THE PUPIL: ANATOMY, PHYSIOLOGY, AND CLINICAL APPLICATIONS: By Irene E. Loewenfeld. 1999. Oxford: Butterworth-Heinemann. Price pound180. Pp. 2278. ISBN 0-750-67143-2.

Abstract

Inspection of the pupil and its reactions is an essential part of the standard neurological examination, and every neurologist learns to recognize abnormalities of clinical significance: miosis or mydriasis, anisocoria, a diminished or sluggish response to light, the relative afferent pupil defect, redilatation lag and light–near dissociation. Most of these pupillary abnormalities have been recognized since the 19th century, some even before that, but our understanding of the mechanisms involved is more recent. It derives mainly from the painstaking research carried out on both animals and man by two German emigré scientists, Otto Lowenstein and Irene Loewenfeld. They established a pupil laboratory in New York in 1940, moving 8 years later to the Columbia-Presbyterian Medical Center. From this laboratory they published a large number of papers in journals of great prestige, attracting medical and other scientists from far and wide, and their influence today is such that almost all current pupil research derives from their work.We learn in the opening section of this book, that when Otto Lowenstein died in 1965, they had already started the enormous task of assembling all their accumulated material, both basic and clinical, into book form. Irene Loewenfeld was left to continue this project alone, a task made all the more difficult because by training she was a physiologist, not a clinician, and she admits that she lacked the necessary clinical experience which she saw as necessary for the job in hand. But after years of intensive labour, the book emerged. It is a fitting monument to Lowenstein himself and to the work they did together.The book is enormous. Volume 1 contains the written material set out in five parts: \`Anatomy and physiology', \`Special fields', \`Methodology', \`Pupillary pathology: symptomatology' and `Pupillary pathology: pupillary signs in various diseases'. This volume contains 1590 pages of …