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August 7, 1987, Vol 258, No. 5 >
ARTICLE | August 7, 1987

Acute Radiation Syndrome FREE

Stuart C. Finch, MD
[+] Author Affiliations

Reprint requests to the Radiation Effects Research Foundation, 5-2 Hijiyama Park, Minami-ku, 732 Hiroshima, Japan (Dr Finch).

A commentary on Paul D, Keller: A clinical syndrome following exposure to atomic bomb explosions. JAMA 1946;131:504-506.


JAMA. 1987;258(5):664-667. doi:10.1001/jama.1987.03400050106037
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References

THE ATOMIC bomb detonations of Hiroshima and Nagasaki in 1945 abruptly awakened the world to the realities of the nuclear age. Radiologists, radiation physicists, and some physicians were aware of the sickness that frequently accompanied the use of x-ray therapy, but few knew the constellation of devastating events that may occur after whole-body exposure to excessive amounts of ionizing radiation. Although the majority of acute deaths in Hiroshima and Nagasaki were due to burns and other forms of physical trauma, at least a third of the victims probably died of radiation sickness, with many more developing varying degrees of acute systemic illness secondary to radiation exposure. The Japanese quickly recognized the peculiar effects that resulted from atomic bomb exposure, but not until observations were reported in the medical literature by several astute American military physicians did the acute radiation syndrome become known throughout the scientific world.

The LANDMARK ARTICLE by

REFERENCES

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Gauss CJ, Lembeke H:  Röntgentiefentherapie . Strahlentherapie Sonderb 1912;;1:1-332.
2 +
Béclère A:  The penetrating-irritation sickness . AJR 1918;;5:498-506.
3 +
Den Hoed D, Levie B, Straub M:  Serious injury of the blood in consequence of teleroentgen-therapy of the whole body . Acta Radiol 1938;;19:151-163.
4 +
Liebow AA, Warren S, De Coursey E:  Pathology of atomic bomb casualties . Am J Pathol 1947;;25:853-1028.
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Oughterson AW, Warren S: Medical Effects of Atomic Bomb in Japan . New York, McGraw-Hill International Book Co, 1956;.
6 +
Liebow AA:  Encounter with disaster: A medical diary of Hiroshima . Yale J Biol Med 1965;;38:61-239.
7 +
Hachiya M: Hiroshima Diary: The Journal of a Japanese Physician— August 6-September 30, 1945 , Wells W (trans and ed). Chapel Hill, NC, The University of North Carolina Press, 1955;.
8 +
Cronkite EP:  Ionizing radiation injury: Its diagnosis by physical examination and clinical laboratory procedures . JAMA 1949;;139:336-369.
9 +
Hempelmann LH:  Acute radiation injuries in man . Surg Gynecol Obstet 1951;;93:385-403.
10 +
Cronkite EP:  Hematology, diagnosis, and therapy of radiation injury . US Armed Forces Med J 1951;;2:1019-1026.
11 +
Cronkite EP:  The diagnosis, prognosis, and treatment of radiation injuries produced by atomic bombs . Radiology 1951;;56:661-669.
12 +
Hempelmann LH, Lisco H, Hoffman JG:  The acute radiation syndrome: A study of nine cases and review of the problem . Ann Intern Med 1952;;36: 279-510.
13 +
Ellinger F: Medical Radiation Biology , Springfield, Ill, Charles C Thomas Publishers, 1957;.
14 +
Brucer M: The Acute Radiation Syndrome: A Medical Report on the Y-12 Accident June 16, 1958 , report ORINS-25. US Atomic Energy Commission, 1959;.
15 +
Thoma GE Jr, Wald N:  The diagnosis and management of accidental radiation injury . J Occup Med 1959;;1:421-447.
