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MEDICALSURVEYOF THE PEOPLEOF RONGELAPAND UTIRIKISLANDS 2WLZaY-2?& Brookhaven National Laboratory BROOK HAVEN NATIONAL LABORATORY AS SO Cl ATEI) UNIVERSITIES, INC. 1 under contract with the UNITED STATES ATOMIC ENERGY COMMISSION
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MEDICALSURVEYOFTHEPEOPLEOF RONGEIAPAND UTIRIKISLANDS with the technical assistance of AROBATI HICKING, PRACTITIONER; AND CHARLES F. DEMOISE, PH.D.’ with the technical assistance of with the technical assistance of ‘Medical Departmentr Brookhaven National laboratory, Upton, New ‘Departmental Medical Services, Trust Territaryaf the Psrcificlslonds, York, 11973 Srripan, Marshall Islonds 969S0 3U.S.Army (ret.), Box 503, Route 2, lortan, Virginia 22079 ter, Las Angeles, California 90073 “lahey Clinic,Boston, Massachusetts 02215 ‘Case Western Reserve University, Cleveland, Ohio 44109 B RO OK HAVEN NATIONAL LABORATORY UPTON, NEW YORK 11973
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l%k report was prepared as an account of Government sponsared work. Neither the United States, nor the Commission, nor any pwson acting on behalf of the Commission: A. Makes any warranty or representation, expressed or implied, with respect to the accuracy, completeness, or usefulness of the information contained in this report, or that the use of any information, apparatus, method, or process disclosed in this report may not infringe privately owned rights; or B. Assumesany liabdities with respect to the use of, or for damages resulting from the use of any information, apparatus, method, or process disclosed in this report. As used in the above, “per-son acting on behalf of the Commission” includes any employee or contractor of the Commission, or employee of such contractor, to the extent that such employee or contractor of the Commission, or employee of such contractor prepares, disseminates, or provides access to, any information pursuant to his employment or contract with the Commission, or his employment with such contractor. Printed in the United Statea of America Clearinghouse for Federal Scientific and Technical Information National Bureau of Standards, U.S. Department of Commerce Price: Printed Copy $3.00; Microfiche $0.65
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Some Studies of Immunological Aspeets of Aging and Fallout Radiation Exposure ........ 31 Statistical Analysis of Data ............................ ................................................................. 32 Response of Lymphocytes to PhYtohemagghstinin Stimulation .................................. 33 Estimation of Internal Body Burdens of Radionuclides in Marshallese.............................. 39 SUMMARY OF FINDINGSIN RONGELAP PEOPLE OVER THE PAST15 YEARS.................. ............. 43
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Genetically Inherited Characteristics; Blood Grouping Studies............................... .... . 49 Other Laboratory Studia .................................................................................................... 49 Pediatric Anthropometric Data (Height and Weight) on Rongelap Results of Culture Fair Intelligence Test (Scale 2 Form A) 1969 .................. 59 Thyroid Data on Exposed Marshallese Populations ................................ ........ 62 Hospital Records of Thyroid Cases (1968.1969) .............................................. 67 Marshall Island Radioehemical Urine Analysis 1967 -1969 ........................ .... 86 Individual Hematological Findings (1967, 1968, 1969) .................................... 89 Mean Blood Counts at Various Times After Exposure .......................... .. .. 125
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f MEDICALSURVEYOF THE PEOPLEOF RONGEIAPAND UTIRIKISLANDS This report presents in detail the results of medical surveys carried out during the past 3 years (March 1967, 1968, and 1969) on the people of Rongelap and Utirik Atolls who had been exposed to fallout radiation in March 1954. Earlier findings are also reviewed. The last detailed report (BNL 50029)11 covered the surveys of March 1965 and 1966, 11 and 12 years after the accident. In view of the seriousness of recent findings regarding development of thyroid abnormalities, continuation of annual medical examinations and publication of detailed reports is considered These people had been accidendy exposed to fallout radiation following a detonation of a high yield thermonuclear device during experiments at Bikini in the Pacific Proving Grounds in March 1954. An unpredicted shift in winds caused a deposition of significant amounts of fallout on four inhabited Marshall Islands to the east of Bikini (see Figure 1) and also on 23 Japanese fishermen aboard their fishing vessel, the Lucky Dragon. Of the inhabitants of the island of Rongelap, 105 nautical miles away from the detonation, 64 received the largest fallout exposure: an estimated dose of 175 rads of whole-body gamma radiation, contamination of the skin sufficient to result in beta burns, and slight internal absorption of radioactive materials through inhalation and ingestion. Another 18 Rongelap people away on a nearby island (Ailingnae), where less fallout occurred, received only an external gamma dose of about 69 rads. There were 28 American servicemen on the island of Ilongerik further to the east who received about the same amount of radiation as did the Rongelap people on Ailingnae. Lastly, 157 Marshallese on Utirik Island, about 200 miles fi.mther east, received an estimated 14 rads of whole-body radiation. The fallout was not visible on this island and no skin effects developed. These data are summarized in Table 1. The exposed people were evacuated from these islands by plane and ship about 2 days after the accident and taken to Kwajalein Naval Base about 150 miles to the south, where they received extensive examinations for the following 3 months. During this period vigorous efforts were necessary to decontaminate the skin completely. In view of the generally negative findings on the American servicemen, they were later returned to their duty stations. The Utirik people were also allowed to return to their home island, where radioactive contamination was slight enough to allow safe habitation. Because Rongelap Atoll was considered to be too highly contaminated, a temporary village was constructed for the Rongelap people (including the 18 from Adingae) on Majuro Atoll several hundred miles to the south, where they lived for the following 3% years and were examined at yearly intervals by a special medical Figure 1. Map of fallout area, Marshall Islands, March 1, 1954. Q
