Document 3jKRvj5KOo7wXw96j5Y3D1XO

THE NEW JERSEY RAD1'I;M DIAL PAINTERS: A CLASSIC IN OCCUPATIONAL CARCINOGENESIS WILLIAM D.SHARPE Luminescence, including radioluminescence, had been known for centuries when Henri Becquerel's investigation of this natural phenomenon led to the discovery of radioactivity. The Curies isolated radium at the turn of the century, and among the earliest uses of naturally occurring radioactive substances was the preparation of radioluminous compounds. The most eficient phosphor-zinc sulfide-seemsto have first been synthesized by Sidot in 1866. It was very soon appreciated that trace metals were required for an efficient phosphor and Giesel, in 1902, prepared radioluminous material by precipitating radium-226 with barium hexacyanoplatinate. In 1903 he demonstrated zinc sulfide's practical potential as a detector for alpha particles emitted by radioactive substances. The commercial potential of radioluminescence was soon appreciated and although a vast literature exists, much of the early history of radioluminous material preparation and handling remains obscure, many formulae and processes remaining trade secrets to this day.' About 1910, radium-activated luminous paint was used on some of the more expensive Swiss and German watches but, toward 1913, a cheaper paint was developed in the United States. This paint was probablydocumentation is lacking-invented by Sabin A. von Sochocky, a Viennese who took a degree in medicine at Prague and later studied atomic physics :i ,1 i , * Read before the Beaumont Medical Hi.tor: Club of Yale University. November 21. 1975 Manuscript prepared during tenure of Contract E( 11-1 1-3377. Medical Research Branch, Division of Biology and Medicine. United States Energy Rexarch and Development 4drninistration 44 ' The literature of radium and mesothorium injury in man is voluminous Although incomplete. bibliog- raphies are provided in A A Moghissi and M W Carter, Public Heulth Imp/icurrun> uj Rudiolummous Uufrrruls I Rockville. Md U S Department of Health. Education and Welfare. PHS, Food and Drug Admin- istration. Bureau of Radiological Health. July 1975 DHEW Pub1 , FDA, 76-8001). and in W D Sharpc, Chronic radium inloxication--clinical and autopsy findings in long-term New Jersey survivors. E m iron- rnenfol Reworrh 1974, 8 243-383 Dr Sdrnuel Berg. o f Newark. a former resident dnd for 5ome years assistant to Dr Harrison S Martidnd dt Newdrk Caty Hospital. has recently brought out a book dealing with 9Martland and his era-Hurrrson Stunford Murric.vd The S t u n ofo Ph\ sictun LI HoJpirul und o n Eru ( N e w aYork Vantage Press, 1978) Dr Berg was kind enough to permit me the use of the manuscnpt before ~ t s 1publication I thank him for this, and for many pa51 courte5ies. as well as for a critical reading of thls manuscript 560 BHM 52 (1979) 560-570 0007-5140/79/0524-056$001 00 0 1979 by The Johns Hopkins University Press __. THE NEW JERSEY RADIUM DIAL PAINTERS 56 1 M DIAL PAINTERS: AL CARCINOGENESIS I with Lord Rutherford at the Cavendish Laboratory. (It will be recalled that I Rutherford had identified the alpha particles of radium as helium nuclei in I 1899.) This water-based paint contained radium-226 and radium-228 (meso- thorium) in a zinc phosphor with trace metals added to provide color. The zinc sulfide itself decomposed because of alpha particle bombardment, and {AWE the cheaper mesothorium proved an acceptable luminizer despite its rela- I t tively short half-life, although better grades of paint continued to contain iZence, had been known for cen- radium-226. Dr. von Sochocky was physicist and part owner of the radium on of this natural phenomenon led lries isolated radium at the turn of I I company whose plant in Orange, New Jersey, was the largest firm of its kind in America. He later cooperated fully in studies of the radium workers untij of naturally occurring radioactive he died on November 14, 1928, of aplastic anemia. minous compounds. The most e%- I Many radioluminous dials were used during World War I , chiefly for ave first been synthesized by Sidot t trace metals were required for an l aircraft and submarine instruments and for watches. An industry developed and, after the war, new markets were sought so that door knobs, light repared radioluminous material by , switches, novelties and relatively inexpensive watch and clock dials were uacyanoplatinate. In 1903 he dem- widely sold, despite a minority voice which deplored the frivolous use of a JI as a detector for alpha particles rare substance with considerable potential