Medical Survey of Rongelap People Seven Years After Exposure to Fallout

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MEDICAL SURVEY OF RONGELAP PEOPLE SEVEN YEARS AFTER EXPOSURE TO FALLOUT A.A. JAFFE, 0.0.S.,2 AND EZRA RIKLON, PRACTITIONER with the technical assistance of ‘ Brookhaven National Laboratory, Upton, New York 2Department of Public Health, TrustTerritory of the Pocific Islands 3South Nassau Communities Hospital, Rockville Centre, New York 4M.D. Anderson Hospital, University of Texas, Houston, Texas 5Sloan-Kettering Institutefor Cancer Research, New York, New York BROOK HAVEN NATIONAL LABORATORY UPTON, NEW YORK

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This report was prepared as an account of Government sponsored work. Neither the United States, nor the Commission, nor any person acting on behalf of the Commission: A. Makes any warranty or representation, expressed or implied, with respect to the accuracy, completeness, or usefulness of the information contained in this report, or that the use of any information, apparatus, method, or process disclosed in this report may not infringe privately owned rights; or B. Assumes any liabilities with respect to the use of, or for damages resulting from the use of any information, apparatus, methcd. or process disclosed in this report. A used in the above, “person acting on behalf of the Commission” includes any employee or contractor of the Commission, or employee of such contractor, to the extent that such employee or contractor of the Commission, or employee of such contractor prepares, disseminates, or provides access to, any information pursuant to his employment or contract with the Commission, or his employment with such contractor. PRINTED IN USA Available from the Office of Technicaf Services Department of Commerce

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Beta Irradiation of the Skin..,... Difficulties Associated With the Examinations . ................... 1961 Survey -Organization and Procedures..

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Summarv and Conclusions.. ,,. 43 ,+ppendix 1. Rorqelap Group and Control Mean Blood Counts at Various Times .After Exposure.. 48 Appendix 2. Ailingnae Group and Control Mean Blood Counts at Various Times .After Exposure .... . 49 Appendix 3. Individual Hematological Findings, 1961.. . . 50 Appendix 4. Individual WBC, Basophil, and .Alkaline Phosphatase Determinations, 1961 ... 56 Appendix 5. Gamma Globulin Groups of Rongelap Islanders (Blood Collected 1959) ............. 59 .4ppendix 6. Individual Physical Examination Findings, 1961 ... .. 60 Appendix 7, Gamma Spectrographic Data, Rongelap People, 1961 ................ 84

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MEDICAL SURVEY OF RONGELAP PEOPLE SEVEN YEARS AFTER EXPOSURE TO FALLOUT The results of a medical survev of the people of Rongelap in the Marshall Islands, carried out in March 1961 at 7 y-ears after the accident, 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 winds 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 vessel, the Lucky Dragon. Of the inhabitants of the island of Rongelap, 105 nautical miles away from the detonation, 64 received the largest fallout exposure: an estimated dose of 175 r of whole-body gamma radiation, contamination of the skin sufficient to result in beta burns,-and slight internal absorption of radioactive materials through inhalation and ingestion. Another 18 Rongelap people away on a nearby island (Ailingnae), where less fallout occurred, received only an external gamma dose of about 69 r. There were 28 .4merican servicemen on the island of Rongerik further to the east who received about the same amount of radiation as did the Rongelap people on Ailingnae. Lastly, 157 Marshallese on Utirik Island, about 200 miles further east, received about an estimated 14 r of whole-body radiation. The fallout was not visible on this island and no skin effects developed. The exposed people were evacuated from these islands by plane and ship about two days after the accident and taken to Kwajalein Naval Baae about 150 miles to the south, where they received extensive examinations for the following three months. In view of the generally negative findings on the American servicemen, they were later returned to their duty stations. The Utirik people were also allowed to return to their home island, where radioactive contamination was slight enough to allow safe habitation. Because Rongelap Atoll was considered to be too highly contaminated. a temporarv village was constructed for the Rongelap people on Majuro Atoll several hundred miles to the south, where they lived for the following 31A years and were examined at yearly intervals by a special medical team. In July 1957, after careful evaluation of the radioactive contamination situation, Rongelap Island was considered safe for habitation. A new village was constructed, and the Rongelap people were moved there by Navy ship. The annual medical surveys have since been carried out on Rongelap Island. A group of more than 100 Rongelap people, who were relatives of the exposed people but had been away from the island at the time of the accident, moved back with the Rongelap people to their home island and have served as an ideal comparison population for the studies. Following the initial survey of the Utirik people on Kwajalein in 1954, a repeat survey was carried out in March 1957. In addition, during the past survey, as in the previous surveys, a visit was made to Majuro .Atoll to examine a group of children who represent part of the control group used for the growth and development studies of the exposed Figure 1. Map of fallout area

