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Brown-séquard: A visionary of science
352
Surg Neurol 1993;40:351-3
The approach adopted by the editors is also useful in that some chapters are generalizations about surgery and complications, whereas others--i.e., that by Kobayashi and Tanaka-present their message by a series of informative cases. Incorporation of illustrative case histories in some other sections would have been useful. In the chapter on orbital masses, a comprehensive explanation of the neuropathology of optic nerve sheath meninginoma is presented together with different surgical options that are applicable to the condition. Unfortunately, however, the results of these different surgical approaches, particularly with respect to visual preservation, are not mentioned. This text represents a milestone in modern surgical practice. The concept is novel and explored comprehensively. The book undoubtedly represents value for money. Although many neurosurgeons may quibble with certain aspects of various chapters, the benefit obtained by frequent reference to it will contribute to further improvements in neurosurgical standards. J. DOUGLAS MILI.ER, M.D., Ph.D. IAN WHITTLE Edinburgh, Scotland, U.K.
B r o w n - S 6 q u a r d : A V i s i o n a r y o f Science. By Michael J. Aminoff, M.D. 211 pages. $68.00. N e w York: Raven Press, 1993. I S B N 0-88167-956-9. This book is the culmination of Aminoffs long-standing interest in Charles-Edouard Brown-S6quard (1817-1894), and the first booklength biography of Brown-S6quard in almost 50 years. In general this biography is a thoughtful, well-written, and balanced synthesis of Brown-S6quard's restless but extremely productive academic career. Although some sections could have benefited from more detail and a more critical analysis, the book is a valuable contribution and deserves a wide readership, particularly among those with interests in the history of either neurophysiology, neurology, or endocrinology. The first section of the book comprises 99 pages and chronicles Brown-S6quard's complicated personal and professional life. For this section, particularly, Aminoff relied heavily on archival material from the Royal College of Physicians in London and the College de France in Paris. This section offers interesting insights into Brown-S~quard's relations with numerous scientific and political notables of the late nineteenth century: particularly well-detailed are his collegial but fiercely competitive relationship with French physiologist Claude Bernard and the friendship and support provided to him by several influential individuals, including British surgeon James Paget, French neurologist Pierre Paul Broca, and American naturalist Louis Agassiz. Although Hughlings Jackson, the preeminent British neurologist, was "deeply influenced" by BrownS6quard, their interesting relationship is unfortunately not well developed.
Book Reviews
Glimpses of Brown-S6quard's personal life are given in the book, in large part gleaned from correspondence in the archives of the Royal College of Physicians. Some of this material was discovered in the early 1960s at the home of BrownS6quard's grandson and latter acquired by the college. The discoverer was Aminoffs former mentor, British neurologist William Goody, whom Aminoff credits for stimulating his own interest in Brown-S6quard in 1966. The second section of the book on Brown-S6quard's "scientific legacy" comprises 74 pages. This section includes four short chapters: an overview summarizing his contributions as a physician and scientist, followed by individual discussions of his studies of the sensory pathways of the spinal cord, his other contributions to neurology, and his work on the endocrine system. Brown-S6quard is best remembered for his pioneering studies of the sensory pathways of the spinal cord. Neurologists and neurosurgeons are likely to be most interested in this portion of the book (chapter 6), and it is unfortunately here that they may be disappointed. The 20-page presentation is inconsistent and confusing. Two pages of general comments on the anatomy of the spinal cord are intended to make the rest of the presentation accessible to "nonmedical readers," but are unlikely to do so and are distracting. Galen is acknowledged to have begun the experimental study of spinal cord function in the second century A.D., but his experiments and observations are referred to only in passing: while Aminoff notes that Brown-S~quard repeated Galen's transection and hemisection experiments, the longitudinal section experiments performed by Brown-S6quard were also anticipated by Galen. In addition, while the earlier contributions of Whytt, Hall, Magendie, Bell, and van Deen are briefly presented as a background to Brown-S6quard's contributions, the relative timing and respective independent contributions of Brown-S6quard and his contemporary Moritz Schiff(1823-1896) are not made clear. More problematic is the discussion of Brown-S6quard's repudiation of his early work in this area--work that is still regarded as essentially correct. Brown-S6quard's recantation 2 years before his death was precipitated by a contradictory report in 1892 from a young British neurologist, Frederick Mott. Brown-S6quard came to doubt the decussation of sensory fibers in the cord: he ultimately attributed the experimentally induced anesthesia to a dynamic inhibitory effect, rather than to interruption of fixed sensory pathways. Aminoff seems to accept this uncritically: "[Brown-S6quard's 1894] paper represents also an extraordinary contribution, encapsulating a concept so profound that several generations of neurologists have neglected it, either out of ignorance or because its implications are so far-reaching." No critical modern analysis is offered to clarify the ambiguities and place the original (or later) work in proper perspective. Some lesion experiments in several monkeys by Denny-Brown (presented in a chapter in 1979) are summarized in support of Brown-S6quard's later views, but the issue is not discussed or interpreted critically in light of other clinical or experimental data: indeed, Aminoff implies that Denny-Brown's 1979 chapter is the only significant work
Book Reviews
on the subject since Brown-S~quard. Relevant observations from patients undergoing cordotomy, for example, are not even mentioned. At the end of the book, Aminoff includes 26 pages of appendices tabulating Brown-S~quard's various honors and credentials, as well as his more than 500 scientific publications. The 41 illustrations throughout the book are generally well
Surg Neurol 1993;40:351-3
353
chosen, although the reproductions of official documents, appointment letters, and award notifications are perhaps super~UOUS.