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Summary of Fallout Effects Group* Composition Fallout observed dose, rads Rongelap 64 Marshallese Heavy (snowlike) 175 Allingnae 18 Marshallese Moderate (mistlike) 69 Rongerik 28 Americans Moderate (mistlike) 78 Utirik 157 Marshallese None 14 *Also exposed were 23 Japanese fishermen who received a sublethal dose. Marshallese Populations Examined Since 1954 Original number Number in group living (1969) Children Conceived After the Fallout Of unexposed parents 110 Extent of skin lesions No skin lesions or epilation CIndividualshave been added since 1957 when this group was first available. team. In July 1957, after careful evaluation of cident, moved back with the exposed people to radioactive contamination, Rongelap Island was considered safe for habitation. A new village was constructed, and the Rongelap people were moved there by Navy ship. (See frontispiece.) The annual surveys are carried out at Rongelap and also at Kwajalein and Majuro Atolls, where a number of Rongelap and Utirik people now reside. Examinations on Utirik Atoll are carried out about once every 3 years. A group of more than 100 Rongelap people, who were relatives of the exposed people but had been away from the island at the time of the actheir home island and have served aa an ideal comparison population for the studies. The number haa since increased to >200. Since the accumulation of data from these surveys is becoming increasingly voluminous, survey reports published by this Laboratory are made as complete as possible and include a considerable amount of raw data, much of it in appendices, so that otherx may have access to complete data. A summary of early and late findings covering the entire 15-year period is presented at the end of this report.
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Reports have been published on the medical findings of surveys made at the following times 7 years,8 8 years, g 9 and 10 years,10 and 11 and 12 years.ll A more complete list of reports, including outside publications, on the results of medical surveys of the Marshallese exposed to fallout, and including a section on some of the radiation ecological studies of these islands published largely by the University of Washington group, appears Several difficulties were encountered in 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 improve registration of such data. The uncertainty on the part of many of the Marshallese as to their own ages is a problem, especially in the growth and development studies among the children and in the aging studies. During the first 2 yearn two separate groups of Marshallese people were used for comparison purposes, but they were unstable, with a large attrition 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 other islands to live with their own people. Those people had been away from Rongelap at the time of the accident and therefore were unexposed. The group matched reasonably well with the exposed group for age and sex. 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. 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 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 shown in Figure 2. These included, in addition to those from the United States, a sizable number of Micronesia 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 teams traveled to Kwajalein in the Marshalls by commercial plane and from there to the various islands by Micronesia cargo ship (Figure 3). Most of the supplies and medical equipment had to 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. GENERAL MEDICAL STATUS During the past 3 years some improvement has been noted in the general health of the Rongelap people. This may be partly due to general improvement in 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 money to purchase such items as kerosene refrigerators, automatic washing machines, and new plastic water cisterns. Gastronenteritis and respiratory infections were still fairly frequent, but skin lesions due to fungus and impetigo appeared somewhat reduced. Fish poisoning still cccurs sporadically among families who happen to eat a poisonous fish and will probably continue to do so, since the poisonous fish are very difficult to identify and may shift from one species to another at times. A rather serious epidemic of Hong Kong influenza 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 who died of meningitis complicating the influenza. In June 1968 a few cases of infectious hepatitis occurred, and also a mild measles outbreak among the younger children. In August 1968 four patients were brought
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Present Known Location of Rongelap and Utirik People Uncicr Study *Includes 4 children exposed m utero. Rongelap and Utirik Populations Examined,* 1967-1969 Children of Rongc[ap Children of Rongelap exposed parent(s) unexposed parents *A few cases d]d not have complete examinations.
