June 10, 2019 • 25 mins
Humans have recognized thyroid disease for thousands of years. But in the 1930s. Saul Hertz had an insight after hearing a physicist's lecture that changed the treatment of hyperthyroidism forever.
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Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radios How Stuff Works. Hello, and welcome
to the podcast. I'm Holly Fry and I'm Tracy B. Wilson. Okay,
so true confession on this one. This episode is inspired
by one of my cats. Yeah, but simultaneously fascinating. It
(00:26):
a lot older than I thought. Yes, Um, it's not
about kiddies or animals really at all, although they are
mentioned in terms of um medical testing. Nothing particularly gruesome,
but just f y, I if that's troublesome for you. Um,
it is in fact about science because my cat, Azzle
was hyper thyroid and so we opted to have radio
(00:46):
iodine therapy treatment for him. And as my vet was
describing this to me and she's like, Oh, it's just
like how they do it in humans, blah blah blah blah,
and I was like, I have never thought about this before.
Where did this all begin? Um? So it just got
me wondering about the origins of this treatment because it
is a very um successful treatment and it's one of
(01:08):
those things that both humans and animals seem to respond
well to, which just was fascinating to me because, as
you know, I love a little bit of science. So
that is what we were talking about today, the advent
of radio iodine therapy. So first we're gonna talk just
a little bit about your thyroid and how it works.
Your thyroid is a small organ that sits below your larynx,
(01:29):
and in the most basic terms, its job is to
convert the iodine and the food you eat into hormones
that regulate your metabolism. Thyroid cells are the only ones
in the human body that take an iodine, but all
of the other cells in the body are affected by
the work that the thyroid does. So the hormone known
as thyroxine abbreviated as T four and the hormone tri iodithyronine,
(01:52):
known also as T three are vital to normal metabolic function.
But the thyroid, which makes those again out of iodine,
isn't out there just functioning so low. It is regulated
by the pituitary gland, which is in turn regulated by
the hypothalamus. If your thyroid isn't producing enough hormone, that's
called hypothyroidism, and it doesn't present really obvious symptoms at
(02:16):
the beginning a lot of the time, but it can
lead to other problems, including obesity and heart disease. Normally,
hypothyroidism is treated with synthetic hormones to get the level
of thyroid function back up to normal. And if your
thyroid is producing too much hormone like my cats, that
is known as hyper thyroidism, and in this case it
(02:37):
sort of overclocks the body's metabolic function. So in this case,
unintentional weight loss and rapid heart rate and even irregular
heartbeat are all symptoms which obviously can lead to some
pretty serious problems if they're left unchecked. The advances in
thyroid treatment that we're going to talk about today it
took place less than a hundred years ago, but thyroid
disease has been part of recorded history going all the
(02:59):
way back to a seven hundred b c E. When
seaweed was prescribed in China to treat goiter. The gorder
is a swelling of the thyroid that's most commonly caused
by low iodine, but the thyroid itself wasn't even recognized
and illustrated until Leonardo da Vinci drew it in fifteen hundred.
The name thyroid didn't exist until sixteen fifty six, when
(03:22):
Thomas Wharton named it using a word for shield because
of the resemblance in shapes to ancient Grecian shields. In
eighteen twenty, Jean Francois Quande made the connection between iodine
and goiter and began to use iodine as a treatment.
By eighteen thirty one, iodine used as a prophylaxis to
prevent thyroid disease was proposed by a Brazilian doctor, but
(03:46):
even so conclusive scientific literature establishing iodine as a necessity
to thyroid function was not published until nineteen o seven
in a paper by doctor David Marine, and it was
Marine's work in thyroid research that eventually led to iodized
salt as a standard approach to preventing thyroid disease as
a public health initiative. I like, how uh it was
(04:08):
nineteen o seven when that happened, But using seaweed to
treat goiter from thousands of years before they were onto it.
They just hadn't done all the math on what exactly
in the seaweed was fixing. The seaweed has lots of
iodine and it that's what was up with that. In
the late eighteen nineties, knowledge about the thyroid really started
(04:29):
to accelerate as Adolph Magnus Levy made the connection between
thyroid function and metabolic rate. Radium was used to treat
a patient's goiter in nineteen o five by physician Robert Abbey,
and the term hyper thyroidism was coined in nineteen ten
by Charles H. Mayo, but descriptions of that condition actually
date back to the eighteen twenties, and for a long
(04:52):
time the only real treatment for hyper thyroidism was surgery,
but it was so risky that often doctors waited until
the patient its illness was pretty advanced to perform the surgery,
and that meant that the patient by that point was
already in a weakened state, which only reduced the likelihood
of a successful outcome. There was actually a pretty high
mortality rate for that surgery. In George de Heavnessy developed
(05:15):
the idea of radioactive tracers to study metabolic pathways. A
tracer per Meriam Webster as a substance used to trace
the course of a chemical or biological process. He went
on to receive a Nobel Prize for his work, but
not for another two decades, and in the early nineteen hundreds,
research into thyroid function and disease was taking place in
(05:35):
a number of different hospitals and medical research centers, because
it really had, as we said, accelerated in terms of
what we knew about thyroid and thyroid disease in the
decades leading up to that, But it was not until
the nineteen thirties that a breakthrough idea occurred to a
physician to use radioactivity in the treatment of hyper thyroidism.
