Conclusion

Chapter 5: Footnotes

3 . J. R. Oppenheimer, Director, Los Alamos Laboratory, to L. H. Hempelmann, Los Alamos Laboratory Health Division Leader, 16 August 1944 ("Your memorandum of August 16, 1944") (ACHRE No. DOE-051094-A-17), 1.

4 . L. H. Hempelmann, Los Alamos Laboratory Health Division Leader, to J. R. Oppenheimer, Director of the Los Alamos Laboratory, 29 August 1944 ("Medical Research Program") (ACHRE No. DOE-051094-A-17), 1.

5 . Interview with Mastick, 23 July 1995, 1.

6 . Glenn Seaborg, head of Chemistry Section C-1 of the Metallurgical Laboratory, to Robert Stone, Health Director of the Metallurgical Laboratory, 5 January 1944 ("Physiological Hazards of Working with Plutonium") (ACHRE No. DOE-070194-A-3), 1.

7 . Ibid.

8 . Robert Stone, Health Director of the Metallurgical Laboratory, to Glenn Seaborg, Head of the Chemistry Section C-1 of the Metallurgical Laboratory, 8 January 1944 ("Hazards of Working with Plutonium") (ACHRE No. DOE-070194-A-4), 1.

9 . Seaborg suggested that several milligrams of the first shipment of plutonium from Oak Ridge be sent on to Dr. Hamilton at Berkeley. A minute amount of plutonium was sent to Hamilton, who began his studies on rats in February 1944. Next came more animal work at Chicago, focusing on the toxic effects of plutonium, as well as its distribution in various tissues. These studies showed that plutonium, like radium, was a "bone-seeking" element, the potential deadly consequences of which radium had already demonstrated. Furthermore, these studies demonstrated that in rats, plutonium distributed itself in bone in a potentially more hazardous way than radium. J. Newell Stannard, Radioactivity and Health: A History (Oak Ridge, Tenn.: Office of Scientific and Technical Information, 1988), 1424.

10 . Richard Rhodes, The Making of the Atomic Bomb (New York: Simon and Schuster, 1986), 547-548.

11 . Ibid., 560.

12 . The most likely route of worker exposure to plutonium would be inhalation. Hempelmann and others wrote to Oppenheimer in March 1945 that "the very important and difficult problem of detection of alpha active material in the lungs has been studied only at this project and here only on a very limited scale. This problem should be given much higher priority here and at other projects." L. H. Hempelmann, Los Alamos Laboratory Health Division Leader et al., to J. R. Oppenheimer, Director of the Los Alamos Laboratory, 15 March 1945 ("Medical Research of Manhattan District concerned with Plutonium") (ACHRE No. DOE-051094-A-17), 1. Inhalation experiments with rodents were undertaken, starting in 1944, at the University of California's Radiation Laboratory and the University of Chicago's Metallurgical Laboratory, although these studies did not result in extensive analysis of data until the latter half of the 1940s. W. H. Langham and J. W. Healy, "Maximum Permissible Body Burdens and Concentrations of Plutonium: Biological Basis and History of Development," in Uranium - Plutonium - Transplutonic Elements, eds. H. C. Hodge et al. (New York: Springer-Verlag, 1973), 576. Wright Langham wrote in 1945 that "if a limited amount of human tracer data are to form the basis of a method of diagnosing internal body contamination," it would be necessary "to assume that [plutonium] is metabolized in the same way regardless of the route of absorption or administration." Wright Langham, Los Alamos Laboratory Health Division, 28 July 1945 ("Report of Conference on Plutonium--May 14th and 15th") (ACHRE No. DOE-051094-A-427), 29. Since the time of the experiments, it has become clearer that the deposition of plutonium in the body can differ in cases of chronic inhalation exposure versus other types of exposures.

13 . Langham and Healy, "Maximum Permissible Body Burdens and Concentrations of Plutonium," 576.

14 . L. H. Hempelmann, Los Alamos Laboratory Health Division Leader, to J. R. Oppenheimer, Director of the Los Alamos National Laboratory, 26 March 1945 ("Meeting of Chemistry Division and Medical Group") (ACHRE No. DOE-051094-A-17), 1.

15 . J. R. Oppenheimer, Director, Los Alamos Laboratory, to Colonel S. L. Warren, 29 March 1945 ("We are enclosing a record of discussions . . .") (ACHRE No. DOE-051094-A-17), 1.

16 . Samuel Bassett [attr.], undated ("Excretion of Plutonium Administered Intravenously to Man. Rate of Excretion in Urine and Feces with Two Observations of Distribution in Tissues") (ACHRE No. DOE-121294-D-10), 29.

17 . Division of Biomedical and Environmental Research and Division of Inspection, AEC, 13 August 1974 ("Disclosure to Patients Injected with Plutonium") (ACHRE No. DOE-051094-A-586), 11.

18 . Ibid.

19 . Ibid., 10.

