Editorial
Reflections on Revolutions in Social Structure and Science 1 Leo G. Rigler. M.D. Two hundred years ago, far-sighted men created a new government and constitution, the basic precepts of which have withstood the stresses and strains of many unforeseen developments. An historical parallel is the revolutionary discovery of the reoentgen rays, and the establishment in a remarkably short time of the basic principles of their use in diagnosis and therapy by Roentgen and other investigators. Tremendous changes have since taken place in both our social structure and the science of radiology, but the basic principles of each are still valid. A new revolution in radiographic diagnosis is upon us, and there will be great opportunities for future radiologists to further develop our specialty. INDEX TERMS:
Bicentennial. Editorials. Radiology and radiologists
Radiology 120:231-232, July 1976
This editorial task caused me to reflect upon the relationship between our country's early history and that of the discipline of radiology. Although five physicians signed the Declaration of Independence, none was a radiologist; we came too late upon the scene to be a direct part of that history. Yet there are significant parallels between the dramatic upheaval in social and governmental structure which transpired 200 years ago and the great revolution in medical science which unfolded just 80 years ago: the discovery of roentgen rays, this "new light." It is difficult to fully plumb the wisdom and foresight of those who created that most revolutionary document, the Constitution, a legalistic framework which has withstood for two centuries the buffeting of civil and foreign wars, worldwide and national depression, domestic rancor, and competition from new forms of government abroad. It seems almost impossible that the selfsame Constitution which provided the basis for a small federation of independent states, a simple and rural society permitting the merest subsistence on enormous areas of undeveloped land, can be used today for our highly complex, densely populated, industrialized, and wasteful society. Our social structure is far more federalized, yet the Constitution has served us well; our original document of basic precepts retains its validity. Of the men who created that document, it may fairly be said that their courage, ingenuity, and magnanimity overwhelms us. On the matter of their remarkable devotion to the public good, Commager noted that Hamilton and Jefferson became bankrupt, and Washington and Adams nearly so, from the neglect of their personal fortunes during their terms of office. Power-hungry and dishonest men have at times unfortunately succeeded in deflecting us from the direction the founding fathers gave us, but in the past we always seem to have risen above such aberrations and restored the basic principles of our social order. Even today, honest and dedicated leaders can elevate our values, subordinate our materialism, and inspire us with the idealism upon which this country was built. 1
It seems as if in the recent history of our country we have spawned a breed of cynics and misanthropes highly critical of our institutions and leadership; there is much disillusionment and loss of confidence in ourselves. We deplore the serious maldistribution of wealth, with its consequent unemployment and poverty; yet we are concerned with the growth of federal control, and its increasing restrictions upon individual initiative, enterprise, and freedom. Amidst this censorious clamor, one may wonder if we have not indeed lost the ability to create a government suited to current needs. But for those who remember a childhood of abject poverty, it is difficult to be negativistic. Sixty years ago a 70-hour work week not uncommonly provided a standard of living well beneath that of today's welfare recipient. Without public dole or public health provisions there were many who were hopeful because of their conviction that in this country any child, poor or rich, could get an excellent education and become whatever he wished; the horizon of opportunity seemed limitless. Today it seems that such opportunity is not as it once was, but the basic structure for improving the quality of life still exists. Can we not again call forth selfless leaders to properly order our priorities and stir us from our morass of materialism and pessimism? There are many aspects of the discovery and development of the roentgen rays which parallel the origin and development of our country. In the 60 years since I began medical school, the changes in the art and practice of medicine have been revolutionary indeed. From a blind groping for diagnosis, with little specific therapy available, we have come to a definitive and scientific type of practice which abounds in therapeutic possibilities. In large part this resulted from the discovery of x rays, which greatly extended our medical vision and facilitated the study of the anatomy, physiology, and pathology of the living. Remarkably enough, Roentgen and the investigators who followed him established practically all of the basic principles of radiology within a short time; their principles are still valid. When one considers the very rapid strides
From the Department of Radiology, UCLA Center for the Health Sciences, Los Angeles, Calif. Accepted for publication in March, 1976. ss
231
232
EDITORIAL
we have taken in the effort to make internal organs visible, from the first passage of a sound in a cadaver to Cannon's feeding of bismuth to a goose for the demonstration of the swallowing mechanism, the genius of the early investigators becomes evident. The first edition of Roentgen Rays in Medicine and Surgery, by Frances Williams, was published in 1901 with the subtitle" An Aid in Diagnosis and as a Therapeutic Agent." In view of its date of origin, the enormous amount of information contained in this volume is astounding; the basic concepts presented are valid even today. In the study of radiology we have passed through a number of revolutions within the revolution, profound changes in methodology comparable to the vast alterations which have taken place in the fabric of our social and economic system. I could not possibly trace, in this short space, the enormous progress which has occurred in the use of roentgen rays. It is true that there have been many errors and false steps taken en route as a