The Life of Ed C Jerman

The Life of Ed C. Jerman:
A Historical Perspective

As every student of Radiologic Technology learns, x-rays were discovered on November 8, 1895 by Wilhelm Conrad Roentgen, a comparatively obscure professor at the University of Wurzburg in Germany. Unfortunately, far fewer have heard of Eddy Clifford Jerman, Sc.D., even though his career and ultimately his death are inextricably intertwined with the field of radiology. In order to fully understand the significance of Jerman's many achievements and contributions to his profession, it is necessary to understand the scientific environment which existed at the time of Roentgen's discovery, as well as the subsequent rapid growth in all phases of x-ray science.

While Roentgen is credited with the "discovery" of x-rays, he was not the first to produce x-rays in the laboratory. In fact, x-rays may have been produced experimentally by William Morgan as early as 1785. Morgan, a Welsh mathematician, was conducting experiments on electrical discharges in a vacuum when he noticed that "according to the length of time during which the mercury was boiled--the 'electric' light turned violet, then purple, then a beautiful green...and then the light became invisible."(1) By the 1850s, scientists around the world were experimenting with cathode rays, and several had undertaken the study of fluorescence associated with these cathode rays. In 1859, Gassoit demonstrated magnetic deflection of cathode rays in an experiment which, according to Clark, must have produced x-rays.(2) During 1869, Hittorf conducted a series of experiments in which he investigated the nature of cathode rays and almost certainly produced x-rays.

In 1890, two Americans named Goodspeed and Jennings accidentally produced shadow prints of metallic objects on a sealed photographic plate at their laboratory in Philadelphia. Goodspeed and Jennings didnÕt realize the significance of their observation and failed to follow up on it. As a result, they refused any claim to priority over Roentgen.(3) According to Bushong, "Probably no fewer than a dozen contemporaries of Roentgen had observed x-radiation, but none of these other physicists had recognized its significance or investigated it."(4)

Once Roentgen realized that he was observing a previously undiscovered kind of ray, he began a series of experiments designed to determine the physical properties of those rays. Sante reports that, "so painstaking and thorough were [Roentgen's] investigations that nothing of importance was added for many years to the scientific facts which he was able to present concerning the nature of these rays."(5) Up until the release of Roentgen's A New Kind of Ray; Preliminary Communication,(6) many scientists believed that the great truths of the Universe were all known. Science, they believed, had little left to accomplish other than filling in small details in a picture whose broad themes they already understood. Roentgen's communication shattered their complacency, and within a month, x-rays were produced and studied in laboratories around the world.

The potential medical uses of x-rays were recognized from the beginning and experimenters began looking for ways to exploit them almost immediately. In January, 1896, Lindenthal made the first contrast-enhanced radiograph of the veins of the hand using Teichmann's mixture.(7) In March, 1896, Pupin was the first to use the intensifying screen, without which many common radiologic exams would be impossible.(8) By May, 1896, a mere six months after their discovery, x-rays were being used during the Italian-Ethiopian Campaign to locate bullets in wounded soldiers. The search for medical uses for x-rays was not confined to diagnostic radiography. An editorial in the February, 1896 Journal of the American Medical Association(9) speculated that x-rays might have therapeutic uses; however, the following month Battelli published the first article detailing deleterious effects of x-rays.(10)

During the first year after Roentgen's discovery, several books and nearly one thousand scientific papers were published on x-rays. Among those who began a new career in x-rays in the wake of Roentgen's preliminary communication was an American involved in the manufacture of electrotherapeutic devices, Ed C. Jerman.

