■日本放射線看護学会

第 7 回学術集会

原子力災害と向き合ってCountermeasure against nuclear disasters
山下 俊一1, 2
Shunichi YAMASHITA1, 2
1
1

福島県立医科大学
2 長崎大学

Fukushima Medical University
2 Nagasaki University

要旨：人類史上最悪の原子爆弾が、広島、長崎にそれぞれ投下されてから 73 年が経過し、生存している原爆被爆者の高齢化とその減少に伴い、当時の貴重な経験や教訓が風化の危機に晒されています。そこで、本年は、本学会が長崎で開催されることから、原爆被災直後の救護活動に携わった代表的な医師の一人である永井隆博士生誕 110 周年を記念し、永井隆博士の人間性に学ぶと同時に、博士を敬慕し続けナイチ
ンゲール賞を受賞された久松シソノ氏の「凛として看護」を学び直す貴重な機会であると言えます。す
なわち、原爆被災からの再起と復興を糧に、長崎の地に学んだ私たちがいかにその経験と教訓を生かし、
現代リスク社会の中で新たな役割を果たす使命と責務があることを共に考えたいと思います。
その上で、東日本大震災、そして東京電力（株）福島第一原子力発電所事故から 7 年半を経過しようとしていますが、今なお避難を余儀なくされている方々や、震災関連での多くの障壁のために、生活の困難や不便さを甘受されている被災者に心からお見舞い申し上げます。震災、そして原発事故後の混乱と混迷の中で、放射線影響研究や被ばく医療を専門とする医療人が、いかなる信念と行動規範に基づき、日本の禍機とも言える困難の中で東奔西走し、危機的状況を乗り越えたのかその活動精神の一端を紹介します。
本依頼原稿の本文は、日本語ではなく英語で紹介しますが、理由は同じテーマですでに本年 6 月の原子
爆弾後障害研究会で先に書かせていただき、重複を避けると同時に、放射線看護領域でもグローバル化
対応に少なからずお役に立てるからだと思うからです。ご理解頂ければ幸甚です。
It has now been 73 years since the disaster of atomic bombings in Hiroshima and Nagasaki, and the situation
surrounding the current modern risk society has changed dramatically: we are facing the decay and also difﬁcult
succession of the valuable experience and lessons learned from the atomic bomb survivors because of their aging
and the decrease of the alive victims.
Radiationʼs effects on the human body have always reminded us of the negative impact of the atomic bombings in
Hiroshima and Nagasaki and the competition in nuclear weapon development. What we should do now is to keep
thinking about and practicing self-discipline to rebuild and maintain trust among people in various situations, evenafter the nuclear disasters.
Now, I would like to focus on the sprit and ideas of Dr. Takashi Nagai, which represent fully decent humanity
rooted in Catholic beliefs, in commemoration of his 110th anniversary of his birth. As we approach the milestoneof the doctorʼs 110th anniversary, we have inherited the feelings of our predecessors who were deprived their lives
doi: 10.24680/rnsj.7.1_26

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by the atomic bombing. We will remember their will, recommit to our mission and role of undauntedly advancing
studies on the after effects of radiation exposure, and explore proper reactions to be taken in the event of nuclear
power plant accidents based on the lessons left by Dr. Nagai. Your understanding would be highly appreciated if
you challenge to read this English version, preparing for globalization.

