text:
Atheroma

An atheroma, or atheromatous plaque, is an abnormal accumulation of material in the inner layer of an arterial wall.

The material consists of mostly macrophage cells, or debris, containing lipids, calcium and a variable amount of fibrous connective tissue. The accumulated material forms a swelling in the artery wall, which may intrude into the lumen of the artery, narrowing it and restricting blood flow. Atheroma is the pathological basis for the disease entity atherosclerosis, a subtype of arteriosclerosis.

Signs and symptoms
For most people, the first symptoms result from atheroma progression within the heart arteries, most commonly resulting in a heart attack and ensuing debility. The heart arteries are difficult to track because they are small (from about 5 mm down to microscopic), they are hidden deep within the chest and they never stop moving. Additionally, all mass-applied clinical strategies focus on both minimal cost and the overall safety of the procedure. Therefore, existing diagnostic strategies for detecting atheroma and tracking response to treatment have been extremely limited. The methods most commonly relied upon, patient symptoms and cardiac stress testing, do not detect any symptoms of the problem until atheromatous disease is very advanced because arteries enlarge, not constrict, in response to increasing atheroma. It is plaque ruptures, producing debris and clots which obstruct blood flow downstream, sometimes also locally (as seen on angiograms), which reduce/stop blood flow. Yet these events occur suddenly and are not revealed in advance by either stress tests or angiograms.

Mechanism
The healthy epicardial coronary artery consists of three layers, the tunica intima, media, and adventitia. Atheroma and changes in the artery wall usually result in small aneurysms (enlargements) just large enough to compensate for the extra wall thickness with no change in the lumen diameter. However, eventually, typically as a result of rupture of vulnerable plaques and clots within the lumen over the plaque, stenosis (narrowing) of the vessel develops in some areas. Less frequently, the artery enlarges so much that a gross aneurysmal enlargement of the artery results. All three results are often observed, at different locations, within the same individual.

Stenosis and closure
Over time, atheromata usually progress in size and thickness and induce the surrounding muscular central region (the media) of the artery to stretch out, which is termed remodeling. Typically, remodeling occurs just enough to compensate for the atheroma's size such that the calibre of the artery opening (lumen) remains unchanged, until about 50% of the artery wall cross-sectional area consists of atheromatous tissue. If the muscular wall enlargement eventually fails to keep up with the enlargement of the atheroma volume, or a clot forms and organizes over the plaque, then the lumen of the artery becomes narrowed as a result of repeated ruptures, clots and fibrosis over the tissues separating the atheroma from the blood stream. This narrowing becomes more common after decades of living, increasingly more common after people are in their 30s to 40s.

The endothelium (the cell monolayer on the inside of the vessel) and covering tissue, termed fibrous cap, separate atheroma from the blood in the lumen. If a rupture (see vulnerable plaque) of the endothelium and fibrous cap occurs, then both a shower of debris from the plaque (debris larger than 5 micrometres are too large to pass through capillaries) combined with a platelet and clotting response (an injury/repair response to both the debris and at the rupture site) begins within fractions of a second, eventually resulting in narrowing or sometimes closure of the lumen. Eventually downstream tissue damage occurs due to closure or obstruction of downstream microvessels and/or closure of the lumen at the rupture, both resulting in loss of blood flow to downstream tissues. This is the principal mechanism of myocardial infarction, stroke or other related cardiovascular disease problems.

While clots at the rupture site typically shrink in volume over time, some of the clot may become organized into fibrotic tissue resulting in narrowing of the artery lumen; the narrowings sometimes seen on angiography examinations, if severe enough. Since angiography methods can only reveal larger lumens, typically larger than 200 micrometres, angiography after a cardiovascular event commonly does not reveal what happened.

Artery enlargement
If the muscular wall enlargement is overdone over time, then a gross enlargement of the artery results, usually over decades of living. This is a less common outcome. Atheroma within aneurysmal enlargement (vessel bulging) can also rupture and shower debris of atheroma and clot downstream. If the arterial enlargement continues to 2 to 3 times the usual diameter, the walls often become weak enough that with just the stress of the pulse, a loss of wall integrity may occur leading to sudden hemorrhage (bleeding), major symptoms and debility; often rapid death. The main stimulus for aneurysm formation is pressure atrophy of the structural support of the muscle layers. The main structural proteins are collagen and elastin. This causes thinning and the wall balloons allowing gross enlargement to occur, as is common in the abdominal region of the aorta.

Histology
The accumulation (swelling) is always in the tunica intima, between the endothelium lining and the smooth muscle middle layer of the artery wall. While the early stages, based on gross appearance, have traditionally been termed fatty streaks by pathologists, they are not composed of fat cells but of accumulations of white blood cells, especially macrophages, that have taken up oxidized low-density lipoprotein (LDL).

After they accumulate large amounts of cytoplasmic membranes (with associated high cholesterol content) they are called foam cells. When foam cells die, their contents are released, which attracts more macrophages and creates an extracellular lipid core near the centre to inner surface of each atherosclerotic plaque.

Conversely, the outer, older portions of the plaque become more calcified, less metabolically active and more physically stiff over time.

Veins do not develop atheromata, because they are not subjected to the same haemodynamic pressure that arteries are, unless surgically moved to function as an artery, as in bypass surgery.

Diagnosis

Because artery walls enlarge at locations with atheroma, detecting atheroma before death and autopsy has long been problematic at best. Most methods have focused on the openings of arteries; while these methods are highly relevant, they totally miss the atheroma within the arterial lumen.

Historically, arterial wall fixation, staining and thin section has been the gold standard for detection and description of atheroma, after death and autopsy. With special stains and examination, micro calcifications can be detected, typically within smooth muscle cells of the arterial media near the fatty streaks within a year or two of fatty streaks forming.

Interventional and non-interventional methods to detect atherosclerosis, specifically vulnerable plaque (non-occlusive or soft plaque), are widely used in research and clinical practice today.

Carotid Intima-media thickness Scan (CIMT can be measured by B-mode ultrasonography) measurement has been recommended by the American Heart Association as the most useful method to identify atherosclerosis and may now very well be the gold standard for detection.

Intravascular ultrasound is the current most sensitive method detecting and measuring more advanced atheroma within living individuals, but has had limited applications due to cost and body invasiveness.

CT scans using state of the art higher resolution spiral, or the higher speed EBT, machines have been the most effective method for detecting calcification present in plaque. However, the atheroma have to be advanced enough to have relatively large areas of calcification within them to create large enough regions of ~130 Hounsfield units which a CT scanner's software can recognize as distinct from the other surrounding tissues. Typically, such regions start occurring within the heart arteries about 2–3 decades after atheroma start developing. The presence of smaller, spotty plaques may actually be more dangerous for progressing to acute myocardial infarction.

Arterial ultrasound, especially of the carotid arteries, with measurement of the thickness of the artery wall, offers a way to partially track the disease progression. As of 2006, the thickness, commonly referred to as IMT for intimal-medial thickness, is not measured clinically though it has been used by some researchers since the mid-1990s to track changes in arterial walls. Traditionally, clinical carotid ultrasounds have only estimated the degree of blood lumen restriction, stenosis, a result of very advanced disease. The National Institute of Health did a five-year $5 million study, headed by medical researcher Kenneth Ouriel, to study intravascular ultrasound techniques regarding atherosclerotic plaque. More progressive clinicians have begun using IMT measurement as a way to quantify and track disease progression or stability within individual patients.

Angiography, since the 1960s, has been the traditional way of evaluating for atheroma. However, angiography is only motion or still images of dye mixed with the blood within the arterial lumen and never show atheroma; the wall of arteries, including atheroma within the arterial wall remain invisible. The limited exception to this rule is that with very advanced atheroma, with extensive calcification within the wall, a halo-like ring of radiodensity can be seen in most older humans, especially when arterial lumens are visualized end-on. On cine-floro, cardiologists and radiologists typically look for these calcification shadows to recognize arteries before they inject any contrast agent during angiograms.

