Study of Response of Human Beings Accidentally Exposed to Significant Fallout Radiation

Home , Helen Redman, The Exposed (novel)

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Jk!-t 1+. “’?mlts,w OPERAIION CASTLE - ~lNAL REPORT PRO Jt(’1 4 1“ ~

* Study of Response of Human Beings Accidentally Exposed to Significant Fallout Radiation

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E. P. Cronkite, Commander, MC, USN .. . V. P. Bond, M. D., Ph.D. L. F,. Browning, Lt. Col., MC, USA W. H. Chapman, Lt., MSC, USN .- . . S. H. Cohn, Ph.D. ft. A. Conard, Commander, MC, USN .+$$$ ,#Je C. L. Dunham, M.D. . 1?. S. Farr, Lt., MC, USN W. S. Hall, Conlm:mder, MC, USN ,,,:$gl~$ti it. Sharp, Lt. (jg), USN N. R. Shulman, L~., MC, USN <~“:’’~,~ \ ~.;L ,).’ , !,3$ ,@ ,\ +“’.:: ! ()t,ltb(, r 1954 ;. g . .. ‘. ,,

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ABSTRACT .

F(Jll(JwIIIg tli(, cf(, donation” of Shot 1 I)n Ilikini Atoll (m 1 Mar(mh 1!)54, 28 Ali)(,]-i(-;ttt*”i\l]ct 239 M~rsllill 1(,s(, W(Sr(J(,x]J(~s(,d to fill lout. One hull(irtd fifty -SCW(,II(I[ th(} Mitrsll:Ill(,s(~ wi~r{ 011 U(Irik /ltoli, M WI,I.(, III) 1{1111~{,l;Il) Aloll, ;Lll(i 18 w(.rt~ (III th(, 1]~.i~hl)orll]g :11011of .Alllll~litilt~. TII(J 2X An)(,rl(:ll]~ w(,I( I)n l{(,!l~!(,rlk Atoll. TII(s l)rI.s(*I\r(I of SIKIIIII(.;IIII fiillo~lt 011tli(~st, i~l(]ll~ was flrsi lll.l(r II IIIII.11 I)v :1 r{>(.{)1.{lltig(h)sil])(4(,r, 1()(’;l[td 011 lton~t, rik, Wh(~[l thls (t(Wl(. () W(.[lt (Iff ti(’alt> ;lt 10[) 1111.III. SIIIII.IIV ;Ift(, I. [II(, (I(,l(]natt(m. Kltl(’rg(mcy surv(>ys (1(.l(x’t(xi rtidlii(loll 011 th(s Inhabitt,d :II!)II,s, ;III(i ISV:I(. II:It 1(III of tl)ll,ii)ll; tnt.% 10 th(~ Nav:Il Stat lolk at KW>lJal(.111W;IS I)rollll)iiy (.;trriect out. ‘1’1)((J(I+(Lof r:l(il:it 1(111to wl)i(. h III() indiviciu; lls werl~ cxpotitxi was (;il(.ulittl,(i frolil the intensities III(II)(i(III t II!,’ IS l;III[is ;III(I It)(, d(,(.;Iy (,XpOIICIIiof the fall(tut nl;lt[. rual. The i]l(i]vlduals On Rongclap Ir(x.(IvtL(l ti~]i)t.(jxll]i;~t(,ly 175 r, thosc~ on Aillnginae received approxinlatcly 69 r, and the Amt, ri - Ians oI~ i{oll~{,rlk rl,(,t,iv(~d ;m average calculated dose of 78 r. The Marsh allese on Utirik re - (.(,]v(!d approxin,; itei y 14 r. The fallout on Rongelap, Ailinginae, and to a lesser extent on Ronge - rik was (distinctly visible, No fallout was observed on Utirik. A significant number of individuals (m Rongeiap suffered from mild nausea and one or two individuals vomited on the day of the exposur(~. with the exception of nausea in one Ailinginae individual, there were no other definite gastrointestinal synlptonls in the other Marshallese or the Americans. The Mar- shallese cm Rongclap and Ailing inae, and the Americans experienced to a varying degree burning of th(~ eyes and itrhing of the skin from 1 to 3 days. Later, signs of radiation injury included definite (,pilatioo 10 th(, Rongelap and Ailinginae groups, and the development of spotty, super- I_i,:ial, hyperl)ign)ented skin lesions that desquamated from the center of the Iesi(ms outwards. rl) SIJM(, (;as(~s lh(, sk}n damage was sufficient to result in raw, weeping lesions. There was no full tl)ick[i(,ss necrosis of the skin. Thr Americans developed only nlinor skin lesions without ~llc(,rntit,rl. TII(, I-1, w(,r(, II() skin 1(.sions in II)(I Utirik natives. All l(,s IOIIS h(~al(,d riq]idly with III}flirll~(~r l)r(,;lk(iown of III(, skin not(:d during (II(! perio(i of obs(, rvat ion. Ml(. rosco[)i(. (>xanlI- 11;111011(Ir 111(ll)sl[, s {)r III(, l(~+ions si)I)wI,ci (hang(w usu;Illy ;~ss(x. i;lt(xl wlt h rmii;li IIm IIljury. Fu]ly [.1(1111(.(1II I(t Iv I(tu; Ils ;iIIIt Il)(),s[, r(,!ll;lin~ng lll~l(t(. of ~ulldll]gs or ]Iilt.s wt, r(. prott,(.t(.(i to Vilrylllg (llgr(,(Ls fr’11111(IOV(>lol)lll(,llt”or I(>HIOIIS. }l(~nlal(~l[~gic rh;uig(>s w(,r(~ d{,fll~ltt~ III tll(, ltoIlgelitp, AIi InKIIIat., mId III(LAnl(,ri(.ull gr(IL.lIs. LylI~pho})(vlia appear(xi prun~~d iy ;ui(i W;IS persistent for ;I IJr(Iio ItgLvi l)(,rlod of tin]c, . Neulropenia occurred in all of th~, Illdivi(iuais with ]Jlitial minimum V:IIU(SS(J(.(.urring tiroun[t th(, 1lth day followe(i by an increast, in the (.ounts ;Inct a secondary !nlnimun] arouuci th~~ 40th tu 45th day. The most consistent henmtologic cha]~(, was the de- I)ression in ~he plateiet (.ounts. Platelets were below normal when first counted on the 10th day of post-exposure and progressively decreased attaining a minimum between the 25th and 30th day. Although recovery commenced following this minimuru, the platelet counts had not returned to 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. Urinary excretion of radioisotopes was studied. Small amounts of radioactive material were found. Estimates of total body burden indicate that there is no long term hazard and that ingestion and inhalation of isotopes did not contribute significantly to the initial radiation exposure.

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FOREWORD

This r(,l)ort IS on{> of th(’ r(q)orls pr(,s(~nt ln~ th(, rtv+ults of tl)t) 34 ~)roj(v.ts part 1(.Ipul InK In 1111,Mlllt:irv f?ff(x}ts l~ro~ran) of Operatl(]li (’ASTI, k’. For rtlad(>rs (nt(’r(’sti’(1 III 0111(>1” pt>r- ! IIIrIII II,,SI i]]forn)atio t),” r(,f(,r(vl(,(~ IS n)adt} to W’f’-934, l{c I)ort of th(’ f’(Iu IIII:In(i(Lr, Tusk Llnit 13, Milil:lry Klf I,(’ts l)ri)~ran). TI)Is sun]n]:lry r(, ~)ort In(’lud(s 1111,foll(lwlng lnforl)l~tii)n of l)IIss Ihl(, ~em,rtii tn[rr(,sf. (a) An ov(!r-:ill cf(’srrll)tion of each dctonat]on, including yield, height of burst, ground zero lorat ion, lin)(, of (ic, tonat ion, ambient atmosl)her]c conditions at detonation t In)t’, \}tc., for the ol)crltion. (]J) f)l S($UhSloll of all I)r(l](i[!t reSUlts. (c) A suninlary of (~a(’h I)roj{,(l, Including objectives and rt~sults. fd) A (’(JIIII)I(sI(’Ilsling of all r(!ports cov(>rlng the Military Kffe(”ts T(%t I)rogram. I)(,tiill(,(l r(,l)oris 1)11(Ioslnt(,try and intrrnal radioa(:tlv(, (.olltiil~)il]~ltlol]” will bt, l)LIi)lIslled as sul)plt, mt,n(s 10 lltis r(,port. Illodiral t(>rrl)lnology in this r(, ~)ort is t~xpla]n(,d in ~)art>nth(’s(’s for the benefit

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PREFACE

olN>r;tl )OT1(. A,S’I’I,1,:(Ii({ II(JI !lwIII(I(, a l)I(lIIiI,{iIrLtl ~)rogra!!]. ‘1”1)(’)Iarl 1(.l})illlts 111 I’rojtwt 4. I WI,].{.(ir; lwll (1.0111 varlolls l;ll)O1.;ll {)1, 11,s ;11)(1 Wt.].1, totally Illl})rt$l)artd (or ;1 fl(~l(i })r(lgl-,11]1 Whl,ll . I III, jIj IIIl Ix)l) Al,:( ‘ MIv II(.:11 1{(, sI, JI. (.11 T(,iIIII WI:IS (jrg:llli~,t~(l ;Ill(>r 111(~ olI($ral 1011 11.111 kIt$gu Ii.

1)1”. .] Idl II~’. Ilugh(’r, l)ir{>(.l(]r, l) Iv IsI(m IJ[ Iliol(]gy aIKI M(.({I(IIIIL, ,AKC, ;ILI(i Lt Col 1,. E. llrownIIIg, M(; . USA, Surg(i(m of the Armtxt For(.t,s Slwclal Wt,;\puns l>r(~j(w.t, st,l(, cttxf the proj - ()(.( (lffl(,(~r and rc,quc.st(ld that the select ion of t(!chn ical and professional pc,rs(]nnel b<’ con)- nlt>n(.(,d lmm(xiiat(!ly. Rear Admiral Clarence Brown. Deputy Surgeon General, Medical De- IJar[nwnt, USN, g;ive immediate and complete support of all naval medical research activities and assigned responsibility to CAPT van Tipton, MC, USN, and CDR Harry Etter, MC, USN, of the Atomic Defense Division, Bureau of Medicine and Surgery, USN, for the implementation of the project. Since little detailed information was available about dose and initial symptomatology, the rese;~rch team was organized to include the following talents for the constitution of the emergency n)(,dical t(?am: internal medicine, hematology, radiation technology and radiobiology. In 111(1s(,ltx.li[)n of 1)(,rsoun(>l th(, cn;phasis was pl;iced on past (?xpericn(,e In biomedical research l!] III(s fi{.ld with aI(jIIII(< WCIa~NJIIS. In addition, provisions were nlad~~ for a s(,rond echelon of sl)(,(,i:ill~,(,(l lwr~(mn(~l in (.as(, they wert! nc!eded. Accordingly, a prev(mtivt, m(,di(ln(, unit of ltl{, (T{)r])llltirlll(,r 111-clljt.1, l~a(,lfi(. Fl~,c,t, W;lS al{.rted for possil)l~~ t);t(.tprioi{)gi(. stud I(>s; blood” I)allk l){,rsf)llll{,l, :IIICfa(kl IlIIIn:Il (linirians ad nurses wt, rc n(ltlfil,d in (.asl~ (.(mdlt i(ms just ifi~ld Ilt(,ll s(.rvi(.~,s [1] 11)(.Kw:{j;ll(,lll or(:a. R(};lr A(illliral ~arth(~i{)nl(.w t]ogall, MC, USN, I)il(.lf](, 1,’lt,t,t MtYII(.ai Oill(,(~r, 1111111(,(11:11(,ly IIIad(, iilly I)tw$dt,(t ni(,d](. al fu(. ilil lI,S of II](, Pa(. ifl( Fic(,l Jv;llial)l (,, I)(!r:.(]nn{,l w(, rt. Ihl:IIII(Xt within the Conlln(.ntal lin];ts {If ltIU u. S. fur tilt, rt,s(.ar(.11 team ‘is foiiows:” Navtil Mcdi(ai R(, s(arch Instltut(! (NMRI) 4 nl(wfic;il ,jffi((~rs (fl. P. Cronkite, imoject officer. R. A. Conard, N. R. ShulmaII, and R. S. F’arr) 2 medical service cori]s officers (W. H. Chapman and R. Sharp) 6 (’nli.steal men (C. R. Sipe, P. K. Schork, C. P. A. Strome, W. C. Cluttt!r, R. E. Hansen, ,J. S. Han) by) U. S. Nitvai i~~diol(}glcal Defense Laboratory (NRDL) 1 civilian M.D. (V. P. Bond) 1 medical service corps officer (L. J. Smith) 4 (:nlisted men (W. H. Gibbs, J. C. Hcndrie, W. S. Argonza, J. Flanagan) Div]:; inn of Biology and Medicine, AEC 2 civilian M.D.’s (C. L. Dunham and G. V. LeR~y) Armed Forc(,s Slx:cial Weapons Project (AFSWP) 1 Army M(,dicai Officer (L. E. Browning) pr(+]]minary studi(,:; ha(l 1)(:(:11made t)y CD}{ W. S. Hall, MC, USN, Station Mt)dic:d ~ffl(.~’r and hIS staff, and (I(!(. or]tali)l] ]iitio]l” I)f ttl(, tl](llvi(~ll:]l~ W;IS W(, II Llll(l{.rwi]v WII(III [lr[jJ(,(.t 4. I p(,rs(Jn-

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nel arrtved in th(, fl(~irt. Pr($linl]nary h(, ma[olo~lc stu(ii(~~ ind I(.iLt(.(1 tIIa I (11(1 IIIIt Iv I({u.i I+ 1111111,II~IV Ilad Il(}t r(,(,(~lv(>(i :1(.(11($1},fatal (It)st.s (JI radl:ltlon. Tl)(’ }Irlnl:lrv l“{’SI)t)IIS 11)1111It>:, WI III III tlIIJ llltl J (s14 ~roul) w(,r(~ (i(~lc~at(,(l ;{s f(~llows: (~ltlll(’;~l (J):.(,rviltl{tlls ;Ili[i (.:lr(~ I,T N. R. Sl)tilni;tn, MC, [ISN or~:lni7,:1tl,,lj aI)(l f,ll(~ralt(]ll tjf I:tljorattlry l,T l{. S. F;irr. Mc”, IISN (“(,ltll)llatl(ln ;11)(1 (hlly ;Illalvslh 01 :111data 1)1”. v. l’. 1)011(1 l),(tlnt:ll!llll;ll 1o11illl(l ra(llal 1(~11lti(~i]sllr(,ll)(,llt l,T (j~) l{. Shnrl). MS{”, {ISN

.“ ,S(,l)lor ]~(,tly of[l(. {*r Ill {.ll:lrg(, ()( I:llxjr;ltory l’. K. S(,h{)rk, II M(’, (ISN As ttl(, (11111(;11 111(.1(11(, lhWflil{llMhl~, ;I fllrlll(.r l]r(~;~k(l{}wllin r{~s}~{llwll)!lllv W:IS IIIU,<,.S.%:II,V. (’(~111 M;III(I(II. l{. A, (“[l!l:ll-(l, MC, LISN, :ItI(l I,t C(JI [,. 1.;. ]Ir,iwll}llk, MC. I)SA. W(~l.t III Jtl{. I“(, SIUIIISIIIII I(]r’ ;1 (I;llly hul, vt.y {)( Sktll It$slolls, illl(l I)r. S. II. (’(>1111w;l.s lllall~~ r(,sll(}ll.sll~lt, 1111’Sllltll’lllt: tilt’ l]r4d)l(*111s(.otl(.(.rll(.(1 w]lll 111(.(,X(.I.(.11{111ljf [.il(il{]is{)l(~ll(,s illl(l tll,, {,slllll;l!(. s (~1ll(~tlv 11111.(ll,llh Ill tll($ (.xl)os(d In(llvlllllals. ‘1’li(, prx)j(v. t ()[fl~.~1. (v)tIIIIII~II(is ;III ~)r III(Ll)rof(,sslt~lml :IIIIi ti, (.h III(;Il mI~IIIIII,rh (JI 1114,gr(IIIII for tlII.11. I,x(. (Lll(~Ilt Illollva[;(lil, Illltl;ltlv(.c ;Ill(t Volllllli Il”v I(mhr Il(nlrs ()[ (,xtr;l w{~rk (lull wt,rl, (,* sential for llle ;M.(.(~[Ill]lisilrllen( of tile (,]; ni(.;ll ill](t rest,ar(.1] ol)]e CtIVI, S, ;In(l for (III, I.iI}IILl I.(II lc(t IIIn {~fthe prc]lmln;iry diItiI In III(I fl(~ld. It IS {)]lIplI:iSIZWf that III(I work was a ~.(xjpt.r:itlv(, [!n(i[!avor in which all w(.r(, IIIUIU;lllV rt(.lmnd(~nt upon (~a(:h oth<, r-. Tht$ wtll LtIKt,ff(~rts of ,111c,iJn- cern(,d ronst ituted a r(,tllarkat)l{, examl)lc of t(.am - work and sa(trif 1(,(, of p(,rson:(l :i[)lbll I(JIIS :il]d deslr(s for tile Ko(xi of the project at large. The! authors wish to exl)ress their gratitude and Indebtedness to Dr. John C. f3ugh(, r, CAPT Van TIIion,. and CDtt Harry Ett(?r; CAPT W. E. Kellum, MC, USN, and CAPT T. L. Willmon, C(\nJIllandili~ and Ex(v. utive Officers, resp(wtively, NMRI; CAPT R. A. Hinners, USN, D]r(xstor, NRI)lr, :tnd CAi JT A. R. Bc~imk[,, MC, USN, As,sociatc, Director, NRDL; all of wimll] g:lvt~ un - limlt(,(l sul)lx)rt and r(,clur[d administrative proct,dur(,s to a bare minimum, thus makln~ it p(JSSIblIm for th(, unit 1(, h[! asst!nlbl[vi and undcrwuy in a matter of ilours. On arrival al Kwajalein, RADM R. S. Clarke, USN. commanding Officer, U. S. Naval Sl:l - tIon, KW:IJUIILIIJ,suiq~(lrl(~d l~roj(v.t 4.1 witi~ all th(, fa(~ilities ;N his dlslmsal. As a r[!sult, :1 lah(~ra(ory an(l (.lllli(. was (:stal)l isil(.d and (lper-sting within 24 Ilours after arrlvtii of (ht. proj(v.t Il(,rs(]llll(:l. i~r{~j(,(.t Ix,rsolltl(,l also wish to acknowledge Ih(, (n.rtstandin~ contributions ()( C(~l C. S. Maul)lil, MC, USA, Flt,ld Con][]]ilnd, AFSWP, CAI~T H. H. Halght, MC, USN, Dlvisiun of Mili- tary Al~l}li(”ali(,l~, Ah;(:; C(JI K. Houghi(m, MC, USAF, Special Weapons Cen((!r: CAPT Donald D(IIIi{,III, MC, USN, CINCPAC Fle(l; Drs. T. L. Shlpman, T. White, and P. Harris t)f L(M Alamos S(”l(>nt[flc Laboratory; Dr. Gordon Dunning, Division of Biology and Mt!diclne. AEC, and Dr. G. V. LA’Roy, University of Chicago. During all phases of the early care of the cxlwseri indi - vlduais, the [oregomg I]ax-ticlpated as much as their other pr]mary duties would permit. In adrfitl(, n the authors wish to thank them for the extensive and complete data which they collected in th~’aiolls or their home laboratories and kindly furnished to the project personnel. Tile c(mtillucms Iw[p and cooi~eration of Trust Territory representatives and their aid ]n obtaining ne(’essary control” data (m native Marsha llese at Majuro IS hereby a(”knowleriged. The authors are partlrularly indebted to Mr. John Tobin. HIS help as an lnt(’rpr(>t(>r am.1 Ills extenslvt’ knowlectg(~ of the Marshailmw language aml habits were lnvaluaill(~. l,l(,ull~ntaut ,1. S. Thonllls(m, MC, USN, furnish(xt his records on t h(, (,xposeci individuals d(,I. I)IIt;l ITIIIl;Lt (xl by t II(, r~({]il!]oll gr.rml~ of tl)(, VP-29 s(}ua(ir(m stationed al Kwajalcin. ‘~h(, iLUthor S wlsll (,sp(,(. ially to {,xi)rcss tileir :Idnlirat!nn for th(, cxcell(mt j(~b (ion{, by tll(~ n}(,(il(.:il p(, rs(mm,l of tlil, U. S. Naval Dlsl)(*nsary, Kwajaic!m, in compl(’ting th(, (Ixt(, nsIvI’ l:dJ()- ratory f,xaflilll;lt r(ms t }I;lt W{,r(, r(, ({uir(, (ito obtain a I)r(]nlpt inliial (>Viii U~ti{>ll (If tll(~ h~,v(~rlt V 1>1 II)(, ra(llat 1011 injury. Th(, authors iiro (h){!ply grat(!fui to Dr. David A. W(md of Iht? Univ(, rslty of C;lllfornla Hos - pital, San E’rtinr is((), ;LIN1f)r, Edward I,. Aii}en an(l M]ss Pat Roan {If NRDL, for l[lv:llu:lblt, :Iid in carrying out tl~{, lllsto~jatl~(]iogi(.al” (~valu at ion of skin lesions. Tht> (!xtens!vt} (011(rlbut Ions l~f Mr. H. H. Hcchter Ln the statist ic:il analyses of the data, and of Mr. C. A. Sondhaus uf !1](, NRDL, in d(~s~r(, ralcul:it](,ns are gratefu’.ly acknowledged.

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CONTENTS

ABSTRACT , ......

FORKWOltl) . . . . . 5

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ILI, USTRATIONS ...... 10

TA131.P;S,...... 12

(; HA1’’I’KR I INTKO1)UCTION . , . . . . 15

I.t ~t)J(>(”tlV(>S...... , . 15 1.2 G(,n(, ral D(,s(:ripll(m of the Exposed Groups . 15 1.3 Eva(. uiit](m aI~d Early Care of the Exposed Groups 15 1.4 Est IInal i(,tl (If Whole Body External Dose . . 16 1.5 F;:+tiru:lte of Miixinlal Skin Dose fron~ the Ground 22

CHAPTER 2 CLINICAL OBSERVATIONS AND THERAPY 24 2.1 Intr(xluctiorl ...... 24 2.2 Symptoms and Signs Related tc) Radiation Injury . . . . 24 2.3 Clinical Observation and Thera}}y as Related to Hematologicai Flncflngs ...... 25 2.4 The Effect of an E~]idemic of Upper Respiratory Infection on an Irradiated P,)[IUM1OI1 ...... 26 2.5 Coml]tris(m with the Utirik Groul] of Diseases Seen in the Rongelap and AllinKlrla(: Grfmps During the Period of Observation . . . . 29 2.6 Chang(’s in W(,ight us an Indication of Disturbance in the Overall M(,tat)oiism ...... 30 2.-1 Th(, Kff(vts of Pr(?Enanc.y ...... 31 2.8 I)ls(’llssl[m (m the US(S of Antibiotics in thi,s Groul) and irl-ftndiatiorl Injury...... 3:1

CHAPTER 3 SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION ,. 34 3.1 Inl roducti,on” -– Early Symptomatology Referable to the Skin ., 34 3.2 Sk.in Lesions ...... 34 3.3 Epilation ...... 39 ,. 3.4 Nail Pigmentation ...... 40 3,5 Factors Influen(:lrrg the Severity of Skin Lesions . . . . 41 3.6 (:orr(,l:[tlorl” w]th Hematol(jgic:d Fin(iings . . . . . 42

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COINTENrS (Continti@d)

3.7 I)lfil.ussi{tl] . ,. . . 3.H C{m(.lusi(ms ......

CHAPTER4 HEMATOLOGY ...... Ii:{

4.1 Intro(iuctlon ...... ,. Ii:i 4.2 Gc’nc’ral Mcth(ds ...... (i:{ 4.3 Meth(xfs (J[ Tr{~ating Data, Control Gruulm. . . . . (;4 4.4 H(’nl:ltologlcal Findings, G(!neral ...... 65 4.5 R(mK(’lal] Group ...... 79 4.6 Ailinglna( Group ...... no 4.7 Ullrik Gr(ml) ...... no 4.tl It(jng{rik (;r[NiII (Anl(, rirans) ...... }{0 4,:) M(m{wyt(.s UI)(I E(wlm)l)hiit.s, All Groups . . . . . 81 4.10 H(,nlal(x”rit, All Grv)ulw ...... N1 4.11 h’lorldloio~y” of IJf’rlldl(, rai t+lo(d ...... HI 4.12 C(]n]lmris(,rl of Htnl:itt)logical Findings lrl Children and Adults, l{(Jng(,la~) Grollp ...... 82 4.13 I)lscusslor) . . . . . 82

CHAPTER 5 INTE~{NAL RADIOA[;TIVE CONTAMINATION 89

5.1 Introduction” ...... 89 5.2 Physi(:al Environment Studies . . . . . 89 5.3 Animal Studies ...... 91 5.4 Human Studies ...... 92 5.5 Discussion...... 96 5.6 Conclusion ...... 96

CHAPTER 6 RECOMMENDATIONS . . . . . 97

REFERENCES ...... 98

ILLUSTRATIONS

CHAl)Tftl{ 1 INTHOI)UC7VON

I I TINi l,ivin~ Ar(,a (~n I{ong(!iilp Island, Indicating the Light, ol)(!ll-lyl)(, of C{)llstru(.lion . . . . . , 17 1.2 Hrstogran] of I}rolxlrti(m of Total I)OHC! Cunlributt>d by Vxrious Energy l{e~i(ms lr(ml th~~ Fallout Radiation , . . . 18 1.3 Cumulalivv Dose as a Function of Tinic After the Detonation . 21 1.4 Comparative, Depth Doses for Bilateral Exposure from a Small Source and Multiple Source 4rr Exposure with Cobdlt-60 . . 21 1.5 Comparative Depth Doses in a Phantom Man of Initial Atomic Bomb Radiation and Radiation from a Field of Fission Products . . 22

CHAPTER 2 CLINICAL OBSERVATIONS AND THERAPY 2.1 The Blood Count Changes in a Two Year Old Child with Fever . . 27 2.2 The Blood Count Changes in a Fifty Year Old Man with Fever . . . 28

●

...... 4 . . . . ----- 4’ .–—— —.. .— -.— — .—— ——__

lLLUSTRAi]”ONi ~Continued)

Pagt’

(’lIAIJTII:I{ 3 SKIN LESIONS, E})ILATION. AND NAIL I’IGMHNTATK)N

~i.I (;f)nll);!]”ist)n of (1~[,ll~t.ldent.e and Tinlt’ Of A}]pt’~riill($(, of El)llut][)ll . NII(I N{w-k l,~%i(ms III fhI, I{ong(,lap and Allinginae C,r(mps . . . 37

