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P r e f a c e to t h e E n g l i s h E d i t i o n
By H iro sh i Iw a m o to
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PREFACE
VII
A SLOW DEATH
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PREFACE
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PREFACE
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PREFACE
Sixty years ago, in her book about the dawn of nuclear re
search, Pearl Buck illustrated the suffering and eventual death
of the world's first criticality accident victim .
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PREFACE
XV
TABLE OF CONTENTS
p. 3
P . 27
P. 37
Day 59
p. 91
Afterword
p. 137
Bibliography
p. 142
E x p o s u r e — S e p t e m b e r 3 0 , 1 9 99
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EXPOSURE
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EXPOSURE
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EXPOSURE
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A C h a n c e M eeting — Day 2
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A CHANCE MEETING
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masks, then disinfected their hands. This was the first tim e
Maekawa would see a victim of high radiation exposure.
Of the two beds in the sterile room, Ouchi was sleeping
on the bed closer to the entrance. Height: 174 cm (5'7 ); weight:
76 kg (167.2 lbs.). Ouchi had been a rugby player in high school
and had a heavy build for a Japanese.
Seeing Ouchi's state, Maekawa doubted his eyes for a
moment. Ouchi did not look like a critical patient from any
angle. His face was slightly red and swollen in parts, and his eyes
were a little bloodshot. But his skin was neither burnt nor
peeling. There were no blisters, and he was fully conscious. Even
to a physician, Ouchi did not appear to have serious radiation
damage.
W hen M aekawa asked Ouchi if he had any pain, he
complained of pain under his ear and in his right hand.
Maekawa recalls their first meeting.
"M r. Ouchi's answers were accurate and honest, very
reliable. I remember very clearly that Mr. Ouchi, who had the
highest level of radiation exposure, was the m ost emotionally
stable of the three patients. Seeing the person before my eyes,
independent of the data of his radiation exposure levels and
his constantly declining lym phocyte count, I thought we
m ight be able to save his life."
T h at evening, M aekaw a spoke of his resolution to a
m em ber attending the m eeting, Tatsuya Kinugasa, Chief
Surgeon at the M itsubishi Kobe Hospital.
"After the meeting ended in the afternoon, I was alone
w ith Professor Maekawa. He said, 'I'll look after him. I'm
going to take him back w ith m e.' I told him that it was a lost
battle and tried to persuade him to change his mind. I might
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A CHANCE MEETING
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H o spital T r a n s f e r — Day 3
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HOSPITAL TRANSFER
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After he hung up, Maekawa told Sasaki, "W e'll take care
of h im ." T h at m om ent, Ouchi's hospital transfer had been
decided.
From a radiological perspective, it was obvious that the
am ount of radiation to which Ouchi had been exposed was
fatal. But O uchi seemed healthy at the m om ent, and did not
appear at all to be a patient who had been exposed to a high
dose of radiation.
M aekawa swore to him self that he would do his utm ost
to treat Ouchi.
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HOSPITAL TRANSFER
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HOSPITAL TRANSFER
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HOSPITAL TRANSFER
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R ad ia tio n E m e r g e n c y T r e a t m e n t T e a m — Day 5
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RADIATION EMERGENCY TREATMENT TEAM
w e la c k k n o w le d g e . M a y b e t h e r e ’s a c h a n c e th a t t o d a y ’s
m e d ic in e w ill h e lp O uchi. Maekawa held on to such un
founded hopes.
At 7:00 AM every morning, the medical team carried out
exam inations w ith Maekawa taking the lead. Deliberation
meetings started at 8:00 AM, where examination results were
discussed and a treatm ent plan was established. At 6:00 PM,
when the day's treatm ents were over, the team m et again to
discuss Ouchi's condition and reassess the treatm ent plan.
T his became the team's daily routine. The 145 m 2 conference
room used for these discussions was packed w ith dozens of
physicians and nurses. There were heated discussions at
every meeting, som etim es lasting nearly two hours.