Classification of lesions

 * Type I: Isolated macrophage foam cells
 * Type II: Multiple foam cell layers
 * Type III: Preatheroma, intermediate lesion
 * Type IV: Atheroma
 * Type V: Fibroatheroma
 * Type VI: Fissured, ulcerated, hemorrhagic, thrombotic lesion
 * Type VII: Calcific lesion
 * Type VIII: Fibrotic lesion

Treatment
Many approaches have been promoted as methods to reduce or reverse atheroma progression:
 * eating a diet of raw fruits, vegetables, nuts, beans, berries, and grains;
 * consuming foods containing omega−3 fatty acids such as fish, fish-derived supplements, as well as flax seed oil, borage oil, and other non-animal-based oils;
 * abdominal fat reduction;
 * aerobic exercise;
 * inhibitors of cholesterol synthesis (known as statins);
 * low normal blood glucose levels (glycated hemoglobin, also called HbA1c);
 * micronutrient (vitamins, potassium, and magnesium) consumption;
 * maintaining normal, or healthy, blood pressure levels;
 * aspirin supplement
 * mouse studies indicated that subcutaneous administration of oligosaccharide 2-hydroxypropyl-β-cyclodextrin (2HPβCD) can solubilize cholesterol, removing it from plaques. However, later work concluded that "treatment with 2HPβCD is ineffective in inducing atherosclerosis regression".

History of research
In developed countries, with improved public health, infection control and increasing life spans, atheroma processes have become an increasingly important problem and burden for society. Atheromata continue to be the primary underlying basis for disability and death, despite a trend for gradual improvement since the early 1960s (adjusted for patient age). Thus, increasing efforts towards better understanding, treating and preventing the problem are continuing to evolve.

According to United States data, 2004, for about 65% of men and 47% of women, the first symptom of cardiovascular disease is myocardial infarction (heart attack) or sudden death (death within one hour of symptom onset).

A significant proportion of artery flow-disrupting events occur at locations with less than 50% lumenal narrowing. Cardiac stress testing, traditionally the most commonly performed non-invasive testing method for blood flow limitations, generally only detects lumen narrowing greater than about 75%, although some physicians advocate nuclear stress tests that can sometimes detect as little as 50%.

The sudden nature of the complications of pre-existing atheroma, vulnerable plaque (non-occlusive or soft plaque), have led, since the 1950s, to the development of intensive care units and complex medical and surgical interventions. Angiography and later cardiac stress testing was begun to either visualize or indirectly detect stenosis. Next came bypass surgery, to plumb transplanted veins, sometimes arteries, around the stenoses and more recently angioplasty, now including stents, most recently drug coated stents, to stretch the stenoses more open.

Yet despite these medical advances, with success in reducing the symptoms of angina and reduced blood flow, atheroma rupture events remain the major problem and still sometimes result in sudden disability and death despite even the most rapid, massive and skilled medical and surgical intervention available anywhere today. According to some clinical trials, bypass surgery and angioplasty procedures have had at best a minimal effect, if any, on improving overall survival. Typically mortality of bypass operations is between 1 and 4%, of angioplasty between 1 and 1.5%.

Additionally, these vascular interventions are often done only after an individual is symptomatic, often already partially disabled, as a result of the disease. It is also clear that both angioplasty and bypass interventions do not prevent future heart attack.

The older methods for understanding atheroma, dating to before World War II, relied on autopsy data. Autopsy data has long shown initiation of fatty streaks in later childhood with slow asymptomatic progression over decades.

One way to see atheroma is the very invasive and costly IVUS ultrasound technology; it gives us the precise volume of the inside intima plus the central media layers of about 25 mm of artery length. Unfortunately, it gives no information about the structural strength of the artery. Angiography does not visualize atheroma; it only makes the blood flow within blood vessels visible. Alternative methods that are non or less physically invasive and less expensive per individual test have been used and are continuing to be developed, such as those using computed tomography (CT; led by the electron beam tomography form, given its greater speed) and magnetic resonance imaging (MRI). The most promising since the early 1990s has been EBT, detecting calcification within the atheroma before most individuals start having clinically recognized symptoms and debility. Statin therapy (to lower cholesterol) does not slow the speed of calcification as determined by CT scan. MRI coronary vessel wall imaging, although currently limited to research studies, has demonstrated the ability to detect vessel wall thickening in asymptomatic high risk individuals. As a non-invasive, ionising radiation free technique, MRI based techniques could have future uses in monitoring disease progression and regression. Most visualization techniques are used in research, they are not widely available to most patients, have significant technical limitations, have not been widely accepted and generally are not covered by medical insurance carriers.

From human clinical trials, it has become increasingly evident that a more effective focus of treatment is slowing, stopping and even partially reversing the atheroma growth process. There are several prospective epidemiologic studies including the Atherosclerosis Risk in Communities (ARIC) Study and the Cardiovascular Health Study (CHS), which have supported a direct correlation of Carotid Intima-media thickness (CIMT) with myocardial infarction and stroke risk in patients without cardiovascular disease history. The ARIC Study was conducted in 15,792 individuals between 5 and 65 years of age in four different regions of the US between 1987 and 1989. The baseline CIMT was measured and measurements were repeated at 4- to 7-year intervals by carotid B mode ultrasonography in this study. An increase in CIMT was correlated with an increased risk for CAD. The CHS was initiated in 1988, and the relationship of CIMT with risk of myocardial infarction and stroke was investigated in 4,476 subjects 65 years of age and below. At the end of approximately six years of follow-up, CIMT measurements were correlated with cardiovascular events.

Paroi artérielle et Risque Cardiovasculaire in Asia Africa/Middle East and Latin America (PARC-AALA) is another important large-scale study, in which 79 centres from countries in Asia, Africa, the Middle East, and Latin America participated, and the distribution of CIMT according to different ethnic groups and its association with the Framingham cardiovascular score was investigated. Multi-linear regression analysis revealed that an increased Framingham cardiovascular score was associated with CIMT, and carotid plaque independent of geographic differences.

Cahn et al. prospectively followed-up 152 patients with coronary artery disease for 6–11 months by carotid artery ultrasonography and noted 22 vascular events (myocardial infarction, transient ischemic attack, stroke, and coronary angioplasty) within this time period. They concluded that carotid atherosclerosis measured by this non-interventional method has prognostic significance in coronary artery patients.

In the Rotterdam Study, Bots et al. followed 7,983 patients >55 years of age for a mean period of 4.6 years, and reported 194 incident myocardial infarctions within this period. CIMT was significantly higher in the myocardial infarction group compared to the other group. Demircan et al. found that the CIMT of patients with acute coronary syndrome were significantly increased compared to patients with stable angina pectoris.

It has been reported in another study that a maximal CIMT value of 0.956 mm had 85.7% sensitivity and 85.1% specificity to predict angiographic CAD. The study group consisted of patients admitted to the cardiology outpatient clinic with symptoms of stable angina pectoris. The study showed CIMT was higher in patients with significant CAD than in patients with non-critical coronary lesions. Regression analysis revealed that thickening of the mean intima-media complex more than 1.0 was predictive of significant CAD our patients. There was incremental significant increase in CIMT with the number coronary vessel involved. In accordance with the literature, it was found that CIMT was significantly higher in the presence of CAD. Furthermore, CIMT was increased as the number of involved vessels increased and the highest CIMT values were noted in patients with left main coronary involvement. However, human clinical trials have been slow to provide clinical & medical evidence, partly because the asymptomatic nature of atheromata make them especially difficult to study. Promising results are found using carotid intima-media thickness scanning (CIMT can be measured by B-mode ultrasonography), B-vitamins that reduce a protein corrosive, homocysteine and that reduce neck carotid artery plaque volume and thickness, and stroke, even in late-stage disease.

