MEDICAL EFFECTS OF THE ATOMIC BOMB

oh 8:15 on the morning of the 6th of August 1945 a city crowded with businessmen shoers people on the way to work overhead an airplane passes scarcely noticed in one fraction of one minute one airplane carrying one bomb has so devastated the city that only an expert could distinguish it from Carthage or Troy Coventry or Warsaw Berlin or Tokyo one plane one bomb one city a weapon of Mag matless destructiveness has opened up New Horizons of offensive Warfare the atomic bomb casts a searching light on present concepts of strategy and tactics and on the overall problems of National Defense Atomic weapons have become the central fact of diplomacy and international relation federal and state authorities labor under a new burden of responsibility on City and local administrations the shadow of atomic eventualities Falls with a new urgency on the medical profession on those who must treat the casualties of any disaster the implications of the atom lie especially heavy for while the atom bomb is a military weapon to the individual practitioner and to the potential victim it is essentially a medical problem all matter liquid gaseous or solid is composed of minute particles known as atom particles so small that billions upon billions are contained in a single grain of table salt a grain of salt under a microscope lens discloses fine details of shape and form the electron microscope with its magnification of 100,000 times or more brings Ultimate Reality One Step nearer if it were possible to magnify matter several thousand times again the molecules of chemical compounds would become visible made up of their component atoms with even greater magnification the atom itself deep within the atom occupying only a small fraction of its total volume rise the nucleus the source of the energy in the atomic bomb is the large complex and unstable nucleus of plutonium or uranium 235 the energy is released in a process known as nuclear fishing in fishing a nuclear particle known as a neutron strikes and splits the nucleus of uranium or plutonium between one and three neutrons are released if enough uranium or plutonium is present the neutrons May strike and split still other nuclei and the process continues this is the Chain Reaction which takes place in the atom bomb in the Chain Reaction nuclear fragments of Fish Fly apart with violent force with increased motion of the atoms the temperature at higher temperatures thermal energy is given off first as infrared radiation then as visible light and finally as ultraviolet radiation within a fraction of a second after detonation the thermal energies of the Chain Reaction are converted to mechanical energy in a climactic explosion The Chain Reaction an atomic furnace in which mass is consumed and energy is produced on an immense scale in fion the energy of particles in motion is converted to Thermal and mechanical energy these are conventional energy forms associated with explosives such as gunpowder and TNT they represent about 80% of the total energy output of fishing the remaining 20% takes the form of nuclear radiation nuclear radiations are not new in iCal experience but are given off by radioactive materials such as the radium in a luminous watch style and in some types of medical therapy normally radium gives off radiation in all directions but if confined the radiation may be limited to a single beam if the beam of radiation passes through a strong magnetic field it is split into three parts one beam of positively charged particles is bent in One Direction This positively charged beam is composed of alpha particles a second beam of negative charge is deflected in the opposite direction this negatively charged beam is composed of beta particles the remainder of the radiation which is not affected by the magnetic field has no electrical charge and is known as gamma radiation these same radiations are also associated with the fish reaction in the atom bomb when a uranium or plutonium atom split the neutrons emitted are accompanied simultaneously by gamma rays the fragments of the original atom are radioactive they return to stability by giving off gamma rays and beta particles the neutrons left over from the fishing reaction may be captured by normally stable atoms rendering them artificially radioactive a source of beta and gamma radiations when fishing occurs on a large scale some uranium or plutonium is left over from the fishing reaction and is a continuing source of alpha radiation the range of alpha particles and air is measured in a few inches alpha particles are almost entirely absorbed by a few sheets of ordinary writing paper they particles have a range in air of several feet but are effectively filtered out by several thin sheets of aluminum gamma rays are the same as xrays of equal energy they are extremely penetrating gamma penetration depends upon the atomic weight or density of the material light substances such as wood are quite ineffective as the filtering material atal against gamma ray heavier materials such as concrete are considerably more effective in filtering the radiation lead a very heavy element is a highly efficient shielding material against gamma rays in contrast to gamma rays neutrons are less affected by heavy elements such as lead and may penetrate considerable thicknesses neutrons are stopped more effectively by water and other light materials which contain large amounts of hydrogen the range and penetration of nuclear radiation varies similarly in tissue alpha particles are absorbed by the outer layers of the skin beta particles penetrate through the skin in into the subcutaneous layers neutrons are very highly penetrating in tissues as our gamma rays although nuclear radiations vary in penetration