PREFACE A 20-year report published 6 years ago (1) covered in detail the medical findings in the Marshallese exposed to radioactive fallout in 1954. The present report updates these findings with emphasis on the data collected during the past 6 years.* Much of the material presented in the 20-year report will not be repeated. The reader is referred to that report for a review of topics such as the general history of the Marshall Islands, past health status of the Marshallese people, use of the islands from 1946 to 1958 as the Pacific proving grounds for testing nuclear devices, the accidental exposure in 1954 of the people of Rongelap and Utirik Atolls, their evacuation and subsequent return to their homes, organization of the medical teams and surveys, relation- ship with the Navy and Trust Territory (TT) governing bodies, etc. The find- ings previously reported in detail will only be summarized in this report. The Brookhaven National Laboratory (BNL) Medical Program has been limited by its mandate: to observe the people who had been exposed to fallout ra- diation on Rongelap, Ailingnae, and Utirik Atolls in 1954 and unexposed compar- ison populations, and to ascertain those diseases in the exposed population that are related to prior exposure to radiation and initiate appropriate treat- ment for these diseases. However, a number of developments have resulted in expansion of the program. Further thyroid abnormalities developed in the exposed Rongelap people and in several exposed Utirik people. An exposed Rongelap male died of leukemia in 1972. The exposed Rongelap and Ailingnae people who had been placed on thyroid hormone treatment were not adhering strictly to the treatment program; as a result many of those who had had thyroid surgery showed evidence of reduced thyroid function, giving rise to con- cern that they might develop clinical hypothyroidism unless they complied with the treatment. Another important consideration was the urgent request of the unexposed people living on Rongelap and Utirik (not in the group regularly examined) to be given annual checkups by the BNL medical team. For the above reasons a number of steps have been taken to expand the program. A physician from BNL was stationed in the Marshall Islands in 1972 as resident physician. His principal responsibilities included (a) monitoring the thyroid treatment program, (b) visiting Rongelap, Utirik, and Bikini Atolls for health care pur- poses every 3 to 4 months, and (c) assisting the TT medical services with the care of Rongelap and Utirik patients at the hospitals at Ebeye and Majuro. A Marshallese nurse was hired by BNL in 1977 and has been of great assistance to the resident physician. In 1978 a clinical laboratory was established in a trailer at the Ebeye Hospital as a supplement to the hospital laboratory to aid the resident physician in making definitive diagnoses. A medical technician from BNL has been stationed in the islands since 1978. In 1976 an agreement was formalized between DOE/BNL and the TT which pro- vided for examinations and health care of all Marshallese living on Rongelap and Utirik by the BNL medical team at the time of their visits; for the resident physician to assist TT medical personnel in the care of Rongelap and 500 co oT *The thyroid section (IX) includes more recent data which became available just before publication of this report. C