Operation Castle: Medical Examination of Rongelap People Six Months After Exposure to Fallout Addendum Report 4.1A

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MEDICAL EXAMINATION OF RONGELAP PEOPLE SIX MONTHS AFTER EXPOSURE TO FALLOUT BEST COPY AVAILABLE Naval Medical Research Institutr U.S. Naval Radiological Defense Laboratory

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tion CASTLE test series in March, 1954. During the early ~~rutL>p(JrI(xi [OIIUWIIIKvxposurt,. ingestion of fallout m:lterul. At the time of the 6-nmnth rcsur~’ey the Ind Iv Idu:I1.- In KeII~.r,Il, appeared healthy und normally active, and no deaths had ocrurred in tb{, intt, rlnl ~)tri(xl. Thr~e babies had been born ~ince exposure; none of whom displayed detectable :]t)[)(jr:ll.~lit!~~s. One rnlscarriage at 3 months occurred during the interim period. NO specimen W:IS .Ivulliible for study. The skin lesions previously prominent had healed completely, and only urc;lslonal byperpigmentation of depigmented scars was seen in a few lndl~ ldu.Ils whu h:id severt ear’:, skin dama~e. Regrowth of hair had commenced during the third n))nth following exposure and was could tw ascribed to radiation exposure, and most had gained weight durin~ th~’inter~m per]od. A measles epidemic was in progress during the examiilations. The severity of the disease in the Rongelap people was no greater than in a contr~ 1 unexposed populatl(m, and the incidence fallout radiation. Analysis of hematological data obtained f~ileci to dem(mstr:~te :1 significant effect of measles on the peripheral blood count. Neutrophile, !ympho(yte, and pl:ltolet counts artivity were detectable in the urine of approximately on(>-thil’d of th(, (LXII(IX(>(III I(I]V1(ILI; IIS.

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The authors are indebted to a numbt,r of individuals at J number of ii~il))iI]\~tI.{t(\t, 1,1(’1* of this type. Drs. John Bugher and Charles Dunham of the Di\isiuII of Bi{>l~Jgy:Ind M\’di(’’:\,, State Department, the Department of the Interior, the Navy Department, :md the ‘rrust Tt>rrl - tories. The Chief of Navai Operations arranged all necessary tr:tnsportation. Con]nl:inder Harry Etter of the Bureau of Medicine and Surgery was instrument~l in comp[e(In~ arrar]KeOfficer, Naval Medical Research Institute (NMRI), placed all necessiiry fa(’llitles of the two laboratories involved at the disposal of the medical team, as did CAPT A. R. F3tI’nk(, R:~dl,~- vey and for his support throughout all phat+es of the endeilvor. Trust Territory Headquarters, Majuro, Marshall Islands, furnished :111nt~cess~ry facllit]~s al Ma]uro, and the entire resurvey team is Krateful for the cooperation i~r)d hosplt:,llty extended tive representative for the resurvey team, materially exped. (ed the ac([lr]~i]lishz~lent of the work. The authors are indebted to all members of the team for their c<x)pcra[ion and extensive analyses of data. The authors are indebted for histopathologica] consul tati[m provided by Dr. D:lvia Wood of the University of California Medical Schooi and by Dr. E. A. Alpen of the NRl)L. Also, to Drs. ings and to Dr. N. L. Petrakis for performing the differential counts.

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1.3 General Methods; Control Population . CHAPTER 3 SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION CHAPTER 5 INTERNAL RADIOACTIVE CONTAMINATION .

