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  • David Cogan in Hiroshima - 1949

    Most ophthalmologists know of David Cogan, MD — past director of the Howe Laboratory at Harvard, ex-chairman of Harvard’s ophthalmology department and former chief editor of the Archives of Ophthalmology.

    He’s known as the eponymic principal of Cogan’s Syndrome, Cogan’s Myasthenic Lid Twitch, the Cogan-Reese Iris Nevus Syndrome, Cogan’s Oculomotor Apraxia, Cogan’s Calcific Scleral Patch, and Cogan’s Microcystic Corneal Dystrophy. Additionally, many ophthalmologists know David Cogan as the leader of a medical group that traveled to Japan in 1949, charged with elucidation of eye abnormalities in people exposed to the atomic bomb.

    Dr. David Cogan photographing eye of unknown atomic bomb survivor. 

    However, new and interesting material has been uncovered regarding Dr. Cogan’s Japan trip. David’s diary on the journey, contained in documents and photographs, were recently donated to the Massachusetts Eye and Ear Infirmary Howe Library by his daughter, Priscilla Cogan. This collection provides detailed insight into the clinical hurdles Cogan faced as well as his reflections on Japan and its peoples at a very unique time in history. I am honored to be the first person outside of Cogan’s family and the archivists, to view this material and the story offered below is derived from those records. All of the following quotations are from Dr. Cogan’s personal journal.

    Dr. Cogan traveled to Japan in 1949 at the invitation of the Atomic Bomb Casualty Commission, a subgroup of the Atomic Energy Commission. His group was tasked to determine the effects of atomic radiation on cataract development in atomic blast survivors (called Hibakusha). Dr. Cogan had experience in radiation induced cataracts through his previous investigations of lens changes in cyclotron workers and was a logical choice.

    Dr. Cogan's "Ophthalmology Team". Dr. David Cogan (left rear) and Dr. Samuel Kimura (right rear) with 3 of the clinic interpreters. 

    The group arrived in Tokyo on Sept. 5, 1949, then traveled overnight by military train to Kyoto and then Hiroshima. “It was frightfully hot and none of us slept well. Our compartment included two GIs, and one of them went berserk, jumping out of his berth claiming he was in a barber shop. I spent the rest of the night reading.”

    Dr. Cogan arrived in Hiroshima on Sept. 7, 1949. On viewing the destructed landscape, fractionally rebuilt, he said, “I felt I had been transported to another world.” He went right to work.

    “It so happened that the afternoon of our arrival at Hiroshima, a research council meeting was taking place, the subject of which was us and our plan of attack,” he wrote.

    Ophthalmology group in an examining room at ABCC eye clinic. Standing (left), Dr. Samuel Kimura, (right), Dr. David Cogan. At slit lamp, unknown patient and Dr. S. Forrest Martin. 

    It immediately became clear to Dr. Cogan that there was a difference of opinion as to study approach. In order to get a random sample, the council’s epidemiologists planned to study only those survivors who lived at defined distances from the blast hypocenter — designated as the atomic commission’s survey population. This would mean only two to three people per day would be available for examination, with unclear exposure history.

    Dr. Cogan’s plan was to examine as many people as possible regardless of their residence location, thereby increasing the chance of finding pathology. “Discussions are to be pursued further tomorrow, but I am going to hold firm,” he said. “We’re making general nuisances of ourselves and may get somewhere yet.” Dr. Cogan’s plan was adopted.

    At the time of Dr. Cogan’s visit, Hiroshima had already been partially reconstructed. “There is surprisingly little evidence of the A-bomb damage,” he wrote. Yet there was still graphic evidence of the effects of the bomb that had exploded 1,500 meters above Hiroshima on Aug. 6, 1945, four years previously. “About 1,000 meters from the hypocenter is a graveyard and a flying stone is embedded into the top of a tombstone, evidently projected by the A-bomb blast,” he noted. “On a gas tank about 2,000 meters from the hypocenter is what may look like a shadow in my pictures, but it is believed to have been the area protected by a human figure” outlined by infrared radiation.

    The space to be utilized as an eye clinic was in the auditorium area of what had been the Japanese army headquarters building, one of the few buildings to survive the bomb. The atomic commission’s headquarters “is located not less than 1,500 meters from the hypocenter and was within the fire-razed area, yet none of it gives the least evidence of destruction.” It was adjacent to the harbor and marked the embarkation point for soldiers and sailors going to war. It was here they would swear their allegiance, and their lives, to the emperor, who on assumption of the throne had named himself the “Showa” emperor, meaning “radiant peace.” Dr. Cogan commented, “It is somewhat ironic that peace would come to this land only through the use of radiant energy.”

