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Preface
In my training in the 1970s I was guided by many clinicians and also by books. Those large neurology tomes were useful, but it was the smaller texts that gave me insight into clinical practice. One by Dr Bryan Matthews, later Professor of Clinical Neurology at Oxford, was Practical Neurology published in 1963, when Matthews was a general neurologist in Derby. His was a book I could enjoy. Some comments are etched in my memory:
‘There are many admirable textbooks of neurology but it is a matter of common observation that they are of more assistance in the passing of written examinations than in the management of practical problems’. Another, quoting Sir Geoffrey Jefferson, remarked ‘ … in life the tracts are not marked in red …’
And, from Matthews on dizziness: ‘ … there can be few physicians so dedicated to their art that they do not experience a slight decline in spirits on learning that their patient complains of giddiness.…’
There was thus some logic in taking Neurology: A Queen Square Textbook, Second Edition, the major reference work that I initiated and edited with colleagues, and turning it into this shorter, practical book. I hope this Handbook will serve two purposes. First, it is to be read – each chapter aims to give a brief overview of an area of neurology. Secondly, this book, a synopsis of our subject, provides a pointer to Neurology: A Queen Square Textbook in its forthcoming Third Edition, a completely separate project that has been fully updated and enhanced by Robin Howard, Dimitri M. Kullman, David Werring, and Michael Zandi. Neurology: A Clinical Handbook is based on the second edition of Neurology: A Queen Square Textbook. The editors and authors of Neurology: A Queen Square Textbook have not been involved in the development of this Handbook.
I struggled with several things. First: references. I decided, because one can source most references rapidly on a mobile phone, I would focus only on those references of personal interest. These are largely my own – but with one paper from my late wife Dr Ruth Seifert on khat and another from my father Professor Sir Cyril Astley Clarke on fatal methyl bromide poisoning – from the 1940s; both are in Chapter 19. Well, I thought … this is my book.
Secondly, with radiology: the internet is full of excellent neuroradiology (e.g. Radiopaedia et al.) that far surpasses printed images. Do please search for such sources – some are mentioned via the additional notes and references on my website:
https://www.drcharlesclarke.com.
My main experience for some 40 years, like that of Bryan Matthews, has been as a general neurologist in UK district general hospitals, largely the busy battleground of Whipps Cross, but always attached to a major neurology unit, initially St Bartholomew’s and latterly Queen Square. I always found the variety within general neurology more attractive than its emerging specialties. I also broadened my experience by working further afield – during a meningococcal epidemic in Boston, in a leprosy clinic in Mysore, south India and elsewhere in India, Nepal and China, often in remote situations on mountaineering expeditions.
I thank many people. My parents Cyril and Féo Clarke were distinguished medical researchers, but I suspect they often despaired of me – their practical son who seemed focused on clinical practice and mountaineering, rather than research and publications. But they always gave me encouragement. Robin Coombs and Peter Lachmann grounded me in immunology at Cambridge. John Newsom‐Davis and Angela Vincent took me into the world of myasthenia at the Royal Free, and my colleagues at Queen Square made Neurology: A Queen Square Textbook both a reality and the source of this book. They are acknowledged personally in each chapter. Wiley commisioned this book and Simon Shorvon suggested I write it.
Within the chapters, Dame Sally Davies and Dr Elizabeth Davies helped me with aspects of public health. Professor Peter Garrard guided me through cognition and dementia. Michael Hayle helped me with the nomenclature of recreational drugs. Professor Kailash Bhatia and Dr Eion Mulroy provided an excellent video of movement disorders (Chapter 7), hosted securely in my website. The new neuroanatomy illustrations were generously provided by Professor Thomas Champney, a fellow yachtsman, I soon discovered, of Miller School of Medicine, University of Miami, Florida – from his excellent book Essential Clinical Neuroanatomy, Wiley Blackwell 2016.
I also searched outside Queen Square, from our former alumni. I found willing and valued contributors, especially to neuroradiology – Professor Raymond Cheung in Hong Kong and Dr Patricio Paredes and Dr Pablo Soffia in Chile.
Why Chile? My partner, Professor Dame Marcela Contreras qualified in Santiago before emigrating to England, long long ago – and she has provided me with immeasurable support.
My daughters Rebecca and Naomi, who have carried their grandfather’s ‘Astley’ into their successful business careers, have also helped, if distantly, by asking repeatedly ‘Dad, when are you going finish this book?’
My publishers Wiley have taken the project to its conclusion, smoothly and helpfully ‐ in particular Mandy Collison, Managing Editor and Sophie Bradwell, Associate Editor for Clinical Medicine in the UK, Hari Sridharan and Sathishwaran P, Content Refinement Specialists in Chennai, South India.
Lastly, and to acknowledge the value of her expertise, Sallie Oxenham in Paris has worked tirelessly on my website design and its content. Also, two MacBook Air computers have been my constant companions – and I have retained not a page of paper. Both computers were stolen several years ago, but Dropbox provided backup without a word being lost – unlike T.E. Lawrence, who mislaid the manuscript of The Seven Pillars of Wisdom on Reading Station in 1919 and had to rewrite the entire book from memory.
In my study I have a portrait of Dr Thomas Sydenham, my distant grandparent, with a note from my 19th and 20th century Leicester grandfather Dr Astley Vavasour Clarke, whom also I never knew – a picture that Astley V. had left to my father. If genes have a role in these endeavours, they probably had a hand in this too.
Charles Astley Clarke
March 2022
https://www.drcharlesclarke.com
Matthews WB. Practical Neurology. Blackwell Scientific Publications, Oxford, 1963 and later editions.
The National Brain Appeal
A proportion of the royalties from Neurology: A Clinical Handbook are donated to The National Brain Appeal. The charity raises funds to advance treatment and research at the National Hospital for Neurology & Neurosurgery and the UCL Institute of Neurology – Queen Square. Donations are used to improve outcome and quality of life for the one in six people affected by a neurological condition, by supporting pioneering research and helping to train tomorrow’s clinicians.
UK Registered Charity Number: 290173
