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out both by palpation of the glends of some of these
people, and also their dose of thyroid replacement drugs.

Since: some who had run out of thyroid replacement medication clinically appeared thryroprivic therefore I feel
usually the entire thyroid was removed, a type of surgery
commonly performed for thyroid cancer and not a simple
benicon adenoma.
However I understand from several sources
that the Brookhaven Institute under the name of Dr. Conard
and his associates reports that in the Marshall Islanders
there are only very few cancers of the thyroid found, but

thet almost all of the lesions of the thyroid were benign

adenomas. This creates a conflict in my mind, since of
the. patients, perhaps eighteen to twenty, who had demonstrated to me thyroid scars, one of them was identified
histologically as a papillary adenocarcinoma of the thyroid, (in Guam) and this in a relatively young man; and
in case of
he presented an unduly hard nodule

in the lower portion of one of the thyroid lobes,

-- so

hard, and so well set apart from the thyroid tissue itself,
that I fear this also might be a carcinoma.
That radiation
would produce so many benign adenomas and so relatively
few carcinomas as I am led indirectly to believe is diffi-

cult for me to accept.

I should, were I involved in

further study, like to see sections of all the thyroids
removed.
One should know that there readily arises an
henest difference of opinion that occurs between pathologists as to what constitutes malignancy in thyroid tumors
and microscopic re-evaluation will be useful.
A second
opinion based on microscopic re-evaluation of the tissue
is justified by the very high incidence of benign tumors
compared with malignant tumors, in face of the known
effects of radiation in producing malignancy.
There appears to be little coubt that the tumors,
benign or malignant, are radiation-induced.
There are
just too many of them to be anything else.
Otherwise one

would have to postulate that the Marshallese had a remark-

ébly high incidence racially of tumors of the thyroid,

this existing before 1946,

Genied this.

and the old people I spoke to

They denied that prior to the bombs there

was any particular epidemic of lumps in the neck.
I
cannot therefore accept the belief that the Marshall
Islanders simply by virtue of their heredity have a tencency toward thyroid tumors.
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The other thing that struck me was the frequency of

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