Preface The medical examinations of the Marshall erning authorities has changedtheir way oflife. Islanders accidentally exposed to radioactive fallThe missionariesbrought¢eligion, clothing, and out in 1954 have now-covered a span of@ years. changed ‘customs. A Helkar economy based on A 5-year period has elapsed since findings have copra production and employment by local govbeen presented in full, and this report includes deernments has tended gradually to supplant the entails of this period as well as a summary of the data vironmental!subsistence. for the entire 20 vears. Some background informaSanitary conditions and health care in the Martion is presentedfirst. shalls had been primitive, with treatment of the The Marshall Islands were chosen as an atomic -sick often involving a large elementof superstition bomb proving ground at-the time of Operation and magic, and apparently did not improve under Crossroads at Bikini in 1946 and were subseJapanese rule. During World War II the Marquently used for numeroustests at both Bikini and shallese were forced to live on low calorie diets Eniwetok until the moratorium was declared in with inadequate medical care. When the U.S. was 1958. These islands were chosen because oftheir madetrustee in 1947, the Navy, underthe ausisolated location in the vast, nearly empty ocean pices of its Bureau of Medicine and Surgery, unarea of Micronesia just north of the equator, east dertook a comprehensive medical survey ofisland of the Caroline Islands, and northwest of the Gilpopulationsin the Trust Territory including the bert Islands, about halfway between the Hawaiian Marshall Islands, using oneofits vessels, the USS Whidbey.) The survey showed that unsanitary conIslands and Australia. The Marshall Islands comprise 34 islands andatolls spread over some 180,000 ditions with regardtoflies, garbage disposal, and square miles of ocean. Each atoll consists of a lowexcretory habits made for multiple intestinal paralying chain of sandy, palm covered islands con- sitic infestations and diseases. A high percentage of nected bya reef surrounding and protecting a centhe people had positive Kah ;, associated with tral blue-green lagoon. Habitable land areaissur-..; * , and widespread treatment:with penicillin prisingly small — only about 70 square milesifishe:* . proved extremely effective.‘Diseases of the eyes entire Marshall Islands. The climate igt ical,axed isend.skin,2acute and chrofi& respiratory diseases, 4 the trade winds blow muchofthe year. es¢ afolls ®"°“andviteminedefaieisigs were especially common. involved in the 1954 accident areJétated inthe'~. o*mafifia..‘Blariasié, yellow:fevar,-gf cholera northern Marshalls: Rongelap “and ‘Allingnac* sse@n:Subsequent healthcareinHieTrust Terabout 100 nautical miles east of Bikini, Rongerik ritery was hamperedbylack of trained medical about 135 miles east of Bikini, and Utirik 275 personnel and poor transportation to the outer miles east of Bikini. islands. This was the status when our special medDuring the past century the Marshallese people ical examinations began. have been governed byfour countries. Germany Someof the events over the years in the Marpurchased the Marshall Islands from Spain in. sh allIIslands that are relevant to the medicalsurFe 1886 and governed them until 1917, when Japan3 oe ae) ireted iggAppendix|. took over under a League of Nations mandate; firstGxiqninatiogsin fisd'ja@¥érthe fallout — Japan declared ownership in 1933 when she broke: re conduttitdsFan emergency‘nedigakteam, from the League of Nations. The United States estetfaby:t Ae ee mic Energy Commission,: ‘* liberated the Marshalls in 1944, during Word .. _sdireined 25. Mae-Gronkite and composed % pergennel whose service’° yof Nayiy mniealmrel “slaggel y helpful for this field... erietite proved @& ueeaeDrivP.be were. conducted at 6 Islands; this was donefirst by the U.S. Navy and 23 <V.P. Bond and at 12 months later by the Departmentofthe Interior. The early explorers and traders foundtheis- 5, “> :CnActin a 956 théesurveys were placed Pr tite. diver Hit f theaurtheieat Brook- people, living in thatched huts, fishing from outnigger canoes, and subsisting entirely from the local environment. The increasing encroachment of civilization via traders, missionaries, and gov- have been conducted in conjunction with the Department of Health Services of the Trust Terntory and with the participation of medical specialists from the Armed Forces and from medicalcenters lands inhabited by friendly, gentle, primitiv@ttpevan 3 tiedelLahigatory.Sinceghentesurveys;i in br WarII, and was given authority under a Unit Natons mandate to administer the scattered isl of Micronesia as the Trust Territory of the Pacific - °