<p>Eben M. Byers died early on the morning of Thursday, March 31, 1932, the victim of a mysterious syndrome that for 18 months had rav- aged his body, corroding his skeletal system until one by one his bones start- ed to splinter and break. Byers had been a powerful man, a broad-chested athlete and sportsman who was an expert trap- shooter and had been the U.S. Amateur Golf Champion in 1907 at the age of 27. As chairman of the A. M. Byers Iron Foundry, he had personiÞed the Roar- ing Twenties, a millionaire socialite and tycoon who had clambered into the upper reaches of New York society. He continued to lead a life of privilege even after the stock market crash, main- taining homes in Pittsburgh, New York, Rhode Island and South Carolina, as well as horse-racing stables in New York and England. When Byers died, his shriveled body must have been barely recognizable to friends who had known him as a robust athlete and ladiesÕ man. He weighed just 92 pounds. His face, once youthful and raÛshly handsome, set oÝ by dark, po- maded hair and deep-set eyes, had been disÞgured by a series of last-ditch op- erations that had removed most of his jaw and part of his skull in a vain at- tempt to stop the destruction of bone. His marrow and kidneys had failed, giving his skin a sallow, ghastly cast. Although a brain abscess had left him nearly mute, he remained lucid almost to the end. He died at 7:30 A.M. at Doc- torsÕ Hospital in New York City. News of ByersÕs death and its myster- ious circumstances reached his former colleagues on Wall Street almost imme- diately. Over the next two weeks the stock of his company, already battered by the Great Depression, lost one third of its value. Worried friends and rela- tives had begun to contact ByersÕs doc- tors from the day of his death to Þnd out if he had died of something conta- gious. By the next afternoon, the author- ities had begun a criminal poisoning in- vestigation and were preparing the body for a forensic autopsy by the chief med- ical examiner of New York. The New York Times announced the preliminary results in a front-page headline: ÒEben M. Byers Dies Of Radium Poisoning.Ó Radium poisoning? How could a man of ByersÕs position and wealth have suf- fered a malady that so far had been con- Þned to a handful of radium chemists and dial painters who used radioactive ink to make watch faces glow in the dark, licking their brushes to draw a Þn- er line? The answer to this question fo- cused attention on a danger that public health oÛcials had only just begun to recognize: even small amounts of toxic substances can kill, over time. The By- ers case thus helped to create the pre- sumption that medicines are dangerous until proved safe. ByersÕs radioactive saga had started on a chartered train returning from the Harvard-Yale game of 1927. Engaging in some late-night revelry in a private Pullman booth, Byers fell from his berth and injured his arm. Despite the best ministrations of his personal physicians and trainers, Byers complained that the ache simply would not go away. Soon the injury was aÝecting his golf game (and, it was rumored, his libido). Even- 94 SCIENTIFIC AMERICAN August 1993 The Great Radium Scandal William J. A. Bailey grew rich from his radium-laced patent medicine until it killed a leading socialite. The scandal helped to usher in modern standards of radioisotope regulation by Roger M. Macklis ROGER M. MACKLIS is chairman of the department of radiation oncology at the Cleveland Clinic Foundation. He di- vides his time between his clinical prac- tice in pediatric radiation oncology and his research into novel anticancer radio- pharmaceuticals. He has written on the history of medicine in a number of pro- fessional journals. He is now preparing a section on radiomedical quackery in the early 1900s for a series to be pub- lished in 1994 under the aegis of the American College of Radiology in honor of the 100th anniversary of the discov- ery of x-rays. Macklis holds a masterÕs degree in biophysics from Yale Univer- sity and a degree from Harvard Medical School. IMMODEST PROPOSAL from the Roaring Twenties promotes Radithor, a radium- laced patent medicine, and its purvey- or, William J. A. Bailey, a college drop- out who gave himself the title of doc- tor. Such advertisements capitalized on the fad for radium, whose eÛcacy in de- stroying tumors made it seem a panacea. Copyright 1993 Scientific American, Inc. tually Byers found his way to a Pitts- burgh physician named Charles Clinton Moyar, who suggested that Byers try Ra- dithor, a patent medicine whose man- ufacturer, the Bailey Radium Laborato- ry in New Jersey, described it as a cure for dyspepsia, high blood