Posts Tagged ‘neurologists’

Neuroanatomy

Neuroanatomy: An Atlas of Structures, Sections, and Systems, 5th Edition

Duane E. Haines

Philadelphia: Lippincott, Williams and Wilkins, 2000.256 pp.

To our ancient ancestors, the mass of gelatinous tissue between our two ears was a mystery for the most part; its importance, nevertheless, was underscored by the serious consequences of damage to it. Several thousand years later, the brain still represents one of the frontiers of biomedicine, a mystery which is tenaciously guarded behind layers of neurobiological riddle. Our first understanding of the importance of our brains to everything from the subtleties of memory and cognition to motor function came together as we gradually pieced together the various deficits suffered by individuals who had damaged parts of their brains. Therefore, the intricate anatomy of the brain became the initial road map to understand the function of the brain. This endeavor continues today, and neuroanatomy remains a common dictionary for piecing together the more detailed understanding of the brain afforded us by the advances in cellular neurobiology and neurophysiology. So it is conceivable that neuroanatomy is a fundamental course taken by junior medical students and graduate students of the neurosciences.

Crucial to learning any anatomy is a good atlas from which structures may be appreciated in their proper orientation. Enter Neuroanatomy by Duane E. Haines, a popular choice for neophytes to the field for the better part of the last two decades. This fifth edition represents the latest revisions to the text since 1995. Several changes, all for the better, have been made to this edition, making it Haines’ strongest product to date. Certain old radiograms have been removed, and sixty new labeled images (CT and MRI) have been included. This is one of the best features of the new edition. Labeled MRI images are placed adjacent to the labeled gross specimens, thereby rendering an effective and highly educational juxtaposition. The understanding of in situ neuroradiological anatomy will be of direct clinical utility for many students of neuroanatomy, and helps to place an important clinical context from which case studies are effectively interpreted. Moreover, consistent with emerging clinical technology, the neurovasculature is also represented by new MRA (magnetic resonance angiography) and MRV (magnetic resonance venography) images, which will again be a more common clinical visualization of the brain vasculature. Important clinical ascending and descending systems have also been coherently put together as color coded pathways to help integrate the systems with the anatomy in a very useful educational tool. All together, the revisions of this latest edition of the Haines atlas make the book more clear, concise, and informative. This is a valuable resource for students of neuroanatomy. The clinical emphasis in the atlas actually serves to strengthen its educational utility as a neuroanatomy atlas, whether or not one plans to follow clinical neuroscience training. I would definitely add this book to my shelf.

Behavioral Neurobiology

Behavioral Neurobiology: The Cellular Organization of Natural Behavior
Thomas J. Carew
Sunderland, Massachusetts: Sinauer Associates, 2000. 435 pp.

The 1990s, dubbed the “Decade of the Brain,” contained a procession of neuroscience advances that showed how far our understanding of the brain has come and how much further it needs to go. So as the decade, which brought NIH budget highs, begins to recede from the rearview mirror, the effects of accelerating pace of neuroscience discoveries can be felt in related areas such as animal behavior. Understanding the molecular and cellular mechanism underpinning the brain’s function has helped produced incisive explanations for behavior that were once limited to description. For an undergraduate, a beginning graduate student, or a dabbling ethologist, Thomas J. Carew’s Behavioral Neurobiology is a succinct and organized textbook that covers a wide array of topics and experiments from classical Pavlovian conditioning to Kandel’s work on memory and alpysia.

A distinguishing feature of Carew’s approach is the case-based mode of explanation. Rather than expostulating some general principle and leaving real examples to a call-out quote or in a margin, Carew takes the opposite approach. To elucidate the mechanisms behind the sensory system, echolocation in bats, prey location in barn owls, and feature analysis in toads are examined. In the “Echolocation in Bats” section, concepts such as Doppler shift compensation and FM sweep are explained in a clear fluid fashion that uses the example of bat echolocation as a logical backdrop. The other two large sections, “Motor Strategies” and “Behavioral Plasticity,” are also explained with a similar approach.

