Autopsy Data for Peace③. Voice of 14y.o Boy in Hiroshima. "75 Years, Atomic Bomb" Dr.Soko (DAY37/50)

He was exposed to Atomic Bomb at Hiroshima Prefectural Daiichi Junior High School, 1 km from the hypocenter.He wore a cotton shirt. Suddenly he felt a flash of light and protected his head under the desk, but he was under wall and debris of the building. 

He desperately escaped the fire and ran to the vicinity of Kaita city. Somebody from a house nearby gave him water. He drank it  but **vomited. **He eventually returned to his home in Saijo on the night of the bombing. 

When he got home, I had an appetite, but he had a discomfort with chest, feeling like clogging with something. If he** ate something, right after that, he vomited.He **repeatedly vomited so much, so he went to bed. He slept a little.

Day2: He had pains in various partsof the body, but he was relatively well. He had a good appetite. Ochazuke was  easy to eat. (Ochazuke is, a local Japanese food which put rice and pour hot water in a bowl, with topping of salty pickles etc.) 

Day3:
He had a general fatigue and took a rest. He felt his stomach was full and had fever at 37.2-37.3℃.

Day5:** He had nausea, and vomited once. He had **appetite loss, and stomachacheat times.

Day 6: He had diarrhea once in the morning and visited the Saijo clinic. Diarrhea had continueduntil he died.

Doctor's findings on Day 6

As a doctor's examination findings, his physique was normal but relatively slim and tall. The nutritional status was fine. There are no rash and apparent abnormalities. 

As a subjective symptom, he had strong malaiseon his whole body, and he had a squeezing pain in his chest. 

He was nauseous, had a slice of bread, and swallowed hot water just a little. The muscles of the whole body are very weak. The fever was 37.2 ℃. There was no lesion in the pharynx, and a thick yellowish white tongue coatingwas seen on the tongue. There was** a slight tenderness in the tip of the stomach and the lower abdomen.**

The white blood cell count was 4,200 and the red blood cell count was 4.60 million, which was in the normal range. Erythrocyte sedimentation velocity (erythrocyte sedimentation) was observed to increase at 21 mm for 1 hour and 45 mm for 2 hours (*erythrocyte sedimentation increases due to inflammation, anemia, blood diseases, etc.). Vitamin B was given to him. (as a treatment at that time).

Day 7-8: A slight runny nose was seen, and an ulcer occurred on the upper lip, which had been aching from the third day.
After that, he had a slight fever occasionally, and his appetite and malaise remained unchanged.
Day11: He had a sore throat.
Day12; he suddenly had a fever of 39 degrees, and a blood test showed a marked decrease in white blood cell count of 1200. The number of red blood cells was 4.14 million and there was no anemia. The first blood transfusion was given on this day.

Day13: He ate only one bite of bread. The white blood cell count was 700,which remarkably decreased. 50 ml of the boy's own blood was injected intramuscularly (as a treatment at the time), and 100 ml of type B blood was transfused.

Day14:He had a high fever of 39℃ or more. 

Day 15: He had nasal congestion.
Day 19: Blood began to be mixed in the runny nose, and nosebleeds **appeared.
Dy 20: **Squeezing chest pain was repeated for 10 minutes, every 30 minutes.
Day 21: Hematuriawas seen, and petechiaewere seen throughout the body.(Bleeding in urine, and small dots of internal bleeding in skin were seen)
Day 22: bleedingwas seen in the bilateral Ocular conjunctiva (bleeding in the white part of the both eyes). He passed away at 16:00.

Pathological  findings

There are bleeding tendencies seen in systemic organs, and findings in the pharynx and digestive organs that are considered as the effects of radiation.
Bleeding findingsare present in the skin, pleura (membrane surrounding the lungs), epicardium, bronchi, lungs, kidneys, bladder, stomach, colon, and cranial pia mater（brain membrane). Petechiae of the eye and scab in the nasal cavityare seen.

Pseudomembrane **(white mucous membrane) and edema were found from the **base of the tongue to the pharynx and larynx.There was a pseudomembrane and necrosis was observed on the tonsil. **Many cells were found in the tonsils, and most of them were large and small plasma cells.
No findings of the esophagus were written. **Erosion was widely observed on one third of the mucosal surface of the stomach.

In the large intestine, necrosis reaching the submucosais seen, but the** reaction of leukocytes such as neutrophils,which is seen in normal bacterial inflammation, is not seen, and a small amount of plasma cell infiltration is seen. The mucous membrane forms a thick pseudomembrane, the submucosa has the highest degree of edema**, and there are **bleeding **in some places.

