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Yevgenil.CHAZOV, Leonid A.ILYIN, Angelina K.GUSKOVA

Novosti Press Agency Publishing House Moscow 1984

English text edited by Boris LUNKOV

Contents

© Novosti Press Agency Publishing House, 1984

Introduction 5

I. Our Duty Is to Work for the Prevention of Nuclear War, for the Health and Happiness of Man 9

II. The Movement of Physicians for the Prevention of Nuclear War 24

III. The Nuclear Weapon: Its Characteristics and the Threat It Poses 52

IV. Main Medico-Biological Effects of Nuclear War, Their Classification and Authenticity of Estimates 62

V. The Neutron Weapon: Its Main Physical Characteristics and Some Medical Effects 69

VI. Possible Early Medical Consequences of the Use of Nuclear Weapons 77

VII. Clinical Analysis of the Early Effects of Irradiation 98

VIII. Late Radiation Effects of Nuclear Explosions 131

IX. Psychological Consequences of Nuclear War 147

X. Genetic Damage Caused by Nuclear Explosion 156

XI. Radiation Impact on Some Critical Systems of the Human Organism and Population Groups 169

XII. Radiation Effects at Population Level 192

XIII. Some Indirect Effects of Nuclear War 207 Conclusion 223 References 225

Introduction

In 1982 we published a book entitled The Danger of Nuclear War: Soviet Physicians' Viewpoint where we wrote: "Albert Einstein said more than two decades ago that we would have to work out completely new criteria of thinking if we wished to survive. And such criteria can only be truth, courage and honesty. In keeping with the Hipppcratic oath, physicians have no right to conceal from their patients the threat to their lives which now looms large in the world." In that book we described possible medical and biological consequences of nuclear war, that we had studied. "The world will be a safer place to live in," we went on to add, "if, after realizing the catastrophic consequences of nuclear war, all people on our beautiful planet, regardless of their age, nationality or occupation, will rise and fight against the nuclear threat.''

Two years have elapsed since that time.

Has the world become a safer place to live in? No, it has not. The buildup of huge arsenals of weapons goes on and new wars break out one after another. New systems of ever more lethal arms are being developed. New made-in-USA nuclear-missile arms are being deployed on Europe's soil which has suffered so much; they are targeted at the vitally important centres of the USSR and of other socialist countries. The spectre of a "first nuclear strike" is hanging over the European continent, bringing closer the mind-boggling prospect of an all-out nuclear catastrophe.

Still, the past two years have given us some hope. People are becoming increasingly aware of the nuclear danger and are steadily stepping up their efforts to avert it.

It was only three years ago that three American and three Soviet physicians proposed the launching of the movement International Physicians for the Prevention of Nuclear War (IPPNW).

Today this movement includes scores of thousands of physicians from nearly 50 countries of the world. They are people of different nationalities and of different religious and political beliefs who have taken a realistic view of the threat to life on Earth brought on by the existence of nuclear arms. The ideas of the movement and its noble mission enjoy the support of an evergrowing number of physicians, medical workers, medical students and nurses. In the Soviet Union alone people have signed the appeal of the physicians of the world, urging the cessation of the nuclear arms race.

Our movement is gaining momentum. Three IPPNW congresses have already been held. Numerous widely attended national conferences are staged within the framework of the movement. Its voice is heeded not only by millions of common people, but by political parties and governments as well. Yet the danger persists.

Never before so many people have been so much aware of the madness of war. Still, while we---medical researchers and physicians, as well as experts in other fields of knowledge---have demonstrated on the basis of available scientifically proven data that nuclear war would result in an unprecedented calamity for all of humankind, and that medicine itself would become victim of a nuclear conflict, there are some politicians who totally dismiss these forecasts. Just look how energetic and purposeful they are in their efforts to extenuate nuclear war and to dispel people's concern over the inevitable consequences of nuclear catastrophe. They assert that "there are no sufficient grounds" for pessimism, claiming that the fact that nuclear war would mean the end of civilization "has not been proved yet". Their cynical allusions to the experience of Hiroshima and Nagasaki which "have risen from the ashes" sound blasphemous.

Therefore, we are taking up the pen once again. Relying on the experience and knowledge accumulated by us, and on publications and studies of our colleagues in the movement, we feel that our prime duty is that of giving continuous warning to the world about the impending catastrophe. Over the past two years we have become even more convinced that by studying possible consequences of nuclear war and by apprizing the peoples and the governments of various countries of the data thus obtained we can make yet another contribution to preventing nuclear war.

Humankind is preparing to enter the 21st century, a century on which people are pinning many hopes and which everyone perceives in a different way. The majority believe that a wonderful epoch will be ushered in, with human intellect and the progress of science and technology making us true masters of nature, capable of changing not only the environment but ourselves as well. Every passing day brings humankind deeper

self-cognition and greater creative ability. At the dawn of each new day millions of people look forward to happiness, joyful life and bright future.

Day-to-day concerns and personal problems make people forget that thousands of missiles and nuclear warheads pose a very serious threat to their future well-being and happiness, and to life itself.

According to UN estimates, currently there are 50 thousand nuclear warheads on Earth, the explosive yield of which is equivalent to more than one million bombs of the type that was dropped on Hiroshima in 1945.

Humankind has created and is keeping in the arsenals a force that can annihilate its makers. It would be in place to recall here the words of the great French scholar Frederic Joliot-Curie who warned that people must not be allowed to channel toward their own destruction the forces of nature which they had succeeded in discovering and taming.

In the world of today there is no room for people who, while not killing anyone themselves, are indifferent to the fact that others continue to be killed on our planet. That indifference is used by certain quarters in the West in a bid to make people accept the idea of the inevitability of nuclear war and the possibility of conducting a ``limited'' nuclear war, and to prove that nuclear war is a conventional war and is therefore winnable. We must actively denounce the currently spread illusions about the possibility of preserving the political and economic foundations in a country involved in a nuclear conflict, illusions that most of the population would survive. Finally, we must work to dispel the illusion that the stockpiling of nuclear weapons is the most effective means of preventing nuclear war, and that the nuclear arms race is thus justified.

That is why one of the major prerequisites for the preservation of peace and the prevention of nuclear war is well-argued information based on scientific data and on the assessment of the possible consequences of such a war. Governments and peoples should have a realistic conception of what a nuclear conflict could bring to humankind.

True to the Hippocratic oath, physicians have no right to conceal from their patients the threat that is hanging over their lives. Physicians see more suffering and tears than anyone else. It is humaneness and mercy that guide us in our daily life and work. How then can we forget about them when faced with the prospect of the annihilation of hundreds of millions of people, and of grief and suffering of all of humankind?

Physicians are honoured and proud to have stated loud and clear, on the basis of scientific data available to them, that should nuclear war break out humankind would find itself in mortal

danger, while the continuation of life on Earth would hang in the balance.

The remark, made several centuries ago by Erasmus, the great Dutch humanist, that only a few whose well-being depends on the people's grief make wars, today is as timely as ever, for the absolute majority of humankind desires peace and peace alone.

The aim of medicine today is to prevent diseases. Nuclear war, that final epidemic on Earth, can be prevented only by appealing to human reason and by activating the self-- preservation instinct inherent in man

The three previously held IPPNW congresses made it possible to denounce nuclear arms---that greatest evil on Earth---and to reveal the threat they pose to the future of humankind.

The English poet John Donne wrote nearly four centuries ago:

``Any mans death diminishes me, because I am involved in Mankinde;

And therefore never send to know for whom the bell tolls;

It tolls for thee.''

We physicians are involved in mankind, and all of us together must not allow the bell to toll for a single inhabitant of our planet or a single nation who could become victim of the use of nuclear arms.

We hope that the material in this book, obtained as a result of scientific research, will help the reader to see the real threat that the nuclear arms race and the presence of nuclear arsenals on our beautiful Earth pose today to every inhabitant of the planet. We shall consider our mission as accomplished if new voices are added to millions of those advocating that nuclear arms be banned. There is no time to lose. There is an overstocking of explosives in the world, and the political situation is highly complicated. There is no room on Earth for nuclear arms, and the sooner they are eliminated, the more securely people will be protected from the danger that the imperialist circles have created for humankind. Each and everyone of us must remember the words carved in the stone of the memorial cenotaph in Hiroshima Peace Memorial Park:

``Rest in peace, for the mistake shall not be repeated.''

I

Our Duty Is to Work for the Prevention of Nuclear War, for the Health and Happiness of Man

Today humankind must decide whether the road it will follow in the next few years will be that of creation or destruction. Will it be a road of peaceful coexistence, of a sensible dialogue between countries with different political systems, and of scientific and technological progress ensuring the well-being of peoples, or that of an unrestrained nuclear arms race fraught with the risk of nuclear conflict and the destruction of life on Earth? Will there be nuclear war, or will there be peace---that is what preoccupies the minds of millions of people on our planet.

We know well what war means. The inhabitants of Europe retain terrifying memories of World War II which left in its wake 50 million people dead, entire towns and villages in ruins and personal tragedies for millions of families. In our country which lost 20 million people there is hardly a family unaffected by the grievous experience of war.

According to one of Switzerland's statistical data centres, out of 5,000 years of human history only 292 years were without wars, while 15,513 big and small wars took the toll of nearly 4,000 million lives. Yet, what would happen to our planet should nuclear catastrophe occur defies any comparison with the experience of the entire history of humankind. To get an idea of what could happen today as a result of a deliberate or accidental outbreak of nuclear war it is

to be recalled that the explosive yield of a large thermonuclear weapon exceeds the total yield of all the explosions detonated during all the wars that humankind has ever waged. It has been estimated that an all-out nuclear war, which is what it will be in the event of a nuclear conflict, would take 2,500 million lives.

Today humankind is already paying an excessively high price for the madness of the nuclear arms race. Nearly 800,000 million dollars, a fantastic amount, are being spent annually in the world on the arms race, while at the same time 40 thousand children in developing countries die every year of hunger and diseases, 500 million people receive inadequate nutrition, 800 million are illiterate and 1,500 million have limited, if any, access to medical services.

The diversion of funds from meeting human needs slows down economic development and increases by the millions the number of people deprived of the basic essentials of life. Whereas $4 per minute are allocated for research to combat miocardial infarction that kills 4 persons every minute, the respective figure of what goes into production of lethal arms is $1 million, or 250 thousand times as high. Ensuring a safe drinking water supply for all the inhabitants of Earth would cost only $30,000 million, and effective malaria control---$500 million, if we assume that the present average annual growth rate of military expenditure will be maintained, then by the year 2000 annual world military spending will reach the figure of one million million dollars at current prices!

It is apparently impossible to establish what contribution could be made to peaceful construction on our planet at the expense of military spending. Still, it is clear that the astronomical sum of 7.5 million million dollars spent after the end of World War II on arms is nothing but payment for wasted effort.

Yet, the arms race as such does not merely involve diversion of funds. Something more frightening is inherent in it--- the threat of the annihilation of civilization on Earth.

Despite the attempts to check and contain the arms race, and the current international negotiations notwithstanding, recent years have not witnessed any lessening of tension. On the contrary, humankind has come closer to an abyss called "nuclear war". The destructive potential of the accumulated nuclear arms is approaching a critical point and continues to rise. In terms of TNT equivalent there are currently over 3 tons of nuclear explosives for every inhabitant on Earth.

The greatest illusion harboured by certain statesmen in the West stems from a profoundly erroneous assumption that nuclear war is but a conventional war with broader implications. Yet, nuclear war is not just one of the alternatives

facing humankind, or a game to be played according to established rules and agreed regulations. Because of the physical properties of nuclear arms and their aftereffects, nuclear war would be the greatest catastrophe in the history of humankind.

The history of our planet knows quite a number of ecological cataclysms, such as the emergence of mountain ridges, the drying out of seas and the movement of continents, and ice ages which led to the extinction of entire species of animals and the destruction of large ecosystems. And still, none of the ecological cataclysms of the past could be compared with the annihilation of civilization as a result of nuclear war.

The taming of nuclear energy represented a scientific breakthrough which opened up before humankind unprecedented prospects for the solution of energy, medical and other scientific and technological problems. At the same time, nuclear energy---that two-faced Janus of today---is the basic element of monstrous weapons of mass destruction. Long before the problem of the practical use of nuclear energy was resolved, prominent scholars had stressed the need for a sober approach to all aspects of research into uranium and its derivatives and into nuclear physics.

Back in the 1920s Academician Vladimir Vernadsky, an outstanding Soviet scientist, had this to say as a warning: "We are approaching a great turning point in the life of humankind, with which nothing it has gone through before can be compared. The time is not far off when man will obtain atomic energy---a source of power which will enable him to build his life the way he likes... Will man be able to use this power for good ends and not for self-destruction?''

In the West, the development of the atomic bomb created the illusions about maintaining "the atomic monopoly" and about the alleged ``right'' to decide with impunity and arbitrarily the destinies of other peoples and of humankind. But even back at that time honest scientists who realized the threat that nuclear arms posed for the future of humankind had sounded the alarm.

One year prior to the tragedy of Hiroshima and Nagasaki Niels Bohr, one of the founders of nuclear physics and a Nobel Prize winner, said that weapons of unprecedented power were being created which would change totally the nature of warfare. He warned that unless an agreement to control the use of radioactive materials was promptly concluded, any temporary advantage, however great, could be offset by the opposite side.

Further warning to humankind about the danger that the nuclear arms race posed to the existence of life on Earth was contained in the declaration of the Pugwash movement launched by Albert Einstein, Bertrand Russell and Frederic Joliot-Curie. Joliot-Curie wrote: "I was tempted to go on

exclusively with my laboratory work. But then I asked myself, 'And who will use the discovery that I have made?' It was then that I realized that to be able to continue my research work with a clear conscience I must join the ranks of those who want scientific achievements to be used for peaceful purposes and not to serve selfish ends of rapacious warmongers... Only when lasting peace has been established, we scientists shall be able to recover peace of mind and to spend whole days in our laboratories. It is then that we shall become bearers of news that will make humankind very happy!''

Out of all types of arms developed up to now, nuclear arms pose the greatest danger to the biosphere. The damage inflicted to the environment by their massive use would be so great as to make impossible its natural restoration.

Today we have in our possession a sufficient amount of facts and substantiated hypotheses to be able to imagine the dimensions of such a man-made tragedy. Nuclear war would be an unprecedented ecological catastrophe, most likely, the last calamity in the h istory of our planet. One of the WH A resolutions states that a thermonuclear conflict in any form and on any scale would inevitably lead to an irreversible devastation of the environment.

Should human civilization perish, and on the face of the clock of our planet's history it occupies a space marked by only a few minutes, the Earth will continue its existence as a celestial body for thousands of millions of years to come. It will continue to rotate and to orbit the sun without the oxygenous atmosphere, vegetation or human beings.

Life cannot be sustained without a strikingly favourable combination of natural factors which accidentally happened to take shape on this small planet where we have been destined to be born. Life exists on Earth under quite restricted physical conditions (climate, temperature, atmospheric oxygen, etc.). If abrupt changes are introduced into any of those elements, a chain reaction may ensue, which would lead to a radical modification of the environment, making it uninhabitable.

We have not yet mastered all the laws of nature, therefore it is impossible to predict all the consequences of nuclear war. It is clear, however, that an all-out nuclear war would lead to an instant death of hundreds of millions of people. The infrastructure of the world civilization would be disrupted, thus making questionable the lot of those who may survive the first attack. Medicine would be helpless to come to the aid of the survivors--- physicians know this better than anyone else. Future generations would receive as their legacy a destroyed biosphere and a planet scorched by radioactive radiation. Delayed nuclear blast effects will continue to plague every coming generation.

The fatal consequences that would be brought on by nuclear war are not part of fantastic conjectures. Not a single state or nation would be able to escape the conflagration. That is the unanimous view shared by leading scientists, and competent military and civilian experts. Historical experience also shows that in the current circumstances even states located far from the seat of conflict can be drawn into war. The first and the second world wars, having begun in Europe, dragged countries from other continents into the slaughter. It is naive to think that should another war, this time a nuclear war, break out, one would be able to sit it out in the mountains or in the jungle.

Unfortunately, however, that is not a universally shared view. US leaders expansively talk about the possibility of surviving in an atomic war provided they have nuclear superiority, of making it ``limited'' or ``protracted'', and of ``controlling'' and ``winning'' it. They want to make people accept the notion that nuclear war is inevitable and even justified.

Nuclear war scenarios are being written. Yet, any such scenario would be incomplete, as humankind has only a limited experience of Hiroshima and Nagasaki to be guided by. Massive use of nuclear arms, thousands of times more powerful than the first atomic bombs, could lead to consequences which we are still unable to predict. Nuclear war would go beyond anything written in a scenario simply because there is no guarantee that the adversary would act according to it. In the circumstances of an all-out catastrophe some of the state leaders cannot be expected to act rationally, "according to the established rules''.

There can be no winners in a nuclear war. Illusions about winning such a war are dispelled by scientific estimates of the possible number of short-term and long -term casualties. Armed with professional knowledge of medical consequences of a nuclear conflict, physicians state that all of humankind would be made its victim.

Furthermore, nuclear arms do not ensure security. UN experts who in 1980 conducted a study of all aspects of nuclear arms, came to a paradoxical conclusion: it is the nuclearweapon states that would sustain the greatest losses as a result of nuclear war.

The easy-going way with which some politicians and military men in the West manipulate the threat posed by the atomic bomb, using it as a means of attaining their own political objectives, is as frightening as the destructive potential of nuclear arms. They are attempting to develop ever new and ever more sophisticated weapons of mass destruction and to extend the arms race to the outer space. NATO top brass tend to measure distances between states and nations in kilo and megatons of nuclear explosives, rather than in kilometres or miles.

The United States and the NATO bloc, having started the arms race, continue to maintain a steady lead. It was back in 1978 that the United States began to increase military expenditures; under the Reagan Administration military spending was boosted still further so that the annual growth rate is seven per cent in real terms. Consequently, the country's military budget requested for 1985 will total a record sum in excess of 300,000 million dollars.

In the postwar years US leaders began to lay particular emphasis on obtaining military superiority. This, in their view, can be accomplished with the help of technological ``breakthroughs'' in weapons' development, and a qualitative arms race. Anyone familiar with the h istory of the postwar period will recall that the arms race accelerated according to the ``action-counteraction'' principle---each time there was a challenge from the West the Soviet Union had to match it. That is what happened throughout the entire period from the explosion of the first atomic bomb in 1945 to the present time. This was the case with strategic bombers, nuclear-powered submarines, multiple independently targeted re-entry vehicles (MIRVs), and cruise missiles. The US has been introducing each new arms system several years ahead of the Soviet Union. The old tactics of playing up the "Soviet military threat" myth and US "lag "was used over and over aga in to justify the development of new types of arms. McGeorge Bundy, national security assistant to presidents Kennedy and Johnson, admitted that the White House sometimes did take far-reaching decisions, claiming the US lagged behind the Soviet Union in some areas; that was the case of the hydrogen bomb in 1952, of the "missile gap" in 1960 and of the ``bombers' gap" in 1976, although actually no lag ever existed. Usually, assertions of this kind were made whenever a request for defence budgetary appropriations was submitted.

Nuclear arms development and manufacture programmes currently underway in the US, including those based on the use of the latest scientific achievements, are intended to increase manifold the destructive potential of US military arsenals, including the one in Europe. Yet, has an arms buildup policy aiming at military superiority ever guaranteed international stability? No, it has not.

A military policy based on similar assumptions is profoundly erroneous. The development and deployment of ever new systems of nuclear arms and of other weapons of mass destruction erode the stability of the military and strategic situation, increase international tensions and sour relations between states. The implementation of arms buildup programmes will lead to higher levels of military confrontation. Peace will become less stable and more fragile. In addition, with every new round of the arms race nuclear arms become more sophisticated.

Consequently, the drafting of international agreements on their limitation and reduction becomes much more difficult.

There is still another important aspect. The stability and international trust are being eroded by the dangerous strategic concepts and doctrines of "a first disarming nuclear blow", "limited nuclear war", "protracted nuclear conflict", and others. All those aggressive, peace-threatening doctrines are based on the assumption that a first use of nuclear arms would supposedly lead to victory in a nuclear war.

Yet, more andmore people are coming to the conclusion that all states, particularly the nuclear powers, should display political will and willingness to negotiate. Their military policy should pursue exclusively defensive objectives and should take into account the legitimate security interests of all states. That is the thrust of the Soviet military doctrine which rules out preemptive wars and the concept of "a first nuclear strike''.

Given the current complicated international situation, what is required in the first place is that there be some progress in limiting and reducing arms and armed forces. Therefore, it is essential to work with determination and perseverence for reaching accords that would ensure the reduction and elimination of arms, especially nuclear arms.

In recent years some results have been achieved in that area---certain channels of the arms race have been blocked and a number of international agreements have been concluded; they play an important restraining role. In their absence the arms race would have overrun all conceivable barriers; without those agreements drafted with the active participation and, for the most part, on the initiative of the Soviet Union, the difficulties facing the limitation of arms, including nuclear arms that are the most dangerous, would be much more serious than they are today.

Of late there was a sharp increase in the number of initiatives on specific disarmament aspects, advanced by various nations and mostly by the socialist countries (more than 100 were launched by the Soviet Union).

The 1960s and 1970s saw the conclusion of treaties banning nuclear weapon tests in the atmosphere, in outer space and under water, on the limitation of underground nuclear weapon tests, on the prohibition of bacteriological weapons, the USSRUSA Treaty on the Limitation of Anti-Ballistic Missile Systems, and others.

Many of those agreements led to the reduction of nuclear arms, in other words, they objectively contributed to easing the danger of nuclear war. The same purpose is served by such preventive measures as the strengthening of the nuclear-- nonproliferation regime, since the spread of nuclear weapons all over the world heightens the danger of nuclear catastrophe.

The non-proliferation regime is based on the nuclear nonproliferation treaty concluded in 1968. Under the treaty the nuclear-weapon states pledged not to transfer nuclear weapons to non-nuclear countries, whereas the latter pledged in turn not to acquire such weapons or to produce them. Some 120 states, including nuclear powers (except France and China), are parties to the treaty. The non-proliferation regime must be strengthened in every possible way, primarily, through adherence to it by states which have material and technical facilities for manufacturing nuclear weapons of their own. South Africa, Israel and other countries are not yet parties to the treaty. The stubborn refusal of these countries to accede to the treaty and to accept the International Atomic Energy Agency safeguards to cover all their nuclear activities has been causing concern among the international community.

Cessation of nuclear-weapon tests is one of the effective measures to curb the nuclear arms race. Tests make it possible to improve nuclear arms and to develop their new varieties. It may be recalled that the 1963 Moscow Treaty banned nuclearweapon tests in three environments---in the atmosphere, in outer space and under water. What is essential now is that underground tests be banned too, and that the ban be adhered to by all the nuclear powers. In recent years talks were conducted between the USSR, the USA and Great Britain with a view to drafting a treaty on the prohibition of nuclear-weapon tests in all the environments, and a protocol to it dealing with peaceful nuclear explosions. The participants in the talks succeeded in resolving some of the issues that had long been standing in the way of an accord, with the Soviet Union making important steps to meet its negotiating partners halfway.

However, starting from the early 1980s the US and Great Britain began to stall the talks. The true reason for that was not unwillingness by the USSR to accept the proposals on verification made by the West (as it is being asserted sometimes), but the lack of political will and willing ness on the part of the United States to conclude an agreement. The United States makes no secret of the fact that the cessation of tests would disrupt implementation of its nuclear programmes.

The start of the production of neutron weapons in the United States manifested anew the danger inherent in the continuation of the process of improving nuclear arms. The introduction of these weapons into the arsenals will lead to the lowering of the so-called nuclear threshold, that is, to a greater risk of an outbreak of nuclear war.

The list of Soviet initiatives designed to limit the arms race looks quite impressive. Here are a few examples.

In 1946 the Soviet Union submitted to the United Nations a draft international convention on banning the use, production,

and stockpiling of atomic weapons and on the destruction of their stockpiles within three months. In 1950 the Soviet delegation tabled a draft declaration on averting the threat of another war and on strengthening peace and the security of peoples and proposed that an unconditional ban on nuclear weapons under strict international control be declared. In 1960 the USSR submitted to the United Nations the basic principles of a treaty on general and complete disarmament, which called for the banning and destruction of all the stockpiles, and for the cessation of production of all types of arms, including atomic, hydrogen, chemical, biological and other types of weapons of mass destruction. Proposals on ending nuclear-weapon production and on transition to the destruction of all nuclearweapon stockpiles remain valid; to this end the USSR is prepared to participate in the drafting of a stage-by-stage nuclear disarmament programme. Among the proposals that are important for the preservation of peace on Earth are those to conclude a treaty on general and complete prohibition of nuclear-weapon tests, and to draft an international convention banning the development and production of new types and systems of weapons of mass destruction. We should also recall the proposal on the strengthening of security guarantees of nonnuclear states (the USSR has repeatedly pledged not to use nuclear arms against those countries which renounce their production or acquisition and do not have them on their territory). The Soviet Union supports the idea of creating nuclear-free zones, specifically in Europe where the level of military confrontation is dangerously high. It is prepared to participate in the talks on creating in Central Europe a zone free from battlefield nuclear arms, as proposed by Sweden.

The proposals of the USSR and of other socialist countries can hardly be objectionable. What sober-minded politician can deny the need for concluding a treaty on reciprocal renunciation of the use of military force and the maintenance of the relations of peace between the Warsaw Treaty and NATO member states?

Who would oppose the idea of working out measures to ensure safe nuclear energy development and to prevent peaceful nuclear installations from being attacked by any means?

Who could be against the proposal to conclude a treaty on the prohibition of the use of force in outer space and from outer space against the Earth, submitted to the United Nations for its consideration?

The implementation of that latest initiative would meet the pressing objective of ensuring exclusively peaceful uses of outer space, in the interests and for the benefit of all people.

Specifically, the initiative calls for a total ban on testing and deployment in outer space of any space-based weapons intended for striking targets on Earth, in air and outer space. In

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addition, agreement should be reached on the total renunciation of the development of new anti-satellite systems, as well as on the destruction of the existing ones. The USSR is prepared to engage in separate talks on anti-satellite systems, including bilateral talks with the United States. On 18 August 1983, in a display of its willingness to ensure a radical solution of the problem of space weapons, the USSR assumed an obligation not to be the first to place in outer space any types of such weapons. That unilateral moratorium announced by our country will remain in effect as long as other states, including the United States, refrain from placing in orbit anti-satellite weapons of any type.

The Soviet Union and the states members of the Warsaw Treaty Organization do notseek military superiority. Yet, they are fully determined not to allow anyone to gain military superiority over them. They have been consistently advocating equality at the lowest possible level.

That approach also underlies the proposals advanced by the USSR at the strategic arms limitation and reduction talks. The Treaty between the Union of Soviet Socialist Republics and the United States of America on the Limitation of Strategic Offensive Arms was signed back in 1979. The SALT-2 Treaty represented the greatest achievement in the history of disarmament negotiations. It was a fair treaty. Yet, the US Administration in fact scuttled it, while at the same time taking the course of building up new strategic arms.

Soviet proposals at the talks call, among other things, for a significant, a more than one-fourth, reduction in the overall number of strategic delivery vehicles, and for a concurrent reduction to agreed levels of the aggregate number of nuclear weapons on those vehicles. These proposals take into account the need for strengthening the overall military and strategic stability and for strict observance of the principle of equality and equal security.

An unbiased observer familiar with US and Soviet proposals at the negotiating table will promptly tell you who is in favour of genuine reductions of strategic nuclear arms and who stands for their unilateral buildup. According to experts' estimates, for instance, the implementation of US proposals, along with its arms modernization programmes, will enable the United States to increase the number of warheads from 12 thousand to 19 thousand.

The situation concerning medium-range nuclear arms in Europe is alarming and dangerous. It was in Europe that late in 1983 NATO began to deploy, in proximity to Soviet frontiers, US Pershing-2s and cruise missiles belonging to the category of "first nuclear strike" weapons. It is not accidental that hundreds of thousands of peaceful citizens in European cities and towns

oppose the deployment in Western Europe of new US nuclear missiles. One can understand their anxiety, for if in the past peace and the destruction of civilization were separated by a 20 to 30 minute strategic missiles flight time from the United States to the USSR, during which period some efforts could still be made to save humankind, now that period can be reduced to 5 to 6 minutes of the missiles flight time from Western Europe to the USSR.

Of course, the USSR will never be the first to use nuclear weapons. However, it cannot neglect its own security or that of its friends and allies. If nuclear arms are used against them, that would produce a chain of irreversible events. Retaliation against the aggressor would be inevitable. According to available estimates, possible losses among the population of Western Europe, resulting from a hypothetical forced retaliatory strike against the launching sites of 572 US missiles deployed there, and from a retaliatory strike at US territory, would be about 33 and 46 million respectively (for more detail see chapter VI).

The Soviet position ensured a mutually acceptable solution. The USSR is not seeking any advantage, even by a single missile, aircraft or nuclear weapon. The implementation of Soviet proposals would lead to a major quantitative reduction of medium-range nuclear arms. The USSR proposed that the two sides---the Soviet Union and the NATO bloc as a whole---should maintain a certain number of medium-range missiles and aircraft at minimal agreed levels. Under that proposal the Soviet Union would have less medium-range missiles and weapons on them than in 1976 when there were no SS-20 missiles.

Another far-reaching Soviet initiative involved the willingness of the USSR to destroy its medium-range missiles, including the SS-20 missiles, subject to reduction in the European part of the country, and to discontinue the deployment of SS-20 missiles in the eastern part of the USSR when the agreement entered into force provided no US missiles were deployed. If the United States had refused to deploy its missiles on schedule as announced by it, thus enabling the talks to go on, the USSR would have destroyed in 1984-1985 200 of its SS-4 missiles. In many respects those proposals facilitated a mutually acceptable accord.

When tabling its proposals the USSR acted on the assumption that there existed an approximate balance in Europe in terms of medium-range delivery systems (missiles and aircraft). At the same time NATO currently enjoys a 1.5 advantage in the number of nuclear warheads of this type.

Marshal Nikolai Ogarkov, Chief of General Staff of the USSR Armed Forces, speaking at a press-conference, held in Moscow on 5 December 1983, said:

``Why then is Washington so stubbornly persisting on

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deploying its missiles in Europe, when it has such an enormous quantity of nuclear weapons? Because it wishes, at all costs, to make its strategic nuclear force capable of launching a so-called `disarming' nuclear strike, i.e., a strike that would deprive the Soviet Union of the capability to deliver a retaliatory nuclear strike against the aggressor.

``Is this goal attainable? The answer is an unequivocal no. Under present-day conditions, with the sides having such large stocks of nuclear weapons and diverse systems of their basing, with widely developed and many times duplicated command systems, this is out of the question. Retaliation will be inevitable in all cases. So only adventurists or people with a suicidal bent can put their stakes on such a strike.''

Yet, since actual deployment of US missiles in Europe is now

underway, the USSR and its allies have of course taken

countermeasures to preserve the balance, both in Europe and

throughout the world. The Soviet Union has given repeated

warnings about those countermeasures. In taking those

measures, however, the USSR, as Yuri Andropov, Chairman of

the Presidium of the USSR Supreme Soviet, stated on 24

November 1983, "does not seek military superiority, and we

shall do only what is absolutely necessary to prevent the military

balance from being disrupted... The Soviet Union is convinced

that peace can be strengthened and the security of peoples

guaranteed not by building up and inventing ever new types of

armaments but, on the contrary, by reducing the existing

armaments to immeasurably lower levels. Mankind has too

many tasks which are not being solved only because colossal

material, intellectual and other resources are being diverted.''

For several years now the idea of a ``freeze'' has been gaining

an ever wider adherence in the world. More and more people,

from workers to politicians, are saying: "What there is, is quite

enough! It's time to stop!''

The Soviet Union is on the side of the world public---it has long been saying that it views with sympathy the idea of a freeze. In the autumn of 1983 the Soviet Union proposed the inclusion in the agenda of the thirty-eighth session of the UN General Assembly of an important and urgent question entitled "Nuclear-Weapon Freeze''.

In making that proposal the Soviet Union acted in the belief that one of the most pressing tasks of today is to put an end to the buildup of nuclear arms and to prevent another spiral of the nuclear arms race which increasingly threatens to engulf the world. The solution of that task would make a major contribution to easing the danger of nuclear war, which looms large over the

peoples.

Given the current deteriorated international situation, a

quantitative and qualitative freeze on nuclear arms, imposed by all the states that have them, would be an exceptionally important step toward curbing the arms race.

The USSR proposed that an end be put, under effective control, to the buildup of all components of nuclear arsenals, including all types of delivery systems and weapons, that deployment of new types of such arms be discontinued, that a moratorium be imposed on all nuclear-weapon tests and on testing new types of their del ivery systems, a nd that man ufacture of fissionable materials for arms development purposes be stopped.

The best means of achieving the objective would be a concurrent quantitative and qualitative freeze on nuclear arms, imposed by all the nuclear powers. At the same time our country is prepared to accept, as a first step, a bilateral freeze to be imposed by the USSR and the United States; this would set an example to be followed by the other nuclear powers.

The implementation of this initiative would significantly enhance confidence among the nuclear-weapon states, and would make it possible to effect a decisive turn toward breaking up the vicious circle of the arms race. It would also provide a general impetus to the reduction and, ultimately, to the total elimination of nuclear arms.

The overwhelming majority of UN member states agreed with the Soviet Union's proposal about the freeze. Only the United States and its allies voted against the General Assembly resolution, thus once again manifesting their reluctance to halt the arms race.

The USSR proposal tabled in the autumn of 1983, urging the UN General Assembly to adopt a declaration condemning nuclear war, has been motivated by a sincere desire to save humankind from nuclear war. The proposal emphasized anew that should a nuclear war break out, it would become the greatest tragedy for humankind, lead to the death of thousands of millions of people and turn our planet into a barren desert.

The proposal was adopted. The UN General Assembly, guided by the lofty ideals proclaimed in the UN Charter, strongly, unconditionally and for all times condemned nuclear war as the most heinour crime that could ever be committed against the peoples, anc as a flagrant violation of the basic human right---the right to life. It denounced the elaboration, presentation, dissemination and advertizing of political and military doctrines and concepts designed to justify the `` legitimacy'' of a first use of nuclear arms and, in general, the ``admissibility'' of unleashing nuclear war. The General Assembly called on all states to pool and multiply efforts to remove the threat^of nuclear war, to put an end to the nuclear arms race, and to reduce and ultimately eliminate nuclear arms.

Yet, the world public is concerned over the fact that the United States and its closest allies have voted against the declaration. They have thus confirmed their refusal to assume an unconditional pledge not to start a nuclear war.

Of course, the world public has welcomed the UN declaration condemning nuclear war, because it is in line with people's longing for a world without nuclear arms.

Noel Gayler, a retired US admiral, who was involved in the testing of nuclear arms, said: "The more you know about them, the less you like them, and the more you are convinced that they have no sensible military use... They always boomerang on the user." Gayler has called on the United States to assume the nonfirst-use pledge.

In its declaration on the prevention of nuclear catastrophe adopted back in 1981 the U N General Assembly characterized a first use of nuclear arms, something which the NATO military doctrine calls for, as the gravest crime against humankind.

If the peoples succeeded in persuading the governments of all the nuclear powers to renounce a first use of nuclear arms (and to follow the example set by the USSR in 1982), the danger of nuclear war would recede, the military and political situation in the world would be radically changed, military confrontation would become less critical, and the strategic stability and international trust would be strengthened. The belief that one can obtain some advantage by delivering a first nuclear strike is untenable from the scientific point of view. Only a madman or a totally irresponsible politician can count on that.

The struggle of the peoples against nuclear danger is highly consonant with the policy of the USSR. In his reply to the appeal of the third IPPNW congress, Yuri Andropov pointed out that the programme of priority measures drafted by the congress, to be implemented by the nuclear powers, does not differ essentially from the position of the USSR and stated:

``We believe that today primary consideration must be given in determining policy by the leaders of all states, above all the nuclear powers, to a concentration of the political will to prevent the catastrophe, to ensure the people's right to life, but not to the irresponsible attempts to get people used to the thought that nuclear war is admissible or that one should strive for nuclear superiority.''

Human instinct of self-preservation cannot be suppressed. The struggle against the catastrophe of nuclear war is a struggle for the protection of such basic human rights as the right to life and health.

Nuclear war places before humankind a palpable alternative---either life or death. All the world problems pale in comparison with that crucial global problem of the 20th century. What is involved is not even the historical contradiction between

capitalism and socialism. The question is whether human civilization can survive.

Mountains of stockpiled arms have never been a reliable guarantee of the security of peoples. Soon it may be too late. Military and nuclear technology is rapidly progressing. Soon it may become impossible to conclude arms agreements based on mutual verification. Sometimes scientific thought cannot keep pace with fast breaking events---12 years prior to the explosion of the first atomic device Ernest Rutherford had predicted that it would be impossible to generate energy through the transformation of the atom. The manufacture of atomic and thermonuclear weapons was the direct result of the discoveries made in the field of physics not long before the beginning of World War II, yet no one could foresee that it would end up with the atomic destruction of Hiroshima and Nagasaki.

That experience should never be repeated.

The future undoubtedly belongs to those who are prepared to fight to the end against the danger of nuclear war and for the cessation of the nuclear arms race; it belongs to those who will be able to say with a clear conscience: "Farewell to arms!''

The Movement of Physicians for the Prevention of Nuclear War

for improving nuclear arms, thus constituting a step toward the general and complete prohibition of nuclear-weapon tests.

In recent years the threat of an outbreak of nuclear war has sharply increased. Non-ratification of the SALT-2 Treaty, approval of large-scale programmes to develop most advanced types of strategic nuclear arms, deployment of first-strike nuclear arms on the territory of Western Europe, and refusal to assume an obligation on the non-first-use of nuclear arms---all of these moves by the US Administration not only aggravated the political situation but also caused profound concern among broad segments of the population in many countries throughout the world. Particular concern was felt by those groups of professionals who were most intimately acquainted with possible consequences of nuclear war and who could not remain indifferent as long as certain members of the military, politicians and even scientists attempted to play down the possible consequences of nuclear war.

Those who know what nuclear weapons really are would have none of the illusions about the possibility of winning a nuclear war or making it ``limited''.

Hiroshima and Nagasaki represent a reality which shows that science and technological progress have produced forces capable of totally eliminating life on our planet. It is only too natural, therefore, that medical researchers and physicians have stood up for the defence of human life and health. It is their view that nuclear arms pose today the greatest danger to people's life and health. On hearing the words "human life is in danger", all physicians are duty-bound to do everything in their power to save it.

In the autumn of 1979 one of us received a letter from Professor Bernard Lown, a leading US cardiologist from Boston (Massachusetts). It was full of concern for the future of humankind and it contained an appeal to physicians the world over to join forces in combatting the nuclear menace. We would I ike to cite excerpts from that letter which marked the beginning of a dialogue between US and Soviet physicians, subsequently leading to the creation of the movement International Physicians for the Prevention of Nuclear War. Professor Lown had this to say:

``Over the past few years, I have been increasingly troubled by the growing thermonuclear armaments race. The year 1978 marked an unhappy milestone for mankind, largely ignored. For the first time, the nations of the world have reached a level of military spending in excess of $ 1,000,000,000 (one billion) per day. These expenditures defy elementary logic, common sense and the most essential morality. There is every likelihood that thermonuclear weapons will be used before the turn of the

Those who were at the origin of research into the atomic energy and held a realistic view of what the atomic bomb was all about were the first to perceive the need for active effort in explaining to the world the threat that nuclear arms posed to the destinies of humankind.

More than 25 years ago, on the initiative of Albert Einstein, Bertrand Russell, Frederic Johot-Curie and others, the Pugwash Movement of scientists was founded for the purpose of assessing the danger that the emergence of weapons of mass destruction had created for humankind. It was basically a physicists' movement, although outstanding scientists in other fields---the physiologist T. Muller the chemist Linus Pauling and others---also joined in. The declaration of the Pugwash Movement was the first warning issued by scientists about the consequences that nuclear war could bring to humankind. The results of the Pugwash conferences, and the publication of scientific reports dealing with nuclear war and the impact of nuclear explosions on the overall radiation level on Earth greatly contributed to the adoption of the 1963 Moscow Treaty Banning Nuclear-Weapon Tests in the Atmosphere, in Outer Space and Under Water. That treaty not only prevented the radiation level on Earth from going higher, but, to a certain extent, narrowed down the possibilities 24

century. Both of our societies will not survive such a thermonuclear holocaust.

``The medical profession, alas, so far has remained silent. Does our profession have no social responsibility except when the casualties start pouring in? I believe the physician has a unique capacity to influence society---silence denotes moral bankruptcy.

``I believe that a conference of Soviet, Japanese and USA physicians organized to discuss the medical consequences of thermonuclear arms race will help rouse world public opinion.''

In the spring of 1980, Cambridge (Massachusetts) played host to a representative conference of US medical researchers and physicians, devoted to the study of the consequences of nuclear war. On behalf of 654 prominent US medical researchers and physicians the conference issued an open statement entitled "Danger---Nuclear War", which was addressed to the leaders of the United States and the USSR. The funds collected during the conference payed for placing that statement as a classified advertisement in The New York Times. It said that those attending the conference were renewing a warning, based on medical and scientific analyses, that nuclear war, even a ``limited'' one, would result in death, injury and disease on a scale that has no precedent in the history of human existence. Incidentally, that explains why the first book about the consequences of nuclear war ever published in the United States was entitled by our US colleagues The Final Epidemy.

In his reply to the sponsors of that statement Chairman of the Presidium of the USSR Supreme Soviet Leonid Brezhnev expressed his confidence that US physicians would be able to make a significant contribution to explaining the disastrous consequences that a nuclear conflict between the United States and the USSR could have for humankind. This explanation would strengthen the will and the hand of those who stand for the cessation of the arms race and for normal relations among all countries, including, of course, between the United States and the USSR. The reply emphasized that the humane and noble work of US medical scientists to avert nuclear war would be received with understanding and support in the Soviet Union.

Leading Soviet medical scientists were also prompt to respond to the appeal of their US colleagues. The reply signed by many academicians and corresponding members of the USSR Academy of Medical Sciences, and by heads of all professional medical societies said, in part: "The catastrophic dimensions and terrifying consequences of a conflict that may involve the use of the latest arms would in no way compare even with what has befallen people during wars in the 20th

century. We physicians, people of the most peaceful and humane of professions, unfortunately have had more occasions than many of our contemporaries to see the sufferings brought on by wars. We are aware more than anyone else of what nuclear war could entail.''

The 1980 Boston conference attended by some 1,000 physicians and medical researchers of most varied medical specialities and religious and political beliefs, and the statement issued by that conference render senseless and ridiculous the irresponsible conjectures of some politicians and hack reporters to the effect that the International Physicians for the Prevention of Nuclear War movement is being stage-managed by Moscow.

Soviet physicians supported the appeal of their US colleagues to physicians the world over to join forces in the fight against the nuclear menace, and in explaining to governments and peoples of the world the true consequences of nuclear war. To this end a meeting of Soviet and American medical scientists was held in Geneva late in 1980. It was attended by Professors Yevgeni Chazov, Leonid llyin, and Mikhail Kuzin of the USSR and by Professor Bernard Lown, Dr. James Muller, and Dr. Eric Chivian of the United States. In the course of the two days of discussions the participants who represented not only two different countries but also different political and religious convictions were unanimous in that a broad-based and representative international movement of physicians for the prevention of nuclear war should be set up. Despite differences between them, they came to the conclusion that, given the current situation in the world, physicians cannot and have no right to remain silent and indifferent when what is involved is the preservation of life and health of hundreds of millions of people.

The sponsors of the moveme'nt continue to believe that for all of over three million physicians working on our planet the fight against nuclear war is not only their responsibility, shared by all honest-minded and humane people, but also their professional duty.

Since medicine proclaims today disease prevention to be the mainstay of medical work, each of us should give some thought to the prevention of the most horrible disease, of the final epidemic that may befall humankind---that of nuclear war. That idea about the responsibility of physicians for the future of humankind had provided the foundation that brought together the participants in the first congress of International Physicians for the Prevention of Nuclear War, held in the United States from 20 to 25 March, 1981.

For the first time ever in the history of medicine researchers and physicians from 11 countries came to Airlie, a small place

the World Health Organization, for drafting resolutions dealing with the effects of nuclear war.

The memorandum adopted by the congress contained for the first time specific data involving various medical consequences of the explosion of a 1 Mt atomic bomb over a city with the population of 1 million people. The estimates produced a horrifying picture, appearing all the more tragic not only on account of the number of those who would die instantly---300 thousand people, and the overall number of casualties---400 thousand, but also because of the conclusion that medicine would be unable to give any effective aid to hundreds, thousands and millions of the wounded, burned and irradiated. Without med ical assistance the survivors would envy the dead--- that was the conclusion that produced a particular strong impression among broad public. As an expression of their anxiety and concern, the participants in the congress, people of different nationalities, religious beliefs and political convictions, unanimously adopted an appeal to the leaders of the United States and the USSR, which ran as follows:

``Nuclear war would be a catastrophe with medical consequences of enormous magnitude and duration for both involved and uninvolved nations.

``The holocaust would in its very beginning kill tens to hundreds of millions of people. Most of the immediate survivors, suffering from wounds and burns, affected by nuclear radiation, deprived of effective medical care or even water and food, would face the prospect of a slow and excruciating death.

``The consequences of nuclear war would continue to affect succeeding generations and their environment for an indefinite period of time.

``Science and technology have placed the most deadly weapons of mass destruction in the hands of the two nations you lead. This huge accumulation imperils us all. The interests of the present and all future generations require that nuclear war be avoided.

``The medical consequences persuade us that the use of nuclear weapons in any form or on any scale must be prevented. To this end we are offering you our sincere support.''

No objective is more vital than to preserve the conditions that make possible the continuation of civilized life on Earth---said an appeal addressed by the congress participants to the heads of all governments and to the United Nations, urging them to give the highest priority to the removal of the threat of nuclear war.

The participants realized full well that success of International Physicians for the Prevention of Nuclear War would be possible only if the overwhelming majority of the representatives of our profession came to perceive their special

The first congress of International Physicians for the Prevention of Nuclear War, held in Airlie (Virginia) in March 1981

near Washington, to discuss on the basis of objective scientific data the possible consequences of nuclear war, and to bring them to the knowledge of governments and of broad public. The congress was held against the background of an uneasy political situation. Some official US circles were busy propagating the notions about "certain things being more important than peace", and "the possibility of winning a nuclear war" and of "conducting a limited nuclear war". Clearly, those circles were averse to having the congress adopt a report that would contain unambiguous scientific data on what could happen to humankind in a nuclear conflict, and would reflect the attitude of the medical community at large toward the nuclear arms race and the threat of an outbreak of nuclear war.

Opposed to huge military spending, the participants in the congress noted that enormous funds went into the technology and preparation of nuclear war at a time when millions of people continued to suffer from hunger and various diseases, while spending on medicine constituted a tiny proportion of appropriations for the preparation of a nuclear war.