Additionally, understanding what drives atheroma development is complex with multiple factors involved, only some of which, such as lipoproteins, more importantly lipoprotein subclass analysis, blood sugar levels and hypertension are best known and researched. More recently, some of the complex immune system patterns that promote, or inhibit, the inherent inflammatory macrophage triggering processes involved in atheroma progression are slowly being better elucidated in animal models of atherosclerosis.

title: Atheroma


text:
Hiroshima (book)

Hiroshima is a 1946 book by American author John Hersey. It tells the stories of six survivors of the atomic bomb dropped on Hiroshima. It is regarded as one of the earliest examples of New Journalism, in which the story-telling techniques of fiction are adapted to non-fiction reporting.

The work was originally published in The New Yorker, which had planned to run it over four issues but instead dedicated the entire edition of August 31, 1946, to a single article. Less than two months later, the article was printed as a book by Alfred A. Knopf. Never out of print, it has sold more than three million copies. "Its story became a part of our ceaseless thinking about world wars and nuclear holocaust," New Yorker essayist Roger Angell wrote in 1995.

Background
Before writing Hiroshima, Hersey had been a war correspondent in the field, writing for Life magazine and The Nan working in the Pacific Theater and followed Lt. John F. Kennedy through the Solomon Islands. One of the first Western journalists to view the ruins of Hiroshima after the bombing, Hersey was commissioned by William Shawn of The New Yorker to write articles about the impact of a nuclear explosion by using witness accounts, a subject virtually untouched by journalists. Hersey interviewed many witnesses; he focused his article on six in particular.

Publication in The New Yorker
Hersey's article was published in the August 31, 1946, issue and began where the magazine's regular "Talk of the Town" column usually began. At the bottom of the page, the editors appended a short note: "TO OUR READERS. The New Yorker this week devotes its entire editorial space to an article on the almost complete obliteration of a city by one atomic bomb, and what happened to the people of that city. It does so in the conviction that few of us have yet comprehended the all but incredible destructive power of this weapon, and that everyone might well take time to consider the terrible implications of its use. The Editors." One of the few people other than the principal editors of The New Yorker tipped to the forthcoming publication was the magazine's principal writer E. B. White, to whom Harold Ross confided his plans. "Hersey has written thirty thousand words on the bombing of Hiroshima (which I can now pronounce in a new and fancy way)", Ross wrote to White in Maine, "one hell of a story, and we are wondering what to do about it ... [William Shawn, managing editor of The New Yorker] wants to wake people up, and says we are the people with a chance to do it, and probably the only people that will do it, if it is done."

Literary reception
Containing a detailed description of the bomb's effects, the article was a publishing sensation. In plain prose, Hersey described the horrifying aftermath of the atomic device: people with melted eyeballs, or people vaporized, leaving only their shadows etched onto walls. The New Yorker article Hiroshima was an immediate best seller and was sold out at newsstands within hours. Many requests for reprints were received by the magazine's offices. The ABC Radio Network preempted regular programming to broadcast readings of the complete text by well-known actors in four half-hour programs. Many radio stations abroad did likewise, including the BBC in Britain, where newsprint rationing that continued after the war's end prevented its publication; Hersey would not permit editing of the piece to cut its length. The Book of the Month Club rushed a copy of the article into book format, which it sent to members as a free selection, saying "We find it hard to conceive of anything being written that could be of more important [sic] at this moment to the human race."

Published a little more than a year after the atomic bomb was dropped on Hiroshima, the American public was shown a different interpretation of the Japanese from what had been previously described in the media. After reading Hiroshima, a Manhattan Project scientist wrote that he wept as he remembered how he had celebrated the dropping of the atomic bomb. Scientists along with the American public felt shame and guilt at the suffering of the people of Hiroshima.

The 31,000 word article was published later the same year by Alfred A. Knopf as a book. Hersey's work is often cited as one of the earliest examples of New Journalism in its melding of elements of non-fiction reportage with the pace and devices of the novel. Hersey's plain prose was praised by critics as a model of understated narrative. Hersey rarely gave interviews and abhorred going on anything resembling book tours, as his longtime editor Judith Jones recalled. "If ever there was a subject calculated to make a writer overwrought and a piece overwritten, it was the bombing of Hiroshima", wrote Hendrik Hertzberg; "yet Hersey's reporting was so meticulous, his sentences and paragraphs were so clear, calm and restrained, that the horror of the story he had to tell came through all the more chillingly."

The author said he adopted the plain style to suit the story he strove to tell. "The flat style was deliberate", Hersey said 40 years later, "and I still think I was right to adopt it. A high literary manner, or a show of passion, would have brought me into the story as a mediator. I wanted to avoid such mediation, so the reader's experience would be as direct as possible."

The founder of The New Yorker Harold Ross told his friend, author Irwin Shaw: "I don't think I've ever got as much satisfaction out of anything else in my life." But The New Yorker's publication of Hersey's article caused trouble with respect to Hersey's relationship with Henry Luce, the co-founder of Time-Life and Hersey's first mentor, who felt Hersey should have reported the event for one of Luce's magazines instead. Despite Luce's misgivings about Hersey's choice of The New Yorker to print the Hiroshima story, the magazine's format and style allowed the author much more freedom in reporting and writing. The Luce publications – Time, Life and Fortune – had nothing similar. Moreover, The New Yorker went to unprecedented lengths to keep the Hersey story secret. The weekly magazine's top editors observed complete secrecy about the printing of the article. While editors Harold Ross and William Shawn spent long hours editing and deliberating every sentence, the magazine's staff was not told anything about the forthcoming issue. Staffers were baffled when the normal weekly proofs were not returned, and their inquiries were not answered. Even the advertisement department was deliberately not informed.

Time magazine said about Hiroshima:

"Every American who has permitted himself to make jokes about atom bombs, or who has come to regard them as just one sensational phenomenon that can now be accepted as part of civilization, like the airplane and the gasoline engine, or who has allowed himself to speculate as to what we might do with them if we were forced into another war, ought to read Mr. Hersey. When this magazine article appears in book form the critics will say that it is in its fashion a classic. But it is rather more than that."

The magazine later termed Hersey's account of the bombing "the most celebrated piece of journalism to come out of World War II."

It was also met with approval by The New Republic which said "Hersey's piece is certainly one of the great classics of the war". While the majority of the excerpts praised the article, Mary McCarthy said that "to have done the atomic bomb justice, Mr. Hersey would have had to interview the dead". It was quickly a book in the Book-of-the-Month Club; it was distributed for free because of the questions it raised about the humanity of the human race. Hiroshima was also read word for word on the radio by the American Broadcasting Company, amplifying its effects.

Publication in Japan
Although the US military government (headed by Douglas MacArthur) dissuaded publishers from bringing out the book in Japan, small numbers of copies were distributed; in January 1947 Hersey gave a reading in English in Tokyo. A Japanese translation of Hiroshima was first published in 1949 Japan; it has not been out of print since. According to Gar Alperovitz in The Decision to Use the Atomic Bomb, "Occupation authorities suppressed various accounts of the atomic bombings. A noteworthy instance involved the denial in later 1946 of a request by the Nippon Times to publish John Hersey's Hiroshima (in English)." MacArthur said in 1948 that despite numerous charges of censorship made against the censors office by the US news media Hiroshima was not banned in Japan.

