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Lehrbuch der neurochirurgie
500
BOOK REVIEWS
facts. Dyspnoea would appear to be largely a sensation from movement or hindrance to movement of the chest wall, coupled with an appreciation of the motor effort being exerted. The final sections of the book are devoted to the effects on respiration of disease, both of the lung and chest wall, and of primary neurological disorders. The latter will be of especial interest to clinical neurologists as it gives a fairly precise location of brain-stem lesions with respiratory dysrhythmias. Finally, a chapter is devoted to the clinical assessment of respiratory muscle function
with the indications for assisted ventilation. This is an important work which has no counterpart either in scope or quality. It is well-written in a pleasing style with full references, including studies published in 1970. It should be of considerable interest to neurophysiologists, anaesthetists and clinicians, both in respiratory medicine and neurology. It will be a standard book t,f reference for a number of years, and is highly recommended. M. J. CAMPBELL
Die anonymen Brie[schreiber (Schriflenreihe zur Theorie und Praxis der medizinischen Psychologie, Vol. 18), by H. BINDER (Ed.}, 148 pages, Hippokrates Verlag, Stuttgart, 1970, DM 19.80.
This is a very thorough study which examines the various factors relevant to this form of behaviour. As the author points out, the need for anonymous letter writing may reflect both a disturbance in the state of our society, as well as in the individual himself, and the mask which anonymity confers upon the writer obscures him from society and also in a sense from his own "identity". It is the latter aspect which seems to be of particular importance in that it permits the upsurge of his inner emotional life in which aggression appears to be a prominent feature. There are many interesting and detailed case histories which illustrate the many valuable observations the author makes both in relation to the personality disorders among these cases, as well as about the psychotic patients in whom the relevance of their behaviour is considered in the light of their psychosis. Dr. Binder's valuable contribution has gone a long way to fill gaps in our understanding of this interesting type of human behaviour.
The introduction of anonymous letters is an effective device used by many playwrights and novelists to heighten the sense of mystery and excitement of their plots. In real life, they form a very small, but fascinating part of criminal activity and one which has received very little in the way of scientific study. Dr. Binder, whose writings on the subject of the law and society and whose contributions to the forensic psychiatric literature are well known, has produced a very valuable monograph based on 100 anonymous letter writers. In his work, which mainly deals with the psychological and psychiatric aspects, the author reveals his considerable skill in analysing the content of such letters and in revealing the personality and motivations of the writers. He is thus able to define certain groups of letter writers in what at first sight appears to be a heterogeneous collection of individuals.
Lehrbuch der Neuroehirurgie, by G. MERREM, 3rd revised edition, 485 pages, 412 illustrations, 5 tables, Volk und Gesundheit, Berlin, 1970, M 75,--. This book finds no parallel in English or American neurosurgical literature. It is however one of a number of such books produced in Germany which endeavour in a short compass to cover anatomy, physiology, pathology and neurosurgery itself. It has always seemed to the reviewer that unless these books are very lightly handled, they are inevitably patchy, neither sufficiently detailed to constitute works of reference nor sufficiently concise to be readable without great effort. This textbook, regrettably, contains many examples of such patchy and uneven coverage, It is doubtful whether an attempt to cover neurosurgical anatomy in 50 pages is really worth the effort, when many excellent text books ofneuro-anatomy are available. The review of pathological anatomy, though highly compressed, contains a wealth of basic information
K. S('HAPIRA
heavily weighted in favour of the German literature, but one is left once again wondering whether the illustrations of photo-micrographs in black and white of a wide variety of tumours really add anything to the student's knowledge, when he will undoubtedly be driven back to more detailed pathological textbooks to obtain a clear microscopic picture. As one might expect, in a book written by a clinical neurosurgeon, the clinical section of the book is more assured in quality, although few British neurosurgeons would recommend the posterior ventricular puncture holes in Fig. 69, with an angle of attack towards the upper lip, in curious divergence from the antero-posterior illustration of the same burrhole in Fig. 71, with which few would disagree. The choice of illustrations in radiological comment is strange, with such oddities as calcified intracranial haematoma and chiasmal arachnoiditis, while one looks in vain for detailed illustration of the angiography of intracranial aneurysms. The general approach to microsurgery
B o o ~ REVmWS
50 1
is traditional; the only flap illustrated in the section on technique for example is a 5-burrhole flap suitable for a convexity tumour without mention of the more difficult and refined approaches to the lesser wing of the sphenoid, the sub-frontal zone or the occipital lobe. which constitute the major problems a trainee has to face. The section on trauma to the nervous system is one of the more detailed parts of the book, but once again curiously outdated in its approach. It scarcely seems necessary in a basic neurosurgical primer to have half a page and an illustration on cerebral fungus, while the infinitely more important subject of extradural haematoma is entirely un-illustrated. By the same token, no less than 11 pages are devoted to the treatment of trigeminal neuralgia and 25 pages to parasellar pathology while the surgery ofaneurysms and angiomas is sketchily covered in a mere 9 pages
