Reviews and Commentary n HISTORICAL
PERSPECTIVES
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.
Radium Girls1
Richard B. Gunderman, MD, PhD Angela S. Gonda, MD
Published online 10.1148/radiol.14141352 Content codes: Radiology 2015; 274:314–318 1
From the Department of Radiology, Indiana University Medical Center, 702 N Barnhill Dr, Room 1053, Indianapolis, IN 46077. Received July 14, 2014; revision requested July 14; revision received August 1; accepted August 18; final version accepted August 19. Address correspondence to R.B.G. (e-mail: [email protected]). Conflicts of interest are listed at the end of this article. RSNA, 2015
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s the Radiological Society of North America celebrates its 100th birthday, it is appropriate that radiology professionals pause to reexamine one of the most notorious but little-known chapters in the history of American radiology–the radium girls, a group of young women whose occupation as watch dial painters in the early 20th century ultimately brought about their tragic demise (1). Their story is important for many reasons. It captured the popular imagination concerning the dangers of exposure to high levels of ionizing radiation. It also helped to draw public attention to a new point of intersection among science, medicine, industry, and the judicial, legislative, and executive branches of government, spawning new forms of legislation, judicial proceedings, and publicity (1). Equally important, even though the story of the radium girls is also approaching its 100th anniversary, it still bears important lessons for radiology today. The story begins with the discovery of radium by Marie and Pierre Curie in 1898 (2). They purified it from uranium ore, in which it is present in concentrations of a fraction of a gram per ton. All of radium’s isotopes are highly radioactive, and its most stable isotope is radium 226, which has a half-life of approximately 1600 years. It decays into radon gas, which is also radioactive. Radium itself emits a faint blue light, but for radioluminescent paint, which was invented in 1908, zinc sulfide and other compounds are added to increase the degree of luminescence. Most devices that were so painted decades ago, such as watches, clocks, and aircraft instruments, no longer glow in the dark, but this is due not to the decay of radium but to degradation of the phosphor. If a new coat of phosphor is applied, they glow again. Such glow-in-the-dark paints were part of a radium craze that swept the
United States and Europe in the 1910s and 1920s (1). Radium was added to a wide variety of products, including toothpaste, facial creams, and even food items. It was added to drinking water in products such as Radithor and Revigator. Radithor was actually referred to as “liquid sunshine” and touted as “nature’s way to health” (3). A number of quack medical products claimed to contain radium, including patent medicines and suppositories as well as the “Radiendocrinator,” which men could wear like a jockstrap (4). Radium was also used by legitimate medical practitioners, including one of the founders of the Johns Hopkins Hospital, Howard Kelly, to treat malignancies such as cervical and uterine cancer. Dating back to 1915, Kelly had experimented with radium application to the cervix and even implantation of radon seeds into large tumors of patients who had been previously deemed inoperable or “hopeless on admission” (5). One of the most popular forms of radioluminescent paints was Undark (6), and one of the U.S. companies most heavily involved in the production and application of such paints was the United States Radium Corporation, which had a factory in Orange, NJ (Fig 1). The firm was involved in extracting and purifying radium, producing the paint, and applying it to products. Many young women used in the plant painted the dials of watches, which were particularly popular in the military. Of course, there were other such operations around the country, and another notable one was located in Ottawa, Ill. The women who worked in these plants ingested radium because they were instructed by their supervisors to lick the tips of their camel hair brushes to maintain a fine point (8). Women tended to hold such jobs because they involved little brute force and delicate handiwork, and such occupations were regarded as cleaner and safer than other forms of manual labor (9).
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Gunderman and Gonda
Figure 1
Figure 1: Advertisement for Undark from 1921 (7).