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RADIATION EMERGENCY TREATMENT TEAM
After that, his son stopped com ing into the hospital
room. T h e nurses assumed that his wife wanted their son to
retain a healthy image of his father.
Ouchi rarely spoke about the accident. But one day, he
suddenly asked Hosokawa, "W hen you're exposed to radiation
like this, is there a risk of contracting leukem ia or som e
thing?"
The unexpected question left Hosokawa at a loss for
words.
"T h e doctors are working hard so that you won't contract
anything, so leave it up to them and do your best."
She was barely able to keep a cheerful expression while
she answered.
"Yeah, you're right."
Ouchi nodded repeatedly.
U ntil then, Ouchi had never expressed any anxiety. His
sudden words made Hosokawa realize, A fter all, h e is a fra id
o f w h a t’s goin g to h a p p en to h im . H e just h a d n ’t sh ow n it.
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RADIATION EMERGENCY TREATMENT TEAM
These irregular methods were first used on-site, and then ap
proved two years later by the company, eventually becoming
part of the operating procedures guide known as the "shadow
guide."
However, the shadow guide included counter-measures
to prevent criticality.
Criticality, w hich offsets fission chain reactions, occurs
when a certain quantity of radioactive substances like highly
fissionable U ranium -235 accum ulates under specific con
ditions. In other words, criticality can be prevented if the
conditions and quantity are properly controlled. Measures
based on two lim itations, mass lim itation and shape restric
tion, can be taken to prevent criticality.
Mass lim itation entails lim iting the quantity of uranium
used each tim e to prevent criticality. However, criticality is
not necessarily reached even if the quantity of uranium
processed exceeds the mass lim itation. W ith an increase in
the surface area of the container, neutrons scatter and do not
com e into contact w ith other nuclei. Fission chain reactions
therefore do not occur, and criticality is prevented. Known as
shape restriction, this preventative measure uses a container
whose shape prevents criticality from being reached.
T h e shadow guide outlined the use of a long, narrow
shape— in other words, a storage tower w ith a large surface
area— to prevent criticality.
However, in the processing work prior to the accident,
even the shadow guide was ignored. In the homogenizing
stage, a short, spherical precipitation tank was used instead
of the storage tower. Because it was shorter, the precipitation
tank was presumably easier to work w ith than the storage
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Operation Procedures at the Conversion Test Building
A SLOW DEATH
tower. We now know that the JCO Tokaim ura Plant's chief,
who managed manufacturing processes, had approved this
improper method.
T h is was th e first tim e O uchi had worked in the
conversion test building. He was follow ing his boss's
directions for each procedure and had no idea of the criticality
risk.
"I wonder if I'm going to contract something like leu
k e m ia ..."
In tim e, Ouchi's fear would becom e reality.
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H e m a t o p o i e t i c Stem Cell T r a n s p l a n t — Day 7
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HEMATOPOIETIC STEM CELL TRANSPLANT
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HEMATOPOIETIC STEM CELL TRANSPLANT
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HEMATOPOIETIC STEM CELL TRANSPLANT
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HEMATOPOIETIC STEM CELL TRANSPLANT
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A rtific ia l R e s p ir a tio n C o n t r o l — Day 11
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ARTIFICIAL RESPIRATION CONTROL
skin underneath started coming off w ith the tape. M arks left
by the tape never disappeared. Gradually, tape became difficult
to use. On October 9, Day 10 after irradiation, it was entirely
forbidden to use tape on Ouchi's skin. (Inset 4)
Like after a burn, blisters appeared on his right hand. And
when his feet were washed or dried w ith a towel, the rubbed
skin cam e off.
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50
ARTIFICIAL RESPIRATION CONTROL
his skin, it was uncertain whether the hole from the puncture
would heal properly.