The clear pictures aid in understanding, and the size of the book lends to easy reading and toting. With a total of 208 illustrations, Behavioral Neurobiology, is not only a clear text tract but also a visually appealing one. The pictures used to describe and explain how bees learn through association is a fascinating read. A suggestion for the next edition would be the use of a CD-ROM or a Flash-enabled program to animate processes such as song recognition in birds. In sum, Carew has written a text that serves as an fine starting point for understanding the neurobiology behind animal behavior.

Neurology in Clinical Practice.

Neurology in Clinical Practice. Principles of Diagnosis and Management
W Bradley, R B Daroff, G M Fenichel, GD Marsden, eds
1880 pp (2 vols)
ISBN 0-409-90193-8
Guildford: Butterworth-Heinemann, 1990

In the past few years many neurologists have tried their hand at the single volume textbook on clinical neurology. Most have been adequate but usually conventional and unimaginative. Now is the era of the blockbuster text, two volumes, multiple international authorship and expensive. Three have appeared recently including Neurology in Clinical Practice, edited by Bradley, Daroff, Fenichel and Marsden. This is a well-produced book which covers all the major areas of neurology and many more besides. The format has been carefully considered by the editors. For example, the usual categoric description of neurology by disease (found in Volume II) is supplemented by 35 chapters, each discussing the clinical approach to a common neurological problem. This is largely successful and will be particularly helpful to the trainee neurologist.

Several chapters deal specifically with neurological investigations and principles of neurological management. Of particular interest are the chapters on the place of laboratory investigations in diagnosis and management and on decision analysis. As we enter an era when neurologists will be pressed to justify their investigation and treatment of patients in financial terms these chapters offer a useful approach.

My main criticism of this tome is the paucity of references. This was a deliberate policy by the editors who instructed authors to provide only recent ones so the reader can look them up to find references in the older literature. This may save space but makes reading the chapters highly frustrating. A book of this size should be properly referenced even if the reference list is printed in characters a few points smaller than the text.

At £160 this is a pair of volumes for the departmental library rather than one’s personal bookshelf. The income of trainee neurologists is unlikely to stretch to this and Adams and Victor’s ‘Principles of Neurology’ at a fraction of the cost is still the best value for money.

Hughlings Jackson on Psychiatry

Kenneth Dewhurst

Oxford, Sanford Publications, 1982. pp. xi + 169

The clinical researches in neurology of John Hughlings Jackson (1834 –  1911) are well known, but his contributions to the field of psychiatry are not; nevertheless, they are considerable, as Kenneth Dewhurst notes in this fine small book. Jackson’s education at the medical school at York provided him with more experience in the field of psychiatry than most of his contemporary medical students. This was made possible by two exceptional professors on the faculty, Daniel Hack Tuke and Thomas Laycock, both of whom became leaders of British psychiatry during their era. Tuke probably had a greater impact on the clinical side while Laycock’s studies on brain reflexology and on the mind-brain problem had an enduring influence on neurophysiology.

Jackson also attended the St. Bartholomew Hospital Medical School in London for a year. He settled in London finally in 1859, where he spent the rest of his life in private practice and was associated with the London Hospital and the National Hospital for the Paralyzed and Epileptic. During his career, he wrote well over 300 articles using a careful observational and philosophical approach, but never put his findings and thoughts together in a coordinated whole in spite of the urgings of his professional friends. Nevertheless, he was “acclaimed as the greatest British scientific clinician of the 19th century.”