pressure, im- potence and more than 150 other Òen- docrinologicÓ maladies. Byers began drinking several bottles a day beginning in December 1927. He told friends that he felt invigorated and rejuvenated. So satisÞed was he with the results that he sent cases to his friends, colleagues and female acquaintances and even fed some of the expensive potion to his racehorses. Like other ar- dent Radithor enthusiasts, Byers appar- ently consumed vast quantities of the nostrum, drinking between 1,000 and 1,500 bottles between 1927 and 1931. He probably accumulated a radiation dosage equivalent to thousands of x- raysÑperhaps three times the lethal dose, if absorbed all at once. The autopsy conducted the day after Byers died conÞrmed that his bones and organs were dangerously radioactive. Placed on a Þlm-plate overnight in the dark, his extracted teeth and jawbone produced a dramatic Þlm exposure pat- tern. As the evidence for radium poison- ing grew, squads of public health oÛ- cers pulled the dangerous materials oÝ store shelves. Nervous citizens sheep- ishly came forward to turn in their own radioactive medicines. Among them was Mayor James J. Walker of New York City, who at Þrst refused to give up his radioactive rejuvenator because, he said, it made him feel so good. My own involvement with the strange case of Eben Byers be- gan in the fall of 1989, when I came across several empty bottles of Radithor in a medical antiques shop and bought one on a whim. Because my lab- oratory research centers on treating cancer with biologically targeted radio- active compounds, I knew it was possi- ble to make water temporarily radioac- tive by incubating it with radium. The radium gives oÝ radon, a radioactive gas whose half-life is short. I assumed that the maker of the patent medicine had resorted to this very inexpensive process and that the RadithorÕs residual activity had decayed to insigniÞcance long ago. I was wrong. Tests performed by my colleagues John L. Humm and Marc R. Bellerive in our gamma-ray spectrosco- py unit at the Dana-Farber Cancer Insti- tute in Boston revealed that almost 70 years after it had been produced, the nearly empty bottle was still dangerous- ly radioactive. We estimated that the original bottle must have contained ap- proximately one microcurie each of ra- dium 226 and radium 228. Intrigued, I bought the rest of the bottles. When they tested equally radioactive, I went to the Countway Medical Library rare book collection and the stacks of the Har- Copyright 1993 Scientific American, Inc. vard University Library to Þnd out more about the lost story of Radithor, the Bai- ley Radium Laboratory and its director and chief scientist, an inventor, entre- preneur and marketing genius named ÒDoctorÓ William J. A. Bailey. A lthough contemporaries, William Bailey and Eben Byers came from opposite ends of the social spec- trum. In a sense, they represented the twin faces of the American dream dur- ing the early decades of the 20th centu- ry. Byers was born in 1880 into a life of privilege, attending St. PaulÕs School and Yale University, where his suave de- meanor and social conquests at nearby girlsÕ schools earned him the nickname ÒFoxy Grandpa.Ó After graduation in 1901, he dabbled in business, traveled and golfed, playing a major role in the Harvard-Yale defeat of the visiting Ox- ford-Cambridge golf team in 1903. The next year he became president and a di- rector of the small Girard Iron Com- pany, which had been built up by his father, Alexander Byers. In 1909, after the death of his older brother, Byers became president and eventually chair- man of the iron foundry. In contrast, William John Aloysius Bai- ley was born into a tough neighborhood in Boston on May 25, 1884. His father, a cook, died when he was young, and Bai- ley and his eight siblings were raised by their mother, Mary, on a weekly in- come of $15. Bailey attended Quincy Grammar School and graduated about 12th in his class from the prestigious Boston Public Latin School, long known as a stepping-stone to the Ivy League for poor boys with quick wits. He did poor- ly on his Harvard entrance examinations but managed to be admitted as a fresh- man in the fall of 1903. Mounting debts forced him to drop out two years later, and although Bailey later claimed to be a Harvard graduate with a doctorate from the University of Vienna, no evidence exists to support either claim. Bailey moved to New York City, work- ing in an import-export business and editing an export catalogue. His letters from the time speak enthusiastically of his master plan: to be appointed the un- oÛcial U.S. trade ambassador to the im- perial government of China. His scheme never materialized. Instead, in