; Coole, Cote ; ct epee a ok we SR ae RENete tee Fa ate lesions only itching, burning sensation amd slight pain were experienced with the more super-— ficial lesions. With deeper lesions more severe pain was experienced. The deeper foot lesions were the most painful and caused some of the people to walk around on their heels for several days during the acute stages. Some of the more severe lesions of the neck and axilla were painful when turning the head or raising the arms. There were no constitutional symptams associated with the lesions. DESCRIPTION OF LESIONS l. Skin lesions* a. Gross The time of appearance and severity of lesions varied with the degree of skin exposure in the different groups. The Rongelap group which showed greatest radioactive camtamination of the skin (according to instrument readings) were first to develop lesions and epilation at about 12-14 days after the accident. They also suffered the most severe lesions. The lesser exposed Ailingnae and Rongerik groups lagged about a week behind in development of lesions which were less severe and extensive. The Utirik group.did not develop any lesions which could be attributed to irradiation of the skin. The relative severity of lesions in the different groups is apparent from the fact that 20 percent of the Rongelap people developed ulcerating lesions while only 5 percent of the Ailingnae and none of the Rongerik people developed lesions of this severity. Ninety percent of the people of Rongelap and Ailingnae developed lesions, compared with only forty percent of the Rongerik group. The lesions were not nearly so ex- tensive on an individual basis in the Ailingnae or Rongerik groups as in the Rongelap group. A comparison of the incidence and time of appearance of epilation and neck lesions in the two groups is illustrated graphically in figure 1. Nearly ail the lesions were spotty and developed on exposed parts of the body not covered by clothing during the fallout. The majority of individuals developed multiple lesions (par-— ticularly the Rongelap group), most of which were superficial. There were several days’ difference in the latent period for lesions on different skin areas. The order of appearance was roughly as follows: scalp (with epilation), neck, axillary region, antecubital fossae, feet, arms, legs, and trunk. Lesions on the flexor surfaces thus tended to precede those on the extensor surfaces. Tables 1 and 2 show the incidence according to of lesions in the various groups. age and time of appearance In the early stages all lesions were characterized by hyperpignentation in the form of macules, papules, or raised plaques. These frequently were smil, 1-2 mm. areas at first, but tended to coalesce into larger lesions in a few days. leathery feel. Most of them had a dry, thickened, In those lesions which were superficial in nature the pigmented stage was followed after several days by dry, scaly desquamation from the central part of the lesion outward, leaving pink to white somewhat thinned epithelium. As the desquamation proceded outward, a character— istic appearance of a central depigmented area fringed with an irregular hyperpigmented zone was seen (plate 11), Repigmentation began in the central area and spread outward over the next few weeks leaving skin of relatively normal appearance. Plates 3, 4, 11, and 12 show superficial] lesions as they appeared initially and six months later. One of the mildest manifestations of skin injury was the development of a blotchy increased pigmentation of the skin with barely perceptible desquamation. Such lesions were most often noted on the face and trunk, * The description of lesions refers to the Marshallese unless otherwise indicated. 427