PNStee way es aN ohn The Ne . “ . : . x ‘ weet Da, Mistnw oeke D“eadJme atee we ae INTRODUCTION Between approximately 5 and 10 hours after detonation of a Marshall Islands in the spring of 1954, a sigmificant amount of posited on neighboring Pacific islands. Exposure to fallout of these islands resulted in whole-body radiation from gamma rays, thermonuclear device in the radioactive fallout was depersonnel living on four of skin lesions and epilation largely from beta irradiation, and a minimal amount of internal radiation. concerned with the effects of fallout on the skin and its appendages. On the “snowlike,” skin. Less out was not severity of This report is mst heavily contaminated island the fallout was described as a powdery material, which fell over a period of several hours and whitened the hair and adhered to the striking fallout described as “mist-like” was observed on two other islands. Fallvisible on still another island which was camtaminated to only a mild degree. The the skin manifestations was roughly proportional to the amount of fallout observed. The canposition of the four island groups and incidence of skin lesions were as follows: Group Fallout Observed Composition Rongelap 64 Marshallese Rongerik 23 White Americans Moderate (mist-like) Ailingnae Utirik 18 Marshallese _ Heavy (snow-like) Moderate (mist—Like) 5 Negro Americans 157 Marshallese None Extensiveness of Skin Lesions and Epilation Extensive Less Extensive Slight No Beta Lesions or Epilation Evacuation of exposed personnel to Kwajalein where medical facilities were available, was accomplished one to two days after the event. It was not until this time that thorough decontamination of the skin was possible. Skin examinations were carried out almost daily during the first 11 weeks and then again at 6 months and 1 year after the accident. Examinations of unexposed Americans and native personnel were also carried out for comparative purposes. Color photographs and biopsies of lesions in various stages of development were taken. SIGNS AND SYMPTOMS During the first 24-48 hours after exposure, about 25 percent of the Marshallese in the two higher exposure groups experienced itching and burning sensation of the skin and a few also complained of burning of the eyes with lachrymation. Those symptoms were present to a much lesser extent in the Americans on Rongerik atoll who were aware of the danger, took shelter in their butler-type buildings and bathed and changed clothes. These precautions greatly reduced the subsequent development of skin lesions in this group. The people on Utirik, the furthest group away from the detonation, suffered no early skin symptoms. By the time of evacuation, one to two days after the event, all symptomatology subsided. On arrival of an emergency medical team on the ninth post-exposure day, the exposed personnel all appeared to be in relatively good health with no unusual findings on skin examinations. The only evidence _of radiation injury was significant depression of peripheral blood elements. However, further evidence of radiation injury became apparent about two weeks after the accident when epilatim and skin lesions began developing. Erythema of the skin was not observed either during the early examinations when a primary erythema might be expected, or later when a secondary erythema might be expected. After subsidence of the initial skin symptoms there were no further symptoms referrable to the skin until the gross beta lesions developed. During the early stages of developing Cc) AC Vo to C54 425