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

Contents Programme


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 Brain 1895 - 1966

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Programme Perrin Lecture Theatre Thursday, 21 June 2012, 5.30pm

• Welcome address Professor Gavin Giovannoni, Professor of Neurology, Barts and The London • Introduction Professor Richard Trembath, Vice Principal and Executive Dean, Barts and The London • Lecture Professor Colin Blakemore, Professor of Neuroscience, University of Oxford • Medal Award and Presentation • Reception

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Commemorative Booklet 03

Message from Professor Gavin Giovannoni

Dear Colleagues, Welcome to the second Lord Brain Memorial Lecture. When I was appointed to Barts and The London in late 2006, I was particularly impressed by the history of the Royal London and St Bartholomew’s Hospitals and their respective medical schools. As a newcomer, I couldn’t understand why we weren’t acknowledging and celebrating the achievements of these two great Institutions in the fields of neurology, neurosurgery and neuroscience. I therefore established The Lord Brain Memorial Lecture and Medal to celebrate and acknowledge Walter Russell Brain’s outstanding contribution to neurology at Barts and The London. The biennial Lord Brain Memorial Lecture and Medal honours a healthcare professional or scientist who has worked in the United Kingdom and has made a major scientific contribution to field of neuroscience. The task of selecting the recipient of the second award was not an easy one as several outstanding candidates were nominated. I hope you all agree that Professor Colin Blakemore is a worthy recipient of the award. Professor Blakemore has done seminal work on many aspects of vision, brain development and plasticity and neurodegenerative diseases. His successful 04 Second Lord Brain Memorial Lecture

tenure as Chief Executive of the MRC, from 2003 to 2007, and his influence on national science policy are well recognised. He has been awarded many prizes for both his research and his work in the public communication of science. Once again we like to welcome Lord Brain’s family who are attending this evening for being so accommodating and supportive of this initiative. Events of this nature do not just happen and I would therefore like to thank the School of Medicine and Dentistry for their long-term commitment to this event and their financial support, Denise Sheer, Rodney Walker and Nicola Brain co-members of the Lord Brain selection committee for their time and efforts, Professor Trembath, our Vice Principal and Executive Dean, for kindly agreeing to do the introduction this evening, Professor Swash, Emeritus Professor of Neurology, for writing a short essay on the neurological tradition at The London Hospital, Dr Morag Brothwell for researching and then writing a mini-biography on Lord Brain and Surinder Pal, our administrator, who makes this event happen.

Professor Gavin Giovannoni MBBCh, PhD, FCP (S.A., Neurol.), FRCP, FRCPath Blizard 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 the Department 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 his undergraduate medical training at the University of the Witwatersrand, South Africa, where he graduated 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 in 1993 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 Scarfe Lecturer, 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 of Neurology, Queen Square in 1999. He was promoted to Reader in Neuroimmunology in 2004. His clinical interests are multiple sclerosis and other inflammatory disorders of the central nervous system. He is particularly interested in clinical issues related to optimising MS disease modifying therapies. His group’s current research is focused on Epstein Barr virus as a possible cause of multiple sclerosis, defining the “multiple sclerosis endophenotype”, multiple sclerosis related neurodegeneration, biomarker discovery, clinical outcomes and immune tolerance strategies. The group focuses on translational research and have an active clinical trial programme.

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

Gavin Giovannoni Commemorative Booklet 05

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

Russell Brain was born in Reading in 1895. His father, Walter John Brain, was a solicitor who had founded a successful legal practice with his brother. His mother, Edith Alice Smith, was the daughter of the architect Charles Smith who had served the city of Reading twice as Mayor. The young Russell Brain attended a good preparatory school in Reading and won a scholarship to Mill Hill, from where, intending a career in law, he read Classics. Realising he was better suited to science, he found that a change of course was not allowed and was persuaded to study history instead. He left school without the education he had sought but well known for his wider interests: a keen supporter of the literary and debating society, and of the photographic society, and secretary of the natural history society. This breadth of interest was to be a remarkable feature of his future public life. The following year, he studied at Reading University College and then went up to New College, Oxford to read history in 1914, but this was the year that war was declared. Disapproving of war, he became involved in fundraising for Belgian refugees who had fled to England and were in need of food and shelter. He and a friend, Rev. P N Harrison, held the second ‘flag day’ in England to raise money for their plight. He then went up to Oxford, where after his first year, quite 06 Second Lord Brain Memorial Lecture