Outline
The article begins on the morning of August 6, 1945, the day the atomic bomb was dropped, killing an estimated 135,000 people. The book begins with the following sentence:

"At exactly fifteen minutes past eight in the morning on August 6, 1945, Japanese time, at the moment when the atomic bomb flashed above Hiroshima, Miss Toshiko Sasaki, a clerk in the personnel department of the East Asia Tin Works, had just sat down at her place in the plant office and was turning her head to speak to the girl at the next desk."

- Hiroshima, John Hersey, 1946

Hersey introduces the six characters: two doctors, a Protestant minister, a widowed seamstress, a young female factory worker and a German Catholic priest. It describes their mornings before the bomb was dropped. Through the book, the lives of these six people overlap as they share similar experiences. Each chapter covers a time period from the morning of the bombing to one year later for each witness. An additional chapter covering the aftermath 40 years after the bombing was added in later editions.

The six characters are:

 * Reverend Mr. Kiyoshi Tanimoto

Tanimoto is 3500 yd from the explosion. A pastor at Hiroshima Methodist Church, a small man in stature, "quick to talk, laugh and cry", weak yet fiery, cautious and thoughtful, he was educated in theology in the U.S. at Emory University, in Atlanta, Georgia, speaks excellent English, obsessed with being spied on, Chairman of Neighborhood Association.

 * Mrs. Hatsuyo Nakamura

Nakamura is 1350 yd from explosion center. She is a widow of a tailor who is raising her three children (10-year-old boy Toshio, eight-year-old girl Yaeko, and five-year-old girl Myeko). Her husband had been killed in Singapore in 1942.

 * Dr. Masakazu Fujii

Fujii is 1550 yd from explosion center. He is described as hedonistic, owner of a private 30-room hospital that contains modern equipment, has family living in Osaka and Kyushu, and is convivial and calm.

 * Father Wilhelm Kleinsorge (Makoto Takakura)

Kleinsorge is 1400 yd from explosion center. Kleinsorge at the time is a 38-year-old German Jesuit priest. Weakened by his wartime diet, he feels unaccepted by the Japanese people and has a "thin face, with a prominent Adam's apple, a hollow chest, dangling hands, big feet.". His father superior within the mission station is Hugo Lassalle.

 * Dr. Terufumi Sasaki

Dr. Terufumi Sasaki is 1650 yd from the center of the explosion. He works as a 25-year-old surgeon at the Red Cross Hospital. He lives with his mother in Mukaihara, an idealist. Upset with poor health services, he practices medicine without a permit in communities lacking in quality health care. He is not related to Miss Toshiko Sasaki.

 * Miss Toshiko Sasaki (Sister Dominique Sasaki)

Sasaki is 1600 yd from the center of the explosion. She is 20 years old and engaged to a soldier, as well as working as a "clerk in the personnel department of the East Asia Tin Works"

"A Noiseless Flash"
This chapter introduces the characters and details the witnesses' accounts of the morning before and their perception of the explosion of the atomic bomb. The explosion occurred at exactly 8:15 am, local time. Miss Toshiko is at her desk and talking to a fellow employee at the Tin factory when the room filled with " a blinding light". and the flash was so powerful that it pushed over a bookshelf crushing Miss Toshiko's leg while she went unconscious. She was covered with a bookshelf while the building collapsed around her. While sitting on his porch, Dr. Masakuza Fujii witnessed a "brilliant yellow" flash and toppled into the river. He injured his shoulder severely. After returning to her home from a safe area, Mrs. Nakamura saw a flash "whiter than any white she had" seen before. She was thrown into the next room while her children were buried in debris. While reading his morning paper, Father Wilhem Kleinsorge witnesses a "terrible flash ... [like] a large meteor colliding with the earth". He found himself in the vegetable garden of the missionary with only small cuts. Standing alone in a corridor, Dr. Terufumi Sasaki saw a "gigantic photographic flash". The explosion ripped the hospital apart but Dr. Sasaki remained untouched except his glasses and shoes had been blown off his body. Dr. Sasaki was now the only doctor to be unhurt in the hospital and the hospital was quickly filled with patients. Reverend Kiyoshi Tanimoto saw a "tremendous flash of light cut across the sky". Tanimoto threw himself against a wall of his home and felt pressure, splinters, and debris falls on him.

"The Fire"
Chapter 2 documents the time immediately after the explosion where the fires are spreading and the witnesses are trying to save others and find safety for themselves. Immediately after the explosion, Reverend Tanimoto ran in search of his family and parishioners. He puts aside the search for his family when he comes across people in need of help and then resumes the search for his family. Mrs. Nakamura travels with her children and neighbor to Asano Park at the Jesuit mission house. Mrs. Nakamura and her children are continuously vomiting. Father Kleinsorge is found wandering the mission grounds with numerous pieces of glass in his back. Father Kleinsorge ran into his room and grabbed a first aid kit and his suitcase containing money and paperwork of the mission. Father Kleinsorge and others go out and bring food back for everyone at Asano Park.

Dr. Fujii's hospital was in the nearby river while he was trapped between its beams, unable to move. Dr. Fujii looks at the city and calls it "an endless parade of misery". Dr. Sasaki "worked without method" in deciding which patient would receive care next. Patients filled every inch of the hospital. People were throwing up everywhere. He became like a robot, repeating treatment on patient after patient. Miss Sasaki still lies unconscious under the bookshelf and crumbled building. Her leg is only severely broken. She is propped up alongside two badly wounded people and left. Father Kleinsorge sets off for Asano Park. Mr. Tanimoto has crossed town to find his family and parishioners. He apologizes to the wounded as he passes by for not being injured. Only out of luck does he run into his wife and child on the banks of the Ōta River. They split up so that she may return to Ushida and he may take care of the church.

"Details are Being Investigated"
Chapter three chronicles the days after the dropping of the bomb, the continuing troubles faced by the survivors, and the possible explanations for the massive devastation that the witnesses come across.

On August 12, the Nakamuras continued to be sick and discovered the rest of their family had perished. Mr. Tanimoto continues to ferry people from one side of the river to the other in hopes of bringing them to safety from the fires. Father Kleinsorge, weakened by his injuries and previous illness, remains in the Park. He is finally welcomed by the Japanese and no longer feels like a foreigner. Dr. Fujii sleeps on the floor of his destroyed family's home. His left clavicle is broken and is covered in many deep cuts. Ten thousand wounded have shown up at the Red Cross Hospital. Dr. Sasaki is still trying to attend to as many people as possible. All that can be done is to put saline on the worst burns. Dead patients were lying everywhere. Miss Sasaki is still left with no help outside the factory. Finally friends come to locate her body and she is transferred to a hospital.

At the end of the chapter, on August 15, the war is over.

"Panic Grass and Feverfew"
It has been twelve days since the bomb was dropped on Hiroshima. Four square miles of the city had been completely destroyed. Since the bombing, Hiroshima has been flooded, which continued chaos and destruction. Many people are now developing radiation sickness and a hatred for the Americans has been festering but decreased once Hiroshima was designated to have safe radiation levels. Father Kleinsorge's wounds were examined and found to have reopened and become inflamed. Even into September, Father Kleinsorge is getting worse. He was taken to the hospital for a high fever, anemia and low leukocyte levels. Mrs. Nakamura still felt nauseated and her hair began to fall out. Once given the okay that the radiation levels in Hiroshima were acceptable and her appearance was presentable, she returned to her home to retrieve her sewing machine but it was rusted and ruined. Mr. Tanimoto also fell ill without any notice. His fever reached 104 degrees Fahrenheit and he was given Vitamin B1 injections to combat the radiation disease. Miss Sasaki remains hospitalized and in pain. The infection has prevented doctors from being able to set her fractured leg. She was discharged from the hospital at the end of April but was severely crippled. Dr. Fujii is still living in a friend's summer home and his injuries have progressed well. He has been noting that many survivors are continuing to experience strange problems. He bought a new clinic in a Hiroshima suburb and once healed began a successful practice. Dr. Sasaki has been studying the progression of patients and assigned three stages to the disease. After six months, the Red Cross Hospital began to function normally. He remained the only surgeon on staff but finally had time to get married in March.

