Brain, Vol. 125, No. 10, 2370-2372,
October 2002
© 2002 Oxford University Press
Book Review |
BRAIN’S DISEASES OF THE NERVOUS SYSTEM, 11TH EDITION
Department of Neurology, University Medical Centre, Utrecht, The Netherlands
BRAIN’S DISEASES OF THE NERVOUS SYSTEM, 11TH EDITION
Edited by Michael Donaghy
2001. Oxford: Oxford University Press
Price £150. ISBN 0192626183.
The sixth edition of Brain’s Diseases of the Nervous System (1962) was the first and only textbook of neurology I ever used more or less regularly, between the decision to choose neurology as a speciality and the actual beginning of my training period. The senior neurologists I subsequently came across quickly introduced me to monographs on subdisciplines such as neuromuscular disease or neuro-ophthalmology, and to medical journals. Therefore the strategy my colleagues and I soon developed if faced with a difficult problem in patient care (research is another story), was to turn to one’s private collection of cherished and well-thumbed books, or sometimes to an appropriate review article. For reasons that I cannot recall I later nevertheless acquired John Walton’s ninth edition (1985), but it was only rarely consulted and with little success. Hence the pristine condition of that dark blue tome on top of my bookcase (it may well have been the first in the series that was too high to fit on an average shelf). This waning attachment to single-volume textbooks equally applied to the American counterparts into which I sometimes looked—the main problem was the obsolescence of the omniscient neurologist rather than the shortcomings of a particular author. The only textbooks I bought since then were old or very old. Personal compendia written by Pratensis, Boerhaave, Romberg, Dejerine, Gowers and others are perfectly suited to give historians of neurology an informal view of the state of neurology at a given time and place, without the hedging style that so often characterizes original publications.
The invitation to review Michael Donaghy’s eleventh edition was a welcome opportunity to renew my acquaintance with this emblem of British neurology. The main question I posed myself was whether in its current form it might perhaps serve budding neurologists, as a halfway house between the student textbook (which hardly existed in my time) and the little shelf with monographs collected during one’s training period. In principle it might, because in its current multi-author format the book is a collection of mini-monographs. In fact that is the only way in which any textbook can survive. Osler’s classic textbook of internal medicine, which first appeared in 1892, eclipsed after its fifteenth edition (1944), to be replaced by multi-author volumes in Great Britain as well as in the US. The dimensions of Donaghy’s ‘Brain’ (22.5 x 28 x 5 cm; my briefcase would not hold it) and weight (3 kg) are such that the book has very much to stay in one place, in the same way as a collection of monographs. The table of contents with its 14 contributors reads more or less like a ‘who’s who’ of neurology in the British Isles. Probably this is why a foreigner was assigned the task to review it. Nonetheless most authors are good friends, and I had to risk losing a few. My original intention was to read the book from cover to cover. This plan allowed me to enjoy the historical introduction, but then miserably failed. Life is too short, as Anthony Hopkins put it, but also I found myself exhausting my energy in splitting hairs over the paragraphs about the neurological examination before I had even arrived at the sections for which the book is mainly going to be used. I then changed to a different strategy, by looking up 100 random but rather difficult subjects, consecutively taken from our weekly case conferences (I copied Roger Gilliatt’s habit of recording names and diagnoses for posterity). This method turned out to have several advantages. First, it provided the opportunity to test the index (a subject to which I shall come back separately). Secondly, it produced percentages without effort—though the reader will be spared confidence intervals. Lastly, it protected me against the well-known temptation to concentrate on pet subjects (but while we are at it I might as well point out that in testing the plantar reflex the key question is not the technique of stimulation but that of inspection).
I assigned a score between 0 and 10 for the quality of the information given about each of the 100 subjects I looked up (not just disease conditions, but also treatments, complications or clinical features). The grand average of all these scores was 7.77, or, according to the grading system used in my grammar school period, 8 minus, in other words ‘almost good’, or practically halfway between ‘sufficient’ (6) and ‘excellent’ (10). Of the 100 subjects 38 were done so well that I assigned a rating of 9 or 10 (with an extra bonus for the entry on sexual arousal by safety pins). Forty-one were given a score of 6–8, and seven were below standard, at least in my opinion. The remaining 14 items I could not find at all, neither in the index nor in the appropriate sections of the book (but there is still a theoretical possibility that the information is somewhere lurking in the text). The 14% of entries I looked for in vain were: leakage of cerebrospinal fluid by trauma; acute hydrocephalus with isolated loss of pupillary reflexes; tethered cord syndrome; cauda equina syndrome in purulent meningitis; recurrent meningitis caused by HSV-2; rippling muscle disease; Brody’s disease (sarcoplasmatic reticulum calcium-ATPase deficiency); Hirayama’s disease (juvenile muscular atrophy of one arm); polyradiculoneuropathy by ethylene glycol poisoning; synaesthesia (for example, pain induced by visual stimuli); the question of whether triptans should be administered during a migraine aura or at the onset of headache; persistence of aphasia after a symptomatic seizure; psychogenic dystonia; and dementia syndrome caused by sodium valproate. Of the seven paragraphs that were distinctly weak, three were in the chapter on diseases of the spinal cord: epidural haematoma, spinal dural arteriovenous fistula (tragically confused with arteriovenous malformations) and syringomyelia. The proportion of entries with useful references in the text was satisfactory (61 of the 100 subjects, or 71% of the 86 positive hits). Once I found that a promised reference was not listed in the bibliography (Auer-Grumbach et al., p. 451), but I did not check this in a systematic fashion.
Well then, the index. Despite its length of 46 pages this section is the weakest point of the book—a defect that seriously affects its usefulness. Grave or at least irritating problems, i.e. the need to look three or more times before the right section was found, occurred in 28 of the 86 subjects that were eventually found. Less than half of the remaining entries were found at the first attempt. Unfortunately there was no method in this madness—the defects were diverse in nature. To begin with, most indexes stick to nouns as a first sorting principle, although of course one has to make exceptions for fixed expressions. Therefore it is not illogical if one has to look for multiple sclerosis under the ‘m’ and not under the ‘s’. But it is definitely illogical to put carotid artery dissection as well as central pontine myelinolysis under the ‘c’, or to choose the ‘e’ for limbic encephalitis but the ‘l’ for limbic leucotomy. Not infrequently keywords are completely missing: for intracranial hypotension or hypoglossal nerve one has to look under the ‘c’ of cerebrospinal fluid and cranial nerves, respectively, for Leber’s disease under the ‘o’ of optic neuropathy, and for venous angioma under the ‘a’ of arteriovenous malformation. Some index terms only guide the reader to the wrong section: ‘head injury, blunt’ refers to a paragraph on epilepsy, and ‘frontal lobe seizures’ to the intricacies of the EEG. Other terms are completely missing from the list, despite corresponding paragraphs in the text (oligodendroglioma, management of motor neurone disease). A less important point of criticism is the listing of eponyms. It is perhaps forgivable that English names in the index (127) far outnumber those of German origin (83) or French eponyms (a piffling 49), but to attribute aneurysms to a person named Berry is taking it too far. And why is Miller-Fisher syndrome indexed under the ‘M’ of his Christian name? A small source of consolation in the index is a list of 10 interleukins, faithfully enumerated. Indexes of printed books are not by definition inferior to those of computerized databases such as the American CD Neuro-base (updated quarterly). A computer search with single search terms is very sensitive but also very non-specific, whereas a printed index can provide logic and hierarchy—but that requires special efforts.
In summary, the main text of the book on the whole admirably fulfils its purpose of guiding the neurologist in training to a variety of clinical features, disease conditions and therapeutic principles, usual and unusual. The new ‘Brain’ is still a monument—a fortress—of British neurology, beautifully restored. The occasional room needs rebuilding, but the main trouble is getting in.
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