1+ lief of itching and pain. Antibiotics were used in a few cases of secondary infections. Thelesions healed within a few weeks with only minimal sequelae (described below). These observations make it apparent that beta burns of the skin having acute symptomsassociated with the lesions may be a serious consequence of fallout exposure. The Marshallese could have avoided many ofthe 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 re- duction in immuno-hematological defenses might have resulted in more serious skin infections con- siderably complicating the skin symptoms. 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 a lesser extent the other exposed groups had absorbed connected with radiation exposure, suchasresidual skin effects: an increase in miscarriages and stillbirths during the first 5 years; suggestive evidence of a lag in complete recovery of peripheral blood elements; evidence of slight chromosome aberrations of the peripheral blood, and some degree of growth retardation in a few children. Other studies on possible late effects during this period were negative (cataracts, aging, mortality, longevity, malignancy). During the second decade following exposure, effects developed in the Rongelap people which had not been heraided duringthefirst 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. considerable amounts of radionuclides by inhala- tion and by ingestion of contaminated food and water? (see Table 3). Although seriouslate effects have developed dueto radioiodine exposure to the thyroid, and near maximum permissible doses of several other radioisotopes were absorbed, no acute symptomsassociated with absorbed isotopes appeared, the only exception being a possible role of the estimated 3 mCiofradioisotopes in the G.I. tract during the first 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 notpreclude developmentoflate effects from such ingestion. Ill. Findings on Follow-Up Examinations (Late Effects) Duringthe first 10 years, after the early effects and before the developmentof thyroid abnormalities, few medicalfindings could be definitely associated with radiation exposure. The general health of the exposed Marshallese appeared to be about the sameas that of the unexposed Marshallese comparison population, with the same types andincidenceof diseases. The deaths that occurred were not related to radiation exposure. In the Rongelapese a few findings were considered to be A. GENERAL MEDICAL FINDINGS The health situation in the Marshall Islands is in many respects improving. Most vector-borne diseases of the tropics do not occur, leprosy is rare, andtuberculosis is not a serious problem. Cardiovascular diseases are rare (except for diabetic gangreneofthe feet). The public and personal hygiene leave much to be desired. Skin infections (impetigo and fungus) andintestinal infestations (amoebae and worms) are endemic. In 1958, one year after their reset- tlement on Rongelap Atoll, stools were examined from 69 exposed and 112 unexposed people.7* Infestation was widespread with manyindividuals showing multiple types of parasites, the main pathogens being Entamoeba histolytica (found in 18.2%), hookworm (5.5%), Trichunis trichtura (34.3%), and Giardia lamblta (7.7%). Flagellates also included Trichomonas hominis. No significant differences were noted between the incidencesin the exposed and unexposed populations. Recently Ascarzs has been introduced into the Marshalls from other districts and infestation with it has become prevalent. Education and constant surveillance will be needed to overcome the parasite problem. Eosinophilia is commonbutis not always associated with helminthicinfestations. *These studies were done by Dr M Goldman and Mr. R.K. Carver, Communicable Disease Center, Chamblee, Ga.