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Pre-1945 Medical Use of High-Dosage Radiation

GOURLEY: What about some of the other tracers?
GOFMAN: The iodine or iron?
GOFMAN: Let me say that I've gotten a lot clearer in my mind on this since February of this past year, when this symposium at the AAAS[28] came up. Nobody seemed to know that radiation was the cause of breast cancer. So, I've gone back and looked.

The '40s are not the interesting period with respect to human experimentation. Human experimentation started back in the '10s and the '00s of this century with Roentgen's discovery. Every disease known to man became subject to treatment with x rays or radium.

I can tell you this because I've been in the dungeon [of the UCSF library], where all the pre-1960 volumes are, day after day of this year and went through page by page in the American Journal of Roentgenology.

I wanted to know the flavor of the times. I wanted to know what the radiologists where saying to each other in their meetings. I went through some 40 years of journals page by page. You know I can find things out by getting a bibliography but I wanted to see what they were saying in their actual papers.

You name the disease; name any disease. You want to know whether asthma was treated with radiation? I'll show you the papers of Dr. Eugene Leddy from the Mayo Clinic in the '20s [and '30s]. We've treated 200 people in the Mayo clinic with x rays. And then they decided to modify it. They treated another 250, and then the final study: "We treated 1,000 people with bronchial asthma with x rays." You think every one of those people had a consent form? That was therapy.

X rays were-there was a radiology department in the Mayo Clinic. They did diagnostic and therapeutic work. Now in the very earliest years after Roentgen's discovery of the x ray and Curie's discovery of radium, both got into medicine very quickly. It looked promising; [but it was not] limited [to] the therapy of cancer, with both x rays and radium. That was only part of the story. Every disease you can think of, there is a paper. Let me just go through some of them.
GOURLEY: All right.
GOFMAN: There was a disorder [that] for a couple of hundred of years worried the hell out of people. That disorder [is] what we call today SIDS-Sudden Infant Death Syndrome. Nobody knew what was causing the SIDS. I have over there, on the shelf in the library, a 1914 issue of Gwathmey's Anesthesia. The worry was that there [were] some kids that have an operation, tonsillectomy or something, and they would die when the anesthetic was given; or, everything was going [fine] and they would just suddenly die.

Over a hundred years back [from today], somebody [thought] this must [be] due to something with [the] thymus gland. It was a mysterious gland that no one knew what it did. We don't know too much today, but more [than we knew then]. There was this idea that the large thymus might be the basis of a [disease] called status thymicolymphaticus. What status thymicolymphaticus did was, first of all, some of these children [had] trouble [because] of obstructed breathing. They were said to have a crowlike respiration and they died. Gwathmey's book indicated that they were complaining [about] anesthesia.[29]

It was a very scary thing if you were a mother and had a baby that was having some respiratory difficulties and you heard about this thymus [problem]. You'd worry about it.

In 1911, a man by the name of Sidney Lange, a physician, a radiologist, in Cincinnati gave [a] paper, saying [he] had a lady bring in a child. She'd had two children before die of this Sudden Infant Death Syndrome. This child was getting blue and having trouble breathing, and he said, "I irradiated the thymus gland." The child did fine, and so I did a second, and a third, and a fourth.

[The Lange work] didn't cause too much change in the first few years. But then it got picked up. The answer to Sudden Infant Death Syndrome was to check the thymus with x rays to see if it is enlarged. You can see the shadow: it's right underneath the breast bone. If there was any indication it's enlarged, [the] treatment was x rays.

Now how much x ray did you think they gave? You talk about tracers, you know tracer experiments, you give somebody a fraction of [a] rad; they gave these kids 200 to 400 rads.

It didn't start with the bomb; it started in 1911 when Sidney Lange gave that paper. And it became the rage. You, as a surgeon who had operated on a child without first checking whether he had [an] enlarged thymus, can face a malpractice suit. So, there were just thousands of children tested.

Some people said, "Hey, look, why do we wait until these kids' tonsils [are] taken out? Why don't we do something better?" Here's what they did.

A man by the name of Sam Donaldson at Ann Arbor, [Michigan], a professor of Radiology, took consecutively 2,000 babies born in the nursery, [and] studied them when they were less than a week old to see if their thymus was enlarged. If their thymus was enlarged, they said, "Why wait until they come in with troubled breathing? Give them the x ray right now." They did.

Two thousand [infants] were studied and 5 percent of them, who they said had enlarged thymus, [were] treated [with x ray]. They weren't to be outdone, because Conti and Paten, at the University of Pittsburgh, constructed a series of 7,400 consecutive children with the exact same thing being done.

So, you're talking about a few human radiation experiments done in the 1940s, when experiments [that] would make you hair stand on end were already completed in the '20s! Not on a few people, not on 18 people with plutonium, but 2,000 children who were not even out of the nursery! The only thing you had to do to get treated with radiation was to be born alive. They didn't treat you if you were born dead. If you were born alive, you got treated.

Mosher at the Massachusetts General [Hospital]-that's like the mecca in medicine-I've already talked to you about Leddy at the Mayo Clinic, which is pretty hot stuff, and Massachusetts General is the mecca of medicine. In 1925, Mosher talked about the kids that had to have tonsillectomy and adenoidectomy. Every one of those kids [who] came to the Massachusetts General or the Massachusetts Eye and Ear Infirmary, for possible surgery of their tonsils, had their thymus studied. No operations were done if their thymus was enlarged. They then had to get 200 to 400 rads to their thymus. He reported on 5,000 children, proudly announcing they hadn't had any of them die under anesthesia.