It is a matter of profound satisfaction that the congress not only produced the first ever summary of the medical consequences of nuclear war, but that it also adopted some documents that were subsequently used by the world public, unofficial international organizations, like the Independent Commission on Disarmament and Security headed by Olaf Palme, and such official world bodies as the United Nations and

role in preventing nuclear war and began actively to work against nuclear arms, explaining to their patients the threat that nuclear arms posed to their health and life. It is with this in mind that they sent an appeal to the physicians of the world, which said:

``Our professional responsibility has brought us together to consider the consequences of the use of nuclear weapons.

``We have participated in full and open discussion of the available data concerning the medical effects of nuclear war and its effects on our planet. Our conclusion was inescapable---a nuclear exchange would have intolerable consequences.

``...No one should be indifferent to the nuclear threat. It hangs over hundreds of millions of people. As physicians who realize what is at stake, we must practise the ultimate in preventive medicine---avoidance of the greatest hazard the world will ever know. Your help is needed in this great endeavour. We urge you:

``1. to inform yourselves, your colleagues, and the general public about the medical effects of nuclear war;

``2. to discuss the medical consequences of nuclear war at meetings of members of medical societies, special symposia, and conferences;

``3. to prepare and publish in the medical press and specialized journals articles about medical consequences of the use of nuclear weapons;

``4. to speak about medical consequences of nuclear war to medical students and to your community;

``5. to use your influence and knowledge to help strengthen the movement of physicians for the prevention of nuclear war." The first I PPNW congress held in the United States was not a ``requiem'' for life on Earth. The words of the memorandum to the effect that wars begin in the mind, but the mind is also capable of preventing war, expressed the belief in the triumph of life on Earth.

As physicians we are proud to note the lofty moral and h uman q ualities of our colleagues throughout the world, and the fact that the papers and reports the congress discussed have been widely acclaimed by physicians from different countries and continents. True to their professional duty, they have been organizing national conferences and meetings to discuss the possible medical consequences of nuclear war, and adopt resolutions and appeals urging cessation of the nuclear arms race and prohibition of nuclear arms, and have been taking steps to help physicians of many countries officially join the new international movement.

In May of 1981 Professor Bernard Lown wrote to one of us:

``We are continuing to gain much public attention. The

physicians movement in the USA is growing rapidly. At a

symposium in Seattle this past month over 1,200 attended and nearly as many had to be turned away. Further, such symposia are to take place in Chicago, Los Angeles, and Cleveland. We are also working on the development of a medical curriculum that will bring the subject of nuclear war to students of medicine. We are also contributing to the organization of other professional groups against nuclear war and already there are such movements among lawyers and nurses.''

In 1981 conferences were held in the United States, Great Britain, Canada, Japan, the FRG and other countries. A conference of West German physicians, held in Hamburg in the autumn of 1981 and attended by over 4,000 people, not only adopted a resolution on banning nuclear arms, but also demanded that deployment in Europe of new US medium-range missiles should not be allowed to take place. In 1981 alone, national movements of physicians for the prevention of nuclear war were founded in 31 countries.

The Soviet Committee "Physicians for the Prevention of Nuclear War" under the Presidium of the USSR Academy of Medical Sciences was set up in July 1981. Among its members are leading medical scientists and heads of nearly all of the country's medical societies. The ideas of the movement were enthusiastically welcomed by broad segments of the USSR medical community. Before long 20,000 researchers and physicians became active contributors.

The Soviet Committee concentrated its efforts in two areas--- first, evaluation of the possible medical consequences of nuclear war on the basis of scientific research, and second, dissemination of information among the Soviet and world public, as well as governments and international organizations about the possible effects of nuclear war. A group of Soviet experts headed by Leonid llyin, Member of the USSR Academy of Medical Sciences, following the initiative of the Soviet PPNW Committee, prepared data estimates on the effects of the use of the neutron weapon and made them available to governments and peoples of the world. They were presented for the first time to the Independent Commission on Disarmament and Security headed by Olof Palme, and they were published prior to the US decision to start a full-scale production of neutron weapons. The Soviet Committee also researched data on the possible consequences of nuclear war in Europe and the possible consequences of a retaliatory nuclear strike, should nuclear arms deployed in Western Europe be used, and presented those data at various congresses and conferences.

In their June 1981 reply to Professor Bernard Lown, and IPPNW co-chairman, the leaders of the Soviet PPNW Committee expressed their satisfaction with the fact that the movement International Physicians for the Prevention of

Nuclear War was expanding and gaining momentum. The hope was expressed that "the spark of our meetings in Geneva and Airlie will kindle flames of hatred for nuclear war in the hearts of people" That reply for the first time formally mentioned the creation of the Soviet national committee of physicians "designated to combine efforts of scientists and physicians for the study of the aftereffects of nuclear war, explanation of the possible aftereffects of nuclear war to the wide circles of population, and organization of the struggle of physicians against the nuclear arms race''.

Within a short period of time the Soviet PPNW Committee has come to be identified with a powerful public movement. It disseminates the ideas of the international movement of physicians, and rallies Soviet physicians behind its noble objectives. As one of the co-founders of International Physicians for the Prevention of Nuclear War the Soviet Committee continues to play an active role in the movement. The leadership of the Soviet Committee have repeatedly received in Moscow delegations of foreign physicians and discussed with them some of the pressing problems of the movement; the Committee's representatives visit foreign countries to establish contacts with national committees, and to exchange experience.

The Soviet Committee maintains particularly close contacts with colleagues from the United States---members of the I PPNW, of Physicians for Social Responsibility and other related organizations. It is to be noted that selfless and active work of many researchers and physicians, including that of US activists in the movement, ensured an unusually broad publicity to appeals issued by the movement and aroused keen interest in it.

In the period following the first IPPNW congress Soviet physicians-members of the Soviet Committee were engaged in explaining to broad Soviet and international public the results of the congress, the documents it had adopted and the objectives of the movement.

The June 1981 session of the USSR Supreme Soviet adopted an appeal entitled "To Parliaments and Peoples of the World''.

As deputies of the USSR Supreme Soviet, President of the USSR Academy of Medical Sciences Nikolai Blokhin and Academician Yevgeni Chazov, co-chairman of the international physicians' movement, had an opportunity to address the session when that important document was discussed, and to describe most of the ideas debated by the IPPNW at its first congress.

Academician Yevgeni Chazov of the USSR and Professor Howard Hiattof the United Statesspoke before the Independent Commission on Disarmament and Security, headed by Olof Palme, presenting research data on the medical consequences

of nuclear war. Addressing a press conference Olof Palme said that the world public at large should be acquainted with the find ings of researchers and physicians and with the results of the international congress of physicians for the prevention of nuclear war.

Of great importance was the participation of Soviet medical workers in a major international symposium of lawyers, devoted to the medical consequences of nuclear war, that was held in 1982.

A representative of the Soviet PPNW Committee attended a special session of medical researchers from various countries, convened in Rome by the Pontifical Academy of Science. That scientific forum discussed the possible consequences of nuclear war for life on Earth and the involvement of the Church in the campaign to prevent nuclear catastrophe.

In December 1981 the Chairman of the Presidium of the USSR Supreme Soviet received in Moscow a group of scientists from the Pontifical Academy of Science at the request of Pope John Paul II, head of the Catholic Church and the Vatican State.

The scientists described the results of the research carried out by the Academy on the consequences of a nuclear war for humankind and presented to the Soviet leadership a copy of the "Declaration on the Consequences of the Use of Nuclear Weapons" containing the findings of the research.

In the course of the discussion the Chairman of the Presidium of the USSR Supreme Soviet stressed the importance of greater public knowledge of the innumerable calamities a nuclear war could bring. That is why the warnings coming from political figures and scientists of various countries deserve the closest attention. This idea also underlies the proposal put forward at the 26th Congress of the CPSU to set up an international committee which would bring home the vital need to avert a nuclear catastrophe. The louder is the authoritative and competent voice of scientists, the more purposeful will be the activities of millions of people to achieve this objective.

A sign of the times is that states, political parties and movements, public and other circles, regardless of their different ideologies, philosophical views or convictions, are rallying together, being aware of their common vital interests and anxious to rid humankind of the menace facing it.

To prevent a nuclear war---such is today the supreme responsibility of the heads of state to their own nations, to humanity, to posterity. It was stressed during the talk that the Soviet leadership is fully aware of this responsibility. The Soviet Union subordinates its foreign policy to this task.

The representatives of the Pontifical Academy of Science agreed that in the present circumstances broad participation of

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the peace forces in the efforts to strengthen peace and security was more vital than ever before.

The World Health Assembly in May 1981 adopted a special resolution on the medical consequences of nuclear war and the role of the World Health Organization in preventing the nuclear arms race and achieving disarmament. That was a major victory for medical scientists and physicians opposing the nuclear arms race and calling for nuclear disarmament.

In our letter to Professor Bernard Lown, the US co-chairman of the movement, we wrote: "We have found support of the World Health Assembly which, despite the position of the US representatives and representatives of some other countries, agreed with the necessity to establish an international committee of scientists studying the aftereffects of nuclear war and problems of disarmament.''

The relevant resolution of the World Health Assembly asked the Director-General:

``(a) to expedite and intensify the study of the contribution that WHO as a United Nations specialized agency could and should make to economic and social development in order to facilitate the implementation of the United Nations resolutions on strengthening of peace, detente and disarmament and prevention of thermonuclear conflict, and for this purpose, invites him to create an international committee composed of prominent experts of medical science and public health;

``(b) to continue collaboration with the United Nations Secretary-General, other governmental and non-governmental organizations, to the extent required, in establishing a large and competent international committee of scientists and experts for comprehensive study and elucidation of the threat of thermonuclear war and its potentially fatal consequences for the life and health of peoples of the world.''

In implementation of that resolution the Director-General of the WHO established a special committee of experts, comprised of scientists from 10 countries, including a representative of the Soviet PPNW Committee, which presented to the WHO a special report based on the study of research data. Eight leading world authorities on the possible consequences of nuclear war participated in the drafting of the report.

The report of the international committee of experts entitled "Effects of Nuclear War on Health and Health Services", over 150 pages long, has summed up the available data on nuclear arms and the possible consequences of their use; copies of the report have been sent to governments and international organizations. The report describes physical characteristics of nuclear explosions and of their effects, immediate and late consequences of nuclear war, and problems of providing aid to the victims. The estimates contained in this official WHO report

fully coincide with the findings made by the participants in I PPNW congresses. Basically, the report comes down to the following:

``1. `Conventional' wars are continually becoming more destructive. However, the introduction of nuclear weapons has added totally new dimensions to warfare.

``2. A single thermonuclear bomb can have an explosive power of a million times the largest conventional bombs and the present stockpiles of nuclear weapons have an explosive power thousands of times greater than all the explosives detonated during the Second World War.

``3. The Committee has considered three possible scenarios of the use of nuclear weapons and estimated their earliest consequences.

``(1) The detonation of a one-megaton bomb over a large city would kill more than one and a half million people and injure as many.

``(2) `Limited' nuclear war with smaller tactical nuclear weapons totalling 20 megatons, aimed at military targets in a relatively densely populated area, would exact a toll of about nine million dead and seriously injured, of whom more than eight million would be civilians. "(3) An all-out nuclear war using at least half of the estimated present stockpiles of nuclear weapons (an approximate total of 10,000 megatons) would result in more than 1,000 million deaths and 1,000 million injured people.

``4. It is obvious that no health service in any area of the world would be capable of dealing adequately with the hundreds of thousands of people seriously injured by blast, heat or radiation from even a single one-megaton bomb. Even the death and disability that could result from an accidental explosion of one bomb from among the enormous stockpiles of weapons could overwhelm national medical resources.

``5. It is difficult to comprehend the catastrophic consequences and the human suffering that would result from the effects of nuclear explosions in the second and third scenarios that are considered. Whatever remained of the medical services in the world could not alleviate the disaster in any significant way.

``6. To the immediate catastrophe must be added the longterm effects on the environment. Famine and diseases would be widespread, and social and economic systems around the world would be totally disrupted.

``7. Therefore the only approach to the treatment of the health effects of nuclear explosions is primary prevention of such explosions, that is, the prevention of atomic war.''

The committee emphasized that WHO "can make important

contributions" to removing the threat of nuclear war and implementing appropriate preventive measures by "systematically distributing information on the health consequences of atomic warfare and by continuing and expanding international cooperation in the field of health.''

The May 1983 resolution of the World Health Assembly commended the work done by the WHO Director-General to study the possible consequences of nuclear war and reaffirmed the need for the WHO to continue its efforts in explaining to humankind the threat posed by an outbreak of nuclear war.

It is to be noted that in December 1983 the UN General Assembly at its thirty-eighth session adopted a special resolution which commended the WHO report.

The public opinion and the peoples of various countries of the world, especially of Europe and of the United States, were becoming increasingly aware of the threat that the very existence of nuclear weapons posed to their lives. Their concern became particularly grave with the approach of the date set for the deployment in some West European countries of new US nuclear missiles. At the same time certain political and military quarters in the United States and NATO began to assert, in an attempt to defuse the intensity of the anti-missile movement in Europe, that the doctrines of a ``limited'' nuclear war and of "nuclear deterrence" served to guarantee peace.

It is against that background that Cambridge (England) played host to the second IPPNW congress held between April 3-6, 1982.

British researchers and physicians, among them Professor Douglas Black, President of the Royal College of Physicians, exerted great efforts to prepare the congress.

The congress was attended by over 200 researchers and physicians from 31 countries of the world. It focused its attention on the possible medical consequences of nuclear war in Europe. As mentioned above, that focus was due to NATO's decision to deploy in some West European countries new US Pershing-2 and cruise missiles which are first-strike nuclear systems. The participants fully realized that deployment of new US missiles in Europe would heighten the danger of an outbreak of nuclear conflict. The plenary session and the 11 working groups discussed various aspects of the possible consequences that a nuclear conflict in Europe would entail not only for the peoples of the continent but also for the entire planet.

The conclusion made by the congress that even partial use of nuclear weapons (1,000 Mt) would lead in the first several days to the death of about 170 million people and would injure another 150 million (out of 670 million of Europe's inhabitants) disproved the statements of those who advocated deployment of US nuclear arms in Europe in a bid to downplay the danger

The second congress of International Physicians for the Prevention of Nuclear War, held in Cambridge in England in April 1982

of such a step for the peoples of Europe. It was confirmed that medicine would be helpless in conditions of a nuclear conflict in Europe, given the fact that there would be only one able-bodied physician for every thousand of those gravely injured.

The memorandum adopted at the congress stated the following among other things: "The participants among whom there were physicians and researchers from the majority of countries of Europe on both sides of the frontier between the West and the East came to unanimous conclusion that nuclear war threatens civilization in Europe and, in fact, all civilized life on our planet. We," the participants in the congress said, "have gathered here because we do not accept the inevitability of nuclear conflict. We do not believe that it is possible to eliminate differences between political systems or attain any social, political or ideological goals through the use of nuclear arms. We share the hope and the belief that people are capable of keeping under control what they have created. We reject the use of technology not for the purpose of improving the quality of life but to develop nuclear arms.''

The congress adopted a number of documents, including appeals to the heads of the United States and the USSR, to the participants in the second special UN General Assembly session

devoted to disarmament, to the heads of the nuclear powers and to physicians of Europe.

In a most concise and concentrated form the view of the physicians and researchers concerning the medical consequences of a nuclear conflict which, should it break out in Europe, would engulf the entire world was expressed in their message to the second special UN General Assembly session devoted to disarmament, which ran as follows:

``1) Nuclear war would be a catastrophe for any country and any people against whom those weapons were used. In the nations directly attacked, tens to hundreds of millions of people would be killed instantly. Millions of those residing in nations not directly attacked would also perish. There is no possibility of an effective medical response in the ensuing chaos. From the medical standpoint alone, the terms `limited' and `winning' have no meaning in the context of nuclear war.

``2) Among those who might survive the initial effects of blast, fire, and radiation, many would face the prospect of prolonged agony and slow death. Untold numbers would succumb to injuries for which no adequate medical treatment could be provided. Widespread starvation, epidemics, and psychological stress would be inevitable.

``Radioactive contamination would spread to vast areas and would pollute the biosphere. The natural protective ozone layer around the Earth might be damaged, with unpredictable consequences to all forms of life and to the very survival of the human species...

``3) Nuclear war in Europe would destroy at a stroke its civilization and the achievements of thousands of years of human effort.

``4) Since physicians would have no remedy for the foreseeable medical consequences of a nuclear war, the only effective action is prevention.

``Mounting military expenditures and the intensification of the arms race heighten tension. Each new crisis worsens the threat of nuclear war. No matter how difficult the international problems facing the world today, there is no acceptable alternative to their resolution through serious and honest negotiations based upon realistic assessments and mutual respect, with account being taken of the security of all states. The imperative of our time is to rule out the very idea of the use of nuclear weapons, in any form or on any scale. Ultimately, nuclear weapons must be destroyed before they destroy humanity.

``The growth in sheer numbers of nuclear weapons and the increasing complexity and sophistication of delivery systems increase the possibility that a nuclear conflict may be triggered by tragic accident.

``Physicians are aware from their daily work that technological systems are liable to malfunction and that human performance may fail because of mental derangement or even simple error. Whereas such failures in medicine may jeopardize a single life, the malfunctioning of military systems may now endanger the existence of humanity.

``The arms race is killing people now by diverting scarce resources from urgent human needs. We therefore urge that measures be taken to reduce military budgets and to channel part of thefunds thus released to improve living standardsand to relieve the condition of millions of people who suffer from lack of food and housing, from poor sanitation, and from widespread but preventable disease.''

The participants in the congress demanded that measures be adopted to prevent nuclear war and eliminate the consequences of the nuclear arms race. They pointed to the need, as a first step, for freezing nuclear arms a nd their del ivery systems, as well as for the renunciation of a first use of nuclear weapons. Their common conviction was that the arms race can and must be halted through negotiation. These and other considerations were emphasized in a message the participants in the congress addressed to the heads of the two great powers---the Soviet Union and the United States.

In his reply to the second IPPNW congress Leonid Brezhnev, Chairman of the Presidium of the USSR Supreme Soviet, said that he fully shared the concern of the participants in the congress over the tense situation obtaining in the world. He wrote:

``Many nations are heavily burdened by social, economic, demographic and other problems; the important thing is to find ways to solve them, rather than aim towards a war, nuclear war included. Any use of nuclear weapons, regardless of scale, would be a crime against humanity.

``Taking this into consideration I share your conclusion that nuclear war would be fatal for any country and for any people against which such weapons might be used.

``The supreme duty of state leaders to their own peoples and to humankind is to rid our planet of impending danger and to preserve peace. It is our duty to leave for posterity a flourishing, rather than a blast-scarred planet. In order that the light may not fade over the Earth we urgently need to put insurmountable barriers in the way of nuclear war.

``I believe that the warnings made by medical researchers and physicians deserve the most serious attention. You are concerned about people's health and life, and you measure actions by states and their representatives against that concern. In the final analysis this seems to be the only correct approach, since the essence of state policy is to serve the peoples.

``Your support of the efforts to limit and reduce nuclear arms is welcomed in the Soviet Union.''

The second IPPNW congress not only contributed to the dissemination of reliable information about the consequences of a nuclear conflict, but also strengthened the authority of the movement among various segments of public opinion and among international and national organizations.

Thousands upon thousands of medical researchers and physicians, aware of their duty to fight for life on Earth, join the ranks of the movement. By the end of 1982 national organizations of physicians militating for the prohibition of nuclear arms and the prevention of nuclear war were set up in 43 countries.

The physicians' movement which stands for the cessation of the nuclear arms race, and for freezing and banning nuclear arms has been steadily expanding and gaining momentum month by month. Numerous conferences of physicians were held in the United States, Canada, Britain, Sweden, Italy, the FRG, Austria, Hungary, Czechoslovakia and other countries. These conferences brought together physicians of different political and religious beliefs, who have a common desire to defend life on Earth and to prevent nuclear catastrophe.

In December 1982 Moscow played host to a representative conference of Soviet physicians working for the prevention of nuclear war. It was attended by more than a thousand people from all of the country's 15 constituent republics.

In their statements based on knowledge of the consequences of nuclear war the participants expressed concern for the future of humankind and called for the curbing of the nuclear arms race and the prohibition of nuclear arms. The possible short-term and long-term consequences of nuclear war were subjected to a detailed and thorough analysis (the summary of reports presented at the conference was published in the Bulletin of the USSR Academy of Medical Sciences).

Responding to an appeal of the second IPPNW congress, the participants in the conference stated:

``Today all honest people on Earth are expressing their concern. Some of them, like us, on account of our profession, more fully realize what nuclear war would really mean for humankind, others are less aware of the danger. They are less aware because they are influenced by prejudices, fraudulent propaganda or illusions. Even among politicians there are probably those who entertain hopes of escaping the flames of a nuclear war should they flare up on the globe.

``A nuclear war would be infinitely tragic. It could mean not only a catastrophe for human civilization, but the end of all life on Earth. Whoever declares the opposite, whoever assumes that

The presidium of the third congress of International Physicians for the Prevention of Nuclear War held in Amsterdam in June 1983

nations could survive such a war and continue to exist among the ruins left by it, is guilty of fraud either because of incompetence or lack of responsibility.

``We welcome the Declaration of the UN General Assembly on the Prevention of Nuclear Catastrophe, which declared a first use of nuclear weapons to be the gravest crime against humanity. Nuclear war must be outlawed and nuclear weapons must be destroyed before they destroy the world.

``We Soviet physicians support the peace initiatives aimed at averting a world nuclear conflagration, at curbing the arms race and, above all, the nuclear arms race. We know that our country does not threaten anyone and does not intend to attack anyone. It has assumed a historic obligation not to use nuclear weapons first. We are convinced that if the other nuclear powers follow this good example, it would be a major step towards removing the nuclear war threat....

``Concern for people's health is our primary professional duty. This means that it is also our responsibility to make sure that those who are preparing for nuclear war are not allowed to play with people's health and lives.

``The greatest danger is to lose heart in the face of the nuclear threat. We believe that if everyone realizes the danger that these weapons pose, and then does not flinch when challenged by

those who would like to use these inhuman weapons, the threat will then be removed.''

The conference which was extensively covered by the Soviet mass media urged all physicians and medical workers of the Soviet Union to support actively the efforts aimed at an immediate cessation of the arms race and transition to genuine measures of disarmament, above all nuclear disarmament.

The third IPPNW congress held in June 1983 in Amsterdam had as its main topic "Nuclear Illusions: The Human Costs". It demonstrated not only the scope of the IPPNW movement and the prestige it enjoyed among researchers, medical workers and the public, and religious and political figures of various countries of the world, but also the dimensions and the importance for the entire human race of the issues discussed by the congress. The congress was attended by over 200 people from 43 countries. In addition to researchers and physicians, Doctor Adeoye Lambo, the WHO Deputy Director-General, other WHO officials and representatives of the Catholic Church and of the Orthodox Church also addressed the gathering. UN Secretary-General J. Perez de Cuellar, the heads of the USSR, the United States and several other countries sent messages of greetings.

Sweden's Prime Minister Olof Palme, retired admiral Noel Gayler (USA), one of the leading spokesmen of the SocialDemocratic Party of Germany Egon Bahr, and the Director of the Institute of US and Canada Studies of the USSR Academy of Sciences, Academician Georgi Arbatov, took part in the political discussion. All of the speakers at the congress and participants in the political discussion expressed growing concern over the situation in the world and the continuing nuclear arms race, and for the future of humankind.

Taking a realistic stand, the congress participants rejected as untenable and dangerous the assertions made by certain politicians in the West to the effect that the stockpiling of nuclear arms provides the best guarantee of peace. Using the `` deterrence'' doctrine as a pretext, the United States has already equipped its strategic nuclear forces with 12,000 nuclear warheads targeted against the Soviet Union. In just one launch 3,400 Mt of nuclear explosives could be used, exceeding the yield of the nuclear bomb dropped on Hiroshima by 270 thousand times.

It was the view of the participants that deployment of US Pershing-2 and cruise missiles in West European countries would pose a particularly grave threat to peace.

The papers discussed at the third IPPNW congress have confirmed that the use of the territory of West European countries for the stationing of US nuclear missiles would be suicidal for them. It was stated at the congress that in the event of a retaliatory strike involving the use of an equivalent number

of Soviet nuclear missiles, up to 33 million people would be killed or injured in the countries planned for deployment of 572 US missiles. The consequences of a retaliatory nuclear strike would be so devastating as to prevent the restoration of normalcy in those countries and put in question their very survival.

The congress devoted much attention to the late consequences of nuclear war and, in particular, to the impact of the changes in the biosphere on the future of humankind. For the first time ever the congress extensively discussed the impact of the nuclear arms race and of tensions on the mind of the contemporary human being, and specifically, on the shaping of the child's psychology.

The congress reaffirmed that work for preserving peace on Earth, for preventing nuclear war is a professional duty of every physician on our planet. The congress proposed an addendum to be made to the Hippocratic oath taken by young physicians, to express the concern of a 20th century physician for the health and life of his patients living under the threat of nuclear war.

On 15 November 1983 the Presidium of the USSR Supreme Soviet, in response to the request of the country's medical community and various medical organizations, and guided by the principles of the struggle for peace and for the prevention of nuclear war, adopted the following addition to be included in the official text of "The Physician's Oath" taken in the USSR:

``Conscious of the danger posed by nuclear arms, to fight tirelessly for peace and for the prevention of nuclear war.''

The congress in Amsterdam has testified to an increased militancy of researchers and physicians of many countries, who advocate a freeze and a ban on nuclear arms. The participants in the congress---people of different age and status, of various nationalities and political beliefs, professors and students, researchers and practitioners, responding to the call of their professional duty, which is to protect life on Earth, unanimously urged all medical workers of the world to speak up against the madness of nuclear war.

The desire to unite the efforts of researchers and physicians of the world in a drive for preventing nuclear war also prompted the adoption by the congress of the "International Physicians' Call for an End to the Nuclear Arms Race". Currently, a campaign is underway in many countries for physicians to put their signatures to that Call which will undoubtedly strengthen and reactivate the international physicians' movement, enhance its authority, and contribute to the dissemination among the peoples of information about the true nature of nuclear war and its consequences.

In the USSR a signature collection campaign got underway on 9 November 1983 at a gathering of representatives of the

medical community held at the All-Union Oncological Centre of the USSR Academy of Medical Sciences, with Academician Nikolai Blokhin, President of the USSR Academy of Medical Sciences, and other leading researchers and physicians among the main speakers. The participants unanimously approved the text of the Call and signed it. Since then hundreds of thousands of physicians from all parts of the country followed suit. The list of signatures thus collected will be presented to the fourth IPPNW congress scheduled to be held in June 1984 in Helsinki and sent to the heads of the five nuclear powers.

The Call to which, we have no doubt, medical workers and physicians of the entire world will affix their signatures, ended in the following words:

``We recognize that to reach agreements to end the nuclear arms race and avert the introduction of nuclear weapons into any conflict represents a major political task. We regard such agreements as crucial and urgent since the threat of nuclear war is the greatest challenge to health and survival that humanity has ever faced. As physicians, we believe a nuclear war would be the final epidemic.''

The delegates to the congress, in conditions of an ever growing danger of an outbreak of nuclear war, reiterated their Appeal to the leaders of the United States and the Soviet Union. That Appeal, expressing profound concern for the future of humankind and at the same time complete confidence in human reason, requested the leaders of the two major nuclear powers to consider the view of the congress participants on nuclear illusions and the human costs involved.

``The first and greatest of all the nuclear illusions, "the Appeal pointed out, "is the assumption that nuclear war is simply one of many alternatives facing humanity, and that nuclear war is but conventional war with magnified consequences. The world stands at the edge of an abyss: humanity now has the technical means for its own destruction.

``An all-out nuclear war would kill hundreds of millions of people instantly. World civilization would be devastated, and the future of those surviving the immediate attack would be in doubt. The medical profession would be helpless to provide effective aid to the living.

``A kindred illusion is the view that nuclear war---both its start and its duration---could be controlled. If nuclear war begins, here in Europe, or anywhere else, it is unlikely to be either `limited' or `prolonged'. It would almost certainly escalate rapidly to a massive exchange and a global holocaust. We base this conclusion on our knowledge of the medical consequences of nuclear explosions and of the manner in which human beings make decisions under stress.

``Such an all-out exchange would eclipse all ecological 44

catastrophes of recorded history. Coming generations would inherit a violated biosphere, an Earth poisoned by radiation. The long-term environmental effects of the nuclear blasts would also afflict children of the future. Indeed, given what is known, and even more important, all that is still unknown about the effects of multiple nuclear explosions, there is the risk that human life on our planet would cease to be.

``Still another illusion is that of gaining and using nuclear `superiority'. So-called `advantages' in numbers or characteristics of weapons cannot be used to obtain a military victory; an `inferior' nuclear enemy would still destroy the opponent. The notion that one side or another can be `ahead' or `behind' in nuclear arms no longer has meaning, and nuclear weapons have ceased to be a means to achieve national political goals.

``Since the destructive potential of the present USA and USSR arsenals vastly exceeds the possible targets of either side, it is an illusion that the acquisition of more nuclear weapons of any type confers any military or political advantage. Hence there is no justification for the introduction of any additional nuclear weapons in Europe or any other region. Furthermore, since maintenance at this excessive level is unnecessary and dangerous we favour reduction of weapons currently deployed.

``The general policy of nuclear deterrence has held hostage vast populations of innocent people. It has led to an ever accelerating arms race. It threatens our children's hope of the future. It weakens our struggle against poverty, famine and illness. It has fostered war-fighting doctrines which increase the risk of nuclear conflict. What is needed are new peace initiatives from both sides---not new missiles.

``The USSR and the USA bear a great responsibility. As the leaders of these two great states, you personally can undertake substantial, specific initiatives to roll back the nuclear threat.

``We believe that:

``A. All nuclear powers should unequivocally agree to refrain from the introduction of nuclear weapons into any conflict. The initiation of nuclear conflict would be tantamount to both genocide and national suicide.

``B. All powers should agree to a sufficiently verifiable freeze on the development, testing, production, and deployment of nuclear weapons and their means of delivery.

``C. A freeze should then be followed by reduction and eventual elimination of nuclear weapons from the arsenals of nations.

``D. Arms control and reductions require a renewed and serious effort to reach agreement on a comprehensive nuclear test ban.

``E. The negotiations currently in progress should be pursued

with diligence, good will and consideration for the interests of both sides. The recent history of arms control negotiations, however, indicates that agreements are falling ever further behind the development and multiplication of nuclear weapons. We wish to emphasize, therefore, that there are routes to progress in addition to negotiation. Both the USA and the USSR have the opportunity to take independent initiatives to reduce tensions, to diminish the risks of nuclear war and to break the deadlock in current negotiations. World attention would then focus on all other nuclear powers to see if such a positive gesture were reciprocated. In such a manner the direction of the arms race would be reversed.

``F. We believe that both the USA and the USSR must learn more about each other. The stereotyped view of each other which now complicates US/USSR relations must be eliminated. This could be accomplished through a large increase in the volume of scientific, technical and cultural exchanges, tourism, and trade. It is essential to increase the information each country has of the other through television, mass media, and other means.

``More than two decades have passed since Albert Einstein said: 'We shall require a substantially new manner of thinking if mankind is to survive.' We must think anew, without the illusions that nuclear war can be averted indefinitely by a policy of deterrence, that we can live safely forever with nuclear weapons deployed, or that nuclear war can be limited, or survived. No East-West dispute is as important as our mutual need to avoid nuclear war.''

An international group composed of representatives of the USSR, the United States, Norway and Finland was instructed to hand this Appeal to the leaders of the United States and the USSR.

On 21 October 1983 the group was received by the First Vice-Chairman of the Presidium of the USSR Supreme Soviet Vasili Kuznetsov who on behalf of the USSR leadership assured the physicians that the Soviet Union is responsive to and supports the efforts of all those who speak up today against the madness of the arms race and for peace. The Soviet Union shares the noble goals of the physicians' movement for the removal of the threat to the life and health of people, wh ich the nuclear arms pose. Vasili Kuznetsov called attention to the statement by Yuri Andropov of 28 September 1983, which is a convincing proof of the adherence by the USSR to peace and detente. He told the delegation that the message would be conveyed to the Chairman of the Presidium of the USSR Supreme Soviet.

On 26 October 1983 the officials of the IPPNW movement received the following reply from Yuri Andropov, Chairman of the Presidium of the USSR Supreme Soviet:

``It was with great attention and interest that I read the Appeal which was given to me a few days ago, addressed by your authoritative forum to the leaders of the Soviet Union and of the United States.

``We regard it as a profoundly humane appeal to prevent nuclear catastrophe. It is in profound harmony with the thoughts and sentiments of the Soviet leadership and of the entire Soviet people.

``I fully agree with your conclusion about the inevitable and genuinely fatal consequences of nuclear war, once it started. You reveal the stark truth that people should be aware of, so that they do not allow the irreparable to happen.

``It is very important that both the deliberations of your congress and the documents adopted by it testify to a growing realization by the medical community of the need to combat the nuclear menace. Your programme of priority measures to be implemented by the nuclear powers is not at variance, in fact, with what our country has been consistently advocating, and with the thrust of our practical efforts.

``The Soviet Union rejects as insane the idea of unleashing a nuclear war, whatever the pretext might be, and considers as criminal the calls for waging such a war. We are convinced that it is concentration of the political will with a view to preventing a catastrophe and ensuring to people the right to life, rather than irresponsible attempts to make people accept the idea of the admissibility of nuclear war, and moves to obtain nuclear superiority, that the leaders of all states, primarily of the nuclear states, should, as a matter of priority, be guided by in shaping their policies.

``The unilateral pledge not to be the first to use nuclear arms, the recent concrete proposal to freeze all nuclear weapons, the purposeful efforts to achieve an effective * accord on the limitation and reduction of nuclear arms, and to prevent yet another round of their buildup in Europe, among other regions--- these are all graphic examples of the contribution of the Soviet Union to the solution of the problem which was at the origin of your movement as well.

``We are ready for radical solutions. Now it is up to the other side to act. As all people of good will, you can rest assured that the USSR will continue to do its utmost to ease international tensions, curb the arms race, whether on Earth or in outer space, and avert nuclear conflagration.

``I would like to wish all the members of the IPPNW every success in their noble and highly necessary mission.''

It is to be noted that the US President has not replied to any of the three appeals sent by the three IPPNW congresses to the leaders of the USSR and the United States.

In November 1983 the documents of the third IPPNW

congress were handed to UN Secretary-General J. Perez de Cuellar who highly appraised the movement's contribution to the struggle for preventing nuclear war.

The Amsterdam congress marked a qualitatively new stage in the history of the physicians' movement, for there it was formally established as an international non-governmental organization with its own charter which reflects its democratic and profoundly humane character, and its own executive bodies. The headquarters of the movement has already published several issues of its bulletin. An international council made up of representatives of all the national branches began its work. One of its first sessions held in Athens in October 1983 adopted several important decisions concerning further expansion of the movement. Greece's Prime Minister Andreas Papandreou, who addressed the meeting, spoke of the need for nuclear disarmament in Europe and for the adoption of effective measures aimed at removing the threat of an outbreak of nuclear war.

The Executive Committee which runs the day-to-day affairs of the movement assists in establishing PPNW national organizations. Professor Bernard Lown and Academician Yevgeni Chazov, as the co-chairmen of the movement, visited Greece, Italy and other countries where they explained the IPPNW programme to local physicians' organizations and to politicians and government officials, gave interviews to local and foreign mass media about the goals and objectives of the movement and, what is most important, about the medical consequences in the event of an outbreak of nuclear war, and the dangers involved in it. The USSR national branch has been always prompt to implement the decisions of the movement's executive bodies.

From the very outset the Soviet PPNW Committee has been devoting much attention to making the ideas of the IPPNW movement easily accessible to the public. The position of Soviet researchers on the possible medical consequences of nuclear war, as well as the documents of the three IPPNW congresses, have been given very extensive coverage in leading Soviet newspapers and magazines and on radio and TV. The newspaper Meditsinskaya Gazeta and all specialized medical periodical publications report extensively on the medical consequences of nuclear war, as well as on the objectives pursued by the IPPNW. Our first book, expressing the view of Soviet physicians and researchers on the danger of nuclear war and published on the initiative of the Soviet PPNW Committee, is familiar to many people in the Soviet Union and abroad, and has aroused considerable interest among Soviet and world public, representing as it was a first try at conducting research into the consequences of nuclear war.

Soviet television devotes much attention to the activities

of the IPPNW. Two of its Studio 9 programmes, devoted to discussion of the medical effects of nuclear war and to the IPPNW movement, have been viewed by an audience of some 150 million.

A TV round-table discussion of Soviet and US physicians and researchers on the subject of the consequences of nuclear war, broadcast by Soviet television in June 1982, played a significant role in disseminating the ideas of the IPPNW and in bringing data on the consequences of nuclear war to the attention of the broad public, governments and peoples of the world. Academicians Leonid llyin, Mikhail Kuzin and Yevgeni Chazov of the USSR and Professor Bernard Lown, Dr. John Pastore and Dr. James Muller of the United States presented scientific data on various aspects of the possible consequences of a nuclear conflict and of the nuclear arms race. Before concluding the discussion the US and Soviet physicians and researchers addressed the following message to the peoples of each other's countries:

``No one should remain indifferent at a time when the militaristic propaganda is attempting to persuade people that the military force will continue to be the most effective policy tool, that a nuclear war is not only conceivable but even desirable under certain circumstances, and that one can count on winning it. To think even for a moment that there is 'nothing unusual' about nuclear war, or that it would not create any extraordinary circumstances is tantamount to be at the mercy of those who would like to turn our planet into something of an inferno, to giving up any hope of establishing sensible relations between people, and what is still worse, to destroying pur will not to allow our civilization and our history to end in this generation.

``We physicians, true to the Hippocratic oath which requires that we protect our patients from whatever threat to their lives, know on account of our profession what nuclear war, radiation, radiation-induced diseases, burns and wounds would really mean. We feel that all should know the truth about the actual danger involved. Everyone should know what really lurks behind talk about pre-emptive, demonstrative and other nuclear strikes, and behind the extolling of nuclear weapons.''

``Only irresponsible people," our message to the American people said, "can speak of the possibility of `limited' nuclear conflicts. Did the citizens of Hiroshima and Nagasaki feel happier because the nuclear strike had spared other cities? And, generally speaking, who would agree to being victimized of his own will? Yet, it is something else that matters. There is no guarantee that a first nuclear strike would not be retaliated, thus leading to an exchange of nuclear strikes that would continue until the nuclear arsenals have been exhausted. And still, the issue is not closed at this either. An outbreak of nuclear war

4---1878 49

could be the result of a malicious intent, miscalculation, technical defect or fateful coincidence. Nuclear arms are a threat in themselves only because they exist.

``That is why all of us---Russians, Americans, Japanese, English, Germans, Czechs, Arabs, French, Mexicans and Ethiopians---all people of our planet, irrespective of their nationality, religion and political beliefs, should speak up against the nuclear arms race, the plans involving the use of nuclear arms, and the propaganda of nuclear war. Nuclear arms must be outlawed, their production discontinued and their stockpiles eliminated.

``There is no time to lose. The explosives accumulated in the world are far too many. People have created weapons that are now posing a threat to them. It is incumbent on all of us, on governments, parliaments and political parties to scrap the tools of war before they have destroyed humankind.

``We believe that reason can prevail. It must prevail and that is why we are addressing this message to you.''

The debate was keenly followed not only in the USSR but in other countries as well. The Novosti Press Agency published its verbatim report. The American public and the movement's leadership had to exert some pressure for a brief summary of the discussion to be broadcast by one of US non-commercial TV channels.

Of late Soviet television has shown a number of programmes ' on the IPPNW movement, including "The Alternative", with the participation of Professor Bernard Lown (USA) and Academician Natalia Bekhtereva (USSR), as well as a debate on the subject of nuclear illusions, with Sweden's Prime Minister Olof Palme, the prominent West German politician Egon Bahr, 1 the US retired admiral Noel Gayler and Academician Georgi [ Arbatov as the participants. A Soviet TV film entitled "I Am a 20th Century Physician", covering the work of the third IPPNW congress, enjoyed wide popularity. That film, seen by tens of mill ions of Soviet viewers, was loaned to the IPPNW and several national organizations to be shown to our colleagues and members of the medical community abroad, thus contributing to the growth of the movement's ranks. Members of the Soviet ' PPNW Committee together with their American colleagues took ' part in a USSR-US TV ``hook-up''---a live debate on the possible late consequences of a nuclear conflict. In December 1983 our physicians came to Washington to attend a symposium on the ecological and biological consequences of nuclear war.

Representatives of the Soviet PPNW Committee regularly f give lectures on the effects of nuclear war before medical \ audiences. The Soviet PPNW Committee maintains very useful f contacts with a recently established committee of Soviet 5 scientists for peace and against nuclear war. Physicians were •

50 !

among those who addressed the all-Union conference of Soviet scientists held in May 1983.

In light of the above, the attempts of certain quarters in the West and of the Western mass media to portray the activities of the Soviet PPNW Committee as one-sided propaganda and a ploy to ``intimidate'' the peoples of other countries appear as nothing but ridiculous. The New York Times was right when, alluding to such attempts, it remarked in its issue of 4 August 1981 that if the Soviet leaders had been nourishing plans for a nuclear war, they no doubt would have to condition their people to accepting the use of nuclear weapons instead of regarding them as an embodiment of all that is monstrous. The US press admits that the Soviet Union has given broad coverage to the documents of the three I PPNW congresses, which convincingly demonstrate that nuclear war would indeed be catastrophic, whereas in the United States the same documents are in effect being ignored.

In assessing the significant contribution that the IPPNW has already made to dispelling quite a few illusions about nuclear weapons, it should be mentioned that due to its efforts international and non-governmental organizations, governments and common people in many countries of the world have become more keenly aware of the threat that the nuclear arms race and a possible outbreak of a nuclear conflict pose to humankind.

We are looking forward to other forums of physicians such as the fourth IPPNW congress which will no doubt make a further contribution to preventing nuclear war.

``The peoples must know the truth about the destructive consequences which a nuclear war could have for humankind"---this principle put forward by the 26th Congress of the Communist Party of the Soviet Union defines one of the objectives inthe struggle for thefuture of humankind; it is for this future that Soviet physicians and medical scientists are fighting and will be always prepared to fight.

Soviet physicians and the Soviet PPNW Committee justly regard themselves as part of a growing world-wide movement of physicians who have but one common goal---to do their best to prevent the madness of nuclear war and to protect honestly and selflessly the health and life of all people on Earth.

In late 1983, on the initiative of the Soviet PPNW Committee, the USSR Ministry of Communications printed an envelope and a stamp dedicated to International Physicians for the Prevention of Nuclear War. The drawing on the envelope shows a physician protecting with his hand the flourishing Earth, while the stamp shows a physician holding a child in his arms. And this is how it should be, for we believe that our work, the work of medical scientists and physicians will help reason to triumph.

Ill

The Nuclear Weapon: Its Characteristics and the Threat It Poses

electron masses. Consequently, the original nucleus is split into two pieces (fragments), releasing vast quantities of energy, of the order of 200 mev (million electron-volts) per fission. The products of fission are nuclei of radioactive isotopes of lighter elements. Through a series of transmutations every fission fragment ultimately becomes a stable ( nonradioactive) atom.

An important point. When a heavy nucleus is split as a result of a neutron capture, not only intranuclear energy is liberated, but also two or three neutrons cause the splitting of other nuclei. This leads to an avalanche-like process commonly known as a fission chain reaction. Atomic nuclei of heavy elements are fissionable, in particular those of uranium and plutonium. Among the isotopes of these elements~^^236^^U and~^^239^^Pu are of the greatest practical importance. Fission of all atomic nuclei contained in one kilogramme of uranium-235 or plutonium-239 will release an amount of energy equivalent to that which would be liberated in an explosion of 18,000 tons of trinitrotoluene (TNT)*. It has been calculated that in a one-kiloton explosion about 57 grammes of fissionable material is used. This means that approximately 10^^23^^ atoms are split, releasing a quantity of energy equivalent to 10^^12^^ calories /V.

As distinguished from the fission reaction the fusion reaction occurs only with light nuclei, such as those of hydrogen isotopes, namely deuterium~^^2^^H (D) and tritium~^^3^^H (T). In such a reaction two nuclei of this kind become fused to form a nucleus of a heavier atom. This process is accompanied by the liberation of energy a larger part of which assumes the form of kinetic energy of high-energy neutrons (up to 14 mev).

It has been established that a fusion reaction produces ten times more neutrons than a fission reaction of equivalent yield. It should be noted that in the latter case the energy of the neutrons is approximately only one-seventh of that of the former case, amounting to about two mev.

The weight of reactants (for instance, light nuclei of tritium and deuterium and heavy nuclei of uranium and plutonium) being equal, a fusion reaction will release three times the quantity of energy liberated by a fission reaction. For example, fusion of all the nuclei contained in one kilogramme of deuterium would release a quantity of energy equivalent to that liberated in an explosion of 57 kilotons of TNT. A fusion reaction develops in temperatures of the order of several tens of millions

Physical Principles of the Nuclear Weapon

Before examining the medical consequences of a nuclear attack it would be expedient to give a brief and simplified description of the physical processes which form the basis of the nuclear weapon and to remind the reader of some particulars of the effects of a nuclear explosion.

A nuclear burst is an instantaneous release of vast energy within a limited space as a result of a definite type of nuclear reactions. In the case of a blast of a conventional (non-nuclear) explosive energy is released as a result of chemical reactions occurring at atomic (as distinguished from intraatomic) level, when intranuclear interactions are not affected. The energy yields of such chemical reactions are less than a millionth of a nuclear reaction.

Nuclear fission and fusion reactions on which nuclear weapons are based are classic examples illustrating the principle of equivalence of mass and energy. In nuclear transmutations the mass of the material decreases (which is known as mass defect), the quantity of energy released being equivalent to the decrease in the mass. This change in the mass actually reflects the difference in the binding energy of nuclear particles (protons and neutrons) in various atomic nuclei.

In a nuclear weapon nuclei are split through the action of neutrons---nuclear particles with no electric charge whose mass is equal to 1,838

* The explosive yield of a nuclear weapon is normally expressed in a TNT equivalent. For instance, a one-kiloton or one-megaton nuclear bomb will release a quantity of energy equivalent to that released in an explosion of 1,000 or 1,000,000 tons of TNT correspondingly.

°K. In a nuclear weapon the fusion, or thermonuclear, reaction is initiated by a nuclear explosion produced by a fission reaction which creates the necessary temperature.

It has been mentioned above that both the fission and fusion reactions are used in nuclear weapons. In the literature, including special literature, the terms "atomic weapon" (based on the fission reaction) and "hydrogen (or thermonuclear) weapon" (based on the thermonuclear fusion reaction) are frequently used. However, it should be pointed out that in both cases the energy of explosion is released through nuclear reactions or transmutations. Therefore, all weapons of this kind, including the so-called neutron bomb, should be referred to as nuclear weapons. Moreover, in superpowerful thermonuclear weapons nuclear reactions occur in the following sequence: fission--- fusion---fission. In this case a considerable part of the energy is released in uranium-238 fission. It should be recalled here that as distinguished from~^^235^^U and~^^239^^Pu---the former occurring in natural uranium in negligible concentrations, and the latter being produced artificially---uranium-238 atoms are contained in natural uranium in the largest quantity (99.3 per cent). At the same time, the atomic nuclei of the three aforementioned isotopes are capable of fission by capturing neutrons of any energy magnitude, while~^^238^^U nuclei will split only under the impact of high-energy neutrons. It follows that uranium-238 cannot serve as a component of a nuclear weapon based on the fission reaction. Such high -energy neutrons can be produced by a fusion reaction. This means that by placing a blanket of natural uranium around a thermonuclear charge it will be possible to create the conditions for initiating a fission reaction of uranium238 atoms, which will result in an instantaneous release of vast quantities of energy. This in turn considerably increases the overall explosive power of such a combined weapon based, as we have seen, on the fission---fusion---fission principle.

