The history and legacy of institutions, though immensely important, is a tricky subject to write about – almost inevitably so, for the more scholarly and comprehensive the writer aspires to be, the greater the risk of asphyxiating the readers’ interest. Mindful no doubt of this danger, Simon Shorvon and Alastair Compston have produced a truly outstanding account of the Mecca of neurology, from its founding in 1859 as the National Hospital for the Paralysed and Epileptic to the recent past. It would have been a formidable challenge weaving together its several themes into a coherent narrative – encompassing, inter alia, the hospital’s prodigious contribution to the evolution of neurology as a scientific discipline, the tensions in fulfilling its tripartite function of providing a clinical service while also maintaining its preeminent position as a centre of teaching research and the recurring financial and organisational threats to its independence.
Queen Square is thus a hefty volume (‘we have not spared the reader details’ (p. 1)) but, ingeniously structured and fluently written, a lively one enriched by vivid contemporaneous descriptions of personalities and events and numerous digressions culled from unpublished papers and memoirs and memories. The authors are fortunate that the history falls conveniently into three distinctive epochs of roughly 50 years, to each of which they allocate two complementary chapters – an integrative overview amplified further by a series of superb biographic profiles of the more prominent dramatis personae.
Queen Square’s meteoric rise from relatively humble beginnings to its preeminent status is inseparable from the exceptional calibre of its consultant staff – of the first 20 physicians appointed, no less than seven would be elected as Fellows of the Royal Society and four would be knighted. The dual perspective – institutional and biographical – afforded by those complementary chapters fruitfully allows the authors space to explore how the character and attributes of these eminent Victorians determined their achievements and the role of Queen Square, as a crucible of collective thought and action, in realising them.
The illustrious Sir William Gowers’ advocacy of the systematic, painstaking recording of the nuances of patients’ histories and physical examinations would both refine and expand the nosology of modern neurology. His own efforts, collating a vast database of more than 20 000 observations on 5000 patients, would lead to his describing several novel neurological disorders (ataxic paraplegia, vasovagal syncope, distal myopathy) and clinical signs (the palatal tremor, sleep paralysis). His magnum opus, A Manual of Diseases of the Nervous System, published in two volumes in 1886 would become ‘The Bible of Neurology’ that can still be read with profit today. And yet his monumental contribution to nosology, the authors note, is a ‘monument’ too to the institution in which he laboured for 40 years, whose reputation attracted patients with so wide a range of neurological disorders (p. 155).
Sir Victor Horsley, the ‘father’ of neurosurgery, illustrates in a different way the contribution of Queen Square as an institution. Horsley was primarily a brilliant experimentalist whose research on cerebral localisation of the simian brain is ‘one of the landmarks of nineteenth-century neuroscience’ (p. 156). Those experimental skills transferred to the operating theatre allowed him to operate with ‘great speed... dexterity and accuracy’ (p. 160). But the success of his audacious operations was predicated on the diagnostic acumen and collaboration of his Queen Square colleagues. This is seen to dramatic effect when he is joined by Gowers in the operating theatre to perform the first spinal decompression procedure – on an army captain with progressive paraplegia: ‘the operation was conducted in an atmosphere of much anxiety’ (p. 160). Horsley’s three initial exploratory incisions revealed no abnormality but, encouraged by Gowers, he persevered, thus exposing a small benign tumour pressing on the spinal cord whose removal would result in a complete recovery. The patient, we learn, remained in good health until he died 20 years later from an unrelated cause.
The intellectual calibre of the next generation of Queen Square neurologists with their own original contributions to neurology was, if anything, more impressive still: Gordon Holmes ‘possessed of seemingly inexhaustible physical and mental energy’ (p. 220) on the visual cortex and disorders of the cerebellum; the erstwhile classics scholar, Kinniar Wilson, ‘with a photographic memory and penetrating eye’ on the basal ganglia; MacDonald Critchley, ‘remembered for his silvery tongue and awe-inspiring erudition’ on the parietal lobes.
There has never been so distinguished a roll call, but their prominence as individuals was almost inevitably a source of friction and the authors detect a significant cultural shift away from the collective endeavour epitomised by the collaboration between Gowers and Horsley towards an, at times acrimonious, interpersonal rivalry. Meanwhile their patrician style and elitist self-perception fostered an exclusivist mentality, resulting – to Queen Square’s considerable disadvantage – in missed opportunities, neurosurgery foundered, neuropsychiatry neglected.
Come the post-war years, its viability as an institution would be further compromised by an instinctive antipathy to the principles of socialised medicine and a reluctance to embrace the novel methods of research of the ascendant clinical science. Queen Square had become, as one of its critics wittily expressed it, ‘one of the great silent areas of neurology’ (p. 279). Its fortunes revived with the appointment (astonishingly, if typically much contested) of the first professor of clinical neurology, Roger Gilliatt, who, with his successors, has presided over a tenfold increase in the numbers of specialist consultant staff.
As this schematic outline suggests, though primarily a superbly executed biography, Queen Square transcends its subject in also being a vivid portrait – perhaps unique – of the internal dynamics of an institution while conveying in high definition (as it were) the changing cultural and social mores of British medicine over the past 150 years.