unmotivated, he failed his prelims. He later reflected ‘I have never been able to remember history: my mind being more suited to logical relationships.’ This called for a change in direction, and a month later, Brain joined the Friends Ambulance Unit, a Quaker organisation. After travelling to a military hospital in York, he used his experience of photography and a book about x-rays to become an orderly in the x-ray department. He later transferred to the x-ray department in King George Hospital where he met his future wife, Stella Langdon-Down. Stella came from a well-known medical family, and was the grand-daughter of the distinguished London Hospital physician John Langdon Down, who described the eponymous Down’s syndrome. It was Stella who encouraged Russell to study medicine and so, taking her advice, he joined evening classes at Birkbeck College in zoology, botany, physics and chemistry, and subsequently passed the London M.B. In January 1919, he returned to New College as a medical student, and passed the Oxford B.M., having been awarded the Theodore Williams’ Scholarship in physiology. In September 1920 he married Stella and was awarded the Price Entrance Scholarship to train at the London Hospital, where his fatherin-law had trained and worked. He qualified B.M. B.Ch (Oxon) in December 1922. At the recently established medical unit of the London Hospital in Whitechapel, Brain began training under the supervision of the First Assistant, George Riddoch. Riddoch was an expert in war injuries of the nervous system, and introduced Brain to clinical neurology. At the time there was growing interest in ‘the new psychology’ – a psychopathology based on the

unconscious, which inspired Brain to consider a career in psychiatry. But Riddoch advised him that he’d ‘better learn some neurology first.’ And so he did, but he never lost his interest in psychiatry and the workings of the human mind. Some years later, Brain became interested in the conundrum of consciousness and the mechanisms of perception. When neither his neurological expertise nor philosophical theories could offer sufficient explanations, he sought answers in his own philosophical musings, displayed in his book Mind, Perception and Science (1951). Once qualified, Brain’s ascent was rapid. Following his house physician years at the London, he moved to Maida Vale Hospital for Nervous Diseases to work as a registrar and was later appointed physician. He then returned to the London Hospital in 1925 and was elected to the staff in 1927. These were his main appointments until retirement. With Eric Strauss, with whom he had been a medical student at New College, he wrote and edited a series of reviews Recent Advances in Neurology and Neuropsychiatry. This was first published in 1929 and was hugely popular. It was followed in 1933 by his seminal work Diseases of the Nervous System, which he continued to revise until 1962. Clinical Neurology, a shorter text for students, was published in 1960, and his monograph, Speech Disorders in 1961. He was the editor of the journal Brain from 1954 until his death, and for some time he edited the Quarterly Journal of Medicine. During this time, Brain had proved himself to be an excellent clinician with a very popular Harley Street practice. His patients encountered a quiet, serious man of few words

but great wisdom and compassion. His famed silences may have at times brought unease, but to those who knew him they were signs of deep thought. His observations during his clinics led to a number of significant contributions to neurology. However, one particular contribution resulted from a problem he observed closer to home. Brain had noticed how his wife would complain of pain and paraesthesia in her hand after pruning shrubs in the garden - a common problem which we now know is caused by compression of the median nerve in the carpal tunnel of the wrist. In 1947, Brain and two colleagues described six such cases in middle aged women and Stella was the first to undergo decompression of the median nerve for carpal tunnel syndrome! In another important report he demonstrated how cervical spondylosis could cause a variety of neurological disturbances by compression of the cord or spinal roots. Brain and his colleagues, especially Marcia Wilkinson, showed how the degeneration of the intervertebral disc and subsequent osteo-arthritic reaction of adjacent vertebrae 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 radiologically by injection of opaque medium into the spinal canal (contrast myelography), and the findings led to the introduction of a laminectomy as treatment for this condition. Some Unknown Problems of Cervical Spondylosis was published in 1963 having been the topic of the Gowers memorial lecture the previous year.

Commemorative Booklet 07

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 paraneoplastic syndromes. In 1951, Brain, Greenfield and Daniel described the degeneration of the cerebellum and spinal cord in association with cancer of the lung and ovary, pathology which could not be explained by metastasis or infection. They collected data from forty-three cases with widely varying neurology, including neuromuscular lesions and dementia. These observations led to the development at the London Hospital of a Unit for the Investigation of carcinomatous neuropathies, of which Brain was director until his death, and in 1964 he and Raymond Adams proposed the first classification of these paraneoplastic disorders. In addition to his outstanding contribution to the field of neurology, Brain was well-known for his thoughtful statesman-like nature and for his sense of fairness, perhaps deriving from his Quaker background. He played a major role in the early development of the National Health Service, in the Royal College of Physicians and in other influential Committees of the day, offering his succinct and insightful analyses on a wide number of issues. He began by serving on the Hospitals Committee and Journal Committee of the British Medical Association. He was also secretary of the London Hospital Medical Council and became its chairman at a difficult time during the Second World War, when it was necessary to assert the interests of medical staff away on active service. In 1950 he was elected President of the Royal College of Physicians, a position he held until 1957. Under Lord Moran, the Royal College had become influential in 08 Second Lord Brain Memorial Lecture

