Three years earlier, the United States had seized on what it saw as a critical and unique opportunity to conduct long-range scientific and medical research on hibakusha—which an Army Medical Corps senior researcher on atomic bomb effects had believed “may not again be offered until another world war.” To this end, President Truman had signed an order to establish the Atomic Bomb Casualty Commission (ABCC), charged with studying atomic bomb survivors to determine how radiation exposure affected their health. U.S. leaders projected that the ABCC’s studies would offer the United States numerous military, scientific, and regulatory benefits—including greater understanding of the impact of nuclear weapons currently in development, support for civil defense planning for potential nuclear attacks on U.S. cities, and data for the reevaluation of international radiation dose limits for physicians, scientists, radiation workers, and patients. These goals inadvertently reflected how little, prior to the atomic bombings, U.S. scientists and military officials knew about the immediate or long-term impact of whole-body radiation, and they foretold how blatantly the ABCC would ignore the medical needs of the survivors. The choices the agency made in fulfilling its mission ignited a bitter, decades-long controversy between the ABCC and hibakusha, their physicians, and research scientists across Japan.
Tensions began early. On paper, the ABCC was established as a collaboration between the United States’ National Research Council and Japan’s National Institute of Health, but in practice the commission was predominantly funded and controlled by agencies of the U.S. government, and it operated inside a country under U.S. military occupation. After years of vitriolic wartime slurs by each country against the other, U.S. and Japanese scientists distrusted one another’s professional integrity and feared the ABCC’s research outcomes would be tainted by national bias: Americans were concerned that the Japanese would exaggerate radiation effects for political purposes, and the Japanese worried that the Americans would minimize radiation effects for their own political gain. Japanese doctors working at the ABCC appreciated the United States’ advanced scientific methodologies, but some felt disrespected by U.S. physicians’ lack of confidence in their medical skills as well as their ability to evaluate research. One American ABCC doctor wrote: “Just the thought of what the Japanese would do if they had free unrestrained use of our data and what they might publish under the imprimatur of the ABCC gives me nightmares.”
The imbalance of power at the ABCC was made worse by wage inequities between U.S. and Japanese physicians working there. The agency’s longtime policy to designate only U.S. physicians and scientists as directors of each city’s operations resulted in the majority of the ABCC’s staff—Japanese doctors, nurses, and support personnel, including many who had survived the atomic bombs and endured extraordinary losses—having to work under U.S. authority. Extreme insult arose when the United States took full possession of all of the ABCC’s research data, study outcomes, and specimens, in part to prevent other nations from gleaning technical information about the bombs that might advance their own nuclear weapons programs. Even Nagasaki and Hiroshima doctors treating hibakusha on a daily basis had no access to these critical findings that could have supported their diagnoses and care. Nagasaki physician Nishimori Issei reflected that “the ABCC’s way of doing research seemed to us full of secrets. We Japanese doctors thought it went against common sense. A doctor who finds something new while conducting research is obligated to make it public for the benefit of all human beings.”
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In Nagasaki, the ABCC’s first offices were set up over a fish market on the wharf, and patients were initially examined at the temporary hospital at Shinkozen Elementary School. During the late 1940s into the early 1950s, thousands of survivors like Do-oh heard a knock at their door and saw an ABCC jeep and staff person waiting outside to transport them to Shinkozen. The ABCC had identified and located them by using the medical studies and informal surveys of hibakusha conducted after the war, and by talking with physicians and scientists, gathering hospital records, and enlisting the help of local police. Although the ABCC was not officially under occupation authority, in Nagasaki’s postwar climate, some hibakusha felt forced to participate because they perceived the ABCC as a function of the occupation and thereby an extension of the U.S. military. At Shinkozen, they underwent physical examinations and were asked a series of questions about their location at the time of the bombing, distance from the hypocenter, direction they were facing, and physical symptoms they had experienced since then. In keeping with the Japanese social custom of reciprocity, ABCC staff sometimes gave survivors small gifts and offered them a taxi ride home.
“We went inside the building,” Do-oh remembered. “I was told to put on a white hospital gown. There was not much of an interview—I think they just looked at my injuries and took photographs of them. There were foreign doctors there, too.” Do-oh had thought she would be given medical treatment—at least to help with her pain—but ABCC staff provided no treatment and no emotional support. “I went home hugely disappointed,” she explained. “As a young girl, I had been seen naked from the waist up and had taken the black cloth off my head in front of men. I felt something like rage.”
Do-oh was not alone. Although public opposition to the ABCC was suppressed by occupation censorship, within the highly sensitive medical, political, and economic climate in Nagasaki and Hiroshima, hibakusha anger toward the ABCC intensified. At a time when hibakusha were just beginning to come to terms with their identities as the only victims of atomic warfare in human history, the Americans who dropped the bombs imposed on them a disturbing new identity as research specimens for the U.S. government. Many survivors hated being studied by doctors from the country that had irradiated them. The ABCC also transgressed cultural boundaries with invasive and intimidating procedures, by examining young people like Do-oh in the nude, collecting blood and semen samples, and taking photographs of survivors’ atomic bomb injuries. Other social and economic oversights alienated survivors: Polished waiting room floors were slippery for women wearing geta; English-only magazines were placed in the waiting rooms; and the ABCC insisted that examinations take place during the day, resulting in loss of pay for those who worked. Even the word “examination” seemed objectifying to many.
