Knowledge of shadows: the introduction of X‐ray images in medicine

Abstract

Ever since the discovery of X-rays in 1895, X-ray imaging has played a large role in the cognitive and practical organization of medicine. This article analyses the way X-ray images were introduced and made sense of in medical thinking and acting around the turn of the century. The implicit assumption in many histories of radiology is that the specific (diagnostic) message of the X-ray images resided inside them from the beginning, and that it is obscured either by technological or epistemological problems. These being solved, it would then be no problem to see directly what information the image contains. In this article this assumption is contested. It is argued that the specific content of the images was shaped by the activities of X-ray workers within the context of medical developments of the time. This shaping, as it is historically reconstructed here, consisted of four methods. X-ray workers (be they physicians, technicians or scientists) experimented with the technology, the images, the photographic materials and the objects that were X-rayed. They used X-ray images of dead bodies to compare them with radiographs of living patients. Radiologists tried to'translate'diagnostic information acquired with other methods into the shadows of the X-ray images. And finally they compared images with images. The process of shaping the content and use of X-ray images, of making them represent reality, took place within specific institutions, and it took a different form in different countries, but also for different parts of the body. Developments of institutionalisation and professionalisation of radiology in England and the Netherlands are presented to provide a small part of the background of this shaping of knowledge of shadows.

Moving beyond local practice: Reconfiguring the adoption of a breast cancer diagnostic technology

“…In the context of technological innovation, practicebased orientations emphasize the inherently situated and/or enacted nature of adoption (i.e. technology is implemented in a specific, local context) (Berg, 1997;Gherardi, 2006;Greenhalgh and Swinglehurst, 2011;Lehoux et al, 1999;Lehoux et al, 2004;Nicolini, 2006;Pasveer 1989). Nicolini (2006Nicolini ( : 2755 suggests, for example, that analyzing technology in practice means "shifting the attention from the supposed effects of technology to the relationships and actions that attach meaning to the new technology and that stabilize its use within the extant work and organizational practices."…”

3. Bodies of knowledge: lay and biomedical understandings of musculoskeletal disorders

“…The very subjectivity of the patient's voice was thought to compromise that objectivity which has become the sine qua non of medical knowledge (Jewson 1976). With the development of new instruments for seeing inside the body, patients' accounts became less necessary to the practice of medicine (Pasveer 1989), and have been increasingly shaped by technological processes since the early twentieth century (Daly 1989). Although it has also been claimed that medicine developed an increasing interest in 'the patient's view' during this period, this interest was not in the patients' views 'in themselves', but only in the window they opened onto pathology (Armstrong 1984).…”

Guidelines, professionals and the production of objectivity: standardisation and the professionalism of insurance medicine

“…Rather, it is a quality of the historically and locally specific network to which this`fact' is attached (Latour 1987, Shapin andSchaffer 1985). X rays, for example, only became objective through the standardisation of X ray equipment and photographic material, through the training of technicians, through the construction of boundaries between normal and pathological, through the stabilisation of links between X ray images and other diagnostic technologies, and so on (Blume 1992, Howell 1995, Pasveer 1989. Objectivity, then, is an effect of a network that can vary across time and space; not a universal characteristic inherent in an entity or process.…”