41. Cure rates cannot be exclusively attributed to radiation therapy advances. For advanced-stage Hodgkin’s disease, radiation therapy is typically combined with chemotherapy (i.e., cancer therapy that uses drugs).
42. There were other important players in the success of radiation therapy for cancer that cannot be adequately recognized here. Advances came from all over the world. The following article reports on just the contributions of Americans to the field: Brady L. W., et al. “Radiation oncology.”
43. For an explanation of cancer chemotherapy and its history, see Mukherjee S. The Emperor of All Maladies.
44. Treating disease with the goal of relieving pain and suffering, but without the intention of cure, is called palliative therapy.
CHAPTER 7: LOCATION, LOCATION, LOCATION
1. We will use the term “atomic bomb” to specifically mean a nuclear fission bomb, and not any other type of nuclear device.
2. Tibbets P. W. Return of the Enola Gay, 161.
3. The flight risks were considered the most uncertain part of the bombing mission. In contrast, scientists had estimated the risk of the bomb failing to detonate as less than 1 in 10,000. The scientists’ confidence was supported by a successful test detonation, code named Trinity, in the New Mexico desert a month earlier. Even though the design of the test bomb was different (plutonium) than the Hiroshima bomb (uranium), the Hiroshima detonation mechanism was considered more simplistic in design and less likely to fail (Tibbets P. W. Return of the Enola Gay, 185).
4. This chapter primarily reports measurements in British units since they were in widespread use at the time, even among scientists, and were used in all original historical sources. The metric unit equivalent is given in parentheses when a value is stated for the first time.
5. The hypocenter is the exact location where a bomb detonates. All forms of damage initially radiate out from this spot. The hypocenter of the Hiroshima bombs was at a height of 1,890 feet (576 meters) above ground level. (The point on the ground directly under the hypocenter is called ground zero.) The eight-mile estimate was provided by William Sterling Parsons (1901–1954), associate director of the Los Alamos Laboratory in charge of atomic bomb ballistics (Tibbets, P. W. Return of the Enola Gay, 162–163).
6. For a complete description of the mathematics Tibbets used to calculate the angle of departure, see: http://user.xmission.com/~tmathews/b29/155degree/155degreemath.html.
7. Walker R. I., et al. Medical Consequences of Nuclear Warfare, 6–10.
8. Sasaki is one of the characters from John Hersey’s nonfictional story Hiroshima. Hersey’s account of the human casualties in the aftermath of the first atomic bombing was initially published in The New Yorker magazine on August 31, 1946, one year after the Hiroshima and Nagasaki bombings. The magazine story was later produced as a book. It remains the most poignant account of the human tragedy surrounding the Hiroshima bombing.
9. Rotter A. J. Hiroshima, 194.
10. Ikeda’s watch was later donated, by his wife, to the Atomic Bomb Artifacts Collection of the Hiroshima Peace Memorial Museum, 1-2 Nakajima-cho, Nakaku, Hiroshima.
11. Hersey J. Hiroshima, 81–82.
12. McRaney W., and J. McGahan. Radiation Dose Reconstruction U.S. Occupation Forces in Hiroshima and Nagasaki, Japan, 1945–1946.
13. Hersey J. Hiroshima, 4.
14. Hersey J. Hiroshima, 24.
15. Hersey J. Hiroshima, 46.
16. It would be a week or more before the general public in Hiroshima learned that the bomb was atomic. (Hersey J. Hiroshima, 62.)
17. Some estimates put the brightness of the bomb at 10 times the sun’s. (Tibbets P. W. Return of the Enola Gay, 228.)
18. Crew members were also issued cyanide capsules in case their plane was shot down and they were captured.
19. The Enola Gay crew didn’t lose sight of the mushroom cloud over Hiroshima until the plane was 415 miles away, the approximate distance between Washington, DC and Boston (Rotter A. J. Hiroshima, 192).
20. Rotter A. J. Hiroshima, 204.
21. In early September (four weeks after the bombing), the death rate among Hiroshima survivors was approximately 100 deaths per day (Weisgall J. M. Operation Crossroads, 7).
