IV Actual Conditions and Development of Medical Care for A-bomb Survivors
1 Relief Work Directly after the Atomic Bombing
Hiroshima’s air defense was inadequate, causing many casualties from the atomic bombing. Without regard for their own injuries, the healthcare professionals who narrowly escaped death treated people in bombed medical facilities and relief stations built in schools, temples, bridges, roads, and parks. Medical personnel in Hiroshima Prefecture and those from other prefectures also provided support. There was international aid as well: Dr. Marcel Junod, who had come to Japan on August 9, 1945 as the new head of the International Committee of the Red Cross’ delegation to Japan, worked to provide medical supplies and conducted relief activities for four days. According to the survey conducted by Hiroshima Prefecture there were 53 relief stations. It is also reported that members of the Hiroshima Branch of the Hiroshima Prefectural Medical Association were engaged in relief activities at 102 relief stations.
At the time, Hiroshima City was home to the Hiroshima First and Second Army Hospitals, the Hiroshima Army Kyosai Hospital, the Hiroshima Prefectural Hospital, the Hiroshima Red Cross Hospital, the Hiroshima Communications Hospital, the Hiroshima Railway Hospital, the hospital at Mitsubishi Heavy Industries, and others. Of these, the First and Second Army Hospitals and the Hiroshima Prefectural Hospital were totally burned down, while other hospitals served as relief stations for A-bomb survivors, despite suffering major damage.
The Red Cross Hospital was located at Senda-machi 1-chome, 1.6 kilometers from the hypocenter. Its No. 1 and No. 2 buildings (built of reinforced concrete) suffered major damage, while the wooden buildings including the south ward, the isolation ward and the dormitory were all lost in the fires that followed. Among the inpatients related to the military, five died and 105 injured, and of hospital staff members and students (including Ken Takeuchi, the hospital director) 51 died and 250 injured. In this situation, the hospital worked feverishly to provide aid. Ms. Kubo (nee Yamane), acting head nurse working in the surgery ward, provides testimony of the confusion prevailing at the time. “We finally got some precious oil that had been kept aside. We tore absorbent cotton wads into large pieces, soaked them in the oil and wiped the faces, backs, hands, and feet of our patients, one after another, using both of our hands, despite the fact that there may have been sand or glass shards stuck in their bodies. Whether it was clean or not, we used peanut oil added from the pharmacy as well, but this also ran out quickly, like sprinkling water on parched soil. Of course, we had absolutely no gauze or bandages.” 43)
Relief stations closed on October 5, 1945, as it was stipulated that relief work in war-related disasters were only to operate for 60 days. According to the survey done by Hiroshima Prefecture, 315,910 A-bomb survivors had been given some form of help at these relief stations.44) On October 5, there were still 479 inpatients and 1,248 outpatients receiving treatment at the relief stations. It was obvious that further measures were needed. So Hiroshima Prefecture discussed the situation with the Japan Medical Treatment Corporation and then opened Misasa Hospital, Kusatsu Hospital, Eba Hospital, Niho Hospital, Yaga Hospital, and Fukushima Clinic as the “Japan Medical Treatment Corporation Hospitals” to treat A-bomb survivors and the general public. Because of inadequate facilities, requests to return classrooms that had been borrowed to schools, and decreasing numbers of A-bomb patients, these hospitals would close one after another.
2 The Study of the Aftereffects of the Atomic Bomb by General Practitioners & the Establishment of the Atomic Bomb Casualty Council
(1) Hiroshima Physicians Working on the Medical Care of A-bomb Survivors
In the late 1940s (before the medical care for the survivors came to be systematically carried out) physicians in Hiroshima were already working to provide medical care for A-bomb survivors and to conduct research on their health conditions. Specifically, the Doyokai was established by eight physicians from varying specialized fields at the end of 1948: Akira Masaoka (obstetrics and gynecology) and Tomin Harada (surgery) as the primary doctors, along with Jun Makidono (Radiology), Gensaku Oho, Muneyuki Mizuno and Kiyoshi Takada (internal medicine), Hideo Goto (ophthalmology), and Ken Takeuchi (surgery). Once a month they gathered at a member’s house and continued their research.45) Providing medical treatment for A-bomb survivors naturally became a common research subject, as the group continued to meet. They studied whether the survivors’ immune systems were weaker, whether they were more susceptible to anemia and other illnesses, whether they had shorter lifespans, and other questions. Using his own funds, Oho investigated the causes of death of A-bomb victims; and in 1951 at the Doyokai, he made a presentation of his findings on the significant increase in cancer incidence among A-bomb survivors. He continued his research, which he presented at the third meeting of the Hiroshima Nagasaki Subcommittee of the Liaison Council for Research Study on Countermeasures for Atomic Bomb Damage, held in Hiroshima City on July 12, 1955, and at other places. His research created a major sensation.