And to get into that, we have to talk about
(05:57):
Saul Hurts. Saul Hurts was born on April twentieth, nineteen
o five, in Cleveland, Ohio. His parents, Erin and Bertha Hurts,
were Polish immigrants who raised Saul and his six brothers
in an Orthodox Jewish household. After a public school, Saul
went to the University of Michigan and then on to
medical school at Harvard. After he got his medical degree
in ninety nine, he did his internship and residency in
(06:20):
Cleveland before moving to Boston. Starting in nineteen thirty one,
he was at the thyroid clinic at Boston's Massachusetts General Hospital,
and five years into his time at that position, in
November of nineteen thirty six, he attended a lunch at
Harvard Medical School in which Carl Compton was giving a lecture,
and Compton, who was the president of m i T
(06:41):
at the time, had entitled his talk what Physics Can
Do for Biology and Medicine, and in it he discussed
the concept of making radioactive isotopes of common elements. After
the lecture was over, Hurts asked Compton a question, could
iodine be made radioactive? He was thinking about a practical
application stion of the science that Compton had discussed in
(07:02):
the talk, which was using radioactive iodine, which theoretically only
the thyroid could absorb, to address thyroid issues. Compton didn't
really know the answer to the question off hand, so
he noted the question, intending to follow up with Hurts later.
It took a month, and when Compton followed up on it,
he apologized. That letter is dated December six and it reads,
(07:26):
dear doctor Hurts, to my chagrin, I have just come
across the memorandum which I made on your question about
the radioactivity of iodine. Iodine can be made artificially radioactive.
It has a half period of decay of twenty five
minutes in amidst of gamma raise and beta raise electrons.
Is put in parenthesis with a maximum energy of two
(07:46):
point one million volts. It is probable that there are
several other periods of decay, but if so, they correspond
to types of radioactivity like the one indicated, and they
are not yet very definitely established and his response letter data.
Eight days later, on December, Hurts thanked Professor Compton and wrote, quote,
the fact that iodine is selectively taken up by the
(08:06):
thyroid gland when injected into the body makes it possible
to hope that iodine, which has made radioactive and which
loses its radioactivity as rapidly as you indicated, would be
a useful method of therapy in cases of overactivity of
the thyroid gland. And then promised Carl Compton that he
would relay the results of any of the tests that
they conducted on animals using radioactive iodi and Saul Hurts
(08:29):
was ready to start exploring this idea in the lab,
and we're going to talk about that after we first
pause for a little sponsor break. Saul Hurts, along with
James Howard Means, who was his supervisor at the hospital
(08:49):
and was actually the man who established Massachusetts General Hospitals
Thyroid Unit, reached out to the physics community. To put
their plan into action, they joined forces with Robbie Evans
and Arthur Roberts of the Massachusetts Institute of Technology to
combine the work of the physicists and physicians to treat
(09:09):
hyper thyroidism. The team started working with the isotope iodine
or just I in rabbits. They used a test group
of four dozen animals. The rabbits thyroids took up the I,
which was of great indicator that Hurts his idea would work.
When the rabbits were tested after the I was administered,
(09:31):
it was found that their thyroid glands had quote nine
times the concentration of radioactive iodine as that found in
the liver. Additionally, the rabbits, among the group with hyper
plastic thyroid glands, which were glands that had additional growth
from cell proliferation, had an even greater retention of radioactive
iodine in the thyroid tissue than those who had healthy
(09:51):
thyroid glands. So the rabbits with abnormalities and their thyroids
actually took up more of this radioactive isotope than the
as that were healthy. And at this point, the I
was being used as a tracer to diagnose thyroid issues,
it was not yet at the phase where it was
being used as a treatment. In a write up of
this initial success, Hurts and his team stated, quote, it
(10:13):
is therefore logical to suppose that, when strongly active materials
are available, the concentration power of the hyperplastic and neoplastic
thyroid for radioactive iodine maybe of clinical or therapeutic significance.
This offered up hope as well for an alternative to
thyroid surgery, one that was far less invasive and consequently
(10:34):
less dangerous. This was, however, very early on. There was
also one fundamental problem that twenty five minute half life.
In very basic terms, the isotope decayed so quickly that
it had to be used immediately after creation or it
would just be useless before it could actually treat the
thyroid tissue. Hurts is Boston group was sharing their information
(10:55):
with another team on the West coast at the University
of California, Berkeley. The California team, headed by Mayo Soli
and Joseph Hamilton's conscripted the help of two other scientists,
Glenn Seaborg and Jack living Goood, who had access to
a cyclotron that's an early particle accelerator apparatus that accelerates
atomic and subatomic particles in a constant magnetic field, and
(11:18):
the cyclotron had only been patented for four years before this,
so it was still a very new technology. Using the cyclotron,
Seaborg and Jack living Good were able to create new
iodine isotopes. First, I won thirty with a half life
of twelve hours, and eventually I won thirty one. I
won thirty one has an eight day half life. These
(11:39):
longer half lives made these isotopes good candidates for Hurtz's treatment.
The longer half life meant that doctors would have time
to treat the problematic thyroid tissue between the isotopes creation
and the point where it became useless. And as the
California team was working with the cyclotron to create those
new isotopes, the Boston team was working with humans to
(11:59):
test whether they ear thyroids like those of the rabbits
in the earlier tests, would uptake the radioactive iodine, and
they had positive results. The data collected from those early
tests was also used to determine procedure and dosage guidelines
for human patients once they moved into the treatment phase,
and once those new isotopes were established and could be
(12:20):
replicated at the Boston Lab after it had acquired its
own cyclotron, it was time for a true clinical trial.
