Encounter with Disaster-A Medical Diary of Hiroshima, 1945

Encounter with Disaster-A Medical Diary of Hiroshima, 1945 .C S P4~ C's > O 0 O a: o0 d C' +Y 3 0 v) C-, 0 N 0 0_ 0- C Ut FOREWORD Although Japanese medical investigating teams had been at work in Hiroshima within three days of the atomic bombing, and although a brief survey had been made between September 8 and 19, 1945 by a team under Colonel Stafford L. Warren representing the "Manhattan District," the responsibility for a comprehensive medical study was placed on the Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan. The timely organization of the Commission was the work of Colonel Ashley W. Oughterson, surgical consultant in the Pacific Theatre of Operations. It was accomplished in the field, since no thoroughgoing preparations had been made in Washington. It was of necessity impromptu, the personnel assigned were not specially prepared, and there was no equipment in hand. This diary provides a record of how the joint Commission was formed, of the establishment of the essential working relationship with Japanese medical investigators immediately after the cessation of hostilities, and of the trials and rewards of daily activities during stressful times from September 18 to December 6, 1945. There is also a short account of the preparation of the report at the Army Institute of Pathology, to the time of its completion on September 7, 1946. At the hazard of disturbing continuity, explanatory notes have been put into the text. These provide background without which the bare daily record might be less than fully comprehensibl Illustrative material was drawn in large part from the original report of the Joint Commission. The writer wishes to express his appreciation to Brigadier General Joe M. Blumberg, the Director of the Armed Forces Institute of Pathology, for making this material availabl Most of it has never been published. All of the early photographs that were incorporated into this report were made by Japanese investigators or news agencies. One of the first on the scene and among the most observant of the investigators was Professor Nishina, the famous physicist. Personnel of the Tokyo Dai-Ichi Military Hospital supplied graphic illustrations of patients at the height of the aplastic anemi Photographs by the Bunka-sha Agency of medical activities at Hiroshima prior to the arrival of the Commission are noteworthy for their technical excellenc Particular credit is due to Captain Charles Brownell and his staff, members of the Joint Commission, who were highly skilled, sensitive to the medical and human problems, and tireless workers. Last and least are personal photographs made by the writer during the time covered by the diary, and again in 1949 on another visit to Hiroshim These provided an opportunity to see the city in renascenc Two of the color plates were first published in Medical Radiography and Photography (Eastman Kodak Company), Volume 24, No. 2, 1948. These were prepared in part from personal 35 mm. transparencies and in part from larger transparencies made by Captain Brownell. Permission to use these was graciously given by the Editor, Mr. William Cornwell. The McGraw-Hill Book Company also permitted the use of several diagrams and sketches reproduced from the original report of the Joint Volume 38, October, 1965 Commi111issioI in M4ledical Effects of thle Atomiiic Bomib itt Japani ( W. Oughterson anid S. \Varren, Eds., 1956). MIen of the Yale Medical School wrere closely associated with the studies at Hiroshimlla fromii the beginning and have remained so to the present timl Colonel Oughterson, himself was an Associate Professor of Surgery on leave, and three others of the seven medical officers assigned to Hiroshimia had been Yale miedical students and twN-o wN-ere on leave froml the faculty. After the Atomic Bomiib Casualty Commllission (ABC was established in 1948. one of the first pathologists assigned was Dr. \Villiam J. \Vedemeyer. A miiajor contribution was made by another former Yale medical student, Dr. Thomiias Francis, Jr., now Professor of Public Health at the University of 'Michigan, who designed the closed population sampling study that is now the core of the operation at ABCC. Since 1957 the ABCC has been tinder the distinguished Directorship of Dr. George B. Darling, Professor of Humian Ecology at Yal Finally, both able personnel and an importanit degree of conitiniuity have been assured by)X the assunmption of responsibility for the miedical service at Hiroshimia since 1958 by the Department ot Internial Medicine at Yal For these reasons it is appropriate that thi-L diary be first published in The Yale Joitrna(il of Biology anld Jledicinl 1. WHY AND HOW For twenty years, while the seven rivers that mleanider into Hiroshimiia Bay have lapped upon the shores of a reviving city, this diary has remiainied in the shorthand in which it wvas set dow-n. The writing was done at the end of each arduous day before and durinig the nmedical investigation in that stricken city, often in exhaustion. Somiie who have known of it have tirged that it would be wrong that such a record, work-a-day as it is, should be permitted to dissolve with the flesh. Let us hope that the experience wllicl it reports w-ill remiiain unique! It is true that feNw Nwho took part are left to tell lhow the challenige was met and w-hat took plac Indeed it is as though somiie curse, like that wlich the superstitious say fell upoIn Lord Carinarvoll and hiis meni whlen they violated the tomb of Pharaoh Tut-ankh-ameni, has beeni visited upon those who pried into the ravaged lheart of Hiroshimi Only three of the seven Amiericaln ml-edical officers liv Doctors Oughterson and Tsuzuki, the chief organizers for the two counitries have died; so too, while still young, have gone Drs. Calvrin Koch, Jack D. Rosenbaum, and MIilton R. Kramer. May this record do honor to these able and devoted meni. It wvas not throughl a horror scribenidi that these notes have languislhed. Rather it was through fear that somne insignificant phrase might be miliscoInstrued in a way that could disturb the amity that has grown between Japan anid Amlerica anid specifically the contintiing cooperation in the Atomiiic Bomb Casualty Coimmission. Too many of the wicked have been all too eager to distort in order to disrupt! Hir oshtittia AMedical Diarv, 1945 Those of us wlho came to Hiroshima in September 1945 sooi1 acquired a profounid admiration and respect for our Japanese counterparts. \Vre knexv that the miiedical study could not be accomplished without knowledge of the language, people, and custonms. \Vre knew also that many skilled menl would l)e needed since the few of us who had been sent represented only a smiattering of the specialties. It is a tribute to the vision and hunmanity of Coloniel Ashley NVT. Oughterson, truly a mian without malice, that the collaboration of Japanese science and mi-edicine w as invited at that critical timl WVe called ourselves the "Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan." As soon as the Japanese discovered that the wvord "Joint" miieant that both inations were to labor shoulder to shoulder to meet the formidable task of the miiedical study, and that they would l)e treated not as enemies vanquished, but rather as colleagues and equals, they gave unstintingly of their thought and labor. The friendships that began then have grown to a firmiiness that wN ill resist calunyv. Mv own involvement was a matter of being at hand -vhen the circumiistance created the need. I wvas servinig on the island of Saipan in thle Marianas, in mny third year as Pathologist to the 39th General Hospital, the Yale lUnit. In early 1945 peaks of effort were required to care for casualties of the OkinaNa and IwNo Jima campaigns. but there wv-ere quiet intervals w,hen scientific hobbies such as the study of cutaneous diphtheria couild be indulged amiiong the interesting, in-telligeint, anld tractable native The contemplation of nature in the lush green jungle or even in the sugar caine Nas dangerous. Although the island Na- declared "secure," these wsere the hidinig places of Japanese soldiers wsishing to l)e left alonIe but likely to ambush intruders. Each evening we watched fleets of B-29 bombers mlakiing a rendezvous with their kind froimi neiglhboring Tinialn aind Guamii to carry death and destruction to IN-o anid Japani. As Nith full loads they lumbered straininlg to the end of the runway, mnany would acttually drop below the level of the cliff that overhunog the reef at land's end. A few did crash into the sea and some would jettison tlheir bombs and circle back to the landing strip. As we lounged on the terrace overlooking the cobalt of Magicienne Bay, we felt the guilt of insuifficieint involvement. This grew wx-lhein the plaines returned in the miiorning, some limilping anld with a cargo of injured or dead, or Nhen we learned of those that never came back. Of the existence of an atolmiic bomb wre had no inkling. It is true that in the Spring of 1945 wagers that the war would eind by August 15 were b)eiig freely imiade by airmen N-ho, wvith enigmiiatic simiiles, even offered population. Volume 38, October, 1965 substantial odds. Yet the actual secret was well kept. Enormous casings shaped like bombs were being dragged on multi-wheeled flat carriers over the hot, white, dusty, coral roads of Saipan, but these were undoubtedly decoys, and none of the bettors knew more than that something great and terrible was in the wind. Only a few had knowledge of the awesonme power that lay in a low, closely guarded, concrete, windowless building on the Island of Tinian only three miles from us across the water. Even as Iwo Jima, the last stepping-stone to Japan, was being seized, and before Tinian received its fateful burden, we were busily expanding our unit to 2,000 beds. We were not alon Vast new hospitals were rising on Tinian and Guam. Together we were to serve as a great center to receive casualties from the expected assault on the Japanese homeland. When, at 8:14 on the morning of August 6, 1945, on command fronm Washington, the hand aboard the Enola Gay loosed beyond recall a new evil in the world, we had no knowledge of how our lives, in fact the lives of all men, would be changed. Only three days later came the second devastating blow, against Nagasaki, before we on Saipan knew of the first. No further conviction was required. I can well remember how the news of peace came to us. It was on the evening of August 11, 1945. My wife to be and I were at cribbage in the Officer's Club. Two befuddled marines were consoling themselves by idly twirling the dials of a short-xvave radio when Carolyn suddenly exclaimed: "Did you hear that? They want peac" I had not heard. We rushed to the set, but by then the station had been lost and we spent the next half hour searching. Finally it cam Personal bottles were rescued from the bar, since the Commanding Officer's orders required that it be closed at 11:00 p.m. Then followed a snake-dance to announce the news to all and sundry in the barracks; it continued past the startled sentries to the fenced-off nurses' compound. All was uproar and gaiety throughout the night, assisted by a supply of Scotch with which the chief nurse had been entrusted by one of the generals. On the next day Destroyer-Escorts equipped with blaring loud speakers cruised along the coast and shouted the news in Japanese into every inlet. They were believed, or else confirmed by more direct sources from Tokyo, since within the week no fewer than 400 of the erstwhile enemy turned themselves in. They had successfully managed to elude several mopping-up operations. Most were neither sick nor thin. Many had continued to feast, as had we when we first arrived, on tinned crab meat made in Japan which bore the label "Approved by Good Housekeeping." This had been cached in caves before the battle for the island. Now came the time to discharge our few patients either back to duty, or to hospitals near home and to release those of our staff who had sufficient "points." The necessary quota applied to most of us who had been with the unit from the time it was organized. Since facilities for transportation were obviously limited I elected to remain for two reasons. First, others had wives and young families at home; second, as historian to the Yale Unit, I wished to record the last events in the closing, and particularly the destruction of the equipment, the return of which to the homeland had been proscribed. Had permission not been granted to remain, I would probably have been ordered back from some point on the long journey hom As it was, the orders caught me unaware and unprepared, but not physically on the homing path, and therefore ready, in fact eager, to set forth on the final step to Japan that we had begun more than three years befor 2. HIROSHIMA RETROSPECT Hiroshima, "broad island," is really a delta cut into six islands by the branches of the River Ot Here lived some 250,000 people, a number that does not include the soldiers of the Chugoku Army in their encampment near the center. On two sides of the delta, which points its apex to the north, the hills rise sharply. It is as if a great flatiron had been pressed from the direction of the sea into the mountains. Only the truncated cone of Hijiyama rising to 225 feet interrupts the flatness. For the most part the houses were of traditional Japanese construction. Most were of one or two stories, built of wooden lathwork and clay. A central heavy tree beam runs longitudinally supporting arch-like ties. These in turn support a lattice of struts that brace the heavy roof of overlapping pantiles. Most of the modern buildings were of the heavy construction necessitated in this land of earthquakes. These were situated along the main street at the southern boundary of the military encampment and also along the broad thoroughfare which ran at right angles directly south from the main entrance of the reservation. These buildings were not in a cluster, but separated by rows of the wooden shops and dwellings. Buildings of weightbearing brick were few, since these are most subject to damage by earthquak Typical Japanese cities built thus tend to be swept by disastrous fires at an average interval of eight years, but the ordinary houses, quick to burn, can be as quickly rebuilt. The open charcoal braziers (hibachi) useful for warmth and for cooking are a constant hazard. In this city of islands the branches of the Ota made natural fire breaks, but the separate islands were themselves large and densely crowded. In recognition of the danger of Ca -, l r, ._R;X.t4fvSso>r-zbCe_J, FJo l'ollillic -38, (ctobcr, iQ6,5 <_ *- <:L) - - tZ ;-< t . r. '- *-J Cn CJ CJ _ t - . _ _ _ 'J > aS r. : ;_ _ ._ ; W CS D ._ _ _ _ W; _ r, _ r, @ sv n > .R -< oo ;R > *_ ' < t C>_ 'J. t tJ 9 . ._ / r. ' fire, especially under air attack, the citizens even before April 1945 had organized patriotic work parties (Giyutai) to create additional fire breaks by leveling blocks of homes. Work parties for this purpose were recruited also from outlying villages such as Otak Hiroshima was not an important center of industry. On the outskirts were a branch of Toyo Industries, Mitsubishi shipyards, and a machinetool factory. The Japan 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 care of the Tokyo First (Dai Ichi) Military Hospital and where we were to establish the headquarters for our work. Industry was also scattered in innumerable home workshops in accordance with the Japanese concept of total war. In Hiroshima, in a roughly pentagonal area near the center of the city, was concentrated the military power of central Japan. The headquarters of the Second Grand Army and of the Chugoku Military district were located near an ornate 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, row on row. Near the entrance of the encampment, facing the boulevard at its southern border was the impressive Gokoku shrin The Hiroshima encampment had served as the springboard for the conquest of Manchuria in 1937-45 and before that for the successful 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 and Iwakuni to the south. In a military sense, at least the army base might be considered a legitimate target, yet it was strange that before August 1945 Hiroshima had escaped almost unharmed. Desultory raids between the middle of March and tlle 30th of April 1945 had inflicted almost no damag During the early summer our propaganda had broadcast threats that a number of cities, including Hiroshima, would be destroyed. The population was tense in expectation. Yet on August 6, the element of surprise was complet Four B-29 bombers were sighted over Hiroshima early in the morning but shortly after 7:00 m. they withdrew to the northwest. Just after 8 :00 three planes returned, but the all-clear had sounded 45 minutes befor Since there was no 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 already reported to the schools or for service in Volume 38, October, 1965 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 parachute and then at 8:14, despite the brightness of the morning survivors were startled by a prolonged and brilliant flash like that of a gigantic magnesium flar 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 proportional to the square of the distance from the epicenter. Its duration was probably less than one tenth of a second and its intensity was sufficient to cause nearby flammable objects, particularly when dark, to burst into flame and to char poles as far as 4,000 yards away from the hypocenter (point directly beneath the center of the explosion). At 600700 yards it was sufficient to chip and roughen granite by unequal expansion of its components. The heat also produced bubbling of tile to about 1,300 yards. It has been found by experiment that to produce this effect a temperature of 1,800° C. acting for four seconds is necessary, but under these conditions the effect is deeper, which indicates that the temperature was higher and the duration less during the Hiroshima explosion. Only surfaces directly exposed sustained flash burns, since the rays of heat, like light, travel in straight lines. Intervening objects prevented the charring or other alteration in the directly exposed surfaces and thereby cast "shadows." The sharpness of shadows cast by constantly moving objects like leaves also suggests the brief duration of the flash. Thousands of persons in the open within a radius of 212 miles sustained more or less severe flash burns depending on distance and the protective effect of clothing. After an interval evident to those at a distance, came a violent shock wave that flattened the fragile wooden buildings. As seen from the hills the houses fell as under a scyth People were hurled from where they were standing. Those closest-by heard almost no sound except for that of falling buildings, but at a distance there was a rumbling roar like that of thunder. The blast wave shot outwards at approximately two miles per second for a relatively short distance, but then after several hundred yards reached the speed of sound (approximately 1,100 feet/second). It rose to a sharp peak, and then the pressure fell below atmospheric for a period perhaps three times that of the positive phas Objects at a distance were deflected away from the center of the blast, but such objects as trees immediately beneath remained standing upright although stripped of branches. The magnitude of the |. ''ll :., Top. Flash burn in acute stage; the upper portion of the body was unclothed and suffered a sharply outlined "profile burn." Patient probably within 1,000 meters. The buttocks and thighs were burned through clothing, but the abdomen was protected by a multilayered cummerbund., Bottom. Keloids of skin in 21-year-old woman at 1,600 meters. Seen in early Niovember 1945. Some protection by means of blouse' and straps -of undergarments. Top left. Patient showing dermatitis and epilation. First MIilitary Hospital fil Distance not recorded but probably within 1,000 nmeters. Patielnt was a soldier in the military compound. Top righlt. Epilation aind petechiae in patient exposed wvithin the military compouild at 1,000 meters. Patient (S-, H. -6176-U) died on 31 August 1945, when the white count had fallen to 45. Lowcer lcft. Epilation, wh-iclh had begun on 20 August, as seen on October 25, 1945. Patient (M-) at Ujina Hospital. He was a soldier who had been indoors on the second story of a two-story Japanese building at 600-700 meters. Slight dowiny regrowth of hair has already begun. Lowver righlt. Epilation in middle-aged onoman. Patient at Ujina out-patient clinic. Regrowth of hair has begun in late October. Hirosliimiia Mlledical Diary, 1915 L f downward pressuire was showvn by the 'dishing" of the reinlforced concrete roofs of buildings. Glass andI other debris were shot through the air like l)ullets, ofteni became imlpacte(l in wood, and inflicted multiple serious inijturies. Simultaneously roilinig cloud, pink or black according to various observers, rose fromil the l)oint of the explosion; thiis, tog,ethier with imlmllense quaiitities of duist fromil the ground and fromii the collapsilig buildings, threw those beneath it illtO almlost total darkniess. This lastedI for somile twenty iniutes. Thousands were trapped in the wreckag Alimiost all of those who cotild not escape tuinder their ownii pow-er perished. Fires beginning everywhere both by direct igition anid by the upsetting of thotisalids of the ol)en hibachi, many still in uise for cookinig l)reakfast, at onice swept the city. A highi xxinid stickedI toward the rising atomilc cloudI fanine(d the flamiles 1hich then created their owin fire storml. The huimiiani victims suiffered burns both by flash alnd by flamii As soonl as the atomiiic natuire of the explosion was aninotince(l a new fear made itself felt the terror of the invisibl The existenice of radiationi effects was known alimiost at onlc People who had been close to the hypocenter lut who had stiffered neithier burns nor traulila, sickene(d and dlied. They felt w-eak anid natiseatedl, couild not eat, developed a severe (liarrhea aind fever and somile died w-ithinl ten days. Those N-ho survived loniger lost their halir helimorrhiages anid ulcers appeared in the skin anid miuitcotis imiemilbranes and(I deathi resuiltedl fromii pulmonary or initestinial inifections. Tlle marrow had beeni destroyed and all elemilents of the blood were deplete(l. If the intent of the bombing was demiloralizationi, this was unquestionably achieved. False rtimors spread-that all w-ho had been in Hiroshimia and Nagasaki w ould die, anidl that the cities would be uninhabitable for 75 years. But there w-as yet anothier effect. Those in power in Japan w-ho were wise liad clearly seen that the war liad been lost when Okinawa andl IwN-o Ji1m1a fell. The Em 1peror had personally soughit to influielice his war couticilors to sue for peac Now, in the face of unianiticipated and uniiprecedenited power that couild overwhlelmii eve\n the milost valorous there was a wv ay to conclide the war wN-ithiout losing face and the fighting wvas brouighit to ani end. Only glimipses can be obtained from accounts of survivors of thle inimenise medical problemils created by an atomic explosion in a densely populated city. Those who lived were (lazed not merely by the immediate force of the explosion but by its vast extent. Many lost consciousness for a few seconds or iinutes even though they had not suffered traumila to the head. Darkness interrupted by onrushinig fires added to the confusion and terror. No one knew which way to escap The river banks and their waters Nere natural Volume 38, October, 1965 havens and were soon teeming. Boats were mobilized to carry survivors upstream. Only a few could be brought out on litters or carts, and almost all who could not rescue themselves were overwhelmed by the flames. Both administrative authority and organized activity had ceased to exist. What was done was on individual initiativ Only three of 45 hospitals in the city remained standing. The two largest and most modern, the Red Cross Hospital and the Communications Department ("Post Office") Hospital, were so severely damaged by blast, as was their equipment, that they could function only as first-aid stations. Less than 10 per cent of the city's 300 physicians were uninjured and nursing strength had been equally depleted. As the fires cooled relief work was begun. The first relief station from outside was set up on the afternoon of August 6 at Tamon in the shelter of Hijiyam Thousands streamed back into the city in search of relatives and friends. Messages were scrawled on the walls of the aid stations. Police control, by tradition an enveloping power in Japan, was resumed with the help of officers from neighboring towns. The Armed Forces gave substantial aid. Two relief parties were dispatched from the Naval base at nearby Kure and the hospital on the base at Iwakuni received 51 patients, many of whom were naval personnel who had been quartered at the Banker's Club, a large building only 200 yards from the hypocenter. Some of these persons died in the first few days purely of radiation effect. The Army assumed responsibility for the care of civilian as well as military casualties although the two large Army Hospitals on the military reservation had been destroyed. Military hospital detachments were brought in from elsewher Accessory aid stations were established in certain buildings on the outskirts that had survived complete destruction, and in adjacent communities as at Oshib One of the most active in the city itself was at the Fukuramachi school. The Red Cross Hospital, despite severe damage to its fine building, took care of 1,000 persons as in-patients, and in addition conducted out-patient clinics. According to the Director, Doctor Hachiya, the Post-Office Hospital began to receive patients by 9:00 m. of August 7, and by the end of that day 400 had been given immediate car A major installation was established on August 25 by the Tokyo Dai Ichi Military Hospital (the Walter Reed of Japan) at the living quarters of the Daiwa rayon mill at Ujina-later to be the base of operations of the Joint Commission. The investigation of the effects of the atomic bomb was begun by the Japanese as early as the first day following the explosion when Professor Nishina, a quantum physicist, came to Hiroshim On August 14, Doctor F,0 Upper. Street shortly after the explosion on August 6, 1945. The injured seeking aid-probably in the shadow of Hijiyam The city is burning in the background. Lower. Temporary tentag Shelters at Hiroshima No. 2 Army Hospital, Motomachi, August 9, 1945. An officer marches by at the left. (Nishina photograph.) T'olitine 38, Octobei-, 1965 Upper. A nurse ministerinig to burned and injured patients, August 9, 1945. The scene is under tentage at the Hiroshima No. 2 Army Hospital at Motomachi. This was staffed by the Second Provisioinal Fukuoka Army Hospital. (Nishina photograph.) Lower. Burned and injured patienlts. (Nishina photograph.) Hi)roshiill Aedical Diary, 1945 U- sionI. (Bunka-Sha photograph.) Upper. The Fukuraniachi Aid Station. This was formerly a high school. (BunkaSha photograph.) Lower. Clinic in session in early October 1945 before arrival of the Joint Commis- l'oliiiiie 38, October, 1965 Uppcr. Bulletiins regardinig the whereabouts anid coniditionis of various persons rit-on1 an initerior wall at the Fukuraniacli Aid Stationi. ( Bunka-Sha photograph.) Lozwer. Nurse in Red Cross Hospital admiinlisterinig treatmlenit 'Lo atiellt. (BunikaSha photograph.) ten Murachi* and Doctor Kimura came and stayed approximately a week, and then returned later in the month accompanied by Doctor Miyazaki. With the help of the Neher cosmic ray counter they found a zone of gamma ray activity approximately ten times background in a region 50 yards across at the hypocenter. This was interpreted to be the result of activation by neutrons of components on the ground. The radioactivity was far below hazardous levels. It is interesting to note that a part of this instrument had been made and tested before the war by Professor Neher himself in the United States. At Takasu to the south and west there was radioactivity of three times background level. It was interpreted to represent the effect of fallout directed by the wind that had blown from the east and by the rains that fell in this region just after the explosion. This activity was extremely low and certainly did not justify the fear of the rumor mongers. The physicists also noted the "shadows" cast on various objects as a result of the heat flash. By sighting along these shadows they were able to establish through a process of triangulation the position of the explosioll. It is amusing that this datum, widely known among scientists in Japan in the second week of August, was considered a secret in the United States for many months. Medical investigations were begun at once and some of the earliest autopsies were performed at the Iwakuni Naval Hospital. At the Commullications Department Hospital careful records were kept of approximately 150 patients, and autopsies were performed by Professor Tamagawa of Okayama University in a makeshift autopsy room on the grounds of the institution. The Prefectural Hospital at Kusatsu was active until November 1945. Autopsies were performed there by Professor Araki of the Kyoto Prefectural University. Patients were transferred to military hospitals at Okayama and elsewhere and to civilian institutions and hospitals as far away as Osaka and even Tokyo. In these settings investigative work and necropsies were also performed. One of the most important investigative units was that maintained by the Tokyo Dai Ichi Military Hospital at Ujin This was superbly staffed. It had been customary for many of the best young Japanese physicians from the major universities to be recruited into the military soon after receiving their medical degrees. Of this group, Majors Motohashi, Misono, and Hata later made valuable contributions to the work of the Joint Com* Dr. Koichi Muracdi, a senior biophysicist of the Institute of Physical and Chemical Research of Tokyo, later became a valuable member of the Joint Commission, especially in the investigation of factors in protection from radiation. He died on March 31, 1964 of leukemi Volume 38, October, 1965 mllissiOn. Ini addition, they lhad collaborated with physicians of tlle Tokyo Imiiperial -University who lhad sent investigating groups iilto Hiroshlilmca and(I lhad also received miiaterials for stund at the University in Tokyo. A report concerning 712 of these patienits w-as completed by personnel of the Tokyo Dai Icli 'Military Hospital anid represenits ani imiiportanit originial doctnmiienit. A miiajor trage(ld wcas suffered by the highly comiipetenit grotup of inv,estigators lheadled 1bw Professor Alashita of the Kv-oto Imlperial Universit-. They took til) residenice at the Onio Armyv Hospital in the village of that namiie on the coast a few miiiles sotitl of Hiroshilmii Durillg the great typhoon of September 17, a lanidslide roared downo i fromii the steel) lills behind the hospital to the sea, crushing several btuildings in its patth and carrying to tlheir deatlhs teni of the finiest miiedical scienitists in Jaapan1, inclundin the famiiotis hematopathologist, Professor Sutiiyam AmloinO some of these gronps of investigators there existed a certaill jealotusv of what might be called intellectual property, and commlllitinlicatiolns amllonlgthelm were niot fre Snch attittudes are lnot uniiicqtue to Japan but tend(l to prevail amilonlg scienitific commiiiluntities thronghont the world. \With a few major exceltions, these teamiis conisidered l)artictular aspects of the prolblemlls in lhanid. Under the diffictult circtimiistalnces, the generally lighl(lqnalitv of the sttidies l)erforlmed is remarkabl In retrosl)ect. it seemiis strano-e thlat a w-ell-staffed and well-e(tuipped miie(lical team lhad n ot been orgaynizedl by the Snroeon General of the U.S. Army for the specific ftinctioni of performincg an intensive investi-ation of biological effects of the atomlic bomb. It was saidl that the Snrgeon General had lnot been iniformiied of the plannied employment of this w-eaponi against the cities. Fntrtlhermiiore General Kirk's personal relationshipsx-itlh General w M\acArthur were reported to be strained. WNe knew that lhe lhad, luring his totur of the Western Pacific in 1945. been reftused l)ermissionl to lanid ill the Philippines. Rtumiior lhad it that vears earlier when Kirk was ill commiiiianlel of a mlilitary hospital in the Philipipines he had declined to a(lllit AMacArthnlr as a patienit becatuse the latter w as then serving in a civilian capacity. The needl for a thoroughgoing medlical stuidy was clearly perceived by Colonel Ashley WV. Otiglterson. then serving as surgical consnltalit to General AMacArthur. Since he knew of no preparations that had been miadle fromn \VNashlinlgton he conceived a plan of action while still on shipboard w-ith GHO on route to Japan. This was presented as a letter anid immediately approved by Brigaclier General Guy B. Denit, Chief Surgeon, GHQ, U.S. Armled Forces in the Pacific. Colonel Oughterson laid down the major directions that Nere actually pursued by the investigating team and his memorandumii to General Denit is therefore reproduced in full: Hir oshliimla AMedical Diary, 1915 Upper. The Oshiba Aid Station. Patietnt brought in by cart receives treatment. (Bunka-Sha photograph.) Lozcer. Families of patients assistinig in the care of their sick relatives. One of the two patients has suffered epilation. (Bunka-Sha photograph.) t"oluttie 38, Octobei-, 1965 Upper. The Conimunicationis Departmnent Hospital seeni from the rear (1,400( meters). The low building behind the central portion of the "vall at the rear of the hospital was used as anl autopsy room by Professo:r Tamagav Lowcr. Professor Tamagawa of Okayama lUniversity in autopsy roomii of Commnilitnications Departmenit Hospital at Hiroshim (Bunka-Sha photograph.) Hirosliuta Mledical Diar), 1915 L I EBOW5 Two views of damage by landslide at the OIno Hospital, near Hiroshima which occurred shortly after 10 p.mon Septemiiber 17, 1945 during, a typhoon. Here were lost ten scientists from the Kyoto Imperial University, includinig Professors Mashita anid Sugiyam The survivors wrote: "WNith much regret, we, therefore, had to stop our work in Hiroshima and return with the ashes of our friends." f'oliiiiie 38, October, 1965 ON BOARD SS GENERAL STURGIS 28 August 1945 MIEMIORANDUMI: TO: Brigadier General Guy Denit SUBJECT: Study of Casualty Producing Effects of Atomlic Bonmbs. 1. A stu(ly of the effects of the two atomiiic bombs usecl in Japlan is of vital imliortance to our country. This uniqlue oplortunity may not again be offeredI until anotlher worl(d X-ar. Plans for recordling all of the available data therefore shlouldk receive first priority. A study of the casualty producing effects of thcse bombs is a funiction of the Medical Department and(l this imiemorand(luml is prepare(l as .a brief outlinie for such a study. 2. The nieecl for study at the earliest (late possibl The casualty producing effects of these bomibs shoul(d be stu(lie(l at the earliest possible mioment for the following reasonis: Much of the dlata Imlust be obtaine(d froml the interrogatioll of the survivors anl(i the soonler this is accomplished the imlore accurate w\ill be thIe results. b. l'ost-miortemii examiiniationi of the deald may provide valuable informliation as to the cause of (leatlh. Three weeks or more will have elapsed anld opportunity for post-iolrtemn examiniation will be limite(d to late (leatlhs amonig the survivors. It is hoped that soImle post-ImlorteIml exaiminiatioins Imlay have been dlone by the Japanese andl that these recor(ds may be amplified by early interrogation of the Japanese pathologists. c. Accurate case histories by interrogations of the in jure( may vprovide the mlost reliable dat These should also le correlated with th ]physical findinigs anid the necessary laboratory examiniationls. d. Residual radiation effects have been suggeste(d as a possible source of daniger and while this appears to be remlote, suclh a possihility should lie investigated at the earliest possible dat 3. The scope of the study. The total number of casualties reportedI at Hiroshlimila is al)l)roximately 160,000 of whoim 8,000 are dead. Even though (lue allowance is mla(le for inaccuracies in these estiimates the scope of the problem is suclh as to re(uire the organizationi of teamiis with intterpreters in ordler to complete an adequate study w ithinl a reasonable time limiit. These tcaimis slhould include pathologists anid cliniciains wxorking under the direction of trained investigators. 4. The data \vhiclh should be obtaine(l. It is recogniizedl that any plan for the collectioni of data slhould be mo(lified according to the circumstainces. The following suggestionls are intell(led to in(licate the miniimuIm rathier thani the maximilunm data required to properly evaluate the casualty producing effects of these bombs. The location of all casualties living and dead should be (leteriiliied in relation to the bomb anlIplotted oII a contour map. b. All living casualties should be identified by number for location on the map) and an exact description of the case kept in a cross index fil Stanidard Hiroshliima Medical Diary, 1945 L LIEB3OW diagniostic nomeniclature should be used. Such a procedure is necessary in order to determinle the differenit casualty producinig zonies. c. The positioin or protectioni of all casualties should be determinied sinice this may be a determiniing factor in blast effects aind burns. (Standinlg, sitting, prone, inidoors, outdoors, in shelters, trenches or behind(I walls etc.) d. Consideration should also be given to such factors as conitour, temlerature, w7ind and humidity in relation to casualties. It is unlikely that the latter factors will be of much inifluenice but contour may be of conlsiderable imp)ortanc Evidence of blast effect should be searched for in both the pathology ali(d in the clinical history. X-ray evidenice of lunig pathology may be helpful. f. Burins slhould be carefully observed as to degree and clharacter, part of the body inivolved, rate of healinig, cause of death, etc. g. All casualties should be recorded as to whether they w ere due to primary effects of the bomb or were seconidary to burninig buildinigs, flyrinig debris or falling walls etc. h. Evidence of residual radiatioin effects. WVhile there is little ilndication that such inijury will be found it should nevertheless receive serious coni- sideration. i. Complete post-mortem examiniatioin should be performed oIn all inijured in whom the cause of death is not clearly established. j. It is hoped that the Japainese may have already organized anl iilvestigationi of the casualties but this is unlikely under the circumstanices. However much valuable data may be obtained from interrogationi of Japanese doctors and pathologists. Also data valuable from a niegative standpoint may be obtainied from uniinjured survivors who were within the daniger zonI 5. It should be emplhasized that since the cffects of atomic bombs are unikniowni, the data should be collected by investigators who are alert to the possibility of death and injury due to as yet unknown causes. 6. It is recommeinded: That in view of the importanice of the data to be obtainied anid in view of the magniitude of the problem that a committee be appoinited by the Chief Surgeoni to survey the possibilities of obtainiing data and to direct the collectioin of the data needed to properly evaluate the casualty producinig effect of the atomic bombs. b. That the various aspects of the investigation of the casualty producing effects of the atomic bomb be correlated through the Office of the Chief Surgeoni. WV. OUGHTERSON Colonel, 'Medical Corps After the GHQ group landed in Japan on September 1, 1945, it was learned that various groups of Japanese scientists had already conducted medical investigations on the patients in Hiroshima and Nagasaki. Contact was established with the Japanese government on September 3, and thereafter reports were received and liaison maintained through the GHQ Surgeon's Offic Voluitie 38, Octobei-, 1965 At about this timle a groulp frolm the 'Manhattan District," the organization that carried the responsibility for developing the atomiiic bomb, arrived in Japani. Its Imlission1 was to coInduict a b)ricf p)relinmiinary study of the effects for ai inmmediate report to Washillngtoll. Tihe miiajor funlctioni was to determ1inie \vhctlher there wsas resi(duial radioactivity in ordler to safegtuard our Professor Tsuzuki's card. troops. This group, unlder commliianid of Brigadier General Thomiias Farrell, was self-containied, w ith its own air transportation andl equipment. In charge of the medical section was Colonel Stafford L. \V;arren, wlhose civilian positiol was that of Professor of Radiology at the University of Rochester, well-knowyn to Doctor Oughterson from civilian lif On Sep-ten1ber 4, 1945 a conferenice was held with General Farrell and the seniormedical officers, and it was agreed that it was desirable to unify the informiiation to be obtained and to produce a joint medical report. General Farrell's group landed on Iwakuni airfield near Hiroshima and made a prelim-ninary survey of physical damage and of casualties in various lhospitals and clinics. After the physicists had confirmed that only mninimlal radio84 activity, well within the limits of safety, was present, the group returned to Tokyo some ten days later. Parenthetically, it is of interest that one localized but intense focus of radioactivity was found in the ashes of one of the crematories but this was traced to a radium source that had been used for treating a uterine tumor. It was obvious that for an intensive medical study the cooperation of the Japanese, who had already made all of the clinical and laboratory observations during the height of the early phase, was essential. Professor Masao Tsuzuki, the Head of the Department of Surgery of the Tokyo Imperial University and Director of the Medical Division of the Japanese Research Council, was contacted. He agreed to enlist the full cooperation of Japanese medical scientists. As a result, the Supreme Commander directed the formation of a "Joint Commission for the Investigation of the Medical Effects of the Atomic Bomb in Japan." This was to include the Mantattan District group while still in Japan; a GHQ study group, still to be organized, which was to perform a more definitive medical study; and the Japanese Government Group under Professor Tsuzuki. Later, on September 25, there arrived a medical investigating team of U.S. Navy personnel (Nav Tech Jap, Team 11) under Commander Shields Warren, M.C. This was composed of 15 officers and enlisted men who were assigned to Nagasaki. With their arrival, it was obvious that duplication or conflict of effort would be ridiculous and the Navy group then worked as part of the Joint Commission in fuil cooperation with the U.S. Army and Japanese componenlts in Nagasaki. Doctor Oughterson proceeded at once to organize the GHQ group and to issue orders for designated personnel. It was on September 18, 1945, when the orders reached Saipan, that this daily record was begun. 3. PREPARATIONS Tuesday, September 18, 1945: At 08:05 on this steaming hot Tuesday morning received news verbally from the Adjutant that I might be leaving "all over the Pacific." The somewhat garbled message had also stated that either Rosenbaum or Rosenberg were to be alerted to go along at once on the same expedition. Rumors were flying. We thought that most likely we would be sent to Japan-maybe to participate in medical work on the atomic bomb-but we hardly dared to think of it. Tension was high. Late in the morning a radio message was received by Jack Bumstead that confirmed our conjectur Japan was to be the destination. It was Rosenbaum who was to go. Instructions were to take along two experienced laboratory technicians. Orders would be cut as soon as they were named. Picked Archambault and Reed who seemed delighted. Called on C.G. and said, Volzittie 38, October, 1965 "Guess wlhere I'm going." "To Japani I suppos" "That's right." There was disappointmiienit but also excitement in her voic I immediately began to coml)lete the few autopsy protocols and other laboratory business remiiaininig and started to pack. Orders for imimiediate dleparttire arrive(d about 3:30 p.m. It wvas necessary to transfer all of the laboratory property to Captain Bornstein, wlho had been assignecI as an addlitional pathologist some weeks befor He signed for $90,000 worth, with uncderstandable reluctanc Hastily packed belongings were thrown into a stationi wagon. Quick, and painiful, leave takinigs were accomlplished but the arrival at the airport at 7 :00 p.m. proved useless, silnce the last I)lane for Gutaml had left at 3:00 p.m. \We had hoped to go oln somiie uinscheduiledI flight. The nlext planle was (lue to depart at 08:30 the next nmorninog. \e retturneid to the 39th General Hospital, leaving all of ouir belongings in the stationi wagon for early departur At abouit 2:00 m11. came a call fromli AMajor TarlnowN-er on Guam wN-ho ha(l gotteni conflusintg orders which w-ere soon1 pUt arighlt since his name was unmllistakably inscribee(l witlh iiine oni the orders. Jack I). Rosenbaum lhad comiie overseas w-itlh the Yale U-nit, leaving hlis in Medicin He was a brilliant stuidenlt of Dr. john P'. 1'eters wvith special interest in mletabolismii, and hlaLd servedI as officer in charge of the chemical laboratorv. Arthuir H. Rosenberg, who was inI charge of serology, had worked at the U.S. Public Healtlh Service V-enereal Disease Researclh Laboratory on Staten- Island. The original ra(lio mlessa(ge was unclear as to hlo wNas to be assigned. Sgts. J-ohli Archambault andl Jack Reed were both stuperb teclhlnicianis anld bears for x-ork. Archambatih had been a pharmacist in Fairfield, Conniectictut aln(d Ree(d lhad been worlkin1g toward ani advanced(lderee in enitomlology at Rtitoers. I was inot suire that they wouldI be happy witlh ani extensioni of duty- at a timie when a returl-ni lhomiie was immiiiinlenit. Coinfidenice in these meni l)rox-ed miiore tlhani justified, since both performed far beyond the call of (ltity throuighout tllcir touir in position as Instruictor capan. * .Scptcu;ibcr 19: Arrived( at airl)ort at 8 :00 m. and was told( that all sesats oln the l)lanle were taken . Outr orclers clearly indicate(l tirgencv how\-e\ver, and places w-ere tlherefore miia(le availabl Landled at 9 :20 m-. oni Guami. Immedliately miiadle arrangements witl the Nav-al Air Transport Service for (ld)arture to Japani oni the first available flight, sclhe(duiled to leave at 10:00 p.m. that night. ?lhi.s left ani enitire day fre Conitacte(d Dr. Harry Zimimiilerimlin, my form11er teacher in pathology at Yale, who was statiolne( Hiroshliima Medical Diary, 1945 L with the Rockefeller Institute unit wlhiclh I had visited several Neeks before during the penicillin crisis. It was a well-spent day. Case records and cultures fromii our paratyphoid epidemic were turned over to Dr. J. T. Syverton. Saw Dr. Norman Stoll and demonstrated our Isosporea hionlisis pictures in which he had expressed an interest durinig my previous visit. After lunclh wevet to the native hospital at Agana Nith Dr. (Conlimanider) Sulzberger who had become interested in cutaneotus diphtheria after I had described otur lonig experienice with it, botlh in our troops aind amiiong thle natives, dturing our previotus visit. At the hospital we smiieared and cultured what to me looked like diphtheritic ulcers in a number of natives. The (leimionstratioin of bacilli in the smears proved completely successful, much to Dr. Sulzberger anid Syverton's surpris I then wvas brought to a nleetilg at the 204th General Hospital that was beinlg condtucted by the patlhology servic Dr. Humilplhries very kindly took me under his w-ing. After the miieeting and a good stupper, was driven to the airport where a C54 NATS aircraft No. 56494 w\as waiting for us. \We reported to the desk at 9 :00 p.m. and boarde(d the planie at 9:40. The take-off was exactly as sclheduile(d at 10:00 p.m. * The Rockefeller Ulnit, unider the comlmlilanid of Dr. ( Captain) Tlhollmas M. Rivers, 1MI.C., U.S.N.R., served a research and conistultative ftunction, and(i Was superbly staffed. Dr. Zimmiiermnan had been an Associate Professor in the pathology departmient at Yale while I was in ny residency. Dr. Normclan Stoll Nas a parasitologist of the Rockefeller Inlstituite at Princetoni, anid Dr. AMarion B. Sulzberger a renowned dermatologist fromll New York. A prev\iotus visit, miiade on August 23 and for the next few days, was precipitated byT ca progblem involving penicillin therapy. \We becamiie aw\are of the dliffictulty at onice, miiore or less by accident. I had been doingc a stud(yNwith Dr. Max Taffel of the penetration of peniicillini inito spinal fltidl in craniocerelbral injurv. One day we found that the apparent blood anld spinal fluidI levels had fallen to approximately one eighth of what they had been before on the samiie scheduile of treatmelnt. At thlat timiie wX-e thoughllt that the streptococcuis that had been carefully trcansported fromii otur previous station in Newv Zealand as a standard for testillg penicillin levels had aone awry, altlhotugh wNe hadl kept standard cultures in storag Oni investigcatioll wse foundicl that a new batch of penicillin had been put into tuse in the lhospital oni the clay the old miiaterial became otutdated, as or(lered. When wx e tested the ouitdatedI penicillinl it was fotind to be fully potent while the "fresh' batclhes were not. We therefore received permission at olnce from the islanid sturgeoni to use the otitdatedI mlaterial, after it had been tested for Volume 38, October, 1965 Col. Verne R. Mason Prof. Kanshi Sassa :f~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Cap. Jac ,,.,,,,,,,., Ros.Enbau Maj. Milton L. Kramer Hitoshtitmia Medical Diarv, 19-15 LIEBOAV .~~~ ~~~~~~~~~~~~ Pro Maah Mak Col). 'Geor- e \ reaclh LeRoy -g Joh chmbu ~ ~ 8 -* : : Sgt.iJcP.Re Volume 38, October, 1965 A- Rki- Col. Elbert De Coursey l. 3B *s> t - wos :; Commander Shields B'arren s: o$ -faj. Samuel Berg Ma;. Hermall Tarnourer :} :o ::. : :: .: . Hiroshimla Medical Diaryj, 1945 was against general policy, but it was surely wise and it miay have been lifesaving. \We at .hlis timiie also asked for tranisportationl to the Rockefeller nnit on1 Guaml to test both our standard streptococcus and the various batches of lellicillin. The laboratory there quickly confirmed our results. The paratyphoid epidemic which interested Dr. Syverton had occurred h iii an engineering unit on Saipan amiiong 65 miien, somiie of wlhomli ad shot onie of the w-ild pigs on the island and barbecued it in a pit. Those hlo ate the pork on the first day remained w-ell, but most of those who had eaten the unrefrigerated imieat on the second day became ill, and two died. Many miore undoubtedly would have succumbed had lnot all available plhysicianls beeni imiobilized at the 369th Station Hospital to care for the patieints (luriong the acute emergency. The problem was largely one of fluid replacemiient therapy. After the critical first 36 hours the survivors began to recover, but had a court miiartial awNaiting themii on discharge, sinice eating native food had been strictly proscribed by the Commlllandinig Gelneral. Doctor Syverton had reqtuested the cultures for study anid they w-ere thenl delixered potency. This local decision im perso1i. * S.eptcJilbcr- 20: The l)lane, although stripped for freiglht tranisport, had tlhree ceintral reclinincg seats witlh canvas backs, one of which I was inivited to us After a smootlh flight w e landed at Iw o jilima at 2 :00 m. A threeqluarter mlooi was shinilng and the night wx-as wonderfully wsarm and clear. WNre had a spectacular view of iMount Suribachi as we came in. The flattened top loomied over the enid of the air field. The island is a dtusty desert covered anid witlh ratlher heavy browni cinders. There are a few gniarledl twx-isted trees. The impression is qtuite like that of a disheveled Camiip Stoniemanl. Orion, which w-e had not seen for almost tlhree years, again clearly rides the sky near the horizoni. W\e soughlt a middle-of-tlhe-night snack and( founld it after mtuclh wanidering about the airport. Then boarded the plan e for anotlher snatch of sleep and anwoke on take-off at 6 :30 m. The w-eatlher was xvondlerfullv clear all the w\ay ul). Photographed Iwo receding ilnto tlle distanice anid also somle of the Volcano Islanids to the nortlh. The w-eather on our trip to Tokyo had been perfection itself all the way. Yet w-e x-ere to the south and east of a typhoon that was devastating Okinawa and lashlinig central Japani. This wxas to have some repercussions for otur miissoion, since we learned later that color film N-hich was sent to us had been damuaged in that stormi on Okinaw Also Hiroshimila itself suffered Volume 38, October, 1965 severely. The city was flooded and numerous landslides interrupted rail traffic. Most tragic of all was the landslide that killed the scientists from the University of Kyoto at the Ono Hospital. ITEM: NIPPON TIMES FRIDAY, SEPTEMBER 21, 1945 TYPHOON HITS FOOD CROPS Kyushu, Shikoku Rice Affected Vegetable Farms Inundated The typhoon which swept over the western part of Japan late Monday afternoon, caused considerable damage in Kyushu and Shikoku districts. After raging over Chugoku district and areas along the Japan Sea, the storm, said to be the most violent this year, was expected to pass over the northern districts and into the Pacific late Tuesday night. Most hard hit were various districts in Kyushu and Shikoku where rice blossoms were just in bloom, and it is feared in these areas that this will have had effects on this year's rice crop. Inundations, it is also reported, caused damage to the growth of various vegetables. Hitting Kagoshima in Kyushu about 2 P.M. Monday, the typhoon swept over the neighborhood of Hiroshima at 10 P.M. the same day and passed into the Japan Sea via the Sanin district. At 10 M. Tuesday, the typhoon landed in the vicinity of Niigata, prevoiusly crossing over Noto Peninsula, and then headed for the north. In the Tokyo area a strong wind began to blow at dawn Tuesday with a velocity of 18.3 meters a second which at its height registered 29.8 meters and an atmospheric pressure of 743.7 millimeters. As a result, damage done was very slight. For a time the tramcar service in the suburbs was suspended but was restored to normal during Tuesday. * We had our first sight of the mainland of Japan at about 9:30 Tokyo tim There was an electrical almost crackling thrill of excitement as we stood against the windows on the port side of the aircraft to regard and photograph the land that had so disordered our lives. We could see the white line of the breakers pounding a promontory and the dark hills beyond. Many of the villages were intact and looked peaceful enough nestling in the valleys with the terraced rice paddies rising above them, tier on tier. But many of the coastal towns were devastated and the shells of houses and often merely their outlines, were visibl Masses of rubble appeared to have been tidily piled to clear the roads. The countryside looked clean, green, and inviting. In harbors along the coast there were some land based mockups of battle ships obviously designed to deceiv Our course took us over Yokoham As we flew over Tokyo Bay we sighted ships of the U.S. fleet, L Upper. Iwo Jima, Mt. Suribachi shortly after dawn, September 19, 1945. Middl Iwo Jima receding, on the way to Japan. Lower. Landfall, Japan, 9:30 m., September 19, 1945. J'ollittie 38, October, 1965 Yokosuk Uppci-. Approachlitig Kiserazu Airfield. lliddlc. 'U.S. ships of the liine in Tokyo Bay seeni from TBMI oni the vay to Lowcr. Approachi ng N_okosuk H-iroshliima Medical Diary, 1945 L flags flving. At 10:15 m. wN-e touched down at Kiserazu Airfield. We had lhoped to arrive at Atsugi but were told that MacArthtur wotuld permit only Armny planes to laInd there and that Kiseraztu w-as the termiinal for NATS. \Ne were miiet by a YounIg Navy lieuteinant wN-ho helped Uts with arrangements to call GHQ in Tokyo. The effort was entirely in vain. \Ve knew that we were across the bay fromii Tokvo. The lieutenianit told us that the distance by land was about 90 miles and that he had no miiotor transportationi to get us ther \Ve could get to Tokyo by train btit the traiins wvere still under Japaniese conitrol aId were said to be crowded beyond capacity witlh the citizenry whose animilus towsard us we could not jtudg I had no stomaclh for takinig this plunge, wrhat with the initerrtupted sleel) of the niglht before anid the additionial burden of our luggag \Ve tlheni decided that ve would make anotlher attempt to call Army headquarters later and(l busied ourselves with inspecting Kiseraztu. Jack Rosenbauim said the lplace was aptly namiied. The field had been lbol)bed and remniiianits of Japanese lplalles were still scattere(l al)out in (lisorder. japanese gtll emiiplacellmenits and dtlgotits ha(l leen left exactly as tlhey wer At wxater's edge we saw l)eople gathering utssels peacefll}v fromii the foul-smiielling water. Oln the field there wsere tlhree hlite plalnes of the DC-3 type miiarked withlgreeln crosses. These wN-ere said to have flown the Japanese peace envoys. The ilnteriors wvere well fitted-out w-itl)lish seats, but in comiplete disarray. 'Many printed and p lhand-written (locumiiienits wvere scattered about in the aisles. I saved a fews as souivenirs. Tlheni retturnied to makce another atteml)t to ring Tokyo agailn without stuccess. After somiie coffee anid fturther talk with the sympathetic flight officer, le stiggested that he could have tus flown in TBM's to Xokostika Airfiekl onl the great islanid naval base off Yokohama now tuiider occupation 1y otur Navy anid 'Marines. This wotild at least bring us to the proper si(le of the bay and 60 miles closer to Tokyo. I hald no clear idea of what a TMAI was, but agreed wsith enthusiasm. These tturned out to l)e sin,gle-enginied torpedo bomibers (Martin) which, whlile not designed for tranisport duty, (1o very Nell in a pinch. Luggage is put into the bomb l)ay. One passeniger rides in the gunner's seat behind the pilot and the other in the seconid otiliner's blister below. Two planies were assigned. Col. LeRoy aiicl I rode in the first anid iMaj. Tarnower andl Sogt. Reed in the seconld. A party consisting of Capt. Rosenbatim an(l Sgt. Archamlbauilt w as left behind, to be dlelivere(l to Yokosuka as sooni as onie of the first plaines retturnied. The flight to Yokosuka occupied only a few miiiinuttes and wve w-ere soon retunited in a hutge hanigar that was a miiadlhotuse of activity. At flight conitrol, which Nas uniider commlnlalnd of Marine Aviation, mlet Marine MIajor Volume 38, October, 1965 White who said he didn't like the Army but would nevertheless fly us to Tachikawa airfield in TBM's if we didn't mind riding pick-a-back. He said that although MacArthur had closed Atsugi to the Navy, Tachikawa might still be open to "the enemy"-at least he had no orders to the contrary. We then quickly flung our luggage into the bomb bays with admonitions to the jovial pilots to keep them closed until we were at least over land. I rode behind the pilot in the gunner's seat and Capt. Rosenbaum rode in the blister below. I'he view was magnificent. The ride was rather a thrill since our pilot suggested that we might like to see the Japanese fleet closeup on the way. He swooped low over the ships, many of which appeared to be dummies with wooden superstructure and mocked-up guns. Others looked to be of the first-line fleet but seemed largely deserted. We touched down at about 3:15 p.m. and the pilots hastily roared off to Yokohama before too many explanations of their possibly illegal presence could be demanded. Tachikawa was apparently a secondary airport. Many of the hangars had been blasted but others were still quite intact. Innumerable of our C47 and C46 planes were all over the field. Our efforts to telephone the Chief Surgeon at Tokyo again were completely unsuccessful as the lines were still not in continuous working order. After explaining our mission we were very kindly assisted by Lieut. Flook and Sgt. Bowen. They assigned us a station wagon and we were on our way to Tokyo, only 20 miles away. Tachikawa itself showed very little damage except for what we were told was the Mitsubishi airplane factory, which had been badly smashed. The countryside on the way to the capital itself was lush and beautiful. The road had long straight stretches with very few crossings. Along the streets in the villages and even on the main road people can be seen dragging carts hugely piled with all sorts of goods and belongings including some apparently newly made boxes. Trade is obviously already beginning to reviv There are also many trucks with smoking, smelly, vertical wood burners mounted at the rear in substitution for the gasoline tank. Many are stalled since we are told that they require cooling, stoking, and cleaning at frequent intervals. Along the way are innumerable children who smile and give the V-for-victory sign. The grown women smile wanly; adult men are impassive but show no sign of hostility. As we entered the outskirts of Tokyo itself the horrible residues of fire and destruction were everywher Block after block had been flattened and only tall chimneys and a few concrete structures were standing. The streets had been cleared and rubble had been piled as neatly as possible out of the way of traffic. Only in the central portion of the city and the immediate vicinity of the L Emperor's Palace was there a concentration of relatively intact buildings. One of the most imposing of these was the headquarters of the U.S. Armed Forces. It was a many-columned marble structure, formerly a life insurance center called the Dai Ichi building. General MacArthur's five-star black limousine stood parked in front. Tall white-helmeted military police were on guard at the entranc Shortly before 5:00 p.m. we met the Surgeon, GHQ, Advanced, Colonel Bruce Webster, on leave from Cornell, who said that he had been expecting us, seemed not too surprised at the difficulties of communication with Tachikawa and was in every way cordial. At his suggestion we presented our orders at the NYK building. Our enlisted men were assigned to quarters in the "Finance Building," a huge hollow square of massive gray stone where they were registered at the Headquarters of the Second Battalion First Cavalry Division. I was assigned a room at the Dai Ichi Hotel, roughly a mile from headquarters. This was a massive white-brick cubical structure with a tall chimney from which issued quantities of black smoke suggesting warmth and comfort. It stood in the midst of a devastated area stark against the elevated railway tracks and we noted that trains were running, all overflowing with peopl I silently gave thanks that I had not chosen this method of entering Tokyo. Colonels and ranks to major were assigned to this hotel. I called Lieut. Kaiser at the Commandant's office and was able by special dispensation to obtain quarters with the rest of us for Capt. Rosenbaum. Elevators at the Dai Ichi were running perfectly and the atmosphere was that of a comfortable commercial hotel. The rooms were more than adequate, many supplied with private baths. Each had a very short and narrow bath tub lined by clean, small, rough yellow tiles. On each floor was an open office filled with affable but evidently poorly nourished young Japanese men eager to take laundry and perform all services. The first supper at the Dai Ichi could hardly be believed, after almost two years on Saipan. Food was actually served by charming Japanese ladies in colorful kimonos-the womenfolk of the men who would gladly have killed us little over a month befor just at the end of supper who should appear but Col. (Scotty) Oughterson in complete battle dress, looking healthy and happy to see us. He told us he had just come from Hiroshima and had seen that city as well as Nagasaki with members of the Manhattan District survey team that had been sent from Washington. They had made a preliminary survey of damage, residual radiation, and medical effects. Scotty's old friend, Stafford Warren, was with the group. He had been in charge of the medical depart97 Volume 38, October, 1965 orF[RFv hi~~giI I . Uppcr. The Dai Ichi Hotel in Tokyo, September 1945. \V:elcomiiig smoke belchies fronm the chiliiminey. Although imiainy of the surrounidiing buildinigs are rubble, this structure is intact. Lozwcr. View from room in the Dai Ichi Hotel, at dusk. On a clear evening tile silihouette of Fujiyama 80 miles away can be clearly seen. Hiroshlimsla Mledical Diary, 1945 L miient of the Manhattan District through the Nvar. \Vrarren s grotup would brief us at the earliest opportunity. After dinner had a long talk with Scotty. Now for the first time we heard what our own mission was to be: the definitive study of the casualties, the collection of old data and mnaterials, the determiniation of factors of distance and protection, and the preparation of a report on the medical effects of the atomic bomb). Bothi cities were to be investigated. I asked what help and equipment we would hav The reply was that we would be divided inlto two teams and that Col. Verne Mason would be senior miedical officer at Hiroshlimna and Col. Elbert DeCoursey at Nagasaki. MIy assignment would be at Hiroshimna and George LeRoy would be with DeCoursey. \V;e theni decided that Rosenbaumn would stay with me as he lhad throughout the war and that TarnowN-er w-ould be with LeRoy. A few more American miiedical officers were on the wvay, but mllost of our associates would be Japanese investigators aand physicians wlhose help Scotty had enlisted tlhrouglh the Jalpanese government. Dr. Tsuzuki would make the arrangemenits. He was Professor of Surgery at the Tokyo Imperial Unixversity and lhad beenl ani Admiral in the IMedical Corps of the Japanese Navy. Scotty said that Dr. Tsuzuki was also a dlirector of the medical divisioii of the Japaanese Researclh Council ancd had the best possible contacts throughout the country. In reply to mny question, Scotty said that despite the formnalities of "purging' of formier Japanese military personnel Dr. Tstuzuki was of suclh stature that he expected no difficulties. As for equipmiient, the answ-er was simple-there just was nonle and we would have to get it ourselves from Americaln hospitals and sllips and on loan from the Japanese institutions. \We were at once to mlake up a list of what would be needed for the study. Scotty then showed me a copy of his memorandutm to General Denit which outlined his plans as he first conceive(l themii. Tlhen to bed full of w-orries, but lulled by Neariness an(l the sound of whlIistling trainis, and for the first time in malny years the ruimble of a city. Colonel V"erne R. Mason had been one of the senior medical consultants in the Pacific theatr He w-as a graduate of Johlls Hopkins who had practiced in Hollywvood for many years aud had had a nutmber of famnous movie stars and other HollywoodI personalities amonig his patients. Colonel Elbert DeCoursey, M.C., anl outstaniding pathologist later to become a Major General and Director of the Armed Forces Institute of Pathology, was the only regular officer to be assigned to the group. He hiad been laboratory constultant in the Pacific theatr I hlad met both men on Saipan in the early T'ollittie 38, October, 1965 spring of 1945 and w as greatly pleased at the opportunity of being associated with them. * Septemiiber 21: To the Chief Surgeon's office at the Headquarters Buildiug early in the imorning where we miiet Captain Nolan of the Manhattan District, a tall and very affable young miian Nho gave us some preliminary details concerninig Hiroshimll MIost interesting was the fact that now at Tokyo convalescing from an illness was a 'Major Motohashi who knew the fate of troops that had been stationed at certain definite places in Hiroshimna at the timle of the explosion. Obviously he was a miian w ith wh-Ilomn to become acquainited. According to Captain Nolan, the Americans had been using Geiger counters and other detection equipmiient and had found no significant residual radiationi. Apparently almiiost all of the radioactive miiaterials were blown highl into the stratosphere and were replaced by air fromii the sides. However, it had rainied twice after the catastroph Most of the patients thlat had been withiln 1,000 yards had died. \Iany had multiple petechial hemorrhages and injury to the bowNel. While in the Surgeon's office, I was given a mimeographed report fromii one of the Japaniese commllllissionls that had been to Hiroshima to study the bomb effects. This report was entitled "Physiological Effects of Atomic Bombing of Hiroshimiia" and had been translated by G2 (Intelligence Service). The subscript described the report as "Full Translation of Handw-ritten Carbon-Copied 'Reports 1 and 2 by Squad Investigating Atomic Bombing of Hiroshima,' Issuing activity not stated, dated 1-2 Sept. 1945." This report w-as a systematic accounit nine pages long of patients treated in the Ujina Branch Hospital, which had been opened on August 25 wlheln 500 patienits were received. It classified patients as those who had suffered burns the and those wX-ho had not. The former, when inl zone of radiation injury, lhad a inmuclh worse prognosis than unburned patients. 'IThe latter had developed alopecia at the tentli day and then after August 20, fourteen days after the explosion, fever, hemorrhages, and diarrhe Leukopenia was also dlocumilenited. The clinical descriptions were by -Major -Motohashi. Surgical notes w-ere by Professor Tsuztuki and Ishikaw Tlhere w-as also a descriptioni of autopsied patients by Dr. AM. 'Miyake, listed as Assistant Instructor in Pathology at the Toky o Imperial University. Amoong the treatments listed w-as autotransfusion of 20 parts of blood and two parts of citrate injected intramituscularly into the thigh. The report also contained a map show-ing the center of the explosion and the location of a number of the patienits included in this study. The translation lhad been wN-ell dlone by laymnien but contailned a few bizarre sentences such as, "The red corptuscles 1lit-osliitnza Medic al Dia ry, 1915 L LIEBONVY slhowed sio-ns of multiple dyes'" whliclh, tranislated from Englisli inito mnedical terininolliogy. 1 presumed to ml-eain "polvchromiatophili" ILater informiiationi disclosed that this j apanese mle(lical report was the first version of a very muticli loniger report p)roduced by personniel of the Tok-yo First -Military Hospital and the Tokyo Imperial tlniversity, whicl was issned mnltclh later. The finial report comibined not only these early observations, w-hiclh were sutbsequently commnniitiicate(d to the Amiiericai mllembllgers of the joilnt Commlission, but also observations miiade (ltrin(g the operation of the Joint Commllllission in Hiroshlilml This final report first was issued in mimileograplhed formii and by several years after my retnrn was undergoing deteriorationi. One copy was tlherefore lamiiiniated for preservationl in the Yale i\Iedical LibrarY. Later that morniing in the Surgeon's office at Headquarters mlet Professor Tsuzuki, the Professor of Surgery at the Tokyo Imperial tUniversity whoml Scotty had mienitionied previously. He was a tall, impressive, digniified gentleman, obviously a commlilaniding presenc His use of English was perfect and it wN-as soonl revealed that he had studied oncology and radiation therapy at thle University of Pennsylvania in the 20's. Doctor Tsuzuki was fully al)prised of the purposes of our mllissionl and was in complete symupathy wvith the necessity of performinig a complete medical study. He stated that both superior mledical personnel and skilled students would be supplied as teaims to lhelp in the wsork. The University of Kyushu near Nagasaki was to pro'ide similar help to the group that was to be quartered ther I mentioned the need of equipment and materials. W\Ve agreed that a list must be made up at once and that w-e should meet the Japanese who would be working with us on the next morning to discuss what would be needed for the actual mission. Colonel Oughterson invited Professor Tsuzuki to supper with us that evening. In the meantime w e were to make an expedition to tap Amiierican sources for as mlluch of the necessary equipment and materials as we could obtain. Spent the rest of the mlorning at work with George LeRoy and Jack Rosenbatimi preparing an equipmlent list. In the early afternoon drove with Oughterson and LeRoy the thirty miles to Yokohama and the Eighth Army Headquarters where the office of the Eleventh Corps Surgeon was located. A broad highway connects Tokyo and Yokoham It is still rough and pock-marked with poorly repaired bomb craters. Traffic is heavy anid slow. Along the side are the inevitable hand-drawn carts. Numiierous of the lumbering wood-burning Japanese vehicles weave in and out and frequently become stalled. There is much impatient military traffic, chiefly of heavy trucks. What must have been numerous houses and factories and banks have been thoroughly pulverized and there is now a stark plain from which rise the chimneys of houses and factories. Often these are intact, suggesting that fire rather than blast had destroyed the buildings. Most grotesque are rusted bank vaults still standing stolidly on heavy foundations. Yokohama itself has also suffered much, but some of the major buildings are still standing. At the Surgeon's office every help was promised us. However, we were informed that medical supplies were extremely scarce and that they were not due to arrive for quite a long tim We then talked with Major Partridge to whom we supplied a complete list of the most important materials that were desired. He at once brought this over to the warehouse of the 29th Medical Depot Company for search. Then "home" to the Dai Ichi Hotel. Professor Tsuzuki arrived promptly at 6:00 for supper, which was had, after a little whiskey, in Colonel Oughterson's room. Colonel George LeRoy was ther At this time various gifts were received by Scotty including a wonderful cypress wood Daruma statu This represents a priest belonging to the sect of Zen whose chief occupation was thinking. I thought the gift appropriat The talk is largely on the cooperative nature of the venture and the types of studies to be undertaken. Doctor Tsuzuki said that there were still many patients in the hospitals representing the more serious cases of aplastic anemia from radiation injury and that these required detailed study. Japanese investigations were still proceeding. Many of these had been begun weeks previously. We would try to consolidate all of the information from these various groups as well as ourselves carry on a direct study of survivors, both in the hospitals and clinics. Doctor Tsuzuki promised to have prepared listings of all hospitals and investigating teams that had records and materials, and assured us that everything would be made available to us for a joint report. As for our own work, systematic records would have to be kept. We would need to design a standard record form which would include not only clinical and laboratory data but also information on factors in protection such as shielding, clothing, etc. We agreed that duplicate records would be kept and the forms prepared both in English and Japanes Doctors Oughterson and Tsuzuki promised to design a record form and submit it to us and others of the group before it was finally duplicated. For record keeping a map would also be needed, circled to indicate various distances from the hypocenter and also divided into sectors. These would assure that patients from all parts of the city were represented. A properly designed survey would rS Upper. Tokyo Imperial University in 1945. Lower. The Institute of Pathology at the Tokyo Imperial University. indicate whether the effects were symmetrically distributed. Doctor Tsuzuki said he could find some good maps and Scotty thought that our map service could make the overprints and reproduce as many copies as were required. Doctor Tsuzuki stated that the "Japanese young doctors" who were to work with us had already been selected and were on call. We agreed that we would meet with them at Tokyo University in the office of the Dean of the Medical School tomorrow morning at 9:30. The evening was a pleasant one, and I received the impression that we were dealing with a highly able and intelligent man of honor. * This impression was abundantly confirmed in all of our relationships subsequently. Professor Tsuzuki was also a man of spirit and was quietly l'oliiiiie 338, Oclober., 1965 Uppcr. Left to right: Dr. Ishii, who was of the greatest help in the pathology studies in Japian, with assistants Ebato and Shimamiini The latter performed much of the histological work in Hiroshim Lower. Members of the Joint Commission. Fronit row, Drs. Hatano, Murachi and Nakao; rear, Drs. Kato and Kakliehi. The late Dr. Murachi was a brillianlt biophysicist to whom is owed miluchi of the w-ork on the shieldinig studies. Hiroshlimfla Medical Diarv, 1945 V confident that his country would regain its stattns. One evening. mlvany eeks after we had arrived at Hiroshimila, in a lecture on burns attended by somle of the Americans and therefore given in English, he said: "Unfortunately my studies oni burns were interrupted by the end of the war, but my son will carry themii on." Twenty years later his sonl, Dr. Masakazu Tsuizutki was indeed studying cardiovascular surgery at the Tokyo University undeler Prof. Seiji Kimoto. Septeniber 22, 1945: On this, a Satturdlay mlorning, we miiet for the first time the groupl) of lapaniese physicians andl investigators who had been sumiimoned by Professor Tsuzuiki, the meni to assist tus in the atomlic bombl) investigationi. I was amlazedl that they couldl be gathered withil the brief span of timle since our (lisctussioln of the previous evening. It left little dooubt regarding his power an(l influenc The scene in the large conference rooml at the University was unlforgettabl At the large T-shaped table coverel with a dark-green cloth were places for the senior Americans and Japanies Against the back of the oak-paneled chamber, rigid and expressionless, almost immobile, there sat in rows on straight-backed chairs the flow-er of the younger mledical talent in Japan. Tea was served. Introdcuctionls were formal, andl somewhat strained. Few of the Japaniese could speak English w\ith the polished accuracy anid fluency of Doctor Tsuztuki ancd somiie knew only a fexv words, but could commuiinicate well x-ith those of us who spoke German or French. Amiiong the mlost imlpressive of the senior mlen was Professor Sassa, the head of one of the university medical (lepartments, a mlanl well-trained in physiology who had worked in London with Starling, and Dean Tamiya of the Medical School, a bacteriologist. Imlpressive also were Doctor Yoshikawa, a chemiiist and Professor -Miyake who had just been miade Professor of Pathology, a towering, graceful, man with a grave, aristocratic manner whose second language vas French. Colonel Oughterson made a little speech in which he emuphasized that the war was over, and that in any event science was nonipolitical. He sai(l that physicians and inivestigators ha(l a loyalty to science, and that the needs of mlankind wotuld be wvell-served by a thorough and informe(d study of radiation effects; that the study could obviously not be performed by us without help, not only because of the language barrier, but because we needed the highly skilled medical scientists for which Japan was famous. Finally he stressed that the work would be truly a joint effort, that we would expect the full cooperation of the Japanese in obtaining complete infornmation, but that it would never be our intent to rob them Tloltittie 38, October, 1965 RESTRICTED GENERAL HEAD;ARTERS UNITED STATES ARMY FORCES, PACIFIC 119 AGPD-A Advance Eohelon AG 210.455 AGPD APO 500 22'Sop 1945 SUBJECT: TO Order. Off & EM concerned, orgns indicated. EM now on DS Advance Ech, this hq, w rr Fol-named off Hiroshima, Nagasr,?k and such eth. r .-.;aces adjaoont thereto as may be necessary on TI;Y for the p.::ue ofcrrying out instructions. Off & 'ii are aut.h te between Hiroshima and Nagasaki at such times as may be rnec6ncary in the acoomplishment of their mission. Upon cr.mpl .L. ret tiis st Tvl by A mil acft is dir for accomplishment o:C an emarg war mission. Govt mtr and water transportation au'-. Personal baggage not to exceed 50 pcunde auth each of,i'c Ei.I whi.l traveling by air, Provisions of par 26, AR 35-4820, 19 Apr 45 apply. Per diem auth each EMI while arayvling by .Lcft in accordance with Sea I, AR 35-4810, 19 Apr 45, Use o- Tzvt qc and messing faoilities enroute by EL is mandatory. G.C * P'452- 0O2 A 212/60425. -< 046'zr=9 MC Z.9th cGen Hospital, APO 244 'JLT COL AVERILL 04l1336 MC 374 th Gen Hospital, APO 1O5 LT COL GECRGE V. LeROY 0482b55 M Gen Hospital, APO 247 MAJOR HERMAN TARNOWER 04031X' i.; 0.0 ttL CGen Hospital, APO 2" 39t>t ICAPT JACK D. ROSENBAUM Gea Hospital, APO 244 310O)'j8,q%' / T Sgt John P. Reed Teo 3 John J. Arclaambault 7.1- P5220 30 th CGen Hospital, liPO 244 By command of General MacARTHUR: MEajor, G.D. Asst IAdjutant General W. BOLL DISTRIBUTION :Off & EM concerned (5 eal Chief Surgeon, Adv Ech (1) 00 39th Gen Hospital, APO 244 (1) CO 304th Gen Hospital, hPO 1058 (1) Fisoal off, AFWESPAC, APO 707 (1) Dir LR Div, AGO (1) Dir Contl Br (2) AG GH4 (8) AG Rear !ch (1) AG-Records (7) AG-PE (1) Hq Cordt, Adv Ech (1) RESTRICTED Orders to carry out imiissionI at Hiroshima and Nagasaki. L of the fruits of their thought and work in publication. Dr. Tsuzuki translated these remarks as they were spoken. He then replied in like spirit in English and Japanese and gave assurance that the best men would be available, that they would work and help unstintingly and that they would withhold nothing-in accordance with the expressed wishes of the Emperor. He expressed the hope also that this effort would be a first step in restoring to normalcy scientific relationships between our nations. As we later mingled with our colleagues-to-be they seemed very intelligent, alert, active, and eager to begin. If there were fears and reservations, these were not difficult to understand, and were in any event well-hidden by the quiet formality and reserve of the meeting. We then went to the Pathology Department which had a large building of its own. Here cups of Japanese tea were again served. This was, although unsweetened, sweetish with medicinal overtones, of a pale yellowgreen color, altogether warming and cheering. It definitely helped to introduce and smooth conversation. At this time the plans for dividing available young men into Hiroshima and Nagasaki groups for the pathological aspects of the study were discussed and a tentative arrangement was arrived at. We discussed what equipment would be needed. Professor Miyake also told us of what pathological materials had already been brought to Tokyo and said that he would give full cooperation in their further study. Immediately after luncheon Colonel LeRoy and I made another arduous trip on the crowded road through the devastated landscape to Yokohama where we found, much to our terrible dismay, that almost none of the equipment or materials that we had requested through Major Partridge were available, except for some nonspecialized bulk items in classes 7 and 9. We made a list of these for requisitioning by Colonel Webster. Then, by accident, we heard that an abandoned Japanese laboratory was housed in the very building where Lieutenant General Eichelberger had his headquarters, and that there was another several houses away on the same street. We went at once to the building and found a remarkable picture of wanton destruction. The laboratory had apparently been used for analyzing fish meal and similar materials and contained large quantities of bottled chemicals. Many of the labels were in Japanese and unintelligible to us. An abundance of glassware was present, which was of enormous help to our spirits. Then home after an extremely rough ride over the craterpocked roads. Stopped in Colonel Webster's office and obtained from him a requisition for the items in stock at the 29th Depot. In the evening had a hot bath, a good supper, and then made a search for Sgts. Reed and Archambault. However, neither was to be found. I left f'oltitiie 38, October, 1965 a note for themii informiinig themii of progress. The w-alk back across the long dark alleys was ghostly w-ith the skeletal hulks of buildings lining darkened streets and hundreds of burned-out cars lying about in confusion. Founld Col. Oughtersoin and told him of our discouragemiient in locating equipment. I showed him the long list of things that we required wlhiclh wtere listed as nonavailable at the medlical supply depot. There were only a few glilmmiiiers of hope in that according to 'Major Partridge mlaterials vere dailv comiiing off the ships at Yokoham LeRoy and I were plalnning to retuirn there tomorrow and would( check further on this poilnt. Scotty adlmitted that he was suprised that medical material w-as in suclh short supply, although after all, Ne had been in the country in force for not more thani two weeks. He had alreadly incquired about equipmiient at the 42ndI General Hospital which had opened a short timle ago in Tokyo. They couldl spare nothinig and were able only to beg a few items themiiselves fromii the hospital ship "AMarigold" w-hich was in the are He w-ould( obtain a list of other hospitals and their locations fronm the Surgeon's office anid would senid various members of our group to forag He sail also that we coul( always be sent what we neededI after we aot (lown to our laboratories anid that hospitals w-ould undoubtedly be opening up in southern Honshu near us. MAly reply w-as that it w-ould be muclh better to have everything in hand so that we could start work at once on what would probably be a dNindling patient populationi. One bright spot after a (lishearteninig day was the arrival of Colonels DeCoursey and Mason wsho were bubbling with enthusiasmii. They said that they had been worried about us since several military planles hadl been lost in the typhoon- of 17-19 September. \We assure(l theml that wve wvere in the clear smiling sunshine to the sotutlh and east. DeCoursey was reassuring about our supply troubles, saying that he knew that plenty of everything was on the way. Septemilbcr 23: Set out again for Yokohamiia bright ancd early by truck with George LeRoy. W\Ve first went to the warehouse with our official requisition to obtain the supplies that were said to be in stock. These included: 50 gallons of DDT; 10 hand sprayers; 48 Freon aerosol insecticide bombs; 24 mosquito bed nets; 10,000 multivitamin capsules; a milass of housekeeping supplies such as soap, Brillo, etc. We had every intention of keeping well w-hile in Japan. \Ve had no clear idea of the circumstances under which we might be living and therefore determined to come well-prepared. WNe were concerned about Japanese type B encephalitis, but acttually found mosquitoes as well as flies Hiroshimtia Medical Diary, 1945 W LIF.BOW A -A Si ; rco m r drc Scribblings listing possible sources of materiel, with directions. T'oluttie 38, October, 1965 to be scarce hy the timle N-e arrived in Hiroshimll The multivitamin pills were to be used as "treatment" for patients in the clinics, since we had been advised by our Japanese colleagues that custom required the physician to give every patient some type of treatlmient after examining him. Actually the fee is considered paymlent for the treatment, not for the diagnosis. The vitamin pills w-ere good-looking, would be entirely acceptable to the patients, and could certainly do them no harm-i. WVe found, however, that they caused us one problem since somiie patients thought they Nere endowed with miiagical properties anid therefore camiie to the clinics mlore than once, thereby introducing a slight bias into our survey procedtures. * Theni on advice of Maj. Partridge to the warehouse of the 268th Qtiartermiiaster Battalion w-hich w-as located after a little difficulty. No officers ill authority w-ere present. Crates of supplies were continually arriving by truck fromii the docks. \We founld a tractable sergeant who w-as directilng the work. We told himii of our mllissionl and of our desperate need. He said that mllost of the crates contained mixed goods and that the only way to tell what w as in themii w-as to read the manifests. MIost of the material destined for the hospital conisisted of sponiges, urinals, and the lik Somiie of the crates, however, amiiong other things, containied some laboratory supplies. Those that w-e designated wx-ere cheerfully opened on the spot and the required materials identified and laid asid The procedure w-as somiiewhat irregular, but everything w as considered expendable and our sergeant seemiied not to have a wN-orry in the Norld as long as we signed for what wN-e took. We told the sergeant to keep a sharp eve out for mlicroscopes, centrifuges, and other miiajor itemiis and we would be back in a few days. We wNere graciously invited to lunch at the wsarehouse-a lunich which conisisted of a large square of Nell-prepared "luncheon meat" in a blanket of scrambled eggs. This was a illuch tastier meal thani the "Spain" that had been our lot in many of our island experiences previously. Then off to raid the laboratory that we had inspected on the previous day after obtaining a large quantity of packing miiaterial fromii the quartermlaster. Things were then rapidly loaded onto a truck wsith the aid of our very cooperative driver. A Nonderful spirit of helpfulness Nas displayed by all with wlhomii w-e cainie in contact and there was practically no red tap A disturbing ex)erience wx-as the hunit for a balance that wN-e had noted on the preceding day in the headquarters buildinig. After a thorough search, iwhere it had been moved since the this Nas discovered in anotlher room preceding (lay. \Ve considered ours to be the prior claimii and in the absence Hiroshima illedical Diariv, 1915 LIEBONV of dissension made off with it. Then a long, cold, and bumapy ride back to Tokyo and on to the University, which we found after much difficulty in the dark. Here, in the Pathology Department, wve dumped all of the miiaterial that wse had acquired. There wN-as considerable excitement at our haul. The Japanese wvere especially interested in the DDT and the aerosol cans. After a hot bath, an additional wsarminig wsas had over some Canadian Club and everybody wA-as in high fettl Later there Nas a meeting in Col. Oughlterson's room all hands present including Capt. Nolan. There was niltclh winid and little turning of the mill was accomplished until Ne got dow-n to the serious business of discussing details of the record formls N-hiclh Dr. Oughterson had roughed out. His considerable experience with abbreviated records in the Connecticut Tumor Registry, of which he w-as one of the founders, had stood us in good stead. It Nas well-designed and occupied only two sides of a single sheet. Names were to be recorded in botlh Japanese and English. All locations were to be by zone number of the mllaps that had been designated and were in preparation. Some ambiguities were clarified after argumnent. \Ve agreed finally that in the short formii certain rules of thuml)b wrould have to be followed; for example, dates of onset and cessation of sigIns anid symptoms w-ould have to be inserted wherever possibl The fornm stressed radiation injury and factors in protection. WTe realized that there miglht be some difficulty in distinguishinig flash burns fromn flamne burns. Presumably Dr. Tsuzuki's group N-as making a simlilar critiqu Scotty also reported that the miaps were to be ready in a day or twso and presented us witlh the list that wTe needed of hospitals in the are \Ve agreed with enthusiasmi- to mlake excursions to these in search of additional supplies. Since I w-as plainining another trip to Yokohamiia in a few days, I picked the M\1arine General Hospital at the Yokosuka Naval base and the 161st Station Hospital. * \V;'hein these records wsere designed, we did not sufficiently realize the diffictllties of identifying persons by their recorded names in Japanes Siince alternatives are available, transcription is especially difficult. We erred also in Inot recording the original home address of the persons as an additional means of identification. As the records were being analyzed, some imiisunderstandings came to light with respect to "epilation," since in soImie instances no distinction was made between epilation resulting from radiation effect and that resulting from burns. This in large part w as more a difficulty of the examining physician in comImIunicating with the patients than it was a fault in the design of the records. Similar problems f'olume 38, October, 1965 .sTCV>- B2.B 27:.I'- -- ;2'; C.' iae T oc ation. I. en in r-'cd ~,ge "ct . by c B3r.b u rn 2'uat`:on or rank nua 2r) nzb 3? aSt RaJ, aton ICIyfnr Debris rallinC -7alls etc. ,. ?Dri7ar, Injury b3-p 2ec_rndary Injur,, h: -DS,t C.n: Burning, Buildinf,g 5. ro,-ct4on ,f,t &( tI a kC-) ldnE, t.ri Ir i;l.w,rr b. lndc'ors: ('utdoors: I; Br- cl; h ab .r _o2cro ,e .-aneesa -auiliing 2-ve-_d in ^,TjO''l d. Clothing ar 1ILph, 2nc; 3al.iilc ;.all trench"I jehind trce,post etc. r-l Any other nr-'tccti-n 'ere oth,-r. nreso ntBurns: re t Dogroc-l.t 3rd ea,rpccnt .,art (,adLat-or.n ffects: Sy. i_u rt OcanJr.ds . Bic inf .--.d '; ota ca 2! LOO ?(s 2r .orc rrhaee Cr_______________ ~ ~ ~ ~~~~~~~~~~~g a_<,~ ~ ~ ~ ~.-. SPEcs 4ilaticrn 9"* si"' o:tea YI" jg ~~ ~~~~~~~~~~~ -r'bros: _Y B.ard Dark'?.+cd Brown. :ed CitoitaliaE / .~b'3ruutc ir a- ,~ ~ ~ ~ ~ Chortimst oto r L cWI "hIr indicotocd mal,e sno-)cial ncr.tion. of 31hiold:inj from ga-.T-'a rays: 3last ffacts: *i Le ee 4e,~~ Front face of record form used by joint Commission. \Vritten in are original notes used as basis for discussion wxith Japaniese miembers. IDSNI BAUDMA 3AIGAI 7&A JIK JUSF!I? TSKIHI ath1zI TT'TAT, HO n S7I 3!rJKTGYf "TAra KATKIff 'AING'.!SiA &SHO(ATEM) KO:OqW BAsKUGEKI TOJI NO IDOKCTRO C TZU NI NTCW TAIBATGO 2. SAIGAIIN. IGHIJISEI; P t.C31 A, N&.J'JA,FF- PIJ SI; RSMi. GA r ici. B'&IJTrAT b. sVKj ,T iI ,I, 'T .DI '.r;'I :0 .-IGI ,US1IRO HIIARI) OIKUNAlt(NA'Nt!r D;T' NO N.RE:'J)XON:RIT1 E2EtIL 'V&T'.'. K:-G MOKUZ3 CIOUSAn d. OKUGAI:AsITHO,.T.:. V1. K;,G?I. '.K'(xo -BAKUPJ.WO 8-iC.' RIT0,vTO,OIUZ,RBGA SO NO T) f.',Bt.O:-CTTIJ5 g. W2.Ti CtIli'.,OI,T.-,UuPI,riDi.U2TTO,Ki .) 1WNO(SRuTRUI,TAsIT, IRO) h. BONOTA mEl I(B6S!II ,TTSrU V.KO,TfMXtRO) 4. KTNPM T'.NIN NO UWI SONO HIGI.J I NI"I S. N3SSH'sThIDO 6. HN 7. GUSTO.ST1ITI TlIDO TOJI NO MNOM 9. SONO GO NO .B"0I J&AI,B KI&;.U(TOS-FI OYO?I BTEI) S0IOflI,wI,TST SCo lo ICEIX. T3UTCUM QYOPI SUIX.&., b. nlT&I .TSa o.l d. E: Y IK MO GU1I f. HI.!'LITAIM h. KMIR3N g. i. SN0Tr,b >ERI3 J, SHO.'CUS!I 1. M ;wTjL'rU8r YI'SU.: BUI k. .Y'l'Au SA:RUI(T'N, N, T3IlO(fI.'3TO) D'l) HIMRt I AXl;I o II"=MJI I'IV.;', m. S SUzm, T=S-PEX,'3T U NO, SONO -O KUI.IEN IGIN3N.Er!GMTSIT. Japanese record form used by Joint Commission. Volume 38, Octobei-, 1965 were encountered with reference to hemorrhages, since some of these were traumatic or associated with disease unrelated to radiation. Human frailties involved in filling out questionnaires and records were revealed when some 35 instances were discovered of what were thought to be duplications in over 6,000 cases. The congruence of recorded facts, even as to dress, was far from perfect. Yet in general most of the major facts, although recorded by different observers, seemed to have been accurately stated and furnished a basis for confidenc * It was already considerably into the next day when the meeting broke up. In my room, I opened an "acipak," the soldiers' comforter, and found some cigarettes, fine for small gifts and tipping, some hard chocolate, which was the object of my hungry search, and some shaving equipment. September 24: On the way out to the University, went in search of our sergeants, since we wanted their help in packing our plunder. Found them and learned that they had been visiting the Nikko shrine some 90 miles away! They were among the first Americans to be there since the war. During the morning, major decisions on the disposition of the Japanese physicians were mad Drs. Tsuzuki and Nakao and our senior people considered the list of 25 whom we had met several days before in terms of specialties so that we would have a reasonably good distribution of talent for the two cities. On advice of the Japanese, who thought the load of work would be greater in Hiroshima and said that Nagasaki had a well-established group of Japanese physicians at the Navy Hospital, 14 were tentatively assigned to Hiroshima and 11 to Nagasaki. I marked the names of those assigned to Hiroshima with an "H" on my list. Dr. Nakao also wanted to be part of the Hiroshima group since he had been studying a collection of bone-marrow slides and peripheral blood from patients there collected by the team from the Tokyo First Military Hospital and Medical School and the Tokyo Imperial University. The Hiroshima group also was to include Dr. Murachi, a biophysicist who had done some of the earliest measurements of residual radiation and other physical effects. * Dr. Kiku Nakao was a charming young Assistant Professor in Dr. Sassa's clinic who proved to be a brilliant hematologist. He made numerous major contributions to the work and to our happy collaboration during our stay in Japan. After the war he held an investigatorship at the Argonne National Laboratory in Chicago and spent a pleasant few days with us in New Haven. Later he became Professor of Medicine at the Tokyo National University. o. so 6. 7. i. Pe oubls ur. hsuM r. TIhii Dr. .aftra W Lt. KMabo. a Dr KitatoH Dr. TlUImd Dr. Isk&loto or . w.r' Pelo1qXtt fttholog PSthltW7 flobt Xintmo LeIns,d SpLvehaeis Intoal odlolnj, 'ebbVU1 In trnal od eIns# CllnlOal twlog Intornal e4d1*1ne, 10. 11. U. Internal -odLe1no, Me Lt. Thm.lo, Dr. YY a 1. J r .WPtDtl_4 Tor&;w M3 rm 1 1 11. 1W. Jws 16. Dr. Jaj1tanl '1 D6. %i. 19. U. 0taae NIla I*. Usma1 Dr. Oqsh N -r. _ 33. Di. u_diwo 54. Dr. 0h1 35. Dr. ti 20. 30. dltiatrLes Ot.uh_ _wyg1 Sotwu Drtdlow ebtetrl 9Ml , X: ~ Xdg First list of "Japanese younig doctors" supplied to Joiint Comillissioni. Those designated by H were assigined to Hiroshim A few chainges were madle later. The remainder of the morniing was spent in identifying materials that Nere still needed for our work with our Japanese colleagues. They were quite willing to designate centrifuges, ovens, staining jars, and other glassware, chemical solutions and stains fronm the various laboratories of the University. Also suggested that each unit take along some of the useful reference books. These were gathered together from various personal libraries. Many are pirated U.S. texts reproduced photographically. There wvere both volumes of Peters and Van Slyk Made a mental note to bring a pirated edition back to Jack Peters. Especially admired is the German hematology by Rohr. This wvill be an interesting companion to my WNlintrobe which I had carried in my luggage from Saipan. These were gathered together and the remainder of the morning was spent in packing, using the materials that we had brought up from Yokoham Volume 3S, October, I965 I1-omiie for luniclh alndI then returnied to the University in the afternloonl to continuiie the work. For the first timiie found timle to go oIn a shoppilng tour. \We had passed what looke(1 like a print shop on our trips to the University. I went on foot and founld some strikinig prints in the Sakai slhol). Thlere were somue fine o0( l)rints on rice paper amiiong dozens that were availclabl Selected some aminiig Utamaros and others. Late in the evening Scotty appeared anid anniiouniced that he had arrainged for airp)lanie tralnsportation for equipmiienit anid personniel, incluidinig the Japanies Aln estimiiate of the weight of the miaterials was to be miiade and the personnel were to be specified. The necessary number of planes would le assigine(d as sooni as wse had the informiationi. WVe are apparently fortunlate that the Air Force has very little to do at this juncture with its hluge nutmber of mleni and ships and they promise to cooperate fully wN-ithi Us. SCptciiub)cr 25: \Valked to the Surgeoni's office after breakfast but founld no furtlher crvstallization of plans. \Was delighted to find that the mlaps were ready. The Hiroshimla map was Japanese and had all of the important features mlarked both in Japaniese and in the Latin alphabet. The circles around the hVpocenter were made at intervals corresponding to 500 meters for the first 3,000 and at 1,000 for two more rings beyond. These w-ere intercepted by radii drawni fromi the hvpocenter. In this way 25 zones were delineated. Thousanids of the record forms had also been mimileograplhed anld were brought w\ith the miaps to the University where the packing was beinig coml)leted. Since the preceding afternoon and during the morning various little prizes were brought in by members of the team Nho had visited the various hospitals. Tlhese, together w ith the Japanese contribtution, gave us the rtidimiients of tw o laboratories and equipped us also for a little clinical work. Practically all of the major items of laboratory equipmeint were from the Tokyo University. Packing of what was there Nas completed toward the end of the morning. Spirits had clearly risen when the work was don After 'unch again took the opportunity wvith Jack Rosenbaum of explorinig Tokyo on foot. The city was very crowded and our soldiers were everywher WValked much of the length of the Ginza in the central district. Althouglh there had been bomb damage, many of the buildings seemed intact and some were already under repair. Some of the rubble in the central district was being cleared by our engineers with bulldozers and other heavy equipml-ent. Great crowds were standing by, gazing in amazemient at monsters such as they had never seen. Our men seemed to be enjoying being the center of attention and gave some virtuoso performances. Shops along the Ginza were filled with all sorts of goods. WVe Hiroshimta Medical Diary, 1945 Map of Hiroshima supplied by Prof. Tsuzuki with overprinit by U.S. Army map service to designate ring zones and sectors. This was used by the Joint Commission for the survey work. The darker rings are drawn at 1,COO-meter intervals about the hypocenter. The military encampmetnt is the pale area wvithin the ininer most ring. III Volume 38, October, 1965 fotundl the Mikimoto jewelry store was groaning with the l)eautiful artificial pearls. The mlost interesting sight however were the carts which lined the curbs. These vere ftull of all sorts of interesting mass-produced cheap trinkets stuch as cigarette lighters, but also produce and a few handcrafted things. Bookstores were full of recently printed magazines, pamphlets, and books. They Nere crowded and the crowds included some curious G.I.'s browsing. The better stores are particularly jammed with soldiers and Japanese minigled in friendly confusion. We found a large department store, conmparable to ouir best, Takashimaya, where I bought a lovely painted silk screen and lacquier plat Oin returninlg to the Dai Ichi was told that a Navy commilainder had flown a seaplane to Hiroshimll He landed in the harbor, which was hazardotus since it was still mined, but was able to taxi in and explore the city. He reported that there was extensive damiiage fromii the typhoon of Septemiiber 17 andl 18 and that the airfield was flooded and would make landing there impossible for somiie timii Also rail traffic was blocked by landslides. On this discouraging note went to bed. Septemiiber 26: Called first at the Surgeon's office to see about developments but found nothing exciting. There met Lieut. Col. James Frenclh, a pathologist from Dr. \Weller's Department at Ann Arbor. He had been given the assignment of miiaking a survey of Japanese laboratories and had done considerable traveling about the country. He joined Ime in the drive to Yokohama in the truck which I had ordered in order to colntinue the next stage of the foraging expe(litionl. and partictularly to check oIn our good sergeant anil any equipmieint that he might have sequesteredI for tus. Oni the way down, French told mle about sonme priests who hadl been in Hiroshimlla and who were in the Catholic Hospital in Tokyo. Their condition was said to be poor. Thouglht it wsould be interesting to visit themii if timle alloNed, anid obtained directions to the hospital froml Frelnclh. I liote(d that a strong centrifugal movenment of our troops appearecl to be taking place from Yokohamiia and that even the Quartermiiaster I)epot was about to be miioved. No really tuseful laboratory itemiis had turnie(d up in the nlew consignmenits. I did, hoNever, pick up 45 cases of Ten-inl-I rations and 13 cases of K field rations. This was authlorize(d by MIajor Prentice oni the basis of "30 miien for 20 days." \Ve w-ouldl at least have a good foodI supply to start with. Also, to my pleasure, foundel Ninter fieldl clothinlg available and bouglht a new pair of field shoes and a fine Eisenhower jacket whiclh I had not seen before in the Pacific. Drove oni to the Marine General Hospital at the Yokosuka Base but came away empty-han(le(l, despite a pleasant receptioni. The 161st Station Hospital, Hiroshlimna Medical Diary, 1945 however, was able to spare us syringes and needles, and to nmy surprise, an autopsy kit. On the way back in the open cab of the truck, I was rather chilled and in the afternoon took a miiuch-needed nap. \VNTas awakened by Col. Oughterson in mid-afternoon who said that the Nagasaki group was to leave tomorrow. I was charged with the responsibility of attending to the loading to take place at the University in the morning. \VNas also inforulle(d that during Prof. Tsuzuki's absence, Prof. Sassa w ould be the cliief liaison officer with the Japanese group, and that Dr. Nakao of his departImieint would be his aid Septemnber 27: At a very early hotur went directly to the University. The trucks lumbered up shortly thereafter. The equipnment which had been designated for Nagasaki was checked off as it was loaded into the trucks. Iilnuilnerable Japanese physicians and younger students, together with their anxiotus fanlilies, were Illilling about. To add to the difficulty, Sgt. Archanlbault, who wvas to go to the airport with the Japanese and to coiltilue on to Nagasaki, was not to be found for some tim Finally lie arrived. He ha(i been delayed in what he called a "bread line" in the Finance Building in Iiis efforts to check out and could not get away. All of the personnel was finally gotten aboard the trucks with firm instructions froill the senior meillmbers of their party inot to move until the roll wvas called. This was finially acilieved and the caravan was safely off. Checked in at lheadquarters and received nothing but discouraging words on prospects for getting the Hiroshima section off and away. Then returlled to the Ulniversity to find Dr. Ishii, the pathologist sclieduled to go Nith us to Hiroshim He appeared tired, sad-faced, anld unislilaveni and was dressed in the remnants of a thinl niilitary uniforill alcd sandals. We discussed ill halting Germian and Englishl further plans for tile pathology study. Conversation was especially difficult because of the japainese custonm of replying affirmatively to all questions even thougih the sense of the answer is intended to be negative, for examllple "Yes,-it is inot so." He told, ille, to nmy great pleasure, that he liad some protocols alid iliaterials already in liand. I replied that I would look forw ard to reviewN-ing the illaterials witi himil and to translatilig the protocols. I expressed especially 1lly desire to liave a cotIllpeteIltly staffed aild equipped histology laboratory so that we could cut and staiin any old blocks, and prepare the new cases as they becaille available at Hirosllilll After a diffictult anld lengthy disctlssionl, I was not quite certain that I hlad been fully understood, alld I was especially disturbed by the fact that hle nevrer sIlliled, inor did lie have the affability of ilmost of Ihis colleagues. Voluitte 38, October, 1965 Dear Mr. . I am very sorry tu say,but there is one matter I want to ;ask you. I have lost my posts, a- y;u know,Institute of Jap.Cancer :Reserch was burnt ,St.Lukes Hospital,where I was working as a director of laboratory,is now used by Allied Force,so I can get incomes from nowher I am now looking for my jab as a doctor everyday,but its rather difficult to find it soon. ',:y father ana my wife of my bosom were died at the bigining of this year und my two young children are left behind,so I must support them Unfortunately I have suffered from bombdamage two times,all my havings were burnt out and now I aa confronted by' crisis if everydayliving under such a terrible inflation nowadays. is there any way to find suitable workplace such as L'ccupatian- armyhospital,ir if Anot,usual orffice: I am indifferent about the sort ;f works, but I hope Job of laboratorywork at hospital an technician or translation. ould you call at every likely place,if you please,though my vocabulary is very poor,and I am afraid I could not be employede I want 500 or 6C0 Yen monthly if possibl Yours Sincerely Letter from Doctor Zeniichiro Ishii, delivered December 15, 1945, after returninlg to Tokyo from his service with the Joint Commission at Hiroshima, which explains his situation. Hiroshima MlIedical Diary, 1915 LIEBOXV The reason for Dr. Ishii's apparent reluictance to becomle friendly with Amlericanis became evident dutrinig the next few days w-henl I gingerly iniquire(l of others about his apparen1t depression. The best answ-er camlle imutich later froml himllself in a letter that he wrote in December after we lhad completed the Nork in Hiroshlilmla and retturned to Tokyo. Despite his personal tragedy, Dr. Ishii gradually became a firml friend, and miy later experienices x-ith himi in traveling and working together remlain amlonig the mlost cherisedI memelories of my assignment in Japan. Later, in conversatioin w-ith Dr. Nakao in the hematology laboratory, there w as nmuch miiore rapport alnd a preliminary review of well-staine(d and well-interpreted henmatology slides w as enjoyed. This was the first contact wvith actuial material fromii patients at Hiroshima and I foundl it most exciting. The mlarrow s, mostly obtained fronm patienits three to fouir weeks after the bombing, shoNwed essenitially the findings of aplastic anemiii \Ve discussed the interpretationi of certain cells and( agreed that they w ere atypical derivatives of reticuloendothelial cells resenmbling plasmiia cells and that the designation "plasmacytoid" w-as appropriat Dr. Nakao promlised to organize this material and to make the clinical records availabl This would keep us well-occupied and wN-ould also represent an actual start on the work of transcription onto the Joint Comnmission forms that were now ready. In the early afternoon back to the hotel. Was asked to translate a remarkable document at the requiest of Col. Stafford \Varren. This was an eye-witness account of the explosion and of the city and people in the days immediately following, written in German by a Father Siemes wlho had been a Jesuit priest living in the hills of Nagatstuka, some three miles from1 Hiroshim It told in detail of the rescue of four of his brethren who had been injure(d in the city during the explosion. I read the story spellbound and horrified. By late afternoon mlost of the translating had been don It was (lictated to a remarkably skillful sergeant of General Farrell's Manhattan D)istrict Group wlho typed the tranislationi directly as it was spoken. * This stirring, beautifully ad(I modlestly written description records Father Siemes' impressionis as he w-itnessed the tragedy from his room1 at the Novitiate of the Society of Jesus. This group of Jesuits had been evacuated to Nagatsuka from Tokyo some six months previously. It is a detailed account of the flight of survivors from the city and of the involvemlent of the Volume 38, Octobet-, 1965 priests, onie of Nhomll lhad sttudied inwedicinie, in the work of rescu Father Superior LaSalle and three other brothers had been in the central miiission and parish house in the city at the miiomenit of the explosion. They were brought to Asano Park along with miianiy others. Twvo of the brothers had only miiinor injuries but were comiipletely exlhausted. One of these was Father Kleinsorge, w-ho lhad been miientioned by Col. Frenclh, and wholl I met later in Tokyo. Father Kleinsorge was lnot able to walk and was left behinld to be brotught out oIn the following day. The priests miinisteredl to imiany other people anid brought 50 of themii to the monastery for car As Father Siemiies put it: "Ouir wN-ork Nas, in the eyes of the people, a greater boost for Christianity thani all otur efforts dturinig the preceding long years." Onie of the mllost fascitnating aspects of this accounlit is the philosoplhical conisiderationi of all warfare, anid specifically of the tuse of this wveapon: "It seemiis logical to uis that lhe ho stupports total war in principle canniiot complain of a wsar against civilians." Remllarkable also is hiis statemiienit of the attittude of the p)eople: "None of uts in those days lheard a single outburst again-st the Amiiericanis on the part of the Japanese, nior was there any} evidence of a v-enigeftul spirit. Tlle japanlese suiffered this terrible blow as plart of the forttunies of war somethin-g to be borne without coml)laint." Fatlher Siemiies' accotunit became a imiajor soturce of material for J]olhn Hersey's imiasterftul ]Hiroshlimua, anid it wvas pnlulished in ftll, ini my impromptu tranislatiol, in Tlle Satiorday Revicz several years later. This I fear dlid less thani ftull jtustice to the style, excitemiient, anid(I literary merit of the orliginal Germani. * A delightful talk and drinik before supper in the chambers of Col. Oughltersoni. In the late evening took occasioni to write letters homiie anid to C.G. an-id to read descriptionis of the initricacies of the Iapalnese drama: Nob, Kabuki. etc. Theni tired, but happy, to bed. Scptcm1bcr 28, 1945: First thinig in the mlorninig wve wvere greeted by newv arrivals, including- Philil) Loge, formerly a Yale mledlical studelnt whliolmi I hadl tauglht. HAe is eager to transfer inlto the Hiroshimlla group and this is finally arranged. M\ajor Milton Kranmer of New York has also beeni assignied, as has a laboratory mani, iIajor Samiiuel Berg, a wvorried bachelor muLiclh concernied about w ho is to take responsibility, especially in working with the Japanies He ruslhes about tryillg to obtain additional supp)lies, but by the end of the day his success tunfortuniately is inimiliial. Captain Calvin Koch. a pleasanit keen-lookinig youngster, joins uIs later. These are our long-awaited reinforcemiients. Hiroshima AMedical Diarn, 1945 Later in the miiorning also miiet Captain Paul 0. Hageman, a formier colleague on the House Staff at the New Haveni Hospital, and Lieutenant Col. Hymer Friedell fromii Western Reserve and the Manhattan Project. Col. Friedell gave us a lecture on radiatioln plhenomen This dealt with elemen-tary princil)les anid definiitions. This wN-as a w-ell-presenited and useful review for all lhanids since none of tus could qualify as ani expert in radiationi biology. Of partictular imiiportanice wsas his implicationi that radiationi injury in these cities cotuld be conisidered essentially gammlla ray effect like that of lhard X-rays. There may have been miinior exceptiolls. Neuttronis traveled far eniotuglh to reaclh the grotunid, but only in a smiiall area benieatlh the explosioni. Indulticed radioactivity x-as therefore niot a miiajor lhazardl. The samiie seemiied to be trtie for fallotit, insofar as the investigatiolns ere carrie(l. Specific iniformiiationi, if know;n, w-as consi(leredllassifie(l. c Later in the miiorning w\ ent to see Dr. Nakao again anid lhe ini(leedl l)rov'e(l to be ini possession of a veritable gold miinl This con1sists of peripheral blood and marrow\ smiiears of nio less tlhani 44 cases that have b)een worked til) in 1-iroshima fromii late ini August to 15 September. Amiionig tllese wN-ere 15 fatalities of w-hom sevenl w\ere atitopsie(l. Agreed w\ith Nakao to begin tl1e work-up of these with him tomorrow. After ltiniclh fotin(d Genieral Farrell's expert stenographer anid finiisled(l (lictating the tranislation of Father Siemles' accouint to him. I was now all the mlore anixiouis to findcl the Germlani jesuit lpriests at the Interniationial Catholic Hospital. Calt. Rosenibauim is eager to comiie alonig anI we miiake first for the St. Like's lMedical Center which is said to be not far fromi the Catholic Hospital. On the way xv-e pass the astonishing sigllt of a lhge nioscqtei inltact and(l glitterillg, comiiplete with domie anid miiniarets. St. Luke's is anl impressive inio(lern sxkyscraper sittiated in aii on)ly' moderately (lamage(l resi(lential zonl It is Inow designiated as the 42nd(l Gelneral Hospital. N\e w-ere mlet b1 MAajor Vollmer who proxidedla brief touIr. Thlere is a beautiful chapel. The laboratory is alrea(dy, functioning. I)nring the WYar it was use(d by the Japanese who were reltictant to returni it. It escale(l signlificanit dlamage, but tin(ler press of war it went inlto ph-ysical (leclilne fromii w\hich it is noxW beii1g rehabilitated. Genieral -MacArthltr lhas favored tlis lplac It is ctirrently in the charge of Col. Yeager. A Plilippine banner has been presented to the hospital togetlher with a portrait of the General by 'Mrs. MacArthur. Obtained miiore precise directions to the Catlholic Hospital at St. Ltike's anild we miiake otir wsay throtilgh a largely burned-out portion of the city. Finallv w-e fincd the hospital with the aid of tw-o small Japallese boys. The hospital itself is intact anid spotless. \We mieet -Mother Harse, a most T'oluttic 38, Octobet-, 1965 gracious Elngishwomian wN-ho is in. charg After tea wN-e are lushered in to imieet Fatlher Kleinlsorg This is ouir first (lirect contact with an actual patienit. We hlave a loin conversation in Germiiai., which he obviously likes to speak althotugh his Eniglislh also is qeuite good. He tells inl his own words of his experiences so graphically described in Father Siemiies' account. He is amiiaze(l at our kniowle(dge of the story tiiutil I tell him of the translation of the Siemiies documileint and thein he has a good lauglh. He is a keein kinidly man, thill and l)ale l)ut showinlg remarkably little other effects, except that his wounds have failed to heal, now somile seven wNeeks after injury. Partial healilng ha(l begun, hut at three w-eeks the wotunids began to SEIBO BYOIN INTERNA TIONAL CATHOLIC HOSPITAL 7Thy5 Yodobashiku, Shimocichiai, 2 chime 670. Vr rw.j W e- -r1 4 ILetterhead of hosl)ital where Father Kleiinsorge was a patient. suppurat He developedI a leukopeni Then homiie through the dusk after a fascinating day. Sepeniber 29, 1945: Col. 'Mason and I are joined by Lieut. Loge and Capt. Koch on a visit to the University. There Nakao nmet us and the first part of the work of reviewting the records began. These appeared to be excellent except that many of the actual marrow couiits have not as yet been don \Ve therefore subdivided ourselves, Japanese and Americans, into teams of counters and record translators. There was a master sumllmlarizing chart. Col. AMason busied himllself with a transcription. The chart obviously Nas the result of a great deal of extremely painstaking effort. After lunch we returned, bringing also MIaj. Kramer, andl continued the work. Theln a long walk hom In the evening met M\Iajor Sylvan Moolten. He is assigned to the Surgeoni's staff. He has had extensive experience in pathology gained at the MUount Sinai Hospital in New York, although he is primarily a clinician. He is a very keen and thoroughly delightful nman who discusses knowledgeably many of the things \-e have seen in the Pacific, including cutaneous diphtheri Hiroshlimaoo Aledicol Dia ry, 1915 V Top. The Jesuit Monastery at Nagatsuka from which Father Sienmes wxitnessed the atomic bombing of Hiroshim Middl St. Luke's Hospital in Tokyo used as the 42nd General Hospital by the U.S. Army Occupation Forces. Bottomii. The Tokyo First (Dai Ichi) MIilitary Hospital, the \Vralter Reed of Japanl. Here wAas located also the Japanlese Army MIedical School. Volume 38, October, 1965 Septemtiber 30, 1945: At breakfast on this pleasant Sunday found that Col. iMason was leaving for Nikko Shrin Decided to spend the morning closeted in my chambers reading and writing letters home, to C.G. and to Paul MIacLean. In the afternoon took the opportunity to explore the city wvith Jack Rosenbaumii and MIilton Kramer. Jack had told me that he had seen people actually starving or ill to the point of unconsciousness at the railroad station. Although the economic state of the country was at a low ebb and rationinlg was strict, I found this difficult to believ But there were indeed frail, dull-eyed people begging, and some, even children, lying huddledI with their parents-a pitiful sight. Passers-by seemed to pay themii little heed. \Ve wsent by Japanese taxi, a smiioker driven by an intrepid man wrho muist have been trained on a juggernaut, to Ueno Park, a famous beatuty spot. This w\cas crowNcded on the brisk afternooni with strollers, both Japanese and Amnericani soldiers. One of the loveliest sights was a five-tiered pagoda witlh its graceftul roof and its glow-ing red-ochre sides. In the city belowN the park tlillngs Were quiite as busy as oni the weekday. We were amnazed at the imm1ilenise crowds fillinlg and overflowN-ing to the outside of lUeno railroad station. There was nio pushinlg. anld everything w-as patience and coturtesv. \We walked back, bemutsed, the long distance througlh the darkeninig but buistling streets. October 1, 1945: To work againi early in the miorniing. Counted innumerable cells. but in the hvpoplastic marrows these are widely scattered anid often difficuilt to classify, andl the work is progressing slowly. Dr. Nakao is mlost helpful, most sinicere, anid clearly expert in hematology. Capt. Koclh aiid Lietut. Loge devote thlemiselves mostly to the periplleral bloods. Constultedl witlh Col. Friedell regarding the possibility of sotmie of the MI.lanhattan District Team cominiig to Hiroshimna w ith us, buit his group has decided to continue back to the U.S. Later met Col. M\ason wlho had returnied from Nikko that nooni. Althouglh our expedition is now poise(l. we mUst aw-ait the rettlrni of Col. Otughterson fromll Nagasaki for finial arranigements. Today acquired iniformiiation concerninig twxo new recruits. Our request for clerical assistance Nas met by the assignment of Staff Sgt. Hial D. Huffaker anid Pvt. MIichas Ohnstad from the 12th Cavalry and 1st Cavalry Artillery respectively who are to go with us. God grant they can type! October? 1945: W\orked all day at the Ulniversity with Col. MIason and 2 all of the junior officers and our Japanese colleagues. Got w-ell in sight of the encd of the blood counting. I . .~~~~~~~~~~~~~~~~~~~. . Top. The pagoda in Ueno Park. Bottom. The Ueno railroad station. Immense crowds patiently await transportation. l'oliiiiie 38, October, 1965 Theni I lhadl anotlher (lifficult working session with Dr. Ishii. Despite our language problemls, it is quite clear that he is a very well-educated pathologist. He show ed mle somle 26 necropsv protocols. These seemle(d very wN-ell workedt-up and(l illustrated with sketclhes. Althouiglh the bulk of the description is in lapanese, many of the technical words are in Germani or Latini. WXeights of organs are in Arabic numilerals. There are many sketches. It is possible to understanid in reasonable detail the substance of the description. This w-e test by going over one or two protocols. For the first timle I have seen Dr. Ishii smile as somle comlical mlisinlterpretation on miy part is nia(l It w-as agreed that 18 of these cases w-ould be cut here in Tokyo and that the rest ouldl be brouglht along with us and cut after we arrived in Hiroshim N\Ve could then comlplete the mlicroscopic descriptionis for this prime group in (lirect personal colntact while carrying on our other work. Dr. Ishii also has a large numiiber of marrow contact preparatioiis which he will bring along that come from the autopsy material. Actual preserved organs of the sanme patients froml whom we have blocks in Dr. Ishii's group are said to be in 'enlarged pieces" in Hiroshimila at the Ujina Hospital. Aniong other imlportalnt information obtained this afternoon is that Mlajor Yamlashilna in the Japanese Army Mledical School has some well-preserved material fromll the very earliest cases. MIost of those in Dr. Isliii's possessioni are in a group that succumilbedI froiii three to five wN-eeks after the bomlbing. WVe take note that iMajor Yamiiashina by all iiieans niust be found. \We decidle also to bring wvith Us to Hiroshimla -Mr. Shiniiianiiie, a niedical student, who is said to be an expert in cutting sections. He is a charminig, sliglht, genitly smlliling youig maiin of studious appearance who comes froiii one of the faiiiilies iiiiportant in the professorial ranks of the Tokyo Iiiiperial University. While waitinig for a seat at the supper table, iiiet up with Capt. Nolaii and Col. Stafforcl WNTarren. The latter was an elongated, spare, grayI-lhaired mustached figure, looking the picture of a pukka sahib, but Nith a iiild and gracious mlannier. He expressed his pleasure at the Siemes translation. Scottv, w-ho had also retturned froiii Nagasaki, was very happy- to see us and pleasedl witlh the work that we had got in hiaiid. In the evenlilng had a long conference witlh Cols. Mason acdl Ougliterson, anid Nas told that Drs. Tsuzuki and( Sassa aiud four of the younger Japanese, including Drs. Kitanioto and(I Okoshi could get off to Hiroshimila by plane on the following nmorninig. \Ve hear now that the Nagasaki group is in excellenit quarters at the Omura Japanese Naval Hospital anid has no less than 150 cases of radiation sickness in hand. Hiroshimzla Aledical Diaryv, 1945 V October 3, 1945: In the early morning Dr. Tsuzuki brought to the front of the Dai Ichi Hotel Dr. Sassa and the "Japanese young doctors." Finally shortly after 8 :00 m. all are ready to board the trucks to take them to Tachikawa Airfield. The present plan is to have a shuttle plane in readiness for the work of taking all of us down. In the morning in consultation with the Japanese at the University prepared a list of the doctors in order of preparedness to go dowvn. Among those ready is Dr. Kato, a debonair bachelor, Who is to assist the men at Hiroshima in getting the early records of the 44 cases up to sluff. In the afternoon went to pick up the rations for the Hiroshima group. We found the Red Gate open. These cases were then placed into the hands of the Japaniese at the Medical School who seemiied reluctant to accept the responsibility. W\e assured them that they would not be prosecuted by our M.P.'s. I found Dr. Ishii wvho said that Dr. Tsuzuki was angry with me for not having discussed the Shimamiinle miatter "through channlels"! He had not mentionied his displeasure to me that morniing, however. After supper was informiied that the plane bearing Dr. Tstuzuki and his companions had been forced to turn back from Hiroshima by heavy overcast and that on the way back its radio commiluniications had brokendowni. The pilot had to fly the unpressurized airplane at over 14,000 feet to be sure to clear Fujiyamiia, which he could not se Near Tokyo he founid a hole in the clouds and was able to buzz Atsugi at dark. Flight control guessed that somiiethinig was wN-rong. Cars and trucks were lined up to illuminate the airstrip. He landed safely after seven hours of conltilnuous hazardous flyinig without certainty of where he was. In the evening met none other than Col. Joseph Sadusk Nho had arrived at the head of a typhus commnnissioni. There had b)een some outbreaks of what Nas considered to be true typhus fever in Japan and somle of our soldiers had comiie down with the diseas * Col. Sadusk had taken his residency in medicine at New Haven with Dr. Francis Blake and had started with the Yale ULnit as a captain, but had been reassigned. He had donle mlluch distinguished Nork in epidemiology in Hawaii and with the UT.S. Ty-phus Comimission and was ultimately promoted to full colonel and decorated Nith the Legion of MWerit. After a post-war career as an outstandinig practitioner in Oakland, California, anid then as a Professor of Conmmunity iMedicine at George WNashinlgton University, he became Chief Food and Drug Admuinistrator. Volume 38, October, 1965 About 9:10 p.m., while I was playilng cribbage with Major Kramler, Col. Oughtersoln camie and said that we were in fact ready to leave in the mlorninig. This meant that we had to get ourselves and the enlisted miien packed. Sgt. Reed was put in charge of the latter detail. In the meantillle I begged a ride to the NYK building to which Capt. Rosenbaum had just beeni moved, and gave the junior officers the good news. Then a hasty job of packing miiy ow-n belongings and to bed at 12 :30 m. Octobcr 4, 1945: Arose at 05:15 and after picking up Koch, Rosenbaum, and Loge rushed to the Uniersity. Then rapid loading of all our equipmiienit and men with the help of numilerous willing Japanese who got the whole job done in time to return to the hotel by 6:55. Breakfast had been arranged and we left the hotel at 7:30 m. Col. 'Mason claimned to know PA3J'GH LI 3T YMOR 1 CmI MIA Lt Cal Li.bow Gal Una= 5- capt Roa Capt Koa f6 1 Itie 'Dr XW OOt* ~sSgt TbC 4 rak 1 si)W 5kdn& s 9r _sol LtK.lc I'AkU Dr Ta-md or okosd4 5 1r Nakao * Lt OlBriox, Char2us Lt mrin 1oh SLt.L Teaksn Green Thohn ig A 3ma±gu !Wildu, '. f. Tah B3m Lin a_uK& K&w 6 Dr KI ,txtorphw i 1et Dr Sa Dr -jtn to be abandonied. List of passenigers for projected flight to Hiroshiimla, October 4, 1945, which lhad the way to the airport and seem-ied to be doing reasonably well at first. It was pouring-a real cloudburst. Finally, however, we became more and more lost and then the good Colonel ultimately admitted complete failure of knowing our whereabouts. Then we strike out more or less cross country. with the help of our inquiring Japanese companions, passing through towns such as Koraida and Yozakawa, but at long last make the correct turn and enter Tachikaw Although we were very late, we were welcomed by our pleasant acquaintance, Lieut. Flook. Col. Oughterson's party also had been late but was there when we arrived. I find a pilot talking excitedly witlh Col. Oughterson. He had flown the Tsuzuki party to Hiroshima and was exhausted by the harrowing experienc Dr. Tsuzuki himiiself was at the airport looking none the worse for it and ready to take off again. WVe were at first rather hopeful of taking off but at last the flight was declared closed. Disgustedly we struck out for home and found that the rain has in fact worsened. Deep puddles are everywhere and many vehicles have become stalled in large lakes. Then back to the hotel to a fine dinner of Spain and cold cuts in the hot and sultry room. In the afternoon slept the sleep of the extremely weary. Later in the evening again met Col. Sadusk and we had a long talk about the good old days at Yale and our various war-time experiences. Bed timne was delayed by another conference with Col. Oughterson. Col. Stafford Warren camle in. He was his delightful self and showed uis the destruction and radioactivity maps of the Hiroshima and Nagasaki areas. WVe discussed also the delayed effects of radiation on the bone marrow in the patients. He stated that these occur after relatively low doses. Col. Warren said that Yawata was originally scheduled for the atomic bombing but that the plans had been changed because of meteorological conditions. Then, finally and wearily to bed with a bad prognosis for tomorrow's weather ringing in mly ears. October 5, 1945: Heavy rains continue and no air transportation can be authorized. In mid-nmorninlg, a visit from Dr. Tsuzuki wvho has apparently done miuch smoothing of the way for our work in Hiroshim He says that the people are in fear of our troops and that this may inhibit our nmission greatly. Dr. Tsuzuki then agreed to introduce nme to General Hirai who is chief of the Pathological Institute of the Japanese Arm)y Medical School. This wsas accomplished after a long trip through the downpour. The General is a small man with a cast in his left eye and a friendly mianner. The insignia on his collar resembles that of a U.S. Navy coIllmuander except that there is a small red star in the lower front corner of the collar. The proiinise is given to us that the slides of the earliest cases T'olutiie 38, October, 1965 in possessioni of the Army AMedical School would be delivered to us with remaining tissties at Hiroshimlla by two miedical studeints who will followv in about tw-o wN-eeks. On returninig, the questioni of food supply for the Japanese componlent of the investigative group is discussed at length by Dr. Tsuzuki and our group and w e agree that all of the doctors and possibly the students as well will l)e fecl by Us. Scotty emphasizes that this wxill have to be cleared by Headquarters since it is at this timle forbidden to distribute Amiierican food supplies to civilians in Japan. October 6-11: These days were spent in disgust at the downpour and wind, but there were somiie bright spots, particularly October 6 when I had the privilege of signinlg for six jeeps for our unit on transfer from Gen. Farrell's group wxhich w as returning to the continental U.S. Now wve had our owin l)rivate means of getting about. There wN-as also the pleasure of working at the lUniversity wx-ith Drs. Nakao and Ishii and exploring Tokyo on foot, w-rapped in a raincoat. The population was still drably and poorly dressed, the mien often in remiinants of military uniformiis or thin (lark suits. \Vonmen were wearing the baggy trousers (iiiomipe) that had been wartime wear by Imnperial decre It was amusiing to see the little Japanese police in dark blue, carrying small swords and directing traffic si(de by side with the strapping M.P.'s of the First Cavalry Div-ision. The latter, who seemiied to have been selecte(l for their size, also stood guard at parade rest before the various gates of the palace and at the doors of radio Tokyo-station JOAK-xwhence had come the Tokyo-Rose broadcast that we had enjoyed in the islands during the \Var. The Kabuki players reopened on October 3 in their own theater and their popularity amonig the Japanese w-as attested by the difficulty, of getting tickets and by the plentiful speculators. Jack Rosenbaum was able to get tickets and we enjoyed a dazzlingly colorftil stylized performance and the traditiolnal Imlusic. I had learned a little al)out the symbolism of the action fromii reading, and kindly English-speakinlg Japanese w ere eager to explain the niuances. The audience was almost entirely Japanes The performances are long and it is customary to bring food. Parts of mlany- days and evenings N-ere also spent in planning our approach to the work at Hiroshim The shieldinig and protection studies would be miost difficult. Scotty emiiphasized the need for a mortality and morbidity curve in relation to distanc \Ve hoped that w-e could identify certain buildinigs and shelters at known distanices fromii the hypocenter wN-here people occupiedl precisely kn-own positionls at the miiomlent of the LLEBOW detonation, and whose fate was known. Drs. Tsuzuki and Murachi said this was definitely possible and that in fact they already had a number of these buildings in mind. It was evident that if we considered only gamma radiation, as seemed reasonable, we could assume straight-line travel of the rays which would intercept the buildings at angles determined by their distance from the hypocenter. If we could then establish the structure of the buildings from building plans, the thickness of steel, concrete, etc. could be calculated through which the radiation would have to penetrate to produce a certain effect or to be completely absorbed with no biological effect. One could assume that the LD-50 dose (i. the dose that would be fatal to half of those exposed) would be in the range of 500 roentgens if delivered to the body as a whol This datum could then give us at least a rough idea of radiation dosage under various conditions. There would be some error in the calculation from scattering of radiation. We hoped also ultimately to learn from the physicists who had designed the bomb both the spectrum and intensity of the radiation at the sourc This, insofar as it was known, was still considered secret, according to Stafford Warren, who would provide no information except that there was a mixture of hard and soft gamma radiations. The hard rays have a shorter wave length and penetrate more deeply than the soft. Effects on tissues, however, would depend on the quantity of radiation absorbed. In the meantime three C-46 aircraft that had been assigned to transport us were lying idle and our patience was severely under test. * 4. THE ENCOUNTER October 12: Finally the dawn is beautifully clear. Consequently called Tachikawa airfield at 6:15 m. and was advised that the trip would be cleared for take-off. Called the "Japanese young doctors." On arrival at the University found that they were not at the appointed place at the Institute of Pathology. I was horrified for a moment but soon thought to look for them in front of the main medical building. There they were-all except Dr. Ishii. He had gone into the country again. Shimamine was there, however, dressed in his dark-blue student's uniform and wrinkled cap. Then off we went. Everything went smoothly this time except that the manifests had somehow become lost in the shuffl However, after a little cajoling of the pilots we quickly prepared a new passenger list. They for one thing seemed pleased that we were at the rendezvous on tim This time Dr. Tsuzuki was not on the list as he had been on Oct. 4, and there were no personnel who were not of our group. The three C-46's were loaded one bv one, heavy laboratory equipment and jeeps strapped to the metal Voluitie 38, October, 1965 floors and passengers to ride in bucket seats at the sid Finally we got X-392 loaded and it took off. Similarly the second plane, X-372, was loaded, the passengers boarded, and a smooth take-off accomplished. All of the Japanese that were present had been assigned to these two airplanes and I thought at first had been loaded aboard. Shortly afterward I went back to attend to plane number X-131 which had not yet been loaded. A manifest was prepared and the load was put aboard, jeeps and all. just as I wvas about to get the crewv together there was a sudden loud tearing sound followed by an explosioin. A large shining silvery C-47 on take-off had suddenly veered to the right and gone off the main runeway which was at a somlewhat higher level than the parking field. It skidded ilnto the rear ends of a number of parked planes wvlhiclh were in a neat row, tails to the strip on the field below. As it came crashing off the runway, it turned completely around and came to rest facing in the direction in which it had started. Its left Wiing had been shorn off and it was burning fiercely w-here it had torn at the fuselag The pilot's compartment in front of the wing had fallen forward and was lying on the field in front of the body of the plan A soldier, his uniform and hair aflame, came running mladly toward us as we dashed onto the field. WVe made quickly for the plane on the windward side as the fire trucks came screaming up and quickly extinguished the fir We first attempted to take care of the two boys who had been pinned in the pilot's compartment and were strapped inlto their seats against the instrumient panel. They were obviously dead althlough seemingly uninjuired. I gave first aid to a third boy who had been rescued fronm the body of the plain I splinted another badly fractured left foot and arm with boards and strips of cloth and bandages that had been brought from the warehouse in anl ambulanc There w-as no hospital near the field nor were physiciains other than ourselves immiediately availabl Others w-ere similarly handled. As I w-as splinting one boy's arml wshose elbowx hadl been fractured, and who was among the less severely injured I looked up to see an air surgeon Lieutenant Colonel leaning over nm I said "Thank God yotu're here," and he replied, "You're doing fine, Averill. I know even less orthopedics than vou do." It was Dr. Thomas \Warthin w-ho had been on the resident staff of the New Haven Hospital with me somle ten years previotusly. He had arrived with supplies, finally, from the Air Force Hospital some miles away. \We finished with the others and sent thelmi all to his hospital. All had been taken safely out of the planes except one boy who had been burnedc to death and the pilot and co-pilot w-ho had been killed in the forward compartment. We then cleanedl up and as I Nwent to my own plane, wIhich fortunately had escaped damage, mlet Dr. Kubo on the way. He hadl not been checked L aboard the other planes as I thought, and had just walked to the airport from his home which was near by. Before take-off there arrived copies of letters from General MacArthur's Headquarters explaining the Joint Commission and requesting cooperation from the Commanding Generals of the Sixth and Eighth Armies. Since we were about to enter the Sixth Army command the letter was especially welcom We left at 11:10 m. in the third plane and had a smooth and pleasant flight except for the fact that much of the land below was obscured by billowy and milky white clouds. Finally we saw the shocking and breathtaking sight of Hiroshima below, devastated, cold-an ash. Our two C-46 predecessors were sitting like great olive-drab moths on the sandy yellowgray field below. We flew over the harbor sighting the beautiful islands, and then made a rough landing with our tail too far up and not touching down quite soon enough. We taxied too far with our over-great momentum and landed in the mud but skirted around the worst parts, raising a great spray in the puddles, but able to come about to join our friends who were waiting. There was really no airport, no tower, no landing lights-only a wind sock. On the field also were some horribly scarred children including a boy who told us in understandable English of his experienc He seemed to know how far he had been from the center of the explosion. In the meantime Major Kramer had made arrangements with the 186th Infantry Regiment to borrow a truck. The unloading was done without incident. They took a large wooden platform and placed it on a 2'2-ton truck which was backed to the airplanes. The jeeps were then driven on and carried to a grassy revetment at the side of the airfield. Each jeep was finally bounced off with a jolt, and then allowed to roll off the steep bank of the revetment. There seemed not to be too much immediate serious damag We then rode through the bleakest scene that could be imagined-past a gray prison with blue-clad prisoners herded by blue-uniformed policemen. The entire city was completely flat except for some concrete buildings that looked reasonably well-preserved as we were landing and from a distance but which are burned out and sometimes twisted and buckled masses upon closer view. The roads are still littered with wreckage of every description. There are many burnedout trucks and cars. Charred poles have collapsed and jumbled wires crisscross the path. Most remarkable is the fact that through this scene of desolation street cars are running through the middle of the devastated and almost empty city. Everywhere there is evidence of a conflagration. As we reach the margin of the city, many houses, although unburned, have been flattened, as if by wind, all in the same direction away from the center of the explosion. J'oluttie 38, October, 196-5 UPI'ICD" Q'F ""It il'Pi. _t '; C. 't AiUkc TI ALLL.D I i;' kCV1 6)', aCC skA-. 12 (6otober 50G SUBJSCT: : TO Atomic Bomb InvestigatIon. Co=-r-ndinf General, Sixth Army, Ad1 1. This headquarters has direeted that a "Joint Cornjssion for the Investigation of the .ffoots or the Atcmto Bomb In Japan" eonduot Uuh Invest i>stticus as arneesesary. The ommission is oopoesd of the followinr three major groups. The 3.anhattaw Projet Group wder "rlFn dier General arwell. b. 'The Gli4 twroup maer the Chief mwoemase orfice, represented by Colonel w. ougbrteron,"'. *. The Japanese Uovernment Group under the direetion of rTuzukci of the imperial University. .r. Tokyo. 2. it Is desired that this ommission bo furnished whatevrOI &aistance Is neossary sad praeticable In order to acooLplish-their isailon. Colonel W. Oughterson ia the plenary rerwesentbtlye of the Joint Commission In Japan. A,proprinte passes should be isxued at his request to enable the parties to enter restricted arets of your oownrand. A TUUiS COPY Fi. Y. M.1.n . Colonol, G.f., Ast Adjutant !'neral. Colonel, :edioal Corps. Order from General MIacArthur establishinlg the Joint Commissiotn. Although lnot included in this order, personinel of a unit serving with the U.S. Navy (Naval Technical Missioni to Japan, Team 11) under Commander Shields \Varren worked in with comnplete integrationv the Armly Unit at Nagasaki. Hiroshliima Aledical Diary, 1945 LI'EBOW Upper. Hiroshim Aerial view on lanciing October 12, 1945. Onlv the heavily reinforced conlcrete buildinigs remain standinig. To the right is seen the military are The hypocenter is just to the left of the broad roadwav x-hich borders this area at its southern (left) margin. The two bank buildings, approximatelv 250 meters from the hypoceniter, can be seen standing closely together. The tall buildiing niear the lower left margin is the Fukuya department stor Lowecr. In the middle portion of the photograph is the burned zonle of the city whereas beyond the broad highway which acted as a firebreak, there is only scattered evidence of mechlainical dlamage to buildings. Aerial viewx at time of arrival, October 12, 1945. Volutiie 38, Octobet-, 1965 Upper. View across hypoceniter from Sanwa banik. In the ceniter is the Challmber oi Comnierce BuildIinig witb its domiied tower. To the right is the Businiessmeni's Club (Koreani buildinig). The low wall niear the ceniter irepresents the onily portion of the Shima private hospital left standing. Middl Ana adjacenit view lookinig fartber niorth. The -Korean Buildlilng" is inow in the ceniter. To the righlt are the great white torni of the Gokoku slhrinie 250 meters from the hypoceniter aiidl close by is the military encaml)ment. Lozeer. Genieral view of city looking toward the harbor. Thire is almost total destructioni with onily a,. few walls of x-eight-bearing brick or conicrete stanidilng. Hiroshlim)la MIedical Diarv, 1915 Our destiiation wNas _Ujin Here w ere the relatively iintact liviing quarters of employees of the Daiwva rayon mill somiie 4'2 kilomiieters fromii the ceiiter whllich had been used as a hospital for care of the inijured by personiel of the Tokvo First AMilitary Hospital wh-lo were still in control. It was nowv alimiost dark. I wN-ent to the headquarters building aind there in a simiall, dimly liglhted roomii miiet 'Major ]Mison1o wxho was in charge of the hospital. He was tall, ratlher (lark, and lhad the look of a miiainiland Mongol. He was obviously weary anid had a rough scraggly black beard. He was curt aiid seemed almlost surly often saying "Wot ?" in a rather gruiff wvay 7'op. Clhamiber of Commerce Building before anid (bottom), after the bombin-g (30() meters). Voluitte 38, Octobei-, 1965 wslhein he did lnot qtuite uinderstanid, but soon introduced tis to Capt. Sasano who was mlluclh imiore suav He then guide(d tus to a buildinlg w\-here we took three large well-lighted roomis, stipplie(I with electric currenit. The btuildinigs wxere long, two-storied, remiiiniscenit of barracks in ouir own army, and arranged in cantoniemiienit styl They w-ere, however, typically Japanese highl-roofed structuires supported hb a heavy tree beam and with the typical Japaniese slidinig walls and (loors. Ouir equtiipi)meilt was all stored after unlloadIinig fromii the trtuck and( placed with somlle attempt at separation of the categories of supplies in a large roomii at the enid of our buildinig. The buildings branche(d off long, straight, covered walks. \We were now hungry. Sergeanit Buckles was appointed miiess officer anid didl the cooking- over a gasolinie stov We hadl plenty of 10-in-I rationis, whliclh mlake simple but tasty anid a(leluiate meals. At supper Jack Roselnbaumii told the rest of uIs a blood-chilling tale of his experienice onl the flighlt down. When hlis plane reache(d altittid, one of the passellgers, Dr. Yasulda, became extremely short of breath anid cvanotic. Jack thoiluTht he might have had a coronary occluision, until he foundi(I that I)r. Yasuida had a therapeuitic pnetiumiothorax wlhich had expanded sufficienitly to cauise respiratory embarrassment as the planie ascend(le(d above 9,000 feet. Oxygen was a(lministere(l ald the flight down was along the coast a few\ lhund(lred feet above sea level. The roomiis had straw mlats but there were, of couirse, no beds. WNe procee(le(l first to spray floor and wl-alls liberally with DDT. A nullimber of Japaiinese military blanikets were obtainied through C(apt. Sasano. These were clean, heavy, of a drabl) yellow-brown color, niade of cottoi1, and h singlll;arlv devoil of warmth. I hadl a sleeping bag with miie wxicl had traaveled the lonig way fromii Camp Edwards to New Zealalnd to Saipan anci now to Hiroshilml As soon1 as lights w-ere oUt w\e hear(d a scurryin1g along the tree beams and(I hoped, even as we dozed off in exhauistioni that nlonIe of the rats, which sounide(d large, would become too in(quisitiv The sleeping bag provide(l nore comlfort thani was available for the rest wlho were qtiite cold. October 13, 1945: Early in the morninig we inspecte(l the establishlmenlt, found three large rooms in one of the buildings to be supplied with pover and water, an(d these we designated as the laboratory. Equipmiielnt and food were placed under the guard of our enlisted men, and Drs. Rosenbaum aild Nakao were dlesignatedI to unpack the laboratory equipment, to lay out a plan, and to gather what furniture cotild be found for the laboratorv. I drove to Kure with Col. Mlason to establish the necessary admimisl trative framework with appropriate representatives of the Sixth Armyiv. Hiroshlia Medical Diary, L iL T'op left. Aerial view of Daiwa Rayoln 'Mill used as a hospital by the Tokyo First NMilitary Hospital and( later by the Joint Commission. The dormitory buildings of the factory which were used for this purpose are in the upper cenlter of the photograph. Bottomii. Entrance duty. to the tjina Hospital. Patients, and military personnel still on Volume 38, October, 1965 The drive was through only partly repaired roads, rough and nervewracking. Considerable traffic, slowly moving trucks, and some military vehicles on the highway made progress very slow. On the way we picked up a young man named Yamashita who was working as an interpreter. He is one of the Los Angeles "double citizens" who had returned to Japan before 1941 and had apparently felt that Japan would be winning the war. He had gotten himself well-fixed for a post-war job, had Japan in fact been victorious. In the harbor of devastated Kure, which sloped steeply to the shore, there were many ships apparently unloading. We presented our orders to the Adjutant General in the Tenth Corps Headquarters, who introduced us to the Provost Marshall, Lieut. Col. Penc He was a stern looking but kindly, graying gentleman who quickly supplied us with the necessary passes, but said that they would be valid only until the end of the month when they could be renewed at ASCOM. This headquarters had not as yet been fully established. The Hiroshima area had been made "off limits" because of careless behavior and looting by souvenir hunters. These were men of the merchant marine who would come into the harbor in boats, keeping a sharp look-out for mines, and then quickly depart. Only supervised groups were permitted to enter to view the city, and of course those on official business. Then tried to call upon Col. Hall, the Surgeon. We found him on an inspection tour out of his offic Here we met Major Cummings, who had been the executive officer to Col. Carton whom I had met on Espiritu Santo in the New Hebrides. Major Cummings was now serving as executive officer to Col. Mudgett, the Base Surgeon. For old times' sake he said that he had a whole case of VO whiskey which he was willing to shar This offer was accepted with alacrity. We paid our respects to Major Hamlin, Col. Hall's executive officer, and then visited the 361st Station Hospital near Kur Unfortunately the site selected for this hospital was waterless and this had caused understandable dismay among the personnel. Later in the afternoon we went to the Japanese prefectural office to see whether better lodgings could be obtained for our operation at Hiroshima, but it was clear that adequate facilities were not availabl We therefore set about to find civilian assistance for cooking and laundry, which was quickly accomplished with the help of Dr. Murachi. Before returning, we visited also the 186th Infantry Regiment where Lieut. Farrell agreed to service our jeeps. Since these had newly arrived directly from the hot and dusty Philippines without attention, they were in obvious need. On our return we found that the laboratory was already getting into shape under the ministrations of Drs. Rosenbaum and Nakao, who had been busy all day. I found also, to my relief, that Dr. Ishii had arrived by train. It was now decided that we would no longer keep guards on our food supply. Our Japanese colleagues told us that absolutely nothing would be touched even though there were many people in dire need. This released both Ohnstadt and Huffaker who with Sgts. Reed and Buckles set to work with a will. Dr. Ishii's arrival now made our group complete as finally planned just before departing Tokyo: Amtericans Col. Verne R. Mason Lieut. Col. Averill Maj. Milton R. Kramer Capt. Calvin 0. Koch Capt. Jack D. Rosenbaum 1st Lieut. J. Philip Loge T/Sgt. John P. Reed S/Sgt. Hial D. Huffaker T/4 James Buckles Pvt. Michas Ohnstadt Japanese Dr. Kanshi Sassa Dr. Kiku Nakao Dr. Koichi Murachi Dr. Shuichi Kato Dr. Toru Tsukada Dr. Ikuya Kubo Dr. Tamaki Kajitani Dr. Koichi Ishikawa Dr. Takeshi Gotoh Dr. Shigeru Hatano Dr. Moto Kawanoura Dr. Toshiaki Yasuda Dr. Hirotake Kakehi Dr. Masaaki Okoshi Dr. Zenichiro Ishii There were also 21 medical students including Mr. Shimamine who came at the request of Dr. Ishii. Major Misono was in charge of the hospital and Maj. Motohashi was also assigned there, although we had not yet met him. Dr. Tsuzuki and Col. Oughterson had not arrived but expected to divide their time between Hiroshima, Nagasaki, and Tokyo. To bed, with some of Major Cummings' VO to soothe us. October 14: Arose on a very cold Sunday morning after a quite comfortable night in my sleeping bag-rubber mattress arrangement. At 9:00 o'clock conferred with the Japanese physicians. It was decided that Dr. Sassa as the senior among the Japanese and Col. Mason as our senior officer should undertake a good-will mission to meet the doctors of the various hospitals and of the Prefectur It was decided to postpone this undertaking since Sundays are taken quite seriously in these parts. We used most of the day in completing the laboratory into a quite functional stat During the day copper sulfate solutions for plasma and blood specificgravity determinations were prepared by Capt. Rosenbaum. I spent a Volume 38, Octobey', 1965 good dleal of miiy time with assistance of our sergeants and some of the Japanese preparing oxalate tubes for collecting blood and dehydrating solutions for histology. Fortunately there Nas pow-er of the proper voltage for our centrifuges and waterbaths. W7e had not been sure of this when the equipimienit was brouglht dlow Late in the ev-ening we lad a seconid constiltationi to crystallize plails for actual wxork. It seemiied expedlienit to w-ork up the _Ujina patients first 41st Div PM UhNITE :TATrS LRiD FORCES PROVOST MARSHAL PASS (Tp.mpr$) x Corps NO- Locct1.on_ rlease Pe-"it Atomic Bomb Survey Col B. R. Iason & driver or member of Address or Organization Name atomic bomb commission, h H entrance to Art Im&.L11.aton or Arca £ Study of the et2ects of the atomic bomb. for purpose ._ State exact uLssjoL &' unit or person coLnCerned 12 November 1945 From hour ___to d-te to(at ebcL 12 December 1945 ____ avt r~4teosAr 12 November 1945 o e oRtA rt fts Ae{Y A-oproved Clared by Provost _G_CIC Dot _ Orgaaization or Area Cor__p___ODep Military lass re(quiredI for entry inito Hiroshliim;a are an(l theni to proceed to hospitalized patienits elsewx-her Survey work on the non-hospitalized populationi w-ould be conducted in clinics later. A laboratory teamii was organiized consistinig of Drs. Nakao and Okoshi anld my self, to be assisted by a numlber of junior mein and students. Clinical teamiis were organized in five units. This w-as greeted with enthusiasmll by all concerned. Our record forms w,ere considered again in great detail in an effort to be certain that there woul( be no mistakes in interpretation. It was decided that the data from the clinical examinations would be recorded on the Japanese forms and then transcribed so that both the Eniglish and Japanese records would be complet Laboratory data xvhen available were to be entered on each. This principle of duplication and sharing the material was to allay any suspicioIn that w-e would sinmply use the Hiroshima Aledical Diary, 1945 material for our own purposes and that the Japanese would be kept froml inaking a study and from publishing on their own'tl. All appeared mlost eager to begin the actual wtork onl the morrow. October 15: In the early morninig again had a mieeting w-ith the teamiis who arranged thetmselves according to plan for the work writh the Ujina Hospital in-patients. The clinical teamiis w-ent to work questioning anid examininiig the patients. An assigned case numiber was left at the bedside for the laboratory teanm so that specimiiens would be properly marked. The laboratory collecting team, consisting of Drs. Okoshi, Nakao and Sgts. Reed and Buckles, followed along obtaining blood and other specimens. This systemn worked out well although the laboratory group tended to lag somlewvlhat belhind. It was remiiarkable to see the patients lying or sitting about on the straw miats of the smiiall rooms. There were no beds. Numerous fires were burning in the charcoal stoves everywher MIany- women wNere presenlt, apparently relatives of patients to whom they iministered, but there were also nurses, wN-earing iioniitpt', white blouses and pancake-shaped hats imiarked in fronIt by a little red cross. \Ve learned that it wN-as Japaniese custoimi for kinfolk to serve patients and even to cook for tlhemii wNhile in hospital. Many of the patienits Nere horribly burned and others had various crude but effective orthopedic appliances. They seemed entirely docile and showed Ino evidence of hostility but rather a submissive courteotusniess. There was a remlarkable absence of odor despite the open infected wounds and burns and pitiful condition of somie of the patients. To us the treatment seemed deficient in that little attention to electrolyte balance and adequate fluid therapy had been paid. Tranisfusioins in our sense were almiiost nonexisteint. The closest approach was the use of blood in quantities of 50 cc. injected into the muscle of the btittocks and the blood was ustually derived fromi the patient himself. German field mediciine was said to have exhibited the same deficiencies. The Japanese pharmacetitical industry had successfully reached the sulfapyridine production stag but even this material was apparently not used in large quantities. The earliest stages of penicillini production also had been attained in Jap)an. but wN-e were told that this material wxas available only in smlall (Itaiitities and wsas rarely used, anid theni only in very smlall doses. This was probably fortunate since the product theni was still qtuite toxic. By late afterinooni all of the lUjina patieiits ha(l been seeni and the teamiis rettirinedl trituimlplhantly to the laboratory roomls. which served as a meetinlg plac On retturninig from the wN-ards we have dinnier prepared froimi the excellenit 10-in-1 rationis by an accommiiiiodatiing Japanese cook variouisly calledl T'oluttic 38, Octobcr, 1965 Top left. Onc of the workers' dormitory buildinigs at the Daiwa Rayon 'Mill in Ujinia usedl as a laboratory by the Joinit Commissioni. Top rigitlt. Prof. Tsuzuki in onie of the corridors at the Ujinia Hospital. Bottomii. A group from tlle laboratory of the Joinit Comimnission at Ujin Four of thle niurses who assisted iii the prel)aration of the glassware are 5shown. The physicians are fromii left to right, Dr. Kato, Dr. Kajitani (at rear), I)r. Nakao, 1Licut. J. Philip ILoge, Dr. Tsukadla and( D)r. Okoslhi. Prof. Tsuzuki's conifi(lelnce in thcse milenl is indlicated by the positions that they have attained since the end(I of the war: )r. NakaoProfessor of Initernial Aledicine at Tokyo Uniiversity; Dr. Kajitani Chief of Surgery at the Cancer Inistitut Two otlhers, Dr. Ishikawa and(I Dr. Hatanio are now also both Professors of Surgery at Tokyo University. Perlmutter or Rochester. He is efficient, quick to learn, and obviously enjoys his job since he is the recipient of what to others seems like manna, which he obviously takes home to share with his family. All of us are now free of the chores of housekeeping and can devote ourselves fully to the job in hand. On this first evening we all gather together, transcribe the records completed, and enter laboratory data that have been obtained in the meantim All seem quite satisfied with the operation and with an opportunity to do systematic and creative work. For numbering and identifying the records I devised a system whereby the prefix H was to indicate the hospitalized cases, 0 for outpatients, and S for persons to be used in a survey. A block of numbers beginning with 6,000 was reserved for the individual Hiroshima patients, and a suffix was added to indicate the source of the record. For the Ujina patients we used the suffix "U." The old Ujina cases in the group from which Dr. Nakao had bone marrow and peripheral blood were given the first block of numbers, H-6,OOOU to H-6,044U. The records of these patients were available at the Ujina Hospital. In fact among those examined today were identified patients who had had previous marrow punctures in the Nakao series. These were especially valuable in terms of follow-up and there was general agreement regarding the desirability of second marrow punctures, which were therefore planned. These might provide evidence of recovery in marrows where there had been leukopenia previously. Col. Mason and Dr. Sassa had been establishing liaison with other hospitals in and near Hiroshima as they had planned. It seemed best to send teams next to the Prefectural Hospital and to the out-patient clinic at the Post Office Hospital, where Dr. Hachiya, the gracious director, welcomed them. Drs. Rosenbaum and Koch were to go to the former in the morning to be followed by Phil Loge and the laboratory team in the afternoon. Col. Mason and Major Kramer, with a group of the Japanese students, were to go to the Post Office Hospital. In discussion with Col. Mason, we concluded my own function for now would be to remain at home base for a time, to maintain the laboratory and to bring it into a functional state for preparing histological sections, to systematize and keep the records, to establish a flow chart of work to be done, to schedule the work for the clinical teams, and in free time to continue the translations of autopsy protocols and records from the hospitalized patients seen earlier at various institutions. Col. Mason said that he preferred to continue with the work of establishing contacts with the Japanese medical institutions, to maintain liaison with Headquarters at Kure, and to function as supply officer. He would obtain from the chief medical officers in the Japanese institutions accounts of the numbers Voluttie 38, October, 1965 and kinds of patients and their findings and experience with them. He was also particularly interested in effects on the eyes and would make a special effort to obtain accurate dat He would rely on us to carry onl with the rest of the labor. )X4L /45*24%v Doctor Hachiya's card anid signiatur Octobcr 16: The teamiis departed by jeep for their destinations immlediately after breakfast. At 09:00, soon after they had gone, Dr. 'Miyazaki, one of a group of Japalnese scientists who had been studying radiation effects in the city, came anid presented data concerninig how the center point of the explosion wsas determiniiied to be 547 meters above the ground. He gave a graphic description of the shadowNs, somie of which had both an umibra and a penumubra, anid also the process of triangulation. He also suggested that the Koimiiaclhi district miglht be the source of secondary radiation, perhaps on account of the water having acquired radioactive properties. He told also of a secondary focus of radiation resultinig fromll the fall of radioactive dust in the Takasu are I then began to work on the first batch of the now comiipleted records of the patients in the group collected by Dr. Nakao. These were translated wvord-for-wN-ord for entry inlto the general series. About noontimiie I was Notes made by Col. Mason at interview with Dr. M. Hachiya, Director of the Communicationis Department (Post-Office) Hospital. Doctor Hachiya later published his detailed "Hiroshima Diary." pleased to find that Col. Oughterson and Dr. Tsuzuki had arrived from Tokyo with a little mail for us. It was a delight to hear from parents and from C.G., now in Main It was a peculiar pleasure also to have a newspaper in hand. We then informed him about our work to date which seemed to be progressing smoothly and our attempts to locate as much of the material as possibl He promised to attempt to get us more transportation, which is our chief deficiency at the present tim Our Japanese chef, Perlmutter, was preparing lunch as Col. Oughterson arrived, much to the latter's pleasur During the afternoon Dr. Kato and I went to the wards and I observed the Japanese technique of vertebral spinous-process marrow punctur It was most impressiv A #19 plain needle was used. In two motions the skin was penetrated to the bone and the needle tapped through the thin- cortical shell into the marrow cavity. In another, suction was applied and a small quantity of what looked like blood drawn into the syring We later stained the smears and found them to be remarkably rich in marrow cells, as was the case with the material that I had seen previously in Tokyo in the patients without aplastic anemi For the first time also I was able to view some of the postmortem material that had been promised by Dr. Ishii. The slides were wellprepared and were well-selected from all significant organs. There was also considerable gross material. Unfortunately much of this was fixed in rather small quantities of formalin and may be not as useful for study as the small blocks that have already been prepared. We planned to attempt to restore some of the color and to photograph the specimens on 35 mm. color film. I had noted that Dr. Ishii had worn only sandals despite cold and wet. On impulse I asked whether he would like an extra pair of shoes that I had along if they would fit. I was able to gather that he would and presented them to him privately. October 17: In the morning, very early, met Dr. Hayashi, a Professor Emeritus of Pharmacology at the Imperial University of Tokyo. He was a most impressive, dignified, white-haired man, alert and keen despite his 71 years. He had been a teacher both of Dr. Tsuzuki and Dr. Sass I explained to him how the work was progressing, discussed plans, and asked for his suggestions. He was most gracious. The team working at the Prefectural Hospital now has almost finished the work. There have been several important developments. An ambulance and a driver, Spears, has been added to our staff. Col. Mason has been foraging and a number of additional sleeping bags have been somehow provided-but there are only three and some of the less senior officers are unhappy. Dr. Murachi, our biophysicist, gave an interesting hint of secondary radiation effects. A man who had returned several days after the bombing to a concrete building had had a transient leukopeni We said that much more evidence would have to be gathered before any cause and effect relationship would be established. Dr. Murachi agreed and stressed that neutrons might have induced sufficient secondary radioactivity to have given the observed result. * Observations of this sort at Hiroshima were isolated and the leukopenia may have had some other caus Members of a military unit, the Ishizuka Regiment, had camped from August 6-11 in the near vicinity of the hypocenter, at Kamiya-cho. Blood counts done by the Japanese before the end of August showed no evidence of leukopeni This well-established observation and physical measurements indicated that there was no biologically significant neutron-induced secondary radiation at Hiroshim During the afternoon several of the autopsy cases were translated by Dr. Ishii from the Japanes I transcribed them and later in the evening dictated the transcripts to Pvt. Ohnstadt. October 18: Teams with Maj. Kramer and Dr. Rosenbaum assigned to Red Cross Hospital. Joined them there about mid-morning. Met the Vice Director, Dr. Shigeto, who is understandably sad and discouraged. Had an extensive tour of what must have been a fine modern hospital. Rooms and equipment have been unbelievably damaged and there are many patients, again attended by their families, amid shattered surroundings. Buckled metal window-frames and broken plaster exposing lathwork are everywhere, although an attempt has been made to clear the debris. On returning, continued translation of protocols with Dr. Ishii. Later in the morning two photographers, Ware and Circus, appeared. These men were on loan from local Headquarters until our own photography unit was asigned. Also Lieut. Vance, Sanitary Corps, a parasitologist has been attached. He seems a very nice sort and brings along a welcome item -another microscop To my amazement and pleasure, two more microscopes arrived with Col. Mason, who had obtained them on loan from the 29th Malaria Survey Detachment. He also brought a radio from the I & E section of Tenth Corps Headquarters (now we would again be in immediate contact with the outside world!) and, best of all, said T'oluttie 38, October, 1965 that a refrigerator, six cubic feet, Frigidaire 11o less, was waiting to be picked up at the 411th Medical Collecting Company. The 361st Station Hospital had furnislhed a uterine curette and an ophthalmoscop He accepted our enthusiastic comnplimienits without blushing and said it was all the result of his eagles screaming. Doctor Slhigeto's card and siginatur In the afterinoon Col. Ouglhterson brought in aii X-ray film Nwhich had beell exposed during the burst of radioactivity and whose location wvas known. This lhad also been seeni previously by members of the Mlanhattan District Group, and(l by the highly competent radiologist, MIajor M\iisono (who had been in command of the hospital when we arrived). \Ve discussed again at length the shielding and protection problem with Dr. Murachi and Maj. Mlisono who had been interested from the beginning and had given these matters muclh tlhought. In fact this was one of Dr. Murachi's priimle interests. \We planned a thorough tour of the city tomlorrow in order that I might have the benefit of his previous observations and thinking. In the evenling there Nas a lecture by Dr. Kitaoka of Okayanma attended by all. He said that the tuberctulill reactions and Schick skill tests were Upper: View across hypocenter toward the domed Chamber of Commerce building (center distance). In the right distance is the Businessmen's Club (Korean building). In the foreground are the Bankers' Club (left), and a bank building (right). Middle: A part of the north wing of the Chamber of Commerce building showing "dishing" of the flat roof as a result of the blast. Lower left: Shadows of railing anid of a human being on the asphalt of the Bantai Bridge, approximately 1,000 meters from the hypocenter. The directly exposed asphalt has been darkened. Sighting along the shadows, in line with the objects which cast them, enabled Japanese scientists to locate the hypocenter by triangulation within a few days of the explosion. Lower right: Effects of heat flash at 1,300 meters. Sharp shadows of leaves of castor plant on blackened telephone pole near the Meiji Bridge (1,300 meters). The plant at one time was taller but the leaves which cast the shadow wilted where directly exposed to the heat rays. The rays were directed downwards from a point approximately 625 meters above the hypocenter. Photograph made on October 31, 1945. Hi) os/i iwoa le(lical Ditrv, 1945 B L,IEBOUI dimiinished amloing exposed patients in whomii there had been letukopenic reaction. October- 19, 1945: In the morniing took a trip with Dr. MuIurachi to the city in the region of the hypocenter. Dr. MIurachi had a detailed know ledge of the noteworthy and most revealing physical features. Ascended the stairs of the burned-out Sanwa Bank to the roof. The reinforced concrete w-alls w-ere solid but many of the partitions had been fragmented and the wood supporting the plaster had burned, as had the furnishings. In one rooml salk,e cups were still on the floor amid the rubbl The roof of the Sanwa, only 500 meters from the lhvpocenter, is one of the best places froml w-hich to view the city, as one can see over the hypocenter itself toward the remarkable domed building which the Japanese call the Commlnlercial Museum (Clhamber of Commerce). 'We mlleasured the thickness of the walls of the Sanw As we Nvent to the formiier iMitsui (Teihoku) Banik, there was still the smell of death and the burned bones of a dead miiani were visible trapped deep within the rubbl Remiiarkably, the walls of the strtuctture itself showed Ino evidence of burning. On the groutld were miany tiles and in the small cemneteries, of whiclh there were mnany. were the vases miade of setomono. At the hypocenter itself trees w-ere tupright but leafless and charred. Nearby were the ruins of a brick building which Dr. Murachi identified as the Shimiia Hospital. This had beeni of weight-bearinig brick wN-hich had completely collapsed. The day was ideal for a photograph which I took fromii in front of the hospital across the hypocenter toward the tw-o impressive bank buildings and tlle ruin of the Banker's Clutb. As w e w-ere walking about, 'Major Hamiilill drove up in a commlanid car to tell uIs that a photographic teaml wN-as expected at the Hiroshimlla airfield later in the day. They were to be assignled to us for the durationi anid had been asked to bring their equipment 'with themii. \We watched the vicinity of the airfield while examininig the various btildinigs btlt sawlno aircraft. \We then drove the short distanice to the broad road betwseeni the maill cit- anid the border of the military reserv ation. On the wvest side w-as the Gokokti shrinie wN-here the most remiiarkable shadow-s on the granite were demiionstrated, and also the interval between the heat w-ave and blast w\axv Nearby w as a higll modern building, again with a sotund outer strtucture but l)lasted and burned within. People had taken roollms in this btuilding for living quarters; now completely windowN-less it lhad been screened w ith rotugh wMoven mnats. Dr. MuIurachi told mle that they -were Koreans wN-ho had always felt dowsntroddeni but now considered thelmiselves victors over the Japaniese and therefore entitled to the best qtuarters. OIn f'ollittic 38, October, 1965 Uppcr. Face of monument at Gokoku shrinie, 300 mcters from hvpocenter. The directly exposed portions of the graniite have become roughened and( flaked, while the portion of the base slhade(d by the upright e(Ige retains the original polish producing a "shadow.' Lowucr. Similar effect on base of gratite rail. The blast vave knocked down the uprights at a time whenl the heat of the flash ha(l become reduced to the exteint where the original appearance of the monunuent is retainied. This demonstrates the difference between the rate of propagationi of the heat wave and of the blast wav Ilfirosliiiiia MI(ed(ical I)iary, 194-5 I IEBO NN's , s.:, =s. --^ jjjj. _s .] . _ - *, . . t :j; 0s *^ 91-: -': 'f sF; :r, ^z_ ::. . 'A g , -! :IV V.l "Profile burnis' of legs. Only the directly exposed skill hias beei burned. There is evidence of keloidl formationi. The patient was a soldier in the militarv coimipound, approximately 900 meters froimi the hypocenter. ( Enilargemelnt of 35 mIllm. transparency.) HiroSliii(l Aledical Diarv, 1915 V tlle topmlost landinig Dr. 'Murachi show-ed me some remarkable shadows of the mletal railing and upright edge of the building on the horizontal cemient slab w-hich supported the former. The shadoNs consisted of dark, grey-brown streaks corresponding to the horizontals and verticals, surrounded by a vaguely defined rusty-brown band. The darker portions represent the umbra, which still had the grimy appearance closer to that of the original cemenit, while the part that had been directly exposed to the hleat had a clean white appearanc The part between, which was rusty brown, represented the penumbra and therefore the effect of a lesser degree of heat. Murachi complained that the shadows were fading and that good photographic records imust be made at onc From the same landing we could look across to the dome of the "Commlercial MIuseum." Here the unbelievable effect of the blast was evident since a concrete wall lhad beeni made concave and a roof converted into a saucer by the downward and lateral forc The most remarkable shadows were on the Bantai Bridge at 1,000 meters fromi the hypoceniter, w-here not only the railing of the bridge but also outlines of people were plainily visible on the asphalt. Farther fronm the center of the city, near the middle of the bridge, was the clear outline of a hand cart and of the person who had apparently been pulliing it. These "shadows" were of a liglhter color than the remiainder of the asphalt Nhich had been dlarkened by the heat flash. During this remiarkable tour w-e discussed possibilities for the protection studies. Dr. AMurachi said that there were official reports on survivors in the Citv Hall, and of employees in the large utility buildings whiclh would give crude data for comlparison with survival of persons in certain wooden bLildinigs, but that imuclh very careful wN-ork wN-ould have to be dcone to establish the exact positioni of individuals. * It is astonishlilng anid a tribute to the resiliency of the people, that even at this early time the city was showing sigIns of revival. \When we first arrived there wNas almliost no one to be seen. The trolley cars that rumbled through the streets amlid the ruinis were almlost empty. A few crude shelters had been put together from the rubble but these w-ere utnoccupied. There wXas dread of the imminient arrival of the unknon conqueror, occasioned by inconisiderate treatment on the part of a few who had entered the area befor But now not only were people movinig back from the villages where they had been staving w-ith relatives anid friends, but bamboo scaffoldinig was beginning to appear on somiie of the larger buildings. Life in the croNded surrounldinig towns wsas activ Clothing and other goods made locally seemiied abunldanit, and even cheaply miianufactured articles Voluttie 38, October,, 1965 Upper lcft. Shadow on the prison Nxall t Hiroshim 2,300 meters. Upper right. Shadow of rail on concrete at Businessmen's Club (Korean building). There is a darker central portion, representing the umbra and a more vaguely defined periphery representing the penumblr (350 meters.) Lo-wer lcft. Light colored shadows of window- framii The wood has been charred w.rhere directly exposed, even througlh glass. The "shadow" represents the original color of the material. Lowcr rigjht. "Shadow" of laddler on gas tanik at 2,200 meters. The "shadow" represents the original color of the tank wThiclh has been lightened by direct exposure to the rays. Other shadows also are seeni on the tank. Hrloshittia Mledical Diarv, 194-5 were oi dlisl)lay. Food was scarce, less so in the miore distant villages, and rationiing wsas still in forc The rice crop was ripeniing even in the close environs of Hiroshinm The attitu(le was definitely no longer onle of paralysis hut one of enicouragemiienit anid hope despite privatioll. * Upon returniiig to the laboratory imiet Maj. 'Motohashi. He wxas a very smiiall, bright-eyed, sharp-jawved, active vouing imlan who gave the appearance of higlh intelligenc He had a fluenit comminlanid of English which lie spoke in a hiigh-pitclhed voic He said that there might he patients at the Nilho Hospital. whereupon I (lispatclhedl him and Capt. Rosenbaum to insvestigat \With lshii and the two photographers who had been assigned l)reviously on loan photographed a great many specimllenls that mliglht be used to illustrate our report. They used a Graphic news camlera and I made the photographs in parallel with color filmii and a 35 mim. ILeic \Ve photographed lunlgs, initestines, helrt, hones, kidneys, and other organs. It had beenl possible to refresh the color of the organs somewhat wxrith 80 per cent alcohol sinlce they h1ad faded d(urinig their lonlg fixation in formiialill. Late in the afternooni discovered that it was bath day and promptly repaired to the comnlitilal pool at the far end of the Ujina living quarters. This is perhaps a quarter of a miiile down the long covered arcades where there is a large building that itself looks like a factory unit. It has a smokestack fromi w hich gray and black smoke belches. Inside all is latuglhter anid good cheer. The 1)ool itself can accommiiiiodate p)erhaps 75 at one timiie at an arm's length apart. The customll is to have a complete scrub before entering the pool. This is donie by filling a small wooden tub with the hot water, wettling anid soaping oneself down, rinsing, and when clean, enterinig the wvater at the cooler encd. "Cooler" means just barely tolerable to Caucasian skin. At the far corner live steam bubbles through the water. I was amiiazed to see habitutes standing almost at that very point. To the uninitiated the approach mllust be very gradual. In the pool conversation is animated. Everyone is relaxed. Gossip and jokes are exchanged. Both the atmiiosphere and the temperature thaw reserve anid onie emiierges with friendly feelings for everyone and everything including cold, gray weather. We had heard tales of how in the villages people walk naked fromii such a bath through wintr) streets without harm. Actually the warmi- pleasant glow remiiainis for somiie hours after suchl a bath. At Ujiia it is available twice a week. I resolxe theni niever to miliss an opportunity. After a goocl supper from Unicle Samii's 10-in-i supply it is acttually pleasant to get back to work in the evening. \Vork is now in full Volutize 38, October, 1965 swing and no one can get to bed before midnight, and we must rise before 6:30 to embark on the day's activities. We now have four Japanese nurses who clean glassware and prepare everything for the next day after we get to bed and who always are in the laboratory when we arriv Since our coming there has not been a moment to spare as we feel the opportunities of observing patients still at the height of illness is quickly disappearing. The last event in the day for me is always to complete this diary. At this time our Japanese hosts favored us with an act of great kindness. The usual facility for elimination, the benjo, consists of a graceful but narrow bowl built close to the ground, designed not to touch the skin but to be squatted over. The more modern devices are provided with facilities for flushing, but this convenience had not yet been provided the workers' barracks in the Daiwa Rayon Mill. Having heard of Western custom, the officers ordered the construction of what they thought were appropriate settees. This task was efficiently and handsomely accomplished -with a single major difficulty. Although the orifice was of reasonable dimensions, the seat, rather than being built like a bench had been made like a saddle, at right angles to the proper direction! The matter was duly rectified with considerable hilarity on both sides. * October 20: In the morning as I was working away at translations in came a Caucasian woman, Mrs. Yamatoda, with a Mr. Suga, an English-speaking friend. She told a long story of how her husband had died during the war after marrying her in 1926. At that time she was left with her relatives who were hostile, especially a former Japanese Naval man. All I could do was to promise that I would have her brought to the Red Cross at Headquarters, where she could present her cas The problem of food for our Japanese colleagues again came up in a lengthy discussion with Dr. Sass They had been supplied from our stock of military rations (Headquarters had given a hesitant blessing), but complained that they found the diet too rich to be agreeable and that they required adequate quantities of their staple, ric As Prof. Sassa put it in no uncertain terms: "Japanese people must have rice !" Knowing that rice was still strictly rationed in Japan I inquired what had become of their ration cards. He was somewhat evasive but gradually it came out, more from his colleagues than himself, that many of the cards had been left with the families in the Tokyo are They had evidently thought that their own problems would be solved, and that their families might have Top. Shadow of person on Bantai bridge at 1,000 meters outlined in chalk. The asphalt has been darkened by exposure to the flash. Farther down the bridge can be seen the outlines of a cart and the person drawing it. Middl Capt. Brownell standing in position of person at the moment of explosion over the shadow shown in the upper figur Bottom. Outline of cart and of person drawing it seen from abov Further to the right are the outlines of other persons on the bridg l'oluitie 38, Octobet-, 1965 the benefit of their own cards. After discussing the mlatter wN-ith Col. Oughtersoni wN-e decided that the best solution under the circumilstanices would be simiiply to demiiand the rice fromii the local authorities. I therefore xwent to the Prefectural Office near Kaitaichi and, stern-faced but polite, simiply requested the ric Conversation with the somiiewN-hat bewildered officer Nas difficult anid conducted througlh an interpreter. He finallv agreed that Ne could have the rice if I wxere to signl for it. This I of course agreed to (lo anad we miade off wN-ith several hunidredl pounds of the graini quickly hoping that niothing untoward would happeni. After the day's xvork our Japanese colleagues suggested that we spendl tomorrow ( Sunday) on Miyajim a famiious shrine islanid in the Inland Sea nearby. \Ve agreed that a (lay- of relaxationi was highly indicated. Sionidav, October 21: After a hearty breakfast on this crisp clear day w\-e crowded everyonie into all of our av ailable vehicles, including the ambulance, anid headed south along the coast toward Hatsukaichi. All then boarded the ferry to the beautiful deep-green hilly island across the sparkling water. As we approached the islanid we glimipsed just off shore the great torni standinig high in the water. Beautiful temiiples lilled the shore and miany of these were over the wN-ater, reached by cat-wsalks. After inspecting these we wxalked througlh the fall wsoods. The colors Nwere beautiful btut miiore subdued thani those of New Eniglaind, wxith ilmany dark bronzeor purple-red cut-leafed mlaples. Fromii the heights there wsere occasional views of the sea and of other islands. Mlany people brouglht their camlleras anid photography of everything in sight wx-as in progress. Olle of our friends pointed to a sign and laughed. It said that this was a restrictedl militarv area and photography was forbiddein-a message now obsolet Our colleagues chose a restaurant deep in the hills for a mid-afternoon meal. The restaurant was located in a lovely ramblinig Japanese country hous Shoes were left outside amiiong a forest of others. The tatanii (miiats) were spotless and one sat or squatted on themi at low tables. The mentu Nas carefully chosen by our friends. \Vith a little wvarmll sake, reserve wvas cast aside, faces flushed, conversationi became animilated and personal. The sake surely is only a formality to make this possible since the effect caninot be from the small quantity of alcohol. Everything was gracefully served by charming kimono-clad ladies. The dinnler lasted several hoturs and there seemed to be plenty of food froml raw fish to mutislhroomii and mieat dishes served with imiotuntains of rice, anid with plenty of sake and te I was uncertaini whether the abundanice indicated somiiethinig illicit about the establishlmlenit in those days of stringencv. \Vre re164 turned home through the sunset and dusk with a much better acquaintance with persons and a better feel of the country. At a meeting in the evening we discussed with the Japanese members methods for performing the survey study in order to obtain some idea of the distribution of effects about the hypocenter in relation to distanc Since there had been complete dislocation of the population and large numbers of people had died or had moved, or were otherwise unavailable, it was obviously not possible to obtain a representative sampl Still, a survey of survivors would disclose those with minor injuries and would give some idea of the distribution and severity of burns under various conditions of protection, and to an extent even of radiation effects. Some of us are particularly interested in amenorrhe Dr. Mitani of the obstetrical department has made a study of this in Tokyo and states that there was clearly such a thing as "war amenorrhea" and that the study would have to be carefully controlled. The distance from the hypocenter would represent a determining factor. Standard record forms were to be prepared for each person in the survey, as for the hospitalized patients, and every fifth person was to have a complete blood count. The Japanese told us that the best way would be to approach the police officers and ask them to have people brought into the clinics and aid stations which were located in outlying parts of the city and in the nearby communities. The point was to obtain for examination numbers of persons who had been in all sectors and who had survived with minor injuries. I would keep a central record on one of the sector maps to be sure that ultimately roughly equal numbers were obtained from all sectors. Col. Mason, Majors Motohashi and Misono and other senior members of the group would make the contacts with the police officers and explain what was required. October 22: Teams were dispatched to the smaller hospitals at Eba and Oshiba and to the out-patient clinics at the Red Cross and Post Office Hospitals. The 20 students who have arrived were sent with the teams to the out-patient departments to receive indoctrination, especially in questioning the patients and in filling out the record forms properly. At the request of Drs. Nakao and Kato discussed the follow-up work on former patients in the early Ujina (Nakao) series. They had been delving into the records and found that several of the discharged soldiers in that group were living in small communities near Hiroshim We decided to attempt to locate them tomorrow. Both Nakao and Kato were confident that these people could be found. They would prepare for hematological workup and spinous-process punctur Volume 38, Octobet-, 1965 Later wvent with Col. MIason aind ani initerpreter to the Hiroslimna W\est Police Stationi where we imiet Chief Suizawa in his rather imiipressive offic He w-as cordial anid gave the imiipressioni of brisk efficiency. \Ve explained that we wanted a good cross-section of the population of both sexes and all ages wlho had been in variouis parts of the city at the nmoment of the explosion and(l who lhad beeni displaced and were now living in the area uinder his jurisdictioni. He offered ftull cooperation, stating that it wotild not be difficult sinice all persons were registered. \\e arrange(l for a visit by ouir tealmis oni the 26th at 9:30 m. Dtiring the day w e visited se-eral other stations anid miiade similar arranigemiients to see fromii 150 to 200 persons. Retuirnied to continutie translationis and to work in the laboratory. October 23: The ouit-patient work was continue(l in the miiajor hospitals an(l a teami was sent to the Ajina Aid Station. Conltinued wNith the protocol translationis. Section cuitting and staining N-as now progressing superbly tunder the miiinistrationis of Drs. Ishii and Shimlamiiin I noticed that the formiier somiietimes now wore the shoes, but lnothing was said. I could niot resist going over some of the slides as they were finished. When one of the jeeps returned, drove into the country with the Japanese physicials andl Phil Log It was fascinating to see the rice dry, brown, fuill of graini, and readv for the harvest. After considerable searching, and inqutiry of miien in the fields and paddies, w'e fouind two of the patieiits. We were graciously received anid served tea oni the miiatted back platfornm of the farm houlses. Mr. Hiroslhi Okita was actually at w-ork oni hiis farm. He was onie of the survivors who had had ratlher extensive clinical anid hemiiatological sttudies twice previouslyr while a patienlt at the LTjina physiciMns of Hospital (Case H-6011-U) anid hald beeni investigated( 1)I We lhad studied two pre viouIs the Tokyo Dai Jchi MAIilitary Hospital. marrow speciiiiens with Dr. Nakao. AIr. Okita, theni a soldier, hal been in the uipper floor of a two-story [apaniese building in the barracks of the 104th Garrison Force at approximlately 1,000 m-ieters fromii the hvpocenlter. He w-as only slightl- injured bv flying glass and debris anid w-as able to Nork anid to mlarclh for the first ten days after the explosioni. Beginnilng on Auigust 20 he began to lose his hair. A week later he developed fever, petechiae anid swellinig of the gumils w-hich becamiie painful anld heillorrhagic and(I tultimately ulcerated. He also developed sore throat anld dlifficultv in swallowing. He was admiiitted to Ujinia on Auigust 30. His w-hite blood couint hadl been 900 on Septemlber 4, btut rose to 1,400 bV September 8 au(I to 4,600 by September 27 hlile he was a patient at the Ujinia Hospital. He also hadl a mzarke(d anelmii The cell couint of his bone marrowlhad beein only 4,000 oln Septemher 4, with approximately half of the cells in the Ot-*N I r---s . --La ,i'.6 R!Iii, 6-- lwx 3._ ct bI) -C£ V U CZ It, V Q t-4 -C. Volume 38, October, 1965 marrow being lymphocytes or plasma cells. In the second specimen obtained on September 27 there was evidence of almost total recovery, except that there was now a relative hyperplasia of normoblasts. Today he appears well and states that he is able to work, although he becomes tired easily. His hair has largely grown back. There are still dark red-brown discolorations of his gums but the ulcers have healed and are no longer painful. He submitted to the marrow puncture with alacrity. We found that his white blood-cell count was 10,400 and that his marrow cell count was 75,000/mm3. The cellular constitution of the marrow was now normal. Despite his healthy appearance the blood proteins measured by the copper sulfate method were only 4.6 gm/100cc. We had a most interesting time and obtained valuable dat Returned late to assist after dinner with the records. During the evening we subdivided the students and junior members into teams, each under a senior Japanese physician, so that the survey work which is to start tomorrow hopefully will go smoothly. Attention was paid to known evidences of compatibility. October 24: Three survey groups were arranged as follows: to Yokogowa, team 1 (Dr. Ishikawa) and team 2 (Dr. Kitamoto) with Capt. Rosenbaum; to Onaga, team 3 (Dr. Yasuda) with Dr. Koch; to Kannon, team 4 (Dr. Ito) and team 5 (Dr. Hatano) with Maj. Kramer. The plan was for the younger doctors and students to be checked by the senior physicians in charge of the teams and by the Americans who also participated actively in the work. Each team took its laboratory equipment for performing blood counts on every fifth patient. Our sergeants acted as drivers and performed laboratory work as required. On returning all teams reported remarkable cooperation from the police and the peopl All records were completed and checked by 11:00 p.m. October 26-30: During these days the survey work progressed apace and the teams seemed congenial, but the work was hard and of a routine natur Fortunately the weather, although cold, was clear most of the time and there was no undue hardship for the waiting patients. Attempts to stagger the clinic visits met with only modest success, and most of the patients were on hand in the morning when the group arrived. Some stood patiently for several hours before they could be questioned and examined and "treated" with the vitamin pills. At the same time old records of discharged patients from the major hospitals such as the Ujina, Red Cross, Prefectural, and Niho and autopsy protocols were being transcribed at Ujina or in the several institutions. Hiroshliimiia Iledical Diar), 1945 L Top. Lieut. J. Philip Loge enljoying a conversationi with one of the patients during on1 October 23, 1945. The patient was a soldier who had suffered severe radiation effect. He is now regaining his hair and able to work. Bottowii left. Anothier patient, O-, visited on October 23. He had been hospitalized at Ujina for severe radiation illness. His hair has now growni back almost completely. Bottoml rig/lit. Same patient. Almiiost healed hemorrhagic and ulcerated lesions of the gums. He permitted a spinlous process puncture to be performed at this tim a follox-up visit at the patient's farm l'olume 38, Octobet-, /965 All nmemibers were rotated througlh this w-ork so that there would be a clhanige from the daily grinid of the survey. A remarkable body of iniforiinatioIi was beinig accuImlulated. Patienlts dyinlg with only imiinor injuries, presumiably from radiation effect, however, were not well-represented. Some records of stuclh patienits were said to be at Iwsakuni Naval Hospital. WNre therefore plannled to visit this institutioni. Also, the persons dVing in the first few day)s wN-ho had been autopsied by MIaj. Yamllashinia, or Dr. Sugiyamia of Kyoto University, (there were conflicting reports) were also to be obtained. Durinig the past several weeks Dr. Tsuzuki and the Japanese miiajors wN-ere preparing a consolidated list of institutionis outside of Hiroshimlia to whiclh people had beeni evacuated and that are to be visited before concludinig the work in Japani. Our nmaster distributioni clhart of the patient survey was growing. Specificationis as to source of the subjects for the sturvey were altered to provide good representation from the various sectors by appropriate inistructionis to the police officers. These were amazingly successful. The list of suffixes to indicate the source of the patients also was growing. By the enid of the work the niumiiber was large and they are reproduced here to provide somiie idea of the scope of the investigation: Aj - Ajina C - City Hall E - Eba Branch of 1st Army Hospital F - Funakoshi Fk - Fukuyama Army Hospital G - Gion-Nagatsuka H - Hiroshima High School Hr - Hiroshima Railroad Station I - Iwakuni J - Prefectural Hospital (at Kusatsu) Kg - Kramer Girls Ki - Kaitaichi Ko - Koimachi Ku - Kaij in-Kai (Kure) M - Mitsubishi Hospital N - Niho OI - Onaga Ot - Otake Ou - Ouzu P - Post Office Hospital Pe - Early IPost Office Cases Pr - Prison R - Red Cross Hospital (Hiroshliimia) S - Saijyo Sa - Seconid Army Hospital Hiroshiimla Medical Diary, Ujinia Hospital Ushida Ujinia Public School No. 1 Us - Ujinia Public School No. 2 Ya - Yaga Yo - Yokoga%Na - Ono Hospital Ono Ushida Hospital (Kyoto Research Commiiittee patienits) Ush - Kyoto Prefectural Medical School (Cases studied at Kyoto) Kps Kyoto Prefectural Medical School (Cases studied at Hiroshima) Kps-H Tot Tottori Army Hospital Takatsuke-- Takatsuke Branch of the Osaka Medical Faculty - Osaka Medical School Osk - Kyoto University Kyoto - Kobe University Kobe Okayama - Okayama Medical School - Okayama Military Hospital Om U Uh Uj October 30, 1945: In the afternoon Commander Shields Warren arrived together with his party and Col. DeCoursey. Commander \Warren was an old friend from pre-war days and a fellow member of the Interurban Pathology Society. He told me that he had naturally joined in the investigation with Col. Oughterson, as a friend from Scotty's Boston days, since his own team was small and consisted of a translator and of several Navy officers and enlisted men. They were now living and working as one with the Nagasaki unit. It had been decided to include the Navy group in the "Joint Commission" and to produce a commoni report. * Dr. Warren was well-prepared for the atomic bomb casualty study, since he was author of a number of articles in the Archives of Pathology on radiation effect. These had been collected into a monograph. After the war, Dr. WVarren was Director of the Division of Biology and Medicine of the U.S. Atomic Energy Commission from 1947 to 1952. Today occurred the only unpleasant incident with the Japanese until now. Major Sinclair, the language officer for the Nagasaki group, was wandering through the buildings and in going through the kitchen he had addressed some remarks to one of the men working ther The man apparently failed to understand Sinclair's Japanes Sinclair thought him rude and slapped him across the face in a manner that he thought appropriate to Japanese custom. This caused a minor furor and great embarrassment. Things are currently tense but we have asked our people to smooth things over. T'olivne 38, Octobei-, VI'65 October- 31: Took Col. Oughltersoni and Nagasaki guests ou what we have now laidI out as the "grand tour." This includes all of the fascinating evidences of blast and heat damiiage in the shrine area at the Chugoku Army headqtuarters, the "Korean Building" with the shadowing on the concrete there, andl the remarkable view of the "Commercial MAuseuim" and the area of the hvpocenter. All were fascinated by the outlines of mllen and vehicles on the Bantai Bridg At another bridge farther fromii the hvpoceniter, Scotty foundel a charred pole with the light shadow of leaves of a castor bean plant. The plant had growN-n anew. In the evening we disctuss the total magnitude of the work. Scotty suggests that "more than 5,000 cases must be studied." This seems a staggering load to those who are laboring daily at the task of seeing the patients, doing the laboratory work, and transcribing the detailed records often until mlidnight or later. Our teams have, however, admittedly become highly efficient and we can survey as many as 300 patients each day, the students doing most of the history taking and requiring less and less supervision. I stress the desire of everyone to comiplete the job and to get home wvithout delay and point out that morale will be difficult to mlaintaill under the load if a definite goal is not set. Scottv has to hurrrv off by train to Tokyo. Later rliscussion with the junior nmembers does indeed elicit grumbling. Remarks are made about "AWVOL Oughtersoni" and Jack Rosenbautml spendls the rest of the evening comilposinig a song to the tune of "Get Mle One Thousanid Roses": Get mle tell thousanid cases, \Vripe tllose smiles off your faces And stay out here another year, While Doctor Tsuzuki \Vlho's my favorite cookie Gives vou all a loud Bronx clheer. There may be other surveys later, Kinda thiink they'd be funl! Tsuzuk' anid I will plani themiiAt the Club 21. So get me teni thousanid cases, Forget other places. Hiroshinma is now your home! very late and very tired. N'ovemiber 1: In the early imiorning w-ith Dr. Nakao received patients from the Ujina out-patient clinic itself. One of the miost striking was patient Shigemori, a formiier soldier in the Nakao group who had imiany To bed Hiroshima Mledical Diary, 1945 signls of radiation effect. There was miiarked epilation. Hemorrlhages and gum lesions were fading but the latter were not quite healed and peridontal ulcerations were still present. A second bone marrow was obtained by Dr. Nakao using the spinous-process techniqu Drove to Gion with Dr. M\itani in the afternoon where arrangemllents were easily made with the senior police officer. It is remarkable that the police control of the population is still firmii. To obtaini any giveni number of persons from any particular locality it has only been necessary to speak to the police chief, who obtainis precisely what is requested at precisely the right tim The people who appear have been entirely docile, submit readily to questioniing andI examiiniation, and seemii grateful for the vitamin pills which are doled out after the examination. The chief showed us a very handlsome sword that had been turned in in accordance with a U.S. occupation order. It had been previously viewed by Col. Mason and vas reserved for him. A charming Nisei interpreter, Jean Ito, assisted in the demonstration. Later in the afternoon proceeded similarly to Koi to arrange work for the coming Saturday morning. Late in the evening discussed -with Col. Mason our food problem. The 30 cases of 10-in-1 rations that had been obtained Nere supposed to be sufficient for 60 men for 40 days. Numerous gtiests, both American and Japanese, had made considerable inroads and our supply was running low. Col. Mason had cheerfully assumed the role of supply and senior contact officer and promised to relieve our looming shortage with additional supplies from the Kure depot. Thlrsday, Novemiibcr 2: This was a lovely bright and clear morning. Col. DeCoursey and Coimmander WVarren were ready to return to Nagasaki. XAVe bade them a fond good-by. Dr. Ishii in the last few days had been busily translating the Japanese protocols by himself inlto German since I was thoroughly occupied with visitors and with trips into the surrounding communities to facilitate survey work through the polic The protocols wNere then ready for dictation in English to Sgt. Huffaker. WNTe completed the identification and separation of all of the old protocols, and prepared a consolidated list by transcribing all of the essential information on the front sheets. The (lay Nas ideal for photography. In the afternoon rode with Col. MIason to the city and photographed maniy of the buildings in the region of the hypocenter and obtained also panoramic views from the top of the "Korean Building." In the evening continued with the transcription of the records. Everyone was in better spirits in keeping with the weather. Volume 38, Octobe)-, 1965 Novemilber 3: Beautiful weather persists. Dr. Ishii and I took advantage to photograph the remiiaining gross mlaterial. The alcohol was successftl in restoring a semiiblance of the previous color. Our clinical teamiis in the field witlh Ishii then plunged inlto the task of completiing the translation of the autopsy l)rotocols. In the early eveniing we continued wvith the l)rotocols of three of the earliest patients who had died wvithin the first fen days at Iwakuni. The stress under which these patients were treated and the lhaste with which the atitopsies had to be performiied was reflected in the sketchiniess of the records. The tissues of these patients, however, w-ere Inot yet available for study. but imiust represenit somiie of the miiost importanit imiaterial. Ishii's quality and wvorth are daily becoming miiore apparenlt. He lhas become a firm anid lhelpful frienid. His education in pathology is superb. He is imiodest, eager to learn, and williing to listein. He is also, like Imiost of his countrymen who are with us, absolutely tireless. He voices actual enthusiasm for completing the work and Ne continiue into the smiiall hours until all protocols in hand are finished. Noveiiiber 3: The strain is beginning to tell and everyoine now is tired. Major Kramer came back late from Gion with his group and was full of disgust and complaints because of difficulties in dealinig with the huge mass of patients. \Ve had been collecting clothing that had been damiiaged during the explosion and the brilliant sunshine was ideal for photography. Many garnments had been brought in that showed the effects of differential heat absorption during the flash. The darker portions of the pattern were completely burned out, and the lighter portions spared. Whliere the heat had struck mlore directly, burning was more complete, but where the incidence of the rays was oblique there was only partial scorching restulting from smiiall differences in color and other factors determining Upper: View across the hypocenter, October 19, 1945. The tree standilng upright indicates the vertical direction of the blast from the bomb that exploded almost directly overhead. The heavy reinforced bank buildings in the distance beyond the hypocenter appear relatively intact, but are burnt-out hulks whose interior partitions have been shattered. In the left foreground are ruins of the Shima Private Hospital, a weight-bearing brick building which has completely collapsed. (Enlargement of 35 mm. transparency.) Lozcer: Sleeve of flowered cottoin blouse showing effects of heat rays (approximately 1,800 meters). Dark paper has been put into the sleev Where the heat rays impinge most directly, the darker flowered pattern has been completely burned through, and there has even been some singeing of the whiter cloth which reflected most of the rays. Where the rays impinged more obliquely, there has been more absorption by the dark red rose petal componenits of the pattern. This effect is best seen at the right center. The green shows less evidence of heat absorption, and the light backgrould cloth is quite intact. Hiroshliim7a Aledical Diarv, 19/5 L LIE BONV i absorption of heat. We used color film and obtained many close-ups with a portrait lens. Discussed with Japanese colleagues the possibility of a holiday for tomorrow, which is Sunday. Major Motohashi came forward with a proposal for a picnic and mushroom hunt which was joyfully accepted by all. The actual occasion of the meeting was the report just completed by Major Motohashi of a most valuable casualty survey that had been conducted by him and Maj. Misono and Drs. Miyazaki and Nakatoni. This was based on the principle that we had earlier discussed of identifying groups of persons at known distances from the hypocenter and under known conditions of protection. The school children were an excellent group for this investigation since their fate had later been determined by responsible authorities as the municipal offices of the city were reestablished. Some of the data had been collected by the principals. The headmaster of a private school, Rio Yasuda, had submitted a detailed separate report. He presented a table of mortality and injuries that could be correlated with the actual distance of the school buildings. Most of these were of a standard two-story Japanese wood-and-tile construction rather similar to the barracks buildings in which we were living and working at Ujin Some of the children had not been in the schools, but were in the open firebreaks. They were exposed to flash burns, and, if close enough, to radiation, while those in school were exposed only to the latter. The table classified the groups according to position and whether known dead, missing (presumed dead), untraced (no information available), injured, or alive and well. I congratulated Major Motohashi since this is the most important accomplishment in obtaining protection data to the present tim Everybody's spirits are lifted as we work late into the night transcribing the records of the day's surveys. Sunday, November 4: A beautiful day dawned for the picnic and mushroom (niatsutake) hunt which is traditional at this time of year. Col. Mason and I and as many as could fit rode in a jeep through the lovely clear morning to the hillside that had been selected. This was on Ushidayama to the northeast. All of the land was owned by three men. Permission was obtained by Maj. Motohashi who led the party up the hill winding through the elevated pathways on the ridges alongside the rice paddies now ready for harvesting. \Ve ascended to the tall pines above the terraced paddies. At one level all of the trees facing the city were scorched brown but their protected sides still retained traces of greenery. This represented the flash burn on the vegetation that occurred UIpper. View frcm roof of Businessmiieni s Club. The slhrinie area bordering the military encamlp)lent is at the lower miiargin. It has beeni pitted xN-ith foxlholes. The broad avenue at the soutlherni margini of the encampment is showx n, and in tlle far listaince is seen the tall Fukuya department stor A streetcar is visibl Lower. View tow-ard the niortheast from the Businessmiieni's Club. Across the militarv encanll)ment is seen the moate(d region of the castl In this area are the remainis of the Chugoku Army Headquarters, secn as a low white buildinlg. To the right and just above the center of the photograph is seeii the large (lark Commlllunication D)epartmnent Building. \fi~ ~ s.H l'oliiiiie 38, Ociobcr, 1965 li I/;ioshima l edical Dial tv, 1945 IAEBOWV at the milomzen t of explosioln. As we velit hiigher we couild see the terraill below that had beeni devastated all abotit the Higashi drill field. Against the flat backgrotnindl couild be seeni the framilework of a conicrete building that had crtliulpled awN-ay fromil the hypocenter, shiowN-ilig clearly the direction of blast imilpact. The dark greeni of the post office btuildinig was also visible above the plain. \Ve are told that it -as ani animial ctustom datling back to feudal tlimes for the lor(ds to permit the peasants and villagers to go on the mintshiroomil hnnlit at this tlime of year; we are milerely folloNwing traditioni. The miuiishiroomils are fouinid amiong the roots of the pine trees in moist, sweet-smelling soil, anid are well-hidden. There are shiotuts whenever a finle slpecimen is dliscovered. The muatsuttavc are larg white, and succtulenlt. All are said to be saf A very finie tramp of some fotur or five hotnrs is enjoyed by everyon Friendships glow ; niational (lifferelices are forgotten; the lhorrors of the War anidl the intensity and strain of the work are far -i l)elow alnd behind. The miniishiroomils are brought (lon to the edge of a Here is the still greeni tree linie where they are roaste(l indler the pcaddy. soughilng pinie bouighis in a shallow pit in simiall pans. They are marvelous with sov sanice conitaininig a fair amilotinit of stigar. The rice is cooked in a very large pot. \Ve are so hungry that it is Inot qtite (lonie h-leln we try the first bowls. Col. MAason anid I discuss ways and imieanis of obtaining additional rice rations for the group, hoping that otir previous inroads will niot have been takeni too seriously by otr owvn government auitihlorities. Tlien hlomile to a hot bath in the comimiuinal [apaniese styl Tlhein still g]lowing, we all go back to the recor(ls to get everything lip to the maomilenit a(lI to plan for fututre operations. N'ovcm1)cr 5: Revivified, evTeryone was siliiig anid actually eager to wl plunge iiito the work this morninog. Iarlv went to Niho here we milet a Japanes _M\r. N'inOl, wo hadl been in Hawaii for 40 years. He ha(l a beauitifuil chrysanthemumi gaardleni whichi milade a great lit with Col. iMason. Th'le villayge was relatively inltact. It had narrow streets line(d by the lapanese lholises which had a weathered beauti. Dr. Mason fotiuid a shop where hie botighit somiie silk. Later we drove to lUshida -where agaiin arrangemilents were madle ithi the local police officer for a survev to follow, anid then to YokogowN The police station there was another ceniter for collectinig Japanese weapons anid e went inl hope of obtainiing a sword. 'None were as vet avrailabl Col. MIasonl however, found in the village a lianidsomile pair of lacquer fjcttaz the wooden shoes worn by Geish Dr. -Mason is quite good at haggling and the purchase was made after a pleasant delay. We thien cotlintied back to Hiroshimna to see the Director of the Redl Cross Hospital, Dr. Takeuchi, who was glad to let us begin a clinic in Volume 38, October, 1965 this hospital designed to start on November 10. In the afternoon we went to see the Vice-Mayor, Mr. Morishita, whom we had contacted to supply figures on the distribution of the population within the city. The information was not yet availabl Then to Kure in the hunt for much-needed supplies. Met Lieut. Col. Jenkins who introduced us to Major Winslow in charge of the 26th Medical Laboratory. He supplied us with some paraffin, and methyl alcohol for our Wright's stain. Inspected the facilities of the laboratory which was now functioning. Then finally hom A letter had been received in the meantime from Col. Oughterson from Tokyo stating that he had consulted statisticians who had advised that 5,000 cases would not be enough, when distributed among the various sectors, to obtain accurate information on the symmetry or asymmetry of the atomic bomb effects. He also suggested, somewhat peevishly, that we were free to leave if we wanted to. November 6: Early in the morning went to consult the authorities at the Railroad Office and there made arrangements for testing all of the employees of the road who were in the building, 4.6 kilometers away from the center. They provided a map of the city showing the burned-out areas. In the early afternoon again visited Mr. Morishita, the Vice-Mayor, who allowed us to trace the fire map more accurately. The Mayor also had promised some pictures of the city before the bombing which were to be ready on Saturday at 1 :30 p.m. Later in the afternoon drove to Otak The chief of police was more than cordial and promised much cooperation and said that the townspeople wished very much to be examined. He also promised three Japanese swords for our group. A friendly gift was in order and a package of cigarettes was gratefully received. Then a long and cold ride hom We had been especially interested in performing a detailed survey at Otake, since this village together with several nearby communities was the home of a number of work parties who were at precisely known locations in Hiroshima at the moment of the explosion. These people returned to the village and were then carefully followed to recovery or death. This was one of the most contributory medical investigations in terms of providing accurate information on the effects both of burns and radiation, and on the calamitous consequences of a combination of the two. Noveniber 7: Expected to spend a quiet day of work at the laboratory, but found that a large team representing the U.S. Strategic Bombing Cl) I- cn 0 ^; = 7:$ cd cn 4H la-l 0 ho Vd 0 =4* l'olzittie 38, October, 1965 2t'lffllWE".r. Urppcr. iNlushroom hunit on Ushidayama near Hiroshimil Lower-. Rice harvest. Near Hiroshima, 1945. W Survey has arrived. With them is Maj. Luther L. Terry of the U.S. Public Health Service as medical officer, accompanied by a photographer. He is desirous of making a report on medical effects but has only a few days and no help except a photographer. He requests cooperation for preparation of a summary and help in obtaining photographs of patients. Since time is short we make a quick change in plans and take Maj. Terry and the photographer to the Post Office Hospital where they make a number of photographs of patients familiar to us. We then return to Ujina and do the same for in-patients. Maj. Terry also visits our team while it is in full swing at the Railroad Workers Clinic. I proceed with transcriptions since we are falling behind. We are planning to start work at Otake early the following morning and pray for good weather. Late in the afternoon a batch of mail is brought by a team of photographers who are actually assigned to us with Capt. Charles Brownell at their head. Their arrival and the mail instantaneously improve morale and we continue at our tasks until a very late hour. * Dr. Luther L. Terry was a regular officer in the U.S. Public Health Service and rose to the rank of Surgeon General in the early 60's. The negatives that were prepared at the time of his visit, which he mentions in an appreciative letter, were ultimately made available to the Joint Commission in Washington. Charles Brownell had been an employee of the Eastman Kodak Company and was a very skillful photographer with a splendid feel for photography of patients and biological specimens. Unfortunately some of the color film that was available to him had been ruined, apparently on Okinawa during the great storm of mid-September, and the transparencies when developed were a hideous blu Others were quite superb. Through his help, his company was able to enlarge 35 mm. color film which was in my possession to a degree useful for preparing larger transparencies and ultimately for color reproductions, as of the "shadows" on the Bantai Bridg In particular, minute sections of the 35 mm. transparencies were enlarged with a remarkable degree of detail and fidelity of color as, for example, the lesions of patient Okita whose case record appears earlier in this diary, and the postmortem specimen of a heart, showing petechia Novemitber 8: The weather is lovely and we are all set to depart at 07:45 in a convoy of two ambulances and two jeeps. At Otake we proceed to the large local school. The Mayor and Dr. Nagaoka, a prominent physician who had followed the patients, are there to greet us. A large Volume 38, October, 1965 v X w65q A36 - tV ~~ k(~~~~4~~~V4 -gc~~~~ ) i-u£i( m ~ A, ~Y .g,~~~~~~~~~~~~~~~~~~. s~a~ g ,: Az A Note of appreciation from Dr. Luther L. Terry, then holding the rank of Major in the USPHS. Doctor Terry later become Surgeon General of the USPHS. L Upper. Group during a visit to Jwakuni. The Naval captain in charge is seated at the front. Members of the Joint Commission are right to left in the rear, Dr. Ishii and Dr. Kitamoto. Capt. J. D. Rosenbaum is fourth from right. Lower. Clinic in session at a temporary building at the Hiroshima central railway office at Ujina Novemler 7, 1945. Senior students and medical graduates are interviewing and examining survivors. Standing at the rear agaitist the window is Dr. Luther L. Terry of the USSBS. Seated to his right is Maj. Kramer, and to his left Dr. Hatano. Volititic 38, Octabet-, 1965 roomii in the sclhool is filled wNith miiore thani 200 people all kneeling anld sittilng Onl miiats. Some 580 residents of the town had been in the vicinitv of the Koi Bridge (2,400 imieters) at the timiie of the explosion. They had gonle there to assist in the creationi of fire breaks since bombing raids were expected. Many are miiarked with the dark nnt-hrown pigmlienltationl that we have comiie to call the miiask of Hiroshlimll Their faces were exposed in the openi wlhile facinig the sonrce of the explosion but niot so close as to stuffer acttual third-degree burns wsith loss of skini. The appearance is that of verv deel) sunbnrn hnt it has persisted with its deep-brown- color for over three miioniths. Otlher btnrnis are of various shades of red and brown. The sighlt is horrible since it involves somiie of the yonngest anid of the women. These peol)le miiade a remarkable contrast study to those of two other grotnps fron1i Otake that w-ere closer to the ceniter of the city anid wlho stnffered frolmi radiation effects that the people oni the Koi Bridge were sparedl despite the persistent widespread injnry so easily- visibl Dr. Nagaok.a provided detailed iniformiiation fromii his records and the surviving foremen of the varions grotnps were interviewed. We are graciously treatedl. At lInich h1ad a large l)late of rice and other assorted foods. By the enid of the afterniooni ouir grotnp ha(l interviewed 320 patients and had done a samiiplinig study of laboratory dat At the enid of the afternoon black tea anld tanigerinies were servedI anid theni another lonig cold ride lhollm During this day acqntired the tlhree beautifnl sw-ords which lhad been promiiised by the police chief, onie of wN-hich I presented to Calvin Koch. Then more transcriptions of records. Good talk w-ith -Maj. Terry, Capt. Bro-wnell, anid the rest. M\Iaj. Terry has been chilled andl we providde himii with my sleepling byag for a miiore comfortable nighlt. Otur several large roomiis are now well-poputlated with sleepers. prettiest ** The detailed record of the experience of the "patriotic workmen's groups" fromii Otake anid snrrounidinig commiiiiuniities is onie of the miiost initerestinlg anid revealing facets of our enitire ex)erience in Hiroshilml It wsas imiadle eslpecially vivid to uIs by the opportunity of examining the survix-ors en miiasse and of appreciating their remarkable spirit. It was possible to reconistruct the scene at the tinme of injury almiiost precisely. Throtuglh the initerest of an observant anid devoted physician of Otake, Dr. Naagaoka, accurate folloN-tip informiiation was obtained in the quiet of the villages away fromii the confusioni of the aid stations and hospitals. There were three miiajor groups from Otake, each tinder the charge of a foremlani who camiie to work in Hiroshimlla oni the day of the bombing. The Hirosliimla Mledical Diary, 1915 t4o#V Z41tC'*1 gucrest sI T"M~. Me \1v L., (:,t La,"-kr40LCOV. 6 I ON Iii- -4 1 I+r w-g- r- .Aat ; Sketch prepared by Lt. Elder of the British ImlissionI showing position of various of the Otake workmen's groups. Buildings are sketched from interpretationi of stereoscopic pre-strike photographs made from reconnlaissanice plan There are slight differences from Maj. Ganunig's interpretationi. The sketch is dated 21 November 1945. l'ollitiic 38, October, 1965 Upper. Chart to show positioins of the various wo-rkmein's groups fromii Otake and of the Koi bridg Persons in the Hinio group on the Koi bridge suffered chiefly from burns, but not from radiatioin effect. Lowe!r. Reproduction of perspective drawing prepared by Maj. Gailuilg from prestrike air views, showing shadows of the buildings as they would have appeared in the glare of the bomb. Those groups which were in the shadows of the buildings, the Nagato group to the left of the roadway, and the Morimoto group to the right, suffered radiation effect. Those who w!ere oIn the river bank near the Temrma bridge shown belowv (groups from Kuba, Tachido and Ogata), had a tremendous mortality from burns, complicated by radiation injury. first, consisting of 580 persons under Mr. Hino, were crossing, or had just crossed the Koi Bridge, approximately 1X miles from the hypocenter. These were predominantly the people seen in the clinic on November 8. Two men were killed by a collapsing building, seven persons died within a week as the result of burns, but the others survived without signs of radiation effect. The other groups had already arrived in the city and were awaiting assignment near the Otake Group Office, only 1,000 meters from the hypocenter. A reconstruction of the scene was possible from pre-strike stereoscopic air views of Hiroshima made by American reconnaissance planes. This was first accomplished by Lieut. Elder during the visit of the British mission, and again at the request of the Joint Commission, at greater leisure, after returning to Washington, by Maj. L. Ganung, who also drew in the shadows as they would have been cast by the buildings in the glare of the bomb. Men of Mr. Nagato's group had been lolling about in the shadows of the buildings prior to muster. Those in this group who were otherwise unhurt returned to Otake on foot. All subsequently showed evidence of radiation effect, with loss of hair, and most had petechia Seventy-two of 130 died of radiation effects, the first on August 20, and almost all of the rest by September 13. The consequences were similar in the case of Mr. Morimoto's group, similarly shielded and only a short distance from the Nagato group. Those who were on the bank of the river near the Temma Bridge, however, including groups from Kuba and Tachido villages and from the Ogata district, were unprotected from heat by the houses and suffered tremendous mortality, many on the spot, and most by August 10. There were only ten survivors of a total of 193 men and these all showed radiation effect, even though their burns had partly healed. This study provided a sharp contrast between those who had suffered purely from severe radiation effect at 1,000 meters and those who had, at the same distance, also been exposed to burns. The radiation complicated the effects of the burns which were in themselves sever The third group at 2,400 meters, without radiation effects, and with less severe burns, had a much higher survival rat * Novemlber 9: In the morning began the photography work with Capt. Brownell and his very pleasant crew. A permanent rack was made for the camera and the equipment was prepared for synchronized flash shots. This took a good part of the morning. Early in the afternoon spent Voluine 38, Ortobet-, 1965 miiuch timlle goinlg over otir records and observations to date with Dr. Terrv who was about to depart. He wished to take the negatives with hillm. I was fearful that they might be lost. He promised to give them1 to Col. Schwichtenberg, nowx the semior medical officer at Advanced Headquarters in Tokvo. It is rumolored that Col. Dietnaide and Gen. Mlorgan froml the Surgeon General's Office anld Col. Shull', the mledical constultant of the Sixth Arnmy are to arrive in Hiroshim Later in the evening was at work wheni the anniiotuncemiienit camiie that Col. Shull had indeed arrived. WVe welcomed him but lhad to pltunige back to get the (lay's transcription work finisled(l. Otur first print wN-as developed 1w Capt. Brownell anid his staff during the evening. The black anid w-hite work was stuperl). A'oz'cui bcr- 10, 1945, Satuorda': Early in the mlorning conitinued witl photography, chiefly of the specimiienis of clothinig and atitopsv material, with Capt. BrownN-iell's equipmlenit. There is no certainty that miiy own 35 mmll1. slhots x-ill prove to be prol)erly exposed since I had no exposutre miieter w-heni the photography wN-as first don Three itemiis of clothinlg that had been brought in wsere especially remarkabl One wNas a girl's shirt writlh a pattern of smiiall roses on the sleeves, slhotilders anid collar, andl pocket flaps. Somiie of the roses hiad l)ecome completely burned througlh o0l the sidle imiost di rectly facing the explosion, but others on the cturve of the sleeve showed a brown scorchinig only of the darker petals of the roses, with the greeni of tlhe leaves intact. The light pinik background also was spare(l. Aniother shirt had a pattern of dark-blue polka dots againist a lighter blue-green cloth. This showed simiiilar effects witli less burIiiilg where tile rays were niore obliqu The tlilrd silirt coinsisted of striped ray on. In parts of it only- certainl folds had apl)arenltlv beell exposed to tlhe flash and hlere the dark stripes had disinItegrated leaving the white initact. WNe also photographed in black aild -hite a piece of rice paper oi w-hicll the lbrtished Japallese cliaracters hlad been sharply butrned otut, althougih the rest of the paper was inltact. This was froli a sclloolroom about 1 ' 2 illiles fromii the hy-pocenlter. These clotlles caused ille s0ille difficultv since I carried tlielli in iill hanid luggage oil the way b)ack to the UlUited States. The luggage w-as sutbject to iilspectioil bly Customiis in Hawaii and the ilone-too-clean ladies' garilleilts caused somile eyebrow s to be raised. This clotliiilg was ptit oil perillaileint display, at the AFIP alollg with the records, specinllens, anld h other illaterials, but unifortunatelyI as lecoille faded with tile years. * Theil off with Dr. Mlitani to Hirosiinla Prison to arrange for a survey tealll visit. \Ve tliotigilt this would provide aii opportuinity for investigatinlg Hi} os/liimla Mledical Diary, 194-5 V Abov View of the Koi bridge (2,400 meters) from the hypocenter. Persons of the group from Otake were oI1, or had just left, this bridg Below. The river bank near the Temmlia Bridge (1,000 nmeters) which is shown in the background. effects of the heat flash on men whose exact position was known and who (at 2,300 + meters) were beyond the range of severe gamma radiation. We had been told that some were exercising in the open and others confined to their cells. A good comparison could be made of effects of radiant heat on persons in the open and under various degrees of shading. Comparison with the Otake group who had been on the Koi Bridge in another part of the city at about the same distance from the hypocenter also would be of interest. We met the prison doctor to whom we explained the aims of the survey, especially our need to know just where each man was-if near a window whether it was open or not, the precise clothing, etc. Dr. Mitani also asked permission to perform some sperm counts on the prisoners who would serve as controls for a study Dr. Okoshi was performing on persons exposed to radiation in Hiroshim At the distance of the prison no significant radiation effect would be expected. Small gifts would be furnished those prisoners who cooperated. The prison medical officer was entirely agreeable to all of the proposals. Arrangements were made to begin the survey on Monday morning. We were introduced to the warden who presented Dr. Mitani with a large basket of fine tangerines. Later in the afternoon went again to the office of the Vice-Mayor who had kept his promise and had left us a good collection of pictures from the various school books, postcards, etc., showing the city as it was before the bombing. Later more photography. Then a satisfying Japanese bath, some cribbage with Maj. Kramer, more work on records, and then to bed. Novemtber 11, 1945: Early on this Sunday morning went again to Otake with Dr. Ishii who said that we had received an invitation to dine but was rather mysterious about it. It was a beautiful morning after a someewhat miisty sunris We called first at the home of the Mayor Upper. Differential effect of dark and light surfaces in absorbing heat. The material is rice paper representing a teacher's name card, which was oln the outside of a classroom facing the center at 2,300 meters. The inked characters, which read "Arai House," have been burned out, whereas the white paper has reflected the heat and is almost intact. Lozwer left. Scorching of the darker blue-black stripes, Nith less effect on the lighter stripes by heat rays at 1,700 meters. Only certain folds of this garment onI the side away from the bomb were in the path of the rays. On the near side a portion of the cloth was charred. Patient suffered second and third degree burns of the chest, underlying the charred cloth where it was tightly stretched over the skin, and also of the exposed face, chest, arms, and neck. Lower right. Charring and scorching of dark blue portions of the polka dot pattern of clothing at 1,600 meters. Minimal effect on lighter background. Some of the polka dots have become completely burned through. Others are partly scorched. l'olititie 38, Octobei-, 1965 .i Plan of cell blocks supplied by Clhief Warden at Hiroshlilmla Prison where a detail(l study of burn injurics was performiied bY the Joint CoImmnission. At 2,300 Im1eters fromIl the hypocenter there XXwere Ino serious immediate racliation injuries. 7 X c_ -1-b w s --t ~ ~ ~ t B ct ' - ctwC~-'S. -AL-~~~~ e K s~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Cl H*H>oSGs < - =<_K_ i~a 6 R4 c&4w-eR X b tP%5-- /v-G . -2<de,9 lt . j~ -4M -}9 '- < 9 . A-G4-~ ^:. 7 o z-~ ^^ o Z 'F X ~ Notes miadle tru _~~~~~i by Col. Mason during interviewx wxith Prisoni. Simiulated Japaniese doodlinigs in miargini. the as. istant wvarden at Hiroshiimai dl anid fouind that hie hiad arrange(l for us to visit Dr. Nagaok 'We wNere escorted to the doctor's homi This was typically walled off fromi the street anid hiad its own private court comiplete wAithi dwarf trees. He was arather tall miiddle-aged mian w,ith a lined grave face and qluiet demleanlor, (Iressed in the traditional dark kimono. e were introduced to MIrs. Nagaok The receptioni wAas ceremionious and miost graciouis. Sukiyak"i was served iJapanese manner with a charcoal stove in the mile of the tabl Taro anid uiiatsv -take wAere thrown in together with smiall (julantities of mieat anid chiicken anid muchi soY sauce and coarse brownl suigar. The lady of the house did not partake of the meal, but appeared only, occasionially to serv Our conversation wNas entirely through interpretation but I was able to capture a sense of Dr. Nagoaka's concern for the citizens Volume 38, October, 1963 of his village, many of whom had been his patients in the past. Most interesting was his evident appreciation of the scientific value of the records he had kept. After the fine dinner a beautiful blue silk haori (lady's short coat) was brought out and ceremoniously presented to m Dr. Nagaoka said that he had learned that I was planning to marry and that he hoped that my wife would be happy with this gift. On returning I found that Col. Mason had opened an acipak and all the chocolate and other good things were placed above his bed ready to be distributed. This was done for all hands. Novemiiber 12: Spent the morning photographing the remainder of the autopsy specimens with Charlie Brownell. Was informed in the early afternoon that three technicians were to arrive from the 262nd Station Hospital. They did indeed arrive accompanied by Maj. Achenard and Capt. Pierc This was a tangible result of Col. Oughterson's efforts to strengthen our staff. Dr. Ishii reported that Dr. Tamagawa of the Okayama University Medical School was in the city and we went to meet him at the Post Office liospital. He promised material, but had not as yet worked up the autopsies that he had performed in late August. We visited the morgue which was in a shed behind the hospital, almost in the open air. Later in the cold afternoon a fine bath which this time had been reserved for the Japanese officers and physicians and for us. This was less gay than usual but also less crowded. The teams that returned from the prison reported that the work was especially worthwhil Col. Mason had obtained a detailed record of casualties with unusually complete follow-up data, since survivors continued under imprisonment. In the evening was assisted in translating captions and identifying details of the pictures that had been supplied by the mayor's assistant. We considered these a find because of photographic restrictions that had been in force in Hiroshima since the Manchurian war. Dr. Murachi reported considerable progress in his major preoccupation with the building and protection studies, in which he was now assisted Left. Typical profile burn. The patient, a nurse at the Red Cross Hospital, aged 17. was exposed at 1,700 meters. There is depigmentation sharply outlined by pigmented tissue in a very narrow band. There is a crusted exudate in the peri-aural region. Right. Typical "mask" burn in a prisoner at the Hiroshima prison (2,300 meters). The pigmentation has a deep chocolate brown color. The outlines are very sharp. There is protection of the upper portion of the neck which was shaded by the mandibl At this distance there were no burns beneath the clothing. A blue prison cap protected the skin. of the forehead. Hiroshimria Medical Diary, 1945 Volume 38, October, 1965 IW were Top. Hiroshinma castle before, amid (bottomn) after the bonmhing. Near the castle the headquarters of the military forces itl Hiroshimia (800 mileters). by Dr. \Iurai, an excellent radiologist froml Tokyo who had joined the grouip. His inv/estigationis had ideintifie(l tentativelv a nutmiiber of buildings stuitable for obtaining the (lata desired: the Banker's Club, the Nippon Bank, the Chligoktu Electric Company building, a large concrete uiniderground slhelter near Hiroshima castle adjacent to the Headquarters of the Cltgoku Army, the Hiroshima Broadcasting Station (JOFK). All Hiroshima Mlledical Diary, 1945 of these were withliln 1,000 mleters of the hypoceinter. Drs. 'Murachi and MVIurai had begun the detailed wvork of inqtiry and tracing of individual patients who had beeni at their desks or in other fixed positions. Since many of these were dead, Dr. iMurachi said that it was a matter of going from one person to aniother in the various villages or outskirts of the city to obtaiin hearsay reports, and( confirmation when possibl This was (liffictult and( tinme-consuminiig, but a surprising amounit of useful information bad already beeni gathered. At this timiie a less focused but still quite useful stud(ys was also in the iimaking. This consiste(d of the comiipilation of reports onl the fate of people in the muajor buildings, whiclh miade possible a comparison of the protective effect of concrete buildings as compared with woodeln structures. For this purpose the report of the Communications Department, which had several butildings at various points in the city, was especially useful. Informatioin oni the fate of the personnel had been compiled by- Dr. Hachiy Similar information was obtained by questioning officials of the Hiroshima City Hall and Red Cross Hospital. In addition, since most of the school buildings had been of wood, the fate of the children in the btildings provided coml)parative (lat Particularly tuseful was the report of the Yasudla Private School which has beenimentioned. Novcemb1ecr 13: \Vent to the Red Cross Hospital and( took photographs of patients well-known to tus, oine of a young nurse with depigmentation which was very severe, but outlined by a sharp line of dark brown. Althotuglh the skies were gray and threatening, took the photographlic teamii to Hiroshimila castle in the military headquarters are The castle was a tangled pile of rubble on a stone base situated in a corner of a sqluare plot of land surrounded by a moat. Photographed all aspects of the unidergrotund concrete bunker near the military headquarters in which 20 young girls had served as telephone operators. Both inside and outside views were recorded. Dr. Murai had prepared a "shadow( diagram'i" of the bunker. This showed the thickness of earth and concrete projected on the ground that wotld have intervened between a person in any part of the btunker anid the gammlila rays, assuming that they traveled in perfectly straighlt linies from the epiceniter. \Ve disctussed the principles as they w-otil(l apply to more complex structtures andI it was quite clear that (letailed btilinig plans wotould have to be obtainedl. Despite tlle drizzle, visited several other underground shelters. In one, directly opposite the headquarters building I fotunid in the litter anid rtubble a bltue covere(d Volutiie 38, Oclobet-, 1965 Exterior and interior of Communiications Bunker. Cliugoku Armiy Headquarters. (800 meters). Hiroshliml(aIMedical Diary, 1945 V Initial sketclh of building plan of Cenitral Teleplholne Office showing, position of certaini persons whlo were sul)sequently traced. copy of The Life of Clafsczcit.v, the famiiotus Pruissiani militarv tacticianl, written in Englislh anlel extensively annotated in Japanies The covers were faded and( stainedl -with moistture but this treasture itself was esselntially intact. In the evening was (leliglhted to find that Dr. Nakao had acquired additionial informiationi, largely blood dat on the early patients in the Iwaktini T'olu"ie 38, Octobei-, 1965 series. These were transcribed. Ishii lhas had no success in obtainilng additionial autopsy nmaterial but the search is still on. AN'ovemiiber 14: In the early morninlg photographed patients with C. Brownell's teamii at the Post Office Hospital. At the samiie time obtainied tissues fromii maniy autopsy cases. Most of these seemed irrelevant or were lacking in miaterial. Dr. Tamiiagawa seemiied well-iniformiied but talked about Notes regarding finidiiigs ill certain lersons whose position in the Cenitral Telephone Otffice was known and(I for w-hom shileldinig (lata were calenilated. eaclh case at great lenigtlh. Dr. Islii w-as of the greatest lheli) in abstractilln thLe monologu Later in the afterniooni lhad a mllost initerestinig visit at the prison w-here inmiiiates were pb)otographed. AIany lha(l the samiie imiask-like dee)lv pigmented burns as the Otake pattients. Somiie remarkable shadow s onl tlle wall of the prisoni cast by onie wall againist the wall at right anigles to it were fotund(l by Capt. Rosenibatiumi and photograplhed. Dr. Okoslhi had good sticcess in obtaining seobiet i speciiioeiis froili tle prisoners. Oni the preceding day Col. AMason lbad blrought alonig a supply of chocolate bars whlich were tused as a reward for the meni N-ho cooperated. In the evening I Nas appalled to discover that somiie Iwakuni cases coInsiste(l of protocols that did niot miiatch aultOpsy miaterial or that there wN-ere Hiroshima AMedical Diary, 1945 THE UFE OF CLAUSEWITZ Ig:I± The Reality of War: A Companion to Clausewitz E Gordon Highlanders L C T tt+];§ffi1XR0 rc h , Major Stewart L. Murray iStr Z 2g:V Popular Edition 13: Captain Hillard -e *&3io V-OI{Al'& k5Uo Atteridge it I ! 6 0 S t .I±tJ Famous Modern Battles, The British Army of To-day ; .C It D£k .t Spenser J3!g;6( 1 Wilkinson O Clausewitz i; ia tt Top. Portioin of first page of Clausewitz. From bunker at Japanese military headquarters in the castle area at Hiroshim Bottomji. Imprint of Japaniese Army Transportationi Corps oIn flyleaf of Clausewitz. Volutize 38, October, 1965 tissues from some early deaths without protocols. Asked Dr. Ishii to visit Iwakuni to see that everything was properly lined up. He seemed embarrassed by this difficulty and assured me that everything would soon fall into lin * The eager and excellent photographic team consisting of Capt. Charles G. Brownell, M.C. and Capt. Ted Bloodhart, S.C., which at long last had been assigned to us, was a most important and stimulating addition. Much of my time in those days was spent in bringing their talents to bear on the photography of tissue specimens, clothing, and patients who had become familiar in the various hospitals and clinics, or as new and worthy subjects were identified by the teams in the field. Later they performed yeoman service in recording the appearances of the effects of physical phenomena such as the "shadows" on the bridges and buildings. The major buildings and shelters in which the special casualty studies were being performed were also photographed. For correlative work, one set of views of the buildings was made from the direction of the hypocenter. * Novemiiber 15: Most of the day was spent with Brownell-Bloodhart, et al. making numerous photographs of the large buildings, mostly in the direction of the rays from the bomb for correlation with protection factors. All of the important rooms were photographed. Upon returning, saw Zenker's solution being mixed and guessed at once that an autopsy was in the offing. There was indeed a case to do: a lung abscess. Dr. Ishii and I performed the autopsy together. The patient was a 31-year-old soldier who was recovering from radiation-induced aplastic anemia, but died on the hundredth day. This was the ultimate consequence, perhaps, of focal pulmonary necrosis which had developed during the earlier agranulocytosis from which the patient suffered. During the autopsy I saw a number of persons in the hallway outside the small and none-too-clean autopsy room peering in whenever the door was opened. Among them I noted an elderly gentleman in street clothes whom I assumed to be the undertaker. When I asked Dr. Ishii whether this was true, he inquired and then told miie nonchalantly that it was the patient's father waiting to claim the body. I was distressed but the elderly gentleman himself showed no emotion. After the autopsy was completed I found that the first photos of the specimen had returned. These were reasonably good but rather too full of highlights and had to be redon The remainder of the day was spent with Drs. Murachi and Murai in compiling the Hir osliimi Aledical Diary, 1945 t' Uppcr. Bankers Club (200 meters from the hypocenter). used to conduct the business of the city throughout the time the Joint Commission was at work in Hiroshim Lozwcr. Hiroshiima City Hall. Despite its burned-out condition this building was Volume 38, October, 1965 information that had been obtained to date on the building and shielding studies. At this time only the position in the buildings and fate of certain persons could be established, and a crude estimate made of the direction of the rays. The building plans needed to determine the relation to the airburst itself and thus the angle of incidence of the gamma rays, assuming a limited source, were not availabl Immense labor was necessary to obtain the projections of all the components of the buildings, exclusive of the furnishings, in order to determine depth of shield, which was calculated in "water equivalent." Novemlber 16: The survey work is now nearly complet Only Loge and Koch are involved with the teams, working at the Post Office Hospital clinic, which is still activ Here are seen as outpatients employees of the Communications Department. Spent most of the day in the field with Drs. Murai and Rosenbaum and the photographic group at the radio station. This was a small battered dark-green concrete building. Parts of it seemed unsafe and the work was conducted gingerly with tests to see whether the weight of a man could be born Although only a few persons were exposed in this building, their positions were accurately known, and Murachi has been insistent on the value of the detailed study. Also began photography on the Nippon Bank, a much larger and more complex structure in which there were only a few survivors. Its proximity to the hypocenter and its very heavy construction could provide valuable data on the amount of shielding necessary for protection. Returned to find Maj. Kramer in the midst of transcription of the Communications Bureau reports. These gave raw survival data for the employees, but not visitors, in the various divisions of the Communications Department. These comprised several large buildings in the heart of the city. Novemlber 17: Continued with photographic documentation of buildings near the hypocenter with Kramer and Rosenbaum whose clinical duties are now complete, and Murai, Murachi, and the photographers. Col. Oughterson finally arrived late in the evening followed by Dr. Tsuzuki not long after. An impromptu meal was prepared and then, with Col. Mason and Dr. Tsuzuki, talked into the small hours on the progress that had been made and what was still to be don Scotty was particularly interested in the work with the Otake villagers and what had been learned from the survey of school children that had been carried out largely on 3 I'.I !sI t.M. .; -.7. Views of Nippon bank (250 meters): Upper. Building seen from outside, with camera in line with the hvpocenter. Middl Eighteen inches of cinders had been placed on top of the tile for protection against fire raids. Capt. Brownell is in the pictur Lower. Interior view showing shattered concrete partition. Volume 38, October, 1965 the initiative of the Japanese medical officers. After looking at my now crowded distribution chart, Scotty agreed that although more patients would be better, the survey work could be considered at an end and that he would be satisfied with our total of well over 6,000 cases. This was to my immense relief, since I knew that those who had been doing the daily stint were weary and anxious to go home, or at least to have a chang There remained still many important collections of material elsewhere that had been gathered by various investigating groups from the Japanese institutions. Also some patients had been evacuated in numbers to other places. Some of these institutions contained the particularly precious records of patients examined and investigated soon after the bombing. We had already collected some of the most valuable material in surveys at Iwakuni and at Saijyo Sanatorium. The latter required an overnight trip. There still remained a number of institutions in Okayalila and in the Kyoto district, especially at the Imperial University there, and we still had the major problem of obtaining building plans from the central offices in Tokyo. It was agreed that it would be best to send a team ahead to Kyoto to begin the transcription of records and review of collections of material ther Maj. Kramer would be in the advanced party and Col. Mason and Capt. Rosenbaum would join him there after completing work at Hiroshim My own assignment was to go to the intermediate points, allowing the most time for Okayama as soon as the shielding and population surveys could be completed her The chief remaining problem, and perhaps one of the miost imnportant objectives of the joint Commission, was to establish mortality and casualty curves, in order that information on particular groups-for example, those relatively protected in concrete buildings-could be related to the general casualties at the same distance from the hypocenter. Since it was iowv very late, we determined to postpone this discussion until tomorrow so that all could contribute their thoughts. This problem had never been far from our minds. Novemiber 18: Much of the day was spent by the entire group in discussion of how best to obtain the information for constructing a casualty curve in relation to distanc The best idea put forward is that a sampling should be made of survivors who are to be questioned not only concerning their own injuries but also the fate of their relatives who were in the city. As we discuss the matter it is obvious that there will be some error since certain persons may have been en route, and some may not have been in the place where they were supposed to b We decide to proceed W with this since it appears to be the only way in which we can obtain information regarding persons now dead. It is clear that we will need help from those more expert in population studies, especially in the matter of proper sampling. Col. Oughterson suggests that such men must be available on the USSBS team which has now left this are He promises to investigate at onc Our Japanese colleagues also suggest that older school girls could perform this survey very well once the list of persons is selected. In the late afternoon Dr. Tamagawa arrived and we invited him to a late supper with us. He brought more records and the transcriptions of these were begun with both Tamagawa and Ishii at work. Novemlber 19: Drs. Tsuzuki and Oughterson left for Nagasaki in the hope of obtaining expert help with the population study from the USSBS now at work ther This morning made a tour with Brownell and Co. to photograph the various "shadows." Most of these were still clearly visible but the penumbra effect on the "Korean building" was less evident. Photographed Brownell himself actually standing in the footmarks on the Bantai Bridg Returned in time for a farewell dinner for Milton Kramer who was leaving for Kyoto to begin the work of collecting case records and other materials available ther Arrangements had been made by Dr. Tsuzuki. Maj. Kramer left by train in company with Drs. Ito, Hatano, and Gotoh. We were to be reunited in Kyoto within the next two weeks. The remainder of the afternoon was spent in histological work, cutting and staining, to bring our material closer to completion. To bed late at night. Novemzber 20: Col. Oughterson returned from Nagasaki. He had in the meantime contacted the USSBS in regard to help with the demography of the casualty study. A Navy Lieutenant, Mr. Nisselson, who is said to have a good statistical background, has been assigned to us and is to come soon. Later in the day, without our prior knowledge, members of a large British mission arrived with Col. Solandt, a Canadian physiologist, in charge of the casualty aspects. They seemed a very keen and pleasant group. We made a working tour of the more interesting and revealing institutions and landmarks in midafternoon. More of the building exteriors were photographed by Brownell. On returning, discussed census figures with Col. Solandt and found some discrepancies between his data and ours that must be resolved. Of major interest to the British group are the protection and survival dat We discuss our procedure and findings to l'olzitiie 38, Ortobei-, 1965 date in great detail. They Nere, of coturse, fascinatedl by the Otake workmen's groups and the fact that good follow-up data are availabl WNre discussed the possibilitiy of mlaking a visual reconstructionl of the city before the bombing froml air mlaps in order to establish the shadow-ing effects of the buildings, and theN- said they would attemiipt it. A',Tovecilbcr 21: "Ne spent a part of the mlorninig reviewing the medical findings and protection data with Col. Solandt ancd others of his group. Later in the morninlg we returnied to the Mayor's office with Col. Solandt and again had a long talk, stressing the necessity for correct data and also the need for the rice ration lists for setting up the populationl survival study. The city now\ is rather heavily populated with investigating groups concerned largely Nith estimiiates of damag Lieutenanits Martin and M\Iontgomery are here froml Survey Teaml #4. On returniing wve mleet Group Captain Thomiias an(l Group Commliland(ler Bronow skv of the Britislh milissionl which has been busily at work on the stereoscopic prebombing air milaps. Lieut. Elder has prepared a perspective (lrawing of the banks of the river near the Koi Bridge where the Otake workmen's groups were situiated at the moment of the explosion. Actual btiildinigs and the positionl of the men were identified with the help of our Japanese colleagues w\ho had been with us at Otak Jack Rosenbaum left for Nagasaki in nmid-afternooni. He had requested this trip before joininig the group in Kyoto. * For the casualtv studies several basic pieces of iniformlationi w ere required. The first of these was the actual population of the city on August 6. The best estimate that could be made, 255,000, was onl the basis of the rice-rationiing figures of June 30, 1945. Those, as of the last of tuly ha(l been lost in the fires of August 6. An estimate based on newx-spaper circtulation gave a figure lower by 25,000, but this was consideredI minimiial and less reliable because it was based on more assutmptionis than the estinmate for the rationing dlat Data on the distribution of the popuilation in the various sectors were also requested fromii Mr. -Morishita, the Vice-MaYor, and he ultimiiately comiiplied. For the constructioni of the casualty cturve, the mletlhod finallv chosen after consultatioii n with the statisticians, Lietit. H. Nisselson, USSBS, Lieut. M. Habel, F.A and Dr. -Motosaburo 'Masutvam Instittite of Statistical WMathematics, Tokyo Imiiperial University, was to secutre a raindomii sample of the population aged betw-een 13 and 60. The first probleml wxas to randonize the choice of precincts. For this purpose a designationl num'ber, 270, wsas choseni. The populations of the iil(lividual precincts were Hiyroshiyytya Medical Diary, 1945 aclded and the first selected was the one in which the cumilulated population fell closest to 270. This number was theni added to the new total and the populations of the precincts Nere further cumulated, the one chosen being that wlhiclh fell closest to the new total and so oni. On this basis, 265 of the 523 available precincts were chosen. A nationial census had, fortunately, been taken early in November 1945. The Hiroshima High School girls were responsible for handing out ancd collecting a qtuestionnaire directed to H I ROSH IM A RELATION OF MORTALITY AND TOTAL CASUALTY RATES TO DISTANCE Percent too X _ _ " X'L 4OOOmef*rs' Iopen Deaths from<burns Totol Cosuolty Rote- Mortality Rote 60 -/OOOmW oX2X shielded50 _Dh from radiation _- _ __ -- °- Kilometers .j The general casualty and mortality curves at Hiroshima as determined fromii the population study. Against the general curve are shownvi mortality figures from the two Otake groups, some of whom were shielded from burns although not protected from radiation effect by being in the shadow of Japanese houses, anid some who were in the open on a river bank and suffered both burns and radiation injury. eaclh twentieth person oni the census lists of the designated precincts that wvas to provide informationi not only about the persons selected for the sample, but also about their relatives in the city. Some 3,740 of the cards issued to 4,700 persons in the samiiple were returned. This procedure wN-as supervised by a group led by Lieut. (later Capt.) Marvin Habel and Dr. M\asuyama who also ultimately calculated the results. These cards, after exclusion of duplications, provided iniformiiation on the fate of 20,586 people at various distalnces fromii the hypocenter. Con1fidence in the validity of the dlata obtained was supported by the high mortality figure obtained by this metlhod for the indivriduals in the innlermiost 500-mleter ring. It could theni be calculated that 25.5 per cent Volume 38, October, 1965 of the total population (64,600 persons) had been killed, 27 per cent had beeii injutred, and(I 47.5 per cenit had escaped physically unscathed. Againist the total mortality curve also could be plotted data obtained fromi special groups suchl as the Otake wsorkmeni. * 1Vo,z?cumibr 22: Thanksgiving Day. Had long discussioin with Col. Oughterson concerniing the termiinationi of this study which is now clearly in sight. The shieldiing survey has now been completed. \What reImains to be done is the general casualty study. This has now been thoroughly discussed and the detail designed by Lieut. Habel, in consultation with Lieut. Nisselsen and Dr. M\Iasuyam The final report Nill be written in WVashington at the Army Institute of Pathology and George LeRoy and I w ill be assigned to do it, with wlhatever help we need. The question of how to return the mlass of records, slides, and tissues that have now beeni accumulated to the U.S. arises. I suggest that the best way w-ould be to send themii sealed to the Chief Surgeon's Office in Tokyo through USSBS for conisignmlienit to the AIP. Then Col. Oughterson departed for Kure to investigate the possibilities with USSBS wNhich is based ther Upon his retuirn he lhas miiade a tentative arraingemiient w ith the USSBS to carry the records to Tokyo for delivery to Col. LeRoy who will have returned bv that timl The ship is the USS Haines, a Destroyer Escort vessel converted for transport, now called an APD. Lieut. MIcCarthy, supply officer of the Hainies, wsill take custody. Our numiibers have niow been reduced but there are still enough to make a merrv feast of 10-in-1 rations with its excellent canned chicken a not too bad substitute for turkey. The delicious Japanese tangerines add gaiety in substitution for cranberry sauc Noveiiiber- 23: In the morning arranged for packing of all our records, photographs, and slides. Then by jeep to Kur There were hundreds of vessels in the broad harbor and the U;SS Haioes was invisible, overshadowed by the towering hulks of transports and warships. Conversation witlh the shore patrol reveals that the only way to locate the vessel is fromn a chart on the commnland ship. They hail the launch which plies betwNeen ship and shor This quickly- brings me to the commlanid ship, the massive spic-and-span cruiser, Oklahomla City. As a Lieutenanit Colonel I wN-as piped aboard and, keeping vwhat little I knewN, of Naval etiquette in iinmd, saluted the flag at the stern and theni the officer of the deck wlho uslheredime into the captaini's austere presenic The U.TSS Haiomes wsas quickly founid on the detailed imlap that indicated the position of every vessel in the harbor. The captain invited mle to the officers' miess for coffee and then graciously sent me to the Haines in his gig. The Haines, as a DE, was much broader than she looked from the water. Lieut. Commander Laurent was in command but Lieut. McCarthy who was to receive the consignment of records was ashore and due to return later in the afternoon. Although there was much pressing business back in Hiroshima, I decided to stay aboard to make detailed arrangements with him. Members of the USSBS who were there told me of their fascinating experiences throughout Japan and also of the difficulties of the landlubber's life aboard a DE, converted or not. Finally Lieut. McCarthy arrived. We discussed the techniques of packing and trans-shipment. I indicated also that we would like to send our Sgt. Buckles back to Tokyo on the ship so that the material could be delivered in person to Col. LeRoy. Lieut. McCarthy said that this could be arranged with proper orders. Since the Haines was to sail within a few days we decided that it would be best to bring the crates, and Sgt. Buckles aboard tomorrow if possibl After more coffee we parted, Lieut. McCarthy promising to have us met at the dock in the late afternoon tomorrow. Before leaving Kure I picked up two five-gallon water cans for shipping the wet tissues. Saturday, November 24: The day was spent in arranging all of the material systematically and in making a manifest of the records, tissues, photographs, and other materials. The tissues were wrapped in gauze, labeled with waterproof tags and put in formalin in these water cans. Everything was finally accomplished. The boxes were nailed shut with corners painted according to specifications. On our way to the ship we stopped at Kure to see Lieut. Col. Hall concerning the return of Sgt. Buckles to Tokyo. This was quickly accomplished and Buckles and the boxes were brought to the dock where Lieut. McCarthy graciously took all in charge, after signing for the latter. Sunday, November 25: This was a red-letter day since Gen. Hugh Morgan and Col. Francis Dieuaide, consultants to the Surgeon General, were scheduled to arrive for a visit. Col. Mason and I therefore went to Kure, but these gentlemen were nowhere to be found. After an idle morning we returned. We discussed again with Col. Oughterson the closing of the establishment at Ujin This would rest on me after the others had gon We have considerable borrowed equipment that must be returned to the units that had given it to us on loan with the firm understanding that it would be returned at the completion of the work. Japanese equipment that had been borrowed from Tokyo Imperial University must also be sent back. After closing the laboratory at Ujina there would remain only Volutize 38, Octobei-, -1965 the population study which would proceed under Dr. Masuyama anid Lieut. Habel, and the work of collecting records and materials from other institutions. Dr. Ishii and 1, who were now close friends, would travel together by jeep. Our first stop is to be Okayamia where both the Uiniversity and the Mlilitary Hospital are said to have many records. \We were informed that the nu-merous landslides that have occurred in the mountainous country to the north after the September and October rain have made road travel between Hiroshima andl Okayama all but impossibl The railroads, however, have been kept in runninig order and we are advised to send the jeep by flatcar and to proceed to OkaYamia by train. WNe would thenl go cross-cotunitry to join the group at Kyoto. It is obviotus also that considerable work will have to be done upoIn returninig to Tokyo, especially to complete the collection of building plans of those structuires in Which the protection studies were don Dr. Tsuzuki has assured tus that these would be available in Tokyo, since plans for public utility and hospital buildings would have been kept in central offices ther Then took the short trip out of town to the Kaitaichi railroad stationi and made tentative arrangements to get men and equipment on the train. After supper Col. Oughterson is in a philosophical mlood. I renmind himi of my desire to return as soon as the job in Japan is comapleted. He promises to mlake appropriate arrangemenits in the Surgeon's office uponl lis imminienit return to Headquarters in Tokyo. \Ve discuiss also at length whliat we have learned of Japan andl of the influence of the Emperor. Scottv asstures us from wlhat he has been able to observe on his trips to Tokyo that MIacArthur is held in great respect and is doing a remarkable jol) wN-ithotut the slightest sigin of vindictiveness anl with J[apan's futuire recovery foremilost in miind. This has been mlaking a tremlend(lotus imlpression on the people, who can hardlyz believe it. Mo,iodav, Novcnilbr 26: In the early mlorniing made anothler trip to Kaitaichi station and arranged for the (leparttire of otur personnel to Kyoto an(l Tokyo ancd for the transportation to Toky-o of the large quantities of Japanese laboratory and(l other equipmllenit that hadl been loaned to tus ai(I w-hich had now been crated at lUjin It was to be selnt in a closedl boxcar andl Lieuit. Habel wX-as to be at the receiving end in order to release it froml custody. Everythinog was trtucked dowin, the loading was supervise(l, aid(I the boxcar sealed. Outr two junior officers left for Kyvoto. Theni retturned to Ujina and fotund( that Gen. Morgan, Col. Tturner. anid Col. )ieutaide had arrivled. L-tunch w-as preparel. It was a particular pleasure to renew accluaiitances with C(ol. Dieuaidle whoi I lIad milet miiany Hiroshlia Medical Diary, 1945 V imionths previously in New Zealanid Nhere he was mzakinig a consultanit's tour. \Ve then took the senior officers on the VIP tour of the city throulgh all of the selected places. Gen. Morgan was my guest-a dignified greyhaired figure of heroic dimensions who looked the part of senior consultanlt. On the way I presented to him some more details of the plani of the study ancd what had been accomplished. \NVhen Ne came to the ' Koreain building" in order to gain an advantageouis view of the city, I found that things had changed for the w-orse since my last visit. It w-as most revoltinig that the landings had b)een use(l as suirface toilets. The General stepped gingerly andl kept a stiff upper lip anid was rewarded by seeiing the raililg vhich were still quite clear and sharp although the peniumbra shadows w was fading in the cemiienit at the top. He marveled at the energy of the people who wvere beginniing to return to the sites of their holmies. Rude shelters were springing up amidl the rtubble, walled and covered with bits of rusted corrtugated maetal, but still the beginnings of a rebirth. To otur disappointment the shadoNs on the bridge were now only faintly visible but inmpressed the General. Otur visitors then returned to Kture witl Col. Turner. It was now getting dark and beginning to drizzle slightly. Thl eni homiie to a delightful steaming bath. One important iteml still remaiined to be coimipleted. This wvas the protocol that I had promisedl to Dr. Shigeto of a girl, Fusako Tsuta, froml the Red C'ross Hospital who hald been atitopsied. The slides were now comupleted. The death as we expected was not clearly related to the atomiiic-bomllb inijtury, but rather to typhoid fever. The mlicroscopic descriptions were comiipleted and typed ouit by Sgt. Huffaker. Then we cooked sonme bacon anll eggs and brouglht Col. Ouightersoni and( Col. AMason to the railroadl station to see tlhemii off oIn the liglht traini. Fonid goo(dniiglhts and Godspeed w-ere said. Col. M\ason was bound for Kyoto and Scotty for Tokyo. 3. MOPPING UP ANovemiibcer 27: The final closing of the shop was the order of the (lay. The first itemii of business w-as to returni the refrigerator to the ambulance company. This was (lone wsith the willing help of our remiiaininig enlistedl i imien who were eager to returni closer to civilization. The refrigerator had been a trustworthy servant througlhout our stay. Tlhen to Kure whliere Sgt. :Huffaker, who had performied splendidly, was left at his new assigrnment at the 361st Stationi Hospital. Col. -Mason's curette and mxy autopsy kit were also left there ancd the radio was returned to the tendler miiercies of the I & l officers. Tlhen hlurried lback to Ujinal for Isllii anid our luggag Islhii and I mladle the train sclheduled far 2 :58 p.m. The jeep Volunte 38, October, 1965 wN-as put oIn a flatcar. The trip from Kure was through a country of sharply pyramnidal terraced hills, looking like the lovely islands in the inland se W;'e arrived at 7:20 p.m. The jeep was ready for us WN'hen I opened the fronit comlpartmiient I foutnd that the copy of \Vintrobe's Hemiiatology that I had put there was missing. I then looked in the mletal compartmiienit in the back seat, also unlocked, but all of the numerous cans of chicken froiim the tenl-in-one rations that w e had stored there were still intact. Tlhis w-as ironic since the chicken wvould have made a muclh more digestible diet for hutngry people than the ARVintrob WNe did not have an easy timie findinig lodgings for Dr. Ishii. WN-e stopped at a Japanese hotel but there was no room. \Ve becamie thoroughly confused trying to find the Okavamia Japanese -Military Hospital from directions that Islhii had obtained but finally obtained a place of lodging there for Ishii. Then Nvent in search of the 21st Regimental Combat Team stationed in Okayama and found it after considerable difficulty. I w-as given a place in 18, a tguest roomn," bare and cold except for a smiiall charcoal fire in a brazier. Theni somne writing of these notes and wearilv to bed. Noz'cuii)er 28: In the miiorning met Gen. MAiura, a friend and formiier co-worker of Prof. Tstiuzki. Throtughl Ishii, he extendedIhis cooperation anld w-as all politeiiess. A num-iber of patients fromii Hiroshima were in this hospital. We photographed several and theln w-ent to inspect the laboratory. Some gross material was there which after considerable (lisctissionl w-as shared as had been agreed. Again wve emplhasized that they were free to prepare their onn reports on their owln observations. At Okavamia University w-e were received by Dr. Tanabe, a patlhologist. He seemiied a charminig person w-ho offered every help for our wNork incluiding a large room with his personal electric heater. This w-as gratefully received since the Neather was raw. \Vent to work with Dr. Ishii on the translation of the autopsy protocols that were available both from the MIilitary- Hospital and from the University files. Two of the more important are still missing. Again it wras interesting to observe that when our attitude wvas made known and the hand of friendship extended it was gladly seized. Again "lhomiie" after much Japanese tea and conversation. The officers of the Comibat Team w-ere a gruff but friendly lot and not very communicativ They seemed to accept their assignment on that frigid plateau in the two-thirds-destroyed city quite philosophically. Their disposition to share their whisky was helpful. Novemiiber 29: Dr. Ishii and I worked througlh the day translatinig the autopsy material records. Late in the afternoon we wN-ere introduced to Prof. Tsuida, the Head of the Dept. of Surgery at the LTniversity of Hiroshlitiia Aledical Dianr, 1945 L Okayam He has the mlost orniate office that I have seen in Japan to dat He andl his staff hadl taken care of some of the evacnees fromii Hiroshim Later in the afterlnoon Dr. Tamagaw a wlho had prexviously visited at Hiroshima fulfilledl his agreemiient to share w ith us miiaterial froml a number of autopsies he had performle(d both at Hiroshimlla an{d at Okayamii Dr. Tsuda gave permiiissioin to take his clinical records with ns to Kvoto where it would be miiore convenient to transcribe thelmi and wh-lere m-nore free to concenltrate on the there would be miiore help. W\e were now M1ilitary Hospital records. Novemiibcr 30: Translations continued. \We founid certain discrepancies in previously abstracted charts from the Okavama Military Hospital anld consequently reviewA-ed the original records with special car Slides already prepared wNere given to tus from a numiiber of cases by Prof. Tanab A few more not currently available are to be cuit and sent to Us. Wre were now ready to continue our journey. Again packed up our beloniginigs alnd new acquisitions for an early start on the followN-ing moruinig. Satutrdav, December 1: Started at exactly 06:30 on the long roadl to Kyoto. Ishii was ready anid w\-aiting when I called for himii. It w-as a sparkling clear day after a very tlhreatening afternoon oni the day befor The weatlher was freezing cold and it Nas difficult to keep wzarmi w\hile driving in the open jeep evein in the brilliant sunshin The trip wAas through rough high country with the roads still interrupted by washouts created by the fall rains; the roads were sometimies negotiable by jeep, but on occasion required detours. Many stops are made for discussions of the best way across the mlounitains from village to village by Dr. Isllii. The people were curious but very friendly since there has been almost no penetration by American occulpation forces into this territory. At about 09:30 wse stopped for breakfast in the sunlight and to thaw out a little bit in the courtyard of a farmiihous We were most graciously received by a delightful peasant family who prepared some hot tea for uis. They also seemed very appreciative of our own food that wve in(luced them to share with Us. \VTe departed good friends, leaving some packages of chocolate and cigarettes. As the day warnmed, the trip through the ImlouIntainous Hyogo prefecture becamle even more delightful. There w-ere sharp ridges andl peaks covered by the deep green of pine forests rising above terraced paddies full of dark water that reflected mountains and brilliant sky. Our progress toward Himleji w-as slow because of the detours. \Ve entered this beautiful city at about noon. Here there was a story-book castle reminiscent of the one at Hiroshima as seen in pre-wxar photographs. The building, gleaming white, rises to a tower of mainy levels with Voliiine 38, Orlobet-, 1965 swN-eeping graceful grey tile-covered roofs and an ornate top story. \Vre took timiie to explore the building wlhich wNithinl actually is a simaple wooden structtire w ith rough walls. Jshii told me that truly ancienit castles are rare in J.apani since fires on the average burn the Japaniese cities at eighty-ear intervals. The castle is set in a lovely park of grass and trees that adds to its beauty. We left Himeji reluctantly and proceeded alonlg a splendid road to Kobe wvhich we reached 1 2 houirs later. This is a large commlllercial center, much of it devastated by bombing and fir Kyoto was not far and w e mlade off along a crowded highwvay to reach our destiniation at about 4:00 p.m. The Surgeoni's office was at Sixth Army Headquarters wN-hich occupied a tremlenidous black building, the Daikan. In the Surgeon's office was Col. 'M. DaN-soni Tyson whose namiie was quite familiar althouglh I had niever mlet him. He had beeni on the house staff in pathology at Yale before continuinig in surgery. In civilian life he had been one of the seniior surgeons at the Hitchcock Hospital in Hanover, New Hamplishire w-here there w-as a large niucleus of Yale-educated mne(lical mieni. I was assigned a rooml at the Biwsako, but before proceeding there it was necessary first to find quarters for Dr. Ishii. Suitable lodgings wNere founld at a ramiibling Japanese hotel labeled "Off Limits." An additional difficulty was that MNaj. Kramiier and Capts. Rosenbaum and Loge were quartered bevonld the center of the city in a tall white commllercial-looking building remiiniscenit of the Dai Ichi. At long last found Jack Rosenbaum anid the others. They reported that they had imiade excellent progress in collecting anid transcribing the clinical data anld that there wNere onily a few imore days of work left to (1o. \We went to the Mlivako. the mlost splendid hotel in the city, used for senior officers' quarters. We all enjoyed the retunioni over cocktails and( a delightful stupper of roast beef. The tisefulniess of having otur own tranisportation nows became obvious since I dliscovered that the Biw-ako wx-as far otut of towx-n on Lake Biw It wsrs dark and(l the miiap was diffictult to follow after leavinig the miiain road. There were a few smiiall sigins in Ei-iglish which had to be read by flashlighlt, but at lonig last the hotel was fotund oni what seemiiedl to be a smiiall islanid connlected with a bridge to the miiainlanid. This was obviously a resort anid I was given ani immillenise dlouble room with private bath. There crisp cleani slheets anid the soft mlattress soonl received a tired body. Entertainmiiienit wx-as in progress and the Imlusic of the samnisei was a lullabv onlv briefly heard. It all seemed like a dreatm after Hiroshimn Smndav, Deccuuibcr 2: WVoke rather late but refreshed. Happily, breakfast wvas still being mlost graciously served by persoIns wN-ho behaved like couirtiers. Tlle Biwako was indee(d loxely throtuglhot.t w-ith hulge commlnlon Him-oshintia Mlledical Diari, 1945 V rootmis anid delightful lawns and gardens. Fromii my secoiid-floor window the loftv hills on the far side of the lake N-ere reflected in the blue water. Since I knew we wsould have imiuch to do in Kyoto anid since I had not miet the Surgeoni in comminianid I returnied to Headqtiarters. To my stirprise even the senior officers w-ere ther I wxas introdtuced to Gen. Haginis. The General wN-as a bit suspicious of our ImlissiOI, since the intact and(I lovely city of Kvoto had becomiie a miecca for those of the military desiring a real taste of Japanese life in its pre-wN ar stat I informiied him that all of this had happenied while our backs wxere turned on the rest of the coutntr during our labors anid that our imiajor aimii was to obtaini materials anid records fromii various lJapanese instittutionis. I then becamlle the recipienit of a onie andl olne-half hour lecture on the world in general anid especially on how wicked the 'Negroes wer I was anixiotus to leave hlis office to visit the Kyoto University where Ishii had told mle a pathology imieeting was to be in progress. AMany of the senior pathologists of Japan were ther I had the l)leasure of miieeting at once Dr. Riojunl Kinoslhita w ho was H e spoke English beautifully. They repaired to Clhiniese restauranits in the vicinity which were in operation but, unfortunately, off limiiits to nmilitary personnlel and I had to conitenit myself with the remnianits of a "K" ration. The grouinds of the 'University w ere delightful in the bright stunislhinle anid the lunich was enjoyed in solitud Then returned to the mleetinag where solmie beautiful pathology was shown. Among the finiest denmonistrations, the lectures bein-g incomprehensible to me, was that of Hamiiazaki who spoke on cytological details in diseased tissu It was a pleasure also to meet the w-orld famiious hemiatologist of the Ulliversitv, Dr. Amiianio, w-ho seemiied reserved and depressed. I was told that he lhad been with the group that had been lost in the landslide during the typhoon of micld-September. Dr. Kinoshita said he had several autopsy cases fromii Hiroshlimila available anid invited mle to visit his institute at Osak I had to leave before Prof. Tanabe, who was speakinig, wvas finiished, but ultimately the slides that he had promised reached me through the kind offices of Dr. Ishii. Late in the afternion had supper at the AMivako xN-ith Col. MIason. While there boughlt aniother beautiful satsutiiia powder box anid somiie woodeni bamboo cigarette cases. 'Most imiiportant of all w-as a lovely strinlg of pearls. designledl for C.G. Col. AMason had already investigated all of the local stores anid provided miie w ith details as well as with a miiap. Then homiie to the Biwako through the dark but still lovely counitrysid Deccuiber 3: Early in the morninig ic-went to miieet the physicians at the were well-received anid they gave us all of the Prefectural Hospital. We presiding. Voluttie 38, October, 1965 gross mlaterial from the few cases that wsere availabl At this timle also saw for the first time films that had been made by the staff by exposinlg roentgen films to the bones of the bomb victims. These seenm to be artifacts, since the outline of the bone was (1) sharp, (2) translucent in contrast -with the black of the rest of the film. At Headquarters in the later morning was interrogated at length by ILieut. Col. Bogue of G2 who delved thoroughly into my past history, recent and o0l, apparently considering our wlhole mission suspect. I produced a copy of our orders of Oct. 12 and informeid him that all cooperation would be expected, or I w-ould find it necessary to coml-municate directly with Headquarters in Tokvo. This produced a marvelous effect, since the requiremiient for assistalnce from the Sixth Army wNas quite clearly indicated. Called on Prof. Amano in his crowded laboratory at the Kvoto lUniversity. \Ve had a somiiewhat halting disctissioni since his English was far from fluent. Dr. Ishii was most helpful throughout. After some hesitationl Prof. Amano informed me that the hematology slides of the three earliest cases whiclh had been auitopsied at Ninoshimia would be nmade availabl I then asked himii to collect this material for the followving morning in time for 9 o'clock. Dr. Funaoka, the Professor of Anatomy, was also consulted anid stated that some of the autopsy material was still at Kanazawa University on the \Western side of the country but that he would telephone to expedlite the transmittal of the material. The late Prof. Sugiyanma had taught at Kanazawsa in the past. Deceiwber 4: Promptly in the morning went Nith Dr. Ishii and received the slides from Dr. Amano. He appeared to be a very sad mlan indeed and recounted how he had lost his wife and child. WN7hen w\e went to see Dr. Funaoka he regretfully said that he had not had a reply from Kanazawa but that the material would be forthcoming, perhaps by 3 :00 p.m. In the meantime we had been invited by Dr. Amano to visit a MIrs. M\Iiura who was German and wlho wishedl to meet an American. At her home w%e wN-ere served a delightful tea, with Germani kuchen. The conversation also was bilingual, in German with me and in Japanese with Drs. Amano and Ishii. A very pleasant interlud \When we returned to Dr. Funaoka's office at the University were glad to find that the slides had indeed arrived from Kanazaw However, the gross nmaterial had been taken away by Lieut. Col. French who w-as conducting a survey of Japanese laboratories for SCAP. This put an additional complication into the problem, but we had some confidence that this aspect could be rectified ultimately. Gradually various local intricacies camiie to light: Dr. Amanio also proved to have some slides Hiroshlimlla Medical Diary, 1945 L of the Ono cases. Dr. Fukutani, a mlemiiber of the samle departmiient, had additional slides on the same cases bnt from different organs! Also Dr. Fukutani had all of the Ushida slides. This remarkable fact resulted from misunderstandings that followed the early happy leadership of Sugiyama, a fine hematologist and pathologist who had been a studeint of Prof. Kiyono, after whom the institute at Kyoto was named. Further complications were that a member of the Kyoto group had been asked to leave the auitopsy room at Nagasaki because, without permission, he had apparently begun to tamper with some of the material that had been acquired by Commllainder Shields WNarren. T he matter wvas finally resolved by asking Dr. Ishii to call Prof. MIori, the Chief of the Institute of Pathology, on the telephone in order to request his help in obtaining representative slides. This was finally accomplislhed and the mystery of the errant slides was finally solved. A nuimiber of the slides required remounting because they had become stuck together. W\e said that w e would return on the 6th for thes Decemslber 5: I left Dr. Ishii in Kyoto to complete the hagglinog about the slides in his ow,n quiet and efficient manner anid went wN-ith Dr. IshikawN-a to keep my appointment with Prof. Kinoshita in Osak On the w-av wve stopped at the Takatsuke Medical School to pick up two important cases for the Nagasaki group. There we met Dr. Eguchi, who was very gracious and gave me, without stint, all of his important material and an excellent set of clinical and pathological records and slides. While there Dr. IshikaN-a volunteered the information that he had just acquired from Dr. Eguchi that Dr. Kuno of the Japanese Naval Hospital at Iwakuni, who still had in his possession some of the best of the early material, was living nearby. \Ve went on a most interesting hunt through the residential districts and finally found Dr. Kuno's wife and charming daughter and father in a clean and lovely Japanese hom There after introductions and tea, a long letter was left by Dr. Ishikawa in the hope that it would be aniswered by Dr. Kuno. WVe proceeded to Osaka and, after dinnier in a small Japanese restaurant fortunately not labeled off-limits, went on to see Dr. Kinoshita at his department. He was most cordial and after delivering a tirade against the mix-up caused by Col. French's intervention, through no fault of his own, finally produced the specimens that were needed. These included both gross and microscopic material. He discussed some of his own investigative work on nutrition. One set of studies was made on prisoners who had a reasonably constant diet of rice and beans and certain vegetables to a total of 2,200 calories daily, with 110 grams of protein. They, however, Volume 38, October, 1965 developed edlemiia and in somiie inistanices a "cachectic" type of imialnutritioni. \Vrhen five grams of gelatin xvere given (laily good healtlh as restored. or the coniditioin could be prevented if prisoniers were fed gelatin initially. He had continuEtedI his researclhes. Amiiong other pieces of researclh were: 1) \Vork oni the hiistogeniesis of chickeni sarcomas. He believed that they arise fromii adventitial cells. 2) In the buttter-yellox- wxork that hadl gained him world-wN-ide famiie, catalase may be tised as ani index of whether or lnot the liver is gOnllg to become canicerous: It decreases slharply miuiich before the tumilor is grossly detectabl Dr. Kinioshita lhad )been in the tTIjited States imianiy tin1es, lhadl a Caucasiani wife, and wsas fully famlliliar w itlh the W\esterni wN-orld. Theni after a v-ery lonig anid w-earinig but remarkably interesting (lay back alonig the busy road to Kvoto throtuglh the gatherinig dark. Decedwer 6: Oni this, whliclh wsas to he our last day in Kyoto, founld tllat our Japaniese colleagues lbad already l)urchased tickets ancd that there was nio prollem in getting themii 'lhomiie" in the miiorninig. WVent again to the University anid received the bone-marrow slides fromii Dr. Amanio and also calle(d oni Dr. Funlaoka wN-ho was niot ther I was, howN-ever, advised that hiis miiaterial would he in readiniess later in the afternooni. Another lonig talk x-as lhad w-itlh Dr. Amiianio conicerning hemiiatology in genieral. He seemiied miiost pleased at the gift of soal) anid butter and eggs that I lld broughlt for M\rs. Mitur * Prof. Amiianio lhad been ani authlor, x-ith Prof. Kivono and Prof. Sugiyamiia, of an outstandinig book, putblished in 1938, Die Lellre der Vitalfiirbiulil. Since the war he has written a 'large hematology text of his owsin. * Early in the afterniooni I finally xvent to the finanice office and discovered that I Nas owed what seemledI to mle the enormiious sum of 11,253 yenl, which included al)l)roximatelv $220 worth of undeserved per diemii. This was a solmieNwhat illogical, but nevertheless useful. consequence of orders to live in a place w-here it was almlost impossible to spend moniey and where wxe were almost completely isolated and confinled to standard field rations. \With this tremiienidous anmounit of money inl hland, I was ready to buy a few little thinlgs anid this was accomiiplished in a tril) about the city wsitlh Dr. Loge-a silver cigarette box, a lovely satsitumia bowl handand decorated( now scarce, anid a red lacquer tray and bowxls. Then rushed back to the Biwako, signed out aiud quickly lpacked all belongings; then to the traini. There was a long but not too un1pleasant wN-ait in the station. IIiosIlii(la Medical Diary, 1915 The berths in the Japanese trains were comifortable but fotur men wN-ere in a single roomii, and only one at a time cotuld dress. Dcceulibc'r 7: Oni this anniversarv arrivred againi in Tokyo about 1'2 hours late, fotind the Surgeon's office and received at once a coturteous offer of transportationi. In the imieantimiie took a "taxi jeep" to obtain our own jeep at the Shiodomiie yards, which I thotuglht might have arrived by this tim It was there but wvould not start anid had to be dragged off the flatcar. Inspection revealed that the rotor had been taken out and that somiie of the wires had been stripped. There was nothing to do but wralk back to the Sturgeon's office and obtain transportation after signinlg in. A blessed quantity of mail was waiting. I was l)leased again to be assigned to nmy old homiie, the Dai Ichi. Obtained rooml 858 wlhich Nas sans bath, but a roomii witlh bath wN-as promiiisedl soon. In the mid(dle of the afternoon imiet Lieut. Col. Barnacle who Nas takinig the Chief Sturgeon's l)lace pro tem. He was in every way kind and pleasant. Col. Ouightersoin was there anld seemiied satisfied with the tultimiiate otutcomiie of the work. He also said that we wouldt l)e or(lered back jtust as sooni as he ha(l retturneid to the Ulnited States. Decenider 8: Our records had been delivered to an office in the Strgeon's division that was to l)e assigned to imie for the remiiainder of miiy timii \Veent to the University and fotund Dr. Hatano wlho wanted to take me to the Tokyo First Military Hospital. At the University also met Dr. Tsutizuki who, to my surprise, was performiiing a hysterectomy, and Dr. Mitani. Dr. MIitani offered mle his sw-ord and said this wvas a family heirloomii, an "old sw-ord" mlade at least 400 years ago of (IrawNn Danmascuis steel. The scabbard anid hand(Ile he said were mloderni anid witlhout particular w-ortlh. I said that I shotild be glad to keel) the wxeaponi for him in token of otur friendship) btt that I would wish to returrn it whenl tlle political circtumstanices againi permitted. He said that he considere(d it a symbol of miilitarismii anid that he no longer w-anitedl it in his family and w otild tturn it over to miie in a fewlays. d At the hospital it Nas a pleasure to imieet againi Gen. Hirai and AMaj. Misonio and for the first timle Maj. Ohashli a pathologist who had lone mnanx of the autopsies at lUjina dturing Septemiber. All promiiised to have preparecl the autopsy tissuies that had been ctit in Tokyo w\hichl wN-ere related to the protocols that we had been tranislatinig in Hiroshilmla with Dr. Ishii. Ani appointment was made for -Monday imiorninlg to mlleet these gentlemen againi wN-heni everythinig was to be in readiness. Gen. Hirai promiiised to have imiaterial fromii the patienits atitopsiel by i\Iaj. Yamlashilna on Ninoshimia Islanid in the first few (lays after the bomibing. I had alreadl' Voluine 38, October, 1965 Jinv 26, 10S7 Dr. Jaeushi Mittai Departnt of Obs. & Oyn. Osaka National University 0saa, Japan Dear Dr. Mitanis aUy recall that yu entrust d pur :mily sard to my poe sesion duing tbe days of our ooepeatUon in Hiz1os*z. I 3mw Al Cooaiderd this a- trstoeshxip of an beir2es, to ths time Mo.n lt migat be posible to rtun it. It may, of oom et be tiat you n lo ger bav an interest in suh a military symbol. In that initanwe I inten tc keep it a a memnto of a busy eAd bM) time that vbd toang d ta p.tber. v I *.ry :much interest in bow ,iou are gettng on ij or present activities. With awry good wisb. Yours snorelly, Join'.lads Ely Professor of Pkatholog AALust Reproduction of carbon copy of letter offering return of sword to Professor Mitani. Averll received some of this material from Dr. Amano, including bone marrows and certain tissues obtained by the late Dr. Sugiyam Dr. Hatano also said that Dr. Kusano of the Tokyo Infectious Disease Institute had done some autopsies at Saijyo of Hiroshima patients and that he would gladly give us material. We then went by jeep in search of the Institute but had failed by closing time and returned, somewhat disgustedly, hom December 9: Drs. Oughterson and LeRoy had received orders to return and were to leave tomorrow. George LeRoy's father was ill. After L 4h Motoomachi Nagasaki, Japan July 15, 1957 Dear Dr. : I have just read with pleasure your letter which was I beg your pardon for forwarded from Osaka University to m I have always recollected your kindness and my long silenc courtesy during the days of our cooperation in Hiroshim I know that you are-now working especially on lung-pathology. Concerning the sword which I presented you before, I hope you keep it as an expression of my appreciation. I was appointed as a professor of Ilagasaki University in 1947 and have worked to reestablish our department. After coming to Nagasaki Mrs. Mitani had suffered from pulmonary tuberculosis for a few years, but she has recovered from it completely and is now enjoying complete health except decrease of vital capacity caused by thoracoplastic operation. Our only son Hiroshi is now attending to the school of technology of Tokyo University and is expected to be graduated from it the next March. I myself have been always healthy, grew fat and my hair has become thinner. I am now majoring in uterine cancer and chorionepithelioma malignum and have published several works on them. Most of them were published in Japanese and I don't think it adequate to present you those copies. But I should like to present you some copies of our works published in. Enclish under seDarate cover, and hope they will be of some use to you. I suppose you have several children by now, and I hope I hope to have the opportunity your family are well and happy. to see you again in the neir futur Yours sincerely, Yasushi Mitani, M.D. Professor of Obstetrics & Gynecology, Nagasaki University Letter iiidicating refusal of Professor NMitaini to receive swrord. f'olzittie 38, Oclobei-, 1965 packing a number of itemiis to be brought back personally by Dr. Oughterson, spent the afternoon at the zoo with Maj. Kramer and then wanidered through the beautiful park oni the crisp afternoon. Then a quiet evelling at home, broken only by a gay celebration in honor of those departing. At least some of us were on the homecom--ing path. * Decemiber 10, 1945-Jan iary 25, 1946: It would be best to contract rather than to give a daily account of what seemiied to be anl encdless timie in Tokyo before orders came to return. One name and one number on the endless roster of those with the same desire has a special importance only to oneself. Had I then more of the philosophy of the country where I was now an enforced guest, and w-ere there not a special Nedding to attend more than 7,000 nmiles aNay, I would have taken inore joy in the privilege that was min During this timiie there was opportunity for becominig better acquainted in their owin setting with the brilliant men of Japan who had worked so diligently with us at Hiroshima-a fact that I did appreciate then, and value even more highly now. MIJany have indeed fulfilled the promise implied in Prof. Tsuizuki's choice of them for this work twenty years ago when they w-ere very young men, and they now occupy positions of leadership in Japanese medicin As it was, there were still two weeks of labor to gather up the loose ends. On Monday, December 10, at another visit to the Tokyo First Military Hospital, the autopsy imiaterial was indeed ready. It incluided the three earliest cases atutopsied by Maj. Yamashin At this time also, AMaj. Motohashi showN-ed imie some superb photographs of patienlts with petechiae, ulcerative lesions of the mllUcous membranies, and epilation from the earlier Ujina series. He said that they had all the prints required and graciously presented the glass negatives. I did finally have the pleasure of meeting Dr. Kusano at the Institute for Inifectious Diseases anid he likewise supplied the Saijyo imiaterial. Our records, histological slides, and gross tissues N-ere now largely in order, except that w e had very little material on the ey Although interesting effects oni the eyes had been (lescribed by the well-knownsi ophtlhaltmiologist, Dr. Takehisa Oguchi (after whomi a here(litary type of nyctalopia has beeni namaed), N-orking at the Kaijini Kai Hospital in Kure, anid although extenisive notes had been taken by Dr. MIason, we had almost no tissu On iniquiry of our good friend Prof. 'Miyak with wN-hom I hadl briefly disctissed the subject before, I fouind that Prof. Shoji of the Eve Institute andl he were planniinlg a collaborative study of the eyes, but that the sections had not as vet been prepare(l. Prof. Miake Hir-oslim.,il AMedical Dia ry, 1915 LI EBOW said that he wsas planning to share this mlaterial wvhen it had been embedled in celloidin and cut, alnd these blocks did indeed reach us soimie six mlonitlhs later. I was informeed also that a documiienitary filml had beeni preparedl at Hiroshima by the Nippon Eigasha late in Auguist of 1945. but that this had not been completely developed. After much discussion witlh Mlessrs. Kobayamla and Aihara, of that Company. the film was developed and on December 19 viewed in the Surgeon's offic As expected it was a remarkable record. Its possible use for propaganda purposes was also not difficult to visualiz The film had been made on nitrate rather than safety stock but a copy was retained and sent to the United States for use by the Amlericani component of the Joint Commissioni. Of greatest help in obtaining the all-important building plans were Drs. .Murai and Murachi. Those of the broadlcasting station wvere the first to come to hanid, on Decemlber 10. \Within another w eek blueprints of the Communication Department buildings xvere located. This representedl the bulk of the mlaterial needed. Those of the Central Telephone Office were found later and those of the Bankers Club Nere located after considerable detective Nork on the part of Drs. M\,Iurai and Murachi at the architect's office in Osaka and were subsequently (lelivered. In the mealntilmie mlaniy w informative discussionis were heldl ith these tw-o remarkable mlen who had been calculating slhieldilng factors in a preliminary way. They were also most kind in showing me miuichl of Tokyo that I would have missed otherwis On December 14 all of the Amiiericans of the Joint Commiiiiission who reiiaiied Nere entertainied at a splendi(l dinnlier at the -Militarv Hospital, with all of ouir Japanese colleaguies in the military, an(l manv of the younger civilians in attendanc There was plenty of "Suntory" a fine whiskey with the taste of Scotch. The best of the tradlitionial Japanese (lislhes were served, complete with enitrees of raw fishl anid squid. alnd endlless quianitities of warmii sake to wash the many courses (lown. The spirit was a token of comradeslip based on personial uinderstanidinig that developed uniider stress and( on recogiition of miierit and that crossedl barriers of race aln(d politics. Mlfore than thlis, it was a tribute to the wisdom of Ashley \W. O)tihterson that the ounger of mas noy have possessed. llOt As to ouir personal affairs, we learnedI for ourselves wh-lat hals lonlg beenl known that there is niothlilng miiore irksome thalni a delay in getting lhomiie after loong x-ar. AMuistering ouit on "poinlts," of which wve had a great sIfficiencV, couldI have been arranlge(l at onice, -et this woul(l precltule ftulfilling our resj ,onsibility for writing the report. The imiatter was especially Volume 38, October, 1965 comiiplicated in my case since certain notes were still in shorthand. When Col. Schwichtenberg returned on December 12 he reiterated what Scotty had said, that Ne would have to await orders from Washington. W;e were relieved to discover that someone had thought to assign us to the Eighth Army, since our original orders had called for our return to our original stations, wlhich in our case would have been the Marianas-perish the thought. WVe therefore presented ourselves to ASCOM in Yokohama and were delighted to find Brig. Gen. Earl M\axwell in charg Gen. Mlaxwrell had been the Chief Surgeon of the Army in the South Pacific, where I had comiie to know him well. He and Col. Snyder Nere sympathetic and said that they Nould take good care of us while we were in Japan. Lieut. Phil Loge, soonl to be Captain, was assigned to the 42nd General Hospital in Tokyo Nhere he was very happy and wrhere we all spent mally pleasant evenings later. Maj. Kramier was made Chief of the AMedical Service at the 334th Station Hospital in Yokohomii Rosenbaum and myself were to be left to our owsin devices in the Chief Surgeon's office in Tokyo for tlle w mlomelent. Later Rosenbaum Mas assigned, "condemned" as he put it, to the 334th. Gen. AMaxwell iiivited Jack and me to dinner oli the folloN-ing evening in his quarters at the New Grand in Yokohama, an establishmnent of faded hut substantial splencdor that had been MlacArthur's first home on hiis returni to lapan. The General, always good company, was at his best and was reinforced by Col. DeLorimiiier, Chief of the ArmiSy School of Roentgenologv. \Ve particularly enjoyed reminiscing about persoiialities in the Yale Hospital Unit as it had been in the South Pacific, anld particularlv about Cols. Paul Harper and Scotty Oughterson hiinmself. Tlle evening dlidl much to bolster our spirits, but it wsas still only Decemlber 12 anid wX-e were destined for a long wait. Contacts w-ith Dr. Ishii were only occasional, as he w-as busy writh his owin affairs. It wvas on Saturday, December 15 when he presented me with twN-o thiiigs-a treasure of a blue and red obi for my bride, and the letter in w\hich lie told for the first time of lis plight. Successful efforts were lmlade to obtaiii a position for him, and tlhereafter, having survived a siege of typhoid, possibly acquired dutriiig the mneiiiorable autopsy on the youing Upper. iMembers of the Joinit Commiiission, December 1 945. From left to right Lieut. J. Philip Loge, the late MIaj. Milton L. Kramer, and the late Capt. Jack D. Rosenbauni. Iliddl The Dai Ichi buildinig, Headquarters of SCAP, Janiuary 1, 1946, decorated for the New Year. Lower, A part of the immense crowd awaitinig the arrival of Genieral MNacArthur oln New Year's Day 1946. The ladies are -wearing -ay kimionios for the first time in public. lfii-oslhii,a lle(lical )iary, 1945 IAEBOWV Volume 38, October, 1965 from the Red Cross Hospital in Hiroshima, things began to go better. He was appointed to the Professorship of Pathology at Shinshu University in M\atsumoto. \Vre made the best of Tokyo, enjoying the sights and the sounds of this great capital. Amiiong the most pleasant were made by the violinist, Mari Iwamoto, by the Nippon Symphony, now revived, and by a choir, mixed Japanese and Americani, singing the MKessiah together. In the interval of three months sinlce our coming, the city was showing definite signs of recoverv. MIuch of the rubble had been cleared. Scaffolding, often a spiderwork cunningly fashioned of bamnboo, Nas rising and stone and concrete wsere filling old wounds. Shops were bright with wares. Christmas camle and the Dai Ichi building across the mloat from the Imperial palace xwas swvathed in green and illuminated, somewhat garishly, like a card. On the sparkling afternoon of January 1 a vast crowd, the ladies now for the first time in public dressed in colorful kimonos, stood in a respectful, almost worshipful, silence as Gen. MacArthur arrived at his headquarters. The New Year's greeting oni the building seemiied to be intended for civilians as wvell as for the occupation forces. \Without signl or sound from \VNashingon and the first w eeks of the New Year gone, I wvas tempted to accept an opening for a return passage as commiiiiandinig officer of a hospital ship, a purely administrative post, but one that wN-ould have brought me by way of Okinawa and taken at least 30 days. It is good to report that a miore temperate judgmiient prevailed, for on the 20th, in response to the urginigs of Col. Schwichtenberg at this end ancd possibly fromii the patient Oughterson at the other, the blessed orders camii Although miiost of the Commllission's impedimenta had gonie back, I lhad retained eniouglh records to keep miiyself occupied in preparing some drafts of portions of the final report. These plus the slides and records and blueprinits and the tissues miore recently acquired made a sizable package of somiie 250 pounds, which w-as sealed in a trunk, labeled "Secret," and returnied wN-ith mie as courier, at a high priority. The difficulties of the returni w-ere minor indeed comlpared to its joys. There were, inevitably, engine repairs oni our elderly C-54 at Kwajalein; a very unmilitary custoimis officer at Honolulu asking suspiciously whether there were any seeds or feathers in the sealed and inviolable trunik, and sniffing, to my embarrassmient, at the soiled and atom-burned clothing in my personal luggag But then fresh HaNaiian pineapple and scenery for a day; two days in San Francisco; and at last a landing in four inches of snow at the WVashington National Airport at 1 :00 m. of a Saturday morning. For a time we considered ourselves lucky for the pilot was on the point of returninig patient Hiroshimla Medical Diary, 1945 across the Alleghenies, but decided to chance it, and won. Although the airport was cozy enough, WVashington snowstorms in 1946, even more than now, had the unhappy effect of isolating us. I put my sealed trunk in charge of the security officer and decided to doze until the thaws cam Only the arrival of Gen. Joe Collins on a later flight saved us. He had been commander of the 25th Division and we had met him many times as a frequent visitor to the 39th General Hospital. The General with his customary grace, delivered some of us to our hotel, the Sheraton Park, in his staff car and ordered the driver to come back until all were rescued. The warm bed was welcome, blut even mlore the joy of being back at last. 4. Q.F. Early in the morninig of january 28 when I reported for duty, as ordered, to Col. James Earl Ash, Commanding Officer of the Army Institute of Pathology, I saluted as smartly as I could. This courtly gentleman vas astonished, but regained his composure sufficiently to return the courtesy. Forgiveness was not long in coming, and he said that he had been expecting mne and that Col. LeRoy and I had been assigned a special roomii for our work. This was a large chamber separated from the remainder of the second floor of the wonderful old Army Institute of Pathology by a ten-foot wrall. Thus immilured, our records could stay in the required security. The Institute, located at 7th Street and Independence Avenue, with its back to the mall, was a structure dating to a time not long after the Civil \Var, with the large windows and pleasant inconveniences characteristic of that er Enclosed in its dingy but glowinig dark-red brick and nlustv woodwork were one of the greatest medical libraries in the world and the treasures old and new of Army- medicin Here the relics of Lincoln's assassiniation were reverently preserved together with medical miemiienitoes and records of all the wNars. But more than this, it was a treasure house of the science of pathology an immense storehouse of tissues and of the thoughts of the men who had examined them. Both as an itemi in the history of warfare and of the substance of science there was no mlore fitting place to Nhich the collection that had been gathered in Japan should be brought. Nor was there anywhere a place better-prepared to facilitate the preparation of a report. \VNhile the Institute Nas military in its origin and affiliation, it had been filling an honored function as a consultation center for pathologists throughout the wvorld. 1Iost important was that it was permeated by the fatherly spirit of "Didi" Ash, a scholar inl his oWIn right, and it had about it an Emersoniani atmosphere of "con- tented industry." l'ollittie 38, October, 1965 \VNhen I arrived Col. LeRov was off to Rochester on temporary (lItty. It was a relief to find that everything had comle safely across the Pacific. I was sooIn made acquainte(l -ith the procedures of the Instittut A single accession numlber (#158930) Nas assigned to the entire collection, ullder which it remaiins to this day. WN'hile awaiting orders for leave, I began to unpack with the willing help of Capt. Edward B. Smith. The five-gallon water cans had serve(l well andl the tissues Nere identified, blocked and cut. Recordls were put in order and everything was gotten in readiness. Discussions were held with Col. Oughterson and Ash regarding a secretariat whiclh obviously wN-ould be necessary. In the nleantimiie I called C.G. and was pleased to discover her willingness to come to New York. Our "engagement" lasted only ten days and w e returned happily, after being married in Rochester, to Washington late in February to share the first six months of our marriage with the atomic bomlb. The first task was to decide upon the basic structure of the report ancd this was done in consultation Nith Col. Oughterson. Although he left the military service soon after our return he maintained contact with us by frequent visits to Washington. It wN-as obvious that the work would have to represent the confluence of four main streams of activity: 1) Statistical analysis of the data, 2) illustrative wvork, 3) the shielding study, 4) preparation of the body of the report. Col. Oughterson arranged for the statistical work to be (lone at the office of the Air Surgeon through the cooperation of Col. Robert Lyons, Chief of the Biometrics Division. The Joint Commission was most fortunate to obtain the services of 'Maj. Cuyler Hammond*, and he was assisted by Dr. B. Aubrey Schnleider, and Capt. Henry L. Barnett. The first task was to set tip a code and key, at whichl Dr. Harmmond wNas a past master. It required extensive constiltation on the tise of ternms and on the clarification of certain ambigtiities, insofar as this w as possibl This he obtained from Capt. Barnett and froml the others of us by an exchange of ideas and frequent exchange of visits across the Potomlac. It was an education in itself to work with a man of MIaj. Hammond's background, intelligence, and integrity. The results of this statistical analysis in thenmselves occtipy one stotit volutie of the Joint Commission * Dr. Hammond's outstandinig talents later were recognized by his appointment as Chief Statistician of the American Cancer Society, a post which hie contillues to hold. For a time he was also Professor of Statistics at Yal Dr. Schneider died suddenly at an early ag Dr. Barnett returned to teaching at Cornell, aind noxx is Chairman of the Pediatrics Department at the Albert Hinsteini Medical School. V Capt. Browrnell was ptut in charge of systematizing the 1,500 photograplhs that had beeni obtained by the Joint Coimmission. The bulk of the mlaterial consiste(l of phlotographs nmade by himllself and his teamii. In addition many photographs hadl been giveni to the j-oillt Commlilission by several Japanese newx-s agencies, notably Bunka-sha anid Domlei, and( by P'rof. Nishina whlio was in the city within a few\ days of the bombing; there was also the priceless group of glass negatives presented by AMaj. 'Motohashi of the Tokyo First MNilitary Hospital. In addition the personial 35 mnmi. kodaclhromes that hadl been mlade by Col. Oughtersoni and myself proved to be a valuable resource, since manv of the larger color filnms in Capt. Browniell's stock had been danmaged, probably by lheat. The smiiall kodachromes were enlarged and now comiprise an important compolnenit of the official record. Capt. Browvnell personally supervised the process at the laboratories of his company, Eastman Kodak, in Rochester. He was responsible also for the reproduction andl enlargement froml the negatives, and the preparation of albumls with appropriate identificationls fronm w-hich the illustrations for the final report wvere selected. Photomllicrographs were prepared with Mr. Roy AM. Reeve, a gentleman of the old school, who was also a muaster of the modern technology for Nhich the Army Institute of Pathology -as famiious. Diagrams and charts ancd other art work fromi our crude sketches were skillfullv prepared by Mr. Harry Nussbaumll. Col. Otughtersoni also had arranged wx-ith the U.S. Strategic Bomibing Survey to calculate the shielding factors fromii the various building planis that had been obtained by this group anid by ourselves. \We were in possession of the survival data for persons in specific positionls in these buil(lings. These had been obtainied largely through the painstaking efforts of Drs. Murachi and MAurai. The arduous xvork of making tlle projections froml the building plans was carried out by Lieut. Col. Herbert S. SwAanson of the Corps of Engineers, assisted by a num-iber of skilled draftsnmen, in the office of Prof. Harry L. Bowmvian who was Chief of the Physical Damage Section of the USSBS on loaln fromii the University of Pittsburglh. These men were housed in temporary buildings (still standing 20 years later) next to the \V'ashinlgtoni airport. Frequent visits were made to ensture the necessary comlmunicationi. As a yokemate George LeRoy Nxas tireless, learned, stimlulatilg, and witty. WNre thoroughly enjoyed being at hard labor for six monthls, particularly as a semiiblance of order began to appear out of the great nebula of data that had been accumilulated. We can say only good things about our secretaries, IMildred Broscious, MIargaret Dismukes, John O'Donnell, clat -Many of the coInReport which is comiiposed chiefly of tabulate(l also imcorporate(I into the body of the report. cluisions were Volziiiie 38, Octobei-, 1965 Agnes Petsing, aiid iMargaret Robb. They wsere niot only efficienit, but tinlcomplaininlg and had a renmarkably high tolerance for persiflag \Ve decided that insofar as possible we would attemapt to compare the effects ini the two cities, writing independently btut in parallel. This Nas possible in miost of the eleven sections iinto whiclh this work niaturally divided itself. V'olutmie I Sectioni 1-Introductioni and sutimmary of the lllost ings. Section 2-Physics. Section 3-The cities. Volumiie II Section 4-.Materials anid miiethods. Section 5 Clinical observatiolls. Volume III Section 6-Hematology. Section 7- Bone mnarroW. Volume IN' Section 8-Pathology. V'olumiie V Section 9-Statistical anlalvsis. V'olumiie VI Section 10-Population and casualties. Section 11 Building and shieldinig studies. impl)ortant filnd- Section 2 on Physics was writteni w-ith the collaboration of R. F. 1\arschak, Ph.D., a physicist. It seemed best to combine data fromii the two cities onl helmlatology anid also on the bone marrow and this section was written by LeRoy, while I took responsibility siilarly for the volume on pathology. The statistical section w-as compiled anid written 1y the teai at the Air Surgeoni's office led 1y Cuyler Hamiimond. Having established the ml-ajor categories, muclh of the early Nork conlsisted of sorting out anid systemiiatizing. For example the autopsy miiaterial fromii Hiroshimia consisted of the records and slides of three of the early patients fromi Ninoshima, anid of 12 from Ujina autopsied by Maj. Yamiiashina; eight in a later group autopsied by Maj. Ohashi; 26 by the group fromii Tokyo Imiiperial Uniiversity at Ujina; two at Tokyo Imperial University itself upon evacuees from Ujina; two performiied at Ujinia dtiriing the time of the Joint Commissioin; 13 fromii Uslhida; 10 from OIno (Kyoto Imperial LTniversity) six fromii the Kyoto Prefectural University; six fromii Iwsakunii, includinig sev,eral very early cases; eight from Okavamia Military Hospital; one from the Okayama MVedical School; 21 from Saijyo; 19 from the Post Office Hospital, performed by Prof. Tamagawa; one from Yodobashi Hospital in Tokyo; three from Osak This represented a total of 141 cases of which two had to be discarded. Most of the protocols had already been translated and redictated into the standard form used by the Army Medical Department. Others were still in shorthand and required dictation. This was the first order of business. Later, as the slides were cut they required study and description. The cases had to be grouped according to distance from the hypocenter and time of death, and the individual findings from the groups had to be catalogued and illustrated. Similar problems arose for most of the other sections. In many instances the completion of portions of the work by others-for example, the statistical analyses-had to be awaited, and the results then incorporated into the general text. As we wrote, ideas were exchanged, debated, and finally used or not until a pattern emerged. This was employed to present the data from both cities whenever applicabl Drs. Oughterson and Shields Warren were frequently asked for guidance, and we were the beneficiaries of consultations wanted and unwanted from a large number of interested persons. We were also the recipients of some lessons in the cold business of war. One afternoon an officer in the Intelligence Section called to say that Dr. Solly Zuckerman of the British Medical Research Council was coming to see m This was a pleasant surprise since I had known Dr. Zuckerman during my medical school days in the early 30's when he was a Fellow in Prof. Fulton's department at Yale; Later he became the Professor of Anatomy at the University of Birmingham. During the war he had been concerned with the analysis of the effects of weapons. The concepts of Standardized Casualty Rate (SCR) and Standardized Killed Rate (SKR) had been developed, terms as cold and gruesome as they sound. It was his mission to learn the SKR and SCR for the atomic bomb. Prof. Zuckerman made us familiar with the methods for the calculation. Fundamentally the SKR is the number killed, assuming a population density of one person per thousand square feet in the area at risk. The latter represents the sum of the products of the fractions killed in each ring zone by the areas of the ring zones. On this basis we ultimately found in Hiroshima that the vulnerable area for the killed was 2.85 square miles, and for all casualties 9.36 square miles. From these data an SKR of 79,450, and an SCR of 260,900 were calculated. This SCR is about 6,500 times as great as for a high-explosive bomb in Britain, assuming a population half in the open and half in British houses. This ratio is approximate because of the dubious Voluitte 38, October, 1965 assumption that the populations under consideration are comparabl These data ultimately reached the British and the world. When Col. Swanson and Prof. Bowman's calculations were completed, the painstaking labor of tracing the persons and projecting the plans of the buildings was finally rewarded. It was found that at 250 to 450 meters from the hypocenter (650-750 meters from airburst), more than 150 inches of water (5 feet, 4 inches of concrete) were needed to protect against death from radiation and more than 250 inches of water and nine feet of concrete to protect against radiation injury. At 750 meters (960 meters from airburst) more than 50 inches of water were necessary to protect against death, and more than 250 inches of water (nine feet of concrete) against radiation injury. At 1,000 meters (1,165 meters from airburst) more than 3.8 inches of water (1.7 inches of concrete) were required to protect against serious radiation injury. At this distance very few persons who were in concrete structures suffered severe radiation effects. When these calculations had been completed, Dr. Victor Weisskopf of the Massachusetts Institute of Technology, one of the consultants to the Manhattan Project, came to see us in order to determine whether the medical data would correlate with physical estimates of radiation dosage at various distances from the epicenter. He had with him a penciled curv It was remarkable that the points, supplied on the basis of an assumed L.D. 50 dose for man, fell rather closely along the curv As it neared its end, the tempo of accomplishment in the preparation of the report actually seemed to increas Some acceleration may have resulted from external stimuli. As September approached my Chief at Yale, Dr. M. C. \Vinternitz, was pointing out with clarity and force that the school year was about to begin. As a last act we prepared a letter for Col. Oughterson's signature that summarized the major findings, pointed out some directions where further investigation was needed, and most particularly stressed the importance of a continuing study over many years of the population that had been exposed. This letter was addressed to the Surgeon Generals of the Army, Navy, and Air Force, to whom the report was duly transmitted. This recommendation was subsequently referred by the Surgeon General of the Army to the National Research Council and was in fact the major stimulus to the creation of the Atomic Bomb Casualty Commission that has continued the collaborative effort between Japanese and American scientists that began with the original investigation of 1945. And so the work was completed almost one year after it was begun. It was the end of many journeys, the end of a taxing challenge and struggle, Hiroslhima Aledical Diarv, 1915 NI -I Rebirtlb of a City: Top. View across hypocenter to-ward tbe Geibi anid Sanwa bank building-s. Tbe wall at tbe left is a renmlanit of the Sbiniia Hospital. The uprigbt tree, stripped of branches, inidicates tbe downward (lirectioni of the blast very close to tbe bypocelnter. At the riglbt are the sbiattered( walls of tbe Banikers Club. Bottomii. Tbe city in process of regrowtb, Marcb 1949. View comparable to tbe abov ancd of can excitinig adv-enituire, ancd the eind aindI the begiinninog of many searchilngs of souil. The uise of this wN-eapoln as w-e contemiiplated it, anid theni miiore wx-hen we saw its effects, and theni even as wve wrote of it, filled Us wNith revuilsion. \V'e acquiredI a symlpatlhy, not for those on the periphery who acquired a Promiiethetus coml)lex and cried cutlpa umia as a mleanis of proclaiming their own imiiportaInce, but for the physicists w-ho bore the real responsibility for the levelopment of the atomic bomub cand who suffered genuiine tormlent of coniscienic \Vrere we, even in the aftermiiath, accessories to a crime against T'olume 38, October, 1965 att .*. 4* Rebirth of a city andl a mloniunieiit to peace: UTpper lcft. View of Clhamiiber of Commllerce Building from balcony of Businessmiieln's Club. The impact of the blast in buckling the concrete walls is evident. Lower lcft. Viexx com)parable to the one at left, made in 'March 1949 showinlg rebuilding of the city. The Chamnber Building has been left as a monument of the first atomic bombing. Right. Peace moniumenit at the Chamber of Commllerce Buildling, 'March 1949. Hiroshimia Medical Diary, 1945 ' nmankind? Surely death and injury of innocents is wickedness that can never be condoned. But even killing by hand, in comiibat, while honoring the traditions of "chivalry" is still mnurder. The criimie is of the samiie kind. Chivalry wras crushed and burned wlhen the first unseeing stones and firebrands were hurled. It had died centuries before Hiroshim We thouglht also of the 15,000 hospital beds in the MIarianas now never to be used, and of the hundreds of thousands of lives, American and Japanese, that would have been the cost of assault and conquest of the hoimie islands of Japan. Had more been spared than were lost and maimed in the twro cities? But why could not an atomic explosion near, but not tuponI, a living city, have been as persuasive? Even if it was "necessary" to destroy one city, how could one justify the devastation of another? WVe could only lhope that reasons based on morality as xvell as strategy dictated the decisions. \When we saw the pitifully crippled and miiaimiied -e felt both guilt and sham But was the absence of resentfulness the stoicism of a brave and disciplined people or was this also somiie reflection of guilt on their owin part? Perhaps there w-as an element of botl. But once the deed wras done, criminal or salutary, there was clearlv a duty to perform: to measure not merely the power of a weaponi soon to becomiie outmioded or extinct, but the nature and extent of radiation injury in mlan. Never l)efore had hlumllani beings been exposed en mnasse to this force that surely would have to be lived with, or even lived by. This power cotuld be harniessed for good although it would always carry a threat. In pertormling this work, wre could then, not merely unithinkinglN obey orders, but milake a partial and uneasy peace with conscienic \Vhile the opportunity was born of tragedy, it was clearly a necessity to make the best use of it. \NVe pluniged into the task with an inner compulsion for we knew that timiie was runnlling out. The work could surely have been done much better by a team selected in advance and equipped wvith all the instrumenits of modern laboratory scienc As it was, mtiuch less would have been accomiiplished w-ithout the expert knowledge, ingenuity, ideas, and uniflagging efforts of otur Japanese colleagues. \Vrhen onl September 6, 1946, the comiipleted report of some 1,300 pages, bounld in six substantial volumes, was hanided to Col. Ash, there ended a still vivid chapter. But while the chapter came to an end we were left w%Nith the uneasy feeling that the book remiiains unfiniished-and it conitinues as a hlaunlitng memory. Mav the evil of which it tells never come back! http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Yale Journal of Biology and Medicine PubMed Central

Encounter with Disaster-A Medical Diary of Hiroshima, 1945

The Yale Journal of Biology and Medicine, Volume 38 (2) – Oct 1, 1965

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Abstract

.C S P4~ C's > O 0 O a: o0 d C' +Y 3 0 v) C-, 0 N 0 0_ 0- C Ut FOREWORD Although Japanese medical investigating teams had been at work in Hiroshima within three days of the atomic bombing, and although a brief survey had been made between September 8 and 19, 1945 by a team under Colonel Stafford L. Warren representing the "Manhattan District," the responsibility for a comprehensive medical study was placed on the Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan. The timely organization of the Commission was the work of Colonel Ashley W. Oughterson, surgical consultant in the Pacific Theatre of Operations. It was accomplished in the field, since no thoroughgoing preparations had been made in Washington. It was of necessity impromptu, the personnel assigned were not specially prepared, and there was no equipment in hand. This diary provides a record of how the joint Commission was formed, of the establishment of the essential working relationship with Japanese medical investigators immediately after the cessation of hostilities, and of the trials and rewards of daily activities during stressful times from September 18 to December 6, 1945. There is also a short account of the preparation of the report at the Army Institute of Pathology, to the time of its completion on September 7, 1946. At the hazard of disturbing continuity, explanatory notes have been put into the text. These provide background without which the bare daily record might be less than fully comprehensibl Illustrative material was drawn in large part from the original report of the Joint Commission. The writer wishes to express his appreciation to Brigadier General Joe M. Blumberg, the Director of the Armed Forces Institute of Pathology, for making this material availabl Most of it has never been published. All of the early photographs that were incorporated into this report were made by Japanese investigators or news agencies. One of the first on the scene and among the most observant of the investigators was Professor Nishina, the famous physicist. Personnel of the Tokyo Dai-Ichi Military Hospital supplied graphic illustrations of patients at the height of the aplastic anemi Photographs by the Bunka-sha Agency of medical activities at Hiroshima prior to the arrival of the Commission are noteworthy for their technical excellenc Particular credit is due to Captain Charles Brownell and his staff, members of the Joint Commission, who were highly skilled, sensitive to the medical and human problems, and tireless workers. Last and least are personal photographs made by the writer during the time covered by the diary, and again in 1949 on another visit to Hiroshim These provided an opportunity to see the city in renascenc Two of the color plates were first published in Medical Radiography and Photography (Eastman Kodak Company), Volume 24, No. 2, 1948. These were prepared in part from personal 35 mm. transparencies and in part from larger transparencies made by Captain Brownell. Permission to use these was graciously given by the Editor, Mr. William Cornwell. The McGraw-Hill Book Company also permitted the use of several diagrams and sketches reproduced from the original report of the Joint Volume 38, October, 1965 Commi111issioI in M4ledical Effects of thle Atomiiic Bomib itt Japani ( W. Oughterson anid S. \Varren, Eds., 1956). MIen of the Yale Medical School wrere closely associated with the studies at Hiroshimlla fromii the beginning and have remained so to the present timl Colonel Oughterson, himself was an Associate Professor of Surgery on leave, and three others of the seven medical officers assigned to Hiroshimia had been Yale miedical students and twN-o wN-ere on leave froml the faculty. After the Atomic Bomiib Casualty Commllission (ABC was established in 1948. one of the first pathologists assigned was Dr. \Villiam J. \Vedemeyer. A miiajor contribution was made by another former Yale medical student, Dr. Thomiias Francis, Jr., now Professor of Public Health at the University of 'Michigan, who designed the closed population sampling study that is now the core of the operation at ABCC. Since 1957 the ABCC has been tinder the distinguished Directorship of Dr. George B. Darling, Professor of Humian Ecology at Yal Finally, both able personnel and an importanit degree of conitiniuity have been assured by)X the assunmption of responsibility for the miedical service at Hiroshimia since 1958 by the Department ot Internial Medicine at Yal For these reasons it is appropriate that thi-L diary be first published in The Yale Joitrna(il of Biology anld Jledicinl 1. WHY AND HOW For twenty years, while the seven rivers that mleanider into Hiroshimiia Bay have lapped upon the shores of a reviving city, this diary has remiainied in the shorthand in which it wvas set dow-n. The writing was done at the end of each arduous day before and durinig the nmedical investigation in that stricken city, often in exhaustion. Somiie who have known of it have tirged that it would be wrong that such a record, work-a-day as it is, should be permitted to dissolve with the flesh. Let us hope that the experience wllicl it reports w-ill remiiain unique! It is true that feNw Nwho took part are left to tell lhow the challenige was met and w-hat took plac Indeed it is as though somiie curse, like that wlich the superstitious say fell upoIn Lord Carinarvoll and hiis meni whlen they violated the tomb of Pharaoh Tut-ankh-ameni, has beeni visited upon those who pried into the ravaged lheart of Hiroshimi Only three of the seven Amiericaln ml-edical officers liv Doctors Oughterson and Tsuzuki, the chief organizers for the two counitries have died; so too, while still young, have gone Drs. Calvrin Koch, Jack D. Rosenbaum, and MIilton R. Kramer. May this record do honor to these able and devoted meni. It wvas not throughl a horror scribenidi that these notes have languislhed. Rather it was through fear that somne insignificant phrase might be miliscoInstrued in a way that could disturb the amity that has grown between Japan anid Amlerica anid specifically the contintiing cooperation in the Atomiiic Bomb Casualty Coimmission. Too many of the wicked have been all too eager to distort in order to disrupt! Hir oshtittia AMedical Diarv, 1945 Those of us wlho came to Hiroshima in September 1945 sooi1 acquired a profounid admiration and respect for our Japanese counterparts. \Vre knexv that the miiedical study could not be accomplished without knowledge of the language, people, and custonms. \Vre knew also that many skilled menl would l)e needed since the few of us who had been sent represented only a smiattering of the specialties. It is a tribute to the vision and hunmanity of Coloniel Ashley NVT. Oughterson, truly a mian without malice, that the collaboration of Japanese science and mi-edicine w as invited at that critical timl WVe called ourselves the "Joint Commission for the Investigation of the Effects of the Atomic Bomb in Japan." As soon as the Japanese discovered that the wvord "Joint" miieant that both inations were to labor shoulder to shoulder to meet the formidable task of the miiedical study, and that they would l)e treated not as enemies vanquished, but rather as colleagues and equals, they gave unstintingly of their thought and labor. The friendships that began then have grown to a firmiiness that wN ill resist calunyv. Mv own involvement was a matter of being at hand -vhen the circumiistance created the need. I wvas servinig on the island of Saipan in thle Marianas, in mny third year as Pathologist to the 39th General Hospital, the Yale lUnit. In early 1945 peaks of effort were required to care for casualties of the OkinaNa and IwNo Jima campaigns. but there wv-ere quiet intervals w,hen scientific hobbies such as the study of cutaneous diphtheria couild be indulged amiiong the interesting, in-telligeint, anld tractable native The contemplation of nature in the lush green jungle or even in the sugar caine Nas dangerous. Although the island Na- declared "secure," these wsere the hidinig places of Japanese soldiers wsishing to l)e left alonIe but likely to ambush intruders. Each evening we watched fleets of B-29 bombers mlakiing a rendezvous with their kind froimi neiglhboring Tinialn aind Guamii to carry death and destruction to IN-o anid Japani. As Nith full loads they lumbered straininlg to the end of the runway, mnany would acttually drop below the level of the cliff that overhunog the reef at land's end. A few did crash into the sea and some would jettison tlheir bombs and circle back to the landing strip. As we lounged on the terrace overlooking the cobalt of Magicienne Bay, we felt the guilt of insuifficieint involvement. This grew wx-lhein the plaines returned in the miiorning, some limilping anld with a cargo of injured or dead, or Nhen we learned of those that never came back. Of the existence of an atolmiic bomb wre had no inkling. It is true that in the Spring of 1945 wagers that the war would eind by August 15 were b)eiig freely imiade by airmen N-ho, wvith enigmiiatic simiiles, even offered population. Volume 38, October, 1965 substantial odds. Yet the actual secret was well kept. Enormous casings shaped like bombs were being dragged on multi-wheeled flat carriers over the hot, white, dusty, coral roads of Saipan, but these were undoubtedly decoys, and none of the bettors knew more than that something great and terrible was in the wind. Only a few had knowledge of the awesonme power that lay in a low, closely guarded, concrete, windowless building on the Island of Tinian only three miles from us across the water. Even as Iwo Jima, the last stepping-stone to Japan, was being seized, and before Tinian received its fateful burden, we were busily expanding our unit to 2,000 beds. We were not alon Vast new hospitals were rising on Tinian and Guam. Together we were to serve as a great center to receive casualties from the expected assault on the Japanese homeland. When, at 8:14 on the morning of August 6, 1945, on command fronm Washington, the hand aboard the Enola Gay loosed beyond recall a new evil in the world, we had no knowledge of how our lives, in fact the lives of all men, would be changed. Only three days later came the second devastating blow, against Nagasaki, before we on Saipan knew of the first. No further conviction was required. I can well remember how the news of peace came to us. It was on the evening of August 11, 1945. My wife to be and I were at cribbage in the Officer's Club. Two befuddled marines were consoling themselves by idly twirling the dials of a short-xvave radio when Carolyn suddenly exclaimed: "Did you hear that? They want peac" I had not heard. We rushed to the set, but by then the station had been lost and we spent the next half hour searching. Finally it cam Personal bottles were rescued from the bar, since the Commanding Officer's orders required that it be closed at 11:00 p.m. Then followed a snake-dance to announce the news to all and sundry in the barracks; it continued past the startled sentries to the fenced-off nurses' compound. All was uproar and gaiety throughout the night, assisted by a supply of Scotch with which the chief nurse had been entrusted by one of the generals. On the next day Destroyer-Escorts equipped with blaring loud speakers cruised along the coast and shouted the news in Japanese into every inlet. They were believed, or else confirmed by more direct sources from Tokyo, since within the week no fewer than 400 of the erstwhile enemy turned themselves in. They had successfully managed to elude several mopping-up operations. Most were neither sick nor thin. Many had continued to feast, as had we when we first arrived, on tinned crab meat made in Japan which bore the label "Approved by Good Housekeeping." This had been cached in caves before the battle for the island. Now came the time to discharge our few patients either back to duty, or to hospitals near home and to release those of our staff who had sufficient "points." The necessary quota applied to most of us who had been with the unit from the time it was organized. Since facilities for transportation were obviously limited I elected to remain for two reasons. First, others had wives and young families at home; second, as historian to the Yale Unit, I wished to record the last events in the closing, and particularly the destruction of the equipment, the return of which to the homeland had been proscribed. Had permission not been granted to remain, I would probably have been ordered back from some point on the long journey hom As it was, the orders caught me unaware and unprepared, but not physically on the homing path, and therefore ready, in fact eager, to set forth on the final step to Japan that we had begun more than three years befor 2. HIROSHIMA RETROSPECT Hiroshima, "broad island," is really a delta cut into six islands by the branches of the River Ot Here lived some 250,000 people, a number that does not include the soldiers of the Chugoku Army in their encampment near the center. On two sides of the delta, which points its apex to the north, the hills rise sharply. It is as if a great flatiron had been pressed from the direction of the sea into the mountains. Only the truncated cone of Hijiyama rising to 225 feet interrupts the flatness. For the most part the houses were of traditional Japanese construction. Most were of one or two stories, built of wooden lathwork and clay. A central heavy tree beam runs longitudinally supporting arch-like ties. These in turn support a lattice of struts that brace the heavy roof of overlapping pantiles. Most of the modern buildings were of the heavy construction necessitated in this land of earthquakes. These were situated along the main street at the southern boundary of the military encampment and also along the broad thoroughfare which ran at right angles directly south from the main entrance of the reservation. These buildings were not in a cluster, but separated by rows of the wooden shops and dwellings. Buildings of weightbearing brick were few, since these are most subject to damage by earthquak Typical Japanese cities built thus tend to be swept by disastrous fires at an average interval of eight years, but the ordinary houses, quick to burn, can be as quickly rebuilt. The open charcoal braziers (hibachi) useful for warmth and for cooking are a constant hazard. In this city of islands the branches of the Ota made natural fire breaks, but the separate islands were themselves large and densely crowded. In recognition of the danger of Ca -, l r, ._R;X.t4fvSso>r-zbCe_J, FJo l'ollillic -38, (ctobcr, iQ6,5 <_ *- <:L) - - tZ ;-< t . r. '- *-J Cn CJ CJ _ t - . _ _ _ 'J > aS r. : ;_ _ ._ ; W CS D ._ _ _ _ W; _ r, _ r, @ sv n > .R -< oo ;R > *_ ' < t C>_ 'J. t tJ 9 . ._ / r. ' fire, especially under air attack, the citizens even before April 1945 had organized patriotic work parties (Giyutai) to create additional fire breaks by leveling blocks of homes. Work parties for this purpose were recruited also from outlying villages such as Otak Hiroshima was not an important center of industry. On the outskirts were a branch of Toyo Industries, Mitsubishi shipyards, and a machinetool factory. The Japan 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 care of the Tokyo First (Dai Ichi) Military Hospital and where we were to establish the headquarters for our work. Industry was also scattered in innumerable home workshops in accordance with the Japanese concept of total war. In Hiroshima, in a roughly pentagonal area near the center of the city, was concentrated the military power of central Japan. The headquarters of the Second Grand Army and of the Chugoku Military district were located near an ornate 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, row on row. Near the entrance of the encampment, facing the boulevard at its southern border was the impressive Gokoku shrin The Hiroshima encampment had served as the springboard for the conquest of Manchuria in 1937-45 and before that for the successful 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 and Iwakuni to the south. In a military sense, at least the army base might be considered a legitimate target, yet it was strange that before August 1945 Hiroshima had escaped almost unharmed. Desultory raids between the middle of March and tlle 30th of April 1945 had inflicted almost no damag During the early summer our propaganda had broadcast threats that a number of cities, including Hiroshima, would be destroyed. The population was tense in expectation. Yet on August 6, the element of surprise was complet Four B-29 bombers were sighted over Hiroshima early in the morning but shortly after 7:00 m. they withdrew to the northwest. Just after 8 :00 three planes returned, but the all-clear had sounded 45 minutes befor Since there was no 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 already reported to the schools or for service in Volume 38, October, 1965 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 parachute and then at 8:14, despite the brightness of the morning survivors were startled by a prolonged and brilliant flash like that of a gigantic magnesium flar 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 proportional to the square of the distance from the epicenter. Its duration was probably less than one tenth of a second and its intensity was sufficient to cause nearby flammable objects, particularly when dark, to burst into flame and to char poles as far as 4,000 yards away from the hypocenter (point directly beneath the center of the explosion). At 600700 yards it was sufficient to chip and roughen granite by unequal expansion of its components. The heat also produced bubbling of tile to about 1,300 yards. It has been found by experiment that to produce this effect a temperature of 1,800° C. acting for four seconds is necessary, but under these conditions the effect is deeper, which indicates that the temperature was higher and the duration less during the Hiroshima explosion. Only surfaces directly exposed sustained flash burns, since the rays of heat, like light, travel in straight lines. Intervening objects prevented the charring or other alteration in the directly exposed surfaces and thereby cast "shadows." The sharpness of shadows cast by constantly moving objects like leaves also suggests the brief duration of the flash. Thousands of persons in the open within a radius of 212 miles sustained more or less severe flash burns depending on distance and the protective effect of clothing. After an interval evident to those at a distance, came a violent shock wave that flattened the fragile wooden buildings. As seen from the hills the houses fell as under a scyth People were hurled from where they were standing. Those closest-by heard almost no sound except for that of falling buildings, but at a distance there was a rumbling roar like that of thunder. The blast wave shot outwards at approximately two miles per second for a relatively short distance, but then after several hundred yards reached the speed of sound (approximately 1,100 feet/second). It rose to a sharp peak, and then the pressure fell below atmospheric for a period perhaps three times that of the positive phas Objects at a distance were deflected away from the center of the blast, but such objects as trees immediately beneath remained standing upright although stripped of branches. The magnitude of the |. ''ll :., Top. Flash burn in acute stage; the upper portion of the body was unclothed and suffered a sharply outlined "profile burn." Patient probably within 1,000 meters. The buttocks and thighs were burned through clothing, but the abdomen was protected by a multilayered cummerbund., Bottom. Keloids of skin in 21-year-old woman at 1,600 meters. Seen in early Niovember 1945. Some protection by means of blouse' and straps -of undergarments. Top left. Patient showing dermatitis and epilation. First MIilitary Hospital fil Distance not recorded but probably within 1,000 nmeters. Patielnt was a soldier in the military compound. Top righlt. Epilation aind petechiae in patient exposed wvithin the military compouild at 1,000 meters. Patient (S-, H. -6176-U) died on 31 August 1945, when the white count had fallen to 45. Lowcer lcft. Epilation, wh-iclh had begun on 20 August, as seen on October 25, 1945. Patient (M-) at Ujina Hospital. He was a soldier who had been indoors on the second story of a two-story Japanese building at 600-700 meters. Slight dowiny regrowth of hair has already begun. Lowver righlt. Epilation in middle-aged onoman. Patient at Ujina out-patient clinic. Regrowth of hair has begun in late October. Hirosliimiia Mlledical Diary, 1915 L f downward pressuire was showvn by the 'dishing" of the reinlforced concrete roofs of buildings. Glass andI other debris were shot through the air like l)ullets, ofteni became imlpacte(l in wood, and inflicted multiple serious inijturies. Simultaneously roilinig cloud, pink or black according to various observers, rose fromil the l)oint of the explosion; thiis, tog,ethier with imlmllense quaiitities of duist fromil the ground and fromii the collapsilig buildings, threw those beneath it illtO almlost total darkniess. This lastedI for somile twenty iniutes. Thousands were trapped in the wreckag Alimiost all of those who cotild not escape tuinder their ownii pow-er perished. Fires beginning everywhere both by direct igition anid by the upsetting of thotisalids of the ol)en hibachi, many still in uise for cookinig l)reakfast, at onice swept the city. A highi xxinid stickedI toward the rising atomilc cloudI fanine(d the flamiles 1hich then created their owin fire storml. The huimiiani victims suiffered burns both by flash alnd by flamii As soonl as the atomiiic natuire of the explosion was aninotince(l a new fear made itself felt the terror of the invisibl The existenice of radiationi effects was known alimiost at onlc People who had been close to the hypocenter lut who had stiffered neithier burns nor traulila, sickene(d and dlied. They felt w-eak anid natiseatedl, couild not eat, developed a severe (liarrhea aind fever and somile died w-ithinl ten days. Those N-ho survived loniger lost their halir helimorrhiages anid ulcers appeared in the skin anid miuitcotis imiemilbranes and(I deathi resuiltedl fromii pulmonary or initestinial inifections. Tlle marrow had beeni destroyed and all elemilents of the blood were deplete(l. If the intent of the bombing was demiloralizationi, this was unquestionably achieved. False rtimors spread-that all w-ho had been in Hiroshimia and Nagasaki w ould die, anidl that the cities would be uninhabitable for 75 years. But there w-as yet anothier effect. Those in power in Japan w-ho were wise liad clearly seen that the war liad been lost when Okinawa andl IwN-o Ji1m1a fell. The Em 1peror had personally soughit to influielice his war couticilors to sue for peac Now, in the face of unianiticipated and uniiprecedenited power that couild overwhlelmii eve\n the milost valorous there was a wv ay to conclide the war wN-ithiout losing face and the fighting wvas brouighit to ani end. Only glimipses can be obtained from accounts of survivors of thle inimenise medical problemils created by an atomic explosion in a densely populated city. Those who lived were (lazed not merely by the immediate force of the explosion but by its vast extent. Many lost consciousness for a few seconds or iinutes even though they had not suffered traumila to the head. Darkness interrupted by onrushinig fires added to the confusion and terror. No one knew which way to escap The river banks and their waters Nere natural Volume 38, October, 1965 havens and were soon teeming. Boats were mobilized to carry survivors upstream. Only a few could be brought out on litters or carts, and almost all who could not rescue themselves were overwhelmed by the flames. Both administrative authority and organized activity had ceased to exist. What was done was on individual initiativ Only three of 45 hospitals in the city remained standing. The two largest and most modern, the Red Cross Hospital and the Communications Department ("Post Office") Hospital, were so severely damaged by blast, as was their equipment, that they could function only as first-aid stations. Less than 10 per cent of the city's 300 physicians were uninjured and nursing strength had been equally depleted. As the fires cooled relief work was begun. The first relief station from outside was set up on the afternoon of August 6 at Tamon in the shelter of Hijiyam Thousands streamed back into the city in search of relatives and friends. Messages were scrawled on the walls of the aid stations. Police control, by tradition an enveloping power in Japan, was resumed with the help of officers from neighboring towns. The Armed Forces gave substantial aid. Two relief parties were dispatched from the Naval base at nearby Kure and the hospital on the base at Iwakuni received 51 patients, many of whom were naval personnel who had been quartered at the Banker's Club, a large building only 200 yards from the hypocenter. Some of these persons died in the first few days purely of radiation effect. The Army assumed responsibility for the care of civilian as well as military casualties although the two large Army Hospitals on the military reservation had been destroyed. Military hospital detachments were brought in from elsewher Accessory aid stations were established in certain buildings on the outskirts that had survived complete destruction, and in adjacent communities as at Oshib One of the most active in the city itself was at the Fukuramachi school. The Red Cross Hospital, despite severe damage to its fine building, took care of 1,000 persons as in-patients, and in addition conducted out-patient clinics. According to the Director, Doctor Hachiya, the Post-Office Hospital began to receive patients by 9:00 m. of August 7, and by the end of that day 400 had been given immediate car A major installation was established on August 25 by the Tokyo Dai Ichi Military Hospital (the Walter Reed of Japan) at the living quarters of the Daiwa rayon mill at Ujina-later to be the base of operations of the Joint Commission. The investigation of the effects of the atomic bomb was begun by the Japanese as early as the first day following the explosion when Professor Nishina, a quantum physicist, came to Hiroshim On August 14, Doctor F,0 Upper. Street shortly after the explosion on August 6, 1945. The injured seeking aid-probably in the shadow of Hijiyam The city is burning in the background. Lower. Temporary tentag Shelters at Hiroshima No. 2 Army Hospital, Motomachi, August 9, 1945. An officer marches by at the left. (Nishina photograph.) T'olitine 38, Octobei-, 1965 Upper. A nurse ministerinig to burned and injured patients, August 9, 1945. The scene is under tentage at the Hiroshima No. 2 Army Hospital at Motomachi. This was staffed by the Second Provisioinal Fukuoka Army Hospital. (Nishina photograph.) Lower. Burned and injured patienlts. (Nishina photograph.) Hi)roshiill Aedical Diary, 1945 U- sionI. (Bunka-Sha photograph.) Upper. The Fukuraniachi Aid Station. This was formerly a high school. (BunkaSha photograph.) Lower. Clinic in session in early October 1945 before arrival of the Joint Commis- l'oliiiiie 38, October, 1965 Uppcr. Bulletiins regardinig the whereabouts anid coniditionis of various persons rit-on1 an initerior wall at the Fukuraniacli Aid Stationi. ( Bunka-Sha photograph.) Lozwer. Nurse in Red Cross Hospital admiinlisterinig treatmlenit 'Lo atiellt. (BunikaSha photograph.) ten Murachi* and Doctor Kimura came and stayed approximately a week, and then returned later in the month accompanied by Doctor Miyazaki. With the help of the Neher cosmic ray counter they found a zone of gamma ray activity approximately ten times background in a region 50 yards across at the hypocenter. This was interpreted to be the result of activation by neutrons of components on the ground. The radioactivity was far below hazardous levels. It is interesting to note that a part of this instrument had been made and tested before the war by Professor Neher himself in the United States. At Takasu to the south and west there was radioactivity of three times background level. It was interpreted to represent the effect of fallout directed by the wind that had blown from the east and by the rains that fell in this region just after the explosion. This activity was extremely low and certainly did not justify the fear of the rumor mongers. The physicists also noted the "shadows" cast on various objects as a result of the heat flash. By sighting along these shadows they were able to establish through a process of triangulation the position of the explosioll. It is amusing that this datum, widely known among scientists in Japan in the second week of August, was considered a secret in the United States for many months. Medical investigations were begun at once and some of the earliest autopsies were performed at the Iwakuni Naval Hospital. At the Commullications Department Hospital careful records were kept of approximately 150 patients, and autopsies were performed by Professor Tamagawa of Okayama University in a makeshift autopsy room on the grounds of the institution. The Prefectural Hospital at Kusatsu was active until November 1945. Autopsies were performed there by Professor Araki of the Kyoto Prefectural University. Patients were transferred to military hospitals at Okayama and elsewhere and to civilian institutions and hospitals as far away as Osaka and even Tokyo. In these settings investigative work and necropsies were also performed. One of the most important investigative units was that maintained by the Tokyo Dai Ichi Military Hospital at Ujin This was superbly staffed. It had been customary for many of the best young Japanese physicians from the major universities to be recruited into the military soon after receiving their medical degrees. Of this group, Majors Motohashi, Misono, and Hata later made valuable contributions to the work of the Joint Com* Dr. Koichi Muracdi, a senior biophysicist of the Institute of Physical and Chemical Research of Tokyo, later became a valuable member of the Joint Commission, especially in the investigation of factors in protection from radiation. He died on March 31, 1964 of leukemi Volume 38, October, 1965 mllissiOn. Ini addition, they lhad collaborated with physicians of tlle Tokyo Imiiperial -University who lhad sent investigating groups iilto Hiroshlilmca and(I lhad also received miiaterials for stund at the University in Tokyo. A report concerning 712 of these patienits w-as completed by personnel of the Tokyo Dai Icli 'Military Hospital anid represenits ani imiiportanit originial doctnmiienit. A miiajor trage(ld wcas suffered by the highly comiipetenit grotup of inv,estigators lheadled 1bw Professor Alashita of the Kv-oto Imlperial Universit-. They took til) residenice at the Onio Armyv Hospital in the village of that namiie on the coast a few miiiles sotitl of Hiroshilmii Durillg the great typhoon of September 17, a lanidslide roared downo i fromii the steel) lills behind the hospital to the sea, crushing several btuildings in its patth and carrying to tlheir deatlhs teni of the finiest miiedical scienitists in Jaapan1, inclundin the famiiotis hematopathologist, Professor Sutiiyam AmloinO some of these gronps of investigators there existed a certaill jealotusv of what might be called intellectual property, and commlllitinlicatiolns amllonlgthelm were niot fre Snch attittudes are lnot uniiicqtue to Japan but tend(l to prevail amilonlg scienitific commiiiluntities thronghont the world. \With a few major exceltions, these teamiis conisidered l)artictular aspects of the prolblemlls in lhanid. Under the diffictult circtimiistalnces, the generally lighl(lqnalitv of the sttidies l)erforlmed is remarkabl In retrosl)ect. it seemiis strano-e thlat a w-ell-staffed and well-e(tuipped miie(lical team lhad n ot been orgaynizedl by the Snroeon General of the U.S. Army for the specific ftinctioni of performincg an intensive investi-ation of biological effects of the atomlic bomb. It was saidl that the Snrgeon General had lnot been iniformiied of the plannied employment of this w-eaponi against the cities. Fntrtlhermiiore General Kirk's personal relationshipsx-itlh General w M\acArthur were reported to be strained. WNe knew that lhe lhad, luring his totur of the Western Pacific in 1945. been reftused l)ermissionl to lanid ill the Philippines. Rtumiior lhad it that vears earlier when Kirk was ill commiiiianlel of a mlilitary hospital in the Philipipines he had declined to a(lllit AMacArthnlr as a patienit becatuse the latter w as then serving in a civilian capacity. The needl for a thoroughgoing medlical stuidy was clearly perceived by Colonel Ashley WV. Otiglterson. then serving as surgical consnltalit to General AMacArthur. Since he knew of no preparations that had been miadle fromn \VNashlinlgton he conceived a plan of action while still on shipboard w-ith GHO on route to Japan. This was presented as a letter anid immediately approved by Brigaclier General Guy B. Denit, Chief Surgeon, GHQ, U.S. Armled Forces in the Pacific. Colonel Oughterson laid down the major directions that Nere actually pursued by the investigating team and his memorandumii to General Denit is therefore reproduced in full: Hir oshliimla AMedical Diary, 1915 Upper. The Oshiba Aid Station. Patietnt brought in by cart receives treatment. (Bunka-Sha photograph.) Lozcer. Families of patients assistinig in the care of their sick relatives. One of the two patients has suffered epilation. (Bunka-Sha photograph.) t"oluttie 38, Octobei-, 1965 Upper. The Conimunicationis Departmnent Hospital seeni from the rear (1,400( meters). The low building behind the central portion of the "vall at the rear of the hospital was used as anl autopsy room by Professo:r Tamagav Lowcr. Professor Tamagawa of Okayama lUniversity in autopsy roomii of Commnilitnications Departmenit Hospital at Hiroshim (Bunka-Sha photograph.) Hirosliuta Mledical Diar), 1915 L I EBOW5 Two views of damage by landslide at the OIno Hospital, near Hiroshima which occurred shortly after 10 p.mon Septemiiber 17, 1945 during, a typhoon. Here were lost ten scientists from the Kyoto Imperial University, includinig Professors Mashita anid Sugiyam The survivors wrote: "WNith much regret, we, therefore, had to stop our work in Hiroshima and return with the ashes of our friends." f'oliiiiie 38, October, 1965 ON BOARD SS GENERAL STURGIS 28 August 1945 MIEMIORANDUMI: TO: Brigadier General Guy Denit SUBJECT: Study of Casualty Producing Effects of Atomlic Bonmbs. 1. A stu(ly of the effects of the two atomiiic bombs usecl in Japlan is of vital imliortance to our country. This uniqlue oplortunity may not again be offeredI until anotlher worl(d X-ar. Plans for recordling all of the available data therefore shlouldk receive first priority. A study of the casualty producing effects of thcse bombs is a funiction of the Medical Department and(l this imiemorand(luml is prepare(l as .a brief outlinie for such a study. 2. The nieecl for study at the earliest (late possibl The casualty producing effects of these bomibs shoul(d be stu(lie(l at the earliest possible mioment for the following reasonis: Much of the dlata Imlust be obtaine(d froml the interrogatioll of the survivors anl(i the soonler this is accomplished the imlore accurate w\ill be thIe results. b. l'ost-miortemii examiiniationi of the deald may provide valuable informliation as to the cause of (leatlh. Three weeks or more will have elapsed anld opportunity for post-iolrtemn examiniation will be limite(d to late (leatlhs amonig the survivors. It is hoped that soImle post-ImlorteIml exaiminiatioins Imlay have been dlone by the Japanese andl that these recor(ds may be amplified by early interrogation of the Japanese pathologists. c. Accurate case histories by interrogations of the in jure( may vprovide the mlost reliable dat These should also le correlated with th ]physical findinigs anid the necessary laboratory examiniationls. d. Residual radiation effects have been suggeste(d as a possible source of daniger and while this appears to be remlote, suclh a possihility should lie investigated at the earliest possible dat 3. The scope of the study. The total number of casualties reportedI at Hiroshlimila is al)l)roximately 160,000 of whoim 8,000 are dead. Even though (lue allowance is mla(le for inaccuracies in these estiimates the scope of the problem is suclh as to re(uire the organizationi of teamiis with intterpreters in ordler to complete an adequate study w ithinl a reasonable time limiit. These tcaimis slhould include pathologists anid cliniciains wxorking under the direction of trained investigators. 4. The data \vhiclh should be obtaine(l. It is recogniizedl that any plan for the collectioni of data slhould be mo(lified according to the circumstainces. The following suggestionls are intell(led to in(licate the miniimuIm rathier thani the maximilunm data required to properly evaluate the casualty producing effects of these bombs. The location of all casualties living and dead should be (leteriiliied in relation to the bomb anlIplotted oII a contour map. b. All living casualties should be identified by number for location on the map) and an exact description of the case kept in a cross index fil Stanidard Hiroshliima Medical Diary, 1945 L LIEB3OW diagniostic nomeniclature should be used. Such a procedure is necessary in order to determinle the differenit casualty producinig zonies. c. The positioin or protectioni of all casualties should be determinied sinice this may be a determiniing factor in blast effects aind burns. (Standinlg, sitting, prone, inidoors, outdoors, in shelters, trenches or behind(I walls etc.) d. Consideration should also be given to such factors as conitour, temlerature, w7ind and humidity in relation to casualties. It is unlikely that the latter factors will be of much inifluenice but contour may be of conlsiderable imp)ortanc Evidence of blast effect should be searched for in both the pathology ali(d in the clinical history. X-ray evidenice of lunig pathology may be helpful. f. Burins slhould be carefully observed as to degree and clharacter, part of the body inivolved, rate of healinig, cause of death, etc. g. All casualties should be recorded as to whether they w ere due to primary effects of the bomb or were seconidary to burninig buildinigs, flyrinig debris or falling walls etc. h. Evidence of residual radiatioin effects. WVhile there is little ilndication that such inijury will be found it should nevertheless receive serious coni- sideration. i. Complete post-mortem examiniatioin should be performed oIn all inijured in whom the cause of death is not clearly established. j. It is hoped that the Japainese may have already organized anl iilvestigationi of the casualties but this is unlikely under the circumstanices. However much valuable data may be obtained from interrogationi of Japanese doctors and pathologists. Also data valuable from a niegative standpoint may be obtainied from uniinjured survivors who were within the daniger zonI 5. It should be emplhasized that since the cffects of atomic bombs are unikniowni, the data should be collected by investigators who are alert to the possibility of death and injury due to as yet unknown causes. 6. It is recommeinded: That in view of the importanice of the data to be obtainied anid in view of the magniitude of the problem that a committee be appoinited by the Chief Surgeoni to survey the possibilities of obtainiing data and to direct the collectioin of the data needed to properly evaluate the casualty producinig effect of the atomic bombs. b. That the various aspects of the investigation of the casualty producing effects of the atomic bomb be correlated through the Office of the Chief Surgeoni. WV. OUGHTERSON Colonel, 'Medical Corps After the GHQ group landed in Japan on September 1, 1945, it was learned that various groups of Japanese scientists had already conducted medical investigations on the patients in Hiroshima and Nagasaki. Contact was established with the Japanese government on September 3, and thereafter reports were received and liaison maintained through the GHQ Surgeon's Offic Voluitie 38, Octobei-, 1965 At about this timle a groulp frolm the 'Manhattan District," the organization that carried the responsibility for developing the atomiiic bomb, arrived in Japani. Its Imlission1 was to coInduict a b)ricf p)relinmiinary study of the effects for ai inmmediate report to Washillngtoll. Tihe miiajor funlctioni was to determ1inie \vhctlher there wsas resi(duial radioactivity in ordler to safegtuard our Professor Tsuzuki's card. troops. This group, unlder commliianid of Brigadier General Thomiias Farrell, was self-containied, w ith its own air transportation andl equipment. In charge of the medical section was Colonel Stafford L. \V;arren, wlhose civilian positiol was that of Professor of Radiology at the University of Rochester, well-knowyn to Doctor Oughterson from civilian lif On Sep-ten1ber 4, 1945 a conferenice was held with General Farrell and the seniormedical officers, and it was agreed that it was desirable to unify the informiiation to be obtained and to produce a joint medical report. General Farrell's group landed on Iwakuni airfield near Hiroshima and made a prelim-ninary survey of physical damage and of casualties in various lhospitals and clinics. After the physicists had confirmed that only mninimlal radio84 activity, well within the limits of safety, was present, the group returned to Tokyo some ten days later. Parenthetically, it is of interest that one localized but intense focus of radioactivity was found in the ashes of one of the crematories but this was traced to a radium source that had been used for treating a uterine tumor. It was obvious that for an intensive medical study the cooperation of the Japanese, who had already made all of the clinical and laboratory observations during the height of the early phase, was essential. Professor Masao Tsuzuki, the Head of the Department of Surgery of the Tokyo Imperial University and Director of the Medical Division of the Japanese Research Council, was contacted. He agreed to enlist the full cooperation of Japanese medical scientists. As a result, the Supreme Commander directed the formation of a "Joint Commission for the Investigation of the Medical Effects of the Atomic Bomb in Japan." This was to include the Mantattan District group while still in Japan; a GHQ study group, still to be organized, which was to perform a more definitive medical study; and the Japanese Government Group under Professor Tsuzuki. Later, on September 25, there arrived a medical investigating team of U.S. Navy personnel (Nav Tech Jap, Team 11) under Commander Shields Warren, M.C. This was composed of 15 officers and enlisted men who were assigned to Nagasaki. With their arrival, it was obvious that duplication or conflict of effort would be ridiculous and the Navy group then worked as part of the Joint Commission in fuil cooperation with the U.S. Army and Japanese componenlts in Nagasaki. Doctor Oughterson proceeded at once to organize the GHQ group and to issue orders for designated personnel. It was on September 18, 1945, when the orders reached Saipan, that this daily record was begun. 3. PREPARATIONS Tuesday, September 18, 1945: At 08:05 on this steaming hot Tuesday morning received news verbally from the Adjutant that I might be leaving "all over the Pacific." The somewhat garbled message had also stated that either Rosenbaum or Rosenberg were to be alerted to go along at once on the same expedition. Rumors were flying. We thought that most likely we would be sent to Japan-maybe to participate in medical work on the atomic bomb-but we hardly dared to think of it. Tension was high. Late in the morning a radio message was received by Jack Bumstead that confirmed our conjectur Japan was to be the destination. It was Rosenbaum who was to go. Instructions were to take along two experienced laboratory technicians. Orders would be cut as soon as they were named. Picked Archambault and Reed who seemed delighted. Called on C.G. and said, Volzittie 38, October, 1965 "Guess wlhere I'm going." "To Japani I suppos" "That's right." There was disappointmiienit but also excitement in her voic I immediately began to coml)lete the few autopsy protocols and other laboratory business remiiaininig and started to pack. Orders for imimiediate dleparttire arrive(d about 3:30 p.m. It wvas necessary to transfer all of the laboratory property to Captain Bornstein, wlho had been assignecI as an addlitional pathologist some weeks befor He signed for $90,000 worth, with uncderstandable reluctanc Hastily packed belongings were thrown into a stationi wagon. Quick, and painiful, leave takinigs were accomlplished but the arrival at the airport at 7 :00 p.m. proved useless, silnce the last I)lane for Gutaml had left at 3:00 p.m. \We had hoped to go oln somiie uinscheduiledI flight. The nlext planle was (lue to depart at 08:30 the next nmorninog. \e retturneid to the 39th General Hospital, leaving all of ouir belongings in the stationi wagon for early departur At abouit 2:00 m11. came a call fromli AMajor TarlnowN-er on Guam wN-ho ha(l gotteni conflusintg orders which w-ere soon1 pUt arighlt since his name was unmllistakably inscribee(l witlh iiine oni the orders. Jack I). Rosenbaum lhad comiie overseas w-itlh the Yale U-nit, leaving hlis in Medicin He was a brilliant stuidenlt of Dr. john P'. 1'eters wvith special interest in mletabolismii, and hlaLd servedI as officer in charge of the chemical laboratorv. Arthuir H. Rosenberg, who was inI charge of serology, had worked at the U.S. Public Healtlh Service V-enereal Disease Researclh Laboratory on Staten- Island. The original ra(lio mlessa(ge was unclear as to hlo wNas to be assigned. Sgts. J-ohli Archambault andl Jack Reed were both stuperb teclhlnicianis anld bears for x-ork. Archambatih had been a pharmacist in Fairfield, Conniectictut aln(d Ree(d lhad been worlkin1g toward ani advanced(lderee in enitomlology at Rtitoers. I was inot suire that they wouldI be happy witlh ani extensioni of duty- at a timie when a returl-ni lhomiie was immiiiinlenit. Coinfidenice in these meni l)rox-ed miiore tlhani justified, since both performed far beyond the call of (ltity throuighout tllcir touir in position as Instruictor capan. * .Scptcu;ibcr 19: Arrived( at airl)ort at 8 :00 m. and was told( that all sesats oln the l)lanle were taken . Outr orclers clearly indicate(l tirgencv how\-e\ver, and places w-ere tlherefore miia(le availabl Landled at 9 :20 m-. oni Guami. Immedliately miiadle arrangements witl the Nav-al Air Transport Service for (ld)arture to Japani oni the first available flight, sclhe(duiled to leave at 10:00 p.m. that night. ?lhi.s left ani enitire day fre Conitacte(d Dr. Harry Zimimiilerimlin, my form11er teacher in pathology at Yale, who was statiolne( Hiroshliima Medical Diary, 1945 L with the Rockefeller Institute unit wlhiclh I had visited several Neeks before during the penicillin crisis. It was a well-spent day. Case records and cultures fromii our paratyphoid epidemic were turned over to Dr. J. T. Syverton. Saw Dr. Norman Stoll and demonstrated our Isosporea hionlisis pictures in which he had expressed an interest durinig my previous visit. After lunclh wevet to the native hospital at Agana Nith Dr. (Conlimanider) Sulzberger who had become interested in cutaneotus diphtheria after I had described otur lonig experienice with it, botlh in our troops aind amiiong thle natives, dturing our previotus visit. At the hospital we smiieared and cultured what to me looked like diphtheritic ulcers in a number of natives. The (leimionstratioin of bacilli in the smears proved completely successful, much to Dr. Sulzberger anid Syverton's surpris I then wvas brought to a nleetilg at the 204th General Hospital that was beinlg condtucted by the patlhology servic Dr. Humilplhries very kindly took me under his w-ing. After the miieeting and a good stupper, was driven to the airport where a C54 NATS aircraft No. 56494 w\as waiting for us. \We reported to the desk at 9 :00 p.m. and boarde(d the planie at 9:40. The take-off was exactly as sclheduile(d at 10:00 p.m. * The Rockefeller Ulnit, unider the comlmlilanid of Dr. ( Captain) Tlhollmas M. Rivers, 1MI.C., U.S.N.R., served a research and conistultative ftunction, and(i Was superbly staffed. Dr. Zimmiiermnan had been an Associate Professor in the pathology departmient at Yale while I was in ny residency. Dr. Normclan Stoll Nas a parasitologist of the Rockefeller Inlstituite at Princetoni, anid Dr. AMarion B. Sulzberger a renowned dermatologist fromll New York. A prev\iotus visit, miiade on August 23 and for the next few days, was precipitated byT ca progblem involving penicillin therapy. \We becamiie aw\are of the dliffictulty at onice, miiore or less by accident. I had been doingc a stud(yNwith Dr. Max Taffel of the penetration of peniicillini inito spinal fltidl in craniocerelbral injurv. One day we found that the apparent blood anld spinal fluidI levels had fallen to approximately one eighth of what they had been before on the samiie scheduile of treatmelnt. At thlat timiie wX-e thoughllt that the streptococcuis that had been carefully trcansported fromii otur previous station in Newv Zealand as a standard for testillg penicillin levels had aone awry, altlhotugh wNe hadl kept standard cultures in storag Oni investigcatioll wse foundicl that a new batch of penicillin had been put into tuse in the lhospital oni the clay the old miiaterial became otutdated, as or(lered. When wx e tested the ouitdatedI penicillinl it was fotind to be fully potent while the "fresh' batclhes were not. We therefore received permission at olnce from the islanid sturgeoni to use the otitdatedI mlaterial, after it had been tested for Volume 38, October, 1965 Col. Verne R. Mason Prof. Kanshi Sassa :f~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Cap. Jac ,,.,,,,,,,., Ros.Enbau Maj. Milton L. Kramer Hitoshtitmia Medical Diarv, 19-15 LIEBOAV .~~~ ~~~~~~~~~~~~ Pro Maah Mak Col). 'Geor- e \ reaclh LeRoy -g Joh chmbu ~ ~ 8 -* : : Sgt.iJcP.Re Volume 38, October, 1965 A- Rki- Col. Elbert De Coursey l. 3B *s> t - wos :; Commander Shields B'arren s: o$ -faj. Samuel Berg Ma;. Hermall Tarnourer :} :o ::. : :: .: . Hiroshimla Medical Diaryj, 1945 was against general policy, but it was surely wise and it miay have been lifesaving. \We at .hlis timiie also asked for tranisportationl to the Rockefeller nnit on1 Guaml to test both our standard streptococcus and the various batches of lellicillin. The laboratory there quickly confirmed our results. The paratyphoid epidemic which interested Dr. Syverton had occurred h iii an engineering unit on Saipan amiiong 65 miien, somiie of wlhomli ad shot onie of the w-ild pigs on the island and barbecued it in a pit. Those hlo ate the pork on the first day remained w-ell, but most of those who had eaten the unrefrigerated imieat on the second day became ill, and two died. Many miore undoubtedly would have succumbed had lnot all available plhysicianls beeni imiobilized at the 369th Station Hospital to care for the patieints (luriong the acute emergency. The problem was largely one of fluid replacemiient therapy. After the critical first 36 hours the survivors began to recover, but had a court miiartial awNaiting themii on discharge, sinice eating native food had been strictly proscribed by the Commlllandinig Gelneral. Doctor Syverton had reqtuested the cultures for study anid they w-ere thenl delixered potency. This local decision im perso1i. * S.eptcJilbcr- 20: The l)lane, although stripped for freiglht tranisport, had tlhree ceintral reclinincg seats witlh canvas backs, one of which I was inivited to us After a smootlh flight w e landed at Iw o jilima at 2 :00 m. A threeqluarter mlooi was shinilng and the night wx-as wonderfully wsarm and clear. WNre had a spectacular view of iMount Suribachi as we came in. The flattened top loomied over the enid of the air field. The island is a dtusty desert covered anid witlh ratlher heavy browni cinders. There are a few gniarledl twx-isted trees. The impression is qtuite like that of a disheveled Camiip Stoniemanl. Orion, which w-e had not seen for almost tlhree years, again clearly rides the sky near the horizoni. W\e soughlt a middle-of-tlhe-night snack and( founld it after mtuclh wanidering about the airport. Then boarded the plan e for anotlher snatch of sleep and anwoke on take-off at 6 :30 m. The w-eatlher was xvondlerfullv clear all the w\ay ul). Photographed Iwo receding ilnto tlle distanice anid also somle of the Volcano Islanids to the nortlh. The w-eather on our trip to Tokyo had been perfection itself all the way. Yet w-e x-ere to the south and east of a typhoon that was devastating Okinawa and lashlinig central Japani. This wxas to have some repercussions for otur miissoion, since we learned later that color film N-hich was sent to us had been damuaged in that stormi on Okinaw Also Hiroshimila itself suffered Volume 38, October, 1965 severely. The city was flooded and numerous landslides interrupted rail traffic. Most tragic of all was the landslide that killed the scientists from the University of Kyoto at the Ono Hospital. ITEM: NIPPON TIMES FRIDAY, SEPTEMBER 21, 1945 TYPHOON HITS FOOD CROPS Kyushu, Shikoku Rice Affected Vegetable Farms Inundated The typhoon which swept over the western part of Japan late Monday afternoon, caused considerable damage in Kyushu and Shikoku districts. After raging over Chugoku district and areas along the Japan Sea, the storm, said to be the most violent this year, was expected to pass over the northern districts and into the Pacific late Tuesday night. Most hard hit were various districts in Kyushu and Shikoku where rice blossoms were just in bloom, and it is feared in these areas that this will have had effects on this year's rice crop. Inundations, it is also reported, caused damage to the growth of various vegetables. Hitting Kagoshima in Kyushu about 2 P.M. Monday, the typhoon swept over the neighborhood of Hiroshima at 10 P.M. the same day and passed into the Japan Sea via the Sanin district. At 10 M. Tuesday, the typhoon landed in the vicinity of Niigata, prevoiusly crossing over Noto Peninsula, and then headed for the north. In the Tokyo area a strong wind began to blow at dawn Tuesday with a velocity of 18.3 meters a second which at its height registered 29.8 meters and an atmospheric pressure of 743.7 millimeters. As a result, damage done was very slight. For a time the tramcar service in the suburbs was suspended but was restored to normal during Tuesday. * We had our first sight of the mainland of Japan at about 9:30 Tokyo tim There was an electrical almost crackling thrill of excitement as we stood against the windows on the port side of the aircraft to regard and photograph the land that had so disordered our lives. We could see the white line of the breakers pounding a promontory and the dark hills beyond. Many of the villages were intact and looked peaceful enough nestling in the valleys with the terraced rice paddies rising above them, tier on tier. But many of the coastal towns were devastated and the shells of houses and often merely their outlines, were visibl Masses of rubble appeared to have been tidily piled to clear the roads. The countryside looked clean, green, and inviting. In harbors along the coast there were some land based mockups of battle ships obviously designed to deceiv Our course took us over Yokoham As we flew over Tokyo Bay we sighted ships of the U.S. fleet, L Upper. Iwo Jima, Mt. Suribachi shortly after dawn, September 19, 1945. Middl Iwo Jima receding, on the way to Japan. Lower. Landfall, Japan, 9:30 m., September 19, 1945. J'ollittie 38, October, 1965 Yokosuk Uppci-. Approachlitig Kiserazu Airfield. lliddlc. 'U.S. ships of the liine in Tokyo Bay seeni from TBMI oni the vay to Lowcr. Approachi ng N_okosuk H-iroshliima Medical Diary, 1945 L flags flving. At 10:15 m. wN-e touched down at Kiserazu Airfield. We had lhoped to arrive at Atsugi but were told that MacArthtur wotuld permit only Armny planes to laInd there and that Kiseraztu w-as the termiinal for NATS. \Ne were miiet by a YounIg Navy lieuteinant wN-ho helped Uts with arrangements to call GHQ in Tokyo. The effort was entirely in vain. \Ve knew that we were across the bay fromii Tokvo. The lieutenianit told us that the distance by land was about 90 miles and that he had no miiotor transportationi to get us ther \Ve could get to Tokyo by train btit the traiins wvere still under Japaniese conitrol aId were said to be crowded beyond capacity witlh the citizenry whose animilus towsard us we could not jtudg I had no stomaclh for takinig this plunge, wrhat with the initerrtupted sleel) of the niglht before anid the additionial burden of our luggag \Ve tlheni decided that ve would make anotlher attempt to call Army headquarters later and(l busied ourselves with inspecting Kiseraztu. Jack Rosenbauim said the lplace was aptly namiied. The field had been lbol)bed and remniiianits of Japanese lplalles were still scattere(l al)out in (lisorder. japanese gtll emiiplacellmenits and dtlgotits ha(l leen left exactly as tlhey wer At wxater's edge we saw l)eople gathering utssels peacefll}v fromii the foul-smiielling water. Oln the field there wsere tlhree hlite plalnes of the DC-3 type miiarked withlgreeln crosses. These wN-ere said to have flown the Japanese peace envoys. The ilnteriors wvere well fitted-out w-itl)lish seats, but in comiplete disarray. 'Many printed and p lhand-written (locumiiienits wvere scattered about in the aisles. I saved a fews as souivenirs. Tlheni retturnied to makce another atteml)t to ring Tokyo agailn without stuccess. After somiie coffee anid fturther talk with the sympathetic flight officer, le stiggested that he could have tus flown in TBM's to Xokostika Airfiekl onl the great islanid naval base off Yokohama now tuiider occupation 1y otur Navy anid 'Marines. This wotild at least bring us to the proper si(le of the bay and 60 miles closer to Tokyo. I hald no clear idea of what a TMAI was, but agreed wsith enthusiasm. These tturned out to l)e sin,gle-enginied torpedo bomibers (Martin) which, whlile not designed for tranisport duty, (1o very Nell in a pinch. Luggage is put into the bomb l)ay. One passeniger rides in the gunner's seat behind the pilot and the other in the seconid otiliner's blister below. Two planies were assigned. Col. LeRoy aiicl I rode in the first anid iMaj. Tarnower andl Sogt. Reed in the seconld. A party consisting of Capt. Rosenbatim an(l Sgt. Archamlbauilt w as left behind, to be dlelivere(l to Yokosuka as sooni as onie of the first plaines retturnied. The flight to Yokosuka occupied only a few miiiinuttes and wve w-ere soon retunited in a hutge hanigar that was a miiadlhotuse of activity. At flight conitrol, which Nas uniider commlnlalnd of Marine Aviation, mlet Marine MIajor Volume 38, October, 1965 White who said he didn't like the Army but would nevertheless fly us to Tachikawa airfield in TBM's if we didn't mind riding pick-a-back. He said that although MacArthur had closed Atsugi to the Navy, Tachikawa might still be open to "the enemy"-at least he had no orders to the contrary. We then quickly flung our luggage into the bomb bays with admonitions to the jovial pilots to keep them closed until we were at least over land. I rode behind the pilot in the gunner's seat and Capt. Rosenbaum rode in the blister below. I'he view was magnificent. The ride was rather a thrill since our pilot suggested that we might like to see the Japanese fleet closeup on the way. He swooped low over the ships, many of which appeared to be dummies with wooden superstructure and mocked-up guns. Others looked to be of the first-line fleet but seemed largely deserted. We touched down at about 3:15 p.m. and the pilots hastily roared off to Yokohama before too many explanations of their possibly illegal presence could be demanded. Tachikawa was apparently a secondary airport. Many of the hangars had been blasted but others were still quite intact. Innumerable of our C47 and C46 planes were all over the field. Our efforts to telephone the Chief Surgeon at Tokyo again were completely unsuccessful as the lines were still not in continuous working order. After explaining our mission we were very kindly assisted by Lieut. Flook and Sgt. Bowen. They assigned us a station wagon and we were on our way to Tokyo, only 20 miles away. Tachikawa itself showed very little damage except for what we were told was the Mitsubishi airplane factory, which had been badly smashed. The countryside on the way to the capital itself was lush and beautiful. The road had long straight stretches with very few crossings. Along the streets in the villages and even on the main road people can be seen dragging carts hugely piled with all sorts of goods and belongings including some apparently newly made boxes. Trade is obviously already beginning to reviv There are also many trucks with smoking, smelly, vertical wood burners mounted at the rear in substitution for the gasoline tank. Many are stalled since we are told that they require cooling, stoking, and cleaning at frequent intervals. Along the way are innumerable children who smile and give the V-for-victory sign. The grown women smile wanly; adult men are impassive but show no sign of hostility. As we entered the outskirts of Tokyo itself the horrible residues of fire and destruction were everywher Block after block had been flattened and only tall chimneys and a few concrete structures were standing. The streets had been cleared and rubble had been piled as neatly as possible out of the way of traffic. Only in the central portion of the city and the immediate vicinity of the L Emperor's Palace was there a concentration of relatively intact buildings. One of the most imposing of these was the headquarters of the U.S. Armed Forces. It was a many-columned marble structure, formerly a life insurance center called the Dai Ichi building. General MacArthur's five-star black limousine stood parked in front. Tall white-helmeted military police were on guard at the entranc Shortly before 5:00 p.m. we met the Surgeon, GHQ, Advanced, Colonel Bruce Webster, on leave from Cornell, who said that he had been expecting us, seemed not too surprised at the difficulties of communication with Tachikawa and was in every way cordial. At his suggestion we presented our orders at the NYK building. Our enlisted men were assigned to quarters in the "Finance Building," a huge hollow square of massive gray stone where they were registered at the Headquarters of the Second Battalion First Cavalry Division. I was assigned a room at the Dai Ichi Hotel, roughly a mile from headquarters. This was a massive white-brick cubical structure with a tall chimney from which issued quantities of black smoke suggesting warmth and comfort. It stood in the midst of a devastated area stark against the elevated railway tracks and we noted that trains were running, all overflowing with peopl I silently gave thanks that I had not chosen this method of entering Tokyo. Colonels and ranks to major were assigned to this hotel. I called Lieut. Kaiser at the Commandant's office and was able by special dispensation to obtain quarters with the rest of us for Capt. Rosenbaum. Elevators at the Dai Ichi were running perfectly and the atmosphere was that of a comfortable commercial hotel. The rooms were more than adequate, many supplied with private baths. Each had a very short and narrow bath tub lined by clean, small, rough yellow tiles. On each floor was an open office filled with affable but evidently poorly nourished young Japanese men eager to take laundry and perform all services. The first supper at the Dai Ichi could hardly be believed, after almost two years on Saipan. Food was actually served by charming Japanese ladies in colorful kimonos-the womenfolk of the men who would gladly have killed us little over a month befor just at the end of supper who should appear but Col. (Scotty) Oughterson in complete battle dress, looking healthy and happy to see us. He told us he had just come from Hiroshima and had seen that city as well as Nagasaki with members of the Manhattan District survey team that had been sent from Washington. They had made a preliminary survey of damage, residual radiation, and medical effects. Scotty's old friend, Stafford Warren, was with the group. He had been in charge of the medical depart97 Volume 38, October, 1965 orF[RFv hi~~giI I . Uppcr. The Dai Ichi Hotel in Tokyo, September 1945. \V:elcomiiig smoke belchies fronm the chiliiminey. Although imiainy of the surrounidiing buildinigs are rubble, this structure is intact. Lozwcr. View from room in the Dai Ichi Hotel, at dusk. On a clear evening tile silihouette of Fujiyama 80 miles away can be clearly seen. Hiroshlimsla Mledical Diary, 1945 L miient of the Manhattan District through the Nvar. \Vrarren s grotup would brief us at the earliest opportunity. After dinner had a long talk with Scotty. Now for the first time we heard what our own mission was to be: the definitive study of the casualties, the collection of old data and mnaterials, the determiniation of factors of distance and protection, and the preparation of a report on the medical effects of the atomic bomb). Bothi cities were to be investigated. I asked what help and equipment we would hav The reply was that we would be divided inlto two teams and that Col. Verne Mason would be senior miedical officer at Hiroshlimna and Col. Elbert DeCoursey at Nagasaki. MIy assignment would be at Hiroshimna and George LeRoy would be with DeCoursey. \V;e theni decided that Rosenbaumn would stay with me as he lhad throughout the war and that TarnowN-er w-ould be with LeRoy. A few more American miiedical officers were on the wvay, but mllost of our associates would be Japanese investigators aand physicians wlhose help Scotty had enlisted tlhrouglh the Jalpanese government. Dr. Tsuzuki would make the arrangemenits. He was Professor of Surgery at the Tokyo Imperial Unixversity and lhad beenl ani Admiral in the IMedical Corps of the Japanese Navy. Scotty said that Dr. Tsuzuki was also a dlirector of the medical divisioii of the Japaanese Researclh Council ancd had the best possible contacts throughout the country. In reply to mny question, Scotty said that despite the formnalities of "purging' of formier Japanese military personnel Dr. Tstuzuki was of suclh stature that he expected no difficulties. As for equipmiient, the answ-er was simple-there just was nonle and we would have to get it ourselves from Americaln hospitals and sllips and on loan from the Japanese institutions. \We were at once to mlake up a list of what would be needed for the study. Scotty then showed me a copy of his memorandutm to General Denit which outlined his plans as he first conceive(l themii. Tlhen to bed full of w-orries, but lulled by Neariness an(l the sound of whlIistling trainis, and for the first time in malny years the ruimble of a city. Colonel V"erne R. Mason had been one of the senior medical consultants in the Pacific theatr He w-as a graduate of Johlls Hopkins who had practiced in Hollywvood for many years aud had had a nutmber of famnous movie stars and other HollywoodI personalities amonig his patients. Colonel Elbert DeCoursey, M.C., anl outstaniding pathologist later to become a Major General and Director of the Armed Forces Institute of Pathology, was the only regular officer to be assigned to the group. He hiad been laboratory constultant in the Pacific theatr I hlad met both men on Saipan in the early T'ollittie 38, October, 1965 spring of 1945 and w as greatly pleased at the opportunity of being associated with them. * Septemiiber 21: To the Chief Surgeon's office at the Headquarters Buildiug early in the imorning where we miiet Captain Nolan of the Manhattan District, a tall and very affable young miian Nho gave us some preliminary details concerninig Hiroshimll MIost interesting was the fact that now at Tokyo convalescing from an illness was a 'Major Motohashi who knew the fate of troops that had been stationed at certain definite places in Hiroshimna at the timle of the explosion. Obviously he was a miian w ith wh-Ilomn to become acquainited. According to Captain Nolan, the Americans had been using Geiger counters and other detection equipmiient and had found no significant residual radiationi. Apparently almiiost all of the radioactive miiaterials were blown highl into the stratosphere and were replaced by air fromii the sides. However, it had rainied twice after the catastroph Most of the patients thlat had been withiln 1,000 yards had died. \Iany had multiple petechial hemorrhages and injury to the bowNel. While in the Surgeon's office, I was given a mimeographed report fromii one of the Japaniese commllllissionls that had been to Hiroshima to study the bomb effects. This report was entitled "Physiological Effects of Atomic Bombing of Hiroshimiia" and had been translated by G2 (Intelligence Service). The subscript described the report as "Full Translation of Handw-ritten Carbon-Copied 'Reports 1 and 2 by Squad Investigating Atomic Bombing of Hiroshima,' Issuing activity not stated, dated 1-2 Sept. 1945." This report w-as a systematic accounit nine pages long of patients treated in the Ujina Branch Hospital, which had been opened on August 25 wlheln 500 patienits were received. It classified patients as those who had suffered burns the and those wX-ho had not. The former, when inl zone of radiation injury, lhad a inmuclh worse prognosis than unburned patients. 'IThe latter had developed alopecia at the tentli day and then after August 20, fourteen days after the explosion, fever, hemorrhages, and diarrhe Leukopenia was also dlocumilenited. The clinical descriptions were by -Major -Motohashi. Surgical notes w-ere by Professor Tsuztuki and Ishikaw Tlhere w-as also a descriptioni of autopsied patients by Dr. AM. 'Miyake, listed as Assistant Instructor in Pathology at the Toky o Imperial University. Amoong the treatments listed w-as autotransfusion of 20 parts of blood and two parts of citrate injected intramituscularly into the thigh. The report also contained a map show-ing the center of the explosion and the location of a number of the patienits included in this study. The translation lhad been wN-ell dlone by laymnien but contailned a few bizarre sentences such as, "The red corptuscles 1lit-osliitnza Medic al Dia ry, 1915 L LIEBONVY slhowed sio-ns of multiple dyes'" whliclh, tranislated from Englisli inito mnedical terininolliogy. 1 presumed to ml-eain "polvchromiatophili" ILater informiiationi disclosed that this j apanese mle(lical report was the first version of a very muticli loniger report p)roduced by personniel of the Tok-yo First -Military Hospital and the Tokyo Imperial tlniversity, whicl was issned mnltclh later. The finial report comibined not only these early observations, w-hiclh were sutbsequently commnniitiicate(d to the Amiiericai mllembllgers of the joilnt Commlission, but also observations miiade (ltrin(g the operation of the Joint Commllllission in Hiroshlilml This final report first was issued in mimileograplhed formii and by several years after my retnrn was undergoing deteriorationi. One copy was tlherefore lamiiiniated for preservationl in the Yale i\Iedical LibrarY. Later that morniing in the Surgeon's office at Headquarters mlet Professor Tsuzuki, the Professor of Surgery at the Tokyo Imperial tUniversity whoml Scotty had mienitionied previously. He was a tall, impressive, digniified gentleman, obviously a commlilaniding presenc His use of English was perfect and it wN-as soonl revealed that he had studied oncology and radiation therapy at thle University of Pennsylvania in the 20's. Doctor Tsuzuki was fully al)prised of the purposes of our mllissionl and was in complete symupathy wvith the necessity of performinig a complete medical study. He stated that both superior mledical personnel and skilled students would be supplied as teaims to lhelp in the wsork. The University of Kyushu near Nagasaki was to pro'ide similar help to the group that was to be quartered ther I mentioned the need of equipment and materials. W\Ve agreed that a list must be made up at once and that w-e should meet the Japanese who would be working with us on the next morning to discuss what would be needed for the actual mission. Colonel Oughterson invited Professor Tsuzuki to supper with us that evening. In the meantime w e were to make an expedition to tap Amiierican sources for as mlluch of the necessary equipment and materials as we could obtain. Spent the rest of the mlorning at work with George LeRoy and Jack Rosenbatimi preparing an equipmlent list. In the early afternoon drove with Oughterson and LeRoy the thirty miles to Yokohama and the Eighth Army Headquarters where the office of the Eleventh Corps Surgeon was located. A broad highway connects Tokyo and Yokoham It is still rough and pock-marked with poorly repaired bomb craters. Traffic is heavy anid slow. Along the side are the inevitable hand-drawn carts. Numiierous of the lumbering wood-burning Japanese vehicles weave in and out and frequently become stalled. There is much impatient military traffic, chiefly of heavy trucks. What must have been numerous houses and factories and banks have been thoroughly pulverized and there is now a stark plain from which rise the chimneys of houses and factories. Often these are intact, suggesting that fire rather than blast had destroyed the buildings. Most grotesque are rusted bank vaults still standing stolidly on heavy foundations. Yokohama itself has also suffered much, but some of the major buildings are still standing. At the Surgeon's office every help was promised us. However, we were informed that medical supplies were extremely scarce and that they were not due to arrive for quite a long tim We then talked with Major Partridge to whom we supplied a complete list of the most important materials that were desired. He at once brought this over to the warehouse of the 29th Medical Depot Company for search. Then "home" to the Dai Ichi Hotel. Professor Tsuzuki arrived promptly at 6:00 for supper, which was had, after a little whiskey, in Colonel Oughterson's room. Colonel George LeRoy was ther At this time various gifts were received by Scotty including a wonderful cypress wood Daruma statu This represents a priest belonging to the sect of Zen whose chief occupation was thinking. I thought the gift appropriat The talk is largely on the cooperative nature of the venture and the types of studies to be undertaken. Doctor Tsuzuki said that there were still many patients in the hospitals representing the more serious cases of aplastic anemia from radiation injury and that these required detailed study. Japanese investigations were still proceeding. Many of these had been begun weeks previously. We would try to consolidate all of the information from these various groups as well as ourselves carry on a direct study of survivors, both in the hospitals and clinics. Doctor Tsuzuki promised to have prepared listings of all hospitals and investigating teams that had records and materials, and assured us that everything would be made available to us for a joint report. As for our own work, systematic records would have to be kept. We would need to design a standard record form which would include not only clinical and laboratory data but also information on factors in protection such as shielding, clothing, etc. We agreed that duplicate records would be kept and the forms prepared both in English and Japanes Doctors Oughterson and Tsuzuki promised to design a record form and submit it to us and others of the group before it was finally duplicated. For record keeping a map would also be needed, circled to indicate various distances from the hypocenter and also divided into sectors. These would assure that patients from all parts of the city were represented. A properly designed survey would rS Upper. Tokyo Imperial University in 1945. Lower. The Institute of Pathology at the Tokyo Imperial University. indicate whether the effects were symmetrically distributed. Doctor Tsuzuki said he could find some good maps and Scotty thought that our map service could make the overprints and reproduce as many copies as were required. Doctor Tsuzuki stated that the "Japanese young doctors" who were to work with us had already been selected and were on call. We agreed that we would meet with them at Tokyo University in the office of the Dean of the Medical School tomorrow morning at 9:30. The evening was a pleasant one, and I received the impression that we were dealing with a highly able and intelligent man of honor. * This impression was abundantly confirmed in all of our relationships subsequently. Professor Tsuzuki was also a man of spirit and was quietly l'oliiiiie 338, Oclober., 1965 Uppcr. Left to right: Dr. Ishii, who was of the greatest help in the pathology studies in Japian, with assistants Ebato and Shimamiini The latter performed much of the histological work in Hiroshim Lower. Members of the Joint Commission. Fronit row, Drs. Hatano, Murachi and Nakao; rear, Drs. Kato and Kakliehi. The late Dr. Murachi was a brillianlt biophysicist to whom is owed miluchi of the w-ork on the shieldinig studies. Hiroshlimfla Medical Diarv, 1945 V confident that his country would regain its stattns. One evening. mlvany eeks after we had arrived at Hiroshimila, in a lecture on burns attended by somle of the Americans and therefore given in English, he said: "Unfortunately my studies oni burns were interrupted by the end of the war, but my son will carry themii on." Twenty years later his sonl, Dr. Masakazu Tsuizutki was indeed studying cardiovascular surgery at the Tokyo University undeler Prof. Seiji Kimoto. Septeniber 22, 1945: On this, a Satturdlay mlorning, we miiet for the first time the groupl) of lapaniese physicians andl investigators who had been sumiimoned by Professor Tsuzuiki, the meni to assist tus in the atomlic bombl) investigationi. I was amlazedl that they couldl be gathered withil the brief span of timle since our (lisctussioln of the previous evening. It left little dooubt regarding his power an(l influenc The scene in the large conference rooml at the University was unlforgettabl At the large T-shaped table coverel with a dark-green cloth were places for the senior Americans and Japanies Against the back of the oak-paneled chamber, rigid and expressionless, almost immobile, there sat in rows on straight-backed chairs the flow-er of the younger mledical talent in Japan. Tea was served. Introdcuctionls were formal, andl somewhat strained. Few of the Japaniese could speak English w\ith the polished accuracy anid fluency of Doctor Tsuztuki ancd somiie knew only a fexv words, but could commuiinicate well x-ith those of us who spoke German or French. Amiiong the mlost imlpressive of the senior mlen was Professor Sassa, the head of one of the university medical (lepartments, a mlanl well-trained in physiology who had worked in London with Starling, and Dean Tamiya of the Medical School, a bacteriologist. Imlpressive also were Doctor Yoshikawa, a chemiiist and Professor -Miyake who had just been miade Professor of Pathology, a towering, graceful, man with a grave, aristocratic manner whose second language vas French. Colonel Oughterson made a little speech in which he emuphasized that the war was over, and that in any event science was nonipolitical. He sai(l that physicians and inivestigators ha(l a loyalty to science, and that the needs of mlankind wotuld be wvell-served by a thorough and informe(d study of radiation effects; that the study could obviously not be performed by us without help, not only because of the language barrier, but because we needed the highly skilled medical scientists for which Japan was famous. Finally he stressed that the work would be truly a joint effort, that we would expect the full cooperation of the Japanese in obtaining complete infornmation, but that it would never be our intent to rob them Tloltittie 38, October, 1965 RESTRICTED GENERAL HEAD;ARTERS UNITED STATES ARMY FORCES, PACIFIC 119 AGPD-A Advance Eohelon AG 210.455 AGPD APO 500 22'Sop 1945 SUBJECT: TO Order. Off & EM concerned, orgns indicated. EM now on DS Advance Ech, this hq, w rr Fol-named off Hiroshima, Nagasr,?k and such eth. r .-.;aces adjaoont thereto as may be necessary on TI;Y for the p.::ue ofcrrying out instructions. Off & 'ii are aut.h te between Hiroshima and Nagasaki at such times as may be rnec6ncary in the acoomplishment of their mission. Upon cr.mpl .L. ret tiis st Tvl by A mil acft is dir for accomplishment o:C an emarg war mission. Govt mtr and water transportation au'-. Personal baggage not to exceed 50 pcunde auth each of,i'c Ei.I whi.l traveling by air, Provisions of par 26, AR 35-4820, 19 Apr 45 apply. Per diem auth each EMI while arayvling by .Lcft in accordance with Sea I, AR 35-4810, 19 Apr 45, Use o- Tzvt qc and messing faoilities enroute by EL is mandatory. G.C * P'452- 0O2 A 212/60425. -< 046'zr=9 MC Z.9th cGen Hospital, APO 244 'JLT COL AVERILL 04l1336 MC 374 th Gen Hospital, APO 1O5 LT COL GECRGE V. LeROY 0482b55 M Gen Hospital, APO 247 MAJOR HERMAN TARNOWER 04031X' i.; 0.0 ttL CGen Hospital, APO 2" 39t>t ICAPT JACK D. ROSENBAUM Gea Hospital, APO 244 310O)'j8,q%' / T Sgt John P. Reed Teo 3 John J. Arclaambault 7.1- P5220 30 th CGen Hospital, liPO 244 By command of General MacARTHUR: MEajor, G.D. Asst IAdjutant General W. BOLL DISTRIBUTION :Off & EM concerned (5 eal Chief Surgeon, Adv Ech (1) 00 39th Gen Hospital, APO 244 (1) CO 304th Gen Hospital, hPO 1058 (1) Fisoal off, AFWESPAC, APO 707 (1) Dir LR Div, AGO (1) Dir Contl Br (2) AG GH4 (8) AG Rear !ch (1) AG-Records (7) AG-PE (1) Hq Cordt, Adv Ech (1) RESTRICTED Orders to carry out imiissionI at Hiroshima and Nagasaki. L of the fruits of their thought and work in publication. Dr. Tsuzuki translated these remarks as they were spoken. He then replied in like spirit in English and Japanese and gave assurance that the best men would be available, that they would work and help unstintingly and that they would withhold nothing-in accordance with the expressed wishes of the Emperor. He expressed the hope also that this effort would be a first step in restoring to normalcy scientific relationships between our nations. As we later mingled with our colleagues-to-be they seemed very intelligent, alert, active, and eager to begin. If there were fears and reservations, these were not difficult to understand, and were in any event well-hidden by the quiet formality and reserve of the meeting. We then went to the Pathology Department which had a large building of its own. Here cups of Japanese tea were again served. This was, although unsweetened, sweetish with medicinal overtones, of a pale yellowgreen color, altogether warming and cheering. It definitely helped to introduce and smooth conversation. At this time the plans for dividing available young men into Hiroshima and Nagasaki groups for the pathological aspects of the study were discussed and a tentative arrangement was arrived at. We discussed what equipment would be needed. Professor Miyake also told us of what pathological materials had already been brought to Tokyo and said that he would give full cooperation in their further study. Immediately after luncheon Colonel LeRoy and I made another arduous trip on the crowded road through the devastated landscape to Yokohama where we found, much to our terrible dismay, that almost none of the equipment or materials that we had requested through Major Partridge were available, except for some nonspecialized bulk items in classes 7 and 9. We made a list of these for requisitioning by Colonel Webster. Then, by accident, we heard that an abandoned Japanese laboratory was housed in the very building where Lieutenant General Eichelberger had his headquarters, and that there was another several houses away on the same street. We went at once to the building and found a remarkable picture of wanton destruction. The laboratory had apparently been used for analyzing fish meal and similar materials and contained large quantities of bottled chemicals. Many of the labels were in Japanese and unintelligible to us. An abundance of glassware was present, which was of enormous help to our spirits. Then home after an extremely rough ride over the craterpocked roads. Stopped in Colonel Webster's office and obtained from him a requisition for the items in stock at the 29th Depot. In the evening had a hot bath, a good supper, and then made a search for Sgts. Reed and Archambault. However, neither was to be found. I left f'oltitiie 38, October, 1965 a note for themii informiinig themii of progress. The w-alk back across the long dark alleys was ghostly w-ith the skeletal hulks of buildings lining darkened streets and hundreds of burned-out cars lying about in confusion. Founld Col. Oughtersoin and told him of our discouragemiient in locating equipment. I showed him the long list of things that we required wlhiclh wtere listed as nonavailable at the medlical supply depot. There were only a few glilmmiiiers of hope in that according to 'Major Partridge mlaterials vere dailv comiiing off the ships at Yokoham LeRoy and I were plalnning to retuirn there tomorrow and would( check further on this poilnt. Scotty adlmitted that he was suprised that medical material w-as in suclh short supply, although after all, Ne had been in the country in force for not more thani two weeks. He had alreadly incquired about equipmiient at the 42ndI General Hospital which had opened a short timle ago in Tokyo. They couldl spare nothinig and were able only to beg a few items themiiselves fromii the hospital ship "AMarigold" w-hich was in the are He w-ould( obtain a list of other hospitals and their locations fronm the Surgeon's office anid would senid various members of our group to forag He sail also that we coul( always be sent what we neededI after we aot (lown to our laboratories anid that hospitals w-ould undoubtedly be opening up in southern Honshu near us. MAly reply w-as that it w-ould be muclh better to have everything in hand so that we could start work at once on what would probably be a dNindling patient populationi. One bright spot after a (lishearteninig day was the arrival of Colonels DeCoursey and Mason wsho were bubbling with enthusiasmii. They said that they had been worried about us since several military planles hadl been lost in the typhoon- of 17-19 September. \We assure(l theml that wve wvere in the clear smiling sunshine to the sotutlh and east. DeCoursey was reassuring about our supply troubles, saying that he knew that plenty of everything was on the way. Septemilbcr 23: Set out again for Yokohamiia bright ancd early by truck with George LeRoy. W\Ve first went to the warehouse with our official requisition to obtain the supplies that were said to be in stock. These included: 50 gallons of DDT; 10 hand sprayers; 48 Freon aerosol insecticide bombs; 24 mosquito bed nets; 10,000 multivitamin capsules; a milass of housekeeping supplies such as soap, Brillo, etc. We had every intention of keeping well w-hile in Japan. \Ve had no clear idea of the circumstances under which we might be living and therefore determined to come well-prepared. WNe were concerned about Japanese type B encephalitis, but acttually found mosquitoes as well as flies Hiroshimtia Medical Diary, 1945 W LIF.BOW A -A Si ; rco m r drc Scribblings listing possible sources of materiel, with directions. T'oluttie 38, October, 1965 to be scarce hy the timle N-e arrived in Hiroshimll The multivitamin pills were to be used as "treatment" for patients in the clinics, since we had been advised by our Japanese colleagues that custom required the physician to give every patient some type of treatlmient after examining him. Actually the fee is considered paymlent for the treatment, not for the diagnosis. The vitamin pills w-ere good-looking, would be entirely acceptable to the patients, and could certainly do them no harm-i. WVe found, however, that they caused us one problem since somiie patients thought they Nere endowed with miiagical properties anid therefore camiie to the clinics mlore than once, thereby introducing a slight bias into our survey procedtures. * Theni on advice of Maj. Partridge to the warehouse of the 268th Qtiartermiiaster Battalion w-hich w-as located after a little difficulty. No officers ill authority w-ere present. Crates of supplies were continually arriving by truck fromii the docks. \We founld a tractable sergeant who w-as directilng the work. We told himii of our mllissionl and of our desperate need. He said that mllost of the crates contained mixed goods and that the only way to tell what w as in themii w-as to read the manifests. MIost of the material destined for the hospital conisisted of sponiges, urinals, and the lik Somiie of the crates, however, amiiong other things, containied some laboratory supplies. Those that w-e designated wx-ere cheerfully opened on the spot and the required materials identified and laid asid The procedure w-as somiiewhat irregular, but everything w as considered expendable and our sergeant seemiied not to have a wN-orry in the Norld as long as we signed for what wN-e took. We told the sergeant to keep a sharp eve out for mlicroscopes, centrifuges, and other miiajor itemiis and we would be back in a few days. We wNere graciously invited to lunch at the wsarehouse-a lunich which conisisted of a large square of Nell-prepared "luncheon meat" in a blanket of scrambled eggs. This was a illuch tastier meal thani the "Spain" that had been our lot in many of our island experiences previously. Then off to raid the laboratory that we had inspected on the previous day after obtaining a large quantity of packing miiaterial fromii the quartermlaster. Things were then rapidly loaded onto a truck wsith the aid of our very cooperative driver. A Nonderful spirit of helpfulness Nas displayed by all with wlhomii w-e cainie in contact and there was practically no red tap A disturbing ex)erience wx-as the hunit for a balance that wN-e had noted on the preceding day in the headquarters buildinig. After a thorough search, iwhere it had been moved since the this Nas discovered in anotlher room preceding (lay. \Ve considered ours to be the prior claimii and in the absence Hiroshima illedical Diariv, 1915 LIEBONV of dissension made off with it. Then a long, cold, and bumapy ride back to Tokyo and on to the University, which we found after much difficulty in the dark. Here, in the Pathology Department, wve dumped all of the miiaterial that wse had acquired. There wN-as considerable excitement at our haul. The Japanese wvere especially interested in the DDT and the aerosol cans. After a hot bath, an additional wsarminig wsas had over some Canadian Club and everybody wA-as in high fettl Later there Nas a meeting in Col. Oughlterson's room all hands present including Capt. Nolan. There was niltclh winid and little turning of the mill was accomplished until Ne got dow-n to the serious business of discussing details of the record formls N-hiclh Dr. Oughterson had roughed out. His considerable experience with abbreviated records in the Connecticut Tumor Registry, of which he w-as one of the founders, had stood us in good stead. It Nas well-designed and occupied only two sides of a single sheet. Names were to be recorded in botlh Japanese and English. All locations were to be by zone number of the mllaps that had been designated and were in preparation. Some ambiguities were clarified after argumnent. \Ve agreed finally that in the short formii certain rules of thuml)b wrould have to be followed; for example, dates of onset and cessation of sigIns anid symptoms w-ould have to be inserted wherever possibl The fornm stressed radiation injury and factors in protection. WTe realized that there miglht be some difficulty in distinguishinig flash burns fromn flamne burns. Presumably Dr. Tsuzuki's group N-as making a simlilar critiqu Scotty also reported that the miaps were to be ready in a day or twso and presented us witlh the list that wTe needed of hospitals in the are \Ve agreed with enthusiasmi- to mlake excursions to these in search of additional supplies. Since I w-as plainining another trip to Yokohamiia in a few days, I picked the M\1arine General Hospital at the Yokosuka Naval base and the 161st Station Hospital. * \V;'hein these records wsere designed, we did not sufficiently realize the diffictllties of identifying persons by their recorded names in Japanes Siince alternatives are available, transcription is especially difficult. We erred also in Inot recording the original home address of the persons as an additional means of identification. As the records were being analyzed, some imiisunderstandings came to light with respect to "epilation," since in soImie instances no distinction was made between epilation resulting from radiation effect and that resulting from burns. This in large part w as more a difficulty of the examining physician in comImIunicating with the patients than it was a fault in the design of the records. Similar problems f'olume 38, October, 1965 .sTCV>- B2.B 27:.I'- -- ;2'; C.' iae T oc ation. I. en in r-'cd ~,ge "ct . by c B3r.b u rn 2'uat`:on or rank nua 2r) nzb 3? aSt RaJ, aton ICIyfnr Debris rallinC -7alls etc. ,. ?Dri7ar, Injury b3-p 2ec_rndary Injur,, h: -DS,t C.n: Burning, Buildinf,g 5. ro,-ct4on ,f,t &( tI a kC-) ldnE, t.ri Ir i;l.w,rr b. lndc'ors: ('utdoors: I; Br- cl; h ab .r _o2cro ,e .-aneesa -auiliing 2-ve-_d in ^,TjO''l d. Clothing ar 1ILph, 2nc; 3al.iilc ;.all trench"I jehind trce,post etc. r-l Any other nr-'tccti-n 'ere oth,-r. nreso ntBurns: re t Dogroc-l.t 3rd ea,rpccnt .,art (,adLat-or.n ffects: Sy. i_u rt OcanJr.ds . Bic inf .--.d '; ota ca 2! LOO ?(s 2r .orc rrhaee Cr_______________ ~ ~ ~ ~~~~~~~~~~~g a_<,~ ~ ~ ~ ~.-. SPEcs 4ilaticrn 9"* si"' o:tea YI" jg ~~ ~~~~~~~~~~~ -r'bros: _Y B.ard Dark'?.+cd Brown. :ed CitoitaliaE / .~b'3ruutc ir a- ,~ ~ ~ ~ ~ Chortimst oto r L cWI "hIr indicotocd mal,e sno-)cial ncr.tion. of 31hiold:inj from ga-.T-'a rays: 3last ffacts: *i Le ee 4e,~~ Front face of record form used by joint Commission. \Vritten in are original notes used as basis for discussion wxith Japaniese miembers. IDSNI BAUDMA 3AIGAI 7&A JIK JUSF!I? TSKIHI ath1zI TT'TAT, HO n S7I 3!rJKTGYf "TAra KATKIff 'AING'.!SiA &SHO(ATEM) KO:OqW BAsKUGEKI TOJI NO IDOKCTRO C TZU NI NTCW TAIBATGO 2. SAIGAIIN. IGHIJISEI; P t.C31 A, N&.J'JA,FF- PIJ SI; RSMi. GA r ici. B'&IJTrAT b. sVKj ,T iI ,I, 'T .DI '.r;'I :0 .-IGI ,US1IRO HIIARI) OIKUNAlt(NA'Nt!r D;T' NO N.RE:'J)XON:RIT1 E2EtIL 'V&T'.'. K:-G MOKUZ3 CIOUSAn d. OKUGAI:AsITHO,.T.:. V1. K;,G?I. '.K'(xo -BAKUPJ.WO 8-iC.' RIT0,vTO,OIUZ,RBGA SO NO T) f.',Bt.O:-CTTIJ5 g. W2.Ti CtIli'.,OI,T.-,UuPI,riDi.U2TTO,Ki .) 1WNO(SRuTRUI,TAsIT, IRO) h. BONOTA mEl I(B6S!II ,TTSrU V.KO,TfMXtRO) 4. KTNPM T'.NIN NO UWI SONO HIGI.J I NI"I S. N3SSH'sThIDO 6. HN 7. GUSTO.ST1ITI TlIDO TOJI NO MNOM 9. SONO GO NO .B"0I J&AI,B KI&;.U(TOS-FI OYO?I BTEI) S0IOflI,wI,TST SCo lo ICEIX. T3UTCUM QYOPI SUIX.&., b. nlT&I .TSa o.l d. E: Y IK MO GU1I f. HI.!'LITAIM h. KMIR3N g. i. SN0Tr,b >ERI3 J, SHO.'CUS!I 1. M ;wTjL'rU8r YI'SU.: BUI k. .Y'l'Au SA:RUI(T'N, N, T3IlO(fI.'3TO) D'l) HIMRt I AXl;I o II"=MJI I'IV.;', m. S SUzm, T=S-PEX,'3T U NO, SONO -O KUI.IEN IGIN3N.Er!GMTSIT. Japanese record form used by Joint Commission. Volume 38, Octobei-, 1965 were encountered with reference to hemorrhages, since some of these were traumatic or associated with disease unrelated to radiation. Human frailties involved in filling out questionnaires and records were revealed when some 35 instances were discovered of what were thought to be duplications in over 6,000 cases. The congruence of recorded facts, even as to dress, was far from perfect. Yet in general most of the major facts, although recorded by different observers, seemed to have been accurately stated and furnished a basis for confidenc * It was already considerably into the next day when the meeting broke up. In my room, I opened an "acipak," the soldiers' comforter, and found some cigarettes, fine for small gifts and tipping, some hard chocolate, which was the object of my hungry search, and some shaving equipment. September 24: On the way out to the University, went in search of our sergeants, since we wanted their help in packing our plunder. Found them and learned that they had been visiting the Nikko shrine some 90 miles away! They were among the first Americans to be there since the war. During the morning, major decisions on the disposition of the Japanese physicians were mad Drs. Tsuzuki and Nakao and our senior people considered the list of 25 whom we had met several days before in terms of specialties so that we would have a reasonably good distribution of talent for the two cities. On advice of the Japanese, who thought the load of work would be greater in Hiroshima and said that Nagasaki had a well-established group of Japanese physicians at the Navy Hospital, 14 were tentatively assigned to Hiroshima and 11 to Nagasaki. I marked the names of those assigned to Hiroshima with an "H" on my list. Dr. Nakao also wanted to be part of the Hiroshima group since he had been studying a collection of bone-marrow slides and peripheral blood from patients there collected by the team from the Tokyo First Military Hospital and Medical School and the Tokyo Imperial University. The Hiroshima group also was to include Dr. Murachi, a biophysicist who had done some of the earliest measurements of residual radiation and other physical effects. * Dr. Kiku Nakao was a charming young Assistant Professor in Dr. Sassa's clinic who proved to be a brilliant hematologist. He made numerous major contributions to the work and to our happy collaboration during our stay in Japan. After the war he held an investigatorship at the Argonne National Laboratory in Chicago and spent a pleasant few days with us in New Haven. Later he became Professor of Medicine at the Tokyo National University. o. so 6. 7. i. Pe oubls ur. hsuM r. TIhii Dr. .aftra W Lt. KMabo. a Dr KitatoH Dr. TlUImd Dr. Isk&loto or . w.r' Pelo1qXtt fttholog PSthltW7 flobt Xintmo LeIns,d SpLvehaeis Intoal odlolnj, 'ebbVU1 In trnal od eIns# CllnlOal twlog Intornal e4d1*1ne, 10. 11. U. Internal -odLe1no, Me Lt. Thm.lo, Dr. YY a 1. J r .WPtDtl_4 Tor&;w M3 rm 1 1 11. 1W. Jws 16. Dr. Jaj1tanl '1 D6. %i. 19. U. 0taae NIla I*. Usma1 Dr. Oqsh N -r. _ 33. Di. u_diwo 54. Dr. 0h1 35. Dr. ti 20. 30. dltiatrLes Ot.uh_ _wyg1 Sotwu Drtdlow ebtetrl 9Ml , X: ~ Xdg First list of "Japanese younig doctors" supplied to Joiint Comillissioni. Those designated by H were assigined to Hiroshim A few chainges were madle later. The remainder of the morniing was spent in identifying materials that Nere still needed for our work with our Japanese colleagues. They were quite willing to designate centrifuges, ovens, staining jars, and other glassware, chemical solutions and stains fronm the various laboratories of the University. Also suggested that each unit take along some of the useful reference books. These were gathered together from various personal libraries. Many are pirated U.S. texts reproduced photographically. There wvere both volumes of Peters and Van Slyk Made a mental note to bring a pirated edition back to Jack Peters. Especially admired is the German hematology by Rohr. This wvill be an interesting companion to my WNlintrobe which I had carried in my luggage from Saipan. These were gathered together and the remainder of the morning was spent in packing, using the materials that we had brought up from Yokoham Volume 3S, October, I965 I1-omiie for luniclh alndI then returnied to the University in the afternloonl to continuiie the work. For the first timiie found timle to go oIn a shoppilng tour. \We had passed what looke(1 like a print shop on our trips to the University. I went on foot and founld some strikinig prints in the Sakai slhol). Thlere were somue fine o0( l)rints on rice paper amiiong dozens that were availclabl Selected some aminiig Utamaros and others. Late in the evening Scotty appeared anid anniiouniced that he had arrainged for airp)lanie tralnsportation for equipmiienit anid personniel, incluidinig the Japanies Aln estimiiate of the weight of the miaterials was to be miiade and the personnel were to be specified. The necessary number of planes would le assigine(d as sooni as wse had the informiationi. WVe are apparently fortunlate that the Air Force has very little to do at this juncture with its hluge nutmber of mleni and ships and they promise to cooperate fully wN-ithi Us. SCptciiub)cr 25: \Valked to the Surgeoni's office after breakfast but founld no furtlher crvstallization of plans. \Was delighted to find that the mlaps were ready. The Hiroshimla map was Japanese and had all of the important features mlarked both in Japaniese and in the Latin alphabet. The circles around the hVpocenter were made at intervals corresponding to 500 meters for the first 3,000 and at 1,000 for two more rings beyond. These w-ere intercepted by radii drawni fromi the hvpocenter. In this way 25 zones were delineated. Thousanids of the record forms had also been mimileograplhed anld were brought w\ith the miaps to the University where the packing was beinig coml)leted. Since the preceding afternoon and during the morning various little prizes were brought in by members of the team Nho had visited the various hospitals. Tlhese, together w ith the Japanese contribtution, gave us the rtidimiients of tw o laboratories and equipped us also for a little clinical work. Practically all of the major items of laboratory equipmeint were from the Tokyo University. Packing of what was there Nas completed toward the end of the morning. Spirits had clearly risen when the work was don After 'unch again took the opportunity wvith Jack Rosenbaum of explorinig Tokyo on foot. The city was very crowded and our soldiers were everywher WValked much of the length of the Ginza in the central district. Althouglh there had been bomb damage, many of the buildings seemed intact and some were already under repair. Some of the rubble in the central district was being cleared by our engineers with bulldozers and other heavy equipml-ent. Great crowds were standing by, gazing in amazemient at monsters such as they had never seen. Our men seemed to be enjoying being the center of attention and gave some virtuoso performances. Shops along the Ginza were filled with all sorts of goods. WVe Hiroshimta Medical Diary, 1945 Map of Hiroshima supplied by Prof. Tsuzuki with overprinit by U.S. Army map service to designate ring zones and sectors. This was used by the Joint Commission for the survey work. The darker rings are drawn at 1,COO-meter intervals about the hypocenter. The military encampmetnt is the pale area wvithin the ininer most ring. III Volume 38, October, 1965 fotundl the Mikimoto jewelry store was groaning with the l)eautiful artificial pearls. The mlost interesting sight however were the carts which lined the curbs. These vere ftull of all sorts of interesting mass-produced cheap trinkets stuch as cigarette lighters, but also produce and a few handcrafted things. Bookstores were full of recently printed magazines, pamphlets, and books. They Nere crowded and the crowds included some curious G.I.'s browsing. The better stores are particularly jammed with soldiers and Japanese minigled in friendly confusion. We found a large department store, conmparable to ouir best, Takashimaya, where I bought a lovely painted silk screen and lacquier plat Oin returninlg to the Dai Ichi was told that a Navy commilainder had flown a seaplane to Hiroshimll He landed in the harbor, which was hazardotus since it was still mined, but was able to taxi in and explore the city. He reported that there was extensive damiiage fromii the typhoon of Septemiiber 17 andl 18 and that the airfield was flooded and would make landing there impossible for somiie timii Also rail traffic was blocked by landslides. On this discouraging note went to bed. Septemiiber 26: Called first at the Surgeon's office to see about developments but found nothing exciting. There met Lieut. Col. James Frenclh, a pathologist from Dr. \Weller's Department at Ann Arbor. He had been given the assignment of miiaking a survey of Japanese laboratories and had done considerable traveling about the country. He joined Ime in the drive to Yokohama in the truck which I had ordered in order to colntinue the next stage of the foraging expe(litionl. and partictularly to check oIn our good sergeant anil any equipmieint that he might have sequesteredI for tus. Oni the way down, French told mle about sonme priests who hadl been in Hiroshimlla and who were in the Catholic Hospital in Tokyo. Their condition was said to be poor. Thouglht it wsould be interesting to visit themii if timle alloNed, anid obtained directions to the hospital froml Frelnclh. I liote(d that a strong centrifugal movenment of our troops appearecl to be taking place from Yokohamiia and that even the Quartermiiaster I)epot was about to be miioved. No really tuseful laboratory itemiis had turnie(d up in the nlew consignmenits. I did, hoNever, pick up 45 cases of Ten-inl-I rations and 13 cases of K field rations. This was authlorize(d by MIajor Prentice oni the basis of "30 miien for 20 days." \Ve w-ouldl at least have a good foodI supply to start with. Also, to my pleasure, foundel Ninter fieldl clothinlg available and bouglht a new pair of field shoes and a fine Eisenhower jacket whiclh I had not seen before in the Pacific. Drove oni to the Marine General Hospital at the Yokosuka Base but came away empty-han(le(l, despite a pleasant receptioni. The 161st Station Hospital, Hiroshlimna Medical Diary, 1945 however, was able to spare us syringes and needles, and to nmy surprise, an autopsy kit. On the way back in the open cab of the truck, I was rather chilled and in the afternoon took a miiuch-needed nap. \VNTas awakened by Col. Oughterson in mid-afternoon who said that the Nagasaki group was to leave tomorrow. I was charged with the responsibility of attending to the loading to take place at the University in the morning. \VNas also inforulle(d that during Prof. Tsuzuki's absence, Prof. Sassa w ould be the cliief liaison officer with the Japanese group, and that Dr. Nakao of his departImieint would be his aid Septemnber 27: At a very early hotur went directly to the University. The trucks lumbered up shortly thereafter. The equipnment which had been designated for Nagasaki was checked off as it was loaded into the trucks. Iilnuilnerable Japanese physicians and younger students, together with their anxiotus fanlilies, were Illilling about. To add to the difficulty, Sgt. Archanlbault, who wvas to go to the airport with the Japanese and to coiltilue on to Nagasaki, was not to be found for some tim Finally lie arrived. He ha(i been delayed in what he called a "bread line" in the Finance Building in Iiis efforts to check out and could not get away. All of the personnel was finally gotten aboard the trucks with firm instructions froill the senior meillmbers of their party inot to move until the roll wvas called. This was finially acilieved and the caravan was safely off. Checked in at lheadquarters and received nothing but discouraging words on prospects for getting the Hiroshima section off and away. Then returlled to the Ulniversity to find Dr. Ishii, the pathologist sclieduled to go Nith us to Hiroshim He appeared tired, sad-faced, anld unislilaveni and was dressed in the remnants of a thinl niilitary uniforill alcd sandals. We discussed ill halting Germian and Englishl further plans for tile pathology study. Conversation was especially difficult because of the japainese custonm of replying affirmatively to all questions even thougih the sense of the answer is intended to be negative, for examllple "Yes,-it is inot so." He told, ille, to nmy great pleasure, that he liad some protocols alid iliaterials already in liand. I replied that I would look forw ard to reviewN-ing the illaterials witi himil and to translatilig the protocols. I expressed especially 1lly desire to liave a cotIllpeteIltly staffed aild equipped histology laboratory so that we could cut and staiin any old blocks, and prepare the new cases as they becaille available at Hirosllilll After a diffictult anld lengthy disctlssionl, I was not quite certain that I hlad been fully understood, alld I was especially disturbed by the fact that hle nevrer sIlliled, inor did lie have the affability of ilmost of Ihis colleagues. Voluitte 38, October, 1965 Dear Mr. . I am very sorry tu say,but there is one matter I want to ;ask you. I have lost my posts, a- y;u know,Institute of Jap.Cancer :Reserch was burnt ,St.Lukes Hospital,where I was working as a director of laboratory,is now used by Allied Force,so I can get incomes from nowher I am now looking for my jab as a doctor everyday,but its rather difficult to find it soon. ',:y father ana my wife of my bosom were died at the bigining of this year und my two young children are left behind,so I must support them Unfortunately I have suffered from bombdamage two times,all my havings were burnt out and now I aa confronted by' crisis if everydayliving under such a terrible inflation nowadays. is there any way to find suitable workplace such as L'ccupatian- armyhospital,ir if Anot,usual orffice: I am indifferent about the sort ;f works, but I hope Job of laboratorywork at hospital an technician or translation. ould you call at every likely place,if you please,though my vocabulary is very poor,and I am afraid I could not be employede I want 500 or 6C0 Yen monthly if possibl Yours Sincerely Letter from Doctor Zeniichiro Ishii, delivered December 15, 1945, after returninlg to Tokyo from his service with the Joint Commission at Hiroshima, which explains his situation. Hiroshima MlIedical Diary, 1915 LIEBOXV The reason for Dr. Ishii's apparent reluictance to becomle friendly with Amlericanis became evident dutrinig the next few days w-henl I gingerly iniquire(l of others about his apparen1t depression. The best answ-er camlle imutich later froml himllself in a letter that he wrote in December after we lhad completed the Nork in Hiroshlilmla and retturned to Tokyo. Despite his personal tragedy, Dr. Ishii gradually became a firml friend, and miy later experienices x-ith himi in traveling and working together remlain amlonig the mlost cherisedI memelories of my assignment in Japan. Later, in conversatioin w-ith Dr. Nakao in the hematology laboratory, there w as nmuch miiore rapport alnd a preliminary review of well-staine(d and well-interpreted henmatology slides w as enjoyed. This was the first contact wvith actuial material fromii patients at Hiroshima and I foundl it most exciting. The mlarrow s, mostly obtained fronm patienits three to fouir weeks after the bombing, shoNwed essenitially the findings of aplastic anemiii \Ve discussed the interpretationi of certain cells and( agreed that they w ere atypical derivatives of reticuloendothelial cells resenmbling plasmiia cells and that the designation "plasmacytoid" w-as appropriat Dr. Nakao promlised to organize this material and to make the clinical records availabl This would keep us well-occupied and wN-ould also represent an actual start on the work of transcription onto the Joint Comnmission forms that were now ready. In the early afternoon back to the hotel. Was asked to translate a remarkable document at the requiest of Col. Stafford \Varren. This was an eye-witness account of the explosion and of the city and people in the days immediately following, written in German by a Father Siemes wlho had been a Jesuit priest living in the hills of Nagatstuka, some three miles from1 Hiroshim It told in detail of the rescue of four of his brethren who had been injure(d in the city during the explosion. I read the story spellbound and horrified. By late afternoon mlost of the translating had been don It was (lictated to a remarkably skillful sergeant of General Farrell's Manhattan D)istrict Group wlho typed the tranislationi directly as it was spoken. * This stirring, beautifully ad(I modlestly written description records Father Siemes' impressionis as he w-itnessed the tragedy from his room1 at the Novitiate of the Society of Jesus. This group of Jesuits had been evacuated to Nagatsuka from Tokyo some six months previously. It is a detailed account of the flight of survivors from the city and of the involvemlent of the Volume 38, Octobet-, 1965 priests, onie of Nhomll lhad sttudied inwedicinie, in the work of rescu Father Superior LaSalle and three other brothers had been in the central miiission and parish house in the city at the miiomenit of the explosion. They were brought to Asano Park along with miianiy others. Twvo of the brothers had only miiinor injuries but were comiipletely exlhausted. One of these was Father Kleinsorge, w-ho lhad been miientioned by Col. Frenclh, and wholl I met later in Tokyo. Father Kleinsorge was lnot able to walk and was left behinld to be brotught out oIn the following day. The priests miinisteredl to imiany other people anid brought 50 of themii to the monastery for car As Father Siemiies put it: "Ouir wN-ork Nas, in the eyes of the people, a greater boost for Christianity thani all otur efforts dturinig the preceding long years." Onie of the mllost fascitnating aspects of this accounlit is the philosoplhical conisiderationi of all warfare, anid specifically of the tuse of this wveapon: "It seemiis logical to uis that lhe ho stupports total war in principle canniiot complain of a wsar against civilians." Remllarkable also is hiis statemiienit of the attittude of the p)eople: "None of uts in those days lheard a single outburst again-st the Amiiericanis on the part of the Japanese, nior was there any} evidence of a v-enigeftul spirit. Tlle japanlese suiffered this terrible blow as plart of the forttunies of war somethin-g to be borne without coml)laint." Fatlher Siemiies' accotunit became a imiajor soturce of material for J]olhn Hersey's imiasterftul ]Hiroshlimua, anid it wvas pnlulished in ftll, ini my impromptu tranislatiol, in Tlle Satiorday Revicz several years later. This I fear dlid less thani ftull jtustice to the style, excitemiient, anid(I literary merit of the orliginal Germani. * A delightful talk and drinik before supper in the chambers of Col. Oughltersoni. In the late evening took occasioni to write letters homiie anid to C.G. an-id to read descriptionis of the initricacies of the Iapalnese drama: Nob, Kabuki. etc. Theni tired, but happy, to bed. Scptcm1bcr 28, 1945: First thinig in the mlorninig wve wvere greeted by newv arrivals, including- Philil) Loge, formerly a Yale mledlical studelnt whliolmi I hadl tauglht. HAe is eager to transfer inlto the Hiroshimlla group and this is finally arranged. M\ajor Milton Kranmer of New York has also beeni assignied, as has a laboratory mani, iIajor Samiiuel Berg, a wvorried bachelor muLiclh concernied about w ho is to take responsibility, especially in working with the Japanies He ruslhes about tryillg to obtain additional supp)lies, but by the end of the day his success tunfortuniately is inimiliial. Captain Calvin Koch. a pleasanit keen-lookinig youngster, joins uIs later. These are our long-awaited reinforcemiients. Hiroshima AMedical Diarn, 1945 Later in the miiorning also miiet Captain Paul 0. Hageman, a formier colleague on the House Staff at the New Haveni Hospital, and Lieutenant Col. Hymer Friedell fromii Western Reserve and the Manhattan Project. Col. Friedell gave us a lecture on radiatioln plhenomen This dealt with elemen-tary princil)les anid definiitions. This wN-as a w-ell-presenited and useful review for all lhanids since none of tus could qualify as ani expert in radiationi biology. Of partictular imiiportanice wsas his implicationi that radiationi injury in these cities cotuld be conisidered essentially gammlla ray effect like that of lhard X-rays. There may have been miinior exceptiolls. Neuttronis traveled far eniotuglh to reaclh the grotunid, but only in a smiiall area benieatlh the explosioni. Indulticed radioactivity x-as therefore niot a miiajor lhazardl. The samiie seemiied to be trtie for fallotit, insofar as the investigatiolns ere carrie(l. Specific iniformiiationi, if know;n, w-as consi(leredllassifie(l. c Later in the miiorning w\ ent to see Dr. Nakao again anid lhe ini(leedl l)rov'e(l to be ini possession of a veritable gold miinl This con1sists of peripheral blood and marrow\ smiiears of nio less tlhani 44 cases that have b)een worked til) in 1-iroshima fromii late ini August to 15 September. Amiionig tllese wN-ere 15 fatalities of w-hom sevenl w\ere atitopsie(l. Agreed w\ith Nakao to begin tl1e work-up of these with him tomorrow. After ltiniclh fotin(d Genieral Farrell's expert stenographer anid finiisled(l (lictating the tranislation of Father Siemles' accouint to him. I was now all the mlore anixiouis to findcl the Germlani jesuit lpriests at the Interniationial Catholic Hospital. Calt. Rosenibauim is eager to comiie alonig anI we miiake first for the St. Like's lMedical Center which is said to be not far fromi the Catholic Hospital. On the way xv-e pass the astonishing sigllt of a lhge nioscqtei inltact and(l glitterillg, comiiplete with domie anid miiniarets. St. Luke's is anl impressive inio(lern sxkyscraper sittiated in aii on)ly' moderately (lamage(l resi(lential zonl It is Inow designiated as the 42nd(l Gelneral Hospital. N\e w-ere mlet b1 MAajor Vollmer who proxidedla brief touIr. Thlere is a beautiful chapel. The laboratory is alrea(dy, functioning. I)nring the WYar it was use(d by the Japanese who were reltictant to returni it. It escale(l signlificanit dlamage, but tin(ler press of war it went inlto ph-ysical (leclilne fromii w\hich it is noxW beii1g rehabilitated. Genieral -MacArthltr lhas favored tlis lplac It is ctirrently in the charge of Col. Yeager. A Plilippine banner has been presented to the hospital togetlher with a portrait of the General by 'Mrs. MacArthur. Obtained miiore precise directions to the Catlholic Hospital at St. Ltike's anild we miiake otir wsay throtilgh a largely burned-out portion of the city. Finallv w-e fincd the hospital with the aid of tw-o small Japallese boys. The hospital itself is intact anid spotless. \We mieet -Mother Harse, a most T'oluttic 38, Octobet-, 1965 gracious Elngishwomian wN-ho is in. charg After tea wN-e are lushered in to imieet Fatlher Kleinlsorg This is ouir first (lirect contact with an actual patienit. We hlave a loin conversation in Germiiai., which he obviously likes to speak althotugh his Eniglislh also is qeuite good. He tells inl his own words of his experiences so graphically described in Father Siemiies' account. He is amiiaze(l at our kniowle(dge of the story tiiutil I tell him of the translation of the Siemiies documileint and thein he has a good lauglh. He is a keein kinidly man, thill and l)ale l)ut showinlg remarkably little other effects, except that his wounds have failed to heal, now somile seven wNeeks after injury. Partial healilng ha(l begun, hut at three w-eeks the wotunids began to SEIBO BYOIN INTERNA TIONAL CATHOLIC HOSPITAL 7Thy5 Yodobashiku, Shimocichiai, 2 chime 670. Vr rw.j W e- -r1 4 ILetterhead of hosl)ital where Father Kleiinsorge was a patient. suppurat He developedI a leukopeni Then homiie through the dusk after a fascinating day. Sepeniber 29, 1945: Col. 'Mason and I are joined by Lieut. Loge and Capt. Koch on a visit to the University. There Nakao nmet us and the first part of the work of reviewting the records began. These appeared to be excellent except that many of the actual marrow couiits have not as yet been don \Ve therefore subdivided ourselves, Japanese and Americans, into teams of counters and record translators. There was a master sumllmlarizing chart. Col. AMason busied himllself with a transcription. The chart obviously Nas the result of a great deal of extremely painstaking effort. After lunch we returned, bringing also MIaj. Kramer, andl continued the work. Theln a long walk hom In the evening met M\Iajor Sylvan Moolten. He is assigned to the Surgeoni's staff. He has had extensive experience in pathology gained at the MUount Sinai Hospital in New York, although he is primarily a clinician. He is a very keen and thoroughly delightful nman who discusses knowledgeably many of the things \-e have seen in the Pacific, including cutaneous diphtheri Hiroshlimaoo Aledicol Dia ry, 1915 V Top. The Jesuit Monastery at Nagatsuka from which Father Sienmes wxitnessed the atomic bombing of Hiroshim Middl St. Luke's Hospital in Tokyo used as the 42nd General Hospital by the U.S. Army Occupation Forces. Bottomii. The Tokyo First (Dai Ichi) MIilitary Hospital, the \Vralter Reed of Japanl. Here wAas located also the Japanlese Army MIedical School. Volume 38, October, 1965 Septemtiber 30, 1945: At breakfast on this pleasant Sunday found that Col. iMason was leaving for Nikko Shrin Decided to spend the morning closeted in my chambers reading and writing letters home, to C.G. and to Paul MIacLean. In the afternoon took the opportunity to explore the city wvith Jack Rosenbaumii and MIilton Kramer. Jack had told me that he had seen people actually starving or ill to the point of unconsciousness at the railroad station. Although the economic state of the country was at a low ebb and rationinlg was strict, I found this difficult to believ But there were indeed frail, dull-eyed people begging, and some, even children, lying huddledI with their parents-a pitiful sight. Passers-by seemed to pay themii little heed. \Ve wsent by Japanese taxi, a smiioker driven by an intrepid man wrho muist have been trained on a juggernaut, to Ueno Park, a famous beatuty spot. This w\cas crowNcded on the brisk afternooni with strollers, both Japanese and Amnericani soldiers. One of the loveliest sights was a five-tiered pagoda witlh its graceftul roof and its glow-ing red-ochre sides. In the city belowN the park tlillngs Were quiite as busy as oni the weekday. We were amnazed at the imm1ilenise crowds fillinlg and overflowN-ing to the outside of lUeno railroad station. There was nio pushinlg. anld everything w-as patience and coturtesv. \We walked back, bemutsed, the long distance througlh the darkeninig but buistling streets. October 1, 1945: To work againi early in the miorniing. Counted innumerable cells. but in the hvpoplastic marrows these are widely scattered anid often difficuilt to classify, andl the work is progressing slowly. Dr. Nakao is mlost helpful, most sinicere, anid clearly expert in hematology. Capt. Koclh aiid Lietut. Loge devote thlemiselves mostly to the periplleral bloods. Constultedl witlh Col. Friedell regarding the possibility of sotmie of the MI.lanhattan District Team cominiig to Hiroshimna w ith us, buit his group has decided to continue back to the U.S. Later met Col. M\ason wlho had returnied from Nikko that nooni. Althouglh our expedition is now poise(l. we mUst aw-ait the rettlrni of Col. Otughterson fromll Nagasaki for finial arranigements. Today acquired iniformiiation concerninig twxo new recruits. Our request for clerical assistance Nas met by the assignment of Staff Sgt. Hial D. Huffaker anid Pvt. MIichas Ohnstad from the 12th Cavalry and 1st Cavalry Artillery respectively who are to go with us. God grant they can type! October? 1945: W\orked all day at the Ulniversity with Col. MIason and 2 all of the junior officers and our Japanese colleagues. Got w-ell in sight of the encd of the blood counting. I . .~~~~~~~~~~~~~~~~~~~. . Top. The pagoda in Ueno Park. Bottom. The Ueno railroad station. Immense crowds patiently await transportation. l'oliiiiie 38, October, 1965 Theni I lhadl anotlher (lifficult working session with Dr. Ishii. Despite our language problemls, it is quite clear that he is a very well-educated pathologist. He show ed mle somle 26 necropsv protocols. These seemle(d very wN-ell workedt-up and(l illustrated with sketclhes. Althouiglh the bulk of the description is in lapanese, many of the technical words are in Germani or Latini. WXeights of organs are in Arabic numilerals. There are many sketches. It is possible to understanid in reasonable detail the substance of the description. This w-e test by going over one or two protocols. For the first timle I have seen Dr. Ishii smile as somle comlical mlisinlterpretation on miy part is nia(l It w-as agreed that 18 of these cases w-ould be cut here in Tokyo and that the rest ouldl be brouglht along with us and cut after we arrived in Hiroshim N\Ve could then comlplete the mlicroscopic descriptionis for this prime group in (lirect personal colntact while carrying on our other work. Dr. Ishii also has a large numiiber of marrow contact preparatioiis which he will bring along that come from the autopsy material. Actual preserved organs of the sanme patients froml whom we have blocks in Dr. Ishii's group are said to be in 'enlarged pieces" in Hiroshimila at the Ujina Hospital. Aniong other imlportalnt information obtained this afternoon is that Mlajor Yamlashilna in the Japanese Army Mledical School has some well-preserved material fromll the very earliest cases. MIost of those in Dr. Isliii's possessioni are in a group that succumilbedI froiii three to five wN-eeks after the bomlbing. WVe take note that iMajor Yamiiashina by all iiieans niust be found. \We decidle also to bring wvith Us to Hiroshimla -Mr. Shiniiianiiie, a niedical student, who is said to be an expert in cutting sections. He is a charminig, sliglht, genitly smlliling youig maiin of studious appearance who comes froiii one of the faiiiilies iiiiportant in the professorial ranks of the Tokyo Iiiiperial University. While waitinig for a seat at the supper table, iiiet up with Capt. Nolaii and Col. Stafforcl WNTarren. The latter was an elongated, spare, grayI-lhaired mustached figure, looking the picture of a pukka sahib, but Nith a iiild and gracious mlannier. He expressed his pleasure at the Siemes translation. Scottv, w-ho had also retturned froiii Nagasaki, was very happy- to see us and pleasedl witlh the work that we had got in hiaiid. In the evenlilng had a long conference witlh Cols. Mason acdl Ougliterson, anid Nas told that Drs. Tsuzuki and( Sassa aiud four of the younger Japanese, including Drs. Kitanioto and(I Okoshi could get off to Hiroshimila by plane on the following nmorninig. \Ve hear now that the Nagasaki group is in excellenit quarters at the Omura Japanese Naval Hospital anid has no less than 150 cases of radiation sickness in hand. Hiroshimzla Aledical Diaryv, 1945 V October 3, 1945: In the early morning Dr. Tsuzuki brought to the front of the Dai Ichi Hotel Dr. Sassa and the "Japanese young doctors." Finally shortly after 8 :00 m. all are ready to board the trucks to take them to Tachikawa Airfield. The present plan is to have a shuttle plane in readiness for the work of taking all of us down. In the morning in consultation with the Japanese at the University prepared a list of the doctors in order of preparedness to go dowvn. Among those ready is Dr. Kato, a debonair bachelor, Who is to assist the men at Hiroshima in getting the early records of the 44 cases up to sluff. In the afternoon went to pick up the rations for the Hiroshima group. We found the Red Gate open. These cases were then placed into the hands of the Japaniese at the Medical School who seemiied reluctant to accept the responsibility. W\e assured them that they would not be prosecuted by our M.P.'s. I found Dr. Ishii wvho said that Dr. Tsuzuki was angry with me for not having discussed the Shimamiinle miatter "through channlels"! He had not mentionied his displeasure to me that morniing, however. After supper was informiied that the plane bearing Dr. Tstuzuki and his companions had been forced to turn back from Hiroshima by heavy overcast and that on the way back its radio commiluniications had brokendowni. The pilot had to fly the unpressurized airplane at over 14,000 feet to be sure to clear Fujiyamiia, which he could not se Near Tokyo he founid a hole in the clouds and was able to buzz Atsugi at dark. Flight control guessed that somiiethinig was wN-rong. Cars and trucks were lined up to illuminate the airstrip. He landed safely after seven hours of conltilnuous hazardous flyinig without certainty of where he was. In the evening met none other than Col. Joseph Sadusk Nho had arrived at the head of a typhus commnnissioni. There had b)een some outbreaks of what Nas considered to be true typhus fever in Japan and somle of our soldiers had comiie down with the diseas * Col. Sadusk had taken his residency in medicine at New Haven with Dr. Francis Blake and had started with the Yale ULnit as a captain, but had been reassigned. He had donle mlluch distinguished Nork in epidemiology in Hawaii and with the UT.S. Ty-phus Comimission and was ultimately promoted to full colonel and decorated Nith the Legion of MWerit. After a post-war career as an outstandinig practitioner in Oakland, California, anid then as a Professor of Conmmunity iMedicine at George WNashinlgton University, he became Chief Food and Drug Admuinistrator. Volume 38, October, 1965 About 9:10 p.m., while I was playilng cribbage with Major Kramler, Col. Oughtersoln camie and said that we were in fact ready to leave in the mlorninig. This meant that we had to get ourselves and the enlisted miien packed. Sgt. Reed was put in charge of the latter detail. In the meantillle I begged a ride to the NYK building to which Capt. Rosenbaum had just beeni moved, and gave the junior officers the good news. Then a hasty job of packing miiy ow-n belongings and to bed at 12 :30 m. Octobcr 4, 1945: Arose at 05:15 and after picking up Koch, Rosenbaum, and Loge rushed to the Uniersity. Then rapid loading of all our equipmiienit and men with the help of numilerous willing Japanese who got the whole job done in time to return to the hotel by 6:55. Breakfast had been arranged and we left the hotel at 7:30 m. Col. 'Mason claimned to know PA3J'GH LI 3T YMOR 1 CmI MIA Lt Cal Li.bow Gal Una= 5- capt Roa Capt Koa f6 1 Itie 'Dr XW OOt* ~sSgt TbC 4 rak 1 si)W 5kdn& s 9r _sol LtK.lc I'AkU Dr Ta-md or okosd4 5 1r Nakao * Lt OlBriox, Char2us Lt mrin 1oh SLt.L Teaksn Green Thohn ig A 3ma±gu !Wildu, '. f. Tah B3m Lin a_uK& K&w 6 Dr KI ,txtorphw i 1et Dr Sa Dr -jtn to be abandonied. List of passenigers for projected flight to Hiroshiimla, October 4, 1945, which lhad the way to the airport and seem-ied to be doing reasonably well at first. It was pouring-a real cloudburst. Finally, however, we became more and more lost and then the good Colonel ultimately admitted complete failure of knowing our whereabouts. Then we strike out more or less cross country. with the help of our inquiring Japanese companions, passing through towns such as Koraida and Yozakawa, but at long last make the correct turn and enter Tachikaw Although we were very late, we were welcomed by our pleasant acquaintance, Lieut. Flook. Col. Oughterson's party also had been late but was there when we arrived. I find a pilot talking excitedly witlh Col. Oughterson. He had flown the Tsuzuki party to Hiroshima and was exhausted by the harrowing experienc Dr. Tsuzuki himiiself was at the airport looking none the worse for it and ready to take off again. WVe were at first rather hopeful of taking off but at last the flight was declared closed. Disgustedly we struck out for home and found that the rain has in fact worsened. Deep puddles are everywhere and many vehicles have become stalled in large lakes. Then back to the hotel to a fine dinner of Spain and cold cuts in the hot and sultry room. In the afternoon slept the sleep of the extremely weary. Later in the evening again met Col. Sadusk and we had a long talk about the good old days at Yale and our various war-time experiences. Bed timne was delayed by another conference with Col. Oughterson. Col. Stafford Warren camle in. He was his delightful self and showed uis the destruction and radioactivity maps of the Hiroshima and Nagasaki areas. WVe discussed also the delayed effects of radiation on the bone marrow in the patients. He stated that these occur after relatively low doses. Col. Warren said that Yawata was originally scheduled for the atomic bombing but that the plans had been changed because of meteorological conditions. Then, finally and wearily to bed with a bad prognosis for tomorrow's weather ringing in mly ears. October 5, 1945: Heavy rains continue and no air transportation can be authorized. In mid-nmorninlg, a visit from Dr. Tsuzuki wvho has apparently done miuch smoothing of the way for our work in Hiroshim He says that the people are in fear of our troops and that this may inhibit our nmission greatly. Dr. Tsuzuki then agreed to introduce nme to General Hirai who is chief of the Pathological Institute of the Japanese Arm)y Medical School. This wsas accomplished after a long trip through the downpour. The General is a small man with a cast in his left eye and a friendly mianner. The insignia on his collar resembles that of a U.S. Navy coIllmuander except that there is a small red star in the lower front corner of the collar. The proiinise is given to us that the slides of the earliest cases T'olutiie 38, October, 1965 in possessioni of the Army AMedical School would be delivered to us with remaining tissties at Hiroshimlla by two miedical studeints who will followv in about tw-o wN-eeks. On returninig, the questioni of food supply for the Japanese componlent of the investigative group is discussed at length by Dr. Tsuzuki and our group and w e agree that all of the doctors and possibly the students as well will l)e fecl by Us. Scotty emphasizes that this wxill have to be cleared by Headquarters since it is at this timle forbidden to distribute Amiierican food supplies to civilians in Japan. October 6-11: These days were spent in disgust at the downpour and wind, but there were somiie bright spots, particularly October 6 when I had the privilege of signinlg for six jeeps for our unit on transfer from Gen. Farrell's group wxhich w as returning to the continental U.S. Now wve had our owin l)rivate means of getting about. There wN-as also the pleasure of working at the lUniversity wx-ith Drs. Nakao and Ishii and exploring Tokyo on foot, w-rapped in a raincoat. The population was still drably and poorly dressed, the mien often in remiinants of military uniformiis or thin (lark suits. \Vonmen were wearing the baggy trousers (iiiomipe) that had been wartime wear by Imnperial decre It was amusiing to see the little Japanese police in dark blue, carrying small swords and directing traffic si(de by side with the strapping M.P.'s of the First Cavalry Div-ision. The latter, who seemiied to have been selecte(l for their size, also stood guard at parade rest before the various gates of the palace and at the doors of radio Tokyo-station JOAK-xwhence had come the Tokyo-Rose broadcast that we had enjoyed in the islands during the \Var. The Kabuki players reopened on October 3 in their own theater and their popularity amonig the Japanese w-as attested by the difficulty, of getting tickets and by the plentiful speculators. Jack Rosenbaum was able to get tickets and we enjoyed a dazzlingly colorftil stylized performance and the traditiolnal Imlusic. I had learned a little al)out the symbolism of the action fromii reading, and kindly English-speakinlg Japanese w ere eager to explain the niuances. The audience was almost entirely Japanes The performances are long and it is customary to bring food. Parts of mlany- days and evenings N-ere also spent in planning our approach to the work at Hiroshim The shieldinig and protection studies would be miost difficult. Scotty emiiphasized the need for a mortality and morbidity curve in relation to distanc \Ve hoped that w-e could identify certain buildinigs and shelters at known distanices fromii the hypocenter wN-here people occupiedl precisely kn-own positionls at the miiomlent of the LLEBOW detonation, and whose fate was known. Drs. Tsuzuki and Murachi said this was definitely possible and that in fact they already had a number of these buildings in mind. It was evident that if we considered only gamma radiation, as seemed reasonable, we could assume straight-line travel of the rays which would intercept the buildings at angles determined by their distance from the hypocenter. If we could then establish the structure of the buildings from building plans, the thickness of steel, concrete, etc. could be calculated through which the radiation would have to penetrate to produce a certain effect or to be completely absorbed with no biological effect. One could assume that the LD-50 dose (i. the dose that would be fatal to half of those exposed) would be in the range of 500 roentgens if delivered to the body as a whol This datum could then give us at least a rough idea of radiation dosage under various conditions. There would be some error in the calculation from scattering of radiation. We hoped also ultimately to learn from the physicists who had designed the bomb both the spectrum and intensity of the radiation at the sourc This, insofar as it was known, was still considered secret, according to Stafford Warren, who would provide no information except that there was a mixture of hard and soft gamma radiations. The hard rays have a shorter wave length and penetrate more deeply than the soft. Effects on tissues, however, would depend on the quantity of radiation absorbed. In the meantime three C-46 aircraft that had been assigned to transport us were lying idle and our patience was severely under test. * 4. THE ENCOUNTER October 12: Finally the dawn is beautifully clear. Consequently called Tachikawa airfield at 6:15 m. and was advised that the trip would be cleared for take-off. Called the "Japanese young doctors." On arrival at the University found that they were not at the appointed place at the Institute of Pathology. I was horrified for a moment but soon thought to look for them in front of the main medical building. There they were-all except Dr. Ishii. He had gone into the country again. Shimamine was there, however, dressed in his dark-blue student's uniform and wrinkled cap. Then off we went. Everything went smoothly this time except that the manifests had somehow become lost in the shuffl However, after a little cajoling of the pilots we quickly prepared a new passenger list. They for one thing seemed pleased that we were at the rendezvous on tim This time Dr. Tsuzuki was not on the list as he had been on Oct. 4, and there were no personnel who were not of our group. The three C-46's were loaded one bv one, heavy laboratory equipment and jeeps strapped to the metal Voluitie 38, October, 1965 floors and passengers to ride in bucket seats at the sid Finally we got X-392 loaded and it took off. Similarly the second plane, X-372, was loaded, the passengers boarded, and a smooth take-off accomplished. All of the Japanese that were present had been assigned to these two airplanes and I thought at first had been loaded aboard. Shortly afterward I went back to attend to plane number X-131 which had not yet been loaded. A manifest was prepared and the load was put aboard, jeeps and all. just as I wvas about to get the crewv together there was a sudden loud tearing sound followed by an explosioin. A large shining silvery C-47 on take-off had suddenly veered to the right and gone off the main runeway which was at a somlewhat higher level than the parking field. It skidded ilnto the rear ends of a number of parked planes wvlhiclh were in a neat row, tails to the strip on the field below. As it came crashing off the runway, it turned completely around and came to rest facing in the direction in which it had started. Its left Wiing had been shorn off and it was burning fiercely w-here it had torn at the fuselag The pilot's compartment in front of the wing had fallen forward and was lying on the field in front of the body of the plan A soldier, his uniform and hair aflame, came running mladly toward us as we dashed onto the field. WVe made quickly for the plane on the windward side as the fire trucks came screaming up and quickly extinguished the fir We first attempted to take care of the two boys who had been pinned in the pilot's compartment and were strapped inlto their seats against the instrumient panel. They were obviously dead althlough seemingly uninjuired. I gave first aid to a third boy who had been rescued fronm the body of the plain I splinted another badly fractured left foot and arm with boards and strips of cloth and bandages that had been brought from the warehouse in anl ambulanc There w-as no hospital near the field nor were physiciains other than ourselves immiediately availabl Others w-ere similarly handled. As I w-as splinting one boy's arml wshose elbowx hadl been fractured, and who was among the less severely injured I looked up to see an air surgeon Lieutenant Colonel leaning over nm I said "Thank God yotu're here," and he replied, "You're doing fine, Averill. I know even less orthopedics than vou do." It was Dr. Thomas \Warthin w-ho had been on the resident staff of the New Haven Hospital with me somle ten years previotusly. He had arrived with supplies, finally, from the Air Force Hospital some miles away. \We finished with the others and sent thelmi all to his hospital. All had been taken safely out of the planes except one boy who had been burnedc to death and the pilot and co-pilot w-ho had been killed in the forward compartment. We then cleanedl up and as I Nwent to my own plane, wIhich fortunately had escaped damage, mlet Dr. Kubo on the way. He hadl not been checked L aboard the other planes as I thought, and had just walked to the airport from his home which was near by. Before take-off there arrived copies of letters from General MacArthur's Headquarters explaining the Joint Commission and requesting cooperation from the Commanding Generals of the Sixth and Eighth Armies. Since we were about to enter the Sixth Army command the letter was especially welcom We left at 11:10 m. in the third plane and had a smooth and pleasant flight except for the fact that much of the land below was obscured by billowy and milky white clouds. Finally we saw the shocking and breathtaking sight of Hiroshima below, devastated, cold-an ash. Our two C-46 predecessors were sitting like great olive-drab moths on the sandy yellowgray field below. We flew over the harbor sighting the beautiful islands, and then made a rough landing with our tail too far up and not touching down quite soon enough. We taxied too far with our over-great momentum and landed in the mud but skirted around the worst parts, raising a great spray in the puddles, but able to come about to join our friends who were waiting. There was really no airport, no tower, no landing lights-only a wind sock. On the field also were some horribly scarred children including a boy who told us in understandable English of his experienc He seemed to know how far he had been from the center of the explosion. In the meantime Major Kramer had made arrangements with the 186th Infantry Regiment to borrow a truck. The unloading was done without incident. They took a large wooden platform and placed it on a 2'2-ton truck which was backed to the airplanes. The jeeps were then driven on and carried to a grassy revetment at the side of the airfield. Each jeep was finally bounced off with a jolt, and then allowed to roll off the steep bank of the revetment. There seemed not to be too much immediate serious damag We then rode through the bleakest scene that could be imagined-past a gray prison with blue-clad prisoners herded by blue-uniformed policemen. The entire city was completely flat except for some concrete buildings that looked reasonably well-preserved as we were landing and from a distance but which are burned out and sometimes twisted and buckled masses upon closer view. The roads are still littered with wreckage of every description. There are many burnedout trucks and cars. Charred poles have collapsed and jumbled wires crisscross the path. Most remarkable is the fact that through this scene of desolation street cars are running through the middle of the devastated and almost empty city. Everywhere there is evidence of a conflagration. As we reach the margin of the city, many houses, although unburned, have been flattened, as if by wind, all in the same direction away from the center of the explosion. J'oluttie 38, October, 196-5 UPI'ICD" Q'F ""It il'Pi. _t '; C. 't AiUkc TI ALLL.D I i;' kCV1 6)', aCC skA-. 12 (6otober 50G SUBJSCT: : TO Atomic Bomb InvestigatIon. Co=-r-ndinf General, Sixth Army, Ad1 1. This headquarters has direeted that a "Joint Cornjssion for the Investigation of the .ffoots or the Atcmto Bomb In Japan" eonduot Uuh Invest i>stticus as arneesesary. The ommission is oopoesd of the followinr three major groups. The 3.anhattaw Projet Group wder "rlFn dier General arwell. b. 'The Gli4 twroup maer the Chief mwoemase orfice, represented by Colonel w. ougbrteron,"'. *. The Japanese Uovernment Group under the direetion of rTuzukci of the imperial University. .r. Tokyo. 2. it Is desired that this ommission bo furnished whatevrOI &aistance Is neossary sad praeticable In order to acooLplish-their isailon. Colonel W. Oughterson ia the plenary rerwesentbtlye of the Joint Commission In Japan. A,proprinte passes should be isxued at his request to enable the parties to enter restricted arets of your oownrand. A TUUiS COPY Fi. Y. M.1.n . Colonol, G.f., Ast Adjutant !'neral. Colonel, :edioal Corps. Order from General MIacArthur establishinlg the Joint Commissiotn. Although lnot included in this order, personinel of a unit serving with the U.S. Navy (Naval Technical Missioni to Japan, Team 11) under Commander Shields \Varren worked in with comnplete integrationv the Armly Unit at Nagasaki. Hiroshliima Aledical Diary, 1945 LI'EBOW Upper. Hiroshim Aerial view on lanciing October 12, 1945. Onlv the heavily reinforced conlcrete buildinigs remain standinig. To the right is seen the military are The hypocenter is just to the left of the broad roadwav x-hich borders this area at its southern (left) margin. The two bank buildings, approximatelv 250 meters from the hypoceniter, can be seen standing closely together. The tall buildiing niear the lower left margin is the Fukuya department stor Lowecr. In the middle portion of the photograph is the burned zonle of the city whereas beyond the broad highway which acted as a firebreak, there is only scattered evidence of mechlainical dlamage to buildings. Aerial viewx at time of arrival, October 12, 1945. Volutiie 38, Octobet-, 1965 Upper. View across hypoceniter from Sanwa banik. In the ceniter is the Challmber oi Comnierce BuildIinig witb its domiied tower. To the right is the Businiessmeni's Club (Koreani buildinig). The low wall niear the ceniter irepresents the onily portion of the Shima private hospital left standing. Middl Ana adjacenit view lookinig fartber niorth. The -Korean Buildlilng" is inow in the ceniter. To the righlt are the great white torni of the Gokoku slhrinie 250 meters from the hypoceniter aiidl close by is the military encaml)ment. Lozeer. Genieral view of city looking toward the harbor. Thire is almost total destructioni with onily a,. few walls of x-eight-bearing brick or conicrete stanidilng. Hiroshlim)la MIedical Diarv, 1915 Our destiiation wNas _Ujin Here w ere the relatively iintact liviing quarters of employees of the Daiwva rayon mill somiie 4'2 kilomiieters fromii the ceiiter whllich had been used as a hospital for care of the inijured by personiel of the Tokvo First AMilitary Hospital wh-lo were still in control. It was nowv alimiost dark. I wN-ent to the headquarters building aind there in a simiall, dimly liglhted roomii miiet 'Major ]Mison1o wxho was in charge of the hospital. He was tall, ratlher (lark, and lhad the look of a miiainiland Mongol. He was obviously weary anid had a rough scraggly black beard. He was curt aiid seemed almlost surly often saying "Wot ?" in a rather gruiff wvay 7'op. Clhamiber of Commerce Building before anid (bottom), after the bombin-g (30() meters). Voluitte 38, Octobei-, 1965 wslhein he did lnot qtuite uinderstanid, but soon introduced tis to Capt. Sasano who was mlluclh imiore suav He then guide(d tus to a buildinlg w\-here we took three large well-lighted roomis, stipplie(I with electric currenit. The btuildinigs wxere long, two-storied, remiiiniscenit of barracks in ouir own army, and arranged in cantoniemiienit styl They w-ere, however, typically Japanese highl-roofed structuires supported hb a heavy tree beam and with the typical Japaniese slidinig walls and (loors. Ouir equtiipi)meilt was all stored after unlloadIinig fromii the trtuck and( placed with somlle attempt at separation of the categories of supplies in a large roomii at the enid of our buildinig. The buildings branche(d off long, straight, covered walks. \We were now hungry. Sergeanit Buckles was appointed miiess officer anid didl the cooking- over a gasolinie stov We hadl plenty of 10-in-I rationis, whliclh mlake simple but tasty anid a(leluiate meals. At supper Jack Roselnbaumii told the rest of uIs a blood-chilling tale of his experienice onl the flighlt down. When hlis plane reache(d altittid, one of the passellgers, Dr. Yasulda, became extremely short of breath anid cvanotic. Jack thoiluTht he might have had a coronary occluision, until he foundi(I that I)r. Yasuida had a therapeuitic pnetiumiothorax wlhich had expanded sufficienitly to cauise respiratory embarrassment as the planie ascend(le(d above 9,000 feet. Oxygen was a(lministere(l ald the flight down was along the coast a few\ lhund(lred feet above sea level. The roomiis had straw mlats but there were, of couirse, no beds. WNe procee(le(l first to spray floor and wl-alls liberally with DDT. A nullimber of Japaiinese military blanikets were obtainied through C(apt. Sasano. These were clean, heavy, of a drabl) yellow-brown color, niade of cottoi1, and h singlll;arlv devoil of warmth. I hadl a sleeping bag with miie wxicl had traaveled the lonig way fromii Camp Edwards to New Zealalnd to Saipan anci now to Hiroshilml As soon1 as lights w-ere oUt w\e hear(d a scurryin1g along the tree beams and(I hoped, even as we dozed off in exhauistioni that nlonIe of the rats, which sounide(d large, would become too in(quisitiv The sleeping bag provide(l nore comlfort thani was available for the rest wlho were qtiite cold. October 13, 1945: Early in the morninig we inspecte(l the establishlmenlt, found three large rooms in one of the buildings to be supplied with pover and water, an(d these we designated as the laboratory. Equipmiielnt and food were placed under the guard of our enlisted men, and Drs. Rosenbaum aild Nakao were dlesignatedI to unpack the laboratory equipment, to lay out a plan, and to gather what furniture cotild be found for the laboratorv. I drove to Kure with Col. Mlason to establish the necessary admimisl trative framework with appropriate representatives of the Sixth Armyiv. Hiroshlia Medical Diary, L iL T'op left. Aerial view of Daiwa Rayoln 'Mill used as a hospital by the Tokyo First NMilitary Hospital and( later by the Joint Commission. The dormitory buildings of the factory which were used for this purpose are in the upper cenlter of the photograph. Bottomii. Entrance duty. to the tjina Hospital. Patients, and military personnel still on Volume 38, October, 1965 The drive was through only partly repaired roads, rough and nervewracking. Considerable traffic, slowly moving trucks, and some military vehicles on the highway made progress very slow. On the way we picked up a young man named Yamashita who was working as an interpreter. He is one of the Los Angeles "double citizens" who had returned to Japan before 1941 and had apparently felt that Japan would be winning the war. He had gotten himself well-fixed for a post-war job, had Japan in fact been victorious. In the harbor of devastated Kure, which sloped steeply to the shore, there were many ships apparently unloading. We presented our orders to the Adjutant General in the Tenth Corps Headquarters, who introduced us to the Provost Marshall, Lieut. Col. Penc He was a stern looking but kindly, graying gentleman who quickly supplied us with the necessary passes, but said that they would be valid only until the end of the month when they could be renewed at ASCOM. This headquarters had not as yet been fully established. The Hiroshima area had been made "off limits" because of careless behavior and looting by souvenir hunters. These were men of the merchant marine who would come into the harbor in boats, keeping a sharp look-out for mines, and then quickly depart. Only supervised groups were permitted to enter to view the city, and of course those on official business. Then tried to call upon Col. Hall, the Surgeon. We found him on an inspection tour out of his offic Here we met Major Cummings, who had been the executive officer to Col. Carton whom I had met on Espiritu Santo in the New Hebrides. Major Cummings was now serving as executive officer to Col. Mudgett, the Base Surgeon. For old times' sake he said that he had a whole case of VO whiskey which he was willing to shar This offer was accepted with alacrity. We paid our respects to Major Hamlin, Col. Hall's executive officer, and then visited the 361st Station Hospital near Kur Unfortunately the site selected for this hospital was waterless and this had caused understandable dismay among the personnel. Later in the afternoon we went to the Japanese prefectural office to see whether better lodgings could be obtained for our operation at Hiroshima, but it was clear that adequate facilities were not availabl We therefore set about to find civilian assistance for cooking and laundry, which was quickly accomplished with the help of Dr. Murachi. Before returning, we visited also the 186th Infantry Regiment where Lieut. Farrell agreed to service our jeeps. Since these had newly arrived directly from the hot and dusty Philippines without attention, they were in obvious need. On our return we found that the laboratory was already getting into shape under the ministrations of Drs. Rosenbaum and Nakao, who had been busy all day. I found also, to my relief, that Dr. Ishii had arrived by train. It was now decided that we would no longer keep guards on our food supply. Our Japanese colleagues told us that absolutely nothing would be touched even though there were many people in dire need. This released both Ohnstadt and Huffaker who with Sgts. Reed and Buckles set to work with a will. Dr. Ishii's arrival now made our group complete as finally planned just before departing Tokyo: Amtericans Col. Verne R. Mason Lieut. Col. Averill Maj. Milton R. Kramer Capt. Calvin 0. Koch Capt. Jack D. Rosenbaum 1st Lieut. J. Philip Loge T/Sgt. John P. Reed S/Sgt. Hial D. Huffaker T/4 James Buckles Pvt. Michas Ohnstadt Japanese Dr. Kanshi Sassa Dr. Kiku Nakao Dr. Koichi Murachi Dr. Shuichi Kato Dr. Toru Tsukada Dr. Ikuya Kubo Dr. Tamaki Kajitani Dr. Koichi Ishikawa Dr. Takeshi Gotoh Dr. Shigeru Hatano Dr. Moto Kawanoura Dr. Toshiaki Yasuda Dr. Hirotake Kakehi Dr. Masaaki Okoshi Dr. Zenichiro Ishii There were also 21 medical students including Mr. Shimamine who came at the request of Dr. Ishii. Major Misono was in charge of the hospital and Maj. Motohashi was also assigned there, although we had not yet met him. Dr. Tsuzuki and Col. Oughterson had not arrived but expected to divide their time between Hiroshima, Nagasaki, and Tokyo. To bed, with some of Major Cummings' VO to soothe us. October 14: Arose on a very cold Sunday morning after a quite comfortable night in my sleeping bag-rubber mattress arrangement. At 9:00 o'clock conferred with the Japanese physicians. It was decided that Dr. Sassa as the senior among the Japanese and Col. Mason as our senior officer should undertake a good-will mission to meet the doctors of the various hospitals and of the Prefectur It was decided to postpone this undertaking since Sundays are taken quite seriously in these parts. We used most of the day in completing the laboratory into a quite functional stat During the day copper sulfate solutions for plasma and blood specificgravity determinations were prepared by Capt. Rosenbaum. I spent a Volume 38, Octobey', 1965 good dleal of miiy time with assistance of our sergeants and some of the Japanese preparing oxalate tubes for collecting blood and dehydrating solutions for histology. Fortunately there Nas pow-er of the proper voltage for our centrifuges and waterbaths. W7e had not been sure of this when the equipimienit was brouglht dlow Late in the ev-ening we lad a seconid constiltationi to crystallize plails for actual wxork. It seemiied expedlienit to w-ork up the _Ujina patients first 41st Div PM UhNITE :TATrS LRiD FORCES PROVOST MARSHAL PASS (Tp.mpr$) x Corps NO- Locct1.on_ rlease Pe-"it Atomic Bomb Survey Col B. R. Iason & driver or member of Address or Organization Name atomic bomb commission, h H entrance to Art Im&.L11.aton or Arca £ Study of the et2ects of the atomic bomb. for purpose ._ State exact uLssjoL &' unit or person coLnCerned 12 November 1945 From hour ___to d-te to(at ebcL 12 December 1945 ____ avt r~4teosAr 12 November 1945 o e oRtA rt fts Ae{Y A-oproved Clared by Provost _G_CIC Dot _ Orgaaization or Area Cor__p___ODep Military lass re(quiredI for entry inito Hiroshliim;a are an(l theni to proceed to hospitalized patienits elsewx-her Survey work on the non-hospitalized populationi w-ould be conducted in clinics later. A laboratory teamii was organiized consistinig of Drs. Nakao and Okoshi anld my self, to be assisted by a numlber of junior mein and students. Clinical teamiis were organized in five units. This w-as greeted with enthusiasmll by all concerned. Our record forms w,ere considered again in great detail in an effort to be certain that there woul( be no mistakes in interpretation. It was decided that the data from the clinical examinations would be recorded on the Japanese forms and then transcribed so that both the Eniglish and Japanese records would be complet Laboratory data xvhen available were to be entered on each. This principle of duplication and sharing the material was to allay any suspicioIn that w-e would sinmply use the Hiroshima Aledical Diary, 1945 material for our own purposes and that the Japanese would be kept froml inaking a study and from publishing on their own'tl. All appeared mlost eager to begin the actual wtork onl the morrow. October 15: In the early morninig again had a mieeting w-ith the teamiis who arranged thetmselves according to plan for the work writh the Ujina Hospital in-patients. The clinical teamiis w-ent to work questioning anid examininiig the patients. An assigned case numiber was left at the bedside for the laboratory teanm so that specimiiens would be properly marked. The laboratory collecting team, consisting of Drs. Okoshi, Nakao and Sgts. Reed and Buckles, followed along obtaining blood and other specimens. This systemn worked out well although the laboratory group tended to lag somlewvlhat belhind. It was remiiarkable to see the patients lying or sitting about on the straw miats of the smiiall rooms. There were no beds. Numerous fires were burning in the charcoal stoves everywher MIany- women wNere presenlt, apparently relatives of patients to whom they iministered, but there were also nurses, wN-earing iioniitpt', white blouses and pancake-shaped hats imiarked in fronIt by a little red cross. \Ve learned that it wN-as Japaniese custoimi for kinfolk to serve patients and even to cook for tlhemii wNhile in hospital. Many of the patienits Nere horribly burned and others had various crude but effective orthopedic appliances. They seemed entirely docile and showed Ino evidence of hostility but rather a submissive courteotusniess. There was a remlarkable absence of odor despite the open infected wounds and burns and pitiful condition of somie of the patients. To us the treatment seemed deficient in that little attention to electrolyte balance and adequate fluid therapy had been paid. Tranisfusioins in our sense were almiiost nonexisteint. The closest approach was the use of blood in quantities of 50 cc. injected into the muscle of the btittocks and the blood was ustually derived fromi the patient himself. German field mediciine was said to have exhibited the same deficiencies. The Japanese pharmacetitical industry had successfully reached the sulfapyridine production stag but even this material was apparently not used in large quantities. The earliest stages of penicillini production also had been attained in Jap)an. but wN-e were told that this material wxas available only in smlall (Itaiitities and wsas rarely used, anid theni only in very smlall doses. This was probably fortunate since the product theni was still qtuite toxic. By late afterinooni all of the lUjina patieiits ha(l been seeni and the teamiis rettirinedl trituimlplhantly to the laboratory roomls. which served as a meetinlg plac On retturninig from the wN-ards we have dinnier prepared froimi the excellenit 10-in-1 rationis by an accommiiiiodatiing Japanese cook variouisly calledl T'oluttic 38, Octobcr, 1965 Top left. Onc of the workers' dormitory buildinigs at the Daiwa Rayon 'Mill in Ujinia usedl as a laboratory by the Joinit Commissioni. Top rigitlt. Prof. Tsuzuki in onie of the corridors at the Ujinia Hospital. Bottomii. A group from tlle laboratory of the Joinit Comimnission at Ujin Four of thle niurses who assisted iii the prel)aration of the glassware are 5shown. The physicians are fromii left to right, Dr. Kato, Dr. Kajitani (at rear), I)r. Nakao, 1Licut. J. Philip ILoge, Dr. Tsukadla and( D)r. Okoslhi. Prof. Tsuzuki's conifi(lelnce in thcse milenl is indlicated by the positions that they have attained since the end(I of the war: )r. NakaoProfessor of Initernial Aledicine at Tokyo Uniiversity; Dr. Kajitani Chief of Surgery at the Cancer Inistitut Two otlhers, Dr. Ishikawa and(I Dr. Hatanio are now also both Professors of Surgery at Tokyo University. Perlmutter or Rochester. He is efficient, quick to learn, and obviously enjoys his job since he is the recipient of what to others seems like manna, which he obviously takes home to share with his family. All of us are now free of the chores of housekeeping and can devote ourselves fully to the job in hand. On this first evening we all gather together, transcribe the records completed, and enter laboratory data that have been obtained in the meantim All seem quite satisfied with the operation and with an opportunity to do systematic and creative work. For numbering and identifying the records I devised a system whereby the prefix H was to indicate the hospitalized cases, 0 for outpatients, and S for persons to be used in a survey. A block of numbers beginning with 6,000 was reserved for the individual Hiroshima patients, and a suffix was added to indicate the source of the record. For the Ujina patients we used the suffix "U." The old Ujina cases in the group from which Dr. Nakao had bone marrow and peripheral blood were given the first block of numbers, H-6,OOOU to H-6,044U. The records of these patients were available at the Ujina Hospital. In fact among those examined today were identified patients who had had previous marrow punctures in the Nakao series. These were especially valuable in terms of follow-up and there was general agreement regarding the desirability of second marrow punctures, which were therefore planned. These might provide evidence of recovery in marrows where there had been leukopenia previously. Col. Mason and Dr. Sassa had been establishing liaison with other hospitals in and near Hiroshima as they had planned. It seemed best to send teams next to the Prefectural Hospital and to the out-patient clinic at the Post Office Hospital, where Dr. Hachiya, the gracious director, welcomed them. Drs. Rosenbaum and Koch were to go to the former in the morning to be followed by Phil Loge and the laboratory team in the afternoon. Col. Mason and Major Kramer, with a group of the Japanese students, were to go to the Post Office Hospital. In discussion with Col. Mason, we concluded my own function for now would be to remain at home base for a time, to maintain the laboratory and to bring it into a functional state for preparing histological sections, to systematize and keep the records, to establish a flow chart of work to be done, to schedule the work for the clinical teams, and in free time to continue the translations of autopsy protocols and records from the hospitalized patients seen earlier at various institutions. Col. Mason said that he preferred to continue with the work of establishing contacts with the Japanese medical institutions, to maintain liaison with Headquarters at Kure, and to function as supply officer. He would obtain from the chief medical officers in the Japanese institutions accounts of the numbers Voluttie 38, October, 1965 and kinds of patients and their findings and experience with them. He was also particularly interested in effects on the eyes and would make a special effort to obtain accurate dat He would rely on us to carry onl with the rest of the labor. )X4L /45*24%v Doctor Hachiya's card anid signiatur Octobcr 16: The teamiis departed by jeep for their destinations immlediately after breakfast. At 09:00, soon after they had gone, Dr. 'Miyazaki, one of a group of Japalnese scientists who had been studying radiation effects in the city, came anid presented data concerninig how the center point of the explosion wsas determiniiied to be 547 meters above the ground. He gave a graphic description of the shadowNs, somie of which had both an umibra and a penumubra, anid also the process of triangulation. He also suggested that the Koimiiaclhi district miglht be the source of secondary radiation, perhaps on account of the water having acquired radioactive properties. He told also of a secondary focus of radiation resultinig fromll the fall of radioactive dust in the Takasu are I then began to work on the first batch of the now comiipleted records of the patients in the group collected by Dr. Nakao. These were translated wvord-for-wN-ord for entry inlto the general series. About noontimiie I was Notes made by Col. Mason at interview with Dr. M. Hachiya, Director of the Communicationis Department (Post-Office) Hospital. Doctor Hachiya later published his detailed "Hiroshima Diary." pleased to find that Col. Oughterson and Dr. Tsuzuki had arrived from Tokyo with a little mail for us. It was a delight to hear from parents and from C.G., now in Main It was a peculiar pleasure also to have a newspaper in hand. We then informed him about our work to date which seemed to be progressing smoothly and our attempts to locate as much of the material as possibl He promised to attempt to get us more transportation, which is our chief deficiency at the present tim Our Japanese chef, Perlmutter, was preparing lunch as Col. Oughterson arrived, much to the latter's pleasur During the afternoon Dr. Kato and I went to the wards and I observed the Japanese technique of vertebral spinous-process marrow punctur It was most impressiv A #19 plain needle was used. In two motions the skin was penetrated to the bone and the needle tapped through the thin- cortical shell into the marrow cavity. In another, suction was applied and a small quantity of what looked like blood drawn into the syring We later stained the smears and found them to be remarkably rich in marrow cells, as was the case with the material that I had seen previously in Tokyo in the patients without aplastic anemi For the first time also I was able to view some of the postmortem material that had been promised by Dr. Ishii. The slides were wellprepared and were well-selected from all significant organs. There was also considerable gross material. Unfortunately much of this was fixed in rather small quantities of formalin and may be not as useful for study as the small blocks that have already been prepared. We planned to attempt to restore some of the color and to photograph the specimens on 35 mm. color film. I had noted that Dr. Ishii had worn only sandals despite cold and wet. On impulse I asked whether he would like an extra pair of shoes that I had along if they would fit. I was able to gather that he would and presented them to him privately. October 17: In the morning, very early, met Dr. Hayashi, a Professor Emeritus of Pharmacology at the Imperial University of Tokyo. He was a most impressive, dignified, white-haired man, alert and keen despite his 71 years. He had been a teacher both of Dr. Tsuzuki and Dr. Sass I explained to him how the work was progressing, discussed plans, and asked for his suggestions. He was most gracious. The team working at the Prefectural Hospital now has almost finished the work. There have been several important developments. An ambulance and a driver, Spears, has been added to our staff. Col. Mason has been foraging and a number of additional sleeping bags have been somehow provided-but there are only three and some of the less senior officers are unhappy. Dr. Murachi, our biophysicist, gave an interesting hint of secondary radiation effects. A man who had returned several days after the bombing to a concrete building had had a transient leukopeni We said that much more evidence would have to be gathered before any cause and effect relationship would be established. Dr. Murachi agreed and stressed that neutrons might have induced sufficient secondary radioactivity to have given the observed result. * Observations of this sort at Hiroshima were isolated and the leukopenia may have had some other caus Members of a military unit, the Ishizuka Regiment, had camped from August 6-11 in the near vicinity of the hypocenter, at Kamiya-cho. Blood counts done by the Japanese before the end of August showed no evidence of leukopeni This well-established observation and physical measurements indicated that there was no biologically significant neutron-induced secondary radiation at Hiroshim During the afternoon several of the autopsy cases were translated by Dr. Ishii from the Japanes I transcribed them and later in the evening dictated the transcripts to Pvt. Ohnstadt. October 18: Teams with Maj. Kramer and Dr. Rosenbaum assigned to Red Cross Hospital. Joined them there about mid-morning. Met the Vice Director, Dr. Shigeto, who is understandably sad and discouraged. Had an extensive tour of what must have been a fine modern hospital. Rooms and equipment have been unbelievably damaged and there are many patients, again attended by their families, amid shattered surroundings. Buckled metal window-frames and broken plaster exposing lathwork are everywhere, although an attempt has been made to clear the debris. On returning, continued translation of protocols with Dr. Ishii. Later in the morning two photographers, Ware and Circus, appeared. These men were on loan from local Headquarters until our own photography unit was asigned. Also Lieut. Vance, Sanitary Corps, a parasitologist has been attached. He seems a very nice sort and brings along a welcome item -another microscop To my amazement and pleasure, two more microscopes arrived with Col. Mason, who had obtained them on loan from the 29th Malaria Survey Detachment. He also brought a radio from the I & E section of Tenth Corps Headquarters (now we would again be in immediate contact with the outside world!) and, best of all, said T'oluttie 38, October, 1965 that a refrigerator, six cubic feet, Frigidaire 11o less, was waiting to be picked up at the 411th Medical Collecting Company. The 361st Station Hospital had furnislhed a uterine curette and an ophthalmoscop He accepted our enthusiastic comnplimienits without blushing and said it was all the result of his eagles screaming. Doctor Slhigeto's card and siginatur In the afterinoon Col. Ouglhterson brought in aii X-ray film Nwhich had beell exposed during the burst of radioactivity and whose location wvas known. This lhad also been seeni previously by members of the Mlanhattan District Group, and(l by the highly competent radiologist, MIajor M\iisono (who had been in command of the hospital when we arrived). \Ve discussed again at length the shielding and protection problem with Dr. Murachi and Maj. Mlisono who had been interested from the beginning and had given these matters muclh tlhought. In fact this was one of Dr. Murachi's priimle interests. \We planned a thorough tour of the city tomlorrow in order that I might have the benefit of his previous observations and thinking. In the evenling there Nas a lecture by Dr. Kitaoka of Okayanma attended by all. He said that the tuberctulill reactions and Schick skill tests were Upper: View across hypocenter toward the domed Chamber of Commerce building (center distance). In the right distance is the Businessmen's Club (Korean building). In the foreground are the Bankers' Club (left), and a bank building (right). Middle: A part of the north wing of the Chamber of Commerce building showing "dishing" of the flat roof as a result of the blast. Lower left: Shadows of railing anid of a human being on the asphalt of the Bantai Bridge, approximately 1,000 meters from the hypocenter. The directly exposed asphalt has been darkened. Sighting along the shadows, in line with the objects which cast them, enabled Japanese scientists to locate the hypocenter by triangulation within a few days of the explosion. Lower right: Effects of heat flash at 1,300 meters. Sharp shadows of leaves of castor plant on blackened telephone pole near the Meiji Bridge (1,300 meters). The plant at one time was taller but the leaves which cast the shadow wilted where directly exposed to the heat rays. The rays were directed downwards from a point approximately 625 meters above the hypocenter. Photograph made on October 31, 1945. Hi) os/i iwoa le(lical Ditrv, 1945 B L,IEBOUI dimiinished amloing exposed patients in whomii there had been letukopenic reaction. October- 19, 1945: In the morniing took a trip with Dr. MuIurachi to the city in the region of the hypocenter. Dr. MIurachi had a detailed know ledge of the noteworthy and most revealing physical features. Ascended the stairs of the burned-out Sanwa Bank to the roof. The reinforced concrete w-alls w-ere solid but many of the partitions had been fragmented and the wood supporting the plaster had burned, as had the furnishings. In one rooml salk,e cups were still on the floor amid the rubbl The roof of the Sanwa, only 500 meters from the lhvpocenter, is one of the best places froml w-hich to view the city, as one can see over the hypocenter itself toward the remarkable domed building which the Japanese call the Commlnlercial Museum (Clhamber of Commerce). 'We mlleasured the thickness of the walls of the Sanw As we Nvent to the formiier iMitsui (Teihoku) Banik, there was still the smell of death and the burned bones of a dead miiani were visible trapped deep within the rubbl Remiiarkably, the walls of the strtuctture itself showed Ino evidence of burning. On the groutld were miany tiles and in the small cemneteries, of whiclh there were mnany. were the vases miade of setomono. At the hypocenter itself trees w-ere tupright but leafless and charred. Nearby were the ruins of a brick building which Dr. Murachi identified as the Shimiia Hospital. This had beeni of weight-bearinig brick wN-hich had completely collapsed. The day was ideal for a photograph which I took fromii in front of the hospital across the hypocenter toward the tw-o impressive bank buildings and tlle ruin of the Banker's Clutb. As w e w-ere walking about, 'Major Hamiilill drove up in a commlanid car to tell uIs that a photographic teaml wN-as expected at the Hiroshimlla airfield later in the day. They were to be assignled to us for the durationi anid had been asked to bring their equipment 'with themii. \We watched the vicinity of the airfield while examininig the various btildinigs btlt sawlno aircraft. \We then drove the short distanice to the broad road betwseeni the maill cit- anid the border of the military reserv ation. On the wvest side w-as the Gokokti shrinie wN-here the most remiiarkable shadow-s on the granite were demiionstrated, and also the interval between the heat w-ave and blast w\axv Nearby w as a higll modern building, again with a sotund outer strtucture but l)lasted and burned within. People had taken roollms in this btuilding for living quarters; now completely windowN-less it lhad been screened w ith rotugh wMoven mnats. Dr. MuIurachi told mle that they -were Koreans wN-ho had always felt dowsntroddeni but now considered thelmiselves victors over the Japaniese and therefore entitled to the best qtuarters. OIn f'ollittic 38, October, 1965 Uppcr. Face of monument at Gokoku shrinie, 300 mcters from hvpocenter. The directly exposed portions of the graniite have become roughened and( flaked, while the portion of the base slhade(d by the upright e(Ige retains the original polish producing a "shadow.' Lowucr. Similar effect on base of gratite rail. The blast vave knocked down the uprights at a time whenl the heat of the flash ha(l become reduced to the exteint where the original appearance of the monunuent is retainied. This demonstrates the difference between the rate of propagationi of the heat wave and of the blast wav Ilfirosliiiiia MI(ed(ical I)iary, 194-5 I IEBO NN's , s.:, =s. --^ jjjj. _s .] . _ - *, . . t :j; 0s *^ 91-: -': 'f sF; :r, ^z_ ::. . 'A g , -! :IV V.l "Profile burnis' of legs. Only the directly exposed skill hias beei burned. There is evidence of keloidl formationi. The patient was a soldier in the militarv coimipound, approximately 900 meters froimi the hypocenter. ( Enilargemelnt of 35 mIllm. transparency.) HiroSliii(l Aledical Diarv, 1915 V tlle topmlost landinig Dr. 'Murachi show-ed me some remarkable shadows of the mletal railing and upright edge of the building on the horizontal cemient slab w-hich supported the former. The shadoNs consisted of dark, grey-brown streaks corresponding to the horizontals and verticals, surrounded by a vaguely defined rusty-brown band. The darker portions represent the umbra, which still had the grimy appearance closer to that of the original cemenit, while the part that had been directly exposed to the hleat had a clean white appearanc The part between, which was rusty brown, represented the penumbra and therefore the effect of a lesser degree of heat. Murachi complained that the shadows were fading and that good photographic records imust be made at onc From the same landing we could look across to the dome of the "Commlercial MIuseum." Here the unbelievable effect of the blast was evident since a concrete wall lhad beeni made concave and a roof converted into a saucer by the downward and lateral forc The most remarkable shadows were on the Bantai Bridge at 1,000 meters fromi the hypoceniter, w-here not only the railing of the bridge but also outlines of people were plainily visible on the asphalt. Farther fronm the center of the city, near the middle of the bridge, was the clear outline of a hand cart and of the person who had apparently been pulliing it. These "shadows" were of a liglhter color than the remiainder of the asphalt Nhich had been dlarkened by the heat flash. During this remiarkable tour w-e discussed possibilities for the protection studies. Dr. AMurachi said that there were official reports on survivors in the Citv Hall, and of employees in the large utility buildings whiclh would give crude data for comlparison with survival of persons in certain wooden bLildinigs, but that imuclh very careful wN-ork wN-ould have to be dcone to establish the exact positioni of individuals. * It is astonishlilng anid a tribute to the resiliency of the people, that even at this early time the city was showing sigIns of revival. \When we first arrived there wNas almliost no one to be seen. The trolley cars that rumbled through the streets amlid the ruinis were almlost empty. A few crude shelters had been put together from the rubble but these w-ere utnoccupied. There wXas dread of the imminient arrival of the unknon conqueror, occasioned by inconisiderate treatment on the part of a few who had entered the area befor But now not only were people movinig back from the villages where they had been staving w-ith relatives anid friends, but bamboo scaffoldinig was beginning to appear on somiie of the larger buildings. Life in the croNded surrounldinig towns wsas activ Clothing and other goods made locally seemiied abunldanit, and even cheaply miianufactured articles Voluttie 38, October,, 1965 Upper lcft. Shadow on the prison Nxall t Hiroshim 2,300 meters. Upper right. Shadow of rail on concrete at Businessmen's Club (Korean building). There is a darker central portion, representing the umbra and a more vaguely defined periphery representing the penumblr (350 meters.) Lo-wer lcft. Light colored shadows of window- framii The wood has been charred w.rhere directly exposed, even througlh glass. The "shadow" represents the original color of the material. Lowcr rigjht. "Shadow" of laddler on gas tanik at 2,200 meters. The "shadow" represents the original color of the tank wThiclh has been lightened by direct exposure to the rays. Other shadows also are seeni on the tank. Hrloshittia Mledical Diarv, 194-5 were oi dlisl)lay. Food was scarce, less so in the miore distant villages, and rationiing wsas still in forc The rice crop was ripeniing even in the close environs of Hiroshinm The attitu(le was definitely no longer onle of paralysis hut one of enicouragemiienit anid hope despite privatioll. * Upon returniiig to the laboratory imiet Maj. 'Motohashi. He wxas a very smiiall, bright-eyed, sharp-jawved, active vouing imlan who gave the appearance of higlh intelligenc He had a fluenit comminlanid of English which lie spoke in a hiigh-pitclhed voic He said that there might he patients at the Nilho Hospital. whereupon I (lispatclhedl him and Capt. Rosenbaum to insvestigat \With lshii and the two photographers who had been assigned l)reviously on loan photographed a great many specimllenls that mliglht be used to illustrate our report. They used a Graphic news camlera and I made the photographs in parallel with color filmii and a 35 mim. ILeic \Ve photographed lunlgs, initestines, helrt, hones, kidneys, and other organs. It had beenl possible to refresh the color of the organs somewhat wxrith 80 per cent alcohol sinlce they h1ad faded d(urinig their lonlg fixation in formiialill. Late in the afternooni discovered that it was bath day and promptly repaired to the comnlitilal pool at the far end of the Ujina living quarters. This is perhaps a quarter of a miiile down the long covered arcades where there is a large building that itself looks like a factory unit. It has a smokestack fromi w hich gray and black smoke belches. Inside all is latuglhter anid good cheer. The 1)ool itself can accommiiiiodate p)erhaps 75 at one timiie at an arm's length apart. The customll is to have a complete scrub before entering the pool. This is donie by filling a small wooden tub with the hot water, wettling anid soaping oneself down, rinsing, and when clean, enterinig the wvater at the cooler encd. "Cooler" means just barely tolerable to Caucasian skin. At the far corner live steam bubbles through the water. I was amiiazed to see habitutes standing almost at that very point. To the uninitiated the approach mllust be very gradual. In the pool conversation is animated. Everyone is relaxed. Gossip and jokes are exchanged. Both the atmiiosphere and the temperature thaw reserve anid onie emiierges with friendly feelings for everyone and everything including cold, gray weather. We had heard tales of how in the villages people walk naked fromii such a bath through wintr) streets without harm. Actually the warmi- pleasant glow remiiainis for somiie hours after suchl a bath. At Ujiia it is available twice a week. I resolxe theni niever to miliss an opportunity. After a goocl supper from Unicle Samii's 10-in-i supply it is acttually pleasant to get back to work in the evening. \Vork is now in full Volutize 38, October, 1965 swing and no one can get to bed before midnight, and we must rise before 6:30 to embark on the day's activities. We now have four Japanese nurses who clean glassware and prepare everything for the next day after we get to bed and who always are in the laboratory when we arriv Since our coming there has not been a moment to spare as we feel the opportunities of observing patients still at the height of illness is quickly disappearing. The last event in the day for me is always to complete this diary. At this time our Japanese hosts favored us with an act of great kindness. The usual facility for elimination, the benjo, consists of a graceful but narrow bowl built close to the ground, designed not to touch the skin but to be squatted over. The more modern devices are provided with facilities for flushing, but this convenience had not yet been provided the workers' barracks in the Daiwa Rayon Mill. Having heard of Western custom, the officers ordered the construction of what they thought were appropriate settees. This task was efficiently and handsomely accomplished -with a single major difficulty. Although the orifice was of reasonable dimensions, the seat, rather than being built like a bench had been made like a saddle, at right angles to the proper direction! The matter was duly rectified with considerable hilarity on both sides. * October 20: In the morning as I was working away at translations in came a Caucasian woman, Mrs. Yamatoda, with a Mr. Suga, an English-speaking friend. She told a long story of how her husband had died during the war after marrying her in 1926. At that time she was left with her relatives who were hostile, especially a former Japanese Naval man. All I could do was to promise that I would have her brought to the Red Cross at Headquarters, where she could present her cas The problem of food for our Japanese colleagues again came up in a lengthy discussion with Dr. Sass They had been supplied from our stock of military rations (Headquarters had given a hesitant blessing), but complained that they found the diet too rich to be agreeable and that they required adequate quantities of their staple, ric As Prof. Sassa put it in no uncertain terms: "Japanese people must have rice !" Knowing that rice was still strictly rationed in Japan I inquired what had become of their ration cards. He was somewhat evasive but gradually it came out, more from his colleagues than himself, that many of the cards had been left with the families in the Tokyo are They had evidently thought that their own problems would be solved, and that their families might have Top. Shadow of person on Bantai bridge at 1,000 meters outlined in chalk. The asphalt has been darkened by exposure to the flash. Farther down the bridge can be seen the outlines of a cart and the person drawing it. Middl Capt. Brownell standing in position of person at the moment of explosion over the shadow shown in the upper figur Bottom. Outline of cart and of person drawing it seen from abov Further to the right are the outlines of other persons on the bridg l'oluitie 38, Octobet-, 1965 the benefit of their own cards. After discussing the mlatter wN-ith Col. Oughtersoni wN-e decided that the best solution under the circumilstanices would be simiiply to demiiand the rice fromii the local authorities. I therefore xwent to the Prefectural Office near Kaitaichi and, stern-faced but polite, simiply requested the ric Conversation with the somiiewN-hat bewildered officer Nas difficult anid conducted througlh an interpreter. He finallv agreed that Ne could have the rice if I wxere to signl for it. This I of course agreed to (lo anad we miade off wN-ith several hunidredl pounds of the graini quickly hoping that niothing untoward would happeni. After the day's xvork our Japanese colleagues suggested that we spendl tomorrow ( Sunday) on Miyajim a famiious shrine islanid in the Inland Sea nearby. \Ve agreed that a (lay- of relaxationi was highly indicated. Sionidav, October 21: After a hearty breakfast on this crisp clear day w\-e crowded everyonie into all of our av ailable vehicles, including the ambulance, anid headed south along the coast toward Hatsukaichi. All then boarded the ferry to the beautiful deep-green hilly island across the sparkling water. As we approached the islanid we glimipsed just off shore the great torni standinig high in the water. Beautiful temiiples lilled the shore and miany of these were over the wN-ater, reached by cat-wsalks. After inspecting these we wxalked througlh the fall wsoods. The colors Nwere beautiful btut miiore subdued thani those of New Eniglaind, wxith ilmany dark bronzeor purple-red cut-leafed mlaples. Fromii the heights there wsere occasional views of the sea and of other islands. Mlany people brouglht their camlleras anid photography of everything in sight wx-as in progress. Olle of our friends pointed to a sign and laughed. It said that this was a restrictedl militarv area and photography was forbiddein-a message now obsolet Our colleagues chose a restaurant deep in the hills for a mid-afternoon meal. The restaurant was located in a lovely ramblinig Japanese country hous Shoes were left outside amiiong a forest of others. The tatanii (miiats) were spotless and one sat or squatted on themi at low tables. The mentu Nas carefully chosen by our friends. \Vith a little wvarmll sake, reserve wvas cast aside, faces flushed, conversationi became animilated and personal. The sake surely is only a formality to make this possible since the effect caninot be from the small quantity of alcohol. Everything was gracefully served by charming kimono-clad ladies. The dinnler lasted several hoturs and there seemed to be plenty of food froml raw fish to mutislhroomii and mieat dishes served with imiotuntains of rice, anid with plenty of sake and te I was uncertaini whether the abundanice indicated somiiethinig illicit about the establishlmlenit in those days of stringencv. \Vre re164 turned home through the sunset and dusk with a much better acquaintance with persons and a better feel of the country. At a meeting in the evening we discussed with the Japanese members methods for performing the survey study in order to obtain some idea of the distribution of effects about the hypocenter in relation to distanc Since there had been complete dislocation of the population and large numbers of people had died or had moved, or were otherwise unavailable, it was obviously not possible to obtain a representative sampl Still, a survey of survivors would disclose those with minor injuries and would give some idea of the distribution and severity of burns under various conditions of protection, and to an extent even of radiation effects. Some of us are particularly interested in amenorrhe Dr. Mitani of the obstetrical department has made a study of this in Tokyo and states that there was clearly such a thing as "war amenorrhea" and that the study would have to be carefully controlled. The distance from the hypocenter would represent a determining factor. Standard record forms were to be prepared for each person in the survey, as for the hospitalized patients, and every fifth person was to have a complete blood count. The Japanese told us that the best way would be to approach the police officers and ask them to have people brought into the clinics and aid stations which were located in outlying parts of the city and in the nearby communities. The point was to obtain for examination numbers of persons who had been in all sectors and who had survived with minor injuries. I would keep a central record on one of the sector maps to be sure that ultimately roughly equal numbers were obtained from all sectors. Col. Mason, Majors Motohashi and Misono and other senior members of the group would make the contacts with the police officers and explain what was required. October 22: Teams were dispatched to the smaller hospitals at Eba and Oshiba and to the out-patient clinics at the Red Cross and Post Office Hospitals. The 20 students who have arrived were sent with the teams to the out-patient departments to receive indoctrination, especially in questioning the patients and in filling out the record forms properly. At the request of Drs. Nakao and Kato discussed the follow-up work on former patients in the early Ujina (Nakao) series. They had been delving into the records and found that several of the discharged soldiers in that group were living in small communities near Hiroshim We decided to attempt to locate them tomorrow. Both Nakao and Kato were confident that these people could be found. They would prepare for hematological workup and spinous-process punctur Volume 38, Octobet-, 1965 Later wvent with Col. MIason aind ani initerpreter to the Hiroslimna W\est Police Stationi where we imiet Chief Suizawa in his rather imiipressive offic He w-as cordial anid gave the imiipressioni of brisk efficiency. \Ve explained that we wanted a good cross-section of the population of both sexes and all ages wlho had been in variouis parts of the city at the nmoment of the explosion and(l who lhad beeni displaced and were now living in the area uinder his jurisdictioni. He offered ftull cooperation, stating that it wotild not be difficult sinice all persons were registered. \\e arrange(l for a visit by ouir tealmis oni the 26th at 9:30 m. Dtiring the day w e visited se-eral other stations anid miiade similar arranigemiients to see fromii 150 to 200 persons. Retuirnied to continutie translationis and to work in the laboratory. October 23: The ouit-patient work was continue(l in the miiajor hospitals an(l a teami was sent to the Ajina Aid Station. Conltinued wNith the protocol translationis. Section cuitting and staining N-as now progressing superbly tunder the miiinistrationis of Drs. Ishii and Shimlamiiin I noticed that the formiier somiietimes now wore the shoes, but lnothing was said. I could niot resist going over some of the slides as they were finished. When one of the jeeps returned, drove into the country with the Japanese physicials andl Phil Log It was fascinating to see the rice dry, brown, fuill of graini, and readv for the harvest. After considerable searching, and inqutiry of miien in the fields and paddies, w'e fouind two of the patieiits. We were graciously received anid served tea oni the miiatted back platfornm of the farm houlses. Mr. Hiroslhi Okita was actually at w-ork oni hiis farm. He was onie of the survivors who had had ratlher extensive clinical anid hemiiatological sttudies twice previouslyr while a patienlt at the LTjina physiciMns of Hospital (Case H-6011-U) anid hald beeni investigated( 1)I We lhad studied two pre viouIs the Tokyo Dai Jchi MAIilitary Hospital. marrow speciiiiens with Dr. Nakao. AIr. Okita, theni a soldier, hal been in the uipper floor of a two-story [apaniese building in the barracks of the 104th Garrison Force at approximlately 1,000 m-ieters fromii the hvpocenlter. He w-as only slightl- injured bv flying glass and debris anid w-as able to Nork anid to mlarclh for the first ten days after the explosioni. Beginnilng on Auigust 20 he began to lose his hair. A week later he developed fever, petechiae anid swellinig of the gumils w-hich becamiie painful anld heillorrhagic and(I tultimately ulcerated. He also developed sore throat anld dlifficultv in swallowing. He was admiiitted to Ujinia on Auigust 30. His w-hite blood couint hadl been 900 on Septemlber 4, btut rose to 1,400 bV September 8 au(I to 4,600 by September 27 hlile he was a patient at the Ujinia Hospital. He also hadl a mzarke(d anelmii The cell couint of his bone marrowlhad beein only 4,000 oln Septemher 4, with approximately half of the cells in the Ot-*N I r---s . --La ,i'.6 R!Iii, 6-- lwx 3._ ct bI) -C£ V U CZ It, V Q t-4 -C. Volume 38, October, 1965 marrow being lymphocytes or plasma cells. In the second specimen obtained on September 27 there was evidence of almost total recovery, except that there was now a relative hyperplasia of normoblasts. Today he appears well and states that he is able to work, although he becomes tired easily. His hair has largely grown back. There are still dark red-brown discolorations of his gums but the ulcers have healed and are no longer painful. He submitted to the marrow puncture with alacrity. We found that his white blood-cell count was 10,400 and that his marrow cell count was 75,000/mm3. The cellular constitution of the marrow was now normal. Despite his healthy appearance the blood proteins measured by the copper sulfate method were only 4.6 gm/100cc. We had a most interesting time and obtained valuable dat Returned late to assist after dinner with the records. During the evening we subdivided the students and junior members into teams, each under a senior Japanese physician, so that the survey work which is to start tomorrow hopefully will go smoothly. Attention was paid to known evidences of compatibility. October 24: Three survey groups were arranged as follows: to Yokogowa, team 1 (Dr. Ishikawa) and team 2 (Dr. Kitamoto) with Capt. Rosenbaum; to Onaga, team 3 (Dr. Yasuda) with Dr. Koch; to Kannon, team 4 (Dr. Ito) and team 5 (Dr. Hatano) with Maj. Kramer. The plan was for the younger doctors and students to be checked by the senior physicians in charge of the teams and by the Americans who also participated actively in the work. Each team took its laboratory equipment for performing blood counts on every fifth patient. Our sergeants acted as drivers and performed laboratory work as required. On returning all teams reported remarkable cooperation from the police and the peopl All records were completed and checked by 11:00 p.m. October 26-30: During these days the survey work progressed apace and the teams seemed congenial, but the work was hard and of a routine natur Fortunately the weather, although cold, was clear most of the time and there was no undue hardship for the waiting patients. Attempts to stagger the clinic visits met with only modest success, and most of the patients were on hand in the morning when the group arrived. Some stood patiently for several hours before they could be questioned and examined and "treated" with the vitamin pills. At the same time old records of discharged patients from the major hospitals such as the Ujina, Red Cross, Prefectural, and Niho and autopsy protocols were being transcribed at Ujina or in the several institutions. Hiroshliimiia Iledical Diar), 1945 L Top. Lieut. J. Philip Loge enljoying a conversationi with one of the patients during on1 October 23, 1945. The patient was a soldier who had suffered severe radiation effect. He is now regaining his hair and able to work. Bottowii left. Anothier patient, O-, visited on October 23. He had been hospitalized at Ujina for severe radiation illness. His hair has now growni back almost completely. Bottoml rig/lit. Same patient. Almiiost healed hemorrhagic and ulcerated lesions of the gums. He permitted a spinlous process puncture to be performed at this tim a follox-up visit at the patient's farm l'olume 38, Octobet-, /965 All nmemibers were rotated througlh this w-ork so that there would be a clhanige from the daily grinid of the survey. A remarkable body of iniforiinatioIi was beinig accuImlulated. Patienlts dyinlg with only imiinor injuries, presumiably from radiation effect, however, were not well-represented. Some records of stuclh patienits were said to be at Iwsakuni Naval Hospital. WNre therefore plannled to visit this institutioni. Also, the persons dVing in the first few day)s wN-ho had been autopsied by MIaj. Yamllashinia, or Dr. Sugiyamia of Kyoto University, (there were conflicting reports) were also to be obtained. Durinig the past several weeks Dr. Tsuzuki and the Japanese miiajors wN-ere preparing a consolidated list of institutionis outside of Hiroshimlia to whiclh people had beeni evacuated and that are to be visited before concludinig the work in Japani. Our nmaster distributioni clhart of the patient survey was growing. Specificationis as to source of the subjects for the sturvey were altered to provide good representation from the various sectors by appropriate inistructionis to the police officers. These were amazingly successful. The list of suffixes to indicate the source of the patients also was growing. By the enid of the work the niumiiber was large and they are reproduced here to provide somiie idea of the scope of the investigation: Aj - Ajina C - City Hall E - Eba Branch of 1st Army Hospital F - Funakoshi Fk - Fukuyama Army Hospital G - Gion-Nagatsuka H - Hiroshima High School Hr - Hiroshima Railroad Station I - Iwakuni J - Prefectural Hospital (at Kusatsu) Kg - Kramer Girls Ki - Kaitaichi Ko - Koimachi Ku - Kaij in-Kai (Kure) M - Mitsubishi Hospital N - Niho OI - Onaga Ot - Otake Ou - Ouzu P - Post Office Hospital Pe - Early IPost Office Cases Pr - Prison R - Red Cross Hospital (Hiroshliimia) S - Saijyo Sa - Seconid Army Hospital Hiroshiimla Medical Diary, Ujinia Hospital Ushida Ujinia Public School No. 1 Us - Ujinia Public School No. 2 Ya - Yaga Yo - Yokoga%Na - Ono Hospital Ono Ushida Hospital (Kyoto Research Commiiittee patienits) Ush - Kyoto Prefectural Medical School (Cases studied at Kyoto) Kps Kyoto Prefectural Medical School (Cases studied at Hiroshima) Kps-H Tot Tottori Army Hospital Takatsuke-- Takatsuke Branch of the Osaka Medical Faculty - Osaka Medical School Osk - Kyoto University Kyoto - Kobe University Kobe Okayama - Okayama Medical School - Okayama Military Hospital Om U Uh Uj October 30, 1945: In the afternoon Commander Shields Warren arrived together with his party and Col. DeCoursey. Commander \Warren was an old friend from pre-war days and a fellow member of the Interurban Pathology Society. He told me that he had naturally joined in the investigation with Col. Oughterson, as a friend from Scotty's Boston days, since his own team was small and consisted of a translator and of several Navy officers and enlisted men. They were now living and working as one with the Nagasaki unit. It had been decided to include the Navy group in the "Joint Commission" and to produce a commoni report. * Dr. Warren was well-prepared for the atomic bomb casualty study, since he was author of a number of articles in the Archives of Pathology on radiation effect. These had been collected into a monograph. After the war, Dr. WVarren was Director of the Division of Biology and Medicine of the U.S. Atomic Energy Commission from 1947 to 1952. Today occurred the only unpleasant incident with the Japanese until now. Major Sinclair, the language officer for the Nagasaki group, was wandering through the buildings and in going through the kitchen he had addressed some remarks to one of the men working ther The man apparently failed to understand Sinclair's Japanes Sinclair thought him rude and slapped him across the face in a manner that he thought appropriate to Japanese custom. This caused a minor furor and great embarrassment. Things are currently tense but we have asked our people to smooth things over. T'olivne 38, Octobei-, VI'65 October- 31: Took Col. Oughltersoni and Nagasaki guests ou what we have now laidI out as the "grand tour." This includes all of the fascinating evidences of blast and heat damiiage in the shrine area at the Chugoku Army headqtuarters, the "Korean Building" with the shadowing on the concrete there, andl the remarkable view of the "Commercial MAuseuim" and the area of the hvpocenter. All were fascinated by the outlines of mllen and vehicles on the Bantai Bridg At another bridge farther fromii the hvpoceniter, Scotty foundel a charred pole with the light shadow of leaves of a castor bean plant. The plant had growN-n anew. In the evening we disctuss the total magnitude of the work. Scotty suggests that "more than 5,000 cases must be studied." This seems a staggering load to those who are laboring daily at the task of seeing the patients, doing the laboratory work, and transcribing the detailed records often until mlidnight or later. Our teams have, however, admittedly become highly efficient and we can survey as many as 300 patients each day, the students doing most of the history taking and requiring less and less supervision. I stress the desire of everyone to comiplete the job and to get home wvithout delay and point out that morale will be difficult to mlaintaill under the load if a definite goal is not set. Scottv has to hurrrv off by train to Tokyo. Later rliscussion with the junior nmembers does indeed elicit grumbling. Remarks are made about "AWVOL Oughtersoni" and Jack Rosenbautml spendls the rest of the evening comilposinig a song to the tune of "Get Mle One Thousanid Roses": Get mle tell thousanid cases, \Vripe tllose smiles off your faces And stay out here another year, While Doctor Tsuzuki \Vlho's my favorite cookie Gives vou all a loud Bronx clheer. There may be other surveys later, Kinda thiink they'd be funl! Tsuzuk' anid I will plani themiiAt the Club 21. So get me teni thousanid cases, Forget other places. Hiroshinma is now your home! very late and very tired. N'ovemiber 1: In the early imiorning w-ith Dr. Nakao received patients from the Ujina out-patient clinic itself. One of the miost striking was patient Shigemori, a formiier soldier in the Nakao group who had imiany To bed Hiroshima Mledical Diary, 1945 signls of radiation effect. There was miiarked epilation. Hemorrlhages and gum lesions were fading but the latter were not quite healed and peridontal ulcerations were still present. A second bone marrow was obtained by Dr. Nakao using the spinous-process techniqu Drove to Gion with Dr. M\itani in the afternoon where arrangemllents were easily made with the senior police officer. It is remarkable that the police control of the population is still firmii. To obtaini any giveni number of persons from any particular locality it has only been necessary to speak to the police chief, who obtainis precisely what is requested at precisely the right tim The people who appear have been entirely docile, submit readily to questioniing andI examiiniation, and seemii grateful for the vitamin pills which are doled out after the examination. The chief showed us a very handlsome sword that had been turned in in accordance with a U.S. occupation order. It had been previously viewed by Col. Mason and vas reserved for him. A charming Nisei interpreter, Jean Ito, assisted in the demonstration. Later in the afternoon proceeded similarly to Koi to arrange work for the coming Saturday morning. Late in the evening discussed -with Col. Mason our food problem. The 30 cases of 10-in-1 rations that had been obtained Nere supposed to be sufficient for 60 men for 40 days. Numerous gtiests, both American and Japanese, had made considerable inroads and our supply was running low. Col. Mason had cheerfully assumed the role of supply and senior contact officer and promised to relieve our looming shortage with additional supplies from the Kure depot. Thlrsday, Novemiibcr 2: This was a lovely bright and clear morning. Col. DeCoursey and Coimmander WVarren were ready to return to Nagasaki. XAVe bade them a fond good-by. Dr. Ishii in the last few days had been busily translating the Japanese protocols by himself inlto German since I was thoroughly occupied with visitors and with trips into the surrounding communities to facilitate survey work through the polic The protocols wNere then ready for dictation in English to Sgt. Huffaker. WNTe completed the identification and separation of all of the old protocols, and prepared a consolidated list by transcribing all of the essential information on the front sheets. The (lay Nas ideal for photography. In the afternoon rode with Col. MIason to the city and photographed maniy of the buildings in the region of the hypocenter and obtained also panoramic views from the top of the "Korean Building." In the evening continued with the transcription of the records. Everyone was in better spirits in keeping with the weather. Volume 38, Octobe)-, 1965 Novemilber 3: Beautiful weather persists. Dr. Ishii and I took advantage to photograph the remiiaining gross mlaterial. The alcohol was successftl in restoring a semiiblance of the previous color. Our clinical teamiis in the field witlh Ishii then plunged inlto the task of completiing the translation of the autopsy l)rotocols. In the early eveniing we continued wvith the l)rotocols of three of the earliest patients who had died wvithin the first fen days at Iwakuni. The stress under which these patients were treated and the lhaste with which the atitopsies had to be performiied was reflected in the sketchiniess of the records. The tissues of these patients, however, w-ere Inot yet available for study. but imiust represenit somiie of the miiost importanit imiaterial. Ishii's quality and wvorth are daily becoming miiore apparenlt. He lhas become a firm anid lhelpful frienid. His education in pathology is superb. He is imiodest, eager to learn, and williing to listein. He is also, like Imiost of his countrymen who are with us, absolutely tireless. He voices actual enthusiasm for completing the work and Ne continiue into the smiiall hours until all protocols in hand are finished. Noveiiiber 3: The strain is beginning to tell and everyoine now is tired. Major Kramer came back late from Gion with his group and was full of disgust and complaints because of difficulties in dealinig with the huge mass of patients. \Ve had been collecting clothing that had been damiiaged during the explosion and the brilliant sunshine was ideal for photography. Many garnments had been brought in that showed the effects of differential heat absorption during the flash. The darker portions of the pattern were completely burned out, and the lighter portions spared. Whliere the heat had struck mlore directly, burning was more complete, but where the incidence of the rays was oblique there was only partial scorching restulting from smiiall differences in color and other factors determining Upper: View across the hypocenter, October 19, 1945. The tree standilng upright indicates the vertical direction of the blast from the bomb that exploded almost directly overhead. The heavy reinforced bank buildings in the distance beyond the hypocenter appear relatively intact, but are burnt-out hulks whose interior partitions have been shattered. In the left foreground are ruins of the Shima Private Hospital, a weight-bearing brick building which has completely collapsed. (Enlargement of 35 mm. transparency.) Lozcer: Sleeve of flowered cottoin blouse showing effects of heat rays (approximately 1,800 meters). Dark paper has been put into the sleev Where the heat rays impinge most directly, the darker flowered pattern has been completely burned through, and there has even been some singeing of the whiter cloth which reflected most of the rays. Where the rays impinged more obliquely, there has been more absorption by the dark red rose petal componenits of the pattern. This effect is best seen at the right center. The green shows less evidence of heat absorption, and the light backgrould cloth is quite intact. Hiroshliim7a Aledical Diarv, 19/5 L LIE BONV i absorption of heat. We used color film and obtained many close-ups with a portrait lens. Discussed with Japanese colleagues the possibility of a holiday for tomorrow, which is Sunday. Major Motohashi came forward with a proposal for a picnic and mushroom hunt which was joyfully accepted by all. The actual occasion of the meeting was the report just completed by Major Motohashi of a most valuable casualty survey that had been conducted by him and Maj. Misono and Drs. Miyazaki and Nakatoni. This was based on the principle that we had earlier discussed of identifying groups of persons at known distances from the hypocenter and under known conditions of protection. The school children were an excellent group for this investigation since their fate had later been determined by responsible authorities as the municipal offices of the city were reestablished. Some of the data had been collected by the principals. The headmaster of a private school, Rio Yasuda, had submitted a detailed separate report. He presented a table of mortality and injuries that could be correlated with the actual distance of the school buildings. Most of these were of a standard two-story Japanese wood-and-tile construction rather similar to the barracks buildings in which we were living and working at Ujin Some of the children had not been in the schools, but were in the open firebreaks. They were exposed to flash burns, and, if close enough, to radiation, while those in school were exposed only to the latter. The table classified the groups according to position and whether known dead, missing (presumed dead), untraced (no information available), injured, or alive and well. I congratulated Major Motohashi since this is the most important accomplishment in obtaining protection data to the present tim Everybody's spirits are lifted as we work late into the night transcribing the records of the day's surveys. Sunday, November 4: A beautiful day dawned for the picnic and mushroom (niatsutake) hunt which is traditional at this time of year. Col. Mason and I and as many as could fit rode in a jeep through the lovely clear morning to the hillside that had been selected. This was on Ushidayama to the northeast. All of the land was owned by three men. Permission was obtained by Maj. Motohashi who led the party up the hill winding through the elevated pathways on the ridges alongside the rice paddies now ready for harvesting. \Ve ascended to the tall pines above the terraced paddies. At one level all of the trees facing the city were scorched brown but their protected sides still retained traces of greenery. This represented the flash burn on the vegetation that occurred UIpper. View frcm roof of Businessmiieni s Club. The slhrinie area bordering the military encamlp)lent is at the lower miiargin. It has beeni pitted xN-ith foxlholes. The broad avenue at the soutlherni margini of the encampment is showx n, and in tlle far listaince is seen the tall Fukuya department stor A streetcar is visibl Lower. View tow-ard the niortheast from the Businessmiieni's Club. Across the militarv encanll)ment is seen the moate(d region of the castl In this area are the remainis of the Chugoku Army Headquarters, secn as a low white buildinlg. To the right and just above the center of the photograph is seeii the large (lark Commlllunication D)epartmnent Building. \fi~ ~ s.H l'oliiiiie 38, Ociobcr, 1965 li I/;ioshima l edical Dial tv, 1945 IAEBOWV at the milomzen t of explosioln. As we velit hiigher we couild see the terraill below that had beeni devastated all abotit the Higashi drill field. Against the flat backgrotnindl couild be seeni the framilework of a conicrete building that had crtliulpled awN-ay fromil the hypocenter, shiowN-ilig clearly the direction of blast imilpact. The dark greeni of the post office btuildinig was also visible above the plain. \Ve are told that it -as ani animial ctustom datling back to feudal tlimes for the lor(ds to permit the peasants and villagers to go on the mintshiroomil hnnlit at this tlime of year; we are milerely folloNwing traditioni. The miuiishiroomils are fouinid amiong the roots of the pine trees in moist, sweet-smelling soil, anid are well-hidden. There are shiotuts whenever a finle slpecimen is dliscovered. The muatsuttavc are larg white, and succtulenlt. All are said to be saf A very finie tramp of some fotur or five hotnrs is enjoyed by everyon Friendships glow ; niational (lifferelices are forgotten; the lhorrors of the War anidl the intensity and strain of the work are far -i l)elow alnd behind. The miniishiroomils are brought (lon to the edge of a Here is the still greeni tree linie where they are roaste(l indler the pcaddy. soughilng pinie bouighis in a shallow pit in simiall pans. They are marvelous with sov sanice conitaininig a fair amilotinit of stigar. The rice is cooked in a very large pot. \Ve are so hungry that it is Inot qtite (lonie h-leln we try the first bowls. Col. MAason anid I discuss ways and imieanis of obtaining additional rice rations for the group, hoping that otir previous inroads will niot have been takeni too seriously by otr owvn government auitihlorities. Tlien hlomile to a hot bath in the comimiuinal [apaniese styl Tlhein still g]lowing, we all go back to the recor(ls to get everything lip to the maomilenit a(lI to plan for fututre operations. N'ovcm1)cr 5: Revivified, evTeryone was siliiig anid actually eager to wl plunge iiito the work this morninog. Iarlv went to Niho here we milet a Japanes _M\r. N'inOl, wo hadl been in Hawaii for 40 years. He ha(l a beauitifuil chrysanthemumi gaardleni whichi milade a great lit with Col. iMason. Th'le villayge was relatively inltact. It had narrow streets line(d by the lapanese lholises which had a weathered beauti. Dr. Mason fotiuid a shop where hie botighit somiie silk. Later we drove to lUshida -where agaiin arrangemilents were madle ithi the local police officer for a survev to follow, anid then to YokogowN The police station there was another ceniter for collectinig Japanese weapons anid e went inl hope of obtainiing a sword. 'None were as vet avrailabl Col. MIasonl however, found in the village a lianidsomile pair of lacquer fjcttaz the wooden shoes worn by Geish Dr. -Mason is quite good at haggling and the purchase was made after a pleasant delay. We thien cotlintied back to Hiroshimna to see the Director of the Redl Cross Hospital, Dr. Takeuchi, who was glad to let us begin a clinic in Volume 38, October, 1965 this hospital designed to start on November 10. In the afternoon we went to see the Vice-Mayor, Mr. Morishita, whom we had contacted to supply figures on the distribution of the population within the city. The information was not yet availabl Then to Kure in the hunt for much-needed supplies. Met Lieut. Col. Jenkins who introduced us to Major Winslow in charge of the 26th Medical Laboratory. He supplied us with some paraffin, and methyl alcohol for our Wright's stain. Inspected the facilities of the laboratory which was now functioning. Then finally hom A letter had been received in the meantime from Col. Oughterson from Tokyo stating that he had consulted statisticians who had advised that 5,000 cases would not be enough, when distributed among the various sectors, to obtain accurate information on the symmetry or asymmetry of the atomic bomb effects. He also suggested, somewhat peevishly, that we were free to leave if we wanted to. November 6: Early in the morning went to consult the authorities at the Railroad Office and there made arrangements for testing all of the employees of the road who were in the building, 4.6 kilometers away from the center. They provided a map of the city showing the burned-out areas. In the early afternoon again visited Mr. Morishita, the Vice-Mayor, who allowed us to trace the fire map more accurately. The Mayor also had promised some pictures of the city before the bombing which were to be ready on Saturday at 1 :30 p.m. Later in the afternoon drove to Otak The chief of police was more than cordial and promised much cooperation and said that the townspeople wished very much to be examined. He also promised three Japanese swords for our group. A friendly gift was in order and a package of cigarettes was gratefully received. Then a long and cold ride hom We had been especially interested in performing a detailed survey at Otake, since this village together with several nearby communities was the home of a number of work parties who were at precisely known locations in Hiroshima at the moment of the explosion. These people returned to the village and were then carefully followed to recovery or death. This was one of the most contributory medical investigations in terms of providing accurate information on the effects both of burns and radiation, and on the calamitous consequences of a combination of the two. Noveniber 7: Expected to spend a quiet day of work at the laboratory, but found that a large team representing the U.S. Strategic Bombing Cl) I- cn 0 ^; = 7:$ cd cn 4H la-l 0 ho Vd 0 =4* l'olzittie 38, October, 1965 2t'lffllWE".r. Urppcr. iNlushroom hunit on Ushidayama near Hiroshimil Lower-. Rice harvest. Near Hiroshima, 1945. W Survey has arrived. With them is Maj. Luther L. Terry of the U.S. Public Health Service as medical officer, accompanied by a photographer. He is desirous of making a report on medical effects but has only a few days and no help except a photographer. He requests cooperation for preparation of a summary and help in obtaining photographs of patients. Since time is short we make a quick change in plans and take Maj. Terry and the photographer to the Post Office Hospital where they make a number of photographs of patients familiar to us. We then return to Ujina and do the same for in-patients. Maj. Terry also visits our team while it is in full swing at the Railroad Workers Clinic. I proceed with transcriptions since we are falling behind. We are planning to start work at Otake early the following morning and pray for good weather. Late in the afternoon a batch of mail is brought by a team of photographers who are actually assigned to us with Capt. Charles Brownell at their head. Their arrival and the mail instantaneously improve morale and we continue at our tasks until a very late hour. * Dr. Luther L. Terry was a regular officer in the U.S. Public Health Service and rose to the rank of Surgeon General in the early 60's. The negatives that were prepared at the time of his visit, which he mentions in an appreciative letter, were ultimately made available to the Joint Commission in Washington. Charles Brownell had been an employee of the Eastman Kodak Company and was a very skillful photographer with a splendid feel for photography of patients and biological specimens. Unfortunately some of the color film that was available to him had been ruined, apparently on Okinawa during the great storm of mid-September, and the transparencies when developed were a hideous blu Others were quite superb. Through his help, his company was able to enlarge 35 mm. color film which was in my possession to a degree useful for preparing larger transparencies and ultimately for color reproductions, as of the "shadows" on the Bantai Bridg In particular, minute sections of the 35 mm. transparencies were enlarged with a remarkable degree of detail and fidelity of color as, for example, the lesions of patient Okita whose case record appears earlier in this diary, and the postmortem specimen of a heart, showing petechia Novemitber 8: The weather is lovely and we are all set to depart at 07:45 in a convoy of two ambulances and two jeeps. At Otake we proceed to the large local school. The Mayor and Dr. Nagaoka, a prominent physician who had followed the patients, are there to greet us. A large Volume 38, October, 1965 v X w65q A36 - tV ~~ k(~~~~4~~~V4 -gc~~~~ ) i-u£i( m ~ A, ~Y .g,~~~~~~~~~~~~~~~~~~. s~a~ g ,: Az A Note of appreciation from Dr. Luther L. Terry, then holding the rank of Major in the USPHS. Doctor Terry later become Surgeon General of the USPHS. L Upper. Group during a visit to Jwakuni. The Naval captain in charge is seated at the front. Members of the Joint Commission are right to left in the rear, Dr. Ishii and Dr. Kitamoto. Capt. J. D. Rosenbaum is fourth from right. Lower. Clinic in session at a temporary building at the Hiroshima central railway office at Ujina Novemler 7, 1945. Senior students and medical graduates are interviewing and examining survivors. Standing at the rear agaitist the window is Dr. Luther L. Terry of the USSBS. Seated to his right is Maj. Kramer, and to his left Dr. Hatano. Volititic 38, Octabet-, 1965 roomii in the sclhool is filled wNith miiore thani 200 people all kneeling anld sittilng Onl miiats. Some 580 residents of the town had been in the vicinitv of the Koi Bridge (2,400 imieters) at the timiie of the explosion. They had gonle there to assist in the creationi of fire breaks since bombing raids were expected. Many are miiarked with the dark nnt-hrown pigmlienltationl that we have comiie to call the miiask of Hiroshlimll Their faces were exposed in the openi wlhile facinig the sonrce of the explosion but niot so close as to stuffer acttual third-degree burns wsith loss of skini. The appearance is that of verv deel) sunbnrn hnt it has persisted with its deep-brown- color for over three miioniths. Otlher btnrnis are of various shades of red and brown. The sighlt is horrible since it involves somiie of the yonngest anid of the women. These peol)le miiade a remarkable contrast study to those of two other grotnps fron1i Otake that w-ere closer to the ceniter of the city anid wlho stnffered frolmi radiation effects that the people oni the Koi Bridge were sparedl despite the persistent widespread injnry so easily- visibl Dr. Nagaok.a provided detailed iniformiiation fromii his records and the surviving foremen of the varions grotnps were interviewed. We are graciously treatedl. At lInich h1ad a large l)late of rice and other assorted foods. By the enid of the afterniooni ouir grotnp ha(l interviewed 320 patients and had done a samiiplinig study of laboratory dat At the enid of the afternoon black tea anld tanigerinies were servedI anid theni another lonig cold ride lhollm During this day acqntired the tlhree beautifnl sw-ords which lhad been promiiised by the police chief, onie of wN-hich I presented to Calvin Koch. Then more transcriptions of records. Good talk w-ith -Maj. Terry, Capt. Bro-wnell, anid the rest. M\Iaj. Terry has been chilled andl we providde himii with my sleepling byag for a miiore comfortable nighlt. Otur several large roomiis are now well-poputlated with sleepers. prettiest ** The detailed record of the experience of the "patriotic workmen's groups" fromii Otake anid snrrounidinig commiiiiuniities is onie of the miiost initerestinlg anid revealing facets of our enitire ex)erience in Hiroshilml It wsas imiadle eslpecially vivid to uIs by the opportunity of examining the survix-ors en miiasse and of appreciating their remarkable spirit. It was possible to reconistruct the scene at the tinme of injury almiiost precisely. Throtuglh the initerest of an observant anid devoted physician of Otake, Dr. Naagaoka, accurate folloN-tip informiiation was obtained in the quiet of the villages away fromii the confusioni of the aid stations and hospitals. There were three miiajor groups from Otake, each tinder the charge of a foremlani who camiie to work in Hiroshimlla oni the day of the bombing. The Hirosliimla Mledical Diary, 1915 t4o#V Z41tC'*1 gucrest sI T"M~. Me \1v L., (:,t La,"-kr40LCOV. 6 I ON Iii- -4 1 I+r w-g- r- .Aat ; Sketch prepared by Lt. Elder of the British ImlissionI showing position of various of the Otake workmen's groups. Buildings are sketched from interpretationi of stereoscopic pre-strike photographs made from reconnlaissanice plan There are slight differences from Maj. Ganunig's interpretationi. The sketch is dated 21 November 1945. l'ollitiic 38, October, 1965 Upper. Chart to show positioins of the various wo-rkmein's groups fromii Otake and of the Koi bridg Persons in the Hinio group on the Koi bridge suffered chiefly from burns, but not from radiatioin effect. Lowe!r. Reproduction of perspective drawing prepared by Maj. Gailuilg from prestrike air views, showing shadows of the buildings as they would have appeared in the glare of the bomb. Those groups which were in the shadows of the buildings, the Nagato group to the left of the roadway, and the Morimoto group to the right, suffered radiation effect. Those who w!ere oIn the river bank near the Temrma bridge shown belowv (groups from Kuba, Tachido and Ogata), had a tremendous mortality from burns, complicated by radiation injury. first, consisting of 580 persons under Mr. Hino, were crossing, or had just crossed the Koi Bridge, approximately 1X miles from the hypocenter. These were predominantly the people seen in the clinic on November 8. Two men were killed by a collapsing building, seven persons died within a week as the result of burns, but the others survived without signs of radiation effect. The other groups had already arrived in the city and were awaiting assignment near the Otake Group Office, only 1,000 meters from the hypocenter. A reconstruction of the scene was possible from pre-strike stereoscopic air views of Hiroshima made by American reconnaissance planes. This was first accomplished by Lieut. Elder during the visit of the British mission, and again at the request of the Joint Commission, at greater leisure, after returning to Washington, by Maj. L. Ganung, who also drew in the shadows as they would have been cast by the buildings in the glare of the bomb. Men of Mr. Nagato's group had been lolling about in the shadows of the buildings prior to muster. Those in this group who were otherwise unhurt returned to Otake on foot. All subsequently showed evidence of radiation effect, with loss of hair, and most had petechia Seventy-two of 130 died of radiation effects, the first on August 20, and almost all of the rest by September 13. The consequences were similar in the case of Mr. Morimoto's group, similarly shielded and only a short distance from the Nagato group. Those who were on the bank of the river near the Temma Bridge, however, including groups from Kuba and Tachido villages and from the Ogata district, were unprotected from heat by the houses and suffered tremendous mortality, many on the spot, and most by August 10. There were only ten survivors of a total of 193 men and these all showed radiation effect, even though their burns had partly healed. This study provided a sharp contrast between those who had suffered purely from severe radiation effect at 1,000 meters and those who had, at the same distance, also been exposed to burns. The radiation complicated the effects of the burns which were in themselves sever The third group at 2,400 meters, without radiation effects, and with less severe burns, had a much higher survival rat * Novemlber 9: In the morning began the photography work with Capt. Brownell and his very pleasant crew. A permanent rack was made for the camera and the equipment was prepared for synchronized flash shots. This took a good part of the morning. Early in the afternoon spent Voluine 38, Ortobet-, 1965 miiuch timlle goinlg over otir records and observations to date with Dr. Terrv who was about to depart. He wished to take the negatives with hillm. I was fearful that they might be lost. He promised to give them1 to Col. Schwichtenberg, nowx the semior medical officer at Advanced Headquarters in Tokvo. It is rumolored that Col. Dietnaide and Gen. Mlorgan froml the Surgeon General's Office anld Col. Shull', the mledical constultant of the Sixth Arnmy are to arrive in Hiroshim Later in the evening was at work wheni the anniiotuncemiienit camiie that Col. Shull had indeed arrived. WVe welcomed him but lhad to pltunige back to get the (lay's transcription work finisled(l. Otur first print wN-as developed 1w Capt. Brownell anid his staff during the evening. The black anid w-hite work was stuperl). A'oz'cui bcr- 10, 1945, Satuorda': Early in the mlorning conitinued witl photography, chiefly of the specimiienis of clothinig and atitopsv material, with Capt. BrownN-iell's equipmlenit. There is no certainty that miiy own 35 mmll1. slhots x-ill prove to be prol)erly exposed since I had no exposutre miieter w-heni the photography wN-as first don Three itemiis of clothinlg that had been brought in wsere especially remarkabl One wNas a girl's shirt writlh a pattern of smiiall roses on the sleeves, slhotilders anid collar, andl pocket flaps. Somiie of the roses hiad l)ecome completely burned througlh o0l the sidle imiost di rectly facing the explosion, but others on the cturve of the sleeve showed a brown scorchinig only of the darker petals of the roses, with the greeni of tlhe leaves intact. The light pinik background also was spare(l. Aniother shirt had a pattern of dark-blue polka dots againist a lighter blue-green cloth. This showed simiiilar effects witli less burIiiilg where tile rays were niore obliqu The tlilrd silirt coinsisted of striped ray on. In parts of it only- certainl folds had apl)arenltlv beell exposed to tlhe flash and hlere the dark stripes had disinItegrated leaving the white initact. WNe also photographed in black aild -hite a piece of rice paper oi w-hicll the lbrtished Japallese cliaracters hlad been sharply butrned otut, althougih the rest of the paper was inltact. This was froli a sclloolroom about 1 ' 2 illiles fromii the hy-pocenlter. These clotlles caused ille s0ille difficultv since I carried tlielli in iill hanid luggage oil the way b)ack to the UlUited States. The luggage w-as sutbject to iilspectioil bly Customiis in Hawaii and the ilone-too-clean ladies' garilleilts caused somile eyebrow s to be raised. This clotliiilg was ptit oil perillaileint display, at the AFIP alollg with the records, specinllens, anld h other illaterials, but unifortunatelyI as lecoille faded with tile years. * Theil off with Dr. Mlitani to Hirosiinla Prison to arrange for a survey tealll visit. \Ve tliotigilt this would provide aii opportuinity for investigatinlg Hi} os/liimla Mledical Diary, 194-5 V Abov View of the Koi bridge (2,400 meters) from the hypocenter. Persons of the group from Otake were oI1, or had just left, this bridg Below. The river bank near the Temmlia Bridge (1,000 nmeters) which is shown in the background. effects of the heat flash on men whose exact position was known and who (at 2,300 + meters) were beyond the range of severe gamma radiation. We had been told that some were exercising in the open and others confined to their cells. A good comparison could be made of effects of radiant heat on persons in the open and under various degrees of shading. Comparison with the Otake group who had been on the Koi Bridge in another part of the city at about the same distance from the hypocenter also would be of interest. We met the prison doctor to whom we explained the aims of the survey, especially our need to know just where each man was-if near a window whether it was open or not, the precise clothing, etc. Dr. Mitani also asked permission to perform some sperm counts on the prisoners who would serve as controls for a study Dr. Okoshi was performing on persons exposed to radiation in Hiroshim At the distance of the prison no significant radiation effect would be expected. Small gifts would be furnished those prisoners who cooperated. The prison medical officer was entirely agreeable to all of the proposals. Arrangements were made to begin the survey on Monday morning. We were introduced to the warden who presented Dr. Mitani with a large basket of fine tangerines. Later in the afternoon went again to the office of the Vice-Mayor who had kept his promise and had left us a good collection of pictures from the various school books, postcards, etc., showing the city as it was before the bombing. Later more photography. Then a satisfying Japanese bath, some cribbage with Maj. Kramer, more work on records, and then to bed. Novemtber 11, 1945: Early on this Sunday morning went again to Otake with Dr. Ishii who said that we had received an invitation to dine but was rather mysterious about it. It was a beautiful morning after a someewhat miisty sunris We called first at the home of the Mayor Upper. Differential effect of dark and light surfaces in absorbing heat. The material is rice paper representing a teacher's name card, which was oln the outside of a classroom facing the center at 2,300 meters. The inked characters, which read "Arai House," have been burned out, whereas the white paper has reflected the heat and is almost intact. Lozwer left. Scorching of the darker blue-black stripes, Nith less effect on the lighter stripes by heat rays at 1,700 meters. Only certain folds of this garment onI the side away from the bomb were in the path of the rays. On the near side a portion of the cloth was charred. Patient suffered second and third degree burns of the chest, underlying the charred cloth where it was tightly stretched over the skin, and also of the exposed face, chest, arms, and neck. Lower right. Charring and scorching of dark blue portions of the polka dot pattern of clothing at 1,600 meters. Minimal effect on lighter background. Some of the polka dots have become completely burned through. Others are partly scorched. l'olititie 38, Octobei-, 1965 .i Plan of cell blocks supplied by Clhief Warden at Hiroshlilmla Prison where a detail(l study of burn injurics was performiied bY the Joint CoImmnission. At 2,300 Im1eters fromIl the hypocenter there XXwere Ino serious immediate racliation injuries. 7 X c_ -1-b w s --t ~ ~ ~ t B ct ' - ctwC~-'S. -AL-~~~~ e K s~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~Cl H*H>oSGs < - =<_K_ i~a 6 R4 c&4w-eR X b tP%5-- /v-G . -2<de,9 lt . j~ -4M -}9 '- < 9 . A-G4-~ ^:. 7 o z-~ ^^ o Z 'F X ~ Notes miadle tru _~~~~~i by Col. Mason during interviewx wxith Prisoni. Simiulated Japaniese doodlinigs in miargini. the as. istant wvarden at Hiroshiimai dl anid fouind that hie hiad arrange(l for us to visit Dr. Nagaok 'We wNere escorted to the doctor's homi This was typically walled off fromi the street anid hiad its own private court comiplete wAithi dwarf trees. He was arather tall miiddle-aged mian w,ith a lined grave face and qluiet demleanlor, (Iressed in the traditional dark kimono. e were introduced to MIrs. Nagaok The receptioni wAas ceremionious and miost graciouis. Sukiyak"i was served iJapanese manner with a charcoal stove in the mile of the tabl Taro anid uiiatsv -take wAere thrown in together with smiall (julantities of mieat anid chiicken anid muchi soY sauce and coarse brownl suigar. The lady of the house did not partake of the meal, but appeared only, occasionially to serv Our conversation wNas entirely through interpretation but I was able to capture a sense of Dr. Nagoaka's concern for the citizens Volume 38, October, 1963 of his village, many of whom had been his patients in the past. Most interesting was his evident appreciation of the scientific value of the records he had kept. After the fine dinner a beautiful blue silk haori (lady's short coat) was brought out and ceremoniously presented to m Dr. Nagaoka said that he had learned that I was planning to marry and that he hoped that my wife would be happy with this gift. On returning I found that Col. Mason had opened an acipak and all the chocolate and other good things were placed above his bed ready to be distributed. This was done for all hands. Novemiiber 12: Spent the morning photographing the remainder of the autopsy specimens with Charlie Brownell. Was informed in the early afternoon that three technicians were to arrive from the 262nd Station Hospital. They did indeed arrive accompanied by Maj. Achenard and Capt. Pierc This was a tangible result of Col. Oughterson's efforts to strengthen our staff. Dr. Ishii reported that Dr. Tamagawa of the Okayama University Medical School was in the city and we went to meet him at the Post Office liospital. He promised material, but had not as yet worked up the autopsies that he had performed in late August. We visited the morgue which was in a shed behind the hospital, almost in the open air. Later in the cold afternoon a fine bath which this time had been reserved for the Japanese officers and physicians and for us. This was less gay than usual but also less crowded. The teams that returned from the prison reported that the work was especially worthwhil Col. Mason had obtained a detailed record of casualties with unusually complete follow-up data, since survivors continued under imprisonment. In the evening was assisted in translating captions and identifying details of the pictures that had been supplied by the mayor's assistant. We considered these a find because of photographic restrictions that had been in force in Hiroshima since the Manchurian war. Dr. Murachi reported considerable progress in his major preoccupation with the building and protection studies, in which he was now assisted Left. Typical profile burn. The patient, a nurse at the Red Cross Hospital, aged 17. was exposed at 1,700 meters. There is depigmentation sharply outlined by pigmented tissue in a very narrow band. There is a crusted exudate in the peri-aural region. Right. Typical "mask" burn in a prisoner at the Hiroshima prison (2,300 meters). The pigmentation has a deep chocolate brown color. The outlines are very sharp. There is protection of the upper portion of the neck which was shaded by the mandibl At this distance there were no burns beneath the clothing. A blue prison cap protected the skin. of the forehead. Hiroshimria Medical Diary, 1945 Volume 38, October, 1965 IW were Top. Hiroshinma castle before, amid (bottomn) after the bonmhing. Near the castle the headquarters of the military forces itl Hiroshimia (800 mileters). by Dr. \Iurai, an excellent radiologist froml Tokyo who had joined the grouip. His inv/estigationis had ideintifie(l tentativelv a nutmiiber of buildings stuitable for obtaining the (lata desired: the Banker's Club, the Nippon Bank, the Chligoktu Electric Company building, a large concrete uiniderground slhelter near Hiroshima castle adjacent to the Headquarters of the Cltgoku Army, the Hiroshima Broadcasting Station (JOFK). All Hiroshima Mlledical Diary, 1945 of these were withliln 1,000 mleters of the hypoceinter. Drs. 'Murachi and MVIurai had begun the detailed wvork of inqtiry and tracing of individual patients who had beeni at their desks or in other fixed positions. Since many of these were dead, Dr. iMurachi said that it was a matter of going from one person to aniother in the various villages or outskirts of the city to obtaiin hearsay reports, and( confirmation when possibl This was (liffictult and( tinme-consuminiig, but a surprising amounit of useful information bad already beeni gathered. At this timiie a less focused but still quite useful stud(ys was also in the iimaking. This consiste(d of the comiipilation of reports onl the fate of people in the muajor buildings, whiclh miade possible a comparison of the protective effect of concrete buildings as compared with woodeln structures. For this purpose the report of the Communications Department, which had several butildings at various points in the city, was especially useful. Informatioin oni the fate of the personnel had been compiled by- Dr. Hachiy Similar information was obtained by questioning officials of the Hiroshima City Hall and Red Cross Hospital. In addition, since most of the school buildings had been of wood, the fate of the children in the btildings provided coml)parative (lat Particularly tuseful was the report of the Yasudla Private School which has beenimentioned. Novcemb1ecr 13: \Vent to the Red Cross Hospital and( took photographs of patients well-known to tus, oine of a young nurse with depigmentation which was very severe, but outlined by a sharp line of dark brown. Althotuglh the skies were gray and threatening, took the photographlic teamii to Hiroshimila castle in the military headquarters are The castle was a tangled pile of rubble on a stone base situated in a corner of a sqluare plot of land surrounded by a moat. Photographed all aspects of the unidergrotund concrete bunker near the military headquarters in which 20 young girls had served as telephone operators. Both inside and outside views were recorded. Dr. Murai had prepared a "shadow( diagram'i" of the bunker. This showed the thickness of earth and concrete projected on the ground that wotld have intervened between a person in any part of the btunker anid the gammlila rays, assuming that they traveled in perfectly straighlt linies from the epiceniter. \Ve disctussed the principles as they w-otil(l apply to more complex structtures andI it was quite clear that (letailed btilinig plans wotould have to be obtainedl. Despite tlle drizzle, visited several other underground shelters. In one, directly opposite the headquarters building I fotunid in the litter anid rtubble a bltue covere(d Volutiie 38, Oclobet-, 1965 Exterior and interior of Communiications Bunker. Cliugoku Armiy Headquarters. (800 meters). Hiroshliml(aIMedical Diary, 1945 V Initial sketclh of building plan of Cenitral Teleplholne Office showing, position of certaini persons whlo were sul)sequently traced. copy of The Life of Clafsczcit.v, the famiiotus Pruissiani militarv tacticianl, written in Englislh anlel extensively annotated in Japanies The covers were faded and( stainedl -with moistture but this treasture itself was esselntially intact. In the evening was (leliglhted to find that Dr. Nakao had acquired additionial informiationi, largely blood dat on the early patients in the Iwaktini T'olu"ie 38, Octobei-, 1965 series. These were transcribed. Ishii lhas had no success in obtainilng additionial autopsy nmaterial but the search is still on. AN'ovemiiber 14: In the early morninlg photographed patients with C. Brownell's teamii at the Post Office Hospital. At the samiie time obtainied tissues fromii maniy autopsy cases. Most of these seemed irrelevant or were lacking in miaterial. Dr. Tamiiagawa seemiied well-iniformiied but talked about Notes regarding finidiiigs ill certain lersons whose position in the Cenitral Telephone Otffice was known and(I for w-hom shileldinig (lata were calenilated. eaclh case at great lenigtlh. Dr. Islii w-as of the greatest lheli) in abstractilln thLe monologu Later in the afterniooni lhad a mllost initerestinig visit at the prison w-here inmiiiates were pb)otographed. AIany lha(l the samiie imiask-like dee)lv pigmented burns as the Otake pattients. Somiie remarkable shadow s onl tlle wall of the prisoni cast by onie wall againist the wall at right anigles to it were fotund(l by Capt. Rosenibatiumi and photograplhed. Dr. Okoslhi had good sticcess in obtaining seobiet i speciiioeiis froili tle prisoners. Oni the preceding day Col. AMason lbad blrought alonig a supply of chocolate bars whlich were tused as a reward for the meni N-ho cooperated. In the evening I Nas appalled to discover that somiie Iwakuni cases coInsiste(l of protocols that did niot miiatch aultOpsy miaterial or that there wN-ere Hiroshima AMedical Diary, 1945 THE UFE OF CLAUSEWITZ Ig:I± The Reality of War: A Companion to Clausewitz E Gordon Highlanders L C T tt+];§ffi1XR0 rc h , Major Stewart L. Murray iStr Z 2g:V Popular Edition 13: Captain Hillard -e *&3io V-OI{Al'& k5Uo Atteridge it I ! 6 0 S t .I±tJ Famous Modern Battles, The British Army of To-day ; .C It D£k .t Spenser J3!g;6( 1 Wilkinson O Clausewitz i; ia tt Top. Portioin of first page of Clausewitz. From bunker at Japanese military headquarters in the castle area at Hiroshim Bottomji. Imprint of Japaniese Army Transportationi Corps oIn flyleaf of Clausewitz. Volutize 38, October, 1965 tissues from some early deaths without protocols. Asked Dr. Ishii to visit Iwakuni to see that everything was properly lined up. He seemed embarrassed by this difficulty and assured me that everything would soon fall into lin * The eager and excellent photographic team consisting of Capt. Charles G. Brownell, M.C. and Capt. Ted Bloodhart, S.C., which at long last had been assigned to us, was a most important and stimulating addition. Much of my time in those days was spent in bringing their talents to bear on the photography of tissue specimens, clothing, and patients who had become familiar in the various hospitals and clinics, or as new and worthy subjects were identified by the teams in the field. Later they performed yeoman service in recording the appearances of the effects of physical phenomena such as the "shadows" on the bridges and buildings. The major buildings and shelters in which the special casualty studies were being performed were also photographed. For correlative work, one set of views of the buildings was made from the direction of the hypocenter. * Novemiiber 15: Most of the day was spent with Brownell-Bloodhart, et al. making numerous photographs of the large buildings, mostly in the direction of the rays from the bomb for correlation with protection factors. All of the important rooms were photographed. Upon returning, saw Zenker's solution being mixed and guessed at once that an autopsy was in the offing. There was indeed a case to do: a lung abscess. Dr. Ishii and I performed the autopsy together. The patient was a 31-year-old soldier who was recovering from radiation-induced aplastic anemia, but died on the hundredth day. This was the ultimate consequence, perhaps, of focal pulmonary necrosis which had developed during the earlier agranulocytosis from which the patient suffered. During the autopsy I saw a number of persons in the hallway outside the small and none-too-clean autopsy room peering in whenever the door was opened. Among them I noted an elderly gentleman in street clothes whom I assumed to be the undertaker. When I asked Dr. Ishii whether this was true, he inquired and then told miie nonchalantly that it was the patient's father waiting to claim the body. I was distressed but the elderly gentleman himself showed no emotion. After the autopsy was completed I found that the first photos of the specimen had returned. These were reasonably good but rather too full of highlights and had to be redon The remainder of the day was spent with Drs. Murachi and Murai in compiling the Hir osliimi Aledical Diary, 1945 t' Uppcr. Bankers Club (200 meters from the hypocenter). used to conduct the business of the city throughout the time the Joint Commission was at work in Hiroshim Lozwcr. Hiroshiima City Hall. Despite its burned-out condition this building was Volume 38, October, 1965 information that had been obtained to date on the building and shielding studies. At this time only the position in the buildings and fate of certain persons could be established, and a crude estimate made of the direction of the rays. The building plans needed to determine the relation to the airburst itself and thus the angle of incidence of the gamma rays, assuming a limited source, were not availabl Immense labor was necessary to obtain the projections of all the components of the buildings, exclusive of the furnishings, in order to determine depth of shield, which was calculated in "water equivalent." Novemlber 16: The survey work is now nearly complet Only Loge and Koch are involved with the teams, working at the Post Office Hospital clinic, which is still activ Here are seen as outpatients employees of the Communications Department. Spent most of the day in the field with Drs. Murai and Rosenbaum and the photographic group at the radio station. This was a small battered dark-green concrete building. Parts of it seemed unsafe and the work was conducted gingerly with tests to see whether the weight of a man could be born Although only a few persons were exposed in this building, their positions were accurately known, and Murachi has been insistent on the value of the detailed study. Also began photography on the Nippon Bank, a much larger and more complex structure in which there were only a few survivors. Its proximity to the hypocenter and its very heavy construction could provide valuable data on the amount of shielding necessary for protection. Returned to find Maj. Kramer in the midst of transcription of the Communications Bureau reports. These gave raw survival data for the employees, but not visitors, in the various divisions of the Communications Department. These comprised several large buildings in the heart of the city. Novemlber 17: Continued with photographic documentation of buildings near the hypocenter with Kramer and Rosenbaum whose clinical duties are now complete, and Murai, Murachi, and the photographers. Col. Oughterson finally arrived late in the evening followed by Dr. Tsuzuki not long after. An impromptu meal was prepared and then, with Col. Mason and Dr. Tsuzuki, talked into the small hours on the progress that had been made and what was still to be don Scotty was particularly interested in the work with the Otake villagers and what had been learned from the survey of school children that had been carried out largely on 3 I'.I !sI t.M. .; -.7. Views of Nippon bank (250 meters): Upper. Building seen from outside, with camera in line with the hvpocenter. Middl Eighteen inches of cinders had been placed on top of the tile for protection against fire raids. Capt. Brownell is in the pictur Lower. Interior view showing shattered concrete partition. Volume 38, October, 1965 the initiative of the Japanese medical officers. After looking at my now crowded distribution chart, Scotty agreed that although more patients would be better, the survey work could be considered at an end and that he would be satisfied with our total of well over 6,000 cases. This was to my immense relief, since I knew that those who had been doing the daily stint were weary and anxious to go home, or at least to have a chang There remained still many important collections of material elsewhere that had been gathered by various investigating groups from the Japanese institutions. Also some patients had been evacuated in numbers to other places. Some of these institutions contained the particularly precious records of patients examined and investigated soon after the bombing. We had already collected some of the most valuable material in surveys at Iwakuni and at Saijyo Sanatorium. The latter required an overnight trip. There still remained a number of institutions in Okayalila and in the Kyoto district, especially at the Imperial University there, and we still had the major problem of obtaining building plans from the central offices in Tokyo. It was agreed that it would be best to send a team ahead to Kyoto to begin the transcription of records and review of collections of material ther Maj. Kramer would be in the advanced party and Col. Mason and Capt. Rosenbaum would join him there after completing work at Hiroshim My own assignment was to go to the intermediate points, allowing the most time for Okayama as soon as the shielding and population surveys could be completed her The chief remaining problem, and perhaps one of the miost imnportant objectives of the joint Commission, was to establish mortality and casualty curves, in order that information on particular groups-for example, those relatively protected in concrete buildings-could be related to the general casualties at the same distance from the hypocenter. Since it was iowv very late, we determined to postpone this discussion until tomorrow so that all could contribute their thoughts. This problem had never been far from our minds. Novemiber 18: Much of the day was spent by the entire group in discussion of how best to obtain the information for constructing a casualty curve in relation to distanc The best idea put forward is that a sampling should be made of survivors who are to be questioned not only concerning their own injuries but also the fate of their relatives who were in the city. As we discuss the matter it is obvious that there will be some error since certain persons may have been en route, and some may not have been in the place where they were supposed to b We decide to proceed W with this since it appears to be the only way in which we can obtain information regarding persons now dead. It is clear that we will need help from those more expert in population studies, especially in the matter of proper sampling. Col. Oughterson suggests that such men must be available on the USSBS team which has now left this are He promises to investigate at onc Our Japanese colleagues also suggest that older school girls could perform this survey very well once the list of persons is selected. In the late afternoon Dr. Tamagawa arrived and we invited him to a late supper with us. He brought more records and the transcriptions of these were begun with both Tamagawa and Ishii at work. Novemlber 19: Drs. Tsuzuki and Oughterson left for Nagasaki in the hope of obtaining expert help with the population study from the USSBS now at work ther This morning made a tour with Brownell and Co. to photograph the various "shadows." Most of these were still clearly visible but the penumbra effect on the "Korean building" was less evident. Photographed Brownell himself actually standing in the footmarks on the Bantai Bridg Returned in time for a farewell dinner for Milton Kramer who was leaving for Kyoto to begin the work of collecting case records and other materials available ther Arrangements had been made by Dr. Tsuzuki. Maj. Kramer left by train in company with Drs. Ito, Hatano, and Gotoh. We were to be reunited in Kyoto within the next two weeks. The remainder of the afternoon was spent in histological work, cutting and staining, to bring our material closer to completion. To bed late at night. Novemzber 20: Col. Oughterson returned from Nagasaki. He had in the meantime contacted the USSBS in regard to help with the demography of the casualty study. A Navy Lieutenant, Mr. Nisselson, who is said to have a good statistical background, has been assigned to us and is to come soon. Later in the day, without our prior knowledge, members of a large British mission arrived with Col. Solandt, a Canadian physiologist, in charge of the casualty aspects. They seemed a very keen and pleasant group. We made a working tour of the more interesting and revealing institutions and landmarks in midafternoon. More of the building exteriors were photographed by Brownell. On returning, discussed census figures with Col. Solandt and found some discrepancies between his data and ours that must be resolved. Of major interest to the British group are the protection and survival dat We discuss our procedure and findings to l'olzitiie 38, Ortobei-, 1965 date in great detail. They Nere, of coturse, fascinatedl by the Otake workmen's groups and the fact that good follow-up data are availabl WNre discussed the possibilitiy of mlaking a visual reconstructionl of the city before the bombing froml air mlaps in order to establish the shadow-ing effects of the buildings, and theN- said they would attemiipt it. A',Tovecilbcr 21: "Ne spent a part of the mlorninig reviewing the medical findings and protection data with Col. Solandt ancd others of his group. Later in the morninlg we returnied to the Mayor's office with Col. Solandt and again had a long talk, stressing the necessity for correct data and also the need for the rice ration lists for setting up the populationl survival study. The city now\ is rather heavily populated with investigating groups concerned largely Nith estimiiates of damag Lieutenanits Martin and M\Iontgomery are here froml Survey Teaml #4. On returniing wve mleet Group Captain Thomiias an(l Group Commliland(ler Bronow skv of the Britislh milissionl which has been busily at work on the stereoscopic prebombing air milaps. Lieut. Elder has prepared a perspective (lrawing of the banks of the river near the Koi Bridge where the Otake workmen's groups were situiated at the moment of the explosion. Actual btiildinigs and the positionl of the men were identified with the help of our Japanese colleagues w\ho had been with us at Otak Jack Rosenbaum left for Nagasaki in nmid-afternooni. He had requested this trip before joininig the group in Kyoto. * For the casualtv studies several basic pieces of iniformlationi w ere required. The first of these was the actual population of the city on August 6. The best estimate that could be made, 255,000, was onl the basis of the rice-rationiing figures of June 30, 1945. Those, as of the last of tuly ha(l been lost in the fires of August 6. An estimate based on newx-spaper circtulation gave a figure lower by 25,000, but this was consideredI minimiial and less reliable because it was based on more assutmptionis than the estinmate for the rationing dlat Data on the distribution of the popuilation in the various sectors were also requested fromii Mr. -Morishita, the Vice-MaYor, and he ultimiiately comiiplied. For the constructioni of the casualty cturve, the mletlhod finallv chosen after consultatioii n with the statisticians, Lietit. H. Nisselson, USSBS, Lieut. M. Habel, F.A and Dr. -Motosaburo 'Masutvam Instittite of Statistical WMathematics, Tokyo Imiiperial University, was to secutre a raindomii sample of the population aged betw-een 13 and 60. The first probleml wxas to randonize the choice of precincts. For this purpose a designationl num'ber, 270, wsas choseni. The populations of the iil(lividual precincts were Hiyroshiyytya Medical Diary, 1945 aclded and the first selected was the one in which the cumilulated population fell closest to 270. This number was theni added to the new total and the populations of the precincts Nere further cumulated, the one chosen being that wlhiclh fell closest to the new total and so oni. On this basis, 265 of the 523 available precincts were chosen. A nationial census had, fortunately, been taken early in November 1945. The Hiroshima High School girls were responsible for handing out ancd collecting a qtuestionnaire directed to H I ROSH IM A RELATION OF MORTALITY AND TOTAL CASUALTY RATES TO DISTANCE Percent too X _ _ " X'L 4OOOmef*rs' Iopen Deaths from<burns Totol Cosuolty Rote- Mortality Rote 60 -/OOOmW oX2X shielded50 _Dh from radiation _- _ __ -- °- Kilometers .j The general casualty and mortality curves at Hiroshima as determined fromii the population study. Against the general curve are shownvi mortality figures from the two Otake groups, some of whom were shielded from burns although not protected from radiation effect by being in the shadow of Japanese houses, anid some who were in the open on a river bank and suffered both burns and radiation injury. eaclh twentieth person oni the census lists of the designated precincts that wvas to provide informationi not only about the persons selected for the sample, but also about their relatives in the city. Some 3,740 of the cards issued to 4,700 persons in the samiiple were returned. This procedure wN-as supervised by a group led by Lieut. (later Capt.) Marvin Habel and Dr. M\asuyama who also ultimately calculated the results. These cards, after exclusion of duplications, provided iniformiiation on the fate of 20,586 people at various distalnces fromii the hypocenter. Con1fidence in the validity of the dlata obtained was supported by the high mortality figure obtained by this metlhod for the indivriduals in the innlermiost 500-mleter ring. It could theni be calculated that 25.5 per cent Volume 38, October, 1965 of the total population (64,600 persons) had been killed, 27 per cent had beeii injutred, and(I 47.5 per cenit had escaped physically unscathed. Againist the total mortality curve also could be plotted data obtained fromi special groups suchl as the Otake wsorkmeni. * 1Vo,z?cumibr 22: Thanksgiving Day. Had long discussioin with Col. Oughterson concerniing the termiinationi of this study which is now clearly in sight. The shieldiing survey has now been completed. \What reImains to be done is the general casualty study. This has now been thoroughly discussed and the detail designed by Lieut. Habel, in consultation with Lieut. Nisselsen and Dr. M\Iasuyam The final report Nill be written in WVashington at the Army Institute of Pathology and George LeRoy and I w ill be assigned to do it, with wlhatever help we need. The question of how to return the mlass of records, slides, and tissues that have now beeni accumulated to the U.S. arises. I suggest that the best way w-ould be to send themii sealed to the Chief Surgeon's Office in Tokyo through USSBS for conisignmlienit to the AIP. Then Col. Oughterson departed for Kure to investigate the possibilities with USSBS wNhich is based ther Upon his retuirn he lhas miiade a tentative arraingemiient w ith the USSBS to carry the records to Tokyo for delivery to Col. LeRoy who will have returned bv that timl The ship is the USS Haines, a Destroyer Escort vessel converted for transport, now called an APD. Lieut. MIcCarthy, supply officer of the Hainies, wsill take custody. Our numiibers have niow been reduced but there are still enough to make a merrv feast of 10-in-1 rations with its excellent canned chicken a not too bad substitute for turkey. The delicious Japanese tangerines add gaiety in substitution for cranberry sauc Noveiiiber- 23: In the morning arranged for packing of all our records, photographs, and slides. Then by jeep to Kur There were hundreds of vessels in the broad harbor and the U;SS Haioes was invisible, overshadowed by the towering hulks of transports and warships. Conversation witlh the shore patrol reveals that the only way to locate the vessel is fromn a chart on the commnland ship. They hail the launch which plies betwNeen ship and shor This quickly- brings me to the commlanid ship, the massive spic-and-span cruiser, Oklahomla City. As a Lieutenanit Colonel I wN-as piped aboard and, keeping vwhat little I knewN, of Naval etiquette in iinmd, saluted the flag at the stern and theni the officer of the deck wlho uslheredime into the captaini's austere presenic The U.TSS Haiomes wsas quickly founid on the detailed imlap that indicated the position of every vessel in the harbor. The captain invited mle to the officers' miess for coffee and then graciously sent me to the Haines in his gig. The Haines, as a DE, was much broader than she looked from the water. Lieut. Commander Laurent was in command but Lieut. McCarthy who was to receive the consignment of records was ashore and due to return later in the afternoon. Although there was much pressing business back in Hiroshima, I decided to stay aboard to make detailed arrangements with him. Members of the USSBS who were there told me of their fascinating experiences throughout Japan and also of the difficulties of the landlubber's life aboard a DE, converted or not. Finally Lieut. McCarthy arrived. We discussed the techniques of packing and trans-shipment. I indicated also that we would like to send our Sgt. Buckles back to Tokyo on the ship so that the material could be delivered in person to Col. LeRoy. Lieut. McCarthy said that this could be arranged with proper orders. Since the Haines was to sail within a few days we decided that it would be best to bring the crates, and Sgt. Buckles aboard tomorrow if possibl After more coffee we parted, Lieut. McCarthy promising to have us met at the dock in the late afternoon tomorrow. Before leaving Kure I picked up two five-gallon water cans for shipping the wet tissues. Saturday, November 24: The day was spent in arranging all of the material systematically and in making a manifest of the records, tissues, photographs, and other materials. The tissues were wrapped in gauze, labeled with waterproof tags and put in formalin in these water cans. Everything was finally accomplished. The boxes were nailed shut with corners painted according to specifications. On our way to the ship we stopped at Kure to see Lieut. Col. Hall concerning the return of Sgt. Buckles to Tokyo. This was quickly accomplished and Buckles and the boxes were brought to the dock where Lieut. McCarthy graciously took all in charge, after signing for the latter. Sunday, November 25: This was a red-letter day since Gen. Hugh Morgan and Col. Francis Dieuaide, consultants to the Surgeon General, were scheduled to arrive for a visit. Col. Mason and I therefore went to Kure, but these gentlemen were nowhere to be found. After an idle morning we returned. We discussed again with Col. Oughterson the closing of the establishment at Ujin This would rest on me after the others had gon We have considerable borrowed equipment that must be returned to the units that had given it to us on loan with the firm understanding that it would be returned at the completion of the work. Japanese equipment that had been borrowed from Tokyo Imperial University must also be sent back. After closing the laboratory at Ujina there would remain only Volutize 38, Octobei-, -1965 the population study which would proceed under Dr. Masuyama anid Lieut. Habel, and the work of collecting records and materials from other institutions. Dr. Ishii and 1, who were now close friends, would travel together by jeep. Our first stop is to be Okayamia where both the Uiniversity and the Mlilitary Hospital are said to have many records. \We were informed that the nu-merous landslides that have occurred in the mountainous country to the north after the September and October rain have made road travel between Hiroshima andl Okayama all but impossibl The railroads, however, have been kept in runninig order and we are advised to send the jeep by flatcar and to proceed to OkaYamia by train. WNe would thenl go cross-cotunitry to join the group at Kyoto. It is obviotus also that considerable work will have to be done upoIn returninig to Tokyo, especially to complete the collection of building plans of those structuires in Which the protection studies were don Dr. Tsuzuki has assured tus that these would be available in Tokyo, since plans for public utility and hospital buildings would have been kept in central offices ther Then took the short trip out of town to the Kaitaichi railroad stationi and made tentative arrangements to get men and equipment on the train. After supper Col. Oughterson is in a philosophical mlood. I renmind himi of my desire to return as soon as the job in Japan is comapleted. He promises to mlake appropriate arrangemenits in the Surgeon's office uponl lis imminienit return to Headquarters in Tokyo. \Ve discuiss also at length whliat we have learned of Japan andl of the influence of the Emperor. Scottv asstures us from wlhat he has been able to observe on his trips to Tokyo that MIacArthur is held in great respect and is doing a remarkable jol) wN-ithotut the slightest sigin of vindictiveness anl with J[apan's futuire recovery foremilost in miind. This has been mlaking a tremlend(lotus imlpression on the people, who can hardlyz believe it. Mo,iodav, Novcnilbr 26: In the early mlorniing made anothler trip to Kaitaichi station and arranged for the (leparttire of otur personnel to Kyoto an(l Tokyo ancd for the transportation to Toky-o of the large quantities of Japanese laboratory and(l other equipmllenit that hadl been loaned to tus ai(I w-hich had now been crated at lUjin It was to be selnt in a closedl boxcar andl Lieuit. Habel wX-as to be at the receiving end in order to release it froml custody. Everythinog was trtucked dowin, the loading was supervise(l, aid(I the boxcar sealed. Outr two junior officers left for Kyvoto. Theni retturned to Ujina and fotund( that Gen. Morgan, Col. Tturner. anid Col. )ieutaide had arrivled. L-tunch w-as preparel. It was a particular pleasure to renew accluaiitances with C(ol. Dieuaidle whoi I lIad milet miiany Hiroshlia Medical Diary, 1945 V imionths previously in New Zealanid Nhere he was mzakinig a consultanit's tour. \Ve then took the senior officers on the VIP tour of the city throulgh all of the selected places. Gen. Morgan was my guest-a dignified greyhaired figure of heroic dimensions who looked the part of senior consultanlt. On the way I presented to him some more details of the plani of the study ancd what had been accomplished. \NVhen Ne came to the ' Koreain building" in order to gain an advantageouis view of the city, I found that things had changed for the w-orse since my last visit. It w-as most revoltinig that the landings had b)een use(l as suirface toilets. The General stepped gingerly andl kept a stiff upper lip anid was rewarded by seeiing the raililg vhich were still quite clear and sharp although the peniumbra shadows w was fading in the cemiienit at the top. He marveled at the energy of the people who wvere beginniing to return to the sites of their holmies. Rude shelters were springing up amidl the rtubble, walled and covered with bits of rusted corrtugated maetal, but still the beginnings of a rebirth. To otur disappointment the shadoNs on the bridge were now only faintly visible but inmpressed the General. Otur visitors then returned to Kture witl Col. Turner. It was now getting dark and beginning to drizzle slightly. Thl eni homiie to a delightful steaming bath. One important iteml still remaiined to be coimipleted. This wvas the protocol that I had promisedl to Dr. Shigeto of a girl, Fusako Tsuta, froml the Red C'ross Hospital who hald been atitopsied. The slides were now comupleted. The death as we expected was not clearly related to the atomiiic-bomllb inijtury, but rather to typhoid fever. The mlicroscopic descriptions were comiipleted and typed ouit by Sgt. Huffaker. Then we cooked sonme bacon anll eggs and brouglht Col. Ouightersoni and( Col. AMason to the railroadl station to see tlhemii off oIn the liglht traini. Fonid goo(dniiglhts and Godspeed w-ere said. Col. M\ason was bound for Kyoto and Scotty for Tokyo. 3. MOPPING UP ANovemiibcer 27: The final closing of the shop was the order of the (lay. The first itemii of business w-as to returni the refrigerator to the ambulance company. This was (lone wsith the willing help of our remiiaininig enlistedl i imien who were eager to returni closer to civilization. The refrigerator had been a trustworthy servant througlhout our stay. Tlhen to Kure whliere Sgt. :Huffaker, who had performied splendidly, was left at his new assigrnment at the 361st Stationi Hospital. Col. -Mason's curette and mxy autopsy kit were also left there ancd the radio was returned to the tendler miiercies of the I & l officers. Tlhen hlurried lback to Ujinal for Isllii anid our luggag Islhii and I mladle the train sclheduled far 2 :58 p.m. The jeep Volunte 38, October, 1965 wN-as put oIn a flatcar. The trip from Kure was through a country of sharply pyramnidal terraced hills, looking like the lovely islands in the inland se W;'e arrived at 7:20 p.m. The jeep was ready for us WN'hen I opened the fronit comlpartmiient I foutnd that the copy of \Vintrobe's Hemiiatology that I had put there was missing. I then looked in the mletal compartmiienit in the back seat, also unlocked, but all of the numerous cans of chicken froiim the tenl-in-one rations that w e had stored there were still intact. Tlhis w-as ironic since the chicken wvould have made a muclh more digestible diet for hutngry people than the ARVintrob WNe did not have an easy timie findinig lodgings for Dr. Ishii. WN-e stopped at a Japanese hotel but there was no room. \Ve becamie thoroughly confused trying to find the Okavamia Japanese -Military Hospital from directions that Islhii had obtained but finally obtained a place of lodging there for Ishii. Then Nvent in search of the 21st Regimental Combat Team stationed in Okayama and found it after considerable difficulty. I w-as given a place in 18, a tguest roomn," bare and cold except for a smiiall charcoal fire in a brazier. Theni somne writing of these notes and wearilv to bed. Noz'cuii)er 28: In the miiorning met Gen. MAiura, a friend and formiier co-worker of Prof. Tstiuzki. Throtughl Ishii, he extendedIhis cooperation anld w-as all politeiiess. A num-iber of patients fromii Hiroshima were in this hospital. We photographed several and theln w-ent to inspect the laboratory. Some gross material was there which after considerable (lisctissionl w-as shared as had been agreed. Again wve emplhasized that they were free to prepare their onn reports on their owln observations. At Okavamia University w-e were received by Dr. Tanabe, a patlhologist. He seemiied a charminig person w-ho offered every help for our wNork incluiding a large room with his personal electric heater. This w-as gratefully received since the Neather was raw. \Vent to work with Dr. Ishii on the translation of the autopsy protocols that were available both from the MIilitary- Hospital and from the University files. Two of the more important are still missing. Again it wras interesting to observe that when our attitude wvas made known and the hand of friendship extended it was gladly seized. Again "lhomiie" after much Japanese tea and conversation. The officers of the Comibat Team w-ere a gruff but friendly lot and not very communicativ They seemed to accept their assignment on that frigid plateau in the two-thirds-destroyed city quite philosophically. Their disposition to share their whisky was helpful. Novemiiber 29: Dr. Ishii and I worked througlh the day translatinig the autopsy material records. Late in the afternoon we wN-ere introduced to Prof. Tsuida, the Head of the Dept. of Surgery at the LTniversity of Hiroshlitiia Aledical Dianr, 1945 L Okayam He has the mlost orniate office that I have seen in Japan to dat He andl his staff hadl taken care of some of the evacnees fromii Hiroshim Later in the afterlnoon Dr. Tamagaw a wlho had prexviously visited at Hiroshima fulfilledl his agreemiient to share w ith us miiaterial froml a number of autopsies he had performle(d both at Hiroshimlla an{d at Okayamii Dr. Tsuda gave permiiissioin to take his clinical records with ns to Kvoto where it would be miiore convenient to transcribe thelmi and wh-lere m-nore free to concenltrate on the there would be miiore help. W\e were now M1ilitary Hospital records. Novemiibcr 30: Translations continued. \We founid certain discrepancies in previously abstracted charts from the Okavama Military Hospital anld consequently reviewA-ed the original records with special car Slides already prepared wNere given to tus from a numiiber of cases by Prof. Tanab A few more not currently available are to be cuit and sent to Us. Wre were now ready to continue our journey. Again packed up our beloniginigs alnd new acquisitions for an early start on the followN-ing moruinig. Satutrdav, December 1: Started at exactly 06:30 on the long roadl to Kyoto. Ishii was ready anid w\-aiting when I called for himii. It w-as a sparkling clear day after a very tlhreatening afternoon oni the day befor The weatlher was freezing cold and it Nas difficult to keep wzarmi w\hile driving in the open jeep evein in the brilliant sunshin The trip wAas through rough high country with the roads still interrupted by washouts created by the fall rains; the roads were sometimies negotiable by jeep, but on occasion required detours. Many stops are made for discussions of the best way across the mlounitains from village to village by Dr. Isllii. The people were curious but very friendly since there has been almost no penetration by American occulpation forces into this territory. At about 09:30 wse stopped for breakfast in the sunlight and to thaw out a little bit in the courtyard of a farmiihous We were most graciously received by a delightful peasant family who prepared some hot tea for uis. They also seemed very appreciative of our own food that wve in(luced them to share with Us. \VTe departed good friends, leaving some packages of chocolate and cigarettes. As the day warnmed, the trip through the ImlouIntainous Hyogo prefecture becamle even more delightful. There w-ere sharp ridges andl peaks covered by the deep green of pine forests rising above terraced paddies full of dark water that reflected mountains and brilliant sky. Our progress toward Himleji w-as slow because of the detours. \Ve entered this beautiful city at about noon. Here there was a story-book castle reminiscent of the one at Hiroshima as seen in pre-wxar photographs. The building, gleaming white, rises to a tower of mainy levels with Voliiine 38, Orlobet-, 1965 swN-eeping graceful grey tile-covered roofs and an ornate top story. \Vre took timiie to explore the building wlhich wNithinl actually is a simaple wooden structtire w ith rough walls. Jshii told me that truly ancienit castles are rare in J.apani since fires on the average burn the Japaniese cities at eighty-ear intervals. The castle is set in a lovely park of grass and trees that adds to its beauty. We left Himeji reluctantly and proceeded alonlg a splendid road to Kobe wvhich we reached 1 2 houirs later. This is a large commlllercial center, much of it devastated by bombing and fir Kyoto was not far and w e mlade off along a crowded highwvay to reach our destiniation at about 4:00 p.m. The Surgeoni's office was at Sixth Army Headquarters wN-hich occupied a tremlenidous black building, the Daikan. In the Surgeon's office was Col. 'M. DaN-soni Tyson whose namiie was quite familiar althouglh I had niever mlet him. He had beeni on the house staff in pathology at Yale before continuinig in surgery. In civilian life he had been one of the seniior surgeons at the Hitchcock Hospital in Hanover, New Hamplishire w-here there w-as a large niucleus of Yale-educated mne(lical mieni. I was assigned a rooml at the Biwsako, but before proceeding there it was necessary first to find quarters for Dr. Ishii. Suitable lodgings wNere founld at a ramiibling Japanese hotel labeled "Off Limits." An additional difficulty was that MNaj. Kramiier and Capts. Rosenbaum and Loge were quartered bevonld the center of the city in a tall white commllercial-looking building remiiniscenit of the Dai Ichi. At long last found Jack Rosenbaum anid the others. They reported that they had imiade excellent progress in collecting anid transcribing the clinical data anld that there wNere onily a few imore days of work left to (1o. \We went to the Mlivako. the mlost splendid hotel in the city, used for senior officers' quarters. We all enjoyed the retunioni over cocktails and( a delightful stupper of roast beef. The tisefulniess of having otur own tranisportation nows became obvious since I dliscovered that the Biw-ako wx-as far otut of towx-n on Lake Biw It wsrs dark and(l the miiap was diffictult to follow after leavinig the miiain road. There were a few smiiall sigins in Ei-iglish which had to be read by flashlighlt, but at lonig last the hotel was fotund oni what seemiiedl to be a smiiall islanid connlected with a bridge to the miiainlanid. This was obviously a resort anid I was given ani immillenise dlouble room with private bath. There crisp cleani slheets anid the soft mlattress soonl received a tired body. Entertainmiiienit wx-as in progress and the Imlusic of the samnisei was a lullabv onlv briefly heard. It all seemed like a dreatm after Hiroshimn Smndav, Deccuuibcr 2: WVoke rather late but refreshed. Happily, breakfast wvas still being mlost graciously served by persoIns wN-ho behaved like couirtiers. Tlle Biwako was indee(d loxely throtuglhot.t w-ith hulge commlnlon Him-oshintia Mlledical Diari, 1945 V rootmis anid delightful lawns and gardens. Fromii my secoiid-floor window the loftv hills on the far side of the lake N-ere reflected in the blue water. Since I knew we wsould have imiuch to do in Kyoto anid since I had not miet the Surgeoni in comminianid I returnied to Headqtiarters. To my stirprise even the senior officers w-ere ther I wxas introdtuced to Gen. Haginis. The General wN-as a bit suspicious of our ImlissiOI, since the intact and(I lovely city of Kvoto had becomiie a miecca for those of the military desiring a real taste of Japanese life in its pre-wN ar stat I informiied him that all of this had happenied while our backs wxere turned on the rest of the coutntr during our labors anid that our imiajor aimii was to obtaini materials anid records fromii various lJapanese instittutionis. I then becamlle the recipienit of a onie andl olne-half hour lecture on the world in general anid especially on how wicked the 'Negroes wer I was anixiotus to leave hlis office to visit the Kyoto University where Ishii had told mle a pathology imieeting was to be in progress. AMany of the senior pathologists of Japan were ther I had the l)leasure of miieeting at once Dr. Riojunl Kinoslhita w ho was H e spoke English beautifully. They repaired to Clhiniese restauranits in the vicinity which were in operation but, unfortunately, off limiiits to nmilitary personnlel and I had to conitenit myself with the remnianits of a "K" ration. The grouinds of the 'University w ere delightful in the bright stunislhinle anid the lunich was enjoyed in solitud Then returned to the mleetinag where solmie beautiful pathology was shown. Among the finiest denmonistrations, the lectures bein-g incomprehensible to me, was that of Hamiiazaki who spoke on cytological details in diseased tissu It was a pleasure also to meet the w-orld famiious hemiatologist of the Ulliversitv, Dr. Amiianio, w-ho seemiied reserved and depressed. I was told that he lhad been with the group that had been lost in the landslide during the typhoon of micld-September. Dr. Kinoshita said he had several autopsy cases fromii Hiroshlimila available anid invited mle to visit his institute at Osak I had to leave before Prof. Tanabe, who was speakinig, wvas finiished, but ultimately the slides that he had promised reached me through the kind offices of Dr. Ishii. Late in the afternion had supper at the AMivako xN-ith Col. MIason. While there boughlt aniother beautiful satsutiiia powder box anid somiie woodeni bamboo cigarette cases. 'Most imiiportant of all w-as a lovely strinlg of pearls. designledl for C.G. Col. AMason had already investigated all of the local stores anid provided miie w ith details as well as with a miiap. Then homiie to the Biwako through the dark but still lovely counitrysid Deccuiber 3: Early in the morninig ic-went to miieet the physicians at the were well-received anid they gave us all of the Prefectural Hospital. We presiding. Voluttie 38, October, 1965 gross mlaterial from the few cases that wsere availabl At this timle also saw for the first time films that had been made by the staff by exposinlg roentgen films to the bones of the bomb victims. These seenm to be artifacts, since the outline of the bone was (1) sharp, (2) translucent in contrast -with the black of the rest of the film. At Headquarters in the later morning was interrogated at length by ILieut. Col. Bogue of G2 who delved thoroughly into my past history, recent and o0l, apparently considering our wlhole mission suspect. I produced a copy of our orders of Oct. 12 and informeid him that all cooperation would be expected, or I w-ould find it necessary to coml-municate directly with Headquarters in Tokvo. This produced a marvelous effect, since the requiremiient for assistalnce from the Sixth Army wNas quite clearly indicated. Called on Prof. Amano in his crowded laboratory at the Kvoto lUniversity. \Ve had a somiiewhat halting disctissioni since his English was far from fluent. Dr. Ishii was most helpful throughout. After some hesitationl Prof. Amano informed me that the hematology slides of the three earliest cases whiclh had been auitopsied at Ninoshimia would be nmade availabl I then asked himii to collect this material for the followving morning in time for 9 o'clock. Dr. Funaoka, the Professor of Anatomy, was also consulted anid stated that some of the autopsy material was still at Kanazawa University on the \Western side of the country but that he would telephone to expedlite the transmittal of the material. The late Prof. Sugiyanma had taught at Kanazawsa in the past. Deceiwber 4: Promptly in the morning went Nith Dr. Ishii and received the slides from Dr. Amano. He appeared to be a very sad mlan indeed and recounted how he had lost his wife and child. WN7hen w\e went to see Dr. Funaoka he regretfully said that he had not had a reply from Kanazawa but that the material would be forthcoming, perhaps by 3 :00 p.m. In the meantime we had been invited by Dr. Amano to visit a MIrs. M\Iiura who was German and wlho wishedl to meet an American. At her home w%e wN-ere served a delightful tea, with Germani kuchen. The conversation also was bilingual, in German with me and in Japanese with Drs. Amano and Ishii. A very pleasant interlud \When we returned to Dr. Funaoka's office at the University were glad to find that the slides had indeed arrived from Kanazaw However, the gross nmaterial had been taken away by Lieut. Col. French who w-as conducting a survey of Japanese laboratories for SCAP. This put an additional complication into the problem, but we had some confidence that this aspect could be rectified ultimately. Gradually various local intricacies camiie to light: Dr. Amanio also proved to have some slides Hiroshlimlla Medical Diary, 1945 L of the Ono cases. Dr. Fukutani, a mlemiiber of the samle departmiient, had additional slides on the same cases bnt from different organs! Also Dr. Fukutani had all of the Ushida slides. This remarkable fact resulted from misunderstandings that followed the early happy leadership of Sugiyama, a fine hematologist and pathologist who had been a studeint of Prof. Kiyono, after whom the institute at Kyoto was named. Further complications were that a member of the Kyoto group had been asked to leave the auitopsy room at Nagasaki because, without permission, he had apparently begun to tamper with some of the material that had been acquired by Commllainder Shields WNarren. T he matter wvas finally resolved by asking Dr. Ishii to call Prof. MIori, the Chief of the Institute of Pathology, on the telephone in order to request his help in obtaining representative slides. This was finally accomplislhed and the mystery of the errant slides was finally solved. A nuimiber of the slides required remounting because they had become stuck together. W\e said that w e would return on the 6th for thes Decemslber 5: I left Dr. Ishii in Kyoto to complete the hagglinog about the slides in his ow,n quiet and efficient manner anid went wN-ith Dr. IshikawN-a to keep my appointment with Prof. Kinoshita in Osak On the w-av wve stopped at the Takatsuke Medical School to pick up two important cases for the Nagasaki group. There we met Dr. Eguchi, who was very gracious and gave me, without stint, all of his important material and an excellent set of clinical and pathological records and slides. While there Dr. IshikaN-a volunteered the information that he had just acquired from Dr. Eguchi that Dr. Kuno of the Japanese Naval Hospital at Iwakuni, who still had in his possession some of the best of the early material, was living nearby. \Ve went on a most interesting hunt through the residential districts and finally found Dr. Kuno's wife and charming daughter and father in a clean and lovely Japanese hom There after introductions and tea, a long letter was left by Dr. Ishikawa in the hope that it would be aniswered by Dr. Kuno. WVe proceeded to Osaka and, after dinnier in a small Japanese restaurant fortunately not labeled off-limits, went on to see Dr. Kinoshita at his department. He was most cordial and after delivering a tirade against the mix-up caused by Col. French's intervention, through no fault of his own, finally produced the specimens that were needed. These included both gross and microscopic material. He discussed some of his own investigative work on nutrition. One set of studies was made on prisoners who had a reasonably constant diet of rice and beans and certain vegetables to a total of 2,200 calories daily, with 110 grams of protein. They, however, Volume 38, October, 1965 developed edlemiia and in somiie inistanices a "cachectic" type of imialnutritioni. \Vrhen five grams of gelatin xvere given (laily good healtlh as restored. or the coniditioin could be prevented if prisoniers were fed gelatin initially. He had continuEtedI his researclhes. Amiiong other pieces of researclh were: 1) \Vork oni the hiistogeniesis of chickeni sarcomas. He believed that they arise fromii adventitial cells. 2) In the buttter-yellox- wxork that hadl gained him world-wN-ide famiie, catalase may be tised as ani index of whether or lnot the liver is gOnllg to become canicerous: It decreases slharply miuiich before the tumilor is grossly detectabl Dr. Kinioshita lhad )been in the tTIjited States imianiy tin1es, lhadl a Caucasiani wife, and wsas fully famlliliar w itlh the W\esterni wN-orld. Theni after a v-ery lonig anid w-earinig but remarkably interesting (lay back alonig the busy road to Kvoto throtuglh the gatherinig dark. Decedwer 6: Oni this, whliclh wsas to he our last day in Kyoto, founld tllat our Japaniese colleagues lbad already l)urchased tickets ancd that there was nio prollem in getting themii 'lhomiie" in the miiorninig. WVent again to the University anid received the bone-marrow slides fromii Dr. Amanio and also calle(d oni Dr. Funlaoka wN-ho was niot ther I was, howN-ever, advised that hiis miiaterial would he in readiniess later in the afternooni. Another lonig talk x-as lhad w-itlh Dr. Amiianio conicerning hemiiatology in genieral. He seemiied miiost pleased at the gift of soal) anid butter and eggs that I lld broughlt for M\rs. Mitur * Prof. Amiianio lhad been ani authlor, x-ith Prof. Kivono and Prof. Sugiyamiia, of an outstandinig book, putblished in 1938, Die Lellre der Vitalfiirbiulil. Since the war he has written a 'large hematology text of his owsin. * Early in the afterniooni I finally xvent to the finanice office and discovered that I Nas owed what seemledI to mle the enormiious sum of 11,253 yenl, which included al)l)roximatelv $220 worth of undeserved per diemii. This was a solmieNwhat illogical, but nevertheless useful. consequence of orders to live in a place w-here it was almlost impossible to spend moniey and where wxe were almost completely isolated and confinled to standard field rations. \With this tremiienidous anmounit of money inl hland, I was ready to buy a few little thinlgs anid this was accomiiplished in a tril) about the city wsitlh Dr. Loge-a silver cigarette box, a lovely satsitumia bowl handand decorated( now scarce, anid a red lacquer tray and bowxls. Then rushed back to the Biwako, signed out aiud quickly lpacked all belongings; then to the traini. There was a long but not too un1pleasant wN-ait in the station. IIiosIlii(la Medical Diary, 1915 The berths in the Japanese trains were comifortable but fotur men wN-ere in a single roomii, and only one at a time cotuld dress. Dcceulibc'r 7: Oni this anniversarv arrivred againi in Tokyo about 1'2 hours late, fotind the Surgeon's office and received at once a coturteous offer of transportationi. In the imieantimiie took a "taxi jeep" to obtain our own jeep at the Shiodomiie yards, which I thotuglht might have arrived by this tim It was there but wvould not start anid had to be dragged off the flatcar. Inspection revealed that the rotor had been taken out and that somiie of the wires had been stripped. There was nothing to do but wralk back to the Sturgeon's office and obtain transportation after signinlg in. A blessed quantity of mail was waiting. I was l)leased again to be assigned to nmy old homiie, the Dai Ichi. Obtained rooml 858 wlhich Nas sans bath, but a roomii witlh bath wN-as promiiisedl soon. In the mid(dle of the afternoon imiet Lieut. Col. Barnacle who Nas takinig the Chief Sturgeon's l)lace pro tem. He was in every way kind and pleasant. Col. Ouightersoin was there anld seemiied satisfied with the tultimiiate otutcomiie of the work. He also said that we wouldt l)e or(lered back jtust as sooni as he ha(l retturneid to the Ulnited States. Decenider 8: Our records had been delivered to an office in the Strgeon's division that was to l)e assigned to imie for the remiiainder of miiy timii \Veent to the University and fotund Dr. Hatano wlho wanted to take me to the Tokyo First Military Hospital. At the University also met Dr. Tsutizuki who, to my surprise, was performiiing a hysterectomy, and Dr. Mitani. Dr. MIitani offered mle his sw-ord and said this wvas a family heirloomii, an "old sw-ord" mlade at least 400 years ago of (IrawNn Danmascuis steel. The scabbard anid hand(Ile he said were mloderni anid witlhout particular w-ortlh. I said that I shotild be glad to keel) the wxeaponi for him in token of otur friendship) btt that I would wish to returrn it whenl tlle political circtumstanices againi permitted. He said that he considere(d it a symbol of miilitarismii anid that he no longer w-anitedl it in his family and w otild tturn it over to miie in a fewlays. d At the hospital it Nas a pleasure to imieet againi Gen. Hirai and AMaj. Misonio and for the first timle Maj. Ohashli a pathologist who had lone mnanx of the autopsies at lUjina dturing Septemiber. All promiiised to have preparecl the autopsy tissuies that had been ctit in Tokyo w\hichl wN-ere related to the protocols that we had been tranislatinig in Hiroshilmla with Dr. Ishii. Ani appointment was made for -Monday imiorninlg to mlleet these gentlemen againi wN-heni everythinig was to be in readiness. Gen. Hirai promiiised to have imiaterial fromii the patienits atitopsiel by i\Iaj. Yamlashilna on Ninoshimia Islanid in the first few (lays after the bomibing. I had alreadl' Voluine 38, October, 1965 Jinv 26, 10S7 Dr. Jaeushi Mittai Departnt of Obs. & Oyn. Osaka National University 0saa, Japan Dear Dr. Mitanis aUy recall that yu entrust d pur :mily sard to my poe sesion duing tbe days of our ooepeatUon in Hiz1os*z. I 3mw Al Cooaiderd this a- trstoeshxip of an beir2es, to ths time Mo.n lt migat be posible to rtun it. It may, of oom et be tiat you n lo ger bav an interest in suh a military symbol. In that initanwe I inten tc keep it a a memnto of a busy eAd bM) time that vbd toang d ta p.tber. v I *.ry :much interest in bow ,iou are gettng on ij or present activities. With awry good wisb. Yours snorelly, Join'.lads Ely Professor of Pkatholog AALust Reproduction of carbon copy of letter offering return of sword to Professor Mitani. Averll received some of this material from Dr. Amano, including bone marrows and certain tissues obtained by the late Dr. Sugiyam Dr. Hatano also said that Dr. Kusano of the Tokyo Infectious Disease Institute had done some autopsies at Saijyo of Hiroshima patients and that he would gladly give us material. We then went by jeep in search of the Institute but had failed by closing time and returned, somewhat disgustedly, hom December 9: Drs. Oughterson and LeRoy had received orders to return and were to leave tomorrow. George LeRoy's father was ill. After L 4h Motoomachi Nagasaki, Japan July 15, 1957 Dear Dr. : I have just read with pleasure your letter which was I beg your pardon for forwarded from Osaka University to m I have always recollected your kindness and my long silenc courtesy during the days of our cooperation in Hiroshim I know that you are-now working especially on lung-pathology. Concerning the sword which I presented you before, I hope you keep it as an expression of my appreciation. I was appointed as a professor of Ilagasaki University in 1947 and have worked to reestablish our department. After coming to Nagasaki Mrs. Mitani had suffered from pulmonary tuberculosis for a few years, but she has recovered from it completely and is now enjoying complete health except decrease of vital capacity caused by thoracoplastic operation. Our only son Hiroshi is now attending to the school of technology of Tokyo University and is expected to be graduated from it the next March. I myself have been always healthy, grew fat and my hair has become thinner. I am now majoring in uterine cancer and chorionepithelioma malignum and have published several works on them. Most of them were published in Japanese and I don't think it adequate to present you those copies. But I should like to present you some copies of our works published in. Enclish under seDarate cover, and hope they will be of some use to you. I suppose you have several children by now, and I hope I hope to have the opportunity your family are well and happy. to see you again in the neir futur Yours sincerely, Yasushi Mitani, M.D. Professor of Obstetrics & Gynecology, Nagasaki University Letter iiidicating refusal of Professor NMitaini to receive swrord. f'olzittie 38, Oclobei-, 1965 packing a number of itemiis to be brought back personally by Dr. Oughterson, spent the afternoon at the zoo with Maj. Kramer and then wanidered through the beautiful park oni the crisp afternoon. Then a quiet evelling at home, broken only by a gay celebration in honor of those departing. At least some of us were on the homecom--ing path. * Decemiber 10, 1945-Jan iary 25, 1946: It would be best to contract rather than to give a daily account of what seemiied to be anl encdless timie in Tokyo before orders came to return. One name and one number on the endless roster of those with the same desire has a special importance only to oneself. Had I then more of the philosophy of the country where I was now an enforced guest, and w-ere there not a special Nedding to attend more than 7,000 nmiles aNay, I would have taken inore joy in the privilege that was min During this timiie there was opportunity for becominig better acquainted in their owin setting with the brilliant men of Japan who had worked so diligently with us at Hiroshima-a fact that I did appreciate then, and value even more highly now. MIJany have indeed fulfilled the promise implied in Prof. Tsuizuki's choice of them for this work twenty years ago when they w-ere very young men, and they now occupy positions of leadership in Japanese medicin As it was, there were still two weeks of labor to gather up the loose ends. On Monday, December 10, at another visit to the Tokyo First Military Hospital, the autopsy imiaterial was indeed ready. It incluided the three earliest cases atutopsied by Maj. Yamashin At this time also, AMaj. Motohashi showN-ed imie some superb photographs of patienlts with petechiae, ulcerative lesions of the mllUcous membranies, and epilation from the earlier Ujina series. He said that they had all the prints required and graciously presented the glass negatives. I did finally have the pleasure of meeting Dr. Kusano at the Institute for Inifectious Diseases anid he likewise supplied the Saijyo imiaterial. Our records, histological slides, and gross tissues N-ere now largely in order, except that w e had very little material on the ey Although interesting effects oni the eyes had been (lescribed by the well-knownsi ophtlhaltmiologist, Dr. Takehisa Oguchi (after whomi a here(litary type of nyctalopia has beeni namaed), N-orking at the Kaijini Kai Hospital in Kure, anid although extenisive notes had been taken by Dr. MIason, we had almost no tissu On iniquiry of our good friend Prof. 'Miyak with wN-hom I hadl briefly disctissed the subject before, I fouind that Prof. Shoji of the Eve Institute andl he were planniinlg a collaborative study of the eyes, but that the sections had not as vet been prepare(l. Prof. Miake Hir-oslim.,il AMedical Dia ry, 1915 LI EBOW said that he wsas planning to share this mlaterial wvhen it had been embedled in celloidin and cut, alnd these blocks did indeed reach us soimie six mlonitlhs later. I was informeed also that a documiienitary filml had beeni preparedl at Hiroshima by the Nippon Eigasha late in Auguist of 1945. but that this had not been completely developed. After much discussion witlh Mlessrs. Kobayamla and Aihara, of that Company. the film was developed and on December 19 viewed in the Surgeon's offic As expected it was a remarkable record. Its possible use for propaganda purposes was also not difficult to visualiz The film had been made on nitrate rather than safety stock but a copy was retained and sent to the United States for use by the Amlericani component of the Joint Commissioni. Of greatest help in obtaining the all-important building plans were Drs. .Murai and Murachi. Those of the broadlcasting station wvere the first to come to hanid, on Decemlber 10. \Within another w eek blueprints of the Communication Department buildings xvere located. This representedl the bulk of the mlaterial needed. Those of the Central Telephone Office were found later and those of the Bankers Club Nere located after considerable detective Nork on the part of Drs. M\,Iurai and Murachi at the architect's office in Osaka and were subsequently (lelivered. In the mealntilmie mlaniy w informative discussionis were heldl ith these tw-o remarkable mlen who had been calculating slhieldilng factors in a preliminary way. They were also most kind in showing me miuichl of Tokyo that I would have missed otherwis On December 14 all of the Amiiericans of the Joint Commiiiiission who reiiaiied Nere entertainied at a splendi(l dinnlier at the -Militarv Hospital, with all of ouir Japanese colleaguies in the military, an(l manv of the younger civilians in attendanc There was plenty of "Suntory" a fine whiskey with the taste of Scotch. The best of the tradlitionial Japanese (lislhes were served, complete with enitrees of raw fishl anid squid. alnd endlless quianitities of warmii sake to wash the many courses (lown. The spirit was a token of comradeslip based on personial uinderstanidinig that developed uniider stress and( on recogiition of miierit and that crossedl barriers of race aln(d politics. Mlfore than thlis, it was a tribute to the wisdom of Ashley \W. O)tihterson that the ounger of mas noy have possessed. llOt As to ouir personal affairs, we learnedI for ourselves wh-lat hals lonlg beenl known that there is niothlilng miiore irksome thalni a delay in getting lhomiie after loong x-ar. AMuistering ouit on "poinlts," of which wve had a great sIfficiencV, couldI have been arranlge(l at onice, -et this woul(l precltule ftulfilling our resj ,onsibility for writing the report. The imiatter was especially Volume 38, October, 1965 comiiplicated in my case since certain notes were still in shorthand. When Col. Schwichtenberg returned on December 12 he reiterated what Scotty had said, that Ne would have to await orders from Washington. W;e were relieved to discover that someone had thought to assign us to the Eighth Army, since our original orders had called for our return to our original stations, wlhich in our case would have been the Marianas-perish the thought. WVe therefore presented ourselves to ASCOM in Yokohama and were delighted to find Brig. Gen. Earl M\axwell in charg Gen. Mlaxwrell had been the Chief Surgeon of the Army in the South Pacific, where I had comiie to know him well. He and Col. Snyder Nere sympathetic and said that they Nould take good care of us while we were in Japan. Lieut. Phil Loge, soonl to be Captain, was assigned to the 42nd General Hospital in Tokyo Nhere he was very happy and wrhere we all spent mally pleasant evenings later. Maj. Kramier was made Chief of the AMedical Service at the 334th Station Hospital in Yokohomii Rosenbaum and myself were to be left to our owsin devices in the Chief Surgeon's office in Tokyo for tlle w mlomelent. Later Rosenbaum Mas assigned, "condemned" as he put it, to the 334th. Gen. AMaxwell iiivited Jack and me to dinner oli the folloN-ing evening in his quarters at the New Grand in Yokohama, an establishmnent of faded hut substantial splencdor that had been MlacArthur's first home on hiis returni to lapan. The General, always good company, was at his best and was reinforced by Col. DeLorimiiier, Chief of the ArmiSy School of Roentgenologv. \Ve particularly enjoyed reminiscing about persoiialities in the Yale Hospital Unit as it had been in the South Pacific, anld particularlv about Cols. Paul Harper and Scotty Oughterson hiinmself. Tlle evening dlidl much to bolster our spirits, but it wsas still only Decemlber 12 anid wX-e were destined for a long wait. Contacts w-ith Dr. Ishii were only occasional, as he w-as busy writh his owin affairs. It wvas on Saturday, December 15 when he presented me with twN-o thiiigs-a treasure of a blue and red obi for my bride, and the letter in w\hich lie told for the first time of lis plight. Successful efforts were lmlade to obtaiii a position for him, and tlhereafter, having survived a siege of typhoid, possibly acquired dutriiig the mneiiiorable autopsy on the youing Upper. iMembers of the Joinit Commiiission, December 1 945. From left to right Lieut. J. Philip Loge, the late MIaj. Milton L. Kramer, and the late Capt. Jack D. Rosenbauni. Iliddl The Dai Ichi buildinig, Headquarters of SCAP, Janiuary 1, 1946, decorated for the New Year. Lower, A part of the immense crowd awaitinig the arrival of Genieral MNacArthur oln New Year's Day 1946. The ladies are -wearing -ay kimionios for the first time in public. lfii-oslhii,a lle(lical )iary, 1945 IAEBOWV Volume 38, October, 1965 from the Red Cross Hospital in Hiroshima, things began to go better. He was appointed to the Professorship of Pathology at Shinshu University in M\atsumoto. \Vre made the best of Tokyo, enjoying the sights and the sounds of this great capital. Amiiong the most pleasant were made by the violinist, Mari Iwamoto, by the Nippon Symphony, now revived, and by a choir, mixed Japanese and Americani, singing the MKessiah together. In the interval of three months sinlce our coming, the city was showing definite signs of recoverv. MIuch of the rubble had been cleared. Scaffolding, often a spiderwork cunningly fashioned of bamnboo, Nas rising and stone and concrete wsere filling old wounds. Shops were bright with wares. Christmas camle and the Dai Ichi building across the mloat from the Imperial palace xwas swvathed in green and illuminated, somewhat garishly, like a card. On the sparkling afternoon of January 1 a vast crowd, the ladies now for the first time in public dressed in colorful kimonos, stood in a respectful, almost worshipful, silence as Gen. MacArthur arrived at his headquarters. The New Year's greeting oni the building seemiied to be intended for civilians as wvell as for the occupation forces. \Without signl or sound from \VNashingon and the first w eeks of the New Year gone, I wvas tempted to accept an opening for a return passage as commiiiiandinig officer of a hospital ship, a purely administrative post, but one that wN-ould have brought me by way of Okinawa and taken at least 30 days. It is good to report that a miore temperate judgmiient prevailed, for on the 20th, in response to the urginigs of Col. Schwichtenberg at this end ancd possibly fromii the patient Oughterson at the other, the blessed orders camii Although miiost of the Commllission's impedimenta had gonie back, I lhad retained eniouglh records to keep miiyself occupied in preparing some drafts of portions of the final report. These plus the slides and records and blueprinits and the tissues miore recently acquired made a sizable package of somiie 250 pounds, which w-as sealed in a trunk, labeled "Secret," and returnied wN-ith mie as courier, at a high priority. The difficulties of the returni w-ere minor indeed comlpared to its joys. There were, inevitably, engine repairs oni our elderly C-54 at Kwajalein; a very unmilitary custoimis officer at Honolulu asking suspiciously whether there were any seeds or feathers in the sealed and inviolable trunik, and sniffing, to my embarrassmient, at the soiled and atom-burned clothing in my personal luggag But then fresh HaNaiian pineapple and scenery for a day; two days in San Francisco; and at last a landing in four inches of snow at the WVashington National Airport at 1 :00 m. of a Saturday morning. For a time we considered ourselves lucky for the pilot was on the point of returninig patient Hiroshimla Medical Diary, 1945 across the Alleghenies, but decided to chance it, and won. Although the airport was cozy enough, WVashington snowstorms in 1946, even more than now, had the unhappy effect of isolating us. I put my sealed trunk in charge of the security officer and decided to doze until the thaws cam Only the arrival of Gen. Joe Collins on a later flight saved us. He had been commander of the 25th Division and we had met him many times as a frequent visitor to the 39th General Hospital. The General with his customary grace, delivered some of us to our hotel, the Sheraton Park, in his staff car and ordered the driver to come back until all were rescued. The warm bed was welcome, blut even mlore the joy of being back at last. 4. Q.F. Early in the morninig of january 28 when I reported for duty, as ordered, to Col. James Earl Ash, Commanding Officer of the Army Institute of Pathology, I saluted as smartly as I could. This courtly gentleman vas astonished, but regained his composure sufficiently to return the courtesy. Forgiveness was not long in coming, and he said that he had been expecting mne and that Col. LeRoy and I had been assigned a special roomii for our work. This was a large chamber separated from the remainder of the second floor of the wonderful old Army Institute of Pathology by a ten-foot wrall. Thus immilured, our records could stay in the required security. The Institute, located at 7th Street and Independence Avenue, with its back to the mall, was a structure dating to a time not long after the Civil \Var, with the large windows and pleasant inconveniences characteristic of that er Enclosed in its dingy but glowinig dark-red brick and nlustv woodwork were one of the greatest medical libraries in the world and the treasures old and new of Army- medicin Here the relics of Lincoln's assassiniation were reverently preserved together with medical miemiienitoes and records of all the wNars. But more than this, it was a treasure house of the science of pathology an immense storehouse of tissues and of the thoughts of the men who had examined them. Both as an itemi in the history of warfare and of the substance of science there was no mlore fitting place to Nhich the collection that had been gathered in Japan should be brought. Nor was there anywhere a place better-prepared to facilitate the preparation of a report. \VNhile the Institute Nas military in its origin and affiliation, it had been filling an honored function as a consultation center for pathologists throughout the wvorld. 1Iost important was that it was permeated by the fatherly spirit of "Didi" Ash, a scholar inl his oWIn right, and it had about it an Emersoniani atmosphere of "con- tented industry." l'ollittie 38, October, 1965 \VNhen I arrived Col. LeRov was off to Rochester on temporary (lItty. It was a relief to find that everything had comle safely across the Pacific. I was sooIn made acquainte(l -ith the procedures of the Instittut A single accession numlber (#158930) Nas assigned to the entire collection, ullder which it remaiins to this day. WN'hile awaiting orders for leave, I began to unpack with the willing help of Capt. Edward B. Smith. The five-gallon water cans had serve(l well andl the tissues Nere identified, blocked and cut. Recordls were put in order and everything was gotten in readiness. Discussions were held with Col. Oughterson and Ash regarding a secretariat whiclh obviously wN-ould be necessary. In the nleantimiie I called C.G. and was pleased to discover her willingness to come to New York. Our "engagement" lasted only ten days and w e returned happily, after being married in Rochester, to Washington late in February to share the first six months of our marriage with the atomic bomlb. The first task was to decide upon the basic structure of the report ancd this was done in consultation Nith Col. Oughterson. Although he left the military service soon after our return he maintained contact with us by frequent visits to Washington. It wN-as obvious that the work would have to represent the confluence of four main streams of activity: 1) Statistical analysis of the data, 2) illustrative wvork, 3) the shielding study, 4) preparation of the body of the report. Col. Oughterson arranged for the statistical work to be (lone at the office of the Air Surgeon through the cooperation of Col. Robert Lyons, Chief of the Biometrics Division. The Joint Commission was most fortunate to obtain the services of 'Maj. Cuyler Hammond*, and he was assisted by Dr. B. Aubrey Schnleider, and Capt. Henry L. Barnett. The first task was to set tip a code and key, at whichl Dr. Harmmond wNas a past master. It required extensive constiltation on the tise of ternms and on the clarification of certain ambigtiities, insofar as this w as possibl This he obtained from Capt. Barnett and froml the others of us by an exchange of ideas and frequent exchange of visits across the Potomlac. It was an education in itself to work with a man of MIaj. Hammond's background, intelligence, and integrity. The results of this statistical analysis in thenmselves occtipy one stotit volutie of the Joint Commission * Dr. Hammond's outstandinig talents later were recognized by his appointment as Chief Statistician of the American Cancer Society, a post which hie contillues to hold. For a time he was also Professor of Statistics at Yal Dr. Schneider died suddenly at an early ag Dr. Barnett returned to teaching at Cornell, aind noxx is Chairman of the Pediatrics Department at the Albert Hinsteini Medical School. V Capt. Browrnell was ptut in charge of systematizing the 1,500 photograplhs that had beeni obtained by the Joint Coimmission. The bulk of the mlaterial consiste(l of phlotographs nmade by himllself and his teamii. In addition many photographs hadl been giveni to the j-oillt Commlilission by several Japanese newx-s agencies, notably Bunka-sha anid Domlei, and( by P'rof. Nishina whlio was in the city within a few\ days of the bombing; there was also the priceless group of glass negatives presented by AMaj. 'Motohashi of the Tokyo First MNilitary Hospital. In addition the personial 35 mnmi. kodaclhromes that hadl been mlade by Col. Oughtersoni and myself proved to be a valuable resource, since manv of the larger color filnms in Capt. Browniell's stock had been danmaged, probably by lheat. The smiiall kodachromes were enlarged and now comiprise an important compolnenit of the official record. Capt. Browvnell personally supervised the process at the laboratories of his company, Eastman Kodak, in Rochester. He was responsible also for the reproduction andl enlargement froml the negatives, and the preparation of albumls with appropriate identificationls fronm w-hich the illustrations for the final report wvere selected. Photomllicrographs were prepared with Mr. Roy AM. Reeve, a gentleman of the old school, who was also a muaster of the modern technology for Nhich the Army Institute of Pathology -as famiious. Diagrams and charts ancd other art work fromi our crude sketches were skillfullv prepared by Mr. Harry Nussbaumll. Col. Otughtersoni also had arranged wx-ith the U.S. Strategic Bomibing Survey to calculate the shielding factors fromii the various building planis that had been obtained by this group anid by ourselves. \We were in possession of the survival data for persons in specific positionls in these buil(lings. These had been obtainied largely through the painstaking efforts of Drs. Murachi and MAurai. The arduous xvork of making tlle projections froml the building plans was carried out by Lieut. Col. Herbert S. SwAanson of the Corps of Engineers, assisted by a num-iber of skilled draftsnmen, in the office of Prof. Harry L. Bowmvian who was Chief of the Physical Damage Section of the USSBS on loaln fromii the University of Pittsburglh. These men were housed in temporary buildings (still standing 20 years later) next to the \V'ashinlgtoni airport. Frequent visits were made to ensture the necessary comlmunicationi. As a yokemate George LeRoy Nxas tireless, learned, stimlulatilg, and witty. WNre thoroughly enjoyed being at hard labor for six monthls, particularly as a semiiblance of order began to appear out of the great nebula of data that had been accumilulated. We can say only good things about our secretaries, IMildred Broscious, MIargaret Dismukes, John O'Donnell, clat -Many of the coInReport which is comiiposed chiefly of tabulate(l also imcorporate(I into the body of the report. cluisions were Volziiiie 38, Octobei-, 1965 Agnes Petsing, aiid iMargaret Robb. They wsere niot only efficienit, but tinlcomplaininlg and had a renmarkably high tolerance for persiflag \Ve decided that insofar as possible we would attemapt to compare the effects ini the two cities, writing independently btut in parallel. This Nas possible in miost of the eleven sections iinto whiclh this work niaturally divided itself. V'olutmie I Sectioni 1-Introductioni and sutimmary of the lllost ings. Section 2-Physics. Section 3-The cities. Volumiie II Section 4-.Materials anid miiethods. Section 5 Clinical observatiolls. Volume III Section 6-Hematology. Section 7- Bone mnarroW. Volume IN' Section 8-Pathology. V'olumiie V Section 9-Statistical anlalvsis. V'olumiie VI Section 10-Population and casualties. Section 11 Building and shieldinig studies. impl)ortant filnd- Section 2 on Physics was writteni w-ith the collaboration of R. F. 1\arschak, Ph.D., a physicist. It seemed best to combine data fromii the two cities onl helmlatology anid also on the bone marrow and this section was written by LeRoy, while I took responsibility siilarly for the volume on pathology. The statistical section w-as compiled anid written 1y the teai at the Air Surgeoni's office led 1y Cuyler Hamiimond. Having established the ml-ajor categories, muclh of the early Nork conlsisted of sorting out anid systemiiatizing. For example the autopsy miiaterial fromii Hiroshimia consisted of the records and slides of three of the early patients fromi Ninoshima, anid of 12 from Ujina autopsied by Maj. Yamiiashina; eight in a later group autopsied by Maj. Ohashi; 26 by the group fromii Tokyo Imiiperial Uniiversity at Ujina; two at Tokyo Imperial University itself upon evacuees from Ujina; two performiied at Ujinia dtiriing the time of the Joint Commissioin; 13 fromii Uslhida; 10 from OIno (Kyoto Imperial LTniversity) six fromii the Kyoto Prefectural University; six fromii Iwsakunii, includinig sev,eral very early cases; eight from Okavamia Military Hospital; one from the Okayama MVedical School; 21 from Saijyo; 19 from the Post Office Hospital, performed by Prof. Tamagawa; one from Yodobashi Hospital in Tokyo; three from Osak This represented a total of 141 cases of which two had to be discarded. Most of the protocols had already been translated and redictated into the standard form used by the Army Medical Department. Others were still in shorthand and required dictation. This was the first order of business. Later, as the slides were cut they required study and description. The cases had to be grouped according to distance from the hypocenter and time of death, and the individual findings from the groups had to be catalogued and illustrated. Similar problems arose for most of the other sections. In many instances the completion of portions of the work by others-for example, the statistical analyses-had to be awaited, and the results then incorporated into the general text. As we wrote, ideas were exchanged, debated, and finally used or not until a pattern emerged. This was employed to present the data from both cities whenever applicabl Drs. Oughterson and Shields Warren were frequently asked for guidance, and we were the beneficiaries of consultations wanted and unwanted from a large number of interested persons. We were also the recipients of some lessons in the cold business of war. One afternoon an officer in the Intelligence Section called to say that Dr. Solly Zuckerman of the British Medical Research Council was coming to see m This was a pleasant surprise since I had known Dr. Zuckerman during my medical school days in the early 30's when he was a Fellow in Prof. Fulton's department at Yale; Later he became the Professor of Anatomy at the University of Birmingham. During the war he had been concerned with the analysis of the effects of weapons. The concepts of Standardized Casualty Rate (SCR) and Standardized Killed Rate (SKR) had been developed, terms as cold and gruesome as they sound. It was his mission to learn the SKR and SCR for the atomic bomb. Prof. Zuckerman made us familiar with the methods for the calculation. Fundamentally the SKR is the number killed, assuming a population density of one person per thousand square feet in the area at risk. The latter represents the sum of the products of the fractions killed in each ring zone by the areas of the ring zones. On this basis we ultimately found in Hiroshima that the vulnerable area for the killed was 2.85 square miles, and for all casualties 9.36 square miles. From these data an SKR of 79,450, and an SCR of 260,900 were calculated. This SCR is about 6,500 times as great as for a high-explosive bomb in Britain, assuming a population half in the open and half in British houses. This ratio is approximate because of the dubious Voluitte 38, October, 1965 assumption that the populations under consideration are comparabl These data ultimately reached the British and the world. When Col. Swanson and Prof. Bowman's calculations were completed, the painstaking labor of tracing the persons and projecting the plans of the buildings was finally rewarded. It was found that at 250 to 450 meters from the hypocenter (650-750 meters from airburst), more than 150 inches of water (5 feet, 4 inches of concrete) were needed to protect against death from radiation and more than 250 inches of water and nine feet of concrete to protect against radiation injury. At 750 meters (960 meters from airburst) more than 50 inches of water were necessary to protect against death, and more than 250 inches of water (nine feet of concrete) against radiation injury. At 1,000 meters (1,165 meters from airburst) more than 3.8 inches of water (1.7 inches of concrete) were required to protect against serious radiation injury. At this distance very few persons who were in concrete structures suffered severe radiation effects. When these calculations had been completed, Dr. Victor Weisskopf of the Massachusetts Institute of Technology, one of the consultants to the Manhattan Project, came to see us in order to determine whether the medical data would correlate with physical estimates of radiation dosage at various distances from the epicenter. He had with him a penciled curv It was remarkable that the points, supplied on the basis of an assumed L.D. 50 dose for man, fell rather closely along the curv As it neared its end, the tempo of accomplishment in the preparation of the report actually seemed to increas Some acceleration may have resulted from external stimuli. As September approached my Chief at Yale, Dr. M. C. \Vinternitz, was pointing out with clarity and force that the school year was about to begin. As a last act we prepared a letter for Col. Oughterson's signature that summarized the major findings, pointed out some directions where further investigation was needed, and most particularly stressed the importance of a continuing study over many years of the population that had been exposed. This letter was addressed to the Surgeon Generals of the Army, Navy, and Air Force, to whom the report was duly transmitted. This recommendation was subsequently referred by the Surgeon General of the Army to the National Research Council and was in fact the major stimulus to the creation of the Atomic Bomb Casualty Commission that has continued the collaborative effort between Japanese and American scientists that began with the original investigation of 1945. And so the work was completed almost one year after it was begun. It was the end of many journeys, the end of a taxing challenge and struggle, Hiroslhima Aledical Diarv, 1915 NI -I Rebirtlb of a City: Top. View across hypocenter to-ward tbe Geibi anid Sanwa bank building-s. Tbe wall at tbe left is a renmlanit of the Sbiniia Hospital. The uprigbt tree, stripped of branches, inidicates tbe downward (lirectioni of the blast very close to tbe bypocelnter. At the riglbt are the sbiattered( walls of tbe Banikers Club. Bottomii. Tbe city in process of regrowtb, Marcb 1949. View comparable to tbe abov ancd of can excitinig adv-enituire, ancd the eind aindI the begiinninog of many searchilngs of souil. The uise of this wN-eapoln as w-e contemiiplated it, anid theni miiore wx-hen we saw its effects, and theni even as wve wrote of it, filled Us wNith revuilsion. \V'e acquiredI a symlpatlhy, not for those on the periphery who acquired a Promiiethetus coml)lex and cried cutlpa umia as a mleanis of proclaiming their own imiiportaInce, but for the physicists w-ho bore the