Dr. Nagaiʼs philosophy of life
The stark reality is that every person dies. Whether· As we land on the shore, the morning mist ﬂows,
immediately before enemyʼs shooting begins.

we believe in a life after death or not, each one of us has· Around a cactus basket on the corner, I gasp in

his or her own view of life in the present. Even a person

surprise, running into an enemy face to face.

who has no religion has to have something to believe· I jumped over the basked to catch the wrist of thein and take into consideration, in order to live. Nursing

enemy soldier; it was warm and sweaty.

as well as Medicine is that work which helps people to· The enemy who ran away left behind a pot of millet. I

recover from illnesses; it demands not only diagnoses

wash and then prepare supper with it.

and evidence-based approach but also care and cures

Surprisingly, Dr. Nagai volunteered to provide

from both mental and physical aspects. The ﬁeld needs

medical care to local residents while being transferred

medical personnel, researchers and, nurses and healthamong inland villages across China. His venerable andprofessionals who have an unwavering view of life andfair behavior as a doctor who served everyone under

an inseparable relationship with society.

the extreme circumstances of the war, regardless ofFirst, let us consider the beliefs of Dr. Nagai, who

nationality, race, social status, or whether friend or foe,

saw the atomic bombing as the providence of Heaven

is, indeed, touching.

and who was greatly inﬂuenced by his experience of· While I am diagnosing this man, forget about his

being poised between life and death as a military surgeon

nationality

during the Second Sino-Japanese War and his encounter· At a stone house hides a person who fails to escape, inwith his future wife, Midori, a Catholic since her birth,

the subdued voice telling his suffering of asthma.

in Urakami, Nagasaki. Born originally into a Shintoist

Of course, it is never easy to equate the historicalfamily in Izumo, in the Shimane Prefecture, he wasperson who lived in a different environment and with araised with the idea to“Revere Heaven, Love People”

different social background with people in the present.

and was greatly inﬂuenced by his father, who helped

One universal view of the environment and health,

him to gain perspective on the existence of souls whenhowever, holds that there are ever-present and life-

faced with his motherʼs death. Among the four elements

threatening risks around us, such as negative healthof human life, which are birth, illness, aging, and death,effects and anxiety brought by radiation exposure. We

the greatest risk in the present world is obviously the risk

are always surrounded by invisible health and life risks.

to life, or, in other words, death. This fact applies evenThis implies many commonalities between his time andto the developed society of the 21st century, despite ourour own.

remarkable advances in life science and technology.

It is presumed, concerning his illness, that Dr. Nagai

Dr. Nagai gained and demonstrated this idea of humanoperated an X-ray irradiation system without X-ray ﬁlms

love as he was transferred from place to place in China

when the war was close to end and everything was induring the 1937 Shanghai Incident (the Sino-Japanesea state of shortage. Under those circumstances, he had

War). He wrote poems and made picture postcards at

no option but to perform a diagnostic on chest X-rays

the very moments when he was poised between life anddirectly using ﬂuoroscopy. This repeated exposure fordeath. Here are some of his compositions (“Tanka”),

himself to the radiation from these chest x-rays caused

introduced by the late Dr. Kinichiro Hamazato, a

him to eventually develop chronic myeloid leukemia.

radiologist, which depict lively scenes when he came

After experiencing this, coupled with his close exposure

across the enemy in China.

to the radiation from the atomic bombing, he had a
日本放射線看護学会誌 VOL.7 NO.1 201927

narrow escape from death and accepted his fate: no only
his past, but also what would happen to him in the future.
Even after becoming ill as the war ended, he seemed toenjoy a robust spiritual life at a very small home called“Nyoko-do” Hall at Urakami in Nagasaki. There, hecontinued writing from his sick bed, which is said to bea miracle. Speaking not only as a medical practitioner,
but also as a human being, I have deep respect for his
way of life; he literally encountered once-in-a-lifetime
circumstances that led to a daily self-awareness of death,and he demonstrated an excellent model for terminal
care in working with the natural courses of disease.
Moreover, he was a paragon for developing humansʼ

Figure 1.

capabilities, which remain applicable to today as we(courtesyof the Atomic Bomb Disease Institute Nagasaki
University)

pursue the best ways to maintain a sound mind anddemonstrates the value of passing it down for posterity.

resilient way of life in the midst of hardship.
The greatest crisis among the many challenges anddifﬁculties he met in his life was undoubtedly the atomic

The records it includes are full of ideas and observations
rooted in his profound knowledge.

