SUPPLEMENT
that environment, is tile sum total of all the radiation from all sources that he encoun-ters during lliS lifetime. This includes not
only the unavoidable exposure from
natu-rally occurring sources but also man-made
sources such as fission products from the
atmospheric testing of nuclear weapons, the
necessary exposures associated with the
beneficial application of radiation in medi-cal practice, and, for some, occupational
exposures. Specific effort to minimize the
build-up of this environment over a period
of time will do more good than large scale
remedial measures, which at best affect only a small fraction of that environment.
In summary then, the general position of
the Federal Government is that the control
of the man-made hazards associated with
the burgeoning scientific revolution
re-quires team work between agencies of the
Federal Government, between the Federal
Government and the governments of
small-er political subdivisions, between
govern-ment and industry, and between
govern-ment and medicine. The Federal Radiation
Council has provided recommendations for
a general national policy and quantitative
guidelines for two classes of activities in-volving radiation. One class, the radiation
protection guide, is intended to be used as
a basis for the control and regulation of
normal peacetime operations in which
radiation is a part. Tile other class,
protec-tive action guide, is intelldied to provide a common basis for evaluation of tile
circum-stances under which remedial action should
be ordered by appropriate government
agencies to reduce the risk that would
otherwise be associated with an accident
involving a radiation source. Rules and
reg-ulations, when they are appropriate, are
formulated by the various federal agencies within the areas of their statutory authority.
Any action at any level is the result of a
judgment involving the weighing of
alter-natives. As medical men ‘ou do this every
time you prescribe for a patient. As
govern-ment we do this when we recommend a
source of action for a specific set of circum-stances. Both the radiation protection guide and the protective action guide of the Fed-eral Radiation Council are designed to pro-vide a common basis for responsible authori-ties to make appropriate judgments.
DISCUSSION
Dn. SAENGER: To date the work of the
Federal Radiation Council has been fortui-tous. It has, by skilled and adroit
commit-teemanship, and by a fortunate turn of the
international wheel, been able to generate a
family of recommendations (radiation
pro-tection and protective action guides) which have really not been tested. These remarks
are not made to be unjust but in an effort
to point out the very difficult position of the Federal Radiation Council as the interface between a large mass of scientific data and
the need for infrequent but presumably
prompt action by public authorities to
pro-tect the health of citizens. Each course of
action recommended by the Federal
Radia-tion Council has, in addition to its health
aspects, tremendous socioeconomic and
po-litical implications. The ability of scientists,
and particularly physicians, to handle prob-lems in these areas is limited.
Doctor Tompkins discusses tile problem
of 1131 during the 1962 tests in a very scien-tific and tactful way. As can be found in St.
Louis newspapers and in the 1963 Joint
Committee on Atomic Energy hearmgs,
there developed heated and, at times,
acri-monious debate as to what courses of
ac-tion should be taken.
At that time when the levels of 1131 in tile
milk of the St. Louis area rose to about
1,000 pCi per liter for some days, the Greater St. Louis Citizens’ Committee for Nuclear Information exerted considerable pressure
either to withhold milk or give prophylactic potassium iodine to the pediatric and
preg-nant population. This proposal obviously
as-0 1 nCi = 1,000 pCi.
j 84,000 pCi.
pects. Since the milk levels were consider-ably lower than those following Windscale, there vould have been an interesting series of protests from the milk lobby since their
products could have been used only for
processed or aged dairy products. The
booklet, Radioactive Fallout, a Manual for
the Fluid Milk Industry, is quoted in the
Hearings of Joint Committee for Atomic
Energy, August 20-27, 1962. Part 2 is partic-ularly illterestillg reading. If stable iodide
were recommended, there was great
uncer-tainty as to how much iodism would be
in-duced, not by recommended doses of
io-dide but by the individuals who believe
that, if a little medicine is good, much med-icine is better. The upshot of the
controver-sy was that nothing was done and, because
the radiation doses were relatively low, it is doubtful if anyone will detect any
deleteri-ous effects from that episode with any
de-gree of certainty.
