Principles of Neurology [antikvár]

PREFACEIn the first edition of Principles of Neurology, we remarked that the preface of a textbook is frequently considered to be a rather useless appendage, doing litde more than adding to the book's weight or distracting critics from its contents. The value of a book should be judged by its substance and composition. In his foreword to Cromwell, Victor Hugo expressed this sentiment more figuratively: one seldom inspects the cellar of a house after visiting its salons or examines the roots of a tree after eating its fruit.Yet there has to be a place where authors can state the purpose of their work, the manner in which it was conceived, and the reasons for foisting yet another book on a medical public already overburdened with an immense literature. To sustain our analogy, although one seldom derives pleasure from inspecting the cellar of a house, one is not sorry to have done so especially if one is to purchase it.In writing the Principles of Neurology, we have adopted a method of exposidon quite unlike that of standard textbooks of neurology, in which the many diseases of the nervous system are described in tedious succession. Instead, we have chosen to introduce the subject with a discussion of the phenomenology, or cardinal manifestations, of neurologic diseasea detailed exposition of the symptoms and signs of disordered nervous function, their anatomic and physiologic bases, and their clinical implications. This is followed by an account of the various syndromes of which these symptoms are a part, and this, in turn, by a consideration of the diseases that express themselves by each syndrome. We believe this to be a logical approach to neurologic disease, for in practice the patient presents with symptoms of disordered neurologic function, not with a disease already diagnosed. Furthermore, the sequence of symptoms to syndrome to disease recapitulates the rational process by which the neurologist makes a diagnosis. In teaching students and residents, we have found this method to be eminently successful, and it is to the student andresident that this work is primarily directed. In the strictest sense, we believe this text to be an introduction to neurologic medicine.The compass of our book differs in several other ways from contemporary textbooks of neurology. A significant portion of it has been allotted to psychiatric syndromes and the major psychiatric diseases. This has been done in the belief that all physicians, including neurologists, should be knowledgeable about diagnosis of the depressive states, neuroses, personality disorders and schizophrenia, and about the biologic facts that pertain to these disorders. The neuropsychiatrie effects of alcoholism and drug abuse are also described in detail. Similarly, we have consigned a section of the book to a description of muscle diseases, which more and more are coming under the purview of neurologists. Also, developmental and hereditary metabolic diseases are emphasized, since these topics are integral in the education of pediatric neurologists. Finally, the effects of growth, maturation, and aging on the nervous system are elaborated in detail because all deviations from the normal acquire significance only when viewed against the background of these natural, age-linked changes. Thus our book provides information that is essential to the proper understanding of medicine, pediatrics, geriatrics, and psychiatry, and it should be found useful by practitioners of each of these medical disciplines.ft is evident from these remarks that emphasis throughout this text is on the clinical expression of disease rather than on new discoveries in biologic science. Our primary aim, in conformity with Oslerian tradition, is to present clinical phenomena as we have observed them, along with the underiying physiologic and pathologic changes. Of course, pertinent neurobiologie data are not disregarded, but always they are subordinate to the clinical aspects of disease and are presented only insofar as they bear upon and explain the clinical phenomena.IX