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Adams and Victor’s manual of neurology, 7th edn
  1. Michael Donaghy

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    By M Victor and A H Ropper (Pp 547, US$39.95). Published by McGraw-Hill Companies, New York, 2002. ISBN 0-07-137351-9

    Nearly 20 years ago I used books to learn my neurology in three stages. First was an introductory reading of the late Bryan Matthews’ Practical neurology, then a couple of years’ strap-hanging on the tube to learn the facts by reading the second edition of Adams and Victor’s large Principles of neurology, then back to Matthews for a dose of intuition. When I picked up this little manual of neurology nearly two decades later, I immediately recognised the distinctive descendant of my Principles of neurology. The chapter organisation, diagrams, and writing style have changed little over these years.

    Principles of neurology was a wonderful book. So is the manual merely a pruned facsimile? It is based on the same two major parts. The first chapters on cardinal manifestations of disease are good and clinically insightful. But perhaps in this era they should start with the symptoms rather than with a long diatribe on the anatomy and physiology. The headache chapter contains clear accounts of tension headache and migraine, but there is no introduction about how to tell the two apart and how to differentiate them from more sinister headaches. The major pathological categories of neurological disease are organised predictably and reliably, as one expects from such authoritative authors; Raymond Adams has stepped down for this, the seventh edition. Some of the chapters are let down by old and gauntly reproduced computed tomograms. Why is it that publishers seem to find it difficult to reproduce brain imaging well? Alan Ropper’s touch as an expert neuromuscular physician shows through strongly in the chapters on nerve and muscle disease. The summary chapters on psychiatric disorders will be reassuringly understandable to neurologists but may lack sufficient discussion to court psychiatrists.

    Should small textbooks have a different philosophy from large ones? This is a condensed version of a large textbook and reproduces the same approach. In reality, despite being pocket sized, it is quite long at nearly 550 pages. It is for the junior trainee in neurology who is learning to trade in facts and who will be reassured by its presence in pocket or briefcase. “Last minuters” may use it for their Board exams. But I wouldn’t recommend it for medical students because it is not the starting point from which to gain the intuition or perspective about those few neurological problems that constitute the majority of neurology.

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