Macdonald Critchley had a long life which was devoted to neurology from his first entry to Queen Square as a house physician in 1923, and ended 74 years later as his last book was going through the press. He is widely thought of as the great authority on disorders of higher cerebral function, but in the three quarters of the century during which he contributed to neurology, he covered a remarkable range of topics.
Macdonald Critchley was an immensely talented boy who matriculated from the Christian Brothers’ College in Bristol at 15. Too young to go to university, in the year while he waited he began to learn German to add to his considerable skills in French and Latin. This was, of course, during the First World War and German was declining in popularity, so he decided to change to Greek.
At 16 he was admitted to Bristol University, but by 1917 he was in the Army. During this period, when he was largely involved with ceremonial duties, a technical infringement led to his being imprisoned, a dispiriting experience, but one which, he later observed, he would not have missed. Released, he became interested in flying and in 1918 he became a cadet in the Royal Flying Corps. During this period he began to learn Russian. With the end of the War he returned to Bristol University and graduated at the age of 21 with first class honours, having found time to exercise his acting talents treading on the boards of many of the theatres in and around Bristol.
After a brief period as a house physician there, he came to London, first to Great Ormond Street, then to Maida Vale and, finally, in 1923, to Queen Square. Here his development was shaped by the distinguished physicians on the staff - Sir Gordon Holmes [Munk’s Roll, Vol.V, p. 195], James Stansfield Collier [Munk’s Roll, Vol.IV, p.446], Samuel Alexander Kinnier Wilson [Munk’s Roll, Vol.IV, p.540] and James Samuel Risien Russell [Munk’s Roll, Vol.IV, p.396]. The last had been on the consultant staff with John Hughlings Jackson [Munk’s Roll, Vol.IV, p. 161], Sir William Gowers [Munk’s Roll, Vol.IV, p.264], Sir David Ferrier [Munk’s Roll, Vol.IV, p.246] and Sir Victor Horsley, and Critchley, as Russell’s last house physician, began then to accumulate a fund of knowledge about the lives and working methods of these great 19th century founders of British neurology.
Critchley began to publish while he was a resident. In 1924 there were seven papers, including three on movement disorders and three on various aspects of calcium metabolism and its alteration in disease. In the years which followed his interests began to include those which came to dominate his work in later years: in 1927 he published on defects in reading and writing in children, a prelude to one of his major contributions forty years later, for which he received the Sam T Orton prize in the US. He published his first book shortly afterwards, in 1928, On mirror writing, London, Kegan Paul, Trench, Trubner & Co. The year 1927 saw his appointment to the consultant staff at both the National and King’s College Hospitals and no less remarkable was his election to the fellowship of the Royal College of Physicians at the age of just 30. In 1931 he gave the Goulstonian lecture at the College on The neurology of old age, a topic which sixty years later is one of the major concerns of neurology.
Increasingly in the 1930s his writings reflect a growing concern with higher cerebral function: the dementias, hallucinatory states and aphasia. The Second World War radically, if temporarily, changed his direction. He was called upon to organize the neurological and psychiatric services for the Royal Navy. His wartime observations in the Arctic and in the tropics provided the substance of his Croonian lecture to the College in 1945 when he spoke on the Problems of Naval warfare under climatic extremes.
After the War his interests extended to the punch drunk syndromes and migraine. His most influential book came in 1953: The parietal lobes, London, Edward Arnold. It was a landmark which was pivotal in the growth of the field of cognitive neurology.
These achievements in what one might call the science and practice of neurology are remarkable enough and for them he received the recognition of his peers worldwide with honorary degrees, prizes, named lectureships, visiting professorships and memberships of numerous national neurological societies. But there is much more. He wrote monographs on the two figures whose work influenced him most; Sir William Gowers (London, William Heinemann Medical Books,1949), and Hughlings Jackson, all but fifty years later (New York/Oxford, Oxford University Press, 1998). This, his last book, was written with his second wife, Eileen. In it Critchley reveals one of his many skills: his ability to distil the ideas of others and to make them comprehensible in short compass while retaining the flavour that in the original emerges from the richness of detail.
His accomplishments were wider still. He was a considerable essayist, writing on topics as diverse as self portraiture (he was a good painter himself), gesture, Indian mythology and dance, criminals and man’s attitude to his nose.
In the daily life of Queen Square he was the epitome of the distinguished physician - quiet, elegant, unhurried, and always civil. His apparent aloofness derived from a shyness which concealed from many his sympathetic concern for others. He was a brilliant teacher who attracted postgraduate students from all over the world. He was dean of the Institute of Neurology from 1948 to 1953. In the wider life of the profession, he served as president of the Association of British Neurologists, and of the section of neurology of the Royal Society of Medicine. He was the first elected vice-president of the Royal College of Physicians; his last great public office was as president of the World Federation of Neurology.
What was the basis of Critchley’s achievements? His remarkable intelligence goes without saying. He had a wide ranging curiosity and powers of observation and analysis which enabled him to extract new insights from the symptoms with which his patients came. And he was an indefatigable worker: he continued to see patients well into his 80s, and was writing to within 36 hours of his death. Macdonald Critchley was in the mould of the great figures of the last century who defined neurology as a medical specialty. His contribution in the middle of this century was a continuation of theirs. It is part of the foundation supporting at the century’s end the new edifice of the subject he made his own: cognitive neurology.
W I McDonald
[Migraine News, Spring 1998; Brit.med.J., 1998,316,478; The Independent, 24 Oct 1997; The Times, 16 Oct 1997; The Guardian, 16 Oct 1997; The Daily Telegraph, 27 Oct 1997]