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Oral Histories

Radiologist Earl R. Miller, M.D.

Foreword

Short Biography

Part I (August 9, 1994)

Wartime Work on Radiation Exposure

Remembrances of Joseph Hamilton

Neutron Therapy Research

Relations Between UC Berkeley and UC San Francisco

Working for the Manhattan Project and UC Medical Center

Process for Obtaining Radioactive Isotopes

Human Applications Committee and Informed Consent

Textbox: About Consent Forms (April 11, 1995)

Work With Soley to Diagnose and Treat Thyroid Disease With Iodine-131

Patient Consent; Contradicting Perceptions

Wartime Plutonium Injections

Hamilton's Research on Effects of Cyclotron-Produced Radioisotopes

Textbox: Dr. Joe Hamilton (April 21, 1995)

Research With Patients From Laguna Honda Home

Radioactive Iodine Uptake in Schizophrenia Patients

Recalling Dr. Joseph Hamilton

Invention of a Baby Holder (1951)

Technique to Produce Infinite Laminograms

Introduction of Stereoscopy to X-ray Film Making

Postwar Preference for Unclassified Research

Zirconium and Plutonium Injections

Research With Healthy Volunteers

Tracing the Records of Patient Consent

A Career in Research

Professional Contribution

Textbox: Recollections of Research Activities (April 11, 1995)

Remembrances of Personalities

Tension Between John Lawrence and Stone

Textbox: Robert Spencer Stone, M.D., L.L.D. (March 10, 1967)

Part II (August 17, 1994)

Use of Tomography to Diagnose Tuberculosis Patients

Textbox: History of Radiology, University of California at San Francisco, as Seen by Earl R. Miller, M.D. in the Mid 1980's

Working in the Radiological Research Laboratory

Investigating How Radiologists See Images

Establishment of the UCSF Radiation Laboratory

Remembrances of University Presidents Sproul and Kerr

Early Career

Work Through the AMA to Improve Radiology Training

Rise of Radiology Specialization

Study of Pediatric Patients With Congenital Heart Disease

Physiologic Studies

Appendix

Brief History, Earl R. Miller, MD

E.R. Miller's Residency and Career at UC

Recollections of an Old Crock (March 16, 1978)

Activities of Earl R. Miller as Indicated by Published Material (April 22, 1995)

Chronological Bibliography

DOE/EH-0474

HUMAN RADIATION STUDIES:
REMEMBERING THE EARLY YEARS

Oral History of Radiologist Earl R. Miller, M.D.

Conducted August 9 and 17, 1994

United States Department of Energy
Office of Human Radiation Experiments
June 1995

FOREWORD

I

n December 1993, U.S. Secretary of Energy Hazel R. O'Leary announced her Openness Initiative. As part of this initiative, the Department of Energy undertook an effort to identify and catalog historical documents on radiation experiments that had used human subjects. The Office of Human Radiation Experiments coordinated the Department's search for records about these experiments. An enormous volume of historical records has been located. Many of these records were disorganized; often poorly cataloged, if at all; and scattered across the country in holding areas, archives, and records centers.

The Department has produced a roadmap to the large universe of pertinent information: Human Radiation Experiments: The Department of Energy Roadmap to the Story and the Records (DOE/EH-0445, February 1995). The collected documents are also accessible through the Internet World Wide Web under http://www.hss.energy.gov/healthsafety/ohre. The passage of time, the state of existing records, and the fact that some decisionmaking processes were never documented in written form, caused the Department to consider other means to supplement the documentary record.

In September 1994, the Office of Human Radiation Experiments, in collaboration with Lawrence Berkeley Laboratory, began an oral history project to fulfill this goal. The project involved interviewing researchers and others with firsthand knowledge of either the human radiation experimentation that occurred during the Cold War or the institutional context in which such experimentation took place. The purpose of this project was to enrich the documentary record, provide missing information, and allow the researchers an opportunity to provide their perspective.

Thirty audiotaped interviews were conducted from September 1994 through January 1995. Interviewees were permitted to review the transcripts of their oral histories. Their comments were incorporated into the final version of the transcript if those comments supplemented, clarified, or corrected the contents of the interviews.

