Morton F. Arnsdorf

A Mathematician Reads the Newspaper by John Allen Paulos (review)

learn from polio: Difficult people may be right, orthodoxy may be wrong, and great names may be wrong. Although it is used in only a few countries, SaIk lived to see his vaccine available in a purified form which eliminated the danger that some virions might have escaped inactivation. Sabin knew that the Americas were certified free of paralysis caused by wild poliovirus. Both SaIk and Sabin were intensely interested in the campaigns to eradicate polio in the Indian subcontinent and in Africa. This is an arresting story well told, and the stories of individual polio sufferers show other sides of pain, despair, and triumph. Science, medicine, and humanity are combined to form an integrated whole. I enjoyed this book very much, and I think that FDR, Sister Kenny, SaIk, and Sabin would have enjoyed it too.

Note from the Book Review Editor

John Kastor’s book, Governance of Teaching Hospitals:Turmoil at Penn and Hopkins, concerns the trials and tribulations of two of the nation’s leading academic medical centers during the 1990s. Dr. Kastor at that time was the Chairman of Medicine at the University of Maryland, so he perhaps had greater access to the many players at these and other institutions than most academic writers. Methodologically, Dr. Kastor created his book from interviews with over 260 individuals at the University of Pennsylvania and at Johns Hopkins. Perceptions differed widely, depending on the individuals and their positions in the several academic, clinical, teaching, and administrative hierarchies. One potential danger of such an approach is central to John Godfrey Saxe’s famous fable, “The Blind Men and the Elephant,” in which six blind men of Indostan unsuccessfully attempt to describe the elephant to each other’s satisfaction. Another is that the selection of what should be emphasized reflects another perception, that of Dr. Kastor. But such are the problems of the historian’s craft. We thought it would be interesting to have this book reviewed from two different perspectives. Stanford J. Goldblatt, a partner at the Chicago law firm Winston and Strawn, is a member of the Board of Trustees of both the University of Chicago and of the University of Chicago Hospitals and Health Systems. Michael C. Riordan is the President and Chief Executive Officer of the University of Chicago Hospitals and Health System. We would welcome e-mails or letters to the editor about this topic.We hope that you will join in this critical discussion.

Professor Hein J.J. Wellens: 33 Years of Cardiology and Arrhythmology (review)

Perspectives in Biology and Medicine If a patient is unable to breath adequately, the arterial blood oxygen saturation will fall, and at a certain level cardiac arrest occurs.There is then an interval of approximately four minutes before brain death is inevitable. Gawanda’s account of the treatment of a difficult, comatose auto-accident victim is complete and candid, recalling all of his uncertainties and difficulties. The attempted endotracheal intubation failed, and Gawanda attempted a tracheostomy. He failed again. Fortunately, a senior “seen-it-all” anesthesiologist was able to slip a pediatrics-sized tube through the vocal cords, thus saving the patient’s life. Gawanda addresses the banality of error, but points out that all doctors make mistakes, even the most respected. A feature of every major teaching hospital is the regular morbidity and mortality conference, a discussion of cases in which unexpected or unforeseen complications have occurred. In the Gawanda case, his own errors were identified: first, his failure to call for assistance when the complexity of the problem was recognized, and second, technical errors consequent on his own lack of practical experience in the performance of a tracheostomy. Medical practice teems with examples of errors waiting to happen and the statistical probability of something going wrong is very real. Factors other than the individual skills, experience, and judgment of physicians play an important role: for example, devices used for a specific purpose may vary between manufacturers. This excellent book contains something for everyone involved or interested in progress in the sciences. It is highly recommended.

