Ringworm affair

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The ringworm affair refers to late-stage side effects of therapy in which at least 20,000 Israelis , especially children, were treated with x-rays in the head area for tinea capitis (scalp ringworm) between 1948 and 1960 .

The patients were mostly immigrants from North Africa and the Middle East. The radiation has probably increased the cancer risk of those affected by more than three times the cancer risk of unirradiated ringworm patients.

Historical background

The Kopfhautringelflechte, also known as tinea capitis , ringworm and Favus is known, was in the 19th century one of the most common fungal diseases in children in Jewish communities in Eretz Israel ( Palestine ) and abroad. At the beginning of the 20th century, the Hadassah Medical Center in Jerusalem treated the occurrence of scalp ringworm in the religious Jewish community of Jerusalem with radiation. The disease then almost completely disappeared.

An estimated 200,000 children worldwide were treated with X-rays for tinea capitis using the Adamson-Kienbock standard method between 1910 and 1959 , up to the time of the introduction of griseofulvin , the first effective antifungal drug . X-ray therapy for ringworm has been used since 1903.

With the mass immigration of the 1940s and 1950s, many new cases of ringworm emerged in Israel. Immigrant children from Asia and North Africa were particularly affected; The causes were cramped living conditions and a lack of hygiene. The ringworm was treated with radiation. This was done under the supervision of the Hadassah Medical Center in Jerusalem (Prof. Dostrovsky and Prof. Drukman).

Years later, as a result of the treatment, some of the patients developed malignant and non-malignant growths ( meningiomas ) on the meninges. Research groups in Israel and around the world recorded the medical history of patients who had been irradiated as children in order to clarify a suspected connection with the development of tumors . In Israel, this study was carried out by Professor Baruch Modan, who published an article in the prestigious medical journal The Lancet in 1974 in which Modan found a causal link between irradiation of ringworm patients and the occurrence of tumors on the head and neck.

In 1994, based on Modan's findings, Israel passed a compensation law. Compensation should be paid to patients themselves or their relatives who were diagnosed with ringworm between January 1, 1946 and December 31, 1960 and were treated accordingly. The law contained a clause that placed the burden of proof on those affected that there was a causal connection between the disease and therapy.

In 1994 the Knesset passed law requiring the Israeli government to pay compensation.

Ringworm Children - 2003 documentary

The documentary with the Hebrew title "The Ringworm Children" (Yaldei Hagazezet), filmed and directed by David Asher and David Nachmias Balchasan from the Dimona Communications Center, was presented of 2003. The film received the award for “Best Documentary” at the Haifa International Film Festival. The documentary attacked the health care system in Israel in the 1950s and called the case "The Holocaust of the Ringworm Children" (shoat yaldei hagazezet). The film also harshly criticizes the compensation law and the politicians who passed it.

The treatment of ringworm patients was seen by Sephardi activists in Israel as a prime example of the injustice suffered by immigrants in the 1950s as a result of the inadequacy, negligence, paternalism or irresponsibility of the Israeli authorities in accepting and integrating new immigrants into Israel was done to Israeli society.

Many of the allegations related to the treatment of ringworm in Israel were the result of poor reporting that presented the reality in a biased and skewed manner. Both the Sephardi and the medical profession were unaware of two important factors:

  1. The broad international context of the Israeli program - namely, that it was considered a recognized and safe treatment at the time (such as x-raying children in shoe stores at the time) and that the therapy was used worldwide - by Syria and Yugoslavia to USA, Portugal and Sweden. Indeed, radiation was a standard treatment and was partly adopted by UNICEF .
  2. The specific Jewish context - namely, that this form of mass radiation treatment was used earlier in other parts of the Jewish world, with Ashkenazim children on an even larger scale, and also with Jewish and non-Jewish immigrants in the United States.

In 2007 filmmakers David Asher Nachmias and David Balchasan voiced concerns and regrets and distanced themselves from the movie's conclusions. At a meeting of academics in Jerusalem in April 2007 on the subject of ringworm victims, David Balachsan said: "If I had the power, I would delete this film." A statement in this sense contains the reaction of Eli Philo, who was present in the conference room has been a victim of radiation therapy himself.

Ringworm Affair - 2007 documentary

The late effects of therapy were also the subject of in Israel turned documentary entitled The ringworm affair of the children , under the direction of David Asher Belhassen and Asher Hemias. The documentary won the award for "Best Documentary" at the Haifa International Film Festival and was presented as a documentary at the "Israel Film Festival" in Los Angeles in 2007 .

The documentary claims that the dose of X-rays that the children were treated with was thousands of times higher than the maximum recommended dose; It is also claimed that the program was funded by the United States to test the effects of the high dose of radiation on humans.

In fact, the treatment dose in Israel was the same as that used in other parts of the world. The documented dosages of Israeli children were similar (if not lower) than those of children treated for ringworm at New York University Hospital between 1940 and 1959. A study from the early 1950s found that x-ray therapy was effective in almost all ringworm cases.

The documentary claims that 100,000 children were irradiated and that 6,000 of them died shortly after treatment. Many of the ringworm children later developed the cancer .