The largest complaint, however, was that the ABCC conducted medical examinations without also offering medical care. What Do-oh and other hibakusha didn’t know was that the ABCC’s mission to conduct detailed studies of survivors’ radiation-related illnesses included a strict mandate to provide them no medical treatment. As hibakusha became aware of this directive, many felt even more dehumanized, and they experienced powerful feelings of being used by the United States as guinea pigs in a military experiment. Some also resented the ABCC’s no-treatment policy in light of the shortage of medicine and medical equipment available in Japan after the war, contrasted with the millions of dollars that poured into the ABCC. In the United States, activist Norman Cousins praised the ABCC’s work as both excellent and important, but he openly criticized the agency for what he saw as a “strange spectacle of a man suffering from [radiation] sickness getting thousands of dollars’ worth of analysis but not one cent of treatment from the Commission.”
The United States offered numerous reasons for its no-treatment policy. Early on, officials said that American physicians could not pass Japanese medical licensure exams because of the language barrier—but by 1951, 70 percent of doctors on ABCC staff were Japanese physicians who could have provided medical care. The United States also asserted that occupation policy did not allow American physicians to render aid to Japanese citizens, giving an inaccurate impression that the ABCC was under the occupation’s authority. Other arguments included that medical care was not a relevant activity within the scope of the ABCC’s scholarly scientific research, that the cost of providing care would be prohibitive, and that the ABCC’s provision of care to survivors would have a negative impact on lo
cal physicians by depriving them of the opportunity to administer these services to their own community (a position many Japanese physicians disputed). As late as 1961, U.S. authorities overseeing the ABCC maintained that offering medical care to atomic bomb survivors would oblige the United States to deliver care to every Japanese citizen injured during the war, which in return would require Japan to provide treatment to every American injured in battles with Japanese soldiers, including those wounded at Pearl Harbor. In putting forth each of these reasons, the United States failed to distinguish between other Japanese war casualties and hibakusha who were subjects of the ABCC’s long-term scientific study for U.S. military purposes.
Underlying every explanation was the highly charged concern that providing medical care to hibakusha—even while conducting studies on their medical conditions—could be interpreted as an act of atonement by the United States for using the atomic bombs, a position that was unequivocally rejected at every level of the U.S. government. The United States held tightly to this position despite the fact that in postwar Europe, the U.S. military provided medical care to former enemies under Allied occupation without any suggestion of responsibility for their injuries. So sensitive was this issue that ABCC directors rejected a hiring proposal to prioritize hibakusha as employees so as not to be perceived as atoning for the bombs by giving them preferential treatment.
Japanese scientists and early hibakusha activists also equated treatment to U.S. atonement, and hibakusha were caught between the polarized stances of the two governments, each wanting the other to claim moral, financial, and medical responsibility for the atomic bombings. As this fierce international tug-of-war dragged on, hibakusha continued to suffer and often die from illnesses related to their radiation exposure, and neither the barely solvent Japanese government nor the U.S.-directed ABCC provided financial or medical support. Out of compassion for their patients, some of the ABCC’s Japanese doctors occasionally broke policy and provided medical care—including chemotherapy and other protocols—both at the ABCC’s clinic and during house calls, where they could treat simple cases without notice or with the silent acceptance of their American supervisors.
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The ABCC further inflamed survivors’ ill feelings by conducting autopsies on hibakusha who died while participating in its studies, which inadvertently reinforced the survivors’ perception that they were being used like laboratory animals for scientific purposes. Hibakusha sensitivities were exacerbated by the fact that autopsies were both foreign and invasive to Japanese family and community rituals, and because ABCC staff were dissecting their family members’ bodies for U.S. military and civil defense research, without any apparent benefit to other atomic bomb survivors. The ABCC’s Mortality Detection Network paid cash fees to Japanese medical providers in Nagasaki and Hiroshima to report hibakusha deaths as quickly as possible so that ABCC staff (called “vultures” by dissenters) could hurry to a deceased survivor’s bedside to request permission to perform the autopsy. Some families refused, but despite their discomfort, others consented, perhaps because of direct pressure by ABCC staff, because they felt they had no choice, or because they hoped for better understanding of their loved ones’ conditions.
In both cities combined, by the late 1950s, an estimated five hundred autopsies were conducted each year. Autopsy specimens of infants were stored in Nagasaki, but the tissues, slides, and body parts of older children and adults were extracted, examined, and quickly dispatched to the United States. Under the auspices of the U.S. Atomic Energy Commission (AEC), the new governmental agency established to oversee research, production, and control over nuclear weapons and atomic energy applications, these specimens were classified as state secrets and cross-categorized by various divisions of the Armed Forces Institute of Pathology (AFIP), where they were studied to understand the impact of high-dose radiation on the human body. After examination and data recording, the body parts and related records were stored in AFIP Quonset huts outside Washington, D.C., for ongoing research and later warehoused in a new building constructed to protect the materials from a potential atomic bomb attack.
