short memoir of dr. macdonald critchley

2
Macdonald Critchley’s The Parietal Lobes was already established as the definitive work in the field when I became his Senior House Physician at Queen Square in 1963. He was then the Senior Physician of the Hospital with responsibility for a considerable number of beds and teaching postgraduate students. He was moreover a major figure in British medicine, being Vice-President of the Royal College of Physicians and a member of the General Medical Council, the regulatory body of the medical profession. As a neurologist his opinion was widely sought within the UK and abroad. Despite the many demands on his time, he remained actively interested in disorders of higher cerebral function. A particularly enjoyable task for his Senior House Physician was keeping an eye open for cases anywhere in the Hospital that might interest him. His manner was serene and his approach unhurried. He conveyed the impression that his only concern was that of the moment. He was quietly spoken and his comments were models of precision. When he examined a patient with a cerebral disorder he would sit patiently taking a succession of items from the special bag that he kept for such cases, asking the patient to manipulate them or to answer questions about them. He would store his observations in his prodigious memory and write them down later in his large format case-books. After he retired he continued to see patients and to teach until he was in his eighties. In later years his secretary would sit behind him and record everything he and the patient said, noting even the pauses in the patient’s speech and their duration. Recalling now the impression that his sessions with patients of special interest created, I am reminded of Gordon Holmes’s (1954) description of the method of John Hughlings Jackson whose house physician he had been. Holmes (1954) wrote: “[Jackson’s method] was simple, and owed nothing to apparatus or instrumental techniques; it may be summed up as that of the unresting contemplation of facts of observation, scrupulously and untiringly acquired”. Critchley’s approach, like Jackson’s (of whom with his wife he wrote a biography in 1998) differed from that of the neuropsychologist. It was that of the physician and included observations of a more clinical nature. They too found a place in The Parietal Lobes (1953) and repay studying today. He set them in the context of a profound knowledge of the German and French literature (he spoke both languages fluently) as well as that in English. Here he displayed one of his great skills: his ability to distil the ideas of others and to make them comprehensible in short compass while retaining the flavour that in the original emerges from the richness of detail. Though The Parietal Lobes (1953) is Critchley’s best remembered contribution to neurology, there were many others, reflecting his wide-ranging curiosity and remarkable powers of observation and analysis, which enabled him to extract new insights from the symptoms with which his patients came. His early papers dealt with movement disorders and various aspects of calcium metabolism and its alteration in disease. His first contributions to the study of cerebral function came in 1927 in papers on defects in reading and writing in children (a topic to which he made a major contribution over the next 60 years) and a monograph Mirror Writing (1928). In the 1930s his writings show an increasing Cortex, (2006) 42, 782-783 BIOGRAPHICAL NOTE SHORT MEMOIR OF DR. MACDONALD CRITCHLEY BN 0-8058-2618-1, Lawrence Erlbaum Associates, 2003, 456 pages. Price: U.S.$ 49.95, U.K. £ 34.50.

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Page 1: Short Memoir of Dr. Macdonald Critchley

Macdonald Critchley’s The Parietal Lobes wasalready established as the definitive work in thefield when I became his Senior House Physician atQueen Square in 1963. He was then the SeniorPhysician of the Hospital with responsibility for aconsiderable number of beds and teachingpostgraduate students. He was moreover a majorfigure in British medicine, being Vice-President ofthe Royal College of Physicians and a member ofthe General Medical Council, the regulatory body ofthe medical profession. As a neurologist his opinionwas widely sought within the UK and abroad.Despite the many demands on his time, he remainedactively interested in disorders of higher cerebralfunction. A particularly enjoyable task for his SeniorHouse Physician was keeping an eye open for casesanywhere in the Hospital that might interest him.

His manner was serene and his approachunhurried. He conveyed the impression that his onlyconcern was that of the moment. He was quietlyspoken and his comments were models of precision.When he examined a patient with a cerebraldisorder he would sit patiently taking a successionof items from the special bag that he kept for suchcases, asking the patient to manipulate them or toanswer questions about them. He would store hisobservations in his prodigious memory and writethem down later in his large format case-books.After he retired he continued to see patients and toteach until he was in his eighties. In later years hissecretary would sit behind him and recordeverything he and the patient said, noting even thepauses in the patient’s speech and their duration.Recalling now the impression that his sessions withpatients of special interest created, I am reminded ofGordon Holmes’s (1954) description of the methodof John Hughlings Jackson whose house physicianhe had been. Holmes (1954) wrote:

“[Jackson’s method] was simple, and owednothing to apparatus or instrumental techniques; itmay be summed up as that of the unrestingcontemplation of facts of observation, scrupulouslyand untiringly acquired”.

