PAGES 2 _2__ THIS DOCu r 7 C _ _ 0 '-- 7 6 i i __A-- -_ 2 L O N 19 April 4 6 Subject Trans nitts 1 of ieI c r-t o To Colonel Stafford l • Warren MoC Chief of Lledicnl tection r1anro ttan Bng r 30 i· District PoOo Box E �lr RidgG Tou _ lo Enclosisd herewith J t hc FU AL H3PORT OF li IHIJINGS OF THE ANHATTAN DISTRICT ATQ H� -�c _-rj rnVBST GATING GRJUPSAT ilIROSHil� -·-·-AND NAGhSAKI 2 A preltmi Ur ry - -epo rt �t the findine s was sub rlitted in December 45 a 3o T hi s finlll report pi 1pr red under the general direction of the undersig aad co�1si ts enscilt i' llJ of three sectic ns They were prripared undar the mmedio to •lh cction of the follc1·1ing personnel Part I Prepn j·cc aud written by Captu 11 L Barnett i C and revie'i ed by Lt Col 1 L Friedell I C and G v LeRoy � o The statistical analysi c t1 J interpretation was done by t I J Wantmen and 'D Tiedeman J ·r ntm9 n also assisted materially in the writing of Part l Part II Prepar ' J i Dd ritten_ by Capt o f Howland �1 c B RE diation c Phlsical Damt �- tidy Prep ired and written by Cap� R Tybout C E Part I Hiror hfoa · Prepared nnd written by l tajor N Varley C E Part II Nag id Younga C E r DECLASSIFIED l p u t h o r i t y l i ·· Prapared and writ J tJ 2 f n by �jor V Ca IED Q DECt S SIF 1 '1 00 S 1 By__ ____ NARS Date �- NClASSifIED Translations of Japanese documents was done under the directfon of Lto Io V I u n h 1 Io 4o Signed lienry L Barnett Capt • 1- oCo liLB sb DECLASSIFIED p utbority l NtJj J4W J lJNCtDJED UNClASS HEU Following the atomic bo 0 bings of Hiroshima on 6 August 1945 g and Nagasaki on 9 August 1945a a group of 21 anhattan Distri ct officers and enli sted personne l were sent frc m the various c ontinental installations to Ti nia n i a rie nas The group was to proc eed to Japan f or t he general purpose of invest i i a tins the t · o Jo panes a citie s as ear ly e s possible if and when Japan su rrendered The general purpose of the mi ssion was twofold The more can prehensive as·p ec t was t o observe the total effect s of t he atomic b ombs • on the citi es a nd the people exposed The spec ifi c objective wa to i nvestigate any uni que effects due to radiatio n An investi gation of the l atter v as at the time of the surrender part icu1arly imper tant for t wo reasons 11 The Japanese were reporting the appearance of uncanny delayed effects in persona exposed to the bombsg whic h seemed unquestionably to be due to radiation in addition» they were stating that people oing into the cities after the b0mbini s w1 1re developing similar symptoms From the standpoint of protecting the hea l th and 'I • morale of occupation troopsj as iell as from other consideratlons 0 it became imperative to determine the validity of these reports as early as possible This was the primary purpose of the entir e miss i ono The g oup doing t he investigatlon consisted essential l y of medica l personnel and civil and electronic engineers One-half of the group was in Na saki fran 20 September to 6 October and the r emaining half in liiroshima from 3 to 7 ctober o 1 1JNCIASSlf D UNCLASSIFIED The med i cal s tudy i s resented herevli t h 'l'he study c oncerning radioactiv ity Tybout i s pr e sentec l in i ection B of this reporto The investigations of phys ical de ma Ge to Hiroshima Varley and to Nagasaki Youngs constit ute Section Co •• ·• • p ECLASSIFIED Authority _ bJ Ji 4bD j - - UNClASSlflEtl • suu Y • DECLASSIFIED j utborilY 1J rJ D VJ UNClASSlflEb t _ ClASSlflED The best eBtimr- tes nv£ i lt• b1o at the prsssnt tima of the m u-nl ier 0£ casualties due to tho o to nic bo nbincs of d iroshima and i-l gase ki are Population Ilirosi1ima Na ase ki 320 000 260 000 78 000 37 000 35 ooo Dead Injured Totnl Cnsualties 30 000 65 000 115 000 These casualties were pr i marily due to w rns and mechanical in ' jurieso • In a ddition there were patients v ho showed a croup of unusual s ymi tor is and findin s which were concluded ·to be due to radiationo Scxne of t haso patients otherwise uninjured diedo The morta lity among 249 patien' s shu ing these effects was f ound to be about 16%-o Uost of these de ths occurred duri ng t he fourth week after the bombings o istimates based on the study or a selected roup of 900 patients indicated that total casualties occurred as far out as 4250 meters at NacQsaki and 3750 noters at iliroshi na furns extended oonsiderably farther than the other two and physical injuries sanewhut farther than the rudio tion e f' foota The averase _radius of partial physical dam age at Hiroshima was S900 meterso from medical fimings the e dence is that persons not exposed to the bcmbs Vero not injured by radioactivity persisting in the areas Integrated radiation dosages were calculated frcr gwn 'lla ray in- tensities measured abQUt six woeke after the bombings DECLASSIFIED Uthorit ' _bl J_D 4b0 f UNCLASSIFIED These indicate -t - a t the highest total do a e lhit · rould have eon re ei ved a t Hiroshima was between 6 and 25 roent ens of @mna ray rad iation0 and the highest in the Nagasaki area betwee n 30 and 1100 It was £ ls o determined that t ru s persistent radi oactivity originated a l most ent irely from aeposited fissi n products rather than from elements mude radioactive by the neutronso The gamma ray intensities at the time of the explosiqnwe r e calcu- lated from neasurements usin X ray films found in lliroshima o These in dicate intensities of 12 roentcens at 2300 meters as compared with a • theoretically predicted maximum of 3 roe t 6 ens Both of these figur es are considerably below what wou ld have been expected fr om the medical findingso The bombinGs affected over-all areas of l8o7 square iles includinb 3o0 square mi les of river at Hiroshima 8 and 42 09 square miles including 805 square r iiles of water at Nagasaki Onl y about 908 square miles of the latter was b lilt up however the re ainder being sparsely settled0 • The areas nost severely darna ed in both cities had an il verage radius of about one mileo ii thin t11is areu all bulldinE S not of substantial cons truction particularly wooden frwne and me sonry tuildings 8 were completely destroyed by the bl st In other ore substantial buildings such as those with heavy reluforced concrete frames• the buildings did not col lapse but dama e to bulldini lHLt3r i rs und casual tics v1ere nevertheless severe frcrn both blast und fires pproxima tely 39 per cont of 50 000 buildi s in Na si' ki were destroyed or seriously de me Gad f mw 11 1 DECLASSIFIED SECTION A 1fodical Study • Part Io Clinical and Laboratory Part Ilo Pathology Appendix • DECLASSIFIED j t y N AH jb06' 'UNCLASSIFIED UNCLASSIFIED Secti on 1 P rt I lledi oe l Study Clinical Laboratorl CON1·ENTS F'orward Chapter I o • rranerlll an '1'1pl e of pati ents s tudied 004000 1 J othod of collection of data 4 o o o 4 Rel ia bility •• ••• • ••• ••••• o 5 Chapter II 2 Distribut i on by city and sex 12 3 Distri rution by hospito l •• •••·•• 12 • 4o Ch apt er II DiE tribution by age 13 Descrlptior of Findi ngs 16 l Cacualty est imates •• •• •••• •••••• 17 - Burl'l 8 - Mechanica l i njuries •• • ••••• ••••• 36 ••• • • • • •• • •••• o•o ••• • • ••• • 2 4 Radiation i njuries DECLASSIFIED p utbority bJ AJj J4W j •••••••o oo•• •o 41 UNCLASSIFIED Chapter J V 0 Cause of Injuries Burns 0000 000 ♦ 00•0 • 0••000 Mecham cul injuries Radiat ion Ao Bo • II C • 0 0 000 000 0 0 000000000 00 0 0 0 82 000 00 84 0•0 00 • 00 84 0 0 dEvidence t that sympt oms were u 0 ionizing r adiat ion · tv1d o oo• 84 ence concerning inj o from p rsis t ent radioactivit ury BioloGical calibr ation of ya 85 cam ma ray intensity 88 0•00 0000000 Chapter V 0 NNI 71bl ffJ A ntho CLASSIFIED 0 0000• •• •0 0 - Conclusion OflOOOOOOoOO ■ • o ■ ■ ■ •o ■ ooo ■ oo ■ ooo 91 FOR fARD • t ly DECLASSIFIED _N Af j J°IW9J UNCLASSilED UNCLASSlfIED It was not i ntcn l ed that ' ho ned ico l section make any detailed study beyond 1 es-cablishin the presence or a bsence of effects due to radiation and 2 if such effects were observed 0 determining whether they were due entirely to radl ation released at the time of the explosions or in part to persi stent adi oactivityo In the cour s e · of t he i nvestir ati onD however cert a i n inpressions were 1 a ined of the more comprehensive effects of the bombs in producing casualt ieso _ I t was obviou s that ·any detai l ed i nvestigati on of the ca sualty producing effe ct s of atomi c bombs a s used ar ai nst Japan would requi r e a t l east sever a l months study o The investigat i on i nitiated by the 1anhatta n District group was there f ore continued by a joint medica l atcmic bomb investigatinc group ccmposed of medi cal personnel derived from three additiJnal independent u nitso The chisf of t hes e was an Army group orga rl zed under Colonel Ashley Oughterson t 1oCo o AUS for The Surr eon Gene -a l A secorxi was a Navy group under Commander Shields t iarren now Captain i l - C S USNR for the ission to Jape no u S vc l Techni cal The last was a group of Japanese investigators under Dr lasa o Tsuzuki for the Japanese goverlll lento Orza ization of the Joint Cor imission vm s ccmplc ted and the detailed work begun by the time the anhattan District Group le rt Japan in Oct ober 1945 The material collected by tho Joint Com ission was· brought to -'ashington D C during early January 1946 and analysis of it was 1 beeun The i 1anhattan District e roup is actively engai ed in this study at the present time Howevor o f or t he most part only data brou t ho ck pECLASSIFIED I ·cyJltJ D J bD J j utborl UNCLASSIF1£0 UNCLASSlfIEil i October was u sed i n the r eport sutmi tted hereo A preliminary report of the ini tial inve stiza tion c J PSli UiX l - R lport I VIUS sub ni tted in December 1945 t his is t he fi no l r oporto Alt 1ouc h the study of the Joint Com iission wi ll be f a r more complete fra l the medi cal standpoint neverthele ss t iti s repor t a nswers the spe cific questi ons concerni ng ' radiati on a nd persi s tent r a dioactivi ty for which the 1liss ion vm s sent o DECLASSIFIED ll tJ D J4b0i'f UNClASSJfJBJ JNClASSlflED CH 1 PTER I Personne l and Procedure DECLASSIFIED Authority _bl AJj J4hO J lo Investigating group 2o General sample lf patients studied 3o I lethod of collection of data 4o Reliability 5o Data studied UNCLASSIAED Cha pter I o Personne l and Procedure UNCLASSIFIED In Nagasaki the mater ial st ldied was collected b four AUS Medical Corps officers working with four young recently graduated Japane s e doctors and one Japanese school t eacher an interpreter •' f O acted only as In Hiroshima the colle ction of data was done similarly by four AUS iedical Corps officer s with the help of Japanese physicinnso 2o Genera l Se nple of Patients Studied The patients studied in this roup vtere mainly hospital patients o This roup is therefore a selected one in that the r i ore seri ou sly in jured would be more likely to be ad aittad to hospitalso In l'laea saki an attempt was made t o includ e all of the hos pi l patie nts ho had been injured by the bCX' l b• whereas in l iroshima a n attem _ t was made t o restrict the selection to patients vtn o were thought to s how effects of -r adiation injury The few non°hospita l pati ents seen in Nagasaki were usually ambu l a tory and were intervi ewed and examined if possible whenever t hey we re enc ount ered and the c ircums ta noes permitted o · 3o Method of Collection of Data Information about spec i fic patients was obtained by om or a com bina tion of methods The - -ecords v f iJ t hmtQ wno had been in the hospit1 1 ls but who were not t nere a t the time of the i nvestigation either beca use they had died or h d been discharGedp wero trans l a t ed and copied pECLASSIFIED j utbority _bJ tJJ J4bD S Histories were t a ken and physical exa minati ons done on pat i e nts in t he hospi tal s at t he tL o of the investisation Earlier laboratory work vras copie d from the pat i ents 9 records and laboratory files in both types of patie 'l ts laboratory studies were done on the la·l ter groupo usually t he AUS 1ledical Corps officer and the Japanese physician worked tosethe r in obtaining the t1istories and doing the exa mi nations Date on a few of the patients particularly the earlier cases 11 were obtained by interview with the Japanese physic i ans who had ta en care of the p tientso 4 Reliability In j ud ing the reliability of the data obtained in thi s studyp several factors must be kept prominently in mind In the first place 11 it is apparent that all of the information on the effects of the banbs on people of the two cities durinG the first 50 to 60 do ya is based enti rely on the observations of the Japanese Although conclus ions from these observations can be drawn fr om retnbulating a nd reanalyzing the cases the obs ervatio ns durin6 this L portant period are not first hand iome cenerul opin loas of the r e liability of the Japanese observa tions were forned du rin the ltl rbd of the b vestigati • This judgment can be applied to evalua tini the relia b i lity of the earlier observat i onso There was wide vario tion in the accuracJ of the observa tions of the various groups of Japanese physicians By enero l compa rison with American medice l method s it vm s felt that nore attention is given by Japanese physicians to t he 1istorj· n rn to thf f physical e xa 11ination Fortunately however the irnportunt fim iline s fran physical exar i inationsD e •11 epilation purpura D ulcerative stoma titis etc D a re obvious mani festations and undoubtedly were recorded correctly by the Japanese DECLASSIFIED I 4othori Y bJ AJ_f J jbQ 'J UNCLASSIFIED UNGUlSSlFlED The comment above on the Japnnese methods r efers nore to the physical diar nosis of such inter ml diseases as heart disease eva luation of syste iic diseases etc oD wh ich are of l ittle consequence in this studyo k- rthermore it was felt tho t there wns a tende ncy even among the best groups of Japanese investi ators to draw definite conclusions fron mea er datao Other s pecific factors i nfluence the reli bility of the data o Pr eminent a i one these was the overwhel ni·n g load on the hospita ls which followed the bombiili Si due to the tre endous romber of casual t i es and damage to hospital buildin15s and personne lo This was sufficiently great duri ng the first few days almost to precl de anj-thirlf but emergency treatment of patientso iee '· ppendix II - Report I for first- hand de s cription of a rrival of Ha asaki patients at Omura Naval Hospitalo Although this overloading undoubtedly contribu ted to the difficulty in making and recordin complete examinations it shou ld be emphasized that records were kept re n a rk ' ll r hell u1lder t i 1e circumste ncaso The co pleteness of this lnvestigation was limited by the short period of time a llowed 16 days in gasaki and 6 days in iroshima o It is felt t hat ore r eliance can be placed on the mat erial collected by t he joint eff9rts of American and Japanese phys icians after our arrival than on t he material based entirely on earlier Japanese obsar vations The distribution of t he Nagasaki cases in this respect is shown in Table I Distinction between s ources was not r ecorded for the lliroshiml3 cases at the time the data were collect ed DECLASSIFIED AuthOrity bJ Afj J4W J'j f- UNCLASSIFIED TAELE rC 1 Source of Information by Hospital for Pa tients Studied _ _ __ ________ _Na s _a_k_i__ _ _ _ _ _ _ _ _ __ Hos12ita l Japane se Source Only Japanes e American Sourc e Shinkozen Ishahya Omura Hos pital Un rec orded 15 13 204 134 1 8 TOTAL 233 235 51 39 A final word on the relinbili ty of the data sho'J ld be sa i d v ri th respect to the attitude o r the Japanese hys i c i anso It was f elt t hat at no time duri n the period of the study d i d a ny i ntentional di honesty or attempts to impede the investi ation in any wny occuro On the contrary# the study received the Great est cooperation frcn the Japanese physicians# v thout which it would have been very much more difficu lt if not impossibleo The groups studied in this report represent a highly selected group of patients and the find l n s repr esent those re ort ed during the first 50 days and obs rvutions made during the foll o i g two weekso Thereforeg they are not representative of effects on the total popula tionJi nor do they describe the effects over the entire period from the ti'Yle the bombs were dropped o 1 DECLASSIFIED utbority bJ --- tJj 4bO lj Tables not murked b a stor isk1 1 si 1ow datt 1 W roup studiedo 1 11 other tables are marked by asterisks and the source of information is given UNCLASSIFIED 8 5o UNCLASSfffED Data Studied In addition to the usunl edical observat i ons special emphasis wts placed on factors pertinent to the purposes of the investieationo T is re luted primarily to the distance of tho subject from the explos on l the shielding of the subject by intervenin objects including clothinc and the occurrence and the tine of onset of synptoms due to radiationo See Chapter IV - 4o I The distance frcxn GZ in Nar asa i was dP terrained by use of a rec- tangular coordinate m p on which patients inter viewed pointed out their ap iro timate location at the time of the explosiono From this the distance and direct ion of the subject from GZ was determ inedo For patients in iiiroshima only the distance as stated by the patient was recordedo Whether the pati ents were indoors outdoors or near intervenin objects and how th- 3y 1vere clothed was usked of patients seen This infor nation was not a vailo ble for a la r e enour h pro2ortion of the patients studied to permit analysis Effects wnich could be due to ionizing radiation wore particularly investi-ated As soon as the Ill ture of the bo nbs beca i e mo 'm to the u Japanese and cases with epilation were observed special attention was iven to the presence or absence of this find in Tho same is true for The points on the cround which wera deter nined to be directly under the points of det mation in each cl ty See l iecti on C will be referred to in the Joint neport as they are in the British Report 11 as GZ meaning T 1is is distin£ Uished fran AZ D meanu Ground Zero o c 11 ing Air lero • For the sake of brevity a nd co 1 istency these pECL _A _ SS _IF_IE_D____ riesignations will bEil used henceforth in this report j utbority tJj 4W J1 -- UNCLASSIFIED UNCLASSIFIED petechiae and for oropharynieal lesionso The latter wera descr ibed by a large var iety of terms v 'hlch in the analysis could not te d i ffer- entiatedo Laboratol7 exa ina tions of £ rt l cular i nterest were the white and red blood cell counts d i fferenti a l s and platelet countso I DECLASSIFIED t y l Afj J9b0 ' UNClASSlfIED 10 CliAPTb R II Description of Group_ Studied DECLASSIFIED j utbOrity bJ Afj J4b057j lo Total group 2o Distribution by city and sex 3o Distribution b r hospi tal 4 Distribution by age IKWSSIFIED UNCLASSJFIED Chapter IIo lo D ziscription Grou_ E _ Studied Total Grouy Data we re obtained and rocorded by the methods described on appro x i mate l y 1600 c ases at NaGasaki · and 500 cases a t fiirosti 'Tlao 0 h en those rec ords · ero revi e wed pr ior to analy sis it becrune evide nt that certain of them ho d to be immediately rejected solely on the bas is of insuffi This applied for the most art to NaGo saki caseso cient infor iationo As hus been d escribed the _ irocedure at i·lagasaki wa s to collect data on a ll of the patients who wer0 or had been in the hospita ls irrespective of how little i nformation w s avai 1E1ble on the dischare ed po tientso At W roaJ- i maii on the other h and patients for Vhom more c omplete data v rere avail1 1 ble and who wore thouc ht to s how some evidence o f radiation in- jury were s electedo foll owing basis T is initial rejection of patie nts was done on the Cases in w 1ich neither the distance from Gl nor the ou t come beyond two weeks after the bo 1 b were known were disoardedo The re ia i_ni g pa tients were incl lded i n the studyo The group studied co ipri ed •• tutt l uf JO0 pu tients were from Uiroshima and 468 from Ha asc ki uf t hese 432 The known d ifferences in the types and efficiencies of the two bombs e s well us differences i n the construction and the land contou rs in the two c it ies surzested thut the two groups s 10uld not be considered homo6 cmeous The pat ients fra i the t wo cities were th refore considered separatolyo DECLASSIFIED I A J NI J4W5j UNCLASS flta 2o Disti·ibution by City nnd Sex Of t J e 432 patients at Hiroshima 149 were fe nale s a nd 274 I J e leso No sex vru s recorded for the remainl 9 patientso stu·died at Na asaki 9 Of t h e 4 68 patients 319 were fe nales and 298 were ma les o The city and sex distr ibut ion is shm n in Table IIo · TABLE II Patients Studied as Grouped by City and Hiroshima Sex Female Male Unrecorded TOTAL 3 Nagasaki 149 274 170 298 Total 319 572 9 9 432 s x 468 900 Distribution by Hospit The ho s _ itals in the two cities in which the greatest number of patients were stud ied v'rere the Ujina Red Cross nnd Teshin hospita ls -in airoshima and the Omura Shinkozenp and shahya h o spitals in Na asaki o The· distribution and survival fi ures for patients st udied in these hos itals is s lOwn in Table IIIo At first a s tudy of c ases by hospital gro· ips was co ns i dered • hoVieVer fr O l Table III it may be observed thu t the t rOL ps become relatively smal l in number v1hen b r oken down by hospita lo Because of these small num1 ers c nd because of the relatively small differences in survival resu lts the patients from the three hospitals in each city were treated as a sine le groupo DECLASSIFIED Authority bJ AJJ J4W Jj UNCtASSIF1 0 Distributlo of Outc o r e by Hospital for Patients Studied Total No Deceased Survived ' f 0 0 Hiroshima Hospital s 205 89 135 Ujina ' 'eshin Red Cross TOTAL 90o2% 85 o4 8 7o4 423 11 7 88 3 69 Nagasaki Hospitals Shinkozen Isha hya Omura aospital Un• recorded TOT L 210 7' 25o0 78o 3% 52 289 48o4 5lo6 9 llol 88 09 419 40o3 59a7 75 0 Outcome is unknown for 3 Hiroshima and 49 Na a sa ki patientso 4o Distribution by Age Table rv gives the distribution of a Ge by sex for both Hiroshima and Na asaki patients The liiros t ima fema l es rane ed in age from lO to 69 yea1·s the males fr om 1 to 89 years Both male and female Na saki patients r an ed in a e from 1 to 69 yearso I ECLASSIFIED j uthority bJ tJj J4bD J UNCLASSIREd TA BLE IT Distribution of AGe by City a nd Sex for Patients Studied Age in Years Fer i al es t·l ales 0 0 l 1 7 Total Hiroshima IIosRitals 80 89 70- 79 60 69 50-59 40-49 30-39 20- 29 10-19 0- 9 Age Unrecorded TOTAL 7 l 14 19 18 29 28 S6 34 30 115 31 37 65 84 149 61 0 2 4 5 4 7 273 422 0 0 0 0 10 13 24 149 56 Na8asaki Hospitals 80- 89 70 79 60 69 50 59 0 0 4 14 40 - 4 9 11 14 14 26 62 40 30-39 2 29 10 19 0 9 42 67 78 6 110 1 3 109 188 13 4 170 298 468 Age Unrecorded TOTAL 7 76 Both a ge and sex Vlere unrec-orded for persons in' liiroshimao In the stud of the modica f i 1 u i iic s 11 one of t he factors which was controlled was aGe• At no point howeverg did a Ge seem to be pertinento In addition to theseo it was plannod when the a nalysis was bei Un to ane lyze the findin s by military or civilian status and by direction UNCLASSIFIEn sECRfJ 15 from GZo Division of tho groups by the forner was not done beca use of insuff ici e nt informationo Nar a saki il l tientso Di rection frao l was known only for In thi s - roup even thouGr there were some sugg es- tive t rends very little considerat ion could be Given to then because of the muny unknown factors involvedo r DECLASSIFIED _ ti JI 4b J 51 UNCLASSIFIED CUi PTilli III Description Findings lo Casua ty estimates Ao Bo 2o Total casualties 1 RelatL n to distance 2 Ca u se Cas ualties amonr pati ent s su rviving i mmedia tely a fter the explos ion 1 ltelu ti0n t o d i stance 2 Re l a tion t o time 3 Cause Burns Ao Description B Inc i dence anci r tl l ati on to morta lity Relation to distance Su muary Co Do 3 o 1 e c hanical Injuries A D Description Incidence Relati0n t o mortality Relation to di tance Bo Su nmary Bo C 4 Radia tion Injury Description of symptoms Incidence of symptoms o nd inter-relationship helatiJn t o time of onset elation to distance Bo kel ti on to outcuue Fo L boratory findings A 13 C Do Ge Ho Ic b ty DECLASSIFIED bl Afj J4b09J iscellane uus effects Description of type s Su n 11ury UNCLASSIFIED lo i 1any Ca sualty Estimates eyec witness accounts of the bombi ngs of lliroshima a nd Nagasaki have been writteno See Appendix II Reports I and III The extensive destruct ion of civic i ru ta 11 o tiom hospitals fire a nd police departments overnment agencies and the state of utter confusion im mediutely fo llowing the explosions as descri bed in these reports» attest to t he i nherent difficulties in makini estimates of casualties In a ddition» the japa nese do not have r egistration lo ws and the peripdic censuses a re not complete Fina lly the e rea t fires that ro e ed in ea ch city tota lly c onsumed many bodieso f A Tota l Casualties The rrumber of tota l casua lties have been estimated at var ious times since the bo nblnr s wi th wide discrepancies At the tbe of the departur e of the ianhattan District group the first week in October the most generally a ccepted f ieures were thos e civen i n Table V belowo TABLE V • Estimates of Casualties l Hiroshima Pre-raid population Dead • iissing TOTAL DEAD OR ISSING Injured TOTAL CASUALTIES liiro hir ia Source Na as9 ki Source J20 0UU 66 000 10 000 76 000 58 000 Uar ase ki 260 000 23 359 l 927 25 286 40 993 134 000 66 279 Official Japanes e News Report Nagasaki Pre£ecture l An extensive study of casualties conduct ed by the Joint Commissi on is being comp leted and will be presented in th Joint Report o In general it will indicate that the dead in Hiroshima were reater by perhaps 20% than the 66 000 reported Additional incompletely analyzed data indicates that in Na asaki the number dead should be as much as 50% greater than the 23 359 reported on l Septembero DECLASSIFIED Authority N tJJ 4t1J J j llNCLASSIFl b l o distanc o lut ion to -Re--------- ui1cL aSSIFffl The rolution of totu l casualties to distance from GZ is of' prb10 ry imyortance in evu luuting the casualty produc i ng effects of 0 the b t rnbs o t stimates oi this rebti mshlp for the to-ca l po uliltbn of i u gasak i a re shovm i n Table VI TABLB VI Rela'ci0n of Total Casualties to Distunce from Gl l Ce lcula ced No • Killed per Distancf l from G Number Gi eters Killed 0 500 1000 1500 2000 500 1000 1500 2000 3000 TOT L ' Source Number Inj ured Number Ussing Totul Casualtie s 70 505 3 p688 8 678 221 112 960 1 0 478 17 p 137 ll 958 1 127 1 799 3 9597 17 9 592 6 965 299412 12 207 9 589 20 204 4011993 6 568 67 765 28 U11it 0 500 Mo hrea 7i 505 1 229 l 736 32 6 Na asaki lunlcipality 20 Au st2st 1945 0 l No figures for total pre ra id population at these different distL nces were available These l'ould be necessary t o c -mpute percent mortality A cu lculati m given in the· British ltepor tC 2 and based on a preliminary an l ysis of the fore e ntioned s tudy of t he Joint Co nmission p 17 gives the following calculated values for percent mortality at incre $ing distances fr om Gl • Dist nce from GZ 1 eet Percent iortali t y 0 1000 9300% 1000 2000 92o0 2000 3000 8600 3000 4000 69 0 4000 - 5000 49o0 5000 - 6000 31 5 6000 7000 12 5 7000 8000 1 3 8000 9000 0 5 9000 10000 o 2 Report of the British iso v 1 to J i 1 to a Oll u n investigation of the effects of the atomic b Jmbs dropped at llirosl- ima and Nagase ki 0 0 DECLASSIFIED Authority _N tJ i 4W J f Jtstiu f UNCLASSlf1£0 19 2 Cause UNCL4SSIFIED It seems highly- probti blc fr0m tha vari0us reports that t he greatest total number of deaths r ere t h ose occurrinr i nmodiat ely after t he bo 1bin1 s o 'i'he cause of the se can only be s urmise d and as so aptly stated in the British Re port those ne r the center were probv bly killed as it were several times ovor by euch casua ltyproducing a 6 ont sepnrf tely1' o It is the general impre ss i on t hu t the proper order of importa nce for po sible ca ses of dea th in t hi s e r iup is Burns mechanical injury and blast o I arly est im s te s by t he Japanese are s hown in Tubl e V Io TABLB VII Cause of Immediate Deaths Cause of Injury Hiroshima Naeasaki Bo Source Percent Burns Falling Debr is 60 0% 30 other lOo Burns Falling Debris 1''lyint glass cuts othor Number of' Cases 101 10 95 9o 8 8 7 7 Report of Ja panese Army edical Co n ni tteo Casualties a i iong Pa ti onts 1 urviving Immediately after the Explosions I lore inforitatlon i s availo ble concerning the number and distri bution of casualties survivi ng i m nediately a fter the explosions Table VIII shows total figures from variuus hos pitalso DECLASSIFIED wthority 1 1'I tJj J4bD Jc_J 20 UNCif SSIFIED KET TABLE VIII ' Number and Distribution of Casualties Noo of Place Patient s Treated Trei ted % No CXitcame Unknown discharged Known Alive No % Known Dead % No Na asaki Qnura Ha val 758 155 20o4% 158 2008% 445 5807% 689 239 34 7 l0o7 3 76 5406 1 0 231 484 39o3% Ilospo Ishahya i vavc l I iospo Hiroshima Ono Hospital 1t e Source 74 151 12o3% 596 48o4% Interviev1s with hospital officia ls o The percent dead in Table VIII are minimum ficures for pat ients surviving immediately after the explosi ons who sought medical careo They refer to total casualties without regard to distance from GZ 1 Relation to Distance Table IX presents mortality results in relation to distance from G for the s all select sa ple studied by us o TABLE IX Relation of Dista nce from