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Figure 4. Marshallese children watching Western movie at Rongelap. Figure 5. Marshallese technique of “herding” fish ashore. Fish are being caught for annual feast during medical survey.
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Mortality, 1954-1969, by Age as of 1954 Group Age: <lo 11-20 21-30 31-40 41-50 51-60 61-70 71-80 >80 Total * *mk ~oup ~m not examined until 1957 and includes occasional new subjects examined through 1966 (Subject 1511). Heart disease, diabetes Asthma, heart failure 1967 to the United States for extensive thyroid studies at Brookhaven National Laboratory and later surgery in Boston. In 1969 five further cases were brought over for thyroid studies and surgery in The deaths during the past 3 years are included in Tables 5 and 6. Three exposed people died. The died of pneumonia complicating influenza, had had a partial thyroidectomy for benign thyroid adenoma the previous year. Another death, that of a 7 l-year-old woman ( # 13), was thought to be due to cancer of the uterus, and an 88-year-old man ( # 55) died of cardiovascular disease with heart failure. Among the unexposed population three older men died, one with diabetes ( #853), Infection in urinary tract, diabetes Pneumonia, secondary to influenza Pneumonia, secondary to influenza Diabetes, cancer of cervix (?) Infection complicating diabetes Congestive heart failure one with heart failure ( #860) and one from undied of complications of diabetes. A 24-year-old male ( #967) died in an auto accident. The boy mentioned above died of complications of influenza. During the past 15 years, 16 deaths have occurred among the exposed Rongelap people. This represents 13.0 deaths per 1000 persons per annum compared with 8.3 per 1000 for the Marshall Islands as a whole (1960). Table 7 lists the births and miscarriages during the last 3 years for both populations. The 33 births during the 3-year period in the exposed group, compared with 30 in the unexposed group, are in line with the birth rate in previous years and show no impairment of fertility in the exposed women.
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Births and Fetal Deaths’ by Year Year Women aged 15-45 Total pregnancies Livebirths M aIncludes stillbkths and neonatal deaths. CIncludesonly children conceived after March 1, 1954. bIncludes nonexposed females married to exposed males. The occurrence of 4 miscarriages or stillbirths in each of the two groups also conforms with the incidence in recent years, the exposed women showing no greater incidence than the unexposed Vital statistics over the 3-year period for the population at Utirik were not reliable since the Health Aide had left the island the previous year and taken the records, Apparently no unusual epidemics occurred among the island people, and they escaped the Hong Kong flu. At least 6 deaths occurred during the past 3 years, but the causes could not be definitely ascertained. Of the original 15’7 people on Utirik at the time of exposure, 127 are now living. In addition some 100 Utirik people live on the island who were not exposed to fallout but moved back later. Quite a few Utirik people now live on Ebeye and Majuro (see Table 3). Seven births were reported for the 3 years but probably more had occurred. The general health status of the Utirik people and the sanitary conditions of the island appeared to be about the same as 3 years before. PHYSICAL EXAMINATIONS - CHILDREN Pediatric examinations were conducted on the Marshallese subjects under the chronological age of 20 years with the exception of adolescent girls who were pregnant or who had had babies. The
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Figure 6. …
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