for medical use. Although some The commercial potential of early colleagues of Roentgen and the Curies had warned of danger, it was not :d and although a vast literature until the New Jersey disaster that it was appreciated just how dangerous ,luminous material preparation and internally deposited radioactive substances could be. The use of radiolumi- and processes remaining trade nous paint proved to be a fad which, by 1926, had run its course. Fears of radium, publicity given to the injured workers and litigation killed the indus- u s paint was used on some of the tches but, toward 1913, a cheaper rates. This paint was probablyiabin A. von Sochocky, a Viennese te and later studied atomic physics t try. The company moved from Orange in 1926, and its plant was tom down in 1930. Between 1917 and 1924, when the industry in New Jersey began its col- lapse, something like a thousand people worked at radium extraction and dial painting in northern New Jersey, most of them in Orange. Many worked only a few days and at no one time do more than about three hundred seem to have been so employed. Jobs were scarce, especially for relatively un- r'ale University. November 21. 1975. Manuscript :ai Research Branch, Division of Biology and .nt Administration. >an is voluminous. Although incomplete. bibliog skilled women; the pay was good for that time and place; work was light and working conditions seemed pleasant. Workers interviewed a generation later agreed that "it wasn't like the usual factory j o b at all." Yet, from a popula- sr. Public Heulth lmplicutiuns of Rudiolurninous dcation and Welfare, PHS. Food and Drug Admin.<WPubl.. FDA, 76-8001): and In W. D. S h a r p . . g s in long-term N e w Jersey survivors," &ni.lron- Newark. a former restdent and for some years tion not much larger than a thousand, by 1925 five had unequivocally died of radium intoxication. In 1931, Dr. Harrison S. Martland, the Essex County Medical Examiner, reported eight autopsies from eighteen deaths between September 1922 and June 193 1 which he considered due to radium.' Ten had wal. has recently brought out a book dealing with ron oj u Ph,v.\iciun. (I HoJpird und u n &rcl ( N e w jaw necrosis and aplastic anemia, and five had osteogenic sarcomas. He then o permit me the use of the manuscript before its urtesies. as well as for a critical reading of this H . S . Martland. "The occurrence of malignancy in radioactive persons." .4nwr. J . C u n w r . 1931. I S : .) 560-570 ?y The Johns Hopkins University Press 562 WILLIAM D. SHARPE regarded the former as ear/? and the latter as late manifestations of radium intoxication. The Radioluminous Paint Exact written formulae of the radioluminous paints have not survived but retrospective analyses suggest that the typical paint used about 1920 consisted of between 0.7 and 0.4 mg. of a natural radioactive substance (the "luminizer") for each 100 grams of dry, finely powdered, heat crystallized zinc sulfide containing traces of metallic salts-cadmium 0.05%, copper O.OOl%, manganese 0.002%. Zinc sulfide, by itself, fluoresces poorly and the trace metals were required to produce a commercially useful paint. Alpha particles released during radioactive decay activated the zinc sulfide-trace metal phosphor to produce innumerable flashes of light which the human eye fused into a steady glow whose color depended on the trace metals. Until about 1918, only radium-226 (as the insoluble sulfate or bromide) was used as the luminizer but, after 1918, mesothorium (radium-228) and possibly radiothorium (thorium-228) were added to or replaced the much more expensive radium-226. These cheaper elements were byproducts of the local gas mantle manufacturing industry and, although their availability varied. they yielded a cheaper and commercially acceptable radioluminous paint used in New Jersey and sold to manufacturers in other areas for use with inexpensive watches, clocks and novelty items. Dry paint used in the New Jersey plants was weighed out in small glass vials, and that intended for watch dials was ground in small mortars just before use with distilled water, gelatin and gum arabic. This slurry was diluted and issued in 10 ml. lots. The water-based paint required brush application whereas most radioluminous paint used elsewhere had an oil or varnish base, and was applied using glass rods or metal pen nibs. Characters were painted, in the New Jersey plant, using very fine camels' hair brushes which most workers pointed by drawing against the comers of their mouths. Payment was by "piece work,'' usually $1.44 for 24 dials, and a dextrous worker could earn a substantial income in those lightly taxed days. However, the more characters she painted, the more frequently she pointed her brush and the more paint she swallowed. Dr. Frederick L. Hoffman, a Prudential Life Insurance Company statistician, calculated that if a worker painted 250 dials daily, and many did. licking fourteen times for each dial, she would swallow about 1.75 grams of paint daily, representing a weekly dose of 15 to 125 micrograms of radioactive material.' Martland's 1929paper .F L Hoffmdn. Radium cmesothonum) necrosis, J A M A 1925.85 961 65 refers I ska-Cu permit lowing Jaw, ,Vc In Oc necrosi years e phosph and sta phorus Szamats in a lett As far a. compou mesotho been caL Sample. wrote: ' containt Betwc were cotive stor and jau formed Health 1 radiumdial pair and 48.five tho den for Loca! 'H S 5 466-73. 35: These p 169 6A W death. Arr :HARPE er as lure manifestations of radium iinous paints have nor survived but ,ypical paint used about 1920 connatural radioactive substance (the finely powdered, heat crystallized lic s a l t s d a d m i u m 0.05%, copper . by itself, fluoresces poorly and the t commercially useful paint. Alpha 'ay activated the zinc sulfide-trace !lashes of light which the human eye lpended on the trace metals. s the insoluble sulfate or bromide) >18, mesothorium (radium-228) and re added to or replaced the much .ier elements were byproducts of the and, although their availability var.iercially acceptable radioluminous .anufacturers in other areas for use ovelty items. lnts was weighed out in small glass was ground in small mortars just I and gum arabic. This slurry was water-based paint required brush . paint used elsewhere had an oil or \ rods or metal pen nibs. Characters sing very fine camels' hair brushes against the comers of their mouths. $1.44 for 24 dials, and a dextrous - in those lightly taxed days. Howhe more frequently she pointed her ed. Dr. Frederick L. Hoffman, a istician, calculated that if a worker lcking fourteen times for each dial, paint daily, representing a weekly v e material.3 Martland's 1929paper .A..M.A.. 1925.85 961-65 THE NEW JERSEY RADIUM DIAL PAINTERS 563 refers to a New York Journal reporter's interview with Madame Sklodowska-Cune during which she expressed surprise that the government would permit such careless handling of radium and mesothorium, regarding swallowing such materials as "~riminal."~ Juit' Necrosis In October 1922, an Orange physician reported what he called phosphorus necrosis of the jaw in a radium dial painter who had quit work two-and-a-half years earlier in good health after working two-and-a-half years. Because phosphorus poisoning was, at the time, a compensable disease, both local and state health departments investigated the plants, but found no phosphorus in use and therefore noted no violation of state laws. Martin Szamatolski, Ph.D., of the New Jersey State Department of Health, w o t e in a letter dated January 30, 1923: As far a s I know,luminous compounds d o not contain phosphorus, but are usually compounds of zinc t o which are added a b o u t 1/1,00Oth part of radium and mesothorium compounds. It is my belief that the serious condition of the jaw has been caused by the influence of the radium. . . . Samples of the radioluminous paint were analysed, and on April 6, 1923, he wrote: " . . . such trouble as may have been caused is due to the radium contained therein. . . . " 5 This was an unsupported, but accurate, opinion. Between 1922and 1924,seven radium dial painters died. No investigations were conducted, and their death certificates list a variety of causes: ulcerative stomatitis, syphilis, gingivitis, primary anemia, sepsis, Vincent's angina and jaw necrosis due to phosphorus poisoning. Autopsies were not performed because there was no evidence of foul play, and because the State Health Department had passed the plants as safe. Radium osteonecrosis and radium-induced aplastic anemia were at that time unknown. The first radium dial painter known to have died (September 12, 1922) was exhumed in 1927, and 48.4 micrograms of radium-226 were found in her body, approximately five thousand times the presently accepted maximum permissible body burden for an industrial worker using radioactive materials .6 Local dentists had many young women under treatment for stubborn, ' H . S. Martland. "Occupational poisoning in manufacture of luminous watch dials, J . A . M . A . . 1929. 92: 466-73, 352-39. 