General Characteristics of the Effects of a Nuclear Explosion

Nuclear explosions---air, surface and underwater bursts---are classified depending on the position of the centre of the blast in relation to the Earth's surface. Each type of explosion is characterized by its specific external development and its effects. Unlike the explosion of a conventional weapon, based on the chemical reactions of explosives, a nuclear burst produces a number of different effects, the main four being:

1) an explosive blast (in particular, overpressure of the shock front);

2) thermal radiation, most of which takes the form of visible light;

3) initial (instantaneous) nuclear radiation; and

4) residual nuclear radiation.

The energy of a nuclear explosion is distributed among its effects as follows: blast---about 50 per cent, thermal (luminous) radiation---30-35 per cent, initial radiation---5 per cent and residual radiation---about 10 per cent /1, 2, 3/. These estimates apply to an air burst. In other types of explosions the ratios are somewhat different. For instance, in a surface burst the effect of thermal radiation is reduced by 25-50 per cent compared to that of an air burst. In a high-altitude burst (above 20 km) there is practically no blast owing to the low density of the air. As a result, practically all the energy of the burst assumes the form of thermal and initial radiation.

A nuclear explosion creates super-high temperatures which produce an extremely bright flash of very hot ionized air, a socalled fireball. About 0,0001 of a second after a one-megaton air burst the brightness of the fireball at a distance of 100 kilometres (in clear weather) exceeds that of the sun at noon in the tropics 30 to one. The thermal effect comprises a range of radiations in the visible and infrared spectra, which travel at the speed of light. That is why the flash of light and heat affect people and the environment before the blast. The effect of thermal radiation lasts while the fireball glows up to tens of seconds (in a 20-- kiloton air burst it lasts for approximately three seconds and in a 10-megaton burst---for about 10 seconds). The temperature of the radiation escaping from the luminous region ranges from 6,000° to 8,000° K. The light flash produces burns of exposed portions of the skin and ``flashblindness'' (in most cases the retina is affected). People looking in the direction of explosion will be temporarily blinded due to the effect of the visible components of the flash. For instance, a 10-megaton bomb detonated at an altitude of 15 km may cause sudden blindness in persons looking from a distance of 200 km /4/. First-degree burns result from the effect of thermal radiation flux having the intensity of about 3 Cal/cm^^2^^ whereas third-degree burns are caused by a flux of about 10 Cal/cm^^2^^. intensity. An air burst of a one-megaton weapon may cause third- to first-degree body burns in persons who are at a distance of 11 -16 km from ground zero.

Along with the direct effect of the luminous (thermal) flash upon people, fires caused by the flash or as a result of the shock wave will produce additional burn lesions, constituting another aggravating factor.

Under certain circumstances such fires can reach dangerous proportions, specifically in the event of so-called fire storms and

conflagrations. A firestorm results from numerous small fires merging into a single convective column of fire with a temperature exceeding 1,000° Centigrade, which moves rapidly inwards from the perimeter, I n the zone swept by a firestorm even people in shelters which withstood the impact of the blast could die from asphyxiation through lack of oxygen. It should, however, be noted that some authors believe that firestorms are not likely to occur in cities built up by modern structures.

In a conflagration the fire front moves outwards from the centre, spreading to new territory as long as there is material to fuel it. The area and the amount of damage caused by such fires may exceed those caused directly by the heat flash from a nuclear burst /4/.

The explosive blast is formed as a result of rapid expansion of gases in the fireball, whose pressure may reach a million kg per sq cm, and transmission of this energy to the atmosphere in the form of a powerful shock. At the moment of formation the blast propagates, in immediate proximity of ground zero, at a speed exceeding that of sound. The effect of the explosive blast is usually described in terms of the maximum overpressure of the shock front, although in most cases the actual parameter which makes it a factor of injury is the dynamic, or kinetic-energy, head.

If the overpressure of the shock front is 0.2 kg per sq cm or higher, people suffer injuries from it on open ground. The overpressure being 0.5 kg per sq cm, the blast strikes a person with a force of 2,500 kg. In the event of a one-megaton air burst people suffer grave injuries on open ground within a distance of five-seven kilometres.

Injuries of people caused by the blast are produced mostly by its throwing action. Thrown by the energy of the blast, the victim receives mechanical injuries upon impact with hard surfaces. In addition, the air stream violently hurtles the surrounding objects, resulting in various degrees of injuries among people, including fatalities.

Injuries resulting directly from the effect of overpressure on the human body are insignificant in number compared to those caused by the blast's throwing action or by wounds inflicted by flying fragments, debris etc. /5/. It should be noted that there is no direct dependence between the power of a nuclear burst and its effects, those of the blast in particular. In this case the socalled "cubic law" is applicable, which consists in the fact that the distance from ground zero at which the overpressure of the shock front is formed is proportional to the cubic root of the power of the burst, not to its actual power. Therefore, if the power of the burst is increased 1,000 to one (from one kiloton to one megaton), the distance at which the same overpressure (say, 1 kg per sq cm) is formed will be only 10, but not 1,000, 56

times greater than in the case of a one-kiloton bomb. Hence it is obvious that, other conditions being equal, the scale of damage and human losses caused by the blast of a one-megaton bomb over a city and of those inflicted by five 200-kiloton bombs will not be the same. Indeed, the area of lethal effect in the case of detonation of five such bombs will exceed almost two to one that produced by the explosion of a one-megaton bomb /4/.

Ionizing radiation, which is a characteristic feature of nuclear explosions, consists of a neutron flux, gamma radiation, beta particles and a relatively small quantity of alpha particles (which are of no practical significance in this case) produced by uranium and plutonium which have escaped fission or helium nuclei formed in the fusion reaction. The neutrons and part of the gamma radiation are emitted practically instantaneously at the moment of the nuclear detonation. They actually form the socalled initial nuclear radiation. It is generally assumed that the time of the greatest effect of gamma-neutron radiation is under one second. It follows that people caught in the zone of initial nuclear radiation are unable to take any active protective measures (i.e., take refuge in shelters, etc.). The rest of the gamma radiation and beta particles are the result of radioactive decay of nuclear explosion products. This is known as residual radiation (fallout) which consists of the radioactive products of a nuclear explosion in the form of a complex mixture of over 200 radioactive isotopes of 36 elements, their half-life ranging from fractions of a second to several million years.

The great penetrating power of initial nuclear radiation and the high biological efficiency of neutrons and gamma radiation determine their role as a potent effect of nuclear weapons. It should be mentioned that owing to the difference between the mean free path in the air of neutrons and that of gamma photons neutron intensity and, hence, dose of irradiation, drop at a faster rate than in the case of gamma radiation (as the distance from ground zero increases). Generally speaking, the irradiation doses of initial nuclear radiation depend on a number of circumstances, the most important being the type of nuclear weapon, its power and type of burst. The general rule is that the lower the yield of the weapon the greater the relative share of initial radiation (among other factors) in the overall effect of a nuclear explosion. This rule is particularly manifest in low-yield explosions, as illustrated by the following example. The yield of a nuclear bomb being reduced to one-thousandth (say from one megaton to one kiloton), the blast and thermal radiation effects distances correspondingly decrease to one twenty-fifth and one-tenth, whereas the initial radiation effect distance goes down to only one third /1, 2, 3/. It follows that the higher the yield of the nuclear weapon the lower the relative share of initial radiation in the overall effect of a nuclear burst, since the initial

nuclear radiation effect distance is overlapped by the deadly effect of thermal radiation and of the blast.

Still another effect of a nuclear explosion is residual radiation. In the main it is the result of fission of heavy nuclei. After the radioactive dust of the nuclear burst cloud containing these substances settles on the ground in the form of fallout they constitute a source of irradiation of people, flora and fauna. Only 57 grammes of fission products are created per kiloton of yield. However, one minute after the explosion their overall radioactivity is equivalent to that of 30,000 tons of radium.

Despite rapid decay (12 hours after the explosion the level of radioactivity drops to nearly one three-thousandths), nuclear burst products settling in the area of a ground or underwater explosion constitute a major hazard. Radioactive fallout is divided into two types---early (local) and late (global). The former is understood to consist of radioactive dust which precipitates onto the Earth's surface within 24 hours after the explosion. As is obvious from the term, global fallout is radioactive matter which settles all over the planet.

If a nuclear weapon is exploded at a height at which the fireball does not touch the ground, this is termed an air burst. In this case all the products of the explosion are carried off by upward currents of the air to the higher layers of the atmosphere and later partially to the stratosphere. Approximately seven days later these radioactive products gradually begin to settle on the Earth's surface in the form of global fallout, stratospheric halfresidence time ranging from 12 to 18 months. The radioactive particles deposited in the troposphere settle on the Earth's surface faster, their half-residence time being approximately one month /6/. If an air burst occurs in the Northern Hemisphere, approximately 70 per cent of the products settle on its surface, close to one-third depositing in the Southern Hemisphere as a result of stratospheric transfer. Owing to intensive dispersion of the radioactive products of an air burst by high-altitude winds, to rapid decay of short-lived radionuclides and relatively prolonged deposition of long-lived products, radioactive fallout resulting from such explosions does not constitute a highly perilous radiation effect to the population. However, the products of global fallout subject people to external and internal irradiation, thus being a source of prolonged small irradiation doses which may subsequently lead to so-called late radiation consequences (discussed in detail below).

The pattern of a surface (ground) or near-surface burst is different. In this case the nuclear weapon is detonated either directly on the surface of the Earth or at a small height so that the fireball touches the ground. The products of the explosion together with large masses of soil (a large portion of which is evaporated by super-high temperatures) are drawn in by the 58

fireball and then, after a series of evolutions, are deposited from the burst cloud in the form of radioactive particles of various dispersion, as the cloud moves together with the air masses. It has been calculated that if five per cent of the energy released in a surface burst of a one-megaton bomb is used for heating the ground, close to 20,000 tons of evaporated soil is drawn in by the fireball. In such explosions about 60 per cent of the radioactive products will settle on the Earth's surface in the form of local fallout. The area affected by this fallout is known as the radioactive plume. The remaining high-dispersion radioactive products are carried off into the higher layers of the atmosphere to be subsequently deposited thousands of kilometres away from the place of the explosion (global fallout). Calculations have shown that the radioactive plume of a one-megaton ground burst, bordered by the isolines of exposure doses within several rad*, may cover an area of several thousand square kilometres. For instance; when the USA exploded a 15-megaton thermonuclear device on the Bikini atoll on March 1, 1954, its radioactive products contaminated an area of 18,000 square kilometres in the Pacific Ocean.

People caught in the radioactive plume of a ground .burst may be subjected to three types of acute radiation hazards during several days after the explosion: external gamma and beta irradiation, contact, and internal irradiation. Under any circumstances the main radiation hazard determining losses in human life in the earliest period after the explosion will be external gamma irradiation. Its source is the area contaminated with decaying radioactive products /?/. As a result of the decay of short-lived radionuclides over 50 per cent of the total exposure dose of gamma radiation is formed already by the end of the first week after the explosion. During this period contact beta irradiation is possible too. It will affect mainly the exposed portions of the skin /7, 8/. According to some estimates, within the bounds of a radioactive plume in which the effective dose of external gamma radiation is only 20 rad, nuclear burst products deposited on the skin may build up an irradiation dose of up to 1,000 rad /9/. It follows that people in the local fallout plume may suffer from radiation burns on exposed parts of the body. Finally, the third type of hazard is internal irradiation mainly by radioactive isotopes of iodine, above all iodine-131, included in the ``young'' fission products of heavy nuclei /7, 10/. The dangerous period will last at least three weeks after the explosion. This radionuclide enters the body through milk from livestock grazing on pastures contaminated with radioactive

* For the sake of simplification, here and below units of radioactivity and irradiation doses are given in traditional terms and not in the new SI unit system

products. In this case irradiation will threaten above all the foetuses of pregnant women, and children especially, because they will consume whole milk with dangerously large quantities of iodine-131 which is selectively accumulated in the thyroid gland/10, 11/.

During the subsequent period (i.e., several months or even years after the explosion) it will be the long-lived radioactive strontium and caesium isotopes (^^90^^Sr and~^^137^^Cs) that will be the main source of internal irradiation of people in relatively small doses. These radioactive isotopes enter the human body through the alimentary tract with contaminated foodstuffs, such as milk, bread etc. /11, 12/.

time of the day. Thus, in a town or city at rush hour, especially in summer, when most people wear light clothes and are outside buildings, i.e., when they are least protected against the effects of a nuclear explosion, the losses will be higher than at night when they are indoors. The density of local fallout and, hence, the irradiation doses will be largely determined by the weather conditions, above all by the speed of high-altitude winds over the area of the explosion. It would be possible to name other conditions on which the effect of a nuclear blast depends. However, it should be particularly emphasized that in any case, under the most optimal conditions lessening the destructive effect of a nuclear explosion, the employment of nuclear weapons will lead to disastrous consequences for people and their environment.

Some Factors and Conditions Determining the Effect of the Nuclear Weapon

The effect of the nuclear weapon on people and their environment depends on a whole range of circumstances. We have already mentioned a few. Let us attempt to systematize our information on this matter.

The scale and specific features of the nuclear weapon's effect are mainly determined by:

---single and total yield of the nuclear weapons employed;

---type of nuclear weapon;

---type of nuclear explosion;

---character of target (town or rural area);

---ground relief (mountains or plain);

---population density and distribution in the explosion area or local fallout zone;

---degree of shielding available to the population and people's behaviour at the moment of the nuclear attack and in the subsequent period;

---time of the day, day of the week and season of the year;

---weather conditions.

Other conditions being equal, the effect of the blast, thermal radiation and initial radiation will be greater in a town or village situated on a plain than in an inhabited locality built on hill slopes. This is borne out by the sad experience of Hiroshima and Nagasaki. Though the yield of the atomic bomb dropped on Hiroshima was just over a half of that exploded over Nagasaki, the number of killed and injured was much higher, because the former is situated on a plain and the latter on the slopes of hills that jag the harbour. In the event of a nuclear attack losses in human life will largely depend on the element of surprise and the

IV

Main Medico-Biological Effects of Nuclear War, Their Classification and Authenticity of Estimates

the results of our own studies the effect is appraised only on the basis of the number of people killed or injured in population groups of hundreds of thousands to one million or more; several million; and tens and hundreds of millions. It would be expedient to distinguish between direct (immediate) and indirect effects of nuclear explosions on the population.

The direct effects on people, flora and fauna are produced by the effects of a nuclear explosion, such as the blast, luminous (thermal) radiation, initial nuclear radiation and residual radiation in the form of local radioactive fallout (caused by ground bursts).

These direct effects result in the death or injury of people caused by various mechanical injuries (multiple wounds, fractures, prolonged crush syndrome, etc.), burns of the body and eyes, acute radiation sickness and radiation syndromes.

Combined forms of such injuries may be observed in the nuclear explosion area. These effects also include late radiation consequences, such as more frequent malignant tumours and genetic disorders which may be caused by prolonged irradiation from radioactive fallout.

Indirect effects are those caused by the destruction or crippling damage of material and technical facilities, dislocation of the economy and the disruption of all the elements of social life.

Indirect effects or rather consequences of nuclear war will include famine, outbursts of epidemic diseases, a sharp rise in general somatic pathology (particularly of infectious etiology---tuberculosis, dysentery, hepatites, etc.), the development of various psychological and psychic disturbances and diseases both among people who have actually survived a nuclear attack and the residents of a country or region that has been drawn into a nuclear conflict. It is quite obvious that in an all-out nuclear war these consequences will also affect to a greater or lesser extent the population of countries not directly involved in the conflict (see below).

Among indirect consequences are cause-effect phenomena possible after the massive employment of nuclear weapons of an enormous total yield. We have in mind injuries inflicted on people and the animal and vegetable kingdoms by sharply increased hard (290-300 nanometres) ultraviolet solar radiation on the Earth's surface because of the disturbance ( depletion) of the layer of ozone in the stratosphere, etc.

Within the framework of our concepts it is important to distinguish between the early (immediate) and late ( longterm) medico-biological effects of a nuclear war.

Early consequences are essentially the results of direct effects of nuclear explosions within a relatively short period. It may be assumed that early consequences will make themselves

To give a consistent idea of the character and possible scope of the main medicobiological consequences of the use of nuclear weapons, it would be useful to examine them in greater detail. This will enable the reader to acquire a comprehensive view of the events that will inevitably follow from a nuclear holocaust. We hope that he or she will be able to form an objective opinion of the role and significance of these consequences for the life and health of people and the quality of their environment.

An estimate of the consequences of a nuclear war and their quantitative study should be based first of all on an analysis of the probable versions or models of nuclear attacks.

The information published on these questions /e.g., 13-16/ makes it possible to single out at least three hypothetical versions for the purpose we have in mind. We shall thus consider single, multiple, and massive nuclear attacks of great total yields. For instance, some authors /15-16/ have examined, as a version of a massive attack, a case when the belligerents exchange nuclear strikes with a total yield of 10,000-20,000 megatons.

In analyzing these versions we may differentiate for the sake of convenience between local, regional, and global effects of the nuclear weapon.

Judging by the available publications and 62

felt within two-four months following a nuclear strike. Late consequences become evident later---many months or even years after such an attack.

Genetic effects (which are among late consequences) will evidently be observed over a period of many decades, in a number of generations of descendants of the irradiated people.

Table 1 is an example of quantitative analysis of the structure and dynamics of the early consequences of nuclear explosions. It gives summarized data on losses suffered by the civilian population in Hiroshima and Nagasaki. The information has been taken from a report of the Atomic Bomb Casualty Commission /17/ (see Table 1).

An analysis of the data given in Table 1 shows that the number of people who lost their lives on the first day after the explosion amounted to one-third of the total number of people who happened to be in Hiroshima and Nagasaki at the moment of the nuclear attack. During the first four months the number of fatalities rose to 47-61 per cent. Out of the total number of fatalities during this period more than half of the cases (70.3-56.4 per cent) died on the first day after the nuclear explosions. Those who suffered from burns, wounds and irradiation, but survived the first day, made up in both cities approximately two-thirds of the total number of victims.

By the end of the fourth month the number of injured survivors constituted 52.9 per cent in Hiroshima and 39.1 per cent in Nagasaki of the total number of casualties among the population of these cities.

It follows that the immediate consequences of a nuclear attack are attended by the practically instantaneous death of large masses of people and the injury of a comparable number of people many of whom die later, in particular because of inadequate medical aid and treatment.

Somatic disorders induced by radiation within the range of from sublethal to so-called small doses are among the first on the list of late consequences.

These consequences should also include non-radiation injuries, wounds and burns, sicknesses that have caused disablement or death and that have been caused by mechanical injuries.

Skin cancers produced by the hard component of ultraviolet solar radiation can also be regarded as a possible late consequence.

Radiation effects of long-term character may be manifested among two dissimilar population groups of different size: (a) people who happened to be in the area of the nuclear explosion or on its plume; and (b) people who were beyond the direct

Table 1

Casualties and mortality for Hiroshima and Nagasaki

(Quoted from /17/)

Description

Number

Total

Total

of people

number

number

of

of

casual-

deaths.

ties, per

per cent

cent

HIROSHIMA

Total number of casualties

136,000

100.0

Died on the first day

45,000

33.1

70.3

Died after the first day

19,000

14.0

Died in the first four months

64,000

47.1

Living injured 1st day

91,000

66.9

Surviving casualties

72,000

52.9

NAGASAKI

Total number of casualties

64,000

Died on the first day

22,000

34.4

56.4

Died after the first day

17,000

26.5

43.6

Died in the first four months

39,000

60.9

100.0

Living injured 1st day

42,000

65.6

Surviving casualties

25,000

39.1

effects distance, but who were subjected to small irradiation doses by global radioactive fallout.

A thorough analysis of the late effects of the use of nuclear bombs in Hiroshima and Nagasaki carried out by WHO experts on the basis of numerous publications has led to the conclusion /4/ that all radiation consequences can be divided into the following three types: (1) effects for which a definite relationship to radiation exposure has been established; (2) effects for which there is a probable relationship; and (3) effects for which no relationship has been shown. Specifically, no radiation-related acceleration of ageing, suppression of immune response and fertility, or genetic effects have been observed. Experts believe, however, that these negative findings cannot be considered as establishing the fact that such effects do not exist. Such findings may mean that the sample sizes were not adequate or the indices of radiation effects employed in Japan were not sufficiently sensitive.

Among the late consequences, such as lenticular cataract, presenility syndrome, benign and malignant tumours and genetic defects, special attention is traditionally paid to malignant

5---1878 "•*

tumours in people affected by radiation and to genetic disorders in their descendants, when the effect of ionizing radiation is quantitatively predicted at population level.

According to the latest findings, there is no dose threshold for ionizing radiation to produce these effects, their probable incidence being linearly dependent on the irradiation dose.

Finally, ecological effects of a massive nuclear attack should also be classed as late consequences of a nuclear war directly affecting human life and health. These include possible homeostatic disturbances in natural associations, emergence of highly virulent mutant forms of microorganisms, insects, etc. It should be pointed out that this highly important question has practically not yet been studied. Therefore, it is necessary to display caution towards any quantitative appraisals in this field.

It should be mentioned that so-called indirect consequences of a nuclear war will gravely complicate the outcome of direct effects. They will apparently play a decisive role in an overwhelming number of cases both in the fate of the victims and in the restoration of the life and health of a human population.

Even a mere enumeration of the possible effects of the use of nuclear weapons on people and the environment gives a general idea of the vast range and variety of the severe and fatal consequences of a nuclear war for humankind and the biosphere as a whole. At the same time it is necessary to establish whether it is possible in principle to make credible appraisals of the consequences of a nuclear disaster for humankind.

An analysis of numerous publications and statements on the problem will call attention to the following. The qualitative and quantitative appraisals of the consequences of employment of nuclear weapons and the conclusions on the character and scope of these consequences differ widely and are quite contradictory. Leaving aside the nature of the premises and the reliability of the initial data for analytical estimates, and also the motives of some of the authors, the conclusions can be summed up as follows.

There is a widespread tendency to belittle or deliberately to ignore the possible scope and nature of the consequences of the use of nuclear weapons. This is graphically evidenced by the attempts of high-standing spokesmen of the US Administration and the US and other Western military circles to prove that the neutron weapon is practically ``harmless'' to the civilian population.

The following analysis objectively reveals the obvious tendentiousness or, to be more exact, mendacity of this conclusion.

Other authors sometimes conspicuously emphasize the quantitative and qualitative aspects of late radiological consequences and geophysical effects of a massive nuclear attack, neglecting the decisive role of the direct effects of nuclear warfare. This cannot but lead to biased and erroneous conclusions.

There is a third approach which wholly negates the need for such appraisals, because, its advocates say, a nuclear war will kill all life on the planet.

But there exist, and this is of central importance, unbiased, objective appraisals based on an analysis of thoroughly checked data and well-tested models, on generally accepted, at least for the present, scientific hypotheses and concepts.

The present authors are certain that this is the only sound approach to any discussion of this highly topical issue. At the same time it is necessary to point out that the present state of scientific knowledge in this field is such that far from all known, much less probable, consequences of nuclear warfare can be quantitatively estimated with adequate reliability. It seems necessary therefore to establish three categories of consequences (and also factors and circumstances contributing to them):

1. Consequences which in principle lend themselves to a quantitative description.

2. Consequences which are difficult to predict.

3. Consequences which are unpredictable.

It is important to emphasize the essential distinction between the effects of the use of nuclear weapons and those of nuclear war. The difference is above all a qualitative one, i.e. that apart from the infinite variety of initial assumptions about the nature of a nuclear war, its consequences depend on a,complexity of interacting factors, many aspects of which are unknown or unpredictable. For this reason, whereas it is possible to a certain, although limited, extent to describe the effects of nuclear weapons, any estimate of the consequences of a nuclear war is bound to be fairly speculative, at least for the time being.

An all-round systems analysis of the consequences of a nuclear war, which would cover the practically unexplored mutual influences of a multitude of factors and circumstances that might aggravate the character and scope of expected consequences and, perhaps, reveal effects heretofore unknown, is yet to be elaborated and discussed.

An analysis of the research findings based on broad scientific data and definite conceptions enables us to offer certain considerations about the present state of our knowledge of the problem. We can say, in principle, that the direct effects of nuclear weapons on people now lend themselves to a relatively reliable quantitative appraisal sufficient to obtain approximate data on the character and structure of the expected losses

among the population. At the same time it would be wrong to identify such estimates with concrete realities.

This conclusion is corroborated by the obvious fact that, in the event of a nuclear attack, the situation in the area of explosion or that of local radioactive fallout would be inevitably aggravated by many factors and circumstances, and in the context of our study it is impossible to make a rational quantitative appraisal of the negative role they would play.

Proceeding from the hypothesis that the action of ionizing radiation has no threshold it is possible at present to make a sufficiently accurate estimation of the extent of late radiation effects on the victims of irradiation or the population affected by fallout. At the same time our present knowledge enables us only to make assumptions as to the quantitative estimation of most of the indirect consequences of a nuclear war. However, there is no doubt that the incidence of general somatic diseases will soar among the victims of a nuclear conflict as a result of hunger, worsened housing and living conditions, lack of adequate medical aid and of many other negative factors which will be the rule rather than the exception in the tragedy which may befall human civilization.

Some works, for instance /16/, bring forth what we believe is a weighty argument: science does not yet know all the possible consequences of the massive employment of nuclear weapons in war. As of today the number of unpredictable effects is supposed to be approximately equal to the number of those already known.

It follows that in the interpretation of quantitative scientific data on the entire range of the medico-biological effects of nuclear war it would be advisable to regard the pertinent information, owing to many uncertainties, as the lowest limit of a realistic range of estimates.

V

The Neutron Weapon: Its Main Physical Characteristics and Some Medical Effects

On the sixth of August 1981, thirty-six years to a day after the atomic bombing of Hiroshima, the President of the United States, in a gesture cynically trampling on the memory of its victims, announced the decision to begin full-scale production of the neutron weapon.

The apologists for the new barbaric weapon of mass destruction have been doing their utmost to mislead the peoples about the magnitude of the danger involved in this decision and to prevent them from realizing the gravity of the situation and the need for all men and women of good will actively to oppose it. The militarists are trying to persuade the world that the decision taken was almost routine, a matter of modernizing weapons already in the Pentagon arsenal and a purely internal affair for the United States.

There is truly no limit to the cynicism of top Washington officials and their NATO accomplices who are going out of their way in futile and absurd attempts to prove the `` humaneness'' of this weapon, asserting that it is completely harmless for civilians. For instance, one of the Pentagon generals went as far as to say that a neutron weapon explosion would not even make china tinkle in the cupbords in the houses of a nearby village. In the same fashion the former director of Springer's Die Welt Herbert Kremp wrote in that paper that after the

use of the neutron bomb "the beauty of Dresden would remain intact despite the death of its inhabitants". His words are echoed by the paper Welt am Sonntag, also belonging to Axel Springer: "The new bomb (i.e. the neutron weapon---Ed.) kills men while leaving intact the surrounding objects. It piles up mountains of corpses, without any outward sign of injury, inside skyscrapers, factory buildings and tanks" (quoted from /18/). In sharp contrast to such cannibalistic assertions, the West German philosopher K. Bloch angrily denounced the new weapon: "One is haunted by the thought that the neutron weapon is intended not against the enemy but against people in general. In our society man is becoming superfluous. Unemployment and rationalization of production make a substantial portion of human labour resources unnecessary. Aren't we in danger of finding ourselves one day in a situation when this weapon will be used to kill millions of people who have become deadwood for society?" (quoted from /18/).

The development and production of the neutron weapon in the United States is without-doubt another of Washington's "pioneering achievements" in the nuclear arms race.

What are the real facts about the neutron weapon? What are its real physical characteristics? And the real medical effects of its possible use?

The neutron weapon, designed to destroy human life with the help of initial radiation, achieves this cannibalistic aim by sharply increasing the intensity of high-energy neutron radiation as a result of nuclear fusion reactions which, in turn, are initiated with the help of the fission reaction.

As was noted in the report of the International Committee of Experts in Medical Sciences and Public Health /4/, neutron bombs are deliberately designed to kill living organisms by radiation.

The neutron weapon is a variety of the nuclear weapon which functions on the fission-fusion principle. In this weapon nuclear fission reactions, which release temperatures of the order of tens of millions of degrees, initiate the fusion of light nuclei. Reactions of nuclear fusion, which form the basis of this weapon, consist in the interaction of deuterium and tritium ions, releasing neutrons with the energy of about 14 million electron volts (mev). Since the yield of a nuclear weapon is within the kiloton range /19-24/ this is actually a minithermonuclear bomb with a minimum loss of neutrons. We may recall that the smaller the power of the nuclear bomb the greater the relative effect of initial radiation. The increased yield of neutron radiation in this type of weapon is conditioned by the fact that a fusion reaction releases about ten times more neutrons than a heavy-nucleus fission reaction (n-10^^24^^ and n-10^^23^^ per kiloton respectively). It should also be remembered that fusion neutrons have an energy

that is nearly seven times greater than that of fission neutrons (-2 mev). Therefore, they spread over greater distances, have greater power of penetrating various obstacles and thus form greater irradiation doses.

These characteristics determine the ``advantages'' of the neutron weapon which certain Western circles choose to call an "enhanced radiation weapon". This is simply an attempt to disguise a nuclear weapon as a conventional one in order to eliminate the fundamental distinction between them and thus to lower the existing nuclear threshold.

Various estimates /19-23/ show that from 30 to 80 per cent of the energy of a neutron weapon is released in the form of neutron radiation. The distribution of energy depends on the ratio between the fission and fusion reactions. Thus, in various neutron weapons this ratio may be approximately 50:50, 40:60, or 25:75. In particular, the neutron warhead of the US Lance missile uses 40 per cent of the energy for the blast and 30 per cent for initial radiation /21 /. A simple calculation shows that in the case of a one-kiloton warhead 0.4 kiloton is used for building up a blast equivalent in power to 80 five-ton highexplosive (TNT) bombs. Therefore, the neutron weapon is a nuclear weapon which also has effects other than initial radiation.

More than that, neutron activation resulting from a neutron bomb explosion in the surface layer of the soil, in metal articles and structures, in foodstuffs, etc. will be approximately ten times higher than that produced by an atomic explosion of equivalent yield. It was reported /22/ that the survivors of the atomic attack on Hiroshima and the rescue teams might have received a doze of about 130 rad of secondary (or neutron-activated) gamma radiation in the two days they had spent in proximity of ground zero. It should be mentioned that the 12.5-kiloton bomb dropped on Hiroshima produced a higher level of neutron radiation than the 22-kiloton bomb of a different design exploded over Nagasaki.

The main effect of the neutron weapon is initial radiation consisting mainly of fast neutrons and gamma photons. For instance, the irradiation dose beyond the blast and thermal radiation distance (150-300 metres) may reach a level of hundreds of thousands of rad in the open. It should be recalled that the minimum lethal dose of neutron irradiation for man is about 300-400 rad.

Among the various types of ionizing radiation produced by nuclear explosions, neutron radiation has the most marked biological effect. This is above all conditioned by the specific interaction between neutrons and biological tissues and structures. Since neutrons carry no electric charge, they do not directly ionize or excite atoms as they pass through a substance.

lonization and excitation are activated indirectly through the scattering and capture of neutrons by nuclei of various atoms, hydrogen above all. Depending on the energy spectrum, a wide range of interaction reactions occurs between these particles and the atomic nuclei of biological structures.

Fast neutrons interact with biological structures in various ways. They mostly participate in elastic-scattering reactions of light nuclei with the escape of recoil protons which are densely ionizing particles. This reaction forms 70-80 per cent of the total absorbed dose in the tissue /25/. Thus, man is here exposed to densely ionizing radiation, i.e. radiation that releases high levels of energy per unit of path travelled in the tissues of the body. It is also necessary to mention the capture of neutrons by some atomic nuclei of biological structures. Such reactions give rise to so-called induced radioactivity in the human body (for instance, ~^^24^^Naand~^^32^^P).

In examining the biological effect of neutron radiation it should be borne in mind that, as compared to gamma radiation--- the second major component of prompt radiation caused by a nuclear explosion---neutrons are characterized by a more injurious effect at all levels of biological organization, from the molecular level to that of an organism. This is determined by the powerful depressing effect of neutrons on the cells of the tissue proliferative pool and the deeper damage of the molecular mechanisms which make up the genetic apparatus of somatic and sex cells. When tissues have been affected by neutrons, the process of recovery is slower and qualitatively inferior than in the case of gamma irradiation. These specific features condition a graver clinical pattern and less favourable outcome of acute neutron injuries and the high biological effectiveness in inducing late radiation effects in victims and their descendants. Thus acute radiation sickness caused by exposure to neutron radiation is characterized by more severe clinical manifestations and a more severe course than in the case of gamma and X-ray radiation. The recovery processes in the organism as a whole are slower, and treatment of this type of pathology is, unfortunately, less effective. An important point should be emphasized here. Should the neutron weapon ever be used, its nuclear radiation will affect people in a very broad range of absorbed radiation doses, differing by 5-6 orders of magnitude.

One of the main objectives of the aggressor using this barbaric weapon is to make the exposed people instantly lose their ability to act. To achieve this aim the victims have to receive superlethal doses of rad iation or, put figuratively, doses that kill a man before he is dead. The practically instantaneous loss of a person's ability to act comes as a result of exposure to radiation in doses which cause the so-called cerebral, or brain form of radiation sickness. American experts estimate that such dose

rates are within the range of 3,000 to 8,000 rad and more /26/. When the central nervous system and above all the brain tissue are thus affected, people experience loss of coordination of movements (ataxia), shock, convulsion, and coma. Depending on the level of exposure, the fatal outcome may occur in a matter of several hours or a few days. Only the neutron weapon is capable of having such effects. In the case of ``normal'' nuclear weapons of similar yield the zone of superlethal radiation injuries is superceded by the action of the blast wave and flash, and the suffering of people comes to an immediate end due to lethal burns and mechanical injuries.

At lower doses (1,000-3,000 rad and less) produced by the use of the neutron weapon people will receive acute radiation injuries of various degrees of severity and suffer from many irreversible pathological effects. For example, the available data concerning the biological action of neutrons indicate that they have an extremely dangerous effect on the organisms of living creatures; among human beings it could mean the development of such pathologies as cataracts of the lens of the eye, malignant tumours and leukemia, and genetic defects. In this respect, according to the estimates of various authors and authoritative research organizations which have looked into this problem, the neutrons are five-ten times more effective than gamma radiation. Based on several considerations one can assume that in relation to its ability to induce these pathologies in people nuclear radiation from neutron weapons, consisting of neutrons and high-energy gamma rays, will be about seven times more dangerous than ``standard'' gamma radiation. For the same reasons exposure to neutron radiation, compared with gamma or X-ray radiation, is more dangerous for embryos and foetuses in utero. Despite the still insufficient data as regards this question it can be confidently asserted that depending on the dose received by the mother children who were exposed to neutron irradiation in utero will be affected by a broad range of biological (teratogenic) effects, from death to various malformations and defects. In the opinion of the noted British geneticist J. Edwards, the special aspect of the neutron weapon is that its mutilating effect on man is not limited in time, and even several generations after its use children will be born with various radiation-induced malformations. In other words, the neutron weapon is, to a significant degree, a genetic weapon.

Table 2 gives a general illustration of our survey of expected medical effects of the neutron weapon on people.

In appraising any possible medical consequences of the use of the neutron weapon it is essential to proceed from the fundamental proposition that the civilian population will inevitably become its victim. Anyone with a sober approach to contemporary reality, even though uninitiated in military affairs,

Table 2

population density, the distance between two neighbouring towns or villages often being no more than one or two kilometres.

In the light of these circumstances and of the published data /19-21, 24 et al./ on the radiation-effect distance of a onekiloton neutron weapon one can easily see that the absolutely lethal irradiation zone will have an area of about eight square kilometres around ground zero. Further, the area of the circle in which the irradiation doses will range, say, from 1 to 100 rad will be 10 square kilometres, etc.

There is a hypothesis about ionizing radiation having no threshold. In this connection it would be appropriate to recall that late radiation effects may result from infinitely small doses. Taking into account the great nuclear radiation effect of the neutron weapon it is clear that even small radiation doses will affect people very seriously.

The above examples give only a general idea about the levels of irradiation doses produced by an explosion of only one onekiloton neutron warhead and the corresponding effects zones.

Should one try to correlate these estimates of one hypothetical explosion with the realities of a military conflict with the employment of many neutron weapons, not in an uninhabited wilderness, but over a territory with a dense population, one should surely realize that talk about the neutron weapon being harmless for the civilian population is totally absurd.

In his paper "The Neutron Bomb and the Related Doctrine" /22/ Dr. J. Miettinen, a Finnish authority on radiation protection, writes that if troops take cover in urban zones from which the civilian population has not been evacuated, the effect of the neutron weapon on the civilian population will be far more injurious as compared to that of the atomic weapon of equivalent yield. The number of civilians killed will double, whereas the survivors will suffer from much higher irradiation doses.

In the event of massive use of neutron weapons, even if the explosions are spaced at intervals of 2-3 km, the radiation level in the whole area covered by the explosions will be sufficient to give a lethal dose of neutrons to all persons caught in the open /4/.

The book by F. Di Pasquantonio /23/, which is mostly devoted to the analysis of the political and military consequences of the development and use of the neutron weapon, provides the following estimates and calculations. The radiation dose on the ground at a distance of 400 m from the centre of a 1 - kt neutron weapon explosion will be about 418,000 rad. It follows that even people in a protective shelter with the shielding factor of 500 will receive a dose of 836 rad, which is about twice as high as the minimum absolute lethal dose. Furthermore, the author makes a reasonable assumption that

Some data on the effects of the neutron weapon

/22, 23, 26/

Distance from Approximate

ground zero of a 1 radiation

kt neutron weapon doses

explosion (metres) (fad)

Effect on people

700 16,000 Instantaneous and complete loss of physical

and intellectual activity. Agony of death lasting 1 -2 days.

8,000 In a few minutes man completely loses capacity for acting. Those irradiated are doomed to die in 2-6 days.

1,400 650 Irradiation results in severe malfunctions of the

organism in about an hour following the explosion. Death caused by acute radiation disease follows after 2-3 weeks

1,700

150 About 10 per cent of those injured may die within several months. Among the rest there will be a higher incidence of malignant tumours and leukemia, which may develop after 15-25 years.

2,300

15 Radiation disease does not develop Subsequently some of those irradiated are likely to develop malignant tumours or leukemia Negative genetic consequences may occur in several generations of the descenda nts of those initially exposed.

will clearly see that the position upheld by the apologists of this allegedly "most humane" weapon is untenable. In actual fact this is the most sophisticated and inhuman weapon. They claim, however, that it is designed only to destroy enemy military personnel while guaranteeing the preservation of the life and health of the civilian population.

Let us analyze some of the pertinent facts.

The USA intends to deploy the neutron weapon in Western Europe. According to the press, there are 380 neutron warheads for the Lance missile and 800 rounds for heavy howitzers.

If the neutron weapon is used, its employment will certainly not be limited to a single bomb. Some authors maintain that hundreds or even thousands of such weapons will be exploded /20, 21/.

Western Europe has a high degree of urbanization and

groups of civilians who, by a happy chance, have avoided acute irradiation in injurious closes would be moved by humanitarian concerns to attempt to reach their houses and find out about the fate of their relatives caught in the effects zone. Mr. Pasquantonio believes that such people, who will appear in the zone after a relatively short interval of time at a distance of, say, 200-400 metres from the point of detonation, would within 2 hours spent there be exposed to doses of radiation (caused by neutron-induced radioactivity) amounting to 1,400-300 rad.

Such are some of the estimates independently obtained by scientists from various countries, convincingly confirming the indisputable fact that, should the neutron weapon be used, the civilian population will become its victim.

The nature of its effects makes the neutron weapon in a way akin to chemical and biological weapons.

The neutron weapon is also, in a way, an ecological weapon*. The data cited above also make clear that the neutron weapon is at least as dangerous as the chemical weapon, the use of which is banned by the 1925 Geneva Protocol.

Article 23 of the Hague convention on land warfare bans the infliction upon people of senseless suffering through the use of means of warfare which have no advantage over other means of destruction.

The neutron weapon in effect nullifies this convention.

The above rather brief analysis of the radiation pathology caused by the neutron weapon gives an idea of the sufferings that will be experienced by the victims of this sadistic weapon.

The record of wars in the twentieth century, and particularly of the Second World War and the war in Vietnam started by the United States, demonstrates that the rule of international law that "no harm should be caused to the civilian population" has not been observed. On the contrary, civilians have often been victims of bombings with terrible consequences.

One thing should always be remembered regarding the neutron weapon: the particular decision regarding its direct use could be left to the discretion of commanders on the spot. Therefore the use of the nuclear (neutron) weapon may become a routine and thus more probable. Let us again recall that the deployment of neutron weapons in Western Europe will drastically lower the nuclear threshold.

The ``pure'' neutron bomb has already contaminated the political climate in Europe and in the whole world. In the future the neutron weapon may become one of the most merciless means of mass annihilation of people.

* For example, the American scientist A. Westing estimates /27/ that an explosion of a 1 -kt neutron weapon would destroy or damage 310 hectares of coniferous forest, 170 hectares of deciduous forest, and 140 hectares of grassland. It would take centuries to restore the ecosystems thus affected.

VI

Possible Early Medical Consequences of the Use of Nuclear Weapons

At first glance it may seem ironic that medical scientists from various countries are actively involved in studying issues relating to the quantitative aspect of the expected consequences of the use of nuclear weapons that would affect people and the environment. Indeed, the physicians' fundamental task is something entirely different, i. e. prevention and treatment of disease, and more recently also active involvement in studying the problem of individual health and the general health of the population. The irony, however, is only apparent, for the famous maxim that "nuclear war is the final epidemic in the history of humankind" is not an empty phrase but a statement based, in particular, on an objective assessment by medical scientists of the consequences that thermonuclear catastrophe would have for the inhabitants of the Earth. The self-evident truth that, in order to combat a disease effectively, one has to know its cause acquires a special meaning when the object of discussion is nuclear war and its consequences for humankind and the environment.

For physicians, who know more than anyone else what death and human suffering mean, understanding the nature and magnitude of the consequences of the use of nuclear weapons is of critical importance in shaping their public stand and making their own professional contribution to the struggle against nuclear war.

In recent years numerous papers and reports have been published in many countries, discussing the consequences of the possible use of nuclear weapons /13-16, 28-30 and many others/.

The present authors base their discussion of the problem, which concerns above all the immediate medical effects of nuclear explosions, mostly on the results of their own research. The data they obtained in the 1981 -1983 period were reported extensively to the first, second and third congresses of International Physicians for the Prevention of Nuclear War and discussed in a number of scientific papers /31 -35 et al./.

Finally, the book also uses material from the report of the International Committee of Experts in Medical and Public Health, "Effects of Nuclear War on Health and Health Services" /4/, to which one of these authors contributed research data.

The logic of our research consisted in an orderly assessment of the expected immediate medical effects (fatalities and injuries) among population as a result of the detonation of a single nuclear weapon of a definite yield over a modern city; study of the effects of massive nuclear explosions in the event of conflict on the European continent; and, finally, estimate of possible casualties among the Earth's population as a result of an all-out nuclear holocaust. One may presume that these assumptions cover most of the possible spectrum of events or that any hypotheses of the use of nuclear weapons are likely to result in medical effects within the range of estimates given below.

The methods of calculation and tabulation of data used here are based on /1 -3, 28, 36/.

It is obvious that the objectives of this research required assumption of certain variants or, as they are called in the West, scenarios of nuclear war. Indeed, there is no lack of such scenarios in the foreign literature /e. g., 15, 16, 28 et al./. In particular, one such US scenario /16/ is based on a hypothetical exchange of nuclear strikes between the belligerents (the US and the USSR) in the Northern Hemisphere, with one-megaton nuclear explosions having a total yield of 10,000 megatons (described in greater detail below). One should bear in mind that such total power of nuclear explosions is equivalent to that of about 800,000 atomic bombs of the kind that destroyed Hiroshima on the morning of August 6, 1945.

Expected Casualties as a Result of a One-Megaton Nuclear Explosion Over a City with a Population of One Million

In our analysis we have examined a hypothetical single nuclear strike of great power (one megaton) at a modern city with a population of one million. We analyzed two types of nuclear explosion: air and surface bursts. Each of these was to have occurred over the centre of a token city with an area slightly more than 300 square kilometres with a uniform population density of 3,200 per square kilometre. The attack was to be carried out in daytime, in clear weather in summer, 10 per cent of the city residents being outdoors and 90 per cent in buildings.

A surface burst would inflict losses not only with its blast, thermal radiation and initial nuclear radiation, but also by radioactive fallout (plume) which will cover a considerable area downwind from ground zero. Therefore, radiation will affect a considerable part of the population in suburbs and inhabited localities far beyond the effect distances of the blast, thermal radiation and initial nuclear radiation.

The radiation effects examined included cases of acute radiation sickness of the first-fourth degrees and late radiation consequences, such as malignant tumours and genetic effects produced only by gamma radiation from the ground contaminated with nuclear explosion products. Radiation pathology caused by exposure of the skin to radioactive substances and the entry of these substances into the human body was not quantitatively appraised.

The above effects were studied in terms of the expected distribution of gamma radiation doses over the area of the radioactive plume, these doses causing radiation sickness of varying degrees and late consequences. It was assumed that 60 per cent of the nuclear explosion products of a one-megaton burst would be deposited on an elliptically shaped radioactive plume. The high-altitude wind speed was taken to be 50 kilometres per hour. The entire area of the plume was to have a uniform population density of 70 per square kilometre.

It follows from the above that the number of people expected to be affected by acute radiation sickness of the first-fourth degrees would be directly proportional to the contaminated area and population density.

The incidence of expected late consequences was estimated on the basis of collective dose and risk values characterizing the inducement of these consequences (see Chapter XII).

Gamma radiation from ground contaminated with local

fallout constitutes the main hazard. The actual doses of gamma radiation the people will get in the contaminated area will depend on the duration of their stay on open ground, in buildings or structures. This is because various barriers (such as materials of which buildings are made) lessen the intensity of gamma radiation to some degree or another. Therefore, to establish the actual irradiation levels in this case it is necessary to allow for a so-called mean diurnal shielding factor (C). This factor takes into account the behaviour pattern of people, i. e., the time they spend outdoors and indoors, and also the degree in which the intensity of gamma radiation is weakened in various buildings, i. e., in brick or wooden houses.