In 1961 in FRC Report No. 2, levels for
1131 were set as follows: Range I, 0 to 10 pc
per day; Range II, 10 to 100 pc per day;
Range III, 100 to 1,000 pc per day. When
FRC Report No. 5 was issued in 1964 it
was recommended that protective action
guides need not be invoked unless radiation doses to the thyroid were anticipated to ex-ceed 10 rads for infants.
If 84 nCi#{176}per day are ingested for 1 week,
the thyroid gland of the 1-year-old child
will receive 10 rad. This value of 84 nCif is
about 60 to 100 times that encountered in
St. Louis. The decision makers would then
have several courses of action. Children
and pregnant women could stop using fresh
milk. Cattle could, where possible, be
switched from fresh to stored feed. Fresh
milk could be brought from other
uncon-taminated areas and contaminated milk
could be used for processed dairy products, or processing plants to remove 1131 could be set up if available. Thyroid blocking agents
were not considered in the report because
their effects at safe doses in a large popula-tion are simply unknown.
Tile probability that the radiation protec
tion guides were somewhat low in 1962 is
not a criticism of the FRC.
It is extremely difficult to set guides for dose limits to individuals in case of nuclear
warfare under many circumstances. The
National Committee On Radiation
Protec-tion has lowered occupational radiation
1ev-els from 1 r per week to 100 mr per week
over the past 2 decades after prolonged
study. The Federal Radiation Council
re-sponsibility for setting guides depends on
so many imponderable factors that it is
re-markable that any appropriate guides can
be formulated under the complex
condi-lions of our society.
In FRC Report No. 7 the problems of
cesium137, strontium89 and strontium”#{176} are discussed. These nuclides are more difficult to handle because they have longer physical and effective half lives and are deposited over a longer time period4 The protection action guides are expressed in terms of dose
to bone marrow and soft tissue and may be
invoked depending on the circumstance of
the fallout of dose levels from 15 rads to 0.2 rads. Tables relating concentrations of
nu-clides in milk to bone marrow and whole
body doses are given in FRC Report No. 7
so that, with environmental surveillance,
appropriate calculation, and courageous yet
tactful public health officials, measures to
meet protection action guides could be
in-stituted.
Under what circumstances might this
action be necessary? It seems rather doubt-ful that there will be a renaissance of atrno-spheric weapons testing on any major scale. The reasons for this statement rest in part on the assumption that by not testing in the atmosphere the member nations of the
nu-clear weapons club are more easily able to
maintain their wholesomeness of outlook
and primarily on the assumption that most
everything one needs to know about the
be-havior of these weapons in the atmosphere
has already been learned. Thus, only
novi-Strontium’ half life = 53 days; strontium”’
half life = 25 years; ccsium” half life = 37
tiates need contaminate the atmosphere
and such newcomers can perform only at
relatively low levels without destroying the
energy which they have labored so hard to
create. The great nuclear powers can
con-tinue small technical refinements in caves
or iloles. Hence, atmospheric weapons
testing has probably reached and passed its
zenith.
The possibility of peacetime, civilian fall-out must also be considered. The accidental
release of 1131 and other nuclides from
power reactors is possible. Contamination
by mixed fission products during the
ex-change of fuel elements or in reprocessing plants can occur. There is the possibility
under some unusual circumstances of
con-tamination by a large quantity of a specific nuclide used for specific industrial or
scien-tific purposes. There is the possibility of
contamination from nuclear power sources
associated with space propulsion and from
underground testing to a limited degree.