In January, Saul Hurts treated his first human patient with
hyper thyroid using a combination of I one thirty and
I one thirty one. This is a patient identified in
his notes as Elizabeth D. It was the birth of
(12:41):
nuclear medicine. It is often referred to as the first
and the gold standard and targeted radio nuclide therapy. Hurts
that his team treated additional patients at the rate of
one a month, tracking their progress after receiving the radio
iodine therapy, and most of them had significant improvement in
their conditions. The Cleveland Press ran a story about Hurts
his work under the headline former Clevelander developed first atomic
(13:04):
medical cure. After initial success with the treatment, Hurts began
to take on more patients as candidates for radio iodine treatment,
and in two he expanded his work with radio iodine
therapy and began clinical trials of treatment for patients with
thyroid cancer. And this was actually something that he had
begun working on, at least in its theoretical form as
(13:24):
early as nineteen thirty seven, when those initial rabbit trials
for hyperthyroidism were underway. This three starch had gotten the
attention of the medical community early on. In two the
Mayo Clinic arranged for one of their physicians, Dr. F.
Raymond Keating, Jr. To spend six months in Boston working
with the researchers at Massachusetts General Hospital to learn about
(13:45):
their work with radioactive iodine. Later, the Mayo Clinics Dr
Samuel Haynes wrote of this period quote, when ray Keating
finished his fellowship, we asked Howard Means to let him
go to the m g H for six months. We
were a specially interested in having him see what Means
Salt Hurts and Rulan Rawlson were doing with radio iodine,
(14:06):
a program which as you know, was carried out with
Robilie Evans and Wendell Peacock from m I T raised
day in Boston was very successful, and when he came
back he had arranged with Evans to have small amounts
of I one one sent to him to be used
in some studies in chicks. Haines also described the Mayo
clinics first use of I one in thyroid treatment in
the same writing, which was a letter that he was
(14:27):
writing to a colleague at Cornell, and he wrote of
the patient, who was a woman who had been quite
ill and for whom surgery would have been a highly
dangerous prospect. He wrote that she had a good outcome
with the I one thirty one treatment. So this treatment
developed through Hurts. His work was indeed one spreading to
other clinics and being used by other doctors, and was
saving people from very high risk surgeries. But Hurts had
(14:50):
the unfortunate timing of developing this breakthrough treatment at the
same time that World War Two was brewing. Saal Hurts
put aside his medical research temporarily in nine in forty
three and joined the Navy to fight against Hitler's Nazi regime.
But before he shipped out, Hurts, who did not want
work in this new field to be hampered by his absence,
met with a private practice doctor who worked part time
(15:13):
at m g H, and that was Dr Earl M. Chapman.
Chapman had continued to make time for medical research even
while running his own practice, and he was ineligible for
military service, so Hurts asked him if he would keep
working with Hurts his roster of thyroid patients, and Chapman
probably flattered agreed and continued the work that Hurts had begun.
(15:34):
But when Saul Hurts returned from the war, there were
problems between the two men. Chapman didn't want to give
up the project and give it back to its originator
after his two years of involvement, and of course Hurts
wanted his research project back, but he wasn't given his
old position at MGH. Instead he took a position at
the Beth Israel Hospital. Yeah, there are many um stories
(15:56):
that are told among their colleagues about the fights that
broke out of this issue. Uh. And then those two
former colleagues eventually found themselves just each running their own trials.
And then they both wrote papers about them. And Chapman
actually finished his paper first and submitted it to the
Journal of the American Medical Association for review and publication.
(16:17):
This kicked off some drama, and we'll get to that
paper and the rivalry between the two of them and
how that was stirred up after we take a quick
break and hear from one of our sponsors. So though
Chapman had beaten Hurts to the finish line, on writing
(16:38):
the paper itself, he didn't get published. First, the Journal
of the American Medical Association returned his paper and said
it needed to be edited for length before it could
be published. And in the meantime, the editor, who knew
that Hurts had been the one to spearhead the work
in this field and yet had not even been mentioned
in Chapman's paper, reached out to Saul Hurts and encouraged
(16:59):
him to do his own right up as quickly as possible.
So Hurts, along with Arthur Roberts, finished his own paper
recounting the methods and results of his trials treating hyper
thyroid patients with IE one. The end of all this
jockeying was that the Journal of the American Medical Association
published both the Chapman and Hurts papers, both on the
same topic, both researched in the same hospital, printed in
(17:22):
the same issue on May eleven six. Both scientists findings
were made available to the Journal of the American Medical
Association's readership, and if nothing else, two papers on exactly
the same topic with only minor differences and treatment methodology
achieved one thing. It made nuclear medicine a really hot
topic and established radio iodi in therapy as an effective
(17:43):
way to treat thyroid disease. Yeah, they had been writing
other papers leading up to that, but that was really
the paper that was, like, we have figured out how
to treat hyper thyroid. Here's how we do it. Here
the methods, And they both essentially did the same thing.
Depending on whose account you read, chapman approach was a
little less careful in terms of dosage and like how
(18:04):
he he managed patient treatment, but um, they were still very,
very similar. And interestingly enough, that was not the end
of the squabbling over academic papers and who got credit
for the research that led to this game changing treatment.
In reference to an earlier paper on the radio iodine
work they were doing, an mg H Saul Hurts wrote
(18:24):
the following letter to a doctor gold forbe on April twelfth.
