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Oral Histories

Radiologist Earl R. Miller, M.D.


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


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


Earl R. Miller, M.D.

I was born on the South (laugh) side of Milwaukee, Wisconsin in October 1907, the year of the Great Panic. I presume that there is a connection, but I prefer to ignore it. My elementary school days were passed learning how to get beaten up. I remember using the word wafted' in a sentence one day in the eighth grade. I hurt for days after that.

My mother died when I was thirteen years old, and Dad was broke after her seven- year illness. During High School, I became chief cook and bottle washer. Cordon Bleu I was not, but we survived. During the summers, I worked in a foundry, in an ice house, and a pea canning factory as a weigher. I was given the weigher job because I could count.

About this time, I met Eddie Krumbiegle who lived on 7th Avenue near Greenfield Avenue. That was about 4 blocks from where I lived. We were about the same age. Except for my Dad, he became one of the most influential persons in my life in boating, scholarship, and music.

During high school days, we started to see a bit of each other, mainly at my house. We built a sailboat together, a 17 flat bottomed, center boarded, sloop rigged sailboat with a bow sprit forward and a boomkin aft. We even made the wooden spars with draw knife and spoke shave. We launched it one summer day in Lake Michigan on the North Side beside the beautiful yacht Christina owned by the Pabst brewing company family. On the day of the maiden voyage, the Captain of the Christina, recognizing that we were novices, asked if he could go along for the ride. We jumped at that, and he took the helm.. I will never forget my sensation when we raised the sails. The boat became alive and I was hooked on boating. We had an offshore breeze and sailed South on a broad reach along the shore. What a thrill About a half hour out, the starboard tumbuckle let go and the mast tipped to port. The Captain flipped the boat around on the port tack and sailed us home, laughing all the way. We replaced the tumbuckle with one that would had worked well on the Queen Mary if she had had sails.

I became so involved in boating that I owned 13 boats in my lifetime. They were mostly sail boats: monohull, catamaran, trimarans; some had inboard, outboard, and inboard-outboard engines on motor boats. Years later I designed and built a catamaran in my garage (yes, she did come out of the door, with minor reconstruction of the garage door.) Built along the lines of a Tiger Cat, she was seventeen feet long and, at one time we got eighteen measured knots out of her. What a thrill That boat almost cost me my life twice. The first time happened when I was pouring flotation into the bows. The directions say that the material is dangerous and must always be used in the open air. No one believes directions, and it was cold outside. I began to cough a little, and then the phone rang. The phone was at the top of the stairs in a closed off space. There the coughing became really severe and I suddenly realized the smell was that of cyanide, and I could see the green room in San Quentin. I dropped the phone, ran outside, and survived, but now I read directions. Later, under the Richmond Bridge, north of San Francisco, in a following sea, the aft hatch covers floated up enough to let the aft end of the boat swamp. I was sunk up to my chest and the boat floated at that canted level. A tug from the Long wharf (Chevron) came by and picked up my passenger and me. We got aboard and I was given a cup of hot coffee. I remember trying to hold it still enough to drink. I was shaking so much that I had to hold it in both hands. it was practice for the time that I might become a drunk. The flotation almost killed me, but then it saved our lives. Even Steven.

One day, I was up in Ft. Reyes, California, duck hunting. I went into town for a bottle to give to the club. On the way, there was a Lion's Club bazaar. and on the field, I noticed what seemed to be a boat on top of a boat. I went over to examine this strange structure and found that it was a foldable 24 foot trimaran with the sponsons folded on top of the main hull. The hull was full of water, so I figured that if it would hold the water in, it would hold the water out Only the hulls were there. The price, after $40 had been crossed out, was S15. I decided then and there that I had to have that boat. I went back to the club and one of the men, Toby Giacomini, agreed that he would deliver it to Sausalito if I bought it. I immediately made out a check for the $15, and then wrote a check for the Lion's club as a contribution...but I wanted that boat for $15, for the following reason: I named it the V which Is the appearance of a trimaran from the aft end but also was the price of the Latin. How erudite can you get?

Later, I fell in love with a beautifully built 28 foot trimaran equipped with an El Toro dinghy. I couldn't resist it. I still had the catamaran and the 24 foot trimaran so, I had four boats with nine hulls. There are two solutions to that one.

The bigger tri was a great joy. The kids used to dance on the deck. In the summertime, the sun does not go down till about 9pm. I would leave the office, take the twenty minutes to get to the boat, go out on San Francisco Bay, watch the sun go down, and then see the lights come up in the City. Dazzling sight!

One day, Bob Moseley, then a airman of the Radiology Department of the University of Chicago, came aboard for a day of sailing. He was very tired from a long stretch of hard work. The boarding was celebrated by a Bloody Mary, followed by undiluted Beefeaters for the rest of the day. I have a picture of Bob with the drink blowing out of his glass as he manned the helm. One of the advantages of a trimaran is that, while your drink may blow over the side, it will never tip over. Preparing to come into berth, I started to put down the sails and start the kicker. Bob asked me what I was doing... "Every good sailor sails into the berth." he said. I said, "Go ahead." Without a minute's hesitation, he took the helm and brought the boat into a perfect landing. About three o'clock, the next morning, he woke up in a cold sweat thinking about this and never forgave me for letting him do it.

I was interested in the mind of Russ Morgan at work. He was a graduate Electrical Engineer and Professor and Chairman of the Department of Radiology at Johns Hopkins. He came aboard one day, having never been on a sail boat in his life. After we had started, I told him to take the wheel. He did, quietly as always. He looked up at the sails, turned the boat both into and off the wind while studying the action. I warned him only about gibing and explained that maneuver and its consequences, again only once. He sailed the whole day like a pro.
Enough about sailing.

There was another way in which Eddie Krumbiegel enriched my life. He played the piano. Both he and I had had the usual lessons. The results were nothing spectacular. We attended dances at the Wisconsin Roof where there was a piano player who became the soloist. Some time each night the rest of the big band pretended to get into a squabble and one by one they left the stage. The last one off put a huge megaphone over the piano player's head and he started to play. All the dancing stopped and the assembled mob stood close to watch and listen. We were entertained by a unforgettable jazz concert.

Eddie decided to take lessons from this man. He charged $10 for a half hour session, a huge sum in those days. He taught the fundamentals of harmony and a solid left hand using 10ths in the base. I listened to the change in Eddie's playing and decided that I too would go to the man br lessons. Using the money that I was earning from giving lessons on the very popular ukulele, I took six piano lessons. This experience changed my life. I now understood how music was made and from that time on I could - make music. During College days, I played piano in dance bands at Fraternity parties and for awhile I held a joy accompanying Bruce Will, a singer buddy of mine, on the local radio station in Madison. That paid $20 each for a half hour's work.

I also learned an economic lesson while teaching the uke. With time I gathered more and more students. I decided to double my fee from $3 per hour to $6 per hour in order to reduce the number of students and have more time for myself. Instead the number of students doubled. The lesson was that if I charged double I must be worth double. But I didn't change.

Our families couldn't send us away to College so Eddie went to a local normal school and I went to the University of Wisconsin Extension Division In a dreary office building in Downtown Milwaukee. Three nights a week I worked in a bowling alley setting up pins for five cents a game, and no tips. I developed a strong back and an acquaintance with Acey Deucy, a fast betting card game. I had a chance to watch some of the pros at work in this game and have never gambled with people I didn't know since. Dinner was usually a one pound bowl of "Chili" which sold for fifteen cents. I can't look a bean in the face since, and the feeling is mutual. I nearly flunked out that first year at the college level. The only thing I remember clearly was a statement made by the professor of Chemistry. He came from Waukesha, Wisconsin, the home of the "World's Finest Spring Water." The best drink in the world,- he said, is one drop of Waukesha Spring Water in a barrel of Whiskey.- So much for higher education.

My family took a long motor trip during one summer and Eddie and I played loud music at my house with pick-up bands. Since the windows were all open, I'm sure the neighbors wanted to kill us.

Summer ended and I decided to go to the same school that Eddie attended. At least there was a campus there with playing fields and girls. I learned that Eddie was a straight A student. I remember the day I said to myself that n he could get all A's, so could. So I did.

Eddie went on to Medical School at Marquette where he was considered to be the best student they ever had there. For example, one day an examination was given. Eddie turned in his paper at the end of the first hour. He was informed that it was to be a three hour exam. He received the highest mark in the class. He went on to be elected and reelected to the office of the Chief of Public Health in Milwaukee where he served with distinction hr the rest of his active life. I went on to Madison and we lost track of one another.

College days.

