ATTACHMENT 1 267062 HG US DOE ARCHIVES 326 US ATOMIC ENERGY COMMISSION COLLECTION: Div Biology & Medicine Box 3218 Folder MCBM Minutes ADMIRAL GREAVES: Well, Dr. Duncan has given a very excellent description of the experimental work and studies that are being carried on in many fields. Our problem in the Navy is of course similar to that of everyone else. Our personnel will be liable to injury and liable to become casualties the same as anyone else, so we are interested in all those explorations in the field of hemorrhage and infection and the other things in prevention. In addition to that we do have some problems that are peculiar to the Naval service. For example, being a sea-going outfit, we are particularly interested in material damage to the vessels and to contamination that might follow the type of explosion that would occur under conditions at sea. This subject has been studied and is being studied out at the research laboratories at Hunter Point, and they have discovered some interesting things. For example, they have found that contamination is reduced very markedly if the surfaces are wet at the time the contamination occurs. If the contamination occurs on a wet surface the decontamination can be effected to an extent of about 98 percent. If the contamination occurs at a time while the surfaces are being wet, they are being flooded with sea water for example, it can reduced to 99 per cent. If they can work out some system of getting an alarm to start flooding the water decks of the ship and then cut off the flooding so that they won't be flooding contaminated water from over the side, and get out of that area where there is an amount of good pure water, they prevent a problem which is very important. 1 SPECIAL REREVIEW FINAL DETERMINATION UNCLASSIFIED "illegible" "illegible" Reviewed "illegible" Date 11/14/80 Another thing that we are interested in is something that has not been mentioned here, or I missed it if it was, and that is the effects upon personnel in a submarine, for example, if we succeed in powering such a submarine with an atomic engine. We know that personnel that are subjected to radiation, doses of radiation, if they are put at rest, their changes for recovery are pretty good in many cases, but that condition does not prevail in a submarine. They must keep on the job, and there is an element of work and fatigue and all of that sort of thing which we all know increases the effect of radiation. That is a problem that is more and more coming to be thought of by our people that are interested in this. Of course, we are also interested in a way if it is possible, to protect individuals against the effects of radiation prior to their being exposed to radiation. Dr. Kruger out in Berkeley and the people across the Bay at Hunter's Point are working on experiments and projects on that line. I have brought with me two people who know more about our radiation problems and perhaps they might have something to say. CAPTAIN BEHRENS: I have nothing much more to add. We are naturally interested in the contamination and decontamination because of the increased susceptibility to the effects of an under-water burst and as Admiral Greaves pointed out that problem is of considerable concern, and also the problems that might be associated with nuclear reactors. That brings in the whole matter of calculated risk which all of the services are interested in, and it is not only the services but probably the civilians as well. 2 There is no way of telling, in certain localities, at any rate, whether or not there might not be an under-water burst. In most places it is quite obvious that such a use of an atomic bomb would not be profitable, but here and there it might be, and of course there might be a ground level burst. The net outcome of that would be that you might be faced with the necessity of sending rescue parties or salvage parties into contaminated areas either for purposes of rescue or again for purposes of following up in the military venture. So the problem of calculated risk comes in, and that is of course an area in which we would like more information. We have plenty of information about patients but we don't have too much information as to what the effectiveness of personnel are going to be if they are exposed to something like in the neighborhood of 100 R, because it is a different proposition when they are working than if they are patients, and can lie down and rest and get good medical attention between the times when they get the treatment. They are interested in seeing how effective they will be and how much their morale might suffer and how the remote effects might be affected by the amount of work and effort nd exposure to various aspects of the environment. That originally doesn't cause us too much concern, that is exposure to the and exposure to cold and fatigue. We usually don't think too much f that, but when it is added to radiation, it could make quite a difference. For instance, we have lost several sets of experimental animals in which they were studying the LD-50 because the truck broke down and they were exposed to hot weather for a few hours and then the whole outfit died instead of as some reduced percentage of them. 3 So that is the type of problem I think we are all interested in, both civilian and military. That is about all that I have to add to the discussion. CAPTAIN HAIGHT: I think the only thing that I could add that might have some value would be a question of anoxia. It has already been provided definition that extreme anoxia has a protective effect, and the aviators are particularly in that. They would like to run that from extreme anoxia to partial anoxia, and see if partial anoxia would give some protective effect because the condition of the atmosphere in a closed cabin plan can be quite carefully controlled. It would be theoretically possible if a modern anoxia was helpful to produce that affect within the plane. DR. WARREN: Have you in mind the figures of Dr. Dowdy's experiments, Dr. Dunham? DR. DUNHAM: His was something like 90 per cent or 95 percent nitrogen and 5 per cent carbon dioxide, and it was practically total anoxia, and the Argonne National Laboratory had followed on with some smaller organisms in the same type of work, and I don't believe they have found appreciable effects unless they go back practically to the whole limit. I wouldn't perhaps want to go on record with that statement, but I think that is what they have pretty well decided. It has got to be a really gross anoxia. DR. WARREN: I would like to ask General Powell what he would regard as the pretty critical level as far as oxygen is concerned, and where would he start to worry about the ability for the pilots to properly carry out their job or the bombardiers to do their work performing in properly. 