- in the United States, including endocrinologists, cardiologists, hematologists, internists, surgeons, ophthalmologists, and parasitologists (see Appendix 2). The variety of specialists indicates the diversity of the examinations conducted over the years. The BNLgroup hasbeen fortunate in maintaining a close liaison with the Atomic Bomb Casualty Commission in Japan,andseveral physicians formerly associated with it have participated in our surveys. We havealso hada close relationship with the people studying the Japanese fishermen exposed to the Bravo fallout; in 1964 exchange visits were arranged for Dr. Kumatori and the author to attend surveys both of these fishermen and of the Marshallese. In May 1954, upon completion of theinitial ex- aminations (conducted at Kwajalein), the 82 Rongelap people, because of the contamination of their homeislands, were moved to Majuro Atoll, and they were examined there in September 1954 and in March 1955, 1956, and 1957. They returned to Rongelap, to live in a newly built village, in July 1957, after radiological surveys had showntheisland to be safe for habitation. The 157 Uurik people were taken homeafter theinitial examinations, since their island was only slightly contaminated and was consideredsafe for habita- tion. The 28 military personnel exposed on Rongerik Atoll were taken to Tripler Army Hospitalfor further examinations. Following theinitial acute effects of radiation on the Rongelap people, the examinations over the next 9 years revealed few significant findings. An increase in miscarriages andstillbirths among the exposed women during the first 5 years was thoughtto be related to radiation exposure, but general health and disease incidencein the exposed people were about the sameas in the unexposed Rongelap people who had returned from otherislands and served as a comparison population. During this uneventful period, suggestions were made for reducing the scope or frequency of the surveys, but these were neverseriously considered since it wasrealized thatlittle is known aboutthe lateeffects of radiation on humansandeffects mightstill appear. In 1963 the unexpected apearance of growth retardation in some children andof thyroid abnormalities fully justified this reasoning. In 1972 a case of fatal acute myelogenous leukemia developed in a 19-year-old exposed Rongelap boy, indicating the need for additional surveillance. The surveys therefore were expandedto include a hematological check in the exposed Rongelap people every 6 months. At that time also difficulties were encountered in maintaininga strict thyroid treatment program in the exposed Rongelap people, with potential serious results, particularly in the people who had had thyroid surgery. The decision was therefore madeto place a resident physician in the Marshall Islands tokeep check on the treatment program andassist the Trust Territory in general health care of the Rongelap and Utirik people. The medical findings on the Marshallese have been published in numerous BNL reports and journalarticles.2-23 Someproblems have been encountered in carrying out the medical surveys in the islands. Careful planningis required for all necessary equipment and supplies to be on hand at the remotelocation, and procedures must be adapted to field conditions with proper electronic support. Some tech- nical procedures such as staining of blood smears and cell cultures present problems undertropical, | humid conditions. Providing adequate transportation has been a majordifficulty. While the Navy furnished LST’s and amphibious planes, problems were minimal, but for most of the surveys we have hadto rely on cargo ships chartered by the Trust Territory, and these have sometimes proved unreliable in meeting schedules or hazardous because of faulty life-saving devices and inadequate navigational equipment. Once the survev team was lost at sea for more than a daytryingtofind an is- land, and twice ships ran aground onreefs. Smallboat travel in rough waters was hazardous; the trip from ship to shore was sometimesin outrigger canoes and might result in wet passengers and baggage. To overcome these problems, an LCU was recently acquired for carrying out the AECsponsored radiological and medical surveys in the Marshall Islands. Other problems included the following: The language barrier hampered communication with the people, even though a limited numberof reliable English-speaking people were usually available. The lack of adequate vitalstatistics resulted in uncertainty in the exact age of many of the people; and medical records were poorly kept, particularly in the outerislands (e.g., the health aide would often give the cause of death as “too old”). It was difficult to obtain consent for an au- topsy, even at district medical centers, because of feelings against mutilation of the body after death. Someof the subjects thought that drawing blood made them feel weak; and some questioned the