J Neurol Neurosurg Psychiatry 1999;67 833 Prospective, population based studies of 3 Egger M, Schneider M, Davey Smith G. Spuri- 7 Politzer A. Die anatomische und histologische ous precision? Meta-analysis of observational Zergliederung des menschlichen Gehörorgans. cavernous malformations are needed studies. BMJ 1998;316:140–4. Stuttgart: Enke, 1889. 4 Brown RD Jr, Wiebers DO, Torner JC, et al. 8 Politzer A. Geschichte der Ohrenheilkunde. In their welcome systematic review of su- Incidence and prevalence of intracranial vascu- Stuttgart: Enke, 1907 Band I, 1913 Band II. pratentorial cavernous malformations and lar malformations in Olmsted County, Minne- 9 Politzer A. Die Beleuchtigungsbilder des Trommel- 1 sota, 1965–1992. Neurology 1996;46:949–52. fells im gesunden und kranken Zustande. Wien: epilepsy, Moran et al illustrate the pitfalls of 5 Rigamonti D, Drayer BP, Johnson PC, et al. The Braunmüller, 1865. regarding the prognosis of a disease in MRI appearance of cavernous malformations 10 Politzer A. Atlas der Beleuchtigungsbilder des selected case series as representative of its (angiomas). J Neurosurg 1987;67:518–24. Trommelfells im gesunden und kranken Zustande. natural history.2 Studies of cavernous malfor- Wien: Braunmüller, 1896. mation prognosis have usually lacked clear Neurological stamp: Adam Politzer inception cohorts with respect to mode of presentation and treatment. Referral filter (1835–1920) bias has so often restricted ascertainment by tertiary referral centres, and further selection Recently, I found an interesting manuscript BOOK REVIEWS bias has made the prognosis seem worse than in your journal about Adam Politzer under it really is, as demonstrated by the authors’ the section on neurological stamps. I was own series of 33 patients in which temporal mildly disappointed by the presence of some lobe lesion location and intractable seizures inaccuracies concerning the biography of predominated. Conversely, by leaving com- Adam Politzer, and write to you to correct these imprecisions. Mononeuropathies: Examination, Diagnosis munity mortality unaccounted for, the prog- and Treatment by A STAAL, J VAN GIJN, and F Adam Politzer published in 1878 the first nosis can seem better than it actually is. SPAANS (pp 243, £35.00). Published by W B Completeness of follow up has been variable volume of his textbook of otology under the Saunders, London, 1999. and not always prospective. Furthermore, original German title Lehrbuch der Ohren- authors have varied in their choice of heilkunde für praktische Ärzte und Studierende. The authors say that they wrote this book from The second volume was published in 1882 to a frustration at having to look at several diVer- outcome, in particular their definition of 1 haemorrhage (clinical or radiological), choice complete his work. Since the second edition, ent sources to solve a single clinical problem. of period at risk (from birth, time of diagno- this textbook of otology was printed in one The introductory chapters contain sound sis, or start of observation) and calculation of volume. clinical advice on a general approach to outcomes for each patient or for each lesion. The finding that ossicles vibrate to sound patients with mononeuropathy. Then each Any analyses of such heterogeneous case stimuli was not made by Politzer but by Her- nerve is dealt with in turn using the same for- series should be ruthlessly systematic, but mann von Helmholtz with his resonance mat: anatomy; history; examination— even so it is necessary to be wary about draw- theory published in 1863 completed by the including the method of examination of the mechanism of ossicles and tympanic mem- ing firm conclusions from them.3 relevant muscles and the area of sensory brane in 1868.2 Politzer was one of his The only existing population based study loss—electrophysiological findings; diVeren- students in 1861 in Heidelberg. of cavernous malformations,4 albeit with a tial diagnosis; causes, often tabulated; and Adam Politzer invented, notably, a revolu- denominator of merely 50 000, was retro- finally treatment. The line drawings of the tionary method to make the eustachian tube spective. The study spanned fundamental anatomy are clear, highlighting sites of com- permeable in 1863,3 developments in the non-invasive diagnosis of a method which made pression. The line drawings of power testing cavernous malformations during the 1980s him famous and carries his name. He also are less satisfactory. The movement to be developed an acoumeter in 18774 to measure with magnetic resonance imaging,5 which led tested is well illustrated but the site of the to increasing detection rates with time. hearing, replacing the watch, which was used muscle being tested (and hopefully observed) There is, therefore, clearly a need for a until this date. is not shown and for some muscles lies