Audiotaped Interview of Dr. Frederick Bonte
December 16, 2004
DR. DANA MATHEWS: It's December 16, 2004, and I'm interviewing Dr. Frederick Bonte as one of the past presidents of the Southwestern Chapter of the Society of Nuclear Medicine. Dr. Bonte was the ninth chapter president (term ending 1965), and there were a lot of exciting developments in nuclear medicine in that year. .
DR. BONTE: Indeed there were. The Brookhaven and University of Chicago groups had perfected the generators for technetium-99m and had worked out a lot of the chemistry necessary to label compounds with that emitter, and there was a good deal of activity in the instrument makers who previously had been making imaging devices with thick crystals capable of scans using I-131. Overnight, they found themselves with the need to redesign their instrument systems so that they could capture the 140 keV photon of technetium-99m which was coming into use as pertechnetate ion for brain scanning, for thyroid imaging (and as a label for other compounds, principally serum albumin.
We ourselves were doing blood pool imaging and a young resident and I, Carl Peterson, conceived the idea of boiling albumin and causing it to precipitate, and we injected the precipitate into the ear vein of a rabbit and had a lung scan, which was one of the first ever made with technetium serum albumin aggregates of various sizes available in the labs at the school.
Some important things were happening because we had good people in training there. One of them was Dr. William Hendee, who most recently became the first physicist to become the president of the American Board of Radiology; but along the way he also was the first PhD to chair a medical department of radiology at the University of Colorado, which he did quite successfully, and he was working on the electron microscopy of irradiated tissue culture cells.
At the same time a young radiology trainee, Dr. James Belli (sp?) and I were working with irradiated tissue cultures with irradiation done at various temperatures, and we found out that radiation is more lethal to irradiated cells when they're hot and less lethal when they're cold, and this principle has become well known in radiation oncology.
And there actually have been attempts to heat tissue and so forth from the outside in order to render them more radiosensitive. We ourselves didn't succeed in doing this, but others have. I think Dr. Antich now with our department actually has done it successfully.
DR. MATHEWS: At the time you became president in 1964, how many members were in the Southwestern Chapter?
DR. BONTE: I don't know exactly, but there were several dozen, and there were some serious people in the business. For example, at M.D. Anderson there was Tom Haynie, who—when he was in training at Michigan—had actually developed the lung scan with Dr. Beierwaltes there. They made up radioactive inert particles of some sort, and found that they were captured in a capillary bed of the lungs, and that's where the test really got started.
And there was some other good people located at the various, then-existing medical schools, Galveston; and several good nuclear medicine people were going through the military hospital at Beaumont General. One of them, Martin Nusynowitz, later became president of the College of Nuclear Physicians and very well known in the field, so there was competence around the area even though there weren't very many people, and they were widely disseminated.
However, around the country, there were enough people so that the concept of nuclear medicine as a medical specialty had come into being, and as a matter of fact, several medical schools had created sections of departments, usually radiology, but occasionally internal medicine. The Veteran's Administration had free-standing departments of nuclear medicine, not under any other.
Here (The University of Texas Southwestern Medical Center), of course, we had a nuclear medicine section from the beginning, and they did also at M.D. Anderson Hospital, so the concept of a free-standing enterprise had been developed, and it was within the next couple of years that three specialty boards and the Society of Nuclear Medicine would get together to form a specialty board of nuclear medicine.
I was one of the people asked to do this by the Board of Radiology of which I was then a member, but the whole issue was in ferment in 1965, and obviously headed somewhere, and it actually frightened people in some of the disciplines with the fact that they might have to qualify with yet another specialty board to do what they were doing.
DR. MATHEWS: So was the Chapter politically active at that time pushing for nuclear medicine?
DR. BONTE: Yes, for example, I represented the Chapter as the president on the Board of Trustees of the Society of Nuclear Medicine, and there was a good deal of positive sentiment in that group for establishing nuclear medicine as a discrete medical specialty. As a matter of fact, in the eyes of lots of people doing it, it already was, but it needed to be dignified with the apparatus of the specialty board, a member of the American Board of Medical Specialties.
At the same time people were proselytizing among the radiology organizations. For example, in 1965 I was on the Executive Council of the American Roentgen Ray Society, and they changed the name of their journal to the American Journal of Roentgenology Radium Therapy and Nuclear Medicine, which was the first time that the words had appeared on any journal except the Journal of Nuclear Medicine. That was a big push forward too because they were then a politically powerful group.