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The accumulation of data from these surveys is becoming increasingly voluminous. Since conditions have not been favorable for performance of extensive statistical analyses or use of electronic computing procedures to store and manipulate the data, the annual survev reports published by this Laboratory are ma& as complete as possible. This report, therefore. includes a considerable amount of raw data, much of it in appendices, so that others may have an opportunity to make further calculations if desired. Summary of Past Findings Reports have been published on the findings of surveys made at the following times after expoyears,” 3 years, > 4 years,” and 5 and 6 years.: The following is a brief summary of the findings preDuring the first 24 to 48 hr after exposure, about ?4 of the Rongelap people experienced anorexia and nausea. A few vomited and had diarrhea. Many also experienced itching and burning of the skin, and a few complained of lachrvmation and burning of the eves. Following this, the people remained asymptomatic until about 2 weeks after the accident, when cutaneous lesions and loss of hair developed, due largely to beta irradiation of the skin. It was apparent when the people were first examined, a few days after exposure, that the lymphocytes were considerably depressed and that significant doses of radiation had probably been received. In addition to the wholebodv dose of radiation and the beta irradiation of the skin, radiochemical analyses of the urine showed that measurable amounts of radioactive material had also been absorbed internally. The effects of the radiation can best be summarized under three headkgs according to the mode of exposure: penetrating irradiation, skin irradiation, and internal irradiation. The changes in the peripheral blood of the more heavily exposed Rongelap people who received 175 r will be reviewed in the section on hematological examinations (see Figures 34, 39, and 43, and Appendices 1 and ‘2). The changes in the Ailingnae and L’tirik groups were similar but less marked. Certain unexplained fluctuations have occurred from year to year in the peripheral blood levels of the comparison populations as well as of the exposed groups. The mean leukoqyte level of the exposed group showed a marked decrease at the time of the 1960 survey (no unexposed people were examined). Depression of the peripheral blood elements as represented by mean population levels occurred as follows. Lymphocytes fell promptly and by the third day mere about 557c of the control values in adults. and sli,ghtlv lower in children. There was only slight recovery after six months. At 2 years, although further recovery was evident. the mean values of these cells were still found to be below the comparison population levels (75 to 80%). .4t 3 years the mean lymphocyte counts were slightly below those of the comparison population. At 4 years the mean level appeared to be about the same as that of the comparison population, but many counts remained lower. However, at 5 years, [Vmphogte levels appeared for the first time to equal those of the unexposed group, except that analyses showed more counts below the average of the unNeutrophil levels fluctuated considerably during the first few weeks but fell gradually to a low of about 50% of comparison population levels by the 6th week after exposure. Slow recovery ensued, but at 6 months they were still slightly below the unexposed levels. However, by 1 year post exposure they had returned to the level of the comparison population and have remained so, with the possible exception of those of children <12 years old, which generally have been lower than those of the unexposed children of comparable Platelets fell to about 30% of the unexposed values by the 4th week. By 6 months they had reached 75% of the controls; at 1 year the mean platelet count was still below that of the control population but higher than at the 6-month survey. Although further increases were apparent at the 2-, 3-, and 4-year examinations, the levels were still below those of the comparison population. At 5 years post exposure, exposed people still had mean platelet levels iO to 159’o below those of the Changes in hematocrit were not remarkable in any of the groups during the period of maximum depression of leukocytes. However, it appeared

