After an initial disastrous introduction to neurology as a medical student, my lifelong affair with the specialty began in 1977 as a medical resident followed by my first year of neurology residency in 1978. From the start, the first edition of Principles of Neurology became my bible, which I and my co-trainees read from cover to cover. The field has changed immensely since that time, and widely distributed neurology textbooks are multiauthored by experts in the large number of neurology subspecialties that now dominate the field. This results in chapters providing considerable detail but often in a very patchy, inconsistent, and sometimes inaccurate fashion. The publication of the twelfth edition of Adams and Victor’s celebrated text reaffirms that there is still an important place on the shelves of neurology trainees and practitioners for a volume that originated from the two remarkable neurological authorities, Raymond Adams and Maurice Victor, and is now written by four experienced authors sharing their clinical experience with a uniform approach to the presentation of the field that is typically lost in the world of multiauthored texts.
As in the original, the current edition starts by emphasizing the classical approach to neurological patients. The authors highlight the importance of a solid understanding of neuroanatomy and the possible symptomatology caused by dysfunction of the nervous system that is critical to the combined deductive and inductive (Holmesian) approach to neurological diagnosis that makes the specialty of neurology so interesting and stimulating to those who practice it. Patient-based learning became a defined teaching approach long after Adams and Victor first wrote their text. However, the recognition of the importance of the patient in the acquisition of knowledge about a field, especially as it applies to neurology, was clearly acknowledged and is paramount in subsequent editions, including this one.
With the remarkable advances in neuroscience and medicine in general, it is impossible for a single textbook to cover all aspects of neurology in detail. This emphasizes the importance of lifelong learning in medicine that and clearly requires an initial strong clinical basis upon which to build and learn, as provided in this book. Although technology and understanding of the biological basis of disease and therapeutics are ever-changing, the way the patient presents to the clinician has changed little since the origins of medicine. This further highlights the importance of the consistent, patient-based approach provided here as well as the historical perspectives included.
Finally, although the old portrayal of neurology as a “diagnose and adios” specialty is largely accepted as outmoded, the clinical knowledge-base and the coverage of research and therapeutic advances in Adams and Victor’s Principles of Neurology proactively encourage the clinician seeing patients suffering from neurological diseases to diagnose and administer, ameliorate, and advocate.
This fitting 50th anniversary edition of the major textbook in neurology affirms the appeal and durability of an iconic vehicle for the transmission of knowledge and wisdom acquired through experience.
Anthony E. Lang, OC, MD, FRCPC, FAAN, FCAHS, FRSC
Director, Edmond J. Safra Program in Parkinson’s Disease and the Rossy PSP Centre
Toronto Western Hospital
Toronto, Ontario, Canada