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    "localId": "75730744",
    "label": "Memorandum to Mr. Roeder [A. Roeder], no date",
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    "id": "75730744",
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    "title": "Memorandum to Mr. Roeder [A. Roeder], no date",
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        "Safety Light Collection",
        "Records Related to Radium Dial Painters"
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    "seq": 4,
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    "ocrText": "138\nMemorandum\nRelating to the probable causative element\nunderlying the disease of about 12 girls formerly\nemployed by the U. S. Radium Corporation at Orange, N. J.\nOrigination of said disease attacking the gums and jawbones of operators and\nfinally becoming systemic causing death ultimately, are associated with the painting\nof numerals and hands of watches, clocks, etc., with so-called self-phosphorescent\nmaterials using fortheir fixation, various adhesives and a camel's hair brush. During\nthe process of painting, in order to keep the brush pointed, the operator acquires the\nhabit of shaping the brush by putting it between her lips and in so doing it is now\nsuspected that a certain amount of self-phosphorescent material may reach and be de-\nposited between the interspaces of the teeth, gums or tongue thus causing or contri-\nbuting to the ailment in question. Since in this process, the operator deals with sev-\neral substances and is also exposed to various other irritative agents, it is well to\nconsider each agent separately and the action they could have alone or in combination\nwith others to provoks such conditions.\nLuminous Material\nThe materials that each operator has to deal with are as follows:\nUNDARK, a composition of phosphorescent crystalline zinc sulphide compound\ncontaining small quantities of other elements such as copper, manganese, lead, arsenic,\nthalium, uranium, selenium, etc,; in order to render it luminous in the dark, it is\nmixed with various radioactive elements. The usual radioactive mixture contains radium,\nmesothorium and radiothorium.\nThe usual luminous material an operator deals with most of the time contain\nvarious proportions of radioactive elements of joint radioactivity equivalent to about\n1 milligram of gamma radiation of radium element as an average, mixed with about 40\ngrams of phosphorescent zinc sulphide in most minute sub-divisions; ultimate particles\nof radioactive elements being rendered insoluble in ordinary solvents. This also ap-\nplies to phosphorescent zinc sulphide crystals which are not, or very little, soluble\nin ordinary solvents.\nADHESIVES - Most commonly used adhesives are represented by a solution of gum\narabic in water. Luminous material is mixed with this adhesive and painted. This ad-\nhesive when put in the crucible for mixing is not sterile since certain amounts of it\nremain in the crucible every day and are used, with new material, the following day.\nCrucibles remain exposed more or less to air, dust, etc. Furthermore, the camel's\nhair brush is not sterilized before or after working with luminous material or adhe-\nsives and so also carries a certain amount of contamination from saliva and its contents.\nConditions during Operations\nIt is well to consider the process of \"pointing\" the brush by moistening it\nbetween the lips in order to estimate the probable amount of material that reaches\nthe oral cavity. The small brush as used for painting, when dipped into the thick\nmixture of radioactive inc sulphide with adhesive, can hold, when fully dipped into\nthe mixture, from about 7 to 10 milligrams of substance as a whole. The \"pointing\"\nof the brush, however, is done before dipping the brush into the mixture, or after\nremoving as much of the mixture as is possible from the brush onto the side of the\ncrucible. That is to say that at the time of \"pointing\" the brush does not hold\nmore than a few milligrams at the most. When the operator \"points\" the brush be-\n139\n-2-\ntween the lips, only a minute quantity of the mixture can remain upon the lips, thus\nreaching the tongue, as larger amounts would be noticeable by the peculiar taste of\nthe mixture (adhesive).\nAssuming that an operator repeats the operation of \"pointing\" several hun-\ndred times daily, the total amount of the material to reach the oral cavity could amount\nto from a few milligrams to about 100 milligrams. There is\nnot\nhowever\nthe\nprobability\nthat amounts larger than 1 or 2 milligrams remain constantly in the mouth due to the\ntaste and the probable spitting or swallowing of same, etc.\nIt is interesting to speculate also on the probable distribution of the material\nwhen once it passes the lips. Of course, one would think that the material would be\nequally distri throughout the mouth until it is either swallowed or disposed of\notherwise. Further thought would seem to indicate that equilibrium amounts of material\npresent continuously in the mouth throughout the whole day, bearing fluctuations such\nas the diminishing of average amounts during eating and drinking of water, could not\namount to more than a few milligrams of zinc sulphide at a time.