One year after the bombing, Mr. Tanimoto's church had been ruined and he no longer had his exceptional vitality; Mrs. Nakamura was destitute; Dr. Fujii had lost the thirty-room hospital it took him many years to acquire, and no prospects of rebuilding it; Father Kleinsorge was back in the hospital; Dr. Sasaki was not capable of the work he had once done; Miss Sasaki was a cripple.

"The Aftermath"
This chapter was added forty years after the initial publication in The New Yorker. It appeared in the July 15, 1985 issue of The New Yorker. Hersey returned to Hiroshima to learn what has become of the six survivors. His record of what he found became chapter 5 in subsequent editions of the book. The survivors of the Hiroshima bombing are now referred to as hibakusha (explosion-affected people). The Japanese initially refused to take any responsibility for the American atomic bombing or the population affected. The victims were discriminated against, and many employers refused to hire a hibakusha because they could not work as hard. Their exposure, called "A-bomb sickness" in Japan, left them with chronic weakness, dizziness and digestive issues, among others. In 1954, the Lucky Dragon No. 5 contamination incident created a political movement for the hibakusha and created the A-bomb Victims Medical Care Law. This law allowed for medical attention for the hibakusha and a monthly allowance for them.

Kiyoshi Tanimoto continued to preach the gospel to the people rebuilding in Hiroshima. He was brought to the United States by the Methodist Board of Missions to raise money for his church. On March 5, 1949, his memorandum, Hiroshima Ideas, was published. In 1950, he returned to America for his second speaking tour. On this trip, he spoke to members of the House Foreign Affairs Committee. Because of his worldwide tours, he was nicknamed "The A-bomb minister". In 1955, he returned to America with more Hiroshima Maidens, women who were school-age girls when they were seriously disfigured as a result of the bomb's thermal flash, and who went to the U.S. for reconstructive surgery. During this trip, he appeared on This Is Your Life with Ralph Edwards. He was surprised to meet Captain Robert Lewis, the co-pilot of the Enola Gay. He died on September 28, 1986.

For a time, Mrs. Nakamura made only enough income to get by and feed her family. She fell ill and could no longer work. To receive treatment, she was forced to sell her sewing machine. She worked odd jobs like delivering bread where she could take three or four days off to recover before working again. She continued to earn just enough to survive. She worked at a mothball factory for 13 years but did not immediately sign up for her health allowance through the A-bomb Victims Medical Care Law. She was invited to be a member of the Bereaved Family Association and traveled the world.

In 1948, Dr. Fujii built a new medical practice in Hiroshima. He was fortunate enough to face no long-lasting effects of the A-bomb sickness. Dr. Fujii died on January 12, 1973.

Father Wilhelm Kleinsorge continued to suffer from radiation exposure. In 1948, he was named the priest at a much larger church in another part of town. He became a Japanese citizen and changed his name to Father Makoto Takakura. He fell into a coma and died on November 19, 1977. There were always fresh flowers on his grave.

Dr. Terufumi Sasaki, who suffered no side effects from the bombing, was haunted by the images of the Red Cross Hospital after the bombing. In 1951, Dr. Sasaki quit working at the Red Cross Hospital. He started his own practice in his hometown and normally performed simple surgeries. He decided to build a geriatric hospital. He continued to regret not keeping better track of all the cremated bodies at the hospital.

Toshiko Sasaki was abandoned by her fiancé after being left crippled. Over a 14-month period she underwent orthopedic surgery to improve the condition of her leg. After working in an orphanage for five years, she became a nun with the Society of the Helpers of Holy Souls. Taking her final vows in 1953, she adopted the name of Sister Dominique. She was quickly noticed for her potential and made a director of the Garden of St. Joseph, an old people's home. She retired in 1978 and was rewarded with a trip to the Holy See. She did volunteer work and spent two years as Mother Superior at Misasa, where she had undergone her novitiate.

Lasting impact
The publication of the article placed Hiroshima and the atomic bomb at the heart of the nuclear war debate. In Hiroshima in History and Memory, Michael J. Hogan writes that Hiroshima created a realization of the magnitude of the event and an entrance into the analysis of the event. It put forward three issues that before had not been faced: the force of modern science, the bomb and the future of nuclear weapons.

The events of the dropping of the atomic bomb live in the psyche of everyone and were brought to gruesome light by Hersey. Hiroshima has and will continue to be "part of our ceaseless thinking about world wars and nuclear holocaust". The effects of the radiation sickness have continued to be a concern for the world and the safety of nuclear power. These concerns have resurfaced since the Fukushima Daiichi nuclear reactor incident. The images brought to the public after the publishing of Hiroshima were revived in the world's eyes.

In his essay From Yellow Peril to Japanese Wasteland: John Hersey's "Hiroshima", Patrick B. Sharp also saw Hiroshima as a counterpoint to "Yellow Peril" fiction like Flash Gordon and Buck Rogers, which were "narrated from the point of view of an 'everyman' who witnesses the invasion of his country first hand. As the narrators struggle to survive, we get to witness the horror of the attack through their eyes, and come to loathe the enemy aliens that have so cruelly and unjustly invaded their country." While in Yellow Peril fiction scientists and soldiers who defeat the invaders are portrayed as heroes, Hersey portrays Japanese and German clergymen, doctors, and other ordinary citizens as heroes.

Essays on the Red Circle Authors website included Hiroshima in the Atomic Bomb Literature cycle. Still, relevant anthologies like Nihon no Genbaku Bungaku or The Crazy Iris and Other Stories of the Atomic Aftermath are confined solely to Japanese writers. In her 1953 short story Fireflies, writer Yōko Ōta, a representative of the Atomic Bomb Literature, repeatedly refers to Hersey's report and Dr. Sasaki, whom she calls Dr. X in her story, "the young doctor that John Hersey had written about in Hiroshima".

In 1999, the original article was ranked as the finest piece of American journalism of the 20th century by a panel of experts assembled by New York University's journalism department.

The book was featured on BBC Radio 4's A Good Read in November 2020.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Hiroshima (book)


text:
Jimmy Rollins

James Calvin Rollins (born November 27, 1978), nicknamed "J-Roll", is an American former professional baseball shortstop, who played in Major League Baseball (MLB) for the Philadelphia Phillies (2000–2014), Los Angeles Dodgers (2015), and Chicago White Sox (2016).

After growing up in Alameda, California, and attending Encinal High School, Rollins was drafted by the Phillies in the second round of the 1996 MLB draft. After spending most of five seasons with Phillies minor league teams, he made his big league debut on September 17, 2000.

At the major league level, Rollins quickly earned recognition as an excellent defensive shortstop. In 2001, he became the Phillies' leadoff hitter, a role he retained for almost ten years. Rollins made three All-Star Game appearances in his career. While with the Phillies, he compiled a 38-game hitting streak, which spanned the end of the 2005 season and the start of the 2006 season, the longest in team history. Rollins was named the National League (NL) Most Valuable Player (MVP) in 2007, as the Phillies won their division in the first of five consecutive seasons. He was also a key component of the 2008 World Series champion team that defeated the Tampa Bay Rays.

In his career, Rollins led the NL four times in triples, and once each in runs, stolen bases, and stolen base percentage. As of 2023, he is the Phillies career leader in at bats (8,628), hits (2,306), doubles (479), and power-speed number (292.5), second in games played (2,090) and stolen bases (453), and third in runs scored (1,325), triples (111), and stolen base percentage (82.66). Rollins won the Gold Glove Award four times, as well as the Silver Slugger Award, and the Roberto Clemente Award (once each).

