Statement by Eugene P Cronkite, Subject: Somatic Effects (Marshallese)

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the IMtd States, for 3 June 1957at Fallout ad Its Effeats on Menu. e Joint Ctittee on Atomic En g, (%n~esa of the open hearings on ‘The &t e of Radioactive

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X have been naked to aunansrizethe early wn to external radiotfon with particular reference to the ef?ec radiation on the Mershalleae, the Los Alamon accident ami radium. j have been askd to comment on the beta burns in the Harshallese and of beta burns. Since mynersonal experience is limited to the tid imal experimentation I shall limit ~self to these arxlsupply refer~ for the others. It is quite impossible to cover all of tMs material in a roast of time so I sliallconcentrate upon the effects of exposure to ~el on animals and man vith a clinical description of the sytirome of r~ nesa ns n function of dose My prepared statonent of racl~ationand highlight the discussion in the study of the ?farshallese(1), inclules numerous references and further that time will not permit discussion of at length here. Radiation sydromes vary 89 a function of the type of exposure, the time @fter exposure to radiation. In general radiation injurlw into three ~e5eral classes: ionizing rndiation vhlch are dose and time depetient. b) Superficial rndiation burns producsd by soft radiations (1 ener~ x or gamna radiations). 0] Radiation Injury producai by the deposition of radionuclti he dose and an be dltiad In the latter casa the clinical picture varies with the site ami amoun ?&h of the atmte is assoc~atsxiwith an early phsse in vhich acut ad signs may be observd, and a late phase in which chronic changee o tions GUCh as cancer may be obserwd. 1 wish b emphasize also that t e degree

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of injury ati the cllnlcal manifestationsare proportionate h thf is partlcular4 tme of the spiromes ofvhale body radiation. Tl I repeat, highly dependent on dose and the after e~osure. fierc dOBCriptiOII. The probl= is subtle end complex ad one must alvay the in mind. THE SYNDROHR!3F’RCMTOTAL IDDY PENETRATING RADIATIONS The dose depcmdant syrxlromeeresulting from total My expost mammal ham been described in detail and I shall only mmmarize tk further details one is referred to the follouing references ( 1 - large doses (apprcndmtely &XIO r or more) the central nervous 9y~ wi”.lchcm be sbbreviatd CM is T;rOdUCed. Denth nay occur urder t h~>crcxcitubjlityj dinorders of equilibrium, lncoordination, respi this syndrome are always uniformly fatal. If an occasional finimal man, survives this CNS he has yet to experimce the gsstrointestin which uhen producad by doses in excees of 1500 r is always fatal u atter is ezxi ear dose ad le of producing in three to nine days for mammals. Presumablyman also vill respond in a compar ble manner us laboratory admels. The GIS is so namxl because of the marked nauac , vomiting, diarrhea, and denudation of the lining of the smell bowel. The GIS a urdf~mly vivors of this which has been in most laboratory mimsls. If the short duration GI of a few hours lower dosen, does not produce the three to &e day d th, the ssyrdrornehave yet to experience the eequelae of bne rrm depression temcd the lmmopoietic e@rorne (I!S). me HS is not n cessarily fatal. It is the clinical picture that is seen in the lethal range for all general the 50% lethal dose values reported, rapresent the LD50 for t e squela of tioE, thrombopenia, afi anczaiavith the possible resultlng infections cliff-e p-

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ad typoxl.adue to anaias any one of uhich may be fatal. Ma detailed description of the pethogezreeisof these phenomena have been publish The 13hovepicture of radi~tion s~romes is based on antial e closely to thg general mammlian response outlined slxmd with the e some differences in time of occurrence. The the Jrrpanoseat.Hiroshixuiad Nagasaki. one would nat expuct it ta bmbing of !iI_roshimaand Ragcsaki, deaths from radiation injuries \ the acute pha9e are uncommon after the ?Oth day. Predictions of the effects of various dQses of game radietior to military and civil defense rh~ing. ~ the absolute Sensititil mdiation were knovn, and if it were practical to determine tho do: tier catastrophe cowiitions, a realistic at8tistical prognosis col However, these prediction cannot be made accurately at tho presenl involvai vith est~tion of dose recelvtxl by the individual, presez diffiaultiea. It is probable that do~e estfmates uill be availabl{ devices or fkon dose contour lines am? the position of ixxilviduale I%e difficulties of relying hemdly on the dose esttitee for a @I are apparent. TIM exact position of the individual ad the depw le case of man,