Thus, it follows that for a person exposed to radiation outdoors in the area of the radioactive plume for 24 hours the mean diurnal shielding factor will be 1. For instance, if C is equal to 5, the actual dose is one-fifth of that in the open for a given period of time.

Our calculations were based on two C magnitudes---1.5 and 5.

Table 3 gives the estimated effects of a one-megaton nuclear explosion on the population of a token city with a population of one million.

radiation injuries, because the blast and thermal radiation distances overlap the initial radiationeffectdistance. However, it may be assumed that 3-5 per cent of the injured will suffer from acute radiation effects which will not only make it more difficult to diagnose them among persons with non-radiation injuries, but will for the most part seriously complicate the course and outcome of the main injuries, such as burns, wounds and their combinations.

In addition, account should be taken of the fact that the appearance of multiple warhead missiles has made it necessary to consider bursts of relatively low yield when assessing the effects of nuclear strikes on civilian population/5/. This is due to the fact that with nuclear explosions of lower power instantaneous radiation becomes a more significant factor, causing death or injury where there is no change in the overpressure of the shock front (see Chapter III). Therefore the pattern of casualties among population under such circumstances will differ substantially from data presented in Table 3, due to greater numbers of casualties caused by radiation injuries and multiple injuries aggravated by radiation.

In the event of a surface burst total casualties will be somewhat smaller (two-thirds of those caused by an air burst), mainly because of fewer fatalities.

The above regularities in the pattern and numbers of losses coincide in principle with those quoted in other works /14, 30, 37 et al./. Minor discrepancies are not of fundamental importance if we take into account the general difficulties encountered in making such estimates.

It has already been pointed out that, as distinguished from an air burst, a surface burst produces a strong additional effect, namely, residual radiation in the form of local radioactive fallout. Table 4 gives the main estimates characterizing this effect on people caught in the radioactive plume. It gives figures on possible radiation casualties (differentiated with respect to various degrees of radiation sickness, including the fatal cases) depending on how the people were shielded at the time of the explosion.

A number of conclusions follow from.an analysis of the data given in Table 4.

First, if factor C is equal to 5, the population of an area of 2,800 sq km may be afflicted by acute radiation sickness of various degrees, the area of lethal effect being 900 sq km. It is obvious that if the mean diurnal shielding factor is lower, the area will grow and so, consequently, will the number of deaths and injuries. Thus, it follows from Table 4 that, if factor C is equal to 1.5, people inhabiting a contaminated area of up to 7,200 sq km will suffer from acute radiation sickness, the lethal effect zone reaching close to 2,250 sq km.

6---1878 81

Table 3

Estimated effects of a one-megaton nuclear explosion on a city with a population of one million

(thousand people)

Categories of population

Air burst Surface burst

Fatalities by the end of the first day

Injured,

including

thermal injuries mechanical injuries thermal injuries combined with mechanical injuries

Uninjured

310 380

150 200

30 310

200 350

90 230

30 450

It follows from the table that in the event of an air burst the total toll of life from all explosion effects would be of the order of 310,000. One hundred and eighty thousand people will suffer from burns and burns combined with mechanical injuries. Two hundred thousand people will receive various wounds. Thus, the number of people in need of medical aid will be 380,000, or more than one-third, and the total number of victims will exceed two-thirds of the population of one million. In the case of a highyield air burst over a city there will be practically no "pure"

Table 4

Estimated number of acute radiation injuries caused by early local fallout after a one-megaton surface nuclear explosion

exposed to the hazard of irradiation of the thyroid gland through the consumption of milk contaminated with iodine-131. In some cases this radiation hazard may prove to be the main one. In estimating the late effects on people caught in the radioactive plume of a hypothetical one-megaton burst its outer dose contour was arbitrarily set at 20 rad, calculated up to the theoretically complete decay of nuclear explosion products. Th is corresponded to a radioactive plume area of the order of 15,000 sq km with a population of about one million. According to our forecast, 75 per cent of the total number of fatal malignant tumour cases and of genetic disorders caused by this surface burst would be observed among the members of this community. This means that the remaining 25 per cent will occur at greater distances from ground zero and will correspondingly be caused by even smaller radiation doses.

These estimates have finally shown that C (mean diurnal shielding factor) being a stable 5, a total of about 24,000 people will suffer from late radiation injuries and, C factor beinq 1 5 about 53,000.

Summing up these estimates one would arrive at the conclusion that the pattern of human losses resulting from a high-yield surface burst differs greatly from that caused by an air burst. In the former case the number of victims suffering from radiation injuries who were beyond the blast, thermal radiation and initial nuclear radiation distances will sharply increase, because they will be subjected to large irradiation doses from local fallout.

A comparison of the figures given in Tables 3 and 4 will show that the overall number of people injured as a result of a surface explosion may reach 550,000 (factor C being 5). In addition to the 200,000 people who will die in the city on the first day after the attack, another 63,000 caught in the area contaminated with local radioactive fallout will die of acute radiation sickness.

It would be appropriate here to point out certain peculiarities of the irradiation of people, as well as animals, in areas contaminated with radiation. The formation of absorbed doses from external radiation and radionuclides incorporated in the body will depend on several factors, i. e., the specific density of radioactive contamination of the environment, isotope composition of the products of nuclear explosions, and the source from which those products enter the body.

In such cases, as noted above, the main component of radiation causing early effects will be the prolonged external irradiation whereas late effects will mostly be caused by gradual formation of the total dose from internal sources /4, 7, 50/.

Expected total dose rates which do not cause immediate fatalities will nevertheless be a significant factor both in producing symptoms of chronic radiation disease among a number of

^^6^^ 83

Degree of radiation sickness

Area of radioactive plume and casualties depending on various magnitudes of C

C=1.5

C=5

Area, sq km

Casualties, thousand

Area, sq km

Casualties, thousand

I

2,800

1,120

II

1,910

III

IV

1,840

Fatalities

2,250

Note: The casualty figures are given to the nearest thousand

Second, in keeping with the above calculations, population density being 70 per sq km and C being 5, the number of victims will reach nearly 200,000 of whom about 63,000 will die (unless they receive medical aid) one or two months after the nuclear attack. If C is 1.5, nearly 500,000 people will suffer from acute radiation sickness of various degrees with about 160,000 fatal cases.

These tentative estimates reveal the role of shielding in decreasing losses among the population from acute radiation injuries.

In making a comprehensive estimate of the immediate radiation effects of a surface burst it is necessary to take into account not only contact irradiation of the skin but also internal irradiation.

Without going into details we should like to point out that dairy cattle grazing mostly on pastures contaminated by radioactive fallout (with particles ranging in size from 40 to 100 mem) may constitute the "iodine hazard" (see Chapter XII). It follows from /38,39/ and our research data /10,11 / that there is every reason to believe that in zones contaminated with radioactive fallout from a surface burst, where effective gamma radiation doses are below 100 rad, the thyroid gland of children consuming the milk of cows and goats may get irradiation doses of several thousand rad (according to some estimates, even tens of thousands of rad) /39, 40/. All tentative estimates and predictions, including the above given, should be regarded as more or less credible illustrations of the main thesis that the population, particularly children, expectant mothers and newborn infants who find themselves in the area of the radioactive plume, is

people thus affected and, particularly, in producing diverse late consequences of exposure, especially tumours.

It can be assumed on the basis of experimental material /52, 54, 55 et al./ that the combination of external irradiation at changing rates of exposure and of the effects of internal sources will expand the range of immediate clinical symptoms, prolonging and slowing down the processes of recovery, as after a shortterm external irradiation. Finally, it will result in more varied and frequent pathological manifestations of remote effects of irradiation.

The material contained here supports the fundamental conclusion that a single air or ground nuclear explosion will result in disastrous casualties among the population.

Early Medical Effects of a Nuclear War for the Population of the European Continent

It is a fact that Europe has long been a region with one of the highest concentrations of weapons, including the most destructive weapons. There is hardly a place on Earth where arms arsenals are so excessively overstocked. And yet ever new and increasingly destructive weapons are being added to the existing stocks.

Europe is being prepared for the use of neutron and chemical weapons in warfare. The most modern medium-range missiles, which form part of the US first-strike potential, are being brought here. The US leaders believe that the stationing in Europe of hundreds of modern missiles will make it possible to attain political objectives in a ``limited'' nuclear war on the European continent without letting it escalate into a global nuclear war and avoid massive retaliatory nuclear strikes against US territory.

We proceed from the premise, which for us is self-evident, that the doctrine of limited nuclear war is unrealistic. The logic of a modern nuclear conflict renders futile any hope of containing a nuclear war within local limits. It is also clear that the use of any territory for the stationing of strategic-purpose arms inevitably draws the country concerned into a confrontation between the nuclear powers, wherever such a confrontation may take place.

The present generation's idea of the destructive consequences of the use of nuclear weapons is mainly based on the atomic bombings of Hiroshima and Nagasaki by the United States. The tragedy of their inhabitants, however, is only remotely comparable to the nature and magnitude of the consequences humankind would face should a nuclear war break out in this day and age.

The nuclear bombs that were detonated over the two Japanese cities with the interval of three days on August 6 and 9, 1945 had the power of 12.5 and 22 kilotons, and at present they would therefore be classified as low-yield weapons. The consequences of these barbaric bombings, not dictated by any military need, are well known. Still, the survivors could count on outside help that the state was in a position to provide, for Japan's economic and human resources, the country's infrastructure, were not affected to such an extent that the victims of Hiroshima and Nagasaki would be completely abandoned. Using present-day terminology, Japan could be said to have been a target of a limited nuclear strike.

At present the total destructive power of the nuclear weapons accumulated in the world is equivalent to several million atomic bombs of the kind used against Japan while the power of single nuclear weapons can be as high as tens of megatons. One nuclear-missile submarine carries nuclear explosives with a destructive power substantially exceeding the total yield of all the weapons detonated throughout the history of wars since the invention of gunpowder. One nuclear-missile submarine of the Ohio class, for instance, carries 24 Trident-1 missiles with a total destructive power of 19,200 kt /41 /, i. e. 600 times as great as the bombs used against Japan. In one salvo the Ohio can hit about 200 targets, delivering to each of them a strike five times more powerful than the one which destroyed Nagasaki.

In the event of massive use of nuclear weapons brought to target by various delivery vehicles, the concept of national borders, as well as the words "outside help" will for all practical purposes become meaningless.

These authors are not military men or politicians. They proceed from an objective premise that once a nuclear conflict has broken out it will inevitably and promptly escalate into a global nuclear catastrophe. The objective of this chapter is to attempt to give a general idea of the immediate effects of a nuclear war for the population of the European continent inhabiting the area from the Atlantic coast to the Urals.

As noted in the report of the United Nations SecretaryGeneral published in 1980 /42/, with reference to a US source /43/, the objective of a massive nuclear strike against the main sources of enemy power will be to destroy the very basis of existence of an entire nation by wiping out industrial facilities and major centres as well as a substantial portion of the population.

It is believed in the United States that such a strike should inflict "unacceptable damage" to the enemy, which former US Secretary of Defense Robert McNamara interpreted to mean the destruction of one-fourth to one-third of the population of a

major industrial power (emphasis added) and the destruction of one half to two-thirds of its industrial potential (quoted from

This concept forms the basis for a hypothetical attack described in the above-mentioned report, whereby nuclear strikes with the total destructive power of 303 Mt are aimed at 200 major cities and industrial areas of the Soviet Union. The authors of the report estimate that in such an attack the number of casualties among the population of the USSR would total many million.

Let us recall that in World War II ``only'' 5 million tons of TNT were detonated; the figure cited above is sixty times higher.

It is appropriate to recall here that such concepts of using nuclear weapons for the destruction of the Soviet Union's industrial potential (and hence the country's human resources) were developed in the United States long before McNamara. The reality of those threats has been confirmed by the recently declassified documents from US archives. Document 329 of November 3,1945, issued by the Joint Intelligence Committee, contained a targeting plan identifying 20 most important targets for strategic nuclear bombing in the Soviet Union. Directive 432 D of December 15, 1945 of the Joint War Plans Committee estimated that with 196 atomic bombs the United States would be capable of delivering such destruction upon the industrial sources of military power in the USSR that a desision could eventually be obtained (quoted from /44/). One shudders to think that those plans were being drafted at a time when the guns of World War II, in which the United States and the Soviet Union were allies, had just become silent, and when the survivors of Hiroshima and Nagasaki had not yet had time to count all those who died, were mutilated or struck by radiation disease.

To obtain even a general picture of the expected medical consequences of a possible nuclear war for the European continent, some rough figure has to be assumed representing the total destructive power of the nuclear weapons. It would be no exageration if we take as a basis of calculations a figure which is merely one-tenth of the yield---10,000 Mt---assumed in the scenario of the US authors /16/. We shall therefore discuss the consequences of a nuclear attack using one-megaton nuclear weapons with the total power of 1,000 Mt.

The European continent has the population of 671 million. We arbitrarily divided its territory, which has the area of approximately 10.3 million km^^2^^, into five regions, i. e. Western (I), Central (II), Southern (III), Northern (IV), and Eastern (V).

Table 5 shows the areas of the regions, their total population and population density.

Table 5

Description of the regions of Europe

Region number

Designation

Area, million km^^2^^

Population, million

Population density, pers./km^^2^^

I

Western

1.04

II

Central

1.02

III

Southern

1.66

IV

Northern

1.20

18.3

V

Eastern

5.40

35.4

Fig. 1 shows the location and configuration of the regions.

It was assumed that half the nuclear explosions would be air bursts and the other half, ground bursts. 500 ground bursts were assumed to be distributed uniformly over the continent's surface whereas 500 air explosions were hypothesized over 500 major European cities, including 44 cities with the population of over one million, 108 cities with the population of between 300,000 and one million, and 348 cities with the population of between 100,000 and 300,000.

It should be recalled once again that in the event of powerful air explosions various burns and mechanical injuries will be the immediate cause of fatalities and casualties among people, while after ground explosions there will be an additional major cause of fatalities and acute injuries, i. e., radiation pathology caused mostly by gamma irradiation of people as a result of local radioactive fallout.

One more point should be made here as to how the populations of cities struck by air explosions would be add itionally affected by radioactive fallout from ground nuclear explosions. As a result of massive use of nuclear weapons some of these cities will be caught in the plume of highly radioactive fallout produced by the ground bursts. This may cause irradiation in doses leading to casualties among survivors in those cities. This factor is taken into account in our estimates, whose model is based on the premise of radiation injuries among people in the radioactive plume of ground explosions being statistically independent of any injuries caused by air bursts in the cities. It was further assumed that the median lethal effective dose of irradiation by fallout for those not affected by the air burst in the city was 450 rad (4.5 Gy") while for persons who had suffered injuries (burns, wounds and their combinations)

1 gray (Gy) equals 100 rad.

d) fatalities and other casualties among rural and urban* population caused by the effects of local rad ioactive fallout from ground explosions.

Tables 6 and 7 reflect the main results of our analysis. The data obtained demonstrate beyond any doubt the unprecedented scale of human losses in the event of massive use of nuclear weapons, specifically casualties among the inhabitants of Europe.

As may be seen from Table 6, under the premises and assumptions we adopted, the number of victims of nuclear strikes will be as high as 314 million, i. e., almost half the European population.

Children, adults and old people, the healthy and the sick, pregnant women and foetuses in utero---no one will be spared in the nuclear conflagration. One hundred million persons will be killed virtually at once and 68 million will die from fatal doses of radiation. Out of 4.7 million pregnant women, expecting the birth of their children with joy and hope, over half will die while the rest will be maimed or affected by acute radiation sickness.

The total number of casualties (wounded, burned and suffering from acute radiation sickness) will be as high as 150 million. Those multitudes of injured people will actually be deprived of effective medical assistance, above all due to the fact that the few physicians and medical workers surviving and capable of acting under the circumstances will find it physically impossible to provide such aid.

Table 6

Expected number of victims among the population of the European continent as a result of nuclear strikes of 1,000 Mt total power

(million persons)

Fig. 1. The European continent schematically divided into regional zones /32/

the median lethal effective dose was assumed to be equal to 200 rad (2Gy).

Thus the overall picture of the medical consequences caused by the direct effects of nuclear explosions comprises the following estimates:

a) casualties among the population (persons who died or were injured in the first day following the explosion) in 500 cities as a result of air bursts;

b) further fatalities and casualties in the target cities which were caught in the plume of highly radioactive fallout from ground bursts;

c) casualties among the population struck by ground bursts (calculations based on the average density of population on the continent);

Description of nuclear explosion factors causing casualties among population

Killed

Injured Total casualties

Direct effect of 500 air explosions over major cities

97.7

57.5 155.2

Effect of ground bursts' radioactive fallout upon cities targeted for air explosions

14.8

14.2

29.0

Direct effects at sites of 500 ground bursts

2.3

3.4

5.7

Effect of radioactive fallout from 500 ground nuclear explosions

52.9

70.9

123.8

Total casualties among population 167.7

146.0

313.7

Excluding the population of 500 target cities.

Estimates of human losses in each of Europe's regions are given in Table 7.

Survivors of the catastrophe will to the end of their days be haunted by physical and mental suffering and experience numerous deprivations. Their children and grandchildren will, even before they are born, be fatally predisposed to develop malignant diseases and hereditary defects. The living will indeed envy the dead.

As was noted above, under the hypothesis discussed here, about half the population of the European continent will not suffer injuries caused by the direct effects of nuclear explosions and will not be irradiated by the fallout in the trail from ground explosions in doses usually causing acute radiation sickness. All of them, however, will inevitably receive radiation doses which substantially exceed the levels of ionizing radiation's natural background. Therefore this category of population has to be regarded as a group with a higher risk of developing malignant tumours and producing offspring with genetic dysfunctions.

On the basis of modern estimates of the expected incidence of development of fatal malignant tumours and genetic consequences* it can be shown that, under the hypothesis analyzed here, the number of such fatally doomed people will reach several million. Finally, it is important to emphasize that people who have not suffered from the direct effects of the use of nuclear weapons will most likely face numerous formidable problems brought about by the destruction of the social and economic fabric of society.

Concluding this analysis we have to point once again to the fact that it is based on an arbitrary assumption of the destructive power of nuclear weapons detonated over the European continent, which represents merely 10 per cent of the total destructive power of nuclear weapons (10,000 Mt) that, according to estimates /16/, may be used by the belligerents. One has also to bear in mind that our analysis of the consequences of a nuclear war for the population of the European continent has been somewhat simplified, focusing narrowly on consequences for Europe, whereas it will be impossible to contain the conflict within these limits. In other words, the magnitude of a nuclear catastrophe will be immeasurably greater.

It is widely known that the present United States Administration has chosen as a basis of its nuclear strategy the adventuristic concept of waging a nuclear war on the territory of Europe in the expectation that the United States will be able to escape nuclear retaliation.

Table 7

Casualties among the population in the regions of Europe

(million persons)

Region

Killed

Injured

Total casualties

Western

33.1

29.7

62.8

Central

37.0

32.5

69.5

Southern

42.2

37.0

79.2

Northern

5.5

4.8

10.3

Eastern

49.9

42.0

91.9

Total for Europe

167.7

146.0

313.7

The population of Western Europe thus automatically becomes hostage to Washington's nuclear ambitions. This absurd ``strategy'' is obviously untenable. The following analysis is one of the many possible illustrations confirming this assessment.

A major factor of destabilization of the international situation in present conditions is the stationing in Western Europe of US medium-range rockets which are first-strike nuclear weapons. 572 Pershing-2 and Tomahawk cruise missiles are being supplied to the already overstocked nuclear arsenal in Western Europe, adding a further 100,000 kilotonsof nuclear explosives to the European nuclear armoury.

This action is turning Europe into a forward base for the US strategic nuclear forces since these missiles can reach targets located over the entire European territory of the Soviet Union up to the Urals.

Proceeding with our analysis, we must also mention certain premises of US military doctrine as formulated in the Pentagon document "Fiscal Year 1984-1988 Defense Guidance" and in Directive 59 signed by President Carter.

The world press has pointed out that these documents envisaged all the means of attaining superiority over the Soviet Union in a nuclear war, including the first use of nuclear weapons.

This is obviously linked with the notion, current in the West, of inflicting "unacceptable damage" to the opponent. Any sober-minded person would understand that once the nuclear weapons---weapons of mass destruction---are used, this would entail a chain of irreversible events. There is no doubt that the use of nuclear arms would jeopardize the vital interests of the other side and most likely would prompt it to deliver a maximum level of destruction in a full-scope retaliatory nuclear strike.

G iven all this, a question could be asked as to what the early medical consequences could be of a retaliatory strike against the

* This aspect of the problem is discussed in greater detail in Chapters X, XII

aggressor who would be the first to use nuclear weapons against the Soviet Union (the Soviet Union has unilaterally pledged not to be the first to use nuclear weapons).

One could consider the consequences of such a---we repeat---hypothetical nuclear strike aimed only at the launching sites of American medium-range missiles being deployed by NATO in several West European countries and of a retaliatory strike against the United States, from whose territory strategic nuclear weapons would be also launched in a first strike against the USSR.

With respect to several countries of Western Europe the estimates were made assuming the equivalency of the retaliatory strike both in terms of the number of missiles NATO plans to deploy in each of those countries (Table 8) and in terms of the number of nuclear explosions over the territory of the country concerned.

Each launching site of the ``Euromissiles'', which are assumed to be uniformly distributed over the territories of these countries', would be struck by one 100-kiloton ground nuclear blast.

hundred (300-400) strikes with 0.5-Mt nuclear weapons. Similarly to the estimates cited above (see p. 87) it was hypothesized that half of the explosions would be air bursts over major cities, the other half being ground bursts uniformly distributed over the region's land mass.

The estimates of casualties in West European countries are based on population density data for each country.

Table 9 gives data on the possible medical consequences of a forced retaliatory blow at the launching sites of US medium-range missiles.

Table 9

Possible medical effects in several West European countries as a result

of a hypothetical retaliatory nuclear strike against launching sites of

572 US missiles to be deployed in West European countries

Country Average population density pers./km^^2^^

Population, million

Casualties, million

total number of victims

including

killed

injured

Belgium

9.85

2.9

0.4

2.5

Netherlands

14.0

4.2

0.7

3.5

FRG

59.0

9.8

1.5

8.3

Italy

57.2

6.2

1.1

5.1

Great Britain

56.0

9.5

1.6

7.9

Numbers of US nuclear missiles planned

for deployment on territories of NATO

member countries /41 /

Table 8

Designation of missiles

Total

196.1

32.6

5.3

27.3

Country Pershing-2 Tomahawk (cruise)

Belgium

---48

Netherlands

---48

FRG

108 96

Italy

---112

Great Britain

---160

It follows from Table 9 that under the conditions and assumptions adopted here a retaliatory nuclear strike against countries from whose territory US medium-range missiles would be launched in a first strike may result in 33 million casualties among the population of those countries, or approximately 17 per cent of their population.

Table 10 shows the results obtained in estimating possible medical effects of a retaliatory nuclear strike for each of the two arbitrarily selected regions of the United States.

Our estimates show that within the spectrum of hypothetical conditions of a retaliatory strike assumed here the total number of casualties in the Eastern region of the United States may be nearly 50 million and in the Western region, almost 21 million, i.e. 60-70 per cent of their inhabitants respectively.

The estimates presented in Tables 9 and 10 are, of course, rough approximations and, like any estimates of this kind, the figures cited here can be regarded as authentic only in terms of their orders of magnitude. Nevertheless, these figures, like

Casualties among the population resulting from a retaliatory strike against the United States have been analyzed on the basis of hypothetical examples with respect to the Western or Eastern regions of that country, each having an area of about 1 million km^^2^^ (i.e. similar to the overall territory of the countries of Western Europe). The number of nuclear strikes has also been assumed arbitrarily, amounting to several

Except cities.

TablelO

Possible medical effects in the Western or Eastern regions of the United States of a hypothetical retaliatory nuclear strike

contribution (joint study of the short-term effects of the use of nuclear weapons) to the report of 36th session of the World Health Assembly (May 1983) subsequently entitled "Effects of Nuclear War on Health and Health Services /4, Annex 2/. The agreed hypothetical scenario of an all-out thermonuclear war assumed the use of 10,000 Mt of nuclear weapons in nuclear strikes which were distributed in the following way: 90 per cent in Europe, Asia, and North America, and 10 per cent in Africa, South America, and Australia and Oceania.

The number of nuclear strikes with weapons of 1-Mt explosive power (half fission and half fusion) was assumed to be proportional to the population of each continent; half of the bursts were assumed to be air bursts over major cities (with a population greater than 60,000) and half---surface bursts, uniformly distributed over the land area of a given continent. For radioactive fallout an average shielding factor (C) of 5 was assumed for cities, 1.5 for rural areas, the high-altitude wind velocity being 50 km per hour. The results of our calculations of casualties and the results obtained by Prof. J. Rotblat were rounded off to the nearest five million: such "rounding off" has horrible implications but reflects the uncertainty regarding the accuracy of the estimates. Table 11 shows the results of pur assessment of possible casualties among the population in an all-out nuclear war, caused by the injurious action of nuclear explosions.

Region of the United States

Population, Casualties, million

Total number of victims

including

killed

injured

Eastern Western

83 40.1 -45.9 30 19.0-20.7

17.9-20.8 10.0-11.2

22.2-25.1 9.0-95

many others discussed in this book, should be more than enough to convince each and every inhabitant of the Earth that nuclear war is not a game played according to known rules or governed by mutually established constraints. Due to the physical characteristics of nuclear weapons and the consequences of their use, nuclear war would be the ultimate catastrophe in the history of humanity, which would develop in a way similar to an uncontrollable chain reaction.

Nuclear war would begin by causing mass deaths in numbers beyond any comparison and within extremely small intervals of time; it would subsequently generate a prolonged chain of late effects. Finally, it would leave its imprint on the succeeding generations, predisposing them to possible heightened risks. And this would be not so much the possible accumulating genetic defects but the grave and indelible psychological legacy and the irretrievable loss of civilization's tremendous achievements and its centuries-old heritage.

Table 11

Expected medical effects of an all-out nuclear war

(million persons)

Continent

Population, million

Yield of weapons used (Mt)

Killed

Injured

Total casualties

Europe

1,650

Asia

2,620

6,450

1,500

North America

Africa

South America

Australia,

Oceania

Total

4,390

10,000

1,150

1,095

2,245

Possible medical effects of an allout nuclear war

Since the leaders of the present US Administration and the Pentagon have been saying that it is possible to win an all-out (global) nuclear war and since they extend the policy of protecting their imperialist interests to practically all regions of the globe, it becomes clear that in this context the term "global war" has to be understood in its literal meaning, i.e. that not only the countries that possess nuclear weapons but also those that do not have them may be subjected to nuclear strikes. Attempts to assess the possible direct casualties among the population of the Earth as a result of an all-out nuclear war were made independently by a Soviet (L. llyin) and a British (J. Rotblat) scientists, acting as WHO experts, as part of their

It follows from the data presented in the table that, should an all-out nuclear war break out, one-third of humankind can be expected to die just as a result of the direct effects of nuclear weapons, with the total number of victims possibly exceeding 2,000 million persons. Of 1,000 million injured about half may

die due to lack of effective medical aid /4/. In reality, however, as we have already stated, the real losses in a nuclear war will be even more significant as a result of indirect effects.

An independent calculation carried out by J. Rotblat was based on somewhat different assumptions. The main difference was that the targets of nuclear strikes (military, industrial and economic installations located in non-urban areas) were assumed not to be distributed uniformly over the country or continent but concentrated in certain areas where the population density was higher than the average. The shield ing factor for fallout was assumed to be 3 in rural areas of developed countries, and 2 in less developed countries. However, despite these and some other differences in the assumptions adopted, the results obtained by both authors were strikingly similar. For example, the total number of casualties caused by an all-out nuclear war was estimated by J. Rotblat to be 2,500 million against 2,245 million in our calculations, i.e. with a difference of no more than 10 per cent. The agreement in the figures obtained in effect demonstrates once again that an all-out nuclear war will lead to the collapse of human civilization.

The study also included an assessment of possible long-term radiological consequences of nuclear bombardment for the population of the world. The estimates refer only to gamma ray doses received externally from radioactive fallout and were based on currently accepted values (recommended by the International Commission on Radiological Protection) of the risk factors for cancer deaths and genetic defects. The purely tentative estimates demonstrate that there might be up to 50 million fatal cases of cancer and up to 20 million cases of genetic impairment in the first two generations following the exposure to radiation.

The material presented in this chapter constitutes clear evidence that analytical estimates of the possible number of human victims caused by the use of nuclear weapons conjure up a scene beyond human comprehension. We believe, however, that these estimates have an important practical meaning in that they demonstrate clearly one thing: nuclear war must be prevented from ever happening.

At the same time these estimates should not be considered in isolation from the subsequent chain of tragic events which.will inevitably strike the survivors and their environment when, in the words of Robert Lifton, the natural order of life and death will be replaced by the unnatural order of prevalence of death over life. What is involved is economic, social, medico-biological and other consequences of total devastation after a nuclear holocaust as well as disruptions in the homeostatis of the biosphere and ecological and geophysical cataclysms which cannot be theoretically excluded.

The consequences in their totality are summarized in a somewhat emotional form in a paper (quoted from /4/) dealing mostly with the indirect effects of an all-out nuclear war. The authors of this study believe, in particular, that enormous amounts of light-absorbing and light-reflecting particulate debris formed as a result of thousands of nuclear explosions would cloak the atmosphere in a dark veil which would hinder sunlight for many weeks. Vast fires will sweep over forest land and agricultural fields, and these fires along with those in oil and gas fields will load the lower atmosphere with tiny particles of tar, soot and ash. These events are expected to cause a severe photochemical smog. A large reduction of the stratospheric ozone layer cannot be excluded, which may lead to an increased intensity of solar ultraviolet radiation, with serious consequences for humans, plants and animals.

Agricultural and natural ecosystems, whose homeostasisthe authors believe will be disrupted, "will be vulnerable to attack by pests that thrive on ailing plants. Cockroaches and rats, carrion birds and organisms of decay will increase in frequency... The economies... will collapse... Commodities and services now taken for granted will no longer exist. No modern economic system based on economies of scale, specialization and international exchange would be likely to survive the war... .

``The complete breakdown of the system of international trade in fertilizers, fuel, farm machinery and technology and funds, would also deprive many Third World countries of resources that are currently needed to sustain them, thus creating a lethal gap between the number of people and the resources available to support them... .

``Decades and even centuries will have to pass before there is any possibility of restoring social and economic life.''

We would like to end this chapter by referring to the final document of the first special session of the United Nations General Assembly devoted to disarmament, which was adopted by consensus (q uoted from /42/). For the first time in the h istory of the United Nations it set forth an agreed programme of action in the field of disarmament, outlining the priority tasks and measures which the states should urgently begin to implement. The document declares that nuclear disarmament is the highest and most urgent of priorities. This is because nuclear weapons pose the greatest danger to mankind and to the survival of civilization. It is essential to halt and reverse the nuclear arms race in all its aspects in order to avert the danger of war involving nuclear weapons. The ultimate goal in this context is the complete elimination of nuclear weapons.

7---1878

VII

Clinical Analysis of the Early Effects of Irradiation

3) study of the correlation between dose rates and clinical signs of the injury in certain thoroughly documented cases of acute radiation sickness caused by inforeseen exposure of people to radiation in occupational or accidental situations /59-G4/. The number of cases thus observed and described in the most complete surveys available /54, 55, 61 / is no more than 150 while over the entire period that nuclear industry has been in existence throughout the world the number of cases with observable clinical signs and unfavourable outcomes has been even less.

Each of the sources mentioned above has its strong points and weaknesses, depending on completeness of dosimetric and clinical data, variability of effects in relation to dose distribution over time and in the body, and correlation with the other injurious factors. A critical analysis of these data can be found, among other publications, in /65/. The review of all this material makes it possible better to understand data on the effects of nuclear explosions.

In the past three years there have been three international congresses and a number of national and bilateral symposia (in the USSR, the FRG, Belgium and Italy, 1982-1983), where medical radiologists made a thorough review of all the available clinical data on the acute and late effects of radiation exposure caused by nuclear explosion. They were able to arrive at agreed, though approximate, estimates of radiation injuries caused by the atomic bombing of Japan in 1945. Substantial clinical arguments were added to the alarming forecasts of dose rates, which would result from a nuclear conflict under the various hypotheses presented at the conferences mentioned above /35, 36, 67, 68/.

Must we again and again recall those horrifying estimates and repeat the terrible descriptions of death and suffering which befell the two Japanese cities? We believe that this must be done---and not just to pay tribute to the memory of the victims of Hiroshima and Nagasaki. This must be done in order to ensure the correct interpretation of the facts which today, as before, stir the minds of people around the world, and to prevent a repetition of similar events, possibly on an even larger scale. These purposes are served by truthful information about and accurate knowledge of past events.

Although there can be no definite prognosis for the infinite number of possible situations caused by the consequences of nuclear explosions, we believe that a clinical physician should appraise the late and, especially, immediate effects of a nuclear war as an unprecedented disaster. It would, within a short time, carry away a vast number of human lives, violently disrupt the lives of the survivors and affect the fate of their descendants. We shall try to prove this thesis below. .

7

99

The detonation of atomic bombs over the two Japanese cities in August 1945 and the immediate effects of US nuclearweapon tests in the Pacific were actually humankind's first encounter with the possible consequences of a nuclear war. In addition to numerous reports and accounts, the facts observed at that time have been described in detail by eyewitnesses /46/ and journalists /47/ and provided the basis for a number of monographs and surveys/17, 48, 49/.

In nearly 40 years that have passed since the first use of nuclear weapons over the cities of Hiroshima and Nagasaki data regarding radiation dose rates and the effects caused by them, as well as by other injurious factors resulting from the use of nuclear weapons, have been repeatedly corrected and revised. Initial data pertaining to the events which had tragic consequences for hundreds of thousands of people were, naturally, incomplete and sometimes contradictory.

They were subsequently revised in the light of:

1) estimates of short-term and long-term effects of experimental detonations of nuclear devices which affected more limited cohorts /50-54/;

2) hypothetical calculations regarding possible nuclear strikes for individual countries and the entire world /1, 4, 14, 15, 55-58, et al./;

Direct Early Effects of Nuclear Explosion

A 12.5-kiloton atomic bomb was detonated at a substantial altitude (500 metres) over the centre of Hiroshima. Up to 60 per cent of the population and most of the administrative buildings and housing lay within a radius of two kilometres from ground zero.

In Nagasaki about one-fourth of the inhabitants were shielded from the flash by the hilly terrain, whereas only about 30 per cent of the population were in the zone immediately adjoining ground zero. The Nagasaki bomb was more powerful---22.5 kt---than the one dropped on Hiroshima and therefore mortality within the 2-km radius was similar in both cities, i.e. about 50 per cent.

It can therefore be expected that, with more powerful nuclear devices used over large and densely populated cities, approximately 50 per cent of their population would die in the early stages. The same estimate can be found in the previous chapters of this book.

As many as one-fourth to one-third of a city's population may die as a result of the explosion itself, most of them in the first 5-7 days; these deaths will be caused by thermal radiation and blast and by their combination with high doses of nuclear radiation.

The data concerning the number of dead and missing in Hiroshima and Nagasaki and the time of their deaths have been compiled on the basis of different sources (reports by prefecture authorities, special services and commission, etc.) and are presented in Tables 12 and 13 which have been taken from the general survey of the effects of the atomic bombing of these two cities /17, 68/.

Fig. 2 illustrates the correlation between the population of different zones and numbers of those killed and injured.

Fig. 3 shows the configuration of the territories of the two cities in relation to ground zero, a factor which had a bearing on the number and nature of casualties.

The number of people affected by the flash and blast at short distances from the point of explosion of those relatively small bombs was as high as 30-50 per cent of the total (see Fig. 4).

In addition to injuries caused by the explosion, additional injuries may be caused by the damage done to surrounding buildings and objects. In Japan, as many as 52-69 per cent of the buildings (depending on their type) were destroyed with in a 5-km radius from the explosion. Structures engulfed in fire, flying debris, smoke and dust suspended in the air completed the picture of the terrible devastation. Incomplete data obtained at

Total number of dead and missing in Hiroshima and Nagasaki /68/

Table 12

Source

Dead Missing

Total

HIROSHIMA

Hiroshima Prefecture,

Governor's report, 20 August 1945

32,959 9,591

42,550

Hiroshima Prefecture,

public health section report, 25 August 1945

46,185 17,429

63,614

Hiroshima Prefecture,

police department report, 30 November 1945

78,150 13,983

92,133

Hiroshima City, "official report," 8 March 1946

47,185 17,425

64,610

Hiroshima City, survey

section report, 10 August 1946

118,661 3,677

122,338'

Joint Japan-United States survey report, 1 951

64,602

64,602

Japan Council against A-and H-bombs: "White

119,000-133,000 (32,900 military

151,900- 165,900

paper on A-bomb da-

personnel not

mages," 1961

included)

Nagasaki Prefecture,

report, 31 August 1945 Nagasaki Prefecture, external affairs section, 23 October 1945 Private estimate by MotosaburO Masuyama, January 1946 survey British Mission report 1947

Nagasaki City, A-bomb Records Preservation

Committee, 1949 Joint Japan-United States survey report, 1951

Joint Japan-United States survey report, 1956

NAGASAKI 19,748 23,753

29,398-37,507 39,500

73,884

29,570-37,997- 39,214

39,000

1,924 1,924

21,672 25,677

29,398-37,507 39,500

73,884 29,570-39,214

39,000

Estimated one year after the bombing.

Hiroshima

Nagasaki

Population

1.0 2.0 3.0 4.0 5.0 ka

X10^^3^^

Distance from ground zero

1.0 2.0 3.0 4.0 5.0 ka

Distance from ground zero

Fig. 2. Civilian casualties in Hiroshima and Nagasaki in relation to distance from ground zero /4/

the end of the first week after the detonation indicate that among those who sought medical assistance in hospitals most were people with thermal (about 50 per cent), mechanical (33 per cent) and multiple (16 per cent) injuries. Even more indicative is the distribution according to the type of injury at later stages (15-20 days after the explosion). Among those with mechanical injuries 54 per cent had concussions, 35 per cent were wounded by glass fragments, and only 12 per cent had bone fractures. Many victims with fractures did not survive to receive medical assistance even at those early stages. Some died under piles of

Table 13 Time distribution of deaths among 16,007 persons in Hiroshima /68/

Fig. 3. Comparison of damagedareas in Hiroshima and Nagasaki /68/ Hiroshima: continuous line indicates city limits; dashed line shows the burned-up zone;

Nagasaki: thin continuous line shows the burned-up zone; dot-dashed line shows the totally demolished area

debris and in demolished buildings. The fate of many others is simply unknown. While mechanical injuries are not fatal in themselves, they are always painful and are frequently aggravated by infection and gangrene with necrosis of tissues.

Thermal radiation caused burns mainly among unshielded people Within a distance of up to two kilometres from ground zero up to 50 per cent of the people in Hiroshima and 35 per cent in Nagasaki suffered from burns. Within a distance of two kilometres from ground zero in Hiroshima 83 per cent of the people were wounded by the blast and flying debris from collapsing buildings. The figure for Nagasaki was 72 per cent.

Date of Death

Percentage of total

Cumulative percentage

6 August 1945

28.9

28.9

Date unknown

Missing

11.1

7-13 August 1945

7.8

14-20 August 1945

4.0

61.2

By end of August 1945

By end of September 1 945

By end of December 1 946

0.5

1947 1949

2.1

1950-1957

6.1

84.0

November 1965

100.0

I^^60^^

second day) after the attack and within a distance of from one to two kilometres, 85.3-83.7 per cent. The fatality rate showed only a small drop beyond one kilometre, though the levels of thermal and initial radiation were lower there.

The chaos created by the explosion made it difficult exactly to determine the number of casualties and early deaths. The estimates were made in the course of several years through extrapolation of more detailed information about limited, mostly organized, groups to the number of inhabitants of a given city district, or through the superimposition of the effects zone contours onto the district. Other methods were also used, e.g. on the basis of so-called circular zones of the cities, number of rations issued, etc. Hence the considerable discrepancies in absolute figures on losses given by authors /72/. Though the information is far from complete, there is no doubt that about one person out of every two who were in the effects zone was killed (or missing). As for the whole population of both cities, at least one out of every three or four people met with a fatal end. Within a distance of under one kilometre from ground zero 90 per cent of the deaths occurred on the first day after the attack. Up to 20 per cent of all fatalities were recorded in the first six days after the explosions.

By the end of the third week after the attack relatively complete medical data were obtained about only 6,973 cases in Hiroshima and 6,859 in Nagasaki. During this period the death toll from various causes, including rediation sickness, was particularly high. The pattern of injuries was very dynamic. It could be referred to only as of a definite date. For instance, on the 20th day 34.9 per cent of the survivors were suffering from radiation sickness, 20.6 per cent from burns and 35.5 per cent from wounds. The uninjured accounted for only 24.4 per cent. Quite often the injuries were combined. The largest number of radiation sickness cases came from the zone closest to ground zero (four out of every five people injured or even more).

Here is some more information on the principal direct effects of the atomic explosions: burns, including blindness, traumas, radiation sickness, and combinations thereof, analyzed in /48, 66, 68/.

Clinical symptoms of burns mainly resulting from the light flash, which led to early fatalities, were most manifest within a distance of from 0.5 to 4-5 km.

Burns among people who had no shielding other than their clothing were very extensive and deep. They were immediately accompanied by a grave pain syndrome, peeling off of the skin and sometimes by the charring of limbs and the head. In all the zones, out of the total number of survivors who had no shielding nearly 71 per cent received burns, out of those who had some shielding outdoors, 28 per cent, and out of those who were

2.o 53 53 to *»*• Distance from ground zero

1.0 2.0 3.0 4.0

N. Distance from ground zero

Fig. 4. Number of blast injuries and burns among civilians in Hiroshima (H) and Nagasaki (N) depending on distance from ground zero /4/

In Hiroshima buildings were badly damaged in an area of 13.2 sq km and in Nagasaki, of 6.7 sq km.

In Hiroshima 37 per cent of the population were affected by initial radiation, mostly those within traditional Japanese wooden houses. This figure for Nagasaki was 34 per cent.

Three zones of declining rate of radiation injuries were established: the first within a distance of less than 1 km from ground zero, the second within a distance of from 1 to 1.5 km and the third within a distance of from 1.5 to 2 km. In Hiroshima these zones were characterized by the following rate of injuries: the first 85.9 per cent, the second 38.6 per cent and the third 10.1 per cent. In the case of Nagasaki they were correspond inqly 53.5, 38 and 18.2 per cent/54/.

The scale of damage and the number of casualties resulting from the explosion of only one relatively small atomic bomb horrified even those who had lived through the last war and its bombings.

The fate of the survivors and of the cities which had undergone a nuclear attack was unusual too.

Thermal radiation from the fireball could be felt at a distance of up to six kilometres. The blast swept buildings down like a hurricane and tore the clothes off people. The fire that raged in an area of up to 11.5 square kilometres in Hiroshima and of close to nine square kilometres in Nagasaki generated a wind with a speed of 45-55 km p.h., which intensified combustion. Crops were burning in the fields, trees in orchards and parks, and people were turned into flaming torches. Tens of thousands of injured people hastened to hospitals and clinics, demanding water and assistance. Many were looking for missing relatives and many others fell down dead as a result of pain shock.

Among people exposed to the effects of a nuclear explosion in the open within a distance of under one km from ground zero the fatality rate reached 93.7 per cent quickly (on the first or

Percentage of burn victims

o o ooo So o o o <

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^^3^^~x

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1000 2000 3000 4000 5000 M

areas. The face, ear lobules and hands were particularly badly deformed. The skin affected by such burns changed its colour. Healing was slow, especially in case of combination with radiation sickness.

Burns affecting eyes caused complete, though often brief (up to five seconds), blindness. The eyelids, cornea, and conjunctive of the eye would be inflamed, though in fewer cases. Later the lens would also become affected.

The information on the number of fatalities caused by mechanical injuries is the least accurate. It is accepted that within a distance of 2 to 2.5 kilometres from ground zero 35 per cent of the people were injured by the blast; within a distance of from 2.5 to 3.5 kilometres, 32 per cent; and within a distance of 4 to 5 kilometres, 12 per cent. The largest number of injured people (69 per cent) happened to be in massive buildings. People in light buildings were wounded less frequently (34 per cent). Those who happened to be outdoors without shielding at a distance of about five kilometres from ground zero received the fewest wounds (17 per cent).

Fatality was the highest in or near completely demolished buildings. At a distance of about 1.5 km from ground zero the survivors suffered mainly from medium-degree injuries inflicted by falling debris or from traumas caused by falls. In most cases these were severe contusions (54 per cent), lacerated wounds caused by broken glass (35 per cent) and, less frequently, fractures (11 per cent). Wounds were mostly complicated by different abscesses and erysipelatous inflammation. Cases of anaerobic infection and tetanus were relatively few, perhaps because most of the wounds were caused by flying objects which had not been polluted with soil. Very slow healing of wounds was due to inadequate treatment given with great delay.

Among other lesions we should mention the relatively frequent damage of ear drums (1 -8 per cent) by the pressure of the blast. About six per cent of the survivors complained of a temporary loss of consciousness and close to 15 per cent, of noise in their ears (tinnitus aurium), dizziness and headache.

The gravest injuries with crushing, rupture of blood vessels, internal haemorrhage and blood-circulation disorders were registered within 500 metres from ground zero. These victims, being at the earliest time after explosion in the almost 100 per cent lethal zone, received no medical aid.

It should be pointed out that a large number of people suffered simultaneously from burns, woundsand, later, radiation sickness. Combined injuries of this kind created serious complications.

Within certain distances from ground zero people were subjected to two or even all the three main effects of a nuclear

Distance from ground zero

Fig. 5. Frequency of burn cases in relation to distance and shielding in Hiroshima /68/:

1---outdoors with no shielding; 2---in Japanese-style houses; 3--- outdoors with shielding; 4---in stone houses

indoors, 13-15 percent (See Fig. 5). Soon after the attack burns accounted for two-fifths of all the injuries, half of the victims dying. Three out of four fatal cases in the early period died of burns.

Owing to direct propagation of light the contours of the injury were clearly defined, as burns caused by the light flash sometimes reproduced the outline of the objects protecting the skin, the density and colour of the fabric of clothing. The head and the limbs were more frequently affected by burns (87 per cent). All of the II and III degree burns were complicated by infection. Subsequently, in nearly 75 per cent of the cases ugly keloid scars deformed and distorted the function of the affected

explosion. Combined injuries, such as serious wounds and extensive burns, which were further aggravated by radiation sickness, caused disorders in electrolytes and protein metabolism in the very first days. Figure 5 shows the proportion of those who were irradiated in addition to receiving mechanical injuries and burns in relation to the total number of people affected by the explosion.

From 21 to 69 per cent of all injured in 100-1,000 rad zones exhibited typical symptoms of acute radiation sickness. The incidence of acute radiation sickness was higher (in a three-- totwo or two-to-one proportion) among people affected by the explosion in open space, i.e., not in shelters.

In keeping with the radiation sickness classification adopted in Japan several groups of cases were established and data were analyzed on 13,000 radiation sickness cases and 757 fatalities, including 329 who died before the twentieth day following the atomic explosion and 428 who died after the twentieth day.

