Medical Survey of the People of Rongelap and Utirik Islands, Nine Years After Exposure to Fallout Radiation (March, 1963) (Encl: LTR to C L Dunham, DTD 5/17/63)

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MEDICAL SURVEY OF THE PEOPLE OF R!3NGELAP 4.()s()I!!7 AND UTIRIK ISLANDS, NINE YEARS AFTER Wataru We Sutow, MOD., William C, Moloney, M-DO, Bradford Cannon, MeD., Arabati Hicking, Practitioner, and Ezra Riklon, Practitioner BROOKHAVEN NATIONAL LABORATORY under contract with the United States Atomic Energy Commission and in coordination with the Trust Territory of the Pacific Islands

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AND UTIRIK ISLANDS, NINE YEARS AYIER EXPOSURE TO FALLOUT RADIATION (I%IRCH,1963). Bradford Cannon, M.D. , Arabati Hicking, Practitioner, and Ezra Riklon, Practitioner with the technical assistance of William A. Scottl, Douglas Clareusl, Irving Jonas2, and Kalman Kittien 1Brookhaven National Laboratory, Upton, New York 2South Nassau Communities Hospital, Rockville Centre, New York 3M.D. Anderson Hospital, University of Texas, Ho~ston, Texas 4Boston City Hospital, Boston, Massachusetts 5Massachusetts General Hospital, Boston, Massachusetts 6Department of Public Health, Trust Territory of the Pacific Islands

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This report represents a summary of the major findings of the Medical Survey of the peoples of Rongelap and Utirik atolls carried out in March 1963, 9 years after exposure to fallout radiation. Complete data for the survey, including a complete review of past findings, individual findings, and appendices will be published in a report to be combined with ccxnpletedata of the ten year post-exposure survey to be carried out in %rch 1964. ~rief summary of past findings: These people had been accidentally 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. Of the inhabitants of the Island of Rongelap, 105 miles away from detonation, 64 people received the largest fallout exposure, an estimated dose of 175 roentgens (r) whole bady gamma radiation; contamination of the skin sufficient to result in beta burns, and slight internal absorption of radioactive materials through inhalation and ingestion. Other Rongelap people away on a nearby island (Ailingnae), where less fallout occurred, received only an external gamma dose of 69 r. The people of Utirik Island about 200 miles east of Rongelap, received an estimated dose of 14 r wtiolebody radiation. Fallout was not visible on this Island and no skin and beta burns developed. The exposed people were evacuated by planes and ships about 2 days after the accident. Because of contamination of their home island, the people of Rongelap were not moved back until 1957 when radioactivity had subsided to a safe level. On their return, they were established in a new village b~ilt for them. The Utirik people were returned to their Island after several months, (following initial mtedicalexaminations), since contamination levels there were not considered hazardous. Annual medical examinations have been carried o“~ton the Roagelap people and the Utirik people have been examined 4 times including the present

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moved back to Rongelap Island Detailed information on serve as a comparison population. past findings of the effects of fallout radiation exposure on these people may be found in published survey reports (1-~. Past examinations of the Utirik people showed only a minimal early effect o~ their blood levels, but with no other findings at any time suggestive of radiation effects. The Rongelap people, on the other hand, had slight transitory gastrointestinal and skin symptoms during the first two days due to radiation exposure, followed by significant depression of blood elements, the development of widespread beta burns to the skin with some loss of hair, and measurable internal absorption of radionuclides. However, the gamma dose (175 r) received by the more heavily exposed 64 psople of Ro.ngelapwas not lethal, since no deaths have occurred in the group that appeared to be related to their exposure. In spite of some early loss of weight in a number of the group, and th~ depression of their blood elements, none showed any signs of illness, infections, or bleeding that might be related to the penetrating gamma effect, and no special therapy was necessary. The beta burns healed within several months without complications, though residual pi~entation changes and scarring remain in some cases. The hair regrew by six months. Radiochemical urine analyses showed rapid excretion of the radionuclides that had been absorbed, the levels not being distinguishable from the nonexposed Marshallese by two years after exposure. Subsequent return to their home island resulted in slight increases in body burdens of radionuclides, but the levels at$ained have remained far belo-.the stated maximum p~rmissible levels. During the first five years after exposure, a somewhat higher incidence of miscarriages and stillbirths were noted in the exposed wmnen. Another effect bzlieved to be a residual radiation effect, ~S the finding of slightly retarded growth and ‘development in some of the exposed children. Fertility did not appear to be significan~ly impaired since the birth rate in the exposed group has been cornparabl,.