(;ol(~r I’l:it(, s 3.1 RIrl y liVl)(,l”lliKIll(’llt(I(t M;IculO]I:IIIIII;II” Neck LI>si(ms NI 15 I);IYs. (:;{s{s 30, AI:{$ 15, F...... 47(10 3.2 N{,(.k 1(,S1011S ;II 28 [Jays. Wt!t lJI’S{~llil Illiilioll. Whil(l (’l)l{)r Is (’;ll;l[nillr I,tdi{m. C;tw, 78, AK(*37, F...... 47(,/) :{,:{ 1{(,1IIgIII(LIItII~g Sulwrfl(.i:tl PWrk l,(>Si(JIIS ilt 40 DiIyN. Hyl)t~l”}~i~tllt~lllt,[i Arc,iih 1)01 [: I)IIII) I(4{}IV I)(>S(}Uil l}l; lt(S(i. CUS(, 24, AK{, I 5, F. . 47(([) 3.4 I{(,;III,(I N(h(”k I)(LSI(IIIS:It 77 I)AYS SIIOWIIIK fh~ky l)l~lt]t)[lliit itul of Ilii(k of N(’[”k. C;ist> 39, AK(’ 15 F’...... 47(11) 3.5 Hylj~’rlligm(’ntrd R;IIsmi Plaquc?s and Bullae on Dorsum of Feet and To(!s M 28 Days. One Lesion on Left Foot Shows Dce~wr Involvement. Feet were Painful at This Time...... 49(b) 3.6 Lesions 10 Days Later. Bullae Have Broken, Desquamation is Essential Iy Complete, and Lesions Have Healed. Feet no Longer Painful . . 49(b) 3.7 Lesions 6 Days Later Showing Repigmentatirm Except for Small Scar on Dorsum of Left Foot at Site of Deepest Lesion . . . . 49(b) 3.8 Extensive Lesions in Bay, Age 13, Case 26 . . . . . 51(C) 3.9 Extensive Lesions in Boy, Age ;3, Case 26 . . . . . 51((.) 3.10 Wh{)lf, Body Vi~’w of Lesions in Same Case as Plates 3.8-- 3.9 . . 53((.1) 3.11 Wh{~l(’ B(xty Vit’w of Lesions in Same Case as Plates 3.8- 3.9 , . 53((”1) 3.12 1~(’squ;lnlati(m of Back ,~f Scalp at 28 Days. E}]ilation Occurrt’d E;Irl i(’r i n [>(!squ;tmatud Ar(’a. (See Plate 3.14.) Nott’ PersiMent Ul(.(}riltioll (}f L,~ft Ear...... 55(d) 3.13 Eiglit(,t,ll IIIys Lai(hr. Sralp Lesions Have Healed With Rcpi~nlentidion III Sk]n, NI} Efiiir Growth Evident in Epilated Areas. Ear Lflceratl[m l~(~rsists Wilh Little Improvement...... 55(d) 3.14 Epilatit]rr in Man at 18 Days. Case 79, Age 41. Scalp Lesions Present in Ar(’its of El]ilation. (Same Case as in Plates 3.12 and 3.13. ) . . 57(e) 3.15 S.polty Epilatioo in Boy, Age 13, at 28 Days. Case 26. Note Scalp Lesi(ms in Areas of Epilation. (Same Case as in Plates 3.8 -3.1 1.) . 57(e) 3.16 Epilation in 7 Yr. Old Girl at 28 Days. Case 72. . . . . 57(L’) 3.17 l~l~mt?nted Bands in Semilunar Ar(?a of Fingernails at 77 Days . . 57(C) 3.18 (X1OO, H&E) Epidermis: Extensiwe Transepidermal Damage With Less Involved Zones oh Either Side . . . . , . 59(J-) 3.19 (X1OO, H&E) Epidermis: Arcades of Minimal Damage Occur in R[!lation to Excretory Ducts of Sweat Gla’nds...... 59(f) 3.20 (x400, H&E) (Case lf26) Transepidt?rmal Damage With Disorganization of (hf. Mall) ighian Layer ...... 59(f) 3.21 (X 100, H&E) (Case #63) Transepidermal Damage With Disor~anizatitm of the Malpighian Layer ...... 59(/) 3.22 (Xl 00, H&E) (Cast! #75) LOOM! Lamination of Stratum Corn(’um with OuLwar[l Papillary Projections and R($sultant “Rugose” App(’itrancl’ . 61 (AJ) 3.23 (x400, H&E) (Case ff75) Siim[! as 3.22. Occasional Pcrinu~l~ar Cytoplasmir Halos in Mid Strittuni Granulosum . . . . 61 (K) 3.24 (XIOO, H&E) (Case #39) Narrow Rugose Ei~ldernlls With PaIJiliarY Extensions Downward of Stratum Malplghii . . . . . 61 (

,.’ ...... ,, .. — -..—— _-— ——...... ---— .--..-—...— --.- .. .—— ___ ._ ——.—- — –-—.—..—.-—— -- -——

ILLUSTRATIONS” (Continued)

CHAPTEI{ 4 HEMATOLOGY

4.1 Serial Clmng{’s in N(’utrophilc Counts of Rf]ngelap Group [or Thos(> L,CSS than 5 Y(!ars Nnd G rtmt(?r than 5 Yvars of Ago . . . 67 4.2 St!rt;~l Cha IW(’s in l,vmph~wytv Count of Ht)IIgclap Croup f[m Th(wt, Ltiss th;ln 5 Y{:i~rs :il}ciC,r(li\(~~r than 5 Yi~nrs {>fAgo . . (in 4.3 Con)parntlvt, Serial (;hi~ll~t~s in the Totul i,t,ukoryit~, Nt~utrol]hilt, :}nd l,yn)lh(jt.yl(, C(mnts in Thos(, Grwil[,r than 5 Ycilrs Old, lhm~:(,l;i!) Grtmp ...... 4.4 S(}l”lill l)l;lt[,l{it (;h;lllg(.H in ThoH~~ L{*EJHlil;ilt 15 Yoarti ;Ind Grelitt$r Ih;ll) 15 Yt,:lrs t~f AK{. t)f th(, l{[m~clnl) Grt~ull . . . 70 4.:) ,Sf.rl;;l ‘1’~)t;ll 1,{,ukl)f, y(i,, Ntwd r(qd]lll,, :11)(I1,ymphtwyltj Count in l,:XINJS(W1Allt[,ri(.;t[ls ...... 71 4.(i Scrl:ll I>l;it{,l(,l CfJunls in Exlmst, d An}[~ri(s;ins . . . . 72 4.7 S(’rl:ll Eosln[lphilc Counts fm Those Lt’ss than and Greatt~r than 5 Y(?ars of Age, of tile I+ongt>lap Group . . . . . 73 4.8 Serial Hematocrils for All Exposed Groups . . . . 74 4.9 Cumulative Neutrophile Counts for the Rongelap, Ailinginae and Majuro Groups at the Time of Peak Depression . . . 75 4.10 Cumulative Lymphocyte Counts for the Rongelap, Ailinginae and Majuro Groups at the Time of Peak Depression . . . 76 4.11 Cumulative Platelet Counts for the Rongelap, Ailinginae, Utirik and MaJuro Groups at the Time of Peak Depression . . . 77

CHAPTER 5 INTERNAL RADIOACTIVE CONTAMINATION

5.1 Well, Rmgelap . , ...... 90 5.2 Cislvrn, Rongelap ...... 90 5.3 Aut[~radi(Mrallh of Itongclal) Chicken Tibia, 11/2x, 21 Hr Exptmurt’ Aninml Si!(.rifi(:ed 45 Days Post-exposure . . . . . 91 5.4 Auloradit]graph of I{(mKt!lap Pig Tibia, 42 Hr Exposure. Animal Sticrlfic(bd 58 [Jays Post-exposure ...... 92

TABLES

CHAPTER 1 INTRODUCTION

1.1 Exposed and Control Unexposed Groups . . . . . 16

CHAPTER 2 CLINICAL OBSERVATIONS AND THERAPY

2.1 Diseases that Appeared During Observation of the Rongelap and Ailinginae Groups ...... 29 2.2 Diseases that Appeared During Observation of the Utirik Group 30 2.3 Weight Changes, Rongelap and Ai}inginae Groups . . . 31 2.4 Blood Counts on Pregnant Individuals, Rongelap and Ailinginae Groups ...... 32 2.5 Patients Treated With Antibiotics ...... 32

$+ “.

y;>, “ * ,<>,.*,, ;<’&j&~~ 12 ,’

,...... >...... , ...... —.-— — ..—. .— - —-— ______... .—.—.-— —.—-. —— -- ,’.

:.;.J & \ , ● TABLES (Continue . . l’:ll!.(

(’HAP’I’KR :{ SKIN’ l, flSIONS, KI’ILATION, ANll NAI1, l’lGMKN”~A’~lON 35 3.1 L(>sl{ms 11)tt~)llg(’l;ll) Grf)llP . . - . - . 4[) :].2 i,(,siuns in Aillwlnilt’ and Ronwrik Grlws . . . . ?.3 Sur[acth Dost’s III r(’1) Rrquired (O l’rt)dure Rt’cofznizablt) 45 li~)itit’rlllal injury ...... - . .

CIiAPTEll 4 HEMATOI,OGY 64 4.1 ti:1 4.2 (M 4.3 06 4.4 (;6 4.5 . 78 4.fi 79 Ailir)Killo(’ GI”t)IIl), Mt,itl) Bl(Kd (; UUIIt S itt TiIII(I of I’t’:lk Drljr(wtilo!l . 4.7 82 4.8 tl(,lliat(l(”rit, Ail W)~)sllrt’ Grws . . . “ “ 4,9 Lymphocyte? and Platelet Cot)]lntrlsui] Dy Age of Mean Nt?utrophile, 82 C(mIIts In tho l{[mgl!iap Group at the Time of Peak Dcpressi~)!l . . Characl(’rls(i(.s of Avaiiablt? Data on the Hematolugical Efferts of 4.10 . 84 Pem!lrating Radiation ...... - - - Mean Peripheral Biood Count Values for Several Control 4.11 . 84 Populations (x 10*) ......

CHAPTER 5 INTERNAL RADIOACTIVE CONTAMINATION . 93 5.1 Gross Beta Activity in Urine of Rongelw Grow . . . . . 94 5.2 Radiochcmical Analysis of .Tissues and Urine of Rongelap Pigs .

13~14 , .’.;,’. /’

K,lj+”: : “’, .;. , ; ., . .. . . K-’:+’ ; : ,“.r<...... # —. ______. ——.- . ...——...... —-_-_— ,.. . . .,. .

.p Wwbk. .%,<*. UU - ,< b<*&

L’HA1’TER 1

INTRODUCTION

1.1 OBJECTIVES

Project 4.1 was organized with the following specific objectives: (1) To evaluate the severity of tile radiation injury in the human beings exposed to the fallout radiation. (2) To pr(wide for all necessary medical care for these individuals. (3) TO {Sondurt a scientific study of radiation injury in human beings.

1.2 GENERA L DESCRIPTION OF -.THE. EXPOSED- —.-.—-GROUPS-—-

SIN)I 1 of O]wration CASTLE was detonated on 1 March 1954. Following” the detonation sig- nillc;lnt ;tm{mnts ()[ riidi(mctlve materials fell cm the following popula!ed nei~idmring atolls: (1) ll{mgcluI), (2) Ailing! nae, (3) Rongerik, and (4) Utirik. Exposure gr(mps :trt) identified ac - {,(jrdtnK to (Iteir gcograpl~iral loca IJoJI at the time of exposure. The numbers of individuals involved, their Iot”ation, Ihe distance of the atoll on which the” were located from the site of the detomatltm on Bikini, the calculated dose of radiation, the pi’vbable time of beginninK of the fallout and its durati(m arc Uabulated in Table 1.1. The Rongelap group received the highest calculated dose. These individuals were living under relatively primitive conditions in lightly con- structed palm houses (Fig. 1. 1). The Ailinginae people were a part of the Rongelap group who were on their Ailinginae farms from the time the fallout began to the time of evacuation. Their calculated dose was smaller than that of the other members of their group that had remained on Rongelap. The third and largest group of fvIarshallese, inhabitants of the atoll of Utirik, received the smallest dose of radiation. The American military personnel exposed on Rongerik were aware of the significance of {xllout and promptly put on additional clothing to protect the skin. As far as duties would permit, they remained inside of Butler-type buildings. In contrast, most of the niltive Marshal lese remained OU( of doors and thus were more heavily contamin;~ted bythe malt’ rii!l f:illilig (m the ;Iti]lls. Some (J[ the Marsha llese, howevsr, went Swimming during the fal)tml nnd m;IIIy of the (.hildren wactc!d in the vmter; thu~ washing a [,(msiderable amount O( the nmterinl from their skins.

1.3 EVACUATION AND EARLY CARE OF THE EXPOSED GROUPS

The American military personnel were evacuated to Kwajalein via air in two groups on 2 March. The native Marshallese were evacuated by a combination of air and surface trans-

. . :: :“” - “-” “-...... —- —— .. — . — -.———z ..—.—— ..- -...... — .— . ..-.. .-- .— . . . . ., ,...... I)ort;lti(m. Sinre x survey of :111individual ;sl;(;w-c a.ih:lt’tf)ei(l WilS siwIIit;Itd ,-(MII;IIUIWII 1<,,, {d skin mId (’10111(’. S, ~)r[)nll)t d(,(.(lllt;][l)lll:ltior~ w

‘I’.ll )1{ 1. I I,;XIU)SKD AND (’ON’~R[)l. (I NEXIK)SI,; I) (;l{OUI)S

Approxlulnlt hwtntfntwl

‘I’l)L; II I)istnll[,l$ l{cu(lin~s 1{1.s1 Kstillltu{. (; r(mp Numh(>r frIIm Illkini Tinw {)f lls(,d in 1)os(.

H . 2[1.5 hr 2tlo III r ‘hr 7t) (/l mm)) Ii + :) ~~v~ }{ , :{4 III. (20 m{m) Ar,),ri(:nns, Ct)llf P(,1 KW:IJ AI II Isrli.:uI M} LI, sIIIIII(. w,, (;4 I oh }[ + so hr :17fi mrihr 175 f’.xl)(ls(,(l ( 16 P{WIPIL*I H -1 7 lkv% 1111{1~{1:11) }1 + 51 hr (48 pt!l)plu) AI II IIKIII:I(. I H ti:i H + 58 hr 100 mrhr (ii/ H + 9 duys I 57 27(1 Slartc,d at 411 mr/hr 14 H+55hr H + 8 days Completed at H+7~hr Marshall use, 117 ConlrOl M:iju i-u Group

Tot al F;xposcd – 267 Tolal Controls --222 _...— .—— .—. ...—.-— . .. . —— —— -- .—...—. —-.-—

● S(Y’ s(.ctlol} I .4.:1.

1.4 ESTIMATION OF WHO1,E BODY EXTERNAL DOSE

‘1’he estinmtwf villues ~Jf external dose given in l~able 1.1 were biised on readiww or AN IJI)R-39 []eld lnstrllmelits. Averages of a number of dose rate measurements on each isl:{ld :Lt :1 given lime were used. The readings were taken in air , ilpproximtltely 3 feet above ground, several days after the inhabitants were evacuated. Before this time, adequate surveys with well calibrated instruments had not been possible. Several variables which influence the results are indicated below. These will be discussed in grf?ater detxi I in an addendum report on external dose, which will contain the data, methods ;Ind [!;IIculations by which the external dose analysis was made.

1.4.1 Energy Distribution of the Fallout Gamma Radiation, It~V_aaiat.ion——-—With Timel..-. the R–esp;ns~—-. Of the “Meter ~; Eych E.nerg~_Region. ?ld_]tg Qrr.@ig! F.a$t@gr .t!e.-To@ Dose—..——.Spectrum—. Fallout deposited as an effectively infinite plane source resulted in the dose-energy histo- gram shown in Fig. 1.2. Its energy distribution was the result of degradation of the original

...... *..*...... --- . . . .,- ...... ,, ...... ___.—— . —.——.——.— —~-— — — ..—

. . -. :......

.... . *.

Indicating the Light, Opm-ty W! of C{mstructll~n F .g. 1.1 The Living Area on Rongelap Ishmd,

~- ...... ,.,...... —-——— ——- - _-. _———— —--———. -— -. -- —

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I I ------—-- 0 0 -U3 _.. - - p ‘u L: --- II L4

— -0 0 ------0-- > u x ------Oz -0= ~w -- —------z ------— w ., ------“------— ------0 -0 f a

------

0 0 ------N ------

----- 0 I 0 0 0 (u ,+4 3S00 1V101 30 1N33 U3d

- —. —-......

1.4.2 f?.ate of Deray of the Fallout Mixture

De{iiy r:ltes of fallout silmples were meilsured in the fteld ;LncfIII the l;lix)r:itory, where :1 f:tirly f’(msistent piitt~rn wits observed am(mg t,arious I(walions and samples. III addition, theur’etirai ronsider:tti{)ns b:!sed on the radi!~chemicul [.ompositiun (If the [:III{w( mixture permitted de(-ay rates to be cai(wlated for different intervals between tl)e times of ]nittal exposure and later survey readings. These agreed well with the expt?rlmental data, slid were used both III the dose (.;{l(, ul;ttions durin~ the exposure intervals and in extra p(~lating the inter survey rend ings t{) earner times.

1.4.3 “1’im(, t)l Arrival ()[ the Rndi(xfctive Cloud, Duration [)f the F:tll{mt, nnd Timr (d Ev;Icu;I - tl(m for ftnrh Caw

Only tll(! II me of evil cuati(m is known accurately for all the islands. 011 Ihmgerik, however, tile time of ;wrlval of the rxditractive cloud was determined precisely by the continuously rt?- t,f)rding df~se riitc monitor” at the v xither stati{m. The fallout became visible i~t the time the Instrument firs( indicated the presence of a radiation field itbove bil~kgrolll]d. The material had the appearance of snow. The times of beginning of falkmt on RtJIwe]ap and Ailinginae were estimated from similar visual observations, combined with knowledge of the relative distances of these atolls from Bikini and the wind velocities in the area. Fallout was not observed cm Utirik, hence the estimate of arrival time there was made on the basis flf the Ronge- rik fallout time, wind, and distance factors. Two extreme possibilities exist relative to the duration of the fallout: the first, that the tallout occurred entirely within a short time; the second, that it was gradual and extended over u period of many hours. The m{mitoring instrument on Rongerik went off-scale at 100 mr hr, 1~ Il(mr after the dose rate began to rise above backgr(mnd. If this rxte of increase is extra- polated ,10 a point for which subsequent deray would reduce the dose rilte tf~ the v:llwes found xt later times, a l(mg fallout is implied. This was taken as (me Iimitlng rast!, :imf (“orresimnflin~ doses wcrt, r;~l{”wlatecf. Ih)wrver, the Ixwsibility does not seem grwt thut this :Lrtlialty oc- t,urr cd. Itxi.s tin}: dal; i are incimclusive, tmt( severnl indici]tlf}lls tending t(> f:iv(lr tht’ short tlmc’ l~yl)t)lht’sis a r(, sumnw ri7wd below. First: :1 I{)Jw f:lll{nlt I)r{dmbly would not I}t, uniformly hmtvy thr(wgh(ml. tin! first Ijf)rtllnl tming tlw m{wt ll~ttmsc :tnff the Ixil:ince ta]ling ~Xf. The tot:ll phcnl)men(m thus t(imis toward the effect 01 a shorter fallout. This is supported by monitor data frt)m othtir nu(”le:i r cwe!lts. Second: the estimated durations of fallout, of about 18 hours, whirh result from the alxwe extrapolation for Rongerik and Rongelap, appear too long to have occurred al the distances of these atolls ffom Bikini, since the wind velocity in the area was high enough for the (’loud to pass over the islands in a considerably shorter time. Third: the accounts of the visibility of the fallout, although confli :ting, do not seem to indicate such late cessation,

.,...... — —.— ..-.— .. ._. —_____ .._ .______..____.. __._.._. -

{Iu(.e su{’1) J lli~ll (i[wc t~f r:idi:ltl(ln. Fifth: {In Illirik, (rely ii sh{)rt fiilltm( time Is r(msistent with the later IIIISe riites (AMerved, prt~vidmt the fxllt)ut begiln as Iil(e iLs was estimated from wind iind distinct> fa(”ti)rs. A {ret’ hour dur:iti[m* (If fallout appears likely. On the other islands the actuul fi~llout timt~ ]s known 10 hove exceeded (me h(mr; h(~wever, since the approximate dose discussed ilbove was seen to fit the film dat:~ on Ih)ligerlk, ]t W:IS ~!sed for the [Xher islands os listed in (he cal{-ulnti(ms ill Table 1.1. The hour limlt is thus “’iLneffective value.”’ If the l{]ng fallout ciise IS also considered, a lower limit for the dose may also be estimated, though the uj)per limit is taken as most probable. The ranges are then as follows: Rtmgerik 50 r 104 r; R~mgelap 102 r -175 r; Ailinginae 53 r-69 r; and Utirik --14 r. The dose value for Rongerik given In Table 1.1 is 75 per cent of the short fallout case value,” :iver:lged for 28.5 and 34 hour exposures. This best expresses the average air dose re- (:eived hy pers(mnel WIN)spent roughly half their time inside structures where the dose rate was later f{mncf t(J be r{mgh]y ha]f that outdoors. On the other islands no such shielding was present. Figure 1.3, for the Rongelap atoll, illustrates the cumulative dose as a function of time after the dekmatton. It can be seen thatthe rate of delivery of the dose varied continuously, the nmji)r portifm being reretved at the higher dose rate prevailing in the early portion of the eX~(JSUre f]eriod. f3y the time that 90 per cent of the dose had been received, for example, the d(,sc ra(e had [:lllen tt) css thiin 30 per cent of its initial value. Thus the dose” rate o.f t?xposure differed markedly from tlrat usually encountered using x-ray units.

1.4.4 Geometry of the Exposures.. A third difference between the tyf]e of exposure encountered here and other external exposures lay in the geometry of the source. These doses were delivered from a plane source, s(> that the radiation field did not follow the narrow beam geometry usually employed experimentally. in such a diffuse 360° field, the decrease of dose with depth in tissue is less pronounced than that resulting from a unilateral or bilateral exposure to an X-ray beam, so that for a Riven energy, the close at the center of the abdomen is approximately 50 per rent higher than a given air dos[? w(wld imply for the narrow beam case. Figure 1.4 illustrates ~ln ex- I)erim{’ll(:tl simulat i(m of the field geometry usin~ J spherically oriented group of Couo SOLIrres witl~ :1 i)hxnlom plil(,ed at their (’enter, compared with a conventional depth dose rurve (Mainecf witl] a sln~le stmrce. It would nppe:ir under the rircumstanreti that the midline dose, rnther thitll d{~se mtmsured in :Ii r, would be the better pu rameter in terms predicting bi(>logiral ef - fects. 011 this INMIS, the air dose values stated in Ti~ble 1.1 should be muitipliecf by ilpl)rl)~J- In;llel y !.5 I II order (I) i.(~mllare their efferts to th{we [~f an exposure usin~ 4 narrow ht?am gw)mutry. If tl~is Is d(me, assumil]~ a f:lst filll(~ut of (me hour, the following” doses in lerms of :1]}:Lir (h)se ulider Iitl)()[.ilt()ry r(mcfitiulw result: l~ongt~lup 260 r; Ailinginae 100 r; Rrm~t?rik 120 r; :L])d Ulirlk 21 r.

—. ..—. .——— * While it is obvious that the fallout lasted longer than one hour, calculations of dose are based on an assumed one hour fallout as explained in the text.

...... ● ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎✎✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✚✎ ”,...... —— — .—. — .. ..— ..— ——— .— ----

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DtPIH [JOSE DISTRIBUTION IN CYLINDRICAL PHANTOM, co ‘t ACILITY, (N Ml{l)

f~,r l\il:lt(, ral Exposure from iI SIIINII S(wrm, OIId MU II IIIIC

...... ,, .,...... “. -“’ ...... ! ...:: ,. .-.., . . . . — . . .—— — ..— —— — — ... —- —— —— —.—.—...... —. —.—*

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_.-— —. ..— — __ ..- ..-..—. ___ .-

I y I 8 I I EXf ’I }{ l)O:>t IN PHANTOM MAN I I “ INII IAL RA[)IATK)N I - -u- - RI.’; II)IIOL } It 1 11 i I 1 I I I 1 @

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!-’Ig. 1.EI C{)mpariitivc Depth Doses in :1 Phantom MUII of Inltml Atomic Bomb il~dint i[m mid I{ad[:iti<)n from ~ 1,’Ield {~f Fissi[m Products

gamma dose. The midline gamma dose is approximately 60 per cent of the portion of the air gamma dose due to 80 kv radiation .or above. This portion in turn is estimated to be 90 per cent of the gamma dose measured in air by the instrument. Thus the dose at the surface of a phantom exposed to mixed fission product radiation from an external plane source might be expected to be 3, (0.6)(0.9) or about six times the midline dose, if both occur at 3 feet off the ground. Such a depth dose measurement has in fact been made experimentally at a previous

,...... - .— - . . . .. —.. . ___ _ — —.-. _ .-.—— -—. .. . ,..—.. — .—. ..-—---—-. — —..—. . .. _——

* F. W. Chambers, Project 2.2b, Residual Gamma Depth Dose Measurements in Unit- Density Material, AFSWP, WT-719, Operation UPSHOT-KNOTHOLE.

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(’I{AI>TI,:l{ 2

CLINICAL OBSERVATIONS AND THERAPY

2.1 lN’I’I{O[)UCTION

1( was km~wn in)nl{’dial(~ly Lhat tl~{texposed ~roups had rereived a significant dnlount of p{,lltt r~iting radial ion 10 the et]llrc, body, extensive contaminfition of thti skin, and possibie inter - I)ai ,l{~p~witlorr of radioactive rrjaterials. 11 was tht~ref[~re d~~cided tlmt clinical olwervations \vould I)e as extensive i~nd frequent as facil ities and personnel permitted in order to recognizti and car(, l,w rtidiation ~i[fet’ts as ctirly as possible, Accordin@y complete initial histories and phy:ii(al cx~minations with numerous follow-up [~xam~nations were carried out. Surveys of the sk 1:1W{JI(, conducted at frequent intervals and the det;iiled skin findings are reported in chaptt’r 3. fi;xt~nslv(’ t~~>n]ill[)logi(::il s~u~iics were conducted, the detailed results of which ar!, prrs~wt(’d in f’lMI~t(,r 4. I{t:sults of exilrninal l(]ns for urinary excretion of radio isotopt?s are reported in (.II;1[)1(,I’ 5, . . . III ;Id(l It I(JII h) l)l!rio(ii(” (,xiir~lirl;~lior)s, routine sick call was held twice d:Iily. M(dic:.. c~lr(’ v.1> ,ivi!il:il)l(, ill al I tlnl(,s :11)(1lmspit:il faciliti~, s w{,rl~ avitiluble at the Kw:lj:lieill Nnval DIspt’Il- S.lry. II) vi(, w VI tlN, wid[,spr(,;ui t.ol][ll(:tlrlg ol]inions in rt~gard to the va!ut, of v:lrious })r(~phvlilr’tic LtII(i (11(,].;ip(,uti(. rr)(,:t.sul.(~s III I r(,:l(r])t,nt of radiation effects, it was d(,ckded in adv:ir](”{’ th~l( tlI(LI.IjIy wInJl(l 111)1lx, KIV(~II:trl)ilr:lrily hrrl would I)t) instiluttld arj i[dicuted clillicaity for spe- (.11I(. (.oi]dlllolls” (III WI II Id Iv I(luiIl Imsis. Howevt. r, if s(, vere gr.inul<){.yt(jpc~lli;~ dev{~lolw(i (b(.,l(~w 10(N) (.ttls (rll) th(, }]r(,}dlyln(ti( ust, of :mtibi[)tics was to be c(msi{il’rtd. Wholt’ blood Iransfu- slt)ils w(,r( Iik{,wlst, (t} Iw ust, d only 11~(:asc~ of dt, vt,l[)pment of serious anell~ia.