GZ to Percent i fortality i n Patients Studied Distance from GZ Ktio Oo25 - 0 74 1 75 1 25 lo75 2 25 2 75 3 25 3 75 TOTAL DECLASSIFIED Uthority _bl 1 tJj bD J lliroshime Total No 18 Na 1 asaki Deceased No % 2 26 10 l llo 18 Total No 3 98 90 30 14 l6o 13 43 l lo 3o24 4 14 12 3 7 5 371 268 3 74 4 24 82 14 l % 19 148 10 N 12 1 24 lo 74 2 24 2 74 102 • Deceased 50 srteREr' UNCLASSIFIED 25 % 19 1a 7% f 2 o Relation to V me The time of occurrence of deaths of patients who survived im- mediately after t he explosions is sho m in Fieure lo lt can be seen that there is a marked preponderance of deaths durin the fou rth week a t Hiroshimao At lfo ge1 sa ki1 on the other hund by far the c reutest wmber of deaths in any single week occurred d irine t he fi rst we ek o Thi s fi gu re shows the difference in the method of sampli nr in the two cities probubly better than any other analysis present ed The most plausible explunation for the difference is that as previ ou·s l y d e scribed» an attenpt wus made a t Hir oshima to select patients s ho ·dng signs of radiation injur r1 whereas all hospitalized Nagasaki a tients were includea l o F'rom t r is i t can be infer red that t e rea test number of deaths i n patients showin6 recognizable effec t s of radiation occurred during the f ourth weeko For the t otal hospital po pulation$ on the other hand the reu test number of dea t hs oc curr ed during the first woeko 3 Cuuse The main causes of death amonc p tients surviving immediately a fter the explosions are burns mechanical lnjuries and radiation · The reutost percentar e of deaths a ong hos ital patients was dur ing the first week$ as shown in Figure lo i e ny of these were known to be due to burns u nd fewer to mechanical injurie t The reoognizable l Ti1is explanation for the difference in time of death among patients who survived immediate l y after the explosio'n is far more likoly than any based upon actual differences between t he t wo cities DECLASSIFIED p uthority _- tJj J 4W Jj UNCLASSfflED • R8 ATt Jf Of IEAlltS AIDI PATI f H1'S SUR' IY l tCi 11£ 111£01A1E EJ fl OSIClt TO ThE CE Of 'YH 61 OfAlHS t ll'llt'l a e•J ir- ' 4 s 6 c · 9 -Q C I' - ht IIEEJm AFTER 11£ El Pt OSICSCS l FIGURE_ _ f J t effects due to radiat ion rb cel 1 occurre d du r ini the firs t week see Cm pter 111 4 so tha t the proper order of importance would appeur to be thut glven l The proportion of totu l deaths both im nedi te and luter due to the vari ous as uses cannot be d etermined frcrn this study of selected patients o l Any estimo te of whr t part ri diation muy have c ontributed to the i n uedia te deti ths or to deu ths occurring before the r ec ognizable fects appeared ure on the basis of specu lbt i n aud 6hould be inter preted as sucho er r jty 1 DECLASSIFIED 1'l Ali 14b05'J UNCLASSIFIED Ao Description 'l'wo types of rurns were observedo These are gene rally differen tiated as fle nc or fire burns and so called f l ash burnso • The early nppeara nce of tho f ormer type ns repor ted by the J P«'l i ese and the later appenrance C 1 S observed na s not unusual The flU sh burns on the other haild presented soveral interestlng f ea tureso i iarked red ness of the affected skin areas appeared aLiost b1 rtedi atelyi according to the Japanese ith proi ressive chanGe s in the s k in taking place over a period of n few hours ti11Hl aen 1 1 rt r 5U days the ao st dis tinotive feo ture of these burns was their shurp li llitntion to exposed skin are1 1 s f acing the center of tile explosion l or instance a patient who had been wa lkine in a direction a t right o n6 les to a line drawn between i1im and the center of the ex ilosion nnd wl1ose arms wero sv1in - i ng mi ht have burns only on the outside of the arm nearest tho center and t l e inside of the other arm Plates I and II show oxa ' llples or this t ype of bur no • or the most part u ny tne of s r ieldine protected the skin against liuch rurns although burns thr Gh 0ne and very ocousionally more layers of clothinr did occur ln patients nefAr the center In such oa ses 0 i t was not unus ui l to find burns t hroui h black 11 bl it not through whi te clothinr in the swne patient Hush burns o lso tended to in volve o reu s whe re the clothes were tir htly drawn over the skin such a s the elbows and shoulders DECLASSIFIED Authority NAJj 4W J UNCLASSIFIED I • UNClASSJF fD PLATES I-IIo FLASH BURNS Ja panese pi ctures of patients ·showing chara c t eristic distribution of s o- cal l ed flash burns during the early healing sta go Note the sha rp borders of the burns and their limitation to exposed skin surfaces facing the centero This is particularly str iking in Pluta lo See Text DECLASSIFIED Autho rity bl tJj J4W J7j Crep IIl- 2 UNCLASSIFIED I Pl i TE I ' l LAiJH mnm SEE ' 2XT I Il-2 DECLASSIFIED Authority - NAJj J4W2J mlCI ASSlflED UNClASSJFJED PUTE Ilo FLASH BURNS SEE TEXT IIX 2 I DECLASSIFIED AUth_ ity - N Ji J3ND 5j UNCLASSIFIED The degree c nd extent of burns in tho 900 cuses s tudied were not revealing becauso of insufficiont dnta The incidence of the var i ou s degrtSes of flash burns in hos i tul pl tients however is of int'erest a nd s ime esti -nutcs are a vailtl i i 1 1 1rum Japanese reportco Of 20 3 bu rned patie nts e d nitted t o luura i i wa l hos ital Nacasai i for instance 2 9 were c lassifi ed as 1st degree 0 148 a s 2 nd d egree a nd 3 1 as 3rd d egree See Ai i end i x II Report IIo dur i ng healin g would tend to The appearance of t he burns as obs e rved conf i rm t he fact t h1at t h e ma jority of the flas h bu r ns wer e 2nd degree a lthough it i s fel t t hat 3r d degree P Ure · f l ash bu rns were u n likely or ver y inf r equ ent o · 'f he appeure nce of bot h types ot bur n s whe n seen during t he h eal i ng stue e was characterized by sever a l ot her features Although u n doubt e d ly al 1ost a ll of the i ncon p l etely heal e d ru rns showed s ome signs of infection their eneral appear1 4nce was unusual l y good when consi dered in the lie ht of the unbelievubly poor c i rcumstances under whic h they had to be tret ted There 'mre frequentlyII however large amou nts of kel id for mation tnich v10uld sup ge st eeneral secondary i nf eotion o A further rather striking feature of the hcalinr flash burns was the almost c onst1 1 nt presence of some degre e of ski n pigp1entat ioL1 occasion ally lith an adjacent area of depi gµi entution Bo Incidence e nd Rolo tion to ortality The comparative incidence of the two types of tur ns i n t he 900 cases studied could not be det ermined The decision 1su a lly c ould n ot be made in patients whose findin s were known only fr om record s and DECLASSIFIED Authority N AJj J4W Jj ONCLASSIR D this constituted a larf e enoui i1 nunLer that the difforentie tion was not siE nifica nt i stimates of this by the Japunese in patients reuchini the hospitals vary c onsiderubly rut of the burns -were flash bur as o i-t was the genera l opinion th at most eo n t pendix 11 9 Rci Ort I which stutes that 197 of 208 burned pu tioots dmi tted to Cmura ravnl ilospi t1 1 l Table X shows the incidence of burns in the group studied T ABL x l Incidence of BurIW in Patients Studied Tota l Po tients CirY Sex N Patients with Burne % No Ii F 140 27 H M 110 4l o N N 269 99 34 34 J l 13 6 84 620 F V 19 It can be seen from Table X that 19% of 140 fema les and 41% of 269 males at iurosiiima had burns Corrospondinc fi u es for Nacasaki reveal 34 of 99 females and 62% of 136 males havinr bJ rns selection of the type of hospital patients lb S ince no mad e in the Na asaki erou p the l ttor figures are prob bly better estim tes of the •incidence of burns in all hospital p1 1 tientso 1 In this and in several of the fo llowlng Tablos it will be noted tha t the number of p1 1 tients consider ed varies and is le s than the total nu lber included in the study The reason for t i is is that in the study of inter-correlations only patients for whcxn thero was def inite i ni'or uatiun as to whether et ch of t he symptoms studi ed was present or absent were included DECLASSIFIED Authority N Afj J4W J UNCLASS flEb The Japu hese report the incidence of burns in patients surviving more than a f 13w hours after the explosions and seeidni medica l atten ' tion us hir h as 95 o Sac Appendix II Report lo As mentioned the Japanese als o report that the ma jority of the burns ore 2nd degree o It see ns apparent therefore that a la rg e proportion of the medical and hospital co re required durinc the early poriod a fter the b• i nbing was rel ted to the ca re und treatment of burnso The tot a l mortality due to rurns a lone cannot be estimated with any degree of accuracy As discussed above it is believed that the majority of a 11 of the deaths occurred immediately and how many of these were due to b lrns is unknown C stimates as high as 75J have bean ma de by the Japane se and most of the re ' orts attribute over 50 of the deaths to burns The relationship between burns and death in the Groups studied is shown in Table AI TABLE X 1 Relation Between 131 lrna and Death in Plltients Studied Survivors Cit t Sax DECLASSIFIED Authority H 1'' li N M N M N AfJ 4W J j i' I N 128 249 97 147 Deceased N Survivors Showing Sym tom Deceased Showing Sym trm 190% 420 37 650 25 % 300 790 92 0 % 16 20 43 99 007 - 68 o4 l x 2 p 079 19 33 oOl 21055 oOl This shows that for i Iiroshima f ema l e s 19 of 128 su rvi vors a nd 251 of 16 d e c eased had burns · For Hiroshima ma les 42% of 249 survivors and 30 o o f' 20 a6c ea sed had burns This doe s not indic11t e a significant l r elation betwe en burns and death in t he Hiroshima pat i ents but it must be kept in mind that a sel ection of pa tlents shov iug Jlllptoms of radie t ion disease was a tte npted there which excluded many patients with burnso At Na gas aki on the other hand 37' o f 9 7 fema le sur vivors and 797 of 43 fe a l e deceu sed had burns and 6 5l of 14 7 male survivors as compared with 92% of 99 ma le deceased hu d burns This indicates a highly significant relati m between burns and dea th C helation to Distance That a rehl t i oh exists between the occurrenoe of burns und the distance from the c enter of the explos ion is 1t1entioned in most Japanese reports They state that the closer t o GZ the greater the proportion of people b trned Although this would certa i nly a ppear a t first g lance to be reas onable there are several fo ctors whi c h v10ul d tend to at te uate the relutionship as o bserved i n thi s studyo I t required much less shielding to protect a ainst flash burns t han a gainst any other oe sue lty produoing o r ent Although unprotected per s ons very oloso to l The differences botween the percent showine t he symptoms for survi vors and dec eased were tested st itisticallyo Th is was usually done by the chi square technique Tho conventional levels for significance have been adopted P 05 oOl P 05 p 01 DECLASSIFIED p uthority 1'J AJj J4W lf Hot significant Siqiificant uir rily significant UNCI ASSlf £0 un ri f t t frtrn Ul U - 'ivu»f u JJ Gl undoubtedly all received flash burns a large rn unber of such persons were in the groups killed outright and woul d therefor e not be included in studies of persons surv·i'ving immediatol y after the explosionso Finally at greater distances where the turns would be expected to i Je less severe many peo_p le receivi ng such burns probu bly did not Get to · the hospitalso For the groups studi ed the relation- ship between the presence of burns and the di stance fr om GZ is shown in Table XIIo TABLE XII Relation between Occurrence of Burns and Distance f r om GZ in Patients Studied Symptom Symptom Symptom Present Absent City Sex Total Absent N Uo II H F 130 108 M 237 N N F M 111 15' 147 66 58 j Jo 22 90 46 ' 99 Symptom Present hl lJistance M Distance Km Ko lo48 lo35 1 32 lo38 l o48 l o49 l o67 1 31 Point Ste ndard Deviation 5o69 5o3l 6061 7o72 o07 ol2 ol2 022 This rela ionship has been expressed in the column headed Point Biserial Correlation p ected direction These correlation rosults are not in the ex- Thus it is ev ident that t he selection factor is operating • l The point biseral correlations were computed by means of the Pearson product-moment correlation formula With one of the two variables dichotQni ed vi presence or absence of symptom A negative result would indicate thut the farther away from Gt the individual was l ocated the less likely he was to have the symptan In order to be considered ignificant correlations w0uld have to be greater than - 20 when based on sampl s of less than 200 cases • DECLASSIFIED Authority bJ tJj 4bO j ·UNCl SSlf £0 Bi- serial Cor relation r 33 rqrLJ1 rl ' l r o f- iv · hJ J 1 1 It is of pa rarnount interc t • owovcr t o from G¼ at whi ch burns were observectCl o w • ' ij the maximum distance Tho number of patients with - burns and their distance fro l Gl is s hown ln Figure 2 o This figure indicates that t here is a marked difference between the two cities althout h this ·might be due in part to the differe nce i n methods of se lection of 9B tient s It can be estima ted that patients with burns a t iiroshima were a l l less than 2250 met ers rrom· the center at the time of the bombingo At Nngasaki 9 p atients_with burns were observed out to t he remark ble distance of 4250 meterso Burning of physical objects was observed out to 2700 meters at iliroshi map as described in Section Co The types of physical agents causiri e the burns will be discus sed in Chapter IV-l o Do Swrunary Two types of burns t fire or flame and so-called flush were obI ' served in patients injured by the atomic bombs o They were of all decrees of severity and probnbly accounted for the majority of the injur i es and deaths It is estimated from this study that they ax- 1 The reliability of these observa tions is limited by t he method of obtaining the information as previously discussed The findines reported here will be checked by tho se in the Joint Re port in which the verbal accounts of the distances of patients fran Gt was in miuJ · cas·es checked by going with the subject to the location specified DECLASSIFIED Authority 1-J AJ j J4W Jv NJJR UNCLASSIFIED • • fJIJ t 11 P ½ I j l L • JlI ' ' •I I - -i1 i - l I I _ t r--- '--75 I t a - I I - I -- � • I I - - 1 I I • i n -l1�-7J •- ' I - I I __ _ r r n e1 _ NMiUS - - I l l-��--' - I I 1-I - I � I ·--t 1- · I l-��1 1 1 - r- - -I I1_ I I ' I l--�-I - j i ' I 1---I 1 I - - - - - - -l- - J I · -----J _ _ _____ Cf F V•H J' i - M llll-'J� OISTA - 'f i W 'f l ' l i J� OOSfRVf D ffil f I f E AT tended out to 2250 meters at Hiroshima and 42 50 meters at Nu t o se kio Prot ect io1 appeared to be given f r o n flash burns by a1·nost a ny i ntervening ob ect A large proportion of the medi cal and hospi tal care requ i red uring the early periods after the bumbinr s was rel a t ed t o t he care nd trei tmcnt of burns o I DECLASSIFIED p uthOf 1 1 Uj - J I -stt rti UNCLASSIFIED 3o Mechanical Itjuries Descrip_tion Ao 'l he nechanical injur ies included fractures l a cera t ions 3 C-'ntusions tbn sions and other eff ects to be expected from crumblln walls fly- ing debris and glass and other indirect blast effectso The appearance of these various types of mechanical i njurie s was not remarka bleo 11£ ny of t he Japanese The direct bl ist 0i'fects d_e serve some mentiono reports describe im i11edia te effects such t ts r uptured abdomens with protrudi ne intest ines and protruding eyes No e stimate of t h e number of immediate deaths or ear ly symptoms due to direct blast can be made It is quite certain however ti1ut very fe ruptur1ed ear drums occurred and it is the gener£1 l fee ling that the direct blast effects were not e reato Incidence B The incidence of mechanical· injuries recorded in the 6roup studied · is shown in Table AIII TABL1' XIII Incidence of · rechanical Injuries in Groups Studied Females Total No 140 Patients with Injuries Hiroshima Mechanical Injury l Na a saki Lacerations Males Total N - 269 N 7 No 42 30 100 Total N - 99 Contusions 58 38 Fractures 6 58% 38 60 Total No 64 % 37% 0 136 44 47% J2o 5 4 l The different types of m cui i i li cal inju ies could not be determined for the Hirosi1ima patientso DECLASSIFIED 1 II f uthority l Afj J jb0£J UNCl ASSlflEO No estitllb tas are available for the total i ncidence or proport ions of diff'erent types of mechanical injuries f' or the total populations or surviving groups Relation to lilortality Co The relationship between mechanical injuries as represented by lacerations and death in the Groups studied is shown in Table XIVo TABLE XIV Relationship between Mechanical Injuries Lacerations and Death in Patients Studied Citl Sex Survivors No Survivors Showing Deceased Symptoms N H li N F 128 16 M 249 F 97 N M 145 20 24 29 % ------ Deceased Showing Symptoms % x2 30 % 380% ol2 073 370 350 62 0 oOO 099 oOl 094 83 8064 01 61 51 p It can be seen from Table XIV that no significant ass ociation b t ween the presence of lacerations and death existed except in the case of the Nagasaki males r 'ven though this P value is a t the hi ghly sig- nificant level the P values for the other groups are so high that one is forced to minimize the importance of this result The rejection of patients having lacerations but not showine radiati on symptoms in the Hir oshima i roup wou ld ni luence this findinG as wo 1 ld the overall selection of all the groups There a re no Japanese estimates avail- able on the relation of mechar1ical injuries to deaths of the total ex posed populations or of the survivors DECLASSIFIED j uthOrity 1'J tJj J 4W Jj I UNCLASSIFIED Re l ation to LJistance Do The association bet ween the occurrence of mechanioal injuries as manifested by l acerations and the distance f r om GZ is si10wn in Tab lo 1 Vo TABLI XV Assoc iation Bet ween Oc currence of s echa nioal I njuries and Distance from GZ in Patients Studied -- Total Citl Sex 1 1 ll N N No --- F M F M Symptoms Absent Jo 1 50 92 237 115 158 153 SymptQJls Present No 44 38 84 71 73 85 Symptoms Absent i i Distance lfmo lo54 lo52 l o49 1066 Symptoms Present hl Distance Standard Deviation Kmo l o26 l ol9 lo 34 lo4l 5o69 5o3l 7o04 7o6l Point Bi ' serial Cor relati on 23 - 029 ' oll - 17 The fact that all four oorrela tions are ne ative a nd that two of them oan be considered gnii'icant indicates that even i n this selected sample the incidence of mechanlcal injuries varies inversely with distancoo e F'i Ure 3 shows the number of people with lacerati ons a nd their distance from GZ Although not as marked as with burns it can be seen thut there is a difference between t he t wo citios o It oan be estimated that patients with lucerations at liiroshima wer e less than 3250 meters from G wherea s at Nagasaki they were out to 3750 meters ii'o SUTlllil lry Without doubt mechanical injuries accounted for a l arge number of immediate deatha as well a s deaths among the people survi ving immediately DECLASSIFIED r rity tl Ni J9b06j 1 UNCLASSlfIfD •• OF PAi'§ENTS W31U I ACERAYJOOS I Yl IT 44 __ wsrnvEO AY r- I- - r -1 I I I I I I I I I I I I I OIST Ja Fi'fl 4 2o7j I-- r-7 I I I 0 I 2 2 5 '--- · I I I I 2 2 0 2 ·i K'-' i o'lJ 8ot Oc7' '--- t °o' I I I CE1' T 6'8 9 I - - jJ 'l '¥-' 13 59 '27 7 J ·- fEllALES l' lli C£N11ER 2 31 - VMlOUS OI STAtt ES FRCM I I j I FIGlJRE _ c -- after the explos i onso available 9 The i ncidence Ya r·ied inversely with dista nce Lace rations extended out further at Na v saki than ut liirosuima a lthough ' he difference between the two cities and the total distances vare l ess than for burnso I f No estimates of t he mun bar of these are DECLASSIFIED j utbority - N AJj J9'b D5j • UNCLASSIFIED • fl • 4 Q Radiation Injuries · UNCUSS flfD Although fe ior in number ths n the casualties due to wrns i nd meche nioo l injux-ies tho symptoms of greatest e enere l medical in ' terest and of particular interost to the members of thi s investigating group were t hose due to ioniz l ig radiation l o According to t ha Jupanese observiti ons the a rly symptoms in this group of J u tients clo ely resemb'l ed the G Jllptoms obsorved in patients receiving intansiv roentt en therapy as well as those observed in experimental ninmls reoeiv l ng laree doseh of i -rayso The i nportant symptoms a nd findinr s reported by the Japanese and observed by us wore epilatlon purpura and othEtr hemorrhagic r11 nU'estations oroph aryngeal les i ons vorniting diarrhea and fever o Associated wi th these s ymptoms aertnin import1 1 nt ' laboratory emmiru tions were raported by the Japanese a_nd exa11ples of these wer also observedo l The proper designation of tlds tJl 8 of inj iz y is somewhat di 'f'icult Probably tho two most direct dosig11at1ons are radi tidn injury and gtillLU rat injury the forruar is not entirely suit Ltble in that it does not define the type of radiation as iJnizing and allows possible confusion with other types of radiation a g •• infra-red The objec tion to· the ltltter is that it li aits the ionizing radiati on to gamm a rays which 1vere undoubtedly the most important but the possibla contribution of neutrons and even beta rays to the biologica l effeots cannot be entirely ignored dls tivn injury has the advantage uf custan sinoe it is £enurally u nderstood in medicine to refer to X -ray effects as distineui shed fro ' th fects r f actinic radie tion Ao oordingly o radlation injur Y will be used in this report to mean injury due_ only to ionizine r diatien • - This designation v1ill also be used in the· Joint lieport although ray injury is used i n the British Jieport 7 'I tJj J°lbDb DECLASSIFIED N _ UNCLASSlf £0 4 1 I • as might ba expected ovary cradation of s everity as ob ervad de pending primarily on shielding from the ioni3ing radiation e ither by air dist anoe f1•om bomb or by l nterv ni ng objeotso of these symptoms e nd finc i 1 ' S ftnci f - fl The doscri ption stud 7 of' the factors res ponsible for variations in ·s everity is the nain subject of this section of the studyo - iSpilation was one of the n ost sps ctaoul lr v nd obviou s fi ndingso The ap Jearance of the cpilating patient was typicalo Plates III VIII The orown was involved more thu n the sides and in many ins- tances the r ae nblance to rrionk 's tonsure was striki ng cases th a hair wa totally lost In extreme In aue cases regrowth of hai r had begun by tho timo ve saw the patients 50 days after the b01J1bingso Curious ly epilation of hair other than thnt of the scalp was extremely unusualo Petechiae and other he norrhagi 0 ma nifestu tions were also striking findine a Bleeding began us ally fr a i the g- uns and in the more serious- l y affected was sooi1 evident fr every possi hle source purpura appeared on the li nbs and on pras ure points Pet echiae and Plates n a XI large ecchytnoses developed about need punoturea and wounds partially healed · broke down and bled il'eely many of the patients Re tinal hemorrhar es occurred in See Appendix r Heport II nd the coagulation time wn s prolonged The bleedinc time The platelets were characteris- tically reduced in numbers DECLASSIFIED - _ ity N J D J Jb09j UNCLASSIFIED PLATES III VIH l PIL ti TION • Patients et Liiroshim a and Naga saki showing varying de reeG of epilation Note that epilation is alw ost exclusively li ited to the hair of the scalp · ee Text Chap Ii lu4A 1 DECLASSIFIED Authority 1'I tJj J4b0 1 tlNCLASSlntb • 4 PLATE II I EPlLATION SEE TEXT IlI 4A I DECLASSIFIED Authority - NAJj 9W t I UNCLASSIFIED PLATE IV E ILATION SEE TEXT III-4A DECLASSIFIED Authority - NtJj J4W J UNCLASSIFIED ·• Pl ' 'E 1 • EPILATION s r •nT I I I-4A DECLASSIFIED wthority 1 bJ J D 4W lJ S5GRB - UNCLAssm PLATE VI EPlLATION SEI TEXT I I I-4A DECLASSIFIED Authority _bl Afj 4W J UNCLASSIFIEll· UNCLASSIFIED ·• ' I I PLATE Vl l • EPILATION SEE 'l'EYT II I 4A I DECLASSIFIED Authority -1 NAfj 9b 2J U'1ClASSIFIED UNtl ASSIFIED •• PliATE v n EPILATION EE TEXT 1II-4A DECLASSIFIED Authority NtJj J4bD UNCLASSIFIED Pt TBCilIAE Three patients- one generalized peteohiae •1 DECLASSIFIED - I ' l AJj J9W63 t t a au opsy showin UNCLASSIFIED j ✓ ' UNClASSlflEU I PLATE IX PET100HIAE SEE TEXT III-4A UNCLASSIFIEJ DECLASSIFIED utbority bl AJ D J 4bD J ◄ P LATE X PETECHIAE l11-4A SEE TEXT I DECLASSIFIED Authority - 1'J Jj 4 UNCLASSIF1£D• Pl AT s w Xl ' 1 'Tl-'CHIAE RE l'EXT I I t-4A DECLASSIFIE Authority _ NtJj J'lW J IJNCLASS1FIED ploGions wa s r -3ported r e t hor frequently by the Ja paneseo This u sua lly had aubsided by the follovdni morning a l t houe h ocoaslona lly it con- tinued for two t o t hree days Vo ni ·t i ng v t 1 s not infreque ntly reported and observed durin the cours e of' t he later symptoms although t these times it gen r a lly appea red to · bs relat ed to other manifestations of systenic reaction a ssocia ted with i n fection Diarrhea of var yinc degrees of a sv erity was reported and observed In the ore aevero cases it wns f requently bloody For reasons which are not at all cle r the diarrhea in s ome i n s tances Vila very persia tento Lesion e of t he gums the ort i l muc ous mombr-anes and the throat were observed· The affect ad areas bec q_me de e req the n viola0io11s in color and in ma iy inste nces u lcer t i on tt nd necrosis f ollowodo These lesions differed in no way from t he fami liar lesions of agraw- looytio anginao Blood counts done a nd r ec orded by the Japanese a5 well as counts done by- the t anha·btan Distr ict grwp on such patients regularly showed a l euoopenia count W s below 1 000 In ext r eme cases the white blood cell In assooi tion with the l8110openi a a nd the oropharyngeal lesi ons a variety of ot her infe ctive processes were seen lq1 ulds a burns which were h ea lin g a de quately suppurated and serious necrosis oocurred more extensive Decubitus u loers be ame more severe and lt the sElJJle time similar ulcer 1 1 tions we ro observed in the larynx the bowel and in fem ale s t he zeni talla 1''e ver ·usl lally aocompanied thes e l e sions DECLASSIFIED I p utbority lJ J_i J3b0 'J UNCLASSIFIED manifested f'or t he most part b t 9 lllenor rhea and interruption of' pregnancieso See Chapter B ur 4d Incidence of Sym Ptom_s and Jnter relutionship The above were the prominent symptoms find in s and laboratory data ro3ported to us by the Japanese und excet't for the initio l nausea and vo nitlng obsel'il'ed by the ianhatto n District groupo An attempt was made to deter nino tho relut i 1Ja ui' these to one another to the time of' onseti t o the distance from t h1 cento r and to outoOll e of patients in order -to describe the chronolo y of this t ype of lnjury and to evaluate tha protective effect of shieldin o The percent ge incidence of the symptoms observed and recorded in the groups of pe tients stadied aro l isted in Table i VIo TABLE XVI Percentage Ino idanoe or Selected Signe and Symptcms i n 644 Patients Studied lliroahi ma Peroont Having Symptom Females Hales Nausea Vom1tin Diarrhea Bloody stools l lpile tion Peteohia e Fever Orophilryne eal leGions TOT AL N DECLASSIFIED - II p uthority 1 J AJj 11 JJbj Nagasaki Percent Having Symptom Females J l eu 51 % 34 % 11 % 80 39 39 26 0 56 360 420 lOo 360 18 49 120 l8o 55 a 660 35 270 35 0 140 5 25 269 99 UNCLASSIFIED 40% So 130 136 in the selected gr oup studied It Wt' s not possible therefore to define symptom catef odes on the bas i s of -this study•o Co Relation to Time of' Onset The week of onsetp without regard t o distance from az l · of epilation in 5 7 patients» petechiae in 35 and haryngitis in 5 7 i s shown in Figure 4 '£hoss de t Q refer t o Nazase ki pati ents only-o i nformation wus not e vnilable for pa t ionts at liiroshicae o This The onset of pharyngitis is ssWil ed to follow i n a general_ way the onset of leucopenia although the relationship between the t wo cannot be consi- dered to bo as c loae a s thu t between t hro nbooytopeni a and petechiaeo F'igure 4 shows a dofinit a peak fcir the time of onset of epilation during the eeoond week with B munber of cases beginningj however 11 as early as t he firs t and· ae late as t he fifth weeko The week of en set of petechiao and pharyngitis raneed from the first to the eixth waek With both of' t hase sympt s a do finlte peak oocurr ed during the fourth week l a _It woul d be 0£ graat value to be a ble to rel te suoh factors ae this t o equivalent radiation dosage by oonsiderine the amount of ahialdin6 by a lr distance and other intorve ning mnteriala The sm o 11 number of patients and lack of ir1for nation does not allow t his i n tbis study In this particular analysis of the ti e or onset of radiation S YlllptQns it is truo also tl1' t any variation in time of onset or any one symptom dependent entirely on dosage would be negli ibly emall oom pared with variation in tim of onset of different symptQllle The -l atter is wmt thoee figures are i ntended to desoribeo DECLASSIFIED AuthOrity _N AJj 4b05 UNCLASSIFIED s• • R£LATI OF CF EPII ATI lj3 • PETBlf e ANO f tillfMGI Tl S 10 W£EX OF CHSEi' OF SllPlOllo 41 o - - -o - -- EPU AYICN N fl PfRCOO' F PATIENTS HIWtf«i SYIIPn M lO e - · - __ _ _ _ _ _ _ _ _ _L - _ __ 2 _ ---- 1 ---·r __ _ _ _ __ _ _ _ __ _ _ _ 6 FIGURu E- '4 ''--_ 7 ✓ s• • • R£LAT111i O F W EPUATICJi P£T8li Jc 0 ANO fHClfffllitllS 10 emt Of NIEY Of SllPllllo 41 0 PfRCe« F I o - I PATIENTS KIWltG SVIFTOY g9 0 _ · · --··I ·- - EPU ATHl t Ng S7 1-lLl'EctllAC Ni 3 5 · D --' lO 0 · ' c -- - y 6 2 1 _· - 3 '' c · w-n ii r··r'' il FIGURE 4 s• • RELATUli OF W EPllATi 8 PETaJiile 0 AHO ftillfMGITlS 10 OF NE' Of Slll nllo • 4t 0 0 - -·- --· · · __ EP U ATI O t Ng fl 1-'CTECHIAf ll g 3 5 _ PfRCENI' F PATIENTS