72 Bikini (see Table 41 and Appendix 12), and a gamma surveyof the island was made by Greenhouse et al.156 (see Appendix 14). On Bikini Island almost all the gammaradiation is now dueto 137Cs. The gammalevel due to natural radioactivity is considerably less on these islands than in the U.S.,; this is why the average gamma dose to an inhabitant is lower in Bikini Village than in certain parts of the U.S. The peopleliving on Bikini eat a diet consisting almost entirely of imported food, but they ingest slight amountsof radicactivity from local seafood. The newly planted coconut, pandanus, and breadfruit trees will not bear fruit in any significant quantity for some vears yet. The urinary radionuclidelevel of the Bikini people is now several times as high as whenthey wereliving on Kili Island, butstill considerably below the permissible range. Thetotal estimated internal bone marrow dose in 1974 to the people living on Bikini was abouthalf that to the people living on Rongelap, but with the ex- ternal dose included, the dose to the bone marrow was about the same(see Table 42). It is reassuring that analvses of urine for plutonium showlevels near background in the Bikini people (see Table ining groups have been concernedalso with general health care at the timeoftheir visits. The responsibilities have been filled by carrying out extensive annual examinations, supplementedin re- cent years by semiannual hematology checks and quarterly visits by a resident physician. The examinations, which have been carried out with the assistance of the Trust Territory Health Services, have resulted in extensive medical histories and records for each individual and have madeit possible to diagnose and treat manydiseases andillnesses at an earlystage. An importantaspect of the medicalsurveys is to maintain rapport with the people, to keep them informedof the medical findings, to explain the need for examinations, and at times to correct un- founded rumors about fallout effects. Unfortu-. nately this has not always been successfully kept up because of differences in language andculture. Somestudies have been of benefit to the Marshall Islands as a whole, such as the surveysofthe incidence of diabetes and of parasitic infestation. In addition,a great deal of data has accumulated from studies of genetically inherited characteristics which may prove valuable not only in determin- 37). Well water on Bikini has had low levels of ac- ing possible genetic effects of radiation but also in anthropology. should be considerably lower than thelevels based 8. COMPARISON WITH OTHER HUMAN EXPOSURES tivity (see Table 38). The dietary levels projected for Bikini when the newly plantedtrees bearfruit on analysesof fruit from old trees because of the soil removal procedures used at planting, but their actual evaluation must await maturity of the trees and further analyses. It is planned to add supplementary calcium to the diet of the Bikini people to help reduce absorption of 9°Sr. Experiments are under way to investigate the tolerance of Marshallese people for powdered milk as a source of calcium. Races other than the Caucasianarereported to have a lower tolerance for milk because of a genetic inability to digest lactose which gives rise to abdominal discomfort, diarrhea, and other symptoms. !4% Vil. Comments and Conclusions A. THE EXAMINATIONS The primary responsibility assigned the medical team by the AEC (now ERDA) was the diagnosis and treatmentof possible effects of radiation exposure in the Marshallese, but inevitably the exam- In contrast to other groups exposedto radiation, the Marshallese are unique in that they comprise the only human population ever exposed to acute radiation from fallout. The accident focused attention for the first time on the hazardsoffallout from nuclear detonations. The atomic blasts above Hiroshima and Nagasaki resulted in casualties due to penetrating gammaand neutronradition directly from the bombswithlittle or no fallout involved and therefore caused no effects due to internal] absorption of radioactive materials. In contrast, the Marshallese were not exposedto direct effects of the detonation but only to radioactive fallout resulting in whole-body, skin, and internal exposure. Trauma and extreme psychological disturbances did not contribute to the effects in the Marshallese as they did in the Japanese. The importanceofthe hazard from internal absorption of radioactive iodine has been clearly demonstrated by the Marshallese experience. The 23 Japanese fishermen on the Lucky Dragon received an exposure similar to that of the Rongelap group but