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inevitable hostility of people still over- 101 Medicine & Global Survival 1995; Vol. 2, No. 2 Children of the Atomic Bomb Children of the Atomic Bomb: An AmericanPhysician's Memoir of Nagasaki, Hiroshima,and the Marshall Islands James N. Yamazaki, MD; Louis B. Fleming Copyright Duke University Press 1995.Reprinted with permission. has been a 50-year effort to understand the medical effects of exposure to radiation. Dr.cians sent to Japan in 1949 to study the effects of radiation on children. Dr. Yamazaki'sUniversity Press will publish Dr. Yamazaki's memoir, "Children of the Atomic Bomb." Partautobiography, part eyewitness account, and part scientific review of the medical evidenceto date, Dr. Yamazaki's book, brief excerpts from which follow, is a moving reminder not tle I knew then about the bomb and its dev-to them in the interviews I had with the prin-stemmed from a desire to avoid greater back--tected by the mountain ridge that separatesthe Urakami and Nishiyama Valleys. There had been an air raid alarm earlierthat morning, but no bombs fell. Some peoplehad come out of shelters as eleven o'clockapproached, only to hear the distant throb ofbomber engines. Before many could takecover again, there was a flash of extremelybright light, blinding even on the far side ofthe mountain ridge, then a thunderous blastthat shook the school building for a fullminute, followed by terrifying darkness asthe atomic cloud eclipsed the sun. Deguchi ordered a police patrol to findout what had happened on the other side ofthe ridge. The policemen were back in min-utes. The industrial area was engulfed inflames, they said, thousands appeared dead,and the survivors were running in panic,many of them left with only burning shredsof their clothing. The railroad station, a quar-ter of a mile away, was destroyed. Health ser-vices were paralyzed with the destruction ofthe University Medical Center. The new pre-fectural offices had burned to the ground.The fires were spreading.Three hours later, the first refugees fromthe Urakami Valley struggled around andover the ridge to reach the Katsuyama Schoolwhere Deguchi was working. They collapsedin utter shock. No organized rescue efforthad been possible in the first hours. Rescueteams from the navy hospitals that tried toenter the Urakami Valley on the first daywere driven back by a wall of flame. Trucksand trains were able to transport those escap-ing to the north, but many died in the crowd-ed vehicles before they ever reached neigh-boring towns.... Over the next three days, the policebegan to gather the dead. The bodies of thosewho could be identified were turned over torelatives, who had joined the search. Thosewho could not be identified were cremated,the ashes buried in common graves. Twoweeks were required to remove all of thedead from the Urakami Valley. "The first reports to Tokyo were thatthere had been no serious damage," ChiefDeguchi told me. In fact, every part of the cityhad suffered some damage, ranging frombroken windows in outlying areas to inciner-ation at the hypocenter. From the minute thebomb detonated, there was general despair,he said. As the hours passed and the extent ofthe damage of that single bomb became clear-er, there was a growing realization that resis-lessons of this incredible exposure to radia- Expanding Research [E]very effort was being made to Children of the Atomic BombYamazaki 102 geneticist at the University of Michigan atAnn Arbor]. The program included a profes-of the Genetics Center. I managed the pro-In anticipation of expanding the pro-We decided to use two groups of chil-development of the 134 survivors for com- Emerging Answers babies were born with abnormalities, includ-Among the survivors, the mean head circum-ference, body height, and weight were signif- 103 Medicine & Global Survival 1995; Vol. 2, No. 2 Children of the Atomic Bomb We had to acknowledge that we couldnot specify the degree to which radiation hadbeen responsible for the morbidity and mor-tality. These women had suffered extensivetrauma, burns, malnutrition, and infection,each of which could have had a role in thenegative pregnancy outcomes.... The discovery of leukemia among thesurvivors set the stage for what would becomethe largest cancer research program of its typein the history of medicine. By 1957, more than100,000 people in Nagasaki and Hiroshimawere participating in the program. When the study began, the emphasiswas on using death statistics to calculate themedical consequences of the bombs. But itsoon became clear that this would not yield afull and complete answer. Because of moderntreatments and other factors, it was likelythat many with radiation-induced cancermight survive and eventually die of othercauses. So a lifetime study of the incidence ofcancer among the survivors was proposed bythe ABCC. Each case of cancer was recordedat the time of diagnosis. Hospital recordswere monitored. Complete tumor registrieswere established in Nagasaki and Hiroshima.And the actual radiation exposure for eachperson in the study was calculated using theDS86 dosimetry, providing accurate esti-mates according to the individual's distancefrom the hypocenter and any shielding thatmight have modified the exposure. The first comprehensive report on theincidence of cancer among the survivors wasissued in February 1994 [1], and it covered anextraordinary base of eighty thousand per-sons. Building on the continuing mortalitystudy, the research confirmed and quantifiedwith new precision the cancer risks of radia-tion.... We still cannot measure with assurancethe extent of late-developing cancers amongthe survivors. However, the 1994 cumulativereport on the incidence of cancer and theongoing mortality study have demonstratedincreases attributable to bomb radiation inthe incidence of nine different cancers: breast,colon, lung and respiratory tract, ovary, sali-excluding melanomaexcluding melanomastomach, thyroid, and urinary bladder. At thesame time, the study found no increase dueto radiation in cancer of the cervix, esopha-gus, gall bladder, kidney, larynx, oral cavity,pancreas, pharynx, prostate, rectum, anduterus. In the span of two generations, we havecome to know many, perhaps most, of theshort-term risks of radiation. Children are themost at risk, particularly for mental retarda-tion, retarded development, and elevatedincidence of cancer.... We must wait another twenty years, Ithink, until the end of the normal life span of Reference 1. Radiation Effects Research Foundation. RERFspecial report 1994. Radiation Research 1994. Children of the Atomic BombYamazaki 104 105 Medicine & Global Survival 1995; Vol. 2, No. 2 Children of the Atomic Bomb