On the other hand, the m edical team wanted to avoid a
lapse of dyspnea. They carefully debated the options and de
cided that a pleural puncture was inevitable to improve
Ouchi's breathing conditions. On October 6, Day 7 after
irradiation, the procedure to remove m oisture from Ouchi's
chest was carried out.
W ith pressure applied through a medical mask, Ouchi's
lungs were forced to expand in order to increase the oxygen
in his blood. Because the m ask had to be sealed tightly on his
face to apply pressure, it was painful to wear. Ouchi was
pushed beyond his lim it, as evidenced by his num erous
outcries recorded in the nursing records during this period.
"I can't take it any m ore!"
"Stop it!"
"I want to go back to Ibaraki!"
"M o th er!"
"D on 't leave m e alone!"
Junko Nawa heard th ese words in person w hile
administering the m ask treatm ent to send in more oxygen.
Ouchi made painful expressions during the treatm ent. Nawa
administered the treatm ent w ith words of encouragement.
"O nly five more minutes. Hang in there." Ouchi suddenly sat
up, took off the m ask and yelled.
"I don't want to do this anymore. Forget the treatm ent,
I'm going home. I'm leaving."
W itnessing O uchi resist violently for the first tim e,
Nawa was shocked. H e ’s a c tu a lly b een h av in g a h a r d tim e,
h e ’s r e a lly suffering. Nawa did her best to encourage Ouchi.
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ARTIFICIAL RESPIRATION CONTROL
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ARTIFICIAL RESPIRATION CONTROL
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His S ister's C e l l s — Day 18
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HI S S I S T E R ' S CELLS
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HI S S I S T E R ' S CELLS
also felt that they had cleared the first hurdle and felt relieved.
In 1957, the first hematopoietic stem cell transplantation
was performed in Pittsburgh, USA, after an accelerator acci
dent. Bone m arrow was transplanted from the patient's
id entical tw in brother. T h e patient survived, but it was
impossible to confirm whether the bone marrow cells had
taken root; identical twins share the same shape of w hite
blood cells. After the 1958 radiation accident in Yugoslavia,
six patien ts received bone m arrow transplants, but the
effectiveness of the transplants could not be confirmed.
University of California Professor Gale, a m ember of
Ouchi's medical team, performed 13 bone marrow transplants
and six hem atopoietic stem cell transplants from fetal liver
cells for victim s of the C hernobyl reactor accident. T h e
transplanted cells functioned transiently allowing the victim s
to survive sufficiently long for their own bone marrow to
recover.
The peripheral blood stem cell transplantation performed
on Ouchi was the first such attempt in the history of radiation
emergency medicine.
T h e virtual destruction of O uchi's im m unocytes by
massive radiation actually helped, as his sister's cells were
able to take root w ithout being rejected. In any case, the
transplant was considered successful at that point.
However, O uchi's condition had not necessarily
improved. He constantly moved his body, perhaps due to
intensified pain, and he was often put to sleep w ith sedatives.
Whenever the nurses provided treatm ent, they made an
effort to call out to him as they always had, recounting stories
to entertain or relax him.
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HI S S I S T E R ' S CELLS
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M a n i f e s t a t io n s of R ad ia tio n D a m a g e — Day 27
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MANIFESTATIONS OF RADIATION DAMAGE
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MANIFESTATIONS OF RADIATION DAMAGE
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MANIFESTATIONS OF RADIATION DAMAGE
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MANIFESTATIONS OF RADIATION DAMAGE
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A Sm all H o p e — Day 50
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A SMALL HOPE
skin. Hoashi was relieved that it was not mold and sim ul
taneously prayed for th e new skin to spread as m uch as
possible.
As if responding to Hoashi's prayer, the regenerated skin
spread little by little. But it did not regenerate on the front of
his body where the skin had fallen off.
The volume of fluids seeping from his skin gradually
increased and exceeded 2 L per day by mid-November. Finding
a way to prevent fluid loss becam e the focal point of Ouchi's
treatm ent.
