Naked to the Bone: Medical Imaging in the Twentieth Century (review)

A contributor to the distinguished Sloan Technology Series, Bettyann Kevles has chosen the task of making the history of radiology accessible to the general public. She does this brilliantly. The book is a tour-de-force in terms of what it sets out to do—namely, to describe the rise of radiology for the nontechnical reader, to give us an overview of the history of other recent techniques of diagnostic imaging, and to establish the relevance of these highly technical tales with colorful detail. Kevles is a science-writer rather than an academic, author of several previous science books for young adults, and she uses the techniques of the journalist rather than those of the dyed-in-the-wool scholar: her text relies primarily on interviews, with recourse to the secondary literature in order to fill in the background. She makes the United States the center of gravity of the story in the early years, rather than Central Europe.

It is important to understand what this history is not. It is not an account of the rise of radiology constructed from primary published sources; Kevles cites little from the contemporary medical literature on radiology. It is not even an attempt to provide “coverage” of the subject, for she slides over most of the history of radiotherapy and has almost nothing on interventional radiology, both essential to understanding the contours of the discipline. But she does offer riveting chapters on the rise of CT, MRI, and PET scanning, using the abovementioned kinds of sources.

Rather, the real contribution of this marvelous and highly readable book is to make the history of radiology accessible to nonradiologists—including physicians in other specialties, medical historians, and the general public. The history of radiology is an extremely technical subject, involving as it does some understanding of physics and of the technology of safely delivering ionizing radiation to the human body. Most readers do not in fact know what a Bucky diaphragm is (called here a Bucky grid), or a Coolidge tube. Kevles explains these matters clearly, puts them in the context of the rise of the discipline, and charts their social impact.

Because the book relies heavily on secondary sources, it will probably not make much of an impact on the history of medicine, except perhaps for an innovative chapter on how the concept of looking inside the body may have influenced avant-garde art in the years from 1900 to 1930. But Kevles does, through the use of arresting anecdotes and apposite quotations from interviews, open up to the nonspecialist reader what had previously been a sort of boring black box: earlier histories of radiology were written for insiders and were organized as technical chronicles.

In a sense, the book is a model of how to write medical history in an interesting manner. But it also reminds us that a scientific education does count for something—and most readers of this journal would not have called the mediastinum “a part of the lungs invisible to ordinary X-rays because of the bones surrounding it” (p. 109).

My only real criticism is that, in an effort to justify the argument that the history of radiology is of absorbing interest, Kevles somewhat overstates the case. Thus we read that “the discovery of X-rays was one of the nails in the coffin of Victorian prudery” (p. 14), among a number of exclamations intended to convince us that the rise of radiology represents a major cultural milestone. The pleasure of Kevles’s prose, and the excitement of learning such behind-the-scenes stories as how CT scanning saved the life of Ronald Reagan’s press secretary, James Brady, more than compensate for these distractions.