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    "id": "75721294",
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    "title": "Report, 1926",
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        "Safety Light Collection",
        "Records Related to Radium Dial Painters"
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    "ocrText": "RADIUM-THORIUM POISONING FROM DIAL PAINTING\nFrederick B. Flinn, Ph.D.\nAss't Prof. Physiology in Industrial Hygiene\nCollege of Physicians and Surgeons\nColumbia University, N.Y.O.\nSeven girls employed at one time in painting dials with a luminous mater-\nial have died with pathologic conditions that require some explanation as to the\ncause and an examination of the exposure to which they were subjected. The path-\nologic condition referred to consisted of a necrosis of the jaw which has been\nobserved generally to follow the removal of a tooth or dental intervention in the\nform of treatment of some kind. Severe anemia sets in terminating in death. This\nholds true for six of the cases. The seventh case did not develop necrosis of the\njaw, but showed the anemic condition. It is commonly reported by her associates\nthat she had eaten sea food the Sunday before her death which had rendered her 111.\nBesides the cases which have resulted in death there have been several cases of\njaw necrosis among the girls that have been successfully treated.\nThe necrosis of the jaw in these cases is said to differ from phosphorus\npoisoning or ordinary necrosis or typical osteomyletis only in the number of areas\ninvolved in the first place, and the remote location of the areas from one another.\nAfter operative procedure these cases usually take on a very rapid form of necro-\nsis which necessitates operative procedures at weekly periods in order to cut down\nthe sepsis. In the later stages of the disease these necrotic areas present a\nliquidfaction which resembles more or less of a gelatinous character rather than a\nbony disintegration. One dentist speaks of a case which he has successfully treated\nasalow grade infection of the mandible. This necrotic condition differs in his\nopinion from the ordinary necrosis found in the jaw principally in the fact that\nit persisted over such a long period of time and showed a tendency to recur unless\nfree drainage was at all times maintained, meaning by this that if the wound\n-2-\nappeared to be clean and was allowed to heal as in the ordinary case it would\nclose up and then later show a recurrence of the condition.\nOrdinary necrosis of the jaw is far more common than generally admitted\nbut its pronosis is very good under proper treatment. Necrotic conditions have\nheen found to exist in from twenty to thirty cases in a dental clinic treating\nfrom 5000 to 6000 patients per annum. Necrosis is a death of the tissue and\nmust not be confused with such forms of bone destruction as caries or suppurating\nosteitis in which the bone is destroyed by progressive cellular disintegration.\nIn phosphorus jaw we have the actual attacking of the tooth tissue. Thorps(1)\nfound that fumes of phosphorus would destroy 0.37 percent of the weight of the\ntooth in twelve hours in cases of decayed teeth. As far as we know radium has\nno specific action on these tissues. The etiology of Jaw necrosis is fairly\nwell understood and includes systemic infections such as syphilis, tuberculosis,\nscarlet and typhoid fever. Inorganic poisons and drugs may act either by local\napplications or systemic absorption, as phosphorus, arsenic, mercury, hydrogen,\nperioxide. Radium and x-ray treatment have been known to cause necrosis. Besides\ndental lesions such as alveolar and pyorrhea alveolaris, a large proportion of\nthe cases have their genesis in the dental work. It was more common when cocaine\nwas used as a local anesthetic.\nUnfortunately some of the cases under discussion are complicated by such\nthings as joint trouble, diabetes, and syphilitic conditions. Vincent's Angina\nwas also present. The question as to how commonly the early stages are to be\nfound in other girls that have worked in this factory is a matter of dispute.\nSeveral of the dental surgeons who have treated these girls claimed to have detecte\nthe incipient stages in the x-ray pictures of the jaws of a large number of the\nworkers. Other competent surgeons who have examined the same films deny that my\nbone changes have taken place. Several of these suspected cases have had\nabscessed teeth which the attending dentists refused to extract because he was\n-3-\nafraid of starting a necrotic condition. These teeth were extracted by other\ndentists, the gums healed normally and no signs of any trouble ever appeared.\nIt may be stated that the girls as a whole were worked up to such a state that\nthey were afraid to have any dental work done.\nAt the time I was called to investigate the possibility of an unsuspected\nindustrial hazard in the dial painting industry, the plant which had employed\nthe girls 80 far discussed had practically shut down and it was impossible to\nmake a thorough examination of their working conditions on an average working day.\nFortunately Dr. Cecil Drinker(2) had made such 8 survey when the attention of the\nplant officials was first called to the suspected hazards. Dr. Drinker's con-\nclusions briefly were that the condition arose from the girls' habit of pointing\ntheir brushes between their lips and thus permitting the ingress of small amounts\nof radio-active material to the oral cavity. From his own work with zinc, he was\ninclined to lay the whole blame on the members of the radio-active families\npresent in the luminous paint.