result of man's ignorance and, sadly enough, his avarice. But improvements in the health of the nation, in the longevity of the individual, and in the enjoyment of that longevity, are so great that, instead of incessant complaints, we might well be extraordinarily grateful for the work of the pioneers in the field. Although it was already known at the time Williams' book was published that radiation might affect cells in a destructive way, it was many years before this knowledge could be applied to prevent the damage to individuals which created the "martyrs" to the roentgen rays immortalized by Percy Brown. Even beyond this, our knowledge of the more remote and damaging genetic effects of the roentgen rays came much later. Unfortunately, x rays are today being misused in a more pervasive and insidious fashion. Far too many unnecessary examinations are being done, very often by untrained and inexperienced physicians, so that what utility they might have is lost. There are many reasons for this, including the arrogance of some practitioners and the self-doubt of others. X-ray examinations may serve as an easy substitute for hard work, as a shifting of responsibility, as a shield against fears of
July 1976
criticism or the threat of malpractice suits. Examinations may serve as well for economic aggrandizement; too often this fault is shared by the radiologist. As in the abuse of our public trust, these abuses of the roentgen ray examinations are generally outweighed by the benefits their proper use confer. Happily, we can look forward to a scientific revolution the equal of any we have seen in the past. The advantages of new methods of x-ray imaging, of nuclear scanning, and of ultrasonic echography are just beginning to surface. More revolutionary still is the development of computerassisted technology for whole body scanning, which promises to match the spectacular achievements made thus far in the study of the brain. Our ability to recognize disease processes in the incipient state may be multiplied, and the study of abnormal physiology accelerated, by this technology. The pioneers in the use of contrast media, cholecystography, and excretory urography, in the use of image intensification and the modern use of the catheter, have given us a basis from which to move forward once again. Another milestone in the improvement of the imaging of pathology and abnormal physiology is in the offing. There is a great opportunity for the newer generations of physicians, the future specialists in radiology, to generate the expansion and development of the science. Let us hope that the leadership of the future will not be lured by unworthy enticements and led astray, but will instead abide by the words of their oath: "I will keep pure and holy both my life and my art." There are vast areas of land which lie untouched for future generations to explore. Given the imagination, skill, and will, they should yield rich returns. Resources of the mind, likewise untapped, challenge the imagination and will of the physician, and especially the radiologist, to further ensure the health of our people.
Department of Radiology UCLA Center for the Health Sciences Los Angeles, Calif. 90024
Reflections on Revolutions in Social Structure and Science 1 Leo G. Rigler. M.D. Two hundred years ago, far-sighted men created a new government and constitution, the basic precepts of which have withstood the stresses and strains of many unforeseen developments. An historical parallel is the revolutionary discovery of the reoentgen rays, and the establishment in a remarkably short time of the basic principles of their use in diagnosis and therapy by Roentgen and other investigators. Tremendous changes have since taken place in both our social structure and the science of radiology, but the basic principles of each are still valid. A new revolution in radiographic diagnosis is upon us, and there will be great opportunities for future radiologists to further develop our specialty. INDEX TERMS:
Bicentennial. Editorials. Radiology and radiologists
Radiology 120:231-232, July 1976
This editorial task caused me to reflect upon the relationship between our country's early history and that of the discipline of radiology. Although five physicians signed the Declaration of Independence, none was a radiologist; we came too late upon the scene to be a direct part of that history. Yet there are significant parallels between the dramatic upheaval in social and governmental structure which transpired 200 years ago and the great revolution in medical science which unfolded just 80 years ago: the discovery of roentgen rays, this "new light." It is difficult to fully plumb the wisdom and foresight of those who created that most revolutionary document, the Constitution, a legalistic framework which has withstood for two centuries the buffeting of civil and foreign wars, worldwide and national depression, domestic rancor, and competition from new forms of government abroad. It seems almost impossible that the selfsame Constitution which provided the basis for a small federation of independent states, a simple and rural society permitting the merest subsistence on enormous areas of undeveloped land, can be used today for our highly complex, densely populated, industrialized, and wasteful society. Our social structure is far more federalized, yet the Constitution has served us well; our original document of basic precepts retains its validity. Of the men who created that document, it may fairly be said that their courage, ingenuity, and magnanimity overwhelms us. On the matter of their remarkable devotion to the public good, Commager noted that Hamilton and Jefferson became bankrupt, and Washington and Adams nearly so, from the neglect of their personal fortunes during their terms of office. Power-hungry and dishonest men have at times unfortunately succeeded in deflecting us from the direction the founding fathers gave us, but in the past we always seem to have risen above such aberrations and restored the basic principles of our social order. Even today, honest and dedicated leaders can elevate our values, subordinate our materialism, and inspire us with the idealism upon which this country was built. 1
