King R. An Atlas of Peripheral Nerve Pathology Arnold, London, 1999. ISBN 0 340 586664. 217 pp h/b. Price £125.00

Abstract

It is a rare event indeed that a pathological anatomy text could be referred to as exciting bedtime reading. Ros King's wonderful atlas is such an exception! She has succeeded in compiling a superb pictorial atlas of both normal and abnormal peripheral nerve morphology gleaned from nearly 1800 peripheral nerve biopsy specimens analysed over 30 (plus) years in the Department of Clinical Neurosciences at the Royal Free Hospital in London, under the guidance of Professor P.K. Thomas. It is enormously gratifying to see this volume appear as a permanent testament to the distinguished department that dominated this subject for so many years. It will be a particular pleasure for neurological residents (including myself), postgraduate students and the many other visitors who spend periods of training at the Royal Free Hospital, to browse this atlas. No doubt they will reminisce the weekly nerve biopsy reporting sessions, crammed like sardines in a darkened room around the microscope. Latecomers would be forced to crane their necks around the door to see the projected biopsies and listen to the erudite exchanges on morphological minutiae between Ros King and P.K. Thomas, interspersed with genially received offerings from the on-looking crowd. The volume is laid out as an atlas rather than a definitive textbook, the emphasis being very much on light micrographs of semi-thin sections and electron microscopy, accompanied by text which in the main amounts to little more than extended, descriptive legends. Within this pleasing and easily digestible format lies a fair degree of well-constructed order. The atlas is divided into sections, commencing with the normal anatomy and morphometry of peripheral nerves, including important chapters on preparative artefacts and biopsy techniques. The second section of the book is devoted to pathological changes in a very wide variety of neurological conditions. This section of the atlas is broken down into chapters describing the major pathological changes arising in axons, Schwann cells, myelin, extracellular compartments and blood vessels. There is also a detailed chapter on cellular infiltrates that are found in nerve biopsies, principally lymphocytes and macrophages. As a personal bias I would have preferred to see this chapter entitled ‘inflammatory changes’ and include images of immunoglobulin and complement deposits, neither of which are covered in any detail, if at all, in micrographs or in the text. Similarly, the important emerging field of skin biopsy as a means to examine neural elements is not covered. However, the content is not intended to be exhaustive, but more closely reflects the local view and experience at the Royal Free Hospital. The volume concludes with a vital appendix on tissue processing schedules. It is clear that the atlas has been compiled by a pathologist with an interest in clinical problems rather than a clinician with an interest in pathology. Thus, the layout is divided up according to pathological criteria rather than disease categories. As such it could be difficult to steer one's way around the book if searching for pathological abnormalities found in a particular clinical condition. However, the atlas is reasonably well indexed and contains an extensive bibliography of over 500 references. This atlas will be greatly enjoyed by a very large number of pathologists and clinical investigators interested in peripheral nerve disease for many years to come and forms an essential part of any departmental library, if not adorning a bedside table.