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OCR for page 1
Chapter I
BAC KGROUN D
THE present monograph is designed as a de-
tailed report on certain efforts made during the
period 1946-1955 to provide answers to the
following two questions:
1. Can there be observed, during the first year
of life, any differences between the children
born to parents, one or both of whom were
exposed to the effects of the atomic bombings
of Hiroshima and Nagasaki, and the children
born to suitable control parents, and
2. If differences do exist, how are these to be
interpreted ?
1.1 The general administrative framework of
the study. The study to be described was
undertaken as one facet of a comprehensive at-
tempt to obtain detailed information concern-
ing the various possible late or delayed biologi-
cal effects of exposure to an atomic bombing.
Certain information pertinent to the develop-
ment of the over-all program is essential to an
understanding of the manner in which the effort
to provide answers to the two questions listed
above evolved.
The background of this program begins
shortly after Japan's surrender, when a Joint
Army-Navy Commission made extensive obser-
vations in Hiroshima and Nagasaki on the sur-
vivors of the bombings. At the conclusion of the
Commission's work its chairman, Cot. A. W.
Oughterson, M.C., AUS, recommended to the
Surgeon General of the Army that the National
Academy of Sciences National Research
Council be requested to undertake a long-range
study of the medical and biological effects of
the atomic bomb. This recommendation was
transmitted by Surgeon Gen. Norman T. Kirk
to Lewis H. Weed, chairman of the Division of
Medical Sciences of the National Research
Council. As a result, in June of 1946, a con-
ference group was convened by the Council,
and in November, following its recommenda
1
hon. a tve-man commission composed of repre-
sentatives of the Council, the Army, and the
Navy left for Japan for the purposes of (1)
determining the current status of Japanese work
on atomic bomb casualties, (2) evaluating the
feasibility of American participation in con-
tinued research on these casualties, and (3)
indicating the lines along which such studies
should proceed. This commission, composed of
Austin Brues, Paul S. Henshaw, Lt. Melvin
Block, M.C., AUS, Lt. James N1. Neel, M.C.,
AUS, and Lt. (j.g.) Frederick Ullrich, (MC)
USNR, submitted a report of its findings to the
Council in January, 1947.
The June, 1946 conference group had recom-
mended that appropriate action be taken to
obtain a Presidential Directive authorizing the
National Research Council to initiate a long-
range study of atomic bomb effects. This Di-
rective was issued at the request of the Secretary
of the Navy, James T. Forrestal, in November,
1946, and on its authority the Council, in Janu-
ary, 1947, established a Committee on Atomic
Casualties, composed of Thomas M. Rivers
(chairman), George W. Beadle, Detlev W.
Bronk, Austin Brues, George M. Lyon, C. P.
Rhoads, Shields Warren, Stafford L. Warren,
George H. Whipple, and Raymond E. Zirkle.
At its first meeting, on March 25, 1947, the
Committee on Atomic Casualties went on record
to the effect that a large-scale program should
be organized towards the end of learning as
much as possible of medical significance from
the Japanese experience. Financial support for
the program was sought from the U.S. Atomic
Energy Commission, which, during the fall of
1947, formally signified its intention of financ-
ing the program in Japan.
Ever since November of 1946, i.e., beginning
with the visit of the five-man commission re-
ferred to earlier, there has been resident in
Japan a group of investigators and supporting
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Genetic Efects of Atomic Bombs
personnel concerned with various phases of the
over-all program. This group has been known
as the Atomic Bomb Casualty Commission
(ABCC) . Starting with a scant handful, it grew
until at its peak strength it consisted of 143
"allied" personnel (Americans, English, Aus-
tralians, etc.) and 918 Japanese Nationals.
At the time that the ABCC began its opera-
tions in Japan, that country was of course under
U.S. Military Occupation. It was Occupation
policy that groups such as the Atomic Bomb
Casualty Commission, having to do primarily
with the Japanese people, should work with
and through some existing Japanese agency. In
early 1947, the Japanese Ministry of Welfare,
at the instigation of the Public Health and
Welfare Section of GHQ, SCAP, established a
National Institute of Health, designed to oc-
cupy roughly the place in Japanese medicine
which the National Institutes of Health then
occupied in the United States. Several months
later, in June of 1947, Brig. Gen. C. F. Sams,
then Chief of the Public Health and Welfare
Section, suggested that it would be appropriate
for the ABCC to develop its program in co-
operation with the Japanese National Institute
of Health. Eventually there was established an
Atomic Bomb Casualty Section of the Japanese
National Institute of Health. The personnel of
this Section have been closely integrated with
ABCC personnel, in such a manner as to make
the program truly a combined Japanese-Ameri-
can effort.
1.2 The beginnings of the Genetics Program.
-So well known are the genetic effects of the
irradiation of a variety of plant and animal ma-
terial that inevitably one of the foremost ques-
tions in the minds of those considering the
possible late consequences of the atomic bomb-
ings had to do with the characteristics of the
children of exposed parents. As a member of
the five-man survey commission which went to
Japan in the late fall of 1946, the senior author
was especially responsible for an evaluation of
the lines along which the study of this question
could best proceed. The results of this evalua-
tion were laid before an ad hoc Genetics Con-
ference convened by the National Research
Council in the summer of 1947, composed of
G. W. Beadle (chairman), D. R. Charles, C. H.
Danforth, H. ]. Muller, L. H. Snyder, and Lt.
