Lord Brain 2012 Commemorative Booklet

Lord Brain Memorial Lecture 2012Professor Colin BlakemoreEvolution of the human brain: why was bigger better?Commemorative Booklet

ContentsProgramme

Message from Professor Gavin Giovannoni

Biography Lord Brain

The Neurological tradition at the London Hospital

Biography Professor Richard Trembath

Biography Professor Colin Blakemore and recipient of the Lord Brain Memorial Medal

Lecture abstract Lecture abstract – Evolution of the human brain: why was bigger better?

Neuroscience at Barts and The London

Blizard Institute

Past recipients

Walter Russell Brain1895 - 1966

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Commemorative Booklet 03

ProgrammePerrin Lecture TheatreThursday, 21 June 2012, 5.30pm

• Welcome addressProfessor Gavin Giovannoni, Professor of Neurology, Barts and The London

• IntroductionProfessor Richard Trembath, Vice Principal and Executive Dean, Barts and The London

• LectureProfessor Colin Blakemore, Professor of Neuroscience, University of Oxford

• MedalAward and Presentation

• Reception

02 Second Lord Brain Memorial Lecture


Message from Professor Gavin Giovannoni

Dear Colleagues,

Welcome to thesecond Lord BrainMemorial Lecture.

When I wasappointed to Bartsand The London inlate 2006, I wasparticularlyimpressed by thehistory of the Royal

London and St Bartholomew’s Hospitals and theirrespective medical schools. As a newcomer, Icouldn’t understand why we weren’tacknowledging and celebrating theachievements of these two great Institutions inthe fields of neurology, neurosurgery andneuroscience. I therefore established The LordBrain Memorial Lecture and Medal to celebrateand acknowledge Walter Russell Brain’soutstanding contribution to neurology at Bartsand The London.

The biennial Lord Brain Memorial Lecture andMedal honours a healthcare professional orscientist who has worked in the United Kingdomand has made a major scientific contribution tofield of neuroscience. The task of selecting therecipient of the second award was not an easyone as several outstanding candidates werenominated. I hope you all agree that ProfessorColin Blakemore is a worthy recipient of theaward. Professor Blakemore has done seminalwork on many aspects of vision, braindevelopment and plasticity andneurodegenerative diseases. His successful

tenure as Chief Executive of the MRC, from 2003to 2007, and his influence on national sciencepolicy are well recognised. He has been awardedmany prizes for both his research and his work inthe public communication of science.

Once again we like to welcome Lord Brain’sfamily who are attending this evening for being soaccommodating and supportive of this initiative.

Events of this nature do not just happen and Iwould therefore like to thank the School ofMedicine and Dentistry for their long-termcommitment to this event and their financialsupport, Denise Sheer, Rodney Walker andNicola Brain co-members of the Lord Brainselection committee for their time and efforts,Professor Trembath, our Vice Principal andExecutive Dean, for kindly agreeing to do theintroduction this evening, Professor Swash,Emeritus Professor of Neurology, for writing ashort essay on the neurological tradition at TheLondon Hospital, Dr Morag Brothwell forresearching and then writing a mini-biography onLord Brain and Surinder Pal, our administrator,who makes this event happen.

Thank you for attending the lecture; I am sure theevening will be an enjoyable one.

Yours sincerely

Gavin Giovannoni


Professor Gavin GiovannoniMBBCh, PhD, FCP (S.A., Neurol.), FRCP, FRCPathBlizard Institute, Barts and The London School of Medicine and Dentistry

Gavin Giovannoni was appointed to the Chair of Neurology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London and theDepartment of Neurology, Barts Health in November 2006. In September 2008 he took over as the Neuroscience and Trauma Centre Lead in the Blizard Institute. Gavin did hisundergraduate medical training at the University of the Witwatersrand, South Africa, where hegraduated cum laude in 1987 winning the prizes for best graduate in medicine and surgery.He moved to the Institute of Neurology, University College London, Queen Square, London in1993 after completing his specialist training in neurology in South Africa. After three years as a clinical research fellow, under Professor Ed Thompson, and then two years as the ScarfeLecturer, working for Professor W. Ian McDonald, he was awarded a PhD in immunology from the University of London in 1998. He was appointed as a Clinical Senior Lecturer, Royal Free and University College Medical School, in 1998 and moved back to Institute ofNeurology, Queen Square in 1999. He was promoted to Reader in Neuroimmunology in 2004. His clinical interests are multiple sclerosis and other inflammatory disorders of thecentral nervous system. He is particularly interested in clinical issues related to optimising MSdisease modifying therapies. His group’s current research is focused on Epstein Barr virus as apossible cause of multiple sclerosis, defining the “multiple sclerosis endophenotype”, multiplesclerosis related neurodegeneration, biomarker discovery, clinical outcomes and immunetolerance strategies. The group focuses on translational research and have an active clinicaltrial programme.

unconscious, which inspired Brain to consider acareer in psychiatry. But Riddoch advised himthat he’d ‘better learn some neurology first.’ And so he did, but he never lost his interest inpsychiatry and the workings of the human mind.Some years later, Brain became interested in theconundrum of consciousness and themechanisms of perception. When neither hisneurological expertise nor philosophical theoriescould offer sufficient explanations, he soughtanswers in his own philosophical musings,displayed in his book Mind, Perception andScience (1951).

Once qualified, Brain’s ascent was rapid.Following his house physician years at theLondon, he moved to Maida Vale Hospital forNervous Diseases to work as a registrar and waslater appointed physician. He then returned tothe London Hospital in 1925 and was elected tothe staff in 1927. These were his mainappointments until retirement. With Eric Strauss,with whom he had been a medical student atNew College, he wrote and edited a series ofreviews Recent Advances in Neurology andNeuropsychiatry. This was first published in1929 and was hugely popular. It was followed in 1933 by his seminal work Diseases of theNervous System, which he continued to reviseuntil 1962. Clinical Neurology, a shorter text forstudents, was published in 1960, and hismonograph, Speech Disorders in 1961. He wasthe editor of the journal Brain from 1954 until hisdeath, and for some time he edited the QuarterlyJournal of Medicine. During this time, Brain hadproved himself to be an excellent clinician with avery popular Harley Street practice. His patientsencountered a quiet, serious man of few words

but great wisdom and compassion. His famedsilences may have at times brought unease, butto those who knew him they were signs of deepthought. His observations during his clinics led to a number of significant contributions toneurology. However, one particular contributionresulted from a problem he observed closer tohome. Brain had noticed how his wife wouldcomplain of pain and paraesthesia in her handafter pruning shrubs in the garden - a commonproblem which we now know is caused bycompression of the median nerve in the carpaltunnel of the wrist. In 1947, Brain and twocolleagues described six such cases in middleaged women and Stella was the first to undergodecompression of the median nerve for carpaltunnel syndrome!

In another important report he demonstrated how cervical spondylosis could cause a variety ofneurological disturbances by compression of thecord or spinal roots. Brain and his colleagues,especially Marcia Wilkinson, showed how thedegeneration of the intervertebral disc andsubsequent osteo-arthritic reaction of adjacentvertebrae could result in new bone formation,that impinged upon the nerve roots. In addition,intervertebral discs protruding posteriorly into the cervical canal could reduce canal diameter.These features were demonstrated radiologicallyby injection of opaque medium into the spinalcanal (contrast myelography), and the findingsled to the introduction of a laminectomy astreatment for this condition. Some UnknownProblems of Cervical Spondylosis was publishedin 1963 having been the topic of the Gowersmemorial lecture the previous year.