20 . Wright Langham, Los Alamos Laboratory Health Division, to Hymer Friedell, Executive Officer of the Manhattan District's Medical Section, 6 April 1945 ("Although we sent you directions for the 49 experiment along with the material . . .") (ACHRE No. DOE-120894-E-1), 1.

21 . Wilson O. Edmonds, AEC Resident Investigator, to Jon D. Anderson, Director, Division of Inspection, 15 July 1974 ("Division of Biomedical and Environmental Research, Headquarters--Request to Locate Mr. Ebb Cade") (ACHRE No. DOE-051094-A-611), 2.

22 . Undated document ("Experiment I on P. 49+4") (ACHRE No. DOE-113094-B-5), 1.

23 . The Committee uses names of subjects in this chapter only where the names were already a matter of public record.

24 . "Experiment I on P. 49+4," 1.

25 . Ibid.

26 . Hannah E. Silberstein, University of Rochester, to Wright Langham, Los Alamos Laboratory Health Division, 25 October 1945 ("This letter is to report the injection on the second human product subject, HP-2 . . .") (ACHRE No. DOE-121294-D-19), 1.

27 . W. H. Weyzen, 25 April 1974 ("Visit with Dr. Joe Howland, Chapel Hill Holiday Inn, April 24, 1974") (ACHRE No. DOE-121294-D-18), 1.

28 . Hymer Friedell, interviewed by Steve Klaidman and Ron Neumann (ACHRE), transcript of audio recording, 23 August 1994 (ACHRE Research Project Series, Interview Program File, Targeted Interview Project), 49-50.

29 . "Experiment I on P. 49+4," 3.

30 . Ibid.

31 . Ibid., 2.

32 . Captain David Goldring, Medical Corps, to Wright Langham, Los Alamos Laboratory Health Division, 19 September 1945 ("Enclosed is a brief resume of E. C.'s medical history . . .") (ACHRE No. NARA-082294-A-47), 1.

33 . Karl Morgan, interviewed by Gil Whittemore and Miriam Bowling (ACHRE), transcript of audio recording, 6 January 1995 (ACHRE Research Project Series, Interview Program File, Targeted Interview Project), 147.

34 . Edmonds to Anderson, 15 July 1974, 3.

35 . "Experiment I on p. 49+4," 3.

36 . On 7 May 1945 Germany had surrendered to the Allied forces. The Manhattan Engineer District continued on with the building and testing of the first atomic bomb (the first test was scheduled for July of that year).

37 . Robert Stone, Health Director of the Metallurgical Laboratory, to Stafford Warren, Hymer Friedell et al., undated ("On Monday, May 14th, we plan to have an all day meeting dealing with plutonium . . .") (ACHRE No. NARA-082294-A-51), 1.

38 . Wright Langham, Los Alamos Laboratory Health Division, 28 July 1945 ("Report of Conference on Plutonium--May 14th and 15th") (ACHRE No. DOE-051094-A-427), 29.

39 . Colonel Hymer Friedell, Executive Officer of the Manhattan District's Medical Section, to L. H. Hempelmann, 11 April 1945 ("Enclosed is a protocol of the clinical experiment as we intend to carry it out . . .") (ACHRE No. DOE-121294-D-1), 1.

40 . Ibid.

41 . J. J. Nickson to R. S. Stone, 23 January 1946 ("Abstract of Monthly Report for January, 1946") (ACHRE No. DOE-051094-A), 1.

42 . E. R. Russell and J. J. Nickson, 2 October 1946 ("The Distribution and Excretion of Plutonium in Two Human Subjects") (ACHRE No. DOE-051094-A-370), 1.

43 . Ibid.

44 . Ibid.

45 . Ibid., 2.

46 . Ibid.

47 . Nickson to Stone, 23 January 1946, 1.

48 . Sidney Marks, 3 May 1974 ("Interview with Dr. Leon Jacobson . . . by Marks and Miazga at about 1:30 p.m. on 4/16/74") (ACHRE No. DOE-121294-D-15), 2.

49 . W. H. Weyzen, 25 April 1974 ("Visit with Edwin R. Russell, Savannah River Plant, April 23, 1974") (ACHRE No. 121294-D-17), 1.

50 . Andrew H. Dowdy, Director of AEC Rochester Project ("Proposed Research Program and Budget: July 1, 1947 - July 1, 1948") (ACHRE No. DOE-061794-B-16).

51 . William F. Bale, Head of Special Problems Division, undated ("Contributions of the Division of Special Problems to the Manhattan Project") (ACHRE No. DOE-113094-B), 1.

52 . L. H. Hempelmann and Wright H. Langham, undated ("Detailed Plan of 'Product' Part of Rochester Experiment") (ACHRE No. 121294-D-2), 5.

53 . W. H. Langham, undated ("Revised Plan of 'Product' Part of Rochester Experiment") (ACHRE No. DOE-121294-D-3), 2.