An emergency skin graft was deliberated.
If it attached temporarily, even skin cultivated from
other people could serve as a "gauze replacement," preventing
fluid loss until the grafted skin was rejected and fell off. It
w o u ld a ls o h e lp to p rev en t in fectio n , Maekawa reasoned.
Cultured skin grafts have a "grow th factor" effect, which
encourages skin growth. If it was successful, there would be
hope for Ouchi's cells to regenerate in the m eantim e.
Maekawa solicited cooperation from institutions that
fabricated cultured skin: Saint Marianna University School of
M edicine, Ehim e U niversity, Kitasato U niversity, Tokyo
Women's Medical University and Tokai University. He asked
these five universities to contribute as m uch cryopreserved
cultured skin as possible. Cultured skin was im m ediately
delivered from each university, and on November 8, Day 50
after irradiation, cultured skin grafts were made to Ouchi's
right abdomen and right leg.
In skin grafts used to treat burn victim s, the damaged
skin is cut off using a scalpel to cause bleeding; the procedure
encourages the cultured skin to adhere more quickly. But in
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A SMALL HOPE
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80
1 W orking co n d itio n s at th e tim e of th e ac c id e n t. O uchi w a s su p p o rtin g th e fu n n el used
to pour th e u ran iu m so lu tio n . M asato S h in o h a ra , w h o w a s p ou ring th e so lu tio n , w a s
also ex p o sed to a h ig h d o se of n eu tro n b eam rad ia tio n .
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A SMALL HOPE
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A SMALL HOPE
exhausted for the patient's treatm ent. Yet, the treatm ent
itself was inflicting pain on the patient. Under such condi
tions, how m uch longer could medical personnel be permitted
to continue treatment? Yamaguchi constantly contemplated
this question.
M any members of the m edical team were also asking
themselves sim ilar questions. But no one dared to broach the
subject. If someone on the m edical team voiced their doubt
of continuing active treatm ent for Ouchi, and this doubt
spread among the others, everyone would start to doubt why
and for w hom the treatm ent was being continued. Such
doubts would affect the morale of the entire team.
The idea frightened Yamaguchi somewhat.
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Day 59
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DAY 59
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D A Y 59
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DAY 59
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T h e E n d le s s B a t t l e — Day 63
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"E 1V T M 1"
T h at was how Ouchi's consciousness level was recorded
in his chart after the cardiac arrest.
Due to the artificial respiration apparatus (Tube), V (Verbal
Response) was still impossible. However, E (Eye Opening) and
M (Motor Response) were rated as 1, the lowest level. Ouchi no
longer opened his eyes nor moved his body at all.
According to Ouchi's chart, images of his brain waves
taken after the cardiac arrest were "definitely not flat," but
they no longer reacted to stim uli. There was concern about
post-resuscitation encephalopathy, a condition where water
accum u lates in the brain. T h is condition augm ents the
pressure inside the cranium, increasing the risk of blood not
circulating to the brain. Im m ediately after Ouchi's resus
citation, the medical team started administering M annitol to
reduce brain water content.
D espite O uchi's inability to respond after his resus
citation, the nurses continued to speak to him.
Junko Nawa tried to catch the words, It hu rts, from a
faint movement in his brow. She tried to detect the words, I ’m
in p a in , from a subtle change in pulse appearing on the
electro-cardiogram m onitor. Each tim e, she thought, Mr.
O u ch i is in p ain . H e w a n ts us to stop. I f i t ’s r ea lly n ecessary,
h e w an ts us to d o it so it d o e s n ’t hurt.
Nawa always spoke to Ouchi whenever she was looking
after him.
"M r. Ouchi, it's tim e for the nurses to change shifts."
"W e're starting the intravenous drip."
"W e're going to wash your eyes."
