Medical Survey of the People of Rongelap + Utirik Islands Nine + Ten Years After Exposure to Fallout Radiation 1963 and 1964

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MEDICAL SURVEY OF THE PEOPLE OF RONGELAP AND UTIRIK ISLANDS NINE AND TEN YEARS AFTER EXPOSURE TO FA11OUT RADIATION (MARCH 1963 AND MARCH 1964) wilh ho Iochndwssistwncoof ISAACLAW PRACTITIOWR: AND JETOIIAIUAIII,?MCTITIOIEP B RO OK HAVEN NATIONAL LABORATORY UPTON, NEW YORK BEST COPY AVAILABLE

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Difficultia~t4 With the Examinatmns.. Results of Pl@cal Exammatioru Growth and Devcloprncnt Studia. ,. E.aainophi~ Monouytcs, and Basophds Statistical .hlysis of Rongelap Blood Data Ger Pzu Four Yan Chddrcn of Expacd Pamrts Bone Marrow Examinations Red Cell Mas and Plasma Volume Stud]a

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Other laboratory Studica Folic Acid Dcterminatti. The Ag System Ferulity, Miscamagcs, %llbirthc. and Genetic Effects Growth and Development %tdics. Infernally Ataorbcd Iwtopca.. Rongclap Group and Comml Wan Blood bunts Utmk Group Mczn Blcod Counts at \“arious Times .Wter Exposure 53 Indiwdual Hematologrcal Findings, 1963 54 Individual Hematologrcal Findings. 1964 [ndi~idual Bamphll Dctcrmmatmm. I%3 and 1964 74 Individual .Adult Phwlcal Findings 78 Individual Children Phvslcal Findmqs I(JO Xawa and Vomiting Foilowmq ExpMurc to Fallout of !WarshallcYC. March 1. 1954 I 33 1957 Throuqh 1964, on Rongclap Cbntroi [ Uncxpmcd) Children 134 1956 Tbmugh 1964, on Chtldrcn Born [o Expuscd Parents [38 i 954 nmugh 1964. on Rongclap Ex~ Children 140 Bone Manww Diffcrcntlal Counts 167

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MEDICALSURVEYOF THEPEOPLEOF RONGEIAPAND UTIRIKlSIANOS NINEANO TENYEARSAHER EXPOSURETO FA11OUTRAOIATIOH The remits of a mcdicaf survey of the people c4 Rongelap in the Marshall Mans& carried out us March 1963 and March 1964,9 and 10 vursak the atcidertt, are presented in this report. 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. An unpredicted shift in winda 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 vcascl, the Lucky Dragon. Of the inhabitant of the island of RongeIap, 105 nautical miles away from the detonation. 64 received the largest fallout exposure: an est]matcd dcac of 175 rads of whole-bcdy gamma radiation, contamination of tic skin suRicien: to rcsuh LI beta burns, and slight internal abcorptlon of radiactive materials through inhalation and ingcation. Another 18 Rorqclap people away on a nearby Island ( Adingnac), where leas fallout occurred, rccmvcd only an external gamma doac of about 69 rads. There were 28 Amcrlcan servicemen on the island of Rongenk fsm-dzer to the east who received about the same amount of radiauon as did the Rongelap people on .Ailinqnae. Lastly, 157 Manhalks.c on Utirlk Island, about 200 miles further east, received about an estimated 14 rads of whole-bodv radiation. T~,e fallout was not wwble on this Island and no skm effects developed. The expmscd pcrrpie were evacuated from thee islands bv plane atld ship about two davs after [he acclaent and taken to Kwaydein Naval 6X about 150 miics to the south; where thev ret.eivcd extcnwve cxam:nat]ons ior the following three months. In wcw of the gcneraily ne~auve findings on the Amcr]can scrviccmcn, they were later returned to their duty stations. The Utir]k people were also allowed to return to their home iiland, where radioactive contamination was siig@ enough to aliow safe habitation. Bccauac Rongclap Ass&as considered to be too highly contaminated, a temporary village was constructed for the Rongelap people on Majurts Atoll several hundred miles to the south, where they lived for the following 3% years and were examined at ycadv intervals by a ~~id medical team. In July 1957, after carefuf cva Iuation of the radioactive contamination s!tuation, Rongclap Island was co~sidered safe cohabitation. A ncw viffagc was conswucnxf, and tk Rongclap people wcm moved there by Navy ship. The annual mc&cal surveys have since been carticd out on Rongclap Island. .A group of more than 100 Rongclap people, who were relatives of rhc exposed woplc but had been away from the island lt the time of the accident, moved back with the Rongelap ptople to drclr home Eland and have served as an [deal comw. risen population for the studies. This number has slncc increased to about ‘200. Following the initial survey of the Utirik people on Kwajalcin m 1954, a repeat survey was carried out m March 1957. In addition. durtng the past sumey,

