TECHNICAL REPORT

28-59
m mm^m

MEDICAL EXAMINATION OF HIROSHIMA PATIENTS

WITH RADIATION CATARACTS

PAUL G FILLMORE, M D

COriginally published 1952 K % ^ )

Department of Medicine, Duke University

Duke -Xfm'fW'

ATOMIC BOMB CASUALTY COMMISSION

HIROSHIMA AND NAGASAKI JAPAN

\ Cooperatve Research A^encv of

VS>, KATI0\4I ACADFM"! OV SCILNCtS NATIONAI RF SHRCH COINC!
and
J W A N F S F NATIONS INSTITUTF OF m A I T H Of THf MIMSTRV Ot m ALTH AND W H f A R t
B ill fu ds pro lied b
L S A ATOMIC PMfi(^ COMMISSION
JAP\N!-Sf NATIONAL INSririTF OF HIAITH
U S A PUBHC HFAI TH SfRMCI

m m m m m ^ m m ^
* 0 -;, ± K ~ / ffi ^ ,» i J, 1 ti m ^J 7 P4 fti 1 in k It!
t m n Ji-. '^ \>] n -fi m -k h m
(4-rarri/jSfi^, fti fiw ffrM, ifjf*-f loiin iSfitn ' ^ H * « * J )
 DISCLAIMER

This report was prepared as an account of work sponsored by an

agency of the United States Government. Neither the United States
Government nor any agency Thereof, nor any of their employees,
makes any warranty, express or implied, or assumes any legal
liability or responsibility for the accuracy, completeness, or
usefulness of any information, apparatus, product, or process
disclosed, or represents that its use would not infringe privately
owned rights. Reference herein to any specific commercial product,
process, or service by trade name, trademark, manufacturer, or
otherwise does not necessarily constitute or imply its endorsement,
recommendation, or favoring by the United States Government or any
agency thereof. The views and opinions of authors expressed herein
do not necessarily state or reflect those of the United States
Government or any agency thereof.
 DISCLAIMER

Portions of this document may be illegible in

electronic image products. Images are produced
from the best available original document.
I

CONTENTS

List of Figures
ffPAKI-fiSt- • • ••••••• ................Page i

Purpose
H m - - - - - ••••••• •••••- • • • ••••• • 1

Background and Previous Pertinent Literature

imisi.zi&.m(om'^ • • •••••• • - • • 2
Patients
m ^ • ••• • • • • 7

Results
m s • •••••• • • • • • •••• 9
General Observations of Japanese E y e s
H*A®(fiK-Dl,^Tffl—«KJSS • • • • •••• 27

Summary and Conclusion

msfcj;t;*sii • • ••••••••• ••••• • 29

References
##5t[K • 31

•
 i

FIGURES
» A@

Figure 1. Distribution by age, 2000-meter survey

m 2000m|IgM»gf-®¥lp3fl^tfJ- - • • --Page Y
Epilation, 2000-meter survey
2000m mmmmK *? y- s K^S- •
Distribution by age, 1000-meter survey
loaommmmmoimfAii-^-- •••••••••
Epilation, 1000-meter survey

{
•
OPHTHALMOLOGIC SURVEY OF ATOMIC BOMB SURVIVORS
IN JAPAN, 1949

PURPOSE

T h e ophthalmologic study which this commu-

nication proposes to report is part of a long-term
•nm fcr>m'-m t- j ; na-M-yifiW/'S-i^Mfit z tz A K
project conducted by the Atomic Bomb Casualty
Commission CABCC) to investigate the medical
and biological effects of the atomic bombing
in Japan.

The request for an ophthalmic survey was

apparently initiated by the Committee on
Ophthalmology of the National Research Council
with the implied intent of determining what, if
any, delayed injury to the eyes had resulted
from the atomic bombing. T h e undertaking was WMSfiMM SM-ii C A B C c 0 AifT'^i; -> T (, N S SJiJ]
prompted in considerable measure by the recent
discovery of cataracts in cyclotron workers who
had been chronically exposed to forms of radiant
energy Cneutrons and gamma rays^ similar to
those which were given off by the atomic bomb.

T h e assumed task of the study group was

threefold : (1) to determine qualitatively, by
history and examination, whether or not ocular
lesions, other than traumatic, resulted from the
atomic bombing; (2} to ascertain what the
approximate frequency of these lesions was in a nfzct'dc ® 3Sft© A il mm i ^i:!? t. ^ S l i ^ < ^f
sample group of the surviving population who
had been near the hypocenter at the time of the
explosion ; and ( 3 ) to note any incidental find-
r--&nfzo
ings that might be considered of significance
or interest in a routine examination of the eyes t)6, (1) JS fmm^ f ®M*^«ftii^-jy^K(tKf--[-
of a Japanese population. mmmii±i.fzfp¥M^^mmi3xowmc±',xmm
fcfij/Eb, (2) m>t-'m/j^ b m m r m m L t z S i ^ r i *
BACKGROUND A N D PREVIOUS
vrfM-cioii 5 cm'i®3H^'®A#®i!t3;^W*^s6,
PERTINENT LITERATURE (3) Li J^K ® -Mmmm-k:^ -ft"** a t ^ \tm^a^ *

The atomic bombs were dropped over Jl'MBjAa"S1945fp8 ji 6 U K, Mt-C 8 j^ 9 n {C

Reprinted by permission of Transactions of the American Ophthalmological Society. Originally
appeared 1950, Vol. 48, pp. 62-87.
Hiroshima on August 6, 1945, and over Nagasaki
on August 9, 1945. On August 28,1945, a plan was
K-0!,^T®fltliiA^3'z;Tbtlfco Manhattan Project
drawn up for the study of atomic bomb casual-
ties. A mission from the Manhattan Project was *^ ?'> 'M-Mmmmti -ts nx MmMmTio:)nmmmom
assigned to the determination of the residual
5t!C3^/Co -r®HllfJ!C, KKiJffifM^USjjfebTl^
radioactivity in the bombed cities. Considerable
assistance was obtained from the Japanese fz UAiSlfif®IlirBB*^ & feMs s; ®«liij/j^# 6 t i , JS
Government groups who had already made
"il5nj^'B'®S|]fi-icJ;.oT rH4s;iCi>it5Mi^'M»®>aJ
preliminary observations, and at the suggestion
of the Supreme Commander there was appointed mcm-tz-hWM&mi mkiy^ntzo coiasM®
a "Joint Commission for the Investigation of the
i4ii*ltt—np Liebow, W a r r e n isi^U De Courseyi
Effects of the Atomic Bomb in Japan." The
report of this commission, summarized in part in oAlarmf^tsii-cisy), M^, :t}&(OtM\MWxU
the article of Liebow, Warren, and De Coursey,'
provides the most comprehensive survey of the
terrain, the physical characteristics of the land, xo:ir^hmfiWsmii)m^s.t>n, ^|Sc®W^43.J;t>"
and the medical and biological effects on the
population, including many illustrations and
eyewitness accounts.

A resume of the Joint Commission's report is

beyond the scope of this survey, but it is note-
x\tfi\.-^tfi, Wi'M^mMim'n-, m%isi.-j-mmmi^]
worthy that the casualties were divided into
mechanical injuries, thermal injuries, and injuries mi^x^wpAcmAinxi-^zctumi s nx\,^
from ionizing radiations. Mechanical injuries
were those resulting from falling timbers and
So mw-m-mt^^o:>mm.isxv-imM\ ®M«T

flying d e b r i s ; injuries with glass particles from #i<:;«©Mtifc*'yy^nKXimtm^i^-^fzo <:©

shattered window panes were especially frequent.
Such injuries were sustained at distances of at
least 4000 meters from the hypocenter and were
due to the blast of the bomb. Thermal injuries
were caused either by radiant heat, in which
case the heat was intense but lasted for only a
fraction of a second, or by flame burns.
effects of radiant heat were evident in the form
of burns up to 4000 meters from the hypocenter,
but rarely did they result in second-degree burns
at a distance greater than 3000 meters.
of short duration they produced characteristically
a "profile" type of burn with protection of struc-
tures not in a rectilinear projection from
bomb. They also produced relatively
superficial charring and less deep penetration in
comparison with flame burns. They
produced curious configurations according to the
clothing which was being worn at the time ; thus
burns often showed patterns when the overlying
g;©feWii;;li'C^ill!J; ^')'Pf£ < t fe4000mJ)i|/:ji2)ft;S|-e
M'^j, m-m'mymmcxz,h(Dxh-ofzo m¥Aiik
fjTii*otzm, 1 #®M^>® 1 i!,->') - < m^mm
h^tzmMkic.i^/oh(D/j\ fiZ<,^ii.'XPiicx7j'xmx
The
i^-otzo msm^iomwii, M'C^itii*^'^^ 4ooom*-(:ii
m^ojm-^iiimifzt^ 3000mj;iJ:®ii!t;i|-?{ijiWt
®.^»Btti-e*-ptzo fmrnoMmmm i^.w^-^fz
Being
26, i<:Ii©iai-f*'^!J-^xA^ofcSi5^ii#,l3ti.-r ^^iM.
i^-omMfis^ MmM±i^tz<itfjmmx&^fzo -xn
the
more Kx.zxmtitmhx, mwmm^iii-MimmMii
&mi-i^<um^m^'i,ctii'pfiti^-^fzo 5fwc,
further
imm\immm\^mihx^^fz-amcxi), •^.iwsm
clothing had been of varying thickness, and when
clothing was of a light and dark design, the
burns, selectively under the dark portions, often mu.mK'smmr^L\L\:,x, -coifi^t-Siirifi'iiKpm
reproduced the design on the skin with remark-
Ltzo ~-}j-, xmit, mimicszMmmmxt
able fidelity. T h e flame burns resulted either
from the spontaneous ignition of the clothing by fcSilM'JiS; mo-)±mfjfiXXici.6 fe®-(?*-3fcc
the radiant heat or from the general conflagration
that followed the bombing. Most of the early |;jffl®?Eii-iK, i-t:J?*.SM®ioiiBg®?Eir^-c73A*
deaths, that is, those occurring within the first
mx, ii«ft<jfe','f/j\«s«®fcy3Tj& -ofzc
ten days, were due to mechanical or thermal
injuries.

T h e injuries from ionizing radiations were 'itilMM-!: .i zm'ii-'.iM,:ik:fy.z.[i.iyc<j:)mMoy --t -f

theoretically attributable to any or all of the
following forms of energy : visible rays, ultra-
violet rays, gamma rays and neutrons ; the only
significant source was direct radiation from the x»:,So ^iSJsMmimm"^}omwi--'^^(Dmii.mm
bomb at the time of the explosion. It is thought
that induced radiation on the ground or deposi-
®|!fTli-fi';*fftiJfl€-&il--J-|r!i7[< \-'AX& -o tz t-^s
tion of fission products was insufficient to have
had a harmful effect. It is not clear what effect X. ?>ti So mmwiisX.z^^m'jm^<j^-'±^\^M-i- s]#fi
the visible and ultraviolet radiations had on the imhfj-^XiiLfi.i-'ffi, !8!::M-rSI#»f®Bitgtticoi;N
body as a whole, but reference will be made to
T^izEi-So imm(ommo-yi^yiii^v^i-tfiV-7-
possible ocular effects subsequently. Most of
|giCJ;S fe®-c?*5-oT, ^n-*c-'a®fi5*l!CI/Vj^ftSftl
the radiation effects were due to neutrons and
gamma rays, and what t h e varying effect was IM^ii-3 fz AN ii&ibi --tn 1-.®l|i*©Mf5\c-&isfs.
of each is probably of academic interest only. I^o *• V-7-W.^'MtSitJfe/-©SiJ(Y.iWMi)-b©tfh
Although the proportion of neutron to gamma rays
a i ® M i C i bTj«4>i-S c ttii'-A\''iiiX\,^7^ifi, ^coy
is known to decrease as a function of distance from
the bomb, information on the absolute amounts ^.<?®ji7.7iyif-"-®|fiMB:i-oi,^r®HI4i±l§i<t>^L
of energy of each is not publicly available.

It is commonly stated that the spectrum of WMW h'®«£f*%bfci12ii»JA.«iax.^.-/ Yivoy^i.

electromagnetic radiations resulting from the
m'iymi. x\wjmt\n\-x&-pfztmm.HA\.-r.\^
bomb had the same general distribution as that
of the sun. T h e peak effects of the radiation So M M w i f t A © ^ * ; * , J|t'MioiJ/jNf,2MBI]|tlc
became evident at ten days to two weeks after
i S w t i , m^^, ^St*iJ;'Jfij(iU*»©M-'i>;6^4bfcc
the bombing and were manifest by epilation,
purpura, and drop in white blood count. A host *®B/jNiC:^fi0?,r;VCC h'#J, :t8>;?r<M, '%l*i0')ti\

of other symptoms were also frequent (diarrhea, b t t ' b t f i H i i i i n , S;f. <ft:l-t*Si:ldWbfci?S.s,-o

anorexia, fever, and so on), probably attributable
», U:S#®#»iWji'd:iAftg®fcyj'tbfc?iF;UiiiK
to radiation b u t hard to separate from the results
of the unsanitary conditions following the SlJ1-S©(iWSt-(:*So
bombing.

T h e effect of shielding was, of course, of prime

ii«©iJ«-tt, iX4-«';*t/j\''kbfc*^i!/->') c i i c
importance in determining the type of lesion ; no
doubt it was responsible in large measure for the
diversity of lesions produced. Those who were
in the open at the time of the explosion were
exposed to radiant heat and ionizing radiation;
those who were protected b y wooden buildings miitir\,^fzxiimmmiis<dfs.ii'^'otzf)-mmM%m
were not exposed to radiant heat but were
exposed to ionizing radiations ; while those who
were in concrete buildings were relatively pro- &mMMtfnxh^fzo
tected from both.

T h e ocular effects of the atomic bombings have

already been the subject of numerous publica-
5 o* *fti® {WM, 1945-ip 8 j^ 9 n rj^mcmm$ n
tions.* T h e first report was apparently that to
the Section of Preventive Medicine of the West tz u4^mw-MLM0iomnm'Gii'^ tz^Am ^ M, wjLgn
Kyushu Military District b y Matsuoka,2 ophthal- 'itmg-mwMKiMaiLfzh(O0Xvx$>-otzo m
mologist of the Japanese Army rescue squad sent
j t J S J ; IQ 0—1999m JC t,N fz 492 ^c^J, 453 f.lcmU
to Hiroshima on August 9, 1945. Of 492 patients
within two kilometers of the hypocenter, 453 had •i^i, 3 ^icm^wJiisj^L^ 1 tAcnmsMi:mAfzo
conjunctivitis, 3 had burns of the eyelashes, and
mmoMmomi^mmmic BmLtztwubhUfz mm
one had infiltration of the cornea. No lesion of
the eye was found attributable to the direct effect miif£i)^-ofzo micMt6i'0M(Dm9\cmi-Mmm
of the blast. Case reports of atomic bomb effects
'^t bTB, iomcm'^ ffiiJ =>y-.icxzmo:>fmis
on the eye followed by Hata3 on perforation of
the eye with glass and separation of the retina J:t>'S5«!Ci;S«Kail!(:oi,>T«f^-bfco H-rrJ-f tt
by contusion ; by Shoji'' on cataracts occurring mmmmnmc&K. < m.moymmmmi.c x -> T/I; b
within a few weeks after the explosion and
presumably due to the direct effect of the b l a s t ;
by Ikui'>6 on ectropion of the lid from burns of WfA«!C J; s BMIR^I-S f J; J>'a-«tta l^plico (, NTM
the face and on concussion c a t a r a c t ; and by
frbfeo ih\\\iix-'jfii,tii^u±fmtmm(JiX¥,\z.'^
Koyama and Sasaki^ on burns of the cornea and
retina. A brief report on the acute effects of i^riJ'S-bfco lASictJij-st!Kf5'a;'©,d;#:iJ*f!coiN
the Hiroshima eye casualties was also given by T f e i l f ^ s i~J;r>U:frJ •* : $ ^ f i i | i K « f t b T l , N S o
Yoshimoto^ and Shoji.''

T h e first ocular study of any considerable W3S:©irKii'i*«o fzm)]on\mt-m%\i\\\\'\, ^t

series was made by Tamura, Ikui, Nakano,
Hiwatashi, and Oshio,^ on patients from the
Nagasaki area who were within two kilometers I-iJ;!) 2000m P i r a ! C l N f c S l l t J f t K ® S # * M * t b
of the hypocenter at the time of the explosion.
tzo «®ISi|i, diO'iXoUim.WWsWbf'^o -'f'flh
T h e acute effects noted were : (1) thermal burns
of the eyelids which were remarkable in leaving *., (1) mmmm—m-m^o^mmMWiAm-ofzxc
a minimum of scarring ; ( 2 ) keratoconjunctivitis
^&nfi\^m^miistitzo (2) nm§si—m\m^
lasting only a few days and presumed to be due
to ultraviolet radiation ; ( 3 ) iridodialysis, luxa- %%\,tzK\m-f r.mtm'AMvi.X s t® t^f^^xx.
tion of the lens, hemorrhages in the retina and tzo (3) ii-mmwu /Y.htWM'^-i, mi%i3xmriJ-f^wMK

*For the sources of reference in the Japanese literature, we are indebted to Dr. Ikui.

1 l / [ i ® > C t t i K « K o i ; N T t t i f e ^ : K ! C f l T > C 5 A^^tz-'o

4
vitreous, and separation of the retina, all resulting
from the direct effect of the b l a s t ; and ( 4 )
ai-cfeofco (4) W-^^i'i. s«T*t—*-5xrri(;<t;S
injuries by foreign bodies of which glass splin-
ters predominated. Effects coming on 10-14 days fe©7i5A^fc*i'ii6^co M-liJ&S^M bfcMfrcB
after the bombing were noted in patients with
radiation sickness and consisted of hemorrhages
in the lids, conjunctiva, and retina, and occa- ission t)^ li uimtcmm, mm3XLmmoyi\i(\i
sionally infiltration and necrosis of the cornea.
T h e retinopathy, consisting of exudates as well
as hemorrhages, was especially noteworthy as it fco iiniii^ms\\'mii:(Dmmmbii, m&^m^-ir'-ji
was found in 22 of 115 patients on whom IMLfz n5^o:)!3.S-(nip, 22t,icm>6i iifz c i/ji[J
ophthalmoscopic examination was done. J/l-^fco

These same authors made a patho-histologic Urmm, M«fcMli®20|l75M.i40|Jt:ic?'Eil-Lfc

studyif of 48 eyeballs removed from 29 persons
who had died 20 to 40 days after the atomic 2y^fj^^jmihhfz'i8imr'.::^'.'xm-mmwm&mi:
bombing of Nagasaki. Most of them died of
bacteremia complicating radiation sickness.
fja ->fco-coyx-^miimm^MiicmmvA'Gm i
Colonies of bacteria were frequently found in the xniiiLfzo »mMmmmMimiH\cuiu-tmi/j^j
retinal vessels and occasionally free in the retina.
T h e retinal hemorrhages were not remarkable, iifz±i, SSrriQjftilf^HciliibrtNfco IHUdiifiKa;-?;-
and it was noteworthy that there was no evidence
of disease in the retinal vessels. T h e white spots
m^fs. <, mmiimicmm(DW¥mfs:fj-^'^tzc tm-n
which had been seen clinically had their his-
U §tifco i;ij)/lcI:Jgi6 iiifzafEiiSlStiiBlc!iW«
tologic counterpart in cytoid bodies (associated
with hemorrhages}, collections of white blood mBomitrnm (tBrfa^tt--?} aifiu$s?ffl3t, m§m
cells, colonies of bacteria, and albuminous mate-
rial. Separation of the retina of slight degree isi.om&mmnx$>^fzc mtommmmtji'^m<•:>
was occasionally found, mainly in the posterior
segment but also adjacent to the ora serrata. S&bti, S-:i Lxm^MlciAC,-htzfjimViBM&<
T h e choroid was frequently infiltrated with mono-
cytes, plasma cells, and lymphocytes, and
icfeggyjbnfco mmmiciinimmi, mnm^
contained bacterial colonies in the vessels and free xnv v/N-j^icic.kssffl*?*!?, ymwM^i'iisxn
in the tissue. T h e colonies were sometimes, but
not always, associated with cellular reaction. m.»mcmmw&^fzo co:)mmmmiiMiciiMm
Necrosis of the cornea and adjacent conjunctiva
was present in one case. Vacuoles in the equa- si.B4fl^oT!,Nfco nmisxrjmmmmommtim
torial region of the lens were found in six cases,
and the nuclei of the equatorial cells which lay
icsfebtifco /UiM^Mmicwsi:<imicm&, -M
beneath the capsule were degenerated in two i'ii'#«T®#asi5aiiia©ij(ijfe<r 2mm&j, mmi
cases with evidence of swelling and disintegra-
tion of a thin layer beneath the anterior and m rom<.-'imcm.misx'jiimoywm^& ^ fco
posterior capsules.