16 +
Ingram M, Howland JW, Hansen CH Jr:  Sequential manifestations of acute radiation injury vs 'acute radiation syndrome' stereotype . Ann NY Acad Sci 1964;;114:356-367.
17 +
Karus JS, Stanbury JB:  Fatal radiation syndrome from accidental nuclear excursion . N Engl J Med 1965;;272:755-761.
18 +
Saenger EL: Medical Aspects of Radiation Accidents: A Handbook for Physicians, Health Physicists and Industrial Hygienists . US Atomic Energy Commission, 1963;.
19 +
Andrews GA:  Radiation accidents and their management . Radiat Res 1967;;7( (suppl) ):390-397.
20 +
Andrews GA:  Medical management of accidental total-body irradiation , in Hübner KF, Fry SA (ed): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier Science Publishing Co Inc, 1980;, pp 297-310.
21 +
Saenger EL:  Radiation accidents . Ann Emerg Med 1986;;15:1061-1066.
22 +
Rubin P, Casarett GW: Radiation Syndromes in Clinical Radiation Pathology . Philadelphia, WB Saunders Co, vol 2, 1968;.
23 +
Fajardo LF: Pathology of Radiation Injury . New York, Masson Publishers USA Inc, 1982;.
24 +
 USSR State Committee on the Utilization of Atomic Energy : The Accident at the Chernobyl Nuclear Power Plant and Its Consequences , working document for the Post-accident Review Meeting compiled for the IAEA Experts' Meeting, (Aug 25) -29, 1986, Vienna, 1986;.
25 +
Bond VP, Cronkite EP: Workshop on Short-term Health Effects of Reactor Accidents: Chernobyl , report BNL 52030. US Dept of Energy, 1986;.
26 +
Geiger HJ:  The accident at Chernobyl and the medical response . JAMA 1986;;256:609-612.
27 +
Fanger H, Lushbaugh CC:  Radiation death from cardiovascular shock following a criticality accident: Report of a second death from a newly defined human radiation death syndrome . Arch Pathol Lab Med 1967;;83:446-460.
28 +
Chaudhuri JP, Messerschmidt O:  Amount of peripheral reticulocytes as biologic dosimetry of ionizing radiation: Experiments in the rabbit . Acta Radiol Oncol 1982;, 21:177-179.
29 +
Bender MA:  X-ray-induced chromosome aberrations in normal diploid human tissue cultures . Science 1957;;126:974-975.
30 +
Scott D, Lyons CY:  Homogeneous sensitivity of human peripheral lymphocytes to radiation-induced chromosome damage . Nature 1979;;278:756-758.
31 +
Littlefield LG, Joiner EE, Du Frain RJ, et al:  Cytogenetic dose estimates from in vivo samples from persons involved in real or suspected radiation exposures , in Hübner KF, Fry SA (ed): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier Science Publishing Co Inc, 1980;, pp 375-391.
32 +
Kakati S, Kowalczyk JR, Gibas Z, et al:  Use of radiation-induced chromosomal damage in human lymphocytes as a biological dosimeter is questionable . Cancer Genet Cytogenet 1986;;22:137-141.
33 +
Kohn J:  Measurement of amylase activity—A useful indication of tissue damage after major radiation accidents? Br Med J 1986;;292:1523-1524.
34 +
Sagstuen E, Theisen H, Henriksen T:  Dosimetry by ESR spectroscopy following a radiation accident . Health Phys 1983;;45:961-968.
35 +
Mole RH:  Sodium in man and the assessment of radiation dose after criticality accidents . Phys Med Biol 1984;;29:1307-1327.
36 +
Hakoda M, Akiyama M, Tatsugawa K, et al:  Mutant 6-TG resistant T-lymphocytes in the peripheral blood of A-bomb survivors: I. Measurement of their frequency . J Radiat Res 1986;;27:89.
37 +
Langlois RG, Bigbee WL, Kyoizumi S, et al:  Evidence for increased somatic cell mutations at the glycophorin A locus in atomic bomb survivors . Science 1987;;236:445-448.