'These quotations are from Samuel Berg, Harrison Stanford Martland ( N e w York: Vantage Res%1978). p. 169. A . W . SI. George. A. 0. Gettler and R . H . Muller, "Radioacrive substances in a body five years after death." Arch. Pothohyy. 1929. 7: 397-403. 564 WILLIAM D SHARPE refractory mandibular and maxrllary osteomyelitis which resisted the usu treatments and which was known locally as "jaw rot." so poorly did this behave that many dentists refused to perform extractions or oral surgery on dial painters for fear of initiating or aggravating jaw necrosis. In September 1924, Dr. Theodor Blum reported an unusual mandibular osteomyelitis in one patient. Uncertain as to etiology but sure that he had not before encountered a similar case, he mentioned "radium jaw" in a footnote to his published article.' Meanwhile, the industry grew: 8500 dials were painted during 1913, and 2,200,000 during 1919. By 1924, the New Jersey Consumers' League for the Improvement of Working Conditions was complaining about objectionable fumes from the plant in Orange, and was concerned about possible occupational poisoning. This concern seemed well-founded: "acid fumes ate clothes right off the line" and an aspiring opera singer claimed that his voice had been "ruined" by the same fumes. Neither the State Department of Labor nor the United States Public Health Service acted, but the Consumers' League remained interested. Noting the incidence ofjaw necrosis, anemia and mouth lesions, Dr. F. L. Hoffman, in 1925, described five dead and twelve living patients with jaw osteomyelitis.s He suggested that this was due to mesothorium intoxication acquired by licking the brushes, and the N e w York Times duly reported "New Radium Disease Found" on May 30, 1925. After this statistical definition of jaw necrosis and anemia as an industrial disease, Dr. H. S . Martland entered the picture as County Medical Examiner and his 1929 paper credits Hoffman with the clinical definition of radium o s t e o n e c r ~ s i s . ~ Although under New Jersey's Workmen's Compensation Law, as in most jurisdictions, only specifically named occupational diseases were compensable, the factory owners were seriously disturbed. They turned to Harvard Medical School, and invited W. B. Castle, Katherine R. Drinker and C. K. Drinker, who were environmental health and safety experts rather than radiation scientists, to visit the plant on April 16-18, 1924, but because of cases before the courts,,their report was not published until August 1925. l o They had been asked about zinc intoxication from the phosphor, and apparently not about radium or mesothorium. Local folklore has it that the workers' .Theodor Blum. '05reom~elitisof the mandible and mdxilla. J A m r r Drnral 4 5 5 0 ~ 1926. I / 802-5 * Hoffman, u p n r i n 3 dbOVe) Martland, up ( i f In. 4 above) l o W B Castle. Katherine R Drinker and C K Drinker. Necrosl, of the Jaw in workers employed in applying a luminous paint containing radium. J IndurJrrru/H!qrt.nr. 1925, 7 317-82 D SHARPE steomyelitis which resisted the usual d y as *'jaw rot." So poorly did this Terform extractions or oral surgery 011 gravating jaw necrosis. In September unusual mandibular osteomyelitis in Jt sure that he had not before encounadium jaw**in a footnote to his pub- ) dials were painted during 1913, and .ew Jersey Consumers' League for the was complaining about objectionable vas concerned about possible occupaned well-founded: "acid fumes ate ing opera singer claimed that his voice ies. Neither the State Department of lealth Service acted, but the Consum- ,, anemia and mouth lesions, Dr. F. L. d and twelve living patients with jaw was due to mesothorium intoxication 1 the Nen- York Times duly reported ~y 30, 1925. After this statistical definiindustrial disease, Dr. H. S. Martland 11 Examiner and his 1929paper credits If radium o s t e o n e c r ~ s i s . ~ kmen's Compensation Law, as in most occupational diseases were compens.ly disturbed. They turned to Harvard istle, Katherine R. Drinker and C. K. Ith and safety experts rather than radi~ p r i l16-18, 1924, but because of cases I t published until August 1925.