bombing. Witnessing the immeasurable casualties in thearea utterly devastated by the bombs led him to front-line

The contents and outline are as follows.

relief activities immediately following the bombings. We
should learn from his steadfast dedication to providing aproper response to nuclear disasters.
by Dr.
Takashi Nagai

Chapter 1

Thoughts on atomic bombs

Section 1

The explosion of atoms

Section 2

Bombings

Section 3

Impact of the atomic bombs

Chapter 2

August 9, 1945, 11:02 A.M. The second atomic bomb,

Overview of radiation injuries
Latent period — tissue sensitivity —following the ﬁrst in Hiroshima, was dropped in thetissue damage—systemic disorders

Urakami area of Nagasaki City, which turned into a very

Chapter 3

The Japanese Armyʼs actions

hell of agony and despair. Valuable reports about Dr.

Section 1

The day of the explosions

Nagaiʼs relief support activities performed immediately

Section 2

Days 2 and 3

Section 3

The Mitsuyama relief squad1)

after the bombing have been archived. Among themis his Atomic Bomb Rescue and Relief Report, which

Chapter 4

is full of lessons learned from the atomic bombs, theSymptoms of patients after the atomic
bombingtheme of this article. It is an invaluable reference for

Section 1

Categorization of symptoms

medical personnel (Figure 1). The report, which should

Section 2

Details of symptoms

have been submitted to Kohei Koyano, the President of

Chapter 5

Nagasaki Medical College (now the School of Medicine

Statistics of patients after the atomic
bombing

at Nagasaki University) after its completion in October

Section 1

Overall statistics

1945, had been missing for 25 years and was discovered

Section 2

Injurieswith great repercussions. Aside from its mysterious

Section 3

Deathshistory, the report is incredibly logical, despite

Chapter 6

Medical therapies

having been compiled without reference materials or

Section 1

Milieu therapies

supporting literature, nor being polished or revised; thisSection 2

Spa therapies

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Section 3

Stimulation therapies via autologous bloodtransfusions

Section 4

doctorʼs eye.
Nagaiʼs report remains outstanding, despite theGeneral symptomatic therapies

passage of time, because it discusses the future ofPrediction of the future and its measuresradiation exposure influences near the epicenters of

Section 1

Residential issues near the epicenter

the bombings and how they relate to the human body

Section 2

Damage to the human body (delayed

while also aiming to observe and reﬂect on the atomic

diseases-late diseases)bombs themselves, based on his knowledge andAgricultural products

personal experience. His ultimate intention appears

Observationsin the comment, “Finally, I can serenely reﬂect on my

Section 1

Atomic bombs

behaviors and clarify the responsibility of Japanʼs defeat

Section 2

Personal injuries

in the war”.

Section 3

Treatments

In Chapter 9, he points out his responsibility for

Reﬂections

not taking measures to prevent the atomic bomb

Section 1

Advanced preparations

attack, despite his specialized expertise of radiation

Section 2

Post-bombing efforts

medicine, and his deep regret regarding his failures as

Conclusiona doctor aiming to provide guidance to his patients.

Chapter 7

Section 3
Chapter 8

Chapter 9

Chapter 10

He also blames himself for failing to measure residual
The medical treatment record presented in the former

radioactivity after the disaster, which resulted in a lackpart of this report simply describes how, after the warof evacuation measures that could have led bombing

ended following the Nagasaki bombing, Dr. Nagai

survivors to safer places. Considering that the situation

examined 125 people who had been exposed to close-

at the time made it extremely difﬁcult to rescue people

range radiation for a total of 1829 days. Among thiswho had been in close proximity to the epicentersʼ blasts

group there was a high death rate, 23%. By observing

and seriously burnt or injured what made Dr. Nagai, a

the patientsʼ clinical symptoms, he categorized their

man of outstanding knowledge and humanity, regret

injuries as prompt, early, delayed, or late, based on their

so deeply the response to residentsʼ evacuation when

expression periods, and described them as follows:

they were exposed to radiation: that they should haveexternal injuries, burns, combined injuries, early

been evacuated immediately from the devastated area?

