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Retinal Hemorrhage as Seen in an Atomic-Bomb Casualty
RETINAL HEMORRHAGE IN ATOMIC-BOMB CASUALTY
799
'Lindner, K. Heilungsversuche bei prognostisch ungiinstigen Fallen von Netzhautabebungen. Zeit. f. Augenh., 1933, v. 81, p. 277. 'McAlester, A. W., and Borley, W. E. A double-bladed knife for scleral incisions in shortening of the globe. Amer. Jour. Ophth., 1944, v. 27, p. 641. "Miiller, L. Eine neue operative Behandlung der Netzhautabhebung. Klin. M. f. Augenh., 1903, v. 41, p. 459. 11 . Operative treatment of detachment of the retina. Ophth. Rev., 1913, v. 32, p. 324. " Pischel, D. K. Basic principles of retinal detachment operations, with special reference to eyeball shortening operation. Trans. Amer. Acad. Ophth. and Otolaryn., 194S, v. 49, p. 155. 13 , and Miller, M. Retinal detachment cured by eyeball shortening operation; report of case. Arch, of Ophth., 1939, v. 22, p. 974. " Morgan, O. G. Excision of ciliary staphyloma. Trans. Ophth. Soc. United Kingdom, 1943, v. 43, p. 182. " Spaeth, E. B. The principles and practice of ophthalmic surgery. Ed. 3, Philadelphia, Lea & Febiger, 1944, p. 567. " Vail, D. Equatorial scleral staphyloma and retinal detachment cured by excision. Amer. Jour. Ophth., 1941, v. 24, p. 403. " Wiener, Meyer. A surgical experiment in changing the refraction of the eye. Proc. Soc. Exp. Biol. and Med., 1940, v. 43, p. 384.
R E T I N A L H E M O R R H A G E AS SEEN IN AX ATOMIC-BOMB CASUALTY K A R L B.
BENKWITH,
M.D.
Montgomery, Alabama The writer was recently stationed in Japan as Force Surgeon on the staff of Marine General Ray Robinson, the Commanding General of the Fukuoka Occupation Force. W e were the first troops to arrive and assume occupation control of Northern Kyushu and Southern H o n shu, Japan, early in September, 1945. Located in Fukuoka was the Kyushu Imperial University and its medical school, which hospitalized many atomic-bomb patients from both Hiroshima and Nagasaki. Through the courtesy of Drs. T a m u r a and Ikui, who directed the Ophthalmic Institute of the Kyushu Imperial University, the illustrations for the case herewith reported were made available. T h e patient was a Japanese girl, aged 14 years, showing retinal hemorrhages as a result of the atomic-bomb explosion at Nagasaki, Kyushu, Japan, on August 9th. T h e salient fact was that this patient suffered from excessive gamma-ray ir-
radiations, which produced her clinical picture. She was first observed early in
Fig. 1 (Benkwith). The patient on October 10, 1945. Recent symptoms were petechiae in the skin, slight epilation, bleeding from the gums, and blurred vision.
800
KARL B. BENKWITH
September when an American-Japanese medical investigation team proceeded to Nagasaki to appraise the effects of the "bomb" on a cross section of the Nagasaki population. She was discovered to be ambulatory, although she had earlier suffered from malaise, headache, fever, nausea, and diarrhea. It was later (fig. 1) that she noted petechiae in her skin, slight epilation, bleeding from the gums, and blurred vision. She was hospitalized for observation at the Ophthalmic Institute, Kyushu Imperial University at Fukuoka, where initial blood studies showed a leucopenia of 2,200 white blood corpuscles, prolonged bleeding time, decrease of platelets, and an anemia of 2.2 million red blood cells. She showed no evidence of blast wounds, cuts, or burns. She was approximately one mile from the accepted hypo-center of the atomic-bomb explosion, in her home, which was demolished at that time. Examination of the fundi early in September showed a similar picture in each eye; that is, one of massive preretinal hemorrhages and hemorrhages into the fiber layer of the retina (fig. 2). These hemorrhages were distributed about the discs and in close association with the retinal vessels for approximately three disc diameters peripheral to the discs. In
the macula of the left eye was a large sausage-shaped hemorrhage appearing to be fed by the terminal arterioles and venules of that region. Small, fluffy, white exudates, were scattered about the disc and in close approximation to the retinal vessels of greater caliber. During hospitalization the patient remained ambulatory and received little specific medication except iron, persimmon-leaf extract, plus the Japanese diet of rice, vegetables, and tea. The ill effects of the excessive radiant energy on this patient gradually subsided, so that by November there was a definite clearing of the fundi. The retinal hemorrhages were absorbed faster than the whitish areas of apparent serofibrinous exudate, which also disappeared. Very little evidence of pathologic change was visible in the fundi by December. However, in the fundus of the left eye a small white, although more discolored, area persisted. This is shown in the drawing to lie just inferior to the macular region. The vitreous was clear of floaters, and the vision returned to normal. The patient's general physical condition showed improvement which coincided with the improved ocular findings. She was pronounced well and recovered at the turn of the year. 400 Norman Bridge Road (6)