Eddy Clifford Jerman was born on a farm near Prattsburg in Ripley County, Indiana on November 21, 1865. Jerman's father, Loda W.D. Jerman, was a physician. According to Hoing, Jerman first became curious about electrical phenomena after finding a faradic battery which was operated by a fluid cell and a battery in his fatherÕs office.(11)

Jerman received his elementary and secondary education in the public schools of Ballstown, Indiana where his family had moved in 1870. Jerman then enrolled in the Preparatory Department of Franklin College in Franklin, Indiana in 1882. During the 1883-1884 academic year, Jerman was given the choice of pursuing either Classical Studies or Science. Jerman chose to pursue Classical Studies, a choice which he repeated the following year. Ed Jerman dropped out of Franklin College in 1885 at the end of his sophomore year. While no record of why Jerman left Franklin College exists, Dale Trout, who became associated with Jerman in 1928, reports that Jerman was plagued by ill health while in school and had been advised to spend as much time as possible outdoors.(12)

After leaving Franklin College in 1885, Jerman moved to Texas where he took a job selling books. While this job provided Jerman with plenty of time outdoors, he soon left Texas for financial reasons. Jerman returned to Indiana and accepted a position as the assistant to a telegraphy instructor at an Indianapolis business college. While in this position, Jerman began writing a history of Ripley County, Indiana which was published in 1891.

In 1887, Jerman married Martha Adeline Bloom. Jerman left Indianapolis in 1888 and took a position installing burglar alarms in Franklin and Martinsville, Indiana. From 1889-1891 Jerman was associated with a physicians' supply company in Cincinnati, Ohio. In 1891, he supervised the rewiring of the H.R. Allen Surgical Institute where he was subsequently permitted to set up an electrical shop in the basement of one of the buildings.

Jerman was not entirely content with his career in the commercial end of the electrical field and by 1891 he had begun to concentrate his efforts on devising cautery sets and supervising the manufacture of galvanic and faradic apparatus for use in electrotherapeutics. The best known of Jerman's contributions to the field of electrotherapeutics was the Pattee static machine which he began building for the Electrotherapeutic Manufacturing Company in 1892.

Soon after reading the first reports of Roentgen's discovery, Jerman decided to duplicate Roentgen's experiment. Jerman and three associates began their first attempt on the evening of March 16, 1896. When their initial experiments were concluded at 3:00 AM on March 17, Jerman and his associates had succeeded in producing a radiograph of his hand sufficient to demonstrate the shadows of the bones of his fingers.(13)

Jerman wrote about his earliest efforts in a letter to Glasser dated August 29, 1930. In that letter he said:

During 1893 I began the manufacture of large static machines containing from 16 to 24 glass plates 30 and 33 inches in diameter. When Roentgen's paper was broadcast to the world [during] the latter part of December, 1895, and during January of 1896, first through the lay press and quickly followed by the scientific press, I quickly found that I had all the equipment necessary for producing the x-rays except a Crookes tube. I finally succeeded in getting a Crookes tube, imported through Oelschlaeger of New York. I received this tube in March, 1896, and my first successful exposure was made with a small Pattee two plate static machine....The exposure was of my own left hand, and was of 30 minutes duration, the hand being bound down with electrical tape to prevent movement during the exposure.(14)

In 1897, Jerman organized the Jerman Medical Electric Company to supply x-ray equipment to physicians. It wasn't long before Jerman realized the need for improved x-ray machines capable of operating at higher KVP and handling increased tube currents. In order for Jerman to begin producing this new generation of equipment, it was first necessary for him to instruct skilled mechanics on the nature and mechanisms of these new machines. This proved to be the start of the teaching role which would occupy most of the rest of Jerman's career. As part of each sale that his company made, Jerman provided one week of training to the physician and his staff in technique. Within two years after the discovery of x-rays, Jerman was traveling across the country offering instruction to physicians, physicists, and others in the technical operation of x-ray equipment in their offices for a set daily fee plus expenses.

As the demand for Jerman's instructional services grew, the time which he could devote to sales became increasingly limited. These increased demands on his time caused financial and health problems for him. Jerman was advised by physicians to move to Arizona for his health. He and his family boarded the train to Arizona, but he became very ill during the trip and was taken to a hospital in Topeka, Kansas. Jerman's health improved in the hospital, and it was not long before the hospital staff had him working as a radiography instructor.(12 p. 358) Jerman settled in the Topeka area after his release from the hospital and, in 1909, he became the Kansas representative for the Scheidel Western Company, a leading manufacturer of x-ray equipment.

