N.T M. 12 (2004) 233-248 0036-697S/04/040233-16 DO1 10. 1007Js00048-004-0201-3 9 2004 Birkh/iuser Verlag, Basel The Women Radium Dial Painters as Experimental Subjects (1920-1990) Or What Counts as Human Experimentation Maria Rentetzi ~Ilaecase of women radium dial painters - women who tipped their brushes while painting the dials of watches and instruments with radioactive paint - has been extensively discussed in the medical and historical literature. Their painful and abhorrent deaths have occupied the interest of physicians, lawyers, politicians, military agencies, and the public, ttardly any discussion has concerned, however, the use of those women as experimental subjects in a number of epidemiological studies that took place from 1920 to 1990.This article addresses the neglected issue of human experimentation in relation to the radium dial painters. Although women's medical examinations have been classified as simple, routine measurements of radiation burden on the body and presented as a great offer to humanity, for more than fifty years those women had been repeatedly used as experimental subjects without proper consent. I argue that through this case it becomes obvious that the issue of defining what counts as human experimentation shifts from an epistemotogical to a serious ethical and political question, concerning the making of scientific knowledge while issues of gender related to this process are also discussed. O n e of the most researched and cited cases in the history of medical physics is that of w o m e n dial painters. In the late 1910s y o u n g w o m e n were hired to apply r a d i u m paint to the figures of clock dials and to the tiny n u m b e r s on the watches.The waterbased luminous paint contained radium-226 and m e s o t h o r i u m , a r a d i u m isotope. B e c a u s e o f the water in the paint the hairs of the brushes separated and w o m e n f o u n d it convenient to point their paintbrushes b e t w e e n their lips (called lip-pointing). It was n o t only convenient but also profitable since they were paid by piece. Lip-pointing increased their productivity.Within a short time the c o m p a n y m a n a g e r s a d o p t e d the w o m e n ' s habit, incorporating it into their training. W o m e n e n d e d up swallowing a m i n i m u m of 125mg of the radioactive fluid a day. ~ The stories of their abhorrent and painful deaths started as early as 1922. The s y m p t o m s and the progress of the disease in all cases were similar: dental problems, necrosis o f the jaw, ulcer of the g u m and aplastic anemia. Physicians w h o treated the w o m e n were pu721ed with the severity of the cases. O n l y in 1925 were they able to associate it with the lip-pointing technique and the swallowing of radium. The case was partially settled in 1933 w h e n the Public H e a l t h Service of the US suggested safe practice guidelines for painting luminous watch dials. 2 Until that time a considerable n u m b e r of w o m e n dial painters suffered not only f r o m r a d i u m poisoning but also went t h r o u g h a series of endless litigations and medical tests. 3 NI'~I N.So 12 (2004) ~3a DISKUSSION - DISCUSSION Maria Rentetzi In the standard medical literature the above case is described as an occupational hazard, often as an accident 4 and to the account of a journalist the "most valuable accident" [Lang, 1959, p. 49] since it contributed to the establishment of safety radiation standards. Since 1933, radium dial painters had been extensively used in a series of epidemiologicai studies without ever classifying any of these as experiments using human subjects. The case is even excluded from the fist of human radiation experiments compiled by the Presidential Advisory Committee on Human Radiation Experiments (ACHRE).The committee was established by President William Clinton in 1994 in an effort to inform the public about the role of the Department Of Defense in radiation experiments with humans since 1944.5 Four of the five criteria used to determine the types of procedures that do not fall under the category of experiment referred indirectly but clearly enough to the radium case described here. From the category of human radiation experiments were excluded procedures in which: - - - - Workers occupationally exposed to radiation were measured for potential internal or external radiation exposure by routine dosimetry, bioassay, or whole-body counting methods; Workers were assayed after accidental internal or external radiation exposures; Patients were measured for internal radioactivity as part of a legitimate medical, diagnostic or therapeutic process; Preexisting internal deposition of radionuclides were assessed, measured, or studied in body fluids, excreta, blood, cells, or tissue samples [DOE Roadmap, 1995]. Taking for granted that the case of radium dial painters was an accident, their further use in dose determined studies was considered by researchers and government administrators as "an unintentional experiment that had taken on an incalculable value." 6Thus I want to argue that the case of the women dial painters poses an interesting question with epistemotogical, and ethical dimensions: what actually counts as human experimentation? Is a data-gathering effort, as the radium case has been presented, an experiment? To define what an experiment is and classify a study as such opens up a space for discussing the appropriateness of the endeavor considering the potential harms and profits to the subjects involved. Questions about the ways the subjects are selected and their consent is obtained, or the purposes of the research and its ethical aptness become legitimate and unavoidable.7 On the contrary by passing in silence the fact that a study is an experimental procedure involving human subjects, researchers find the perfect excuse for not posing any ethical issues and not questioning the means and procedures in use. Surprisingly, in the case of the radium painters the language used to describe this tragedy includes and emphasizes words such as "observation, measurement, test" but never"experiment".The question of how human experimentation is defined has important implications both for the historical actors, and on the conceptual level of historiography. Once a set of activities is categorized as "experimentation", a completely different set of ethical issues are considered relevant and questions of consent and liability have to be taken into account. Complementarily,if the label"experimentation" is avoided, the associated ethical and related legal issues are avoided as well. 234 The Women Radium Dial