(2) Establishment of the Hiroshima City Atomic Bomb Survivors’ Treatment Council & the Treatment of A-bomb survivors
Coverage of issues related to the atomic bombings, which had been suppressed under the “press code,” began when Japan regained its independence in 1952. There was news on young female A-bomb survivors, called “Hiroshima Maidens,” receiving treatment in Tokyo, Osaka, and the United States. Following this, physicians in Hiroshima made efforts to provide free treatment for A-bomb survivors, saying that “treatment should be available in Hiroshima, conducted by local doctors.”46) The City of Hiroshima learned of this, and with the help of the Hiroshima City Medical Association, decided to implement treatment for A-bomb survivors. In this way, the Hiroshima Atomic Bomb Survivors’ Treatment Council (ABSTC, today’s Hiroshima Atomic Bomb Casualty Council) was established on January 13, 1953 and began treating A-bomb survivors for free.47)
3 Legislating Medical Treatment for A-bomb Survivors
(1) Enacting the A-bomb Survivors Medical Care Law and its Problems
On March 1, 1954, more than a year after the ABSTC began treating A-bomb survivors, the Daigo Fukuryu Maru (Lucky Dragon No. 5), a Japanese fishing boat, encountered nuclear fallout (“the ashes of death”) from a hydrogen-bomb test conducted by the United States at Bikini Atoll. Twenty three crew members in the boat were exposed to radiation. When the ABSTC and the Hiroshima City Council learned that the national government was going to provide the crew members compensation and treatment at national expense, they began action to petition the national government to cover all A-bomb survivors’ medical treatment expenses and to assist with their livelihoods.48)
Thanks to this action, medical expenses for A-bomb survivors were to be covered by the national budget from fiscal 1954 to 1956―although this was not sufficient. Then in 1956, the A-bomb Survivors Medical Care Law passed the Diet. It was promulgated on March 31 and implemented on April 1.
With this law, A-bomb survivors obtained an Atomic Bomb Survivor’s Certificate, which enabled them to receive medical examinations and treatment on national funds. However, this law did not provide medical allowances or other livelihood support. The law also limited the scope of medical treatment expenses covered by the government. As the law was inadequate in many ways, it was amended on August 1, 1960 and a new special A-bomb survivors system was established. Under this system, medical expenses for certified survivors were covered by the government, including for A-bomb diseases and for other diseases. In addition, medical allowances were provided to those who were certified by the Minister of Health and Welfare that they needed medical treatment for A-bomb diseases.
(2) Concerning the Enactment of the A-bomb Survivors Special Measures Law
The A-bomb Survivors Medical Care Law made medical examinations and treatments payable by national funds, which was a major step forward for the treatment of A-bomb survivors. However, even with the creation of the special A-bomb survivors system and the expansion of the applicable scope, there were patients left outside this system. This raised the question of the grounds on which the survivors were certified to be eligible to these benefits. And even though medical allowances were paid and the amount was increased twice, it was not enough to support the survivors’ livelihoods if they lacked other sources of income. The biggest problem was that the livelihood support that had been requested from the beginning did not see any progress.
People continued tenacious negotiations to overcome these problems. In 1968 the A-bomb Survivors Special Measures Law was promulgated on May 20 and enacted on September 1. This act provided survivors with medical allowances as well as a new special allowances, health management allowances, and nursing allowances. While it was still not enough, it was another step forward for medical care and welfare for A-bomb survivors. However, there were still limitations on the scope of eligibility of this law in terms of diseases, age, income, and other factors.49)
4 Medical Care of A-bomb Survivors & Research Institutions
(1) Opening of the Hiroshima Atomic-bomb Hospital and its Activities
The ABSTC, which was providing free medical treatment for A-bomb survivors, urged the Ministry of Health and Welfare to establish a hospital specialized in treatment of A-bomb survivors at the Hiroshima Citizens Hospital. Around the same time, the Japanese Red Cross Society, which was planning to establish hospitals specialized in treatment of A-bomb survivors in Hiroshima and Nagasaki, asked the Ministry of Posts and Telecommunications to allocate 30 million yen in donations from New Year’s lottery postcards. The relevant people met on January 15, 1955 to hold discussions and coordinate the opinions of the two parties. Those representing the Japanese Red Cross Society proposed 1) that the hospital be managed by the Red Cross, and 2) administered by the City and the ABSTC; and that 3) the facility be built inside the Hiroshima Red Cross Hospital. The ABSTC replied that they would further study proposals 1 and 2 in Hiroshima, while they urged the Red Cross to reconsider proposal 3.50)
Discussions were mediated by the Ministry of Health and Welfare, and on February 5, 1955 the Ministry proposed a mediation plan: the facility be built on the premises of the Hiroshima Red Cross Hospital but be structurally separate from the hospital; the building be maintained and managed by the Hiroshima Red Cross Hospital; a steering committee (provisional name) be established, and the hospital be administered based on the committee’s decisions; and the hospital for A-bomb survivors introduce an open system to allow all physicians to freely use the A-bomb disease hospital facilities.51) This was agreed on by all parties.
