Na BACKGROUND ‘57 04 40 82 10 31 104 340 Several difficulties were encounteredin carrying out the examinations. The language barrier was one, since very few of the Marshallese speak English, but usually some Marshallese were available who spoke enough English to serve as interpreters when necessary. The lack of vital statistics and demographic data on the Marshallese imposes serious limitations in interpretation and evaluation of the medical data. Trust Territory officials are attempting to improveregistration of such data. The uncertainty on the part of manyof the Marshallese as to their own ages is a problem, especially in the growth and developmentstudies amongthe children andin the aging studies. Duringthefirst 2 years two separate groups of Marshallese people were used for comparison purposes, but they were unstable, with a largeattrition rate. At the time of the 3-year survey the Rongelap population at Majuro Atoll was found to have doubled during the preceding 12 months because of the influx of relatives who had come ‘back from otherislands to live with their own urey as ble , 80 ing ‘nd ORGANIZATION OF THE 1967-69 SURVEYS In 1967 and 1969 complete surveys were made of all of the comparison population as well as the exposed people. In 1968 only the exposed group was examined, in line with our policy of Ch to eal people. Those people had been away from Rongelapat the time of the accident and therefore were unexposed. The group matched reasonably well with the exposed group for age andsex. This group has gradually increased and is now more than twice the size of the exposed group. Table 2 shows the various Marshallese populations that have been examined since 1954. doing a complete survey only in alternate years. In 1969 the Utirik population was also examined, for the first time since 1966. The physicians and technicians participating in the different surveys are listed on the title page and are shownin Figure 2. These included,in addition to those from the United States, a sizable number of Micronesian medical personnel. The examinations were carried out at Majuro, Ebeye, and Rongelap, since a number of Roneglap people drift back and forth between these three islands, and at Utirik (see Table 3). The medical teamstraveled to Kwajalein in the Marshalls by commercial plane and from there to the various islands by Micronesian cargo ship (Figure 3). Most of the supplies and medical equipmenthadto be carried with the team except for a considerable amount of permanent equipment, including two examination trailers, established at Rongelap. Table 4 shows the numbers of people examined during the 1967-1969 surveys. Findings GENERAL MEDICAL STATUS During the past 3 years some improvementhas been noted in the general health of the Rongelap people. This may be partly due to general improvementin sanitation and hygenic measures. Garbage disposal appears to have reduced the fly population, and children are using the outhouses rather than the beach for defecation. The people have more moneyto purchase such items as kero- sene refrigerators, automatic washing machines, and new plastic watercisterns. Gastronenteritis and respiratory infections werestill fairly frequent, but skin lesions due to fungus and impetigo appeared somewhatreduced. Fish poisoningstill occurs sporadically among families who happen to eat a poisonousfish and will probably continue to do so, since the poisonousfish are very difficult to identify and may shift from one species to another at times. A rather serious epidemic of Hong Konginfluenza occurred among the Rongelap people in 1968 and may have been responsible for the deaths of a 58-year-old exposed woman and of an unexposed boy whodied of meningitis complicating the influenza. In June 1968 a few cases of infectious hepatitis occurred, and also a mild measles outbreak among the youngerchildren. In August 1968 four patients were brought Aon ian Reports have been published on the medical findings of surveys madeatthe following times after exposure: initial examination,! 6 months,? 1 year,? 2 years,‘ 3 years,° 4 years,® 5 and years,’ 7 years,® 8 years,® 9 and 10 years,'® and 11 and 12 years.11 A more completelist of reports, including outside publications, on the results of medical surveys of the Marshallese exposed tofallout, and including a section on someof the radiation ecological studies of these islands published largely by the University of Washington group, appears in BNL 50029.13 OG2 200 le re ee ee ee en 3