Hiroshima was a city at work.  The streets were filled.  Children had reported to schools; it was a time when direct exposure in the open was at its peak…then, at 8:14 AM a prolonged and brilliant flash.  Accompanying the flash of light was an instantaneous flash of heat traveling with the speed of light…duration probably less than one-tenth of a second, and its intensity sufficient to cause nearby things to burst into flames as far as four thousand yards from the hypocenter, with temperatures exceeding 1800 degrees Celsius…then a shock wave (Liebow 24).

On August 6, 1945, a fifteen-kiloton atomic bomb ignited the center of Hiroshima, Japan, instantly killing more than 100,000 people, and injuring hundreds more.  Three days later, a second atomic bomb exploded over Nagasaki, resulting in 70,000 additional deaths (Marston 13).  Not only did the atomic bombs dropped by the United States kill thousands of Japanese and demolish two major cities, but they spawned serious medical implications on both the survivors and future generations.  For months after the explosions, in addition to the severe burns covering most of the victims’ bodies, survivors developed symptoms that puzzled doctors, such as blood cell abnormalities, high fevers, chronic fatigue, diarrhea, vomiting, hair loss, and depression.  “Radiation sickness” and “Acute Radiation Syndrome” were terms used by doctors to describe these various symptoms in survivors that surfaced a few months later, sometimes within hours, after the blasts.  Moreover, years later doctors noticed an increase in the incidence of cancer among the survivors (“Acute…).  Many stipulations circulated within the medical community regarding the etymology of this increase in cancer.  Scientists finally alleged that long-term radiation exposure was to blame.  Yet months later, radioactivity investigations, having began immediately following the blasts by the Japanese, showed that radioactivity was far below hazardous levels, and such levels “did not justify the fear of rumors of high radioactivity” (Liebow 34).

On the other hand, although a well-staffed and equipped medical team had not been organized by the Surgeon General of the US Army for investigation of the biological implications of the atomic bomb, Colonel Ashly Oughterson, the surgical consultant to General MacArthur, saw need for such a medical study.  Thus, Oughterson devised a study in late August of 1945, and by September that same year, an American team of scientists, having persuaded the Japanese government to join them, began a collaborative investigation to study the residual radiation effects of the bombs (Liebow 38).  The research team focused on the medical consequences of radiation, seeking answers to three main questions: what are the immediate effects, does radiation result in an increase in cancer incidence over the long-term, and how does radiation influence the future generations of survivors?

 Upon impact of the atomic bomb in Hiroshima, hundreds died immediately from the massive force of the explosion alone.  Three months after the initiation of the joint project, in January of 1946, the team figured the vulnerable area for those killed instantly was approximately 2.9 square miles from the hypocenter, and for all casualties, (those dying soon after from severe injuries), 9.4 square miles.  (Marston 204).  One doctor explains how, even at a distance as far as ten miles from the hypocenter, the sheer force of the bomb could cause such fatal injuries, “The blast wave created by nuclear explosions inflicts injuries on people because of shifts in environmental pressures as the air front hits the human body.  This is enough to displace the body against a standing rigid surface, leading to the collapse of structures on people nearby” (Marston 264).  Additionally, if the direct force of the explosion was not enough, severe burns occurred to most victims’ bodies.  Thermal energy released from nuclear explosion can cause both thermal burns, from the direct radiation and termed “flash” burns, and secondary, or “flame” burns, which result from nearby flammable objects igniting and engulfing an individual.  Over 90% of the victims’ burns in Hiroshima and Nagasaki were from direct thermal radiation, or “flash” burns (Marston 267).  Numerous studies demonstrate that radiation significantly impairs the immune system, the human body’s mode of fighting infection (Marston 318).  Thus, due to the decreased efficacy of the immune system, these burns not only crippled many of the victims, but also increased susceptibility to infection. Moreover, because infection develops rapidly following any burn, immediate treatment of burn victims is imperative.  In Hiroshima, however, intensive medical care could not begin for five days, for not only were officials overwhelmed by the plethora of victims, but many physicians themselves were also killed or incurred severe injuries (Marston 270).  Of all the deaths in Japan, 90-100% occurred within the first two weeks, and 26% of those surviving the initial period died the following two months (Marston 236).  Perhaps had immediate care been provided to the many burn victims, such high fatality rates would not have resulted.