Construction began on January 15, 1956, costing 69.97 million yen (plus 3.4 million yen in medical equipment expenses), and completed on September 11. It was a three-story (120 beds) reinforced concrete hospital. Meanwhile, the first meeting of the Steering Committee was held on August 23 with 17 members to decide various matters including the name of the hospital (Hiroshima Atomic-bomb Hospital). Thus the hospital opened on September 20. The facilities were improved over the years, and from its opening through fiscal 1975 it admitted 5,681 inpatients (actual number).
(2) Opening of the Hiroshima Atomic Bomb Survivors Welfare Center
While it was evident that healthcare facilities and livelihood support facilities for A-bomb survivors were needed to improve medical care for A-bomb survivors, as mentioned earlier, the A-bomb Survivors Medical Care Law did not provide these measures. The Hiroshima Atomic Bomb Casualty Council (former ABSTC) submitted a petition in September 1958 on the method of allocating the donations from New Year postcards when it learned that donations of New Year’s lottery postcards could be allocated to organizations that provided treatment and support to A-bomb survivors. This resulted in the allocation of 17.3 million yen in fiscal year 1958 and 35 million yen in fiscal 1959, and with this, a three-story reinforced concrete Hiroshima Atomic Bomb Survivors Welfare Center opened on July 1, 1961 on the north side of the Hiroshima City Hall at a cost of 55.84 million yen.
The basic policies of the Welfare Center developed by the Council were that the center would be a comprehensive welfare facility providing health guidance, livelihood consultation, and vocational training. However, as allocated funds shrank, the concept had to be reconsidered. Respecting the Ministry of Posts and Telecommunications’ opinion, the Council’s secretariat offered a proposal focusing on vocational training since the Atomic-bomb Survivors Hospital had been already established for survivors’ healthcare. The directors representing physicians persuaded the secretariat by advocating the importance of medical examinations, which was an important part of the A-bomb Survivors Medical Care Law, and it was decided that the focus of the Center would be on health guidance. In this way, a clinical laboratory was established at the Center and run by the Hiroshima City Medical Association. This Center has played a key role to conduct medical checkups for A-bomb survivors.52)
(3) Surveys and Research on the Aftereffects of the Atomic Bomb
Based on the order given by the U.S. President to the National Academy of Sciences and the National Research Council, the Atomic Bomb Casualty Commission (ABCC) was established to study the medical and biological effects of the radiation on A-bomb survivors in Hiroshima and Nagasaki. The ABCC started its activities in Hiroshima in March 1947. Later it was decided that the research would be continued based on equal cooperative relations between Japan and the United States, and the ABCC was reorganized as the Radiation Effects Research Foundation (RERF) in April 1975. The Atomic Bomb Casualty Research Meeting was founded to establish measures for diagnosis and treatment of various ailments caused by the atomic bombs. The first meeting was held on June 13, 1959 and has been periodically held to this day.
The Hiroshima Prefectural Medical College was involved in research on A-bomb survivors from early on. It established a radioisotope committee in 1952. This policy was succeeded by the Hiroshima University’s Faculty of Medicine, which established the Institute for Nuclear Radiation Research on April 1, 1958. On April 1, 1961 the Research Institute for Nuclear Medicine and Biology (today’s Research Institute for Radiation Biology and Medicine) opened with four divisions: Basic Research on Radiation Damage; Pathology and Oncology; Epidemiology and Social Medicine; and the First Clinical Department (internal medicine). The Research Institute has expanded its organization and assumed a role as a comprehensive research institute on the medical care of A-bomb survivors.53)
5 Internationalization of the Medical Care for A-bomb Survivors
While there were many Korean A-bomb survivors, for many years, there were no measures to support them after they returned to Korea. Korean A-bomb survivors formed the Association for the Relief of Korean Atomic Bomb Victims in 1967, and on August 10, 1970 Shin Youngsoo, president of the association, came to Japan to seek support. In response, a Japan-Korea joint council was established to provide relief for Korean A-bomb survivors in October 1971. Around the time Korean A-bomb survivors began to be invited to receive treatment in Japan, and a delegation of four physicians was sent to South Korea to conduct medical examinations. In December 1973 the Hapcheon A-bomb Survivors Welfare Center was opened in Gyeongsangnam-do to treat A-bomb survivors in Korea.
