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Encounter With Disaster

Encounter With Disaster

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THE
YALE
JOURNAL
OFBIOLOGY
AND
MEDICINE
56
(1983),
23-38
Encounter
with
Disaster:
A
Medical
Diary
of
Hiroshima,
1945
AVERILL
A.
LIEBOW
Dr.
Liebow
was
Professor
of
Pathology
at
Yale
from
1946
through
1968.
Thereafter
he
was
Professor
of
Pathology
at
theUniversity
of
California,
San
Diego,
untilhis
death
in
1978.
Condensed
from
the
original
publication,
The
Yale
Journal
of
Biology
and
Medicine
38:
61-239,
1965
The
effects
of
the
atomic
bomb
dropped
on
Hiroshima
andNagasaki
in
1945
are
described.
Immediately
after
the
bombing,
Japanese
civilian
and
military
authorities
mobilized
an
intense
effort
to
provide
help
to
the
damaged
cities
and
their
inhabitants.
At
the
same
time,
research
was
undertaken
by
the
Japanese
in
anattempt
to
determine
the
nature
of
the
effects
of
the
bombs
on
the
population.
Some
weeks
later,
the
American
armed
services
and
the
Manhattan
Districtalso
organized
an
investigation
of
these
effects.
This
memoir
describestheearly
days
of
the
American
research
effort,
its
integration
with
the
Japanese
program,
and
thedevelop-
mentof
a
Joint
Commission
to
study
the
effects
of
the
bombing.
After
the
first
rapid
survey,
described
inthis
paper,
theeffort
was
reorganized
andcontinuedunder
the
sponsorship
of
the
NationalResearch
Councils
of
America
and
Japan
as
the
Atomic
Bomb
Casualty
Commission.
INTRODUCTION
The
introduction
of
atomicweapons
into
warfare
at
Hiroshima
on
August
6,
1945,
permanently
altered
the
implications
of
armed
combat
between
nations.
Ever
since
that
day
the
possibility
of
nuclearattack
has
obsessed
the
strategic
planning
of
all
nations.
In
1982,
powerful
forces
are
pressing
for
expansion
of
military
nuclear
power
on
the
one
hand,
and
for
plans
to
reduce
nuclear
armaments
on
the
other.
In-
ternational
movements
among
physicians
have
emphasized
the
anticipated
total
breakdown
of
medical
services
after
nuclearattack,
and
the
consequent
impotence
of
the
medical
establishment.
Health
professionals
of
both
the
East
and
West
are
at-
tempting
to
persuade
thepolitical
decision
makers
that
the
breakdown
of
medical
support
after
a
nuclear
attack
would
be
so
widespread
that
even
the
ordinary
measures
of
sanitation
and
first
aid
would
be
virtually
destroyed
for
long
enough
to
cause
a
high
rate
of
disability
in
the
target
population
from
malnutrition,
infection,
and
the
consequences
of
"ordinary"
trauma,
in
addition
to
the
widely
publicized
ef-
fects
of
radiation.
It
is
not
necessary
to
imagine
these
effects.
Hiroshima
shows
clearly
what
happened
in
a
small
town
subjected
to
a
singlesmall
bomb
which
produced
virtually
no
residual
radiation
in
the
bombed
area.
At
Hiroshima
and
later
at
Nagasaki,
the
damage
was
localized
and
external
medical
support
was
available.
The
results
of
morewidespread
attacks
can
be
visualized
simply
by
considering
what
might
have
happened
at
Hiroshima
if
it
had
been
impossible
to
obtain
medical
support
within
the
first
few
hours
from
Japanese
and,
some
days
later,
from
American
military
medicalorganizations.
23
Copyright
°
1983
by
The
Yale
Journal
of
Biology
and
Medicine,
Inc.
Allrights
of
reproduction
in
any
form
reserved.
 