medical politics. Brain also became one of the leading medical statesmen of his time, involved in any matter where the interests of the public were relevant to or affected by the medical profession. In this capacity, he was appointed to a number of Royal Commissions including that on Marriage and Divorce in 1952, and on Mental Certification and Detention in 1954. Here he played a vital role in improving conditions for people with mental health problems. The present law on drug addiction is also largely based on the recommendations of his committee on drug addiction in 1966. In 1963, he was also elected President of the British Association for the Advancement of Science, a great honour to a physician still in active practice. He was particularly honoured by his election to Fellowship of the Royal Society in 1964, a major achievement for a clinician not engaged directly in scientific work, and was a member of the Council of the Royal Society in 1965. His contributions to medicine and to society in general were recognised by his appointment to the Order of Knights in 1952, and then as a Baronet in 1954, and a Baron in 1962, leading to his entry into the House of Lords. He was an honorary fellow of New College, Oxford, as well as numerous universities in this country and abroad, and was President of the Association of Physicians in 1956 and of the Association of British Neurologists in 1960. Given these many responsibilities and accolades, it is remarkable that Brain maintained so many interests outside the medical arena. He was a keen bird-watcher, gardener and photographer and was well-known for his love of literature and philosophy. He read widely, carefully

documenting which books were worthwhile (some of which he would recommend to his patients) and kept several notebooks of quotations that he would use for after-dinner speeches, which were always carefully prepared and rehearsed. His poems and verses were printed privately in 1962, and he published a number of volumes of critically acclaimed essays including Some Reflections on Genius, reviewed by one critic as a ‘pithy, learned and very readable’ exploration of intellect. In this essay he likened the intellectual trajectories of the poet and the scientist in their search for inspiration and discovery, bridging the two worlds he inhabited. The Nature of Experience summarised a series of Riddell memorial lectures that Brain gave in 1958, describing the processes of perception and the mechanisms of hallucination and illusion, a reflection of his fascination with the mind. In 1957, he wrote Tea with Walter de la Mare, a small book recollecting conversations with the poet, which was deemed ‘one of those which would retain a place on the shelf of the elect’ by a reviewer.

Morag Brothwell, Christopher Brain, Gavin Giovannoni and Michael Swash References Pickering, G.W. Walter Russell Brain First Baron Brain of Eynsham. 1985-1966. Biogr. Mems Fell. R. Soc. 1968 14, 61-82 Osmond, H. Some Reflections on Genius. The Canadian Medical Association Journal 1961: 85; 756-757 – Obituary in BMJ Autobiographical Notes by Lord Brain

In the public eye, Russell Brain was a truly exceptional clinician, statesman, philosopher, writer and poet, but behind the scenes he was a devoted husband and father to his three children, Christopher, Michael and Janet, and a loyal member of the Society of Friends. Asked to what he owed his success, Brain would answer that, firstly ‘it would be genes a long way ahead of other factors’, and then secondly his wife, who encouraged him to study medicine and supported him throughout his life. Commemorative Booklet 09

Walter Russell Brain 1895-1966 Bibliography

PAPERS 1922-23. (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. 10 Second Lord Brain Memorial Lecture

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.

Commemorative Booklet 11

Walter Russell Brain 1895-1966 Bibliography

1941. Visual disorientation with special reference to lesions of the right cerebral hemi- sphere. 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.

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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 Neuropsychiatry. (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 13

Walter Russell Brain 1895-1966 Bibliography

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.

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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 disorders associated 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.

Commemorative Booklet 15

Walter Russell Brain 1895-1966 Bibliography

CONTRIBUTIONS TO SYMPOSIA 1958. 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.

MEDICAL BOOKS 1929. (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.

NON-MEDICAL PUBLICATIONS 1927. 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. 21 1964. Retsina. Privately published by Staples, Printers. 1966. Science and man. London: Faber & Faber.

GENERAL AND HISTORICAL 1935. 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.

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Commemorative Booklet 17

Walter Russell Brain 1895-1966 Bibliography

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

The Neurological Tradition at the London By Michael Swash

In his Schorstein Lecture given at the London in 1959, Lord Brain addressed this subject, publishing it in the Lancet in the same year. His lecture was subtitled “on the importance of being thirty”, that being the mean age of consultant appointments in Neurology at the London until post-war bottlenecks in NHS preferment resulted in a surfeit of Senior Registrars, many approaching 40 years of age before appointment to the consultant grade. Brain’s thesis was that a neurologist’s best work is commenced before the age of 30 years, and the lecture proved influential. Beginnings: The London Hospital was founded in 1740, famously after a meeting in the Feathers public house in the City. From the start there seems to have been an interest in neurological illness. John Andrée, the first physician appointed to the staff in 1740, published a two-volume book on epilepsy and related disorders in 1753. John Cooke (1756-1823), also an early physician to the hospital, published his ‘Treatise on Nervous Diseases’, one of the first comprehensive textbooks of neurology written in English, in 1820. His book is organized in three general sections; Epilepsy, Apoplexy and Palsy, with extensive historical introductions to each section. James Parkinson: James Parkinson (1755-1824) described paralysis agitans in a now scarce monograph in 1817. He had been a dresser at the London Hospital for six months in 1776, and afterwards was a practitioner in East London, maintaining close professional relations with the London. His monograph provides a remarkably complete

