Serendipity and the Open Mind—Part 1

There’s no discussion about serendipity without mentioning the namesake of our society, Wilhelm Conrad Roentgen. I’m sure we all also recognize the world’s first radiograph on the right, taken on November 8, 1895. It’s an image of his wife Anna Bertha’s hand only a couple of weeks after Roentgen discovered what he termed “x-rays”—x for something unknown. Roentgen was studying cathode rays in his lab in a dark room, and he noted a glow several feet away from where he was standing. Although he was not the first to note that cathode rays could permeate thin metal sheets or light up a fluorescent screen near them, he was the first to put those pieces together. And for that, he won the first Nobel Prize in physics in 1901.

I love this quotation attributed to Albert Szent-Györgyi, a Hungarian biochemist, who, among other things, aptly won a Nobel Prize in 1937 for the isolation of vitamin C: “Discovery consists of seeing what everyone else has seen and thinking what no one else has thought.” Many have called the discovery of x-rays serendipity—defined by the Oxford Dictionary as the occurrence in development of events by chance, in a happy or beneficial way, and by Merriam-Webster as a faculty or phenomenon of finding valuable or agreeable things not sought for. The term was first used in 1754 by Horace Walpole, the fourth Earl of Orford, who is remembered for a silly fairytale about three princes from the country of Serendip. Due to a series of accidents and keen mental judgment, these princes were able to discern the nature of a lost camel, of all things. But there’s another factor that lets serendipity thrive: keeping an open mind. There are many other points in the history of science and radiology where serendipity and open-mindedness played a role, and we’ll look at a few of those stories here in InPractice.

This is Dr. John McIntyre of Glasgow, Scotland. Although not a radiologist, he was actually the first person to in the world to set up an x-ray department in March of 1896, after lecturing on “The New Light: X-rays” a mere month after their discovery. The serendipity in his story is the chance intersection of electricity and medicine. An apprentice electrician before studying medicine, Dr. McIntyre was fascinated by the potential uses of electricity in medicine. He was named consulting medical electrician at the Glasgow Royal Infirmary in 1895, and although mainly interested in diseases of the ears, nose, and throat, Dr. McIntyre was the first to image a renal stone in vivo in April of 1896. He was also the first to show movement of a frog’s leg using cineradiography, later a beating heart, and then a bismuth meal in the stomach.

But even before the word serendipity made it into the English vernacular, the notion of serendipity existed. “The greatest part of the invention being, but a luckey bitt of chance [sic]” is attributed to English polymath Robert Hook in 1679. A man of many talents, he is credited for being the first to describe cells under a microscope. In fact, Hook designed his own compound microscope and coined the term cell. He also described the force applied to a spring and its deformation, what’s known as Hook’s law of elasticity.

Our next story nicely illustrates Robert Hook’s thoughts about invention and chance. This is Dr. Earl Osborne, who was a dermatology resident at the Mayo Clinic. Dr. Osborne, along with physician and pharmacologist Leonard Rowntree, is credited with discovering that intravenous administration of sodium iodine salts for treating syphilis faintly opacified the urinary tract. Dr. Osborne is said to have serendipitously noted the opacification of the bladder in one of his patients who had an abdominal roentgenogram during treatment. When asked about this discovery, he stated, “it occurred to one of us that if in roentgenology of the urinary tract advantage could be taken of the fact that sodium iodine, after its introduction into the body is normally excreted in the urine, roentgenograms of the kidneys, ureters, and bladder might be secured without the need for catheterization.” Anybody recognize the term KUB in this statement?

Initial investigations of sodium iodide also included a radiologist named Charles Sutherland and a urologist named Albert Scholl and were published in JAMA in February of 1923. The image on the left is from that paper, taken two hours after the administration of 200 cc of a 20% solution of sodium iodine showing opacification of the bladder. The roentgenogram on the right was taken about an hour after the administration of 100 cc of a 10% solution. You can see that the bladder is opacified, and there’s faint opacification of the kidneys, spleen, and liver. Ironically, neither Dr. Osborne nor Dr. Rowntree pursued this any further, but Dr. Osborne did go on to help found the American Board of Dermatology.

Dr. Donald Cameron, a young Minnesota surgeon, is seemingly forgotten in all of the fuss about Drs. Rowntree and Osborne. He published a preliminary report about the oral and intravenous administration of sodium iodine as an opaque medium in roentgenology in JAMA in 1918, five years before Sutherland’s paper came out. Cameron published this preliminary report in case he didn’t return from World War I. He published one more article a few months later, but then never pursued this line of research any further. But he did return from WWI and established a hospital in the Midwest now called the Cameron Memorial Community Hospital that still exists today.

Like the discovery that sodium iodine opacifies the urinary tract, the origins of oral cholecystography are serendipitous, too. As the story goes, Dr. Warren Cole was working in a lab experimenting with compounds that were known to be excreted by the liver into bile. Four and a half months went by before he even ever saw a gallbladder image, until one day this image was obtained in one of the lab dogs.

Now, where is the serendipity in this particular story? The dog’s caretaker forgot to feed that particular dog that morning. (But don’t worry, he got his evening meal!) It was only a few months later that the experiment was successfully duplicated in human subjects. These are images after an administration of the compound showing progressive opacification of the gallbladder by 24 hours, then washout at 32 hours.

I look forward to continuing our exploration of serendipity and the open mind in the Fall issue of ARRS InPractice magazine.