Established in 2002 Brief Early History of Liverpool Radiology Thurstan Holland:  Born in Bridgewater, Somerset in 1863, educated in Bristol and at University College, London.  Entered general practice in Princes Park in 1889.  Sir Robert Jones: Pioneering orthopaedic surgeon, saw the possibilities of x rays in orthopaedic surgery. Thurstan Holland was assistant to Robert Jones at his free Sunday clinics, and also had an interest in photography. Sir Oliver Lodge, eminent Professor of Physics in Liverpool, played a major role in the introduction of x rays in Liverpool and Britain.  At the request of Jones, he showed a shotgun pellet in the hand of a boy.  Jones obtained a primitive x ray tube from Germany and persuaded Holland to become honorary radiologist at the Royal Southern  Hospital. In 1904, Holland moved to Liverpool Royal Infirmary. Professor Wilberforce, Professor of Physics, lent Holland an x ray set which was  installed under the main staircase. Holland did more than anyone else to further the medical speciality of Radiology. He put Radiology in a clinical setting. The  department at LRI which he built up between the wars was regarded as the most advanced in the country. He was concerned to  establish high standards of training in Radiology and that candidates had good clinical experience. The Establishment of Radiology Training in the UK The British Association for the Advancement of Radiology and Physiology had been set up in 1917 with the object of promoting the  advancement of Radiology (and Physiology) on scientific lines under the direct control of the medical profession.  The Association searched for a university to undertake a diploma course in Radiology. London University was not interested but  Cambridge University was. The first course started in Cambridge in 1919. Originally 6 months long, with 3 months devoted to Physics  and the rest of the time to lectures in Radiology and clinical experience in hospital x ray departments.The Cambridge course was later  extended to 9 months. Candidates were not required to be resident in Cambridge. In London, the lecture course was run at 32  Welbeck Street, in the former chapel of the Imperial Russian Embassy. 32 Welbeck Street later became the headquarters of the BIR.  In Liverpool, Thurstan Holland conducted tutorials in his rooms in Rodney Street.The Diploma was granted to established radiologists  on presentation of a thesis.  The DMRE (Cambridge) was necessary to become a qualified specialist in Radiology. The Cambridge  DMRE lasted until 1942. The Edinburgh DMRE started in 1926, the London University and Conjoint Board DMRE in 1933.  The Establishment of the Liverpool DMRE The University of Liverpool Faculty of Medicine at its meeting on 11 November 1919 agreed to recommend that the Report of the  Committee on Diploma of Medical Radiology and Electrology be approved and forwarded to Senate and Council.  At a Faculty meeting on 23 June 1920, the Dean reported that no extra financial responsibility would be incurred by the institution of  the DMRE. The Vice Chancellor was informed of this fact.  The first course for the DMRE (Liverpool) was held during the 1920-21 session, commencing early in October 1920. It lasted during  the autumn and lent terms until March 1921.  At a Faculty meeting on 15 October 1920, it was agreed that Dr Thurston Holland be appointed Lecturer in charge of the newly  formed Department of Radiology and also that he be appointed a member of Faculty.  At a Faculty meeting on 18 February 1921 alterations to the Ordinances and Regulations were recommended. The Ordinance change  concerned the possession of a qualification to practice medicine was recommended by the University for the candidates. That  radiologists should be medically qualified had been an issue for some years.  The Regulations change covered the holding of the  DMRE examination once a year at the end of the Lent Term.  4 candidates enrolled on the first DMRE course. Under the supervision of Professor Wilberforce (who had succeeded Sir Oliver Lodge  as Professor of Physics in 1900, and was described as 'a man of easy dignity and unfailing charm'), a course in Physics was given on  2 afternoons each week by a Mr Edwards.  Radiology was taught in the X Ray Department of the Royal Infirmary by Dr Holland. 3 of the candidates attended daily in the  Department for practical instruction. One of these was in charge of the X Ray Dept of Burnley Infirmary and attended on 2 days.  