None of the peacetime sources would
re-sult in widespread contamination of the
type found after earlier atmospheric
weap-on testing. More likely would be
involve-ment of a community or segment thereof
and its environs, depending on variables of
the accident, terrain, meteorological condi-tions, etc. Public health and safety authori-ties, physicians, and federal agencies should
be prepared with detailed plans to cope
with such emergencies as outlined in
Fed-eral Radiation Council’s and other publica-tions (Saenger, E. L., ed: Medical Aspects of Radiation Accidents. U.S. Atomic Energy
Commission. Washington, D.C.
Govern-ment Printing Office, 1963).
One aspect of particular concern is our
lack of ability to study metabolic pathways
of radionuclides in normal individuals of
any age. Why do we want to study normal
individuals? One of the reasons for the con-fusions in setting of standards is that the
metabolic data on which the analyses are
made derive largely from sick rather than
well subjects. With the development of
whole body counters permitting detection
of radionuclides at pico and nanocurie
1ev-els it is possible to carry out studies with no
risk to human beings. Lacking studies of
normal individuals, it is extremely difficult to determine effective half times, etc., and it is virtually impossible even to explore the
possibilities of pharmacological counter
measures. The pendulum of pediatric
intro-spection regarding the beneficial uses of
ra-diation has in recent years swung from the
intense desire to fluoroscope anything which
moves to an intense concern about the
del-eterious effects of any radiation. This view-point has not advanced our scientific objec-tivity in dealing with these problems.
Finally, one might raise a small question
as to the reasons why this group as well as
the Federal Radiation Council does not
de-bate the really serious pediatric significance
of wartime radioactive fallout. Although
there are some gaps in our present
knowl-edge of peacetime fallout requiring some
coin flipping on the part of committees
set-ting peacetime protective action guides, no
one seems to want to make any provisions
for the same problem on a far larger scale
than that which concerns us here. It is this latter reality which should be considered.
DR. CHARLES: Without getting bogged
down in any numbers game with Dr.
Tompkins, I want to ask him what the
pro-tective action guide advantage was over the
radiation protection guide, since he had
identified one limitation of the radiation
protection guide as not applicable to the
sudden release of radioactivity by a foreign
power. Why does the protective action
guide have a greater flexibility and adapt-ability in this relationship, aside from the built-in delay and that it is 20 times higher?
What adverse effects did he have in mind
when he said the situation in Utah was a
real threat in regard to invoking counter
measures? What counter measures can be
applied under the protective action guide
not possible with the radiation protection
guide? The practicing physicians also have
been confused by the Federal Radiation
Council, and I wonder what purpose has
the game are being changed when the game is not turning out well.
DR. TOMPKINs: If one assumes the
exis-tence of a threshold, or if one assumes one
can set a value whether it be concentration, a dose, or any other parameter that should
not be exceeded on biological grounds
only, setting standards becomes straight
forward. Now, this is exactly opposite to
the situation of the Federal Radiation
Council in setting up radiation protection guides. Consequently, I reject the sugges-tion that Dr. Charles makes that the
Feder-al Radiation Council raised any previous
standard. It has not done any such thing. It has created a new set of recommendations for a different class and type of problem.
We have not changed the rules of the
game. We do not accept an underlying
con-cept or philosophy that implies the
exis-tence of a threshold.
DR. CHADWICK: The second question is
what are the ill effects the Council has in
mind?
DR. CIIAnLES: Yes, especially as applied
to what happened in Utah. You said that
the Utah action had potential adverse
effects.
DR. TofPKINs: I beg your pardon Dr. Charles I did not say any such thing. I cited the general situation in this country which
included not only Utah, which is a rather
special case involving a small yield weapon
and relatively iligh doses, but it also
in-cluded the situation in tile upper Midwest
and around St. Louis, where the question at
issue-shall counter measures affecting the
entire dairy industry and hence the
nutri-tion of a large section of the United States
population-be undertaken at this time?
Our answer was no, for the reason that
from studies of previous Russian test series
termination appeared close. The notion of
instituting counter measures at this point of
time simply adds up to closing the barn
door after the horse is gone. If one is to
take counter measures they should have
been taken a year earlier. That is exactly
what is wrong with the concept of a limit.
