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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

1Dr. Gregg Herken, Ph.D., actually is a Senior Policy and Research Analyst for the presidential Advisory Committee on Human Radiation Experiments.

2University of California, San Francisco

3Dr. Robert Stone was an early researcher at the Lawrence Radiation Laboratory and the UCSF and became a major figure in radiobiology research. During the Manhattan Project he served at the University of Chicago as Associate Director for Health under Arthur Compton.

4Dr. Arthur Compton, University of Chicago, a key member of the scientific team that established the Manhattan Project

5the U.S. Government's top-secret project to develop an atomic bomb during World War II

6created at the University of Chicago early in the effort to develop the atomic bomb. "Met Lab" researchers, led by Dr. Enrico Fermi, produced the first sustained nuclear chain reaction on December 2, 1942.

7University of California, Los Angeles

8the count of the number of red and white blood cells and platelets in a specific volume of blood

9Dosimeters, or film badges, were worn routinely to measure accumulated personal exposure to radiation.

10accelerators in which particles move in spiral paths in a constant magnetic field. The resulting beam of high-speed particles can disintegrate atomic nuclei and produce radioactive isotopes.

11a physician who diagnoses disease, broken bones, and other physical conditions using x rays or other imaging techniques

12radiation treatment in which the radiation source is located outside the body

13"kilovolts"—thousand volts

14Manhattan Engineer District, the Federal Agency set up to develop the atomic bomb under the top secret Manhattan Project

15the system of glands, tissues, and passages involved in generating lymphocytes and circulating them through the body in the medium of lymph; it includes the lymph vessels, lymph nodes, thymus, and spleen.

16This secrecy was maintained on an unprecedented scale, as described in "The Bomb Goes Public" (p. 54) in F.G. Gosling, The Manhattan Project: Making the Atomic Bomb (DOE/HR-0096), September 1994: "The release of the Smyth Report on August 12 [1945], which contained general technical information calculated to satisfy public curiosity without disclosing any atomic secrets, brought the Manhattan Project into fuller view. Americans were astounded to learn of the existence of a far-flung, government-run, top secret operation with a physical plant, payroll, and labor force comparable in size to the American automobile industry. Approximately 130,000 people were employed by the project at its peak, amongst them many of the nation's leading scientists and engineers."

17Dr. Joseph Hamilton, an M.D., conducted important radioisotope research at University of California, Berkeley.

18a part of the Lawrence Radiation Laboratory at the University of California, Berkeley

19Hamilton died of leukemia. His peers generally agree that Hamilton's illness was brought on by his cavalier disregard of the dangers of radiation.

20an elementary particle found in the nucleus of most atoms and having no electrical charge

21Dr. Low-Beer, M.D., a refugee from Czechoslovakia

22therapy of cancer using an accelerator to produce a neutron beam of radiation

23Robert Gordon Sproul, president of the University of California

24were receiving salaries from both the MED and the UC Medical Center

25Originally headquartered in Washington, DC, the MED moved to the new weapons complex in Oak Ridge, Tennessee, in the summer of 1943.

26relating to the functions and activities of living organisms and their parts

27Dr. Mayo Soley, M.D., took his own life, June 21, 1949, at age 42. He had been Dean of the Medical College of the State University of Iowa since July 1, 1948. The coroner stated that there was no apparent reason for the act. Source: New York Times; June 22, 1949; p.16.

28overactivity of the thyroid gland, resulting in basal metabolic rate and other physiological problems

29relating to the study of the nature, function, and diseases of the blood and of blood-forming organs

30Between 1948 and 1958, Miller authored or coauthored 17 published papers on thyroid disease and its diagnosis and treatment with 131I.

31the U.S. Atomic Energy Commission, predecessor agency to the U.S. Department of Energy and Nuclear Regulatory Commission (NRC); established January 1, 1947

32a malignant tumor composed of epithelial tissue—the tissue layer covering body surfaces or lining the internal surfaces of body cavities, tubes, and hollow organs

33Radiation therapy using iodine-131 is still the treatment of choice for many thyroid disorders, including hyperthyroidism, Grave's disease, and thyroid cancer.