Although Ouchi never reacted, she believed: Mr. O u chi
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D e c e m b e r 21, 1 9 9 9 — Day 83
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DECEMBER 2 1 , 1999
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DECEMBER 2 1 , 1999
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DECEMBER 2 1 , 1 999
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DECEMBER 2 1 , 1999
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DECEMBER 21, 1999
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Pa per C r a n e s — the F u tu r e
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PAPER CRANES
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PAPER CRANES
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PAPER CRANES
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PAPER CRANES
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PAPER CRANES
October 11, 2000. More than a year had passed since the
accident. T h e Ibaraki Prefectural Police Departm ent Inves
tigation Headquarters had arrested the JCO chief at the tim e
of the accident as well as five others. The JCO was deemed
responsible for neglecting to advise workers of the potential
risk of criticality, and for repeatedly conducting operations
unauthorized by the state, including the illegal use of a bucket
to handle the uranium solution. For their lack of supervision
and safety education— w hich could have prevented the
criticality accident that had caused the deaths of Ouchi and
Shinohara— the six m en were charged w ith professional
negligence resulting in death. This was the first tim e arrests
had been made following a nuclear power plant accident in
Japan.
The six m en were prosecuted, and alm ost a year passed
since Ouchi's death. Around that time, a letter from Ouchi's
wife arrived in Maekawa's hands.
In the letter, Ouchi's wife related news of the m em orial
service for the first anniversary of Ouchi's death, and of her
and her son's m ove out of th e fam ily hom e. T h e letter
continued:
"S in ce the accident, there is som ething I constantly
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PAPER CRANES
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A ft e r w o r d
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On April 23, 2001, the trial for the six JCO employees
charged w ith professional negligence resulting in the deaths
of Mr. O uchi and Mr. Shinohara began. During the pro
ceedings, the prosecution revealed the following testim ony
from Mr. Ouchi's wife: "M y husband always said that his job
wasn't dangerous, but I don't think he fully understood the
risks of his job. Today, I consider m y husband to have been
killed by his company."
Ouchi and Shinohara's boss, who had also been exposed to
neutron beam radiation, was also charged w ith crim inal
liability in the trial. The superior made the following statement
regarding the company's inadequate safety education: "W e
weren't educated on how to avoid criticality. I thought it was
fine to pour a large volume of uranium solution into the tank."
M arch 3, 2003. T h e M ito D istric t C ourt ruled the
company's long-term carelessness regarding safety control to
be the cause of the criticality accident. The six defendants
were each sentenced to two to three years' imprisonment with
probation. N either the prosecution nor the defense appealed
this ruling, and the defendants accepted the guilty verdict.
On April 18, JCO announced that it had abandoned its
intention to resume operations at the uranium processing
plant. JCO would continue to exist as a company managing
low -level radiation w aste stored at the plant, providing
com pensation to companies and residents affected by the
criticality accident.
JCO then announced its plan to remove on-site facilities
and became embroiled in a year-long dispute w ith Tokaimura
village, which wanted to preserve the site as a reminder of the
accident.
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AFTERWORD
One Sunday in late July, I visited Tokaim ura for the first
tim e in five years. I found th e A tom ic Energy Scien ce
M useum along Route 245, w hich is lined by nuclear-related
facilities including the Japan A tom ic Energy Agency— an
independent administrative agency formed when the Japan
A tom ic Energy Research Institute and the Nuclear Fuel Cycle
Development Institute combined—Tokyo University research
facilities, and plants belonging to the Japan A tom ic Power
Company. When I parked m y car in a lot where a m ascot
based on Einstein welcomed visitors, I faced the m ain build
ing, w hich featured, in the words of I b a ia k i A to m ic Energy
2006, "educational games showing nuclear fission and chain
reaction s." I entered the annex to the right of the m ain
building. The object I had come to see was displayed in a small
exhibit space im m ediately to the left of the entrance.
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AFTERWORD
Hiroshi Iwamoto
Science and Culture Department,
NHK News Bureau
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BIBLIOGRAPHY