In 1923, Critchley (1900 - 1997) moved to the National Hospital. Critchley was a prolific writer, publishing more than 300 single-author journal articles
Tall, slim and always impeccably dressed, Macdonald Critchley cast an imposing and handsome figure. Aged just 15, he was offered a place to read medicine at the University of Bristol but, deemed too young to go to university and already fluent in French and Latin, Critchley stayed on at school and taught himself ancient Greek and a smattering of Russian. His graduation from medical school was delayed by the first world war and Critchley graduated from Bristol Medical School with first-class honours at the age of 21.
In 1923, Critchley moved to the National Hospital where he became Risien Russell’s last house physician. After only three years’ training in neurology, Critchley was appointed to the staff at Queen Square and then also at King’s College Hospital, where he worked with Kinnier Wilson.
Critchley was a prolific writer, publishing many books and more than 300 single-author journal articles over a period of six decades – starting in his early twenties, when he was a resident, through to his nineties.
As a junior doctor, Critchley published on neurological complications of disordered calcium metabolism and movement disorders. He reinforced Marie’s concepts of arteriosclerotic Parkinson’s syndrome, and wrote important papers – which are still read – on essential tremors and occupational cramps. He was also one of the first neurologists to investigate the neglected field of the neurological consequences of ageing, including ‘soft extrapyramidal signs’, and he described the ‘striatal variety’ of the punch-drunk syndrome in which Parkinsonism is a striking feature.
A recurring topic of interest was speech, with books on The Language of Gesture (1939), Aphasiology and Other Aspects of Language (1970) and Silent Language (1975) in which Critchley discusses the neurology of gesture, ‘hearing eyes’, and deaf mute signing. A related interest was dyslexia. Critchley’s first article on reading and writing difficulties in children appeared in 1927, in which he discusses mirror-writing, a topic on which he had already published a small monograph. Critchley returned to the topic of reading in Developmental Dyslexia (1964), reissued with revisions as The Dyslexic Child (1970). With Ronald Henson, Critchley edited a volume of essays on Music and the Brain (1977), with a foreword by Sir Michael Tippett. This contains the definitive description of musicogenic epilepsy.
Critchley’s fascination for the unusual and the bizarre led him to stray outside the conservative and formal boundaries of neurology in these essays and lectures. Against this background of prolific and eclectic writing, Critchley’s most important monograph was on The Parietal Lobes (1953). This classic monograph remains an important analysis and source of reference. At Queen Square, he was considered the great authority on higher cerebral function and a worthy successor to Hughlings Jackson and Bastian. Some of his outstanding neurological achievements continue to resurface, including a well-documented case of a patient with clinical features that would have fulfilled all the consensus criteria for semantic dementia, not widely recognised until the 1980s but fully described in his case notes of 1938.
Critchley had the great gift of being able to distil ideas and make these accessible to other people. He was a brilliant teacher, who attracted students from around the world, and his controlled showmanship guaranteed a packed house at the Wednesday afternoon and Saturday morning clinical demonstrations at Queen Square. His delivery was unhurried, given without notes, and his interaction with the patient showed great tact and ingenuity. His style was to place diseases of the nervous system in their historical context and, although competent at eliciting physical signs, this was not his forte. He used various ingenious instruments: a black-and-white tie, which he sometimes removed to demonstrate optokinetic nystagmus; a tendon hammer inscribed ‘with admiration … from the Mayo clinic’; a large coloured hatpin; an alarm on his watch that he used to startle students; and, for eliciting the plantar response, a carved ivory hand given to him by Babinski, a gold cornuto purchased in Italy by his second wife Eileen, and a feather, discarded by a pigeon in Queen Square and provided to him by Sister Magnusson, or one from a flamingo picked up in San Diego zoo. Critchley carried a special bag filled with unusual objects which he would ask the patient to handle or answer questions about when examining the higher centres.
Critchley was a neurologist appreciated far more in continental Europe and the Americas than at home. In fulfilling his responsibilities as president of both the World Federation of Neurology and the International League Against Epilepsy, he was the first Queen Square physician to travel extensively and lecture all over the world.
His lucid biographies and colourful essays on Jackson and Gowers, and his teachers Holmes, Ferrier, Wilson and Collier, enriched for many years the hagiography and folklore of Queen Square for its many alumni and visitors from around the world.