Jackson’s greatest contribution to the understanding of psychiatric issues arose from his careful studies of epilepsy and its phenomena. As he slowly collected material from 1866 on, he became interested in selected patients who experienced odors undetectable to others present (a form of olfactory hallucination). These subjects also revealed episodes of losses of consciousness, automatic movements and thoughts, and the appearance of certain dream-like states. Jackson also explored the amnesia that was associated with these states and finally named them “uncinate fits.” Over the years the terminology changed to epileptic equivalents, psychomotor epilepsy, and currently to temporal lobe epilepsy. Dewhurst also discusses a famous case of Jackson’s known as “Quaerens or Dr. Z.”, who has recently been identified by the studies of D. C. Taylor and S. M. Marsh as Dr. Arthur Thomas Myers, a distinguished sportsman and physician whose major contribution to medical history was his careful reportage of his own case, albeit anonymously. He became a patient of Jackson’s who published Myers’ case and included Myers’ autobiographical study. Both in his own right and through the efforts of his brother, Frederick W. H. Myers, Arthur contributed to the movement for the study of parapsychological phenomena and those of the subconscious. Arthur wrote articles on both hypnotism and telepathy. It was his brother Frederick, however, who helped to found the Society for Psychical Research and wrote extensively on subliminal matters. Both went to LeHavre, France, in 1886 to watch a then unknown professor of philosophy named Pierre Janet do experiments on hypnosis at a distance.

Arthur died in January 1894 from an overdose of chloral hydrate. His illness plus his medical focus thereup had made possible a greater clinical understanding of temporal lobe epilepsy. Exploration of the connections of the temporal lobes to psychiatry has experienced a resurgence during the past two decades. That religious and parapsychological behavior could be connected to this area of the brain was pointed out in a 1970 article by Drs. Dewhurst and Beard. They reported six cases of epilepsy with investigative evidence suggesting a temporal lobe focus. All of these patients reported experiences of religious conversion. Approaching the question from the other side, the authors also found support for their thesis from the history of conversions in a number of saints and religious figures who also had a history of convulsive-like episodes. A more recent study brought further confirmation to this view as well as demonstrating a high incident of dissociation and multiple personality in these patients.

Other topics explored by Dewhurst in Jackson’s writings are: the mind-body problem, consciousness, delirium, coma, psychosis, hysteria, dreams, Gilles de la Tourette Syndrome, obsessions, jokes, etc. Dewhurst concludes his book with a two-chapter review of Jackson’s impact on continental psychiatry as well as on British and North American psychiatry. Among the familiar names that emerge are: Freud, Pick, Charcot, Ribot, Henri Ey, S. Weir Mitchell, J. J. Putnam, Adolf Meyer, and Bernard Sachs.

We are highly indebted to Dr. Dewhurst for surveying John Hughlings Jackson’s voluminous writings and culling those comments of psychiatric import and placing them in their historical context. An excellent index makes the various topics easily accessible. Dewhurst has continued to make valuable contributions to the history of medicine. His range is impressive. He is famous for his 17th century book-length studies on Sydenham, Willis, and Locke. He recently wrote a book on Fredrich Schiller (19th century), and he now has an excellent book on Jackson.

The Neurology of Eye Movements

The Neurology of Eye Movements, 3rd ed. CD-ROM

Leigh RJ, Zee DS. New York: Oxford University Press; 1999

CD-ROM – ISBN 0-19-512974-1

656 pp. with index – ISBN 0-19-512972-5

The neurology of eye movements sometimes seems to be an esoteric concern to many in the neurosciences. However, the analysis of eye movements often turns out to be extremely valuable in clinical practice. Eye movements are examples of other motor phenomena and, because they are more simple than limb movements, they often give greater insight into problems of paresis, fatigue or coordination. They particularly lend themselves to quantitative evaluation. The knowledge of specific types of eye movement deficiencies is an important tool for localizing disease and diagnosing neurological disorders.

Drs. John Leigh and David Zee have issued the third edition of their highly praised book, The Neurology of Eye Movements. In addition to the classic text, they have also produced, for the first time, a CD-ROM version. Both text and CD versions follow a similar outline, with an initial survey of the basic forms of eye motions. There follows an analysis of the vestibular-ocular system and the classical saccadic and pursuit systems, conjugate gaze, gaze holding, eye-head movements and vergence movements. These are superb chapters and give up-to-date information on the anatomical and physiological basis of these movements. The text is accompanied by excellent tables and figures.