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1 +
Gauss CJ, Lembeke H:  Röntgentiefentherapie . Strahlentherapie Sonderb 1912;;1:1-332.
2 +
Béclère A:  The penetrating-irritation sickness . AJR 1918;;5:498-506.
3 +
Den Hoed D, Levie B, Straub M:  Serious injury of the blood in consequence of teleroentgen-therapy of the whole body . Acta Radiol 1938;;19:151-163.
4 +
Liebow AA, Warren S, De Coursey E:  Pathology of atomic bomb casualties . Am J Pathol 1947;;25:853-1028.
5 +
Oughterson AW, Warren S: Medical Effects of Atomic Bomb in Japan . New York, McGraw-Hill International Book Co, 1956;.
6 +
Liebow AA:  Encounter with disaster: A medical diary of Hiroshima . Yale J Biol Med 1965;;38:61-239.
7 +
Hachiya M: Hiroshima Diary: The Journal of a Japanese Physician— August 6-September 30, 1945 , Wells W (trans and ed). Chapel Hill, NC, The University of North Carolina Press, 1955;.
8 +
Cronkite EP:  Ionizing radiation injury: Its diagnosis by physical examination and clinical laboratory procedures . JAMA 1949;;139:336-369.
9 +
Hempelmann LH:  Acute radiation injuries in man . Surg Gynecol Obstet 1951;;93:385-403.
10 +
Cronkite EP:  Hematology, diagnosis, and therapy of radiation injury . US Armed Forces Med J 1951;;2:1019-1026.
11 +
Cronkite EP:  The diagnosis, prognosis, and treatment of radiation injuries produced by atomic bombs . Radiology 1951;;56:661-669.
12 +
Hempelmann LH, Lisco H, Hoffman JG:  The acute radiation syndrome: A study of nine cases and review of the problem . Ann Intern Med 1952;;36: 279-510.
13 +
Ellinger F: Medical Radiation Biology , Springfield, Ill, Charles C Thomas Publishers, 1957;.
14 +
Brucer M: The Acute Radiation Syndrome: A Medical Report on the Y-12 Accident June 16, 1958 , report ORINS-25. US Atomic Energy Commission, 1959;.
15 +
Thoma GE Jr, Wald N:  The diagnosis and management of accidental radiation injury . J Occup Med 1959;;1:421-447.
16 +
Ingram M, Howland JW, Hansen CH Jr:  Sequential manifestations of acute radiation injury vs 'acute radiation syndrome' stereotype . Ann NY Acad Sci 1964;;114:356-367.
17 +
Karus JS, Stanbury JB:  Fatal radiation syndrome from accidental nuclear excursion . N Engl J Med 1965;;272:755-761.
18 +
Saenger EL: Medical Aspects of Radiation Accidents: A Handbook for Physicians, Health Physicists and Industrial Hygienists . US Atomic Energy Commission, 1963;.
19 +
Andrews GA:  Radiation accidents and their management . Radiat Res 1967;;7( (suppl) ):390-397.
20 +
Andrews GA:  Medical management of accidental total-body irradiation , in Hübner KF, Fry SA (ed): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier Science Publishing Co Inc, 1980;, pp 297-310.
21 +
Saenger EL:  Radiation accidents . Ann Emerg Med 1986;;15:1061-1066.
22 +
Rubin P, Casarett GW: Radiation Syndromes in Clinical Radiation Pathology . Philadelphia, WB Saunders Co, vol 2, 1968;.
23 +
Fajardo LF: Pathology of Radiation Injury . New York, Masson Publishers USA Inc, 1982;.
24 +
 USSR State Committee on the Utilization of Atomic Energy : The Accident at the Chernobyl Nuclear Power Plant and Its Consequences , working document for the Post-accident Review Meeting compiled for the IAEA Experts' Meeting, (Aug 25) -29, 1986, Vienna, 1986;.
25 +
Bond VP, Cronkite EP: Workshop on Short-term Health Effects of Reactor Accidents: Chernobyl , report BNL 52030. US Dept of Energy, 1986;.
26 +
Geiger HJ:  The accident at Chernobyl and the medical response . JAMA 1986;;256:609-612.
27 +
Fanger H, Lushbaugh CC:  Radiation death from cardiovascular shock following a criticality accident: Report of a second death from a newly defined human radiation death syndrome . Arch Pathol Lab Med 1967;;83:446-460.
28 +
Chaudhuri JP, Messerschmidt O:  Amount of peripheral reticulocytes as biologic dosimetry of ionizing radiation: Experiments in the rabbit . Acta Radiol Oncol 1982;, 21:177-179.
29 +
Bender MA:  X-ray-induced chromosome aberrations in normal diploid human tissue cultures . Science 1957;;126:974-975.
30 +
Scott D, Lyons CY:  Homogeneous sensitivity of human peripheral lymphocytes to radiation-induced chromosome damage . Nature 1979;;278:756-758.
31 +
Littlefield LG, Joiner EE, Du Frain RJ, et al:  Cytogenetic dose estimates from in vivo samples from persons involved in real or suspected radiation exposures , in Hübner KF, Fry SA (ed): The Medical Basis for Radiation Accident Preparedness . New York, Elsevier Science Publishing Co Inc, 1980;, pp 375-391.
32 +
Kakati S, Kowalczyk JR, Gibas Z, et al:  Use of radiation-induced chromosomal damage in human lymphocytes as a biological dosimeter is questionable . Cancer Genet Cytogenet 1986;;22:137-141.
33 +
Kohn J:  Measurement of amylase activity—A useful indication of tissue damage after major radiation accidents? Br Med J 1986;;292:1523-1524.
34 +
Sagstuen E, Theisen H, Henriksen T:  Dosimetry by ESR spectroscopy following a radiation accident . Health Phys 1983;;45:961-968.
35 +
Mole RH:  Sodium in man and the assessment of radiation dose after criticality accidents . Phys Med Biol 1984;;29:1307-1327.
36 +
Hakoda M, Akiyama M, Tatsugawa K, et al:  Mutant 6-TG resistant T-lymphocytes in the peripheral blood of A-bomb survivors: I. Measurement of their frequency . J Radiat Res 1986;;27:89.
37 +
Langlois RG, Bigbee WL, Kyoizumi S, et al:  Evidence for increased somatic cell mutations at the glycophorin A locus in atomic bomb survivors . Science 1987;;236:445-448.

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