2.2 sYM1)1OMS AND SIGNS. RELATED To RADIATION INJIJRy

S(’veraf syrnptums lhat developed during the first day or two after exposure pr(~lrably were attritmtablt> to radiation. Itching and burning of the ~kin and eyes during [Ills period occur red in over [IIIe quart(’r of tht’ ttnngelap population, to a lesser extent in the Ailingtnae and to a very slight ~.xt[,r]t in tht~ Aruerirxns. The skin symtomiltolok~* might hxve been due in part to the marked alkalinity of th(, fall(mt mxlerial (calcluni oxide). About two thirds of the R(mgelitp grrmp rcp[]rted nausea during this early period and one tenth of the group reported vonliting and diarrhea. Only orw Ailingina~ individual reported nausea. The people of Utirik And the Americans developed 11[) signs or syniptorns that might be related to radiation.

.— * The s ymtomatoictgy is based on que sticrrrings through an interpreter by several observers. Despite the repeated interrogations and the inevitable suggestion of the interrogators, the sto - ries remained ren\arkably consistent.

...... ,...... ,,...... ,...... : ...... —— —.—.—————— ...... —. ——... ---- .. -- . ._. -

2.3 CLINICAL OIMEIt VATlON ANT) THE IViPY AS IWLATEI) ‘ro Ii EMAr~OljOL; ICAIl F’INriNGs

‘),:{.1 1,(wk(t(’yl{ COUIIIS

dlscover(,d in its earliesl stages, (2) Since some individuals might require antibiotics for long periods of time if infection occurred, the premature administration of such drugs would not only possibly obscure medical Indication of treatment, but might potentially lead to the development of drug resistant organ- isms in an individual with an already lowered resistance to infection. (3) There is no accurate knowledge of the number of grar’~iocytes required by mail to pre- vent the types of infection seen in agranulocytosis. (4) The otrscrved situation was not strictly comparable to agranulocytosis with an aplastic marruw due to potentially lethal doses of radiation. In the laiter instance, granulocytes fall rapidly and there are practically none in the circulation wher infection occurs. In the} present ~roull Of indiviciuals exposed to radiation, although most counts were approximately one-fourth (J( n(jrrrial, tl~c f;l]l to 111:11 level was gradual and Mere was some evicft~nrc of granulocytti regeneration. Whltc counts were r(~pt’ated at three or four day intervi~ls on all of lh~’ exposed individuals and more fre{lu~~nlly on thos(, with tho lowest counts. Those with symptoms or el~w:lted tern - l~(!ruturt,s w{,re Lreat(wf (jnly after an attemi)t to establish a tfiugnosis was madt>, (’v(’11 if a period of obs{,rvation was nerestjary. During the olmervation period, the patients were t,xnnlined at f requenl Lntcrvals and the temperature checked every few hours, ‘rwcn(y-sevtvl individuals had total leukocyte counts of 4000 or below or :ibsolutc nt>u- fr(q)lillc ([rents of 2500 {}r IL*SSat some tlnl~’ durin~ (I)e period UI observation. 01 tl~(’se 27, 13 l~ad synlptoms of disease that required evaluation for possible antibiotic therapy. l?lt>veo of the 13 had severe upper respiratory infections, one individual had abdominal pains and ftwer, and one had urticaria (hives) with fever. The incidence and type of symptoms in the group with low leukocyte counts did not differ materially from those in the remainder of the population and it appeared that the occurrence of disease and the presence of ieukopenia was coincidental. The 13 instances in which it was neceesary to consider the use of antibiotic therapy in noutropenic individuals are summarized below: Eleven of the 13 individuals had severe upper respiratory infections. Eight of these had malaise, sore throat, nasal discharge, and temperatures that varied between 99 and 101 .4°F and then fell to normal within a 12 hour per’iod. Since the response of this group to upper rt?spiru - tory infection appeared identical with that of individuals without neutropenia, no therapy was given. Two of the 11 had marked malaise, headache, abdominal pain, nausea., diarrhea, and high fever. Both were children, one age seven, the other age two. In both instam:es, the symptoms were out of proportion to the physical findings, which were negative except for head colds and mild pharyngeal injection. The seven-year old child had a temperature of 102.6 when first seen

.,, ...... ,. — .--— ——.-————..——_ --— . . —— —. . ...—...... ——_. ___ . .._ . . 3

. . ., ..., .. . :ind 4 hours lat(’r, 104. The two-y(wr old child had an Initial Lcmprraturt. L)I 101.8 tlt~~rtit>s which ruse to 103.5 degrees in 4 hours. Both werv ~iv{m intranwsrulor procaine peni(’tilin when lb<, sharp rise in liimpc’ratu re occurred, and both were without symptoms iknd [twt)r the following day. A wwond inj~wti!m of pt’nicillin was ~iv(>n at thl!i timci, and therupv wns disct)n- linucd. in Spl((> 01 tilt, [:{cl thiit llIt! 11(’(1[ r(ipllilcs r(~nul IIi(*(f d(q)r(!ss(vf III 1)(IIII cas(’s I(lIIK :ifl(~r tl)(~ fl, v(, r h:Id l)a~s(~d, lxIliI imtividual~ r<’covered and Iuid no [urlher illness. In IJigur{i 2.1 fhc i)limd (“OUI)lSand plal{$l(,ls of the lwo-y~iir old patient and U]I> time of tfw’ ocrurrcnce of th(’ l)lne~s will] f(~v(!r :(re iliustra(t~d. A ont,-year oid boy Im(i synlplonls of upp(,r respiratory infertlon fm” several days i~(!foru Iwing brougilt to the clinic. When he was tweti, his tcmperalurr was 100./1 ~i(!gr[)(’s. h] addilion t(, the h[!a(i m]]ds thc!rc was pharyngeal injection and num(irous C(NIrs(’ rhonchi (whc(!zln~) thr(mghout the Ch(’kd. A dlagnmis of upper r(!~pirxtory htivcti(m with ul+- s(}ci:it(wl t]ronchitis W:)Hmud(? :imf thr (.hilcf wus giv(,n a stn~lr Intramuscui;ir lnjt~~’lion of pro- C: I}IIC I){mi(’illili. On tl)(, (oil IJwiIIg day m) raies or rhollchi wttrt, heard, th(! t(’nip{’rittur(’ w:ls f)!) ’’k’,:Illd he rt. milinm.l :isynlpt(mm!ic without furth~’r trt?iltn~l:nt. One of the 13 individuals was it 50-year old man who reported to the c1 ink: with w(udmrs~, m!rvt)umess, mL1d al)do IIIInal pain, iinc! shooting pain in the upper anterior c!h(’d, {JilLltt’Ni] ]Y. He iip}}(:iircd n~f~cierat{’ly i] i, his temp(’raturu was 99.6( ’F, and the only positive phys)cul finding was moderate tender n~,ss ill ti)~~right upper quadr:ln( of the abdomen. Since his KrJIIUIOCYi U ctmnt rernaincd low on repeated (Ix:tmin:tti(m, he wus seen at frequent intervals. Within a 10 hour period the temperature rose to 101 .6”F, following which it fell gradually to normal. The ab- dom inal tenderness cent inued for 24 hours and then gradually disappeared during the subsequent two days. A diagnosis of cholecystitis (inflammation of the gall bladder) was made. NO sPecMic therapy was given. In Figure 2.2 his white blood count and platelet counts in relation to the appearance of symptoms are shown. A female, 38, developed generalized urticaria, fever, and headache: Urticaria and fever subsided within 8 hours without any therapy.

2.3.2 Platelet Counts

All individuals with a platelet count of 100,000 or less were examined daily for evidence of hemorrhage into the skin, mucous membranes, and retinae. Urine was en”mined “for red cells and alimmin, and wonlen were questioned concerning excessive menstruation. There was no evidence of hemorrhage into tissues even though 11 individuals reached platelet levels between 35,000 and 65,000. Two women menstruated when their platelet counts were 150,000 and 130,000 r[’spectively. Both menstruated several extra days and thought that the bleeding was excessive but not sufficient 10 cause concern. .

2.3.3 Hematocrit-. Changes Nineteen individuals iri the Rongelap group had hernatocrlts of 35 per cent or below; however, none of these were below 31 per cent. Nine of the 19 were children, aged one to five years who would be expected to have a lower hematocrit than normal adults; four were over 70 years of age, in which age group a decreased hematocrit is frequently present without obvious cause. Two of the 19 had had menorrhagia (profuse menstruation) prior to the determination, two were three to four months pregnant and had not received supplementary iron, and two were young women. The low hematocrits that were observed could be explained on the basis of normal physiological variations rather than to the effects of irradiation on hematopoiesis (blood for- mat ion). At no time were whole blood transfusions considered since hematocrits remained within levels consistent with well being and normal activity.

2.4 THE EFFECT OF AN EPIDEMIC OF UPPER—. RESPIRATORY.—. .— —.. INFECTION. —..-. ON AN IRRADIATED— POPtiLATION

Between the 27th and 42nd post-exposure days an epidemic of upper respiratory diseases (URI) occurred. Fifty-eight per cent of the Rongelap group and 56 per cent of the Ailinginae group were involved. Seventy per cent of tiie affected individuals developed symptoms between 26

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I I

Of the 64 individuals fronl Rollgelap, 27 had no respiratory infect~on and of these 13 (48 per (’cnt) without URI showed a rjse in leukocytes; 37 had the infection, and of these, 24 (53 per rent) showed a rise; 7 of these 24 showed a rise three or more days before symptoms appeared. Of the 18 from Ailinginae, 8 had no respiratory infection and 3 (37 per cent) of these showed a rise; 10 had the infection, of these, 3 (33 per cent) showed a rise in count. It is also of interest that not only the irradiated individuals developed the respiratory infection but in addition the medical personnel involved in their care and study also developed equally severe respiratory infections. The respiratory infections consisted of moderate malaise, sort! throat with prominent lymphoid follicles, pharyngitis, moderate fever on the first t~y, and a purulent (pus) nasal and tracheal discharge for 10 days.

2.5 COMPARISON WITH THE UTIRIK GROUP OF DISEASES SEEN IN THE RONGELAP AND AILINGINAE GROUPS DURING THE PERIOD:OF Observation

The di~easeti that were st?en in the Rongelap and Ailinginae groups during the period of observation art! listed in “ral.)lc 2.1. None of these appeared to be reiateci to th(, effects of irradiation, either directly or as a result of the hematologic disturtmnres. For comparison, the diseases that were seen in the Utirik group during the period of observi~tion art! listed in Ti~ble 2.2. The high incidence of gastroenteritis (inflammation of the sto[nach and iniestim?s) in both groups was probably due to the Marshallese keeping perishable foods unrefrigerated for long periods, and was not seen after this practice was stopped. It would appear that a higher per - c entage of the Rongelap-Ail inginae group developed upper respiratory infections compared to the Utirik group. However, all of the Rongelap-Ailingina e group were questioned concerning even mild symptoms of URI, whereas only those of the L tirik group with severe symptoms of

29 -—— — 4 --

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1)1s(.:1s(,

os(lw)~lrtllrit IS (j IIInl (IIs{,:Is(,) 4 . tl)ltil{. ]1(1111:1of :Inkl(,, with ncwrolI(, dt,~t,n(~rnti(m 1 ((,:111[.(,1.) C~lIrI)m(, I)r(}ll(. hitis 1,’1111111(1,I)( ,.:ilf (’111{1111(,bI,IIIIVII ItIS ;IINI l]rtm{,hiot,tnsl.~ Al) <(,(%s Ill .[)14, of foot” (:; II.1)1111(1[* (>1) rl~ht ti)l~h “1’11111h ,,xLr:t<,t i(n) ll’l IIINus Inl(,(ll(,ll ,)( glln)H :In(l ~xil:ll(, (’111)111.11,11, I rillltll:ttl(, (;:1 .11, ,4.,,1,.,.1115 11,)IN.I. I ,.sl)ir:il,, r,v Inl(.(:tl{m, + At.11.rItw, Ic.r,bl I( INS:III (.lJ])ltU] V(II1) I lllii;lnl:l - “ 1

II(111 (,1 Vc,ln) In]l)(tllgo 3 l).vsm(.n(, rrh(,ii (p: IIntul munslruation) 1 Exfol int we (1(,rmatf,l)llytosts (seal Ing fungus 1 lnlt.vtltm IJI skin) Ecf roI)IwI, right cyc (malformed eyelid) 1 Asthma 1 BeIIIgII hvpcrtcnsion with headache (high blood 1 r)r[wsurfi) H,vpt:rmctrt)pia with h(,:tduche (far slghtectness) 1 - ‘“ M.yopiii with h~,u[lach(. (n(,ar sightcdncss) 1 FutIgus ]nflwtl[]n, auditory canal 1 ‘1’rl(h,]montis w]th cysLiLis (i!) flumatl(m of 1 I>l;ltldt,r)’ TIm.;I (r]ngwOrlllj 1 sllnplt. Il(wi:lct)(. 3 131011(,11111s 1 1~,, ,SII)I(. rul)tllr(,(l int(, rv(, rtebral {IIN(’ 1 FI,V1,IH ,,f unkw)wn (ari Kin 1 MtallK,]lt;tin 1{11,)1 1

l’r(,~rlulll.y 6 .— . .

URI cxme to the clinic for treatment. Similarly, the per cent of the Rongelap-Ailin@nae group tl~at developed purulent infections appears highe”r than the Utirik group. However, the diseases are tabulated for the period of observation Of each group, and the Utirik group was observed for only half as long since they were moved to another island when it was evident that further study was unnecessary,

2.6 CHANGES IN WEIGHT AS AN INDICATION OF DISTURBANCE IN THE OVERALL ME- TABOLISM

The body weight of individuals in the Rongelap-Allinginae group was followed routinely. Since they had an unrestricted diet and Al ate well, their change in weight might be taken as an

30 u ~ ....-----...... -...... —.— —— .——. . ..— — ——— ——.—— .—— —. ..— -—. . ...—.—..— . .-—--- .-— —..=.-. ..—.

...... ildicatiull of any tilsturimnc(> in Lheir ovt!r-nl] mttabolis!n. ‘~ht, Wt?igllt (’ll;il:g(’s ilI.IJ sumnl; lrizfwi III Tnl)ic ;!.3. 11 wl)uld l)tL Cxl)ti(”((-(t that within n }wrioti t)[ Six w(w’i{H, Imiivldu:ils INII(JW1(; ytw r~ ill)[l I);irti(’uliirlv II II)H(S I)III[)w II y(,:irs would K:IIII HOIIIC w(,lghl TIIr C;t(.t {tI:It IIII)SI [)f tlIIS III I(Is I

1111’iillJoll Sill. Ill Slllt(’ of Il)i,ir r(’lnliv[’ly Ill:lt’liv(’ Ilrl’ Nll(i Ilt’ilI“ty Hppl’t II{$N,1)11)s1(1[ 1111’:I(hlltti :IIH(I lI)sl wei~!l)t wllirh lIlityiII[ll[.;ltv H(MIM*iIItI,rl I,r Iontst. with lll{~ir m~rnuil mt~l:IINIlisnI ‘1’ltt’rt’ Is . .

‘1’:11)1{,2.:1 Mll(; li’1’ CIIANGES. I{ ONGEI.A1) ,\ N]) All,l NGi NAK (;l{O1ll)S

A~l~ (:ill{. g(lrll’s

Dt~l(lw 7 V(,urs Below I 6 yt’:1 r+ Ab, )vt. I (i .V{>III.S

i{ongt~ Iwp Group

17 2 4 :1(; i .“) 14

5 3 3.5 0.5- 10.() 0.5 10.0 l– 11.5 1:{ I!) 21

.2 ., 4 0.5 5.5 ().:)- 5.5 0.!1 8 77 80 58

Aillnginw. Group

N un)lwr t,bsth rwd 7 9.. Nufnbc r tlutl g:l]nc’d 0 3 wc ight Average g:l!n (lb) 2.7 Sprc$ml [,f gain (lb) 2–4 Number that lost 6 6 WC>ight Avcrugc 10ss (ib) 2 2 Spr(*:d {~f I(JSS (lb) 0.5--3 U.5–4. O 11, r cent IJ ~ruup 88 67 th:it lost weight .—-— —.— ——.. . . .

ment is open to question. Unfortunately, the weight of the individuals from Utirik was not sys - tematica]]y fcdiowed and no satisfactory control exists to aid iII intewretiw th~ 10SH in weWht of the RoItgelal)-Ailingi n:Le group.

2.7 THE EFFECTS ON PREGNANCY

Four women in the Rongelap group were pregnant when brought to Kwajalein. Two were in the first trimester, one in the second trimester, and one in the third trimester. None of these women had abnormal symptoms referable to pregnancy, and as far as can be determined pregnancy continued in a normal fashion. In the Ailinginae grot-p, one woman w= in the second trimester. No abnormality was detected. Fetal movement~ were unaffected in the individud in the third trimester. The hematologic changes of the pregnant women are listed in Table 2.4. Two individuals in the first trimester had marked depression of pla:elets but at no time was

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‘I”ilhl[, 2.4 II IA)O1)COUN’I’S” ON l)lth;GNAN’l’ lNI)IVII)ITA1.S I{ ON(; I,:I, AI> AND AI I, IN(; INAK (;1{0111’S

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1,’1rsl :i5,(luu I ,M)o :!,()()() h“I 1s1 !lO, ()(1() :), t)uu : ,:, UO %.(,(llltl I !Il), olw .1,000” :;, ()(10 1’}11).,1 I ~(), ()()() 10,000 ‘7,()()U

Ailinginm, G rImp

S(w)nd 170,000 7,000 3,200 ..

T:]hl(: Y.h PATIENTS TREATED WITH ANTIBIOTICS -. Antlblbtic Poticnt No. of I]UY8 t rented ulmd -,, N(I. ‘-: Condition

1 flw!p UXLCIW ivc slough uf epidermis 2 Penicillin l)f r(ll ,1 T

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1);1s I,,>,*II 1)0111.

2.8 DfSCUSSION ON ‘l’HP; USE Ok’ AN’1’ILI1O’I’1CSIN TIIIS GI{OIJI) ANIJ IN l{AI NA’1’l(JN lN,IIIHY

:Ipw’:ir tll~tiL[lt]biL)ti~fj sllmld not be started until thctw is a clear-cut clinical indi(atlon for the use 0[ these ilge IlttJ.

. .

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CHAPTER 3

SKIN LESIONS, EPILATION, AND PIGMENTATION

3.1 INTRODIJCTION EARLY SYM PTOMATO1,OGY REFERABLE TO THE SKIN

Tllv Marsllallese on Rongclap saw a visible fallmrt of powdery material that began approxi- I?liLt Cly fiv(’ tmurs after lhti initial flildl was seen. TIMI powder whitened the hair :md adhered to tll(,lr skin JS a salt-like film. The Martrhallese (m Ailinginae rept]rted a similar lmt less strlk- in~ 1:111(ml. “~ltf, Amerit’:ms {m lb)n~euik also saw a fallout and described it its ‘“mis(-like. ” Tile hl~rsl)illlCbSt! (III Utlrik dId 111)1 set! il f:kilotlt. The early symptoms were limited lo the Hongelap, Ailing lnae, and t(t il lesser ,xt~!nt the Arnericanti {m Hrmgerik. The early symptoms t.onsisted 0[ a generalized it{’hing and burmng of the skin, limited aimost exclusively to the exposed parts of lhe body. A l~ss c{msisterrt symptum wits burning of the eyes accompanied by tears. The sympt[)ms began the night of the fallout and continued into the next day. A few individuals had symptoms lasting as lung a~ two or three days. Decontamination of the skin of the exposed in- chv iduals was initiated either aboard the destroyers while they were being- evacuitted or upon ihei r arrival at the naval base on Kwajaleln. The classical initial erythema of radiation injury to the skin wati not miired by the observers who examined these individuals during the first 10 days. [f an initial erytt}ema developed in the native Marshallese, it was masked by their dark skin. An erylllema was not seen in the white skinned Americans exposed on Rongerik.

3.2 SKIN LESIONS

3.2.1 (ieneral Deserlptitm

Skll~ I(IS1{NISfirst appt>ared in ilIe flongelirp group after 12 to 15 days and in the Ailinginae atl(l Ih,l)gcllk ~:r(wl)ti :(fler 20 (lays. ‘J’herr were m) tjkin lesions 111lhe Ulirlk group. There WiIS (,(11I,Sl(l(, l’illll(, [I[ffcrci){.{, jt) tl)(, I{,llgtfl (I( time rte(,<,srj:try ff)r the development of !Jlt’ various lt’ - SI~JIIH. Ilf)wev{,r, i{ Wil S f{}llllll Illtll tlicre wits a t.fmsislent pattern Ill the sequentiill tlt’\~t’lol)lllt’ll~ III)e:+ItIIIs (m vari(ws t,xpIjst’d par’ls of lht’ txl(ly. ‘~lw prirrrlpal It’sitms m.(,urred rougl)ly in tiw foll~)wll)~”st’qucrli ial t}rder: s[”AII) (wltll el)ilatiun); nw’k, axill~ry region, anttw. ul)ital fossae, f~~(l, iirms, le~s, and t runk. Lesions on the flexor surfaces tended to prerede lIMJSCt~n the ex- tens{jr surfwes {see Table 3.1 for the time of appearance of various lesions). A clear cut primary erythema was not seen, nor was a late erythema. In a few cases, there was considerable scratching of the skin due to intense itching prior to development of gross lesions. In these cases, an erythema of questionable etiology was observed. This ery - thema may well have been due to the scratching. Erythema was likewise not observed preceding development of lesions in the white and Negro Americans of the Rongerik group. The first inctication of a developing lesion was an increase in pigmentat on. These pigment ed areas appeared in the form of macules, papules, raised plaques, or larger areas of

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‘1’,y[)(()( AK(L (} !; AK<, (i ITI AKI> l(i & OVI.I. ‘I’I)l J]i (;rt)III1 1,(.s1(111 ( 1:1 pt,(~pl(.) I I 3 p[x)pl(~) (:1}1 p(.( lplv) (ti4 pl’ll~dl’)

Epilnll,}ll I pills 7.(; :m.4 [ :1.11 [7.2 17 2 pills :IN.6 :{().7 !i. .’) 17.2 17 :{ plus S:i. tl 23.() N.:] 22.() 1(;

‘r(~td 1[)().() 92. I 27.fi !ili.2 I t;

Skill l,f,si~]l]s AI III~-(; r. . :)().7 3a. 4 :)4.2 34.4 -, tl&ll)(ls-wl-isl h :Ilt.7 23.{) 1H.4 21. tl F(!(,t 23.() 53.B 5:{. () 45.3 Arm ~ 15.3 I 5.:! 10.:1 [2.5 l,t.~s ‘;.(; 23.() 4.:i ‘i. tl “~rullk I 5.3 23.(1 4.3 9.4

Nail l’t~rrj{,ntali(m 61.5 100.0 35.() 8!). (1 .-. . “ lJ[~sl-{,xp(tsurl~ d;lys.

rounding skin. As the desquamation proceeded outward, the areas developed a rhararterislic appearance of a (,entral depigmented area fringed with a hyperpigmented z[me. Al a later stage, I)igmentation be~an in tile cenlral areas and spread outwards. After a few wet’ks thv cy(le was t(~mpleltd, ]eaving in most instances a relatively normal appearing skin. Appr’(lximaic’)y 20 per’ cent of the Rongelap group developed leyi(ms wiil(.h WI)rL’mt)rt! s(! - vere. Th(:fi(l Ic’ti.tms ml@\l he (.onsidererf as rtmlparahle t{) ser(m(f dl’~rt’t’ 1IIt’r IIIal Imrns. ‘1’il(’ (l(,c~l)c,r It, si(ms (j[.(,urrt,d I)rilwipal]y (m tile fet!t ;ind to ~ lesser t}XttlIIt t)[l iiIIL s(. ilil) :III(i [)l~ck :IIId I II OIIV (,ast, ~m t he ear. Iltlsler ftjrmtlti(m waa II(I1 c[mlmon. }l~lwevor, (III t II(’ I(wl, s(~IIIt’ larK~s i)ull;te (t)ilst(:rs) :Ippcartd. Aft cr a few days, \ltt*hyperplgmented Icsi(ms tji Iowe(i wt’t dt’.squ:inla - tion witil weeping and (rusting, leaving depigrnented raw surfwes of varying art?a. S[)n]tl ()[ these lesions became secondarily infected. Epitheliums rapidly covered the ulcerated areas within a week to 10 days. Pigmentatictn followed during the next few weeks. As healing m’ur- . red many of the more severe lesions (particularly on the neck and antecubital fossav) developed a thickening of the skin with an ‘“orange peel” appearance and a dusky, grayish-brown (’olot (see Plate 3.4).

...... -. . ..,...... ,.. .: ...,. .“. ,. .,. . . . — -— — —.. —.—.—.— . —----- ...... __ -—. —..-. . .._——..=

. ..” ...... in Table 3.1 is labuh+ted the im,idence of the.va’;](’ms types O( lcsi(ms II) tilt, l{tIIwel.11) I:r IIII~I with a l)reakdown as 10 a~e and the median time O( :Ippearanre. Simllnr d;l(:l ii~t, prt’wllui III ‘riiblc 3.2 ft~r the Aillngln#e xnd Rongerik groups.