Madison, beautiful Madison, became my home for a number of years after that. I studied physics and mathematics there. Being poor, I lived in the dorms that were provided by the University, lovely, large stone buildings on the shores of Lake Mendota. We poor people lived like kings. Being poor during summer school in Madison is like being rich on the Riviera.... in spades and bikinis The thirties were depression days, but there were some compensations. Filet Mignons sold for ten cents a steak When barbecued over an open fire on Picnic Point, they were delicious indeed. When lighted by the spectacular Mid-west sunsets, all was right with the world.

Pocket money was made by playing in dance bands at fraternity and sorority parties. It was interesting to see how the other halt lived. I remember getting a prize in a French class: the booby prize for having the worst pronunciation the professor had ever encountered.

One day, the great Dr. Warren Weaver, later Head of the Rockefeller Institute, teaching statistics to about 25 post graduate students in physics and mathematics in Wisconsin in 1930, said to us, "Think of a number." Pause. "I'll give you a hundred to one odds that the number is less than 10 to the 18th." He was a man who thought BIG. I never learned the art, but I've met some since who thought the same way.

Professor Wahlin, during my post graduate study in physics, gave me a task of finding forbidden transitions in the infrared spectrum of copper and suggested that I use an interrupted copper arc to bring them about. It was fun making up the apparatus, but a little disconcerting when the lab burned up one night. Nothing much was hurt because the lab was in a concrete hole in a basement room which housed a Bowen 21' grating where the spectroscopic work was done. I tried again, and after monitoring the arc for 365 hours (I remember that because it was exactly the number of days in a year), and getting no data on the photographic plate, I decided that if I had found all the forbidden transitions in all of the spectra of all of the elements, it would not have made any real difference to PEOPLE.

After a short week with my professor who seemed relieved that I was leaving. he suggested that I might go over to the Medical school and talk to Dr. Pohle, head of the Department of Radiology, to see if work in that area might be more to my liking. I was ushered into The Presence by a red-headed secretary. She wasn't shaking in her boots, but I was. After what seemed like hours, THE MAN looked up from his papers, listened to my story, and assigned tour papers to be read and reported on in a week. Having nothing else to do, I read the assigned ones and then read all of those listed in those bibliographies. this sounded like fun. I reported in to THE MAN through the red head, and had the same wait. He asked me about the assignment and then suggested that I read about ten more papers. After each, I said, I read it.- One was Cade's book on Radioactivity. That stopped him for an eternity which by actual time was about four seconds.

He rose, strode out of the door, and said. Follow me.- That I did, like a little dachshund. Down the corridor, down the steps, to the left, and then to the left again. No words. He took a key from his key ring, unlocked a door, turned to me, gave me the key, and said, "This is your lab." and walked off

There I was in a basement again. I didn't see him for about a week. During that time, I stole all the equipment that I could get from the basement of the hospital preparing to do work that I wasn't sure about, but it seemed like the lab needed some more goodies. The reading helped too, but it was unaimed but fun. Then came a tour of the department where I met Dr. Lester Paul. From that day on, work became a real joy. Dr. Paul let me see him at work and we finally rigged up a means of doing serial films on barium enemas to study the physiology of the colon. That was the start of my life- long interest in presenting anatomical and physiological data simultaneously.

The boss had finally assigned me the joy of calibration of therapy equipment. That gave some track to the day. I was also given the task of looking into the ultra-violet therapy machines and calibrating them. Physical therapy was a part of Radiology then Dr. Pohle also became interested n therapy with positive and negative ions in air. This was an exciting idea but it didn't take long for me to realize that I needed to know much more about a lot of things before I could make any sense out of such a complicated process. The investigation soon died an ionized death.

Dr. Pohle told me about a job at the Rockefeller Institute in New York working in the Department of Biophysics. I was off to the Big Apple. What a year New York in the depression days was a friendly place in which one could walk anywhere anytime, and walk I did. I had an actual salary which, at that time, seemed magnificent. That let me try the exciting foods and see the exciting places. The third Avenue El takes one to the Battery and the Staten Island Ferry. The subway whisks one from the Rockefeller to Columbia in minutes. Columbia at that time ran night classes, and there I got my first taste of Biology and Zoology. At Cooper's Union, there were night classes in advanced mathematics. The worst Time of the year was having Christmas dinner alone in a automat. The work at the Lab consisted of raising fruit flies and irradiating the eggs with a copper anode pumped out tube for the purpose of creating mutations (copper, again). Flies and me don't get along too well right at this moment. One of the pieces of equipment on my desk is a fly swatter.

In the spring, Dr. Pohle invited me back to Wisconsin to nun the radon plant and to be the physicist for the department. I drove from New York to Madison in an open, three seated, 1917 Willy's Knight, car for which I paid $75. The only accident I had was when a fire occurred in the engine outside of Akron, Ohio. A farmer and roadside sand put me on my way again after the farmer rewired the car. Good Samaritans were plentiful in those days. The trip was made in three days at 35 miles per hour, except in Chicago where I had to speed up. The car died in front of the dorm in Madison, was towed off, and never moved again. I think Chicago dealt is a mortal wound, but it waited to die in a beautiful place. That car had a real personality.

The job was a half-time job that paid $73.08 a month but did include a $50 a month research budget for materials. The money came from the Steenback patent for making Vitamin D. This money was given to research people in the University and was the greatest idea yet. It one ever wants to leave money to a University for young researchers, this is the way to do it... Not to pay salaries, but to give to the workers, the materials and tools to do the work.

It didn't take long to get the radon pumping joy down to a system. I did the work at night with a total investment of twenty minutes of time spend out over about one and a halt hours, three times a week. This left plenty of time for study and classes. The other part of the work was calibration of the therapy equipment on a daily basis, and changing the air-cooled tubes when they blew out.

The BIG MAN never made a mistake But he did once. Harry Hook was a technician in the diagnostic department. He was small enough to get his arms into the tank that held the burned out tube and he could get it out of the tank. Harry could get into more trouble in a minute than an army could in a year. The Boss, grounded the big capacitors with a single stroke of the grounding rod. Harry reached in for the tube. Out the door he flew when the big arc hit him. He swore, picked himself up, and went in and grounded the capacitors in the same way that the Boss had done. He reached into the tank and out the door he flew! That was Harry all over.

I build a copper transmission anode pumped-out tube like that we had used at Rockefeller but it was to be used for trying to get Laue patterns from various mammalian tissues. The anode was water cooled. It consisted of a thin copper (again) sheet. The water was piped to the tube from a sink on the other end of the lab, through glass tubes held together by rubber sleeves. Dr. Pohle was waiting for me one morning with a scowl on his face. He hadn't liked the idea of having to have forty- seven pails of water mopped up in the lab when the water line broke during the night. It must have been the copper.

Dr. Pohle used to invite the whole staff for dinner on frequent occasions at his beautiful house out in Shorewood. His supply of drinks found willing users because we couldn't afford liquor in those days (since it was prohibition). Target shooting in the basement was a usual after dinner sport. Your target from the night before was always on your desk in the morning.

One day in the late Spring after a couple years on the job, I went to the office to talk to the chief about what he thought about my going to Medical School. I was tempted in this direction because, while I knew more than the doctors about the radioactivity that they were using, they were the ones that applied it to people and made a difference to them. They signed their names, and I could only assure them that what they got from me was the right stuff (the red-head was still there). This Time, the chief rose almost immediately after hearing my opening gambit and said, "Follow me." I'd heard those words before, and I landed in the basement Without a word, we went through the halls out into the sunshine, and over to the little house where the Dean of the Medical School held sway. I didn't know that that was where we were heading. In fact I didn't know that the Medical School had a Dean.

The boss lead me into an office, introduced me to the great Dean Bardeen, saying, "Here's a candidate for your school," and left without another word. After he got my records, the Dean accepted me. Things were simpler in those days. I think I got in because the boss and the Dean were friends. A whole new life opened up. In those days, they used to take anyone with a C average into medical school. On our first day in class, there were 180 students. At the end of three days, after going into the anatomy lab, there were about 160. After the first six week's exams, there were about 120. After the Pathology exam in the second year, there were about 90. Only 50 were inducted into the third year. It is said that this is a bad system and that It leads to killing competition between the students. Exactly the opposite was true. We helped each other as much as we could. Those who made it into the third year really wanted to practice medicine, and I think that, in general, it made for a fine medical profession. They were tested in the fire.