*OThey In from the phosphor, and apparently ocal folklore has it that the workers' d maxilla. J Amvr D c n t o / A \ w < 1926, I / 802-5 lrinker. ' Necrori5 o f the Jdw in worker\ employed In ,,trrcil H\yirne 1925, 7 317-82 THE N E W JERSEY RADIUM DIAL PAINTERS 565 underwear and skin shone in the dark, but the radioactive luminizer and binding vehicles were added to the phosphor just before use. and this "shining in the dark" was probably the zinc sulfide which can be briefly activated by sunlight. The presence of radioactivity was established in some of the workers, and Castle, Drinker and Drinker suggested that the portals of entry were the skin and gastrointestinal tract. They recommended that dial painters refrain from pointing their brushes in their mouths on general principles and, although they did not draw a causal relationship between radioactive material and the injuries in question, they concluded that such a relationship could be assumed. Aplustic Anemia On June 5, 1925, an East Orange physician reported the death of a 36year-old chemist who had worked fourteen years at the radium plant. Dr. Martland, as Medical Examiner, performed an autopsy the following day which revealed aplastic anemia and terminal bronchopneumonia. Fatal aplastic anemia had been reported among radium workers in Europe, but without postmortem confirmation, and this was apparently the first case to be published. Howard Baker, the radium company's chief chemist, cooperated fully and postmortem assays yielded 14 micrograms of radioactive material in the body, estimated to be five percent radium-226 and the remainder radium-228 (mesothorium). The report, delayed by litigation, appeared in August 1926." Exactly one week after this first autopsy, Dr. Philip Conlon asked Dr. Martland to see in consultation a 35-year-old dial painter in St. Mary's Hospital, Orange, who had painted dials from 1917 until 1923. Her hemoglobin was 25 percent of normal and her leukocyte count less than 1000 c.mm. She died on June 17, 1925, and is reported in a paper by Martland, Conlon and Knef.I2 Drs. Conlon and Martland each had one additional case still alive, and the histology of aplastic anemia due to radium was first reported at a meeting of the New York Pathological Society in October 1925.l 3 In May 1925, Martland had examined two young dial painters, both of whom had necrosis of the jaw and severe anemia. Both soon died, and he ' I G . S . Reitter and H . S . Martland. "Leucopenic anemia of the regenerative type due to exporure I O radium and mesothorium..' A m r r . J . Rornrueno/ou?.. 1926. 16 161-67. H . S . Martland. Philip Conlon and J. P. Knef. "Some unrecognized danger\ in the ube and handling of radioactive >ub,tances." J.A..M.,.. 192s. 83. 1769-76. " H. S . Martland. "Some unrecognized dangera in the u\e and handling of radioactive wbatancea." ProcrrdinyA 01 r/ir .Veri )i)rk Pirthol~r~icirJlocirt\. 1 9 3 . n.5. 1 5 . 88-91. 566 WlLLIAM D.SHARPE performed autopsies. At about the same time, he examined the company's chief physicist, Dr. von Sochocky, and made the diagnosis of radiuminduced anemia. Dr. von Sochocky had extracted approximately 30 grams of an 5(' L+ radium between 1913 and '1921, and will be recalled as the inventor of the water-based radioluminous paint used in New Jersey. He had chronic radiation dermatitis on his fingers and, while helping Dr. Martland assay radioactivity of the radium workers' exhaled breath, discovered that his own breath was more radioactive than theirs. He died in 1928 of the consequences of his II c>\ I Ihc n L) Jnc invention. h I) In October 1925, Dr. Martland defined radium intoxication as a new occupational disease, basing his report on the first two cases who came to au- .I\ me topsy and on five workers still alive whose expired air contained measurable Th radioactivity. H e described how the radionuclides entered the body, the lltr form in which they were ingested, their storage in the reticuloendothelial wc system, how they could be recovered, their demonstration by photographic and electroscopic methods, their presence in exhaled air, the characteristics plu of the anemia which occurred, the autopsy findings and the hopeless prognosis. l4 tlrr 191 .- In December 1926, Dr. Frederick B. Flinn, a physicist on the faculty of fur Columbia University's Institute of Public Health, had commented: E An industrial hazard does not exist in the painting of luminous dials. The only evidence contrary to this conclusion rests in the fact that five employees at the plant in Orange, N.J., have died from some cause that cannot be determined at this date.I5 19: of cor or Flinn believed that the jaw necrosis was due to bacterial invasion compli- the cated by syphilis, but from the beginning had conceded all of Martland's data of and observations. In May 1927, Flinn described a dial painter from Connect- enc icut who had antral sinusitis, a spontaneous fracture of the femur and later thr died of aplastic anemia.I6 In 1928, he published his agreement that Martland ca. had been correct.17 Car._ Cancer In September 1927, Dr. Martland performed an autopsy on a 35-year-old woman who had painted dials eight years earlier and had left work in good health. Autopsy revealed both osteosarcoma of the scapula and aplastic thr un Jer in frc " /bid. " F. B . Flinn. "Radioacrive material an industrial hazard?" J...