3.2.2 Description and IlluMri~l ion ~~fSpecific Lesions

. The scalp and forehead lcslons appeared 12 to 14 days followinx exposure along with t*pl- Iati(m In lhv K(mgclap group. The skin lesions were maculopapular with a spotty did ribution. Tht>y w{!re (oncentra(t+ in thv areas of epilation. Tht’se lesions are Illust rat t’d in Plates 3.12 to 3.16. Sralp lesi(ms clmtinu{’d Lht’lr al)pearitnce over a period of about a m(mt Il. Th+, ~r(lu~s of 1(,si{jns in v:lrious Sl;L~IeS w(LI.(. I]rt>sen( in th(? HiImt? individual. ‘rhis Wtis IJilrt i[.ul:lriy Il(jlill)]t’ amf~n~ (Itc t.llildrcn. ‘ri~~, int”ld[’m’(’ t}f w’alp lesions w;is greatest in the O to 15 year ~r,lup (sm. ‘rat)l(, 3. 1). ‘1’11(,nt,(,k lILMIImSw(:re tli(, IIIIM (.{)inmon and I)LJK;LIItheir nppt?arance il few di]ys aftt!r Ihts wall) lt’sio!~s. ‘1’h(:s(LIt”fiions nppt!ar(’(1 ns I]ypurpigmlwted maculcs und papul(!ti wllirh sprcmd and (.l)dll>srt,d It)lo r-;ll~lli J)l; lqu(!s. ‘1’IIc’ lc~lt)ns usu:illy il~pearod fit-tit [m t IN’ Midt’ and f rtml s](ms I(!ndecf lo or(.ur in women wlwre their thick tmlr touched lhelr necks. Axdlary lesions were marulcqxtpular, less abundant, and developed simullantv-msly with the ne[k Iesiuntj. Tliese lesions are illustrated in Plales 3.10 and 3.11. The axlllary lesions were more comrpon in the young children. Anlecubital fossae lesions appeared about a week later than did the neck and axillary lesions. These are illustrated in Plates 3.9 and 3.10. The foot lesions developed later than the lesions of the antecubital fossae. These lesions were lo(ated mainly on the dorsum of the foot between or on the toes. They were initially charart eri zed by large pigrnenied plaques with subsequent bullous formation and in eight cases raw crusting lesions of varying degree followed the bullae. The foot lesions were not as common in children under 5 years of age as in the older age groups. Sequential lesions in a 14- year old girl are shown on Plates 3.5 to 3.7. One of the more severe foot lesions is shown in .t Plate 3.8. Lesi(ms of lhe hands, arms, legs, and trunk were less common, less severe, and developed later. A rt>iis of increased pigmentation were scattered over the abdomen, c!hest, arms, legs, and fa(’e. II)Crcased pigmentat ion of the sides of the face is illustrated in Plate 3.4. A striking early lesion was an erythernatous, weeping, excoriating lesion surrounding the anus which Oc- rurred in several of the babies and a few of the older people. These lesions were severe initially but l~ealed rapidly. Mo:it of the Marsha] lese had multiple lesions. The combination of epilation and the con- trasting hyperpigmentecf and depigmerhed areas adjal’ent to normal skin presented a striking al)pear~inre. The mul(iple lesions are illustrated in Plates 3.8 to 3.11.

3.2.3 Severity and Time Appearance of —Lesions in the Various Exposure Groups R IS not feasible to quantify accurately the severity and extensiveness of the skin lesions in the various groups. However, it was the uniform opinion of all observers that the most severe and extensive lesions occurred in the Rongelap group. The lesions that developed in the Ailinglnae group were much less severe and extensive, and the Rongerik group (Americans) hud only mild lesions. Skin lesions were completely absent in 60 per cent of the Rongerik group, as opposed to approximately 10 per cent in both the Rongelap and Ailinginae groups. Transepidermal necrosis occurred in 20 per cent of the Rongelap and in 5 per cent of the Ailinginae people. No lesions of this severity were seen in the Rongerik group. The lesicms appeared earlier in the Rongelap group suggesting a higher dose. The comparison of the incidence of epilation and neck lesions and time of appearance is illustrated in Fig. 3.1 for the Rongelap and Ailinginae groups.

...... *.. . ..,. ,. .-...... ’ ...... ,...... —.-— ----— -. .-— .- —— — .— .— —.-. L ______-______...... ,...... ‘......

.-‘ s.. ?...—..””:

Plate 3.3 Replgmenting superficial neck lesions at Phte 3.4 Htwled 1](’[’lilesiotis at 77 days showing 40 days. Hyperpigmented area: not completely dusky pigmentation of b:ick of neck case 39, age 15, F. ● desquamated. Case 24, age 15, F.

4 ...... : . ----- .. :::. :. :...... -...... -. ..: -. .. ---— ————— ..— .... —- —.——__ —..—. .-—. .-. ______. .

. . .

. ., 7 f (1 I d, \ b) 1,$ .1 ,. I ,-! .- ,: -- ,. C. I [1 ,. 1) \ I .- -a I ,, \ I .1 I \ i) 1 t,, \ I J x : 0( \ z ‘j‘\ \ 0 ‘%\, \ ‘\ \ \ \, \ m z IL. [1 —.

---- 4

I I 1

o c 0 0 P- 0 0 ( u u-l e r-l N

...... ,.. , ...... , . . : .,...... ’, . . ...,: ...... ,. —. .- .— ——— -.—.....—. — .— .—4..s.______------

. . . 3.2.4 Hlstopatholc)gy

Seven biopsies were taken of neck lesions and one of an axillary lesion during t II(’ (bird t () fourth week after exposure cm the Rt~ngelap people. ‘rhe lesions biopsied at that t Imt’ wtirt’ in the hypcrpigmtwttxi stage with lilt Ie or no desquama! ion (sheciding) having ort. urrcci. Most uf (hese I}lopsies were taken from individuals who sh(}wed lesions of greater than avtira~i> sii- verily. A serfmd group of biopsies from the Rongt’lap group (repeated in three Individuals) were taken; four al the seventh week ixjst-exposure i~nd five at the eighth-week i)erlod. These were taken from the nm. k and antecubitxl fossae. All of these lesitms had dcsquanmted and the depigmcnted skin l)ad repigrnenle(i to a dusky, gray (O(}lor with some thickening (“t)~iillg~-[)t’el” appearance) of the skin. Bi(jpsles were not Laken from open leMicmH or from the frt’t f[lr ftwr t)f infect ](ln. Ali biopsy wounds healed rapidly with n{) tiecondary l“oiI~l)licati{)l~~. TIIe micr{~scopir flnding~ are tmmmarize(i a~ follows: Eariy bi{~f)sit!s 3rd to 4th wtwk. Epidermis ‘rr:lns~’l)i(i(,rr~l:il (lama~e was n~dt’d with a fuw lnl(, rventn~ arcades sh(}win~ iestt dnmage (Plale M3.18 amf 3.1!)). ‘f’lw et]i[iermis in t}w mod ~,xtensively involved artms showtd (tmslder- at)ll, al roptly wI[h fl:ltlcnlng of (he reit, l)e~s. in l)lar(’s the cptdermi~ was rtxiu(.1’(i to it thit.k - ness (If 2 (() 3 (ells (Pl:ltes 3.20 amt 3.21). The ct.lis ~]f the mitipiglltan layer SI1OWA pleonlorphic nuclei, pyknosts and (.yloplasmlt. haios, giant ceils an~i in a few instances multi nurleti(ed reils. Pyknosts of {,elis of the basal layer wits comrnoniy seen. Focai disorganization of the mal- pighlarl and basal layers was usually present in the more extensively damaged arcades. Cells laden with pigment were frequently present throughout the epidermis and Intercellular pigment was noied in some sections. The stratum granulosum was usually atrophic or even absent. Imperfect keratinization with parakeratosis was visible in all sections. Hyperkeratosis was also seen. The stratum corneum was ioosely fibrillated. The arcades of minimal damage were usually found in areas where sweat ducts approached the epidermis (Plate 3.19). There was an apparent increase in the numbei of cells and mitotic figures in the neck of the ducts and the adjoining areas where regeneration was underway. In these areas the stratum granuiosum was near normal width and pigmentation of the basal cells noted in tile more severely damaged areas was lacking. Chan~es in the dermis were largely confined to the pars papillaris (F’ates 3:18 timmgh 3.21). Miid ddema in some cases was noted. Capillary loops were often indistinct and when dis~”ernibie “they fretiut’nlly were associated with an increased number of pericytes. The t?ndo- tltc!liiil {.eils tdl[)wed swelllng and were polygonal in shape. Teiangiectatic ~.hanges (diiii(ed bl,jtd vessels) werv nol{!d in areas where the overlying epidermis showed greatesl damage with lymplif~t.yt I(I infiltrall~m surr(mndlng the lclangie(.tat i(. spa(’es. Chromatoplmre~, fiiicd witl~ nlei:m]u pigment, wet-t’ prt]mlnent In Il)e superficial (iermis. The fine elastll. fibriis running ]nl~) tilt, pars paplllat-ls were [)flen altered or absent. LJtlle if any damage was seen below the superficial pars reticularis. The hair foliicies wert, narrow (Plate 3.22) and In most instances devoid of shafts in this regwn. There was some telangiectasis of the capillary spiices bounded by lymphocytes and monuulear phagocytes in the superfi(:ial pars reticuiaris. Some of the large elastic fibers in this region showed slight sweiling in some instances: No damage to fii.mocytes or collagen fibers was noted. Second series, 7th and 8th weeks post-exposure. Epidermis In general, reparative processes of”the-epiderrnls appeare–d to have been fairiy good, except for a few persistent areas of atrophy with narrowing of the epidermis and finger-like downgrowths of the stratum m:lipighii (Plate 3.24). These occ”urred in areas of greatest epidermal narrowing and the cells showed rather prominent pi~.ment content. There were many outward eplderrnal excrescences covered by thickened stratum corneum which was stili loosely Iaminaied -- such phenomenon produuing a wrinkled appearance which probably accounted for the “orange-peel” Iike appearance of the skin noted grossly in the areas biopsied (Plate 3.22). In almost all instanc; s the basai layer was intact with little or no disort:anizaticm noted. There were a few scatterc~i areas in which (JV~aSlOnal epithelial cells with pyknotic nuciei and peri - nurlear cytoplafimi(’ 11”’tl(lti (It,curred In the stratum Kranul(mum and malpighlan iaycrs (Pia(e 3.23). “rhere were (,(.( ;is Ion:il :Ir(:ades in which tlw epidermis, particularly tile stratum gr:mu - losum, appeared IL) I)(:;mtu:l Ily w]dened. These o((.u~red almost []reduminantiy in relationslup 38

—..——— — .—— _ —_.. ___ .- . —. . . —. —.— — L—— ____ _-_. __.. ___... _. ___ .’.—__——

......

.,4- +’

● ☛ wM.mi._

1’1;11! :!!) II VI) I, I’I)IIJ II II.111(,(1 1:11,s(,(1 1)1;1(111(.s ;1])(1 Pl:ltf 36 lj{~siolls 10 (I;lys Iillt’1”. 1~1111:11’ ll:lV(’ 111111.11011 (1(11:,1111101 1(.(1, ;Ifl(l t(l{$h ;11 :8 [I; lys 011{, l) f’ok(>ll, ([($S(lll; llll; ltloll IS (M(,ll[l; liiy (,0111})1(,1,(,, ;Ill(i 11:1011 1)11 11[1 11)01 :, II[)M > (11~1,]11,1lllvolv(,ll)l~lll. k’(’(’( I(,SIIIIIS II; lv(, Il{vll(xl FIY’L II(1 I{)llK( ’I’ ])ilillflll. W(t’1 II, LIIII III :1( 1111,’.1.1111(,,

...... ” . . ..: .”.. .“: ...... ::. ::: ...... ”... .: ..:

—. ..=— -— .-._...._ _.._. ——...— ---— -— —---—- .—. — —. -—

...... 10 the ~.Onlipolls Sw{,a( ~land ducts nt sit;~:tj “i, tleru tl}t~ li\ltt>I In,nt,lI-;ittxl1114,t,~)ttlt,trl)ls.A II:)r row zone of Ilarakeral lnc~sis iind amorlth~ms debt-ls wi~s St III l}r~,sen{ IN.IM,tN.Ut I)CSM I;IIU III granul(~sunl :Ind llIt’ lt~t,st,ly laminated Ar:ltul:l (.ornt,um. Dcrn)ls Tlw (.aplllary l(I(Ips In (I]t’ (ierma] pNIIIll;It’, allhIIugh llrt’m’tit; Wt’rt’ II(1Iullitl)rlllly (Iislln(’[. Pcrirytes remainmi in inrreasecf number but fewer iylnphtj~.ytrs wt~rt” pr~’s~,nt. Gt)nrrally, [hvre appeared to be sl@lt telanglectasis of I)le cilplll~rlt,s In the pars pal)lllurls and ItIt’ superf)cl~l purs retie-uiari~ (Plate 3.24). Thttre watj some edema of the p:~rs paplllariy (Plate 3.22). Scattered pigmtml laden chromatoplmrcti were )rre~ulilrly distributed In ttw papillary layer (Plate 3.23). In some cases hair slmfts in the superficial pars retirularls were quite narrow, at rt~phir, and occasionally absent; in others the hair shafts ~ppeii red normal, Sn}iill hair follicles (Plate 3.22) and secretory sweat ducts in Home cases sh,)wed miid atrophy. Blt]psies of three piKnlented mild lesions were taken fr

3.2.5 SyrlIljlIJItI:itfJl(Jgy and Treatmen(

On LhtI day ,)f t’xplmure, ttrhitlg and burning of the skin wittt prevalent. This subsided and [or a lwrltd t~f 10 to 14 days or longer thl, rt, was neither sut)jertivt, nor ol)je(,tlve ~widtmce of skin injury. ltc.lling and burning reappeared either pr~[)r tl) or in the early pigmentation stage. With thv deeper Iesi[ms there wiiS also pain. Pain was ralher marked with the foot ieslcms. During the painful Imri(jd some of the foot lesions were also hot and presented it brawny edema, A ctm]nlon c[m]plainl was a tenderness in the great toes medial tu the nails. However, visible lesions in this area were infr~uent. ‘1’his symptom usually preceded the appearance of gross lesions eisewhere on (he feet. Many of the individuals who developed painful foot lesions were observed walkln# oa their heels for several days. The painfulness of the foot lesions may Jiave resulted from their greater severity, and may have been accentuated by the dependent nature of the foot. Some of the lesion? of the neck and axilla were painful when turning the head or raising the arms. The acute reaction and pain subsided after a few days. There were no constitutional symptoms. The treatment of skin lesions was largely non-specific. Most of the superficial lesions were treated wit h calamme lotion with one per cent phenol, which in most cases relieved the itching, burning or pain. A few of the painful hyperpigmented lesions not relieved by calamine with phenol were treated with pontocaine oinlment, with apparent success. When the epitheliums tfesquanlatect the itching was reIieved by daily washing with soap and water and the application t~f a wat(, r soluble vanishing type ointment wl)ich kept the injured skin soft and pliable. Raw areas, wllIrl I b(, (,itm~ se(, ondarily infected, were treated by washing witil soap and by the appli - (.atl(mf)]aurtv)rny(. in ointment. i3ullous Iesi(ms of the feet were left intart as Itmg as m) synlp- t[~fns were j)rt, s(, nl. if II:iinful, the bullae were ilt3pirilte(i with stt~rile (echuiques t t) rt*nl{we the (.lear straw-(.t)lort.d flul(i. A single ;tspirati~m was ad~te sire. e tlw bullac~dld not rt,fill. One f(Nd lesion dt>vclf,l)e(i :LII t,xtensive, raw weepin~ ulcer. Proidlylurtir i)enirillin was given for two days, dttr)n~ wt)i(. t) I Imr Il}t, lesion developed healthy granulation tissue. iion)e” i~f the le - ‘ ~i(ms of t lie sk)n ()[ the f{~t>tremained thickened, less pliable, and painful after de.Wui~mation. This was relieved by the use ttf vaseline or rocoa butter to soften the tissues. One persistent Sar lesion did not heal after d.esquamalion. This was treated with warm ix)ric arid compresses and washing with surgical soap to remove the eschar. Granulation tissue formed, and epitheli - urn was slowly growing in from the edges of the ulcer when the initial observation period was terminated 74 days after exposure. Upon resurvey six months after exposure heaiing was com - piete, with a depigmented scar remaining as evidence of the previous ulcer.

3.3 EPILATION

The incidence of and time of appearance of epilation in the Rongelap and Ailinginae groups is illustrated in Tables 3.1, 3.2 and Fig. 3.1. Epilation was first observed on the 14th post-

39 —..—— .— —--——.———— .-

exposure day in the Rongelap group”~nd-~as.~o&lnkd to the head. Tile epilation Wil S dlvidmi arbitrarily into three degrees of severity. “1+” epilatlon indicates loss c)f hair wiliuwt ohvitNIS thinning; “2+” indicates a loss {~fhair sufficient t~~cause obvious thin spots; and “3+ “’ indlt.ulcls an exter, sive epilaiion with i)iild spots. Table 3.1 illustrates that there was a greater dt’grrt> of epil:lti{m In the rhildrcn (O ({) ’15 ye:lrs). Over 90 per cent developed ~plliiti{)n of sl~n~c degree in the 0 to 15 yt!ars grt~up, c~]mp~rcxi 1(I (rely 28 p{!r (“cnt in thv older age group. Tt](’ pre}ltm- -. deran(’f’ of sc;ilp It’si(ms in tile ilrc:is ()[ epilati(m Indirates that radiatiim fronl tilt’ filllt~ut mu- ----

‘1’}11)1{ :!.2 1,1’:SIONS IN All,l N(il NAh: ANI) I{ONlil’:l{l K (; I{(JIII)S

l~t,l. (’(*III Ijl.r’ (’(III ‘1’vl)(. ()[ or ‘I’1] 1111 M(,ruI ‘I’i III(, 01 of “rtltul MI,IUI ‘1’1111($III 1,(, s1{)11 wtlll 1,(, s11111s Al))){Siirnnt.{,” with L(-SI(>IIS Al)ptmnrw)(.(.”

l.:~)ilut](m I I;.7 27 3.5 I 42

1.(, s101)s 4)[: scalp & Fart, 2(i 10.7 :12 Neck iuI(i Shtml(icrs 61.() 27 14.3 30 I)zi[.k ().0 7.1 28 Axilla 22.2 24 3.5 23 Ant(xwhltd FOSS[l(, 11.1 28 25.0 29 Hand & Wrist :1.G 38 3.5 47 F(;et 16.7 33 3.5 43 I.qs .’5.(; 44 0.()

Nail 40 Disc !orHtlorl” 77.7 38 17.9 .s (All Nc~roes) .— -. .- —-.

● L)uys JMISi ‘I> XPOSUW. I on{, cast, rlIIlm[d slight (.plltitltm. Qucsthmable.

terial on tile skin is primarily responsible for the epilation. In the Ailinginae group only three cases of mild epilation developed in children (Tat)le 3-2). Slight regrowth of hair was observed in all individuals nine weeks after exposure. Hair regrowth was complete and normal six months after exposure-

3-4 .NAIL PIGMENTATION

An unexpected observation was the discovery of a bluish-brown pigmentation of the fingernails which was first well documented on the 23rd post-exposure day. The discoloration began in the semilunar area of the fingernails (to a lesser extent in the toenails), and tended to spread outward sometimes in streaks. As the discolored area grew outwards the semilunar Area usually be{:ame clear. In a few cases, detachment of the end of the nail from the nail bed was observed when the pigmentation reached the end of the nail. Plate 3.17 shows pigment ed bands in tile nails at 77 days. The discoloration of the nails was seen in 89 per cent of the Rongelap and 78 per cent of tiw Ailinginae group. It appeared to be a radiation response peculiar to the dark-skinned races since it was seen in all of the American Negroes in the Rongertk group and in none of tile white men. ‘rhis lesion was not observed In the Utirik group nor in the control Mardmllese. Sin(”e the nail I]igmentation occurred in individuals witilout skin lesions, it ‘dp- peared to be tiw result of ii more penetrating component of radiation than contact radiation which pred(~minantly []roduced the skin lesions. 40 A ...... ,-, ...... - ...... ‘! ...... —. —.-. —.- ..— _—— ——.— .— ..—. ..—-—.— —... ——. .—-—-.-—- ---

...... ----.

. , ‘.

Pkltcs 3.8 3.9 Extensive lesions in boy, age 13, case 26.

c’

, ...... _.. --—.——.—. —. . .- .——<.. — 3.5 FACTOKS INFLUENCING THE SEVEitlT”Y’OF SKIN LES1ONS

3.5.2 —Energy of Beta Piarticletr

From avililablc ditlil (m the fallout mat eria] It has be{,n Cx]cul:i(eti ttut 50 (1) 80 pt, r t.{~nt of the beta r:lys during (he exiwsure period werr soft with an avt~ra~e energy ;Jf :Ilxml 100 kt’v. Since 80 microns of tissue - uces 50 per rent aitenuali(m of sut’h radi:it i(m, 1 the, grealt’r portion of energy was dissi s in the:epithelium which is roughly 40 to 70 ml{’r{ms in lili~sk- ness. The remaining 20 to 50 per cent of the beta rays wt~rt~ of higher energy, will} an avt’rilgt’ of approximately 600 kev. The latter.,- would penetrate well intc) the derma since it takes 800 microns of tissue to produce 50 @@ircent attenuation. I ,2 ~11;ldditi(]l], a wide speUtl,U1ll (If gaXllnla energies irradiated the skin. Approximately 10 per rent of the total gamma spectrum was below 80 kev which would be absorbed largely in the superfi{. ial layers of tile skin. The remainder of the gamma spe(, trum is distributed between 100 and 1600 kev with a large proportion between 600 umi 800 kev.

3.5.3 l~hysi($ai Dose to the Skin

Tilere lH m) practiral way to estimate the physical dose to the art?ad of skm where lesions were f[mnd. The ent ire surface of the body of the Rongelap group received approximately 175 r from gamma irradiation derived from fission products distributed on the ground, trees, and buildings. To this 175 r would have to be added the beta component. In view of the htgh bstik to gamma ratio in fission products, one might expect the total beta surface- dose to ~ skin to be large. The maximal skin doses from the plane field of radiation are estimated in ~hapter 1. To these doses must be added the contribution of the material deposited on the skin. The latter can not be calculated, or estimated biologically with any degree of accuracy. A rough approximation of dose received at the ilair follicles can be made as follow.% The hair follicles must have received a dose comparable to the known minimal epilating dose of about 400 r for 200 kvp X-rays. Since regrowth of hair occurred, tile upper limit of dose at the depth of the hair follicle must not have exceeded the permanent epilating dose of around 700 r of 200 kvp X-ray. $

3.5.4 Protective and.- Aggravating— Factors The individuals who remained indoors or under the trees showed smnt? protect ion as compared to those who were in the open dJring the period of the fallout. Those WIM went swimming or bathed were also- prote(.ted to varying degrees. $jmall cilildren WIN)wtInt wading cfevelopt~d few[?r foot Iesi(ms. Clothing, even a single layer of cotl on mat er]al, offertwf almost (.omplcte I)rotectlon, as was d(~rn(mstrat(d by the Fi(.! thilt les]ontt developed almI)tIt (,ntlrcly (III the ex - I)os(;d [Jilrts of the body. Sin(.e the lesions predominate in areas where perspiration 1S abundant such as folds of li]e neck. axillae, and antecubital fossae, it seems likely t])at the abundant perspiration produced by a hot, humid climate tended to cause the material to concentrate and adhere to ~hese areas. In addit]on, the coconut oil hair dressing used by the Marshallese acted as an effective rollert- ing agent for the radioactive material. This was proved since the hair was the most highly contaminated part of the body. The concentration of radioactive material on the hair may have been responsible for the large number of scalp lesions, epilation and the large number and se~erity of neck lesions in women.

...... —— -—.-— .- .—.. ---- . — ——..-—-——-—— -—-————--————--—------.—.-— -*

,...... :. There was a delay of two and one-half day~ bt!forr satisfactory doc(mlnmina(i{m WNSp(w-

. 3.6 CORRELATION WITH klEMATOLo(ilCAIJ FINDINGS ... . A(lempts at’ correlation of the severity and extensiveness of skin lesions with nulximum depression of plat elel, Iymphoc yte, and neutropbi Ie txmnts were nuldt’ for illliividuals in thr Rortgelap groui]. No posilive correlation was found. Thus the rontammiation of the skin apparently di(i not significantly contribute to the total-body dose of irradiation.

3.7 DISCUSSION

There has been little previous experience with radiation dermatitis resulting from exposure 10 f:tlltmt material from nuclear detonations, and the general c.onsentms until now has been t hilt t Iw haz. ird fr(]nl fal Iimt material was ne~ligible. With the Hiroshima anti Nagitsikk! dettxla- t i(ms, f:lll(mt mater]al was not a problem since the b{mbs were exploded high in the air. The flasl] lmrns of llte Jupanese were purely thermal. Fr(ml the [Jr(3S62nl experlem.e it is quite evident that following detonation of a large scale dcvi(e (’l(JB+) to the ground, serious exposure of pers~mnel may occur from fallout material, even :i( considerable distances from the site of detonation. The incident described in this paper is the first example of large numbers of radiation burns produced by exposure to such fallout mater ml. Knowlton, et al.’ described burns of the hands of four individuals who were handling fission product material following an experimental detonation. Also, following the Alamwordo . detonation, there were a number of cattle that developed lesions due to deposit of fallout nla- terial on their backs. s In addition, there were a number of sheep that developed lesions closely resembling radiation burns following a Nevada detonation. However, Lushbaughc -reported that the histopathological characteristics of these lesions did not conform in all respects to radiation dermatitis. It is of considerable interest to compare the present experience with that ac- cepted in the past as the typical course of radiation burns of the skin. The gross lesions of the hands described by Knowlton, et al. occurred from an exposure of about one hour, resulting in doses between 3000 and 16,000 rep of beta radiation (maximum energy about 1 Mev) with a small gamma component considered to be insignificant. The lesions were des(. ribed as developing in four phases: (1) An initial phase which began almost imme- diately :ifter exposure and consisted of an erythema with tingling and burning of the hands, rt!a(.hlll~ a pe:lk in 48 Il{wrs and suhslding rapidly so that by 3 to 5 days there was a relative :Lbst’l~f.t, of sIg IIs; (2) A secf)nd phxse which occurred from about the 3rd to the 6tb or tllh day and wiis (’ha rarleri~. wi hy a more severe erythema; (3) The third phase at 8 to 12 dnys, which waH (’lmra(.1(.rized hy veslciv :Ind t)u}litt’ formation. The erythema spread to new iirem during the f(,lll,w!n~ twtj weeks, anti III(’ active pruvess subsided by 24 to 32 days. The bullat’ dried UP, and dcquanlati(m and epithelization took place in less severely damaged ~reas; (~) Tile fourth phase or chronic stage was characi erized by further breakdown of skin with necrosis h~ areas which were damaged sufficiently to compromise the blood supply. Atrophy of the epidermis and loss of epithelial structures took place, which necessitated skin grafting in some cases. Robbins, et al.’ reported six cases accidentally exposed to scattered cathode rays (beta) from a 1200 kv primary beam with exposure time of about 2 minutes and a rough estimation of dose to the skin of between 1000 and 2000 rep. The lesions described were similar to those reported by Knowlton, et al.’ with a primary erythema developing within 36 hours, secondary erythema with vesiculation and bullae formation appeartng about 12 to 14 days later; and, in the more severely affectedj a tertiary phase characterized by further breakdown of the skin. In comparison. with severe roentgen ray reactions these investigators stress the unique pe - riodicity of cathode ray burns, relative absence of deep damage to the skin, less pain, rapidity

...... ,.4...... , ...... —— -.— - —.-——.——..-—.—_.—. —— —. . —— .. —-. .— —. .- — .—— —.—:—..— —..——-—. . ... ——.- J . —-_-_ —..

. .

. . .