K W tt«i SYlf lOY 10 --' 0 ' JI __ s -- -n --a 6 7 Cf s u - Ill r-r--a FIGURE 4 The t i me of onset of · with these selected sympt- xns for a chronoloGical descr i ption of the disease st£i te obsorved is ahovm i n f'ii i r o 5o seen that a peak for t he time of onset first weeko or Fr om this it can be diar rhea occurr ed in the After e n init ial drvp t her e is a fairly well sustained ourvo with no defini ta trend thr oughout the six weekso bloody diarrhea show no particular t rend The ourve for The time of onset of £ever showa a definite peak dur i ng ·che first week with a second peak in the fourth weeko lt shou ld be notGd the t the latter ooincides with the peak observed in l•'i gure 4 for pharyngitiGo Do Relation to Distance The relu tion of these symptcxns a nd findings to disJ ence fran GZ is sho vn in Table XVIIo lt can be seon that epilation petechiae hemorrhage other than petechi e oloody s t ools vomiting diarrhea and amanorrhea re nega tively related t o distance in all four groups of p tients e The results are significant for the lliroshimo oases for the first four of the six findings i e for epilation peteohiae oth r hemorrhaco and vomiting Although significant intarQrela ti orwhips between these syniptane wore not found the sie nifioant relationships between them am dista noe is sugeestive' evidence at least t oot this 6roup of symptocns were direotly related to the bomb The maximum d istances from GZ of pat ients ha vine opilation and petechiae are ahowri in Figures 6 and 7 N NJ 4bD JJ DECLASSIFIED Authority From these it oan be seen UNCLASSIFIED _j - ► I r 0 ' ' Q t t ' 0 SO _ ABATI Cit OF cx cutECE f DIARIKA • a ooo DIARIIEA9 All Ff Vf R TO flfD I • CE NiET CF fflPTIIISo t 1 0--------0 OIARRID N 121 P8iC£NT F' PATIEHIS HIWlr l SYIFT« 00 0 0 ·- ---- ------'-------1------'----- ----- -----__ '--2 ' mJ OF CHE' CF SYiFTIM ' FIGlTilu E_ _6 __ ► - • 00 ' 1 Q I 0 I c '60 I TABIJ XVI I Relation of SymptO l S ·to Distance i n Pati ents Studied tom City Sex Sympt om Sympt om S Ymptom S ylnp t om Total Absent Present N N H Absent rt Di6tance Present f 1 Distance fun lol5 Km hpilation li H N N Petechiae B 11 N N Homorrhage other than petechiae or bloody stools t f'- - z c- en -- - Vomiting -r rr c J F 1i1 M F M 238 1'' M F M 1'' M l o56 102 36 85 38 l o4 l 1 40 6 2 6 81 14 1 115 26 l o6l 1 32 7 93 13 S 240 55 J 46 78 94 lo59 1 52 5066 5 31 100 141 81 119 22 1 44 1 69 l S5 1 20 1 24 53 44 36 69 9 7 107 18 27 1 63 24 28 l 31 10 15 13 1 31 1 68 1 29 l o4 0 4 9 96 44 l o68 lo41 lo4 9 71 lo66 Ii H N N M Ii 1 H ti 82 40 F 21 F DeviE tion 96 153 64 43 87 134 N 15 30 6 2 H F 15 3 84 289 143 N M 1'' M 100 58 71 19 lo 6 7 Point Biserial Corral9 tion Standard o33 ·- 4l 01 - - ol4 5o 69 loll 21 - 029 12 1 42 6 8'1 7 90 ' oO l ol9 l o24 86 087 3 066 4 068 34 o29 1 4 7 l 16 lo 33 6 43 ' 70 20 ' ol6 - 44 l e22 73 4 79 4 o6l 5 o46 l o23 6066 30 l o3 7 1 si lo 7 5 1 04 6086 ol3 'ol2 098 086 0 41 -029 - n c ' ' ' '- c - J ir - - - i e · ' r ·•· - - a Diarrhea u n 142 8c00 - -t '1 __ r r - ' 61 ' 'A Bk XVII oont'd Total Symptom AD1enor rhea City Sex N Symptom Present N Symptom Absent M Distance Kmo - ymptom Present in Distance Km Standard Deviation 32 47 l 1 11 38 lo48 lo0 5 lo44 130 81 49 5o69 172 75 lll 66 1 43 1 42 1 36 lo48 2S8 1 32 1 55 1 61 1 46 5 32 6 83 7 98 61 lo58 129 l o55 1 11 lo 52 1 28 1 40 1 4 7 5066 5a3l 6 91 6 65 F F 45 85 i F H N l 1 F M 101 Hl F 4 F 1 s3 240 li tJ Symptom Absent N 3o80 6 90 Point Biserial Correlation - 008 -003 Oropharyngeal leeions N Fever H H N N iJ 70 92 66 111 21 20 26 30 49 72 lo36 0 004 Q9 ol2 08 - 023 28 24 01 I MJW£R - PATOENTS flTH EPOtATI MIO TOTA IU'8ER msERlffO AT -· -I I - I I I 0 I oosrANCE Att» - wmR I -· - I I I I I -2 0 --0 I I 2 C I 0 ---r I I I I -·- -· 0 2 2 0 5 ·J I 1 8 68 1' • - '-' 25 13 ' 9 3 I I VAl IWS 01STAfta S FROH M t I 13 'o' I I ' ' -o I I - - 1 J 2 I FIGlJRE _ _6_ _ oi S -- I I I 01 S I I I 2 I o I I o srAICE 2c7 corrm - I I I 0 1 I I l 1 --- I I o'I I I I I I I I I I o I I I I I I -- e o 2 7 • StrZJ ' lc Z S 14 lfi o Ool _ 2 - I- 16 2 Ooi 30 Oci 6o ' J v • _ 1 5 - C J 8 FIGtJRE __7 __ UNCLASS fIED t -mt t here was no de f i nite difference betwee n t he ·two cities or bet eon the two sympt0 iso t can be eati mo ted that C ises of' opilation tended out to 3'160 neters at ffaG' tStud o nrl ·l o 2750 meters at i iiroshimao r uses of' p1Jteci1i ae eixta nded oot to 3250 meters a t both Gitieso Relation to o- tcom• The relo tionship be·i ween the oocurr ence of these symrtoms and i ea t h is shown in T b A IA ppo 65 a 1d 66 0 It oan be seen that 1 atechia e and other hr morrhage are · cnifioantly r el ted to death in both c ities and in a d ition that epil ltion iB sic ni fioa ntly related to rise th in filroshima fe ales and Nagasaki males Diarrhea oropharyne eal lesions t t ld fever were significantll_ r elated to dea h in irregular groups These i rregularities onnnot be explained Table M shows t h e mortality among hospital patients with radiation injury l in r elution to dlstance o Relation of Distance to Percent lleath2 t nong Patients Showing Hadiation Ef fects Distance f'rom GZ Km 26 • 75 1 o25 lo 76 2 25 074 l 24 lo74 2o24 2 74 - Iiiroshima Patient·s with Radiati on ln rl N 9 105 38 19 6 2 75 3 24 3 25 s 74 3 75 n 4o24 TOTAL N'a o saki Deat hs % 11 % Patients with Rad i Qt i on In11url Deaths No 5 21 9 ·1e 4 27 2 3 o 12 8 3 l 178 17 4% 3 2 - % 2000% - l 71 l 6¾ l F'or this analysis only patients having epilation alone or both petechiae and leucopenia of leas than 4000 were considered UNCLASSIFIED • ' l ' l 0 i - 1 · t ol t • 0 t j 65 t TAllLE X IA t i I Relati on betwoen Ooourrenoe of Symptans and Death in Putients Studied S YmptOill Epila tion Petechiae i Hemor rhage other than petoohie o or bl oody stools c c - -- Vomiting -i ra Diarrhea City Sex Number Survivors Deceased Survivors Showing Symptom % Deceased Shordne S ptom % 72% x2 H H N N F ti 248 18 22 21% 36 0 41 F l t 96 139 17 17 350 53 19 7l o ii fl ll F M F 129 18 23 5l o 100 l3 a45 249 i53o Sl o 13 '17 0 M 5 139 13 N 9 l2o 780 6 02 25 31 22 12 42 34 10 10 9 79 13 l6o 500 50 69 130 15 l6 e 87 a 43 33 8 51 18 750 86 0 6 2 50 Oo 1'' li H N N t4 F M Ii F H N· N F H M N F M F N ·u 127 20 14 8 6 1 1 6 249 18 22 95 17 430 138 24 49 129 9 100 61 45 0 650 880 18003 06 1 21 18 51 6 63 5 22 14 31 33 43 004 1 38 24 1 25 p oOl 81 027 01 oOl 01 01 oOl 01 02 oOl 01 84 24 063 26 01 3o 3 0 ol4 • 71 l 90 10 98 ol1 ' _oOl 1 -- f l r -trr _ li 'f ---- -i r-r rQJ • I C 66 tr b B XIX cont'd· Sympton AmenorrheA Citz Sex H N Oropharyngec l lesions Fever H li N N H li N N F F Number Survivors Deceased 39 87 5 3 F 126 18 M 21 Survivors Shovnng Symptan % 0 28 % 400% 67 37 230 250 p x2 oOO 08 LOO 44 ol5 9086 070 oOl 19 57c 36 700 F M 139 F 1'1 F - 129 18 249 60 23 26 500 580 680 81 · 40 74 - · 410 249 96 14 10 Deceased Showi Symptom 028 078 llo42 060 oOl 830 52 80 5 65 002 1000 10 Sl 009 6038 0 76 01 eOl s·•n It can be seen that 17 4% of the pa ti e nts chm·1inJJI · at lilrfi shi na and l5o5i at na aeo ki • died I t is interosti ne to note tha 't although the percenta e i ncidence of ra d h tion injury in the r0up selected at liiroshima wtts 41 2 c ontrusted with 15 2% in the group selected at Na3nseki the mor t ality in those e owine radio ti n injury ro s appr oximately the saueo F Laboratory Findi 1r s The in1portant laboratory findiags were related to disturbances in the hematopoietlc function and were manifested by leucopenia anJmia am hrombocytopeniQ o P rticularly severo degroas of leucopenia had been reported during the latter part of ooguet by the Japanese in both cities In September by which time most of t he pationts wore showing increasing white blood cell counts marked thrombooytopenia and progressi 'ely severe anemia was r eported On the whole the l Oat severe anemias other th an those coi ncident i th he norrhage due to thrombo-- oytopenia were reported toward the erd or September and the ber i nni of October The r elation of ohan es in white n nd red blood cel l counts to time after the bambiand distunoe of the sub ject from Gt Mis investigated in the groups st died These relations are shown in Tables AXl and XJt 11 The data refet to s1ncle counts on i ndividual pe t onts A inspection of Table Ml shows that the trends kre not clear cut or consistant They su cest however that leuc e l la w s ore suvere in patients near GZ than in those farther out In addition it can be observed thut there 1e a tendency for the leucocyte counts do11e durin the first four weeks 1 DECLASSIFIED - NNY J4W5J to be lov er than those done aftor that time UNCLASSIFI ED e G 0 I t rJ t ' 0 58 I TABL I XXI W B C in Relation to eek of Bxrunimtion and Distanoe fran GZ HIROSH I f A 0 1 0 Km Week of' Nmminations Cella per mm3 lean 1 1 - lo5 Km Mxaminations Cells per mm3 Over loS Km o E xemim-tions Celia par No Mean Examination No 4 or less 27 23 17 1700 15 4200 7 6 6 2700 3600 28 3100 24 noo 25 26 3700 3200 4000 7 and over 50 4900 22 4500 6 4500 No Mc in NA GAS bK I 4 or less 5 6 7 and over 14 14 3400 3000 24 11 6600 7200 10 2 100 3 14 21 3400 3900 5200 10 16 6600 5700 5000 13 4700 19 mm3 -- i • § ' I t_'1j • 0 i C 69 d I TABLE XAII I R B Co in Relation to i eek of Examiration and Distance fran GZ H IROSJ UMA Week 0£ l m ni nat i on 4 or less 5 6 7 and over 0 - 0 1 Kiu -Examimtions Cells per mm3 li Mco n 24 8 6 41 Over lol Kmo Emmimtions Cells per IIDl13 N llean 3 l4xlo6 18 3 44 3o27 2o82 ·4 7 3 33xl06 3 58 2 89 17 3 16 NAGASAKI 4 or less 5 6 7 and over 8 8 4 9 3 23 2 56 11 2o 75 16 3o05 3o 5 5 3 23 s ·1s 6 2 21 · ' t 'curijr l il - - - H lJ Unfortunat ely when one nukes sim ifor cc npo risvns betv1oen soma of tho specific gr oups i the o bove concluoi ·J i s do not h oldo nevertheless ' the frequency of these disox-epancies is not to o lo re e to make the above conolusl ns n·tenable Tho ohanges in the red blood cell cou nt in relation to weak of examination a nd d istance fro n GZ shO Y no trends o iscella neau s L ffeots Go The relation of nausea and vomiting occurrin very s oon after the explosi ons t o the appee renca of l te symptoms known to be due t o r a dia · if tion of interesto I l'Oedl£ te nausea a nd vo niti ng is known to occur in experiment ul a ni01£1 l s receivinr laree doses of e eneral body r a diation and sim ilurly in pu tients treated therapeutior lly On the other hand the occurrence of thes e sympto na ao a resu l t or psyohio shook i s als o w-ell known wid many of' them co 1 l d have been due to t hlo Atte tpts were - nade to deter iine to v1hich of t hef 'e t wo fact·ors t he im lediate ne u ea and vomiting i ht be due In the collection of date at Hiroshima this early nausea and vomit ing was askod for specifically and these sym pto ns were recorded only if they ocourred at this time At Nae asaki on the other ho nd_ no special inquiry w a made concernine the se symptoms and they were recorded if they llppeared at any time attar the explosion The point biseria l oon elations botv@en the occurrence of immediate nausea and distimoe from Ol was - 41 for niroshi a fe nale5 and ·• l 7 for Hiroshima males Therefore points representing the per- cent ha in naueea at a given distance ere plotted -1 AU NAfj 73W2J I DECLASSIFIED The resulting UNCLASSIF1 0 curve is shown in F'ir ure 80 From thls Figure it raay be noted that the ralo t ionship between the S Yinptom and thti disttt nce is ratner str ik- ing for the femal eso Addi tiona 1 data bearing on tnis question was obtained as sho m in Table XX III fruu a Japanese study on s oldiers at fiiroshjma who were v ithln 1500 metsrs of GZo The leuoooyte counts were for the period of 15 to 30 nugusto TAB £ XXIIIiet W B Co per mm3 $ Iannediate I1lav sea and Vaniting Present Absent 2600 7 3600 4500 5500 6600 8 1 1 7uoo 7 7 4 0 10 8600 2 7 9500 1 l Source 3 7 7 Ro port of Sawada Colllmi t-toe In this Table the degree of suppre Sion of the leuoocyte count an be considered a measure of t he severity of radiation The trend suggests that immediate rv i usea o nd van ting occur in pati ents who later show leucoponia Since intlodiAte musea vm s observed to be rolated net 1tlvely to di stance and immodio te nausea and vomi ting tended to occur in patiants who later showed l euoope nie it can be inferred that they may be rt dia tion effects II ic -t v NAJj 74bQ2 thor ECLASSIFIED 11 - REIATICli CF PATIElffll K Vllll IIIEDIAlE IIWJSEA • TO De STNQ AHlt 1'£ cacmt IO 70 CF 6o PATIEIITS twms 811EDIA1E 5 USEA JO 20 c ' c - s en _ - 10 0 OoJ c J FIGUR E-------8- The effect of expo ure t o th- bcrnbo special interest 011 reproduction is of Junen9rrh a was reported f tequontly ao i in tlEU'ly instances where the menstrual periods we re stated to be rc 1 1lar before the bombinr s liowever 3 the incidence and the relation of amenorrhea to other fac tors are grossly influenced by the lar e amount 0£ war amenorrhea which is Anown to mve existed i n Japano The previous menstrual history was not known for most of the patients ' i n this atudy and couuequently it ffl S not felt that reliable r ela- tions could be establ ished l G e No tabulutic n of a bortlons or pr8' ature deliveries were made in the study or the ta nhattan District group wt llWllerou s patients were settn in whom t hey had ocourredo Ocul ar injuries produced b7 tho atonio bo blncs i n both c ities were tho subject of' a speoial investigation mo de by unAUS edioal Corps officor tooiporarily a·ctaohod to tho O nhattan District e roupo See Appendix I Report LLo i njuries were seen The usua l mecha nioal types 0£ ocular In addition lesions consisting of retinal hemo- rrhage and exudation •1ore observed and 76% of the patients shcming them had other eigns of radiation injur y 1 1 A detailed study of the effects on the r eproductive syst em 1a being done in the Joint Report Although in omplete this will indicate that al 1o t all pregnancies 1n vranen out to 2000 meters were tenninated abnormally and that effects on spermatogenesiu and menstruation extended out further tha nmy othor reco nizablo radiation effecto UNCLASSIFIED DECLASSIFIED p uthoricy JJ Ji J jh06j I I llo Description or XxPes On the bas i s of these findinzs and i mpressions tor e ther with independent material cri ovm fran e nima l experiments and roentgen therapy experience a total descriptive pic·rure of the symp t oms and sii311s dt ie to r adiation can be drawn Relative radio tlon dosage l n the patients e m rnined cot tld have be en estimated nly by consider- ing tha wnount of shi lding by e ir d ist ance 'ram Gi or other objects· and as p r eviously described this c oL ld not be determined o I t is known from animal experimerts howeverD t hat t he greater tho doae or general body radiation tho mor o severe the symptoroG and the sarlier On thiG basis r l i a i vo cios c a i n the patients exposed they appearo CWl be judc ed by the severity wid time or appearo noe of the symptoms Thi s al lows an arbitrary d i vision of the patient s i n• and findi nr so to three types on the basis of the save ity of their symptoms o These would in genoral correspond to variat ions in the dose ot radi • tlon reoeivedo Ta blr3 XXIV A t anera l descript i on of these types is s 1own in mmplos of ee oh type are shown in Figures 9 10 and 11 which give the hospital course of thr od Hiroshima pu tients o lo Summary The following symptans and findinss due to radiation wore observed pi lation leucopenia and its associated ·i nfeotlous processes thran bocytopenia and its a ocanpaeyinc hemorrhagio manifesto tions anemie 1 and effects on t ho r eproduotive system a The time of onset of these viu-ious symptoms ro nged from the first week ai'ter the bombin s until at least eight weeks after a t which time the observations were l 1t O B DECLASSIFIED JWthority N AJ D UNCU SS f Eb TL1 BLE X IV Clinical Sym_etoms and Findings Day after ExploLl ost Severe sion lo Mild 2 l o Nau sea and vomit ing after 1-2 hrurao 3o NO DBFI ITE SYi 1PTO IS l o No usea a nd voodting after 1e2 hourso 4o l 5o 2 lii i ali yr diarrhea 60 3o cJ _ ti 7o '4 o Or yn ions 60 Fever o- o So 9 60 Rapid emaciation 10 Death 11 Mortality probably i - 12 I 100% 13 1 l4o l5o 16 170 NO DEFI NI TE S Yl- PTO iS 2 B9ginning epilation pr eel ead Zi@n w 1 I l8o l9o 20 3o Loss of Qppetite and general malaiseo la Ep1'1atio P 2o A aca ox¼e and 4 Fever 21 1 11 ion me laise o 3o Sore throat nes 4 · Pallor tio 5 Petechie o 22 23 2 26 26 g nr allur 27 · 280 6 Diarrhea 7• Joderate emaoia tiono • 7 Pt' teoh t 1ol diarrhea Of 'Pslilfl 011¥1 290 30 Jlomatem • a Rapid annciation 31 0 • Recovery unless oom• plioated by previa s poor health or super- Death imposed injuri es or £ortQlity probably 60% infections -i a tienµ injv red b eek at' this stage and ap e 1 idity r thes e repor axplai t co u se of d I I 1 _N ND J3NJ j j I AU DECLASSIFIED a or me c l e ueeti on the _ CLASSIFIED injuries ey had wt it of known Sum nary o Ra di n I njury Laborator t Findin Pe r iod f Bxami nation 2 - 2_ Dara 1 ost Severe Mode ately Severe Leucopenia Ex-creme Anemia federate F xtrene Extrooie Mod o rate · i xtr eme ThrOO booytopeni Period Leuoopenia Anemin Thrai1booytopenia Mild Moderate oderate Moderate 2£ Examimtion - E ls None Moderate Severe Moderate Se ere l foderate if ode1·at e Moderate None UNCLASSIFIED II DECLASSIFIED Authori 1 AJj J3b05 J 5 SEPT_ 7 8 9 IO 11 I 12 13 · I5 16 I 7 22 18 ·1·9 20 2 3 RADIATIO TEMPE I l TURE 38 ii C ' --- -- ' L ·BYMPTCRS • 1 700 ROM • GRO NO ·zER TYPE •l I I -- ___ ___ ___________ ___ FIL l f' 1 -•J i 'I• IIJ t __ _ ____ OAlE SEPT_ __ ____ 4 5 8 10 I I 9 12 13 RADI ATIO ----t ' TEMPE • -1 I l 15 16 17 18 1·9 22 2 3 SEVER INJURY TTFcr ACER'ATI 38 TURE J • • lHI 1 ' · -- · I I i ' so R C ' I L WBC 0 0 · jooo i I I I I • ·i SYMPTOMS ANO OF WAS A rI A J PANES 700 GRO ND · · ·zER J - »- -- ' - · ·- TY PE - · ---- ' -- - - --'-------''------ ---' DECLASSIFIED Au ity NAfj Jj • I J t oonoluded number oocurring during the foorth weok The ocourrenoo of these Sj'lllptoms was seen in putients whose location ut the time of' the b xnb- ings Wli 6 estimated to be out to 3750 moters from Gt at Nagasaki and 3260 meters at liiros im I I Doe ths occurred throuc -iwt thi period with the greatest DECLASSIFIED Authority NtJj 4bO Jj UNCLASSIFIED I CH i PTER N Cause _£f Injuries lo Bi i rm 2a 1lechanice l injuries 3 Radiation i njuries A i 'vidence that ·sym ptoms were due t o B c 'vidGnoe conerni ng l n jur¥ frarl persistent r adioactirtty Biological cali bration of gamna ray i ntensity ioni i ng radiationo c DECLASSIFIED Authority - NtJj 9W J f UNClASSIFIED -- There is so ne disa c reem ont among the vurious i nvestii atinc r roops in the· interpretation of the aye wit11 es s accounts a s to how the fir9s I startado Sane believe that there was r onero 1 spOLl'taneous coni'lacz-ation at least near the cem ar at Naeasaki o It is the opinion of the lanbattan District r roup frc n -the a c counts however- that therv were no large soale sponta neous fires as a res t lt of th e explosions although there were maey instances of clothes and othor v ery cwmbustible materials so blrningo It waa thouGht that the lar o £ires which swept ea oh city soon after the explos ion wors for the aost part due to seoondary cau ses such us t he overturning of oauldrons and electrical short circuits o Section C Seo other than this there is nothing remarke ble about the oausa of the fire burns o There are several interes'cine f l c tors ho vevor concerning the 30- oal led flash burn5 Speotral mee sure nents me de ut the Al amac ordo test showed that the ultra-violet enisf ion Vias eqL iftlent to that of sunli£71to Because of' the brief duration soe below and the eood air a bsorption t his was not of medica l oonsequenoa VllS The heating of--tha a i r also not a serious problem at the level of the ground t the height of the se bl rats tho superheated air adjac ent to the bomb should not have touched th grour19 The effective heat was not all infra red 0 It included the entire visible spectrum and may be conceived of as identieal with the eating I DECLASSIFIED -1 NAfj 14bl 2'J UNCLASSIf1£0 NCUiSS FIE effect obtained vm en the sun's ra ys o re concentrated by a reflecting glass o Assuming th t human bodies acted as black bodies true f or infra 0 red b lt not for visible licht where perhaps only 5 is absorbed the rest being reflected and that tha eat capacity and oonductivlty of the body is equivtllcmt to wa·t er the following d ata based on the Ala ma 6 ordo · test measurements can be of'fer edo Allowing a duration of heat or one second the amount delivered at 1000 meters was 26 calories per om2o The depth of penetration of tha heat or the noxious heat effect oan be caloulatecl by assur ling the amount r equired to raise the temperature £'ran 300 to 1000 Co as shaNn in Table XXVo TABLE xz vr Distance 11eters2 Heat Dolivered oe l cm2 seco 600 100 1000 25 3000 3 Depth Heated to 1000 c in l 8800 l4o0 mm 3o0 0 4 Values given by v F Weisakopf t conference at UaS ng1neer' s Offioe Roc aster Arc Rochester N Y This gives reasonabJ o values 'or the occurrence of 'turn out to the distanoee observed 1'he differences i n the calculations as well as in• the medical findin s between the t vo c i ties are not 1noluded in th1G discussion but from both points of view t he value of 100 oal cm2 aec should probably be reduced by as much ae 50% for Hiroshima and increased by 50' o for Nagasaki -I IAut_ NAH J1b06j I DECLASSIFIED UNCLASSIFIED • e 2o 1ech9 nical Injur i es The mechanica l i njuries for the nost pa rt resulted fran col lapse of buildir f s nd from flyi g glaas a nd other misal eso Two factors chiefly i nf luenoed the i ncidence of' suoh injurieso Proxi ' mity ·co GZ was probt bly the nos t important _singl 0 factor aff'ecting the number of casuultieao See Secti on C Part II Chapter XIIIo The type of buildi ng was the s·scond most importc nt factor The typical Japanese frume bu ild ing top heavy wi th clay tile roofin j and used principally for dw9llings collapeed on the occupf nto und fi re consumed • the wrecke ge o ' l'he many masonry brick or st1 ne buildin a princi pally small f'o ctories churches eto also collapsed and people re ceived abrut the same type of injuries s s those in wooden buildingt1 • Injuries to occupa its of rei nforc Jd c o cretc ildings v1e1·e primarily due to fl7inc glass and r llin suspeurled ceilings of wood or metallath and plastero Injuries to those in st ructural steel-frame l uildincs were a combirntion of' the above typeso The injuries due to direct blast as previously d6scribed were leas thnn expected i n proportion to the other injuries o This appears to be due chiefly to the fact that the hei ht above the ground at which the bOIIlb was d etonated m eant tmt no person was clos lr than that distance from the act ual point of maxi mum pressure 3 Ao Radiation Injuries 'videnos that S i5 toms were due t o Ionizing Radiation It la stated in the int oduotion t hat one 0£ the two specific I DECLASSIFIED - NAii 79 UNCLASSIFIED 1 purposes of t his stucl y W'dlS to determine if parsons exposed to the atomio bombs e t Hiroshima and Nae aeaki wer e affected 'by radiation Epilattona louoopenfa with its accompanying sympta s n ' d thrombocyto panie with its manif es'ca tions ware observed in patients axposed to the b bsa and sone of these patients died as a result of theseo From roent en therapy experience and nnimal experiments _these symptoms are kn mn to result rr® larce doses of ionizing t'Qdilition am it is highl y improbable that this pt rt cul CVl uiJ i il l tion of symptans could occur- on a larg$ sonle from any other causeo It VJB s kno m also 9 from theoretical predictions that an ·instar taneous discharge of high energy gamma rays e- r c 3 of neutrons ould occur below the point of de•• tonation of the b®l S o That this did occur Vlith neutrons was s hown see Section B y the detection of induoed radioactivity near the centers of the explcsionso It was concluded therefore that t ersons did show effects f'r o n radiation and thut sane of these died as a re · sult of ito Bo Evidenoe Conc erning Injury f'rcm Pers istent Radioactivity The second specific purpose of thls mission was to determine if the effects from radiation-ware all due to the inatnntanoouu di scharges at the time of the explosions or if poople were being har n ed in ad dition from persistent induced radioactivity vestigated from two point of view This question wus in- Direct mea suranants ' of' persistent radioaoti vity wore r 1ade a t the time of the investigation As discussed in Section B Tybout calculations bo sed on these measurements were DECLASSIFIED Authority - NAJj 4W Jj f CLASSIFIED I made of the integrated radiation osabss o These cal cu lations showed that the hie hast doaace tJ u t wa i ld have been received f rom persistent radioactivity at liiroshim a was between 6 and 25 roente ens of gamma r diationo Tho hlg hest in aagaGaki was botween 30 and 110 roentgens of gam 111 r a diation Nfl J 50-Saki rut to The h isher figu re docs not refer to the city of a localized are in the Ushiywna districto In interpretinc these f indin s i·I roust be understood that to get t hese dosaees one would ·have had to remain at t e points of hic hest radioaotivi ty f'rom one hour to abw t six VCeks af'ter the bombings o apparent tra t It i s insofar as cwld be deter nined a t diroehima and i n the oi ty of Nagasaki the res idual radi ation a lone could not have been de trimental to the health of persons e nteri ng and living in the bombed areas after the explosiona o The maximum calculated dosage vmi c h oould have been receiv·ed by persons o onstantly present in the Uishiyame dis trict nea r lvaga saki is well a bove the accepted tolerance dose 11 l o From this findin accor'dinr ly one could not be certain that radiation eff ects in tllis d istriot did not occur al tl10UCh it is highly i m-pr0c bable that any harmfu l symptoms would have reaultedo The seoom approach to tJ1is question was to determine if e ey persons not in the oities at the time of the explosions but coming in 1 nmediately after exhibited any symptoms or findin s which might have bee due to persistent induced radioactivity By the time of the arrival or the anhattan District croup several Japanese studies 1 This 1s defined as the a iount of radiati on a human being can take · day after day imefinitely without influenci ng the course of hie l ife or produolne residual or latent effects -1 NA j 74W2 DECLASSIFIED CLASSJFIEi had been dona on such e •sons UNCf Sif IF Ta ble I presented in the report of the Sa wade Comoittae ppendix ·II RClport II shows t he whit e counts of nine subj'lcts who had c ome i nto Na asaki i m nediate ly after the explos io 1 a nd ha d been liv i ng i n s e l f-made huta a bout 500 meters from OZ f'rora 9 to 31 Au at 19-1 5 Ta bl e II I i n t he s ame re- port shows the leucocyta counts of 14 amber s of the Kyus hu University Rel i ef PaX4ty wh o ucr e Horki og in the cent ra l e rea fran 14 to 23 Au01st 19450 Table XXVI shows leu cocyte counts done by Dr Sosu 'B uoup between 3 a ad 10 Scpte nber 1945 on 22 f iold iers at 1Iir os h ima im o at the t me of t he explosion were 4 2 Km a u yo On 7 August 1946 t hey went i nto Hirosh ima 500 meters from GL t o ew cuata t he i n juredt and they worke d i n ' i s centro l a rea f'or one weeko TABLE XXVI LeucocEe Counts Done on 22 Soldiers Hiroshima - 1 B C l 6 700 2 Hoo - Noo V B C 12 13 12 700 9 000 3 8 600 14 10 200 6 6 10 300 16 16 7 8 9 8 000 6 800 7 900 10 ll • Source 9 800 6 600 9 800 21 7 700 8 000 5 60 0 13 000 5 700 811300 4 000 8 000 9 000 22 10 400 17 18 19 20 Dr Sosa's C0 Qlllitteo None of tho EUbjec ta in any of these studies shorted aey a Ytnptans which co ld be attributed to radiation and as can be aeon tram I DECLASSIFIED N A i 1bQ UNCLASSIFlm t he 'l'abl es thei r lcucocyt@ counts wor0 consis ent l y within the norm al ran e Duri ng ths period of our inve6tigat i on Japanese doc tors and patients '16X'e requested to br ine to u s any patients who they thought ight be examples of parsons hurmed from per sistent radioact i vityo No such subjects -1ore foundo It was oonoluded therefore as resul t of these f i ndinGS and l a ck of fhidingB thut u l 'lihoagh a sma ll quantity of induced radio activity was fou nd i t had not been suffic i ent to co use any d81llons- trable hurm t o perso n living in the two cities after the bombi ngso · Co Biol ogical Calibr tion of Ga -uma Ray Intensitl The type a1nd intens'ity of radiat io n cauoine these sympt o ns is of' special i nterest 0£ the four typ s of ioni zing r adiationwhi oh c ould have been responsible ge m n a rays and neutrons demand ths great est attention These are the most penetrating t ypes and applied ao enoral body radiation the only type t hat co ld have aa ueed the L portant symptom s due to bone marrow damage The les s penetrating alpha and beta rays owld tw ve c intrib tted to t he epilation but the extent this 1£ any cou ld not be doter i«ed or It s extre nely difficult to dist i nzu ish between the qualitative bi ological effeots or car ima r ays and neutrons exaspt tor ·the induction of radiouctivity by th latter Induced radioactivity fu biological ti s sue was detected only out to a distance of about lOOO meters It c n be considered therefore thnt beyond this distance at least the pe Wtr ating effects were due 1 o IC utho CLASSIFIED - N Jj J 'jbD ' j UNCLASSJf1£0 gamma r aY6o ilNGLASSIFIEV 89 If an abrup decr ease i n t he off eats on bone marrow should be fcund at t ni s di sta nce in the studi es o f' t he