In 1958, a young patient who we'll call 'Patient X' sat opposite a doctor, fidgeting. Just eight-years-old, her feet didn't reach the floor.
The orthopedist was stumped. Each of this patient's feet had broken twice within the last four months. He had been sure she had the brittle bone syndrome, but the tests had all come back normal.
"Did something happen to your feet?" he asked. The patent glanced nervously toward her mother. "Madam," the doctor said to the woman, "would you mind stepping out of the room for a moment?"
Once the woman was gone, the doctor turned to the child. "We got pennies for being good," she said. "Yes..." the doctor encouraged. "We weren't allowed to cross streets, but we could cross alleys."
The doctor was growing impatient. "And..." he prodded. "There was a shoe store. We'd take our pennies, feed them into the machine, and look at our feet." The doctor didn't need to hear any more; he knew exactly what was wrong with his patient.
Meet the shoe-fitting fluoroscope
In 1920, Dr. Jacob Lowe demonstrated a shoe-fitting fluoroscope at a shoe retailer convention in Boston, Massachusetts, and again in 1921 in Milwaukee, Wisconsin. Lowe filed a patent application in 1919, and it was approved in 1927 before being assigned to the Adrian Company of Milwaukee, Wisconsin.
A fluoroscope uses X-rays to create real-time moving images of the interior of an object. At its simplest, a fluoroscope is comprised of an X-ray source and a fluorescent screen, between which a patient is placed.
In the UK, the Pedoscope Company filed a British patent application in 1924, which was granted in 1926.
From the 1920s through the 1950s, the machines made their way into shoe stores in the United States, Canada, the United Kingdom, South Africa, Germany, and Switzerland. They gave nervous parents the assurance that their child's shoes were being fitted properly.
An estimated 10,000 machines were sold in the U.S., 3,000 were sold in the UK, 1,500 were sold in Switzerland, and 1,000 in Canada.
The machines were 4 feet (1.2 m) high and made of metal covered in wood. At the bottom was an opening ledge where an adult or child could place their feet. At the top of the machine were three viewing portholes, one for the shoe's wearer, one for a shoe salesman, and one for a parent.
Children were instructed to wiggle their toes to demonstrate how much room there was inside the shoe. Both the bones of the feet and the outline of the shoe were clearly visible.
The first scientific examination of the fluoroscopes wasn't done until 1948, and it showed that not only were the machines ineffective at shoe-fitting, they were also dangerous.
During the 20-second viewing time, American-made machines delivered about 13 roentgen (0.13 sievert (Sv), while British Pedoscopes were approximately ten times less powerful.
Although the beam of radiation was directed at the feet, a large amount would scatter in all directions. As a result, shoe salesmen received a whole-body dose of radiation, as did anybody standing near the machines.
Estimates reveal that shoe salesmen were exposed to more than [1 mSv/hr] if they were standing 10 feet from one of the machines. If standing near the machines for two hours per day, they could be exposed to 2 mSv per day, which is equivalent to an entire years' worth of natural radiation exposure!
There are records of three shoe salesmen suffering serious effects: a radiation burn requiring amputation in 1950, a case of dermatitis with ulceration in 1957, and a case of basal cell carcinoma in 2004. It is likely that many more were affected. According to a report in the Wisconsin Medical Journal, the machines may have led to a high incidence of foot cancer.
The machines are banned
In 1957, Pennsylvania became the first U.S. state to ban the shoe-fitting fluoroscope. In 1959, Switzerland followed suit, and by 1970, 33 U.S. states banned the machines.
In spite of being banned in Massachusetts, in the late 1970s, a member of the Massachusetts Department of Labor and Industries stepped into a "corner store" in Boston only to find one of the machines still in use. The store's owner was letting children take a look at their feet through the machine if they bought 10 cents worth of candy!
Due to the lack of records, there is no way to correlate cancers that arise decades later to those who were exposed to radiation by the shoe-fitting fluoroscope.
I am "Patient X."