12 examiners. However, even at the nadir of depression (platelets, 28 to 30 days; granulocvtes, 42 to 46 days) no associated bleeding tendencyorincrease in infections was seen. Eleven individuals had platelet counts between 35,000 and 65,000 but without evidence of bleeding. Between days 23 and 42 post exposure, 10% of the Rongelap group developed granulocytopenia of < 1000 cells and 42% had leukocyte counts < 4000 or absolute granulocyte counts < 2500. During this period an epidemic of upperrespiratory infections occurred involving more than half the exposed population. Theillness in the higher exposure Rongelap group was no more severe than in the less exposed groups, and individuals in all groups were able to show an upward trendin leukocytes during the illness. Prophylactic treatment with antibiotics was notinstituted because it was considered wiser to withhold them until a real need mightarise. Antibiotics were given in certain cases where such therapyis ordinarily indicated. 2. Effects of Skin Exposure Beta burnsof the skin are described in detail in the original report of the medical findings.? The fallout was ubiquitous on Rongelap, Ailingnae, and Rongetik. The gritty white flakes clung to the moist skin, got into the hair, were inhaled, and were ingested with contaminated food and water. Areas of the skin covered by clothing were largely protected, and some whobathed in the lagoon and children who waded at the water’s edge unknowingly were protecting themselves since they were later found to have fewer skin burns. However, the majority of the people on Rongelap and Ailingnae had widespread contamination ofexposed surfaces of the body; the skin dose was probablyin the thousandsof rads and was due mostly to the beta component. Most of the people complained of itching and burning of the skin for the first 24 to 48 hr, and some complained also of burning and lachrymation of the eyes. This may have been duepartly to the caustic nature ofthe fallout. These symptoms were less evident in the American servicemen on Rongerik and were absent in the Utirik people. Table 6 shows the amountoffallout and theresulting skin burns for different groups. Personnel decontamination commenced on board the Navy ships used for evacuation, where the people were given saltwater showers and clothing donated by the crew. Onarrival at Kwajalein the skin was still contaminated, and decontamination procedures were continued for several days. Clothing was laundered repeatedly, and wasdis- cardedif its radiation level was not sufficientlyre- duced. Thefirst skin burns appeared about 12 to 14 days post exposure in the Rongelap people; burns appeared somewhat later in the Ailingnae and Rongerik groups and were less severe and extensive. About 90% of the Rongelap and Ailingnae groups and 40% of the Rongerik groups developed lesions, but none of the Utirik people. The lesions were multiple and spotty (Figure 5) and were characterized by superficial hyperpigmented macules, patches, or raised plaques, which desquamated within a few days leaving thin, pink epithelium (Figure 6). No erythemawas observed before or during developmentofthe lesions: it may have been lacking because ofinsufficient dose to dermis, or it may have been obscured by the darkness of the skin. Deeper burns with ulceration were noted in about 15% of the Rongelap people. Epilation (Figure 7) usually accompanied scalp lesions and was prevalent in >90% ofthe exposed Rongelap children (Table 7); it occurred to less degrees in adults and Ailingnae groups. Lesions were most commonontheanterior neck, axillae, antecubital fossae, and feet, but even the anal region in some youngchildren was involved. Lesions of the dorsum ofthe feet (Figure 8) were Table 6 Skin Lesions? Group Composition Fallout observed Skin lesions and epilation Rongelap Ailingnae Rongerik 64 Marshallese 18 Marshallese 23 White Americans Heavy (snowlike) Moderate (mistlike) Moderate (mistlike) Extensive Less extensive Slight Curik 5 Negro Americans 157 Marshallese None : None