34deficient in thyroid secretions, resulting in goiter, myxedema (thickening of the skin, blunting of the senses and intellect, and labored speech), and, in children, cretinism (stunted growth, deformity, and mental retardation)

35having a normally functioning thyroid gland

36Miller's final publication with Dailey was, as he recalled, in 1955: Studies with radioiodine. V. Validity of histologic determination of I131 radiation changes in the thyroid gland. Radiology 65:384–93.

37having an atomic number higher than 92, the atomic number of uranium; also called transuranic

38In an AEC-funded experiment, Dr. Kenneth Scott inhaled an active smoke containing zirconium-89. The purpose of the experiment was to determine the degree to which the lungs would retain very finely divided active smoke suspended in air. The results showed that almost 100 percent of the inhaled activity (about 0.5 microcurie of zirconium-89) was retained within the lungs and upper respiratory tract.

39a tube or box fitted with a screen coated with a fluorescent substance, used for viewing deep body structures by means of x-ray or other radiation

40the branch of medical science dealing with tumors, including the origin, development, diagnosis, and treatment of cancer

41a thin, flexible tube inserted into a bodily passage, vessel, or cavity to allow fluids to pass into or out of it, to distend it, or to convey diagnostic or other instruments through it

42relating to metastatis, the spread of disease-producing organisms or of malignant or cancerous cells to other parts of the body by way of the blood or lymphatic vessels or membranous surfaces; or, the condition so produced

43opaque to radiation; hence, visible in x-ray photos and under a fluoroscope

44of or pertaining to veins

45the formation and growth of neoplasms (tumors)

46million electron-volts

47accelerators in which protons are raised to very high energy levels (currently several billion electron-volts)

48pertaining to vessels that convey blood, such as veins and arteries

49one of the clinics at University of California, San Francisco Medical Center (a psychiatric unit)

50Dr. Soley left UCSF in 1948 to become the Dean of the University of Iowa Medical School. He planned to open a thyroid clinic and an iodine-131 diagnostic and treatment clinic. While helping the university prepare the iodine lab, Soley engaged in clinical work for about six months before he died in 1949.

51See Miller's first boxed editing insert, preceding, under "Human Applications Committee and Informed Consent."

52E.R. Miller. "A Device for Immobilizing Children During Radiographic Examinations." Radiology 58:421–23, March 1952.

53dosimeters

54an elasticized bandage, usually in a continuous strip, for securely binding an injured joint

55In the early '70s Dr. Miller, together with E.M. Curry and B.B. Hruska, coauthored two papers on this subject in Radiology: "An Infinite Number of Laminograms from a Finite Number of Radiographs," Radiology 98:249–56, Feb. 1971; and "A Simplified Procedure for Viewing Multiple Films to Create an Infinite Number of Laminograms," Radiology 110, No. 2, Feb. 1973.

56the point about which a lever pivots

57a technique for changing an alternating current (ac) into a direct current (dc)

58a sensitive television-camera tube in which a beam of low-velocity electrons scans a photoemissive mosaic

59x-ray images produced by x-ray examination of the heart and its blood vessels following intravenous injection of radiopaque fluid

60of the brain, especially the forward and upper part, which governs voluntary movement and conscious processes

61a radiopaque substance introduced into a part of the body to provide a contrasting background for the tissues in an x-ray examination

62the use of a stereoscope, an optical instrument through which two pictures of the same object, taken from slightly different points of view, are viewed, one by each eye, producing the effect of a single picture of the object, with the appearance of depth (like a "3-D" photo)

63horizontal distance between the two lenses of a stereoscope

64face-down

65from the side

66formerly called UC Radiation Laboratory; now Lawrence Berkeley Laboratory, a National Laboratory on the campus of University of California at Berkeley

67the nations against whom the Allies fought, consisting chiefly of Germany, Italy, and Japan

68Low-Beer, B.V.A., K.G. Scott, J.G. Hamilton, and R.S. Stone. "Comparative Deposition of Zr95 in a Reticulo Endothelial Tumor to Normal Tissues in a Human Patient." Berkeley, CA: University of California Radiation Laboratory, UCRL-68.

69In 1946, at UCSF and the Crocker Radiation Laboratory at Berkeley, AEC-sponsored research was carried out to study the uptake and deposition of zirconium. The subject, a 55-year-old female patient with a reticulo endothelial tumor that had arisen in the spleen and then metastasized to the liver and left leg, was given a test dose of zirconium-95. She was administered 1.76 millicuries of zirconium-95 in saline by intravenous injection 24 hours prior to a scheduled midthigh amputation of the left leg. Samples of the tumor, as well as normal tissue, were later obtained from the limb for zirconium-95 assay.