\nAmount of Radioactivity\nH aving assumed that a few milligrams of UNDARK of the quality containing 1\nmilligram of radioactive element to 40 grams of zinc may remain constantly in the\nmouth during working hours, it appears that this amount would also be accompanied by\nfrom 25 to 50 millimicrograms, or 000025 to 000050 milligram of radioactivity. It\ncould be further supposed that larger amounts of material than that mentioned are pro-\nbably swallowed. The question arises as to what effect, if any, this amount of radio-\nactivity could produce locally. Such small doses of radioactivity in contact with the\ntissues, day in and day out, alone, do not seem to have any effect as a such whatsoever.\n(Radioactive compresses can be here used as an example.) This can be seen from the ex-\nperiences of the radium laboratories where chemists crystallize radium solutions every\nday Furthermore, in the luminous material laboratories where large amounts of material\nare prepared, weighed, bottled, etc.; where chemists and physicists are exposed continu-\nously to much stronger concentrations of radioactivity, in contact with their skin, lips\ntongue, etc., through the medium of cigarretes, dust, etc. Assuming, however, that the\nabove mentioned amounts of radioactivity present in the mouth are of sufficient intensity\nto start local trouble, their effect on the blood system would be noticeable before any\nlocal trouble could start. This is due to the fact that of all the organs, the blood\nmaking apparatus of the human body is the most sansitive to radioactivity. Taking this\nas an index and comparing it with the amounts which could be present in the oral cavity\nof the operator throughout the day, we reach surprising facts, as follows:\nThe smallestsingle amount of radioactivity essential to produce visible micro-\nscopic or morphologic blood changes, such as increase of erythrocytes and leukocytes or\ndecrease of leukocytes with decrease of erythrocytes following, would be in the order\nof about 20 micrograms injected intravenously in single doses or distributed in at\nleast 2 microgram doses per day for longer periods of time, when injected intravenous-\nly; 20 micrograms ingested in soluble form does not show any influence on the blood\nin a single dose. The amounts mentioned are about two thousand times larger than those\nassumed in the case of operators. The radioactivity the operators work with, as men-\ntioned before, is in insoluble form, therefore it could not, to any large extent, pene-\ntrate the tissue and accumulate therein, and act, after a certain period of time, in\n8. cumulative way. On the other hand, if we dismiss the possibility of its penetration\n- 3 -\n140\ninto the tissue and the gradual accumulation, then the amounts (as would be evident\nby the presence of radioactive elements in the jawbones which could be easily detected)\nof radioactivity present in the mouth although constantly present, is far too small to\nproduce local destruction of the tissue such as is produced by larger amounts of radio-\nactivity on skin or mucuoustmembranes.\nThis applies to irritative qualities of radioactivity produced by beta and gamma\nradiations, whereas alpha radiation emitted by radium is not considered. During the ex-\ntraction of radioactivé elements in laboratories, likewise their use in the medical pro-\nfession, etc., burns and destruction of tissues occur due to the exposure to said radio-\nactive elements sealed in containers of glass or metal. Radiations which go through\nsaid containers consist only of beta and gamma rays representing only a fraction, that\nis 5%, of the total radium energy. The rest of the energy represented by alpha radia-\ntion is screened off by the glass or other material of which the container is made.\nThe alpha radiation emitted by the Radium elements are of very low penetrative\npower and is easily screened by 2 or 3 layers of ordinary cigarette paper but is very\nirritative to tissues. It would appear possible that small quantities of radioactive\nelements mixed with phosphorescent zinc sulphide and deposited on the tissue, acting up-\non same for considerable intervals of time, may produce irritative effects by the above\nmentioned alpha radiations.\nIf said weak radiations are combined with physical-chemical irritating effects\nof zinc sulphide and centered upon a certain spot of tissue for a long period of time,\nit could be assumed that under conditions it could produce local changes on the mu-\ncuous membranes, not directly comparable to the necrotic or vesicant effect of beta and\ngamma. radiations but sufficient to lower the resistance of the local tissues to the\npathogenic bacteria's entrance and start of osteonecrosis.\nThat the cases in question are results of such joint effect of verious agents\nrather than of single ones, is the logical assumption so much more since effects of\nburns produced by radioactive elements are never progressive but heal eventually, con-\ntrary to the effects of the softx-ray radiations, and they never produce necrosis of\nthe bone.\nIn order to substantiate the former assumption and so establish what agent, or\ngroup of agents, was responsible for the pathological conditions in question, it is\nnecessary to diagnose correctly the number of said cases; diagnosis to be centered upon:\n(a) whether the disease is malignant or not, local or metasthasing,\n(b) Whether it is bone necrosis with presence of some predominant bacterial;\n(c) whether this necrosis is local, or\n(d) whether it becomes constitutional, and if so after how long a time after the\nappearance of the first symptom.\nCultures from local tissues and blood studies should solve the above question and\nestablish the diagnosis.\nRemark:\nCrystalline phosphorescent zinc sulphide is not soluble in ordinary solvents but\nit dissolves slowly in contact with tissues by oxydation."
}