Forty years ago, when the offices of the Atomic Bomb Casualty Commission first opened in Nagasaki, the city was strikingly different from the one we now know. Evidence of the physical damage wrought by the atomic bombing was all about. The University was a shambles; the location of its former basic science departments was marked only by the remnants of the footings which had once supported the buildings these departments shared. The concrete structures nearby, which had withstood the blast, were gutted, cornices akimbo and metal window frames hung precariously from the walls. Of the two tall chimneys which had stood behind these buildings, only one was intact, the other canted dangerously. Urakami church, the largest Catholic one in Japan in 1945, consisted of only a few pieces of red brick wall reaching imploringly heavenward, the arched stone entrances opened onto a weedy void. Broken pieces of statuary surrounded the spot where formerly a church had stood, one possibly not majestic in the tradition of a Chartres, a Durham, a Rheims, or a Saint Peter’s but an impressive expression of awe nonetheless. Streetcars rumbled into the valley over tracks still untrue, and the few houses, where once there had been many, were conspicuously temporary.

The economy of the city was battered; unemployment or underemployment was widespread. Nagasaki’s heavy industry, a major employment was almost at a standstill. Staples were still rationed. Few people could indulge themselves in food much less in tourist travel. There were essentially no local resources upon which a new research institution could call. Indeed, there were even few suitable locations to house the proposed program of study. Accordingly, work began in temporary quarters until more suitable arrangements could be made. Finally, in 1950, the Commission was able to move into the Kaikan which would serve as its home as well as that of the Radiation Effects Research Foundation until the present structure in Hotarujaya was opened a few years ago.

Save for the first year immediately following the cessation of hostilities, Nagasaki had no large cadre of foreign troops; a small military government team and the occasional uniformed visitor were the Occupation’s only presence. Their compound was located on the grounds subsequently occupied by the old Atomic Bomb Hospital, funds for which the Commission was instrumental in raising. A few homes through the city had been rented from the Japan Procurement Agency for the families of this small force, and the Matsuda family residence served as the Bachelor Officer’s Quarters and a billet for transients. Some of these houses would become in time the homes of members of the Commission’s staff.

As in Hiroshima, one of the first programs to begin was the examination of the children born to the survivors, the so-called genetic study, and in the first year or so much of the staff was involved in the scientific implementation or administration of this activity. Every day of the week, irrespective of weather, our jeeps scurried busily about the city bringing examination teams to homes where a child had been recently born. Each family received a small o-miyage, a bar of gentle soap for bathing the infant, as a manifestation of our appreciation and recognition of the tradition of Japanese gift-giving. Other investigations, notably studies of growth and development as well as the first examinations of the in utero exposed, were soon underway. Recruitment of personnel, American and Japanese, attempted to keep pace with the expanding program. It is amazing in retrospect to peruse the early rosters of employees. Our staff included daughters of the owners of Okamasa, Hamaya, and the Sawayama family, and many members of the city’s present medical community, including Dr. Matsuda, the Dean of the Medical School. The late Dr. Robert Kurata was the physician initially in charge of the Nagasaki studies, and remained in this capacity until the fall of 1949 and the arrivals of Dr. James Yamazaki, and shortly thereafter Phyllis and Stanley Wright, all board certified pediatricians. They broadened the in utero studies, initiated systematic pediatric examinations, managed the clinical follow-up of the children of the survivors, and supervised the examinations of the survivors themselves. The first ad hoc radiation censuses were begun, and efforts made to describe more fully the circumstances surrounding the exposure of the survivors.

It was also at this time, indeed in 1950, that I first met Dr. Shirabe, himself a survivor and a most good-natured caring man, whose friendship I feel privileged to know. He has staunchly supported the studies from their very inception, and has given willingly of his time and experience to our betterment. At the request of Drs. Yamazaki and Samuel Kimura, Dr. Shirabe arranged a small informal meeting at which he and numerous other exposed members of the hospital staff described in careful detail their own experiences on 9 August and the days that followed. These hours and the poignant recollections etched the human dimension of this tragedy more indelibly in my mind than any subsequent event. Although I could not share their travail physically, I could emotionally.

