Preface mt + ite Te LM ee TRF be The medical examinations of the Marshall erning authdgitieshaschangedtheir.way.oflife. Islanders accidentally exposed to radioactive fallThe missionaties broughtreligion” hing, and out in 1954 have now covered a span of 20 years. changed customs. A dollar econom}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 ofthe data vironmental subsistence. for the entire 20 years. Some background informa: Sanitary cgnditiogs and health care:in-the Mar- shalls had beef, B.primitive, with treatment ofthe tion is presentedfirst. The Marshall Islands were chosen as an atomic bomb proving ground at the time of Operation sick often tayal wang alarge elementof superstition and magic, a Crossroads at Bikini in 1946 and were subse- tly did not improve under = Japgnese rule. DuringWorld War II the Mar- quently used for numeroustests at both Bikinj-and Eniwetok until the moratorium was declared in sh were forced to live en low calorie diets with inadequate medical care. When the U.S. was 1958. These islands were chosen becauseoftheir isolated location in the vast, nearly empty ocean area of Micronesia just north of the equator, east of the Caroline Islands, and northwest of the Gil- made trustee in 1947, the Navy, under the aus- pices of its Bureau of Medicine and Surgery, un- dertook a comprehensive medical survey ofisland populations in the Trust Territory including the bert Islands, about halfway between the Hawaiian Marshall Islands, using oneof its vessels, the USS Islands ¢qm- Whidbey3-The surveyshowed that unsanitary conditions with regard to flies, garbage disposal, and lying chain of sandy, palm covered isl connected by a reef surrounding and protettifig a cen- sitic infestations and diseases. A high percentage of the people hadpositive Kahn tests, associated with yaws, and widespread treatment with penicillin proved extremely effective. Diseases of the eyes and skin, aeute and chronic respiratory diseases, and vitamin deficiencies were especially common. Islands and Australia. The Mars prise 34 islands andatolls spread over someT8000 square miles of ocean. Eachatoll consists ofa low- excretory habitsgnade for multiple intestinal para- tral blue-green lagoon. Habitable land areais sur- prisingly small - only about 70 square mifes in the entire Marshall Islands. The climateis tropical, and the trade winds blow much af theyear. Theatoils involved in the 1954 atgigent are located in the northern Marshalls:gR6ngelap and Ailingnae Normalaria, filariasis, yellow fever, or cholera was seen. Subsequent health care in the Trust Territory was hamperedby lack of trained medical personnel and poor transportation to the outer islands. This was the status when ourspecial medical examinations began. about 100 nautical mites east of Bikini, Rongerik about 135 miles east of Bikini, and Utirik 275 miles east of Bikini. During the past century the Marshallese people have been governed byfour countries. Germany purchased the Marshall Islands from Spain in 1886 and governed them until 1917, when Japan Someof the events over the years in the Mar- took over under a League of Nations mandate; Japaa declared-ownerghip ig.1933 whenshe broke fronétheLeague of Nations” Ehe Bnited States liberated the Marshalls in 1944, during World WarII, and wasgiven authority underUnited . Nations mandate toadministerthescatte: lands of Micronesia asthe Trust.Territory.ofthe Pacific shall 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, Tequested by the Atomic Energy Commission, directed By Dr. E.P. Cronkite and composed largely 0 Navy medical personnel whose service experience proved extremely helpfulfor this fieldOR gperats #. Resurveys were conductedat 6 der Dr. V.P. Bond and at 12 months Islands; this was donefirst’by theUS Navjcend £ronkite. In 1956 the surveys were later by the Departmentof the Interior. as =the direction of the author at BrookThe earlyexplorers. andradersfoundthee lands inhabited by “tri adty; “gen sri, ——— Majonal Laboratory. Since then the surveys people, living in thatched huts, Ashisgtrom"ise out- ee 7hiagbe‘behSiadunedin conjunction with the Derigger canoes, and subsisting entirely from the partmentof Health Services of the Trust Territory local environment. The increasing encroachment and with the participation of medical specialists of civilization via traders, missionaries, and govfrom the Armed Forces and from medical centers il