On the Western Front of the First World War, Gordon Holmes transformed neurology. There, between 1915 and 1918, existed a coincidence of factors. These, combined with Holmes’ voracious curiosity, adventurous nature and eclectic skillset produced a profound, lasting legacy.
His early life was spent in Castlebellingham, Ireland. Initial schooling may explain this adventurous spirit; The Dundalk Educational Institution produced three VC Awardees along with the most outstanding Irish fighter pilot of the First World War (McCrea and Patterson, 2014). He studied Medicine in Trinity College, Dublin, then spent two years at the Senckenberg Institute in Frankfurt, under Ludwig Edinger and Carl Wiegert (Fine et al, 2011). Thus, Holmes’ training saw him grounded thoroughly in the German Neuroanatomy tradition which saw his stunning hand-drawn diagrams of Golz’ famous “dog without a forebrain” published in the Journal of Physiology (Holmes, 1901). To this may be added his subsequent rigourous inculcation in clinical observation under Hughlings Jackson at Queen Square, London. In Holmes was a unique mix of artist, anatomist, physiologist and clinician, waiting for the right set of circumstances.
This mix of circumstances arrived in 1914 when Holmes was appointed as consultant neurologist to the British Armies in France. Harvey Cushing describes his tireless work thus; “There are 900 acutely ill soldiers, convoys of 300 wounded might arrive in a day, and there were only 10 Doctors; in less than 9 months Holmes had amassed a lifes work” (Lepore, 1994).
Here, a confluence of events led to some of the most important neurologic advances of the 20th Century. The Brodie helmet used on the Western front was designed to be cheaply produced from a single stamping of metal and provided good protection from airburst shells but not from rounds that burst closer to ground level, leaving the occipital cortex and cerebellum vulnerable (Shadrake and Pugh, 2014). The introduction of new rifles in the late 1800’s imparted enough velocity to allow a projectile enter the skull and cause limited (and measurable) damage, but not so much velocity as to produce the lethal damage that modern weapons do.
Holmes’ training in anatomy, physiology and clinical observation uniquely disposed him to the characterisation and mapping of visual field loss due to lesions of the occipital lobe. His extensive pre-war experience in measuring functional loss due to cerebellar tumours (Stewart and Holmes, 1904) was also invaluable when studying the large cerebellar lesions consequent to shrapnel and bullet wounds.
Holmes’ maps of visual field localisation (Holmes, 1918) survived unaltered for 73 years (Horton and Hoyt, 1991). His description of the clinical signs of cerebellar damage (Holmes, 1917), provide neurologic tools in current use.
Ireland, The UK and Europe have cause to be proud of his legacy which has extended globally with warm tributes from notables such as Wilder Penfield (Penfield, 1967). His achievements resulted from his interdisciplinarity and refusal to think in narrow silos. The right person with the appropriate talents came forward to do their duty a time of unique challenge (and ironically) unique creativity.