Great stress was laid on the importance of this practical work. Additional daily instruction was given on the reading of plates and the  reporting of cases. A course of lectures, once a week, was included.  Instruction was also given in the application of radium for the treatment of disease. Electrotherapeutics was taught in the Royal  Infirmary where there was a large and well equipped department, an average of 1,000 treatments being given each week. The  candidates attended at least one day a week.   The exam was in 2 parts. In Part 1 (Physics), Professor Wilberforce examined all 4 candidates. In Part 2 (radiology and  Electrotherapeutics), Dr Barclay of Manchester examined, together with Dr Holland..  One candidate, Dr Anderson of New Zealand, was subsequently appointed on the recommendation of Dr Barclay to the post of  research scholar in Radiology at the Manchester Royal Infirmary.  Dr Mather, another DMRE candidate, was appointed radiologist to the Royal Southern Hospital and was one of the first to specialise  in Paediatric Radiology. The other candidate, Dr Roberts, was appointed to the post of registrar in the X Ray Dept at Liverpool Royal Infirmary.  The following year, 1921-22, there were 5 candidates. Two started but did not complete the course. The other 3 passed; one was a  radiologist at Hull Infirmary, one came from Australia, and the other was a Liverpool graduate.  In 1923, time was provided for the teaching of Radiology in the undergraduate curriculum.  Throughout the 1920s, there were 4-6 DMRE students per year.  In 1927-28, the first woman was enrolled on the course. One of the first women on the course was Dr Norah Walker, who became a  Consultant Radiologist at Alder Hey Childrens Hospital and died in 1992 aged 93. Thurstan Holland was elected FRCS in 1929 and President of the British Institute of Radiology in 1929-30.  The 1930s In 1932 Thurstan Holland retired. R E Roberts was appointed lecturer in Radiology.  In 1932-33 the DMRE course was extended over three terms. The Faculty of Medicine had applied for, and been granted, recognition  of the course of instruction as complying with the regulations of the Conjoint Board for its Diploma in Radiology.  In this same year only 3 candidates were enrolled, 2 of whom obtained the DMRE. The extension of the course from 2 to 3 terms was  considered to be a cause for the small number of candidates. In 1933-34, 3 Diplomas were awarded. It was decided that in future the DMRE course would only be held if a minimum of 3  candidates had definitely notified the Lecturer in Radiology by the beginning of September of their intention to take the course  commencing the following month. In 1935, Thurstan Holland was awarded an honorary LLD of Liverpool University.  In 1936 there were no registrations onto the course.  Also in 1936, Professor Chadwick , who had Succeeded Wilberforce as Professor of Physics) was awarded the Nobel Prize for  Physics. In 1938 Dr Rubin was appointed Honorary Assistant Lecturer in Radiology. Radiology was deleted from the undergraduate curriculum  in 1936 in order to conform with the new rules laid down by the GMC.   In 1939 Dr Roberts became the first President of the Faculty of Radiologists, which had been formed by the amalgamation of the  British Association of Radiologists and the Association of Radiologists of Great Britain & Ireland. The 1940s In 1940-41, there were 7 candidates, 5 of whom passed. Dr R E Roberts was appointed Honorary Consultant Radiologist to the Army in 1940.  In 1940-41 there were 2 Diplomas awarded, In 1941 Thurstan Holland died. The DMRE was discontinued in 1941 for the duration of the War.  1946 - Dr R E Roberts died suddenly, aged 55. He was succeeded by Dr P H Whittaker, initially as acting Lecturer in Charge of  Radiology. The M Rad and DMRD New legislation came into being for replacement of the DMRE by a Mastership in Radiology (M Rad), which coud be taken in either  Radiodiagnosis or Radiotherapy. The M Rad was awarded to candidates who had completed a 2 year course of instruction and who had satisfied examiners in written  and oral examinations. Lectures were in Physiology, Anatomy, Pathology, Medicine and Surgery in addition to Radiology and Physics.  Part 1: Physics and Pathology.  Part 2: Radiodiagnosis or Radiotherapy..  It was found impossible in 2 years of training to achieve a high standard of academic attainment or to have the experience and  judgement which are associated with a candidate for a Masters degree. It was suggested that the DMRD should be reintroduced and obtainable after 18 months, the time recognised by other universities  and the Conjoint Board.  It was suggested that the instruction in Physics with the DMRD should be more concentratedand completed in 4 months, similar to the  same course in London. It was considered that the shadow of the Part 1 (Physics) hung over students who then gave insufficient  attention to Radiology until this exam was completed. Students would therefore have a longer period to concentrate on Radiology.  Instruction in Radiodiagnosis would continue throughout the whole 18 months. Thereafter the M Rad was only conferred on candidates who hold the University diploma and who have completed 2 years of  radiological work after obtaining the DMRD. At the end of this time they must complete a thesis on some radiological subject which  should show evidence of original work  experience and maturity in,Radiology, and also submit it to an examination.    In 1947 the Department of Radiology was split into Dept of Radiodiagnosis and Dept of Radiotherapy, in order to meet special  requirements for courses leading to M Rad. Also in 1947 Dr Chalmers was appointed Special Temporary Lecturer in Physics applied to Medical Radiology. In 1947/48, 6 of 8 students who completed their second year course were awarded the DMRD. The Radiology course was 'filled to  capacity'. 12 took the Part 1 DMRD (Conjoint) in the April, 8 being successful.  In 1948 14 registered in first year and 10 in second year for M Rad. 2 resigned from the first year.   The failure rate for DMRD in the UK was slightly over 59% for last 2 years. The Liverpool success rate in 1948 was felt to be a  satisfactory reflection of the adequacy of the teaching in postgraduate radiology.  1949/50 saw the inception of the new Liverpool DMRD to replace the M Rad.  All 10 candidates passed the Part 1.  In the past it had been the practice to employ students as registrars only during their second year of study. In 1950 'it appears that we  have to consider further the custom which has been adopted elsewhere n the country and offer them employment as junior registrars  during their first year if we hope to maintain an adequate supply of students for our own diploma. It appears that the demand for  radiologists is still considerable and it would be inadvisable to reduce the number entering the course at the present time.' (Annual  Report).  A technician was appointed to work in the X Ray Dept of the Royal Infirmary to tabulate and copy films for teaching purposes. The  amount of teaching material at the disposal of the Dept of Radiodiagnosis is unrivalled by any school in the country.'  There was now a weekly meeting in the form of a discussion class, attended by the postgraduate students. In 1951 Dr G D Scarrow was appointed Assistant Lecturer. There were 6 first year and 10 second year students, 3 M Rads and 5  DMRDs were awarded. In 1952, in accordance with the reduction in the Senior Registrar grade throughout the country, it was decided that it would be right to  reduce the Radiology student intake within this region to conform with this reduction. In this region there was 'a generous allocation of  4 senior registrar appointments.' This was much larger than the number allocated to Leeds, Birmingham and Bristol. It was decided  that a training establishment of 4 registrars was now appropriate. In 1955, 5 were accepted onto the DMRD course. The annual report noted that 'the number of applicants to take the course had not  diminished, although most of the other courses in the country have a very meagre supply of students'. This was probably because the  Liverpool course was full time and 'because we are able to give the students a very satisfactory clinical training.'  In 1956, 9 students were accepted as the Ministry of Health was anxious to increase the number of trainees in Radiology. During the  previous 2 years there had been considerable falling off in the number of British students taking up Radiology.The position throughout  the country was serious and there was a marked shortage in applicants. At this time Liverpool was responsible for up to one third of  the total number of trainees available in this country. It was felt that Liverpool had a duty to increase the number since the supply of  students to this centre appeared to be adequate. Liverpool had been responsible for the greatest number of radiologists trained in the  previous 20 years.  