Suffering and Death among Early American Roentgenologists: The Power of Remotely Anatomizing the Living Body in Fin

de Sicle America
daniel s . goldberg

summary: This manuscript has two aims. First, I extend the historiography on early American roentgenology that demonstrates that dozens of early adopters knowingly suffered intense pain, mutilation, and death for the sake of the X-ray. The objective is to pinpoint as precisely as possible when and to what extent the roentgenologists knew of the life-threatening risks of X-ray exposure. Second, I articulate a partial explanation for their behavior that is rooted in the social power of remotely anatomizing the living body in fin de sicle American scientific and medical culture. keywords: roentgenology, fin de sicle, objectivity, visible, anatomy, suffering, cancer

Suffering, Science, and Sight

Between July 10, 1897, and March 1, 1909, at Massachusetts General Hospital, Charles Allen Porter performed thirty-two surgeries on his colleague and friend, the physician and roentgenologist Walter James Dodd.1 All of these operations were skin grafts, excisions, or amputations of Dodds

The author would like to acknowledge the insight and suggestions of three anonymous reviewers and the editors of the Bulletin of the History of Medicine. In addition, guidance and feedback from Jason Glenn, Dayle DeLancey, Russell Maulitz, and the audience at the American Association for the History of Medicine 2009 Annual Conference made this project possible. Finally, thanks go to Todd Savitt and Kenneth DeVille for reading and commenting on a late draft of this work. 1. According to Dodds biographer, by the time Dodd died of cancer in 1916, he had been subjected to no fewer than fifty operations under ether. John Macy, Walter James Dodd: A Biographical Sketch (Boston: Houghton Mifflin, 1918), 26.

Bull. Hist. Med., 2011, 85 : 128

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fingers due to burns and cancerous lesions. Over the course of these twelve years, Dodd suffered, in Porters words, pain beyond description.2 Dodds biographer, John Macy, refers to Dodds endur[ance of] untellable torments,3 and Porter marks May 1905 as the first time in eight years[] the patient was free from pain.4 Dodds relief was short-lived, however, as the ulcerations and lesions on his fingers required additional surgeries by November 1905, when Porter resected an epithelioma and performed skin grafts on several other precancerous lesions.5 Consistent with Dodds wishes, Porter strove to avoid amputation of Dodds digits: [S]urgeon and patient together fought stubbornly and courageously to save as much as possible of those useful hands.6 By August 13, 1897, Porter had already performed fifteen different skin grafts after excision of ulcerous lesions on Dodds fingers, and he completed an additional seven similar operations by 1902. There is no mention of amputation until October 31, 1902, when Porter amputated both of Dodds ring fingers at the knuckle, almost certainly because a consulting pathologist reported the ulcers on these fingers were unmistakable carcinoma.7 By April 25, 1907, Porter had performed twenty-five operations on Dodds fingers, but observed that [t]he patient was at work at a medical school and did not submit to an operation until July 5, 1907, at which time it was evident that the forefinger must be amputated, for undoubted epitheliomatous ulcerations were forming.8 However, even malignancies did not necessarily prompt action swift enough for Porter, as he concludes his narrative by noting undue and dangerous delay in amputating the cancerous forefinger of the right hand.9 Porter also unsuccessfully spent two months trying to save the stump of the little finger, apparently because in spite of the severe pain the patient seemed unwilling to sacrifice it, owing to the damaged forefinger, and the fear that with its possible loss in the future the thumb would have nothing to press

2. Charles Allen Porter, Transactions of the American Roentgen Ray Society (Ninth annual meeting, December 2830, 1908), 14145, quotation on 141. 3. Macy, Walter James Dodd (n. 1), 22. 4. Porter, Transactions (n. 2), 142. 5. Ibid. While in contemporary parlance the term epithelioma refers to a benign form of cancer, in Porters time the term signified a malignant carcinoma. Daniel Paul Serwer, The Rise of Radiation Protection: Science, Medicine, and Technology in Society, 19861935 (Ph.D. diss., Princeton University, 1976), 40. 6. Macy, Walter James Dodd (n. 1), 26; see also Porter, Transactions (n. 2), 141. 7. Porter, Transactions (n. 2), 141. 8. Ibid., 142. 9. Ibid., 145.

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against in grasping small objects.10 Macy reports that [r]ather than yield a fragment of a joint, Dodd would endure the agony of keeping it for months after it should have been removed.11 On several occasions, Dodds wife discovered by accident that he had had severe hemorrhages which he had concealed from her; on being accused, he meekly admitted the factand then dismissed it.12 Although Dodds personal papers have not survived, no mention of his ordeals is contained in some of the extant correspondence with colleagues. For example, while Porter amputated Dodds ring fingers on October 31, 1902, Dodd was hard at work two months later, requesting, by letter dated December 26, 1902, the opportunity to take one more plate of a fracture belonging to a patient of Dodds colleague.13 The instrumentality of Dodds suffering was the X-ray. According to Porter, he began working with a static X-ray machine in March 1896, upgrading to a more powerful twelve-inch induction coil in October 1896.14 Severe dermatitis commenced in November 1896. The question, therefore, is why Dodd was willing to suffer over the next twelve years even when the dangers of X-ray exposure were well known very shortly after news broke of Roentgens discovery in November 1895. Moreover, Porter and Macy note that Dodd suffered even more torment by virtue of his insistence in avoiding amputation at all costs. Admittedly, the use of the hands is integral to a variety of occupational endeavors.15 Nevertheless, Dodds biographer Macy, his contemporary Percy Brown, who in 1936 published an account of the martyrdom of the early American roentgenologists,16 and historian Rebecca Herzig all indicate that Dodd particularly feared losing the ability to grasp small objects primarily because without that function he would be unable to manipulate the X-ray controls. A certain level of function in his hands was a sine qua non for Dodds roentgenological work. Hence, it was, in Macys words, the fact that his hands
10. Ibid., 145. 11. Macy, Walter James Dodd (n. 1), 26. 12. Ibid., 24. 13. Maurice Howe Richardson papers, 18691913, Harvard Medical Library in the Francis A. Countway Library of Medicine, Boston, Mass., HMS c167, folder 27, box 10. 14. Porter, Transactions (n. 2), 141. 15. Indeed, Galen repeatedly emphasized the anatomical, medical, and spiritual importance of the hands. Nancy G. Siraisi, Vesalius and the Reading of Galens Teleology, Renaiss. Quart. 50 (1997): 137. 16. Percy Brown, American Martyrs to Science through the Roentgen Rays (Springfield, Ill.: Charles C Thomas, 1936). At the time he wrote the book, Brown was a past president of the American Roentgen Ray Society as well as a contemporary of many of the early American roentgenologists.

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were especially useful to his work that prompted Dodds willingness to endure the exposure of raw nerve endings in his digits for months on end rather than succumb to amputation. Macy rhapsodizes that Dodd lived for his work and he determined to preserve and use as long as possible the manual instruments on which his work depended.17 Dodds behavior is not isolated among early American roentgenologists. Charles Lester Leonard continued to work with X-rays even as radiation-induced cancer dissolved his body, resulting in his death in 1913. Mihran Krikor Kassabian continued to expose his hands to X-rays for years after publishing a 1900 article on X-ray-induced skin irritation, refusing to cease his work even as his fingers, axillary glands, and chest tissue were removed to halt the cancer that would take his life in 1910. Similar stories apply to dozens of other early American roentgenologists.18 The central inquiry of this essay is why these X-ray workers were willing to suffer intense, constant pain for years on end, mutilation, and even premature death so that they could continue to work with X-rays.19

