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Vol 9 No 1, January 1355, by Rigzshiichi Ruriyana, Vice President of the ho:pitzl; Cr. Tochiku, Professor encritus of Tokyo University; PrQfeEsOr Shinizu, of ?o!<yo UnivcrsKieistry of Kelfsre; the group of physicians who trcetcd t%c i-G;ltient; Frlor to the autopsy Dr.Royaua, Chair;;an, Departzxnt of Irternal kcdicine End Dr. ffumtori, Chief Physician gave R full one-hour report on the clinical progr&s. A suzzzy of this report is given beloio: Aikichi Xuboyana: age, 40; sex, ale. Clinics1 dizgxz is: radiation sickness. 1934. Fe cPeut t&o r;:eka es chief radio operator aboard the ship fol1cwir.g the esposixe, arrived at Yakfzu Port, Shlzuo’ka Prefecture, a&d zas hospitslized at tSe Internal Wdicine Depertznt of the Plrst Tokyo Xatioml Eo-1Pital ox 23 l:xch. At that tina he vias treated for radiation ?iisttcpoT%t:ira rota to 39.3 dcgrezs but fell grsduzlly and rezained slightly abwe nor::21anti1 abo2t 7 Yap. The Khite cell count tose to betacen 5,O;O aad 6,030 toznrd the end of Eay but the nuz$er of oucleated he PM first hospitalized; blozl platelets were bctgeen 30,000 and 40,050. Letsr, I’olloSiilg blood transfusions, the red cell count in-‘ crezsad to between 4 nillion and 5.3 aillion, acd the nur.%r of blood platelets rose to shout 350,000. A corlditio?l of ane:.‘a ws noted at
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about 300,mo. 7o::ard the end, the vhite cell co..nt increnscd to abo It 20,GOO; mrrow cells abad n:icleated red cells were soon in peripheral blood she liver on palpation X:~S soner:hnt core ind.;mted than at the tioe of initial hospitalization. Liver f. nctio3 nlso was irpoired end BSP (30 xii)_te valae) was 50 percent tomrd 20 3 -no. Jaundice was observed around 24 Jmo and the ja::r:dice index by EeulcnL,._7’.*cht’s rethod was 60 between the ;,*ly b.:c Goco to 30 early in A g st. DCP (30 ufn to vale) cas 20 por- ;ztlont lapsed into n corn on 31 A g..st and re:.ained SO Gnti.1 abodt 2 Septmber. The jaundice index r;as 226 on 2 Septczbcr. The patient redeclined grad-ally mtil hts death on 23 Soptezber. Daring this tine the hospital tried 11 blood transfzsions of 200 cc each and 51 treatments with dry blood plasm 100 cc each, uatil the baSinning of June, viscera. For f.zthcr radiation tests certain portions of the viscera I!ii-diCl1 Df~~lrtl:O;lt) and other portiona wera sent to Dr. 30 of the Virology Drp3rtcent, Eoto Prceedical Department for the detection of virus in the liver and blood. P3rt of the liver, kidney, lung, bone, etc vns sent to chemical analysis. Tests are being conducted in every field by experta ar.5 ecze rcs.:lts are no-# ptblishod. The autopsy findfngs in the case of Slight mln.:tr?t:oa; intensive yellow pi&zer.tatfon over the entire inferior rcxillar joint bit cot in the large joints of the uppar liclbs, ar,d cnly to a slight cxtmt in the large joints of the loser limbs. Slight necrosis in the back. P.pils QOZkratf?ly dilated; the right and of nedi..n intcmity and capillcrice were slightly congested. Sl fght ezslllzg in the abSozi;ral region, ‘bolng rzoro groco-mced in the dpper n.zvel; navel very shallow. Hexa on bilateral insteps by inpressions; Slight &~*a at the into-ma1 fezera region but so;lechat tore on the
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rlsilt ccrvic3.f eczicm to aa Lippor lateral chest rab’iotl. Cervical circuraaneous pmctiforn cxtravasations in the scapular region. About ten extrarasat ions, the size of a millet graih or red ham, frm the loft shoulder in the right and left inguical regions, the left being about 0 centicoters and the right 5.5 centP>oters. ‘Cld appez4ccto:zy scar in the right iliac region of the ab4ocen. Eevcral traces of puncture fn the left fossa illcs partly covwed by scabs. Scar ftoa win incision about 8 co:ltiS?tC?s long, closed with low oaturos. Zrin