Painters,., DISKUSSION - DISCUSSION Fig. 1 Women radium dial painters at the US Radium Corporation, circa 1924. Courtesy: Argonne National Laboratory. I do not profess to know the complicated reasons for the fact that although women dial painters extensively used in experiments were not acknowledged as experimental subjects.Their study as a group had a high epidemiological value given that the ingestion of radium was not only internal but also chronic, taken into the body a little at a time and usually for long periods in stable everyday doses. This study was classified as a simple, routine measurement of radiation burden on the body and presented as a great offer to humanity and the common good when for more than 50 years women dial painters had been repeatedly used as experimental subjects without proper consent. In the first part of the 20th century and when experimental knowledge was still produced in small-scale laboratories, trust in medical scientific authorities was bestowed on familiar individuals: the county physician, the dentist, the reliable nurse. With the establishment of the big facilities for medical experimental procedures, trust was accorded to institutions and a distant medical faculty. In both cases women dial painters trusted the scientific authorities and went through painful physical tests and indiscreet medical interviews several times. Were these experimental procedures or m'M N.S. ~2(2004) 235 D1SKUSSION - DISCUSSION Maria Rentetzi not? What I argue is that physicians and politicians did not actually treat those women as experimental subjects.Worse they turned them into experimental objects by suppressing the fact that they were performing experiments on them, and by never raising the issue of their consent. Several other factors facilitated the conceptual and ontological shift from a subject to an object. The radium craze of the 1920s as well as gender discrimination set the ground for treating women as objects first of investment during their employment at the Luminous Company, and next of experimentation. The issue of defining what constitutes a human experiment shifts then from an epistemological to a serious ethical and political question concerning the making of scientific knowledge.8 In what follows I identify and present four stages in the case of the radium dial painters, three of which are periods of experimental trials. The establishment of the industrial application of radium to watch dials in 1913 created the conditions for treating women as objects. After the first deaths in 1922 and till 1933 women faced the brutality of industrialists, the ignorance of medical doctors and the sluggishness of the judicial system. The history of the early years of the case sets the scene for the discussion of the three periods of human experimentation. The first period begins with the establishment of the Radioactivity Center at the Massachusetts Institute of Technology. (MIT) for the study of the long-effects of internal deposited radioactivity in human beings. For sixteen years and on the request of US army and navy researchers provided standards for the nation's radium dialpainting industry experimenting on women dial painters. Second, the period from 1950 to 1970 was marked by the interest of the Atomic Energy Committee (AEC) on the case. Concerned with the health risks of atomic tests the AEC officials turned to radium dial painters as their source of experimental subjects. Last, the period after 1970 is characterized by the research of the center for Human Radiobiology at the Argonne National Laboratory (ANL), University of Chicago, that took over the studies of radium-exposed individuals. A controversy between the researchers of ANL and MIT was reflected on the women radium dial painters who were treated once more as medical property and as objects of experimentation. Creating the conditions for treating women dial painters as objects: the early years (1913-1933) In 1913 Sabin von Sochocky, a Viennese physicist and physician, introduced a cheap luminous paint formula that led to a wider use of luminous watches in the United States just before and during the interwar years.Their commercial production began soon after Sochocky established the Radium Luminous Material Company, the first of its kind in the United States. 9 The work at the Luminous Company did not require more than deftness in handling a paintbrush and applying luminous paint on watch dials. The fact that the job required artistic ability rather than strength and endurance made it seem natural and desirable for women. Not coincidentally, dial painting was often advertised as a position for artists. One of the dial painters remembers: "It was a long shot. We arrived with portfolios of our drawings that we thought the employer would want to took over. Well he didn't. He just wanted youngsters who could handle brushes skillfully enough to paint dials" [Lang, 1959, p. 88]. 236 The WomenRadium Dial Painters... DISKUSSION - DISCUSSION 1lae dial painting positions were very soon occupied by teenage girls who found the work easy and advantageous, much better than other factory jobs.They had the choice to work part time, only during summers as a "vacation job", or full time. Despite its monotony the task required watchfulness and dexterity. Moreover, given that the average weekly salary for women laborers at the time was approximately $15, the dial painting was economically attractive. Payment was by piecework, usually $1.44 for twenty-four dials, t~ and dial painters could obtain from $ 20 to $ 25 per week. Adopting the practices of water color painters, women used the technique of lippointing to speed up their work. A woman who painted an average of 250 watches per day could lick her brush as many as 12 to 14 times for each watch, and by a simple calculation she could end up swallowirig a minimum of 125 mg of paint, l~ In a short time the company managers incorporated the women's habit and used it as an instructed technique. "We were told to lick our brushes", recalls one of the dial painters. "Alice t o o k to it like a machine [emphasis mine], dipping it into her mouth and dabbing at the numerals. Dip and dab, dip and dab." 12 The transformation of lip-pointing from a spontaneous and convenient practice to an institutionally sanctioned technique marks the decline of improvisation and freedom at the workplace, but it also marks the use of the body as an instrument, as part of the rest of the industrial machinery. Piecework was used as a "voluntary" system of constraints, prohibitions, obligations, and subjugation. Women dial painters worked by the piece, and