The Service of X-Rays in Public Health
Herman N. Bundesen · Radiology · 1927
In a general way, it can be said that public health work is theoretically divisible into two parts—curative medicine and preventive medicine. Under the phrase “curative medicine” I would include all of the procedures by which we may cure an individual or a community of its ills. Preventive medicine—and this may seem like a paradox to you—includes curative medicine and all medical, surgical, and sanitary practices by which the individual, the group, or the community is preserved from the ills of the mind and flesh that might otherwise afflict it. I include curative medicine as a major branch of preventive medicine in this sense. To use only a single illustration, every case of diphtheria that is brought to termination by a physician, is one more case that is the more quickly eliminated from the number of foci of infection for the susceptible population. Inasmuch as X-rays make possible certain types of diagnoses that are otherwise impossible, and for many groups of pathological conditions make for an accuracy that is on a par with autopsy technic, the importance of the radiologist in curative and in preventive medicine is plain. One of the starting points in the proper administration of a health department is the collection of an accurate body of statistics on deaths and their causes. Without knowledge of how many deaths are occurring in the community, in which seasons of the year, among which racial, nativity, age, or sex groups, and, particularly, from what causes, public health administration is little more than the back-yard sanitation of our professional ancestors. We have reasonably complete reporting of deaths in most of the United States. Further, most of the statements that appear on a death certificate are given with reasonable precision. But the statements of the primary causes of death, taken by and large, are still woefully inaccurate. From the well-known work of Dr. Cabot, Dr. Emerson and others, it is safe to conclude that about 5 per cent of the statements of cause of death cannot be accepted without autopsy ; about 50 per cent are acceptable if supporting data are available, and the remaining 45 per cent are probably reliable. It is plain where the radiologist comes in. Upon him must fall one of the primary burdens for improving the accuracy of the diagnoses of causes of sickness and of death. The radiologist must work during the lifetime of the individual as the autopsy pathologist does after death has safeguarded him from the “slings and arrows of outrageous fortune.” To illustrate the type of uncertainty in administrative practice that comes from the questionable status of diagnostic technic, consider the situation with respect to cancer. Anybody can show that the death rates for cancer, as calculated from reported deaths, are increasing.