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Charcot Constructing neurology By Christopher G. Goetz Michel Bonduelle and Toby Geljand New York Oxford University Press 1995 392 pp illustrated $55

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Movement Disorders 1 and 2
Edited by C. D. Marsden and S. Fahn
Buttenuorth-Heinemann, 1995
847 pp, $135.00
These two volumes, originally published in 1982 and 1987
as part of the Butterworth International Medical review series, are combined and reissued in one volume as part of
the successor series, The Blue Books of Practical Neurology.
According to the preface to this reissued volume, the publishers are responding to demand from the readers of the most
recent review of this discipline, Movement Disorders 3. Why
the demand for out-of-print books in a rapidly advancing
field with a recent update in 1995? Because each volume is
a gem in its own right; each succeeding volume is complementary to the other and not simply a duplicative update.
To be sure, they chronicle the important advances; but the
vast majority of the chapters in each volume covers a different aspect and can stand alone as the definitive discussion
of that topic.
There are many virtues to reissuing these outstanding volumes. One of the most obvious is the skillful editing and
organization. Each volume is divided into two major sections, one on parkinsonism and the second on the various
dyskinesias. Each section has a valuable introduction by the
editors with their own personal view of the problems in need
of attention and provides the framework for the chapters to
follow. The editors also fill in some critical gaps (eg, when to
start treatment for Parkinson’s disease and with what drug).
Additional critical commentaries on some of the chapters
(eg, the editors’ afterword on surgical treatments and the late
Anita Harding’s “Olivopontocerebellar atrophy is not a useful concept”) provide needed balance. The editors also encouraged the authors to present their personal viewpoint,
which makes most of the chapters lively and compelling
reading. In an extensive preface to the reissue the editors
comment on the significance of the contributions in the reissued volumes and put them in the context of volume 3 and
the changes that have occurred since their publication, including a table of the most recent classification of dopamine
receptors. In itself, this preface is a worthy and cogent summary of the current field of movement disorders and puts
in perspective the breadth and depth of the material covered
in this reissue.
Because of the rapid advances in the laboratory, some of
the chapters based on scientific issues could be considered
of historical interest only. The coverage of pathology and
neurochemistry, for example, are the only areas that are revisited in each volume in order to update the new knowledge
gained in the interim. Though dated, these chapters still provide a wealth of information necessary for our current understanding. Many of the chapters on clinical issues are timeless
and remain the most complete and authoritative account
found anywhere (in particular, the chapters on fluctuations
of disability in Parkinson’s disease, the nosology and pathophysiology of myoclonus in volume I , and PSP and the two
chapters on dystonia in volume 2).
In other words this reissue is not just for history buffs.
Rereading these volumes was a joy for the clarity of the writing and the wealth of insights that are just as true today as
when they were written. The clinical chapters in particular
are must reading for their up-to-date practical value in the
diagnosis and care of these patients. In combination with
Movement Disorders 3, these complementary volumes contain
a much more complete and readable coverage in this area
than any textbook could or other monograph has. The clever
editing and organization make it easy to use as a practical
guide for the trainee and practicing clinician as well as serving as a reference for the serious student of movement disorders. The publishers made a wise decision in reissuing Movement Disorders 1 and 2.
john P.Hammerstad, M D
Portland, OR
Charcot: Constructing Neurology
By Christopher G. Goetz, Michel Bonduelle, and Toby
New York, Oxford University Press, 1995
392 pp, illustrated, $55.00
This volume, the fruit of the collaboration between two neurologists and a medical historian, is more than a scholarly
biography of one of the founders of modern neurology. It
provides fresh insight into the character of one of the most
illustrious medical professors in nineteenth century Paris, the
professional and social milieu of the period, and the evolution of clinical concepts of neurological and psychiatric importance. Drawing on original sources in France and the
United States, the authors have produced a fascinating and
well-written account of the man who became a legend in his
own lifetime, a peddler of influence in the corridors of academic medicine, and a clinical scholar with a well-deserved
reputation as an academician (not least in his own eyes), but
who, in the opinion of some, squandered this reputation by
his controversial work and distasteful public exhibitions related to the subjects of hysteria and hypnotism.
Both the strengths and failings of this remarkable man,
and his contributions to the advance of neurology are appraised in their historical context. His contributions to other
aspects of clinical medicine, such as on gout, rheumatoid
arthritis, and geriatrics, are deliberately neglected or discussed
only in passing. Charcot’s achievements were many and important, and the anatomoclinical correlations that he emphasized continue to provide an ordered underpinning for clinical neurology. These contributions may seem to compensate
amply for his autocratic manner, majestic exercise of power,
and flagrant manipulation of others to serve his own ends
and further the careers of his disciples. Nevertheless, there
were negative aspects of his intolerance. For example, it will
never be known to what extent he delayed the development
of new concepts about the operation of the nervous system
in health and disease by his influence and prejudice against
experimental studies in animals.
This absorbing new biography makes use of previously
neglected archival material to provide a thoughtful and revealing analysis of Charcot and his contributions to neurol-
Copyright 0 1996 by the American Neurological Association
ogy. The text is generously complemented by numerous illustrations and drawings, some by Charcor himself, many of
which have not been published previously and are an added
delight. Detailed source notes and an extensive bibliography
provide a valuable resource for those anxious to pursue individual topics. This book can be strongly recommended to
medical and social historians and to clinical neurologists interested in the origin and evolution of the specialty. 1 enjoyed
it enormously.
