Roentgenology and Internship

Abstract

The increase in the number of accessories to diagnosis and treatment in medical practice has been so rapid as to bewilder the average old-time practitioner. He has been too busy to withdraw from his work regularly to pursue the graduate work which might have aided him in keeping abreast of the times. Medical journals are coming to convey medical ideas in language which he can barely understand and meagerly comprehend. His armamentarium is becoming as obsolete as his saddlebags. He views with cynicism the, novel ways of the new competitive medical recruit. In efforts to justify himself, he casts insidious reflections upon the efforts of his rival novice to establish in practice a system of scientific research and clinical pursuit. Among other essential aids to the successful practice of medicine, radiology has attained a well established place. Its reception by the profession and the laity was less hampered than was that of some other now accepted adjuncts to practice. The appeal to the sense of sight gave a rational impression, which readily appealed to clinicians in legitimate practice as well as to the eager mercenary observers on the side lines. Commercial enterprises soon recognized the portent of this accessory and proceeded to develop all types of apparatus. Being manufactured, they needed to be sold, and strenuous efforts were made profitably to dispose of the various electrical machines. Thus was established another of the many anomalous situations so frequently observed in the evolution of medical science—a commercial world foisting its hypothetical and unproven products upon a scientific profession. Ere long medically trained mechanists developed more rational and serviceable apparatus. Again, crafty tradesmanship produced machines faster than medical education could develop qualified operators. The obvious outcome was poor clinical results under legitimate management and dreadful results under the reckless direction of unscrupulous exploiters. Laws and administrative means of control became imperative. Inasmuch as a license to practise medicine carries with it a right to use any legitimate measure which will benefit the patient, every such licensed person was permitted to buy an X-ray outfit and proceed to experiment with it on patients. Eventually, out of intelligent research work a standard of technic has been developed which every operator now should know. Gross experimentation should no longer be tolerated even under the cautious tactics of untrained physicians, and much less under the careless commercialism of illegal practitioners. Professional ethics now rightly demand skillfully trained clinical technicians and experienced interpreters in this important medical procedure. In the State of Pennsylvania, when the intern law was passed in 1914, there could be found barely two dozen relatively competent roentgenologists to man the laboratories in the hundred hospitals required for intern training.