While the foregoing study has not been pub- AzBom'MiMi&MxiiZfji, -c®tp© 6ISAiCo
lished, six of the specimens from this study
l^T-€-©^ Schlaegel" A^-ftifrb, /KSht^^micm
were subsequently reported by SchlaegePi with
the additional observation that there was slight ffi®iEJ¥*s*ofci(DM'^mMf^hiifzc mmfsmm
thickening of the posterior capsules. An «»T*]5ff-'^*5 Miural2 tCX-oXn^lioUtziji, C
analogous pathohistologic study was made by
ffl#i@#tt®-^Kttmmx ^fiffi -^ fco $ k> K
Miura,'2 but this report was not available to us.
A further pathohistologic study has been made wiideria hmmm.m'^ff3m%xfifs ^ rt,^ so
by Helenor Wilder.'^

T h e only instance of burn of the retina to have

been reported is that of Koyama and Sasaki.''
Their patient was searching the sky at the time
iM©fs#iAs*s©^-<j & Zo c ©,ii#ttM?g©rf
of the flash, looking for the airplane. She had fM, mtm^^Lx'S^s.xh^tzo i*:.a#K«.e®ii
no immediate visual symptoms, but 30 minutes
later developed severe pain in the eyes, 'S:Wjr;mmst:^-o tzM, 30iyi^Kmmicm.m. mm
photophobia, and swelling of lids. She was
isxv-mmmm^ikiS'tzo ii^nmAmLtziji^om
hospitalized for one month but was not seen by
an ophthalmologist at that time. The acute itms.nmow^^s:i^a^^^fco si^mtmmmc
symptoms had subsided at the end of the month,
and on examination she was found to have
His $ t o fztii. mfm^rmmnrnT-i^mcizm-i
Symmetrical opacification of the lower half of mmsmmisxommmutmajmsmicm'j^tz
both corneas and a central scotoma of both eyes,
most dense in a ring shape corresponding to the t^mKm9io:>ip'(s.niM.^m!:i>fzo mj&mjmitmmm
six to eight degree isopters. T h e fundi at first
S{i8PKiM,MigfLii© 3 ^ffl 1 fiis:® A t s ®Mae,
showed a grayish white zone, one-third the size
of the disc, on the temporal side of each macula,
and obliteration of the normal paramacular ring
reflex. T h e fundi subsequently cleared up, but fco ^omwrnmimmbtzmnmt^mLtzo
the scotomata were permanent.

Benkwith'* described in detail an instance of Benkwith" ummmmm.^if'^fzmmtiiMojim

retinal hemorrhage with radiation disease, and
ic-oi^-^x^micWi^b, JAM'S {immMmii$> -otz
Hiroseis found retinal hemorrhages in 62 of 164
patients with presumed radiation sickness. t^^ioUtz 164 ;f.©S^-*, 62^(C|Baid!JlU^,SJ6
Tanakais reported a staphyloma of the cornea fco iB*« Kiiii!ceH-rsfigp$«i-®igm4;bfc^ig
resulting from an ocular injury caused by the
€#B^«^-Tb, -?:®»^ar#;ttc®m^®##:®'ftii
atomic bomb and suggested that its pathogenesis
was similar to the keloid formation elsewhere in
the patient's body. T h e retinopathy associated mW-htzo ft!S-l«S355,m!c:'ffoT|ia;bfcliR!i-Eic;oiN
with radiation sickness has been described also -Ctt Flick''' k,yl-<Xii^, C(Dmti)inm^X&Z
by Flick,!''' with the additional observation that
th» changes were reversible.
i®S^:6^illI/Lbtlfco

Up to the time of the present writing no ^'mK-f.mt.x\c\-ixmcKmi'^nno:)WMi.fi

delayed cataracts have been reported in the litera-
ture, but one of the patients described in the h^m, c®mfi(D 1 #'!iK-oi.NTttrAiii8iijhmwwV'€-
present manuscript is being currently reported at
the Kyushu Ophthalmological Society Meeting ^^ (1949fp9j?}23H} XmMbXh'^Zo ikmOShK
(September 23, 1949} by Hirose,i8 and two
2 moMimi'WmimFL Lxm-^ ic^M^jLtzox^^
additional cases of radiation cataract in the
present report have been recognized by and called mK&mhfzo
to our attention by Ikui.
PATIENTS
m m
T h e patients were divided into t h e following
|g^^*i^©!([K:»Sbfco
classifications:

Group 1: Survey Cases, ( a } T h e 1000 patients SslSI MMrM\m.(a) COm-i:mjM,tZ> 1000

making up this group were drawn at random
from a list in t h e census files of persons within «!i, im9i}iom>t-^mx'o 2000m pi^-^ r a ^ u K
2000 meters of t h e hypocenter and in the "open"
Pfc^©AniiS«?i*^b«fr-MHi'i! bfco C®flf:®
at t h e time of t h e atomic bomb explosion. T h e
age distribution of this group and t h e distribu- if-WyMtJis X rJ.M:\>At^ h ®ffiJt® Kfc > b T®:a-/ff
tion as a function of distance from the hypocenter
are presented in Figs. 1 and 2. (&} A supple- !i, la 1 iJ J^G^^M
' 2 iC . ^ b fco (b) ABC c ® A n i l
mentary survey was made of all available
persons listed at t h e present time in t h e ABCC 3Ksai|-c'M'bJ-iii.i; 0 lOOOm jyp'i-c««bfci3dAb
census files as being within 1000 meters of t h e
-t*S^^fi!Co(..T-el5ft}Sl«0MMKla?3Sr;4-'ii»

FIGURE 1. DISTRIBUTION BY AGE, 2000-METERS SURVEY

m 1 2000m mmm<Moif''mA9t''^

B
3

6-10 11-15 16-2021-25 26-30^l-3536-404L505t6P6li7p7!iS28L9£

Present age (1949}

IS ffi 0 ip- i i

7
hypocenter (exclusive of the 14 patients included bfco fib CmsHmmc-^ibtz^u^^m^tz') co:)
in the previous group}. This amounted to 231
persons. T h e distribution as a function of age 23i^Ktx -ofco¥IB*JXv^m't.mti-> b ommo
and distance from the hypocenter is presented
t Lx&&mi, a 3 f j;(i>Ta4 itzfxbfco
in Figs. 3 and 4.

FIGURE 2. EPILATION, 2000-METER SURVEY

H 2 2000m m&mm-icis'dzm.^

DEGREE OF EPILATION

NOT EPILATED
•
_ _ , SLIGHTLY EPILATED
g
3
MODERATELY EPILATED

SEVERELY EPILATED

600- 800- 1000- 1200- 1400- I60O- 1800"

799 999 1199 1599 1599 1799 2000

Distance from hypocenter in meters

l i J(l^ IS A^ b ® EB H (m}
FIGURE 3. DISTRIBUTION BY AGE, 1000-METER SURVEY
11 s 1000m mmmm(Dif-mmy^

•a

B
3

1-5 6-10 11-15 16-20 21-25 2 6 - 3 0 3 1 - 3 5 3 6 - 4 0 4 l : S ) 5 t a 0 61:20 2 1 ^

2 2 2 2

Present age (1949}

m ff. ® if %
 FIGURE 4. EPILATION, lOOO-METER SURVEY
H 4 1000m rMliMmi-Kisi-}ZU^

BESBEEOFEPItATION
SEE0FEPIL/iT|ON

HOT EPILATEO

U umfi b
SUGHTLY EPILATEO

MOPERATaVEWLATEO

SEVERELY EPILATEO
S
200- 400- 600-
399 699 799 looo
Distance from hypocenter in meters
s C
' .^ m f}^ ?> o m it (m}

Group 2: yfon-survey Cases. T h e patients

making up this group were reached by means
mmmmom'<(-tm\iiW9\(D')5m'^m&htzo c®
other than the random sampling of the survey
group. Some were reached through local mat, J47C[JSfR^*HbT#fc^^AB C C®flll©
ophthalmologists, some through referrals and immi^i'm^tsnfz^, srHsa-^^iiTrbfctf, *.
from other ABCC clinics, some others through
newspaper publicity, and some were called in. Si;^tt^g©fcyj*frirsJ:-5*Jlii/^bfc:# fe ^ ->
From this group were separated those who fco comi)^ h immxcmn bfzwmmtfih -^tzt&
were thought to have ophthalmologic lesions
attributable to the atomic bomb. htitz^^mmbtzo

RESULTS IS *

GROUP 1 ( a } m 1 P Ca}

Survey of 1000 patients within 2000 meters of m>\s-mX S32000mji[raffl,a-tl000;g®ia^ (1000m

hypocenter (including fourteen within 1000
fiira®S:S-i4ig*itir}
meters}.

A. Subjective Visual Phenomena A. Q'-mMMwrn

Practically everyone was aware of a bright flash
of light, likened by many to a magnesium photo- i> % t'^y i^tmtKfztK.fzmi^i^-^o X^'Wco^ii^
flash, foU-^wed, according to most observers, by
a period of darkness lasting several minutes. o'^n'MSmifi-otztaoo 2:®PiStt TMi/^S:^^'
T h e darkness was described variously as "black tBfcJ, rM;0^A^:*>.-:>fcJ;-5!t:fix.fcJ * S l ^ a Dt/js
cloud," "smoky vision," or "yellow light." A few
^feKj.3,x.fcj fsEtm-^icifm-antzo '>i:®^tt
did not recall seeing the flash but were aware of
the subsequent darkness. Despite the darkness, K}te*SfciiHtab-ri^^X:i^ofc:as, ^ ® t : ® l t 3 ^
most believed their vision was normal at the
IS&Tl/^fco C®Bg$Kfe;4>:i>t)?>'t'. ^ < ® A t i *
time and none gave a description of seeing visual
patterns such as might be expected with after- 0m(Dmt}itiEn^-&-r>fzt:^^, mfSi&xofiWii
images. It seems likely, therefore, that the m^ilfzt}&-^fzA'dfS.fJ^'--'f^o Ltzfji-oXmM^lC
darkness described after the explosion was due 5: bfc i a -5 IS $ \immk(J:>nmK XZX^^hisbb
to atmospheric conditions rather than to a
disturbance in the visual apparatus. Wi^'-\kWiicxzho:)X$>-ofzXo\cm-)iiZo

Many patients stated that they were blind for ^ < ®s^-tt»]St:bij'i?> < o'jmm:wA7^ts.-h^'>
some time after the explosion, but in most
instances this was due either to swelling of the tztm-^fzii, ciUi^ < ®ig-&aAI«® fci'jKllw./'js
lids from burns with consequent closure of the mMbxummmmLfzct, $>zi:Minmmcxz
eyes, or to keratitis and not to any neuroretinal
lesion. However one patient became tempora- i.o)x&-oxmnmmmmmr.xz ho^x H fs. *^ ^
rily blind in association with headache, followed
by loss of consciousness ten days after the
fco fcfc'b, im-r:itis.mwnmcmmmr)-mii
atomic bomb. T h e findings in this patient are oyjm^^jdb, ^omc'jiWbfzo coy&wsmmi
now entirely normal. Another patient who
developed gradual loss of vision, beginning one tiffi-trK^ < -[Emtr*So sij® i ^o:)mri'Gmm i
month after the atomic bomb and progressing
to the present, showed advanced optic atrophy.
T h e lesion is presumed to be intracranial and IS*. jiffftiMiifi^#iiiirtgAbtifco c&mmiWi
not related to the atomic bomb. One other
patient developed difficulty in vision three days SWffi© fe©t!* oxm&cmiMi3ifS.i}-^-^tzXo lOS.
after the atomic bomb in association with amnesia
ioiiZo *®ufp 1 ^limw^ 3u bxm!s.m3xn
and confusion. Three patients in whom the
present examination of the eyes revealed no mmmmci^^ - t s : ^ ^ ^ * ^ bfco im.oymnm.^
abnormality gave a history of partial loss of
vision in both eyes occurring about one month
x^w,^mitfs\^^:§(o ot>3 tMrnmrn i ti^n^^x ^
after t h e atomic bomb and lasting two to four Piis®'m5yifiwm9i.i}-i2-pj3.imwi-o-'^\.'^tztm-<
weeks. T h e r e was no marked radiation sickness
in any of these three, and in only one was there fco ^:nb®3i^®(,^t't^lcfe||^-/j;/&iifIg;,©iifi
severe epilation and burns.
< , 1 ^-,ay^AcWio:,m&isXVfX'!>Mi& -ofco

No patients in the survey group developed m'\'-o-)^mmmcwMo^)jU'i:iixv^tztm-<tz

permanent central scotomata, although several
i)i, coyM^M)cmmorpicMMmii\hbm,^^i_k\^tz
were allegedly looking in the direction of the
bomb at the time of the explosion. ^1iS*'-ofco

B. Keratoconjunctivitis B. nmm'!}i

T h e number of patients who gave a history

of bilateral keratoconjunctivitis, within a few
days or a few weeks after the atomic bombing
ickimbfsommonmw'ki:'^^ bfzmm>iyt-<tz-ri
and not obviously caused by trauma or burns, ii56^,-^*-pfco C®E]i-c42^ii|g']i:'',n lCfif,?i'iil
was 56. Of these, 42 gave a history of keratitis
(as photophobia, foreign-body sensation, lacrima- am, mms, mM$>zkH-mm ^±b, §mM
tion, or redness} coming on within the first day
S.S(/•>iiWmTMm^^fzi:}£^fzo CW^j®it®M'bJtll
and lasting for several hours or several days.
These patients were 1200 to 2000 meters from ti^ih(Dmmii, 1200;a^b2000mT?^ofco MM-jtS.'^
the hypocenter. In none were there permanent
sequelae. Discounting a few who belisved they
mhV.m^t'noytiKk.MAihtifs.ii-^'>fzo it-'HfSi-^
had symptoms for as long as a month, the cause M;«A%'a^fciftx.fci!?fc®^-4-i^ij-B', c:®|/jffj©
of this early and temporary keratitis was presu-
mably the ultraviolet radiation, for a similar his-
tory of keratitis is known to result from exposure
So ts-^ts::ymws:f%m'Mi'e(Dmom9mmcmts
to other sources of ultraviolet radiation. This tiZ .tlkbZ c }zt)mhnxh^Zi)^hXi>Zo ctxti
is in keeping with the observation of some of
the Japanese ophthalmologists who treated such
ilSiI#:®»H FB1®^®?^^!C S -O fzm^O B *AflS
persons within the first few days after the bomb- pm&mmc-i^t z o mnmic x -o xfmwjt^&si
ing. Presumably there were many more with
bfc:tttS;t>< k,-ot^\,^t!Ssijnzf)i, isSefcA
keratoconjunctivitis from ultraviolet radiation
but in whom the ocular symptoms were masked mhVAkiif)^ < $ t i T 1/1fc® -r- S. 5 9 o
by the thermal injuries.

A history of delayed keratitis was obtained in S^ft^aii^©lHK/j314^K#b tl, tf:!R©^4tt

fourteen cases, symptoms coming on within the
first week in eight patients, within the first month
#-?, h'mitmBt^imfj^nmwmbfzo 3^®mig-
in four, and after several months in two. The
OM'^'iM^ ?> ® gfJilttllOO i2000m©lf-eig, o tz, ^
symptoms lasted from several days to several
months. T h e distances of the three patients from mtf-jfsmA&m^i'tKDm^ic hmA ^nut-^-^tzo
the hypocenter were between 1100 and 2000 iiUh(Dr&m(D}ztifzn»mim^xzm?m.nmt
meters. In none were there permanent sequelae.
^mtk,oy(:^Zi}\ tfcfnfc"y-^s--e®f6®MHit:
How much these cases represent a delayed kera-
titis due to radiation and how much to other
XZM%^nWk^i^i:m-thox^Z>M±-^.m\c\m^
causes cannot be stated with any conviction.

While 56 patients thus gave a history of some coxo \t.m^tmmmz.mm-b-^<iinw'M%'iL b tz

sort of keratitis following the atomic bomb as
It^K^isB-^fc/js c ® cl3 ic KI|^«i5iSii©Ha-Sl5K(, ^
far out as the periphery of the zone studied, it
is surprising that there were not sufficiently fc^fe^ttiSo b*=.b3iK®gMA«*S!J-fc=t/J^
severe exposures to produce permanent corneal
opacities, in view of the severe burns of the face
that so many received. Thus, approximately zms.o:)%mMiip-^ fzc turn <-^^ c txhZo
one-quarter of those in the series gave a history illE*fSs#®» 4 5>® 1 ii)^mowmisXvi bsi btf
of burn of the face with loss of skin and often
burn of eyebrows and eyelashes, and yet had
mm.tm^&Wi^'^omMxm(r)mm^i:m-<tzi)i,
normal corneas at the present examination. None ^^^(Dm&xunmdimx^'ofco m'jmisxxj'i^
had permanent corneal opacities attributable to
AmKMmbtzWimnmMM^£'jkbtzm-mifs.ij^ ->
ultraviolet or infra-red radiation. T h e reason
for this sparing of the eyes is not apparent. fco mMmffic(rMmtM'&^\ifzm.Mimht-^x\±
T h e blink reflex would certainly not have been
rapid enough. One factor may have been the
naturally narrow palpebral fissure in the
S o - w i b T t t , u::$^xoi]mMtii§imx<, ±m
Japanese with the protective overhanging of the mi)iA-'-oxyzfzA^miititzt^:t^nzo mat
upper lid. It is also conceivable that some
jtisbT, mic>dm»mti$>zfzybicm''mMo:im'r
measure of protection against the long infra-red
rays may have been afforded to the eye, in miyx-\bxi>zmM.oy^mM$>^tzt}-^iimifs.^^t^
comparison with the skin, by the fluid film that
covers the eye.
 It is also noteworthy that no case w a s found !;i)i£® X j i * s 1/ Mi *" -y V - I S M t - t ^ S i t fcfiTfti
showing evidence of xerosis of the cornea or
rr '5,2*6 ^ixZXo ts.m%i> Z \ ^ ii*-5I'5ft!Sfe®fSR
conjunctiva such a s is occasionally found
following severe x-ray or gamma ray exposure. ^7i<'m-MWfiy:> ^tififj-' -otzcbfcf*;H-HLZ

C. Lens Changes C. /R'ral*©i^'[K

Abnormalities of the lenses were noted in 81 /kWi»©II^A!i8iigic:»lfe^ixfztfi, mmn'-xz
persons, in none of whom were the findings
considered to b e due to radiation. In four
t^,7^ e>tifcfe©H^j:;S^ofcoSA^®4 MiC/KiTiWI*
additional persons there were abnormalities of «|3 SI->!iPHt-/K.Wif*ffiH®JS«di*!}, 'cixmm\
the posterior capsule or adjacent cortex which,
while thought not to result from radiation, were mx-x z fe©'rttft t,^ i:#x- ^tifzmimwx-x Z9i
considered to show morphologic changes that ftCAj^l-SBffi'f-ffAMK^-TKbTl^ S tmotifz^
suggested the radiation type. I n none of the
persons in the 1000-2000 meter survey series was iooo-2ooom ,ai*t>sfiif K li ij [3 mMmmn imiv.m
an unquestionable case of radiation cataract \i.'i&ibhXxflt)--'^tzo
found.

