of healing, and absence of pigmentation. These puints would apply to the Marshallese except
for the multiphasie reactions and pigmentation. Crawford® reports a case of cathode ray burns
of the hands which were similar to those described by Robbins, et al?
Experimental beta radiation burns in human beings have been reported by Low- Beer® and
Wirth and Raper! Both investigators used P?? dises applied (o the flexor surfaces of the
arms, forearms, or thighs for varying lengths of time. Low: Beer reported “monophasie” skin
reactions. He found that a calculated dose of 143 rep to the first millimeter of akin, ignoring
self-absorption, produced a threshold erythema. Dry, scaly, desquamation was produced by
7200 rep in the first millimeter and bullous, wet desquamation was produced by 17,000 rep to
the first millimeter, Erythema developed in 3 to 4 days, followed later by pigmentation and
desguamation with higher doses.
Recovery was observed with doses of 17,000 rep,
‘Phe lestons
later showed depigimented centers with hyperpizmented edges (also seen in the present lesions).
Wirth and Raper’? produced primary erythema within 6 hours afler exposure to a dose of
635 tu 1180 rep of P™ radiation. Minute vesicles with dry, spotty desquamation were noted with
1180 rep at about the 5th to 6th weeks post-exposure.
Following the detonation on 1 March 1954, 23 Japanese fishermen were contaminated with
fallout material. Apparently they were exposed to roughly the same total-body dose of radiation as were the Rongelap group. The skin Jesions which developed are described by Morton,
et al."'-!?) Lesions developed which were sinillar in most respects to those seen in the Marshallese people, and were characterized by pigmentation, desquamation with depigmentation,
spolty epilation of the head and ulcerations developing particularly on the scalp, ears, neck,
and hands (the latter probably from handling contaminated fishing lines). Erythema and vesicle
formation, as well as inflammation of the eyes were more prominent than in the Marshallese.
Pigmentation apparently was not as prominent in the Japanese. The lesions appeared earlier
than in the Marshallese (about 7 to 8 days post-exyp sure). As in the Marshaliese the lesions
occurred mainly on exposed parts of the body not protected by clothing.
°
In addition to the Marshallese and Japanese, several Navy men on ships in the test area
developed a few smali pigmented lesions of “belt-line” distribution, apparently due to fallout
material,
.
-4
The lesions reported in this paper when compared tou radiation lesions described in the
past presented certain unique features which merit further discussion.
The early symptoms of itching and burning of the skin and eyes were probably due mainly
{to skin irradiation from (the fallout material. However, the chemical nature of this material
may have contributed to the irritation. It has been noted’? that irritating chemucais applied
during or shortly after irradiation enhance the effects of radiation.
The lack of prominence of an erythema was notable, particularly in view of the severity of
some of the lesiong that developed. Wilhelmy!‘ states that erythema only occurs when the dose
reaching the papillary layer exceeds a certain level. Perhaps the dose to the dermis was insufficient tu evoke the response. On the other hand, the darkness of the skin and the development of hyperpigmentation may have masked an erythema. Microscopically, a superficial
hyperemia was not a notable finding.
Wirth and Raper’? point out that they were impressed in their studies on p* radiation of
the human skin with the difficulty of distinguishing between true erythema and tanning, par-
ticularly in the skin of brunette individuals. It was unfortunate that color filters were not
available to aid in distinguishing an erythema as suggested by Harris, et al.'*
In genera] the latent period before development of obvious signs and symptoms for radiation injury to the skin is inversely proportional to the dose of radiation.'®’'’ In the present
series of cases the relatively long latent period is suggestive of a low dose of radiation. However, the wide spectrum of beta eneryies and particulate distribution of radioactive material
‘drastically altered the depth dose, as compared with that in previous experlence; hence strict
comparisons cannot be made. The later development of lesions in the Ailinginae and Rongerik
groups as contrasted with the Rongelap people is in keeping with the relative severity of
lesions noted.
43