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as in the previous SUS-VCVX,a wsit was made to Kwajakin and Majuro Atolls for cxaminat]on ofa number of Rongclap people, now rcxiding at !hatolls, and also qroups ofchildrcn who represent part of the control group used for the growth arsd dcvclopmcnt studi= of the cxpcacd children. Table I Iiws the various populations that have been examined since 1954. The accumulation ofdata from these survcvs u becoming increasingly voiumlnous, Since conditions have not been favorable for performance rrf extcnslse stalisl]cal analyses or usc of ekctronm ~omputtnq pmccdurcs to store and manipulate (he data, [hc annual SUI-VCVreports pubiishcd by this Laboratory arc mad. as compfctc as pcmwblc. Thci 01 raw data. much of lt In appcnd!ces. so th.a[ others ma~ have an opportunity to make further Summary of Past Pindings Reports have been published on the findinqs tf surc Intt]a[ examination, b months, - I year, 2 and 8 \cars. The foilowlnq is a bncfsumma~ of During the fimt 24 to 48 hr tier exptmure, about % of [hc Rongclap pcopie cxpcrienccd anorexia and nauxca. .4 fcw vomited and had dkrhea. In appcndlx 10 the individual histories of “au== and vomltinq arc tabulated. Many also expcricnccd ]tching and burning of the skin, and a few complained of Iachs-vmation and burning of the tomatic until about 2 weeks after the acc~dent, when cutaneous lewcms and I{as of ham dcvclofxd, duc Iargcly to bta irradiation of the skin. [t was apparcn[ when :hc people were fimt examined. a few davs af[cr exposure, that the Ivmpfmcvta were constderablv dcprcxscd and that stqntficant doses of radiation had probablv been rccclvcd. In Jmounts of radioacnve matcrlal had also been ab sorbccf Intcrnaliv. The cticcts ot the radiation can best bc summarized under three hcadlnqs according to the mode ofcxpsurc Pcnciratlnq !rradiaOnc of the carlicm findings Indicative of sqtcdicant cxpmurc in these people was Iowcrinq of biaod. This wax most mar marked in the other grot sure. The hcmopoictic d pro~rtional to the daat Even in the 157 Utirrk PC xn catimamtf 14 nda. it WI alight platelet dcprarnn The smaller group on A the huqh and low cxpoau logical rccorda of blcod 6 and Ailingnae group art the Rongclap pcqsle wem amival al Kwajakist 3 but showed a sliqht rcs only xkight mcrcau nom bwmg year, mean coun of the companxcm popd rcmainccf dightlv below. the first month: poxubb prcvalcncc of beta burn 5 and 6 weeks pat cx= about half that of the cod the adults and slightly h CICnt to rcsuh m anv afp pruccsscs, and Indeed It philic Icukomtcus was P rcachcd ll~ar control ICVI dots not appear to bc co sounqcr and older aqc P blood counts and f-mdv c crcasinq dcpremm, mad week. A spufi of rccovcr