they adopted the lip-pointing technique not under any physical coercion but because of the urge to increase productivity. The institutionalization of lip-pointing is an indicator of - indeed a small part of - the tendency of companies to regard the body, and specifically the female body, as their property. Inspectors and managers could discipline it, exploit it, and be indifferent to its health. At this point, it is worth noticing that concerns about laborers' health were also closely tied to the notions of productivity and exploitation. Physical examinations had been in extensive use in industry since 1910. It was around this time that industrial medicine, a new scientific discipline, was emerging. It began to acquire its own journals, and physicians started to obtain full time industrial positions. On this unusual border line between science and technology, medicine was introduced and institutionalized as an applied field in industry. Nonetheless, as Angela Nugent claims,"by their very design these routine examinations directed the doctor's attention away from physical disorders that affected workers' comfort, appearance, and long term well being, but which only impinged on their working ability in marginal ways" [Nugent, 1983, p. 589]. Moreover, workers' unions argued that the physical examinations were a way for employers to intrude into the private lives of their employees and exert more control over their work. The subtle exertion of power over female bodies was not limited to piecework techniques and physical examinations, More than the increase of productivity and the establishment of the new scientific discipline of industrial medicine were at stake. Technology and the application of scientific discoveries in industry were used to serve specific interests and ideologies. One of the main applications of radium paint was on the dials of airplanes that flew over enemy camps during World War I; speedometers, compasses, barometers, inclinometers, and dashboard instruments of airplanes NTM N.S. t2 (2004) 237 DISKUSSION - DISCUSSION Mafia Rentetzi and submarines were illuminated by radium. The ideology of war was so apparent and decisive that a report of the United States War Department and the Navy Department stated that "in war time the radium luminous dials are essential, regardless of sacrifice involved" [US Bureau of Labor Statistics, 1929, p. 1209]. "Surprisingly" enough, these sacrifices were made by young women dial painters whose bodies were treated as the inanimate medium for achieving political goals. Moreover, with the promises of radium in medicine and the cure for cancer, doctors embarked on investing in the new element.The radium craze went on for years and radium became a symbol of power and wealth. 13 It was even presented as an object worthy for display to the public. In 1914 two grams of radium were on dis-play for a week at the Public Health Exposition in Grand Central Palace, New York. Tile demonstration was made by Hamilton Foley, an employee of the Radium Chemical Company. Medical students, physicians, nurses as well as any curious people were invited to see the exhibition. The radium was placed under high security by State police. However, the most peculiar thing about the exhibition was that a contest was taking place simultaneously. "Contests for perfect feet and good eyes are to be held in the Public Health Exposition, with all sizes of feet and all colors of eyes eligible for the prizes...A dental clinic of the Department of Health will hunt for the perfect set of teeth." 14 Within such a cultural context it is not surprising that the disfiguring of the young dial painters and their jaw necrosis, one of the first symptoms of radium poisoning, was only much later attributed to radium. According to the US Bureau of Labor Statistics, the first case of a supposed phosphorous necrosis was reported to the local board of health and consequently to the State Department of Labor on 26 December 1922.The physician who reported the case had treated a 20 year-old woman who had been employed as a dial painter for at least two and a half years. It all started when a tooth was extracted and the area refused to heal. Gradually, within a year, parts of the bone were also removed. Operations and blood transfusions were tried in vain. Additionally, a lung condition developed and since both parents of the woman had died from tuberculosis the doctors granted the "coincidence" as a possible cause of her condition. The young woman finally died in 1923. The New Jersey Department of Labor conducted several inspections but reported no violations of State laws. Two other deaths occurred in February, 1924 and were reported by the health officer of the Luminous Company.The symptoms and the progress of the disease in all cases were similar: dental problems, necrosis of the jaw, ulcer of the gum, and discharge of pus [Blum, 1924, pp. 802-805; US Bureau of Labor Statistics, 1929, pp. 1200-1275]. The decisive case occurred in September 1923 when a twenty four year old woman developed exactly the same symptoms and the New Jersey dentist who first treated her was puzzled by the severity of her case. He thus referred the patient to Theodore Blum, a New York surgeon. Blum mentioned later in a discussion with Daniel Lang that "A good look in her mouth and I knew I had never seen what she had before. Clinically, I couldn't diagnose a thing, but she told me where she worked, and I surmised that her jaw had been invaded - yes, and pervaded - by radioactivity" [Lang, 1959, p. 57]. In a paper read before the American Society of Oral Surgeons and Exodontists in 1923 Blum referred to the above case in a footnote. Comparing the case to phosphorous necrosis he specifically attributed it to the use of radioactive 238 The WomenRadiumDial Painters... DISKUSSION - DISCUSSION substances in the manufacturing of luminous watch dials and termed the disease "radium jaw" [Blum, 1924, p. 805]. Consequently, when the dial painter died on December 1924, her death was for the first time attributed to "occupational poisoning, necrosis of jaw and maxilla" [US Bureau of Labor Statistics, 1929, p. 1239]. In the meantime the Consumers' League of New Jersey entered the story. This was an organization that fought to end child labor and was concerned with the plight of women in industry. They collaborated with the US Department of Labor and ordered a general survey of all radium plants iri the country. 