DOUGLAS J. LANSKA, M.D. Lexington, Kentucky
Surg Neurol 1993;40:351-3
The approach adopted by the editors is also useful in that some chapters are generalizations about surgery and complications, whereas others--i.e., that by Kobayashi and Tanaka-present their message by a series of informative cases. Incorporation of illustrative case histories in some other sections would have been useful. In the chapter on orbital masses, a comprehensive explanation of the neuropathology of optic nerve sheath meninginoma is presented together with different surgical options that are applicable to the condition. Unfortunately, however, the results of these different surgical approaches, particularly with respect to visual preservation, are not mentioned. This text represents a milestone in modern surgical practice. The concept is novel and explored comprehensively. The book undoubtedly represents value for money. Although many neurosurgeons may quibble with certain aspects of various chapters, the benefit obtained by frequent reference to it will contribute to further improvements in neurosurgical standards. J. DOUGLAS MILI.ER, M.D., Ph.D. IAN WHITTLE Edinburgh, Scotland, U.K.
B r o w n - S 6 q u a r d : A V i s i o n a r y o f Science. By Michael J. Aminoff, M.D. 211 pages. $68.00. N e w York: Raven Press, 1993. I S B N 0-88167-956-9. This book is the culmination of Aminoffs long-standing interest in Charles-Edouard Brown-S6quard (1817-1894), and the first booklength biography of Brown-S6quard in almost 50 years. In general this biography is a thoughtful, well-written, and balanced synthesis of Brown-S6quard's restless but extremely productive academic career. Although some sections could have benefited from more detail and a more critical analysis, the book is a valuable contribution and deserves a wide readership, particularly among those with interests in the history of either neurophysiology, neurology, or endocrinology. The first section of the book comprises 99 pages and chronicles Brown-S6quard's complicated personal and professional life. For this section, particularly, Aminoff relied heavily on archival material from the Royal College of Physicians in London and the College de France in Paris. This section offers interesting insights into Brown-S~quard's relations with numerous scientific and political notables of the late nineteenth century: particularly well-detailed are his collegial but fiercely competitive relationship with French physiologist Claude Bernard and the friendship and support provided to him by several influential individuals, including British surgeon James Paget, French neurologist Pierre Paul Broca, and American naturalist Louis Agassiz. Although Hughlings Jackson, the preeminent British neurologist, was "deeply influenced" by BrownS6quard, their interesting relationship is unfortunately not well developed.
Book Reviews
Glimpses of Brown-S6quard's personal life are given in the book, in large part gleaned from correspondence in the archives of the Royal College of Physicians. Some of this material was discovered in the early 1960s at the home of BrownS6quard's grandson and latter acquired by the college. The discoverer was Aminoffs former mentor, British neurologist William Goody, whom Aminoff credits for stimulating his own interest in Brown-S6quard in 1966. The second section of the book on Brown-S6quard's "scientific legacy" comprises 74 pages. This section includes four short chapters: an overview summarizing his contributions as a physician and scientist, followed by individual discussions of his studies of the sensory pathways of the spinal cord, his other contributions to neurology, and his work on the endocrine system. Brown-S6quard is best remembered for his pioneering studies of the sensory pathways of the spinal cord. Neurologists and neurosurgeons are likely to be most interested in this portion of the book (chapter 6), and it is unfortunately here that they may be disappointed. The 20-page presentation is inconsistent and confusing. Two pages of general comments on the anatomy of the spinal cord are intended to make the rest of the presentation accessible to "nonmedical readers," but are unlikely to do so and are distracting. Galen is acknowledged to have begun the experimental study of spinal cord function in the second century A.D., but his experiments and observations are referred to only in passing: while Aminoff notes that Brown-S~quard repeated Galen's transection and hemisection experiments, the longitudinal section experiments performed by Brown-S6quard were also anticipated by Galen. In addition, while the earlier contributions of Whytt, Hall, Magendie, Bell, and van Deen are briefly presented as a background to Brown-S6quard's contributions, the relative timing and respective independent contributions of Brown-S6quard and his contemporary Moritz Schiff(1823-1896) are not made clear. More problematic is the discussion of Brown-S6quard's repudiation of his early work in this area--work that is still regarded as essentially correct. Brown-S6quard's recantation 2 years before his death was precipitated by a contradictory report in 1892 from a young British neurologist, Frederick Mott. Brown-S6quard came to doubt the decussation of sensory fibers in the cord: he ultimately attributed the experimentally induced anesthesia to a dynamic inhibitory effect, rather than to interruption of fixed sensory pathways. Aminoff seems to accept this uncritically: "[Brown-S6quard's 1894] paper represents also an extraordinary contribution, encapsulating a concept so profound that several generations of neurologists have neglected it, either out of ignorance or because its implications are so far-reaching." No critical modern analysis is offered to clarify the ambiguities and place the original (or later) work in proper perspective. Some lesion experiments in several monkeys by Denny-Brown (presented in a chapter in 1979) are summarized in support of Brown-S6quard's later views, but the issue is not discussed or interpreted critically in light of other clinical or experimental data: indeed, Aminoff implies that Denny-Brown's 1979 chapter is the only significant work
Book Reviews
on the subject since Brown-S~quard. Relevant observations from patients undergoing cordotomy, for example, are not even mentioned. At the end of the book, Aminoff includes 26 pages of appendices tabulating Brown-S~quard's various honors and credentials, as well as his more than 500 scientific publications. The 41 illustrations throughout the book are generally well
Surg Neurol 1993;40:351-3
353
chosen, although the reproductions of official documents, appointment letters, and award notifications are perhaps super~UOUS.
DOUGLAS J. LANSKA, M.D. Lexington, Kentucky