By the 20th day up to 1,500 cases of radiation sickness had been diagnosed, while the number of people suffering from its separate symptoms, i.e. light forms of acute radiation sickness, was three times greater, i.e. reached 30-35 per cent of the total number of casualties.

In the early period fatal outcome was mainly due, even if radiation-sickness symptoms were registered, to burns and wounds.

Japanese researchers divide the symptoms of direct radiation injury into those which occur immediately or within a short time (from several minutes to 1 -3 hours after the exposure) and last up to a week---their manifestations were thought to have occurred between 6 and 17 August 1945; those which were delayed 3-4 weeks (appearing between August 18 and early September); and those which occurred after a longer interval, from the fifth week up to the time the acute radiation disease became pronounced, i.e. late September. Among the 181 fatal cases recorded up to August 17,159 persons had fever, 85----diarrhea (including 16 with bloody stools), and 22 had haemorrhage. The leukocyte count was 300-400 cells per mm^^3^^. The frequency of radiation sickness symptoms and their relation to dose rates (distance to ground zero) is shown on Fig.6.

These symptoms of acute radiation sickness, wh ich appear in early stages, aggravate the condition of patients affected within hours or days after the explosion and by doses equal to or somewhat exceeding 200 rad. The frequency of nausea and vomiting, and especially the time of their onset, was clearly correlated with the radiation dose; it was as high as 40-50 per cent /17,48,49,66,68/ in cases with doses exceeding 400-600 rad, within the radius of 1 -2 km from the ground zero of a smallyield (12-22 kt) explosion.

|l Vomiting |35

Nausea

J3

Anorexia

J69

Epilation

Porpura

1 4

jeal lesions |ei

fl Haemorrhage [38

1.5 [14 Haeaorrhage 1.5 [10 fever

Diarrhea |43

[11 Bloody diarrhaa

°!s| Bloody diarrhea

1 1 &cpo«ad <l,ooo

] Exposed > 5,000 n

Fig. 6. Frequency of radiation sickness symptoms depending on distance from ground zero /4/

Vomiting occurred two or three times or, less frequently, more than ten times and normally subsided toward the morning of the day following the explosion while nausea continued for several days. Thirst and lack of appetite were also noted.

Those in whom these symptoms persisted died as a rule. If thirst, diarrhea and fatigue lasted for more than a week, cramps and mental disturbances followed, with death occurring on the 10-12th day after the explosion.

One can imagine the suffering of those people, deprived by the nuclear catastrophe of elementary comforts; it is also clear that providing them with the necessary minimum of hygienic conditions and doing something to relieve their sufferings was extremely difficult, if not practically impossible.

Over a half of the persons who were in the zones nearest to ground zero had brief spells of diarrhea and lesions of the oropharyngeal cavity as well asgeneral malaise. Although not all outcomes were fatal, all of these people were for a long time helpless and in need of treatment.

For the persons who received higher doses of radiation (over 400-600 rad) the second and third weeks were characterized by a steady worsening of their condition, by the persistence or even greater severity of the symptoms described above, particularly haemorrhage, and by the onset of epilation; lethal outcome occurred in many of these cases (see Fig. 7). I n 50 per cent of the cases who died after the 20th day, radiation disease was among the determining if not the most significant factors that caused death.

40 _r

30

40

SO

Days after explosion

Fig. 7. Relationship between some symptoms of radiation disease and fatality rate and time of death /68/

I n some of the cases with doses in the range of 200-400 rad a brief period of remission of radiation injury symptoms was noted, with the wounds and surface burns appearing to heal somewhat. There was a ray of hope for survival. Following this the victims and those around them were tragically shocked by an ``inexplicable'' worsening of their condition, development of inflamed and necrotic areas around burns and wounds, recurrence of high temperature, and the onset of haemorrhage and dyspeptic dysfunctions.

In subsequent years studies revealed the principal mechanisms and time patterns of the "period of apparent recovery" which lasts from several days to 3-4 weeks, and of the relapse which inevitably follows. The temporary improvement reflected merely a kind of clinical compensation for the steady deterioration of the hemopoietic function during the bone-marrow form of radiation sickness; it preceded the inevitable worsening of the patient's condition and a new wave of fatalities, mostly in the period from the third to sixth or seventh week after the exposure.

Fatalities after 20 or more days and up to 2 months are caused mostly by the bone-marrow form of acute radiation

Fig. 8. Main clinical signs in a case with fatal outcome on the 13th day after the explosion /68/; 1---temperature ('C); 2---pulse (beats per minute)

sickness and its complications or, towards the fourth month, by multiple injuries. Towards the 8-13th week mortality caused exclusively by acute radiation sickness is practically zero. The relationship between lethality and the dose rate (distance) is still observed.

Fragmentary blood analyses carried out within the same time intervals reveal distinct signs of leukopenia, which correlate clearly with the prognosis of survival, with the granular leukocyte count dropping in the interval between the second and third weeks from 4,200 to 120 cells per mm^^3^^ (in a lethal,

relatively well-studied case). Signs of anemia appeared and developed, with erythrocyte counts decreasing by a factor of 1.5-2. There was a sharp drop in the number of platelets (thrombocytes) to one-fifth or one-sixth of the normal level.

Mechanical and thermal injuries may occur within a greater radius than radiation injuries induced by doses leading to acute radiation sickness. As a result of combined irradiation and mechanical injury circulatory disorders, including cases of collapse and shock, become more pronounced, even at dose rates below 1,000 rad. Wounds and burn lesions result in a further loss of blood and plasma, causing a sharp and early aggravation in the victim's condition /1,4,7,65,66/. The combination of the nuclear explosion's injurious factors sharpens the need for more urgent assistance measures and renders the victims particularly helpless already in the first minutes and hours following the explosion, i.e. at a stage when in the case of a curable radiation disease a temporary remission would set in, as described above, corresponding to the latent period of the second or third-degree acute radiation sickness and lasting up to 2-3 weeks.

The most acute forms of radiation sickness (IV degree) in Hiroshima and Nagasaki were camouflaged with thermal lesions and wounds and were therefore followed up quite incompletely.

A study of the few and incomplete case records with a fatal outcome in Hiroshima and Nagasaki within the first two weeks and an analysis of other clinical /59,61,69/ and experimental /70,71/ material have enabled the present authors /65/ to outline the more grave---cerebral, toxemic and itestinal---forms of radiation sickness and to describe their manifestation as follows.

A general mean irradiation dose of 1,000-2,000 rad causes an intestinal form of acute radiation sickness. It is characterized by the early and marked symptoms of acute enteritis: diarrhea with fetid liquid evacuations, later on with blood and debris of epithelium, distention of the abdomen and pains in it. There are also distinct signs of dehydration and loss of electrolytes resulting in cardiac disorders and adynamia. The fatal outcome is accompanied by bleeding sickness phenomena, extensive ulceration of the mucosa of the alimentary tract and of the skin. Hemopoiesis is deeply inhibited, and dissemination of microbes and sepsis is observed. The immensely suffering patients die between the 10th and 14th day after irradiation

After a general dose of 2,000-5,000 rad the clinical course of acute radiation sickness is even more grave. Between the first and fifth day there is a brief and insignificant improvement, the symptoms of the initial reaction becoming less marked. On the fifth or sixth day there is a recurrence of general intoxication and

blood-circulation (including cerebral circulation) disorders leading to a fatal outcome. Blood pressure rapidly declines, faster dehydration is observed and general intoxication progresses. If the sickness assumes a toxemic form, fatal outcome on the fifth-ninth day may be preceded by or coincide with a disastrous drop in the number of leukocytes. In some cases they disappear altogether from peripheric blood. Certain elements of such a clinical pattern have been cited by Japanese researchers who observed them in the rare cases with a fatal outcome in this early period which have been made available (See Fig. 8).

Cases subjected to irradiation doses exceeding 5,000-8,000 rad are even more severe. Afflicted by the nervous form of sickness, the patients die in the first three days or sometines immediately at the moment of irradiation (when the dose is equal or exceeds 10,000 rad). The severe prodromal syndrome typical for this dose range (vomiting, diarrhea and high temperature) is preceded by a phase of acute cerebral disorders accompanied by mental disturbances, dropping of blood pressure, adynamia and sometimes convulsions. Already in the first few hours after irradiation the victim is afflicted with fever, and the skin and subcutaneous tissues are affected (pain, edema, numbness and pricking of the affected parts of the body).

The explosion of a neutron weapon releases a higher amount of energy in the form of initial radiation, also within the mediumdose range, which produces the typical bone-marrow form of the radiation disease and causes injuries of the intestinal tract. Typical symptoms of the intestinal form of radiation sickness are combined with early blood-circulation disorders and toxemia. Cases afflicted with the toxemic form of sickness are characterized by marked symptoms of cerebral disorders. Therefore the neutron weapon, which has a selective anti-personnel action, alters the mechanism of fatal outcome and increases the number of transitional clinical forms, but does not at all alleviate the dreadful suffering caused by the combined effects produced by a ``conventional'' nuclear explosion within the high-lethality zone.

Generally speaking, both the combined effects of a usual nuclear burst and the effect of high-dose radiation of the neutron weapon necessitate the quickest possible medical aid to victims. The victims' helplessness increases from the first minutes and hours after the explosion when those afflicted with isolated acute radiation sickness of II or III degree could experience a temporary remission corresponding to that in the latent period of the sickness which lasts from two to three weeks.

While at a later stage of the development of acute radiation disease there is a regrouping of the cohort on account of the deaths of those with a more severe, third or fourth degree of the

8---1878

O

I

200 r

Cases

with recovery (ii-iii)

£ 5

i i i i i i

10 20 30 40 50

Days after explosion

10 20 30 40 50

Days after explosion

Fig. 10. Relationship between bone-marrow cell counts and outcome (groups II-III are the same as in Fig. 9) /68/

data for Hiroshima and Nagasaki in 1979 /68/ (see Figs. 9 and 10).

The postmortem examinations conducted on 25 victims who died in the first two weeks, and the somewhat more thorough and complete postmortems done within the second peak lethal period (from the third to sixth week) confirmed the nature of the clinical syndromes observed. They revealed profound radiation injuries affecting hemopoiesis, intestines and spermatogenic epithelium, severe disruptions of the electrolyte balance, and, later, changes in the endocrine glands and cardiovascular and nervous systems. The most frequent infectious complications were necrotic-haemorrhagic pneumonias leading to fatal outcomes. In situations when atomic bombings and the destruction caused by them disorganize medical facilities, major outbreaks of various infections should generally be expected, with unfavourable outcomes also in cases of less grave radiation injuries. Outbreaks of dysentery, hepatitis and tonsillitis as well as aggravation of tuberculosis were recorded among the inhabitants of the Japanese cities affected by the explosions.

We have already pointed out that the wounds and burns of

Fig. 9. Relationship between peripheric blood cell count and time of fatal outcome in groups of victims with injuries of different degree of severity (groups I---IV, with decreasing likelihood of fatal outcome) /68/

sickness in the first 2-3 weeks, physicians would still have on their hands a substantial group of severely afflicted victims with doses between 200 and 600 rad. Over one-third of them suffer from infectious complications (fever, pneumonia, enterocolitis, sepsis) caused by the deep depression of hemopoiesis, and onethird to two-fifths of them have signs of bleeding, affecting the skin and intestines or, sometimes, the brain and the heart. These complications result in fatalities /4,17,65/. The most acute period will become longer, with more severe suffering; in the event of multiple injuries they will continue for days or even months. The frequency of fatal outcomes increases.

The pattern of various symptoms over the duration of the acute period of radiation sickness and the relationship of fatal outcomes with the number of cells in the blood and bone marrow are quite consistent /69,70/ and can be represented graphically; this was done by the committee which analyzed

nuclear burst victims would be almost inevitably infected. The general pattern of acute radiation sickness was characterized by infectious complications also in other organs and tissues. Only about 10 per cent of the cases with infectious lesions of the mucosa of the oral cavity and pharynx similar to agranulocytic angina survived the explosion. The condition of the victims was badly aggravated by frequent and severe ulcerous-necrotic lesions of the gums and mucosa of the oral cavity resulting from infection. It also interfered with the taking of meals.

In addition to cutaneous suppuration, the Japanese physicians observed cerebral abscesses, haemorrhagic and ulcerous lesions of the intestines, and sepsis /48,49,51/.

It follows from the above that in the period between the second and eighth week after the explosion even cases which are curable in principle will require many complicated medical procedures which are difficult to perform in a situation characterized by mass casualties. To ensure the survival of even one patient exposed to a dose of 200-600 rad, painstaking efforts of competent and numerous medical personnel are required /60,64,66,72/. Case records of individual patients who received accidental overdoses of radiation /72,73/ point to the need for prolonged treatment involving large quantities of expensive antibacterial medicines, in particular those required for injections, transfusion therapy with salt solutions and detoxifying liquids and infusions of blood components (thrombocyte and leukocyte mass) in quantities calling for a large number of donors.

These procedures are quite difficult and time-consuming even for less severely afflicted patients, as in cases with mediumdegree radiation injuries.

Now, wh ich of these procedures can be used if the number of cases runs into tens and hundreds of thousands, and who is going to treat these cases?

Nor could one seriously discuss the possibility, in the event of mass injuries, of using bone-marrow transplants from selected donors, although this procedure has been proved effective in cases of severe radiation injuries to bone marrow with in the dose range of 600-1,000 rad /74-76/.

Every victim, particularly those with multiple injuries, requires careful nursing, bed rest, a special diet and elaborate diagnostication over a long period of time to identify the nature of complications such as X-rayexamination and laboratory tests.

Even if the set of necessary measures in simplified along rational lines, and some of the functions are carried out by the patients themselves, by other patients or by auxiliary personnel, the task of organizing medical aid, as is evidenced by the experience of Hiroshima and Nagasaki, is a formidable one. In this section we have dealt mostly with clearly marked

symptoms which sharply affect a person's health and call for relatively simple measures to provide the victims with minimum comfort and medical assistance, relieving only the most urgent ones. Among the disruptions of hemopoiesis we have mentioned only those which involve a clear drop in leukocyte and thrombocyte counts and hence are most significant in terms of development of bleeding and infectional complications.

It appears that a higher death rate among women in labour and the newly born in the period immediately following the explosion, as well as aggravated cases of aborted pregnancies reported in Japan should also be mentioned in this context. It has been recorded, for example, that about one-third of the pregnant women exposed to radiation had miscarriages (45 out of 177 in Nagasaki), whereas previous average miscarriage incidence in the same area did not exceed 6 per cent. Ten of the 45 women with aborted pregnancies and seven of the twelve premature infants died in the first week /49,51,68/.

So far we have deliberately dealt with symptoms directly causing suffering to the victims, symptoms that can be identified and often lead to an unfavourable immediate outcome. They constitute, so to say, the tip of a huge iceberg that can be seen above the surface of the water, an iceberg of radiation and combined forms of injury, which are far more extensive and play a far greater role in the fate of the victims. They develop with in a wider range of doses and manifest themselves in the form of numerous and diverse clinical and physiological effects.

Among them one might single out some additional manifestations linked with the effects of the nuclear explosion, includ ing those which are also a reaction to the grave psychological stress and the extremely unfavourable socio-economic and publichealth situation which had emerged in Japan in 1945 as a result of what was in effect a "local nuclear war''.

The direct although less distinctly marked effects of radiation include, in the first place, regularly occurring changes in peripheric blood counts, wh ich suggest that all persons exposed to doses starting with 1 Gy (100 rad) experience during a certain period of depression of lymphoid and medullary hemopoiesis, followed by a difficult process of normalization. Numerous manuals and monographs /65, 70, 71/, as well as other publications /60, 62, 76/ contain graphs representing granulocyte, thrombocyte, lymphocyte and, in more severe cases, erythrocyte counts in relation to time and dose range. We present below such typical curves for cases of relatively uniform gamma irradiation, which were not aggravated by other injuries and ended for the most part in clinical recoveries /77/ (see Fig. 11). Physicians will realize that such changes involve the risk of the patient's developing numerous complications.

As can be seen from the figures, the period of depressed hemopoiesis and distinct cytopenia occurs to a greater or lesser extent within the entire range of doses (2-10 Gy); in combination with other factors (poor sanitary conditions or lack of food) its unfavourable effects can be particularly pronounced.

In this period persons who have been exposed and have radiation sickness lose, completely or partially, cellular and humoral resistance to viral and bacterial infections /66.70 et al./. Since the nuclear explosion leads to the disruption of sanitation and health services, outbreaks of communicable diseases ( dysentery, tuberculosis, hepatitis, tonsillitis, etc.) regularly occurred among the population on the Japanese cities.

Other significant injuries have also been reported. Sperm analysis, for example, showed that among the people who were near ground zero counts of spermatozoa dropped according to a regular pattern /51,68 et al./ (see Table 14).

Table 14 Number of spermatozoa in relation to dose rate

(distance from ground zero) /51/

• • • i---i---i---i---i---i---i---r-

8 12 16 20 24 28 32 36 40 44 48 52 56 60

Number of spermatozoa

in I me

0-1 cl

1.0-1.5

1.5-2.0

20-2.5

2.5-3.0

3.0-35

Total persons studied

0-5,000 5,000- 10,000 10,000

0 3

4 15

3 23

1 21

2 5

10 71

Total

1----1----1----1---I----r

4 8 12 16 20 24 28 32 36 40 44 48 52 56 60

This drop was especially pronounced (at the same distance) in the group of people of 20 or less years of age, i.e. those reaching the age of fatherhood.

Such studies were first conducted in October-November 1945, two months after the explosion. Recovery was extremely slow, as can also be seen from the data regarding the fishermen exposed during the nuclear test explosion on Bikini atoll (Fig.12). Hence, exposure to non-lethal doses of radiation causes a disruption of spermatogenesis and fertilization ability for a period of 1 -2 years, while the endocrine function of male gonads is affected even more significantly and for longer periods.

Women's menstrual function was also affected to a certain extent. First studies of this kind, covering 504 women, were conducted in the third month after the explosions over the Japanese cities. Termination of menstruations for varying periods occurred in 71.6 per cent of women who had previously had

Fig. 11. Typical curves representing neutrophil (a), lymphocyte (b), and thrombocyte (c) counts in cases with different doses of relatively uniform gamma irradiation /77/. The abscissa represents days after irradiation; the ordinate, the number of cells (a and bx10^^3^^ mcl, c*10^^5^^ mcl.) Figures over the curves indicate dose rates (rad)

.....I I--I~"T---1---)--j---r---

8 12 16 20 24 28 32 36 40 44 48 52 96 60

Days after exposure

Number/aim 10 , . > I, , , \

ranges which permit survival. These are various endocrine disturbances, vegetovascular dysfunctions, metabolism disorders caused by infectional-toxic complications and secondary injuries of organs observed among radiation sickness survivors. Such conditions are even more likely if the radiation disease is combined with infection from burns or wounds. It should be remembered that the cohort studied for the purpose of analyzing late effects of the atomic explosion /4,14,17,67,68/ represented a substantially reduced group of survivors. The group included a relatively small number (about 8-10 per cent) of persons with doses exceeding 200 rad (but as a rule no more than 400 rad), who had moderately severe clinical syndromes of radiation sickness. So the fact that irregularities were observed is rather remarkable, while their absence after a long interval should not be considered as unusual.

Epilation, which in itself has no clinical significance, served, however, as another indication of the dose received; it was regularly found in the group of symptoms which manifest themselves at doses exceeding the minimum rates that cause epilation (350 rad or more).

As for people with more severe injuries, they simply died too early to be affected by the late consequences of radiation exposure.

The literature concerning the development of the eye lens cataract which within certain dose ranges is considered as a clear manifestation of irradiation effects, has been surprisingly fragmentary and incomplete /68/. There is no doubt, however, that the cataract may develop under the impact of single doses equal to or exceeding 200 rad (2 Gy) not only in the first 1 -3 years after the exposure but later as well, including some of the cases with deteriorating eyesight. Observations of individual patients indicate that these effects subsequently affect the lives of survivors, incapacitating them and requiring surgery /65/.

For example, the observations of Toda, reported by Dr. Takeshi Ohkita /78/, demonstrate a distinct relationship between the incidence of cataract and dose rate (distance from ground zero); cataract formation was a rather frequent symptom in observations covering 230 eyes. As the radius decreased from 2.0 to 1.0 km by 0.2-km intervals, the cataract was found in 2.6- 12-22.2-50 and 55.6 per cent respectively of the eyes examined.

There is practically no research data on the dynamics of the condition of the nervous and cardiovascular systems of the victims of the nuclear bombing of Japan. Mention can only be made of some early Japanese studies, descriptions of some individual cases, as well as autopsies conducted in the first sixtwelve months after the attack, which report a regular pattern of injuries affecting the capillary network of the skin, internal organs and especially the brain /51/, disruption of the general

Fig. 12. Counts of spermatozoa (in 1 mm^^3^^) in cases exposed to radioactive fallout in March 1954 (doses of 100-400 rad) /51/ The abscissa represents dates; the ordinate, the number of cells per mm³ The dashed zone represents the number of cells sufficient for fertilization

normal menstruation. The frequency of these irregularities showed clear correlation with the distance from ground zero (from 100 per cent to 25 per cent at distances of 0.5 and 3 9 km respectively). This emphasizes the cause-effect relationship of these dysfunctions with radiation exposure, also confirmed by the fact that they occurred with greater frequency among radiation sickness cases. Miscarriages more often occurred at the early stages of pregnancy and were recorded in 25 4 per cent of pregnant women.

Late effects of radiation exposure develop in relatively more resistant organs and tissues; in this case manifestations of the injury are often more difficult to observe than those described above but they are nevertheless quite real also within dose

and regional blood circulation and general asthenia, undoubtedly aggravated by the psychogenetic and unfavourable socioeconomic factors of the nuclear explosion /48,56,66-68/.

Careful observation of victims of accidental exposure in peacetime, who were of course not subject to the additional unfavourable impact of these factors caused by a nuclear explosion, indicate that in the first year after the exposure the syndromes of neurovascular disorders, vegetative dysfunctions and metabolic changes in the myocardium were, as a rule, most prominent. Depending on the intensity and severity of the disease, these particular disorders restricted to a certain extent the patients' working ability, worsened their condition and caused deeper asthenia /65/.

Possibility of Rendering Medical Assistance and the Impact of Treatment

Of the overall number of casualties, which may be from twofifths to one-half of the population in the effects zone, one-th ird to two-thirds require medical assistance /66-6S/. In addition to problems caused by the gravity and diversity of injuries, rendering such assistance will be made more difficult by simultaneous casualties among medical workers, the destruction of most of the health facilities and a sharp reduction of food reserves, the disorganization of transport and the overall deterioration of sanitation and public health situation /4,56,66,68/.

The relatively high effectiveness of therapy achieved in treating individual cases affected by doses leading to the bone-marrow syndrome (100-1,000 rad) /65,72etal./ would be inconceivable under the conditions of a nuclear attack /4,35,48,49,67/. Optimal treatment methods, designed for individual radiation sickness patients, would be so much affected by the actual circumstances after a nuclear explosion that no tangible effect could be expected.

In estimating the consequences of a nuclear strike one should not disregard the unfavourable impact of extremely high, unprecedented overall numbers of casualties. It was established during the Great Patriotic War of 1941-1945 /79/that with the number of wounded increasing from 5,000 to 20,000, lethality goes up by approximately four per cent. The casualties caused by single nuclear strikes against the two Japanese cities were greater than those caused by all massive bombing raids against Tokyo during World War II, with 200,000 and 80,000 persons killed respectively.

Special chapters on the subject are included in the surveys 122

Fig. 13. Pattern of destruction of housing and its usability in a token city with a population of 1 mill ion follow ing the detonation of a 1 -Mt nuclear weapon /37/

published by the committee to assess the consequences of the nuclear bombing of the two Japanese cities; there are also other reports describing in graphic detail the nature of the so-called total collapse of human life /66/. The authors of the surveys conclude that the nuclear strike is not only a blow against the health and personality of the individual, bringing about the disruption of his physical environment and causing pain and death; it also undermines the psychological infrastructure of the community dehumanizing and destroying social institutions and law and order. These changes are brought about primarily by the destruction of housing, factories and offices, disruption of transportation and communications facilities over a large area (see Figs.13,14), and a breakup of the population structure in the affected cities and villages. Even though in ten years the population of Hiroshima and Nagasaki did reach again the pre-

In Nagasaki there was a zone of similar destruction, but there were areas and services (fire service, radio broadcasting, etc.) which survived and functioned already on the first or second day. Even there was a tremendous gap between the vast human needs and the inadequate possibilities for meeting them.

Damage to material property---private, public and corporate---was huge and difficult to repair, despite the fact that in 1945 the rest of Japan was left intact. What, then, may be the consequences of large-scale nuclear strikes against an entire country, or even a continent, or the entire world?

The people affected directly by the explosions in Japan showed a rather uniform distribution by age and sex; it was less uniform in relation to occupational activities, due in part to the pre-attack population pattern. It was later determined that the bombing had been preceded by a selective evacuation of large groups of children, pregnant women, etc.

This led to the emergence of a vast group of orphaned children whose parents had remained in the cities affected by the nuclear bombing. Many single helpless old people were left, too. In many families some of the members were missing; the survivors could not reach each other in the prevailing chaos. Thus the family, that important social unit of primary self-help, for the most part practically ceased to function.

Numerous roadblocks, raging fires, loss of customary bearings owing to destruction of buildings, the shortage of medicines and dressing materials, and damage of the water-supply system, etc. interfere with the collection and treatment of the sick and wounded 746,47,49,56,66,68 et al./.

The extrapolation to a global nuclear conflict of this problem is horrifying. Large numbers of dead bodies in the two Japanese cities were piled up to be burned without an attempt not only to identify but even to count the dead. Trams and other means of transportation were destroyed in whole with all the dead bodies in them. Horror-stricken people were aimlessly wandering through the city in the hope of finding or identifying their relatives either among the survivors or among the dead. They interfered with the burial of the dead or tried to do so on their own, contrary to the recommendations of the rescue services.

The need for medical aid, although not always uniform, is obvious, especially in the case of combined injuries from nuclear weapons, for a great number of victims (65-67 per cent in Hiroshima and Nagasaki) from the very first day after the nuclear attack. One out of every three injured people needs this aid during three-four months or even longer after the nuclear burst. Every case, particularly those with two or even three injuries, requires careful nursing, bed rest, a special diet and water and elaborate diagnostication over a long period of time to identify the character of complications (X-ray examination, laboratory

Fig. 14. Zones of disrupted public utilities in the same city as in Fig. 13

/37/.

The outer perimeter indicates city limits.

Letters represent damage to: p---power supply; c---communications; g---

gas supply; s---sewerage; E is ground zero

attack level, the demographic balance had not been restored, with the resulting damage to the social fabric.

The location of the city in relation to ground zero also influences the possibility of preserving hospital facilities and government agencies (see Figure?). In Hiroshima, for example, the principal medical and communications facilities, as well as prefecture offices, police and fire stations, radio stations and schools were demolished. The proportion of medical personnel killed or injured reached 80-90 per cent. Within the radius of 1.2-1.5 km from ground zero only 53 reception stations began to function in the first day; given the numbers---tens of thousands---of those who sought aid, the medical personnel available was extremely inadequate.

tests, etc.), competent medical attention in curable cases and measures to relieve the suffering of hopeless cases. Among persons who sought medical assistance at early stages the rate of lethality reached 5-10 per cent per day, which poses a special problem concerning the timely burial or disposal and decontamination of the corpses in order to avoid the serious danger which would arise if the dead are left unburied for a long time 748,49,68,80 et al./.

The city of Leningrad, besieged during the Great Patriotic War, faced many such problems. It was only high social motivation and personal heroism of the city's defenders that made it possible to avoid the worst consequences of mass deaths /81/. Similar difficulties in Japan in 1945 hindered dissection and the assessment of the number and pattern of casualties due to non-identification of victims. Postmortem data is therefore extremely incomplete. Only 25 postmortems were performed on corpses of persons who died between August 6 and September 9, 1945 in Hiroshima and Nagasaki, and 98 postmortems in Hiroshima between the third and sixth weeks after the attack /51,68 et al./.

At the same time it is known that cytopenia in fatal cases was observed three to four weeks after the exposure. Among people who died within the first week or in 2-2.5 months leukocyte count was moderately depressed or normal, i.e. the causes of their deaths were already different. Some of the cases, if given medical assistance, could have survived.

Every clinician familiar with radiation and mechanical injuries, who is shown a few photographs of the victims of the nuclear explosions in Japan in a state of acute suffering and the brief and incomplete notes from case records, will have a true enough idea of the frightful condition of the patients and their terrible suffering. Their sufferings are caused by burns and wounds which are aggravated by bone-marrow insufficiency, ulcerous and necrotic lesions in the mucous membrane of the oral cavity, diarrhea, bleeding, and high fever.

Physicians are familiar with relatively few cases of hemopoietic depression and its complications, which are different in origin. Such patients are placed in specialized clinics and receive all necessary care; however, hematologists and oncologists, who are well familiar with these cases, justifiably consider them to be among the most difficult and medically complex. May those who have not seen patients with signs of radiation disease get a realistic idea of the extreme gravity and suffering of hemopoietic patients in their assessment of the mass casualties of nuclear weapons.

Most physicians and medical personnel a re even less familiar with the cases of combined---medium-degree and severe--- injuries caused by several factors, including radiation, although

surgeons have seen patients with burn lesions and multiple mechanical injuries, who fill clinics and hospitals after earthquakes and other disasters, as well as during wars which cause a real "epidemic of injuries". To get an idea of the kind of so-called combined injuries in cohorts of victims, produced by nuclear explosions of various yields, one should take into account the aggravating effect of "radiation-induced cytopenic background", and also the fact that victims will have multiple injuries affecting various segments of the body and parts of its surface, that there will be a large proportion of internal injuries and high frequency of the crush syndrome /1,4,14,35,68/. Such cases will never reach first-aid stations at all; in Hiroshima and Nagasaki they died or were reported missing in the very first days after the explosion.

The number of injuries of different types depends on many factors and may change depending on several conditions. For example, the frequency of burns cannot depend solely on the distance from ground zero. Mechanical injuries in shelters and buildings (especially those of a particular design) may become even more numerous because of secondary wounds inflicted by flying debris, glass fragments, and collapsing walls and roofs. The type of structure is probably of greater significance than distance (see Figure 3). The frequency and the severity of radiation lesions caused by the explosion depend more regularly on shielding and distance.

Besides the gravity of the injuries, the difficulties involved in diagnosing and sorting, the extreme shortage of medical personnel, dressing material and medicines, as well as inadequate conditions for the treatment of cases, there is yet another factor, that of the mental and behavioural disturbances among the victims themselves, which hamper efforts to provide them with timely and adequate elementary medical assistance, particularly in the first stages following the explosion.

The number of those dead and missing in Hiroshima and Nagasaki exceeded the number of civilian casualties caused by the massive bombing raids against Tokyo (80,000), Dresden (135,000), and the civilian casualties in Britain and France combined (114,000) in all the years of Worjd War II. The two relatively small Japanese cities lost 17.6-12.6 per cent of their inhabitants in the very first days and 18.1 and 35 per cent respectively by the 20th day after the attack. All of those people should have been identified and buried; up to the moment of death they should have received compassion therapy. This was obviously impossible, even with outside help.

Four months later 72,000 and 25,000 persons in the two cities were in need of medical assistance, including 25,000 and 9,000 persons respectively with multiple injuries, and 8,000 and 5,000 cases of acute radiation sickness.

victims; 80 of them died in the very first hour. In the course of 20 days a hospital in Nagasaki provided out-patient treatment for 9 000 injured persons and hospitalized 800 persons, of whom 350 died in the same period /68,82/. Fig.15 illustrates the lethality statistics.

Police and members of emergency teams assisted in picking up the injured and in providing medical aid. Their work, however, was also extremely difficult, since ruined buildings changed the appearance of the cities and hampered orientation. Both the dead and those still alive---who could yet be saved---- were buried under the rubble. Fires raged everywhere. The disruption of communications hindered salvage operations.

In the first days refuse and waste were either not removed at all or disposed of partially and with great delay. The horrible stench lessened people's need for food, but thirst remained. All eyewitnesses of the nuclear attack emphasize heavy depression and demoralization among the population, citing numerous examples of inadequate behaviour which made the already grave situation even worse. Physicians, feeling depressed because of their inability to give people so much needed assistance also did not always behave rationally. US journalist J. Hersey /47/ recorded the account of one physician who had survived and worked for 19 hours without interruption. At the moment of the explosion he was at a large Red Cross hospital, where only ten out of 200 nurses and six out of 30 doctors were able to work after the attack. I n the first hours 65 of the city's 150 physicians were killed, and 1,654 of the 1,780 nurses were killed or injured. Patients were sitting or lying on the floors of buildings, outer and inner staircases, and on footpaths. They crawled or walked, propping up each other, not knowing where they should go. Over 10,000 persons sought help at a hospital which had only 600 beds already filled with the wounded and the unremoved bodies of the killed. All available means were being used by physicians to treat burns and wounds, with instruments and dressing material scattered in disorder. Their stocks were rapidly diminishing.

Groans and cries for help were heard from under the rubble and from demolished buildings. People who approached physicians had whole patches of skin peeling off, with their hands raised in excruciating pain; many were vomiting, with their heads down and their eyes staring aimlessly or filled with anguish. Some were carrying the bodies of their children already dead; they refused to part with the corpses, oblivious of the smell. Sometimes relatives, on seeing each other, either did not recognize their loved ones, or just went on walking, carried by the stream of people. In a park where huge groups of victims sought comfort in the shade of the trees near the water, the living and the dead with their eyes open were found lying or sitting

1 2 3 4 5 6 7 8 910 12 14 16 18 20 22 24 26 28 30 32 34 36 38 4 41

Fig. 15. The distribution of fatal outcomes in August-October 1945, Hiroshima and Nagasaki /51/.

The abscissa indicates the number of days after the explosion; the ordinate, the proportion of fatal outcomes in relation to the total number of recorded deaths. The last column shows average lethality per day in the period between 41st and 85th days

Of the 45 hospitals in Hiroshima three could be said to have survived the explosion, but they were fit only to provide outpatient care or merely shelter for the severely injured; they were unable to perform all the necessary complex medical procedures and operations.

Casualties among medical personnel were as high as 50-90 per cent. Thus the number of cases in need of sorting and emergency assistance ran into several thousand per medical worker, and into several hundred as regards subsequent treatment. These estimates were reported by participants in a seminar of French and Belgian physicians involved in the movement to prevent nuclear war. They concluded that if the surviving medical personnel worked 20 hours a day for two weeks following the nuclear attack, devoting ten minutes to each of the victims, they would be able to make only one examination per case.

That gives the reader a rough idea of the actual requirements in terms of medical personnel and facilities.

Only 2,500 Japanese physicians and nurses made a heroic effort (report by Dr. Ohkita) receiving at first-aid stations in the first five days 105,000 injured persons; yet, as medical people they could hardly do anything to help those victims.

One morning a first-aid station in Hiroshima received 400

9---1878

together, their postures indicating that for many death had come suddenly and sometimes silently. Those masses of helpless victims were then struck by a gale-force wind which tore trees out of the ground and whirled huge funnels of debris, causing more injuries.

Two-three weeks after the explosion the city was still in a state of terrible devastation, with shattered and deformed buildings and messages for the missing scribbled everywhere on wrecked walls. Parts of vehicles as if frozen in movement, bonfires of corpses, patches of green pushing up from under the rubble on the rusty brown of the earth....

Gradually, garbage collection was resumed, the situation stabilized and the surviving patients no longer had to be moved from one medical facility to another. Death records on a caseby-case basis began to be filed more systematically, envelopes containing ashes were placed in an improvised columbarium. Rumours about the nature of the bomb and the mechanism of its action, which had circulated in the first two weeks, g?ve way to more reasonable assumptions.

A powerful typhoon and flood on September 17, 1945 dealt the final deadly blow to the grief-stricken population of the afflicted cities. By that time a new, previously unknown disease became mainly developed, with its nature having been established. Thousands of surviving radiation sickness cases were not, for the most part, among the gravest ones. The victims who had more severe radiation affliction or multiple injuries caused by other effects of the explosion had died before their disease was identified.

One of the Red Cross doctors, described by J. Hersey /47/, together with his colleagues observed the progress of the disease on himself and on others, identified the sequence of its typical symptoms, and established the causes of adverse outcomes.

The description of clinical effects contained here reflects the available amount of scientific data on radiation sickness and provides a retrospective analysis of the existing material. However, one must not overlook the initial descriptions and accounts which most straightforwardly record the general situation in the zone of destruction, making it possible to perceive in full the overal human, in addition to merely professional, aspect of this new and horrible nosological form of disease caused by the impact of nuclear explosion radiation.

VIII

Late Radiation Effects of Nuclear Explosions

A nuclear war would result in a horrendous number of casualties occurring directly in the wake of the explosion. Yet the consequences of nuclear war are not confined to direct effects which emerge within the next few months. In the 200-1,000 rad dose range researchers justifiably predict a number of protracted and delayed effects, especially if the doses are not received simultaneously but within a period of several weeks to several months, as can be expected when irradiation occurs in the zone of radiactive fallout plume 752,58,83-90 et al./. In such circumstances there is an increase in the proportion of people with the aggregate dose of 350-1,000 rad received within 1 to 12 months. Those people do not face the prospect of an immediate early death and for them the projected estimates basically involve remote irradiation effects. The criteria for this group in terms of possible effects frequency are still rather imprecise. Extrapolations mostly involve the totality of the population irradiated in Hiroshima and Nagasaki, with the proportion of people who received a single 200-400 rad dose standing at no more than 10 per cent, and with a low likelihood of identifying late stochastic effects, including oncological effects, in cohorts of 80- 100 thousand persons. Predominant among the survivors of Hiroshima and Nagasaki were people who received a dose equal to or less

than 50 rad, making it very difficult to distinguish them from the non-irradiated population, especially where it concerned late effects. Some experimental data are also used in examining the issue /85, 86, 91 -95/, but it has been established /53, 54/ that such extrapolations ought to be even more conservative.

In recent years Japanese researchers in cooperation with a number of international organizations have done much to increase our knowledge of late nuclear explosion effects and to make it more accurate and substantiated.

Numerous studies /4, 17, 82, 96-99/ contain data concerning the updating of Japan's regional national cancer records which now cover prefectures with the population of several million; they show a rise in the number of autopsies performed in recent years on virtually all deceased persons who received a more than 100 rad irradiation dose, resulting in a greater number of identifications of certain types of cancer. The dose range of cancer patients' records has been expanded, with individual dose levels being reviewed. There have been more frequent comparisons of cancer incidence over a period of time among persons with different dose rates and differing degree of severity of early symptoms. That makes all conclusions, and especially projections, more scientifically substantiated, since the assessment of possible subsequent dynamics of cancer incidence is based on a time period which is in excess of onethird of human life, in other words, a period sufficient for identifying the main lethality trends for the most common types of tumours.

Leukosis, especially its acute forms, is one of the diseases that has been proved beyond reasonable doubt to stem from nuclear explosion effects.

Leukemic transformations of hemopoiesis are most likely to occur within 5 to 10 years following irradiation resulting during that period in a greater (fivefold to tenfold) incidence of leukemia as against reference groups or persons who received a less than 10 rad dose (see Fig. 16).

The UNSCEAR (the UN Scientific Committee on the Effects of Atomic Radiation) publications over a number of years /53, 54/ also contain strong evidence of excessive mortality from leukosis among men and women of all ages who as a result of nuclear explosion received doses of 50-200 rad, as compared with groups with less than a 10-rad dose and nationwide statistics.

As Figure 16 shows, the increase in the number of leukosis cases occurred mostly in the first five-fifteen years after the nuclear explosion and could be clearly traced to the rate of exposure (Fig. 17). Predominant during that period were cases of acute leukosis with extremely rapid and unfavourable de132

Acute leukemia

Age< 15

Chronic granulocytic leukeoia 15

Tears after irradiation

Fig. 16. Effect of age at time of explosion and of time following explosion on relative incidence of leukemia in Japan /4/. The abscissa represents years following the time of explosion, the ordinate shows relative risk

velopment. Throughout the entire period of observation the number of leukosis cases among those irradiated at the time of the explosion was 3 to 4 times above the level which would be expected on the basis of adequate samples (64 and 14.2 in Hiroshima and 20 and 7.1 in Nagasaki respectively).

The total number of cases included in the latest survey /68/

eoo doses

1-49

50-99 100-199

200 - 299

Fig. 17. Incidence of leukemia per year depending on dose rate,

between 1950-1951, Hiroshima and Nagasaki /4/

Abscissa---doses (rad)

Ordinate---frequency (10^^5^^) per year

Single shading---Hiroshima

Double shading---Nagasaki

was 207 acute and 105 chronic leukemia cases in Hiroshima. 226 cases were recorded among 39,000 people who had been less than 2 km away from ground zero /4/.

Data on Nagasaki are more limited (38 cases as against 141 in Hiroshima) among those selected for detailed study /4/. In Nagasaki too all of the cases resulted in deaths within various periods from the moment the disease had been spotted. Consistent correlation with dose rate (distance from ground zero) was observed, with the actual case frequency in the two cities for the same dose range exceeding the expected by a similar factor (3.5-4.3) during the period up to 1971-1975 /14, 17, 96/. By 1983 /4, 54/ the increase over the expected leukemia incidence level was only 43 per cent. One could observe an obvious relation between the earliest cases of acute leukemia and exposure doses responsible for radiation sickness (Fig. 18).

The distribution of certain forms of leukosis among the

Fig. 18. Annual frequency of leukemia of all types among Hiroshima (H)

and Nagasaki (N) atomic burst survivors as compared to a reference

group (1950-1975) /68/

Abscissa---doses

Mark at extreme right---reference group data

Ordinate---number of cases

affected population and the reference group, and among those born after the explosion is shown on Fig. 19. The number of cases is sufficient for comparative analysis.

As was indicated in the preceding chapter /65, 77 et al./ all persons exposed to doses of 100-400 rad suffer from a cytopenic syndrome of varying duration and severity. The syndrome is due to transitory significant depression of he-

H Irradiation

1 rad

r°

H Irradiation < 1 rad and non-irradiated N

Born after the explosion

N

_L

Number

200 300

Overall dose (rad)

eoo of cases

Fig. 20. Leukemia mortality per dose unit at different dose range, based on T65D and ORNL dose estimates /100/

the limited number of people among whom such a significant increase in its frequency has been observed, the consequences of irradiation can hardly be viewed as anything but very grave. The increase up to millions of people in the absolute numbers that would be affected by a nuclear war and greater irradiation doses up to several hundred rad among the survivors who would not die immediately after the nuclear explosion warrant the conclusion that radiation effects of this kind would be even more unfavourable than in Hiroshima and Nagasaki. The identification of the effect, mainly within 5 to 15 years, and a clear link to the rate of dose received confirm that it is radiation that is most responsible for leukemia among those affected by the nuclear explosion.

Some forms of leukosis continue to remain more frequent even now, yet among those born after the explosion their distribution differs from that observed among those directly exposed to nuclear explosion effects (see Fig.19).

One can also note a narrowing down of differences in the frequency of certain nosological forms (chronic myeloid leukosis and lymphoid leukosis), that were observed for the two cities where the dose rates were different---an indication that the 'impact of the radiation of nuclear explosion which was the main factor responsible for their occurrence in the Fl generation (children of those injured in the explosion) is losing its significance.

The gravity of the disease, the suffering of leukosis patients and the difficulties involved in their treatment are common

Fig. 19. Leukemia cases of different types in Hiroshima (H) and Nagasaki (N) among various groups of population /68/ Single shading---chronic myeloleukosis Dots---chronic lympholeukosis Blank space---acute leukosis

mopoietic organs resulting from the interphase death of cells, the breakup of the process of division and physiological repopulation in various hemopoietic tissues with a subsequent activation of the system's resources which are not mobilized in cases of total irradiation. That makes for greater likelihood of aberrations in DNA synthesis, affects the number of chromosome aberrations among predecessors and early stages of hemopoietic cells, and makes them vulnerable to tumoural (leukemic) transformations. The ORNL review* of the neutron component and the overall rate of doses as compared to T65D estimates shows no change in the general trends of oncological effects. Yet, as ORNL doses are slightly lower than T65D estimates, the frequency of leukosis per dose unit becomes greater in the new assessment; therefore, the projected assessment of the explosion-related risk is even more grave /100/. This is shown on Fig. 20.

Given the stable relatively low incidence of leukosisamong all other oncological diseases, the fatal outcome of the disease and

* ORNL doses---tentative dose review data based on studies by US national laboratories /100/. T65D---dose estimates based on data obtained by the Japanese-US group in 1965 /17/.

knowledge. Even though relatively rare, the treatment of this disease calls for the use of numerous personnel and resources of all qualified hematological clinics in various countries of the world. Just think of what those patients and medical workers would have to go through in a nuclear devastated environment in a situation when the number of cases would grow, say 3-4 fold, or even tenfold, as it occurred in Hiroshima and Nagasaki Th ink of the moral burden that would be placed on their next of kin or on those likely to expect the development of such diseases after being exposed to radiation.

Still, the oncogenic effects of nuclear explosion are not confined to leukosis. Damaged cellular and humoral immunity protracted pluriglandular endocrine hypofunction and dysfunction aggravated by psycological stress and the dislocation of the living environment in the wake of the explosion appear to be along with other general factors, real additional risk factors likely to increase the frequency of development and clinical manifestation of other tumours among the nuclear explosion survivors As was stated above /54, 82, 99 et al./, since 1962-1964 cancer records have been carefully kept in 11 other Japanese cities, besides Nagasaki and Hiroshima. The ageing of the population in the cohort affected by nuclear explosion led to an increase of up to several thousand in the total number of recorded cancer cases. Eight dose range groups have been identified among them (plus a group of people who were outside the city limits at the time of the explosion and who subsequently returned, and people whose dose has not been established).

Comparison is made in these conditions between test groups (1,870 and 5,948 cancer cases) and a reference group. Special account has been made of multiple tumours (there were several hundred cases with two or three localizations). Most of the data were verified clinically and by postmortem analysis. Death certificates as the only source were used quite rarely (in 10 per cent of cases). Two periods were singled out for observation--- prior to 1970 and after 1970 (in other words, what is currently being studied is the second 25-year period since the explosion, with each period representing roughly one-third of a human life span of 75 years).

The distribution of diseases among different age and sex groups, particularly over the latest observation period, was found to be in line with the general trends of oncological morbidity in Japan. Yet, for practically all types of cancer and for the entire group (all leukosis tumours) the incidence was higher than in the reference group (Fig. 21), consistent with 90 per cent of confidence interval (see Fig. 22).