He writes quote with reference to the article submitted for
publication by doctors s. Hurts and Arthur Roberts, A change
is desired with the addition of Professor Robili D Evans
as a third co author. He has shared considerably in
the time devoted to this problem, and we have decided
(18:44):
that full credit to the Massachusetts Institute of Technology cannot
be given without including him as co author. His title
is Assistant Professor of Physics at the Massachusetts Institute of Technology,
and we would appreciate the addition to the authorship of
him on the publication. But many years later, in Dr
Arthur Roberts wrote a scathing letter to Dr John Stanbury,
(19:08):
who wrote a book titled A Constant Ferment, The History
of the MGH Thyroid Clinic and the work that was
done there from en n Apparently Stanbury interviewed Evans and
spoke very highly of him in the book. Roberts, who
had received pre publication manuscript, just tour into Evans. In
this letter. Roberts had actually worked for Evans at m
(19:31):
I T. And, according to his account quote Evans made
it condition of my employment. I wish I still had
the letter that his name was to appear on all publications.
Even at the time, this was unusual and occasioned much comment.
It led to the contretemps concerning the late edition of
his name to our first paper. It was on the
(19:51):
second paper, But after that Saul and I felt sufficiently
secure that we ignored him in our subsequent publications. Had
he actually participated it in the work there would have
been no problem including him. Roberts continued his takedown of
Evans over the course of several pages, calling him, among
other things, quote a thoroughly unprincipled racist manipulator. Also cautioned
(20:14):
author Stanbury, quote I would believe nothing on this subject
from Chapman, whose self interest is obvious, and who bungled,
whether deliberately or not. The follow up on Hurts's original
series when Hurts joined the Navy, apparently despite all of
roberts and passioned rhetoric, though Stanbury did not make changes
to its manuscript, this whole mess of exchanges is a
good reminder that even people who do important and groundbreaking
(20:35):
work are often mired in their own personal conflicts that
are not necessarily apparent to the outside. I yeah, it's
such a This sort of thing does happen in academia
with some frequency. Um, if you have any friends who
are maybe professors or researchers, they probably have similar stories.
I should also note that, Um, in the midst of
that big shake up, Evans went with Chapman while Roberts
(20:58):
went with Hurts, So they sort of set raided into
two teams. And that's kind of why there is so
much friction between them. But as for Saul Hurts, he
continued his work in radio iodine therapy. In fall of
ninety six, he set up the Radioactive Isotope Research Fund,
and a few years later that fund paid for the
establishment of the Radioactive Isotope Research Institute, with offices in
(21:21):
Boston and New York. Hurts believe that the study of
thyroid cancer and research into its possible treatments could lead
to breakthroughs in the treatment of all cancers, and he
was happy to discuss this work with the media anytime
they asked. Unfortunately, though, that work was cut short. Saul
Hurts died suddenly at the age of forty five, and
they had a heart attack on July. His daughter, Barbara,
(21:44):
who was just three when her father died, has become
the steward of his story and legacy and has worked
with professionals in the medical community to make sure that
his contributions to medical science are documented and remembered. To
that end, she's set up a digital archive online and
has made some of a correspondence and research available. Yeah,
I used a lot of that in any of these
(22:05):
letters that were quoting back and forth, often came from
her her archive. UH. In the Society of Nuclear Medicine
and Molecular Imaging established the Doctor Saul Hurt's Lifetime Achievement
Award to recognize those who have quote made outstanding contributions
to radio nuclide therapy. That's awesome. Yeah, so my personal
thanks to Dr Saul Hurts because now my cat has
(22:27):
benefited directly from his work. Uh. And that is because
this process that he came up with in the nineteen thirties,
literally just after hearing a lecture and going, hu, I
wonder if I could use that UM still works. It
is a very common treatment with a really high rate
of success. Uh. So much so that with only minor changes,
it is really pretty much one of the recommended treatments
(22:49):
today in both people and animals. Yeah, thank you, Saw Hurts.
I know people who have had it, and only one cat,
which is yours. Yeah. Yes, he went to what I
called radio I had. I'd sleepaway camp for a few
days because he was radioactive. Now he's home. We haven't
had his follow up blood work yet, but all signs
point to successful outcome. UM. But it is just fascinating
(23:11):
and cool. It's like I said, it's one of those
things that it is literally a ninety year old treatment
that has come up with just through like this moment
of insight, and yet it is still like really benefiting
people's lives and is still, as we said, the gold
standard of treatment. I have another sort of um medical
thing in listener mail is from our listener Stephanie, and
(23:35):
she writes, Dear Tracy and Holly, thank you so much
for the Dr Alice Hamilton episode, which I listened to
with much chagrin. I'll admit when I read this letter
that scared me a little, but yeah, I always kind
of brace for impact. Her next sentence illustrates why. She says,
I spent nearly twenty years working in toxicology, occupational health
and environmental health information and never heard of her. In fact,
(23:59):
I spent several years helping to create the site talks Tutor,
which included looking at textbooks and histories of toxicology and
occupational health, and I did not come across her name,
which makes me sad. Uh So she also sent us
some some cute things, some pens and little notepads. Um.
She writes with warm regards, Stephanie, thank you so much, Stephanie.
I feel like she is one of those people Alice
(24:19):
Hamilton's who just doesn't get credit for really all the
ways many of us have benefited from her work every
day without even knowing it. So thank you. Uh. If
you would like to write to us, you can do
so at History podcast at house to Works dot com.
