UNCERTAINTY MEDICINE: THE DEVELOPMENT OF RADIATION THERAPY, 1895-1925 _______________ A Dissertation Presented to The Faculty of the Department of History University of Houston _______________ In Partial Fulfillment Of the Requirements for the Degree of Doctor of Philosophy _______________ By Jeffrey C. Womack December, 2016 UNCERTAINTY MEDICINE: THE DEVELOPMENT OF RADIATION THERAPY, 1895-1925 _________________________ Jeffrey C. Womack APPROVED: _________________________ Martin Melosi, Ph.D. Committee Chair _________________________ James Schafer, Ph.D. _________________________ Ioanna Semendeferi, Ph.D. _________________________ James H. Jones, Ph.D. University of Arkansas _________________________ Steven G. Craig, Ph.D. Interim Dean, College of Liberal Arts and Social Sciences Department of Economics ii AN ABSTRACT OF UNCERTAINTY MEDICINE: THE DEVELOPMENT OF RADIATION THERAPY, 1895-1925 _______________ A Dissertation Presented to The Faculty of the Department of History University of Houston _______________ In Partial Fulfillment Of the Requirements for the Degree of Doctor of Philosophy _______________ By Jeffrey C. Womack December, 2016 ABSTRACT This dissertation offers an overview of the development of x-ray and radium therapy in both the United States and Great Britain in the period from 1896 to 1925. Specific attention is paid to the early work of pioneering radiation therapists, many of whom had not completed a traditional medical education, and to debates within the field over the safety and efficacy of radiation therapy. The project chronicles early experiments with x-ray and radium treatment, and it situates human experimentation within the ethical paradigm of the period—the so-called “Golden Rule”—as well as examining debates amongst radiation therapists over issues of professional identity. X-ray and radium apparatus receive extensive treatment, as does the changing technology of radium production, the market in radon-infused water, and the debate over dosimetry and radiation exposure. Radiation therapy was an interesting example of a new technology that presented both powerful therapeutic potential and significant risks for patients. Unfortunately, early radiation therapists were often guilty of downplaying both the dangers of exposure and the shortcomings of their equipment. That refusal to recognize danger led to tremendous human suffering for both therapists and patients. iv ACKNOWLEDGEMENTS The completion of this project was made possible by the generosity of many people. Most of the research was conducted at the Historical Library of the College of Physicians of Philadelphia, where I benefited enormously from the generous support of the staff and from the financial generosity of the library, which provided me funding as a Wood Institute Research Associate; I offer special thanks to librarians Annie Brogan and Beth Landers, and to Director Robert Hicks. The Philadelphia Area Center for the History of Science provided me with several opportunities to workshop portions of the project, and Babak Ashrafi encouraged me along the way, helping me to find my place in the scholarly community when I moved to Philadelphia. Helpful feedback is invaluable in a project such as this one, and James Schafer unfailingly provided insightful, generous commentary. Time is the other irreplaceable resource, and without the support of my perfect partner, Elizabeth, the project would not have been completed. Early in my graduate career, Joseph A. Pratt and Martin V. Melosi took it upon themselves to mentor me and to fund my work. They stuck with me through a long and sometimes bumpy road, and I worked out what it means to be a historian by watching the two of them. Their generosity is the foundation upon which this project is built. v TABLE OF CONTENTS Abstract ........................................................................................................................................... iv Acknowledgements .......................................................................................................................... v Table of Contents ............................................................................................................................ vi INTRODUCTION – The Problem of Uncertainty ............................................................................... 1 CHAPTER 1 – X-ray Therapy in the Röntgen Rush, 1895-1900 ...................................................... 23 CHAPTER 2 – Therapy of Uncertainty: X-rays from 1900-1914 ..................................................... 92 CHAPTER 3 – Radium Therapy ..................................................................................................... 154 CHAPTER 4 – The Disappearing Roentgenologist ........................................................................ 