22. Hersey J. Hiroshima, 72.
23. A syndrome is a collection of symptoms that characterizes a specific disease state.
24. The dose ranges given for each syndrome are approximations, not absolute boundaries. Also, there is some overlap of the syndromes at the doses near the cusps. So the minimum and maximum doses given for each syndrome should not be considered to be definitive thresholds, but rather just the approximate dose boundaries within which the symptoms of the syndrome predominate. Nevertheless, knowledge of the whole-body dose that a patient received is the single most important factor contributing to the patient’s prognosis, including expected time to death or likelihood of survival.
25. Walker R. I., and T. J. Cerveny. Medical Consequences of Nuclear Warfare, 22.
26. Hersey J. Hiroshima, 78.
27. White blood cells can undergo a form of programmed cell death (also known by the Greek word apoptosis), which is more rapid than the necrotic death that most other cell types undergo.
28. After the Chernobyl nuclear power plant accident that took place in the Ukraine in 1986, some victims were treated with a medical procedure called bone marrow transplantation (BMT), which replaces the victim’s destroyed bone marrow with healthy marrow from a donor. BMT is a highly sophisticated medical procedure that rescues some patients who would otherwise have died from the hematopoietic syndrome. But it has several drawbacks. A successful BMT requires a tissue-matched donor and highly trained personnel with sophisticated medical facilities, and entails the risk that a suboptimal donor match will itself cause death by graft versus host disease. This is a condition where the donor’s immune system, harbored within the donated bone marrow (the graft), will actually attack the patient’s body tissues (the host), mistaking them for foreign invaders. In practice, BMT is only a viable option for patients within a very narrow range of whole-body doses (approximately 8,000 to 10,000 mSv). For all of the reasons above, BMT is not the panacea for radiation sickness that it was once thought to be.
29. If the dose is spread out over an extended time, the threshold for radiation sickness is even higher (>3,000 mSv) because cells can repair damage that accumulates at a slower rate. Doses that are received instantaneously, however, as from the atomic bomb, are more damaging because they overwhelm the cells’ repair systems.
30. The drop-off of radiation dose with distance follows the inverse-square law, meaning that the dose decreases in inverse proportion to the square of the distance from the source. For example, the dose at two meters from a radiation source (i.e., a point source) will be one quarter of the dose at one meter (dose = 1/d2 = 1/22 = 1/4). Doubling the distance will quarter the dose, and quadrupling the distance (i.e., 4 times the distance) will result in 1/16 of the dose. Thus, radiation sickness cases will be clustered between restricted perimeter bands that encompass a narrow range of doses from approximately 1,000 to 10,000 mSv. For the atomic bomb of Hiroshima, that band was approximately 800 to 1,800 yards from ground zero (Nagamoto T., et al. “Thermoluminescent dosimetry of gamma rays”).
31. Rotter A. J. Hiroshima, 198.
32. Hersey J. Hiroshima, 81; Weisgall J. M. Operation Crossroads, 210; Rotter A. J. Hiroshima, 222.
33. Rotter A. J. Hiroshima, 194.
34. Rotter A. J. Hiroshima, 201.
35. According to Tibbets, the US military was unaware that 23 downed US fliers were being held captive in Hiroshima Castle at the time of the bombing (Tibbets, P. W. Return of the Enola Gay, 202).
36. Los Alamos physicists Hans Bethe (1906–2005) and Klaus Fuchs (1911–1988) were largely responsible for designing the implosion mechanism for the plutonium bomb. Fuchs turned out to be a Soviet spy, and diagrams of the implosion design ultimately made their way to Soviet bomb scientists by way of Soviet age
nts, Julius and Ethel Rosenberg. The Rosenbergs were executed for espionage in 1953 in Sing Sing Prison’s electric chair.
37. Cullings H. M. et al. “Dose estimates”; see figure 5 of this article.
38. The statement can be traced back to Aeschylus (525–456 BC), the Greek dramatist, but is most widely attributed to Senator Hiram Johnson (1866–1945), who in 1918, at the height of both World War I and the Spanish flu epidemic, said, “The first casualty, when war comes, is the truth.” Coincidentally, Johnson died on August 6, 1945, the day of the Hiroshima bombing.
39. Rotter A. J. Hiroshima, 206.
40. Rotter A. J. Hiroshima, 223.
41. Hersey J. Hiroshima, 89.
42. Walker R. I., et al. Medical Consequences of Nuclear Warfare, 5.
43. Walker R. I., et al. Medical Consequences of Nuclear Warfare, 8.
CHAPTER 8: SNOW WARNING
1. Hoffman M. “Forgotten Atrocity of the Atomic Age.”
2. Although the fishermen initially thought they had witnessed a meteor hitting Earth, they presently deduced what had actually occurred and kept radio silence during their return, because they were afraid that they would be arrested at sea by the American military due to the classified nature of what they had seen (Ōishi M. The Day the Sun Rose in the West, 5).