You can also find us on social media as Missed
in History and Missed in History dot com is the
website where you can find all of our episodes that
(24:41):
have ever existed and show notes for any of the
ones that Tracy and I have worked on. Would you
like to subscribe to the podcast we would like for
you to do that. You can do that on the
I Heart Radio app, at Apple Podcasts, or wherever you
listen to podcasts. Stuffy, Missed and Just Street Class is
a production of I Heart Radio's How Stuff Works. For
(25:03):
more podcasts for my heart Radio, visit the heart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
H
Welcome to Stuff You Missed in History Class, a production
of I Heart Radios How Stuff Works. Hello, and welcome
to the podcast. I'm Holly Fry and I'm Tracy B. Wilson. Okay,
so true confession on this one. This episode is inspired
by one of my cats. Yeah, but simultaneously fascinating. It
(00:26):
a lot older than I thought. Yes, Um, it's not
about kiddies or animals really at all, although they are
mentioned in terms of um medical testing. Nothing particularly gruesome,
but just f y, I if that's troublesome for you. Um,
it is in fact about science because my cat, Azzle
was hyper thyroid and so we opted to have radio
(00:46):
iodine therapy treatment for him. And as my vet was
describing this to me and she's like, Oh, it's just
like how they do it in humans, blah blah blah blah,
and I was like, I have never thought about this before.
Where did this all begin? Um? So it just got
me wondering about the origins of this treatment because it
is a very um successful treatment and it's one of
(01:08):
those things that both humans and animals seem to respond
well to, which just was fascinating to me because, as
you know, I love a little bit of science. So
that is what we were talking about today, the advent
of radio iodine therapy. So first we're gonna talk just
a little bit about your thyroid and how it works.
Your thyroid is a small organ that sits below your larynx,
(01:29):
and in the most basic terms, its job is to
convert the iodine and the food you eat into hormones
that regulate your metabolism. Thyroid cells are the only ones
in the human body that take an iodine, but all
of the other cells in the body are affected by
the work that the thyroid does. So the hormone known
as thyroxine abbreviated as T four and the hormone tri iodithyronine,
(01:52):
known also as T three are vital to normal metabolic function.
But the thyroid, which makes those again out of iodine,
isn't out there just functioning so low. It is regulated
by the pituitary gland, which is in turn regulated by
the hypothalamus. If your thyroid isn't producing enough hormone, that's
called hypothyroidism, and it doesn't present really obvious symptoms at
(02:16):
the beginning a lot of the time, but it can
lead to other problems, including obesity and heart disease. Normally,
hypothyroidism is treated with synthetic hormones to get the level
of thyroid function back up to normal. And if your
thyroid is producing too much hormone like my cats, that
is known as hyper thyroidism, and in this case it
(02:37):
sort of overclocks the body's metabolic function. So in this case,
unintentional weight loss and rapid heart rate and even irregular
heartbeat are all symptoms which obviously can lead to some
pretty serious problems if they're left unchecked. The advances in
thyroid treatment that we're going to talk about today it
took place less than a hundred years ago, but thyroid
disease has been part of recorded history going all the
(02:59):
way back to a seven hundred b c E. When
seaweed was prescribed in China to treat goiter. The gorder
is a swelling of the thyroid that's most commonly caused
by low iodine, but the thyroid itself wasn't even recognized
and illustrated until Leonardo da Vinci drew it in fifteen hundred.
The name thyroid didn't exist until sixteen fifty six, when
(03:22):
Thomas Wharton named it using a word for shield because
of the resemblance in shapes to ancient Grecian shields. In
eighteen twenty, Jean Francois Quande made the connection between iodine
and goiter and began to use iodine as a treatment.
By eighteen thirty one, iodine used as a prophylaxis to
prevent thyroid disease was proposed by a Brazilian doctor, but
(03:46):
even so conclusive scientific literature establishing iodine as a necessity
to thyroid function was not published until nineteen o seven
in a paper by doctor David Marine, and it was
Marine's work in thyroid research that eventually led to iodized
salt as a standard approach to preventing thyroid disease as
a public health initiative. I like, how uh it was
(04:08):
nineteen o seven when that happened, But using seaweed to
treat goiter from thousands of years before they were onto it.
They just hadn't done all the math on what exactly
in the seaweed was fixing. The seaweed has lots of
iodine and it that's what was up with that. In
the late eighteen nineties, knowledge about the thyroid really started
(04:29):
to accelerate as Adolph Magnus Levy made the connection between
thyroid function and metabolic rate. Radium was used to treat
a patient's goiter in nineteen o five by physician Robert Abbey,
and the term hyper thyroidism was coined in nineteen ten
by Charles H. Mayo, but descriptions of that condition actually
date back to the eighteen twenties, and for a long
(04:52):
time the only real treatment for hyper thyroidism was surgery,
but it was so risky that often doctors waited until
the patient its illness was pretty advanced to perform the surgery,
and that meant that the patient by that point was
already in a weakened state, which only reduced the likelihood
of a successful outcome. There was actually a pretty high
mortality rate for that surgery. In George de Heavnessy developed
(05:15):
the idea of radioactive tracers to study metabolic pathways. A
tracer per Meriam Webster as a substance used to trace
the course of a chemical or biological process. He went
on to receive a Nobel Prize for his work, but
not for another two decades, and in the early nineteen hundreds,
research into thyroid function and disease was taking place in
(05:35):
a number of different hospitals and medical research centers, because
it really had, as we said, accelerated in terms of
what we knew about thyroid and thyroid disease in the
decades leading up to that, But it was not until
the nineteen thirties that a breakthrough idea occurred to a
physician to use radioactivity in the treatment of hyper thyroidism.