Walter Russell Brain 1895-1966 Baron Brain of Eynsham: a biography

Russell Brain wasborn in Reading in1895. His father,Walter John Brain,was a solicitor whohad founded asuccessful legalpractice with hisbrother. Hismother, Edith AliceSmith, was thedaughter of thearchitect Charles

Smith who had served the city of Reading twiceas Mayor. The young Russell Brain attended agood preparatory school in Reading and won ascholarship to Mill Hill, from where, intending acareer in law, he read Classics. Realising he wasbetter suited to science, he found that a changeof course was not allowed and was persuaded tostudy history instead. He left school without theeducation he had sought but well known for hiswider interests: a keen supporter of the literaryand debating society, and of the photographicsociety, and secretary of the natural historysociety. This breadth of interest was to be aremarkable feature of his future public life.

The following year, he studied at ReadingUniversity College and then went up to NewCollege, Oxford to read history in 1914, but thiswas the year that war was declared. Disapprovingof war, he became involved in fundraising forBelgian refugees who had fled to England andwere in need of food and shelter. He and a friend,Rev. P N Harrison, held the second ‘flag day’ inEngland to raise money for their plight. He thenwent up to Oxford, where after his first year, quite

unmotivated, he failed his prelims. He laterreflected ‘I have never been able to rememberhistory: my mind being more suited to logicalrelationships.’ This called for a change indirection, and a month later, Brain joined theFriends Ambulance Unit, a Quaker organisation.After travelling to a military hospital in York, heused his experience of photography and a bookabout x-rays to become an orderly in the x-raydepartment. He later transferred to the x-raydepartment in King George Hospital where hemet his future wife, Stella Langdon-Down. Stellacame from a well-known medical family, and wasthe grand-daughter of the distinguished LondonHospital physician John Langdon Down, whodescribed the eponymous Down’s syndrome. It was Stella who encouraged Russell to studymedicine and so, taking her advice, he joinedevening classes at Birkbeck College in zoology,botany, physics and chemistry, and subsequentlypassed the London M.B. In January 1919, hereturned to New College as a medical student,and passed the Oxford B.M., having beenawarded the Theodore Williams’ Scholarship inphysiology. In September 1920 he married Stellaand was awarded the Price Entrance Scholarshipto train at the London Hospital, where his father-in-law had trained and worked. He qualified B.M.B.Ch (Oxon) in December 1922.

At the recently established medical unit of theLondon Hospital in Whitechapel, Brain begantraining under the supervision of the FirstAssistant, George Riddoch. Riddoch was anexpert in war injuries of the nervous system, andintroduced Brain to clinical neurology. At thetime there was growing interest in ‘the newpsychology’ – a psychopathology based on the


documenting which books were worthwhile(some of which he would recommend to hispatients) and kept several notebooks ofquotations that he would use for after-dinnerspeeches, which were always carefully preparedand rehearsed.

His poems and verses were printed privately in1962, and he published a number of volumes ofcritically acclaimed essays including SomeReflections on Genius, reviewed by one critic as a‘pithy, learned and very readable’ exploration ofintellect. In this essay he likened the intellectualtrajectories of the poet and the scientist in theirsearch for inspiration and discovery, bridging thetwo worlds he inhabited. The Nature ofExperience summarised a series of Riddellmemorial lectures that Brain gave in 1958,describing the processes of perception and themechanisms of hallucination and illusion, areflection of his fascination with the mind. In1957, he wrote Tea with Walter de la Mare, asmall book recollecting conversations with thepoet, which was deemed ‘one of those whichwould retain a place on the shelf of the elect’ by a reviewer.

In the public eye, Russell Brain was a trulyexceptional clinician, statesman, philosopher,writer and poet, but behind the scenes he was adevoted husband and father to his three children,Christopher, Michael and Janet, and a loyalmember of the Society of Friends. Asked to whathe owed his success, Brain would answer that,firstly ‘it would be genes a long way ahead ofother factors’, and then secondly his wife, whoencouraged him to study medicine andsupported him throughout his life.

Morag Brothwell, Christopher Brain, Gavin Giovannoni and Michael Swash

References Pickering, G.W. Walter Russell Brain First BaronBrain of Eynsham. 1985-1966. Biogr. Mems Fell.R. Soc. 1968 14, 61-82

Osmond, H. Some Reflections on Genius. The Canadian Medical Association Journal1961: 85; 756-757

http://www.jstor.org/pss/25410717 –Obituary in BMJ

Autobiographical Notes by Lord Brain


Walter Russell Brain 1895-1966

Brain, with a team at The London Hospital,especially Ronald Henson and Henry Urich, were among the first to describe paraneoplasticsyndromes. In 1951, Brain, Greenfield andDaniel described the degeneration of thecerebellum and spinal cord in association withcancer of the lung and ovary, pathology whichcould not be explained by metastasis or infection.They collected data from forty-three cases withwidely varying neurology, includingneuromuscular lesions and dementia. Theseobservations led to the development at theLondon Hospital of a Unit for the Investigation ofcarcinomatous neuropathies, of which Brain wasdirector until his death, and in 1964 he andRaymond Adams proposed the first classificationof these paraneoplastic disorders.

In addition to his outstanding contribution to thefield of neurology, Brain was well-known for histhoughtful statesman-like nature and for hissense of fairness, perhaps deriving from hisQuaker background. He played a major role inthe early development of the National HealthService, in the Royal College of Physicians and inother influential Committees of the day, offeringhis succinct and insightful analyses on a widenumber of issues. He began by serving on theHospitals Committee and Journal Committee ofthe British Medical Association. He was alsosecretary of the London Hospital Medical Counciland became its chairman at a difficult timeduring the Second World War, when it wasnecessary to assert the interests of medical staffaway on active service. In 1950 he was electedPresident of the Royal College of Physicians, aposition he held until 1957. Under Lord Moran,the Royal College had become influential in

medical politics. Brain also became one of theleading medical statesmen of his time, involvedin any matter where the interests of the publicwere relevant to or affected by the medicalprofession. In this capacity, he was appointed toa number of Royal Commissions including thaton Marriage and Divorce in 1952, and on MentalCertification and Detention in 1954. Here heplayed a vital role in improving conditions forpeople with mental health problems. Thepresent law on drug addiction is also largelybased on the recommendations of his committeeon drug addiction in 1966. In 1963, he was alsoelected President of the British Association forthe Advancement of Science, a great honour to a physician still in active practice. He wasparticularly honoured by his election toFellowship of the Royal Society in 1964, a majorachievement for a clinician not engaged directlyin scientific work, and was a member of theCouncil of the Royal Society in 1965. Hiscontributions to medicine and to society ingeneral were recognised by his appointment to the Order of Knights in 1952, and then as aBaronet in 1954, and a Baron in 1962, leading to his entry into the House of Lords. He was anhonorary fellow of New College, Oxford, as well as numerous universities in this country andabroad, and was President of the Association of Physicians in 1956 and of the Association ofBritish Neurologists in 1960.

Given these many responsibilities and accolades,it is remarkable that Brain maintained so manyinterests outside the medical arena. He was akeen bird-watcher, gardener and photographerand was well-known for his love of literature andphilosophy. He read widely, carefully



Walter Russell Brain 1895-1966Bibliography


PAPERS1922-23. (With G. RIDDOCH.) Case of right fronto-parietal tumour; cracked-pot percussion note

over right frontal bone; left palmar reflex. Proc. Roy. Soc. Med. 16 (Sect. Neurol.), 84. 1923. Epidemic hiccup and encephalitis lethargica. Brit. med. J. 2, 78. 1925. The mode of inheritance of hereditary ataxia. Quart. J. Med. 18, 351. 1925. A clinical study of increased intracranial pressure in 60 cases of cerebral tumour.