3. Retrieval of the radioactive catch was largely successful, and the fish from the Lucky Dragon No. 5 were buried in a large pit dug on a vacant lot bordering the entrance to Tokyo Central Wholesale Market. Today there is a Tokyo Metro Subway stop near the entrance to the market, with a “Tuna Memorial” plaque marking the approximate gravesite of the contaminated fish (Ōishi M. The Day the Sun Rose in the West, 126–133).
4. Mahaffey J. Atomic Accidents, 82.
5. Ivy Mike, the first hydrogen bomb tested, was detonated on Enewetak Atoll in the Marshall Islands (near Bikini Atoll) on November 1, 1952.
6. We will consistently use the term “hydrogen bomb” when referring to bomb designs based on nuclear fusion. Be aware, however, that this type of bomb is also sometimes called an H bomb or a thermonuclear weapon.
7. The distance between the Capitol Building and the White House is about two miles (3.2 kilometers). The distance between Washington, DC’s mall and Baltimore’s Inner Harbor is about 40 miles (64.4 kilometers).
8. When the Paris fashion designer Louis Réard introduced his new women’s swimsuit design for the summer of 1946, he called it the bikini, and suggested that its revealing design was just as shocking as the Bikini Atoll atomic bomb tests that were capturing the public’s attention that summer.
9. This atoll was spelled Eniwetok until 1974, when the United States government changed its official spelling to Enewetak so that the word’s phonetics more closely matched the pronunciation of the Marshall Islanders.
10. Nuclear bombs can be of either the fission or fusion type. In this book, we will use the term atomic bomb to mean a fission bomb, and the term hydrogen bomb to mean a fusion bomb.
11. Japanese artist Isao Hashimoto has created a time-lapse video map of the 2,053 nuclear explosions that took place between 1945 and 1998. The March 1, 1954, hydrogen bomb test (called Castle Bravo) on Bikini occurs 3 minutes and 4 seconds into the 14:24 minute video: https://www.youtube.com/watch?v=LLCF7vPanrY.
12. Ōishi M. The Day the Sun Rose in the West, 35.
13. Kuboyama’s death galvanized the antinuclear movement in Japan. Although many Japanese had felt that they needed to share some of the culpability for the bombings of Hiroshima and Nagasaki because their own government had been an aggressor with an avowed strategy of “total war,” they saw Kuboyama as an innocent martyr of the United States’ aggressive and irresponsible participation in a nuclear arms race conducted during peacetime. More than 400,000 people attended Kuboyama’s funeral. Further fanning the attendees’ outrage, nuclear physicist Edward Teller, the developer of the hydrogen bomb, was alleged to have insensitively retorted, “It’s unreasonable to make such a big deal over the death of a fisherman” (Ōishi M. The Day the Sun Rose in the West, 126).
14. Although some have proposed that the purpose of the high altitude detonation was to minimize fallout, this is not true. Aboveground detonation was chosen because it evenly distributed and maximized the shock wave effects that, along with fire, were among the most damaging aspects of the atomic bombs (see chapter 7).
15. The isotopes of hydrogen are hydrogen-1 (the major natural isotope), hydrogen-2 (deuterium), and hydrogen-3 (tritium). Of the three, only hydrogen-3 is radioactive.
16. The lithium-6 of lithium deuteride undergoes fission to produce tritium (hydrogen-3), which then fuses with the deuterium (hydrogen-2) to release energy.
17. Ironically, lithium-7, with its three protons and four neutrons, was the very atom that the Cavendish scientists first split with protons, demonstrating the feasibility of nuclear fission (see chapter 5). But lithium-7 was not thought to be susceptible to fission by neutrons. What the bomb physicists did not know was that lithium-7 could efficiently be converted to lithium-6, by a one neutron in, two neutrons out, reaction (n, 2n). Thus, lithium-7’s conversion into lithium-6 further fueled the fusion reaction beyond all expectations.