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APPENDIX A EXPOSED POPULATION: COMPARISON WITH INITIAL FINDINGS OF Individual WEIGHTS AND HE MATOLOGICAL k’Al. UES . APPENDIX B CONTROL POPULATION: INDIVM UAL WEIGHTS ANI) HEMATOLOGY CHAPTER 3 SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION 4.1 Serial Post-exposure Changes in the Mean Total Leukocyte, Neutrophile, and Lymphocyte Counts for the Rongelap Group 4.2 Serial Post-exposure Changes in the Mean Platelet Counts for the Rongelap Group. ....... 4.3 Cumulative Neutrophile Counts for the Rongelap Group at the Time of Maximum Depression and 6 Months After Exposure 4.4 Cumulative Platelet Counts for the Rongelap Group at the Time of Maximum Depression and 6 Months After Exposure CHAPTER 2 CLINICAL EXAMINATION 2.1 Positive Findings on Physical Examination of the Expose ‘i and Hematological Data for Control Populations by Age and by Sex Mean Values for Peripheral Blood Determina~ion~ on the-Rongelap Mean Values for Peripheral Blood Determinations on the Ailinginae Mean- Blood C-ounts for the Exposed and Control Populations, with and Bone Marrow Differential Counts on Exposed and Control Marshallese .

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The present medical resurvey was organized as the first of a contemplated series detion from fallout during Operation CASTLE. Fi)llowin~ the detonation of a thermonuclear device on Blkinl Atoll (m 1 Marrh, 1954, 28 Americans (}n Rorrgcrik Atoll and 239 Marshallese (64 on Rtln~ela\), 18 ~~nAlling~llae, .Ind 157 on Utirik) were exposed to significant amounts of radiat~[)n from fallout rlwse indlv ldu:l Is San Francisco. A report of medical findings has been issued ;1s an C)per:itlor) CASTLE report.’ The present report is concerned with the medical status 6 months later of the Marsha llese people who received the highest estimated dose of gamma r~c:ation, the Rongelap and Ailln~inae The Rongelap group was exposed to an estimated 175 r of gamma radlatlon, calculated from dose rates measured free in air, over a period of approximately 46 )Ir. The Aillnginae group received an estimated 69 r of gamma radiation over approximately 54 h Both groups received additional beta radiation to exposed skin areas. All findings were rn( : e severe In the Rongelap [ban in the Ailinginae group. These findings are rev]ewed l~ter in the report. Beraust of the continuing hazard from radiation on their home atolls, the Rongelap and Ailing]nae people were not returned to their homes after observation at Kw;tjalein. Instead, they were rewed to Majuro Atoll, the Trust Territory Headquarters for the Marshall Islands. * The Utirik people, who received comparatively slight exposure, were returned to the]r home atoll following observation at Kwajalein and were not examitied during the present resurvey. The exposed Americans had been returned to their duty stations in the Unl:ed States

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1.3 GENERAL METHODS; CONTROL POPULATION growth and Mher future ch~lngts iI) the two groups. age and sex to be pa]red witil the merrlbers of the exposed grtmp. Thus, (Ixch ln{ilvldu.!l of th,, exposed group was assigned a control individual of tl~e same sex unri ap~lr~)xlrr!;ii(~l} tl!~! s.lr]l{, age. The age distribution of the exposed and control populations 1~ given with (lit’ l\{,III.Il\)loSl,’.ll results in Chap. 4. The age distribution of the exposed and control groups wus thl} s.ini{, . t’xcept that suitable controls were not found for two women of reported ages 60 and 100, nor were controls established for the three babies born to members of the exposed group since March. 1954. Numbers were assigned to the controls by adding 1000 to the number of the corresponding member of the exposed group. For example, Labnir, number 1011, was the control fur 1. E. P. Cronkite et al., Study of Response of Human Beings Accidentally Exposed t{) SLg[l]f~[.iI)t Fallout Radiation, Operation Castle final report of Project 4.1.

