Rupert Hallam and the development of dermatology in Sheffield
A.J.G.McDONAGH
Consultant Dermatologist, Royal Hallamshire Hospital, Glossop Road, Sheffield
S10 2JF, U.K.
(British Journal of Dermatology 2000; 143: 23-25.)
Summary (Arthur) Rupert Hallam worked as a dermatologist in Sheffield from
1911 to 1944. Early in his career, he also specialized in diagnostic radiology and
established this speciality in Sheffield. Hallam performed investigative work on the
aetiology of papular urticaria and erythema multiforme, the prognosis of psoriasis,
and the aetiology of chilblains. He was an original member of the British Association
of Dermatologists from 1920 becoming president in 1935. He also helped to found the
North of England Dermatological Society. He was an innovator in both clinical and
administrative matters and was the first British dermatologist to develop a full-time
training post in the speciality.
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Best known of the early Sheffield Dermatologists, Rupert Hallam was honoured in
retirement by the application of his name to the Dermatology Department, an eponym
retained to the present day. Although Hallam's influence was less pervasive than that
of some of his more famous contemporaries, a study of his career is an interesting
perspective of early twentieth century dermatology in Britain.
Bearing a surname closely associated with the Sheffield region (Arthur) Rupert
Hallam (1878-1955) was the eldest son of Dr Arthur Hallam, a general practitioner
and honorary surgeon to the Sheffield Royal Infirmary. Rupert Hallam attended the
Sheffield Grammar School but before starting his medical training spent 5 years in
Hamburg. After Hamburg, he went to Edinburgh University where he graduated in
1901. Early on, he had intended to take up general practice with his father but after
returning to Sheffield, his interest in dermatology was stimulated while he was House
Physician to the Royal Infirmary. At this point, in 1902, the first Sheffield
dermatologist, W. Dale James, was extremely ill with tuberculosis and Hallam's
duties included the care of patients with skin disease. W.T.Cocking, the next
incumbent dermatologist was suffering from a prolonged illness (also tuberculosis)
and Hallam was constrained to manage on his own initiative. He subsequently held
posts of house surgeon and anaesthetist to the Royal Infirmary and his MD (1905)
was on general anaesthetics. In 1906, he was appointed medical officer to the newly
created electrical department at the Royal Infirmary, which quickly developed into a
department of diagnostic and therapeutic radiology. Hallam's appointment as a
radiologist was later recognized as a fortunate coincidence when it was realized that
X-ray therapy would have a major role in the dermatologist's treatment repertoire. Not
only did he establish the speciality of diagnostic radiology in Sheffield but by the time
of his retirement a large proportion of dermatology patients, probably about 40%,
were treated with X-rays. In a discussion on the role of X-ray therapy in 1943, he
remarked that '...X-ray therapy is just as much a part of dermatology as Lassar's paste'
but he nevertheless advocated caution against overuse of X-rays.(1) As a result of
Hallam's experience in the field, he became a member of the National Radium
Commission.
On the resignation of Cocking in 1911, Hallam was appointed Medical Officer in
charge of the skin department. At that time, the duties also included responsibility for
venereology and in 1914 he introduced evening venereal clinics. During the First
World War (1914-18), Hallam served in the Royal Army Medical Corps (RAMC)
with the rank of major and in collaboration with S.R.Milner, FRS, Professor of
Physics in Sheffield, developed an accurate radiological technique for locating foreign
bodies prior to surgical removal. Because of Cocking's untimely death, Hallam had
found himself in charge of dermatology much earlier than he ever expected. He
regretted missing the occasion to visit European centres of dermatology before joining
the Honorary Staff at the Royal Infirmary and took opportunities available during his
time in the RAMC to visit a number of clinics abroad. On returning to civilian life in
1919, he asked to be allowed to resign from X-ray work while continuing with
dermatology, a request not granted until 1925 when he gave up diagnostic radiology.
In 1921, because of his interest in venereology, he was invited on an international
lecture tour on the social aspects of venereal disease.
Hallam's early years as a senior dermatologist were crowded with a wide range of
duties and he was conscious of the dangers of professional isolation. Although he was
not the sole physician for skin diseases in Sheffield, his other colleagues worked at
the Royal Hospital rather than the Infirmary. Arthur Hall (later Sir Arthur Hall) was a
polymath who held, successively, the chairs of physiology, pathology and medicine
and did much to foster the developing medical faculty of the University of Sheffield.
Hall's MD had been on infantile eczema but he gave up dermatology clinics in 1911
to concentrate on University matters and was succeeded clinically by E.F.Skinner
whose interests moved progressively towards psychiatry. Hallam was determined to
maintain contact with his dermatological colleagues and some of his holidays were
spent visiting dermatology clinics in Europe. He also helped to establish the North of
England Dermatological Society and became President in 1930, the year after its
foundation.
He attended the International Congresses of Dermatology held in
Copenhagen (1930) and Budapest (1935).
In 1925, when Hallam assumed charge of dermatology at the Royal Infirmary,
plans were agreed for a new skin department and he incorporated some of the designs
and layouts he had seen in clinics abroad. The size of this department was not
enlarged until 1949 (after his retirement), when it was named after Hallam. The
sparsity of dermatologists in England in the early years of the twentieth century is
illustrated by the fact that in 1930, Hallam was the only consultant dermatologist in an
area stretching from the Yorkshire Pennines to the east coast. He did establish the post
of a full-time clinical assistant (equivalent of the latter day senior registrar), a
development entirely novel in its day. This post was originally occupied by H.