So this became the rage in medicine for something like 45 to 50 years. The atomic era was near the end of that; they were pretty much over by 1960. In fact, in 1948, just after I'd been at USC[30] Med Center-the Pathology professor, one of them, Jim Reinhardt and Jesse Carr-Jesse Carr, the coroner of San Francisco and professor of Pathology-wrote an indignant paper in Archives of Pediatrics in 1948, scathingly criticizing the people who said that this thymus enlargement was a myth. "I know, I see these autopsies, I am [a] coroner," [he wrote]. He used to lecture in Pathology.

Here was this thing that went on for 50 years. This business of human experimentation in the '40s and '50s, forget it. The big period of human experimentation was the '10s, '20s, and '30s. [The human experimentation after 1940 couldn't compare.]

Now why did I get interested in that, in particular? [Because] in fact, in irradiating these thymuses, they couldn't keep from irradiating breasts, and these kids are developing breast cancer now.

Breast cancer, if you want to know the real story, it's not a disorder [in which] you should look for what happened to you two years ago. If you want to know about breast cancer, look back 10, 20, 30, 40, and possibly 50 years ago [or more]. Because it's proved beyond [a] doubt, that those people who got irradiated then, 10, 20, 30, 40, 50 years later show up with clinical breast cancer. The most sensitive infants are irradiated in utero.[31]

Now I don't know, but I'll bet you between the Mayo Clinic, New York University, [and] the dermatologists throughout this country, [they] were the biggest users of x rays and radium. Now let me put it in the vernacular: There [is not any] disease that they didn't treat-none: eczema, psoriasis, lichen planus, warts, boils, carbuncles.

Interestingly enough, they really thought they were getting good results. On this thymus thing, I can show you paper after paper: "I've treated 5,000 of these children with 90 percent success." I can show you famous people saying, "If you don't get a result from treating thymus, you've got the wrong diagnosis because all of the cases I treat respond." Yes, all this appeared later.

So, the dermatologists all were going crazy. George MacKee, a professor of Dermatology in 1921, said, that the most valuable agent in dermatology for treatment is radium and x ray: "We are successfully treating 82 separate diseases with x rays and radium."

How many of those people do you think [gave] him formal consent? You got 82 different diseases, you'd think they didn't know about these. As manna from heaven, they had to experiment on people. They write up on papers on thousands of patients, 82 different diseases treated by dermatologist[s].

My brother-in-law, Jim McGinley, was the head of dermatology at Kaiser, San Francisco; he just retired. You'll see his name on some of the publications that we did on heart disease work. He got some of the special people with lesions, like heart lesions, but the lesions are out on their skin, called xanthomatosis.[32] He said the last people at Kaiser, about 1960, put away their x-ray machines; but [un]til 1960, they were treating people with x rays regularly.

There isn't a disease they didn't try. Can you imagine asthma? A thousand patients at the Mayo Clinic treated for asthma! [At] Mass. General, 5,000 treated checked for [enlarged] thymus. That's where it all started.

And what happened in the human experimentation period, these people who treated all these patients made a cardinal mistake in radiology. What was their cardinal mistake? I don't look at them and fault them individually for anything they did. I don't fault Eugene Leddy for treating a thousand patients with radiation. I might, in Leddy's shoes at that time, have done exactly the same thing. But a cardinal mistake, and it's being made today, by the way, but for a much more "malignant" reason today[, was made].

People thought if there was harm to be seen from a new agent, you surely ought to see it in 30 or 60 or 90 days; a year was like an eternity. The entire radiation community's thinking was, "massive doses." Radiologists were losing fingers, radiologists were developing cancer of the skin and dying of it. They refer to them in the journals as the pioneers who gave their life for their technology. Big dose-nobody argued about it. But 200 to 400 rads, which today we think of [as] mountainous, big doses that they didn't think were harmful, for a crazy reason.

They didn't have very good ways of measuring radiation at that time. So they used [what] was called the erythema skin test. If you take an area of the skin and irradiate with x rays, keep increasing the milliamps at a time [with] the x-ray beams on. Finally, you'll get to a situation where a week after the radiation you get a reddening of the skin, called erythema. That's the medical term for reddening. They said, "Look, below that dose, there's certainly not much to worry about." That's 300 roentgens. [That] is what's required to give you an erythema.

So it got into the mindset of the whole group of people worldwide, that doses like 100 rads, 200 rads, they're not going to do anything. And besides, if you haven't seen something [with]in a year, what are you worried about? I could show you in paper after paper from the finest institutions in this country or abroad, stating, "If it doesn't really work in every patient, we can [at least] say there will be no harm." Two hundred to 400 [rads]! And so the idea that the harm would come 10, 20, 30, 40, 50 years later, simply was never thought of.

This is an illustration of what we've called disaster creep. Scientists and physicians never in the early part of this century, never thought of the possibility that what they had to look out for was something 40 years down the line. Properly, people get pretty damn excited if the most sensitive [to radiation] are kiddies that are less than a year old. At 40 years old, they don't regard themselves as proper candidates to die. A 40-year-later cancer is a serious matter.

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