For persons who received a more than 200-rad dose greater incidence was also noted for tumours of certain localizations 138

All cases

Injury

---4

All diseases

All malignant tumours

Leukemia

All malignant tumours, excluding leukemia

Benign and non-specific tumours All diseases, excluding tumours

Tuberculosis

Vascular lesions of the central J. nervous system'

Disease of the circulatory---- fsystem

Diseases of the digestive system Other diseases

^-

0.5

Relative risk

Fig. 21. Relative risk and 80 per cent confidence intervals for the principal groups of death causes, 1950-1978 (200+rad compared with 0 rad) /4/

Leukemia

All malignant tumours, excluding

leukemia

Esophagus

Stomach

Large intestine

Rectum

•

Pancreas

------------

Other cancers of the digestive system

Lung

Breast

---

Uterus

------

Urinary tract

Malignant lymphona

Multiple myeloma

Other site

Relative risk

Fig. 22. Relative risk (80 per cent probability) for all types of cancer, 1950-1978 (200+rad compared with 0 rad) /4/

0-9 Age at time of explosion

800 600

\

i

---

400 200 0

__ m

I

h

\

\

Fig. 24. Incidence of mammary gland cancer in Hiroshima (shaded column) and Nagasaki (white column) in relation to dose levels /4/. Abscissa---T65D (rad) Ordinate---incidence per year (10^^6^^)

Tear of death

Fig. 23. Cumulative mortality rate from lung cancer (10^^3^^) in relation to age at time of explosion, 1950-1978 /4/

(hemopoietic organs, lungs, urinary tracts, mammary glands) (see Fig. 22). Higher incidence of stomach cancer was reliably established only in the second observation period (after 1970 and, mostly, prior to 1978).

Lung cancer shows consistently higher incidence over the entire period. (Fig.23 shows the link between higher incidence and age at the time of the explosion). In recent years higher incidence of pancreas cancer and myeloma has been observed among those irradiated. The incidence of thyroid tumours also increased /101/. The dose relationship remains in effect for all oncological diseases. Figs.24 and 25 show the dose relationship of the incidence of mammary gland cancer and lung cancer respectively. The relationship is less distinct for the prostate and mammary gland cancer. We feel that the latter is typical of hormone dependent cancers /83, 86/. With the average kermato-air dose at 17.9 to 48.8 rad (according to 1965 dose data), the number of cases identified exceeds the expected level by 11 per cent for all types of cancer, 42 per cent for leukosis, 34 per cent for mammary gland cancer, 27 per cent for the thyroid 140

0-9

10-99

100 +

Fig. 25. Lung cancer lethality in Hiroshima and Nagasaki, 1950-1972

/78/.

Abscissa---doses (rad)

Ordinate---number of cases (10^^5^^/year)

gland and 34 per cent for myeloma. Those figures are slightly higher and show a more regular dependence than the figures for the same tumours which ended in a fatal outcome.

Particular mention should be made of data on thyroid cancer,

which show a distinct relationship to age at the time of exposure---which underscores once again the special vulnerability of children and youth to nuclear burst effects.

Publications /4, 17, 82, 101/ show a 2.5 times higher incidence of clinically identified thyroid cancer cases among female survivors of Hiroshima and Nagasaki who were at a distance of less than 1.5 km from ground zero. The dose relationship was obvious (6 cases against 3 expected cases in the group which received a 10-15 rad dose, and 25 against 4.5 among persons with a more than 50-rad dose). Additional exposure to radioactive iodine contained in the fallout caused by the ground burst increases the overall dose affecting the thyroid gland of children and, hence, there is a greater risk of tumours and dysfunctions developing in the gland which is so important for shaping the organism in childhood and adolescence /52, 54, 102/. In the Marshall Islands it took 14 to 26 years for this effect to appear. The frequency of adenoma cases varies, depending on the dose rate, from 9 to 36 per cent (6.6 per cent for the reference sample) and from 4.7 to 1.9 per cent for cancer (against 0.9 per cent in the reference sample).

Here we must once again recall the multiplication effect which increases the absolute numbers of human casualties and of the years of poor health and results from the increase in the number of people irradiated and in the dose rates projected for a nuclear conflict, especially when accompanied by introduction into human environment and foodstuffs of large quantities of radioactive iodine. Preceding chapters and several publications /85, 86, 92-95/ have demonstrated the special significance that protracted irradiation by other radionucl ides (strontium, cerium) has for oncogenesis.

It is more difficult to give clinical interpretation to data on lung cancer due to its relatively high general frequency and the overall trend toward an increase in the number of lung cancer cases in recent years among men and women of advanced age throughout the world. Among the available data we would like to single out those published in the survey /17/ on the comparison of the results of 1,700 postmortems of persons who were exposed to a 10 or more rad dose, including only 127 of those who received doses of 200 or more rad, and 1,196 postmortems of persons whose irradiation dose was less than 10 rad. The frequency of pathomorphologically diagnosed lung cancer in the first group was 10.2 per cent, that is, twice as high as in the second group and, according to nationwide statistics, among people from Japan's other cities.

We believe that even a si ight increase in the frequency of that common oncological disease, which takes a very unfavourable course, deserves most careful attention and cannot be disregarded.

We could also mention the publication /103/ on higher frequency of certain types of primary tumours of the liver, even though relationship was established between the frequency and the spread of hepatitis B antigen rather than the dose rate.

The comparison of certain other indicators of health among the surviving part of the population, of the average longevity of persons with different dose rates and its reduction caused by various reasons other than tumours, did not establish a regular pattern of differences between various subgroups /171/.

In later periods it proved impossible to establish the relationship between the frequency of clinically meaningful changes, typical of all atomic burst survivors, in the nervous and cardiovascular systems and the rate of dose received at the time of the nuclear explosions in Japan, as can also be seen from the analysis of the mortality structure (Figure 21).

Yet, a somewhat greater frequency of certain changes for the group as a whole is not, in our view, accidental. Along with some other distortions it reflects the unfavourable impact of the totality of factors caused by the explosion, which are common for all and which gravely damaged the environment and the way of life of those people.

Some papers analyze the intimal mechanisms, the knowledge of which reveals how certain irradiation effects are altered underthe complicated additional impact of internal and external factors. Their authors found, for instance, a weakening of the natural protective cytotoxic function of lymph cells among persons who had received a small dose at the time of the explosion. That fact was proved /104/ 35 years after the explosion, and the authors trace it to a possible change of antitumoural immunity. A number of non-specific mechanisms which change the organism's adaptive abilities as well as the abilities of its regulatory systems and of the endocrine-humoral mediation may produce among those who received some 500 rad, apart from direct carcinogenic impact, a 3 to 7 per cent drop, i.e. a reduction by several years, in average longevity /54/--- amounting to a huge loss for society. We believe that in making an overall assessment of the consequences of nuclear war one should not overlook the fact that people of various age groups may have d ied early, either immed iately after the burst or due to a higher incidence or shorter latent period of spontaneous tumours, even if their frequency among the survivors is not greater.

An additional factor which takes into account the difference in the life expectancy of various age cohorts between those irradiated and non-irradiated is, in our view, highly informative and useful in evaluating the damage inflicted by the nuclear explosion's radiation /105/. Accounting for it may help to reflect other causes of excessive mortality among the survivors, in

addition to nuclear explosion radiation, as well as the changes in the relative impact of different death factors among persons of a certain age group, which undergo a sharp transformation under the powerful influence of numerous explosion effects that unfavourably affect both the injured and their descendants.

For instance, we have already mentioned data /66, 67/ on excessive mortality among babies less than one year old and newly born in Hiroshima and Nagasaki. The data demonstrate an irregular pattern of lethality causes, different from that common for children of less than 10 years of age, and the direct marked relationship with the mother's irradiation in the last three months of pregnancy. What is important here, in our view, is not only or not so much the impact of radiation on the foetus in these last three months, as the fact that babies were born to sick mothers and that their early postnatal development took place in the most unfavourable living environment brought on by the nuclear explosion.

Such phenomena have been observed among those injured in other wars, yet they would be of special meaning in a nuclear war. It may be recalled /81 /, for instance, that lack of adequate food for nursing mothers, as well as grave psychological sufferings affected the morbidity and mortality rates among some 80,000 children born in besieged Leningrad. In 1941- 1942 41 -60 per cent of pregnancies ended in premature birth, with the mothers' mortality rate amounting to 2.4 per cent (a tenfold increase over the prewar period). The babies' measurements upon birth were less than normal by 600 grammes in weight, 2 cm in height and 1.5 cm in head and chest measurements. Their plight was somewhat eased through the heroic efforts of Soviet medical personnel to save young mothers and babies. Yet, how can one help mothers and their babies in the aftermath of a nuclear attack?

That the above effects are caused largely by non-radiation factors of the explosion can be seen in the fact that children born 10 years after the burst and later, as well as older children in Hiroshima and Nagasaki, have closer to normal health indicators. The structure of death causes among them and their relative importance were within regular limits. Yet among them, too, certain physiological parameters (dynamics of skeleton formation, correlation of some anthropometric parameters in different age groups, and the time of onset of puberty) showed signs of some radiation-induced distortions, which will be subsequently dealt with here in greater detail.

The impact of the nuclear explosion on the development in later periods of non-tumoural diseases and acceleration of age involution, or premature ageing, appears to be more complex and less clearly established.

The relationship was established between the irradiation

dose and the frequency of cirrhosis of the liver cases among the survivors /103/. As we already mentioned above, the frequency of primary cancer of the liver and the biliary tract in the same group was found to be in closer correlation with the distribution of the antigen of hepatitis B virus than with the radiation dose. That shows that the impact of radiation factors can be indirect and can appear in combination with other concurrent unfavourable factors of higher risk.

It should be also recalled /?/ that postmortems performed on 349 deceased males established, in addition to typical involutional transformations, a clear link between the signs of testicular sclerosis and hypoplasia of interstitial cells on the one hand, and the radiation dose on the other. That shows that changes in the formation of sexual hormones can last over a significantly longer period than the period required for restoring spermatogenesis, something which significantly affects the development of certain hormone-dependent diseases.

Later studies of skin elasticity, of the body-height to mass ratio and of the heart size /17/ also revealed certain signs of radiation impact on physiological indicators of age.

At the same time it has not yet been possible to establish reliably any differences in the frequency of principal cardiovascular diseases, diabetis and rheumatoid arthritis between those irradiated and their contemporaries coming from the same regions of Japan. Yet, establishing the relative importance of radiation as one among many risk factors for the development of these polyetiological diseases in restricted groups and, furthermore, extrapolation of the available quantitative parameters in estimating the consequences of an all-out nuclear conflict should be viewed as a serious challenge.

Many effects have a lengthy latent period. Therefore, today it is not yet possible to draw a definitive conclusion as to all likely late consequences of high-yield nuclear explosions. Their effects take longer to emerge and may manifest themselves toward the end of a person's life.

There is no doubt that grave and rather common types of oncological and other diseases take a heavy psychological toll, as concurrently irradiated people who have known each other well, die one after another. Even if only some of those deaths can be directly ascribed to radiation effects, they are all viewed by the injured as irradiation-induced. Such attitudes give rise to oppressive moods, depression and anxiety among all the survivors who expect the same seemingly predetermined outcome. All this has happened in Japan and cannot but cause alarm in the scientific and medical community in an atmosphere of rampant nuclear arms race with its risk of a global nuclear conflict.

We have attempted to analyze these inherently complex late

10---1878 145

effects of nuclear explosion on the health of the survivors and to establish, wherever possible, the direct contribution of radiation and other factors to the genesis of various forms and syndromes.

We have also demonstrated that somatic---and psychological---``marks'' haunt even those who at the time of the explosion received relatively small doses, affecting them for a long time, practically till the end of their lives. The damage to health could become even greater in the complex overall socioeconomic and ecological situation that would be brought on by an all-out nuclear war.

So far we have described the effects of two low-yield atomic bursts. Physicians cannot fail to realize that in the aftermath of a global nuclear conflict the impact of all these factors on the health of the survivors would be much greater. It can be said with certainty that its consequences, including late effects, would be extremely negative, although it is still difficult to quantify them in any exhaustive way.

IX

Psychological Consequences of Nuclear War

10-

Frightening scenes of sudden catastrophic destruction of habitual environment, massive death of people and the feeling of helplessness in the face of raging elements have always affected individual mentality in a most powerful way. People have experienced such feelings during powerful earthquakes, volcano eruptions, hurricanes, floods and wars, as well as during sieges of fortresses and cities. Nuclear war would mean multiple action of all these effects, surpassing in scale each and every one of them. It is therefore legitimate for scientists and physicians to try to predict what could happen to individuals and society should nuclear arms be used and, what is more, should an all-out nuclear war break out.

That purpose is served by truthful accounts, such as the Hiroshima Diary /46/, memoirs by eyewitnesses /66/, newsmen's reports /47/, statements by participants in international congresses of Physicians for the Prevention of Nuclear War and, finally, by the efforts of psychologists and psychiatrists to give scholarly interpretation to these documents of great concern to all humankind /106-111 /.

First, we shall attempt to establish some sort of classification based on etiopathogenetic mechanisms of complex past and projected reactive conditions which have very special

characteristic and in our view, require great accuracy in predicting certain variations of eventual psychiatric and psychological reactions.

There are four groups of responses that can be singled out as follows:

1. Direct response of individuals and the community affected by the nuclear attack in the two Japanese cities.

2. Delayed prolonged reactions of individuals to the disease they had to endure, and to their changed status in society (among the survivors of the bombings of Hiroshima and Nagasaki).

3. Society's reaction in the country (Japan) directly affected by the nuclear explosion to that event and to the world developments in connection with the nuclear war threat.

4. Individual responses among people in contemporary society and in certain groups and communities to continuing threat of nuclear war.

The etiological factors in the first group of reactions were discussed in detail above when describing direct medicobiological effects of the first-ever nuclear attack and of the ensuing socio-economic dislocation in the two Japanese cities. These factors are sufficiently obvious and distinct for us to consider the responses of people, who for the first time in their life saw scenes of such massive destruction and death, as more or less authentic both as regards individuals and society as a whole.

The study based on inverviews with 75 Hiroshima survivors, conducted by US psychiatrist Robert Lifton 17 years after the catastrophe, was designed to revive memories of immediate impressions and to uncover remaining anxieties and fears and to establish how the survivors perceived society.

That and other studies showed that reactions of the first group are basically consistent with painfully developing grave reactive states which are accompanied mostly by certain signs of the depression syndrome and also of hypobulia and hypokinesia, sometimes with a brief period of inadequate behaviour. The most striking psychological feature of the immediate impression produced by the nuclear explosion was the sense of a sudden and total shift away from normal existence towards a horrifying encounter with death. For instance, a young university professor who at the time of the explosion was 2,500 metres away from ground zero sums up that feeling of supernatural terrifying irreality as the sense of being in inferno, a metaphor frequently used by other survivors. Lifton believes that beginning from the initial moment of contact with the atomic

bomb, that emotional feature characterizes the emotional state of the victim, which continues indefinitely. The "psychological detachment" reaction has also been identified, which is a typical form of response to insurmountable threatening factors and which manifests itself in non-reaction to these factors and in ignoring former values and inhibitions. Even if the reaction can be hightly adaptive, being a means of psychological defence, it may vary in strength, at times becoming similar to a psychotic mechanism. As eyewitnesses of those tragic events testify, everyone seemed to have gone mad, while those who had survived behaved as persons ignoring the appeals of friends, as egoistic and self-centred individuals who were guided by their instinct rather than civilized norms. Psychological detachment is likely to last from several hours to several days or even months and may result in a prolonged feeling of depression and helplessness.

Apart from the above, somatogenically induced (i.e. caused by wounds, burns, or a grave overall condition) individual reactions and psychotic conditions were typical of the first group of reactions, which were aggravated by one's inability to help oneself and others, general social disorganization in the first hours and days after the explosion, slow and incomplete restoration of social institutions or the emergence of individuals who assumed leadership roles in an attempt to introduce some order into the activities of separate survivor groups and to make them more purposeful.

We should also point to some special features of the Japanese national character, which revealed themselves in those tragic hours and days---courage in suffering, greatest fortitude, loyalty in most cases to one's professional duty, and a desire to search for the causes and to perceive the meaning of what is going on, a trait which develops at an early age. At the same time many people noted surprising tolerance, acceptance of an unfavourable outcome, and a special attitude toward the damage done to nature as the habitat and the source of life, possibly stemming from the Japanese system of religious and ethical notions. Those features may have been an additional cause for subsequent severe reactions that we included in the second group. There emerged prolonged and lasting profound depressions, burdensome both for the individual and the community, which generated the expectation of an inevitable fatal outcome, fear, a sense of inferiority, doom and isolation from society.

A young clerk irradiated at a distance of 2,000 metres admitted nearly 20 years after the catastrophe that he still felt scared each time he learned of people still dying in hospitals of diseases caused by the atomic explosion, that he thought that sooner or later the same might happen to him.

That the survivors identify themselves with the dead or injured means existing in a psychosomatic vicious circle---the slightest common injury or disease is likely to be associated with the impact of radiation and everything related to its effects begins to be associated with death.

Thus, an all-embracing term---"the atomic bomb disease"--- has emerged, which, on the one hand, refers to such fatal conditions as early acute radiation effects and later cases of leukemia and, on the other, to a borderline state of fatigue, general weakness, "susceptibility to the common cold" and general nervousness. It is this group of reactions, by far not always now matching the person's actual condition, which was typically augmented and heightened by the unfavourable situation common to a large group of people, by the identification of the individual prognosis with the fate of those involved in the same events who are dying of various causes, and by the information gleaned from extensive but not always objective reports of the mass media.

An unsettled socially complex situation (involving the right to marry, moral and material responsibility for the well-being of children, medical treatment financing) in conditions of progressive somatic aggravation of the effects of certain burst factors led not only to psychogenetically induced worsening of the people's state of health but also to greater fixation by the injured on changes in their condition. To a question by Professor A. Kozlova and one of the authors about their thoughts for the future or about the likelihood of natural recovery, the injured replied that they were prepared to meet with dignity the (inevitable) fatal outcome, that they regarded their poor health as a natural and typical consequences of the nuclear explosion, that they disregarded or did not think much of the non-specific ailments they had developed (ulcers, tuberculosis) and to some extent brushed aside the need for their treatment in the belief that those ills "did not really matter" and were of no consequence to their fate. Many of the atomic explosion survivors have developed both a specific personal self-appraisal and the sense of being perceived in a special way by others, which has a special impact on the life strategy and behaviour of those people.

One who has talked to the injured in the 1960s still feels the pain caused by contacts with those people who had to live with a self-imposed feeling of their inevitable and agonizing departure from life, coupled with their sense of social inferiority ("our marriage would either be childless, or if there are children no one knows what their lot will be").

Some of those people have found an outlet for themselves in active public or selfless professional work often linked with the

fate of the inhabitants of the two destroyed cities and with the struggle for peace. Yet, their inner feeling of being particularly inferior was very hard to overcome completely.

Of course, with the passing of years, somatopsychological aggravations and involutionary depression additionally developed, as well as possible organic mental diseases in a number of cases. Still, the publications available do not provide any reliable data on their frequency and structure.

Special mention should be made of the shaping of personality of individuals who experienced the events brought on by the nuclear explosions when they were still little children or adolescents. In a child's reaction to all psychogenetic and physical factors, of critical importance are those organs and systems which continue their morphofunctional development after birth very unevenly during certain age periods.

The vividness with which children and adolescents typically receive tragic impressions, the loss by them of the sorely needed warmth and protection of their families and society at the time of the catastrophe and also later, as well as a complex range of emotional shifts reinforced by dysfunction of the nervous system and the endocrine glands, subsequently make their reactive conditions particularly durable and grave, while their personality continues to be shaped in a sad and less than normally active community of adults burdened with their own worries and concerns, for the fate of children among other things.

Drawings of the explosion "as remembered" by children, their faces appearing on the photographs taken in those horrible days testify to the depth and strength of their feelings. The malleability of the child's nervous system, gradual restoration of disrupted internal regulatory mechanisms and normalization of the social and demographic structures will no doubt lead to some positive results. Yet, it seems that termination of such complex and durable reactive conditions and complete mental recovery are hardly possible in many cases.

The period of the shaping of personality in the extraordinary circumstances brought on by the explosion leaves a lasting imprint and is further aggravated by other psychotraumatic and somatogenetically unfavourable factors. That can change the individual's adaptive abilities and, in a number of cases, contribute to the development of truly psychopathological syndromes and to a pathological evolution of the mind. It appears, however, that the main result is various disadaptational functional changes and mutually reinforcing, as in a vicious circle, syndromes of the vegetative-vascular and vegetative-endocrine regulation disorders.

The third group of reactions among the population directly affected by the explosion is related to their own tragic ex-

perience brought on by nuclear radiation. These reactions make people particularly apprehensive of the risk of recurrence of similar events and even of irradiation for medical or diagnostic purposes/112, 113, 196/.

Among the etiological and reinforcing factors are protracted grievous impressions of the continued suffering of the injured, ambiguous and incomplete information about various factual data on the atomic explosion and the constant revision and changing interpretation of the events, generating a sense of insecurity and doubt about the accuracy of available information.

Along with real and justified concerns and opposition to all signs of nuclear war preparations, constant anxiety heightened by insufficient information results in an excessive broadening of the sphere of "expected danger". That leads to an obsessive checking of foodstuffs and the environment:for signs of radioactivity, fear of X-ray examination, arbitrary interpretation of the relationship between any changes in one's state of health and the effects of irradiation, and an aggressive attitude toward nuclear power generation. '

A common human reaction to nuclear danger is that of fear i and great uncertainty. When the danger is perceived as im- J minent and personally threatening, people attempt either to take ; cover or to avoid the danger, and their behaviour generally * becomes adaptive. At the same time, earlier studies of various ; calamities have demonstrated that danger or menace which cannot be perceived by the senses has a very great impact on the • mind. Ionizing radiation presents particular difficulties in terms ^l of perception of danger and, consequently, in developing ' orientational guidelines for shaping adequate and effective ' adaptive behaviour. Misinformation often results in a distorted view of reality and in developing negative adaptive reactions.

Finally, let us turn to a reaction, which takes most varied forms among individuals and groups of people and may be found throughout the world, to the continuing threat of nuclear war. The world already knows what a nuclear explosion means. Popular-science publications, works of fiction, scientific research papers and the aspects of the political situation constitute a complex array of information sources, having an impact on the minds of men. Psychiatrists and psychologists point to the existence of various forms of adaptation or decompensation of personality, depending on numerous circumstances. Different forms of reactions are discussed, beginning with totally shunning any thought of danger and ending with a breakdown and a possible morbid resolve of an individual operator, who is tired of tense waiting, or who has committed a fatal error, "to make the threat become a reality as soon as possible"/66,107,109,110/.

In addition, many authors have analyzed the role of the personality's basic traits, as well as age, bad habits, acceptance of life in isolated environment---individually or in groups (the problem of shelters)---capacity for self-discipline, and way of I ife. The studies show that sensory deprivation, closed space and protracted isolation in a potentially dangerous physical environment may result in various types of aberrant behaviour, development of depression symptoms, disruption of cognitive and perception abilities, as well as the development of various behavioural disorders---starting with excitement and somatic disorders and all the way to hallucinations and paranoid mentality. It has to be pointed out that due to the impossibility of ending the isolation, a stronger than experimentally recorded psychological decompensation can be expected.

Along with the above-mentioned studies, attempts are made to quantify how many of those involved in the tragic events will react in what way to a given stress situation, and what those reactions will entail in communities with different ethical norms and social structures, in families and collectives.

We have carefully studied such publications, quite abundant abroad, and believe that by and large they are not consistent with the rulesof strictly scientific research on which this book is based. These publications deal with emotional assumptions, clearly reflecting the different social and political concepts of other authors. They overlook, as a rule, "sensibilization of society", and the incomplete and contradictory nature of information conflicting with everyone's own peculiar notions of nuclear catastrophe. All such projections are based on data related to humankind's first encounter with nuclear explosion, something that is far from adequate, as we have seen above.

Almost all of the authors point out that introduction of orderly elements, though on individual initiative, has a definite good effect and helps people withstand the extreme circumstances for some time. In this sense one could speak of the desirability of improving certain services, like civil defence units, and of advising people to assist in their efforts.

Yet, on the whole, the effectiveness of such efforts depends, besides psychological factors, also on material factors and on the overall situation ensuring the adequate activity of the units that come to the aid of the injured. An optimistic outlook can hardly be warranted here.

Thus, reviewing the last group of reactions it has to be recognized without reservation that all people living under the threat of nuclear war are subject to a long and severe moral trial. Even if some may not feel as strongly about it as others, they justly regard nuclear war as the greatest disaster in the history of humankind. The individual traits of each and every human being,

the social system under which he lives, the amount of information available, as well as awareness of one's own position in efforts to preserve peace give rise to different solutions and types of conduct.

We are witnessing a huge upsurge in the world-wide struggle against the nuclear arms buildup and for the preservation of peace on Earth. People who are aware of their contribution and usefulness as participants in that progressive movement which brings together people of various beliefs and creeds, convert their reaction to the threat of war into an adequate and active protest against war and work for peace, and they are in the majority.

The socio-political orientation of the Soviet Union does not produce any conflict between the natural longing of Soviet people for peace and the approach of our state to that issue in the international arena. Yet, it is equally natural for our country's people to share anxieties and concerns felt by the people of other countries for the fate of the world.

Finally, it is no less natural for some people throughout the world, due to their individual characteristics, a given social and occupational situation and many other reasons, to be unable to express their reactions through adequate behaviour, when subjected to prolonged grave moral stress. It is our view that despite a relatively lesser frequency of inadequate reactions in peacetime, they will be more organic in their origin (primacy of personality characteristics), while the totality of the affecting factors will make them more protracted and negative. Of course, these people will prove to be less resilient to other tests in their lives, something which is to be borne in mind in making projections about psychological effects of any war.

We have attempted here to establish, on the basis of all available facts, how the individual personality may be affected by nuclear war.

We have tried to classify in a rational way the types of reactions which are highly different in terms of their etiology, incidence, development and outlook. With all the external similarity of reactive conditions, the difference in their etiological factors is quite obvious and makes it possible to single out at each phase the basic psychotraumatic factors and their typical manifestations.

Yet, common to all of them is the threat of nuclear war, the horrible experience of which has for nearly 40 years been a heavy moral burden for humankind.

These effects outlast all somatic effects, and they are more tangible in succeeding generations than genetic damage.

Therefore, the struggle against the threat of nuclear war is a struggle incumbent on physicians for the mental health of the

present and future generations. This is a most important aspect of the movement for prevention of nuclear war. The significance of the movement in improving the health of people can hardly be overestimated. In short, we are duty-bound to pass on to our contemporaries and to their ch ildren a world in wh ich one can be confident of the future, a world that guarantees the right to the preservation of human life in all its physical and spiritual manifestations, as the greatest common heritage of people on planet Earth.

Genetic Damage Caused by Nuclear Explosion

Chromosome defects (aberrations) may be qualitative and quantitative. After some aberrations, though, chromosomes are restored in new abnormal configurations termed translocation, inversion, the loss or additional insertion of a fragment ( deletion and duplication).

Better knowledge of the natural frequency of all these developments is crucial for a correct interpretation of data on changes in their frequency and nature in studying the influence of some or other factors, including that of nuclear explosion.

When extrapolating data obtained from experiments on animals (monkeys, mice), on drosophilae and bacteria assumptions are made which make assessments less precise:

---there is proportional dependence between the yield of spontaneous and induced aberrations;

---the number of aberrations induced in the sex cells of a given species and of man is the same;

---the extent of damage to the cells of man and the studied species equally depends on physical and biological factors.

The observation of children conceived by mothers or fathers exposed to radiation in Hiroshima and Nagasaki has shown so far that the aberrations of chromosomes in somatic cells (translocations and dicentrics), which had taken place in the parents, have not been found in their offspring. No definite increase was registered either in the frequency of congenital malformations, metabolic disturbances, changes in blood proteins or in the infant mortality rate, except for children born soon after irradiation. At a later period no changes were found either in the sex ratio which is also considered to be a genetic effect /66, 68, 114/. Some deviations, though, should be described in greater detail.

UNSCEAR materials /53,54/ give data on recessive gene mutations. The children under observation were subdivided into those born to parents exposed close to ground zero (the average gonad dose received by both parents was approximately 59 rem), and those less irradiated, whose parents were further removed from the site of explosion, who received less than one rad. The number of children in each group exceeded 27,000. Among the 28 studied genes two mutations were found in children of most exposed parents. However, the findings are on the whole too few for an exhaustive evaluation of the mutation frequencies to be made among persons affected by the nuclear explosions.

An estimate is given /4/ of a possible number of new recessive mutations in man. It is based on the assumption that the effectiveness of radiation in relation to their induction exceeds 7.2 times over that of dominant mutations, while the

It is not only the prospect of people being killed or injured by direct exposure to radiation, but also genetic damage to coming generations that is a source of grave concern to humankind. The study of this question involves great difficulties and no simple answer can be given to it now. This pertains to the assessment of the available data on about 20,000 children born to parents affected by the atomic explosions in Japan and, in a greater measure, to prognostication of various possible versions of nuclear war.

It I "*s been established that in 50 per cent or more of the cases spontaneous abortion has been the result of a hereditary defect. If a defect does not cause abortion, the children are born with deformities or diseases, which was the case with 10.5 per cent of all children born alive /53, 54/.

Radiation can cause two kinds of changes: heritable changes in the elementary units--- genes, and in the organellas in which genes are localized---the chromosomes of sex and somatic cells. Genetic mutations are manifest in the first offspring of the father or the mother whose sex cells had been irradiated, in which case they are called dominant. In case a mutation gene of both parents is required for mutation, they are called recessive. Their number, according to the probability law, will be increasing from generation to generation.

number of genes of both categories, capable of mutation, is practically the same (see Table 15).

Table 15

Estimated number

of cases of serious genetic ill health

in offspring (excluding abortion) from parents

irradiated with 10^^6^^ man/rem in a population

of constant size

Acute

exposure

Chronic

exposure

Category of genetic effect

First

Equilibrium

First

Equilibrium

generation

generation

Unbalanced translocation:

risk of malformed liveborn

Trisomics and XO

Simple dominants

Dominants of incomplete

penetrance and multifac-

torial disease maintained

by mutation

Multifactorial disease not

maintained by mutation

Recessive disease

(2,700)

(2,700)

(720)

(720)

DOSE (HAD)

Fig. 26. Incidence of chromosome aberrations in lymphocytes depending on dose rate received in Hiroshima and Nagasaki /4/

Table 16

Chrorosome aberrations in bone marrow among the survivors of the Hiroshima atomic bombardment

From the 1983 report of WHO experts /4/, p. 150.

The estimates have been made for the two situations of chronic and acute (one-time) exposure; they also take into account an increased incidence of some categories of diseases, approximately tenfold in the subsequent generations (upon the achievement of equilibrium).

It is known that the frequency of chromosome changes in the cells of blood and bone marrow in the early period of radiation sickness depends on the irradiation dose (see Fig. 26). Similar research was made also in a later period among those effected by the atomic explosions (see Table 16).

So, even 30 years later, the number of aberrant cells depended on the dose. All the aberrations were of a stable type. Meanwhile nearly all those persons were in a satisfactory health condition and their blood-test results were normal. Thus, the role of chromosome changes in the life of the exposed persons is yet to be specifically established.

To find out if irradiation of the germ cells of parents could increase the frequency of chromosome disturbances among children, the somatic chromosomes of the children of the

Distance from Number of

ground studied cases zero

(km)

Number of

With chromosome aberrations

analyzed cells

Number of cells (per cent)

Number of cases (per cent)

0.5 0.6-1.0 1.1-1.5 1 6-2.0 2.1-3.0

20 21 18 23 23

1,127 789 556 728 737

262 (23.2) 101 (128) 1 (0.2) 0 3 (04)

18 (90.0) 11 (52.4) 1 (6.2) 0 1 (4.3)

Reference sample

Quoted from /78/

atomic bombardment survivors were studied. The chromosome analysis was made among 10,820 children, 5,058 in the reference group (children of least irradiated parents), with the dose of one rad, and 5,762 persons of the main group (child-

ren of the most irradiated parents); the gonad dose for both parents was 87 rem. The differences in the frequency of chromosome disturbances between the children of the main and reference groups, as has been said, were insignificant in statistical terms /54, 68/.

Evidently, this is accounted for by the fact that most of the zygotes with chromosome disturbances cannot survive, which causes death to the foetus at an early stage of development and therefore results in abortion.

Spontaneous abortions among non-irradiated women are caused in half of the cases by various kinds of chromosome anomalies, most often by trisomy, the monosomia of chromosome X and tetraploidy. It may be assumed that the frequency of these anomalies increases due to irradiation and so does the probability of abortion.

In 1948-1953, that is, in the first three to five years after the explosions, about 70,000 spontaneous abortions were registered among women from Hiroshima and Nagasaki /115/, which is indirect proof of the above assumption. This is also confirmed by the data /116/ on the increased foetus mortality in the case of irradiated parents, as compared with the reference group (2.7 per cent), which ranged between 4.4 and 23.3 per cent depending on whether it was only irradiation or signs of radiation sickness that were found in the mother. Thus, one in every four foetuses of mothers who were less than two kilometres away from ground zero and had radiation sickness died.

Abnormalities affecting vitality are normally not associated with zygotes having a normal set of chromosomes or balanced reciprocal translocations. Most of zygotes with non-balanced translocations (i.e., with deletions and duplications of certain chromosome segments) are not viable and are eliminated at an early stage of embryonal development (missed pregnancy) or lead to miscarriage (abortion).

A small part of zygotes with unbalanced translocations can be viable, despite the disbalance of chromosomes, and pregnancy is thus continued, but the children may be born with a congenital defect. In what way the process will proceed, that is, how viability is influenced by disbalance, depends on many factors: location of rupture points in chromosomes involved in translocation, the length of translocated segments, the genetic content of segments and the disjunction ability of translocations in the miosis.

What is known from the publications on the proportion of balanced reciprocal translocations, which can produce viable offspring, has so far been insufficient.

It may be assumed, however, that two-fifths of the chromo-

somes that have suffered even a small defect can produce viable zygotes, and some of them may be capable of developing viable offspring, though with some or other genetic defects /117/.

Cytogenetic examination of the persons irradiated in Hiroshima has confirmed, as is seen from Table 16, that cells with radiation-induced aberrations of chromosomes can be present in the lymphocytes circulating in peripheric blood within periods of more than 30 years after irradiation, while the frequency of aberrant cells is proportional to the irradiation dose. Symmetric exchange (reciprocal translocations and inversion) was found, and cells with unstable aberrations (dicentrics and rings) occurred less frequently /118, 119/. A comparison was made between the frequency of radiation-induced aberrations of chromosomes measured by the conventional method of colouring chromosomes and by the method of differentiated colouring, which allows for a more precise and fuller identification of chromosome changes. For that purpose 23 persons irradiated in Hiroshima were picked out. The doses of gamma quanta and neutrons ranged between 1 and 8.5 Gy (this value is now being revised). It has been confirmed that the frequency of aberrant cells depends on the dose and is higher when measured by the method of differentiated colouring of chromosomes as compared to the conventional colouring method /120/.

The summarized data show that the cancerogenic effect of irradiation is utmost in the case of relatively small doses; it decreases when the dose is higher. This coincides with the experimental data on the induction of mutant strains and myeloid leukemia in mice. With a high dose a considerable portion of damaged cells evidently perish, without causing either normal or malignant growth /83, 86/.

The development of cancer in those who suffered from the nuclear explosions is analyzed in detail separately. Only some generalized data on the cancerogenic effect of small irradiation doses are cited here to analyze a relationship between them and the radiation effect on the genome of somatic cells. In /121/ 80,000 people living in Hiroshima and Nagasaki were divided, in accordance with the distance from ground zero or with the time elapsed after the bombing, into groups with a dose of 0 rad, 1 -9 rad and those who were not in the cities at the time of the explosions. All the examined were believed to have been also affected by rad ioact ive fallout, whose dose was estimated at less than 10 rad. Tumours were definitely more frequent among irradiated persons. For all malignant diseases the risk factor was 6 x 10 ^rad"^^1^^, or six times as much as the previously established chronic low-energy, low-dose radiation. It is pointed out that the incidence of the lethal effect of radiation-induced cancer

11---1878

should be accepted at five per cent of total mortality caused by all types of cancer. The frequency of leukemia with the increase of the dose from 0 to 10-49 rad grew by 50 per cent, that is, it already accounted for about a half of all deaths caused by leukemia /122/. The risk of developing acute leukemia and chronic myeloleukemia, depending on the time that elapsed after irradiation in Hiroshima and Nagasaki and the age of the persons at the moment of irradiation, has been analyzed. It has been shown that the latent period of acute leukemia is increasing with age at the moment of irradiation. For chronic myeloleukemia this distinction is less explicit /4, 68, 78, 114/.

The causes of the death of 5,103 persons who survived the bombings of Hiroshima and Nagasaki in 1945 and died in 1975- 1978 were probed into /123/. Apart from the previously revealed diseases whose frequency clearly depends on the dose, the same dependence has been discovered in recent years with regard to the cancer of the large intestine and multiple myeloma /68/. The relative and absolute risk of the appearance of malignant neoplasms, with the exception of leukosis, was much higher when irradiation occurred at young age, especially among women /4/. So it was discovered that the origin of many kinds of tumours depended on the dose and on the age at the time of irradiation. However, the basic regularities of cancer development characteristic of the reference groups (influence of age, sex, ethnic factors, etc.) remained /122, 123/.

The influence of genetic changes in somatic cells as a result of irradiation on the subsequent development of cancer is being gradually specified. Data on the interrelationship of chromosome aberrations in the somatic cells of man with cancerogenic effects have been obtained. Especially important progress has been made in understanding the genetic foundations of cancer in recent years. That was due to the convergence of the ideas and methods of virus oncology, cytogenetics and molecular biology. To understand the operation of these mechanisms and thus to emphasize once again the role of genetic changes in the assessment of consequences of nuclear war one has to summarize, if only briefly, the results of the major areas of research in this area.

Some viruses are known to cause malignant tumours in hens, mice, cats and other animals. The study of retroviruses and viruses which acutely transform cells in a culture and induce neoplastic diseases with a brief latent period in infected animals has shown that the genomes of the latter contain specific genes that are responsible for the tumour effect.

Molecular hybridization has led to the discovery of partially latent genetic loci, homologous to viral oncogenes in the cells of vertebrates. Experimental data have thus confirmed the hypo-

thesis that the cell homologues of viral oncogenes are to be found in the group of normal genes located in parts of chromosomes that are permanent for this type, but are potentially carcenogenically active. It has been discovered that a few genes localized in man may be regarded as oncogenes causing the growth of specific tumours associated with chromosome .aberrations.

To give an example of this kind of processes, it is assumed that malignant transformation of cells is related to the restructuring of chromosomes in tumours like chronic myeloleukemia, cancer of the urinary bladder and others. It was these tumours that did not show an obvious connection with the dose rate in atomic explosion survivors, and that were discovered in persons with an insignificantly small dose.

The appearance of tumours in large groups of people with a very small irradiation dose can be seen as a result of a slight but crucial chromosome restructuring in one somatic cell. These tumours, as a rule, are less obviously related to tissues that are critical for irradiation, and are less dependent on the dose. This assumption regarding the role of genetic changes is applicable precisely to such neoplasms as cancer of the urinary bladder and chronic myeloleukemia which grew more frequent in recent years in all people irradiated during the explosions and which do not closely depend on the dose.

Tumours of the thyroid gland, as was noted above /101,102, 124/ were more frequent among those exposed to external radiation of a nuclear explosion. However, the rise in their frequency was most regular among the population of the Marshall Islands after the fallout caused by the nuclear explosion detonated by the USA in 1954 /52/. Analyzing tne above changes, it would be more correct to view them outside the category of genetic damage, though the aggregate impact of genetic defects and the damage of thyroid cells, similar to the non-stochastic effects of irradiation, cannot be entirely ruled out.

As has already been mentioned, a developing human embryo or foetus is extremely sensitive to irradiation. It is necessary to consider to what extent genetic defects are responsible for th is. Observations have shown that the period of the greatest sensitivity of the foetus' brain to irradiation with a considerable retardation of mental development is 8 to 15 weeks of pregnancy /125/. This period corresponds to the time required for the development of neurons in man's cerebral hemispheres, which accords with the generally accepted concept of (lightened radiosensitivity of separating-cell populations. The mother's malnutrition may also cause mental derangement. This is confirmed by a high frequency of mental retardation cases

11-

among the non-irradiated reference population groups in Japan of the same age, resulting from malnutrition. Both these factors would be combined in a nuclear war, and so social and economic dislocation would aggravate the consequences of intrauterine irradiation.

The data on super-high radiosensitivity of human embryogeny at the pre-implantation stage have not been confirmed. The period preceding the main organogeny of man is evidently also less sensitive than the period following it (10-18 weeks of pregnancy). However, brief delays of growth, including frequent instances of a subnormal size of the head, though without mental retardation, were registered in children whose mothers had been irradiated in Hiroshima and Nagasaki during the 4 to 9 weeks of pregnancy.

The frequency of microcephalia in five to 15 weeks old irradiated foetuses increased from five per cent in the reference group to 7.5 per cent at a dose of 1 -9 rad, 14 per cent at a dose of 10-19 rad, and up to 50 per cent at a dose of 50-149 rad. The risk of abnormal mental development increased from one to 12.3 per cent when the dose rose to 200-299 rad /1, 54, 68, 122/.

Thus it has been confirmed that irradiation of a developing brain by a dose of about 100 rad can cause a serious damage of the central nervous system and its malfunctioning. The role of genetic d isorders in these defects cannot be entirely ruled out for children whose mothers were exposed to radiation before conception. In most of the described observations the direct effects of irradiation on foetuses and children were examined. The condition of their offspring is yet to be studied.

Calculation of the risk of microcephalia and abnormal mental development is based (in prognostic assessment /4, 53, 54, 78, 125/) on a number of factors: the number of people of childbearing age in the examined group; the "vulnerable period" of irradiation (about 2 months) of the foetus; irradiation dose rate of one or both parents and the extent of the radiation risk estimated on the basis of the observations conducted in Japan, being equal to 1 ^x 10~^^5^^rad~^^1^^ at the dose of 50 rad for radiations with a high linear loss of energy.

But even if we assume that the number of children is merely ten times as big as in Hiroshima and Nagasaki (200,000) and the effective gonadal dose reaches ⁿx 10^^10^^ man/rem ("x 10^s man/ sivert), in the first generation there will be up to 2.3 per cent of microcephalia cases with mental retardation. The resulting social burden is hard to imagine. Besides, more than a half of all the children (tens of thousands) would need treatment in specialized clinics.

Considering that some of these deviations will be possibly linked with genetic defects, this effect may grow in frequency in the next generations, unless preventive measures are taken,

which will substantially cut back reproduction of the population.

In the previous edition of this book we made approximate assessments by way of a forecast of a possible frequency of the total and varying in scope genetic damage, proceeding from the genetic risk value of 0.4 * 10'^^4^^/rem ~^^1^^, according to the recommendations of the International Commission on Radiological Protection (ICRP).

In some instances (survival of large groups of people in radioactive-fallout zones with a relatively low rate of individual doses), irradiation-induced remote (genetic) consequences of this type may be more pronounced, affecting tens of thousands of children in the first generation alone /54/.

It has been estimated /126/, with due account of the above observations, that in the event of irradiation (with a low dose rate and linear loss of energy) totalling 10 rad per generation (30 years) there would be 15 cases of dominant diseases and those linked with chromosome X per million newborns in the first generation, and 100 cases with the balance achieved after several generations. With an irradiation of 100 rad per generation these figures would be 1,500 and 10,000 for dominant diseases and those linked with chromosome X per million pregnancies, 240 and 400 for diseases associated with the structural aberrations of chromosomes, and 450 and 4,500 for diseases of complex etiology in the first generation and at the time of balance respectively. Thus, in case of irradiation of populations with a dose of 100 rad per generation under similar conditions, the total number of expected genetic diseases would be about 2,200 cases per million pregnancies in the first generation (i.e.,1,500+240+450=2,190) and nearly 15,000per million pregnancies after the balance has been achieved (i.e., 10,000+400+4,500=14,900). Of course, their share in the spontaneous level of genetic effects is small (less than 10 per cent). But the gravity of social and economic consequences of this number of genetic diseases would be enormous, not to mention the moral burden for the relatives of these sick people.

If the average life expectancy of man is assumed to be 70 years (70-10^^6^^ years per million liveborns), the genetic diseases occurring in usual conditions would result in 2,300,000 years of subnormal life and nearly 3,000,000 years of life lost per million liveborns in a population exposed to radiation in above conditions of 100 rad per generation; there would emerge more cases of genetic damage resulting in 50,000 years of subnormal life and about the same number of years of life lost per million liveborns in the first generation. Upon the achievement of balance the figures will be 340,000 and 286,000 respectively. These evaluations of damage were first made when the

UNSCEAR report to the UN General Assembly was being prepared in 1982 /54/.

The cited figures need no comment.

The revision of the dose estimates in Hiroshima and Nagasaki made in recent years /54, 100/ can somewhat increase the estimated risk of the genetic effects of irradiation, but not very much (see Fig. 27).

The main general regularities, including those concerning the relationship between the rate of chromosome aberrations and the dose, remain unchanged (see Fig. 28).

We have examined all groups of evident and hypothetical genetic effects in sex and somatic cells in irradiated people and their children, and have also considered the possible increased frequency of tumours among the atomic explosion survivors on their offspring, that is, the effect of somatic cells on the chromosome system.

The data obtained point to diverse adverse effects of atomic explosion radiation on the genetic system, which, however, have not yet been completely outlined and need further close study. For the first two generations the effects on the chromosomes of somatic cells are more obvious and significant than those of germ cells.

This evidently accounts for the difference in the data obtained for the first and the second generations after the explosion.

The genetic effects revealed by data on the outcome of pregnancies were studied once again. The researchers considered the sex ratio, weight at birth, frequency of malformations, mortinatality, intrauterine and early (up to 9 months) mortality of newborns, and data on their development in 70,000 pregnant women in 1948-1953. The shift in the correlation between the sexes observed after the explosions gradually levelled off by 1954-1962. The 1972 mortality rate among children (54,000 observations) no longer revealed a clear relationship with their parents' irradiation dose.

Further attempts /4, 53,54,126/ to assess the genetic risk by other methods (extrapolation of experimental data, apart from direct observation) have confirmed the radiation effect on the genetic system of large populations and the social damage caused by the resulting defects. It has been pointed out with greater insistency, however, that extrapolation from laboratory experiments on small animals should be done with great care and that direct methods are preferable /54, 126, 127/.

The regressive analysis method has shown that the minimal dose, doubling the number of lethal mutations, is 47 rad for the father, 125 rad for the mother, and 67 rad for both parents. The doubling dose for both sexes is now being corrected, with the preliminary estimate being one Gy (100 rad).

RON DOSE l-RADIATION DOSE EFT

I

ttGHT

M

%

I

z

a

z

« rn 1

1

10- 50- 100- 200- 300- 400+

49 99 199 299 399

V400

T65 GENERAL DOSE GROUP

Fig. 27. Comparative distribution of those irradiated depending on the dose range based on T65D and ORNL dose estimates /100/

---T65D HIROSHIMA

---T65D NAGASAKI

---ORNL HIROSHIMA

---ORNLNAGASAKI

300 400

TOTAL DOSE (rad)

Fig. 28. Number of aberrant cells per dose unit at different dose range based on T65D and ORNL dose estimates /100/

The relatively small number of people who survived the above irradiation dose and produced offspring made it difficult to establish a statistically meaningful effect on the population level in Hiroshima and Nagasaki. But a calculation made on this basis can well be used in prognostic assessments with regard to global nuclear conflicts or the possible use of neutron weapons, when the size of such categories would greatly increase and the probable nature of the genetic effect may be established.