-......

.- ......

*. “

...... ” . : .”.””:.”: ...... ” :.::: . ...; ...... ::..+...... —– .— — .—. ———— .- . .— ——— .——___ . .

. . . . . of healing, and absence of pigmentation. ‘~h-ese polnls would apply lcI the M;irsli.rlltist> tLxcL,j)l for the multi phasic reactions and pigmentat ion- Crawfordn reports a case (If catlmd(’ r~y Imrns of the hands wh~tt were simiiar to those described by f{obbills, et al.7 -.. Experimenlai betia radial i[m burns In hunmn beln~ti have been reported by -Low- Metir’ and Wirt h :ind Ralwr. w Both invest igittors used #* dirwti appl]cd 10 the flexor surfiwem t)f the “- arms, fl~rearm~, or thi~ha for varying len~hs of time. Low Dwr r[qmrted ‘“tt~(ill~)l~lt:tst~.”skin ~ rf!acllonti. Ht. fi~und that a ral{, ulated dose ~g 143 rep to the first millimeter (d skin, igtwiring .’. rmlf-abw]rp(ion, pruduccd a threshold erythema. Dry, trraly, d~~uilmati(]ii was pr(uiured by 7200 rep in the fIrst mill irrm~tcr and tmllous, wvt desquilrnat itm wtt~ pr{nhwwf hy 17,000 rep 10 (he first millimeter. Ery(henm developed in 3 t~~4 duy~, followrd later hy ptgnj(’nt:t( iim and tlesquamati(m w]III higher dt)tie~. Recovery wus obtrervrd with d~]ses t~f 17,000 rrp. ‘f’he Ierdtnlm later sl)t,wed dcpignmntcd (.mdcrs with hyperpigmented edgeti (HISO Hew hI tlw prer+ent k!- si~ms). .. Wirtll and Raper10 produced primary eryt lwrna within 6 hours after exposure t (} ii dose (}f 635 to 1180 rep of P$z radiution. Minute vesiclrs with dry, spotty de~uamati{m were nt~ted with 1180 rep at about the 5th to 6111weeks post-~xp(lsure. Following the detormtion on 1 March 1954, 23 Japanese fishermen were runtaminated wilh fallout material. Apparently they were exposed to roughly the same total-body dose of radia - tion as were the Rongelap group. The skin lesions which deveIoped are described by Morton, et al 11~lz Le~i~ns developed wtlich were similar in most res~ects to those seen in tt~e Mar- shallese people, and were characterized by pigmentation, desquamation with depigmentation, spotty epilation of the head and ulcerations developing particularly on the scalp, ears, neck, and hands (the latter probably from handling contaminated fishing lines). Erylhema and vesicle formation, as well as inflammation of the eyes were more promment than in the Marshallese. Pigmentation apparently was not as prominent m the Japanese. The lesions appeared earlier than in the Marshallese (about 7 to 8 days post-ex[ inure). As in the Marshallese the lesions o[$curred mainly on exposed parts of the body not protected by clothing. In addition to the Marshallese and Japanese, seve”ral Navy men on ships in the test area devt?}(Jp@d a few small pigmented lesions of “belt-line” dist ribut ion, apparently due to fiallout material. ..! The Ieslons reported in this paper when ct)rnpartd 10 radiation leadons dewribed in the I)iLst presenled rertain unique’ features which merit further riiscustrion. The eorly sympioms of itching and burning of the skin ;Itld eyes were probably due mainly 1(}skin ~rradialion from the faliout material. however, the chemical nature of this material may have contributed to the irritation. It has been notedf$ that irritating chemicals i~pplied during cw shortly after irradiation enhance the effects of radiation. Th@,lack of prominence of an erythema was notable, particularly in view of the severity of some of the lesions that developed, Wilhelmy It ~tate~ t~t erythema only occurs when the dose reaching the papillary layer exceeds a certain level. Perhaps t~ dose to the dermis was insufficient to evoke the response. On the other hand, the darkness of the skin and the development of hyperpigmentalion may have masked an erythema. Microscopically, a superficial . .=..?- i~yperemia was not a notable finding, Wirth and Raper10 point out that they were impressed in their studies cm @z radiation of the human skin with the difficulty of distinguishing between true erythema and tanning, particularly in the skin of brunette individuals. It wasunfortunate that color filters were not avaiiable to aid in distinguishing an erythema as suggested by Harris, et al.ls In general the laient period before deveiopn]ent of obvious signtr and symptoms for radiation injury to the skin is inversely proportional to tiw dose of radiation. ‘8”17 In tl)e present series of cases the relatively long Iateni period IS suggestive of a low dose of radia(ion. How- ever, the wide spectrum of beta energies and particulate distribution of radioactive material drastically altered the depth dose, as compared with that in previous experience; hence strict ccrmparisons cannot be made. The later development of lesions In the Ailinginae and Rongerik groups as contrasted with the Rongelap people is in keeping with the relative severity of lesions noted.

...... ,...... ,.. . . ,... . . - ...... __.—— . .- —. —____—— .. —_ —______. ____ _..- ______.._.-. ...— -— ____

...... A unique feature of the present cases was the appreciable differences in IIIC l;Ltt,nt prrl(niti observed for lesions on various parts ()[ the body. These dlf[rrenre~ (.ilrtnot be t’q)ln intd entirely on the bas)s of severity, since the severe foot lesi(m~ dtwc’l{>ped altt>r ll~{wl I)tlitsr lv - sions. However, the severily might have been in part due to tlw depvndent p(Isiti(uI of Ihe I(I(JI rather than greater radiation injury. Lesions on flexor surfaces in ~eneral preceded Icisi(ms on extensor surfaces. The present data suggest that the latent period and radiation sensitivity . of various skin areas may differ. Previous work has shown timt flexor surfaces witil thinner -*.-’ epidermis are in ~cneral more sensitive than extensor surfaces with thtcker epithellulu.’s The destruct ive and atrophic changes of the epidermis, disturbances in kerat iniznt ion, and atrophy of hair follicles are characteristic of histopaiholo~]c radiatitm injury of lIw skin. D’ta’iu-31 Severe injury to th[! dermis and bl{mf vessels was not observed. The minimal dt”rrni[l Injury wiUl severe ep’iderma] )njury is in keeptng with the I[jw ener~y bela component presvnt and thv marked de{. rease in d(!plh d(]s(! twcr it distanre {If a few micr(ms fr~)n~ the surfm-t’. t{yI~crl~ignlcntittit,l] of injured iir:ii~ wa~ n c(msistvnt finding in the Marsha llt’tie, the Japa - nuse, and Ilw Ameriran Ne~r[wH. l~lgmented lvsitms were alst) obtierved to n le~m’r t’xtent in [he whit{) Arnerirans. l~igmentuii(]n of thi~ natur~’ hiiti not been drrwrlbed ii~ II constant rirarac - terisil{ of radlatit~n [larIIagc_tt) thli trkln. There 18 no sat l~fii(.t(]ry t:xplitnaiitm for il)e da rker duBky-~ray rolor t hat appr;ired in some of th(’ sk]n Icsi(nis as healing pr(~~restied. Tile (tt)lor changes may be due lt~ altt!rali~ms i.n I[)(”ill plgrnen( produrtl(m, vawuiar c}ran~es, or a thinning of the epidermis, rendering it more translucent wit h resultant darker appearance of the pigment layer. Later biopsies may explain this phenomenon. There are features of the lesions described that appear unique, e.g., the absence of visible multiphasic responses, the presence of early hyperpigmentation, the long latent periods, and the severe epidermal injury with minimal dermal injury. It is possible that differences may in

part be on a racial basis. ● In addition, the marked difference in histologic response of the epidermis and dermis in the present series is in marked contrast to the usual radiation response of the skin produced by high energy X- or beta-rays. In Table 3.3 are Ii steal the approximate minimal surface skin doses required to produce recognizable epidermal injury in ar.. reals. It is apparent from the table that beta ‘ray energy is of considerable importance in determining the degree of injury. A number of assumptions, including knowledge or the beta ray spectrum from the fallout, would have to be made if these . data were to be used to estimate biologically the beta dose received by the Marshallese. The difference in dose between that required to produce threshold skin damage and that for permanent damage in pigs is 500 10 1000 rep.so It is impossible L(J estimate Lhe probability of development of radiation cancer at the site of the healed Jesions. The absence of scarring, telangiectasis, and extensive chronic vascular Iesrons tends to imprtwe the prognosis since the foregoing are usually observed to precede the development of riidlation cancer. A filvorab]e pri)~nt]sis is also suggested by Li]e following evidence: an analysis of 1100 individuals exposed to low voltage X-ray for dermatological conditions revealed no evidence of cancer induction 5 to 23 years after treatment. MacKee is states tt]at epithelionlata rarely develop after a single dose of radiation to tht? skin. Lastly, the incidence of skin cancer in Negroes 1s one sixth to one ninth the incidence in Caucasians.SS If neoplasia can develup purely as the result of epidermal irradiation, the incidence of late cancer”s may be enhanced since the dose of radiation and the visible gross and microscopic injury to the epidermis greatly exceeded that to the dermis. Since many children and young adults were involved, the life expectancy of a large number of the exposed people will exceed the long induction period for development of radiation cancer observed in radiologists. Long

* Reported cl inicai experience with radiation skin lesions is based predominantly on the response of white-skinned people, whereas the type of lesions described herein, with one clear cut exception, were observed m Japanese, Marshallese (negroid), and American Negroes. The exception was a dark brunette individual.

...... -. . ... ,. , ...... --- -—. - ——-. -—.—. --- .-.-.— —— ——.—_-—.____.’__.— ..- .—. . .—.———--- .—————— ...... t’ . . ,: ...... ,. .

.W9,.-”7.. ., ---- ..w, ~m.

. ..

‘“+

...... ——. -—— _.. -—— .—-. —__ ._____ .:.. ___.& ____ —— _____...... -

exposure to tropical sunlight, potentially ”~arcino~enic” in itself, may h~creust’ tlw pr(}bubility (d neoplast ic change. The influence of the sub-lethal whole body exposure received by theue people on skin cancer induction is not known. The transverse band of pigmentation that was observed in the fingernail~ ha been previously observed by Suttcuz34 in a negress who received 150 r of soft X-ray to the hands. The

. Tablo 3.3 SURFACE D(X3ESIN REI’ RisQUIRED TO PRODUCE RkXXX;NlZA}3LE itPIDERMAL INJURY —. .—. - ---- . . . . Average .%rfact! lnvestt@or Animal Irwmpe Energy (Mcv) L){mr(Wp) —.. — . .— ---- —.. *,$1 Rnts 0.6 I,:)00 4,000” p Rat n 0.5 4,000 *,12 MI(w 0.5 [ ,500 n l{ntzblt~ P 0.5 5,000 IJUKIIL)ZLUKI1’ Shuep Srw 0.3 z, MI(J -6,000 Moritz and # H(.nrlquesso Pigs 0.05 20,000-:30,000 Morl Lz and HenriquesSO Pigs Co’o 0.1 4,000-5,000 Moritz and HenriquesSO Pigs 0.2 2,000-3,000 Moritz and Henriques’” Pigs SrgO 0.3 1,500-2,000 Moritz and Henriques’a Pigs pl 0.5 1,500-2,000 Moritz and Y90 ‘Henriques$o Pigs 0.7 1,500-2,000 ——

., nature of the pigment is not known. Since it occurred in all exposed American Negroes, m~Y of the Marshaliese, and none of the American whites, lt is a radiation response peculiar to” negkoid races. The pigmentation was apparently produced by as little as 75 r of gamma radiation since the American Negroes developed the phenomenon !n the absence of significant contamination of the hands.

3.8 CONCLUSIONS

As a result of this accident the following conclusions can be drawn with respect to betii damage to the skin. a. Serious skin contamination of personnel from fallout may occur many miles from the detonation of a nuclear device. Resultant radiation damage to the skin may be the major radiation effect under conditions where early evacuation from the field of radiation reduces the whole body exposure. b. Fairly extensive skin lesions resulting from fallout beta radiation apparently produce little or no systemic or hematological effects. c. Decontamination of the skin must be prompt to be effective because of the initial high beta dose rate. d. A latent period of a few days to three to four weeks may elapse before signs and symptoms of skin damage are evident. e. Clothing and/or any type of shelter gives almost complete protection to the skin.

...... , . ..- ...... —. .. —- ——.—.—..—..____ —______.. ..__ _. .— —. . ..-______.. .—_____ .-. -Y—--- ,’

—.— —c —— .— — NOTE

For purpoRe& of documentation the following color plates (Plates 3.1 through 9.24) numbered with letters U, b, C, CI, d, tJ, f, and g a!% cm- sidered to be pageB 47-57, 59, and 61-62.

-, i .,

---

...... ,. . .!-. ..-...... ———-.. . . --—-— - -——. .— ---- ...... ,-.x...... ,’ ...... ,.. ”A’ ,,~ -., , . *+* -~ . . 1. ‘. >’.”‘ . . . . ::...... -. !’ ~- ,.

. *. .“*.

Plate 3.I5 Spotty epllatlon in boy, age 13, at 28 !. days. Cuse 26. Note scalp Imio:w in areas of i, epilation. (Same case as in Plates 3.8--3.11.~ i ;. ,.

... -.

—–

plat(, 3,16 EI)IliLLI(Jt I Ill 7 Y1’. 01([ Klrl ill 28 (Iiiys. [’late 3 17 I] IKII)(LIIhO(i Case 72 lingcrl);~lls at ’77 days.

. e

i ...... I t .. .— —— .._ ——. — _— . .. . — -. . ,. ..,. ,.,’ -,. ..$ —. -. ,++. ,’, .,,-. . ,, ...... # ...... “......

> > . .

1) ,. r ~!.. -h .- ,.. .

iX)l A)l{ I>I, A’I’II; S

I’1:11(.H 3.IH thrllll~h :1.:!1 ?lIl,nv I<,FIIOIIH Ill 22 dll,vtr IMM41($xlMwurt, (l~lltl{w 3.18 through :!.:0, (.;:, ~,! 2(;; 1~1:,1{. :1.21. C:lr+(, (i:!).

i>l:,~~ :i. 1!) (x 100,” H& P;) Ilpl(l(, rmls: A rcmlcs of rl)ln)lnal damage occur in relation h) c.xcretory ducts of Sw(,at ~l:ln (l.<. “S1r: II IIrn gr:lnulosllm of IWINI wi(lth and shows scant alteration. Undcr- l,yir)g strilturn mnll)ighl i SIIIIWS Inarkwl dcwrcas(, ii) plgmcmt. In the dccpcr portion of the overlying, loos(!ly I;in] itittt{.(1 SI rulum m)rnc~um modcrute amounts of pigment, however, are present. one ]sirrow orc;ittt, of mt)rt, SC.V(,I(, Lr:mscpiderm:il dama~e shows alteration of the stratum ~r:inul{)sum wIlh Intc. rctllular (,(lnta, l)ykrlosis, swollen nuclei, and pigment scattered thr(mgh - (JUL, The Iatt(,r IS (-sIx:{: I:Iliv d(~nsl, in the conLigu(ms prnkeratotic m:lterlal. Dcrmls: A m~~- crutc ccl]ul::r Infiltrutot chic[]v prrivnsculim, is most pronounced in the superficial pars rf:l. icularis Whfhrr Lhl>rc i.+ :( miltl Lclangicctasls......

pl;,t(> :]. ~() (X4(M), Il&k:) ((’NM, lf2~) ‘~ranscpi(lcrrnnl d:lmagc~ with disorganization of the mal - pl~hi:ln l:i,y[~r. Sl raturn gr.;lnlll;)surn tibm.ml. Malpi~him) und I)SSNI layer only ty) to tb~ce c-ells Ihwk w ilh (.x III I I;II I(,rl I)! lri~nl(?!!t I, IItw:Ird l{)wnrd p!! ml, eratinizwi zont. utyic&t tn Htl :Itum (torn(,llni. l’igm~;nl l:Id($ri (.hl~)r!l:lt{)l)l)or(~s un(i histiocytt!~ in pars pnpillnris of corimn. Ltlttcr IS td(hmaL[~lls :~nd 1111i lir;Il~$fl i~y ntothhr:ttc numlwrs of Iynlph{]c,vtcs , Immonuckw r ph~goc. vtes aml s{.:ill(,r(vl lIIgn1($111Cd 1~.uko{.yl(~s. (;:lpillurv loIIps Ilwlislitwt.

])l:~t~ :j.~1 (XI(N), II KIE) ((::1s(, Ilti:l) ‘1’r;ins($pi(l~,rrli:;l d:lmngl> with disorganization of the mal- }]lghiim l:I,vI, I. SII~hl l)iil.:ik(,t.tilosis. M igr:il ion 1)r LSXIOIiutlon outwnrd of pigment. Loose I;lmin;lti{)r] of s! r:Ilum w)rnc~lm. l~lgll)(.nt I;lderi ~hr~)matophores and histiwytcs in 5LIWrflCl:d pnrw jxipillaris of (,i>rlurn. M;Irl.cd {,vllul:tr in[il Lr:lli{m of ~trs papiilitrls. Slight telangicctasis of super t’i(. i:ll p:lrs rclicul:l rls.

● ✎ ✎✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎✎✎☛✎ ● O** ...... ** . . :: ...... *= :: ...... ● ...* ...... * ...... **.* .—— ...... ,,, ,. . .. .*, -’,.~.p ,,. .,. .,- . ,.. . ,,. . -. *,e:&: ......

—., .

‘1 ,

Plate 3.18

Plate 3.20 Plate 3.21

...... *...... I ...... ; .’, . ,, ,.. ,,, ,. :’. :, -. . –--” ,...... i .. ’-- .. ’”,::” “.. :-. ,.q$? ...... ,::. . . . i..:” “::”:; “:: ;.>......

COLOR PI ,ATitS .

pl:kt(.s :1.z~ and :1.z:] show lt.~ions *1 53 dnys post -exposure.

p]~t’: :].~: (xl ()(l, I{& E;) (Clls(, i75) LOOS13lam huition of st rntum co rneum with outward jupil - .-. I:iry pr(~j(:ctions :in(i ;i:sultunt ‘‘ rugosc” nppearnnce. Strstum grmmkmum of good width. Basal and m:llplghinn ]ay($rs dixtim,t with pigment present. Sll~ht edema of corhun with mild tclangicct:tsls ;Ind slight incrc:ks(’ m Purivasculnr Iymphocytue and peric.yt@s. Small, atrophic h:llr foil IcI(, adjiic~,l]t trJ S(+:ICCOUS giund-- In mid pars rcticw]aris.

[>1~~’! :j.~o (x’loo, ” ll&E) (C:lst, #75) Same as 3.22. Occasional perinuclear cytuplnsmic halos III mill stratum gr;lnulos urn. l: IxJsely laminated stratum corneum. I>igmont laden chromato- phores In super-fici:ll coriurn ulonK with occnslomd lymphocytes and mononuclear phagocytes.

i’l:ttc :!.24 ~hows 1(,sions b(wond t)iopsy) at 46 days ~xwt-exposure,

~>l:it(. :1.~4 (x I (N), tl&. E) (C:, HC fi:j:)) Ntir~OW rugos(! ~.p~dcrmls with pnplllary extensions cfown- . w:lr(j of HImtiim m;llphig-~i. Lullc r urr heavily lmlen with melanotlc pigment. Slight tulangi - {I(:t.asls of p:trs I):ipi]larls :in(l p;trs rcttculuris of dormts. C)ccasionnl pigment laden chroma- lt]ph~]rus In mqM! rficial d(!rn)iH. ... b +- . . . ..-. ------.,_.-

-4 - “1 -=- L= .-..

., . 60

...... *..*...... *...... ● ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎☛ ✎ ✎ ✎✎✎☛ ✎ ✎ ✎ ✎ ✎ ✎ ✎ i .- ———-—————------.—’ ,. ,.- -.. ..+7--- .. . .. “’~~+ ..-. .. . . :.. m .- ...=.—., ,.-, ...... :.. . .::...... -......

p.,

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~.: ,:. .-.,:. CHAPTER 4 E: t’. ““.;. ;,I . . ~. HEMATOLOGY

. 4.1 lNTHOf)UCTION

Since it is generally a~reed that a deprewion in the formed elements of the peripheral blood is the most useful [)ractic:il clinical index of the degree of exposure “h) i~)nizing radiatitm, a systematic study of the leukocytes and platelets was relied upon as a nwq{)r tiid in cvaluatiw! L the clinical status, severity of the radiation injury, and prognosis of the exposed individuals. ; Animal experimentation had previously shown that the rate of development and magnitude of :. the depression were equally important in evaluating the severity of radiation injury. Since ..< there had been no previous exposure of human beings to significant amounts of fallout radiation, ,.. no hematologicai data known to be strictly applicable* were available fur. use as a guide i-n the. I evaluation of the exposed Americans and Marshallese. Accordingly emphasis was placed on “ ~s~~= ,: ‘“= . ..., systematic serial studies, utilizing a few highly standardized hernatologic deter minations. to --1 .. ...+ insure that individual and group trends would have maxtmum validity, Sin~k it was known that .. L; the Utirik group had received a very small dose of radiation compdred to the other exposure ~+:’ ~ groups, less extensive determinations were carried out on these people. . . ..- - i ------.

4.2 GENERAL METHODS-- t

~f3111at(J10@Cd examinations included total leukocyte, neutrophile, lymphocyte and platelet . . counts, and hematocrit determinations. Whenever posstble an entire exposure group was sludied in a single day. Occasionally two days were required to complete the larger groups. Capillary blood was used, usually obtained from the finger but occasionally from the heel or ear. Two pipettes each for total leukocyte and platelet counts were filled. From each pipette a single hemocylorneter chamber was filled. All pipettes were rotated for 10 minutes, and the cells were allowed to settle for 10 minu~es in the hemocytometer chamber before counting. A 3 per cent acetic acid diluting fluid was used for total leukocyte counts. The blood was diluted 1 with. 1 per cent ammonium oxalate for platelet counts and counted in flat bottom hemocytome- . ters using a dark phase contrast microscope. ~b Two hlWd snlears were madt~ with each ex- amination, using a beveled end glass slide for spreading. One blood smear was fixed in methyl :. alcohol. The other was stained by Wright’s method, from which a 100 cell differential count was made. Hematocrits were performed using heparinized capillary tubes. One end of the capillary tube was heat sealed and the tube was centrifuged in an ALOE centrifuge at 12,500 . rpm for 5 minutes. — *A large literature on the hematoll~gic effects of radiation exists; however, these data were not relied upon for direct comparison :md evaluation of the exposed individuals for reasons that will be indicated later in the discussion.

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. 4.3 METHODS OF TREATING DATA, CONTROL GROUPS 9 $ Pre-exposure Mood c[mnts were not available on the exposed Marsha llcue m- Americans; hence the individuals could not be used”as their own controls, In order to estinmte thtl severity of the hematn]ogic response it was neressary to establish control groups as’ comparable as possible in respect to age, race, sex, background, and habits. A Marshallese cent rol group living on Majuro, comparable with respect to age and sex to the Rongelap peoplt., was used aN

‘1’:lblc, 4. I HE MAI’OL(XICAL RESULTS, CONTROL”{;lK)UPS .- — ..—...... — ...—.— _.. —.__ —.— .—. -—-— —. tlcnmtocrlt* N(). (1’cr Cent) (:(u)lrol Ag(! i11 WI}(’ Ncutrophlles L,yn!phorytes IUII(C1(*IS (;ll)up {yr} (ip. (. l($) (x 10$) (x 10? (h 10’) MF (Jmib .. .- .. .— .-— . ..— —.—. . -.. M;~Jur(J ()-5 22 13.2 4.8 7.4 38.8 3s.5 :17.:1 :17.8 (10) (12) (22) (i-1~ 14 1o.fi 4.8 5.1 38.6 41.3 4t).{i 40.9 (0) (H) (14) 15-50 6:1 0.4 4,8 4.0 30.9 46.8 40.4 43.3 (29) (34) ((i:]) , 50 14 9.6 5.0 3,7 30.7 43.6 41.8 43.0 . (lo) (4) (14) r- >5 91 9.7 4.8 4.1 33.6 45A 40.6 <15 37 38.6 ‘ =- a- . ..15 76 31L8 -! Kwaj- >18 28 7.8 4.1 3.1 23.8 ‘– 44.9 Americans .— .. ● Numbers in purmttheses indicate number of Indtvlduals in the group.

the Marshallese control group. For comparison with the exposed Americans, blood counts were made on approximately 85 American males, on duty at Kwajalein. All who had not been on duty in the tropics for more than two months were excluded since the exposed Americans on Ron~erik had been in the area for about two months before exposure. In addition several who wert~ recently associated wi(h radiowtive materials were excluded. The resulting smaller group of 67 was used as the Kwaj -American control group. Preparatory to anaiyzin~ the hematolngical resul~s on the exposed Marshailese, data from the control Majuro Group were examined to determine If there was an age or sex dependence i n the hematologic td)servati[]ns (Table 4.1 ). Althou@ the neutrophile count was independent of age, th(~ lynil)l)tjcyic. cf>unls were significantly higher in children below the age of 5. Similarly th(’ pla’telet count was higher in the younger age groups; however, a relative depression ilp- peared to occur at about age 15. The total leukocyte, neutrophile and lymphocyte counts were independent of sex. The hematocrit of females was lower than that of males, particularly in the child bearing age group. The age and sex dependency of these endpoints is comparable to that in published data.%’ ‘T To obtain valid comparisons within and among the various exposure groups, they were stratified in accordance with age or sex dependency noted for the control groups. Although each individual in all groups was studied hematologically, those Marshallese with serious long- . standing diseases were omitted from the analysis. A total of two from the Rongelap and two from the Majuro groups were omitted on this basis. 64

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● ✞✍ 4.4 HEMATOLOGICAL FINDINGS, GENERAL ✌✌

✎

✎✎ Total leukocyte, neutrophile, lymphocyte, monocyte, platelet and eosinophile rourds for the severs} exposure gr(mps are given by day imd by age In Tob]e~ 4.2 to 4.5, Tht? mean total white count, neutrophile, lymphocyte and platelet counts at the times of p(!ak deprt!ssion (time cwer whlrh counts were consistently the lowest) are shown .in T;lbles 4.6 itnd 4.7 (pp 78 and 79) for each individual in the Rongelap and Ailin~inae groups, respectively. Hemxtologicfil findings as a functlun of time and age are shown alsc) in Figs. 4.1 to 4.8. The cumulative distribution rurves for the various exposure groups, using the average uf counts obtained over the period of maximum depression (days 39 to 51 for leukocytes; days .26 to 30 for platelets) are shown in

Figs. 4.9 to 4.11. ● In the figures emphasis is placed on the individual blood elements rather th:in on the total ieukocyte count, since the component elements have distinct and different time trends after irradiation. . ,. .. ..-_ .r~lbic 4.2 KON(i ELAP GROUP MEAN r3L0011mums r3y DAY AND-”HY AGk: “1 .—..—--- .—-——— . Neutrophi les l,Yrnphocyle S Plliloll.ts Monocyt~\s E,)sln{)phllcs A. (.h Lo’) (x 10J) (x 10’) –{. loq (x 10$ —.—-— —.—. ..— . ..— . ,----- .,., .5 .5 .5 >5 <5 >5 <15 . 15 .5 >5 .5 >5 .-, , — ..1”—. —. -. -. —. - .._- .. .. 3 9.0 8.2 6.4 4.7 I.tr 2.2 0.8 0.3 0.1 0.7 ,, ‘7 4.!) 6.2 10 6.6 7.1 3.5 4.5 2.6 2.1 27.5 22.1 2.9 1.7 l.ti 1.(; 12 5.9 G.3 3.5 3.9 2.1 1.7 4.2 5.4 1.9 1.!1 15 5.9 6.5 3.2 4.1 2.4 1.9 26. I 19.l! :1.0 2.:1 I.1 1.3 I u 6.7 7.2 :).4 4,7 2.4 2.1 2:{.0 1!).6 2.7 1.7 :1.5 1.6 22 7.(1 7.4 4.3 5.0 2.li 2.1 16.2 14.7 l.~ 2.() 2.:! I.fl 2{; 5.7 l;. 1 3.() :1.!) 2.3 l.t! 12.(; 1(1.il 1.s 1.1; 1.11 I.:1 :1{) ‘7.(; 7./! 4.() 5.3 :{.2 2. I 1:1.:1 I I.[) 1.:, (1.3 :k.4 2.2

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Majuro 13.2 9.7 4.8 4.8 ‘7.4 4.1 38.5 30.8 2.0 2.0 9.5 4.7 Controls —— —

. . *In the Utirik group the cumulative distribution curve for platelet counts only is presented since hematologicai determinations in this group were not made during the 39 to 51 day period, used for leukocyte comparisons among the other groups.

