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Radiation Sickness or Death Caused by 
Surreptitious Administration of Ionizing Radiation
to an Individual 

Report No. 4 of The Molecular Biology Working Group to 
The Biomedical Intelligence Subcommittee of 
The Scientific Intelligence Committee of 
USIB 27aug69*

PREFACE

The present study and analyses of radiation sickness or death caused by surreptitious administration of ionizing radiation to an individual is presented to BMIS in response to the request of the Office of the Assistant Chief of Staff for Intelligence, Department of the Army to S.I.C. dated 11 March 1969. The request was initiated because reports from the press and from the Field Operations Division, ACSI suggested that Alexander Dubcek, Czechoslovak Communist Party leader, may have radiation sickness due to radiation exposure or consumption of radioisotopes during his August 1968 captivity in Moscow. It has not, so far, proven possible to confirm or deny these reports. Therefore, a general study of the feasibility and possible nature of such an operation was requested and undertaken.

Attachments

Conclusions

1. Surreptitious administration of a lethal or sublethal dose of ionizing radiation to an individual is technically possible. However, it is also, in general, technically possible to detect the fact that this has been done by examining the patient at a later time in a modern well equipped general hospital.

2. Completely surreptitious administration of a lethal dose of ionizing radiation to man in such a way that the subsequent illness remains undiagnosable appears not to be possible except under two most unlikely situations. A huge dose (sufficient to produce rapid central nervous system death) of X or gamma radiation can cause the death of animals within a few minutes leaving little evidence of the cause of death. The required dose in man is not known. It would not appear reasonable to expect such high doses to be delivered in a clandestine operation. Secondly, a low level of radiation can cause the development of certain forms of cancer which in turn may be fatal and not attributable to radiation. In the individual case, however, it is not possible to predict with reasonable certainty whether such a cancer will appear or when it will appear. Radiation induced cancers usually develop years after the time of radiation. A clandestine operation based on so uncertain an outcome is not considered likely.

3. A great many situations can be devised, and some have occurred, by which a man might receive a lethal dose of ionizing radiation from either internal or external sources without being aware of the event at the time of exposure. There is presently no convincing evidence that the human being can normally detect ionizing radiation by hearing, sight, odor, touch, or other normal sense. It is, however, possible (with the exceptions noted in paragraph 2) to make the correct diagnosis of radiation damage after careful study of the patient. Of greatest importance in the diagnosis of radiation damage is the suspicion that it might have occurred (i.e., its inclusion in the differential diagnosis), the availability of adequate hospital and laboratory facilities and the availability of expert consultation. Given these conditions, a firm diagnosis of radiation injury can be made. There is, however, no known specific curative or preventative treatment of significant value for radiation injury itself and the person who has already received a clearly supralethal dose must be expected at the present time to die in spite of treatment. Treatment by bone marrow transplantation holds some promise in selected cases.

4. Similarly, many methods can be devised by which sublethal doses of ionizing radiation could produce localized destruction Of tissue, a limb or an organ. Although the exposure may be undetected, the subsequent illness should be accessible to correct diagnosis. With current methods of treatment the tissue damage produced by radiation cannot be reversed or prevented to any significant extent except by removing the source of the radiation. In contrast to the tissue damage itself, the patient may be expected to benefit a great deal from proper medical treatment.

5. In view of the existence of other tried and true methods of political assassination, the use of ionizing radiation for this purpose would seem unnecessarily cumbersome unless the enemy were to expect some compelling advantage peculiar to the administration of radiation. For example, the onset of symptoms and death due to radiation may be delayed for hours or days and weeks respectively after an acute dose is administered. A delay conceivably could be important, but is not unique to radiation damage and may occur after the administration of a lethal dose of certain drugs. Public reaction to the discovery of a political assassination by radiation would have to have been taken into account by the enemy.

6. The facilities needed to make the diagnosis of radiation damage include alpha, beta, and gamma counters for urine and feces, a gamma scanner such as is used for the diagnosis of thyroid disease with 131I, and a whole body counter. All of these facilities except the whole body counter can be found in a well equipped modern hospital doing radioisotope work in an advanced country. A whole body counter and the special medical expertise necessary for diagnosis are available to most countries. Special expertise for chromosomal analysis would be helpful. The superior facilities and expertise necessary for the diagnosis and treatment of radiation sickness do exist in Czechoslovakia at the present time.

Discussion

1. Historical Examples

There have been very few cases of radiation injury which have occurred in circumstances other than: 1) radioactive material processing industry; 2) nuclear reactors; 3) atomic bomb explosions.

Note:
These areas have been well reviewed recently in: Bond, V.P., Fliedner, T.M., Archambeau, J.O.: Mammalian Radiation Lethality, Academic Press, New York, 1965 (Chapter 6 - Experiences with Radiation Injury in Man); and 2) Sagan, L.A.: "Recent Studies Among Persons Exposed to Radiation from Military or Industrial Sources -- A Review" in First International Symposium on- the Biological Interpretation of Dose from Accelerator-Produced Radiation, United States Atomic Energy Commission, Washington, 1967.