 Apart from external burns, radiation exposure internally effects an individual.  A variety of symptoms were exhibited in the survivors following the blasts in both Hiroshima and Nagasaki.  Complaints of diarrhea, nausea, spontaneous bleeding, clouding of the eye lens, and temporary sterility in males, collectively became known as “Acute Radiation Syndrome.”  Sadly, these symptoms often resulted in death.  Within the science community, it is standard assumption that in the absence of intense medical treatment, a 350 “rad,” (a unit used to measure the amount of radiation), would cause a 50% fatality rate within two months (Marston 224).  Moreover, under wartime conditions, with a shortage of food and poor nutrition, as was the case in Japan, it is believed that exposure of 100 rads is considered potentially fatal (“Acute…”).  Hiroshima received 220 rads, more than two times the estimated fatal amount under wartime conditions.  One can conclude, therefore, that apart from the initial impact, most fatalities were from radiation sickness due to such high exposure.  Yet, exact fatality figures for Nagasaki and Hiroshima are not 100% accurate, for it is difficult to ascertain whether one died from radiation, or from the blast itself (Marston 235).  Regardless, the atomic bombs resulted in a tremendous loss of life within a few weeks following the explosions, both due to radiation and secondary burns.

 Hiroshima and Nagasaki slowly rebuilt their communities following the war.  Despite such endeavors, however, efforts to cover the devastating destruction of the bombs could not hide the sadness and guilt espoused by the survivors.  Believing they had seen the end of the bombs’ effects, inhabitants in both Nagasaki and Hiroshima were puzzled by the increase in leukemia incidence in both cities; three years following the radiation exposure, leukemia rates peaked in Japan (Marston 329).  This prevalence of cancer was first noted by a Japanese physician, Gensaku Oho, who, in 1956, encouraged medical associations within Nagasaki and Hiroshima to create tumor registries for a more exact analysis of tumor development (“Cancer…).  In addition to the formation of registries, the joint team of American and Japanese researchers also began examining cancer incidence rates in search of any significant factor which may explain the phenomenon.  The team noted that although radiation does appear to cause more cancer death, it is not at an age earlier than what one would predict given normal cancer development; radiation does not produce or induce a specific “radiation-type” cancer, it just enhances the incidence of tumor development (Marston 331).  Data from the study shows that in Nagasaki, the rate of tumor-type cancer incidence among radiation exposed survivors has not exceeded that of the control population since the early 1970’s (Marston 327).  The future looks promising.

On the other hand, leukemia, a non-tumor type cancer, is remarkably different.  An excess risk of leukemia was one of the earliest delayed effects of radiation exposure seen in the victims, and today, more than 50 years after the bombs, this excess is reflected as the most widely apparent long-term radiation effect (“Leukemia…”).  Currently, unlike Nagasaki, Hiroshima, where radiation effects are more pronounced, appears to have continued increased leukemia rates among survivors.  In addition, the study reflects a significant correlation between the age of an individual at the time of the bomb, and the increase in leukemia incidence; the younger an individual at the time of the explosion, the more at risk he is for development (Marston 329).  Thus, although leukemia is a rare disease, accounting for only 4% of all cancer deaths in the world, leukemia deaths constitute about 20% of the total excess cancers reflected by the study in Japan (“Leukemia…”).