By 1916, Jerman had been through two business failures which had left him discouraged and "on the verge of entering some new field of activity."(15) In an effort to evaluate his options, he took an extended trip visiting friends in the x-ray field across the country. After prolonged consideration, Jerman determined that the success or failure of any x-ray laboratory depended on three essentialsÑequipment, technique, and interpretation. Jerman felt confident that physicians could accurately interpret radiographs if the anatomy was clearly demonstrated. He also knew that equipment was being improved on an almost daily basis. Nowhere, however, was there any organized instruction available in radiographic technique.(16) Jerman had found his mission in life.

The problems facing Jerman in his efforts to standardize radiographic technique become apparent in looking at his description of the conditions facing the operators of gas tubes and static machines in the early days of Radiology. In "X-ray technic: from the old to the new", which was published in Radiology during 1925, Jerman wrote:

The first four or five years the static machine, with the occasional small induction coil was used to supply the energy to the very inefficient tubes of that period. The static machines were erratic, being exceedingly susceptible to atmospheric conditions, especially humidity. They would work sometimes. It not infrequently required hours of patient endeavor on the part of the operator to coax the machine into action....There were no meters for measuring the variable gap in inches or in K.V.P. The time and distance factors could, of course, be measured and duplicated, but the fraction of a milliampere and the gap that might be put into action were purely speculative. During the first two or three years, one hand of the operator usually functioned as a penetrometer. The penetrating value of the x-ray energy from the tube was determined by looking at the shadow of the bones of the hand and wrist with the ordinary non-protected hand fluoroscope....If the vacuum of the tube did not climb too high or drop too low, if the tube did not puncture, if the patient could be strapped in a stationary position for a long enough time, if the motor man could be kept at his job, and provided extreme care was used in the developing process a fairly decent radiograph of an extremity might be obtained. It is necessary to use the words "might be" because of the fact that there were several unknown factors creeping in here and there which upset all our plans from time to time....During this first stage in the progress in the x-ray art the technician required the maximum of ingenuity, initiative, and patience in order to accomplish anything at all worth while.(17 p.245)

Fortunately, improvements in the design of tubes, x-ray machines, and related equipment continued at a steady pace, with each improvement allowing the operator greater control over technique.

Jerman's ability to impart technical information to physicians and others came to the attention of Charles Samms, president of Victor. At the time, Samms was traveling around the country looking for talent to insure Victor's continued success in the wake of the first major consolidation of x-ray manufacturers which had occurred in 1916. Under the leadership of Samms, and his partner, Julius Wantz, Victor was rapidly assuming a dominant position in the American x-ray market due, in large part, to their practice of aggressively recruiting individuals with proven talent from outside of their organization.

On May 20, 1917, Jerman joined Victor, where he established the first educational department in the x-ray industry to provide fundamental and technical knowledge to users of Victor's equipment and to Victor's sales staff. Jerman was the first to establish an orderly radiographic procedure to replace the hit or miss method common among operators of early x-ray machines, but before that was possible it was necessary to define radiographic qualities and to identify and arrange the factors which contributed to those qualities. The establishment of an orderly radiographic procedure was also dependent on a series of technical advances, particularly the introduction of the Coolidge hot cathode tube in 1913, followed quickly by the development of the autotransformer control. In writing of these advances, Jerman said:

The Coolidge tube made it possible to duplicate more uniformly a given energy gap or voltage and milliamperage; tube troubles largely vanished. The autotransformer gave much finer control of the gap or voltage and helped to steady the milliamperage factor as well....The developments during this stage did more towards simplifying the work of the technician than during all previous stages combined. With the better control of the gap and milliamperage, he could more consistently produce more uniform results.(17 p. 246)

Despite these improvements, it would not be until the development of the stabilizer and the sphere gap that early technicians would gain perfect control of milliamperage and a satisfactory method of measuring the gap or voltage. The stabilizer made it possible to deliver a constant milliamperage over an indefinite period of time, as well as making it possible to duplicate a definite milliamperage from time to time. The stabilizer also made it possible to deliver a known higher milliamperage with a smaller focal spot tube. The sphere gap, meanwhile, provided a reasonably accurate method of measuring the gap or voltage directly in inches or indirectly in K.V.P.