However, there are occasional reports of individuals exposed to radiation that have the features of either: 1) unawareness on the part of the individual that he was receiving radiation; or 2) intentional application of radiation source.

a. Clandestine Radiation Leading to Injury

(1) Proposed Sterilization of Jews in Nazi Germany (Ref 1)

As part of the attempt to eliminate the Jewish population in Germany during World War II, radiation of the genital region was proposed. It was postulated that 300 to 600 r over a two minute period would be sufficient for men; 300 to 350 r was proposed for women. In a letter to Himmler, The following technique was proposed:

"One practical method, for example. would be to have the persons to be processed step up to a window where they would be asked certain questions or have to fill out certain forms, detaining them for two to three minutes. The official behind the window could operate the equipment, in such a way that the switch simultaneously turned on two X-ray tubes, since exposure must be from two sides. A two tube installation thus could sterilize 150-200 persons a day."

There is no indication that this procedure was ever used.

(2) Radioactive Thallium for a Soviet Defector? (Ref 2)

In 1954, a Soviet Secret Agent, Nikolai Khokhlov, gave himself up to U.S. authorities rather than carry out an assassination in West Germany. He subsequently joined the emigrant Russian revolutionary movement centered in West Germany. In 1957, while attending a Frankfurt conference, he became sick with nausea, vomiting and fainting. Having been hospitalized for acute gastritis, on the sixth day he developed widespread ecchymoses. At the same time, it was discovered that his hair was falling out. Thallium poisoning was suspected. on review of his activities on the day he became sick, he recalled a bad-tasting cup of coffee after his speech; he thought this coffee may have been poisoned. His condition worsened with the development of marrow failure leading to anemia and leucopoenia on the seventh day of hospitalization. He was transferred to the U.S. military hospital in Frankfurt for treatment. It was a month after onset before he was released. No definitive toxicology is known to have been done; the thallium diagnosis was made on clinical grounds. Some time later, American consultants reviewing the case suggested that radioactive thallium ingested in food could most easily explain the syndrome.

(3) Radioisotopes in the Soup for a Politician (Ref 3)

Alexander Dubcek, Czechoslovak Communist Party leader, was hospitalized in Bratislava in January 1969, because of a "cold" and had to cancel a speech. Rumors spread that the cause of this illness and of symptoms in the preceding month -widespread pain, nausea, diminished ability to concentrate, uncoordinated thinking, irrationality - was radiation sickness. On the basis of a general medical examination, it was rumored that a large dose of strontium was found and that he had only two years to live. It was postulated that Soviet leaders had caused this problem in August 1968, when Dubcek was detained in Moscow, probably through the placement of radioisotopes in his soup. No reliable evidence is available that this in fact did occur and Dubcek is still alive in September 1969.

b. Suicidal use of Radioisotopes.

(1) Radioisotope Technician and 99Tc + 131I (Ref 4)

At Walter Reed General Hospital, in March 1969, an enlisted man assigned to the Nuclear Medicine Section ingested small amounts of technetium-99* and iodine-131, probably On three separate occasions within a week. Thyroid scanning indicated 13 1 in the thyroid gland on 18 March 1969. Radioactive material, principally 99Tc, was found in the colon by scanning on 20 larch 1969; a stool specimen of 24 March 1969, contained both 99Tc and 131I. Quantities ingested were believed to be small, no greater than 20 uCi of 131I or 10 mCi of 99Tc. No symptoms developed attributable to the isotopes. It was believed that the man had a character disorder (there had been a knife wound suicide gesture in February). It was thought he had ingested radioisotopes in order to gain attention.

*Used for brain scanning by means of intravenous injection.

(2) Radiologist and 131I + 60CO (Ref 5)

An approximately 40 year old radiologist, in charge of radiotherapy at a Midwest hospital in 1960, reported overexposure to radiation. He believed cobalt-60 had been placed in the seat of his chair; inspection found 2-3 needles containing 10 to 11 mCi of 60CO in the chair. He believed that someone had put radioactive iodine into his coffee several days earlier; thyroid scanning revealed an uptake of 1.5 mCi of 131I proving that there had been recent administration. No serious clinical symptoms developed. It was decided that these events were selfinduced. He later received psychiatric care.**

(3) Soviet Technician and 137Cs (Ref 6)

In 1960, a 19 year old research worker in a radiological laboratory in Moscow decided to commit suicide because of unfavorable relationships with his family. He took a hermetically sealed aluminum capsule filled with radioactive cesium-137, with an activity of 10 r, from the plant gamadefectoscopy laboratory. He put the capsule in his left trouser pocket for five hours, then shifted it under his jacket around the abdomen and back for 15 hours. The mean doses received in the trunk (approximately 3000 rad) and in the entire body (approximately 2000 rad) were very large. Nausea and weakness were noted within four hours. Abdominal pain and diarrhea started at seven hours. Necrotic burns developed around the trunk. Bloody diarrhea became intense by the 13th day, and peritonitis followed. An aplastic anemia developed. He died after I5 days.