214 CONCLUSION – Seen but not Felt ................................................................................................ 243 Bibliography ................................................................................................................................. 255 vi Beth & Bede, Joe & Jimmy, and to Marty. Thanks. vii “What a goodly company are these our pioneers, who have sacrificed their lives to the Baal-fires of the Roentgen rays! They have joined the band of the immortals…who have lost their lives for the progress of the race. These are not the martyrs, but the gladiators of science. All honour to them and to their survivors, from whose lips we almost seem to hear the proud salutation, ‘Morituri te salutant.’” -W. Deane Butcher (ed.), Archives of the Roentgen Ray, 1913 viii INTRODUCTION – THE PROBLEM OF UNCERTAINTY The key fact of radiation therapy—the truth overhanging the entire field—was that no one knew how or why it worked. Though sometimes portrayed as merely serendipitous, the discovery of new sources of ionizing radiation in 1895 and 1896 was actually the logical, and probably inevitable, result of ongoing research into cathode rays and other electrical phenomena. This research was made possible by new developments in the technology of vacuum tubes and increasingly powerful electrical equipment. The application of radiation for therapeutic ends also represented a natural progression; individuals working with radiation could not help but notice that it affected their bodies, causing burns and other physiological results. The observation of results, however, did not imply understanding. An active cathode ray tube or a sample of uranium pitchblende would expose a photographic plate. X-ray emitters and radium samples caused skin reactions. To understand why these things happened, however, would require observers to develop new knowledge about the world around them. This study examines the development of radium and x-ray therapy in the thirty-year period following Wilhelm Conrad Röntgen’s discovery of x-rays, in 1895. It argues that the best way to understand the behavior of therapists, the progression of the technology, and the development of radiation therapy as a medical profession is to think about how individuals working with radiation responded to uncertainty: uncertainty about the technology and how it worked, uncertainty about the causes of disease, uncertainty about the professional structure of medicine, uncertainty about the availability of materials, and even the day-to-day uncertainty of running a small business. In some cases, the new treatments developed by early radiation therapists represented a triumph over uncertainty, but the high price of those victories was measured in the lives of both therapists and patients. Moreover, much of that suffering was both predictable and unnecessary. People got hurt because many radiation workers became too comfortable with uncertainty, accepting unnecessary risks and allowing optimism to blind them to the evidence of danger. Historians on X-rays and Radium In the hundred years following the initial discovery of x-rays, historical treatments of x- rays and radium remained somewhat sparse. Both Röntgen and the Curies attracted a few biographical treatments (especially the latter, given Marie Curie’s lasting fame).1 Marie Curie produced the first of these herself, publishing a biography of her late husband in 1923.2 The x- ray and radium discovery narratives became a sort of parable in the history of science, told and retold with an emphasis on serendipity—so fortunate that Röntgen noticed the glowing screen!—or scientific grit—the Curies’ shack had no heat in the winter!—or as a cautionary tale, as with all of the accounts of the “Radium Girls,” whose exposure to radium paint led to gruesome and untimely deaths.3 The subject of radiation in medicine, specifically, attracted an occasional treatment, mostly from people within the field, such as health physicist Richard Mould. Short retrospectives or founder bios occasionally appeared in JAMA, the BMJ, or the various radiology journals.4 1 W. Robert Nitske, The Life of Wilhelm Conrad Röntgen, Discoverer of the X Ray (Tucson: University of Arizona Press, 1971); Denis Brian, The Curies: A Biography of the Most Controversial Family in Science (Hoboken, N.J: J. Wiley, 2005); Barbara Goldsmith, Obsessive Genius: The Inner World of Marie Curie (Great Discoveries) (W. W. Norton & Company, 2011). 2 Marie Curie, Pierre Curie (New York: The Macmillan Co, 1923). 3 See, for example, Alan Ralph Bleich, The Story of X-Rays from Röntgen to Isotopes (New York, NY: Dover Publications, Inc., 1960); Royston M. Roberts and John H. Lienhard, Serendipity: