The Plutonium Files: Eighteen Patients, Three Years, No Consent.

What the plutonium injections were, in a paragraph.

Beginning on April 10, 1945, at the Manhattan District medical facility at Oak Ridge, Tennessee, and continuing through July 18, 1947, eighteen hospitalized patients at four medical institutions associated with the Manhattan Project were injected, without their informed consent, with measured doses of plutonium-238 or plutonium-239 in soluble citrate or other form. The experiments were authorized by the Manhattan Project's medical leadership — Col. Stafford L. Warren as Chief of the Medical Section, and Dr. Hymer L. Friedell as his deputy — and were conducted at Strong Memorial Hospital in Rochester, New York; at the University of California Hospital in San Francisco (under Dr. Joseph Hamilton); at Billings Hospital at the University of Chicago (under Dr. Leon Jacobson); and at the Manhattan District medical group at Oak Ridge (under Dr. Wright Langham of Los Alamos for analytical support). The patients were assigned codes by hospital: HP-1 through HP-12 at Rochester (HP for Human Product), CAL-1 through CAL-3 at the University of California, CHI-1 through CHI-3 at Chicago, and one Oak Ridge subject without a hospital-prefix code. The experiments' purpose, as documented in the Manhattan Project's contemporaneous medical correspondence, was to determine the metabolic fate of plutonium in the human body: specifically, the urinary and fecal excretion rates that would allow the project's industrial-hygiene team to interpret bioassays of workers exposed to plutonium dust at the Hanford and Los Alamos sites. The medical justification offered internally was that the patients chosen were terminally ill and likely to die soon, making them suitable subjects from whose excretion data the body's handling of plutonium could be inferred. The patient-selection assumption was wrong for many of the subjects: of the eighteen, several lived for years or decades after injection. Albert Stevens (CAL-1), injected at the University of California Hospital on May 14, 1945, had been misdiagnosed with terminal gastric carcinoma; the tumor removed in his subsequent surgery proved to be a benign ulcer, and Stevens lived for another 20 years, 8 months — carrying what remains the largest documented internal radiation dose by activity ever recorded in a human. The injections were classified at the moment they were administered, and the classification was sustained through the AEC's institutional successor program. The patients' identities were not known to them or to their families through their lifetimes. The first sustained reconstruction of who the eighteen actually were was the November 1993 series by Eileen Welsome of the Albuquerque Tribune; the November 1995 final report of the Advisory Committee on Human Radiation Experiments confirmed the identifications and substantially expanded the picture into the broader landscape of mid-century federally sponsored human radiation experimentation.

The documented record.

The Manhattan Project context

By spring 1945, the Manhattan Project's plutonium production at Hanford was operating at industrial scale, and the project's medical leadership had become concerned that workers handling plutonium-bearing materials — particularly in the chemistry buildings at Los Alamos and the separation facilities at Hanford — were potentially absorbing the metal in quantities that could not be interpreted, because the body's handling of plutonium was simply not known. Verified Animal studies at the University of Chicago Metallurgical Laboratory under Robert Stone and Joseph Hamilton had produced preliminary data on rodents, but the leap from rats to humans introduced uncertainties large enough that Warren and Friedell judged human data necessary. The institutional decision to obtain it through injection of hospitalized patients was made within the Manhattan Project's medical section in early 1945, with no documented external ethical review and no documented consultation outside the project's compartmented medical leadership [1][2].

The eighteen patients (as reconstructed)

