USSBS Report 13, The Effects of the Atomic Bombs on Health Services in Hiroshima and Nagasaki

8/3/2019 USSBS Report 13, The Effects of the Atomic Bombs on Health Services in Hiroshima and Nagasaki

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THE UNITED STATESSTRATEGIC BOMBING SURVEY

The EffectsOFAtomic BombsON

Health and Medical ServicesIN

Hiroshima and Nagasaki

Medical DivisionMarch 1947

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THE UNITED STATESSTRATEGIC BOMBING SURVEY

The EffectsOF

Atomic BombsON

Health and Medical ServicesIN

Hiroshima and Nagasaki

Medical DivisionMarch 1947C

For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C.Price 45 cents


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no",I z^

y. . lypiRINTENOENT Of DOCUMENTS

MAY 13 1947

This report was written primarily for the use of the United States StrategicBombing Survey in the preparation of further reports of a more comprehensivenature. Any conclusions or opinions expressed in this report must be con-sidered as limited to the specific material covered and as subject to furtherinterpretation in the light of further studies conducted by the Survey.

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FOREWORDUnited States Strategic Bombing Survey

established by the Secretary of War on 31944, purusant to a directive from the

President Roosevelt. Its mission was to con-an impartial ajid expert study of the effects

our aerial attack on Germany, to be used inwith air attacks on Japan and to estab-

a basis for evaluating the importance andof air power as an instrument of

strategy, for planning the future develop-of the United States armed forces, and for

future economic policies with respectthe national defense. A summary report and

200 supporting reports containing the find-of the Survey in Germany have been15 August 1945, President Trimian requestedthe Survey conduct a similar study of theof all types of air attack in the war againstsubmitting reports in duplicate to theof War and to the Secretary of the Navy.officers of the Survey during its Japanese

were:Franklin D'Olier, Chairman.Paul H. Nitze, Henry C. Alexander,

Vice Chairmen.Harry L. Bowman,J. Kenneth Galbraith,Rensis Likert,Frank A. McNamee, Jr.,Fred Searls, Jr.,Monroe E. Spaght,Dr. Lewis R. Thompson,Theodore P. Wright, Directors.Walter Wilds, Secretary.

Survey's complement provided for 300350 officers, and 500 enlisted men. The

military segment of the organization was drawnfrom the Army to the extent of 60 percent, andfrom the Navy to the extent of 40 percent. Boththe Army and the Nav^y gave the Survey all pos-sible assistance in furnishing men, supplies, trans-port, and information. The Survey operated fromheadquarters established in Tokyo early in Sep-tember 1945, with subheadquarters in Nagoya,Osaka, Hiroshima, and Nagasaki, and with mobileteams operating in other parts of Japan, theislands of the Pacific, and the Asiatic mainland.

It was possible to reconstruct much of wartimeJapanese military planning and execution, engage-ment by engagement, and campaign by campaign,and to secure reasonably accurate statistics onJapan's economy and war-production, plant byplant, and industry by industry. In addition,studies were conducted on Japan's over-all stra-tegic plans and the background of her entry intothe war, the internal discussions and negotiationsleading to her acceptance of unconditional sur-render, the course of health and morale among thecivilian population, the effectiveness of the Japa-nese civilian defense organization, and the eflfectsof the atomic bombs. Separate reports will beissued covering each phase of the study.The Survey interrogated more than 700 Japa-

nese military. Government, and industrial officials.It also recovered and translated many documentswhich not only have been useful to the Survey, butalso will furnish data valuable for other studies.Arrangements have been made to turn over theSurvey's files to the Central Intelhgence Group,through which they will be available for furtherexamination and distribution.

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TABLE OF CONTENTSlBge

I . IxTROnt'CTION . 1Survey Staflf 1II. Effects on Medical Facilities and Personnel 2

A. Status of Medical Care Prior to Bombing 2B. The Atomic Boiul)ing 3C. The Fate of Medical Facilities 4D. Restoration of Hospitals After Bombing 10E. Effects on Medical Personnel 21

III. Nature of Atomic Bomb Casualties 22A. Introduction 22B. Secondary Injuries 24C. Flash Burns 25D. Radiation Effects 43

1. Primary fission products 432. Induced radioactivity 433. Onmma rays 46

a. Clinical picture 46b. Radius of effect 49c. Shielding 49

4. Effects on reproduction 53E. Relative Importance of Various Types of Injury 53F. Treatment 55G. Number of Casualties 55

1 Hh-oshima 552. Nagasaki 56

H. Summary 56IV. Environmental Sanitation 58

A. General 58B. Hiroshima 58

1. Water supply 58a. Public water supply 58b. Piivate water supplies 59

2. Sewage and waste disposal 59a. Public sewerage 59b. Night soil collection and disposal 61c. Garbage and refuse collection and dis-

posal - 613. Milk and food sanitation '1 62

, a. Milk supply 62b. Food sanitation 62

4. Insect and rodent control 625. Disposal of dead _- 626. Evacuation.., , 1 627. Comments . 63


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IV. Environmental SanitationContinued pageC. Nagasaki 63

1 Water supply 63a. Public water supply 63b. Private water supply 67

2. Sewage and waste disposal 67a. Public sewerage 67b. Night soil collection and disposal 68c. Garbage and refuse collection and dis-posal 68

3. Milk and food sanitation 68a. Milk supply 68b. Food sanitation 69

4. Insect and rodent control 69D. Summary 70

V. Food Supply and Nutrition. 71A. Effect on Food Supplies 71B. Effect on Nutrition 74C. Summary 76

VI. Communicable Diseases 77A. The Notifiable Diseases 77B. Tuberculosis 79C. Venereal Disease 79

VII. Industrial Health and Hygiene 81A. General 81B. Industrial Medical Care 81

1. Personnel 812. Facilities . 813. Treatment 824. Safety devices 8251 Health and hygiene inspections 826. Physical examinations 82

C. Effects of Atomic Bombing on Workers 821 Working conditions 822. Worker casualties 833. Absenteeism 834. Occupational diseases 83

D. Summary 83VIII. Summary and Conclusions 84

TABLESNumber Page1. Analysis of 1,080 Cases at Hiroshima Showing Percentage of Radiation Effects at

Various Distances from Bomb 542. Analysis of 381 Cases at Nagasaki Showing the Percentage of Various Injuries at

Various Distances from Explosion 543. Follow-up Study of the Fate of 16,718 School Children in Hiroshima Located at

Various Distances from the Center of Bomb Burst 564. Monthly Average of Daily Bacterial Count, B. Coli, and Residual Chlorine 665. Bomb Damage to Stocks of Staple Foods 726. Bomb Damage to Stocks of Supplementary Foods 727. Food Stocks of the Miso Industry Damaged by Bombing 728. Food Stocks of the Shoyu Industry Damaged bv Bombing 72

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XunibiT Page9. Daily Necessities in Stock on 5 October 1945City of Nagasaki 73

10. Basic Coniniodity Ration of Cereals as of Knd of October 1945 7311. Prevalence of Heportable Conununicable Diseases in Nagasaki City and Pre-

fecture 7612. Dysentery Cases in Nagasaki in the month of October 7713. Hospital In-patients and Cases of Communicable Diseases 7814. Cases of Dysentery in Nagasaki Prefecture 7815. Comparison of Casualty Effects of Incendiary HE Raids and of Atomic Bomb

Raids 85

ILLUSTRATIONSFigure Paee

1. The rubble in the foreground is the only remains of the Shima Surgical Hospital,Hiroshima, which was only 100 feet from ground zero 5

2. Tada Hospital, Hiroshima, located 2,600 feet from ground zero. Inflammableportion of building burned and remainder was completely gutted 5

3. Japanese Red Cross Office Building, Hiroshima, 740 feet from ground zero 64. Interior of Japanese Red Cross Office Building, Hiroshima. Building was com-

pletely gutted and structural damage shows effects of downward thrust of blast.All occupants were killed 6

5. Exterior view, rear, of Red Cross Hospital, Hiroshima, 4,860 feet from center ofblast. Note destruction of surrounding properties and damage to the buildingitself 7

6. Interior, first floor. Red Cross hospital, Hiroshima; 90 percent of occupants werecasualties and hospital ceased operation for some time 7

7. Hiroshima Communications Ho.spital, 4,900 feet from ground zero. Though thebasic structure was not damaged, there was considerable functional damage andmany injuries to occupants 8

8. Front view of .\rmy-Navy Relief Hospital, Ujina, Hiroshima, located 10,400 feetfrom ground zero 8

9. Army-Navy Relief Hospital, Hiroshima. Note structural damage even at dis-tance of 10,400 feet 9

10. Exterior view of Army-Navy Relief Hospital, Hiroshima. Moderate damage wassustained by the building and many occupants suffered injuries due to fl.vingglass and other missiles 9

11. Exterior of Building 17, Nagaski University Hospital. The center of hospitalbuildings was 2,400 feet from ground zero. Note severe destruction despitebomb-resistance of the basic structure of the building 11