Part II provides 2 sections on diagnosis, the first is on the diagnosis of peripheral ocular motor palsy and strabismus. Many would think of this as the “classical section” of a text on ocular motor problems. It details clinical testing of diplopia and, for neurologists, a must read description on how to diagnose strabismus (which is often left out of the classical neurological education). This is followed by a superb section on central disorders of motility, with enlightening dissections of the various forms of nystagmus and saccadic intrusions, as well as a useful discussion of vertigo and its treatment. Specific disease entities are treated in this latter section. There are discussions on eye movements and psychiatric disorders, stupor and coma, multiple sclerosis and metabolic deficiencies, all of which are excellent.

The CD-ROM version allows easy movement between chapters. It provides excellent access to the often-cited tables and figures that one has to find again when they are referred to in subsequent chapters. This is a more difficult task when reading the book because page headings do not indicate chapter numbers, which would help one locate the tables and figures more easily. The CD version has something that the hard cover version does not have — video clips. The videos, 60 in number, include virtually every sort of eye movement disorder one could want to view. These videos alone are worth the price of the CD; although they are relatively short, each shows the eye movement clearly. My one problem with the CD version is that the key word search feature often failed to reveal all of the important references; I found it much easier to use the index in the back of the book for this endeavour.

The authors suggest that this book is for neurologists, ophthalmologists, otolaryngologists, optometrists, neurosurgeons, psychiatrists and basic researchers. I suspect neurologists and ophthalmologists would enjoy it the most. Otolaryngologists who have a specific interest in vertigo would certainly find this text useful, though the vestibular systems are probably dealt with in more detail in other works. There are likely few neurosurgeons and psychiatrists who will purchase this, which is a shame because I think everyone could learn from this text.

I think everyone in neurology should own a copy of this text. The major question is which version to buy, the hard cover or the CD. I would guess that a neurology resident on a restricted income might want to buy the CD version for the videos alone. However, if you have seen these eye movements many times and just want a review of the neurological basis of eye movements, perhaps the book, which offers a better index, would be easier to read. Whichever one you decide to purchase, the price is quite reasonable for the information enclosed. I would suggest both versions.

The Hippocampal and Parietal Foundations of Spatial Cognition

The Hippocampal and Parietal Foundations of Spatial Cognition

Burgess N, Jeffery KJ, O’Keefe J, editors

Oxford: Oxford University Press; 1999. 490 pp. with index

ISBN 0-19-852452-8 (paper)

This well-organized volume has much of interest to basic researchers. The 3 roughly equal sections discuss, first, the parietal cortex, then the hippocampal formation and, finally, the interaction of the two in spatial learning and memory. Studies of rats, monkeys and humans are included. Among the techniques reviewed are behavioural, neuropsychological, electrophysiological, brain imaging and neural net computational modeling. Reading this book from cover to cover reveals a lot of repetition of similar material, such as anatomical details. It is often surprising to read about the same ideas in different chapters that do not cross-reference each other. However, for the reader who uses this book as a source of specific information about cortical regional specialization of function, the chapters provide independent and complete reviews of the latest relevant work.

The sophisticated studies of Milner and Goodale, identifying 2 streams of visual information processing with different functions, provide a useful basis for integrating much of the work presented in the first section on the parietal cortex and some of the studies presented in the third section on integration of parietal and hippocampal function. Goodale et al have argued that the dorsal stream of visual processing into the superior parietal lobe is concerned with the use of that information for the generation of motor actions; damage to this area leads to optic ataxia. The ventral stream projecting into the inferior parietal lobe and dorsal temporal cortex is concerned with what is being seen; damage here leads to spatial neglect. The chapter by Karnath, for example, presents results of studies showing that patients with damage to the right parietal cortex made exploratory eye movements consistent with an ipsilesional deviation of egocentric space representation. The same patients showed no deficit in goal-directed arm movements to targets around them. These findings are consistent with the idea that there are 2 streams of processing and that the damage in the patients studied affected the ventral but not the dorsal stream.