Of the 81 persons with lenticular abnormali- ^uhwmmoihz 81 #i'!i® ip 38 nz- -g-Aftigfihiirt

ties, 38 had senile cataracts of the predominantly
cortical type, and 12 of the predominantly
[!$•, \2uz^xmmnn, "^^n^wiikmA^, &z
nuclear t y p e ; 18 had isolated opacities in the x^^it^mmim.vLWi'ofz'ummmm, s '^,\cmmn
embryonic nucleus or outlining the Y s u t u r e s ; 8
had coronary cataracts; 5 had one or more bluish, P?, 5;giciiSA:|g©:Sli;feS!,Mi4J|cif,ltfcti-eii
lacelike opacities situated on, or in the embryonic jy I-.®#*>&SO'>'fc V— y.vmm, 3 ^ginMfiffiiaW
nucleus; 3 had lamellar cataracts; one had a
unilateral posterior polar cataract in association n, i«KiHjli;©a:S«--f1'-5--«ftt:1*Sa«|5|, i«
with high m y o p i a ; one had a unilateral collar
button cataract in association with a n old lesion
of the cornea ; one had congenital cataracts with 1 nci\m.myfm')%x^-f\nn, i nz-iY-umi^i
microphthalmia ; and one had a congenital white *!C5'cAft® aiiA^* o tz,
membrane on the anterior capsule.

T h e characteristic changes that make up radia- rimu^nnm'w&wi-mnc'oi.-^xixWi&tzyx'.

tion cataracts will be discussed subsequently.
c ® jgi£*fg5f}¥t; M M i c J; S i Sioli S a rai?*--1
The fact that none occurred in this series
suggests that the frequency at present is less than f!lfe3J6hWiii^-^tzM-m., m&oymn.ffi^^'i^X
one in a thousand. It is entirely possible, how- T t ; * S z. i*/j<!t-rSo fcfc'bmi-Mertl?®Jf!K
ever, that some of this same group will develop
Hiiio-ipt fcii«txai h*^feWtiSl ^ c i ;5iftl ij t IT
cataracts in the future, as it is well known that
the latent period for radiation cataracts may b e
I ^ S ®T, c ®cfJ©35T-^A^^ISarap¥4-ife b S 21 i
a decade or longer. ith^oztm-htiZo

T h e absence of exfoliation of the lens capsule

may also be noteworthy in view of the large
T<fe S c i * ^ x . S tithhW-BMUUfli^'^fz c i fe
amount of infra-red radiations to which the eyes
of some of the patients must have been exposed.
D. Neuroretinal Lesions D. uwmmmm^
N o lesions were found in the fundus which icjaKLtg-Mis*^*. s trnjotitzmimmum^ k>
were thought to have been directly related to
the atomic bomb. T w o persons, of 75 years and
ni-ii)^ ->fco75:rteo^-ffls^- 2 igicit-teaK^tt
60 years respectively, had degeneration of the
central retina, but neither person had been look-
®*!cS(l#«g£»;,a®?iHt\±JctOTM26/j5|gj6 btxfco 1/^
ing at the sky at the time of t h e explosion and
only one of them had symptoms of radiation tmc h^x'tmmM'sm.ti'kz tm-^ntzo % 3 ©
sickness and epilation. They were thought to
have senile macular degeneration. A third
s ^ i i , rnni-rsmxh-^fz-bs ijijS4"*a5KaiT-®
patient with normal visual acuity had some m.m\^w-fii:> -^ fco 1 wsfC'MSTsu ^"^-ot. tzn
mottling of the central portions of the fundus.
One patient gave a history of intermittent
amblyopia beginning before the atomic bomb fco
explosion, but the objective findings were normal

One patient had a unilateral hole of the 1 mxii 1 fisKiSfs®sMi<:tf oT, mmMK-iw
macula in association with high myopia, and three
h^, 3^!C&-t,^)S*Saill52^®|S|iSdS$.ofco 8:g©
patients had evidence of an old chorioretinitis.
Only eight patients had hypertensive and arterio-
sclerotic changes in the retinal vessels, and in tzifi, -e®:/^irti-(?\>coymntmsysMmit^oymi%
all of these the changes were mild ; none had
a vascular retinopathy. T w o had a bilateral
WM-Ut^^f^o 2^Kiiijiigii»*i««i*«<fe^, ^mx
optic atrophy, due in one case to methyl alcohol ii^9=-;l/T;lx3-;n4T||©fcfeT$!},* {fe®#'!lT(i
poisoning* and of undetermined cause in the
swiiTpHji-t; * ofcA-ssp> < t%M.nmm-cm&bfz t
other but presumably associated with an intra-
cranial lesion. One patient had a unilateral optic fflim^tifco i{«t;ii®®aa*J!<:oi,^triS(:ofc
atrophy and aberrant regeneration of the third
-mwm^um^isxxjm 3 wmyis^m^wMfii:, ->
nerve following a perforating injury ot the
cheek. One patient had a vertical and horizon- fco 1 '^xii.mwfA&m'-.'iibtzim-isxnmmmk
tal nystagmus following cerebral concussion. t)ih-3fco *#:©2moyMsmM\z.kmbtzhox$>
These last two cases were the only ones
ofco
attributable to the atomic bomb.

£ . Miscellaneous Ocular Findings E. •e©{i®Bfilfrl.

While of doubtful significance in reference to m.mt(omi^(o%'Mmimio u-^i^, 'fBcomntii
the atomic bomb, the following abnormalities
were noted in the survey patients and are
included here merely for the sake of completeness.
Trichiasis unassociated -with entropion : 14
cases.

*This patient stated that when the atomic bomb struck Hiroshima he felt the end of the world
was at hand and consequently decided to make his exodus in as pleasant a frame of mind as
possible. Hence he took a large amount of alcohol.
*fi]®fi^i-j, mMmKtjX»-m.bfzm, WMcom'o^mb. x^ztz»m)itcM::-in t-Si^t^bx^mo:)
TJi-zt-^u^mMbtzo
13
 Thirteen of these patients were children and C®43, 13::gttT-|tt-e*-5fco ^f!lKtt^gL^B:6>
the trichiasis was associated with considerable
epiblepharon in all cases. T h e lashes of the a!9®SiJf!Slg*145-5Ti/^fco Tlgitraffli|®«^*i3it
inner aspects of the lower lids were usually the
ones responsible and therefore caused contact bx^ommxib-ox, m^nu-^^ftmcnmtm
with the cornea when the eye was adducted.
bfco 2ig©S:#©;5.iC±|!gltKfe|gJ6fco •i^Ki)-^
Only in two of the patients was there also
involvement of the lashes of the upper lids. In fi^o^M.o±.)m.n^^tnm.o:>nmy-mthzm
three patients there was considerable keratitis
epithelialis and some pannus formation in the g®/x°V %7,mf&iii>-^tziji, tt^SL^®fcfe®@^
lower inner angle of the cornea, b u t it was
noteworthy that the trichiasis had caused tfimmm < mrn-x^, -otzct tims $ tifco
surprisingly little subjective disturbance.

Ptosis (unilateral} : 1 case. mm \m mm •• i m

Dacryocystitis: 2 cases. wnta. 2#-!i
Trachoma (quiescent and a c t i v e } : 13 cases. h 7 n - V ({fitftfj^io'siirtt}: im

As the palpebral conjunctiva was not examined -^Mm^it.'Dh^xmmMm^m^btiii-^^tzoxii

in all patients, it is probable that many more
had trachoma than is here indicated. bi(:^<®,S^iCF7 3 - v : i s * i 9 # S t S t 3 f t S o

Pterygium ' 12 cases.

KttKtt- : 12 m
Inflamed pingueculum ' 3 cases.
mmmmwMi: ^m
Ketatitis (inactive), type unspecified: 16 cases.

Herpetic : 1 case ; phlyctenular : 1 case ; trauma-

nm^ ( # « § * * }
v t t ^ K i ^ 1^0, fAm&.nwk^ 3M, mmn
tic : 3 cases ; interstitial: 4 cases ; epithelialis :

2 cases ; ophthalmia neonatorum: 1 case.

Miscellaneous corneal ahno-i malities: one case

each of white ring of cornea, senile marginal
ftKafeii, ^xmm^m^Y., 'hnm, isxxy
thinning, microcornea, and crocodile shagreen to
posterior surface of cornea. nfmMo:)h\cmkx^m:miflifi'cn im

Argyll Robertson pupils: 1 case. mmrniimM. ^m

Albinism.: 1 case. afeffi:im
Persistent hyaloid remnant • 1 case. mi-^wm}- iM
Asteroid hyalitis : 2 cases. mszm-fWii. 2M
Phthisis bulbi: 1 case. mrtm: iM

Myopia : No record of the presence or absence

of myopia was kept for the entire survey group, S« : •Mm.MMim-lC-^h-^xmi®4iWi:iiUbfl
but in a sample of 155 cases unilateral myopia
i)y-otztji, 155f!|®|gA*, -fiffifiia;Osip, 1.00
was found once, bilateral myopia of 1.00 to 3.00
diopters was found in 7 (4.5 percent} and of t)^}>3.ooi>-:t7'' h >) -omm&m^^m (4.55^}, 3
3-14 diopters in 4 ( 2 . 5 percent}.
dence of myopia greater than one diopter was
found for this small group to be of the order
of 7 percent.
T h u s the inci- i)yihU 'Jt-f V ') -©ffl(JSE-SIA^'4flI (2.5%} SSfe
h-ntzo 1 >>'*-/ h ') -J;i}>iiS®ffili©»*?1SH<i
co/hmmnrii 7 96mmx$> s i s * ^tifco

F, Non-ocular Findings F . MPJMomM.

Observation was made on patients of the mmmmcDm-^-ic-oi^^x, moyxm, m^isxv:
survey series as to burns of the face, epilation,
m.mmmm.om'm^hfs-^tzo 394^!Ccfesi¥ffi®ii
and radiation sickness. Some burn of the face
occurred in 394 patients, with loss of the skin of MXMiii^y), 256 fjcm(oSi!^M-Miiiihntzo c
face in 256. Burns of the lids occurred in a ©•} feTBgHAft©*-3 tz4io:)mi'^iW.mx$)Zi^fi^
considerable, although undetermined, number of
fl^oyXWX&^tzo b;5^b, mB.isXrymo:>W.mi
these patients. Yet the residual scarring of the
lids and of the face was surprisingly slight.
m < nmM-n$, -ofco mmAmt 4 p ® ^ i c g i i i^n
Ectropion of the lids was found in four patients fco 'Xi/vty^<X(DX%li.MiMi(Ofz^ibXi>.oX, i^
only. Practically all of the burns were of the fs. t) oyi.^m-bi$> o fztfi& i < sa?-* Tig b^i:*^ o fc i
flash type and presumably had shown consider-
able charring without deep penetration.
SfctiSo

Epilation, for our purposes, means loss of head m.^oy^mxii, m^umm, /ii^abSiM±lt^®
hair, eyebrows or eyelashes and may have been
sS^*-S!*b, -eti(iis®11^6^j»«d>*St/'>(i?Bil
an immediate occurrence resulting from heat or
a delayed occurrence (usually 10 to 18 days} tMm(Dmmfiwm (M^taion/j-^bispH} t b T
resulting from the ionizing radiations. It may, * c ofct :^x. t> n s o 'y)^WM t mmmm t © «-
of course, be both immediate and delayed owing
n^micxzMmfiis xxym'm^se9x& -> tztjy hm
to the conjoint effect of thermal and ionizing
radiations, b u t in this case the delayed effect nfs>.^t}i, co:)i§,^, mmMmii'mmmx¥jo:)tzib
would be obscured b y the immediate burns.
TFiaiiTSSo S I * . i i ^ ^ S i ^ M i i i ^ ® * ^ * ^ - ?
Immediate burns of the head with loss of scalp
hair, eyebrows, or eyelashes were noted in m.Mo:iW.mmxmitm200mxmAk>iitzo * < ©^-
approximately 200 patients. In many, only the TttK=s*siMis^®^M«^bTi''fco mm&m
eyebrows and eyelashes were burned. Delayed
mB.m^tbxa., immicm'Ami>i^, 65micm^
epilation of the scalp hair was recorded as partial
in 160 cases and practically complete in 65 cases tm-^fsm-^i-^h -^fzc tmMbfz CM 2 }o fi'^©
( F i g . 2}. Delayed epilation of the eyebrows
mmmiimi22micm ^, m.^(Dm?mM^itim\^
occurred in 22 cases and of the cilia in 16 cases.
T h e duration of the epilation in the cases in SLbtzo ^IsK^ffliS*i?.tifc-r.Kf!ll<:*o-itZU^mn
which it was complete varied from several weeks
\i, mmAi^b 6 ii^n®PaiT* o fco M ^ O T H i , s i f
to six months. No correlation was found
®»t^al*^ b®gFill®FBlicfflMHi^(iJ8a6 hixtst^-y
between the duration of the epilation and tne
distance of the patient from the hypocenter. fco

While the entity of radiation sickness is well smm.9m.oyMmi~\-'M^iiM-mxm-^zt)\ -e

defined, it is not easy to separate some of its
®fiEVt®+!CB, tMMt&tbhm&bxi.'^fs\,-^m
manifestations from infections not necessarily
associated with radiation. Thus, anorexia, MS©g;«*§S!Ct?BiJffi*fii/"^ l>®;S^*So Sti-JHK
malaise, nausea, vomiting, diarrhea, fever, and
even petechiae which, along with reduction in the T#j, mmisxnmkiiiik^^^'t:imm.w,'pt #t
white blood cell count, make up the entity of
radiation sickness may result from such un- K, «'jg#:ffl#ffi^iSttig®*S*ibTa;bfc%®A>.
sanitary conditions as prevailed following t h e
k.'Rin-f, iM'bhw.mui^xzhoxiifii.-^o bfc
atomic bombing and are not necessarily due to
the radiation. Without, therefore, knowledge ffi-^T, m.m^9.Mf^a:>f&m.m\z.isn z'^mtmc-o
of the white blood cell count during the critical
few weeks following t h e bombing, it seems
\,^x(D'mM-ififinti\t, **fisg5S®ir-ffissiMiii
futile to attempt a n y evaluation at this late m.\c->^-^xm^mM^'^\cfS'^xmm^m^zaytm
date of the presence or severity of the radiation
sickness. Suffice it to say that approximately wsx')K,gt3tiSo ccxumt-mm^oym^^-ht.
one-half of the surveyed persons gave a history
» ® # : © ftM© I S a PsBflic Jli!i f J; o? 1 Sftftii A^ * o
of fever and gastrointestinal disturbances and
approximately one-tenth gave a history of fctm\ »<ji0S-® 1 t)imk]i^^-bi$i-ofzta^fcc
petechiae at some time during the first few
t^iEx&rZiC'S'ibZo
weeks following the bombing.

GROUP 1 ( & } , m i m Ch)

Survey of 231 patients within 1000 meters of •M'tiSJ;!} looomjj^ra©,!!^ 231 ; g ® i a S T , c ii

t h e hypocenter, comprising t h e total available
(iABCCAPii«le«K«SBti(:^:®i[f!^iraiC(/^fc
number of persons listed at present in the ABCC
census files as having been in this area at t h e tiaA$tLT!;^s;t:^MT*So ajibHijia®g¥Ki^
time of the explosion (exclusive of the fourteen
included in the previous group}. &fci4ig:&i<<}

A. Subjective Visual Phenomena A. a'i:rjSi:ftPf»

Of the patients in whom the objective findings
±Stf©|i1tel!fli.A^lE?|T2bofc^®4i, 25^tm
were normal, 25 stated that they had impaired
vision at, or within a few weeks following, the mmi> zh^it^(D'^m.mmmcu:timmfji& -otzt^^
time of the explosion, b u t in only two cases
•<fzf]i, -€:®tti©2;gffl;^K-t®P|^tJifMi©FB'!it:
was this thought to be significant in respect to
the atomic bomb. T h e complaints of the others 4i.9.fsmiMii>Z t:^K. htitzo -t®fiti®^-®£si?tt
were thought to be due to presbyopia, myopia,
MS:, T&m. ^Aftarapss&si^ii^-AftSjfMffiK
senile cataracts, or senile macular degeneration,
having no causal connection with the atomic xzi>(Dt^^ibtim'Mtom?ikmmi.fsf}y-ofzo m
bomb. Of the two patients who were thought
micmm btzW3o:>^mff$> -o tz tn^. btifc 2 ^ 0
to have had visual complaints attributable to
the atomic b o m b , one had poor vision with *, i^Ktt@®iiifK r.no^aj is^fi^t^'^fzxofs.'^
"black clouds" before the eyes, and one com-
•nnmii^h^, -ffeoi^tt ra^<Mx.fcj tw^TLtzo
plained of "red vision." I n b o t h instances, the
visual difficulty had come on approximately nmxcis^^x, 'mMmii-wmm3MBBbximm
three weeks after the bombing in association
mm. (5Sit mwsi.isxrsmi.ii.io Kwubfcfe®
with radiation sickness (fever, pharyngitis, and
petechiae} and the complaints of both are T, 2mi%wm.isxr3m=fW\^\M>mmxh-,tzt-^
presumed to have been caused by retinal and
X.iitlSo
vitreous hemorrhages.
B. Keratoconjunctivitis B. ft liS K i^t
Five patients stated they had symptoms of »M^®**y® U ®*J; '0 Biiitttt^!ii^®li£t^ CM
bilateral keratitis (pnotophobia, lacrimation,
foreign-body sensation} coming on within the
m. mMisxrfMmm ffi, 2 utyh 3 nr^i^^fc> 5
first day after the explosion, and lasting two or 45®lt-§*^a5--cfco (:tiittS^)<^^iJKJ;Sfe®
three days. These were presumably due to
ultraviolet radiation. In one other patient with >fij3tlfco hmfSWWk7\<.btzmo:> 1 jg®B.g-T'B
similar symptoms the condition lasted three
*®i,KP:ii3spjji/a^fcds, c(jym.mm.]Kmwsx
weeks, but inasmuch as this patient also had
extensive burns of the face it was possibly a miMic$>.o fzoyx^&mWii^Wi^&ti^o X'^Jh
thermal injury rather than abiotic. Six patients
SiJ<«!i«KJ;Sfe®T*-ofco 6ig®S*{3;«Ji3
also gave a history of keratitis coming on 3 to
4 we-^ks after the explosion and lasting for n^:4.mmmcnmmiSibtzt}&-<, *®* 1 ^ T
several days (in one patient} or one or more
months (in the other patients}. All of these umBmmi, 'io:yu-yxitit^nw^iM^^fzo en
patients had symptoms of radiation sickness,
ho::)m.mt^xi<imkmmB0i;mii&^, nmi^y
and the cause of the keratitis was presumably
the ionizing radiations. MHttS; t> < ',&mmmx$> -^ fco

C. Lenses C . /K Ifa i^
Abnormalities of the lenses were noted in 20
/UIM&^nii. d ®ff T20::g®,IS^iCiSyj -j^-Lfco
patients of this series. Eight had senile cortical
cataracts. Seven had congenital opacities 8 ^iaimx&3inm&\H¥$fii$> -^ fco 7 ^iciirKhi,
situated in the lens nucleus ; one had an anterior
polar opacity ; one had several vacuoles in the
m&co^x&mm, i^icmmmm, ^^cmm
anterior cortex ; and five had posterior capsular Hic^f-T©^i!a, 5 ^Ki,-i.mm<j:>mmimmt}Ss-b
cataracts which were believed to have been
caused b y radiation from the atomic bomb. tis/KhtW^m^&mmi^)^fco ciii0&Mirs
These latter will be discussed subsequently,
2 sf.® Mi-ii^a mfm t ^h^xw^&t zo
together with the cases of radiation cataract in
Group 2.