18 Second Lord Brain Memorial Lecture

description of the disease, except for the omission of rigidity. It was only with the advent of more complete schemata of clinical examination that this feature was later recognized by JeanMartin Charcot, in Paris, and it was Charcot who first used the eponymous nomenclature that remains in use today. Parkinson himself, a prolific pamphleteer and agitator for political reform, often unpopular with the authorities of the day was also a distinguished geologist and fossil collector, and the founder of the Royal Geological Society. William John Little: In 1834 WJ Little (1810-1894), a surgeon with a special interest in orthopaedics, described cerebral palsy and recognized its association with birth trauma and hypoxia. He was an apothecary's apprentice before entering medical school at the London Hospital at the age of 18. He was admitted to the Royal College of Surgeons in 1832. Little introduced tenotomy to Britain for the management of talipes, a technique he had learned in Germany, and founded the National Orthopaedic Hospital in London. Jonathan Hutchinson and Hughlings Jackson: Sir Jonathan Hutchinson (1828-1913) was influential and productive in many areas of medicine throughout his long life. His neurological contributions included papers on neurosyphilis, optic neuritis (not then distinguished from papilloedema), the syndromes of internal carotid artery aneurysms and carotid occlusion, and on torticollis. He contributed a seminal paper on the pupils to the first volume of Brain in 1878. He was a founder member and President of the Neurological Society of London – later subsumed into the Commemorative Booklet, June 2010 19

The Neurological Tradition at the London By Michael Swash

Royal Society of Medicine. It was he who encouraged the young John Hughlings Jackson (1836-1911) to study neurology. Jackson is now widely recognized as perhaps the most original of the “founders of neurology”. Like Hutchinson, Jackson was a graduate of the York Medical School under Thomas Laycock. With Hutchinson’s support and influence Jackson joined the staff of the London in 1859, as well as the newly formed Hospital for the Paralysed and Epileptic at Queen Square. Jackson codified clinical phenomena, especially eye movements, epilepsy, language disorders, disorders of motor control, and right hemisphere functions, interpreting them as positive or negative phenomena in the light of Darwinian evolution. In this approach he was much influenced by his friend, Herbert Spencer, the philosopher. His concept of levels of function in the brain was especially influential, extending also into European psychiatry. Warren Tay: Warren Tay (1844-1927), a surgeon and dermatologist with an interest in disorders of the eyes, made the first description of the characteristic fundoscopic appearance of TaySachs disease in 1881, recognizing the familial causation of the disease in 1884, when the ophthalmoscope was still a novel instrument. Bernard Sachs, a New York neurologist, described the pathology in 1887. Henry Head: Henry Head (1861-1940), perhaps the first clinical neuroscientist, was educated, as were many of his generation, in both England and Germany, before his appointment at the London 20 Second Lord Brain Memorial Lecture

(Queen Square having declined to appoint him). He became one of the leading figures in European neurology, making major contributions to knowledge of the segmental dermatomal distributions on the body, to visceral sensation and, with WHR Rivers, to sensory physiology itself, introducing von Frey’s hairs into clinical and research practice in Britain. His observations on the recovery of sensation after nerve injury were made following section of his own superficial radial nerve by his colleague at the London, Sir James Sherren who, himself, wrote an important monograph on peripheral nerve injuries and their management (1908). With his neurological colleagues at the London, George Riddoch (18881947) and Theodore Thompson (1878-1938), he published extensively on spinal cord injury. Head made a major contribution to understanding aphasia and to the neurophysiology of language (1926), painstakingly studying patients braininjured in the First War in relation to their brain lesions. With EG Fearnsides (1883-1919), in the Department of Morbid Anatomy, he studied neurosyphilis. Fearnsides, continuing to work with HM Turnbull in Morbid Anatomy, made the first comprehensive description of intracerebral aneurysms in 1916, but his career was tragically cut short in a boating accident aged only 36 years. Head was selected by Sir Walter Fletcher, Secretary of the newly formed Medical Research Council, as a suitable candidate to develop the first academic unit of medicine in Britain, at the London Hospital, but Head was unable to persuade the House Committee to designate his required total of 100 beds and suitable staff to the project, and the opportunity passed when he retired, aged only 58 years, with Parkinson’s disease.

Russell Brain and later: After Head retired, W Russell Brain (1895-1966) joined Riddoch on the staff, quickly establishing a reputation as a skilled and knowledgeable clinician. He wrote extensively on neurological topics, including defining contributions on carpal tunnel syndrome and with Marcia Wilkinson, on the neurological complications of cervical spondylosis, including its differential diagnosis from multiple sclerosis. His hugely influential Textbook of Neurological Disorders was first published in 1933, and went through five personally written editions until 1962. Later editions have been multi-authored. With Ronald Henson (1915-1994), and Henry Urich, he described and classified the paraneoplastic syndromes. Brain had a national reputation as a diagnostician. Although essentially a very private man, his teaching rounds, serious affairs though they were, were highly valued. When Brain retired in 1962 Christopher Earl, another superb clinician and teacher, joined Henson in the neurological unit. Alan Ridley was appointed when Earl resigned Michael Swash was appointed as the third neurologist in 1972 and became the first Professor of Neurology in the Medical School in 1993. Michael Swash trained at the London Hospital Medical College and at The University of Virginia School of Medicine, graduating in 1962. He did the residency program in neurology with Dr Joseph M Foley and Dr Maurice Victor at Case-Western Reserve University, Cleveland, Ohio, and as a Fellow in Neurophysiology at Washington University, St Louis, Missouri. Returning to London in 1968, he was Registrar in Neurology at the London, and then MRC