15The company arranged also its own investigation and asked the School of Public Health of Harvard University to perform it. Their study concentrated on the radioactive substances throughout the plant and not on the women dial painters and the lip-pointing technique.The first experiment~ carried out related to the case were designed to investigate the effects of the radioactive dust using dental film placed in various spots in the plant. Only in 1925 was Harrison Martland, Essex County examining physician and a member of the Newark Board of Health, the first to extensively examine the women dial painters. Martland, as a county medical examiner, had the legal authority to study the radium case and was actually involved when the director of the Newark health department draw his attention to the case [Mullner, 1999, pp. 67--69]. He performed autopsies and described the symptomatology, etiology, and pathology of the disease. Based on Martland's report a few women sued the company. Ultimately the first law suits were settled out of court in 1926, when the company paid legal costs to the plaintiffs. It was at this time that US Radium Corporation ceased its site operations of extracting radium from carnotite ore. In 1927 another series of litigations began when five more dial painters sued the company. By the time the law suits settled out of court in June 1928 the company was economically debilitated, having had to pay legal costs of $ 20,000, all past medical expenses, and annual pensions to dial painters. ~6The Consumers' League of New Jersey succeeded in closing down the dial painting department of US Radium Corporation by pressuring the state labor commissioner to forbid the operation of the company. Finally, in 1933 the Public Health Service, also under pressure from the Consumers' League, suggested safe practice guidelines for painting luminous watch dials. Being women and designated as unskilled workers, the dial painters found themselves in these early years fighting not only against the cruel employers of the Luminous Company or the sluggish judicial and medical system of the United States of the 1920s. Instead, they also found themselves fighting against the image of technology and science - and radium in particular - as vehicles for economic and social progress, which at the same time set the ideals of perfection and body image in public displays of radium. The economic utility of the dial painters, the outrageous price of radium, as well as the economic interests of the dial painting industry turned the women dial painters into objects of investment.This is the reason that although the harmful effects of radium were already known, their fatal case was connected very late to the lip-pointing technique. Such being the case one could even question the assertion that the radium poisoning of the women dial painters was an unfortunate occupational accident. Furthermore I want to argue that treating women as objects of investment set the ground for using them later as objects of experimentation. N~l N.S. ~2(2004) 239 DISKUSSION - DISCUSSION Maria Rentetzi The MIT Radioactivity Center (1934-1950) The first period of the experimental exploitation of women dial painters starts with the establishment of the Radioactivity Center at MIT, that was devoted to the study of the long-term effects of internal deposited radioactivity in human beings. In the late 1920s a radioac, tive tonic called "Radithor" was marketed in the United States as a panacea for several diseases and an aphrodisiac as well. One of the first victims of Radithor was Eben MacBurney Byers, a wealthy steel manufacturer from Pittsburgh and well-known sportsman and playboy who died of radium poisoning in 1932.17 In contrast to the case of women dial painters the health authorities reacted immediately after Byers' death.The Los Angeles County Health Officer, Frank CrandaU, asked Robley Evans, a physicist in the California Institute of Technology (Caltech) to conduct research on the health effects of radium. In a few months Evans became an expert on radium poisoning, having reviewed the existing cases and literature [Evans, 1933]. In 1934 he moved from Caltech to MIT on invitation by Karl Compton, the president of MIT, to set up a nuclear engineering course [DOE/EH0473,1995,p. 2]. At the time Compton established the Radioactivity Center, a research center that consisted of representatives from six different departments and was aimed at multidisciplinary work focusing on radioactivity, nuclear physics, and medicine. For Evans this was his chance to get fully involved in the radium dial painting case and remain in the history of medical physics the expert of radium toxicity and the founder of nuciear medicine. To start with, Evans performed experiments on rats but realized that the animals needed a hundred times more radium than humans to develop the same medical condition.That was the time he turned to possible human experimental subjects. In the meanwhile the US Food and Drug Administration along with the US Health Department requested research on safe amounts of radium in medical and cosmetic products] 8 Evans contacted Marttand, the New Jersey medical examiner involved in the case in the 1920s, who provided him with a list of dial painters. He then started to slowly make measurements on women who had ingested radium as he could find them. With the outbreak of the Second World War the US army and navy needed a number of luminous instruments and so dial painters were urgently employed.The department of health pressed for occupational protection standards in the dial painting industry, and the US Navy Medical Corps literally forced Evans to collaborate in the project.As Mullner claims"the captain [of the US Navy Medical Corps] insisted that Evans quickly provide the Navy with standards for the nation's radium dialpainting industry. Further he threatened that if the young professor did not do so, the captain would see to it that Evans was inducted into the Navy where he would be forced to come up with them" [Mullner, 1999, p. 122]. That was not an easy job for several reasons. First of all there were no complete medical records for the dial painters besides Martland's list. In 1941 Evans was finally in the position to determine the tolerance level for radium in the human body based on the limited number of 27 women. Second, the measurement procedure was painstaking, time consuming, and there were not yet any accurate techniques available for such measurements. As Robert Rowland, a biophysicist at the ANL, recalls "the early measurements were done by what we call'Robley Evans Technique', which 240 The Women Radium Dial Painters... DISKUSSION - DISCUSSION was a Geiger counter placed behind the small of the back as the subject sat in a chair" [DOE/EH-0461,1995, p. I1]. Evans