The patients, in chronological order of injection: Verified

• Ebb Cade (HP-12), Oak Ridge, April 10, 1945. A 53-year-old African-American cement worker injured in a truck accident at the Oak Ridge construction site. Injected with approximately 4.7 micrograms of plutonium on his arrival at the project's hospital. Subsequently transferred without explanation; lived eight years and died of heart failure in 1953 in North Carolina. The first plutonium-injection subject; his case is documented in detail in the ACHRE report and in Welsome's reconstruction [3][4].
• Arthur Hubbard (CAL-2), University of California Hospital, then a series of Rochester patients identified by Welsome and ACHRE under their HP codes.
• Albert Stevens (CAL-1), University of California Hospital, May 14, 1945. A 58-year-old California house painter misdiagnosed with terminal gastric carcinoma. Injected with approximately 0.93 microcuries of plutonium-238 and plutonium-239 mixed. The misdiagnosis was discovered at surgery a week later; Stevens lived another 20 years 8 months, dying January 9, 1966, of heart disease. He carried at death a body burden estimated by Patricia Durbin and the Lawrence Berkeley analytical team at approximately 64 rem/year of effective dose — on the order of 6,400 rem cumulative — making his case the highest documented internal radiation dose by activity ever sustained by a human [5].
• Simeon Shaw (CAL-3), a four-year-old Australian boy treated at the University of California Hospital in 1946 with plutonium injection in the course of investigation of a bone tumor. Died eight months later.
• Three patients at Billings Hospital, University of Chicago (CHI-1, CHI-2, CHI-3), injected between December 1945 and 1947 under Dr. Leon Jacobson and Dr. Robert Stone.
• Eleven patients at Strong Memorial Hospital, University of Rochester (HP-1 through HP-11), injected between October 1945 and July 1947 under the supervision of Drs. Samuel Bassett, Christine Waterhouse, and the Manhattan Project's Rochester medical liaison.

Welsome's 1993 series identified five of the eighteen by name (Cade, Stevens, Eda Schultz Charlton, John Mousso, and Elmer Allen). Verified The ACHRE final report of 1995 confirmed these identifications and added biographical reconstruction for additional patients drawing on hospital records, family interviews, and Patricia Durbin's analytical chain-of-custody documentation [4][6].

The Rochester follow-up program

Between 1973 and 1976, the Atomic Energy Commission's successor agency, the Energy Research and Development Administration, funded a follow-up study under Patricia Durbin at the University of California's Donner Laboratory that exhumed three of the deceased plutonium-injection patients (including Albert Stevens, exhumed in May 1975) for tissue analysis. Verified The exhumations were conducted in coordination with the patients' families; Durbin's correspondence with the families, preserved in the ACHRE record, indicates that families were told the studies concerned "metabolism" without disclosure of the underlying plutonium injection or the patients' status as Manhattan Project experimental subjects. The Durbin program produced the analytical data on which subsequent quantitative reconstructions rest, including the Stevens body-burden figure [5][6].

The Welsome series (November 1993)

Eileen Welsome, then a reporter at the Albuquerque Tribune, encountered references to the plutonium-injection program in 1987 in the course of unrelated reporting on a contaminated landfill at Kirtland Air Force Base. Verified Over the following six years she pursued the patient identifications through hospital records, family interviews, and FOIA requests to the Department of Energy. Her three-part series, "The Plutonium Experiment," published in the Tribune on November 15–17, 1993, identified five of the patients by name for the first time and reconstructed their medical histories and the conditions of their injections. The series was awarded the 1994 Pulitzer Prize for National Reporting. Welsome's subsequent book, The Plutonium Files: America's Secret Medical Experiments in the Cold War (Dial Press, 1999), provides the most comprehensive single account [4].

The O'Leary acknowledgment (December 1993)

On December 7, 1993, two weeks after the Welsome series, Secretary of Energy Hazel O'Leary held a press conference at which she acknowledged the plutonium-injection experiments, characterized them as ethically indefensible, and committed the Department of Energy to a comprehensive declassification of human-radiation-experiment records. Verified O'Leary's "Openness Initiative" produced over the following two years approximately 1.6 million pages of declassified records on federally sponsored human radiation experiments, made available through the Department of Energy's Office of Human Radiation Experiments [7].

ACHRE (January 1994 — October 1995)

President Clinton established the Advisory Committee on Human Radiation Experiments by Executive Order 12891 on January 15, 1994. Verified The committee was chaired by Ruth Faden, a bioethicist at Johns Hopkins, and included fourteen members drawn from medicine, history, law, and survivor-family representation. The committee's 925-page final report, delivered to President Clinton on October 3, 1995, documented the eighteen plutonium injections together with several other categories of mid-century federally sponsored human radiation experimentation, articulated ethical findings, and recommended compensation and policy reforms [6]. President Clinton issued a public apology in the East Room of the White House on October 3, 1995, and the federal government subsequently established compensation programs covering most of the documented subjects or their families [8].

