Queen Square, Richardson, Robertson and PSP before 1964
Purpose: To record the historical events associated with the first clinical identification of progressive supranuclear palsy (PSP) by JC Richardson in Toronto 50 years ago.
Methods: Primary sources of information included interviews with John Steele, John Wherret and Andrew Lees, as well as examination of archival film made by E Graeme Robertson.
Results: 50 years ago, Canadian neurologist J. Clifford Richardson identified patients in Toronto with a syndrome of supranuclear vertical gaze palsy, pseudobulbar palsy, axial rigidity and cognitive impairment. Although much scepticism surrounded his predication that the nosological entity he termed PSP existed outside of Toronto, it is now acknowledged as a sporadic primary tauopathy that is as common as ALS. Allusions to a similar syndrome can be found in the writings of English novelist Charles Dickens, and possible cases were also reported from Charcot’s clinic at the turn of the nineteenth century. Richardson’s neurology training was exclusively at the National Hospital in Queen Square, where he was strongly influenced by Gordon Holmes and Charles Symonds. Robertson took some candid film footage in the 1950s of his Neurological colleagues, including documentation of the long lineage of experienced (and famous) Neurologists who will have worked with Richardson during his time at Queen Square. In one, filmed in Melbourne in 1954, Macdonald Critchley appears to simulate the gait of a patient with PSP.
Conclusions: It is likely that Richardson’s Queen Square experience exposed him to patients with unusual movement disorders and perhaps even patients with PSP. Although he does not mention any British cases, in his seminal description, Richardson predicted that further clinico-pathological observations would broaden the clinical syndrome and that PSP was unlikely to be a disorder restricted to the Toronto region. It is possible that Robertson had also recognised the differences between these patients and Parkinson’s disease.