\.M.A.. 1926. 97: 2078-81 ''Idem. " A case of antral inu us it is complicated by radium poisoning." L u r w y o . j c o p e . 1927. 37 341-49. SHARPE -ie time, he examined the company's ind made the diagnosis of radium' extracted approximately 30 grams of ill be recalled as the inventor of the n New Jersey. He had chronic radiahelping Dr. Martland assay radioaceath, discovered that his own breath ed in 1928 of the consequences of his :d radium intoxication as a new occuthe first two cases who came to auose expired air contained measurable radionuclides entered the body, the eir storage in the reticuloendothelial their demonstration by photographic nce in exhaled air, the characteristics opsy findings and the hopeless prog- . Flinn, a physicist on the faculty of )lit Health, had commented: ie painting of luminous dials. The only n the fact that five employees at the plant :that cannot be determined at this date. l 5 'as due to bacterial invasion compliIghad conceded all of Martland's data lescribed a dial painter from Connectneous fracture of the femur and later ublished his agreement that Martland ,donned an autopsy on a 35-year-old ars earlier and had left work in good .arcoma of the scapula and aplastic izard?" J . A . M . A . . 1926.87: 1078-81. sdiurn poisoning," Liir\.nyo.\cope. 1927, 37 341.49. ,ran MPd. & S u r y . J . . 1928. 197: 1309-14. I. THE NEW JERSEY RADIUM DIAL PAINTERS 567 anemia, and postmortem assays demonstrated that her body contained about 50 micrograms of radioactive material, chiefly radium-228 (mesothorium). When he reported this in July 1929, he noted: I interpret this sarcoma as possibly arising in a bone in which a previous radiation osteitis had existed for some time as a result of deposits in the skeleton. In reviewing the I5 fatal cases I had found evidence that one of the earlier cases had been diagnosed as sarcoma of the femur from the clinical course and the roentgen examination. and had been treated by high voltage roentgen therapy. This was never proved, however, at autopsy. The incidence of two osteogenic sarcomas in 15 patients dying as a result of an occupational poisoning by radioactive substances is too high to be mere coincidence.'* The earlier patient, a twenty-year-old dial painter, died in April 1924. Martland's 1931 review reports five osteosarcomas among eighteen dead radium workers. l9 For some years during the middle twenties, many radium workers complained of "rheumatic pains" in their joints, especially in their hips, sometimes severe enough to interfere with sleep or walking. Then, in 1926 and 1927, and continuing thereafter, some had spontaneous, non-traumatic fractures of their long bones, especially the femur, which healed poorly. Radium workers continued to die. From 252 death certificates dated from 1922 to 1966, sixteen are recorded for the decade ending in 1930: eight died of aplastic anemia, four from osteonecrosis and sepsis, and four of osteosarcoma. During the decade ending in 1940, two more died from bone necrosis or sepsis, and twelve died of cancer. Six were osteogenic sarcomas, two of the bronchus or lung and one each of breast, ovary, an unspecified sarcoma of the orbit and an unspecified sarcoma of the neck. During the decade ending in 1950, one died of osteonecrosis and sepsis, but 22 died of cancer: three osteosarcomas, and two carcinomas of the paranasal sinuses. In two cases, no primary site is recorded and the other fifteen deaths were from cancers arising in eleven distinct primary sites. Twenty-eight cancer deaths occurred during the decade ending in 1960: three were primary in the paranasal sinuses, three osteosarcomas, two of uncertain origin and the remainder from thirteen primary sites. The New Jersey Radium Research Project closed in 1967, and for the six years ending in 1966, twenty-seven cancer deaths are recorded: two osteosarcomas, two from uncertain primaries and the others from fourteen primary sites. " Manland, op. rif. (n.4 above). Is Manland, op. cif. (n. 2 above). c 568 WILLIAM D.SHARPE Litigation In 1926, suits involving the first two known fatal cases were settled out of court, without assumption of liability by the company, for approximately what their estates would have