the years leading up to World War I, Bailey trav- eled widely, acquiring a cosmopolitan veneer that later served him well. The outbreak of war found him drilling oil in Russia, but he headed home to tinker in a mechanical workshop when war- time commerce proved impractical. It is at this period that BaileyÕs name Þrst began to appear in connection with various scams. On May 8, 1915, the New York Times reported that he had been arrested on charges of running a mail- order swindle out of the Carnegie Engi- neering Corporation (a paper Þrm with no relation to the Carnegie steel empire). He accepted advance mail deposits for a $600 car to be assembled in Michigan and delivered to a pickup point in Pitts- burgh. No factory existed, and Bailey and two others were found guilty and sen- tenced to 30 days in jail. In May of 1918, Bailey was Þned $200 plus costs for fraudulently promoting 96 SCIENTIFIC AMERICAN August 1993 EBEN M. BYERS, athlete and ladiesÕ man, as he appeared in his prime, several years before his consumption of Radithor led to the destruction of his bones and, in 1932, to his death. The scandal swept radioactive potions from drugstore shelves. WILLIAM BAILEY had compiled a history of shady business dealings before striking gold with Radithor. He seems, how- ever, to have believed his own propaganda, having taken his own medicine over a period of years. Copyright 1993 Scientific American, Inc. a patent medicine for male impotence called Las-I-Go For Superb Manhood. Chemical analysis of these pills revealed that the active ingredient was strych- nine. This episode appears to mark the beginning of BaileyÕs fascination with sexual stimulants and aphrodisiacs. Radiation research was a natural draw for Bailey because it had become a glamour Þeld in medicine. This glamour derived from the novelty of the phe- nomenon and its evident value in imag- ing the body and destroying tumors. Workers generally believed other, more subtle applications were waiting to be found. For instance, Marie Curie, who with her husband, Pierre, had discov- ered radium in 1898, set as one of her major postwar tasks the investigation of the eÝects of minute quantities of radium on cells, animals and humans. In England, this Þeld was called mild ra- dium therapy to diÝerentiate it from the use of much larger doses in the treat- ment of cancer. M ild radium therapy can be traced to the homeopathic and physical medicine theories of the 19th century. They held that most healing processes were natural and that tiny quantities of naturally occurring materials, coupled with exercise and sunlight, could cure most maladies. Pro- ponents of these theories believed in the legendary healing powers of the great European hot springs. One mystery per- sisted, however. The waters appeared to lose their potency just a few days after they were bottled. In 1903 the discov- ery was made that the apparent phar- macological agent dissolved in these waters was radon. After Ernest Ruth- erfordÕs investigation of alpha-particle emissions from radium and radon, the transient healing eÝects the hot springs were reputed to have were ascribed to these particles. Workers hypothesized that the alpha particles might account for the opera- tion of the endocrine system, a connec- tion that is not as strange as it may seem. Both Þelds had recently come to fascinate the medical world, and each had won the highest honors. In 1921 Frederick Soddy received the Nobel Prize in Chemistry for his work on radioiso- topes. In that same year, Frederick G. Banting and Charles H. Best isolated in- sulin, work for which Banting and John J. R. MacLeod won the 1923 Nobel Prize in Physiology or Medicine. The one dis- covery provided a new kind of energy, the other, a method of controlling the bodyÕs transduction of energyÑthe pro- cess by which sugars and other basic foods are converted into more readily usable forms. Might radioactivity be the spark that set the biophysical machin- ery in motion? The German physiologist George Wendt, in his address to the 13th Inter- national Congress of Physiologists, re- ported that human leukocytes exposed to low-level radium radiation began migrating toward the radium source and that moribund vitamin-starved rats could temporarily be rejuvenated by ex- posure to radium. Like the stuÝ of ho- meopathic legends, radium appeared to be a substance with two distinct modes of medical eÛcacy: in large quantities, it was destructive, but in trace amounts, it was beneÞcent, perhaps even necessary. Legends translated into products more quickly then than they do now. The feeble jurisdiction of the Food and Drug Administration did not extend to radium, which it