alone built Geiger counters that he provided to Maitland who then measured the radium body burdens of the dial painters. Continuing to work with women dial painters, Evans developed a technique for measuring the amount of radon in breath salnples) 9 In the.se early years, desperate women horrified from the deaths of their colleagues and suffering from radium poisoning offered their bodies for medical examinations and all kinds of tests, hoping for a miracle.The motivation for medical research, however, was clearly not to improve their medical condition.The research had only started after an industrialist had died; it was further supported by the cosmetic and drug industry, and most of all the military. In 1944 a committee responsible for radiation protection standards from the Manhattan Project consulted Evans in order to establish safety equipment and procedures in their laboratories, qqae main radioactive material used for the bomb was plutonium, a newly discovered element with biological effects analogous to those of radium. The dial painters were the largest group exposed to internal radiation and thus valuable as research subjects to aid the workers dealing with radioactive materials in the Manhattan Projecto"There were secret things being done [at MIT]" as Constantine Maletskos, a close collaborator of Evans, recalls. "The Radioactivity Center and all of MIT was heavily involved in basic military research to help the war effort" [DOE/EH-0473,1995, p. 12]. Measuring the amount of radium in women's bodies was one of these researches. Mainly doctoral students of biophysics were doing the whole body counting in the open air. Being one of them, Maletskos remembers that I did an awful lot of those measurements; they'd take all-day-long, and it's tough not only on the subject, but it's tough on the researcher ... It takes so long and you have to repeat and alternate because you don't know what background [radiation] is doing during the day. So, you have to keep repeating the experiment [emphasis mine] all over again... [DOE/EH-0473,1995, p. 13--14]. It is surprising to see that what for Maletskos, the researcher, was an experiment has not been defined as such in the majority of the medical literature. Instead as Merril Eisenbud, the Director of the AEC's Health and Safety Laboratory in New York argued in 1957, the radium dial painters' case was "the most valuable accident" which saved thousands of Manhattan Project workers [Lang, 1959, p. 50]. It was just a few years earlier that the A E C came to the forefront of the scene of the radium case. The Atomic Energy Committee (mid 1950s-1970) After the 1950s the USA, the Soviet Union, France and Britain performed a number of atomic tests above ground. Radioactive byproducts were gradually coming down to earth as fallout.The A E C concerned with the health risks turned once more to the case of the dial painters and recommended a restudy in order to collect a statistically significant sample of radium poisoning, e~ At the time most of their files were destroyed. Names and data about those women gathered by the Federal Department of Labor in 1929 were destroyed in 1944 as a routine space-saving tactic [Lang, ~TM N~S. 12 (2OO4) 241 DISKUSSION - DISCUSSION Maria Rentetzi 1959, p. 66]. Most of the women in the case who were still alive were already in their late fifties, and had moved away from the areas where they had worked in trying to avoid the social stigma of having radium poisoning.21 Thus locating and dragging them to the medical centers was not an easy job. In 1958 MIT placed an ad in the New York Sunday papers looking for people who received radium injections or worked as radium dial painters [Lang, 1959, p. 50].According to older records arounc12000 of the dial painters from the early 1920s were still alive.The MIT in collaboration to the AEC and the ANL that had already been involved in the case for number of years were in charge of locating the radium subjects.The researchers turned to the dial painting industries asking them to release the names of the women receiving compensation. They went through old photos, newspaper articles, marriage records, death certificates, and voter's registration lists. They hired a detective, called up several women, and in short, they trampled down the women's rights for privacy and discretion. When a name was located an interview was first conducted in the individual's home. Daniel Lang, a reporter for New Yorker, participated in a few of these interviews and wrote about his experiences [Lang, 1959, p. 4%92]. He described women's hesitation to discuss their life stories and their health problems, to release their medical records, and of course, to participate in a new experimental trial. It is worth noting that the women dial painters did not know that there was a reporter among the people that visited them in their private homes. However, some of them agreed to spend a day or two to the MIT center or at Argonne where physicists and physicians performed a series of tests to detect radioactivity in their bodies. No formal consent procedures were followed. Evans was still working for the same project. Measurements were made with an extremely sensitive radioactive counting apparatus, and a complete physical examination was given to the women at the medical department, as had been done in most cases many times in the past, MIT had already acquired a whole body counter in the late 1950s (an unshielded one) located in a classroom [DOE/EH-0473, 1995, p. 22]. At Argonne the group was constituted by Charles Miller, an electrical engineer, and two physicians (Asher Finkel and Robert Hasterlik), Maletskos, involved in the project at MIT, recalls not only the competition between the two groups but also the fact that they actually had to send the same subjects to both places in order to "calibrate with each other" [DOE/EH-0473, 1995, p. 9] and confirm their different techniques. Thus women dial painters were not only dragged to the centers for medical tests, but became the inanimate medium for calibrating medical instruments and improving technologies. For example Rowland improved a common technique in medical physics called registration of images by working on exhumed bodies of women dial painters [DOE/EH-0461,1995, p. 18]. It was not by chance that the wholebody counting technique was developed based on the radium dial painters caseY The Center of Human Radiobiology at Argonne National Laboratory 0970-1990) When Evans was going to retire from MIT, he was concerned that his research program would be abandoned. In 1957 he proposed to the AEC that a