PULMONARY CHANGES IN COLLAGEN DISEASES 457

a h i s to ry o f a l lergy a n d s o m e h a v e had r h e u m a t o i d s y m p t o m s . I t is difficult to k n o w at this s tage whe ther the H a m m a n - R i c h S y n d r o m e is in fact the n a r r o w l y def ined ent i ty wh ich these au tho r s descr ibed o r whe the r it f o r m s par t o f a la rger g roup o f f ibro t ic les ions w h i c h m e r g e in to the co l l agen diseases.

Acknowledgements.--I would like to thank Dr J. J. R. Duthie of the Rheumatic Diseases Unit, Northern General Hospital, for the willing help which he has given me. I am also grateful to Dr I. W. B. Grant, Dr N. W. Home and Dr J. K. Sclater who have allowed me to use films of patients under their care to illustrate this review and I am particularly grateful to Dr J. MacNamara for reading the proofs and for offering much helpful criticism.

S U M M A R Y

The c o m m o n lung les ion in the co l l agen diseases is p u l m o n a r y fibrosis. I t is f o u n d m o s t f r equen t ly and is grea tes t in degree in the s lowly p rogress ive fo rms o f this disease pa r t i cu l a r ly sc l e rode rma , d e r m a t o m y o s i t i s and r h e u m a t o i d ar thr i t is . The m o r e acute diseases o f this g roup s h o w l u n g changes wh ich are n o t specific. P leu ra l a n d pe r i ca rd ia l effusions are c o m m o n in D . L . E . and eos inoph i l i c les ions occu r in per ia r te r i t i s nodosa . I n b o t h o f these dense infarc t - l ike opac i t i es m a y be f o u n d and these m a y cavi ta te . T h e only specific les ion is the r h e u m a t i c n o d u l e wh ich can o c c u r in the absence o f p n e u m o c o n i o s i s a n d is t h e n difficult to dis- t inguish f r o m seconda ry deposi ts .

REFERENCES

CAPLAN, A. (1953). Thorax, 8, 29. CRUICKSHANK, B. (1954). Ann. rheum. Dis. 13, 136. ELLMAN, P. & CUDKOWlCZ, L. (1954). Thorax, 9, 46. HA~MAN, A. L. & RIc*q, A. R. (1944). Bull. Johns Hopk.

Hosp. 74, 177. KLEMPERER, P., POLLOCK, A. D. & BAEHR, G. (1942).

J. Amer. reed. Ass. 119, 331. MORROW, J. (3., SCHROEDER, H. R. & PERVEY, H. M. (1953).

Circulation, 8, 828. RosE, (3. A. & SPENCER, H. (1957). Quart. J. Med. 26, 43. RUBEN, E. H. & LunLrt~R, R. (1957). Medicine, 36, 397. SCAD~IN~, J. (3. (1958). Proc. R. Soc. Med. 51, 649. S~NCLAIR, R. J. (3. & CRUICKSHANK, B. (1956). Quart. J.

Med. 25, 313. Z~EK, P. M. (1953). New Engl. J. Med. 248, 764.

B O O K

Cardiac Arrest and Resuscitation. By B. B. MILSTEIN. Pp. 219, 37 illustrations. 1963. London: Lloyd Luke. Price, 35s.

As the title suggests this book deals solely with the aetiology, pathology, diagnosis and treatment of cardiac arrest. It was not designed to meet solely the needs of diagnostic radiolo- gists, and does not cover the wide variety of allergic reactions that arise from the use of contrast media. Cardiac arrest is an emergency with which any doctor may have to deal. However, in modern radiological practice it may be en- countered more frequently than in the past, owing to the great increase in the number of diagnostic techniques employing contrast media.

The first one hundred pages are devoted to the pathology, prevention and diagnosis of cardiac arrest. The author points out that there may be premonitory symptoms and signs, which if noted, may give an opportunity to prevent either cardiac asystole or ventricular fibrillation. Cardiac arrest in the radiodiagnostic department certainly occurs with greater frequency after the use of excessive doses of contrast material. The writer emphasises the large part played by anoxia in inducing arrest in a large number of c a s e s .

It is emphasised that the diagnosis of cardiac arrest should be made by noting the absence of pulsation in a large artery, e.g., the carotid or femoral--and not by listening to the chest with a stethoscope. However it is not pointed out that even in normal patients it may be at times difficult for the inexperienced to palpate carotid pulsation.

R E V I E W

It is stated that fatalities are usually due to delay in starting treatment--often as a result of multiple diagnostic tests being applied. It should be appreciated that the im- mediate objective is not to restart the heart, but to restore the supply of oxygenated blood to the brain. If this is not done within three minutes, serious cerebral damage or death is inevitable. External cardiac massage will supply an adequate artificial circulation. The method of applying this i s described and the need for maintaining adequate respiration at the same time is discussed. The indications for performing internal cardiac massage are considered and the present position regarding both internal and external defibrillators is stated. The value of the electrocardiogram is considered to differentiate asystole and ventricular fibrillation.

Attention is given to the various steps necessary to treat cardiac arrest as it occurs in different situations such as the theatre, the x-ray department, the consulting rooms and even in the home.

It is the duty of those doctors not already familiar with the present position regarding cardiac arrest, to read this book. At least some of the fear of encountering this emer- gency will disappear, and the case examples quoted will justify the adoption of a more optimistic outlook.

The need for some authoritative direction in this subject has been apparent for some time, and the author has admirably dealt with this need, in this excellent publication.

J. O. C.

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