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to that of the comparison population. Mortality in the exposed group remained ab~~t the same as in the comparison population and no evidence of premature aging was recognized and no leukemia developed. One death from cancer in an older exposed woman occurred at five years postexposure . too early it is believed to be related to radiation exposure. No skin malignancies have been noted as a sequelae to beta burns, but there appears to be an increase in the number of pigmented nevi in the beta irradiated skin areas. No specific genetic studies have been carried out but no increase in congenital malformations has been noted in the children of exposed parents. The survey team consisted of 10 physicians and technicians fru.nthe United States and ten from the Trust Territory. Just prior to the survey, an epidemic of poliomyelitis, type 1, had spread through the Islands and Rongelap was among the islands affected. Twenty-three children and three adults developed the disease, with one death occurring in a woman in the exposed group and several cases of partial paralysis in the children. Fortunately the epidemic did not affect Utirik. At the time of the survey, the epidemic had been brought under control by widespread immunization with Sabine oral vaccine by Navy and Public Health teams. Examinations were carried out on 70 Rongelap people in the exposed group, 35 children of exposed parents, 195 unexposed Rongelap paople (adults and children) comprising the comparison population, and 84 Utirik p,?oplewho had been exposed. A Trust Territory cargo ship was used to transport the team and equipment to Rongelap and Utirik. The team lived ashore at both Islands during the psriod of the examinations. Smaller groups of Rongelap and Utirik people were also examined at Ebeye, (Kwajalein Atoll), and Majuro. The attitude of the people as usual was most cordial and cooperative on both Islands.

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Interval Medical History: Rongelap. During the past year, the only disease epidemic of note was the recent p~liomyelitis epidemic. No children in the exposed group were affected. All cases in children were less than 7 years of age. Eleven children of exposed parents and 12 of unexposed parents were involved. Mild residual facial or limb paralysis (as of March 1) was noted in 8 and more severe paralysis died of bulbar paralysis (see below). Deaths - A. Four deaths had occurred in the exposed 60 years of age. Died, July 1962, with a stated diagnosis in 2 children. One adult of cancer of the cervix. Previous examinations had shown progressive loss of weight and increasing hypertension. On the past survey, bleeding was noted from the cervical os and a gynecological checkup had been recmuended but death occurred before this was carried out. No autopsy was obtained. (2) #46, male, 84 years of age. Died July 1962. History of arteriosclerotic heart disease, a stroke a number of years ago, and senility. No autopsy was obtained. (3) #26, male, 21 years of age. Died in D=cember 1962, two months after a fall from a coconut tree. Death was preceded by disorientation and amnesia with convulsive seizures and finally coma. Autopsy showed meningeal damage grossly and histologically. Brain damage was the likely ca’.useof death. Other findings were few, but of interest was notation of giant and multinucleated cells in the meninges area. (4) //52,female, 55 years of age. Died in February 1963, with larnygeal paralysis during the poliomyelitis epidemic. Death appeared to be from poliomyelitis with bulbar involvement. No autopsy w~s obtained. - B. Death in a child of exposed parent: #107, female, 4 years of age. Died in October 1962 of acute of malnutrition and weakness, gastroenteritis and dehydration. Child had a history skin infections, loss of pigment in hair. No autops~”

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- C. Death of a man in the comparison group: #953, male, 47 years of age. Died in July 1962 with acute asthmatic attack, He had a long history of asthma. No autopsy was obtained. During the past nine years since exposure, 9 deaths have occurred in the exposed group. This represents 12.2 deaths per 1000 compared with 8.3 per 1000 for the Marshall Islands as a whole in 1960. The greater mortality in the exposed Rongelap people may be related to the larger percentage of older people in the group. In regard view of the small to the death from cancer in the exposed woman, there is no establishing causal relationship with radiation exposure, in number of people involved in this study, and the pausity of vital statistics on malignancies in the Marshall Islands. Births, miscarriages, stillbirths and neonatal deaths - Three healthy babies were born to exposed parents and 4 to unexposed parents. The birth rate in the exposed group parallels fairly closely that in the unexposed group. One (one month) due to infant diarrhea occurred in a twin born to exposed parents. A stillbirth (full term) with congenital abnormalities (ectromelus) was born to exposed parents. Since this anomaly is not too uncomnon, it is not possible to incriminate radiation exposure in view of obvio~s statistical Utirik. It was difficult to get accurate demographic data due to poorly kept records. It appeared, however, that during the p~st four years, since last examined, the people of Utirik have been generally free of major epidemics of disease. Several bouts of dysentery-type diarrhea o:curred involving a dozen or so people on each occasion, but therapy with penicillin was effective. Some sickness from eating improperly prepared arrow-root starch was reported. About five deaths had occurred in older psople from pneumonia, skin infections, and diarrhea. Six infant deaths were rec~rded. There did not appear to have been a~: unusual illness or deaths and the birth rate appeared to b.zabout the same as had