4 GENERAL POWELL: Well, 10,000 feet is the general level at which we require them to take oxygen because of the effect on night vision. DR. WARREN: So that any significant amount of anoxia as a means of radiation protection at least, you would be afraid of that from the operational standpoint? GENERAL POWELL: That is right. CAPITAL HAIGHT: I have nothing further. That you. GENERAL COONEY: General Bliss was unable to attend this afternoon and he send his regrets. I didn't know until fifteen minutes ago that I was to substitute for him. The Army is doing very little work on ionizing radiation because they feel that the field has been so well covered. They are very much interested in the thermal burn problem and they are carried on extensive studies along this line. I attended a symposium last week at NRC on this problem and I was tremendously impressed with the amount of work that is being done, and the amount of information that has been accumulated but I was more impressed with the complexity of the problem and the care of thermal burns, and I certainly am convinced in my own mind that there just is no simple treatment for the problem of thermal burns. I thought the one good cheerful note in the whole thing was the use of blood substitutes. We had a man from Sweden and one from Scotland and several from England and apparently they are using dextran, and it looks, I would say, quite promising along these lines. I think the one big problem that we have and the one becoming more acute and the one which I feel we do not have the answer for, is the reaction of the soldier to ionizing radiation. I believe it is becoming 5 more acute because I think that the use of the weapon as a tactical weapon ha now gone beyond the realm of possibility and into the realm of probability. Now, we have lots of experimental work on animals and we have lots of cases of whole body radiation treatments, but all of them in patients and we have no controls and we don't have anything that we can put our finger on. A few years ago I asked the radiological society of North America to give me the answer in this problem: How much ionizing radiation can a healthy soldier take and still perform his duties? They wrote letters to every radiologist in the country and received six replies as to patients who had received whole body radiation. Most of this work was unsatisfactory because the data was very poor. I don't believe we can go too much on our Hiroshima and Nagasaki studies because there are so many complicating factors. Dr. Edward Everett brought out an interesting point in his thermal work with dogs, and found that as little as 100 R to a dog with 20 or 30 per cent body thermal burn is very, very important, and so I think the data from Hiroshima and Nagasaki is colored. There were thermal injuries in poor states of nutrition. Now, at every conference I attend of the military, I am asked by the line officer how much radiation can a man take I tell him what I think, and they task me where I get it, and that is where I fall down. I tell them that I think men can take 100 R. Well, as a result of this conference in San Francisco, we found that one question that was asked was how much ionizing radiation, an acute dose, will be required to put an individual out of work in so far as they army is 6 concurred. The answers varied from 800 R to 25R, and 800 R by Templeman and Cooney, and 25 R by Dr. Portman, a very outstanding radiologist. At our meetings we will have one doctor in the service get up and say that you can take 100 R, and another doctor in the service get up and say, "I know that 25 R will make patients sick." So we are very much in a quandary and we have a responsibility that is tremendous. If this weapon is used tactically on a corps or on a division, and if we have, say, 5,000 troops who have received 100 R radiation, the Commander is going to want to know from me, "Is it all right for me to reassemble these men and take them into combat?" I don't know the answer to that question. Now, I can't see that we can statistically prove it, and I don't believe we can take enough of normal well patients and give them whole body radiation so that we will prove anything to the statisticians, but I do feel that if we had 200 patients that we could say, "We have given these people 25 R, or 50 R, or 100 R, or 150 R," I would be willing to stop there and say you did or did not affect them. I think psychologically it would make a lot of difference to the soldier if we were able to tell him that, that this is a little different than any weapon we have used before, and they realize the machine gun and the other type of thing, be they don't realize what this is, and if we can assure them that we have something pretty good to put our finger on, I don't believe that otherwise we re living up to our responsibility. Personally I see no difference in subjecting men to this than I do to any other type of experimentation that has ever been carried on. Walter Reed killed some people. It was certainly the end result that was very wonderful. Shall we wait until we find out and force people and force 7 thousands of young men perhaps and maybe lose the battle as a result of not knowing, and so on? We force people to crawl through the infiltration plants for a purpose, and in doing so many of other are killed and we had some killed just last week. I think that we have a very definite purpose in mind here, and I personally feel it is our responsibility an we should make an effort to try to answer the problem. I feel that we can get volunteers both officer and enlisted to take up to as much 100 R and 150 R, whole body radiation. DR. GREGG: Thank you, General Cooney. I think that I'm right I understanding that when you say that the effect on troops, you mean the relatively quick, within 24 hours effect, or do you mean the whole spectrum? GENERAL COONEY: The problem that I cited is that we have a large concentration of troops, and we have an overhead burst and we have 10,000 men who have been subjected to, say, from 25 to 150 R, and the Commander wants to know are these men going to be fit to go into combat, and shall I leave them here, or shall I send them home. I don't have that answer for him. DR. GREGG: Dr. Powell, do you have anything to add? GENERAL POWELL: I would like to say that was one of the main things that I was interested in, that has been presented by General Cooney. That is what we are all faced with, the answer that the line personnel want to know, and they have now of course enough knowledge of this that they are able to talk about it, and it is the same story when they get the doctors together, one has one answer and one another. It is hard for them to analyze how we can come up with such wide answers. 