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[BIDMC RADIOLOGY]
One day in November of 1895, a physics professor
named Wilhelm Conrad Roentgen was bent over his
laboratory table in Wursburg, Germany. He was
investigating cathode-ray fluorescence by Note: to see any of
passing electricity through tubes filled with the historical photos
rarified gas, similar to our fluorescent light below full-size,
bulbs. Suddenly he noticed a strange glow click on them. This
emanating from a small screen lying nearby on requires that your
the table. This was not supposed to be part of Web browser's
the experiment! Preferences be
configured correctly.
Fascinated with the new phenomenon, he These photos are from
investigated it day and night for seven weeks. the Beth Israel
He saw the outline of the bones in his hand and Deaconess archives
then in his wife's hand. Roentgen realized that and are copyrighted
a previously unknown "invisible light" was by the hospital.
causing the fluorescence and the resultant image
(it turned out to be an electromagnetic wave
with a very short wavelength). Because "X" is
used in mathematics to indicate an unknown
quantity, he called the phenomenon an "X-ray."
On December 28, 1895, Roentgen wrote up his
findings in the Wursburg Physical Medical
Society Journal -- and became instantly famous.
At a January meeting his "X-ray" was named the
"Roentgen Ray." So enthusiastic was the
scientific world over this discovery that more
than a thousand articles and over fifty books
about the "Roentgen Ray" were published in that
first year, 1896.
Within several years, two French researchers
named Pierre and Marie Curie had isolated
radium, an element that emits radiation as it
decays. This gave further impetus to the medical
advances that had begun with Roentgen's
discovery. Equipment was rapidly manufactured
and installed in major hospitals; surgeons were
especially delighted with its ability to reveal
the body's secrets. Roentgen himself never tried
to patent or benefit financially from his
discovery.
Boston, with its mixture of science and industry
and its many institutions of higher learning,
was the city to lead the way in America. Two of
the earliest American physicists to confirm
Roentgen's work, Professor Amos Dolberg and
Professor John Trowbridge, were both centered in
Boston, as were many other pioneers. At first,
X-rays of patients were performed in the physics
labs of MIT; but when the first year of
Roentgenology had ended, the City of Boston
boasted five X-ray machines being used for
medical purposes.
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The History of Radiology at Boston's Beth Israel
Deaconess Medical Center
by Morris Simon, M.D.
Toward the end of the 19th century, Boston
experienced a large influx of Jewish immigrants
who had fled persecution in eastern Europe. They
spoke little English, had different social,
dietary and religious traditions, and were
distrustful of the medical care available at
existing Boston hospitals. A group of young
Jewish doctors and community leaders met on June
21, 1896 to plan a Jewish hospital for "persons
of any creed or nationality." This began in 1902
as the Mount Sinai Hospital Outpatient
Department, funded by a federation of charitable
organizations. Part-time physicians staffing
twenty medical clinics were immediately
overwhelmed by patients. Dr. Ariel W. George was
appointed the first roentgenologist in 1909.
Patients were transferred to his office and the
X-ray plates were sent back to the hospital.
Pressure for inpatient services was strong but
the dispensary was experiencing severe financial
difficulties. In May 1916 the hospital was
abruptly closed since "the war had made it
impossible to raise funds." But the idea of a
major hospital had taken root. The Beth Israel
Hospital opened its doors within eight months
with the majority of the physicians from the
Mount Sinai Hospital; its objectives and bylaws
virtually identical. One of these physicians was
Dr. Samuel A. Robins, a Tufts graduate who had
switched from obstetrics to roentgenology after
four months of training with Paul F. Butler at
the City Hospital.
Samuel A. Robins, M.D., Chief of Radiology,
1918-1955
Dr. Robins was appointed roentgenologist at Beth
Israel Hospital in 1918. Starting with a
portable machine borrowed from his office, he
soon installed two x-ray machines in a barn
across the road from the hospital. These
machines were operated by the color and sound of
the gas tubes with much guess work. Patients
were brought over on stretchers, bundled up
against the weather. Because of wartime
conditions, the X-ray department (which was on
the ground floor of the nurses' home) did not
open until March 1919. At that time the hospital
had fifty inpatient beds. In 1922 it was decided
that the primary clinical purpose of Beth Israel
should be expanded to "stimulate investigation
and research," as well as teaching and training
of medical students and physicians.
Post-graduate training opportunities for Jewish
doctors were almost nonexistent in Boston. It
was decided to build a new hospital close to the
Harvard Medical School. Funds were raised and
the new site on Brookline Avenue was purchased.
