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t...eUmitcd st5te9, for 3 June 1957 at the open hecrixs on ‘TrieIkture of FMiosctive BEST COPY AVAILABLE
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Mr. Chahnan, Congressmen and Observers: I have been askad to surmarize the early effects of exposure of animals rodiation on the )%rshallese, the Los Almos accident and radium. In addition I have been asked to com.nenton the beta burns in the Marshallese and other examples of beta burns. Since my personal experience is l~ted to the Marshallese and animal experimentation I shall limit myself to these ad supply reference material It is quite tipossible to cover all of this ~aterial in a of time so I shall concentrate upon the effects of exposure to on animals aml man vith a clinical description of t},es~yndrome ness as a function of dose of radiation and Mghlip>t the discussion with illustratfve material collected in the study of thel%rshellese (l). My prepared state~ent includes numerous references and further material that time will not permit discussion of at length here. Radiation s@romes vary as a function of the type of exposure, the dose and the time after ex~osure to rad~ation. In general rediation injuries can be dividd The syndromes of whole body radiation injury produced by penetrating ionizing rod:ation which are dose ard ttie deperdent. Stiierficfalradiation burns producd by soft radiations (beta and low Radiation injury produced by the deposition of redionuclides within In the latter case the clinical picture varies uith the site ad amount of deposition.
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of injuxy and the clinlcal manifestations are uroportlonate to the dose. ThlB\ is particularly true of the syrdroinesof w!.oleImdy radiation. The latter is and I repeat, highly dependent on dose and time after exposure. There Is no simple description. The problem is subtle and complex ad one must always bear dose ad time in mind. The dose dependent syrdromes resulting from total tody e~osure in the ‘A:mml have ‘oeendescribed in detail and I shall only amnarize them here. For further details one is referred to the following references ( 1 - 12 ). titer large doses (approxixetely 6000 r or more) the central nervous system syrxirone vl.ichcan be ab-creviatd CM is produced. Death may occur umler the team uhile being irradiated or after some ?.curs. ‘he clinical picture is characterized by hj~erexcitabilit.y,disorders of equilibrium, incoordination, respiratory distress Convulsions may preceed death. Doses Capabl”eof producingand intermittent stupor. this syndrome are alsays uniformly fatal. If an occasional enimal, and presumably nan, survives this CNS nine days for mammals. he has yet to experience the gastrointestinal syrdrone (GIS), doses in excess of 1500 r is always fatal within three to Presumably man also will respond in a comparable nar~er as la?mratory animals. The GIS is so named because of the marked nausea, voniting, diarrhea, ad denudation of the lining of the .-11 bevel. The GIS is a unifamly ffitalsydrme in most laboratoq afiimals. If the s!lortduration GIS of’a few hours resulting from lcwer doses, does not produce the tkee to nine day death, the surtivors of this sy-drome have yet to experience the sequelae of bone marrow depression which has beer,term~ the hemopoietic smrome (Es). TineHS is not necessarily fatal. It is the clinical ~icture that is seen in the lethal range for all mmnals a.zuiin general the 50% lethal dose values r~ort~, represent the LD5° for the sequels of henopoietic depression - naxely granulocytopenia, depressed defenses ageinst infection, -t}iombopenia, ard an=ia vith the pcssible resulting infections, diffuse pm
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purpa, Ed hypcxis due to enemla, my one of which nay be fatal. ~~w d@t3fl~ - descriptions of the p9~hO&~IIeS1Sof tk.esep}i@J30~e~have been published (1-4,12-16). The ative picture of radiation syndromes is based on animal exper~entation; however, hman experience particularly as observed at Hiroshha and Nagasaki and in the l’mrshallese~tives has indicated that man prok~bly con-espofis quite closely to the Eeneral rr~rn.alianresponse outlined above with the exception of the Jnpanese at Hiroshima and Hagesaki. One vculd not expect it to have been observd since doses to produce this syndrome were well vithln the area of aLmost total destruction. The GIS with deaths in the first week are well documented clinically and patholo#cally as are desths from the HS. ?kuever in the case of man, de~ths from infection were most prevalent in the second to fourth weeks (maximum incidence durin~ the third week) end from hemorrha=ticphenomena in the third to the sixth weeks (maximum incidence in the fourth veek). In the Japanese, after the knbing of Hiroshima and ?;sgasaki,deaths from radiation injuries were occurring as lete as the seventh week. ‘his j.sin contrast to other animals where deaths from the acute pkse are ~nco.rnonafter the 30th day. Predictions of the effects of various doses of gama radietion are essential to nilitax-yand civil defense planning. If the absolute sensitivity of man to rediation were known, and M it were practical to detem.ine the dose to grO~S unier catastrophe cc.tiitions,a realistic BtatistScal prognosis could be made. these predictions carmot be nade accurately at the present time. Probl=s with estimtion of dose received by the individual, present red practic~ difficulties. It is probable that dose estimates vill be available froa dosimetry devices ar-fro= dose contour lines and the position of individuals during exposure. The dif~icdties Of relying iieatilyon the dose est~mtes for a single iniitidual ere a?pment. -The exact position of the Irdividlxiland the degree cf skielding
