14 lief of itching and pain. Antibiotics were used in a few cases of secondaryinfections. The lesions healed within a few weeks with only minimal sequelae (described below). dence of a lag in complete recovery of peripheral blood elements; evidence of slight chromosome These observations make it apparentthat beta burns of the skin having acute symptomsassoctated with the lesions may be a serious consequence of fallout exposure. The Marshallese could have avoided manyofthelesions if they had knownto 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. 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 development of thyroid abnormalities, associated with 3. Effects of Internally Absorbed Radionuclides of leukemia and a possible increased incidence of as pointed outin Section IT. 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 considerable amounts of radionuclides by inhalation and by ingestion of contaminated food and water? (see Table 3). Althoughserious late 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 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 thatlack of early symptoms associated with ingestion of radioactive material in an acute fallout situation does not preclude developmentoflate effects from such ingestion. lll. Findings on Follow-Up Examinations (Late Effects) Duringthe first 10 years, after the early effects andbefore the developmentof thyroid abnormalities, few medical findings could be definitely associated with radiation exposure. The general health of the exposed Marshallese appeared to be about the sameas thatof the unexposed Marshailese 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 “OOObT TI connected with radiation exposure, such as residual skin effects; an increase in miscarriages and stillbirths during thefirst 5 vears: suggestive evtaberrationsof the peripheral blood, and some de- gree of growth retardation in a few children. Other studies on possible late effects during this period were negative (cataracts, aging, mortality, longevity, malignancy). growth retardation in some children. A fatal case 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 Marshail Islands is in many respects improving. Most vector-borne diseases of the tropics do not occur, leprosyis rare, and tuberculosis is not a serious problem. Cardio- vascular diseases are rare (except for diabetic gan- greneofthe 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 yearafter their reset- tlement on Rongelap Atoll, stoois 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%), Trichurts tnchwura (34.3%), and Giardia lamblia (7.7%). Flagellates also included Trichomonas hominis. No significant differ- ences 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 prevalent. 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.