54 . The choice not to use subjects suffering from malignant conditions is discussed retrospectively in a partial draft version of the 1950 report (probably written by Dr. Bassett). This discussion was not included in the final version of the report:

The individuals chosen as subjects for the experiment were a miscellaneous group of male and female hospital patients for the most part with well established diagnoses. Preference was given to those who might reasonably gain from continued residence in the hospital for a month or more. . . . Patients with malignant disease were also omitted from the group on the grounds that their metabolism might be affected in an unknown manner.

Bassett, "Excretion of Plutonium Administered Intravenously to Man," 2.

55 . Ibid.

56 . Wright Langham et al., 20 September 1950 ("Distribution and Excretion of Plutonium Administered Intravenously to Man") (ACHRE No. DOE-070194-A-18), 10.

57 . Wright Langham, 27 September 1957 ("Proceedings of the Second Annual Meeting on Bio-Assay and Analytical Chemistry: October 11 and 12, 1956 -- Panel Discussion of Plutonium") (ACHRE No. DOE-120894-C-1), 80.

58 . W. H. Langham et al., "The Los Alamos Scientific Laboratory's Experience with Plutonium in Man," Health Physics 8 (1962): 755.

59 . Addison's disease is an endocrine disease produced by adrenal gland failure. Today this disease is treated with steroid therapy that was developed in the 1940s and that was extremely expensive at the time of the experiments. HP-6, diagnosed with Addison's, was given steroid treatment as part of his care at the University of Rochester; he lived until 1984.

Scleroderma is a collagen-vascular disease that can produce extreme pain, especially in the hands; can affect eating and swallowing if the esophagus is involved; and eventually leads to organ failure and death. Steroids are the treatment of choice today, but if this disease is not well controlled it can still be fatal. HP-8, who was diagnosed with scleroderma, lived until 1975.

60 . Bassett, "Excretion of Plutonium Administered Intravenously to Man," 2. Her provisional diagnosis according to this report was mild hepatitis and malnutrition. Ibid, 18. Her medical records indicate, however, that she had symptoms related to nutritional deficiencies, which appear to have been alleviated with proper diet and rest. Strong Memorial Hospital, 20 December 1945 ("Discharge Summary Form") (ACHRE No. DOE-051094-A-612), 1.

61 . Wright Langham, Los Alamos Laboratory Health Division, to Samuel Bassett, Head of Metabolism Ward of Strong Memorial Hospital, 13 March 1946 ("Your letter of February 27 regarding Hp 11 was startling, to say the least . . .") (ACHRE No. DOE-121294-D-4), 1.

62 . Document dated 17 April 1974 ("Comments on Meeting with Dr. Hempelmann on April 17, 1974") (ACHRE No. DOE-121294-D-16), 1.

A 1955 letter from Dr. Hempelmann to the AEC's Division of Biology and Medicine (discussed in more detail in chapter 13) indicates Hempelmann's belief that, in general, patients could be easily deceived about the true research purpose of a medical intervention. In this letter, Hempelmann (who was by then professor of experimental radiology at Rochester) is proposing that researchers present themselves as life insurance agents to AEC workers as a ruse, in order to conceal the true purpose of follow-up medical examinations. He observes that it would be more difficult to deceive workers than it would be to mislead patients in a hospital:

If you feel that the physical examinations are vital to the survey, then, perhaps, you could offer to pay the people to compensate them for the time and effort that they will spend on the part of your alleged survey for the insurance company. They would think they were getting something for nothing and might not feel that you were worried or they were seriously ill. I don't know if these ideas are helpful at all. It is more difficult to find an excuse for these individual workers than it is in the case of patients who were treated for something or other at a hospital.

Louis Hempelmann, University of Rochester, to Charles Dunham, Director, AEC Division of Biology and Medicine, 2 June 1955 ("I did not have an opportunity . . ." ) (ACHRE No. DOE-092694-A), 1. 63 . Patricia Durbin, 9 December 1971 ("Report on Visit to Rochester") (ACHRE No. DOE-121294-D-12), 1.

64 . Patricia Durbin, 10 December 1971 ("Dr. Wright Langham, of the Los Alamos Scientific Laboratory, was the biochemist who performed the Pu analyses . . .") (ACHRE No. DOE-121294-D-13), 1.

65 . "Comments on Meeting with Dr. Hempelmann on April 17, 1974," 1.

66 . Langham further instructed Rochester to look for the following longer-term "symptoms" in the examination of the patients: "Judging from the recent observations that Robley Evans has made, a generalized osteitis with rarefaction of the bones of the feet, the jaw and the heads of the long bones with coarsening of the trabeculae are the most likely symptoms." Wright Langham, Los Alamos Health Division, to Dr. Joe Howland, Chief of University of Rochester's Division of Medical Services, 2 October 1950 ("I am very glad to hear that you will manage to get follow-ups on the two subjects . . .") (ACHRE No. DOE-121294-D-11), 1.

67 . Wright Langham, Los Alamos Laboratory Health Division, to Samuel Bassett, Head of Metabolism Ward of Strong Memorial Hospital, 25 October 1946 ("I just received a shipment of samples which I am sure are the ones you collected on HP-3 . . .") (ACHRE No. DOE-121294-D-5), 1.