XI

Radiation Impact on Some Critical Systems of the Human Organism and Population Groups

Since no effective medical aid could be rendered to those who suffered from the air nuclear explosions in Hiroshima and Nagasaki, people who received a relatively small dose prevailed among the late survivors. Merely seven to eight per cent of the 80-90 thousand people who lived long after the nuclear explosions in Japan had received an irradiation dose of 200 or more rad /4, 17/. Consequently, irradiation doses exceeding 100 rad, not to mention 200 rad, combined with the effect of other destructive factors and other adverse circumstances resulting from an air nuclear explosion, should be viewed primarily in the context of early immediate effects, producing a high mortality rate.

The situation is different in case of groundlevel nuclear explosions. In this case dose distribution in time is such that aggregate doses of 100 to 1,000 rad could be accumulated within a week, a month, or a year, which, without resulting in instant death, would increase the number of people with a relatively high irradiation dose rate, who would live for a longer period of time.

The zones with such radiation dose rates could be large enough, extending to tens of thousands of kilometres.

For this reason attention has been drawn in the assessment of the consequences of nuclear explosions, specifically the late effects, to relat-

ively low single doses of 100 rad or less and low exposure rates. The latter are significant for some organs and systems and for more radiosensitive population groups.

Most sensitive, or critical, organs are reasonably regarded to be those which during irradiation are in a state of intensive development, with their physiological functions being in the process of formation. Therefore, the critical group of the population includes children in which a number of organs and systems, such as the nervous and endocrine systems, continue to develop after birth. Most vulnerable is the physiological system of the mother-foetus relationship, which can also be regarded as critical when nuclear radiation totally affects large population groups. One must also bear in mind the peculiar reaction of the endocrine, and especially generative, systems of man to the action of any damaging agents, including radiation /125, 128-130/.

Prevalent among the multitude of changes registered within a wide range of doses a long time after an explosion are syndromes of complex origin. As a rule, these syndromes do not reveal an obvious connection with the dose, as in the case of direct effects of irradiation. In large population groups there may be more frequent cases of somatic and tumoural diseases found in irradiated persons. There have also been some other, still less specific effects, such as the delayed development and underdevelopment of organ structures, the malfunctioning of the regulating and hormonal systems, imbalances in the development of the body and its immunal properties, changes in the life span of some age groups and the main causes of their death (see previous chapters).

Recognition of the fact that these changes are linked with the destructive factors of nuclear explosion greatly increases the possibility of spotting effects which, though occurring in embryos or in children, often become sufficiently pronounced only at adult age.

Therefore, in evaluating the late consequences of irradiation one should bear in mind the connection, established in general pathology, between early functional disorders in the endocrine and nervous systems of children and a number of diseases registered in adults. Among these are hormonecaused cancers, hypertension, ischemia of the heart, premature ageing and other diseases.

Now let us consider the early (immediate) and remote (late) effects of a nuclear explosion on the above-mentioned critical systems and on groups of people, and try to establish the cause-effect relationships that are typical of them.

The chief sources of information here are primarily the factual data on large groups of Japanese children irradiated during the nuclear explosions in utero or soon after birth

/4, 68, 121, 131-137/. The following factors were studied:

---early infant mortality, its extent and structure;

---defects and disorders in the development of the osteal, nervous, cardiovascular and other systems in foetuses and children;

---causes of late fatal outcomes (after 5-20 years) among persons who were children at the time of the explosion;

---signs of disharmonious development of teenagers (sexual and locomotor systems);

---disorders in neurohumoral control, allergic reactions, etc;

---retarded physical and mental development at different ages.

A number of publications /4, 68, 115, 116/ are devoted to health conditions of pregnant women, birth outcome, and the influence of sex and age on disease frequency.

The data, statistical for the most part /4, 48, 49, 51, 68 et al./, obtained during examination of large groups, were later corrected on the basis of more detailed research into radiation effect on children at various periods of their development under conditions of therapeutic and diagnostic uses of radiation. Some of the conclusions were verified by special physiological clinical examinations of small groups of children when more precise data on the distribution of doses in the body became available /54, 138, 139, 140/.

The UN Scientific Committee on the Effects of Atomic Radiation conducted studies of radiation effects on the foetus and child in 1964, 1969, and 1977; another one is planned for 1983-1986.

Experimental data analysis /125, 141-143/ has shown that in the development process there may be several stages in the differentiation of embryo structures, which are extremely sensitive to radiation, which causes defects in organs, death of the foetus and abortions. Data on the duration, doses and typical effects of external radiation on various species of animals are more precise (see Fig. 29). These data are extrapolated on human beings.

There are three periods of embryogeny: (I) preimplantation, (II) main organogeny, and (III) the foetal period. Different types of the main consequences of radiation are typical for each period.

The most frequent radiation effect in the first period is the death of the embryo (i.e. abortion).

Irradiation in the second period also causes the death of the embryo, leading to abortion, while in animals it causes a reduction in the number of the young in the litter and a higher neonatal and postnatal death rate among newborns. There occur various typical defects and disorders in the development of organs and systems of foetuses which at the time of

RATS, ~^^20^^ DATS

approximately ten times as strong as the possibility of causing damage to the same organs in a mature age.

In humans pregnancy lasts far longer than in most mammals, especially the second and third periods of embryogeny. The early stages of embryonic development of various mammals, including human beings, do not differ much in terms of their duration, and they are considered to be more sensitive to all teratogenic effects, including irradiation. So, the experimentally obtained data covering these early stages may well be applied to man. The findings become less reliable if applied to human beings in the preimplantation period.

One should note /54, 142/ not only the great vulnerability of germ cells and tissues to radiation but also the qualitative effect produced by their irradiation. Thus, the dose affecting a mature neuron amounts to several thousand rad, while changes in the neuroblast appear at the dose of as few as 25 to 40 rad /125, 142/.

Development defects---the teratogenic effect---stem primarily from the direct impact of radiation on cells and tissues; their frequency and gravity clearly depend on the radiation dose. A combined action of several factors on regulatory mechanisms may modify, albeit insignificantly, irradiationinduced changes. This must be borne in mind in the event of a combined action of several nuclear explosion factors.

The great regenerative potential of the embryo, allowing for the restoration of some perished cells and for the stimulation of originally unharmed cells to multiply, makes it different from mature organisms. It creates the possibility of saving the life of a child with a delayed or deformed development of some of its regional anatomic structures. Children with a long record of multiple defects constitute a heavy social burden; their number may be greatly increased as a result of nuclear explosions.

The extent of post-radiation suppression of the sex-- hormone secretion activity and the formation of cells taking part in impregnation differ greatly from children to adults. Hormonogenic disorders become more serious and stable in a developing body than in that of an adult, while in adults it is only the fertilization function that may suffer. Thus the irradiation effect on the endocrine system is far more grave in a child, seriously affecting its health.

As the embryo grows, its sensitivity to radiation declines. Yet, in later periods too there may occur brief peaks (up to 24 hours) of extremely high sensitivity to radiation. This explains why there may develop considerable disorders in some of the foetuses irradiated at an older age, which are disproportionate to the dose received (Fig. 30).

Some reviews /125, 136, 141-145/ provide a detailed analysis of the dependence of the frequency and nature of

HUMAN SPECIES, WEEKS

I______

Fig. 29. Comparative characteristics of pregnancy periods among humans and rats, and effects of a 100-rad irradiation dose on the rat's embryo at different time intervals /125/

irradiation underwent the stage of intensive morphofunctional differentiation. Some organs may suffer more than others, depending on the pregnancy period.

Irradiation doses causing the death of the embryo in the third---foetal---period are comparable with doses affecting a newborn in the early postnatal period. The main result of irradiation of the foetus and child is radiation sickness of varying severity. Disorder (retardation) of development have been less studied so far. A correlation of doses causing radiation sickness of similar gravity in children and adults has not been reliably established.

There have been indications that an exposure dose of five rad can be regarded as the threshold dose causing teratogenic effects. Yet, for human beings that dose is of little relevance.

The dose range causing microcephalia, a most typical defect in man's development, is from 10 to 150 rad /54/. If the criterion of an increased frequency of defects in development is applied, the biological effect of irradiation on the foetus is

origin. The comparison revealed that irradiated children had a lower IQ than their brothers and sisters (p«0.05) and the children in the reference group (p < 0.001), showed poorer performance during psychological tests, studied fewer years at school, and ran a higher (10-20 per cent) risk of developing certain mental disturbances.

Days and sometimes weeks pass from the moment the damage is done to the cell population up to the discovery of its deficit (oocytes); tens of years may separate the emergence of the deficit of the cell population from the identification of its fertility.

A dose of about 100 rad may kill 50 per cent of foetuses in the preimplantation period, with the remaining half manifesting no defects in their development. Thus, malformations appear in the organogeny period, although the hypoplasia of organs and tissues may also occur in the event of irradiation at a different stage. Neonatal death rate is the highest when irradiation occurs during early organogeny.

Changes in children may be highly diverse; irradiation in the foetal period most frequently affects the brain, the eyes, the skeleton, the sexual glands and thymus, producing anomalously located organs.

It has been found that the frequency of the termination of pregnancy, the subnormal size of the body and the weight of the foetus, as well as other disorders depend to a certain extent on the time of exposure (pregnancy period). Most sensitive is the first third or half of pregnancy.

The way disorders develop under the effect of radiation is similar to that of other injurious factors (such as chemical and thermal factors) in terms of their onset and nature, which adds to the combined effect of the adverse factors of the explosion.

Neuroblasts, the immature cells of the nervous system, which are highly sensitive to radiation, last the longest in a developing organism, especially in man. Besides, there is the continuing myelinization of the conduction tract of the foetus; therefore, defects in the development of the nervous system have been most frequently observed when irradiation had occurred at different stages of pregnancy. The irradiation dose, damaging these sensitive elements of the nerve tissue of an embryo, stands at 10 to 40 rad /125 et al./.

The role of some parts of the brain, of its structures and metabolites in the development of disorders and functional failures most typical of prenatal irradiation by a relatively small dose (up to 150-200 rad) was experimentally analyzed on primates among other species /125, 144, 145/. It has been shown that there exists a definite morphologic substrate (loss of dendrites and disruption of links between certain cortical areas and the hippocamp, performing the functions of short-term

0-1

8-9

16-17

24-25

32-33 38++

•PREGNANCY TIME (weeks)

Fig. 30. Relationship between frequency of typical malformation (microcephalia) and dose rate and pregnancy time /125/

damage on the dose and dose rate and on the stage of the embryonic period. The study of the dynamics of the formation of some parts of the skeleton, the oocyte population and the division stage of the impregnated cell /141, 146/ analyzes the possible mechanism of the effect of damaging agents, including radiation, revealed at a later period. It has been shown that if what is taken into account is all the data covering the whole period of pregnancy rather than the development stage (6-11 weeks), such obvious defects as the decreased size of the head and mental retardation may be overlooked or recorded only superficially /125, 136/.

Irradiation of children in the early postnatal period can also affect mental development and higher nervous activity /140/. To prove the role of radiation and of the dose rate, research was conducted into the effect of the irradiation of the hairy part of the head in cases of epidermophytosis among children aged one to 15 years. According to the estimates arrived at, the irradiation doses on the surface of the cerebral hemispheres were 121 to 139 rad, while at the depth of 25 mm---95-121 rad. Their mental development was judged on the basis of archive data concerning the IQ tests conducted at school, the number of school years completed and the results of conscription tests.

Comparison was made between data on 10,842 children under treatment and relevant data on their brothers and sisters, as well as on healthy children of the same age, sex and ethnic

3-

HUMAN FOEEBRAIN

Defects and inhibited development in man also most often occur in the central nervous system, specifically in the brain and pituitary body /131, 132/.

Apart from the radiation impact on all the irregular changes, due account must be taken of a set of causes affecting the health condition and the development of a growing organism. It is believed that there are over 50 factors directly affecting the foetus and the mother's organism. Some of them, however, as in the case of the mother's health, also depend on the effect of radiation, thus making the mother-foetus system most vulnerable.

All these general propositions have been duly taken into account in our further data assessment.

It must be remembered that children under 16 years of age constitute not only the future of a nation, but also at any given moment a numerous group, amounting to a quarter or even one-third of the population. Of every 1,000 women who in turn account for a half of the entire population, 20 to 30 are concurrently at different stages of pregnancy, resulting in some cases in childbirth. All of them---the mother, the foetus and the infant---constitute a numerous population group which is particularly vulnerable due to its high sensitivity to radiation.

Assessment of the impact of nuclear explosion radiation on this group is a key criterion of the threat of nuclear war. There are numerous factual data on this matter. Nuclear explosion is known to cause frequent abortions (roughly one in every third woman; 45 out of 177 pregnant women in Nagasaki), the mean rate in the region before that not exceeding six per cent. Of 45 women who aborted ten died very soon / 48, 49, 68, 115, 116/. Thus the natural replenishment of population is immediately reduced by one-third, while one-fourth of children lose their mothers soon after birth.

Already the first Japanese researchers noticed the high vulnerability of pregnant women to all the effects of the atomic explosions as well as the high death rate of foetuses, even in periods close to normal birth.

Foetus mortality was particularly high (23.3 per cent) if the mothers had signs of radiation sickness. But even in cases when women received irradiation doses that did not produce signs of radiation sickness, the fatality of foetuses was nearly double that registered among non-irradiated women (4.4 and 2.7 per cent respectively). The mortality rate of newborn infants reached 26.1 per cent and was especially high if the mothers were afflicted with radiation sickness. Children of mothers suffering from radiation sickness were also more frequently mentally retarded /4, 17, 147-149/.

The fatality pattern among irradiated infants, both stillborn and liveborn, showed a sharp change in the causes of death.

2-

INCLUSION

OF LG MARKERS

(DNA)

1-

MONTHS

WEEKS

DELIVERY

Fig. 31. Correlation between pregnancy time and intensity of DNA syntheses (Ig markers) and of human forebrain development /125/

memory) /125/. This closely ties in with the commonly known data on failures of the metabolism of nucleic acids following irradiation.

The relationship between the time of irradiation and the effect on the late stages of embryogeny and of early postnatal development, as distinct from a simple reduction in the size of the brain after irradiation at an earlier stage, is accounted for by the fact that it is at the later stages of pregnancy that DNA actively enters the nerve cells of the foetus/125/ (see Fig. 31).

12---1878

highest in the first two years (Table 17), i.e., every fifth child had major development defects.

Table 17

Number of malformations in Hiroshima and Nagasaki in the period from 1949 to 1953 /132/

i Number of foetuses 1 and infants • examined

Sept 1949- 1950

Total for 41/3 years

Malformed

Normal

Total

IX 1949 XII 1950

Fig. 33 shows the distribution of defects in the organs and systems of a foetus.

In Hiroshima and Nagasaki irradiation of the foetus and newborn infants regularly led to decreased stature, weight, and head and chest circumference of infants irradiated with a dose ranging from 10 to 150 rad before the eighteenth week of pregnancy. The rate of smaller-sized heads and mental retardation showed certain dependence on the dose (see Table 18 and Fig. 34)

Table 18 Frequency and relative risk of mental retardation depending

OVERALL NUMBER OF BORN CHILDREN

NUMBER

OP CHILDREN

WITH

MALFORMATIONS

on irradiation dose ,'51 /

Dose, rad

Hiroshima

Nagasaki

Number of observed

Frequency Relative Number risk of observed

Frequency Relative risk

Out of town or

far from irrad

-

ation zone

5(2)

1.0(1.0)

4(2)

1.0(1.0)

3(1)

3.4(3.8)

-

10-49

2(1)

1.8(1.5)

-

50-99

3(1)

10.6(11.8)

-

100-199

4(1)

229(289)

200-299

62.3(104.0)

1(1)

553(922)

26.4(52.7)

Fig. 32. Incidence of malformations in Hiroshima and Nagasaki from 1949 to 1953/132/

This was observed not only immediately after the nuclear burst, but also in the next two-three years /51, 131, 132/

In the first five years after the atomic attack numerous anomalies and defects in development were observed most frequently (see Fig. 32).

The frequency of developmental defects found among irradiated and non-irradiated children in 1949-1953 is shown on Fig. 33 based on the material in /132/.

The frequency of malformations for the same period according to postmortem data reached 20 per cent and was

Notes:

1. Figures in parentheses concern children whose parents had subnormal-sized heads or signs of mental retardation. 2 Relative risk is taken as 1 in reference groups; other factors are compared to it.

12-

OSTEOMUSCULAR SYSTEM

31.3%

Pathologically undersized heads and retarded mental development were most common among the children of Hiroshima who received a dose of 50 rad or more, as is indicated in the publications /51, 115, 116, 152, 153/.

There have also been changes in the eye, namely, in the colouring of the iris, lenticular opacity and congenital cataract.

By 1958, over 20,000 persons who had been children at the time of the atomic explosions in Hiroshima and Nagasaki, were under medical observation. Of them, 3,200 underwent five thorough examinations at the age of 21 to 38 /4, 68/.

The height of the children irradiated in Hiroshima was found to be three to five cm less than normal. This regularity was most pronounced in children irradiated at the embryonal stage or at the age of five or less.

As compared to the reference group, there was definitely a greater number of children with smaller heads among those who had suffered from the atomic explosions in both cities, especially in Hiroshima.

The frequency of the changes discovered later depended on the period of pregnancy (with higher frequency for less than 17-week long pregnancies) and less so on the irradiation dose. The circumference of the head in 17-year-olds was below normal by one cm, height---by 2-3 cm and weight---by 3kg.

Frequency of the cases of retarded mental development were clearly traced to the dose and nature of irradiation in Hiroshima. In Nagasaki the dependence was not so marked. At any rate, that was the assessment based on T65D doses /4,68,150,151,153/.

The psychological and personality tests conducted according to the system employed in Japan, as well as the children's progress in mathematics and languages during the seven-year school course following the atomic explosions revealed noticeable deviations in irradiated children (see Fig. 35). These distinctions gradually became less marked. It was not only radiation but also other non-specific (e.g. emotional) factors that affected the children's learning ability. This means that the registered changes were not caused by radiation alone, but were brought on by a more complex combination of factors

The examination of over 1,600 19-year-old boys and girls who had been irradiated in utero at a distance of two or less kilometres from ground zero has shown that the number of cases of mental development alterations accompanied by characteristic manifestations was in Hiroshima three to eight times as large as in Nagasaki, with gamma radiation doses being similar in range /4, 68, 114/.

The relationship between undersized head and the signs of

CARDIOVASCULAR SYSTEM

CENTRAL NERVOUS SYSTEM

DIGESTIVE TRACT

34.6%

21,2%

16.7%

UHOGENITAL SYSTEM

33.3%

RESPIRATORY SYSTEM

20.0%

6 10 20 30 40 50 60 70 80 90 100 %

Fig. 33. Incidence of developmental defects in various systems /132/: irradiated---double shading, non-irradiated---unshaded space; children whose irradiation dose is unknown---single shading

0 1-9 10-19 20-29 30-49 50-149 1HH

DOSE (rad)

Fig. 34. Relationship between frequency of smaller head cases and irradiation dose rate /4/

00%

I

I

I

I

I

received surgical treatment were better developed physically, while 44 per cent of the irradiated children had subnormal development. Signs of abnormal development were registered in two-thirds of children subjected to radiation therapy. Most of them had subnormal weight and physiological irregularities in the size of various parts of the body.

Attempts to establish which parts of the body, if irradiated, are typically subject to changes in their physical development and to vegetovascular disorders have shown that they more frequently /139/ develop following the irradiation of the head, particularly the diencephalon area, where the nerve and endocrine centres influencing the child's growth are located (seeTable19).

Table 19

Malfunction incidence in the vegetative and endocrine systems.

depending on the irradiation dose received by the hypothalamic

and hypophysial area /"139,

6 GRADE

Fig. 35. Differences in the intellectual development between the irradiated (shaded column) andthereferencegroup (unshaded column),

retarded or insufficient mental development was discussed in a number of special papers /4,147,148,153/ and surveys /4, 68, 144, 145/. The problem was also dealt with in the UNSCEAR summary reports for 1977-1982 and in the preparatory studies of the irradiation effects conducted in a number of world organizations (WHO, IAEA, and others); all data thus obtained were expected to be subsequently generalized by experts. Delayed mental development was also registered in a number of cases. These cases were under special observation; it was subsequently found that they married later than usual /4, 122, 133,152/. Most of the 63 examined children who had married in the adult age either had offspring or were not married long enough (less than five years) to be regarded as definitely sterile. The remaining 373 people who had been irradiated in childhood produced 1,505 liveborns. Medical observation of these children continues.

That subnormal height and weight is mainly due to radiation is evidenced by data on the examination of small groups of children who have undergone surgical and radiological treatment on account of angiomas in various parts of the body /138,139/.

The angiomas were irradiated by doses ranging from 400 to 2,000 rad (total). Other parts of the head received up to 600 rad, and the body from five to 100 rad. The irradiation dose rates were evaluated on the basis of carefully taken special measurements, with due account of the irradiation conditions in each particular case.

For the purpose of comparison the groups of children were divided into various categories in terms of their development (high, normal and subnormal).

It was established that 70 to 85 per cent of the children in the reference group and among those who had

Symptoms of vegetovascular and vegetoendocrine malfunction

Average dose rate (rad) and the number of children examined

51-130 21-50 3-20

(12 persons) (23 persons) (26 persons)

Persistent arterial hypotension 8 Susceptibility to arterial

hypertension 2

High temperature 4

Persistent subfebrile condition 4 Alteration of vegetovascular (orthoclinostatic, oculocardiac)

reflexes 10

Acrocyanosis 8

Hyperhidrosis 9

Cutis marmoiata 7 Vegetative paroxysms, including

abdominal ones 4

Obesity 3

Premature menses 3

Abnormal growth 3

3 6 2

14 5 9 4

3 3 3 2

Similarly, if the head was exposed to irradiation, asymmetric and delayed closing of wrist-joint metaphysises was observed. These grew with the increase in the irradiation dose received by the diencephalon (from 10 to 400 rad) in one out of every three children, especially if irradiation occurred at the age of less than six months /138/ (see Table 20).

Those findings are highly significant. The study has shown

Table 20

Dependence of abnormal wrist-joint development on the dose

received by the hypothalamic and hypophysial area 11-13 years

following irradiation (single-dose) /138/

method and the reduction in absolute dose rates at certain distances from ground zero have ``increased'' the radiation effect and the number of anomalies per dose unit (see previous chapter).

For some time boys were prevalent among children born of irradiated mothers /Ml. This is explained by a higher mortality rate among more radiosensitive female embryos injured at the germ-cell stage.

Fertility and reproductive-function indices of irradiated persons and their offspring have been studied. It has been found that there were fewer marriages between persons whose mothers had been irradiated with doses exceeding 100 rad during pregnancy. .

The number of people born from 2,500 persons irradiated in utero, especially in 63 people with smaller than normal heads, was fewer than in reference groups.

A careful analysis showed the complex nature of this phenomenon, which reflects, aside from the effect of radiation, the irradiated people's fear of the difficulties of adjustment in life and their disbelief in the possibility of marriage and an adequate upbringing of children. The number of births and the interval between marriages and births showed no significant dependence on dose rates but in general differed from reference-group figures.

It is difficult, however, to preclude the direct impact of radiation on the above-described changes. Several researchers have confirmed the effect of a nuclear explosion on the endocrine system, especially in children irradiated at an early age, before the structure and functions of the sexual system were completely formed /4, 122, 154/.

Obvious though brief delays of the first menstruation in girls from 12 to 15 years of age have been recorded /17, 155/.

Fig. 36 shows the onset of menstrual periods in girls of different age groups /155/.

The time of the first menstrual period was shifted to the winter season---an indication of a more powerful synchronizing effect of the radiation factor of the explosions as compared with normal climatic and ethnic factors. The girls who had menstruated before the atomic blast had temporary amenorrhea which lasted one to four months. The average age at which the first menstruation (menarche) began and the duration of the delay depended, apart from the radiation factor, on the damage inflicted on the girls' health by other effects of the explosion: all these changes were more frequent among those who had symptoms of radiation injuries, burns and other damage, that is, among sick girls who had gone through extreme suffering and were under great mental stress, while conditions for their treatment were utterly inadequate.

Frequency

Dose received by the hypothalamic Total

and hypophysial area, rad frequency

0.1-10 10.1-20 20.1-40

Abnormal wrist-joint

development

Normal wrist-joint

development

Total

that ossification in all children irradiated in utero during the atomic explosions was also delayed by 6 to 9 months, as compared with the reference group. However, no clear relationship with the irradiation dose received by the mother was established, evidently due to insufficient dosimetric information 717, 148/.

Thus, with irradiation doses being relatively small, there is a high frequency of fatal outcomes at all stages of the development of human embryos, and the course of pregnancy is often interrupted. Children are born with serious defects of organs. Their harmonious development is disrupted, and their intellect, emotional reflexes and vegetovascular regulation are affected.

In analyzing the possible consequences of an all-out nuclear war, we want to express our grave concern over the fate of children, that numerous population group so vital for the future of humankind.

A number of phenomena observed in irradiated children have undergone certain changes.

For instance, five years after the explosions no obvious distinctions were found among children in Hiroshima and Nagasaki in terms of hemopoiesis, which is evidently due to a high regenerative potential of that system. However data /4,17, 78/ have been obtained indicating that cells with stable aberrations and even clones of such cells stably remained and even formed in the bone marrow of persons who received the highest irradiation dose (in childhood, at a distance of less than one kilometre from the ground zero) /4, 78/.

The revision of certain dose components (gamma and neutron) showed nothing new in terms of the relationship between this effect and the irradiation dose /98/.

On the contrary, additional possibilities to identify chromosome anomalies through the use of the differentiated colouring

DP TO 12

The observation of a small group of children who had undergone radiation therapy, especially when the doses administered to the diencephalon were 20 to 130 rad, confirmed that the central regulatory system and the symptoms produced by its dysfunction had been affected by irradiation /138, 139/.

It is necessary to emphasize a particular danger posed by a combined effect of internal (radioactive iodine) and external irradiation of children, as evidenced by a noticeably higher incidence of thyroid gland tumours in the event of concurrent overall and local irradiation or a combination of radioiodine and external irradiation /4, 17, 52-54/, as compared to the effect of either overall external /53, 54/ or radioactive iodine (internal) /10/ irradiation. It is these combinations that are characteristic of ground-level nuclear explosions. The thyroid gland is not the only one to be damaged in children by irradiation which evidently affects the nervous and endocrine control systems as a whole. At the same time these systems are known to be particularly vulnerable in the period of their formation, when irradiation can set off a series of other disorders and have a negative effect on the child's overall development. But the damage to the thyroid gland is also obvious: the incidence of thyroid gland tumours among persons irradiated in Hiroshima and Nagasaki was 100-300 per cent higher, especially among women irradiated at the age of 15 to 29 years /101, 102/.

The incidence of thyroid gland tumours among the population of the Marshall Islands reached 36 per cent for the most irradiated groups, including up to 4.7 per cent of cancer cases. In reference groups the figures were 6.6 and 0.9 per cent respectively /102/. Still more frequent, however, (up to 52 per cent) were instances of disorders in thyroid hormonogenesis, pinpointed during the study of iodine exchange in the body and of thyroglobulin excretion.

These malfunctions of the gland are an indication of serious disorders occurring in the child's organism in the period of growth. The main type of disorders caused by irradiation is hypothyroidism. The hypofunction of the thyroid gland is known to have a marked effect on the functioning of the cardiovascular system, on immunity to infection, and on the rate of physiologic growth and age involution. So it is our view that a damaged thyroid gland may be a source of many pathological effects likely to develop among nuclear explosion survivors at a later period.

Another major pathogenic factor is produced by changes in the area of the diencephalon and the pituitary body which are affected by both small irradiation doses and by other factors so obvious in the conditions of nuclear war. Of these the most harmful is the immense emotional psychogenic effect on the entire nervous and endocrine regulatory system and the con-

18 YEARS

REFERENCE GROUP IRRADIATED UNINJURED

-----------INJURED

Fig. 36. Distribution of age at which menstruation commenced among girls from Hiroshima and Nagasaki /155/

There is good reason to believe that this time shift of one or two years, brief as it was, had not been caused by malfunctions m the ovary, since the radiation dose received by it was lower than for the whole of the body /150,151 /; rather the change was caused by the reaction of the central nervous-endocrine system regulating the ovarian cycle, which is highly sensitive to radiation.

At the same time the renewal of menstruation does not yet mean that the functions of the ovaries in irradiated girls were fully restored. The same applies to the restoration of spermatogeny, which does not mean that the formation of male hormones, so important for the developing organism of bovs was restored. ' '

Whatever the ca uses of these d isturba nces in the sexual cycle while the adolescent organism is maturing, their impact remains giving rise to a series of non-specific phenomena caused by the totality of the effects of a nuclear explosion.

sequent development of emotional and personality disturbances, as well as of vegetovascular disorders.

The numerous effects of the psychopathogenic factor resulting from a nuclear explosion make themselves felt practically during all the life of the victims. This has been demonstrated in specialized studies conducted by psychiatrists and psychologists (see Chapter IX) and in numerous objectively written articles by journalists from various countries.

The mental shock suffered by children and adolescents is especially great. In this situation they are most helpless and vulnerable. Having lost their next of kin, having witnessed horrible suffering, the death of vast numbers of people, raging fires and incredible devastation, children describe what they have seen and suffered in emotional and ingenuous accounts and in drawings which are too painful to hear and see. The sense of inferiority, the ever-present death threat and a special status in society, affecting every aspect of social and personal adaptation, spell out the tragedy facing these children and adolescents when they grow up.

I n what way can these seemingly moderate physical and very serious nervous and mental disorders suffered by children and adolescents as a result of a nuclear explosion subsequently affect their fate and the health of future generations?

Will there be any changes in the age structure and social identity of society, given a special susceptibility of certain critical population groups to immediate and late effects of nuclear war?

In a paper presented at the first IPPNW congress we already drew attention to certain changes typical of all those irradiated during the explosions in Japan, though not all of them clearly depended on the dose rate. These include increased death rate among newbornsand infants whose mothers were irradiated not only at the early stage, but also in the last three months of pregnancy; changes in the causes of fatal outcomes in different age groups, especially within the first decade following the explosion; higher incidence of some, mostly hormone-caused cancers, such as mammary gland cancer; and also certain somatic diseases at a later period.

All these changes brought on by the combined effects of the nuclear explosion would doubtlessly affect the destinies of the survivors, disrupt their harmonious age evolution, and upset the normal balance among certain population groups with regard to sex, age, and the causes and time of death. They would weaken and distort the physiological and psychic stimuli to building a family and bearing children, and to personal and social development. The inferiority complex, the feeling of anxiety and insecurity will even get hold of practically healthy people. Those were the obvious logical premises.

Yet, tentative data on the average life expectancy and the

incidence of some diseases among the overall population of Hiroshima and Nagasaki over a period of 30 years seem to have failed to confirm these apprehensions /4, 17, 68/.

But can these data be considered as exhaustive? Do they fully take into account the premature death of people and the resultant changes in the sex and age composition of the population, the consequences of these changes in terms of the number of marriages and birth control, as well as other factors that may be brought on by a nuclear war /66,112/7 Do they take into account cases of premature death caused by tumours and certain other diseases which even at normal frequency have a shorter latent period and develop in a less favourable way?

There is yet another factor /105/ which makes it possible to take into account the difference between the irradiated and nonirradiated population in terms of the life span and the causes of death among various age groups and which, in our view, may be very useful.

The use of some additional methods of mathematical analysis enables us to analyze other causes of excessive mortality, as well as the impact of certain explosion factors on changes in the role of various death-causing mechanisms among persons of certain age, which undergo profound transformations under the powerful adverse effect of the nuclear explosion on the persons themselves and on their offspring.

In analyzing these insufficiently studied effects we examined the data on the age distribution among the population of Hiroshima and Nagasaki, cited /101, 102/ in connection with the study of the incidence of thyroid gland tumours. The authors compared data on Hiroshima and Nagasaki with those pertaining to the population of other cities /156/.

Our analysis showed (Fig. 37) that back in 1965 the share of people under 30 (who had been under the age of ten at the time of the explosion) among the irradiated men and women sharply decreased in Hiroshima (somewhat less in Nagasaki), amounting on the whole to 8.4 per cent, while the same share in Japan's entire urban population in the same year was 30.8 per cent. Surely, such a change in the age pattern twenty years after the explosion reflects not only the predominant adverse immediate effect of nuclear catastrophe on children, but also a persistent, demographically unfavourable social situation in which those irradiated have found themselves due to many of the abovementioned reason.

That is a highly significant change. A sharp drop (four times or more) in the share of young people among the population is not merely the result of a past event (nuclear explosion). It predetermines a subsequent drop in the birth rate, disruption of the harmonious succession of generations, inadequate replenishment of society with able-bodied men

HIROSHIMA

NAGASAKI

months) infant mortality, and data pertaining to the development of newborns. The sex ratio change recorded after the nuclear explosions subsequently disappeared (in 1954-1962). The 1972 study of 54,000 cases showed no distinct connection between infant mortality and the irradiation dose the parents had received. Still, the age composition of the population has not yet been restored; therefore we cannot totally dismiss the impact of the totality of the nuclear explosion factors on the age makeup /68, 105/.

Thus, an analysis of the simultaneous action of all the factors of nuclear explosion makes it possible to identify still further aspects of their extremely adverse effect on particularly sensitive and vulnerable, critical population groups---children and mothers. The resulting grave social consequences can hardly be overrated.

TWO CITIES

ALL JAPANESE CITIES

Fig. 37. Distribution by age of the populaton of Hiroshima and Nagasaki in 1965 as compared to the population of other Japanese cities /101, 156/, shaded space showing proportion of people up to thirty years of age

and women, and many other developments that sharply disrupt the country's social infrastructure for many decades to come following the nuclear explosion. Countries that endured devastating wars /79, 157/ have experienced some of the aspects of those changes. Yet, the dimensions and the longlasting effect of a nuclear conflict have on parallel and are even hard to imagine.

It may be recalled that in 1948-1953 studies were conducted of the outcome of 70,000 pregnancies /115, 116/, specifically, the sex ratio, weight of infants at birth, incidence of malformations and stillbirths, intrauterine and early (up to nine

XII

Radiation Effects at Population Level

in fact no evidence at present to prove that the regularities of the action in the biosphere of radioactive products of a probable massive nuclear attack will differ in any way from those established for the radioactive fallout from nuclear-weapon test explosions. It appears that in a nuclear war the difference will mainly be of a quantitative character. This point being important for our examination, we shall deal with it in greater detail.

In keeping with information put out by the UN Scientific Committee on the Effects of Atomic Radiation (see Table 21) the aggregate yield of nuclear explosions in the atmosphere has reached 545 megatons, including 217 megatons, i.e., approximately 40 per cent, of fission yield /158/. It should be recalled that nuclear fission* is mainly responsible for the contamination of the biosphere with nuclear explosion products. An analysis of the data given in Table 21 shows that close to 13 per cent of nuclear explosion products was deposited on the Earth's surface in the form of local fallout (mostly due to surface and underwater bursts), 10 per cent was injected into the troposphere, its bulk (168 megatons of fission yield) reaching the stratosphere. While tropospheric fallout is mainly made up of radionuclides with a half-life of up to two months, such as iodine-131, barium-140 and strontium-89, stratospheric fallout mainly consists of long-lived radionuclides, such as caesium-137 and strontium-90, with half-life of about 30 years.

It is obvious that to make a quantitative estimate of theoretically possible radiation consequences that might follow from a nuclear conflict (or any other consequences of such a holocaust) it would be necessary to work on the basis of information on a hypothetical total yield of the nuclear weapons exploded, types of bursts, unit yields thereof, fission-to-fusion yield ratio, etc All these data are necessary for the calculation of expected radioactive contamination levels for environment This, in turn, will help calculate the possible doses of irradiation the population will be exposed to

It is this index that serves as a basis for quantitative appraisals of radiation consequences for the population. In the overwhelming number of cases they will be caused by global fallout only. However, it should be borne in mind that such an approach will be valid if all high-yield nuclear weapons** are exploded in the air. Air bursts produce practically no local fallout. However, in the event of other types of nuclear warfare /13, 15, 28/, i.e., with the use of surface bursts and, hence, with local fallout, an

One of the serious biological consequences of nuclear war will be universal radioactive contamination of the biosphere. With radioactive fallout settling on the entire surface of the planet all the elements of the biosphere without exception will be irradiated as a result of the decay of artificial radioactive substances from nuclear explosions.

Numerous researches carried out all over the world, including large-scale research programmes, have provided ample scientific information on the behaviour in the biosphere of radioactive products from nuclear-weapon tests. Practically all these data are thoroughly analyzed and periodically summed up by the UN Scientific Committee on the Effects of Atomic Radiation to be made available to the UN member states and thus to the scientists of the whole world.

Knowledge of the main regularities of the behaviour (migration) of nuclear explosion products in the so-called biological chains, the human organism forming their final link, makes it possible to predict irradiation doses for biocenoses, for separate natural associations and for various groups of the population, including the irradiation of the entire human population. The latter circumstance plays a major role in making approximate quantitative appraisals of the scale of late radiation consequences for the Earth's population or the population of separate world regions inlhe event of a nuclear disaster. There is

* Among the biologicallydangerousradionuclides produced mainlyasa result of fusion reactions in nuclear explosions are carbon-14 and tritium. " Here and below only massive nuclear strikes will be discussed.

13---1878

Table 21

Let us look, in particular, into a hypothetic conflict in the NortherrvHemisphere, in an area bordered by 30°N and 80 N, with massive employment of nuclear weapons of high unit yields ranging from 1 to 20 megatons, total TNT equivalent amounting to 10,000 megatons /16/. Out of this quantity fission yield adds up to 4,000 megatons.

Half of the weapons are exploded in the air and the other half at ground level.

The area between 30° N and 80° N is equal to 1.64.10^^8^^ square kilometres, land area being 9 • 2 • 10^^7^^ square kilometres, and has a population of 2,400 million. The total population of the world is taken as 4,400 million, 4,000 million living in the Northern Hemisphere. The annual number of liveborn children is 29 per 1,000 inhabitants /159/.

It has already been mentioned that as a source of ionizing radiation fallout subjects people to external gamma irradiation from the ground, and to internal irradiation when people inhale air contaminated with nuclear explosion products and when radionuclides enter the body through the digestive tract with food and water.

In such cases it is obviously difficult to establish the exact irradiation dose. This is due not only to the need to make a great number of calculations. To estimate it adequately it is necessary to take proper account of the general external gamma irradiation, the specific character of internal irradiation of the organs and tissues, and the combined irradiation of the entire organism from various sources of radiation. In this work the authors have used in several cases the term "effective equivalent dose commitment".* In this context we may point out that at present the socalled dose commitment is the main yardstick used in appraising the radiation consequences from the prolonged exposure of a human population to radioactive matter, in particular global fallout. In general terms the maximum dose commitment is accumulated during the period of complete decay of the given radionuchde. In the case of long-lived radionuclides, such as carbon-14 with a half-life of 1,590 years, the dose commitment is calculated arbitrarily till the year 2000 or 2050, etc It is then referred to as the incomplete dose commitment

The estimates below deal with the dose commitment equivalent that will be accumulated over a period of 20 years after a nuclear attack. (Thus, for certain long-lived radionuclides, such as strontium-90, caesium-137 and carbon-14, appraisals are made in the form of incomplete dose commitments).

Having found the irradiation doses in terms of rad, it will be

Summary of yields and partitioning of debris from atmospheric nuclear testing /158/

Period (years)

Total yield (Mt)

Fission I yield (Mt)

Part it ion ing of debris produced by fission (Mt)

Local Troposphenc Stratospheric fallout injection injection

1945-1951

0.75

1952-1954

37.02

18.20

17.96

1955 1956

14.01

1 48

8.34

1957-1958

81 39

5.48

29 57

1960-1961

122.43

25.52

0.06

217.40

5.89

70.61

1964' -1970

21 23

15.13

2.15

12.96

1971-1974

6.46

5.56

1.54

1976-1978

0.14

Total

545.13 216.73

27.53

21.12

168.08

* This table convincingly proves the effectiveness of the 1963 Moscow Treaty on the banning of nuclear-weapon tests in three environments in preventing the intensive radioactive contamination of the biosphere. The data on the 1964-1978 period reflect the situation created by continued nuclear-weapon tests by states (the People's Republic of China and until 1974 France) which have not joined the treaty.

appraisal of the radiation consequences for the population of vast areas solely on the basis of data on global fallout would not only be inadequate, but altogether wrong.

Indeed, the surviving population of targeted states (even with only partial employment of ground bursts) will be first subjected to the effect of local fallout, then partially to tropospheric fallout and finally, some time later, to prolonged irradiation from global fallout.

The population of states not directly participating in the nuclear conflict, situated thousands of kilometres away from the targets of nuclear attack, will be affected only by global fallout. However, in a number of cases, if ground bursts occur at a distance of less than 1,000 kilometres from the boundaries of non-belligerents, their population will, apparently, be affected also by local and tropospheric fallout. We intend to discuss these considerations below, taking recourse to elements of quantitative analysis.

Some Western authors describe the consequences of a hypothetic exchange of massive nuclear strikes /13-16, 28 et

al./.

* To obtain a better idea on these complicated matters the reader is referred to works /e.g. 54, 160/ which deal with the fundamentals of the problem and give pertinent definitions

13 195

possible to calculate the theoretical incidence of radiation consequences for the population. It will be remembered that th is category of effects includes malignant tumours with fatal outcome among irradiated people and genetic defects in their descendants. The concept of linear dependence of biological effects on the irradiation dose predetermines the conjectural character of their manifestation at population level. This means that the incidence (or probability) of the above diseases is determined only by the overall dose to which the given human population has been exposed. It does not depend on whether, say, 1,000,000 (1-10^^6^^) people will receive a dose of one rad (rem) or 100,000 (1 -10^^5^^), a dose of 10 rem. In any of these cases the product of the mean individual dose multiplied by the size of the irradiated population will be the same, namely, 1 -10⁶ man-rem. Therefore, the absolute number of theoretically expected cases of malignant tumours and genetic defects in each of these groups will be of equal magnitude.

In its publication No 26 /160/ the International Commission on Radiological Protection recommends the following risk factors (or incidence of aforementioned consequences) for appraising the effect of small ionizing radiation doses (gamma and beta radiation): to estimate the total number of malignant tumours with fatal outcome at 1.25 10~^^4^^ per rem dose, i.e., 12.5 cases per 100,000 people exposed to a dose of 1 rem, and of genetic defects---0.4 -10~^^4^^ per rem dose, or 4 cases per 100,000 people exposed to a dose of 1 rem. It follows that, if a population of 1 10^^6^^ has been exposed to a dose of 1 rem (i.e., 10^^6^^ manrem), the overall number of malignant tumours with a fatal outcome to be expected in this population will be 125 cases*.

By calculating the complete dose commitment from these explosions /158/ in the above context of a 20-year irradiation period we shall obtain the mean individual, commitment dose equivalent for the population of the Earth which will amount to about 0.1 rem. Hence the magnitude of the dose to be induced by nuclear explosions with a total yield of 1.10^^4^^ megatons will

be

1-10-M-10^^4^^

= ~1.84 rem

5.45-10^^2^^

The second approach was based on more exact data. To this end effective equivalent doses were calculated for each'year of the entire period and eventually added up. It was assumed that the doses of external gamma radiation induced by fallout comprising various radionuclides deposited on the ground would include: in the first year zirconium-95, ruthenium103 and barium-140; in the first five-seven years ruthenium106, cerium-141, 144; and in the 2-year period caesium-137 accounting for 28 per cent of the complete dose commitment formed by this isotope.

The doses formed as a result of the intake of radioactive matter with food were correspondingly estimated on the basis of long-lived caesium-137 and strontium-90 alone.

As a result, it was estimated that over the 20-year period the effective equivalent dose would be 2.16 rem. Thus, though the estimates were made independently the difference in the values obtained did not exceed 15 per cent. We have, therefore, decided to base our calculations of late consequences of global fallout on a 2.16-rem dose.

If an ``average'' man is exposed to a 2.16-remdoseovera 20- year period following a nuclear disaster, the toll of human life from malignant tumours on the planet will be: 4.4 • 10^^9^^ • 2.16 • 10° 1.25 • 10~^^4^^ = 11.88 • 10^^5^^, or 1,200,000 cases. The total number of genetic defects (disturbances) will be correspondingly 380,000.

It has been pointed out that doses from global fallout will be higher in the hemisphere in which nuclear explosions took place.

The UN Scientific Committee on the Effects of Atomic Radiation /158/ published information on dose commitments for the world population and for the inhabitants of the Northern and Southern Hemispheres, resulting from the atmospheric nuclear-weapon tests. These data have made it possible to estimate the radiation consequences for the population of these regions in the event of an all-out nuclear war. The population of the Northern Hemisphere considerably exceeding that of the Southern Hemisphere and the dose commitments being higher in the former, the absolute number of cases to be registered among the population of the Southern Hemisphere (over a long

Global Fallout Consequences

Let us look into the radiation consequences of global fallout in the context of the chosen version of nuclear attack. Here we have employed two methods of approach.

The first consists in estimating dose commitments to be produced by nuclear weapons with a total yield of 10,000 megatons by comparing it with a ``standard'' yield of nuclear weapons already exploded, the doze commitment data on the latter being available. We have accepted as a ``standard'' the yield of all the nuclear test explosions in the atmosphere before 1978, i.e., 545 megatons (see Table 21), fission yield accounting for 40 per cent of the total yield.

To simplify all further calculations the size of the population of the world and its separate reg ions is assumed to be constant for the given period. Th is assumption does not materially affect the final estimate.

period of time) will amount to about seven per cent of the expected incidence in the Northern Hemisphere.

The above absolute figures characterizing human casualties on the Earth as a result of radiation effects, are, of course, of a very tentative character. It should be mentioned that the irradiation doses induced by radioactive fallout are calculated on the basis of mean data with a number of allowances. As a rule, these calculations ignore possible local atmospheric, hydrological and ecological anomalies or peculiarities that might condition certain extremums of irradiation doses to which people might be exposed, and which considerably deviate from the mean values. To support this possibility we could refer to a whole range of facts from radiation hygiene practice. Thus, there are several regions in the Northern Hemisphere where, owing to a number of reasons, biogeochemical properties of soils and vegetation in particular, certain plant species relatively intensively accumulate radioactive isotopes, caesium-137 for instance, which happens to be a most biologically hazardous radioactive component of global fallout /161-165/.

If a person consumes the milk or flesh of animals fed on vegetable fodder contaminated with thisradionuclide, he or she will receive an internal irradiation dose tens of times higher than people of other regions where the irradiation level from caesium137 from global fallout is ``average''. It is quite possible that with the accumulation of information on the environment as a result of studies carried out in more regions, data will be obtained on other specific biological migration chains of radionuclides similar to those described above.

By now numerous studies have convincingly revealed that animal and human embryos and foetuses are highly sensitive (vulnerable) to ionizing radiation (see, for example, /54, 166, 167/).