**Five instances of misadministration of radiopharmaceuticals (131I and 32p) to patients have been reported. In three cases I the wrong dosage was given. In two cases, patients were switched. Serious injuries did not result. Roeder, J.R.: "A Statistical Summary of U.S. AEC Licensees' Internal Exposure Experience 1957-1966" in Kornberg, H.A. and Norvard, W.D. (editors): Diagnosis and Treatment of Deposited Radionuclides. Excerpta Medica ' Foundation, Amsterdam, 1968. 1 more recent case involves a 73 year old woman who received 200 mCi of radioactive gold-198 for a liver scan, instead of the planned 200 uCi. She died 69 days later of brain hemorrhage related to her hematopoietic depression. Baron, J.M., Yachnin, S Polcyn, R., Fitch, F.W. and Sturner, W.Q.: Accidental Radiogold (198Au) Liver Scan Overdose with Fatal Outcome, (to be published)

c. Unconsciously Sustained Accidental Radiation Injury

(1) Radium Dial Painters (Ref 7, 8)

Luminous paint contains minute quantities of radium or thorium, and workers engaged in painting dials by hand were accustomed to bringing their brushes to a fine point by drawing the bristles through their moistened lips. Each day they ingested a small quantity of luminous paint. Most of the radioactive material was promptly excreted, but a fraction was deposited in the bone. There were 50 dial painting studios in the United States in the 1920's, and approximately 2,000 persons were exposed to this danger before it was discovered in 1926. Many of the victims developed radiation necrosis of the mandible; others died of intractable progressive anemia and leucopoenia; others lived long enough to develop osteogenic sarcoma.

Note:
In the 19201s, radium injections were also used medically to treat gout, arthritis, arteriosclerosis. leukemia and Hodgkin's Disease. Oral administration was also employed, and there was an over-the-counter item called "Radithor" (each vial containing 1 uCi of radium and 1 uCi of thorium), which carried the recommendation that one vial be taken after each meal. One 52 year old man drank 1,400 bottles of "Radithor" over a period of five years; he became anemic and emaciated and died with necrosis of the jaw and brain abscess. Body load of radium at autopsy was calculated to be 73.66 micrograms.

REF: Gettler, A.0. and Norris, C.: Poisoning from Drinking Radium Water. Journal of the American Medical Association 100: 400-402, 1933.

(2) Mexican Family Exposed to 60Co (Ref 9, 10)

Shortly after a young Mexican couple and their two children , a 10 year old boy and a two year old girl, moved into a house in March 1962, the boy discovered a five-curie source of cobalt-60 in a field, although no one recognized it as such at the time. This 1/2 inch item presumably had been in a shielded container; how it was removed from the container is not known. The boy carried the cobalt-source in his packet for several days. Then it was placed in a cabinet that held kitchen utensils, where it remained until recovered by the owner 112 days .later. over a period of seven months, tour people died - son (29 April); wife (19 July); daughter (18 August); and grandmother (15 October). All had hematopoietic depression syndrome, but the diagnosis was not made until the third victim was dying. The father had mild anemia and darkening of the fingernails, but no serious difficulty, presumably because he was away at work most of the time. Estimated radiation doses were: 4700 r; 3500 r; 3000 r; and 2870 r, for the victims and 1200 r for the surviving father. These dose estimates are uncertain because neither the number of hours of exposure nor the distance from the cobalt source is known with certainty.

(3) Argentine Welder and 137Cs (Ref 11)

A 37 year old Bolivian welder, working in La Plata, Argentina, on the construction of a chemical plant, found a small metallic object on the floor and placed it in the right front pocket of his work jeans. It was a 13 Ci source of cesium-137, being used by industrial radiographers to inspect welds. The man carried the cesium-source in his right front pants pocket for seven hours, and in his left front pacts pocket for 10 hours on the second day. He was forced to quit work on the second day because of pain in both mid-thighs anteriorly. He proceeded to develop necrotic lesions of both mid-thighs, desquamation of the penis and scrotum, and ulceration of both hands. Dosimetric measurements revealed that he had received 2710 rads at the affected surface over two days. Long term follow-up is not known.

2. Sources of Ionizing Radiation

Since there exist thousands of individual types of ionizing radiation sources that might be considered for the surreptitious administration of a dose to man, it is necessary to evaluate their potentialities in small numbers of groups or categories that will hopefully be all-inclusive. It is customary in the medical literature to divide sources of radiation into two major groups, external and internal.