sandwiched in the end of the book before a quick 2½ pages on stereotaxis. One looks in vain for even a passing reference to micro-neurosurgery, to the recent and expanding literature on intracranial pressure and cerebral blood flow, or even for a mention of acoustic neuroma, surely an important subject from the surgical and teaching point of view. In conclusion, the reviewer found this a book which by its attempts to be comprehensive within a short compass succeeded only in being notably deficient in detail, verbose in generality, and incredibly silent on the expanding fringes of modern neurosurgery. It is, however, unlikely to be translated into English, so that the English-speaking neurosurgical trainee need not concern himself with it further. L. SYMON
Minimal Brain Dysfunction in Children (A Volume in the Wiley Series on Psychological Disorders,
by a psychiatrist, is the thing and examination and investigation contribute little. The recognition of the disorder is, to say the least, open-ended as he engagingly explains in a chapter on "Prevalence and Diagnosis". "With no further knowledge, any preadolescent child admitted to a child guidance clinic is most probably in the category until proven otherwise". Indeed the author advocates a policy of deliberate over-diagnosis because of his deep convictions about the value of dexamphetaminein therapy. This is where his concept of the disorder as a physiological state becomes central. He postulates a morbid dysfunction, perhaps of certain limbic structures, which prevents normal modulation of activity and especially disturbs the normal responses to external reward and punishment and the achievement of self-satisfaction. This leads to the typical behaviour pattern and also stunts normal psychological development. The primary dysfunction, whatever its nature, responds in a highly specific fashion to treatment with dexamphetamine; so much so that he half-jokingly refers to it as "congenital hypoamphetaminaemia". This response is his major justification for the assertion that this "complex, heterogeneous and sometimes mutually contradictory group of behavioural characteristics" comprise a single syndrome. Dr. Wender's experience is apparently considerable but he gives accounts of only 12 illustrative patients and there is no systematic review of his own material. Statistics are quoted freely from the experience of others and amount to a useful review of the literature but it certainly detracts from the value of the book that the author fails to support his own vigorous and interesting assertions with facts of his own. He recommends treatment with dexamphetamine in unusually high doses of 10~,0 (usually about 20) mg/day. It is disappointing after his emphasis on the theoretical implications of the immediate favourable response, that
edited by IRVINGB. WEINER), by PAULH. WENDErt, with a foreword by LEON EISEr~BERG, xvi+242 pages, 8 illustrations, 6 tables, Wiley, Chichester, 1971, £5,--. Dr. Wender disarmingly ends his book with the advice "caveat lector". This is as well for he builds a highly individual framework of statements and hypotheses about the hyperactive child and his treatment, in which speculation deliberately ranges freely beyond the bounds of evidence. Whether the reader finds this irritating or stimulating depends on his viewpoint and frame of mind. Unfortunately his sympathy for the author is further strained by the frequent use of jargon ("Their utility has been devaluated for multiple reasons") and painful neologisms ("To err is likely but to err planfully is human"). Nevertheless the book is a useful one. The author regards "minimal brain dysfunction" both as a syndrome and as a physiological state. As infants his patients had typically been irritable and sleepless, as toddlers destructive, unresponsive to their parents and acrident-prone. The fuller picture emerged at school age characterised by uncontrolled hyperactivity (rarely inactivity), clumsiness, underachievement in relation to intelligence, impulsiveness, intolerance, unresponsiveness to praise or punishment and poor emotional control. The causes of this state apparently included various forms of cerebral malformation or damage but Dr. Wender also implicates genetic factors, the extremes of normal variation and reactions to deprivation and stress. Epilepsy is barely mentioned and does not appear in the index. Although various minor neurological signs are common, the author believes that the neurologist (and incidentally also the psychologist) plays little or no useful role in diagnosis or management. The history, best taken
BOOK REVIEWS
facts. Dyspnoea would appear to be largely a sensation from movement or hindrance to movement of the chest wall, coupled with an appreciation of the motor effort being exerted. The final sections of the book are devoted to the effects on respiration of disease, both of the lung and chest wall, and of primary neurological disorders. The latter will be of especial interest to clinical neurologists as it gives a fairly precise location of brain-stem lesions with respiratory dysrhythmias. Finally, a chapter is devoted to the clinical assessment of respiratory muscle function
with the indications for assisted ventilation. This is an important work which has no counterpart either in scope or quality. It is well-written in a pleasing style with full references, including studies published in 1970. It should be of considerable interest to neurophysiologists, anaesthetists and clinicians, both in respiratory medicine and neurology. It will be a standard book t,f reference for a number of years, and is highly recommended. M. J. CAMPBELL
Die anonymen Brie[schreiber (Schriflenreihe zur Theorie und Praxis der medizinischen Psychologie, Vol. 18), by H. BINDER (Ed.}, 148 pages, Hippokrates Verlag, Stuttgart, 1970, DM 19.80.