The Dying President: Franklin D. Roosevelt, 1944-1945 (review)

Dr. Howard G. Bruenn, a rather heroic figure in this book, was an attending physician of mine at Columbia-Presbyterian Medical Center when I was a medical student in the early to mid-1960s. I therefore was very much interested in the publication of Robert H. Ferrell’s book, in which Dr. Bruenn figures so prominently. Robert H. Ferrell is a Distinguished Professor of History Emeritus at Indiana University. Ferrell’s thesis is that FDR orchestrated medical cover-ups to allow his reelection in 1944, and these cover-ups ultimately had an extremely negative impact on his political performance. The book begins with the statement that FDR “knew he was suffering from cardiovascular disease, knew he was seriously ill, and chose to keep that fact a secret.” Mysterious things seem to happen to the medical records of presidents, and FDR’s medical record has disappeared. This book is based on the diary of Margaret Suckley, a cousin of the President, on notes kept by Dr. Bruenn, and on interviews with Dr. Bruenn and others who were involved in the care of FDR. Cardiology was a relatively new field in the 1930s and 1940s. James B. Herrick first diagnosed a myocardial infarction due to occlusion of a coronary artery in 1910, and he was not believed by most of the medical community. The electrocardiograph was being developed at about the same time. The field itself was created by Dr. Paul Dudley White in the 1920s, but there was little expertise in cardiology in the 1920s and 1930s. Both diagnosis and therapy were primitive. Dr. Bruenn represented the new generation of well-trained specialists. He had received his M.D. from Johns Hopkins in 1929, and both his house-staff and cardiologic training at the Columbia-Presbyterian Medical Center in New York. He received his military commission on 29 October 1942, and was assigned to the Bethesda Naval Hospital, where he became head of the Electrocardiograph Department. The President’s primary physician was Vice Admiral Ross McIntire, Surgeon General of the U.S. Navy. Dr. McIntire was the protégé of Rear Admiral Cary Grayson, the personal physician of President Woodrow Wilson who was directly involved in keeping the knowledge of Wilson’s stroke from the American public. Grayson, referring to FDR, said to McIntire, “The President is as strong as a horse with the exception of a chronic sinus condition that makes him susceptible to colds. That is where you come in.” McIntyre, after all, was an otolaryngologist.

A History of Electrocardiography By George E. Burch and Nicholas P. DePasquale (review)

On occasion, an event transports one back to a different time and a different place. This may be a photograph, a whiff of perfume, a movie, a piece of music or, as in this case, rediscovering a book. A History of Electrocardiography was written by Drs. George Burch and Nicholas DePasquale and was first published, in a limited quantity, in 1964. I first became familiar with it a few years later, as I developed an interest in electrocardiography and cellular and basic electrophysiology. The original book had been unavailable for years, jealously guarded by those who had a copy and coveted by those who did not. To my delight, Norman Publishing reissued the book with an introduction by Dr. Joel Howell, a distinguished historian of science at the University of Michigan. As I was late in reading the original version, I was late in becoming aware of the reissue of this gem. So somewhat belatedly, I would like to bring to the attention of many of you that this book is once again available. On opening the book, I was carried back to my training in the 1960s. To me, there was and remains something mystical and mysterious about interpreting the squiggles on the electrocardiogram and relating them to pathophysiology and to disease. I held in awe many of my teachers who unlocked these mysteries with such seeming ease, and I wanted quite desperately to be admitted to this fellowship. The 1960s was an exciting time for those of us interested in the electricity of the heart. We witnessed an explosive growth in our knowledge of cellular electrophysiology; in the use of DC electroversion, electrophysiologic provocative stimulation, and intracardiac electrocardiography; and in the application of computers to the interpretation of electrocardiograms, to signal processing, and to electrocardiographic research. Any right-thinking cardiologist knew (and, interventional cardiology notwithstanding, perhaps still does know) that the heart was an electrical organ. Drs. Burch and DePasquale did us a great service in humanizing the basis of our electrophysiologic and electrocardiographic science and, in turn, reminding us of the continuity of our science. We receive enlightenment from our teachers, work for a time on problems and make our contributions, and pass on what we know to the next generation. I remember fondly Dr. Burchs discussion of the early history of electrocardiography shortly before his death at a meeting of the Association of University Cardiologists, an organization he was instrumental in