HISTORICAL REVIEW The history of medical concern in the off-site area and the Medical Liaison Officer Network (MLON) is tied closely to the history of the NTS. It developed from the point of extrapolating “what might happen" from data of surface and air monitoring, to delineation of body burdens of radionuclides by biclogical sampling and whole-body counting. While this growth was occurring, there was also development of knowledge of radiation injury by the selected physicians of MLON. By 1968, most of the MLON representatives had more knowledge of radiation injury than did 99 percent of the “experts” in 1957. In 1957, there were less than 100 physicians in the entire United States who had any significant training in radiation injury, and only a few of these physictang had ever seen a case of acute radiation injury, much less treated one. Medical knowledge became more and more specialized; and, like the Phoenix bird of mythology, we saw the demise of the radiation injury generalist and the evolvement of the radiation injury specialist. In 1954, the Public Health Service was given the responsibility for radiological safety in the off-site area (that area surrounding the NTS for a radius of about 300 miles). Two PHS officers were permanently assigned to the Las Vegas Branch of the Albuquerque Operations Office of the AEC. In addition, a number of personnel were assigned on a temporary basis as monitors. One PHS physician was also on temporary assignment. He, in addition to functioning as a monitor, also functioned part time as a physician liaison in regard to possible or alleged radiation injury in the off-site area. By the fall of 1956, plans had been worked out for the first MLON with representation from 13 areas surrounding the NTS. The physicians in this group were mostly those in practice in the area. In establishing this Network, tt was described as primarily an epidemiologic function. The description stated: "The primary function of physicians participating in this Network is that of liaison, It is contemplated that the Liaison Officers will serve as a link between the local physician who sees the patient with a suspected or possible radiation injury, and a qualified expert in radiological health. Responsibility of the Liaison Officers will not extend beyond a preliminary investigation of the reported circumstances. His work will be, in effect, that of an epidemiologist. In any case where more than superficial investigation is desired, the Liaison Officer will be expected to refer the case to the Public Health Service Headquarters Group for follow-up by the Public Health Service and the Atomic Energy Commission.” These early MLON representatives were not expected to have either the training or the experience to qualify them as medical expert witnesses in the area of radiation injury, and they were not to be classified as such experts. The MLON Liaison Officers were expected to have some knowledge of radiation and radiation effects. 18 In establishing this first group of MLON representatives, those chosen were given two weeks of indoctrination and training at Mercury, Nevada, in February, 1957. This training provided information in radtological health activities, including data and current scientific knowledge of long-term acute hazards, and the relationship between radioactive fallout and industrial and medical exposures. The Coordinator for this group, except for a brief time, functioned through offices at PHS Headquarters in Washington, D.C. In the 1957 modification to the memorandum of understanding between the Atomic Energy Commission and the Public Health Service, a change was made to officially establish the Medical Liaison Officer Network. This paragraph is as follows: "Scope B--Liaison Officer Network 1. Establish a network of Liaison Officers throughout the Continental United States and its territories to assist the AEC in the investigation of reported incidents, complaints, and claims related to the AEC's test activities. The location of these Liaison Officers shall be in accordance with an operations plan to be prepared by the PHS and approved by the Albuquerque Operations Office. 2. The PHS shall be responsible for the organization of the Liaison Officer Network and indoctrination of its members." In 1957, the operational plan for the MLON was quite brief, describing the administrative plan in which the composition of the Network and security requirements were established. This Network had representatives in each of the then eight regional offices, and in only thirteen states. This plan also established the mechanism by which investigations would be carried out and the mechanism of reporting the results of investigations. In 1957, a full-time Medical Officer was detailed to the Nevada Test Organization with the responsibility of medical contact with the physicians in the off-site area. During the six months’ test period in 1957, this officer traveled over 25,000 miles making contact not only with the physicians of the area, but also, on their request, with certain of their patients. This same physician also handled a part of the MLON Operations which included the investigation of a number of cases either personally or by telephone, including one case in Mexico. Because of the information which this medical officer was able to supply to local physicians in the off-site area, many of the potential complaints could be handled by the local physicians based upon the knowledge which he had received. The types of cases investigated ranged from those that could possibly be due to radiation--leukemia, thyroid nodules, depigmentation, depilation—-to some which had no possible connection with radiation-~green and red sweat, cracked teeth, muscle spasm, Cases of flash blindness, allegedly due to viewing the fireball, were also investigated. Some of these cases carried with them very interesting stories. One young boy had died of leukemia in the winter of 1957. This investigation included interviews with the parents, and also with the Reno physicians who 19