17. Macy, Walter James Dodd (n. 1), 27. 18. The experiences of most of these roentgenologists are documented to greater or lesser specificity in Browns book. Unfortunately, a comprehensive account of the numbers and demographic composition of early American roentgenologists is lacking, perhaps in part due to a lack of evidence. The American Roentgen Ray Society formed only in 1900, and transactions from its proceedings are not available until 1903 (for the 1902 meeting). This is also the earliest date at which a roster of members (N = 221) is extant. Transactions of the American Roentgen Ray Society, Third Annual Meeting (Louisville, Ky.: Courier-Journal Job, 1903). However, given the fluidity of specialties and utilization of technologies at the time, it is not safe to presume that such a roster captures the entire American roentgenological community. Further complicating the matter is the widespread proliferation of X-ray machines, due in part to the ease with which they could be fabricated, outside of doctors offices and hospitals to photographic studios and even private homes. For a detailed study of early utilization of X-rays in American hospitals, see Joel D. Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1995), 10368. However, Howells seminal study does notand is not intended toprovide a holistic assessment of the composition and character of the early American roentgenological community. Such an assessment awaits future work. 19. It is important to note that physicians qua roentgenologists and scientists were certainly not the exclusive operators of X-ray machines at the fin de sicle. Quite the contrary, it was common for all manner of persons to operate X-ray machines, including photographers, office assistants, and nurses. See Charles E. Rosenberg, The Care of Strangers: The Rise of Americas Hospital System (New York: Basic Books, 1987), 18283; Peter L. Twohig, Education, Expertise, Experience and the Making of Hospital Workers in Canada, 19201960, Scientia Canadensis 29 (2006): 13153. By 1920 the American Association of Radiologic Technicians had formed as the trade association for these diverse X-ray technicians. Building on Rebecca Herzigs work, this article focuses specifically on the communities of physicians and scientists who died as a result of radiation-induced cancer and attempts to account for

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The hagiographical explanation for this behavior challenges the notion of the roentgenologists willingness to suffer by suggesting that they were simply unaware of the danger. Macy writes that [m]any [radiographers] were hurt and some were killed by the unknown power which they were studying for the benefit of others. They paid the price of ignorance and with their sufferings bought the knowledge which has made the X-ray safe for patients and operators.20 Herzig observes that the twenty-first-century reader may find it impossible to understand why, absent ignorance of the danger, the early roentgenologists would voluntarily suffer so. Yet, as the historiography suggests, this explanation is implausible.21 There is ample evidence that early American roentgenologists knew almost immediately of the danger arising from X-ray exposure. The question of why most professionals did so is the central inquiry here. Ideally, personal papers of a representative sample of the early roentgenologists would have survived and would have provided key insights in answering this question. Unfortunately, this is not the case, and in the absence of personal testimony from the roentgenologists themselves, interpreters are left with the task of developing historically plausible accounts that shed some light on the puzzle.22 This essay has two objectives. The first aim is to flesh out the historiography demonstrating that early American roentgenologists were aware of the life-threatening dangers of X-ray exposure. While this historiography

their apparent willingness to suffer and die. The account proffered herein may or may not be explanatory for communities of X-ray technicians who were not physicians or scientists, but a complete analysis of the latter is reserved for future work. In any case, the emphasis here is not intended as a slight to the larger history of X-ray workers. For a trade history of the latter, see E. L. Harris, The Shadowmakers: A History of Radiologic Technology (Albuquerque: American Society of Radiologic Technologists, 1995). 20. Macy, Walter James Dodd (n. 1), 1718. 21. In particular, see Serwer, Rise of Radiation Protection (n. 5), 152; Stanley Joel Reiser, Medicine and the Reign of Technology (Cambridge, Mass.: Cambridge University Press, 1978), 4568; Bettyann Holzmann Kevles, Naked to the Bone: Medical Imaging in the Twentieth Century (New Brunswick, N.J.: Rutgers University Press, 1997), 953; Rebecca M. Herzig, Suffering for Science: Reason and Sacrifice in Modern America (New Brunswick, N.J.: Rutgers University Press, 2005), 85100; Rebecca M. Herzig, In the Name of Science: Suffering, Sacrifice, and the Formation of American Roentgenology, Amer. Quart. 53 (2001): 56389. 22. Although such a methodology will not produce an account as complete or as satisfying as that gleaned from personal testimony, given the lack of such evidence, the methodology both reflects necessary limitations and is consistent with methods utilized in the general historiography on early American roentgenologists. See Serwer, Rise of Radiation Protection (n. 5), 152; Reiser, Medicine and the Reign of Technology (n. 21), 4568; Herzig, Suffering for Science (n. 21), 85100.

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is reasonably well developed, the bulk of the literature primarily addresses awareness of the risk of burns rather than cognizance of the risk of radiation-induced cancer. Accordingly, this essay examines the available evidence in detail in an attempt to pinpoint as precisely as possible when, and to what extent, the perils of radiation-induced cancer could have been known by American roentgenologists. The second objective of this essay is to offer a partial explanation for the roentgenologists willingness to suffer and die for the sake of their art. Herzig argues persuasively that a powerful ethos of self-sacrifice and abnegation accounts for the early American roentgenologists behavior. The complementary explanation proffered here builds on Herzigs work in arguing that the martyrdom of the roentgenologists turns on the explanatory and meaning-making power earned in rendering the inner body visible in fin de sicle America. While the discovery of X-rays must be seen in context with the development of other kinds of late-nineteenth-century imaging techniques (e.g., photography, lithography, etc.), the reaction to Roentgens discovery makes clear that the power to see inside the body was a watershed, both for American society in general and for professional healers and scientists in particular. Accordingly, the thesis of this essay is that use of X-ray imaging techniques harnessed the power of seeing the inner body in fin de sicle American culture and that this power was so significant at the time that it can reasonably be offered as at least part of the explanation for the apparent eagerness by which some early roentgenologists suffered and died. When philosophers of science discuss power, they often refer to it in an epistemic sense in which power is analyzed in terms of its explanatory capacity.23 This framework posits an epistemological component to power, suggesting that the scope of a particular way of conceptualizing the world is mediated by the extent to which it explains features of our lived experiences. If so, it is worth noting that in his seminal account of the rising power of the visible lesion in nineteenth-century medicine, Foucault subtitled the work An Archaeology of Medical Perception.24 The perceptive possibilities suggested by the new imaging techniques are tied to the investigators ability to show the Eye/I what could hitherto not be seen.25
23. E.g., Thomas S. Kuhn, The Structure of Scientific Revolutions, 3rd ed. (Chicago: University of Chicago Press, 1996); Paul Feyerabend, Farewell to Reason (New York: Verso Books, 1987); Richard Rorty, Truth and Progress (Cambridge: Cambridge University Press, 1998). Of course, this is not to assert that theory selection is simply a function of fitting with the facts; Feyerabend, for one, took pains to undermine this view. 24. Michel Foucault, The Birth of the Clinic: An Archaeology of Medical Perception, trans. Alan M. Sheridan Smith (New York: Vintage, 1994). 25. The term Eye/I was coined by A. Richard Turner in reference to the Renaissance and early modern enmeshment between the investigating, scientific eye and the self. A.