At the present time, a medical student is practically given his MD at the time he enters medical school. By the time he graduates, that person is not necessarily the same one who applied to that school. Just because he's a bright guy doesn't mean that he will become a good doctor. It is said that the Wisconsin system is too expensive. I think that the cost of one poor doctor exceeds the cost of starting the training of many and weeding out those that do not cut the mustard and who are unwilling to do what is necessary to become a part of this great profession. During our four years in school, our teachers found out more than how much we knew. They found out what kind of persons we were. The class was small enough so that our major teachers know us all by name. A class of 50 students seems to be about the right number and when the classes get too large, this important aspect of teaching is lost. The students also learned something about the teachers as people. They became our heroes rather than our faceless antagonists.

I remember one time almost asking Dr. William Middleton, Professor of Medicine, why his patients sometimes died. I thought that any physician as great as he would never let them die. I bit my tongue just in time...and it hurts yet. Dr. Middleton, The Big Train,- was a short man who came from Pennsylvania. He gave the whole morning each day to teaching medicine during the third year. One day before I got into school, he made the crack to some poor erring student that he got the brown derby for his luckless answer to a question. A brown derby is Pennsylvania slang for a dunce cap. The boys got together and presented him with a real brown derby. Brown derbies were hard to get in those days, but with such a project, persistence paid off. The hat was about a size 9. That made it drape over one's ears in a silly fashion. Each year thereafter, a brown derby was found and presented to the Big Train by the third year class. Dr. Middleton wore it the first day of class as a symbol of humility. It was a touching experience.

Then came the second day He entered class on the minute as usual, picked up the hat, and asked the first question. The day's assignment was on gout. Victor Neu was a Ph.D. in Pharmacy. He had worked in research on uric acid in chickens during his post graduate days. 'What's the normal level of uric acid The answer was given in chicken units...and the hat sailed across the room to be signed and worn by a man forever after named "Hyperuricacidemia Neu." He was never addressed any other way...and the Big Train never forgot. The hat was worn until the next Boo -boo when it was passed gratefully to the next red-faced victim. I was lucky enough never to have had to wear the hat. I'll never knew why...but I do remember that when it was announced that I had made AOA, The Medical School Honor Society, the Big Train snorted. He knew I wouldn't amount to anything.

The Big Train had a nickname for almost all the students. One of the students in the class had been straight A from 'day one' in school. He was a home Irishman who was too bright to exist. We called him Dog Face, the Big Train called him Big Shot. We were partners in Physiology laboratory, four of us. When Dog Face got within ten him to recording data and all was well. He became a successful psychiatrist.

The Big Train ran all of this classes by means of quick sessions on assigned material. Woe unto anyone who was not prepared. I can't think of a better way to teach. At the end of a class, the MAN would summarize the whole thing and bring it all together for us. Marvelous!

He also ran the weekly Pathology conference. The protocol was handed out on the preceding week. He stood before us on conference day and quizzed the class on all of the findings and demanded that we knew what they meant. Then he would put it all together and make his diagnosis. The pathologist, Dr. Bunting, would rise and, if possible, tear the diagnosis to shreds. It didn't happen to often, but when it did, mere was great glee among the peons. It was part of his teaching of humility, and we all respected him for his demonstration of it. He put himself on the line.

Half of our last year in school, during 1936, was spent away from the campus in various activities. One of these included living in an insane asylum for two weeks. I remember my first meeting with paranoid schizophrenic. He was a well-trained engineer and very bright. His trigger point was that he knew the world was flat. When asked about this, he would embark upon a big tirade about the tact that all the measuring instruments were affected by the position on the flat earth dish, and this would account for all of the observations. Scary...and so reasonable.

We also spent several weeks in Chicago on the home delivery service. I saw houses still lighted by Kerosene lamps and water drawn from the corner hydrant. I remember sitting up all night with a patient waiting to deliver what ultimately turned out to be nine month-sized fibroid, the fetal head and extremities were so clearly outlined. That started my interest in error of interpretation.

When waiting for deliveries, we used to put cups of kerosene under the legs of the chairs in which we attempted to sleep to keep the lice and other bugs off us. It worked. We sat yogi fashion on the chairs. I've been bowlegged ever since.

The system of delivery depended upon using newspapers to make a bed. They are sterile and they were the only things that were except those that we brought with us in our little black bag. That black bag and the white coat was a free pass through purgatory. There never was a "doc" assaulted or robbed, even though we passed through the toughest part of Chicago on the way to our cases during its toughest days. We were the 'angels of mercy' and nobody bothered us. We successfully delivered a baby on the second floor of a house one night. At the same time, a murder was committed on the front steps. The world came out even.

We spent two weeks in a pest house (hospital for infectious diseases) and making rounds with the city health officer, Dr. Foxx, who quarantined the houses in which contagious disease occurred. I'll never forget the requirement that we pin Dr. Foxx in smoking his many cigars throughout the day. It nearly killed me, but the trouble was that I go to like them just when I couldn't afford them. It was during this time that I saw a hospital full of patients with small pox in every stage described in the texts. This was during a special visit to an outlying hospital that the boss arranged. That was one of the most harrowing sights I ever encountered.

Part of the time I spent as an extern in a private Catholic hospital. One of my first acts was to stop all medication. The patients had pages full of prescriptions, and I thought that was too many. Most of the patients did very well, but I was called on the carpet when the incidence of fecal impactions became no noticeably higher than in the past. My cure for dull needles sent from central supply was to break them and send them back. I never knew why they weren't happy with that. The sisters put in an organ for the entertainment of the interns and patient I used to play jazz on it. One day it disappeared. Not a word was spoken, but I got the message. I only now really understand why so many people were happy to get me out of their sight.

Graduation came at the end of a lovely June. The Big Train handed out the diplomas. He addressed us all as Mister or Miss, emphasizing the tact that we still had to pass our State Boards before we were really licensed doctors.

I headed for Kansas City, Missouri, for my internship in the Research Hospital there. I drove down with a mend in a box on spools known as a Chevy coupe, purchased for $35. I'll never forget the taste of Mississippi cat fish served by a woman who could have served as a model for Aunt Jemima It was in a town along the River which consisted of a bar-restaurant and a filling station. If she had moved to New York, she would have put the 21 out of business.

Internship was year of years. We were given rooms in the hospital. I got there early, so I had a room to myself. There were five of us in a two hundred bed acute care hospital. Each of us had 40 beds to care for. During that year, a full night's sleep was a thing we read about. I slept through the night only two times. I remember napping in a chair while waiting for a delivery. The phone rang. I picked up a coke bottle on the table beside me, stuck it in my ear, and kept shouting help till the laughter woke me up.

We lived off the fat of the land. We had a room, 6 intern logs, 4 big meals a day, and $25 a month. On that, we drank Vat 69. I had wanted to live in a boss-run town, and I got my wish. What an experience The car thieves used to put a piece of yarn about their steering wheels to indicate to other car thieves that this was a car-thief's car. The "doc"s around the hospital all had yarn around their steering wheels once they heard about it. It worked. If you found a corner of your license plate bent up, you immediately bent it down again. That was the mark that indicated that you had a particular brand of radio for which your car was to be stolen when the order went out for that particular brand. One of the staff of the hospital was an insider in the party. He knew all the ropes. One day, all of his tires were stolen. He mentioned it to the policeman on his beat. The new ones were delivered and even put on his car for him by the police.

One man was repairing a section of his sidewalk by himself. He was approached by a passerby who asked what kind of cement he was using. He said, "Portland." Within a few minutes, the water company truck drove up and the driver said that, unfortunately, there was a leak in the pipes in the neighborhood, and he would have to shut off the water to his house. The man went nuts waiting for the water to be turned on again. He talked to some of his neighbors and finally got the message that the bosses owned Readimix. He bought Readimix, displayed it prominently, and the water went on. No connection I'm sure.

Cheny Street was the red light district and a place for bars, gambling, and marvelous music. John Leach, one of my classmates, went out on the town one night and landed in a pint. There was a bubble dancer there. Oh course, Johnny could not help hitting the balloon with his cigarette whereupon the balloon burst. Since the balloon was all she wore, she was naked as a jay bird. She landed in his lap. He took a good look at her and realized that her skin was covered with the sores of secondary syphilis. He dropped her on the floor, went to the bar, ordered two gins and washed with them.

One of the attending physicians tended to write whole pages of orders and all were marked 'stat.' One patient came in one night for some trivial complaint (she needed rest). The usual orders were written. The interns had to do all of the lab work at night. Johnny Leach drew the task. He realized that none of the orders were necessary as an emergency. He let them go until 3 am, when he called the doctor and engaged him in a long discussion about the case. He repeated the call at 4 am for further discussion. It was my first experience with an intern curing a doctor of an almost incurable disease called: graphic diarrhea.