Scientific knowledge

Research from the first decade of the 21st century puts the Israeli ringworm affair in a completely new context. The medical historian Shifra Shvarts evaluated a number of references from Israeli sources as well as from international organizations.

From archival material in the Hadassah archives, United Nations archives, and in a growing number of countries, it appears that mass treatment for ringworm in Israel was based on treatments that had been developed and used decades earlier. Between the years 1921–1938 there was an action among the Jews in Eastern Europe (e.g. among the Ashkenasi Jews), during which around 27,000 Eastern European children were irradiated in the same way - partly to make it easier for their families to emigrate because ringworm was one of the causes of denials of immigration to the United States and other immigration countries.

The procedure carried out with Sephardi children from the Mediterranean region was based on this then generally recognized European procedure. The organizers were convinced that the European method of treating the disease was successful and without any adverse side effects. Therefore, the Jews of Morocco should also benefit from it. Since most of the Jewish children who had been irradiated in Eastern Europe were murdered in the Holocaust , there was no way of knowing the harmful effects of such treatment.

A key figure in the conception and implementation of the ringworm campaign in the Jewish community of North Africa was Professor Moshe Prywes, who later became President of Ben Gurion University and the founder of the Medical School of Ben Gurion University. Prywes traveled to North Africa in 1947. On the basis of his findings, he created a comprehensive program for the eradication of infectious diseases in the potential immigrants to Israel. The program was called TTT, after the program’s main target diseases: tinea , trachoma and tuberculosis .

At the same time as radiation therapy for tinea was administered in Israel in the 1950s, radiation was also administered to thousands of Yugoslav children (around 50,000), in Portugal (30,000) and Syria (7,000). Supporter and organizer of the action to eliminate ringworm was UNICEF. The organization also supported the purchase of X-ray equipment for this purpose. UNICEF was in charge of radiation therapy in Yugoslavia and Syria and even supplied the X-ray machines that were used in Israel and the means to handle the immigration process e.g. B. Shaar Haaliyah south of Haifa . With the development of the drug griseofulvin for the treatment of this disease, UNICEF began to force the delivery of the drug to all countries with a high proportion of tinea diseases as part of its strategy of eradicating infectious diseases in mothers and children as far as possible.

It is controversial how many children of Moroccan origin actually suffered damage to their health as a result of tinea therapy. There are estimates (for example in the above documentary) that claim there were hundreds of thousands or more. A non-profit association founded in 1999 began organizing former patients to receive compensation. This association estimates the number of Sephardi children irradiated to be 200,000.

A more precise assessment can be derived from reliable statistical data in a historical context. In Yaron Tzur's work on Moroccan Judaism between 1940 and 1954 - “A Society Torn apart” (Kihilah K'ruah), the demographics of the Moroccan Jewish population found by the author testify that the numbers must have been much lower. According to the census in Morocco in 1947 and after the data was corrected, at most 240,000 Jews lived in Morocco at that time. The work is a comprehensive study, is based on archival material and contains letters from key figures, legation reports on Israel, a rich bibliography and a list of all settlements in Morocco where Jews have lived, even those with only a few families. The information shows that 80,000 Jews emigrated from Morocco by 1956. Therefore, the maximum number of immigrant children in the ringworm age group cannot have exceeded 20,000 to 25,000. Assuming that not all children in this age group were affected, there is no solid statistical evidence to support the assumption that more than 10,000 to 15,000 affected people have received radiation. The Israeli Ministry of Health keeps data on 10,000 people; apparently this is the total number of patients treated from all ethnicities.

Reports from the Israeli Ministry of Health to UNICEF, which have also been published in medical journals, indicate that around 15,000 children in Israel received X-ray therapy between 1948 and 1959. There is firm evidence that children from Eastern European countries who were suspected of having ringworm were also irradiated. Their number is difficult to determine; it is probably a few thousand. Giora Leshem, Professor Modan's statistical assistant, refers to the cancer registry in his 1974 study and assumes that the number of irradiated children from Morocco is around 15,000.

In, statistical relationships between radiation treatments and cancer diseases are investigated using a group of 2224 irradiated and 1380 non-irradiated individuals. Among so-called Europids , the risk of developing cancer was 3.6 times that of irradiated persons compared to the cancer incidence rate of non-irradiated persons. The risk was particularly low among African Americans, which, in the opinion of the authors, indicates a possible cofactor for ultraviolet radiation in fair-skinned individuals. Children who were younger on the radiation were particularly at risk. The radiation dose of the examined group was about 4.8  gray in the skin.

