TREATMENT FOR RADIATION INJURY

The first problem I should like to mention is that of acute whole body radiation injury. This was relatively a minor one at Hiroshima and at Nagasaki. Only a small percentage of fatalities resulted solely from radiation exposure, perhaps 15 percent. Of the surviving casualties an even smaller percentage suffered the syndrome of whole body radiation injury. With large, megaton thermonuclear weapons and all their resulting fallout I would expect the ratio to be no higher for purely radiation casualties if shelters are prepared in advance-I repeat, if shelters are prepared in advance.

Treatment for whole body radiation injury is not specific in spite of much research by the AEC and Department of Defense. As much as we need it, there is today no satisfactory prophylactic medicine or antidote. We have made little progress in developing drugs which are both safe and which will optimize resistance to radiation over periods of weeks and months. Sometime in the not too far distant future it may be possible to increase temporarily a person's resistance to the immediate effects of radiation by administration of the proper combination of drugs. While such a "radiation pill" may have application to military operations and possibly to lifesaving rescue operations involving radiation accidents, we do not foresee that this will have widespread civil defense applications. This is because the drugs now under study must be given just before a short exposure to a heavy radiation dose.

It is clearly established, however, that antibiotics and other supportive treatment would be lifesaving for an appreciable fraction of those injured by radiation. Therefore, the stockpiling of antibiotics, which, I believe is already underway, is a must. They must be stockpiled in a way which makes them available to those who need them. Therapy need not commence immediately; in the instances where it would do the most good it can start 2 to 3 weeks after exposure to several hundred roentgens. In this connection, it is important to remember that there are many people living today who have survived, with minimal or no treatment, doses of radiation in the hundreds of roentgens. For example, some of those involved in radiation accidents, many of the survivors in Japan and medical patients who have received radiation therapy. Research in progress will improve our understanding of radiation effects. From this we expect that more information will be available to guide us in devising preventive agents and treatment.

SUPPLIES IN SHELTERS

Prevention is always more desirable than cure, and this applies to radiation injury just as it does to contagious diseases. Studies have shown that relatively simple shelters can be constructed in basements or adjacent to houses. Such simple shelters could reduce the radiation dose to persons inside by a factor of 100 to 200. With such protection, the exposure could be kept low enough in most places to produce no immediate symptoms in any reasonably normal individual. The problem, of course, is not that simple. Shelters must have adequate food and water to maintain a family for several weeks. In some parts of the Nation heat would be necessary during a winter war.

Sanitary facilities must be provided. Some means of communication such as a portable radio has been recommended. A radiation detection and measuring instrument would make the family more self-reliant. Certain basic medical supplies necessary for self-care will be important.

MORALE AND INDOCTRINATION

In the regions of heaviest fallout persons will have to stay more or less pinned down for several weeks. Here they would face the supplemental problem of keeping mind and spirit in good order. It is essential that continued attention be given to this aspect of protection for our civil defense planning, including indoctrination into when and for how long it is wise to leave the shelter for brief but increasing periods.

Dr. Gordon Dunning pointed out in 1959 that in areas of relatively heavy fallout, the ingestion of all the fallout on 1 square foot at 1 week after the fallout occurred might be sufficient to cause death to adults or children due to irradiation of the gastrointestinal tract. Fresh milk might be so heavily contaminated with radioiodine that a single pint would contain enough activity to destroy an infant's thyroid gland. This, too, poses a problem of indoctrination.