I had heard about the 'old' Docs making a diagnosis with their noses, but I had never seen it in action until one day when I called in the top internist on the staff to help out with a case that was puzzling to me. The patient was in a L-shaped room out of sight of the door. The Doc opened the door, sniffed, closed the door, and said, 'Typhus' and walked away. His diagnosis proved to be right.

Dr. Ira Lockwood was the Radiologist for the hospital. He was a busy and wonderful man. I saw mammography being practiced there for the first time. I remember a particular case where the surgeon diagnosed a benign lesion on one side and a malignant one on the other. Dr. Lockwood disagreed with both diagnoses. Dr. Lockwood was right. He used an ordinary Par speed films and screens. I think it might be interesting to see how many of the lesions could be diagnosed correctly using these techniques, at a great saving of patient exposure. I have the feeling that any lump over about 2 cm in diameter could be handled as well with these techniques as they can be the present methods.

I applied to Dr. Robert Newell at Stanford for a residency in Radiology to start on July 1, 1937 and he accepted me. Only two year residencies were offered there. Part of the time was spent in therapy and part in diagnosis. Six months were spent in Pathology. I spent seven months at the San Francisco County Hospital under Harry Garland.

Dr. Newell was a most kind and gracious gentleman. I remember being invited to his house to a welcoming party for me. Chiefs did that in those days. He made great martinis. I was deep in conversation and sipping away with joy in my heart. Dr. Newell kept coming around with the martini pitcher refilling my glass. I said, "You are very persistent, Doctor Newell." He countered with, "You are very persistent, Dr. Miller."

During the second year of the residency, there were three Miller's as residents: Edith, Ivan, and Earl. Each of us got tired of our own names.

My Time in Pathology was spent under Dave Wood in Oncology and the young Bill Dock who was then the head of the Pathology department. Dr. Dock had a photographic memory. One day, a resident asked him a question. He answered it and told the resident to go to the Journal "X," book on the right side of page "x" for the reference. The resident did, and there it was!

Besides handling the routine surgical specimens and autopsies, I started to study, under Dr. Docks direction, the coronary arteries by injection of a lead oxide gel mixture, making stereo radiographs of the specimens and reradiographing them after dissection. among other things, we noted that most of the coronary artery disease was wide-spread, and only a rare case showed a single area of obstruction. Either the disease has changed, the diagnosis is made earlier, or we had a selected group, because the single lesions seem to be more common now.

Under Dr. Wood, I took on the study and classification of brain tumors. This was not only rewarding but frightening as well. I grew to have great respect for pathologists through this experience.

I wrote my first paper at that time. It concerned Carcinoma of the thymus in a child with widespread osteoarthropathy. The exercise led me through both carcinoma of the thymus and osteoarthropathy as well. It taught me the pain of writing. The pain has endured to this day, and it gets worse rather than better with continued efforts to write. I guess the reason that one continues to write is that It feels so good when one stops. If I had a wish, it would be to write easily.

My Time at the County Hospital was spent under Dr. L Henry Garland... and when I say, under, I mean under.- He seemed to be on top of me all the time, but in that, I was not alone. He taught by scarification, but teach, he did. I kept studying him for a long time in the attempt to figure out what made him the great man he was. I came to the conclusion that one of his outstanding characteristics was his immeasurably high intelligence. He was the fastest man with a word that I know. It was strange to me how many times his name comes up in conversation long alter he was dead. He made a lasting mark. This fantastic man was an artist, a charming host, a skier of note, a wit with a sharp edge, a good poker player, a patron of the arts, a connoisseur of wines, and, above all, a gifted radiologist. One could till a page with adjectives. Let's say he is just a phenomenon.

Tomography had just come into being, and there was no device for it at the County. I went down to the shop and with the help of some of the guys there, I build the gadget, and attached it to one of the x-ray machines. There was a great deal of tuberculosis in the hospital, and a whole ward was set aside for the treatment of this terrible disease. One of the great problems that occurred in these patients was a chronically positive sputum in patients in whom no cavities could be identified and treated by collapse. In order to test the technique. I asked the physicians on the TB service to send me six patients in whom no cavities had been demonstrated by serious and thorough radiographic study and who still had a positive sputum. In all six, the tomograms showed previously unidentified cavities. This was a banner day for the x-ray department. It s funny how looking for holes can be so rewarding. Must be what a golfer feels like.

My two years at Stanford was coming to an end, and I had to find a place to complete my third year of residency. I wrote a glowing description of myself (biased, of course) and sent it off to five places all on ocean shores. I had stuttered from rag weed allergy so severely that I found out that I could only live on the coast where the stuff didn't grow. Out of the five, I chose Yale because I wanted to live in the East again to see if it still was as exciting as it had been.

Yale was a different kettle of fish. I had been offered an instructorship, and I jumped at it. To get paid $3,000 a year to study at a great school was heaven indeed. I was started n therapy because, presumably, I knew something about it. n was there that I did the first radiography with a therapy machine for localization of the beam relative to the organ being radiated. At first. this was a scary experience since, even with a larynx, it was possible to miss it by a mile in spite of very careful attention to beam localization. After awhile, it became routine. and I could sleep nights.

Hugh Wilson ran the department He was a gracious host and a fine person. In the department, he was a tyrant Like Harry Garland, he taught by scarification. He saw every case done in the department every day and every case was seen by every staff member and resident in the program. He was uncanny in his ability to detect lesions. I remember the time when he was called to the phone from a morning conference. He was stopped on the way by a physician who wanted him to just look at- a series of about 40 films that were strung around on the illuminators in the staff viewing room. Hugh was in a hurry, but he glanced over them at an angle and called out the lesions he could see. We studied the case later at leisure.. and very thoroughly. He had called every one.

We used wax cylinders for reporting cases. Hugh Wilson was having the usual trouble with the administration trying to gel typing help. Jake, the secretary (Mrs. Jacobs actually) did it ail. She'd work till midnight getting out the reports. The boss finally told her he'd fire her if she worked overtime. The cylinders piled up until they covered a whole wail of filing cases. He kept ordering new cylinders. Finally, the head of the purchasing department came in to see what was going on, and Hugh just pointed to the mass of untyped cylinders...That got action. They finally got a new typist.

Jake was one of those unbelievable people with a photographic memory. I remember one time when Hugh Wilson asked her to bring the films of a red-headed minister whom we had studied several weeks before. Jake came in with the films in about a minute (God's truth).

It did not take long for me to realize that I really knew very little about diagnostic radiology in terms of the way that it was practiced at Yale. This was a humbling and eye-opening experience. The second year residents knew so much more than I did that I was ashamed. My Board examinations were coming up at the end of the year, so that meant get busy. I examined the situation and decided that the only way I could possible learn enough was to read the whole literature published in Radiology and the american Journal of Radiology for the last ten years. I divided the number of volumes by the number of days I had to study and realized that I would have to master one half of a bound volume per matter how long it took. I relearned how to bum the 3am oil, but it seemed to have paid off. For some reason, they let me pass the boards

I actually enjoyed taking them. I wouldn't want to repeat the experience now. How these young people master all they have to know is beyond comprehension. It's obvious that they are more intelligent and talented than we were or better trained. The teaching by specialists in each branch of the field may account for some of the changes, but also the material with which the teaching starts is at a higher level now than it ever has been. Now, the top people in their classes are choosing radiology, and it is exciting to be around them. They're so smart as to be unreal.

Near the end of my time n New Haven, I was invited to Boston to consider a job in private practice there. Of course, the red carpet was laid out to impress the youngster, and I was taken to the Harvard Club for dinner. For those of you who might never have seen this magnificent structure, I must tell you that it was imposing indeed. As one enters the wood lined and quiet main hall, one is faced with a magnificent wide stair case. It was an awesome sight when, from the top of the stairs, an imposing white- haired gentleman of the old school started down the stairs, drunk as a skunk and weaving from one bannister of the other. I maintained an outward demur demeanor, but I nearly busted a gut in the process. I still like Boston, but there are some things about in that impress me less than they did earlier.

Dr. Robert Stone invited me to come to UC as an instructor at $3,500 a year, starting July 1940. He was a Scotsman to the core with a tight fist on the buck and a really great person. He was the first to have administered radioactive material to a human being for the purpose of therapy. He had the first continuously operating million volt therapy machine. He had a three phase radiographic machine for chest radiography before 1940. He initiated a neutron therapy program in Berkeley using at the cyclotrons as source. The retroactive study of his work is a monument to his thoroughness and care.

