Radiologist Earl R. Miller, M.D.

(The six pages that follow were scanned from a printed document provided by Dr. Miller after the interview.)

EARLY HISTORY

Even in the early 1940's many doctors made their living in practices off campus. They either donated their time or were paid a pittance by UC. They worked only part time.Gradually, UC became peopled by full time employees with additional Clinical Faculty on a part time unpaid basis. There were no full time paid Faculty at the San Francisco General Hospital. The changeover to a full time faculty was gradual.

HOWARD RUGGLES

He was the first Radiologist at UC. He came in daily in the morning and read the films which were ordered by the clinicians and taken by the technicians. He would read even a single film of an extremity for example. He wrote with Holmes of the MGH in Boston, the first major textbook of Radiology. It was THE textbook.... five eights of an inch thick and covered all of Radiological diagnosis and therapy.

Dr. Ruggles loved his greenhouse. During his time at UC, glass plates were used to record the x-ray images. He took the obsolete ones and built his greenhouse with them.. Look down, see a fbwer. Look up and see duodenal ulcer, Paget s Disease, Sarcoma of bone etc. Scary!

DR. ROBERT SPENSER STONE MD LLD

Dr. Stone was the first full time Radiologist at UC. The Department was a branch of Surgery until about 1941. He was first chaimman of the department aner it became a department of the University in its own right. No one else in the depatment had a title other than his academic rank. Oniy the head of department could become a full professor. This was a common practice in many Universities at that time.

Before I came to UC, Dr Stone did both diagnosis and therapy as did most of the Radiologists of that time. He was the first to administer 1000 K radiation and the first to use radioactive isotopes wffl therapeutic intent. He was proud of his work in diagnosis as can be seen from the encephalogram in his portrait, but his real forte was in therapy and radiation safety.

In 1942, Dr. Arthur Compton invited Dr. Stone to Chicago to set up and head the Radiation Health Division ot the Metallurgical Laboratory. Later, this became the Manhattan Project, Later he went to Oak Ridge where he lived with unpaved roads in an an unfinished town and spent the War years there.

After the War he undertook neutron therapy for the treatment of malignancy using the 60 cyclotron in Donner Lab and later using the BIG machines on the Hill.The AEC funded his Radiological Laboratory on the San Francisco Campus where he directed research with the sychroncyclotron and dld patient therapy with this modality.

With the coming of Moffit Hospital, he got funds to finance the 13th floor as a Cancer Research Institute. He got $1,000,000 for this; a huge amount in those days. When the committees were formed to get the funds for me Moffitt Hospital the estimate for the whole project was $2,000,000.

He had a lovely home in Forest Hills in San Francisco. His garden was a showcase. He did all of his own gardening. He spent his vacations in the high Sierras, hiking and fishing, and doing photography. He enjoyed his weekly bridge game with friends.

THE DEPARTMENT IN 1940

The department occupied the east end of third floor of UC Hospital. Therapy had a 200 KV, a 1000 KV, and 1 low voltage machine along one corridor. There was one office and a small shop.

Diagnosis consisted ot 3 radiographic rooms, 1 fluoro, 1 darkroom in 1 corridor, 1 reading room with 4 reading areas on the ·poop-deck- (area above surgery) 1 small consultation room, 1 typist, 3 technicians, small file room, and Dr. Stone's office and place for his secretary. Dr. Capp and I were the staff. There were 2 residents. We all lived and worked on the poop deck. The #1 chest room had a modern 3-phase generator. The #2 room had a mechanical rectifier and open bowl tube holder with exposed high voltage wires. Fluoro had discarded therapy tubes for rectifiers and no facilities for spot filming. Dr. Jim Irwin (resident) and I blew out so many of the rectifiers doing hand-held spots in fluoro that we finally got some decent equipment for spot filming in 1940.

GROWTH OF THE DEPARTMENT

I came to the department ion July 1, 1940. In 1941,I got an office in the old radon plant room (shades of old times.) I made my living during medical school years running a radon plant in the Department of Radiology at the University of Wisconsin.) Research with I¹³¹ done here.

In 1950, Dr. Mike Shimkin brought a Cancer Research Lab to the Laguna Honda Hospital. In it was an obsolete fluoroscopic-radioqraphic room. Here, Dr. Howard Bierman and I did arterial catheterization and visualization of all of the arteries of all of the viscera of the whole body by introduction of catheters and opaque material in the brachial, carotid, and femoral arteries and directly into the arterial supply of the organ. Chemotherapy was carried out via catheter in the hepatic artery to metastases in the liver.