And to get into that, we have to talk about
(05:57):
Saul Hurts. Saul Hurts was born on April twentieth, nineteen
o five, in Cleveland, Ohio. His parents, Erin and Bertha Hurts,
were Polish immigrants who raised Saul and his six brothers
in an Orthodox Jewish household. After a public school, Saul
went to the University of Michigan and then on to
medical school at Harvard. After he got his medical degree
in ninety nine, he did his internship and residency in
(06:20):
Cleveland before moving to Boston. Starting in nineteen thirty one,
he was at the thyroid clinic at Boston's Massachusetts General Hospital,
and five years into his time at that position, in
November of nineteen thirty six, he attended a lunch at
Harvard Medical School in which Carl Compton was giving a lecture,
and Compton, who was the president of m i T
(06:41):
at the time, had entitled his talk what Physics Can
Do for Biology and Medicine, and in it he discussed
the concept of making radioactive isotopes of common elements. After
the lecture was over, Hurts asked Compton a question, could
iodine be made radioactive? He was thinking about a practical
application stion of the science that Compton had discussed in
(07:02):
the talk, which was using radioactive iodine, which theoretically only
the thyroid could absorb, to address thyroid issues. Compton didn't
really know the answer to the question off hand, so
he noted the question, intending to follow up with Hurts later.
It took a month, and when Compton followed up on it,
he apologized. That letter is dated December six and it reads,
(07:26):
dear doctor Hurts, to my chagrin, I have just come
across the memorandum which I made on your question about
the radioactivity of iodine. Iodine can be made artificially radioactive.
It has a half period of decay of twenty five
minutes in amidst of gamma raise and beta raise electrons.
Is put in parenthesis with a maximum energy of two
(07:46):
point one million volts. It is probable that there are
several other periods of decay, but if so, they correspond
to types of radioactivity like the one indicated, and they
are not yet very definitely established and his response letter data.
Eight days later, on December, Hurts thanked Professor Compton and wrote, quote,
the fact that iodine is selectively taken up by the
(08:06):
thyroid gland when injected into the body makes it possible
to hope that iodine, which has made radioactive and which
loses its radioactivity as rapidly as you indicated, would be
a useful method of therapy in cases of overactivity of
the thyroid gland. And then promised Carl Compton that he
would relay the results of any of the tests that
they conducted on animals using radioactive iodi and Saul Hurts
(08:29):
was ready to start exploring this idea in the lab,
and we're going to talk about that after we first
pause for a little sponsor break. Saul Hurts, along with
James Howard Means, who was his supervisor at the hospital
(08:49):
and was actually the man who established Massachusetts General Hospitals
Thyroid Unit, reached out to the physics community. To put
their plan into action, they joined forces with Robbie Evans
and Arthur Roberts of the Massachusetts Institute of Technology to
combine the work of the physicists and physicians to treat
(09:09):
hyper thyroidism. The team started working with the isotope iodine
or just I in rabbits. They used a test group
of four dozen animals. The rabbits thyroids took up the I,
which was of great indicator that Hurts his idea would work.
When the rabbits were tested after the I was administered,
(09:31):
it was found that their thyroid glands had quote nine
times the concentration of radioactive iodine as that found in
the liver. Additionally, the rabbits, among the group with hyper
plastic thyroid glands, which were glands that had additional growth
from cell proliferation, had an even greater retention of radioactive
iodine in the thyroid tissue than those who had healthy
(09:51):
thyroid glands. So the rabbits with abnormalities and their thyroids
actually took up more of this radioactive isotope than the
as that were healthy. And at this point, the I
was being used as a tracer to diagnose thyroid issues,
it was not yet at the phase where it was
being used as a treatment. In a write up of
this initial success, Hurts and his team stated, quote, it
(10:13):
is therefore logical to suppose that, when strongly active materials
are available, the concentration power of the hyperplastic and neoplastic
thyroid for radioactive iodine maybe of clinical or therapeutic significance.
This offered up hope as well for an alternative to
thyroid surgery, one that was far less invasive and consequently
(10:34):
less dangerous. This was, however, very early on. There was
also one fundamental problem that twenty five minute half life.
In very basic terms, the isotope decayed so quickly that
it had to be used immediately after creation or it
would just be useless before it could actually treat the
thyroid tissue. Hurts is Boston group was sharing their information
(10:55):
with another team on the West coast at the University
of California, Berkeley. The California team, headed by Mayo Soli
and Joseph Hamilton's conscripted the help of two other scientists,
Glenn Seaborg and Jack living Goood, who had access to
a cyclotron that's an early particle accelerator apparatus that accelerates
atomic and subatomic particles in a constant magnetic field, and
(11:18):
the cyclotron had only been patented for four years before this,
so it was still a very new technology. Using the cyclotron,
Seaborg and Jack living Good were able to create new
iodine isotopes. First, I won thirty with a half life
of twelve hours, and eventually I won thirty one. I
won thirty one has an eight day half life. These
(11:39):
longer half lives made these isotopes good candidates for Hurtz's treatment.
The longer half life meant that doctors would have time
to treat the problematic thyroid tissue between the isotopes creation
and the point where it became useless. And as the
California team was working with the cyclotron to create those
new isotopes, the Boston team was working with humans to
(11:59):
test whether they ear thyroids like those of the rabbits
in the earlier tests, would uptake the radioactive iodine, and
they had positive results. The data collected from those early
tests was also used to determine procedure and dosage guidelines
for human patients once they moved into the treatment phase,
and once those new isotopes were established and could be
(12:20):
replicated at the Boston Lab after it had acquired its
own cyclotron, it was time for a true clinical trial.