digestive problems, early blood disorders, delayedThis can be explained as nothing apart from his far-blood disorders, and indirect disorders. By examining

sightedness, which allowed him to predict the occurrence

the available therapies, he also presented the effects ofof late-onset consequences of radiation injuries.

stimulation therapy via autologous blood transfusion andHowever, many victims died from the bombsʼ explosions

spa therapies, which were difﬁcult to evaluate clinicallyand the injuries they suffered right away. It was to be

now due to their short-term possibility for observation.

expected that there would be acute radiation injuries

His report unveils the efforts and regrets of his

caused by exposure to such a large amount of radiation.

predecessors who had strived to provide the best

His words may have come from his deep sadness andmedical care under such extreme circumstances andregret for the helpless people who died.

with limited capabilities, often which only allowed

In Chapter 10ʼs Conclusion, Dr. Nagai reveals histhem to perform simple blood tests, in addition to theirhonest feelings. He makes comments that are seemingly

physical examinations, to form the basis of medical

the only complaints in the entire work, warning thetreatment. Still, he noted, people in engaged in all relief

Japanese people about their disdain for and illiteracy

activities tried their best at the time. He commented thatwhen it comes science by referring to the atomic

he respected milieu therapy and advised patients to rest

bombing saying, “It caused an enormous terror, likeat home; this clearly demonstrates the quintessential

a bolt from the blue, in the brain of Japanese people

aspect of medicine: looking into a patientʼs mind using a

who are scientifically in sleep”. Furthermore, he
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shows his amazement in the results of the research anddevelopment capabilities of technology that the U.S.
demonstrated. This exceeded his hatred of the misery
inﬂicted by the atomic bombs, and he encouraged theJapanese people to work to understand pure science andto develop not only an interest in radiation and nuclear
physics, but also a yearning for the peaceful use of
atomic energy.
Response to the Fukushima nuclear power station
accident and the spirit of Dr. Nagai
Dr. Nagai presented a lecture on acute radiation
syndrome at the Plenary Session of the Acta Medica
Nagasakiensia in November 1946 in Nagasaki; he
had been invited to do so as one of the doctors who

Figure 2.

Dr. Takashi Nagai presenting a report on nuclear
diseases at the Plenary Session of the Acta
Medica Nagasakiensia, November 17, 1946
(courtesy of the estate of Dr. Kinichiro Hamasato)

had been subject to radiation exposure after thebombing (Figure 2). Although the official record of

spirit. Ms. Hisamatsu worked closely with Dr. Nagai

the presentation has been regrettably lost, because

until his death and even until her death dedicated her life

the journal for that year was unpublished, his speech

to carrying on in his spirit.

reportedly presented the situation of the damage at

Many of our predecessors who experienced the atomic

that time in detail. This information was passed downbombings in Hiroshima and Nagasaki became absolutely

via later studies and reports on radiation consequences

opposed to wars and had a strong desire to abolishand is represented by the Document of the Nagasaki

nuclear weapons. Still, preparation for and responses to

Atomic Bombing, by Dr. Kodo Yasuyama, which tookradiation accidents and nuclear disasters are always in

40 years to be published after its completion in 1951

demand. However, we should admit that Japan failed to2)learn sincerely from the Chernobyl accident, the worst(it was reprinted in 2007), and The Concentric Circle
3)

of Death, by Dr. Tatsuichiro Akizuki. It was not only

nuclear accident in history, which happened in the Soviet

these researchers, but also Prof. Raisuke Shirabe, aUnion on April 26, 1986. Many people in Japan believed

doctor who specialized in Nagasaki atomic bomb-related

that a similar accident would never happen there, anddiseases, and other people concerned who undertook thethey even underestimated the real need for radiation

painstaking efforts and showed undaunted perseverance

emergency medicine. In this context, nuclear energy

to restore and reconstruct the demolished Nagasaki

came into greater use, and the number of industrial

Medical University at the very site of the atomic

nuclear power stations across the country reached 54

4)bombing. I would like to call the feeling and spirit ofbefore the Great East Japan Earthquake of 2011. The

our forerunners, as described above, the “Nagai spirit”.