Colby presents fascinating electrophysiological data recorded in the ventral intraparietal area in monkeys. Cells were found to be responsive to both visual and so-matosensory stimuli; neurons with foveal visual receptive fields had somatosensory receptive fields on or around the muzzle. It was as if the mouth was the “fovea” of the facial somatosensory system! Furthermore, visual receptive fields moved across the retina in order to maintain spatial correspondence with somatosensory fields, suggesting that stimuli are coded in a head-centred reference frame. Patients with parietal cortical damage can be seen to suffer from a deficit in updating spatial representations for use by the motor system. Colby suggests that the remapping of visual fields observed in parietal cortical neurons provides the substrate for this updating.

In coaching students preparing for comprehensive examinations, one of my colleagues often counsels them to identify landmark papers that open whole new areas of investigation. Two such works in Spatial Cognition are Scoville and Milner’s paper and O’Keefe and Nadal’s 1978 book The Hippocampus as a Cognitive Map. The former is the first report of a role for the hippocampus in recent memory, and the latter identifies the place specificity of hippocampal cells. Juxtaposition of the ideas from these 2 classic works influences much of the thinking in Spatial Cognition. Some interesting ideas linking recent memory and place specificity can be found.

Mishkin et al, for example, discuss episodic and semantic memory. When a new item, association or fact is being encoded into memory, the relevant sensory information arrives as an episode that includes spatial information, as well as temporal cues and information about emotional and mental states. The amount of contextual information that is retained determines the nature of the stored memory: con-textually rich memories include spatial and other information and are, therefore, episodic; contextually poor memories record only the facts, and therefore constitute semantic memory. From this point of view, semantic memory is lower in a hierarchy of mnemonic sophistication than episodic memory. Mishkin et al argue that the hippocampus is necessary for episodic but not for semantic memory. Spatial information would be intrinsic to episodic memory. Rolls, Gaffan and Hornak make similar arguments in later chapters.

One distinction that guides some of the discussion of the interactions between parietal and hippocampal systems in space and memory is that between allocentric and egocentric frames of reference. Egocentric reference is putatively mediated by parietal circuits, and allocentric reference by hippocam-pal circuits. Rolls reported that 46% of the spatial cells of the hippocampus represented space in allocentric coordinates, versus 10% that, by comparison, were egocentric. Maguire reported that positron-emission tomographic (PET) images of people who walked mentally along a recently learned spatial route showed right hippocampal activation, suggesting that this region provides an allocentric representation of space. Parietal cortical regions seemed to play a role in egocentric movements through environments.

Another work that strongly influences many authors writing in Spatial Cognition and could be added to the comprehensive reading list that I mentioned earlier is The Visual Brain in Action by Milner and Goodale. This is the source of the idea, mentioned above, that the dorsal stream guides visuomotor actions and the ventral stream identification of what is seen. In the final chapter, Milner et al suggest that, if a participant was required to perform a delayed motor act, accurate performance would depend on the ventral stream because the egocentric coordinates that are tracked by the dorsal stream will have changed during the delay (assuming the participant moves). Thus, visually guided motor acts like pointing should be impaired after a delay in people with damage to the ventral stream. Results supported this conclusion.

One interesting contrast that I found in Spatial Cognition was between Rolls’ and Maguire’s view of imaging studies. Rolls reported the results of electrophysiological studies in rats and monkeys showing that hippocampal cells in rats were place cells, responding when the rat was in that place; in monkeys, hippocampal cells fired when the monkey looked to a particular place, even if it didn’t go there. Rolls argues that imaging studies could not make this distinction; they did not provide a full description of what was being represented in the brain. Maguire reports differences in regional activation assessed by PET imaging, as described above, and concludes that PET offers a means to pursue many outstanding questions in understanding neuronal control of spatial cognition. I suspect that they are both right. The breadth of techniques reported in this book and the emerging clarity of the knowledge about the cognitive functions of these brain regions attests to the power of multiple empirical approaches to the study of the brain for discovering the mechanisms underlying the amazing abilities of this structure.

Psychiatry

Psychiatry. Second edition. Oxford Core Texts series

Gelder M, Mayou R, Geddes J

New York: Oxford University Press; 1999

ISBN 0-19262-888-7

The first edition of this book was called The Concise Oxford Text of Psychiatry, and the title change implies that the authors and publishers are attempting to broaden the book’s appeal. The 3 authors are senior academic psychiatrists from the University of Oxford.

