Charles Thurstan Holland

Charles Thurstan Holland (1863-1941) was a pioneering radiologist who played a pivotal role in establishing radiology as a specialty in its own right.

Early life

Charles Thurstan Holland was born in Bridgwater, Somerset on 7 March 1863. He studied medicine at University College Hospital in London, graduating in 1888 with MRCS, LRCP. He started working as a general practitioner in Liverpool in 1889, where he struck up a friendship with Robert Jones (1857-1933), a trailblazing orthopedic surgeon. Indeed the Jones fracture was named after the surgeon. Holland started assisting Jones in his large surgical Sunday free clinic.

Pioneering radiologist

In February 1896, one of the first ever radiographs was taken in England. A young man, Robert Jones (no relation to the surgeon) had shot himself in the hand and the wound had subsequently healed. On physical exam the location of the bullet could not be ascertained. In the Department of Physics at University College in Liverpool (later the University of Liverpool) Holland assisted Oliver Lodge, a Professor of Physics, in taking an x-ray of the hand. After multiple attempts, a poor-quality blurry radiograph showed where the bullet lay, albeit with an exposure time of 90 minutes!

Soon thereafter Jones asked Holland if he would be interested in setting up a radiology service, and - as he later recalled - Holland jumped at the chance. Jones personally ordered and paid for an x-ray apparatus from Newton & Co., of Fleet Street, London, for the sum of £30 (approximately $3500 today) . As Holland later recalled, Jones had realized the important potential that the x-rays offered for his own specialty .

The original set-up consisted of a three inch spark induction coil and five Grove cells (a type of 19 century battery) with an output of ~10-12 volts . Nitric acid had to be added to the cells for every session, and decanted off at the end, a very unpleasant task. The first tube was of a very crude design, and lacked an anticathode producing radiation of the x-rays in all directions out of the glass tube!

Soon they replaced it with a focused x-ray tube, as designed by Herbert Jackson, professor of chemistry at King's College London, creating a focused beam of x-rays, allowing much sharper images to be produced.

Thurstan Holland took his very first radiograph on 29 May 1896. It was of his own hand with an exposure time of two minutes! Over the rest of 1896 he took a further 261 radiographs, covering a broad range of subjects, including normal bone growth of the hand, foreign bodies, arthritis, fractures and a stillbirth.

To the modern eye many of the images look fairly crude but it is impossible to appreciate today how little anyone knew in those early days. As Thurstan Holland remarked in an article in 1938 about those earliest days "There were no x-ray departments in any of the hospitals. There were no experts. There was no literature. No one knew anything about radiographs of the normal, to say nothing of the abnormal" .

He was appointed honorary radiologist to the Royal Southern Hospital in Liverpool in 1896, and worked there until 1904. This may have been the first appointment of a radiologist in the world . The first x-ray department was a basement room, with a hard stone floor, perpetual damp, no heating and a single sink with cold water only. He had no assistants, no official position on the medical staff, and did not even receive a salary! He later said “From a purely monetary point of view, it meant bankruptcy. It cost me far more than I ever made out of it.”

Thurstan Holland fragment and other discoveries

Those early years were hard; he personally performed all the radiographs himself, followed by their developing and printing. He usually did not leave work before midnight . He chalked up two important discoveries in that first year. Within six months he had demonstrated the chronology of the appearance of the major ossification centers of the human skeleton. He also realized the import of the Thurstan Holland fragment, as found in Salter-Harris type II fractures.

He made numerous other contributions to the radiology literature, in particular in the detection of urinary tract calculi, in which he had a major interest. He was one of the first to demonstrate the renal shadow and calculi on the plain abdominal film.

Responsible use of x-rays

Holland was unapologetic when it came to the responsible use of x-rays in the diagnostic process. He stated that “No case, however simple, should he allowed to be sent from the outpatient or casualty department until a complete and thorough examination has been made and a definite conclusion as to the diagnosis arrived at and put in writing”. This view remains as true now as one century ago, and most radiologists today would continue to uphold and promote it.

Later life

In 1904 he moved to the Liverpool Royal Infirmary, a major academic center, to set up a new department of radiology, where he was employed as honorary radiologist until 1923. He was also radiologist to the Royal Liverpool Children’s Hospital from 1907-1932. He was appointed lecturer in radiology at the University of Liverpool in 1920, a post he held until 1931. The University of Liverpool awarded him an Honorary Master in Surgery for organizing its first Radiology Diploma in 1922.

During the First World War (1914-1918), he was a radiologist at the First Western General Hospital, and a consultant radiologist for Western Command, holding the rank of major.

Much to his chagrin he was unable to accept the many invitations he had to lecture in America due to suffering from severe seasickness.

He passed away on 16 January 1941 at the age of 77 years.

At his passing it was said that “Radiology has lost a leader, the last of the pioneers, who did much to establish this branch of medicine on a sound basis”.

Accolades

Due to his pioneering and outstanding achievements he received many accolades throughout his life:

• President of Roentgen Society twice (1904 and 1916)
• President of the Electro-therapeutical section of the Royal Society of Medicine (1914)
• Honorary Master of Surgery (ChM) University of Liverpool (1922)
• President of the First International Congress of Radiology (1925)
• Honorary Fellow of the Royal College of Surgeons (1928)
• President of the British Institute of Radiology (1929)
• Honorary Fellow of the American College of Radiology
• Honorary Member of the American Roentgen Ray Society
• Honorary member of radiologic societies in Austria, Germany, Italy, Norway, and Switzerland
• Honorary Doctor of Laws (LLD), University of Liverpool

Legacy

Arguably he did more than any other single individual to establish radiology as a specialty in its own right.