Research Fellow in Neuropathology, working on muscle spindles. Michael Swash has published more than 500 original papers and reports, and 16 books, many in several editions, especially Hutchison’s Clinical Methods, a London Hospital classic now more than 100 years in continuous publication. The merger with Barts induced a major and long-overdue increase in staffing levels in the department. Gavin Giovannoni succeeded Michael Swash as Professor of Neurology, with an expanded department, in 2006. Neuropathology: HM Turnbull (1875-1955), renowned as a pathologist, very much encouraged neuropathology, then in its infancy. He followed up Fearnsides’ observations on intracranial aneurysm in work that enabled Charles Symonds, working at Guys and Queen Square, to describe the clinical diagnosis of subarachnoid haemorrhage. With James MacIntosh (18821948) Turnbull described the clinical and pathological features of post-vaccinial encephalomyelitis. MacIntosh and Sir Paul Fildes (1882-1971), then working in the Department of Microbiology at the London, confirmed Noguchi’s discovery of the treponemal basis of syphilis, a discovery that led to a revolution in neurological diagnosis, causing the reclassification of a number of syndromes previously misattributed to syphilitic infection. Dorothy Russell (1895-1983) succeeded Turnbull as Professor of Morbid Anatomy in 1944 – the first woman to achieve professorial status in pathology in Europe. She had been one of the first lady medical students at the London, Commemorative Booklet 21

The Neurological Tradition at the London By Michael Swash

and had trained there and later in Montreal with Wilder Penfield, who had learned silver stain technology from Dr Pio del Rio Hortega, Ramon y Cajal’s former student and colleague in Madrid. With the outbreak of war in 1939 Russell moved to Oxford where Hortega was working with Hugh Cairns in the military Neurosurgical Head Injury Unit at St High’s College. Ronald Henson was also relocated to St Hugh’s during the bombing of London; Russell Brain was relocated with JG Greenfield, the neuropathologist, Chase Farm Hospital in North London. Dorothy Russell transferred this silver technology to the London and used it to great effect with Lucien Rubinstein (1924-1983) in their defining monograph “Tumours of the Nervous System”, a book that ran through five editions and continues to this day, long after both its original authors have passed away. In addition, Russell made huge contributions, often with Crooke, to knowledge of the pituitary gland, to the classification and causation of hydrocephalus, and to general neuropathology. When Rubinstein moved to the USA (first to Columbia, and then to Stanford), Henry Urich took over the neuropathological department continuing the tradition of expertise in cerebral tumours and brain malformations. He was followed by Carl Scholtz, and then by Jennian Geddes. Sir Hugh Cairns and Neurosurgery: The neurosurgical unit at the London was founded by Cairns (1896-1952), although neurosurgical procedures were of course frequently performed before his appointment in 1926. Cairns, an Australian Rhodes scholar, first spent a year in pathology with Turnbull, and then worked in general and renal surgery at the 22 Second Lord Brain Memorial Lecture

London. Prior to his taking up this appointment as Neurosurgeon, the Hospital Governors sent him in 1926 to Boston to work with Harvey Cushing, so that on his return he could introduce the innovative techniques pioneered by Cushing to Britain. Once the Unit was fully established, in 1933, there were hosts of visitors keen to learn the new methods. In 1938 Cairns was tempted by Lord Nuffield’s offer to join his new School of Medicine at Oxford as Professor of Surgery, leaving the neurosurgical department at the London in the capable hands of his former student, Douglas Northfield (1902-1976), who was later joined by JV Crawford. Northfield developed pioneering procedures in tumour surgery, spinal surgery, the management of hydrocephalus, and epilepsy surgery. Northfield’s book “Surgery of the Nervous System’ (1973) represented the apogee of neurosurgical technique and knowledge to that time. Crawford was succeeded by Tom King, himself a meticulous surgeon with a major interest, in collaboration with Andrew Morrison, in acoustic Schwannoma surgery. ES Watkins, the first Professor of Neurosurgery, who brought new methods of stereotaxic surgery moved to the London from the USA, succeeded Northfield. Fary Afshar, himself a London Hospital graduate, rejoined the London as Neurosurgeon when the neurosurgical unit at Barts closed. He and his colleagues were joined by Peter Richardson, who succeeded Watkins, and by other colleagues.