Joint Commission i t cou l d ba 0xpl ained by the obs ervati on that neutrons are approximately t en times as hemntol ogi ca lly effect i ve as X-raya o Thare i s no indica t l m of tr ls in our s tud i e5 o In general however it seems quite certai n thut t he ma i n bi ological effect s were due t o gamma rays o On th basi s of exposure of film f ound a t Hi r oshima and theo- retica l predictions oaloul ations of amina ray i nte 1Sit i e s a t inoreaaing distances at Hi r os hima a nd Nage Ga i wer e made o The s e are dis cussed in Secti on C of t lus report The value s pr e sent ed t here r a nee f ran 3 t o 12 roentgens at 2300 meters a t Hir oshima These do not correspond to l'that is oxpscted fran the biological e ffects o Any att empt to calibrate r adiati on intenslt o tiw bi 1 s io v£ ui ological effect horrrever is frau r ht vd th d ii' 'l cul tie s• u nless dona by the mo ·t oar eftllly control led exper ents a ud is virtually impos s ible under the c i rcumstances here 0£ e reatest impor t a nce 1s that dat a on shielding both by air and by intervenin objocts · are insuffi cient to eive reli able estimates of relative exposur e equivalent d osag l Even if thi 8 M'lre known the small number u nd s election o f the pa tients ww l d not permit evalua- tion_-of the faoto r of variation i a indi v i dual suso pt ibility• In addition the ener gy spectrum of the c 'lllllla ' r ays on which the munber of l '1' his may bo roughly determill4Lble i n studies done by the J oint Commission city N A tholDECLASSIFIED Al i J4Wb UNCLASSIFIEll · o 1 n tf 11 ll f r a_' r rij ·q r l P 1 r oentgens to produoe epilation at loast l depends is no known and the i nflu enoe of t he time intensi ty factor a t theaa levels i s not known Despite all of these fa otors s Cllle e s tima•t e or tha number of roentgens r equired to produce radiation ef f ects can be givene Such est imatea are s 1own in Table JG VII o TABLE XXVII Roentgens Required to Produce Radiation Bffeots Radiation Intensity Kv so 260 1000 Roent en Dose Required _ for t p la tion 200 400 5GC It was shown in l 'igures 5 Md 6 ppo 59 and 62 tha c b th epila tion and peteohi a e occurred in patients as far out as 30JO metor s and re vor y 'req uont between 1600 a nd 2000 meters o It seems most unlikely tho t either the time-intensity factor or va riu ti on i n 1nd1vidu l usoeptibility could a ccount for t he occurrence of thaee ef fect s at dosage levele of the order of 5 t o 10 r oentgens 1 Aa judged from blood chanc et in tha r at the biological eff eotivenosa per roentgen it practica lly imepeDdent of the wavo length of the radiation and i n genaral is a very slow ana var ing funct ion of the 10n distrib11t1on Thia is not eql lally t rue 1 however wl th a surface effect auoh as e pilation DECLASSIFIED Authority N AJj J4bD lj UNCLASSIF1£0 C uAPrm ·v Conclusioiw DECLASSIFIED Authority NAJ D J4W-5 U CI ASSIFIED i 2 C ib PT R V Conclusions The best estimates of the number of casualties at Hiroshima and Nagasaki a vailable at the present time are· Population Dead Injui ad Total Casualties Hiroshima Naesaki 320 000 260 000 78 000 3 7 000 35p000 30p000 115 000 66 ·ooo These oasualtios WGre primarily du e to burns11 mochanioal injuries and radiationo Their i rnportanca ae ca s ulll lty-producin a ente is in the order llstedo The treatast single factor influenoio the occurrenoe of oasualties' appoarod to be the distance from the center of GZ Saeed on the study of 900 selected cases eatinlates of the maximum distance at whic h _ympt0 ns due to the various · cc aualt producing e f' fects and deaths W8re observed as shown in Figure 12 o I t can b·e seen that burns extended considerably _farther tha the other two eiQ fctots and rl eohe nieal i n_juries somewhat fG rth r thnn radiation injuryo In addition the effocts extended fhrthar at Nr q aaaki t hnn at Hiroshi Tho unusual symptoms and f'indln£ e obsei -ved wore epilation o petechiae and other hemorrhagic ·manifes tations and profwnd leucc penia asociated with infectious prooesse1 particularly about the oropha rymto 1'h ere were also indications of disturbances of the repro duct1ve eystems In the pe tients etudi t these eympta is were found in »neral to be negatively related to distanceo DECLASSIFIED Authority - NtJj J4W Jj It is inferred that UNCLASSfffED o I - ► i • e0 Q e t j r NJUR t ' MD HJ R CBSERV£0 AT YARIOlS OISTAl«S f'Q 1t£ b i I F PAflf NlS WITH VMICXJS 1lP£S OF IN J lrl Ml tf AlH COO'fflo '7tNt f c7 e - ' ' ou ofS 201' DIST CE FACllB cmm i Z f r ' 1' - t- - - - -· - J J 9 3- ' - H □I C I J VJ I 7 3 ' 7 2·- l r--1-- _ 1 -- J J' r_• - HllRC IIIAO H RO I 9 1 ·- l· '2· C J 19 r ' -- tN MOUAYO G iWlli'i1 i P81 A ii'ila'4 - nM usea and vomiting occurr inz a f n hours after the ex plosions were also radiation effeotso that certain rt of these t was further found in the patients studied sympto ls were s i tnificantly re la·ted to dee tho is concluded that persons exposed t o the bombs at the time of detonation did s how e ffects from i onizing radiation o nd tha t some of these pa tient otherwise uninj ured died o The precent of deaths due to r adiation injury as well as to other specifi c causes cannot be determined from thj s study From the general picture however it appears thtit deaths due to reoognizable effects of radiation were far less tha n thos e due t o other ceuseso The mor4lity in hospital patients sho1 1ng defi lite radiation injury was approximately l r o in both cities i ost of these deaths occurred durine the fourth we- k a f'ter the bombi ngs The evidence f'rom nedionl fin dines points to the conclusion that persons not exposed to tho bo 11bs were not injured by radioactivity persisting in ths areas DECLASSIFIED - - l Autho r i t y • Sootion be 95 oaical Study Fon-a rd••••··• ·• · ·••·•·· •• • •·· · •· ··•• 96 • o• ••• 98 Clu4ptor I D uoription o I ater i al Studied Chapter II Doucripticu of Fiooings • •• • • • ·••••• ••• 101 J · L j 11ries other than radio ti on • • • • 102 2 · Radi ct i on i njur i eo •• •••••••• ••••• 104 A D c Fhyeiolo£ica l effeo· a on nlmal s •• ••• • •••••• ••• • ••••• lOf f nthologica l ef f ct in nim lc ••• ••••• •• ••• •••• • • ••• 105 f t l ologi0'4l off ct o in hur ian be i ni o • •• ••• • • • •••• •• • • 116 Chap or III bll - ity bi Ali 1 1 DECLASSIFIED 1 1 Concluaio c ••• • ••• ••• • ••• ••••• • • • • • • 142 UNCLASSIFIED The analysis o the petholor i cnl information obtained from Uaf Usaki and Hiroshlma 5 presents great difficulty due largely to the incan plete nature of t he i nformation on the series 0£ cases from which this s udy i s me de As has been mentioned tho a rrival of the American Party did not oc cur unti l - six weeks after the actual bom b- i ngs o Hence for the peri od up to this date the information was ob- · tained directly frooi Japanese sour ceso Due 1ar8ely to the state of utter confusion and lac of medical r esource existine at that time they are quit e incomple te as will be showno l Becnuae of the nature of the data the approach of this paper deals with 1 a brief review of the nature of the physical agents which caused the pathol ogical dam a ei 2 a zoneral discussion of the pathological materia l as a vn1ole and s the presentation of the findingo observed in the study of the speci nene Strese will be ple osd on the damagin e f feots due to am na and neutron irradiation inasmuch as the nature of t ioce oi' ects 0 1 t 1e i1UJ1Ut n subject is oom- para tively unknown and not we ll understood The previoudy discussed agents which are important as faotors in the pathologioal demo go nr e 1 blast and the followine succusion wave 2 the terrir1c heat radiation which includes the exposures to rays fron1 the infra -red t o tho ultra-violet ranges of the spectrum 1 · 1'he Joint Com nbsion has a considerably larger and moro extensive e roup of cases than those here presented and it is hoped that many of the caps existing in this ccount will be bridged UNCLASSIFIEO and 3 the ionizing radiati on which is similar to Xmrays o The patholoe ical effects of aoute neutrc n radiation are iridistin guishable from the ewuma r adiation damage Tho blast effeots a s far as can be determined 1'rom eye witness reports are very similar to those observed following cyclonic wind storms and to a lesser axt ant other high explosive ordnance - The damage consists for the most part in injuries i'ran missiles coming from t'Cllling buildinbs and the like being thrown against the casualtyo F'k'aotures and traumatio wounds of all types were reoorded o Cases of eVisceration uere likewise r eported in ab tndanoe but in ceneral the tendency of later clini cal obcorvers is to l6o unt the frequency of such oventso This is also t r ue of crushing injuries attributed to the force of air pressure from t he bl st itself The fl a sh effects are dafi uitely an entity and will be disoue C d in sane detail later lost important as a distinotly new and overwheb1ing agent ie the gamma and neut r on irr adiation This also includes the effects of any possible r adioactivi t y fr Q11 fission product depositionD The major portion of the pathol ogioal ooount will be deYoted to the specific injuries from gamma radiation ctv w 11 J1ND6 J I A uthnr ECLASSIFIED - UNCLASSIFIED CHAPTER I e I Description cty NAH T1bQf I A uthor ECLASSIFIED - 2£ tateri al Studied UNCLASSIFIED Chapter I - D scr ipti on 0£ etarial Studied During - he limited sojourn i n Na sasa ki and Hiroshima it was possible to colloct pa chologicaJ lllQ terial fr® 24 autopsies 1'en of -these including inorrc of t he ea rly cases were obtained from liagasui and the reIM i nder from liiroshima Parallel clinical r1t- cords ware not obtainabl e in many of the earlier c seso Autopsies were carried cut in many i nstfl nces by inexperienced observerso Data on the names of the casual tiec al'ld other speoifio_facts o rtenwere inaoourate or not obtained o The fixation of mf ny ot the specimens was· ex tre nely poor due to l ack of ohamioals and roagsntGo m'1 good specimens unfit for atudyo This rendered Of the 24 collected ff i r data a re available on appr oximately 20 as is shown belowo The subdiv ision of t he onss s acoordin to date of de th is im- portant Bl a ca it serves s a msthod for judging the progresei on of the pe thologioal chanr es o The following tawlat ion shows the crouping • of oases into weekly int ervals a 'ter the exploaionai lGt week none 1 2nd tlf'f ek - 3r d week 4tb woek 5t h W Jek - 6t h week 7t h week 8th week 9t h week 3 2 110119 l 7 4 2 Of these oases ten were males and ten were femaleao DECLASSIFIED Authority NAJj W lj I J UNCLASSIFIED The dis t ri but i on of t he ce ses by ac e is a s 0-10 11-20 2l 30 31 40 41-50 51 60 - 4 oases 6 case6 3 c see ° 5 o ses no cases 3 OQ88S The distribution of t he oases by the nature of the injury was Radiation eff ects only 8 cases Rndi ti on plu s burns ' 3 cases Radiation plus trauma Radiation plus 'burns plus t rauma 3 oases 6 o ses In the discussion whioh follows an attempt will be made to give a chronological picture of the course inwro oh the pathological picturo developed in these fata l casesb The available matorial is of such a Xbture that it divides i t s elf eharply into two rather distinct catea sorioss 1 oas·e e obser ved in the 3rd and 4th weeks and 2 cases observed in the 7th to 9t h weeks The pa thologioa l descriptions which follow will eXpQnd the f i1 di ngs in these two croupa at len th Emmimtian of the nature of the path olo r eve ls that there is a time 0laasifloation a l so Th first l¢oup involves those irxii iduals who were injured by the blas t and those burned immediately either by the heat radiation f'ran the bomb itselt' or tram the fire of burning buildints and debris The s econd and most important roup is that w hioh ehows radiation injury DECLASSIFIED AUthority f _ j J1b061 j 1r rnss1AED - SJFIED 101 CHAPTh 'ft II Deaorip tion 2£ l' ndings lo In juries other th m radiation 2o ftadiati on i njuries Ao Phyoiologioal effects on enimals B Pat holocical effeots in animals C Pathological effects in hW IJW bein s • UNCLASSIFIED DECLASSIFIED 1 Authority NtJj J4W Jj Chapter II Q 10 e Desorietio o Findings lo In_juries other than Radiation Th type of injury related to blast has boen discussed earliero One additional co runent Nhich should be mentioned is the relative ra ri t y of rl lptured 6ar drums alwayu in high frequency f ollowing hi h explosive detonation a nd which W OUld tend to minimbo the ef- fect of the blast v ave iti1elf'o The burns r semble very closely the flash b trn on a very large acale Individu1ale who wore under the bombs and even at some distanoe b-om th811l had the expooed areas of their skin charred to a dark brown • color third deg ec burn nnd dit Jd w1 thin a few hours a t the mosto Those individuals up to approximately 4600 feet eho Yed second and thired degree rurns of l eGe i ntensity over those are s or akin expoaed unprotected t o the blas t Even thin clothing gave considerable pro- tection xoept whero tii htly stretched across tho slcin oloth wa6 Dark colQred found very suoceptible to iGni tion nd sKin aroo s so covered showed burneo The pathological- picture of the typioal skin injQry iJ presented in l'late Io This shows a pictux-e of second decree burn with ed IDa of the epidermis ocmplete disintsrrat1on of the Malpighian layer with ' m ch pyknotio debris edema and b yaliniiatlon 0£ the underlying layers of the skin Thranbi Qre visible in the blood vessels and sane be oterial clumps Qre scattered throughout 1 I Authority NAJj J j DECLASSIFIED U JClASSfFIED '1 PLATE I • 51rn 1 £A l I '30l1AB · 2ND DEGREE BUUJ UNCLASSIFIED DECLASSIFIED I worilY JJ AJ_f J3NJ 7' The pi cture of burn pathol ogy a nd i t s related s hocking e f fects ha been discus sed t l ength i n the medica l jou ne ls of the past rew yes re and requir es no further oonunento I ndi v i duals who survived rec latively seve e burns and t hon developed radiation sickness will be disou Gsed l atar o 2o mdit1tion Inj url mSJnuch e s tha pat hol ogical material obtai ned t'rcxn UagaseJd and lilroshima was col l e ct ed f r an Japanese eouroes9 some six or ei ht weeke a 1'ter the bo nbin it i s expsoted that gaps would and do occur ln the datb thus gainedo He nce it i s deemed wise to i ntersper se at this point a brief physiol ogi c l and pathologica l sum1iary of the sequence of event s occurring a f t er a nimals rats dogs posed to a killi ng dose 0 £ x- r adiationo M d monkeys are ex- The bi ol ogical effects of x rayG are i ndisti ngu i6habl a f r Qn t hose of t he gamma rays libereted by the bombBo • Ao Physiological Effect s in Animals After normal a nimals dogs aro exposed to a killing dose of I x ra Y5 there ie a latent peri od in the development of' symptoms £or e pproxitll taly one to two huur s at this tiao e preliminary period or prostration set s i n absoo1ated with a prlma r7 fall in blood pressur e Sane salivation diarr beap nausea and vanitinc may follow at thia time The diarrhea is sel dom of bloody nature The peripheral blood picture shows a n elevation in t he ci r culati ng polyroorphonuclear leucocytet or approximately 20 to 30j over t he c ontrol valueso DECLASSIFIED Authority NtJj J 4W J At the same time r LASSIFIED there is a shar-p declino iu the circula tini lymphocytes ·to as much o s one•tenth of the normal 'Vt l1 1oso The above symptans pro ess through the second day nnd with a continuation of a n accelerated heart ratep lovrored blood pre sure und occasional v0nitin o Very l ttle food is taken 11 nd some weight i s losto On the third day 0 the ani3l8 1 resumes eatinG nd r00ove s sa ne weight The polymorphoou clear leucooyte count of the peripheral blood has now fallen to a lo 'i level as lllt lch as one titth to one tenth of the normal value b with a parallel depreGsion of the lymphocyte aeries Q well · This state cont inues up to approximo toly t he ni nth or tenth day or slightly longer varying with the species at which time an I abrupt rise in temperature of the e nime l oocurso T1 is is asaooiated with blood ooncentration caused by a lowering of the fluid elements of the bloodo lurther conoentration is acno lished by the onset ot further diarrhea often of bl oody nature occur ilemorrhages occur other body ·0rga4s into So ne copious salivation-may the eikin muoosal areas a a well as- tiigns of sepsis and localized 1nf'ectron then appear o D'l -th occurs with the onset of shook somewhere between t he tenth a nd twentieth day a f'ter the administration of t he r ld1at1on B - Patholo5ioal Effects in Animals Pathological examination of the injured animals saorificed at the moat q portune periods for accurate study reveale that the most x-ray eensitive tissues can be gro pad in order of their severity of inYolvan cmt as I DECLASSIFIED p uthority bJ tJj 4bD j 1 the bone marrow thymub i f persisting and UNC·LASSlfltd testis as a group 2 noxt the lymphatic tissues spleen gut epithelium a nd ovaryo Little or no damage is observed in the panoreas 0 kidneyg lung heart adrenal nervous tissue skin or muscleo This latter statement refers t o direct xnray da nu ge and not to the secondary effects of bone marrow dopression such as hemorrh ace and infection which do cause cha n es in thee organao am imtion of each of the individual susceptible organs e t critical interva ls yields the follovring inforroationo ·• Thia aooount is nec6ssarily quite brief but will ive the reader a ohronologica l picture of the events occurring in ths gaps in the b unan information Ae far as can be determined there is very little differenoe between the change in animal f-l il l human and such variation Yill be oonspicmnisly pointed wto ay In this a more can plate piot11re of the development of the degenerative and egenerative processes oan be gained and tho dl similt rities betwf en a nimti 1 and human polntea outo Bone Ak rraa Dogs Following the depressing dosar e of x rays 1 the bone marrow- shows oonspiouou signs of dogenerution ofa progressive natureo Fir t the early o lls of the myelooyte series be in to lose their normal oel lar and particularly D lCle '-1 detail Cell walls baoane poorly donarcatedp mtolei begin to ahr i nk and later the f'onner ueas of oomplete m yelopoeai appear somewhat as syncitiae of pyknotic oellul flr elements and ll'hat can be termed nuclear debris whic 1 is dark staining with the be sic dyecio I -1 DECLASSIFIED Authority __ - NAfj J 4W Jj - UNCWSIFlrn - 10· This prooess of diaa ppearanoa of the gr anulocytos ia aesooiated with an inpouring of adult erythrocytes so that thew arrow a inusoida beoome so filled wi•th cells as to uppoar hemorrhagic in Mture o This dege nerative process contimies up throui i the eighth to eleventh days 9 or more and at i t s end ·t he rae rro 'l appeflrs to be a r etioulum w1 th oo sion- al islets of dea d cellult• r elu 1 JJ t s any portion There is no sign or activity e t To follow t hi s process 9 photomicroGraphs of dog rib 1111Arrow have bee11 prepiAred 1-b te I represents th_e oontrol marrow with its abundance of all cellular elements Plate III ahov s the above affect at t he and of 14 ays with no sign of cellular activityo A word must be s id concerning the failure of erythropoeaia as wellD This process in the animnl material studied is associ ated again with the earl 3e5 days disappearance of the mcleatecl cells which a lso 1usume a shrunken pyknotic c ppee ra nce the marrow retioulumo and gradually diGappaar f'rom It is evident e lao that the adult oe lla BU ff' r little injury i rlO slll lch as t he erythrooyte count ia maintained through tile normal lite spa n of' the oell 1100 hence sllo·s only a VM'Y alorr er xi gradual tall Th16 accountG for the absence or ane niao in the early phases of radiation s1ckness o Certain phenomena inust bs mentioned at this time which contribute to the dif1' lo1 1lty in t he gauging of the effect or given dose ce of x rayas on the blood fom in elements Above a oertair1 level of dosaee suoh as 100 r the depressicg effect on the marrow with the resultant effect on the disappearance of the white cell elements trom I DECLASSIFIED J Uthority - I NAJ f J1t lJ5J j PLATE ll ilCltMAL RIB MARROW DOG llNCI ASSIFl£8 14 DAlS AFrER PLATE III TOTAo r BODY RIB MARR J l 000 RADITION 350 R K OOSlTIII c 11 A nthor CLASSIFIED I A j Jb06' SEREJ7 110- the poripherul blood app a1 be the eari e velopment and extent of depression as i t would with a l e·thal d osageo The stress of the increas d dos ge enteru the picture only a s an i ndex to the severity of the involvement ioeo the length or timo the marrow remains depre s sad the extent of the wiping wt of the cellular elements und the like The axplani tion of this phe llDTl em ia not cleiu- and no attempt will be made to preaent the va rious potential possibilities whioh might underlie it A period of depresaion ie noted in whioh the marrow remaillB re• latively aoel ular and i n whioh the marrow apaoeG lose the cellu lar debris ascoo i Ated w th the degenerative prooese At the end or thie time new regeneratio n of cell a set up ialbnds scattered through the marrow spaces The period of onset or erythropoasia oocurs in about the 4th to 7th day in the rat Qnd a little l tor thnn the 14th day in th a dog s far aa oMn be dtttennined 1'rlll1 av •race f'i U eB The OQlluiar islaoos at fir t prollferate v ry lowly nnd tho time fro• esta blishmont or the ne Y area a ls olow Jyelopoosis is delayed by aeveral days after the initiation of erythropoesis Tho ne-H oells appear hormal although blood smears may show an increase in monooytelika forms The periphoral blood smears reflect t he na t re of this prooess with peraietent l eucopenia and a slow dooline in erythrocytes Plate IV • After this period i n which oells are being formed slowly a spurt in the production of new oells oocurs At t he me t ime allowi ng for I I -i bJ AJj J9b hj DECLASSIFIED Authority - UNCLASSIFIED PLA 'l'F IV RIB MARRON DOO 28 DAYS AFTr R TOTAL BODY Ri DIATION 3 50 R DECLASSIFIED 1 b tJj J9blbj UNCLASSlf ED a period or m1 1tur tion 'che peripheral blood reflootis CA change with appearance of new elements a nd proportiorui 1 rises in leucooyte and 80' il 'Jha t l ter the erythrocyte oountso This rise in the rat occurs about the 20th to 24th day on the avera e and at bout the 30th to 36th day in the dog Exa nination ·of llliU OYJS a t this period may roveal a gel tinouo ppearanae on gross e m nioation due to tho larGe numbers of formative cells occupying the marrow 6paoesD oollapsing the blood vessels and rendering the marrow relutively free of adult red oells Plate V The giant cells or megake ryooytes are T10rthy of mention iraemuoh as they are important as the site of platelet formation which i6 also depre d to low levels Thest1 likewise disappear early fran the marrow and are not reformed until relatively late in the regenerative oycle the emot time being a round the 20th day tor the rat flnd unknown for the dog Following t he reganerative perioo the proliferation may oont1mae no that as muoh as twioo the nol'mal nwnber of coll elc nents ue observed in the marrow counts In t he dog thia happens around the 56th day As th respootive need for blood cell elements is now solved the marrow reverts to the normal state this period being relatively unknown but perhaps a bout 100 days The Lymphatic Systems The effeot of the radiation on the lymphr a tio system follows a I DECLASSIFIED Authority NtJj J4bO Jj Ut Cl SS f ED • PLATE V R 6o DAYS AFTER• TOlB MARRO ' DOG I DECLASSIFIED j uthority _bJ AfJ J4b05 ' TAL BODY RADIATIO ' J50 R UNtUSS f tD JICHtr n similar p i 0 cure o 1 UNCLASSir1tU 111 t hin El matter of hours af'tar- i r radiation is I given the first signs of oe llular deg neration with loss of' oell d tail pyknosis and nacleai· fre onentation iis observed in the nodeso This continues throu hout t he followinc six to ten days with the wiping ou t oi t he germinal centers l eavin an a pa rent ly -degenerate ratioulwno This degenerative cha n e is follm ed by a 'all in the circulating l_ym phocyteo t o a very low leve lo As in t he bone marr ow signs of regeneration app nr ln the form of small islands ·or cells w hi cn start to reappear in four to six days after the period of canplete depr essiono Age ln t he process is very slow lid radual with the normal typ of arohitectare of the node not being rcgalned until same five weeks later in rat apeoimensi1 and 0006iderably later i n t he doge ' l'he_amount 0£ d e s t1-uoti on and the degree of da inage are a lso pr portional to the xmray dcsace employedp blt as in the marrow re d- leaa ·or dose the relntive time factors are ·the aame The SJ leens 'l'h3 l ymphatio etruot- 1res in the spleen behave essentia lly the same ae those deaoribed abovo the period of regeneration appearing to be SOlllewhat delayed over that observed in the l h nodes As late as 40 days ohantea ooour iu t he form or inorensine oollularity ot the pulp in the rat · Islands of extr£Unedu l l ary myalopoesis have been reported in the rat as being formed during the reparative process DECLASSIFIED AuthOrity 1'J tJJ J4bD-5 Such are not present UMt f tu ' 15- in tho dog in the present study groupo An isolated finding in t he heali ng and recenerative proces ses ia the development of aw cdant iron pi entation in the spleen follaw 0 ing da aee as shown by special stains The possi ble explanation is the inor0ased erythrocyte dostz•uction during this period a Stomaoh and -Intestine The destruction of the epithelial tissue of the stomach and bo vel has l one been known to exist as well as those physlologi o l phenomena associ ated with 1 t This dw o t A ge to t he bowel in animal i s again pro porti ona l to the amount of x-ray do geo It occurs rapidly wit hin matter of hours and develops t o a muximum extent in a matter of two to three days The changes observed f ollO -iring high exposure i n doi e are an edema and hynline appearance to the cells 8lll orgeme· 11 witn blood and in ex 0 treme cases actual desque mation of the m uoous membrane in shrede liemorrhage into the involved area is not unoom nono llealing is relativel y rapid and is fully in pro eas within a f@ ays atter the initial cw mage Residuals in the form of scarring are almost COlllpletel y abaent Sane weeks attar the initial damage he uorr ge Qnd subsequent ulceration into large areas of the bowel may occur doge am be in · themselves lethal IA -i Jj 71W5j DECLASSIFIED 1'J UN ClASSlf1£D I I 11 - •• - i i j I - Testis Arter a single lethal dose of x-radiation to the testis a gradual depression in sperm fortnation occurs- The first oells involved are the pri nary spel Dl cells r fu ich are adjacent to the vJO lls -of th tubule o These bec e swollen lose their identity and dis ppearo They are followed in turn by tho s permatogonia apannat ooyte spenna tide and sperm hich disappe r by continuous matur tiun so that for 20 to 30 days there is production of mature spermo The Sertoli cells am stroma remain e s the only rsmnants of the ori ino l active tiesueo Later marked atrophy and shrinking of the entire organ ooours a Th$ prooees is sl n and gr adual and requires wee s for its completion 'l'he time of regeneration or r eformation is delayed and in large number of to stances the oor 'lplete return to normal function· is not apparento other issues As ment oned previously the liver lung kidney pancreas heart nervous tissue skin and mu sole show no a ppreciable effect of n pathologioa l nature exoept in thoso instances in 111 hioh the dosage to giveJ1 area is extramel y high o c • Patholocical E f'feots on Human Bei$s The material presented below is subdivided into seotlona similar to those in the foregoing ocu1 u1t i i lOb of the detailed dosoription will be omitted due to gaps in the available informution pECILASSIFIED Authority 1'J tJl -1 J1W For the SECRET L 7 • UNCLASSfFIEV purpose of cla rif'ica·t ion e series of photomicrogra pha has been pre pared illustrative of the chan ea describedo ch raup of -pictures is preceded by a normal er ample for ocmparative purposes so that the progression can be easily shmma The radioaensitivo tissues for the human are identical with 1 hose for the a aimal o nd consist of the bone marrow lymphatic system spleeni testis and to a la s conspiouous extent the o ry The primary changes in the bone marrow oausa lethal effects elsewhere in the body in the form of infection bleeding 5l nd anamiao Before starting on the descripu tive aco oi ant it oa n be generalized ' that uaide from the 1mmodiate effects of' burns» moat of the early deaths in the first three to tou weeko were caused by infeotion during the next three to fwr weeks with aome overlapping of e61 oh ee1-ies deaths v 8re related to hemorrha e and sane infeotion during the fol lowing time up to several months most deaths were rel ted to severe 1 r o nia · ith these gener lhationa in mind descriptions of the chances in ·che various organo will now be made Bone Jarraw Plato VI is bone marrow presentatiun or the normal eta ta 0£ resting femoral It oonshtt essantiillly of a loose net ork oJ fat cells with interspersed island u ment or marrow oells in various stages ot dovelop• Both red and whito cell series a re reprssented o Occasional normal mege karyocytes arr noted o by red oellso There is no engorgement of the marrw It must be a gain stressed that the femoral marro f as shown here has muoh more of' a fat reticulum than the vertebral or rib DECLASSIFIED Authority II - NtJJ J4hl iJ - -- -- - SECREr DNCI ASSIFiED PLATZ VIo NORMAL FEMORhL UARROW liUIIAN SECRET