14 PHYSICAL EXAMINATIONS ~ ADULTS Thepositive clinical findings in adult Rongelap and Utirik people are listed in Table 9. The general health status and incidence of physical abnormalities of the exposed Rongelap people was about the sameas of the unexposed people on the island except for thyroid abnormalities, which are described separately below. The varying frequencies reported from year to year on such abnormalities as prostatic hypertrophy, cervicitis, and arteriosclerosis probably reflect tosome extent rn a nea * 7 * differences in clinical evaluation among the ex- amining physicians. During the past 3 years, skin lesions appearedto be less prevalent, perhaps because ofbetter hygienic conditions (the importance of daily baths with soap and water has been stressed). Special ophthalmological examinations were carried out in 1967 andslit-lamp observations for enumeration of subcapsular flecks of the lens in 1969. These findings are described separately below. As part of the cancer survey, x rays of the chest were taken every 2 years (halfthe group in alternate years) on both exposed and unexposed Rongelap people. The roentenograms showed about equal incidence of cardiovascular findings in the two groups. Two cases with inactive tuberculous pulmonary lesions were noted, but no evidenceofprimary or metastatic pulmonary malignantlesions was seen. Papanicolaou smears were taken from the vaginal region of all women examined. Evidence of inflammatory reactions andinfections with trichomonas and bacteria were common. Only one smear in an unexposed woman was sug- gestive of cancer of the uterus. The medical authorities in the Marshall Islands were notified of this case. Except for cancer of the thyroid (described below) only one case of cancer was noted during the 3 years, in a 71-year-old exposed woman (#13) who died with bleeding from the genital tract thought to be due to cancerof the uterus. In 1968 one 34-year-old exposed Ailingnae woman (#70) was found to have a hard non-tender tumor several centimeters in diameter lateral to the lowerleft lobe of the thyroid. She was brought to the United States with several other Rongelap people who were to undergo thyroid surgery. Surgical removalof this tumor revealed a benign neurofibroma. A numberof other benign softtissue tumors were noted during the examinations. Examination ofresidual“beta burns,” present in about 20 cases, showed only minimalscarring, 5005211 atrophy, and pigment changes. The lesions have exhibited little or no change during the past sev- eral years. No further increase has been seen recently in benign moles, which were noted several years ago in areas of the neck that had sustained “beta burns.” No evidence of any malignant skin changes have beenseen. OPHTHALMOLOGICAL FINDINGS, 1967 SURVEY Ophthalmological examinations were carried out* in 1967 on 63 exposed people, 62 children of exposed parents, and 185 people in the comparison population, a total of 310 (see Table 10). As noted in previous surveys, as compared with American populations there was an increased incidence of large corneas and enlarged, tortuous, and bizzare-patterned retinal vessels, and a lower incidence of myopia, strabismus, amblyopia esophoria, retinitis pigmentosa, and congenital glaucoma. The incidence of arcussenilis is higher in the Marshallese than in similar age groups in the United States, which is in keeping with the general observation that the Marshallese age faster than Caucasians. The incidence was higherin the exposed group (30%) than in the unexposed group (13%); however, on the basis of previous studies, the difference is probably notsignificant. Although diabetes mellitus has a moderately high incidence in the Marshallese, only one case of diabetic retinopathy was noted. This is in keeping with the observation that diabetes in the Marshallese occurs largely in older individuals. Theincidenceof pinguecula and pterygium is high in the Marshall Islands. The incidence of pterygium wasslightly higher in the exposed group. Abnormalities of the crystalline lens, characterized below,are greater in the Marshall Islanders than in similar age groups in the United States. The abnormalities observed consist of polychromatic sheen changes, lenticular opacitiesof all degrees, and cataracts. The polychromatic sheen varied from a few fine granules to large granular plaquessituated on the posterior lens capsule in the zone of specularreflection. In minimal cases the granules were yellowish and in some cases appeared slightly darker with a “beaten brass” color. Where the granules had coalesced into a *By Dr. Austin Lowrey, a memberof the 1967 survey team.