Skin burns in survivors

Before we dig into the evidence, a few words about terminology are in order. Skin burns can be classified according to the cause and, independently, according to severity.

If one surveys multiple eyewitness reports, a dichotomy emerges between burns that became manifest immediately after the bombing and those that developed more slowly. We will here quote one illustrative example for each. Sumiteru Taniguchi of Nagasaki [156, p. 113] suffered burns immediately:

The wind from the blast, coming from behind, hurled me and my bicycle to the ground … I think two or three minutes passed before the earth stopped trembling and I heaved myself up. … The skin of my left arm had peeled from the upper arm to the tips of my fingers and was hanging in strips. When I felt my back and buttocks, I found that the skin there had been burned to a pulp and that only the front part of the clothes I had been wearing remained.

The burns to Taniguchi’s backside were indeed extensive (see Figure 9.4 B), and he had to lie with his face down for more than a year until the wounds finally began to heal, ultimately with severe scarring and keloid formation.

Figure 9.4: Two cases of ‘nuclear flash burn’ from Nagasaki. Photographs from [146], taken in October. A: This man was wearing a khaki uniform when exposed in the open at 0.5 miles from the hypocenter. (He should have died of radiation sickness within days.). The pattern of hypo- and hyperpigmentation on his back suggests second degree burns, perhaps due to mustard gas, while the thick scar tissue on his right elbow suggests a more severe burn, possibly by napalm. B: Extensive burns in a man 1.2 miles from the hypocenter. The details given in [146] suggest that this man is Sumiteru Taniguchi (see text).

An instance of delayed skin injury in a bombing victim is described by the physician Michihiko Hachiya [62]. In his diary, he notes between August 6^th and August 8^th:

• (6^th) I opened my eyes; Dr. Sasada was feeling my pulse. What had happened? … I must have fainted.
• (7^th) Dr. Sasada, who had looked after me yesterday, lay on my left. I had thought he escaped injury, but now I could see that he was badly burned. His arms and hands were bandaged and his childish face obscured by swelling … 
• (8^th) Dr. Sasada’s face was more swollen this morning than yesterday, and blood-stained pus oozed from his bandaged arms and hands. I felt a wave of pity when I thought how he had used those hands to help me two days ago.

Further on in his diary, Hachiya reports how Dr. Sasada later develops symptoms of bone marrow suppression, but ultimately recovers. From Hachiya’s description, it is apparent that Sasada’s hands were injured not in the bombing itself; he could not have felt Hachiya’s (presumably faint and rapid) pulse with wounded, bandaged hands. His burns sprung up only after he had tended to many victims who, like Hachiya himself, had been more severely injured outright.118

Mr. Taniguchi’s immediately manifest burns and tattered clothes strongly suggest that he was hit directly with some sort of incendiary, most likely napalm. In contrast, the most straightforward explanation for Dr. Sasada’s delayed burns is that, by touching the skin and clothes of his patients who had been contaminated with sulfur mustard, he was himself exposed to toxic quantities of it. His swollen face and subsequent symptoms of bone marrow suppression are likewise suggestive of mustard gas exposure.

The limited available data do not permit us to estimate the relative abundance of each type of burn; we will therefore merely discuss qualitatively the evidence which leads us to attribute them to napalm and to mustard gas, respectively.

According to his description of his own travails on August 6^th, Hachiya himself, like Mr. Taniguchi, was most likely burned by napalm, possibly with some additional mustard lesions as well. As he struggles towards the hospital, bereft of his clothes, he observes:

Figure 9.5: Victims of the napalm attack at Trang Bang, South Vietnam, on June 8^th 1972. A: Minutes after the bombing, a girl in the nude (Kim Phuc) is running toward a group of photographers. B: She has severe burns, whose full extent is apparent only from behind. C: Kim’s grandmother is carrying her grandchild Danh, Kim’s cousin, who is extensively burned and will die within the hour. Scorched skin is peeling from his foot and backside.