External sources are outside of the body and produce their effect by the radiation which travels from the source to the target. Internal sources are within the body itself and are usually incorporated into the metabolic systems of the target. External sources may be further categorized by the types of ionizing radiation that they produce, i.e., X- or gamma-radiation, beta-radiation, alpha-radiation, neutrons, fission products, molecular or ion beams, exotic particles (mesons, etc.). Electric, magnetic, and other forms of electromagnetic fields are not under consideration here. All types of radiation except X- or gamma-rays may be excluded from further consideration either because they do not penetrate the skin at reasonably low energies, or because they require large complex, generally immobile machines for their production. Only under very specialized circumstances in which the target is near the machine would these sources be considered. External X- and gamma-ray sources may be further subdivided into isotopic sources (that may be either sealed or unsealed) and machine sources. External radioactive isotopic sources of X- or gamma-radiation could be reliably designed and manufactured from a large variety of substances, could be small in weight and volume (of the source itself) and could produce a radiation field as intense as required. Two major problems would be encountered with such sources. Since the radiation field from isotopic sources cannot be turned on and off at will, sources of the required intensity would constitute a hazard to other individuals as well as the target unless enclosed in a massive and heavy shield. Secondly, the radiation field would be subject to detection by a variety of standard and easily obtainable devices. These problems render the use of this type of radiation source cumbersome and rather easily detectable for the purpose under consideration. Radiation producing machines are worthy of consideration primarily because of their probable occurrence'. in the normal life of the target; for example, in the form of diagnostic medical X-ray machines. Some of these machines particularly fluoroscopic machines, could be deliberately modified to give a damaging dose. Medical therapeutic X-ray machines deliver much higher doses but are less likely to enter the normal life of a person. Installing one of these machines in an unusual place for surreptitious radiation would be expensive, cumbersome, would involve the efforts of many people, and the radiation field would generate immediate alarm if detected. For example, by a small device called a "chirper" worn in the pocket.

Internal sources are radioisotopic in nature. They may emit alpha, beta or gamma-rays individually or in combination and may. exist in countless molecular forms. They could be administered by mouth, by inhalation, by injection or by any other method used to administer drugs. They would enter the metabolic systems of the target and be distributed in the manner characteristic of the chemical form of the radioisotope. Doses could be administered that would be either lethal, sublethal, or sufficient to destroy selectively certain organs. It would unquestionably be possible to administer such a radioisotope surreptitiously and with a reasonably small likelihood of immediate detection.

To determine the feasibility of such a method of political assassination, examination of the likelihood of detection is necessary. Unless radiation exposure is suspected, its detection by routine clinical procedures is doubtful. If radiation damage is suspected, detection and identification of the isotope is possible either during the illness or after the death of the target. This conclusion is based upon the following general line of reasoning. All known radioisotopes can be detected and counted by equipment available in a good, modern, well-equipped general hospital with a radioisotope laboratory. The amount of radioisotope needed for detection and counting is many orders of magnitude less than that required for a lethal dose. Under certain circumstances identification of the isotopes involved may be difficult. The only conceivable way of administering a lethal dose so that the amount of radioisotope remaining is undetectable by the time symptoms of radiation sickness appear is to use an isotope of very short physical half-life. The use of such short half-life materials would place severe limitations on the permissible time interval between the production of the isotope in the reactor, its extraction, preparation and its administration to the target. Furthermore, the administrator would have to handle very hot samples before the time of administration. Therefore the reasonable conclusion to be drawn is that although the administration of lethal internal dose of radioisotope surreptitiously is possible, the likelihood of detection of the internal source at a later time must be considered. Gamma emitting radioisotope are excluded from consideration because they would be detectable at once from the outside of the body and might constitute a hazard to other people. Discussion of the internal sealed source will be deferred to the section on novel methods.

3. Clinical Effects of Ionizing Radiation Exposure in Man

The clinical symptoms induced in man by ionizing radiation vary with the part of the body receiving the dose. Discussion will therefore be divided into three parts: a) whole body radiation; b) partial body radiation; c) effects of internally deposited radioisotopes.

a. Whole Body Radiation

Present knowledge of the clinical symptomatology as a precise function of whole body ionizing radiation exposure in humans is limited, despite a rather large amount of available data from several nuclear accidents: the Hiroshima -Nagasaki detonations; the Marshallese Islander's experience; and extensive use of radiation therapy and radioisotopes in clinical practice, as well as from controlled experiments using subhuman primates. A number of factors are known to effect the clinical responses of humans and subhuman primates to radiation exposure: total dose; kind of exposure (partial or whole body); dose-rate; the kind (or quality) of radiation; general health of the subjects before and after exposure (diet, physical activity, etc.). In human experiences, such factors have not been well controlled. Consequently, the degree of influence on observed clinical symptomatology cannot be accurately assessed. The present best estimates of clinical symptomatology have come from controlled experiments in subhuman primates and lower mammals. These estimates are probably unreliable in extrapolation to humans, since humans appear to be more radio-sensitive than smaller mammals. Some corrections have been made on the basis of data principally from the Hiroshima Nagasaki blasts, the Marshall Islands fallout accident, and radiation therapy.