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b will not be lmown precisely. TF,edozinetry device, records the dose or dose rzte, uhich may not reflect accurately, because of shielding ad energ dwe.*ence of the device, the deposition of radiant energy at tho site of interest, namdy the bone ,narrovad the lining of the intestinal tract~ The problems associatd with prdictingmdical effects from physical est~ Stion of dose can be further illustrated as follovs: it is apparent that dose estjr,ctesnvailabl.ewill be air doses. ‘he dose received by the air is of academic ~nterest only, since the de~ee of effect in living things is due to the deposition of energy and Its distrthut!on in the cr~tical tissues. Acc~rdingly one must know the depth dose psttern or r.oreprec~sely the pattern of absorbd dose in sensitive crit~cal ti~sues. This problen has been explord experimentally at great length and Ss d=scribed fn deteil in references (17). More need not be said k.ereother tkan the f~ct tk.atthe uniforn field of radiation cor~ng at an individual from all directions is rere effective per r in &ir than dose of rmlifitionof directional. qu~lity. In urban areas there may ke sk.ieldingfrom the fallout field by buildtigs or inhomogeneities in the field due to drift in dry windy areas. With the prompt red~ation shieldl??gmay be significantarxlthe proyfiity of large buildings may siously influence scatter and pe~.u.rbthe uniformity of the radiation. last= a fallout field may be made unidirectional by heavy shielding from buildings on one side. ‘fhusestlnmtes of dose calculated from dose rates or derivsd from an integratjn~ t~e of dosimeter that adds up to the total dose receiv~~ or fo~ Position of an ird!vtdusl durin~ exposure, cannot be accepted as the best irdex of the probable fate of this individual, or as the final .guldeto treatient, me physician is interestcxiin the individual from the standpoint of sorting casualties with some chance of surv5val and those for whom nothing can be done, and of equsl iqortance the troop-cor,arrlerIs interested in the over all.prognosis of large grcups of individuals in oriierto r,akeplans for disposition end replac=ent. These two different desires cannot be Completely net by physical esthetes of dose. Ho* ever, nature }.asbeen helpful.. The manifest,sticnsof redistion injury vary with
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4 t},e anclmt of r.ldiationreceived. In other ucrds, the sjaptons of the irdivlduel or grQups of Mivi.d’mls becones in a sense a personal indicator of ones’ oun fate. & perience with humn radiation injury in E!irosM_maani ‘iagasakl(L,5,1O,11) with strongly suggest that the best incex of the ~eriousness of exposure of the individRadiation injairyis complex and subtle, and the nanifestntions of the injlury vary considerably. IrIa germral sense, individuals e~osed in the lethal ra~e, (kere some, but not all, will die in the first several weeks following expcsure) cen he divided according to sjmptoms and signs, into grows having a diff=ent no ~haW line of’de~rcetion axong the ~O-~S. The distinguishing features are severitv and pwsiste~ce of voxitlng arxldiarrheao. If voj:itingoccurs proxptly or witldn a fm’ ~-oursand contfiues ad is followai in rayid succession bJ prostration, dkzzrhea, anorexia md fever the within the first week. Tnere is .nokncvn ti~erapyfor these pwple; accofifi.glY irls cetastropke attention s3:ouldhe ticvotd principally to others for whom there is some lope or in b?.oratl-Aerapyis clearl}”il>fiicat~. Vomiting nay OCC-U early but will be of relatively s~.ortd’~ation fo~~ow~ }ou-rsand-rev~irlso for montks. ‘f’tieneu’~opliflcount is depressed to low
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~(7 -9 days). The plfiteletccunt ~Lay reach very IOU levels after two weeks. &- ternal evidence of bleeding may occur within two to four weeks. ‘fhisnOUP represents the lethal dose range in the classlcal phamncolobgc sense. h this grOllp the symptom free period ‘(theletent period) lasts from one to three weeks with little clinical evidence of injuries other than slight fatigue. At the teminatlon of the latent perhd, the patient zay develop puqmra, * epil~,tionoral and cutaneous leslons, infections of wourds or burns,”dinrrl:eaor melem**. ‘he mortality will be sufficient time is provided for bone marrov rege?lerationthe survival rate will be In g-roup1 (Stival impossible) and grcup 2 (Sti.val possible) the blood picture is not as well documented as in group 3 (Swvival probable). There are good clinical reasons to believe that in the lethal range the granulocfle depressions j during the second week.will be mrked and below 1,000 per mm Cbservat”ons made in Japan conf~ th~g contention. However in the sublethal range it takes nuch longer for the granulocyte and platelet ccunt of ran to reach ninimal values, as the data of ?)e$nitethe chaotic conditions that efisted in Hiroshimaother ruumals. - Klkuchi arriVakisaka (11) shows that there was a core rapid ad r.arked groups 1 (Survival improbable) ad group 2 (Survival possible) tk.anin group 3 (Stival probable). Before going on to group 3 survival probable, I cannot ref~sin from a cement on therapy. l+~chhas been learned from the experimental t!:erapyof radiation injury in enimals. It has been coficluslvelyS?,OWRth~t protection can be afforded by the tran~lar.tation of bone marrow from one strain of animal to another. The protection afforded by transplantation of genetically specific ,=terial, that is from one ad long lastlng. If tk,~material for transpleritationhes its-source in enother strain of nouse, the protection ‘isless marked and not “as ‘: Black stools from digested klood long lasting. If the