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Within this highly charged atmosphere, hibakusha found an advocate in thirty-three-year-old pediatrician James Yamazaki, the city’s third ABCC director. A second-generation Japanese American, Yamazaki had served as a U.S. Army combat surgeon in northern Europe while his family was interned in a War Relocation Authority camp in Jerome, Arkansas. He later spent six months in a German prisoner-of-war camp. After the war, he continued his medical training in the United States before being asked to serve in Nagasaki.
Dr. Yamazaki had been briefed on his assignment before leaving for Japan, but it was only when he arrived in Nagasaki in late 1949 that the magnitude of destruction and human suffering became real. He wandered through the wreckage of a Mitsubishi torpedo factory and saw the still-razed hypocenter area and the ruins of Urakami Church. “There was, of course, a missing dimension,” he later wrote. “The dead, the dying, the blistered survivors, and the victims in frantic flight were long since gone.”
Dr. James N. Yamazaki before leaving for battle in northern Europe, ca. 1944. (Courtesy of Children of the Atomic Bomb, UCLA Asian American Studies Center)
Dr. Yamazaki saw how pervasive the distrust had become between the ABCC and Nagasaki’s medical professionals and survivors. As the only American doctor at the Nagasaki facility, and with limited Japanese language skills, he determined that one of his first goals would be to gain the confidence of both hibakusha and the Nagasaki medical community. To this end, after finding a new location for the ABCC’s clinic, laboratory, and offices, Yamazaki developed a strong collaborative working relationship with Dr. Shirabe Raisuke, now the director of Nagasaki Medical College Hospital. This relationship resulted in a mutually cooperative affiliation between the ABCC and the Medical College, which included the participation of Nagasaki medical students in the ABCC’s studies as part of their training and weekly lectures by Dr. Yamazaki on current practices in American medicine. Dr. Yamazaki held Dr. Shirabe in great esteem. “I was most struck by his eyes,” he remembered, “. . . that crinkled engagingly when he smiled or laughed. His geniality concealed the trauma of his bomb experience, the tragedy of his family.”
In his capacity as liaison between the ABCC and Nagasaki Medical College, Dr. Shirabe guided Dr. Yamazaki through the ruins of the Medical College, still mostly unrestored from four years earlier. As they walked, Shirabe quietly identified each building, described how it was affected by the bomb, and told Yamazaki the numbers of faculty, nurses, staff, and students, including one of his sons, who had been killed instantly. Inside a demolished laboratory, the two doctors stood on piles of rubble and peered out of a broken window into the valley below, where the hypocenter was located a half mile away.
On another occasion, Shirabe arranged what Yamazaki called an “extraordinary briefing” for him and American physicians from Hiroshima’s ABCC offices to hear from medical professionals who had experienced the Nagasaki bombing. In a small, partially demolished classroom, fifteen doctors, nurses, and support staff from Nagasaki Medical College Hospital told their stories of survival and their struggles to provide care to hibakusha after the bombing. Dr. Shirabe stood before charts and maps of Nagasaki, pointing out different locations and clarifying the range and scope of destruction throughout the city.
Several weeks later, Shirabe delivered to his new colleague the still-censored research study of the acute effects on eight thousand survivors that Shirabe had conducted four years earlier with the help of medical school faculty and students. It was difficult for Dr. Yamazaki to comprehend the extent, rationale, and impact of the occupation’s censorship of Japanese research on the medical aftereffects of the bombs. “They completed the study in 1946,” he explained, referring to Shirabe’s team. “Four years later, he was handing it to me—the first medical report our team was to receive coverin
g that critically important population.”
Still, Dr. Yamazaki was barred access to numerous other studies carried out by Japanese research teams in the four years after the atomic bomb attacks, and later he discovered that even he—an American serving American purposes who had security clearance from the Atomic Energy Commission—had not been given access to early U.S. studies on the short-term effects of the atomic bombs. In fact, he knew nothing of their existence until shortly before he left Japan two years later. These reports, Yamazaki remembered, “would have been immensely helpful . . . as we groped our way toward establishing our research on the effects of the radiation.”
During his tenure in Nagasaki, Dr. Yamazaki directed a staff of 250 and supervised numerous studies of adults and children on topics including cancers, reduced vigor, changes in vision, abnormal pigmentation, hair loss, epidemiological changes, sterility, and shortened life span. As a pediatrician, he gave particular focus to two comprehensive studies involving Nagasaki infants and children—whom researchers expected to be the most vulnerable to radiation exposure. The first study tracked statistics on children who had been exposed to radiation inside their mother’s wombs, including fetal deaths and mortality rates for those who died while a part of the study.
Dr. Yamazaki felt compassion for these families’ losses, and he was attuned to their sensitivities about the ABCC’s conducting autopsies on their children. Under his direction, a new policy was implemented: In order to prevent grief-stricken parents from receiving a direct request from the ABCC, a Nagasaki midwife with a relationship with the family helped negotiate this difficult conversation. “With the quiet guidance of the midwives,” Yamazaki remembered, “the parents came to understand the potential importance of autopsies to all of them. The great majority gave their permission.”
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