Scientifically, tests were being developed at a number of institutions, brain scanning with sodium pertechnetate became a meaningful test. Blood pool scans for the detection of mediastinal and abdominal masses and the identification of pericardial effusions were performed. This was before the development of ultrasound which replaced it for that purpose, but this was a frequently-done test, and bone scanning was beginning to make its appearance.
Strontium-85 was an element that was used early in the game, and you got few dots for your efforts, but it did help in localizing certain malignant lesions, and needless to say, it was soon replaced by other agents. Liver scanning had been one of the first procedures developed when it was found that the dye, rose bengal, which is taken up by hepatocytes in large quantities, could easily be labeled with radioiodine, and I-131 rose bengal liver scans were done quite frequently. These and brain scans along with radioiodine scans of the thyroid were probably the most common studies done in the laboratory.
The nuclear medicine laboratory in Parkland Hospital was quite busy. We would frequently have 30 patients a day. We not only did the work for Parkland, but we did it for Children's Medical Center and some of the patients from St. Paul. And patients would be referred in from the community because there wasn't wide access to nuclear medicine in the community hospitals at that time.
DR. MATHEWS: Was it your interest in nuclear medicine that led to the development of a bigger center at Parkland than in some of the surrounding areas?
DR. BONTE: Yes, because I had been trained in nuclear medicine during my residency at the University Hospitals in Cleveland. The chairman of the department there was Dr. Hymer Friedell, who was one of the original University of California group which grew up with Lawrence cyclotron, and the whole concept of tracer studies including imaging really was born there from the idea of De Hevesy in the teens; but it took the development of first the cyclotron, then a reactor to make radioisotopes of commonly-occurring elements available to use for medical purposes.
And a number of people who trained in the programs that were sponsored by the Atomic Energy Commission (who sponsored the one in Cleveland) went out and “colonized” the country like Johnny Appleseed. Where they went, nuclear trees grew, and that's how Parkland happened to get into the business.
DR. MATHEWS: And M.D. Anderson, were they “colonized”?
DR. BONTE: Yes, by Tom Haynie from the University of Michigan where he had trained with Dr. Bill Beierwaltes, who was one of the authentic pioneers of the business.
DR. MATHEWS: How about San Antonio?
DR. BONTE: Well, San Antonio did not have a medical school at that time, but one of the earliest developments in nuclear medicine occurred when Dr. Fred Riley who trained here, went into the practice of radiology in San Antonio; and Dr. Riley is a very bright fellow, and it soon became apparent to people that what he was doing was for real, and he could produce reliable results with tests involving radioactivity.
DR. MATHEWS: And I guess there was a medical school in Galveston. Did they have nuclear medicine?
DR. BONTE: Yes, they did. At that time I think Dr. Gorten, who was quite able, was in charge of the program. He later moved to Houston with a private group, but he had gotten things started at around that time at the Galveston Medical School on a high level, so the specialty was coming along.
DR. MATHEWS: Do you have special memories of any of our past presidents?
DR. BONTE: Dr. J. R. Maxfield, Jr. also trained with the California group at a later time than Dr. Friedell, and his father was in the practice of medicine here in town. Dr. Maxfield came back, and he developed nuclear medicine as part of his private practice. I don't know how much he did, but he was politically very active, and he was one of the founders of what was called the Southwestern Society of Nuclear Medicine, which later became the Southwestern Chapter of the National Society.
Don Sutherland was a hematologist whom I didn't know well, and he left very shortly after this. Felix Pircher was in practice in Houston, and he was a very entertaining fellow with a dutchy accent. I had met Felix shortly after I came here, and at that time, believe it or not, people who did nuclear medicine were called “isotopists”. Pircher and I agreed that this sounded like something illegal that you did to little children. We needed a lot better name than that.
DR. MATHEWS: So that would be í-sotopists?
DR. BONTE: But if you had had much Greek and you placed the accent on the antepenultimate syllable, you became an is-ó-topist.
DR. MATHEWS: That's pretty funny. Well, in 1986 you got the Texas Radiologic Society gold medal. What did you get that for?
DR. BONTE: Being politically active on behalf of radiology. Shortly after I was elected to the Board of Radiology, I was summoned by John Roach, who was the president of the Board, and he instructed me and a fellow by the name of Richard King, who was also a radiotherapist, to work with a group who were going to found the Board of Nuclear Medicine. The reason that Dr. Roach did this is because the Board of Radiology actually had an abortive effort to certify people in nuclear medicine.
In 1957 and I think in 1958 they advertised that they would examine any board certified specialist in nuclear medicine regardless of discipline at an oral examination to be held at a place to be named later, and I got a phone call from a Dr. Traian Leucutia who was an elderly and politically very powerful radiation therapist in Detroit, and he asked me if I'd heard about this exam in 1957, and I said yes, sir. I've heard about it. He said, “You're going to take it.”