We do not accept the limit concept as
ap-plicable to the basic question of risk reduc-tion after the materials are in tile environ-ment. That is a different type of problem.
The third (Iuestion was, what is the
ad-vantage the protective action guide has
ex-cept for the fact that it is higher? The
con-ceptual advantage of the protective action
guide is that it is oriented to the kinds of
situation mentioned, relative to nuclear
warfare, which we think is tile most likely
source requiring this kind of action from
public health authorities and the Federal
Government. We have listed the kinds of
action we have in mind. We accepted some
and rejected others. We take a dim view of
adding staples to the normal diet as one of
our prerogatives. That is something that
silould be done on an individual basis by
the physician instead of the government.
The problems envisioned have not yet been
encountered seriously. The guidance
pro-vided is sufficient for this problem. Now,
coming back to the point you keep raising,
I think Dr. Thompson mentioned that in
the 1963 Hearings, even under
recoin-mendations of the FRC Report No. 5, the
state of Utah would have taken the same
action.
DR. THrnsIPsoN: Yes, that is rigilt.
DR. TosLPKINS: I don’t think this is the
point at issue. I think under FRC Report
No. 5 all of the basis exists to justify such a position publicly. This was not true in 1962. The question is, is tile basis proper?
Dn. MAY5: There are a number of
addi-tional tilings which need to be said about radiation protection guidance.
In 1960 the Federal Radiation Council
defined the radiation protection guide as,
“The radiation dose which should not be
exceeded without careful consideration of
the reasons for doing so’ (Federal
Radia-tion Council Report No. 1, page 3). To this definition they added the statement, “Every
effort should be made to encourage the
maintenance of radiation doses as far below this guide as practicable.”
In 1961, the Federal Radiation Council
set the radiation protection guide for 1131
aver-TABLE I
TILYIIOID I)osn LEVELS (IIAI.s IN’ 1YEAR) SUPPLEMENT
age of 0.5 rads per year for an exposed
group in the general population and 1.5
rads per year for individuals
(
FederalRadiation Council Report No. 2, page 9).
Children were designated as the critical
population. Federal Radiation Council
Re-port No. 2 also stated
(
page 8)
, “Currently,the major concern is environmental
con-tamination resulting from fallout from the
explosion of nuclear devices and the release
of radioiodine during the use and
pro-cessing of fuel for reactors.” Thus, it ap-peared that the radiation protection guides applied to fallout.
In 1962, Nevada tests carried fallout into
Utah, causing I’s’ exposures to exceed the
existing radiation protection guides. United
States Public Health Service monitoring of
the Salt Lake Milk Pool indicated an
aver-age dose to infants thyroids of 0.63 rads,
whereas measurements of milk from our 39
farnl stations scattered throughout Utah
in-dicated an average infant thyroid dose of
0.77 rads, in good agreement with the
United States Public Health Service value.
Tile highest individual dose among our
stations was between 9 and 26 rads. Even
higher doses probably occurred on some
farms wilich were not monitored.
Following the vigorous urging of Dr.
Robert C. Pendleton
(
Associate Professorof Molecular and Genetic Biology,
Univer-sity of Utah), the Utah State Department
of Health recommended protective action
to reduce the exposures from this incident.
The Federal Radiation Council condemned
this action (which was based on Federal
Radiation Council guidance) as
unneces-sary, stating, “The Federal Radiation
Coun-cil does not recommend such action under
present circumstances.” (Federal Radiation
Council statement, Radiological Health
Data, III, 11, page ii, November 1962.)
In 1963 the problem of radiation
stan-dards and counter measures for fallout was
aired at Congressional Hearings of the
Sub-committee on Research, Development and
Radiation, of the Joint Committee on
atom-ic energy. Dr. Tompkins, speaking for the
Federal Radiation Council, said, “. . . it is
For the l’or (lit
Source .