799
'Lindner, K. Heilungsversuche bei prognostisch ungiinstigen Fallen von Netzhautabebungen. Zeit. f. Augenh., 1933, v. 81, p. 277. 'McAlester, A. W., and Borley, W. E. A double-bladed knife for scleral incisions in shortening of the globe. Amer. Jour. Ophth., 1944, v. 27, p. 641. "Miiller, L. Eine neue operative Behandlung der Netzhautabhebung. Klin. M. f. Augenh., 1903, v. 41, p. 459. 11 . Operative treatment of detachment of the retina. Ophth. Rev., 1913, v. 32, p. 324. " Pischel, D. K. Basic principles of retinal detachment operations, with special reference to eyeball shortening operation. Trans. Amer. Acad. Ophth. and Otolaryn., 194S, v. 49, p. 155. 13 , and Miller, M. Retinal detachment cured by eyeball shortening operation; report of case. Arch, of Ophth., 1939, v. 22, p. 974. " Morgan, O. G. Excision of ciliary staphyloma. Trans. Ophth. Soc. United Kingdom, 1943, v. 43, p. 182. " Spaeth, E. B. The principles and practice of ophthalmic surgery. Ed. 3, Philadelphia, Lea & Febiger, 1944, p. 567. " Vail, D. Equatorial scleral staphyloma and retinal detachment cured by excision. Amer. Jour. Ophth., 1941, v. 24, p. 403. " Wiener, Meyer. A surgical experiment in changing the refraction of the eye. Proc. Soc. Exp. Biol. and Med., 1940, v. 43, p. 384.
R E T I N A L H E M O R R H A G E AS SEEN IN AX ATOMIC-BOMB CASUALTY K A R L B.
BENKWITH,
M.D.
Montgomery, Alabama The writer was recently stationed in Japan as Force Surgeon on the staff of Marine General Ray Robinson, the Commanding General of the Fukuoka Occupation Force. W e were the first troops to arrive and assume occupation control of Northern Kyushu and Southern H o n shu, Japan, early in September, 1945. Located in Fukuoka was the Kyushu Imperial University and its medical school, which hospitalized many atomic-bomb patients from both Hiroshima and Nagasaki. Through the courtesy of Drs. T a m u r a and Ikui, who directed the Ophthalmic Institute of the Kyushu Imperial University, the illustrations for the case herewith reported were made available. T h e patient was a Japanese girl, aged 14 years, showing retinal hemorrhages as a result of the atomic-bomb explosion at Nagasaki, Kyushu, Japan, on August 9th. T h e salient fact was that this patient suffered from excessive gamma-ray ir-
radiations, which produced her clinical picture. She was first observed early in
Fig. 1 (Benkwith). The patient on October 10, 1945. Recent symptoms were petechiae in the skin, slight epilation, bleeding from the gums, and blurred vision.
800
KARL B. BENKWITH
September when an American-Japanese medical investigation team proceeded to Nagasaki to appraise the effects of the "bomb" on a cross section of the Nagasaki population. She was discovered to be ambulatory, although she had earlier suffered from malaise, headache, fever, nausea, and diarrhea. It was later (fig. 1) that she noted petechiae in her skin, slight epilation, bleeding from the gums, and blurred vision. She was hospitalized for observation at the Ophthalmic Institute, Kyushu Imperial University at Fukuoka, where initial blood studies showed a leucopenia of 2,200 white blood corpuscles, prolonged bleeding time, decrease of platelets, and an anemia of 2.2 million red blood cells. She showed no evidence of blast wounds, cuts, or burns. She was approximately one mile from the accepted hypo-center of the atomic-bomb explosion, in her home, which was demolished at that time. Examination of the fundi early in September showed a similar picture in each eye; that is, one of massive preretinal hemorrhages and hemorrhages into the fiber layer of the retina (fig. 2). These hemorrhages were distributed about the discs and in close association with the retinal vessels for approximately three disc diameters peripheral to the discs. In
the macula of the left eye was a large sausage-shaped hemorrhage appearing to be fed by the terminal arterioles and venules of that region. Small, fluffy, white exudates, were scattered about the disc and in close approximation to the retinal vessels of greater caliber. During hospitalization the patient remained ambulatory and received little specific medication except iron, persimmon-leaf extract, plus the Japanese diet of rice, vegetables, and tea. The ill effects of the excessive radiant energy on this patient gradually subsided, so that by November there was a definite clearing of the fundi. The retinal hemorrhages were absorbed faster than the whitish areas of apparent serofibrinous exudate, which also disappeared. Very little evidence of pathologic change was visible in the fundi by December. However, in the fundus of the left eye a small white, although more discolored, area persisted. This is shown in the drawing to lie just inferior to the macular region. The vitreous was clear of floaters, and the vision returned to normal. The patient's general physical condition showed improvement which coincided with the improved ocular findings. She was pronounced well and recovered at the turn of the year. 400 Norman Bridge Road (6)