PEACETIME VERSUS POSTWAR RADIATION HAZARDS

We

On the other hand, in dealing with this situation we will have to give up for the time being and perhaps for a generation or so, the peactime radiation protection criteria geared to the proposition of reducing the probability of even delayed injury to close to zero. would expect that the incidence of leukemia in the surviving population would be increased, probably by a factor of several for a few decades and then taper off. A similar increase in bone cancer, but a smaller number of cases, might appear later as a result of the unavoidable ingestion of strontium 90 in food over the ensuing years. Neither condition, I hasten to add, would be likely to become a principal cause of death. It is unlikely that even leukemia would become as common as fatal diphtheria was in 1900, or scarlet fever or whooping cough. It would also be possible that a relatively high incidence of thyroid cancer would occur in those who had been infants or small children at the time and who had inadvertently ingested appreciable quantities of radioiodine. When compared to the immediate deaths and injuries from blasts and fire which would wipe out tens of millions of people, these delayed effects, although they might involve several hundred thousand persons, over a number of years would be relatively small and could be tolerated. Even if the survivors had received an average radiation dose which would double the mutation rate in a single generation it would not be disastrous to the population though it would cause added suffering.

BLAST AND BURN INJURIES

Much has been written and said about the radiation hazards, and certainly this must be continued. However, we must not lose sight of the blast injuries and burns. Thousands of them have occurred in conventional war. In any nuclear war their numbers would be multi

plied manyfold. The medical procedures for their treatment, though well known, are not simple. Just as we would seek to prevent radiation injury and to limit radiation injury, we should endeavor to use knowledge and protective measures to hold down the number and severity of blast injuries and burns. Burn prevention is of special importance. As you will see later from one of Mr. Corsbie's charts, as the weapons yield increases into the megaton range the area covered by thermal radiation is quite large in relation to the area covered by prompt radiation and blast, and one must expect that there will be among the casualties a large number of burn cases among those in direct line of sight and in areas of conflagration, outside the range of the initial radiation and beyond the range of heavy blast damage. The same means taken to shield against fallout will greatly reduce the number of thermal burns, provided, of course, one is in the shelter at the time of the burst. Adequate warning of an attack will greatly assist in reducing casualties, provided the people take cover. Even if one does not receive any warning of a 10 megaton burst, it is possible for those at the greater distances, 20-30 miles, to reduce the danger from burns by seeking cover instantly upon seeing the awesome flash of light characteristic of a nuclear detonation. It takes 6 seconds to deliver 50 percent of the energy.

WEAPON EFFECTS ON THE ENVIRONMENT

There are problems in addition to those which directly involve human life. The damage to forests by fire and to pine forests in particular by radiation from fallout are examples. Many thousands of square miles of pine forests would receive lethal radiation. To prevent denuding of the land reforestation programs would have to be instituted within a year or two. Fortunately, deciduous trees and the grasses, especially the latter, are less sensitive to radiation than pine trees. The grasses would suffer little damage from fallout. The deciduous trees might be seriously damaged in the heaviest fallout areas, that is, in areas where heavy fallout patterns were superimposed. Definitive studies on this point are underway.

The matter of rehabilitation of surviving livestock and the redevelopment of farms in areas of relatively low fallout would also be great but not insurmountable.

ATOMIC ENERGY COMMISSION DISCUSSIONS

Whatever the problems, where they are associated with protection, health, food, or rehabilitation, it is certain that we are all in this together. We in the Division of Biology and Medicine expect to continue to devote attention and effort to nonmilitary defense subjects. Over the years we have made available to the civil defense agency a large number of technical and scientific reports, classified and unclassified. Additional information has been made available through AEC-Department of Defense cooperation. "The Effects of Atomic Weapons," published in 1950, and "The Effects of Nuclear Weapons," published in 1957, represent the more significant contributions. Culminating a joint effort of the Department of Defense and the AEC, the revised edition of the book should be published before the end of this year.

The AEC has conducted technical and scientific programs and training exercises for and with civil defense at the Nevada test site. A series of experimental determinations of radiation shielding have been made to supply data of value in determining protection against fallout in homes, buildings, and shelters. We have assisted and are assisting in the development of radiological defense instruments. Tours and briefings for civil defense officials have been arranged. These are typical activities.

Among the signs of the times is evidence of a quickening of interest in civil defense. As a medical doctor with a better than average working knowledge of the effects of nuclear weapons, and above all as a citizen of the United States of America, I hope that the time for rapid progress, the time for doing, is near at hand.

Thank you.

Mr. HOLIFIELD. Thank you very much, Dr. Dunham. That is certainly a fine statement.