The x-ray department at UC in 1940 consisted of three diagnostic rooms (chest and two general rooms, one of which had a sinus machine) and one fluoro room. There was a separate therapy area. Bob Stone had divided therapy from diagnosis, something new at the time when most of the big shots in the field felt that all radiologists had to be generalists and trained in both diagnoses and therapy, and to be expert in every phase of the field. There was a small waiting room and one manual darkroom. The hallway was used as the inpatient waiting room. There was a visiting- staff viewing room just outside the file room. The radiologists read the films on the poop deck up three steps from the normal floor level over the high ceilinged surgeries. There were five reading spaces, the chief had an office, and I finally got one down the hall in an old radon pumping pant (back to the old days). All the rest of the staff and residents worked totally at their reading desks.

We still had a mechanical rectifier for the x-ray machine for use in the bone room and open bowl tubes. Shock hazard was a real peril in these days.. and shocks did happen. But no law suits. No spot films were take in fluoro because Bob Stone used old therapy tubes for rectifiers, and there wasn't enough power to take a spot. Dr. Jim Irwin and I changed that real soon since we took spots, overloaded the tubes and kept burning them out. That led to action. We finally got a generator with enough power to take spot films

Most of the spot films were terrible...either under or over exposed. The mortality rate for films was about 50%, and the other 50% were awful. I thought that there ought to be a way to more accurately time the films, so I assigned the joy of coming up with an idea to a clever house of officer for correcting the problem. About 11 o'clock one Saturday morning, he came into the Poop Deck and admitted that it couldn't be done. By one o'clock that afternoon, I had devised and calibrated a simple system for lowering the spot film tower to contact with the patient, a time scale mounted beside the tower indicated the proper time for the exposure. We never last a spot film after that because of improper exposure if the device was used and there was not too much motion.

In doing the calibration, I was surprised to learn that, to produce the same background density on a film, a patient 20 cm thick took twenty times a much exposure as one ten cm. thick. Few people guess anywhere near that ratio when asked the question. Dr. Lee Lusted ultimately made a device for automatically setting the Time, using the same basic idea. I still think that this method is the best one for timing fluoroscopic film exposures...even better than the photo timer because it saves patient exposure. If the field is covered by a barium filled gut, the exposure of the spot film is much higher than it need be because the timer doesn't recognize the fact that there is barium in the way. The background only needs to be monitored, and the thickness measuring system accomplishes that.

When I first came to UC, the day consisted of finding a foot high stack of films at each reading place in the morning (constantly replenished), reading films, consulting with the visiting doctors, running to surgery and autopsies, going to medical surgical and pediatric rounds, doing fluoro (after dark adaptation for 30 minutes) at 1 pm after a film of the abdomen was taken. The barium had been given at 8am on the ward so we saw the patient first with a 5 hour distribution of barium in the gut. Myelograms were done after Gl fluoro. I held clip rounds' from 5-7pm. The name clip' came from the fact that we furnished each reader with bull dog clips. It a case was interesting from any point of view, the reader put a dip on it. At 5 pm, we just went down the files and pulled out those cases with clips on them and that furnished an interested rounds. The fluoro man read his own fluoros, but everybody read everything else. All private cases were checked with a radiologist before the patient was dismissed from the department. The place was buzzing and getting a myelogram or an encephalogram into the schedule was a real hassle. House officers did emergency cases after regular hours. They spent the first six weeks of their training as technicians. They all hated the chore but thanked us for the experience once they got into private practice.

Anything special was done after 5pm. For example, Dr. Edwin Boldrey, (a neurosurgeon) brought a sheep to the bone room one evening for a cerebral angiogram. One has to be careful with sheep because when you try to do an angiogram on them, they tend to ram the needle right back at ewe.

A few days later, we did the first cerebral angiogram on a human patient. Sally M. had a buzzing in her head, and she was losing the sight of one eye. Five serial films were taken on hand thrown cassettes after surgical exposure of the common carotid artery and injection of Diadrast . The result was a beautiful lateral angiogram of the carotids showing an aneurysm 1x2cm lying over the sella. The films were shown the next morning at Neurosurgical conference. They were put up without a word. The professor, Dr. Howard Nafzigger, the BIG MAN at UC looked at them and quiet reigned. He had not been consulted before the action was taken.

Cerebral angiography was off to the races. The cases were always done after 5pm in the chest room. We introduced stereo filming shortly after the start. The examinations were made in a space about 6 feet wide between a fixed table and the wall. An anesthetist, Dr. Boldrey, a person the 'throw' the films, a person to catch the films, one to move the stick for the stereo shift and one to expose the films in the anteroom, comprised the team. Films were exposed on the word 'shoot.' It sounded like the home office of 'Murder, Inc.'

Dr. Mary Olney, a pediatrician, was interested in patients with congenital heart disease. 1941 was in the days before any kind of cardiac surgery. Cases were selected that had no chance o1 survival and they were studied by intravenous angiocardiograms using Diadrast as the opaque medium with the parent's informed consent. At that time, I read the cases three times at various intervals before a final report was made. There was a lot to learn.

About that time, surgery for coarctation of the aorta was being started. The cases were selected by Dr. Brodie Stevens and Dr. Mary Olney. We used retrograde arteriography for this work. The opaque medium was injected up-stream in the brachial artery. This flooded the aorta and all of its branches. The injection via a catheter on the same route was introduced shortly thereafter, with the tip of the catheter at the aorta. These produced creditable aortic angiograms. Lower extremity venograms became common about this time or the study of varicies.

Dr. Hideo Minagi reminded me of a patient who came into the hospital in the early 1940's. She was a sweet child with Popeye's forearms. They were HUGE. The underlying cause was bilateral lymphagiomata. The first Lymph angiogram was performed on her.

At the start of World War II, Dr. Stone was recruited to run the Radiation Safety Division of the Metallurgical Laboratory at the University of Chicago. I was recruited to run the Radiation Safety and Health Physics section of the Manhattan District in Berkeley on a 'half-time' basis, by Colonel Stafford Warren, M.D, Chairman of the Department of Radiology at Rochester, New York.. This amounted to two afternoons a week which ran from 1pm to midnight. I also became acting and then later chief of the department of Radiology at UC. When Dr. Stone came back, I resigned as chairman of the department with a sigh of relief and never had the urge to become a department chairman again. I had got it out of my system!

The Manhattan District Days were exciting indeed. Becoming acquainted with people who became future Nobel Prize winners like Ernest Lawrence, Ed. MacMillan, Bob Oppenheimer, Glen Seaborg, Emile Segre, Leo Szilard, Bob Thronton, and Luis Alverez was the most exiting part.

I almost went to work for Dr. Oppenheimer. I received a call one night, asking whether I would have dinner at this house. Gas rationing was on so I took the train to Berkeley and was to meet him at the triangular drug store on University Avenue. This store had three doors. Finding each other looked like a Keystone Cops comedy, each of us going around and around before finally meeting. A mend of Dr. Oppenheimer's finally tracked me down, and as we were going to the car, he asked me whether I liked hot food. I said I did. I hate hot food! We drove up to the beautiful home at 1 Eagle's nest, had a drink and then 'dinner.' This consisted of a special macaroni dish laced with special hot hot peppers that a friend had sent to Bob from Mexico. French bread and an excellent red wine. I nearly died...There was some guarded talk after dinner about a place called Los Alamos and my willingness to go there. Even it he had been willing to take me, after that dinner the fate was decided. If I had to live through that kind of food, the deal was off.

Our monthly trips to Chicago to attend a meeting of all the heads of sections of the project provided an opportunity to see people like Fermi, Wiegner, and others at work. Being in a room full of Nobel prize winners is a exciting experience. I soon learned my place in the a mouse in the corner.

On one of the trips, as the train was going through the desert, Ernest Lawrence unsheathed a portable radio, turned it on, and placed it in the comer of the window. The reception was excellent. Ed MacMillan, later also a Nobelist in physics, said that he would have put the radio in the middle of the window. Lawrence pointed out that the window frame acted as an excellent aerial...and then, with a sly smile commented, "If it hadn't worked, I could have given you an equally logical explanation."

I also remember a six o'clock meeting in Lawrence's office. The secretaries had left and the phone rang. It had about six lines coming into it with lights on the wall to indicate the line. He picked up the phone, began punching buttons, and getting nowhere! He slammed down the phone and said I can't answer the darned thing. Nobelists in physics are human too.

After the War, Dr. Howard Bierman came into view. He worked at the Oncology Lab in the Laguna Honda Old Peoples Home in San Francisco where a laboratory had been set up. The x-ray equipment was antiquated, but it was on this fluoro equipment hat he catheterized all the major arteries of the body and I made the angiograms. The most exciting time spent at Laguna Honda was when we started the work on the use of adrenaline in the hepatic artery in patients with metastases in the liver.

