This paper is an intermediate report of the clinical observations and various investigations made upon the 16 patients of the radiation sickness caused by BIKINI ashes on. 1st March 1934. The patients were admitted to the First Tokyo National Hospital on March 28th, and this report shall be for the period of the 5 months from March 28th to the end of August, 1964. Later, a thorough and complete report will be given, in which some amendments may be added to the present paper.
INTRODUCTION: At 3.50 a. m. on 1st March 1954, the 5th Lucky Dragon, a fishing boat, with a crew of twenty three on board, was located at about 100 miles east of BIKINI. The boat was under grey-white ash-fall for more than 5 hours. The crew was exposed to the ash-fall for 1.5 to 5 hours. The evening of that day they suffered from headache, anorexia, conjunctivitis and later nausea, vomiting, exhaustion and diarrehea, Several days later they suffered from itching, pain, rash, and erosion on the exposed skin areas. One week later two of the crew had hemorrhage of gingiva and some of the crew suffered from depilation. On March 19th, the boat returned to its base at Yaizu. On March 16th, the crew was admitted to the Kyoritsu Yaizu Hospital and on March 28th, 16 patients out of 23 were transfered to our hospital (the First Tokyo National Hospital).
On March 26th, Prof. Kimura's laboratory of Tokyo University made the analysis of the ashes taken from the 5th Lucky Dragon and found the following radioactive substances: Sr-89, Sr-90, Y-90, Y-91, Zr-96, Nb-95m, Nb-95, Ru-103, Ru-106, Te-129m, Te-129, Te-132, I-131, I-132, Ba-140, La-140, Ce-141, Ce-144, Pr-143, Pr-194, Nd-147, Pm-147, S-35, Ca-45, U-237, and Pu-239. The remaining radiation of the boat was investigated by Dr. Kakei et al. of March 17th and found it to be around 100mr/hr. Upon this data the total radiation was estimated at a count of 270 to 440γ. on the crew. In addition to the external exposure of such radiation, internal exposure, such as respiration of contaminated air, drinking of contaminated water and taking of contaminated food, shall be taken into consideration in the present cases. Radioactivity was found in the bile and urine taken from the patients.
GENERAL REMARKS: The 16 cases were strong young men but their body weight began to decrease from the middle of May and high or slight fever, anorexia, feeling of exhaustion, diarrhea and headache continued.
Skin and Hair: Irregular depilation, depigmentation, pigmentation with rain and itching, and erosion was observed. Some cases had folliculitis with pustules in April, while others recovered from erosions and at the end of May, regeneration of hair began. In July, hair condition was almost normal.
Blood and Bone-marrow: At the middle of April, the lowest peripheral leucocyte count was less than 2, 000. Two cases who had lower leucocyte count recovered earlier, i. e., their leucocytes increased to around 5, 000 at the middle of May. Meanu hile, the other cases had from 3, 033 to 4.000 count during the entire period. The former cases had also moderate anemia while the latter had only slight anemia. Blood platelet count of the former cases was less than 20, 000 and the recovery was slower than that of the leucocyte count. Reticulocyte count kept pace with that of leucocyte. In the former cases, myelocyte and other immature blood cells appeared temporarily in the circulated blood and eosinophile cells increased. The count of bone-marrow cells decreased remarkably (8, 000), i. e. panmyelophthisis, which later recovered slowly. In the latter cases, peripheral leucocyte findings and myelogram had almost no changes from the beginning of our observation and count of bone marrow cells was remarkably different by the sites of bone-marrow puncture. Vacuole and toxic granula appeared in the neutrophile cells in the circulated blood and vacuoles also appeared in lymphocyte and monocyte.

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The present paper is a intermediate report of autopsy of the late Mr. Kuboyama who was on the boat which was exposed to ash-fall near Bikini on March 1st, 1954. He was on the boat as chief radio operator for 2 weeks after the exposure.
The case developed acute radiation sickness in which radiation dermatitis and general myelopathia were the chief symptoms. For these symptoms, blood infusion, blood-plasma infusion, administration of antibiotics and other treatments were tried. In June the case developed liver disturbances with icterus and in spite of the findings of recovery in the blood picture, the case developed cholemia and ascites, and finally into leukemic blood reactions and the patient died on the 207th day of exposure. The result of autopsy is as follows:
1. Partial recovery picture in bone-marrows from general myelopathia. (Fig. 1)
2. Atrophic degenerations of lymphatic nodules. (Fig. 9)
3. Atrophy and function disturbance of testis. Swelling of the basal membrane of seminal tubules. (Fig. 10)
4. Atrophy of liver (860g) with inflammatory cell infiltration and slight cirrhosis. (Fig. 2, 4, 5)
5. Atrophic spleen (90g) with congestion. (Fig. 6)
6. Turbidity and swelling of pancreas (120g) with several small fat necrosis.
7. Serious cholernic nephrosis of kidneys (220g-left; 190 g-right). (Fig. 8)
8. Atrophic degeneration of myocardium Exudation in the interstice. Hemorrhage in the endocardium of left ventricle. Heart (320g). (Fig. 7)
9. Pneumonia with mixed infection of Aspergillus Fumigatus at the upper and lower lobes of left lung and the upper lobe of right lung. (Fig. 3)
10. Degenerative atrophy and partial acute inflammation of gastroenteric membrane and lymp hatic system.
11. Exudation at thoratic cavity (14cc-left; 17cc-right). Ascites (2, 600cc).
12. Remarkable yellow turbidity and partial hemorrhage at skin and mucosa.
13. Medium edema at bilateral insteps.
The most important findings were the fatal liver disturbances of the endodermal system. Generally, it is said that the liver is radiation-resistant. However, in the case of Mr. Kuboyama, not only was he externally exposured but also internally exposured and radiation hepatopathia shall be considered. Incidentally, Dr. Kimura's laboratory of Tokyo University Chemical Science Department found positive fission products in the liver tissues of Mr. Kuboyama. These data are under carefull consideration. Of course we cannot deny the secondary virus hepatitis, subsquent to the blood or blood-plasma infusion which was a thoroughly necessary measure in the treatment of the case. However, it may be considered that the said radiation hepatopathia induced the infection of virus hepatitis or in the least accelerated the development of virus hepatitis. The problem is, together with the infection of aspergillus fumigates pneumonia, one of the important questions in our studies.

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