Renwick Vickers who later became Hallam's consultant colleague. Although mainly
associated with the Sheffield Royal Infirmary, Hallam served most of the Sheffield
Hospitals during his career, as well as Chesterfield Royal Infirmary and, for a time,
the Derbyshire Royal Infirmary. Teaching was one of his strengths and his clinics
were popular with medical students. He held an appointment as Lecturer in Diseases
of the Skin, University of Sheffield from 1931/2 until his retirement.
Hallam regarded dermatology as a branch of general medicine and was a strong
advocate of the importance of training in general medicine. In 1936 when considering
the appointment of a second dermatologist, he submitted published work for election
to the MRCP so that he could insist on the new appointee having the diploma. He was
elected to the Fellowship in 1940. An original member of the British Association of
Dermatologists from its foundation in 1920, he became President in 1935 when the
fifteenth annual meeting was held in Sheffield. The events of this meeting included an
address by Sir Arthur Hall on Dermatology: yesterday and today (2) containing some
ideas still highly relevant today regarding dermatological education for medical
students and GPs, a clinical meeting at the Royal Infirmary, a visit to the Rutland
Steelworks (Messrs Samuel Osborn & Co) and a coach trip to the Peak District.
Hallam was later elected an honorary member of the British Association of
Dermatologists.
Hallam always tried to include some investigative work in his busy routine and his
main interests were in the common skin diseases. In addition to case reports, he wrote
articles on the aetiology of papular urticaria,(3,4) the aetiology of erythema
multiforme,(5) the treatment of urticaria,(6) 'fungous' infections of the hands and
feet,(7) chilblains,(8) the prognosis of psoriasis,(9) the causation and treatment of
dermatitis (10)
and staphylococcal infections.(11,12) In the 1920s, there was
uncertainty about the cause of papular urticaria and Hallam performed investigations
on the effect of admitting children to hospital with findings, supporting the theory that
insect bites were the cause of the condition and against a role for food allergy. His
work on erythema multiforme with Edington, the Professor of Bacteriology provided
evidence against tuberculosis in the aetiology. His paper on the aetiology and
pathology of chilblains was read at the International Congress of Dermatology in
Copenhagen, 1930. Although many of the therapeutic agents of Hallam's time have
fallen from use, it is notable that after the elapse of over 70 years, our understanding
of the aetiology of urticaria has changed relatively little. A slight surprise to me was
that Hallam found aspirin beneficial in some cases. He was an early entrant to the list
of authors reporting photosensitivity from sulphonamides. (3)
Hallam hoped to retire before he reached the age of 65 but when the Second
World War began, his junior colleague was mobilized and Hallam had to manage a
busy wartime clinic with little assistance. During this period, his consulting room,
records and library were destroyed by German bombing. He finally retired under the
effects of ill health and overwork in 1944 and moved to the south-west, living in
Cornwall, Dorset and Somerset where he pursued his hobbies of painting, gardening,
walking and sailing. He had considerable skill in drawing and a striking self-portrait
remains on display in the skin department in Sheffield to the present day. Personal
memories of Hallam in Sheffield have now passed into history except that occasional
patients with lifelong dermatoses remember seeing him in childhood. Renwick
Vickers wrote in his obituary (14) that Hallam '... was not an easy man to know. His
tall, dignified, austere figure was somewhat forbidding to the casual acquaintance
but those who were fortunate enough to be his friends and to work with him found
him to be a most loyal and entertaining adviser and colleague.'
References
1 Hallam R, Beaumont W, Brain RT et al. Discussion on application of physical
methods in the treatment of skin disease. Br J Dermatol 1943; 55:269-79.
2 Hall AJ. Dermatology: yesterday and today. Br J Dermatol 1935: 47: 389-94.
3 Hallam R. Papular urticaria. Br J Dermatol 1927; 39: 95-111.
4 Hallam R. Further observations in the aetiology of papular urticaria (lichen
urticatus). Br J Dermatol 1932: 44: 117-23.
5 Hallam R, Edington JW. An investigation of the alleged tuberculous aetiology
of erythema exudativum multiforme (Hebra). Br J Dermatol 1933: 45: 133-41.
6 Hallam R. The treatment of urticaria. Lancet 1927; i: 1359-60.
7 Hallam R. Fungous infections of the hands and feet. Br Med J 1928: i: 835-8.
8 Hallam R. The enigma of the chilblain. Br Med J 1931; i: 215-16.
9 Hallam R. The prognosis of psoriasis. Br J Dermatol 1934: 46: 221-3.
10 Hallam R. Causation and treatment of dermatitis. Lancet 1938: i: 1259-62.
11 Hallam R. Recurrent boils. Br Med J 1932: ii: 670-2.
12 Hallam R. The prognosis of staphylococcal infections of the skin. Lancet 1934;
i: 1353-4.
13 Hallam R. Severe skin and general reaction following the administration of
M&B 693 and exposure to ultraviolet light. Br Med J 1939: i: 559-60.
14 Vickers HR. Rupert Hallam: obituary Br Med J 1955; ii: 741-2.