72 Bikini (see Table 41 and Appendix 12), and a gamma surveyof the island was made by Greenhouse et al.15§ (see Appendix 14). On Bikini Island almost all the gamma radiation is now due to !37Cs,. The gammalevel due to ining groups have been concerned also with gen- eral health care at the timeof their visits. The responsibilities have been filled by carrying out ex- natural radioactivity is considerably less on these tensive annual examinations, supplementedin recent years by semiannual hematology checks and quarterly visits by a resident physician. The exam- gammadose to an inhabitant is lower in Bikini assistance of the Trust Territory Health Services, islands than in the U.S.; this is whythe average Village than in certain parts of the U.S. The peopleliving on Bikini eat a diet consisting almost entirely of imported food, but they ingest slight amountsofradioactivity from local seafood. The newly planted coconut, pandanus, and breadfruit trees will not bear fruit in any significant quantity for some years yet. The urinary radionuclidelevel of the Bikini people is now several times as high as when they wereliving on Kili Island, butstill considerably below the permissible range. Thetotal estimated internal bone marrowdose in 1974 to the people living on Bikini was about half that to the people living on Rongelap, but with the ex- ternal dose included, the dose to the bone marrow was about the same(see Table 42). It is reassuring that analyses of urine for plutonium show levels near backgroundin the Bikini people (see Table 37). Well water on Bikini has had towlevels of ac- tivity (see Table 38). The dietary levels projected for Bikini when the newly planted trees bear fruit should be considerably lower than the levels based on analysesoffruit from old trees because of the soil removal procedures used at planting, but their actual evaluation must await maturity of thetrees and further analyses. It is planned to add supplementarycalcium to the diet of the Bikini people to help reduce absorption of Sr. Experiments are under wayto investigate the tolerance of Mar- © shallese people for powdered milk as a source of calcium. Races other than the Caucasian are reported to have a lowertolerance for milk because of a genetic inability to digest lactose which gives rise to abdominal discomfort, diarrhea, and other symptoms.!75 Vil. Comments and Conclusions A. THE EXAMINATIONS The primary responsibility assigned the medical team by the AEC (now ERDA)was the diagnosis and treatmentof possible effects of radiation exposure in the Marshallese, but inevitably the exam- inations, which have been carried out with the ’ have resulted in extensive medical histories and records for each individual and have madeit possible to diagnose and treat many diseases andillnesses at an early stage. An important aspect of the medical surveys is to maintain rapport with the people, to keep them informed of the medicalfindings, to explain the need for examinations, and at times to correct un- founded rumors about fallout effects. Unfortunately this has not always been successfully kept up because ofdifferences in language and culture. Somestudies have been of benefit to the Marshall Islands as a whole, such as the surveys of the incidence of diabetes and of parasitic infestation. In addition, a great deal of data has accumulated from studies of genetically inherited characteristics which mayprovevaluable not only in determining possible genetic effects of radiation but also in anthropology. B. COMPARISON WITH OTHER HUMAN EXPOSURES In contrast to other groups exposed to radiation, the Marshallese are unique in that they comprise the only human population ever exposed to acute radiation from fallout. accident tention for thefirst time on the hazards offallout anatiantatricblasts above det iroshima and Nagasaki resulted in casualties due to penetrating gammaand neutronradition directly from the bombs with little or no fallout involved and therefore caused noeffects dueto internal absorption of radioactive materials. In contrast, the Marshallese were not exposedto direct effects of the detonation but only to radioactive fallout resulting in whole-body, skin, and internal exposure. Trauma and extreme psychological disturbances did not contribute to the effects in the Marshallese as they did in the Japanese. The importance of the hazard from internal absorption of radioactive iodine has been clearly demonstrated by the Marshallese experience. The 23 Japanese fishermen on the Lucky Dragon received an exposure similar to that of the Rongelap group but