An angiogram was made, adrenaline was injected, and a repeat angiogram was taken. The normal arteries contracted and the abnormal tumor vessels did not Nitrogen mustard was injected, and Howard calculated that the dose to the tumor was about 20,000 times that which the tumor would have received if the material had been injected by vein. This still seems to me to be a useful form of therapy for people with metastatic tumors in the liver and perhaps in other tumors. With the new drugs, it should be successful. At that time, the method was tried on only those with terminal cancer as a last ditch effort. This work was published in the early 1950's.

During the War, Dr. Mayo Soley from UC and Dr. Joe Hamilton from the Radiation Lab in Berkeley had been working on Radioiodine and its uptake in the thyroid. Ken Scott said that he could provide me with some radioactive iodine (I-131) if I wanted to work on the thyroid problem. I jumped at the chance. Over a period of about ten years, I worked with Dr. Soley and Dr. Morris Dailey on the problem of the diagnostic and therapeutic value of I-131 in both benign and malignant disease of the thyroid. The uptake rate proved to be a tremendous importance in the diagnosis of thyroid activity. And the material was of importance in the treatment of hyperthyroidism, and it still is used successfully.

In the early days of this work, I spent a great deal of my Time with my head in the bowels of the electronic scalers trying to keep them working. Geiger counters and later sodium iodide crystals were used to measure the radioactivity. It was difficult to get reliable multiplier photo tubes in those days. We put several in a deep freeze and after having determined their background counting rates, I checked the background after the freezing. I finally picked one that was the most stable and it worked for years. I still think this is a good test for the best tube.

After the War, there was a lot of interest in radiation exposure of technicians and patients. Film badges were introduced and checked. Certain of our technicians were heavily exposed. Review of the situation showed that only those who had radiographed babies were in jeopardy. They held me babies during the filming. I put up a prize of a big doughnut (BIG spender) for the design of a useful baby holder that would work in all positions.

Nobody collected the prize even though a number of designs and models were made by the technicians. I got to thinking about papoose carriers and went to the campus shop and had them cut out some pieces of 1/4 inch plywood forms to which the baby could be immobilized by the use of Ace elastic bandages. A wooden vice to hold the boards upright was included. This worked like a charm, and I even got a prize from the RSNA as gadgeteer for it. It still didn't have a name. My wife, Blossom, suggested "Brattbored" and won the doughnut. It's still the best baby immobilizer around. "Bratt" because you would never call a baby a "brat", "bored" because when immobilized and kept warm with a blanket, the babies always went to sleep.

I'll never forget the day that a bright pediatrician came in to the department toting a 50 pound, lead encrusted gadget for scanning legs. He had labored mightily on this. He was interested in determining leg length accurately for his growth studies, in the treatment of dwarfism. I hated to do this to him, but I put a child on the fluoro table, made a horizontal slit of the shutters, pulled the fluoro tower smoothly along its track during exposure of a hand held film, and handed him a scanogram. Later, a motor driven device which moved the tube stand as in tomography was made that employed a slit in the filter holder of an ordinary x-ray tube and that settled that problem.

Dr. Stone was given a transverse tomographic device which employed a stationary tube, a rotating patient and a synchronously rotating film. He was interested in having it used for localization of malignant lesions in the mediastinum in preparation for their treatment. The patient was strapped in the chair which rotated at a fast rate during the exposure of the film...a dizzying sight and experience. As the machine stood, it could not be used successfully because there was no way to tell where the cut would be. Normally, I found that if we worked for about two to three hours on a patient, we could get some usable results. I rigged a rod from the tube to the film holder gadget. At the intersection of the rod and the midline of the patient at a given level, the level of the cut could be determined. With this help, I remember having a patient in and out of the department in 40 minutes after having made a series of successful transverse tomograms of the whole mediastinum at 1 cm intervals. The dose to the patient was high and even the best films let much to be desired so the worked stopped.

In July of 1949, I became the youngest full professor on the San Francisco Campus. I never will forget the feeling of having "arrived" and also the feeling of security that resulted from that promotion. Promotions were easier in those days. I couldn't be fired if I never did another lick of work. That idea lasted for about a day when I wondered what I would do with myself if I did that. I got back to work with a vengeance and have enjoyed it ever since. It must have been something like the time that I read about a professor of chemistry who had just won the Nobel Prize. A picture of him showed that he was the classical caricature of the ragged, absent-minded professor. I commented at dinner that I wondered what he would do with the $47,000 prize. My wife said immediately, Oh, he'll buy the shotgun he always wanted, caress it for an evening, and then get back to work. Some of us are like that.

I've often wondered why one works so hard in his profession and in other activities, e.g. sports. The obvious answer is to get ahead in one's work, to gain promotion, to gain applause, to gain the esteem of one's colleagues and friends, to increase one's income, but there seems to be much more. I've learned this since I've retired, since no matter how hard I work, I can't increase my income since it is fixed, and I expect no applause for it, yet I've never worked harder In my life on the most difficult problem I have ever attacked. Somehow, it must be primarily for self-satisfaction.

Where did this drive for self-satisfaction come from? It seems to be one of the most important things that can be instilled into a child, since, if it is installed, one need never worry about this child afterward, since he or she will take care of himself or herself and, will set high personal standards of productivity. This seems to be a form of 'long-term- selfishness' because it is dear that the payoff comes late in life, not early. I felt that I should pay for the opportunity to work, rather than being paid for it. Fun is what it's called. An academic works hard so he can have a glowing obituary!

In the middle 50's, I was offered the chairmanships of a number of university departments around the country. Most radiologists my age were offered similar jobs. I had had my belly full of chairmanship from my earlier experience with administrative jobs. Finally, in 1957, a big one came up at Columbia, New York, that included a three story building for research. I wanted the research room, but I didn't want what went with it. I kept quiet about that.

With the permission of the Dean and Bob Stone, I was allowed to have dinner with President Sproul in the Faculty Club in Berkeley to discuss the situation. I ended up telling him that if I could have some research space on the San Francisco campus, I would be satisfied to continue where I was. He promised that I could have it, and that was the happiest day of my life.

Bob Sproul was a truly great man with a voice to match. He knew everything that went on in the whole University as big as it was, and his word was his bond. I came up with the design of a laboratory of 3,000 square feet that included a shop, an electronics lab, an x-ray room, a dark room, and a conference room. True to his word, he came up with $80,000 to produce and to equip the lab just as I had designed it. The University dug out the space from an old Pathology storage room under the old Medical School building, and there was my shiny lab (back in the basement again). Over the years, I had to support the lab with outside funds and for the most part, this was accomplished with some help over the rough spots between grants. The lab became my reason for being, and I am grateful to Bob Stone and to Alex Margulis for the halt of my time that I could spend in it. This lab earned its keep over the years by supplying to the department and to my physiology lab in the Cancer Research Institute on the 13th floor of Moffatt Hospital the equipment that was needed and could be supplied in no other way.

In about 1953, the funds for the new Moffitt Hospital came through, and I became involved in the planning of the new diagnostic x-ray department. One of the biggest problems was looking into the future and attempting to predict the rate of growth of Radiology in a University department. I studied the twenty years of records of the number of examinations, number of staff, published papers, income and any other data I could get. It was clear that the growth was exponential from every point of view.

It is dangerous to extrapolate log curves but it seemed to be the only thing to do. I predicted that the department would be obsolete in ten years. It was a proud day when I reexamined the data in 1965, ten years after the new hospital had opened to find that the prediction was right on the extrapolated line of numbers of patient examined and number of examinations performed. The prediction of obsolescence also proved true. The work load exceeded the capacity of she department in the space provided by that time.

The department was designed as a box within a box with the dark rooms in the center. Outpatients were handled on one side and Inpatients on the other. The technical work flowed from the outside toward the center and the completed films flowed forward to the reading and consultation rooms. The design was good for its time, but with the growth of special procedures the whole face of Radiology has changed. One of my many losing battles was to attempt to influence the design of the new department. It has become clear that what is now called the central x-ray department is really a special procedure suite. Plain film examinations are mixed in with them and complicate the working. I define a special procedure as one that demands the presence of a radiologist during the performance of a study. Plain film examinations can be carried out by technicians alone.

It is my considered opinion that all of the plain film examinations should be carried out on the patient wards. Each of these wards is about a 50 bed 'hospital.' Each of these would have a part-time radiologist who would make rounds with the attending physicians on the ward and design the radiological procedures. The plain films would be read there. The referring physicians would have immediate access to these films and it is to their advantage to see that these films are not stolen or last. No patient would have to be transported off the floor for any plain film examination. The ward department would consist of one x-ray filming room, a dark room and a reading room. All files would be kept in the reading room for the duration of the patient's stay on the ward.

