[Dose, radiation effect and initial symptoms following unexpected whole body irradiation: an analysis of 19 accidents].

The radiation induced effects on the haemopoietic system and the human body after acute unexpected whole body irradiation are manifold. Therefore it is meaningful to incorporate the scientific foundations of radiation effects in the available knowledge about the consequences of radiation exposure. From this aspect the present paper evaluates 19 acute radiation accidents which were published between 1945 and 1986 in the scientific literature involving about 597 individuals. Even in the case of an uncomplicated radiation effect the physician must not rely on the estimated physical dose because it does not or does not necessarily correlate with the different course of events taken by the individual categories of the acute radiation syndrome. In fact, the dose is of minor importance to the physician because as a rule it can only be determined too late due to the complex parameters. The classification, therapy and prognosis of the accident victims is largely governed by the pathophysiology which results from the random probability of the cell killing mechanisms by radiation, inhomogeneous dose distribution and the scattered distribution of the haemopoietic system in the human body. The fact that in the case of accidentally induced total body irradiation there is only inhomogeneous distribution of radiation dose is a life-saving factor in most cases. Furthermore, it is pointed out that by means of simple diagnostic methods, e.g. the initial symptoms, the first classification of accident victims is also largely possible without referring to the dose.