Principles of Internal Medicine

A review of such a text as this, which contains 311 major headings encompassing over 1,700 printed pages and contributions by 85 authors, is a major chore and this reader has assumed that his mission was obviously not to read all of it in detail. This review is based on an approach from two orientations-the reviewer has read carefully those sections with whose content he is reasonably well informed, and, in contrast, has read some of the sections dealing with material about which he has little or no information. In this way a sample of the total text has been considered from the standpoint of a peer and a student. The general format of the book represents an approach to the study of medicine which implies certain very definite principles of education with which this reviewer is in total agreement. These principles include an understanding of the normal and pathological physiology of disease states, and an approach to specific diseases through the medium of general discussions of disorders and the gradual development of a variety of theses to a final exposition of specific disease entities. In this manner the minutiae are properly relegated to a position of lesser prominence and the student is encouraged to consider and understand general principles. The sections on the posterior pituitary gland and on fluid and electrolyte therapy, as well as the section on the kidneys, are all excellent. The discussion of disordered renal function approaches renal physiology in a less meticulous fashion than might be desired. The concepts of "threshold" and "'non-threshold" substances seem to linger; the terms "acids" and "bases" are used in an historically older context and the more appropriate semantic representations of acids and bases are not included. This is true in the section on fluid and electrolyte balance, and in the section dealing with changes in electrolyte composition as well. In the section on disordered renal function the reabsorption of solutes and water is described as a back-diffusion process encouraged by the diminished hydrostatic pressure within the venous system of the peritubular blood vessels and the increased colloid osmotic pressure of the blood traversing these vessels. This implies that the fluid in the tubular lumen and the blood stream are in a direct dynamic equilibrium relationship and implies that the tubular epithelium is playing a rather mendi-cant role as an inert and "dead" membrane. The evidence suggests certainly that this …