Not so long ago, just over a century, there were no neurologists—at least not in the UK in the sense of physicians who specialised entirely in neurology. By half a century ago a few neurologists had emerged from general internal medicine and were practising in the major cities, particularly London, and mostly in teaching hospitals, usually with a large private practice as well. Some made occasional excursions to distant cities to see a few patients, have a nice lunch and return to London, satisfied with a good day’s work of making diagnoses but not much else. Of course, the thousands of patients with neurological problems never saw these famous men (and they were all men); they were looked after by general internal physicians, and by the emerging speciality of geriatricians who took on the strokes. Indeed, in the 1970s an argument was made, by non-neurologists, that neurologists were really rather redundant—they saw few patients, never as an emergency and never out of hours, and anyway CT scanning should put them out of business as the purveyors of the extreme exponents of lesion localisation. UK neurologists were hardly making much contribution to health care, although in many other countries there were far more neurologists and they were by then fully engaged with stroke, head injury and the multiplicity of problems seen in general neurology clinics.

In the 1980s UK neurologists began to wake up to the fact that they did have a lot to offer to patients with neurological problems, both in emergency and non-emergency settings, and that with the demise of the general internal physician there was no one else to look after these patients. By then most cities (at least those with a teaching hospital) had a neurology department, usually alongside a neurosurgery department, perhaps with 3–10 neurologists, often …