Preface en et te SF eae “ce The medical examinations of the Marshall erring authogities haschanged their.way. oflife. Islanders accidentally exposed to radioactive fallThe missionaties broughtreligion, ‘dothing, and out in 1954 have now covered a span of 20 years. changed customs. A dollar economy based: on A 5-year period has elapsed since findings have =- copra production and employment bylocalgovbeen presented in full; andthis report includes de- ~ ernments hastended gradually to supplantthe entails of this period as well as a summary efthe data _ vironmental subsistence. for the entire 20 years. Some background informa. Sanitary conditions and health careinthe Martion is presentedfirst. shalls had beeft_primitive, with treatment of the The Marshall Islands were chosen as an atomic sick often iayaligng alarge elementof superstition bomb proving ground at the time of Operation and magic, an@appareatly did not improve under . Japanese rule. During World War II the Mar- Crossroads at Bikini in 1946 and were subse- ” shalfese were forced to live on low calorie diets quently used for numeroustests at both Bikinj-and ~ Eniwetok until the moratorium was declared in 1958. These islands were chosen becauseoftheir isolated location in the vast, nearly empty ocean area of Micronesia just north of the equator,east with inadequate medical care. When the U.S. was madetrustee in 1947, the Navy, under the aus- pices of its Bureau of Medicine and Surgery, un- dertook a comprehensive medical survey of island populations in the Trust Territory including the Marshall Islands, using oneof its vessels, the USS Whidbey+-The surveyshowed that unsanitarycon- of the Caroline Islands, and northwest of the Gilbert Islands, about halfway between the Hawaiian Islands and Australia. The Mars Islands ¢qm- prise 34 islands andatolls spread over some TBO-0 ditions with regard to flies, garbage disposal, and excretory habits.gnade for multiple intestinal parasitic infestations and diseases. A high percentage of square miles of ocean. Each atoll consists ofa low- lying chain of sandy, palm covered islagas connected by a reef surrounding and protetfifig a central blue-green lagoon. Habitable land areais surprisingly small - only about 70 square miles in the entire Marshall Isiands. The climateis tropical, and the trade winds blow much .agthe year. Theatolls the people had positive Kahntests, associated with yaws, and widespread treatment with penicillin proved extremely effective. Diseases of the eyes and skin, acute and chronic respiratory diseases, and vitamin deficiencies were especially common. involved in the 1954 atcident are located in the Nomalaria, filariasis, yellow fever, or cholera northern Marshalls: Rongelap and Ailingnae about 100 nautical mites east of Bikini, Rongerik about 135 miles east of Bikini, and Utirik 275 mules east of Bikint. During the past century the Marshallese people have been governed bv four countries. Germany purchased the Marshall Islands from Spain in 1886 and governed them until 1917, when Japan took over under a League of Nations mandate; Japas declaredownerghip 14.1933 when she broke fronf-theLeague of Nations The ¥nited States liberated the Marshalls in 1944, during World WarII, and was given authority underadJnited © Nations mandate toadminister the scattefeqfislands of Micronesia asthe Trust Territory-ofthePacific Islands: this was done first’by theUS Nevieand later by the Departmentofthe Interior. ‘oe The early explorers. andgragersfound' ths-is- was seen. Subsequenthealth care in the Trust Territory was hamperedbylack of trained medical personnel and poortransportation to the outer islands. This was the status when ourspecial medical examinations began. Someof the events over the years in the Marshall Islands that are relevant to the medicalsurveys are listed in Appendix 1. Thefirst examinations in 1954 after the fallout were conducted by an emergency medical team, requested by the Atomic Energy Commission, directed. by Dr. E.P. Cronkite and composed largely of Navy medical personnel whoseservice experience proved extremely helpful for this field* type operatiagr. Resurveys were conducted at 6 abiiths gnder Dr. V.P. Bond andat 12 months undef ronkite. In 1956 the surveys were -.. .Pkac - Miez-the direction of the author at Brook- lands inhabited by “tigndly, “gentle, rimjtiwe- zthavtn Majonal Laboratory. Since then the surveys people, living in thatched huts, Ashiti@ trom out- Eee ime beeheénducted in conjunction with the Departmentof Health Services of the Trust Territory rigger canoes, and subsisting entirely from the and with the participation of medical specialists local environment. The increasing encroachment from the Armed Forces and from medical centers of civilization via traders, missionaries, and govil