    Nagasaki atomic bomb survivor with extensive keloid formation after thermal burns. 

    Renovations to the space for the “eye clinic” were completed and equipment ready to go on Sept. 12, 1949. “There are two examining rooms each with slit lamps. A perimeter is in one room and my photographic set-up in the other”. “Three (additional) cubicles are for visual acuity testing and history taking by the interns,” with the help of “splendid” bilingual interpreters. Prior to the opening of the clinic, Cogan examined a 22-year-old waitress from the atomic commission cafeteria “who had failing vision for eight months. She was in a streetcar 500 to 1,000 meters from the hypocenter.

    “Her face was burned, but her body was shielded by people around her (and the streetcar). Beginning two weeks after the A-bomb all her hair fell out, and she was bald for one year. Her vision was, however, normal (measured 20/20 OU) up to eight months ago but has progressively degraded since then.” It was determined that she had cataracts as the cause of her vision loss and that they were of the type compatible with those induced by radiation. The patient, “Hatsue Kimura was then our first discovery of a positive eye effect of atomic radiation.”

    The type of cataract the ophthalmology team was looking for consisted of disk-shaped opacities “in the axial zone of the posterior lens capsule over an area of 2 to 4 mm, with occasional punctate dots farther toward the periphery. The central opaque disks had jagged but relatively sharp edges.” In more marked cases peripheral changes were denser than the central changes, forming a doughnut-shaped opacity. They usually contained polychromatic crystals. These changes are not pathognomonic of radiation cataracts and are found to varying degrees in other types of cataracts.  However, if this type of lenticular change was bilaterally symmetrical and occurred in a relatively young person with a history of radiation exposure, etiology due to radiation was considered highly likely. Dr. Cogan wrote, “These cataracts are similar to those which have previously been associated with exposure to x-rays and gamma rays.”

    September 13, 1949 was the first day patients were seen in the eye clinic. “Thirty cases from the [commission] survey were examined, and five cases were transported in by Dr. Hiroshi Ikui [the chief local ophthalmologist]. Two additional cases of radiation cataracts were found, total being three at this time.” By the second day, unsolicited patients were also coming for free diagnosis. The newspapers had announced the arrival of Dr. Cogan and his colleagues, and it was hoped this advertising would produce additional candidate patients. By the second week of operations, fifty patients a day were being examined. However, Dr. Cogan was disappointed to find that although these all are listed as having been in the “open” at the time of the bomb, many of them were shielded by buildings, trees or other persons, etc., “so that the amount of radiation which they received is greatly variable.”

    The eye group was functioning six days per week, but Dr. Cogan took Sunday off and went to a shrine island called Miyajima, about 40 miles up the coast from Hiroshima, then took a 30-minute ferry run from the mainland.

    Ruins of Nagasaki Medical College one day after the atomic bomb explosion. (Reuters/Torahiko Ogawa/Handout/Issei Kato).

    “Miyajima is famous for its Shinto Shrine with a Torii [a gate symbolizing transition from the mundane to the sacred], the oldest in Japan, about 60 feet out in the water.” Miyajima Shrine (Itsukushima) “is a place where one is not supposed to go with one’s wife until after being married for seven years lest it make the Sun Goddess jealous. The implication is that the romance of marriage lasts no more than seven years,” he wrote. Dr. Cogan thought the island was beautiful and enjoyed his visit. But on leaving the island, he wrote “There was a large number of drunk Japanese on the island — I have not seen natives drunk elsewhere.”

    As Dr. Cogan’s stay in Japan lengthened, he became familiar, by frequency of contact, with several Japanese characters: “The symbol for ‘men’ looks to me like a person running in a big hurry. I’ve been told on unquestionable authority that a certain character, used singly, means ‘women’, but when repeated means ‘quarrelsome’ and when repeated twice means ‘noisy.’ I don’t know what repetition of the symbol for ‘men’ might mean.”