Population Indu’idua.
Radiation protect ion
guide (1961) 0.5 1.5
ttaIi infant exposures
(l96) 0.6-1)8 9-6
Protective action guide
(1964) l() 30
abundantly clear at the present time that
the Goverllment has no standards that it
would accredit to being specifically estab-lished for the purpose of evaluating fallout”
(page 354, Part I of the hearings).
In 1964, following considerable
congres-sional pressure to establish guidance for
fallout, the Federal Radiation Council
is-sued a protective action guide for 1131. It
was defined as, “The projected absorbed
dose . . . which warrants protective action . . .“
(
Federal Radiation Council Report No.5, page 3) . It differed not only in name
from the older radiation protection guide, but also in the fact that for 1131 it was 20
times higher, as shown in Table I.
It seems appropriate to ask why the new
guide was set 20 times higher than the old.
Was there new evidence in 1964 that 1131
was less damaging than believed in 1961
when the old guide was established? It is
interesting that, among tile children irradi-ated with high doses of fallout I’s’ ill the Marshailese Islands, the first thyroid tumors
were discovered 5 months before the new
protective action guide for 1131 was issued.
(See Congressional Hearing on Federal
Radiation Council Protective Action Guides, pages 688-690, June 1965.)
If it can be shown that thyroid doses of
10 to 30 rads to infants will cause no harm throughout their entire life span, I would
not object to ignoring doses below these
levels. But, until such evidence is available,
I prefer 30 days of powdered milk rather
We need a graded series of responses, in which protective action is mandatory at the
highest (most dangerous
)
levels. Actionmust be prompt to be effective. Prompt
ac-tion in cases of serious contamination
should not be subject to the administrative delays inherent in the requirement of prov-ing to officials
(
who may be very unfamiliar with radiation)
that the health benefits as-sociated with reduction in dose will offset the undesirable factors associated with the action. A radiation incident does not permit the luxury of a leisurely debate.DR. SAENGER: In response to what Dr.
Mays has said, the protective action guide
was established after the facts. Also, you
may ask where the figures of 10 and 30 rads
come from. Dr. Bustad, prior to the
Han-ford Iodine Conference, slipped me a real
curve by asking me to write a review of the
relative carcinogenic effect of x-ray versus radioiodine (Health Physics, 9:1271-1384, 1963
)
. The reasoning comes out somethingas follows: if you take the lowest dose, at
which we saw neoplasm in x-irradiated chil-dren, the dose was about 100 r, give or take
a bit. The doses of radioiodine which have
been found in children with
hyperthyroid-ism to give or yield carcinoma have been of
the order of roughly 2,000 r and more. These
would correspond roughly to dosage of 5
mc and greater of 1131. There are two
re-ported cases of thyroid cancer following
ra-dioiodine therapy of hyperthyroidism in
children (Starr,
et
al.: j. Nuc. Med., 5:81, 1964; and Sheline, et al.:J.
Clin. Endocri-nol., 19:127, 1959).If one then compares 100 r as the lowest
observed x-ray dose causing cancer to an
estimate of 2,000 r as the lowest mean dose
delivered by 1131 causing cancer in the
re-ported cases, x-radiation will be more effec-tive in inducing cancer than I’s’ by a factor
of 20 or more. It has been apparent to us
that there ilas been quite a difference from
this high dose rate x-radiation to the low
dose rate of radioiodine.
I think that one might regard the
inci-dence of neopiasm in the Marshaliese
chil-dren as perhaps coming from the whole
body irradiation, which in part was
re-ceived by the thyroid in addition to the
amount of radioiodine which was actually
retained in the glands.
(
Note in proof: todate all of these tumors in Marshallese chil-dren have been benign. Conard, et al. : New
Eng.
J.
