Study of Response of Human Beings Accidentally Exposed to Significant Fallout Radiation (Operation Castle - Final Report Project 4.1) (Deleted)

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Yment consists of 104 pages NO. 1 7 6 of 400 copies, Series A Report to the Scientific Director tk o ~ i i ~ OPERATION CASTLE - FINAL REPORT PROJECT 4.1 Study of Response of, Human Beings Accidentally Exposed to Significant Fallout Radiation Naval Medical Research San Francisco. California U. 9. Naval Radiological Defense La transrnlssion or revela

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Following the detonation of Shot 1 on Bikini Atoll on 1 March 1954, 28 Americans and 239 Marshallese were exposed to fallout. One hundred fifty-seven of the Marshallese were on Utirik Atoll, 64 were on Rongelap Atoll, and 18 were on the neighboring atoll of Ailinginae. The 28 Americans were on Rongerik Atoll. The presence of significant fallout on these atolls was f i r s t determined by a recording dosimeter, located on Rongerik, when this device went off scale at 100 mr/hr shortly after t h e detonation. Emergency surveys detected radiation on the inhabited atolls, and evacuation of inhabitants to the Naval Station at Kwajalein was promptly carried out. The dose of radiation to which the individuals were exposed was calculated from the intensities found on the islands and t h e decay exponent of the fallout material. The individuals on Rongelap received approximately 175 r, those on Ailinginae received approximately 69 r, and the Americans on Rongerik received an average calculated dose of 78 r. The Marshallese on Utirik received approximately 14 r. The fallout on Rongelap, Ailinginae, and to a lesser extent on Rongerik was distinctly visible. No fallout w a s observed on Utirik. A significant number of individuals on Rongelap suffered from mild nausea and one or two individuals vomited on the day of the sxposure. With the exception of nausea in one Ailinginae individual, there were no other definite gastrointestinal symptoms in the other Marshallese or the Americans. The Marshallese on Rongelap and Ailinginae, and the Americans experienced to a varying degree burning of the eyes and itching of the skin from 1 to 3 days. Later, signs of radiation injury included definite epilation in the Rongelap and Ailinginae groups, and the development of spotty, superficial, hyperpigmented skin lesions that desquamated from the center of the lesions outwards. In some cases the skin damage was sufficient to result in raw, weeping lesions. There was no full thickness necrosis of the skin. The Americans developed only minor skin lesions without ulceration. There were no skin lesions in the Utirik natives. All lesions healed rapidly with no further breakdown of the skin noted during the period of observation. Microscopic examination of biopsies of the lesions showed changes usually associated with radiation injury. Fully clothed individuals and those remaining inside of buildings or huts were protected to varying degrees from development of lesions. Hematologic changes were definite in the Rongelap, Ailinginae, and the American grotips. Lymphopenia appeared promptly and w a s persistent for a prolonged period of time. Neutropenia occurred in all of the individuals with initial minimum values occurring around the 11th day followed by an increase in the counts and a secondary minimum around the 40th to 45th day. The most consistent hematologic change was the depression in the platelet counts. Platelets were below normal when first counted on the 10th day od post-exposure and progressively decreased attaining a minimum between the 25th and 30th day. Although recovery commenced following this minimum, the platelet counts had not returned t o normal by the completion of the initial study on the 76th post-exposure day. The incidence of various respiratory and cutaneous infections was identical in all exposure groups and bore no relationship to the hematologic changes. were found. Estimates of total body burden indicate that there is no long t e r m hazard and that ingestion and inhalation of isotopes did not contribute significadly to the initial radiatlon Urinary excretion of radioisotopes was studied. Small amounts of radioactive material

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This report i s one of the reports presenting the, results of the 34 projects participating in the Military Effects Program of Operation CASTLE. For readers interested in other pertinent test information, reference is made to WT-934,Report of the Commander, Task Unit 13, Military Effects Program. This summary report includes the following information of possible general interest. location, time of detonation, ambient atmospheric conditions at detonation time, etc., for the (a) An over-all description of each detonation, including yield, height of burst, ground zero (b) Discussion of all project results. (c) A summary of each project, including objectives and results. (d) A complete listing of all reports covering the Military Effects Test Program. Detailed reports on dosimetry and internal radioactive contamination will be published as Much of the medical terminology in this report is explained in parentheses for the benefit supplements to this report. of the layman.

