The Legend of Émil H. Grubbé

Prologue

August 1933. "From a purely historical standpoint, I promise that [my next] paper will be one of the most momentous in X-Ray literature." –Émil H. Grubbé, The Radiological Review (Grubbé 1933a).

As the following quotes from that promised paper attest, Émil Grubbé was not one to disappoint: "Under the light of this newly found material, I feel that the claims which have been made for others, to priority in the therapeutic use of X-rays, should no longer go unchallenged… after nearly four decades of waiting, I am in a position to assert my claims… and to receive the credit, which, I feel, should have been mine all these years" (Grubbé 1933b). And assert his claims he did! Grubbé announced:

1. That he was the first to develop dermatitis as a result of exposure to X-rays. [Okay, admittedly that’s nothing to brag about, but take a look at the following.]
2. That he was the first to employ X-rays for therapeutic purposes.
3. That he was the first to use lead as protection against X-rays.

But we’re getting ahead of ourselves. Perhaps we should begin at the beginning.

Part One

January 1896. Émil H. Grubbé had just learned of Röntgen’s discovery of X-rays. By a remarkable coincidence, Grubbé had already been experimenting with Crookes tubes himself! Possessing the necessary equipment, and completely familiar with its operation, Grubbé was perfectly positioned to initiate his own investigations into x rays. Furthermore, he had not only been using Crookes tubes, he had also been manufacturing them, and he discovered that he could maximize their X-ray production by a careful adjustment of the vacuum. During the evacuation of each tube, Grubbé measured its output by visualizing the x-ray image of his hand on a fluorescent screen. When the image indicated that the X-ray production had peaked, Grubbé halted the evacuation of the tube.

The fluorescent screen consisted of barium platinocyanide coated on the bottom of a hatbox suspended from the ceiling in front of the tube. According to Grubbé, this device (the hatbox with the barium platinocyanide coated on the bottom) was the first fluoroscope—an invention often attributed to Salvioni or Edison!

Unfortunately, the constant exposure of his hand to X-rays resulted in a painful dermatitis. The dermatitis became so severe that on the 27th of January 1896, Grubbé sought advice from Dr. J.P. Cobb, a faculty member at Hahnemann Medical School in Chicago where Grubbé was a student. Dr. J.E. Gilman, also on the Hahnemann faculty, was present during the examination and commented that anything capable of doing so much damage to normal cells offered possibilities as a therapeutic agent. Another of those present, Dr. R. Ludlum, was so impressed by Gilman’s suggestion that he asked Grubbé to treat a patient of his with an incurable cancer of the left breast.

At 10:00 a.m. Wednesday, 29 January 1896, Ludlum’s patient, Mrs. Rose Lee, showed up at Grubbé’s office for treatment. "And so, without the blaring of trumpets or the beating of drums, X-ray therapy was born." "Little did I realize that I was blazing a new trail…little did I realize that this was the beginning of a new epoch in the history of medicine." So wrote Émil Grubbé (1933b).

In addition to being the first therapeutic application of x rays, this occasion also marks the first on which shielding was employed as protection against the harmful effects of radiation—"Remembering my dermatitis, I protected the healthy parts of the patient’s body with lead" (Grubbé 1933b).

The following day, Grubbé treated his second patient, Mr. A. Carr, who had been referred to him by Dr. A.C. Halphide. Along with Drs. Ludlum and Gilman, Halphide had been present when Dr. Cobb examined Grubbé’s hand.

A few years after these momentous events transpired, in 1901 to be precise, a violent argument broke out between Grubbé and H.P. Pratt, both members of the Chicago Electromedical Society. Pratt claimed that it had been he, not Grubbé, who had been the first to employ x rays for therapeutic purposes! Fighting words indeed! The dispute became so intense that the Society broke apart. This same H.P. Pratt, as one of a group of "professional electro-therapeutic hijackers," would later wrest control of the American X-Ray Journal (the first North American journal devoted to the radiological sciences) and almost destroy the Roentgen Society of the United States, the forerunner of the American Roentgen Ray Society (Brecher and Brecher 1969).

Following his dispute with Pratt, Grubbé seems to have temporarily abandoned the issue of priority. As he would say later: "I never made a campaign to have my claims of priority…officially, as it were, accepted." Even had he been less inclined to hide his light under a bushel, he believed that his supporting documentation had been destroyed in a fire, a loss that made an assertion of his claims extremely difficult.

But in 1933 the situation changed dramatically! In the bottom of a partially burnt barrel, Grubbé discovered the documents that he believed had been destroyed: two handwritten and dated letters. The first, and more important, was from Dr. Ludlum and it referred Mrs. Rose Lee to Grubbé for the first therapeutic application of X-rays.

E.H. Grubbe

12 Pacific Ave.

Dear Sir:

This will introduce Mrs. Rose Lee who has carcinoma of the left breast.

She is willing to have you make X-ray applications.

I hope you can help her.

Yours truely,

R. Ludlum, M.D.

Jan. 28 - 1896

The other letter, from Dr. Halphide, referred Grubbé’s second patient.