Five additional patients showed changes in $ ^} K 5 ^om-^-.cmmic x zm^:^7imt zA

the posterior capsules suggestive of the radiation
type, but the changes were not sufficiently siii^^"Mmmi&-0fzii, mim&\Hntmw\irzi,c
definite at the time to justify the diagnosis of a+'jncsi.&(f^fsirrmififp ^ fco 1 ^ ® , ® ^ K «[«
radiation cataract. One patient had minimal
posterior cortical opacities in the axial region HI©ittS15!c:g< imifsmBinM.mfii^ ^, '^^mo:yW^^
of both eyes, with two vacuoles beneath the mrm F:<:2o©'^8afe*-ofco :^m.^\aifkm»r}i
anterior capsule of t h e right eye. T h i s patient
had had no radiation sickness but did have miUt)-y^fzidi, -r©^Ttt, »M3d^;3:^J;i}^^
complete epilation of scalp hair beginning, fsm-%bi^x-t'o^fpjifmA^f^o ciimm^nnm
allegedly, three months after the atomic bomb
Tt)!} •} S trnJofiZo ffe® 1 ^®E«-!s:(ifflS© 1
and lasting three months. It seems altogether
likely that this is an instance of incipient radi- rnm(DmnKWMsmiMWfii>'D, i-im&jY-MMW
ation cataract. Another patient showed a faint «"iIm!C2-o©t)g)jfiiS#i OSihi'^mtEJotyzy)
axial opacity in the right eye over a 1 mm fe*>ofco /XSi'!l4-HfiS!ilEmTa!D'>fco MmaiiWA
zone with two scintillating reflections (possibly
vacuoles} just in front of the posterior capsule (Dm%-&zv-'{tmMii$>zxo{cm-^n, ftK-®>w v
of the right eye. T h e anterior capsule was m-4 'Aoi 1 \cum^wi'm{.wMMm^$>'otztp, /Y.hh
normal. T h e left eye, which apparently had
an injury or ulcer of the cornea, showed an miiEEx&-r>fco j^m.^\-c\i.tkmwm.wsfs-otz
opacity of the lower nasal quadrant of the corner
ifi. 4/J^j!FB^^^i^-ii:ftK^^S:bfco ctifctfc
and a posterior synechia, but the lens was clear.
T h e patient had had no radiation sickness but %m\'r\nmM(j:)^AW&b'-hzt^%-itizfp, z^itp
had been almost completely epilated for four
months. This is also thought to be a possible
%%x$>Zfs '}/Ki'f?,|$#:«iSS®—fliIffilSMBS < --
instance of early radiation cataract but, if true, i ChXhZo 3rg©m.|i-!':tt/J<ifBWt-*®^#M'Z
the uni laterality of the posterior capsular opacity
is surprising. Three patients showed either \i7im.flK%i, & Si,Mi/XiVi#:-«T©'4>fi:©'5^BA<*
haziness and irregular reflexes from the posterior
capsule or a few subcapsular vacuoles that were
thought to be borderline abnormalities. These
patients will be examined again at a later date.
f), -ctaimirnkfimnt^yL^ntzo cui-^j®,®

D. Neuroretinal Lesions

Two patients in this group had bilateral

macular degeneration and one had unilateral D. mnmmmn'M.
macular degeneration. One other patient had a
cmnoyp 2 ^®S-iiCiiiiifli!ttSISf.gI5^'ttd^*. V),
unilateral coloboma of the choroid ; one patient
had retinitis pigmentosa ; one patient had optic 1 n'~-~m^ftmMmi&':>fy,ffi©i nz.-&mm.
atrophy of undetermined origin; and three
patients had mild hypertensive and arteriosclerotic
mwKm., I ncihMmmwvii, i nowMx^m^v-y
changes in the retinal arteries. mm.mm, 3 ncmm.mmo:)m^o:>mi]x!i^§MM
E. Miscellaneous Ocular Findings \m:mu^&--fy
Four patients in this group were noted to have E. 'c®'ftIi®iWft
shown trachoma and one patient had had a
perforating injury of the eyeball.

F. Non-ocular Findings F. KPi51-®/frM

Burns of the face which were sufficiently severe
]iLmAWr^i:aibznms.fsm\Uxm-L contxa.
to result in loss of skin occurred in only ten
patients of this series. In the two-kilometer 10;^,®/>!C,?^bnfco 2000m|a5Mfiftf-Tii, -ewffe
survey group the incidence of comparable burns
®flT.|cJt-<THft?lS:©AS®^a-.>l?« 5KPi VAX^
was more than five times as great, a difference
which is undoubtedly explained by the fact that v\-, r®Miw<)0'^Wioy«m'i:::tf^o)%^ty^^-x
almost all of the survivors within the one-
imMom'S)'^\cnbx& zm(r)'&mfy»:> -> tztv^o
kilometer range had some form of shielding
from the thermal effects of the bomb. m'Xicx-^xwm-iiizxhho o

On the other hand, the percentage in the one- mmcisi.-^x, iooomg¥TKK5gbfc.^-®W55-4<ii

kilometer group who were epilated was much 2000m|tT.J;l3 iJ;^;il^ (Mi^Wdo lOOOmfff-t; ii60%
greater than in the two kilometer group (see Um^lOU^btz tniMi-^ilXh^ Zt3i2000mmxii^
Fig. 4}. Sixty percent were recorded as
completely epilated in the one kilometer group,
omti96^mp'.c±.mznmx^':^fzo yc^jym.^
but only slightly more than 4 percent for the bT1/^ fc t^-otzAommsmit, sf^iiit-^n&i.
two-kilometer group. T h e duration of the epila-
tion in those in whom it was said to have been r, 25^i)ilt)yJit).;^2{)yJh i9^tli2tpntPi>5i^
complete was less than one month in 8 ; from
one to two months in 2 5 ; from two to five
months in 4 9 ; from five months to one year in tm^<fzo ii^ommi'^mx$,'=fzo
18; and, allegedly, longer than one year in 12.
T h e duration was not known in 9.

T h e difficulty in evaluating radiation sickness mj-]»j5,®*9ffiffi rzc t^mmfs r. t i-mxcfm b

has already been discussed. Of the 231 patients
in this series, 205 gave a history of delayed fco <: ®gf-ffl 231 ^0cfiT 205 igttgfgttfflmmm,
malaise, gastrointestinal symptoms, or pharyn- mmm:^hzkA-i.mwkoymm.^m^fzffi, -tti&«
gitis, which might be interpreted as radiation
sickness. One hundred and nineteen gave a mmfAm.h.m%K^xizfpk,%wi\^o ug^gaigig
history of petechiae coming on within the first
#:©»lo®ifciiFigrlJK, mi^m)i'i.bfzy^is^^tzo
few weeks after the explosion.

GROUP 2 » 2 p

T h i s was made up of persons who were reached •c (Jim\±mjto:)mfm, ffffti®sii*. s i.^'±mno:>

through local ophthalmologists, through news-
paper publicity, or through hearsay.
therefore, a highly selected group, and the inci-
dence of disease in this series gives no indication
of the frequency in the population at large.
only a small number was there thought to be
any causal connection with the atomic bomb.
mmv:-X'^xm&btzxii--hfi-otzo btzti-^x, c
It is,
nttt.Si6TiiMKifiS¥T$. r,, c (DmorMnmsimt
±.l^0Xmcisij ZU^®§m^^t h&XUfSh^o
In
mmt(DmiMit>zt&t>rifz(Dac <{PRX$,':>
fco

T h e cases seen who gave no history or findings w.^.no:)^xm'Mt0m^i^7i<mbfzmm^mmii

suggestive of association with the atomic bomb
are listed according to diagnosis as follows : fst^'^fzh&^.mv/Aicmc^^to

Normal : 101. iH n 101

Lids and lacrimal apparatus: Dacryocystoste- mmisxmm

nosis: 1 ; ectropion (upper l i d } : 1 ; trichiasis M'Sfflilff. 1. AK UsmWD 1. il-=ggLd:
(epiblepharon} : 4 ; trichiasis (trachoma} : 1 ; (pVllfiit} 4 , SfHgSLife ( h 7 3 - -7} 1,
chalazion : 1 ; trachoma (active} : 3 ; vernal con- m m 1, h 5 3 - -7 (ygijitt} 3 , .ft^ig
junctivitis ( l i d s } : 3. i!i^ CfSii} 3

Extraocular muscles : N y s t a g m u s : 2 ; strabis- ^i- m m

mus : 3 ; chronic progressive ophthalmoplegia m m 2, ;i\ m 3,
externa : 2. •\m.mntmmwMw- 2
 Conjunctiva and cornea : Catarrhal conjunc- mmsx-omm
tivitis: 3; vernal conjunctivitis (bulbar}: 1; rupture,
ii^jt-'&mvm 3, #3s*gigiJ5 (fUM-ft) 1.
Descemet's membrane ( b i r t h } : 1 ; interstitial
keratitis : 5 ; phlyctenular keratoconjunctivitis :
-rx ?< ^mmm cibtm:) i, msmm'^^i 5,
1 ; leucoma : 1 ; sclerokeratitis: 1. /jvx?i-s;*jMig?ft I. mi 1, fmimi 1

Lens : Senile cataract: 4 ; diabetic c a t a r a c t : 1 ; /K hh #

coronary cataract : 1 ; nuclear sclerosis : 1 ; -^Affiarap? 4, mmn^\^\Hn 1, Mv^a
secondary cataract: 1 ; congenital cataract: 1 ; wp? 1, 7KijhmBmb 1, - ^ s a r a p ? 1.
exfoliation of lens capsule: 1. 56AftaraPf? 1, 7XiT?ift:'«»« l

Retina and optic nerve: Central serous retino- mmisx&m^fm.

pathy : 1 ; macular degeneration: 1 ; separated
'^Uiij'^mmmmmm 1, mmmm 1, mmm
retina : 2 ; retinitis proliferans (Bales' disease} :
m 2, mmmsm'^ c Eaiesfeo 1, mm
1 ; retinitis pigmentosa: 3 ; retinitis punctata
albescens: 1 ; optic atrophy (probably methyl mm-'^ 3, ei^y^mmri 1. mwmmm ( s
a l c o h o l } : 2.
i i < p<?-ii^r;i/=i-;ix{c,j:S} 2

Uvea:
Iritis : 3 ; uveitis : 1 ; Harada's disease : 1. If iS m
*r. m 'A 3, ^mm'ii 1, mmm 1
Eye as a whole : Ametropia : 16 ; chronic m ^ i^
glaucoma : 2 ; phthisis bulbi : 1 ; congenital ^lE® 16, fi'ft^rap? 2, m>%m 1. ^ A
microphthalmos : 2. m^mm 2

T h e patients in the non-survey group who umcmmbtzmm^i) s t ^M_ hUfz^m&mi

were believed to have had lesions resulting from
the atomic bomb are discussed in the following
?ff©ffl4f !c;oi,->Tia^>c|»fff©iftiiY> |e! b)iM)3?Ti^-v
paragraphs, arranged according to the headings
So c&mir.isif zmmni'M IZMMICXZfe®T*
used in the description of the survey cases. It
should be borne in mind that the evidence that -^tztyoiimii, mM.mcxzx'oht:bz>im%
the lesions in this group were in fact due to the
ti^mW'^isxrjBm^r-ti'-Mm.icxzh&xii-.tzctic.
atomic bomb depended on time relationships and
morphologic characteristics, rather than on 'S&tZ&WjmZo
comparative statistics.

A. Subjective Visual Disturbance A. rmMMM^w

The only patient falling into this category
^Y-Mmminx c ©^yiiic AsiKi-©m^tt3o:j-®
in the non-survey series iWas a 30-year-old man
who was on the sixth floor inside a concrete ST, »MS#K:I$itMi: J} 450 m® 3 v ^ y ^ h jijg
building 450 meters from the hypocenter at the
time of the explosion. Except for a mild burn $1!©6mici^fzo ii'®iia(S®Afi«-»i-^Ttt«smr-j
of the ear, he had no symptoms until approxi-
mately three weeks after the explosion, when 3 mrsmmtz tT*M=#j-!t mrmMsi^-^ fca^ -c
he became blind. At the same time he
®!t$, iwnA-fs<fizt\^micmim>A^isxi>i&
developed profound epilation and radiation
sickness (including petechiae}. His vision mmnm (itvcftsiM-f^t-} ^-/-tbfco utiii2ipM
gradually returned two months later. At the 'my<^<MKWiU. bfco miom-mmciiUMinm
time of the present examination, vision was
20/30 O.U. and the only objective findings were 20/30 x&i), m.-oy^iimrxmijY^hHmcisiizm
the presence of flocculent opacities in the lens
VMmx, 'jnxm^nntnmsmwyym^ii^fy.
having a lamellar distribution similar to that
seen with congenital cataracts.

T h e cause of blindness in this patient is not A}M.^ncis\iz'km(jymmi.mifpx{ifs<.-^i)\ m

evident, but it was obviously part of the radia-
ihAcmmmim^-tixfi -ofcoiM-®arapvii
tion syndrome. T h e present cataracts are
considered unrelated to the rest of the condition *®(i®)i'F.t»;ii««T*S h-^y.-HiZo th-'ooy
since similar changes are seen not infrequently l-imWsmtmrJf.MyA^ircii.tsi.-'b, iSt-Ma
in Japanese persons, and there were no changes
in the posterior capsule such as occur with
rai!?icff- o x'A: bzxo ts/nhm^-RoyMiUmA >-}
radiation cataracts. tl^-Jl/Vj^iiTftSo
B. Keratoconjunctivitis B. nmm^A
While several patients in the non-survey group
i\--m^mmnxn^o-y&^fpmm'myv.bfz-~-]}mi
gave a history of a *ransient keratitis following
the atomic bombing, only one showed residual mMioymm^i:]&-^fzi)\ i^.o-i^j-ti-ciucumbtz
opacities of the cornea thought to be attributable
to it. T h i s patient, previously reported by
>:#x.t>tifcffiM®aS!MSi*S-bfco Afll-^iiPiftif
Koyama and Sasaki,'' was a 23-year-old girl who
Ic/biiMsXxyVf.M-A^'' KX-oXWi'^i^iifzo cnii23
was 2000 meters from the hypocenter gazing
into the sky at the time of the explosion. She : r ® fc-tST, «-M!i#,'C il'M'Wllii; D2000m-T;3r;^MT
was knocked down by the blast but does not
remember any visual disturbance until 30 minutes
yfzo fmiKX':>xmnfzf3\ 3o^ji-mcMUhrxmo:)fz
later when her lids became swollen from burns mmi}mmbx^A^^fl < s s t Tiis:tip?*®* -^
of her face and she could not see. For several
days she had pain in the eyeballs, and the fcct-i-r,dtibtti^o miimumymMfp&'o. im
photophobia was severe. She was hospitalized
for a month and the photophobia disappeared,
tt-iiKT*-ofco 1 ip)^FsSAK b T m n i i m'JKbfz
but she was not examined by an ophthalmologist.
i\ mfm(DmMi-s:»fsfP'otzo m^, vm$>zh-'
She had no epilation, diarrhea, or fever. When
examined two months after the bombing, she mmwifsfp^fzo w.m'^2tpn bxm&^s:iifzm
was found to have symmetrical opacities of the
lower halves of both corneas. T h e distribution
[MmMiioyvA'-mcMmii.M.mmsA mtzo umo
of the opacities was likened to a mountain with
muiio^x 0 xA-Mf}i\'mxm%m)mxmi\MK&
a rounded, sharply demarcated upper edge
extending into the pupillary area and a less &, Ti*©^*!?!!'^bi<mmxf> -ofcoii A li I'i B
well defined lower edge. T h e pupils were round,
and the lenses were clear. The retina and T, /jc,',i'i{|:!is/vTi.^fco mmsx-ymffii, fti-ids
visual fields showed abnormalities to be described
.'<zxnfsnn^^i<bfzo
subsequently.

T h e patient was examined by us four years

ffi-i? mm 4 -ff-iticAnif*-#• s b, mmmi FSR
after the bombing and showed superficial and
deep opacities in the lower portions of both KM^hfi:isxzym?$mmy;sMzc ximmmmcii
corneas. T h e y could just be seen grossly as ^-Di«!RM«3tbTax.s©^T^-ofc;4i, mwm
patchy opacities but were conspicuous by slit-
lamp examination. In other respects the eyes
I^STttMS^^T* -ofco -e©{t!l©;*iT«(lH«iE'ff|T*
were normal. -5 fco

C . Lens Changes C . /KAi'if*:®*^^

T e n cases of cataracts thought to be caused 'MmAkimicx s is-^^tisawpfi^iowigyifco

by ionizing radiation were seen. Five were
-e©iii® 5miiwiifi'^wm^mm-om.fix-k'^fco M
patients in the 1000-meter survey series. Two,
including one in the survey group, were referred 3 * t M g i « 0 1 ^,<r ftVjfc 2 ^ WAi^-tm-k b, 1 ^ ii
to us by Dr. Ikui and one by Dr. K. Hirose.*
;i;«i<fe:ifliifS* ffimffbfzo fi®2:g©m«- (-e®-?
T w o other patients were seen b y us because of
their complaints of failing vision (one was an *.® l A l i A B C C ® K J t T « - p f c } liWM&tv^

employee of the ABCC!}, and the tenth person, TfHrilfOfcyjictliSb, iOA[J®S^-(i, Sll±®3-i
who had no visual complaint, was called in be-
ifflifsip-0tzf)\ mi^mcmo:) 9;g®cji© 1 ^i-ift
cause she was known to have been with one
of the other nine at the time of the explosion. icx.-'fzct mm\ b tz © Ti^-a^frft ^ fco

Nine of the patients were exposed at Hiroshima 9 •^4(i)i;iljffl|5«.#T* 1}, 1 ^iiM«S©»M-ijT

and one at Nagasaki. All were said to have had
*-3fco (/^t"'tifc-»'MmjlJ:toi^Ti.SiHi»M^fc^
normal visual acuity prior to, and for some time
after, the bombing. Seven were males and ii>®F0lHM/J!iTH'ff?i© c i T * -^ fco 7 ^i^i^M
three were females. T h e ages at the time of
the exposure were 13 to 55 years. All were T, •i^tiM^X&':>tzo mf4W4-miiViti]^i^^-As-
within 550 to 950 meters of the hypocenter at xh -ofco y^ixh^MmymL^mi-^ h 5501,-. ^^ 950
the time of the explosion. T h r e e were standing
together in the forward part of a street car. ^^(DX-Siicytzo 3 Uit^n&%o:>m%x-my\iyx
Four were in wooden houses roofed with tile.
Ofco 4^ttiii.?AiSmf^Wici^fco l«!iASa%
One was crouching behind a wooden b u i l d i n g ;
one was walking in the street, shielded by the ® # : T - } r < t-3T!/''fco 1 fitt?fl«*iJ-*l^T:fi!},
plastered wall of a b u i l d i n g ; and one is not
it?ii;&® b o < t,^HtT;ifKt?;jiTo^fco 1 fAy&Wp
known to have had any shielding. Two had
thermal burns of the profile type ( t h a t is, from *-3fcc ili'my\ixyfiyo 2 ^\ciimi(DWMkfs
radiant h e a t } ; all had epilation of the head
SsS ("r&^3&W-lis2cj;sfeffl} ts'-hv), y^uky
after a latent period of one to four weeks, with
complete baldness lasting three to five months. 1WM-^ b 4 iars®?sKM®#:(cgi«®)M =s y^ m t
Six had vomiting on the day of the explosion,
ij, •76^ysr6my3i).nf)='i5fj>nmmyfzo e^',:;
and eight had symptoms one to three weeks after
the explosion consisting of fever and malaise ; ii««3HiBBfc/j^-*^3, 8t,ii»m^im?M)'jii3m
five had vomiting and diarrhea and five had
mbxmM<(i;XU^mi3MUioy^Mfi^& 0, 5^,iim.
petechiae. One developed a sloughing lesion
of the buccal mucosa and another a localized l&isXZf f»mi> !}, 5 1^)' le 5 ^!C;,^!lJ;mjfll/)^* o
necrosis of the cheek with perforation. Whether
fco ^t,iinmmir.ummh%m*:^Aib, mo^i^y,
* This case was reported at the Kyushu Ophthalmological Society Meeting at Kumamoto, Sept.
23, 1949.
*ii;#'IIiil949'if.9;j23|i/i/|iitfT5S/jitlfc;LfflllMfP-f:-^T^i<3nfc.