classiÞed as a natu- ral element rather than a drug. Radio- active candies, liniments, potions and creams were widely available by 1915. At Þrst, the fashion appears to have been for the most part conÞned to Eu- rope. In the U.S., interest in the medici- nal, ÒcatalyticÓ properties of radium and its decay products surged after double Nobel laureate Marie Curie made a whis- tle-stop railway tour across the country in 1921. It is not known whether William Bai- ley actually encountered Curie, but it is clear that beginning in the early 1920s he became enraptured with radioactiv- ity and its eÝects on life. He produced a translation of CurieÕs 1910 classic, TraitŽ de RadioactivitŽ. He incorporated a company in New York City called As- sociated Radium Chemists, Inc., which put out a line of radioactive patent medicines, including Dax for coughs, Clax for inßuenza and Arium for run- down metabolisms. Before the Byers af- fair, this operation was closed by the Department of Agriculture on grounds of fraudulent advertising. Bailey soon went on to found two new Þrms in New York City. The Thor- one Company (Thorium Hormones) produced cure-alls containing radium and thorium for Òall glandular, metab- olism and faulty chemistry conditions,Ó especially impotence. The American En- docrine Laboratory produced the Ra- dioendocrinator, a gold-plated radi- um-containing harness that could be worn around the neck (to rejuvenate the thyroid), around the trunk (to irra- diate the adrenals or ovaries) or, for en- ervated males, under the scrotum in a special jockstrap. The device sold Þrst for $1,000, then $500 and then Þnally $150 as the market became saturated. Bailey sought opportunities to present his theories at legitimate scientiÞc meetings. In a public relations coup, he managed to secure an invitation to speak at the medicin- al products session of the American Chemical Society meeting in Washing- ton, D.C., in 1924. ÒWe have cornered aberration, disease, old age, and in fact life and death themselves in the en- docrines!Ó Bailey thundered. ÒIn and around these glands must center all fu- ture eÝorts for human regeneration.Ó The next day the New York Times ex- cerpted the talk in a lengthy and com- plimentary article. In 1925 Bailey moved to East Orange, N.J., and opened the Bailey Radium Laboratories. It was here that he creat- ed and bottled his promotional master- piece, Radithor. Ironically, 1925 also marked the beginning of the end for mild radium therapy. A group of New Jersey radium chemists and dial paint- ers working at the U.S. Radium Corpora- tion died after a protracted and myste- rious syndrome of kidney disease, low SCIENTIFIC AMERICAN August 1993 97 RADITHOR VIAL from a curio shop turned out to be dangerously radioactive some 70 years after its original purchas- er had nearly drained it. This Þnding supports at least one of BaileyÕs claims: he actually did use radium, rather than a cheaper, short-lived isotope. The vial originally contained about a microcurie each of radium 226 and radium 228. Copyright 1993 Scientific American, Inc. blood counts and widespread deterio- ration of their bones. Some experts mut- tered about possible radium poisoning, but Bailey disagreed. ÒThere is no proof that radium was responsible for the deaths,Ó he opined, when called by the New York Times for an expert comment. His company shipped promotional pamphlets to every registered physi- cian in the U.S., Þlling them with testi- monials from patients and physicians as well as with photographs purporting to show the extraction, puriÞcation and testing of radium at the Bailey Labs. In fact, Bailey simply bought puriÞed ra- dium wholesale from the nearby Amer- ican Radium Laboratory, bottling it in distilled water and marking up the price by almost 500 percent. He oÝered phys- icians a 17 percent rebate as a Òprofes- sional fee,Ó a practice that the American Medical Association condemned as Òfee- splitting quackeryÓ in 1927. The promotions quickly made Bailey a rich man. He sold more than 400,000 half-ounce bottles between 1925 and 1930. Yet although evidence began to mount that small quantities of radio- active material could be devastating to health, the public at Þrst took little notice. No one seemed to worry about a sickness that had so far been con- Þned to poor, working-class women who painted radium onto watch dials. The FDA issued warnings, but it had no recourse to legal action. The Federal Trade Commission therefore took the lead by beginning an investigation of BaileyÕs claims in 1928. On February 5, 1930, the agency Þled an oÛcial com- plaint charging Bailey with falsely ad- vertising the eÛcacy and harmlessness of his products. It was at about this time that Eben By- ers began to experience unusual aches and pains. He told his private physician that he had lost Òthat toned-up feeling.