10

and feet. Marked improvement wasnotedin the
case of an 80-yr-old man whohadsuffered a cerebral accident 2 years previously; much ofthe unilateral paralysis had disappeared. Three other
aged exposed people, two females, one supposedly

101 years of age and one 75, and one male 79,
were obviously becoming more infirm. Theyrarely

left the seclusion of the mats beneath their houses.
Only one unexposed person wasin this same age
range, a male aged 84 whowasstill able to move

about fairly well.

In April 1958, after the March survey, a death
occurred in a 36-yr-old male from the Ailingnae
group, which had received about 69 r of gamma
irradiation from thefallout in 1954. He had complained in Marchofepigastric pain, anorexia, and
loss of vigor. Physical examination at that time

was essentially negative except for epigastric tenderness. A tentative diagnosis of peptic ulcer was
made, although it could not be substantiated
since x-rays were not available. He improved on
an ulcer diet including canned milk. About 3
weekslater, after the survey team hadleft, he be-

came acutely ill and was transferred to the Naval
Hospital at Kwajalein, where he died the following day. The entire skin and mucous membranes
of the mouth were covered with uniocularvesicles
and bullae. Autopsy revealed acute bilateral
pneumonia of unknownorigin and passive congestion of the liver. A diagnosis of varicella was
made. Microscopic examinationofthe skin lesions
showedinclusion bodies typical of varicella.*
The striking thing aboutthe physical examinations in both the exposed and unexposed people
was the relative paucity of findings associated with
degenerative diseases, While the group under
observationis too small to permit any validstatistical analysis, the clinical impression wasthat
diseases such as atherosclerosis and hyptertension
were considerably less common and of lesser
severity than in a comparable group of our population. Among the 114 people 50 yearsold orless,
none had a blood pressure greater than 140/90.
Among the 23 persons older than 50 years, 6 had
pressures ranging from 160 to 220 systolic and 90

to 110 diastolic, and 2 had systolic elevations of
160 to 170 but diastolic pressures of 75 to 80. The

groups were too small for these findings to be
*We are grateful to Capt. B.E. Bassham, (MC) USN, for

doing the autopsy, and to Dr. $.W. Lippincott and Dr. H.A.
Johnson of Brookhaven National Laboratoryfor the histological
examination.

evaluated relative to American statistics, but it

can besaid that theblood pressures do not exceed
those commonly found and probably are lower.
There was a general feeling that conditions like

hernia, varicose veins, hemorrhoids, and vaginal

prolapse were much less common than one might
anticipate in examining a random group of people
of similar age in our society. Oneinteresting finding was a relatively high incidence of kyphosis.
While this is commonin older people in our own
population, it was particularly striking in the
Marshallese, because it appeared to be localized
to the lower thoracic and lumbarregion. Fungus
infections of the skin, particularly Tenia versicolor,
were widespread.
Growth and DevelopmentStudies

Cross sectional data on height and weight and
bone age determinations for the 2- and 3-year
surveys gave an impression of lag in growth and
developmentin the exposed children compared
with unexposed children of the same age. However, in an attemptto obtain more accurate birth
dates of the children for the 4-year survey, the
ages of someofthe children, previously thought to
be well established, were found to be questionable.
The absence of recorded birth information seriously complicates the determination of the accuracy of given chronological ages and dates of
birth. More definitive evaluation of data will be
possible whenverification of birth dates is completed. Detailed geneological and biologicalhistories are being compiled to establish the most
probable birth date of each child. (Unfortunately,
the 1958 roentgenogramsof the wrist and knee,
intended for assessment of osseous maturation,
were lost at sea.)

In addition to cross sectional studies, longitudinal studies of incremental growth data and bone
maturation studies over the period since exposure
will be undertaken when the ages of the children
are better established.
Ophthalmological Examinations

Table 2 shows the major ophthalmological
findings. Generally the Rongelap people, exposed
and unexposed, showed superior vision and accommodation. The majority of disorders were
found in the conjunctiva, cornea, andlens. Irritation of the eyes from bright tropical sunlight and
exposure to coral dust probably play a part in the
high incidence of conjunctival and cornealdefects.

Select target paragraph3