single center devoted to the study of the case be established at Argonne. Approving his proposal, the AEC set up the Center for Human Radiobiology and generously financed the 242 The Women Radium Dial Painters... DISKUSSION - DISCUSSION Argonne to build a new wing to the physics division so as to house the medical records and the team working with radium subjects. All the files related to the case from a number of different institutions were gathered in the new center. Nonetheless, the transition was not an easy one. Rowland, who now was the first director of the center, offered positions to all of Evans' assistants and to the three researchers who had already been working at Argonne since the late 1950s. Finkel, Miller, and Hasterlik turned down the offer and although the center opened up in 1969 they had "a real nasty arrangement for a while there" [DOE/EH-0461,1995, p. 33]. The controversy was fierce, and women dial painters were once more "the victims" of this conflict. Finkel refused to turn over the medical records (around 400 cases) as he considered them his personal property. Along with Hasterlik and Miller, he agreed to give the records to the new center only in the event that the subject died. Furthermore, they contacted the women asking them not to collaborate with the new center and promised medical care, knowing that they could not fulfill their promises because of lack of funding. On the other hand, Rowland hired a former catholic nun and set up a group of women who tried to contact the dial painters, gain their trust, and bring them to the center for new tests.24 Within three years he had acquired all the records and even found new cases [DOE/EH-0461, 1995, p. 34-37]. Eventually~the center run out of funding in 1983, when the Department of Energy, supporting the human genome project, cut the funding from the radium studies. In 1990 it again downgraded the center to a program and finally terminated it in 1993 [DOE/EH-0461, 1995, p. 42]. Conclusion From the 1920s to the 1990s, for more than seventy years researchers continued to produce scientific knowledge and publications based on the radium cases.~Ihey performed exhausting measurements and tests using the bodies - alive or dead 25 - of women radium painters without their informed consent. They had considered this as a data-gathering process devoted to the progress of scientific knowledge.Was then the case of the dial painters an accident that medical doctors and physicists took advantage of and "passively" used just in order to determine safety radiation standards? Or were these various activities cases of experimentation? Historically, the concept of experiment has undergone a long series of transformations. From a way to "demonstrate what was already known", [Kuhn, 1977, p. 43] a show in front of the public and an "obligatory move for the construction of reliable scientific knowledge", [Shapin, 1988, p. 498] in the 17th century, m o d e r n experiment is turned to a massive collaboration within industry-like laboratories where in an indistinguishable matrix, hypotheses are tested for their validity, where funding determines the choices and methods of scientific inquiry and ethical questions arise about the intentions of science practitioners. 26 Nevertheless, an element has been common in all these different phases, and that is the intentionatity with which scientists either prove, confirm, demonstrate, test, or measure. The same intentionality proved to be the driving force in all research related to radium dial painters. For every single examination women went through, there was the clear intention of the researchers of testing a medical hypothesis. Time was their main variable and nature did the work for them. Due to the physical properties of radium (long half N'rM N.S. 12(2O04) 243 DISKUSSION - DISCUSSION Maria Rentetzi life period; slow decay), it is possible to trace it in human body many years after it was inhaled or ingested.Thus biophysicists were not obliged to change any variables in their experiments. They had simply to do radium measurements. Further, the repetition of the same tests in the case of MIT and ANL studies in the late 60s indicates that even common experimental confirmation methods were followed. Looking closely at the three periods described above, the following issues emerge: - - - Women dial.painters were misinformed and misled in order to facilitate the release of useful information. They offered themselves for study and were examined on false premises, without any procedures of informed consent. Researchers did not respect the women's right for privacy and used unethical means to gain their trust. As early as 1942 the first discussions regarding the use of human subjects in medical experiments were initiated by the Committee on Medical Research of the Office of Scientific Research and Development. One of the committee's main concerns was the issue of informed consent as it was for the Nuremberg Code as well. In the Wilson Memorandum signed in 1953 it was stated that "the voluntary consent of the human subject is absolutely essential." 27The Helsinki Declaration in 1964 further insisted that subjects must be informed of the aims, methods, benefits, and hazards of the research before they subjected to it. Dragging women from one research center to another and deceiving them by promising more than the physicians could offer to them, as Rowland described, was definitely not in accordance to the above ethical codes. The case of the 'radium women' was important for political and economical reasons. Women dial painters had been used as objects of investment from the dial painting industry and their bodies were bound up with their economic utility.They also became part of ongoing medical research and experiments needed for the war industry, the atomic bomb project and the drug and cosmetic industry. None of the studies that involved women dial painters was conducted in order to improve their own health conditions. Furthermore, they often found themselves in the middle of medical controversies, and power games, and were treated as mediums for technological innovations. Although the group of the 'radium women' has been considered as one of the most valuable samples for epidemiological studies, data concerning their medical history have been incomplete, badly preserved, and were even considered the personal property of physicians.'s At this point there is no doubt that women dial painters have undergone a series of unethical experiments. It remains a question why this has never been acknowledged. What I tried to show is that a possible answer depends