Gordon Morgan Holmes
- Adie's syndrome
- Balint's syndrome
- Head-Holmes syndrome
- Holmes' syndrome I
- Holmes' syndrome II
- Stewart-Holmes sign
- Stewart-Holmes syndrome
- Stewart-Holmes test
Biography of Gordon Morgan Holmes
Gordon Morgan Holmes' father was a successful farmer at Dellin House, Castlebellingham, County Louth, about 40 miles north of Dublin. The early death of his mother, Kathleen, née Morgan, and his father's remarriage, deeply affected Holmes, and although he had three brothers and three sisters, he was a solitary child. Despite a transient dyslexia, Holmes was a brilliant scholar and after completing his education as a boarder at Dundalk academy, he entered Trinity College, Dublin, and graduated in medicine in 1897, at the age of 21 years.
Holmes was a resident at the Richmond Asylum, but soon after qualification he worked his passage to New Zealand, serving as ship's surgeon. Holmes then undertook 2 1/2 years postgraduate study in neurology in Germany. Initially he was in Berlin, but he said «it was all spoon feeding» and he went to Frankfurt am Main where he worked at the Senckenberg Institute with Ludwig Edinger (1855-1919) and Carl Weigert (1845-1904).
Edinger suggested that he investigated the experimental model of Friedrich Leopold Goltz (1834-1902), which was a dog who had had its brain extirpated, saying «I can’t make anything of it!» It is possible that this experimental animal may have aroused his initial interest in the cerebellum. He said, «I might have become a German» for there was an effort to create a post for him in Frankfurt, but Ehrlich had just commenced his work on Salvarsan and it was decided that the money over the next two years go to that work. Holmes therefore returned to London and became a resident medical officer at the National Hospital for Nervous Diseases in Queen Square, under John Hughlings Jackson (1835-1911), the doyen of British neurologists.
In 1906 Holmes was appointed as director of clinical research at Queen Square, where he commenced collaborating with Henry Head (1861-1940) in 1908. This led to the first accurate account of the functions of the optic thalamus and its relation to the cerebral cortex. The two men complemented one another because Head was imaginative and enthusiastic as well as speculative, whereas Holmes insisted upon attention to detail and would never bend facts to fit a hypothesis. At times this led to clashes between the two, but they continued a close collaboration until the outbreak of the 1st World War.
Holmes retained his urge for adventure and he sought a place on Captain Robert Falcon Scott's (1868-1912) ill-fated expedition to the South Pole. A ruptured Achilles tendon necessitated the abandonment of his plan and Holmes profited from his convalescence by obtaining a higher medical degree. In 1910, having obtained a higher medical degree, Holmes was appointed to the staff of the National Hospital when a senior colleague died suddenly. Thereafter his life revolved around his clinical and teaching activities in this hospital, which were unpaid, and a successful private practice.
Upon the outbreak of World War I Holmes was appointed as consultant neurologist to the British Expeditionary Forces. Working with his neurosurgical colleague Percy Sargent (born 1873) in a field hospital they had set up, he had a unique opportunity for the investigation of the effects of lesions in specific regions of the brain on balance, vision and bladder function. While in France, Holmes met his future wife, Dr Rosalie Jobson, an Oxford graduate and an international sportswoman, to whom he subsequently proposed marriage while rowing on the Thames.
Holmes' observations on gunshot wounds re-awakened his interest in cerebellar disease; this culminated in his classical analysis of the symptoms of cerebellar lesions which were published in his Croonian Lectures to the Royal College of Physicians in 1922, where he added more cases of gunshot wounds to his 1st World War experience as well as patients with cerebellar tumours.
When Holmes returned to the staff of the Charing Cross Hospital after World War I, he was joined by William Adie, a young Australian who became his friend. Holmes and Adie shared interests in neurology and neuroanatomy, and in 1941 they published separate papers on the condition which now bear their conjoined eponym. It seems probable that they had entered into extensive discussion of the disorder which they had documented.
In the period between the wars, Holmes had concurrent appointments at Queen Square, Moorfields Eye Hospital and the Charing Cross Hospital. He was an exceptional teacher of clinical neurology and his weekly case discussions at Queen Square attracted numerous postgraduates.
Holmes disliked medical politics and when forced to be on committees was said to vary between someone who was overwhelmingly bored to being forceful and bullying! He introduced to England the painstaking physical examination of a neurologist and even outstripped Gowers in his systematic collection of clinical data and its correlation with anatomy and pathology.
He investigated amyotonia congenita with James Stanfield Collier (1870-1935) (Brain, London, 1909, 32: 269-284) and described the first removal of a suprarenal tumour (by Percy Sargent) reversing virilism in the patient. He was editor of the journal Brain for many years and was well known for aiding young neurologists by going over their manuscripts and ruthlessly abbreviating and improving the English.
A man held i awe
As a young man Holmes was described as tall, handsome, and athletic, with dark, curly hair, later as having powerful physique, beetling brows and a piercing gaze. His inner warmth was masked by an abrupt manner, and he was held in awe by his students and junior staff. Despite these intimidating tributes, however, he was esteemed and widely respected. His biographer, Parson Smith, stated "His ward round took place behind locked doors. His nursing staff, who thought he was wonderful, saw to it that the patients lay still; they were not allowed to read a paper as the rustle might prove distracting. Only a jug of water with a glass was permitted on the locker top and, though in certain cases a vomit bowl might be provided, it was not expected to be touched; the use of a bedpan was not even to be contemplated."
Parson Smith went on to say of his teaching rounds, "He might grasp a worried student by the lapels of his coat and gently rock him backward and forward in rhythm with his instruction."
Adventurous martinet on the Thames
As an antidote to his hectic medical life Holmes enjoyed long summer holidays in his old home in Ireland where he coached the village tug-of-war team. He also derived pleasure from taking his resident medical staff for an annual 3-day row along the river Thames from Oxford to London.
Outside of medicine Holmes was interested in ecclesiastic Gothic architecture and the geology of Ireland and also the garden. Guests to his country cottage would be commandeered into performing such tasks as tree felling and trench digging. He was a keen golfer until shortly before his death. He was a martinet and together with his rather brusque manner these characteristics may have accounted for his late recognition in the honours. He received the CMG and CBE for his activities in World War I. His academic achievements led to his election to the fellowship of the Royal Society and the award of several honorary degrees, and his overall contributions to neurology were acknowledged with a knighthood in 1951.
«The pathologist is useful when kept to heel.»
Quoted in Archives of Internal Medicine, Chicago, 1965, 116: 164.