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As such, it is no accident that X-rays were also called X-lights by none other than Roentgen himself.26 The demonstrative power of X-ray techniques was tied to the reification of the internal body, and in addition to the confirmation of nascent theories of disease and illness that centered on the discernment of discrete, material pathologies. In essence, the power of these imaging techniques rests in part on their illumination of previously opaque spaces inside the body. This is a species of what Kadlec terms the investigators semiotic power.27 In addition, showing how someones outer pain could be localized to an actual space inside the bodya broken bone, for examplethat could be made visible by X-ray is an obvious means of constructing meaning in the face of suffering. Why does the patient suffer pain in his or her thigh? Because the patient has broken his or her femur, and it is the X-ray that gives visible evidence of this occurrence. In the formerly dark spaces of the body, the X-rays shone their powerful beams and illuminated the sacred structures of human anatomy. However, as historians of objectivity and scientific imaging have emphasized, the cultural and social power of imaging a natural object in the midto late-nineteenth-century West is far too significant to reside solely within cultures of biomedicine and scientific practice itself.28 Rather, the power

Richard Turner, Inventing Leonardo (Berkeley: University of California Press, 1992), 15590. In their recent history of objectivity, Daston and Galison pick up on the theme, emphasizing the ways in which beliefs about a particular notion of objectivity shaped in deep ways the relevant construction of the scientific self. Lorraine Daston and Peter Galison, Objectivity (New York: Zone Books, 2007). The term is evocative precisely because it symbolizes the close relationship between the power of scientific and clinical sightTurners focus is on Leonardo, who was, after all, seeing cadavers in his anatomical depictionsand the self. This theme is the central subject of this article. For the claim that the practices of the roentgenologists shaped the content of the X-ray images themselves, see Barron H. Lerner, The Perils of X-Ray Vision: How Radiographic Images Have Historically Influenced Perception, Perspect. Biol. Med. 35 (1992): 38297; Bernike Pasveer, Knowledge of Shadows: The Introduction of X-ray Images in Medicine, Sociol. Health Illness 11 (1989): 36081. Several social scientists advance the same argument as applied to contemporary brain imaging techniques, thereby suggesting important links between the intellectual history of American roentgenology and contemporary American attitudes, practices, and beliefs toward novel medical imaging techniques. Kelly Joyce, Magnetic Appeal: MRI and the Myth of Transparency (Ithaca, N.Y.: Cornell University Press, 2008); Joseph Dumit, Picturing Personhood: Brain Scans and Biomedical Identity (Princeton, N.J.: Princeton University Press, 2004). 26. Herzig, In the Name of Science (n. 21), 565. 27. David Kadlec, X-Ray Testimonials in Muriel Rukeyser, Modernism/Modernity 5 (1998): 2347. 28. See, e.g., Daston and Galison, Objectivity (n. 25); Jennifer Tucker, Nature Exposed: Photography as Eyewitness in Victorian Science (Baltimore: Johns Hopkins University Press,

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of scientific imaging techniques like the X-ray at the time is inextricably linked to larger public discourses regarding the meaning of imaging natural objects in general. This wider social context is even more significant as to X-rays because, as Joel Howell points out, X-rays were perhaps the first medical image to be widely accessible, in similar, (if not identical) form to medical and lay observers alike.29 Thus, the meaning generated by the roentgenologists activities can be fruitfully understood only in the context of some of these larger social and cultural frameworks through which the meanings of scientific images in general and X-rays in particular were interpreted, and this essay examines some of these contexts in which the power of the X-ray was situated. Amid other mid- to late-nineteenth-century imaging techniques, there are several reasons for focusing on the X-ray. First, given that Roentgen made his discovery late in 1895, there is no better imaging technique through which to examine fin de sicle attitudes and practices. Indeed, the fin de sicle itself is a pivotal time in constructing the modern West in general and for American medical history in particular, as so many of the theoretical and practical changes occurring in American medicine and science took shape in the mid- to late nineteenth century. Examining the period from 1895 to 1910 is useful because it shows how the myriad dialectic changes both reflected and are reflected in the practice of roentgenology at the time.30 Focusing on roentgenology during this period is therefore a way of inquiring into the social effects of the new discourses on medicine and science that took shape in the mid- to late nineteenth century.31 Second, it is crucial to understand how astonishing it must have been at the fin de sicle to be able to stand apart from the living body and see its inner structures. Almost four centuries after Vesalius had decried those anatomists who refused to carry out dissections themselves, the X-ray delivered on its promise of remotely anatomizing the living body. Herzig observes the reverence with which X-rays were perceived: Invisible, active at a distance, and powerful beyond any received understanding, the uncanny X-ray invited religious comparison.32 Similarly, in their Sep2005); Jennifer L. Mnookin, The Image of Truth: Photographic Evidence and the Power of Analogy, Yale J. Law Human. 10 (1998): 174. 29. Howell, Technology in the Hospital (n. 18), 135. 30. This includes, among many others, the changes in theories of disease and illness, the influence of heredity and Darwinian theories on science and medicine, increasing professional sovereignty for physicians, the genesis of public health movements, and the changing role of hospitals. 31. Kevles, Naked to the Bone (n. 21), 4653. 32. Herzig, In the Name of Science (n. 21), 571.

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tember 1896 treatise on X-raysappropriately subtitled Photography of the Invisible and Its Value in SurgeryWilliam James Morton and Edwin Hammer observed that, as compared to prior experiments with cathode rays, the transformation from what had been merely an interesting scientific fact into a positive power for good, which will affect the entire human race had two bases.33 The first is that Roentgens experiments produced similar effects to prior efforts, but at comparatively enormous distances from the tube.34 The second base is the fact that the rays Roentgen produced enabled the depiction of bones within the living flesh.35 Thus, the significance of anatomizing the living body from a relatively great distance was, to Morton and Hammer, quite literally transformative, rendering X-rays able to broadly affect the life and happiness of the human race and thus become of universal importance.36 Ultimately, the clinic may have been born around 1800, but examination of American roentgenology between 1895 and 1910 is useful in informing an archaeology of medical perception.

Early Reports of X-Rays: Metaphors and Dangers

In December 1895, European newspapers blazed forth with news of what Roentgen himself termed a the light that never was.37 In one of the earliest American accounts of Roentgens discovery, the January 6, 1896, New York Sun reported that Roentgen had discovered the light that never was.38 The image of light and perception is, no pun intended, quite visible throughout much of the discourse on roentgenology examined herein. This is an elegant example of Evelyn Fox Kellers conception of the feedback loop, of the ways in which the social phenomena of scientific practice are shaped by the metaphors used to speak of such practice in public discourse.39 Early roentgenologists themselves frequently utilized such metaphors; Lisa Cartwright quotes at length from a memorial speech of 1897 delivered

33. William J. Morton and Edwin W. Hammer, The X-Ray: Or Photography of the Invisible and Its Value in Surgery (New York: American Technical Book Co., 1896), 99. 34. Ibid., 99. 35. Ibid., 99. 36. Ibid, 7. 37. David DiSantis, Early American Radiology: The Pioneer Years, Amer. J. Roentg. 147 (1986): 85053. 38. The New Photography, New York Sun, January 6, 1896. 39. Evelyn Fox Keller, Making Sense of Life: Explaining Biological Development with Models, Metaphors, and Machines (Cambridge, Mass.: Harvard University Press, 2002), 11373; Refiguring Life: Metaphors of Twentieth-Century Biology (New York: Columbia University Press, 1995), 85.

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at the British Roentgen Society that begins by noting that on November 8, 1895, a light which, so far as human observation goes, never was on land or sea, was first observed.40 The hitherto unrecognized rays . . . penetrate[d] the cardboard shield . . . and [made] darkness visible.41 Cartwright argues that the meaning of light in fin de sicle American culture had begun to change from a notion of light simply reflecting off surfaces to a conception in which light becomes a brutal force that physically penetrates its object, stripping away its concealing surface to lay its structure bare.42 Whether scientific, clinical, legal, or lay, discourse surrounding X-rays commonly used metaphors of light and the sun. This language connotes the veridical power of X-rays, their capacity to show the truth of what was hitherto obscure if not altogether opaque.43 The power of X-rays resided in significant part in their capacity to illuminate, to open up previously dark spaces that resisted the investigating Eye/Is gaze. Accordingly, both the fact and the frequency of light and sun metaphors are important markers of the epistemic power that X-rays promised. In any case, it did not take long for the news of the Roentgen rays to travel the Atlantic. David DiSantis observes that [t]he Roentgen fever in the European scientific community quickly became an American epidemic as well.44 The first American roentgenology experiments took place late in the first quarter of 1896, and the first confirmed death subsequent to X-ray exposure was that of Clarence Madison Dally, a glassblower in the
40. Quoted in Lisa Cartwright, Screening the Body: Tracing Medicines Visual Culture (Minneapolis: University of Minnesota Press, 1995), 111. While the focus herein is on American roentgenology, the close connections at the fin de sicle between American and European medical science justify occasional reference to European sources. A fuller explanation of the significance of this transatlantic exchange in pinpointing when American roentgenologists knew or could have known of the life-threatening dangers of X-rays is discussed below. 41. Ibid., 111. 42. Ibid., 113. 43. In truth, how communities assessed the veridical capacity of X-rays and other scientific imaging techniques of the time is significantly more complex than a simple assertion of truth incarnate allows. Some of this complexity is discussed in this article in the section titled The Cultural Significance of the X-Ray; for a fuller discussion see Daniel S. Goldberg, The History of Scientific and Clinical Images in Mid-to-Late 19th Century American Legal Culture: Implications for Contemporary Law and Neuroscience, in Law and Neuroscience: Current Legal Issues, ed. Michael Freeman (Oxford: Oxford University Press, 2011); Daston and Galison, Objectivity (n. 25); Tucker, Nature Exposed (n. 28); Tal Golan, Laws of Men and Laws of Nature: The History of Scientific Expert Testimony (Cambridge, Mass.: Harvard University Press, 2004); Mnookin, Image of Truth (n. 28); Kenneth Allen De Ville, Medical Malpractice in Nineteenth-Century America: Origins and Legacy (New York: New York University Press, 1990), 22123. 44. DiSantis, Early American Radiology (n. 37), 850.