68 . Samuel Bassett et al., 19 July 1948 ("The Excretion of Hexavalent Uranium Following Intravenous Administration II. Studies on Human Subjects") (ACHRE No. CON-030795-A-1), 8.

69 . Andrew H. Dowdy, Director, Manhattan Department, University of Rochester, to the Area Engineer, Rochester Area, 22 October 1946 ("Clearance of Material for Seminar") (ACHRE No. DOE-120994-A-4), 1.

70 . Madison Square Area Engineer, 24 October 1946 ("Uranium Studies in Humans") (ACHRE No. DOE 120994-A-4), 1.

71 . Robert M. Fink ("Biological Studies with Polonium, Radium, and Plutonium") (ACHRE No. CON-030795-A-2), 122.

72 . K. Z. Morgan, Oak Ridge National Laboratory Health Physics Division, to R. S. Stone, Health Director of the Metallurgical Laboratory, 5 May 1945 ("Tolerance Values for Polonium Used at Clinton Laboratories") (ACHRE No. DOE-113094-B-6), 2.

73 . Fink, "Biological Studies with Polonium, Radium, and Plutonium," 122.

74 . A supplemental volume contains a chapter on the development of human subject research at the University of California at Berkeley and San Francisco.

75 . Hamilton's work with plutonium had begun in 1942 with support from the Office of Scientific Research and Development; it was later supported by the Manhattan Engineer District.

76 . Joseph Hamilton, Radiation Laboratory of University of California at Berkeley, to Colonel E. B. Kelly, 28 August 1946 ("Summary of Research Program for Contract #W-7405-eng-48-A") (ACHRE No. DOE-113094-B-8), 2.

77 . Joseph Hamilton, 11 January 1945 ("Proposed Biochemical Program at University of California") (ACHRE No. IND-071395-A-14), 2.

78 . Ibid.

79 . At least eleven patients were injected with columbium (later renamed niobium) or zirconium between 1948 and 1950. These experiments appear to have been outside the federal effort.

80 . Joseph Hamilton, 10 May 1945 ("Progress Report for Month of May 1945") (ACHRE No. DOE-072694-B-65), 4.

81 . Joseph Hamilton, 14 June 1945 ("Progress Report for Month of June 1945") (ACHRE No. DOE-072694-B-66), 4.

82 . Ibid.

83 . Joseph G. Hamilton, Radiation Laboratory, University of California, Berkeley, to Captain Joe W. Howland, 23 April 1946 ("The problems of the research program . . .") (ACHRE No. DOE-120894-E-40), 2.

84 . Joseph G. Hamilton, Radiation Laboratory, University of California, Berkeley, to Robert Stone, Metallurgical Laboratory, 7 July 1945 ("I am writing concerning our experimental subject . . .") (ACHRE No. IND-071395-A), 1.

85 . Joe W. Howland, First Lieutenant, Medical Corps, to the Area Engineer, California Area, 12 July 1945 ("Status of Experimental Subject") (ACHRE No. IND-071395-A), 1.

86 . Kenneth Scott, interviewed by Sally Hughes (University of California Oral History Project), transcript of audio recording, 17 December 1979, 49-50.

87 . Ibid.

88 . Hamilton, "Progress Report for Month of June 1945," 4.

89 . Joseph Hamilton, 14 September 1945 ("Progress Report for Month of September 1945") (ACHRE No. DOE-072694-B-67), 5.

90 . "Mercy Flight Brings Aussie Boy Here: Suffering From Rare Bone Ailment, He Seeks U.S. Treatment," San Francisco Examiner, 16 April 1946, 1.

91 . In addition to this injection, which was not performed for his benefit, the child also received superficial external radiation (five doses of 250 rad over five days) for palliation of his pain. A 1995 report written by an ad hoc committee at the University of California at San Francisco (UCSF) described the child's prognosis as having been "grave with palliation the only option." With that in mind, superficial irradiation was performed to reduce the patient's pain, not to destroy the sarcoma of the right leg. University of California at San Francisco, February 1995 ("Report of the USCF Ad Hoc Fact Finding Committee on World War II Human Radiation Experiments, February 1995, Appendix 19: Summary of the medical record of CAL-2") (ACHRE No. UCSF-022495-A-6), 3.

92 . UCSF, "Report of the USCF Ad Hoc Fact Finding Committee," 27.

93 . Loren J. Larson, Assistant in Orthopedic Surgery, University of California Hospital, 11 June 1946 ("To Whom It May Concern . . .") (ACHRE No. DOE-051094-A-605), 2.

94 . Joseph Hamilton, Radiation Laboratory of the University of California at Berkeley, to Samuel K. Allison, 11 September 1945 ("Plans for Future Biological Research") (ACHRE No. IND-071395-A-2), 3.

95 . UCSF, "Report of the USCF Ad Hoc Fact Finding Committee," 27.