8 However, I was not quite aware of the exact nature of this meeting and maybe the extent of the things that we should show interest in, and for fear that I might pass over something that we definitely do have interest in, as specific thoughts, I would like to just go over what I have drafted up and I think the program has been well covered, and I don't see how any of us can afford to not be interested in every phase of it, because we never know what particular phase we may be caught in. Of course, we will have specific interests, but we may all be victims of some particular phase that is not primarily what we are thinking about. We certainly are aware of all of the fine work that is going on in the fundamental biophysics of flash burns. A recent symposium was just held here and certainly it is evidence that you have sufficient work certainly going forth, and we hope that it will continue. There is an additional study in the fundamental mechanisms as to what produces the tissue injury and the tissue response to the effect, and any other knowledge fundamental to the problem of protection and treatment. Protection devices against thermal injury and radiation are important. That is the clothing, masks, gloves and so forth for the protection of the individual and for further development of precipitators, filters and other items of this type. A valuation of prophylactic and therapeutic agents for ionizing radiation injuries by the study of human patients--in other words an extension of studies now being carried out on patients receiving regular therapeutic radiation. We are interested in the effects of different combinations of blasts, thermal and ionizing radiation injuries, with respect to prognosis, that immediate clinical picture, segregation and selection of patients for selective treatment. 9 This evaluation of the minimum effective measures for the initial care of mass atomic warfare casualties -- this could be followed by development of training material or self-help, ordinary first aid and the value of extraordinary first aid extended over a matter of hours or even days. Individuals we feel must be prepared to do much more and for a longer period than our present concepts of first aid imply. The differential effects of local shielding as a protective measure against ionizing radiation is important. As to the personal decontamination procedure, simple and rapid improved methods are needed, and also needed is a better doctrine for the treatment of contaminated in-take skin and contaminated wounds with some determination as to when this treatment is an emergency and when radical treatment should be considered. There is thee problem of the disposal of decontaminating materials which become contaminated, and the design of treatment facilities for the contaminated wounds. That is the problem that we think needs further study. In the field of developmental items, and facilities, there is continuous simplification of field radiological facilities and reduction in the number of replacement parts. The ones that we have now are certainly very prone to get out of fix very readily, and certainly require an awful lot of maintenance. Decontamination equipment: Airborne radiological and analytical laboratory. This airborne laboratory should be able to do accurate analysis of samples from the nose and desk tops. Water analysis for the identification of the radioactive material, 10 particularly aimed at chemical precipitation of the radioactive matter, and that should be one of the functions of such a laboratory. There are a few other items that we think are of maybe a little more urgent or interest, and that is the estimation of the maximum medical load with the minimal essential treatment. In other words, an estimation of hospital capabilities factors we feel are needed for the estimation of the maximum medical load with minimal essential treatment that can be rendered to mass casualties of atomic warfare catastrophe. This should be in terms of so many patients per day per so many hospital beds per so many hospital staff. Further factors may be necessary for the different combinations of the blast, thermal and radiation injuries. Reliable human radiation dosage tolerances. That has been well covered. Components and recommendations of the AEC on film badge dosimeters. It must be recognized in the military operation that they are not as simple as desired. We have been particularly interested in the proposal, I believe, that is from the Polaroid Company, and a new device that we certainly have high hopes for due to the simplification and being able to read it directly. Technical medical information. We believe that there is still need for more technical manuals and more technical medical training films and slides other training aids, particularly for the medical personnel. 11 I believe probably some of that is not particularly applicable, maybe, but I was afraid that I might lose out and I might forget some of the points that might still be of interest and perhaps some of that is covered. DR. GREE: That is helpful, thank you. Now, Dr. Warren, have you got any comment to make on any of these questions? DR. WARREN: There are several of real interest. It think perhaps one of the central ones is this question of the calculated risk or the tolerance of the human. There are a number of problems that come up in relation to a determination of this sort. Admiral Greaves has called attention to the various problems raised by fatigue, work and so in the same individual. That is of course paralleled by some of the Rochester observations on experimental animals that are being worked in a treadmill, as against those that have an opportunity for a rest. I would like to go back to one of the remarks made this morning in relation to sociology, that sociologists sometimes forget that humans are pretty much like animals, in a good many ways. We have an enormous amount of animal data. That is animal data that we have been trying to accumulate and to tabulate over the years. There was the Army project at Hopkins that you will recall, General Cooney, that gathered some information. There was an effort by the NEPA project to gather up known information, and there is the survey of the radiologists that you mentioned and other types of things. We are negated presently in an attempt to get together all of the animal data for various types of radiation, and review it a carefully as possible, and see where the general picture seems to come out. There 12 are two very important things about it, the animal work that "illegible" definite bering on this problem. One is that very fortunately the radio-sensitivity of various species of animals tends to fall on either side of that of man. We have the extraordinarily sensitive guinea pig on the one hand, and we have the relatively insensitive rat on the other hand. In fact, if we want to go to the best of all, we have the cockroaches that lived so nicely on the Japanese vessels at Bikini. The problem of getting adequate numbers for statistical significance is very great. I think General Cooney's comment in relation to the estimates of the radiologists is extraordinarily pertinent in this regard because I don't suppose that there are half a dozen radiologists in the country that have seen an acute death from radiation, and yet every radiologist practically was ready to stick his neck out and estimate not much it would take to kill. One of the reasons for the extraordinarily complexity and confusion that exists is existing in this field because a good many radiologists who have not earned a right to an opinion have nonetheless expressed that opinion very loudly and very vociferously. That has helped to confuse the issue very, very materially. We have learned enough from animals and from the humans at Hiroshima and Nagasaki to be quite certain that there are extraordinary variables in this picture. There are species variables, genetics variables within species, variations in condition of the individual within that species. I think that it might be almost more dangerous or more misleading to give an artificial accuracy to an answer that is of necessity an answer that spreads over a broad range in light of these variables--it might be worse to give a suedo accuracy to state things in terms of a range. 