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EXPOSURE TO RADIUM PREPARATIONS.
EXPOSURE TO RADIUM PREPARATIONS.
5
etc., were said to be caused by long and repeated exposures to radio-
A diminution of the number of polynuclears of 1 and 2 nuclei
active substances (1) but more recent experimental and clinical
and an augmentation of the polynuclears of 4 and 5 nuclei were
evidence shows that these general symptoms are perhaps not so fre-
noted (8)
quent in occurrence nor so important as danger signals as are the
The small variety of mononuclears is especially sensitive to radia-
now well recognized blood changes.
tion, as measured by their disappearance from the peripheral circu-
The polymorphonuclear leucocytic and the lymphocytic blood con-
lation after exposure of the animal to radiation (9)
tent of radium workers is decidedly lower than that of normal indi-
The lymphocyte is the most radio-sensitive cell in the animal or-
viduals. Even among workers with the least exposure to radiation
ganism. The change in the numerical relationship of the two types
there was no evidence of leucocytosis. This contrasts with the fact
of white cells is not accompanied by noticeable change in the total
that, in small animals, alternate periods of radiation and freedom from
leucocytic count (10).
radiation will, under certain conditions, produce profound leucocy-
The red cells seem to be diminished in numbers in the radium
tosis, and the leucopenia following a single dose of Röntgen rays
workers. The hemoglobin content of the blood is less affected, so
is often followed by leucocytosis (2).
that the color index is high. This finding, combined with the fact
The low polymorphonuclear blood content commonly found and
that there is no evidence of red cell regeneration, and with the asso-
the anemia of an aplastic type affecting the much exposed workers
ciated polynuclear leucopenia, points to an interference with the pro-
point to an interference with the output of blood cells from the bone
duction of red cells and polynuclears in the bone marrow. It would
marrow. Among X-ray workers there is rarely any evidence of such
seem that the penetrating gamma rays of radium react and injure
an effect, though a small fall in the number of circulating polymorphs
the bone marrow, whereas the less penetrating rays exhibit their
and a mild anemia have been noted in a few cases. It would seem that
effects chiefly upon lymphocytes and lymphoid tissues, which are
the penetrating gamma rays are able to reach the bone marrow,
not protected by a covering of bone (11).
whereas the relatively soft X-rays used clinically fail in this respect (3).
With increased protection for radium workers, evidence is found of
An initial fall in the number of circulating lymphocytes occurs in
a return of the altered blood condition of the workers to the normal.
the blood soon after exposure to radiation. The experimental and
In the case of the red cells, the polymorphs, and the hemoglobin,
observational data bear upon one another to the extent of showing
the return to normal was complete; only a mild lymphopenia per-
that both X-rays and gamma rays may be expected to cause lympho-
sisted (12). Three deaths were reported in 1921 as occurring among
cytes to disappear from the circulation. Changes in the red blood
persons employed in handling radium at the London Radium Insti-
cells have also occurred after a single gamma ray exposure; they are
tute (5). These fatal cases were accompanied by anemia, which has
not of a pronounced character, however, unless the radiation is very
occurred from time to time among radium workers. Taking into
prolonged (4).
account the great rarity of aplastic pernicious anemia, it is reason-
There is a constant occurrence of a marked polynuclear leucopenia.
able to conclude that exposure to radium was an important etiologi-
The recovery from the leucopenia is very slow. There is agreement
cal factor.
in respect to the destruction of lymphocytes. Destructive changes
From the available literature on this subject it appears that con-
in bone marrow have also been described (5)
tinued exposure to radiation usually produces the following harmful
A thrombopenia was found to be a lesion common to vitamine-A
effects:
deficiency and exposure to radium (6)
1. Pain, sensitiveness, or anesthesia of the skin of exposed fingers
Undue exposure to the X-rays or radium is associated at times
or hand.
with a moderate leucoplakia, a relative lymphocytosis, a relative
2. Burns or destruction of the skin and underlying tissues.
polycythemia, and occasionally an eosinophilia. A low blood pres-
3. Effect upon the blood and blood-making organs-usually a pro-
sure, which does not seem to be associated with any other definite
found leucopenia affecting both the polynuclears and lymphocytes;
symptoms, is quite common. The skin changes found in the earlier
a decrease in blood platelets; also a milder anemia accompanied by
workers are not increasing and are being avoided entirely by the
a high color index. The reduction of the lymphocytes seems to be
later ones because of increased knowledge and increased protec-
definite and regular; the effect upon the polynuclears is irregular.
tion (7).
4. Sterility.
5. The inhibition of the absorption of fat in the intestinal canal.
This has been demonstrated experimentally (13).
