Autonomic Failure: A Textbook of Clinical Disorders of the Autonomic Nervous System, 4th edn

It is a pleasure to see the fouth edition of this well-regarded book on the autonomic nervous system. The book was first published in 1983 and has grown in size and scope with each succeeding edition. The present edition, with 55 chapters by 74 authors, incorporates the substantial advances made since 1992. It is divided into six parts. The first two parts contain accounts of the anatomy, physiology, pathology, and other basic aspects of the autonomic nervous system. They are followed by a section on clinical autonomic testing. The remaining three parts are clinically oriented and relate to primary autonomic failure syndromes, peripheral autonomic neuropathies, and other disorders associated with autonomic dysfunction. Most of the authors are from the United States or United Kingdom, with some from other European countries or Australia. A number of them are well-respected and widely known investigators or clinicians. The book is more wide-ranging in its coverage than is suggested by its title. For example, there are individual chapters on nerve growth factor and on genetic approaches to the autonomic nervous system, two chapters on the control of the cerebral circulation, and other chapters that focus on migraine, pain, shock, and sympathetic neural mechanisms in hypertension. Perhaps in consequence, the book sometimes appears to lack a certain cohesiveness. Would clinicians requiring further information on migraine or shock, for example, really think to turn to a book of this sort? It might have been preferable to maintain a rather more focused approach, in keeping with the original aims of the book as expressed in the preface. Furthermore, regardless of where they are placed in the framework of the book, many chapters provide only a general account of the subject, with little specific direction for clinicians who might turn to the book for practical advice or guidance. For instance, the index directs the reader seeking information on the postural orthostatic tachycardia syndrome to only one page, where it is discussed in a few brief lines that provide little guidance about the management of affected patients. These are minor concerns that do not detract from the overall value of the book. The book continues to have a useful role in providing a convenient introduction to, and summary of, the rapidly accumulating literature on the autonomic nervous system, and will be useful to clinicians in many different fields. It is a handsome volume, with a clear typeface, good illustrations and tables, a useful list of abbreviations in the front-matter, and an adequate index. I shall consult it often and can strongly recommend it. BOOK REVIEW