The Effects of Fallout Radiation on Marshallese Children

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THE EFFECTS OF FALLOUT ON MARSHALLESE CHILDREN COLLECTION fl~~m 1 hti On \lar, i, 1954, native lnli~bltants of several atolls In the llarshall Islands were exposed acclcientallv to fallout racilatlon following the experlmerttal cfetonatlon of a large thermonuclear device at Bikini Island. The heaviest fallout occurred on Fbongelsp Island, cfownw;rKI a])d about 100 miles east of Bk]nl. Since th~ttime the exposed people nave undergone regular and Intensive medical examlnotlons. the results of which have been documented in a number of pubilcatlons. ]-i This report summarizes the findings on the exposed Rongelap people who were children at the time of exposure. In particular, these flndmgs are compared to those noted In the exposed adult population. FALLOUT AND RADIATION DOSES At the time of the atomic bomb test, the fn-eball touched the surfaces of the earth and ocean. particulate matter were sucked Tremendous amounts of inc~nerated up into the cloud. Because of an unBEST COPY AVAIMBLE

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662 SUTOW AND CONARD predicted shift m wmd dlrect~on, radioactively contaminated fallout was deposited on Rongelap, A~lmgnae, and Utlrlk atolls. On Rong-clap. the fallout, which coated the ground and vegetation and formed cfeposlts on the hair and skin of the people, was descr~bec as “snow-like ““ Less dense “mist-like” fallout was noted on Alllngnae. A~lmgnae, some 40 miles south of Rongelap, was actually closer to Blkim. but lt was s]tuated more out of the lme of the cloud passage. NO vlslble evidence of fallout was observed on L!tirlk. 250 miles from Fallout commenced on Rongelap and All]ngnae 4 to 6 hr after the detonation of the bomb. The rac?ioactlve cloud reached Ut]rlk about considerably to the dose. T]]e most I)roboble dose to the thyrolci :lJM Culateci to be in the range of 700 to 1400 rads. Except for tile thyroid glmci, the dose from absorbed rxiloactlve material appears to !mve been mlnlmal with no cilscernlble biological effects.7 Subsequent to the return of Rol]~el~p people to their home islJnc!, the body burdens of 13’CS, ‘5Zn, and !’OSr rose to low levels, but these Gummo dOse, Thyroid close, Population tuds (I), rods Age <10 years “ 175 700 to 1400 Age <10 years 69 275 to 550 Ago <10 years 14 55 to 110

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re.iched equlllbrmm with environmental sources by 1961. No effects from these Isotopes have been detected. *’g POPULATIONS UNDER STUDY Isll~nd. The 18 wi~o were exposed to faliout on Admgnae were Rorigelzp Island. 157 L?.irshzllese people received fallout radmtlon. In additlofi, on the boat “Lucky Dra~on, ”’ were subjected to sublethal doses of Under 10 years 10 to 1.5years 16~ years In tl)e Rongelap group, 12 of the 64 were under 5 years of age, 18 were between 5 and 16 years, and 34 were over 16 years of a~e. Among these clllldren, 19 were under the oge of 10 ye~rs. Four fetuses were exposed m utero on Rongelap. In the Alllngnoe group, 6 of the 18 were chlldrel). Jll tu]aer tile ace of 10 years. on Llt]r]ji, 63 of the 157 were chllcfrell 15 ye~rs of age and younger. Of the 63, 54 were u]:der 10 years of age. Ron:elap was considered to be hab~table in 1957. At that time the people were transferred back to their home Island. When repatriation took place, a group of about 200 unexposed people also moved to Rongelap, Tius nonexposed group, mostly relatlves and former mhabNants of the island, has served as the comparison population for the continuing studies of the exposed people. Among the nonexposed group, 48 were under 10 years of age in March 1954 and 8 were between 10 and 15 years of age. 10 Following the initial intensive medical studies, follow-up examinations of the Rongelap and Ailingnae people have been conducted at 6 ,