Family and background
Rollins grew up in Alameda as a member of an athletic family. His mother played competitive fastpitch softball, and he credits the experience with helping him develop a cerebral approach to the game, as well as a passion for the middle infield. His father was a wrestler and weightlifter. Rollins has been described as having "a near-photographic memory of games and at-bats and pitches". Rollins' brother, Antwon, played with minor league affiliates of the Texas Rangers. His sister, Shay Rollins, was a starter on the University of San Francisco's women's basketball team, and he is the cousin of former MLB player Tony Tarasco. Despite the athletes in his family, his father encouraged Rollins to pursue music as well as baseball. Rollins played the trumpet while growing up, and participated in various MC Hammer and Mavis Staples music videos during his adolescent years. Rollins was an Oakland Athletics fan growing up and regularly attended games at Oakland–Alameda County Coliseum.

In 1996, Rollins graduated from Encinal High School in Alameda. His parents refused to let him continue playing football, instead directing him to focus on baseball. He finished his high school baseball career as the holder of 10 school records, including highest batting average (.484), and most stolen bases (99). For his performance, USA Today named him a member of its All-USA High School Baseball Team, and Baseball America named him the top infielder in Northern California, as well as a second-team All-American. The American Baseball Coaches Association and Rawlings also named Rollins to their All-America Second Team. He committed to play college baseball at Arizona State University on a scholarship, but after "effusive" praise from Phillies' Bay Area scout Bob Poole, the team drafted him in the second round of the 1996 Major League Baseball draft.

Minor leagues: 1996–2000
After being drafted by the Phillies in the second round of the 1996 draft, Rollins was assigned to the rookie-league Martinsville Phillies. He led the team in walks and stole 20 bases, but batted only .238/.351/.285.

However, Rollins still earned a promotion to the low-A Piedmont Boll Weevils for the 1997 season. The youngest player on the team at age 18, he led the team in games played, at-bats, runs (94; 5th in the league), hits (151; 4th), triples (8; tied for 4th), stolen bases (46; 5th), and walks. Rollins batted .270/.330/.370 and had 560 at-bats, over 100 more than second-place Dave Francia. For his performance, he was named a co-winner of the Paul Owens Award, given to the Phillies' top minor league player. At the end of the season, Rollins played in the Florida Instructional League.

Rollins was promoted to high-A Clearwater in 1998. While playing alongside future Phillies teammates Pat Burrell, Johnny Estrada, Adam Eaton, and Brandon Duckworth, Rollins batted .244/.306/.354 with 18 doubles and 23 stolen bases; once again, he was the youngest player on the team. Eaton, Burrell, and Rollins were all promoted to AA Reading together the next year, and Rollins led the team in games and at-bats, as well as hits. His 145 hits gave him an average of .273, and led to a late-season promotion to Scranton/Wilkes-Barre, where he played four games. In 2000, he led Scranton in games played, doubles, and triples, and helped lead the team to the playoffs.

Rollins received a September call-up to the Phillies. He debuted on September 17 Wearing #29 against the Florida Marlins and had two hits in four at-bats in the game, with his first MLB hit being a triple off of Chuck Smith of the Marlins. He batted .321 in 14 games, stealing three bases and batting in five runs. After the season, Baseball America named him the Phillies' top organizational prospect. He was a finalist for the United States national baseball team to participate in the 2000 Olympics.

2001–2004
Rollins switched uniform numbers from 29 to what would be his permanent uniform number 11, despite wearing number 6 for the 2003 season only. Rollins spent the entire 2001 season with the major league Phillies and hit his first MLB home run on May 2 off of Brian Bohanon of the Colorado Rockies. In his rookie season Rollins led the National League in triples and stolen bases, becoming the first rookie to do so since 1951, and led the NL in at bats. He was a member of the NL all-star team in the 2001 Major League Baseball All-Star Game, the Phillies only representative. In July, he took over from Doug Glanville as the Phillies' leadoff hitter, a role he maintained for nearly a decade. At the conclusion of the season, the Negro Leagues Baseball Museum named him the co-winner of the Cool Papa Bell Award, given to the stolen bases leader; MLB managers voted him to the Topps Major League Rookie All-Star team; and Baseball America named him the fifth-best rookie in MLB.

Entering the 2002 season, despite his youth, Rollins sought to be a leader in the Phillies' clubhouse; an article in The Philadelphia Inquirer said, "Rollins, even at just 23 years old, may now have the clout needed to be a stern voice that makes a difference in the clubhouse and on the field." Rollins' season was characterized by a strong first half, and a "sophomore jinx" at the plate that plagued him in the second half of the season. For his performance in the early months of the season, he earned his second consecutive selection to the MLB All-Star game, in doing so becoming the first Phillie and first MLB shortstop ever to reach the game in each of his first two seasons. After the all-star game, however, he struggled at the plate, striking out frequently and chasing many high pitches that were out of the strike zone. Ultimately, Rollins finished the season among the NL leaders in defensive statistics – he compiled a .980 fielding percentage (second in NL), 695 total chances (third in NL), 504 assists (fourth in NL), and 226 putouts (fifth in NL). Meanwhile, offensively, he regressed from his 2001 campaign, batting .245/.306/.380 with 11 home runs, but still leading the NL with 10 triples; he stole 31 bases, 15 fewer than he did in 2001. After the season, he participated in the Major League Baseball Japan All-Star Series.

Prior to the 2003 season, he worked with Tony Gwynn on skills at the plate, predominantly using the whole field and being more of a "slap hitter". However, he began the season slowly, sustaining a hamstring injury in spring training that hindered his progress, and ultimately struggling at the plate early in the season, causing manager Larry Bowa to drop him in the lineup. Throughout the season, he sought to maintain the focus that he admitted to having lost the previous season, and he eventually rebounded to post a "respectable" stat line – a .263/.320/.387 with eight home runs and 62 RBIs, though he stole what at the time was a career-low 20 bases. Among his season highlights were a game-winning RBI against John Smoltz in June, and stealing his 100th career base in September, both of which occurred in games against the Atlanta Braves.

On January 15, Rollins signed a $2.4 million contract with the Phillies to avoid salary arbitration. According to one biography of Rollins,

"In 2004, Jimmy finally became the player the Phillies had been waiting for. He batted .289/.348/.455, scored 119 runs, led the league in triples, cut down considerably on his strikeouts, batted well from both sides of the plate, and hit well in the clutch. The workouts with Gwynn had helped, but it was joining morning sessions with (Bobby) Abreu that enabled him to sting the ball with authority and consistency."

Overall, he achieved another "quadruple-double" (home runs, stolen bases, doubles, and triples in double figures in a single season), his first career grand slam and posted career highs in a plethora of offensive categories including batting average, slugging percentage, RBIs, and hits.

2005–2007
Under new manager Charlie Manuel, whose offensive strategy predominantly revolved around hitting many home runs, Rollins struggled to post a strong batting average early in the Phillies' 2005 season. Nevertheless, he was again selected to the NL All-Star team. His offensive strategy changed in early August, when he began a hitting streak that spanned the season's final 36 games; during the streak, he hit .379. It was the longest hitting streak in Phillies' history, surpassing Ed Delahanty, whose streak lasted 31 games. Throughout the streak, Rollins aspired to maintain a team-first mentality, and noted that he would trade the streak for a playoff berth: "If we lose and I keep the streak, what does that mean? The season is automatically over. The playoffs is everything. That's what we all want." Ultimately, the Phillies missed the playoffs by one game. Overall, Rollins compiled his fourth career quadruple-double, tying Johnny Damon for most among active players, and batted .290/.338/.431 with 12 home runs, 54 RBIs, and 41 stolen bases.