Others moved as though in pain, like scarecrows, their arms held out from their bodies with forearms and hands dangling. These people puzzled me until I suddenly realized that they had been burned and were holding their arms out to prevent the painful friction of raw surfaces rubbing together. A naked woman carrying a naked baby came into view. I averted my gaze. Perhaps they had been in the bath. But then I saw a naked man, and it occurred to me that, like myself, some strange thing had deprived them of their clothes.

Have we seen something like this anywhere else? Considering the widespread use of napalm—large amounts were dropped on Japan, and even larger ones on Korea and Vietnam—generally accessible information on napalm is extremely scarce (see Section 7.4). However, there is one very widely known picture of a napalm victim: Kim Phuc, a Vietnamese girl who in 1972 suffered burns when her village in South Vietnam was attacked by the country’s own air force (the village had been infiltrated by the Vietcong). This picture (Figure 9.5 A) shows her running in the nude, in the ‘scarecrow’ posture also described by Hachiya. The real extent of her burns is only visible from another angle (Figure 9.5 B), which also reveals the immediate peeling of the skin. Peeling and flapping skin are likewise apparent in Kim’s even more severely burned cousin Danh (Figure 9.5 C). While the little boy died within an hour of the attack, Kim survived. Even with expert surgical treatment, however, her burn wounds turned into extensive scars that resemble the keloids shown in Figure 9.3.

The pronounced tendency of ‘nuclear flash burns’ to heal with keloid formation has often been noted; Harada [174] cites figures of > 70% for burns and > 20% for injuries from a reference in Japanese. The same is true of napalm burns. According to the Russian physician Plaksin [142], keloid formation was observed in 52.7% of all patients in a series of 1026 Korean napalm burn patients. The author ascribes this to the high amount of heat transferred from the burning napalm to the adjacent tissues.

Figure 9.6: Splash burn to the face and neck caused by napalm and gasoline. This picture appears as Figure 7 in Block and Tsuzuki [169].

While pictures of victims with ‘nuclear flash burns’ abound, those of napalm burns from conventionally firebombed Japanese cities such as Tokyo are surprisingly hard to find, even though survivors with napalm burns should have been common enough. I have only found one such picture, which is shown here as Figure 9.6. According to the source [169],119 the victim was burned in an incendiary bombing raid on Tokyo when burning napalm hit a nearby fuel barrel, causing it to explode. The effect of burning gasoline on the skin would have been similar to that of burning napalm itself. The authors state explicitly that his lesions were ‘entirely comparable’ to those in atomic bomb survivors, and also that they saw more than twenty similarly afflicted bombing victims from Tokyo. In all likelihood, at least some of those patients had been struck by napalm directly rather than by burning gasoline.

In summary, the evidence strongly suggests that those of the burns in Hiroshima and Nagasaki that were manifest immediately, accompanied by burning and stripping of clothes, and followed by keloid formation, were caused by napalm. While rare, explicit accounts of exposure to napalm or a similar substance can indeed be found. John Toland [76, p. 803] relates this experience of a boy in Nagasaki:

Hajime Iwanaga, who would be fourteen the next day, was bathing in the Urakami River near the torpedo factory. He … exuberantly ducked his face in the water as the pika120 flashed. Seconds later he emerged into a blinding world. Something warm clung to his left shoulder. It was yellowish. Mystified, he touched it and saw skin come off. He splashed toward the bank as the sky darkened ominously, and was reaching for his clothes when two dark-green spheres, the size of baseballs, streaked at him. One struck his shirt, set it afire, and disintegrated.

Those green spheres carried fire, but did apparently not cause any harm through kinetic impact, which means that they consisted of some soft, incendiary material, much like napalm. The material on the shoulder may have been a chunk of napalm, too, that was extinguished when the boy dived underwater. For comparison, here is Kim Phuc’s recollection:

Her first memory of the engulfing fires was the sight of flames licking her left arm, where there was an ugly, brownish-black gob. She tried to brush it off, only to scream out at the pain of the burn that had now spread to the inside of her other hand.

In both cases, the size and texture of the lumps of incendiary material described are consistent with those of napalm [141].