Med., 274:1391, 1966.) For thesereasons, it would be difficult to show that
10 r and 30 r are unsafe and these values
are quite acceptable to me.
DR. CHADWICK: There is one serious
mis-conception that I hear which I wish to
cor-rect. The question was raised by Dr. Mays
as to what evidence was available that the
risk of deleterious effects from radiation to
the thyroid gland had changed between the
time of issuance of the radiation protection guide and the protective action guide. This reflects a basic difficulty, and I think we
must understand this problem. A basic
as-sumption is that there is no threshold to
radiation damage; therefore, the formula-tion of standards is based on a benefit risk balance. If at the level of the radiation
pro-tection guide there is a proper balance,
there would be two justifications for chang-ing the numerical value of the guide on this approach. One is if there was information that the risk had changed, this, therefore,
would call for a reciprocal change in the
benefit value to restore the balance. There is, however, another reason for change-a cilange in tile benefit side of the balance.
This, too, would disturb the balance even
though the risk remains the same. This is
precisely what led to the change from the
radiation protection guide to the protective action guide. It was a judgment on the part
of the Federal Radiation Council that the
values on the so-called benefit side were
different. Now benefit is a poor term to use because, in the case of radioactive fallout
of nuclides in milk, there are obviously no
benefits for the children. The benefit side of the balance changes to another form of risk
-the risk of the total impact associated
with the measures taken to reduce the
ex-posure. Wilat this change meant was that
tile impact associated with control
to be taken after the material was released was greater than the impact associated with
the controls at the source. One can
ap-propriately argue this point but one should
avoid the misconception that it was a
change in the risk estimate of radiation
effects. It was a change in the weight, if
you will, of the other side of the balance, that is, the impact that was associated with the different control measures.
DR. CHAmjs: If I understand you
cor-rectly you are saying exactly what Dr.
Mays and I have indicated. Namely, that
the risk of invoking counter measures was
so great that the threshold or whatever you call the protective action guide or radiation
protection guide, had to be raised to
pre-vent you from ever using the counter
mea-sures!
DR. CHADWICK: When you say the risk of the counter measures this is not a complete
statement. It is the overall impact that is
associated with the measure. The difficulty is in monitoring all the milk supply, in in-forming the farmers of the measures to
pro-tect, etc.
(
in other words, the overalldifficulties associated with taking the
con-trol measure
)
as opposed to regulatingre-lease, from sources in which we already
have a mechanism set up to do this.
DR. CHARLES: We are saying the same
tiling. In order to eliminate the need to in-voke counter measures, the criteria raised levels twentyfold so that it was less likely in
the future there would be any need for any
state health authority to do what was done
in Utah. There is a failure of
communica-tion here because we are saying the same
things about what the Federal Radiation
Council did.
DR. TOMPKINS: Well obviously everyone has their opinions. As I said before, I com-pletely reject the accusation of raising the
levels. We did not. I cannot deal with a
bias. If you insist on retaining it,be my
guest. We have done no such thing.
How-ever, it migilt be worthwhile to go back to
some of the discussions we had in the
pro-tective action guide working group to clari-fy some of the things we are discussing.
Dr. Chadwick has pointed out that the
impact of radiation protection guide levels
were considered. In nuclear industry the
questions concerned the needs for better
containment around reactors, as better
filters in the affluent stack, needed
engi-neering developments to effect reduction in
risk by source control. The average citizen is affected only by what these controls fail to achieve. The responsibility for reducing effluents to low levels is placed specifically
on the people who are most capable of
dealing with a technology, which, if not
controlled, could be exceedingly hazardous. Now let’s look at the other side. To carry the example a little further, if one is willing
to pay the price-to charge the farmers and
the dairy industry, who have nothing to do
with the existence of the hazards, with
ex-posure limiting responsibilities-we need
neither radiation protection guides or pro-tective action guides. It is technically
possi-ble to reduce the exposure to iodine so
there will literally be none, by the process
of legislating law requiring that no dairy
cow ever be fed from a crop not harvested
4 or 5 months previously. Thus, all the
io-dine is allowed to decay. Now all that soci-ety has to do is make the farmer
responsi-ble for what this sector of our society is
doing. It is technically feasible. Politically, how on earth can you justify it? The people affected in the case of the protective action
guides are people who are in no way
ac-countable for the event when one says to a
farmer, “I am sorry your milk is no longer
suitable for the market.” What kind of
justification can a health officer give? What
is the evidence? That is the question.
