Document text
Machine-read from the scan, so expect some errors. Lines that couldn’t be read are left out.
Page 1
ASSOCIATED UNIVERSITIES, INC, gard t o possible radiation effects should be pursued with greatest vigor, I refer t o )a) the hematological effects, (b) growth and development studies in children, (c) beta lesions of the skin and (d) body burden o f radioisotopes, Those studies which have revealed positive findings in the past in reI am anxious t o formulate plm s for studies to be carried out on the annual medical survey t o be conducted on t h e Marshallcse i n March, 1958, It is antic ipa ted that three weeks will be spent on Rongelap Island and several days on Majuto Island, it? carryin?, out the examination, and laboratory examinations of a basic nature w i ' l l be carried out as i n the would like to out1i.ne m y thinking on the subject at this time and would appreciate your comments. Keeping i n mind the limited facilities and personnel with which the exaninationi will be conducted as well as the language barrier difficulty,it would seem to m e the nr i or it y for special studies should be based on the following considerComplete history, physical However, there are special studies that should be considered and I particularly in the Japanese and animals, aging and longevity, incidence of degenerative diseases, malignancy (leukemia, Studies based on known long term effects of radiation in human beings, Such studies include effects on 3, Studies of positive findings cornon t o both exposed and unexposed Marshallese people which may have ad irc ct influence on the future prognosis of the long term effects of radiation. he mato cr its), !rich incidence of paf as it is m, high total proteins and gama globulin of the sera, hiqh incidence of congenital defects, be studies of the homogeneity of the population, psychological studies,etc, Such findings include the tendency t o anexcia (low O f less priority would I Fcrther elaboration on the various studies in these different categories follaws, zQ 1. (a) ~Iemstological, I t is anticipated that three complete blood studies on 6 each person inclndin[: WRC,differential counts, platelet counts and hematocrits, Lj will be conducted over t!ie three week period as was done last year. I n view of 6the fact that tbe lymphocyte and platelet mean counts have remained slightly below 0the mean counts ofthe 'inexposed groups i t would be desirable to investigate the possibility of lowered reserve capacity of the hemapoetic tissues for these blood elements, For instance,it night be possible t o test for lymphopoetic capacity by challenging with some lymphocvtic stimulating substance (pertussis vaccine?), or platelet response by stimulating platelet production by some means, Possibly radio iron uptake st dies mi:;ht be o f value in evaluation e ry thro poetic integrity. Do you have any suggestions a1on.r this line ?
Page 2
la rly in view of suggestive findings of some impairment i n the exposed children, Such studies would include anthropometric measurements and x-ray of wrists and tibia for bone development. include gross observations with color photography and biopsy with his to logical study of selected cases. The added burden of the mall doses of radiation in the people necessary i n doing bone x-ray and possible tracer rbe uptake studies is not considered t o be much o f an in cri mental hazard since the technique used would in sure mincounter (steel room with 4 inch thick walls, floor and ceiling, equipped with crystal and 100 channel analyzer) will be installed on the LST t o be used for urine collections on individuals to be brought back for radiochemical analyses, I t is hoped also that some correlation may be drawn between body burden (evaluated from gama spectroscopy) and urinary excretion rates o f isotopes (from radiochemical analysis of the urine), i n view of the fact that the people have been moved back t o their home island which is slightly contaminated, Growth and development studies in the children should be continued patticuStudies of residual beta lesions of the skin will be continued, These will Evaluation o f body burdens of radioisotopes, It is planned thata whole body Gama spectroscopy will be carried out on exposed and non-exposed In addition concerted effort wi2l be mode to obtain sufficient This study is of increased importance 2, Inthe second category,ie, long term effects of radiation, the following fields of study should be considered, (a) Studies of longevity will in the long run give the most definite answer on the effects of radiation on aging, but such information will take years, In the meantime i t would be desirable to evaluate premature aging by attempting to estimate the biological age of the indivi dual s compared with their actual age. We are faced here with the difficulty that some of the ages, particularly of the older people are not precisely known (maybe off by several years), ble, Studies to determine biological age are extremely difficult to plan since quant if i cation of biological effects associated with aging are far from precise. I am not aware of