12. Side view of Building 33, Nagasaki University Hospital, showing extensive func-tional damage 11

13. Building 13, Nagasaki University Hospital, showing degree of destruction 1214. Buildings 35, 36 and 17, Nagasaki University Ho.spital 1215. Interior of amphitheater of Nagasaki University. Brass rails around the balcony

were melted by the intense heat 1316. View of corridor in one of the fireproof buildings, showing wreckage and complete

burn-out of interior 1317. Burned-out ward in one of the north buildings of Nagasaki University Hospital- _ 1418. View of one of the less severely damaged rooms of Nagasaki University Hospital _ _ 1419. Third floor corridor of Building 2 showing extent of damage.s 1520. Oculist examining room on second floor of Building 3, Nagasaki University

Hospital 1521. General view of central portion of Medical College, Nagasaki. The center of the

college was 1,700 feet from ground zero 1622. South end of grounds of Nagasaki Medical College. One small, reinforced-con-

crete building is standing but all others were destroyed by blast and fire 1623. View of grounds of Naga-saki Medical College showing little rubble after complete

destruction of surrounding buildings 1724. Interior of library, Naga-saki Medical College. All papers and volumes were com-

pletely consumed by fire 17

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Figure PagO25. Reinforced-concrete, record vault on second floor. There were small steel case-

ment windows on two sides away from the blast but solid walls on the near side.Records stored imder stairway were burned to ashes 18

26. Ruins in foreground represent remains of tuberculosis sanatorium, Nagasaki. Thebuildings were 2,700 feet from ground zero and were of inflammable construction. 18

27. Joint Commission Clinic at Hiroshima Railroad Station. This is illustrative ofthe manner in which the various teams of the unit worked 23

28. M. Y., 22 years old, male. Photo shows multiple lacerations due to flying glassfragments 26

29. T. Y., 18 years old, male, dressed in knee-length trousers and walking away fromblast. Third degree burns 2830. T. Y., 35 years old, male. Prone in open, 5,600 feet from ground zero, bare from

waist up, blast from direction of feet. Note sharp line of demarcation of heal-ing flash burns. Protected area on neck is due to folding of skin resulting fromextension of neck 29

31. S. S., 27 years old, male. Flash burns of back, arm, hand, face, and neck. Noteirregular outline of burned areas with more severe burns on expo.sed surfaces. _ 30

32. J. H., 53 years old, male. Sitting in Japanese house before open window at 6,000feet. Note sharp line of demarcation of healed flash burns on exposed sur-faces 31

33. M. M., 22 years old, male. Standing 6 feet from open window at 4,000 feet fromcenter of blast. Shows shirt which was worn at time of explosion and was notscorched 3234. Same patient as Figure 33. Note scars of healed flash burns of shoulder and backand sharp line of more severe burns on exposed surfaces. Shirt was notscorched 33

35. S. T., 49 years old, female. Note pigmentation of healed flash burns. V-shapedarea of protection on left shoulder was due to increased thickness of clothingat seam of insertion of sleeve and across shoulder to neck 34

36. H. K., 33 years old, male. Photo shows severe burns of exposed surfaces andsome burns of trunk through kimono. Note protection of skin of left chestdue to increased thickness of clothing at lapel of kimono 35

37. T. K., 34 years old, male. In open facing blast, wearing white shirt, blue coatand trousers. No change in shirt but coat and trousers charred. Severe flashburns and recovering from radiation sickness 37

38. Y. T., 19 years old, male. Photo shows localized alopecia in burned area belowline of cap and with no burns above and no generalized epilation. Note sharpline of protection of collar and severe burning of shoulder and trunk throughshirt - 38

39. .M. I., 19 years old, female. Flash burns of feet, blast from right. Note areaof unburned skin at base of great toe on left foot due to protection of Japanesesa ndal strap 39

40. S. N., 37 years old, male. Was working in open at 5,500 feet from center of blast,wearing trousers but bare above waist. Blast came from right. Note area ofprotection over spine due to shielding by right side-of back _ _. 40

41. Same patient as Figure 40. Note protection of under surface of arm and lateralthorax by position of arm at side 41

42. T. O., 55 years old, male. Was sitting before open window in position shown at6,000 feet, wearing long-sleeved kimono. Due to direction of blast he receivedsevere burns of exposed hands but only first-degree burn of exposed face andneck 42

43. H. T., 15 years old, male. Was naked above waist, in open at 5,250 feet, watch-ing United States planes. Note iiartially healed flash burns with excess granu-lation tissue and contractures of both elbows 44

44. Healed burns in both groins which apparently resulted from induced radio-activity of an iron key in right watch pocket and ahmiinum cigarette case inleft side pocket 45

45. Clinical summary of case recovering from radiation disease (Hiro.shima) SuniikoKanekuni. Age, 24 years. Sex, female. Occupation, none 47

46. Clinical summary of case dying of radiation disease (Hiroshima) Tetsumi Moto-yama. Age, unknown. Sex, male. Occupation, soldier 48

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Figure Page47. K. X., 9 years old, iiialc. Staiidiiij; in open 2,300 fi'ct fi-om blast. I'alictit

suffered lacerations and radiation sickne.ss. Photo shows generalized epila-tion 50

48. S. Y., 19 years old, female. Sitting on second floor of 3-story concrete building2,625 feet from center of blast. Patient suffered radiation sickness. Pliotoshows generalized epilation 51

49. S. I., 38 years old, male. Recovering from radiation sickness. Plioto taken3 months after bombing shows necrosis of gum and underlying mandible 52

50. Treatment plant. Public water supply. Slow sand filter unwatered and inprocess of being cleaned . 6051. Flush-type fire hydrant in street. Water on to supply domestic needs. Note

low pressure and opportunity for back syphonage 6052. Layout sketch of water supply, Nagasaki 6453. Sand filter beds and covered storage reservoir. Hongochihigh water plant,

Nagasaki 6554. Loading "honey buckets" of night soil on canal boats for transportation to rural

areas, Nagasaki 65

71327647 2 IX


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I. INTRODUCTIONMotlical Division of the Survey selected

urban and industrial areas infor the study of the effects of aerial bom-

upon the public health and upon healthAs special United States Army and

medical missions svere making intensiveof the nature and scope of casualties from

atomic bombs, no special emphasis was placedthis phase of the general health problem,

the survey at Hn-oshima and Nagasaki wasalong the same lines as in othsr cities.

information contained herein concerning theof casualties from the atomic bombs wasderived from data obtained from theseand Navy missions and "The Report of

British Mission to Japan on an Investigationthe effects of the Atomic Bombs Dropped at

and Nagasaki" which contains datafrom the same sources.

report presented here briefly outlines thediate and remote measurable effects of the

bombs and the subsequent widespreadon the health of the civilian population.investigation includes the different phases of

health following the outlme used in thehealth survey of Japan. This reportchapters which relate to medical and

facilities and services, nature of air-raidsanitary facilities and services, food

and nutrition, communicable diseases, andhealth and hygiene.^was a notable difference in the attemptedof public health services in the two

At Nagasaki, the occupation forces hadup headquarters with an active section on

health in the local military government.group was supervising and assisting in the

of hospitals, clinics, disease reporting

and control, and tiie various necessary healthservices. At Hiroshima, however, the local pub-lic health program had been largely delegated toJapanese officials, who had taken over severalbuildmgs for use as hospitals, and had assistedin the reoccupation of the Retl Cross Hospitalwhich had ccaseil operation as a result of thebombing. Teams of Japanese physicians andmedical students from the large medical centerswere carrying on limited treatment of bombvictims. SURVEY STAFFThe staff of the Medical Division of the Survey

consisted of six officers and one civilian from thePublic Health Service, three officers and fourenlisted men from the Army. The Chief of theMedical Division, Brig. Gen. Lewis R. Thompson,Assistant Surgeon General, United States PublicHealth Service, could select freely the PublicHealth Service officers attached to the Survey,and chose officers known for their ability in certainfields of public health work. The Array andPublic Health Service officers detailed to theseseveral fields were: Maj. Luther L. Terry, UnitedStates Public Health Service, medical facilitiesand persomiel and nature of bomb casualties;Lt. Col. Robert H. Flinn, United States PublicHealth Service, industrial health and hygiene;Maj. Robert S. Goodhart, United States PublicHealth Service, and Maj. Henry J. Rugo, A. U. S.,food supply and nutrition; Maj. Jesse Yaukey,United States Pubfic Health Service, communi-cable diseases; Col. Ralph O. Tarbett, UnitedStates Public Health Service, and Capt. Paul J.Houser, A. U. S., sanitary facilities and services.Mr. Lester J. Marier of the United States PublicHealth Service acted as executive secretary forthe Medical Division.


