On 20 November 1953, I arrived in Hiroshima via pediatrics, radiation biology, and troop train. Three years earlier, upon completing my training in pediatrics, I did not feel finished. Specialty training seemed too narrowing, so I obtained a little-sought-after fellowship in radiation biology sponsored by the US Atomic Energy Commission (AEC) to train a few physicians in this new broad-spectrum field. After five months each at Duke University for classroom work and Western Reserve University for laboratory studies, the Korean War started. I was called to military service and because of the fellowship was assigned to the Atomic Energy Project at the University of Rochester for two years. After bleeding 96 dogs each day in studies of X-ray lethality, I brightened my outlook by making rounds of the pediatrics ward. There I learned that when X-ray films were ordered for small children they were routinely subjected to fluoroscopy (high doses), as required by the Radiology Department. An unfriendly meeting with its chairman and his staff led to a change in policy, to my review of the literature on potential hazards of medical radiation to children, and to the now-famous studies by Louis Hempelmann of infants who had received radiotherapy for thymic enlargement.

When I heard that John Morton, professor of surgery at the University of Rochester, was to spend six months as interim director of the Atomic Bomb Casualty Commission (ABCC), it seemed that my own short assignment there would add clinical experience to what I had already learned. I was interviewed by Grant Taylor, the departing director of ABCC, and agreed to a one-year term. Soon after, I was in Honolulu for an overnight stay in a $4-a-night hut in a jungle (now the International Market) across the street from its parent, the Moana Hotel, then to Wake Island and Tokyo by Pan American sleeper DC-6–the berth was in what is now known as the overhead luggage rack. Next, a night at the marvelous Imperial Hotel [designed by Frank Lloyd Wright and razed many years ago] in Tokyo, and from there to Hiroshima by US troop train.

Early pediatrics studies

Being in Japan at that time was like being seven years old again and seeing many things for the first time. It was enchanting, and the work was fascinating. We examined about 20 children a day in the clinic, as Japanese children’s songs played on a tape recorder in the waiting room. The patients were 9-19 years old. There was much to learn, much to teach, and fun all the time.

That clinic, which was alive with people and the charm of the children, is now occupied by RERF’s Research Information Center. Our half-dozen young nurses were supervised by Yaeko Hirayama, a former midwife, who had the personality of a lovable top sergeant. ABCC’s chief nurse was Wakayo Ueda, who worked with two American nurses from Duke University. The world may never have seen better nursing service in a clinic.

Wataru W Sutow, whom I was to replace as chief of pediatrics, was finishing his analysis of child development after in-utero exposure. Margaret (Pat) Sullivan from Duke was the other US pediatrician in the department. Pat was a superb clinician, with a special capacity for endearing herself to the children and their mothers. She and Wat went on to become pioneers in pediatric cancer chemotherapy at the MD Anderson cancer hospital in Houston. Also on the staff was Earl Reynolds, an anthropologist, who was finishing his collection of data. Among the clinic personnel were eight Japanese pediatricians and psychometric testers. The youthful staff gave ABCC a campus-like atmosphere.

At that time clinical research at ABCC, as elsewhere, was based on instinct rather than on strict scientific design. Chronic-disease epidemiology had not yet emerged from its famous forebear, infectious-disease epidemiology. The ABCC genetics program was an exception because of its mathematical basis. As a substitute for radiation dose, we used distance from the hypocenter. These figures were kept in the Biostatistics Department to avoid observer bias that may well have occurred had the distances been recorded on the clinic charts. My plan was to summarize the findings for a publication at the end of my tenure.

The most noteworthy observation, already known from studies by Murphy and Goldstein in Philadelphia, was small head size and severe mental retardation among children born of mothers who had received radiotherapy early in pregnancy. Murphy had been a professor at my medical school, where he loved to tell of these findings. It is remarkable that I witnessed the evolution of this story over the next 47 years.

George Plummer was the first to publish on this condition among Hiroshima survivors–seven children with severe mental retardation after in-utero radiation exposure (ABCC Technical Report 29-C-59). There seemed to be nothing more to do until a US television crew came for a story. Their questions led me to realize that we had no denominator for the seven cases. Review of the data raised the number of cases to 15, and another 18 were found with small head size but without mental retardation. Later this lesser effect was found to be six times more common than severe mental retardation.

Other findings of interest were the occurrence of leukemia before 1955 in 18 persons under 19 years old who had been within 1530 m of the hypocenter, visual impairment (due to myopia?) in 20% of the children who were exposed when 6-9 years old and within 1800 m of the hypocenter, compared with 9% among those children of the same ages who had been further away. No such difference was found among the group under age 6, and we wondered if it would occur when they reached the same age as the older cohort. Twenty-six children had persistent effects from the blast or burns. The most common late effect, we sensed, was fear of late effects–at times disabling.

In writing up the results, access to the distance from hypocenter for each child was denied by Biostatistics on the grounds that the data belonged to it alone. This obstacle was overcome by nocturnal visits to the Biostatistics files.

American superstars visit ABCC, staff member takes to the sea

Several extracurricular events were worthy of note.

On 12 February 1954, Dr Morton and I were walking through the reception area of ABCC when Joe DiMaggio and Marilyn Monroe came through the front door. They were on their honeymoon, accompanied by Bobby Brown, who had played baseball for the NY Yankees while a Stanford University medical student. They had come to see Brown’s classmate, Jack Lewis, an internist at ABCC. Within milliseconds everyone at ABCC poured into the area, and we were no longer alone with the superstars. Brown eventually became the president of the American League.

The anthropologist member of the pediatrics staff, Earl Reynolds, decided on an unusual way to return home with his wife and two teenaged children. He had a small boat built and, after some practice outings, was ready to leave for Hawaii with several Japanese crewmen who did not speak English. Naval officers from US ships visiting the area looked at the boat and crew and said they would be lost at sea. Forty-seven days after their departure from Japan, they arrived in Hawaii. Earl published an account of the voyage in The Saturday Evening Post and promptly set sail again. Eventually, he defied a ban on ships in waters near a nuclear-test site in the South Pacific and was arrested. His wife, Barbara, a writer of children’s books, often returned to Hiroshima, where she was held in high esteem as a pacifist.

ABCC and the Lucky Dragon

On 1 March 1954, a US nuclear weapons test at Bikini resulted in fallout on the Marshall Islands and its vicinity. About two weeks later, a Japanese fishing boat, the Lucky Dragon, arrived in Tokyo with its 23 fisherman, who had been living amidst heavy fallout dust. They had been fishing for tuna in the fallout area. Dr Morton led an ABCC group to Tokyo, where they were permitted to examine the men. Newspapers were full of stories concerning the men and the contaminated fish, considered a threat to all Japan. (See RERF Update 5[1]:10-13, 1993; 5[2]:8-10, 1993; 5[3]:7-9, 1993.) In June, ABCC was visited by an American reporter who was well regarded by the US Embassy, or so we were told by Frank (Tax) Connell, the acting director of ABCC, just before he left for Tokyo to welcome the new director, Robert H Holmes. For an hour I told the reporter what we were doing in pediatrics, and as he rose to leave, he asked in an informal tone if he and his family should worry when Japanese newspapers reported that yesterday’s rainwater contained 20,000 radiation counts. I said that one has to compare the 20,000 with the number of counts in rainwater known to be uncontaminated. One should be aware, I added, that in the US the unit of measure was the milliliter, so we would say 20 counts per millimeter per minute. In Japan the unit of measure was the liter, so the 20,000 represented counts per liter per minute. The next day there were Japanese reporters all over the place to interview Lowell Woodbury, the chief of Biostatistics, and me because of our insults to Japanese scientists. Lowell had been quoted by the American reporter as saying that the Japanese did not take into account natural radioactivity in fruits and vegetables, and I had been quoted as saying that they exaggerated radiation exposures by 1000 times. That was my introduction to the new director, who started his term handling that “hot potato.”

Hiroshima Diary by Michihiko Hachiya

Several cultural events highlighted my time in Japan. Soon after my arrival someone gave me a rough draft translation of Michihiko Hachiya’s Hiroshima Diary. The power of the account was heightened by some residual Japanese-English in the writing. Warner Wells, a surgeon from the University of North Carolina on the staff of ABCC, had learned of the work, which had appeared in an obscure medical journal of the Communications Ministry. Hachiya was the director of the Communications Hospital (Teishin Byoin) in Hiroshima. Wells arranged for the work’s translation at ABCC with the help of Neal Tsukifuji. The book lost some of its Japanese “feel” but gained a fine literary polish with further editing in North Carolina. When it was published in the US, in 1955, it received critical acclaim on the front pages of major book-review supplements, such as that of The New York Times. The book was translated into more than a dozen languages, became an international best seller, and is still in print.

Hachiya accepted only a small sum for his work which he put into an educational fund for atomic-bomb orphans. It was said, perhaps in jest, that publishers in Tokyo, unaware of the book’s origin, asked to have it translated into Japanese. After I read the draft, I came to know Hachiya well enough to appreciate his fine mind and literary ability. I rejoiced in the success of his book as it became known throughout the world.