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 Ailinginae groups had been exposed to penetrating gamma
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 pe-
riphera] blood counts were within the range of normal for individual counts, although definitely
below the mean values for the control groups. The bone marrow findings were in no way diagnostic, and thus a diagnosis of previous exposure would be difficult, if not impossible, without
a medical history.
The marked improvement in the appearance of the skin of most of the exposed individuals
is in conformity with the superficial nature of the earlier lesions that resulted principally from
exposure to soft radiation. Even the 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 chromatophores of 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 superficial or deep lesions, although there was suggestive evidence of atrophy in the deep foot lesions
and of atrophy and telangiectasis in the persistent ear lesion. It is possible that the deep lesions, particularly that on the ear of One individual, may still break down, requiring consideration 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) lack of gross telangiectasis or extensive vascular
changes that would portend chronic radiodermatitis, (3) the lack of marked histologic changes
after 6 months, and (4) the fact that the Negroid skin is reported 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 cancer development, (2) the continuous exposure to tropical sunlight, (3) the possible
influence of the sublethal whole-body exposure, and (4) the persistent aberrations in pigmentation.
The apparent delay in recovery of mean peripheral) blood counts to normal 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.
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“y
CHAPTER 6