Letter to C L Dunham, Subject: Medical Team Returned from Two-Year Medical Resurvey of Rongelap People and Controls

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Upton, Long Island, Division of Biology and Medicine Atomic Energy Commission The medical team returned 15 March 1956 from the two-year medical resurvey of the Rongelap people and controls. Everything went extremely smoothly with a minimum of difficulties. Johnston Island, however, seems to have a magnetic effect for our group since once again we had to spend 24 hours there due to engine trouble. Enclosed is a preliminary report of the two-year medical resurvey findings in the Rongelap people and controls. While we were at Majuro, a United Nations’ group visited the atoll. Great Britain, India, Belgium, Guatamala and China were represented. They conferred with us on the status of the Marshallese. A copy of the report which I submitted to them is enclosed. They seemed to be favorably impressed with the handling of the problem. There are several specific problems and recommendationswhich I would like to bring up. Most of the problems center around the return of the Rongelap people to their home atoll. Upon their return to Rongelap, the people will be almost completely isolated and their only contact with the outside world will be the visiting Trust Territory field trip ship which will touch off there, at most, every three or four months. This will mean that the people will have to depend almost entirely for medical care on their medical aid man (Jabwe). His training is such that only the barest first aid care can be e~ected from him. Since these people have received significant amounts of ratiation, the long term effects of which are uncertain, and in view of the unique worldwide interest in these people, disproportionateradiological importance may be attached to any disease that may develop among them and any suggestion @f negligence in medical attention may be the cause of great embarrassment. This problem is not easily soluble. The easiest way out would be, in my opinion, to leave the people at Majuro. However, since we are committed to return the people to their homes and that is also their express wish The following might be considered: , we must consider other measures. 1 (1) Establish radio communications on Rongelap. This would , probably also require training one of the Rongelap people in the use

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of the radio (receivingand broadcasting). Or, better still, place a regular radioman there who can also carry out maintenance and repair. (2) Arrange for evacuation, via air, and treatment of all ill persons through Trust Territory Headqwters, Guam, or through the Navy (3) ~~ge for a ~nthly or semi-monthly visit, by air, of a physician to Rongelap for survey of the people. (4) At the time of evacuation, hold on hfajuro, at the Marshall Island Memorial Hospital, all individuals requiring medical supervision. A fund would probably have to be established to allay expenses for the families of those se~o. If adequate medical supervision could be established at Rongelap, this measure might not (5) Arr=ge~nts might be ~de to send any special cases needing careful evaluation or specific therapy for consultation and treatment to the Naval Hospital on Guam. Advantage might be taken of the Military-Medico Symposium held at the U. S. Naval Hospital, Guam, once yearly where a group of well known specialists examine and treat special cases. In this regard, the Rongelap boy, Norio, with rheumatic heart disease might be thoroughly evaluated there for possible cardiac Naval Hospital on Guam.) One Of two more problems were discussed with Mr. Ness and others at Majuro concerning the Rongelap people: (1) Task Force 7 has been sending an allotment for food. As you know, the number of people on Ejit has almost doubled due to the influx of would-be relatives and supposed Rongelap people. The allotment has not been increased to meet this increased demand and, therefore, there apparently is not enough food for all. (3) Food will probably have to be furnished on Rongelap for a while, at least, until the people can become seld’-sustainlngby processing copra, etc. One other problem was discussed with Dr. Hickinsc,the Director of !the hospital there, in regard to Tibas, the leper. i%e of his problem would be to send him to a leper colony. are apparently none left thereabouts. It was suggested

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that possible employment of Tibas at the hospital might help solve his problem. He promised to consider this. In my opinion, future resurveys of the Rongelap people should continue. Such resurveys should be continued on a yearly basis as ~las been done in the past in view of the fact that certain of the blood elements are not yet back to normal and there is continued necessiiy for observation of the residual skin lesions. Since future examinaz.ions will no doubt be conducted at Rongelap, plans should be started for either establishing a laboratory with electricity and water supply on the island or arrangements made to use a small ship which might act as a floating laboratory. The latter would probably be preferable. The .voup is deeply grateful to you and the qembers of your staff and to the Havy Department and Trust Territory for the many arrangements whit’n were responsible for the successful completion of this mission. (2) Medical Survey Report to United Nationst group