Michael J. Amino8 MD, FRCP
University of Caltfornia, San Francisco, CA
The Babinski Sign: A Centenary
B y 1 van Gqn
Utvecht, Universiteit Utrecht, I996
176 pp, illustrated
The name of Joseph Babinski is known to all physicians as
a result of his description of the extensor plantar response
and its clinical significance in a series of papers commencing
in 1896. It may seem curious that neurologists and others
concerned with the function of the brain spend so much
time in peering at the toes of their luckless patients while
scratching the soles of their feet. Nevertheless, it is difficult
to overemphasize the importance of the sign that now bears
his name, and ironic that the austere Babinski, born in
France of Polish parents, never obtained a senior academic
appointment in Paris despite his scholarly contributions to
the field. Fortunately, he was eventually appointed chief of
the neurology service at the famous La Piti6 Hospital, where
he devoted himself to clinical work, teaching, and nurturing
the development of French neurosurgery. His scholarly contributions involved, but were not limited to, the description
of several signs to distinguish between organic hemiparesis
and nonorganic weakness, and it was in this context that
he described the sign that has come to symbolize clinical
In this charming little book, which consists of 139 pages
of text plus an extensive bibliography, D r van Gijn first provides a brief biographical sketch of this remote and proud
man whose name is so familiar but whose life and achievements are known to only a few, accompanied by a selection
of photographs that will delight medical historians. The remainder of the book provides a multifaceted analysis from
a historical perspective of the Babinski sign. l h i s includes a
discussion of the criteria for the sign, as not all upward
movements of the great toe during plantar stimulation relate
to reflex activity. Consideration is given to the clinical significance of the response, and the acrimonious exchange is
recalled between Nathan and Smith, neuroanatoniists who
dared challenge its association with the integrity of the pyramidal tract, and Sir Francis Walshe, the intellectual clinician who bitingly championed the traditional concept by emphasizing that dysfunction rather than structural disruption
of the pyramidal system governs the appearance of an extensor plantar response. A variety of different stimuli or sites of
stimulation have been used to elicit an extensor plantar response, and this has resulted in a profusion of eponymous
signs that serve only to confuse the neurological novice.
132 Annals of Neurology Vol 40
No 1 July 1996
Fourteen such maneuvers are described in this book, as also
are five different methods of eliciting stretch reflexes of the
toe muscles that were initially advances as a substitute for
the Babinski sign. The physiological underpinning of the
Babinski sign is also discussed and clarified.
This book also provides information of immediate relevance to all clinicians. For example, the heterogeneity of the
motor deficit occurring in the legs after cerebral or spinal
lesions, that is, the occurrence of some but not other pyramidal signs, is discussed. An important chapter deals with certain practical aspects, such as the optimal method of stimulating the plantar reflex and problems in interpreting the
response, and provides guidelines to facilitate interpretation.
The teaching that I received as a resident, that the best stimulus is provided by the key to a three-liter Bentley, is recalled
as folklore and probably originated with Henry Miller. In
the current health-care climate a wooden Q-tip will certainly
suffice and indeed is the preferred instrument of borh Dr
van Gijn and this reviewer. The patient should be relaxed
and supine, and an upward movement of the great toe considered pathological only if reproducible and caused by contraction of the extensor hallucis longus muscle, and then only
if there is synchronous visible or palpable contraction of
other flexor muscles (such as the tensor fascia lata and the
hamstrings in the lower extremity).
Among the challenges that academic neurologists have occasionally to face is that of the clinical demonstration, at
which they are required to exhibit the neurologic findings
in a complex case to an audience of eager medical or postgraduate students, and that of the ward round as “visiting
professor,” during which they are expected to come up with
some original observations or comment concerning the impossible cases that are generally reserved for such occasions.
In these contexts, it must be admitted that there are inany
advantages in being able to obtain the plantar response of
one’s choice. This reviewer was taught the art of ensuring the
desired response by a charismatic British neurologist whose
examination of patients was noted for its supreme clinical
elegance. Those requiring such insider information will find
it among the pages of this book.
In sum, this little gem of a book, published on the centenary of Babinski’s first description of his famous sign, is
enjoyable, informative, and contains material of immediate
practical and clinical relevance. It will appeal to clinical neurologists and medical historians, to whom it is warmly recommended.
Michael 1.Amino8 MD, FRCP
University of Caltfornia, San Francisco, CA.
Neurology in Clinical Practice, Vols I and 11, ed 2
Edited by Walter G. Bradley, Robert B. Day08
Gerald M. Fenichel, and C. David Marsden
Boston, Butterworth-Heinemann, I996
2128 pp, illustrated, $325.00
The first edition (1991) of this multiauthored text was rapidly recognized as a valuable reference work by reviewers and
neurological clinicians. Soon thereafter, the editors undertook an extensive critical assessment of the work in prepara-
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bonduelle, geljand, illustrated, neurology, university, charcot, 392, michel, new, goetz, 1995, york, christopher, construction, toby, pres, oxford
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