The diagnosis, prognosis, and treatment of radiation injuries produced by atomic bombs.

Abstract

The purpose of this paper is the presentation of practical information on the diagnosis, prognosis, and treatment of such radiation injuries as may be seen in atomic warfare. Others have amply covered the physical effects of the atomic bomb. The chaos that will exist in the immediate post-explosion period has been succinctly described. We are all aware that the greatest hazard is panic caused by the overwhelming fear. Progressive education and indoctrination of the public should allay this greatest of hazards in atomic warfare. Providing that there is some semblance of order in the civil population, it seems self-evident that care of the injured should be organized along the general lines of military medical care, i.e., first aid, collection, transportation, evacuation, etc., but under previously organized civil direction not military. The medical problems following an atomic bomb explosion are complex. The immediate problem will be of a magnitude that will seem almost insuperable. It may be necessary in the early period to lower our high standards of care to a practical level that makes it feasible to care for hundreds of thousands of casualties. The after-care will last for months, and it is certain that the salvage rate will be higher if the definitive care is in special centers under the direction of competent specialists. This latter principle should never be compromised. It obviously does not apply to the immediate period after the explosion, when the only objective is the rapid first aid and evacuation of those still alive. Others have emphasized that, percentage-wise, radiation injury is of lesser importance, but 10 per cent of 100,000 casualties still present a frightful problem. Radiation injury resulting directly or indirectly from the use of atomic weapons may be divided into two categories: (1) the superficial ionizing radiation burn from soft radiation (beta); (2) total body radiation injury, “the syndrome of acute radiation injury,” from penetrating whole body radiation (gamma and neutrons). The radiation burn was not seen in Japan; it is a remote possibility and has been discussed adequately elsewhere (1–4). In respect to exposure of the whole body to penetrating ionizing radiation there are three important questions to be answered: 1. Was there significant exposure? 2. If exposure occurred, what is the prognosis? 3. If exposure occurred, what is the effect on other injuries? The answers to these questions may not be easily obtained. Since animal experimentation has clearly demonstrated wide sublethal, lethal, and supralethal ranges, and since radiation intensity diminishes sharply with the distance from the source (the exploding bomb), one can arbitrarily divide an exposed population into three general groups based on likelihood of survival: Group One: Survival from radiation injury is improbable (supralethal doses). Group Two: Survival from radiation injury is spontaneously possible (the lethal range).