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1:1.2 8.7 4.ff 4.ff 7.4 4. I :48.5 30.11 2.() 2.0 n.rl 4.7 .

Table 4.4 UTIRIK GROUP MEAN BLoOD COUNT BY DAY AND BY AGE .—. W.B. C. Neutrophlles Lymphocvteti Platelets Monocytes Eoslnophiles (. lo~) (x 10+ (x l(y) (x 104) {x 1(+} (~ 10’} P.E, Day .——

. ‘“”T-<5 ,,~ <5 >5 <5 >5 <15 >15 ‘5 >S <5 .5 .. I 4 9,4 8.? 4.7 4.2 4.9 3.2 0.6 0.2 -’”2.0 1.2 -. 14 10.0 8.6 4.1 3.2 5:1 2.9 4.9 4.2 3.6 2.7 . .19 37.7 S1.5 29 10.1 9.7 4.9 5.8 4.8 3.2 33.2 28.6 2.2 l+-- %1 “ o .,...-=-- MaJuro 13.2 9.7 4.8 4.8 7.4 4.1 38.5 30.8 2.0 2.0 9.5 4.7 . Controls —- — -..

Table 4.:) RONGERIK GROUP MEAN BLOOD COUNT BY DAY —-. --- —.. — _ .-—. ——.-— ._ . .._ .. . W.tl, (:. Nt.tttrophllvw I.yrnphocyleg Pluteletc Monocylen Eominc)phblem I’. E, I):lv (~ I(P) (. 1(P) (. IOJ) (x 104) (x Id) (- Id) — ..-—. —— -.

I !l.() fl.1 3.3 0.1 1.6 H 6.(I 4.:1 2.1 1.9 O.b !) 6.2 4.0 2.0 2.0 0,4 10 [i.:1 3.8 2.2 2.2 0.3 11 6.2 3.9 2.1 1.8 0.5 12! 6.(J 3.7 2.1 1.5 0.7 13 6.1 3.7 2.1 1.7 1.2 l:> 6.1 3.H 2.0 1.7 1.3 16 H. 1 4.7 2.9 22.0 2.8 2.5 19 7.9 4.H 2.7 22.2 2.4 2.1 23 6.7 4.2 2.1 17.9 1.6 1.4 28 7.2 4.1 2.5 14.4 2.0 2.1 1 33 6.7 4.1 2.2 16.1 1.8 2.2 39 6.8 3.8 2.7 20.1 1.4 1.5 43 “ 7.6 4.4 2.9 21.8 1.4 2.0 47 7.8 4.6 3.1 20.2 2.7 1.5 51 5.7 3.2 2.2 16.8 2.4 1.7 r Kwajalein 7.8 4.1 3.1 23.8 2.6 2.7 COntrOls .— .—

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Fig. 4. Serial Changes in Neutrophile Counts of Rcmgelap Group for Those Less Than .3 Years and Gre A!er T}.ar. ; Y5~rs :: .+ge f

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AEO(lreuler Than 15 +- ..; 1--- , 4 (;420 1s0 26s0 355 ---.;. 7 5220 195 2520 252 . ,.~r 242 ----- 9 5470 125 2700 -, -...,. :. 10 4550 10s 2770 – T57 .3 L :+4 - 11 :1120 86 1570 135 12 4670 150 3270 127 .. 13 4050 105 2370 152 e “-’ - 170 14 4570 55 2770 ~ -k -’ 18 6100 45 4320 i 65 , 22 4470 130 2500 190 25 6250 110 4050 212 > 21 6620 110 3600 265 l.. 30 5700 85 3920 160 :14 5900 125 3650 235 37 5970 130 3120 257 40 5600 140 2450 28? 46 462(I 136 2350 21U 49 6620 100 4060 2!22 ~,~ 5620 [60 2!470 24:! !;:! 4400 135 14s.0 272 !,0 6170 126 3520 255 57 :,02(I ,,.r, 2020 27(I !,H 471,0 w I w) (K) olt70 I90 4obo 247 (iz 110 :>170 ‘JHz ($:1 4270 us 2!ho 1u li4 .)(XW 70 3220 20:, {>6 6100 145 2620 312 68 4600 120 2400 202 71 7950 105 4950 270 73 3970 60 2630 126 74 9900 155 7250 255 78 5400 95 3350 195 79 78oO 70 5120 250 . 80 5670 100 2920 252 82 .5250 130 2620 247 . —

I ...... 0...... 00. ● ...... *. . ..*...... - . ..*. --..*** ...... ** ...... = ● ...... * . . . . . ● **- I .— .–-— ——.-——-. — -— ———-— — ,, .. .,- ...,...... ,. .,>.. .. >.

. t...... ‘1’:II)ILo 4.7 AI LINGINAK GI1O(IP MEAN 111.()()0 CO(JN”l’S A“]’ ‘I”IMK-(}l’ l’h; /\K 1)1’I’1{1.’SSION :. -. . —- .- .- .-

W.B.C. Phlt(,l(,ts ~ 10’ N(wtr[)phil(.s I,vlllpll’wyl,$s . .

. * e 1; !).750 215 :!470 Ii H:150 lH!} :lri20 \.-z-.. 41 1:)70 1H(I :!:3$0 F 1- . ,< ;’. . ;, .,. L.”

1- L

I li 170 37s ;{.nll 23’4-() 1(; 4(;70 1!)5 2200 2270 2X (;270 115 :{7.),} :270 2!) (i751) 11:) 4300 ‘1~~() :{ 1 :)65( I 145 2!)50 2450 41 5120 130 3050 2271) 4:{ {i150 215 :1700 2000

45 565(J 1Ho 4170 1470 L !;() 7050 95 3970 2901) L1 7750 170 4620 29!30 59 12400 105 H120 :{670 70 5070 1 H5 :1000 1750

—— -, 4.5 IK3NGELAP GROUP

The atxmlut e neut r~}philc c(mnt of both the younger and older age groups fell during tht? st,romf week to a value, ilppr(~xim~tely 70 to 80 per cent of that of the cuntrols (s(’e Fig. 4.1). F[~lll)wing the depression of the t(JIal neut rophlle count during the second week, the values wtire u!istable until the fifth week. At this time the be~innin~ of a second drop (P ~ 0.01) was noted for t)oth age groups, and a low value of approximately 50 per cent of contruls was rt?acht!d. The count was mainlined at approximately 75 per cent of control values from the seventh week to (he end of the study. Althtmgh both age groups ff~llowed the same general time ~attern of response, the lower age grtmp was below that of the older group throughout most of the observation period. The absolute lymphocyte count of the older age group ( Fig: 4.2) had fallen by the third day to a value approximately 55 per cent of the control group. This value was maintained thrcmgh- out the study, and there was no definite evidence of an upward trend during the s(udy. The values for the younger age group likewise fell before the third day to a value approximately 25 per cent of the control, following which there was a significant upward trend. With the total lymphocyte count, there is a consistent difference between the two age groups. Howtwer, during the first four weeks the difference is accentuated when ex~ressed as per cent decrease hecausc of the relatively high lymphocyte levels in the lower age control group. Aftt*r this w>riodthe differences expressed as per cent are less ,marked since recovery was more ral)id in the y(mnger age group. The cellular elements chiefly responsible for the fluctuations in total white blood cell crmnt can be determined by comparing the total white, neutrophile and lymphocyte counts ( Fig. 4.3). It is st!en that the lymphocyte count remained essentially constant throughout the ]wriod . of study, while the total neutr(jphile count fluctuated with a p:lttern essentially identical to th:lt

...... ,...... ’” “,’ ...... ” ...... :.....’. .: ”.: —..—-—— — —.— k . .. —_ —_. .— . ——--= – -----%””=’ “-

4.6 AI I,lNGINAE Gl{OUl}

IJJ Ibis grv,uf) Ilt(, rt WL,I.(* (}Illy tl)rm, imlivirfu;lls t)(,low age 5, For this reason, remarks will k rf)nfil](’(i (iss(’nli;illy 11)thr older :Lge group. ‘l%t~aiwolule ll(Lu~rophllL! rvmnt fluctuated around the control value for the first six weeks t~f t)l~servati(m (Table 4.3). At this time the counts began to fall, and a value approximately 76 t per cent uf the control count was reached and maintained throughout the duration of the observation period. Tho lymphocytes in this group fell to a value of 5S per cent of normal during the first week. The counts then fluctuated around this value throughout the period of observatic n, ; and no definite upward trend of the lymphocyte count was noted during the period of obaerva- - e- . &-- tirrn. --~. ,. ---- As was noted in the Rongelap group the lymphocyte counts remained at an essentially con- < ‘-<; “~ stant low level throughout the period of observation. The total leukocyte count in this grou~ .Zjiii“-T- also reflected changes in the neutrophile count. .- ,< he platelet counts in the Ailinginae group were low, approximately 75 per cent of normal, “ * ““: when first enumerated on pusi -exposure day 10. The counts remained at this level during the “~ -+ secund and third week; howevt!r, a definite fall in count was noted during the fourth week when a low value 45 per cent of corrt rol was attained. The counts returned during the fifth week to a value appr{)ximat cly 70 per ce[ltof the control level, where they remained for the duration of the otx+crvidion period. A sec(mdary Pall, as observed in the Rongelap group Wils not detected.

4.7 UTIRIK GROUP

in the greater [ban 5 a~~ ~roup the total white bloud cell and neutrophile counts were depressed slightly twluw control values during the first and second weeks (Table 4.4). The lymphocyte counts were below control levels consistently, and the total white count equal to the control value obtained on day 29 was due to a neutrophilic leukocytosis. PiateliX counts on the 29th day were significantly lower than on the 19th day and were lower than control values. The 29th day coincides with the time of maxtmum depression for the more heavily exposed groups.

4.8 ——RONGERIK GROUP (AMERICANS)

The neutrophile count in general reflected the time course of the total leukocyte count ( Fig. 4.5). Neut rophiles account ed almost entirely for the marked rise in total count on post- . exposure day one, and the values for absolute neutrophile count fluctuated near the control

80 <

...... ------. :: .-...... ---- ...... ——. ——.—— —— . . ..

4.9 MONOCYTES ANI) EOSINOPHILES, ALL GROUPS

h’r-(,m Tal)le 4.2 it is LMM:II lhut il]e nlealt nlonocyte” rm.rnt for the lti)ngt,lill) ~r(wp rose ab- ruptly frf~m :M early value below corrtrol levels to a well defined peak On duy 12, f(ll](JWillg which it” fluctuated at values below the control level for the duration of the observation period. A similar t i me t rend was noted in the Ailinginiie und Utirik groups. The e(~sinoptlile count in the older age individuals, Rongelap group, rose lrom very low levels observed (m day 3 to values approximating 35 per cent of control during the second ;. week, where it remained from the third to the fifth week ( Fig. 4,7). The counts theri decreased . ( P .: 0.01), and remained at a value approximately 15 per cent o: control throughout the re- -. mainder of the study. The time trend of response was similar in the younger age individuals, m.- L. however, changes in the younger age group were relatively greater if considered in terms of =&qZ,’ *.<<-‘ . the control values. Similar trends in eosinophile count were not evident in other exposure -. -—- ~ =!..+ groups. +’ ~k&;*...... It is mmsible that the rise in eosino~hiles represents that reported as occurring “ . . . two t..&-.. ” to three weeks after short-wave-length irradiation”. u ...,.,, ~. 4.10 HEMATOCRIT, ALL GROUPS * The hemah)crit values for all exposed groups are shown in Table 4.8 and in F“ig. 4.8 (a de- / tailed breakdown of hematocrit by age and sex for control groups is given In Table 4. 1). When hemalucrlts were first done on the 22nd day, mean values for the Rongelap and Ailingtnae groups were below those of the r.trrrtrol population. A significant trend in values after this time c[mld nol be detected statistically.

4.11 MORPHOLOGY OF PERIPHERAL.. .- BLOOD

Significant morphological cellular changes, with the exception of a small number of abnormal mononuclear cells* seen in a number of individuals during the period of neutropenia, were not observed. Similarly altered cells have been observed previously.*s Coml)lc?te evaluation of these changes in the present study would necessitate an exhaustive serial study of the hematology slides.

*There was considerable difference in opirdon in respect to classification of these cells. They were classified as atypical monocytes, degenerating lymphocytes, atypical myelocytes, monocytoid lymphocytes, and lymphocytes in transition to rnyelocytes. At the time of this report there was no unanimity of opinion in respect to classification and significance of these cells.

‘- 1 ...... , .! ...... -. .,...... ’ .; —-..—— ,.. . — - —.—— . ~.a.y,? , -. ;.. . ,.” . . . .,. . 1“ ‘rl{hi{: 4.”ti llk :”M}{ ’1’&”lih. Ai,l. l,:XPOS1.ll{t.. (;l{{)LIl~S . ‘4 lhm~t,lnp At 1lnglnn~, (Itlrlh

[.”l.lll;l]OS l;(~nlnlt,s L’olllt) (’(llllh(’011)1) l):l\ —.. .- .—— -. — . :, .?5 .5 >5 .5 >5 .. .5 >5 .5 >5 <5 .5 .’\dlllts I :5*. ‘? -—. —.. . ,.. . . 22 3}1.1 42.5 311.() 3!). I :{llrl 40.7 37.5 40.(i 3’7.0 39.4 37.3 4(L0 . .+ xi 45.7 . . 2(i :15.8 4(1.3 35.0 :{!).I 3(;.5 43.2 3H.() 36,7 37.0 38.9 ,... - ‘, -., 28 44.5 ,,. ,.:~ 2!) 36.9 42.9 ,.,. . ..- 30 :!11. 1 40.5 :14.:i 37.7 &,-. 36.4 3!l.2 W.i. o 44.6 32.() 37.2 34.7 39.7 ~.. ; ,.- 3:! :I(i. tl 4 1.() :{4.11 37.:1 :1$.9 :1!).() 3C).5 43. B :{{1.() 37.2 36.3 39.4 45.4 :)!) 36.4 41.(; ~l(i. (1 :17. (i 30.2 40.0 35.() 45. ti 35.0 37.6 35.0 4(J.3 44i.7 !. 4 :i 35.7 41.() :M;.2 37.1; :15.!) :{:).0 36.0 45.2 35.0 37.0 35.7 3!4.7 44.() 47 42.14 31{. :1 40.3

(hit r{lth :H{.L 4:,.2 :17.:1 40.li :!7.1{ 4:1.() 3tL5 45.’2 37.3 40,0 37.11 43.() 37. H 4:1.0 44.9 . -— ,.

*AKt I III ,y(.:irs.

4.12 COMPARISON OF HEMATOLOGICAL —..FINDINGS.—. ..—IN CHILDREN AND ADULTS, RONGEZ LAP GROUP

It is seen from Tables 4.2 to 4.4 and Figs. 4.1, 4.2, and 4.4 that differences in the degree . of depression of cellular elements were-present between children and adults. In Table 4.9, the mean values of the neutrophile, lymphocyte and platelet counts at time of peak depression for

each element are given in terms of absolute count and per cent of appropriate control value - —... . . ;“- (mean platelet counts were calculated for the less than 5 and greater than 5 age ~roups for this . *..: .;:.’ .“’: comparison). .;---., -—- *, -s. . -% [’!...::: Tnblc 4.9 COMPARISON BY AGE OF MEAN NEUTROPHILE, LYMPHOCYTE ‘*:”;. ,. AND PLATELET COUNTS IN THE RONGELAP GROUP ..? AT THE TIME OF PEAK DEPRESSION -.. ., .,. . .- . “+

Absolute Count x 10S Per Cent of Control

‘r.vp. Of C{,]l AK(! <5 Agc z 5 Age <5 Age >6 .—.. .

N(!uI ri)phllu 2.7 3. I 56 64 I,.ympho(!yt(, 2.!) ~.~ 40 54 1’1:11(.1{,1s 115 122 30 36

It is seen that in ierms of absolute counts, the children showed a greater depression of the neutrophile count, and the same degree of depression of the plateket counts and less depression of the lymphocyte count. These differences can be most easily described at the time of peak depression. Expressed as per cent of control, all elements were affected more markedly in the younger age group. These results would indicate that children are more sensitive to radiation, or that other biological or physical factors resulted in a relatively greater effect.

4.13 DISCUSSION

4.13.1 General An estimation of the severity of radiation damage incurred can be attempted by comparing the present results with previous hematological data on total Iody exposure. The present data

...... : :.. :*< ...... :. ::.: : ., :.. - . ..- . . . . ● ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ✎ ..” ———.—..—. —. ———--—--— “ ,. . .

i r(,llresc,nl IIN, 4jIlly Iarg(, .st*ri{.s III whirl] sysi(,ll liili(; ”S(,l”i:il”(.-(\IIIIl S”iIII ‘lIIt, :,;IIIIIL Ill{llvlllll,ll:l Il; iv!. I)IV,II ])(ws IIII(L, :111(1 thus th(jy (,om])ris(, the most romplvle datn avaltll)l[, {III 1111111:111INLIIIKSIIX ● pw(wi in tll{, hi~ll sul}ldhni r:ln~(,. II is also ,)[ illilx}rtallct,, (Ilt’rol{)rt’, 1[) (sx;lnllm, Ill{, l)r~,s<,lll \ r~,suits iI) c{]njull(”ii(m wi(li I):lst (;xlwrivnr(, in :111(,ffort ((I g;I III :1 ()(~tl(,r [IIICI(,I.S(;III(IIIIK (Jl tttv ,7* ll{,rl}:il{~lt)~:lc:ll r(,sl}{jnst, of hUIII;I II lwill~s (Sxlx)s(,(l to Il(,llot I’;llily! l.il(ii~ttl(jll ill lll(t s,lbl(,tll;tl r;lll~t,. . In (ht’ f~)ll{~wit)g discussion it will b{’ ~en(’r:illy assumt’d IIM1 tht’ ll~tlli:llolo~l(”lll” t’[ft’rts due l)ri marilv 10 th(, p(.net r:tting gamma ratli;ltiol~ rec(’ivt’d. . noted wer(, ‘rh(’ lN4a ratllatitm iIi- . jury of (ht, skin may hav;t ~fintribuled Lt) fluctuatit~ns in the whilt> Lwunt cturiIIN thLI Iwrh)d {)f <.: . arlive Iesionb durin~ the third, f(mrth, and fifth week, but is ctmslderud not l{) havv t.~)lltribut(~d si~nificanlly to delwession of any peripheral elements (st’e ~lli~pt{’r 3). ThtI (h’grm’ U( ilttt’rwll contamination with fission products (see chapter 5) was probably too s[~~illl tt] {Stintritnde significantly to the early hemalological effects observed. Although it is nl)t Imssiblc 10 say with certainty that these added factors dtd not materially affect the hernatological pattern seen} It will ttmwme evirftmt in the discussion that the changes observed are not inconsistent with those ,.-,- t,) be exprcted fr(~n) t?xpf)surc 1~)penetrating radiation alone. Thus thr hrn~atol(>~irxl Challg(?S IIOIWI :tr(’ r{~nsidrred It) b{>the rcwult of a single exposur($ to ]wo{lratillg gamm:~ radiation, dC$- 1lvt>r(~d at ral)i(ily decreasing dose rates over a Iwrlod of approximately t w(l days. Unless otl]crwisr Stilt (>(t;111(iis(. ussioll will be lin)lt[,tf to the adult Rongelilp ~r(iup. TII(c [}rirlrilllt~ sf)urr{~s (If [)r(wi(ms data avail:tble f[~r conllxtrisoil, :Itxl thti chararteristjrs a]]cl limitations of (!i~(~harII sum[nilri’/.d’d 111Table 4.10, Pt’rusal of thlt tabl(’ will n]idi(’ al~l)armd lh(~ difficulties ilivolvud in itttcml)(ing strict ct]ml]arisons; ht)w~’v(’r, somt’ sta(t’nl(’nts can bC m:ldc cit’sl)it(, ~h(’ ol)vious” Iirni[ati{)ns. For easy refercnct:, ‘“normal’” v: Ilues for 1)(’ril)heral 1)10(KI(.IIu IIts, frt)m the l)res(~nt duta and fron~ (h{, literature are presentmt in Tabl(’ 4.11.

‘> 4. 13.2 C[)ml)i]rison with the .Japanese Data !..

The limitations sta.cul in Table 4.10 apply to the Japanese low @se groups ● E t{) H in par- ● ticular, in which values given’g’” are pooled and include individuals lucated it( the time of the ..._& bombing such that they may not have received significant exposure. Hence,” while the pattern of change with respect to time is of value, absolute counts probably are high. The time course of hematological change i] the Rongelap people corresponded must closqly with these low exposure ,Japanese groups in which defirdte signs of severe radiation exposure were present in some individuals but in which essentially no mortality occurred (initial hemotological studies on the Japanese terminated at 15 weeks). The early period up to approximately six weeks was characterized by considerable variation in total white count in both the Rongelap and Japanese people. This fluctuation may be associated with the presence of thermal or other injuries in the Japanese or the active skin lesions in the Marshallese, or may correspond to the “abortive rise” noted for animals following exposure. ‘*’U From the sixth week until the termination of th($ acute studies on the Marshallese during the tenth week, the Japanese and Marsha llese (’(rents remained al similar levels. Th(! [~cutr[)l)hi Ie count in bt~tl) the Japanese and Marshallese in general parnll(!ltxi the total wl)lte count. TIM; lyn]l)l)l)rytc count in both gr{mlw was de})ress(.d early and renlailleci dt?pressed al WIIU(:S (If alq)r{)xima((,]y 2000 until week 10. The high value of 2692 rcportt~d for the .Iapancs{) [(jr weeks 12 to 15 must I;(* suspected of being high for tht’ reas{ms given il) set-ti(jn 4.13.2. Three (.lli~ra(”t(!risli(:s (J[ lhe .Japanese ht>rnatological trends should be p(jiidt!d out: a) while hi~h dfwc exposure groups wtth significant mortality stwwed early del)ressi,)l] with a definite low poir.t at four weeks, the lower dose groups showed no definite minimum at four weeks but rathe,r a continued depression until the eighth or ninth weeks. b) While the mean values for total white and neutrophile counts for even the heavily exposed groups had returned to within

*The Jap~”nese casualties were divided into groups A to H on the basis of degree of expos- . . . ure as determined roughly by distance from the hypocenter and approximate degree of shielding. In groups E to H essentially no mortality ascribable to radiation exposure occurred in the first 3 or 4 months.

...... -...... -...... ”...... — —.- — —— .-—. — —. .’ .— _ ~, ->. --- i. . ., . . . . .: .. ”..:;. .-’,’...... Table 4.10 CliARAC”r ERISTICS OF AVAII,A131>F; DATA ON “1’IIK llF~I\’I’o l,()(ii{”/\l. : K8’FE(’TS OF I) EN ETRATING RADIATION —. . ..> S4)urcr of d:dn JnP:]nCSt- (:linlcld I,nborntorv Exp)stwl l,:lr~(, .=” Ch]trnct{. risllrs 1k)mbi ri~s4s”4’ Rudloth(,rnpy4g A(hcldcwt S’” “0 Mnrshulit.sr ANIN]nlS*bl .*

Numlwrs In (;r<)ups I,:lrgv Smull Snlnll L/i rgc I.llqfc . -. L Ailrqunry of ( :tml r!)ls Fiilr ihwr I)qu)r (h)tbci v~.~y KIMKf ;? S{~ri:ll (k NJnis N{] Y(,S Yt~s y,.N Ya,k (;011111I ng Fnlr Vjlir ( ;4N)(I (;()( )(1 (illlMi “...’. ,’ TtThlllqul,s* i, (:hunt.(.I)(I)iati duli 10 l.:lrK(. I,urgc I ,u r~t! Slllld 1 .Slllllll :, . . . Wlnlpl Illg :- !-’-: 1~.rlmiqutw ~. ‘<, . “Nt~rJl)!d” Y(*S N,) Y(’S Yt!s Y(*S individu:lis lot(, rnal None Nom’ Non{’ Minimal Nom> c

●Same technicians for afl counts; rigidly standardized techniques throughout etc.

Table 4.11 MEAN PERIPHERAL BLOOD COUNT VALUES FOi{ SEVERAL CONTROL POI’LJLATIONS (x 104)

Kwnj - Source of data Jup.mcsc Ku re, Americun M:ljuro Iktermin:itiun 1947 _l:j4p2 1948-19496’ Amcricans*S7 AmerlcansS’ COnlrOis hntrnls — -. 9.9 !1.5 7.4 7.0 7.8 !).7 5.5 5.0 4.4 4.3 4.1 4.8 2.9 2.8 2.5 2.1 3.1 4.1 O.ti 0.6 ().3 0.4 0.3 0.2 0.9 1.0 0.2 0.2 0,3 ().5 0.1 0.0 0.0 0.0 0.1 2507 238 308 ——.. ————— —— . . .—. .—— — . . .. —--- --— — -- -- —.

tThe mean vaiue for 50 normal young American men, using the technique employed in the present study W&3 2.”)7,000

...... -...... ——— - —— ., . .. ,. .

!-~.’.

. . .,. :. ,’. .