18. Enrico Fermi, the physicist who had performed the original Chicago Pile experiment demonstrating the feasibility of attaining criticality, had warned Slotin that his team’s screwdriver approach to measuring criticality was dangerous. At one point Fermi had cautioned Slotin, “Keep doing that experiment that way and you’ll be dead within a year!” Fermi’s prediction was correct (Welsome E. The Plutonium Files, 184).
19. The Soviet Union would eventually test detonate five bombs larger than Shrimp.
20. An atoll is a circular ring of coral islands formed by coral growth along the rim of an extinct volcano that is gradually sinking into the ocean. Atoll islands, common in the Pacific, were made famous by the voyages of Charles Darwin, who visited many and speculated on their geological origin.
21. On both Bikini Atoll and nearby Enewetak Atoll, the United States performed a total of 67 test detonations of nuclear devices, totaling 100 megatons of TNT. This is the equivalent of detonating one Hiroshima bomb every day for 19 years. It was more explosive power than has ever been detonated during all wars combined, since the beginning of human history.
22. Weisgall J. M. Operation Crossroads, 107.
23. Figueroa R., and S. Harding. Science and Other Cultures, 106–125.
24. Weisgall J. M. Operation Crossroads, 36.
25. Ōishi M. The Day the Sun Rose in the West, 30.
26. After the accident, the Lucky Dragon No. 5 was decontaminated and used for many years as a training vessel for the Tokyo University of Fisheries. It was ultimately sold for scrap, but before it could be demolished, a public campaign was waged to save it as a memorial. It is now on permanent display at the Tokyo Metropolitan Museum’s Daigo Fukuryu Maru Exhibition Hall.
27. According to a commission set up in 1994 by President Clinton to study this incident and other human-subject radiation projects conducted by the US government, Project 4.1 was created for the following clinical and research purposes: “(1) evaluate the severity of radiation injury to the human beings exposed; (2) provide for all necessary medical care; and (3) conduct a scientific study of radiation injuries to human beings.” See Final Report of the Advisory Committee on Human Radiation Experiments, chapter 12, part 3, “The Marshallese.” Available online at http://biotech.law.lsu.edu/research/reports/ACHRE. Scholars have noted that the affected islanders were enrolled automatically into the research study in violation of clinical and bioethical principals, even as judged against the practices and requirements of medical ethics at that time (Johnston B. R., and H. M. Barker. Consequential Damages of Nuclear War). Given the stated link between clinical care and research in Project 4.1’s stated goals, treatment was likely conditioned on participation in the study, giving affected islanders no reasonable avenue to opt out of the research.
28. Ōishi M. The Day th
e Sun Rose in the West, 38.
29. It is suspected that the Soviets learned about deuterium-tritium fusion through their spy, physicist Klaus Fuchs, who had worked on the Manhattan Project. But it is not certain exactly what fusion secrets Fuchs actually passed on. In any event, the Soviets had been working on fusion bombs even before they had developed the fission bombs needed to trigger them.
30. Ōishi M. The Day the Sun Rose in the West, 31.
31. Rowland R. E. Radium in Humans.
32. Quoted in Mullner R. Deadly Glow, 134.
33. Mullner R. Deadly Glow, 135.
34. Iodine is usually added to table salt as a dietary supplement to prevent iodine insufficiency, the major cause of goiter—a disease of the thyroid gland.
35. Some marine organisms can concentrate fission products as much as 100,000 times. During the Baker fission bomb test of Operation Crossroads, in 1946, the hulls of observer ships remained highly radioactive even after moving to nonradioactive waters. It was soon found that algae and barnacles on the exterior of the hulls had concentrated the fission products to such an extent that the sailors’ bunks had to be moved away from the interior hull walls so they wouldn’t be overexposed to radiation while they slept (Weisgall J. M. Operation Crossroads, 232–233).
36. Baumann E. “Ueber das normale Vorkommen von Jod.”
37. Advisory Committee on Human Radiation Experiments. The Human Experiments, 371.
38. Figueroa R., and S. Harding. Science and Other Cultures, 116.
39. This is usually the case. However, cesium also sticks to clay, and if soil has a fairly high clay content, the cesium will remain much longer.
40. Ōishi M. The Day the Sun Rose in the West, 43.
41. Ōishi M. The Day the Sun Rose in the West, 78.
42. The National Institute of Radiological Sciences in Chiba, Japan, administered the study, with funding from the United States.
43. Ōishi M. The Day the Sun Rose in the West, 64.
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