Following this development, medical examinations started for A-bomb survivors in other countries as well, and from March to April 1977, the first delegation of physicians was dispatched to conduct medical examinations on A-bomb survivors living in the United States. Although it has a slightly different purpose, the Hiroshima International Council for the Health Care of the Radiation-exposed (HICARE) was established in 1991 to make use of the expertise that Hiroshima had accumulated through treating A-bomb survivors. It has conducted a wide variety of activities, such as accepting trainees, including those involved in treating radiation victims of the Chernobyl disaster. While not directly related to medical treatment of radiation victims or A-bomb survivors, the First World Congress of the International Physicians for the Prevention of Nuclear War (IPPNW) was held in March 1981. The Japanese Affiliate of IPPNW was established in the same year, and the Hiroshima chapter was established in 1982. IPPNW’s World Congress took place in Hiroshima in 1989 and in 2012. In this way, the physicians in Japan, which suffered from the atomic bombings, have continued calling for prevention of nuclear war.
Hiroshima lost many medical institutions and healthcare professionals from the atomic bombing, but the physicians of Hiroshima rose up, even though they were also A-bomb survivors, and promoted medical care for A-bomb survivors with the support of people from all around the world. Today they contribute to the medical care for radiation victims around the world.
43. Hiroshima Sekijuji Byoin Enkakushi Genko (Kadai) [Manuscript of history of the Hiroshima Red Cross Hospital (tentative title)]. August 1990.
44. Hiroshima Genbaku Iryoshi Henshu Iinkai. Hiroshima Genbaku Iryoshi (History of Medical Care for A-bomb Survivors in Hiroshima). Hiroshima Atomic Bomb Casualty Council, 1961: p. 148.
45. The Doyokai is explained in detail in the aforementioned Hiroshimashi Ishikaishi: Dai Ni Hen (History of the Hiroshima City Medical Association, Vol. 2). pp. 330 – 333.
46. Hiroshima City Medical Association. Hiroshimashi ni Okeru Genbaku Shogaisha Chiryo Taisaku no Gaiyo (Overview of Treatment of A-bomb Survivors in Hiroshima City). 1954: p. 2.
47. Hiroshima Genbaku Iryoshi Henshu Iinkai. op. cit., pp. 471 – 473.
48. Genbaku Shogaisha Chiryohi Zengaku Kokko Futan ni Kansuru Ketsugi (Resolution on All Medical Expenses for A-bomb Survivors to Be Borne by the National Treasury). May 25, 1954. (Hiroshima City Council)
49. Regarading to the “A-bomb Survivors Medical Care Law” and the “A-bomb Survivors Special Measures Law,” referred to as the Atomic Bomb Damage Measures Department, Health Bureau, City of Hiroshima. Hiroshimashi Genbaku Hibakusha Engo Gyoseishi (History of A-bomb Survivors Support Administration of the City of Hiroshima). 1996: pp. 124 – 181.
50. Chugoku Shimbun, January 16, 1955 edition.
51. Hiroshima Genbaku Iryoshi Henshu Iinkai. Hiroshima Genbaku Iryoshi (History of Medical Care for A-bomb Survivors in Hiroshima). Hiroshima Atomic Bomb Casualty Council, 1961: pp. 569 – 570.
52. Regarding the role of the Hiroshima Atomic Bomb Survivors Welfare Center in managing the health of A-bomb survivors, referenced the aforementioned Hiroshimashi Ishikaishi: Dai Ni Hen (History of the Hiroshima City Medical Association Vol.2), pp. 509 – 531.
53. Regarding to the Research Institute for Nuclear Medicine and Biology, referenced the aforementioned Hiroshima Daigaku Igakubu Goju Nenshi: Tsushi Hen (50-Year History of the Hiroshima University Faculty of Medicine: Overview). pp. 359 –374.