548. Price DM 240.

Recent Advances in Arterial Diseases: Atherosclerosis, Hypertension and Vasospasm (Progess in Clinical and Biological Research,

Vol. 219) edited by Thomas N. Tulenko & Robert H. Cox. New York: Alan R. Liss. 1986. 1st edition. Pp. 390. Price f50.00.

Recent Advances in Respiratory Medicine Number 4 edited by David C. Flenley & Thomas C. Petty. Edinburgh: Churchill Livingstone. 1986. 1st edition. Pp. 285. Price f37.50.

The Respiratory Therapist as Manager James B. Fink & Arthur K. Fink. Chicago: Year Book Medical (distributed by Wolfe Medical Publications, London). 1986. 1st edition. Pp. 542. Price 534.00.

Surgery of Coronary Artery Disease D. J. Wheatley. London: Chapman & Hall. 1986. 1st edition. Pp. 676. Price f47.50.