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employ of Thomas Edison. Dally contracted multiple carcinomas as a result of radiation exposure.45 The pain in his hands began almost immediately after X-ray exposure in 1896, and by 1900 he had already lost all the hair on the front of his scalp, his eyebrows, and his eyelashes.46 After unsuccessful skin grafts, his left hand was amputated in 1902.47 This was followed by the amputation of both arms due to metastatic disease and Dallys death in October 1904.48 The fact that Dally worked in Edisons laboratory is crucial. Edison enjoyed significant fame by 1895, and therefore his own perspective on the dangers, if any, of X-rays is important at least in part because his findings merited greater media coverage. Following William Randolph Hearsts public request that Edison as an especial favor to the [New York Journal], undertake to make a cathodograph of a human brain,49 [r]eporters flocked to the West Orange, New Jersey, laboratory.50 Edisons view on the dangers of the nascent roentgenology thus provides a significant marker in unpacking the extent to which early American roentgenologists exposed themselves to the danger of X-rays blindly. A San Francisco Call article of June 30, 1901 mentions Dallys brother Charles by name in context of Edisons advice to surgeons as to cancer.51 The article is subtitled Where Disease Is Due to Radium or X Rays He Suggests Remedy.52 This already implies a causal relation between X-rays and cancer. The article continues,
Mr. Edison watched carefully the progress of the cancer which developed from the slight flush on the back of one of the hands of his assistant, Charles Dally, who has since lost his arm. The disease had its origin in burns by the Roentgen rays.53

It is difficult to imagine how causation could be asserted any more plainly: The [cancer] had its origin in burns by the Roentgen rays. If the articles factual premises are sound, it follows that both Mr. Edison and the author of the article averred as early as 1901 that X-rays caused burns and cancer. The same newspaper reported on August 4, 1903, that Edison

45. Herzig, In the Name of Science (n. 21), 566. 46. Ibid. 47. Ibid. 48. Ibid. 49. DiSantis, Early American Radiology (n. 37), 851. 50. Ibid., 851. 51. Edison on Cancer: Hints to Surgeons, San Francisco Call, June 30, 1901 (hereafter referred to as Edison on Cancer). 52. Ibid. 53. Ibid.

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described to-day the injurious effects upon himself, which have followed his recent experiments with the X-ray. These may affect Edisons health seriously, but he believes that he has made a discovery of importance to medical science. He is firmly convinced that the destroying process of the X-ray that has necessitated the amputation of the left arm and fingers of the right hand of Clarence Dally, one of his assistants, and is now threatening the left hand of Charles Dally, his brother, is, the direct result of the killing or paralyzing of certain white blood corpuscles known as phagocytes.54

Thus, after watching the progression of Dallys cancer, Edison decided to test the X-rays on himself. The X-rays burned his hands, and this likely influenced his thinking about the causal relationship between X-rays and cancer.55 Edisons choice to expose his hands was likely not coincidental, given that many roentgenologists judged the intensity of the X-rays by its effects on their hands.56 Redness on the hands signaled that the X-rays were working well, and thus it is unsurprising that the vast majority of X-ray burns suffered by the roentgenologists began on the hands, which is also where the ulcers and cancerous lesions tended to appear initially. Amputations followed the same trajectory, as Dodds case shows. Chronologically, in the 1901 article Edison is reported as carefully watch[ing] the progress of Charles Dallys cancer;57 in the 1903 article he is providing a specific biochemical etiology for the X-rays destruction of Charles Dallys tissue.58 Accordingly, no less a figure than Edison himself was aware of the causal possibilities of X-rays as to cancer as early as 1901, and if the 1903 article is accurate, he was by that time convinced enough of the causal relationship to posit a physiological mechanism for it. Yet there is further evidence for the claim that both Edison and a significant number of physicians were aware of the dangers of X-rays soon after experiments began in the United States in 1896. An editorial in the Journal of the American Medical Association opined on Edisons 1903 comments regarding the mechanism by which X-rays destroyed tissue and did so less than two weeks after Edison made these comments.59 The editorial

54. Believes X-Ray Kills White Blood CorpusclesEdison Thinks He Has Made a Discovery of Real Importance to Science, San Francisco Call, August 4, 1903 (hereafter referred to as Edison Believes). 55. Ibid. 56. Edmund H. Burrows, Pioneers and Early Years: A History of British Radiology (St. Anne, UK: Colophon Press, 1986), 22023. I am indebted to an anonymous reviewer for stressing the significance of this point. 57. Edison on Cancer (n. 51). 58. Edison Believes (n. 54). 59. Editorial, Edison and X-Ray Injuries, J. Amer. Med. Assoc. 41 (1903): 499.

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is worth quoting extensively, as it strongly suggests that American roentgenologists, or at least a significant number of them, were well aware of the life-threatening dangers of X-rays shortly after their discovery. The editorial begins, At this somewhat late day, Mr. Edison, and, through him, the newspapers have all of a sudden discovered that x-rays can cause injuries, and, like many other belated discoveries, the topic is now one of lively interest in the daily press.60 Note the sarcasm evident in the phrase all of a sudden discovered, implying that this discovery was not something that was heretofore unknown. Moreover, the date of the discovery is late. The editorial goes on to describe Edisons injuries and to link them to X-ray exposure: His left eye is out of focus, his digestion is upset and lumps have formed all through the region of his stomach. He knows it is the result of the x-rays, because he held the tube close to his stomach when he was working with x-rays five or six years ago.61 In spite of this buildup, the authors are unimpressed, claiming that nothing Edison describes is out of the ordinary: Without any doubt [Edisons assistants] have had x-ray burns, but there is nothing to indicate that the burns are not of the ordinary character of other x-ray burns.62 Of course, this implies that the fact of X-ray burns at all is ordinary, and the authors go on to cite articles by Pusey, Allen and White, Scholtz, Grouven, Gassmann, and others that show very definitely the changes that occur in tissues under the influence of x-rays.63 They therefore dismiss Edisons theory of phagocyte destruction as not of serious interest.64 The conclusion proffered by the editorialists is most important:
He has, as far as can be judged by the newspaper reports, found nothing that has not been found before, and offered no explanation that is of any value. He is rehashing in the daily press facts that had been learned by physicians through said experience seven years ago.65

The first sentence summarizes the theme thus far, whereas the second sentence delivers a further rhetorical punch, that Edison is merely repeating what physicians learned seven years prior (1896) shortly after X-ray experiments began: X-rays are dangerous. Note that the significance of this statement is not a function of its correspondence with reality. Even if it is not the casethough it likely isthat American investigators knew
60. Ibid., 499. 61. Ibid., 499. 62. Ibid., 499. 63. Ibid., 499. 64. Ibid., 499. 65. Ibid., 499.