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PRELIMINARY REPORT ON THE TWO-YEAR MEDICAL RESURVEY OF THE RONGELAP PEOPIJZ There has been little il.hess atnongthe people during the past~ year and they appeared to be in good health and in a good state of nutrition. An epidemic of chickenpox had occurred during the past year without complications. Many of the older Rongelap people are beginning to become more infirm, such as Lecor, the 100-year old I woman. Lexnan, the 78-year old preacher, is getting quite feeble and -given up preach= Of the Rita controls, 57 of the original 82 Most of the clinical findings were found to be similar to those that had been seen in previous enminations and occurred with about the same degree of frequency in the controls as in the Rongelap people. A few additional findings, not believed to be ntw diseases, were noted which probably had been overlooked before. Two Rongelap people had developed serious diseases during the past year. Kanene, NO. 46, a 77year old man, developed an apparent cerebral accident about 9 months ago and was partially paralyzed in the right arm and left leg. He cannot get around without help, though there is some improvement in t%nction at present. The other case was Norio, a is-year old boy, who was hospitalized with acute rheumatic heart disease with congestitie failure in December. He improved on digitalis and salicylates. Though he is apparently fully active at present, there is evidence of pronounced mitral disease and some degree of cardiomegaly, but with no evidence of decompensation. Tibas, No. 77, the leper, continues to show active, indolent ulcers on the soles of his feet. He presents a real problem in psychological adjustment since he is ostracized by his people and leads a lonely etistence. None of the clinical entities noted in the ongelap people a to be related in any way to radiation effect.? Itisdifficulto~= I impossible to say whether any of the increas~d aging might be due to radiation effect. Fertility certainly was not affected in view of the number of new babies and increase in pregnancies. In both control and Rongelap children, impetigenous lesions remain quite common. Fifteen Rongelap people continue to show reco~izable residual radiation skin lesions, but all lesions showed some degree of improvement on this examination. Areas of hyperpigmentation, particularly on the back of the necks, showed less \ hyperpigmentationand in some cases pigment had returned to normal. The dus~ color noted earlier was not apparent at this time. All deeper lesions which had shown depigmentationnow showed some de~ee of repigmentation. The foot lesions showing most residual changes were in Ikuiha (No. 25), Iroji (No. 26) and Norio (No. 76). These lesions showed depigmentation,atrophy of the skin and some degree of adherence to subcutaneous tissues. The ear lesion in Time (No. 79) continues to show scarring, atrophy and in one place adherence of the skin to the underlying cartilage. In none of these cases, was there

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evidence of tissue feel that surgical breakdown or sign of malignancy. Dr. Cannon did procedures were indicated in any of these cases at this time. Coior pictures and biopsies were taken which will be reported on later. Preliminary survey of the hematologlcaldata shows that there 1s in most cases continued improvement in the,blood picture of improvement depends on which set of control data is comparison. The W.B.C. and absolute neutrophiles appear to be about normal now. The lymphocfies, though slightly increased over one year, still appear to be slightly below control means. The platelets showed slight increase in the males over the one-year counts, but slight decrease was noted in the females, so that in general the platelet mean counts still remain slightly below control mean counts. The hematocrit was found to be about the same as in the control people. In view of the eosinophilia present in many of the people, both controls and Rongelap, stool examinations were carried out on 10 Rongelap individuals with high eosinophil counts. No ova or parasites were seen. The cause for the eosinophilia remains obscure. Examination of the eyes by Colonel Lowrey revealed no lens \. opacities or other findings which could be directly related to radiation effect. Many eye conditions were encountered among both controls and Rongelap people, however. In several cases cataracts had resulted in marked visual impairmnt and surgical removal was accomplished. Fifty-seven liters of urine were collectedat random from exposedl Rongelap people and precipitated for radiochemical analysis at Walter Reed Army Hospital. Preliminary results have revealed measurable activity to be present. A more detailed report, along with specific analysis for radionuclides, will be forthcoming in the near future. Ten individual 24-hour urine samples on Rongelap people were obtained and given to NRDL for analysis. No results have been reported on these samples yet.