The human LD50/60 for acute whole body ionizing radiation exposure is well estimated to be 250-300 rads. The dose at which the probability of lethality approaches 100% is in the range 800-1000 rads. The predicted clinical effects of single acute ionizing radiation in humans are summarized in Table I. The signs observed during the prodromal post-irradiation period are those attributable to gastrointestinal effects. Because gastrointestinal symptomology is manifestly visible, it is the most reliably recorded in clinical notes. Estimates of absorbed dose required to produce clinical gastro intestinal responses in 50% of exposed humans are given in Table II. Although gastrointestinal symptoms are usually the first to appear and may be incapacitating they are not sufficiently characteristic of radiation sickness to be diagnostic of this syndrome. The diagnosis, in the absence of a history of radiation exposure, can be most easily and definitely made on the basis of hematological studies including both peripheral blood and bone marrow and possibly by chromosomal studies. After exposure no blood changes are apparent for a few days. Then the blood count drops at a rate which is characteristic for each type of blood cell. The depth of depression of the blood count is proportional to the amount of radiation damage to the bone marrow. During the period of maximum depression, a transient increase in blood count may occur. Marrow cells which have been damaged by radiation may attempt to divide and produce abnormal cells in the marrow. These changes all taken together are diagnostic of radiation sickness.

 

Table I - Acute Clinical Effects Of Single High Dose Rate Exposures Of Whole-Body Irradiation To Healthy Adults

					0-100 RADS	100-200		   200-600		 600-1000 Rads 
					Subclinical	Subclinical	   Subclinical		 Subclinical
					Range 		Range 		   Range 		 Range 
Initial Phase	Incidence of
		Nausea &		None		5-50%		   50-100%		 75-100% 
		Vomiting

		Time of onset		---		Approx 3-6 hrs	   Approx 2-4 hrs	 Approx 1-2 hrs
		Duration		---		Less than 24 hrs   Less than 24 hrs	 Less than 48 hrs

									   Can perform		 Can perform only
									   routine tasks.	 simple routine
		Combat							   Sustained combat 	 tasks. Significant
		Effectiveness		100%		100%		   or comparable	 incapacitation in
									   activities		 upper part of
									   hampered for 6-20 	 range. Lasts more
									   hrs			 than 24 hrs

												 None to approx 7
Latent Phase	Duration		---		More than 2 wks	   Approx 7-15 days 	 days

									   Severe		 Severe
		Signs and						   Leukopenia;		 Leukopenia;
		symptoms		None		Moderate	   Purpura,		 Purpura,
							Leukopenia	   hemorrhage;		 hemorrhage;
									   Infection; Epilation  Infection; Epilation
									   about 300 RADS 	 about 300 RADS

Second Phase 	Time of Onset		---		2 wks or more 	   Several days to 2 	 Several days to 2
		Post Exposure						   wks			 wks

		Critical Period
		Post Exposure		---		None		   4-6 wks		 4-6 wks

		Organ System				Hematopoietic	   Hematopoietic	 Hematopoietic
		Responsible		None		Tissue		   Tissue		 Tissue

Hospitalization	Percentage		None		Less than 5%	   90%			 100%

		Duration		---		45-60 days	   60-90 days		 90-120 days

Incidence of 				None		None		   0-80%		 90-100%
Death

Average Time 
of Death				---		---		   3 wks to 2 months	 3 wks to 2 months

Therapy					None		Reassurance	   Blood		 Blood Transfusion, 
	 						Hematologic	   Transfusion,		 Antibiotics
							Surveillance	   Antibiotics

Table I continued . . .

				  1000-3000 RADS	Over 3000 RADS 
				  (Lethal Range)	(Lethal Range)
Initial Phase	Incidence of
		Nausea &	  100%			100% 
		Vomiting

		Time of Onset	  Less than 1 hr	Less than 1 hr

		Duration	  Less than 		Approx 48 hrs
				  48 hrs

				  Progressive		Progressive
				  incapacitation	incapacitation
				  following an		following an 
				  early 		early 
		Combat		  capability for	capability for
		Effectiveness	  intermittent		intermittent heroic
				  heroic response 	heroic response.