studies, and specialized therapies such as physiotherapy, occupational therapy, as well as oncology and radiotherapy are pre-requisites to modern practice. The London was in the forefront in the provision of these modalities. Skull X-rays were available before the First War, EEG recordings using two saline pad Berger electrodes were in use for the diagnosis of epilepsy and cerebral tumours in the 1930s and, after the Second War, a formally constituted Department of Electro-Encephalography was established by Dr Samuel Last, later with the assistance of Leo Honigsberger, who had an interest in epilepsy monitoring,. Donald Scott developed this department with Pamela Prior from the early 1960s. Electromyography and nerve conduction studies were provided by Kit Wynn-Parry in the Department of Physical Medicine. Later, as this specialty developed, these investigations joined EEG in the Department of Clinical Neurophysiology. Radiotherapy was in active use before the Second War, and radioisotope brain scanning preceded the advent of CT and then MR brain imaging in the 1970s and 1980s respectively. Rehabilitative services were provided in collaboration with the relevant related specialties beginning in the nineteenth century. Acknowledgement: I thank Mr Jonathan Evans in the Royal London Hospital Archives Centre for his invaluable help.

Further Reading Clarke-Kennedy AE The London; a study of the 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 Med 1997;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 of Neurology. Springfield, Illinois, Charles C Thomas. 1969 Morris EW. A history of the London Hospital. London, Edward Arnold. 1926 Swash M. John Hughlings-Jackson: a sesquicentennial tribute. J Neurol, Neurosurg Psychiatry1986 49 981-985 Swash M. Henry Head and the development of clinical neuroscience. Brain 2008;131:3453-3456 Swash M. And Lord Brain said. Practical Neurology 2007;7:250-251

Related specialties: Associated skills and facilities are essential to the practice of a specialty. For neurology and neurosurgery, neuropathology, neuroradiology, clinical neurophysiology, various laboratory Commemorative Booklet, June 2010 23

Professor Richard Trembath Barts and The London School of Medicine and Dentistry

Richard Trembath, F Med Sci, took up the post of Vice Principal (Health) and Executive Dean on 1st September 2011. Prior to this appointment he was the Director of the NIHR Comprehensive Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and Head of the KCL Division of Genetics & Molecular Medicine at King’s College London. He is an Honorary Consultant in Clinical Genetics at the Genetics Centre, at Guy’s Hospital. He is a Director on the UCL partnership board. He is a Senior Investigator for the National Institute of Health Research, a former Clinical Academic Group Lead within King’s Health Partners and a Fellow of the Academy of Medical Sciences.

The main focus of Professor Trembath’s research is to identify genes and delineate the molecular pathways underlying a range of human genetic disorders using both established and emerging technologies. Major interests include investigating the genetic architecture of common inflammatory skin, such as Psoriasis and Acne. Most recently, the group have launched a series of studies looking at the genetic determinants for extreme phenotypes within more common disorders, with examples including severe and adverse response to therapies.

He trained in Medicine at Guy's Hospital Medical School and undertook postgraduate studies at the Institute of Child Health, London before to moving to the Department of Genetics at the University of Leicester in 1992. He was appointed to the Foundation Chair of Medical Genetics in Leicester in 1998. Professor Trembath serves on Advisory and Editorial Boards and Committees of numerous national and international journals and academic societies. He is past President of The British Society of Human Genetics.

24 Second Lord Brain Memorial Lecture

Commemorative Booklet 25

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

Colin Blakemore is Professor of Neuroscience at the University of Oxford. He also holds emeritus Professorships at Warwick, Peking Union Medical College and at the Duke-NUS Graduate Medical School in Singapore, where he is External Scientific Advisor to the Neuroscience Research Partnership. Colin has been President of the British Association for the Advancement of Science, the British Neuroscience Association, the Physiological Society and the Biosciences Federation (now the Society of Biology). He is a Fellow of the Royal Society and the Academy of Medical Sciences and an Honorary Fellow of the Royal College of Physicians, the British Pharmacological Society, the Society of Biology and the British Association for the Advancement of Science. He is a Member of Academia Europaea and the European Academy of Sciences and Arts, and a Foreign Member of several academies of science, including the Royal Netherlands Academy, the National Academy of Sciences of India and the Chinese Academy of Engineering. He holds ten Honorary Degrees.

1996-2003 he was also Director of the Centre for Cognitive Neuroscience. His research has been concerned with many aspects of vision, development, plasticity of the brain and neurodegenerative disease. He has been a Visiting Fellow or Professor in the USA, France, China, Singapore, Italy, the Czech Republic, Japan, Canada, New Zealand and the Netherlands. From 2003-2007 he was Chief Executive of the UK Medical Research Council. He is currently Chair of the General Advisory Committee on Science at the Food Standards Agency, a Commissioner of the UK Drug Policy Commission and a member of Legal & General’s Longevity Science Advisory Group. He works for a number of UK charities: he is President of the Motor Neurone Disease Association and Brain Tumour UK, Vice-President and Trustee of the PSP Association, and Vice-Patron of SANE. He chairs the Selection Committee for The Brain Prize.

Evolution of the human brain: why was bigger better?