22
these were caused by radiation sickness or by limymiy\t•?m.w&.mfi.-'sz'A}.bfco cmA^/AI.!
the unsanitary conditions prevailing at the time
could not be determined. One of the three
m)imcxz h(otp, <feSi^iii"iif#©#»a}K#Ji::<t
female patients had had amenorrhea since the S ho:>x&^tzMi9:%x^fsip-otzo 3^oyp:^f§-.
explosion and the other two began thei- menses
at ages 17 and 19 which was approximately
.^iuy ip 01 f, mmpx^mi mx * o, {t© 2fMf>t
three years after the explosion.
miM-J 3 'ytz o fci7:J-ii9:r0S#!=?;J***Mfco
T h e only ocular complaint of the patients was
m-iUcisi] Slif(:"-®»©'-V.r5?ii#i:tlSiiTS>ofc,
failing vision. T h e onset of subjective visual
symptoms was said to have been as early as \A-mfMMm:o)mt o a. i f,®/s mi¥- < nm i
one month after the bombing in one patient,
fp}-y^x$,-ofztyionfzy, zo)!M.^ii^®&^mw
but the patient was in an apprehensive mental
state at the time and it is by no means certain myyt<'i:'mmy& D, co:)mmEi'.Mmjmf^iHm~
that this initial complaint was due lo incipient
X S fc®T* -9fci i liJAi b T f t t T i i ^ A O o # 0 7
cataracts. T h e latent period of visual symptoms
in seven other patients was 6 months in one ;g©/I^K isii ZU-MeVyMlkmiiikoyM D T * o
p a t i e n t ; 2\i years in o n e ; and 2)4 years in
fco 6fp)ii^lf„ 2imit)^lf„ 2i-\=.:'iift)i5tu 3
five. Three patients had had no ocular com-
plaints. T h e failure of vision was said to have f,iaimoy^-.MlifStj-"^fzo #i::'J®!)iSii(i7 ^,©l<:S-
been either gradual or step-wise and fluctuant xiriM^ipfjzymmmy'i&m$ymw!fp&'>fz
in the seven patients, one of these patients
having thought some improvement followed each
tyi^ix, c.®"]"® 1 ^limAbtZ]^ky'ioyit^7M
loss. ]y.oymk-yh':>fzt-^yLtzo

The cataracts consisted of opacities in the aW[5-?fi/Kiir##:-«®«i;?IST 2 /j^ (, 4 mm©^lJfl©

axial zone of the posterior lenticular capsules
over an area of 2 to 4 mm, with occasional wmx, BtiT-i}fc-:'tYAmn,\z. hm.mfih -ofco ifria
punctate dots farther toward the periphery. (irfflMTBii>fffl#:T$>-.fco '|3-b;'!I5©?PagH4-l'Jl!i
The findings were approximately symmetrical
in the two eyes. T h e central opaque discs had
'^mmoyismii'K^miix^ -otz-y, )M.WA'&mmm
jagged but nevertheless relatively sharp edges. T*ofco mtyWikrfmxii-^fc 5 ^,®m^-Tii,
In the five patients in whom the changes were
most marked, the peripheral portions of the
y[^~mA^immMMo:>w>ii%mv><i-%x <}fets<, ^
opaque discs were denser than the central por- BS^Tii Y---r-'Xmm^^W>Jkbxytzo umJl^lAiW
tions, forming doughnut-shaped opacities when
examined with the ophthalmoscope. With the mms-xii, ci0iss!iu-~xvcinai'Mb, 'i^K®
slit-lamp biomicroscope the opacities were of a
•y>'^^m\idiX•y-'pmiymw.ph -^fcoc oymmiif^
lacelike texture having a few polychromatic
crystals and a few vacuoles. T h e opacities UiW^fBArJl\i£.iiii, -e© \'uyAi!n.nyWV'Xyfi.y
were confined to the posterior capsules with no
Xnxh-ofzjf\ '*:i'}mi/UmW*^^yMiym^:bxy
apparent extension into the underlying cortex,
but the vacuoles were situated just in front of fco RfeMlibfc 2{?!lTii, llg3!icf;L:^THfl#:2|rt!C
the capsules. In the two most advanced cases
mmx-'jimb, ^(Dxpfmiwmi-m./'^yyfzo J:©*
there was a distinct separation of the opacity
centrally into two laminae from front to back >h-%a:>'^\mfMmy>mm.^xli, ±ad®2ffiiH4i^b
with a relatively clear interval between them.
TJ; WAyWi:)\mb, ^ixlimmiXtiAfz 'c --;•
 Toward the periphery of this central disc the ••^tt;©|gSKffi31"S i © T * ) o f c o F--;--v/g©|ft
two laminae fused to form a denser ring
corresponding to the doughnut-shaped opacity ^/KlTBi'iirj-bTl^tsh^hWiXli, tp,t-S\ilC/Uht^
seen with the ophthalmoscope. In the less
advanced cases which did not show the doughnut '^^0±?r.&o:)UMt}i$,'O, -ttUi—WJitTbfcfiEW
configuration, the central portion showed an
icisnz^miv^mmommmicmubxytzo ty b
opacification of the whole thickness of the
posterior capsule similar to the peripheral portion X, j:tl-;>©araPS!i'&®MjlClf.'oT4'/i:.NgI5S®/)S
of the disc in the more advanced cases. Thus
it appears that progression of these cataracts is 2 Mic{,m bX'icoAmiimwiy, wms^^ihi-^x^^y
accompanied by a separation of the central
opacity into two layers, separated by a clear mbxhysymsmwzj:zX"jiciA5:iihtiZo 7^
interval, and an extension of the unsplit opacity
toward the periphery. T h e anterior capsule icii/Uhmmich'pn(owmi^$>>}, 3^icmi-'o
also showed a few punctate dots in seven of the
patients and an occasional vacuole in three.
mifpSri'^fzo fcfc'b, y-rnomxh/Uhi^&fiis
The lens cortex and nucleus, however, was
entirely clear in all cases. XzJmii±< 'MfStj-s-fsby-^tzo

T h e cataracts are considered to be similar to

those which have previously been associated with cOi^mvHMCilc XBisXlJi} -y v-|g®M#]!c
exposure to x-rays and gamma rays.'^ What
part neutrons played in their pathogenesis is w--oxAibtz&mmcmubtzh(Dt-^K-hiiZo "
not evident. T h e patients were in a zone where 'prnf-immncowAnci'-^Ms zmm 19 i:W<bfzt}^ii
neutrons and gamma rays were present, although mht^xfsyo ffl^-ii4Jtt f t**VV-|g®<fe-ofct?
information on the amounts of each is not mcyfzm, •i(D^^com&ic'Di,-'X03tfiii{Lm]^
publicly available. Most persons in this zone txrfSh^o (i®[XM®AS15fl-0Aii. Mkmi^mfM
died either from thermal or mechanical injuries
V*f-®fci6, &ZyiiMiBm&o:)tzih^i.t:bfzo ctx
or from radiation sickness. T h a t these persons
survived and developed cataracts may have been 'hOA.atjiA'.^crjc >o&m$^'Aibfzc tamcA-M
due simply to biologic variations ; but it cannot iW&McXZh0tj-=.i>'Mtifiyo b;*^b, ^nm^
be reasonably denied that, while the cataracts
msmmAsmm^'Siiifc*S3RT$> s ®KM b, fm
w^ere the result of exposure of the head region,
the absence of lethal radiation disease may be mmimyjimoyxmii^t^o^ojmox^imfpj&m-ii
explained by a shielding of much of the rest of tiXi.-'tztzAtph^mfltj'^ti^y'') ctli^iMlfAlc-S-M
the body. Five of the patients had very little,
T t ^ X O o 5t:,Xli, ik^»?)i&iyi>-ofztbXhm
if any, radiation sickness, and it is not impossible
that the symptoms in the others may not have <ferftT, mcom4i-Kisi^z>j;i.,i)^^m.mrjimxtstj^
->fci:tx.>}|i,ttt,^j:i(i/j;t,^o bA^b, m.:^-t-<x
been caused b y radiation. Yet all of them had
profound epilation of the head, which was \cmiL®M^owi^f}i&'o, ^nf)immo:>mf>ix$>
undoubtedly a radiation effect. I t is possible
-otzct limytiifsi}^-o fco TifFfiK¥W©mPPT \J:-O
that the three standing in the front of the street
car were protected in t h e lower halves of their
Tl^fc3iaic;-oo^-cii, -t® F-T=#/)vi*i!ri0;=i(© F©
bodies by the metallic baseboard below the car ±mw<¥-tA^ i -i ©•fi!i©is'i^0 tz yoy&m^ x -o xUM
windows and by the shielding from other persons. 3 IxTi yzct (i^4x. ^ ti So

Aside from t h ; foregoing cases with outright m i A^te/JCi'i'if4:i<:'ftftapilKi©* -> fcHiJid503ii-;fMPi

24
posterior capsular cataracts, several border-line Alc, :g r-®VLM:<:S< litis®JS}'i^/55*-ofc»>, cii
cases were seen that were thought not to
represent radiatijn cataracts but in which final
litmm'^i'Wyt^yttliA^^^hxifstp-^tz, IPWA

judgment will be postponed until further tfj^Llr li 6/j^ J3 7!;ii 1 imtciiii-r SMSt T/iSM-r
examination, six months or one year hence.
These cases r°presented an unusual amount So Jill•}®?,r;Mii/KiW3f*#;'ftic.Slfi|i^X|2a^/r<bfc
of marking of the posterior cap,sules and
t\ mmLmi.ywmf)mxyhntz t®li i mhtstp
none showed opacification that was visible by
ophthalmoscopic examination. -5 fco

Aside from these cases which are thought to TB::fJsMMi '6-JL yiiZciiC,©ii'fM^li^!.^T, '>
be normal variants, a few patients were seen
with abnormalities in the posterior capsule that
a®^-!<:/K,'n'i»ft*0j|ffr/j^,«i6 ^^.ntzifi, ^iililk
wer:^ nevertheless not attributed to radiation. l-WiK|dWLfci(i^^f>ti/'i:*^-5fco 1 ^(ilT-J--®
0:io patient was a 17-year-oId diabetic boy who
had b°en 2000 meters from the hypocenter at 'P'^fX%BtrHffi&'0. K-M!f#!C'M'Wt!iJ; '92000m'C|3
the time of the explosion and had had no burns,
•^tzti, x¥:, (K^, $>zyiimmKmiifsfp-^
epilation, or radiation sickness. Examination
at the present time showed diffuse opacification fco iM-S:®MSTii, m»/KhMomSUcisi}ZMh
of the posterior capsule and anterior capsule in
the axial regions and extensive bluish-white
{A^m*isXLyuhmn'M(DmSimmfs i,yym' ik
opacities i i the anterior and posterior cortex of )S:no^]xm.wim^^&<Dmm^MMzo m.wyn^-.y.iw,
both lenses. The presumptive diagnosis was
diabetic cataracts. KisttafipSTisofco

The normal posterior capsule may be likened
to a layer of glass immersed in water and having
a varying amount of etching of its
The etching is usually most evident in the axial
or periaxial region and can be seen by local
illumination as dots and threadlike lines.
they are arranged like the tracks made by
wind-blown beach grass on the otherwise smooth
sand. They are most evident on the posterior
surface of the capsule and presumably represent
remnants of the hyaloid system.
illumination, the posterior capsule often shows
optical irregularities in the axial and periaxial
regions similar to the " w a r t s " on the posterior
surface of the cornea.
TK',t^i:/Ki'ti'#^-«!i, my&btz-ti =7 x!-fc ix. i
-\X, •6®i«Ji|KS>!?0mj£0l"ia;6iS>So C©i"li"!!i
surface.
M't.TttttS* S(/Mi#J?llt!'f KiJi^Tftfcfijic-y^yx
h!}, 'g\m&X}iihzyii^ik(DMt bx My i n
Often
So b(ibiix4i'i(i*..t-5t^-jfmmo^A-jyMm
omi?-iMlcmi^ixXY^Z»0X 6 KffdRS^iS c i
fc* so ym li/um'^sMmygc %sa ^ 4 ^ T * D ,
By trans- &y, <fifi/•i*:r<0iSifi*zj^N-rfe©i £ t > n s c JSMS
Kxnii/Khhm^M<s^kmisxnmiimutr. bii bti
•)tW]-fs:^<rM-^$)'0, -iniimmmriiciji}zrmA
ymubxyz.

D. Neuroretinal Abnormalities D. unmmm%n

A-pproximately ten persons gave a history of mo^f)imw^ny'i^.'^Axi,yz.toysitiiMyi'£-yj!i
having been gazing at the sky at the time of
t,yMrmyAx:;s'0, pfs < hfe1 ^jmrn^s-o'-x
the explision, some at the airplane and at least
one at the p-irachute carrying the bomb, but tz'<=7 V.-.- \-yMxytztfi, 1 'y.axiJ-^tmMhhzy
only one person showed any possible evidence iiWifS*ftlfti®W!)c*^* D -5 Z tJiUnifco Affltl'U
of retinal or nervous system damage. This
patient,'' the same one who was previously pMn'nmio:>my>&^<fyj^ 23:j-®A-eTi»;-.''
referred to with keratitis, was a 23-year-old girl
^'is-mx D2000m-^afe i}, '^aijj^AXv^fzipW-My
who had been 2000 meters from the hypocenter
and was gazing skyward but does not know imxfiotzjpiz•}ipiiimxhZo mmruiAW}}
whether or not it was in the direction of the
lifsfp-otzo w.um.'iipjibxm.^.btzi'^ij, mwm
bomb. At first there were no visual disturbances.
When examined two months after the bombing gi01/3 oiXisisoy'xBi^oMmfjAiim'P>t-%ym JJ
there was a grayish-white opacity one-third the
K*-ofco -f-ifif#iS?„IMSTli'loC^ie;5iA5,jgyji^y.i,
size of the disc just temporal to each fovea.
By campimetry a central scotoma was found, ^uiiwmM6i-'i^smi,cmirrzm-j>yiimViy&
most dense in a ring-shaped area occupying the
6 to 8 degree isopters. It was symmetrical in hmfi-x, mmxMm^x-&-ofzo utjmmmyu
the two eyes. T h e visual acuity, which was
TH'filT* -ofzct tm hUxy tzfyifiJEWJlilimx
known to have been normal before the bombing,
was correctible to O.D. 0.6 (20/50} and O.S. 0,9 0.6 (20,50} /EttMTO.g (20,30} Tafe-pfco » ) M t t 4
(20/30}, Examination four years after the
bombing showed similar bilateral ring-shaped ^r- bT'ii-ii b fci^ftT h muKhA mfs mwjfvU^rMy
scotomata, but no abnormalities were found in
the fundus.

This patient is presumed to have had an 'Am.^nc HMmic X z%m'?<xmti& ->fctm^tt^

infra-red burn of the retina and was the only
patient seen on whom such a diagnosis was ii, ipipz;m\'& FbfcW{i-®af^-T$,-ofc,,
made.

One other patient in the non-survey series mm.n'4i.moyfAo:) i ^.xa \ m\ymmmmi.fp

had retinitis proliferans in one eye. T h e patient
is said to have lost her vision in this eye
& -0fcoAf-iManmm^y c uMwmj^'Ai -yzt
immediately after the atomic bomb, presumably o.-}>ti, criii^y_> imf-Vf'A\\tiWfzkbxi6h-xfp¥^
from a vitreous hemorrhage, although there was
no known trauma. \%o:,iimifsyo

E. Miscellaneous Ocular Findings E. -r©'fai®IKrrM

Perforation of the globe, frequently with loss b!i biillHffliUi^* S I, ^ iillMi*fJ*ff 0 Wi* ttMlffl
of the eye, or phthisis bulbi, was seen in 21
ii2im\a&ibm, *®iii4i5'iiTiifjitgA^f=i -iiuxy
patients, in four of whom it was bilateral. In
practically all cases the injury was caused by fco itbi:^3\icisyxtiyyym,'nobmnxio^). t'
glass and in many cases it was accompanied by i.o:,m>yisyxmB:isXxJmo:):^"Siymu.tj'-$i-otzo
multiple scars of the lids and face. For some
y©-MSli'i.^<HJiTS,Sffi, ciiwommi bli b\im
reason which is not apparent, these scars often
had a distinct blue color. T h a t it was glass
muii^x$> o fco c (Dmi^owMtmmiBhiowMi
rather than any inherent characteristic of the fSW&.X$:) Zty-oX^fJbbii 7 ^® fcfeT* o fc
scar formation that caused this discoloration is ctii, nAXKis\izxmmisxxi^-'mmyco:)m
suggested by the fact that burn scars and fs&'M^Mi^'S^^fsyWMicx->xmuisixZo ca.)
surgical scars in the Japanese show no similar *;a/)5¥;cfiiJ'(S;-A^ tz±jyxz hoxh-:- fc -'. -• -5
pigmentation. T h e possibility that the dis-
coloration was simply due to dirt that had
mmL^izWi ztliX^tsyiP, -c®-Sftii^^t-,ffi
been carried into the wounds could not be
excluded, but its uniformity and the absence of
granular texture made this possibility unlikely. '\lZo

Iridodialysis resulting from the bomb was seen 'fmKxz'Ktimmi i {^aicsyjin, -e^fi/i-Mw
in one patient and is presumed to have occurred
\z.xzxi)k>, fjbibAzmymcxzHmxAibfz
from a blow with some blunt object rather than
from the blast. tJSJoixZo

Two persons who had had evidence of brain immcmmuoymmifi -^fc2 ^^om^-y ikmis
injury at the time of the bomb had complicating
eye signs, one with bilateral sixth nerve
mm.m*^&'o, i^,xiimmcr)'^i6^i?mm^'^<^, ftii0i
paralysis and one with optic atrophy. t,xiim'iimmmf)i& -3 fco

Pupillary areflexia was found in one eye of mm^mm, mimfjsby-otz 1 ^®,®a-® 1 m

a patient who had been blind for several days
iammmwMAc,txfzo yM A,«^K!ii!Hi^,'Li
after the explosion. She is presumed to have
had an intraocular hemorrhage at the time.

GENERAL OBSERVATIONS ON JAPANESE

B *A©ig(co^,^r <D-Ka<)ii^
EYES

Since, to our knowledge, no comparable a.^®J*SlK!9Tii*iC®IH#GaA®BH!C-oi,^T

examination has been reported on a large number }i:fibmziiki&0m'Mmf^^nxh-^tsi,^0x, i\,i
of normal Caucasian eyes, the following
y'mmi&mm ii®-#,«ft ii?^^ izfr.^ tp hm ifs
observation may have little comparative
significance. The data is, therefore, not yo btzti-^X, z.oy-mMiMi\mcmktz(Dxii
presented statistically, b u t rather as our impres- fsix, tsbhUAfAobm (Mh(.t^xoxm^Ay
sion of certain differences between Japanese
micmmb#S} taA®Ki®Ftg!C*5ftliffi:::'50^
eyes (presumably applicable to all Orientals}
and Caucasian eyes. T®f^.<? ®)fr!si i bTi2S-< So

Trichiasis in association with epiblepharon is MUIMIsicff -5 It^WXyi11AAM*Kis^-^xMiilc

so frequent in Japanese children that it may
be considered a normal variant. T h e responsible
f l S T * S 0 T , ymi'^WJS'Sl%x$>Z t*jr^ibii
lashes are usually those in the inner portion zisyh'-mnfsyo yoMAnffizmmt, wftyymk
of the lower lid and produce keratitis and
fl«©ffii-=§T* -^xMrnnmomw^mcimims x
occasionally pannus in the lower nasal quadrant
of both corneas. It is not accompanied by xjmicii/^°y :x ypy'AibZo mw.(Dmm.m%ym%9-.n
scarring of the lids or b y entropion. The
mimofsv\, ll-^£L4;®fcA®a'Eft'jPf*-i±«-<?T
subjective disturbances caused b y the trichiasis
are variable, but It was noteworthy that there 3DSV, fMHiOfinWTfec:41 bomXix^fmbtzWX-
was no case in which these symptoms were as •f-Mxts < iKfiCiiji'nV^*^-!? < fsy c btAmAiyifz„
marked as might be expected, and often there c om?(ktm^t%M.\cu^xMi/:> h ntt3%\apy
were no symptoms at all. In view of the fact
that the condition was found almost exclusively /)V>T, cmifS.m.'tzK'iSii-^xifsz hy t ,'iu>n
in children, it is presumed that it becomes
So
outgrown.