The Department of Energy is grateful to the scientists and researchers who agreed to participate in this project, many of whom were pioneers in the development of nuclear medicine.

DISCLAIMER

The opinions expressed by the interviewee are his own and do not necessarily reflect those of the U.S. Department of Energy. The Department neither endorses nor disagrees with such views. Moreover, the Department of Energy makes no representations as to the accuracy or completeness of the information provided by the interviewee.

ORAL HISTORY OF RADIOLOGIST EARL R. MILLER, M.D.

Dr. Earl R. Miller was selected for the oral history project because of his research at the University of California (UC) Medical School at San Francisco, California. This oral history covers Dr. Miller's service involvement with the Manhattan Engineer District; total body irradiation; Dr. Ernest Lawrence's heavy-ion therapy; the division between UC Medical School and Donner Laboratory; and the receiving of isotopes made on Berkeley's 60-inch cyclotron. Dr. Miller also discusses his research on cleft palates and his infant cardio- and urinary tract studies.

Two oral interviews were conducted with Dr. Miller at his residence in San Rafael, California. On August 9, 1994, Ms. Anna Berge of the Lawrence Berkeley Laboratory Archives and Records Office and Dr. Gregg Herken of the Advisory Committee on Human Radiation Experiments interviewed Dr. Miller. On August 17, 1994, Ms. Berge met with Dr. Miller for a follow-up interview.

Short Biography

Earl R. Miller was born in Milwaukee, Wisconsin, on October 18, 1907. He was married in 1931 and was widowed in 1978. He has two children. By 1931, he had received both his B.A. and M.A. in Physics from the University of Wisconsin (UW). He attended the UW Medical School from 1932 to 1936. After receiving his medical degree, Dr. Miller interned at Research Hospital in Kansas City, Missouri (1936–37), completed a residency in Radiology at Stanford University (1937–39), and was an instructor in Radiology at Yale University (1939–40).

In 1940, he joined the faculty of the Radiology Department at the University of California Medical School at San Francisco as an instructor and was board certified in Radiology. He served as chairman of the Department of Radiology from 1943 to 1945. In 1949, he was made a full professor in Radiology, a position he held until his retirement in 1974. From 1958 to 1974, he was the Director of the Radiological Research Laboratory in the Department of Radiology. From the mid-1950s until he retired, Dr. Miller spent his mornings in clinical practice and teaching, while his afternoons were spent in clinical and laboratory research. His research included the introduction and use of angiography; the use of radioiodine; the development and use of x-ray diagnostic techniques, sound movies, and ways to reduce patient exposure; and the study of error in radiologic interpretation.

During this same period, Dr. Miller held the following positions:

  • 1943 to 1945—Director of Health Physics for the Berkeley Division of the Manhattan Engineer District,
  • 1950—Fellow of the American College of Radiology (ACR),
  • 1954 to 1957—Member of the Board of Chancellors of ACR and Chairman from 1957 to 1958,
  • 1957 to 1965—Member of ACR's Commission on Education and Chairman from 1960 to 1965, and
  • 1960s and 1970s—Served three terms on research panels on radiology for the National Institutes of Health.

Among his many honors, Dr. Miller received a Gold Medal award from the ACR in 1972, and the Regents of University of California renamed the Research Radiological Laboratory the Earl R. Miller Radiologic Imaging Laboratory in 1978. Dr. Miller was a pioneer in radiology and has published more than 135 papers.


Part I (August 9, 1994)

Wartime Work on Radiation Exposure

BERGE: This is an interview with Earl Miller by Anna Berge and Gregg Herken of the Lawrence Berkeley Laboratory Archives and Records Office and of the Smithsonian Air and Space Museum,1 [respectively,] on August 9, 1994, at Earl Miller's residence.
HERKEN: You were just going to tell us about the relationship between the Division of Medical Physics and UCSF2 and how in fact, you were that contact.
MILLER: In 1942, early on, Dr. Stone,3 who was the head of the Radiology Department at UCSF, was recruited, I think by Dr. [Arthur] Compton,4 to head up the radiation safety of what became the Manhattan Project.5 At that time it was called the Metallurgical Lab.6 At any rate, that left the [UCSF Radiology] Department without a head, and I got called for that. That's when I learned I would never never ever [want to] be a chairman again.

