Petechiae and other hemorrhagic manifestations were striking findings. Bleeding began usually from the gums and in the more seriously affected was soon evident from every possible source. Petechiae appeared on the limbs and on pressure points. Large ecchymoses (hemorrhages under the skin) developed about needle punctures, and wounds partially healed broke down and bled freely. Retinal hemorrhages occurred in many of the patients. The bleeding time and the coagulation time were prolonged. The platelets (coagulation of the blood) were characteristically reduced in numbers.
Nausea and vomiting appearing within a few hours after the explosion was reported frequently by the Japanese. This usually had subsided by the following morning, although occasionally it continued for two or three days. Vomiting was not infrequently reported and observed during the course of the later symptoms, although at these times it generally appeared to be related to other manifestation of systemic reactions associated with infection.
Diarrhea of varying degrees of severity was reported and observed. In the more severe cases, it was frequently bloody. For reasons which are not yet clear, the diarrhea in some cases was very persistent.
Lesions of the gums, and the oral mucous membrane, and the throat were observed. The affected areas became deep red, then violacious in color; and in many instances ulcerations and necrosis (breakdown of tissue) followed. Blood counts done and recorded by the Japanese, as well as counts done by the Manhattan Engineer District Group, on such patients regularly showed leucopenia (low-white blood cell count). In extreme cases the white blood cell count was below 1,000 (normal count is around 7,000). In association with the leucopenia and the oropharyngeal lesions, a variety of other infective processes were seen. Wounds and burns which were healing adequately suppurated and serious necrosis occurred. At the same time, similar ulcerations were observed in the larynx, bowels, and in females, the gentalia. Fever usually accompanied these lesions.
Eye injuries produced by the atomic bombings in both cities were the subject of special investigations. The usual types of mechanical injuries were seen. In addition, lesions consisting of retinal hemorrhage and exudation were observed and 75% of the patients showing them had other signs of radiation injury.
The progress of radiation disease of various degrees of severity is shown in the following table:
Summary of Radiation Injury
Clinical Symptoms and Findings
Day
after
Explo-
sion Most Severe Moderately Severe Mild
1. 1. Nausea and vomiting 1. Nausea and vomiting
2. after 1-2 hours. after 1-2 hours.
3. NO DEFINITE SYMPTOMS
4.
5. 2. Diarrhea
6. 3. Vomiting NO DEFINITE SYMPTOMS
7. 4. Inflammation of the
mouth and throat
8. 5. Fever
9. 6. Rapid emaciation
10. Death NO DEFINITE SYMPTOMS
11. (Mortality probably 2. Beginning epilation.
12. 100%)
13.
14.
15.
16.
17.
18. 3. Loss of appetite
19. and general malaise. 1. Epilation
20. 4. Fever. 2. Loss of appetite
21. 5. Severe inflammation and malaise.
22. of the mouth and throat 3. Sore throat.
23. 4. Pallor.
24. 5. Petechiae
25. 6. Diarrhea
26. 7. Moderate emacia-
27. 6. Pallor. tion.
28. 7. Petechiae, diarrhea
29. and nose bleeds (Recovery unless com-
30. plicated by previous
31. 8. Rapid emaciation poor health or
Death super-imposed in-
(Mortality probably 50%) juries or infec-
tion).
It was concluded that persons exposed to the bombs at the time of detonation did show effects from ionizing radiation and that some of these patients, otherwise uninjured, died. Deaths from radiation began about a week after exposure and reached a peak in 3 to 4 weeks. They practically ceased to occur after 7 to 8 weeks.
Treatment of the burns and other physical injuries was carried out by the Japanese by orthodox methods. Treatment of radiation effects by them included general supportative measures such as rest and high vitamin and caloric diets. Liver and calcium preparations were administered by injection and blood transfusions were used to combat hemorrhage. Special vitamin preparations and other special drugs used in the treatment of similar medical conditions were used by American Army Medical Corps officers after their arrival. Although the general measures instituted were of some benefit no definite effect of any of the specific measures on the course of the disease could be demonstrated. The use of sulfonamide drugs by the Japanese and particularly of penicillin by the American physicians after their arrival undoubtedly helped control the infections and they appear to be the single important type of treatment which may have effectively altered the earlier course of these patients.