It turns out that 80% of the examinations done on in-patients consist of plain films. The problem of lost films, referring physician transport, patient transport, elevator usage, and referring physicians disgust because he has to wait for films would all disappear. The radiological service to the patients and to their physicians would be immeasurably improved. Reports from special procedures done in the special procedures suite would be transmitted to the radiologist on the ward for immediate access by the referring physician and integration into the complete radiological examination of the patient. The radiologists who work part-time on the ward would be doing special procedures for the rest of the day. They would become doctors again and general radiologists with special expertise in some l areas. The idea gets turned down by all radiologists who have heard about it, immediately, and without due consideration.

When the money for the new hospital came through, Bob Stone got a million dollars from the NIH for a cancer research center and ward which was put on the thirteenth floor. In it was an x-ray room b be dedicated to the work on arteriography on cancer patients and to other special procedures that would develop. However, by this time, Howard Bierman had left the University and the place fell to me because of Dave Wood. He was the Director of the Cancer Institute and thought I could do some effective work there.

This became a physiological laboratory where combined anatomical and physiological studies were carried out on speech and swallowing and on the physiology of the lower urinary tract. The Radiological Research Lab fed equipment and ideas into the lab on the 13th floor. We did our first movies using image intensifiers in this lab and introduced the idea of taking movies off the monitors. A Vidicon camera read physiologic data from paper recorders in the case of the urinary tract and from CRT's presenting data from sound spectrographs during speech. The video signals from the two TV cameras were mixed and presented on on monitor from which the cinescopic movies were made. The data were also supplied to video tapes.

Thus, we had the original data from the paper recorders, me tapes for immediate play back, and the movie films for leisurely study and filing. The importance of this approach is that it provided physiologic and anatomic data simultaneously. It is my considered opinion that the interpretation of either one in the absence of the other can lead to gross error of interpretation in any organ that changes quickly as a function of time. The idea applies naturally to the gastrointestinal tract, the lung, the cardiovascular system and to the urinary tract.

I met Lucie Lawson at a cocktail party one night, and she got me started on the study of abnormal, mostly hypernasal, speech. This lasted for about 20 years.

Dr. Frank Hinman first got me interested in the lower urinary tract. Dr. Goran Enhoming, a Gynecologist from Sweden who worked with Frank and me for several weeks, introduced the whole idea of the study of the urethral pressures in combination with the bladder pressures and this allowed us to really begin the study of the tract. These were productive years and fun. Enhoming was an inventive guy. among the many things that he did was to mold a swimming pool out of plastic and float it in the sea in front of his house in Stockholm, and impressive sight in an impressive site.

The device that made the urinary tract studies really come alive was developed by Ed McCurry, an engineer in the lab. He put a chopper in the lines carrying data from the transducers in the bladder, urethra, rectum, and anus and was thus able to display on each channel of the recorders, two lines of data, as a function of time. These showed the absolute values of the data as well as the differences between two interdependent variables. For example, the bladder and rectum (intraabdominal) pressures were shown on one channel, and the bladder and various parts of the urethra were shown on another. 8 channels were used in all, in addition to sound. Voiding rates were determined as a function of time. The mechanisms of continence, incontinence, and normal voiding were elucidated. Emile Tanagho, the new head of the urology department at UC did great work in the anatomical and physiologic aspects of the lower urinary tract and has become a world expert in the field through these studies.

Perhaps the most important thing that was learned from these studies is that water runs downhill. The head of pressure in the bladder must exceed the pressure in every part of the urethra for water to flow from the bladder. The bladder pressure can rise due to detrussor contraction or by passive response to a rise in intraabdominal pressure. The intraurethral pressure can tall with strain and thus reduce the pressure gradient between the bladder and urethra and this too will make water flow. Intraurethral pressure can drop with no other change and water flows. A similar situation occurs on defecation unless the stool is liquid. The gradient between the colon and anal channel also must become negative before defecation can occur. It all seems so simple now, but it was a great struggle to see our way clear. The study of the lower urinary tract by means of fluoroscopically taken movies is not without its dangers. One patient managed to hit the fluoro unit with a strong stream of urine and the sparks flew. This almost led to total inconvenience for all the people in the room.

In the early 1960's, I became interested in the matter of eye strain while reading x-rays. It seemed to me that when one first turned on the lights or pulled a big film off the illuminator that one was hit with a bright blast of light to which the pupil had to respond. This happened many times a day and caused fatigue. Also, glare from unused lighted illuminators reduced the contrast that one could see due to the small pupil size and cone pigment bleaching. Dr. William Saunders who was at that time working at the Veterans Hospital, and I began to work on the problem of making an illuminator that would shut itself off when no film was on the box and turn itself on when a film was put up on the box. The device operated on a micro switch which was actuated by the thickness of the film and worked well.

General Electric came up with a system which operated even better than ours. It used the movement of the edge of the film when it was put up on the illuminator to actuate the switch and this became an item in their line. When using the device, one should keep only the central light on at all times, and all the rest off. In addition to reducing the glare from one's own light boxes, it reduces the back lighting from other workers in the same room. It turned out that it was better to have the light go from high- to medium rather than having it go from off to medium. The change and the fatigue is less in the latter case, and one has at least some light to work by at all times.

During the time that I was reading emergency films we would attempt to telephone reports to the Emergency Room. The phones were so busy that I could almost never get them. I thought it might be a good idea to have a direct connection between the two paces. An engineer from the Dictaphone company said it couldn't be done. Ed McCurry designed a system for connecting two dictating machines, one on which the original report was dictated and one in the Emergency Room that repeated the report as it was being dictated. A light indicated that a new report was on the magnetic belt. The people in the Emergency Room simply backed up the belt to the previously indicated space made at the beginning of the report and listened to the report at the Time that was convenient for them. This worked great for a number of years.

The system was designed so that it could have been put on all the wards and each of the wards and the clinics could have had immediate reception of the reports as they were dictated. The total cost for such a system was about $25,000 for nine floors in the hospital and for nine clinics. In spite of the success of the Emergency Room system, the idea was never adopted by the main department. I still think it is the best way to get information to the patient's areas, unless one went to the idea of the department on each floor.

We had a video disc on loan to us In the Lab for examining its usefulness and quality. This led to the idea that perhaps we could transmit the x-ray images to the various floors and clinics. This also worked well, but it too never got off the ground. The device employed an inexpensive Vidicon TV camera and a zoom lens so that the ultimate resolution of the system was determined by the size of the grain on the film. As the films emerged from the darkroom, a technician would record the requisition on the line of the disc and then each of the films taken for that examination. A radiologist would circle any positive finding and that part of the film would later be enlarged and recorded. The name of the patient was always easily visible on the constant position on the display so that the people on the ward could page- through the various disc images at a rapid rate, find the ones they wanted and then examine those. This system would cost about $250,000.

We decided not to use a random access system because of its high expense and thus came up with the idea of having parts of dedicated discs for each of the wards. This reduced the expense considerably and would have worked well. The discs held enough images so that several days films of patients on the ward were always available. We even came up with the idea of having images side by side on a split screen . Such systems, much reduced in size and concept, have been used elsewhere with success. Perhaps the biggest objection to such a system is that the referring physicians can by-pass the Radiologist for his consultation. I think it would not occur because in the difficult cases the referring physicians would come down to talk about the case. In the normal and easy cases, they would be saved the trip. These considerations led me to the concept of the individual x-ray department on the floors which would, I think, solve all the problems and would pay for itself very quickly it one considered all of the costs of patient and doctor transport, and wasted time.

During my residency at Stanford, chests, sinuses, and even wrists were taken with stereoscopic films. I learned the power of the technique. I also became aware of serioscopy, the technique by which one superimposes two stereo films and slides one with respect to the other in the direction of the shift. The images that are at the same level come into sharp relief, and the level of the lesion and other images can be determined, since all things at the same level come into focus at the same time. This idea stuck in my head for years. I thought that there ought to be some way in which those matched- images could be made to stand out from the rest of the images on the film.

We started out to work on this, and again Ed McCurry came up with a really classy idea that ultimately showed that you could not get the desired images out from only two films, in a useful form. One TV camera looked at one of the films of the stereo pair and other other looked at the second one. The video signals from the two cameras were fed to a subtraction unit. Where the signals were identical, the output of the subtraction unit was zero. Where they were different, the output was either positive or negative. A positive or negative signal triggered a circuit which banked the video signal. The area that was blanked could be shown on the monitor as a uniform area of brightness which could be adjusted from black to white. Where the output of the subtraction unit was zero, the video signal was transmitted without alteration. What we saw on the monitor were the matched- images interspersed with black, gray, or white patterns. The patterns created by the non-matched images so overwhelmed the picture that they were nearly all one saw, although the matched images could be distinguished with effort from the mishmash.