I said, “Yes, sir. Where is it going to be?” He said, “At the Shoreham Hotel in Washington D.C.” So I dutifully reported to the Shoreham Hotel in Washington D.C. I found that indeed there was an oral examination. There were three examiners. One was Dr. Leucutia himself, and he and I swapped radiotherapy cases that we had been doing lately. He didn't do much radionuclide work, and he was interested in thyroids.
Another was a fellow by the name of Don Childs who had established nuclear medicine at the Mayo Clinic, and he was a knowledgeable fellow, and the third was the terrifying Dr. Edith Quimby. Edith Quimby, one of the first medical physicists, was the nemesis of many generations of radiology candidates. She examined in physics. She was the senior author of a four-author textbook in radiological physics which was heavily used in her examination, and she had developed the custom of the cards of various colors. You went in for your physics exam. There was a pink stack, a yellow stack, a blue stack, a green stack, and so on, and the examiner would say, Take a card off the yellow stack and answer the question.
Well, Dr. Quimby looked something like an upgrade version of Queen Victoria. She was in her 60s or 70s, still beautiful, had silver hair which she used to pile on top of her head, and she wore a long gown and actually walked with a cane like Queen Victoria, and she had a powerful voice and commanding, glittering blue eyes.
And when I walked in that morning, the room was dark, and Dr. Quimby was sitting on the other side of the customary card table with the colored piles, and she said in a sort of un-Quimby-like voice, “Take a card from the blue stack.” So I took a card from the blue stack. She said, “Answer the question.” Fortunately, I knew the answer, and I began to answer it, I suppose in a loud voice, and she recoiled from the table, and then she leaned over and said, “For God's sake, Bonte. Can't you tell that I've got a hangover this morning?” She said, “Keep it down!”. Afterwards, she and I got to be good friends on the Board of Radiology, and she sent my wife and me a case of champagne when we got married.
DR. MATHEWS: That's so funny. I thought maybe you were going to say she had a migraine, but she kind of did.
DR. BONTE: No. I noticed that there were wisps of silver hair sticking out one way or the other, and the glittering eyes were a little redder than usual.
DR. MATHEWS: Okay. Are there some other folks that you remember?
DR. BONTE: Yes. There are—I remember John Hidalgo. You'll notice that he didn't have a doctoral degree of any sort, but he was a radiological physicist who early in the game had specialized in nuclear medicine, and he was in New Orleans and quite well known.
He wrote papers, appeared at meetings and so on, and he and another master's degree physicist by the name of Craig Harris at Duke had a lot to do with the custom of the Society of Nuclear Medicine electing a non-physician every fourth term, and as a matter of fact, both of them served as presidents of the National organization.
But Hidalgo did more than anybody I know of to get nuclear medicine off the ground in New Orleans, and the field owes him a lot, and you seldom hear anything about him anymore. I don't even know whether he's living or not, but he deserves more credit than he gets these days for developing the field, and he served as an active president in the Southwestern Chapter, and pushed for the development of the medical specialty board. He also pulled for the development of a medical scientist board, and many years later it actually came into being, and I think still examines.
DR. MATHEWS: I know that at one point, Parkland Hospital had a radiology technology training program.
DR. BONTE: Yes.
DR. MATHEWS: Did we ever have a nuclear medicine technologists training program?
DR. BONTE: A formal one, no. I trained people on an ad hoc basis strictly in nuclear medicine, and in the early days of the department I used to give a formal course in nuclear medicine. There were 30-some lectures in it starting with radiological medical nuclear physics, and we developed technologists or I inherited them.
The chief technologist at Beaumont General Hospital was a master sergeant, Chuck Graham. He retired from the service, and he came around looking for a job, and I hired him on the moment because he turned out to be a well-trained and superb technologist.
John Moore (long time radiology technologist in the UTSWMC department) at a later time actually started life in the radiological technologists training program, and it turned out that although he was legally blind, he was the only person in our group who could successfully catheterize the anterior descending coronary artery of a dog with a fluoroscope. I couldn't do it. Ed Christensen couldn't do it. George Curry couldn't do it. Bob Parkey couldn't do it, but John Moore who was blind could do it, and he spent many years as a technologist in nuclear medicine before he moved up the ladder in the department. So we trained people on an ad hoc basis, but strictly in nuclear medicine or we hired people who had a background in it.