they all have the same destructive effect on tissue cells in general radiation causes ionization in the component atoms of cells altering their chemical nature and impairing or destroying their normal function alpha particles cause intense ionization but are cheaply absorbed by the dead outer layers of the skin and do little damage to the living tissue beneath beta particles penetrate deeper but cause less ionization they may result in serious damage to the skin and super icial tissues neither Alpha nor beta Rays causes serious damage to deep tissues unless the source of the Rays is inside the body neutrons travel an auratic course and lose their energy after colliding with several other atoms under the impact of the neutrons light hydrogen atoms in the tissue fly off at high velocities producing ionization in neighboring cells on striking tissue gamma rays eject beta particles from atoms within the cells the beta particles in turn cause ionization in the local tissue with gamma rays of low energy the most intense ionization of tissue cells is produced in The Superficial layers with gamma radiation of high higher energy the peak of ionization is in the deeper tissues and effective ionization occurs throughout the entire body with whole body radiation ionization causes loss of function of the more sensitive tissues and organs the degree of loss depends upon the dosage if the exposure is both General and severe death results fishing materials are a source of three types of potentially destructive energy nuclear radiations thermal energy and mechanical energy accompanying the reaction and residual radiation from the F fishing products all these forms of energy are released in fantastic quantities within a fraction of a second after the detonation of the bomb first there is an emission of thermal energy gamma rays and neutrons depending upon the altitude of the burst the neutrons reach the Target in large or small quantities or not at all the gamma rays extend far from the Target Center a massive pressure wave and Winds of cyclonic velocity inflict great destruction on the target the fireball shoots into the stratosphere forming a mushroom cloud composed of steam superheated gases and vaporized metal a source of radioactivity until dispersed by prevailing high altitude wind the effect of the explosion on a military Target is no longer a matter of conjecture never before have such complex and devastating energies been available for military use never before has disaster struck with such sudden violence so compressed in time and space when the atom bomb explodes everything happens at once at Ground Zero the below the explosion piles of brick stone and concrete Rubble marked the center of Destruction and the high point of human mortality on sites where factories once stood wrecked machines are the only identifying feature a few empty hulks of earthquake resistant steel and concrete structors bear witness to the crushing force of the blast in the few buildings which remain standing the roofs are collapsed by the vertical pressure of the blast the occupants are crashed under the wreckage or trapped in the burning debris those in the open are instantly charred by temperatures of thousands of degrees and a moment later are struck by the mechanical force of the blast those who take refuge in deep underground shelters survive otherwise the the area near the Target Center is one of nearly total loss in buildings and in humans victims of the multiple effects of the bomb farther from the center of the blast the destruction although not complete is extremely severe even those buildings which remain standing offer slight protection the extended pressures of the blast penetrate through windows and doors to building Interiors where the ensuing fires finish the job in this area that the blast effect is exerted slantingly downward rather than vertically whole buildings are displaced bodily from their foundations the extended blast exerted over entire surfaces causes a general Distortion rather than the localized penetration of conventional explosives Factory buildings that collapsed as though by the pressure of a giant hand on buildings with weightbearing walls of stone or brick the pressure has a devastating effect frame structures are demolished the debris is a prolific source of fires from short circuits and cooking stoves much of the firefighting apparatus is destroyed while Rubble filed streets close the area to the equipment which remains from the area of severe destruction some of the injured are able to make their way to comparative safety in the outer limits of the city in the outer reaches of the target the destruction is less severe and reflects the Sheltering Contour of the terrain destruction by fire varies frequenly with the direction of the wind even at the outermost limits of Destruction flying debris and splintered glass cause great variety of minor casualties on the periphery of the target there is an immense zone of minor to moderate damage within it an intermediate zone of severe destruction at the center a zone of absolute total devastation the bomb in addition to its unprecedented destructiveness is particularly effective as a casualty producing agent in the central zone of complete destruction a large majority die within the first few hours from the combined effects of heat and blast many of those not killed are seriously injured in the intermediate Zone the mortality from heat and blast falls off sharply and the number of injured survivors greatly increases in the alha zone while relatively few are killed there are many injuries mostly of a minor nature this is the typical picture of the bomb's thermal and traumatic effects but superimposed over these conventional effects are the novel effects of