any single biological end point that can be used t o bracket an individual ' s age a t all closely, Therefore, in arriving at an estimate of biological age 1 wonder if i t would be possible to establish an overall "score" for various endpoints i n an individual weighted according to relative importance, Weighted scores might be established for such characteristics of aging as: retinal and general arteriosclerosis,cataracts, arcus sen il is, accommodation, skin elasticity,senile ker a to ses, greying of the hair, blood pressure, cardiac function, kidney function, degree of agility (or fragility),osteoarthritis, mental agility,reflexes etc,I plan to investigate the feasibility of this approach, Do you know ef any specific tests for aging that might be considered? e ration might be given to studies of hexosamine t o collagen ratio of skin,ratio of keto steroids to cor tico ids in the urine, vitamin B-12 levels as indices of age. phosphatase determination on neutrophiles b y D r , Maloney) and basophile counts on 4000 white cells. Premature aging and shortening of life spano Even so, such studies should be attempted if posskStudies for leukemoid tendencies will be repeated. These include alkaline
Page 3
(c) Thyroid function,In view of the fact that the Rongelap people received a dose of about 300 rep tothe thyroid gland (an estimated 175 r whole body gamma dose plus an estimated 100-150 rep to the thyroid from internally absorbed ed thyroid malignancy and leukemias i n people who i n infancy o r childhood had received similar doses of radiation to the thyroid, He carried out total cholester o2determinations on the sera of the Marshallese this past year, No abnormally !dgh cholesterol s were found, However, on.the next survey it might be desirable to do plasma bound Iodine studies at leqst on those individuals, parti cula rly children,with chok ster of levels in the higher ranges, associated with radiation aging, ' here fore tests for kidney function should microscopic examination done on those samples showing positive albumen only), Perhaps these shoufd be repeated again next year. Serum creatinine levels were determined but no significantly high values were found, However, we might consider doing blood urea urine urea levels on those people showiw creatinine levels in the upper ranges. Should liver function tests o r any other test along this line be considered? On the past survey routine urinalysis was carried out (with Nephrosclerosis is said to be one of the diseases repeated as in t h e past, Slit lamp observation for radiation induced opa cities of the lens will be (f) With such m a l l numbers of people involved and i n view of the negative nature of the genetic studies carried out in large numbers of Japanese people we have not been encoutaged t o undertake such studies, However, i n my opinion, there are several factors which place these studies i n the Marshallese ina more favorable light ; 1, the relative isolation of the people insures repeat examinations over a period of years witha minimum o f rnixhg with other island population; 2, consanguinous marriages are common; 3, there is considerable intermarriage among the irradiated group. The incidence of congenital defects among the Marshallese appears high(possibly due t o consanguinous mntings over a long period of years), Thus far we have only ex mined the offspring for abnormali ties which might be found on routine physical examinations and nothing of significance has been found, Dt, J, Nee1 suggests that data on congenital defects in offspring of consanguinous marriages would be valuable i n connection with their study along this line in the Japanese, 3. I n t h e third category,ie,abnormalities common to both exposed and unexposed Marshallese, the relatively tow hernatocrit levels should be investigated, deficiencies should be ruled out, The prevalence of intestinal parasites(with high eos in ophile counts) might be more completely evaluated by stool studies for ova and parasites. contemplated, Since many types of parasites are present the procedure would be more feasible if there were a "universal" vermifuge of some type, (This study is aside from radiation effects.) Attempts at i age scale treatment for parasitism night be The high serum protein levels prevalent i n these people could be further invest i - gated, Preliminary electro ph ore tic data indicate a high gama globulin fraction, Perhaps parasitism, chronic infections ? or diet may be partly responsible, Anthropological studies to show the degree of homogeneity of the Marshallese might be interesting, The hemoglobin types seen to indicate a considerable degree of background , Blood group studies indicate a large Asiatic component i n their
Page 4
psychological studies and psychiatric testing would be interesting in view of the apparent lack of emotional difficulties observed in these people, I realize that in this letter I have only touched the high spots, He are limited i n the number of studies we Can undertake and would therefore appreciate very much your comments and suggestions, Medical Depar bent Marshall Islands Project)