REVISION OF “EFFECTS OF NUCLEAR WEAPONS"

I notice on page 9 you say that you are about ready to bring out your new book on "Weapons Effects." That is a revision of the 1957 pub

lication?

Dr. DUNHAM. Yes.

Mr. HOLIFIELD. What time this year do you think that will be ready, Doctor?

Mr. DUNHAM. Probably in December, will it not, Mr. Corsbie? What time do we expect the new edition of "Weapons Effects” to be available?

Mr. CORSBIE. It will be late in the year, probably December. Mr. HOLIFIELD. I think it will be important to get that out as quickly as possible.

The original book, I think, gave to the civil defense people an understanding of this problem which they didn't have before, and certainly the new book will bring them up to date on it.

I understand that you came in from your vacation, sir, to give this testimony.

Dr. DUNHAM. I wanted to help, because I feel very strongly about this.

Mr. HOLIFIELD. I know you want to help. And you have rendered great service in this field in times past. And we appreciate your coming in and making your statement.

I am sorry that it affected your vacation. Maybe you can get an extra day or two. I will speak to your boss about it.

Thank you, sir.

Now, Mr. Corsbie, I believe you are next. We are glad to have you before us again, Mr. Corsbie.

STATEMENT OF R. L. CORSBIE, DEPUTY ASSISTANT DIRECTOR FOR CIVIL EFFECTS, DIVISION OF BIOLOGY AND MEDICINE, U.S. ATOMIC ENERGY COMMISSION

Mr. CORSBIE. It is the purpose of my remarks to cover briefly the effects of nuclear explosions, giving attention to those aspects which are of concern in discussions of defense against attack.

Beginning with weapons having an energy release equivalent to about 20,000 tons of TNT, technological efforts have produced weapons much smaller and many times larger. Thus one may speak of yields ranging from less than a kiloton, up through the tens and hundreds of kilotons, to the megaton and multimegaton.

PROTECTION FROM COMBINATION OF WEAPON EFFECTS

It is the opinion of many who have been associated with the development of technical information on nuclear weapons that the planning and establishment of protective measures proceed on a proper course only when appropriate consideration is given to all hazards. The requirements for complete defensive measures are based upon the knowledge of the combined effects.

It is convenient for illustrative purposes to speak in terms of a single detonation. Commonsense tells us that we may be incautious to adopt a single detonation as an assumption upon which to base our plans. Although one weapon may be capable of destroying a target, several weapons may be used because of anticipated inaccuracies in placement or interference with delivery.

At the instant of a nuclear explosion an intense, brilliant light is emitted, the most brilliant light on earth. The light from lowyield explosions has been seen at distances such as 400 miles during tests. The light from a megaton burst at high altitude over Johnston Island in 1958 was observed in Hawaii, over 700 miles away. The brilliant light identifies a nuclear explosion, as does the fireball. For the larger weapons the fireballs reach substantial size. For example, a 1-megaton burst produces a fireball with a maximum diameter a little less than 111⁄2 miles. Seen from a distance of 25 miles, this fireball would appear to have a diameter about 6 times that of the sun.

INITIAL RADIATION

The explosion is accompanied by the emission of a highly energetic burst of nuclear radiation, principally the gamma rays and neutrons for our purposes. These radiations are far more penerating than the gamma rays from fallout, but fortunately the range in the air is not great as compared with blast and thermal radiation. For those concerned with the design of blast-resistant shelters which will withstand the close-in effects, the initial radiation is very much to be considered. Thicker or more massive shields are required to attenuate the initial radiations than is the case with radiation from fallout.

LIGHT AND HEAT

About 35 percent of the energy of an airburst is emitted as thermal radiation, much of it in the form of heat. The heat is sufficient to start fires and cause burns over large areas. It is an important casualty agent, particularly for megaton and multimegaton explosions. The heat is radiated from low yield explosions during a very brief period. As the yield increases, the time is extended, although it is still a period of seconds during which the most hazardous emission