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II. EFFECTS ON MEDICAL FACILITIES AND PERSONNELIn order to appreciate the effects of the atomic

bombs on Hiroshima and Nagasalvi one mustreahze something of the chai'acter and extent ofmedical institutions in the two cities. In addi-tion, it is important for one to reahze the magni-tude of the destructive forces since tliey so com-pletely surpass all previous concepts of destruc-tion that one might have when thinking in termsof ordinary incendiary or high-explosive bombing.A. STATUS OF MEDICAL CARE PRIORTO BOMBING

1. Generally speaking, the Japanese are notaccustomed to good medical care as one uses theterm in light of practice in the Western world.Hospitals are usually available to only those whoare able to pay and the average Japanese citizenhas never been educated to the value and use ofhospitals. Though the number of physicians perunit of population compares favorably with thatin the United States, the average physician ispoorly trained and the character of medicine whichhe practices is far below Western standards.Even the licensed physicians resort to unconven-tional and unscientific methods which have theirorigin in Fai-Eastern religion and superstition.In addition, the government licenses a group of"persons engaged in the traditional methods oftreatment," such as acupuncture, massage andmoxa. There are also a large ninnber of un-licensed cultists who treat persons by means offaith healing. Both the licensed and unlicensedcultists have fairly large followings, particularlyin the rural population and the lower classes

2. The average Japanese hospital is a smallprivate hospital which consists of 10 to 50 beds.Actually, the term "beds" is used loosely in thisrespect since few of them have western-style beds.The rooms in such hospitals are very much likerooms in Japanese homes with tatami flobrs andbeds made by spreading bedding (Futon) upon thefloor. It is thus impossible to give an accuratebed capacity, this figure actually representingthe number that can be crowded into the avail-able space. On the other hand, the larger cityinstitutions and university hospitals are usuallywell equipped, of modern construction and usewestern beds throughout. Despite this fact,there are in every city large numbers of thesesmall Japanese-style hospitals. Too, a large

percentage of the population never go to hospitals,but are born, have their illnesses and babies, anddie in their own homes. Most of the births inJapan are attended by midwives.

3. Hiroshima and Nagasaki did not differ fromthe usual medium-sized Japanese city. Hiro-shima had two Army hospitals and an Army-Navy relief hospital in addition to the civilianinstitutions. The Red Cross Hospital and theCommunications Hospital were modern structuresand were the better institutions of the city. Inaddition there were many small Japanese hospitalsscattered over the city. In the spring of 1945 amedical college was started in Hiroshima and thefirst class had matriculated. Though no schoolbuilding was available they were bemg taught inone of the local hospitals at the time of the bomb-ing. The supply of doctors and nurses seemedup to Japanese standards and it was thought thatthe city was well provided with medical care.

4. The situation in Nagasaki ditt'ercd from Hiro-shima in that it possessed one of the finest medicalcenters in Japan. The University Hospital wasthe pride of the city and was reputed to be secondto none m Japan except the Imperial UniversityHospital in Tokyo. It was a large modern unitconsisting of numy Ijuildmgs and contained about500 beds. This number represented more thanthree-quarters of the hospital facilities in thecity. The Medical College was located near thehospital and had a large staff of well trainedteachers. There were in addition a tuberculosissanitorium and many small private and hidustrialhospitals. Here too, the number of physiciansand nurses seemed to be adecjuate in comparisonto other Japanese cities.

5. Since most of the other large cities of Japanhad l)een subjected to demolition and hieendiaryraids during late 1944 and 1945 it was natural forNagasaki and Hiroshima to ex})ect similar treat-ment. Hiroshima contained no large war indus-tries and had been bombed on one previousoccasion only. At that time a single B-29 haddrojjped several demolition bombs on a suburbandistrict but there was little damage done. Naga-Siiki had experienced demolition bombing onseveral occasions but these raids were directed atkey industrial plants. On 1 August 1945, 6bombs were dropped on the University Hospitalhittuig the operating room and laboratories and

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in tlu' dn\X\\ of 3 stiulcnts and 30-4(1casuallifs. Many patii'iits wore tlicii cvani-as an air-raid precaution. The Inct that

had been so comi)l('t('ly spared ofapparently gave rise to some rumors

tlie city was being saved for some "fantastic"Several survivors relate havin


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use so that soon the conflagi'ations were beyondcontrol.

5. In Nagasaki a similar but slightly less cata-strophic pictui-e occurred. The blast was notcentered over the main business section of thecity but was up the valley about 2 miles. Therewere large mdustrial plants, hospitals, the medicalschool and partially built-up residential areasnear the ground zero. The terrain in this areawas uneven with large hills which shielded certainareas. Due to the shielding factor and the dis-tance of the explosion from the center of the city,Nagasaki was less completely destroyed thanHiroshima and the panic was apparently less.

C. THE FATE OF MEDICAL FACILITIES1. The fate of the hospitals in Hiroshima is

particularly interesting in the light of this chaosand destruction. Many of the smaller hospitalsand clinics were located in the center of the cityand were of typical Japanese construction. Forinstance, the Shima Surgical Hospital (Fig. 1) wasonly 100 feet from ground zero. It was partlybrick but largely wooden construction. The blastblew it flat, and it is believed that all of the occu-pants were killed immediately. The remains ofthe building burned, and the spot is now a mass offlattened rubble. The Tada Hospital was partlyreinforced concrete and partly wooden construc-tion. Located at 2,600 feet from gromid zero itwas completely demolished, and the only remnantswere the concrete foundation and the gutted andbroken concrete portions of the building (Fig. 2).The exact fate of its occupants could not bedefinitely determmed but it is believed that theywere all killed by the blast and succeedmg fire.Another building of medical nature which waslocated near the center of the blast was the JapanRed Cross Office Building. It was only 740 feetfrom ground zero and was almost completelydemolished. The windows, wmdow casements,and doors were blown out and even the concretestructure was broken by the downward thrust ofthe blast. The building was then gutted by fireand all occupants perished (Figs. 3 and 4). TheHiroshima Army Hospitals No. 1 and No. 2 werelocated withm 1,500-2,000 feet of ground zero.It is reported that 80 percent of the persoraieland all of the patients (500 in No. 1 and 650 inNo. 2) were killed. The ultimate fate of the sur-viving 20 percent of the personnel is not known,

but on the basis of other experiences at thisdistance it is probable that a large percentage ofthem died of injuries or radiation effects. Thehospital buildmgs collapsed and burned. TheRed Cross Hospital, which was the city's largestand best hospital, was located 4,860 feet fromgroimd zero. The basic structure of the building,which is reinforced concrete, remained virtuallyintact. However, steel window casements wereblown out or twisted and torn on the side nearthe blast (Fig. 5) and the interior was seriouslydamaged by fallmg plaster, broken partitions, andfalling ceilings (Fig. 6). There were 90 percentcasualties of the occupants of this buikUng andthe damage was so great that the hospital ceasedoperation for several weeks after the bombing.It did, however, serve as a first-aid station andout-patient clinic in the interim. Practically allinstruments and supplies in this hospital werecompletely destroyed or damaged beyond repair.The Hiroshima Communications Hospital waslocated at a similar distance from the groundzero, 4,900 feet. It, too, was of reii\forced-con-crete construction. Though the concrete frame-work of the building remained intact it sufferedeven more severe damage than did the Red CrossHospital. Steel window casements were blownout, partitions blown down, and all of the contentswere damaged beyond repair (Fig. 7). It was laterreoccupied as were most of the buildings wliicliwere left standbig. An example of a hospitallocated at greater distance from ground zero isthe Army-Navy Relief Hospital. It was 10,400feet from the ground zero and sustamed consider-able damage (Figs. 8, 9, and 10). The building wasstucco and two floors in height. Though it didnot collapse, it was seriously damaged. Most ofthe tile roof was bioken and blown off, windowframes were broken and blown out, and in a fewplaces walls were crushed. The principal mjuriesto the occupants of this hospital were due toflying glass and other missiles. Many smallerhospitals and clinics were destroyed in similarmanner, depending upon their distance from thecentei' of the blast. Since practically all of thesebuildings were of wooden construction they wereeither blown down and/or burned shortly there-after. There was little evidence of their existeiH'eto one who came into the area later. It has beenimpossible to trace the fate of theu occupants butit is felt that it coincided to some extent withthe fate of other persors in Japanese-type homes


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Figure 1.The rubble in the foreground i^ ihc- rcjiiains of the Shinia Surgical Hospiial, Hiroshima,which was only 1(10 leet from ground zero.

figure 2. 1 aua Hospital, liiiosliima, located 2,600 feet fromground zero. Inflammable portion of building burned andremainder was completely gutted.


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Figure 4.Interior of Japanese Red Cross Office Building, Hiroshima. Building was com-pletely gutted and structural damage shows effects of downward thrust of blast. Alloccupants were killed.

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Figure 5.Exterior view, rear, of Red Cross Hospital, Hiroshima, 4,860 feet from centerof blast. Note destruction of surrounding properties and damage to the building itself.

Figure 6.Interior, first floor. Red Cross Hospital, Hiroshima; 90 percent of occupantswere casualties and hospital ceased operation for some time.