One final conclusion drawn from the cancer study regards the amount of exposure, or dose of radiation.  The “linear hypothesis” says that the “probability of developing a radiation-induced cancer is proportional to the radiation dose;” the chance that a given cancer death is associated with atomic bomb radiation exposure is linearly associated with concentration (“Cancer…”).  This hypothesis is supported by data collected in Hiroshima, where, as noted above, radiation had a more definitive effect.  Additionally, it appears that the population of survivors afflicted with leukemia increased, despite falling radiation levels (defending the premise of radiation inducing cancer, and not directly causing it) (Marston 226).  It goes without noting, however, that regardless of the radiation dose, or age of the victim when exposed, through 1978 the overall rate of death among survivors from leukemia was two times as high as it was for those not exposed (Marston 330).

Of greatest interest, however, is the question of lasting effects among survivors and future generations-does radiation exposure cause increased birth defects in the children of survivors?  Scientists knew that radiation damages cell DNA.  Extensive lab studies have also demonstrated that human DNA exposed to radiation may break apart and rejoin into patterns differing from their original forms.  As a result, mutations develop.  Studies also reflect that such DNA damage from radiation exposure can enhance cancer growth, which thus explains the increased cancer prevalence among atomic bomb survivors (“Mutation…”).  The question remains, however, does radiation exposure also damage one’s sex cells such that his children will express an increased birth defect ratio?

In 1948 the Atomic Bomb Casualty Commission (ABCC) initiated a three-phase study to examine this question of birth defect commonality among children of atomic bomb survivors.  For six years, all pregnant women in Hiroshima and Nagasaki were required to register their pregnancy by the completion of the fifth lunar month (Neel 3).  At the onset of the study, certain dietary staples were rationed in Japan, as they had for most of the war.  Pregnant women, however, received additional supplements in order to ensure good health.  To establish an accurate subject pool for the study, therefore, the system of surveillance was tied to the process through which pregnant women registered for these supplementary rations.  Because of this system, more than 90% of the pregnancies occurring within these cities were appropriately identified (“Are birth…”).  Therefore, from the approximate 76,626 births occurring over this six-year period, data of viability, congenital defect, neonatal death, sex, and birth-weight was collected.

Despite these efforts, however, the data showed no significant difference between children of exposed parents from those of unexposed (“Are birth…”).  It was argued, however, that a complete record of subjects was not attained due the lack of midwives reporting births.  In addition, the legitimacy of the study remained questionable, for even if most pregnancies were in fact recorded, the research team claimed that “…critical data on genetic effects was missed because of ‘delayed’ initiation of the study” (Neel 3).  Subsequently, due to the poor outlook of discovering a significant correlation, the government terminated the study in 1954.  The government did recommend, however, that continued registration of births, along with the monitoring of survival rates and sex ratios, should continue for use in future studies (Neel 4).

Following termination of phase one, phase two of the genetic study was initiated in 1955 and continued until 1968.  This time, however, data collection was limited to determining the sex ratio of newborns, for it was hypothesized that the sex ratio could be altered due to varying degrees of parental exposure to radiation. This theory stems from the fact that females have two copies of the X-chromosome, whereas males have one copy of each, an X and Y chromosome.  Thus, lethal mutations born on either the X or Y chromosome will alter the ratio.
Three cohorts were established: one containing all children born to survivors where parents had significant radiation exposure (within 200 meters of the hypocenter), one with children born to parents not in the city when the bombs hit, and a final group consisting of children born to one or both parents located distally from the hypocenter; 15% of the births during this period involved parents thought to have incurred significant exposure (Neel 4).  Yet, despite such precise organization and logical theory, no significant association between sex ratio and degree of parental exposure was demonstrated; genetic studies of offspring were again put to an end in 1968 (Neel 124).