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Within hours of exposure to radiation, approximately two-thirds of the Rong~Lip pe;~pl(} reported nausea. Itching and burning of the skin and eyes rfur~ng tbls period u(.curreri in t]vt,r em-quarter of the Wmgelap residents and in a smaller number 0[ [he Alilnginac pt)pulat~t~l). With the exception of r.ikin lesions and epilation rep~rted in Chap. 3. there were m] further symptoms nor findings on physical examination that could be ,ittribut~’d witl} cert;tlnty to radj:ition exposure. All individuals were normally active throughout the perlocf of obser~)atlon. The various clinical conditions encountered in the highest exposed Rongelap :ind Aillnglnae groups were not remarkably different in IVpe or extent from those seen in the lei~st exposed Utlrlk group. Although a number of indi~lduals were markedly neutropenic, no mfectlons attributable to neutropeniafw’v se were observed. No external evidenre of hemorrhage was obser~fed, ,al - though platelet counts in 20 per cent of the Rongelap group fell to 90,000 mms or lower at the time of maximum depression. Antibiotics were used in a few individuals where indicated for incidental infections. However, no prophylactic or therapeutic drugs wer? necessary or given because of whole-body radiation exposure alone. The following procedures were carried out routinely on both exposed and control groups: (1) b:ief past history, * (2) complete mtervai history, (3) skin examinati[m ~including biopsies growth and tievelopmerrt studies. Past ;~istories revealed little of note, with the exce~tion of a high incidence of yaws (exposed group, 23; control group, 17) and gonorrhea (exposed group, 21; control group, 19). One * Interval and past histories were taken by Dr. John Iaman, u Gilbertese physician who spoke excellent English as well as Marshallese. English-speaking Marshallese nurses aided m the physical exarninations. .

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control patient gave a history of syphilis for which she had been treated twl(’c. Intttrv.il histories were essentially negative. No deaths had oc(urred In the exptseci \,(~pul:IIIc~N, .In(i tllrt>ti of exposure were approximately 3, 6, xnd 7 months. Three other prr~n,lnclr~ wtmrv n(~tt,ti during Luetlc heart disease (?) 1 Heart disease, etiology unknown o Fibromyoma of uterus (?) 0 Hernia, Inguinal, direct o’ Table 2.1 summarizes the principal findings from history and physical examinations, and additional data on individuals are given in Appendices A and B. Dermatologicll findings are reported in detai! in Chap, 3. There appeared to be no significant difference in d.sease incidence between exposed and control populations, and no findings, with the except~on of those reported in Chap. 3, could be ascribed to radiation effects. A measles epidemic, in progress in both populations during the examinations, had begun to decline n the control group but was still at its peak in the exposed group at the completion of this study. The time interval between the peak incidence of measles in the two popt lations was probably due to tie relative isolation of the exposed group. . Body weights of the exposed patients were compared with their weights in March, 1954. Although there were a few :nstances of significant weight loss in indi!, iduals, the OY+‘-~li ~O?u- .

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lation showed an increase. This was probably becau~e of relative inactivity III .ldditl~m ICIhLLVInr. . urements taken on children age 19 or less showed no si~nifl~.ant ;Ilmt]rn]tilitit>s. 1. John Caffey, Pediatric X-ray Diagnosis, Year Book Polishers, 1950