atomic radiation depending upon the altitude of the explosion neutrons reach the ground in greater or lesser quantities but are effective mainly at the center of the target gamma rays however blanket the two inner zones of the target area and a small part of the outer zone their intensity is greatest directly under the bomb diminishing rapidly at greater distances from The Source little effective radiation dosage occurs beyond the intermediate Zone radiation dosage depends partly upon distance from the explosion it also varies with the shielding afforded by intervening materials the greater the thickness of a given material the greater the absorption and the less the effective dosage the denser the material the greater the protection afforded concrete is a better shielding material than an equal thickness of brick less dense materials such as wood and plaster offer virtually no protection light frame buildings give little or no protection many storage structures of massive steel and concrete do offer a degree of safety particularly in the lower floors and Cellar and away from Windows individual dosage by gamma rays depends upon the twin factors of distance from the source and shielding maximum exposure occurs near the Target Center where many virtually unshielded receive extremely severe dosages a smaller number receive effective but non-lethal dosages farther from the center the dosage is less severe relatively few are affected and many receive no radiation the combined effects of radiation Plus those from heat and blast produce an early mortality in the center zone of nearly 100% with so many forces operating death cannot be ascribed to any one cause in the intermediate Zone the early death rate is lower with a great increase in injured survivors few are uninjured in the peripheral Zone most casualties sustain minor damage few die and many escape uninjured the injured survivors constitute the treatment problem as the medical services must face it a few hours after the moment of detonation a simple graph representing thousands of individual casualties produced simultaneously in one city by one bomb detonated at Optimum altitude over the center of a flat Target area the casualty statistics are staggering assuming the bomb strikes an unprepared and unalerted city of all over population density of one person per thousand square ft with a total population of a qu million it is estimated that approximately 40,000 will die outright 140,000 will be injured of whom a further proportion will subsequently die the intermediate Zone contains most of the injured survivors and a great majority of the more serious casualties the medical services must direct their main effort toward this intermediate area of severe destruction of those injured nearly half are burned an equal number sustained traumatic injury although usually of a minor nature since the seriously injured survive only by virtue of organized rescue in many patients Burns and Trauma are found together an additional number show radiation effects without other complications often radiation is combined with conventional injuries particularly near the central zone while the effects of radiation may not be immediately apparent the thousands who have sustained trauma and burns are in instant need of treatment the crisis is heighten by the sudden destruction of medical facilities in the Target area most of the hospitals are rendered nearly or completely useless doctors and nurses and centrally located Hospitals and Clinics suffer extremely high casualties Medical supplies and equipment are largely destroyed the medical services unprepared for disaster are eliminated as an effective organization the patients are numbered by scores of thousands their injuries are combined not simple this is something new without example and previous Human Experience the history of modern war affords no valid parallel in typical bombing with conventional High explosives immediate counter measures go into effect all energies are concentrated on the work of Defense when fires break out fire a fighting equipment goes into action to confine and localize the Damage rescue squads Converge on the fil destruction first aid teams penetrate the baguer area to administer emergency medical care serious cases are removed immediately to prepared medical stations where well staffed facilities accommodate the sudden influx of patient throughout the bombardment community services continue to function telephones work water runs the injured are rescued streets remain open factories continue to produce people remain at their jobs trains enter and leave the city the population finds protection underground and surviv after they attack the fire subside the city digs out the localized damage is absorbed and repaired the living bury the dead the city weathers the crisis and survives as a going concern these are the essential facts of conventional bombing however severe it occurs peace meal in the has fought peace meal it is localized in space it is spread out in time but with the atomic bomb mass destruction gains a new dimension in the absence of planning local Administration and Authority end the main links and the chain of responsibility are broken the bom Community is brotherless unprotected Ed and helpless at the moment of Crisis the streets are closed there is no transportation and no Fire Control there is no firefighting equipment the water does not run there are no Public Services no electricity there is no communication production ceases hospitals are neither well staffed nor well equipped the fragments of the medical plant that do survive exist in a virtual vacum in atomic bombing there are two essential factors it is total it happens all over it is simultaneous it all happens at once oh