The Plutonium Files (56 page)

Saenger never exposed any patient in the Cincinnati study to the higher doses he had proposed in his initial report to the Pentagon. According to Defense Department records, the largest dose of total-body irradiation administered to any one subject appears to have been 200 rads, with a few patients receiving 300 rads of partial-body irradiation.

In a 1962 memo entitled “An Appraisal of Human Studies in Radio-biological Aspects of Weapons Effects,” Saenger brought up the possibility of using “healthy volunteers” in his experiment. “Once patients from the therapy group are being managed so that their hematologic consequences of radiation have been controlled then it will be advisable to utilize a less ill, more normal group of individuals for study.”
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However, there is no evidence that he went ahead with any plan to irradiate healthy people.

Ultimately, the Defense Atomic Support Agency contributed a total of $671,000 toward the Cincinnati study. Saenger has emphasized repeatedly
that the funds were used to pay only for the observational data and extensive laboratory tests. The military was not involved in the choice of patients, doses, treatment, or care. Cincinnati General Hospital spent some $483,000 of its own funds on patient care.
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As in other TBI studies, researchers specifically sought patients with radioresistant tumors who had a stable blood picture and normal kidney function.
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That profile, of course, closely resembles that of a healthy soldier or nuclear worker and would enable scientists to hunt more easily for a biological dosimeter and conduct their psychological tests. But TBI is generally not used for such tumors. Indeed, a year before the study began no less an authority on the subject than Shields Warren himself had written in
Scientific American:
“Radioresistant tumors are generally not treated with radiation because the damage to surrounding tissue is too great.”

Efforts were made to exclude patients who had already received local radiation or chemotherapy in order not to confound the results. Like the School of Aviation Medicine’s Herbert Gerstner, the Cincinnati group early on recognized that patients already exposed to radiation suffered more deleterious effects the second time around.

All the patients enrolled in the TBI experiment had widespread cancer, but many were still leading relatively normal lives. In their report for the first year of the experiment, Saenger and his colleagues wrote, “Our patients of course all have incurable and/or metastatic cancer, and although in reasonably good clinical condition, cannot be considered as normal.”
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Later progress reports stated that the subjects were “in relatively good health,” “clinically stable, many of them working daily,” and able to “perform activities of daily living.”
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Following a long tunnel with overhead, exposed pipes that wound its way through the basement of Cincinnati General Hospital, the patients arrived at the irradiation chamber. Inside was a Cobalt 60 Teletherapy Unit, surrounded by several feet of lead. The experimental subjects were homemakers, seamstresses, maids, salesmen, carpenters, and clerks. Sixty-two percent were African American. Most were poor or had such low-paying jobs they could not afford private physicians. Many had very little formal education.

The patients were led into the room where they were placed in a sitting position 282 centimeters, or about nine feet, from the source.
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Their legs were raised and their head tilted slightly forward. Half the exposure was delivered laterally through one side of the body. Then the patient was turned and the remaining radiation delivered. The treatment usually took one-half to one hour.

Toward the end of the eleven-year study, Saenger informed the Defense Department that he hoped to expose some patients with a blast of radiation from one direction. “Whenever possible unidirectional radiation will be attempted since this type of exposure is of military interest.”
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David Egilman, a physician and professor at Brown University and longtime critic of the experiment, maintained the crouched position and “unidirectional” radiation closely resembled how soldiers would be exposed on the nuclear battlefield. There is no evidence, however, that the unidirectional radiation was given, pointed out R. Joseph Parker, Saenger’s attorney.