Before reviewing the book, I made a list of the key requirements of a textbook for medical students: clarity, comprehensiveness, conciseness, cost, practicality and pertinence. This book scores high on all these items with the exception of cost and pertinence. It emphasizes strongly the integration between psychiatry and general medicine, yet the psychosocial aspects of medicine and psychiatry are also underlined. An appropriate balance between comprehensiveness and overinclusive detail is maintained, and liberal use is made of tables, diagrams lists and summaries. Many chapters also include “screening questions” — a list of questions that can be asked of a patient to rule out a specific diagnosis. The chapters on suicide, pharmacotherapy and “psychological” treatment (as the psychotherapies are called in the quaint British tradition) are particularly well written.

The book has its limitations. The chapter on psychiatry and the law is written for British readers and has limited relevance to other jurisdictions. For a soft cover, this book is not cheap. Finally, there are few references, although each chapter concludes with a recommended reading list.

With these provisos, the book can be highly recommended to medical students and to non-psychiatric residents who are interested in a readable and practical introduction to psychiatry.

Psychosocial Factors in Pain

Psychosocial Factors in Pain: Critical Perspectives

Gatchel RJ, Turk DC, editors

New York: The Guilford Press; 1999. 510 pp. with index

ISGN 1-57230-285-2

The preface to this book stakes out its claim. We are told that 4 main developments, each involving psychologists, served as the impetus for a revolution in thinking about pain. This revolution consists in the rejection of a “medical model” in favour of a “bio-psychosocial approach.”

The volume comprises 30 chapters. Of these, the first 9 make up Part I, on biopsychosocial context. In Part II 11 chapters deal with special topics and populations, and Part III provides 10 more on issues in prevention and management. The book finishes with an overview on resolution and evolution. Three out of the 43 authors of the 30 chapters are physicians dealing with pain and AIDS (a magnificent review), the epidemiology of low-back pain, and work style and work-related upper extremity disorders. There is an epidemiologist or two, a dentist with qualifications in psychology, and almost all the rest are psychologists dealing with pain. These include 3 Canadians (Gagliese, Katz and Melzack), Flor from Germany, and Main (from Glasgow and now Manchester).

The great bulk of the material reflects the work and views of US psychologists and their special psychosocial context.

This is a long volume, well produced and full of information, often very well worked out. The text itself is easy to read and very solidly written for the most part. Some chapters are excellent in whole or in part, while others seem to exist only to disappoint.

It is an irritating pity that what could have been a superb volume is marred by 2 faults of emphasis. One is needless special pleading and the other is an ill-founded, albeit highly sophisticated, tendency to revise the understanding of what it means to favour a back-pain disability model.

The special pleading begins with the listing of 10 contributors to the psychological approach. Three of these were actually physicians but not identified as such. More important, and tellingly, there is a lack of understanding or recognition that psychosocial factors have always been strong in medicine. Psychologists now dwell in a field long inhabited and not relinquished by internists, family doctors, neurologists, psychiatrists and a host of others.

Psychologists are much more numerous than psychiatrists in the field of pain and have made great contributions, starting with Hebb and Melzack. But some of their contributions (e.g., behavioural therapy of pain) remain controversial, and the field in which they have gained most recognition and added most to the subject appears to be cognitive treatment, which, incidentally, was applied to pain by a psychiatrist, A.T. Beck. Thus, what should have been a friendly and sociable claim to have made a large contribution has been spoiled by exaggeration.

More important, the way in which the biopsychosocial construct is now treated serves to reduce the biological element and to suggest that pain is largely due to psychological causes. I partly made that mistake myself and can sympathize, but the fact is that we have very few genuine indications that pain for which physical explanations are lacking is due to psychological causes except when it occurs with or after the onset of an obvious affective disorder. In other cases, and especially with musculoskeletal pain that arises with questionable indications of psychological difficulty, there is insufficient evidence to support the view that pain is due to vaguely alleged “behavioural factors,” but there is growing evidence from systematic controlled investigations that the determining factor is the state of the facet joints or degeneration (not prolapse) of intervertebral disks.