\nIt has been estimated that about two thousand girls in this country had\nbeen employed in dial painting at the peak of the industry and my inquiries among\nthe employees of different concerns have failed to reveal a single case that was\nsimilar to those observed among the employees of the Orange plant. Moreover we\nhave made inquiries in England and other European countries and find that there\nis no record of any jaw necrosis among their dial workers. It is interesting to\nnote that my foreign correspondents call attention to the fact that the employees\nare warned since the cases reported in Orange against pointing their brushes in\ntheir mouths. At least we may assume that this habit was universal both from\nEuropean reports and from my own observations in factories in this country.\nThe Orange Plant has had approximately 375 girls employed in dial painting\nat different times. The number of girls employed at any one time varied from a\n-4-\ndozen to over two hundred depending on the work. The average employee remained\nwith them from one to two years, while some of the more steady continued the work\nfive or years. No cases were reported to the company until 1923 when it was\nthought that one of the girls condition might be explained by her previous em-\nployment. She had left the employ of The Orange Plant three or four years pre-\nviously.\nI was impressed in looking over the available data by the fact that all\nof the girls who have died worked in the plant between the years 1917-1920 and\nin some cases had been away from the plant several years before pathologic condi-\ntions appeared. The question naturally arises as to whether there had been any\nchange in the mixture in that period or whether there were other shop conditions\nor infections present that were not present in the later years or at other plants.\nThe luminous paint used in this work consists of a specially prepared\nzine sulphide mixed with small amounts of radium or a mixture of thorium and\nradium salts and very infinitesimal amounts of copper. The zino used is prepared\nfrom the best grade of sine sulphide obtainable by repeated precipitation. The\nradio-active compound is added in a soluble form to an emulsion of zino sulphide\nand precipitated out with an alkaline sulphate with constant stirring. It is\nhard to conceive of the radium or thorium sulphate formed as being in anything\nbut almost colloidal condition which must be absorbed by the zinc sulphide. The\namount of radium thorium present varies according to the grade of material re-\nquired, but it is from 0.7 of a milligram to 3 or 4 milligrams per hundred grams\nof zinc sulphide. When used this material is mixed with an adhesive compound by\nthe girls in a small 10 00 porcelain crucible with a glass rod and then thinned\nout with distilled water. The girls are rather energetic in their mixing and I\nhave noticed droplets of the mixture on their persons and clothes as well as on\nthe benches. Also in holding the crucible with one hand during the mixing, some\n-5-\nof the paint got on the hand used to hold the container. The girls could be seen\ntouching their hair and other parts of the body with this hand and it was sur-\nprising how luminous these portions of the body became when flashed and then ob-\nserved in a dark room. The aprons which the girls wore were observed to shine\nall over when returned from the laundry. We felt as if the paint had been \"set\"\nin the washing process. We have never been able to detect any luminousity any-\nwhere where actual contact with the paint by means of the brush, hands or\nsplashing could not explain it.\nThe girls apply the luminous paint to the dials with small camel hair\nbrushes. It has been their custom to point their brushes between their lips\nafter applying it to the dial and dipping it in water. Many decorative painters\nof glass and china have the same unsanitary habit, which has been the source of\nlead poisoning. The number of times that any girl would put the brush to her\nmouth depended on the individual. Probably it was anywhere from two or three\nthough\ntimes a day to as many times for each dial painted. We learned that/each girl\nwas given her own brush, they often took each others brushes and of course this\nhabit furnished an excellent method for conveying infection. The amount of\npaint that a girlwwould use a day again varied with the type of work being done.\nIt would be fair to say that an average amount would be 6 grams.\nTo get some idea as to the amounts of paint that a girl might possibly\nget into her mouth if all the paint left on the brush after painting the dial\nwas taken in, four girls were requested to point their brushes on cloths which\nwe collected and examined. (The fact is that they dipped the brushes into water\nthus removing most of the paint before they pointed the brush between the lips.)\nThe girls were also instructed to keep track of the amount of paint that they\nused in that time. Our results are as follows:\n-6-\nC.M. Paint used 1 gram Paint on cloth 0.043 grams radium contents .00053 mg\nL.P.\n\"\n\"\n2\n\"\n:\n\"\n11\n0.205 \"\nH\n=\n.0026 mg\nA.D.\n\"\n11 10 12\n11\n19\n19\n0.342\n\"\n:\n11\n.0043 11\nB.W.\n\"\n\" 10 \"\n\"\n:\n\"\n0.512\n:\n11\n:\n.0065 #\nAverage for 10 grams\n\"\n\"\n:\n0.576\n19\n11\n=\n10072 #\nThe paint that these girls were using was supposed to contain 2.66 mgs\nof radio-active material to 100 grams of zinc sulphide.