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Operation CASTLE did not include a biomedical program. The participants in Project 4.1 were drawn from various laboratories and were totally unprepared for a field program when the joint DOD-AEC Medical Research Team was organized after the operation had begun. Browning, MC, USA, Surgeon of the Armed Forces Special Weapons Project, selected the project officer and requested that the selection of technical and professional personnel be commenced immediately. Rear Admiral Clarence Brown, Deputy Surgeon General, Medical Department, USN, gave immediate and complete support of all naval medical research activities and assigned responsibility to CAPT Van Tipton, MC, USN, and CDR Harry Etter, MC, USH, of the Atomic Defense Division, Bureau of Medicine and Surgery, USN, for the implementation of Since little detailed information w a s available about dose and initial symptomatology, the research team was organized to include the following talents for the constitution of the emergency medical team: internal medicine, hematology, radiation technology and radiobiology. In the selection of personnel the emphasis was placed on past experience in biomedical research in the field with atomic weapons. In addition, provisions were made for a second echelon of specialized personnel in case they were needed. Accordingly, a preventive medicine unit of the Commander-in-Chief, Pacific Fleet, was alerted for possible bacteriologic studies; blood bank personnel, and additional clinicians and nurses were notified in case conditions justified their services in the Kwajalein area. Rear Admiral Bartholomew Hogan, MC. USN, Pacific Fleet Medical Officer, immediately made any needed medical facilities of the Pacific Fleet Personnel were obtained within the Continental limits of the U. S. for the research team Naval Medical Research Institute (NMRI) 2 medical service corps officers (W.H. Chapman and R. Sharp) 1 medical service corps officer (L. J. Smith) 1 Army Medical Officer (L. E. Browning) Division of Biology and Medicine, A J X Armed Forces Special Weapons Project (AFSWP) Preliminary studies had been made by CDR W. S. Hall, MC, USN, Station Medical Officer and his staff. and decontamination of the individuals was well underwajr when Project 4.1 person-

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had not received acutely fatal doses of radiation. The primary responsibilities within the project group were delegated as follows: Compilation and daily analysis of all data-Dr. V. P. Bond Senior Petty Officer in charge of laboratory -P. K. Schork, HMC, USN AS the clinical picture developed, a further breakdown in responsibility was necessary. COmfor a daily survey of skin lesions, and Dr. S. H. Cohn w a s made .responsible for studying the problems Concerned with the excretion of radioisotopes and the estimates of body burdens in the exposed individuals. The project officer commends all of the professional and technical members of the group for their excellent motivation, initiative, and voluntary long hours of extra work that were essential for the accomplishment of the clinical and research objectives, and for the rapid COllection of the preliminary data in the field. It is emphasized that the work was a cooperative endeavor in which all were mutually dependent upon each other. The willing efforts of all concerned constituted a remarkable example of team-work and sacrifice of personal ambitions and desires for the good of the project at large. The authors wish to express their gratitude and indebtedness to Dr. John C. Bugher, CAPT Commanding and Executive Officers, respectively, NMRI; CAPT R. A. Hinners, USN, Director, limited support and reduced administrative procedures t o a bare minimum, thus making it possible for the unit to be assembled and underway in a matter of hours. tion, Kwajalein, supported Project 4.1 with all the facilities at his disposal. As a result, a laboratory and clinic w a s established and operating within 24 hours after arrival of the project Project personnel also wish to acknowledge the outstanding contributions of Col C. S. tary Application, AEC; Col K. Roughton, MC, USAF, Special Weapons Center; CAPT Donald Scientific Laboratory; Dr. Gordon Dunning, Division of Biology and Medicine? AEC, and Dr. G. V. LeRoy, University of Chicago. During all phases of the early care of the exposed individuals, the foregoing participated as much as their other primary duties would permit. In addition the authors wish to thank them for the extensive and complete data which they collected in the atolls o r their home laboratories and kindly furnished t o the project personnel. The continuous help and cmperation of Trust Territory representatives and their aid in obtaining necessary control data on native Marshallese at Majuro i s hereby acknowledged. The authors are particularly indebted to M r . John Tobin. H i s help a8 an interpreter and his extensive knowledge of the Marshallese language and habits were invaluable. Lieutentant J. S. Thompson, MC, USN, furnished his records on the exposed individuals decontaminated by the radiation group of the VP-29 squadron stationed at Kwajalein. The authors wish especially to express their admiration for the excellent job done by the medical personnel of the U. S. Naval Dispensary, Kwajalein, in completing the extensive laboratory examinations that were required to obtain a prompt initial evaluation of the severity of the radiation injury. The authors are deeply grateful to Dr. David A. Wood of the university of California Hospital, San Francisco, and Dr. Edward L. Alpen and M i s s Pat Roan of NRDL, for invaluable aid in carrying out the histopathological evaluation of skin lesions. The extensive contributions of N'RDL in dosage calculations a r e gratefully acknowledged.

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1.2 General Description of the Exposed Groups.. 15 1.3 Evacuation and Early Care of the Exposed Groups.. 15 1.5 Estimate of Maximal Skin Dose from the Ground.. 22 1.4 Estimation of Whole Body External Dose . . 16 CHAPTER2 CLINICAL OBSERVATIONS AND THERAPY. 2.2 Symptoms and Signs Related to Radiation Injury . 2.7 The Effects of Pregnancy. Clinical Observation and Therapy as Related to Hematological The Effect of an Epidemic of Upper Respiratory Infection on an Irradiated Comparison with the Ull rik Group of Diseases Seen in the Rongelap and Ailinginae Groups During the Period of Observation. Changes in Weight as a n Indication of Disturbance in the Overall Discussion on the Use of Antibiotics in this Group and in Radiation CHAPTER3 SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION . 3.1 Introduction- Early Symptomatology Refer able to the Skin . 3.5 Factors Influencing the Severity of Skin Lesions. 3.6Correlation with Hematological Findings.

