( . C 40280 R PROTOCOL FOR THE 1974 MEDICAL SURVEY IN THE MARSHALL ISLANDS The 1974 Medical Survey will begin about the middle of March and will include examinations at Rongelap, Utirik, Bikini, Ebeye and Ma juro. The Rongelap people, exposed and unexposed, are examined completely annually, Utirik people every 3-4 years. In addition, following the death of a 19-year-old exposed Rongelap boy last year with acute leukemia, hematological examination in the exposed Rongelap people now takes place twice a year. On the forthcoming survey the exposed and unexposed Rongelap people will be examined completely (except for some of the unexposed examined recently by Dr. Knudsen, our resident physician in the islands). The Rongelap and Utirik populations under study are scattered largely between their home islands, Ebeye and Majuro, the district center, Visits to all these islands will therefore be necessary. Utirik will be visited for purposes of general health care, radiological monitoring of personnel and environment, and for a diabetic survey. Bikini will be visited at the end of the survey for radiological monitoring of personnel and environment. Some 50 workmen are there and it is possible that by the time of our survey some of the Bikini people will have returned. It is hoped that an LCU will be assigned to the AEC by the Army for our use for medical visits and radiological surveys in the Marshalls. If this materializes we plan on having on the LCU a trailer set up for whole body counting (lead shadow shielded gamma spectrographic instrument). Another trailer would have a complete "physicians office" arrangement including x ray. This vessel, though slow, could be beached conveniently near the villages. Except at Rongelap and Ebeye, we would live aboard the LCU. A "bunker" traiier would be brought on the vessel for sleeping purposes and an eating facility would be established. If the LCU is not furnished we will have to charter a "Trust Territory" cargo vessel, Though faster, such a vessel leaves much to be desired. (I'm sure that those who have been on previous surveys will say that this is putting it mildly. ) In addition to the routine history, physical examination and laboratory work, this survey will be highlighted by several other special examinations including a study of thyroid reserve in the exposed people who have not had surgery, a diabetic survey, a genetic study of children of exposed and unexposed parents, and radiological monitoring of personnel and environment at Utirik, Rongelap and Bikini. The procedures for these examinations and the reasons for doing them will be described below. We are extremely fortunate in having Dr. James Field to head up the diabetic survey and Drs. Reed Larsen and Yon Wolff, the thyroid examinations. We are also most fortunate in having the cooperation and support from the Trust Territory, particularly Drs. Kumangai, Iaman and Riklon., In this brief communication time does not permit a discussion of background information concerning political trials and tribulations which our team has had to face during the past several years. Suffice it to say that we are pleased that certain misunderstandings have been cleared up and I think we can count on full cooperation from the Micronesian Congress and local politicians. Senator 0. Borja, who headsup the investigational committee for the Congress, has been of great help in accomplishing the improvement in the situation and he may be accompanying us on the survey. Mr. Bryan Farley, an advisor, may also be along. -le- Mr. William Streenan of