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uill mt be knofi precisely, ‘h3 dosimetrydeviae, recofis the das B or dooe rate, uhich may not refleat accurately, because of’shielding and eneqg d 9pexrlmoe of the detice, the deposition of radiant e~ergy at the site of interest, nunelythe bone mamwv ard the lining of the intestinal tract. The problam associated vlth predicting medical effects from pl~8icaYestim8tfon of dose can be further illustrated as follw6: it is apparent that cioae estjmntea ovailable will be air doses. The do6e received by the aiz is of academic Interest only, 8ince the degree of effect in living things ie due tO the deposition the depth dose ~ottern or Tore precisely the pattern of absorbti 306 in sensitive critical tisslles. This yroblan has been cxplcrd experimentally at and is described in datcil ~n references (17). Moro nod not be sai all directions is yore effectivo per r in air thnn dose of radi~it.ion quality. Xn urban :~reRstheremay he shieldingfrom the fallout flel or inhomogeneities in the field due to drift in dry ulndy area8. w t radfation sh$eldin~ rcayhe s’!gn.fflcantand the proximity of large buil iously influence scatter ad perturb the unlfomity of the radiation. fallout fieldn~y be made unidirectional by keavyzhielding frcm buil dde. Thus esttintes of clo9ecalculatrxlfrom dose roto$ or derived f grating type of dosimctcr that adds up to the total dose receivczi,oz of an itiitidual durinc exposure, cannot be accepted as the best indc ings may sex ~ble fate of this ~nilividual,or as the find guide to trestient. ‘1%~ physician i8 interested in the individual from the standpointof aorttig casualtie 9 with SOma chance of stival ard those for whom nothing can be done, and of aqua i importance the troop eonmuuder is interested in the owr all prognosis of large ~oups of individuals in order to mnke plans for disposition ad repbcesnent. ~eee two different desires cannot be completely met by phy8ical estimates of doge. How= ever, nature has been helpful.. l’hemanifefttationsof radiat~on ln$ury m ry with

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Ithe amount of radiation received. In other vords, the g~toma of + groups of Lndltiduals becozea h a aenae a personal indicator of one perience with human radiation injury in MrosMnw ard l%&&ki (4,5, reactir accidents (3,6,9) ad the fallout accident (1,18) to be desc strongly suggest that the heat incex of the sefiouaness of expomre ual is the sy.zptcxnatolo~,in addition to the physical estimate of d Rmlintion injury is cmplex and subtle, mi the manifestations (here some, but not all, Jill die in the first :;overalveek9 folloui can be dividd eccor~ing to Uymptons a,tisigns, into groups hav~ng a pcctively, irngrubablezpossibls, and P~Obs-t?lcl.IL will he apparent severity and pcrsisionce of vomiting a~d d.tarrhc~. If vonitlng occurs promptly or within a few lxmrs ani conttiuea follouai in rapid wcce~sion bf prostration, dlarrhsa, anorexia and prognosis is .mava: death will olmost definitely occur in lW$ of t uitMn the first ueek. There is no knovn tllorapyfor these people; in a catastrophe attention should be dcwotcd pri]~cipallyto others f is some hope or in vhorntherapy i~ clemly i~xiicatd. Vomiting may occur early but uill be of relatively short duratio by a period of vdl being. In this period of voll being marked chang place h the hemopoietic tissues. @pho@es arepmfoumily depress the degree and time of maximum depression deperxiingupon the dose. S fectionmey be seen vhen tho total neutrophil count has reached VMU Ixt thcra is

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(7 -9 days). The platelet ternal evidence of bleeding sentg the lethal dose range count my reach ve~ 10U levels after t may occur vithin tvo to fo= weeks. Th in the classical phanaacologic 8en8e. the symptom free period [the latent period) lasts from one to three little cltnical evidamce of injuries other than slight fatigue. At of the latent period, the patient my develop purpurR,* epilation o lesions, infections of UOUAS or burns, dinrr):eaor molena~e. me significant, with therapy the sumlval tine can be expected to be is provided for kone fiarrouregeneration the surviy picture is not as uell documontd as in .Tc,vp3 [Surtival probable) ~corlcl~.l:~cnlreasor:] to !:elievet53t in the letkal rsnge the granv in Japan c~l~~n this contention. T!oveverin tho sublethal range i longer for the grandocfio and plstelet count of ISanto reach miniu compared to other mammals. Despite the chaotic conditions that efi the data of Xikuchi ati ‘Jalclsaka(11) shows that there was a more r decrease in groups 1 (Survival improbable) ati group 2 (Su_mival pa ~grc~up3 (Survival probable). Before going on to group 3 rcfr:]infrom a comment on therapy. Much has been learned from the experimontnl thernpy anlmils. It has been conclusively s}:ovnthet protection transplantation of bne marrow from one 3train of animal aff’ord~ by transplantation of genetically specific material, that member of the same strain to an irradiatedmember of tie same strai ard.long Iaatingo If the material for transplantation has its source in another 9trdn ‘ofmouse$ the protection is less markmd and not ‘aslong lastin . If the * Bleeding into skin

