The title of this book would suggest that the reader would need to be in London and have a strong pair of walking boots at the ready. However while the book does provide a walking guide, it also makes an excellent read in its own right. This is because the author provides a fascinating insight into the historical development of healthcare which is relevant not only in London but in the country as a whole. The author Nick Black is well qualified to provide this as his “day job” is Professor of Healthcare Services Research at the London School of Hygiene and Tropical Medicine. He has many talents to draw on in the book and not only writes well for example describing the emerging Soho as a “foreign land in a sea of Englishness” but also has a discriminating eye for the architectural merits of the buildings he describes. The book is well illustrated with many photographs and historical prints that allows the reader to take a virtual tour if he or she is not able to visit the capital.

There is an excellent brief introduction on the historical development of healthcare services over the last few hundred years from Church almshouses to socialist state planning. The book then presents the reader with seven walks described in different chapters and each of the chapters takes an historical theme. The themes include the transition of the medicine from trade to profession, the influence of the Church and City, the mergers of the major teaching hospitals and the development of primary care. The walks do not take you to the blue plaque houses of the great physicians or the hallowed halls of the historic and famous hospitals but presents an eclectic and idiosyncratic selection of buildings in central London which illustrate the themes. It includes some unknown gems such as the story of Mary Seacole who was the offspring of a freed black slave from Jamaica and a Scottish army officer. She preceded Florence Nightingale to the Crimea to nurse the wounded British soldiers at the battle front and was ungraciously dismissed by Florence Nightingale as a “brothel keeping quack” but was greeted by 80,000 members of the public to honour her work in the Crimea. Another was the work of Dr George Armstrong who ran the Dispensary for the Infant Poor and treated private patients for three days a week through the front door and poor patients for three days a week through the back door but unfortunately did not get the financial balance correct and ended up in the debtor’s prison. The book also pays tribute to international nature of medicine in London and the ideas which were imported from overseas. The foundation of the voluntary hospitals derived from the influence of the French Huguenots and the development of professional societies from models in Italy and Austria.

At times the tours are like an archaeological excavation showing where the old hospitals and medical institutions flourished and died but are now marked only by hotels and office blocks. The author recalls details of 10 leprosy hospitals, 21 private schools of anatomy that competed for bodies for dissection (so much so that the Surgeon in one school John Sheldon was horrified to be presented with his sister’s body!) and innumerable specialist hospitals covering every system and every nationality. These have come and gone over the centuries but it does demonstrate that it is not just present physicians that have to deal with change. It has been with us since the start of medicine and it is driven by social and well as technological change. History provides many lessons and with these we can understand the present and possibly the future better. There is a chapter describing the mergers of the great teaching hospitals in London into larger and more specialised hospitals often taking the medical care out from the city centre to suburbs. It may seem like a logical and permanent solution to today’s health planners, but undertaking these walks through London should teach us that today’s changes are just the next chapter in the evolution of healthcare. Those walking through London in 100 years from today will view a different medical landscape and see today’s solution as a historical past. What will they make of today’s mega-hospitals with advances in biotechnology, nanotechnology and universal electronic networks?