168 Injury: the British Journal of Accident Surgery Vol. 10/No. 2

major injuries unit and rarely in a sports injury clinic; indeed some of the examples are of road traffic accidents.

None the less, it is a valuable sports injury reference book with a particularly useful format. There are three sections; the first section deals with injuries according to the region of the body, the second section deals with injuries according to specific sports and the third section is almost a quiz. The second section could be very helpful in difficult clinical problems, such as the diagnosis of leg pain in runners. There are extensive references. Not surpris- ingly there is a bias towards American sports, and sadly some of the Olympic sports, e.g. rowing, do not get a mention in spite of the fact that they produce several intrinsic sports injuries.

This is a useful, readable and interesting book for all surgeons dealing with injury, but 1 doubt if it completely fills the need for a volume on the radiology of true sports injuries.

NIGEL TUBBS

An Introduction to Neurosurgery. By Bryan Jennett. 210×140mm. Pp. xii,+356 illustrated, with index. 1977. London, Hienemann. £9.95.

This is too good a book to be allowed to fall unguided into the wrong hands. In justice to the work it will be necessary to explain at some length why this should be so. But first, if its chief merits---its conciseness, clarity and high literary quality--are stressed, it will be better taken for granted that its popularity, which has called for a third edition within thirteen years, is well deserved. The recent cloud of economic depression has had at least one silver lining, in that publishers and editors can no longer squander so much print on bad and badly written books and articles. Surgeons aspiring to be intelligible in what they write might well model themselves on Professor Jennett who has, for some time now, set a high standard of literacy-- which would have been taken for granted by an eighteenth-century surgical writer, such as Pott. The recommendations in the foreword to the first edition of Jennett 's book-- their origins range, with appro- priate width, from Birkenhead to Kuala Lumpur- - have been amply justified.

Textbooks, we all know, cannot themselves teach surgery; but not everyone appreciates how confusing, occasionally, even harmful, they can be unless adequate practical experience accompanies their reading. Moreover, this experience must be guided by an adequately qualified supervisor. Any interest that

readers of Injury may have in neurosurgery will relate mainly to head injuries. Few such injuries ever require actual surgery; but for those that do, Jefferson made a distinction between neurosurgery and cranial surgery--an important practical distinction which should be widely understood. Neurosurgery requires a considerable understanding of the nervous system and its vasculature, much of which can be obtained from this book. I t requires also the practical experience of rather a long apprenticeship, at first, closely supervised, later, decreasingly so.

In contrast, cranial surgery extends only to the dura mater (except for those who have been taught how to make a small hole in that membrane in order to release subdural collections of fluid). Cranial surgery is easily learnt by almost anyone willing to submit to informed instruction. Basic medical knowledge is clearly desirable, but in fact an assort- ment of lay orderlies and others usefully performed a variety of minor surgical procedures during the exigencies of World War II. For example, a batman, who had been the night porter at a London hotel, readily picked up the technique of dealing compe- tently with wounds of the scalp and skull which had not penetrated the dura. Why then should not all who have the FRCS, particularly those in accident departments, be able to do the same?

It is not for lack of books such as this one, which gives precise instructions, it is simply that many have never been personally instructed. Even if they know how to make a burr hole (the technique is easily learnt and practised in the post-mortem room), it is still more difficult to know when and where to make one. It is this incomplete knowledge which may encourage inappropriate, and occasionally hazardous, surgical intervention, and worse, a failure to intervene appropriately.

This book is not therefore the answer to the maiden accident surgeon's prayer, but it is something good for him to read while he persuades his chief to allow him to go and work for at least six months in a place where there are plenty of head injuries; where there are surgeons who really know about head injuries and who, like the casualties themselves, will come in after the pubs have closed; and where someone knowledge- able is always available to discuss the management of a worrying case.

Experience in head-injury management is not mandatory for higher training and accreditation in orthopaedic surgery. It is therefore up to any surgeon who is likely to have consultant responsibility for these injuries later to make sure for himself that somehow he receives adequate practical training for this task.

JOHN POTTER