72 Bikini (see Table df and Appendix 12), and a gamma survey of the island was made by Greenhouse ef al(see Appendix 4). On Bikini Island alinose all the ganuna radiation is now due to Cy. The gamma level dite to natural radivactivityis considerably less on these islands thay in the ULS.; this is why the average gamunia dose to an inhabitant is lower in: Bikini Village than in certain parts of the U.S. The people living on Bikini eat a dict consisting almost entirely of imported food, but they ingest slight amounts of radioaclivity trom local seatoord. The newly planted coconut, pandanus, and breadfruit trees will not bear fruit in any significant quantity for some sears vet. Phe urinary radionuclide level of the Bikini people iss ow several times as high as when they were living on Kili Island, but still can- siderably below the permissible range. The toid estimated internal bone marrowdose in 1974 ta the people living on Bikini was about half chat to the peaple living on Rongelap, but with the external dose included, the dose to the bane marrow was about the same (see Table 42). lis reassuring that analyses of urive for plutonium show levels nese background in the Bikini people (see Table 373. Weil water on Bikini bas had low levels of ac- tivity (see Table 3%), The clictary levels projected for Bikini when the newly planted trees bese fruit shoud be considerably lower than the levels luased on analyses of fruit from old trees because of the son renoval procedures used at planting, but thetr aciual evaluation niust await maturity of the trees and further analyses. [tis planned te ..dd supplementary calchuin tothe diet of the Bikini peaple tubes educe absurption of “Sr. Experiments are ub‘ oway to investigate the tolerance of Marshallese people for powdered milk as a source uf calcium. Races other than the Caucasian are reported to have a lower tolerance for milk because ofa genetic inability ta digest lactase which gives rise to abdaminad discomfort. diarrhea, and ather ssinploms, 1 Vil. Comments and Conclusions A. THE EXAMINATIONS ‘Phe primary responsibility assigned the medica! leam by the NEC (now ERIDA) was the diagic as and treatment of possible ellects of radiation expo- sure inthe Marshallese, but inevieably the exam- ining groups have been concerned also with general health care at the time of heir vistis, The re- sponsibilities have been filled by carryiig out ex- tensive annual examinations, supplemented in recent vears by semiannual hematology checks and quarterlyvisits by a resident physician, The exaiminations, whieh have been carried aut with the assistance of the Vrust Perritury Pealth Services, have resulted in extensive medical distories anc records for cach individual and have made it possible ta diagnose and treat muy dixcases and ill- Hesses at an carly stage. An ioporuint aspect of tae medical surveys is to Manwvain cappert with the people, to keep them informed of the medical dindings. to explain the need for examinations, and al limes to correct unfoun ed rumors about fallout elleci. Unfortu. mately this has not always been successfully kept up because of dillerences in language and culture. Some studies have been of benefit to the Marshail Islands as a whole, such as the surveys of the incidence of diabetes and of parasitic infestauion. In addition. a great deal of data has accuanulated from studies of genetically inherited characteristics which may prove valuable not only in determin: ing possible pence effects of radiation but alse in aathropolouy. B. COMPARISON WITH OTHER HUMAN EXPOSURES In contrast to other groups exposed to radiation, the Afarshallese are unique in that \. ey comprise the only human pupulation ever exposed to acute radiation from fallout. Vhe accident © cused attenwon forthe lirst time oan the hazards of fallout fra nuclear detonaiions. Phe atoms: blasts above Hiroshima and Nagasaki resulted in casualties due to penetrating gaaima and neutron radition dircetty from the bombs wiah linde or ao fallout ine valved and therefore caused no ¢lfeets die ta ine tern abserpiion ad cadioaclive materials. [ncn trast, the Sfarshallese were not exposed to direct clleets of the detonation but onty to radionetive fillout resullitig in whole-body, skin. wad imbernual exposure, Trauma and extreme psychelouwical ais- turbances did pot conpribure to the effects ia the Marshallese as dhey did da the Japanese. Pie ine portauce of the hazard from iuernal absarpion of radioactive tadine bas bees ctearly demonstrated by the Marshallese experience. The 25 fananese fishermen on the Sake Drage received an expa- sure stnilar te that of the Rongelap group but