Secondary 	Duration	  None to approx  	None
Phase				  2 days

		Signs &		  Diarrhea; Fever; 	Convulsions;
		Symptoms	  Disturbance of	Tremor; Ataxia;
				  Electrolyte 		Lethargy
				  Balance
		Time of Onset	
		Post Exposure	  2-3 days  		---

		Critical period	  5-14 days		1-48 hrs  
		Post Exposure

		Organ System	  Tract			Central Nervous
		Responsible 	  Gastrointestinal 	System

Hospitalization Percentage	  100%			100%

		Duration	  2 weeks		2 days

		Incidence of
		Death		  90-100%

		Therapy		  Maintenance of
				  Electrolyte 		Sedatives
				  Balance

Table II - Estimates For Exposure (R) And Absorbed (RAD) Doses Required To Cause 50 Percent Of Patients To Show Various Clinical Responses

Clinical 	Normal Arithmetic 	Log-Normal 
Response 	Distribution            Distribution
		(rads)	  (R)		(rads)		(R)
Anorexia 	12119	  18329 	 9712		14718
					   -11		   -16
Nausea 		13920	  21030	13920 		21030
					   -17		   -26
Fatigue		18125	  27438	14735		22353
			   		   -28		   -43
Vomiting 	21422	  32533	18339		27758
					   -32 		   -48
Diarrhea 	23932	  36148	230235		348357
					   -116		   -176
Death		25128	  38143	23575		356114
					   -57		   -87
 

b. Partial Body Radiation

Radiation directed to a portion of the body may cause local tissue destruction. The symptoms that follow depend of course upon the nature of the tissue destroyed. Different tissues vary a great deal in their sensitivity to radiation. In general, more primitive, rapidly dividing cells are more susceptible to radiation damage than are highly differentiated cells that divide rarely or not at all. Some examples of localized radiation damage and the dose required to produce the damage will now be given. Erythema. of the skin may occur within four weeks after a single radiation dose of 400 to 750 rads. A more rapid appearance of erythema followed by blisters, moist desquamation, and ulceration follows doses between 1600 and 2000 rads. Erythema with high doses may appear within a few hours, then disappear only to reappear at a later time. Such high doses to a limb may destroy the vascular endothelium, an event which may be followed by fibrous obliteration of the vascular lumen and destruction of the blood supply to the area with consequent gangrene. The bone marrow and the tissues of the gastrointestinal tract that figure prominently in the whole body acute radiation syndrome are among the most sensitive to radiation. The brain and nervous system are among the most resistant tissues to radiation damage but sufficiently high doses produce mental confusion and even a "cerebral death" before the symptoms from other tissues have time to develop. Cataracts in the lens of the eyes, various forms of cancer, and sterility can be produced by radiation. The first two may develop years after the dose is administered.

c. Effects of Internally Deposited Radioisotopes

In instances where the exposure results tram internal deposition of a radioisotope, the result is partial body irradiation, and the frank clinical manifestations are likely to be mild. In fact, medical evidence of such exposure may be apparent only from careful hematological and histological examinations. Nevertheless, the long-range effect of such exposure, depending on the isotope and total dosage, can be incapacitation and/or death, usually from secondary results such as aplastic anemia, leukemia, etc. In terms of internal radiation the . distinguishing features are its localization and long continuing nature. In determining biological effects a knowledge of the nature of the radiation (alpha, beta or gamma), the metabolic routes and the biological half-life are paramount. Difficulties arise due to uneven distribution of radioactivity in the body and the unique physical processes involved in radioactive decay at each isotope. One group of biologically hazardous radioisotopes are the "bone seekers." These may have a long radiological and biological half-life and produce high energy beta particles. They cause greater damage to bone and to radio-sensitive bone marrow than to other tissues. The damage results in a reduction of blood cells and thus effects the entire body. As an example, the deposition of 1 to 2 micrograms of radium results in terminal anemia, bone necrosis and osteogenic sarcoma appearing after a number of years. The total damage done will depend on four factors: 1) the LET* of the radiation; 2) the physical half-life of the radionuclide; 3) the quantity of radionuclide absorbed; and 4) the biological halt-life of the radionuclide.

Note:
*LET - linear energy transfer or the amount of energy transferred from the particle of radiation to the tissue per unit length of path of the particle as it passes through the tissue.

d. Predictability-Reliability of Dose/Response Response Relationship

Determination of the feasibility of the use of surreptitious administration of radiation for political assassination depends very much on whether the effect of a given dose can be reliably predicted in an individual. As noted above, the LD50 for man for an acute dose of whole body radiation is well estimated at 250-300 rads. This means, however, that a man receiving this dose would have a 50% chance of living. The LD100 is in the range of 800 to 1000 rads. Doses of acute whole body radiation in excess of this figure would almost certainly be fatal. However, such large doses of ionizing radiation may not be fatal it administered to only part of the body. This implies that it might be difficult to administer surreptitiously whole body radiation from an external source in such a way that a predetermined effect other than death would occur with reasonably certainty. For death, a large excess of radiation would probably be administered with the consequent acceleration and intensification of symptoms.

The uncertainties in predicting the effects of internally administered radioisotopes are generally even greater. Clinical experience sufficiently great to determine dose response curves with reasonable accuracy has been limited to a few isotopes. Therefore, in the case of internal emitters, the demand for a certain predetermined effect would require the administration of excess doses with consequent severe tissue destruction and easy delectability.