Brain, 48, 105. 1926. On the rotated or 'cerebellar' posture of the head. Brain, 49, 61. 1926. The inheritance of epilepsy. Quart. J. Med. 19, 299. 1926. The nervous symptoms of insulin hypoglycaemia in rabbits contrasted with the convulsions

induced by cocaine. Quart. J. Exper. Physiol. 16, 43. 1927. The association of low blood cholesterol with the occurrence of fits in epileptics. Lancet, 2,

325. 1927. On the significance of the flexor posture of the upper limb in hemiplegia, with an account of

quadrupedal extensor reflex. Brain, 50, 113. 1927. Heredity in simple goitre. Quart. J. Med. 20, 303. 1928. Posture of the hand in chorea. Lancet, 1, 439. 1928. The treatment of the sequels of head injury. Lancet, 1, 668. 1928. The use of hypertonic solutions in the treatment of increased intracranial pressure. Brit.

med. J. 1, 86. 1928. The treatment of tic. Lancet, 1, 1295. 1928. Facial naevus: Tumour of the pons, ?angioma. Proc. Roy. Soc. Med. 21, 1319. 1928. (With G. RIDDOCH.) Diseases of the brain and skull. In A textbook of surgical diagnosis

(edited by A. J. Walton), 1, 462. 1929. (With M. LANGDON-DOWN.) Time of day in relation to convulsions in epilepsy. Lancet, 1,

1029. 1929. (With D. HUNTER & H. M. TURNBULL.) Acute meningo-encephalitis of childhood. Lancet,

1, 221. 1929. The cholesterol of the blood plasma in epilepsy. Lancet, 2, 12. 1929. The therapeutic uses of Luminal. Lancet, 2, 867. 1930. (With C. I. SCHIFF.) Acute meningo-encephalitis associated with herpes zoster. Lancet, 2,

70. 1930. Pain in the leg. Practitioner, 125, 731. 1930. Exophthalmos of central origin. Brit. med. J. 2, 937.

1930. Disseminated sclerosis: Critical review. Quart. J. med. 23, 343. 1931. (With R. D. CURRAN.) The grasp-reflex of the foot. Proc. Roy. Soc. Med. 24, 43. 1931. Zoster, varicella and encephalitis. Brit. med. J. 1, 81. 1932. (With R. D. CURRAN.) The grasp-reflex of the foot. Brain, 55, 347. 1932. Minor mental disorders. Practitioner, 129, 130. 1932. The functions of the sympathetic nervous system. Proc. Roy. Soc. Med. 25, 105. 1933. (With H. CAIRNS.) Aural vertigo. Treatment by division of eighth nerve. Lancet, 1, 946. 1933. On the diagnosis of pain in the upper limb. Clin. J. 62, 17. 1934. Some varieties of acute optic and retrobulbar neuritis. Ophthal Soc. Trans. 54, 221. 1934. Inheritance of epilepsy. In The chances of morbid inheritance. (Ed. by C. P. Blacker.)

London: H. K. Lewis & Co.1935. The anaemias in relation to life insurance. Trans. Ass. Med. Soc. (London, 1936). p. 39. 1935. Epilepsy. Postgrad. med. J. 11, 145. 1936. Prognosis of disseminated sclerosis. Lancet, 2, 866. 1936. Exophthalmos following the administration of thyroid extract. Lancet, 1, 182. 1937. Exophthalmos ophthalmoplegia. Trans. Ophthal. Soc. 57, 107. 1937. Epilepsy. Brit. Encyclopaedia of Med. Practice, p. 97. 1937. Intrinsic diseases of the spinal cord. In Oxford loose-leaf medicine. (Ed. by H. A. Christian.)

Chap. 14, 328. New York. 1937. Tumours of the spinal cord and other lesions causing compression. In Oxford loose-leaf

medicine. (Ed. by H. A. Christian.) Chap. 16, 447. New York. 1937. (WithJ. G. GREENFIELD.) Epiloia. Brit. Encyclopaedia of Med. Practice, 5, 117. 1937. (With D. S. RUSSELL.) The neurological sequelae of spinal anaesthesia. Proc. Roy. Soc.

Med. 30, 1024. 1938. The diagnosis of epilepsy beginning in adult life. Postgrad. med. J. 14, 116. 1938. Two cases of Graves's disease with muscular atrophy. Guy's Hosp. Repts. 88, 125. 1938. (With H. M. TURNBULL.) Exophthalmic ophthalmoplegia. Quart. J. Med. 7, 293. 1939. Speech defects. Brit. Encyclopaedia of Med. Practice, 11, 294. 1939. Sleep: Normal and pathological. Brit. med. J. 2, 51. 1939. Exophthalmos in Graves's disease. Lancet, 2, 1217. 1941. Brain and mind. Lancet, 1, 745. 1941. Visual object agnosia with special reference to the Gestalt Theory. Brain, 64, 43.




1941. Visual disorientation with special reference to lesions of the right cerebral hemisphere.Brain, 64, 244.

1942. Rehabilitation after injuries to the central nervous system. Proc. Roy. Soc. Med. 35, 302. 1943. (With J. G. GREENFIELD & D. W. C. NORTHFIELD.) A case of atypical Lindau's disease. J.

Neurol. 6, 32. 1943. Thyrotoxicosis in relation to ophthalmology. Trans. Ophth. Soc. 63, 3. 1943. Discussion on recent experiences of acute encephalomyelitis and allied conditions.

Proc. Roy. Soc. Med. 36, 319. 1945. Exophthalmos and endocrine disturbance. Proc. Roy. Soc. Med. 38, 666. 1945. Speech and handedness. Lancet, 2, 837. 1947. (With A. D. WRIGHT & M. WILKINSON.) Spontaneous compression of both median

nerves in the carpal tunnel. Lancet, 1, 277. 1947. Malnutrition of the nervous system. Brit. med. J. 2, 763. 1947. Some observations on visual hallucinations and cerebral metamorphopsia. Acta Psychiat.

et Neurol. 46, 28. 1948. Brachial neuralgia. Lancet, 1, 393. 1948. Rupture of the intervertebral disc in the cervical region. Proc. Roy. Soc. Med. 41, 509. 1948. (With J. G. GEEENFIELD & D. S. RUSSELL.) Subacute inclusion encephalitis. Brain, 71,

365. 1948. Amyotrophic lateral sclerosis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed.

p. 30. 1948. Disseminated sclerosis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed.

p. 222. 1948. Encephalitis lethargica. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed.

p. 279. 1948. Epilepsy. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 286. 1948. Myasthenia gravis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 559. 1948. Paralysis agitans. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 615. 1948. Paraplegia. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 616.1948. Poliomyelitis and polioencephalitis, acute. In Index of Treatment. (Ed. by Sir Robert

Hutchison.) 13th ed. p. 645. 1948. Tabes dorsalis. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 808. 1948. Tics. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 839.

1948. Wry-neck, spasmodic. In Index of Treatment. (Ed. by Sir Robert Hutchison.) 13th ed. p. 905.

1949. Psychiatry and neurology. In Modern practice in psychological medicine. (Ed. by J. R. Rees.) London: Butterworth & Company, p. 135.

1949. Modern views on epilepsy. Ass. Med. Soc. p. 197. 1950. Grasp reflex of the foot. Medicina Clinica, 5, 293. 1950. (With J. G. GREENFIELD.) Late infantile metachromatic leuco-encephalopathy with

primary degeneration of the interfascicular oligodendroglia. Brain, 73, 291. 1950. The concept of the schema. In 'Neurology and psychiatry': In Perspectives in Neuro-

psychiatry. (Ed. by Derek Richter.) London: H. K. Lewis & Co. 1950. The cerebral basis of consciousness. Brain, 73, 465. 1951. Mind and matter. Lancet, 1, 863. 1951. (With J. G. GREENFIELD & D. SUTTON.) Epiloia. Brit. Encyclopaedia of Med. Practice.

2nd ed. 5, 266. 1952. The management of endocrine exophthalmos. Proc. Roy. Soc. Med. 45, 237. 1952. (With D. W. C. NORTHFIELD & M. WILKINSON.) The neurological manifestations of

cervical spondylosis. Brain, 75, 187. 1954. Spondylosis: the known and the unknown. Ann. Rheum. Dis. 13, 2; and Lancet, 2, 687. 1954. Loss of visualization. Proc. Roy. Soc. Med. 47, 288. 1954. Spondylose cervicale. Revue Neurologique, 90, 209. 1954. Les affections dues a la Thesaurismose de Kerasine. Acta Neurol et Psychiat. Belgica, p.