This troubled me for quite awhile since when one looked at the films sterioscopically, the eye had no difficulty seeing the matched images; the others were suppressed. The unmatched images were patternless blurs. (This became an important part of later work on seeing- and pattern recognition). I finally got it through my thick head that what I really was trying to do was tomography with two films, and that simply does not work.

In the middle of the night some weeks later, it occurred to me that, if one was using a single phase radiographic machine with an exposure time of one second and one made a tomogram with it that one was taking 120 radiographs of the object, each from a slightly different angle and each with 1/120 of the exposure of the finished film. Why wouldn't it work with few films?

We used a dried skull for a model, took seven films of it from equally spaced positions, each with 1/7 of the exposure time required to produce good- film, superimposed the films in register, and had an infinite number of tomograms from 7 films. Eureka! We even devised a very simple system for sliding the films relative to one another by means of a lever, and it works. No one uses the system. Ah well!

I still had the problem of understanding why this system of tomography itself really worked. What was it that allowed an observer to see a nodule in the lung so well on a tomogram? There are facile explanations for this, but none really satisfied me.

I had carried out a simple experiment some time before. I had taken a radiograph of an aluminum step wedge using a cardboard film holder that gave a good picture of 12 steps. I then put ten films in the same holder and exposed the lot with one tenth of the previous exposure. On each of the ten films taken when the group was exposed, one could recognize only about 6 steps. When the ten films were superimposed, all 12 steps could be recognized and measurements of the transmissions through each of the steps were identical to those on the good- film when allowance was made for the absorption by the film base.

I checked this by making the measurements with nine clear films superimposed upon the "good" film. The superimposition of the ten films created contrast enhancement and edge enhancement. Densities did indeed add (something that was known long before), and there were images invisible to the eye in the underexposed films in the parts that appeared to be dear. The edges of the steps could not be seen. It became dear that it was the underexposure of each of the individuals films that was the important aspect. Unmatched sections of the film did not give the contrast enhancement that allowed one to see edges and structures below a threshold. This too became an important part of the later work on pattern recognition and seeing.

When the matched portions of the underexposed films are superimposed they do create increase contrast and edge enhancement and structures can be identified that enhancement does not occur and the structures remain invisible. It is the underexposure of the unregistered structures that make them invisible on tomograms when they do not lie in the tomographic plane.

I turned the situation around for use in mammography. If one gets increased contrast by the superimposition of films in register, why not put two films in the cardboard holder when a radiograph of the breast was taken? A good' film of the breast was taken. On a second exposure, two films were stapled together in the holder and half the previous exposure was given. When the two underexposed films were viewed in register, the good' film with twice the patient exposure could not be distinguished from that which had been taken with half the patient exposure. A positive photographic contact print o a radiograph can be superimposed on the original) to create the same result. This is useful also for showing small gall stones that are hard to see. This isn't being used either. Ah, well!

The techniques employing subtraction have been used with great success. For example, in cerebral arteriography the image of the skill nearly disappears by the superimposition of a positive and negative radiograph of the skull before and after the introduction of a contrast medium. The result comes about because of the elapse of time between exposures and the introduction of the opaque medium. In proper register, all of the edges of the skull disappear when properly exposed positive and negative images are superimposed.

It occurred to me that with the use of the TV subtraction unit, we might selectively remove unwanted edges from a single films. The television camera looks at a radiograph. The video signal is delayed and inverted, the video signal from the delayed image is subtracted from the original and the result is displayed on a monitor. Where the signals are equal, no image appears on the monitor. Unequal signals are amplified and fed to the monitor. This results in the disappearance of all of the edges parallel to the horizontal raster lines, and the enhancement of all the lines not parallel to the raster lines. By rotation of the film, successive edges can be made to disappear. This is useful, for example, for making the images of ribs disappear and removing the images of the horizontal plates of vertebral bodies for the study of the posterior parts of the spine.

It occurred to me that this might also be accomplished with photographic and radiographic images, employing the original and a slightly shifted negative of the original. This also works and is available to those who do not have TV capability. The use of the technique provides a sort of cameo effect, a pseudo, three dimensional shadowing that is startling. But it is the subtraction of the unwanted images that is the important thing.

It was my crying need to understand how one saw edges, their length, orientation, radius of curvature, and rates of change of luminance in the z-axis and rates of change of the various parameters in the x-y plane of an image required for the recognition of patterns that lead to my early retirement in order to spend full time on the study. I'm still at it and struggling. Some work like this is going on in Philadelphia, but I remember Philadelphia for many other reasons.

Philadelphia was a Mecca for Radiology. Dr. Eugene Pendergrass has been the Big Wheel for decades. He, perhaps more than anyone else, influenced the Board exams and the thinking of radiologists toward the concept that everyone should be a generalist in both therapy and diagnosis. I no longer know whether he still maintains the stance. But there were other younger people there who became my friends. among them was Dick Chamberlain. What a guy! He had a his and hers kitchen in "Old Rottenstone," his house in Chestnut Hill. There he prepared gourmet meals and lovely martinis.

I remember once when Herb and Joanie Stauffer were there for cocktails. Dick always put his martinis in the freezer and they developed a fuzz of ice on top. Herb took one look at his glass and said, "Hah! a slurry with a binge on top." That led shortly to the crack that "Absinthe makes the frond grow hearter."

Dick collected gems and gadgets. I remember seeing television in his house for the first time. I sat for three hours watching Bert Parks answer a telephone during a drive for funds for cancer research. That was the only program on the tube. I thought about this later and concluded that anyone who spent his time in that way was ready for the loony bin Unfortunately that applied to me.

Phil Hodes was a part of the Philadelphia contingent. I remember meeting him first at the end of an AMA meeting in Atlantic City. He was always hungry late at night. As we walked the Boardwalk toward our hotel, he spotted a man on a bench and politely inquired whether there was any place near where we could get a small snack of steamed clams and a big lobster. The man indicated that there was the best place in town two blocks west and two blocks north. As we turned away, the man said, "Tell them the chef at the Hadden House sent you, I always eat there."(Hadden House was a luxury hotel) It turned out to be lovely meal with me stuffed to the eyebrows but happy. We referred everyone at the hotel to the place thereafter. They must have made a million. The character that played the organ was a joy.

Phil and I also met again in New Orleans where we spent the evenings 'doing' the French Quarter. At the last place we hit about 3am, the drinks were expensive because of the strippers on stage, and I finally allowed as how I was out of cash. Phil swears that later I was staggering down the street with a slide rule in my hand calculating that it had cost us $1.08 per minute to be in the joint! The next morning he went into the bathroom to prepare for the day. He came running out saying, There's a bum in there." When I went in and looked in the same mirror, I had to agree.

We left New Orleans for the Inter American Congress in Mexico City. I was first on the around for something to happen. Finally, two men appeared on the platform and started talking into the microphone. I was informed by someone who could speak English that they were calling for me to begin. As I came up on to the platform, I was faced by a whole flock of TV and news cameramen who had come to record the conference for the news. One of the news men said, "Say something!" That phrase is guaranteed to make a person tongue-tied, and it had that effect on me. My hemming and hawing did not make the news that night. There are several other conversation stoppers that I've learned since: "Say something good about something." Have a beautiful woman pass by. Serve good food to hungry people.

I might just add that when my paper on angiography was published, all the illustrations were upside down.

I remember another time in Mexico when I was a visiting professor at the University of Mexico Medical School. among the several talks I gave was one on the x-ray analysis of speech. I started out the talk with a detailed analysis of mechanisms of communication. I had got as far as explaining the need to develop the thought, turn it into words, inspire, speak the words, have the listener hear the words...and on and on. I suddenly realized that to my audience I was speaking in a foreign language on the art of communications, and I burst out laughing. There was a stunned silence in the auditorium. I explained to the translator who in turn explained to the audience. An appreciative roar rose from the assembled multitude, and I went on speaking very slowly about the x-ray analysis of the movement of the mouth and pharynx during speech, the spectral analysis of the sounds, and other simpler things, to a much relaxed audience.

I retired on April Fool's Day 1974 in order to travel on cruise ships. In addition I wanted time to think about the problem of the two definitions of the word seeing in relation to error in radiologic interpretation. To see is (a) to perceive with the eyes and (b) to understand the meaning of the retinal image.

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