Part 11

The mechanical injuries included fractures, lacerations, contusions, abrasions, and other effects to be expected from falling roofs, crumbling walls, flying debris and glass, and other indirect blast effects. The appearance of these various types of mechanical injuries was not remarkable to the medical authorities who studied them.

It was estimated that patients with lacerations at Hiroshima were less than 10,600 feet from X, whereas at Nagasaki they extended as far as 12,200 feet.

The tremendous drag of wind, even as far as 1 mile from X, must have resulted in many injuries and deaths. Some large pieces of a prison wall, for example, were flung 80 feet, and many have gone 30 feet high before falling. The same fate must have befallen many persons, and the chances of a human being surviving such treatment are probably small.

BLAST INJURIES

No estimate of the number of deaths or early symptoms due to blast pressure can be made. The pressures developed on the ground under the explosions were not sufficient to kill more than those people very near the center of damage (within a few hundred feet at most). Very few cases of ruptured ear drums were noted, and it is the general feeling of the medical authorities that the direct blast effects were not great. Many of the Japanese reports, which are believed to be false, describe immediate effects such as ruptured abdomens with protruding intestines and protruding eyes, but no such results were actually traced to the effect of air pressure alone.

RADIATION INJURIES

As pointed out in another section of this report the radiations from the nuclear explosions which caused injuries to persons were primarily those experienced within the first second after the explosion; a few may have occurred later, but all occurred in the first minute. The other two general types of radiation, viz., radiation from scattered fission products and induced radioactivity from objects near the center of explosion, were definitely proved not to have caused any casualties.

The proper designation of radiation injuries is somewhat difficult. Probably the two most direct designations are radiation injury and gamma ray injury. The former term is not entirely suitable in that it does not define the type of radiation as ionizing and allows possible confusion with other types of radiation (e.g., infra-red). The objection to the latter term is that it limits the ionizing radiation to gamma rays, which were undoubtedly the most important; but the possible contribution of neutron and even beta rays to the biological effects cannot be entirely ignored. Radiation injury has the advantage of custom, since it is generally understood in medicine to refer to X-ray effect as distinguished from the effects of actinic radiation. Accordingly, radiation injury is used in this report to mean injury due only to ionizing radiation.

According to Japanese observations, the early symptons in patients suffering from radiation injury closely resembled the symptons observed in patients receiving intensive roentgen therapy, as well as those observed in experimental animals receiving large doses of X-rays. The important symptoms reported by the Japanese and observed by American authorities were epilation (lose of hair), petechiae (bleeding into the skin), and other hemorrhagic manifestations, oropharyngeal lesions (inflammation of the mouth and throat), vomiting, diarrhea, and fever.

Epilation was one of the most spectacular and obvious findings. The appearance of the epilated patient was typical. The crown was involved more than the sides, and in many instances the resemblance to a monk's tonsure was striking. In extreme cases the hair was totally lost. In some cases, re-growth of hair had begun by the time patients were seen 50 days after the bombing. Curiously, epilation of hair other than that of the scalp was extremely unusual.

Petechiae and other hemorrhagic manifestations were striking findings. Bleeding began usually from the gums and in the more seriously affected was soon evident from every possible source. Petechiae appeared on the limbs and on pressure points. Large ecchymoses (hemorrhages under the skin) developed about needle punctures, and wounds partially healed broke down and bled freely. Retinal hemorrhages occurred in many of the patients. The bleeding time and the coagulation time were prolonged. The platelets (coagulation of the blood) were characteristically reduced in numbers.

Nausea and vomiting appearing within a few hours after the explosion was reported frequently by the Japanese. This usually had subsided by the following morning, although occasionally it continued for two or three days. Vomiting was not infrequently reported and observed during the course of the later symptoms, although at these times it generally appeared to be related to other manifestation of systemic reactions associated with infection.

Diarrhea of varying degrees of severity was reported and observed. In the more severe cases, it was frequently bloody. For reasons which are not yet clear, the diarrhea in some cases was very persistent.

Lesions of the gums, and the oral mucous membrane, and the throat were observed. The affected areas became deep red, then violacious in color; and in many instances ulcerations and necrosis (breakdown of tissue) followed. Blood counts done and recorded by the Japanese, as well as counts done by the Manhattan Engineer District Group, on such patients regularly showed leucopenia (low-white blood cell count). In extreme cases the white blood cell count was below 1,000 (normal count is around 7,000). In association with the leucopenia and the oropharyngeal lesions, a variety of other infective processes were seen. Wounds and burns which were healing adequately suppurated and serious necrosis occurred. At the same time, similar ulcerations were observed in the larynx, bowels, and in females, the gentalia. Fever usually accompanied these lesions.

Eye injuries produced by the atomic bombings in both cities were the subject of special investigations. The usual types of mechanical injuries were seen. In addition, lesions consisting of retinal hemorrhage and exudation were observed and 75% of the patients showing them had other signs of radiation injury.

