ATTACHMENT 13




                  BROOKHAVEN NATIONAL LABORATORY
                   ASSOCIATED UNIVERSITIES, INC.
                         UPTON, L.I., N.Y.
                        TEL. YAPHANK 4-6262

                           June 3, 1959



Dr. H. David Bruner
Director, Medical Division
Division of Biology and Medicine
Atomic Energy Commission
Washington 25, D.C.

Dear Dave:

     Enclosed is a copy of a memorandum I have written to Dr.
Farr expressing my viewpoints on the indications for and scope of
future medical surveys in the Marshall Islands.

     In view of the possibility that the Trust Territory may have
other opinions as to the scope and frequency of these surveys.  I
thought it would be best to get my thoughts on the matter
recorded.  Some of these thoughts were also expressed in the
summary report or the present medical status of the Marshallese I
sent you for the use of the State Department, but the memorandum
contains an explanation of some of these points specifically
concerned with future surveys.


                                   Sincerely yours,
     
                                   Bob

                                   Robert A. Conard, M.D.

Enclosure
hlb

cc:  Dr. C. L. Dunham

                                        good!

REPOSITORY     Washington National Records Center
COLLECTION     32681-6
BOX No.        Box 1
FOLDER


                  BROOKHAVEN NATIONAL LABORATORY
                            MEMORANDUM

DATE:          June 2, 1959

TO:            Dr. L. H. Farr

FROM:          R.A. Conard

SUBJECT:       Future Marshallese Surveys

     I would like to express my viewpoints on various aspects of
the medical status of the Marshallese exposed to fallout in 1954
as related to the need for future examinations and frequency and
scope of examinations.

     The people of Rongelap received a high-sublethal dose of
gamma radiation, extensive beta burns of the skin, and
significant internal absorption of fission products.  The gamma
radiation exposure was the most serious and resulted in
significant depression of the blood-forming organs.  Even at five
years post-exposure, it appears that the blood platelets have not
returned completely to the levels of the unexposed comparison
group, though there are no other evidences of their acute
exposure other than atrophy and scarring of the skin from beta
radiation in a few cases.  These findings need continued
observation.  Very little is known of the late effects of
radiation in human beings.  Increased incidence of leukemia in
the exposed Japanese has been noted and, in animal studies, the
following late effects of radiation are believed to result:  life
shortening, premature aging, increase in degenerative disease,
increased incidence of malignancies, opacities of the lenses of
the eyes, and genetic change.  At this stage of our knowledge, we
must assume that any or all of these changes may occur in the
exposed Marshallese.  The seriousness of their exposure cannot be
minimized.

     Low levels of radiative contamination persist on Rongelap
Atoll.  The levels are considered safe for habitation.  However,
the extent of contamination is greater than found elsewhere in
the world and, since there has been no previous experience with
populations exposed to such levels, contained careful checks of
the body burdens of radionuclides in these people is indicated to
insure no unexpected increase.

     From these considerations it is apparent that we are
obligated to carry out future examinations on the exposed people
to the extent that they are deemed necessary as time goes on so
that any untoward effects that may develop may be diagnosed as
soon as possible and the best medical therapy instituted.  Any
action short of this would compromise our responsibility and lay
us open to criticism.
                                -2-

     In considering the possibility of carrying out the
examinations at greater than yearly intervals, the following
facts must be borne in mind.  Continuity of these examinations is
of utmost importance.  Unfortunately, during the interim between
the annual medical surveys, it has been apparent that precise
information on the medical status of the people during the
interim has not been available.  The interim medical care of the
people is in the hands of the health aide who has not sufficient
background and experience to fill this need and the visits of the
Marshallese medical practitioner to the island are too infrequent
and short.  In order that at least emergency care could be made
available, a radio was installed on Rongelap several years ago
and arrangements were made with the Naval medial group at
Kwajalein and the Trust Territory group at Aba to evaluate
emergency cases for diagnosis and treatment and, in addition,
final diagnosis as determined by autopsy in fatal cases has been
possible.  Therefore, in view of these facts, increasing the
interval between examinations will further reduce continuity
unless more reliable interim arrangements can be made.

     It is true that the medical program for the Rongelap people
placed them in a more favorable position for medical care than is
true of other Marshall Islanders which may tend to promote some
dissatisfaction on the part of the less favored islanders.  More
important is the fact that this special treatment unavoidably
increased concern in the exposed Rongelap about their health and
no doubt along with the other special treatment, such as food
subsidies and other assistance, fosters an attitude of expecting
handouts and tends to retard economic independence which is the
goal of Trust Territory authorities.  While recognizing these
facts, I believe that they are secondary to our responsibility in
continuing a medical program which will insure as rapidly and
efficiently as possible the diagnosis and treatment of any
radiation injuries which have been incurred in these people
through no fault of their own.  It is gratifying that the Trust
Territory and the Atomic Energy Commission have whole-heartedly
supported this objective and have assisted in every way possible
in implementing the program.

     The following specific recommendations are made:

     1.   A medical survey of the Rongelap people is considered
necessary next year (1960).  The survey would include only
essential examinations which could probably be accomplished in
about 10 days at Rongelap and with a slight reduction in the size
of the medical team as compared with last year.  A smaller ship
than an LST (such as an LSM) might be satisfactory if available. 
The following important examinations would be carried out:

     a)   One blood examination instead of two (primarily to see
if platelets are back to the unexposed population levels and
secondarily to survey for leukemia).

                                -3-

     b)   Interval history and physical examinations (to
determine if any radiation-induced changes are occurring).

     c)   Determination of body burdens of radioisotopes (to be
carried out by radiochemical urinalyses and whole-body gamma
spectroscopy) to determine if body burdens have reached
equilibrium with the environment.  Though no expected significant
increase in body burdens is anticipated, continued checks on
future surveys of radioactive levels in these people is
indicated.

     2.   In order to help insure interim medical care of the
Rongelap people, it is recommended that the authorities at
Kwajalein and the Trust Territory at the Ebey continue to arrange
visits to Rongelap by physicians at monthly intervals and carry
out evaluation and treatment of emergency cases.

hlb

cc:  Dr. C. L. Dunham
     Dr. H. D. Bruner