Medical Survey of the People of Rongelap and Utirik Islands, Nine Years After Exposure to Fallout Radiation

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MEDICAL SURVEY OF THE PEOPLE OF RONGELAP AND UTIRIK ISLANDS, NINE YEARS AFTER EXPOSURE TO FALLOIIC MDIATION (MARCH> 1963). Bradford Cannon, M.D., Arabati Hicking, Practitioner, and Ezra Riklon. Practitioner P BROOKHAVEN NATIONAL LABORATORY v under cmtract with the United States Atomic Energy Commission and in coordination with the Trust Territory of the Pacific Islands

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MEDICAL SURVEY OF TSE PSOPLE OF RONCELAP AND U’TIRIK ISLANDS, NINE YEARS AFTER EXPOSURE TO FALLOUT RADIATION (lQRCH, 1963). Bradford Cannon, M.D. , Arabati Hicking, Practitioner, and Ezra Riklon, Practitioner with the technical assistance of William A. Scottl, Douglas Clareusl, Irving Jonss2, ‘Brookhaven National Laboratory, Upton, New york Nassau Communities Hospital, Rockville Centre, New york 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 1563, 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 cmnplete data of the ten year post-exposure survey to be carried out in %rch 1964. Brief summary of pcast 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 fram detonation, 64 people received the largest fallo~t exposure, an estimated dose of 175 roentgens (r) whole body gannna radiation; contamination of the skin sufficient to result in beta burns, and slight internal absorption of radioactive Rongelap people away on a received only an external materials through inhalation and ingestion. Other nearby island (Ailingnae), where less fallout occurred, gamma dose of 69 r. The people of Utirik Island about 200 miles east of Rongelap, received an estimated dose of 14 r whole body”radiation. Fallout was not visible on this Island and no skin and beta burns developed. The exposed people -~ere 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 Utirik people were returned to their Island medical examinations), since contamination new village built for them. The after several months, (following initial levels there were not considered Annual medical examinations have been carried o~t on the Rongelap the Utirik pegple have been examined 4 times including the present

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mwed back to Roagelap Island serve as a comparison population. Detailed information on 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 on their blood levels, but with no a:her finiings 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, follo~ed by significant depression of blood elements, spread beta burns to the skin with some loss of hair, absorption of radionuclides. However,’ the gamma dose the development of wide. and measurable internal (175 r) received by the more heavily exposed 64 people of Romgelap was not lethal, since no deaths have occurred in the graup that appeared to be related to their exposure. In spite of some early loss of weight in a nunber of the group, and ths 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 nscessary. The beta burns healed within several months without complications, though residual pigmentation 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 twa years after exposure. Subsequent return to their horns island resulted in ~light increases in body burdens of radionuclides, but the levels attained have remained far belo-~ the stated maximum permissible levels. During the first five years after exposure, a somewhat higher incidence of miscarriages and stillbirths were noted in the exposed w~men. Another effect believed to be a residual radiation effect, was the finding of slightly retarded growth and development in so.ne of the exposed children. Fertility did not appear to be significantly impaired since the birth rate in the exposed group has been comparable

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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 oat but no increase in congenital malformations has been noted in the children of exposed p~rents. The survey team consisted of 10 physicians and technicians from the 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 brw~ght under control by widespread immunization with Sabine oral vaccine by Navy and Public Health teams. Examinations were carried o-~t 35 children of exposed parents, 195 on 70 Rongelap people in the exposed group, unexposed Rongelap paople (adults and children) comprising the comparison population, and 84 Utirik people who 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 period of the examinations. Smaller groups of Rongelap and Utirik at Ebeye, (Kwajalein Atoll), and Majuro. The attitude of was most cordial and cooperative on both Islands. ~sople were also examined the people as usual