297; and Reports 5th Int. Neurological Congress, Lisbon, 1953, Vol. 1. 1954. Cervical spondylosis. Ann. Int. Med. 41, 439. 1954. Cerebral vascular disorders. Lancet, 2, 831. 1954. Aphasia, apraxia and agnosia. In Neurology by S. A. K. Wilson, 3, 1413. 1955. Cortisone in exophthalmos. Lancet, 1, 6. 1955. Mind and body. Brain, 78, 669. 1955. Exophthalmic ophthalmoplegia. Trans. Ophthal. Soc. 75, 351. 1955. Semantics: A symposium. Arch. Linguist. 8, 1. 1956. Perception and imperception. The Thirtieth Maudsley Lecture. J. Ment. Sci. 102, 221. 1956. Pain. Physiotherapy, 42, 293. 1956. Some aspects of the neurology of the cervical spine. J. Faculty Radiol. 8, 74.

Commemorative Booklet 1514 Second Lord Brain Memorial Lecture


1956. Cerebro-vascular disease. Anatomical and physiological factors in treatment. Proc. Roy. Soc. Med. 49, 164.

1957. Differential diagnosis of acroparesthesiae. Gen. Practnr., Lond. 15, 94. 1957. (With M. WILKINSON.) The association of cervical spondylosis with disseminated sclerosis.

Brain, 80, 456. 1957. Order and disorder of the cerebral circulation. Lancet, 2, 857. 1958. (With M. WILKINSON.) Cervical arthropathy in syringomyelia, tabes dorsalis and diabetes.

Brain, 81, 275. 1958. The physiological basis of consciousness. A critical review. Brain, 81, 426. 1958. (With R. A. HENSON.) Neurological syndromes associated with carcinoma.

The carcinomatous neuropathies. Lancet, 2, 971. 1958. Neurology of the cervical spine. London Hosp. Gaz. 61, II (Oct.).1958. The carcinomatous neuropathies. 5th Int. Congress of Intern. Med., Philadelphia. 1958. Neurology of the cervical spine. Trans. Coll. Phys. Surg. and Gynaecolog., S. Africa, 2, 33. 1958. Hughlings Jackson's ideas of consciousness in the light of today. In The brain and its

functions. Blackwell Scientific Pubns. p. 83. 1959. Pathogenesis and treatment of endocrine exophthalmos. Lancet, 1, 109. 1959. Cervical spondylosis. Cecil-Loeb Textbook of medicine, 1959, 10th Ed. 1950.

Philadelphia and London: W. B. Saunders & Co. 1959. Posture. Brit. med. J. 1, 1498. 1959. (With M. WILKINSON.) The extensor plantar reflex and its relationship to the functions

of the pyramidal tract. Brain, 82, 297. 1960. The myopathies of late onset. Swiss med. J. 90, 904. 1961. The neurology of language. Brain, 84, 145. 1961. Consciousness and the brain. Bewusstseinsstorungen. (Ed. by H. Staub and H. Tholen.)

Stuttgart: G. Thieme. 1962. Vertigo of central origin. Proc. Roy. Soc. Med. 55, 361. 1962. Recent work on the physiological basis of speech. Advanc. Sci. Lond. 19, 207. 1962. Diagnosis, prognosis and treatment of endocrine exophthalmos. Trans. Ophthal. Soc. 82,

223. 1962. The assessment of pain in man and animals. Proceedings of International Symposium, 1961. (Ed. by C. A. Keele and Robert Smith.) p. 3. London: Universities Federation for Animal

Welfare.

1963. The language of psychiatry. Brit. J. Psychiat. 109, 4. 1963. Neurological complications of neoplasms. Lancet, 1, 179. 1963. Some unsolved problems of cervical spondylosis. Brit. med. J. 1, 771. 1963. Cervical spondylosis. Cecil-Loeb Textbook of medicine, 11th Ed., 1703. Philadelphia

and London: W. B. Saunders & Co. 1963. Some reflections on brain and mind. Brain, 86, 381. 1964. Cerebro-vascular disease as a cause of falls in the elderly. Geront. Clin. 6, 167. 1964. (With BARBARA ALLEN.) Encephalitis due to infection with Toxocara canis. Lancet, 1,

1355. 1964. Science and behaviour. Advanc. Sci. 21, 91. 1964. Psychosomatic medicine and the brain-mind relationship. Lancet, 2, 325. 1964. Human mind in 1984. New Scientist, 21, 806. 1964. (With A. S. PARKS & P. M. F. BISHOP.) Some medical aspects of oral contraceptives.

Lancet, 2, 1329. 1965. Science and antiscience. Science, 148, 192. 1965. (With M. WILKINSON.) Subacute cerebellar degeneration in patients with carcinoma.

In Remote effects of cancer on the nervous system. (Ed. F. H. Norris and Lord Brain.) New York: Grune and Stratton.

1965. (With R. D. ADAMS.) A guide to the classification and investigation of neurological disordersassociated with neoplasms. In Remote effects of cancer on the nervous system.(Ed. F. H. Norris and Lord Brain.) New York: Grune and Stratton.

1965. Subacute cerebellar degeneration associated with neoplasms. Brain, 88, 465. 1965. Motor neurone disease as a manifestation of neoplasms (with a note on the course of

classical motor neurone disease). Brain, 88, 479. 1965. Structure of the scientific paper. Brit. med. J. 2, 868. 1965. Drug dependence. Nature, Lond. 208, 825. 1965. Perception: A trialogue. Brain, 88, 697. 1966. Hashimoto's disease and encephalopathy. Lancet, 2, 512. 1966. Disorders of memory. Neurology, 14, No. 2. 1966. Medical issues in abortion law reform. Lancet, 1, 727.



CONTRIBUTIONS TO SYMPOSIA1958. Cerebral vascular disease. Transactions of the 2nd Conference held under the auspices of

the American Heart Association. New York and London: I. S. Wright and C. H. Millikan. 1958. The neurological basis of behaviour. A CIBA Foundation Symposium. (Ed. G. E. W.

Wolstenholme and C. M. O'Connor.) London: J. & A. Churchill. 1959. Significant trends in medical research. CIBA Foundation 10th Anniversary Symposium.

(Ed. G. E. W. Wolstenholme, C. M. O'Connor and M. O'Connor.) London: J. & A. Churchill. 1963. Man and his future. A CIBA Foundation volume. (Ed. Gordon Wolstenholme.)

London: J. & A. Churchill. 1964. Statement of the problem. Disorders of language. CIBA Foundation Symposium.

(Ed. by A. V. S. de Reuck and M. O'Connor.) London: J. & A. Churchill.

NON-MEDICAL PUBLICATIONS1927. Galatea or thefuture ofDarwinism. London: Kegan, Paul, Trench, Trubner & Company. 1944. Man, society and religion. London: George Allen & Unwin. 1950. Speech and thought. In The physical basis of mind. (Ed. by P. Laslett.) Oxford: Basil

Blackwell. 1951. Mind, perception and science. Oxford: Blackwell Scientific Publications. 1952. The contribution of medicine to our idea of mind. Cambridge University Press. 1955. Language, meaning and mind. Nature, Lond. 176, 673. 1957. Tea with Walter de la Mare. London: Faber & Faber, 2nd impression 1957, 3rd

impression 1958. 1959. The nature of experience. Oxford University Press. 1959. Science, philosophy and religion. Cambridge University Press. 1960. Some reflections on genius, and other essays. London: Pitman Medical Publishing

Company Limited, 2nd impression 1961. 1961. Poems and verses. Privately printed. 1961. Body, brain, mind and soul. In The humanist frame. (Ed. Julian Huxley.) London:

George Allen & Unwin. 1964. Doctors past and present. London: Pitman Medical Publishing Company Limited. 1964. Science and behaviour. Presidential address to the British Assn. Advancement of Science,

p. 211964. Retsina. Privately published by Staples, Printers. 1966. Science and man. London: Faber & Faber.

