Simon Shorvon and Alastair Compston, with contributions by Andrew Lees, Michael Clark and Martin Rossor, 561 pp., Cambridge University Press, November 2018

Queen Square is one of those rare and special places where the walls and wards, labs and clinics hum with the stories of careers forged, patients saved and breakthroughs made. When I started clinical training in neurology, many of my teachers had worked at the famous Queen Square and regularly regaled us with anecdotes of their experiences, their narratives often triggered by clinical presentations of the most unusual ailments and maladies. Inevitably, this inspired an ambition to work there and I was pleased to spend a number of years undertaking clinical rotations and then subsequently postdoctoral work at the Sobell Department within the Institute of Neurology. These years served to imprint many of the names, periods, rivalries and discoveries that are explored in detail through Shorvon and Compston’s recently published history of Queen Square (figure 1). As a neurologist, the subject matter is infinitely fascinating, and the resulting work is both insightful and intriguing.

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Figure 1

Looking forward, looking back. A new history of Queen Square, building on the shoulders of a giant. A timely update of the original 1954 account by Holmes (‘one of the neurological giants, and in his generation was … the outstanding neurological exponent of the world’).1

It is difficult to conceive how one would embark on a history of Queen Square, an institutional giant across the clinical neurosciences with a history dating back to 1859. Faced with this challenge, the authors have chosen an engaging method that runs with multiple narratives, incorporating a focus on the biographies of dominant clinicians across three specific eras—the turn of the 19th century; the World War periods; Post-War to 1977. These narratives place Queen Square and its characters into a wider consideration of social history and the emergence of British neurology from national and international perspectives. As a result, there is a focus on clinical service development, the role of clinical research and the growth and necessity of hands-on training. Shorvon and Compston expertly explore the key tensions across the domains, with an often-penetrating articulation of the pressures expended on key individuals and their very human responses to these influences. As is often the case, financial difficulties served to precipitate a number of crises, particularly in early phases of the hospital when income was entirely philanthropic. These predicaments are thoughtfully examined with insights into the launch of the National Health Service and the advent of national health policies making absorbing reading.

The strength of Queen Square, particularly in its first hundred years, lay with the emerging reputations of its key clinicians. These individuals were largely responsible for the success of the Institution and its growth as an international centre of neuroscience excellence. As a consequence, I found myself engrossed in the biographical details of key individuals, people who had fascinated me, with the political discourse providing useful background. The dissection of Samuel Alexander Kinnier Wilson—a formidable man and clinician, described by McDonald Critchley as the ‘Marco Polo’ of the extrapyramidal system—was particularly incisive. While much of the narrative is well known, particularly Wilson’s ability to hold court in the outpatient department ‘using patients for themes for discourse’, the inclusion of photos, including of Wilson holding a teaching session for 110 postgraduates circa 1930, brought the historical conversation to life. The work also touches on Wilson’s founding of the Journal of Neurology and Psychopathology in 1920, perhaps marking his most lasting contribution to the clinical neurosciences, with the now Journal of Neurology, Neurosurgery and Psychiatry celebrating 100 continuous years of publishing innovations across those fields. As noted by the authors, it was Wilson’s diverse and expansive interest in the clinical neurosciences that translated into achievement and international reputation well beyond many of his peers.

Similarly, a fascinating account of Francis Martin Rouse Walshe, described as a ‘dominant figure on the staff at Queen Square in the middle decades of the twentieth century’ explores in detail his acknowledgement of Sir Charles Sherrington, and with it the desire to integrate physiological knowledge and reflex function into clinical neurology. Indeed, it was this very aspect of neurology that first drew me to the field—the direct translation of physiology as the underlying basis for neurological phenomena, with these notions subsequently taken on by many worldwide, including my own teachers.

The final sections of the book delve into the foundations for the current iteration of Queen Square. Inevitably, systems and networks become more complex and the need to establish larger research hubs are gradually recognised. In that vein, the attempt to entice Denny-Brown back to Queen Square makes fascinating reading, particularly when looking ahead to the current model of Queen Square and the Institute of Neurology. The concept of recruiting large functioning teams, rather than talented individuals, and providing institutional support to promote research success was clearly just the beginning of the Institute’s ongoing success, with expansions across all aspects of neuroscience research creating the behemoth that stands today. The crucial roles of David Marsden and Anita Harding in that transformation are justifiably highlighted. As a result, this book is a must-read for anyone who has an interest or background in neurology. The authors and contributors have produced an absorbing clinical, cultural and historical biography of one of the world’s great medical institutions—a gargantuan task. The Queen Square lineage indeed remains strong.