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Figure " I I 1 1 < ,li i ma < m n:. uons Hospital, 4,900 feet from ground zero. Thoughthe basic siruciure was not diiniaged, there was considerable functional damage andmany injuries to occupants.

Figure 8.Front view of Army-Navy Relief Hospital, Ujina, Hiroshima, located 10,400feet from ground zero.


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Figure 9.Army -Navy Relief Hospital, Hiroshima. Note structural damage even atdistance of 10,400 feet.

Figure. 10.Exterior view of Army-Navy Relief Hospital, Hiroshima. Moderatedamage was sustained by the building and many occupants suffered injuries due toflying glass and other missiles.


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at similar distances from ground zero. Actuallythe incidence of flash burns was probably lower,since few of them would liave been outdoors, butthe secondary injuries were probably higher. In-asmuch as they were already ill and many nodoubt were helpless, the mortality rate surelyexceeded that of the general population at com-parable distances.

2. Thus it may be said of Hiroshima thatessentially all of the civilian hospitals an.d 2 largeArmy hospitals were located within 5,000 feet ofgi'ound zero and were fmictionally completelydestroyed. Those within 3,000 feet were totallydestroyed and the mortality rate of the occupantswas practically 100 percent. Two large hospitalsof reinforced concrete construction were located4,860 and 4,900 feet from the ground zero. Thebasic structures remained erect Imt there was suchsevere interior ilamage that neither was able tocontinue operation as a hospital. The casualtyrate in these 2 hospitals was approximately 90percent. Hospitals and clinics beyond 7,000-10,000 feet often remained standing but werebadly damaged and there were many casualtiesdue to flying glass and other missiles.

3. The destruction of hospitals in Nagasalvi waseven more outstanding than, that in Hiroshima.Suxce the Nagasaki University Hospital containedover three-quarters of the hospital beds m thecity it represented the bulk of the city's hospitalfacilities. The center of the hospital groinids wasonly 2,400 feet from ground zero and from afunctional standpoint the hospital was completelyobliterated. Most of the buildiiigs were of rein-forced-concrete construction but a great deal ofwood was used in interior construction and fittings.The basic structin-e of al) these builduigs remainedessentiaUy intact but there was severe damageotherwise (Figs. 11-20). The blast effects werevery severe and almost every building was guttedby fire. The mortality rate of occupants of thishospital was at least 80 percent, two-thirds beingkilled outright. The Nagasaki Medical Collegewas located even closer to ground zer-o, bemg only1,700 feet distant. A large portion of the build-ings were of inflammable nature l)ut a few smaUbuildings were constructed of reinforced concrete.The wooden buildings were blowir down and sul>-sequently consumed by flames. The concretestructures remained erect but were completelygutted by fire (Figs. 21-25). Of the 850 medicalstudents present 600 were killed and 12 of the 16

professors were also lost. The third and fourthyear medical students escaped by virtue of thefact that they were elsewhere at the time of thebomb blast. Almost all of the other occupantsof the bufldLn.gs were kflled outi-ight. All medicalequipment and supplies m the medical collegebuilduigs were completely destroyed by blast andfire. The Nagasaki Tuberculosis Sanitorium waslocated across tbe vaUcy from the coUege and thehospital but was only 2,600 feet from gromid zero.Since the buflding.s were aU of wooden constructionthey were completely destroyed by blast and fire(Fig. 26). It was reported that all of the patientsand other occupants of the sanitorium were kiUed.Except the 2 hospitals mentioned above therewere no others of any size located within Nagasaki,although there were many small private hospitalsand clinics of typical Japanese construction, scat-tered throughout the city. The fate of thesebuilduigs and then- occupants corresponded uigeneral to that of buildings of similar constructionat comparable distances Irom the bomb in Hho-shimi. However, there was an additional factorof the hills shielding some structures in Nagasaki.In Hiroshima the eft'ective zone was enthely flatand hills on the outsknts of the city were so dis-tant that they did not interfere with the effects ofthe bomb to any appreciable extent. On theother hand, in Nagasaki many structures thatwould otherwise have suffered much more severedamage were partially or completely protectedfrom the Ijoml) effects liy hills.

4. In summarJ^ it may be said of the hospitalfacilities in Nagasaki that over 80 percent of thehospital beds and the Medical College were locatedwithin 3,000 feet of ground zero and were com-pletely destroyed. Reinforced-concrete buildingswithin this range remained standing but weri'completely gutted l)y fire; buildings of woodenconstruction were completely destroyed by firoand blast; the mortality I'ate of occupants of thisgroup of buildings was about 75-80 percent.

D. RESTORATION OF HOSPITALSAFTER BOMBING1. All jiniazing feature of the atomic bombings

to one going into the ai'cas later was the poorI'ecuperative powers of the population towardstlu^ restoration of all types of facilities. Thoughthis was probably less so in the medical field thanin others it was still alarmingly apparent. The

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Figure 11.Exterior of Building 17, Nagasaki University Hospital. The center ofhospital buildings was 2,400 feet from ground zero. Note severe destruction despitebomb-resistance of the basic structure of the building.

-^^

fi^i 1

Figure li.Side view of Building 33, Nagasaki University Hospital, showing extensivefunctional damage.

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Figure 13-Building 13, Nagasaki University Hospital, showing degree of destruction.

Figure 14.Buildings 35, 36 and 17, Nagasaki University Hospital.12


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Figure 15.Interior of amphitheater of Nagasaki University Hospital. lirass rails aroundthe balcony were inelted by the intense heat.

Figure 16.View of corridor in one of the fireproof buildings, showing wreckage andcomplete burn-out of interior.13


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Figure 1 7.Burned-out ward in one of the north buildings of Nagasaki University Hospital.

Figure 18.View of one of the less severely damaged rooms of Nagasaki University Hospital.14-


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Figure 19.Third floor corridor of Building 2 showing extent of damage.

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Figure 21.General view of central portion of Medical College, Nagasaki. The center ofthe college was 1 ,700 feet from ground zero.

-' Msi -'^-""11*^11111 ~ - '" >'''^~ ^~ -;.l^aki Medical (College showing little ruhlilc ilitcomplete destruction of ^urr^)undi^g buildings.

Figure 24.Interior of library, Nagasaki Medical College. All papers and volumes werecompletely consumed by fire.


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Figure 25.Reinforced concrete record vaulc on second floor. There were small steelcasement windows on two sides away from the blast but solid walls on the near side.Records stored under stairway were burned to ashes.

Figure 26.Ruins in foreground represent remains of lubercu!i>Ms >,uiitrium, Nagasaki.The buildings were 2,700 feet from ground zero and were of inflammable construction.18


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i>f till' iicopic imiiicdintcly after tl\(' l)()inhing-so i^ri'tit that Ilinisliiina was literally (lescrtcd.

was apparently less true of Nagasaki and I insprobably due to the fact that tlie city was less

deslroyeil, but the same apathy wasThe collossal efl'ects of (lie l)()nd)s and the

followinfl'ects

the lyjilioons of Sept(>inber and eai'ly Oclo-may have conlril)Uted to this psycholoiiicalSince the most outstanding- feature of thebombs was the hiyh rate of human casual-

it was natural that this was the greatestin the. areas following the bomlting.

even in this regard tlu' progress was astound-slow and hajihazard. Other cviilcnces of

were almost cora])letely absent. Forat the lime the Medical Division visited

:i months after the bond)ing, the firstcar was beginning operation, i)eo])le wan-aindessly about the ruins, and only a fewhad been built as evidence of reocciipation

the city. Xo system for collection of night soilgarbage had been instituted. Leaking water

were seen all over the city with no I'videnceany attention. It was reported that followingbond)ing several days were required for dis-of the dead and then they were simply piledheaps and l)urned without attempts at

or enumeration. Street cars wereas a method of cremating the bodies within.

in all, there appeared to be no organizationno initiative.The care of the wounded immediately afterbombmg was essentially nil in Hiroshima.

the sphere of family ties there seemed tolittle concern for their fellow man. It is true

essentially all of the medical sui)plies wereby the bombing, and that there were

hospitals and little with which to work. Forfirst 3 days there was no organized medical

At the end of this time the Prefect uralDepartment was successful in getting aof the surviving physicians together and

begin ministering to the wounded who re-in the city. Up until tliis time all nursing

medical care had been on an individual basis.more seriously injured were placed in the few

public buildings on the outskirts of theMany of them died but many seriouslycases remained. Small stocks of medical

sup|)lies which had been stored in cax'es outsidethe city were brought out but were soon e.xhaustcd.\A'ith ail mediial su|)|)lies gone and practicallynone being brought in the ti-catmcnt of the injuredseems to have consisted largely of olfei ing a, placeof refuge. There is no doubt that many died whomight hav


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treatment and other groups were ofRcially trans-ferred by the Japanese Government to medicalcenters in Osaka, Kyoto, and Tokyo for studyand treatment.

