Hugh S. Pratt “.D. October 7, 19,. Page seven I was asked to listen to a number of heart murmurs without benefit of any reliable history or prior findings. We examined one baby (18 months old) who was seriously il], cachectic, febrile, lethargic, who had spent a great deal of time in the hospital at Majuro and Kwajelein. No prévious data was available. The preliminary impression was severe malnutrition with secondary infection; ? malabsorption syndrome but with an extensive differential diagnosis. We flew the mother and child both to Kwajelein when we completed the study and admitted the baby to the Kwajelein hospital. Dr. Beal, the Cheif Medical Officer, agreed that the baby was seriously i1] but did not want to be "dumped on" and therefore within 24 hours was threatening to send the baby to the Ebeye Hospital, a totally inadequate facility, to await transfer to Honolulu. Since the study group is relatively small and medical records are, I feel, essential to patient care, I would recommend that selected clinical data on the study groups, and other pertinent data generated by the resident BNL primary physician be placed on microfiche and that copies of the data plus a reader be available at each clinical examination site; ie, BNL, Majuro, Ebeye, Rongelap, and Utirik, as well as the research vessel. I strongly favor the problem-oriented medical record, since it is the only medical record system I know of that is structured for flexible computer storage, manipulation, analysis, and retreival.