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l If tl-,eprotective raterial comes fron another species of animal the protection is very short lived and not nearly as effective. In ?rincipd the transplantation of bone marrow would significantly Increase the survival rate of exposd human befngs in the group 2 (Smvival possible) ad possibly to a less= extent in the group 1 (Survival tiprobable) casualties. The amounts of bone marrov needed are large and the mongrel nature of man takes it unlikely that very much could be expectd in the way of long term protective effect. In my opinion it would be the worst type of wishful.thinking to expect that one could l.avean effective bone narrow bank in the case of an atoruiccatastrophe. Mu&.vork is yet to be done under carefully controlled clinical conditions before one ceuld be opthistic about tLe use of this procedure in man under highly controlled coalitions, for an individual patient let alone under conditions of a nuclear catastrophe. However, the treatment of group 2 casualties is not at all ?:opeless There is ample clinical experience in corditfons ub.erethe lxme mmrow pressed and in which there are inadequate numbers of circulattig relatively comnon clinlcal conditions produced by sensitivity to is severely de cells. In these drugs, or occurring naturally as disease processes, the combined use of the wide spectrum antibiotics that are now available, and the judicious use of blood transfusions significantly increases the sumiva.1 time of the individuals, thus giving nature a longer period of the to repair spontaneously the damages that kas been suffered. Accordingly one could feel optimistic in respect to increasfig sfgrdficantly the survival rate of tl;egroup 2 (%rvival possible) casualties by vide spreed controlled use of antlb20tics.* Preparation and stockpiling for such an =ergency is obviously reqtir~. This group cofisistsof individuals who =ay or my not IJaveked fleeting naus@a * Blood transfusions would be helpful to a lidted exttcntfor anemia. ne pro~FilitY of availability of enough blood for burns and ot~qerinjuries is low. Eence vkm blood may be needed for radiation injuqy supply ~~y be eti-austed.
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‘* am3 “votit!ngon the day of exposure, In this gToup there is no further evidence of effects of the exposure except the hematolo~ic (blood) changes that can be dtected by 6erial studies of the blood with particular reference to lymphocytes and plctelets. The lymphocytes reach low levels early, withfi @ homs, ad maY S!.OWlittle evidence of recovery for many months after exposure. The granulocytes may s-howsone depression during the secorrdand third week. However, considerable variation iS encountered. ‘%e late fall in the granulocytes, during the 6tb or ?th week, may occur and should be watched for. Platelet counts reach lowest levels on approdmtely the 30th day at tbe time when zax?m.unbleeding was observed in let count ad the development of haorrkage is in rnerkedcontrast to that seen in laboratory animals where pletelets reach their lowest levels between the 10th ard In this group inidviduds with neutrophil counts below 1030 per cubic mm. may be @replete by asymptonatic. L4kewise, patients with platelet counts of 75,000 per cubic mm. or less may show It is veil knoun that all lethal doses of’radiation, ad no external signs of blecxling. defenses ageinst infection are Iowerad, even by sub thus, patients with ~evere hematologic depression should be kept under close observat~on and administer~ approprtite therapy as indicated. There is rmsor~ably good animal experimentation to indicate t~,atsublethally e~;osed colonies of animals are ::oresusceptible to endemic and epidmic infection. The numbers of individuals in grcup 3 (Survival probable) will be greater than Group 2 casualties will be able to help in their own cere to a llmited extent. &cup 3 ca-sualtfeswill be useful arria mderate mount of work will rot be ham-ful. !l’berest-of my con.ents will be focused on the fallcut
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\ on March 1, 1954. Followinc detonation, unexpected changes in the wind structure deposited radioactive ~aterfals on inhabited atolls and cn ship of Joint Task Force #7uMch was corducti.ngthe tests. Radi~tlon surveys of the areas revealed injurious radiatfon I.evels;therefore evacution was ordered, and was carricxiout as quickly as possible with the facilities available. Althouth the estimatd accumulated doses to human beings were believed to be below dangerous levels that would produce lasting injury or mortallty the Gxnnander of the Task Force requested assistance of the iYepzrtrnentof Defense and the United States Atomic ~ergy Cornnission. A neilicslteam was requested which would be organized to provide the best possible care of the exposed persons and to make a r.edicalstudy of the exposures. me responsibility for organization of tbe m~ica~ te~ was shard betveen the J+med Forces Special weapons Commission. Since e-peedwis essential and since the United …
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