As both the complexity of radiographic equipment and the volume of radiological procedures being performed by radiologists continued to grow, the need for a new class of technical workers who could assist the radiologists and who could perform much of the routine work became apparent. There was no formal training system for technicians in place up to this point in time. Training usually was an apprenticeship of sorts, with the radiologist training some individual, frequently a nurse or other member of his staff, to be his technician. While this method of training technicians may have proved adequate at first, World War I created an unprecedented demand for experienced technicians to staff the military hospitals. The shortage of technicians which ensued, combined with the radiologists not having established any formal standards for the training or qualification of technicians, caused a proliferation of mail order courses and for-profit schools. It also contributed to the growth of the commercial x-ray laboratories. While the mail order courses and for-profit schools were viewed as a minor problem by the radiologists, the commercial x-ray laboratories, which were not associated with qualified radiologists, were seen to be the major problem. In fact, the commercial x-ray laboratories were the root cause of repeated friction between the radiologists and the technicians which continued through at least the end of the 1930s.

Dr. Thomas A. Groover, president of the American Roentgen Ray Society (ARRS) during 1926, laid the blame for the commercial x-ray laboratory squarely at the feet of the physicians, writing:

No thoughtful physician can escape the conclusion that they [the commercial x-ray laboratories] are an evil product of his own profession, but it might be possible, even at this late date, for them to cure it could they be brought to a realization of its serious and inevitable consequences.(18 p. 258)

Groover then went on to give his analysis of the causes of the problems with the technicians:

With respect to the training of technicians, roentgenologists as a rule have been oblivious to their responsibilities and neglectful of their opportunities. In the first place little or no consideration has been given to the selection of material. When they first began to be employed it was not at all uncommon for the office boy, maid, or hospital orderly to be given the assignment. No systematic course of study or training was prescribed. They were taught a few simple routine procedures and left largely to their own devices. No attempt was made to invest their occupation with any degree of dignity, or to inculcate the ideals and ethics of the medical profession. The result has been that today technicians as a class are a heterogeneous admixture without any fixed ideals or sense of allegiance to the physician or duty to the public. With such a background it is but natural that many of them commercialize such knowledge as they may have acquired, especially since they are accorded little encouragement to do so by both the medical and dental professions.(18 p. 259)

During 1920, Jerman, with the cooperation of several radiologists and the support of Victor, began to explore forming a society where the technicians could associate with colleagues to discuss mutual concerns and further their educational opportunities. On October 25-26, 1920, Victor sponsored a meeting at the Morrison Hotel in Chicago. Thirteen technicians from nine states and one Canadian province met with Jerman. With Jerman acting as chairman and Freda Copple acting as secretary, this group proceeded to organize the American Association of Radiological Technicians (AART), forerunner to today's American Society of Radiologic Technologists. Jerman was elected president of the newly formed AART and immediately went to work recruiting more technicians.(19 pp. 622-623)

Around the same time as the technicians were meeting, the Radiological Society of North America (RSNA) appointed a committee made up of three radiologists--E.W. Rowe of Lincoln, Nebraska, Benjamin Orndoff of Chicago, and Byron Darling of New York City--to determine whether there was a need for the radiologists to control the education of x-ray technicians. The RSNA committee ultimately decided to recommend the establishment of a registry to certify x-ray technicians. In 1922, the ARRS accepted an invitation from the RSNA to participate in the establishment of the technicians' registry and on November 18, 1922, they created the American Registry of X-Ray Technicians (ARXT) with Jerman as examiner.(19 p. 623)

The AART held its second meeting in Chicago on June 27, 1931. At that meeting, the fruits of Jerman's missionary efforts among the technicians were apparent as thirty-three new charter members were admitted. This meeting, like the first meeting during the previous autumn, was seen as a Victor/Jerman affair. After this second meeting, the techniciansÕ meetings were suspended for several years for a combination of reasons.