At the time, the women had no idea that radium might represent a threat to their health. Accounts in the popular media, including widespread advertising, tended to create the opposite impression: namely, that radium offered numerous health benefits. Some of the women even painted their lips, their
fingernails, and their teeth with it. In one such plant, the workers received several cents for each dial they painted and typically painted 250 dials per day, producing a weekly income of $20–$25 (1). It is estimated that these women would ingest approximately 4000 µg of radium in a matter of 6 months (10). Aside
Radiology: Volume 274: Number 2—February 2015 n radiology.rsna.org
from watches, other products included house numbers, light switches, and dolls’ eyes. It is estimated that over a period of several decades, approximately 4000 women were used around the country as radioluminescent painters (1). One such employee was Grace Fryer, an 18-year-old New Jersey woman who worked at U.S. Radium from 1917 to 1920, when she left to take a better job as a bank teller. Fryer had begun to lose her teeth and develop painful infections in her jaw. When she visited the dentist, radiographs showed that her jaw was decaying, developing a moth-eaten appearance. She visited doctors, but no one could explain the cause of her problems. Soon other young women with similar problems were turning up in doctor’s offices in New Jersey, and before long it became apparent that all had one thing in common: they had been employed by U.S. Radium. In 1925, Fryer began looking for an attorney who would take her case, but it took 2 years before she found a young attorney who would represent her. In the meantime, Fryer was visited by Frederick Flinn, a specialist from Columbia University who conducted an extensive examination of Fryer and her case (11). He informed her that, based on his expert opinion, she was in fact fine. Any problems she might suppose herself to be suffering, he determined, could not be attributed to U.S. Radium. Only later did it emerge that the “specialist” was in fact neither licensed to practice medicine nor even a physician. In fact, he was a toxicologist on contract with U.S. Radium (12). Based in part on her physician’s conclusion that employment at U.S. Radium must be a factor in the rare but similar cases that were cropping up in New Jersey, Fryer was unpersuaded by Flinn’s conclusions and continued to attempt to convince others of the truth of her claims. Earlier in the 1920s, Cecil Drinker, who would later become dean of the Harvard School of Public Health, had been asked by U.S. Radium to investigate the working conditions at the company. Drinker’s report, submitted to the company in 1924, concluded that the workforce was being contaminated by radium, that a number of former 315
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workers had developed blood disorders, and that at least one chemist had developed areas of necrosis on his hands and elsewhere. Here is an excerpt from Drinker’s original report, describing the breadth of the contamination:
Gunderman and Gonda
Figure 2
Dust samples collected in the workroom from various locations and from chairs not used by the workers were all luminous in the dark room. Their hair, faces, hands, arms, necks, the dresses, the under-clothes, even the corsets of the dial painters were luminous. One of the girls showed luminous spots on her legs and thighs. The back of another was luminous almost to the waist (13).
However, when Drinker’s report reached the New Jersey government, it had been altered to state that the company’s employees were in good health. Later, another Harvard professor, Alice Hamilton, learned of the case. She wrote to Drinker’s wife, Katherine Drinker, PhD, to alert the Drinkers to what U.S. Radium and its president, Arthur Roeder, had been up to: Mr. Roeder is not giving you and Dr. Drinker a very square deal. I had heard before that he tells everyone he is absolutely safe because he has a report from you exonerating him from any possible responsibility in the illness of the girls, but now it looks as if he has gone still farther. The New Jersey Department of Labor has a copy of your report and it shows that “every girl is in perfect condition.” Do you suppose Roeder could do such a thing as to issue a forged report in your name? (14).
The Drinkers were outraged, and Cecil Drinker published his original report in a scientific journal, over the objections of U.S. Radium. The company also appears to have participated in a misinformation campaign, attempting to tarnish the reputations of the radium girls by suggesting that their complaints were attributable to syphilis (15). Eventually, after 2 years of trying, in 1927 Grace Fryer found an attorney, Raymond Berry, who would take her case. Four other former employees 316
Figure 2: Photo of Chicago newspaper headline highlighting the plight of the dial painters (16). (Image courtesy of Leonard Grossman.)
joined the case: Edna Hussman, Albina Larice, Quinta McDonald, and Katherine Schaub. Soon popularly dubbed the “radium girls,” they sought compensation in the amount of $250 000 each for their injuries. The first hearing took place in January of 1928. By this time, two of the claimants were bedridden and none were able to
raise their arms to take the oath before giving their testimony (1). As the case moved forward, U.S. Radium requested a delay because several of its employees were vacationing in Europe. The judge agreed, and the radium girls were told that they would have to wait until September before the case would be heard (Fig 2).
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Gunderman and Gonda
Figure 3
Figure 3: Dial painters’ work room at a radium factory (25).
Not knowing if they would survive that long, the girls were heartbroken. But again Alice Hamilton came to their aid. She brought the case to the attention of newspaper columnist Walter Lippmann, who railed against the judge’s decision in the New York press (17). Lippmann wrote: This is a damnable travesty of justice. There is no possible excuse for such a delay. The women are dying. If ever a case called for prompt adjudication, it is the case of five crippled women who are fighting for a few miserable dollars to ease their last days on earth (18).