At one time, my wife, Cecile, worked for me as a chief research technician, and she had trained in Bethesda at the naval hospital in laboratory techniques, and it was very easy for her to incorporate radioisotopes into what she was doing. She was also a splendid technologist. She worked with George Curry and me a good deal and Carl Peterson. Carl and I wrote that paper on doing a lung scan with technetium serum albumin in a rabbit who turned out to have a lung scan to our great surprise.
DR. MATHEWS: Without anticipating what was going to happen?
DR. BONTE: Well, we were lucky seeing the glob we injected. Jack Maxfield was the brother of J. R. Maxfield and Bill Maxfield was the youngest brother of the family, and Jack did some nuclear medicine, and his older brother J. R. was probably the prototype for J. R. on the Dallas series.
Both Jack and Bill Maxfield were very reputable and highly thought off, and Bill Maxfield left here to become the chairman of radiology at the University of South Florida Medical School and then went into private practice, but Jack Maxfield ran the local radiology practice, and as I say, he was highly thought of by his referents, but all three of the Maxfields served as presidents.
One of the non-physician presidents of the Southwestern Chapter was Billy Banks, and Billy Banks was the head of veterinary radiology at the vet school at A&M, and boy, did he have a fancy lab, and he was very smart. I learned a lot from Billy. As a matter of fact, his son went through the residency program here some years ago. I lost track of him after he left Parkland, but he was the son of Billy Banks, the man who started veterinary nuclear medicine in this part of the world (Texas), and he was one of the few vets who did nuclear medicine anywhere. I forget where he trained, but wherever it was, they did a heck of a good job on him.
He first pointed out to me that hyperthyroidism was a fatal terminal disease in elderly cats, and they developed apathetic hyperthyroidism just like some elderly patients do. As a matter of fact, it's far more common in cats than in people, and Banks somehow had realized this along the way and was able to diagnose it by doing uptakes in cats, and he would treat them with radioactive iodine, and they would begin to regain the weight they had lost and the pep that they had lost as well, and whether he ever wrote this up or not, I don't know, but he certainly should have.
And I'm sure the vets who train these days all know about it, but he first introduced the concept to the medical doctors, and he also was a very good president. He had an excellent sense of humor to go with his fancy lab and his special knowledge of animals.
Let's see. Philip Johnson also trained at the University of Michigan like Tom Haynie, and he also practiced, as I recall, at M.D. Anderson. I forget what happened to him. He may have died at an early age, but while he was still at the University of Michigan, he wrote one of the really good original textbooks in nuclear medicine. Beierwaltes and Johnson and a physicist there wrote a slim book that was the Mettler and Guiberteau of its day as every radiology resident had to have a Beierwaltes to learn his nuclear medicine from.
There was a humorous thing about that book. As the field was growing and, you know, technetium was being added to the armamentarium in dozens of forms, everybody waited around for a second edition of Beierwaltes' textbook, and since I knew him, I called him and asked him, “When can we expect a second edition?” And he said, “You can't ever expect it because it's dead.” I asked him, “How did that happen?” because it was a big seller, and it was the only big seller in the field as far as residents were concerned. He said, “The physicists killed it.”
In order to publish a second edition, they had to get the permission of this guy, Solari, and he refused to work on another edition with Beierwaltes and Johnson, and, he refused to let them publish it without him since they had a joint copyright on the thing, and unfortunately that was really the end of what was the best residents' textbook in nuclear medicine at the time.
DR. MATHEWS: Well, I know from talks you and I have had before that Parkland was one of the first places in this area to treat patients with hyperthyroidism with radioactive iodine and that you and Dr. Robert Parkey saw quite a number of patients. Was that something considered pretty radical at that time?
DR. BONTE: Yes. When I first came to Dallas, even to Parkland, the treatment of choice for Grave's disease was thought of as partial thyroidectomy. They do a lobectomy trying not to nick the recurrent laryngeal nerve which happens all too often, and all sorts of dire things were predicted for the future of people who were treated with radioactive iodine. They would have grossly misshapen children. They would die of leukemia in two or three years, so on.
However, we'd been at this long enough since the early days at the University of California that anybody who trained in one of the Atomic Energy Commission laboratories knew that this was false, and there were no genetic consequences, and there were no deformed people, and if there was an incidence of leukemia, it had to be darn small because by that time people had been treated with radioiodine for, oh, 15 years starting in California and then Boston where the second cyclotron was built.
And actually it didn't take all that much trouble selling the idea here because for one thing the surgeons liked the idea because that gave them the chance to spare parathyroids with all the misery that they used to have with total thyroidectomies.