This is a very thorough study which examines the various factors relevant to this form of behaviour. As the author points out, the need for anonymous letter writing may reflect both a disturbance in the state of our society, as well as in the individual himself, and the mask which anonymity confers upon the writer obscures him from society and also in a sense from his own "identity". It is the latter aspect which seems to be of particular importance in that it permits the upsurge of his inner emotional life in which aggression appears to be a prominent feature. There are many interesting and detailed case histories which illustrate the many valuable observations the author makes both in relation to the personality disorders among these cases, as well as about the psychotic patients in whom the relevance of their behaviour is considered in the light of their psychosis. Dr. Binder's valuable contribution has gone a long way to fill gaps in our understanding of this interesting type of human behaviour.
The introduction of anonymous letters is an effective device used by many playwrights and novelists to heighten the sense of mystery and excitement of their plots. In real life, they form a very small, but fascinating part of criminal activity and one which has received very little in the way of scientific study. Dr. Binder, whose writings on the subject of the law and society and whose contributions to the forensic psychiatric literature are well known, has produced a very valuable monograph based on 100 anonymous letter writers. In his work, which mainly deals with the psychological and psychiatric aspects, the author reveals his considerable skill in analysing the content of such letters and in revealing the personality and motivations of the writers. He is thus able to define certain groups of letter writers in what at first sight appears to be a heterogeneous collection of individuals.
Lehrbuch der Neuroehirurgie, by G. MERREM, 3rd revised edition, 485 pages, 412 illustrations, 5 tables, Volk und Gesundheit, Berlin, 1970, M 75,--. This book finds no parallel in English or American neurosurgical literature. It is however one of a number of such books produced in Germany which endeavour in a short compass to cover anatomy, physiology, pathology and neurosurgery itself. It has always seemed to the reviewer that unless these books are very lightly handled, they are inevitably patchy, neither sufficiently detailed to constitute works of reference nor sufficiently concise to be readable without great effort. This textbook, regrettably, contains many examples of such patchy and uneven coverage, It is doubtful whether an attempt to cover neurosurgical anatomy in 50 pages is really worth the effort, when many excellent text books ofneuro-anatomy are available. The review of pathological anatomy, though highly compressed, contains a wealth of basic information
K. S('HAPIRA
heavily weighted in favour of the German literature, but one is left once again wondering whether the illustrations of photo-micrographs in black and white of a wide variety of tumours really add anything to the student's knowledge, when he will undoubtedly be driven back to more detailed pathological textbooks to obtain a clear microscopic picture. As one might expect, in a book written by a clinical neurosurgeon, the clinical section of the book is more assured in quality, although few British neurosurgeons would recommend the posterior ventricular puncture holes in Fig. 69, with an angle of attack towards the upper lip, in curious divergence from the antero-posterior illustration of the same burrhole in Fig. 71, with which few would disagree. The choice of illustrations in radiological comment is strange, with such oddities as calcified intracranial haematoma and chiasmal arachnoiditis, while one looks in vain for detailed illustration of the angiography of intracranial aneurysms. The general approach to microsurgery
B o o ~ REVmWS
50 1
is traditional; the only flap illustrated in the section on technique for example is a 5-burrhole flap suitable for a convexity tumour without mention of the more difficult and refined approaches to the lesser wing of the sphenoid, the sub-frontal zone or the occipital lobe. which constitute the major problems a trainee has to face. The section on trauma to the nervous system is one of the more detailed parts of the book, but once again curiously outdated in its approach. It scarcely seems necessary in a basic neurosurgical primer to have half a page and an illustration on cerebral fungus, while the infinitely more important subject of extradural haematoma is entirely un-illustrated. By the same token, no less than 11 pages are devoted to the treatment of trigeminal neuralgia and 25 pages to parasellar pathology while the surgery ofaneurysms and angiomas is sketchily covered in a mere 9 pages