Scientists, however, were relentless in their pursuit of identifying some type of genetic effect on offspring.  In 1969, a third phase to the genetic study was initiated, focusing on congenital defects, malignancy incidence, birth weight, and neonatal mortality (Neel 7).  The study continued until 1990, and, although no consistent findings suggested of an effect of parental exposure on birth weight, neonatal mortality, or increased malignancies in the children, a distinction between children born in utero from those conceived after the bombings, was apparent (Neel 178, 190, 397).  Such observation led to the hypothesis that although radiation may not cause defects in future progeny, perhaps children conceived before the bombs hit do show increased mutative effects.
Stages of embryogenesis are sensitive to radiation, and therefore, although not being gene-based, varying degrees of teratogenic, or in utero, defects can occur.  Generally, these defects lead to spontaneous abortion.  In both Nagasaki and Hiroshima, however, analyses have shown that the probability of severe mental retardation is strongly associated with the degree to which the mother was exposed to radiation.  Women exposed to radiation during the third and fourth month of gestation appear to deliver children particularly prone to brain damage, and often have anatomical malformations like facial clefts or too many fingers and toes.  On the other hand, embryos in other stages of development do not exhibit such deformities.  Among the 800 in utero survivors included in the study’s population, twenty-one severely mentally retarded individuals were identified (“Growth...).
In the late 1950’s, IQ tests and data on school performance were collected from in utero survivors.  Researchers concluded that radiation exposure had a negative impact on both outcomes; survivors had an IQ loss of approximately five points, and performed at a decreased level in school (“Growth…).  This result is supported by the apparent decreased level of intelligence seen in large portions of the generation born during the first years after the war (Neel 344).

Despite the failure of the initial genetic study to identify a significant genetically based radiation effect on the children of survivors, scientists remain optimistic in discovering a correlation.  They argue that one cannot accurately determine how much genetic damage occurred in Nagasaki and Hiroshima, as most gene mutations result in spontaneous abortions.  In addition, the majority of genetic mutations are recessive, for only a small proportion reflect such mutagenic events.  Therefore, should a particular gene mutation occur, it may not be noticed, as the fetus will likely not live to term, or the mutation is masked by expression of the correct, dominant gene (Neel 10).

The initial and long-term devastation incurred from the atomic bomb did not only physically effect civilians in Nagasaki and Hiroshima.  Rather, the aftermath of the bombs had an extensive psychological impact on both the survivors and their families.  The possibility of such psychological implications, however, was not explored in Japan for another seventeen years following the blasts.  Perhaps the prime reason for such delay was due to the ambiguity surrounding the question of to what extent symptoms reported by survivors were actually psychological, as some symptoms resembled radiation-induced effects (“Psychological…”).  In the late 1950’s, psychologists in Hiroshima and Nagasaki reported increased complaints among survivors of neurotic symptoms, including general fatigue, amnesia, and lack of concentration, symptoms easily confused with radiation sickness.  After surveys were given to survivors, however, additional symptoms included, “…recalling the occurrence and becoming upset, experiencing an increased sense of unresponsiveness and immobility, and feeling guilt and discouragement” (“Psychological...”). When interviewed initially, having encountered so much horror enabled survivors to feel incapable of emotion.  They behaved mechanically, acting emotionally numb, while at the same time, knowing they were partly trying to pretend to be unaffected to protect themselves from the accepting the trauma (Marston 311).  When asked to describe the explosion, few could recall his initial perception.  As Dr. James Thompson remarks,

Few people could recall their initial perceptions.  Some saw the pika-a flash of light-or felt a wave of heat, and some heard the don-the thunder of the explosion…everyone assumed that a bomb had fallen out of a clear sky directly on them, and they were suddenly and absolutely shifted from normal existence to an overwhelming encounter with death, a theme which stayed with each survivor indefinitely (Marston 310).

Because the Japanese culture is one of a high degree of group identification and respect for authority, most survivors focused on the “ultimate horror” which had left them with a profound sense of pity and shame.  One psychiatrist notes, “Survivors were convinced that their survival was made possible by deaths of others, and this conviction caused them terrible guilt” (Marston 312).