70(if injected before the amputation) if the body part was going to be removed anyway; or (if injected afterward) if the body part was already removed

71that is, to tell you whether blood or lymph circulation was [or had been] reaching that body part

72The President's Advisory Committee on Human Radiation Experiments

73Lawrence Berkeley Laboratory Archives and Records Office, where Berge works

74For the transcript of the interview with Durbin, see DOE/EH-0458, Human Radiation Studies: Remembering the Early Years; Oral History of Dr. Patricia Wallace Durbin, Ph.D. (July 1995).

75Dr. Paul Aebersold established the administrative system for distribution of radioactive isotopes. After working on the Manhattan Project at Los Alamos, New Mexico, and Oak Ridge, Tennessee from 1942 to 1946, he served as director of the Atomic Energy Commission's Isotopes Division at Oak Ridge from 1947 to 1957. He retired as the Director of the AEC's Office of Isotopes Development in 1965. Two-and-a-half years later, he committed suicide. For additional information on Dr. Aebersold, see "Safety of the Nuclear Industry" in the interview with Merril Eisenbud (DOE/EH-0456, May 1995); "Remembrances of Personalities" in the interview with Earl Miller (DOE/EH-0474, June 1995); and "Oak Ridge Committees (Isotope Distribution, Human Use, et al.)" and "Vanderbilt University Study of Pregnant Women and Iron-59" in the interview with Karl Morgan (DOE/EH-0475, June 1995).

76referring to Dr. Gregg Herken, Ph.D., who had participated with Berge in the August 9, 1994 interview of Dr. Miller

77a method of making x-ray photographs of a selected plane of the body

78an infectious disease that usually affects the lungs, causing small, firm, rounded nodules or swelling

79showing or indicating the presence of disease

80saliva mixed with mucus or pus, coughed or spat from the lungs or respiratory passages

81Dr. Miller gives a full explanation of laminography earlier, in "Technique to Produce Infinite Laminograms."

82cathode ray tube, as used in televisions and computer monitors, consisting of a vacuum tube generating a focused beam of electrons, which illuminate phosphors on a screen to form a visible image

83the rate at which the contrast of the image changed per unit of distance across an x-ray image. See Dr. Miller's elaboration, which appears two paragraphs later.

84For more on the role of contrast in interpreting an x-ray image, see Dr. Miller's paper, "A Multiple-Film Technique for Contrast Enhancement and/or Reduction of Patient Exposure," in Radiology 110:2 (February 1973).

85extrasensory perception

86Senator Dianne Feinstein (D-CA)

87American Medical Association

88Dr. Miller is exaggerating, of course; the highest intelligence quotient ever recorded on the Stanford-Binet test was below 230; only one person in 50,000 has an IQ of 170 or higher.

89the use of a fluoroscope (a tube or box fitted with a screen coated with a fluorescent substance, used for viewing deep body structures by means of x-ray or other radiation)

90National Institutes of Health, Bethesda, Maryland

91the medical specialty concerned with correcting deformities or functional impairments of the skeletal system, especially the arms, legs, hands, feet, and spine, and their associated structures, such as muscles and ligaments

92the scientific, clinical, and surgical aspects of the study of the urinary and genitourinary tract

93the practice of reflecting ultrasonic waves off interior body structures to produce a visual image, or sonogram, for diagnostics

94computer aided tomography; or, an x-ray image obtained by examination with a CAT scanner

95magnetic resonance imaging (a process of producing images of the body regardless of the presence of bone by means of a strong magnetic field and low-energy radio waves)

96relating to nerves or the nervous system

97x-ray examination of the heart and its blood vessels following intravenous injection of radiopaque fluid

98pertaining to the division between the two thin-walled upper chambers (atria) of the heart

99pertaining to a partition between the two ventricles (lower chambers) of the heart

100At that time, no radioisotope had been more thoroughly characterized for its biomedical effects than radium.

101inability to restrain natural discharges of urine or feces

102a printed stream of paper, usually perforated for subsequent separation into sheets, that plots variables against time and emerges continuously from an instrument

103the pronouncing of oral sounds as nasal sounds