I. V. Neel. It was clearly recognized by the
members of this Conference that the demonstra
Chapter I
tion of the potential genetic effects of the ir-
radiation of the human species presented many
difficulties not encountered in laboratory ma-
terial. It was further recognized that post-war
conditions in Japan were by no means the most
favorable for a study of this type.
In finally recommending that a rather large-
scale effort be undertaken in Japan, the Confer-
ence felt constrained to make the following
statement:
"Although there is every reason to infer that
genetic effects can be produced and have been
produced in man by atomic radiation, neverthe-
less the conference wishes to make it clear that
it cannot guarantee significant results from this
or any other study on the Japanese material. In
contrast to laboratory data, this material is too
much influenced by extraneous variables and
too little adapted to disclosing genetic effects.
In spite of these facts, the conference feels that
this unique possibility for demonstrating genetic
effects caused by atomic radiation should not
be lost." (Genetics Conference, 1947.)
Although the study which was undertaken
will for purposes of convenience be termed the
"Genetics Program," because of its obvious
implications, it must be emphasized that those
concerned in its organization and conduct have
always regarded it first and foremost as an
effort to collect data on the characteristics of
the children born to the irradiated survivors of
the atomic bombings, data which, if indicating
that the bombs had had some effect, were then
subject to several possible interpretations, ge-
netic and otherwise.
1.3 The early f~pa'~ese efforts along these
lines.- The U.S. Army-Navy Joint Commis-
sion which studied the medical effects of the
atomic bombs in Japan as soon as possible after
the surrender worked in close cooperation with
the Medical Section of a special Committee for
the Investigation of the Effects of the Atomic
Bombs, appointed by the Japanese National Re-
search Council. The members of this group also
recognized clearly the desirability of long-range
studies on the medical effects of the bombs, but
in the organization of such studies were greatly
handicapped by post-war conditions in Japan.
The administrative reorganization of the Japa-
nese National Research Council and other
aspects of Japanese science which the Occupa-
tion sponsored also unavoidably created uncer-
tainties which delayed the work of this group.
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Background
Despite these many difficulties, at the time that
the U.S. National Research Council's survey
group visited Hiroshima in December of 1946
they found the Japanese planning to obtain data
on the characteristics of the children then be-
ing born. This program, under the immediate
supervision of Dr. I. Matsubayashi, was care-
fully reviewed. It was felt to be inadequate in
several respects. Nevertheless, it is certainly a
favorable commentary on Japanese interest in
the problem and desire to carry on research that
plans for even a small program had been set up
under the circumstances then prevailing. This
program was in effect very briefly and then
merged with the program of the ABCC; Dr.
Matsubayashi became a member of the ABCC
staff.
I.4 Scientific arid administrative considera-
tions shaping the r;at?'re of the program ire
fapan. The lines along which the Genetics
Program in Japan was laid out in 194661947
were dictated not only by purely scientific con-
siderations but also by certain practicalities of
the situation. The more important scientific
considerations were as follows:
1.4.! The possible observable genetic ef-
fects of irradiation upon the first generation
born after an atomic bombing are many and
varied. These include changes in the sex ratio,
an increase in the frequency of stillbirths, an
increase in the frequency of congenital mal-
formation, an increase in infant mortality, etc.
Each of these possible indicator of genetic
damage is also influenced by a number of other
factor; there are no knows' antique yardsticks
of genetic damage. Under these circumstances,
the crux of any program of study was the feasi-
bility of establishing control material which in-
sofar as possible differed from the irradiated
only with respect to the radiation factor.
1.4.2 At the time this program was organ-
ized, although there was available a mass of data
concerned with spontaneous mutation rates and
the genetic effects of irradiation on Drosophila,
little was known concerning spontaneous muta-
tion rates in mammals, including man, and,
with the exception of the work of Charles
(1950), still less concerning the mutagenic
effects of the irradiation of mammalian ma-
terial. Largely by extrapolation from the Dro-
sophila material, it could be anticipated that in
the light of the probable irradiation dosages sus-
tained by the survivors of Hiroshima and Naga
3
saki, only very slight genetic effects should be
detected in the first generation. In particular,
it is worth pointing out that although the atomic
bombs were dropped in August of 1945, be-
cause of the various time-consuming administra-
tive developments recounted above, involving
policy decisions and their means of implementa-
tion for the National 'Research Council, the U.S.
Atomic Energy Commission, the U.S. Army of
Occupation in Japan, and the Japanese Govern-
ment, it was March of 1948 before the Genetics
Program as it will be described presently was
actually in action. The first children to come
under the scrutiny of the program were con-
ceived in October of 1947. There was thus a
loss of information for the two years following
the bombing. For a variety of reasons, some to
be discussed below, it was felt that no attempt
to reconstruct the frequency of malformations,
stillbirths, or neonatal death during'these first
two post-bomb years could succeed. The practi-
cal corollary of these considerations was the
necessity, once the program got under way, of a
large-scale effort which would utilize as much
of the available material as possible.