5. Most of the fatahties due to flash burns andsecondary injuries occurred within a few daysafter the bombing. The peak of deaths due toradiation effects was not reached until late Augustor the early part of September. Very few casessuffering from radiation died after 1 October anddeaths due to other causes had practically ceasedby this time. Thus during October the essentialmedical care was directed almost exclusivelytoward burn cases, most of which were flash burns.A large number were still in hospitals but the vastmajority of these patients could be treated as out-patients. By 1 November adequate hospitalspace was available but it was still of emergencynature and medical supplies were inadequate.Many of the burns remained unhealed. Inade-quate medical care, poor nutrition, and secondaryinfection were important factors in this delayedhealing.

6. The effects of the atomic bombing of Naga-saki were very similar to those in Hiroshima.Even though it followed the bombing of Hiroshimaby 3 days, wartime secrecy, general confusion andthe short elapse of time did not allow the popula-tion of Nagasaki any particular advantage fromthe previous experience. The psychological reac-tion of the people was essentially the same and thechaos in the city seems to have been almost asgreat. A very important difi'erence lietween thetwo cities was that Nagasaki was not so completelydestroyed. Further, the bomb blast was cen-tered over a more industrial area and the characterof the buildings resulted in less extensive fires.But from the medical standpoint the bombmgwas particularly catastrophic because the bulk ofthe city's hospital facihties were located within aradius of 3,000 feet of the center of the explosion.The destruction of the University Hospital andthe Medical College was so great that the buildingsleft standing could not be rcoccupied even foremergency medical care. Other hospitals andclinics, includmg the Tuberculosis Sanitorium, hadburned to a heap of ashes. The only remainingfacilities were small private clinics and hos])itnlsand many of them were seriously damaged. Essen-tially no organized medical care was carried out forseveral days after the ])ombing. The SliinJvosenhospital was established in an old school ])uiiding

for the care of bomb victims, but it was woefull\inadequate. At one time it harbored over .500victims. Fortunately, there was a large medicaldepot at Omura, 20 miles away. Such large stocksof supplies were on hand here that Nagasaki didnot suft'er in this respect as did Hiroshima. An-other school building was converted into an infec-tious disease hospital.

7. At the time the Allied Military Governmenientered Nagasaki, about 1 October, the populationwas found to be apathetic and profoundly lethaigic. Even at this time the collection of garbageand night soil had not been reestablished, restora-tion of other public utilities was lacking and thehospital facilities were inadequate. Tlu-ough theinitiative of the Military Government, a system ofreporting mfectious diseases was instituted, thecollection of garbage and night soil was reestab-lished, and attempts were made to increase thesupply of safe water. A survey of the remaininghospitals and clinics at this time by CaptainHome of American Military Government revealedsuch obvious inadequacies that the survey was noteven completed. A perusal of the incomplete re-port reveals that there were many small privatehospitals remaining, most of which were damagedand without satisfactory potential value even ifthey were repaired. In the face of the inadequacyof the Shinkosen Hospital, and the absence of otherfacilities in Nagasaki, boml) victims were trans-ferred to the Omura Naval Hospital where theconditions were much better. The ShmkosenHospital has now been evacuated and abandoned.

8. When Nagasaki was visited by the MedicalDivision, about three months after the bombing,conditions were stUl very primitive. A visit to theInfectious Disease Hospital revealed that theschool building in which it was located had beenseriously damaged by bombing and no repairshad been made. The roof was part ially destroyed,there were no window panes and the building wasfilthy. All of the patients, both male and female,were in adjacent beds in the same ward. Membersof their families were present and were going inand out at will. The hospital had a capacity of35 beds and contained 21 patients; 18 cases ol'dysentery and 3 cases of typhoid fever, at thetime of the visit. There were no isolation pic-cautions in pracitice. The only medicine andsupplies were those furnished ])y the Military'Government. Because of these conditions theMilitary Government had taken over a Japanese

20


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hospital of 103 hods and 12 hassiiicts andconverting it for uso as a .Tai)ancs(' civihan

It was cxpoctt-d to hi' availahlc verytlunraftor. The Oiuura C.cncral Hos-

(formerly a Xaval liospital) was in excellentand was heing used for the care of atomic

victims. Thus, it may be seen that by 1some senil)laiice of medical care andjirocedures liad lieen reestablished in

but the facilities were still inadequate.entire program had to bo directed and forced

the Americans though they did not enter theuntil nearly 2 months after the bombing.The devastating etfects of the atomic bombsmedical facilities can be appreciated in theof the foregoing presentation. Not only were

existing facilities almost completely destro.yedthere was extreme apatlij- toward the restor-of hospitals and the care of the injured.

ON MEDICAL PERSONNELIt was almost impossible to get any accurate

relative to the number of doctors,and other medical personnel in the area

to bombing, the number injured and killed,the number actually present at the time

visit by the Medical Division. Data ob-from various sources showed extremeand were often mu-eliable. Naturally,

medical pereonnel in general met the sameas others located at the same distances frombomb. The number of casualties also prob-bore a direct relationship to the fate of

since medical personnel would be con-at those institutions and rouglily into the size of the hospital or clinic.

The number of physicians in Hiroshima priorbombmg has been variously estimated fromto 298. The former figure was suppHed toMedical Division by the Prefectural Healthand the latter figure was included in an

by the Prefectural Governor on 9 Sep-1945. The actual figures prot)ably fallthese two extremes. Regardless of the

number it is knowTi that the casualty ratethis group was veiy high. About 90 per-

were casualties and 60 of these physicianskilled. One month later only 30 physiciansable to perform their usual duties.The Hiroshima Prefectural Medical Collegestarted in the spring of 1945 and the first

class had mali'iculated. As a result of the bond)-ing the liospital was demolisheil and one memberof tlic i'acuKy Wiis killed and aiiotiuT injured.The nund)er of students killed and injured couldnot l)e detei'mined.

4. Prior to the bombing there were 1,780nurses in Hiroshima. Of these, 1,054 were killedor injured on (1 August. Consequently, the citysuffered greatly because of the lack of nurses andmany imti-ained volunteers had lo be pressed intoservice in caring for the injiu'ed.

5. The experience in Nagasaki was very similarto that in Hiroshima. The exact numlxsr ofphysicians in the city piior to the bond)ing couldnot be determined but there were ])robably about200-250 in 1944, This number may have de-creased slightly in 1945 as a result of actualbombing and the effects of partial evacuation ofthe city in preparation for raids. Due to thedifferent character of the two cities it would atfirst appear that the loss of medical personnelwould have been proportionate^ less in Nagasaki.Howi!ver, a factor which counterbalanced thisfact to some extent was that the largest numberand best of the medical ])ersonnel were concen-trated in the medical school and the UniversityHospital, both of which were completely destroyedwith a large percentage of their occupants.Actual investigation as of 1 November revealedthat there were about 120 physicians in Nagasaki.So apparently the city did fare better than Hiro-sliima wliich had less than half that many phy-sicians at about the same time.

6. The damage to the Nagasaki Medical Col-lege and University Hospital has already beendescribed. Reports reveal that 600 of the 850medical students were killed and some othersmay have died later. Of the sumnvors practicallyevery one was injm-ed and at least half had radia-tion sickness later. There were 16 of the 20facidty members present at the time of the bondj-ing and 12 of them were killed and the othersinjured.

7. The casualty rate among nui'ses in Nagasakicould not be accurately determined. Therewere 683 nurses in the city on 1 November butit is not Icnown how many of those had come inafter the bombing. The precentage of fatalitiesand injuries probably closely paralleled tliat ofthe physicians but no accurate figures are avadableto support tliis supposition.

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III. NATURE OF ATOMIC BOMB CASUALTIESA. INTRODUCTION

1. Several groups stiulie


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71327647 23


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tion must await final analysis of the data for thecombined i-cport. The material presented hereinmust be considered preliminary and may be al-tered in some details by the final and completestudy. It is felt, however, that it presents asummary of all the information available on thesubject at this time. Generally speaking, theeffects may be divided into three large groups:

(1) Secondary injuries, consisting of blast ef-fects, secondary burns and injuries produced byfalling and flying debris.

(2) Flash burns.(3) Radiation effects.

Inasmuch as each of these categories seems to bequite distinct they will be discussed separately.

B. SECONDARY INJURIES1. The blast effects of the atomic bombs as m-dicated by the eft'ects on objects and persons in the

target area are similar in most respects to thoseof other blast weapons. Examination of struc-tures and clinical material indicates that the pos-itive phase was probably longer than is usuallyseen in the high explosive blast, and that the nega-tive phase was also of long duration. It is diffi-cult or impossible to state the exact effect that theblast had on human life. There is evidence thatthe effects were considerable on structures andprobably was responsible for many deaths nearthe center of the explosion. However, since theblast eft'ects were combmed with other effects suchas primary and secondary burns, radiation effects,and the injuries produced by falling debris, theexact degree to which it influenced the number ofdeaths cannot be accurately stated.