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Interval Medical History: Rongelap, During the past year, the only disease epidemic of note was the recent poliomyelitis 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 ware involved. Mild residual facial or limb paralysis (as of March 1) was noted in 8 and more severe paralysis in 2 children. One adult died of bulbar paralysis (see below). Deaths - A. Four deaths had occurred in the exposed group: (1) /}30, female, 60 years of age. Died, July 1962, ’with a stated diagnosis of cancer of the cervix. Previous examinations had shown progressive loss of weight and increasing hypertension. On the past surwey, bleeding was noted from the cervical os and a gynecological checkup had been recamnended 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 December 1962, two months after a fall from a coconut tree. Death was preceded bydisorientation and amnesia with convulsive seizures and finally coma. Autopsy showed meningeal damage grossly and histologically. Brain damage was the likely cause of 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 was obtained. - B. Death in a child of exposed parent: //107, female, 4 years of a~e. Died in October gastroenteritis and dehydration. Child had a history skin infections, loss of pigment in hair. No autopsy

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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 to the death from cancer in the exposed woman, there is no justification for establishing causal relationship with radiation exposure, in view of the small 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 barn to exposed parents and 4 to unexposed parents. The birth rate in the exposed group parallels fairly closely that in the unexposed group. One. neonatal death (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 ano,maly 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 recmds. It appeared, however, that during the past four years, since last examined, the people of Utirik have been generally free of major epidemics of disease. Several bouts of dysentery-type diarrhea ozcurred involving a dozen or so people on each occasion, but therapy with penicillin w~s effective. Some sickness from eating improperly prepared arrow-root starch was reported. About five deaths had o~curred in older people from pneummia, skin infections, and diarrhea. Six infant deaths wsre retarded. There did not appear to have been any unusual illnsss or deaths and the birth rate appeared to b,zab~ut the same as had bzen previously noted.

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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 hypsrtrophy 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 examined. This number———— consisted of 25 children exposed on Rongelap, 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 been summarized in Table II, page 8, Of particular interest was the development of a palpable nodule in the thyroid gland of a 12 year old girl (/}17), who had been exposed to fallout irradiation on Rongelap. Histological study of the nodule has been planned, During the p~liomyelitis epidemic on these atolls, 23 children in the study developed 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 UTIRIK Argyll Robertson pupil 1 Myocardial damage or a) dislocation of hip 1 b) prominent head of Lenticular opacities, cataracts 12 19 9 moderate to severe 12 10 3 - Cardiac enlargement 33 Pregnancies 65 2 Rheumatic heart dis. 1 Rongelap exposed (including Ailingnae)

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SUMMARY OF PHYSICAL FINDINGS Exposed Control Nonexposed Born before Born after children of Rongelap Utirik Jan. 1,1955 Jan. 1,1955 exposed parents Active skin lesions 1 0 2 13 4— Blood pressure taken Acute otitis media Chronic otitis media Excoriation of lip Black spots - tongue Rales in lungs ‘~ 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 previo~sly reported. As shown in Figures 2 and 4 (page 10), no difference was apparent in median statures betwsen girls in the exposed and control groups and between girls born to exposed and unexposed parents. Among the boys, however, retardation in statural growth of the between the aqes of 10 and 17 years as compared to that of the was again noted (Figure 1, page 10). The difference in median 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 -~ith exposed parents w[ere o~ the average 4 months yo~nger than the boys in the group with nonexposed parents. Leukemia sumzy Careful examinations for physical signs of leukemia and——..-—-- —z exa-ninations of the blood cells including basophil counts of 400’3 white cells, revealed no evidence of leukemic tendency in either expo,sed or unexposed people. Residual beta burns These are listed in Table III, page 11.—— ——_______& Very few chan~es w<hre noted in the lesions as compared with last year. The number of pigmented macular and p.apular nevus-like lesions previo~sly noted in burned areas seem to have slightly increased in some cases. No cases of chronic radiation dermatitis or skin cancer were noted. Hematolo~ical examinations The hematological findings are summarized in——.—____________J 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 down into a~e 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 groups. Platelet levels this year were lower in the exposed graup than last year with greater deficit of this element in nearly all age groups than noted with the le:lkocytes.

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MEOIAN STATURES 1958-1963 BOYS \ CHRONOLOGICAL …