Until recently the effect of radioactive fallout on children irradiated in utero was practically not examined at all. This has been largely due to the difficulties involved in tackling the problem and lack of generally accepted quantitative appraisals in this sphere. In this connection the works of several authors /168-170/ merit attention, as they have shown a linear dependence of higher than average incidence in liveborn infants on the dose of diagnostic X-ray radiation, including such minimum dozes as 0.2-0.25 rad The UN Scientific Committee on the Effects of Atomic Radiation /54, 166/ has stated that it is difficult to establish the incidence of malignant tumours with a fatal outcome as a result of irradiation of the foetus with an acceptable degree of reliability. However, these values may be about 2-2.5 10"^^4^^ per rad (rem). It is believed that leukemia accounts for half of the malignant tumour cases. According to R. Holford's estimates /168/ based on the mathematical proces198

sing of data acquired by several researchers studying the consequences of obstetric radiography, this value ranges from 373 to 747 tumour cases per million births per rad (rem), or on the average 5.6 -10^-4 per rem.

If adequate information is lacking, the only way to avoid underestimating the risk involved is to proceed from the most conservative provisos. However, in this case it is important to bear in mind the element of uncertainty they contribute to the appraisal. If we assume in our calculations a risk factor of 5.6-10"^^4^^ per rem which characterizes the development of malignant tumours with a fatal outcome among liveborn infants irradiated in utero, we shall be able theoretically to estimate the damage, with respect to this index, inflicted by global fallout, taking into account the above irradiation levels.

To simplify matters let us assume that all children born in the course of a given year were exposed to an identical irradiation dose in utero which was typical of that year after the nuclear attack. The irradiation doses the foetuses were exposed to were estimated only on the basis of uniform irradiation sources (i.e. external gamma radiation and internal irradiation from radioactive substances characterized by uniform distribution in the organism).

The risk factor of late somatic-stochastic effects for a liveborn infant irradiated in utero depends on two components: direct risk during intrauterine development and the risk from irradiation of the individual after birth: R = r, d, +r₂ d₂, where

R, is general risk;

r, is risk resulting from irradiation in utero (5.6-10~^^4^^

per rem);

r_z is risk for man* (1.25-10'^^4^^ per rem); d, and d, are correspondingly irradiation doses accumulated during the period of intrauterine development and after birth (during a 20-year period).

This gives us the number of malignant tumours with a fatal outcome among people of this category in the world (average birth rate being 29 per 1,000 inhabitants)---about 150,000 cases.

A large number of researches have helped to establish that embryos and foetuses are extremely sensitive to irradiation, particularly during the critical phases of organogenesis. This means that irradiation induces defects in development at these critical phases. However, even today there is no common opinion on whether or not there is a dose threshold in irradiation-induced foetus anomalies, microcephalia in par-

* Newborn infants and children in general are more sensitive to irradiation than adults. However, here this factor is not taken into account

ticular, though most authors are in favour of the ``threshold'' conception.

In the last few years a series of works /171, 172/ have appeared which postulate, with respect to such diseases, a linear dependence of the effect on the dose, i.e. the absence of a threshold. If this is so, it is possible to appraise the consequences of irradiation with respect to this phenomenon, provided the risk factors are established.

In 1969 the UN Scientific Committee on the Effects of Atomic Radiation /173/ estimated the possible incidence of microcephalia (which in particular manifests itself in retarded mental development of children) within the range of 10"^^3^^ per rad for doses exceeding 50 rad at a high dose rate. It has been found that among the children of Hiroshima and Nagasaki the incidence of microcephalia and mental retardation is higher than average owing to irradiation of pregnant women /17/.

Local radioactive fallout from ground bursts is quite capable of irradiating large numbers of people with doses of 50 rad (rem). Therefore, with some reservations, it is possible to estimate these effects too.

Consequences of Local and Tropospheric Fallout

To appraise the radiation consequences of local fallout it was assumed that the radioactive plume from a ground burst is formed in the course of 24 hours. The speed of high-altitude winds being 50 or 25 kilometres per hour, the length of such a plume from a one-megaton explosion would be correspondingly 1,200 and 600 kilometres, and its area limited by an isoline of, say, a 0.3-rad dose (till complete decay of the radioactive products) will be several tens of thousands of square kilometres.

An important conclusion follows: if 5,000 one-megaton ground bursts are exploded, the entire land area of the Northern Hemisphere, bordered in the south by 30" north latitude and in the north by 80° north latitude (9.2 • 10^^7^^ km^^2^^), will be covered by local fallout at least twice.

In estimating the radiation situation in the region as a result of local fallout it was assumed that tropospheric fallout contributed no more than five per cent to the total irradiation level. External gamma radiation doses from the ground contaminated with radioactive fallout were calculated, as well as the internal irradiation doses to which bone marrow, thyroid gland and gastrointestinal tract would be exposed as a result of alimentary intake of nuclear explosion products, in particular, of the radionuclides of barium, strontium, iodine, and other elements.

In calculating internal irradiation doses several allowances

inevitably had to be made. To take account of the biological accessibility factor characterizing radionuclides in migration chains it was necessary to assume that 80 per cent of the surface bursts were effected on silicate ground and 20 per cent on carbonate ground. In computing the radiation conditions in keeping with this pattern the irradiation doses received by the human thyroid gland are the least accurate.

Table 22 gives the results of calculating the estimated doses of external and internal irradiation to which the population would be exposed from local and tropospheric fallout.

Table 22

Probable external and internal irradiation doses to which people would

be exposed from local and tropospheric fallout of surface bursts with a

total yield of 5,000 megatons in the Northern Hemisphere in an area

between 30* N and 80* N (rem)

Gamma irradiation dose of the whole body

Internal irradiation doses

Bone marrow Gastrointestinal tract Thyroid gland

0.4

It is obvious from the table that the dose of gamma irradiation to which the whole body will be exposed may be estimated at 60 rem (over a period of 20 years), the doses received by red bone marrow at 0.4, gastrointestinal tract at 6 and thyroid gland at 88 rem. It should be borne in mind that, other conditions being equal, general irradiation of the entire body is more dangerous than the local irradiation of body segments or separate organs as a result of selective accumulation of radioactive substances in them. In analyzing the specific features of irradiation of the population by local fallout it is important to take account of the following. Since stratospheric fallout comprises long-lived radionuclides, its irradiation doses are built up over a long period of time, while in the case of local and tropospheric fallout the body accumulates gamma radiation doses in much less time. For instance, by the end of the first month close to 54 per cent of the full commitment dose (accumulated from the local fallout) is formed; in the course of six months, approximately 69 per cent, and in 20 years, 84 per cent.

In analyzing the data on internal irradiation doses one can see that the figures for the thyroid gland are the highest. It should be mentioned that all data quoted here characterize irradiation doses of adults. At the same time it is well known /10,11/that, if the organism of an adult and that of a child receive an identical quantity of radioactive iodine, the irradiation dose absorbed by

the thyroid gland of the child will be approximately ten times higher. Therefore, the doses for the child population (from birth to 14 years of age) should be increased ten to one.

Table 23 gives estimates of late radiation consequences for the population in the form of the expected incidence of malignant tumours developed in various organs and tissues, with a fatal outcome. The risk factors produced by the International Commission on Radiation Protection to characterize the development of tumours per irradiation-dose unit for each organ /160/ have been used for the purpose.

Table 23

Expected incidence of malignant tumours with fatal outcome as a result of the effect of local and tropospheric fallout

consequences, in particular on cases of microcephalia in children irradiated in utero, is very important. We have already mentioned several works which suggest that there is a linear dependence of teratogenic effects on the irradiation dose.

Specialists failing to agree on acceptable principles for extrapolation of the rate of teratogenic effects down to doses of less than 50 rad, it is difficult to offer any quantitative estimates of these consequences. However, it has been found possible to make a few estimates on a broader scale according to which this pathology may be found in several hundred thousand or even one-two million children born in the first two years after the nuclear holocaust.

All the above estimates do not make any allowance for the mean diurnal shielding factor (C) which registers the time the population stays out of doors and indoors and takes into account the shielding afforded to people by their homes, offices, factories, etc. from gamma radiation. If factor C is approximately equal to 2, all the estimates will be cut down to half. However, in the context of our examination such corrections will not change in principle the general conclusion on the real possibility of losses amounting to many millions of human lives from malignant tumours that will be caused by the effects of radioactive fallout resulting from the chosen version of nuclear war.

Summing up our basic appraisals at population level, it should be said that the expected fatality in the world from malignant tumours induced by stratospheric fallout would exceed one million. In addition, about 400,000 descendants of irradiated people will have genetic defects.

Some ten million inhabitants of the Northern Hemisphere (between 30° N and 80° N), if the mean diurnal shielding factor C is 2, will die of malignant tumours induced by local and tropospheric fallout. An additional 700,000 people may die of cancer because they were irradiated in utero. It may be assumed that as a result of intrauterine irradiation from several hundred thousand to a million children will suffer from microcephalia and, hence, from retarded mental development.

Finally, it may be expected that close to three million descendants of people living in that region will be afflicted with genetic defects.

It should be mentioned that this work is dealing chiefly with late consequences, leading to a fatal outcome, for an irradiated human population. However, in estimating the total damage inflicted by radioactive fallout to human health it will evidently be necessary to take account of the total incidence of malignant and benign tumours induced by it. Let us examine this problem on the basis of incidence of malignant and benign tumours of the thyroid gland resulting from irradiation.

According to the US Advisory Committee on the Biological

Type of late consequences

Risk factor of develop Number of cases, mentof tumour per rem million

Leukemia

2.0-10-^^5^^

2.88

Mammary gland cancer

2.5-10-5

3.60

Thyroid gland cancer

5.0-10-^^6^^

4.62

Lung cancer

2.0-10-5

Malignant tumours in other organs and tissues

5.0-10-^^5^^

7.20

In estimating the overall consequences following the irradiation of the thyroid gland of the entire population the authors have taken into account the higher irradiation doses received by children and their number in the region (approximately 700 million).

As can be seen from Table 23 local radioactive fallout can give rise to malignant tumours in millions of people. The overall fatality from malignant tumours induced by ionizing radiation is expected to be 21 million, of these approximately 3 million dying of leukemia, 3.6 million of mammary gland cancer, over 4.5 million of thyroid gland cancer, etc.

Estimates also show that about 1.6 million people irradiated in utero may subsequently die of malignant tumours*.

Finally, about 6 million descendants of irradiated parents are doomed to suffering caused by genetic disorders.

The information on the probable incidence of teratogenic

``It is assumed that the live-birth rate of this region is 20 per 1,000 inhabitants.

Effects of Ionizing Radiation /174/, the risk factor of irradiationinduced benign tumours (nodular changes) in the thyroid gland reaches 2-10"^^4^^ per rem. The risk of the development of malignant tumours in the thyroid gland with a fatal outcome is 5-10'⁶ per rem. The incidence of such carcinomas accounts for only 3 per cent of the total number of nodules /160/.

Thus, the general risk factor characterizing the development of malignant and benign tumours in the thyroid gland is4-10~⁴ per rem. It follows that in order to make a theoretical estimate of the expected incidence of thyroid gland tumours induced by radioactive fallout it would be necessary to multiply by several tens of times the figures in Table 23 on fatalities from malignant thyroid gland tumours.

It should be borne in mind that the quality of medical aid to the survivors of nuclear war will sharply deteriorate. It follows, therefore, that owing to delayed diagnoses and many other negative factors fatalities from various malignant tumours ( including those induced by ionizing radiation) will show a rise over the average peacetime figures.

The section dealing with clinical data in conditions of nuclear warfare examined the various non-specific factors which will inevitably aggravate the incidence of general somatic and malignant diseases among the survivors of a nuclear attack. There should be no illusions about irradiation of thousands of millions of people with individual doses of several dozen rem, which will exceed the level of natural radioactive background several hundred to one, failing to harm the health of this population. We have attempted to appraise only the malignant and genetic effects of this irradiation. Other consequences are now difficult to predict owing to lack of any substantial scientific information on the matter.

Completing our examination of the theme discussed in this section it would be logical to ask the question: would it be possible to carry out, after a nuclear attack, effective preventive measures to save people from late consequences resulting from radioactive fallout, local fallout above all?

The main effort should be concentrated on sharply decreasing the external and internal irradiation doses. The measures undertaken to this end should affect the entire population living in the acea from 30°N to 80°N, because the fatal hazard, for instance, of tumours concerns every single individual with a definite degree of probability (10~^^2^^, or almost one in a hundred, in this particular case).

To reduce external gamma radiation doses, say, to one-- hundredth it is necessary to increase hundred to one the mean diurnal shielding factor for the entire population of the region.

In considering the possibilities of reducing the internal irradiation doses which will be determined by the intake of

radioactive substances with food it is necessary to take account of the following facts and considerations.

Under normal farming conditions it is impossible to reduce direct contamination of crops in the fields with radioactive matter, unless they are destroyed. Nor is it possible to lower the mean level of radioactivity in farm products /12/. There have been many proposals for altering (decreasing) the entry of fission products into food chains, which, however, seem quite unfeasible. The moving of dairy cattle to ``clean'' pastures in order to decrease the radioactivity of milk (from iodine-131, for instance) would be purposeless in the context of a total nuclear war. Sheltering livestock in stalls and feeding it on clean fodder stored in anticipation of these conditions for a period of at least one month (till the bulk of iodine-131 has decayed on the pastures) would involve numerous, most probably insurmountable, difficulties.

Theoretically it would be possible to change the diet of the population so that it would consist of foods with a smaller concentration of radionuclides. However, in the postwar period this line of action would be totally impracticable and its effectiveness would be doubtful.

Various methods have been proposed to lower the level of milk radioactivity, in particular, through decontamination of strontium-90. However, they are mainly based on laboratory research and, owing to a number of reasons and considerations, cannot be applied on a large scale.

Soviet and foreign scientists have developed medicines preventing the accumulation in the body of long-lived radionuclides, such as strontium-90 and caesium-137 /11 /. They can be successfully used for preventive purposes, if radioactive isotopes are taken in only once or in a brief period of time. However, if the entire population of many hundred million takes these medicines over a period of several years, which would in itself be hardly possible after a nuclear disaster, these medicines could possibly do harm to the health of a human population, harm that could, perhaps, outbalance the useful effect in decreasing the radiation consequences for scores or hundreds of thousands of people.

Scientists have also developed recommendations for mass prophylaxis against the assimilation of radioactive strontium by the organism which may have received it over a long period of time. These recommendations are based on the phenomenon of moderate reduction of the level of accumulation of this radionuclide by increasing the calcium content of a calciumdeficient diet or by fluorinating drinking water up to the normal physiological fluorine level. This is more a question of maintaining a balanced diet everywhere with respect to the above biological elements (from the standpoint of general hygienic

requirements) rather than a question of radiation shielding. If a balanced diet is maintained, an increase in calcium or fluorine content would not essentially affect the behaviour of strontium90 in the human organism /11/.

From the standpoint of effectiveness in the situation being discussed all the aforementioned methods, techniques and measures are either prospectless, inexpedient or totally impracticable.

At the same time, as regards the prevention of internal irradiation of the thyroid gland only through accumulation of radioactive iodine in it, there are two ways of protection in principle.

The first way is of a purely organizational character. It consists in enforcing a universal ban on the consumption of milk from livestock grazing on pastures contaminated with local radioactive fallout. This ban should be observed for at least several (4-5) weeks after the explosion so that the bulk of radioactive iodine in the fallout should decay.

The second way consists in the organization and administration in the same period of so-called iodine prophylaxis of the entire population. This means that the population will have to take medicines containing stable iodine which prevents the entry of radioactive iodine into the thyroid gland, even though the person may be consuming contaminated milk, and accelerates the removal of radioactive iodine from the body /11 /.

Though these preventive measures are doubtlessly effective, they will hardly be always practicable in the event of a nuclear disaster.

It should also be borne in mind that the main radiation hazard arising from local fallout is external gamma radiation. This is evidenced by the above data and in particular by Table 23 which shows that the fatality rate from thyroid gland tumours accounts for about 20 per cent of all malignant tumours 80 per cent of which are induced by external gamma radiation.

XIII

Some Indirect Effects of Nuclear War

Numerous studies of the injurious effects of nuclear weapons and of the consequences of a thermonuclear war are conducted largely in the hope that an all-round realistic assessment of this tragedy for the life and health of humankind and for its environment will help avert the impending catastrophe. It is quite natural, therefore, that many researchers, especially in recent years, have concentrated on the study of the less known consequences of nuclear war, brought on primarily by a largescale use of nuclear arms. This accent stems from the conviction shared by most scientists of the world that the doctrine of a ``limited'' nuclear war and similar concepts of ``local'' nuclear conflicts are unrealistic and have nothing to do with the actual state of affairs in the world today or with the specifics of nuclear weapons and the capabilities of their delivery systems. It is this conviction that has prompted research into the possible global effects of the use of nuclear weapons on nature in the broad sense of the word, on the life and health of humankind, an integral component of the biosphere. The authors of an ever growing number of publications are attempting to comprehend and give if only a purely descriptive interpretation of the possible geophysical, ecological, sanitary and medico-biological effects of an all-out nuclear war, as well as of the economic and social consequences of such a Catastrophe.

As has been repeatedly stated in this book, the indirect effects and consequences of a nuclear conflict, which are the subject matter of this chapter, fall mostly within the category of effects which are hard to predict or unpredictable.

It is also important to note that some of the supposed global effects described in the literature appear at closer examination not to be so obvious, while the prospect of a number of medico-biological consequences (such as epidemics of the plague and smallpox) is open to question (e.g., /175/).

In describing the late consequences of the damage done to some biocenoses or of the disruption of the homeostasis in natural communities, excessive preeminence is often accorded to the role and significance of ionizing radiation (in detriment to other major factors of radiation). One reason for this is that such assumptions do not take account of the actual dose rates that may be expected to affect in such situations the various components of the ecological systems, and their ability to resist radiation.

The reader has to know all this to be able to analyze critically the numerous descriptions in the scientific and popular literature of the possible indirect consequences of nuclear war, and to have an objective view of the effects that would inevitably manifest themselves and of those whose likelihood is not so obvious.

would render people less immune to diseases, making them more susceptible to infectious and conventionally nonpathogenic agents. The shortage of antibiotics and other germand virus-killing medicines would be conducive to outbreaks of streptococcal and staphylococcal infections, tuberculosis, infectious hepatitis and other nosological forms of infectious etiology. There would be a higher incidence of general somatic diseases among the nuclear attack survivors. Psychological effects of many of the nuclear explosion factors would become most persistent. Among these would be concomitant fixed reactions to the acute situation accompanying the use of nuclear weapons and prolonged reactions to the death of relatives and other people who would be affected by the same disaster and would die at different time intervals and from different diseases. The self-appraisal of an individual who would survive a nuclear explosion would change in a peculiar way, since his social adaptation would be disrupted.

History shows that the disruption of the urban infrastructure during World War II, obviously much smaller in scope than the possible extent of devastation in the event of a nuclear war, was one of the causes of the huge loss of human life and great suffering among the civilian population. An idea of the medical consequences of one such event can be gained from the published data on Leningrad, covering the period of the city's heroic struggle during the 900-day siege by Nazi troops in the course of the Great Patriotic War /81-157/. The siege had an extremely adverse effect on the health of the city population, children above all. Starvation and excessive nervous strain among pregnant women resulted in a higher frequency of premature births which, in turn, caused substantial delay in the physical development of the children born. The aggravating circumstances of life in a besieged city caused higher morbidity, especially among children who suffered from alimentary hypotrophy, dystrophy, and rickets. The health of the adult population worsened drastically. There was a rise in the incidence of various diseases; 64-95 per cent of women aged 20 to 40 suffered from amenorrhea; prenatal and postnatal complications (eclampsia) and diseases among the expectant mothers (pneumonia), caused by exhaustion and resulting in a higher mortality rate, increased by 53 per cent. Among young people who had survived the siege a much higher incidence of malignant hypertension and other diseases was observed. The population of the besieged city suffered from an increase in the number of infectious diseases: there were outbreaks of dysentery, typhoid, typhus and leptospirosis.

In the wake of a nuclear catastrophe hunger would affect many of the survivors. There is every reason to believe that food shortages would become the number one problem. According

14---1878 209

Sanitary and Socio-Economic Consequences of Nuclear War

In this section we shall only attempt to outline some of the sanitary and socio-economic problems that the survivors of a nuclear attack would be confronted with.

Nuclear explosions would destroy the infrastructure of the attacked cities and population centres, their utilities and, above all, housing. For a long time (the duration of this period is impossible to predict) the population would be left without water, power and gas supply, central heating, solid and liquid wastes disposal facilities, etc. In summer time waste and untreated sewage would contribute to an explosion-like increase in the population of flies and other insects, which may in turn lead to the spread of infectious diseases. In the event of an all-out nuclear war it will be impossible to take effective infectious disease-control measures involving the use of modern sanitary and hygienic means and effectively functioning public health services

Hunger, privation, poor sanitation and inadequate nutrition

to official statistics, world food reserves are quite limited and roughly equal a two-month supply of grain at current consumption rates /176/.

The destruction of many industrial enterprises, including those of the agrocomplex, may lead to a halt (or a sharp reduction at best) in the production of goods required to meet people's daily necessities (food, clothes, medicines, etc.). This would create immense difficulties, even if there are some food reserves, for in an all-out nuclear war a greater or lesser part of these reserves and agricultural crops may be destroyed by explosions and fires, while the delivery to consumers of foodstuffs from the fields and from the storages would in most cases become impossible due to lack of transportation and manpower. The stoppage of power supply and the breakdown of refrigeration facilities would render unusable huge stocks of frozen foods. Moreover, since international trade and economic relations would be suspended or rather severed for an indefinite period of time, outside aid to a starving population would naturally be difficult or most probably impossible to provide.

It may be recalled that at present a large portion of food exports goes to those parts of the world where millions of people are suffering from malnutrition and famine despite grain imports. It has been estimated that over 500 million people in the developing countries live at a marginal or deficient level of nutrition. By 1990food shortages in the food-deficient countries are expected to be of the order of 120-140 million metric tons. Out of this deficit Asia will account for 40 per cent, Africa and the Middle East---for 47 per cent and Latin America---for 12 per cent /177/. In the aftermath of an all-out nuclear war there would be no food-exporting countries while hunger would cross the borders of the warring countries, striking millions of people around the world /178/.

Among the essential factors aggravating the sanitary and ecological situation in the wake of nuclear strikes may be the destruction of industrial enterprises, especially those of the chemical, oil, gas, and other industries, together with their stocks of finished goods and raw materials and liquid or solid wastes often containing highly toxic substances and aggressive chemical compounds. As a result, massive amounts of these chemicals would be released into the environment, polluting the air, water, including open-air water reservoirs, soil and vegetation. All this may cause mass acute poisoning and chronic injuries among the population, perniciously affecting the fauna and the flora, specifically, the size and quality of farm crops. According to available published data, this aspect of the problem has not yet been subjected to a thorough quantitative analysis, although the possible catastrophic consequences of

such developments and their sweeping effect on the population are not questioned by anyone.

To illustrate the effect of chemical pollutants on the health of the population, one could cite the available data /157/ showing that a lasting action on the human organism of such common air pollutants as sulphur dioxide, carbon monoxide and nitric oxides, in case their critical concentration in the air is exceeded by more than 400 per cent, may lead to a higher incidence of a large number of nosological diseases (chronic non-specific lung diseases, bronchial asthma, etc.). Incidentally, pollution of the atmosphere by the products of combustion, inevitable in an all - out nuclear war (see below) would undoubtedly increase the incidence of general somatic diseases among the surviving part of the population weakened by the hardships of war.

Nuclear explosions in industrial areas may damage storage tanks containing huge amounts of highly toxic waste effluents. It is hard to predict in quantitative terms the ensuing consequences, with millions of cubic metres of effluents being dumped into open-air water reservoirs and large rivers, flooding fields and pastures.

Thus, the destruction of storage tanks containing acid effluents would bring about a sharp increase of acid products in water reservoirs, injuring or killing fish, plankton and benthos. According to /157/, upon the destruction of storage tanks containing the liquid waste of chemical and other factories and the mixing of noxious agents with underground water, the natural self-purification of the water would take a minimum of 1 -2 months before a permissible concentration has been achieved. This means that massive ejection of toxic chemicals into the environment may cause mass poisoning of people (through the use of polluted water) in the period immediately following a nuclear attack. It is assumed that soil shifts brought on by ground nuclear explosions would change the natural hydrogeological situation, produce depression holes, and alter the direction of the flow of subterranean waters, with toxic substances inevitably reaching water-bearing levels.

The study of the quantitative aspects of these effects, specifically the effect of the destruction of chemical factories, is, from the medical, ecological and sanitatory point of view, a highly important area of future research.

I n publications of recent years much more attention has been paid to the analysis of the consequences of nuclear strikes at nuclear power installations, above all atomic power plants /28, 36,87, 88, 179-181/.

The authors of these publications work on the assumption that in the event of 1 -Mt ground-level nuclear explosion over a one-thousand-megawatt nuclear reactor the radioactive materials at the site of the plant and inside the reactor would

produced would differ from that of the typical radioactive products of nuclear explosion, as is graphically shown in Fig. 38 containing data on the total quantity and the decay speed of radioactive products formed:

(a) in the wake of a ground-level explosion of a 1 -megaton bomb;

(b) in the active zone of a 1,000-megawatt nuclear reactor, and

(c) in spent heat-emitting fuel elements stored in cooling ponds.

A comparative analysis of these data shows that for a few days following a nuclear explosion above a nuclear power plant the radiation situation in the radioactive plume would be shaped primarily by the products of nuclear explosion, whereas during the subsequent period the long-lived fallout component would begin to assume an increasing and even a predominant role due to ``reactor'' nuclides. That general proposition, however, requires appropriate interpretation in terms of the assessment of the possible exposure dose rates received in the open and the area on which they may be produced.

Thus, acute radiation injuries among the population in a radiation-contaminated area would be the result of a relatively brief irradiation, produced primarily by the decay of the shortlived products of nuclear explosion. This makes it obvious that the addition of long-lived reactor nuclides, considering their actual number and decay rate (Figure 38), to the fragments of a ground nuclear explosion would not result in a directly proportional increase in the radioactive plume area where acute radiation injuries, including those with fatal outcomes, may occur. Indeed, the analysis of the published data/87,179-181 / shows that in this case, other conditions being equal, the area of lethal radiation dose rates would be 14-25 per cent larger as compared to a ``conventional'' ground explosion.

By virtue of similar physical peculiarities involved in the shaping of a radiation situation, the long-lived ``reactor'' component of the fallout would cause prolonged contamination of the terrain by relatively smaller and less rapidly accumulating irradiation doses, but on a much larger area of the radioactive plume (as compared with what would happen in the wake of a ground-level nuclear explosion of the same yield over any other ``non-nuclear'' target). To illustrate this fundamental proposition let us refer to the data /36,179/ shown in Table 24, which indicates the possible areas of the radioactive plume where 10, 50 and 150 rad per year doses may be accumulated one month following a 1 -Mt ground explosion and a 1 -Mt nuclear explosion above a 1,000-megawatt atomic reactor.

As can be seen from Table 24, with dose rates and parameters contained therein a nuclear explosion over a nuclear

TIME AFTER EXPLOSION (BEIEASE), HODH

Fig. 38. Dynamics of decay of radioactive substances: 1---products of 1 -Mt nuclear explosion; 2---in 1,000-megawatt atomic reactor active zone; 3---in spent heat-emitting fuel elements stored in cooling ponds /36, 87, 179, 180/

evaporate in the fireball and would be drawn into the radioactive cloud together with the products of nuclear explosion. Then they would precipitate in the form of radioactive particles of varying dispersity on the surface of the Earth from the radioactive cloud as it moves along with the air mass downwind. The fallout distribution in terms of the area, and the shape of the radioactive plume would be very much similar to those observed in the event of a ``conventional'' ground-level explosion. Still, the decay of the complex mixture of radioactive substances thus

Table 24

Area of the radioactive plume after a one-megaton ground-level

nuclear explosion and an explosion of the same yield

over a 1,000-megawatt atomic power reactor /36, 179/

above do not offer exhaustive information concerning the expected irradiation dose rates for people, or dose rates accumulated on the terrain contaminated by radioactive fallout. The point is that in a real situation people would not stay in the open day and night. Therefore, their actual irradiation dose rates would be smaller, decreasing in proportion to the numerical value of the factors of the average diurnal protection of the population (C) (see Chapter VI).

By early 1982, 272 nuclear power reactors were in operation in 23 countries, with the total rated capacity amounting to 152,000 megawatts. Currently, 236 nuclear power reactors with the total rated capacity of about 220,000 megawatts are under construction.

It is assumed that by 1985 nuclear power plants will become operational in as many as 32 countries, and by the year 2000---in 50 countries /184-187/. If the location of these plants is marked on the world map, it would bequiteeasy, knowing their capacity and sites on the territory of different states, to make an approximate assessment of the possible consequences of nuclear strikes at these power plants. These consequences would be of particular gravity for densely-populated regions, specifically, for the population of relatively small countries and adjacent states.

Progress of human civilization requires further development of nuclear power engineering; it will inevitably continue to expand still more, and at a fast growing pace. Indeed, as can be seen from the above-cited data, the number of states developing their own nuclear power engineering will nearly double in the next few years.

Along with the intensive growth of nuclear power engineering, there will be an increase in the number of more advanced nuclear power plants, research atomic reactors, nuclear fuel producing and processing facilities, and storages of fissionable materials. The energy contained in the atomic nucleus can be converted, to quote Igor Kurchatov, organizer and leading figure of Soviet nuclear science and technology, "into a powerful source of energy bringing well-being and happiness to all people on Earth''.

In peacetime, there is every reason to believe that due to overall scientific and technological progress and the efforts made by human society to ensure radiation safety nuclear power industry and engineering neither at present nor in the future will lead to any biologically significant negative consequences for the human population and the environment /182, 184, 188/. Indeed, owing to the immense efforts of scientists, engineers and designers, outstanding achievements have been made in ensuring the radiation safety of the nuclear fuel cycle. Thus, the

Dose' (rad)

Area (km^^2^^)

1 megaton

1 megaton exploded over a 1,000-megawatt atomic reactor

2.000

34,000

4,000

46,000

25,000

1 22,000

``Doses accumulated in the first year one month after the explosion.

power plant would result in a radioactive plume reaching into tens of thousands of square kilometres, far in excess of the area affected by a ground nuclear explosion producing the same dose rates.

The above data provide additional illustration of the fact that a nuclear strike at an atomic power plant would aggravate the radiation situation over large downwind areas and would doubtlessly cause greater radiation damage, as compared to a ground-level explosion detonated over a different target.

For reasons set forth in Chapter IV, we naturally do not intend to comment on the accuracy of these data, still less on the degree of their reliability, or quantitative uncertainty for this could give a false idea of the accuracy of any such estimates. Besides, one should always make due account of many factors allowing for an upward or downward adjustment of the data.

The above estimates show the possible consequences of a single 1 -Mt nuclear strike at a 1,000-megawatt reactor.

It is known that the most of the nuclear power plants in operation or under construction have from two to six reactors (several power units) /182-187/. Moreover, spent fuel elements are stored as a rule at atomic power plants in cooling ponds. This means that in the event of pinpointed nuclear strikes at nuclear power plants greater amounts of radioactive materials may be released into the atmosphere than has been estimated /36, 87, 179, 180/.

Yet it is also obvious that the number of casualties among the population would depend not only on the distance from ground zero, but also on the weather conditions, the effectiveness of warning systems and shielding, and on whether people are in the open, in buildings, shelters, etc. Thus, all the data cited

technological systems of nuclear power plants have been designed and operate in such a way as to provide practically complete isolation of radioactive materials from the biosphere, while the unavoidable release of radionuclides into the environment is infinitely minimal as compared with the established permissible ceiling /182, 184/. In the USSR, for instance, the individual irradiation dose received by a person living 20 kilometres away from a nuclear power plant equals at least onethousandth of the dose produced by the natural radioactive background /182,188/. Scientists and engineers are well aware of the fact that this branch of the national economy is among the best in terms of labour safety, health protection and its impact on the environment.

But as has been repeatedly noted, in the event of a military conflict involving the use of nuclear weapons the destruction of the above-mentioned facilities would have very grave consequences.

For this reason the Soviet Government, having the relevant scientific data on the problem and motivated by the natural desire to prevent a nuclear catastrophe, has made repeated foreign-policy moves in this direction and has even pledged not to be the first to use nuclear weapons.

The draft resolution submitted by the Soviet Government to the 37th session of the UN General Assembly in the autumn of 1982 and entitled "Intensification of Efforts to Remove the Threat of Nuclear War and Ensure the Safe Development of Nuclear Energy", urged to declare, in particular, that a predetermined destruction of civilian nuclear facilities even by conventional weapons would in fact be tantamount to a nuclear attack, that is, an action already qualified by the United Nations as the gravest of crimes against humanity.

In a letter to UN Secretary-General Perez de Cuellar, Andrei Gromyko, Minister of Foreign Affairs of the USSR, stressed:

``Destruction of peaceful nuclear installations by means of nuclear weapons would have totally disastrous consequences on a global scale. The need for ensuring the safe development of nuclear energy is therefore organically linked to the problem of preventing the unleashing of nuclear war. And this, in turn, makes it even more urgent to intensify efforts to remove the very possibility of the outbreak of such a war---in other words, to reduce and ultimately to eliminate nuclear weapons.

``Moreover, the cessation of the nuclear arms race, combined with the ensuring of the safe development of nuclear energy, would provide additional incentives for the further development of international co-operation in the peaceful uses of the atom.''

That proposal of the Soviet Union has been reflected in a number of UN General Assembly resolutions.

Ecological and Geophysical Effects of Nuclear War

Of all the man-made effects on the human environment, war has been the most destructive factor. Whereas in the past the negative impact of wars on the environment was confined to relatively small damage inflicted on local geography, modern nuclear war would inevitably affect the environment on a global scale. In Europe, World War I was fought on a territory of 200,000 square kilometres, while in World War II the area of hostilities was extended to 3.3 million square kilometres /189/. There was a steady rise in the number of civilian casualties. It has been estimated /4, 36, 42/ that in a nuclear war, even if only military targets came under attack, the number of victims among the civilian population would approximately exceed the number of military casualties by a factor of 16 to 1.

The history of wars knows of many instances of deliberate environmentai destruction.

Samson let out a few hundred foxes with their tails aflame to set fire to the fields and gardens of the Philistines.

The British used incendiaries to destroy crops when they fought the insurgents in Malaya in 1950.

During the US aggression in Vietnam, American troops used incendiaries, herbicides and defoliants to destroy crops and forests which provided food and shelter to the guerrillas and the civilian population of the country.

During World War II Nazi troops demolished dams as they were retreating to flood large areas of the Dutch territory. In the Korean War the US delivered strikes at irrigation dams in the north, causing large-scale devastation.

The destruction of forests ruins one of the major regulatory components of the biosphere.

During the Great Patriotic War 20 million hectares of forests werecutdown or damaged in the USSR. During the 1961 -1973 Vietnam war the use of herbicides by the US resulted in the destruction of 568,000 hectares of woodland; 5,600 hectares of forests were badly damaged, and crops were destroyed on an area of 363,800 hectares.

In a nuclear war ecological damage may ensue both from the direct action of nuclear explosion injurious factors on various components of the ecosystem and from secondary, indirect effects (for instance, large-scale fires, chemicals released into the environment, a change in the intensity and spectral composition of the solar ultraviolet radiation reaching the surface of the Earth, etc.). All these effects have been termed "secondary ecological weapons" /190/.

Table25

190, 192/. It is assumed that such fires, together with secondary fires in cities and industrial centres, may cause intensive smoke pollution of the atmosphere, creating global photochemical smog characterized by a high content of tropospheric ozone. This assumption stems from theoretical estimates /192/ based on a nuclear war scenario involving the use in the Northern Hemisphere of some 14,700 warheads with the aggregate nuclear yield of the order of 5,700 Mt /28/. The assumption is that nuclear weapons in excess of 1 Mt would be used only on relatively rare occasions. Therefore, the researchers concentrated on the troposphere, because due to relatively lower altitudes that the clouds produced by less than 1-Mt nuclear explosions would reach, it would be the troposphere, rather than the stratosphere, that would be affected by the secondary effects of thousands of such explosions. The release into the atmosphere of the products of combustion in the form of aerosols of fine dispersity, capable of absorbing and diffusing light, and of gases---mostly nitric and carbonic oxides and hydrocarbons---would disrupt the photochemical processes in the atmosphere and change its physical properties.

The authors based their estimates on the proposition that one million square kilometres of forests and an amount of oil and gas equivalent to that produced in the world in a year at the present consumption level would burn as a result of fires (it is methane, which makes up 25 per cent of gas, that would burn in the process, while ethane and propane would be released into the atmosphere). As a result of forest fires, 1.3-^2.5-10^^15^^ g of carbon in gaseous form and 2-^4 • 10^^14^^ g of carbon aerosol (with the largest aerosol particles being less than 0.1 microns) would be injected into the atmosphere. Aerosols of such dispersity are known to absorb visible and infrared solar radiation. As submicron particles would remain in the atmosphere from five to ten days, and forest fires would continue for up to two months, the authors believe that the aerosols would spread throughout the Northern Hemisphere. Consequently, even at noon in summer the pollution of the troposphere would be so great as to dim the intensity of sunlight by a factor of 2-150. It is to be noted, however, that many researchers have doubts about the dimming effect predicted by P. Crutzen and J. Birks /192/ believing, first, that the estimated amount of aerosols injected into the troposphere would be quite comparable with a powerful volcano eruption and, second, that it is unlikely that forests would be burning for two months, steadily releasing new portions of aerosols into the troposphere (aerosols would be washed down with rain). It should be noted here that, with regard to our subject, the data on volcanic aerosols should be used with circumspection, for their physical properties are not identical to those of the aerosols created by fires, while the excessive

Effects of a surface nuclear explosion on various ecosystem components /191/

Type of damage

Damaged area (hectares)

Atomic bomb 20 kt

Hydrogen bomb 10 Mt

1. Blast-produced crater

2. Death of vertebrates caused by

the blast

1,540

3. Destruction of all vegetation by

initial radiation

12,100

4. Destruction of trees by initial

radiation

63,800

5. Felling of trees by the blast

52,500

6. Death of vertebrates from initial

radiation

177,000

7. Ignition of dry vegetation caused

by thermal radiation

117,000

8. Death of vertebrates caused by

thermal radiation

1,000

150,000

Note: Data on the effects of ionizing radiation are based on the irradiation dose rate during the first 24 hours following the explosion.

A general idea of the dire effects of ground-level nuclear explosion on various components of ecosystems can be gained from Table 25 /191/.

It is the view of a number of researchers /4, 191,192 et al./ that in a thermonuclear war forest fires and burning crops may destroy or gravely damage plants and animals on an area covering millions of square kilometres. This would sharply disrupt the natural balance in the ecosystems, specifically the agrocenoses of the affected regions. The land, bared of woods, would later be overgrown with shrubs and grass which have a far smaller biomass, while the erosion of topsoil would reduce land fertility.

We have already mentioned the possible damaging effect on the environment produced by a release of toxic chemicals and of various pollutants in the event of the destruction in a nuclear attack of chemical factories together with their stocks of finished products, liquid-waste storage tanks, etc.

In studying the possible global geophysical effects and the concomitant ecological consequences of an all-out nuclear war increasing attention has been paid of late to large-scale fires caused by the ignition of forests, oil and gas /4, 30, 43,

amount of condensation nuclei in the air would reduce the ability of the clouds to produce precipitation which would otherwise wash clean the atmosphere. Forest, oil and gas fires would send into the air about 35-^50-10^^12^^ g of nitric oxides, which would by far exceed the amount of N0₂ likely to appear in the troposphere as a result of nuclear explosions (~10³² molecules or 10,000 tons per 1 -Mt yield). Nitric oxides, as a major element in the atmospheric photochemistry are known to play a key role in the formation of photochemical smog. Besides, under the impact of sunlight nitric oxides, carbon monoxide and hydrocarbons, going through a complex process of photochemical reactions, may produce vast amounts of ozone in the troposphere. It is also believed that multistage photochemical conversions could produce peroxyacety I nitrate (PAN)---a highly toxic compound for plants. Hence, a "grave world-wide smog situation" may be predicted, with a high concentration of ozone (16-10-^^8^^ by volume) and of PAN (50-100-10-^^9^^). A fewhours-long action of high ozone concentration on grain, maize and soya bean crops would result in noticeable crop losses, while a month-long exposure to ozone would have a lethal

effect on plants.

Here we should like to draw the reader's attention to the following thing. According to the just mentioned nuclear war scenario, it is estimated that there would be a sharp increase in ozone concentration in the troposphere, whereas a massive use of nuclear weapons of greater single yield (1 Mt or more) /16/ is likely to produce a diametrically opposite phenomenon in the stratosphere. It is believed /16, 192-194/ that as a result of photochemical reactions (qualitatively different from those which may occur in the troposphere) triggered off by `` bombproduced'' nitric oxides stratospheric ozone would be depleted by a certain amount.

It is known that the ozone layer at the altitude of 20-25 kilometres acts as a shield of sorts, protecting the biosphere from the harmful effect of ultraviolet solar radiation, namely, ultraviolet radiation in the 290-300 nanometre band, which is biologically very active. The biological effect of this hard ultraviolet radiation results from its absorption by proteins and nucleic acids of plant and animal cells, accompanied by the onset of photochemical reactions, with subsequent cell damage.

According to some estimates, the use of thermonuclear weapons (10,000 Mt) with a high single yield in the Northern Hemisphere would result in a 50-60 per cent reduction of ozone concentration in the protective layer, and a 20-30 per cent drop in the Southern Hemisphere. Updated estimates /4,194/ show that it would take some two years before the original ozone concentration level has been reached again.

Finally, there are indications that nuclear explosions may be

deliberately used as geophysical weapons, with a view, in particular, to creating artificial tsunami.

There are two known types of tsunami: those caused by strong submarine seismic tremours, and those produced by the release of gravimetric energy as a result of a fault of alluvium and rock that form the edge of a multilayer continental plateau. It is the latter type that may be set off artificially by a series of wellaimed underwater nuclear explosions /195/.

What are the possible consequences of all these theoretically feasible geophysical effects? It is assumed that a drop in solar radiation intensity, photochemical smog and aerosol fallout on the Earth's plant cover would have an adverse effect on plant productivity and on agricultural production in general. Nitric oxides would increase the pH acidity of rainwater. The biological processes in the ocean would also be affected, since the projected decrease in solar insolation by a factor of 100 may kill the major part of the upper phyto and zooplankton. A partial depletion of the ozone layer may have serious consequences not only for the warring states, but also far away from the area struck by powerful nuclear explosions. Among other things, ultraviolet radiation would have a deadly effect on useful bacteria, insects, plants and animals the world over.

It is quite obvious that should all of these effects, or even some of them, ever occur they would have a highly negative impact on the life and health of nuclear attack survivors.

Before concluding this chapter, it is to be pointed out that there is a good deal of uncertainty and assumption in the descriptions of a ``postnuclear'' atmosphere and in the projections concerning its recovery. And not surprisingly so, considering the complexity of the problem under discussion and the lack of reliable experimental methods of checking the assumptions made.

It is our view that, given the currently available knowledge of this complex and scantily studied area, any estimates and projections should be regarded as possible, but not obvious, consequences of a thermonuclear war.

There is yet another important point that should be made here.

In analyzing the diversity of the obvious and possible consequences of nuclear war, the question is often raised as to their relative significance for man and his environment.

We feel that the very posing of this question is in most cases mere rhetoric.

It is common knowledge that any theoretical analysis of the quantitative aspect of the indirect effects of nuclear war requires that we proceed from a number of conditions, assumptions and reservations which serve to underscore that there is a good deal of uncertainty about this complex problem.

There is no doubt that the actual consequences of nuclear strikes would be largely shaped by a wide range of various specific factors characteristic of a given area or region that would come under a nuclear attack.

It is easy indeed to demonstrate that in some situations the crucial factor for the life and health of the population and for the environment would be the release of vast amounts of highly toxic substances in the wake of the destruction of chemical factories, while in others it may be large-scale forest fires or burning oil storage tanks.

Among other crucial factors there may also be found the radiological effects of nuclear strikes at atomic power plants, as well as the consequences brought on by the destruction of dams of irrigation systems.

What is obvious in such comparisons and assumptions is that a combination of these or any other negative factors would involve not just a simple adding up of effects, but their synergistic impact on people and their environment.

Conclusion

One of the reasons for writing this book is the fact that in the period since the previous publication we have obtained additional research data on the medical and biological consequences of nuclear war, which leave no illusion as to the nature and scale of a nuclear catastrophe for the life and health of humankind. An objective study of the specifics of nuclear weapons---which are weapons of mass destruction---and of the capabilities of their delivery systems convinces us over and over again that given the current explosive situation any use of nuclear weapons would inevitably trigger off an all-out nuclear war. This immutable fact cannot be shaken by any speculation about the possibility of waging a limited nuclear war, and of arranging some kind of demonstrative nuclear explosions, or by similar abstract talk, which has nothing to do with the logic of a modern military conflict involving the use of nuclear weapons.

Briefly summing up the research data, estimates and forecasts given in the book, which cannot claim to offer a comprehensive analysis of the problem, the following basic conclusion can be made:

An all-out nuclear war would be a catastrophe not only for the population of the countries where the bombs would be exploded; it would be a catastrophe threatening the very existence of human civilization.

Nonetheless, some quarters and politicians in the West are attempting to make people accept the ideathata nuclearwarcan be won.

This malicious and fraudulent myth must be dispelled. If this book goes some way towards doing this, its authors will consider their mission accomplished.

We physicians, more than anyone else aware of the infinite suffering and horror a nuclear war would bring to people, must

convince nations and their governments that they should work to prevent the flames of nuclear war from ever raging on our planet Earth. It is now, at this very moment, that we must toll the anti-nuclear bell. There is no time to lose.

This is well realized in the Soviet Union. "To consider prevention of a nuclear war to be the prime aim of a state's foreign policy. To preclude situations likely to lead to a nuclear conflict," such, in the words of General Secretary of the CPSU Central Committee, Chairman of the Presidium of the USSR Supreme Soviet Konstantin Chernenko, is one of the key norms on which relations should be based between powers in possession of nuclear weapons.

In ending this book we are convinced that reason will ultimately triumph over nuclear madness.

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1 p. 20 K.

Yevgeni CHAZOV, b. 1929, professor, Member of the USSR Academy of Sciences and the USSR Academy of Medical Sciences, Director-General of the Cardiological Research Centre of the USSR Academy of Medical Sciences, Member of the Presidium of the USSR Academy of Medical Sciences, Chairman of the Soviet Committee "Physicians for the Prevention of Nuclear War''.

Leonid ILYIN, b. 1928, professor, Member of the USSR Academy of Medical Sciences, Director of the Institute of Biophysics of the USSR Ministry of Public Health, VicePresident of the USSR Academy of Medical Sciences, Vice-Chairman of the Soviet Committee "Physicians for the Prevention of Nuclear War",

Angelina GUSKOVA, b. 1924, professor, D. Sc. (Medicine), head of department at the Institute of Biophysics of the USSR Ministry of Public Health, member of the Soviet Committee "Physicians for the Prevention of Nuclear War''.

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