96 . Joseph Hamilton, Radiation Laboratory of the University of California at Berkeley, to John Fulton, Historical Library, Yale University Medical Center, 19 July 1946 ("Inasmuch as both the Lawrence brothers are away at the moment, I thought it best that I answer your letter of July 16, 1946, to John . . .") (ACHRE No. DOE-122294-A-3), 1.

97 . T. S. Chapman, Chief of Operations Branch, Research Division, to Area Engineer, Berkeley Area, 30 December 1946 ("Human Experiments") (ACHRE No. DOE-112194-D-3), 1.

98 . Form dated 2 May 1946 ("Consent for Operation and/or Administration of Anaesthetic") (ACHRE No. DOE-051094-A-604), 1.

99 . Colonel K. D. Nichols, Corps of Engineers, to the Area Engineer, California Area, 24 December 1946 ("Administration of Radioactive Substances to Human Subjects") (ACHRE No. DOE-113094-B-2), 1. This order followed a renewed request to the Army by Hamilton for additional plutonium, "to be used for certain human studies," and a further progress report on the injection of Albert Stevens.

100 . John L. Burling, AEC Legal Division, to Edwin E. Huddleson, AEC Deputy General Counsel, 7 March 1947 ("Clinical Testing.") (ACHRE No. DOE-051094-A-468), 1.

101 . Undated document ("CH-3607 . . . Excerpts from statements of reviewers") (ACHRE No. 113094-B-9), 1.

102 . Ibid.

103 . Ibid. For discussion of classification levels, see chapter 13.

104 . "Off Project" probably refers to work not sponsored by the AEC.

105 . Major B. M. Brundage, Chief, Medical Division, to Declassification Section, 19 March 1947 ("Clearance of Technical Documents") (ACHRE No. DOE-113094-B-4), 1.

106 . Hoylande D. Young, Argonne National Laboratory, to Charles A. Keller, 25 July 1947 ("Declassification has been refused for the following reports . . .") (ACHRE No. NARA-050995-A-6), 1.

107 . Carroll Wilson, AEC General Manager, to Robert Stone, University of California Medical Center, 12 August 1947 ("Declassification of Biological and Medical Papers") (ACHRE No. DOE-061394-A-111), 1.

108 . Wright Langham, Los Alamos Laboratory Health Division, to Stafford Warren, University of California, 1 July 1950 ("Dr. Bassett has been here and helped me finish the semi-final draft of the Plutonium Report . . .") (ACHRE No. DOE-082294-B-72), 1.

109 . Wright Langham, Los Alamos Laboratory Health Division, to Joe W. Howland, Chief, Division of Medical Services, University of Rochester School of Medicine and Dentistry, 15 April 1950 ("I am curious to hear your reaction to the names that I sent you . . .") (ACHRE No. DOE-082294-B-73), 1.

110 . Andrew H. Dowdy, Director of the Manhattan Department, University of Rochester, to Norris E. Bradbarry [sic], Director of the Los Alamos Laboratory, 18 February 1947 ("Dr. Wright Langham and Dr. Samuel Bassett were discussing with me today the technical details relative to writing the report . . .") (ACHRE No. DOE-121294-D-6), 1.

111 . Langham to Warren, 1 July 1950, 1.

112 . Walter D. Claus, Acting Chief, Biophysics Branch, AEC Division of Biology and Medicine, to Wright Langham, Los Alamos Laboratory Health Division, 30 August 1950 ("You will be pleased to learn that Dr. Shields Warren has approved your report for CONFIDENTIAL classification . . .") (ACHRE No. DOE-082294-B-2), 1.

113 . It is not clear when CH-3607, the report Dr. Friedell recommended for declassification in December 1946, was declassified. The copy retrieved by the Committee bears a 31 December 1946 declassification date and no indication of subsequent reclassification. Russell and Nickson, "The Distribution and Excretion of Plutonium in Two Human Subjects," 1. In 1956 Dr. Langham made a brief reference to fifteen experimental subjects at an unclassified technical conference. Langham, "Proceedings of the Second Annual Meeting on Bio-Assay and Analytical Chemistry," 80. In 1951, a report, based on Metallurgical Laboratory Memorandum MUC-ERR-209 ("Distribution and Excretion of Plutonium") appeared in a volume of the public Manhattan District research history.

114 . While the Wilson letters do not expressly reference the plutonium experiments, the context seems to leave little question that the policies stated in the letters were arrived at with the plutonium experiments in mind. In 1974, when asked what steps had been taken when the plutonium injections had been brought to the attention of the AEC, Shields Warren, who became director of the AEC's Division of Biology and Medicine in late 1947, said that it had been decided "that the rules [should be] properly drawn up by the . . . Human Applications Isotope Committee . . . so that use without full safeguards could not occur, and that . . . nothing of the sort could happen in the future." Shields Warren, interviewed by L. A. Miazga, Sidney Marks, and Walter Weyzen (AEC), transcript of audio recording, 9 April 1974 (ACHRE No. DOE-121294-D-14), 10.