2. One factor which must be considered in astudy of the blast eft'ects is that the bombs wereaerial burst and even at ground zero a person orstructure was some distance from the center of theexplosion. It is well to remember, too, that nearthe center of the explosion the blast eft'ects weredownward. Toward the periphery of the eft'ec-tivc zone the blast became more lateral in direc-tion. It a])pcar.s that few persons were thrownagainst buikhngs but that most of the blast eft'ectsresulted in casualties by collapsing buildings andflying missiles, especially glass. Ai)parentiy therewere comparatively few instances of legs oi- armsbeing torn from the body by flying debris. It wasi-eported in Nagasaki that there were eviflences ofoverpressure in the shock wave. Large numbers

of the dead were said by survivors to have theirabdomens ruptured and intestines protruding.Others were reported to have shown protrudingeyes and tongues and to look as if they had l^eendrowned. Such accounts were not obtained inHiroshima. Genuine effects of overpressure seemto have been rare. Among the survivors therewere a few cases of ruptured eardrums. Of 106cases examined by the Japanese in Hiroshima on11-12 August, only .3 showed ruptured eardrums.A study done in October at tlu Omura hospital re-vealed that only 2 of 92 cases from Nagasaki hadruptured eardrums and 3 other cases may havedied. On the basis of the available informationthe British have estimated that the maximumpressure under the liomb probably did not reachtwo atmospheres. Most observers felt that trueblast effects alone were rare and probably ac-counted for only a small percentage of thecasualties.

3. The secondary burns probably accounted fora considerable number of the deaths in both Hiro-shima and Nagasaki. Large numbers of struc-tures were blown down upon people and shortlythereafter caught fire. The accounts of eye-witnesses who were in the area at the time attestto the large number of people who were injuredand pinned beneath debris and finally succumbedto the eft'ects of heat from the burning collapsedstructures. In interviewing at a later date per-sons who showed burns it was felt that compara-tively few of these were secondary burns. Mostof the people who succumbed to secondary burnswere injured otherwise or pinned beneath debrisand therefore were unable to escape from the fires.There were a few instances of definite secondar}'burns which were minor among people who sur-vived. It is probable that most of the peoplewho acquired secondary burns were so disabled byother factors that the burns were responsible fortheir death. The fires particularly in Hiroshimaapparently built up more slowly than has beenencountered in cities that were subjected to heavyincendiary raids. This gave persons more timeto escape from the damaged or demolished build-higs. There are relatively few instances reportedwhere people were able to escape from buildingsand yet appeared to succumb to secondary burns.Large numbers of people who suffered other effectsfrom the bomb tell of their escape through thedemolished and partially burned city, but therewere no reports of large inimbers of people drop-

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in the center of the streets either from theof heat or from tlie effects of carbon mon-

snch as was seen in Tokyo, Osaka, or in thecities. Some of the secondary burns inapparently resulted from their effortsmembers of their families or others from

collapsed and burning buildings. A few sec-burns resulted from jirimary flaming ofbut many people reported such instancesthey were able to beat the fires out with-

sustaining burns of the underlying skin.The injuries produced by falling and flyingwere apparently large in number. As onenaturally expect, the percentage and seri-of such hijuries was much greater near

center of the bomb explosion. It appearsinterviews of survivors that the collapse of

buildings was sudden and that thousands ofwere pinned beneath the debris. Afterperiods of time many were able to extract

and many were extracted by the assist-of others. The natia-e of these injuries didvary greatly fiom what one might expect.

niunbers of these jjeople succumbed duefact that they could not be extracted from

debris. Though the Japanese houses are gen-of light construction, they usually carryroof timbers and heavy tile roofs. These

probably played a considerableui the large numbers of such casualties.

feature of Japanese construction whichmany minor casualties was the extensive

of glass panels. Injuries by lijjnng glass be-e more prominent at increasing distancesground zero; as the more serious casualty-

factors faded in the periphery, thedue to flying glass became mcreasingly

(Fig. 28). It should be noted thatsuch uijuries were frequent, they rarelyin death.Available information indicates that second-

injuries occurred up to distances of 15,000from ground zero. Japanese houses collapsed

a radius of about 7,000 feet at both Hii'o-and Nagasaki, but serious damage I'esulted

much wider range. For instance, at Nagasakimeteorological station which was located onexposed hill at 16,000 feet had all of the win-

broken on the near side and many of theframes were broken aTid displaced. A

part of the roof was stripped of tiles. Manyin Hiroshima suffered damage to glass

and overhead gear at distances up to 15,000 f(>(>t.It appears that secondary injuries, particularlythose of lethal natiue, began to fall off rapidlyat distances beyond 7.000 feet, but that many ofminor nature did occur up to 15,000 feet.

C. FLASH BURNS1. The (Icgi'i'c of I lie heal blast whicli lollowcd

shortly after the explosion of the atomic l)()tnbsin the two cilii's lias not been accurately estimated.The British rcjxirt reveals that considerable studyof physical structures was tlone in an attempt toevaluate the amount of heat present at variousdistances from the center of the explosion. It iswell known that the duration of the flash wasextremely biief, probably a small fraction of asecond and that the heat wave followed the obser-vation of the flash of th(> exploding l)oml). Thispoint is emphasized by the fact that many peojilefacmg the blast were able to close their eyesIx'fore the heat wave reached them. Japaneseclaim that in some instances persons were able toshield their faces with tlieir hands between thetime the flash was seen and the time the heatwave reached them. The British report pointsout the roughening of polished granite whichoccurred in Hiroshima up to distances of 1,200feet or more and in Nagasaki up to a distance of1,800 feet or more from the ground zero. Japa-nese scientists investigating this problem havereported that this effect occurred up to 3,000 feetat Hiroshima and 5,000 feet at Nagasaki. Basingtheir estimation on the depth of roughening orspalling of the granite, the Japanese physicistshave estimated a ground temperature at 1,500feet from ground zero at Hiroshima to haveexceeded 2,000 C. The British group wereunable to concur in this figure and felt that itshould be treated with reserve. In addition tothe effects on polished granite other evidence ofhigh temperature such as the bubbling of tileswas seen in both cities. The tile bubbles becameprogressively smaller at increasing distances fromground zero. On the basis of the study of thetile, Japanese geologists feel that the temperaturenecessary for such effects is near 2,000 C, witlia minimum of 1,200 C, and that such phenomenaoccurred at distances beyond 2,000 feet in Naga-saki and beyond 1,500 feet in Hiroshima. Theyfeel that these observations confirm their estimatesbased on the effect on polished granite. In addi-

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Figure 28.M. Y., 22. years old, male. Photo shows typical multiple lacerations due to flying glass fragments.

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lo llu" ("frocts on polislicd gniiiilc and tiles,were clVccts on olluT ()l)ji'cts sucli as road

treated and untreated tindiei's. I'alirieshuman skin whieli aided in estiniatinii' the

of heat present at various distances fromzero. Instanees of spontaneous ilaming ofwere reported to have occurred l)e\ond

feet. Scorching of teU^graph |)oles dis-at roughly 9.001) feet in Hiroshima and

feet in Nagasaki. It thus ap|)ears thatheat wave following the explosion of the atomic

extended over a large area and that ilgreat intensity within a radius of o.OOO-

feet. Exact figures cannot he given attime Itut more detailed study may in time

this point.Another interesting and significant feature

the heat wave was shadows cast by interveningwhich protected otherwise exposed surfaces

the direct heat radiation. All interveningwere successful in shielding objects and

occasion clumps of grass or the leaf of a tree wasto ofi'er some protection before they withered

burned. Due to the size of the radiating firenarrow objects were found to cast shadows

than themselves and with gradient edges.feature will be elaborated upon later in dis-

the flash burns of human skin.The eftect upon fabrics was particularly in-

Material which was examined in Hiro-showed clearly the dift'erence in the absorp-

of beat between dark colored fabrics andcolored ones. For instance, a white cottonwhich was examined had pale pink sleeveswhich was superimposed print green leaves

red flowers. Over one shoulder of the gar-the red and green colored areas were burned

and over a larger surrounding area the coloredwere partially burned. The white, how-

remained intact. In a shirt of alternatingand light grey stripes about one-eighth inchthe dark stripes completely burned out but

light stripes scorched only slightly. A whitewith blue polka dots showed the dots to be

over a large area while the white remainedA kimono with white lozenges on abackground showed large areas wliich were

It was said to have been fired directlybad to be beaten out. On the edges of the

area the white figures had survived bute blue was charred. It was generally recognizedthe Japanese in the two cities that persons

were more likely to he burned at the same distancefi'om the homli exjjlosion if they were wearingl)lack or dark colored clothing. Tiie British re-])ort a i)ieee of ,hi|)ancse paper on which characterswere written in black ink and the characters hadbeen burned out at a distance of 7,500 feet. Theyalso obtained reports but did not see evidence thatred iid< survived where black ink was l)urned out.The inlluence of the nature of the coloring nuittercannot be entirely ruled out, but it is felt thatthe absorption of radiant heat due to the coloritself was the piime factor in this dift'erentialdestruction of various colored garments.