One day, my good friend Staff[ord] Warren appeared. He was a professor of Radiology at [the University of] Rochester in [Rochester,] New York. He came then to UCLA7 and became the dean there. He appeared on the scene one day and recruited me to head up the Radiation Safety Division of the Manhattan Project over in Berkeley.
HERKEN: This would have been what date?
MILLER: I think it was in early '43.
HERKEN: You worked in radiation safety?
MILLER: Yes, two half-days a week, I directed it. I would leave UCSF at noon, and I would go over to Berkeley. Usually the half-day finished at 10 or 11 or midnight. The work consisted primarily of getting blood counts8 on people, checking out their radiation dosimeters,9 and making the rounds of the various parts of the Berkeley Manhattan District. That got me into seeing the work of the physicists at the cyclotrons10 and the chemists.
HERKEN: You knew Stone beforehand?
MILLER: He gave me a job as an instructor at UC in the Department of Radiology in 1940. Now we're going to talk about Stone?
HERKEN: Yes.
MILLER: Okay. He was an excellent radiologist.11 His main work and interest, when I got there, was in radiation therapy, and he was a pioneer in that. When I got there, there was a need for some young buck who had just finished his residency as an instructor in Diagnosis. That's what I did. What else [would you like to know] about Stone?
HERKEN: You said he was engaged in teletherapy.12 This would be with total body irradiation [(TBI)] with x rays?
MILLER: Not total body irradiation. He treated patients with various kinds of malignancies with modalities that varied from 100 kV13 up to one of the very early million-volt machines.
HERKEN: This was the "Sloan machine"?
MILLER: Yes. He built the tanks and whatever.
HERKEN: Stone indicated in the official history that he wrote for the MED14 project that he was doing TBIs in the period of 1940.
MILLER: What's that?
HERKEN: Total body irradiation, TBIs, from 1942 to 1946 under contract of the Manhattan Project.
MILLER: He wrote that?
HERKEN: Yes. It was the case, actually, that there were three hospitals involved. There was San Francisco, New York, and Rochester.
MILLER: The last was Staff Warren.
HERKEN: That's right. It was a MED project, a Manhattan Project. They were interested in the effects of radiation upon the workers, and this was a way of finding out how it affected people. They were getting terminal patients in this case. I think there were a total of 32 or 36 in this case.
MILLER: Oh, yes. Okay. I presume that this total body irradiation was for a real purpose.
HERKEN: It wasn't therapeutic?
MILLER: Yes, I suppose it was aimed at being therapeutic. That's important. The idea was to see if there could be an effect, let's say, on the blood system or the lymphatic system15 that, influenced by the total body radiation, would do something helpful for the treatment of the cancer.
HERKEN: Were you aware, and were the people aware, of that part of the project? That would have been a secret project, it would have been classified at that time [by] the MED, the Manhattan Project.
MILLER: They classified everything. The important thing at that time in that war was a race for a bomb. Even the fact that radiologists were recruited to work was secret, because somebody over in Nazi Germany would have said, "Radiologists, they're all doing that? They must be doing something which deals with radiation! A radiation bomb!" It was hidden, yes, only from the bad boys over in Germany and from people who would talk out of turn.16
HERKEN: But pretty much, doctors at UCSF knew about what Stone was doing for the Manhattan Project?
MILLER: No, nobody knew what either Dr. Stone or I was doing. I want to go back to that. The secrecy dealt with not giving information to the people we were at war with.

Remembrances of Joseph Hamilton

HERKEN: Hamilton17 is another figure that we're interested in. Can you tell us a bit about how you met him, when you met him? I assume it's about this time.
MILLER: He was running the 60-inch cyclotron in the Crocker Lab.18 He was doing really fantastically important work checking up with animals on the effect on every organ of every radioactive isotope. As I say, he did a great great job. Ken Scott was involved in some of the chemistry parts of it. Ken was quite an inventor, too.

