Plutonium Injection Medical Case File 40-009 (Correspondence, Reports, Lab Results, Death Certificate, 10/31/45 - 7/03/84)

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SUBJECT: Updates on Series 40 Cases an update on the current status and whereabouts of 40-01 2.I would appreciate receiving this

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LAB0RAT0RY PRIVACY ACT MATERIAL. REMOVED I spoke with Dr. Joseph Ga utter y today (716/394-2500) about obtaining i n Canandaigua, New York. x - rays taken while a patient art he F. F. Thompson Hospital I explained how important these x - rays are to the s$dy and he promised t o see i f he could have them sent tous on loan. If this cannot be effected, he will drop me anote.

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“RIVACY ACT MATERIAL REMOVED Deatha Certificates requested from the State of New York, December 3, 1984 Date of Death: Place of Death: Schenectady County, Schenectady Please search 1983 t o the present indices Canandaigua, New York Canandaigua Nursing Home, Canandaigua

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PRIVACY ACT MATERIAL REMOVED 3 LABORATORY INTRA - LABORATORY MEMO about.He said she had died and there was no post-mortem done. He will senda copy of her last hospitalization as well as the date of her death. He said in her last years she had had divert i cul it is,tvo strokes, a fractured hip and progressive senility.

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SUBJECT: Location of Dr.Christine Waterhouse Christine Waterhouse, M.D., once physician to 40-009 and 40-012, has left as Kennebunk, ME. Christine Waterhouse, MD, in Bid de ford, ME (about 10 miles from Kennebunk), as The 1979-1980 Directory of Medical Specialists lists her birthplace Directory assistance for Maine (207) lists the office of a

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SUBJECT: Current status of239Pu injection case 40-009 1. Mrs.. Leventry obtained the current telephone number (207/283-0255, via FTS operator 833-3131) ofDr.Christine Waterhouse, who i s now living in Maine. 2.I called Dr. Waterhouse on June 3 and asked ifshe knew ifthe two patients her of the negative response.toDr. Adams' letter of April 3, 1981, t o Dr. Robert He in ig, and she replied that the patients were in the care of Dr. Hornick, Chairman ofthe Department o f Medicine at the University of Rochester. She said she would make enquiries and would call me back. .) were still alive and i f so, i n whose care.Itol dc _-_._ 3.Dr. Waterhouse called me on June 5; is alive and is in a nursing ground. The University of Rochester is paying the nursing home and Dr.Gua tter y. Dr. Waterhouse thought that west and a good chance of eventually getting some material for examination. is almost certainly notable to will \ Gua tter y (335 Parrish Street, Canandaigua, NY 14424) who knows about her backAn eventual autopsy might be permitted by the son and his wife, whom 5. Dr. Waterhouse i s still trying to find out the status of 40-012. OiilliACV ACT MATERIAL REMOVED

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CENTER FOR HUMAN RADIOBIOLOGY American Medical Association In order to follow up subjects in o u r radium research project, I am anxious to contact D r . Christine Waterhouse who was formerly at the University of Rochester Hospitals. I would appreciate your help in obtaining a current address (and if possible, a phone number) for her. EE A ji iw

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and for the sake of completeness of our records vie should like t o know if t h e y are still dive, or, if dead, what the causcs of death were. understand that since Dr. Waterhouse left Rochester, most of her patients are now in your care. Does this apply to these t w o and if so, are you information about .their present status? \Ye should be .able to give us a n y

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This patient, a forty-nine year old white _fe-male, was admitted to the hospital with complaints of pigmentation of the skin, pKuritic-- dermatitis and dependent edema. Initial clinical studies were carried out in November. and December 1945, a t which time diagnoses of hepatitis of unknown etiology and hypoproteinemia were made. She was admitted for follow-up examination in October 1946, when she appeared in goad health. / y 4 * //J/. . PRIVACY ACT MATERIAL REMOVED