MEDICAL BOOKS1929. (With E. B. STRAUss.) Recent advances in neurology. London: J. & A. Churchill, Ist

Ed.; 2nd Ed. 1930; 3rd Ed. 1934; 4th Ed. 1940; 5th Ed. 1945; Italian Ed. 1949; 6th Ed. 1955; Spanish Ed., published in Madrid (1931).

1933. Diseases of the nervous system. London: Oxford University Press, Ist Ed.; 2nd Ed. 1940 3rd Ed. 1947; 4th Ed. 1951; 5th Ed. 1955; Spanish Ed. (Argentine) 1958;

Italian Ed. (Rome) 1958. 1960. Clinical neurology. London: Oxford University Press, Ist Ed. 1960; 2nd Ed. 1964. 1961. Speech disorders: aphasia, apraxia and agnosia. London: Butterworth. 1965. Speech disorders. London: Butterworth. 1966. Science and man. London: Faber & Faber.

GENERAL AND HISTORICAL1935. Hughlings Jackson. London Hosp. Gaz. 38, 212. 1943. Lord Monboddo: Evolutionist and Anti-Johnsonian. London Hosp. Gaz. Dec. p. 6. 1952. The neurology of John Hunter's last illness. Brit. med. J. 2, 1371. 1953. The need for a philosophy of medicine. Lancet, 1, 959. 1953. Vital statistics and the doctor. Brit. med. J. 2, 1283. 1953. The future of clinical neurology. Lancet, 2, 1109. 1953. The doctor in the modern world. St George's Hosp. Gaz. 39, 5. 1955. Language, meaning and mind. Nature, Lond. 176, 673. 1956. Public opinion and mental illness. Lancet, 2, 1149. 1957. Address to the Association of Physicians of Great Britain and Ireland at its 50th

Annual General Meeting (1956). Quart. J. Med. 26, 101. 1957. Harvey: The ocular philosopher. Lancet, 1, 1235. 1957. The treatment of pain. S. African med. J. 31, 973. 1957. Thomas Lawrence, M.D., P.R.C.P. Medical History, 1, 293. 1957. Conversations with Sherrington. Lancet, 2, 1109. 1958. Neurology: past, present and future. Brit. med. J. 1, 355. 1958. The need for experiment. Lancet, 2, 1322. 1959. William Harvey, neurologist. Brit. med. J. 2, 899. 1960. Socrates on the Health Service, Dialogues of today. London: The Lancet Ltd.

In his Schorstein Lecture given at the London in1959, Lord Brain addressed this subject,publishing it in the Lancet in the same year. Hislecture was subtitled “on the importance of beingthirty”, that being the mean age of consultantappointments in Neurology at the London untilpost-war bottlenecks in NHS preferment resultedin a surfeit of Senior Registrars, manyapproaching 40 years of age before appointmentto the consultant grade. Brain’s thesis was that aneurologist’s best work is commenced before theage of 30 years, and the lecture provedinfluential.

Beginnings:The London Hospital was founded in 1740,famously after a meeting in the Feathers publichouse in the City. From the start there seems to have been an interest in neurological illness.John Andrée, the first physician appointed to thestaff in 1740, published a two-volume book onepilepsy and related disorders in 1753. JohnCooke (1756-1823), also an early physician tothe hospital, published his ‘Treatise on NervousDiseases’, one of the first comprehensivetextbooks of neurology written in English, in1820. His book is organized in three generalsections; Epilepsy, Apoplexy and Palsy, withextensive historical introductions to each section.

James Parkinson:James Parkinson (1755-1824) describedparalysis agitans in a now scarce monograph in 1817. He had been a dresser at the LondonHospital for six months in 1776, and afterwardswas a practitioner in East London, maintainingclose professional relations with the London. Hismonograph provides a remarkably complete

description of the disease, except for theomission of rigidity. It was only with the advent ofmore complete schemata of clinical examinationthat this feature was later recognized by Jean-Martin Charcot, in Paris, and it was Charcot whofirst used the eponymous nomenclature thatremains in use today. Parkinson himself, aprolific pamphleteer and agitator for politicalreform, often unpopular with the authorities ofthe day was also a distinguished geologist andfossil collector, and the founder of the RoyalGeological Society.

William John Little:In 1834 WJ Little (1810-1894), a surgeon with a special interest in orthopaedics, describedcerebral palsy and recognized its association with birth trauma and hypoxia. He was anapothecary's apprentice before entering medicalschool at the London Hospital at the age of 18.He was admitted to the Royal College of Surgeonsin 1832. Little introduced tenotomy to Britain forthe management of talipes, a technique he hadlearned in Germany, and founded the NationalOrthopaedic Hospital in London.

Jonathan Hutchinson and Hughlings Jackson:Sir Jonathan Hutchinson (1828-1913) wasinfluential and productive in many areas ofmedicine throughout his long life. His neurologicalcontributions included papers on neurosyphilis,optic neuritis (not then distinguished frompapilloedema), the syndromes of internal carotidartery aneurysms and carotid occlusion, and ontorticollis. He contributed a seminal paper on thepupils to the first volume of Brain in 1878. He was afounder member and President of the NeurologicalSociety of London – later subsumed into the

Commemorative Booklet, June 2010 1918 Second Lord Brain Memorial Lecture


1963. The doctor's place in society. The London School of Economics and Political Science. 1967. Medicine and government. Tavistock Publications.

ReferencesTitle: Walter Russell Brain First Baron Brain of Eynsham. 1895-1966 Author(s): George W. Pickering Source: Biographical Memoirs of Fellows of the Royal Society, Vol. 14, (Nov., 1968), pp. 61-82 Publisher(s): The Royal Society Stable URL: http://www.jstor.org/stable/769439

The Neurological Tradition at the LondonBy Michael Swash

Royal Society of Medicine. It was he whoencouraged the young John Hughlings Jackson(1836-1911) to study neurology. Jackson is nowwidely recognized as perhaps the most original of the “founders of neurology”. Like Hutchinson,Jackson was a graduate of the York MedicalSchool under Thomas Laycock. WithHutchinson’s support and influence Jacksonjoined the staff of the London in 1859, as well asthe newly formed Hospital for the Paralysed andEpileptic at Queen Square. Jackson codifiedclinical phenomena, especially eye movements,epilepsy, language disorders, disorders of motorcontrol, and right hemisphere functions,interpreting them as positive or negativephenomena in the light of Darwinian evolution. In this approach he was much influenced by hisfriend, Herbert Spencer, the philosopher. Hisconcept of levels of function in the brain wasespecially influential, extending also intoEuropean psychiatry.

Warren Tay:Warren Tay (1844-1927), a surgeon anddermatologist with an interest in disorders of the eyes, made the first description of thecharacteristic fundoscopic appearance of Tay-Sachs disease in 1881, recognizing the familialcausation of the disease in 1884, when theophthalmoscope was still a novel instrument.Bernard Sachs, a New York neurologist,described the pathology in 1887.