One of the most insidious practices connected with rejecting the patient’s pain consists in describing correlated information as “predictive.” Every psychologist knows that correlations do not demonstrate a causal link, except when there is a serial position, and should not be thought of as a causal consequence. Yet the insinuating word “prediction” is used repeatedly to corroborate some argument for psychological causation.

I do not want to leave the impression that Gatchel and Turk, as editors, make no attempt to acknowledge evidence that complicates their message. They recognize much of it. However, overall the book states the problems softly when they relate to weaknesses in psychological achievement, and overstates the failures of the organic approach. This is the more distressing because the authors and editors have all made significant contributions in the past, and continue to do so. Unfortunately, as one of my colleagues puts it, those who state their adherence to the biopsychosocial approach most loudly do not appear to be as serious about the “bio-” element.

John Hughlings Jackson: Father of English Neurology

John Hughlings Jackson: Father of English Neurology

Critchley M, Critchley EA

New York: Oxford University Press; 1998. 228 pp

ISBN 0-19512-339-5 (hard cover)

John Hughlings Jackson was an independent-minded, creative thinker who has enjoyed legendary status. The Critchleys’ new biography tells us that it was said that Jackson’s guess was worth the facts of 10 men. The authors of this biography have provided an exhaustive, although excruciatingly detailed, description of Jackson’s life (there are 2 pages on his use or non-use of a hyphen between Hughlings and Jackson), professional work and legacy. Embodied within the volume is much information relevant to the golden age of neurology — the latter half of the 19th century — and the key individuals who developed neurology, especially in the United Kingdom, including the establishment of the National Hospital and the journal Brain. The Critchleys profess to decry hagiolatry, but begin the book with the following statement “He possessed the rare combination of characteristics that ’sets the man among the little band of whom are Aristotle and Newton and Darwin.’” The book is uneven, with obsessive detailing of the Jackson family tree and repetition of Jackson’s personal characteristics.

Nevertheless, the topic is one of fascination, the material scrupulously researched, and the book an explanation to a modern audience of what it was about Jackson that enraptured both contemporary and subsequent generations of those thinking about the nervous system.

Jacksonian concepts of the central nervous system need both an explanation and a guidebook. A critic once described Jackson’s writing as resembling the “love of God in that it surpasseth all understanding.” Those who wish to read Jackson in the original might be daunted by the following assessment by Sir George Savage, “His whole frame of mind was so carefully exacting that he scarcely ever dares to make a definite statement without qualifying it in some way; so that in studying his writings one meets endless footnotes and parentheses which are somewhat confusing.” The Critchleys make a reasonable effort in this volume, but picking Jackson’s key observations is not easy. We are told many times more often the importance of the observations than what they actually were. Certainly Jackson’s view of the brain comprised both holistic and compartmentalized notions. His successive levels of integration of motor functions coexisted with views contrary-minded to the passion for discrete localization that characterized his time. As the Critchleys state, the second half of the 19th century was a period of neurological fervour, when clinical-pathologic correlation was winning easy prizes. This work was descriptive in character, not reflective. They further point out that Jackson’s ideas, especially on aphasia, were temporarily overshadowed by those who conducted brief clinical studies highlighting the obvious. It is true that Jackson owed his principal contributions to germs of ideas derived from Herbert Spencer’s concept of “dissolution.” Nevertheless, one can’t help but feel affection for the man the Critchleys describe — his single-mindedness and recognition of the complexities of central nervous organization in the human brain. One feels a similar affection for his biographers, who have toiled tirelessly — in Mac-donald Critchley’s case, well into his 10th decade — to produce this work.

