IN CONFIDENCE
-2occur after a given exposure and the frequency with which they occur.
This incider’ +1 information therefore has widely recognized importance,
for example o the International Commission on Radiological Protection,
and in the Jnited Nations Scientific Committee on the Effects of
Atomic Radiation, particularly in view of the careful clinical examinations that are made on the Marshallese people.
(c) To offer any treatment, or advice about treatment, for any
condition detected by the general medical examinations, although
unrelated to radiation.
It is obvious that if a strongly qualified
and equipped medical team is making rather extensive examinations in
any case to detect and treat any radiation induced condition, the team
would wish to offer treatment of any other condition as well. In fact
I think that this general and nonradiation aspect of the visit clearly
occupied a major proportion of the team's effort. A general "sick-call"
for any ill member of the community was announced and held on each day
(in Rongelap and Utirik), and each patient so seen was discussed in
detail by the whole group in the light of the different findings
(clinical examination, blood count, X-ray etc.). The rather full clinical
examination of the radiation exposed people was also supplemented by eye
examinations and by electrocardiographic, blood and chest X-ray and urine
examinations in many cases, and these were of evident value in general
medical surveillance, as judged by conditions detected which were
unrelated to radiation but which required treatment.
L..
Coming to the points raised in our memorandum of agreement,
l(a).
It is difficult to say at all exactly what interval is
necessary, but new nodules have been detected on this visit in two
people, and possibly a further instance of depression of thyroid function
(the latter diagnosis depended partly on later chemical analysis of the
blood sample). Both these conditions call for rather prompt action: for
the nodules, to establish by surgical removal that they are benign and
that they cannot become malignant, or to plan appropriate operation if
either should prove to be malignant; and for the depression of thyroid
function, 1f confirmed, to start or increase thyroxine ("Synthroid")
dosage.
I understand that one radiation exposed person has been found to
have a significantly low white blood cell count, and this will require
immediate investigation and probably treatment.
The thyroid tumours of the type liable to follow radiation are
relatively slow growing, even if malignant, and the apparently successful
complete removal of all that have previously occurred is reassuring.
Whether this would have been the case with less frequent examinations is
uncertain. There would clearly be greater risk, however, even at this
Stage after exposure, in widening the interval considerably, since annual
thyroid examinations help in ensuring that a malignant nodule is detected
early enough for it to be completely removed before it has spread too far
th
223
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