In January, Saul Hurts treated his first human patient with
hyper thyroid using a combination of I one thirty and
I one thirty one. This is a patient identified in
his notes as Elizabeth D. It was the birth of
(12:41):
nuclear medicine. It is often referred to as the first
and the gold standard and targeted radio nuclide therapy. Hurts
that his team treated additional patients at the rate of
one a month, tracking their progress after receiving the radio
iodine therapy, and most of them had significant improvement in
their conditions. The Cleveland Press ran a story about Hurts
his work under the headline former Clevelander developed first atomic
(13:04):
medical cure. After initial success with the treatment, Hurts began
to take on more patients as candidates for radio iodine treatment,
and in two he expanded his work with radio iodine
therapy and began clinical trials of treatment for patients with
thyroid cancer. And this was actually something that he had
begun working on, at least in its theoretical form as
(13:24):
early as nineteen thirty seven, when those initial rabbit trials
for hyperthyroidism were underway. This three starch had gotten the
attention of the medical community early on. In two the
Mayo Clinic arranged for one of their physicians, Dr. F.
Raymond Keating, Jr. To spend six months in Boston working
with the researchers at Massachusetts General Hospital to learn about
(13:45):
their work with radioactive iodine. Later, the Mayo Clinics Dr
Samuel Haynes wrote of this period quote, when ray Keating
finished his fellowship, we asked Howard Means to let him
go to the m g H for six months. We
were a specially interested in having him see what Means
Salt Hurts and Rulan Rawlson were doing with radio iodine,
(14:06):
a program which as you know, was carried out with
Robilie Evans and Wendell Peacock from m I T raised
day in Boston was very successful, and when he came
back he had arranged with Evans to have small amounts
of I one one sent to him to be used
in some studies in chicks. Haines also described the Mayo
clinics first use of I one in thyroid treatment in
the same writing, which was a letter that he was
(14:27):
writing to a colleague at Cornell, and he wrote of
the patient, who was a woman who had been quite
ill and for whom surgery would have been a highly
dangerous prospect. He wrote that she had a good outcome
with the I one thirty one treatment. So this treatment
developed through Hurts. His work was indeed one spreading to
other clinics and being used by other doctors, and was
saving people from very high risk surgeries. But Hurts had
(14:50):
the unfortunate timing of developing this breakthrough treatment at the
same time that World War Two was brewing. Saal Hurts
put aside his medical research temporarily in nine in forty
three and joined the Navy to fight against Hitler's Nazi regime.
But before he shipped out, Hurts, who did not want
work in this new field to be hampered by his absence,
met with a private practice doctor who worked part time
(15:13):
at m g H, and that was Dr Earl M. Chapman.
Chapman had continued to make time for medical research even
while running his own practice, and he was ineligible for
military service, so Hurts asked him if he would keep
working with Hurts his roster of thyroid patients, and Chapman
probably flattered agreed and continued the work that Hurts had begun.
(15:34):
But when Saul Hurts returned from the war, there were
problems between the two men. Chapman didn't want to give
up the project and give it back to its originator
after his two years of involvement, and of course Hurts
wanted his research project back, but he wasn't given his
old position at MGH. Instead he took a position at
the Beth Israel Hospital. Yeah, there are many um stories
(15:56):
that are told among their colleagues about the fights that
broke out of this issue. Uh. And then those two
former colleagues eventually found themselves just each running their own trials.
And then they both wrote papers about them. And Chapman
actually finished his paper first and submitted it to the
Journal of the American Medical Association for review and publication.
(16:17):
This kicked off some drama, and we'll get to that
paper and the rivalry between the two of them and
how that was stirred up after we take a quick
break and hear from one of our sponsors. So though
Chapman had beaten Hurts to the finish line, on writing
(16:38):
the paper itself, he didn't get published. First, the Journal
of the American Medical Association returned his paper and said
it needed to be edited for length before it could
be published. And in the meantime, the editor, who knew
that Hurts had been the one to spearhead the work
in this field and yet had not even been mentioned
in Chapman's paper, reached out to Saul Hurts and encouraged
(16:59):
him to do his own right up as quickly as possible.
So Hurts, along with Arthur Roberts, finished his own paper
recounting the methods and results of his trials treating hyper
thyroid patients with IE one. The end of all this
jockeying was that the Journal of the American Medical Association
published both the Chapman and Hurts papers, both on the
same topic, both researched in the same hospital, printed in
(17:22):
the same issue on May eleven six. Both scientists findings
were made available to the Journal of the American Medical
Association's readership, and if nothing else, two papers on exactly
the same topic with only minor differences and treatment methodology
achieved one thing. It made nuclear medicine a really hot
topic and established radio iodi in therapy as an effective
(17:43):
way to treat thyroid disease. Yeah, they had been writing
other papers leading up to that, but that was really
the paper that was, like, we have figured out how
to treat hyper thyroid. Here's how we do it. Here
the methods, And they both essentially did the same thing.
Depending on whose account you read, chapman approach was a
little less careful in terms of dosage and like how
(18:04):
he he managed patient treatment, but um, they were still very,
very similar. And interestingly enough, that was not the end
of the squabbling over academic papers and who got credit
for the research that led to this game changing treatment.
In reference to an earlier paper on the radio iodine
work they were doing, an mg H Saul Hurts wrote
(18:24):
the following letter to a doctor gold forbe on April twelfth.