4. The eft'ect of the flash upon the human skinwas seen to be conij)arable in Hiroshima andNagasaki. Survivors in the two cities stated thatpeople who were in the open directly under theexplosion of the bomb were so severely burnedthat the skin was charred dark brown or blackand that they died within a few minutes or hours.The Joint Commission's preliminary observationsindicate that burns of unprotected skin occurredat distances of 12,000 to 13,000 feet from the cen-ter of the explosion. Third degree burns occuj-redup to 4,500 feet and some such burns were reportedu]) to 7,200 feet. Many persons reported havingfelt a heat blast at distances as far as 24,000 feetfrom ground zero, but were not burned. Thedegi-ee of th(> buin of unprotected skin naturallyvaiicd inversely with the distance from the centerof explosion. Flash burns as seo>n were largelyconfined to the exposed areas of the body butoccasionally they had occurred through vai-yingthicknesses of clothin.g. Many illustrations of thiswei-e seen (Figs. 29-34). Generally speaking,the thicker the clothing was the more likely itwas to give complete protection against flashburns. For instance, one was seen who wasbuined over the shoulder except foi- a T-shapedarea about one-fourth inch in breadth which re-irained unburned. When the gaiment she waswearing at the time was studied, it was seen thatthe T-shapetl area coi-responded to an increasedthickness of the clothing due to the seam at theinsertion of the sleeve and across the shoulder tothe neck line fFig. 35). Several people were seenwho were burn.ed through a singh; thickness ofkimono but a broad band extending down eachside of the garment which corresponded to theincreased thickness due to the la()cl was miburnodor less severely bunied (Fig 36). There weremany instances where skin vvas bmned beneatli

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Figure 29.T. Y., 18 years old, male dressed in knee-length trousers and walking away from blast. Third degree burns.

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Figure 30.T. Y., 35 years old, male. Prone in open, 5,600 feet from ground zero, bare from waist up, blast fromdireaion of feet. Note sharp line of demarcation of healing flash burns. Protected area on neck, is dueto folding of skin resulting from extension of neck.

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Figure 3 l.-S. S., 2 7 years old, male. Flash burns of back arm, hand, face, and neck.. Note irregular outline of burnedareas with more severe burns on exposed surfaces.

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32.J. H., 5 3 years old, male. Sitting in Japanese house before open window at 6,000 feet. Note sharp line ofdemarcation of healed flash burns on exposed surfaces.

71327647 C. 31


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Figure 33.M. M., 22 years old, male. Standing 6 feet from open window at 4,000 feet from center of blast. Showsshirt which was worn at time of explosion and was not scorched.

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34.- -Same patient as figure 33. Note scars of healed flash burns of shoulder and back and sharp line of more severeburns on exposed surfaces. Shirt was not scorched.


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Figure 3 5.S. T., 49 years old, female. Note pigmentation of healed flash burns. T-shaped area of protection on leftshoulder was due to increased thickness of clothing at seam of insertion of sleeve and across shoulder to neck.

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35


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tiii'litly fitted clothing, Init was uii.l)um.('(l beneathlooselj' fitted portions (Figs. 37 and 3


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' ;iiiMiiiiiiiiiiiiiiCiiBfcyiiiii6ii

3

37.T. K., 34 years old, male. In open facing blast, wearing white shirt, blue coat and trousers. No change inshirt but coat and trousers charred. Severe flash burns and recovering from radiation sickness.

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Figure 38.Y. T., 19 years old, male. Photo shows localized alopecia in burned area below line of cap with no burnsabove and no generalized epilation. Note sharp line of protection of collar and severe burning of shoulder and trunkthrough shirt.

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w

39.M. I., 19 years old, female. Flash burns of feet, blast from right. Note area of unburned skin at base ofgreat toe on left foot due to protection of Japanese sandal strap.

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Figure id. S. N., ^7 years old, male. Was working in open at 5,500 feet from center of bUiM, weariiij; trousers but bareabove waist. Blast came from right. Note area of protection over spine due to shielding by right side of back.

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4 1 .Same patient as Figure 40. Flash burn. Note protection of under surface of arm and lateral thorax by positionof arm at side.

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Figure 42.T. O., 5 5 years old, malekimono. Dueexposed face and neck^lefvpH Wimr-ri^ h . a' ""."" Tuf ""^"^ before Open window in position shown at 6,000 feet, wearing longsleeved kimono. Due to direction of blast he received severe burns of exposed hands but only first degree burn ol

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Although iiiforinnt ion docs not coiMcidcthat collecti'd l)y I lie Civilian Defense

it is possible that i()in])l('te analysis ofthe (lata which have hecn collcclcd hy the

C\iinniissi()n may shed some light on (hisTlie Joint Commission studied a group

aSfl workmen in Jliioshima who weic marchingthe Koi Bridge facing the hoinh at aof 7,500 feet. All wcfc buiiu'd with theof three at the rear who were |)rotcctcd

the eaves of a building. Anothei' instance ofdegree of protection afTorded by certain

is shown in the following example.large group of workmen were in the streetwere so placed that some of them were

a one-story Japanese building and othersbehind a two-story Japanese building.were no burns among the group ix-liindtwo-story buikling, but all of those who

apparently partially protected by the one-building received burns.It was reported, by' the Japanese physicians

attended many of the burned cases, and italso the impression of all who subsequently

these burns, that they healed promptlydid not show any unusual clinical features.group felt on observing many of these burnsthere might be an increased tendency to the

of keloid in the healing. Questioningmany Japanese physicians resulted in theiropinion that the tendency to keloid

no greater from these bui-ns than fromthermal burns. It was explained that thedegree of secondary infection which followed

most cases and resulted in delayed healinghave been responsible for the excess scarformation which was rather frequentlyAt the time the Medical Division visited

area, 3 months after the explosion of themany of the burns were still unhealese using a Lauritsen electroscope and thenby American scientists using Geiger coiuiters. AtHiroshima activity has been greatest at the centerwith other active areas near the Koi bridge andfurther west of the bridge. At Nagasaki thegreatest activity is in the liills northeast ofthe center of the explosion. The higher counts ofradioactivity in these areas is felt to be due todirect deposits of fission products. Both areas liedownwind from the center of the explosion and atHiroshima, Japanese physicists have foimd knownfission products (in the barium, lantlianum andstrontium fractions) in deposits in these areas.This further supports the idea of direct depositionrather than induced radioactivity. The imjiortantpoint from the medical standpoint is that thedegree of activity in these areas is not sufllcientto produce casualties.

2. Induced Radioactivity caused by the inter-action of neutrons with matter.As stated abovethere is no evidence of significant induced radio-activity in the soil of tlie two cities. One j)atient,a young Japanese male, was seen in the KyotoImperial University hospital who did show whatmay have been an eft'ect of induced radioactivity.He had been in Nagasaki at the time of the bomb-ing, about 5,500 feet from the center of the explo-sion. Although he api)eared to remain well for aperiod following the explosion, during this time hecarried in his watch pocket on the right an ironkey and in his left side pocket a metal (probablyaluminum) cigarette case both of which he hadbeen carrying at the time of the bomb burst. Atthe end of about 3 weeks he first began to feel illand subsequently showed the rather typical find-ings of radiation sickness with epilation of thescalp and leiicopenia. He also developed burns in,the legion of both groins which roughly corres-ponded in size and position to the k(\v and the

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i .wndrafelllWffiftiijg!" '^

9^0^^#^sr!ir^

iFigure 43.H. T., 15 years old, male. Was naked above waist, in open at 5,2 50 feet, watching United States planes.Note partially healed flash burns with excess granulation tissue and contractures of both elbows.

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44.Healed burns in both groins which apparently resulted from induced radioactivity of an iron key in rightwatch pocket and aluminuin cigarette case in left side pocket.

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cigarette case (Fig. 44). He subsequently recoveredbut typical pigmented scars remained at the siteof the burns which liiid healed slowly. It wasi-eported by his physician in Kyoto that thecigarette case showed radioactivity as determinedby exposure of X-ray film at the end of 2 months,but in 3 months had lost the activity. The keywas not tested. Certainly the general effects cannot be interpreted to be the result of radioactivityfrom the two metal objects, but it seems clear thatthe objects were probably responsible for the skinbiu'ns. No other cases suggesting the effects ofinduced radioactivity of matter sufficient to pro-duce clinical efTects could be foimd by any of thegroups working in either city. Japanese scientistshave found the ]ihosphorus in the bones of humanvictims to be radioactive. This phenomenon canbe attributed only to neutrons. However, theeffect of total body radiation with neutrons is notwell known and may differ in other ways from theefTect of gamma rays. Thus the contributionneutrons may have made to other observed bio-logical effects cannot be estimated.

