A Classical Epidemiological Investigation
Around the turn of the 20th century, scientific advancements occurred at a record pace. From Maxwell’s theory of electromagnetic waves to Einstein’s theories of relativity, long-standing mysteries of the universe were revealed. Medical discoveries also progressed feverishly. Countless lives were saved because of the practice of using antiseptics during surgery. The theory of germs gave us a greater understanding into the transmission of disease. Vaccines for cholera, anthrax, rabies, tetanus, diphtheria, typhoid fever, pertussis, tuberculosis, the plague, and many others were developed. In 1901, the ABO system of blood typing was successfully used for safer transfusions. Felix Hoffman developed aspirin from willow tree bark. The discovery of X-rays revolutionized diagnostic medicine, and the theory of radioactivity was proposed by Marie and Pierre Curie. An optimistic future lay ahead, but instead of cautiously navigating through this new field of radioactivity, arrogance and greed blazed the trail. Such is the story of the Radium Girls.
Radium (Ra) has several isotopes, 4 of which exist in nature. Ra-226 is the most common isotope found in nature and it is derived from decaying uranium. It has a half-life of about 1600 years and is mainly an alpha emitter. However, as it decays it also emits gamma radiation. Ra-228 is another common isotope but it emits beta particles and has a half-life of 6.7 years. Alpha particles can’t penetrate the skin whereas beta particles can; however, they can’t pass through one’s body. Gamma particles are the most dangerous because they can pass right through a person, irradiating all the tissue. Both Ra-226 and Ra-228 become extremely toxic once ingested, but since Ra-228 is more energetic, it is 2.5 times more effective in producing bone sarcomas. Another aspect of Ra-228 is that as it degrades inside one’s body, its daughter product, radon 220 (Rn-220), is not as easily expelled as the daughter product of Ra-226 (Rn-222). Radium is also what is called a “bone seeker.” Essentially, once it enters the body, and as it spreads, it gets readily deposited within bones and along their surfaces. As new bone growth occurs, radium gets deposited deep into bone, essentially forever. It is this very aspect that makes radium so dangerous, particularly with prolonged exposure. Once it is in the bone, its ionizing radiation can wreak havoc on surrounding tissue, including other bones.
In 1898, Marie and Pierre Curie discovered radium. In nature, it is a silvery-white element that in sufficient quantities glows blue. It was radium that showed the most promise to Marie Curie, who referred to it as “my beautiful radium.” Unlike polonium, which burnt out quickly, radium’s glow seemed eternal. Shortly after its discovery, the “Radium Craze” began. The medical community was fascinated with radium and its daughter products: radon, polonium, lead, and bismuth. Quickly, internal and external radium therapeutics emerged treating such ailments as arthritis, hypertension, pain, and schizophrenia, and there was even a tonic marketed as a cure for stomach cancer. In the 1920s, the energy drink Radithor was introduced and was guaranteed to make the drinker “sparkle with energy.” Other radium-laced creams, candies, rejuvenating powders, and lotions were readily available over the counter. It was also discovered that many of the “therapeutic” hot springs in Europe emitted radon gas. In an effort to capitalize on that fact, some New York spas put uranium ore into their pools.
Radium was a booming business. One of the earlier attempts to commercialize radium was in the form of radioluminescent paint. William J. Hammer is credited with creating it. By mixing radium with zinc sulfide, he developed a paint that glowed green and applied his glowing paint to watch and clock dials. One big mistake was that Hammer never patented the process. In 1903, George Kunz, a gemologist from Tiffany & Company, patented Hammer’s paint himself. In Switzerland, glow-in-the-dark clocks and watches were in fashion, but in America, the idea didn’t take off until World War I. In 1915, 2 physicians, Sabin A. von Sochocky and George Willis, founded the Radium Luminous Material Corporation in Newark, NJ. Their radioluminescent paint was called Undark. There were other dial-painting companies, but the company that Sochocky and Willis created became the largest and most infamous.