In Section 1.4, we noted the similarity of skin lesions described by John Hersey in victims of the Hiroshima bombing to those observed by Alexander [22] in the mustard gas casualties at Bari. Eyewitness testimony from Hiroshima and Nagasaki further suggests that chemical burns to the skin by mustard gas were common. Kiyoko Sato, a girl from Hiroshima, had been evacuated to the countryside and returned to the city about a week after the bombing. Upon arrival, she finds her mother just a few moments after she has died [156, p. 55]:

If I had only walked a little faster, I would have been in time! I was distressed that I had not been able to see her alive and cried loudly. My mother’s face was covered in blisters and had swollen to twice its normal size, and her hair had fallen out. She was unrecognizable as the mother I had known so well.

A boy from Nagasaki, Yoshiro Yamawaki, walked across the city in search of his father on the day after the bombing, together with his twin brother [175]:

There were many dead bodies amongst the debris littering the roads. The faces, arms and legs of the dead had become swollen and discolored, causing them to look like black rubber dolls. As we stepped on the bodies with our shoes, the skin would come peeling off like that of an over-ripe peach, exposing the white fat underneath.

Neither witness mentions any scorching of the dead bodies in question, and both descriptions match the known appearance of mustard gas burns.121 We already noted above instances of burns becoming manifest only on the next day or occurring under clothing that remained intact; neither incendiaries nor flash burn can account for these observations. Having already considered the evidence that points to mustard gas as the cause of ‘radiation disease’, we now see that the expected skin lesions were prevalent also.

The light intensities assumed to have been released by the bombings in Hiroshima and Nagasaki are shown in Figure 9.1 A. The surface temperature of the ‘ball of light’ at its most luminous stage should be in the range of 5000-7000 °K [90], which is similar to that of the sun. Therefore, the supposed atomic flash can be likened to a brief, intense pulse of sunlight, with similar proportions of ultraviolet, visible, and infrared light.

A number of experimental studies on animals and on human volunteers have attempted to model the flash burns produced by nuclear bombs. In a study on dogs [176], a thermal dose of cal/cm² 8 was applied to 20% of the body surface. Figure 9.1 A shows that this intensity is well within the range of intensities expected near the hypocenter. Mortality was relatively low (2 dogs out of 30) and due to septicemia. The wounds appeared different from those caused by contact burns:

Following a flash burn of the magnitude given in this study, an eschar is formed on the burned surface. … This initial eschar persists throughout … Healing of the flash wound was usually complete by four weeks with the eschar acting as a protective dressing for epithelization from deep hair follicles and wound edges.

These results suggest that peeling of the skin might not occur in nuclear flash burns. However, blistering lesions were observed in an experimental study on human volunteers [177]. At sufficiently high doses, a superficial skin layer came off one or two days after the irradiation and left behind a red, moist wound, which does resemble the observations of peeling skin in the bombing victims. This study reports several more pertinent observations that we can compare with those made in those victims:

• A dose of cal/cm² 2 produced only a transient erythema, which typically subsided within half an hour. This represents a first degree burn.
• With doses of cal/cm² 3.9 and above, erythema of the lesion itself was immediate, and it persisted until it gave way to blisters, whereas the vicinity of the lesion showed delayed and transient erythema. Thus, any lesions of at least second degree are visible in some form immediately and throughout.
• The maximal dose given—cal/cm² 4.8—produced at least second degree burns in all volunteers, and third degree burns in some.
• While for obvious reasons the experimental flash burns were small (1.25 cm in diameter), it nevertheless was evident that the entire light-exposed area was evenly burned.
• The volunteers reported immediate pain, which was described as sharp or stinging and increased with the intensity of the flash.

Clothes should offer some protection against flash burns, although it is conceivable that at very high intensity the clothing might burn up, and enough heat might be left over to damage the skin underneath. A study by Mixter [178] used an animal model (pigs) to compare the doses required to set burns in nude skin to those required with skin areas covered by one or by two layers of fabric, respectively. With nude skin, the doses determined by Mixter are similar to those that had been determined in humans by Evans et al. [177].

While Mixter’s data on the effect of clothing show some scatter, a reasonable approximation is that each layer of fabric raises the energy threshold for a burn by a factor of 2.5. Thus, burns beneath two layers of fabric—which can be assumed to have been present in most victims at least around the hips—would require about 6 times more energy than on exposed skin.