The above discussion is not intended to create the impression that the response in man to a given dose of radiation is any more erratic in principle than the response; for example, to a drug. The lack of precise predictability of response to a radiation dose results from the paucity of data on man and the fact that most of the existing data is derived from radiation accidents in which the actual dose received by the patient and its distribution over his body is difficult to determine with accuracy. In fact, the clinical treatment of radiation accident victims is guided by the sequence and severity of developing clinical symptoms rather than by physical estimate of the dose received. This implies that the sequence of clinical events is systematic and predictable to a practical degree.

4. Hypothetical Specific Examples of Surreptitious Radiation and Their Detection

We've been unable to conceive of a practical method for the surreptitious administration of a lethal dose of radiation for the purpose of political assassination such that the subsequent illness or cause of death could not be diagnosed with accuracy in medical facilities that currently exist in most highly developed countries. The administration of huge doses sufficient to cause "cerebral death" is considered impractical because of the size and complexity of the apparatus required or the weight of the shielding. The administration of carcinogenic doses of intensity low enough to avoid the acute radiation syndrome are considered impractical because of the long time generally required for cancer production and the unpredictability of the results in an individual case.

However, it the possibility of subsequent detection and diagnosis is admitted, several techniques for the surreptitious administration of a lethal dose of radiation are feasible. The most obvious of these is the administration in the food or drink of the target of a lethal dose of any one of a large number of alpha or beta emitting radioisotopes. Such isotopes can be small in volume and weight, handled safely with a minimum of shielding, and provide minimum risk of detection before or during administration. A practical and effective supraclinical dose of radiophosphorus would be 1000 Ci (about 1.0 gram of dibasic sodium phosphate) , which could be administered surreptitiously in an appropriate liquid or food item. It would present a problem to disguise the taste. Clinical tests it accomplished within a reasonable time after administration, would reveal the assault. Later, detection would be unlikely until the victim became morbid as a result of induced blood anomaly. Radiophosphorus, because of its high-energy beta (1.72 mev) can be detected during external monitoring by high-efficiency detectors such as whole body radiation counters.

With minor variations, the above reasoning could be applied to radioactive strontium. Strontium is deposited largely in newly forming bone. It has a long halt life so the dose could be reduced to produce a later effect. It would, however, be detected it looked for.

It is apparently possible to shoot a needle into an animal and presumably into a person, without his being aware of the fact. Such a needle could be loaded, for example, with radioactive cobalt (60CO) a gamma emitter. The needle would probably be detected by diagnostic X-ray and certainly by an ordinary hospital scanner used for isotope diagnosis, when symptoms appeared.

And then there is the indigestible capsule containing a gamma emitting radioisotope placed in the medicine jar in the hope that fatal radiation dose will be administered and the capsule excreted before symptoms appear. The operational difficulties and uncertainties associated with this approach would seen to be great. A sealed gamma source under the bed or in the automobile could administer a fatal dose but the resulting acute radiation syndrome could be correctly diagnosed.

These several examples serve to show that while a political assassination with radiation could be committed, it also could be detected at a later time. Of course, at that later time it might be difficult or impossible to demonstrate who administered the dose. Consequently, the assassination could be attributed to the wrong party.

5. Prophylaxis and Therapy

Clinical management of human radiation injury is symptomatic and supportive, e.g., the administration of antibiotics to combat secondary infection; fluids and perhaps most effective, blood transfusion and marrow transplantation to counter hematopoietic damage and shock. No specific chemotherapy of primary radiation injury is known. A number of chemical compounds have shown some efficacy for prophylaxis of radiation injury. Generally, to be effective, these chemical drugs must be administered prior to the radiation exposure.

The most promising chemical radioprotectors are of a class known as aminothiols. They are believed to effect their radioprotective action by scavenging the damaging free radicals produced by ionizing radiation in biological material. These compounds may also complex with biologically important cellular species before irradiation and, by acting as direct energy traps, prevent damage at critical molecular sites. None of these compounds are presently available in significant quantities at pharmacological purity. A few have been produced under contract, in test quantities only. Some examples of these compounds are: 1) beta -mercaptoethylamine; 2) aminopropylamino-ethane thiophosphoric acid, and 3) 2-(l-decylaminoethanethiosulfuric acid.