Staphylococcic and rosacea keratitis was

*Ilic:eij-sa-«?®fel!l>lt«bT, «'ffliJiiift#
conspicuous by its rarity in comparison with
our experiences in the United States, Acne of ummmnymiypfsyct*yu<L-otzo mo)si/t
the face also appeared much less common.
iittz=}\miC'Msiy-otzo iiLJjlcistyyx h 93--^'!i
Trachoma, on the other hand, was frequent,
being present in 5 percent to 10 percent of the ii«T, mH&lo:) 5 fp{^ji096icmA ibixfzo MVi¥ilA-
patients examined. Pterygia and conspicuous
isxzfMi^fsmmmAMiipfs < t fe;i5H©*siiiij7
Pinguecula were perhaps somewhat more
frequent than in at least some parts of the cmtm J;(}feSib<(/^< b/j^'M^T^oT, mm
United States ( N o r t h e a s t } and it appeared that
mmmoxmm, i^A&meii^i^tmxbxnwmic
the pinguec-ala were situated closer to the
limbus than is the case with Caucasian eyes, E< biibiiMiK^oTo^fco i^mmmm&x$>
often actually overriding the cornea. One case
ofc 1 miCisyxMibihUfz^JimmViiinii, mwA
of incipient pterygium in a heavily pigmented
eye is perhaps especially noteworthy because n-mo:)mmcmbx^Mm<^ zf)yh'mxfsh^ tPA
of its possible significance in the pathogenesis
^otlfzyxmcmAisnZo M^iCS/t®^^!© 1 ram
of pterygia in general. Just in advance of the
spearhead of the pterygium was a 1 mm zone mJjlcim^^fl&Mim-ob$,Z ]:&omf}-i$>'^x, WAk
of flat pigmented epithelium suggesting that
nnymJj^ VJM.fpnm&byjWryxyz c i<£-7i;-it
epithelium had grown over from the limbus in
advance of the pterygium. bfco

Vernal conjunctivitis of both bulbar and mi^isxmumoi^i^^Mmiii, mMicisiy,x lo

palpebral type appeared more common than In
a comparable group In the United States, i,-}rt^yx6 KS'Sii b tifco

Evidence of arteriosclerotic or hypertensive SMftJiffc-K*S l >

- !ia iM! mW&iMfA&oym'Ji li,
vascular disease was rare, but Bales' disease in
•inx$>^tztp, ^^^ Ids a z 'Eaies moyMtmut
young persons was relatively frequent. Only
mwifpfp-ofzo m^BUi^mi2mMAtztznx^,
two instances of primary glaucoma were seen,
and by inquiry among ophthalmologists this "), mfmy^'}fyfztc6xii, n^icisyzco:)r)i
seems to be relatively Infrequent in Japan, mmmii&mf-Mp'X-o icisj-jntzo

Prcbably occurring in Caucasian eyes also, &K> <i^iAomxh%§i.bxvyzoDx^b-'jtp, u

but being less evident, is the depigmentation
A-AlcisDZa tmmxfiy fe®ii^#i;i|o,J;6S'}iJ6:®
of the pigment epithelium of the fundus with
age and with high myopia. This leads regularly &mcf\yx±irzmmomM i:&oyu{^xi>Zo c
in the seventh decade to an exaggeration of the numv.' isiiz mfi^mm • i ima s -i; -o T,;§.fiT
tesselated appearance of the fundus. s*siettiSo

28
SUMMARY AND CONCLUSION
mms^v-mm
Previous reports of ocular lesions resulting tvlifriiiWbfclKfe^^!rooT®|,£A®mfiii. 3-
from the atomic bomb have been concerned i b xw^mifiio J; V rMmrx<tko^mmyo\ mem
chiefly with traumatic Injuries and retinal
T S f e ® T < f e o f c o A5B:fi©A*l-~'"l-3T(i, ^MlC
complications of radiation sickness. T h e present
/WW bfc[iM©ii^l4}H«*^* s ttnii-imiiAiM^^
study was undertaken with the prime motive of
determining what, if any, delayed injuries to ZhO-iXhZ fpyjjy'&t S C i*^m.h. ite-fi®Mxcfs
the eyes had resulted from the atomic bombing. ofco

Accordingly, 1000 persons who were listed as b fc y '-> x-mmy\m\yz i •> T«<bJti!<fc lo 2000m
having been In the "open" and within two
kilometers of the hypocenter at the time of the P i r t T * - o f c i ; d A b T s 6 S lOOOif.^f, C1©,I3S-®
explosion were selected at random from the
fcyji<:)|fMfe*5ai'tSM-ii0Arifl^-fV,.dl*A^bWf=?%
census files of the Atomic Bomb Casualty
Commission for study. In addition, 231 others,
liHi'ij bfcc yo:){itpyM'(LAriJl±,,dMy-S:'i>i&x 0
comprising the total available number of
surviving persons listed at present in the census 1000mj;j,rt©|lg:S/kfM i b T £ A b T t . S 231 ^io
files as havimg been within one kilometer of
the hypocenter, were examined, as were several X O-rrMflffi, J^lJ;i:HHHIx®*H/^*. S i^U&lWiOWm
hundred others who were contacted through
newspaper publicity, referrals from local icx-> x^^btzim^tA'mymtbtzo
ophthalmologists, or through hearsay.

T h e survey resulted in bringing in persons c©jiA-TliU-biHtpmh)Vv*^*sip, &zyir&

having, or having had, a variety of ocular
*lc|H.^bfcA-«?<rl^i£bfco H'Mi'MStbfclSlim
conditions. Those connected with the atomic
bomb included the following diagnoses; multiple Kii2«:®fe0*^£ofco rfSbh, KtiC-HSK©
injuries of eyes and eyelids ; keratoconjunctivitis
f^k (Dwm, WAU is X n \kmMimc x z nmsi
from ultraviolet and ionizing radiations; thermal
burn of the cornea and of the retina ; retinitis Ak, imiisxymwy-)¥k^y mi^iA-mw.'y^shyxr-ik
proliferans; and radiation cataracts. The t-»araFvo araK'iiM'M!::J:SfWtife0iB-®aig
cataracts were the only delayed manifestations
'Bi/i'fWT.fc-^fco
of ocular injury from the atomic bomb.

T e n cases of radiation cataract were found. /jMMaWl>'$!iioW!c:SSJ6bti, v^^tWfe-M'C^i4.fc

T h e y all occurred in persons who were within
01000m£l,[^T \WA\ !COfcA\ feSoiiAMXIi
one kilometer of the hypocenter and who were
either in the "open" or protected by a wood or b-o <t,^frT#iS*nT(/-^fc.<i!C/l bfco yttixz.^
plaster wall. All had a delayed and entire loss
ill!©iif§BiS^4?)K*^'iafc:6\ -est b feiM^fX®
of scalp hair, b u t did not necessarily have
radiation sickness. T h e ages at the time of \ifStP':>tZo S'Sli#^»«13/j^?>55:J tTTfeofco
exposure were between l 3 and 55. Three were
3^yimrX, 7^,[igftT^ofcc
females and seven were males.

T h e lens changes consisted predominantly of /Ki'if#®€lbfe. A3Pi>/jvJCif?i#:|S*«iSl5©SI*fe

granular opacification of the posterior capsules S ® T $ , ^ f c o jftfei|iila®{5'!lTiilfl|i/)Sl mm£!,>-©
in the axial zone. T h e mildest cases showed
simply an asterisk-shaped central opacity, not m^o:>ip>b.m^mtmimmu^^/UU¥'M.yicmyi z
more than 1 mm in diameter, having several
fc/j-T4,-ofco fcoiagsfiWTii, miMiex-ox
subcapsular vacuoles. T h e more marked cases
showed, with the ophthalmoscope, a discoid M-ii^mMcnmrnM^my, yunmimfs i- -
opacity of the posterior capsule, having a
••)-'XMXi>-oX, l|^JC^® 3 n^A vcim&mmc&mfi
characteristic doughnut shape with a relatively
more translucent zone in the central 3-4 mm A'-mmistvjYti'&Zo mms^fAMULmixii, coym
region. W i t h the slit-lamp biomicroscope the
opacity was seen to be made up of granules
mii y- -y^v^ymm^^fstmw.tyba!}, ^Wiomn
forming a lacelike pattern and containing many n'>;ytmyiiM'imAi%m&-y c, ii tzo -jHrn^-a
scintillating highlights and occasional polychro-
matic reflections. In the more marked cases mxii, mmummcm'iisix, z-mmuMomai
the opacities appeared to be split from front to
ii.mfimytmffi&zxoKjaaii-btifco c(om/-^
back with a relatively clear lamina between the
opaque layers. This clear lamina, which had tzh-4ii/KluW^-M0m^ic'^byf}yS,zyiii®mt';-
a thickness equal to or several times that of the
posterior capsule, was generally seen in the x$)-ox, -mffjiaiv~i--ymmM&A'-mmsmm
region corresponding to the translucent portion
3 rsM^jcmy^ btifco c(ommmbiAibzwrn
of the doughnut. In the early cases, before the
lamination occurs, the greatest opacification of iJimomxii, /Kimf^-AyRhmymmnrnvMiy^^ib
the capsule is to be found axially, but as the
splitting takes place the greatest opacity extends
btisA^, '^yimALbzic-otix, mmo:}^hmh>u
progressively toward the periphery, forming the yyrmiknmmahi -> x3S)} b, mMY-jfs v - x -> m
characteristic doughnut-shaped reflex. Whereas
the posterior opaque lamina coincides with the mAim>-s.tZo '^jj(DyEmmmii/Mh#'^\fny-m
posterior surface of the lens, the anterior lamina
tzyyMbx, hVson^nmic'M'Ait z c t h&
may bulge forward, but it is nevertheless sharply
demarcated from the underlying cortex. It does So yi^cD&ntommimmxmi^ootM-wmis
not show the extension into the cortex which
is seen with the usual cataracta complicata and
xrji^m&iHmxmy >,iiz X n ^i;;i£S-x©f*Sii/j;
posterior polar cataracts. Vacuoles situated just yo *fe«.gfflMicfc!,->T$x.i/kiVil*#;-*®-r<- K
beneath the posterior capsules are frequently
found even in the mildest cases. vyf?Mifi b i i bii/igy) ^ tifco

W i t h the more advanced changes, fine opacities iih\ymY.ifiWis-tzxcy>nx, %\m^swmiiyi.\is

are also to be found in the anterior capsule and
#:Hii**JiOVjC,'ii'#Sij*T'Kfeg^)btiSo ccoi^i-^
in the anterior subcapsular zone. Here they
are often accompanied by vacuoles. icii, bllbli'ii'Mfj^iiZo

T h e latent period for the subjective disturb-

f^mmcihimtz&mmwtfOWAiKMiim'fS 2 if.x
ances resulting from the cataracts Is about two
years. T h e progress is slow and sometimes &Zo -?:®jiffli^«TB#KiiJtPff-jT*S, {i'Mffj
step-wise. Objective findings may antedate the
subjective findings. T h e frequency of radiation
I'jVAAmmmimc^aii'o c t t^dbZo * « « a w
cataracts Is at present of the order of 2 J<
, > percent Kt®iii)ti:tt/^®®Tii 1000m pA\H o~j m.%A:M-^x\i
of survivors within the one kilometer zone, but 2 . 5 ^ H l g T J, S/j->', 'MlRMli^^'^-yiytzZCth^
since the latent period may be many years, it
is obvious that the frequency may increase
X. 1}tis0T, cummimm'Anmrrztpfesiti
considerably in the years to come. fsvytlimifpX$>Zo

T h e occurrence of radiation cataracts is thought tMM\^\^¥fOS,^±{i, y0yUfHfMW:>fzi6lCB

to be significant not only on account of their
ocular implications but more especially because i l / j ' : * S ! i ' * ^ ! } T f t <, •eti*5J|-#%#:©S|;j®)M:i;
they are the first delayed effects of the atomic
©ItPWTS) S © T # : Z « " S ; T S > S > # X . btiSo
bomb to have been demonstrated in the body
as a whole.

REFERENCES
m m ic m

1. Liebow AE, Warren S, De Coursey E : Pathology of atomic bomb casualties. Amer J Path
2 5 : 853, 1949

2, Matsuoka H : Unpublished

3. m x^'- fsiJ-mmcmy <m^m. uJf&m 3:306, 1945

( H a t a B : Injuries to eyes by atomic bomb. Nippon Rinsho-Jap J Clin)

4. H-:mmn3 y^^Mtc^zmnm. mfmmmm. 14 :i, me

(Shoji Y : Injuries of eyes by air attacks. Ganka Rinsho Iho-Pract O p h t h a l l

5. AiAt- m.mfmmcikzm.w^usmB?im. i. w.m»xmaiizwM&. mnmmm'iH

40 : 21, 1946
(Ikui H : Ectropion palpebral and contusion cataract caused by atomic bomb. 1. A case of
ectropion of lid after burns of the face by atomic bomb. Ganka Rinsho Iho-Pract Ophthal}

6. A-j\-- my0.7'mmcyiz\mmunfi&nn. 2. inf-'mwommcinzmifuHn. mmimmm

40 : 21, 1946
(^Ikul H : Ectropion palpebral and contusion cataract caused by atomic bomb. 2. A case of
contusion cataract by blast of atomic bomb, Ganka Rinsho Iho-Pract Ophthal}

7. /hum-^. -Fr.-<?A myw.f-mmcxznmxmm, mfmrnmrn 40:177, me

i_Koyama A, Sasaki T : A case of burn of the cornea and retina by atomic bomb. Ganka
Rinsho Iho-Pract O p h t h a l )

8. i;A&my^.micxzm§m. mn&Aimw. 41:15, 1947

(Yoshimoto R: Ocular injuries from air attacks (abstract}, Ganka Rinsho Iho-Pract Ophthal)

9. [iiW;i^. ^i-:;r- m, m • mf-mmc^zmmmmmBVA. m¥[mmmn 40:90, me

( T a m u r a S, Ikui H, et al : Ocular lesions from the atomic bomb. Ganka Rinsho Iho-Pracf
Ophthal)

10. Tamura S, Ikui H, et al : Unpublished

(*3«S}

31
11. Schlaegel T F : Ocular histopathology of some Nagasaki atomic bomb casualties. Amer J
Ophthal 30 : 127, 1947
(MttffljsMftSic?>^nz mmmmm
12. H f f J^-J# : M-f S » E K J f ® ? H « l i ^ # l K l W ' i g . BM'&m-^^mi^ 51 ( 5 / 6 ) : 60, 1946
(Mlura H : Pathohistologic examination of eyes of atomic bomb disease. Nippon Ganka
Gakkal Zasshi-Acta Soc Ophthalmol J a p )

13. Wilder H : Appendix to Pathology Section. Joint Commission Report. Unpublished

Q^uwmmm^m mm^m \A-U im-M')
14. Benkwith KB : Retinal hemorrhages as seen in atomic bomb casualty. Amer J Ophthal
29 : 799, 1946
(g:®«t?K^ b tifcMUfBidO
15. mm^-^^y.smicisiizyi^vpzwyf-mmim's.co'm'o. mw&mmi 42:26, i948
(Hirose K : Changes In ocular fundus with atomic bomb disease (abstract}. Ganka Rinsho
Iho-Pract Ophthal}

16. mipnx^y. miMmcmzpiWkmm, fsicji: Keloid ®jHfii. wmmf-±mt,M. ei:386, m?

( T a n a k a Y : Staphyloma corneae, especially keloid-like thickening of the cornea by the atom
bomb. Nilgata Igakkai Zasshi-NIIgata Med J )

17. Flick JJ : Ocular lesions following the atomic bombing of Hiroshima and Nagasaki. Amer
J Ophthal 31 : 137, 1948
CfAft • smowMv^yKxzmfy.m.')
18. )A-»l:fe^tii):gi^'S!i¥KJ;Sarar#. flSfWs*R# 4 5 : 3 8 3 , 1951
(Hirose K : A case of cataract probably caused by the atomic bomb, (abstract). Ganka
Rinsho Iho-Pract O p h t h a l )

19. Rohrschnelder W : Untersuchungen uber die Morphologic und Entstehung der Rontgen-
strahlenkatrakt helm Menschen. Arch f Augenh 106 : 221, 1932
QAf^(Dyyvyym'tAnn<Dmmtmmy>m&')

32
 TECHNICAL REPORT
28-59
m m m ^ m

ATOMIC BOMB RADIATION CATARACT

CASE REPORT WITH HISTOPATHOLOGIC STUDY

w. m -^ m m n & iH w

SAMUEL J. KIMURA, M. D.i

HIROSHI IKUI, M.D.2 Si ^ m
(Originally published 1951 m^tO

Division of Ophthalmology, University of California School of Medicinei and

Department of Ophthalmology, Kyushu University School of Medicine^
California X^M'^mmV^WCsi' is X om-JtlA^R^/^SBIll^^iSc^^^

ATOMIC BOMB CASUALTY COMMISSION

HIROSHIMA AND NAGASAKI, JAPAN

A Cooperative Research AKenr\ of

U.S.A. N A I I O N A L ACADEMY O F SCIENCES • NATIONAL RI-SFARCH COUNt'L
and
J.tPANESE N.W10N'AL INSHTUTE OF HEALTH OF THE .MINLSTRY OF HEM TH AND WELFARE
«ith fmcis provided bv
U S ^ ATOMIC t \ f R ( n COMMISSiON
JAPANESE NATIONAL INSTiTITI OF HF^i IH
U S A . Pl'BIlC HFMTH SIRMCL

)1 !» f l
l.'v ,«

* a -^i ± K - -i-- tS .."J .'S i )•/ .'i. r> M .>'<: -]'• I'll (H ;!: « k .'If
i v-) tJ * jfc l"l 1*1 if 5)1 ^ f* m

(Millie i-iikai:. fii.eiHjLi-fh«irmfyi 11 -jni\:\'tiit'\.i.:ii.-niinni:i.i)

 ACKNOWLEDGMENT

The authors express their gratitude to Dr. David G. Cogan and Dr. Michael J. Hogan
for their constructive criticisms and help in the preparation of this paper.

m^\t:^U^ii-OmX\C-ii'0, mMMmoXZim^JS^fiS-ofz Dr. David G. Cogan isX

XI Dr. Michael J. Hogan IcmM^'&^kti'f Zo

{
 CONTENTS

List of Figures
M^A\n--'RM •-• ••••-.•-. •••• • • Page i
Case Report
mmWi^ ••••••• - • - •- •••••••• • • • 1

Histopathology of Extracted Lens

mih/Y.ts^»(DMmmm^mms.---- •- • • •- • • 4
Discussion
^ Px • •••• ••••••••• • ••••••• 7

Summary
m m • • • • •••• • ••••-••• ••••- 10

References
-B-^xm • • -•-- • ••••- ••••••- • 11

)
 {

FIGURES
m A m

Figure 1. Radiation cataract lens

m mi«earap?-©/KiPFi» • • • Page 5
2. Lens cortex
yKShitoMM • - •-•• 6
3. Lens cortex
7jC|f,#©S® • • •••• • • 7

4. Diagrammatic representation of findings on ophthalmoscopic

and slitlamp examination
m&mtmfmmmcxzmE&mTf-i • »
 ^''-s-^^^Op
^^^
^^%' • %

ri
m
n
m o P? g >
m c
g. s. 5
W T] ^
C
m s s?
+1;
a y r -
! |i c O
3. a"
?-5i- +5
S >
c
CO
if 8 >
m
m 5; b m
S b
m
(»
- 5 & a. at
2.
> 2
m
6 f e
3f?

s
DISCLAIMER m
This report was prepared as an account of -work sponsored by an agency of the United States
Government. Neither the United States Government nor any agency thereof, nor any of their
employees, makes any warranty, express or implied, or assumes any legal liability or responsi-
bility for the accuracy, completeness, or usefulness of any information, apparatus, product, or
process disclosed, or represents that its use would not infringe privately owned rights. Refer-
ence herein to any specific commercial product, process, or service by trade name, trademark,
manufacturer, or otherwise does not necessarily constitute or imply its endorsement, recom-
mendation, or favoring by the United States Government or any agency thereof. The views
and opinions of authors expressed herein do not necessarily state or reflect those of the
United States Government or any agency thereof.
i
 ATOMIC BOMB RADIATION CATARACT
CASE REPORT WITH HISTOPATHOLOGIC STUDY

IS n ]fe 14 f i 14 S rt P*

SAMUEL J, KIMURA, M, D. AND HIROSHI IKUI, M, D,

Radiation cataract Is a late effect of the atomic mm^emmifAmiisA^iim^'^'icisiizitm

bomb that has appeared among the more heavily
irradiated survivors in Hiroshima City and ffms.yi&mm^'sii tzmmiAiifmKmotxxyzm
Nagasaki City, Japan (Cogan et al 0 . The
m(D"^mmXi>Z (Cogan^Oo (ltl?>?ik#1©ASP
great majority of these cases were discovered
as a result of an ophthalmic survey of the
available survivors. {^yiimmA'-.^'-^-oy&r-wyMMoDmmmi $ nfy

Clinically, these cataracts are similar In

mmmcii, ciUhi^wmoyAmii^yhyyms
appearance to those produced b y roentgen rays
Xrjvi^t^j^lcXZ^cotMabxtyZfji, ^=fas>fp
and radium, and exhibit some fairly definite
characteristics, A posterior polar opacity fs'ommtsnwL-^^^A^to 'S:mmcmmfjmfkb. -=&©
develops which has fairly sharp borders both
umoamfs i^ificim'^mmiifpfs'ommx $) Zo
anteriorly and equatorially. It lies in the
subcapsular region and appears as a lacelike cixlim.mA-'ic$,^x, /hlBfs'S.m^-fiyfiy'-y.Vi
disc containing small vacuoles. As the cataract Vm&i.oicAK.Zo firaP?A^itt^!cotiT, c&Pi
progresses, this disc-shaped opacity may assume
tJMS.mii, Rohrschnelder (1929}2 Mm^JM-<f^A:
a plano-convex form as first described by
Rohrschnelder (1929}.2 At this stage, the visual oic, ^'•avi^^-tzcta^iZo cmmxii, u
acuity is very definitely reduced. Tjum^xii-oi^ h tWkmtZo
T h e so-called complicated cataracts differ from mfmm^Bnmi'tiifpm'^m 'M'\rmx^ ' } *
radiation cataracts In that they are diffuse,
,f0ft:©ffi©S!55>i©iil?*^, n < fsytyy^XWLii
flocculent, and not sharply defined from the rest
of the lens. m>&Bnntii%fiZo

One patient with a radiation cataract who had 2iv-nisMmywm^'§:iixytzm.%m>&.iAnn^

been examined periodically for two years elected
-j3tz 1 ^o:)m^b\ ^oymmf)mmyM.nbfzMx
to have a lens extraction on account of reduced
visual acuity although the opacification was not h^sfp-^fziii, WAfj^mbtztyomsix, 7um
far advanced. Histopathologic study of the
Sffl»l*l&Sbfco cymmic©M:t0tS*HffMfc
sections of this lens together with the clinical
study of the patient forms the basis of this J; xiTY-ixhrnmommmmr-imxA^ 11 (c L ^ ^ ©
report. X^ So
CASE REPORT fi fij m ft
HISTORY

Reprinted by permission from American Journal of Ophthalmology. Originally appeared 1951,

Vol. 34, pp. 811-816.