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"ocrText": "4\nEXPOSURE TO RADIUM PREPARATIONS.\nEXPOSURE TO RADIUM PREPARATIONS.\n5\netc., were said to be caused by long and repeated exposures to radio-\nA diminution of the number of polynuclears of 1 and 2 nuclei\nactive substances (1) but more recent experimental and clinical\nand an augmentation of the polynuclears of 4 and 5 nuclei were\nevidence shows that these general symptoms are perhaps not so fre-\nnoted (8)\nquent in occurrence nor so important as danger signals as are the\nThe small variety of mononuclears is especially sensitive to radia-\nnow well recognized blood changes.\ntion, as measured by their disappearance from the peripheral circu-\nThe polymorphonuclear leucocytic and the lymphocytic blood con-\nlation after exposure of the animal to radiation (9)\ntent of radium workers is decidedly lower than that of normal indi-\nThe lymphocyte is the most radio-sensitive cell in the animal or-\nviduals. Even among workers with the least exposure to radiation\nganism. The change in the numerical relationship of the two types\nthere was no evidence of leucocytosis. This contrasts with the fact\nof white cells is not accompanied by noticeable change in the total\nthat, in small animals, alternate periods of radiation and freedom from\nleucocytic count (10).\nradiation will, under certain conditions, produce profound leucocy-\nThe red cells seem to be diminished in numbers in the radium\ntosis, and the leucopenia following a single dose of Röntgen rays\nworkers. The hemoglobin content of the blood is less affected, so\nis often followed by leucocytosis (2).\nthat the color index is high. This finding, combined with the fact\nThe low polymorphonuclear blood content commonly found and\nthat there is no evidence of red cell regeneration, and with the asso-\nthe anemia of an aplastic type affecting the much exposed workers\nciated polynuclear leucopenia, points to an interference with the pro-\npoint to an interference with the output of blood cells from the bone\nduction of red cells and polynuclears in the bone marrow. It would\nmarrow. Among X-ray workers there is rarely any evidence of such\nseem that the penetrating gamma rays of radium react and injure\nan effect, though a small fall in the number of circulating polymorphs\nthe bone marrow, whereas the less penetrating rays exhibit their\nand a mild anemia have been noted in a few cases. It would seem that\neffects chiefly upon lymphocytes and lymphoid tissues, which are\nthe penetrating gamma rays are able to reach the bone marrow,\nnot protected by a covering of bone (11).\nwhereas the relatively soft X-rays used clinically fail in this respect (3).\nWith increased protection for radium workers, evidence is found of\nAn initial fall in the number of circulating lymphocytes occurs in\na return of the altered blood condition of the workers to the normal.\nthe blood soon after exposure to radiation. The experimental and\nIn the case of the red cells, the polymorphs, and the hemoglobin,\nobservational data bear upon one another to the extent of showing\nthe return to normal was complete; only a mild lymphopenia per-\nthat both X-rays and gamma rays may be expected to cause lympho-\nsisted (12). Three deaths were reported in 1921 as occurring among\ncytes to disappear from the circulation. Changes in the red blood\npersons employed in handling radium at the London Radium Insti-\ncells have also occurred after a single gamma ray exposure; they are\ntute (5). These fatal cases were accompanied by anemia, which has\nnot of a pronounced character, however, unless the radiation is very\noccurred from time to time among radium workers. Taking into\nprolonged (4).\naccount the great rarity of aplastic pernicious anemia, it is reason-\nThere is a constant occurrence of a marked polynuclear leucopenia.\nable to conclude that exposure to radium was an important etiologi-\nThe recovery from the leucopenia is very slow. There is agreement\ncal factor.\nin respect to the destruction of lymphocytes. Destructive changes\nFrom the available literature on this subject it appears that con-\nin bone marrow have also been described (5)\ntinued exposure to radiation usually produces the following harmful\nA thrombopenia was found to be a lesion common to vitamine-A\neffects:\ndeficiency and exposure to radium (6)\n1. Pain, sensitiveness, or anesthesia of the skin of exposed fingers\nUndue exposure to the X-rays or radium is associated at times\nor hand.\nwith a moderate leucoplakia, a relative lymphocytosis, a relative\n2. Burns or destruction of the skin and underlying tissues.\npolycythemia, and occasionally an eosinophilia. A low blood pres-\n3. Effect upon the blood and blood-making organs-usually a pro-\nsure, which does not seem to be associated with any other definite\nfound leucopenia affecting both the polynuclears and lymphocytes;\nsymptoms, is quite common. The skin changes found in the earlier\na decrease in blood platelets; also a milder anemia accompanied by\nworkers are not increasing and are being avoided entirely by the\na high color index. The reduction of the lymphocytes seems to be\nlater ones because of increased knowledge and increased protec-\ndefinite and regular; the effect upon the polynuclears is irregular.\ntion (7).\n4. Sterility.\n5. The inhibition of the absorption of fat in the intestinal canal.\nThis has been demonstrated experimentally (13)."
}