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Results of examinations. The people of Rongelap and Utirik were found to be generally in good health. Their nutrition was reasonably good with no apparent deficiencies of vitamins or other dietary components. Fewer fungus and other skin infections were noted and this was thought to be related to the generally improved hygienic and sanitary conditions on the Islands. Adult examinations. In Table I (next page) are listed the incidence of various physical abnormalities in the adult populations of Rongelap and Utirik examined. The general incidence of various abnormalities in the exposed people did not appear to be significantly different from that in the unexposed people. The incidence of moderate to severe arteriosclerosis was somewhat greater in the exposed Rongelap group, but this might be accounted for by the fact that there was a larger number of older people in this group. No malignant lesions were detected in either the exposed or unexposed groups. Pelvic examinations revealed the usual older men but with large number of cervical erosions, lacerations, etc. inthe Rectal examinations revealed prostatic hyp=rtrophy in several no evidence of malignancy. It was noted that there were fewer infections of the skin than previously observed. Pediatric examinations. A total of 212 children were examinedO This number consisted of 25 children exposed on Rongelapj 32 children exposed on Utirik, 35 children born after the fallout to exposed parents, and 120 controls. The list of abnormal physical findings in the exposed and control groups of children have summarized in Table II, page 8. Of particular in:erest was the development palpable nodule in the thyroid gland of a 12 year old girl (#17), who had exposed to fallout irradiation on Rongelape Histological study of the nodule has been planned. During the poliomyelitis epidemic on these atolls, 23 children in the study develo?ed symptoms and signs suggestive of poliomyelitis. Residual weakness of muscle groups was evident in 13 of these children at the time of the

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PHYSICAL FINDINGS IN RONGELAP AND.UJUItIK Argyll Robertson pupil moderate to severe b) prominent head of Myocardial damage or Rheumatic heart dis. 1

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Active skin lesions Blood pressure taken Acute otitis media Chronic otitis media Excoriation of lip Black spots - tongue Rales in lungs SUMMARY OF PHYSICAL FINDINGS Born before Born after * Subject No. 17, female, 12 5/12 years of age.

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Analysis of the statural data from the survey indicated the persistence of the trends previously reported. As shown in Figures 2 and 4 (page 10), no difference was apparent in median and control groups and between girls Among the boys, however, retardation statures betwaen girls in the exposed born to exposed and unexposed parents. in statural growth of the exposed group between the ages of 10 and 17 years as compared to that of the control group was again noted (Figure 1, page 10). The difference in median statures between boys born to exposed parents and those of nonexposed parents was also evident in 1963 (Figure 3, page 10). This difference has been attributed to the fact that the boys in the group -~ithexposed parents were on the average 4 months younger than the boys in the group with nonexposed parents. Leukemia survey Careful examinations for physical signs of leukemia and. ——.—-.—-L examinations of the blood cells including basophil counts of 4009 white cells, revealed no evidence of leukemic tendency in either exposed or unexposed people. Residual beta burns These are listed in Table III, page 11. Very few—————. .—--4 pigmented macular and seem to have slightly the lesions as compared with last year. The number of papular nevus-like lesions previo~sly noted in burned areas increased in some cases. No cases of chronic radiation dermatitis or skin cancer were noted, Table IV, page 12, and in Figures 5 through 7 (pages 13, 14, 15). As has previously been done, the data in Table IV have been broken don into age groups. In general the exposed Rongelap people continued to show slightly lower mean values for the total leukocytes, neutrophils, and lymphocytes, particularly in the older age groul’:,. Platelet levels this year ware lower in the exposed group than last year with greater deficit of this element in nearly all age groups than noted with the Ielkoc:tk>.

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MEDIAN STATURES 1958-1963 BOYS MEDIAN STATURES 1958 -1963 GIRLS BOYS BORN AFTER FALLOUT , GIRLS BORN AFTER FALLOUT

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variation front neck; Pigment changes left ACF, dorsum first right toe; pigmented ACF first toe tion left ACF. back neck; biope chest and back; dorsum left foot. neck; ~. back neck neck; pigment varia. Numerous pigmented macules both sides neck; few on arms, ACF front neck;biop, right neck; mole left ACF. depigmentation …