REFERENCES

  1. Mitscherlich, A. and Mielke, F.: Doctors of Infamy - The Story of the Nazi Medical Crimes. Henry Schuman, New York, 1949 (pp 136-141)
  2. Khokhlov, N.: In the Name of Conscience. Fredrick Muller, London, 1959 (in Postscript - - "the Poison Rays")
  3. Czech Sources Say Dubcek has Cancer - Blame Soviets. Baltimore Sun, 9 January 1969
  4. Report of Overexposure to Atomic Energy Commission, Walter Reed Army Medical Center, Washington, 1 May 1969
  5. Nonpublic record at Division of Compliance, U. S. Atomic Energy Commission, Washington, D.C. (Information from J. R. Roeder).
  6. Aleksyeva, 0. G.,Bibikova, A. F., Vyalove, N. A., Ivanov, A.-Ye.Krayevskiy, N. A., Kurshakov, N. A., Paramonova, N. V., Petushkov, V. N., Snegireva, V. V., Studenikins, L. A., Shtukkenberg, Yu. M. and Shulyatikova, A. Va.: Sluchay Ostroy Lucnevoy Bolezni U Cheloveka. (A Case of Acute Radiation Sickness in Man) Gosudarstvennoye Izdatel'stvo Meditsinskoy Literature, Moscow, 1962. Translated by Foreign Technology Division, Air Force System Command, Wright-Patterson Air Force Base. FTD-TT-63-558 (151 pp)
  7. Martland, H. S., Conlon, P., Knef, J. P.: Some 'Unrecognized Dangers in the Use and Handling of Radioactive Substances. J.A.M.A. 85: 1769-1776, 1925
  8. Evans, R.D.: The Effect of Skeletally Deposited Alpha-Ray Emitters in Man. Brit. J. Rad. 39: 881-895, 1966
  9. Andrews, G. A.: Mexican co60 Radiation Accident. Isotopes and Radiation Technology 1(2): 200-201,1 1963
  10. Martinez, G. R., Cassab, H. G., Ganem, G. G., Guttman, K. Z., Lieberman, K. X., Vater, B. L., Linares, M. V., and Rodriguez, M. H.: Observaciones Sobre La Exposicion Accidental de una Familia a una Fuente de Cobalto60. Revista Medica Instituto Mexicano del Seguro Social 3 (Supp 1):14-69, 1964
  11. Lushbaugh, C. C.! Foreign Travel Report -- 21 November 1968. Oak Ridge Associated Universities, Oak Ridge, Tenn.
  12. Dept. of the Army. Effects on Personnel, Chap. XI in "The Effects of Nuclear Weapons," DA Pamphlet 39-3, 1964
  13. Brown, D. G., R. G. Cragle and T. R. Noonan, eds. "Dose Rate in Mammalian Radiation Biology," Conference 680410. Symposium sponsored by NT-AEC Agricultural Research Laboratory and NSAEC. Oak Ridge, Tennessee, 1968
  14. Life Sciences Research Office, Office of Biomedical Studies, FASEB. "A Study of Early Radiation -Induced Biological Changes as Indicators of Radiation Injury.,, USAMRDC, OTSG, DA. Washington, 1969
  15. Nuclear Handbook for Medical Service Personnel, Draft TV, OTSG, DA.11 March 1969

ACSI-IFS 11 March 1969

MEMORANDUM FOR: CHAIRMAN, SCIENTIFIC INTELLIGENCE COMMITTEE

SUBJECT: Radiation Sickness Caused by Surreptitious Individual Radiation

1. (C) Alexander Dubcek, Czechoslovak Communist party leader, has radiation sickness due to radiation exposure or consumption of radioisotopes during his August capacity in Moscow, according to newspaper account (Enclosure 1) that corresponds with reports from Field Operations Division, ACSI.

2. (C) Inquiry by ACSI regarding accuracy of this report and feasibility of such a clandestine injurious procedure was difficult to answer because of lack of information. Search at ACSI library and DIA library disclosed no pertinent material. Visits to radiologist and to radioisotope therapist provided useful background (Enclosure 2).

3. (C) Request Biomedical Intelligence Subcommittee (BMIS) consider subject, "Radiation Sickness or Death Caused by Surreptitious Radiation (X-ray, Beta-radiation, Radioisotope Ingestion) of Individual." Appropriate BMIS paper should be prepared, discussing historical examples of individual over dosage, possible radiation sources - machines and isotopes, probable techniques of clandestine administration, clinical symptomatology of acute and chronic illness, predictability of effects, methods of detection of use of this procedure, estimate of likelihood of Soviet use of this procedure. It is believed that considerable experience exists in the medical radiology and nuclear physics fields regarding effects of individual overdosage, and that theoretical expertise on surreptitious application will be forthcoming from same group.

Sgt. W. E. W. T. Howe
W. E. W. HOWE HOWE
Army Member
Scientific Intelligence

2 Incl.

Army Member Scientific Intelligence
Downgraded at 3 year intervals Committee
Declassified after 12 years
DOD DIR 5200.10

source: CIA-051595-A 1 document; 0.05 cu. ft. Source: Central Intelligence Agency Contents Description: Report of the United States Intelligence Board from 27 August 1969 on "Radiation Sickness or Death Caused by Surreptitious Administration of Ionizing Radiation to an Individual." Descriptors: Radiation--Ionizing; Radiation Injury; Central Intelligence Agency (CIA)

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