March 1, 1984, was the 30th anniversary of the Bravo thermonuclear test that resulted in the accidental exposure of the populations of Rongelap and Utirik atolls to radioactive fallout. The chronicling of the medical events resulting from that exposure is continuedin this report, which covers the period from January 1983 through December 1984. Humanitarian concern for the exposed Marshallese and for other human populations that might suffer from some future exposure continues to be manifested in the worldwide interest of many individuals and institutions who request Brookhaven National Laboratory reports and other published medical articles describing the medical findings. Therefore, an updated listing of all relevant publications from the Medical Department, Brookhaven National Laboratory, is presented in the Reference Section. Articles not issued by Brookhaven National Laboratory but which also relate to the medical aspects of the Marshallese radiation exposure are included for those desiring further information on the subject. Finally, the listing includes Brookhaven National Laboratory-sponsored articles containing Marshallese data that do not concern radiation. For the most recent comprehensive reviews of the principal medical findings since the fallout exposure, the reader is referred to two reports by Dr. Robert A. Conard, director of the Marshall Islands medical program for many years (Conard et al. 1980a; Conard 1984). Thirty years of observation continue to show no detectable increase in mortality in the exposed population as a result of that exposure. The survival curves of the high-exposure Rongelap group, the low-exposure Utirik population, and an unexposed group of Rongelap people matched by age and sex to the exposed Rongelap group in 1957 continue to be similar (Figure 1). This is not surprising because Japanese A-bomb survivors, which include a far greater number of radiation-exposed individuals, many of whom received a much higher radiation dose than the people of Rongelap, have also had no overall shortening of life-span, even when correlated with radiation dose (Kato et al. 1982). A separate study of Nagasaki A-bomb survivors revealed their op TT rer rere 90+ " 80+ % SURVIVING Introduction 70+ 60 }50 F 40 30 90 RONGELAPAND AILINGNAE EXPOSED —~- UTIAIK EXPOSED or: RONGELAP UNEXPOSED wr 1 1955 pep 1960 1965 a 1970 1975 1980 1985 YEAR Figure 1. Percent survivors of the different exposure groups since 1954. The curves are based on the total original populations, including those in utero. 1970-1984 age-specific death rates from all causes to be lower than controls, although it has been suggested that the programs providing health screening of these populations might have led to an underestimation of the effect of radiation on mortality (Okajima et al. 1985). Clearly, therefore, concern over the con- sequences of the 1954 exposure transcends mortality statistics. The general health of the exposed population, morbidity directly or indirectly related to the exposure, and present and future risks continue to be monitored and evaluated by the Brookhaven National Laboratory Marshall Islands medical program. The program pursues tworelated objectives. One is the provision of a cancer-oriented annual examination that follows, as nearly as practicable, the recommendations of the American Cancer Society (1980). The other is a placing in perspective of the risks of radiation exposure as they relate to the overall health of the individual and the Marshallese community. Diabetes mellitus, forexample, is a major health problem in the Republic of the Marshall Islands, affecting some 17% of the adults examined by the medical program. Attention to its attendant complications of renal failure, blindness, severe bacterial infection, peripheral neuropathy, impotence, and accelerated atherosclerotic disease should not be minimized because the focus of the program, as mandated by Public Law 95-134, is necessarily on radiation-related illness. The medical program has continued to address such problems by forwarding periodic