1
 T.H. ( M . F . S400615*}, a 22-year-old student, T. H. ( M . F . S400615*}, 22::J-0^i:^, ESiKif
was first seen by one of us ( H . I.} in April,
SMmr ^nxsif^si^n '^(DWi9if 4 j^ K * ^ © i
1949, three years and eight months after the
atomic bomb blast over Hiroshima City. At A CH.i.} otjm^^iAffzo mmmmmii, m'\>mfp
the time of the bombing, the patient was In the
P.fg-ySOm tmM-&txZm)U.^M't.m(D^l!xi^m-oX
forward part of a streetcar behind the motorman,
heading toward the hypocenter, which is yfztsmomm^cDmcytzo mmimm cfis,} *
estimated to have been around 780 meters away. iyiixyfzfii^txli'MWcX':>xfx^Mliistifzo •*
T h e patient was wearing glasses (myopia} which
^•ytx9lli^'yfsi)y'ofziPJ^^tziy7y., mFricx
were blown off by the blast. No flash burns
were incurred but he was injured by flying glass
fragments. T h e r e were many people in the
(DmiciAOScff-Mi^SA-^ixtzicM^'fstjy'otzo b
streetcar, but only four other survivors have
been found. All have radiation cataracts. fjy hy'yMy^-ohixicmmmB&?im=&M&fzo

T h e patient escaped to the nearby mountain c ©S^BH < 011^^3319-', -t Cxm&m 2 mfuTS:
area and there, about two hours after the atomic
bomb blast, he became nauseated, felt ill, and iciiXMi:hXisb, i<VMm< ^i:-^T«iD±b/co mM.
vomited. He noted severe thirst and diarrhea
which lasted some two weeks.
©/i^Kx., TmM$> '0 cixnm2mrsmyfzo

On about the 14th day, epilation of the scalp 14 H fi tH:6^ b m^oWim^liit. 'O, 3 U t fc li 4 U
hair commenced and within three or four days
x'^^kiau^ bfco 2 A^JJ ms.mi '^i^ici-k^t m b
he became completely bald. After two months,
the scalp hair started to grow back slowly.
ty

Petechias were noted on about the 21st day.

21liimiClhliS.»iimAfZo 2 U tfcK3 HfcoT
Fever (40*^0} followed in two or three days and
continued for 10 days. During this period the
mmAo^cwm-'XM'owBWimyfzo cymwiAb
mucous membrane of the mouth began to slough,
especially that of the gums. Bleeding from the rmmmmymm;^ommimUiMAt.lo, -i^m'AiiM
gums resulted, accompanied by aching of the
teeth. During the third month after exposure, mtiilkiiki'O mmUf-o tZo «M^3;$^H bX^-OhE
the patient developed furunculosis. T h e first
white blood count was taken during the fourth imS,.bfzo 4 fpfi HKftUJ0aifiii*m»5tM7^i:fc
month and it Is remembered to have been around
6000 cells per cubic millimeter. iX, m 6000/mm3Ti> o fc tmSHn'ilil.bXy Zo

Failing vision was noted about two years after »mmA2it.bxuiAmm4:mibfzo 3tpnttzu
exposure to the atomic bomb. He consulted an
4t=.Mmcs>zmnmyMpij, 'S:mm^i>m-fp$>z
ophthalmologist three or four months later and
was then told he had a posterior polar cataract. iWt) tifco

T h e patient was seen by one of us (H,I,} one m^um^jmtMmmi^nx 1 ^^.^ic-f?^© 1

* Master File Number, Atomic Bomb Casualty Commission
ABCC J S A ^ , ? # « ^ -

2
and one-half years after he first noted visual A (H,i.} ©liiii^'Stj-fco Muy'^nyyx^mm
difficulties. An irregular disc-form opacity was
noted beneath the posterior capsule In both eyes.
mwMmyt&ib, coymmicii^< ©/J^$ts-^.mfp
T h e opacities showed many tiny vacuoles and &iO, •ytBii&tzfph^A :i]yMWpiRiitZX-7
light was reflected from them "as from the
surface of mica," Corrected visual acuity was :
iccii>>,'vmfpbmibfzo •if-AB-i.'jjiruB. 20/25,
O.D., 20/25 ; O.S , 20/30. /t.tB20/30T*-:>fco

T h e patient was next examined on October 13, mriiimM4.A'n:oy9i9irwMi3uy{Xo:)muir'S:

1949, a little over four years after exposure to
the atomic bomb. ij-fcc

EXAMINATION

Right eye. The visual acuity was 20/30, tiSM : 'tfuf.WJli 20/ 30, miiSmii^omWM'!S.&
corrected. External examination was negative.
7&jtsip^tzo m\&m.m.M.o-Mw<, /Uhwm^iyAM
Ophthalmoscopy showed an irregular disc-shaped
opacity of the posterior pole; the fundus appeared
iwi\mi'>fMm^:'M.ib, m)&.ii±mAy^ABx& zx
normal throughout,

Slitlamp biomicroscopy showed the posterior mmvmm.mi.oM'M:, m»<&:^ wis?- ii w - ^vc

polar opacity to be lacelike with a few vacuoles
xyo:>xpicP'^oyM&fpmi.bxyfzo c©WSiiH:
interspersed. T h e opacity appeared almost as
though it were part of the posterior capsule * Y&)^'S.U\z.i,Zty -5 J;!} ii, '|£S,#:A©^f}/vi:
rather than in the cortex beneath it. The
-i^{AyxhZfpo^XolcAyfzo HiJA FSPiciigT©
anterior subcapsular area showed several small
vacuoles and a few fine white dots. The
/jNg;/x'4i!tai^^5Sc©«ii/)H^a;y*r;g46fco MU^yy
remaining portion of the lens was normal. ©ffi©hf^>i4iF.m-r* o fco

Left eye. The visual acuity was 20 50, Aits •. KIEIM/Jii 20/50, 'M'A:%U,l^oM'^%ny
corrected. External examination was negative.
Ophthalmoscopy showed a similar posterior polar sAfsfp-otzo m\m.m.-&.oyi^tAAi, nmthmoym*.
opacity but It was larger and the peripheral ftM/s*sAfc/is -«As<, wmui-wvimx
portion was more dense, giving It the appearance
of a "doughnut," pl,_-^-;J 0^1-fifi>£-/KbTOfco

Slitlamp biomicroscopy showed a larger and

more dense posterior polar opacity than that in
- M A i < m9.x&ofco c©ja®!i#:-t llc&'oX
the right eye. It appeared as a plano-convex,
disc-shaped subcapsular opacity. T h e anterior -fOlA, vrnV^o-yXoyAy, -c©riijffl5toJ;0|i:Sl5li
and posterior portions seemed granular with m'r\kx, micxiifyiiimy, ^io:)-^i^m^hhi-^»i
occasional large vacuoles, many polychromatic
crystals, and forming two surfaces that reflected
o T , 2o©iin4-/|#Sbyct-yy^WJpWpb < K%A
light brilliantly. bxyfzo

T h e space between these two surfaces appeared (itLb 2 -ooyjmoWi, J«St©/J^Ste#ii6t/xi-J

optically empty except for numerous small highly &ymyf-^\^t.yxii, -jty-miayvisxi^zx-sx
reflective particles. The peripheral border of *ofco c(DmiiVimmoMmii-mr-mmxm4 x
this disc-shaped opacity was more opaque. As
seen in Figure 4, this thickened border gives the 'AzxoK, cmtmtmvyz^bKmmyy/^ztK
doughnutlike appearance when this type of
opacity Is viewed with an ophthalmoscope. -:J--.'!K©^il-t£3-X.So

Months later the lens changes had advanced Wii^n'^, /K.'tli#:©€^fciijifi-b, BMy^^lcX
and on the patient's insistence the left eye was
^lymyf-m-'^rsfs-ofzo 1949^^12^ 13mc, s-^^©
operated. An intracapsular extraction was
performed by one of us (H.I,}, on December 13, l A (H,i,} icx-^xmnmAimviiontzo ssisis
1949, Under local anesthesia, a conjunctival
flap was made, a full iridectomy was performed,
^©feiic, mm-n-mim'^, ^.M.%mmm%mb,
the zonules stripped, and the lens delivered by rhm^mmb, /um^mm^myxm&btzo 20
the use of a loop. T w o corneoscleral sutures
were placed. The postoperative course was 0*^jsiiii3-4-nftofco # m mmwrnrnx, mm
uneventful and the corrected visual acuity was
2 fpn'4koyf^>'^.mA\i 20/20 X&-0 fco
20/'20 two months after surgery,

H I S T O P A T H O L O G Y OF E X T R A C T E D
LENS

T h e lens was fixed immediately in 10-percent /Y.im{^liM^lciQ%tyu-7 v yXlUlUb^oAyy

formalin and embedded in celloidln. Sections
vlcSaibfco Wi'^ff^'}, -^-7 h^yjyisxxl^
were made and stained with hematoxylin and
eosin,* ^iyyxmf^bfza*

GROSS

The lens measured approximately eight mm. /Uhf^li'iMA Smm, ( g S 2 J - ^ m m ' C * o fco tS:
in diameter and two and one-third mm. In
thickness. The posterior pole showed a
iiicgr-j 4 mm © ri--:^-.'J !t^tfciiS^RiMSS*
"doughnut" or a ring-shaped opacity of about Mibfzo cymiKMmmk'Mo-&^xi,zx o KAK.
four mm. In diameter. This ring appeared to
be a part of the posterior capsule. fco

HISTOPATHOLOGY

Meridional sections through the lens in the / R i f # 0 « * a 5 uumrx'^i^Mi. b fco

axial plane were studied.

Lens capsule. T h e thickness was normal. *B1«:« f*$iiiF.',t, mxhvm.m0A^')iiiyoii

The middle one-third of the posterior lens capsule
icummm-tmy-i^ix, y^ommimmbTTsg©
was wrinkled, thickened, loose, and separated
from the underlying cortex by amorphous debris SR i nmn, * © PtS Kjmiw^omimMs x v-miiifi
and empty space ( F i g . 1-A}. hZ (Hl-A}o
* T h e slides were prepared and stained by the Department of Ophthalmology of Kyushu
University Medical School, Japan.
Kmx:-m'^MmfAxwmm--^(om^%t''Mm,^ws -> fco
4
 Fig. 1 Radiation cataract lens
( A } Amorphous debris and empty spaces between
posterior lens capsule and underlying cortex. ( B }
Peripherally the zone of cataractous degeneration
was thicker and contained more vacuoles. ( F } T h e
junction between the posterior cataractous cortex
and normal cortex anteriorly formed almost a
straight line.

a 1 g?i-j»ftefti!*©/K.ii^#:
(A} rKtfnmkm tTspgRRsymi^mmm^tS?FB'3O
(B} Qifinmfi.mymmiim< ^< 0•^.m^^^xh-^
So CF} '^^o&i^wiM.'stJBmBimom&mi^iim
mx^^^nm^ir^'>xyzo

n ^ •:

T h e epithelium was composed of a single A:niii-m(Dmmfiyjf£-oXis^, mmom^tm

layer of cells which varied in thickness and in
the spacing of the nuclei. There w°rQ some ®?m%ii-Mixfsyo Ms^oimx^zma- % *s
areas which were fairly normal and others where ii, l-.fiiMiXWAcM< fs tiSat/^:*©i-5KtS'>X{->Z
the epithelium tapered gradually to a thH strand.
In the latter areas the nuclei were elonjjated, twyyfji^^'o, cymyxii, mnw&bxwmizm
irregular in shape, and occasionally pyknotic.
mx, mcmkoDmsm$>-^tzo ±&ii'^MyieiiW
T h e r e was no extension of the epithelium beneath
the posterior capsule. C^Xl^fSij-^o

T h e epithelial cells at the equator also were mmmcioH z AxAimmomviisxv'A^i^^Amm

irregular in shape and in distribution The T * ofcoAAEmcisii znm;'$/yjihtA:m'Symim
nuclei of the peripheral lens fibers at the equator
were very irregular in shape and sparse in y»yx:f.mw\x'jym-'mx&-o tz, MIWB»OJ^
distribution. Many of the lens fibers showed
vacuolation. iiciyi^mmiU-^ii-ofzo

Lens cortex There was a clear-cut demarcation

between the normal cortex centrally and the
peripheral cataractous band. T h e r e were no tomiciiU'^^i')bfcii^/j^&ofco i^:ms]iLTm
normal lens fibers peripheral to the zone of
normal cortex. X D omm'syyiiiiymi/Y4i'i{^mui%u^'otz^

Anteriorly, this layer of damaged cortex was Hi]nf ©tMfi bfclg'iSii, /Kiiif#ltr?l50-c^iJ;!} fc/#
thinner than that of the posterior lens. It varied
in thickness and the fibers showed some vacuolar iP^fzo ^oMiSli-fSXlitsi, umym-o'WA
degeneration T h e lens fibers beneath the sgffi/5^*-3fco HiJi:^©/JCl',f'#*gffii, M^}g©!i|f4
anterior capsule were replaced by an amorphous
'M^fiy ct -3Tt't/i-^x. b,}iTJb !}, C4\li^^9 y
granular material which stained deeply with
eosin. yy-^xtAbisiifzo

Posteriorly, the cataractous cortex was quite it.'fTis, ]Amo'i'^\npf-:%{ArywfAiWAxmAV

Fig, 2 Lens cortex
( C } Strands of normal staining lens fibers. ( D } T h e peripheral
area of cataractous cortex ended a b r u p t l y .
II 2 /K ,¥, Ui © fit 'fi
(c} Tfi'rii«ftei/K,',i'ifi:,sp©j: y (D} \'An¥m'mf!oM\mifMyoinx
yzo

,4*,

* * - ' ' . ^,*.liv

5v •*
~.y
ff-

.^' ..*-^..'

,- A .'

,-^'''"'.ff
,"«'
 sharply demarcated. Peripherally the zone *>-ofco \^i^wmmw,ffOinmmix'om<, x'o^
of cataractous degeneration was thicker and
contained more vacuoles (Fig. 1-B}. Within the <0'^MA^f^/-uXytz (Hi-B}o MMlfiomtAiM.^
amorphous and granular staining material there
feifes©41 ic:(i, sb-mcm&.5tis/UhmiM^mfi
were strands of normal staining lens fibers (Fig.
2-C}. ij-otz (Kl2-C}o

At the junction of the outer and the middle muymmmii isxyA^}kmH tymimx, SH
third of the posterior surface, this peripheral
area of cataractous cortex ended abruptly (Fig. (jymm^y\^mmAiS\iy)-iiMncm-oXh^ zcm2 -Dx
2-D}. In the middle third a semicoUapsed space
was present containing clumps of amorphous
debris (Fig. 3-E}. T h e junction between this fc (M3-E}o ^0#:i'fBart!ffttSSt-t©Bfj©IE'fir
posterior cataractous cortex and normal cortex
fs}-^nty?B^0iM.mismx, '^yy\rmxs>-:>fz
anteriorly was well defined and formed almost
a straight line (Fig. 1-F}. (Ml-F}o

The remainder of the cortex and nucleus KfJ©-?:©-ftli©ifl5:5> ;i3 X rj /UimMliJEmx&-^

were normal.

Fig. 3 Lens cortex

( E } In the middle third there was a
semicoUapsed space containing clumps
of amorphous debris.

(E} 'MA^0lifS.fl0^yfMM'i]mMijy
iMi:i>-omimmbfz'i?Miii^Zo

DISCUSSION

T h e correlation between the clinical findings

c oDMAmi-.'rWmytimiUttmm-MfMf'i-1 ©
and the histologic sections of this radiation
cataract is Interesting, immmimmi^^Zo
 Fig, 4 A diagrammatic representation of the findings
on ophthalmoscopic and slitlamp examination
4 mmmtmmammcxzmAomy}^

OPHTHALMOSCOPIC SLIT LAMP

m m m m B %i
Figure 4 shows a diagrammatic representation M 4 lim&mffkSisxtimm-Kim^oyfi-A^rm^^b
of the findings on ophthalmoscopic and slitlamp
examination. This plano-convex opacity, which tzhoyxiiSo imAm&t)i-m.tmA.fzWL%immAn
is seen in more advanced radiation cataracts, is P9!Cj,ibllSc©^OilS!i5?&^^^^i^l#:^T!^:tSM
almost entirely confined to the posterior
subcapsular area. T h e piano-surface Is formed %-tiiixyZo '^MlimfyyiEWJSiYhmBmt'iiAj
by the junction between normal lens fibers
oyM'&.bfz/Y.hmuW.t^mmt.X'T.xmf^hixxy
anteriorly and degenerated lens fibers posteriorly.
The convex portion is formed by posterior So {^MiikUicx-yxm^hUxyZo ^'ty^Wp
capsule. T h e clear area in the center Is probably
composed of a gelatinous liquefied material s 1/ >
- %oyiiMh\^&mip b -e t fzmmoymtm'm^ ?.
derived from the lens fibers containing the small
&b<)JJ4ors!}, c©ivKnmmm'&.oMc^ui:
particles which reflect light brilliantly on
examination with the biomicroscope. )Wfp bxmit Z Wi-T-^-ii^A^'!/ ^ S o

T h e microscopic sections of the lens show Askmymtmin an 3} xir^-^om'&Bn^,

(Fig. 3} the posterior capsule to be wrinkled,
thickened, and collapsed. T h i s finding may be mf-isX rSiSM^m-A So c ©rrfiiiSSISIiSiAfP/i!?

the result of liquefaction of the central part uy&m-cisij SflJS/icic j ; s#:$Tzi!S©tlJ't^SP©^fx'ffc

of the posterior subcapsular opacity with
dehydration during the process of preparing the ©ISSiTt. S/)i feai^Ti^vJi/^o
specimen for microscopic examination. It is
probable that the loss of this fluid releases the m.o:)'mM\cXio"^mcis\Azmmim-miBix, yy
tension on the posterior capsule causing it to
MiSf*a;0lEJ¥iK«;6iUj*fc i:^-x. b^iSo
become thicker and wrinkled.