13 I think General Cooney "illegible" "illegible" "illegible" LD-50 for the human as 400 R, there are certainly some individuals that will die with as little as 200 R, or possibly some with 700 R. Now, there we have an enormous spread relatively speaking to the LD-50. Suppose that we have the situation where a group is irradiated and they are told that with 50 R nobody will be sick and some of them get sick. Confidence is gone just as badly as though they had been told no information at all. I think we have got to be careful that what we say is not narrowed down overly excessively because we have to talk and our knowledge of susceptibility of other types is such that we know that there can be enormous variations in susceptibility to digitalis. We have seen the problems that have come up with the sulfa drugs and so on, and radiation is to exception to that point. In order to get a satisfactory answer to this problem in humans, I don't see how it is possible to have an answer that means anything, over and above what we already have in our animal data and our scattered human data, without going to tens of thousands of individuals. I have tried to get good statistical help on this problem. That at once puts in the question of, "Is such a thing practicable?" If we aware considering things in the Kremlin, undoubtedly it would be practicable. I doubt that it is practicable here. Another point that I think would be worth while calling to your attention, and I would like your judgment on the question of how far would we be warranted in considering results of primates of significance in relation to the human problem, if we had a spectrum running throughout the warm-blooded animals up to man, together with a scattered clinical 14 observation that we have heard on the one hand and the observations in Japan on the other. How closely we could possibly come to the answer is a problem. I would not be quite honest in saying that I am saying if I were not to add that personally I am very much opposed to human experimentation when it isn't for the good of the individual concerned and when there is any other way of solving the problem. I think that General Cooney's citing of Walter Reed's experiments are very much to the point. On the other hand, I think it needs to be remembered that there was no known host that could be used for such experiments, and no way of carrying it out from the standpoint of the known bacterial or virule effects. There was no way of fulfilling the postulates because there was no other way or no other animals than men to be susceptible. These are some of the things that I would like to toss out. DR. GREGG: That is very good. GENERAL COONEY: I agree that statistically we will prove nothing, but generals are hard people to deal with, and if I tell general that "Your men might get sick with 50%," or "They might not get sick until they get 150%," that is a very unsatisfactory answer for him, and he will not accept it. I don't think that we are interested in pushing this thing to the point of finding lethality but I do believe if we had 200 cases whereby we could say that these men did or did not get sick up to 150 R, it would certainly be a great help to us. DR. WARREN: I wonder if it would really be a help if it came to the final analysis. I think that there are two other things that need 15 to be thought of in relation to this. One is how accurate are such measurements going to be in the field, and two, how important are the objectives going to be? I can think in terms of times when even if everybody on a ship was sea-sick, you would still have to keep that ship operating. ADMIRAL GREAVES: I am very glad that this question of human experimentation has come up in the open so quickly and so frankly. I certainly agree with everything that you have said, Dr. Warren, and I appreciate the idea of human experimentation within this country is certainly repugnant. This has come out before, as you know, and it came up at the National research and Development board not so very long ago, and it was thrashed out there, and it went just about like this discussion is going here. We don't like the idea and we have got a lot of data from irradiation of patients for various diseases that they give radiation for, but the question always comes back to this: Can we unit those results to what our problem is? We have a problem to answer, the same thing that General Cooney says. We are going to have it if we have this type of submarine that we are talking about. The Air Force is going to have it if we get that kind of stuff in their planes, that is that type of power in their planes. That is that type of power, and just where and just what can we tell these people as to what is safe and what is not safe. Now, the question that you brought up about the value of using primates -- well, you mentioned on the one side we have the rats. We don't know, as far as I know we don't know what the results would be in that event. I say 16 maybe it would be. I think our position in this matter of human experimentation is the same as everybody else. We don't want to do it if we can get out of doing it, but if that is the only way we can get the answer, that certainly is going to be more economical in the long run to take a few chances now and perhaps not lose a battle or even worse than that, and not lose a war. DR. WARREN: I think that there is a great deal in that, assuming that there is the set of consequences that you propose, and also assuming that accurate answers can be obtained. I think a lot of this is a matter of presentation. For example, I am not at all sure that the data obtained from 200 individuals radiated under known experimental conditions is going to be any more accurate than the data on 20,000 individuals that have been irradiated under non-experimental conditions. We have a very major amount of information, complicated by various factors to be sure, but nonetheless with a very large number of individuals involved, that help to compensate for some of the variables that come into the picture. I would be inclined to take the view that we already have a considerable amount of human data to provide us land-marks for orientation with regard to the human. By and large what we usually do in solving an unknown problem in a field such as this is to do a lot of experimentation in animals, to build up our quantities, our knowledge there, and then get some cross-checks to the human. I have believed so far, at least, that it is feasible for us to get these cross-checks with existing knowledge and by closing with more and more species of vertebrates in on this general picture of the human. 