Doreck, in her organizational profile of the ASRT which appeared in the May/June 1976 issue of Applied Radiology, reported that the meetings were suspended as the result of some prominent radiologists' concerns about the motives of the technicians.(20) Although Doreck does not cite any specific concerns that the radiologists had, it seems reasonable to assume that these concerns were closely related to those mentioned by Groover, and, in particular, to the commercial x-ray laboratories and those technicians who commercialized their talents.

Grigg, in his book Trail of the Invisible Light, says that the techniciansÕ meetings were suspended on "various (commercially competitive) grounds."(19 p. 623) These commercially competitive grounds cited by Grigg undoubtedly have their roots in the 1920 purchase of controlling interest in Victor by the General Electric Company (GE). GE's purchase of Victor seems to have caused problems for two reasons.

The first reason was related to specific operating changes at Victor in the wake of the purchase by GE. From its inception, Victor had relied on a network of independent dealers for sales and service. Victor had provided extensive training and support to these independent dealers, as well as cultivating close ties and cooperation among these dealers. GE's first major decision was to change the way Victor did business. They promptly discontinued all dealerships, replacing them with a factory operated sales and field service organization, which undoubtedly caused hard feelings among the former Victor dealers.

The second reason was the dominant market position which Victor was quickly able to gain as the result of the purchase by GE. Through GE's ownership of the patents on Coolidge's hot cathode tube, as well as his methods for making ductile tungsten for the targets, Victor effectively controlled much of the market for x-ray equipment and had a monopoly on the Coolidge tubes.

In 1925 several technicians met with the radiologists on the board of the ARXT in an effort to determine what changes should be made in order to win the support of radiologists for reviving the AART. It was decided that membership in the AART would be limited to registered technicians and the members were notified that they should become registered if they did not wish to be dropped. Because technicians applying for registration were required to sign an agreement "to work at all times under medical supervision, and under no circumstances to give out written or oral diagnoses or work independently, whether in any private office, hospital in institutional laboratory"(21) the radiologistsÕ concerns were allayed and the AART was reestablished at a meeting at the LaSalle Hotel in Chicago during 1926.

Jerman's reputation continued to grow to the point where the editors of Radiology asked him to contribute a series of articles "of especial interest not only to technicians but to roentgenologists who wish to be progressive."(22) The series of articles, which appeared in Radiology between September, 1925 and August, 1926, began with a review of the development of x-ray technique and ended by passing on specific techniques to the readers.

Over the course of his career Jerman had developed an interest in soft tissue radiography in botany and zoology, as well as an interest in paleontology. This led Jerman to donate his talents to the Field Museum of Natural History in 1925 for a research project which involved a radiological comparison of Egyptian and Peruvian mummies by Professor Roy L. Moodie, a leading expert on the study of ancient evidence of disease. Jerman's presentation of the radiographs he had produced for this study received favorable comment at the 1926 meeting of the RSNA in Milwaukee, Wisconsin.(23 p. 156) The radiologists weren't the only ones impressed by Jerman's mummy radiographs. The editor of the Field Museum of Natural History Anthropological Memoirs wrote in the 1931 monograph containing the mummy studies that, "Thirty-two subjects were made by [Jerman] with such gratifying and convincing results that at my suggestion a Division of Roentgenology was established in the Museum in 1926."(24)

Nineteen twenty-eight saw the publication of Jerman's seminal work. Modern X-Ray Technic(25) was the synthesis of everything that Jerman and his staff at Victor had learned during their years in the x-ray field. It was widely used as a textbook, quickly selling out several printings in the international market. The following year, Jerman, then 63 years old, had the honorary degree of Doctor of Science conferred upon him by his alma mater.(26) It was a fitting tribute to a man who, despite not having graduated from college, had risen to the peak of his profession. The technicians chose their seventh annual meeting at the Sherman Hotel in Chicago from April 28-May 1, 1930 to name Jerman President Emeritus of the newly named American Society of Radiographers.