The
Yale
Journal
of
Biology
and
Medicine
(38:
61-239,
1965)
published
a
diary
kept
by
Dr.
Averill
Liebow
during
the
period
shortly
after
the
bombing
ofHiroshima,
when
hewas
sentto
thatcity
as
part
of
an
American
medical
task
force
assigned
to
collaborate
with
the
Japanese
physicians
in
undertaking
a
study
of
the
medical
effects
of
the
bomb.
This
effort
ultimately
led,
in
1948,
to
the
establishment
of
the
Atomic
Bomb
Casualty
Commission,
a
joint
effort
of
Japanese
and
American
scientists
supported
by
both
the
Japanese
and
American
governments,
which
carried
out
highly
productive
studies
of
the
effect
of
the
bomb
on
thehealth
and
genetic
in-
tegrity
of
the
victims
of
the
blast.
Dr.
Liebow's
diary
gives
a
clear
picture
of
the
nature
of
the
damage
created
by
the
blast,
of
the
way
in
which
support
was
mobilized
forthe
survivors,
and
of
the
initial
stepsin
studying
the
effects
of
the
bombs.
The
Yale
Journal
has
decided
to
reprint
a
portion
of
the
diary
(somewhat
edited
to
reduce
emphasison
personal
details)
in
the
hope
that
those
who
read
it
today
will
at-
tempt
to
translate
this
experience
into
the
vastly
greaterthreat
of
our
time.
What
follows
is
considerably
condensed
from
the
original.
In
addition,
a
small
amountof
referencedmaterial
has
been
added
when
it
could
provide
a
more
quantitative
in-
dication
of
thesituation
than
Liebow
provided
in
his
diary.
PHILIP
K.
BONDY,
M.D.
Editor-in-Chief,
The
Yale
Journal
of
Biology
and
Medicine
Dr.
Liebow's
Diary:
HIROSHIMA
RETROSPECT
Hiroshima
("broad
island")
is
really
a
delta
cut
into
six
islands
by
the
branchesof
the
River
Ota.
Here
lived
some
250,000
people,plus
an
encampment
of
soldiers
of
the
Chugoku
Army
near
the
center.
The
hills
rise
sharply
on
two
sides
of
the
delta,
which
points
its
apex
to
the
north.
It
is
as
if
a
great
flatiron
had
been
pressed
from
the
direction
of
the
sea
intothe
mountains.
Only
the
truncated
cone
of
Hijiyama
ris-
ing
to
70
meters
in
the
southeast
sector
interruptsthe
flatness.
Most
of
the
houses
were
of
traditional
Japanese
construction,
consisting
of
one
or
two
stories
and
built
of
wooden
lathwork
and
clay.
A
central
heavy
tree
beam
runs
longitudinally
supporting
arch-like
ties,
which
support
a
lattice
of
struts
that
brace
the
heavy
roof
of
overlapping
pantiles.
Most
of
the
modern
buildings
were
of
the
heavy
construction
necessitated
inthis
land
of
earthquakes.
These
were
situated
along
the
main
streetat
the
southern
boundary
of
the
military
encampmentand
also
along
the
broad
thoroughfare
which
ran
at
right
angles
directly
south
from
the
main
entry
of
thereservation.
These
buildings
were
not
in
a
cluster,
but
were
separated
by
rows
of
wooden
shopsand
dwellings.
There
were
few
buildings
of
weight-bearing
brick
since
these
are
the
most
subject
to
damage
by
earthquake.
Typical
Japanese
cities
built
in
this
fashion
tend
to
be
swept
by
disastrous
fires
at
an
average
interval
ofabout
eight
years,
but
the
ordinary
houses,
quick
to
burn,
can
as
quickly
be
rebuilt.
The
open
charcoal
braziers
(hibachi)
useful
for
warmth
and
cooking
are
a
constant
hazard.
In
this
city
of
islands
the
branchesof
the
Ota
made
natural
fire
breaks,
but
the
separate
islands
were
themselves
large
and
densely
crowded.
In
recognition
of
the
danger
of
fire,
especially
under
air
attack,the
citizens
even
before
April
1945
had
organized
patriotic
working
parties(Giyutai)
tocreate
additional
fire
breaks
by
leveling
blocks
of
homes.
Work
parties
for
this
purpose
were
recruited
also
from
outlying
villages
such
as
Otake.24
AVERILL
A.
LIEBOW
 