17 I think that if we had not been quite so honestly scientific from the start, and we had said when the question was raised by officers in the line, "Yes, we know definitely that you can take 25 R without anything happening," I am quite sure that that is accurate probably within tenth of one percent, if not accurate within 1/100 of one per cent, but we were hesitant perhaps to say it flatllotedly because we weren't absolutely 100 per cent accurate. We can say, I think, with a good deal of certainty that we know that 25 R is safe. We know that an appreciable proportion of any group of individuals will be seriously ill at 200 R, and that some will die at 200 R. We can say with a fair degree of assurance that with 100 R, other casualties such as burns will be materially complicated and the lethality of minor injuries will arise, and there is a great deal of permanent damage that is done to the organism as well as transient damage at the 100 R level. I wonder if we were to stick to those brackets, if we weren't pretty nearly reasonably accurate, and if that isn't as close as we ought to come. I remember very well when they first put out French 75's in the last war, some enthusiastic ordnance officers got down to a factor of safety of two. Well, that meant that a fair number of the gun burst, and the morale of the artillery training camp, Camp Taylor, was pretty darn low for a while on the basis of that. I don't think that you can skirt too closely to your factors of safety, and to try to narrow it to say that 75 R will do this, and 100% will do that. To my mind that is skirting awfully close to your factor of safety, even if you had absolute knowledge in the field. GENERAL COONEY: I agree with you thoroughly, Dr. Warren, and I 18 quote the figure just as you have quoted to groups of military people. But they say, "Who are you when another man stands up and takes the other side?" Now, if we could get a group of prominent radiologists or prominent doctors and this is what I have been trying to do for years, and I have been so unsuccessful in doing it, if we could get a group of prominent doctors who would say, "Yes, this is it," and if we could give that to the military, we are perfectly satisfied. Up to now we have been unable to do so. DR. WARREN: I wonder if you could not do that if the doctors who knew would be the only ones who talked. It is the doctors who don't know who confuse the issues because they want to talk, too. GENERAL COONEY: That is our problem, doctor. DR. GREGG: General Cooney, you have made one suggestion that interested me very much. That was the point of getting volunteers. Now, I am interested in that principally for his reason: I think that there is enough of the general atmosphere around the AEC affairs that it is singularly important for us to steer away from human experimentation because we never could get, on certain things could not be brought out in the public trial, which is a control. GENERAL COONEY: I agree with that thoroughly. DR. GREGG: So this question of volunteers interests me. I am ignorant of a many good examples that you ma know of mass volunteering on anything. What kind of things can you tell me about that? GENERAL COONEY: We have never had any trouble in the services in getting volunteers from the time of Walter Reed to the present time. You can always get certain soldiers and officers to volunteer for virus work, 19 as has been done, for malaria, or for many things. I think if the problem is stated to them honestly, giving them all of the probabilities, you go to a port of embarkation of troops getting ready to go over to Korea, you would have no trouble whatsoever. Maybe that might not be the point to get it, but it could be very easily done, there, and I am sure it could be done in many camps. You can evaluate this problem and tell them that perhaps it won't be the answer, but it seems to me that we could do it under voluntary measurements rather than involuntary measures when the man has the uniform on and we have to find out, and this way is a much more democratic way of doing it. DR. GREGG: It is. GENERAL COONEY: I certainly agree with you. I don't believe that the Atomic Energy Commission should enter into it, and I don't believe that they have problem. I think it is just until the bomb goes off. When the bomb goes off then the problem exists, and it doesn't exist now to the Commission. They are not faced with this problem. But we are very definitely faced with it, and if you can get me ten prominent doctors in this country to say just what Dr. Warren has said, so that I can give it to the military, and say "This is it," that is all that I ask. DR. WARREN: I would like to think just for a moment to how you could get this experiment, assuming that the volunteers could be had. Now, the difficulty with observations in the past is that some of them have been fatigued, some of them have been burned, and some of them have been tired, and some of them have been under-nourished. Would you take your 200 men and have them all at rest, or would you 20 have some of them tired or would you have some of them wounded, because that is the circumstances under which your men will be. GENERAL COONEY: No, sir; I wouldn't consider any wounded or any burned or any tired. I am thinking merely of a situation where we are making an amphibious landing, and there is an air burst and a certain number will be wounded and a certain number will be burned and they are causalities and they are already out, and a certain number will be sick from radiation. But there will be a large number who will not be. Then the commander is going to say, "Can I use these men an how long can I use them?" DR. WARREN: Some of these men will be tired, and some will be exhausted and some will have lost their lunch going ashore and there will be a number of others. GENERAL COONEY: That may be before the thing starts, and I am thinking of Normandy, and the night before Normandy. DOCTOR WARREN: The emotional situation within the men would be there. I can't conceive of those results being of any greater value. GENERAL COONEY: You mean then psychological? DR. WARREN: If that is so, who is going to give an answer and stick by it? GENERAL COONEY: We can tell the commander that we have done this on 200 healthy individuals and that none of them got sick up to 150 R, and that they would be will ready to carry on, and that seems to me would be something, or we can tell him that they are all sick at 100 R, and he had better not take any of his men who have 100 R, they are out. That is very significant. If it is 50 R, that is important. I don't know. I quote all of these figures and tell the people, and then another officer gets up as it happened at