Much has been written about the details of the women’s grueling and exhausting trial, but after extensive maneuvering among Berry, the media, and the defending counsel, public outcries led the judge to schedule a hearing in June and there was widespread speculation over what the women would do with their awards if they prevailed and won $250 000 each (19). As the hearing
approached, however, U.S. Radium agreed to arbitration to produce an out-of-court settlement. The settlement awarded each of the claimants $10 000, a $600 lifetime annuity, and all medical expenses (1). Although much less than what they sought, it did constitute vindication of their claims. Within a decade, all of the original radium girls were dead, all suffering from radiumrelated sequelae such as anemia, bone fractures, jaw infection, and even sarcomas (20). It would be natural to suppose that this celebrated case brought an end to the use of radium in commercial products such as watches, and business did tail off substantially in the 1930s. But with the outbreak of World War II, demand for products such as luminescent watches and dials again spiked. This time, however, much more elaborate safety measures were in place. But much damage had been done, not only to the radium girls but to the man who invented the radium-based paint. Sabin Arnold von Sochocky, who in 1914 had
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also cofounded the company that became U.S. Radium, died at the age of 45 years in his home in East Orange, NJ. He had lost all his teeth and several of his fingers, and his death in 1928, the year of the radium girls’ settlement, was attributed to radium poisoning. By the mid-1920s, radiologists were quite aware of some sequelae of radiation and had published articles on radiation sickness in patients undergoing cancer treatment (21). Some physicians also recognized the necessity of protecting themselves in the workplace, as demonstrated in a 1924 Radiology article (22): “One of the first maxims learned by the physician is ‘non nocere’ (harm not), and he is seldom faithless to it with regard to his patients. Is his own body less worthy of care?” Yet the girls’ story was first referenced not by the radiology community but by a dentist in 1924 (23) and formally presented at the American Medical Association in 1924, 1925, and later in 1929 (8,15,24). The case of the radium girls led to widespread recognition of occupational 317
HISTORICAL PERSPECTIVES: Radium Girls
hazards throughout the United States, connecting the media, medical community, public, and legislative bodies for the first time. It led to the establishment of the Center for Human Biology at Argonne National Laboratory, which studied the matter until 1993. At that time, nearly 3200 radium painters had been identified and nearly 1600 had been examined. The report confirmed that being a radium painter before 1930 was hazardous. But if the workers did not develop radiation-induced malignancies, the report found no other increased risk of death. Furthermore, there appeared to be a threshold dose for the development of malignancies, about 1000 times natural levels, below which no cases of malignancy had been diagnosed (6). The vast majority of workers in the radium dial factories had suffered no apparent ill effects and reached a ripe old age (Fig 3). In fact, the last of them died in 2014 at the age of 107 years (9). The radium girls have cast a long shadow. Their case helped establish the field of medical physics. Shortly after the girls’ story emerged, radiology began to develop the concept of dose, with the development of film badges and other quantitative measurements of radiation exposure. A year later, the United States Advisory Committee on X-ray and Radium Protection was formed (26). The case led to significant legislation and government regulation aimed at protecting the health and safety of workers. And it established a new legal precedent in the United States—the right of individual workers to sue an employer for the development of occupational diseases. The story has been told in a number of forms, including the 2000 play, Radium Girls (27), by D. W. Gregory, as well as the books Deadly Glow (28), Radium Girls (1), and The Poisoner’s Handbook (29). In 2011, a statue was unveiled in Ottawa, Ill, site of one of the radium watch dial factories, commemorating the radium girls (30). Their story is a forerunner of contemporary discussions of safety and dose reduction in radiologic modalities such as computed tomography and remains one of the most remarkable in the entire history of radiobiology. 318
Gunderman and Gonda
Disclosures of Conflicts of Interest: R.B.G. disclosed no relevant relationships. A.S.G. disclosed no relevant relationships.
14. Alice Hamilton to Cecil Drinker, April 4, 1925. National Consumers’ League Records, Raymond H. Berry files, Manuscript Division, Library of Congress, Washington, D.C.
References
15. Martland HS. Occupational poisoning in manufacture of luminous watch dials: general review of hazard caused by ingestion of luminous paint, with especial reference to the New Jersey cases. J Am Med Assoc 1929; 92(6):466–473.
