Medical Survey of Rongelap People Five and Six Years After Exposure to Fallout (with an Addendum on Vegetation)

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MAYNARD EICHER, DAVID POnER, ISAAC LANWI, PRACTITIONER, EZRA RIKLON, PRACTITIONER, JOHN IAMAN, PRACTITIONER, AND JACK HELKENA, PRACTITIONER

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MEDICAL SURVEY OF RONGELAP PEOPLE FIVE AND SIX YEARS AFTER EXPOSURE TO FALLOUT (With an Addendum on Vegetation) with th~ technieal assistanea of 1Brookhaven National Laboratory, Upton, New York 2Department of Public Health, Trust Territory of the Pacific Islands 3Walter Reed Army Medical Center, Washington, D.C. 4South Nassau Communities Hospital, Rockville Centre, New York SM.D. Anderson Hospital, University of Texas, Houston, Texas *National Institutes of Health, Bethesda, Maryland ‘Atomic Bomb Casualty Commission, Hiroshima, Japan 8Naval Medical Research Institute, Bethesda, Maryland 9Memarial Hospital far Cancer and Allied Diseases, New York, New York BROOKHAVEN NATIONAL LABORATORY

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This rcporr was prepared as an account of Government spmsm-cd work. Neither the United States, nor the Commission, nor any person acting on behalf of the Commission: A. Makes any warranty or rcprcscntation, expressed or implied, with respect to the accuracy, completcmcss, or usefulness of the information contained in this report, or that the usc of any information, apparatus, method, or prcccss discbacd in this report B. Assumes any liabilities with rapcct to the usc of, or for damagu resulting from the use of any information, apparatus, method, or process disclosed in this report. As used in the above, “person acting on trchalfof she CanmiA on” incfuda any employee or contractor of the Cornmisaion, or employee of such contractor, to the extent that such employee or contractor of the Commission, or employee of such contractor prepares, dismninatcs, or provid~ ac~ to, any informauon pusmmnt to his crnploymcnt or contract wsh the Commission, or his employment with such crmrractor. PRINTED IN USA Available from the Office of Technical Set-vicca, Department of Commerce

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Beta Irradiation of the Skin .................................................................................. Difficulties Associated With the Examinations .................................... .............. Attitudes of Rongelap People ................................................ Lwation of Examinations ........................................................ Studieof Aging Criteria .................................................................................. Studies of Genetically Inherited Umactefitia ............................................ Radionuclide Body Burden Evaluation ..........................................................

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Intcmal Medical Hktoq ...................................................................................... Review of Data on Mortality and Pregnancy Terminations Over the Past Six Years ........................................... Growth and Development Studim .................................................................. Residual Beta Burns ............................................ Sodium and Potassium Levels, 1959 ................................................................

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Radiochemical Analysis of Urine .................................................................... 51 Whole-Body Counting With the Gamma Spectrometer ................................ 53 APPENDIX 3. Hematological Findings, 1959 ...... ..................................................... 63

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Figure 5. -United Nations visiting group meeting with Rongelap residents in village church, 1959 Location of Examinations copy was carried out with the 21 -ton steel room placed in the after part of the tank deck, with the air conditioned electronics room and the shower facility close by. The people to be examined entered the ship via the forward ramp directly onto the tank deck, proceeded to the shower facility where they disrobed, took a complete soap and water shower, and donned disposable paper coveralls and slippers, and then proceeded to the 21-ton steel room, where a 10-rein gamma spectroscopy count was obtained. Phonograph music was piped into the steel room during the procedure. The people, except very young children, showed no evidence of fear or claustrophobia and appeared to enjoy the procedure. Further description of the gamma spectrographic methods will be presented The diagnostic x-ray machine was also set up in the tank deck. Rongelap Village. As in 1958, the dispensary. schoolhouse, and council house were used for the examinations (Figure 6). Hematological and other laboratory procedures and ophthalmological examinations were carried out in the dispensary (Figure 7). Medical histories were taken and physical examinations were made in the schoolhouse. The council house provided areas for an administrative center, for collection of urine samples, and for laboratory use by the University of History and Physical Examinations Histories were taken by a Marshallese practitioner with particular emphasis on the interval history during the past year. A special survey was conducted by the pediatrician to ascertain more accurately the birth dates of the Rongelapese, particularly the children. Complete physical examinations were carried out including examinations of the children for urements, and x-ray examinations of the left wrist

