17 cous membranes from improperly prepared arrow-. Tabie i1 root flour is not uncommon. Both haveerroneously been associated with radiation effects in the minds Mortality, Utirik of the Rongelap people. (Av. age at death: 6123) Diabetes mellitus is a major problem andis dis- cussed separately in Section III. G. A program is under wayto build newdispensaries on the outerislands. On Ebeye a new hospital building has provided improved conditions for health care. It is against this general backgroundthat our examinations take place. We are privileged to get generous help from the local health authorities in our task, and conversely when weare on the scene we cannotavoid getting involved in problems outside the scope of fallout complications. Major physical findings during the past 5 years are listed in Table 8. B. VITAL STATISTICS: FERTILITY AND MORTALITY The numberoflive births during thelast 5-year period was 37 amongthe exposed and 69 among the unexposed. Calculated as live births per year per 1000 population these numbers give a birthrate of 112 for the exposed and 106 for the unexposed. In addition, there were 10 miscarriages among the exposed and 18 among the unexposed,so that, in both groups, one pregnancyoutoffive ended in miscarriage. This is approximately the samefre- quency as observedin the past (see Table 9). Legal abortions are not performed in the Mar- shail Islands, and there is no reason to believe that any of the pregnancy terminations on record were provoked. Family planning has not been practiced in the past althoughit is slowly gaining ground. We therefore believe that the fertility and fetus viability indicated by these statistics are the natural ones, and, although the exposed females showed an apparent increase in miscarriages during the first 5 years, there is no evidence suggesting that the history of exposure to radiation has had any permanenteffect on either. The peopie who havedied arelisted by year in Table 10, with their age and probable cause of death (such death certificates as are available are not always specific). The overall mortality rate for the 20-year period is ~12 per 1000 per yearfor the exposed Rongelap group and ~ 13 for the unexposed; for the last 5-year period the rates are ~9 and ~21 respectively. These differences are notstatistically significant; in such small groups IO0CbIT4 Year Subject No. Age & sex 1956 1957 1957 1957 1958 1959 1959 1959 1959 1960 1960 1960 1961 1961 1963 1964 1964 1964 1965 1965 2118 2184 2219 2222 2243 2122 2127 2170 2187 2116 2131 2180 2177 2199 2203 2163 2190 2192 2121 2154 24M 63 M 57 F 63 F 50 M 87 M 73M 46M 61 F 27F. 35 F 76 M LLM 49 F 71F 75M 85 F 84F 68M 31 F Year Subject No. Age & sex 1965 1965 1965 1965 1967 1967 1967 1968 1968 1968 1968 1969 1969 1970 i970 1971 1971 1972 1972 1973 1974 2183 2204 2238 2253 2181 2202 2223 2101 2112 2141 2259 2191 2214 2175 2211 2258 2246 2178 2252 2186 2201 67 M 71F 65 F 36M 78M 72F 79F 62 M 70M 67 F 36 F 90 F 80 M 73M 63 M 64 M 25 F 37M 357M 67 F 68 F observed over such short periods, differences this large or larger could occur by chance ( p<.0.05). Even so, had the trend been in the opposite direction, we would have had reason to be concerned; as an example, we are keeping a careful watch on the apparent increase in malignancies (see Section V). The mortality rate among the exposed Uurik people was ~ 13 for the 20-year period and ~14 for the last 5 years. The deaths arelisted in Table 11, but causes are not given because ofinsufficient data. Recent misconceptions make it necessary to clarify comparisons with district-wide statistics. The vital statistics of the Trust Territory have improved greatly over the 20 years covered by these reports, but they are still not published in sufficient detail to permit valid comparisons with ours. ‘The age distributions are too different: districtwide the median age is 16 years, whereas in our groupit is between 30 and 40. The difference between the mortality in the general population (~7 per 1000 per year) and that in our groups (~ 13) reflects this difference in age distribution andis not related to the history of exposure. A similar ef- fect can be seen on the birthrate ( ~+40 per 1000 per year district-wide and ~110 in our groups).