4.13.4 C{)mlmrisoo wilh Data from Laboratory ——.Accidents.- .— Although in the Los Alamos and Argonne accidents 4$.SOthe type of radiation and the condi - tions of exposure were markedly different from either the Japanese or the Rongelap situations, a large component of penetrating gamma radiation was received and thus attempts at com- . parison may be (If value. Some findings in the hematological responses are pointed out: a) a uniform early rise in white and neutrophile counts over the first few days, similar to that seen .,. . i.- early in the Rongerik American group was observed uniformly. $ b) Of three high-exposure but non-lethal cases, the total white and leukocyte counts continued to show sg,me degree of depression int{) the seventh week nr beyond. C) The Lymphocyte.. coun~~in individuals exposed to as little as 50 rem showed an initial marked depression. In most cases the lymphocyte counts remained at low levels throughout the period or observation. d) Platelet counts were done by a different method, and absolute counts are therefore not comparable. However, of the three high-dose survivors, times (Jf maximum del)rc’ssion were m~t inconsistent with the value of 30 d:Lys (Maincd ill the present studies. ;. Tl)c Ar~(~nnc Laboratory accidentEO involved four individuals who were estimated to have ,,. - received 136, 127, 60, xnd 9 rep, res[)ectivcly. The findings in the two hig~st exposed individuals in gcn{!ra] were ct)nsistcnt with those in the present study. An initial ntwtr(lphilir leuko- (“Y IOSIS was f[)ll~)wcd by fluctuations in t(~tal count, with low values mmtinuing inh) the seventh week. I{[?c(]very was not cnml]lete by the 20th week. The lymphocyte count dei)rcssion was rapid ancl marked, al~d recovery was not evident by the 20th week. Minimum values fur the I)laielet count were obtained be~ween the 25th and 31st day.

4.13.5 Comparison with Animal Data The time trends and severit~(.f peripheral blood count change following total body radiation in animals has been critical~xamined recently,’i and the following general conclusions are presented.

. *Counts ,2 years later were not significantly different from control Japanese values. sz . . tCounts on the Rongelap people 6 months after exposure showed no elevation of the mean total white count, neutrophile or lymphocyte counts over values obtained during the 10th week. %No counts were taken on the Rongelap and Ailinginae groups duriug this early period.

...... ,...... ,, . . . . ‘., ,.. - . . ‘.; l.... ,.,. ,, -’.”””” . —— ——— ,. ,, ,. ,,, . . — ..

...... ! . x) AII initial rise, in ti~tal white rount (rt:fl(v-tcli III th(, nt,utr~)Ihlilc <( NJIII) IU;IV iw(-ilr. . “1’11(’rt’ ;tfter 11)(, ma~nitu(i(~ I)( d{~l)rt.ssit)n ()( the totnl wllitr ;Ind n~.ulrt)l)ltil{~ (.(mnt~, iIIUi u,itlillt Illll\ts Il)cir dur:lti[)l) art, it funrtitll] ,]f radi:dlon dose: A s(wonchlry or aln)rtlvc ris~~ III tht~ t{lt;il whIlc % l’t)unl ( rt.fl~,<,ted III III(, n(.ii! r{)ld]]l(, {Jr Iynlph(wytt, rtmnt) m;iy (wrur, foll{)W,l~{l l)v ii Ht.(.oll(j (~(~ +8 l.r(uls{t. ‘I’h{, rt’ is Illtltt sll(x’i(!s (tiff(’r($nc{) in tht’ r:llt. [If dvi)rt>ssi(m of Iht, totill whi(t> {)r Iuwtro r l)hi If, could at CI)IIIIXI rabl(t (i(tsei+; however, t 11(, ri~t(~ of rect~vvry ;Ind t im~, for c{lmltlvtt, rtw~)vtlry * is quil(, diff(.rent Ln vk~ri(ms spqcil,s. Small animals (mouse, rut, Immstttr) sht~w ].t’l:ltiv(’ly {.(~nl- _= I)lctc recovc,ry to control Ievdtj, ev(’n at doses in tht> lethal range. by tht: end of thtl flftl) wvt’k =. or warlirr. JYata t~n dogs art’ inacit>quaie to indicate when recovery is c{}mplete; h(~wt,vt~r, rt, - turn to control” levels at high dose levels had not ocrurred by the fifth wet>k. Swim) require 9 to 15 or more weeks for complete rerovery. 1)) The r(’sp~]nst? of Iymphncyies is essentially identical in all animal species. Depressi[m can b[, dctect(vt within a f(,w hours, and recovery from the minimum values (achimwd in 36 to ,. 48 hours) roqui r[,s Ii]nger than dfws neut rnphilr rectlvery. Lymph(}cytes fall to very I{}w I(?veis ,- at dI)srs w{?]1 lx~l{}wt 11(,Idhal range, tind Im-reasi n~ dose resuits in no or minimi~l further de- crcasf, ill r(mnt. l,ynli)h{jry(lh dt>})rtwfiion il[)~)(>il rs to hrIVe 110 cilos;l I rehtio IIShlp With it~llt~} r:i(ii:ltloll cf(I:Iths. (’) I>lat(, if,t {.(WIIIS i]:lv(, i)(wtl studied inor+l (Jxt(wsively in do~~. 86 As Wltll ,lL.lliY{}])iIilt>S, ti~(’ r:(l)i(lily :Iiwi m;i~{t~iturtt, {If ti{~l)rt,,s.%it}!lis a funrii(m of dose ix~inw ihr Ietlml riingt>. M:lxinlunl (i(,l)l,(.,s,si{)ll (~(,(,llrs iIy lil(. !)tll {)1. Ifltll day witil (ios(?s in the high ic4hal rilt~ge, by th(, IOtil to 15th (iay :11 s~li)i(?tilai i(>v(!is. i{(,({~very buglns during tht’ tilird week, imt is not c[~mpietc i)v tl)(, 30th city wh{!It most SI uIi Ics iu~v<, been t (,rnlim~ted. Insufficient data are av-aiiabie to indicate the Lime, rcquir(>d for c(]nlplctt, rec(}very. Ch)nsiderai)i{’ evidcncc inciuding studies in the mouse using spienic homogenates. i])duccd ix~cterial infect ions and spontaneous infections i~ave indicated that critical neutrophile levels exist i~eluw wtlich survival is correlated with tile absolute neutrophile count following whole body i rradiat ion. From data (m dogs, it appears that survival is likely unless neutrophile ‘, ., ...... - counts remain below 1200 cells for a period of time. r- Platelet data on dogs indicate that animals with external purpura have platelet counts of 50,000 or below. _— - ~ Insufficient data on large animals are not as yet available to quantify the extent of maxi-. mum depression of either the neutrophile or platelet counts as a function of dose in the sublethal range. The response of the platelet count in the present study was much less subJect to- fluctuation than were tile neutrophile or lymphocyte counts. For the preceding reasons, sys - tematic investigation of the platelet and leukocyte counts in large animals as a functi(m of dose in the subletilal range are indicated. 1( is not possible to say at present whether severity of exposure, or of radiation damage cf)rr(,latcs i)ctter witil abst)iute levels of peripheral Mood count, or with degree of cilange from collli~Ii III lJre-(’xlN)sure i(!vrls. ~)mc evidence on tilis pt]int can be gainmi by ronlparing tile (l~,~r{,{, ()[ (it’i]ressioll {}f tilv n(wlr[)i]i)iic and I)latt,let counts III the Ailing illiit: ami l{[mg(*rik 11.I”(NIIM, i)oli] (If wilicll had ess(, ntiuily the same cairulated c!xpowrt~ i)ut ft~r whici] r(mtrt]l henm- tt)i(q;i(al vaiu(>s wcr(’ r[msi[it, rai)iy different (lilr lyluphocyle count 1s not suitai)it’ ftw conqmri- S(JII SI IICP (ie~rt’(, ()[ [it)lwt:ssit)n was t!strentially tile same in lhese groups and tht’ higher- dose llon~(’iai) gr~mp). A( ii~e iimt’ of Imak depression for each element, both tile neutrophile and pla(t.lei counts w(~r~, essentially identicai in terms of absolute counts, but considerably differ- tmt in terms of the respective control values. Thus some evidence is afforded tilat absolute c(mnts, rather than c~mnts reiative to control values, may be the more reliable index of ex- imsure in this dose range.

4.13.6 Approximation of Minimal Lethal Dose for Man . ,, Some indication of severity of exposure can be gleaned from a comparison of minimum in- ● dividual counts in Japanese groups exposed at Hiroshima and Nagasaki in which fatalities occurred. In general, a significant number of deaths was encountered only in individuals whose neutrophile count fell below 1000. In the Rongelap group 42 or approximately 50 per cent had

...... ,L .,...... ” ,: :*...... :: ... ,. ., ”:: ::...... - ...... ;...... —— - -. i.

w . z-

4.13.7 Peripherill Counts as an Indoxof .-S(tverity t)f Exposure— Tht, rcla[ivc value (If th~, several hematol<~gical dett~rminations in estimating the ctegrer t,f ~.xposurc, as WIIII as tilt, npl)r(jximate dose ran~es over which MaXiIIIUm sctl~sitlvily ft)r each dt>lerminati(~l] c~xists, riin bt~ (,stimalcd by com]mring tht! degree of ht!matol{)~ical rhangc among , ll)e several exposure grfml)s. The relative degree of r.hartgc in neutrophiles, lyn]pluwyte. and . platelets can b(, seen ill Tables 4.2 to 4.5 and Figs. 4.9 10 4.11. Lyml]hocytc cuunts were de- I)ressect appreci:tbly even in the low-exposure Utirik group. In the higher dose groups, how- .. -.<.. 4 (!ver, wltll widely different physical estimates of exposure the lymphocyte couuts showed es- .-,. _>.-,u sentially ideldical degrees of depression. The lymphocyte counts of-the Rnhgelap and Ai]:nginae :+ “t.. !-troups were constantly depressed at a level of approximately 2000 cells. Thus while sensitive -,,- at very low doses, this endpoint may be a poor index of the degree of exposure at higher doses. =-=k“+< The total neutrophile count of the Rongelap group was consistently inure depressed than was !...... that of the Ailinginae group and the difference was of the order of 500 to 1000 cells. However, day-to-day wide fluctuations in the neutrophile counts occurred. Accordingly this endpoint appeared 10 be of limited usefulness as an index of relative exposure severity except when counts ,. on groups to be compared are performed at the same time. The platelet count showed a more systematic trend than did the neutruphiie count. Differ- (~nces between tile ‘low-dose Uti rik group and controls at the time of maximum tiepressiun for :111gr(wl)s roulri be detected, and appreciable differences existed between tl~c means for the Marsh all[:st: lll~h(!r cxlxwur-c groups. Platt’let rounting is as easily carrit’rf (ml xnd rm)re rc- I)rodu(, il)l(. Illat) Ifwko(.yt(, counts. $5.57 Tllu$ . tht, ,)latelot ~(;ullt IIIUy ~)rovt, t{) 1)(’ :1 Ilst’ful Illd(!x of d{.~r~w, (If (,~l){]sur~. thrtm}~tu)tll (I1C sublethal ranKe. T}](. :i}),)v{ ~.i,ll%id(,r;ttiol)s :Irt, in ac(”orrf with previous findings ~~1)hum;lll Iwil]gs an(l alli - 111:11s.

*F’rom geometric and depth dose considerationsset forth in chapter 1, 1 r measured in air in a fission product field is equivalent in its effect on man to approximately 1.5 r of penetrating x- or gamma radiation under geometric conditions usually used in the laboratory. Thus the ,.; . mini mal lethal dose for man exposed to penetrating radiation under the usuai laboratory con- . ditions would be approximately 335 r.

‘“- ...... > ...... :: ... :., ...... :: ...... -* . . . .:...... 4.13.8 Conclusions— .- 1. Consideration of the degree {~fciel~ression of [wriph(~riil ~f’lluliir {~lc,ni~tuts lldi~:ltt,s that exlx]surc ,)f thc}sc RtmKclap pmq)lc was mt)der;ltely severe, probably withi]t 50 ;in~i :It n]t)st 1O() s . r {If th(, level wher(, si~me fatal itit,s w{mld have rl~sulted. + -- 2. The d(’grcc t~f ljffect rvidpm-(d in the H{MIK(II:I1)pe(~l)lc is not inconsist(,nt with Ihv physi - (’al (Istimat(,s of Kamma dos( recrivr(t. B(4a ltx+iiII)s of th~’ skin, :it]ti (I1C lt)w l{~v(~ls of int(’rnill 3 i. c raditu~t’tlv(, collt:lnlilliltioll” ol)s(, r-vd :Ire cf]nsidervd 1101 10 havt’ c(mtrll)uted slgniflc:llltlv i{) tti(~ li(,lll:llf~lo~i(’;tl (’han~!vs seen. ‘ k% :. , 3. ‘iVI(, (,xt(!lisivt> st,rial l)(,l;]:~tol[)gic;il dala ~)l)lilii)ed, considered In cImntx41(In with llrt,- ,. vitlus d:Ila , all{)w r(’:LstIIIal)ly a(’rur;lt(’ (’lltll”;lc((’rlxilii(~ti of lh(’ hemati Jiogirai r(wp(nwt~ of huNI:In i ix~IIII!s {,xlII)sIYi t{ I silq),l(, d(kj{w of }14vI(4 rating radiatiou in tiw i)igh sui)lethal ~illl~l,. Th(, tll]lt~ !,” ., ..

(’III II” S{,{)1 (W(IIIIS is (iii’ft~r(tt)l lrIIm tilat otw(.rvtvi III iiir~e aiilmais ;Illd may 1)(,lit,w.rll)(,d us f{)i- I i(lv)s: . . a) ‘[’ill, (t}l:)i wili((~ r~nlti( i]~~.r~~:~.s(.sduring the fir,st two or n)or~, duys aj)(i t il{)ll li{u’rv:wrs l)f~iow ll,~rjll:ll Icv(!is. TII{’ {t~tai cimld tiien fluctuates over ti~c next [ivt$ or six w(w,ks, witil no dl![llll(t, mlnin)unl ;IIIti witit StIIDe vai LI(.s UIM)VC. n[)rlll;li (the prrsellre of th(, rmal {jr bet;l it~sit)lls, or ~}(l)t,]. ;LI. u1(> pr~)c(.ss(,s (iurlng Illis Iinlc May acr{mllt in ]I:trt for Iilese fluctuutiijns). TiIIJ cOUH1 l)(’($lllll(’S s[abil!xcd during the stweniil or t}l~iltii weeks i{t iow levels, :ind n~i Iii mum counts l)roiJabiy ()(-cur at tilis time. A definil(> trend upward is appartmt in tile ninti~ or tt’nth weeks; howcvf’r, r{]mplett? recovery may require several months (m morlh. i)) The neutrophiie count lmraileis the total white blood cell count. Complete return to nor- mai vaiues does not occur for several months or more. The initial rise in totai white count is due to a neutr,)phiiic ieukocytosis. c.) The drt)p in lymphocytes is early and profound. No evidence of recovery may be appar- , ent severai months after exix)sure, and return to normal levels may not occur for months or years. . d) Thr ])latelet count, unlike the fluctuating tots) leukocyte count, falls in a reguiar fasiliom ami reaches a iow on tile 30th day. Some recovery is evident early; however, as with the other .... elements, recovery may not be r,onll)irte severai months after exposure. 4. As an index of scvc!rily of exposure, particularly in the subietilal r. nge, Ihe total white or n(wt rophiie c(junts a re of Iinlit(, d usefulness because of wide fluctuations and because e.cv - era I w(v>kh mil Y ho rt, quired for maxi mum depression to become ovidcnt. I’he Iymphocyt e count ]s of morl! v:tiut’ in tilis regard i);irticularly in tile low dose range, since depr{wsion occurs with[ll il[)urs of cxlx)sure. H<)wtwer, since a marked depression of lymphocyte counts (w- curs will) low doses and since furtiler increase it] dose produces little more depression, tilis imicx is of little value :il the higil(?r doses. 5. Pix(t:leL r,mnts showed a regular pattern i)f change in the l)resent studies, with li~e same t i nlc of maximum del)ression in all exposure groups and with the de~ree of depression rougi)ly prt)l)f)rli,)n;li t{) the twlrulated doses. It appears, therefore, that the platelet count h:is con- sidurabit’ I,r{)mise ill lhc sut)leihal range as a convenient and relatively easy direct nletilod of dotcrnllllinx tile de~ree [If e.xlx)sure.

...... O●“..**. .* *...... ,., . .: :.: :.:: ...... -. “:.:: :: . . . .- ...... ** .. :-- .# . ..- .. —. .-. .— —.—— .. = ,.. ,., - .... - ., ,. .’ ,, .-,, .,: ,...... -. ,. -p?.+? !. ‘ ,. i... . ‘.! .-. ,, s ,- s ““ * . . . c. ,

-% !.. .6 “7. :, . . 1 “.’ %“ ,.- E ,.

CHAPTER 5

,.. ” INTERNAL RADIOACTIVE CONTAMINANT ON !,

5.1 lNTRODUCTION

A shdy of the nature and extent of the internal radio~ctive cont:imlnation in the exposed human beings was initiated on the 16th day post-detonation, with the collet’tion of 24-hour urine samples from the Rongelap, Ai!inginae and American groups. Additional inforrnatiun on the extent and nature of the radioactive contamination was obtained from domestic animals, food- ! stuffs, water and soil collected on the contaminated atolls and sent to the U. S. Naval IWdio - Iogical Defense Laboratory, the Naval Medical Research Institute, the New York Operations Office of the Atomic Energy Commission, and Lhe Los Alamos Scientific Laboratory for gross activity measur[?ments and r.adiochemical analyses. Data on soil, water, and plants were . ncce~sury to determine lhe feasibility of utilizing the foodstuffs and living area of the contami - ‘ _.g.-“* ..>- nated atolls. L(mg term studies of the domestic animals obtained are being conducted at the . . NRDL, in order to obtain information on the p ssible acute and delayed hxkard from internal ~.., k., ..-’ radlati[m. TIN; main findings of the internal contamination study in the human beings and their en- vir(mment are presented in this report. A debailed report (m the nature and extent of the in -- ternal radiation hazard In human beings and animals, as well as the conttirnination of the envirunrnent will be presented in an addendum report.

5.2 .——PHYSICAL—. EN~RONMENT.—-- .-— STUDIES—. .

A comparison of the food, water and soil samples from Rongelap, Utirik and Rongerik indicated a much higher level of contamination on Rongelap than on the other islands. The activity appeared to be distributed in the same manner on all the islands. In general, the contamination was associated with very fine particulate matter and was uniformly distributed Throughout samples of earth, thatch, and grass. Significant amounts of beta a(!tivity (1 pc pcr plant) as well as fissionable material (1 x 10-L pgm) were present on the external surfaces of pl:ln(s at 42 days, but only small amounts of beta and no alpha activity were detected in the edible portions. Coronut tree sap,’ an important item in the native diet, w:is found to lmve beta :lctivities [If the level of 1 uc/ liter on Rongelap at two months after detonation. Fish r(}llect(!d from the Rongelap lagoon were found to have very high levels uf activity (0.3 to 3 pc per fish) . as late us 120 days post-detonation. r The activity found in soil was determined to be associated mainly with fallout particles . of relatively large diameter. Rongelap water samples from both cisterns and a well (Figs. 5.1 and 5.2) had activities of about 1 ~c/ liter at 30 days. Samples of thatch roofing exhibited the highest levels of activity ‘.n the physical environment. The presence of fissionable material was detected on thatch, grass and on plant food.

...... ! :...... ” : . . . . . :.*: : ...... -...... - ...... ”,: ...... — .-. . —.. — —- . ,,. . ..- ,-..+=.. 4

. . ..” ,., ...... ,, , :,. .

...... ~’”.

I l.- ; :., ,-

,!-

. Fig. 5.1 Well, Rongelap

i, . ..2. . -e-= +&. = ..-4

..-

* ,. , Fig. 5.2 Cjstern, Rongelap ,.

...... **. . . ..*** ...... * ...... ~...... ’ ;“::*...... e. .e ...... ● ...... — —---— —-- —-— —.. - - —- - —— ..-- —- - —..—. ———. .—.——— ., ,. .,, .,, , !.. . ‘ .<-;. :.Ji. ,. . .

‘...... ,...... 5.3 ANIMAI,—— STUDIES

The studies (m the Rong{?lap and Utirik animals included measurement of i!ltermll radil~- artive c[]ntilmi n:lt ion and radio chemicai ;In:IIvsiN of excr(!ta nnd tissues. Tlw :itutr h[>mnttdtjgi {ill il[)(f l); ltl)oil)Ki(’ill {?ff(’(”t S’ of the {>XI X) Hllr(’, :Is well :1s lon~ term effects (U I lhoNt’ :lnimul~, ii re t)c!inK studi(hd. h urfdll~oti, [rrtiiity xnd hnlch~lbtli~y iitudivs 11S wt~li us I“:I(ilII(’]It’ ItIII”JI~ illl~ll - ysis of (~KKS I:lid W heIIH from lt(mtV’l;W w~!r~ i)(’rf~rnled. Th[!sc studies huve provided Inforrn;iti(m (m the extent and nature of the iuternul (’(l!;tanli “ r“ .. n;it i(m in t lw exp( ~sed human beings. For exxmi)le, rttdi(uml(~graphs of aninull Ix)!les prepared I 1 by NRDL and Argonne National Laboratory M ( ~ig~. 5.3 ~nd 5.4) indicute the ptittt’rll Of ~kel- ,. I - etal distribution of fission products, particularly the htgh concentrations of radiuelt>ments ;’ in the epiphyseal region of the long bones. Further, information on these animals (which rc’- 1.*. :,. -, ct?ived a n~uch I)igher external radiation dose than was received by the native group and over 10 t i nies the internal deposition) shouId be of considerable prognostic value for the human ., beings.

-1

I ., . Fig. 5.3 Autoradiogmph of Rongelap Chicken Tibia, l’~ x, 21 hr Exposure. Animaf Sacrificed -. 45 Days Post-exposure (ArgoMe National Laboratory Photo).

...... *..* ● :.’,...... , .-...... ,: :...... :, ...... *** ~— -., ..- ... .——. — .— ~— _ —.. -—- -—— — -—-—— -—- ._ ,, ,. .,, ...... , -. --4 *-7X-...:.

...... “. ,,< ., ...

!. :- .. ~,.,

. . :.:

Fig. 9.4 Auloradiograph of Rongelap Pig Tibia, 42 hr Exposure. Admal ~crffic~’d ~8 DIIYS . Ih)sl-(,xpa)surc. —— -.

5.4 HUMAN STUDIES _—— —.. ! ,.:-”

5.4.1 Ex(:ret_-— —_.iun

Gross beta activity measurements on the urine samples from Rongelap, Ail inginae, and Rongcrik indicate s)~nificant c(mtamination in the majority of samples. The variation in beta nrtivlty (~x(. reted 24 hours amfmg individuals in any f]ne group is quite large (Table 5.1). If tlw mc:ln V:IIU(?S(J[ urini a(. tivity of the adults of the three groups six weeks after cxfxwure :irc rtlml):lrerf, it will be seen :hat the Rongelap gr{ml) had the highest activity, 1208 d m, 24 I1OU rs. ‘f%? Ail in~lnae ~roup h:kd 553 di’mj24 hm}rs, :~nd the American group had 309 d, m 24 h~mrs. A groulj (Jf tlm .fap:lnese fishermen exposed t{) fallout from the same deh]nat ion had a urine :It’tivity l,omp.lrahle to (hat of the Rongelup ndult group. Tllc lnwtn jl[tivily [)f the individuiils under 15 years of age appears h) be considerably loWl:~ ttliil} tllill 01 IIW ;l(iUlt gr(ml). An cxanlinati(m {)( the grmlp r{~lIerttons all:ilyzmf I)y tIw v:lrif)ils i;tl)tJr:ltorirs itlv~)lvcd slv)wed fairly consis~ent levels of artivity [or (he il~dividuitl from d:ly tt, d:ly. The viiriiilion which occurs is not considered to be excessively I.lrge for this type of study. The activity :ts ful~ction of time fell off rapid}y due to the large component of w140 . ?Ja140and other sh(:rt Iived radioisotopes. For example the Rongelap gr~ufJ had a mean * activity of’ 1208 d! m 24 htiurS at 46 days and activity of 339 di m/24 hours at 90 days. At six months post-exposure the Rongelap urine was found to contain a barely detectable amount of beta activity. The results of radiochemical studies of urine indicate that SrS9, Ba140, and the rare eartil group apparently constitute 77 per cent of the total beta activity at 46 days. Strcm - tium -89 contributes 40 per cent of the total beta activity, Ba*40— 11 per cent and the rare earth

...... ” .: .”.. ““. .*.* ● **.... ● ---- -.. . ::.:: .:: ...... -...::. .- ...:: ..*...... - .. —..._. .. —___ . ———————...... ,,. .- -...... , -~,, >-y...... ”. ‘l”ltblt~ fi. I (;1{OSS I! E’I’A ACTIVI1’Y IN Ul{lNli OF ltf.)NGP; I.AP (iI{OLll) i ((11’IIIv (’l,ll(w.t!vl (III 4(;th 1%)s1-{*xINwNi{. I)NY Iln(i ViIlutt.I (’ortx,dmt II, r l)t IrILv . ) Ull(. k 14, (:[lllvctl(lll Dlty)

“rollll ‘1’(llul Volurnv l)(~ta Activity V1)IUIIIO th4Ji Aotlvlty -~.l hr d/mpL4 III’ 24 hr {1Ill 24 Ill’

AUU . 16 .yturs , 120 712 4 455 G34 , 150 894 7 $10 1700 I 1:)5 313 Y 355 201 1’ 40 223 10 980 W9 260 0 11 450 1583 I 80 285 13 340 I 677 455 301 14 780 24 w 18 455 1670 .,, 1(i5 404 .2 47 77 :10 w o 438 34 7J0 5’70 :17 480 7!)2 40 550 1450 46 330 495 49 425 0 02 750 0 55 320 1080 56 700 ;)220 Age 6 to 15 57 550 1095 years 58 750 2170 20 265 1900 60 810 580 .<- .. :- .. . 24 550 0 62 980 1985 26 650 1032 63 635 2260 35 255 0 66 -S55 - ‘ 1715 36 190 236 66 300 2010 ,. 39 280 1100 71 290 1450 47 650 1705 73 230 0 . . 6’7 450 674 78 965 52 72 110 507 79 465 2038 75 440 0 80 540 1353 ’76 980 1180 82 670 2140 —. -——- .—. .— —...... —.—... —..----- Mc:in 439 758 Mean 581 1208 ..

group—25 per cent (of which 11 per cent is La ’40, in equilibrium with Baido at thts time). Fis- simable materiai was not found in significant amounts in any of the urine samples analyzed. Iodine- 131 was f[mnd only in samples analyzed at ear)y time intervals, due to itsrelatively short physical hal[ life.