The liver showed fatty changes and congestion.
The pancreas is slightly enlarged with Langerhans islet cells.
The kidneys are congested and the tubular epithelium is enlarged.
No sperm is found in the seminal vesicles.

How important was having a pathological autopsy?                Pathological findings showed the bleeding findings over the whole body, and throat inflammation (tonsil and pharynx etc) and digestive inflammation (stomach and colon). Those findings were strongly related to the radiation damage. ** Nuclear weapon emits three shocks to humans such as the blasts, the heat and the radiation. From the outside of a body, we cannot see the body damage by radiation. But, by doing autopsy, it became clear that bleeding, bone-marrow disfunction and necrotic colitis and pharyngitis were severely occurred by radiation. Doctor's had to do the autopsy to understand what was happening to patients. Doing autopsy is physically and mentally a hard work especially for doctors who usually work to see alive patients. **The autopsy findings were one of evidences doctor's fight as well as patients'.

Classmates and teachers in the same place

This 14 year-old boy was bombed at a school 1km from the hypocenter. Kunihiko Hara, a student at the time, talked about the moment of the atomic bombing. 

"The sound of a bang suddenly flashed. At the same time, the school collapsed with rattle. At the same time, it was darker than the moonlit night....  dead body with a neck cut, friends about to die. It was like a hell of this world.'' （http://yokoda.sakura.tv/genbaku/kokutaiji.htm）　

Of the three classes of students and teachers at Hiroshima Prefectural Daiichi Junior High School, 1km from the hypocenter, 50 were killed immediately due to the collapse of the school building or burned . Most of the students who escaped from the school building died on the way, or died in the camp. Students in other three classes were working outside as a demolition team of the wooden houses  in preparation for air raids. But most of them were immediately died or burned to die. Some of them with serious injury escaped, but all of them eventually died. 351 students and 15 faculty members died.

Explanation:

Squeezing Pain In the Chest

　This boy has no visible trauma on the outside of his body. As for the subjective symptom, "squeezing pain in the chest" is complained from the day of the bombing.On pathological dissection 22 days after the exposure, pseudomembrane and mucous membrane peeling from the oral cavity to the pharynx were observed, and inflammation due to radiation injury from the oral cavity to the pharynx is suspected. There is no way to confirm whether it was recognized at the time of the bombing, but the "squeezing pain in the chest"  from the day of the bombing suggests the possibility of acute radiation injury around to the esophagus. This is because the author's opinion as a diagnostic doctor who analyzes symptoms is that when a patient has a sore throat, they simply say "my throat hurts" , not complain as "squeezing chest pain".  Furthermore, there was a pathological findings of wide ranged erosions in stomach.  So it is natural to think there were erosions in esophagus located between pharynx and stomach, although there was no record left. Other possibility like cardiac angina cannot completely deny but unlikely to occur in a 14 year old boy. He had continuously had the chest symptom, so it is highly considered that he had a actual lesions in anatomical chest area. 

One of Early Symptoms of Acute Radiation Damage

"I had appetite when I came back home. But food was stuck and it hurts when I swallow food."

This boy's consistent complaint about his chest pain, indicates the lesion beyond pharynx. The pharyngeal findings were not heavy enough to explain his strong complaints.

So I suggest the acute radiation damage makes erosions from pharynx to stomach including esophagus. That is important because this complaints shows the early symptoms of acute radiation damage.

The Difficulty to Diagnose Radiation Damage

That is, there is a high concentration of radiation in a school** 1km southeast of the hypocenter **where the boy was.

 A human body that exposed high dose radiation, had the damage of organs susceptible to radiation, such as bone marrow, lymphoid tissues (such as tonsils), testicles or ovaries, intestines, esophagus, pharynx, stomach, and the hair follicle epithelium.

"Soar Throat" and "Chest Pain as swallowing"

However, **acute radiation injury is difficult to immediately suspect if no obvious history of exposure is known. This is because bone marrow, lymphatic tissue, gonads, etc  are organs that are unlikely to show initial subjective symptoms. **Usually, later tests will reveal blood abnormalities and then, doctors can begin to suspect the radiation injury.

In this regard, the 14-year-old boy's complaint of chest pain was significant, which was occurred immediately after the bombing. As an  initial symptom of high-concentration radiation injury,  "feeling of chest pain  when eating food," can be a clue to suspect acute radiation injury even before blood and other tests are performed. 

In addition, the symptom that "soar throat", which is reported by many non-burn victims, is considered to be important as an initial symptom. It is clear that lymphoid tissue, which is an organ susceptible to radiation, such as the tonsils and pharynx, cause lesions with acute radiation damage. We should know that  important symptom comes up at an early stage is"soar throat". This is more common symptom than chest pain.