CHAPTER 2 CLINICAL OBSERVATIONS AND THERAPY 2.10 INTRODUCTION It was known immediately that the exposed groups had received a significant amount of penetrating radiation to the entire body, extensive contamination of the skin, and possible inter nal deposition of rudivactive materiaks. It was therefore decided that clinical observations would be as extensive and frequent as facilities and personnel permitted in orderto recognize and care for radiation effects as early as possible. Accordingly complete initial histories and physical examinations with numerous follow-up examinations were carried out. Surveys of the skin were conducted at frequent intervals and the detailed skin findings are reported in chapter 3. Extensive hematological studics were conducted, the detailed results of which are presented iochapter 4. Results of examinations for urinary cxcretion of radioisotopes are reported in Chapter 5. | . In addition to periodic examinations, routine sick call was held twice daily. Medica. care was avitilable at all times and hospital facilithes were available at the Kwajalein Naval DispenSary, In view of the widespread conflicting opinions in regard to the value of various prophylactic wnd Urerapeutic measures in treatment of radiation effects, it was decided in advance that therapy would not be given arbitrarily but would be instituted as indicated clinically for speeitie condiuons on an individual basis. However, if severe granulocytopenia developed (below 1060 cells cm) the prophylactie use of antibiotics was to be considered. Whoie blood transfusions were likewise to be used only in case of development of serious anemia. 2.2. SYMPTOMS AND SIGNS RELATED TO RADIATION INJURY Several symptoms that develuped during the first day or two after exposure probably were attributable to radiation. Itching and burning of the skin and eyes during this period occurred in over one quarter of the Rongelap population, to a lesser extent in the Ailinginae and to a very slight extent in the Americans. The skin symtomatology*® might have been due in part to the marked alkalinity of the fallout material (calcium: oxide). About two thirds of the Ronpelap group reported nausea during this early period and one tenth of the group reported vomiting and diarrhea. Only one. Ailinginae individual reported nausea. The people of Utirik and the Americans developed nu signs or symptoms that might be related to radiation. “* The symtomatology is based on questionings through an interpreter by several observers. Despite the repeated interrogations and the inevitable suggestion of the interrogators, the stories remained remarkably consistent. eer f a Be ae eos ahaee * * 24 a ete ee . of8 oF a “* . oo