Islands of Survival

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Life After Nuclear War, by Arthur M. Katz, Cambridge, Mass.: Ballinger Publishing, 1982, 422 pp., $27.50/$14.95.

The Final Epidemic: Physicians and Scientists on Nuclear War, edited by Ruth Adams and Susan Cullen, Chicago: University of Chicago Press, 1982, 254 pp., $4.95 paper.

Life After Nuclear War and The Final Epidemic are, in a sense, companion pieces. Arthur Katz, in Life After Nuclear War, describes the consequences of such a war, based on the scientific information now available plus the use of projections. He has compiled an impressive array of tables and maps. But some of its conclusions are based on theory rather than on fact, and many of his projections assume an act of war encountered with little or no preparedness. To this extent, Katz's book is as much an argument for increased preparedness as it is an argument against nuclear war. He is undoubtedly correct, however, when he points out the "chain reaction" effect produced by the loss of vital supplies, transportation, energy, and skilled personnel.

According to Katz, the degree of centralization that has made us such a powerful industrial nation has now become a major weakness in the age of nuclear war. It is clear that our decentralized structure a century ago—with greater dispersal of our supplies and our manufacturing; with each dwelling more or less self-sufficient with regard to water, lighting, and heat; and with food supplies stored in or near each community—might have made us better able to withstand an attack. From reading Katz's book, one may conclude that our survival could depend on returning to some degree of decentralization—with, of course, adequate shelter.

No thinking person would deny that nuclear war would be the most devastating experience the human race has known. No thinking person wants to see a nuclear war. But Katz does note that the arithmetical increase in the megatonnage of a bomb does not result in a comparable increase in the scope of damage. Will there not, then, be "islands of survival"? And is that not the real essence of the matter?

When Katz criticizes the lack of planning and the failure of the government to provide shelter and various services, he raises valid concerns. The shelter program in this country is, in fact, decades delayed. But again, Katz's arguments may be interpreted as a plea for shelters, food stores, depots of medical supplies, and various programs for distributing essential items after an attack, thus implying that some will survive. He is correct in pointing out that our medical facilities are highly centralized and largely in urban areas. But there is a trend now to establish smaller medical facilities in outlying areas, and this has, to some extent, attracted physicians to these areas.

The Final Epidemic is a book of many contributors, all writers of prestige. Again, it would be impossible to deny the horrors of nuclear war as described in this book. But the various writers do not produce any realistic answers—only the suggestion that we should prevail upon government leaders to avoid nuclear war.

The book begins with Albert Einstein's warning to President Roosevelt, in 1940, that weapons of unprecedented destruction might result from research then being conducted in Nazi Germany. What would have happened to the world if the United States had not embarked on an intensive program to develop nuclear fission, and what would have been the result if Hitler had been the first to master this new and destructive power?

To bring this up to date, what would be the state of the world if the Soviet Union had these weapons and we did not? Fissionable materials and nuclear weapons are now within the reach of many smaller nations with considerable wealth and, too often, with irrational leadership. While both books correctly describe the magnitude of nuclear war, and the desirability of preventing it, they tell nothing of the consequences if some of the deranged leaders of nations were to have access to such weapons.

The Final Epidemic speaks of "exaggerated fears of the Soviet Union." But are these fears exaggerated? And what of the avowed intention expressed repeatedly by Soviet leadership to extend their own brand of government to the entire world?

The Final Epidemic ridicules some of the earlier instructions given school children with regard to getting under desks and covering themselves as best they could. Of course this is subject to ridicule if we are thinking of close proximity to the detonation, where blast, heat, and radiation are intense. But what of the outlying, peripheral areas? Is it unreasonable to assume these children may have some degree of protection from flash, from flying glass, and from debris if they make themselves less vulnerable targets?

Dr. Howard H. Hiatt, one of the contributors to The Final Epidemic, concludes his section with the statement that "we must inform them [our political and military leaders] and the American people of the full-blown clinical picture that would follow a nuclear attack and of the impotence of the medical community to offer a meaningful response." I would have a higher regard for this book if Dr. Hiatt had advocated informing the government and the citizens of the dangers of nuclear war and then had added something like this: "Although the problems which would confront us would be unprecedented, those medical people who survive will make every possible effort to salvage the casualties and to alleviate pain and suffering."

Perhaps all the contributors to The Final Epidemic should consider that, unlike the bright promise in older Disney films, wishing will not make it so.

Max Klinghoffer is a physician specializing in disaster medicine.

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