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almost immediately after they began experimenting with X-rays that the rays at a minimum could cause lingering, disfiguring injuries, the authors of a JAMA editorial were prepared to publicly call out Thomas Edison as merely rehashing facts on the danger of X-rays. The implication is that such facts were known to investigators since the embryonic days of American roentgenology. The fact that the authors were willing to stake such public claims is itself important, even if American roentgenologists did not know of the perils of X-ray exposure early on. Nor need readers wait as long as 1903 to find evidence that the lifethreatening dangers of X-rays were known to the Anglophone roentgenological community. An S.J.R. of London reported in an October 29, 1896, issue of Nature that there is no mistaking the fact that the X-rays are quite capable of inflicting such injury upon the hands as to render them useless for a time, and to leave in doubt their ultimate condition when entirely freed from frequent daily exposure to their influence.66 S.J.R. had begun experimenting with X-rays in May 1896 and proceeds to describe in unpleasant detail the burns on his hands.67 By July the fingers on his left hand swelled considerably, began to leak a kind of discharge, and produced significant pain upon the slightest pressure.68 He kept his fingers bandaged for six weeks, by which time his right hand had begun to be affected as well, S.J.R. having switched to his right hand to manipulate the X-ray.69 Astonishingly, then, even while the X-rays were burning the flesh of his left hand and fingers, he did not cease experimenting with the X-rays but merely switched to using the other hand.70 Seven months later, David Walsh published an article in the July 31, 1897, issue of the British Medical Journal, observing not merely that X-ray exposure is capable of causing deep tissue traumatism but that the damage caused, like the X-ray itself, was comparable to that caused by exposure to the sun.71 Thus, not only were X-rays themselves conceptualized according to metaphors of the sun; so, too, was the danger thereof. The fact that S.J.R. and Walsh were writing from London does not license the conclusion that their perspectives were less relevant to American audiences; quite the contrary, American roentgenologists were almost certainly reading the top European journals and discussing the findings
66. S.J.R., Some Effects of the X-Rays on the Hands, Nature 54 (1896): 621. 67. Ibid. 68. Ibid. 69. Ibid. 70. Ibid. 71. David Walsh, Deep Tissue Traumatism from Roentgen Ray Exposure, Brit. Med. J., July 31, 1897: 27273.

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as to X-rays.72 This is evident in J. C. Whites letter to the editor published in the December 1, 1896, issue of the Boston Medical and Surgical Journal.73 In the letter, White begins by referencing an article in the November 7, 1896, issue of British Medical Journal titled Dermatitis Caused by Roentgen x rays.74 The article describes how a man was exposed to X-rays for a total of two and a half hours, resulting in exfoliation and a severe burn that had not healed in sixteen weeks.75 White then links the report of the European investigators to a case closer to home, involving a woman under the care of a Dr. Warren at Massachusetts General Hospital. She
was exposed to the rays for half an hour on one day, and forty-five minutes on the following day, the tube being placed about six inches in front of her sternum. On the following day the skin over this region became red, and later blistered. Three months subsequently, when seen by mine at the request of Dr. Warren, early in October, there was an area of angry-looking granulations some three inches square, which had obstinately refused to heal. The surface was very sensitive and the region was the seat of severe neuralgic pains. It is reported that at the present date, November 15th, two small open spots persist, and that the region is still painful.76

White begins his letter by reporting on findings in Europe and then confirms the findings at home with empirical evidence from the Massachusetts General Hospital. Such a pattern of rhetoric fits neatly into the cultural ethos of the day, in which American physicians believed that the pinnacles of medicine were to be found in London, Paris, and Vienna.77 Where the dialogue across the Atlantic was so robust, where American physicians cultural and professional authority was tied to apprenticeships and engagement with the axes of European medical science, it is all the more likely that American investigators caught wind of the dangers of X-rays shortly after experimentation began in Europe, rather than shortly after such experimentation began in the United States. Whites letter confirms this analysis and is significant if for no other reason than its date, illustrating that discussion of the dangers of X-rays were present in scientific discourse almost from the inception of roentgenology itself.
72. Kevles, Naked to the Bone (n. 21), 3353. 73. J. C. White, Dermatitis Caused by X-Rays, Boston Med. & Surg. J. 85 (1896): 583. 74. Henry C. Drury, Dermatitis Caused by Roentgen x rays, Brit. Med. J., November 7, 1896: 137778. 75. White, Dermatitis Caused by X-Rays (n. 73), 583. 76. Ibid., 583. 77. Charles E. Rosenberg, Explaining Epidemics and Other Studies in the History of Medicine (Cambridge: Cambridge University Press, 1992), 15253; Paul Starr, The Social Transformation of American Medicine (New York: Basic Books, 1982), 11314.

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Shortly after the 1896 Nature article, a New York Times article of July 30, 1897, displayed the headline Burned by the X-Rays: Pitiable Condition of Miss Josie MacDonald after Being Photographed by Them.78 Miss MacDonald presented to her dentists with intense pain in her jaw, and [i]n order to determine the exact cause they decided to have an X ray photograph taken of the jaw to see if there was an old root there.79 The article goes on to state matter-of-factly that [a] few days afterward Miss MacDonalds face began to swell and grew black.80 Worse, Miss MacDonalds hair fell out, her face blistered, and open sores formed on her neck, on her shoulders, and on one arm.81 Her left ear swelled, and she lost her hearing on the left side.82 She was in constant pain, but the article reports that the consulting physician could not tell who was responsible for the condition of his patient.83 It is important not to read this proposition as a question of medical causation, for the headline itself makes quite clear the view that the X-rays caused MacDonalds injuries. Rather, the consultants question goes to legal causationnot what is responsible for MacDonalds injuries but who is responsible. The remainder of the article makes this point clear, as it reports that MacDonalds brother-in-law complained of the lack of feeling shown by the dentists, who, he said, had shown no interest in the case and had led his sister-in-law to the photographer without her knowledge of what she was about to go through.84 One of the dentists responded by denying responsibility for MacDonalds injuries, contending that MacDonald herself had suggested the use of an X-ray and that he had avoided contacting her for fear of irritating her.85 The article concludes by noting that Miss MacDonald had retained the venerable law firm of Sullivan & Cromwell, and an action will shortly be commenced against the dentists.86 On the very next day, the New York Times carried an article regarding X-rays which concluded that
[w]hether the burns are produced by infinitesimal particles of actual matter thrown off by the tube is a problem for scientists. The protection of patients
78. Burned by the X-Rays: Pitiable Condition of Miss Josie MacDonald after Being Photographed by Them, New York Times, July 30, 1897. 79. Ibid. 80. Ibid. 81. Ibid. 82. Ibid. 83. Ibid. 84. Ibid. 85. Ibid. 86. Ibid.

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against the dangerous emanation, whatever its nature may be, is the practical duty of the X-ray operator.87

Note again that medical causation is deemed of less importance to the lay perspective than the question of social duty and harm. Whatever the mechanism by which X-rays destroy tissue, what matters above all is the X-ray technicians practical duty to protect patientslet alone themselvesfrom the dangers of the X-rays. In addition to the foregoing, there is an abundance of additional evidence suggesting awareness, constructive or otherwise, of the dangers of X-ray exposure early after their introduction in the United States. By 1898, Charles Lester Leonard could confidently report on The X-Ray Burn: Its Production and Prevention in the July 2 edition of the New York Medical Journal.88 He concluded that he had never seen a burn produced where the [aluminum] shield has been used.89 Leonard underwent one amputation after another (first the finger, then the hand and forearm, then the upper arm at the shoulder) before succumbing to cancer in 1913 at the age of fifty-one.90 Far from being unaware of the dangers of X-rays, he continued to work with them even as his distress and suffering increased, right up until the time of his death. As Herzig observes, His pain . . . seems merely to have intensified his fascination with the X-ray.91 The same general sequence of events holds true for a majority of the other martyrs of science whose suffering is documented in Browns book. The possibility that these early roentgenologists were aware of the danger of burns but not of cancer due to X-ray exposure strains credulity. Sustaining this argument requires the dubious assertion of ignorance on the part of the same roentgenologists who were well aware of the risks of burns and watched their burns turn into ulcers and then into cancerous lesions and subsequently had their digits, hands, and arms amputated, all the while refusing to cease work on the X-ray. Moreover, in February 1901, the Boston Medical and Surgical Journal published a letter authored by the influential early roentgenologist William Rollins aptly titled X-Light Kills.92 Rollins proceeded to describe the results of an experiment conducted on guinea pigs, in which a strong male guinea pig was exposed

87. Roentgen Ray Dangers, New York Times, July 31, 1897. 88. Charles Lester Leonard, The X-Ray Burn: Its Production and Prevention, New York Med. J., July 2, 1898: 1820. 89. Ibid., 19. 90. Herzig, In the Name of Science (n. 21), 575. 91. Ibid., 575. 92. William Rollins, X-Light Kills, Boston Med. Surg. J. 144 (1901): 173.