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months and then 2t annual intervals m March. Systematic and com - st~rted m 1958 and have been conducted a! least Mennlally. People 011 The ~cute e:lrly effects of ffillout radlatlon involved pr; marlly R~di:~tlon burns resultlng from deposits of fallout materl~l on the skm developed about 2 weeks after the exposure. H~~erplg]>:elltfit]oll. Epll~t]o]], b .<,enerall~ spotty in nature, be<an 2 to 3 weeks Qfter plete by the sixth month. The new h~lr seemed norln~l m color, texture. and abundunce. Both the frequency and the severity of eplltitlon were more marked among children than among adults (Table 4). Thus 100:; of the children under 5 years of age showed some degree of epilation, 90? of them moderate to severe in degree. Only 27; of those over 16 years of age manifested epilatlon. ‘z”~ In respect to hematoiogic findings and particularly aS they rel~te tO age (Table 5), the following observations have been made: 13-*4 1. At maximum depression of lymphocytes (third day), the values were lower in those under 5 years of age (Z5’~ of nornlal) th~n in those over 5 years of age ( 55’.;, of normal). Recovery W.M nlore rapid in the younger age group, and age differences became less marked after the 2. Platelet v:ilues (J5 perceut of Control v31ues) during the first 12 months were consistently lower among those under 10 yexrs of age

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Percent of control Age under 5 years .lge over 5 years as compared to those over 10 years of age. Maximum depression occurred by 30 days. 3. Granulocyte values dropped during the second week and showed a second drop during the fifth week. By 12 weeks the levels had returned nearly to the control range. Although the pztterns of chmge were the same, the values for children under 5 years of age were below those of the older age groups througi]out most of the first year 4. Complete recovery to normal levels of peripheral Mood elements was slow, Mean levels for platelets, granulocytes, and lyn~phoCytes remained slightly, but consistently, below the control levels

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666 SUTOW AND CONARD during the follow-up surveys until the eleventh year ( 1965). These differences were statlstlcdly .sgnlficant at various examinations. In 1965 the me~n counts for Jll blood elements reached COtltrOl values. Inspectlon3 of the mem vaiues calculated for children aged 15 years or younger ~t the time of each exam: n~tlon showed essentmlly the same pattern of varlatlon from the control values, reaching control The sl$llficant late effects of the flllout r~diation h~ve been the me~surements showed, m the exposed boys only, a sllght but consistent retard~tlon m body size (expressed as st~ture) during growth from statlstlc~lly slgmflcant. SO difference m the growth curves was noted among girls. ‘5 Further exornmation of the data suggested th~t the re - tard>t Ion noted m the boys WAS most mzrked amen: those who were development studies, because of the rel~tlvely small numbers LJf ulat Ions hsve been combmed. ) When this youngest ~~e group was considered separately ( Fig. 1), These children were smuller tlr.m both the control boys and those exchildren showed no st:~tistically significant differences. fn 1963 a nodule was palpated in the thyroid gland of a 13-year-old girl who was exposed to fallout on Rongel:ip at the age of 3 years anct 4 months. A totul thyroidectomy was done. The surgical specimen showed multiple Imdulcs with cystic and hemorrl]:l~ic chan~es. The

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lCulculutcd on hasls of numhcrs of people exammed for frank hypothyroidism, makmg the total incidence of thyroid abnormalities 90’; among this group of 19 children. 16’i; Up to the conclusion of the 1969 survey, operative procedures have been carried out in 12 children with thyroid nodules, In all instances multlple benign adenomatous leslons were found. NO malignant changes have been noted in any of the specimens. The pattern of thyroid-nodule development suggested several relations to age and developmental status of the exposed children.

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Almost all the tumors appeared to develop during the adolescent pericd (Fig. 2). For comparable zges at exposure, the tumors were frost noted at chrcmologlcally earner ages among g]rls, consistent with the normal earner occurrence of ~dolescent changes m girls, The “ latent period” between rzd~atlon exposure and tumor development for 13 of the 15 leslons was 10 to 13 years. AGE AT DEVELOPMENT Or NODULES, yEARS No thyroid tumors hiive been palpated in 48 unexposed Ron~elap foil icular care inoma in onc :uld wtenonmtokl goiter in two. In the Ailingnae Kroup of 12 who were older thin: }0 years of a~e at Cxposurc, a tumor (mwrofibrom:i) lxtcral to the thyroid @wd has

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fmduws .lplw:lred to be correlated mvcrsely with chronolo~]cal tiqc, ope:; . ~w;iy from houses and overhead protection, tlumdo ~dults. Young cmljren play 01: the open ground wth great frequency’. Thus, durli~g the 2 d~ys before evacuation, they would have nacf greater and nmre prothe chlidren were such tlmt they would have received a greater dose ~t mldlme thml adults recelvmg the same alr dose. These factors no doubt contributed to the sk~n leslons and gre~ter depression of blood elements m chlldrei~ as compared to adults. The gre~ter mclcler,ce to lncre.~sed r~cf~~tion dose to tile cl~lldreri’s glands but also to the pllcenlent of Injured cells. Cllnlcal and laboratory dlta indicated that total destruction of the thyroid gland occurred 111 two youngsters. Thit partml destruction of the glands may have resulted in others is suggested by increased thyroid-st~nmlatmg hormone (TSH) levels, lowered thyroxine values, reduced uptake of radioiodme, and the inability of the thyroid glands to respond to further TSH st~mulatlon. 3’‘i The t immg of the nodule development suggests that growth stresses associated with adolescence could have been a precipitating factor in nodule formation. However, the nodules occurred early in adolescence in the younger exposed children and late in adolescence in those who were older at exposure.

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670 SUTOW AND CONARD The finding of thyroid nodules m so many subjects raises the question of the existence of goltrogemc factors unrelated to radlatlon. However. the overwhelming conce]]tratlon of the nodules wlthm o spechilclren) M well IS m 48 unexposed children all Ilvmg m the same or .sImllar environment substantiates the preceding conclusion. Although no thyroid cancer h~s been detected as yet m the Ro].., clap now 15 years from the t~me of exposure, well wlthm the 3- to 27-:.’ear latent period for cancer development reported m the literature. “-~” The subjects are m the l~te teens and early twenties. where the pe-ik physlc~l doses of radlatlon to wluch the thvrold qiancs of the Rcilwel.ip assoclfited with late development of cancer.”! ~!.;; It IS possible th.lt In Under conditions of the f.~llout, the dose to the tliyrold gl:u]d WQSreceived over a period of hours. Thyroid cfincer has developed m one adult. ,llthou~h ttus sm~le ever, tl]e suppression of nodule form~tion In ttle lrr:~(fmted thyroid gland of the r.lt Ilas been reported. 23 clearly the mecl]:mlsm for growth f~ilure m some of the Rollgel.tp with increasmq protx~biIity, tlwt the growth retm’datlon hfis been the result of hypofunctlon of the tljyrold gl;lnd in these children.’6 ‘1: The Slgnlficmt &rowtll spurt in the nlost retarded childrejl following :ldn];n - istrution of thyroid hormone can be cot)sidert~d strong corrobor:~tlve Energy Comm issioil and, in part, by Pub]lc I[calth Scrvict? Ilewwrch

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672 SUTOW AND CONARD Dose Dehvered to the Thyroids of Ch]l~rcn and the Subsequent Development ROSE XTHAL. Have any c!llldren been born to these people? SUTOW: ~e~, we have followed approximately 60 children who !OSENTHAL: HOW about the four who were lrrxflated In utero? f abnormolltles. Two of them were exposed ~t the point betweel) the f~rs! and second trln)esters. find the other two were nbout mlcfwav betwee~ the second ancf thlrc! trimesters. SCHJEIDE: HOW does the rate of hair growth in very y-oung children compare to t!mt In adults? Are the h~ir folllcles much more active SUTOW: I tto not know whether the hair grows differently m the adults and the children in this popuhtlon. AS far as regrowth after epllatlon was concerned, a review of the records indlcfites recovery was about the same in the chilclren and adults, and shut SIX nlol)ths or . so later they were all b:~ck to normul. roll :dmut in the dirt a lot and they I)ossltjly got IIIOrC Of the fallout. material dircc~ly on the hair. SCHJEIDE: The children might not have washed it off, and the : CONARD: Th@ Skin of the scalp of the child is a little thimer than < ,, the adult, and the hair follicles are ctoser to me snjtiace, Since the ;$

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Yi\lli\ZilKI I WOU1(I like to know if thev are multlnodul~r or are .\LPES The (icptil of tjle hair folijr, ies with respect to tne beta YALIAZAKI: It might be to Ilave some measure of the dose rate JS the Various speakers come up, To remind ourselves, the bac~:ground P dose 1s approximately 125 to 150 mradsiyear and the acicled body burden from fallout M 9,11 of this dose.

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UJ THE JOURNAL of the American Nledical Association Paul Van tioyedenek Samples of Paul Van Hoyedenck’s “cybs,” the sculp tured hand, legs and torso consisting cf wheels, rods, nuts, bolts, and bits of electromc equipment, simulate the form and function of their natural counterparts, Whether conceived by the artist as componerrts of a cyberfiet~c man (P 1752) or as independently function. ing entities, thesemetal and plashc creations pfoject a disturbing image Of 8 future surfeited with wwon. and $Iectrtx%ic devices is discussed on page 1745.