Ó He began to lose weight and complained of headaches and toothaches. He was told that he just had a bad case of si- nusitis but became alarmed when his teeth began falling out. Aradiologist in New York City, Jo- seph Steiner, looked at ByersÕs radiographs and noticed some similarities between the developing bony lesions in ByersÕs mandible and those described in the deceased radi- um dial painters. Frederick B. Flinn, the prominent radium expert from the de- partment of industrial medicine at Co- lumbia University, was called in as a consultant and conÞrmed SteinerÕs sus- picions: ByersÕs body was slowly decom- posing, the result of massive radium intoxication from the Radithor. FlinnÕs conclusions were not made public, how- ever, in part because other expertsÑin- cluding ByersÕs personal physicianÑre- fused to accept them. By September 1931 the commissionÕs investigation was well under way, and the ailing Byers was called to testify. He was too ill to travel, so a special attor- ney, Robert H. Winn, was sent to ByersÕs Long Island mansion to take the depo- sition. He later described the scene: ÒA more gruesome experience in a more gorgeous setting would be hard to imagine. We went to Southampton where Byers had a magniÞcent home. There we discovered him in a condition which beggars description. Young in years and mentally alert, he could hard- ly speak. His head was swathed in ban- dages. He had undergone two succes- sive jaw operations and his whole upper jaw, excepting two front teeth, and most of his lower jaw had been removed. All the remaining bone tissue of his body was slowly disintegrating, and holes were actually forming in his skull.Ó On December 19, 1931, the commis- sion issued a cease-and-desist order en- joining the Bailey Radium Laboratories from continuing to market Radithor. The ruling came too late to do Byers any good. With his death in 1932, the com- mission reopened its investigation, and the FDA began campaigning for more sweeping powers. Medical societies took the opportunity to denounce all patent medicine sales, and calls for radium- control laws were voiced throughout America and Europe. The forerunners of the current regulations restricting the sales of radiopharmaceuticals to authorized users actually date back to the Byers aÝair. With the institution of the regulations, the radioactive patent 98 SCIENTIFIC AMERICAN August 1993 INVISIBLE RAYS from ByersÕs teeth left these eerie images on photographic Þlm during the forensic examination that fol- lowed his gruesome death. Decades later a reexamination of the teeth and bones of Byers, Bailey and other consumers of Radithor showed signiÞcant levels of residual radioactivity. Although many individuals had quickly succumbed, someÑ including BaileyÑmanaged to reach a ripe age, often without suÝering any ill eÝects that could be attributed clearly to the radiation. This extraordinary variation in the eÝects of long- term radiation remains unexplained. Copyright 1993 Scientific American, Inc. medicine industry collapsed overnight. Bailey was never prosecuted for By- ersÕs death, and he maintained that it was all a case of misdiagnosis. ÒI have drunk more radium water than any man alive, and I have never suÝered any ill eÝects,Ó he claimed. The Federal Trade Commission oÛcially shut down his Radithor operation in late 1932, but by then the Great Depression had al- ready taken its toll on Radithor sales, and Bailey had moved on to several new radioactive scams: the Bioray, a radioac- tive paperweight advertised as a Òminia- ture sunÓ; the Adrenoray, a radioactive belt clip; and the Thoronator, a reÞll- able radioactive Òhealth spring for ev- ery home or oÛce.Ó Hounded by the press and Newark public health oÛcials, Bailey left town at the height of the Byers scandal and was Þnally located by reporters living at the nearby oÛce-front headquarters of his Adrenoray Company in East Or- ange. When asked what kind of busi- ness was being conducted there, he said it was Òa special advertising businessÓ and that the name on the door ÒdidnÕt mean a thing.Ó Bailey dropped from the limelight. He became the editor of the BloomÞeld Times in New Jersey and wrote books on world politics and health. During World War II, he was an aircraft observ- er under the 1st Fighter Command. He also invented a method of swimming in- struction for soldiers, devices for sub- marine detection and a mechanism for gunsight calibration. He may also have been a wartime manager of a small electronics division of IBM. He died on May 16, 1949, in Tyngsborough, Mass., at the age of 64. Although he died of bladder cancer, he never agreed that small doses of radioactivity were harm- ful, and he asserted that his health and spirits were excellent almost to the end. ÒI have developed,Ó he wrote, Òa philos- ophy of life that does not permit anti- pathies of any kind.