Now for the kind of situation we had in
mind we can use Windscale as an example.
Let’s say there are 100,000 people and 2,000 to 3,000 infants under the protective action
guide of 10 rads for a time of 20 years. The
risk calculation is the number of people
times the dose, times the risk per rad, times
the rad per year: 2,000 X 10 X 1 X 10 X 20 years of risk equals in this population a
value of a little less than one. With less
that any manifest effect whatsoever will happen.
Dn. FORBES: A lot of what we have been
talking about is based upon fear. Fear is
sometimes founded and sometimes
un-founded. I wish to bring up another
ques-tion based upon the same general principle. I think pediatricians and nutritionists have
compounded the fear of not giving a child a
quart of milk every day. This became very
clear to me during a blizzard in Rochester
when we were snowed in for 2 days. A
good many of my neighbors were fearful
because their children could not drink their
usual quota of milk because it couldn’t be
delivered. As pediatricians and nutritionists
we have compounded this fear into such a
state that many parents become vitally
con-cerned when their children might even
tem-porarily be denied this valuable food. Now, the baby is in a different situation, but the ciiild obviously can go for days or weeks or
months without drinking very much milk. It seems to me this fact is available to anyone
who is concerned with the iodine problem.
The use of stored milk for babies is possi-ble. Present conditions of transportation make available stored milk which could be
used for infants. I think we should do
something to allay the fears of mothers that
temporary denial of a glass of milk to their child or their adolescent will be attended with (lireresults.
DR. SPENCER: In view of the fact that
many of the studies of the pathways of
ra-dioisotopes in man have been performed in
our laboratory, I wish to make some
re-marks on the state of health of these
pa-tients and on the validity of these data.
These patients have certain diagnoses which might imply that the patients are
very ill. However, great care is taken in
their proper selection. In order to be
in-eluded in the study, the patients must be in good physical condition, be fully ambulato-ry, have no impairment of renal or intesti-nal function, be able to eat a full caloric diet (2,300 to 2,600 calories per day) , and
be able to cooperate in the complete collec-tion of urine and stools under supervision
by nurses on the metabolic ward. Some
pa-tients had osteoarthritis or osteoporosis and some had cancer
(
e.g., patients who had re-moval of the larynx or of the breast several years prior to the study)
;but, in the majori-ty of tllese patients there was no clinical ev-idence of neoplasm at the time of the study.Other patients had active bone disease, for
instance, multiple myeloma or metastatic
carcinoma of the prostate. The data
ob-tamed have disclosed that tile changes in
calcium metabolism correlated well with
the changes in radiostrontium metabolism, and the radiostrontium metabolism differed greatly from those of patients with normal
bone structure. Despite the limitations of
clinical diagnosis of these patients, we
be-lieve that a great deal of information has
been obtained on the absorption, excretion, intestinal secretion, and retention of a
vari-ety of fission products in human beings.
\Vithout information of the pathways of the
radioisotopes, it is not possible to initiate any methods of their removal or of the
modification of the metabolism of
radioiso-topes in man. Also, it has been learned that
certain correlations exist between tile me-tabolism of a particular radioisotope and other elements. For instance, the excretion of radiostrontium depends greatly on the
calcium metabolism of the individual. It,
therefore, seems that these data give a good
indication of the metabolism of the various
fallout products in man and are a better
source of information than the animal data,