5.4.2 Estimate—. of———_—Body Burden For estimating the human body burden of the various fission products, a semi-empirical approach, involving extrapolation from animal data, was used. Two Rongelap pigs were killed after their average 24 hour’ urinary excretion of fission products was determined. All tissues . were analyzed for total beta activity, as well as for Sr ‘S, Ba 140,and the rare earth content (Table 5.2). By applying the ratio of animal body burden/urine excretion activities to the f , I Rongelap native urine samples analyzed at about the same post-detonation time, a total human body burden of 0.33 pc, for post-exposure day 82 was obtained. If this total human body burden I

...... - ...... :..... :.. : . ..-. . -...... *:., ...... , ...... ,...... -. . . ,.. . . : : ...... -- ——— --- ——— — . —- ———. . . -.,,.. , . ., . ...’..’ -“ ,* --y:::.,....—

,. -.. ;’ .”-...... :.:. “1’able 5.2 RAI}l(.)C}IKMICAL ANALYSIS OF ‘I’ ISSUES AND LIKINE OF R(JN(; k:lrA1’ I’l(is

(All VII IINW (.,lrr(’(.ll”~l for l) Iwf I.v 10 WY d .Sn(. rlfiw, tt]<~ tMnd I’, wl-cxlxwurv l)ny} ; I f l)tIl:I Aollvlt,Y d. ‘m/t{dxl SnmIJlf* , ‘r(llnl ~~n ~atdo ILIII.<*Kllrth .Sumplv ‘~ (~ 10-’) [k lo ~) (\ lo”-~) .- —

i’i~ h’24 (2:1.8 k~n)) Skel(,t{m :)660 060 1010 I,lvl. r 31 1).4fJ 0.:1s 6.4 Colon” & [;ont.ont~ 12 5.0 2.4 :].~ lung (Alvcolnr) 1.5 0.22 0.20 0.8 Stomach ‘ 1.2 0.22 1.1 1.3 Intcstino (Small) 2.3 0.62 0.50 0.51 Kidney 3.3 0.21 0.42 0.74 I{cm:linlng Tissues 690

‘rotal 9630 5667 665 loi20 u rlno .Sumplc, 24 hr (5/27) 13 8.7 1.2 1.6 U rlrw Sample, 24 hr 9.6 Avcrngc for da,ys ti~ to WI post-cxfx>m rc

Pig#25(22.7 kgm) Skt,lch)n (tolnl) 8600 5100 530 690 l.iw~r 27 0.53 0.20 5.5 .(: Olt)n & (: fmtoI1lH 16 5 3.2 4.9 I,ung (Alvcoiar) 1.1 0.26 0.23 0.33 Stomach 2.0 0.29 0.13 0.30 Inl(wtlntt (Small) 2.6 0.8:{ O.ns O.t!n K idm!y 3.1 0.14 0.19 0.52 Rt, rnaining Limmes 220 -—- ‘ Total 8870 5107 -534 702 Urine Sample, 24 hr (5/27) 6.2 4.4 0.40 0.54 Urine Sample, 24 hr 8.1 Average for days 82 to 88 post-exposure Total Average Per cent of Indlvldual Radicelemtmts Srn ~a140 Rare Earth

Skeleton 62 6.8 9.7 Tntul Body 58 6.5 9.0 (Irinc (24 hr) 69 7.9 10.5 —.. .—. ———- .- ..-...——— — —-—. --- —--,

is sepuraled into its (wmpcments using the ratio of individual isotope activities in the urine or in the total b{}dy of the animals al this time, the following values for the Rongelap group, 82 days po~t -det{)nat iml were obta Ined:

Sr8’ - 0.19 flc Ba’40 – 0,021 flc Rare Earth Group – 0.030 PC CXhers – 0.09 pc

The excretion rate of Sr and Ba can be described empirically by a power function, At = Ait-n where n is 0.4 and At is the activ ky remaining in the body at time t (days). The ex- ponent was derived from Cowan, ‘g Sr90 human inhalation data, and it corresponds very closely

...... ,”..”.::” ● ::.*:* . . . . . , ,...... :. :....: :.::-:: ...... “: :.* ● - ...”.”. .. ::.*...... —. .—— .—— — -’ .. . . . ,., . ,...... ::”::’ :.”.”. ;: :.: h) the exponcnl ft)und iII the hufdafi i.;fdIfihl”&17;i “&fN/~rri@ hiKI”L,~itiICy6’. (JSIIIK (Ills 101’I1lUI:l > tion the incfividunl skeletal tx)dy burdens ext r;lpolated buck t{) day one xre :)s ft)llows: ~ . -.4< SrsS 1.6 /1{” - 4* . . .2 - Bn ’40 2.7 /1(’ a FiHHiL)n:ibltI m:tterinl neK,(tive & %, % . ..- B:u+sd (m the SrgU analy~ls, the Hunter -Dallou fItMi L)II diltit62 ;Ind thu rotentttm d;~ta ~Jf Hamiit(m. as %: . the following estim:ltes (if skeietal body burden in the R(mgelap ~ruup (m d:lv 1 wert~ mude: ?K”

a) rare eilrtilgroup - 1.2 ~c b) 1181– 6.4 mc . The integrated dose to the thyroid from llsl and the shorter lived iodine isotopes (lisz, I ‘ss, and -. 11s5), assuming a 20 per cent uptake/24 hours wxs 180 rep. The Ailinginae values were then approximately one-half and the American were one-fourth of these. values. 011 the basis of a radiochernica] analysis on pooled urine samples rollected from a cross section of the Rongelap and American populations, 16 – 18 March, Los Alamos reported” the following estimale of fissions associated with material inhaled and or ingested by the Rongelup native group: I*S1-5.5 x 101s fissions sr8a -1.2 x 101s fissions Ba140 - 1.0 x 10IS fissions

From these data, using certiain assumptions as to the uptake and retention of these radioelements by the body, the following estimate of body burden at one day was derived:

., . Rongelap American ‘--- -_. . . (JIC) (f.lc) ‘ -.ik~+: . .@, 2.2 0-32 - ‘ ~a 140 0.34”2 0.27 RUIOS 0.013 0.015 ~aa 0.19 0.04

llS1 and short lived 5.1 mc 1.9 mc l;sl equivalents Fissionable material 0.016 ~m

The initial body burden of llS1 and short lived iodine isotopes, energetically equivalent to llsl is 5.1 mc. The estimated total integrated dose to the thyroid [rem the iodine isotopes assuming a 20 per cent uptake/.24 hours and with corrections for decay of the very short Iived iantope~ was calculated to be 150 rep for the Rongelap natives and 50 rep for the Americans. It can be seen that with widely different approaches to the estimation of the body burden, the results obtained are very similar with the exception of the Ba140 estimate. An attempt Lo detei.t bone-[ixed radioactive emitters by means of sensitive film badges taped below the knee over the epiphysis of the tibia on 40 exposed Marshallese yielded ne~a - tive results.

5.4.3 ——Internal Radioactive Decontamination Ethylene diamine tetracetic acid (EDTA) has been shown to be the most effective chemical agent to date for mobilizing fission products from the skeleton and for increasing their ex- “. cretion rate. es‘s6’6’ This chelating agent was therefore used in a decontamination therapy attempt on a group of seven Rongelap individuals having relatively large amounts of internally deposited radioelements. Oral administration of calcium EDTA, 1 gmf 25 lb body weight daily

. . ...*..*. .. *.*: . ..*”..”: ...... : ,. +...... :..:: ;“...... I ...... * .s 0.0.. ● ..,...” “ —; ——.—.. ——. —-.— -.. . ,. ,., ,,, . .- . . . , .. ?:...... I 9 for three days increased the .river~ali m“ean hc!tlVil~ JI1 tlfd 24- hlMf ur Intw (,f IIN! t r~uil t’d }}(,ol~l(, by a fm-tor of 2.5 times compared with the pretreatment control excreti~n. Since the rnte of excretiim of activity at this time W.IS about 0.1 per cent, 24 hours, the observed inrr~!:~st’ in f. exc rcti(m did nt~l signif irant ly alter the total body burden. This study and previous animal work .. . >, - .. sug~esl th:lt EDTA, perhaps administered I.V, and at wlrly intervals, might huve I)ewl llf (’on- * >. sidcr:ll]ly greater v:ilut’ in it~i”rensillg the excreti[nl ()[ some of the intern:llly dep(wltod fission produtts. -k ,> 2- 5.5 DISCUSSION .

‘l’lt(>f:l Iliwl mul(’ri:l I pr(}t)illll~ entered ihf! cxp{n+ed people through both the inhal:lti(m and in~es( 11)11r[ml(’s. ‘1’11(1 rol;IttvtIly I;[r};c p;lrtlcle SIZ(L Ild!catcs thnt II)(I pr(dmbllity ()( illluliuti(m {~f;I irt)orn(, (Iotlt;imin;lt i~m wiLs snwll. Thifi is bawf (m the tdmervat hm thut In gtvlcral (rely I);{ rti(lt!s O.1 to 3 p in diamctrr rcarh ll~e alveoli (m Inhulatton and tlmt l~rger piirti(.1~~ nre 68 11] ;,dditioll, the liin~s filt(lr(xl fml by 1IM* nose :tnd upper respiratory passag(I and swdlowml. and a I r sat.s of chirketw autt)psied in the period 24 to 100 days post -detonat ion showed low levels [)( rmltaminatlw), while the gastrointestinal trat’t and its contents were relatively active. The hily h;ld received approxima&ely the same am[mnt of internal contamination as did the Rongelap adult group. The lower urine activities found in the Marsh~llese ..- individuals under 15 years rnny indicate that wtth active bone growth occurring, the internally deposited fission products were more firmly fixed and therefore less readily excreted. It does not seem likely that the children were subjected to any less internal radioactive c(mtidmination than were the iidults.

5.6 CONCLUSION

The degree of internal radiation hazard was too low to have contributed significantly to the acute radiati{m syndrome observed. Efforts to correlate individual body burdens with their clilliral or hematological findings (platelet and white blood cell levels) were unsuccessful. Due to the ability of the skeletal system to concentrate fission products, any injury to the body from these internal emitters would most likely be determined by the radiation effect on the bone. The roncent ration and type of internal radioactive contaminants, however, minimize the probability of any significant long term effects from the internal radiation. The possibility of synergistic effects from the combined exposure to external and near tolerance doses of internal radiation is also very slight. The occurrence of such a synergism . has been demonstrated where animals were subjected to relatively high doses of internal emit- . ters (2 )lclgm) in addition to high external doses. The only suggestion of such a combined effect III this situati~m W;LS from the hematological response otserved in these exposed human . . f beizl~s, which did not [OIIOW precisely the time course characteristically seen in lower mam- mals after short exposure to external radiation.

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* .4 . . S* .1 i ‘-t, [ “%. ,. ‘“ * -. g--e:”,- , ~.1.- L. l.” : i:: ‘. - CHAPTER 6 i ‘

p.. RECOMMENDATIONS ,,

1. 11 is recommended that establishment of a medical team on a continuing basis, prepared ,- to handle emergency Situations connected with radtation, be considered. Qualified personnel should be designated by name; minimal clinical and research procedures considered essential should be established and necessary equipment should be stockpiled. 2. It is recommended that steps be taken to obtain additional data in the laboratory in the following categories: (a) The hematological response of large animals, and preferably man, exposed to radiation producing the depth-dose curve seen wttb fallcmt gamma radiation from a plane field. Data well beyond tht> usual 30-day period, and ~referably for at least a year after exposure, are, necessary. — .> (b) The response of human skin to beta radiation under conditions of different beta ener- . gies, source sizes, and source geometries. .1 .

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REFERENCES

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...... *””:.”: . . . . . : ...... !** .:; ” ::: ...... :~...... -**...... - .**-. *~.,”””” . .— —— —-— -.—- —— —. _ _—. -— ...... 58. Norris, W. P., L. A, Woodruff, P. F. Gus&[tw~ and A. M. Brucs, Report un biological specimens collected on Rongelap Atoll in March 1954, ANL-HDY 731. 59. Cowan, F. P., L. B. Farabee and R. A. Love, HtIalth physics and medical aspects of n ,.. slrontiunl-90 inhalation incident, Am. J. Rcwnl., Rad. Ther. & Nut. Med., 67: tlf)5, 1052. - ~“ 60. Norris, W. P., T. W. Spt’~kmi]ll and P. F. Gustitfson, Studies on the n~ctallollsm of a radium in humant+. Unpublished. Looriey, W. B., Lnte effects (25–40 years) of the early medlctil itnd hdUHt rliil use of rn - dloiictlve nlateriulM, Prctwnt[xf in part at thl’ 35111annuul wtmion of Amcrlcun Colle~tl (If’ Surgeons, Chicago, Illiuois, April 9, 1954. 62. Hunter, H. F., and N. E. Ballcm, Simultuncous SIOW neutron fission of UISb atonls. 1. Indl - vidual and total rates of decay of the fission products, USNRDL-fJ5, April 1949. 63. Hamilton, J. G., The metabolic properties 0[ the fission products and uctlnidt’ t’lements, Rev. Mod. Physics, 20:718, 1948. 64. Harris, P. S., Personal communication. 65. Foreman, H., and J. G. Hamilton, The use of chelattng agents for accelerating excretion of radioelements, AECD-3247, 1951. 66. Cohn, S. H., J. K. Gong and M. C. Fishier, Studies on EDTA treatment of internal radioactive contamination, Nucleonics, 11: 56, 1953. 67. Gong, J. K., W. L. Milne and S. H. Cohn, Studies on the treatment of internal radioactive contamination. IV. Effect of zirconium citrate and EDTA on lhe distribution and excretion of a mixture of long-lived fission products, USNRDL-426, Dec. 1953. 68. Patty, F. A., Indust., Hyg. and Toxicol., Interscience Publisht?rs, Inc., N. Y., 1948.

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1 ‘1 [ 1“ ,. ;.” . ! . DISTRIBUTION ~:.;-: Mt’litary Distn’bution Category 5-50 ,“ ARMY ACTIVITIES

Asst. Chief of Staff, G-3, D/A, Washington 25, D. C., ATTN: Dep. CofS, G-3 (RR&SW) 1 Deputy Chief of St:lff for Logistics, D/A, Washington 25, D. C., ATTN: Director of I{osearch :md Development 2 Chief of Ordnance, D/A, Washington 25, D. C., A’1’TN: ORDTX-AR 3 Chief Signal Officer, D/A, P&O Division, Washington 25, D. C., ATTN: SIGOP 4–6 The Surgeon General, D/A, Washington 25, D. C., ATTN: Chief, R&D Division 7-8 Chief Chemical Officer, D/A, Washington 25, D. C. 9-1o The Quartermaster General, CBR, Liaison Officer, Rusearch and Development Div., D/A, Washington 25, D. C. 11-12 Chief of Engineers, D/A, Washington 25, D. C., ATTN: ENQNB 13-16 Chid’ of TRNEip31’htiOrI, Military Planning and lntelligenoe Div,, Washington 25, D. C. 17 Chief, Army Field Forces, Ft. Monroe, Va. 18-20 President, Board #l, oCAFF, Ft. Bragg, N. C. l~residcnt, Board #2, OCAFF, Ft. Knox, Ky. Pre~ident, Board #3, OCAFF, Ft. Benning, Ga. ., ~-= Commanding Gmwral, First Army, Governor’s Island, New York 4, N. Y. ‘– 24 . , .-. : Commanding General, Second Army, Ft. George G. Meade, Md; 25 ..=. ... - z- Commanding General, Third Army, Ft. McPherson, Ga., ATTN: ACofS, G-3 26 _’.-..,---.. -,=.1 Commanding General, Fourth Army, Ft. Sam Houston, Tex., ATTN: G-3 Section 27 ------Commanding General, Fifth Army, 1660 E. Hyde Park Blvd., Chioago 15, HI, 28 Commanding General, Sixth Army, Presjdio of San Francisco, Calif., ATTN: AMGCT4 29 ( Commanding General, U. S. Army Caribbean, Ft. Amador, C. Z., ATTN: Cml. Off, 30 f Commanding General, USARFANT & MDPR, Ft. Br~ke, Puerto Rico 31 f Commanding General, U. S. Forces Austria, APO 168, c/o PM, New York, N. Y., ATTN: ACofS, G-3 32 Commander-in-Chief, Far East Command, APO 500, c/o PM, San Francisco, Calif., ATTN: ACofS, J-3 33-34 Commanding General, U. S. Army Forces Far East (Main), APO 343, c/o PM, San Francisco, Calif., ATTN: ACofS, G-3 35 Commanding General, U. S. Army Alaska, APO 942, c/o PM, Seattle, Wash. 36 Commanding General, U. S. Army Europe, APO 403, c/o PM, New York, N. Y., ATTN: OPOT Div., Combat Dev. Hr. 37-38 (:ommamiing General, U. S. Army Pacific, APO 958, c/o PM, San Franolsoo, Cal If., ATTN: Cml. Off. 3ti-40 Cornm:mdant, Command und General Staff College, Ft. Leavenworth, Kun., ATTN: ALLLS(AS) 41 Commandant, The ArtiIlery School, Ft. Sill, Okla. 42 Secretary, The AA&GM Branch, The Artillery School, Ft. Bliss, Tex., ATTN: Lt. Col. Albert D. Epley, Dept. of Tactics and Combined Arms 43 Commanding General, Medical Field Service School, Brooke Army Medical Center, Ft. Sam Houston, Tex. 44 Director, Special Weapons Development Office, Ft. Bliss, Tex., ATTN: Lt. Arthur Jaskierny 45 Commandant, Army Medical Service Graduate School, Walter Reed Army Medical Center, Washington 25, D. C. 46 101 “~ ...... ● .0 . . . . , ..: .“: . ..-..*...... : ::=:.. .“ ...... ** .. ”:: :: ...... :: ...... *. ● .* ...... ,. ,, .,, ,, ,,

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NAVY AC TIV1’l”IES

Chief Of Naval opcr:itions, D/N, Washington 23, D. C., ATTN: OP-36 ,65-66 Chief, 13uremr of M~dicinc wrd Surgery, D/N, Washington 25, D. C., ATTN: Special Weapons Defense Div. 67--68 Chirf of Nav:Il Personnel, D/N, Washington 25, D. C. 69 Chwf, Bureau of Ships, D/N, Washington 25, D. C., ATTN: Code 348 70 Chief, Bureau of Supplies and Accounts, D/N, Washington 25, D. C. 71 i Chief, Bureau of Aeronautics, D/N, Washington 25, D. C. 72–73 Commander-irl-Chief, U. S. Pacific Fleet, Fleet Post Office, San Francisco, Calif. , 74 Commander-in-Chief, [J. S. Atlantic Fltw’t, U. S. Navrrl 13mw, Norfolk 11, Va. 75 Commandant, Il. S. M;tr!lw C(, rps, Washington 25, D. C., ATTN: Code A03H -—- ‘ 76 Suln. rlntentk:ni, U. s. Nnv;Ll Postgradu:ile School, Mrmtcrey, Calif. . 77 (:l)mrn:in(liflg (Jfficx, r, 11. S. Navnl Sch(mlH Command, U. S. Naval Station, Troawrc island, San F rul]{.is{.1), (;:II if. ‘iH (:omlntrndln~ olficl, r, U . S. Fl(~{,t ‘I”ralni!)g Ccnlor, Navul Busu, Norfolk 11, VU., ATI’N: Spr!clal w(+llll)n H Sdlo{)i ‘7!) (’,,mm:lndjjl~ (Jfli(:{. r, II. S. Fl{,(,l ‘~ru!nil]g Ct.nlcr, N:iwtl Stutiou, SrIn Dicgu W, Cal If., A’I”TN: (Sll Wl~ S(,hotd) w) [’onlmillulln~ 0111(,(,1, U . S. N: Iv; II l):inui~c (:(mlrol ‘f’r:lllling Ccntor, Navjll Huse, ljhlladclphi~ 12, 1’:1., AT’I’N: AI)C l)cf(m~c (:int l,iinrilng F[)rix. ll(mrd, M:\rlne Birrracks, Camp Lcjcurre, N. C. 83 Comm; lndc, r, U. S. Nav:Il ordnuncc Laboratory, silver Spring 19, Mri., ATTN: R 84 C,~mmandcr, U. S. Naval Ordnance Test Station, In,vokern, China Lake, Cal if. 85 Commnnd]ng Officer’, U. S. Navul Medical Research Inst., Natinmd Nuval Medical Center, Bethcsd:l 14, Md. 86 Di rector, ‘1’he Mulcrial Loborntory, New York Navnl Shipyurd, Brooklyn, N. Y. 87 Cornmandm~ Officer :md Di rector, U. S. N:ivy Electronics Laboratory, .%mDiego 52, CalIf., AT’I’N: Code 4223 88 Commanding Officer, U. S. Naval Radiological Defense Laboratory, San k“rrmcisco 24, Calif., ATTN: Technical Information Division 89-92 Commandqr, U. S. Naval Air Development Center, Johnsville, Pa. 93 I Director, Office of Naval Research Brunch Office, 1000 Geary St., San Francisco, Calif. 94 Officer-in-Charge, U. S. Naval Clothing Factory, U. S. Naval Supply Activities, New York, 95 3rd Avenue and 29th Street, Brooklyn, N. Y., ATTN: R&D Division . Commandant, U. S. Cnast Guard, 1300 E. St. N. W., Washington 25, D. C., ATTN: Capt. J. R. Stcw:i rt 96 4 .“f~.d,...... $.: ‘:.-,~ ...... , ..” ‘ ● 6.:.-d- . ..* ● d .-.. ...;. :,:”...... :.. .* /j$f!”ii. :.?” —.— —.———-——-z-. .-.—-— —— 7, ...... “: -......

‘4 AIR FORCE ACTIVITIES ‘“ “o= ● ● 00 ● ‘o’”~.”;,j ● .7 ~~;: “: ‘. ;;”’:.: ~~- , , * Asst. for Atomic Energy, Headquarters,. ti!%%ioi%?:+?fy.:%(p ,7 I —4 Director of Opcrntivns, Iivndquartcrs, LISAF, Washington 25, f). C., ATTN: Ooorationa Annlvsis.– 98 Director of Pliins, NciId(pI:Irters, USAF, Wttshin@m ~5, D. C., ATTN: War I’lumI Div. 99 I)irtwtor of lit:st,:trch and l)t~vclt~pnicnt, Iieadqunrtrrs, USAF, Washln@on 25, D. C., ATTN: (~t~mhut Cumpwwnitj f)iv. 100 L)ir(wlor of lntelligcnc(,, thwdquurtera, USAF, Washiw@on 25, D. C., ATTN: AFOIN-lf32 101--102 The Surgeon G(lnt*rul, l[un(lquurlt!r~, USAF, WaHhln@on 25, D., C., ATTN: i310. Def. Br., .—. . Prc. Med. Div. ,. 103 Deputy (:hlcf ,,( Stuff, lnt(, I I igenm., l{ondqunrtcr~, U. S. Air Foroes Europe, APO 633, c/o PM, New Y,~rk, N. Y., ATTN: I)lrectornto of Air Tnrgota 104 1 . Communtlero .1!)7th lkxxmnnissnntx. Technical Squacfrtm (Augmmttod), APO 6S3, o/o PM, .. N(:w York, N. Y. 105 Commander, k’nr Eust Atr Forco#, APO 925, c/o PM, San Francisoo, Callf. 106 Commander, Strategic Air Command, Offutt Air Force Ba~e, Omaha, Nebraaka, ATTN: Special Weapons Br::nch, ln~pectlon Div., Inspector Genera] 107 Commander, Tactical Air Command, Langley AFB, Va,, ATTN: Documents Seourity Branoh 108 Commander, Air Defense Command, Ent AFB, CO1O. 109 Commander, Air Materiel Command, Wright-Patterson AFB, Dayton, O., ATTN: MCAfDS 110-111 Commander, Air Training Command, Scott AFB, Belleville, 111.,ATTN: DCS/O GTP 112 Commander, Air Research and Development Command, PO Box 1395, Baltimore, Md., ATTN: RDDN 113 Commander, Air Proving Ground Command, Eglin AFB, Fla., ATTN: AG/TRB 114 Commander, Air University, Maxwell AFB, Ala. 115-116 Commander, Flying Training Air Force, Waco, Tex., ATTN: Direotor of Observer Trainfng 117-124 Commander, Crew Training Air Foroe, Randolph Field, Tex., ATTN: 2GTS, DCS/O 125 Commander, Headquartera, Technical Training Air Force, GulfPort, Miss., ATTN: TA&D 126 Commandant, Air Force School of Aviation Medicine, Rundolnh AFB, Tex. 127-128

Commander, Wright Air Development Center, Wright-Patteraon AFB, Dayton, O., ATTN: !.

WCOESP -129-19Q >- <-T- .“ “.. F.. - Commander, Air Force Cambridge Research Center, 230 Albany Street, Cambridge 39, Maas., ATTN: CRQST-2 131-132 Commander, Air Force Special Weapons Center, Kirtland AF3, N, Mex., ATTN: Library 133-135 Commandant, USAF institute of Technology, Wright-Pattereon AFB, Dayton, O., ATTN: Resident College 136 Commander, Lowry AFB, Denver, Colo., ATTN: Department of Armament Training 137 Commander, 1009th Special Weapons Squadron, Headquarter, USAF, Washington 25, D. C. 138 The RAND Corporation, 1700 Main Street, Santa Monica, Calif., ATTN: Nuolear Energy Division 199-140

OTHER DEPARTMENT OF DEFENSE ACTIVITIES

Asst. Secretary of Defense, Research and Development, D@, Washington 25, D. C. 141 U. S. National Military Representative, Headquarters, SHAPE, APO 55, c/o PM, New York, N. Y., ATTN: Col. J. P. Healy 142 Director, Weapons Systems Evaluation Group, OSD, Rm 2E1OO6, Pentagon, Washington 25, D. C. 143 Commandant, Armed Forces Staff College, Norfolk 11, Vs., ATTN: Seoretary 144 Commanding General, Field Command, Armed Forces Spectal Weapons Project, PO Box 5100, Albuquerque, N. Mex. 145-150 Commanding General, Field Command, Armed Forces, Special Weapons Projeot, PO Box 5100, Albuquerque, N. Mex., ATTN: ‘Technical Training Group 1s1-152 Chief, Armed Forces Special Weapons Project, Washington 25, D. C. 153-161 Commanding General, Military District of Washington, Room 1543, Building T-7, Gravelly Point, Va. 162 . . ATOMIC ENERGY COMMISSION ACTIVITIES Li U. S. Atomic Energy Commission, Classified Technical Library, 1901 Conetitutlon Ave., #l : Washington 25, D. C., ATTN: &Ire. J. M. O’Leary (for DMA) 163-16S LOS Alamoa Scientific Laboratory, Report Library, PO Box 1663, Los AlamoE, N. Mex., ● ATTN: Helen Redman 166-170

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1’ $. -. -. : -La, e. Sundl II [;orpf)rntl on,” Clll~~lfi(.(1 l>~tim{nt l)lvl~l on, Sun . “-9 . MRrl in l,uc(,rt] ‘:” 171- 172 ;., /:, , “ : y ~ University of (:ullforma Itudintl(m I,itl)t,rut{)ry, PO Rox M)FI, Llvormoreo (!ullf., ATTN:. A, ‘ e::*;::,TN:. . . Mnr~nrut Edlumi ‘“ Iix >174 & Wctipm Datu S(x:lllm, T(whnlcul Informntlon SHrvioo, ouk Ridge, Term. I75 . Technical lnform~ll,m Service, onk Rkige, Teun. (rnurplue) 170- 400 ‘.

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