Ó Tax records from Tyngsborough list the total value of the Bailey family real estate as $4,175 at the time of his demise. There is a curious postscript to this story. Soon after my library research on Bailey began, I real- ized that I was treading in the footsteps of a giant. Beginning in the 1930s, Pro- fessor Robley D. Evans, emeritus direc- tor of the Radioactivity Center at the Massachusetts Institute of Technology, had investigated a number of Radithor poisonings as part of his large study of the illnesses of radium dial painters and chemists. Evans and his team from M.I.T. and Argonne National Laboratory studied 29 patients (21 living and eight postmortem) and found wide variation in the distribution of radioactivity ac- creted in the bones and in the resulting consequences for health. Moreover, the toxic eÝects of these radiation loads appeared to vary greatly from one vic- tim to another. The data suggest that some individu- als can tolerate high amounts of bone- seeking radioisotopes, such as radium. Perhaps these people are very eÛcient in excreting the substances or in pro- ducing protective hormones (such as granulocyte colonyÐstimulating factor and the interleukins) that stimulate the growth of blood cells when the body is exposed to radiation. Among these com- paratively lucky consumers of Radithor was Bailey himself. Among the materials that Evans and his colleagues studied in the 1960s were the disinterred remains of two Radithor drinkers whose clinical stories corre- spond so closely to those of Eben By- ers and William Bailey as to consti- tute a positive identiÞcation. The bones of both men showed severe radiation changes and were still dangerously ra- dioactive, almost 50 years after the in- dividuals had drained their last bottle of BaileyÕs elixir. William Bailey, the dean of the radioactive quacks, thus played a major role in the beginning, the cli- max and the end of the era of mild ra- dium therapy. The study of the long-term eÝects of alpha radiation continues. Since my original publication of this research, other apparent victims of medicinal ra- dium poisoning have contacted me, and my colleagues and I are studying their medical records and attempting to un- derstand the radiation eÝects through experiments on rodents. Although the fad of radioactive patent medicines has long passed, some of the data it has be- queathed will continue to suggest an- swers to the problems posed by radon in the home and by nuclear waste in the environment. These insights may also help workers to judge the costs and beneÞts of thera- peutic alpha radiation, now being devel- oped for cancer therapy. For, as Bailey noted with perhaps unwitting presci- ence and certainly with irony: ÒRadio- activity is one of the most remarkable agents in medical science. The discov- eries relating to its action in the body have been so far-reaching that it is im- possible to prophesy future develop- ment. It is perpetual sunshine.Ó SCIENTIFIC AMERICAN August 1993 99 SKELETAL RADIOACTIVITY in Byers is shown in graphs based on estimates of the potency of Radithor and the quantity consumed. Because some decay products are more radioactive than the radium from which they derive, the dose rate increased even after Byers stopped taking the medicine. FURTHER READING THE LATE EFFECTS OF INTERNALLY DE- POSITED RADIOACTIVE MATERIALS IN MAN. Joseph Aub, Robley Evans, L. Hem- pelmann and N. Martland in Medicine, Vol. 31, No. 3, pages 221Ð329; 1952. RADIUM AND MESOTHORIUM POISONING AND DOSIMETRY AND INSTRUMENTA- TION TECHNIQUES IN APPLIED RADIOAC- TIVITY. Robley D. Evans in Annual Prog- ress Reports 1962Ð1968, prepared at the MIT Radioactivity Center under contract AT(30-1)-952. National Technical Infor- mation Service, 1968. NUCLEAR FEAR: A HISTORY OF IMAGES. Spencer R. Weart. Harvard University Press, 1988. RADIOACTIVITY AND HEALTH: A HISTO- RY. J. Newell Stannard. National Techni- cal Information Service, 1988. RADITHOR AND THE ERA OF MILD RADI- UM THERAPY. Roger M. Macklis in Jour- nal of the American Medical Association, Vol. 264, No. 5, pages 614Ð618; August 1, 1990. * A gray is an absorbed dose of one joule per kilogram. JAN 1930 JAN 1932 JAN 1931 JAN 1929 DO SE R AT E (G RA YS * P ER M ON TH ) 0.8 0.6 0.4 0.2 JAN 1928 END OF INGESTION PERIOD RADITHOR RADIUM 228 RADIUM 226 Copyright 1993 Scientific American, Inc. </p>