I have always thought that Critchley has been underrated by his countrymen. He did not appear to have been humble, and his writings redefine pedantry, but he was the longest surviving member of the era that overlapped Jackson’s final years and was also an exhaustive scholar. In the book, Critchley describes Jackson’s interaction with a colleague who had reviewed a piece of work so severely that the author was threatening violence. The reviewer protested to Jackson that the author’s anger was not justified, for he had only reviewed the book, not the man. “That is very true,” said Jackson. “You did not shoot at the man; you shot only at his coat but you must remember that it was on his back.” I am disinclined to shoot at the coat. There are shortcomings in this book to be sure, but there is also much fine biography.

Mind and Brain Sciences in the 21st Century

Mind and Brain Sciences in the 21st Century

Robert L. Solso, editor

Cambridge (MA): The MIT Press; 1999. 354 pp. with index

ISBN 0-262-69223-6 (paper)

In this book 18 prominent writers in the field of neuropsychology and neuroscience review recent progress and make prognostications about where the field is going in the 21st century. The topics range from the serious to the whimsical, but all are challenging, yet lucid, and well written. Carl Sagan is a cosmologist and science author of international reputation, and his wife, Ann Druyan, is an author, lecturer and television producer. All the others are leaders in psychological and neurobiological research. The essays are grouped into 4 sections.

The first section deals with consciousness and the 21st century. In cognitive psychology, consciousness has been a central topic, yet until the last decade, the subject was avoided by most researchers, largely because many believed that it was impossible to study one’s own subjective experience in an objective way. Bernard Baars takes a look at this and describes a world of sentient, self-knowing beings; he hopes humans will achieve this in the next century. Carl Sagan and Ann Druyan challenge the traditional notion that humans are the only animals with true consciousness. They suggest that there is no qualitative discontinuity between the cognitive processes of a human and his pet dog. Richard Thompson explores the concept of “mind” as separate from “brain” (”the Ghost in the machine”). As a behaviourist, he feels that in the 21st century we will come to understand “mind” as the behavioural expression of brain function — nothing more. Endel Tulving, with tongue-in-cheek, describes an incident in which a being from 2096 is sent back (time machine?) to help him with his prognostications, and this being tells him about many new terms and concepts of the future. Tulving cleverly lampoons our use of acronyms and our propensity to think we understand something because we have given it a name.

In the second section, “Brain and mind in the 21st century,” 5 essays deal with the separation between cognitive psychology, largely influenced by behaviourism, and cognitive neuroscience, focussing on brain structure and function. Edward Smith postulates that neuroimaging of the normal brain will bring these 2 approaches together. Michael Posner and Daniel Levitin review the impact of neuroimaging on our understanding of how the brain works. Alan Gevins postulates a world in which everyone might be plugged into a brain scanner much as a mechanic plugs your car into a diagnostic computer. Karl Pribram discusses structures of memory and conscious learning, and Michael Gazzaniga asserts that whatever your brain does, its purpose is sex.

In recent years, psychology has moved away from behaviourism and is now trying to pry open Skinner’s Black Box. In the section “Psychology (memory, theory, and cognition) in the 21st century,” 6 well-known writers try their hand at predicting where psychology will go next. Henry Roediger HI, in a thoughtful essay, reviews the accuracy of past predictions (almost zero) and makes 11 “testable predictions” for the next 25 years. Gay Snodgrass looks back from 2050 and suggests a world of “memory trainers.” Jerome Kagan looks at current concepts in psychology and suggests that specific knowledge will change many and render the rest obsolete, with inevitable consequences for the classification systems. George Sperling discusses the role of theories in advancing knowledge. Neil Miller suggests that the future, as the past, is one of totally unexpected opportunities. Hans J. Eysenck writes a masterful historical overview of psychology and sees the future as an extrapolation of the past.

In the final section, “Mind sciences in the 21st century,” Robert Solso reviews the other essays and offers his views on current trends and new directions. He emphasizes the continuing importance of consciousness, the relationships between neuroimaging data and direct observations of behaviour, and the impact of scientific developments in other non-biological areas of science. He states that there has been a paradigm shift in the basic concept of the scientific method in the 20th century and that this will influence the whole direction of science in the next.

I found this book often challenged my conceptualizing powers; however, it was indeed a fascinating read. In fact, upon second reading I discovered many insights that I had missed the first time.