1. Clark C. Radium girls: women and industrial health reform, 1910–1935. Chapel Hill, NC. University of North Carolina Press, 1997. 2. Curie P, Curie M, Bemont G. Sur une nouvelle substance fortement radio-active, contenue dans la pechblende. C R Acad Sci 1898;127: 1215–1217. 3. Badash L. Radioactivity in America: growth and decay of a science. Baltimore, Md: Johns Hopkins University Press, 1979; 25. 4. Radioactive quack cures: radioendocrinator. Oak Ridge Associated Universities Web site. http://www.orau.org/ptp/collection/quackcures/radend.htm. Updated February 17, 2009. Accessed June 9, 2014. 5. Kelly HA, Burnham CF. Radium in the treatment of carcinomas of the cervix uteri and vagina. J Am Med Assoc 1915;LXV(22):1874– 1878. 6. Rowland RE. Historical background. In: Radium in humans: a review of U.S. studies. Argonne, Ill: Argonne National Laboratory, 1994; 15, 18. 7. Advertisement for Undark from 1921. http://upload.wikimedia.org/wikipedia/ commons/c/c6/Undark_%28Radium_ Girls%29_advertisement%2C_1921%2C_ retouched.png Accessed July 23, 2014. 8. Martland HS, Conlon P, Knef J. Some unrecognized dangers in the use and handling of radioactive substances with especial reference to the storage of insoluble products of radium and mesothorium in the reticulo-endothelial system. J Am Med Assoc 1925;85(23):1769– 1776. 9. Yardley W. Mae Keane, whose job brought radium to her lips, dies at 107. New York Times. http://www.nytimes.com/2014/03/14/ nyregion/mae-keane-who-painted-watch-dials-with-a-radium-mixture-dies-at-107.html?_ r=2. Published March 14, 2014. Accessed June 10, 2014. 10. Evans RD. Radium poisoning: a review of present knowledge. Am J Public Health Nations Health 1933;23(10):1017–1023. 11. Flinn FB. Radioactive material: an industrial hazard? J Am Med Assoc 1926;87(25):2078– 2081. 12. Affidavit of Grace Fryer, Fryer et al. v. U.S. Radium Corp., July 6, 1927; Also, testimony of Grace Fryer, Fryer et al. v. U.S. Radium, January 11, 1928. National Consumers’ League Records, Raymond H. Berry files, Manuscript Division, Library of Congress, Washington, D.C. 13. Castle WB, Drinker KR, Drinker CK. Necrosis of the jaw in radium workers. Journal of Industrial Hygiene 1925;7:371–382.
16. Photo of Chicago newspaper headline highlighting the plight of the dial painters. http:// www.lgrossman.com/pics/radium/slides/ radium%20dial148.html Accessed July 23, 2014. 17. Alice Hamilton to Walter Lippmann, July 12, 1927. Box 12, Folder 496. Lippmann Collection. Located at Yale University Library, New Haven, Conn. 18. Five women doomed to die. New York World. May 10, 1928. 19. Doomed to die, they tell how they’d spend fortune. Newark Sunday Call. May 13, 1928. 20. Stannard JN. Radioactivity and health: a history. Springfield, Va: Office of Scientific and Technical Information, Battelle Memorial Institute. October 1988; 22–29. 21. Schmitz H. The clinical significance and treatment of radiation sickness. Radiology 1924;2(3): 137–142. 22. Carman RD, Miller A. Occupational hazards of the radiologist, with special reference to changes in the blood. Radiology 1924;3(5): 408–419. 23. Blum T. Osteomyelitis of the mandible and maxilla. J Am Dent Assoc 1924;11:802–805. 24. Hoffman FL. Radium (mesothorium) necrosis. J Am Med Assoc 1925;85(13):961–965. 25. Dial painters’ work room at a radium factory. http://en.wikipedia.org/wiki/Radium_Girls# mediaviewer/File:USRadiumGirls-Argonne1, ca1922-23-150dpi.jpg Accessed July 23, 2014. 26. Brodsky A, Kathren RL. Historical development of radiation safety practices in radiology. RadioGraphics 1989;9(6):1267–1275. 27. Gregory DW. Radium girls. Woodstock, Ill: Dramatic Publishing, 2003. 28. Mullner R. Deadly glow: the radium dial worker tragedy. Washington, DC: American Public Health Association, 1999. 29. Blum D. The poisoner’s handbook: murder and the birth of forensic medicine in the Jazz Age. New York, NY: Penguin, 2011. 30. Farabaugh K. “Radium girls” remembered for role in shaping US labor law. Voice of America. http://www.voanews.com/content/radiumgirls-remembered-for-role-in-shaping-uslabor-law-129169888/144746.html. Published September 1, 2011. Accessed June 10, 2014.
radiology.rsna.org n Radiology: Volume 274: Number 2—February 2015
PERSPECTIVES
Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.
