44

cytes. Slight depression of red blood counts, hematocrits, and hemoglobin has beennoted at times.
Bone marrow smears taken at 6 months showed no
gross abnormalities. Smears taken at 8, 9, and 10
years showed an alteration in the myeloid-erythroid ratio manifested by an increased numberof
red cell precursors. Depression of peripheral blood
elements in the Ailingnae and Rongerik groups
was not so pronouncedas in the Rongelap group.
However, a slight lag in complete recovery in the
Ailingnae peripheral blood count has also been
noted. The persistent depression of peripheral
blood elements in the exposed people makes it appearlikely that there is slight residual bone marrow damage.
A general anemic tendency has been evident in
both exposed and unexposed Marshallese. PriceJones curves, on the average, showed slight
microcytic tendency. Serum iron levels have been
generally normal, and the cause of this anemic
tendencyhas been undetermined.
Reticulocyte counts have been about the same in
the exposedas in the unexposed.
Clinicalfindings, except for radiation-induced
lesions of the skin, patchy epilation, and early
gastrointestinal symptoms, revealed no clear-cut
disease processes or symptoms which could berelated directly to radiation effects during thefirst
few years post exposure. No prophylactic or specific therapy for radiation effects was ever considered necessary or given. Epidemics of chicken
pox and measles that occurred during the first
year showedno greater incidence orseverity in the
exposed than in the unexposed Marshallese people.
During thefirst months post exposure about %
of the exposed people exhibited loss of weight of
several pounds. This may possibly have been related to their radiation exposure, although it was
difficult to rule out possible effects due to change
of environment.
At 3 years post exposure the immune response to
primary and secondary tetanus antitoxin was
tested and found not to be significantly different
in the exposed compared with the unexposed
populations.
Beta Irradiation of the Skin

It was impossible to get an accurate estimate of
the radiation dose to the skin. Beta burns of the
skin and epilation appeared about 2 weeks after
exposure, largely on parts of the body not covered
by clothing. About 90% of the people exposed on

500630!

Rongelap had these burns, and a smaller number
developed spotty epilation of the scalp. Most of
the lesions were superficial; they exhibited pigmentation and dry, scaly desquamation, and were
associated with itching and burning sensations.
Rapid healing and repigmentation followed. Some
lesions were deeper, showed wet desquamation,
and were morepainful. A few burns becamesecondarily infected and had to be treated with antibiotics. Repigmentation of the lesions gradually
took place in most instances, and the skin appeared
normal within a few weeks. However, in about 15%

of the people, deeperlesions, particularly on the

dorsum of the feet, continued to show lack of re-

pigmentation with varying degrees of scarring
and atrophy of the skin.
Numeroushistopathological studies have been
made,!-45 and the changes found have been con-

sistent with radiation damage.
Spotty epilation on the heads was shortlived,
regrowth of hair occurring about 3 monthsafter
exposure and complete regrowth of normal hair
by 6 months. No further evidence of epilation has
been seen.

An interesting observation noted during the
first few months after exposure was the development of bluish-brown pigmentation of the semilunarareasof thefingernails and toenails in about
90% of the people exposed on Rongelap. By 6
monthsthis pigmentation had disappeared, having grown out with the nail. The cause of this
phenomenonis not known.
Internal Irradiation

Radiochemical analyses of numerous urine
samples of the exposed population showedinternal absorption of radioactive materials, probably
brought aboutlargely through eating and drinking contaminated food and water and to a lesser
extent through inhalation. Duringthefirst few
days when the bodylevels were at their highest,

the maximum permissible concentrations were approachedorslightly exceeded only in thecase of
strontium-89 and the isotopes of iodine. At that
time the concentrations were believed to be too
low to result in any seriouseffects. Body levelsfell
rapidly, so that by 2 and 3 years post exposure
they were far below the accepted maximum permissible level; even by 6 months activity in the
urine was barely detectable. No acute effects were
observed that could be related to internal exposures. As seen later, however, the significanceof

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