\nIt is commonly reported that some of the girls \"fairly ate\" the material\nand did so because of the feeling that if radium was a cure for cancer they would\nnever get it. It has been suggested that the habit of pointing the brush in the\nmouth is to blame for the jaw trouble; that particles of radio-active material\nbecame lodged between the teeth or in the roof of the mouth and caused an irrita-\ntion that ended in necrosis. This explanation has never proven satisfactory to\nus because of the common use of the tooth brush these days and the passage of\nfluid through the mouth. If a particle did become lodged in these places tempor-\narily it must have been of such infinitesimal quantity as to make it seem highly\nimpossible to cause the irritation necessary to end in necrosis. The gum arabic\nused as an adhesive in this work is digested by the saliva in the mouth and would\nnot hold the sulphide in the mouth. Another theory that has been dévanced is\nthat the particle of radio-active substance may get into the bone through the\nopen spaces in the cancellous structure connected with pyorrhea. The x-ray has\nshown open cancellous spaces connected with pyorrhea. It might be possible that\nduring an almost daily exposure some absorption of radio-active particles did\ntake place just as pus or infectious germs are absorbed in these pyorrheal open\nspaces. Statistically this does not seem probable as otherwise we would expect\nto find other cases reported among the thousands of girls who had the same general\n-7-\nhabit of pointing their brushes. The dentists who have treated the girls em-\nployed at the Orange Plant admit that pyorrhea existed in almost all of the cases.\nWe studied the irritating effect of the luminous paint on guinea pigs and\nhumans. The sides of a number of pigs were shaven and painte dai ly with the\nluminous paint for two weeks. We could not detect a reddening of the skin either\nduring the time that the paint was being applied or at any time after the exposure\nhad ceased. Three of us in the laboratory painted an area on our arms with the\npaint and permitted it to remain on the skin for twenty-four hours. No erythema\ndeveloped at any time after the removal of the paint though the observation was\ncontinued over two weeks. The grums of a number of guinea pigs and several goats\nwere painted daily for a period of six months, but during that time no redness\nof the gram was noted. One of the goats lost two teeth at different times and\nwe took pains to rub the paint into the gums until the new tooth name through.\nOur observations were negative. (Our inquiries among the girls who aften have\npainted small areas of the skin with the material failed to reveal any cases\nof \"burns\".) Unfortunately this goat broke its leg and was killed and cremated\nduring our absence thus preventing us from examining the Jaw bone. An x-ray\npicture taken provious to the accident gave a negative reading. One of course\ncould not expect to find any marked bone change in six months and a series of\nanimals should be studied over a period of years. This is especially true if\nintravenous injections of radio-active material is to continue.\nThe radium thorium sulphate is of the order of a hundred times less sol-\nuble than barium sulphate. The question arose in our mind as to whether any of\nthe radium material could be absorbed through the intestinal walls. We fed\nthree guinea pigs 100 mgs. of luminous paint containing 2.90 mgs. of radium\nmaterial per hundred grams of paint daily by placing the powder down its throat\nand then washing it into the stomach with the minimum amount of water. The\n-8-\npig was watched to be sure that it did not spit out any of the material. This\nwas kept up until each pig had ingested two grams of the paint. Ten days after\nthe last does the pigs were killed with other and dissected. None of the organs\nshowed any signs of the treatment. At the beginning of the experiment the pigs\nwere quiet, but after several days became active and ate very freely. The\nfeces and urine were collected and tested for radio-activity. The organs were\nexamined separately, but this does not mean so much for we did not drain the\nbody of its blood before dissection.\nIn determining the radio activity a specially constructed type of Alpha\nray electroscope was used. First the natural drift, that is the time required\nfor the quartz fibre to pass over a definite number of divisions in the eye piece\nwas determined with the physical conditions in the instrument the same as when\nthe sample was to be read. The sample was then introduced and the time required\nfor the quartz fibre to pass over the same divisions as used in the natural drift\ndetermined. It is obvious that any change in the rate of movement of the fibre\nmust be ascribed to a change brought about by the ionization.of the air within\nthe chamber due to the presence of radio-active substances.\nWe are giving our average determinations on the three pigs in the\nfollowing table:\nOrgan\nDry Weight\nMicro gram radium element per gram of\nmaterial\nHeart\n3.4189 grams\n5 X 10 - 4\nLungs\n3.4618\n4.6 X 10 - 4\nBrains\n3.3708\n2 X 10 - 4\nSpleen\n2.9406\n2.5 X 10 - 4\nLiver\n12.1291\n2.5 X 10 - 3\nKidney\n4.035\n1.6 X 10 - 3\nMuscle after burn- 10.50\n1.6 X 10 - 3\ning\nBones after burning12.30\n.02 micro grams.\nThe feces for the first 10 days contained 1.55 micro grams per gram burnt\nmaterial.\n-9-\nThe feces for the second ten days contained 1.75 micro grams per gran burnt materia\n11\n11\n#\n\"\n10 days after exposure contained 0.23 micro grams per gram\nburnt material.