CHARLES THURSTAN HOLLAND:

PIONEER OF LIVERPOOL RADIOLOGY

BY

AUSTIN CARTY

Consultant Radiologist

Royal Liverpool Hospital

 

I took up my duties as a consultant radiologist at the Royal Southern Hospital on 21 January 1974. The senior registrar, Nick Clitherow, told me it was the oldest hospital x-ray department in the country and as I looked around the equipment I was not prepared to challenge him. In 1977 I commenced private radiology practice at 43 Rodney Street in partnership with Iain Morle. We inherited a significant amount of archival material relating to the activities of the man who had started radiology in the Southern in 1896 and in Rodney Street in the very early 1900’s, Charles Thurstan Holland.

 

The astonishing thing about the discovery of x-rays is the speed with which they were taken into clinical use. True, every physics laboratory across the world had primitive x-ray tubes but this hardly accounts for the epidemic. In Liverpool, progress can be attributed to the patronage of the doyen of orthopaedic surgery, Sir Robert Jones, the flair and dogged determination of Thurstan Holland.

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In January 1896 Robert Jones was already a busy and successful surgeon whose practice revolved around his Sunday ‘free’ clinic in Nelson Street, the prototype of orthopaedic outpatient clinics the world over. He had been consulted about the case of a boy who had shot himself in the hand and in whom the pellet could not be found on probing. Jones had heard about x-rays in a roundabout way from the wife of a Viennese cotton broker, Augustus Wimpfheimer, then resident in Liverpool. Jones asked Oliver Lodge, head of the physics department at Liverpool University if he would help with the new x-rays. On 7 February 1896 the boy was brought to Lodge’s laboratory. The pellet was identified embedded in the third carpo-metacarpal joint. Two weeks later, 22 February, the case was reported in The Lancet (pp 476-7). Holland had been in attendance on 7 February.

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Charles Thurstan Holland was born in the West Country in 1863. He qualified in medicine at University College, London in 1888. He had been in general practice in Princes Avenue, Liverpool, then a very fashionable quarter, since qualification and was one of the senior assistants to Robert Jones at his Sunday clinic. When Jones saw how helpful x-rays had been in finding the pellet he asked Holland: ‘If I pay for an apparatus, will you undertake it?’ Holland leapt at the chance and by May 1896 was installed in primitive quarters in the basement of the Royal Southern Hospital.

 

During 1896 Holland did 261 clinical radiological examinations at the Southern and one of his last published papers (BJR) was an account of this work given to Liverpool Medical Institution (LMI) on the occasion of the centenary of its building in 1937. In the minutes of the LMI for the meeting of 8 October 1896 it is recorded:

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‘Dr Thurstan Holland gave an interesting demonstration of a series of radiographs.

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First shewing a series of normal hands, at different ages, calling attention to the ossifying centers.  He then shewed a similar series of normal feet.  After this came a series of fractures and dislocations and lastly a number shewing the presence of a foreign body. Among the best was that shewing a halfpenny in the trachea of a child’

 

Holland developed his x-ray practice at the Southern over the next eight years. He moved to the Royal Infirmary in 1904 and continued to be Head of Radiology there until 1923. He instituted formal training for radiologists in 1919 preparing candidates for the Cambridge DMRE. Contemporary accounts stress his tenacity, his vision, his gruffness, his kindness and above all his capacity for hard work. He was autocratic in his selection of doctors to train as radiologists and required in them above all a sound grounding in clinical thinking.

 

He had obvious talents for leadership and was twice elected president of the Roentgen Ray Society (1904 and 1916) and of its successor society, the British Institute of Radiology in 1929. He was President of the first ever International Congress of Radiology in London in 1925.

 

An insight unique to the archive in my possession comes from the manuscript of Holland’s Presidential address to the Liverpool Medico-Literary Society in 1895.

 

The secrets of this neat and almost illegible document were released to me a few years ago by Holland’s grand-daughter, Sylvia Roxburgh. She says she was his favorite and frequently took dinner as his guest in the Adelphi Hotel where he was resident in the 1930’s. By coincidence she is a skilled typist and had no difficulty ‘translating’ the manuscript.

 

The address was given on 4 October 1895 at the very time Roentgen was conducting his experiments and there is a telling extract which was destined to be overturned within the year. The essay is entitled ‘The Healing Art’ and, frankly, is a fairly smug account of fin de siecle medical self-satisfaction:

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‘In the case of operative surgery we have, I take it, almost reached the acme of the art. It is difficult to see in what way it can make any further great advances. Every part of the human body, both inside and out, can be subjected to operation with a minimum of risk and a maximum of benefit. And although no doubt improvements will be made in the manner of operating, and in many technical details, it is difficult to see where new operations and great advances are coming from, from the merely operative point of view. That advances in the practice of surgery will come, and are coming every day, and which will be far reaching in their effects, is obvious; but they are not advances, so to speak, in the way of new, unthought of operations.’

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Holland published over 100 papers in national and international literature. He did pioneering work on establishing the landmarks of skeletal maturation in children by preparing one of the first guides to bone age. His work on identifying the accessory bones of the foot is a lasting testimony to his meticulous clinical observation. Most of our knowledge of these structures and our ability to recognize them as normal, not the residue of previous injury, is based on Holland’s work. He made one of the first reports on the hourglass stomach based on a large series of barium meals. He published extensively on the subject of urinary tract stones.

 

Although much of the clinical use of x-rays in the late 1890’s was concerned with identifying bullets in war wounded soldiers, notably in the battle of Omdurman (1898), Holland brought a much sterner discipline to this kind of work in the Great War. He perfected a technique for localizing bullets, devising a depth finder on the principle of the gunner’s height finder. Such localisers were in use in my own practice for locating intra-ocular foreign bodies and the Barnes Wallis Dam Busters’ bouncing bomb used the same principle. One of my earliest patients in 43 Rodney Street was a man of some 80 years referred for an IVP in 1978. The control film showed a lot of shrapnel in his back. I asked him about it and he told me he had been x-rayed in Rodney some 60 years before in 1918. The x-ray doctor told him;

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‘Don’t let those surgeon Johnnies operate on you for shrapnel. It’s all in a place where it wont do you any harm’

 

I showed him Holland’s photograph and he confirmed that this was the man who had given him such sound advice.

 

The quality of clinical reasoning shown by Holland and other pioneers is an example to our generation. We have a richness of technology and modalities at our disposal. However, we are indiscriminate in its use and often illogical in its interpretation. All Holland’s accounts of his radiology are firmly rooted in sound, if terse, clinical history. Radiological interpretation had to make clinical sense.

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There was restraint in the use of tests. If they were unlikely to illuminate the clinical problem they were not done. Radiology was the servant of clinical skills, not the substitute for them. Perhaps it is now the time to return to these roots.

 

Holland lived on in retirement to die in 1941, the year of the death of James Joyce and the year of my birth. Am I the reincarnation of one or the other or a bit of both?