The subjects, of course, did not feel anything while the radiation was being delivered. But Saenger acknowledged in his 1973 paper that the exposures could have initiated the hematologic form of the acute radiation syndrome in some patients.
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Bone marrow failure is the cause of death in this syndrome, but many other organs of the body are also damaged. In his handbook on radiation accidents, Saenger compared the acute radiation syndrome to a viral infection or an illness caused by chemical poisoning.
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In the “prodromal phase” of the acute radiation syndrome, nausea, vomiting, weakness, and fatigue usually begin several hours after exposure. These symptoms subside two or three days later and then the patients enter a latent period in which they generally feel no symptoms. The latent period lasts about twenty days. Then acute illness sets in. Many symptoms occur during this period—vomiting, diarrhea, abdominal pain, fever, disorientation, shock, hemorrhage—but one of the most dangerous symptoms is infection. This danger period lasts about thirty to forty days, and then recovery usually begins. If exposures are high enough, the various stages of the acute radiation syndrome can be compressed, with the latent period disappearing altogether.

Saenger said in his 1973 paper that the TBI could have contributed to the death of eight patients if the disease and effects from previous therapy were excluded.
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A University of Cincinnati faculty committee that reviewed the experiment later found nineteen patients died between twenty and sixty days after the TBI treatment and “could have died from radiation alone.”
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One of the first patients to receive 200 roentgens—a dose that both Shields Warren and Eugene Saenger said could produce fatalities—was John Edgar Webster, Patient No.
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021, a country musician and custodian at an elementary school. He was examined by doctors at Cincinnati General Hospital in April 1962 and diagnosed with bowel cancer that had spread to his left lung. Several weeks later he returned to the hospital to receive the “miracle” treatment that family members thought would cure his cancer. After the so-called cure, Webster planned to take a trip to California to see his eldest son. “My mother was extremely excited after hearing the news of this newly discovered treatment,” Webster’s granddaughter, Peggy Carboina, said in written testimony to a congressional subcommittee.
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On April 28, 1962, Webster became the third patient bombarded with 200 rads of total-body irradiation.

Webster had a severe reaction to the TBI. He could not get out of bed following the treatment. Nor could he keep down food or water. He began to lose weight rapidly. “He would cry due to such pain. We heard him pray that God would take him so the pain would stop,” his granddaughter remembered. Chest X rays showed an invasive substance in the lung that appeared to be either tumor or pneumonia. “His course was progressively downhill, and he expired June 3, 1962 (36 days post TBR),” a Defense Department report states.
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Webster’s relatives told medical officials they did not want an autopsy performed, but years later they discovered that an autopsy was done anyway.

Another patient who had a severe reaction was Patient No. 045, Maude Jacobs. She was a beautiful blond woman who radiated happiness despite a life of severe hardship and continual poverty. Born in Hazard, Kentucky, she was orphaned at ten, married at the age of twelve, and had her first child at thirteen. She washed windows, cleaned houses, and did other people’s laundry. Her formal education ended after third grade, but she struggled to teach herself how to read and write.

In the summer of 1964, the doctors at Cincinnati General Hospital diagnosed Jacobs as having breast cancer that had spread to the bone. She was forty-nine years old and had seven children, six girls and one boy. Chemotherapy helped the primary tumor, but the bone cancer continued to spread. “I don’t think the doctors noes
[sic]
what is wrong with me,” she said in a letter to her sister, Arlie, two months before her death.

One day Jacobs forced her swollen feet into a pair of dress shoes and took a taxi to the hospital. There she was irradiated with 150 rads. She began vomiting immediately and continued to vomit for the next twenty
four hours despite a dose of antinausea medication. “She went out of her mind,” said daughter Lillian Pagano.
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Jacobs regained her sanity briefly when the priest came to administer last rites. They prayed together and then he asked her, “Are you ready to meet the Lord?” She responded, “Yes, I am, Father.”

According to a Defense Department report, Jacobs had a normal blood count prior to the treatment.
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Seven days after she was irradiated, her white blood cell count began falling. The platelet count began to fall fourteen days later. She grew short of breath, her heart started to gallop, and chest films showed a diffuse infiltrate in the left lower lung and collapse of the right lower lung. She was started on antibiotics and other medications but nothing helped. She died December 2, 1964, twenty-five days after the total body irradiation had been administered.