Fukushima accident revealed that the government,

There are more works to which we should also turn our

including Japanʼs Nuclear Safety Commission, had not

5)eyes: Nursing Solemnly, by Shisono Hisamatsu, whofully prepared the tertiary radiation emergency medicine

worked as a young head nurse in the then-Department

system. Although the atomic bombings and the powerof Physiotherapy (present-day Radiology) and who later

station accident cannot be compared at the same level,

led the Nyoko-no-kai Association along with the latethe situation was marked by short-sighted preconceptions

Kinichiro Hamasato as President, and Myosotis: Forget-and prejudices that associated nuclear accidents with6)

me-not, a book compiled by many concerned people ofatomic bombings, leukemia, cancer, and death. As terror

the university and bereaved families. The two books are

and anxiety spread throughout the entire country, thealso precious materials that help us to carry on the Nagai

medical staff involved in the crisis interventions to save

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日本放射線看護学会誌 VOL.7 NO.1 2019

the situation presumably exhibited the Nagai spirit, with

understanding of radiation risks and in reference toor without being aware of it.

international standards of radiation protection during an

An effective response to nuclear disasters requires

emergency. In the meantime, however, a general viewshared ideas about disaster cycles, and these differ overof the risks related to low dose/low dose-rate radiationtime: before and in the midst of an accident, and duringexposure that is meaningful in terms of matters public

restoration and reconstruction efforts. At the time of

exposure cannot be shared easily, according to mya nuclear power station accident, the disaster-cycle

experiences in Chernobyl and Fukushima. To solve theapproach needs to be taken: in addition to preliminary

problem, we must continue forward with disciplined

preparations and training based on the major premiseand logical thinking and a ﬁrm belief in our own humanthat there is no absolute safety, education on radiation

capabilities.

risk is required in ordinary times to raise peopleʼs

In Japan, the issue of radiation exposure has spannedfamiliarity with the idea of radiation protection. During

the decades, from Hiroshima and Nagashima toan emergency response corresponding to a nuclear power

Fukushima and into the present. Despite the signiﬁcantstation accident, which is an industrial crisis, measuresdifference in reality between these incidents, to succeed

should be taken to protect area residents, including

and develop our experience and technology related tostrengthening the governance over crisis management,

radiation emergency medicine, all of which was obtained

directing safety-first and indoor evacuations, andas a result of these incidents, and to promote prepared

mitigating and preventing the publicʼs exposure to

responses to advanced radiation emergency medicine

radiation. Amid the avoidable confusion and chaosand public exposure medicine, we must acknowledge

following an accident, advanced emergency medical

our responsibility, mission, and commitment to thecare for radiation emergencies should be prioritized inmovement now being established in Japan.

accordance with the principle of Disaster Medicine,nevertheless by natural of man-made, intended to

Discussion and summary

protect peopleʼs lives. In such a situation, radiation

The purpose of the mini-review on countermeasures

exposure management for the public at the time of theagainst nuclear disasters has been to describe the atomic

emergency should be passed down as a reference levelbombing disaster and to refer to the lessons learned fromfor restoration and reconstruction efforts, considering

it during the commemoration of the 110th anniversary ofdeeply its beneﬁt and risk of action plan. International

Dr. Nagaiʼs birth. We can best do this by reminding thoseinstitutions also recommend applying different ideas andmedical personnel and researchers, and nurses and healthreference levels from those of ordinary times to times ofprofessionals who respond to todayʼs nuclear disasters

emergency.

