14 lief of itching and pain. Antibiotics were used in a few cases of secondary infections. The lesions healed within a few weeks with only minimal sequelae (described below). These observations makeit apparent that beta burnsof the skin having acute symptomsassociated 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 more serious skin infections considerably complicating the skin symptoms. 3. Effects of Internally Absorbed Radionuclides As pointed out in Section IT. A., radiochemical urine analyses beginning 15 days after the accident indicated that the Rongelap people and to a 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). Althoughseriouslate effects have developed due to radioiodine exposureto 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 duringthefirst 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. lll. Findings on Follow-Up Examinations (Late Effects) During the first 10 years, after the early effects and before the development of thyroid abnormalities, few medical findings could be definitely associated with radiation exposure. The general health of the exposed Marshallese appeared to be aboutthe sameas that of the unexposed Marshall- ese comparison population, with the same types and incidenceof diseases. The deaths that occurred were not related to radiation exposure. In the Rongelapese a few findings were considered to be connected with radiation exposure, such as resid- ual skin effects; an increase in miscarriages and stillbirths during the first 5 vears; suggestive evidence of a lag in complete recovery of peripheral blood elements; evidence of slight chromosome aberrauonsof the peripheral blood, and somedegree 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 heralded during thefirst decade. ‘The most important were the widespread devel- opmentof 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 Marshall Islands is in Many respects improving. Most vector-borne diseases ofthe tropics do not occur,leprosy is rare, and tuberculosis is not a serious problem. Cardiovasculardiseases are rare (exceptfor diabetic gangrene ofthe feet). The public and personal hygiene leave much to be desired. Skin infections (impetigo and fungus) and intestinal infestations (amoebae and worms) are endemic. In 1958, one yearafter their reset- tlement on Rongelap Atoll, 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 fAistolytica (found in 18.2%), hookworm (5.5%), Trichurs trichtura (34.3%), and Giardia lamblia (7.7%). Flagellates also in- cluded Trnchomonas homints. No significant differences were noted between the incidencesin the exposed and unexposed populations. Recently Ascans has been introduced into the Marshalls from other districts and infestation with it has becomeprevalent. Education and constant surveillance will be needed to overcome the parasite problem. Eosinophilia is commonbutis not always associated with helminthic infestations. *These studies were done by Dr. M. Goldman and Mr. R.K. Carver, Communicable Disease Center, Chamblee, Ga.