A
MEDICALDLARY
OFHIROSHIMA,
1945
Hiroshima
was
not
an
important
center
of
industry.
On
the
outskirts
were
a
branch
of
Toyo
industries,
Mitsubishi
shipyards,
and
a
machine-tool
factory.
TheJapan
Steel
Company
was
to
the
northeast.
There
were
also
two
large
rayon
plants,
one
located
at
Ujina
on
the
far
end
of
the
easternmost
island
near
the
harbor.
It
was
here
that
patients
were
later
brought
under
the
care
of
the
Tokyo
First
(Dai
Ichi)
Military
Hospital
and
where
we
were
to
establish
the
headquarters
for
our
work.
Industry
was
alsoscattered
in
innumerable
home
workshops
in
accordance
with
the
Japanese
concept
of
total
war.
In
a
roughlypentagonal
area
near
the
center
of
Hiroshima
was
concentrated
the
military
power
of
central
Japan.
The
headquarters
of
the
Second
Grand
Army
and
of
the
Chugoku
Military
District
were
located
nearanornate
castle,
a
relic
of
the
Tokugawas,
on
an
artificial
island
surrounded
by
a
moat.
Near
the
southwestern
part
of
the
pentagon
were
divisional
headquarters
and
barracks,
rowon
row.
The
impressive
Gokoku
shrine
stood
near
the
entrance
of
the
encampment
facing
the
boulevard
at
its
southern
border.
The
Hiroshimaencampment
had
served
as
the
springboard
for
the
conquest
of
Manchuria
in
1937-45
and
before
that
for
the
suc-
cessful
attack
on
Port
Arthur.
Of
late,
the
military
importance
of
this
center
had
waned
and
it
was
serving
largely
the
function
of
a
quartermaster
depot.
Ordnance
and
munitions
were
stored
in
caves
along
the
road
leading
to
the
naval
bases
of
Kure
to
the
north
andIwakuni
to
thesouth.
Ina
military
sense
at
least,
the
army
base
might
be
considered
a
legitimate
target,yet
it
was
strangethat
before
August
1945
Hiroshima
had
escaped
almost
unharmed.
Desultory
raids
between
the
middle
of
March
and
the
30th
of
April
1945
had
in-
flicted
almostno
damage.
During
the
early
summer
our
propagandahad
broadcast
threats
that
a
number
of
cities,
including
Hiroshima,
would
be
destroyed.
The
population
was
tense
in
expectation.
Yet
on
August
6,
the
elementof
surprise
was
complete.
Four
B-29
bombers
were
sighted
over
Hiroshima
early
in
the
morning
but
shortly
after
7:00
A.M.
they
withdrew
to
the
northwest.
Justafter
8:00
three
planes
returned,
but
the
all-clear
had
sounded
45
minutes
before.
Since
there
wasno
large
concentration
of
hostile
aircraft,
the
people
went
about
their
business
as
they
had
been
told.
At
that
moment
Hiroshima
was
a
city
going
to
work.
Farmers
were
already
in
the
fields
on
the
outskirts
of
the
city.
The
streets
were
filled.
Children
had
alreadyreported
to
the
schools
or
forservice
in
clearing
fire
breaks.
Customers
had
arrived
in
the
banks
but
had
not
as
yet
been
admitted
to
the
floor.
It
was
a
time
when
the
hazard
of
direct
exposure
in
the
open
was
close
to
its
peak.
One
of
the
planes
was
seen
to
release
several
objects
by
parachuteand
then
at
8:14,
despite
the
brightness
of
the
morning,
survivors
were
startled
by
a
prolonged
and
brilliantflash
like
that
of
a
gigantic
magnesium
flare.
Accompanying
the
flash
of
light
was
an
instantaneous
flash
of
heat
traveling
with
the
speed
of
light
and
perceptible
as
far
away
as
Ninoshima,
the
beautiful
conical
island
five
miles
across
Hiroshima
Bay.
The
heat
affected
exposed
objects
with
an
intensity
inversely
pro-
portional
to
the
squareof
the
distance
from
the
epicenter.
Its
duration
was
probably
less
than
one-tenth
of
a
second
and
its
intensity
was
sufficient
to
cause
nearby
flam-
mable
objects,
particularly
when
dark,
to
burst
into
flame
and
to
char
poles
as
far
as
3,600
meters
awayfrom
the
hypocenter.
At
550-650
meters
it
was
sufficient
to
chip
and
roughen
granite
by
unequalexpansion
of
its
components.
The
heat
also
produced
bubbling
of
tile
to
about
1,100
meters.
It
has
been
found
by
experiment
that
to
pro-
duce
this
effect
a
temperature
of
1,800°C
acting
for
four
seconds
is
necessary,
but
under
these
laboratory
conditions
the
effect
is
deeper,
which
indicates
that
the
25

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