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e skin. It was levels of ltukocvtrs and $Iatt(tts of the per. pheral blood. This was moat marked in the 64 people on Rongclap who had received 175 ~ assd was la marked in the other group receiving Iesn eapoaurc. The hcmopoictic deprcArrn wu roughly proportional to the dose of radiation received. Even in the 157 Utirik people who received only sfight piateiet deprcAxs in the group aa a whok. The smaikr group on Ailingnae and _ showed peripheral blood kvcis between three of the high and low exposure groups. The ch~ Iogicai records of blood findings in the Ronge@ and Ailinsptae group arc presented in Figusu20, 27, and 32 and in Appcndicca 1 and 2, and in the ~rnrphaprntcr d about half the Ievei of the comthe Rongelap people WCS-Cfim~ examined on their asmvai at Kwajakin 3 davs after exposure. In to ~j~ o( the Icvels in the comparison children. but showed a slight rise during the following wecka. The deprcsacd level was maintained with onlv slight mcrcau noted by one ~. Its the fislIowing year, mean counts approached the levels of the comparison population and have gcrtcraily remained siightly below. .Vtutrophd levels fluctuated considerably during the Iimt month; posaibiy this was related to the prevalence of beta burns of the skin during tha[ permd. Xcutrophii dcprcxsion became evident bv 5 and 6 wecka pat exposure with ievcls reaching about half that of the comparucns poptsiation in the adults and slightly lower in the children <5 ., process.cs. and indeed it was noted that neulrophilic Icukom tmu was puasibic in people show Ing covcrrd more rapidlv than Iympttocvtc 1~.~ qucnt annual surveys have rcvc~ t@t recovery does not appear to be complete, particularly m voungcr and oid-cr age groups. Phfdd counts showed Ics fluctuation than other biood counts and fairiy consistcntiv showed increasing dcprcraion. reaching Ievcis ofa that of the comparwrm population by t c +th week. .4 spurt of recovery to about 75(L of comparison Icvcis occurred during the foiiowlntg few weeks, which was followed by dower recovery but with mean levels n- reaching higher than 90 to 95% *t ofshemstsprisorspopulation during the oounccd as in the Rongdap @tap. However, a *ght iag in compkete rccovsrcy in the Ailin~ The persistent de- of peripheral blood elements in the cxpoud pco#s maka it lppear likely that there is slight rmidttai bone marrow both caped and unexpoocd Mamhaiicsc. Price. Jones curvm. on the average, showed a siight microcytic tendency. Scru m won Icvcis have generally been normal, and the cause of this anemic tendency has been ussdatcrmirted. - RtfIcMk--I.. counts have been about thesame in the ~ as in the uncxpod people. Except for radiation-induced &ION of the skin, patchy cpifation, and earty gastrointestinal SYSSSP tarns, chmcal txammatsa-s have revealed no disease processes or svmptoms whqh couid k ~1.at=f dircctiy to radiation cficcts. ?Jw”prophvlactlc or SPCCIfiCtherapy of radiation effects was ever con. sidcrcd ncesary or given. Epidcmlcs of chicken pox and rrtmalcs [hat occurred showed no qcater mcidencc or scverlty In the exposed than !n the unexpsrscd Mamhaiissc people. During the first monthspmt exposure about half of the exposed group exhibited Iom O/ urqhf of several pourxia. Ths may poawbiv have &en related to their radiation cxpaurc, aithough it M difficuit to ruic out ctTccta pmsmblv due to change of At 3 years post cxpurc the tmfrtuns rcrprns.wto priand found not to be wgnificandy different in the cxpcd compared IO the unexposed popuiauona

