Book Review: The Essentials of Neuroanatomy

The book reviewed here is from 1973 – ‘The Essentials of Neuroanatomy’ by G Mitchell. On reviewing this book, I came across issues not just about neuroanatomy but also about how knowledge changes with time. Firstly it is a relatively short book at just over 100 pages. In the introduction Mitchell writes about how it started as a private text he had produced for his students. I was interested to learn a little more about the author and came across this obituary here which describes Mitchell as a surgeon and anatomy lecturer who inspired his students and practised surgery around the world. On reading through the book it dawned on me that every work on neuroanatomy is an interpretation much as orchestras will produce their own distinctive interpretation of a classical symphony. The book is divided broadly into three parts. The first part concerns itself with a discussion of the neuroanatomical structures and this is interspersed occasionally with physiology. The second part is a brief introduction to embryology whilst the third part is even briefer and provides the student with an overview of the dissection process.

The first part of the book is arguably the most important. Broadly speaking this consists of both the technical descriptions of the neuroanatomy and the insight laden explanations. I found the former quite hard going particularly as the illustrations are grey scale line drawings which are relatively sparse in the text. As an example

‘On transverse section the pons is seen to consist of a dorsal part which resembles the medulla and of a ventral part which contains both longitudinal and transverse fibres intermixed with small masses of grey matter (the nucleus pontis)‘

Of the latter, the following is an example (on the subject of the thalamus)

‘In .. animals with relatively simple bodies no elaborate sensorium is necessary and the cortex is practically non-existent. In these the thalamus is represented by a few small nuclei. As the body increases in size and complexity the ordinairy special sensory mechanisms become increasingly important. This is associated with a proportionate increase in the thalamus and by the development of cortical areas connected anatomically and functionally with it‘

Along the way, I found myself reminded of the underlying ‘logic’ of the central nervous system that must ultimately underlie the psychological phenomenon that we experience as well as the corresponding psychopathology.

In any interpretation there are constraints and for Mitchell he operates within the constraints of both the knowledge of his time and the medium through which he is interpreting the neuroanatomy.  There are sufficient advances in neuroanatomy for entire volumes to be concerned with single neuroanatomical structures that may take only a paragraph in Mitchell’s book. The methods of investigating the function of the neuroanatomical areas have increased considerably examples being functional Magnetic Resonance Imaging, intraoperative electrode recording and magnetoencephalography. Nevertheless even with these developments there will always be some basic features of neuroanatomy which will remain to be learnt and understood when first approaching the subject and Mitchell is able to communicate these with enthusiasm. However in the very technical areas the deficiencies in the medium become apparent. Text would be improved by more line drawings.

Even if this were addressed, the argument could be taken further. Grey scale line drawings would be improved by introducing colour. Colour drawings would be improved by labelled photographs. Labelled photographs would be improved by silent videos of the structures. Silent videos would be improved by videos with labels and a narrative. Ultimately this would be combined with the ability to rotate the structures through a software interface while accessing the narrative. The reason for this is that neuroanatomy is about 3 dimensional structures and relationships and while an elaborate language has developed to communicate relationships – one picture speaks a thousand words – and a video speaks ten thousand words. Ultimately the video would avoid any misunderstandings and help the audience to get close to the essence of nature. The neuroanatomical text evolves with technology to enhance the learning process.

So is this text redundant? Has it been surpassed by a whole new generation of bright gleaming technologically enhanced neuroanatomy texts. It seems a pity for this to be the case. Mitchell would no doubt have influenced many doctors in training and the book is thus not just a collection of pages but part of a wider system of people. Part of the culture of that period. Also Mitchell’s lifetime experience of surgery and anatomy is bound up within the book and here too there are deeper aspects to the book. Can a lifetime of learning condensed into a single work be easily replaced by technological and technical advances? After all, the student is a person who learns best by experiencing, problem solving and insight rather than an empty vessel waiting to be filled with a river of technical information. Will Mitchell’s text cease to influence medical culture with each successive year that passes as its last edition fades further into history? Does such a book serve a specific function within its era or does it depend upon other factors as with Gray’s Anatomy? In any case, I’m not going to throw my copy of the book away. As it sits on the bookshelf, testimony to the life of an author dedicated to an understanding of the theory and application of neuroanatomy, I expect at some distant point I will develop a flash of insight into a value that this book contains which is absent from colourful and technically advanced contemporary texts.

References

G.A.G Mitchell. The Essentials of Neuroanatomy. Second Edition. Churchill Livingstone. 1973.

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