About 200,000 years ago, modern Homo sapiens appeared, characterised by a sudden increase in brain size. Big brains are costly, in terms of their metabolic demand. The survival of our bigbrained ancestors is usually assumed to have depended on the cognitive advantages of a large brain. But human cognitive achievement has continued to accelerate, long after the stablisation of our genetic makeup and of our basic brain structure. The sudden increase in brain size is not difficult to explain. But its utility and its conservation are harder to understand. The answers might lie in the adaptability and plasticity of the nervous system. Development of complex nervous systems depends on general rules, including adaptive mechanisms to fine-tune connections. Such developmental flexibility might have permitted and accommodated evolutionary changes in organisation of the brain, including the sudden increase in size. Natural selection has also discovered genetic mechanisms that enable neurons to change the strength of their connections in response to the pattern of activity passing through them. Such plasticity helps individuals to match perceptual, cognitive and motor skills to the nature of the world around them. Brain plasticity, although genetically determined, enabled humans to escape from the informational limits in the blueprint of their genes and propelled them into a different mode of evolution. There is no reason to believe that such cognitive evolution, dependent on cultural rather than genetic inheritance, is over.

Colin is a frequent broadcaster on radio and television, and writes books and articles about science and science policy for a wide audience. He has won many prizes for both his research and his work in the public communication of science, including the Royal Society Michael Faraday Prize and David Ferrier Prize.

Colin studied Medical Sciences at Cambridge and did a PhD at the University of California, Berkeley. After working for 11 years in Cambridge, he moved to Oxford as Waynflete Professor of Physiology in 1979, and from 26 Second Lord Brain Memorial Lecture

Commemorative Booklet 27

Neuroscience at Barts and The London

Neuroscience is a partnership between Barts and The London School of Medicine and Dentistry and Barts Health NHS Trust. Barts and The London School of Medicine and Dentistry provide international levels of excellence in research and teaching. The 2008 Research Assessment Exercise results showed the School joining Oxford, Cambridge, Imperial College and University College London in the top five research-active medical and dental schools in England. According to rankings published in the Times Higher Education, Barts and The London scored consistently in the top five in the UK. At the heart of the School’s mission lies world class research. During the last five years, the School has implemented a focused programme of recruitment of leading research groups from the UK and abroad, together with a £100 million investment in state-of-the-art research facilities. Barts Health NHS Trust has been consistently rated amongst the top teaching hospital trusts in the UK for clinical excellence. The Trust has benefited significantly through the £1 billion Private Funding Initiative that is transforming the Barts and The Royal London Hospitals into one of the largest hospital complexes in Europe. Barts Health NHS Trust was created on 1 April 2012 following the approved merger of Barts and The London NHS Trust, Newham University Hospital NHS Trust and Whipps Cross University Hospital NHS Trust. Barts and The London and Barts Health have recently joined UCL Partners, one of five accredited academic health science systems in 28 Second Lord Brain Memorial Lecture

the UK. UCL Partners will allow Barts and The London to translate cutting edge research and innovation into measurable health gain for patients and populations – in London, across the UK, and globally. Neuroscience research at Barts and The London focuses on five broad themes: trauma sciences, neurotrauma & neurodegenerative disorders, neuroinflammation , stem cells, and genomics & cancer. The Centre’s themes have been mapped onto clinical academic units within Barts Health NHS Trust with many of its staff actively involved in clinical research, including phase 2 and 3 clinical trials. The research themes have been created with the specific aim of creating partnerships between basic scientists and clinicians to encourage translational research. Several PIs hold substantial translational neuroscience funding. Professor Gavin Giovannoni is the current Centre Lead. Professor Karim Brohi’s trauma group covers various aspects of trauma research, from injury prevention to public health, the effects of trauma on the body, the body’s response to injury and rehabilitation. A major focus of the group is trauma-associated coagulopathy, a research field in which the group is a world-leader. In neurotrauma, the research emphasis is on spinal cord and peripheral nerve injury, and more recently, head injury. Professor Adina Michael-Titus leads the neurotrauma and neurodegeneration group and under her lead the neurotrauma group has identified several promising neuroprotective therapeutic strategies which will help reduce

the impact of injury. The group’s work on omega3 fatty acids in neurotrauma is supported by several UK and international translational awards. Professor John Priestley has developed biomaterial-based conduits for peripheral nerve and spinal cord repair. Professor Priestley and Dr Xuenong Bo, coordinate a programme of research on neuroregeneration. Neurotex, a BLTSMD spin-out company, has been established to commercialise the work on biomaterials. In the neurotrauma group, Dr Babis Magoulas conducts research that has a particular focus on neuroinflammation and its role in injury and regeneration. In neurodegeneration, Dr Andrea Malaspina has an active research programme which covers various aspects of amyotrophic lateral sclerosis research, from animal models of the disease to neuroprotective agents and new disease biomarkers. Professor Michael-Titus is also leading a new MRC-funded translational programme on novel metal-binding compounds with therapeutic potential in Alzheimer’s disease. Professor Gavin Giovannoni and Professor David Baker head up the neuroimmunology group with their main disease focus being multiple sclerosis. Their research is centred on immune tolerance strategies, developing neuroprotective and neurorestorative therapies for progressive multiple sclerosis and manipulating cannabinoid biology as a therapeutic strategy to improve the symptoms of multiple sclerosis. David Baker's work on cannabis as a potential neuroprotectant in MS continues and has recently being tested in a national MRC-funded trial under the direction of Professor John Zajieck (Plymouth). Another research focus is the role of EBV in the

