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"A-BOMB DISEASE" ]) Impaired Body Substance We have observed that physical fears experienced in relationship to early radiation effects could turn into lifetime bodily concerns. During the years that followed, these fears and concerns became greatly magnified by a development which has come to epitomize the hibakusha's third encounter with death: his growing awareness that medical studies were demonstrating an abnormally high rate of leukemia among survivors of the atomic bomb. There has thus arisen the scientifically inaccurate but emotionally charged term "A-bomb disease/' which has taken for its medical model this always fatal malignancy of the bloodforming organs. The increased incidence of leukemia was first noted in 1948, and reached a peak between 1950 and 1952. It has been greatest in hibakusha exposed closest to the hypocenter, mainly those who were within two thousand meters; for those within a thousand meters the incidence of leukemia has been between ten and fifty times the normal.1 Since 1952 the rate has considerably diminished, but it is still higher than in non-exposed populations, and fears remain strong. The symptoms of leukemia, moreover, rather closely resemble those of earlier radiation effects, including the dreaded "purple spots" and other kinds of hemor- rhage, various forms of blood abnormalities, fever, progressive weakness, and (inevitably in leukemia, and often enough in acute irradiation) death.* Psychologically speaking, leukemia—or the threat of leukemia— became an indefinite extension of earlier "invisible contamination"; and individual cases, particularly in children, became a later counterpart of the "ultimate horror" of the first moments of the experience. One such case of leukemia in a twelve-year-old girl named Sadako Sasaki has, in fact, become Hiroshima's equivalent of an Anne Frank legend. Just two years old at the time of the bomb, she was said to have been exposed at about sixteen hundred meters, but to have shown no ill effects, and even to have been unusually vigorous and athletic, until stricken almost ten years later. Sadako, it is told, struggled to maintain her life by folding paper cranes, in keeping with a Japanese folk belief that since the crane lives a thousand years, the folding of a thousand paper cranes cures one of illness. When she died—still thirty-six short of that number, so the legend goes—her classmates added the missing paper cranes and placed the full thousand in her coffin with her. The same children then played an active part in a national campaign for the construction of a monument to Sadako and all other children who have died because of the atomic bomb. Paper cranes and financial contributions were received from all over Japan, and the monument now stands in the center of Hiroshima's Peace Park. The story has been told and retold in many versions, including a widely distributed film, and has come to symbolize the bomb's recurrent desecration of the pure and vulnerable—of childhood itself.2 Just when the incidence of leukemia was recognized as diminishing and approaching the normal, evidence began accumulating that various other forms of cancer were increasing in incidence among survivorsincluding carcinoma of the stomach, lung, thyroid, ovary, and uterine cervix. Such increases are consistent with the knowledge that these cancers can be induced by irradiation, and that the latent period following irradiation is much longer for them than for the leukemias.3 Moreover, while leukemia is a rare disease (even with its increased incidence, fewer than two hundred cases have been reported among * The two conditions cause similar symptoms because both affect the blood-forming tissues in the bone marrow. In leukemia the peripheral blood is flooded with immature white corpuscles, and white blood cell counts are characteristically extremely high; but they can also be abnormally low, as in acute irradiation. Severe anemia occurs in both. D E A T H I N L I F E 104 'A-Bomb Disease" Hiroshima's significantly exposed population), cancer is not; should the trend continue, as appears likely, the increase in cancer will undoubtedly give further stimulus to various elaborations of death symbolism, just as some of these were beginning to decline. Even now, aware of the increasing statistical evidence in this direction, survivors tend to see themselves as endlessly susceptible: when one lethal condition begins to show signs of attenuation, another, equally deadly, makes its appearance . Other medical conditions, with varying amounts of evidence, have been thought to result from delayed radiation effects. There has been a definite increase in cataracts and related...

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