It seems as if in the recent history of our country we have spawned a breed of cynics and misanthropes highly critical of our institutions and leadership; there is much disillusionment and loss of confidence in ourselves. We deplore the serious maldistribution of wealth, with its consequent unemployment and poverty; yet we are concerned with the growth of federal control, and its increasing restrictions upon individual initiative, enterprise, and freedom. Amidst this censorious clamor, one may wonder if we have not indeed lost the ability to create a government suited to current needs. But for those who remember a childhood of abject poverty, it is difficult to be negativistic. Sixty years ago a 70-hour work week not uncommonly provided a standard of living well beneath that of today's welfare recipient. Without public dole or public health provisions there were many who were hopeful because of their conviction that in this country any child, poor or rich, could get an excellent education and become whatever he wished; the horizon of opportunity seemed limitless. Today it seems that such opportunity is not as it once was, but the basic structure for improving the quality of life still exists. Can we not again call forth selfless leaders to properly order our priorities and stir us from our morass of materialism and pessimism? There are many aspects of the discovery and development of the roentgen rays which parallel the origin and development of our country. In the 60 years since I began medical school, the changes in the art and practice of medicine have been revolutionary indeed. From a blind groping for diagnosis, with little specific therapy available, we have come to a definitive and scientific type of practice which abounds in therapeutic possibilities. In large part this resulted from the discovery of x rays, which greatly extended our medical vision and facilitated the study of the anatomy, physiology, and pathology of the living. Remarkably enough, Roentgen and the investigators who followed him established practically all of the basic principles of radiology within a short time; their principles are still valid. When one considers the very rapid strides
From the Department of Radiology, UCLA Center for the Health Sciences, Los Angeles, Calif. Accepted for publication in March, 1976. ss
231
232
EDITORIAL
we have taken in the effort to make internal organs visible, from the first passage of a sound in a cadaver to Cannon's feeding of bismuth to a goose for the demonstration of the swallowing mechanism, the genius of the early investigators becomes evident. The first edition of Roentgen Rays in Medicine and Surgery, by Frances Williams, was published in 1901 with the subtitle" An Aid in Diagnosis and as a Therapeutic Agent." In view of its date of origin, the enormous amount of information contained in this volume is astounding; the basic concepts presented are valid even today. In the study of radiology we have passed through a number of revolutions within the revolution, profound changes in methodology comparable to the vast alterations which have taken place in the fabric of our social and economic system. I could not possibly trace, in this short space, the enormous progress which has occurred in the use of roentgen rays. It is true that there have been many errors and false steps taken en route as a result of man's ignorance and, sadly enough, his avarice. But improvements in the health of the nation, in the longevity of the individual, and in the enjoyment of that longevity, are so great that, instead of incessant complaints, we might well be extraordinarily grateful for the work of the pioneers in the field. Although it was already known at the time Williams' book was published that radiation might affect cells in a destructive way, it was many years before this knowledge could be applied to prevent the damage to individuals which created the "martyrs" to the roentgen rays immortalized by Percy Brown. Even beyond this, our knowledge of the more remote and damaging genetic effects of the roentgen rays came much later. Unfortunately, x rays are today being misused in a more pervasive and insidious fashion. Far too many unnecessary examinations are being done, very often by untrained and inexperienced physicians, so that what utility they might have is lost. There are many reasons for this, including the arrogance of some practitioners and the self-doubt of others. X-ray examinations may serve as an easy substitute for hard work, as a shifting of responsibility, as a shield against fears of
July 1976
criticism or the threat of malpractice suits. Examinations may serve as well for economic aggrandizement; too often this fault is shared by the radiologist. As in the abuse of our public trust, these abuses of the roentgen ray examinations are generally outweighed by the benefits their proper use confer. Happily, we can look forward to a scientific revolution the equal of any we have seen in the past. The advantages of new methods of x-ray imaging, of nuclear scanning, and of ultrasonic echography are just beginning to surface. More revolutionary still is the development of computerassisted technology for whole body scanning, which promises to match the spectacular achievements made thus far in the study of the brain. Our ability to recognize disease processes in the incipient state may be multiplied, and the study of abnormal physiology accelerated, by this technology. The pioneers in the use of contrast media, cholecystography, and excretory urography, in the use of image intensification and the modern use of the catheter, have given us a basis from which to move forward once again. Another milestone in the improvement of the imaging of pathology and abnormal physiology is in the offing. There is a great opportunity for the newer generations of physicians, the future specialists in radiology, to generate the expansion and development of the science. Let us hope that the leadership of the future will not be lured by unworthy enticements and led astray, but will instead abide by the words of their oath: "I will keep pure and holy both my life and my art." There are vast areas of land which lie untouched for future generations to explore. Given the imagination, skill, and will, they should yield rich returns. Resources of the mind, likewise untapped, challenge the imagination and will of the physician, and especially the radiologist, to further ensure the health of our people.
Department of Radiology UCLA Center for the Health Sciences Los Angeles, Calif. 90024