\nThe urine samples remained more or less constant for the entire period\nand contained radium element equivalent of 2.5 X 10.2 micro grams por gram\nevaporated material. The original material contained by analysis 058 mgs radio-\nactive material in the two grams fed the pig.\nOur results indicate that 97.85 percent of the material ingested in\ntwenty days was eliminated by the end of ten days after the exposure had ceased.\nOr 2.15 percent had been absorbed through the alimentary track and still remained\nin the body.\nFive pigs whose jaws had been painted regularly each day for a period of\nsix months during which time each pig had received an estimated dosage of three\ngrams of the luminous paint containing 2.66 mgs of radio-active element per 100\ngrams, were killed too months after the last application of the paint. Their\nbodies were burnt to an ash and these ashes examined with radium element equiv-\nalent with the following results.\nAnimal\nScale Div. Read\n1st reading 2nd reading\nAverage.\nBlank\n60-50\n197 sec\n197 sec\n197 sec\nA\n\"\n194\n188\n191\nB\nH\n195\n200\n197.5\nBlank\n\"\n199\n195\n197\n0\n\"\n194\n195\n194.5\nD\n#\n194\n196\n195\nM\n\"\n198\n198\n198\nBlank\n11\n198\n197\n197.5\nA repeated\n\"\n191\n192\n191.5\nThe blanks are normal pigs killed and treated the same way as the radium pigs.\nThe tests were made by alpha ray comparison which is considered very\nsensitive for the detection of radio-active material. Pigs B and E show no\nradio-active material. Pigs C and D give a slight indication of its presence,\nthough the time required for a definite drop in potential is so small as to raise\n-10-\nthe question of experimental error. Pig A shows a definite amount of radio-\nactive material even if minute in quantity.\nThat there is a retention of radium-thorium material for some time after\nthe exposure is indicated by an examination of the tissues of several persons\nwho have worked with the material. It is estimated that the bones in the case\nM who had worked in the industry to within several months of her death contained\n,200 mgs of radium equivalent. The tissues of a man who had been engaged in\nweighing and handling the concentrated material and with an exposure many times\ngreater than the case M, though he did not have much exposure during the last\nyear of his life, were examined. It is estimated that his tissues contained\n.015 mgs at the time of his death.\nWe now made an examination of living persons who had been employed or\nwere still employed in radium work. These persons were instructed to take a\nvery thorough bath the night before the test and to report at my office dressed\nin clothes that had never been worn in the factory or laboratory. A person who\nhad never worked in radium was used as a control. From time to time a known\nquantity of radium us placed under the person being examined and readings taken.\nThe person being examined was requested to lie flat on the back in a comfortable\nposition and the dectroscope placed directly over the chest and readings taken\nas described. The results given below are given in the number of divisions the\nquartz fibre will move in one second.\nB At present painting dials\n.00261 div.\nL\n11\n\"\n11\n11\n.00266 \"\nF Control\n00267\n#\n2nd Day\nS Has not worked in plant for six months\n.00849 div.\nF Control\n.00831 #\nS With 10 micro ampule placed under her back .00903\n=\n0 Working in crystallizing room\n.00889 \"\n7 Control\n.00844 #\n-11-\n3rd Day\nF Control\n.00322\nF Control with two 10 micro gram ampules placed uner back .00545\nF. Control with 10 micro gram ampule under back\n.00430\n.00545 minus .00322 equals .00223 div. per see for 20 micro grams radiums\n.00430\n11\n.00322\n#\n.00108\n:\n#\n\"\n\"\n10\n\"\n11\n\"\nOur - -\n4th Day\nse Engaged in plant\n.00279\nDuplicate test\n.00271\nF Control\n.00229\nDuplicate test\n.00225\nJ Working in plant\n.00448\nWith 20 micro grams radium at knee\n.00484\n\" 20 \"\nn under back\n.00655\nTex Control\n.00253\nA test of the expired air of J as compared with the expired air\nof F showed a slight but definite sign of emanations.\nIn addition to the above tests we have examined five girls who are\nengaged in painting dials in another plant but in each case we could not detect\nany increase over the control, but each gave the same increased readings when\na five mioro gram ampule was placed under her back.\nFrom our observations we feel that we are able to detect the presen ce\nof radium in the living organism without much trouble if all of the precautions\nare taken as to controls, etc. In the case of the last five girls we controlled\nthe five ampule readings by observations on a guinea pig into which we had\ninjected the same amount of radio-active material.\nOne may deduct from the above information that a small deposition of\nradium material may take place in the body of persons around a crystallizing\nplant or where a person may come in contact with the concentrated material daily.\nThis may be the result of breathing in some of the actual material or as one of\nthe decomposition products of the emanations inhaled. The effects detected may\nbe either from solid substances deposited in the body that emit gamma radiation,\n-12-\nor from small quantities of gaseous disintegration product which may be in\nthe circulatory system. Both of the men examined were exposed to rather large\nquantities of emanation the day previous to our tests.\nThe first indication of an exposure to radiations is generally found\nin the blood picture. Among the changes noticed are:\n(1) The rapid and profound destruction of lymphocytes, noted even\nwith relatively short exposure.\n(2) The destruction of red corpuscles under prolonged exposure.