a meeting over here the other day with a large number of line men, and they said that that is absurd, it is 21 ridiculous, and they said, "I know that 25 R will make a man so sick that he can't carry on." So where are we? DR. WARREN: That reminds me a good deal, General Cooney, of the situation we frequently have in court when two psychiatrists who have no idea of whether a man is sane or not, when he made a will, and they are being called and are equally positive that he was sane on the one hand on insane on the other. That is one of the reasons that lay juries have learned not to trust medical testimony. I think that you would find with your experiment on these 200 men that the same doctor who said that 25 R would make them deathly sick, would still be saying it, because I have presented one for many years with figures on irradiation of the breast and he pays no at attention to it, and he goes on exactly saying the same thing that he was saying 10 years ago. GENERAL COONEY: Actually we would still have it on paper, and we don't have it now. DR. WARREN: Actually we have got the results of an enormous experiment. We have the experiment involving over 200,000 people in the Nagasaki and Hiroshima areas, and I think that those results are real. I as in there, and I saw the people when they got sick. I know that one can get reasonably accurate calculations as to the amount of radiation that they received, and they can be placed pretty accurately within the buildings. Harry Bowman has figured out for us the amount of shielding that some of them received. I think that we have not made the most of some of the evidence that we have available, and I think perhaps we have been a little too tolerant of some of the radiologists who are arm- chair experts rather than practical 22 experts in this field. GENERAL COONEY: Well, I think that is very true, but I think on the other hand that there is a tremendous number of complications in the data when you evaluate it. For instance, you and I know that it requires 350 R to ebelate a man with 100 KV, an as our intensity goes up it requires more and more. I have a Weapons Effect Handbook which shoes me that you get 25 R at 2,000 yards, and yet our Japanese data shows that we have patients epilated at 2,00 yards. So I am completely confused. I can't understand how it can happen. You epolate a man at 2,000 yards with energy such as we have from the fission bomb. DR. WARREN: There may be some confusion there with the flash burn epilations. That is one of the problems. GENERAL COONEY: That is true. DR. WARREN: That is one of the problems that has to be weighted and brought it. GENERAL COONEY: And I think maybe sickness or illness is there, but there again we have got to have that. If we can get ten doctors to evaluate that for us, and to come up with an answer, then we would be satisfied. If we don't get that, it seems to me that we have a responsibility which we do not have the answer for. CAPT. BEHRENS: It seems to me that you are talking about experiments involving dosages, with an idea of getting a rough approximation to operational efficiency or capability, and it seems to me that it is not quite in the same category, even, a the experiments that were originally done by Walter Reed, which were really involving a serious threat to life. 23 Now, what we are proposing here as near as I can ell, does not involve any threat to life or any serious threat to health. What we are trying to get at is an idea of a rough approximation to the operational efficiency that you could expect and which would so to speak document it a little bit when you present it to the admirals and the generals and the captains who have to talk their people into battle under such conditions. I don't think with the dosages proposed that there is a great deal of danger or any danger at all, and that perhaps that might alter the way we feel about it. We are after a rough approximation of efficiency, and what we might expect from morale rather than looking for facts as to who we would deal with serious irradiation illness. As I understand it, the idea is to stop considerably short of where they get serious radiation illness that would threaten the man's health or life very seriously. DR. WARREN: I think that I would feel very reluctant to go into this in the light of the animal data that exists, to have 100 or 150 R. We know that it does materially shorten the life of animals and I would agree in the light of all we know that it would do so in the case of man. DR. GREGG: There is one stop in the so-to-speak procedure, or the sequence of events, which I want to ask a question about, and it might sound flippant but I don't intend it so, and that is this: Supposing you were to expose 200 men to purely experimental conditions, and give them dosages of 50 R. Let us assume in that 200 there are 75 who at least have some complaints, and among them we will say that there are 25 who have pretty serious disturbance. Are you able to judge whether 24 The symptoms of the men are such symptoms as a line officer could or would disregard anyhow because there is a gap there? What is your line officer going to override? If you tell him most of the men were seasick, I suppose a good number of them were in Normandy, too, but they had to fight and they had to call on themselves for efforts that were away beyond what you get if you just say "How do you feel?" Do you follow my line of questioning? GENERAL COONEY: Yes, sir: I do, but my thinking is a bit different. What I want is this: I have a responsibility to the line officer to tell him whether or not these men are going to be able to fight. I tell him that he has a division of men, we will say 15,00 men who have received up to 100 R. I say "Go ahead and take them, take them into battle." If he gets them into the battle and half of them become ill the next day, I have not answered my responsibility or lived up to my responsibility in evaluating that hazard for the linemen. We take them into a malarial district and we know the hazard and we are able to evaluate that and we know how to take care of it and we can advise the, that such and such a percentage of your men if they take atabrine are not going to get it or they will get it, and he knows how to prepare his campaign. This way he doesn't know how to prepare his campaign because we cant even come close to giving him an answer. DR. GREGG: What you are telling hi is that the men under those circumstances will be unable to fight. GENERAL COONEY: They will be unable to fight, sir, that is what I want to know. DR. GREGG: That defines it much more closely. GENERAL COONEY: That is exactly what I want to tell him, that they 25 will or will not be able to fight. DR. STAKMAN: I would like to raise a question, not a medical one, but an experimental and statistical one. Could you possibly get the information that you want with 200 men? I don't think you could. I think it would be 2,000 would be nearer, and you have got to given them different dosages and you have got to replicate the