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4.3 Methods of Treating Data, Control Groups. . 4.4 Hematological Findings, General . 4.10 Hematocrit, All Groups . 4.11 Morphology of Peripheral Blood 4.12 Comparison of Hematological Findings in Children and Adults, CHAPTER 5 INTERNAL RADIOACTIVE CONTAMINATION . 5.2 Physical Environment Studies . The Living Area on Rongelap Island, Indicating the Light, Histogram of Proportion of Total Dose Contributed by Various Energy Regions from the Fallout Radiation . . 18 Comparative Depth Doses for Bilateral Exposure from a Small Comparative Depth Doses in a Phantom Man of Initial Atomic Bomb 1.3 Cumulative Dose ae a Function of Time After the Detonation . . 21 Radiation and Radiation from a Field of Fission Products . 22 CLINICAL OBSERVATIONS AND THERAPY The Blood Count Changes irk a Two Year Old Child with Fever . . 27 2.2 The Blood Count Changes in a Fifty Year Old Man with Fever . . 28

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CHAPTER 3 SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION 3.1 Comparison of the Incidence and Time of Appearance of Epilation and Neck Lesions in the Rongelap and Ailinginae Groups . Early Hyperpigmented Maculopapular Neck qesions at 15 Days. Case 39, Age 15, F. Neck Lesions at 28 Days. Wet Desquamation. White Color IS Calamine Lotion. Case 78, Age 37, F. . Repigmenting Superficial Neck Lesions at 40 Days. Hyperpigmented Areas not Completely Desquamated. Case 24, Age 15, F. Healed Neck Lesions at 77 Days Showing Dusky Pigmentation of Back of Neck. Case 39, Age 15 F. . Hyperpigmented Raised Plaques and Bullae on Dorsum of Feet and Toes at 28 Days. One Lesion on Left Foot Shows Deeper Involvement. Feet were Painful at This Time. Lesions 10 Days Later. Bullae Have Broken. Desquamation is3.6 Essentially Complete, and Lesions Have Healed. Feet no Longer Painful . Lesions 6 Days Later Showing Repigmentation Except for Small Scar on Dorsum of Left Foot at Site of Deepest Lesion 3.8 Extensive Lesions in Boy, Age 13, Case 26 . 3.9 Extensive Lesions in Boy, Age 13, Case 26 . 3.10 Whole Body View of Lesions in Same Case a8 Plates 3.8-3.9 3.11 Whole Body View of Lesions in Same Case as Plates 3.8-3.9 3.12 Desquamation of Back of Scalp at 28 Days. Epilation Occurred Earlier in Desquamated Area. (See Plate 3.14.) Note Persistent Ulceration of Left Ear. . 3.13 Eighteen Days Later. Scalp Lesions Have Healed With Repigmentation of Skin. No Hair Growth Evident in Epilated Areas. Ear Ulceration Persists With Little Improvement. . 3.14 Epilation in Man at 18 Days, Case 79, Age 41. Scalp Lesions Present in Areas of Epilation. (Same Case as in Plates 3.12 and 3.13.) . 3.15 Spotty Epilation in Boy, Age 13, at 2 8 Days. Case 28. Note Scalp Lesions in Areas of Epilation. (Same Case as in Plates 3.8-3.11.) 3.16 Epilation in 7 Yr. Old Girl at 28 Days. Case 72. 3.17 Pigmented Bands in Semilunar Area of Fingernails at 77 Days . 3.18 (X100, H&E) Epidermis: Extensive Transepidermal Damage With 3.19 (X100, H&E) Epidermis: Arcades of Minimal Damage O c c w in Less Involved Zones on Either Side . Relation to Excretory Ducts of Sweat Glands. of the Malpighian Layer . of the Malpighian Layer . Outward Papillary Projections and Resultant “Rugose” Appearance Cytoptasmic Halos in Mid Stratum Granulosum . Extensions Downward of Stratum Malpighii .

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CHAPTER 3 SKIN LESIONS, EPLATION, AND NAIL PIGMENTA'l'lON 3.1 Lesions in Rongelap Group . 3.2 Lesions in Ailinginae and Rongerik Groups . 3.3 Surface Doses in r e p Required to Produce Recognizable Hematological Results, Control Groups . Rongelap Group, Mean Blood Counts By Day and By Age Ailinginae Group, Mean Blood Count By Day and By Age Utirik Group, Mean Blood Count By Day and By &e . Rongerik Group, Mean Blood Count By Day . 1 . Rongelap Group, Mean Blood Counts at Time of Peak Depression Ailinginae Group, Mean Blood Counts at Time of Peak Depression Hematocrit, All Exposure Groups . Comparison By …