The 2006 Phillies season began with much hype surrounding Rollins, and whether he could extend his hitting streak to pass Joe DiMaggio's record 56 games. He extended the streak two games into the season, but it ended on April 6 when he failed to get a hit in a game against the St. Louis Cardinals. He struggled during the first half of the season, posting a batting average of just .259, but rebounded during the second half, ultimately posting strong cumulative numbers once again. He became the third player in Phillies' history to score at least 100 runs in three consecutive seasons (Chuck Klein and Bobby Abreu), and led all NL shortstops in RBIs, runs scored, extra-base hits, and total bases. He was just short, however, of another quadruple-double. Cumulatively, he hit .277/.334/.478 with 25 home runs and 83 RBIs (at the time, the latter two were career-highs) and 36 stolen bases. Once again, the Phillies barely missed the playoffs.

Before spring training, Rollins announced that the Phillies were the "Team to Beat" in the National League East:

"The Mets had a chance to win the World Series last year. Last year is over. I think we are the team to beat in the NL East, finally. But, that's only on paper."

It became a sports media sensation, especially given that the New York Mets had won the division in 2006 with relative ease. The claim was widely reported, often without the second part of the quote ("only on paper"). USA Today columnist Hal Bodley opined, "The Phillies have needed someone to light a fire, especially in April. Rollins' bold, if not arrogant, prediction might just do that." During the first half of the season, it appeared Rollins had spoken prematurely, as the Mets jumped out to an early divisional lead. On June 28, Rollins had a four-hit game against the Cincinnati Reds, including a game-tying triple. The triple was Rollins' 10th, which gave him his fifth career "quadruple–double".

In August, the Mets' lead began to dissipate, as the Phillies combined several solid series; Rollins was a key component of their success. Rollins was named the National League Player of the Week for August 27 to September 2, 2007. On September 25 against the Atlanta Braves, Rollins hit the home run that completed his 30–30 season. On the last day of the 2007 season, Rollins became the seventh player to collect at least 20 doubles, 20 triples, and 20 home runs in one season when he hit his 20th triple of the year in a 6–1 win over the Washington Nationals that clinched the National League East division championship for the Phillies, which confirmed Rollins' preseason assertion of the Phillies preeminence.

For the 2007 season, he batted .296/.344/.531 and led the league in games (162), at bats (716—a major league record), runs (139), and triples (20), was second in hits (212), total bases (380), extra base hits (88), and power-speed number (34.6), and had 30 home runs, 94 RBIs, and 41 stolen bases (5th in the league). He achieved the "quadruple-double" (double digit doubles, triples, home runs, and stolen bases), becoming the fourth player in history to accomplish the mark. He would join Jim Bottomley as the only players to record a 30 double, 20 triple, and 30 home run season. The club advanced to the playoffs for the first time since their 1993 World Series loss; however, they were swept by the Colorado Rockies in the National League Division Series.

Rollins was named the National League's Most Valuable Player. He also received the NLBM Oscar Charleston Legacy Award (NL MVP), and won the first of three consecutive Gold Glove Awards, becoming the first Phillies shortstop to win a Gold Glove since Larry Bowa in 1978. He was the first player in MLB history to record 200 hits, 20 triples, 30 home runs, and 30 stolen bases in a season. Rollins also set a single-season MLB record for plate appearances with 778.

2008–2011
Unlike in spring training 2007, Rollins "made no guarantees heading into the next season, but that didn't mean the Phillies weren't confident" entering their 2008 season, despite the Mets' acquisition of Johan Santana and a "2007 Rollins-esque" guarantee of winning the division from Carlos Beltrán. After beginning the season by hitting a home run on opening day, Rollins landed on the disabled list (DL) for the first time in his career in early April, suffering an ankle sprain. He returned in May, and had a "productive" summer, ultimately posting a career-high 47 stolen bases, notwithstanding his batting average dropping to .277, and his home run and RBI totals dropping to 11 and 59 respectively. In the postseason, Rollins was a focal point of the team, which ultimately won the 2008 World Series; in the division series (NLDS), he hit a leadoff home run in game four, and in the championship series (NLCS), he hit a leadoff home run in game five, and despite struggles early in the World Series, he eventually contributed with strong situational hitting, helping the Phillies win the series in five games. At the conclusion of the season, Rollins was honored with a Fielding Bible Award for defensive excellence as the top MLB shortstop during the year.

Rollins began 2009 by participating in the 2009 World Baseball Classic (WBC) as a member of Team USA; he hit .417 and was named to the all-tournament team. After setting a career high in stolen bases in 2008, he did not steal one in the season's first 17 games, his longest drought to begin a season since 2004. On May 21, he reached the 1500-hit milestone in a game against the Cincinnati Reds. As of the end of June, however, he was hitting just .205 (he went 28 consecutive at-bats without a hit from the end of June until July 2), and was benched for four games by Charlie Manuel in an effort to encourage him to regain the shorter, lower half-driven swing that he used in his 2007 MVP campaign. He did improve in the second half of the season, batting .288 from July 3 to the end of the year. Overall, he compiled an NL-leading 672 at-bats, finished fourth in doubles (43) and stolen bases (31), and tenth in runs (100); in addition, he had a .250 batting average, 21 home runs (five of which were leadoff, the most in his career), and 77 RBIs, also winning the National League Gold Glove award for shortstops. In the postseason, he helped the Phillies reach the 2009 World Series by hitting a walk-off double in game four of the NLCS. The Phillies failed to repeat as champions, however, losing to the New York Yankees in six games.

Rollins's 2010 season was marked by injuries; he missed a total of 74 games, playing in only 88, the lowest total of his major league career. While warming up in the outfield prior to the Phillies' game on April 12, he strained his right calf, and eventually was placed on the disabled list. He spent April 13 – May 16, and May 22 – June 21 on the DL with that injury; Wilson Valdez served as his backup. When he returned, he hit his first career walk-off home run on June 23, powering the Phillies to a 7–6 victory over the Cleveland Indians. On July 3, he hit his 150th career home run in a game against the Pittsburgh Pirates, and on October 1, he hit his third career grand slam in a game against the Atlanta Braves. Overall, he hit .243 with eight home runs and 41 RBIs. He maintained his strong defense despite poor offense, but after his third consecutive mediocre offensive season, some questioned whether his MVP campaign in 2007 was a fluke.

2011 was a contract year for Rollins, and his performance concurrently rebounded, insofar as he improved his batting average, and home run and RBI totals. He made his 11th consecutive opening day start, and, for the first time in several seasons, he was healthy at the beginning of the season, starting the season's first 49 games. Nevertheless, it took him 54 plate appearances to record his first RBI, the longest drought of his career. On July 20, for the second time in his career, he had a multi-home run game in which one home run came batting right-handed and the other left-handed, the first Phillies player to do it multiple times. His season was not entirely devoid of injuries; on August 22, a right groin strain landed him on the DL, causing him to miss 18 games. He returned in time for the playoffs, and set several Phillies records in the 2011 NLDS, including hits (9), doubles (4), and multi-hit games (4). Despite the records, the Phillies lost the series to the St. Louis Cardinals. Overall, he posted a .268 batting average with 16 home runs and 63 RBIs. At the season's conclusion, Rollins was selected as the shortstop on the MLB Insiders Club Magazine All-Postseason Team. On December 17, 2011, Rollins signed a three-year, $33 million deal with a vesting option for a fourth year, worth another $11 million. The option vested when he reached 1,100 plate appearances in 2013–14.