Radium Girls1
Richard B. Gunderman, MD, PhD Angela S. Gonda, MD
Published online 10.1148/radiol.14141352 Content codes: Radiology 2015; 274:314–318 1
From the Department of Radiology, Indiana University Medical Center, 702 N Barnhill Dr, Room 1053, Indianapolis, IN 46077. Received July 14, 2014; revision requested July 14; revision received August 1; accepted August 18; final version accepted August 19. Address correspondence to R.B.G. (e-mail: [email protected]). Conflicts of interest are listed at the end of this article. RSNA, 2015
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s the Radiological Society of North America celebrates its 100th birthday, it is appropriate that radiology professionals pause to reexamine one of the most notorious but little-known chapters in the history of American radiology–the radium girls, a group of young women whose occupation as watch dial painters in the early 20th century ultimately brought about their tragic demise (1). Their story is important for many reasons. It captured the popular imagination concerning the dangers of exposure to high levels of ionizing radiation. It also helped to draw public attention to a new point of intersection among science, medicine, industry, and the judicial, legislative, and executive branches of government, spawning new forms of legislation, judicial proceedings, and publicity (1). Equally important, even though the story of the radium girls is also approaching its 100th anniversary, it still bears important lessons for radiology today. The story begins with the discovery of radium by Marie and Pierre Curie in 1898 (2). They purified it from uranium ore, in which it is present in concentrations of a fraction of a gram per ton. All of radium’s isotopes are highly radioactive, and its most stable isotope is radium 226, which has a half-life of approximately 1600 years. It decays into radon gas, which is also radioactive. Radium itself emits a faint blue light, but for radioluminescent paint, which was invented in 1908, zinc sulfide and other compounds are added to increase the degree of luminescence. Most devices that were so painted decades ago, such as watches, clocks, and aircraft instruments, no longer glow in the dark, but this is due not to the decay of radium but to degradation of the phosphor. If a new coat of phosphor is applied, they glow again. Such glow-in-the-dark paints were part of a radium craze that swept the
United States and Europe in the 1910s and 1920s (1). Radium was added to a wide variety of products, including toothpaste, facial creams, and even food items. It was added to drinking water in products such as Radithor and Revigator. Radithor was actually referred to as “liquid sunshine” and touted as “nature’s way to health” (3). A number of quack medical products claimed to contain radium, including patent medicines and suppositories as well as the “Radiendocrinator,” which men could wear like a jockstrap (4). Radium was also used by legitimate medical practitioners, including one of the founders of the Johns Hopkins Hospital, Howard Kelly, to treat malignancies such as cervical and uterine cancer. Dating back to 1915, Kelly had experimented with radium application to the cervix and even implantation of radon seeds into large tumors of patients who had been previously deemed inoperable or “hopeless on admission” (5). One of the most popular forms of radioluminescent paints was Undark (6), and one of the U.S. companies most heavily involved in the production and application of such paints was the United States Radium Corporation, which had a factory in Orange, NJ (Fig 1). The firm was involved in extracting and purifying radium, producing the paint, and applying it to products. Many young women used in the plant painted the dials of watches, which were particularly popular in the military. Of course, there were other such operations around the country, and another notable one was located in Ottawa, Ill. The women who worked in these plants ingested radium because they were instructed by their supervisors to lick the tips of their camel hair brushes to maintain a fine point (8). Women tended to hold such jobs because they involved little brute force and delicate handiwork, and such occupations were regarded as cleaner and safer than other forms of manual labor (9).
radiology.rsna.org n Radiology: Volume 274: Number 2—February 2015
HISTORICAL PERSPECTIVES: Radium Girls
Gunderman and Gonda
Figure 1
Figure 1: Advertisement for Undark from 1921 (7).