marrovrs seen previously in the dog slides Plate VII i tha pic'cure observed some 16 days a rter expoeureo The retioulum see ns to be the only pers i stent element being ever vv here • dotted with tho pyknotic remnants of previously normal cells as well as m iolear debri s No active cell elements are noted Shawn also is aome engorgemont by red cells much ore oonspicuous in other sections ' aotually at tlo1eli baing or he orr gic appearancoo This picture oo upe re Yd th thllt shown in Plat I Uo ' the dog marrow at 14 day o Untorturntely thore i no· intermediate atage ing the relative initi l appearance or new in thiG eries show- island of rormative cells This will be demonstrated in a subsequent report For orientation one should refer to Pla te I' of the do_g marrow taken at 28 de yso Thie shme a t first gl Q noe a dogeneru tive a ppeurance wt on closer scrutiey small islands of ho t appear to ba undifferentiated cells cu the re- tieulwo are eeono Plate VIII ohows tho hY perplastio picture of the marrow during tho reoovery phase and compares with the dog t 60 daye • ilote the return of aw·ndant l'lhi te blood cells of all types am dosoriptiona ae well as islands of red oell formation The tatty reticulum is l noet completely replaced with marrow oells Wegakaryooyteo are again present and· blood platelets nonnal One item of difference between the dog 11 Bi human Ylhich must be mentioned is the relative decrease in the numbers of erythroid elements which are regenerated I DECLASSIFIED - SECRET Tlu s has not PLATE VIIo F r KJl AL MARROW HlrMN 16 DAYS AFTER EXPOStraR ' J A'l'OUIC BOMB HIROSHilfA I DECLASSIFIED j uth _ bJ tJj J h J5j lJNClASSIFiED Y DECLASSIFIED wori'Y 1 l Afj i 14h05 PL t 'l'E VIIIo FEUDR L MARROW HU'MAN DAYS AFTER EXPOSURE TO A' 'OMIC BOMB HIROSHIMA occurred in other s pooiea which have been atudied to date includinc the monkey o One might speculate that the l eok of red cell formation in the60 people 'iaS related t o a nutritional deficiency present prior to and during the r di t i on ef fecto Effects Caused by Bor e arrow Dee ession First Pei•iod - rinG t ne early period one to four wseka follow ing exposurep t here is a depr ession of the leuGooyte oount fran ita normal of 8p000 oells per oubio milluneter to extremely low- levelso This gives a chance or the dovelopm nt of infections in·all parts of the body with the invasion of tisauee by pathocenic acd non-pnthogenic baoteriao This will be di soussed tit sane leng·tho Infections of the ski n parti ularly around t he mouth were deeoribed by Japanese physicians 'l'hei e appeared ·1n the form of shall'OW confluent ulcerations exullng reonlsh pus of a eweetish fetid odoro Various types of wcoal C'1 Vit y- ulcerative l esions were common extendi fran a mild -c ingivltis with shtlllow ulceration to a COiUplete aphthoua stcmatitis tonoillitis phnryngitis a ad even to the involvement of the epiglottis lar YQX and trachea · termed an a granulocytic lllncina Sµch a stat is most oanmonly All types of this ato te wore eon by the Japanese and pa tholo£ i cal s oLI ens of it preseM ed b tt by the time of arrival of the A erican irrvestigatlng ptLrty only residual and recovering cases were not d Several co see of n ia or c a ene of ' the mou th were seen sane reapond1nG well to penicillin treatment No pathological' material s1 litable £or photography is i aoluded in this aeries -1 1t thnr CLASSIFIED NClASStf ED rl Frank sepsis with many forms of bacto1·ia was a lso enoountered o This was usually of a fulminating typeo In subsequont slides of' tissues it is possible t o distinguish numerous bacterial clumps with horrever s lmost corr plete bsenoe ppnses a round themo or the nonnal leucocytic res Pneumoni p various types of u lcerative gastro- enteritis and the like v·ere f'ound during this periodo Seoond Period Following the period oli aract rbed by- pre domina e of' infections and cour led to s om0 extent with it was a mor e prolonged period in whi ch bleeding into t he vari1J1 1e tissues and areas of the body was noted '£his was e saooiated vdth prof'ound platelet deficiency related to the al ost completo destruction 0£ the megl la karyocytes of the marrow Henoe the picture of a profound thranbo- cytopenio purpur a is not d Pstech1ae and ecchymoses of various s hes v era observed in all areas of the akin serour s1 1rfaoes nuoosal membranes a od the like Frank he norrhage occurred in the lung tisSL1es the kidney brain be1Hel etc • with symptoms of them being quite pronounced in the oli' ' _ nice l picture A fev · o x snples of these pheno neaa are shown in the tollowing plates and description E oh tissue in turn is preceded by a normal example for oompuri oono Plate Ill ohowe a normal lung Pl te X shows a sootion of lung with the alveol r walls still well marked ' but copious amounts of serum and red blood coll have exuaed into the cavities l Au DECLASSIFIED Note the a lmost SECRET PLATE IXo pEcLASsIFIED - I AUthOri'Y bl AJ D J bf 7 I J NJRPifAL LUNG IIDMAN -- ' ' · PLA 'IE Xo LUNG HUIIAN l 8 DA S AFTER EXPOSURF TO ATOIIIC B0118 NAGASAKI DECLASSIFIED - I 1 athority J tJ_D Jb bJ UNCtASSIF EI complete abaenca of wh i te coll eloments shown thrpughout as wello Clumps of bacteria o r e Pla e XI showa a further process in the devslopment of gangrene o f ·t he l ung with 0omplet 0 l oss of callalar detail and the entire area flooded with red blood cellao Plate XII shows a no mal stoma oh with the capillary arcades well marked out Plata XIII 6hov -s hemorrhage into thut area whioh consists o a liberatlon of rad cells through the normc l capillaries to form the overlying eooh osis • n 8-in note the absenoe of white blood ooll o All sect ions throughou t the t reas of he norrha e a_re similari a Dd wbon coup ed with the leu oopenia ulready in effect produoe tho picture sh-w in bove Third Period Very little data are available on this so•oall third sta e of the eerie£ or pathological avents following marrow depression the stage of ancm ia o It is charaoteri sd by a 'ailure of red blood oell f ormation while ut the same time# the white blood oell series o nd l Ytnphooytes have returned to nonnal levelso Individuals i n this crou p develop a profound QnGmia and i _n spite of blood transfusions to whioh they ree ot pDOrly die with erythrocyte counts of lesG than one million per oubio millblotora Pathological examination or these 1ndtvidnal8 limits the picture to the bone marrow ana the e ffectB of anemia elue me re markedly pa le and bloodless DECLASSIFIED II AUtbOri'Y _N - AJj J4b02J Tiss les are No bleedin tendencies are apparent UNCLASSIFIED PLATE XIo LUNG HUMAN 16 DAYS AFTER EXPOSURE TO ATOMIC BOMB HIROSHIMA 1 -i Jl Afj 'Jb06j DECLASSIFIED Authority r PLATE XIIo - i - ' ' ' ·1 NORMAL S 'roMACH HUMAN r - '-' u Ju Ui J_j PI A 'lE XIII TO di CH HUl f N 28 DAYS AF'IER EXPOSURE ro ATOMIC BOMB HIROSHIMA DECLASSIFIED I 1aori1Y _bl j utu -- tJj J 4b05j The bone marrow is of a gelatin s or yellowish color and packed with all forms of the myelocyte s ri es in apparently normal distributiono Ho 1ever there is e conspicu ous absanoe of erythroid forms smears shov a similar pictur e anemiao i tarrow Death is obvimtsly due to the pro f'o 1nd Speculation a s nontloned beforeg of a role tad nutritional de- f'icioncy m i tst be raised due t o the general nutriti onal status of the affected indi'V'iduals o Thi s phenomena has not been observed in animalso Lympha ti o Tissues As has been previously notod the l ph nod s in various parte of the body are ffected almost imnediately following ir adiation with a oomplete loss or c e llular det il leaving a atra na occupied l'l ith de generatins oella A sain oxa plea of this initial picture are absent the earliost material ahouing the beeinning of lyxnphopoesiso ' the ph nodes in the c ross at approximately the two week period • are so ft and flabby vd th o sl3 of atruotura l detail The microscopic pioture is notod below • Plats XIV el owe a normal lymph node with well ·dei'ined germinal oentera and pt tlp filled with mixed red cells and u dult l imphocytes Plato XV ohowa a bypoplo stic node Without oo nsp1cuous folllcloa In the cortical reglon thore is some early indicati on of lymphocyte fomation aa indicated in blast forms and small and medium lymphooytea The pulp is filled with erythrocytes in increased numbers and in sane cases there is a h orrhngio tendency This slide 18 days indicates the beginning of the raparative process -i NtJj J4b22J DECLASSIFIED j utbority Plate AVI shows a little later I PLATE XIV 0 · pECLASSIFIED NORUI L LYUPH ODE HUIIAN - _bl_ Jj J4bD 1 r Autboflt ' C ' UNCLASSIFIEIJ- PLATE XV o LYMPH NODE HUMAN 24 DAlS AFTra EXPOSURE TO ATOIIIC BOMB HIROSHIMA CLASSIFIED E ·1 tJ D 4bD J _ won Y Ji UNCLASSIFIED PIATE XVI o Ln PH NODE HUMAN 28 DAYS AFTER EXPOSURE ro ATOMIC BOK8 HIROSHIMA I Jj 4W J DECLASSIFIED ·cy_bl _A uthOfl ste e 6 ·t 28 days 9 a t ivhich ti Ine the ce rminal centers are showinr a tendency to round up the follicles 'trith the developmont of 1 1ature forms structures o During the first few weeks with the profound aof'tening of the lymphatio are9 s in the intestino11 sane ulceration and infeotion as noted The blood piou ire as desoriboo ra£lects perfectly the pathological stat e of the l ph nodes 1 t a lven perio io and reappearance or Co nplete early depression normal forms coincide with the degenerative a nci reeenerative phases in ths nodaso Spleen The sequenoe or events in the spleon parallels thut observed in th l ph nodeo und is illustrated in the f'ollmd plat eo 'PJ e te XVII sh owe 18 days spleen fr im fte radiation normal individu l Pla te XVIII is a spleen There is a pronounced laok of l phoid eloq · ments bore and the follicles Qan be made out- only with difficulty An lnoreased a -nount of' blood is noted in th a pulp re o Aroand central veeoeb fev oella ·1hioh app3 ar to be blast fort 116 ijt 1rrouaclod by ema'll lymphooytea • An oocasioml larger cell oulU111 cell is noted ot foreign appearance reti Plate XIA sho the status a t 28 days with the attempted rounding up of oells into follicles and the presence of mature forms in evidence l 1 Lo tar stages 60 days ohow the prasenoe qf normal lymphatic -1 NAfj 741 M DECLA SSIFIED The large oells of questionable reticulwn type are still UNCLASSIFIE PLATE XVIIo NORMAL SPO EN HU UAN UNCLASSIFIED PU TE XVIII SPLEEN HUMAN 18 DAYS AFTER EXPOSURE TO ATOY IC BOMB HIROSIUUA ElNClASS FIW PLATE XIX O SPLF F 1-J HUMAN 28 DAYS AFTER EXPOSURE TO AT0UIC B0 8 HIBOSHir J DECLA SSIFIED A uthority -- llNCLASSJ JlD An a ddit i onal finding in such spleens i s the a bundanoe of iron deposition in a large munber of themo This is demonstrated oonspi ouously by iron stain and is prooo bly related to inoreased red cell des truction in thass i ndhridu ls o Testis inati on of t he limited miount of testicular material in this series for profoWld effac·l s is soo nvha·t disappointlngo • For the · nature or the progressive chanGes i t is necessa y to refer again to the animal do tao One specimen at 18 days is worthy o r oominent and is il- lustrated be lov o Plate AX sho s a no rmal testis with all cell ular elements intaoto Plate XXI shows a specime n a t 18 days in which tha Sertoli cells appeo healthy nd activeo The primary germi l elomente appear some What de e nerate a nd r eduo in number The sperm togonia spel DU itida and sperm a ppear nonnal l though r educed in amount • Later specimens of t 3stes not sho m dflr lonstrate marked atrophic ' oha ngee with only a ctive i ntersti tial cell s and r eticulumo The ovarian m terhl h also limited Sections examined showed the preaenoe of an ocoas i onal small ovum and i t i s impossible to interI pret the findings A bet t er picture will be gained i'ram the examination of tbs physiological effec ts as recorded elsev here UNCLASSIFIED I DECLA Authority V JCI ASSI IE PLATE XXo NOR •A-- TESTIS HUWAN I DECLASSIFIED j uthoril I - AJ i JjW §j I UNt 1 SS f f O _ I 'llNCLASS Flf J PI A 'lE XXIo TESTIS HUMAN 28 DAYS AFTER EXPOSURE TO ATOYIC BOllB NAGASAKI UNCLASSIFIED - - -DECLASSIFIEi -A uthority rvND MOO ss _ t • - Stomach Intestine and Colon The predominant observation i n the bowels aside fran mucosal heinorrmge · is t he appea rance of superficial spotty ulceration with overlying membrane in t ho lower inbestine ileum oaecum9 and oolono The sigmoid regi on we s unual lymarkedly involvedo he process by v1hi oh this ulc-ere tion appearGd seemed to be tru it of an initial hemo 0 rrhage followod by eros inn of the overlying iaohamic mucosa times such u loeration gave a h rringbone appenranceo At The microscopic I seotiona examined invar i bly are too autolyzad to allow oourate intsrpret J tiono C banbsa are also d0ecribad in the stomach duodenum and jejunum Which may be related to trophy with reuulting reduction in the height of the oolunmar 3pitheliura c From tho sections st iid1ed this change io Qdmixed so completely with utolysis to render accurate opinion impos iblao • Epilation This is a phenomenon oh raoteristic of the human reaction long known to radiolo iste who have used x ray as a depilitory agent A brief doscription ot t he gross nature of this findi in the casualties 11 worth montion see Plotoi raphs 1'9 rt I I approximately 7 toll da toJ lowl n the xplos lons and later ln IJl l1Y 1Ddiv1duale the lose or hair from the soalp espeo i ally f o anne an legs became appo ront The loss· is of o diffus e rw ture over the hirsute area the individual ha ire beoomin u loosened and dropping out • --1 - A uthority IVND ¥100 Interspersed are haire of UNCLASSIFIED r- q 1'l-c· - _ J gircate1• vi ability so t hat particu lo rly in wor ien co sue lt ies with lone uncombed hair tho entire mass of hair is held in place by sparse Gcattared long ha ir s 9 the a z·ea s of epilution a ppea r ine betwaan then1 The procesa develops vath moderate sloV1ness requirinc s ome d ys for co npletion Sections tak n t hrzy l h the epilated ar s s how atrophy and loss of c onspicuous cellula - iden t i ·ty of the sweat glands and he ir £ollicle so So -ne ede na appears in th0 skin and underly-inc connective ·t is su a o Bact erial clumps runy be resent in cases h f Lvi proi'ound l euoope niao Ort ly sevei al sections nr availa ble of this material and it is diffi- cult t o formulat e an accurate ooinion of t he nature of the proo sso Ge mine ltad_ a tion of -the Skin Th delayed- effect o f irradiation to t hs skin is also well kncwn t o ppea r in the form of' a n eryth6ma s everal weeks after exposure » and in sane instances a a bui'n It must be st 1 ted e t this time that no aw terial is a vailt ble hich wou ld l ndicate that such erythemas and burns did occur fl-am the b b explosionso All wrned areas e 11 1ned gnva histories of rad tat on heat or fire burns to the body o an obvious c·uaual r e l a ti ons iipo Other Pat ho lo The previous ly ment onod pathological discussion deals rather complete ly With the specific fin linis of medical interest related to tbe atomic bomb other changes of possible nutritional degener tive infeotions ad nature ware observed n parasitic In this brief report 9 however all these aro anitted for- the obvirus purposes or olarity and brevity ijt Lr J 142 CHAPTER IV • • ---» I A uthority tVNT ¥1 0$5_ Cono lllSion 1 UNCLASS FIEU • Chapter IV - Conclusion In conclusion of this disc11ssiong it is ar arent that the positive patholoL ical findings other than those assoc i e ted with blast and heat turns are directly connectee with tha effect of gai una e nd neutron iri-adfat1on of tisrues sui'ficiently sensitive so as to d61lloUBtra te rapid lethal or dW W ging off'ects 0 For comparative purpoaes t it is feasible to sum urize the d ta recorded in the body of this report in ' t bu lar torrno In the following aha rt degeneration or pypoplasi is recorded numerically from ons to f w r » the large nwn9ers indio ti increasing severity of the r_eaction Regeneration in turn is recorded in the' same fashion with the la l ger Il1 lmbers i ndicating l'lore complete return to the normal state 0 A iditional data on the o onk ey a reap pended for oo n parative Urpcseso --UNCLASSIFIE - -r i Authority rvND ¥100 ss_ • 17 18 daya Human Bone Marrow S eleen ymph Node Hypoplaaie 3 H ypoplasia 3 Regeneration l Degenera ti on Dog liypoplaeia 4 Regeneration 0 liypople sia 2 Reg€lneration 2 liypoplasia 2 Regeneration 2 Degeneration Rat liypoplasia 2-3 Regeneration 0•2 Hypoplada 1-2 Regeneration 2-3 liypoplasia l-2 Hegenerati n 2-3 Degeneration 2-3 Monkey Hypoplasia Z-3 Regeneration 0 llypoplasiA 3 Regenerat ion l Immatur0 No data liypoplasia 2 Hypoplc sie l hebenere tion l IlY O le sia 1 hegeneration 2 De eneration 1 2 Regeneration l Dog Hypoplas i a l hegenera tion 2 Hypoplasia l Regsnero tion 4 llypoplo si a 1 Iiei enoration 4 lJegenera·l ion l Rat Norma l Normal llypoplas i a l Degeneration 1 2 M onk ey Regeneration 3-4 Hypoplasio l Regeneration 3 llypoplas i a Imm o turs liyppplaaia 2 c - Rer enore tion 3 65 - 60 days - - Hiim an c -' Hypoplasia 0-2 egenerution 2 '4 Degeneration 4 egeneration 2-4 · Normal Normal Normal Degeneration 2 Nonaal Nonn al Normal erythroid elements Teetis Regenoration l 2 - • C liypoplas 1a 3 Human s Ci'- 144 l-tegeneration 0 28 de y C 0 Site Daya Following Expowre ' Dog Monkey liypople sis Immature Ap sndix •· r- Report I reliminarr Report E£ Fimings 9 Ato nic Investigating Grou Hiroshima Nagasaki •· DECLASSIFIED- A uthority IVN I ¥' j 0655_ muwJ UNCLASSlf1£0 - PR LlMINllhY REPORT OF H r v rnas UF ATQ lC Bll' JB INVESTIGATING GRuUPS AT dIROS lil A AND NAGASAKI Introdu ction Thi x-eport is based_ upon a preliminary evaluation of the data obta lned by the atomic bomb 1uveoi ig u ting groups at Hiroshima and Nagasaki and upon impressions gained whlle doing the worko It contaln s some preliminary tables and some general conclusions which may be altered tmen a detnilod anal ysis of the data is completedo The data obta lned fa l l generally into three distinct cateeories which o r e • however interd eoendent soctionso - and these are re ported in three Section Io t edical reoort A des cription of the effeots of the bombings on the inhabitants of the two oities ie given with a discus sion of what caused the var ious effects insofar as this could be determined from the f i '1d i s of this groupo 0 action IIo ioactiv lt y measurarn nts 0 Measurements of the in- tens ity of radioactivity at the time of the investigation with dslineatlon of t he araas showing activity are shown on plots and the methods of c 01 1nting and the significance oJf the finding r lated to the effeota on pat ients are discussedo Section I l Dar ia ge es timuteso Estimates of the various degrees of structural damage in the two cities is shown on zone maps and the relation of these fir dinr s t o hysical injuries of patients is discussedo 0 - -» Authority SECTlOl lo Ao Purpose of atudY • To determine the actua l ef'fect fi of the atanic bcr nbs on the peo le of liiroshi 'lla a rid Ha gaGald and insofar as poGsibl e t o determine to what the effects were due and how many people were injured o B i ethods of investication iost of t he data v rere deri ved 'ran the foll owing l ines l o Exa ination of patients still living 2 Anal sis of 1·ecords of patients who had died or were not available for exo ui nation f or other ree sonao 3o Autopsy materialo 4 Tabulations of data and opinions of Japanese i nvestigators who had studied the oar lier patients Co lie sultao The results are iven i n ·cha f ollowing paragraphs 1 Symptane and lab oratory fimingao The symp ans and labora tory findings in patients at Hiroshima and N11 gasaki fall into two general groups o The £irat group ino l udes the im ediate effects due to burns and other physical injuries and will 00 discus sed under F below The second grou of findings began af_ter a latont period varyln fran 3 to 30 days The llllportant symptoms and phy ical findings were epilation severe ulosra tive lesi om of the mouth and throat hemorrhae c manifestations inolud ng petechi e severe gastrointestl 'Al s ir i to n s e nd ro pid and extreme em aoia- tion Deaths occurred thro--t hout a period exten ii from l week to 2 months afte t explosion ith the greatest number oocurring about 1 month af'tero The 1mpo1 ta 1t labor tory firxling s related prirnf l rily to disturbances in the hematopoiet2 0 funct1 on manifested by leucopenia o nomia e nd thrombo ytopeniao The most striking flmings at autopsy were si 11S of destract1 on of t he bone marrmv and the lyniphatios ulcerative lesions of the colon a d rectum and signs of h8 Uorrhage throughout the viscera In these cases in general the earlier the symotcms appeared the more s vere vm s the oaee and on ·this basis they oan divided into three groups The details or the symptans laboratory data and autopsy fimin in patients er these three groups are shown in Table I a b and 0 • - Authority I VNCLASSIFIED Table I 0 a Sjnnptans in Patients showing Delayed Eff ectso Day after explosion lo 2 3o 4 60 Bo 9o lOo llo l2o l3 o - Moat Severe Patients usually with in lQO Kmo of center Between loO and 1 5 Km lo Nausea and v_om t ting ai'ter l -2 hours lasting 1-2 days l Nausea and vaniting af'ter 1 2 hours lasting l - 2 days LATENT PERIOD 2o Bloody diarrhea 3 Vomiting r r T 4o Fever So Rapid emaciation Death ortality pr obably 10o% Mild oderatoly Severe lo5 to 2o5 Kmo ' Pi RiuD LATENT Pt R IOD 2o Beginning epilation progressing until deo th l4 o 15 l6o l7o 18 l9 o 200 2l o 220 250 260 27a 3 Loos of appetite and general malaiseo 4 Fever So lierpetiform eruption about mouth and on buocal mucus membranes progressing to necrotic stanatitis with hemo rrhagio gingi itiso 6 Pallor 7 Peteohiae bloody diarrhea opistaxis and hematemesiB o Bo Rapid emaciation Death Mortality probably 50% 0 28 0 29 30 31 - D Authority tVND 'r-100 55_ l o pila tion 2 o Anorexia and s I ma laise Sore throat 4 o Pallor 5o Petechiae 6 0 Diarrhea 7o iodorate em oiam tion Reoovery unless oanplicated by previous poor health or superimposed injuries or infeotions UNCLASSIFIED DECLASSIFIED JJNCLASSIFIED Authority rv rv 123'1 o0 55 Te blo I b I laboratory Findines in Pe Uents Sho ling Delayed Effects LODERATgLY SEVERE FINDING OST 3BV1 RE kd 5th - Day of laboratory determinati on 20 30·ch MILD 30t h- 60th Lei toopenia L oderate Extreme foderate Anemia None i iodere ta Severe Thr a1bocyto ponia None Extreme oderat e liematuria IIJona Frequent I nfrequent - Table I o Autopsy Findincs in Patients Showin pelayed Eff'eot s MOST SEVJ c RE - UODERATELY Sr VERE UILD General aspaot aciation Einaoiation Peteohiae l pilo ion Emaciation Canplioating _ findings burns eto Mouth and ph aryruc Ulooratione Ulcerations Swelling and edema Bone Marrow Grossly normal Myoloid degenera Early degenerative tion changes Colon and rectum Neorot1o ulceration Teatea and ovaries Other viscera Terminal changes Myolois regeneration Erythroble stio degeneration Necrotic uloorations Hemorrhage Genera 1 hemorrhagic findings Atrophied Atrophied Hemorrhage Canplicating findings malnutrition ohr die etc worms Lymph Nodes JJodera te hyper plasia 2o Ce u s of sympto aa o That these sy nptoms o nd findi n s were pr imarily dus ·l o radiat ion vJas concluded fran t h e f 'ollowi ng a o The t heoretical calculati ons pr ed i ct ed an inst antaneous di scha r e o of high e nergy gamma rays nnd neut r ons be low tho point of detom tion which would have been · expected t o cause ser i ous biological effeotso bo The aymptoms and fi ndings we re those which ·would have been predicted f r om anL' lal experiments and f rom known toxi c ef f ects encountered in clinical therapeutic ap 111ication of rad io ti ono Co The exist ence of a defini t e latent per iod befor e the onset of sympt oms a nd t he ooi -re l at ion be'l ween the length of the l atent period and the severity of t he s ymptcms a s shown i n Ta ble Iga stronzly sugGested that the SJmptoms were due to r adi e tiono • d o I nduc ed radioactivity had baem detected very near the center of the explosiono T his could be attributed only to the eff ect of neutrons o able Il shows s uoh i nduced radi oactivity i n bone phosphor us and the relat ion of i t s intensi t y t o the di sta nce f rom t he centero TABLE II Activit y of P i n Bone o Noo Bet a ray min gnio of ash• Distance f'rc n center Kmo lo Hiroshima X lo4 6 000 Ool7 Oo 25 Oo53 Oo60 Oo70 lo28 2o00 2o 3o 4o 5o 6 7 80 2003 24 06 l6o9 4 08 Oo l 26 0 061 •l gm of ash corresponds t o '8 4 • of bona Data f ran Dr Koiti Murati 0 Nuclear Research Labor atory Institute of Physical and Chemical Research Tokyo 3 b'valuation of sympt oms Of t h e sympt ans o nd f i ndi ngs desoribed o t hose whi ch in themsel ves can be considered to be due to rad i ation are e pi l ation l euc openia with its accompanyi nt sympt ans and thranbooytopenia with •its accompanying hemorrhagic manifestations These effects ar e due a lmost wholly t o t he gamma radi ation The additional role that neutr ons may have played i n the producti on of theee symptoms oan not be evaluated from the data Any additional informat i on on the biological effacts of radiation which may be fort hcoming fr0lJ t he -data obtained must await more deta i led a nalysis ' 0 0 4° Evidence a ainst eff ect f r om persistent radioactivit y That the eympt ams fr om r ad i ation wer e· due to t he instantaneous discharge of high ·ensrgy parti cles and not ·to 11¥ persi tent r adioactivity deposited on the UNCLASSIFIED ground wa s also oonolu ed frcm sever l fncts o ao Theora' ical predicttons indicated that the height e bove the ground at which the bomb was detonated w uld not produce any dangerous amounts of persif ten-t redioac lvi' bo The amount of redioe ctivity on the e round determined at the time of the study was very smo 11 and was not su fficient to account for any harmful a a ounts hav-i ng been present since the explosion ·This is 11ora fully dis cussed in Section I I of this report o Co No pers ons oo- ninr into the areas after the ex ilosion were found who showed o ey s i gns or s y nptom s of radiation eff'ac·cso These fact s also ap ly to any effects from radioactive particl e s eoattered along the path of the cloud 5o Distribution of patients showing effects of radiati ono Ta ble I I shows the relationship between the distance fran the cent er o f the e xplosion and the oocurrenoe of' epiJ fltl on and hemorrhe gio diathesis o 'table III Relationshi p between Distance frooi the Center of the Explosion and t he Occurrence of Epilation and Hemorrhagic Diathesiso Nace saki Distance from the 01 ml er lfoo of 606 Kmo 1 0 lo5 2 0 3 0 4o0 ·a Cases Percent 12 llo3 40 6 30 2 43 32 5 10 4 1 and over 3 2 - 4 • • 9 4 2 9 lo9 total 107 It is apparent that the majority of surviving cases showing the s ptoms and findings due to radiation were between 1 0 and 1 5 i mo frcm the center at the time of the explosiono There were few cases studied who were within Oo5 Km of the oenter s ince nost of these must have died so n aft er the ex plosion Fron the Japanese data there may be evidence that patients i n Natasaki aa far away as 4oO Km did show effects of radiation 0 60 Additional effects Physioa l injuries o Physical injuries other than burns included fraotures laoerations oontusionB and similar effects such as would be expected fran blast directly am from the crumbline buildin s and fly-lng debris caueed by the explosion There were evidences of uoh injuries at least as far out as 3 5 Kme from the center Seo Section Ill or this report 0 • 0 - » Authority UNG ASSlFIED b Burns o The b1 u ns 1•rcre of t 10 types o The former we e f lre burns of the usua1- -Eypeo The lattoi - 0 wl ii ch comprised the majority of t he burn§ 0 however9 were distinctive in ·sevaral respectso That they were due to infra-red r ays was concluded fr ln th0 following lo Clinically they resembled sunburns more close l y than ordinary £ire burns o 2 They were sharply delineated by lines representing the border of bare skin areas and they' were limited to those areas which wore facing the center of the explosion For ins t ance a patient who had bean walking at right an6 les to a li ne drawn between him and the center or the explosion and whose arms were swing ine might have burns on the outside of the arm nea rest t he center and the inside of the other armo 3o Patients who were quite close to the center and who had on white and black striped clothes raay have had burns or the sidn only in those areas under t he black clothin o - 4° 1any patients roc- ivered wit as much as 2 3 of the total skin area so bu1·n ed wh ich is llost unlike l y with ordinary burns i f the burns are deeper than 1st degreeD and 5 s further evidence that these differed from the usual type of burns o The majority of these burns were classified as second de reo burnso They healed slowly but vd thout sloughing or many instances of secondary inf'ectiono -The patients showing them were most frequently near the center but with decreasing frequency and aever ityp they may have extended out as f'e r aa 4 o0 Y m There was a mple evi dence of similar burning of physical objectso 0 7 · Relation of other injuries to efi'ects from radiation The evaluation of symptoms and findinr s due wholly to radiation is oanplicated by the occurrence of the other tY es of injury described The majority of patients who shlNied effects of radiation als o had burns and other physical injuries since both types of in jury oocurred mor e frequently in persons near the center of the explosion Thia is s hown in Table IV i n which the depression of the leucocyte