en the lodcr s;rt of the result of artificial rcsp?z?tion. Six scars frm cardiac puncture mnubriwa. A sonsotat black-colored pisentary dogosit follorzd the dorcatitis caused by the ro4iaactivo ash from the neck region to the . latmal cervical region, an4 there has a depilated region about 3 ccntizaters wide caused by the radictctive ash fro3 the lo~sr pwt of the occiput to the nuc3a; the surroundlug hair did not coze out &AXI p:~lled slightly. Inside the center of tte crest of loam left tibLa were small cicatriccs of L,rox-zpig-zztation 2.5 x 2.5 cn and 3 x 2 cla; at the right dorsun of the right foot, in the r$gion corr-_spxilng to the center of the first r-ztntnr.cal was a disccloicd region 1.5 x 2 ~611a:;d in the area tary deposits Fore noted in the are&as. No serious deformtion wns obcerved in the toes. There were no bedsores on the nates, which indicates that the patient was well cared for.. No sselling e;as obsorvcd in the cervical 1y::ph nodes or the fossa dxillaris 03 eithrr side. Subcutaneous fat r;as soi:what diminished. Subcutaneous nuscle tissue US red and mist. FAen the abjo_odiaal cavity ~88 areaed, the ascitic this area t;‘as appropriately mrked by a considerable quantity of naalyinflation in the rogion of the aaJor curvature reached a point about S depr;?s;ed rest of the transverse colon and the s-211 intostices to*zard tlis rzlvic cavity. Y;ith the stozlch rc:wed, tha le:t lbbe of the liver V.IS expo.-;sd at oze fil:g:or’s bre:t3th to the left of aad below the xiphoid ;:rac;crs; the right lobe, tbout three fiuger’s breadth above the liue of the right ctcrnm liue; the left lobe was about one fiqer’s breadth above the le itstern:Aa line. The liver appanred granular end grey-brown in color.
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The din$~rac-a vzs lcvol vith the fourth rib at t!:e right and the foxth intercostzzl space at the left. liost of the am11 intestifies were floating above the ascitcs; the abdcnfnal wall was cxtre~ely thin and trz:xinuco~e m.:Cm-mzs were 8een at places in the corim. The poritoxal side sigr?sid colon and the o.!tsido, in the loft fosea ilica. The peritor,etlm tha Vc?5;:ltcPy xif3 slightly fl~%¶2d~~tcd. 50 congested portions of the the 1s bad ELS capped by a b-a.ltif.11 linual blood vessel. The peritoneal LYEI rmoved, no enlar~e:?xt of mxzr1a interra 933 nsted on tb3 dorsal scarcely recoznlzable. In dissection sozr:thing asszzad to be parenchym toes o5ecrvcd near the upscr cxtreaity. Upon opening tho pericardiu-, cle FZS soist and light red in color. The upper lobe of the left lung sho%rd co:r:;lete fibrous adhesion. The lower part of the lover lobe was not arlhcred, and a pleural cyst containing 14 cc of light yellow liquid itas observed. ‘ihe lo~;ar lobe, from the side to the back, %xs adhered. The left pleura frm the side of the spinal column to the rear of the apex of the l.mg was also ad!lerod. The whole right lung aspsared fibrom an4 plauritic but closer exsnioation revealed that certain parts at the front snd on the o.ltside wera adhered. The front of tha upper lobe shoile4 f it2o.1s s&zsions; the loxr lobe WIS adhered to the diaphragm and the dorsal Pectrcce xre also zdhceed. Soxvhat above this vas a cystic cos%incd 17 cc of yelloa liquid nixed with gelatfnoxs fibrin. was on the rwltan line of the clmvicle. The Sront aud the back of t5e left ventricle were fibrinous and furred. There P’MJ e Et&erate mount of fatty tics2.e .?c.z3oa the cpicardiun. A tow shzill henorr!mge polnts were sezn at the rear ar?d bottm of the k~zrt bsloa the epicardiuar. &t the fro:it of the right ventz’ icle xxi a triangular area which POS assuzd to be a Zrezh zacilla. GiIxr t!:an thle, nothing extrsordimry was extermllp observed. ‘Es left and right ventricles rxre alnost empty. The nyoextravr-.so,t icns xcre o>::e?rv9i bztou the czdocsrdlum of the left ventricle.