    On Monday Sept. 26, 1949, Dr. Cogan traveled to Nagasaki. “A lifetime has passed in the past few days! Rarely have I had such a concentration of thrills as have occurred since writing the previous note and now that I sit down and try to recapitulate the events, my head is in a whirl.” Apparently, Dr. Cogan was to have given a lecture to the Kyushu Ophthalmological Society but met with some difficulties. Because of translation issues, he had planned a purely slide oriented talk. He was told a projector would be available but this “turned out not to be the case (typical!).” Dr. Cogan contacted civil affairs which had 34 projectors, all apparently on loan to various Japanese educational organizations. And because the day was an autumn holiday none were immediately available. Finally, one was found about an hour’s drive from the city. “It arrived just five minutes before my lecture, but when I turned it on, I found there was a short circuit that could not be repaired in time. Therefore, I gave an impromptu talk with the aid of an interpreter and a blackboard.”

    While in Nagasaki, Dr. Cogan visited patients in the Red Cross Hospital and the partially rebuilt Nagasaki University Hospital. “The cement ruins of the former Nagasaki Medical College Hospital were noteworthy”. The college was less than 1 kilometer from the hypocenter. The walls that remained “showed some profile burns, blast in-bowing, and silhouette splattering by fine glass particles. Many bottles had been fused and distorted. Outside were several markers still standing where they had been placed to identify persons killed — placed before the mass cremation.” The Medical Commission Report stated 600 of the 800 medical students and 12 of the 16 professors were killed.

    Dr. Cogan met with several ophthalmologists in Nagasaki and discussed his interest in finding radiation cataracts, “I found them exasperatingly evasive but willing to call in a patient of Hirose’s (Ikui) who was said to have radiation cataracts. They had not seen or heard of any other cases.” The patient in question arrived at the clinic late but “is another case of undoubted radiation cataract who had suffered severe epilation and radiation sickness.”

    He then had some time to shop in Nagasaki and “picked up a long looked for pin for Did (his wife). This time she will not be able to return it for a refund!”

    Dr. Cogan returned to Hiroshima and the atomic commission eye clinic. “Two more cases of radiation cataracts today, making a total of eight. Both were heavily epilated but had little radiation sickness.”

    Oct. 28, 1949. “One of the many confusing things about this trip in Japan and one of the most difficult for me to understand, is myself. Why I should have wanted to call up the mayor of Hiroshima and have gone to him is as much of a mystery to me as it must be to others.” They discussed the mayor’s plans for reconstruction of the city. The mayor iterated his desire to make Hiroshima a world peace memorial, “But if I’m not mistaken there’s a little of the cozy businessman in the mayor.” That afternoon he walked through the hypocenter region. “Picked up a roof tile among the debris that had been burned.” The temperature at the hypocenter at the time of the blast reached 2,000 to 3,000 degrees centigrade — everything that was not incinerated, was burned.

    Nov. 4, 1949. “We have seen 10 radiation cataract patients to date, and we are through! The report is written; a preliminary note has been sent to Science, I am packed, and tonight we leave for Kure, then Tokyo, and we leave Japan. I am already becoming reflective, but the things which I shall remember most vividly are the sunsets over the inland sea and the pale blue of the skies, the soft pink clouds, the green (almost black) island mountains silhouetted against the light background. And in the foreground, the peasants carrying either babies or loads on their backs or pushing along carts of sweet potatoes or suspended on their shoulders the well-balanced water or night-soil buckets. All this, with a square-rigged sampan or two thrown in, makes for thrills the like of which I have rarely experienced.”

    On Nov. 6, 1949, Dr. Cogan left Tokyo for the United States. In the two months he had been in Hiroshima and Nagasaki, he had uncovered 10 cases of radiation cataracts among over 1,000 examined patients, all being within 550 to 950 meters from the bomb’s hypocenters. “Now I’m anxious to get home and live a normal life again — or try to. When [Lt. Col. Carl F.] Tessmer [director of the atomic commission mission] asked me if I would be interested in returning to Japan for a repeat survey in several years hence, I said it should be done. But I also said, ‘The next time the family goes with me.’ ”

    Dr. David Cogan and wife Did Cogan at Osaka Castle, 1965.

    Dr. Cogan returned to Japan in 1965, this time with his wife, Did. That trip also is an interesting story, but the details of that adventure, another of many in the life of a brilliant, humble and remarkable man, must await future recounting.

    Authors note: The author wishes to acknowledge the considerable assistance of Louise Collins, Howe Library director; and Vanessa Formato, archivist, Abraham Pollen Archives, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston. Historical information was also provided by Priscilla Cogan, for which I am grateful.