In the early Department of Surgery that was here when I came, everyone left for political reasons, except Tom Shires, who became the chairman. He had residents like Charlie Baxter and Bill Snyder who liked to do thyroid surgery and did a splendid job of doing it, and liked to work with us in managing thyroid cancers.
The boring part is finding where the metastases were and giving some iodine here and having them back and taking films and giving some more iodine if that first one hadn't done the trick, that—that didn't appeal to the surgeons; and we didn't have any internists here who were interested in thyroid disease. As a matter of fact, one of them, whom I won't name because later he became justly famous, said, “ Having differentiated thyroid cancer is no worse than having a bad cold, and there's really nothing you need to do about this.”
We had a selling job with some of the internists, but they too finally adopted it, though with some grumbling, but that and rose bengal liver scanning were the principal tools that I brought here.
Also, I had had a lot of experience with P-32 therapy of leukemias and lymphomas and treating serous cavity effusions with radioactive colloidal gold and so forth, and I had been part of a group that showed intracavitary nitrogen mustard was better than colloidal gold, so the nukes were all temporarily angry at me.
But colloidal gold went down the tubes. It tended to puddle in places, and 411 keV photon was irradiating every other part of the body, and if the patient survived a long time, they were at risk for some real radiation effects of the doses we were putting in the abdomen in poor ladies with ovarian carcinomatosis, but otherwise we didn't have any trouble getting it started.
The Maxfield boys had done some cases, and I don't know who referred to them, but there was interest in the use of radioactive iodine treating thyroid disease by some internists who didn't actually do it themselves. One of them was Al Harris, and he invited me to lunch one day to find out, you know, what you could really do with this iodine. I think he had tried it a couple times himself before the laws prevented him from ordering it himself. That only happened once here, by the way.
A young internist, who's long gone from the institution, took it on himself to order and administer a dose of radioiodine to a patient with hyperthyroidism, and he was only caught in retrospect, but he never ordered any again. By that time I was the dean of the medical school, and we had a memorable chat about who gave what to whom under what circumstances.
DR. MATHEWS: Are there any other reminisces that you have about the Southwestern Chapter that would be good stories to people like us?
DR. BONTE: The Southwestern Chapter meetings fortunately moved around. We actually did meet in Oklahoma, usually in Oklahoma City, Little Rock, Arkansas. Everybody liked to go to New Orleans.
When there were enough members, we were able to invite guest speakers from outside the Chapter who had special skills. A favorite was Alex Gottschalk who has a thousand stories of all sorts, and not only that, he trained with Hal Anger in Anger's laboratory at the University of California and took part in the development of the Anger camera which became the definitive imaging instrument; and also a colleague of his was a surgeon, Paul Harper, who had a group which developed technetium from what they found out from a chemist at Brookhaven. There were chemists who worked for Harper that developed pertechnetate ion and so forth from a generator, that sort of thing, and then there were people who seemed to be able to do things that none of us could do.
But we used to like to invite people to tell us firsthand what they were doing, and this grew to be quite a popular feature of the meeting, and now there are apparently a number of guest speakers that can be afforded by the Chapter since it's quite large.
I was trying to remember whether we started the business of having an objective film interpretation panel. I know that the idea rapidly caught on with the National organization. I was on the first panel in Seattle a long time ago.
DR. MATHEWS: That's the Stump the Experts?
DR. BONTE: Yes. They just borrowed the concept from the RSNA. That was the most popular thing at the RSNA meetings in those days. You could fill the biggest room that you could find with people to watch Benjamin Felson and company demolish the unknowns one after the other.
Another thing I remember is on one occasion the physicist Earl Gregg, who was one of the Cleveland group, was invited to a meeting in New Orleans. Now Earl Gregg had the reputation of sticking people with his meal bills in a relentless manner, and at the time the physicist here was Jack Krohmer, who later became very famous and got gold medals from everybody in sight.
Krohmer had been at times the victim of Gregg because he worked with him in Cleveland till he came down here, and we had several residents who were giving presentations at the meeting in New Orleans, and Krohmer and I and, I think, three residents went to the meeting. We scheduled a dinner at Arnaud's in a private room upstairs, and invited Earl Gregg. Krohmer and I took the young fellows aside, and then we told them, “Now at the signal, you'll begin to filter out to the men's room, and the last person standing will engage Dr. Gregg in conversation and suddenly disappear.”
And this happened, and the waiter came in with the bill and Gregg starts looking around for people to hand it to and everyone's gone. That's the only bill anybody knows of that he paid during his lifetime.
DR. MATHEWS: Well, thank you, Dr. Bonte. I think this is going to be a good hour's worth of discussion, and I think we'll enjoy seeing this.