He writes quote with reference to the article submitted for
publication by doctors s. Hurts and Arthur Roberts, A change
is desired with the addition of Professor Robili D Evans
as a third co author. He has shared considerably in
the time devoted to this problem, and we have decided
(18:44):
that full credit to the Massachusetts Institute of Technology cannot
be given without including him as co author. His title
is Assistant Professor of Physics at the Massachusetts Institute of Technology,
and we would appreciate the addition to the authorship of
him on the publication. But many years later, in Dr
Arthur Roberts wrote a scathing letter to Dr John Stanbury,
(19:08):
who wrote a book titled A Constant Ferment, The History
of the MGH Thyroid Clinic and the work that was
done there from en n Apparently Stanbury interviewed Evans and
spoke very highly of him in the book. Roberts, who
had received pre publication manuscript, just tour into Evans. In
this letter. Roberts had actually worked for Evans at m
(19:31):
I T. And, according to his account quote Evans made
it condition of my employment. I wish I still had
the letter that his name was to appear on all publications.
Even at the time, this was unusual and occasioned much comment.
It led to the contretemps concerning the late edition of
his name to our first paper. It was on the
(19:51):
second paper, But after that Saul and I felt sufficiently
secure that we ignored him in our subsequent publications. Had
he actually participated it in the work there would have
been no problem including him. Roberts continued his takedown of
Evans over the course of several pages, calling him, among
other things, quote a thoroughly unprincipled racist manipulator. Also cautioned
(20:14):
author Stanbury, quote I would believe nothing on this subject
from Chapman, whose self interest is obvious, and who bungled,
whether deliberately or not. The follow up on Hurts's original
series when Hurts joined the Navy, apparently despite all of
roberts and passioned rhetoric, though Stanbury did not make changes
to its manuscript, this whole mess of exchanges is a
good reminder that even people who do important and groundbreaking
(20:35):
work are often mired in their own personal conflicts that
are not necessarily apparent to the outside. I yeah, it's
such a This sort of thing does happen in academia
with some frequency. Um, if you have any friends who
are maybe professors or researchers, they probably have similar stories.
I should also note that, Um, in the midst of
that big shake up, Evans went with Chapman while Roberts
(20:58):
went with Hurts, So they sort of set raided into
two teams. And that's kind of why there is so
much friction between them. But as for Saul Hurts, he
continued his work in radio iodine therapy. In fall of
ninety six, he set up the Radioactive Isotope Research Fund,
and a few years later that fund paid for the
establishment of the Radioactive Isotope Research Institute, with offices in
(21:21):
Boston and New York. Hurts believe that the study of
thyroid cancer and research into its possible treatments could lead
to breakthroughs in the treatment of all cancers, and he
was happy to discuss this work with the media anytime
they asked. Unfortunately, though, that work was cut short. Saul
Hurts died suddenly at the age of forty five, and
they had a heart attack on July. His daughter, Barbara,
(21:44):
who was just three when her father died, has become
the steward of his story and legacy and has worked
with professionals in the medical community to make sure that
his contributions to medical science are documented and remembered. To
that end, she's set up a digital archive online and
has made some of a correspondence and research available. Yeah,
I used a lot of that in any of these
(22:05):
letters that were quoting back and forth, often came from
her her archive. UH. In the Society of Nuclear Medicine
and Molecular Imaging established the Doctor Saul Hurt's Lifetime Achievement
Award to recognize those who have quote made outstanding contributions
to radio nuclide therapy. That's awesome. Yeah, so my personal
thanks to Dr Saul Hurts because now my cat has
(22:27):
benefited directly from his work. Uh. And that is because
this process that he came up with in the nineteen thirties,
literally just after hearing a lecture and going, hu, I
wonder if I could use that UM still works. It
is a very common treatment with a really high rate
of success. Uh. So much so that with only minor changes,
it is really pretty much one of the recommended treatments
(22:49):
today in both people and animals. Yeah, thank you, Saw Hurts.
I know people who have had it, and only one cat,
which is yours. Yeah. Yes, he went to what I
called radio I had. I'd sleepaway camp for a few
days because he was radioactive. Now he's home. We haven't
had his follow up blood work yet, but all signs
point to successful outcome. UM. But it is just fascinating
(23:11):
and cool. It's like I said, it's one of those
things that it is literally a ninety year old treatment
that has come up with just through like this moment
of insight, and yet it is still like really benefiting
people's lives and is still, as we said, the gold
standard of treatment. I have another sort of um medical
thing in listener mail is from our listener Stephanie, and
(23:35):
she writes, Dear Tracy and Holly, thank you so much
for the Dr Alice Hamilton episode, which I listened to
with much chagrin. I'll admit when I read this letter
that scared me a little, but yeah, I always kind
of brace for impact. Her next sentence illustrates why. She says,
I spent nearly twenty years working in toxicology, occupational health
and environmental health information and never heard of her. In fact,
(23:59):
I spent several years helping to create the site talks Tutor,
which included looking at textbooks and histories of toxicology and
occupational health, and I did not come across her name,
which makes me sad. Uh So she also sent us
some some cute things, some pens and little notepads. Um.
She writes with warm regards, Stephanie, thank you so much, Stephanie.
I feel like she is one of those people Alice
(24:19):
Hamilton's who just doesn't get credit for really all the
ways many of us have benefited from her work every
day without even knowing it. So thank you. Uh. If
you would like to write to us, you can do
so at History podcast at house to Works dot com.
You can also find us on social media as Missed
in History and Missed in History dot com is the
website where you can find all of our episodes that
(24:41):
have ever existed and show notes for any of the
ones that Tracy and I have worked on. Would you
like to subscribe to the podcast we would like for
you to do that. You can do that on the
I Heart Radio app, at Apple Podcasts, or wherever you
listen to podcasts. Stuffy, Missed and Just Street Class is
a production of I Heart Radio's How Stuff Works. For
(25:03):
more podcasts for my heart Radio, visit the heart Radio app,
Apple Podcasts, or wherever you listen to your favorite shows.
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