At the time, the women had no idea that radium might represent a threat to their health. Accounts in the popular media, including widespread advertising, tended to create the opposite impression: namely, that radium offered numerous health benefits. Some of the women even painted their lips, their
fingernails, and their teeth with it. In one such plant, the workers received several cents for each dial they painted and typically painted 250 dials per day, producing a weekly income of $20–$25 (1). It is estimated that these women would ingest approximately 4000 µg of radium in a matter of 6 months (10). Aside
Radiology: Volume 274: Number 2—February 2015 n radiology.rsna.org
from watches, other products included house numbers, light switches, and dolls’ eyes. It is estimated that over a period of several decades, approximately 4000 women were used around the country as radioluminescent painters (1). One such employee was Grace Fryer, an 18-year-old New Jersey woman who worked at U.S. Radium from 1917 to 1920, when she left to take a better job as a bank teller. Fryer had begun to lose her teeth and develop painful infections in her jaw. When she visited the dentist, radiographs showed that her jaw was decaying, developing a moth-eaten appearance. She visited doctors, but no one could explain the cause of her problems. Soon other young women with similar problems were turning up in doctor’s offices in New Jersey, and before long it became apparent that all had one thing in common: they had been employed by U.S. Radium. In 1925, Fryer began looking for an attorney who would take her case, but it took 2 years before she found a young attorney who would represent her. In the meantime, Fryer was visited by Frederick Flinn, a specialist from Columbia University who conducted an extensive examination of Fryer and her case (11). He informed her that, based on his expert opinion, she was in fact fine. Any problems she might suppose herself to be suffering, he determined, could not be attributed to U.S. Radium. Only later did it emerge that the “specialist” was in fact neither licensed to practice medicine nor even a physician. In fact, he was a toxicologist on contract with U.S. Radium (12). Based in part on her physician’s conclusion that employment at U.S. Radium must be a factor in the rare but similar cases that were cropping up in New Jersey, Fryer was unpersuaded by Flinn’s conclusions and continued to attempt to convince others of the truth of her claims. Earlier in the 1920s, Cecil Drinker, who would later become dean of the Harvard School of Public Health, had been asked by U.S. Radium to investigate the working conditions at the company. Drinker’s report, submitted to the company in 1924, concluded that the workforce was being contaminated by radium, that a number of former 315
HISTORICAL PERSPECTIVES: Radium Girls
workers had developed blood disorders, and that at least one chemist had developed areas of necrosis on his hands and elsewhere. Here is an excerpt from Drinker’s original report, describing the breadth of the contamination:
Gunderman and Gonda
Figure 2
Dust samples collected in the workroom from various locations and from chairs not used by the workers were all luminous in the dark room. Their hair, faces, hands, arms, necks, the dresses, the under-clothes, even the corsets of the dial painters were luminous. One of the girls showed luminous spots on her legs and thighs. The back of another was luminous almost to the waist (13).
However, when Drinker’s report reached the New Jersey government, it had been altered to state that the company’s employees were in good health. Later, another Harvard professor, Alice Hamilton, learned of the case. She wrote to Drinker’s wife, Katherine Drinker, PhD, to alert the Drinkers to what U.S. Radium and its president, Arthur Roeder, had been up to: Mr. Roeder is not giving you and Dr. Drinker a very square deal. I had heard before that he tells everyone he is absolutely safe because he has a report from you exonerating him from any possible responsibility in the illness of the girls, but now it looks as if he has gone still farther. The New Jersey Department of Labor has a copy of your report and it shows that “every girl is in perfect condition.” Do you suppose Roeder could do such a thing as to issue a forged report in your name? (14).
The Drinkers were outraged, and Cecil Drinker published his original report in a scientific journal, over the objections of U.S. Radium. The company also appears to have participated in a misinformation campaign, attempting to tarnish the reputations of the radium girls by suggesting that their complaints were attributable to syphilis (15). Eventually, after 2 years of trying, in 1927 Grace Fryer found an attorney, Raymond Berry, who would take her case. Four other former employees 316
Figure 2: Photo of Chicago newspaper headline highlighting the plight of the dial painters (16). (Image courtesy of Leonard Grossman.)
joined the case: Edna Hussman, Albina Larice, Quinta McDonald, and Katherine Schaub. Soon popularly dubbed the “radium girls,” they sought compensation in the amount of $250 000 each for their injuries. The first hearing took place in January of 1928. By this time, two of the claimants were bedridden and none were able to
raise their arms to take the oath before giving their testimony (1). As the case moved forward, U.S. Radium requested a delay because several of its employees were vacationing in Europe. The judge agreed, and the radium girls were told that they would have to wait until September before the case would be heard (Fig 2).
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HISTORICAL PERSPECTIVES: Radium Girls
Gunderman and Gonda
Figure 3
Figure 3: Dial painters’ work room at a radium factory (25).
Not knowing if they would survive that long, the girls were heartbroken. But again Alice Hamilton came to their aid. She brought the case to the attention of newspaper columnist Walter Lippmann, who railed against the judge’s decision in the New York press (17). Lippmann wrote: This is a damnable travesty of justice. There is no possible excuse for such a delay. The women are dying. If ever a case called for prompt adjudication, it is the case of five crippled women who are fighting for a few miserable dollars to ease their last days on earth (18).