T h e original injury to the lens probably /Ky,f*iC4oij-SftlIJ©«*liSib < J J l i c l d S o a

demages the epithelium. T h e observation that
nno:>mmy n'lp.itfs/Wa^mmt^fsfp ^tzty-)
there were no normal lens fibers peripheral to
the cataract makes it seem likely the lens opacity mmp^j, ±/Ji©T<BjiS£i^^X«tf©fcJ6i<:, 7KI?t#:fi
progresses because the epithelium Is Irreversibly
mymrx-f z<&'mihzxoKm.t>nzo JJ^MSP/KIS?.
damaged. T h e changes In the equatorial lens
epithelium and nuclei of the peripheral lens i¥\.msxmnm7Y.M^'mMo:)mr.isnzmmi, c
fibers would seem to verify this observation. 0Mg**»:S-rS vi: -5 KE^tifiZo
 Okusawa (1933},3 after producing experimental mM ci933}3 iimyMmmmm>&t'Anw^i:%§yi:
radiation cataracts In rabbits, concluded that
the lens epithelium was the site of the original
bfefc% /XiSi* bmcmnoMmifiho tztmmb
injury, Tl/^So

Grzedzielski (1935}'' reported histopathologic Grzedzielski (1935}4 i i / M - l l g - B i e r a P ? © ^ ^ 2 O

studies of two lenses with radiation cataracts ©/J<iil#:©ffl«lB-a'ji'tYjSf'>g*i«-grb, araptii/xn
and concluded that the cataract was formed »A-js.mmKi3» zmi^Kx-yxmm^h^xh z t
because of an injury to the lens epithelial cells, MribTl^So

Leinfelder (1936}'' came to the same conclusion, Leinfelder (1936}5 ilFf] bSSstiCii b T t " !9, mK
adding that the cataractous changes in the
yikMWt^^'.) fzM.MMy'^nn'itm'aim.ntzi-'
severely irradiated lens may progress, while
hfiitifsyfp, tMmo:ymeit-^'pfiyi,o:>iimfxbfs
those which are less intensively irradiated do
not. It appears that progression of this type of y ty 0 c t^i:{.i\n\\rycy Zo ^ © a s e r a i ^ © ^
cataract depends on whether the cells of the mi, 7nxkWAJiommyuiKmfsmm-b^& ztpto
lens epithelium are permanently damaged or not, iP\CX'^Xdk.'tZX')XdbZo

Tamura et al 6 studied sections of 48 eyeballs

H+J-b«limiloylii%iWmy.&x^htibfzm.mW&.
from atomic bomb victims who died of a severe
radiation Illness. They found six eyes exhibiting .£©4811®tirj}t*W5^e b, 6 m\c7Y.M^»iS-.'&nyi7Y.h-k
vacuoles in the lens fibers of equatorial sections
WWmiySM^mAbtzo ci©r1t2BH!Cii, i^MS*
of the lens. In two of these eyes the nuclei of
the equatorial lens cells were degenerated and
MiWmmom>yM.i&i, m-tc^isxy^'^ F©KH©?%
there was evidence of swelling and disintegration
of a thin layer of cortex beneath the anterior ym\cm.misxx>mikowM^WA}bfzo cixumym
and posterior capsules. It is possible these were
the result of late fixation of the eyes. -mmi^ -p fcismr $> z nmmiii z o

T h e atomic bomb radiation cataracts were mmwiMmmAnfiummmm, tfsht>-ijy-r

undoubtedly caused b y the initial
that is, gamma rays and neutrons.
highly capable of causing physiologic damage
to the tissues of the body Including the lens.
Even though the lethal range of neutrons is
relatively short, their high biologic effectiveness
suggests that they were at least a contributory
factor In many of the cases,'
radiation; -misi.Xi^^P'&TlcX-^XX>lsM-^nfzmimyo:>f&
Both are
yW^xiiZo cnii^om^muMc, 7M4i^^^ts
'^$fO-^mmch''SibyiAMmfs9)-^^^K.Zcti)Hi,
* s © T * S o ^p'&.''f-o:)mmmiimm'&i>^yt)\
•€-©4.fe'-¥K]«&3fi©Aii/^<: i t i , ^ < ©SLfilictJi^
X, x^i^iyp'pfS < t fe—o©fl-;?j/j:S-WX* ZCt
^itTY^bxyzy

Evans (1948}8 has produced experimental Evans (1948}8 iiftljtp$fifcrftftT-MfriiCX-z-X^

cataracts by means of controlled neutron
wimBnwam'AiKmiAjbfzo *• y^-ui-'^nw'^i:
irradiation. T h a t gamma rays produce cataracts
has been known since Chalupecky (1897}9 first xy^mctCtli, Chalupecky (1897}9 ;6^|n&T^
produced them experimentally. mm-c^nmwi-^b^xmk'mhfixyzo

T h e pathogenesis of radiation cataracts or any •Wi%-m'&.Bm45Lii-mm\z.xz'i0m0$[WmB

other body effects due to radiation is not known. mommnnhixxyfsyo i-&'»ft:#lllitxzfA-Ml-
There are many theories proposed to explain ffjwg^Mmt zfzAic^i 0mMi ih ^nxyzo
the biologic effects due to ionizing radiation.
However, the initial effect of gamma rays and
bi}->' b, iSy-7-misXnA^m'foMM0Wm\i7Uni
neutrons must be on the lens epithelial cells. WAMMUKMiotiZicmyfsyo

Generally, any body damage by radiation -wmic, immicx znm-fs za-m/jfea-f ^ ^ ^

originates In the Individual cells and it is the
nucleus of the cell which reacts to the
ommtpihrntzhox, mmiasLmtzoj\imu0
irradiation. In the lens the only cells with a k&xhZo /U-hWxmk'i:-jitzm~ymmii7Uh^
nucleus are the lens epithelium and the
equatorial lens fibers. .L)iL umm;UhVfmmx * s o

Epithelial cells are generally quite sensitive to y)S.Mm\i-m.\-cmMK%ibx±<m.mx&Zo t

irradiation. Also the equatorial lens epithelium
is actively producing lens fibers at all times and
again such active cells are more sensitive to TI ^ s o c © J; -5 fimm'&Mmiiik%imm.%i K-M bx
irradiation. -)¥mmxhZo

Thus, It appears that both gamma rays and f}^< X, mmommMABofiy-^-mioXv-Aim

neutrons from the initial radiation of the atomic
burst produced ionization In the lens epithelial fli, /JCi'iH#:AK«H!SKKiJi^T'£il^/i bfc J; -5 X
cell nucleus. T h e cataracts are the physiologic
* So fll^|!f ii/jCiWif*: L&icisii Si/Jia«'*'04ai^i
result of the initial damage to the lens
epithelium. mwMx$>Zo

It is not known why the posterior subcapsular Mmnb^/khhU^X 1} ^'^•t.y'SU^iii)^-&iizctf)^

area is affected more than the anterior lens.
Clinically, radiation cataracts first appear at the
^ymi^htsyo mmmcmmmei&mwnmm
posterior pole. Microscopic examination shows micmiotiZo IiSaStil:©MitTfe, mJA h'g^SJ;
definitely that the posterior subcapsular cortex
i} b'i^my&.MfiiMimyist'.^txZ c i/jiti-o § ^i5>
is involved more than the anterior subcapsular
cortex. So

It is conceivable that the lens fibers of the #:S©/KSB#:|g*Sii, /Kh'M hlAloXM \®fzy, 'yftm
posterior pole have a poorer nutrition because
of the lack of lens epithelium. It has been f)iX^:^^X&Ztiy6 Ctf)i^^^(hnZo Kinseyio

shown by Kinsey'" that there is a greater tt/K,rt,i4:0t:iif J; i} Mm^m bXX^g-i m\M%i

metabolic transfer through the anterior surface
of the lens than the posterior surface. ''mmnnzct^ff^bxyzo

SUMMARY

T h i s is the first report of a histopathologic cniiw.mMmm^m^o-:)mmnwf\m\ito^^

study of atomic bomb radiation cataract. The
case was followed periodically for two years.
|/J©tSI%T(feSo c©M:M(i 2 ;ii^i#Bfl:KE:)ttiyjic|lfia
T h e onset of poor visual acuity occurred two •^^tifs-ofzo WAW.m\imM2imAck&^tzo —JJ
years after exposure to the atomic bomb burst. oy/umixM bx-Mmimmny^n-fsy, cn^m
An intracapsular cataract extraction was
'it'bfco
performed on one lens and studies were made.

This lens was particularly interesting for it ^©/jCi'jiWia;, SlUiC Rohrschnelder ^O^'KE-^fc^ji
showed a plano-convex form of posterior polar i'hMoy^yMMM-i;7T^bxytzo-)X., ^W-M'^W.yhO)
opacity, first described by Rohrschnelder, Xi>-otZo

Clinically and histopathologically, atomic \m<myy~.wM,)hm7my§smM'm^B,nnii'^

bomb radiation cataracts are similar to those y vyymsXUy'y-y J^lcX'oX±-fZhoytWMi
produced by roentgen rays and radium, XibZo

REFERENCES
# # A »

1. Cogan DG, Martin SF, Kimura SJ : Atomic bomb cataracts. Science 110 : 654-5, 1949
(tcsarap?}
2. Rohrschnelder W : Klinischer Beitrag zur Entstehung und Morphologie der Rontgen-
strahlenkataract. Arch f Ophth 122 : 282, 1929
cmm&i'i m&mmJAi.yBmc)(At z umm^m:)
3. Okusawa T : Die experlmentelle Untersuchung uber die durch Rontgenstrahlen verursachteii
Veranderungen des LInsenepithels. Acta Soc Ophth Jap 37 : 814-35, 1933
Cmmmm^ xzyyy: AzS.ymi:.l^MtyX0'Mm(fjmD
4. Grzedzielski J : Zur Histologie der Rontgenkataract, Klin Monatsbl f Augenh 95 : 360-9,
1935
(.mm&vmoyMmmic'Dy^x:)
5. Leinfelder PJ, Kerr HD : Roentgen ray cataract, Amer J Ophthal 19:739-56, 1936

cuy hyymyxzBi^rhi)
6. w^Amm. _M
' = Wih •• mr-mm'xzmmioy&mriA. mf-miAimw. 40 (5}: 90, me
( T a m u r a S, Ikui H, et al : Ocular lesions from the atomic bomb, Ganka Rinsho Iho-Pract
Ophthal}
7. T h e Effect of Atomic Weapons, US Gov Ptg Office, Sept 1950
cm /-J.=5SS©5&3R}

8. Evans T D : Effects of small daily doses of fast neutrons on mice. Radiology 50 : 811-34,
1948
m^mr-ioPAu u pn W0tti 1 u-r^y is x utmm
9. Chalupecky : Ueber die Wirkung der Rontgenstrahlen auf des Auges und die Haut. Cent
f Augenh 21 : 234, 267, 308, 1897
QmhiiTky&.mc)(Atz-fMmm%ioymmmc-o\,-'x:)
10. Kinsey EV : Personal communication
(fA fe}

11
 MEDICAL EXAMINATION OF HIROSHIMA PATIENTS
WITH RADIATION CATARACTS

mmnBf^m^^t^jABmm^0

P A U L G, F I L L M O R E , M, D,

Radiation cataracts, the first late manifestation mmfi.i~mpHi, AriSicisi^mmcmyjbiifc

of exposure to atomic bomb radiation reported mmmMmmmm&^kmmx$,Zo cmc-oyx
in man, have been described by Cogan, Martin, li, -yXlC Cogan, Martin isXtJ KImura,l ^lf;^>•
and KImura,! and Cogan, Martin, KImura, and IC Cogan, Martin, Kimura isXZ:^ Ikui 2 0Wm
Ikul,2 KImuraS reported 98 Hiroshima patients ti&Zo KimuraS limm^'tAn¥f^i:AyyZ]XtA,W.
with radiation cataracts. Eighty-five of the 98 mmmi'C'oyxn.fibfzo c©98{5'iiL|485^!iii, m,is.
were among 922 survivors 1000 m or less from JiijJ;'01000mjyfy©|6.Sa£l¥-# 922 ^ijttCjam S n r
the hypocenter, an incidence of 9 . 8 ^ . is^, CtUi9.8!?^©^^4^T*So

This group of 98 patients with radiation .gfeftt»Biftrt!S?*{iTS(:©98;g^Htt, Mihlpic

cataracts is a select group because all were
unquestionably exposed and all show unmistaka- M»s*a;j-T4o!}, timmimy^ibrnfAfimm^
ble delayed response to radiation injury.
Seventy-eight of them have been examined by
the medical department of the Atomic Bomb ^l.)'ti^7iyi'WA\fsmmxf:>Zo y0A^78ti\c-2yx,
Casualty Commission Clinic in Hiroshima in an
effort to discover if other late manifestations
of radiation Injury exist. T h e examinations
ZtzAlc, jKHj^mMM't-M^mM^Simmcish^x
were performed approximately five years after
exposure. mmwA 5 imxfp i, c ^m^mimDutzo

T h e group comprised 45 men and 33 women CCOmmii, •Miis--A^l^ 150~1240m©PB^iCi/->fc;g-?

between the ages of 12 and 69 years, and they
had been from 150 to 1240 m from the hypocenter; imnti-^ h^9ttx0^'fi5^ is X ntK^szt, X to
64 were between 700 and 1099 m. Detailed mfR-^tlXyZo -e04J64;g(i7OO'-lO99m0fKi(:i^
radiation and medical histories were obtained,
and physical examinations were performed. fco s^mfsmMMisxrimm^iA^^n, M-»m&*i
Roentgenograms of the chest and blood, and 'Mm-tstxtzo mi^i^y hy'ym& M^mM, ms.is
uiine and stool specimens were examined.
Thirty-four patients were proctoscoped, and xtfmmnifsiont^io si^ic-ot.^xm'^mm^.fiyn
sternal marrow specimens were obtained from fs-btx, 27ig^.b»H"n'MS/ti*A#bfco Miy&^
27 patients. Additional diagnostic studies were
performed as indicated. icmbX-ioymornVf, '^S;0s"3llS3tifco

Symptoms presumably produced by acute

?Sb < f^fmik%-micx-oX'j\^mc^txf^h}s.h
radiation were vomiting, fever, diarrhea,
oropharyngeal lesions, bleeding gums, purpura,

Reprinted by permission from Science. Originally appeared September 1952, Vol. 116, pp. 322-3.

1
epilation, amenorrhea, and abnormal periods ifnftWK, mm, )K"^, mnmsxmmim^o^nu
after amenorrhea. At least 5 0 ^ of the patients WS%:T*ofco mViODA^fs < t fcso^/)-., ^M'-h
experienced fever, purpura, epilation, amenorrhea,
u, 5Sis, mm, fu^. mnmisxtnuA-.^mkbtz
and vomiting on the day of exposure, suggesting
that at least half of them received severe m, c tiiipfs < i fe-c© A'-'immiio)Mmvmiy
irradiation. 'nytzct^mmtZo

Forty-six of the 78 patients received mechanical 78t,©-5 *>46ig/)^ MAiiJyy.isXy.io)i&o^/hii

injuries described as minor lacerations and
f£.mmcxzimii0&MisxiymmM t bTsdid^sti
penetrating wounds from flying glass and other
small objects. Several patients were bruised fzmmmiu^-siifco '&:i:,iimm btzm^may ^
by falling beams and roofs, but the only major sfjTO«*sij-fc/ji, iift;-©m'fliii, m&rim&'M'r
injury was a depressed skull fracture. As far
xio-ofzo fij:£b#siKi}Tiiaffiiitoi^mwyx
as could be determined, all injuries resulted
from indirect blast effects. Small thermal flash ZWim^AWmcXZ hoi^Xh-^tZo iKtt©,«fi;6n5^,
burns occurred in 15 patients. Five of the burned icti-ofcoyo^^mA-iioy -5 *> 5 ^iCiimUM&liU
patients were free from flash burn scars,suggestlng
<, ciiii^msicMbmymyMmt-iix^''tzct
partial shielding from thermal injury. One scar
resembled a keloid.
*-7Kiig-rso I t,oymmiyx3.^ vi-nxytzc

Seventy-seven of the 78 patients experienced 78;?,0') t.77^mmo:)§m^mkbfco c©MIK

scalp epilation. This observation suggests that
a cataractogenic dose will produce some degree
i^b, &nmm'p.tzn&0mmiixmi0f&sic
of scalp epilation in the majority of patients.
& ZWl0M^0M^=iis c t fe <Dt!S-.t>n S c

Two males and one female above 39 years of

39:;j'-j;i ]:o:)Mm2tysXzJP:¥i^i fyc, itmimm
age had diastolic blood pressures of 100 mm H g
or higher. T h e remaining individuals had blood MV.fP lOOmmHg £1, I - . T ^ o f c o -=-©flIi©A-<?T
pressure recordings within the usual range.
ii, ifiiJh©se«!iiE',^;i!WlrtTJDofco 36f,',zWM'ii}
Thirty-six patients had scars from burns and or
wounds sustained at the time of the explosion. io5:iitzx§jfsp'bii&mK.i^zmmf)^f> -yzo x^
T h e majority were minor and showed only small
mi'mtix, m&m»iimpx$>'ox, mmm-m
amounts of scar tissue. Radiation cataract was
the only physical finding attributed to the late f?i<f^.m'my^m*Mi''hm-^yzm~oywmrAx
effects of the atomic bomb. ik -> fZo

At the time of the study the hematological „f giitf© iiimmtArfx AXU \mMmii'> ^>iifs tp -o
findings did not disclose any blood dyscraslas.
Two patients with radiation cataracts have fco mmMAnwi:iitz2ncfikMAmHyAib
developed acute leukemia, one of them subsequent
tzfji, •r©-5 b©i;f,!ir.©frjf'>t'©#:!c±b, fib© i
to her examination in this study and one child
not included in this report. T h e aspiration t,liT-WTcySU^icA-oXytsfp-Dtzo 27f,tpC-A%
sternal marrow specimens obtained on 27 patients
fcW'H-itK«0ii«rriiii, imMmmmAt-m.
were compatible with the peripheral hema-
tological findings. bxyfzo

Chest films, stool and urine examinations, and Wi-^iixii'fgtjst, iMaif.kmi-M, ^iimcmmmm
serological tests for syphilis revealed no ^\ctsyx, wyi.cubnzxofswrniHhi&yts
abnormalities that could be attributed to the
atomic bomb. T h e histories did not reveal any A^ofco imLy:syx, WA'ymA'Zi-fx-yyPX'AV.yvM.
information which suggested late effects of the
atomic bomb other than visual complaints. moym^R^£}&Ayiz-m\\i\4k>m^fii)^^tzo

T h e shielding factor was not studied. The &moymnii¥juAbfst^-^tzo Am'^Y.yyyxBn

greatest number of patients with cataract
formation in this series was 700-1000 m from the F?-tft"rS,ilii-©A^Ett, •M't^i&XX) 700~1000m
hypocenter. No cataracts have been found in
the survivors in this report that were in the T * o fco •M^tJliS/j^ h 800m MMzWiJ-s. V ^ y - h
Fukuya Department Store, a reinforced concrete
mxy'mk'nwk'.y.-^fzWi^&.cii, 'Mmanx^yz
building 800 m from the hypocenter, where
shielding was afforded. (Dx\^AnniimyhiiUi)^-ofzo

REFERENCES
# # S «

1. Cogan DG, Martin SF, Kimura SJ : Atom bomb cataracts. Science 110:654-5, 1949.
(M'SaWRi}
2. Cogan DG, Martin SF, et a l : Ophthalmologic survey of atomic bomb survivors in Japan,
1949. T r a n s Amer Ophthal Soc 48:62-87, 1950.
(i949^!c: H Aic isyxws -o fzwrnmrntAm^^mm-Mm
3. Kimura SJ : Ophthalmology s u r v e y : Hiroshima report August 1949. Unpublished
ciMfWjsasifSr TAgi i949ff-8j! -mm)