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SKIN LESIONS, EPILATION, AND NAIL PIGMENTATION The Rongelap and Ailinginaegroups observed the fallout as :L powdery material thi{! tell for several hours and clung to their skin and hair. Thorough decontamination was not accomplished unt:l evacuation. occurred one 1 two d:lys later. The dosage to the skin, resulting from soft beta and soft g~mnla radiation, could not be calculated due to the complex make-up of the falloul mater lai, Initial symptomato]o~y r t!ated to the skin consisted of burning and itching in a large number of people, and irritation u: :he eyes with lacrimation in a small number, the first two days after exposure. The early s> n]ptoms were followed by pronounced lesions of the skin and epilation of the head, which first appeared about the 12th to the 14th day post-exposure in the Ron~elap group and after the 20th day in the less-exposed Ailinginae group; the Iesions occurred primarily on the exposed p~rts of the body which were not protected by clothing. Those persons who rem~incd under shelter in their homes developed less severe lesions or no lesions. Also, there was .s(~n]e protection to those who bathed or remained in their homes during the fallout. The development of the skin lesions did not conform in all respects to beta skin lesions described in the literature. No primary or seconds:-, erythema was obser~, ed: hmve~,(,r, the dark skins of these people may have obscured this phenomenon. The lesions showed differences in the latent period and appeared on different parts of the body in roughly th~ foil[)wing sequential order: scalp, neck, axillary region, antecubital fmsae, feet, :trms, Iex:,, ;tnd trunk, El)il;~- tion and scalp and nerk lesions were observed in 60 to 70 per cent {){ the Rongel.lp group, and foot lesions were also commnn. The first indication of a developing skin lesion was the appearance of pigmented marules, Papules, and raised plaques. Usually, these dark pi~mented lesions had a dry, thickened, leathery feel. However, some areas developed only simple hyperpigmentatlon of the skin over extended areas. The majority of lesions were superficial without vesicle formation, which, after several days, showed dry, scaly desquamation of the pigmented skin from the center of the lesion outward. Desquamation left depigmented pink-to-white epitheliums not remarkedly dlf - fer~nt in texture from the surrounding skin. During the next few weeks the lesions gradually became repigmented, resulting in a relatively normal appearance. Approximately 20 per cent of the Rongelap people developed lesions of a deeper nature, which occurred primarily on the feet, to some extent on the neck and scalp, and, in one case, on the ear. These lesions also began with hyperpigmentition, followed in a few days by wet desquamation with weeping and crustfig ulcer formation. In sor]e of the f~t lesions bullae formation occurre~, followed by a breaking of the bullae with ulceration. Many of the lesions were accompanied by symptoms of pruritus and a burning sensation, and some of the deeper lesions were painful during the acute stage. The app! lcation of bland anti >rurltic lotions :~ncf

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gressed distally with growth of the nail. Since all the Americ:in Ne~roes hu[ n(JII~ of the whltti mxl damage m the dermis. Biopsws taken at six weeks post-exposure showed, in generai, that the cpid(rnlis had made a definite recovery. except for a few persistent areas of atrophy and f~nger-like downgrowths of stratum malplghii, with cells showing rather prominent pigment cc~ntent. Thert’ were many outward epidermal excrescences covered by thickened stratum corneum. The dernlls sh(’’~ed less cellular infiltration of the papillary layer but still some slig:.. dt>gree of telanglect:lsic of In addition to an examination of the skin and its appendages of the exposed people, 80 control Marshallese living on Majuro Atoll were also examined. Color pictures were taken of the skin where indicated, and attempts were made to take pictures of lesions magnlfl{ri 20 times. Blopsles were taken at the site cf former lesions in 12 exVmed Individuills. Most were repeat biopsies from individuals who had been studied in this manner during tht’ Inlti.11 exnnl]nations. Several skin hiops Ies from control individuals were also t:~kell. Healing of all the early superficial lesion!+ was essentially complete. The skin had repigmented to normal color, appeared to be of normal texture, and gave no remaining gross evidence of previous injury. Plates 1, 2, 8, and 9 show the early lesions as compared with their appearance at 6 months. Those lesions which had been deeper, and particular y those which showed evidence of transepidermal injury, continued to show slight evidence of previous dam- “age, largely in the form of pigment alterations. Most of the neck lesims, which at 10 to 11 weeks after exposure had shown the thickened skin with grayish, dusk y pigmentation, showed much less thickening and less marked pigmentation at 6 months. It was observed that the skin of the necks of many of the control population, particularly of the -omen, showed sllghtly increased pigmentation. Hence it was frequently difficult to determine whether there was rem~in - ing hyperpigmentation in this area or whether the degree of pigmentation was in the normal range, There were, however,, 10 cases out of an original 16 In which the :~mount of piument:i

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tion of the neck appeared to be definitely incre:~sed at the site of previous lesllms. H(Jwr\’(r, ing of skin ridges). Depigmented foot lesions were observed in six rises, Orw .~n[e[ul,lt.11 fossae lesion also showed a small area of depigmentation. The persistent lesion of the ear, noted in the initial examination, had …