\n(3) The signs of blood destruction and lack of regeneration in the\nbone marrow.\n(4) Modification of the normal relations between corpuscles and\nplasma resulting in the formation of non-corpuscular intravascular\nthrombus or fibrin formation within or outside the vessels.\nMottram calls attention to the fact that the red cells are not as\nsensitive to radiation as are the leucocytes and a sustained low level of the\nlatter should be considered as an indication of undue exposure to radiation. In\nfact he places so much emphasis on this fact that he recommends that persons\npresenting a consistent white count below 6000 should be removed from the ex-\nposure until the blood has become more normal.\nWith this knowledge we examined the girls in a number of factories and\nhad some examined for us in England. Because of the statement bhat the condi-\ntions of the employees of the Orange Plant were due to thorium, we purposely\nmade examinations only in those plants that bought their material from the\nOrange Company. Thus we avoided the criticism that the girls 10 reported on\ndid not have an exposure from the same phint as the girls who had developed\nnecrosis. As far as we know this paint is the same as has been used at all times.\nHoffmann reports that he examined sixty girls using radium paint and found no\n- 13 -\nindication of ill health among them. I have talked with several girls who worked\nin one of the plants in which he made his examination and got the same report as\nto pointing the brush in the mouth. The girls all wore dental films for us while\nothers were placed around the shop or room in which they worked. The films on\nbeing developed showed that they had the same exposure as the girls in the Orange\nPlant. We are inclined not to attach much importance to the films because of\nthe personal habits of the girls discussed earlier in this paper and to the\nfact as is shown later on that an infinitesimal amount of the paint will cause\na fogging of the film.\nEach girl was given a good physical examination, especial attention being\ngiven to an inspection of the gums and roof of the mouth. X-ray examinations were\nmade in cases where possible but were negative in all instances. The gums of\nthe girls as a rule were in a most excellent condition which seems to be contrary\nto the girls who had trouble. The girls were questioned about any dental work\nthat had been done since they began dial painting, especially as to extractions.\nWe found one girl who had been five years in the industry and who as the result\nof an automobile accident had a double fracture. The bone healed in due season\nand nothing out of normal was noted.\nThe general findins are given in the following table. For comparisonse\nsake we have also given the blood pictures of two men over some months who have\nbeen actively engaged in the crystallizing room of a radium plant. It is to be\nnoticed that the blood picture of these two men is quite typical of radium\nexposure.\nRadium Girls\nR.B.C.\nW.B.C.\n1.6\nbetween\n4-4.5\n00.0\nless than\n6000\n65.1\n4.5-5\n10.1 between 6000-7000\n28.5\n5-5.5\n15.2\n11\n7000-8000\n4.8\n5.5-6\n23.8\n#\n8000-9000\n/\n22.2\n\"\n9000-10000\n16.9\n18\n10000-11000\n11.8\nover\n11000\n-14-\nNeutrophiles\nLympho-cytes\n3\nX\nless than 60\n46.5 % between 20-25\n95.2\nbetween 60-72\n42.0\n\" 25-27\n1.8\nover\n72\n10.5\n# 27-29\nLarge Mononuclear\nHosinophiles all fall\n86.8% between 3-8\nwithin the normal range 2-4.\n14.2 over 8\nHemoglobin all good. No menstrual changes or bleeding between period since\nbeginning dial painting. Pulse and blood pressure normal.\n43% have had teeth extracted since they began working in the industry, the\nnumber extracted varying from one to nine. All have had dental work done.\nCrystallizing Plant.\nBegan work with radium in 1922. General\nhealth up to May 15, 1925, good.\nDate\nR.B.C.\nW.B.C.\nPoly.\nLympho.\n7-24-22\n5,620,000\n5,950\n66\n34\n10-3-22\n5,300,000\n6,300\n76\n18\n12-13-22\n5,660,000\n5,500\n38\n50\n2-12-23\n5,510,000\n7,750\n44\n52\n4-26-23\n5,560,000\n3,900\n34\n62\n7-28-24\n4,960,000\n3,500\n70\n28\n10-8-24\n5,660,000\n4,500\n48\n42\n12-15-24\n5,570,000\n4,900\n66\n24\n2-6-25\n4,500,000\n4,750\n64\n32\n5-7-25\n5,350,000\n3,600\n58\n34\nBegan work with radium in 1914. General\nhealth from March 18, 1921 to May 15,1925 good.\n3-18-21\n5,620,000\n5,800\n74\n26\n5-20-21\n4,670,000\n6,750\n64\n36\n7-22-21\n5,240,000\n5,400\n74\n24\n9-30-21\n4,530,000\n4,450\n74\n22\n1- -22\n4,700,000\n4,500\n70\n28\n4-5-22\n4,800,000\n5,100\n70\n30\n6-14-22\n4,590,000\n4,650\n66\n30\n10-4-22\n5,090,000\n5,250\n64\n33\n12-15-22\n4,780,000\n3,900\n62\n16\n2-14-23\n4,430,000\n4,500\n60\n22\n10-5-23\n5,150,000\n4,050\n60\n36\n12-11-23\n4,840,000\n5,400\n84\n16\n2-12-24\n4,600,000\n5,550\n60\n36\n8-1-24\n4,550,000\n5,150\n74\n26\n10-8-24\n6,130,000\n4,650\n-\nno\n--\n12-16-24\nAEA\n12-0-24\n5,160,000\n6,850\n80\n20\n2-6-25\n4,600,000\n4.250\n68\n30\n5-1-25\n4.520,000\n5.450\n66\n28\n-15-\nAn examination of our tables does not indicate in any way that these\ngirls had been exposed to radio-active material. In studying our figures we\nseparated the girls into groups according to the time that they had been work-\ning with luminous material. One has every right to expect that if the luminous\npaint were a hazard that those girls working the longest would give some indi-\ncation of that fact, or at least a certain percentage of the number would. Our\nanalysis is as follows:\n41 yrs. up\n2-4 yrs.\n1-2 yrs.\nLess than 1 yr.