The last few years of Jerman's career were filled with controversy. During the late 1920s, sentiment against GE was once again on the rise and before it was over Jerman would be forced from his position as examiner for the ARXT by rumors involving alleged commercial pressures. Whether this was a new wave of anti-GE sentiment among the radiologists brought on by fresh charges or whether the old animosities had never completely died is not clear. What is clear is that the types of charges being made were similar to those first raised during 1920 and 1921, although they proved more severe.

General Electric had moved quickly on two fronts to protect the dominant market position they had gained with their purchase of Victor. Immediately after they purchased controlling interest in Victor during 1920, GE had it re-incorporated as the Victor X-Ray Company. In 1926, GE purchased all remaining shares of Victor X-Ray stock, turning Victor X-Ray into a wholly owned subsidiary while retaining both the Victor name and the management team led by Samms and Wantz. Finally, in 1930, the Victor name was dropped and General Electric X-Ray Company was born.(19 pp. 100-104)

At the same time, GE aggressively used the courts to protect its patents. As early as 1917, GE published an advertisement in which they assured those who purchase and resell or use Coolidge X-Ray tubes that:

The General Electric Company is prepared to, and will, defend any suit brought against them, in so far as it is based upon such purchase and resale or use, provided that it is promptly notified or any suit or threat of suit involving such tubes or outfits and is given full power to defend the same.(27)

GE had filed suit against Wapler for what they saw as a violation of their Lemp patent on the rotating rectifier, but GE was most aggressive in trying to protect its patent on the Coolidge hot cathode vacuum tube, and it was this effort which probably gave rise to most of the animosity.

The development by Mueller of Hamburg, a subsidiary of Philips, of the Metalix line focus type x-ray tube brought quick action from GE. Radiologists were not happy with the high cost of the Coolidge tubes, so dealers began to import the new inexpensive Metalix tubes. GE responded by seeking injunctions and had the tubes blocked at the ports. The tubes were then smuggled through Canada.(28 p. 158)

Jerman became involved in the Metalix controversy during December, 1928, at the Fourteenth Annual Meeting of the RSNA when Dr. A. Bouwers, a physicist with Philips, read "Self protecting tubes and their influence on the development of x-ray technic,"(29) a paper on Metalix tubes. Bouwers' paper began with an explanation of the physics and design of the tube and then proceeded to go over the advantages he saw point by point. Of greatest interest, according to Bouwers, was the self-protecting property of the tube.(29 p. 194) The Metalix tube was encased in metal which, Bouwers said, provided complete protection to the operator from both the primary and off-focus radiation and eliminated the need for the large leaded glass bowls used with the Coolidge tubes. The elimination of the leaded glass bowl allowed for simplified mounting by means of a clamp. The next advantage mentioned by Bouwers was the focal spot, a line focus, with an effective focal spot size of approximately 1.2mm. The final point raised by Bouwers was the larger output of x-rays obtained for a given energy input when the Metalix was compared to the Coolidge tube.

Jerman began the discussion on Bouwers' paper by saying that since it covered several subjects, and since he had not had the opportunity to study the paper prior to it being read, he would "confine myself to the one part of the subject in which I am, and have been for many years, intensely interested--the matter of protection."(30 p. 202) After saying "Anything which can be done to assist in the protection, especially of those who are constantly employed in the use of x-rays, is certainly of importance," Jerman went on to say that he felt that secondary radiation emanating from below the diaphragm, which is more intense than stray radiation, was a more serious matter. Jerman concluded by saying:

I do not mean to belittle in any way protection above the diaphragm, because it is important, of course, but I believe that if we pay more attention to that radiation after it passes through the diaphragm--the secondary radiation, in other words--we will come pretty near to providing protection from stray radiation above the diaphragm. The matter of protection certainly is worthy of careful consideration, and any type of protection which can be made use of, either above or below, is certainly useful. The only fear I had, or the most important feature which came to my mind, in listening to the paper, was that we should lose sight of the importance or forget the importance of protection from that radiation below the diaphragm.(30 pp. 202-203)