received under the Workmens' Compensation Act had the deaths been covered, but this Act then included only specific, named occupational diseases and radium intoxication was not among them. The general rule governing industrial accidents was that '' . . . where no specific time or occasion can be fixed upon as the time the alleged accident happened, there is no injury by accident within the meaning of the act."'o This was reaffirmed by the decision when the company sued its insurance carriers for reimbursement of the claims it had settled, which held, "Poisoning resulting from industrial use of radium is not an accidental injury within the coverage of the particular employer's liability insurance policy."21 The judge ruled that "radium poisoning is an occupational disease and not an injury by accident," and although radium and mesothorium intoxication were made compensable in 1926.'? a law may not constitutionally be made retroactive, and the disability had to commence within five months of termination of exposure. Adverse publicity for the company was enormous and worldwide, fair trials were impossible and the statute of limitations held off bankruptcy only for a while. The company's insurance carriers paid maximum benefits within the maximum limits of coverage, but cases went to common law demanding dam- ages. In May 1927, five workers joined in a suit before the Supreme Court o.f. New Jersey asking $1,250,000 because they had been "given a year to live. This attracted much attention and came to be known as "The Case of the Five Women Doomed to Die.'' The defense pleaded both that the company had not been negligent and that the statute of limitations (at that time, in New Jersey, two years) barred recovery, so in July 1927 the suit was transferred to the Court of Chancery as a case in equity. However, Federal Judge Clark, acting as a private citizen and for humanitarian reasons, urged the disputants to compromise the suit so that the plaintiffs could obtain some relief while they were still aiive, even though Vice-Chancellor Backes, sitting in Newark, had ruled that the statute of limitations would not debar !he damage action as a case in equity. A preliminary hearing took place on January 12, 1928, but after three days adjourned to April 25, 1928, when again after three days it adjourned to :"Liondale Bleach Works vs. Riker, N . J . L . 426. :' U .S . Radium Corp. vb. Globe Indemnity C o . . 13 .V.J .Miw. 316 178A. 171. afirmed In 116 N J L. 90. 182.4. 626 11935). :: P.L. 1926. Chap. 31. p. 62. a& De I 9fir. c exr WC in ita! ca\ by Oni SUI: ari. brir pla Ne ho* Pes sur Cc I i pa 1 \aiL _- XARPE own fatal cases were settled out of y the company, for approximately .nder the Workmens' Compensation lis Act then included only specific, 1 intoxication was not among them. xidents was that '* . . . where no ?on as the time the alleged accident i t within the meaning of the act."2o hen the company sued its insurance it had settled, which held, "Poisonim is not an accidental injury within r's liability insurance policy."z1 The an occupational disease and not an Jiurn and mesothorium intoxication dw may not constitutionally be made mmence within five months of termifor the company was enormous and md the statute of limitations held off Id maximurn benefits within the max:nt to common law demanding dam] in a suit before the Supreme Court of they had been "given a year to live." ne to be known as "The Case of the :feme pleaded both that the company -tatUte of limitations (at that time, in ry, so in July 1927 the suit was trans,se in equity. However, Federal Judge for humanitarian reasons, urged the that the plaintiffs could obtain some 1 though Vice-Chancellor Backes, sit:Ute of limitations would not debar the 1 January 12, 1928, but after three days gain after three days it adjourned to ;,y.j,.%f;,,3c1.6. 178A. 171. affirmed in 116 N . J . L . 