Jacobs’s death came so suddenly that she was unable to make arrangements for her children. Three of her youngest were sent to an orphanage. Family members said they were never informed of the TBI treatment. “My version of this is they burned her alive,” Lillian Pagano said. “They killed her. They actually took part of her life away.”

For Grey Spanagel, Patient No. 077, death also came soon after irradiation. Spanagel had throat cancer and had already undergone two surgical procedures and two localized radiation treatments. Nevertheless, he was still working and walking every day when Cincinnati doctors recommended that he be given total-body irradiation.
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Spanagel drove himself to the hospital for the treatment.

He was irradiated with 200 rads on November 9, 1967. Prior to the procedure, some of his bone marrow was removed and stored. Two days after irradiation, the bone marrow was infused back into his body. Spanagel tolerated both the TBI and bone marrow procedure well and was sent home the following day. Twenty days later his blood counts began to fall. “His condition continued a downhill course,” the doctors wrote, “and on Dec. 9, 1967, he expired, thirty-one days post TBR.”
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Spanagel’s wife, Madge, told
The Cincinnati Enquirer
that she and her husband were informed by doctors in separate interview sessions that the treatment was for the throat cancer. The doctors never told them the results might be used to help soldiers on the nuclear battlefield, she recalled.
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In quiet laboratories far from the day-to-day horrors of the cancer wards, Saenger’s team of researchers painstakingly studied urine and blood samples
from the patients. Some of the serum was shipped to an Army researcher in Fort Knox, Kentucky. The samples were scrutinized for biochemical changes caused by the radiation. When the researchers could not find a reliable radiation marker in the urinary amino acids, they began studying antibody responses, chromosome abnormalities, and other biochemical and cellular changes. Saenger said many years later that he might have moved on to something else if he had found a clear biological dosimeter in the first ten to twelve patients. “We kept being on the edge of finding what we were looking for so we kept on treating the patients.…”
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The patients’ nausea and vomiting were carefully observed. Saenger said the military wanted the information not because “you fall down and vomit and have a fit and become confused and all that, but that your judgment would be impaired, that you couldn’t fly the plane through the cloud or you couldn’t make it all the way through the cloud and back and so on.”
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The patients were not given antinausea medications for up to three days following the total-body irradiation, a procedure that critics said was consistent with a military experiment but not appropriate for patients undergoing therapy for a disease.

In order to avoid tainting the data, hospital staffers were instructed not to discuss any possible side effects with the patients. “The patient is told that he is to receive treatment to help his sickness.
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There is no discussion of subjective reactions resulting from the treatment.” Certainly withholding information is not consistent with the principle of informing patients of the possible consequences of their treatment.

Saenger told a congressional subcommittee that he didn’t tell the patients of the possible side effects to avoid provoking the symptoms through the power of suggestion.
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“We found, as I think many of us observe in raising children and so on, if you ask leading questions, you very often elicit responses, particularly for things which are somewhat suggestible such as nausea and vomiting.” The patients were given antinausea medication if they “complained,” he added.

Often the patients were moved to a private room after irradiation so that their mental state could be better evaluated. What’s more, the doctors told their military funders, “there are no other patients receiving radiation therapy with whom the patient can exchange experiences.”
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These psychological studies were another important component of the experiment and became more elaborate as the years went on. Tests were administered to measure the patients’ depression, hope, denial, and pessimism. Brief interviews were conducted before and after irradiation and
then “scored” for cognitive dysfunction. Many of the patients were so sick after they were irradiated that they could not complete all the testing. Herb Varin remembers his mother, Nina Cline, complaining about the constant barrage of questioning. “I tell them I’m feeling terrible but they just want to talk to me,” Varin recalled his mother saying.
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The psychological research was pertinent to the military, the Cincinnati doctors wrote, because of the way TBI affected thought processes: