47 u psychic trauma } operative in the mn. The 175-rad Do small to cause th, and the estiternally absorbed lisregarded since * 310 4 rads over ies in weanling ve shown an inof shielded legs, on a radiation-"* It is of interm were noted to ing the first 6 to 8 .? the influence ducing this effect NOOULES from 3 teen-age “rvey. Most pa- range 700 to 1400 rads). The fact that a part of the total dose to the thyroid (175 rads) was due to whole-body gammaexposure (including the pituitary gland) may be of somesignificance. The fact that all three Marshallese developing the thyroid nodules were girls is in accord with the experience of others that thyroid neoplasia and goiters predominate in females. In the report by Sheline et al.** referred to above, § cases among 256 patients treated with I'": developed thyroid nodules. All 8 cases were females: the ages at the time of treatmentin 6 were < 18 (4 aged < 10 and 2 between 20 and 30). In the Marshallese girls, the stress of puberty may have been a factor in the development of the nodules. Nore: During the 11th-year survey now in progress (March 1965) 3 new cases of thyroid nodules in the exposed group have been detected. Two were in boys 12 and 17 years of age and one in an adult woman 41 years of age. The nodules appeared grossly similar to those described in the teen-age girls in this report, and these cases will receive study and treatment. a that radiation ic agent on the MALIGNANCY ical of the lesions : with radioactive 5 strong that the ose girls were inof the thyroid vas substantiated Two older women who had been exposed died with a diagnosis of cancer, one at 67 years of age of ovarian malignancy at 5 years post exposure and the other at 60 years of age of probable cancer ofthe cervix at 8 years post exposure. The diagnos in the latter case was not confirmed by autopsy or biopsy. One unexposed older woman died possibly of cancer of the cervix, but the diagnosis was not B alone, though ed the difference een the exposed agnificant at the 4." and Lindsay rment of thyrod nent of children .. Dr. Lindsay glands removed 2 similar to the een given I['* td dose of = 150 Opes of iodine, ayroid giands of “age received a .ds** (probable YVatnonal Laboratory m, Lawrence Radie*¢zamuned the carty confirmed. No other cases of malignancy have been noted in the unexposed population. No cases of leukemia have been detected in either the exposed or unexposed Rongelapese. Pempheral blood smears were studied closely for leu- kemic cells, including examinations for alkaline phosphatase and basophil counts. The three cases of thyroid nodules plus the two earlier cases of cancer in older exposed women raise the question whether an increased frequency of cancer maybe expected in future years. However, in evaluating the role of radiation, it must be kept in mind that one case of cancer in the exposed group occurred at 5 years after exposure too soon,it is believed, to be related to radiation exposure - and in the second case it was not possible to obtain autopsy or biopsy materia! for con- firmation of the diagnosis. Atomic Bomb Casualty Commission studies have conclusively demonstrated an increased incidence of leukemia in Japanese exposed to the atom bomb radiation.***° An increased incidence has also been noted in patients whohad received radiation therapy for ankylosing spondylitis."' There are many reports of the late developmentof neoplasia, particularly cancer of the thyroid giand, following radiation exposure of infants and children.**-* Increased instances of cancer of the thyrotd gland and adenomata have been reported in the Japanese heavily exposed to ionizing radiation from the atomic bombs.*"* The Marshallese will be carefully observed for such a possibility in future surveys. The question of increased incidence of malignancy in the irradiated Marshallese must be left open for the present. During the past several years, increased numbers of pigmented nevus-like lesions have been noted in previously irradiated areas of the skin, but these have appeared to be quite benign. Neither chronic radiation dermatitis nor cancers of the skin have been noted. INTERNALLY ABSORBED ISOTOPES Radiochemica! urine analyses and whole-body gammaspectrometric analyses revealed that the level of body burdens of radioisotopes in the exposed Rongelapese fell rapidly, so that by 2 and 3 years post exposure the levels were far below the stated maximum permissible level.‘° The return of the Rongelapese to their home island was as- sociated with a rise in their body burdens of Cs'”, Zn**, and Sr*’. By 1961, the whole-body content of Cs’”* had apparently reached an equilibnum with the environment at a value of about 14.7 mC /kg body weight or about 300 times the mean of the medical team measured at the same time. Zn°**, which hadrisen to about 9.9 muC in 1959, fell by 1967 to 1.5 mpC/kg body weight, or about 100 times that measured in members of the medi- cal :eam. The levels of Sr*" in 1962 and 1963 hovered around the 12.0-muC level in adults and about 22 mupCin children, about 5 and 10% of the maximum permissible level (for members of the population at large). It thus appears that body