Although William Neilson, of East Kilbride, near Glasgow, was exposed to radiation to a degree unparalleled in the UK since the Second World War, no one has accepted responsibility for his injuries and his widow has received no compensation.
Mr Neilson received three times the radiation needed to kill a man. Even though his case is one of only a handful in the world, it is unknown outside a narrow circle of radiation experts.
His death highlights the dangers of industrial radiography, whose workers routinely receive much higher radiation doses than those employed in the nuclear power industry, and it suggests that the official figures on exposure to radiation may be grossly underestimating the true picture. For reasons that have never been established, the huge dose of radiation that killed Mr Neilson went unrecorded by the film badge which he wore to measure his exposure.
In 1990, Mr Neilson had part of his right hand amputated after the index finger turned black and gangrenous as a result of radiation damage to the tissues. After that, his injuries got progressively worse for two years until he died.
Formerly a vigorous and active man, he lost weight until, according to his wife Jessie, he was only four stone. He died, aged 61, on 9 June 1992 of bronchopneumonia, radiation-induced myeloid leukaemia, radiation dermatitis and radiation-induced myelodysplasia.
In a final macabre indignity, one of his molar teeth was extracted after death, immersed in a pot of carnivorous beetles to strip it of flesh, and sent
to Japan for analysis. The radiation to which he had been exposed left traces in the tooth enamel. The analysis, by a technique known as electron spin resonance, revealed the cumulative dose that Mr Neilson received was nearly 15 Grays.
Dr David Lloyd, of the National Radiological Protection Board, said: 'It's an enormous dose. Three to five Grays will kill you.' One single chest X- ray represents less than one milliGray - Mr Neilson received 15,000 times as much radiation.
Asked for a statement on how Mr Neilson could have suffered his fatal dose, a spokesman for the Health and Safety Executive said: 'We are not taking any enforcement action because there is no evidence of breach of any regulations by anyone. There is no further pursuit of the matter.'
Mr Neilson spent most of his time as an industrial radiographer working at the BP oil refinery complex at Grangemouth on the Forth estuary in eastern Scotland. His work involved handling highly radioactive sources of gamma rays. These pencil-shaped pieces of metal emit beams of radiation which are similar to hospital X-rays but have much higher energy and are more penetrating. They are used to 'X-ray' welds in pipes and other steel vessels to check that they do not contain hidden flaws.
Mr Neilson became an industrial radiographer in 1974. After a one-month training course and a year's practical experience, he got a job with Metal and Pipeline Endurance Ltd (Mapel), a firm specialising in non-destructive testing, which subcontracted him to BP at Grangemouth.
A BP spokesman said there had been a fatal accident inquiry into Mr Neilson's death - this is the closest equivalent in Scottish law to an inquest, but is highly restricted in scope and held before a judge, known as the Sheriff, sitting without a jury. The spokesman added: 'The Sheriff did not accuse BP of being responsible. It was recognised that he (Mr Neilson) worked at other places than BP.'
Matthew Wernham, speaking on behalf of Mapel, said: 'No payments have been made to Mrs Neilson. No payments were due. At the time of his death, Mr Neilson was not working for us.'
Mr Wernham refused to comment on why his company's health and safety procedures had not detected the massive radiation dose. He, too, cited the fatal accident inquiry: 'The Sheriff did not establish where or when the exposure took place. That determination by the Sheriff is the ending of the inquiry.'
'Horrific death', page 3
Leading article, page 15