Science and solitude vs. clinical consultation.

Abstract

There is an old proverb which says “An humble heart is the beginning of wisdom,” and it is with this in mind that I take my place behind this desk to deliver the twentieth Carman Lecture. I am sensible of the honor that has been done me by our President, of the distinguished character of the audience before me, and of the illustrious men who have preceded me here, and these combine to form a quite understandable basis for the genuine humility with which I approach this task. As to my subject, I shall not attempt to expound upon its importance, since to do so would serve only to bring into strong relief the weakness of the exposition. I shall, therefore, proceed at once to make Dr. Carman a sort of text for the remarks that I intend to make. Dr. Russell D. Carman was one of the truly great men of our profession. A pioneer in the field, he was blessed with unusual powers of observation and with a reflective mind which transformed his observations into theories and dogmas which became important parts of the organized knowledge that today we call Radiology. To Dr. Carman, with Lewis Gregory Cole and James T. Case, we owe the greater part of our fundamental knowledge of the radiology of the gastrointestinal tract. He was a great radiologist, a great physician, and a great man. To most of you, I suppose, he is only a revered name; to some of us he is a remembered friend. I first knew Dr. Carman in 1910, and the circumstances of my earliest meeting with him are of interest because they afford such an amazing contrast with our professional environment of today and because they serve to bring into sharp focus the enormous strides of Radiology in the intervening forty-six years. In 1910, I was a student in the School of Medicine of St. Louis University, where Dr. Carman was Instructor in Medicine and Professor of Roentgenology. On one gray winter day there was posted on the bulletin board of the school a notice advising students that at four o'clock that afternoon, at the City Hospital, Dr. Carman would make an x-ray examination of a hip, and that those interested might go to see this done. How curious that only forty-six years ago a procedure which is today so matter-of-fact and of such everyday occurrence was so unusual as to elicit a special notice! To the students and, indeed, to the physician of that day, the scene was impressive. Snarling flames leaped across a spark-gap; gas tubes glowed with lavender light and were rejected as “too soft,” i.e., their resistance was too low to permit the production of x-rays with sufficient penetrating ability; finally a tube was selected and positioned over the patient, a glass plate enclosed in paper envelopes was slid into a tunnel previously placed beneath the injured hip; a switch was closed and the tube glowed steadily for perhaps fifty to sixty seconds.