Early radiology and early African American physicians.

Readers of Dr Oestreich’s article on early radiology and the National Medical Association (NMA) might wonder why a historian would track the acceptance and use of radiographic techniques specifically among black physicians. To answer that question we must first recognize the significance to medicine of the discovery of x-rays. Consider the problem healers have faced since time immemorial: Caring for and curing patients depends in part on knowing what is occurring within the body. How can healers learn what is happening when someone is sick, without actually opening the body and looking? Before Roentgen, unless the healer was a shaman practicing in a culture where disease was believed to be the result of spirit intrusion or other supernatural causes and therefore did not need to look within the body to cure the patient, healers relied on indirect clues. They noted, for example, patients’ symptoms, visible or palpable changes detectable on the body’s surface, alterations in pulse, and the state of whatever came out of or could be removed from the body, for hints about what was occurring. They observed, smelled, and touched, as appropriate, discharges from all orifices, and inspected the blood removed in venesection. Physical diagnostic techniques provided only indirect information as well. It is telling that the name French physician Rene Laennec gave to the tool he invented in 1816 to improve immediate auscultation (ear-to-chest) was stethoscope, a word meaning “to see into the chest or chest viewer.” The various sounds transmitted through this new instrument (mediate auscultation), correlated with the autopsy findings from patients who, in life, produced similar sounds, allowed physicians to “see”—in a sense—what was happening in the body without actually opening it. Other physical diagnostic methods developed around that time, such as percussion and reflex testing with the reflex hammer, also helped. These were still indirect methods of viewing the body’s activities. The x-ray, however, was different. It allowed, for the first time, direct visualization of some tissues within the body. Physicians and laypeople alike celebrated x-rays as an amazing tool and a great breakthrough in medicine. It was important for African American doctors in the late 19th and early 20th centuries to keep up with this latest advance in medicine if they were to show themselves competent practitioners. Dr Oestreich’s article illustrates that early black physicians were aware of and users of x-rays. Physicians of color did not enter the profession in any numbers until the early 1870s, a few years after Emancipation and just 25 years before the discovery of x-rays. Black doctors had to prove to their current and potential white and black patients and to their white colleagues that they were capable of mastering the body of knowledge and techniques necessary for the practice of medicine. Formal education had not been an option for black people during slavery times. Further, most white Americans believed that men and women of African descent were not educable beyond a very basic level. The small group of black physicians who practiced in the first decades after Emancipation organized themselves in 1895 for mutual support in the face of blatant racism and exclusion from the rest of the medical profession. The NMA was founded (November 1895) just a month before Roentgen announced his discovery of x-rays (December 1895), so both were new to American society. Oestreich’s research indicates that black doctors such as Marcus Wheatland quickly adopted x-rays as part of their practice and used the NMA annual meetings to promote their use. The Journal of the National Medical Association, founded in 1909, almost 15 years after its parent organization, also served as a vehicle to keep black doctors abreast of x-rays and other new tools of the trade. The first article on roentgenology appeared in volume 3 (1911). That article, by a Chicago radiologist of color, Claudius D. Bell of Provident Hospital, sought to reinforce the value of x-rays to fellow African Author Affiliation: Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine at East Carolina University, Greenville; JNMA Editorial Board, Silver Spring, Maryland. Correspondence: Todd L. Savitt, PhD, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Greenville, NC 27834 (savittT@ecu.edu).