CHAPTER2 CLINICAL OBSERVATIONS AND THERAPY 2.1 INFRODUCTION ft was known immediately that the exposed groups had received a significant amount of penetrating radiation to the entire body, extensive contamination of the skin, and possible internal deposition of radioactive materials. It was therefore decided that clinical observations would be as extensive and frequent as facilities and personnel permitted in order to recognize and care for radiation effects as early as possible. Accordingly complete initial histories and physical examinations with numerous follow-up examinations were carried out. Surveys of the skin were conducted at frequent intervals and the detailed skin findings are reported in chapter 3. Extensive hematological studies were conducted, the detailed results of which are presented in chapter 4. Results of examinations for urinary excretion of radioisotopes are reported in chapter 5.00. 4 In addition to periodic examinations, routine sick call was held twice daily. Medici. care was avatlable at all times and hospital facilities were available at the Kwajalein Naval Dispensary. In view of the widespread conflicting opinions in regard to the value of various prophylactic and therapeutic measures in Creatment of radiation effects, it was decided in advance that therapy would not be given arbitrarily but would be instituted as indicated clinically for specifie conditions on an individual basis. However, if severe granulocytopenia developed (below 1060 cells-cm) the prophylactic use of antibiotics was to be considered. Whole blood transfu~ sions were likewise to be used only in case of development of serious anemia. 2.2. SYMPTOMS AND SIGNS RELATED TO RADIATION INJURY Severa] symptoms that developed during the first day or two after exposure probably were attributable to radiation. Itching and burning of the skin and eyes during this period occurred in over one quarter of the Rongelap population, to a lesser extent in the Ailinginae and to a very slight extent in the Americans. The skin symtomatology* might have been due in part to the marked alkalinity of the fallout material (calcium oxide). About two thirds of the Rongelap group reported nausea during this early period and one tenth of the group reported voniiting and diarrhea. Only one Ailinginae individual reported nausea. The people of Utirik and the Americans developed no signs or symptoms that might be related to radiation. * The symtomatology is based on questionings through an interpreter by severai observers. Despite the repeated interrogations and the inevitable suggestion of the interrogators, the stories remained remarkably consistent. a aseeee > . 24