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to X-rays for two hours per day until the animal died on the eleventh day. Rollins noted that he observed no burns on the skin of the guinea pig.93 Similarly, as noted above, there is evidence that just a few short months after Rollinss letter, in June 1901, Edison himself understood a connection between X-rays and cancer. In September 1902, several participants at the twenty-sixth annual meeting of the American Dermatological Association reported cases of what they strongly suspected was radiation-induced cancer. At the meeting, Charles Warrenne Allen exhibited lantern slides of carcinoma of the arm following X-Ray burn.94 Allen observedstrange as it may seemcancerous growths on the arm of a patient exposed to X-rays and therefore concluded that [c]ancer itself may be produced by the injurious effect of the ray in a person not known to be predisposed, as instanced in the case reported of the tubemaker, whose arm had to be amputated for carcinoma developing in the X-Ray cicatrix.95 He added that hystological pathology is now being worked out at my suggestion in our New York Post-Graduate Pathological Laboratory.96 Perhaps even more significant from the transactions of the meeting is the report of Dr. James Clarke White, who states that he wishes to put on record a case of carcinoma of the skin developing at the site of prolonged X-ray dermatitis.97 In the same entry, White refers to my Boston colleagues, suggesting that this James Clarke White is in fact the same J. C. White who reported, from 259 Marlborough Street, BOSTON, in the December 1, 1896, Boston Medical and Surgical Journal a case of severe dermatitis caused by X-rays.98 If this inference is correct, it shows that White understood a connection between X-ray exposure and burns late in 1896 and by September 1902 at the latest had drawn a further connection between X-ray-induced burns and cancer. Commenting on these reports in their 1903 textbook on the use of X-rays, Pusey and Caldwell note that the problem is one of serious importance, and its dangerous possibilities should be borne in mind. It is probable . . . that many cases of epithelioma will be found to develop upon the backs of the hands of x-ray workers who have a persistent, chronic

93. Ibid. 94. Frank Hugh Montgomery, Transactions of the American Dermatological Association at Its Twenty-Sixth Annual Meeting (Chicago: P.F. Pettibone, 1903), 211. 95. Ibid., 180 and 184. 96. Ibid., 182. 97. Ibid., 198. 98. Ibid., 5 and 198; see note 73, sup.

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inflammatory process with hyperkeratosis, as a result of continued exposure to x-rays.99 Thus the argument that early roentgenologists were aware of the risk of burns but unaware of the life-threatening potential of X-ray exposure is dubious. Lisa Cartwright concludes that, by 1903, [t]he link between X rays and cancer was unmistakable.100 Given the evidence examined above, this seems perhaps too parsimonious a chronological assessment. Fairly widespread awareness of the link among roentgenologists could reasonably be imputed as early as 1901 and was almost certainly established by early 1903. In either case, this chronology implies that many of the early American roentgenologists continued to work with X-rays for many years after they had every reason to know of the risk if not the likelihood of radiation-induced cancer caused by their X-ray investigations. If not for dearth of knowledge regarding the dangers of X-rays, then why indeed did the roentgenologists who died do so, knowing what was in store for them? Brown himself concedes this is a difficult question to answer. Herzig argues that the roentgenologists conduct can be explained at least partly in terms of the meaning imbued by participation in a discourse of scientific sacrifice and martyrdom.101 Building on Herzigs work, the following section suggests other reasons for the roentgenologists conduct: the cultural significance of rendering the inner body visible to the scientific Eye and the construction of meaning gained by the investigators status as translators of the tremendum, the fear of the vast unknown.102

The Cultural Significance of the X-Ray: Photography of the Invisible

The set of factors that drove some roentgenologists and other scientists of the time to willingly incur life-threatening risks in the pursuit of their art is a complex and likely multifactorial constellation. As such, in the absence of personal testimony from the roentgenologists in question, explanations for their actions are necessarily partial. However, such incompleteness does not imply the impossibility of historically plausible accounts. Herzigs is one such account; hopefully, the complementary

99. William Allen Pusey and Eugene Wilson Caldwell, The Practical Application of the Rontgen Rays in Therapeutics and Diagnosis (Philadelphia: W.B. Saunders, 1903), 230. 100. Cartwright, Screening the Body (n. 40), 110. 101. Herzig, In the Name of Science (n. 21), 56971. 102. Daniel S. Goldberg, Religion, the Culture of Biomedicine, and the Tremendum: Towards a Non-essentialist Analysis of Interconnection, J. Religion Health 46 (2007): 99108.

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analysis offered here is another. Ultimately, the argument is not that the power of remotely anatomizing the inner body by itself accounts for the early roentgenologists willingness to suffer and die for the sake of their work but simply that no explanation for the latter that ignores the former is sufficient. Comprehending this power requires brief discussion of the larger context regarding the cultural significance of seeing objects via natural investigations in mid- to late-nineteenth-century America. The literature on this topic is immense, but two particular lines of scholarship are arguably most illuminating to fin de sicle discourse on X-rays: Foucaults analysis of the rise of the clinical gaze, and Lorraine Daston and Peter Galisons account of the genesis of the concept of mechanical objectivity. Not coincidentally, the period each of these authors focus on is the nineteenth century; Barron Lerner observes that the new way of seeing represented by the X-ray was inherently related to modernity.103 Although Foucault suffers no shortage of interpreters, the literature on The Birth of the Clinic is surprisingly scarce, given its significance for understanding the rise of allopathic medicine in the West. Therein, Foucault argues that the clinical gaze is characterized in terms of discrete, material pathologies that increasingly became visible at postmortem.104 This marked a change from the previously dominant humoral medical cosmologies in which the hollow channels through which the humors flowed were much more significant than solid entities or lesions.105 Foucault sums up his argument by noting the change from the eighteenth103. Lerner, Perils of X-Ray Vision (n. 25), 384. 104. In addition to Foucault, the literature on the history of pathological anatomy in the nineteenth-century West is immense and vibrant. Recent sources I have found particularly helpful include Helen MacDonald, Procuring Corpses: The English Anatomy Inspectorate, 1842 to 1858, Med. Hist. 53 (2009): 37996; Elizabeth T. Hurren, Whose Body Is It Anyway? Trading the Dead Poor, Coroners Disputes, and the Business of Anatomy at Oxford University, Bull. Hist. Med. 82 (2008): 775819; Helen MacDonald, Human Remains: Dissection, and Its Histories (New Haven, Conn.: Yale University Press, 2005); Tatjana Buklijas, Cultures of Death and Politics of Corpse Supply: Anatomy in Vienna, 18481914, Bull. Hist. Med. 82 (2008): 570607; Alan William Bates, Indecent and Demoralising Representations: Public Anatomy Museums in Mid-Victorian England, Med. Hist. 52 (2008): 122; Ruth Richardson, Death, Dissection, and the Destitute, 2nd ed. (Chicago: University of Chicago Press, 2000); and Russell C. Maulitz, Morbid Appearances: The Anatomy of Pathology in the Early Nineteenth Century (Cambridge: Cambridge University Press, 1987). The definitive American history is Michael Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in NineteenthCentury America (Princeton, N.J.: Princeton University Press, 2002). 105. Robert L. Martensen, The Brain Takes Shape: An Early History (New York: Oxford University Press, 2004); Noga Arikha, Passions and Tempers: A History of the Humours (New York: Harper, 2007).