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vessels of tl:a c:.53;,2~?3iL3 of the left atrim. The mitral valve was also right atrium ti’as xo<!orately enlarged and the endocardlux was flocculated. ne tricdtspid valve ms also noderately jaundiced. The thicknes8 of the Loft ventricle, 2 en; left atrim, 1.2 CQ; right ventricle, 0.8 cm8 right atrim, 0.6 CIU. (111 meaSurer.ents acre mde at the thickest part..) xas tsd.:mted. The plexra waz eln.:.ltozs. In scztion there was a focus of inkction krger than 8 goose c;g in the regions of S1 and S, of tte right apex of the lti~g, iXZiniSc:?;t of gray kept lzation. Other pleura ras edesatous , and furry Bi3riaous areas wr’a saan hcra and there. The places ~hcre adr’csicns wore Tsaled off were es~ezially brilliant rod. In section, this Fllftof the qper lobe Fistic.-*----~tcda focx grcsw~bly szrcot ic ~0~x3 ikz sisn of the iittle fl..,--?rt:p 135 Gbserved at a FlaCe sear t::0 tack abo.zt 3 c.*1above the loser mrgin, at the side of the pleura of the lo--t-r lo!x; the surrounding strora !lzd increased to the size of a atit !.a1 ~:..:c:~~ia, spreading to the circuaferenca.. &math the pleura, at tha lc::r exterior part of the lower lobe were old light grey-white foci of pneumonia about the size of the tip of the throb or little fisgsr. There was a distinct rib trace on the surface of the ple.;ra in this area. (See photograph !;o3.) 1. The other lyng areas acre prominently edcxntoLls,c;ithal.wst no tzir and a great quantity of exudsto. It is notev.orthy Cat all ~TI~~:.XKI~Rfoci Gore apparently of the type cawed by Eold, s.ILh as a filazentous fungus. ‘;ke lyi ;:h ;r0rlaS at the bifurcation of the trachea were the size of <List. ‘2e lkzpb mdes of the lower left bronchus were the eizo of tte tip of the little finger, flat, with a grcy-red cortex, and shoxlng coal d:st deposits. The lyraphnodes of the left lateral trachea were scarcely of a zdilllar S1hnpa. There were several lymph ocrdes on the left lateral t;-achea, a3 large zs beans s-d light red in color. The tvo lynph nodes ct the arc5 of the acrta E’cre recpactively t5e site of a long soy bean 5i:aller 020 at the contar. E.ece cere light red in section and not of a mdullar &ha@. It is notworthy that the lymph nodes belor the banin of the lcr.‘;s -;icre rather atrophic.
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SPLEZX. Eef2ht, 90 g. Size, 9.5 x 7 x 3 CIR. The tunic By%3 tenS0, grey -red, elastic and soft. fn section it shomd no smiling; there v;as ab.:ndant blood and the organ presented a aatory appearance. The trnbcc:1160 lienis acre prcmimnt. The lymphatic follicles were few and not 30 procimnt, but recqnizable. In section, the parcnchym could easily LO fomation of nc3cs YES observed. Tc;rzrd t?.e left side of the right lobe and at the Lroilt of the left lobe %Sdre irrcg-&W cicatriccs. The lorer side of the liver sho_;ed soze fibrirms striation fro?3 the Emgin cppearance of the lobules was erratic and the Glisron’e capsule was side rr?d irrcgalar, with hrsorrhagee aromd the circamfercnce; pmctiform bile %ith dark brom mucus; ; gallstones core not observed. The tiny plfcae of the WUCO?ISnnnbrane ware not clear, there was heavy capillary con=cstion in the mcous eiombrane, and the area near the neck was prosninently tinted with bile. The comon bile duct contained a smll quaatity of thick bile. There was no calcalus and the m.~coua mtn-brane was tinted yellow. Inside the biliary canaliculi, t?ze mjor $ancreatic dact opened at ta cpt 3 za above the pspillayy region, and the EinOr pancreatic duct at a spot 8 sm above the papillary region. and a few ap2ts of csrticsl lipsid substance.wre visible through the fibrous tunic. ~h3 capillnry vessels of the lstbroils tunic were dilated at points. fn spction the thickness of the cortical substance was al-‘ most r.ormtl;there wra few cortical lipoid spots. The pigment layer 11.5 x 7.5 x 4 cz(iight). Abova the right kidney, and at the rear, was an estravscst ion. t?e ehn~a of the right and left kidneys ~8 aboat the extrc;oly aoft. The tmic uns slightly adhered in places, but generally 6ection the color PSS the SBEC; svelling and turbidity were axtrece; the shape of the cortical substance ‘i;as indistinct; and the bwndary of