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If the protective material comes from another species of animal the very short lived aqd not nearly as effeatiye. In principal the tra~ lxme rnarrouvould significantly increase the sumival rate of expos( in the group 2 (Sumival possible) the mongrel nature of man takes it ati possibly to a lesser extent ! The amounts of bone marrov needcx unlikely that veay much could be the vey of long texm protective effect. Inmy opinion it would be { of ui3hful thlnldng to expect that one could l.avean effective tmno In the C?18eof an atomic catastrophe. Hu&.vork is yat to be done ur this procaiure in man tier highly controlledcorxiitions,for an irx let alone urxierconditions of a nuclenr catastrophe. Eouewr, the tre~tment of ~gowp 2 cacueltiosis riotat all liopI is ample clinical experience in corxiitionsu!:ere the bone IMXTOU Is pressed and in vhich there are Inadeqwto nunhers of circulating ce; rel:~tivelycommon clinical conditions produced by seneitlvity to drt nnturally as dlsea6e processes, the combined u~e of the wide spectn that are now available, and the judicious use of blood transfieions increases the sumival time of the inditidusls,thus giving nature I of the to repair spontaneously the damages thut has been wfferd. could feel optlndstic in respect to increasing significantly the w the group 2 (%rvival possible) casualties by uide spread controll~ biotics.* Preparation arxistockpiling for such an mergency is OW This group consists of irxiividualsuho may or may not have had * Blood transfusions vould be helpful to a limited extent for anes of availability of enough blood for-burns and other injuries ia bled rs!aybe neuied for radiation injuxy supply mey be exhauotme large ad

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ati vomiting on tha day of exposure. In this group there is no h of effects of the exposure except the hanataloglc (blood) changes t tected IV serlel studies of the blocd with pmtlcular reference to arriplatelets. ‘b lymphocytes reach 10V Lwels early, within @ h stow little evidence of recovexy for many months after exposure. 7 may shou some depression during the secord ad thifi week. Hovemu ?th week, may occur and should be watched for. Platelet counts re~ on approxixmtely the 30th day at the ttie uhen maxhnzm bleeding va: let count emi the development of.hemorrhage is in marked contrast 1 In this group inidviduals vith neutrophil counts below 1000 p~ may be axaplote by asymptomatic. Lfkevise, patients with platelet per cubic mm. or leas nay Ghou no external signs of ble~ing. It is well known that all defenses against infection are 10V= lethal doses of radiation, arrithus, patients uith nevere hamtolo{ should be kept tier close observation nnd administered appropriate dicated. ~cre is reasor:ablygood antial experimentationto Wilcl exposed colonies of ntimals are l~oresusc~tible to endemic and ep. fie numbers of individual in grcup 3 (Sumival probable) wIIJ in group 2 (SurvfvalPossible) and the zwnber in group 2 will be K graup Z (%rwlval improbable). Croup I casualtieswill be helples Croup 2 casualties vill be able to help in their own cars to a lb Group 3 casualties will be useful ati a moderate amount of work VI No therapy other than observation fs neded for thi8 grOUP. me rest cd’my eoments will be focued cm the fallout acclde hat seen in even by sub er than in not be hamful.

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deposited radioactive mattials on inhabited atolls and on ship of J fluhichwaa inducting the tests. kdiation 8u=WS of theueas r radiation levels; therefore ewcution was orderd, and uas camid o possible vith the facilities available. Althouth the estimatd acct to human beings were believed to be below dangerous Iewls that votd injury or mortality the Gxnmandwr of the Task Force requed~ aasist Department of Defense ad the United States Atomic Energy bmnieaior ues requestd vhich would be organized to provide the best possible posd ~srsons and to make a medical study of the exposures. me rtx organization of tho rnalioalteam vas shared betveen the &med Force: portment had experienced personnel available at the Naval !kdical ~~ Department of the Uavy WS3 requestcrlto provide assistance. He directed the organizationof a team from the two stove mention= the privilege to be the director of this teem. Mthin a period ment vas assembled nnd packed ad the team was airltited to the Mar arriving on the 8th day after the explosion. The interim care and posti individuals had been ably taken care of by the limited medics &atea Nnval Ststion, Kuajalein. I cu pless~ to call atten very high deb~oe of cooperet~on betveen all government agent: numerous individuals who selflessly gave of their the ad e: large and due credit and acknowl@ments are given in the of. the incidenco published by the United States %vernment Rinting Of NATURE OF THEEV~ AND DESCRTPTION CFTHE ~0$~ GROUPS The radioactive material fell on the Imhabited atolls of ~nge int Task Force t as quickly as nce of the :ara of the ex facilities of the Ion to the fact es concerned ad Lcial report of ice ami listed ap, the hentiest

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doBe; on Ailinginae; on %ngerik where American scrvicaen were et !ltirtkvhere the smdleat dose uae received but by the largest mab The l+arshaKle8ewere living under relativelyptlmltive comiitions i more aware of the significance of the fallout then were the put on additional clothing to protect their skin. As far as duties tkcy rained inside of aluminum buildings. Ih contrast to this th In geaernl remained out~idc arrlaccordingly ve.remoro heavily cortta material falling upon the atoll ad upon them. All of the exposed human being~ vere evncuatcd by air …