Joe had no fear of radiation. He used to lean up against the D's. You know what a D is in the cyclotron? They were very radioactive. I was always going around with a Geiger counter in my hands in those days. I tried to talk to him about the danger. He ultimately died of radiation.19 This was massive doses of radiation that he exposed himself to.
HERKEN: I've never quite understood that. Hamilton certainly knew the danger. He knew the physics as well as the medicine behind it.
MILLER: When you talk about the danger, the so-called danger of some radiation has been so overemphasized and so wrongly overemphasized, that this has done a fantastically bad job on making people understand what radiation does to people. You get to the point where a person might not ever have a chest film because of this tremendous [perceived] danger, that they thought was going to kill them, and of course they die of tuberculosis. Even intelligent people are very very concerned about these minute amounts of radiation.

(speaking facetiously) The reason I died young—I'm 86 years old—is because I have a stack of [x-ray] film that's probably a foot and a half high. I made my living during medical school running a radon plant, where you get that bad stuff. That's why I died young. Of course I smoked a lot and drank a lot. The radiation protected me. [(This is meant as sarcasm.)]
HERKEN: But Hamilton's case—we're not talking about minor doses.
MILLER: This was massive, and they were total body radiation.
HERKEN: Why the disregard for the danger?
MILLER: I don't know; he thought he was above it.
HERKEN: I have the impression that his concern was in pure science, hence he was not really concerned with his own well-being.

Neutron Therapy Research

MILLER: Exactly.

Another thing interested me about it. The people who were really injured by radiation, all worked around neutrons.20 I don't know whether the gamma rays from the D's were really an important aspect. Whether he was just another one of the neutron guys: Stone, [Bert] Low-Beer,21 Hamilton.
BERGE: Could you tell us a little bit about Low-Beer?
MILLER: Great guy. He was the head of the [Radiation] Therapy Division [of the Department of Radiology] at UCSF when Stone was away. He was a good radiologist. His research work was primarily surface radiation with phosphorus for skin lesions. He got involved with neutrons later, working with Dr. Stone.
HERKEN: Was he involved in the early neutron teletherapy with Stone?
MILLER: I don't think he was involved with that, early on.

Stone did magnificent work. When Stone took on a project, his records were accepted as the best in the world. When he took on this neutron stuff and his million-volt radiation, all of these patients were followed up faithfully. The records were great.
BERGE: I've got a question about the neutron therapy.22 In the late 1930s John Lawrence was beginning to be discouraged with neutron therapy, and I noticed that there was a revival of it in the later '40s and '50s. What brought about that revival?
MILLER: In 1930?
BERGE: In the late 1930s, John Lawrence was discouraged with the therapeutic effects of neutrons.
MILLER: There were a lot of problems with that. John Lawrence was a physician; he wasn't a radiologist. There were a lot of—I won't say, unpleasantness about it—but a lot of unwillingness to accept the other person's point of view between Stone and John Lawrence. But I didn't know that Lawrence ever got involved. I don't know about the neutron stuff. When Stone took it on, as I remember, there were several people in various parts of the country that were trying to find out what the score was on neutron therapy. I don't know any more than that.

Relations Between UC Berkeley and UC San Francisco

HERKEN: There was apparently tension between the Division of Medical Physics in Berkeley and physicians at UCSF. Can you talk about that a bit?
MILLER: They wanted to start a medical school in Berkeley. I think mainly that was it.
HERKEN: I know that Raymond Birge was the Physics chairman at Berkeley.
MILLER: Who?
HERKEN: Raymond Birge. He was the head of the Physics Department at Berkeley, and he wrote a history of the Physics Department. He talks in his history of the creation of the Division of Medical Physics back as early as 1944. This is when John and Ernest Lawrence went to Sproul23 and proposed the creation of it. Apparently there was some cooing and crowing between physicians at UCSF and John Lawrence in particular.
MILLER: I was never involved in that; I can't help you.
HERKEN: The upshot of it was that if there were any human subjects to be involved in research, that work would be done at UCSF and not at Berkeley, and yet there was a therapeutic unit, as I understand it, at Donner early on.
MILLER: But that was run by Stone. At least, the only people that I know that did anything with neutron therapy with patients was Stone, and later Low-Beer.