literature

  • S. Shvarts, G. Sevo, M. Tasic, M. Shani, S. Sadetzki: The Tinea Capitis Campaign in Serbia in 1950s. In: The Lancet Infectious Diseases. 10 (8), 2010, pp. 571-576.
  • S. Shvarts, P. Romem, I. Romem, M. Shani: The Forgotten Ringworm Campaign of OSE-TOZ in Poland, Harefua. In: Journal of the Israel Medical Federation. 48 (4), 2009, pp. 125-129. (Hebrew)
  • S. Shvarts, V. Drori, Stoler –Liss S .: The international activity and health support in Palestine / Israel after WW2 and the Israel war of independence and the state first years in Katyne et la Suisse: Experts et Expertises Medicales dans les Crises Humanitaires (editor, Debons D.) University of Geneva, Swiss, 2008, pp. 319–328.
  • A. Dostrovsky: Ringworm in Jerusalem's Schools. In: Education (Ha'Chinuch, Hebrew). 9, 1926, p. 98.
  • Prywes Moshe: Prisoner of Hope. Zmora-Bitan-Modan, Jerusalem 1995.
  • RE Albert, AR Omran: Follow-Up Study of Patients Treated by X-ray Epilation for TC. In: Archives of Environmental Health. 17 (6.), 1968, pp. 899-918.
  • P. Crossland: Therapy of tinea capitits, the value of X-ray epilation. In: California Medicine. vol. 84, pp. 351-353 (1956)
  • D. Corbet: New Radiometer for Use with Sabouraud's Pastilles. In: The Lancet. Feb. 21, 191, abstract published in the American Journal of Roentgenology. June 1914, pp. 194-197.
  • GM Crawford, RHII Linkart, RF Tiley: Roentgen Therapy in Acne. In: N Engl J Med. 245, 1951, pp. 726-728.
  • AC Cipollaro, A. Kallos: Measurement pf Gonadal Radiations During Treatment for TC. In: NY State Journal of Medicine. (59) 16, 1959, pp. 3033-3040.
  • NH Harley et al .: Follow-up study of patients treated by X-ray epilation for tinea capitis. Estimation of the doses to the thyroid and pituity glands and other structures of the head and neck. In: Physics Medical Biology. 21 (4) 1976, pp. 631-642.
  • I. Kaplan: The Treatment of Female Sterility with X-Rays to the Ovaries and Pituitary. In: Can Med Assoc J. 76, 1957, pp. 43-64, Retrieved from en: Ringworm affair .

Web links

Individual evidence

  1. ↑ S. Sadetzki, A. Chetrit, L. Freedman, M. Stovall, B. Modan include: Long-term follow-up for Brain Tumor Development after Childhood Exposure to Ionizing Radiation for tinea capitis. In: Radiation Research . Vol. 163, no. 4, 2005, pp. 424-432. PMID 15799699
  2. ^ A b c R. E. Shore, M. Moseson, X. Xue, Y. Tse, N. Harley et al .: Skin Cancer after X-Ray Treatment for Scalp Ringworm. In: Radiation Research. Vol. 157, no. 4, 2002, pp. 410-418. PMID 11893243
  3. ↑ Malcolm Morris, S. Ernest Dore: Light and X-ray Treatment of Skin Diseases. Cassell, 1907, p. 128.
  4. ↑ Modan B, Baidatz D, Mart H, Steinitz R, Levin SG: Radiation-induced head and neck tumours . In: Lancet . 1, No. 7852, February 1974, pp. 277-9. doi : 10.1016 / S0140-6736 (74) 92592-6 . PMID 4130470 .
  5. ↑ חוק לפיצוי נפגעי גזזת, התשנ"ד -1994. (PDF) Retrieved February 3, 2011 .
  6. ↑ You can find a clear statement about this (in Hebrew) at: www.marocmoreshet.com/index.php?showtopic=2551/  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Dead Link / www.marocmoreshet.com  
  7. ↑ course s. in Hebrew: [1]
  8. ^ Opinion and comments in Hebrew in a radio broadcast with audience participation on January 5, 2010 cf. under [2] .
  9. ↑ THE RINGWORM CHILDREN (20th Anniversary Israel Film Festival). (No longer available online.) Israelfilmfestival.com, archived from the original on April 22, 2004 ; Retrieved February 3, 2011 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.israelfilmfestival.com
  10. ↑ The Ringworm Children (FANDANGO). fandango.com, accessed February 3, 2011 .
  11. ↑ Israel Insider - Ringworm and Radiation ( Memento June 3, 2008 in the Internet Archive )
  12. ^ National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII Phase 2. National Academies Press, 2006, ISBN 0-309-09156-X (p. 166)
  13. ^ Luis Felipe Fajardo, Morgan Berthrong, Robert Edwin Anderson: Radiation Pathology. Oxford University Press, 2001, p. 27.
  14. ↑ Allen Hornblum: Acres of Skin: Human Experiments at Holmesburg Prison . 2nd Edition. Routledge, 1998, p. 152.
  15. ↑ Schifra Shvarts: The Forgotten Ringworm Campaign. (in Hebrew) at: http://www.ima.org.il/Ima/FormStorage/Type3/09-04-14.pdf ( Memento of the original from February 29, 2012 in the Internet Archive ) Info: The archive link became automatic used and not yet tested. Please check the original and archive link according to the instructions and then remove this notice. @1@ 2Template: Webachiv / IABot / www.ima.org.il
  16. ↑ gazezet.org.il
  17. ↑ see www.health.gov.il