3. Gamma rays including neutrons and otherpenetrating radiation liberated by the fissionprocess and produced as a part of the totalspectrum of energy.The term gamma rays hereis used in a general sense and includes all pene-trating radiations and neutrons that caused injury.No attempt has been made to distinguish othertypes of radiation which may have contributed tothe injurious effects. A great deal of the informa-tion presented herein was taken from a study ofthe records of the Joint Commission. For detailsof this study one should see the complete report tobe published by the Commission. Since the Allieshad no observers in the area for the first few weeksafter the bomb explosion, the information relativeto the effects during this period has necessarilybeen gathered second hand and is not based onprimary observation by our scientists. It seems,however, that a fairly clear-cut picture has beenobtained through study of the material from manysources.

(a) Clinical picture.In giiiei'al the gammarays were very penetrating. There were no skinlesions which could be dii'pctly attributed togannna rays even in those patieiits showing severeradiation disease. The Japanese staled that thoseindividuals who were very near the center of theexplosion but did not suffer from flash burns or

secondary injuries, became ill within 2 or 3 ('ays.Hemorrhagic diarrhea followed and they expiredquite cjuickly. Some died within 2 or 3 days afterthe onset and most of them within a week. TheJapanese leported that it was difhcult to demon-strate the remarkable changes in the blood pictureof those dying so rapidly. Upper respiratoi'v aiulgastro-intestinal nuicous membranes showed acuteinflamation.The larger portion of the radiation cases which

had been at greater distances did not show severersymptoms until 1 to 4 weeks after the explosion.Many felt weak and listless on the day followingthe boml) burst. Nausea and vomithig appearsalso to have been frequent at this time. Withina day or two the appetite improved and the personfelt quite well imtil symptoms appeared at a latei-date. It is the opinion of some of the Japanesephysicians that those who rested and subjectedthemselves to less physical exertion showed alonger delay before the onset of subsecjuent symp-toms. After this period during which the indi-viduals usually felt perfectly well, they began tonote lassitude, malaise and anorexia. Within 12to 48 hours fever became evident. In manyinstances it reached only 39 C. and remained foronly a few days (Fig. 45). With the subsidence offever the patients usually showed a rapid disap-pearance of other symptoms and soon regainedtheir feeling of good health. The degree of feverapparently had a direct relationship to the degreeof exposure to radiation. In many other casesthe temperature was cpiite high reaching 40 to41 C. The fever once developed was usuallywell sustained and m those , cases terminatingfatally it, conthnied liigli until the end (Fig. 46).Other manifestations which were commonly seenwere leucopenia, epilation, uiflammation and ne-crosis of the gums, stomatitis, pharyngitis, petechiac(and evidence of ulceration of the lower gastro-intestinal tract.

Leucopenia appears to have been a constantaccompaniment of radiation disease. It is believedthat leucopenia existed in some of the milder caseswithout other evidence of radiation effects. It isalso thought that the degree of leucopenia wasprobably the most accurate index of the amouiil ofradiation the jjcrson received. The white 1)I()0(Icount in the more severe cases ranged from I , .)()()to f) with a comjjlete absence of neutrophiles. Thi'moderately severe cases showed total white blood

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of 1,')00 to 3,00(1 with u lU'iitropoiiiii, lunll)()iu' marrow showod ovidcnco of iU>gonoration.milder casos showed WBC counts of 3,000 towitli minor degenerative ciianges in the bone

. The changes in tlie ervthropootic systemusually not as startling but corresponded

to the deficiency of white blood cellBlood platelet formation also was

to be affected.usually began about 2 weeks after the

explosion, though in a few instances it isto have begun as earlj^ as 4 to 5 days

the exposures. The areas involved wereusually in the followmg order depending

the degree of exposure to radiation: scalp,beard, pubic region and eyebrows. The

of the scalp was usually miiform andresulted in complete baldness (Figs. 47 and

Microscopic section of the involved areas hasatrophy of the hair follicles. An interestmgof the epilation which has been reported

the Japanese and has not been confirmed, isit appeared to be less marked in persons withhair than in persons with dark hair even

the exposure was the same. In thosewho surAdved 2 months, evidence of

of the hair was present almost with-exception.

of the gastro-intestinal tract, includ-gingivitis (Fig. 49), stomatitis and pharyngitis,common in the more severe cases. The clinical

seen in these cases is essentially the samethat seen in leucopenias due to other causes.

diarrhea was commonly seen but in manywas difficult to evaluate because of theof its havmg been on an infectious basis.occasionally appeared in the mucousabout the time of the onset of the

However, those hemorrhages appearingthe skin were often more delayed.

findings on those cases dying of radia-effects have been reported to have shown typi-findings which ai'e known to exist in cases

with agranulocytosis. Petechial hemor-of the viscera, inflammation and necrosis

the gums, mouth, pharynx, stonuich, and intes-have been common findmgs. Occasional focal

of the liver has been encountered. Nohemorrhages into the skin or other struc-

have been reported. A large percentage ofcases has been found to have died of secondaiy

diseases such as se])lic broncho-pneumonia, i)neu-monia with early abscess fornuition and pyot borax,and tui)erculosis. Section of the testes is reportedto have siiown "spermatogenesis to be ])oor."Records of microsco])ic examination of ovarieshave not been reported. Deaths from i-adiationbegan about a week after exposure and reached apeak in 3 to 4 weeks. They iiad ijracticallyceased to occur after 7 to 8 weeks.

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Figure 47.K. N., 9 years old, male. Standing in open 2,300 feet from blast. Patient suffered lacerations and radiationsickness. Photo shows generalized epilation.

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48.S. Y., 19 years old, female. Sitting on second floor of 3-story concrete building, 2,625 feet from center ofblast. Patient sufifered radiation sickness. Photo shows generalized epilation.

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Figure 49.S. I., 38 years old, male. Recovering from radiation sickness. Photo taken 3 months after bombing showsnecrosis of gum and underlying mandible.

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A few oxaniplcs catluMcil hy theunit of tlic Joint Comniission may bo

(1) Tbo Bankers Club, wbich is located700 feet from ground zero is a 3-story, strongbuildino; of reinforced concrete with a tileroof. There was no serious damage to themain structure of the building by the l)last.Of 23 people known to lie in the building atthe tim? of the explosion, 20 had secondaryinjuries and 17 had burns but none werekilled immediately. Twenty-one of the 23died between 12 and 23 August all believedto have been due to radiation effects. Theonly 2 survivors were on the ground floorwhere they were probably shielded by allfloors and possibly r>y adjacent buikhngs.

(2) Ihe Communications Building of theChugoku Army Headquarters is a partlyunderground concrete structure located 2,300feet from ground zero. The occupants wereshielded by 12 inches of concrete and 3 feet ofearth. There were no cases of radiationdisease among the 26 or more occupants.

(3) The Chugoku Electric Building is a5-story building of reinforced concrete located2,100 feet from ground zero. There werecasualties due to radiation on all floors on theside near the bomb; many others on the fifthand fourth floors and a few on the third floor.Those people on the first and second floorsaway from the bomb blast and shielded hj theupper floors showed no radiation disease.

(4) The City Hall which is about 5,000 feetfrom ground zero showed only six possiblemild cases of radiation disease.Effects on reproduction.The Jomt Com-

has investigated tliis problem in relationthe effects of radiation. Here, too, the final

is not complete but a few impressions may beor nearly all pregnant women in variousof pregnancy who survived and who had

within 3,000 feet of the center of the explo-have had miscarriages. Even up to 6,500they have had miscarriages or prematurewho died shortly after birth.

In the group of pregnant women between 6,50010,000 feet who could be traced, about one-have given birth to apparently normal ciiil-The remainder had not reached the term

of their ])regnancv or their i)regnancy had ter-mii\ated prematurely. No definite efl'ects attrib-utable to the bomb have been seen in these women.Records of the ?Tiroshima Prefectural HealthDejiartment reveak'd tluit 2 months after theexplosion of the bomb the incidence of miscar-riages, aboi-tions and premature births for theentire city, without consideration of wiiether thewomen were even in the city at the time of thebondnng, was 27 percent as compai'cd with a rateof ai)Out 6 percent prior to the bombing. Otherfactors such as malnutrition, emotional disturb-ances and poor living conditions may play a largepart in this increase. As a matter of fact, there isno concrete evklence upon which one can say thatradiation alone played any definite part.Amenonhea has been a common finding

throughout Japan, especially during the last 2years. There appears to have been an increasein the atomic-bomb areas and from the otherclinical effects there is no doubt but that radiationhad been responsible for many cases in Hiroshimaand Nagasaki. An accurate evaluation, however,has been impossible in \iew of the many factorswliich might contribute to this condition.

vSperm counts done in Hiroshima by the JointCommission have revealed low sperm counts orcomplete as])ermia for as long as 3 months after-wards in males who were within 5,000 feet of thecenter of the explosion. Effects on spermato-genesis ha

USSBS Report 13, The Effects of the Atomic Bombs on Health Services in Hiroshima and Nagasaki

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Transcript of USSBS Report 13, The Effects of the Atomic Bombs on Health Services in Hiroshima and Nagasaki