Some years ago, while writing a book about neurological influences on Victorian literature, I had trouble pinpointing the status of neurology as a discipline in nineteenth-century Britain. Many physicians described retroactively as neurologists by historians, for instance, were known in their own time by different titles (as psychologists, physiologists, anatomists, and general practitioners) and for achievements in various subfields. Take, for example, Sir William Thornley Stoker (1845–1912), an accomplished neurosurgeon who not only performed some of the first brain surgeries in Ireland using David Ferrier's cortical maps but also published articles on hysterectomy, appendectomy, and bowel obstruction, among other topics. Stoker was also known for his political activism as an opponent of certain types of vivisection, and for his famous younger brother, Bram, the author of Dracula (1897). For the breadth of his interests, a twenty-first century interpreter might be tempted to classify Stoker as a general practitioner, despite his status as the leading neurological specialist in Ireland at the time.

If Stephen Casper's The Neurologists: A History of a Medical Specialty in Modern Britain had been available at the time I was writing, I would have gained a much clearer understanding of the historical development of neurology as a discipline, as well as how the field's retroactive construction by modern-day neurologists had added to my confusion. Casper's clearly written, painstakingly researched volume describes the rapid rise of neurology as a specialty in Britain between 1789 and 2000, along with the challenges and controversies that accompanied this increased specialization. Unlike most histories of neurology, Casper's depicts a discipline in flux, one whose boundaries were not clearly delineated in the nineteenth century and remain indistinct even now. While Casper glosses the leading neurological discoveries of this period, culminating in the modern era of neuroimaging and neuropharmacology, he is more interested in the people and the politics behind the formation of the discipline. By highlighting the disagreements between neurologists themselves, as well as cooperative forums in which they organized for political change, he paints a unique picture of the struggle towards medical specialization in this field, and the consequences (both positive and negative) of the discipline's increasing specificity.

Casper's opening chapters address the neurological achievements of the late nineteenth and early twentieth centuries and the generalist medical culture from which they arose. His introduction is an especially valuable resource. It covers nineteenth-century neuroscience in a concise and highly readable format and assumes no prior knowledge of the subject. I would gladly recommend this introduction to students or general readers seeking a succinct, clear overview of this eventful period in British medicine.

In the first and second chapters, Casper describes in greater detail the decades leading up to the First World War, focusing on neurological societies formed by members of this emergent profession. Having access to the minutes of these societies and private letters between members, Casper paints a richly textured picture of the day-to-day activities of these groups, especially the London-based Neurological Society. This group was founded by John Hughlings Jackson and other medical luminaries in 1886 and restructured as a branch of the Royal Society of Medicine in 1907. During this period, the word “neurologist,” coined by Thomas Willis in 1664, was still in very limited circulation, and most physicians were loath to conceive of themselves in such specialist terms (4). Instead, Victorian physicians cultivated the image of the gentleman scholar or Renaissance man. Accordingly, the Neurological Society welcomed members with varied medical backgrounds, including clinicians, researchers, and philosophers. In calling such people “neurologists,” Casper suggests, historians of neurology (many of whom are also practicing neurologists) have attempted to reify the status of their discipline by suggesting its timelessness and stability, thus belying the field's relative newness and ongoing evolution (162–63).

How did British neurology evolve from a loose coalition of gentleman scholars to the highly influential, established medical specialty it is today? Casper addresses this question in the remaining chapters, describing how two world wars and the creation of the National Health Services in the 1940s motivated the field's increasing specialization. So, too, did the Association of British Neurologists, founded in 1932 in response to an internal scandal within the field. The association not only established codes of conduct for its members, but also petitioned for greater governmental recognition of their medical specialty. In the 1950s, for instance, members successfully lobbied the National Health Services to employ greater numbers of neurologists at clinics and research centers throughout Britain, reversing what was widely perceived as a decline in the status of neurology at mid-century. In fact, the interwar period and the decades immediately following proved crucial in establishing Britain's international preeminence in neurology. This period also witnessed major growth in external funding available for neurological researchers—both clinicians and basic scientists—from groups like the Medical Research Council and the Rockefeller Foundation. By the 1970s, Casper explains, neurology was firmly ensconced within the national and international medical establishment. It was also widely seen as a prestigious field with special relevance for its cultural moment. When US President George H. W. Bush declared the 1990s the “Decade of the Brain,” he made official what many had long felt—that “neuroculture” now frames popular self-understanding (177). In Casper's words, “selfhood and brainhood” have “collapsed together” (27).

Refreshingly, Casper does not assume that specialization is an inevitable or even desirable phenomenon, nor does he unquestioningly accept the mechanistic understandings of selfhood introduced by neuroscience. In his thought-provoking conclusion, Casper ponders all of these issues evenhandedly. He also describes how neurology's early history of generalism has made it easier for the discipline to tackle major philosophical questions in the present day. Overall, Casper's highly readable book is a welcome corrective to the self-aggrandizing tendency evident in many histories of neurology. By showing us the people behind the development of modern neurology not as “great men” of science, but as multifaceted human beings and effective political actors, he provides new insight into the formation of the field.