125 years of radiological research—BJR’s history is radiology’s history

It is difficult to appreciate the excitement and astonishment that rebounded around the world when the discovery of X-rays by Wilhelm Roentgen on 8 November 1895 was announced. ¹ The public had to be reassured that this was indeed true, and that Roentgen was a recognised scientist.

The first radiograph that was published in Britain was on 25 January 1896 in the British Medical Journal (BMJ). It had been taken by the electrical engineer Alan A Campbell Swinton and was of his own hand, and Swinton noted that “These photographs are in the nature of shadows, though shadows produced by rays which are not luminous”.

There was intense interest in the medical community, and the BMJ ran a series of review articles by Sidney Rowland who was a medical student at St Bartholomew’s Hospital in London. Rowland was interested in medical journalism and was working in what we would now call an internship, under the editor Ernest Hart who was his uncle. Hart appointed his nephew Sidney “to investigate the application of Roentgen’s discovery and to study practically its applications” and the first report appeared on 8 February 1896. ² Hart’s choice of his nephew was a good one, and the series gave accurate and detailed accounts of the “New Photography” as it became known. It would be a mistake to see Hart’s choice of his nephew as simple nepotism, since Rowland was very much the equal of the task.

Rowland obviously found medical journalism to his taste, as following his series of BMJ articles he started and edited a new journal, the Archives of Clinical Skiagraphy (Figure 1), which, following a series of transformations, became The British Journal of Radiology (BJR). A skiagram was Rowland’s term for a radiographic photograph and is from skia, which is the Greek word for a shadow. His BMJ series would have put Rowland in contact with all who were interested in the new X-rays and he was therefore in an ideal position as editor.

Figure 1.

Cover of the first issue of Archives of Clinical Skiagraphy.

Writing on 2 April 1896 in his preface to the first issue Rowland commented that “The object of this publication is to put on record in permanent form some of the most striking applications of the New Photography to the needs of Medicine and Surgery”. ³ Rowland went on to say that “The progress of this new Art has been so rapid that, although Prof Roentgen’s discovery is only a thing of yesterday, it has already taken its place among the approved and accepted aids to diagnosis”.

The journal contained many radiographs and “In the plates presented in this first number of a publication which will, I hope, take a permanent place in Medical literature, I have presented some examples of the more difficult and instructive achievements of Skiagraphy up to this date”. Rowland finished by thanking all those who had sent him radiographs for publication. Included in the introduction is a “photograph of apparatus and method employed for obtaining a skiagram. In this case the leg” (Figure 2). ⁴ We need to interpret this image in context, since whilst we may see the apparatus as being primitive, for his readers this was cutting edge technology. The radiographer is Sidney Rowland and in the background the induction coil, spark gap and Leyden jars may be seen clearly. The Crookes tube above the leg has neither electrical nor radiation protection. The early plain films were as difficult to interpret as modern complex imaging and could be surprisingly sophisticated as can be seen in the dramatic image of the head and body of a 3-month child from the first issue (Figure 3). ⁵

Figure 2.

Photograph of apparatus and method employed for obtaining a skiagram. In this case, the leg.

Figure 3.

Child: skiagram of skeleton of full grown child, aged 3 months. Note that the intestines, heart, and liver, cast definite shadows.

In the July 1897 journal, Thomas Moore from the Miller Hospital in Greenwich described the case of a pistol wound in the hand. ⁶ Moore was unable to surgically find the bullet just using a simple radiograph (Figure 4a), and after several experiments came up with the idea of using a grid for localisation (Figure 4b) and was successful. His use of a grid is not dissimilar to the use of a grid to guide modern CT intervention. Moore then developed a finer grid that would adapt itself to the part to be radiographed.

Figure 4.

(A) A method of localising a bullet (negative photograph). (B) A method of localising a bullet (positive photograph) with grid applied.

The importance of the journal is clear when we read the words of the radiological pioneer Charles Thurstan Holland, who noted that “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”. ⁷ The journal therefore became essential reading to disseminate information and experiences, and details about practical radiography. There were pages devoted to “Answers to Correspondents” detailing practical advice, and there were also book reviews and advertisements.

The presence of the advertisements should not be minimised, and manufacturers would describe their photographic plates, X-ray tubes and the new apparatus (Figure 5). The role of advertisements in journals has never been simply about generating income for the publishers. Advertisements gave the readers of the journal information about resources needed to develop clinical practice.

Figure 5.

A page of advertisements in the May 1909 Journal of the Roentgen Society.

Many had seen articles in the popular press and Sidney Rowland’s reviews in the BMJ and wanted to meet to discuss this exciting new subject. Dr David Walsh therefore called a first meeting on 18 March 1897, and the first formal meeting of the “X-ray Society” was held on 2 April 1897. ⁸ Silvanus P Thompson was the first President by 3 June 1897. From the beginning it was decided that membership should “include all who are interested in the scientific study of the Roentgen Rays”. This decision was to prove crucial to the ethos of the organisation, although many doctors including Walsh were not entirely happy particularly about “The difficulty of discussing medical matters before a mixed audience”. The name of the society was changed to “The Roentgen Society”, marking the earliest roots of what would become the British Institute of Radiology, and a home was found at the Medical Society of London in Chandos Street.