As they created luminescent watch dials, they continued to research other radioluminescent compounds. The war effort helped them expand, and in 1917, they moved to a larger facility in Orange, NJ. In 1919, they increased production and profitability by changing their paint mixture from Ra-226 to mesothorium (Ra-228). Effectively cornering the US mesothorium market, they would receive thorium extracted from monazite sand from either New Jersey or Chicago and refine it at their facility in Orange. After the refining process, their final product contained approximately 50% mesothorium and 50% barium bromide. By 1921, the company was renamed the U.S. Radium Corporation.
Painting the fine numbers on a watch proved to be a tedious and meticulous ordeal that needed to be done by hand. For this task, teenage girls and young women were hired to fill the positions. Dial painters received about a cent and half per watch, and some women could complete up to 300 watches a day. For that time, it was a good salary, and dial painters could earn more than almost any other profession available to young women. During the painting process, brushes would become dull, losing the fine tips needed for such delicate work. To reshape their brushes, dial painters were trained in a process called “tipping” or “lip pointing.” It consisted of using one’s lips to reshape the brush and keep it clean. It was something that had to be done continuously, and as a result, dial painters ingested roughly 76 microcuries of radium annually.
The management at the U.S. Radium Corporation assured the girls that radium was not harmful and the only side effects were rosy cheeks. Under the false belief that the paint was harmless, many of the girls would paint their fingernails and teeth to surprise their boyfriends at night. Another dangerous aspect of handling radium was the fact that as it decayed, radon gas was released. Lacking sufficient safety protocols, these girls would also inhale radon, adding to their total body burden. By today’s standards, it has been estimated that the radium girls ingested was up to 4000% of an annual dose. They also inhaled radon and radium dust, essentially increasing their exposure to approximately 13,000% more than the maximum annual dose. The lowest annual dose linked to increased cancer risks is about 10 rem (roentgen equivalent in man). To put this in perspective, most people are exposed to an annual dose of background radiation in the range of roughly 0.2 to 0.3 rem. Standing next to the Chernobyl meltdown for an hour would have exposed a person to about 30 rem of radiation. Using today’s standards, 200 rem is believed to cause severe radiation sickness and death; anything in the range of 300 to 400 rem is considered lethal. Some of the dial painters may have been exposed to levels that exceeded 200 rem.
In the early 1920s, the U.S. Radium Corporation conducted internal investigations into radiation exposure in humans. In 1924, they hired Dr. Cecil Drinker, a Harvard physiology professor who looked into the working conditions at their plant. After a thorough review, Drinker concluded that there was extensive contamination at the plant in Orange. Nearly every worker had high levels of blood contamination. Every dial painter was covered from head to toe in radioactive dust. In order to improve working conditions, Drinker made some recommendations, one of which was immediately ending tipping or lip pointing. However, the company ignored his suggestions and barred him from publishing. Then they went a step further. When they turned Dr. Drinker’s report over to the New Jersey Department of Labor, it portrayed the plant in a much different light. Every mention of unsafe working conditions was replaced with praise, and now the report stated, “every girl is in perfect condition.” Even more troubling was the fact that the U.S. Radium Corporation’s own scientists knew radium was far more dangerous than uranium and took precautions to protect themselves. Whenever they handled samples, they would use tongs and worked behind leaded shields. Literature about radium hazards existed as far back as 1906. Publications with references titled “Radium Dangers—Injurious Effects” were disseminated to hospitals and doctors alike, and later, some of that literature even came from the U.S. Radium Corporation. Yet year after year, scores of young women were needlessly exposed to extraordinarily high levels of radiation. That was until Grace Fryer, a young bank teller and former dial painter, began losing her teeth.