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that in 1959 the mean d@~rO{rl# levels were slightly rate of 8.1 per 1000 population, compared with 8.3 lower in the e:<posed people. These blood elements for the comparison population and 6.8 for the in the .~ilingnae group also showed some slight Marshall Islands as a whole. depression beloi~ the unexposed Ieveis but not Certain findings were possiblv related i~ the r~oite so marked aS seen in the Ron~eiaP exposed radiation expmure,, such as loss in weight dfst%eral 4 .eneral anemic tendency w~ted in ~_unds in most of the people during the~rst n]rnts in the exposed group have not ~~JJ~etwned verification of more e’xact a @%f~Q~e of the ,1).irro\\ persists. but other. not immediately ap- a project on the verification of accuracy of aq-es of fmrent. [actors may be involved. the children has not been completed a+~ere- ~eticulocyte counts have been about the &&e fore, the ~ggestive evidence previously presented radiation etfects. aside from skin lesions, 10SSof dren seemed to be fairlv well established. hair. and early symptoms. NTospecific therapy was It was difficult to evaluate the effects on fertility. qi~en. Epidemics of chicken pox and measles oc - However, a review of the 6zrth rate of the exposed {’urred. The diseases encountered were no more group over the past 6 vears seems to indicate no severe or frequent in the irradiated group than in noticeable effect of their exposure on fertility. The in the exposed., cg-ed to the unexposed popued population died of heart diseas~whii had been present at the time ofexposure, who died 2 years after the accident; posure, of coronary heart disease complicating diabetes; (3) a 36-year-old man who died of acute variceila. -I vears after exposure, who had received ~:w::m;: ‘“ ences between the exposed and the unexposed &“~#&3r exposure, people, and about the same incidence as is seen in nt relationkip between any American populations. of these deaths and radiation exposure. Four Ophthalmological surutys showed no remarkable deaths have occurred in the comparison popula- differences bet ween the exposed and unexposed tion. The four deaths that have occurred in the groups except possibly a slightly greater number exposed people since exposure represent a mortality of cases of pterygii, pin,gueculae, and corneal scars

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in the exposed group. It is not known whether this findin@s of any significance in relation to their radiation exposure. Slit-lamp observations showed no op~ of the.lens characteristic of radiation tion exposmp. did not appear to have affected deLate-efe& of radiation. Vviowameteis usuaffv associated with uging were measured or estimated on a O to 4 + scale (skin looseness, elasticity, and senile changes; greving of the hair and balding; hand strength). Comparison of these measurements in exposed and unexposed individuals of the tlie’&& in the exposed as in the unexposed pta@e. The one case of cancer that developed in,.~ exposed ~roup occurred at 5 years after e ~’ re, , tion to radiation exposure. Leukemza surve-ys including physical findings, studies of white cell counts and types, alkaline phosphatase staining, and basophil counts of 4000 white cells showed no Genetic effects have not been specifically studied because of the small number of peopie involved. No apparent radiation-induced genetic changes have been detected on routine physical examination in the first-generation children of exposed parents. If the suggestive evidence of increased miscarriages and stillbirths in the exposed women 1s true, this may represent a genetic effect of exposure. BETA IRRADIAUON OF H SKIN It was impossible to get an wcu@e estimate of expcswre, largely on “’ of the body not covered little pain. Rapid desquamation, and were more painful. .~ few burns became secondarily infected and had to be treated with antibiotics. Repigmentation of the lesions gradually took place in most instances, and the skin appeared normal within a few weeks. However, in about 15% of the people, deeper lesions, particularly noted on the dorsum of the feet, continued to show lack ofrepigmentation with varying degrees of scarring and atrophy of the skin. By 6 years the only residual effects of beta radiation of the skin were seen in 10 cases which scarring, and atrophy at the site of the former burns. Numerous histopathological studies have been made,’” and the changes found have been ‘ consistent with radiation damage. At no time have changes been observed either grody or microscopically indicative of malignant or premalignant change. Spotty the heads was short regrowth of normal t@n has been seen. sure. By 6 months, this pigmentation had largely grown out with the nail and had disappeared in most cases. The cause of this phenomenon has not

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INTERNAL, IRRADIATION den for 1959 was 0.57 pC. The mean body burden of Zntii estimated from whole-bodv counting data numerous urine sarn- was, in 1958, after the return to Rongelap, 0.36 pC, ion showed internal 8 times as high as in 1957, and 0.44 pC in 1959. materials, probably Thus, whereas the Cs’” levels appe~ to have gh eating and drink- -’~d a maximum and actually to have dropped water and to a lesser in 1959, the Zn’;j levels have shown a continued Durin~g first few increase which is proba.b~y rdateci to the long biopreached or shgha exieeded only i~ the ~~e~f ‘2Qtimes as high ~ in 19.57 before the return to sed to 6.@mpC, a~2070 of the estimated months activity in the urine was to the techniques oqdia$he~ca! (which after careful survey was considered safe for habitation, …