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century question what is the matter with you? to the nineteenth-century question where does it hurt? in which we recognize the operation of the clinic and the principle of its entire discourse.106 Or, as Rosenberg avers as to the concept of disease, by the late nineteenth century, social legitimacy presumed somatic identity.107 Foucaults insistence on the importance of seeing the inner body links the genesis of contemporary Western clinical practice itself to this synthetic kind of perception. The centrality of pathological anatomy in clinical practice became, in Robert Martensens words, Western learned medicines most distinctive knowledge-making feature.108 Martensen argues that the early modern emphasis on ocular demonstrations accelerated through the modern era to the point that it lay (and still lies) at the metaphorical heart of Western medicine and, more generally, Western science.109 Martensen identifies two key elements to the power of the visible in the culture of biomedicine: first, discernment of visible, material lesions and, second, clinical correlation, or the linkage of disease symptoms with those lesions.110 This power of clinical sight both contextualizes and helps explain the social and cultural power X-ray techniques enabled by remotely anatomizing the living body. Seeing inside the body facilitated clinical correlation, which Martensen argues constitutes a key code of signification that acts as a critical conceptual framework for contemporary allopathic medicine.111 Accordingly, as applied to X-rays, Lerner points out that [m]uch of the early praise for the chest radiograph . . . cited the objective value of seeing pathologic lesions and correlating those lesions with active tuberculosis.112 X-rays therefore built on and extended this particular code of signification related to clinical sight in ways that produced general amazement among both lay and professional observers. At least part of the reason why remotely anatomizing the inner body generated such astonishment is that the power of clinical sight had an epistemic component in the

106. Foucault, Birth of the Clinic (n. 24), xvi. 107. Charles E. Rosenberg, Contested Boundaries: Psychiatry, Disease, and Diagnosis, Perspect. Biol. Med. 49 (2006): 40724, quotation on 414. 108. Martensen, Brain Takes Shape (n. 105), 95. It should be noted that Western medicine itself is often distinguished in terms of its anatomoclinical or clinicopathological method. See, e.g., Mark F. Sullivan, The Problem of Pain in the Clinicopathological Method, Clin. J. Pain 14 (1998): 197201. 109. Martensen, Brain Takes Shape (n. 105), 96. 110. Ibid. 111. Ibid., 98. 112. Lerner, Perils of X-Ray Vision (n. 25), 389.

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mid- to late-nineteenth-century United States. Sappol elucidates this point in terms of anatomical practices, but his analysis is quite consistent with the fin de sicle discourse regarding X-rays: Dissection was a potent method of producing and disseminating knowledge . . . but also a powerful metaphor. Anatomists crossed and mastered the boundaries between life and death. . . . The dissector claimed the status of an epistemologically privileged cultural arbiter.113 The reverence for anatomy suggest[s] the intensity of the powers invested in dissection. . . . In dissecting the cadaver, the student penetrated, surveyed, and appropriated the interior of the bodyand transformed himself.114 The evidence examined suggests analogous understandings of the meaning of X-rays, which in turn help explain Kadlecs notion that the use of X-rays increased the semiotic power of the physician.115 Sappol is of course analyzing gross anatomical practices in this passage as opposed to pathological anatomy. However, this only reinforces the argument insofar as, given Martensens framework, even the obvious distinction between gross and pathological anatomy suggests an augmentation of epistemic power from the mere ability to see the anatomy of the inner body to the capacity to link visible pathologies with clinical signs and symptoms while the patient was still alive.116 Lerner suggests as much, observing that [b]y allowing physicians to visualize the internal organs of a living patient, [the X-ray] potentially afforded knowledge of disease previously obtainable only at autopsy.117 Sappols analysis suggests (1) a connection between the power of seeing the inner body and the construction of the scientific self and (2) that this connection derives a portion of its power from the epistemic privileges it bestowed. But such privileges would not have existed unless the social context in which anatomical (and roentgenological) practices were situated recognized and affirmed in them some kind of epistemic authority.118 Both of these notionsthe relation between the power of scientific sight and the scientific self and the epistemic valence of such sight in the fin de sicle United Statesare illuminated in important ways in Daston and Galisons recent history of objectivity, which (not coincidentally) focuses

113. Sappol, Traffic of Dead Bodies (n. 104), 23. 114. Ibid., 3. 115. Kadlec, X-Ray Testimonials (n. 27). 116. I am indebted to Todd Savitt for stressing the significance of the distinction. 117. Lerner, Perils of X-Ray Vision (n. 25), 385. 118. This again suggests the plausibility of Kellers conception of the feedback loop relationship between scientific and public discourse.

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on images of natural objects as depicted in scientific atlases from the early modern era to the present. Daston and Galison contend that scientific images are the critical desiderata for identifying a mid-nineteenth-century shift from an earlier conception of objectivity they term truth-to-nature to mechanical objectivity.119 The key distinctions between the two frameworks turn on the epistemic role of subjectivity in constructing the images. Whereas under the older paradigm, the subjective skill and expertise of the natural scientist120 and the artist or draftsman was seen as an indice of its value, the aim in the discourse of mechanical objectivity was to remove as much human influence as possible from the image so as to facilitate the capacity of nature to speak for itself.121 Moreover, whereas in the former the objective is not remotely to re-create in all of the particulars the natural object itself, the ideal in the latter is precisely to maintain maximum fidelity to the specific form and appearance of the object under investigation.122 It is important not to overstate this claim because the epistemic ideal of mechanical objectivity was just that, and even the most vigorous proponents of the veridical capacities of X-ray imaging techniques were generally quite aware of the need for expertise in producing such images and also of the healthy potential for duplicity and misinterpretation in their production.123 Thus J. William White, professor of clinical surgery at the University of Pennsylvania, commented in a 1900 report to the American Surgical Association on the medico-legal aspects of X-rays that [a]s to questions of deformity, skiagraphs alone, without expert surgical interpretation, are generally useless and frequently misleading.124 Similarly, British surgeon and roentgenologist John Hall Edwards opined in 1901 that the many cases in which radiographs are accepted which have been produced at a side show or an exhibition, or by an ordinary professional photographer is a disgrace. . . . The interpretation of a radiograph depends entirely upon the knowledge and experience of the expert who is asked to give an opinion.125 Nevertheless, as Daston and Galison point out, the significance of the discourse on mechanical objectivity is the ideal
119. Daston and Galison, Objectivity (n. 25), 55190. 120. This term is of course anachronistic. 121. Ibid., 11590. 122. Ibid. 123. See note 42, sup. 124. J. William White, Report of the Committee on the Medico-Legal Relations of the X Rays, Boston Med. Surg. J. 144 (1901): 42930. 125. The X-Rays in the Diagnosis of Fractures, Brit. Med. J., June 29, 1901: 164546.

