I4 lief of itching and pain. Antibiotics were used in connected with radiation exposure, such asresid- healed within a few weeks with only minimal sequelae (described below). These observations make it apparent that beta burns of the skin having acute symptoms associated with the lesions may be a serious consequence of fallout exposure. The Marshallese could have avoided manyofthe lesions if they had known to take the proper precautions such as protecting the skin from fallout and early cleansing. Had the whole-body radiation dose been greater,the reduction in immuno-hematological defenses might have resulted in moreserious skin infections considerably complicating the skin symptoms. stillbirths during the first 5 years; suggestive evidence of a lag in complete recoveryof peripheral a few cases of secondary infections. The lesions 3. Effects of Internally Absorbed Radionuclides As pointed out in Section II. A., radiochemical urine analyses beginning 15 days after the accident indicated that the Rongelap people andto lesser extent the other exposed groups had absorbed considerable amounts of radionuclides by inhalation and by ingestion of contaminated food and water? (see Table 3). Although seriouslate effects have developed due to radioiodine exposure to the thyroid, and near maximum permissible doses of several other radioisotopes were absorbed, no acute symptoms associated with absorbed isotopes appeared, the only exception being a posstble role of the estimated 3 mCiof radioisotopes in the G.I. tract during thefirst two days in causing the early G.I. symptoms. These observations indicate that lack of early symptoms associated with ingestion of radioactive material in an acutefallout situation does not preclude developmentoflate effects from such ingestion. Hl. Findings on Follow-Up Examinations (Late Effects) Duringthe first 10 years, after the early effects and before the developmentof thyroid abnormalities, few medical findings could be definitely as- sociated with radiation exposure. Thegeneral health ofexposed the Marshallese appearedto be__ about same the sameasthat the of the unexposed Marshallese comparisonpopulation, w with the sametypes _ andincidence ofdiseases, The deathsthat occurred were notrelated to radiation exposure. In the Rongelapese a few findings were considered to be ual skin effects; an increase in miscarriages and blood elements; evidence of slight chromosome aberrationsof the peripheral blood, and some de- gree of growth retardation in a fewchildren. Other studies on possible late effects during this period were negative (cataracts, aging, mortality, longev ity, malignancy). During the second decade following exposure, effects developed in the Rongelap people which had not been heralded during the first decade. The most important were the widespread developmentof thyroid abnormalities, associated with growth retardation in some children. A fatal case of leukemia and a possible increased incidence of malignancies may or may not have been radiation related; the numbers are too small to permit any definite conclusions. These findings are reviewed below. A. GENERAL MEDICAL FINDINGS The health situation in the MarshallIslands is in many respects improving. Most vector-borne diseases of the tropics do not occur, leprosyis rare, and tuberculosis is not a serious problem. Cardiovascular diseases are rare (except for diabetic gangreneofthefeet). The public and personal hygiene leave muchto be desired. Skin infections (impetigo and fungus) andintestinal infestations (amoebae and worms) are endemic. In 1958, one yearafter their resettlement on RongelapAtoll, stools were examined from 69 exposed and 112 unexposed people.’* Infestation was widespread with manyindividuals showing multiple types of parasites, the main pathogens being Entamoeba histolytzca (found in 18.2%), hookworm (5.5%), Trichuns trichura (34.3%), and Giardia lamblia (7.7%). Flagellates also included Trichomonas homints. No significant differences were noted between the incidences in the exposed and unexposed populations. Recently Ascans has been introduced into the Marshalls from other districts and infestation with it has become prev- alent. Education and constant surveillance will be needed to overcome the parasite problem. Eosinophilia is common butts not always associated with helminthic infestations. *These studies were done by Dr. M. Goldman and Mr. RK. Carver, Communicable Disease Center, Chamblee, Ga.