Much has been written about the details of the women’s grueling and exhausting trial, but after extensive maneuvering among Berry, the media, and the defending counsel, public outcries led the judge to schedule a hearing in June and there was widespread speculation over what the women would do with their awards if they prevailed and won $250 000 each (19). As the hearing
approached, however, U.S. Radium agreed to arbitration to produce an out-of-court settlement. The settlement awarded each of the claimants $10 000, a $600 lifetime annuity, and all medical expenses (1). Although much less than what they sought, it did constitute vindication of their claims. Within a decade, all of the original radium girls were dead, all suffering from radiumrelated sequelae such as anemia, bone fractures, jaw infection, and even sarcomas (20). It would be natural to suppose that this celebrated case brought an end to the use of radium in commercial products such as watches, and business did tail off substantially in the 1930s. But with the outbreak of World War II, demand for products such as luminescent watches and dials again spiked. This time, however, much more elaborate safety measures were in place. But much damage had been done, not only to the radium girls but to the man who invented the radium-based paint. Sabin Arnold von Sochocky, who in 1914 had
Radiology: Volume 274: Number 2—February 2015 n radiology.rsna.org
also cofounded the company that became U.S. Radium, died at the age of 45 years in his home in East Orange, NJ. He had lost all his teeth and several of his fingers, and his death in 1928, the year of the radium girls’ settlement, was attributed to radium poisoning. By the mid-1920s, radiologists were quite aware of some sequelae of radiation and had published articles on radiation sickness in patients undergoing cancer treatment (21). Some physicians also recognized the necessity of protecting themselves in the workplace, as demonstrated in a 1924 Radiology article (22): “One of the first maxims learned by the physician is ‘non nocere’ (harm not), and he is seldom faithless to it with regard to his patients. Is his own body less worthy of care?” Yet the girls’ story was first referenced not by the radiology community but by a dentist in 1924 (23) and formally presented at the American Medical Association in 1924, 1925, and later in 1929 (8,15,24). The case of the radium girls led to widespread recognition of occupational 317
HISTORICAL PERSPECTIVES: Radium Girls
hazards throughout the United States, connecting the media, medical community, public, and legislative bodies for the first time. It led to the establishment of the Center for Human Biology at Argonne National Laboratory, which studied the matter until 1993. At that time, nearly 3200 radium painters had been identified and nearly 1600 had been examined. The report confirmed that being a radium painter before 1930 was hazardous. But if the workers did not develop radiation-induced malignancies, the report found no other increased risk of death. Furthermore, there appeared to be a threshold dose for the development of malignancies, about 1000 times natural levels, below which no cases of malignancy had been diagnosed (6). The vast majority of workers in the radium dial factories had suffered no apparent ill effects and reached a ripe old age (Fig 3). In fact, the last of them died in 2014 at the age of 107 years (9). The radium girls have cast a long shadow. Their case helped establish the field of medical physics. Shortly after the girls’ story emerged, radiology began to develop the concept of dose, with the development of film badges and other quantitative measurements of radiation exposure. A year later, the United States Advisory Committee on X-ray and Radium Protection was formed (26). The case led to significant legislation and government regulation aimed at protecting the health and safety of workers. And it established a new legal precedent in the United States—the right of individual workers to sue an employer for the development of occupational diseases. The story has been told in a number of forms, including the 2000 play, Radium Girls (27), by D. W. Gregory, as well as the books Deadly Glow (28), Radium Girls (1), and The Poisoner’s Handbook (29). In 2011, a statue was unveiled in Ottawa, Ill, site of one of the radium watch dial factories, commemorating the radium girls (30). Their story is a forerunner of contemporary discussions of safety and dose reduction in radiologic modalities such as computed tomography and remains one of the most remarkable in the entire history of radiobiology. 318
Gunderman and Gonda
Disclosures of Conflicts of Interest: R.B.G. disclosed no relevant relationships. A.S.G. disclosed no relevant relationships.
14. Alice Hamilton to Cecil Drinker, April 4, 1925. National Consumers’ League Records, Raymond H. Berry files, Manuscript Division, Library of Congress, Washington, D.C.
References
15. Martland HS. Occupational poisoning in manufacture of luminous watch dials: general review of hazard caused by ingestion of luminous paint, with especial reference to the New Jersey cases. J Am Med Assoc 1929; 92(6):466–473.
