This biography is a detailed depiction of the life and career of a doctor who the author portrayed as ‘the first surgeon to devote most of his time to the nervous system‘. The book’s stated objective was ensuring that Horsley’s ‘medical triumphs‘ gain ‘wider recognition and appreciation’. In that regard, it asserts that he was responsible for establishing the specialty of neurosurgery, a field that the author said was ‘largely unexplored‘ before him. The biography argued that ‘throughout his life’ Horsley ‘had set the fashion rather than following it’, and it supported this assertion by documenting his multidimensional facets as a pioneering neurosurgeon, an effective researcher, an inspiring teacher, and a principled social reformer. The exhaustive portrait the biography paints of its subject is that of a doctor who ‘put the welfare of his patients and of society in general above his own interests or the interest of the profession’; ‘a surgical neurologist who thought deeply about matters of the brain‘; ‘a pioneer who helped to shape…the development of neurosurgery as a specialty‘; and a man who ‘had the strength to act on his moral beliefs regardless of whether they conflicted with those of the authorities’. The narrative is however far from being hagiographic as it documented Horsley’s personal failings as comprehensively as it did his professional successes (pages ix-x, 86 and 174-175).

The book’s depiction of Horsley’s formative medical education and surgical training revealed the factors that determined his career trajectory, and set him up for future success. For example, in its description of his life as a medical student at University College London, the author noted that he trained under such illustrious physicians as Henry Charlton Bastian and Wilson Fox, ‘physician-extraordinary to Queen Victoria‘. Similarly, the narrative showed that Horsley got involved in the study of nerve structure whilst still a house surgeon. And as a surgical registrar, he was ‘responsible for overseeing the preparation of annual reports summarizing the cases seen at the hospital’. During the time he worked as an assistant surgeon, the author said Horsely was able to devote time to research and pathology, and as a staff of the National Hospital at Queen Square, he collaborated with ‘a remarkable group‘ that included ‘the two greatest clinicians in contemporary British neurology’ – John Hughlings Jackson and William Gowers (pages 5-10, 13-19 and 56).

Horsley’s influence on the course of neurosurgery was predictably the dominant theme of the biography, the author asserting that he was key to setting up neurosurgery as a distinct surgical field. The author attributed this to Horsley’s successful removal of a brain tumour in a patient with epilepsy in 1886, a breakthrough operation that was witnessed by the leading neurologists, Hughlings Jackson and David Ferrier. Although Francesco Durante, Rickman Godlee and William McEwan had removed brain tumours before him, the author nevertheless maintained that Horsley’s operation was the first to be based on ‘principles derived from localization experiments in animals’. The book also cited Horsely’s series of 44 cases that demonstrated the feasibility and safety of brain surgery, a milestone that it said marked the birth of ‘the new specialty of neurosurgery’. Indeed, the author argued that Horsley, more than any other surgeon, was ‘responsible for advancing the emerging specialty’, and for developing ‘a school of followers‘. Such was his pioneering role that the author said Horsley’s was ‘the only well-established clinical practice of neurosurgery in the world up to the early twentieth century. The author went further to affirm that Horsley ‘continues to serve as a role model for modern neurosurgeons, combining the diagnostic skills of a competent neurologist with the outstanding technical and operative skills required for success in the operating room’ (pages 52-59, 70, 79, 85 and 91).

This biography is a thorough critical appraisal of one of the most influential doctors in history – the founder of a surgical specialty and the promoter of various social causes. The author documented a complete profile of Horsley with a balanced approach that highlighted both his subject’s positive and negative qualities. The book also provides the proper context to understanding a surgeon who passionately pursued his goals but whose personality was by all accounts complex. Whilst there are competing claims to his priority in brain surgery, and of being the father of the modern specialty, the author argued rather convincingly for his assertion that Horsley deserves credit for both accolades.