CHAPTER 6 DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS 6.1 DISCUSSION It would not have been possible, from physical examination alone at the time of the resurvey, to conclude that the Rongelap and Allinginae groups had been exposed to penetrating gemm2 ~ and external beta radiation, The people were in average good health on physical examination. The residual pigment changes from previous skin lesions were not prominent. The mean peripheral blood counts were within the range of normal for individual counts, although definitely below the mean values for the %ntrol groups. The bone marrow findings were in no way diag- nostic, and thus a diagnosis of previous exposure would be difficult, if not' impossible, without a medical history. The marked improvement in the appearance oft’.: skin of most of the exposed individuals is in conformity with the superficial nature of the ea lier lesions that resulted principally from exposure to soft radiation. Even ie deeper skin lesions showed healing in all cases, with only minimal remaining evidence of damage in the form of scarring and pigment aberrations. The contrasting residual change of hyperpigmentation in the neck lesions and depigmentation in the foot lesions is worthy of comment. In general, the foot lesions were more severe than the neck lesions. It might be assumed that the chromatophores were destroyed; consequently, repigmentation was impossible. On the other hand, the chromatophoresof the neck apparently were not completely destroyed, and thus repigmentation resulted. It is significant that no secondary breakdown of tissue had occurred in either the superficlai or deep lesions, although there was sujgestive evidence of atrophy in the deep foot lesions and of atrophy and telangiectasis in the persistent ear lesion. Jt is possible that the deep lesions, particularly that on the ear of one individual, may still break down, requiring considera- tion of excision and repair. With regard to prognosis over the next several years, there are factors for and against the future development of further lesions, or cancer of the skin in these people. A favorable prognosis is suggested by (1} the superficial nature of most of the lesions with rapid healing and little scarring, (2) isck of gross telangiectasis or extensive vascular changes that would portend chronic radiodermastitis, (3) the lack of marked histologic changes after 6 months, and (4) the fact that the Negroid skin is repcrted to be less prone to develop malignancy. The prognosis still must be guarded, however, when one considers that (1) the large number of young people exposed with long life expectancy probably exceed the induction period of rancer development, (2) the continuous exposure to tropical sunlight, (3) the possible influence of the sublethal whole-body exposure, and (4) the persistent aberrations in pigmenta- tion. The apparent delay in recovery of mear peripheral blood counts to noi mal values has been discussed! in Chap. 4 and, apparently, is in keeping with previous experience on human exposures. Depression appears more protracted in human beings than in large animals. 36 TEMASKI a Sey ot wot een OT. oe LoS la: - rfteen A f