The major treatise of the specialty is now reinforced with an increased emphasis on infectious disease, extensively updated pathology and the latest in molecules biology as it affects diagnosis and management of pulmonary disease. Leaders in the field combine their expertise in the review of AIDS, gene therapy, ARDS, management of cystic fibrosis, opportunistic tuberculosis, occupational lung disorders and more. The necessary biological substrate of lung anatomy and physiology serves as a prelude to exhaustive coverage of etiology, pathophysiology, diagnosis and treatment of all disorders.
The end of the 20th century marks a pivotal point in the development of respiratory medicine. There has been an explosive growth in knowledge relevant to the field and the application of bioengineering, molecular biology, and microbiology to improve the treatment of acute and chronic disorders of the respiratory system. Some innovations, such as the discovery of the cystic fibrosis gene and progress in the field of adult respiratory distress syndrome, were so important that Fishman's Pulmonary Diseases and Disorders had to be updated between editions. This information is incorporated in the third edition, which was edited by an editorial board as a way of acknowledging the diversity of pulmonary medicine.
This edition of Fishman's is well illustrated with high-quality color reproductions and radiographs. The 2777-page, two-volume textbook offers contributions from almost 250 authors. The arrangement of the contents differs from that of the second edition and now consists of 182 chapters, which are organized into 24 sections and 17 parts. A review of the history of respiratory medicine, lung architecture, and pulmonary physiology during various states such as exercise and pregnancy serves as a prelude to the general description of lung immunology, injury, and repair. The coverage of lung diseases and disorders includes chronic obstructive pulmonary disease, interstitial and inflammatory diseases, and neoplasms and infections.
We tried to reach a balanced judgment of this book by reviewing topics we felt quite comfortable with as well as some fields far from our areas of expertise. There is a high risk that depth and detail will suffer if a single book attempts to cover the entire field of respiratory medicine. However, in this case we think that the authors and editors have found a good balance. Among the more than 600 pages dedicated to infectious diseases of the lung, we found many refreshingly new chapters, such as the one on bacterial colonization, which contains most of the important information on this subject. Concepts about the causes of pneumonia are now presented in a single chapter, which makes the subject apparent to physicians who are not routinely involved with this disease. A stronger commitment to the use of one of the methods of diagnosing pneumonia would have been desirable, but we understand that issues currently under debate should not be discussed to a great extent in a textbook.
Sleep and sleep disorders are now presented in a focused, comprehensive, and interesting way. The discussion of sleep physiology and practical aspects, such as the differential diagnosis and the overall evaluation of sleepiness, makes this part valuable for general practitioners and trainees in pulmonary medicine. We found the part on occupational disorders especially valuable because it summarizes the most important occupational and environmental disorders and provides information not only on the pulmonary aspects of the disease but also on the environmental aspects. The chapters on intensive care and therapeutic interventions have been strengthened. This section provides concise information on mechanical ventilation, including new ventilatory strategies, and more general issues concerning intensive care, such as ethical considerations.
The somewhat difficult topic of neoplasms of the lung was presented in a way that challenged our attention but did not overwhelm us with too many details. It may not be suitable for medical students or specialists other than pulmonologists, but it may be valuable for oncologists who are not involved in the day-to-day aspects of lung cancer.
Overall, the new edition stands up well in comparison with other leading textbooks. The chief strength of Fishman's is its emphasis on medical concepts rather than the latest trends in diagnosis or treatment. This approach ensures that the information presented will be up to date for quite a while. This is an important consideration, since this two-volume work is expensive. We highly recommend this book to any practitioner who wants a durable reference on respiratory medicine, to trainees in pulmonary medicine, and most of all, to any respiratory-medicine specialist who wants to challenge his or her knowledge.
Reviewed by Antoni Torres, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