experiment a number of times. If you use the men for the different dosages, you are piling it on. I think that you would have to think in terms of far more than 200 men. GENERAL COONEY: I say statistically it is impossible, and it is not even thinkable, but isn't it better to get some idea with a few men than having to take a chance on the others? Would you send a group of men into an area in which they would get 150 R tomorrow, even if it is a very important area? DR. STAKMAN: The only think I am saying is that if you are still guessing, or your situation is extrapolating from small numbers to larger numbers, and your extrapolating from small numbers on to large numbers that are going to behave differently presumably than they are now, all I am saying is that if we are thinking in terms of experimentation then we should have large enough numbers so that the data would really be significant. DR. GREGG: I think the answer to the man who says, "You doctors all disagree," is to say "Yes, and we will probably until it is necessary to try this experiment out on five or six thousand people. That can't be done. There is a chance that if 200 dozen show you something, a high range of reliability, there is a perfect chance that you may be wrong when you say, "Yes, they can fight," and then it would end up on you just the same, 26 because they couldn't. You might be wrong on the wrong side. GENERAL COONEY: I well realize that, but it seems tome we ought to have a little something. We can say, "Well, all that we have is the data on 200 men, and here it is," and that is something, but when I start talking about animal experimentation, as one general said to me, "What are we -- mice or men?" DR. WARREN: I think one of the things that is very important is that we are in part mice, and only in part men. There are a great many attributes of the mouse that we still have, and we can learn a great deal from what happens to the mouse and carry that on. There wouldn't be any point in any animal experimentation if we accepted that assumption. DR. GREGG: You have to admit the point that some of us are rats, too? GENERAL COONEY: Nevertheless, we have a problem, which we do not have the answer for, and if there is no way, if this is purely illogical, then we would like to have someone tell us. We only ask for some backing of the medical profession. DR. STERN: I would like to follow up Dr. Stakman's question--how great is the difference with rats and mice, and do we need a group of 200 people divided into three groups of 70 people? How is the spread in experimental animals? DR. WARREN: In the various species, take mice for example, you can get a variation of approximately 200 R on the LD-50 just by a change of diet, or a change in conditions in the animal house. DR. STAKMAN: You see my point too is that you are going to try that at different exposures,a nd it wouldn't be fair to take those who had the lower exposure and try them right away on the higher ones. DR. STERN: That is why I said three groups of 70 each. 27 DR. STAKMAN: And you would hope to get them under all of these conditions. that is all that I wanted to say, and I am not arguing as to whether this human experimentation should be done or not. If it is done, I should think that it would be done by the armed forces, but I am simply saying that I think that we have got to think in terms of far larger numbers than 200, to get data that would be really reliable. GENERAL COONEY: I agree with that, there is no question about that. ADMIRAL GREAVES: There is another question that Dr. Warren has just touched on, that I think probably would be of interest. You mentioned the fact that from the animal experimentation that is available, you would hate to submit yourself to 150 R, because in the animals it is known that life is shortened. Well, the type of experimentation that has been discussed so far is pointed toward immediately results and the type of people who would be subjected to that experimental work would be people you would have to control over a relatively short time. You would lose control. But when this subject was broached first by NEPA they proposed doing the work on long-term prisoners, people who would be under the control of observer for sufficient period of time so that the kind of results that you mentioned would be available. Well, that type of experimental work is a little difficult for the armed forces to engage in. DR. GREGG: Is this civilian prisoners, you mean? Ad. Greaves: Yes. DR. GREGG: Doesn't that fall in the category of cruel and unusual punishment? ADMIRAL GREAVES: Not if they would carry out the work as they proposed at the time they proposed it. It would be on an absolutely 28 volunteer basis, and under every safety precaution that could be built up around it. I don't think so, and it didn't strike me as being cruel and unusual. DR. WARREN: It is not very long since we got through trying Germans for doing exactly that thing. ADMIRAL GREAVES: That wasn't voluntary when they did it, they made them do it. I think there are a lot of prisoners and I am given to understand that there are plenty of people in our prisons who will volunteer for that kind of work. DR. WARREN: Always for a quid pro quo. DR. "ILLEGIBLE": Prisoners were used during the way, as you know, for plasma and blood substitutions, on a volunteer basis, and some in the Massachusetts prison, and all of them expected to be released immediately, and asked to have their cases put before the parole boards right off. It was not that they had any promises and indeed it was made clear that there were no promises, but as a result of that they expected to be released. DR. STOCKMAN: Mr. Chairman, may I ask another question. What are you going to do when you are asked for a categorical answer to a question to which there is no honest categorical answer? Are you going to be dishonest? I mean, after all, all of us would have to give these values in terms of ranges. You couldn't give any absolutely flat figure. This isn't the elasticity of steel at a given temperature, with a given force applied to it, and that sort of thing. You are dealing with a heterogeneous biological population, and I don't think that you are ever going to get an answer. 