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nuclear device in the P84flc, seveml inhabi~ ialmda mre accidentally fishermen vere =diated. The faUOut utuial, a vlaitepavdary rnterial, islaads were irradiated froa the fallout by three routeaz 10 Fradiation (gamma) from the ground, trees aud kouaes, resulted in b~diatton; 2. Skin contamination, with f81&ut rwultad in spotty localized irradiation of the skin and scalp; and 3. &ternal mrtmination occurred from ingesting of contamlaatedfood aad ~thing in i’al.lout material. The island groups and at of iavolmaent was as follows: The above people were till evacuated to Xm@lein vbere they were cared for and atudled Oxtensivaly for savaral mmths. ?he Vtirik pOOp~ who had only the most ~ aigps [blood effects) of radiation effects were moved back to theirhomeson Utirik. TIM Moau SUXT’iC~ who also ShmFedonlymimml effects were returned to due shortly &tervwd. The more heavily exposed Eompel.appeople uere moved to Bjlt Island in About 2/3 of the Ron&slapgroupexperienced nausea -- which was beliewd @a to the penektiag radiatio.aexposure. A large number experienced ~tehing and burning of the skin, and a few of the eyes, which was beldeved due to the irradiatim of the skin. ?oUoving this, the people mm free of any a~~ta until lbout g veeh later when skin lesions developed. !l!hereaul taoffmlt hreetyposof radiation were as fo.Uouss -6 roentgens.) Xffects were mnifest only on the bbod elements aa follows: Uhite Blood CeUs (uhioh Proqat tha body against infection) were depressed to about * of normal

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2. Skin Contamination - resulted in Spot* loss of hair and am ahildrenlomthair tieoudagrag andabeut ~ofthead,ults. majority of the skin leslons uwre ~eial and were no developed deeper lesions Vhiah ~ lmping Uzaera. xovever, even these healed mpidly, hat 8 few show san saarring completely regrovnin all roses. 3. InternalContamination- Hoahemiaal studies of urine samples shewed some d9@’ee Of internal absorption of radioaatim matarid.s. Eou8ver, the to- body bwden was found to be Otherthan the skin 1.8A31M, loss of hair and early q8pG therehave been no illnessesor disease processes that have been lncountered which could be lttributed to radiation effeats, lither during the f$ret surrey or mbSeq?aentreeurmm. There have been no deaths, though msny Of the people are quite old. The diseases encountered have been no IXX’S severe or fX’equeat thaa la the unirradhted p~~~c TM* w - even dnring the peziod when the greatest depression of theirblood calls oaaurred. ?or instanae, at that time an spi~c of ~ colds oacurred, but ma no versa in the EongQap pwpla mmpared to others. Therefore, at no tin has it baa ~sury to resort to any speaialiaed treatnent for mdiaixtomefYeats on the blood such as use of propmlaot~c aatibieties, blood transfusions,etc. Emmer, careful consideration amd trea~t has been gimn didrequire earefbltreatuntamd asaresailt ua have been 8t the site of skin bsioas , but it doez not Seem too likely at this time. ?ertility dld not appear to ham been effeated in view of the faatthat about 10 sound babies havmbeenborn in the group sinae the exposure and new pregnancies are In etidence.

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The people haVE reacted to this event philosophically. They are an intelligent and charming people and have given ue the highest dagree of cooperation. -X’s is mutual.respect and affection between us. Thy appear to be comfortably quartered and well fed on Ejit Island. They, of course, wish to return to their horseson Rongelap. It is my understanding that the only thing that has delayed their return is the completion of surveys of their home islands by the Atomic Energy Commission to be certain that the islands are safe. Head of the Medical Resurvey Group