\nBlood Counts\n10 girls\n24 girls\n15 girls\n10 girls\nRed\n4.86\n4.99\n4.96\n4.83\nWhite\n8350\n8260\n9050\n9530\nNeutrophiles\n64.5\n64.4\n65.1\n64.9\nLymphocytes\n25.7\n24.8\n25.1\n25.7\nThe average count for the girls working less than one year can be\ndiscarded because of the small number and because several of those who worked\nbut two or three months showed a high white count. It would be better to con-\nsider the following analysis of a group of Y.W.C.A. girls examined by Dr.\nLarimore(3).\nR.B.C.\nW.B.C.\n10%\nless than 4\n26.6% less than 6000\n47.4% between 4-4.5\n20.5% between 6000-7000\n36.07\n11\n4.5-5\n19.1%\n:\n7000-8000\n5.6%\n17\n5-5.5\n20.3%\n=\n8000-9000\n1.0%\n11\n5.5-6\n8.8%\n:\n9000-10000\n2.0%\n#\n10000-11000\n2.%\nover\n11000\nNeutrophiles\nHosinophiles\n24.8% less than 60\n29.6% less than 1\n60.4% between 60-72\n65.7% between 1-4\n14.8% over 72\n4.7% over\n4\nUnfortunately we cannot compare the lymphocytes and large mononuclears.\nThis group consisted of supposedly normal girls who had not been exposed\nto any industrial hazard. The average red count for the 253 girls examined was\n4.42 with extremes of 2.8 and 5.7. The average white count was 7200 with extremes\nof 3200 and 12000. Table 2 figures serve to emphasize the necessity of not\n-16-\ndepending on a single blood count in studying an industrial hazard. But if an\nabnormal count is encountered the subject should be examined at repeated inter-\nvals. We examined some of the girls two or three times, and cases where we had\nfound a white count around 6000 on the first examination an increase to around\nthe average the group was noted in the succeeding examinations.\nWe also examined the blood of our animals at regular intervals during\nour experiments and could not detect any changes that did not appear in the\nnormal animals. A histological examination of the jaws of the exposed animal\ndid not show any change. Here again we must emphsize the fact that we realize\nthat six months exposure is too short a time to expect any noticeable changes\nfrom an exposure to these minute quantities of radio-active salts. On the other\nhand x-ray pictures taken of the jaws of girls exposed a number of years to the\nmaterial did not indicate any tissue changes and as we have stated their gums\nand mucous membrane of the oral cavity were all in excellent shape. Dr. R.C.\nWilliams(4) has adopted 7500 W.B.C. with plus or minus ten percent as his normal\nfor the rad ium workers at the Bureau of Mines. This is, of course, the mean of\n5000 to 10000 which is taken as the usual normal limits for all conditions of\nnutrition.\nFrom the facts that we have presented one would feel justified in\narriving at the conclusion that an industrial hazard did not exist in the luminous\ndial painting if it were not for the deaths in Orange. Two of the girls in England\nseem to give a slight indication of some exposure. Statistically also the\nevidence is against the assumption that such a hazard existed. If it were not\nso we would have every reason to expect to receive reports of other cases among\nthe four or five thousand girls who have been engaged in this work in Europe and\nthis country. Furthermore cases should have made their appearances in other\nfactories besides the Orange Plant inasmuch as these other girls have used the\nsame material and have worked as long in the industry.\n-17-\nIt also seems strange that two sisters should have contracted the same\npathologic condition from an industrial exposure. If it were not so we would\nhave a right to expect from a statistical view point that a hundred percent of\nthe girls working in the industry would show definite signs of the exposurel\nBut just the opposite for our examinations so far indicate a healthy group.\nWe are informed on very reliable authority that the brother of these two girls\nhas or did suffer for sometime from an obstinate pathologic mouth condition.\nWe are then brought to the conclusion that there must have been some\npeculiar condition existing in the Orange Plant at the times the girls affected\nworked or else the full effects of radium-thorium are not understood. As to\nthe first suggestion, we have no way of telling at this date. All we can say\nis that we have testimony that the girls did exchange brushes. Pyorrhea also\nwas common.\nTurning to the second possibility we are confronted by the fact that\nvery little is known of the effects of minute quantities of radium-thorium\ndeposited in the bones and which may remain there for years throwing off radia-\ntions into the blood stream. Even the matter of excretion seems to be hazy\nas one from reading the literature, would gain the opinion that radium is\neliminated from the body rather rapidly something our experiments do not confirm.\nViol( (5) in his work on excretion found that 35 to 40 percent of the\nradium injected intravenously was excreted in ten days and there after the excre-\ntion rate was around 1 percent per month. He based his observations on an exam-\nination of the excreta. Wada(6) injected 25 and 1000 MU doses of radium into\na series of rabbits and at the end of four months he was unable to detect any\nradium in the organs of the rabbit getting the 25 MU dose. In the case of the\n1000 MU he found radium in the bones and the amount found bore a relationship\nto the amount injected. He has made an interesting observation that may have\nsome bearing on our problem. He feels that in order to get a stimulating effect,\n-18-\nit is better to inject a large quantity at once as the part not eliminated at\nthe beginning is stored in the bones and thus fumishes the blood with a steady\nstroam of emanations. On the other hand small doses given repeatedly act on all\nthe cells of the body and among them the blood forming cells and this repeated\nstimulation is obviously too strong.