29 You have always got to have a range, do you not? I would just like to raise the question as to whether the range isn't sufficiently well known now so that these people who are in difficulty can do nothing but be scientifically hones and say, "Here is the range," and here are some of the factors that affect that range, and there just isn't any precise answer to that. I just can't see how that can be done. I mean dealing with any biological object, you have got hetergenity and you have degrees of probability as a result of large numbers and frequent replication. I don't see quite how you can get it better than that. I just can't see how that can be done. I mean dealing with any biological object, you have got hetergenity and you have degrees of probability as a result of large numbers of and frequent replication. I don't see quite how you can get it better than that. You would have to have large numbers to get it more precisely and a large number of conditions, and a good deal of replications because there is always that in al of this type of material, and there are a lot of imponderables. GENERAL COONEY: Suppose that there is no answer to the problem, and could we get a group of men to agree with us on that? DR. STAKMAN: It seems to me that that is about the best that you can do. ADMIRAL GREAVES: The way it is now, we don't know for sure whether we know why we don't have the answer. DR. STAKMAN: That is right. ADMIRAL GREAVES: It may be that after this work is done, we wouldn't have the answer but we would know why we did not have the answer. DR. STAKMAN: That is right. DR. GREGG: I would like to explore one other thing that General Cooney said, that involves something that you also referred to, Dr. Warren. I know that my own personal first move in a thing like this would be 30 to go out and look in pretty carefully the experience and general reasoning capacity of the doctors giving such extremely different answers. I wouldn't be satisfied without finding out whether those doctors that gave extreme answers on the other side, gave me the general impression of being reliable people or not. Or whether the person who for a lot of different reasons I began to have some confidence in, came somewhere near to an agreed figure. I see your point and I have the same sort of thing sometimes with my own board, and they say, "You doctors don't agree so I guess there is nothing in it at all," but I can get a better concurrence of opinion, we will say, on a case of cardiac failure from five really good men who are cardiologists whom I know are good cardiologists, and I will expect a larger measure of concurrence there than I will if I send out a hurry call for people who call themselves cardiologists and then take down their opinion. DR. STAKMAN: To put it in legal terms, you want to now something about the credibility and reliability of your witnesses? DR. GREGG: Yes, and I think the width of their statements would be narrowed substantially as soon as you sorted them out. Now, that is only my first plus reaction to it. Does that make any sense to it? DR. WARREN: It makes very real sense. DR. GREGG: Where do you think that their answers would lie? DR. WARREN: I think that it would lie quite closely in the group that have had real experience in this field, and I think General Cooney and I for example see very closely eye to eye, and I think that the views that Dr. Hemmelman has, and that Colonel Decoursey has, they are very closely paralleled to ours. 31 And I think that those who have had first-hand experience, that have seen autopsies on cases, that have cared for ill patients, are in pretty general agreement. It is the ones who have had to deal with the nebulous psychological factors of when a patient is going down to the x- ray room for treatment and starts to vomit. I remember very vividly the question of radiation sickness came up in our own hospital some time ago and we suddenly began to get a lot of grief when we hadn't been getting any with dosages which were pretty standard dosages. In looking into it a little more carefully, we found that all of the patients who got sick came form one floor of the hospital and inquiring a little bit we found that the head nurse on that floor, a very sympathetic and well-meaning gal, had somewhere gotten the idea that the use of carbohydrate would prevent sickness and she was going around to these patients before they went to x-ray, and saying, "Now deary, you are going to have an awfully bad time down there, and you are going to be very sick and here is some nice Caro syrup, and if you drink a glass of this and get x- rayed, you won't be sick at all." Well, they went there psychologically prepared, with an upset GI tract, and it isn't any wonder that they were sick when it happened. GENERAL COONEY: I think the whole thing sums up to this, that we in the military are your public servants and if American medicine fails, are we properly discharging our responsibilities. That is all we wish to know, and if some group, some prominent group would tell us, if you have done all that you can on that, then we care certainly very willing to accept it. DR. STAKMAN: May I raise this question: I think that this is awfully 32 important, Mr. Chairman, in many respects, but is this correct? That about the best you can do after everything that has been said here, in a situation like this, is not to get a categorical answer to a question that cannot be answered categorically, but to get a consensus of the most competent people with respect to the range and then that is the best that can be done, unless you want to go into large-scale experimentation DR. GREGG: Yes, that is right. I would like to ask our friends from the armed forces, whether for lack of something better as a basis, it would be in their opinion worthwhile for us to try and get a commission's opinion of this kind, so that they will not be subject to random comments on the part of various radiologists here and there, and add up to the simple statement, "Oh, but that is ridiculous." I don't think tit is reasonable or fair for you to be exposed to that kind of gunfire from all over the landscape, and I don't see why we couldn't take measures to get an ad hoc commission for this and give us an opinion. GENERAL COONEY: That would be a great help, Dr. Gregg. DR. GREGG: I would be furthermore inclined to think that we would take that and if it added any guilt edge for us to transmit it to you as an ad hoc commission that we had appointed for that purpose, and if we could do that so much the better. As you can see, most of us are awfully leery about giving enthusiastic approval to a mass-scale experiment which as Dr. Warren has stated, he feels there is relatively great difficulty except in bracketing to give a categorical answer of the exact number available. From what I know of this world, I would be extremely dubious if it all come out at exactly 74 R. Human beings being what they are, they aren't that way with atabrine 33 or any skin lotion that I used when I was working in the outpatient department in dermatology and so on. So I would think that you would have to get some kid of an expression of the best available opinion, and if it would be of help I think we ought to consider it very carefully. GENERAL COONEY: I think that that is wonderful, that is what we have been trying to do for a long time, and we have been unable to do so. It would be very much appreciated, Dr. Gregg. DR. GREGG: Well, now, I think with that we ought probably in the light of the time limitation, to go on to the next time, and before that I simply would like to say that we are very glad to have Dr. Smith add Dr. Glennan with us and I am going to reserve the order of the next two items and let us take No. 5 before we take N. 4, add No. 5 is the general status of radiation instruments branch and Fort Totten activities. 34