115 . Carroll Wilson, AEC General Manager, to Stafford Warren, University of California, 30 April 1947 ("This is to inform you that the Commission is going ahead with its plans to extend the medical research contracts . . .") (ACHRE No. DOE-051094-A-439), 2.

116 . Carroll Wilson, AEC General Manager, to Robert Stone, University of California Medical School, 5 November 1947 ("Your letter of September 18 regarding the declassification of biological and medical papers was read . . .") (ACHRE No. DOE-061395-A-112), 1.

117 . Dowdy, "Proposed Research Program and Budget: July 1, 1947-July 1, 1948," 25.

118 . A December 1947 memorandum from Dr. Bassett recorded:

In the autumn of 1945 the Section on Human Metabolism was activated under your direction at the request of the Manhattan Engineer District to carry out certain tracer studies with long-lived isotopes. As you know, this program was discontinued in the spring of 1947 under a directive from the Atomic Energy Commission although we were instructed to keep the personnel of the section intact. When this directive was received, it was anticipated that follow-up studies on the several subjects of the original investigation would provide occupation for the employees of the section.

Samuel H. Bassett, Section on Human Metabolism, University of Rochester, to William F. Bale, Head of Special Problems Division, University of Rochester, 2 December 1947 ("Proposal of Work for Metabolism Section") (ACHRE No. DOE-121294-D-7), 1.

Dr. Bassett proposed an interim activity for the employees of the section--a study of certain aspects of radiation injury. This was approved by Bale until "the project research program of the Metabolism Section . . . with regard to tracer studies with heavy elements is clarified."William F. Bale, Head of Special Problems Division, University of Rochester, to Andrew H. Dowdy, Director of AEC's Rochester Project, 3 December 1947 ("Program of Work for Metabolism Section") (ACHRE No. DOE-121294-D-8), 1.

119 . Gilbert Whittemore, 3 March 1995 ("Shields Warren Papers: A Cumulative Update of Excerpts") (ACHRE No. BU-030395-A-1), 3.

120 . Ibid.

121 . Interview with Warren, 9 April 1974, 11.

122 . Ibid.

123 . Ibid. According to Dr. Durbin, it is likely that the "other substances" referred to were probably phophorus 32 and strontium 89, which were used at the University of California between 1941 and 1944 as experimental tracers or for palliation of pain. Dr. Patricia Durbin, telephone interview with Miriam Bowling (ACHRE), 2 August 1995 (ACHRE No. ACHRE-081095-A), 1.

124 . Undated note in medical record of CAL-A from "K.G.S." (Ken G. Scott [attr.]) ("The day after solution is injected . . .") (ACHRE No. UCLA-111094-A-1), 1.

125 . Telephone interview with Durbin, 2 August 1995, 1.

126 . Lori Hefner; telephone interview by John Kruger (ACHRE), 6 July 1995 (ACHRE No. IND-070695-A), 1.

127 . Note in medical record of CAL-3 dated 18 July 1947 ("Elmer Allen Chart") (ACHRE No. DOE-051094-A-615), 2.

128 . Wilson to Warren, 30 April 1947, 2.

129 . UCSF, "Report of the USCF Ad Hoc Fact Finding Committee, Appendix 20: Summaries of the medical record of CAL-3," 3-4.

130 . Ibid., 4. If the diagnosis was correct, surgical amputation would have been appropriate treatment at the time to completely excise the tumor.

131 . B. V. Low Beer et al., Radiation Laboratory, University of California, Berkeley, 15 March 1948 ("Comparative Deposition of Zr-95 in a Reticulo-Endothelial Tumor to Normal Tissues in a Human Patient") (ACHRE No. DOE-101194-B-4), 4.

132 . Ibid. The test dose was administered to the patient just twenty-four hours prior to the midthigh amputation of her leg for cancer.

133 . Shields Warren, Director of AEC's Division of Biology and Medicine, to Albert H. Holland, Jr., AEC Medical Adviser, 19 August 1948 ("Review of Document") (ACHRE No. DOE-101494-B), 1.

134 . Albert H. Holland, Jr., AEC Medical Adviser, to Shields Warren, Director of AEC's Division of Biology and Medicine, 9 August 1948 ("Review of Document") (ACHRE No. DOE-051094-A), 1.

135 . Langham to Howland, 2 October 1950, 1.

136 . Wright Langham, Los Alamos Laboratory Health Division, to Albert H. Holland, AEC Director of Research and Medicine, 20 March 1950 ("It seems that I really fouled up regarding my promise to you at the Washington meeting . . .") (ACHRE No. NARA-082294-A-155), 1.

137 . L. H. Hempelmann, University of Rochester, to Charles Dunham, AEC Division of Biology and Medicine, 23 May 1953 ("There are several things on my mind that I would like to bring to your attention . . .") (ACHRE No. DOE-041495-A-1), 1.

138 . Walter D. Claus, Acting Chief of the Biophysics Branch, AEC Division of Biology and Medicine, to Charles L. Dunham, Chief, Medical Branch, 31 August 1950 ("Physical Examinations at Rochester") (ACHRE No. DOE-051094-A-471), 1.