Henry Head:Henry Head (1861-1940), perhaps the firstclinical neuroscientist, was educated, as weremany of his generation, in both England andGermany, before his appointment at the London

(Queen Square having declined to appoint him).He became one of the leading figures in Europeanneurology, making major contributions toknowledge of the segmental dermatomaldistributions on the body, to visceral sensationand, with WHR Rivers, to sensory physiology itself,introducing von Frey’s hairs into clinical andresearch practice in Britain. His observations onthe recovery of sensation after nerve injury weremade following section of his own superficial radialnerve by his colleague at the London, Sir JamesSherren who, himself, wrote an importantmonograph on peripheral nerve injuries and theirmanagement (1908). With his neurologicalcolleagues at the London, George Riddoch (1888-1947) and Theodore Thompson (1878-1938), hepublished extensively on spinal cord injury. Headmade a major contribution to understandingaphasia and to the neurophysiology of language(1926), painstakingly studying patients brain-injured in the First War in relation to their brainlesions. With EG Fearnsides (1883-1919), in theDepartment of Morbid Anatomy, he studiedneurosyphilis. Fearnsides, continuing to work withHM Turnbull in Morbid Anatomy, made the firstcomprehensive description of intracerebralaneurysms in 1916, but his career was tragicallycut short in a boating accident aged only 36 years.Head was selected by Sir Walter Fletcher,Secretary of the newly formed Medical ResearchCouncil, as a suitable candidate to develop the firstacademic unit of medicine in Britain, at theLondon Hospital, but Head was unable topersuade the House Committee to designate hisrequired total of 100 beds and suitable staff to theproject, and the opportunity passed when heretired, aged only 58 years, with Parkinson’sdisease.

20 Second Lord Brain Memorial Lecture Commemorative Booklet 21

Russell Brain and later:After Head retired, W Russell Brain (1895-1966)joined Riddoch on the staff, quickly establishinga reputation as a skilled and knowledgeableclinician. He wrote extensively on neurologicaltopics, including defining contributions oncarpal tunnel syndrome and with MarciaWilkinson, on the neurological complications ofcervical spondylosis, including its differentialdiagnosis from multiple sclerosis. His hugelyinfluential Textbook of Neurological Disorderswas first published in 1933, and went throughfive personally written editions until 1962. Latereditions have been multi-authored. With RonaldHenson (1915-1994), and Henry Urich, hedescribed and classified the paraneoplasticsyndromes. Brain had a national reputation as adiagnostician. Although essentially a very privateman, his teaching rounds, serious affairs thoughthey were, were highly valued. When Brainretired in 1962 Christopher Earl, another superbclinician and teacher, joined Henson in theneurological unit. Alan Ridley was appointedwhen Earl resigned

Michael Swash was appointed as the thirdneurologist in 1972 and became the firstProfessor of Neurology in the Medical School in1993. Michael Swash trained at the LondonHospital Medical College and at The University ofVirginia School of Medicine, graduating in 1962.He did the residency program in neurology withDr Joseph M Foley and Dr Maurice Victor atCase-Western Reserve University, Cleveland,Ohio, and as a Fellow in Neurophysiology atWashington University, St Louis, Missouri.Returning to London in 1968, he was Registrarin Neurology at the London, and then MRC

Research Fellow in Neuropathology, working onmuscle spindles. Michael Swash has publishedmore than 500 original papers and reports, and16 books, many in several editions, especiallyHutchison’s Clinical Methods, a London Hospitalclassic now more than 100 years in continuouspublication.

The merger with Barts induced a major andlong-overdue increase in staffing levels in thedepartment. Gavin Giovannoni succeededMichael Swash as Professor of Neurology, with an expanded department, in 2006.

Neuropathology:HM Turnbull (1875-1955), renowned as apathologist, very much encouragedneuropathology, then in its infancy. He followedup Fearnsides’ observations on intracranialaneurysm in work that enabled CharlesSymonds, working at Guys and Queen Square, todescribe the clinical diagnosis of subarachnoidhaemorrhage. With James MacIntosh (1882-1948) Turnbull described the clinical andpathological features of post-vaccinialencephalomyelitis. MacIntosh and Sir PaulFildes (1882-1971), then working in theDepartment of Microbiology at the London,confirmed Noguchi’s discovery of thetreponemal basis of syphilis, a discovery that ledto a revolution in neurological diagnosis, causingthe reclassification of a number of syndromespreviously misattributed to syphilitic infection.Dorothy Russell (1895-1983) succeededTurnbull as Professor of Morbid Anatomy in1944 – the first woman to achieve professorialstatus in pathology in Europe. She had been oneof the first lady medical students at the London,


studies, and specialized therapies such asphysiotherapy, occupational therapy, as well asoncology and radiotherapy are pre-requisites tomodern practice. The London was in the forefrontin the provision of these modalities. Skull X-rayswere available before the First War, EEGrecordings using two saline pad Bergerelectrodes were in use for the diagnosis ofepilepsy and cerebral tumours in the 1930s and,after the Second War, a formally constitutedDepartment of Electro-Encephalography wasestablished by Dr Samuel Last, later with theassistance of Leo Honigsberger, who had aninterest in epilepsy monitoring,. Donald Scottdeveloped this department with Pamela Priorfrom the early 1960s. Electromyography andnerve conduction studies were provided by KitWynn-Parry in the Department of PhysicalMedicine. Later, as this specialty developed,these investigations joined EEG in theDepartment of Clinical Neurophysiology.Radiotherapy was in active use before theSecond War, and radioisotope brain scanningpreceded the advent of CT and then MR brain imaging in the 1970s and 1980srespectively. Rehabilitative services wereprovided in collaboration with the relevant related specialties beginning in the nineteenthcentury.

Acknowledgement: I thank Mr Jonathan Evans inthe Royal London Hospital Archives Centre for hisinvaluable help.

Commemorative Booklet, June 2010 23

and had trained there and later in Montreal withWilder Penfield, who had learned silver staintechnology from Dr Pio del Rio Hortega, Ramon yCajal’s former student and colleague in Madrid.With the outbreak of war in 1939 Russell movedto Oxford where Hortega was working with HughCairns in the military Neurosurgical Head InjuryUnit at St High’s College. Ronald Henson wasalso relocated to St Hugh’s during the bombing of London; Russell Brain was relocated with JGGreenfield, the neuropathologist, Chase FarmHospital in North London. Dorothy Russelltransferred this silver technology to the Londonand used it to great effect with Lucien Rubinstein(1924-1983) in their defining monograph“Tumours of the Nervous System”, a book thatran through five editions and continues to thisday, long after both its original authors havepassed away. In addition, Russell made hugecontributions, often with Crooke, to knowledge of the pituitary gland, to the classification andcausation of hydrocephalus, and to generalneuropathology. When Rubinstein moved to theUSA (first to Columbia, and then to Stanford),Henry Urich took over the neuropathologicaldepartment continuing the tradition of expertisein cerebral tumours and brain malformations. He was followed by Carl Scholtz, and then byJennian Geddes.

Sir Hugh Cairns and Neurosurgery:The neurosurgical unit at the London wasfounded by Cairns (1896-1952), althoughneurosurgical procedures were of coursefrequently performed before his appointment in1926. Cairns, an Australian Rhodes scholar, firstspent a year in pathology with Turnbull, and thenworked in general and renal surgery at the

London. Prior to his taking up this appointmentas Neurosurgeon, the Hospital Governors senthim in 1926 to Boston to work with HarveyCushing, so that on his return he could introducethe innovative techniques pioneered by Cushingto Britain. Once the Unit was fully established, in1933, there were hosts of visitors keen to learnthe new methods. In 1938 Cairns was temptedby Lord Nuffield’s offer to join his new School ofMedicine at Oxford as Professor of Surgery,leaving the neurosurgical department at theLondon in the capable hands of his formerstudent, Douglas Northfield (1902-1976), who was later joined by JV Crawford. Northfielddeveloped pioneering procedures in tumoursurgery, spinal surgery, the management ofhydrocephalus, and epilepsy surgery.Northfield’s book “Surgery of the NervousSystem’ (1973) represented the apogee ofneurosurgical technique and knowledge to thattime. Crawford was succeeded by Tom King,himself a meticulous surgeon with a majorinterest, in collaboration with Andrew Morrison,in acoustic Schwannoma surgery. ES Watkins,the first Professor of Neurosurgery, who broughtnew methods of stereotaxic surgery moved to theLondon from the USA, succeeded Northfield.Fary Afshar, himself a London Hospital graduate,rejoined the London as Neurosurgeon when theneurosurgical unit at Barts closed. He and hiscolleagues were joined by Peter Richardson, whosucceeded Watkins, and by other colleagues.