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and hand for bone dcvclrrpmcrr( sturiics); studies metric cxamina(ions; cardiovascular survey; and In 1959, 9G exposed people. including their children, and 166 unexposed people were examined on Rongelap. Cardiovascular Survey. In view of thr possiblrvascular disease, the following cardiovascular survey was carried out. 1. Clinical htstorits recorded present and past health and illnesses, especially cadiac and pulvations in the cardiovascular system in regard to the rhythm and rate of the heart; the nature of the heart sounds and murmurs, if present: the size and shape of the heart by clinical indications; changes in t-he arterial walls as observed by inspection of the retinal arteries and by palpation of the radial, brachiai, and dorsalis pedis arteries; and the appearance of the veins. 3. Instrumrnfal procedures: Sy~(ofic and diastolic blond pressurrs were obtained with the cuff-type aeronoid sphygmomanometer. Oscillometry readings were obtained from both legs at calf Ievcl by the Collins type ofoxeillometer, The highest of the readings obtained at dif7erent pressure levels was used as a single reading for each subject. Elrc/rocard~o,gramswere taken on people 20 years of age and over (84 unexposed and 38 exposed individuals). The electrocardiograms were taken bv a Sanborn Direct Writing apparatus which had been specially shock mounted for field UW.* In almost all subjects the electrocardiograms were taken with 12 leads, to include three standard bipolar limb leads, three augmented unipolar limb leads, and six unipolar or V chest leads in accord with the standard 12-lead prneedure recommended by the American Heart Association. The technical quality of the electrocardiogram was in mcrst instances relatively good, but there were two handicaps. The electric power for the instruments was obtainecf from a qcnrrator on the I.ST by running a cable ashore to ou:]ets in ~he various buil+ rmnt on a pcrmancnl loan haws inqs used for the medical examinations. Inductiot s were aiso technicai variations becauw of variabl, were taken on selected subjects when indicate{} The number (akcn was kept to a minimum I, avoid additional radiation of the exposed people ‘ even though the dose involved was extreme!i small. The films were used chiefly for the study 01 heart size and shape. Chest films were obtained OII I I subjects in the unexposed group and 7 in th[ It should be pointed out that there was m, standardized basal or adjusted level of physical activity, such as resting for one hour before takiny the tests. The patients were seen in the course of the usual exa~ination, as might occur in the outpatient department of a hospital. Arthritis Survey. During the course of other studies on the Rongelap population, it was possible to obtain information on the prevalence ol arthritis and allied pherromcna. Since little is known of the prevalence of these diseases in tropical populations, any such data would be a conarthritides’ besides being of interest in connection with the possible adverse infiuence rsfradiation exposure on degenerative diseases. osteoarthritis on a scale of I + to 4+ by the method of Kellgren and Laurence” as modified by Blurnkrerg et al.” The same x-rays were used to detect any cases of rheumatoid arthritis, uther arthritides, ur bony abnornlalities. * A small ali - quot of serum (0.3 to 0.5 ml) was used to de(ermine the presence of ’’rheumatoid factor” by the this test, a titer of %2 or greater is crmsidcred positive. ” A joint examination on each of the RongeIapese was performed by the medical examiners. and any individual with significant joint findin,qs was re-examined by one of the physicians experienced in the diagnosis ofjoirr: disease. Treatment of the joint disease was undertaken where indi - “We arc indchwd to the followtnq ixrmnncl ofthr Natmnal