to refer to his book “Atomic Bomb Rescue and Relief

Similarly, the responses to people exposed to high-Report”. He wrote many other works, too, including

dose radiation were limited following the Chernobyl

The Bells of Nagasaki, which have been published as

accident, which led to many causalities. During the

a complete collection.7) In choosing to focus on the

Tokaimura criticality accident, as was the case withorigin of his activities, that is his exposure to radiation

the atomic bombing, Dr. Nagai pinpoints in his bookfollowing the atomic bombing, I am delivering to you

the helpless response to acute radiation injuries due toobservations focused on this book, written immediately

exposure to a large amount of radiation. Once a nuclear

following the atomic bomb disaster. The extreme form

accident happens in the modern risk society, ensuringof response to life-threatening crises, whether they

the safety of medical personnel, the Self Defense Forces,

are accidents or unexpected natural or man-made andthe Fire and Disaster Management Agency, the police,

technological disasters has been witnessed in war andand other concerned people becomes is an urgent issue,

conﬂict, and the catastrophe caused by the atomic bombs

and individuals are required to make judgments anddropped in Hiroshima and Nagasaki. The differences

decisions on their own based on their knowledge andbetween the atomic bombing during World War II and日本放射線看護学会誌 VOL.7 NO.1 201931

the nuclear disaster in modern Japan during a time of

Finally, the basic spirit and concept of participating

peace should be logically understood beyond emotions

in nuclear disaster medicine that we have inherited fromsuch as terror and anxiety over radioactivity andHiroshima and Nagasaki has had a negative connotation

radiation. Keeping in mind the lessons learned from thein the past, as it is rooted in the history of the atomic

Chernobyl accident in the former Soviet Union, which

bombings themselves. This means that what is done isoccurred during the Cold War, we can learn the logicaldone and all we can do is learning from our failures anddifferences and similarities with the Fukushima accident.

the past, as doing so will lead to improved development

We should consider the possible responses to nuclear

and better security in ordinary times. These, in turn,disasters based on the history of those societies affected

will allow us to respond well to different phases ofby them; then we can see that the results of broad-the disaster cycle and to secure the budget we need toranging research in basic, clinical, and epidemiologicalprovide this support. In front of the “Nyoko-do” Hallﬁelds. These have been successfully applied to and will

stands a monument inscribed with a quote from Dr.

contribute greatly to the responses offered to atomic

Nagai, “As long as my life goes on, I follow the path ofbomb survivors, from acute radiation injuries due toexploring the truth.” The establishment of an academic

exposure at the time of the bombing to the so-called after

framework for uncovering the truth is closely related

effects of exposure, including late-onset cancer risks andto disaster prevention and mitigation measures for

non-cancer risks.

those phenomena that cause radiation exposure. ThisIn modern risk society, when a nuclear disaster occurs,

will, undoubtedly, lead to a wide-ranging educational

the general public is subject to futile and unnecessary

revolution and renewed awareness among concerned

exposure, and there are wounded and sick people who

people about comprehensive risk management.

require advanced medical care to deal with the radiation
emergency. The role of nurses and health professionals
is critically important when they encounter a nuclear
disaster. The attitude medical personnel take during
such an emergency has a great influence on theirproper and prolonged response, and when considering
later restoration and reconstruction efforts. In Japan,
the current situation requires the restoration andstrengthening of human capabilities to recover peopleʼssense of security, in addition to tackling the issues ofradiation risk management. This demands a shift fromgroup risk assessment to individual risk management,
and to the personal independence and dignity ofrecovering disaster survivors. During a mega industrial
crisis, the organized response from the government andconcerned institutions, so-called “Right Governance”,
is the top priority. We should be reminded that eachof these organizations has enormous capabilities andthat, beyond regular drills and preparation, individual
workersʼ sense of resolution and decision-making skills
have a great inﬂuence not only immediately after thecrisis but also for a long period following it.

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