In 1922, Grace Fryer began having a slew of medical issues. For no apparent reason, her teeth became loose and started falling out. Grace became concerned after her jaw swelled and became inflamed. She went to a doctor who took an image of her mandible using a primitive X-ray camera. The results were astonishing. Her jaw was in a state of serious decay. It resembled a honeycomb with small holes perforating her bone. Other doctors attempted to determine how a previously healthy young woman could rapidly and inexplicably develop such serious health issues. To make matters worse, more young women from Grace’s hometown started appearing with similar medical problems. When dentists attempted removed their teeth, their sockets wouldn’t heal. Infection quickly set in, causing the surrounding tissue to become necrotic. Surgical resection was necessary as their jaws literally rotted away. Other symptoms included severe anemia, arthritis-like pain in their joints, and spontaneous long bone fractures. It baffled doctors. It was truly a medical mystery with no apparent cause. However, around 1925, one dentist theorized what these women had in common. They all worked for the U.S. Radium Corporation at some point.
After learning that her condition may have something to do with her former occupation, Grace began investigating. Then out of the blue, Fredrick Flynn, a specialist from Columbia University, asked to examine her. He claimed he heard of her plight and was referred by friends. After a brief examination, and despite her deteriorating condition, Flynn declared Grace to be in perfect health and his associate promptly agreed. As it turned out, Flynn didn’t have a license to practice medicine, he had no medical training, and his background was in industrial toxicology. He was a plant. He was hired by the U.S. Radium Corporation to maintain an ongoing campaign of misinformation. Between 1922 and 1924, there were 4 radium workers who died under suspicious circumstances. Their deaths were attributed to syphilis, mouth ulcers, and phosphorus poisoning with the characteristic “phossy jaw.”
Phossy jaw was a common symptom of matchstick workers during the turn of the century. Essentially, in the production of yellow/white phosphorus–based matchsticks, workers were exposed to phosphorous vapors that destroyed their jaw bones. However, this condition presented quite differently compared with the tumors and jaw problems from which the dial workers suffered. Basically, in cases of phossy jaw, phosphorus exposure poisons osteoclasts in the jaw, preventing new bone growth. The bone and gums abscess and glow a greenish-white in the dark and virtually fall apart, whereas in cases of radium poisoning, victims had systemic problems and some women presented with tumors the size of grapefruits on their jaws. Phossy jaw was a well-known condition and couldn’t be confused with the tumors in radium poisoning. Again, this was just another part of the misinformation campaign and cover-up perpetrated by the U.S. Radium Corporation.
Phosphorus Posing “Phossy Jaw”
The practices of the U.S. Radium Corporation were eventually exposed by the National Consumers League and a journalist named Walter Lippmann. The National Consumers League contacted Alice Hamilton, who contacted Katherine Drinker, Cecil Drinker’s wife and collaborator on the study for the U.S. Radium Corporation. Ms. Hamilton informed her about the results of their study that was presented to the New Jersey Department of Labor. After which, Dr. Drinker published his original results. What followed was a media and litigation nightmare for the U.S. Radium Corporation. Eventually, they settled out of court and paid each of the 5 women, whom the media dubbed “the living dead,” $10,000 and an additional $600 a year for medical expenses until their deaths. The 5 Radium Girls died over the next few months. Following the civil action and seemingly unaffected by the pain and suffering of these 5 women, Clarence Lee, the president of the U.S. Radium Corporation, wrote, “We unfortunately gave work to a great many people who were physically unfit to procure employment in other lines of industry. Cripples and persons similarly incapacitated were engaged. What was considered an act of kindness on our part has since been turned against us.”
The fallout from the Radium Girls changed labor laws forever as well as the dial painting industry. It also helped science gain a deeper understanding into radiation and its effects on humans. Millions of people were exposed to varying levels of radiation during the Radium Craze, but knowing who and how much was difficult to determine. Scientists were able to follow dial painters throughout their lives, collecting invaluable longitudinal data. Not every woman exposed prematurely died. A couple of interesting conclusions can be made. Once exposed to high levels of radiation, if a person can escape any radium-induced malignancies, his or her life expectancy is normal. In addition, roughly 80% of ingested radium is excreted in feces/urine while the remaining 20% builds up and degrades. However, these aren’t absolute numbers; even with radium that builds up in one’s system, it’s a crap shoot. Radium’s ionizing radiation acts essentially like a shotgun, randomly bombarding surrounding tissue with charged particles with the potential to destroy DNA and cause mutations.
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