Related specialties:Associated skills and facilities are essential to thepractice of a specialty. For neurology andneurosurgery, neuropathology, neuroradiology,clinical neurophysiology, various laboratory



Further ReadingClarke-Kennedy AE The London; a study ofthe voluntary hospital system. vols 1 and 2.London, Pitman Medical 1962

Geddes JF. A portrait of the Lady: a life of Dorothy Russell. J Roy Soc Med1997;90:455-461

Haymaker W. Founders of Neurology.Springfield, Illinois. Charles C Thomas 1953

Jacyna LS. Medicine and Modernism.London, Pickering and Chatto 2008

McHenry LC. Garrison’s History ofNeurology. Springfield, Illinois, Charles CThomas. 1969

Morris EW. A history of the London Hospital.London, Edward Arnold. 1926

Swash M. John Hughlings-Jackson: asesquicentennial tribute. J Neurol,Neurosurg Psychiatry1986 49 981-985

Swash M. Henry Head and thedevelopment of clinical neuroscience. Brain2008;131:3453-3456

Swash M. And Lord Brain said. PracticalNeurology 2007;7:250-251

24 Second Lord Brain Memorial Lecture Commemorative Booklet 25

Richard Trembath, F Med Sci, took upthe post of VicePrincipal (Health)and Executive Deanon 1st September2011. Prior to thisappointment hewas the Director ofthe NIHR

Comprehensive Biomedical Research Centre atGuy’s and St Thomas’ NHS Foundation Trust andHead of the KCL Division of Genetics & MolecularMedicine at King’s College London. He is anHonorary Consultant in Clinical Genetics at theGenetics Centre, at Guy’s Hospital. He is aDirector on the UCL partnership board. He is aSenior Investigator for the National Institute ofHealth Research, a former Clinical AcademicGroup Lead within King’s Health Partners and a Fellow of the Academy of Medical Sciences.

He trained in Medicine at Guy's Hospital MedicalSchool and undertook postgraduate studies atthe Institute of Child Health, London before tomoving to the Department of Genetics at theUniversity of Leicester in 1992. He wasappointed to the Foundation Chair of MedicalGenetics in Leicester in 1998. ProfessorTrembath serves on Advisory and EditorialBoards and Committees of numerous nationaland international journals and academicsocieties. He is past President of The BritishSociety of Human Genetics.

The main focus of Professor Trembath’s researchis to identify genes and delineate the molecularpathways underlying a range of human geneticdisorders using both established and emergingtechnologies. Major interests includeinvestigating the genetic architecture of commoninflammatory skin, such as Psoriasis and Acne.Most recently, the group have launched a seriesof studies looking at the genetic determinants forextreme phenotypes within more commondisorders, with examples including severe and adverse response to therapies.

Professor Richard TrembathBarts and The London School of Medicine and Dentistry


Evolution of the human brain: why was bigger better?

About 200,000 years ago, modern Homo sapiens appeared, characterised by a sudden increasein brain size. Big brains are costly, in terms of their metabolic demand. The survival of our big-brained ancestors is usually assumed to have depended on the cognitive advantages of a largebrain. But human cognitive achievement has continued to accelerate, long after the stablisation ofour genetic makeup and of our basic brain structure. The sudden increase in brain size is notdifficult to explain. But its utility and its conservation are harder to understand. The answers mightlie in the adaptability and plasticity of the nervous system. Development of complex nervoussystems depends on general rules, including adaptive mechanisms to fine-tune connections.Such developmental flexibility might have permitted and accommodated evolutionary changes inorganisation of the brain, including the sudden increase in size. Natural selection has alsodiscovered genetic mechanisms that enable neurons to change the strength of their connectionsin response to the pattern of activity passing through them. Such plasticity helps individuals tomatch perceptual, cognitive and motor skills to the nature of the world around them. Brainplasticity, although genetically determined, enabled humans to escape from the informationallimits in the blueprint of their genes and propelled them into a different mode of evolution. There isno reason to believe that such cognitive evolution, dependent on cultural rather than geneticinheritance, is over.

Colin Blakemoreis Professor ofNeuroscience atthe University ofOxford. He alsoholds emeritusProfessorships atWarwick, PekingUnion MedicalCollege and at the Duke-NUSGraduate MedicalSchool in

Singapore, where he is External Scientific Advisorto the Neuroscience Research Partnership. Colinhas been President of the British Association forthe Advancement of Science, the BritishNeuroscience Association, the PhysiologicalSociety and the Biosciences Federation (now theSociety of Biology). He is a Fellow of the RoyalSociety and the Academy of Medical Sciencesand an Honorary Fellow of the Royal College ofPhysicians, the British Pharmacological Society,the Society of Biology and the British Associationfor the Advancement of Science. He is a Memberof Academia Europaea and the EuropeanAcademy of Sciences and Arts, and a ForeignMember of several academies of science,including the Royal Netherlands Academy, theNational Academy of Sciences of India and theChinese Academy of Engineering. He holds tenHonorary Degrees.

Colin studied Medical Sciences at Cambridgeand did a PhD at the University of California,Berkeley. After working for 11 years inCambridge, he moved to Oxford as WaynfleteProfessor of Physiology in 1979, and from

1996-2003 he was also Director of the Centre forCognitive Neuroscience. His research has beenconcerned with many aspects of vision,development, plasticity of the brain andneurodegenerative disease. He has been aVisiting Fellow or Professor in the USA, France,China, Singapore, Italy, the Czech Republic,Japan, Canada, New Zealand and theNetherlands. From 2003-2007 he was ChiefExecutive of the UK Medical Research Council.

He is currently Chair of the General AdvisoryCommittee on Science at the Food StandardsAgency, a Commissioner of the UK Drug PolicyCommission and a member of Legal & General’sLongevity Science Advisory Group. He works for a number of UK charities: he is President of theMotor Neurone Disease Association and BrainTumour UK, Vice-President and Trustee of thePSP Association, and Vice-Patron of SANE. Hechairs the Selection Committee for The BrainPrize.

Colin is a frequent broadcaster on radio andtelevision, and writes books and articles aboutscience and science policy for a wide audience.He has won many prizes for both his researchand his work in the public communication ofscience, including the Royal Society MichaelFaraday Prize and David Ferrier Prize.

Professor Colin Blakemore Department of Physiology, Anatomy and Genetics University of Oxford


the impact of injury. The group’s work on omega-3 fatty acids in neurotrauma is supported byseveral UK and international translationalawards. Professor John Priestley has developedbiomaterial-based conduits for peripheral nerveand spinal cord repair. Professor Priestley and Dr Xuenong Bo, coordinate a programme ofresearch on neuroregeneration. Neurotex, a BLTSMD spin-out company, has beenestablished to commercialise the work onbiomaterials. In the neurotrauma group, Dr BabisMagoulas conducts research that has aparticular focus on neuroinflammationand its role in injury and regeneration. In neurodegeneration, Dr Andrea Malaspina hasan active research programme which coversvarious aspects of amyotrophic lateral sclerosisresearch, from animal models of the disease to neuroprotective agents and new diseasebiomarkers. Professor Michael-Titus is alsoleading a new MRC-funded translationalprogramme on novel metal-binding compoundswith therapeutic potential in Alzheimer’s disease.

