Defending the Cavewoman: And Other Tales of Evolutionary Neurology
Harold Klawans
New York: WW Norton &
Company, 2000; £15.95
ISBN 0 393 04831 4
Rating: 3/4
Harold Klawans was an evolutionary
neurologist and a "master
physicianstoryteller." Fans of
Oliver Sacks will become fans of Klawans.
He writes in the tone of a favourite old uncle
who tells you tales about his work. You
imagine he would have been a good bedside
teacher. Here Klawans describes cases of
neuropathology and attempts to localise the
lesion: he does so without complicating the
issue and makes general statements that are
easy to digest (and recall) rather than outlining elaborate theories. For example, he
simplifies all the pathology of aphasias into a
few brief words: "If a patient has more trouble speaking than understanding, the lesion
is towards the front of the dominant
hemisphere. If the patient has more trouble
understanding than speaking, the lesion is
towards the back of the hemisphere."
Like Sacks, Klawans illuminates and
entertains with his sympathetic clinical tales.
He was a classically trained neurologist who
saw the deficit and was interested in where
the lesion lay. Sack's approach is more
philosophical - what does the deficit mean
to the patient?
Klawans claimed to be "more clinician
than scientist." This rings true in his obvious
love of medical method. He will evoke the
envy of any medical student with his enthusiastic description of the neurological examination. While Klawans reminds us that the
charm of neurology lies in making the diagnosis by performing and correctly interpreting a clinical examination, many of us would
prefer the easier (but less elegant) option of
ordering computerised tomography and
only dream of the neuroexamination being
the dance that Klawans portrays.
He also demystifies the medical jargon
that so many students cling to. Throughout
the book he describes symptoms, eloquently
illustrating the sterile Latin or Greek
shorthand labels and poohpoohs the
dermatologist's trick of translating a symptom into Latin and calling it a diagnosis.
The shorter second part of the book,
entitled "The brain's soft spots: Programmed
cell death, prions, and pain," is where
Klawans comes into his own. This was more
interesting than the first part as Klawans
diverged from standard case histories to discuss in greater depth DNA, evolution, and
such. This is clearly where his passion lay
and his discussions and conjectures are
thought provoking. Included in the discussion are the origins of mad cow disease and
what makes smaller, weaker, sensedeficient
humans the rulers of the animal kingdom.
Klawans writes clearly and engagingly
while offering summaries that are uncontroversial and serve as good rules to remember
for basic brain localisation. The array of
patients' complaints and different aetiologies is fascinating. Evolutionary explanations for brain pathology make this text
different from standard case history
compendiums.
Sally - Ann S Price, fourth year medical student, University of Leeds
studentBMJ 2001;09:217-260 July ISSN 0966-6494
