Preface erning authorities has changed their wayofiife. The missionaries broughtreligion, clothing, and changed customs. A dollar economy based on copra production and employmentbylocal govermments has tended gradually to supplant the en- The medical examinations of the Marshall Islanders accidentally exposed to radioactive fail- out in 1954 have now covered a span of 20 years. A 5-year period has elapsed since findings have been presented in full, and this report includes details of this period as well as a summary of the data for the entire 20 years. Some background information is presented first. The Marshail Islands were chosen as an atomic bomb proving ground at the time of Operation Crossroads at Bikini in 1946 and were subse- vironmental subsistence. Sanitary conditions and health care in the Mar- shalls had been primitive, with treatmentof the sick often involving a large elementof superstition and magic, and apparently did not improve under Japanese rule. During World War IT the Marshallese were forced to live on low calorie diets with inadequate medical care. When the U.S. was quently used for numeroustests at both Bikini and Eniwetok until the moratorium was declared in 1958. These islands were chosen becauseoftheir made trustee in 1947, the Navy, underthe aus- pices of its Bureau of Medicine and Surgery, un- isolated location in the vast, nearly empty ocean dertook a comprehensive medical survey of island populations in the Trust Territory including the area of Micronesia just north of the equator, east of the Caroline Islands, and northwestof the Gilbert Islands, about halfway between the Hawaiian MarshallIslands, using one of its vessels. the USS — Islands and Australia. The Marshall Islands comprise 34 islands and atolls spread over some 180,000 square miles of ocean. Eachatoll consists of a lowlying chain of sandy, palm coveredislands con- Whidbey.1 The survey showed that unsanitary con- nected by a reef surrounding and protecting a central blue-green lagoon. Habitable land areais sur- ditions with regard to flies, garbage disposal, arid excretory habits made for multiple intestinal parasitic infestations and diseases. A high percentage of the people had positive Kahntests, associated with yaws, and widespread treatment with penicillin the trade winds blow muchofthe year. Theatolls and vitamin deficiencies were especially common. prisingly small ~ only about 70 square miles in the entire Marshall Islands. The climate is tropical, and proved extremely effective. Diseases of the eyes and skin, acute and chronic respiratory diseases, involved in the 1954 accidentare located in the northern Marshalls: Rongelap and Ailingnae No malaria, filariasis, yellow fever, or cholera was seen. Subsequent health care in the Trust Ter- ritory was hampered bylack of trained medical personnel and poor transportation to the outer about 100 nautical miles east of Bikini, Rongerik about 135 miles east of Bikini, and Utirik 275 mules east of Bikini. During the past century the Marshallese people islands. This was the status when our special medical examinations began. have been governed by four countries. Germany Someofthe events over the years in the Marshall Islands that are relevant to the medical sur- purchased the Marshall Islands from Spain in veys are listed in Appendix 1. Thefirst examinations in 1954 after the fallout were conducted by an emergency medical team, 1886 and governed them until 1917, when Japan took over under a League of Nations mandate; Japan declared ownership in1933 when she broke from the Leagueof Nations. The United States liberated the Marshalls in 1944, during World requested by the Atomic Energy Commission, directed by Dr. E.P. Cronkite and composed largely of Navy medical personnel whose service experience proved extremely heipful for this field- War II, and was given authority under a United Nations mandate to administer the scattered islands of Micronesia as the Trust Territory of the Pacific Islands; this was done first by the U.S. Navy and type operation. Resurveys were conducted at 6 months under Dr. V.P. Bond and at [2 months under Dr. Cronkite. In 1956 the surveys were placed under the direction of the author at Brook- later by the Departmentofthe Interior. Theearly explorers and traders foundtheis- lands inhabited by friendly, gentle, primitive haven National Laboratory. Since then the surveys people,living in thatched huts,fishing from out- have been conductedin conjunction with the Departmentof Health Services of the Trust Territory rigger canoes, and subsisting entirely from the local ent ggnment. The increasing encroachment of civilizevia traders, missionaries, and gov- and with the participation of medical specialists from the Armed Forces and from medical centers ill IHCbE98