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itself, the notion that novel imaging techniques could produce scientia, or reasonably certain knowledge, by excising human artifice and subjectivity. Ultimately, Daston and Galison contend that the changing epistemic valence regarding the subjects role in producing scientific images is a major factor in the construction of the scientific self. Applied to X-rays, the argument is that seeing the sacred inner space of the body upon photographic plates served to reify the self as embodied, as subject to rational, causal laws through which the investigating Eye could construct the I. Indeed, support for this idea comes from Herzigs analysis of the role of self-abnegation in accounting for the martyrdom of many early American roentgenologists. Where the distinctive feature of mechanical objectivity is its emphasis on the elimination of subjective influence in producing scientific knowledge, it should be unsurprising that a metaphysical ideal of self-abnegation played an important role in the willingness of some scientists and physicians to suffer and die for the sake of such knowledge. The roentgenologists like Dodd and Leonard and Kassabian suffered grievously and died at least in part for the sake of their work; how else can one explain why so many of them continued to work with X-rays even as they very likely knew the radiation was causing the cancer that was literally swallowing their bodies? The narrative Herzig delineates was arguably a construct through which meaning could be created as the roentgenologists suffered and died. Yet there is another trope through which the participants in the discourse might have imbued their practices with meaning: the adjustment to the tremendum. In prior work, I have suggested an interconnection between religion and the culture of biomedicine, based on Erwin Goodenoughs metaphor of the tremendum, or the fear of the great beyond.126 Part of the significance of the metaphor is that it implicitly connects to the notion of the adjuvants authority as a mediator of the tremendum.127 The very idea of the physicianpriest connotes a kind of spiritual authority, which, given the power of spiritual narratives for societies in general and for nineteenth-century America in particular, ought not be underestimated.128 In the article, I adopt a Wittgensteinian approach to assessing religion and biomedicine, one in which essentialist notions are eschewed in favor of the concept of family resemblances.129 Using Alstons survey of what he terms religion-making characteristics, I compare such charac126. Goldberg, Religion, the Culture of Biomedicine, and the Tremendum (n. 102), 100101. 127. Ibid. 128. Ibid. 129. Ibid., 100.

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teristics to the culture of biomedicine to see if they can be mapped out onto biomedical cultural patterns.130 One such characteristic relies on the notion of sacraments, to which I compare the doctors white coat, black bag, and stethoscope.131 If there is merit to this general framework, there is reason to believe that the X-ray machine itself might qualify as a similar kind of sacrament. The shaman uses the sacraments to commune with arcane, inaccessible knowledge, just as the witch doctors do via their animal horns, magical wood, and magical paste in Evans-Pritchards classic account of witchcraft and magic among the Azande.132 Akin to these witch doctors, the roentgenologists used their imaging techniques and the physical object itself (the machine) to gain access to previously opaque, inaccessible knowledge. And similar to the witch doctors, for whom the perceptible signs they provide for the patient are crucial,133 the signs provided by the roentgenologists in terms of visible images cast on screens or photographic plates demonstrate the power of their techniques. Indeed, early X-rays consisted largely of silhouettes or shadowshence the term skiagram, or shadow figurethereby imparting an ethereal, almost liminal quality to the images.134 This connotation underscores both the sacraments communal and mediatory functions and also the need for the healers expert interpretation and translation of the shadowed signs for the supplicant. Similarly, Richard Selzer observes that even after performing countless operations, he nevertheless feels fear when gazing at internal organs: The hidden geography of the body is a Medusas head one glimpse of which would render blind the presumptuous eye.135 This, of course, is a key aspect that justifies the social role of the shaman as intercessory, as the figure with the acumen and expertise needed to commune with hidden geography, whether the site of communion is the geography of the body or that of some kind of spirit world. Perhaps most compelling in this line of reasoning is surgeonpriest Daniel Halls recent phenomenological com-

130. Ibid. 131. Ibid., 1034. 132. E. E. Evans-Pritchard, Witchcraft, Oracles and Magic among the Azande, ed. Eva Gillies, abridged ed. (1937; repr., Oxford: Clarendon Press, 1976), 72. 133. These signs are crucial in the performance of the sance. Ibid., 7576; see also Paul E. Brodwin, Medicine and Morality in Haiti: The Contest for Healing Power (Cambridge: Cambridge University Press, 1996), 13437. 134. Lerner, Perils of X-Ray Vision (n. 25), 386. I am indebted to an anonymous reviewer for this point. 135. Richard Selzer, Mortal Lessons: Notes on the Art of Surgery (New York: Houghton Mifflin, 1974), 24.

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parison of the ritual altar to the operating table.136 He observes that both the altar and the table require basic illumination, that both focus the agents attention on bodies and blood, and that both tables encounter, receive, and support bodies in life and death.137 Moreover, Hall points out that both the altar and the operating table are literally set apart, which is the criterion for consecration and sanctification in the Catholic tradition: [M]uch of the operating room ritual serves not only sterile technique, but a ritual setting apart of the operative field that effectively marks a barrier between the operating room and the world outside.138 Hall concludes that [a]cross diverse cultures, anthropologists have observed that the role of shaman, priest, and medicine man is frequently filled by the same individual. This is no mere coincidence.139 The argument, then, is that the X-ray imaging techniques offered a powerful way of adjusting to the tremendum for the early roentgenologists. Such mediation is a potent means of constructing meaning in the face of suffering. The significance of the new medical perception was such that gaining the capacity to direct new beams of light into hitherto dark corners of human existence was bound to resonate in a social context in which the visible natural object in general and the visible inner body in particular were becoming epistemologically important as sites in which truths could be unearthed. Within a framework of mechanical objectivity, participants would be likely to confer high value on scientific imaging techniques that promised to reveal the unadulterated truth of the inner body, truths that theoretically existed untouched by the ravages of mortal illness or the butchery of the anatomists. As noted above, Herzig expressly states that the uncanny x-ray invited religious comparison.140 This supports the contention that X-ray imaging techniques were a powerful source of meaning for the roentgenologists at least in part because of the spiritual significance of adjusting to the tremendum.

136. Daniel E. Hall, Altar and Table: A Phenomenology of the Surgeon-Priest, Yale J. Biol. Med. 81 (2008): 19398. 137. Ibid., 195. 138. Ibid., 195. 139. Ibid., 196. 140. Herzig, In the Name of Science (n. 21), 571.

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X-Rays and the Significance of the Remotely Anatomizing the Living Body
This essay has endeavored to pinpoint as precisely as possible when early American roentgenologists knew or should have known of the links between X-ray exposure and cancer and subsequently to offer at least a partial explanation for why a relatively large number of those roentgenologists continued their work even as they suffered mutilation and were cognizant of their likely fate. Remotely anatomizing the inner body was replete with social and cultural significanceon occupational, ethical, economic, spiritual, legal, and professional levelssuch that seeking mastery over the techniques, refining them, and acquiring better and more precise images could have helped the roentgenologists find meaning in their suffering. In short, that the early American roentgenologists were so willing to suffer for the sake of their art says much about the cultural power of seeing the body, which cultural power has roots in medieval and early modern attitudes toward empirical knowledge. By the fin de sicle, the link between the investigating Eye and the modern I had become, if not complete, at least significantly and powerfully enmeshed. Empiric was no longer synonymous with quack; quite the contrary, a quack was increasingly defined as one who ignored the powers of such empiricism. Yet such empiricism differed significantly from older traditions of imaging natural objects, in the sense that the rising discourse of mechanical objectivity privileged the attempt to excise the investigating subjects influence in producing those images. While early American roentgenologists understood full well the subjective skill and expertise needed to produce and interpret X-ray images, the ideal of self-abnegation that pervaded fin de sicle American cultures of science and medicine is consistent with the roentgenologists willingness to suffer and die for the sake of scientific and clinical sight.

daniel s. goldberg, J.D., Ph.D, is an assistant professor in the Department of Bioethics & Interdisciplinary Studies at the Brody School of Medicine, East Carolina University. His historical research focuses on two topics in mid- to late-nineteenth-century America: the history of medical imaging, especially the history of early American roentgenology, and the history of pain without lesion. As to the former, he is currently researching the introduction of X-rays in fin de sicle litigation in the United States as a means of assessing their social

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and cultural significance. As to the latter, he is currently researching attitudes toward pain and malingering in shaping encounters of Civil War amputees with the pension system in postbellum North Carolina. His doctoral dissertation addressed the historical and contemporary undertreatment of pain in the United States, and he continues to work on this topic through an interdisciplinary approach centering on ethics, law, and the history of medicine. His e-mail address is goldbergd@ecu.edu.