139 . Interview with Warren, 9 April 1974, 8.

140 . Patricia W. Durbin, University of California, to William E. Lotz, AEC Division of Biology and Medicine, 13 September 1968 ("You will never guess what I found today . . .") (ACHRE No. DOE-051094-A-606), 1.

141 . Ibid.

142 . Ibid.

143 . Patricia Durbin, 1972 ("Plutonium in Man: A New Look at the Old Data") (ACHRE No. DOE-051094-A-160), 469.

144 . R. E. Rowland, Argonne National Laboratory's Center for Human Radiobiology, 8 November 1973 ("Plutonium Studies at the Center for Human Radiobiology [CHR]") (ACHRE No. DOE-051094-A-608), 4.

145 . I. E. Kirch, Radiological and Environmental Research Division, Argonne National Laboratory, 13 June 1973 ("Center for Human Radiobiology: Radiologist's Report") (ACHRE No. DOE-051094-A-616), 1. The report records: "In the proximal portions of both humeri as well as in the adjacent acromions, there are some changes in the trabeculae which are consistent with findings in early radium deposition, but not yet completely specific. The mandible shows abnormal trabeculae, suggestive of damage due to radiation."

Subclinical bone changes were also observed in a deceased subject who was exhumed for the Argonne study. The same radiologist summarized that an "abnormality is present, namely, that there are very many very small very dense deposits on the surfaces of a number of the bones, and other such deposits in the soft tissues very close to the bone surfaces. This abnormality is attributed to the plutonium which has been administered during the subject's life. The radiographic pattern is unique." I. E. Kirch, Radiological and Environmental Research Division, Argonne National Laboratory, 15 November 1974 ("Center for Human Radiobiology: Radiologist's Report") (ACHRE No. DOE-051094-A-618), 1.

146 . AEC Division of Biomedical and Environmental Research and Division of Inspection, 13 August 1974 ("Disclosure to Patients Injected With Plutonium") (ACHRE No. DOE-051094-A-586), 10.

147 . Ibid.

148 . Ibid.

149 . Ibid.

150 . Ibid.

151 . Robert E. Rowland, Argonne National Laboratory, to H. A. Schultz, 21 December 1972 ("Plutonium Cases") (ACHRE No. DOE-080795-A), 1.

152 . Robert E. Rowland to Miriam Bowling (ACHRE Staff), 7 August 1995 ("Attached is the memo of December 21, 1972 . . .") (ACHRE No. DOE-080795-A), 1.

153 . Ibid.

154 . James L. Liverman to Miriam Bowling (ACHRE Staff), 20 August 1995 ("With your fax of August 9 was included . . .") (ACHRE No. IND-082095-A), 1.

155 . James L. Liverman, 29 April 1974 ("Briefing on Plutonium Project by Dr. James L. Liverman on April 29, 1974") (ACHRE No. DOE-051094-A-196), 8. The 1971 protocol referred to in this briefing had covered a follow-up project involving the radium dial painters. Although the procedures for the two follow-up studies were similar, the original conditions of exposure were quite different. The radium dial painters, unlike the plutonium-injection subjects, had not been chosen as subjects in a carefully planned medical experiment organized by the government. They had been exposed either occupationally as dial painters or therapeutically as patients receiving one of a variety of prewar radium treatments.

156 . Signed form dated 28 August 1974 ("Acknowledgement of Disclosure") (ACHRE No. DOE-051094-A-619), 1.

157 . Document dated 24 May 1974 ("Patients Injected with Plutonium [Draft Report of 5-24-74]") (ACHRE No. DOE-051094-A-607), 1.

158 . There is some evidence suggesting that at least one subject had a serious emotional reaction to the news, many years after the fact, that she had been injected with plutonium. This suggests that physicians involved in the follow-up had cause to be concerned about how at least some patients might respond to knowledge of the injections.

159 . K. F. Eckerman to Barry A. Berven, 7 January 1994 ("The Boston-Oak Ridge Uranium Study") (ACHRE No. DOE-051094-A-425), 1.

160 . John C. Gallimore, Associate Health Physicist, to Dr. W. H. Sweet, Massachusetts General Hospital, 22 March 1954 ("First Results of Uranium Distribution and Excretion Study") (ACHRE No. NARA-082294-A-35), 1.

161 . S. R. Bernard, "Maximum Permissible Amounts of Natural Uranium in the Body, Air and Drinking Water Based on Human Experimental Data," Health Physics 1 (1958): 288-305.

162 . According to the 1957 interim report on the study, it was Harold Hodge of the University of Rochester's Atomic Energy Project, who had been involved with the MED metabolism work at Rochester, who ultimately coordinated the beginning of the joint research. S. R. Bernard and E. G. Struxness, 4 June 1957 ("A Study of the Distribution and Excretion of Uranium in Man: An Interim Report") (ACHRE No. DOE-051094-A-369), 3.