count can be oonsidered a s a eesure of the extent of injury ft'om rad i tion 0 Table IV Relationship betwoen l euoocyto Count and Oocurrenoe of Burns and other Physical Injuries Uninjured Burned other physical injuries 500 1500 0 2500 3600 2 0 l 10 4500 3 9 2 · 5600 10 0 2 3 12 ---» l Authority IVND Mo6 SS_ 6 10 1lNCUSS flE0 - I Oni rijured WoB oCo 6500 7500 8 500 9500 UNrLAss1r1ra r 2·4 13 A 9 11 - ii other physical inj ur ies 0 3 2 0 5 11 6 6 5 0 8 0 Treatmento Tree -l rne nt of the burns a nd other PbY- ica l injuries WJA S done by the Japane se by orthod ox me -t hods o -Despite the inor dinate number or p the poor f a oilities due in part to the gr oss destr uction of medica l inst a l lations these i njur ies # and particular ly the burnsg did very well with ver y lit tle i nfact Lon in spite of the unbe i eva bly poor conditions under which s ome of them wer e bei ng ·t r eatedo -------- Trea tment of the rad ia tion e f fects by the Je panesa included genera l suppor' ative measu e a such a s rest and high vitamin and high · caloric diets a Pa renteral livar a nd calcium a dminis t r a tion thrombin preparationsa ·and blood transfusi orui were used t o c ombat hemorrhageo Pa rentera l vita llin preparations and pentanuclootide were usod by lunar i oan Army Medical Corps off'ioors af'ter their a rri val No definite effect of these measu r es on the course of the disease could be demonst rated The use of sulfor amide drugs by tha Japanese and of penicillin by the American physicians_µndoubt dly helped oo t ol o1 superimpo s ed i o 0 tion o A t U t ' Iv- - -Br - - C- r c d 4 c l f -L U JJ'-tU _ Uv- J y o-J- 9o Casua l ity e s timations o The total number of oas ualities with the percentage of deaths and the dis tribl t i on of the casualities and death particularly i n r e l a tion to t he effects of radiati on can only be ra hly estima ted at the present t ime and may never be a ccurately knowno a Total oa sualities cvusider b e proporti on of the people known t o have been in the t wo ci t ies a t ·the times of the explosi ons cannot be accounted for Many of the s e were probably kil l ed outright and not identifi ed 0 but l a rge number may have found their 1my oµt of the cities and there is no r e oord of them Death oertificates a r e not routinely kept in J apan and the 0 0 vital s t at istics i n gener al are not very o nplete rom what was found t he best es t imates f or t otal caaualit ies i n the two c ities a t t he end or Septanber were as shown i n Ta ble Vo Tabl e V Casuality Est imat es Ci ty Hiroahlma Nagasaki Total present a t · time of exelosion Dead Wounded 400 000 86 000 270 000 40 000 112 000 50 000 - b Sta istios or pat ients showing eff ects of radi ation The total number of patients wh s howed radia ion effeots and the percent a ge of these who died is even more difficu lt to estimate An inherent defe ct 1n i- --1 Authority UNCLASSIFIED CJ filNClASSffIE this information which oan never be overcome is tho faot that me ny patients wsre killed immediately or died from other injuries baf ore they ha d time to develop symptoms due to radiation Recor ds were not kept on the ma jority of the patients and many of those which were availa ble were incompleteo This is pe rticularly true of ·the records of patients adnitted to the hospitals and who were discharged after their burns and wounds were he li j but before they developed symptans due to radiation Attempts to co pare the amount of radiati on received is made particularly difficult by the_ ina bilit Y to estimate the a mount of effective shielding in individual cases aild this di ffer ad in ceneral in the two ci tias o With a l 1 of these qualifice tions D and if one c onsiders only t ose atients ad nitted to hospitals in the two cities1 it can be estimated t hat of ap rox lm tely 4000 iatients admitted to hospitalsj 1300 or 33% showed effects of r adiation and of this number a pproximately one-half died - - -- Authority rvrvD ¥'1 6$_ UNCLASSIFIED INTENSITY OF RADI OACT LVITY F' UND IN AND AROUND HIROSHllIA AND NAGASAKI SECTION II A o Purpose of studyo To ascertain the presence of _residual radioactivity in and around the bombed cities and to evaluate this activity in relation to possible physiological effects o Bo Instrumentso Portable counters Geigor-I ueller Type with ear phone attachments were found to be the nost practical i nstruments for this work Le ndsverk and IVollan el ctrosoopes were also used Direct reading ionization chamber instruments were ava ilable but none Mere sensitive enough to deteot the low intensity rad_ie tion present C Calibrationo The instruments used 'lere calibrated a ainst known radium sources brought for this Uric vse Tb a ci i i br tions were performed · before any readings _were obtained and twice during their tlvo· week period of US8o Do Monitorin a Monitoring parties composed of physioians and teohnicians traineq in th ls work explored the rubble of the lmmbed cities on foot and along roads into the environs Hea6i ll S were made by all i n a prescria bed manner and reoorded iVater sheds and places of habitation in the vici ' nitias of the town were investigateda Eo Resultso The plots of r adiati on intensities are presented in the form of e ui-i tensi y lines on the accompanying maps of the two citiasa Fig I Hiroshl llai F i gso II and IIIa Nagasaki Fo Discussiono features are eeen - lo radiation From a study of the results obtained svveral salient In eaoh city there are two distinct areas of low intensity a0 ba One beneath the point of detone tion Another separated f'rom the first by several kil0111etera These areas can be correlated with the wind directions reported directly after ea oh bombinbo 2° Although the intensity of radiati on is quite low it is measurable vith the very sensitive instruments used ran these measurem onts simple calculations yield the highest radiation intensi ties which were present at any time after the banbln --s f ild tt lso thtj total amount of radiation hioh would have been delivered d rine the whole poriod following the bi 1nb1 ngs lf the highest reading in each city is to an the results of such oaloulations are shown in Table I - - - Authority I JND l' 1 0 UNCLASSIFIED J'iClASSiFifl Tablo Hiroshima Hipiest Reading date Oo4 6 Oot 15 I I ntensi ty t ime b S'ls Tota l Radiation R 0915 60 6 Oo·c 4 5 Nagasaki lo8 26 Sept 45 1230 2 o02 9 Aug 45 l4o2 3 If ' we consider the se i ntensities from a physi olo ical standpoint 0 it is quite obvious t hat the res i dual radiation alone could not have been detrimental to the hoe lth of persons enterin or living in the banbed areas aft er the explosions Although tolei-anoe is oxoeeded slightly tolerance being defined as the amount of radiation a human being oan take day after day indefinitely without i nfl uenc i ng the course of his life or produo l ng esidual or latent etfects 0 t he total amount of radiation is so small and fa lls so r apidly that it i s s oon ineff ective This was confirmed by the fact that no one e ntering t he6e a rea s rter the explosion was found to suffer affects from rad i tion See Section I-D 4 o The measurements perf ormed were in the main for gamma rayso · These are the most penetratl ni tyj e 10 must un ortant from the standpoint of general bodi l y r eact ions Ioasurements of beta rays were also made but were not calibrated because of technical difficulties and inaccuracy in evaluating the r ee dings o Al pha r ay measurements in the fi eld are almost impossible for 'l he same rea sons a nd their biolog ioe l importance in these oonditi on s i s pract ically Xlil No a l pha radiation was found with the pren t liminnry measurements o Th8ll f'ore a fter spot checks were made for beta and alpha r adi ati on whl oh ·were wH hi n the expected limits the gamma radiation was oonoentra ted upon a s t he most pr a ctical measurement i'rcm the technical and physiological viewpoint s Ther e is no possibility that there would be any persistent neutron aot i vity 1- i ECLASSIFIED - I Authority I JND3vjc 0 5ei_ UNCLASSIFIED I Pl Yil CAL DA ' AGE I ll 3 SECTIOM IHo - iii G SAKI Ao Purpose of s ·cud o To observe and rec ord r esidual evidences of physical damage in the bo nbed cities and to evaluate these observations in relation to physiological effe cts Bo Methodso Army ene i ers and civilian physicists i both oities_ observed photogra phed a nd c- llocted s pec imens for later tes·tso Statistico as to the number of buildinc s and types of construction were obtai nedo In the main P the physical damage will be reported u mer separate cover but the effects of blust 9 flying debris pTimary and secondary fires and shielding from radiation are important from the c suality viewpolnto Co - Resultso 1° iones o various degrees of damage with an oxplanation of the type of damag are shown for the two cities in the attached maps Figo I Hiroshima Figo II Nagasakio 2° The destruction of buildings and houses in Nagasaki is shown in table I oompiled by Naeasaki V unicipalityo TABLE I Bestruction of Buildings and Houses in Na asaki Number · Total in Nagaoaki before bombing - Blasted not burned Blasted and burned Blasted and or burned Partia lly burned or blasted Total building and houses dest royed or damaged Undamaged 50 000 2 652 11 494 14 146 5 441 Percent 1000 5 3 23 o0 28o3 l0o9 19 687 39 2 30 413 60 8 3 The folloWing observations on the effects of the type of buildings on the oasualties were obtainedo Wooden buildings A very large portion of buildine s severely damaged by blast were of wood c onstruction with tile roofs typioal of Japanese arohiteoture Nearly all of these buildings near the center of the blasts p incipally dwellings and 6mall factories collapsed and burned Casualties sustained by occupants of such buildings were mainly fran aeoond ry oonoussion effects such as flying misslee and f lling walls and from tires o Even though these buildings were of very light construction persona in them were protected fran the effects of infra-red and ultraviolet rays unless they were situated in front of open windows or doorways On the other hand peraons standing in the open t as great a distance a ---» Authority I JND¥1c o--SS _ 0 as 3 kilometers from the oell ter of the explosion received 11 rlash burns t o thei r exposed skino Very litt le shielding from high energy radi ation ve s provided by t his t ype of house however Also in periphery' of t he damaged a reas 0 secondary fires in these wooden houE ie5 were eas ily aet by overturned charcoal stoves short oircuited ' elaotrical wiring 0 and direct spread of the oonflagrationo b Masonrl buil in s brick and stoneLo A few small factory buildiq s were of this type of constru c· iono- Nearly all of them situated in the blasted areas were collapsed and the occupants of suoh buildings suffer ed from injuries of the same natu re a s did tl ose in wooden type dwellinr s o These walls ·a lthough thicker t han the wo·odon f ra nes · did not prcte t appreciably f rom gamma and immediat e neutron radiationo Oo ruotural steel frame buildings with corrugated iron or Al asbestos roof' am Bidin o This• type of bu ildi n 0 housed most of t he workers W in larse factories a Near the cezrtor of tho bl t L the frames were twisted and bent a few were collapsed but the heavier f'rwnes were only sli htly injured o Injuries to occupants 111ere almost the same a s with wooden buildine a exoept that f ewer were tota lly crushed and burnedo do Reenforced concrete build ineso While dama e to bulldin s wi th heavily reanforced concrete frames vas severe the frames t hemse lves were not destroyed and consequently suoh build ings did not collapse Although lethal casualties were l ess in this type of bui ldi ne seriouG in• jury wa s sustalned by occupants from t he effects of fallin0 false ceiline s and missl cs of metal wood metal- lath plaster ard g lasso This was the only type of structure which per se offered effeotive shielding aGO lnst gamma radiationo Shielding a a lnst lethal amounts of am 11a radi ation was offected by ceilings and vra 11 of reonforced oonorete inches t hick at a distance of 1 2 Kmo from the center while p rsons in adjoining buil dings with corrugated iron or asbestos roofs and oeilines were definitely injured Walls and ceilings of oncrate 4 inohes thiok provided affecti ahielding at a distarioe of lo75 Ml o from the center Persons in suoh buildin s standing in exposed situati ns were injured by the direct effects of l ong and short wave length radiations The interior of these bulldings were almost a ll canpletely burned out fran secondary fires 0 6 7 Do Discussion Although the physical da a e effects of the two cities and their resultant casualt ies were generally enormous and similar there are sane differences hat are important to emphasize l'he aroo dest roy d and the tot l casualties suffered were greater in Hlroshlma than in Nagasaki Reasons for this are the fol lowing lo The bombing point or tar 6ot at a irvshi oa was in the center of the oi ty whl oh was geographically situated on a vtide f l at dolta o The point of 1 mpact at Nagasaki was l n the canter of a narrow valley ECLASSIFIED - A uthority I JN D 1Ci 005S_ UNCLASSIFIED 2o Hiroshima was canposed mainly of Japanese type housos of rooden oonstruction The area bombed at l ae e saki contained larr e steel factory buildings and concrete buildings of modern c onstruction 3o Just previous to the bombi g of Hiroshima plans were being made for the evacuation of unnecessary persons The day of the bombi 40 000 extra people vrare broui ht into the center of the tovm for instructions on these evacuation plan so One 1eok bafora the bombing of Nasnsaki 11 uch plans for the evac ation of unneoessary persons had been carried out and the population in the bombed areas had been reduced o SUM t ARY The primary purposes of tho atomic bomb imreatibating roup sent to Japan by the Manhattan Engineer District were l To prot ot occupation forces fran exposure to radi ation if any significant quantities of radioactivity persisted after tho ato ' 'li c bombings of Hiroshima and Nagasaki by 2 To i nvesti te t he Japanese reports tha t people were bein harmed lasting effects of the bombings and 3 To gath9r information and date om ao The existence if any of per sistent r adioactivity bo The biological effects of the atomic bombs and General factors concerning physical da age al j c sualty estimates insofar as they r elated to the above Co · The answers to the questions involved are presented i n this preliminary repor to This ohief' oonolusions f'ran it are l No harmful amounts of persistent radioactivity were present arter the explosion as determined by ao Measurements of the intensity of radioactivity a t the time of the investigation and - bo Failure to find any olinical evidence of persons harmed by ersistent radioaotivityo 2 The erfeots of the at nic bombs on human beincs were of two main types a Burns and other physioal ef 'ects expected from lare e-scale ex plosions but exceptional in regard to t he large area l4o3 square kilaneters over which they exterded and in regard to an unusual type or burn due chiefl y to infra-red radiation b Oelayed effects which indicated effects fr n rediation 3 The ef'feoto fran radiation were due to ins·bo nta neous dischar e of radiation and not to persistent ra dioactivityo The opinions expressed in this prelimin ry report are not in a y sense 1'1ml For the aost part they represent fairly unanimous opini ons of those who took part in the investi ation The final results will be derived from a detailed analysis of this data obtained - - - -DECLASSIFIED A uthority f JN D ¥1 c $S_ 1 r · - · _ _ Appsndi x I Report II 2 In juri es Produced z Atomic Naga saki John J Flick Ma jor M C r - - -DECLASSIFIED J uthority I Jrv D ¥1 c O $S_ Bombin_g UNCLASSIFIED At the time of the visit to the atanic bombod reas at lliroshim a and Nagasaki for the purpose of makinG a casualty study it was anticipated that some pathologic chane es ·1 0uld lie fountl i l he e 1eo of those survivors who were near the site of the expldsiono It was kno m tha t a larGe a mount of light was produced by the explosion and it cou ld be a ssu111ad that so ne detectable dama e to the tissues of the eye might resulto To tho present date 6 uctober 1945 no primary damage to the ocular structures has been observed that could be interpreted as the resu lt of irradiation of any sorto The pre sident of the Haga saki Medical College Dr Yamane who himself died two weeks after the explosion frcm irradiation s ick ness is said to have treated a nunber of patients with purulent conjunctiv itis occurring 3 or 4 days after t he blast and lasting a bout a week These leslons e 11 resolved and did not involve the cornea or leave e ny permanent sequelaeo No bacteria were found in _the discharge No evidence of such a dise se was found by us and no patient questioned by us ga 1e a history of such a diseaseo A number of patients with flash burns of the face who must have been fa cine the explodine bC7 lb were exa nined under a mydriatic at one of t he hospitals in liiroshllll9 No opacities were seen in the lens and no chan es v1ere present in the conjunctivao The flash burns seemed to s re the eyelids in m uny instances as if the tight closure of the eyes had occurred quic idy enough to hide that area of skino Scme pationts were seen who had lost their lashes a lthou h epilation of the eyebrows was rare 0 • Lesions arising frcm the secondary effects of the explosion are di vided into three groups mechanical injury thermal injury and irradiation injuryo Lesions caused by mechanical factors differed in no way from those produoed by other a gents of' war fare such a s bu llets fra ents and shellso Among those noted wer e penetrating injuries of the e lobe leucome of the cornea traumatic cataract various deformities including ectropion ankyloblepharon S Ylllblapharon detach ent of the retina and various syndromes involying fracture of the s kull o r r i4l ls vi' the oony orbit Many a lbulatory casualties were seen on ' the streets wearing eye patcheso Flash burns _were pi nented and assumed a coppery ooloro There were large numbers of patients ' ho exhibited extensive facial burns of the ordinary type with much dense cicatrix These burns in sane instances had involved the conjunctiva and cornea to such an extent that the rad lacrimatine eyeball had only slight niQve nent and seemed set in a dense ·mass of contracting scaro Lesions associated with irradiation effects were limited to the retlna o They consisted of hemorrhage and exudation Of he patients ex hibitine these retinal lesions 0 '75 per cent had one or mare of the other clinical signs of irradiation or 37 patients whose leukocyte counts war ava lableo 28 or 75°7 per cent ave figures at so ne time of 4 9 000 per cubic centimeter or below Histories takan of oatients presenting eye lesions numbered 460 comprising 42 from the I-la gas ki area and 4 from the Hiroshima areao There were 23 patients un l er 25 y ears of a ge and 23 patients· over 25 years of age Of the four cli nical sir ns found be typical of radiation 0 0 to -- - -DECLASSIFIEi --A utbority UNCU SSIF1£D reaction namelyg petechiae g5 nr ivi'ci s 3 an ina a nd @pllation the c roup u nder 25 yoars of a ze 11 d a n av6ra ' e of 1 52 wh ile ·the rou p over 25 had an a vera e of 1 22 a dif't'erenna of bout 20' per cant o This tends to throw l ight on the rel ationship of a e to sensitivity to ga ll 'Tla irre diationo All of the patients in this study wer e wi thin 2 k i lomet e r s of the conter o f t he exp losiono Of 41 patients wf1ere t he i nf or mation c ould be ol lt a ined » only 8 or 19 o 5 per cent were outside of a building at the · time of the bl ast In these it nust be assumed that some int e r vening absorpti v e mater i a l ioe o concrete must have protected the n fr om 'Tl la ay dosages t ha t woul d ce r tai n l y otherwi se have caused them t o di e before our i nvestigation s begano Be cause of this unknown a nount o f s hie l d ing i Z any z iven ca se# it appears t hat a correlation of the distanc es f rom t he explosion with t he quality a nd i n t ensity of the pathologic effects i s i mpos sible to comput e in s pite of the fac t t hat doses recelved through the a i r by persons at e qual distanc es were proba bly the same o It i s evident t hen tha t in the case of a ny gi ve n pa t i ent at t he t ime of our investig a tion we knew only that he had received a dose of 5 rradia t i on thto t was either subletha l f or h im or lethal with a longer la tent period than other cases had s i'Jown under similar circums t ances As not ed in s ome of t 1 3 ca u l l stor-it1s st1ri al leukocyte counts mad e by the Japane se before our arrival i ndicat e that t he d e 2th of leukocyte depres sion pr obably took place near the f irst week i n Sept em ber in the patient s aliv e and ave ilabl e for our clinlcal appraisal a t the t ime t his survey wa s mad e The l eukoc yte c ounts record ed on the patients hav-e n o c orre l a tive valu e with the eye l esi ons and indicate si n ly the predaninanc_e of l e ukopenia in t hese insta 1ces The lesions observed in this disease appeared in the retina l t issu es and were limited to that structure and to the nerve fibre layer a s i t overlay t he nerve head o The hemorrhages were of f'our types In order of frequency tr ere were fla 1 e hemorrhage pre retinal h8 11orr hage 0 Roth type hemorrhages and vi t1·eous hemorrhe ge 0 F'lane hemorrhace of course is situated in the norve f i bre layer of the re na t i s caus ed by the ruptur e of cap illQries in that layer and the infiltration of cellular blood e l ements between the nerve fibres These · lesion s were very numerous 0 beint saan in 25 or 64 0 3% of the patients They were nearly always situated c lose to the nerve head never farther than 3 disc diameters dis tant Some of the flame hemorrha es were very dense and had a deep mar oon color whi le others were a very pale red only sli5 1tly dar ker tha n the uninvolved retinal tiss ue and underlyi ch oroido 0 T e te in fla r ie hemorrhage 1' is usGd ln this study to refer only to those lesions in which the reflexes from t ho internal limiting membrane re vealed no c 1anr e in leve l as the y passed over the lesion The location in the ner e f2 bre layer was often strikingly de nonstratod by the extension of the lesion continuously onto the diso itsolfo Sane f these took the form of narrow splinter shapes often toin s i tuated parallel to and very close to a large vesselo Pre-retinal hemorrha e occurred in 11 or 23 o of the patients These seemed to be a gross d velopment of the flame hemorrhage in which the - D ECLASSIF A uthority IVND $S__ I NCLASSIFIED j DECLASSIFIED 1 Authority I JN D ¥1 o6$5 blood had leaked into the subhyaloid space producing an elevated rounded hematana immediately adjacent t o but not inva ding the vitreouso These lesions were often quite large see drawin g and ha d straight line 'borders due to sedimentation of the red cells o The surf a ce of the hematoma was smooth and convex as determined by the char a ct er of the reflexo The gra nular appe rance of these masses of blood was a t t r i bute d to clotting which ma y have taken place The distin u s ll li v 'cl aLlo copi c f ea tures of these lesions were their extremel y s harp margi n and t he tendency ·to form hori zontal# straight-edged upper mar gins The serum 'o f the blood could be dimly seen above the stre i ht edge and was usuall y clear enough so t hat underlying retinal vessels could be seen A rather unique type of he norri - i a ge was observed in this studyo It resembled n othinG so much as a Roth spot except that it us l a rger o These lesions were noted especially in 4 or 80 6% of the pat ientso They wer e l reer · tall than most flam a hemor rhages u nd were e b1ost invar i ably seen overl yine a large Wartery a branch of the f'irst order The portion toward the disc v ras smoothly and shar ply outlined while that away f ran t he disc was brush- like o The color wa s deep maroon a nd t he lesion s howed elevat ion of the retina l surface Somewhere on the lesion usually i n the di st a l por t ion was an irregularly round whi t e a rea about - t of the dia net e r of the lesion i tsel f 0 see drawi ng o The pathogenesis of t he se spot s co ld be made out f rom a study of the hemorrha ge forming in a ssoc i a tlon with exudates vid e infra o Vitr eous hemor rhage was not ed i n two 1nstanceso Th er e was an i nfil tration of the vitr eous body i t s e lf by bloud which ha d burst throu gh the hyaloido The view of the f'undus was a l way s more or less obs cured in t his t_ype of hemorrhaeeo Exudation into the retina was a most c omr11 on finding in these patie nts 30 or 6602% 0 They took the for m of round snow white 0 slightly eleva ted A lesions always within 3 disc diamet ers of the d isc its elf and were -sometimes _extremely numerous 40 or 50 bein seen in a s i ngle eyegroundo The spots were scattered in r andom fa s hion ver t he ool a r zone of the retina without any reference to blood vessels In s i uo vf thE pi t ient s however o it was noted occasionally a lesion situated near a n artery would s h ow a i'ine fringe of hemorrhage about its borders particu l a r l y i ts pe riphe ral or distal bordero Some were seen in which this hemor rha e became ltlr ce a nd came to s urround the exudate Th is led us to believe t ha t such a he1 ior r h ge about a n ex udate could de-gelop into a he norr bar e of t he so called Rot h t ype des cr ibed a boveo The mor phologic variat i ons noted in the se exudatos were rat her mar ked o The most com on type WD s as descr i bed round and smoot hl y e levated wit h a f eather • ed mar gin irxiicating t ha t it was a n i nvolvement of _the zone of the neural f i bre Elongated forms were also seen and a peculiar zig- zag f or ma tion in which the extension in l engt h was i n a direction pe rpendioular to t he direct i on of the ner ve fibres composing the l e sion Also in the se t he area of exudat i on would be not everywher e equidist ant fr om t he d i sc producin a Z sha ped figureo In some cases this developm0nt becwne so marked th at these exudates formed one or more rings or wreathes partia lly s urrounding the diso o Subsequent observa ti m of the les i ons showed the ir border s heooming sharper a s they a bsorb i n cont ra st to a hem1Jr rhage i n whi ch t he bor ders 0 became mor e i rd e£in ite a nd irrog le r e bs ogr••··uNCIA SlflED as - A ' ' v_ tu n -· •i •b J residue of an old exudate is a s nall waxy yellowish sharply outlined placque associated with several much smaller sntelli te spotso In some instances rather large sharply outlined greyish speckled areas were seen surroundine a large arteryo These could very well represent residual atrophy from absor tlon of one of the larger hem orrhages o No changes were observed i n the optic discs nor were any pathologic changes noted in the vessels themselves • Genera lized retina l ede na was a very com on accompaniment of he orrru ges a nd exudates so that if edema was present a search for local l e sions was pursued mor0 i ntensivelyo DECLASSIFJfil --Autbority DECLASSIFIED Authority f JN D 'l'4 00 $5 Case Noo 1 22 foma le o Thia patient s dress ed in a blue one piece suit with long trousers and r etas no cap and 'Was in the 1litsubishi Weapons F'e ctoryl l kilometer from the center of the explosion inside a concrete buildingo She suffered no bur ns or woundso One hour after the explosion she vomited The nausea continued for 2 or 3 days with loss of e ppeti te Beginning 13 August there were frequent stools without blood Un 26 Au ust# t h e hair beea n to fa ll Throughout the entire first week of Septanber ahe had s ore bleeding gums 9 nose bleedsD and fever with tons illitis Since 15 September she had com plained of poor vi sion in the right eye ·- The le st menstrual per iod was on 4 August9 after which there was no blo d ing until 25 Septe Tlber when bleeding commenced and had continued unaba ted to the present 2 October o On 24 Septemberg the leukocyte count wus 8 9 600 and the sedir ie t tion rate was 50 for the first hour end 64 for the sec und hour On 14 September• ophtha lmos copic exa nination was done arrl the f'ollowinr descrip·cion re corded Exa inination of the ocu le r fu ndus of the right eye reveals an appre ciable amount of ra ti lal edema enerlll ly and particu lur l y pronounced around the macular region The veins and ertaries are full and of good color There are no pathologic· changes in t h e r ptic di sc In the ri ht foveal re ion is a deep red pre-re•l inal h emorrha r e 4 DD in size and laterally ova l in shapeo The lesion shows marked bulgine into the vitreous o nd the bordex-s are very sharply defined i1 bova t s 1 1 verJ w uci1 lw-e ar thouig1 similar lesiono about 3 DD in size This lesion is elavatod a nd the lower margin is very shar p The upper margin is hor i zonta lly s tra ie 1t The lesion is situated 1 2 DD frcm the papi lla Scattered about in the intervening retina are numerous small fla e-shaped hemorrhages am several white fluffy elevated · exudates particularly on the nasa l side The left fundus shows no hemorrhage but numerous exudates of t he soft white type A On 5 October the following note was made There is a l ar e pre 'W retiml hemorrhar e a bove the right macula 2 1-DD in size There is little evidence of absorption of this les ion The pre-retinal hemorrhage in the f veal r e i on shows