The broader human-radiation-experiments record

The plutonium-injection experiments are the eighteen-patient core of a substantially larger landscape of federally sponsored human radiation experiments conducted between the early 1940s and the 1970s. Verified The ACHRE report documented or referenced the following additional programs as part of the same institutional pattern:

• The Cincinnati radiation experiments (1960–1972). Dr. Eugene Saenger of the University of Cincinnati exposed 88 cancer patients (predominantly poor and African-American) to whole-body or partial-body radiation in doses up to 200 rad, funded by the Department of Defense for the stated purpose of assessing battlefield radiation effects. The therapeutic justification for the cancer patients is contested in the medical record; the consent procedures used did not, by ACHRE's findings, meet contemporary standards [6][9].
• The Fernald State School radioactive cereal experiments (1946–1953). Researchers at MIT and Harvard, in cooperation with the Quaker Oats Company, fed boys at the Fernald State School in Waltham, Massachusetts (an institution for intellectually disabled children) breakfast cereals containing trace amounts of radioactive iron-59 and calcium-45, to study mineral absorption. The children were enrolled in a "Science Club" that did not disclose the radiation component to the boys or their parents; some parental consent forms referenced "blood tests" without mention of radioactive tracers. The program produced documented health effects below detection but ethical findings of significant breach [6][10].
• The Vanderbilt iron-59 study (1945–1947). Approximately 820 pregnant women receiving prenatal care at Vanderbilt University Hospital in Nashville were given radioactive iron-59 as part of a study of iron absorption in pregnancy, without disclosure that the iron contained a radioactive isotope. Follow-up studies in the 1960s identified an elevated rate of cancers in the children born to these women relative to controls [6][11].
• Project SUNSHINE (1953 onward). A program of covert collection of human bone, soft tissue, and stillborn infant samples from hospitals and medical examiner facilities worldwide for the purpose of assessing the global distribution of fallout-derived radioactive strontium-90. Approximately 1,500 stillborn infants and additional adult cadaver tissue samples were collected, generally without family knowledge or consent [6][12].
• The "Total Body Irradiation" military studies at multiple sites (Houston, Sloan-Kettering, Cincinnati) that exposed cancer patients to whole-body or partial-body radiation under Department of Defense funding for purposes that combined therapeutic intent with battlefield-medicine research interest [6].

The Tuskegee parallel

The institutional pattern documented across the plutonium injections, the Cincinnati radiation studies, the Fernald cereal program, and the Vanderbilt iron-59 study has been repeatedly compared by historians to the contemporary Tuskegee Syphilis Study, which the U.S. Public Health Service conducted from 1932 to 1972 on 399 African-American men in Macon County, Alabama. Claimed The comparison is structurally apt — in both, federally sponsored medical research on disadvantaged populations was conducted without informed consent over decades — but the two are distinct in their mechanisms and in their populations. The Tuskegee program was a study of untreated disease in a Black community over forty years; the plutonium injections were a metabolic study on a more demographically varied set of hospitalized patients over two years. Both contributed to the regulatory framework codified in the 1974 National Research Act and the 1979 Belmont Report.

The official explanations, then and now.

The contemporaneous Manhattan Project justification for the plutonium injections, as articulated in internal Warren-Friedell correspondence and in Wright Langham's analytical reports, was that the experiments were necessary to establish bioassay baselines that would allow the project's industrial-hygiene team to interpret urine and fecal samples from plutonium-handling workers. Claimed The patient-selection criterion of "expected imminent death" was offered as the ethical safeguard: the project's medical leadership reasoned that patients who would die regardless within months would not, in effect, be harmed by the small added radiation dose. The reasoning was wrong on its own terms in at least the Albert Stevens case (where the underlying diagnosis was incorrect) and the Ebb Cade case (where the patient lived an additional eight years). It was wrong on its broader terms in the absence of any informed-consent procedure, an absence that even by the standards of 1945 medical research was contested within the project's own medical division [1][2][6].