In 1951, Dr. Stone brought the Radiological Laboratory to the campus. The 70 million volt Synchrocyclotron was housed here and was used for patient therapy and basic physics experiments. Radiobiology experiments were done here.

In 1953, radiographic equipment was installed in the Thoracic Clinic in the old Clinic Building. Here the first x-ray movies were carried out first using 16mm format and later the 35mm format. These were done with a lens manufactured specially by Eastman Kodak. Nine were made. Aperture F0.65. They weighed about ten pounds. Special glass had to be manufactured to be able to achieve this high aperture. Pediatric patients were studied because of their small size. The early studies of congenital cardiac anomalies were done here.

In 1958, President Robert Gordon Sproul was instrumental in getting me space tor the Radiological Research Laboratory. It was first housed in the basement of the medical school building. 3200 square feet. When the Moffitt Hospital and the East and West Health Sciences Towers were built, this lab was relocated in the basement of the East Tower. The Lab consisted of a large well equipped shop, electronics lab, x-ray room, dark room, conference room, and office.

In 1960, H. C. Moffitt Hospital opened. Radiology occupied the third floor. Therapy occupied the East end with north-south and east -west corridors. Diagnosis occupied the big square block on the south side. The east corridor was used for in-patients and the west corridor for out-patients. Each had 4 radiographic rooms. The south side of the department had 3 fluoro rooms. All the films moved to the central double dark room area. They were wet processed by automatic machines now totally obsolete. The films were taken north to the file room, north again to the reading rooms and then north to the consultation room. Originally, four separate reading rooms were provided. These provided privacy but also provided isolation. They were replaced by a large single reading room. Offices occupied the north side of the main Hospital corridor. The Cancer Research Institute occupied the 13th floor of Moffitt. This was brought to the UC by Dr. Stone with funds from the Cancer Institute of the NIH. In it was an experimental x-ray room. Dr. David Wood was the first director. This was a large fluoro-radiographic set up. It was a patient service room used only for experimental studies. This room was originally designed to be used by Dr. Howard Bierman and me for continued work on cancer chemotherapy using intraarterial administration of drugs. Dr. Biemman le1t the University about this time and the room fell to me for my use. Here I had the first image intensifier-image-orthocon TV equipment. The rest of the equipment for this room was designed and built in the Radiological Research Lab. It was in this area that the physiology of the lower urinary tract was worked out using highly sophisticated equipment. We also studied the action of the mouth and pharynx during speech and swallowing in patients with speech abnormalities, mainly cleft palates.

In 1962, Dr. Margulis became chairman of the department. He developed the department as you see it now. This was the best thing that ever happened to the Department of Radiology at UC. Dr. Margulis brought a whole new attitude about what [. . . ]

Radioisotopes: The only radioisotopes used in medicine when I started in radiology were radium and radon for the treatment of Cancer. Artificially produced radioisotopes became available with the advent of the Manhattan District and thus created a whole new sub specialty in Radiology.

Ultra sound: This was unheard of in 1940. Now, it too has become a sub specialty in its own right.

Image Intensification: made the use of television possible in Radiology and it in turn allowed x-ray movies to be done with acceptable patient exposure. This, in turn opened the way to the introduction of combined anatomical physiological studies.

Angiography: in all ot its ramifications and the use ot catheters for minute anatomical studies and interventional Radiology for therapy were unheard of in 1940 and now are a most important part ot Radiology.

A Review of my Own Career in Radiology and some of the lesson I learned from it.
My undergraduate and early postgraduate training was in physics and math. Because of this I was able to work in the Department of Radiology at the University of Wisconsin as physicist and earned my way through medical school running a radon plant.

#1: I am the luckiest man in the world. I often wondered why I shouldn't pay the University for the privilege of working in it and particularly in the field of Radiology where every case is a challenge and every day was fun.

#2: I learned that history is for the old. The old have only the past to think about, whereas the young have the present the the future to think about.

#3: One should prepare hr retirement at age 13 so that you will be ready for it when it comes. Choose hobbies that do not require physical effort.

#4: Retirement is a time for review of one's career and that will be of interest only to the one who does the review since it does not matter to anyone else. Nevertheless, here goes: the only part that counts is the legacy of papers that one writes. Lectures disappear into thin air. Commiltee work gives a chance to know about one's colleges, but in general is a waste ot time. Choose only the committees that further your own goals: in my case, education and research.