 Psychological effects, however, permeated beyond the island of Japan and into the global population.  Such a worldwide effect was not anticipated, nor could it have been, for never had such destruction been seen before.  The destruction from the bombings in Nagasaki and Hiroshima traditionally has been underreported in world history, as much of the film material collected at the time has only recently been released.  Moreover, the integration of these devastating events in elementary and secondary curricula, albeit important, has sparked criticism from many educators.  Students, both American and international alike, are frightened and concerned by the threat of future nuclear war after learning about Nagasaki and Hiroshima (Marston 413).  As one Boston student responds when asked in 1978,

I find it terrifying that every human being in my whole world could be destroyed by one bomb that our nation first discovered.  To destroy our race, people, culture, is essentially the outcome of the A bomb (Marston 414).

These fears, however, are not limited to children and adolescents.  Recent surveys show that adult nuclear war beliefs have changed a little during the four-decade period since Hiroshima and Nagasaki.  In 1946, 63% of adult Americans believed that any subsequent major war would “necessarily be nuclear.”  Today, this statistic has decreased to 54%, an improvement, but still a concern (Marston 446).
As a result, groups like Educators for Social Responsibility began to form in the late 1960’s.  Using Japan as an illustration, these groups have worked to abolish the fear and threat of nuclear war by developing curricula encompassing all aspects of nuclear war; the development of children’s groups opposed to nuclear war reflects the success of these curricula (Marston 414).

The fears exhibited by American students are not isolated examples.  Studies conducted in Finland, Canada, Sweden, Germany, and New Zealand also reflect a sense of trepidation among children.  For example, 50% of students aged 18-24 expect the world to be destroyed by nuclear war.  Similarly, in 1983, 52% of the teenagers interviewed in England thought it was extremely likely that nuclear war would occur within their lifetimes (Marston 421).  Such steps toward educating youth, therefore, are important, and not seen only in the United States.  Rather, awareness and concern of this prevailing worldwide fear among students of nuclear war has created a concerted effort among schools to educate young adolescents everywhere.

Dropping the atomic bombs on Nagasaki and Hiroshima brought an end to many years of destruction and debilitation.  Perhaps had the United States not taken such drastic matters, the war soon would have ended on its own.  Yet, despite such obliteration, at that time nuclear bomb use seemed the appropriate, viable option.  It was not until afterwards, when it was too late, did the world learn of the devastating implications.  And while Japan prospered soon after, negative effects of the bombs linger, effects that will never be covered despite concerted efforts.  The absence of detecting a statistically significant effect of radiation on the frequency of genetically based birth defects should not be construed as evidence that mutations were not induced by parental exposure to atomic radiation.  Nor should we ignore the proliferating psychological implications across the world.  We have an obligation to learn from this tragedy.  We must continue to understand the effects, conduct more studies, and most importantly, identify other means through which to end world conflict.

 
“Acute Radiation Syndrome.”  Radiation Effects Research Foundation.  Online.  28 Nov. 2000.

“Are Birth Defects More Common Among the Children of Atomic-Bomb Survivors?” Radiation Effects Research Foundation.  Online.  28 Nov. 2000.

“Cancer Risks Among Atomic-Bomb Survivors.”  Radiation Effects Research Foundation.  Online.
28 Nov. 2000.

“Growth Impairment and Mental Retardation Among Children Exposed to Atomic-Bomb Radiation Before Birth.”  Radiation Effects Research Foundation.  Online.  28 Nov. 2000.

“Leukemia Risks in Atomic-Bomb Survivors.”  Radiation Effects Research Foundation.  Online.  28 Nov. 2000.

Liebow, Averill.  Encounter with Disaster, A Medical Diary.  New York: W.W. Norton and Company, Inc., 1970.

Marston, Robert Q. M.D., and Fredric Solomon M.D., eds.  The Medical Implications of Nuclear War.  Washington, D.C.: National Academy Press, 1986.

“Mutation in Red Blood Cells.” Radiation Effects Research Foundation.  Online.  28 Nov. 2000.

Neel, James V. M.D., and William J. Schull M.D., eds.  The Children of Atomic Bomb Survivors, A Genetic Study.  Washington, D.C.: National Academy Press, 1991.
 

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