a moth-eaten appearance of the upper temporal margin in d1cating some absor ption Also it shows a gr eyish center One small fresh exudate with no evidence of hemorrhap e around it C Case Noo 280 See dr awing 22 male Admitted 9 August 1945 Patient vm s at the Ohashi Arms Factory 1 200 meters f r om the center Bleeding of the gums be an 13 Se tember The fa lling of hair began l t u gust and bei n to grow back 15 September • There was fever a nd black diarrhea the first week i n Se ter 1ber and tho patient volunteered that when e ate hard r ice his stool v a s oft but when he took soft r i ce hi s stool was hard He suffered no urns on 26 September the leukocyte count was 3 0 0000 Ophthal 'lloscopic exa ' llination on 2 7 September revealed in the right eye many small exudates soattered in the form of a wreathe around the disc no hemorrhageo In the l e ft eye t nere was forr iation of exudates as i n the right and in addition a large fl ame he n x-rha ge in t he lower nasal quadrant close to the dlsc o On 6 October the exudate s a ppoarod unchanr ed a nd the hemorrhage i n t he l e ft ret i ne e Jou 1• t t o be b vs vr olui 0 I DECLASSIFIED Authority NN D lg o65S NCIJiSSIFIEli Case Noo 29 43 female Patient had been standing outside the Arms Factory at the time of explosion She was wearing a black kimono with trousers She received burns of the left face left neck and rizht hand Fal ling of the hair be gan 16 August Patient h d scxne genital bleeding 14 August none sinceo On 23 August the leukocyte count v as 8CO r ed count 4 04 hemoglobin 55% and color index 0068 On 12 September the leukocyte count was 4p300 Ophthalmosoopic examination on 27 Sept ember revealed the ri ht vitreous to be cloudy with two small soft white exucl a tes below the right disc In the la rt eye many small soft v hi te e ucl1 i l 1 cJi ware 6t J1m ono of which had a frinr e of hemorrhace about it On 5 October there were no leslons seen in the right eye and the vitreous was clear The l eft showed numerous absorbing hemorrhages of the lower fundus but no exudate Case Uo 30 18 fema le ·Patient was admitted on 9 August At the ti e of the explosion she was in a wooden house at the Ohash i Fa ctory Sha wore a khaki coatD white shirt and blue trousers She suffered cuts by glass and burns of the right forearm and wristo She states that at t he time of t he oxplosion she v ra s blinded and could not see for t hree days On 15 August she be gan to rufi a fever up to 40 degrees c and the cuts she had received which had partially healed becarne infected She had sore bleeding e ums dur ing the first waek in September for one week a lso a sor e throat naus ea and much waterine of the moutho The leukocyte count was 3a000 on 26 September Ophthalmosoopio examination on 27 September revealed in th9 right eye many whmD elevated radia lly striated exudates up to 3 DD f'rom the disc with one flame he norrhage and retinal edemao In the left eye there were exudates es in the ri ht with several fine splinter-like hemorrl ges On 5 October no hemorrhages were seen in the r ight eye but three small exudat es ware present in the upper nasal quadrant In the left eye one small Z shaped exudate was s een retinal edema was much improved Case No 3lo 18 maleo Patient was at Urakami i n a wooden h ouse 800 meters from the center of the explosion The upper half of the body was naked the lower half covered with a blanket He recelvod lr r ns on t hts i'ti oe right chest right arm and hand On l September he suffered an infecti on of the righ n-ist with much swelling On 26 Septem ber the l eukocyte count was 21 600 On 27 September one small he orrhage of the Roth type was seen in the left lower f tndus On 5 October no fundus lesions cruld be found o Case Noo 32 0 25 femaleo Patient was near Mitsubishi Vmr Plant and was woundod in the falling buildingo She wore black trou sers half sleeved white blue-striped shirt At the time of the explosion she was 3 months pre nant Abortion occurred on l September She received multiple wounds by glass Her gums bled for 6 days beginnine 20 September On 20 far te'llier the leukocyte count was UNCLASSIFIED 5 Case Noo 350 59 maleo Admitted 26 Septe her 194 5 0 having received burns on face with bruises and cuts lie wore thin white coveralls He had a period of unconsciousness on the we y to the hospital l t the time of the explosion he had been 400 meters west of the Ohashi Arms Factory or at a distance of 1 D200 me'cers from the center of the explosion Ue had suffered from weakness and ringing in the ears sir e the explosion For a period of one month prior to ad llissidn to the huspital he had been sufferine from sore bleeding gumso From 25 August 1945 to 3 Septe aber 1945 he h d had fever which ranged as high as 41 degrees C He had had some acute chest pa i esociated with breathine o There V s a large slough involvinr all the soft tissue of the anterior one- third of' the hard palate On 1 September the sedimentation rate wa s 84 the first hour and 136 t he sec nd hour the leuk ocyte count at that time was 7 2000 On 27 September ophthalraoscopic examination under a_ ull pupilla y dilation _revealed many son white exudates cattered about • in both fund1 and a splinter-shaped flame he norrhage extending onto the right disco Re exarnina tion on 5 October showed no exudates in the rie ht eye The splinter hemorrhat e w s smaller There was a smal l exudate temporal to the left disco Case No 360 23s male The patient was at the iitsubishi i eaoons Factory in n wood building at a distance of 2 kilometers He was dressed in a soldier's uniformo He r ceived no burns but suffered minor cuts and abrasions ubout the right side of the face scalp right elbo both forearms and ri 6ht side of chest Ile had a sore throat and nose bleeds for about two days about 8 September On 21 September the sedimentation rate was 115 for the first hour and 146 for the second hour The leukocyte count at that time was 7 200 Ophthalmosoopio examination on 27 September revealed one small flame hemorrhae e On re-exami nation on 5 October no f'undus lesions could be i'ound-o - Case Noo 370 31 male Patient was at the Mitsubishi Arms Fa ctory9 inside dressed in all white clothes sittin down at the time of the explosion Had suffered frcm weakness fever and fallin ' hair since 17 Sept ember and also had a sore throat during tmt timeo The rums had been sore and bleeding since 4 September H receive no burns only minor wounds at the time the ex- plosion During the first week in September his skin was covered with petech1ae On 26 September the sedimentation rate -as 142 for the first hour and 16 for the second hour The leukocyte count at that time was 7 000o On 27 September many flame hernorrhages pre- retina l hemorrhages and exudates were found o On 5 October the followinl note was mt1 de Hemorrhages vory numerous in both fundi both flame and pre- etl nalo Thero are a few exudates There are several Roth type spots related to the left inferior te nporal arterro There is one exudate just temporal to the rir ht dlsc There are two large pre-retinal hemorrhages one related to euci of tu tt mporo l branches of the right fundUSo and 1 - - -DECLASSIFIED Authority NND ¥1c $Ci_ f' UNCLASSIFIED Case Noo 380 34 0 f e a l e o Pa tient had been i nslde a wood en house a'c a d i stance of l o5 k i l o me t ers at the time of expl osion She vms b lrefooted and wore a b l a ok s hirt s h ort s l eeves lon t rousers anc she rece iv ed burns of the left k lee arm for eann a nd ha nd There wore minor wounds of t he head face and backo · She hu s had more or l e ss b lood r d ia rrh a ever since t he ex losiono She had not me nst ruated s i 11 e t he da y be f or e the explosion 11er hai r h s be en fa l ling since 22 Au r ust The sedir 1C 1t · 1 r utt 1 OLl 21 t iptomber was 131 for t he fi rst h our and 160 f'or the second hour 'f he J eukqcy t e count at that t ime was 2 000 Opn cha l noscopi c e xa 1 ir atioil on 2 7 September r evealed hemorrhage e nd exudates Another e7 amination on 5 October revealed one exudate nasal to the left d i s c and a n a r ea of a b s orbed her ior rhage a r ound the pr oximal part of t he s uper ior nasal a rtery No le s i ons we r e seen i n t he rleht fundus o Cas e No o 390 e 49i male Ad nit t ed 10 August B 15 o Ha had been at the Oha shi Weapon Factor y 1 200 met e rs from the c enter of the exp l osi onp s tanding out side wea ring whi t a a hi rt P green t r ous ers and gaite rs He suffer ed burns of t he f ore ar lls le t s ide of face end ne ck lie a l so sustai lad a f r act ure of the l e f t patella Sinc e the ex9 J osi oni h e h ad had tv10 attack s of tons i llit i s and fever up to 39 degrees c On 5 September petech i ae appeared on h i s l oft thi gho li'ran 23 Augu s t t i ll 10 September he had profuse falling of ho i re Since 2 2 Augusti he had had sorep b l eed i ng 6 UlllS• The f ollowing is a table of serial b l ood estima t i o is 6 SeE_ - 8 Se 10 Sept 13 Se e3 16 Se pt 20 SeEt 24 Seet RBC WBC 3 o7 3 o3 500 2 7 2 2' 2 2 2 6 600 3400 Co Ind Bl Time Clo Ti me Oo89 700 1100 s½ Oo9l 0 9 1 2 l oO 10 3 15 3 ol4 3 o0 3000 0 96 5 5 UBG 657 12 3 16 7 3 16 12 3 15 3600 0 96 6 3 ol 4 60o9% 55% 48% 50' 1a 587 5Wo Ophtha lmos c opic exnmi na t5 on o u 2 7 Octobttr revealed many exudat e s On 5 Oct ober P no hemorrha es were seeno An exudate vi t h sharp borders indi oatlni a bsorption was seen in the upper temporal quadra nt of the r ieht eye and below the disc in the l e ft a noth er swiilar lesion was pre sento s ca_ttered over both r etinae a lso fla me he aorrha es a nd Rot h spotso Case Noo 40 42 male Admitted 9 August 1945 At the time of t he explo s i on he was sitt i n g naked to t he waist and wearin ' khaki trousers i nside a wooden buildin at the Ohashi foa pons Faotory 1 200 meters from' t he center of the explosion He had been suffer 1 np from s ore bleeding mms and his hair he d been f a lli ng 'since 13 August 1945 He ca n la ined of 6 8 loss of heari ng in the left ear o Ophthalmoscopio e ta rn ination 2 7 September reveal ed 'll8 rJY e xuda t es in both 'undi but no he norrhag e on 5 vctobe r 1945 the exudates were sti ll pres ent but were smaller and more waxy with sharper borders and exhibit lng tiny satellite spots as if tho absorntion in t hose areas was not canpleteo These changes we re seen in both fundi - D ECLASSIFIED Authority f JND ¥300 ss_ 2 9 5000 On 27 September many exudat6s and flt UT10 and pre-retinal hemorrha as we r e found On 5 Oct obe r» the right eye showed a le rz e pre-retinal hemor rha ge below r elated to the r i ght inf' arior te nporal bra ich of the art eria centre liso There was a l so a l arge bu lging pre-retinal lesions medial t he d i sco There wer e a f ew exudates in the u pper· portion of the fundus o The left f'undus a ppeared the mirror imo ge of the right ·w ith two large pre-retinal he mor r h age sp one above and one belowo No exud ates were saeno to Case Noa 33 • 30 female o Pa tient was i n e wooden Japanese house wearing a one-pieoe c overallo She was 500 meters f'rcm the center of tho ex- losiono She vo nited f l ve or six times on the day of the expl osion On 9 September hair began to fall o On 20 Septembero t he leukocyte c·ount was 2 0 4000 Pre mature menses occurred on 12 August 11 a nd las ted three daya o 1'here has been no genital b l eedi ne since - - 2 ctob r On 27 September 9 ' the only ophtnalmoscopic les on was a broad 11 t hin pl nK1s h 0 f l ame hemorrhe e e in the upper tern pore 1 re ion of che l eft funduso There were no lesi ono in the right fundus o On 5 October t he appearance of the lesion was the swne o ECLASSIFIED -I Authority I JND f100$S_ s UNCLASSIFIED Appendix II - Report I b Effect t 11 _ IDffilosion 9 t Y Atomic Bomb 2 l the Human Body Jlasoa Shiotsuld Omura Naval Hospital lO Septsmber 1945 f ranalated by David Fukuda treatsd a nr mbor of 'pati nts bro1 1i ht co the ·Unura Naval HospltG 1 ho ware inju -ed by ·che o to nic bomb dr opped on N'lga s 1 ki on g Augus_ '45 u I reulfat d th i t ct e unusual effects c li iica L and otherv i soD conJ d rwt bo solely the result of meoh ani ca l f orces and t herma radiat i on tr i t o lso of incred i bly str ong r adiat ion of another type I prosum Jd that when htonic disi ltegration occu rred r a dia ti on v1hioh might he ' re important e f'f'e ts on the hUI11an body could be produced I hv ve a ccord inr l Y et duv n my 01 servations ree ard iug ' he affects l At the time t ia t the oomb was droppad 0 I was in the clinic as usual treating pr tieDt s fhe 9th of Aucu t was a bright sunny day and thera tia i been n o rain for seyer - l d e yso Suddenly J saw a white flash some-thing like tho -t of burninc ma ne s ium by some su ici to have bean of · a bJ uish yeJ low col'or o X h d b e1 rd that a n unusual type of banb had been drop ped on Hiroshima on the 6th of 1rn ustg Elnd I spent an uneasy 60 secunds until I h ea rci a t hunderous roar D ti s if all of the anti a ircraft uns i n the v icinity ho d gone off at once I then experienced a sensation of pr 3ssur e 1'he pre f SUX e wave broKa many windows in the hospital ost of these we re on the n ortheast sid e of the hos pi te lp the side a1vay from ths bl 1 st Some panes of g lass in interiox- d oors were also broken Jhile hurryi out i ide to till a lr rai d shelter I kept wat ch ing the s' r y for enemy planes su 1 J a l arge wli lte cloud in the sho pe of an opened umbrella with a pink or li ht oran 6 e sho d ow in the inner under part gradut1 l l y spr adlng Below this ·were thx-ea white parachutes drifting eu stward e 11a awaited the all cleo r sit no 1 with peculiarly uneasy f'e line o I 'i gura I shov s the cloud which formed after the explosion of the a tomic bo b It disappeared f orty minutes later Taken _by L'c Hl ra of the Japanese Na vy» Chief of Pharmacy of the Qnura I avul Hosp1 cal fror the rear of the Hosp i tal Site of explosion - • North of Nagasaki at the western end of Ugami about on the center of a line connecting the city cornrnorcia l s chool and the Yambzato Grammar Schoolo Near Ohashi llei ht of explosi on lJistQnce from Uragwni - 500 Mo r'rtJm Naeasaki to the Qnura Ne val llospital is a bout 24 Km This is t he a verage oi fib Ures given by the for t near t he hospitulp Qnura hVi tion Supply Depoto Uragami A rsenul Headquarters of the Regimental Districto ieteorol ogical conditions at noon on 9 August leather Be rornetrio pressure Tempar a ture a ot bulbs Hel humidi t i - -··J ECLAssIFIED Authority r JN D ¥1005S '45s • Clear 76305mm Ugo 28 00 21 00 717 r nr r - t - - · A t·out 60C woun iad 1 st t fonts w -tre sent 'bo tho 1 mu ra Na val Hospital t v mi ebout 0100 10 Atigust o These were trans p orted to Qnure Ru Llroa d ' a tl un by tro i n und fr om ther e to the hosp ital by trucko Tha -- pi Od anci of 1 ho pf l tients on that night was h orrifyingo Their ha i r was b 'rnec t hl i l' cJ othes torn to piecas u nd stained by b l ood anc the n Ke par ts 1mra e 11 burnc·d and inflf l med Their wounds were cont lnd natod by 'ilt 1 anJ 1-rnL0 1g · hem ht • d numerous pieces of g l ass 1 u1d wood proje ctinE f ·ur tho skin of th face and back fany were in s u ch e state that th0y h i -1- wi-ch diffic u lty 1·ecobnized a s human beings 500 Fii ure 2 J bet111een 20 '0 9 u 6l 1f AS can be irnc16 inod it wa an appalling scene of c onfusion Nearly tffn hours hud pasned s ince t ho i njuries had been re coived and in spite of t hei r se vere injur e s the majority of the pa tients were quiet as though in a col l e fsed stat o iany were covered with black blobs w - ich we t firs t thou' -' ht to be coagufo ted blood f rom the ir wounds m i i ot l with s noke fr om tho traln L t er O however we learned thut after t he explosion t here hud been a Blaok re in 11 througho'-4t the cityo The patie n ts were i iven roi tins burn trea t -nent and we finished about 0500 r 10 August ' 4 5 See r'igure 3 26 year old ma le 'founds of the body from ricocheting f'ra rnents of r lEL ss 20 Au gust h e aled discha rgedo Notes Jost of th 1 burns wero of second degree sever i ty and then in ordflr o f frequerwy- 9 3rd degree and 1st d egreeo Burns were l l f re on P£i rts covered by hea vy clothingo Amotll those who he d on CP pe such ao milltnry caps there wos a clear cut lino _o demarkatlon corre sponding t o the lower border of the_ capo The lnJury we s very sl r ht i n parts pro' ected by white clothingo Burns occurr1 id under b uck clothinc t however There were some cloth es in a ma tar ial pe tterned with i - hlte and black stripea o and i n these we f ound linenr burns beneath the black stripeso _' i 10re seemed t o be an unpleasant s-nell associnted with the radia t i on burne Titis odor mixed with thllt of the f ish liver oil used in dreasir g pr oduced a nou rly unbearable 6tenoh ditionu as remembered Fe ctory v1vrkor by pationts r'It wns _j i at after tho all clear signal had been g i ven and wo ha d returned to our ola ce o f wor1 Suddenly a flash occurred I felt ver i1 hot and the roof of the factory oame tumbllng d ovm - hen I recovered conscL t isnesa I wa s beneath the ridge of the roof with smoke and fhune a ll E bout me e How 1 got out 1 don't know l ' otory worker Since r had b een war King the night shift I was sleeping u s taira in m y l od ings with only my trousers on I was netll' an open Wl ndov und suddoniy felt as though a hot wind were blowing on me o l wa s thrown down 11 -- ---DECLASSIFIED A uthority NN D3g 005S_ ' Clork had thcx-Jia l ru dla·cion burns on facag naok chests and both upper 1 3 trom ities o irr i-' as in front of e- vro rehousep r upervi-sing the l oa6ing of e tru ck i felt a s though fire were thrown on me fr Jm overhead r VJe s t hrown t o t '1 e ground rt i- 11 the i thera t Jld si111ilui · 1 d oriGs in d e scribine their axperienco at thG tim0 i t t he tJ ne ue thought that the o tvmic bomb caused a terrJ 'ic 2rer- s ra-•wind ciUO -then an intense burst of thermal radiation which 6 uve rise to the burnso Our traat cnt vras at first based upon this concepto - g e r1t J1• i Ne g a s i k_i Later al August went to Naga sa d to view the dam t i o w ich VIEJS beJond clescriptiono It resemb led closely a pict1ira yubliohed ln the papor of 23 Aur ust entitled niroshbie Ce tastrophelf o d l the build ir J S were crushed Telephone poles were uprootedo r ven rcanforoed concr te bulldini s N ir· e crushed like pa per boxosi but p in ' Onera l masonry bul ldings were s t anding but with the interior ruined as t hou n a 1 itan had been pla yinr thero Leaves of trees on surrounding mov ntbli ns hu d be n scorched up to 8 Km away and it looked ns thou h au' imn had CiX l e Tho local peop le describine the c- indition of t he people inst nt ly killed by the blast told of corpses with eyes torn from their s oc t ets so ne eviscarated soma burned t d ashes tany were bl •Jwn from factory buildings across ·the road and into the river It must have been a dreadful scene Sta ti stice l tudy of 208 Patients Admitt ed to Onura ll'a val Hospltal Situation at the Time of t he xplosion Locatl • Type of Building Reinf'orcad lndoorG Outdoor concrete 147 61 17 Sound of E eloslon Color of r'lash Do mace to Building_ Completely 67 137 191 Ueurd by 187 Partially 4estroyed destroyed Wood Concrete destroyed 4 Not heard by 19 Blue red 57 blue-yellow 20 pale blue white 109 29 Wlci te Position Sittin 113 ata iding 47 lying down 48 Clothing_ i'l hite 7'81 oolorad siiort trousers 12 trousers 112 half clothes Ji othElrs ln Direot Sunlign 76 Original Burns Flash 197 fil•e 11 E _t gree of Burns_i 130 short sleeved shirt and short sleeved s11irt and long naKed 58 one piece women's 25 148 3rd degree 3lo UNCLASSIFIED Location I ndoor s 1 t 1tdoor Cl otd ig Clotnod ' ' Naked Source of In ur l Prima ryi by Bomb Indirectly by Fira r f 6 l JO 97% Te blee · I and II fr x 1 inforr i s tlon fran Lt Co no Nobuhi ta Fukuha ra of the Qnura Na·val Hosp1 tal a 'I'ha dam age i n the clty nee1 1s to have been the greatest where the aun was shining a T d s was ap la rently n ot always the case with human beings pati ents Cond i t ion of Eatlants ·at-1 Rr admission On the n xt dayo 10 AugustD 11 patients were a dmi tted to ward a These were transpor ted by train on the night of the -9th nd· vere tre ted by the E mere ency Cor p a t the l atsumura lUe•ne nttir Y l icho l vm urt o They 1era 1 hen trans ferired here by truck I was a scign ed to tl i6 l J 1' 1 and f rom t 1is time on my observati ons were la n ely confined to these 71 patients Ae un the day beforeo we continued to tre£ t t 1ese pa tients t S ordinary burns Patients 1·n t h burns of the o tiro bod f and ones severely wounded by flyln fra nents died in two or three days 1 Died 0500• 11 Fa ctory vrorkor • me le 4 5 yea rs old Au eus t fir ure 4 Exrunples 1iounds over entire body 0 2 ° Student femal e• 19 yea rs old iound s of' both lower extremities v ri t h oo isiden ble hen 1orhae e Died 1040 11 Augusto 3° Student female t 1 e unknown Flash burns of faoe both uppor extromitie backp lght knee 5 and right thigh Died 0500 12 August 4° aotory workera male 29 years oldo Flash burns of faoe and both upper ext remities dounds of bacK wid bot 1 thibhs by flt ing fragments of glass Died 1510 12 AUGUSto FiGure 5 5° Clerlto male 30 yours old extremities Died 2105 12 J ugust He ah burns on back and both upper 6 Fuyoko J r fl4i houi ewifo 41 years old She reoei 7ed flash burns on face tlOO both upper extroml ties contusions and abrasions of both lower extremi tiet J t the tio e of the ex Jloslon she wus nearly in the middle J 1- b mao hi ta sa i i• wr ich is a·bot tt 300 from Ohashio ThlB is about 500 M fr om the vert ical descent point or within 750 i of the explosion in direct line UNCLASSIFIED - DECLASSIFIED Authority NN D Mc $S_ UNCU SlfIE Jit the ti io or a dm u iLu 1 hc t d e te11 pez• ture of 39 0 CD dysentery ike dle x-rhea and in h9r po·dID er ti on a'Lout t ho mouth with a n musue l odor o On the mornlns of l -S 1 ur• 1 - t o l lyc rn i ht s1 1udenly failcdo Koernir 1 s 1Ji i1 ankle clor u 3 3 p lv s und opistrwtonuo 2 plus were notedo Spinal uuncture revealed ·che oerehro n nal fluid t o be tur bid and admixed · wl th dark red bloodo 2atie 1t d ted -i i 700r l4 ugusto Shortly a fter d eati1 nenropsy was p0rfor 11ed Tile usual fi11ding was petechiae of the mucou aenbrc ncs of the inte t inal tract o eapaota lly the rectum9 varyi11g i n size from 'ch t of e grain of rice to a beano In patient Number l th re ero a lso chunGe found at the point of branchi ng of the anterior ind midd le cerebr1il arter ios 0 and also at a brartoh of the posterior cerebral •te l 'y ncJi r t he f'u si for a gyru s of the right te1 poral lobe At these points were clots uei•e h eiaiorrhae s had occv rred 1e '- hc-ught that these rteA lal ruptures may h vo bee 1 ti1e result of i nflam nati on from lodgement of e nbolio s - cond l ry ' o hl ta' ine intox ication from the burns They may have btien purely ol tro umu t 'c orie i ng or other mechani-sms may have been r esponsibl eo the piH muter and alfw in the brain substance are blobclike spots -the slza of a millet seed v1hl h sh uw a -tendency to become a g lutinated into raa ssei s the she of the tlp of the little flnr -ero These resemble the spots we see on tl- e pia in epilepsy u On 1 Factory worker 9 19 year s old ma le Had flash burns of the ri ght upper extremity nd left lower extremity H e was dischaq ed- 15 August 0 after his burns had hou led According to information which we secured later 0 h e becruno ill 1 1 bout t uo we 1ks after his disohe ri e with sympto ns of fevero l oss of a ppetite fa tigue 0 loss of hair of the soalpo Ile developed petechiael a mucoid diarrhea and diod 0 80 tsu ro Ikeip female 17 years oldo She was within 1150 M of t he oentero She received f lash b rns of the left upper extremity She had f ever up to 40°0 Cg loss of a ' poti t o o herpetiform eruption about the mouth cerebral sympt r ns a nd disturbances of eyesight Patechiae which appeared fi rst Of th arms and legs on 11 A ugust became e enerallied on 14 August and ranged in size frorn that o f' a grain of rice to thut of the thumb A blood c ount done on the afternoon of 14 Au ust chowed Erythrocytes lo5M leucocytes 300 lib 3'7%a She died 1630 on 16 Augusto The spinal fluid was similar to th t in Casa 5 0 Necropsy was performed shortly after deatho t The positive firldi •1 s wex-e petechiue the size of a rice grain thr oughout the aliment ry traot Other chan es were a s beforog that iso hemorrhage in the left posterior oorti on of the cerebellum in the vicinity of the posterior inferlor cerebellar a rtery The spots on the pia previously me ntioned were aloo seen in sevoral pl ces 9o Male ti ge not stated o lie suffered from a contus·ion of the ocrotumo Starting on the 11th he begun to have fever The ontusion was a bout l om i n diameter with prn ctioa lly no bleedln o On 14 August he began to los his hair in patchos The ind i vidual hairs could be pulled out without resist inOf lo On 16 J ugust peteohiae b'9ge n to appear and als the peculiar eruption bou t the mouth lie died at 0016 on 16 augusta 0 - - -··oECLASSIFIED Authority N D M c OS5 UNCLASSIFIED 'l'i u-0e r wre pat5 ents Ghov o- ea pl l J t- on i l tl t no herpot iform oruption e7ar developEid s -es c 1ing 4 0 to 41 C at the time of dee tho o bout the mouth These e lao shewed petachiaa a nu th J ysentory Hke ditu rheu c The so patients were tretted by tr1 1 nsfusions of 100 to 200 cc of blood L nd the parenteral udJ1ini6tr tJ on of Vitad n b comp l x and Vitamin Co 5 n trav· - wus glucose a nd liver e tracto ·r e pati ents ot worse i n spite of t r eatment The f ac-c tn i t pti tien' s •J i-th relat ive ly s liEht 'founds and burns showed the 1r o t severe s_ymptom5 is worthy of note K t tr1is t i n o en another ward v 9 rd 12 L ther e wus a fe ua le patiento Chi1 uko Yamada a e t mknown 0 with a brl-ls i QnS of the left arr i and chest and a contusion or the hip She developed herpesD h ir los sg fever and numerous petechiaeo She died 20 i ugusto Necropsy was perfor 11ed o Flndin s --- The body is 't l 'c of a femule corpse of avera r e size show ing noderate emaci tiono Both corneas are cloudy and the pui ils contractedo There i s no swelling of the superfic ial lymph nodes of the bodyo Crusted herpetic l es i on s are present a bout the l i ps The oral mucosa has a gray c oatingo The s ubcutaneous fat is moderately v ell devalopado Post m or-l em lividity is present in t he dependent portions hicor mortis is present throu houto The l eft dam of the diaphrt1gm r eacheo 'the level of tho left sixth rib the right diaphragm is at the level of the f ifth rie ht interspace Xn the pericardial sac are 15 co o f str2'lw 0olored • clear• fhid The cardiao ch1mbers are filled w1 th · liquid and clottad blood The heart is slightly en larged The r i ght l ung is bound dovm by eas ily separated f ibrinous ad hesions it is blue-viol et in color a id is tilled with blood and air The left l un is of similar appear ance except foA t he absence of adhes ionso the thymus shows de enerati on and is atrop hled to t he si ze of t he little finger The peritone is shiney and light yello V in oo lor The liver measures Oxl8x7 cm o• and weighs 1160 Gmo with the ea ll bladder 1t is partially adherent to the diaphra r no The color is dar purplish-rod The surface i s smooth but t iere is a torn area on the po st erior s urf£1ce of the righ'i lobe lOxO 3 cm The torn surface is yellowish tci reddish-brown in color nd t he hepatic lobules can be dist inotly ma de out St001 aoh A portion ls adherent to the spleen a nd pancreas It is abJut no l in slzeo The mucosa i s qu Lte hyperemic t1 nd shows numerous pe techlae t contains bile-stained viscous materialo Gall bladder s Size of a he 's eG • txterlor is los y Contains about 10 co of yellowishgreen bile upleon Purplish red in oolor The surfaoe is Glllooth and glossy except for a tear 4 om l ong by o 5 cm deep running horizonta_ll ' across the cent r The fol licles are not pro ninento Pancreas Of a pink color The cut surface i s gra✓• i cinio are disti iotly visible Kidneys Both light eddish purple in color The capsule st5ips easily The line of demarcat10n between medull a and cortex is clear o The kidney pelves are of normal oa p1 1 city The small intestine and colon a r·e murkedly hypare nic and - on the serous surfaces are petechiae varying in size from tha t of a · grain of rioe to h t of a pea On the mucosa re many ulcerated areas varying in size 'rom thut of' a rice gra in to tht t of a red bean In the large bowel there are patches in rows or ar borizing patterns covered with grayillh membrane which can be reu d ily str ipped away revealing a h 1 Peremio base in the si noid nd rect but not in the rest of the oolon° 0 0 0 Todaohi Kusumoto a patient on ward 6 wus admitted on 25 Augusto He was a 14 year ol d male student who had been l Ml from the fiasho lie had no burns or woundso he oorapl 1 1 ined that in the pai t few days he had had fever -- - -oicLAss1Frnn j utbority 1NO t1o6$5 UNClASSifiED JCU SSIFIED a nd lo sEl of hair o 0n tile mor--iinr r 25 Au l 1 t he had fever of 40o4 C pulse 0 1400 He died t·1e sw ie l lQr- · Lnc o The f ollo ing notes were made at t he time of acbis sl m nTl- EJ putient io of a bout o v era e size and developme nto 'J ho nutr itivn is ra ther poor The bod temperature is 40 4 C and the pulse 140 Pv _ i llar y react i r s l -1 c ish The lower lip is eroded and partly crusted 'Ihe 15 ps ure swolle n The sub na xillary nodes 1 1 re enlarged to the