The Archives of Clinical Skiagraphy became the Archives of the Roentgen Ray from the July 1897 issue, and in the editorial it recorded that the journal will “record the proceedings of the recently formed Roentgen Society, and will consist of original communications, notes, and correspondence… (and) offers itself, not merely as a journal of the new photography, but to some extent as the exponent of an important discovery”. The journal became quarterly and became Archives of the Roentgen Ray (Formerly Archives of Skiagraphy), t he Only Journal in which the Transactions of the Roentgen Society of London are officially reported.

Sidney Rowland shared his editorial position with William S Hedley, a doctor from the (Royal) London Hospital, and then dropped his interest in radiology joining the Lister Institute as a bacteriologist. The journal has been blessed by many influential editors and in 1904 the well-known Birmingham radiologist, and victim of radiation injury, John Hall-Edwards was made editor. The charming cover of April 1904 reflects the design of its period and the wide range of interests (Figure 6).

Figure 6.

The Archives of the Roentgen Ray April 1904, John Hall-Edwards as editor.

In 1904, a new Journal of the Roentgen Society commenced as the Roentgen Society’s official journal and the link with the Archives was lost. ⁹ There were difficulties between the publishers who wanted more independence for the journal and the council of the Roentgen Society. The new journal went through 19 volumes until 1924, when the name changed to The British Journal of Radiology (Roentgen Society Section) The Journal of the Roentgen Society.

The British Association of Radiology and Physiotherapy (BARP) was formed in April 1917 by a group of radiologists in London as a purely medical body, unlike the multidisciplinary Roentgen Society. In 1915, Archives of the Roentgen Ray had been renamed Archives of Radiology and Electrotherapy and from June 1918 it became the journal of BARP. In 1924, the name changed again to The British Journal of Radiology (BIR Section) Archives of Radiology and Electrotherapy. There had been a longstanding desire to have an institute for the study of the radiological sciences, and as a result the British Institute of Radiology was formed. There were therefore two journals each called The British Journal of Radiology, which might seem confusing!

The final change came in 1928 following the amalgamation of the British Institute of Radiology and the Roentgen Society, and the introduction of a new Journal The British Journal of Radiology, New Series (BJR) that continues today. ¹⁰ Figure 7 shows a timeline of how the journal has changed over the years.

Figure 7.

Timeline of the history of BJR.

Over the years, an influential series of supplements to the journal were published giving more detailed information about new developments and, as an example, the important second supplement by Val Mayneord, Professor of Physics applied to Medicine and Physicist to the Royal Cancer Hospital, looking at applications of nuclear physics to medicine appeared in 1950 ¹¹ (Figure 8). Of importance is Supplement 25 which became the standard for depth dose tables in radiotherapy. ¹²

Figure 8.

Supplement number 2, Some Applications of Nuclear Physics to Medicine (1950), signed by Val Mayneord.

There have been many changes to how journals are published over the decades, reflecting scientific, social and technical developments. In addition to the monthly print edition, which is still produced to this day, BJR started being published online in 2001 and today electronic delivery in both HTML and PDF format is the primary format in which BJR is read. The content is purchased either through an institutional subscription or via individual access on a pay-per-view basis. All BIR members have full and unlimited online access to BJR.

In recent years, all previous issues of the journal, stretching back to 1896 and including all the predecessor titles, have been digitised. The fully digitised BJR is a wonderful resource with papers by many of the great names of radiology having published in BJR or its precursors. The original writings of the major figures of the past such as Peter Kerley on tuberculosis, ¹³ Ralston Paterson on radical radiotherapy, ¹⁴ Louis Harold Gray on the effects of ionising radiations, ¹⁵ and James Brailsford on spondylolisthesis ¹⁶ are readily available. We can read the classic papers from the early days of radiotherapy, radiobiology, medical physics, nuclear medicine, ultrasound, CT scanning and MRI.

The journal has however developed following changes in emphasis of the BIR. The early journals contained much more general X-ray publications, including more veterinarian, general science and industrial radiology. The older volumes included obituaries, after dinner speeches, presidential addresses, and eponymous lectures. It is interesting to read the presidential addresses in full, and these give an invaluable insight into the scientific and social mores of the period.

Today BJR is a truly international journal with readers, authors, editors and reviewers from across the world. The journal is broad, covering all aspects of diagnostic radiology, radiography, radiotherapy, nuclear medicine, radiobiology and medical physics. Following the latest publishing trends, papers no longer have page numbers, but each article stands alone with its own unique identifier assigned at the moment of acceptance. ¹⁷ Authors can choose to make their paper immediately available to all by opting to publish their work on an open access basis. The papers themselves have evolved to include new types of media with functionality for video and audio content available as supplementary information.

Having originally grown from multiple roots into a single journal for most of its life, BJR has, in recent years, formed branches with the launch of BJR|Case reports ¹⁸ in 2015 and BJR|Open ¹⁹ in 2018. Both of these sister journals are open access meaning that everyone in the world has unlimited free access to the content.

Having reached 125 years of being a dedicated home for radiological research, we can be sure that the format and style of BJR will continue to develop as radiology continues to progress and that the journal will remain essential reading for those interested in the radiological sciences.