The construction of a series of buildings
started in 1924. The first patients were
admitted in August 1928.
The academic relationship with the medical
school began with the full- time appointment of
Dr. Herman Blumgart in 1928 as chief of a
clinical department of medical research, with
teaching responsibilities for medical students.
The school catalogue for 1928-1929 includes a
description of "an extensive x-ray department"
at Beth Israel Hospital. Dr. Blumgart had
pioneered the use of a radioactive tracer to
study animal and human blood flow, reported in a
series of fifteen scientific papers. He was also
the first to use radioiodine for the treatment
of intractable cardiac disease. He was the first
physician named to the Honor Roll of Nuclear
Pioneers by the Society of Nuclear Medicine in
1969. Dr. Robins conducted a busy private
clinical radiology practice while serving
part-time as Chief of Radiology at BIH. He
became Professor of Radiology and Chairman of
the Radiology course at Tufts Medical School,
his alma mater. He also served as president of
the New England Roentgen Ray Society, the
Greater Boston Medical Society, and the Norfolk
District Medical Society. He published about
thirty-five papers and book chapters dealing
mainly with the genitourinary tract. Dr. Robins
attracted a number of strong associates, notably
Dr. William S. Altman, Dr. Charles Liebman, and
Dr. George White. However his most notable
appointment was undoubtedly that of Dr. Felix
Fleischner, who became the first full-time
radiologist at BIDMC in September 1942.
Felix G. Fleischner, M.D., 1942-1960
Born in Vienna in 1893, Felix Fleischner
graduated from the University of Vienna Medical
School and trained in radiology with a number of
the early pioneers including Haudek, Holzknecht,
and Kienbach. He then became chief of the
roentgen department of the Vienna CS Child's
Hospital for six years with professorial rank.
He was a scholar, publishing eighty-seven papers
in the European radiologic literature before
World War II. He was also a renowned lecturer in
radiology of the post-graduate courses sponsored
by the University of Vienna and the American
Medical Association. In 1930 he became Professor
and head of radiology of the Second Medical
Clinic of the University. As a delegate to the
fifth International Congress of Radiology in
Chicago in 1937, he met a number of leading
American radiologists.
Following the annexation of Austria by Hitler,
Dr. Fleischner fled to Boston with his family in
1938. He spent two years in the radiology
department of the Massachusetts General Hospital
and another two years in private practice in
Greenfield, Massachusetts. He was offered a
position at Beth Israel Hospital in 1942 with
appointments at Harvard and Tufts Medical
Schools. He started the first formal residency
training program in radiology at BIH, and became
Professor of Radiology at Harvard in 1952. The
Fleischner era was characterized by a strong
emphasis on radiologic teaching and research.
During his American career he published an
additional 165 scientific articles (for a total
of 251) and made numerous seminal contributions
to the literature of radiologic imaging. He
received many honors. Two international
symposia, the first on pulmonary embolism and
the second on frontiers of chest radiology, were
dedicated to him. Dr. Fleischner represented the
Harvard Medical School at the 600th anniversary
of the University of Vienna in 1965, an ironic
twist of history.
Dr. Fleischner was an inspirational role model
and mentor to many students, residents and
professional associates. After retirement from
the Beth Israel Hospital in 1960, Dr. Fleischner
continued to teach at the Peter Bent Brigham
Hospital and the Massachusetts General Hospital
until his death in 1969. His finest memorial
tribute was the adoption of his name by the
Fleischner Society, the prestigious
multidisciplinary international society of
leading experts in chest disease.
Search for a Successor, 1960-1963:
Robert Shapiro, M.D. (Director 1962-1963)
While the search for a successor continued, Dr.
Morris Simon, a senior associate of Dr.
Fleischner's, served as Acting Chief. Dr. Robert
Shapiro, Professor of Radiology at Yale and
Director of the St. Raphael's Hospital Radiology
Department was selected as the new Director. He
had authored a classic textbook on myelography.
He accepted the position in 1962 and initiated
negotiations with the medical school and the
other Harvard teaching hospitals in an attempt
to reorganize, consolidate and strengthen the
academic ties between these institutions.
However, the decentralized Harvard pattern was
deeply entrenched and the talks eventually broke
down. As a result, Dr. Shapiro resigned after
one year and returned to New Haven.