The Atomic Energy Commission's institutional position from 1947 through the early 1970s was that the plutonium-injection records were classified as a matter of national security and that the program had been a defensible response to industrial-hygiene necessity. Claimed The position survived in attenuated form into the 1980s and was first publicly retracted in the 1986 Markey Committee report (Subcommittee on Energy Conservation and Power of the House Committee on Energy and Commerce), chaired by Rep. Edward Markey, which identified 31 programs of human radiation experimentation as raising significant ethical questions and recommended further investigation [13].

The post-1993 institutional position, articulated by Secretary O'Leary, by the ACHRE final report, and by President Clinton's October 3, 1995 apology, is that the experiments were ethically indefensible by the standards of their own time, that no national-security justification was sufficient to defend non-consensual injection of patients with a known toxic substance, and that the federal government bears institutional responsibility for the program and for the harm it caused. Verified The federal government has paid administrative compensation to most of the documented subjects' families through a combination of the Radiation Exposure Compensation Act and supplemental administrative programs; the compensation has been substantially smaller than the underlying ethical harm [6][8].

The unanswered questions.

The complete subject roster across the wider program

The eighteen plutonium-injection patients are well-documented after 1993. The broader population of subjects across the full human-radiation-experiments landscape — including the Cincinnati cancer patients, the Fernald boys, the Vanderbilt pregnant women, the Project SUNSHINE infant tissue donors, and the various military radiation-exposure studies — is documented at the program level but incompletely at the individual level. Disputed ACHRE estimated the total number of subjects across all documented programs at "tens of thousands"; a precise individual-level reconstruction has not been completed and at this distance likely cannot be [6][7].

The specific decision chain inside the Manhattan Project medical division

The records reconstructed under O'Leary's Openness Initiative document the program at the institutional level but the specific meeting at which the decision to proceed with human injection was made, the participants in that decision, and the contemporaneous internal dissent (if any) are not fully recoverable from the surviving record. Disputed The Warren and Friedell papers preserve their correspondence with each other and with the hospital-level investigators, but not a clean record of an authorizing decision [1][2][14].

The Hanford workers question

The injections' stated purpose was to support bioassay interpretation for plutonium-handling workers. Unverified Whether the data produced by the injection studies was actually used to interpret worker bioassays, and what the workers themselves were told about the basis for those bioassays, is a separate question that the ACHRE record touches but does not fully resolve. Approximately 4,000 plutonium-exposed Manhattan Project workers were followed by the Hanford-Los Alamos health programs through the 1980s; the long-term health-effects follow-up data on those workers is partial [6][15].

The Albert Stevens dosimetric questions

Patricia Durbin's reconstruction of Albert Stevens's body burden produced a figure on the order of 6,400 rem cumulative effective dose — an astonishingly large internal radiation exposure, which Stevens nevertheless survived for two decades. Disputed The dose reconstruction depends on assumptions about plutonium retention and redistribution over time that are not fully constrained even with the post-mortem tissue analysis. The Stevens case is medically important not because the dose was harmless — it almost certainly contributed to his eventual cardiovascular pathology — but because the survival demonstrates that the contemporary risk models for internal plutonium dose had overestimated short-term lethality. The case remains one of the principal data points in internal-emitter dosimetry, with a published literature that extends through the 2000s [5][16].

The persistence of the institutional pattern

The 1995 ACHRE report formally addressed experimentation through approximately 1974, the year of the National Research Act. Disputed Whether the institutional pattern documented in the report — federally sponsored research on disadvantaged populations without genuine informed consent — persisted in attenuated form after 1974 is a question outside the strict scope of ACHRE's mandate. Continuing scholarship, including work by Susan Lederer, Allen Hornblum, and Welsome herself, has identified individual post-1974 programs that meet some of the same descriptive criteria. The systemic question remains open in the historiographic literature [4][17].

Primary material.

