Diseases of the Nervous System

Ninth Edition. (Pp. 390; figs. 89. 30s.) Edinburgh and London: E. & S. Livingstone, 1958. Tiis moniograph has now attained its ninth edition in the space of eighteen years, a fact whiclh leaves one in no doubt of its popularity. As in previous editions, the book is divided into two parts. 'rle first is an admirably brief and lucid account of the principles of neurological diagnosis, and the second describes the morc common diseases of the nervous system. The arrangement of chapters in this second part follow s the traditionally descriptive patterni of diease which served ncurology so well at the beginning of the cenitury but whiclh, in the light of recenit knowledge, might well be mlodified to take greater account of the localization of lesions in the nervous system and the causationi of disease. For example, the chapter entitled "Muscular Atrophies" includes several diverse conditionis suclh as muscular dystrophy, motor nieurone disease and acroparasthesial, wvhile polion-euritis and poliomyelitis are describedI elsewhere. However, the author's awareniess of the need of some change is shown by the recasting of the chapter enititled in previous editions "Subacute Combined Degeneration of the Cord" unider the hcading of "Manifestations of Vitanmin B12 Deficiency," but it is odd that the manifestation of vitamin Bi deficicncy have inot been gathered together in the same way; Wernicke's encephalopathy is barely mentioned, and in the account of alcoholic neuritis no reference is made to thiamin. The borderland between general medicine and neurology receives more attention than in previous editions. There is a new chapter on the neurological complications of liver disease, but more space might have been devoted to other metabolic diseases, such as diabetes, which present with neurological symptoms. The management of the comatose patient is a common therapeutic problem, but advice on this point is hard to find, for it is scattered throughout the book, and at times archaic (camphor is the sole recommendation for a suitable stimulant, and no mention is made of the lateral decubitus position). The dangers of neostigmin overdose in the treatment of nmyasthenia gravis are ignored. The value of positive pressure respiration in respiratory failure receives nio attenition; admittedly in a book intended for practitioniers anid students claborate (ictails arc not required, but some mention of them is essential to maintain the balance. Despite these criticisms, the reviewer is convinced that this book still remains the best of its kind and that it has many virtues to comnmend it to the non-specialized reader, in particular the thoughtful style, the clarity of description, and the advice on the management of disabled persons, so representative as they are of the author. WVe are glad to see too that this edition, unlike the earlier editioIns, contains a sectioIn of psychologically determined illnesses, such as anxiety neurosis, hysteria, and the "traumlatic" neurosis. J. I. E.