Book Review: Queen Square: A History of the National Hospital and Its Institute of Neurology

By Simon Shorvon and Alastair Compston, Cambridge University Press, Cambridge, 2019

Reviewed by Mark Hallett, MD, DM(hon)

Like most neurologists, I had always known about Queen Square as a mecca for neurology, and I got the opportunity to see it in action when I did a fellowship in London 1975-1976 with David Marsden. At that time, Marsden was at the Institute of Psychiatry in Denmark Hill, but I would go to the clinical demonstrations at Queen Square on Wednesdays and Saturdays. I paid my 50p, sat in the back, and observed the master clinicians.

McDonald Critchley examined a patient with alexia without agraphia and tried to determine whether she had lost her aesthetic abilities. M.J. (Sean) McArdle dazzled me with a 20-minute differential diagnosis of a “dropped index finger” that he observed on physical examination. A nice introduction. Later on, after Marsden moved to Queen Square, I became a frequent visitor. So, as many others, Queen Square has been part of my education. How did it get to be the center of British neurology and have so many achievements?

I was excited to see the book by Simon Shorvon and Alastair Compston. It is a book about the place, the people, and how they related. There are long sections about the important neurologists, but the authors decided not to discuss in detail those persons still alive (leaving later historians to clarify their roles). A bit disappointing, but understandable. The book is meticulous in detail, well researched, and can certainly serve as a single source for essentially everything you would ever want to know about Queen Square and its (deceased) inhabitants up until 1997 when it became a part of University College London.

The National Hospital for the Relief and Cure of the Paralyzed and Epileptic, formally founded in 1859, began admitting patients to a house in Queen Square in 1860 as the first hospital in the world specializing in neurology. The hospital was the idea of Johanna Chandler, and the book details her and her family and all the steps taken for the founding.

We learn the first patient was Margaret Warwick of 7 Hayes Court, Soho. The diagnosis is not noted, but we learn that she was cured! The first physician appointed was Jabez Spence Ramskill who worked there for 38 years. His appointment was followed by the first surgeon, Sir William Fergusson, who might never have actually shown up at the hospital. Three weeks later, Charles-Edouard Brown-Séquard was appointed. We learn in the book that he was already famous, having described his eponymous syndrome, and he was the first of the many accomplished neurologists who followed him. Brown-Séquard lasted only four years at the National Hospital, was hired by Harvard, lasted there only three years, and then bounced around until he succeeded Claude Bernard in the chair of Experimental Medicine at the Collége de France in Paris.

Shorvon and Compston describe the buildings, government relationships, the administrator, and the finances in detail, but I found myself more interested in the neurologists. The biographies, like that of Brown-Séquard, are full of colorful anecdotes. Jackson, Ferrier, Gowers, and Horsley are the “National Hospital Quadrumvirate.”

Jackson is also often referred to as Hughlings Jackson, and you can read the debate as to whether there should be a hyphen. Gowers was the first registrar at the hospital. His powers of observation and obsessive note-taking enabled him to make pioneering observations and become a master diagnostician. Osler described him as “arguably the greatest ever British neurologist”; Critchley wrote that he was the “greatest clinical neurologist who ever lived.” He was a popular lecturer and his textbook, Manual of Diseases of the Nervous System, is described here as “widely considered to be the most authoritative textbook of neurology ever written.”

Holmes, Wilson, Symonds, Walshe, and Critchley, the “five dominant physicians,” also get long biographies that are fun to read. Interestingly, Holmes and Wilson did not get along, as we learn in this quote:

“There was particular animosity between Holmes and Wilson, and, when making their respective rounds at Queen Square, each with his own retinue of doctors of all ranks, neither of them would move aside for the other, so that lengthy blockages ensued.”

Big personalities with big egos, but also many accomplishments.

Coming in to more modern times and persons that I knew, there are excellent biographies of Denny-Brown, one of my teachers at Harvard Medical School; Gilliatt, who joined me at NIH when he retired from Queen Square; Thomas, Newson-Davis, McDonald, Marsden, and finishing with Harding. Their personalities are well captured as well as the impressive elements of their curricula vitae. There is an appendix listing all of the neurologists and other physicians appointed at the National Hospital with their dates of appointment.

As a clinical neurophysiologist, I would be remiss not to mention some early highlights in that area as described in the book. While the first clinical EEG in the world was at the Massachusetts General Hospital, Queen Square was close behind. On the other hand, the EEG Society in Britain was founded in 1943 while that in the U.S. not until 1947. And, it is perhaps for that reason that the first international congress of EEG was held at the National Hospital in 1947. William Cobb and Denis Williams ran the lab at the beginning along with George Dawson. The latter got interested in somatosensory evoked potentials, discovered the giant SEP in cortical myoclonus, and then invented the averager to record these potentials with better signal-to-noise ratio.

The book is well illustrated, including the hospital building at various ages including architectural designs, and, of course, the people. There is a painting of Johanna Chandler and other early principals and photos of those in more modern times. A number are standard headshots or the groups of doctors or nurses, but there are some more interesting ones too, like that of Roger Gilliatt as the best man at the wedding of Princess Margaret and Anthony Armstrong-Jones, and the young Ian McDonald in the evoked potential laboratory.

The book is recommended highly as a valuable historical reference, but also for some entertaining reading about the history of neurology, many important neurologists, and the interesting place where they worked. •

Mark Hallett, MD, DM(hon) is the chief of the Human Motor Control Section of the National Institute of Neurological Disorders and Stroke at the National Institutes of Health in Bethesda, Maryland.