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&c ustekposed people who returned to tti island alao increased, becoming indistinguishable from those of the originally exposed group. However, the levels remain well below the maximum permissible limits. Analyses of bone samples on one of the men who died showed 3.7 strontium-90 units/g Other studies have been carried out on the Rongelap people which are not directly related to radiation effects. An intensive intestinal parasite survey showed that the people were infected with many types of protozoa and helminths. This finding did not entirely account for the generally high incidence of eosinophilia. Other findings that need further explanation are the general anemic tendencies, the high plasma protein levels with increased gamma globulin, and the higher than normal levels of serum protein-bound iodine and vitamin B,:. Another investigation is concerned with genetic studies and determination of the anthropological background of the Marsh aliese from genetically determined traits. Among the traits studied were blood groups and hemoglobin and haptoglobin types. The results shed some light on the origin of these people and the homogeniety of the population. Their blood groups resemble most closely those of the people from Southeast Asia and Indonesia, and the population appears to be relatively homogeneous. WITH THE EXAMINATIONS As mentioned in previous reports, several difficulties were associated with carrying out the examinations as well as interpreting the findings. 1. The language barrier made examinations difficult, since very little English is spoken by the Marshallese. However, there were sufficient English-speaking Marshallese to assist the medical team in most instances. 2. The lack of vital statistics or demographic data on the Marshallese imposed a serious dificulty in interpretation and evaluation of the medical data. Records of births, deaths, etc., have been made by the health aides or magistrates of the villages and supposedly forwarded to the district administrator; however, such records have been incomplete or lost in most instances, and vital statistics are therefore inadequate. Trust Territory officials are now attempting to assemble such data. 3. There is uncertainty on the part of some of the Marshallese as to their exact ages, particuiady among the older group. This imposes certain difficulties in interpreting some of the studies to be During the first 2 years, two separate groups of Marshallese people were used for comparison, each of comparable size to the exposed Rongelap group and matched for age and sex. However, this population was found to be unstable, with a large attrition rate over the 2 years, which made it unsatisfactory. At the time of the 3-year survey, it was found that during the preceding 12 months the Rongelap population at Majuro .4to11 had doubled because of the influx of relatives who had come back from other islands to live with them. These people had been away from Rongelap Atoll at the time of the accidental exposure. This group matched reasonably well for age and sex and was of comparable size. Since the return of the people to Rongelap, however, this group has about doubled in size. Since the I)(ople are of the same stock qeneticallv, thev arc uniquely appropriate to serve as a comparison p~)pulation and have, therefore. been For the 1959 survey, 5 years after the accident, the medical team consisted of seven physicians, one dentist, two scientific specialists, and nine technicians from various institutions and laboratories in the United States. Several Marshallese practitioners and interpreters assisted in carrying out the examinations. A group of five scientists from the University of panied the group to collect soil, marine, and plant samples for radiochemical analysis. These studies are not included in this report. Prior to the main survey on Rongelap, several members of the team visited Majuro to examine

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15 children who are part of the control series for the growth and development studies. Several Rongelap people of the exposed group and the comparison population group who were living in Majuro were also examined. The Navy kindly furnished a ship, the LST USS Duval Coun~. The team met at Eniwetok where the ship had put in to onload the 2 l-ton steel room which had been stored there and also the medical equipment and supplies. The medical team was berthed and fed aboard the ship for the expedition. The ship was beached at Rongelap and Utirik for easy accessibility to the villages. Attitudes of Rongaiap People When the team arrived at Rongelap, the magistrate of the village indicated that there was some confusion and uncertainty in the minds of some of the people as to the necessity and significance of repeated medical examinations. He thought it wise to di a meeting of the village people in the council house so that they could ask questions to help clari~ the situation. For the past 5 years during which the annual examinations have been going on there had been no problem in maintaining excellent rapport with the people, and. indeed, the relations of the team members with the Rongelapese were aiwavs cordial and friendly. It was recognized that there was slightly increasing resistance to blood sampling procedures. Also there was some discontent that, because of the high Sr’” content, they were forbidden to eat coconut mabs, which they consider a delicacy (Figure 4). Since the return of the people to Rongelap, copra production had not increased to the extent that the Trust Territory officials had hoped. Consequently, since copra production is the prime source of income, there was some concern over the slowness with which the people were getting back on their feet economically. It had become necessary to extend food subsistence beyond the time originally planned. Fishing was not being carried on as actively as it should have been. At the village meeting the main questions centered around the necessity for the continued me& cal examinations in view of statements on the part of the medical team in the past that the people were generally in good health. It was difficult to explain to them that, though they appeared to be in good health and to have recovered from the acute effects of radiation, very little was known about the possible late effects of radiation, and continued examinations were essential in order to detect and treat any untoward effects, should they arise. The coconut crab problem was brought UP again, and the reasons for prohibiting their consumption carefully explained through the interpreter. To correct a misconception that several cases of fish poisoning during the past year had been due to eating radioactive fish, it was explained that fish poisoning had been going on in these islands for years and was not connected with radioactivity. After much discussion, it seemed that the people were satisfied with answers to the questions, and preparations for the examinations proceeded. Thereafter complete cooperation and the usual friendly relations prevailed throughout the stay on the island. During the examinations a United Nations team visited Rongelap. A meeting with the people was held in the church (Figure 5), and many aspects of the Rongelap situation were discussed. The repmt of the UN group was favorable toward the special medical assistance being rendered the people. Upon completion of the 1959 survey, a meeting” was held for the people, and they were advised that they were found to be generally in good health with no serious effects of their radiation ex- . posure apparent. but that continued examinations would be nece~~ary in order to insure continued good health. They …