Dr. Hans A. Jarre from Detroit, one of the first in the United States to use the Metalix tube, and who, in his own words, "had the pleasure of a long unofficial connection with C.H.F. Mueller, in Hamburg, where I helped a little with the development of the line focus tube,"(31 p. 203) responded to Jerman's comments by saying:

I regard part of the discussion we have heard to-day [sic] as an attempt at sidetracking the true issue. We wish, rather, to hear about properties and qualities of tubes and foci and not general rules of protection. We know those. We want to hear about self-protecting tubes and improvement of foci.(31 p. 203)

Jarre concluded his remarks with an attack on GE's success in stopping the Metalix tubes at the ports by convincing the government to impose prohibitive tariffs, saying:

I recommend...that the Society, preferably in cooperation with the other societies devoting their efforts to roentgenology, approach the Government with the request that it remove the prohibitive tariff on all European tubes of the hot cathode type, a tariff which prevents us from importing them at an economic price.(31 p. 203)

Dr. I.S. Hirsch of New York, after detailing what he saw to be the advantages of the Metalix tube, echoed Jarre's sentiments, when he said:

It is to be regretted that we, in this country, cannot generally avail ourselves of this very great advance in tube construction. We can get these tubes only by subterfuge and with difficulty. When you consider that we are engaged in a humanitarian work, that we desire these instruments not for any material gain but for the purpose of helping the sick in the simplest, surest, and best way possible, such restrictions as are now imposed for any reason whatsoever on the free importation and use of what the best minds in the world have created to help us in our work, I say, are unjust, iniquitous, and unwarranted. I have the feeling that if an organization such as ours presented this problem in its proper light to the authorities in Washington, all such restrictions would be either eased or removed. Something ought to be done in this matter at once. We have been talking about it long enough.(32 p. 206)

Whether or not Jerman's comments were, as Jarre claimed, an attempt to sidetrack the issue is not completely clear. While it is clear that the true issue for many of the radiologists was the lack of availability of the Metalix tubes, Bouwers had raised the self-protecting property of the tube first and foremost.(29 p. 194) It was to this point that Jerman spoke. In any case, Bouwers, in his closing comments, felt it necessary to respond to Jerman, saying:

I can only emphasize that what [Jerman] said is quite true, that we have to take care of the secondary radiation. But we have tested the intensity of the radiation in a number of x-ray rooms with bad protection boxes and we have also measured the intensity in x-ray rooms with the Metalix tube and found that the radiations in these cases were of entirely different order. I shall try to publish some exact figures in Radiology, but I may say now that in many cases the secondary radiation was of comparatively no importance, as fifty or a hundred times more primary radiation was present on account of insufficient protection. On the other hand, if you know that the only source of radiation in the room is the patient himself, where he is hit by the radiation, one lead screen will do between the patient and yourself to accomplish perfect safety.(30 p. 206)

The exact figures which Bouwers promised apparently never appeared in Radiology, but the overall significance which the leadership of the RSNA assigned to the controversy over the Metalix tube can be inferred from the position which it held in the pages of Radiology. "Self-protecting tubes and their influence on the development of x-ray technic"(29) was the lead article in the September, 1929 issue of Radiology and "Investigation of the characteristics of the Philips type of Mueller Metalix tubes as revealed by the roentgenogram"(33) which was read before the Philadelphia Roentgen Ray Society on March 7, 1929, occupied the same position in the October, 1929 issue of Radiology.

Leo Carl Kotraschek, who had joined the x-ray industry in 1904 and retired as general manager for North American Philips Company in 1957, offered the following perspective on GE's efforts to enforce the Coolidge patent and the RSNA's response:

Members of the RSNA, under the prodding of Eddy Ernst of St. Louis, were up in arms because of GE's action and their high cost of tube replacement. The ultimate result was that a protective corporation was formed and financed [by the RSNA] to fight the GE patent through a lawsuit pending against Lee De Forrest of California on radio tubes.(28 p. 158)

The primary issue in the various legal actions involving the Coolidge patent was the degree of vacuum in the tubes. Zed Atlee, who had been involved in those legal actions while at GE, discussed this issue with Grigg while talking about the development of Westinghouse's right angle, air insulated dental x-ray tube. Atlee told Grigg:

Westinghouse claimed their tube was filled with neon, to get around the Coolidge patent. I was able to prove that the gas was cleaned up during operation so that in effect it was a high vacuum tube. You will recall that the Europeans claimed helium filling avoided this patent (Coolidge's hot cathode tube), which was a farce, too, as we know today that helium goes through glass walls like a sieve.(34 p. 158)

Despite GE having proved that the Metalix and other such tubes were, in fact, high vacuum tubes, the courts ultimately judged the degree of vacuum in a tube to be unpatentable. GE then came out with an elliptical focus tube, claiming that it was superior to the line focus tubes, but in the end they developed a line focus tube of their own.

Jerman remained as examiner for the ARXT through 1931 but was finally forced to sever all connections with the Registry in 1933 due to rumors that he might be using his position as registry examiner to the advantage of GE. The only recorded allegation of improprieties involving the Registry during Jerman's tenure appears in Grigg's excerpts from notes prepared by David Shields, a Cleveland x-ray technician and historian, on March 20, 1963. According to Shields:

Jerman was the examiner for the Technicians' registry through 1931. Whether his commercial connections were or were not detrimental to the Registry and to the Society remains a good question, but I had a personal experience in that respect. I had considered registration as early as 1925, but made no move, especially not after February 22, 1927 when Glenn Files [who worked with Jerman at Victor and GE] told me that if I were to apply, he would blackball my application. This was the outcome of his failure in producing better pediatric films on a temporarily set up Victor-Snook against our old unit. Files declared his films were better, but I did not think so, and was supported by my radiologist, Dr. C.C. McCoy. Thereupon Files lost the sale, and this he never forgave me, especially because I had advocated the competitive equipment test. I joined the registry only in 1939, following the assignment of a Cleveland radiologist, Dr. John D. Osmond, Sr. as a Trustee of the Registry.(35 p. 625)

In the excerpts, Shields does not say whether or not he brought up this incident at the time it occurred. He also offers no explanation as to why he did not register between 1925, when he claims to have first considered registration, and 1927, or of why he did not register until 1939, six years after Jerman was forced to sever all connections with the Registry. In the absence of additional information it is not possible to conclude whether or not Jerman may have abused his position with the Registry.

In 1934, Jerman retired to his home in Winfield, Kansas after a career in x-rays lasting more than thirty-eight years. While at Victor and GE, Jerman had traveled to more than thirty foreign countries and contributed to several journals. He also authored two books and more than one hundred service suggestions.

Jerman was a true pioneer in the use of x-rays. He was one of the first twenty men in North America to produce a radiograph and he personally trained many of his contemporaries as well as those who followed. This will be remembered by many as one of Jerman's great achievements, but undoubtedly, the greatest achievement of his career was his contribution to the development of an orderly radiographic procedure and the standardization of radiographic techniques. More than any other man, Jerman was responsible for organizing the technicians of his day. He co-founded and was President Emeritus of the American Society of X-ray Technicians. He was also an honorary member of the British Society of Radiographers. When the American Registry of X-ray Technicians was organized, it was Jerman who examined the first one thousand applicants. He was a charter member of American Roentgen Ray Society and an associate member of the American Institute of Electrical Engineers.

Like so many of his fellow pioneers, Jerman bore the marks and scars of radiation on his body. In his tribute to Jerman, Thomas W. Lough, R.T. said, "He [Jerman] suffered greatly as the end drew near but was brave and patient through it all."(36) On September 13, 1936, Ed. C. Jerman died at his home in Winfield, Kansas.

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REFERENCES

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34. Atlee Z. Excerpt from Letter to ERN Grigg. In: ERN Grigg. The Trail of Invisible Light. Springfield, IL: Charles C. Thomas; 1965;158.

35. Shields D. Excerpts from Notes Prepared for ERN Grigg Dated March 20, 1963. In: ERN Grigg. The Trail of Invisible Light. Springfield, IL: Charles C. Thomas; 1965.

*Jerman Memorial Lecture