sandwiched in the end of the book before a quick 2½ pages on stereotaxis. One looks in vain for even a passing reference to micro-neurosurgery, to the recent and expanding literature on intracranial pressure and cerebral blood flow, or even for a mention of acoustic neuroma, surely an important subject from the surgical and teaching point of view. In conclusion, the reviewer found this a book which by its attempts to be comprehensive within a short compass succeeded only in being notably deficient in detail, verbose in generality, and incredibly silent on the expanding fringes of modern neurosurgery. It is, however, unlikely to be translated into English, so that the English-speaking neurosurgical trainee need not concern himself with it further. L. SYMON
Minimal Brain Dysfunction in Children (A Volume in the Wiley Series on Psychological Disorders,
by a psychiatrist, is the thing and examination and investigation contribute little. The recognition of the disorder is, to say the least, open-ended as he engagingly explains in a chapter on "Prevalence and Diagnosis". "With no further knowledge, any preadolescent child admitted to a child guidance clinic is most probably in the category until proven otherwise". Indeed the author advocates a policy of deliberate over-diagnosis because of his deep convictions about the value of dexamphetaminein therapy. This is where his concept of the disorder as a physiological state becomes central. He postulates a morbid dysfunction, perhaps of certain limbic structures, which prevents normal modulation of activity and especially disturbs the normal responses to external reward and punishment and the achievement of self-satisfaction. This leads to the typical behaviour pattern and also stunts normal psychological development. The primary dysfunction, whatever its nature, responds in a highly specific fashion to treatment with dexamphetamine; so much so that he half-jokingly refers to it as "congenital hypoamphetaminaemia". This response is his major justification for the assertion that this "complex, heterogeneous and sometimes mutually contradictory group of behavioural characteristics" comprise a single syndrome. Dr. Wender's experience is apparently considerable but he gives accounts of only 12 illustrative patients and there is no systematic review of his own material. Statistics are quoted freely from the experience of others and amount to a useful review of the literature but it certainly detracts from the value of the book that the author fails to support his own vigorous and interesting assertions with facts of his own. He recommends treatment with dexamphetamine in unusually high doses of 10~,0 (usually about 20) mg/day. It is disappointing after his emphasis on the theoretical implications of the immediate favourable response, that
edited by IRVINGB. WEINER), by PAULH. WENDErt, with a foreword by LEON EISEr~BERG, xvi+242 pages, 8 illustrations, 6 tables, Wiley, Chichester, 1971, £5,--. Dr. Wender disarmingly ends his book with the advice "caveat lector". This is as well for he builds a highly individual framework of statements and hypotheses about the hyperactive child and his treatment, in which speculation deliberately ranges freely beyond the bounds of evidence. Whether the reader finds this irritating or stimulating depends on his viewpoint and frame of mind. Unfortunately his sympathy for the author is further strained by the frequent use of jargon ("Their utility has been devaluated for multiple reasons") and painful neologisms ("To err is likely but to err planfully is human"). Nevertheless the book is a useful one. The author regards "minimal brain dysfunction" both as a syndrome and as a physiological state. As infants his patients had typically been irritable and sleepless, as toddlers destructive, unresponsive to their parents and acrident-prone. The fuller picture emerged at school age characterised by uncontrolled hyperactivity (rarely inactivity), clumsiness, underachievement in relation to intelligence, impulsiveness, intolerance, unresponsiveness to praise or punishment and poor emotional control. The causes of this state apparently included various forms of cerebral malformation or damage but Dr. Wender also implicates genetic factors, the extremes of normal variation and reactions to deprivation and stress. Epilepsy is barely mentioned and does not appear in the index. Although various minor neurological signs are common, the author believes that the neurologist (and incidentally also the psychologist) plays little or no useful role in diagnosis or management. The history, best taken