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13ry congnaelon in th's sxxous Eezbrane. Vater’s papilla was clearly eminent bJt not eniargd. Snzll Intestine. Contents: thick yells EUCUS. At various places on the ridges of the plicaeorere hemorrhages in or t&or the mcoua cszbrane about the size of the tip of the little finger. The T:.:CO~Smzbrzne in gcxral Yias eoderately edcxto.xs; the lyxzphatic ~\:nllfr;g in tbo :1~~0~~;3cz;:kane. Contaattr: Soft feces fJl1 of light the wall ~3s fibcut 0.7 cx at the trausveree colon. LY.-.P.?!;cxs. me &z:;?hnwks of the msentery were all srxallcr thm The lyizph nod9 of the lateral a’b~c1.2iiml aorta acre s.cxllerthm the tip of the little finger and spherical; they wre greybroxa in eection. vm c3pillary congestion and hcmrrhsge. The prostate WM not thick. prcsscra cz the spinal vrsicla did not produce a gJsh of sczen.
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RRCTUX. The rmcous ueabrane was moderately odecatoas. TESTICLES. Keightr left, 6.0 gi right, 7.0 g. The sclerotic 6'98 strongly jaundiced and gencx-allyatrophied. In section it was yellow. Slight filaments were withdrawn by pincette. PKXIS. Slight phinosfs. A spot about 2 cx left of the tip of the prepuceas black over an area the size of a pea. SPZ~!.~PIC CO.?!9. . Along the right sperztic cord cas a pmctifona CLcm VZXELS . Ths inside of the coxa artery was prosinently yellow. LD?!?KK0XS. The lynpb nc!es of the right and left inguinal regions were the size of a red bcsn and spherical, grey-shite in section. SYXOVIAL ?zX3R4I,K. The synovial xe&rano of the right knee was exlys$s.tic tissue of the radix linguae ms atrophied; its DXXXIS ce&rane PXLSITE. The mcous nenbrane of the soft palate was turbid; processes in the r!?zp of lymphatic follicles were seen in places. TSZiSILS. Both tonsils vere the size of the tip of the little finger and vere strongly flushed. On the left tonsil, in the fossa glandulae, was soxethfng resembling a purulent plug. At the left rear of the larynx Paa a foul yellow-green cecretion. Extrenely sligl;tglottal &crr:a*:.;soSz3rved. A sinilar foul nural secretion piashoted c3 th.3larynx, the origin of the trachea, and the front of the epiglottis. The Zorgagni'e foma on the left side vas edematous and. Tr=mI=4. ‘The rxcws xccbrane of the trachea was prcxinently yellowi sodcrate e<:er,a~$6 roted. Sporadic, irregular arnular hcnorrhages upper prt of the trachsal fork to the bronchi bilaterally. at the right rc2.rF3rt of the lo-serond of the esophagus was distended, faming a varicocele. Betvsfn the left rear lateral section, corresponding to the tracheal fork and the aorta was an extravasation about 5 CB long; ghe cannnctive and fatty tissues near the extravasation were rhage surro.:ndedt>e br--,..chof tha vague nerve ahich runs near it.
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right lo%, 4.5 x 2.0 x 1.3 CD; isthmus, 3.0 x 1.5 x 0.5 CP). ‘Ihs gland was scxw!:at atrophied; the colloid mtsrial was aparsa. Eenorrhagss cbi>ut the eke of tho hc2.d of a batpin wore observed in the skin of the head at the right parietal region an3 In the fatty tisme of the coriara. B’_Eq?::mIS. Belght, 0.75 3; size, 1.45 x 0.05 x 0.43 CIQ. .Ap~!%?ed left Zezur; it extended a point 17 ca up73r4d from the lower end of the f emr . Fort of fet Carrow vas Jmmdfced. (See photogreph'Hok.)"_ prolifcratic3; bdt ths proliferation was not extensive toward the …
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