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his employment with such contriicwr, ofexfnxura, wim diad 2 yearakfter the laidcnt; dtbe klti; (4) s 80-Pd womars who &d occurred ist the costtparian population. The fk dcatha that have ocmtrml in the q-d P* 1000 popufatim @&trsttm, compared with 8.3 be the Manliall IAo& m l whofe. radiographic studia for bone age) have rcvcalai rhat sf@st rctardatirsss in gtwwds asni dcvciopmcrst 12 years of age lt the time of expoourc, particularly thoac 12 to 18 months of age at expaaurc. Ordv sfight immaturity was rtotcd in the expmxi fcmafe chikfrcn. h wasakm noted that children born ofexpcacd pm-mu ~ sfighdy rctardd and that they had slightly lower Ievcls of neutrophdx. lymphocytes, and platelets compared with maic chdter chfdrcn were cm the average 4 mths older, k *tadidmtj@a Onchnim dtatthcdiikcnm in [t ~ ax difTicuh to evaluate the etkcts on fcrtdity. However, a review of the bwth raft of the exposed group over the paat 8 years seems to Indicaie no noticeable effect d their expcxmrc on fertilitv. The tion p annum compxrcd with 37.3 for the .Mwshall Mands ( 1,957). The 25 births over a j-vear period for the comparison popuiatson rcp-nt a mtc of 21.8 pcr 1000 population. A somewhat greater mcidcncc d mucarnqrs and stdlbtnh was rioted in the cxpoad women during the Iimt 4 ycass after exposure, but bccauac of the paucmy of vid statiatio on the Marshalk and the smalf number of pmpk invofd the data am not rcacf - ifv amenable to statistical anafysis. shrs~tto axtutandirsg diffcrcncm between the ~ard to have ~ hypertermiod on the whok than 5 mtd ia pmpk in the cmntincntaf United fcrcncu kwccrr the exptxxf and the uncxpacd pcopk, andalmut thcsamcinctdcncc aaiasccnm OpAt4alael@tca/ saruqs showed no rcmarkabk in the ~ group. It is mt known whether thk finding is of any Significxn- in mfation to their no opacitica of the Ietm cttaracte@c d radiatim average in the U.S. population. Drxtal rarrry: showed no significant rlitfcrcncca m cari~ rate between cxpaacd and unexpoacrf groups. However, [he Incidence and scvcriiy- of posed group. 1[ is not known whether or not (his finding IS related to radiat]on cfkc:s. The por oraf hvgicrrc ~ncrafly okrwd in the Mamhaflcs had its usual results, namely, high caries rate m tccnaqc chlldrerr, scvcrc Pcrtdontal Icsions in adults ( hcai \ calculus and loss of alvcolxr lxrncl, and ccfcn:ulous mouths m the aged. Radiatmrt exposure did not appear to have at%ctcd dcvcloptng dcntltlon in the exposed children. allv aawmated wlih aqtq were mc-urcd or esliing. accomrnodatlon, vjsual acuity, and arcus wills: hcanng: cardiovascular changu including hlixd prcxsurc and dcqr-ccs of pcnphcral and rc!- inal artcrmaclcrows: neuromuscular function: and [he same age groups showed no apparent difTcrIndlviduais and groups by usc of an average pcrcm tagc score. L@ Awtrxq CITCCU d radiat Ion have no[ been apparent. .4s noted, the mofialitv rate was about the same in the cxpcd as in the unThe one ca too soon, It u I oon to radiat counu and ty cwdencc of Ie child in the in XnY of the cap It wax imfa unuccl Lo ha

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I groups. The pcopk ap Pcrtcnsmrt on the whok jr the continental Unitd pmcd and the unexpoacd mre inctdencc as ia seen in N showed no rcmarkabk ~cculac, and corrseal scam is nnt known whether thu ;ancc In relation to their iarnp obacrvaiiom showed aual and accommodation aqscarcd to be above the i no significant diifercnccx exposed and uricxpoacd sllghtiv greater in the cxnown whether or not this diatlon cffcc:s. The poor lmcly, high caries rate in :re pcrldontal lesions in md Ims of alveolar bone), in the aged. Radiation cx- > have alfcctcd developing Inq of the hair and baldowed no apparent ditTer- : score was calculated for noted, the mortalitv raw the exposed as In the unThe orK c= ufcaatm that developed in the ex. @ group occ.rrd at 5 ycan after cxpaurc, too soon, it is Ixlicvcd, [0 &ar any pticular relation to radiation expaurc. Lnkcwa surveys including phyxical findin~ studies of white =11 and Inss+iAdtuntx of 4000 white cells showed no cvidmcc of leukemia or leukemic tendency. One chi{d in the irradiated group haa had sfigfsdy ckvatcd bamphils but no othm paiti= fissdlngx. Tire carAouaJcnlw and wfhrtfts surveys, as well as the gmcral reatdta of the ph@c.aJ examirsatiorsa, have not shown any apparent increased incidence of &gmmatzsw d.m.m in the cxpacd people. No mdiaucsn-inducccf catamrss have been olmcrvcd in any oftfsc ex~ fxopfc. Gtsdsc cficcts have not been specifically studied bccauac of the smali number of pcop!c involvd. No apparent radiation-induced gencttc changca have been dctct Icd on …