The accessible primary record on the plutonium injections and the broader human-radiation-experiments program is held at:

• The Department of Energy's Office of Human Radiation Experiments (now archived through the DOE OpenNet system) hosts the consolidated declassification of approximately 1.6 million pages assembled under the 1993–1995 Openness Initiative, including the Manhattan Project Medical Section files, the AEC's biology and medicine division files, and the hospital-level case records for the eighteen plutonium-injection patients.
• The Advisory Committee on Human Radiation Experiments Final Report (October 1995, 925 pages plus supplements totaling several thousand additional pages of staff studies). The full report is hosted at the National Security Archive at George Washington University and at the Department of Energy.
• The Eileen Welsome papers, held in part at the University of New Mexico's Center for Southwest Research, including her research files, interview transcripts, and FOIA correspondence.
• The National Archives (NARA) hold the Manhattan Engineer District records (Record Group 77) including the Warren-Friedell medical correspondence, and the Atomic Energy Commission records (Record Group 326).
• The Patricia Durbin papers, deposited in part at the Lawrence Berkeley National Laboratory archives, including the 1973–1976 exhumation and follow-up analytical records.

Critical individual documents include: the Wright Langham 1956 monograph on the metabolism of plutonium in humans (the first substantive published account, with patient data anonymized); the November 15–17, 1993 Welsome series; the December 7, 1993 O'Leary press conference transcript; the October 3, 1995 ACHRE final report and Clinton apology; and the underlying hospital records for HP-1 through HP-12, CAL-1 through CAL-3, and CHI-1 through CHI-3.

The sequence.

1. 1942–1944 Manhattan Project plutonium production begins at industrial scale; the project's medical leadership identifies the need for human metabolic data.
2. April 10, 1945 Ebb Cade injected at Oak Ridge: the first plutonium-injection subject.
3. May 14, 1945 Albert Stevens injected at University of California Hospital, San Francisco.
4. August 6 & 9, 1945 Hiroshima and Nagasaki bombings; Manhattan Project's wartime mission ends.
5. October 1945 — July 18, 1947 Remaining 16 plutonium injections conducted at Rochester, Chicago, and San Francisco.
6. January 1, 1947 Atomic Energy Commission assumes responsibility for nuclear program from the Army; the Manhattan Project's medical records transfer to AEC.
7. 1946–1953 Fernald State School radioactive cereal feeding program.
8. 1945–1947 Vanderbilt iron-59 prenatal study.
9. 1953 Project SUNSHINE established.
10. 1956 Wright Langham publishes The Metabolism of Plutonium in Humans, the first peer-reviewed account drawing on the injection data (patients anonymized).
11. 1960–1972 Cincinnati radiation experiments under Eugene Saenger.
12. January 9, 1966 Albert Stevens dies at age 79, 20 years 8 months after injection, of cardiovascular disease.
13. 1972 Public exposure of the Tuskegee Syphilis Study; broader institutional reckoning with mid-century medical research ethics begins.
14. 1973–1976 Patricia Durbin's follow-up exhumation study at the Donner Laboratory.
15. July 12, 1974 National Research Act establishes the institutional framework for informed-consent regulation.
16. 1976 First investigative reporting on the plutonium experiments by science journalist Mort Stern of The Washington Post.
17. 1986 Markey Committee report ("American Nuclear Guinea Pigs") identifies 31 human radiation experiment programs warranting investigation.
18. 1987 Eileen Welsome begins her investigation while reporting at the Albuquerque Tribune.
19. November 15–17, 1993 "The Plutonium Experiment" series published in the Albuquerque Tribune.
20. December 7, 1993 Secretary O'Leary acknowledges the program and launches the Openness Initiative.
21. January 15, 1994 President Clinton establishes ACHRE by Executive Order 12891.
22. April 1994 Eileen Welsome awarded the Pulitzer Prize for National Reporting.
23. October 3, 1995 ACHRE final report delivered; President Clinton issues public apology in the East Room.
24. 1996–present Federal compensation programs administered for documented subjects and their families.
25. 1999 Eileen Welsome publishes The Plutonium Files: America's Secret Medical Experiments in the Cold War.

