Book Reviews

AR,TERIAL HYPERTENSION. By Edward J. Stieglitz, KS., M.D., Assist- ant Clinical Professor of Medicine, Rush Nedical College, University of Chicago. New York, 1930, 180 pages, with illustrations, Paul B.

Hoeber, Inc.

The purpose of Stieglitz’ book is to give us “the logic of phys’io- logic mechanism” of arterial hypertension so that it may be used at the bedside. He has boldly outlined a theory of the mode of pro- duction and maintenance of elevated blood pressures that has the ad- vantage of the simplicity inherent in all Unitarian doctrines. Two para- graphs quoted from pages 41 and 44 may possibly give the drift of his argument :

“A fundamental conception to be kept in mind, therefore, is that hypertension essentially results from vascular muscular hypertonia and that when the term ‘vascular disease with hypertension’ is used it signifies this hypertonia and its subsequent anatomic changes.”

“The continuous spasticity therefore leads first to hypertrophy, then to fatigue and finally to hyperirritability, and of course to a fur- ther increase in the arterial muscular spasticity. Thus a vicious circle is set in operation. The continuation of the cycle of spasticity, fatigue, hyperirritability, more spasticit,y, fatigue, etc., is the second of the fundamental etiologic or physiologic phenomena and can well be called ‘the perpetuating process of hypertension’ in contrast to the ‘initiating’ process already discussed.”

The subject has been presented with a great deal of enthusiasm and the book should appeal to a,11 the lovers of progressive medical thought. The main contentions are, of course, based largely on theory, and the original will have to be studied if it is desired to obtain the spirit of the presentation. Stieglitz stresses the good effects of bismuth sub- nitrate and of bromides in the treatment of hypertensive states; he is the originator of the idea that the slow liberation of nitrites from bis- muth subnitrate in the intestinal canal serves to keep the spastic arterioles in a relaxed statme. There are some rat,her radical statements such as the idea that iodide therapy in arterial disease is grossly il- logical and is actually contraindicated because the effect of iodine is one of destruction and weakening of the supporting scaffolding which is being placed about the totterin g vascular walls; that the urinary specific gravity with renal decompcnsation is from 1.002 to 1.006; that

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the renal tubules do not reabsorb sugar from glomernlar urine brat cause it to disappear by utilizing it and many others. Such ideas are teeming with interest, and they should form starting points for new ways of thinking that may break the trail for advance in clinical medicine.

H. 0. l&l.