With the necessary proof in hand, Grubbé now wrote the paper that he promised would be "one of the most momentous in X-Ray literature." (Grubbé 1933a).

The version of events that Grubbé presented in this paper, that he was the first to be injured by X-rays, and the first to employ x rays for therapeutic purposes, is widely cited (e.g., Brucer 1990; Feldman 1989; Mould 1993; Morgan and Turner 1967; Osborne and Ellis 1965).

However, an observant reader might notice that much of the radiological literature makes no mention of Grubbé’s glorious contributions. Surely this silence can’t represent simple ignorance? Could a conspiracy be at work? A conspiracy organized by a secret cabal of radiologists to cheat Grubbé of his rightful place in the annals of medicine?

What in the World Is Going on?

The amazing answer, and much, much more, in Part Two of The Legend of Émil Grubbé.

Part Two

Part one of this tale recounted Grubbé’s assertions in the August 1933 issue of Radiology that he was the first to employ X-rays for therapeutic purposes, the first to be injured by X-rays, and the first to employ shielding to protect against the harmful effects of radiation. Grubbé stated that he would have made these claims earlier had it not been for the fact that he had only recently discovered the necessary supporting evidence: signed letters from two physicians in which they referred patients to Grubbé for treatment. Since then, many authors have accepted and repeated Grubbé ’s story. Strangely, just as many maintain a conspicuous silence about Grubbé’s glorious claims. What’s going on? A conspiracy?

In his later years, Émil Grubbé’s extensive radiation injuries left him so terribly disfigured that he remained indoors whenever possible. Even conversations with sympathetic visitors often took place with Grubbé hidden behind a screen. Through his loneliness, one thought sustained him: that he had earned an enduring place in the history of radiology.

To secure this place in history, Grubbé published additional details about his work and further claims of priority in X-Ray Treatment—Its Origin, Birth and Early History (Grubbé 1949). Even then, an irresistible urge to say more led him to one final act of foolishness: he bequeathed his estate to the University of Chicago with the stipulation that the University write and publish his biography.

The downside was that Grubbé had to die to get the biography written. And so, rather reluctantly, he passed away from metastatic cancer. Four years later, in 1964, he got his biography. But it was not the biography Grubbé thought he had paid for—the biographer, Paul Hodges, had taken too thorough a look into the Grubbé legend (Hodges 1964).

The legend is a rich and extensive one. Too extensive to be recounted here. But to get an idea of the daunting task that Hodges faced, it might be worthwhile to consider a few details of Grubbé’s story, and the results of Hodges’ attempts to verify them.

For example, Grubbé claimed that he discovered platinum deposits in Idaho’s Snake River and that he used the platinum in his x-ray tubes and in the production of barium platinocyanide for his fluoroscope. Strangely, Hodges found no records of platinum ever being mined in Idaho—only the merest traces of platinum had been found there. Another of Grubbé’s claims was that he had devised an electric furnace to process his platinum and that he also used it to manufacture synthetic diamonds. This would seem patently absurd since the production of diamonds requires temperatures and pressures well beyond anything Grubbé could have achieved with his homemade equipment. Grubbé also maintained that during this period, 1895-1898, he traveled to Colorado, British Columbia, Brazil, Congo, and South Africa. Given the slowness of transportation in the 1890s, it is remarkable that a full-time medical student with teaching responsibilities could travel three continents and still find the time to treat, as he claimed, hundreds of patients in a burgeoning X-ray practice.

While many of Grubbé’s claims were "palpably erroneous," there is no doubt that he believed much of what he said—even his most outlandish assertions. For example, Grubbé was truly convinced that he had pioneered the therapeutic use of artificial radioisotopes in 1903. Most observers would be hard pressed to accept this claim since the production of artificial radioisotopes didn’t take place until 1934—work for which Frederick and Irene Joliot-Curie received the Nobel Prize. Nevertheless, Grubbé held such a view because he believed that the strontium he administered to his patients became radioactive when he exposed them to x rays (after all, materials exposed to X-rays emit characteristic X-rays of their own). Grubbé was miffed that this magnificent achievement had received so little recognition—"I fail to find any reference to my pioneer work [with radiostrontium]" and he identified John Lawrence and Robert Stone as particularly negligent in this regard. However, Grubbé was not one to hold a grudge: "Perhaps this is merely an oversight on their part, and I should therefore forgive them" (Grubbé 1949).

Fortunately for Grubbé, his biographer, Paul Hodges, might have been skeptical, but he was also fair. Hodges recognized that examples of fabrication and folly like the preceding didn’t establish that Grubbé was lying or deluding himself regarding the most fundamental part of his story—that he was the first to employ X-rays for therapeutic purposes. To evaluate this part of the Grubbé legend, Hodges pursued three lines of investigation.

The first was to determine what was known about Grubbé’s first patients: Mrs. Rose Lee and Mr. A. Carr. Despite his best efforts, Hodges was unable to locate any information about them other than the statements provided by Grubbé. Similarly, an intensive search by the historian Nancy Knight failed to find any references to Mrs. Rose Lee, Mr. A. Carr, or anyone resembling them (Knight and Wilson 1996). In short, there is no evidence that these individuals ever existed.