outside large, population based, prospective, contem- In 1864 Politzer founded with Anton von the illustration. This is followed by some porary epidemiological survey of cavernous Tröltsch and Hermann Schwartze the first chapters discussing causes of peripheral nerve malformations to establish their frequency German and international journal of otology injury other than focal lesions, including and prognosis. With a broad collaborative under the original title Archiv für metabolic and physical factors and tumours. Ohrenheilkunde.5 In 1879 The American Jour- The description of the clinical syndromes is network, including the three other neuro- 6 science centres in Scotland, the Scottish nal of Otology was founded and edited by clear and succinct and well referenced Intracranial Vascular Malformation Study Clarence J Blake and was printed for only 4 throughout. The advice on treatment is sensi- (SIVMS) has been set up (http:// years at this time. ble with a strong emphasis towards conserva- www.dcn.ed.ac.uk/ivm/) to do just this for all In addition to more than 100 publications tive management with clear statements as to types of intracranial vascular malformation in medical journals, and besides his textbook when more rapid intervention is needed. (IVM). Using multiple, overlapping sources of otology, Adam Politzer published three The text is interspersed with illustrative cases of case ascertainment we are building an other books, all translated into English. As which appear in boxes. I thought this worked inception cohort of all incident cases of any well as one book about anatomical and histo- well, although was surprised to find eight doc- logical dissection of the human ear7 and one tors (including a Professor of Neurology with a type of IVM diagnosed after 1 January 1999 8 in the population of Scotland (5.1 million). about the history of otology. Politzer pub- partial musculocutaneous nerve lesion, and a lished an atlas of the tympanic membrane in Dean of the Faculty of Medicine with neural- With prolonged follow up of this cohort we 9 10 hope to settle some of the uncertainties high- 1865, completed and reprinted in 1896. gic amyotrophy), among the 40 or so cases. Politzer was certainly the greatest otologist lighted by Moran et al.1 Moreover we agree While for mononeuropathies the book of the 19th century and probably one of the that, with such poor data available, a manages to act as a single point of reference it greatest of all time. His influence during 50 randomised controlled trial of surgical versus does not do this for some similar clinical years of otology has never been equalled. conservative treatment for cavernous malfor- problems whose presentations may be simi- mations is overdue. ALBERT MUDRY lar. It only briefly touches on radiculopathies ENT Department, University Hospital, Av. de la Gare as they appear in the diVerential diagnosis of RUSTAM AL-SHAHI 6 CH-1003 Lausanne, Switzerland mononeuropathies and skirts round some CHARLES P WARLOW email: [email protected] contentious issues such as the thoracic outlet Department of Clinical Neurosciences, Western General syndrome. The anatomy of the brachial Hospital, Crewe Road, Edinburgh EH4 2XU, UK plexus (something I always have to look up) is Correspondence to: Dr Rustam Al-Shahi, MRC 1 Politzer A. Lehrbuch der Ohrenheilkunde für prak- tische Ärtze und Studierende. Stuttgart: Enke, not reproduced. Clinical Training Fellow, Department of Clinical 1878 Band I, 1882 Band II. Overall I think the authors have succeeded Neurosciences, Bramwell Dott Building, Western 2 von Helmholtz H. Mechanik der Ge- General Hospital, Crewe Road, Edinburgh EH4 hörknöchelchen und des Trommelfells. in their objectives and there is indeed justifi- 2XU email [email protected] Monatsschr Ohrenheil 1868;2:159–64. cation for this book. The book is moderately 3 Politzer A. Ueber ein neues Heilverfahren gegen priced at less than half the price of the com- Schwerhörigkeit, infolge von Unwegsamkeit bined costs two of the books they aim to 1 Moran NF, Fish DR, Kitchen N, et al. der Eustachischen Ohrtrompete. Wien Med Supratentorial cavernous haemangiomas and Wochenschr 1863;6:83–90,102–4. replace. epilepsy: a review of the literature and case 4 Politzer A. Ueber einen einheitlichen Hörmesser. I would suggest that most neurology units series. J Neurol Neurosurg Psychiatry Archiv für Ohrenheilkunde 1877;12:104–9. should get a copy. I would urge you to 1999;66:561–8. 5 Poliker A, van Troeltsch A, Schwartze H. Archiv persuade your orthopaedic colleagues to get 2 Sackett DL, Haynes RB, Guyatt GH, et al. für Ohrenheilkunde. Würzburg: Stahel. Erster Clinical epidemiology. A basic science for clinical Band, 1864. one too. medicine. 2nd ed. Boston: Little, Brown, 6 Blake C J. The American Journal of Otology. Vol I. 1991:173–85. New York: Wood. 1879. GN FULLER.