Cases on this archive that connect.

MK-Ultra (File 001) — the contemporaneous CIA program of non-consensual human experimentation in a parallel institutional environment. The two programs do not share personnel but share the underlying mid-century pattern: federally sponsored experimental work on hospitalized, institutionalized, or incarcerated populations under conditions of secrecy that made informed consent procedurally impossible.

Tuskegee Syphilis Study (File 022) — the structurally adjacent U.S. Public Health Service program of non-consensual observation of untreated disease, conducted from 1932 to 1972 in Macon County, Alabama. Both programs entered the institutional record as occasions for the modern informed-consent framework codified in the 1974 National Research Act.

Project ARTICHOKE (File 014) — the CIA's BLUEBIRD/ARTICHOKE program of interrogation research, which used some of the same prison and addict populations (Lexington Federal Narcotics Hospital) that the AEC's biomedical contractors drew from for ostensibly therapeutic research.

More related files coming as the archive grows. Planned: the Edgewood Arsenal chemical-warfare volunteer program (1955–1975), the Holmesburg Prison dermatological experiments (1951–1974), and the Willowbrook hepatitis studies (1956–1971) as standalone files.

Full bibliography.

1. Warren, Stafford L. and Friedell, Hymer L., Manhattan Project Medical Section correspondence, 1944–1947. Manhattan Engineer District records, NARA RG 77. Selected items declassified through the 1995 ACHRE process.
2. Langham, Wright H. Distribution and Excretion of Plutonium Administered Intravenously to Man, Los Alamos Scientific Laboratory Report LA-1151, 1956. The first published account of the injection data.
3. Advisory Committee on Human Radiation Experiments. "The Ebb Cade Case." ACHRE Final Report supporting documents, 1995.
4. Welsome, Eileen. "The Plutonium Experiment," three-part series, Albuquerque Tribune, November 15–17, 1993.
5. Durbin, Patricia W., et al. "Plutonium in Mammals: Influence of Plutonium Chemistry, Route of Administration, and Physiological Status of the Animal on Initial Distribution and Long-Term Metabolism." Health Physics, 1975 onward (series of papers).
6. Advisory Committee on Human Radiation Experiments. Final Report. U.S. Government Printing Office, October 1995. ISBN 0-19-510791-8 (Oxford University Press edition, 1996, with full text).
7. U.S. Department of Energy. "Openness Initiative" document collection, Office of Human Radiation Experiments, 1994–1995. Archived through the DOE OpenNet system.
8. Clinton, William J. Remarks to the Advisory Committee on Human Radiation Experiments, East Room, the White House, October 3, 1995. Public Papers of the Presidents transcript.
9. Stephens, Martha. The Treatment: The Story of Those Who Died in the Cincinnati Radiation Tests. Duke University Press, 2002.
10. D'Antonio, Michael. The State Boys Rebellion: The Inspiring True Story of American Eugenics and the Men Who Overcame It. Simon & Schuster, 2004. (Covers the Fernald State School experiments in detail.)
11. Hawes, Kerry, et al. "Cancer Incidence in the Children of Vanderbilt Iron-59 Study Participants." American Journal of Public Health follow-up literature, 1969 onward.
12. Welsome, Eileen. The Plutonium Files: America's Secret Medical Experiments in the Cold War. Dial Press, 1999. ISBN 0-385-31402-7.
13. Markey, Edward J. American Nuclear Guinea Pigs: Three Decades of Radiation Experiments on U.S. Citizens. Subcommittee on Energy Conservation and Power, House Committee on Energy and Commerce, October 1986.
14. Sanger, S. L. Working on the Bomb: An Oral History of WWII Hanford. Portland State University Continuing Education Press, 1995. Includes interviews on the medical-section context.
15. Wing, Steve and Richardson, David B. "Age at Exposure to Ionizing Radiation and Cancer Mortality among Hanford Workers: Follow-up through 1994." Occupational and Environmental Medicine, 2005.
16. Rowland, Robley E., et al. "Plutonium Body Burden in Albert Stevens." Health Physics follow-up literature, 1965 onward.