The Voice of Autopsy for Peace, Hiroshima "75 Years A-Bomb" Dr.Soko DAY38/50 (continued writing by August 6, the Day of A-Bomb)

43 y.o. Male, injured head and arms, no burn

He was bombed at a wooden 2-storey house in Shimonaka-cho, about 800m from the hypocenter.

He was wearing only his pants, his upper body was naked. He had a lot of bleeding from his head and arms and had about 10 scratches on his back and the front of his legs.  After 30 minutes,  he had crawled out of his collapsed house. 

Day3: He went to work, but he had a slight fever and tiredness.
He absented from work from Day 4 to Day 13 and returned to the job from Day14.

Day16: When he met the director of the Saijo Sanatorium, Fujii, he recommended the man to enter the Saijo Sanatorium(Clinic),  so he immediately entered. After that, 39 degrees fever continued. He continued to be injected 100 ml of blood every day, vitamin C, and thrombogen (a drug that raises coagulation ability to stop bleeding). He took autologous blood transfusion once. 

Day 21:The fever reached 40 degrees. A blood test on Day 21 showed a marked decrease in white blood cells at 420. White blood cell count remained extremely low at 250 to 550 after that.

Day22: The fever was 40 degrees. His red blood cell count was 2,25 million which showed a marked anemia.

Day23: He passed away. Before he died his white blood cell count  was 170, which was an abnormally low value. 

Day 24:An autopsy was performed. 

Pathological Findings

Throat: Necrotic tonsillitis of the left tonsils (tonsillitis with ulcer), atrophy of the right tonsils, and many plasma cells in the tissues. Ulcerative pharyngitis.
Severe glottal edema
Severe pulmonary edema

Bleeding (epicardium, kidney, large intestine)
Edema of the meninges

Bone Marrow: Most of the bone marrow is white marrow (The bone marrow and is replaced by fat. It indicates the bone marrow was not producing blood). There are plasma cells, lymphocytes and erythroblasts in some places, and a small number of stab cells outside. A small amount of mega-myeloblasts (abnormal cells) was seen.

Testicles: The testicles are filled with degenerative and necrotic cells in the seminiferous tubules and are devoid of sperm. The atrophy of intercellular cells is marked.

Explanations：

A 43-year-old man who was injured when the building was destroyed by a blast at the time of the bombing but had no burns.

On Day3, the man who was responsible enough to go to work had worsening drowsiness and a slight fever.

For 2 weeks from Day 4, he had taken a rest at home, but he returned to work again.

Generally thinking, he must had had common symptoms as most of Hibakusha who were bombed near the hypocenter had. 

It can be inferred that he could not get enough water and food, because he had common symptoms like diarrhea, vomiting, sore throat, chest tightness and headaches, etc. 

Since there are few descriptions of his symptoms at the sanatorium, it can be imagined that he had been patient and did not talk much. Because the director Dr.Fujii at the Saijo Sanatorium saw the man and felt that he was seriously ill, so it is inferred that he had to strongly persuade him to enter the Saijo sanatorium.

The white blood cell count on Day 16 was 420 and on Day 23 was 170, unbelievably low.
Generally, in order to prevent a human-body from being infected, at very least 500 or more neutrophils, are required. Neutrophils are usually present in 50-70% of white blood cells, that means a human need at least about more than (1000-)1500 of white blood cells to live in a normal life.
So from day 16 onwards, the man had few neutrophils and no protection from any weak pathogens.

The doctor who saw this number must have felt this patient's end of a life coming soon. 

The high fever from a few days before he died, inferred he was in the septic state (a condition in which pathogens flow to the whole body along the bloodstream) due to the disfunction of his immune system. Then, the sepsis caused  a multiple organ failure (loss of function of multiple organs) . Those changes were originated from the radiation effect.