Despite growing concern about the demise of coral reefs in many areas of the world, few studies have investigated the possibility that bacteria- or virus-caused diseases may be important agents in the disappearance of living coral tissue from reefs, and that their occurrence and transmission may be influenced by natural or man-made changes in water quality, particularly increased sedimentation and turbidity. One forereef site off St. Croix, U. S. Virgin Islands, and three shallow-water reef sites off Puerto Rico were examined for variations in coral composition, local environmental conditions, and the presence of possible diseases in the stony corals. Visual observations were supplemented with standard histopathological examination under the light microscope of tissues from 257 specimens (representing 9 genera and 13 species), along with additional samples obtained from the Netherlands Antilles, the Grenadines, the Florida Keys and the Smithsonian Coral Reef Microcosm. This procedure proved to be necessary to accurately determine the condition of the colony, to detect the presence of microorganisms, and to correlate tissue health and microparasite infestations with apparent symptoms. These lesions varied with the species and the site. For example, off Guayanilla Bay, three species showed increased or decreased mucosecretory cell development, and another exhibited an unusual microparasite, which may be related to the chronic sedimentation at this site. Although colonies of several species showed signs of “white band disease” at five locations, bacterial colonies composed of Gram-negative rods were present only in acroporid tissues from the relatively pristine St. Croix site and the Netherlands Antilles. The distribution and possible mode of occurrence of these and other diseases and microparasite infestations suggest that acute changes in microhabitat conditions or injuries to individual colonies may be as important to the development of some of these lesions as are chronic adverse environmental conditions over a particular reef.