However, there was no suitable accommodation for the course. The teaching was entirely in hospitals. Most of the film library was in  the rooms of individual consultants. Provisional accommodation for the Department had been found in the old Chemistry Building. In 1957, the Department moved to the new Medical school building, where a photographic department and small X ray room was  housed in the basement. There were also lecture and demonstration rooms and a film library. All academic lectures were now in the  Department. Dr Whittaker was appointed examiner in the Conjoint DMRD.  In 1958, the new Ashton Street medical school was opened by the Queen Mother. The Liverpool Department of Radiodiagnosis was  probably the first teaching department of Radiology to establish a Department actually in a university.   12 DMRDS were awarded in 1958. 13 were accepted onto the first year, with slightly under half coming from overseas.  The annual congress of the Faculty of Radiologistswas held in Liverpool in October 1958.  In 1959 Dr Whittaker became Vice President of the Faculty of Radioloists.  In 1960, 12 students were accepted onto the course and 12 DMRDs were awarded.  In 1962 12 were enrolled. The annual report observed that Liverpool would like to accept more students to help fill the national  shortage, but hospital appointments were not available for more than that number of trainees.   Dr R W Galloway reclassified the film collection and updated it.   More space was needed in the Department. In 1963, because of increased teaching commitments, Drs JHE Carmichael, E Walker and J Winter were appointed as clinical  teachers. In 1964, £350,000 was available for the establishment of the Nuffield Unit of Medical Genetics in the Department of Medicine.  The Faculty of Radiology annual meeting was held in Liverpool.  In 1965 there had been a considerable falling off in the number of British applicants for the Radiology course.This followed the pattern  throughout the country, but Liverpool had been more successful than most schools in recruiting enough students to fill the major  hospital appointments. In May 1967 the Department of Radiodiagnosis transferred from the Bacteriology wing of the new Medical School into its own  accommodation in the wing of the Nuffield Unit of Medical genetics. This anticipated a projected new move into the new hospital in  1973. Drs Couch and Galloway were appointed lecturers. In 1967-68 Dr Whittaker retired as Director of Studies in Radiodiagnosis. In October 1968 Dr Scarrow was appointed in his place. Dr  Scarrow presented a paper on transluminal dilatation of the femoral artery at the Liverpool Medical Institution.   In 1968-69 Dr EL Rubin retired, having been lecturer since 1937. Dr G Ansell was appointed clinical lecturer, along with Dr J  Occleshaw, a neuroradiologist, Mr Friel who now lectured in Physics on the Part 1 course., and Miss Brenda Heslop who taught  Radiography. In 1969-70, a film museum and viewing cubicles were established in the Department. Dr Scarrow conducted research with a gastric  camera and on spinal stenosis. Dr Hiram Baddeley was appointed the first Senior Lecturer.  In 1971-2 it was ordained that students would sit the exam for the FFR at the end of the third year of training.  Dr Baddeley resigned and GHW was appointed Senior Lecturer on 1st September 1972. At the start of the 1972/73 academic year  there was now reciprocity between Part 1 DMRD and Part 1 FFR.   Also in 1972 there was a visit from the Faculty of Radiologists (soon to become the RCR), which resulted in a favourable report. A  provincial meeting of the Faculty was held in Liverpool and had one of the highest ever attendances for such a meeting.  In 1974-75 FFR became RCR.  Drs L Brock and A Carty appointed clinical lecturers  March 1977, GW appointed Professor of Diagnostic Radiology.  Dr Scarrow who had been Director of Studies for the previous 13 years became Deputy Director. Dr AF Evans appointed Senior  Lecturer. In 1980s there was an increase in the number of lecturers to match the diversity of subspecialties. Dr AP Owens was Senior Lecturer  1981-82, and Dr R Mendelson was Senior Lecturer in 1983-84.  Between 1920 and 2002, when the DMRD was abolished because of reorganisation of the FRCR examination system, the DMRE and  DMRD of the University of Liverpool was awarded to 423 candidates.