90. THE NEW JERSEY RADIUM DIAL PAINTERS 569 September 24, 1928. The Chancery Court returned the case to the Supreme Court for trial, but before it was heard, it was settled out of court in June 1918 through Judge Clark's intervention. Each plaintiff got a cash settlement of 510.O00 and a yearly pension of $600 to continue as long as a panel of experts (Drs. Lloyd F. Craver, Edward B. Krumbhaar and James Ewing) found that they suffered from the effects of radium intoxication. The company agreed to pay for future medical care; each got $7500 for her past medical treatment; and legal fees were paid. Publicity then went wild. and many additional suits were filed against the company-at least six reached the docket between 1930 and 1933. Substantial settlements were made to many of the affected women who, feeling that they had not long to live, were remarkably prodigal in their expenditures, again fell upon hard times and again became objects of sensational j o ~ r n a l i s r n(.T~h~e five women died in December 1929, February and October 1933, March 1938, and November 1946. The first and last ofthe five were sisters, and a third sister had been the first recorded victim in September 1922.) Generally, earlier cases against the company claimed that the work was extremely hazardous and that improper precautions had been taken for the workers' protection. Later cases added that the company had been negligent in failing to search out and to treat former employees. The statute of limitations and the company's bankruptcy precluded compensation for many cases, and the law was reaffirmed on appeal from a decision in a suit brought by one of the dial painters: Only fraudulent concealment will stop the running of the time permitted for fding of suit by the Statute of Limitations: in absence of any such fraud, a claim for injuries arising from tipping brushes with tongue to paint radium dials is barred by failure to bring suit within two years (the statutory period) of the causal episode even though plaintiff was ignorant of the harmful potentialities of ingesting radium.?' Neither the company, nor the workers, nor the medical community knew how dangerous radium and mesothorium were, nor did they dream that people would die of their effects half-a-century after a few months of exposure. Conclusion Occupationally absorbed radium and mesothorium produced unfamiliar patterns of disease during the third and fourth decades of this century. :' For a detailed medico-social accounr of one case. see W . D . Sharpe. "Radium osteitis with osteogenic 5arcoma." Bull. .Veu Yurl Acrrd. .Urd.. 1971. 4 7 . 1059-82. :'LaPorte vs. U . S . Radium Corp.. 13 F . Supp. 263 (1936). .. 570 WILLIAM D.SHARPE Although aplastic anemia, osteonecrosis and osteogenic sarcoma were known long before the isolation of radium, the recognition of radium intoxication as a cause in these patients depended upon association of clinical findings with the presence of these new and, in those days, unique substances which could then be identified and measured. The result was the delineation of a new disease and the definition of new safety precautionstoo late, to be sure, to help early cases but soon enough to forestall repetition of the disaster-with radium. Probably this forewarning that very minute quantities of radioactive materials deposited in the human body can be disastrous to the individual helped to avert a much more overwhelming series of radiation accidents during later work with nuclear devices, reactors and sources. In the New Jersey episodes, Federal, State, County and City Health De- partments did what they were established to do, and could not assume responsibilities which had not been assigned by law. Universities and medical schools were of no particular help even at a time when more interested in human disease than now seems to be the case. The Medical Examiner's and Coroner's Ofices, in most parts of the United States, were then still in the eighteenth, if not the seventeenth, century; but Essex County, New Jersey, was lucky enough to have a good Medical Examiner, Dr. Hamson S. Martland, who took jurisdiction as soon as the radium-related deaths seemed suspicious. The second death reported as radium-related was ruled to be a Medical Examiner's case, and all of those subsequently reported were investigated and examined. It might now take longer to identify such an industrial mishap than during the twenties. The neighborhood was small and homogenous, people knew one another, and many of the radium workers walked to work. Their physicians knew each other and talked among themselves. They knew the medical examiner well, indeed, Dr. Martland had a busy consulting practice as a syphiliologist. But who would now first suspect an industrial intoxication, with our fragmentation and professional isolation? And which of us can be sure either that we are not now incubating a similar horror story, or that we could identify it as promptly as did the general practitioners and County Medical Examiner fifty years ago? AT An ginia : hpit order: tions 7 missic can be 60-65 classif medic; Cion b! The of twer one hu unique rural cc Beta admitte 4,555 0. Univer5 from Fe discharg Grogrur The L imate ge of patie. percent,