Working for the Manhattan Project and UC Medical Center

HERKEN: Now, you had a joint appointment with the Division of Medical Physics and with UCSF, or not?
MILLER: I think my appointment was with the Manhattan [Engineer] District through Staff Warren.
HERKEN: Right. But you were on the medical staff of UC Medical Center.
MILLER: Exactly.
HERKEN: And no part of your salary came from the Division of Medical Physics.
MILLER: No, I never got paid for the work.
HERKEN: Hamilton and Stone had joint appointments,24 as I understand it?
MILLER: I don't know.
BERGE: In 1946, it looks like you were head of the Health Physics Division for the Radiation Laboratory.
MILLER: I thought it was way before that. That's what Staff Warren got me into.
BERGE: But the Manhattan District went on until about 1947 or the end of 1946.
MILLER: At the end of the war, that was it for me.
BERGE: What did you do when you were the head of that?
MILLER: I just told you. Remember? The blood counts and all that? That was the thing I did, going around trying to find out if anybody was unduly overexposed to radiation.
BERGE: You mentioned that you didn't ever want to be chairman again after that.
MILLER: That's "the chairman of an x-ray department."
BERGE: You didn't like it?
MILLER: No. I wanted to do my own research.
BERGE: What was your own research contribution?
MILLER: You can read about it in my bibliography.

Process for Obtaining Radioactive Isotopes

HERKEN: I have a question about how the isotopes were obtained and how they were used in research that Hamilton was doing. Since he was running the 60-inch [cyclotron], did he introduce his own [method for producing isotopes such as iodine-131]?
MILLER: There that's where he got it. That's how Ken Scott got me the radioiodine to work on thyroid disease.
HERKEN: How would the mechanism of that work? Would you just call over or see Ken Scott and say, "Make up a batch"?
MILLER: I think he finally was bringing a supply over once a week.
HERKEN: And Scott would get on the ferry over in Berkeley and bring it over to San Francisco and get it to you at the lab.
MILLER: I do not know how he got from Berkeley to San Francisco. The radioiodine was brought to my office, which I [had] turned into a lab. We studied the radioiodine for a long time.
HERKEN: Starting when?
MILLER: When the radioiodine became available. I think that was after the war; I could look up papers. ([The] first paper on radioiodine that I published was in 1948.)
HERKEN: I know that there was an approval process for the isotopes after the war. In order to use isotopes, you had to get permission of the Division of Isotope Distribution out at Oak Ridge.25 Was there anything like that during the war?

Human Applications Committee and Informed Consent

MILLER: I don't know. It seems to me that later on at UCSF there was a committee set up, probably by Stone, dealing with this matter. When I say "set up by Stone," I think it was set up by a lot of other people with this fantastic fear of radiation. Sometime there was one set up at UCSF.
HERKEN: Yes, I think this was something called the Human Applications Committee.
MILLER: Yes. You know more about it than I do.
[Textbox: About Consent Forms (April 11, 1995)]
HERKEN: I've not been able to find out very much about it. Ken Scott talks about it in his oral history. He said that at one point he was even the chair of it. He said the way it worked was that some of the physicians would bring names of potential subjects to them, and they would recommend a course of action. I think this ultimately went to the university president. President Sproul was involved in officially approving it before it would come back and experiments would begin. I was going to ask you if you could remember if that sounds true to you.
MILLER: I don't know. I think by the time that got started I was way off on something else. I got off on x-ray movies and physiologic26 studies.
HERKEN: As far as the approval process was concerned, that was something that was handled in Berkeley. You would call up Ken Scott and say, "Send me iodine-131 [(131I)] for use." And the approval process would be handled by the committee.