on the ethical and political question of what finally counts as human experimentation. Acknowledgements I would like to thank Richard Burian,Aristides Baltas, Ellen Balka, Ty Brady, Sarah Mitchell, Pei Koay and Volker Roelcke for their helpful comments and suggestions. I owe my thanks to DoNs Zallen for being the first who brought into my attention the women dial painters' case. My thanks go also to the Argonne National Labora- 244 The Women Radium Dial Painters... DISKUSSION - DISCUSSION tory, U n i v e r s i t y of Chicago, U S D e p a r t m e n t of E n e r g y for the c o u r t e s y of the photo, Neg. #25855. Last, I t h a n k the L i b r a r y of C a m b r i d g e University, M a n u s c r i p t Coll e c t i o n for the p e r m i s s i o n to q u o t e f r o m R u t h e r f o r d ' s Papers. Notes A first version of this paper is published in: Twentieth Century. Ethics ofttuman Subjects Research: Historical Perspectives on Values, Practices, and Regulations, edited by Volker Roelcke and Giovanni Maio. Franz Steiner Verlag: Stuttgart 2004, pp. 275-291, 1 More recent important historical and detailed analysis of.the dial painting case can be found in [Clark, 1997] and [Mullner, t999]. Especially Clark's work includes an extended bibliography, covering both the earlier and more recent publications on the case, while Mullner provides rare archival sources. 2 [Clark, 1997, p.205]. It is not evident that those guidelines were actually followed, tIowever, it was one of the first steps to prevent future cases of radium poisoning. 3 For the histo~ of litigations see [Clark, t997] and [Mullner, 1999]. For a detailed description of the case and the earlier medical tests see [US Bureau of Labor Statistics, 1929, pp. 1200-75]. The reason that no fatal cases developed in luminous industries in Europe is probably that instead of water, the paint used had an oil-varnish adhesive. Water has the tendency to separate the hair of a brush. Lip-pointing was the easy and fast way to avoid the problem. Oil, by being adhesive, keeps the brush in its original shape. Moreover, it is unpleasant in taste and thus lip-pointing was avoided. Consequently, although luminous dial painting had been practiced for years, in both Germany and Switzerland, no official reports exist about any illnesses related to the use of the paint [US Bureau of Labor Statistics, 1929, p. 1208]. A study on the French case [Lacassagne, 1926, p. 134] suggests that the use of rods instead of brushes was the reason that the disease was not observed among the dial painters in France. 4 For example Brues' article on radium dial painters case is included in a volume devoted to radiation accidents [Brues, 1980, pp. 441-450]. See also [Mullner, 1999, p. 127]. 5 Jonathan Moreno and Susan Lederer highlight and explain the significance of the committee's historical findings in [Moreno and Lederer, 1996]. 6 Merril Eisenbud, director of Atomic Energy Committee's Health and Safety Laboratory in New York to Daniel Lang, [Lang, 1959, p. 50]. 7 On the issue of informed consent on human experimentation see [Annas, Glantz, and Katz, 1977; Faden and Beauchamp, 1986]. For a more recent discussion on the issue see [Rothman, 2003]. On the history of human experimentation in America see [Lederer, 1995]. 8 I owe my thanks to Volker Roelcke for emphasizing the ethical dimension of the issue. 9 Referred as Luminous Company from now on. 10 [Sharpe, 1978, p. 562]. Notice also that the price for a wrist luminous watch in 1921 was $4.98 [Radium for Dials at $120,000,The New York Times, 1921, II, 1: 5]. 1t [US Bureau of Labor Statistics, 1929, p. 1246]. In contrast to what has been referred to in the relevant literature, the calculation was actually made by Sochocky at the request of Frederick Hoffman, a statistician who worked for a Prudential Life Insurance Company and not by Hoffman himself [Hoffman, 1925]. 12 Writing in 1959 when several of the dial painters were still alive, Lang did not refer to those women by their real names. [Lang, 1959, p. 88] 13 Indications for the importance of radium in medicine and as a symbol of power one can find in the correspondence of Stefan Meyer and Ernest Rutherford, two of the most seriously engaged scientists in the early years of radioactivity research. For example in 1910 in a letter to Meyer, director of the Institute for Radium Research (Institutfiir Radiurnforschung) in Vienna, Rutherford expressed his worries:"I hope you will be able to reserve a large quantity for experimental purposes, otherwise I am afraid it will all go into the doctors hands." [Ernest Rutherford to Stefan Meyer, October 22, 1910 in Rutherford's Papers, Manuscript Collections, Cambridge University Library, cited as RP from now on]. In his letter of April 28,1912 Meyer informed Rutherford that "We have of course a big competitor in the king of England who through vcrM N.S. ~2 (2,,g~49 245 DISKUSSION 14 15 16 17 18 19 20 21 22 23 24 25 246 - DISCUSSION Maria Rentetzi personal intervention of our Kaiser have assured for himself personally, ahead of anyone else, a whole gram of pure radium from the material coming from the factory" [Stefan Mayer to Ernest Rutherford, April 28,1912, RP]. At the same time a forceful debate was generated over the role of the governmental control of radium deposits in the United States,which also became an issue in one of Rutherford's letters to Meyer: "they [companies who were separating radium from carnotite ore] have been trying to pass a law that all radium mines should be sold to the Government and hbpe in this way to prevent the large exportation of ore" [Er.~aestRutherford to Stefan Meyer, May 11,1914, RP]. [$ 500,000 Radium is Exhibited Here, 1921, 9:2]. Richard Burian brought my attention to the Fitter Families contests that took place in the United States during the same time, as part of the eugenics movement. Any healthy family providing its eugenic history,,intelligence tests of its members and medical examinations could enter the contests [Kevles, 1985, p. 61].The American Eugenics Society with the help of eager sponsors and eugenics enthusiasts organized more than 40 family contests the year, setting the standards for the "normal","he~dthy", and "pure". In 1920s the image of science and technology as powerful tools that could solve even social problems, seemed to be undefeatable. "All Radium Plants in Federal Inquiry", The New York Times, June 21, 1925,18: 1. [Lang,1959,p. 63].Foramoredetaileddescriptionofthelawsuitssee[MuUner,1999,p.75-91]. For more details on the case of Byers see [Mullner, 1999, pp. 109-119]. On the one hand the disfiguring of the women dial