Critchley’s approach, like Jackson’s (of whomwith his wife he wrote a biography in 1998) differedfrom that of the neuropsychologist. It was that of thephysician and included observations of a moreclinical nature. They too found a place in TheParietal Lobes (1953) and repay studying today. Heset them in the context of a profound knowledge ofthe German and French literature (he spoke both

languages fluently) as well as that in English. Herehe displayed one of his great skills: his ability todistil the ideas of others and to make themcomprehensible in short compass while retaining theflavour that in the original emerges from the richnessof detail.

Though The Parietal Lobes (1953) is Critchley’sbest remembered contribution to neurology, therewere many others, reflecting his wide-rangingcuriosity and remarkable powers of observation andanalysis, which enabled him to extract new insightsfrom the symptoms with which his patients came.His early papers dealt with movement disorders andvarious aspects of calcium metabolism and itsalteration in disease. His first contributions to thestudy of cerebral function came in 1927 in paperson defects in reading and writing in children (atopic to which he made a major contribution overthe next 60 years) and a monograph Mirror Writing(1928). In the 1930s his writings show an increasing

Cortex, (2006) 42, 782-783

BIOGRAPHICAL NOTE

SHORT MEMOIR OF DR. MACDONALD CRITCHLEYBN 0-8058-2618-1, Lawrence Erlbaum Associates, 2003, 456 pages. Price: U.S.$ 49.95, U.K. £ 34.50.

Page 2: Short Memoir of Dr. Macdonald Critchley

Biographical Note 783

concern with higher cerebral function, with paperson the dementias, hallucinatory states and aphasiaand another monograph, The Language of Gesture(1939). The Second World War led to a hiatus,though from his wartime observations in the Arcticand in the tropics he wrote Problems of NavalWarfare under Climatic Extremes, his Croonianlectures to the Royal College of Physicians in 1945.

After the war he returned to his interests indisorders of higher cerebral function, culminatingin The Parietal Lobes (1953) which was followedby Aphasiology and Other Aspects of Language in1970. His wide interests beyond neurology arerevealed in Silent Language (1975) and threevolumes of essays The Divine Banquet of the Brainand Other Essays (1979), The Citadel of the Sensesand Other Essays (1985) and The Ventricle ofMemory: Personal Recollections of SomeNeurologists (1989). His essays on topics asdiverse as self-portraiture (he painted well himself),gesture, Indian mythology and dance, criminals andman’s attitude to his nose revealed to a wideraudience his strengths as a literary stylist.Macdonald Critchley was in the mould of the greatfigures of the nineteenth century who definedneurology as a discipline. His contribution in the

middle of the twentieth century was a continuationof theirs, and provided part of the foundationsupporting in the twenty-first century the newedifice of Cognitive Neurology.

Ian McDonald

REFERENCES

CRITCHLEY M. Mirror Writing. London: Kegan Paul, 1928.CRITCHLEY M. The Language of Gesture. London: Edward Arnold,

1939.CRITCHLEY M. Problems of naval warfare under climatic extremes.

British Medical Journal, 2: 145-148 (173-177; 208-212),1945.

CRITCHLEY M. The Parietal Lobes. London: Edward Arnold, 1953.CRITCHLEY M. Aphasiology and Other Aspects of Language.

London: Edward Arnold, 1970.CRITCHLEY M. Silent Language. London: Butterworth, 1975.CRITCHLEY M. The Divine Banquet of the Brain and Other Essays.

New York: The Raven Press, 1979.CRITCHLEY M. The Citadel of the Senses and Other Essays. New

York: The Raven Press, 1985.CRITCHLEY M. The Ventricle of Memory: Personal Recollections of

Some Neurologists. New York: The Raven Press, 1989.CRITCHLEY M and CRITCHLEY E. John Hughlings Jackson, Father

of English Neurology. New York: Oxford University Press,1998.

HOLMES G. The National Hospital Queen Square 1860-1948.Edinburgh: E&S Livingstone, 1954.

Ian McDonald, Institute of Neurology, Queen Square, London WC1N 3BG, UK.e-mail: [email protected]