The West Riding Asylum and the Origins of British Neurology 1866-1876

Neurology as practiced in the United Kingdom has long been recognised as a clinical discipline with a strong commitment to research. How did this bipartite structure, encompassing both clinical and research expertise, evolve?

It is generally accepted that neurology as a distinct medical discipline originated in the 1860s and 1870s. Much of the existing historiography of British neurology has focused on the role of the National Hospital, Queen Square, London, the first institution specifically dedicated to the care of those with neurological disease, founded in 1860. In contrast, it is the argument of this book that work undertaken at the West Riding Pauper Lunatic Asylum at Wakefield in West Yorkshire in the decade 1866-1876 was a decisive contributor to the origins and evolution of British neurology in ways which differed from those enacted at Queen Square, in particular in its orientation to research.

In his desire to pursue a scientific approach to insanity, James Crichton-Browne, the Medical Superintendent at West Riding Asylum, inaugurated changes which rendered it a “birth-place for neurology rather than as a stimulant for psychiatry”. Firstly, institutional change, building a dedicated pathological laboratory wherein research studies, both clinical and experimental, could be pursued. Secondly, changes to faculty, employing unpaid clinical assistants who could devote time to research studies. Thirdly, founding a house journal, the West Riding Lunatic Asylum Medical Reports, for the publication and dissemination of research undertaken at the Asylum and also including material from established physicians working elsewhere, some of whom were invited to avail themselves of the clinical and experimental resources of the Asylum. Fourthly, arranging annual medical gatherings, termed conversazione, again for the dissemination of research undertaken at the Asylum as well as for the education and entertainment of local practitioners. In the corresponding time period, Queen Square remained an entirely clinical institution, lacking laboratory, clinical assistants, house journal, or public medical meetings.

The source materials are synthesized into a new formulation of the shared past of neurology and psychiatry, establishing the work at the West Riding Asylum in this period as contributing decisively to the research ethos of the nascent discipline and thus forming an integral component in the origins of British neurology.