1.4.3 It was apparent from the outset that
the Genetics Program could not and would not
operate independently of the various other facets
of the activities of the ABCC, but as one of a
collection of integrated units. However, the or-
ganization of the Genetics Program proceeded
somewhat more rapidly than the organization
of other segments of the ABCC. Furthermore,
there was for some time uncertainty as to the
scale of operations in Japan. Under these cir-
cumstances, it was necessary to design a program
with a basic, irreducible framework to which
additions could be made later if circumstances
permitted, but the additions had to be of such
a nature that they would not invalidate a com-
parison of the early and later data. It was fur-
ther necessary that the observations selected as
possible indicators of genetic damage be rela-
tively simple, as devoid as possible of the sub-
jective element, and capable of being carried
out under the conditions in Japan to be de-
scribed below.
1.5 Local considerations shaping the nature
of the program in fapar'. Among the condi-
tions in Japan which were determining elements
in the program, the following deserve special
mention:
1.5.1 In Japan, the practice of obstetrics
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4 Genetic Effects of Atomic Bombs Chapter I
is still largely in the hands of midwives. They
attend approximately 96 per cent of the deliv-
eries. Thus, in 1948, out of a total of 2,681,624
deliveries in Japan, 2,468,821 were attended by
midwives, 102,627, by physicians, and 110,176
by unlicensed attendants. The deliveries for
which midwives and unlicensed attendan* are
responsible usually occur at home.
The prerequisites for licensure as a midwife
were revised upwards during the Occupation.
However, the great majority of midwives now in
practice were of course licensed under the pre~ri-
ous system. This required that a candidate for
admission to a school of midwifery had com-
pleted a kotoshogakko education (about eight
years, corresponding to grammar school). A1-
though not required, some candidates had also
completed chu~gaku (middle school, about four
years, corresponding to high school). The
course in midwifery covered two years. One
could either spend all two years in a school,
or spend one year in school and the last year
obtaining experience either in the obstetrics-
gynecology department of a hospital or in asso-
ciation with a senior midwife. One had then to
pass a prefectural examination for licensure.
The legal minimum age was 20 years. Not un-
commonly a licensed midwife married soon after
completing school and did not return to the
practice of midwifery for some years.
It is apparent that whatever the midwife's
qualifications for the practice of obstetrics may
be, her training had not prepared her for the
detection and careful description of congenital
malformations. This made it necessary with
respect to the Genetics Program to develop a
system whereby each newborn infant was seen
by a physician as soon as possible after birth.
1.5.2 The Japanese economy during the
immediate post-war years, when this study was
instituted, was marginal. There was strict ra-
tioning of food and articles of clothing. Since
official rations were inadequate to meet caloric
needs, there was a widespread "black market"
in food. One of the features of the ration sys-
tem was special provision for pregnant women.
Such women (or their designated representa-
tive) upon certification of pregnancy by a mid-
wife or physician could register at any time after
the fifth lunar month of pregnancy and thereby
obtain access to certain items of value to them
and their future children. Registration was re-
vealed by a preliminary study to be in excess of
95 per cent complete. There was thus available
a system whereby very nearly all pregnant
women could be contacted at mid-pregnancy.
1.5.3 Finally, mention must be made of
the psychological and sociological pitfalls in-
volved in a study of this type. This is scarcely
the place for a detailed analysis of the psycho-
logical problems inherent in the operations of
the ABCC in Hiroshima and Nagasaki. Some
of the inevitable problems in Japanese-American
relationships are apparent. Others were unex-
pected (Matsumoto, 1954~. Each step in the
program had to be planned and taken cautiously,
after every effort had been made to explore the
possible repercussions. In retrospect, the first
year of activity in Japan may be characterized
as an apparently interminable series of confer-
ences punctuated by weekly crises which, al-
though often inconsequential in retrospect, at
the time threatened to stall the entire operation
until met. Lacking any semblance of authority
in Japan, the ABCC was wholly dependent upon
the voluntary cooperation of the Japanese peo-
ple. The good will of the city officials, local
physicians, and above all-of the midwives,
was, if not indispensable, highly desirable. It
should particularly be mentioned that in Japan
the social stigma attached to the birth of a mal-
formed child is rather considerable. Every effort
had to be made to develop a program which
would not antagonize the mothers of malformed
children by exposing them to what they con-
sidered undue publicity. In this effort, the mid-
wives were the key.
Although the destruction and desolation
which were the aftermath of the atomic bomb-
ings have been many times described, neither
photographs nor words are adequate to the
occasion. In addition to the post-war stresses
and strains to which all the inhabitants of Japan
were subject, the citizens of Hiroshima and
Nagasaki were confronted with a more formi-
cable job of reconstruction than the inhabitants
of most Japanese cities, badly bombed though
these had been. These are not the circumstances
in which research or even cooperation in the re-
search of others flourishes.
Representative terms from entire chapter:
genetics program