1. Clark C. Radium girls: women and industrial health reform, 1910–1935. Chapel Hill, NC. University of North Carolina Press, 1997. 2. Curie P, Curie M, Bemont G. Sur une nouvelle substance fortement radio-active, contenue dans la pechblende. C R Acad Sci 1898;127: 1215–1217. 3. Badash L. Radioactivity in America: growth and decay of a science. Baltimore, Md: Johns Hopkins University Press, 1979; 25. 4. Radioactive quack cures: radioendocrinator. Oak Ridge Associated Universities Web site. http://www.orau.org/ptp/collection/quackcures/radend.htm. Updated February 17, 2009. Accessed June 9, 2014. 5. Kelly HA, Burnham CF. Radium in the treatment of carcinomas of the cervix uteri and vagina. J Am Med Assoc 1915;LXV(22):1874– 1878. 6. Rowland RE. Historical background. In: Radium in humans: a review of U.S. studies. Argonne, Ill: Argonne National Laboratory, 1994; 15, 18. 7. Advertisement for Undark from 1921. http://upload.wikimedia.org/wikipedia/ commons/c/c6/Undark_%28Radium_ Girls%29_advertisement%2C_1921%2C_ retouched.png Accessed July 23, 2014. 8. Martland HS, Conlon P, Knef J. Some unrecognized dangers in the use and handling of radioactive substances with especial reference to the storage of insoluble products of radium and mesothorium in the reticulo-endothelial system. J Am Med Assoc 1925;85(23):1769– 1776. 9. Yardley W. Mae Keane, whose job brought radium to her lips, dies at 107. New York Times. http://www.nytimes.com/2014/03/14/ nyregion/mae-keane-who-painted-watch-dials-with-a-radium-mixture-dies-at-107.html?_ r=2. Published March 14, 2014. Accessed June 10, 2014. 10. Evans RD. Radium poisoning: a review of present knowledge. Am J Public Health Nations Health 1933;23(10):1017–1023. 11. Flinn FB. Radioactive material: an industrial hazard? J Am Med Assoc 1926;87(25):2078– 2081. 12. Affidavit of Grace Fryer, Fryer et al. v. U.S. Radium Corp., July 6, 1927; Also, testimony of Grace Fryer, Fryer et al. v. U.S. Radium, January 11, 1928. National Consumers’ League Records, Raymond H. Berry files, Manuscript Division, Library of Congress, Washington, D.C. 13. Castle WB, Drinker KR, Drinker CK. Necrosis of the jaw in radium workers. Journal of Industrial Hygiene 1925;7:371–382.
16. Photo of Chicago newspaper headline highlighting the plight of the dial painters. http:// www.lgrossman.com/pics/radium/slides/ radium%20dial148.html Accessed July 23, 2014. 17. Alice Hamilton to Walter Lippmann, July 12, 1927. Box 12, Folder 496. Lippmann Collection. Located at Yale University Library, New Haven, Conn. 18. Five women doomed to die. New York World. May 10, 1928. 19. Doomed to die, they tell how they’d spend fortune. Newark Sunday Call. May 13, 1928. 20. Stannard JN. Radioactivity and health: a history. Springfield, Va: Office of Scientific and Technical Information, Battelle Memorial Institute. October 1988; 22–29. 21. Schmitz H. The clinical significance and treatment of radiation sickness. Radiology 1924;2(3): 137–142. 22. Carman RD, Miller A. Occupational hazards of the radiologist, with special reference to changes in the blood. Radiology 1924;3(5): 408–419. 23. Blum T. Osteomyelitis of the mandible and maxilla. J Am Dent Assoc 1924;11:802–805. 24. Hoffman FL. Radium (mesothorium) necrosis. J Am Med Assoc 1925;85(13):961–965. 25. Dial painters’ work room at a radium factory. http://en.wikipedia.org/wiki/Radium_Girls# mediaviewer/File:USRadiumGirls-Argonne1, ca1922-23-150dpi.jpg Accessed July 23, 2014. 26. Brodsky A, Kathren RL. Historical development of radiation safety practices in radiology. RadioGraphics 1989;9(6):1267–1275. 27. Gregory DW. Radium girls. Woodstock, Ill: Dramatic Publishing, 2003. 28. Mullner R. Deadly glow: the radium dial worker tragedy. Washington, DC: American Public Health Association, 1999. 29. Blum D. The poisoner’s handbook: murder and the birth of forensic medicine in the Jazz Age. New York, NY: Penguin, 2011. 30. Farabaugh K. “Radium girls” remembered for role in shaping US labor law. Voice of America. http://www.voanews.com/content/radiumgirls-remembered-for-role-in-shaping-uslabor-law-129169888/144746.html. Published September 1, 2011. Accessed June 10, 2014.
radiology.rsna.org n Radiology: Volume 274: Number 2—February 2015