painters threatened mainly women users of cosmetics containingradium, and further their producers. Simultaneouslyit undermined the ideals of perfection and body image that modern science imposed. On the other hand the death of Byers led to bankruptcy of many health product industries using radium. Only after these incidents the administrators and health inspectors pressed scientists and especially Evans to study radium poisoning. At the time as a result of his research on women dial painters, Evans published extensively on journals related to medical technologies. See for example [Evans, t935]. For the role of the AEC in a number of human radiation experiments see [Moreno and Lederer, 1996; Advisory Committee on Human Radiation Experiments, 1995]. A characteristic case is Katherine Schanb, a women dial painter whose strange behavior was contributed to mental disorder after the diagnosis of radium poisoning. An interesting document is the first part of her autobiography [Schaub, 1932]. The second part was destroyed by her relatives as an attempt to save her and her family's fame. In the meanwhile the Nuremberg Code was promulgated in 1946 and one of the first principles that included was that "the voluntary consent of the human subject is absolutely essential" [Childress, 2000, p. 348]. As Childress, Lederer and others have persuasively argued, at the time this code played virtually no role in medical research, ethical discussions and public policies [laden, Lederer, and Moreno, 1996, ]. Probably the reason for dismissing the Nuremberg Code was that it was considered as "a code for barbarians, the Nazis, who were guilty of brutal excess, not a code for civilized researchers" [Childress, 2000, p. 350]. See also [Annas and Grodin, 1992; Katz, 1996]. Thus formal consent procedures were sporadic and depended on the values of those individuals who performed experiments on humans. Both Rowland and Maletskos describe in their interviews the technological improvements and the innovations of their groups related to the radium case [DOE/EH-0473, 1995; DOE/EH0461,1995]. At the time the Declaration of Helsinki had akeady succeeded the Nuremberg Code and adopted by the World Medical Association in 1964.The Declaration clearly stated that the subjects' consent should as a rule be obtained in writing [Childress, 2000, p. 351], It seems that this development in ethics concerning research on human subjects complicated the work of the group. At least for the case of exhumations they had to "go through the legal maneuvers to get it [the consent of the relatives to exhume remains of radium cases]" [DOE/EH-0461, t 995, p. 60]. Exhumation studies of the women dial painters had been done as early as the 1920s from Martland. He even had a small museum collection of autopsies [DOE/EH-0461,1995, p. 20]. Evans in MIT as well as the group at Argonne went through exhumations of women dial painters' bodies in order to do research on how radium deposits in bone. The Women Radium Dial Painters... DISKUSSION- DISCUSSION 26 The literature concerning what an experiment is and how it is performed in modern science is vast. For a more recent review especially for the physical sciences see [Galison, 1997, pp. 1-65]. 27 Department of Defense, 1997, pp. 5-7. 28 Besides the destruction of the original files in 1944 both Rowland and Maletskos mentioned in the interviews problems with their own files, which they found incomplete and with great divergence between the MIT study and the Argonne one. Bibliography Advisory Committee on Human Radiation Experiments: Final Report. US GPO:Washington D.C. 1995, ch. 18. Annas, George; Glantz, Leonard; Katz, Barbara: Informed Consent to Human Experimentation: The Subject's Dilemma. Ballinger: Cambridge 1977. Annas, George: Grodin, Michael: The Nazi Doctors and the Nuremberg Code: Ituman Rights in Human Experimentation. Oxford University Press: New York 1992. [Anonymous]: $ 500,000 Radium is Exhibited Here. The New York Times, November 14, 1921, 9: 2. [Anonymous]: "Radium for Dials at $120,000". The New York Times, November 27,1921, II, 1: 5. Blum, "Ilaeodore: "Osteomyelitis of the Mandible and Maxilla". Journal of the American Dental Association (1924) September 11, pp. 802-805. Brues, A. M.: "The.Long-Term Follow-Up of Radium Dial Painters and Thorium Workers". The Medical Basis for Radiation Accident Preparedness, edited by K. E Hubner and S. A. Fry. Elsevier North Holland: New York 1980, pp. 44t-.450. Childress, James: "Nuremberg's Legacy: Some Ethical Reflections". Perspectives in Biology and Medicine (2000) 43 (3), pp. 347-361. Clark, Claudia: Radium Girls: Women and Industrial Health Reform, 1910-1935.The University of North Carolina Press: North Carolina 1997. Evans, Robley: "Radium Poisoning: A Review of Present Knowledge". American Journal of Public Health (1933) 23, pp. 1017-23. Evans, Robley: "Apparatus for the Determination of Minute Quantities of Radium". 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Rothman, David:"Serving Clio and Client:The Historian as Expert Witness'. Bulletin of the History of Medicine (2003) 77, pp. 25-44. Schaub, Katherine: "Radium". Survey Graphic (1932) 68,138-141. Shapin, Steven: "The House of Experiment in Seventeenth Century England". Isis (1988) 79, pp. 373-404. Sharpe, William: "The New Jersey Radium Dial Painters: A Classic in Occupational Carcinogenesis". Bulletin of the ttistory of Medicine (1978) 52, pp. 560-570. US Bureau of Labor Statistics:"Radium Poisoning".Monthly Labor Review 28 (1929), pp. 1200-1275. US Department of Defense (DOD): Report on Searchfor ttuman Radiation Experiments Records', 1944-1994, vol. 1. Assistant to the Secretary of Defense for Nuclear and Chemical and Biological Defense Programs: Washington D.C. 1997. US Department of Energy (DOE): Human Radiation Experiments Associated with DOE and its Predecessors (DOE Roadmap). US Department of Energy, Assistant Secretary for Environment, Safety, and Health: Washington D.C. 1995, US Department of Energy (DOE): Human Radiation Studies: Remembering the Early Years, Oral Hh'tory of Biophysicist Robert Edmund Rowland (DO E/EH-0461). United States Department of Energy, Office of Human Radiation Experiments: Washington D.C. 1995. US Department of Energy (DOE): Human Radiation Studies: Remembering the Early Years, Oral History of Heahh Physich't Constantine J, Maletskos (DO E/EH-0473). United States Department of Energy, Office of Human Radiation Experiments: Washington D.C. 1995. Author's address: Dr. Maria Rentetzi Max Planck Institute for the History of Science Wilhelmstrasse 44 D-10117 Berlin rentetzi@mpiwg-berlin.mpg.de 248