Coordination of the program in Nagasaki with that in Hiroshima was difficult; telephone service was erratic and travel between the cities excruciatingly slow and dirty. Neither the main line nor the spur from Tosu to Nagasaki was then electrified, diesel engines were not used and the coal burning ones that were deposited soot impartially on people, animals and the terrain. There was, of course, the sokutatsu-bin, and more urgent instructions were often sent through this special postal delivery system. Most of us with programmatic responsibilities, such as myself, although primary residing in the Hiroshima area, visited Nagasaki regularly.

Through much of the mid and late 1950s, certainly after the closure of the clinical genetics program in March 1954, activities in Nagasaki teetered precariously. They were never as extensive as those in Hiroshima, and resonated more readily to change. However, with the initiation of the Unified Program advocated by the Francis Committee, matters improved. Dr. Isamu Nagai joined the staff in 1957, and assumed responsibility for the Nagasaki Laboratory, giving it sustained leadership that had not always previously existed. Late in the summer of 1959, the Child Health Survey which had begun the previous year in Hiroshima was transferred to Nagasaki. With its impending move, it was clear that the space within the Kaikan which had once been more than adequate, indeed so much so that one evening a week the top floor echoed to the calls of square dances, would not now be. An annex was built immediately to the east of the main building to accommodate the additional examination schedules and office space was obtained in an old two-storied wooden building across the street, adjacent to the shoyu factory. The offices of the Child Health Survey were on the first floor, and if memory serves me correctly, contacting and possibly other sections were on the second. With the beginning of the Adult Health Study and the arrival of the Child Health Survey group, a recrudescence occurred. Some of us still think nostalgically of this era as the “golden years.” But perhaps our memories are colored by the many hours shared at the coffee bar, Colombia, near the main street in Shindaiku-machi. Or maybe they just reflect the bettering of Nagasaki’s economic situation; the shipyards were abuzz, food was no longer rationed, and money flowed.

In 1960, Nagasaki had the largest professional, technical and administrative staff it has ever had, over 10 American specialists and more than twice that number of Japanese physicians. Richard Blaisdell was head of medicine, Jann Brown directed pathology, and Zdenek Hrubec was the resident statistician. Many of the younger physicians have gone on to extremely distinguished academic appointments; Gerald Burrows, for example, is now Banting Professor of Medicine at the University of Toronto and an internationally regarded endocrinologist. We were more integrated into the community then than now, partly as a consequence of our number but also because our homes were widely distributed–in Fufugawa, Minami Yamate, Sumiyoshi and other areas. As members of a neighborhood, we came to be known as individuals, appreciated for our own worth, and through this association the institution we served. Friendships were established that continue.

Community support in Nagasaki has been unexceptionable from the outset. Participation rates in all of our studies have always been extremely high, and continue so, but possibly none have enjoyed the civic acceptance of the Child Health Survey. Despite the inconvenience involved, over 99% of the families whose participation we sought agree to do so. Successive mayors and heads of the local medical associations and the university have endorsed our research and contributed their good offices to new initiatives. At the time the Child Health Study began, for example, Mayor Tsutomu Tagawa not only enthusiastically endorsed the program we proposed, but as a measure of his support gave to me an autographed copy of the history of Nagasaki which had only recently been published. As a further illustration of this cooperativeness, the Nagasaki City and Prefectural Medical Associations have not only supported without qualification the Tumor and Tissue Registries which exist, but have taken an active, constructive lead in their development into the resources we all hoped them to be.

As an institution we have obviously weathered the vicissitudes of the past, but must now confront the challenges of the future. Fortunately, we no longer have to justify our existence; the importance of our research is not a matter of debate. But we need to examine constantly the changes that have occurred in science, and to restructure our organization accordingly if we are to fulfill the promise that has always existed. It is not sufficient for us to know merely what happened biologically; we must know why. Without the latter insight, we will not be significantly richer intellectually, nor will their deaths have ensured us a world free of conflict.