pathogenesis of MS and how it interacts with other environmental factors and genetic risk factors. David Baker is the co-founder of Canbex a spin-out company that has identified and developed a group of cannabinoid-like compounds that are excluded from the CNS to treat muscle and bladder spasticity. Dr Klaus Schmierer’s main focus is on the pathological correlates of MRI changes in multiple sclerosis and therapies for primary progressive multiple sclerosis. Professor Silvia Marino’s research has focused on understanding how Polycomb group genes controls stem cell function during the development of the central nervous system and in brain tumours. Moreover, her group uses experimental models to assess whether manipulation of stem cell properties can be exploited to increase regeneration and repair in neuromuscular conditions. In genomics and cancer Professor Denise Sheer's group studies the function of human chromosomes and the genetic basis of cancer, with a focus on critical pathways involved in brain tumours. The groups are establishing a tumour biobank with detailed clinical phenotyping. In addition to the activity of the group leaders highlighted above, there are active research programmes in motor neurone disease, pain, muscle regeneration, neuro-gastroenterology, biomarkers and clinical outcomes.

Commemorative Booklet 29

Blizard Institute

The Blizard Institute was established in 2003 and is the largest of six Institutes within Barts and the London School of Medicine and Dentistry, QMUL. The Institute, which comprises approximately 450 staff based in eight academic Centres and supports over 400 postgraduate students, aims to deliver excellence in all aspects of research, teaching and clinical service. The research of the Institute is based upon focused programmes of basic, clinical and translational programmes of research activity targeted to selected areas of clinical excellence in partner NHS organisations, in particular Barts Health NHS Trust. The Institute was returned in Unit of Assessment 4 of RAE2008 and 80% of

30 Second Lord Brain Memorial Lecture

the outputs were considered world class or internationally excellent. This outcome placed the research of Blizard Institute in joint first position of Hospital Based Clinical Subjects in UK medical schools. Postgraduate programmes The Institute hosts a range of highly successful and sought after postgraduate taught programmes lead by senior staff in individual academic centres. These programmes have been developed in response to the research, teaching and training needs of individuals pursuing careers in disciplines encompassed by the Institute and each course has a unique structure designed to best meet these needs. Additionally, the Institute provides a supportive environment for those wanting to undertake a PhD.

The Institute is housed in the Blizard Building in Whitechapel. The unique, award winning, Blizard Building provides state-of-the-art laboratory accommodation based on an innovative open plan design for staff and postgraduate students. The laboratory facilities are co-located on a single laboratory floor of approximately 3,500m2, the design of which aims to encourage maximal interaction between different research groups and efficient usage of core equipment and facilities. The Centre for Primary Care and Public Health is accommodated in the adjacent and newly refurbished Yvonne Carter Building which provides an excellent environment for research students in these disciplines. The Institute takes its name from Sir William Blizard, the founder of the London Hospital Medical College in 1785.

Public Engagement in Science Public Engagement is a high profile component of the Institute's portfolio of activity largely through the Centre of the Cell Project which showcases the very best of our research in a readily accessible format. The educational and aspiration raising activities of the Centre are targeted upon school children particularly drawn from our local population and are facilitated by co-operation with multiple scientists and teachers from the Blizard Institute.

Commemorative Booklet 31

Past recipients of the Lord Brain Memorial Lecture and Medal

Professor Andrew Lees Institute of Neurology, University College London Andrew Lees was the first recipient of the Lord Brain Memorial Medal. The medal was awarded for his scientific contributions to field of movement disorders in the UK. He is the director of the Reta Lila Weston Institute of Neurological Studies at University College London, and Professor of Neurology at the National Hospital for Neurology and Neurosurgery, Queen Square, London.

32 Second Lord Brain Memorial Lecture


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

Commemorative Booklet 33

Second Lord Brain Memorial Lecture Commemorative Booklet The Lord Brain Memorial Lecture and Medal was established in 2010 in honour and memory of Walter Russell Brain’s outstanding contribution to the field of neurology. The memorial medal pays tribute to healthcare professionals or scientists who have worked in the UK and have made a major scientific contribution to the field of neuroscience. The lecture is held biennially and hosted by the Centre 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 Pal Centre for Neuroscience and Trauma Blizard Institute Barts and The London School of Medicine and Dentistry 4 Newark Street London E1 2AT

This booklet has been produced by the Publications and Web Office for the Barts and The London School of Medicine and Dentistry Pub9259 Any section of this publication is available upon request in accessible formats (large print, audio, etc.). For further information and assistance, please contact: Diversity Specialist,, 020 7882 5585

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