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PRIVACY ACT MATERIAL REMOVED To: CHR Records, Case 40-009 A s a result of our recent detection of Am i n the bones of c a s e 40-0 10, I have re-examined the spectral data taken when Eckerman and I visited Rochester in February 1973, to search for evidence of 241Am Two energy bands were examined: 24-32 keV and 32-63 keV. The first of these includes counts due to the y -ray from 241Am a t 26.4 keV and the peak a t 30 keV due to escape from the proportional counter of a xenon second band includes counts due to forward and back-scattered quanta and to primary y -rays a t 60 keV. Neither band includes a significant contriThe results are set outin the following table. Skull, left, control 4 . 7 f 0 . 5 5 . 4 f 0.5 Right upper abdomen, 40-009 7 . 5 f 0.6 7.5 f 0 . 6 RECE\VED Left upper abdomen, 40-009 5-8 f0.65.9f0.6 Left upper abdomen, control 5.3f0.56.0f0.6 I draw the following conclusions: PRIVACY ACT MATERIAL REMOVED There were no significant counts attributable to 241Am in the measurement a t the skull. There were significant counts attributable to 241Am in the measurement atthe liver. The counting-rates suggest a liver content in the range 2-10 nCi but t h i s is very approximate.

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PRIVACY ACT MATERIAL REMOVED INTRA - LABORATORY MEMO TO: CHR Records Room SUBJECT: In vivo counting - case 40-009 1. This subject, a 75-year old white female, was hospitalised a t the Strong Memorial Hospital, Rochester, N.Y., in the care of Dr. Christine Waterhouse. We took electronic equipment and counters to Rochester in an attempt to detect uranium L X-rays from t h e subject's purative burden of plutonium-239. We drove to Rochester on February 6 , spent most of February 7 setting u p and testing the equipment and made our measurements on the morning of February 8. After making background measurements on a control subject, we dismantled t h e equipment that afternoon and drove back on February 9 . 2 . By mid-morning, t h e proportional counter and associated electronic equipment were set up, tested and operating satisfactorily. A 40-minute background gave 6 . 2 counts/minute in t h e energy band 14-23 keV and this band was used for all measurement results 3. The principal problems encountered were of a mechanical nature; securing the counter to the detector mounting was the main one. The local workshop personnel made a bracket which was used successfully but there were severe dlfficulties in presenting the counter to the patient because (a) the room was very small (about 5 feet x 6 feet), (b) the suspension device was cumbersome and inflexible, and (c) there w a s only a tilting chair and no bed or 4 . Three measurements were made of the subject ' s X-ray emission: from the general region of the liver, from the left side a t the same level, and from the left side of the face. Two background measurements were made on a female control subject, who w a s not however a particularly good match because she weighed 55 kg compared with that it was impossible to get the counter a s c l o s e to her body surface as to that of the patient. This is not considered too important except PRIVACY ACT MATERIAL REMOVED

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5. T h e results are summarised in the following table (counter background not subtracted). Apparently some activity was detected from the left and right upper quadrants. Case 40-009 Control subject Difference *Assumed to b e the same asthe measured value on the left side. 6. A crude calibration was made a t CHR with a point source buried a t 25 different positions in a solid phantom. w a s 0.15 c/min per nCi 239Pu. Attributing all the counts observed from the patient's liver region to plutonium in the liver, we deduce a liver content of 20 nCi. of 300 nCi, whereas three out of five autopsied patients had in excess of 20% in t h e liver. disease. It should be noted that patient 40-009 had infectious hepatitis at the time plutonium was administered and this may have affected the liver deposition. b e placed on the figure of 20 nCi because of the crudity of t h e calibration; it is likely to be low rather than high but it is difficult to envisage it being low by more than a factor of two and certainly not as much as a factor of ten. This is only 6.7% of t h e injected dose T h e other two showed advanced liver Not too much reliance should 7. T h e response observed from the left upper quadrant could have come from the median portion of the liver, as t h e counter could not be placed completely to the left or rcght of the mid-line. An alternative possibility would be a contribution from plutonium deposited in the lower ribs but this would apply equally to t h e counts observed from the liver region, and allowance for t h i s would make our estimate of the liver content surprisingly low.

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TO: CHR Records Room - 3- March 5 , 1973 8. Time and especially the mechanical arrangements in the shield did not permit more extensive investigations of possible X-ray emissions from bone, but it seems clear that even at this level of activity it i s doubtful if the plutonium can be detected. substantiates a statement made by one of us a t the U.N. Geneva Conference in 1958 (Proceedings, vol. 23, page 111).