The progress of radiation disease of various degrees of severity is shown in the following table:

Summary of Radiation Injury Clinical Symptoms and Findings

Day after Explo- sion Most Severe Moderately Severe Mild 1. 1. Nausea and vomiting 1. Nausea and vomiting 2. after 1-2 hours. after 1-2 hours. 3. NO DEFINITE SYMPTOMS 4. 5. 2. Diarrhea 6. 3. Vomiting NO DEFINITE SYMPTOMS 7. 4. Inflammation of the mouth and throat 8. 5. Fever 9. 6. Rapid emaciation 10. Death NO DEFINITE SYMPTOMS 11. (Mortality probably 2. Beginning epilation. 12. 100%) 13. 14. 15. 16. 17. 18. 3. Loss of appetite 19. and general malaise. 1. Epilation 20. 4. Fever. 2. Loss of appetite 21. 5. Severe inflammation and malaise. 22. of the mouth and throat 3. Sore throat. 23. 4. Pallor. 24. 5. Petechiae 25. 6. Diarrhea 26. 7. Moderate emacia- 27. 6. Pallor. tion. 28. 7. Petechiae, diarrhea 29. and nose bleeds (Recovery unless com- 30. plicated by previous 31. 8. Rapid emaciation poor health or Death super-imposed in- (Mortality probably 50%) juries or infec- tion).

It was concluded that persons exposed to the bombs at the time of detonation did show effects from ionizing radiation and that some of these patients, otherwise uninjured, died. Deaths from radiation began about a week after exposure and reached a peak in 3 to 4 weeks. They practically ceased to occur after 7 to 8 weeks.

Treatment of the burns and other physical injuries was carried out by the Japanese by orthodox methods. Treatment of radiation effects by them included general supportative measures such as rest and high vitamin and caloric diets. Liver and calcium preparations were administered by injection and blood transfusions were used to combat hemorrhage. Special vitamin preparations and other special drugs used in the treatment of similar medical conditions were used by American Army Medical Corps officers after their arrival. Although the general measures instituted were of some benefit no definite effect of any of the specific measures on the course of the disease could be demonstrated. The use of sulfonamide drugs by the Japanese and particularly of penicillin by the American physicians after their arrival undoubtedly helped control the infections and they appear to be the single important type of treatment which may have effectively altered the earlier course of these patients.

One of the most important tasks assigned to the mission which investigated the effects of the bombing was that of determining if the radiation effects were all due to the instantaneous discharges at the time of the explosion, or if people were being harmed in addition from persistent radioactivity. This question was investigated from two points of view. Direct measurements of persistent radioactivity were made at the time of the investigation. From these measurements, calculations were made of the graded radiation dosages, i.e., the total amount of radiation which could have been absorbed by any person. These calculations showed that the highest dosage which would have been received from persistent radioactivity at Hiroshima was between 6 and 25 roentgens of gamma radiation; the highest in the Nagasaki Area was between 30 and 110 roentgens of gamma radiation. The latter figure does not refer to the city itself, but to a localized area in the Nishiyama District. In interpreting these findings it must be understood that to get these dosages, one would have had to remain at the point of highest radioactivity for 6 weeks continuously, from the first hour after the bombing. It is apparent therefore that insofar as could be determined at Hiroshima and Nagasaki, the residual radiation alone could not have been detrimental to the health of persons entering and living in the bombed areas after the explosion.

The second approach to this question was to determine if any persons not in the city at the time of the explosion, but coming in immediately afterwards exhibited any symptoms or findings which might have been due to persistence induced radioactivity. By the time of the arrival of the Manhattan Engineer District group, several Japanese studies had been done on such persons. None of the persons examined in any of these studies showed any symptoms which could be attributed to radiation, and their actual blood cell counts were consistently within the normal range. Throughout the period of the Manhattan Engineer District investigation, Japanese doctors and patients were repeatedly requested to bring to them any patients who they thought might be examples of persons harmed from persistent radioactivity. No such subjects were found.

It was concluded therefore as a result of these findings and lack of findings, that although a measurable quantity of induced radioactivity was found, it had not been sufficient to cause any harm to persons living in the two cities after the bombings.

SHIELDING FROM RADIATION

Exact figures on the thicknesses of various substances to provide complete or partial protection from the effects of radiation in relation to the distance from the center of explosion, cannot be released at this time. Studies of collected data are still under way. It can be stated, however, that at a reasonable distance, say about 1/2 mile from the center of explosion, protection to persons from radiation injury can be afforded by a layer of concrete or other material whose thickness does not preclude reasonable construction.

Radiation ultimately caused the death of the few persons not killed by other effects and who were fully exposed to the bombs up to a distance of about 1/2 mile from X. The British Mission has estimated that people in the open had a 50% chance of surviving the effects of radiation at 3/4 of a mile from X.

EFFECTS OF THE ATOMIC BOMBINGS ON THE INHABITANTS OF THE BOMBED CITIES

In both Hiroshima and Nagasaki the tremendous scale of the disaster largely destroyed the cities as entities. Even the worst of all other previous bombing attacks on Germany and Japan, such as the incendiary raids on Hamburg in 1943 and on Tokyo in 1945, were not comparable to the paralyzing effect of the atomic bombs. In addition to the huge number of persons who were killed or injuried so that their services in rehabilitation were not available, a panic flight of the population took place from both cities immediately following the atomic explosions. No significant reconstruction or repair work was accomplished because of the slow return of the population; at the end of November 1945 each of the cities had only about 140,000 people. Although the ending of the war almost immediately after the atomic bombings removed much of the incentive of the Japanese people toward immediate reconstruction of their losses, their paralysis was still remarkable. Even the clearance of wreckage and the burning of the many bodies trapped in it were not well organized some weeks after the bombings. As the British Mission has stated, "the impression which both cities make is of having sunk, in an instant and without a struggle, to the most primitive level."