“Patience and tenacity of purpose are worth more than
twice their weight of cleverness.”
– Thomas Henry Huxley –
There is little to say about investigations – the only important point is to think of them in a logical manner. Examples of useful subheadings you might employ in your card system include biochemistry, haematology, microbiology, and imaging.
Remember that at best, investigations are a good aid to clinical decision making – especially if you understand the principles of evidence based medicine. At worst, they can mislead and confuse, distracting from a well made clinical diagnosis.
The best laboratory in the world is found between the ears of a thinking clinician.
The First X-ray
Wilhelm Roentgen was born in Germany in 1845. He did not show any great ability at school, but seemed to have a natural talent for tinkering with mechanical objects. He entered a technical school in Utrecht in 1862, but was expelled for producing an insulting caricature of a teacher. Actually this was unfair, as someone else had produced it. However, this was a fortuitous twist of fate, as he instead went to university and came under the influence of some excellent teachers who encouraged him to complete a degree in mechanical engineering and later a PhD. Roentgen made his great discovery on November 8, 1895, when working in his dark-room with cathode ray tubes. With great ingenuity and technical skill, he found he could manipulate the cathode ray tube to produce a new sort of ray, which he exposed to a photographic plate to study further. Interestingly objects showed a variable transparency when interposed between the ray and the plate. He called his wife, and had her hold her hand between the rays and the plate. Her bones and a ring on her hand showed as dense shadows, surrounded by a penumbra of flesh, which was more permeable to the rays and thus threw a fainter shadow. With this famous image, the first roentgenogram was produced. Because he didn’t know what the rays were, he labelled them ‘X-rays’. Other researchers later showed that they were electromagnetic rays like light, only with a higher frequency, but the name ‘X-rays’ had stuck, and lives on today.
Roentgen was awarded the Nobel Prize for physics, and the medical community enthusiastically embraced Roentgen’s X-ray device, not only to see through flesh, but to cure disease. Therapeutic claims for the ‘miracle-rays’ rapidly appeared far and wide, and even when it was found the rays could burn or cause more serious sequelae enthusiasm was not dampened. Today X-rays remain fundamental in investigating and treating disease, however, with a more rational approach.