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SUBJECT: Phone call from P. Durbin on 12-20-72 . I've rewritten my notes of t h e above date when Dr. Durbin talked to m e after being unable to reach you. A summary of the conversation about some patients exposed to radioactive materials is given below Death certificates on 1 2 "HP" cases (11 a t Rochester, € at Dr. Durbin has 5 DC's; 3 persons a r e living in Rochester; 2 persons died at h o m e , probably in Albany County. is presently unknown, w a s in Monroe County Home, but no record of his death i n Monroe County to 1957. I person is HP12, to be traced. Clinical tests at Rochester. 1. Dr. Christine Waterhouse sees one man (HP6) and one woman (HP3) regularly i n her clinic. The other woman (HP8)is in her 7 0 ' s and lives crosstown: it may be difficult to g e t her in for a metabolik study. The other .2 persons probably c a n be brought in anytime; if not, a n outpatient study might be tried. / Note: HP6 has Addison's and h a s already lived 46 - 0 p 15 years beyond expectancy. HP8 has schleraderma and has already lived 20 years beyond expectancy. HP3 is in normal health. 2. The ward cost will be only $90 per day per person, because of USPHS support for the ward. This includes routine hematology, creatinine clearance and liver function.

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11. 3 . Dr. Waterhouse wants u s t o provide the following: a. A list of what we want done: b. Containers and shipping instructions for excreta. c. A billing account number with t h e Strong Memorial 4. Possible medical procedures: a. Iliac crest biopsy for material for autoradiographs. b. Blood chromosomes, Dr. Waterhouse m a y want to do this study. only a partial survey. 25 m l blood for studywill contact Utah; w e may need a t Utah and ANL. be able to help us as a day to day contact person at , b. W e should contact'Bill Moss at LASL t o let him know we may be sending samples for analysis soon.

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I had follow - u p coltipleted ofi cases Cal - 111 arid 111'-6. Case Cal - 111 died i n 1934 of causes, not rcasoriahly rel dtd ble to pluto ni urn. Case HP-6 is liv i rig a5of several days d go.I lot ti the ic it cr viewer > who contacted the household,and a review ofthe case tile, suggest that the functioning of this subject is such that direct coliI:act: i s coriI_r'dindicatcd. I hope this is of SOIII ~ best personal w i sties.

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ARCONNE NATIONAL LABORATORY Mailstop E-201, Human Ha al th Studies Office of Health and Environmental Research Office of the Environment U.S. Department of Energy SUBJECT: Congressional Investigation into Heal-th and Safety Policies of the In response to Dr. C. W. Ed in gt on ’ s memorandum of June 27, 1984, on the above subject,I have enclosed a fact sheet on “Plutonium Studies at the Center The fact sheet is in the format requested by Please let me know i f you need more information or documentation.

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Pluto niu,,Studies at the Center for Date Tern in a ted : Ongoing Obi ect ives of Test : 1. To determine the excretion rate of plutonium 27years after injection. 2 . To determine the retention and body distribution of plutoniur?. I n 1945-1947, 18hospital patients of lin it ed life eq ec tar.cy were injected with plutonium in order to obtain information about the retention and organ distribution of plutonium. An important objective was to determine the relationship between the body content and the rate of excretion in order to provide data for estimating the body content of plutonium from re a sure ment s of The results of this study were described in The data in LA-1 151 were reviewed in a manuscript prepared by P. W Durbin for publication in the 1972 volume, Radio biology of Plutonium. Tissue and bone samples had been obtained at autopsy from six of the cases a t times ranging from 5days to 456 days after injection, and the longest collection tine for excreta was about5years.In addition to preparing the manuscript, ' Durbin traced the later history of the cases and disco v z red that four were still living in 1972. The Center ' s direct knowledge of the plutonium injection cases dates from December 13, 1972, when Dr. Durbin brought her records to CHX for possible further follow-up. The Center then undertook to determine excretion rates i n study subjects who were still alive and t o exhume deceased subjects in order to determine the amounts and body distribution of plutonium. During 1973, CHR obtained metabolism samples from three living patients,obtained permission to exhume from next of kin of three deceased patients, and disinterred and transferred to CHR the remains of one of these deceased. The metabolism samples (blood and excreta) were taken at Strong Memorial Hospital(SMH), In 1974, the U.S. Atomic Energy Commission (AEC) reviewed the origins and subsequent follow - u p of the plutonium studies. On December 31, 1974, the AEC authorized CHR to proceed with the program of study of the living patients who …