\nOur experiments bear out Viol to a certain extent. We injected equal\namounts of radium into a number of pigs and killed them at stated periods, burn-\ning them to an ash and making a radium determination. This experiment is still\nbeing continued and will be reported at an early date. Some of our findings\nare:\nAnimal killed 15 minutes after injuction\n4.21 micro grams\n11\n11\n24 hours\n11\n**\n3.73\n11\n\"\n48\n19\nn\n\"\n3.15\n\"\n\"\n7 days\n\"\n\"\n1.32\n14\n11\n14\n\"\n11\n\"\n1.29\n\"\n**\n38\n11\n\"\n\"\n.75\nGudsent (7) states that quantities of .001 mg of radium equivalent\nincreases the vital functions while amounts of .25 inhibit them. Both he and\nBeck feel that the effects are not due to the radium itself but to the mmanati ons,\nBeck discusses a toxemia as the result of the by-products which are brought about\nby their actions on the cellular structure. Due to the ionizing action of\nradium probably many of its effects are physical chemical changes. The obser-\nvations by Chamber and Russ(8) indicate that the red cells of the human blood\nare hemolyzed much more easily by the alpha rays than by the beta and gamma\nrays.\nClark and his associates in discussing tubes for insertion into malignant\ngrowths are emphatic in their statements as to the effect of beta rays when glass\ntubes are used. The glass walls of the tubes are not thick enough to filter out\nsufficient of the beta rays, hence there is frequently an intense sloughing,\ngreat pain and heavy frbrinosis, which outs off all circulation to the parts\nOften leading to further necrosis. The prolonged action of the emanations in\n-19-\nin burled tubes appear to have a particularly devitalizing effect on bones.\nWith the metal needles the irritating beta rays are filtered out and bone\nnecrosis has been observed to be much less frequent.\nUnfortunately almost all of the observations made as to the effect of\nradium and its allied substances are concerned with relatively large amounts\nof material, and many of them on external exposures. Even in the experiments\nin which Mella(9) speaks of minute doses he refers to .05 mg for a rabbit\nweighing approximately 1000 grams which means in proportion 3.5 mgfor the 70\nkilo man.\nOutside of the cases in the Orange Plant we do not have any evidence\nthat would indicate what a daily exposure to infinitesimal amounts of radio\nactive material will do to the organism. Furthermore these cases are by no\nmeans clean out and one should be very careful in stating that they are the\nresult of any dadium thorium exposure. Other factors have not been ruled out\nand bacteria infection has not been disposed of in a satisfactory manner. Long\ncontinued and carefully controlled experiments will be the only way that this\nimportant question can be settled.\nThe theory that the pathologic condition is the result of the presence of\nmesothorium instead of radium is not upheld by our examination of the girls.\nMella(10) has indicated in his work that thorium X does react on different tissue:\nthan radium, but his is the only observation that we have had and his results\nlack uniformityl His summary is that neither in the acute or chronic poisoning\nof the animal by thorium X can its death be traced to changes in the blood\nforming organs, that there is a directly opposed effect between Roentgen rays\nand thorium X. The latter exerts directly only a slight effect on the lymphoid\ntissue. The myeloid tissue on the contrary is earlier and more intensely\ninjured.\n-20-\nIn considering the Effect of Mesothorium and radium we must bear in\nmind certain facts. Mesothorium decays 250 times as fast as radium does, and\nconsequently in its pure state, weight for weight, its activity would greatly\nexceed that of radium. But in these paints the quantity of mesothorium is\nnot expressed in milligrams by weight but by its equivalent in radium. Therefore\nthe activity of the two compounds compared bear the same ratio as the values\nassigned to the preparations.\nAlthough mesothorium gives off no rays, its first decomposition product\nafter mesothorium has been separated gives off powerful beta and gamma rays.\nFor this reason the operator must protect himself against these rays. On the\nother hand in thepproduction of radium, the product giving the penetrating\ngamma rays (RaC) is formed rather slowly.\nIn studying the possible effect of mesothorium that may become deposited\nin the body one must bear in mind the fact that the half period of radium is\n1580 years while that of mesothorium is 6.7 years. In the decay of radium we\nfirst have an emanation having a half period of 3.8 days. This is followed by\nthe active deposit of rapid change (RaA, RaB, RaC) followed by an active deposit\nof slow change RaD, RaB, RaF. Radium D and E emit soft beta rays and have a half\nperiod of 16.5 years and 4.85 days respectively. Radium F or polonium emits\nalpha rays and has a half period of 136.5 days. But in the case of mesothorium\nthe emanations have a half period of only 54.5 seconds, which is followed by\nthorium A, B, and 0 which are comparable to the same series of radium. Thorium\n0 is followed by Thorium D (Th lead) which is stable. Among the thorium decom-\nposition products we do not haveone similar to radon of the radium products\nwhich has a comparatively long live emitting alpha radiations. The maximum range\nof alpha particle from the thorium series is 8.6, while for the radium series\nit is 6.94 cm.