Hodges’ second line of investigation was to determine if Dr. Gilman, presumably the first to suggest the therapeutic value of x rays, or Drs. Ludlum and Halphide, who supposedly referred patients to Grubbé for therapy, had said anything that might confirm Grubbé’s story. The result was another blow to Grubbé’s credibility—no statements were discovered that even partially corroborated Grubbé’s version of events.

Ironically, the most damning statement to be uncovered came from the lips of Émil Grubbé himself. It was made in 1901 at a symposium where Grubbé was responding to a paper presented by none other than Dr. Gilman. A more opportune moment for Grubbé to recount his story could hardly be imagined—the matter at hand is X-ray therapy, and Grubbé is addressing the very man whose suggestion was supposed to have led to the first therapeutical application of X-rays! Grubbé’s words appear to speak for themselves: "I have not had very much experience with the application of the X-rays to cancer. However I have treated several cases by the electrolytic method" (Brecher and Brecher 1969).

Given all this, the only possible conclusion would seem to be that Grubbé’s story was totally false. But there was still the matter of the letters, signed and dated, from Drs. Ludlum and Halphide—the letters that refer Mrs. Lee and Mr. Carr to Grubbé for X-ray treatment.

To determine whether the letters were fakes, or tangible proof of Grubbé’s claim, Hodges asked the Smithsonian Institution, to whom Grubbé had donated the letters, to submit them to the FBI for analysis. Even though the analysis would destroy the letters and leave them unsuitable for future study, the Smithsonian agreed.

The result? The FBI concluded that in style, ink, and paper, the documents were entirely consistent with what they purported to be, letters written in the mid-1890s. The FBI also concluded that the writing and signature on the Ludlum letter were identical to known examples of Ludlum’s writing! In the final analysis, the FBI’s report forced Hodges to accept Grubbé’s claim to have been the first to employ X-rays for therapeutic purposes.

Nevertheless, others remain unconvinced. Ruth and Edward Brecher (1969), for example, find Grubbé so prone to lies and exaggeration that they have concluded that the letters must have been fakes, perhaps concocted in collaboration with Dr. Ludlum.

But history is in the eye of the beholder, and the most recent to investigate the matter, Nancy Knight, sides with Grubbé (Knight and Wilson 1996). She explains, "His bombast may have made Grubbé a particularly unappealing pioneer to his medical colleagues and blinded them to the validity of some, if not all, of his claims to early and innovative work in the field" [my italics].

If Hodges and Knight are correct, there is no getting around the fact that the father of radiotherapy¹ was "difficult and often mean-spirited," a man of "relentless bitterness and contentiousness," his own "copywriter, press agent and advertizing manager," as well as "vain, boastful [and] incompletely truthful." But even if we are less inclined than Hodges and Knight to give Grubbé the benefit of the doubt regarding his claims of priority, we now know better than to mention Grubbé’s name when we find ourselves in the company of therapeutic radiologists—every one of them follows after him.²

Footnotes

1. Not to mention: the first to be injured by radiation, the first to employ shielding for protective purposes, and the inventor of the fluoroscope?
2. Only in time, of course.

References

• Brecher, R.; Brecher, E. The rays—A history of radiology in the United States and Canada. Baltimore, MD: William and Wilkins Company; 1969.
• Brucer, M. A. Chronology of nuclear medicine. St. Louis: Heritage Publications, Inc.; 1990.
• Feldman, A. A sketch of the technical history of radiology from 1896 to 1920. RadioGraphics 9(6):1113-112X; 1989.
• Grubbé, E.H. Priority in the therapeutic use of X-rays. Radiology XXI: 156-162; August 1933.
• Grubbé, E.H. Who was the first to make use of the therapeutic qualities of the X-ray? Radiological Review XXII: 184-187; August 1933.
• Grubbé, E.H. X-ray treatment—Its origin, birth and early history. St. Paul and Minneapolis, MN: Bruce Publishing Company; 1949.
• Hodges, P.C. The life and times of Emil H. Grubbé. Chicago: University of Chicago Press; 1964.
• Knight, N.; Wilson, J.F. The early years of radiation therapy. In: A history of the radiological sciences. McLennan, B. and Gagliardi, R.A., eds. Vol. 1. Reston, VA: Radiology Centennial Inc.; 1996.
• Morgan, K.Z.; Turner, J.E. Principles of radiation protection - A textbook of health physics. New York: John Wiley and Sons, Inc.; 1967.
• Mould, R.F. A century of X-rays and radioactivity in medicine. Bristol: Institute of Physics Publishing; 1993.
• Osborne, S.B.; Ellis, R.E. Protection from ionizing radiation. In: science of ionizing radiation. Etter, L.E., ed. Charles C Thomas; Springfield; 1965.

The assistance of Nancy Knight and Wendell Stampfli is gratefully acknowledged.