Hugh S. Pratt, 4-D. September 6, 1979 Page 3 will become progressiver brings up another point that Any discussion of pathology udes many who may so The exposed population now incl more inportant. of death be whether the precise causes -end of their normal life expectancies, Oe eney only e hav we “natural” or radiation related. It seems paradoxical that t parre 08 detect possible radiation relare effort over the past 25 years to a coreyqual rhe sical examinations possible, to neglect the most thorough of phy ee as se ons of the physical examinati The importance of extending our annual m examinations may be ooole rte prehensive postmo g th our by performin com ed by the Marshallese nor feasi et n but is clearly not generally accept we estas a ional I would strongly recommend first, that present facilities. second, that we embark on an educatio capability to perform such autopsies and ation culturally acceptable. campaign designed to make such an examin an endeavor: deaths may be a There are obvious practical difficulties in such are surely not likely to coincide unexpected and certainly unscheduled, so they ions and logistics are such that nicat with field trips by the survey team; commu sy may be expected; and local autop inordinate delays between times of death and essentially nonexistent. are personnel and facilities to perform autopsies expected value of the Nonetheless, such difficulties could be overcome if the necessary surgical The . results justifies the effort, as I believe it might d at Majuro or store be equipment and fixatives are really minimal and could ds might not islan outer Even the performance of autopsies on the Kwajalein. situ inspection in ing on ntrat Limited autopsies, conce be totally impractical. of organs and judiciously selective tissue sampling, can be performed with minimal intrusion and cosmetic closure, possibly reducing the Marshallese To decrease transportation times, pathologists reluctance to allow them. possibly at Tripler or the University in Honolulu or certainly here at UCLA, The value of having a West Coast contingent of medical personnel intimately involved with the program clearly extends to numerous. other areas. For one thing, it might obviate the need and expense to transport the Marshallese all the way to the East Coast for many diagnostic and/or surgical procedures that could be performed capably at a number of institutions closer and climatically more similar to their native environments. Further, it will become increasingly more important, if the program is expanded to include the Bikini group (and possibly those on other atolls who may have received previously unsuspected exposures), to develop an enlarged and stable reservoir of personnel from which to form the field teams necessary to provide medical and dental care or to I would propose that consideration continue appropriate clinical investigations. given to a formal BNL affiliation with an institution such as UCLA (or a ‘group of institutions) directed toward this end. of forms. It could take any of a number One that has special appeal to me could be established as a combined educational/public service endeavor that should be attractive to professional It should be relatively personnel with a broad range of experience and expertise. simple in an academic medical environment, for example, to establish elective » Fotations, clerkships or externships for advanced medical and dental students and residents in several different disciplines which could be supplemented by Certainmuch of the routine survey werk, selected supervisory faculty members. such as general physical examinations, could be performed canably by advanced students under proper supervision, and the services of residents with training ee? could be recruited to be on standby for such activities.