\nAt the meeting of the Association for the Advan cement of Science in December\n-21-\n1925, S.O. Lind of the Fixed Nitrogen Research Laboratory brought out the fact\nthat the activity of one alpha particle in the production of physical and chem-\nical changes is 10 to 15 fold that which has been ordinarily ascribed to it. This\nmay have some bearing in a study of this subject.\nIn the case we have mentioned in which .015 mg of radium was found in\nthe bone and which has received considerable public attention in some quarters,\nthe man has not been doing any work with high-grade materials for over a year;\nthat is to say he had done no crystallizing of high grade products and was not\nthus exposed directly to radium emanations. It is true that he had made some\nmeasurements on high grade materials but he did no crystallizing. It seems that\nhis break down if attributable at all to radiation from radium, is the result of\naccumulations in his system of radio-active products. In the radium series, the\nproducts following rad ium 0 are some of the long-lived and they gradual ly produce\nproducts giving off alpha rays. Since some time elapsed between his breakdown\nand the years during which he was exposed to radium emanation, there is a possi-\nbility that some of these disintegration products resulting from emanation may\nhave remained in his system. In the thorium series, on the other hand, the\nproducts which follow emanation are all comparatively short-lived, and, hence\nif these disintegration products from emanations have at all attributed to the\nillness, it would seem that the radium products are the ones responsible. This\ncase is complicated by the fact that he suffered from severe hemorrhoids and\nthey interfered toward the end with his social activities at times. At the\ntime Dr. Drinker made the examination of the Orange Plant the blood picture of\nthe man was practically normal.\nWe wanted to determine how small a quantity of radium would fog an x-ray\nfilm in a given time. We took 100 grams of bone ash and mixed it thoroughly\nwith 0.200 grams of luminous paint containing 0.00598 mgs of radio-active\nmaterial. We exposed dental films to one gram, half, quarter, and tenth grams\nof this mixture. At the end of two weeks the tenth gram portion showed a slight\n-22-\nbut definite fogging of the film. At the end of a month the fogging had increased.\nThis tenth gram of the mixture contained 0.00000598 mgs of radio-active material.\nThe result of this experiment showed that it is very hard to determine the\nexposure that a girl was under by means of dental films fastened to the clothing\nas a single particle of the paint might be the cause of the fogging. On the other\nhand it only serves to emphasize the great activity of the radio-active material.\nIt may be interesting to know that many of our igneous and sedimentary rocks con-\ntain around 4 X 10 -6 micro grams of radium element per gram.\nWe feel that our observations so far would lead us to say that the girls at\nthe Orange plant died of some other condition than the rad ium or mesothorium ex-\nposure. The radio-active salts may have played a part but that can only be deter-\nmined by a study lasting over a period of years.\nIt would be interesting to compare the following examination as reported\nin the J. (12) \"There were marked lesions of the mouth and gums, with bleeding.\nThere was beginning necrosis of the soft palate, gums and cheeks, extending down\nto the glottis. --- The patient became progressively more septic and toward the\nend showed marked sloughing of the roof of the mouth and the posterior pharynx,\nextending as far as could be seen. Smears from the mouth showed Vincent's organ-\n1sm and gram positive cocci.\" with one of a case of a young man in Providence\nwhose diagnosis was Vincent's angina and stomatitis. Both cases showed negative\nWasserman. His examination showed \"Throat, pharynx injected. Left tonsillar\nfossa nearly obliterate by necrotic mass, purple and black in wlor, 30 streaked with\nwhite membrane. Similar but smaller amounts of necrosis just back of the lower\nleft molar. Gums everywhere retracted from teeth, ragged and bleeding\". The\nprogress report of this case shows the second day after admission \"gums bleeding\nand necrotic in many places.\" The next day \"purpuric spot on right hand at base\nof thumb. Previously no pectechai.\" The fifth day tonsils still show necrotic\nexudate and gums show necrosis exposing right upper lateral incision\". The patient\ndied on the fifth day.\nCONCLUSIONS\nFrom our examination of girls painting dials with luminous material\ncontaining radium or a mixture of radium and mesothorium, together with animal\nexperiments that have been conducted in our own laboratory, we feel that a\nhazard does not exist in this industry.\nThe animal experiments were of too short a duration to expect bone\nchanges to develop but we have examined a good size group of girls employed in\ndifferent factories, and who have been working in the industry for a number of\nyears and have not observed anything that would indicate a hazard in this work\nif proper precautions are taken.\nOur tests indicate that radium when taken orally is excreted within\na short period. There is no warrant for the statement that it will remain in\nthe body indefinitely if it is once absorbed.\nWe would recommend from a sanitary view point and as an extra precaution\nthat the girls be carefully watched to prevent their pointing the brushes in\ntheir mouths."
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