2012–2014
In 2012, Rollins epitomized the Phillies' general "averageness" by posting a .250 batting average with 23 home runs and 68 RBIs. He hit poorly in the beginning of the season, and did not hit a home run until his 136th at bat of the season, the second-longest it had ever taken him to hit a home run at the beginning of a season. He missed three games from May 21–23 for the birth of his first daughter. On July 31, he hit his fourth career inside-the-park home run, which led active players. His hitting improved over the latter half of the season, and in September, he hit eight home runs. He missed the final three games of the season with a calf strain. During the season, he joined Craig Biggio, Barry Larkin, and Paul Molitor as the only players in MLB history to record 2000 hits, 350 stolen bases, and 150 home runs as a member of one team. It was his fourth career season during which he hit at least 20 home runs and stole 30 bases, which trailed only Bobby and Barry Bonds.

Prior to the 2013 season, Rollins played for Team USA in the 2013 World Baseball Classic (WBC), and was the only player from Team USA to make the event's all-star team; it was his second WBC, and second placement on the all-star team. He was back to the Phillies in time for opening day, and made his 13th consecutive start on opening day. Overall, he tied for fifth in the NL in games (160), and led the team with 600 at-bats, 151 hits, 36 doubles, and 59 walks. He achieved several career milestones during the season, including his 800th RBI (April 22), his 433 double (breaking Ed Delahanty's record on May 15), and his 45th career leadoff home run (fourth most in MLB history; hit on July 20). Despite the achievements, overall, the season was a decline from previous years; his isolated power (ISO) was among the worst in the major leagues, he attempted to steal the fewest bases in his career, and his defense "tanked" according to fielding metrics. He "struggled mightily" and ultimately posted a .252 batting average with six home runs and 39 RBIs.

Rollins attracted media attention in the offseason prior to 2014 when he supposedly expressed disinclination or lack of motivation after commenting "who cares" in regards to spring training; Buster Olney penned a column suggesting that there was a sentiment within the Phillies' organization that he should be traded (the rumors were dispelled by Rollins and Phillies general manager Rubén Amaro, Jr. as ridiculous). He opened the season by hitting a grand slam against the Texas Rangers, which was also his 200th career home run. After two games, Rollins left the team on paternity leave to be with his wife as the couple had their second child. On June 14, Rollins singled to right field for his 2,235th hit to surpass Mike Schmidt as the Phillies' all-time leader in hits. The game paused as Schmidt and the remainder of the Phillies congratulated Rollins at first base. Following the season, Rollins and recently retired Chicago White Sox captain Paul Konerko became the first ever co-winners of the Roberto Clemente Award.

Los Angeles Dodgers
On December 19, 2014, Rollins was traded to the Los Angeles Dodgers in exchange for minor league pitchers Tom Windle and Zach Eflin. Rollins waived his no-trade clause and stated that he was expecting to take on a leadership position with his new team.

Rollins played his first game with the Dodgers during opening day against the San Diego Padres on April 6, 2015, hitting a 3-run homer off of Shawn Kelley, giving the Dodgers a 6–3 victory over the Padres. He struggled offensively with the Dodgers, hitting a career low .224 (the lowest batting average among all qualified major league batters)/.285/.358 with 13 homers and 41 RBI. He also stole 12 bases. In September, he lost his starting job to rookie Corey Seager. For the final game of the season, manager Don Mattingly designated Rollins to be the 2015 player manager.

Chicago White Sox
On February 22, 2016, Rollins signed a minor league contract with the Chicago White Sox that included an invitation to major league spring training. He competed with Tyler Saladino for a starting role at shortstop. At the end of spring training, the team announced that Rollins would serve as their Opening Day shortstop. Due to Rollins' familiar number 11 already being retired in honor of Luis Aparicio, Rollins wore number 7 for the White Sox, which the following year would be worn by the man who replaced Rollins at shortstop, Tim Anderson.

Rollins batted .221/.295/.329 with 2 home runs and 5 stolen bases in 41 games for the White Sox. On June 10, he was designated for assignment so the White Sox could promote Tim Anderson from the minor leagues.

San Francisco Giants
On December 19, 2016, Rollins signed a minor league contract with the San Francisco Giants that included an invitation to spring training. He was released on March 31, 2017.

Post-playing career
In 2019, Rollins returned to the Phillies in two separate capacities: in January, as a special advisor for the team; and in March, as an on-air commentator for their television broadcasts. On May 4, 2019, a retirement ceremony honoring Rollins was held at Citizens Bank Park; the Phillies have not retired Rollins' uniform number 11, although it has not been reissued since he wore it.

After advising the team since 2019, the Phillies announced on March 31, 2022, that Rollins had been named a special advisor to the president of baseball operations.

Career statistics
Rollins, at his retirement, was one of 19 ballplayers to have recorded 2,000 games at the shortstop position and was the only shortstop to have amassed 200 homers and 400 steals. He was 20th all-time among MLB players in career power-speed number (309.8), 31st in stolen base percentage (81.74), 42nd in assists (6,139), and 46th in stolen bases (470). In his career, he led the National League four times in triples, and once each in runs, stolen bases, and stolen base percentage.

, he was the Phillies career leader in at bats (8,628), hits (2,306), doubles (479), and power-speed number (292.5), second in games played (2,090) and stolen bases (453), and third in runs (1,325), triples (111), and stolen base percentage (82.66).

Offense
Growing up, Rollins admired Rickey Henderson, one of the best leadoff hitters in MLB history, and especially early in his career, he sought to emulate Henderson at the plate. This contributed to his propensity to swing early in the count, and chase high pitches, seeking to hit home runs rather than get on base, the stereotypical role of a leadoff hitter. Consequently, he struggled to make contact with the ball, striking out too much, and rarely walking. To help alleviate those predominantly negative tendencies, he worked with Tony Gwynn prior to the 2003 season on using the whole field, and hitting more ground balls than pop-ups. Overall, he "always had a hard time accepting that he is vertically challenged at 5-foot-8", which contributed to his inclination to strive to hit for power rather than contact, and to seek to pull the ball rather than use the whole field. Rollins is the Phillies all-time leader in hits, and has the second-most stolen bases in Phillies history.

Defense
A "supreme defensive shortstop", Rollins won four Gold Glove Awards, and only Omar Vizquel has a better fielding percentage among shortstops who played at least 10 seasons. Rollins attributes some of his defensive prowess to experience, noting that he played in MLB for a long enough time to know most hitters' tendencies and to learn how to read swings, both of which helped him appropriately position himself to get to as many balls as possible. In their 2011 season preview, Lindy's Sports commented that Rollins was an upper-echelon shortstop "with soft hands, excellent agility and plus range left and right" and praised his strong throwing arm, especially from the hole.

Hall of Fame
Rollins was included on the ballot for the National Baseball Hall of Fame class of when it was announced on November 22, 2021. He received Hall of Fame votes on 9.4% of the ballots in his first year of eligibility, falling well short of election to the Hall of Fame. In 2023, this percentage rose to 12.9%.

Personal life
Rollins resides in the Tampa, Florida, area and is married to Johari Smith. They were married on January 23, 2010, in the Cayman Islands. On May 21, 2012, Johari gave birth to the couple's first daughter, Camryn Drew Rollins. Their second daughter, Logan Aliya, was born in early April 2014. When he played for the Phillies, Rollins resided in Woolwich Township, New Jersey. Osiris Johnson, a cousin of Rollins, is also a baseball player, and was drafted in the second round, 37th overall in the 2018 draft by the Miami Marlins.

An active philanthropist, Rollins and his wife Johari have participated in several charitable endeavors including the creation of The Johari & Jimmy Rollins Center for Animal Rehabilitation, which is located in Woolwich Township, New Jersey, and provides several medical rehabilitation services for animals and an annual BaseBOWL charity bowling tournament to benefit the Arthritis Foundation. Rollins is also active politically and campaigned for Barack Obama in the 2008 presidential election. In 2020, he supported Bernie Sanders for president.

Rollins is an investor for esports team NRG Esports.

title: Jimmy Rollins