Book Review: ‘The neurologists A history of a medical specialty in modern Britain, c.1789–2000.’

One of the most important contributions of this book is its consideration of how late-nineteenth and early-twentieth century descriptions and understandings of the brain and the nervous system fell within a wider humanistic project. Casper’s exploration of the archives of the Neurological Society of London offers a unique window onto the nature of debates on topical issues at the time, in particular the conflict between specialisation and general medicine or generalist approaches to the body and mind.

Stephen T. Casper, The Neurologists: A History of a Medical Specialty in Modern Britain c. 1789-2000

Manchester, Manchester University Press, 2014, 288 pages, hardcover £70.00, ISBN: 978-0-7190-9192-6

Stephen T. Casper’s first book is an interesting reflection on the early origins of neurological sciences and the reasons why they came to dominate descriptions of mental processes and human reasoning.  Casper uses traditional techniques in the history of medicine to reveal the long history of the birth and development of the specialism of neurology in Britain.

One of the most important contributions of this book is its consideration of how late-nineteenth and early-twentieth century descriptions and understandings of the brain and the nervous system fell within a wider humanistic project. Casper’s exploration of the archives of the Neurological Society of London offers a unique window onto the nature of debates on topical issues at the time, in particular the conflict between specialisation and general medicine or generalist approaches to the body and mind.  As Casper argues, ‘specialisation’ was an idea that was ‘peculiar to modernity’ which otherwise employed the language of evolution to develop organic models of society ultimately within functionalist sociology. His reflection on neurology as a discipline thus offers insights into how and why neurological hypotheses and ideas prospered in the British context as well how neurologists themselves negotiated their ability to offer wider insights on human nature whilst simultaneously protecting their own science.

Although the term ‘neurology’ can be traced to 1664 in the work of Thomas Willis, and was used by phrenologists in the late 18th-century, it appeared rarely in both medical and lay literature until the latter part of the 19th century.  The specialty of neurology also emerged at this time. Its origins are associated with the foundation of the journal Brain: A Journal of Neurology in 1876. However, Casper argues, neurology did not achieve a coherent form until the interwar period.  And even when it did, there were always attempts to protect it from the constraints of disciplinary limitations and to promote its insights more widely.

The Neurological Society of London had some pretty important members.  In 1886, John Hughlings Jackson became first president of the Society, its members also consisting of David Ferrier, who had famously experimented on cerebral localization of function in animals; Francis Galton, statistician and general polymath; and Herbert Spencer who had been critical in establishing the discipline of psychology using the logic of evolutionary sciences. The society brought thus together a highly significant group of intellectuals, providing a venue for the integration of multiple fields of knowledge.  Most physicians who were members of the Society regarded themselves as generalists with broad interests in physiology, medicine and the general issue of nervous conditions. As Robert Young has argued, these thinkers were critical to harnessing epistemological questions in psychology and relating them to theories of brain and nerve function. 1 Casper’s first chapter reflects on how these ideas influenced the formation of a distinct medical discipline of neurology in the twentieth century.

As many historians have noted, the First World War was critical in the rationalisation of medical practice and the drive for efficiency and economy that compelled the specialisation of both hospital care and scientific disciplines. 2 Casper’s second chapter explores the significance of this to the science of neurology where, he argues, it was particularly transformational.  This chapter looks in depth at the work of Henry Head and Russell Brain, neurologists at the London Hospital, and their discussions of war injuries.  It also examines how they considered the significance of their own practice, which is very revealing in its grandiosity, for example Head’s claim that he worked ‘in the passage-way between the physical universe and the dwelling place of the mind.’  There is something exceptional about these general claims to cultural and scientific knowledge and Casper elucidates this well.

Chapter three explores a controversial episode in the history of scientific research concerning Kathleen Chevassut’s research under James Morgan Purves Stewart into the spinal fluid of patients with multiple sclerosis. Chevassut claimed to have found an organism responsible for causing the disease and argued that a vaccine could be produced, publishing in the Lancet, but wider medical opinion turned against her, guided by the research of emerging expert Edward Carmichael.  Casper argues that this episode drew attention to the need for further regulation in neurological research and the formation of a new professional association, The Association of British Neurologists, from which Purves Stewart was forever excluded. The scandal brought to light the significance of professional guidelines and the threat of the Victorian ideal of united social and medical investigations.  Casper claims that it demonstrated why the science of neurology was restricted in its scope.

Chapter four explores the relationship between neurology and state medicine from the 1940s to the 1960s, pointing out that the success of the Association of British Neurologists and the growing monopoly of neurologists in carving out a well-supported and stable field of clinical practice.  The Association of British Neurologists lobbied the Ministry of Health to appoint an advisor in neurology, which they finally did in 1958.  As Casper notes, it was the success in the formation of neurology as a clinical science that ironically led to its demise as a comprehensive field of scientific enquiry.  At that point, laboratory research was increasingly conducted by basic scientists who did not have a wider interest in clinical problems. Neither did they necessarily have interests in the wider human sciences on the relation between psychology, physiology and evolution. What came to be known as the ‘neurosciences’ were demarcated as a separate field.

As Casper argues in the final chapter, the rise of specialized clinical neurology never fully replaced the earlier model of neurological sciences as part of a wider reflection on human nature and motivation. The formation of the ‘neurosciences’ that drew together biological sciences and social sciences have provided a new kind of outlet for these questions, although within a very different framework of professional expertise.

There are some limitations to Casper’s approach and his focus purely on neurology as a disciplinary practice.  Although this enables precision and focus, sometimes it detracts from the wider debates and discussions about nerves within other fields such as psychoanalysis, psychology and endocrinology.  Furthermore, greater contextualization of debates within the social sciences and the wider political landscape of Britain, particularly in the post-war period, would have enriched the discussion. The history of neurology and the neurosciences is becoming increasingly topical as today’s scholars wrestle again with the hierarchy of the disciplines and the potential of current neuroscience and epigenetics to renew or revitalize the disciplines of sociology and history. 3 4 Although Casper makes links between the historical discipline of neurology and today’s neurosciences, it would have been useful for him to have used more innovative questions to engage more strongly with work by Nikolas Rose and Fernando Vidal on the dominance of the neurosciences and the significance of this in relation to other social sciences, particularly in the post-war period. 5 6 There is much more to be said on how disciplinary lines in the ‘neuro’ disciplines have been drawn and how they may be drawn in the future.

Nevertheless, Casper’s book is a very good reflection on the history of disciplinarity and how knowledge has been created and passed down in the field of neurology. It is an excellent complement to histories of psychological and psychiatric knowledge. It is also a very good reference book as it presents a close reading of archival sources and is meticulously referenced. Casper’s first work also demonstrates his ability to think widely on the connections between disciplines in the creation of medical knowledge. It is thus a welcome addition to the literature on the history of neurology and other disciplines and their relation to the wider history of the human sciences.

Bonnie Evans is a Wellcome Trust Postdoctoral Fellow at Queen Mary, University of London.  She is conducting a project on Neuroscience, Psychology and Education: Autism in the UK 1959-2014. Her peer-reviewed publications include a recent article in History of the Human Sciences: ‘How Autism Became Autism: The Radical Transformation of a Central Concept of Child Development’. Her forthcoming book The Metamorphosis of Autism: A History of Child Development in England (Manchester University Press) is due out in December.