Professor Gavin Giovannoni and Professor DavidBaker head up the neuroimmunology group withtheir main disease focus being multiplesclerosis. Their research is centred on immunetolerance strategies, developing neuroprotectiveand neurorestorative therapies for progressivemultiple sclerosis and manipulating cannabinoidbiology as a therapeutic strategy to improve thesymptoms of multiple sclerosis. David Baker'swork on cannabis as a potential neuroprotectantin MS continues and has recently being tested ina national MRC-funded trial under the directionof Professor John Zajieck (Plymouth). Anotherresearch focus is the role of EBV in the

pathogenesis of MS and how it interacts withother environmental factors and genetic riskfactors. David Baker is the co-founder of Canbexa spin-out company that has identified anddeveloped a group of cannabinoid-likecompounds that are excluded from the CNS to treat muscle and bladder spasticity. Dr KlausSchmierer’smain focus is on the pathologicalcorrelates of MRI changes in multiple sclerosisand therapies for primary progressive multiplesclerosis.

Professor Silvia Marino’s research has focusedon understanding how Polycomb group genescontrols stem cell function during thedevelopment of the central nervous system and in brain tumours. Moreover, her group uses experimental models to assess whethermanipulation of stem cell properties can beexploited to increase regeneration and repair in neuromuscular conditions.

In genomics and cancer Professor DeniseSheer's group studies the function of humanchromosomes and the genetic basis of cancer,with a focus on critical pathways involved inbrain tumours.

The groups are establishing a tumour biobankwith detailed clinical phenotyping. In addition tothe activity of the group leaders highlightedabove, there are active research programmes inmotor neurone disease, pain, muscleregeneration, neuro-gastroenterology,biomarkers and clinical outcomes.

Neuroscience at Barts and The London

Neuroscience is a partnership between Bartsand The London School of Medicine andDentistry and Barts Health NHS Trust.

Barts and The London School of Medicine andDentistry provide international levels ofexcellence in research and teaching. The 2008Research Assessment Exercise results showedthe School joining Oxford, Cambridge, ImperialCollege and University College London in the topfive research-active medical and dental schoolsin England. According to rankings published inthe Times Higher Education, Barts and TheLondon scored consistently in the top five in theUK. At the heart of the School’s mission liesworld class research. During the last five years,the School has implemented a focusedprogramme of recruitment of leading researchgroups from the UK and abroad, together with a£100 million investment in state-of-the-artresearch facilities.

Barts Health NHS Trust has been consistentlyrated amongst the top teaching hospital trusts in the UK for clinical excellence. The Trust hasbenefited significantly through the £1 billionPrivate Funding Initiative that is transforming the Barts and The Royal London Hospitals intoone of the largest hospital complexes in Europe.Barts Health NHS Trust was created on 1 April2012 following the approved merger of Barts and The London NHS Trust, Newham UniversityHospital NHS Trust and Whipps Cross UniversityHospital NHS Trust.

Barts and The London and Barts Health haverecently joined UCL Partners, one of fiveaccredited academic health science systems in

the UK. UCL Partners will allow Barts and TheLondon to translate cutting edge research andinnovation into measurable health gain forpatients and populations – in London, across the UK, and globally.

Neuroscience research at Barts and The Londonfocuses on five broad themes: trauma sciences,neurotrauma & neurodegenerative disorders,neuroinflammation , stem cells, and genomics &cancer. The Centre’s themes have been mappedonto clinical academic units within Barts HealthNHS Trust with many of its staff actively involvedin clinical research, including phase 2 and 3clinical trials. The research themes have beencreated with the specific aim of creatingpartnerships between basic scientists andclinicians to encourage translational research.Several PIs hold substantial translationalneuroscience funding. Professor GavinGiovannoni is the current Centre Lead.

Professor Karim Brohi’s trauma group coversvarious aspects of trauma research, from injuryprevention to public health, the effects of traumaon the body, the body’s response to injury andrehabilitation. A major focus of the group istrauma-associated coagulopathy, a researchfield in which the group is a world-leader. Inneurotrauma, the research emphasis is on spinalcord and peripheral nerve injury, and morerecently, head injury.

Professor Adina Michael-Titus leads theneurotrauma and neurodegeneration group and under her lead the neurotrauma group has identified several promising neuroprotectivetherapeutic strategies which will help reduce

The Institute is housed in the Blizard Building inWhitechapel. The unique, award winning, BlizardBuilding provides state-of-the-art laboratoryaccommodation based on an innovative openplan design for staff and postgraduate students.The laboratory facilities are co-located on a singlelaboratory floor of approximately 3,500m2, thedesign of which aims to encourage maximalinteraction between different research groupsand efficient usage of core equipment andfacilities. The Centre for Primary Care and PublicHealth is accommodated in the adjacent andnewly refurbished Yvonne Carter Building whichprovides an excellent environment for researchstudents in these disciplines.

The Institute takes its name from Sir WilliamBlizard, the founder of the London HospitalMedical College in 1785.

Public Engagement in Science Public Engagement is a high profile componentof the Institute's portfolio of activity largelythrough the Centre of the Cell Project whichshowcases the very best of our research in areadily accessible format. The educational andaspiration raising activities of the Centre aretargeted upon school children particularly drawnfrom our local population and are facilitated byco-operation with multiple scientists andteachers from the Blizard Institute.


Blizard Institute

The Blizard Institute was established in 2003and is the largest of six Institutes within Bartsand the London School of Medicine andDentistry, QMUL. The Institute, which comprisesapproximately 450 staff based in eight academicCentres and supports over 400 postgraduatestudents, aims to deliver excellence in allaspects of research, teaching and clinicalservice.

The research of the Institute is based uponfocused programmes of basic, clinical andtranslational programmes of research activitytargeted to selected areas of clinical excellencein partner NHS organisations, in particular BartsHealth NHS Trust. The Institute was returned inUnit of Assessment 4 of RAE2008 and 80% of

the outputs were considered world class orinternationally excellent. This outcome placedthe research of Blizard Institute in joint firstposition of Hospital Based Clinical Subjects in UK medical schools.

Postgraduate programmesThe Institute hosts a range of highly successfuland sought after postgraduate taughtprogrammes lead by senior staff in individualacademic centres. These programmes havebeen developed in response to the research,teaching and training needs of individualspursuing careers in disciplines encompassed by the Institute and each course has a uniquestructure designed to best meet these needs.Additionally, the Institute provides a supportiveenvironment for those wanting to undertake aPhD. www.centreofthecell.org

Andrew Lees was the first recipient of the LordBrain Memorial Medal. The medal was awardedfor his scientific contributions to field ofmovement disorders in the UK. He is the directorof the Reta Lila Weston Institute of NeurologicalStudies at University College London, andProfessor of Neurology at the National Hospitalfor Neurology and Neurosurgery, Queen Square,London.

He has achieved international recognition for his work in Parkinson’s disease and abnormalmovement disorders. In 2006, he was awardedthe prestigious Movement Disorders ResearchAward by the American Academy of Neurology(AAN).

Past recipients of the Lord Brain MemorialLecture and Medal

Professor Andrew Lees 2010Institute of Neurology, University College London


Second Lord Brain Memorial Lecture Commemorative Booklet

The Lord Brain Memorial Lecture and Medal was established in 2010 in honour and memory ofWalter Russell Brain’s outstanding contribution to the field of neurology. The memorial medal paystribute to healthcare professionals or scientists who have worked in the UK and have made a majorscientific contribution to the field of neuroscience. The lecture is held biennially and hosted by theCentre for Neuroscience and Trauma in the Blizard Institute at the Barts and The London School of

Medicine and Dentistry

For further information contact:Mr Surinder PalCentre for Neuroscience and TraumaBlizard InstituteBarts and The London School of Medicine and Dentistry4 Newark StreetLondon E1 [email protected]

This booklet has been produced by the Publications and Web Office for the Barts and The London School of

Medicine and DentistryPub9259

Any section of this publication is available uponrequest in accessible formats (large print, audio,

etc.). For further information and assistance,please contact: Diversity Specialist,

[email protected], 020 7882 5585

Lord Brain 2012 Commemorative Booklet

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