size of t he t er rn i m l phal a 1 --t 0 ' t he index 'i i er a nd are tendtiro The tongue is drJ and covered v ith a br own co l to l he phar ngeo l mucoua is redciened o The tons ls aro covered with w ilte exudate Ther e are petechia e over t ho ent i re ody- ocalp hair is completely_lost ·There is cardiac palpit1 t i on Breath sound s a re harsh 'I'he liver can be fcl'c 3 cmo below the c os ta l m r g l no The splee n is not palpable 11o Findi i s at aut opsy • ·• The body i s t ha t uf a midd le-siz ed ma le The nutriti on is quit e poor The cornen a r s lightly cloudedo Pupils are moderately d i lated The ora l mucosa i s of' a gra yish color Ton ue is heavily coat ed ·The teeth aro carious t he e ums necrotic a nd covered wi th exudate r·at cou l d t a i ound i n eve1•y joint Post nortam lividity is present iri the dependent portions 'rhere are numerous pataohia e of tha s 1dn from the size o f a millet seed to t ha t of' a r ed bean The hair is noteworthy in thlit it pulls out v e r eas i l y so t hat l a rge a mounts c xne away when touched with the wet ha ndo The diaphra e matic d omes a re at the level of the fifth r ib on both the right and t he l eft There are a dh e s ions betwaan the visceral e nd parietal pleura especially on the r ight sid eo Th e pericardium was smooth and glistening and contai ned 20 c c o clear serous fluid The peritoneum was elistening and did no'c appoar abnormal The liver was stroni5ly adherent to the dia phrar n° Ha e r t No abnormali tles except a few petechiae on the epi ce rdiu n o Lungs L lle d with bl ood a nd· air A fev petechi1 1 a beneath the viGceral pleur o · Liver Surfaca lossy dark p rplish redo The cut surface a ppears e ssentially normul thoUi Jl t he liver l obales are rather indistincto Spleen Dark purpl i sh-red Cu t surface appears normnlo Follicles indistincto Hieh-1 kidney Surface pur lish-red and glossyo The cut s urface i s norm l with a clear line of de arcation between cortex and medulla Ther e a r e a f ew pet e chiae under the kidney ce peula The renal pelvls ls nur mal o Left kirlney SL 1ilar to ri3ht exoept for the presence of clots in t he pe lvi s Panoreas Rather smallo The aoini ure d istinctly visible on t he cut sur face Stomach No abnonnalities except petechiae on the mucosa Bladder Normal mucous membrane -Intestine PortionB are hyper emic _petechia e are numerouso Colon Numerous petechiae Esophagus Num ro s po techiae Diaphragn Petechiaa under the par'ie l pleura of the r1gh v lea f Pia mater Blob- like areas - the size of a millet s eed• Brain Cut surf ace s h ows no abnormalities 0 ·le did 10 a utopsies up t o 31 Aur st epilation Bight of these patients had In general poteohlal spot s were numer ua in the internal organso --··»ECLASSIFIED Authority rvND30o0 $S UNCLASSIFIED UNCLASSIFIED ' • lo Dist '5 b1 1· 1· n o f' pt tfl 11 6 lH Fr_ m oso _ hagu · o re t r m • • 9•••••o•o• • •no o••• •• •3 oases I 1 1 n te tine on 1 - f o o • • • • a- o o o • • o o o o o o • • • o • • Q 6 cases q of ov E· p n rectum only • ••• ••• • • • • • •• • • 2 of e 'bov0 n olon only o• ••••••••••••• •• •• 2 In sp1aon o idneJ•·p etco • •••• • e • • • • • • • • • • • • • • • • 8 ir brain ori 1 yo oo ci•a e •• •• oc- •a• oo•o - •• oooo•·••o•l ca es casaa cases case 2 i l1ite s loughs in alimentary canf l oo•••••••••••••••3 cases 3 iemorrha0e from ressels at base of brain •••••• • •• 6 cases 4 huptured v sce r-a liv r •••• ••• ••• •• •• 0 spl ien •• 0 0 0 • • • 0 0 0 lung •••••••• • ••••• • •••• 0 ••••• 0 0 II O O • Q 0•••••••••••3 oases u 2 oases O O O O O O 0 0 Q •• 0 0 0 •••••••••••••••••••••••• 2 cases Noteworthy f eatures Three cases with sloughs of the intestinal mucosa nad similar l esions of tho oral mucosa Six cases ha d the small cyr- ts between the pia and brain 1mrfaco similar to t hose seen in epilepsyo Cha ng es in the bone marr ow anti oth6r blood forming organs wero not studi edo The illnesses rosultin fr1 m the atom i c bombln of Nagasaki exceptinG thos e killed utri ght as rcvious ly described can ba ·classified j n several ra ti1er well-defined groups 1 2o 3 Burns •founds fran d'ebris hurled about by the blast wave Cases with tiemorrhagio diathesis · a those wl th dysenter r-like s i t s startini shortly af'ter tho boa bing b those with syro pto ne startinr after a latent periodo The cause of the 3rd grou is presumubly radiation 6 iven off by atomic dis integrationo Incubation period Tt is seems to be inversely proportional to the distance from -the centero Por exampJ e Patient 6 Ois noe less than 750 A symptans appeared the same do yo Patient 8 ' Distance 750 1i SJ Tl ptoms a pea red the- same day Patient 12 About 1000 sympto s appeared 4 de ya later 6 other similar cu se- Patient fr om ward 6 Distance about lOOU to 1500 M symptoms appeared 10 days latero u These date are derived from 25 out of -t he 768 cases adrni tted da ta is available on this poin t 1 1c the time of writing -j - ·DECLASSIFIED Authority f JND ¥' iOO SS_ No further UNCLASSIFIED L mo·i o nat lo _ · footo · r c re ived no wounds nd · ere quite well i'lllnediato y after th0 a'ctackt d 1veloped oyin7Jtorns of fa t ie u ep anore-xia and h ir h fever evan to 40 Co id tth time swelllnr and tenderness of the cervical lyr -1ph nc-Jss l-i ppearec in mo --y tO ethsr wi th s ore throat and hoarsene ss 0 1 or two dayr lat r ' t1 0r a Jpanred dis rrhea with a watery muc oid bloody stool Ha i at Vil1 aprY11 i redu Alo ecia bege n to deva lop 0 s preading from J' ints of piythea d siz o Then _ o'cechiae d ve l oped over the entire body and simultau ously bleeding rran the mo uth and L2IIIS and e pistax iso any developed an 1 mus ial harpetirorm erupt i on around t he mouth a s death draw near ·the e re bec imos c e ngrenout r nd the 'etor be comes marked No cardiac d lstl rbances wore aeon except o dr p in blood pre s s ure in t ho termina l stage 1 lany de vel1Jped s rnpta us of a termina l pneumonia r lany complained of stomo ch e che j it t '1e6e dld not alwa ys ha ve vcmi tinr Ascari s was present in mo t Ter nina 11 r central · ne1·vous system sy n• toms appeared with l oss of vision inability t o count fin ers e t 30 cm 1'hose who showed no central nervou s y-stem symptoms remained rnenta lly clear even termine llyj in spite o f severe nv r i a ana nigh fever Ar ong thuse whose ivound s had been hea l ing we l s the granul tions grudually became gangrenous and f oul smelling 'r he sl tes of needle punct ures also became infect ed and ne crotic Laboratury findings On e m 'lin t· on o t t e nrine a lbur in and urobilinogen were fo md Blood findi g s RBC 1 0 to 2 0 11 'BC 200 t o 500 ilb 30 t o 5oiio Bleeding t i me 20 minutos· to 2 hours or more Thr oueh0ut a smearg only one or two l eucocytes mi e ht b e seen These were all lymphocytes f 'evor gradually became Jti -he 1• and r oa ohed o maximum t ennl nallyj dropping s li ht ly at deat h Plat V 0 During the prodromal peri od bullae var ying in s ize frvm n thumbprint to a hon's e gg app ared in var ious places The 0e be c o np rabl e to xoentcen ray erythemas or may be t he result of r ad loaotive materLal a dherent to the skin o Progn osis up to 10 September Dia nosi fortality 100%• Presents no difficultieso Treatment • l Intravenous adcrlnietra t ion of 20% glucose nixed with Vitami n B Co nplex and Vitamin c 0 2° Blood tranttfusions of l00-2J0 cc at ona time 3 Liver extract 0 No special benefit wa noted from ny therapy r iveno Postscript The distance £ran the source seems unbelievably great for the se efi'ects to have been t he result of exposure to radiation from radloe ctive matariala uowever t he magnitude of the radia tion effects may _ be far greater than anything previo sly conceived of in the science of rad10logy Amont the f'oresaid 758 cases admitted to t his hospital there were onl y 3 oases of tetanus This is q1 i te remarA ble when we consider conditions I - -D ECLASSIFIED A uthority f JND ¥' iOO SS _ UNCLASSIFIED At si·ca of i n ury ·J ner-ofors i n suppo t t ile f'unct i m ten 01 1 es autopsiod m nt wou·l d h iva l e 3 nunt ca 1 be 3 iver t c nd t nc conl 0 i on of th a tra i uJ a nd for trans ortatjono troat i 1- - r 0s0 rr tienti i l ts' ink i t bes·t to atte mpt to d ' tbe · 16 o - f n•ming organs lioweve r in six out of t hsr • re -o le al ens in t he pie mater for lhi ch this t r-eat of n• tl V1 1 L b final tatement as to the ideal trea ti his tble Pla ce 6 0 Pethmt 81 female 17 years olda Augu ll Aug 10 180 - JA O Aug n 14 Au 13 Aug 15 41-v - -co- - --- -t•v--------t------- ♦---- -- --- -- 60 Aue o 12 ' 40 ------- ··---- _vA --- - 7 39 - - - -- C -- ------- -·------ -------•---- - Temp_o · ✓ ' g 120 38v-- -- _ --·---- -----ir------- i --- -c- 100 37 1l' --- - --- ··-··----v------•· --------o •------- ♦ ---- Pul e 'a J t I r ••·----·--•--·•- --- ------- -------- 0 ------- ------ Died ln30 • UNCLASSIFIED -- - - -DECLASSIFIED Authority NN D ¥1 c 05S ·NU ASS Flf 1 Appendix II - Report II Researoh 2 i1 Symptoms Caused ----- El_ the Atomio Bao b Professor Toichiro Sawada Committee September r-- DECLASSIFIED Authority NN D¥'i 0055 28g 1946 UNCLASSIFIED llNCL4SSIFIED Ao Effect on the human system of those wi10 were a t tha scene of disaster o On August 31 9 in fr ont of t he Nagasaki Jedioa l University wa were able to l ocate nine persons wh o were not victims of the explosionD but who came here a fterwards and have been living i n self - lle ds huts about 500 eters fran the center of the explos i ono _So e of these people r ushed down to Nagasaki f r oo such distant places as hikoku a nd Kyoto-Prefecturao carefully selected only those of whaa we had reasone bl0 assurance of t heir not having been exposed to tha explosion Tho l auc ocyte c ount of these people was taken see Table I o Tasts r evealed 1 iw t the lowest Vias 4400D th e highe st 8200D and the uvere ge 655Uo •e For ·cunparisonD we f ound ten persons who v ere in Nagasaki or its vi cinity at the ti o of the explosl on and have since been living near the soe r e of disastero - ve have a l s o taken their leucocyte counts The results are as s hown i n Table Il the lowest 3000 the highest 7320 and the averag i650 A comparison of the t wo averages showed the form er in the 6000' s and the latter in the 4000' s 'in lei • i1 smaller tounts but we ' ere unable to determine any physical differences between the two groups o From those results we have obtained a general impression that unless a person is directly exposed to the explosion no physical d sor ders of any imp rt develop even if he doe s live at t ho soeno of disaster a fterwards o Later we examined the leuoooytes of those people who have remai ed at or passed throu h this a rea as members of relief and restora tion partieso Table III shows the results of t he examination to date In almost all oases the leucocyte count is close t o normal and no physical d isorders have come to our attention 0 - 0 and Looking into the aforesaid results we found oases of fatigue diarrhea wnong people who were not' v ict ims of the explosion g but who _h ad been living at the scene of the disaster afterward so The pati ents sus pected that these symptans were caused by radioactive substances ·r emaining at the scene of disaster and they also feared thti t heir lauoooyte count bad decr eased but re-examination of these people showed t ho t their leuoooyte count was absolutely normal rt is • impossible for us to conclude that such aforementloned S Y Ilptoms s fatigue and diarrhea were caused by the aotions of rad l oacti ve substances remaining at the scene of disastero It is perhaps more proper to say that the causes of t hese symptoms were fran overwork neglect of health or neuropathyo Bo -ture of the symptoms caused by the at l nio bomb en t he effects of the atomic bomb on the h DOAn system are analyzed th8Y can be classified into the following three types -- -··DECLASSIFIED Authority I JND3'4c O SS 1 UNCLASSIFIED 11 lo leohanical ei'i'ects 11 Possibly external wounds cat ' socl by flJing objects falling debris etc Caused by thei ble st LiterallyD exploaion wind 2o Burns ceused by ·the hoat waves lld ulti-e v ole·c re yso 3o Effects caused by a great a nount of rad ioactiv e r ey o The mechanical effects caused by the blast are similar t o those caused by ·ordinary bombso Burns caused by heat nre si l ilar to thoso caused by it1oendiary bombsD but burns oau5ed by ultra -vio et ruys i1ave a specio l tra it of healing rather rapidly It can be said -chat the reactions ca used by radioacti ve rays are special feuture6 of 'c e a o io bomb For i 3-_stanoa 9 -ii people are taken ill seve a l w e G after tho e ploJ on and the d ea n rate --W is very high F'rom the viewpo1nt of internal medic me they are spec A a l symptoms and should be classified separately c symptoms caussd by the atomic bon1bo In looki ng xnto the symptoms cauoed by the atcmic b b one should always keep in mind that they are symptoms causod by a gre1 t a mount of various radioactive rays to the hu ma n s rstem It is by these rays t hat the various oel a in the human system are affeoted and t he degree of damage depends lar ely upon the sensi ·t ivity of these cell8 ° ' l 'he maematopoietic cells and the penorative cells are considered most sensitiveo It ls also belioved -chE t t he cells of the various internal oq ans and internal 5 ecret i on or hns are also affected -e Judging trcm the internal sytnptoma to be c iscussed later it is believed that the medullary tissues are maiiily afi' e cted In order t o verifY this fact aspiration of the bone mari·ow has been pGrformed on many patients to study the medullary cells The result of the txamiootion showed that the oells were severely affeotedo The normal percentaGe of orythroblasta is l g but aocording to IV in Matsuda's case for example it is OJ and n Jurata's case The hematoblasts are also o · The norm al peroonta ges of leucobla vt and leuoo ytes are 69 8' o but they have decree sad to l6o 5 in Matsude 8 ce Ge and to 5 ' in 1ura ta ' B oaseo Praotically no change oocurrod in tho ly lph corpuscles Tho re- ticular oells and adipose oells are normallJ abJ t 1% but in Jatsuda 's oase it _increased to 63 'o and in t iurata's cas0· t6 fiuo6%u Theee _faots shov that the bone m r r ov tissues wa1·e sevorely affeot ed and is evidently _due to pa omyelophthisi lor ac re nulooytosis w uoh 1e a colillllon clinio41 term o t is bet i evoc h t t i 'eirod fun Jt I on of - - -DECLASSIFIED Authority Y N D ¥1 c $9 z5biFr UNCLASSIFIED the bone marrow are the ohief cau ses for the symptoms caused by the atomic bomb'o The histological e inatl on of a pieoa of bune marrow has also pr oved these faots o C 0 Clinical Syn1ptomso This Medical Relief Party has diagnosed a nd observed a bout 400 patients at the Shi nkozen Nat i onal School in NaGasaki during a period of' two weeks fran September l to September 140 Table V shows the dates on which tho S'IJ ryto ns occurred Among them the most ·frequent ly complai ned of sy1 ipto11 s fever which is follow-ad by ep$lation_ anemia_ hoadaoheD sys-ce nic fatigue etco i n t hat order of frequency 0 Durine the first week the inost complained of s Jm9toms were nauaea 28 cases out of 32 _ vomiting 23 oases out of 25 auorexia 16 Oeises out of 23 and he daohe 17 oases out of 44 Symptoms such as ilause vomiting systemic fatigue and headache are be l ieved to be caused directly by being exposed to the rad ioa ctive rays Besides these symptansD fever 12 oases out of 70 systemio fa tie ue 7 oa sas out of 35 and diarrhea 6 cases out of 35 also occurred during the f irst week Table V shows that fever epil1 1 tion11 spotted hemorrhage of the skin a nernia 11 systemio fatigue sore t hroe ti tonsillitis odontalgie maoulas on the skin etomatitis and ioterus occurred most often during the f ourth we ek than during e ny other pr eced ing week Among these fever epllation hemorrhage_ sore throat a nd stum atitis should be considered as chief s ymptoms which deve l oped in the late st dium 11 rid with the exceptlon of epil a tion these are conaidered as symptoms of bone marrov consumption These symptoms and blood changes indicating symptans of bone marrow oonsurnption developed in most patients about three or four wee ics after the xplosion Table VI has been prepared by classifying the reactinns caused by radioactiv rays into early and late stadia and also by examining the patients wno were within 3 kmo from the center of the oxplosiono Of the 169 patient examined 27o2% showed absolutely no sign of i llness while the majority 72 8% had sane s_ymptans o ' which more than half occurred in tne early stadium Epilation hemorrhage spotted hemorrhage of the skin gincival • hemorrhage intes inal hemorrha e and e pistaxia 1 stanatitis and fever are considered the chief syinpt0ms which developed in tho late stadiumo Table VII shows the relati onship of these s tnptans to the distance fran the center of th0 explosion° The relatively smnlJ percentaga of thesG s_ymptom s Within 0 5 Jan rad us is perhaps because iost victims in that area died wlthin a short perioel of time after the exl' losion The larr est poroentai e of the 68 symptoms is found between the 1 0 to 1 5 Ian redlus but beyond 2 0 lan• radius there is a marked decline a few exceptional cases occurred beyond 4 o km In other words those who v reire taken ill up to September 14 were ch e ly persons who were 1 ithln lo5 kmo fr® the center of the explosion while only a few were taken ill h lyond a distance of 2 0 km --A utbority --vECLAss ss ___ tv LL D J _ _ -4- -- UNCLASSlfl D· This coincides with the fact that the completely destroyed ar eas i n Nagasaki -w re within lo6 lane to 2o0 kmo f rQn the center of the axplosiono -- Examination of the leucooytes revealed that a sharp decrease of the1n occurred in many patientso Table VI II has bean prepared for the purpose of determining whether the leucooyte oount wil l return to normal or i ot with the lapse of timeo Aocoi•ding to this Table D pa tients with leucocyte counts below 1000 durin the irst period 9 1 - 9 4 c e to 2506% the se ond period' 9 5 9 9 8o2 and the third period 9 10 9 13 only 209700 As a result or these changes patients with leuc ocyte counts of 5000 to 6000 i n the second period increased t o 23 '17 9 and duri ng the tM rd period 17 51 of the patients had counts of 6000 to aoco rt is therefore evident that the lost leucocytes are radually replaced with the lapse of timao 0 Table IX is an observat ion or these changes in r e lution to the distance from the center of the explosi ono Fr om Sept ember l to 4 per ons who -vere close to the center or explosion within l km show a remarkable decrease· in their leucocyta count but the far t her the dist nce the loss conspicuous is the decr ease The leuc ocyte count or many patients who wer e about 3 kmo f r om the cent er of the expl osion especially was al nost cl e to normalo This relationship ·beoa e more distinct with the lapse of t ime For instance from September '10 to l3p even am one those who ware close to the center 0 £ the exp losion those who suffered from leuoopenia became fewo Among normal IB- tients whose leucocyte count was returning t o normal some even had a oount exceeding the avera e number of 80000 This fact was especially noticeable Q llong those who were within the rad ius of 3 lan Thor$ were aotually ore persons with an increase of leucooytes The changes in t he erythocyte count are shown in Table Xo During the early part of September there were relatively few pat ients wit h a noticeable decrease i n the erythrocyte count -a nd most of them mai ntained the normal number of 4 million to 5 milllono However as t i ne went by a gradual decrease in the number of erythrooytes becwne evid nt Durlng the period fran September 10 to 13 34 o6fa of the patients had a count of 3 million or below This indicates that contrary to ' the increase in the leuoooyte count the er ythrocyte count decreases Clinically this coinci des wi th the f'a ct that man y patients have recently developed anemia Furthe nn ore due to the recent increase of l euoooytes myeloblasts a ld medullary cells wer e found in the blood and oa es whi ch showed medu llary reaotions were notioed The change of the hedOGlobln tho decrease of hemetoblast arui the delay of bleeding time wore also nptlcod Alb 11D in in the w-ine was detected in•a £aw oases Durin the early part of September many patients had positive urobi l inogen in t heir urine whioh indioo ted def ecti ve functioning of their liverp but this condition gradually disappear ed other clinical reoorts will be made available on soma other oooasion t 0 £Rl C UNCLASSIFIED DECLASSIFIED Authority rvrv D ¥1 c O Svj Do Prognosis Among the main symptoms which dev·elop in the late stadiumo the more • serious the degree 0£ fever epilatlon pru i ryn itis a nd hemorrhe ge of the s kin the poorer the prognosis but s ome patients with ser ous main symptcxJs are gradually recovering after bei ng considered hopeloss I t is nlso true that the greater the decrease of leucocytes the more serious is the condition or the patient ·but in some cases patiGnts with a leuoocyte count of 1000 or below have reooveredo In generalo the earlier the symptoms develop or the shor'l er the latent period the poorer the pro nosis the lon er t he l atent period the better t he prognosis iVhether o not the patients hud external wounds or burns these symptoms developed several weeks after the explosiono Tnose who overworked themselves instead of remaining quiet when no abnormal symptans -- eveloped at first re the ones who later deve loped SJ'Illptoms and in many Wases the prognosis is bad o It i$ very reasonable to say that the death rate is proportionate -to the extent of axp su e o radioactive rays while the exten or exposure to radioactive rays is n 1nverse ratio to the square of the d1stanoe from the center of the explosl on Therefore the closer a oerson is to the center of the explosion the earlier the symptoms develop wii i ch a lso exj lai s the high death r te am the closer a person is to the canter of t he expl osion the easier it is for him to receive external wounds ar d burns o 13 ny people have died from hese oauaeso Xhus 0 it is very difficult t o c npile accurate st tistios o Moreover n o persons may be at an equal distance fran the center or the explosiono but it is important to take into nocount the extent of cover whether they _w re under oovcr or not which further complico tes the whole situationo An invest igat ion ls being held on these matters at present • • o tedioal Treatment It is_needlesa to say that compl ete r est 9 nutriti on and a supply o Vitamins are portant Besides these 1 believe the injection of grape sugar la very effeotl Ve o F'rarn our experience occasional blood transfus ions for aerious anemia patients have invitorated thei r fee lings or revived t heir spirits and the roeults have been gooclo Si nce _the liver oonto ins hormone that reacts to the blood-ma ki ng action of the medull 9 we have used it at every opportunityp the _r esults seem to be goodo We have in our internal medicine de artinent about 38 patients with a ptans caused by the atomio bomb A fh are oe tieri ts with the combina tion of 1igh 'ever epilation9 spottedm orr 'e o the skin e nd pharyne itiso Who were considered hopeless in t he ear•ly part f Sopte mber • but inost of them are recovering after application of the treatmonts entioned above Only three deaths ooourred Judgment ae to the efflcliloy of the t reat nt o n #ii t s -i i4 s_ rJ dUNCLAsslflED DECLASSIFIED Authority rvl 1 o ¥1 $5 TABLE I The Leuoocyte Count of those Living in the Cantor of the Bombed Area Not in the area at the time of the bombing Name Sex Leucooytes Age I female 18 Ogawa female 32 6 260 'l'akubO male 39 7 800 KanaY8 male 39 5 460 Tajima male 21 E chi female 20 5 460 L 6 660 Takeshita male a ooo Mitsuta ke male 37 4 400 Kubo male 44 s soo Si 550 Averag_e TABLE II The Leuoocyte Count of those Living in the Banbed Canter victim Name Se it lioshika Age Leuoooytes mal e 14 4 720 Inao male 38 5 100 Okabe male 21 4 400 Hs me da female 30 3 200 Yashillla male 42 s tjso iabuohi female 30 11asezaki mnle 33 otsulal male 63 ua tsuo male 63 - -- A'9'erae o I 3 000 · 3 000 - 5 200 7 20 4 650 · ---· ---- - --- --- - ·U11CLASSIFIED TABLE III The Leucocyte Count of the lernbers of t he Kyushu University Relief Party Remained at the Soene of Dia1 s·ter fran Aui 14 to 23rd • Name Sex ·male 25 7 p300 Kur ok1 male -24 60400 Sawa me le 25 5 0800 Morimoto male 36 5s 700 Watanabe male 30 5 600 'l'a kagishi mal 26 s aoo Naka _ J·1ma male 27 Nagao male 25 male 25 611100 male 24 1 aoo Ikeda me le 25 8 200 ula ruoka male 25 5 500 Okazo ki male 26 7 000 Noda Average A utborit ' Leucocytes Inouye I Fukushi e · - _ ASSIFIED --- o ECL Age ' I I - s ouo 5 800 6 440 UNCLASSlflED Microscopic anal 1a ia of t he - e rrow Af f lioted with Symp-co ns Caused by t he At omic Bo nb Normal Percent a ge iCnd l 0f Megalo last - I I I ' Macroblast Er hroblast Oo1% 0 13 '1 11' 0 ct 0 r t SUd e Murata f or a J aoanese Ce 11a 2o9 - l9oo% 16 0 II 0 - Neutr ophil post myolocyto leuoocytes Neutr ophil Staff f orm nuo lus Lobulated Nucleus leuoooytes i ri' 0 m l i'1 - I I 0 Eoainophil oa lls Basoohil cell ct 0 s II '1 0 e Fattl GI 0 3 8% 3 o5 4 o5 69% 605% 0 lo5% loO 6%' lo6 l o6 0 1606 Oo5 0 20o2· - loO r 4 o2 0 Oo3 0 I 3 01% 0 2 0 16 8 ' D Phaa ooY tic 2o0 506% 708 1 Lym pb oorpusoles Plasinatio 0 l o8% So l onoc' t8 Lvmohoid 4o0 60 Neutrophil myelocyte 0 j Ool% Neutroohil pr emyelocyte Oo5% 0 Hematobla st Myeloblast 0% I I I ABOUT 1 o% o l 6 % 22o5% 4 o5fo 0 6% 28o5% l 5 5oo% a a% 5 00% 6006 1 o% Celle whloh are di f fioul to classify Total --Non- nuole ted oell non• nuolea t ed cells E'uo ieated oelle 46 roo- 100% 21 5o UNCU SSIFIED_ • TABLE V Symptoms of the skin 51 4 Anemia 46 44 35 2o 3o Spott ed Hemorrhage Epilati on _ Bee daohe systemic Fatigue Gingival Hemorrhage I lause l So 9o 10 u so re throat Tom illi tis Vom iting 12 Diarrhea 130 Dropsy 14 16 16 17 18 19 Anorexia Vertigo O J ootal gia HafMll turia cule Tinnitus Epista ds 20 2lo · stOJ l9 0h o ohe 22 stano titie • Ioterue cone ipation 26 vVeek 12 Fever 60 let Patients 70 69 lo 4o Tot al No of H ematemesis cnest e ohe Dyspnoea LUnt uloer 28 270 280 290 Ranoptys is 30 tnaannia 31 Hard of hearing 32ci Drivel 33 Frequent urination 34 Blood etool 360 Aouth uloer 360 1'ln aciation - 33 32 31 27 25 25 23 23 15 13 10 9 6 6 4 4 4 3 2 2 2 6 4th 'ileek · 10 36 31 7 7 15 8 4 8 22 27 16 ll 12 l 3 2 4 4 17 12 l l l 2 12 4 6 2 '14 6 l 2 13 l 6 3 3 4 5 2 4 5 6 20 10 l 17 7 3 28 2 '23 6 2 1 l 15 3 2 l 4 3 2 2 l 6th Yeek 7 3 13 9 7 9 1 l l 3 3 3 l l 1 1 l 1 2 2 l l l l 1 l l 5th Week 3rd I leek 2nd Y61ek 1 l 2 l l i l 1 l 1 UNCLASSIFIED -----DE J _utborit ' TABLE VI No of' PeoEle Those who developed symp toms only in early stadium Those who developed symptome only in late stadium Those who developed symp toms in the late as well as the early stadium Those who did not develop symptoms in the early or late stadium % 16 9o5 48 2'8 4 59 34o9 46 21 2 169 lOOoO 00 Total 'lti BLE VII Oo6 l m 0 I 5 - 2o0 - a o 4o0 4o·l over % Towns Distanoe Shiro a Ya mazatoD Takao Mezamel Uragami 0 higesat0 0 Sakamotoo 'l'akenokubo Ohashi Zeniz Rishizaka Ina sal uruna Saiwai Nagasaki Station Mizunoura Showa _ - - - j ECLASSIFIED Authority D ¥1 SS iradokoya t fotohara o 01 12 llo3 43 40 6 30 32 5 4o 3 9o4 3 o4 2 l 9 10 --TABLE VIII Leuoocyte Count No of Peiop1 s % ·--O 1000 13 12 3 1001 2000 15 l4a2 2001 - 3000 24 22 0 6 3001 4000 14 1 2 4001 - 5000 8 5001 - 6000 l 3 l 2Q3 10000 12 11 3 7 6 6 106 100 0 6001 0 Over 10 000 Total 7 5 UNCLASSIFIED I TABLE VIlI Leuoocyto Count - %- No of PsopJ s 0 - 1000 13 12 3 1001 2000 15 l 4o2 2001 3000 24 2i o 6 3001 4000 14 1 2 4001 - 5000 8 7 o5 5001 '6000 l 3 12 3 6001 10000 12 11 3 7 6 6 over 10 000 Total 106 • 100 0 UNCLASSlFIED - ----- ssIFIED pEC hi j utbOrl•J --- c 0s__ - I TABLE IX a o l • b bl I 2000 Below 3000 8 I 6 4 2 I • l J l 2506 I k s 2 I I I '-- I Below Below Below 4000 Below Below 5000 6000 8000 10000 6 4 8 1 2 Ovir 100000 - • C Tota' 39 · - 2 I b b Below r ' 1000 Bel ow- 3 I 3 8 I l 4 l - i o3 9o 3 4a 6 1 2 2 1 3 l 6 I 2 I 2 7 8 I I 2 l l I 3 6 4 13 9 9 3 5 11 l 5 ·4 5 6 6 1806 I I ' ·l I 2 03 9 4 2 I l l I ·35 I 3· 26 C 2 2 ' l 3 2 19 19 6 6 15 802 7 2 802 10 l0o3 110 2 4 6 5 3 5 4 6 7 42 l l 3 9 ·2 3 2 3 2 25 2 l ·2 1 11 9 9 5 48 4 7 6 4 15 10 5 56 3 l 1 4 5 9 5 3 2 9 DECLASSIFIED Authority f JN D¥100 - - - --- - l 15 808 22 l2 o9 16 l6o5 22 l2o9 23 23o 7 ' 21 12 3 30 l7 o5 5 2 l l O 97 28 16 4 4 3 19 llol 1'11 I DECLASSIFIED Authority rVrvD ¥1c C 5E TABLE X Sept l- -4 White corpuscles Dista n-- Under l I 2000 5000 9 45% 7 l ol - 2o0 5 37% 6 ol ca 4 o0 2 3o% 0 O loO Km Under 7000 Under I Under 8000 - 2 10 o 2 lo% 4 27% 0 4 40 1o 4 40 o 35% I40fo r I Sep o5 •9 4 28% 3 21% 6 37% 2 14 lal - 2 0 10 23J' 20 47% 10 23% 3 7% 2ol - 4o0 1 61 7 33% 12 57% l 5% 2 J 4 8 68% 'b l oO Km - Sept 10-13 - 0 l oO -l al • 2 0 -2 1 4 0 0 - Km l 7% 3 21J 8 10 40 so% I 19 24% 13 16% l 2% 13 22 j 12 20' 32 56% I TABLE XI Number o f Rad Blood Corpuscles i Date Below 2 milo I Septo l Below Below Be low over 3 mil o 4 mil o 5 milo 5 mll o 'l'otaJ 7 32 3 - 12 10 l 2 3 3 4 0 l 2 6 12 30 0% 1205% I I I 40 0 · l7oS 22 8 l 11 16 l 42 12 6 6 l l 4 22 3 6 I 9 I l l lol% I 11 12 o5f 1 4 s% I 4 40 l 3 'I i -1 I 4 0 1 16 5 7 8 ' ·i 1 I 30 3400% I 2 5 5oS n I 13 88 I ' l 10 l I 11 12 t--el 3 8 7 4 3 13 l 2 18 3 13 17 17 14- 801% 12 2606% 10 20oi 18 34 5% 5 49 l 0o2 UNCLASSIFIED -- -- - 1 A uthority rvND ¥1 0