Morris Simon, M.D. 1958 - Present (Director
1963-1970)
Dr. Simon graduated from medical school in South
Africa in 1948 and after an internship year and
starting a surgical residency he decided to
become a radiologist. He moved to London in
1950, completed his radiology residency at the
London Hospital and then joined the staff of
Guys Hospital as a radiology registrar. Guys was
the major British referral center for cardiac
cathereterization and cardiac surgery, then in
its infancy. This provided a great opportunity
to correlate the radiologic and hemodynamic
findings in these patients, and this became the
major focus of his research. Meanwhile, across
the Atlantic, Dr. Fleischner had also published
some of the early studies in this new field. It
was thus an easy decision for Dr. Simon to
accept an associate position with the renowned
Dr. Fleischner at Beth Israel Hospital in Boston
in 1958. This led to a close professional as
well as personal relationship between the two
families.
In 1963 Dr. Simon was offered and accepted the
Chief position, at age 37. The challenge was to
maintain and build upon the strong academic and
clinical legacy of Fleischner. Important staff
additions included senior associates Keith
Rabinov, Norman Joffe and Brian Leeming.
Laboratory investigations of the pulmonary
circulation, newer techniques in angiography and
clinical radiology, and early applications of
computer technology to medical-information
processing were the primary interests of the
department. The residency program was enlarged
to twelve. However, after a few stimulating
years, the administrative burdens become
increasingly demanding and frustrating, and Dr.
Simon requested the appointment of a new
Director.
Sven Paulin, M.D., Ph.D. 1970 - Present
(Director 1970-1993)
Dr. Paulin became Chief of Radiology in 1970.
His medical school training, radiologic
residency and first clinical appointments were
all in Sweden. His Ph.D. thesis on coronary
arteriography was recognized as a landmark as
soon as it was published as a monograph. He was
invited to the U.S.A. by Dr. Herbert Abrams and
joined him as a fellow at Stanford. He
subsequently moved to Boston with Dr. Abrams,
who was appointed Chairman at the Peter Bent
Brigham Hospital and Harvard Medical School. Dr.
Paulin's appointment as Chief at the BIDMC was
accompanied by a marked expansion and renovation
of the radiology department and research
facilities including state-of-the-art
angiography equipment and substantial medical
and support staff increases. Dr. Simon and other
senior radiologists remained on the staff and
were joined by Drs. Ferris Hall, Colin McArdle,
Robert Edelman, Eric Fossel, John Kleefield and
others. The stage was set to incorporate the
break-through technologies of the era,
particularly echocardiography, body ultrasound,
computerized tomography, magnetic resonance
imaging, and spectroscopy. Research now focused
on the heart and contrast agents though the
pulmonary circulation and computer projects
continued. Dr. Jean Serur was appointed the
first full time head of radiology research and
was succeeded by Eric Fossel. MR angiography
research was a pioneering effort under Bob
Edelman.
The residency program was increased to sixteen.
The Radiologic Foundation was established. The
first satellite imaging center was opened at
1101 Beacon Street. Full Harvard professorships
are held by Drs. Paulin, Simon, Hall and
Edelman. In 1993 Paulin retired as chairman but
continued to serve as a cardiac radiologist.
Herbert Y. Kressel, M.D. Chairman 1993 - Present
Dr. Kressel assumed the chairmanship of the
department of radiology in 1993. His radiologic
training was at the University of California,
San Francisco. His subsequent national academic
stature and administrative experience were
achieved at the University of Pennsylvania,
where he became the director of the pioneering
magnetic resonance imaging division.
His appointment once again triggered a major new
era of reorganization and expansion of the
radiology department. This reflected the
changing patterns of health care delivery in the
entire country. A new ambulatory center has been
built adjacent to the hospital, virtually
doubling the size of the radiology department.
The new facility opens in January 1996 and will
become the main radiology department. The
original department is being simultaneously
renovated to serve inpatients but will also be
used for major outpatient procedures. New
magnetic resonance facilities for clinical use
and research, and additional spiral CT and
ultrasound equipment are being added. Film
interpretation, teaching and conference spaces
have been expanded. Improved operational
efficiency is being provided by new and expanded
state-of-the-art digital computerization of
patient control and of imaging, as the
department evolves cautiously toward a fully
digitized system. A substantial increase in
support staff as well as medical and nursing
staff has been initiated. Closely linked
satellite facilities have been opened in
Lexington and others are in the planning stage.
The residency program has increased to twenty.
The clerkships for Harvard students have become
extremely popular under the direction of Dr.
Gillian Lieberman. Research activity in MRI and
Spiral CT as well as interventional angiography
and ultrasound have been further invigorated.
The radiology department is once again prepared
to play a leadership role in medical imaging as
we move into the 21st century.