163 . Bernard, "Maximum Permissible Amounts of Natural Uranium in the Body, Air and Drinking Water Based on Human Experimental Data," 296-298; Standards for Protection Against Radiation, 9 C.F.R. 20 (1958-1994).

164 . Robert Bernard, interviewed by J. Newell Stannard, transcript of audio recording, 17 April 1979 (ACHRE No. DOE-061794-A), 8.

165 . A continuation of the study at lower doses was proposed by the ORNL in 1958; it is unclear whether this project went forward. Karl Morgan, Director of ORNL's Health Physics Division, to William Sweet, Massachusetts General Hospital, 16 July 1958 ("Your help in our cooperative study on the distribution and excretion of uranium in man has been of great value to us . . .") (ACHRE No. DOE-021695-A-1), 1. A study similar to the one proposed by the ORNL in 1958 may have taken place during the mid-1960s at Argonne Cancer Research Hospital. K. Z. Morgan to W. H. Jordan, 3 September 1963 ("Proposed Study of Distribution and Excretion of Enriched Uranium Administered to Man") (ACHRE No. DOE-051094-A-620), 1.

166 . Interview with Morgan, 6 January 1995, 118-119.

167 . Form dated 3 November 1953 ("Application for Approval of Radioactive Isotopes: Massachusetts General Hospital") (ACHRE No. MGH-030395-A-1), 4.

168 . Leonard Atkins, M.D., 26 June 1954 ("Necropsy No. ___: June 26, 1954 at 12:30 p.m.") (ACHRE No. DOE-050895-D-1), 6.

169 . Ibid., 1.

170 . Ibid. The "Anatomic Diagnoses" include "Uranium nephrosis, acute."

171 . Ibid., 5.

172 . Bernard and Struxness, "A Study of the Distribution and Excretion of Uranium in Man: An Interim Report," 6.

173 . Undated document ("#1 Cloudy swelling of the epithelium of proximal and distal convoluted tubules . . .") (ACHRE No. DOE-050895-D-2), 1. The document records a diagnosis for the two additional patients as "acute nephrosis," and for subject VI, as "severe subacute nephrosis."

174 . Bernard and Struxness, "A Study of the Distribution and Excretion of Uranium in Man: An Interim Report," 4.

175 . William Sweet, interviewed by Gil Whittemore (ACHRE), transcript of audio recording, 8 April 1995 (ACHRE Research Project Series, Interview Program File, Targeted Interview Project), 46.

176 . By the end of the Committee's deliberations, MGH had not yet completed its search for the patient records of the Boston Project subjects.

177 . Chapman to Area Engineer, Berkeley Area, 30 December 1946, 1.

178 . Weyzen, "Visit with Edwin R. Russell, Savannah River Plant, April 23, 1974," 1.

179 . Interview with Warren, 9 April 1974, 11.

180 . The relatively small population that has been exposed to substantial levels of plutonium precludes definitive conclusions about risks to humans, but the available evidence clearly suggests that an epidemic of cancer of the magnitude that afflicted the radium dial painters from an earlier era has not occurred in plutonium workers. In the case of the radium dial painters, the unprotected handling of only a few pounds of radium led to hundreds of deaths; in contrast, studies of plutonium workers suggest that to date there is no definite excess mortality in this population. A forty-two-year follow-up of twenty-six Manhattan Project workers who worked with plutonium found a total of seven deaths, including three cancers (two lung and one osteogenic sarcoma), a substantially lower mortality rate than expected based on the U.S. population. The authors concluded that "the diseases and physical changes noted in these persons are characteristic of a male population in their 60s." G. L. Voelz and J. N. Lawrence, "A 42-year Medical Follow-up of Manhattan Project Plutonium Workers," Health Physics 61 (1991): 181-190. A larger study of 15,727 LANL workers followed through 1990, some of whom had plutonium exposures, found no cause of death significantly elevated among the plutonium-exposed workers compared with unexposed workers, although there was a nonsignificant 78 percent elevation in lung cancer (a site that is directly exposed) and a single osteogenic sarcoma, a rare cancer that has been associated with plutonium exposure in animal studies. L. D. Wiggs, E. R. Johnson, C. A. Cox-DeVore and G. L. Voelz, "Mortality Through 1990 Among White Male Workers at the Los Alamos National Laboratory: Considering Exposures to Plutonium and Ionizing Radiation," Health Physics 67 (1994): 577-588. Another study of 5,413 workers at the Rocky Flats Nuclear Weapons Plant found elevated risks for various cancers comparing workers with body burdens of 2 nanocuries (nCi) or greater, but with wide uncertainties; no excesses were seen for bone or liver cancers. The authors concluded that "these findings suggest that increased risks for several types of cancers cannot be ruled out at this time for individuals with plutonium body burdens of 2 nCi. Plutonium-burdened individuals should continue to be studied in future years." G. S. Wilkinson et al., "Mortality Among Plutonium and Other Radiation Workers at a Plutonium Weapons Facility," American Journal of Epidemiology 125 (1987): 231-250.