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This paper explores some of the disagreements in the literature on prisoner behavior in the Nazi concentration camps. It also cites wide differences in the findings of early observers of imprisonment effects. Conflicting views of psychoanalysts on the “symptom-free interval” are noted. A high degree of agreement on the pattern of late effects known as the “CC syndrome”, is indicated. The paper reports that there is apparent acceptance of the limited evidence available that clinical records of survivors of Nazi persecution who lived in hiding but were not in camps also fit the “CC syndrome”. Studies are reviewed which suggest that a narrowly psychodynamic or neurobiological emphasis leads to defective interpretations. In this connection disagreements over the importance of the guilt factor (“existential”, “survival”, or “survivor guilt”) are examined. Finally, the paper considers some probable relationships between duration of CC experience, the factor of stress, and early and late sequelae of NCC experience.

IN studying the influence of the irradiation with varying voltages on the biologic reaction of the skin, it is customary to pay attention only to the immediate effect which is best expressed in terms of skin erythema. A voluminous literature dealing with every phase of this subject has already appeared and since the advent of supervoltage roentgen therapy the investigations are being carried into the domain of exceedingly high voltages. It is now more or less generally acknowledged that the same degree of skin erythema may be obtained from increasingly greater physical doses when the irradiation is carried out with increasingly higher voltages. In this respect, an approximate co-ordination of the physical dose and the skin reaction exists up to about 1,200 kv. More recently, however, evidence is accumulating, especially from the clinical side, that some sort of divergence is present also in the late effect, giving rise to certain sequelae which cannot be ignored altogether. Late Skin Effects of Radiation T...

In 1895, Roentgen reported a new form of radiation. In 1896 Becquerel discovered radioactivity. In 1896 also the first cases of radiation dermatitis and epilation were observed (1). By 1902 radiation-induced cancer was reported (2). By 1910 the histopathology of late radiation changes had been documented (3). Each organ or tissue has been shown to have a characteristic pattern of structural and functional alterations which are produced as a late effect of exposure to ionizing radiation (4). These changes appear to be related to early injury to the vascular structures and to connective-tissue elements. This in itself may produce secondary changes in the parenchymal cell of the organ in question. In addition, the parenchymal cell may be injured directly by the ionizing radiation. The interplay of these two mechanisms, and doubtless others as yet unappreciated, results in altered structure and altered ability to perform a normal role in the economy of the body. These changes do not appear to reach a static s...

The long physical and biological half life of /sup 232/Th and the dense ionization produced by its alpha particles within the reticuloendothelial tissue in which the colloidal ThO/sub 2/ accumulates produce severe radiation injuries. The latert period for appearance of injury in man varies from 11 to 24 yr. Clinical symptoms of Thorotrast injuries have been recentiy observed in five patients. Skin measuremerts of radioactivity demonstrated the presence of Thorotrast in liver, spleen, and bone marrow. So many factors affect these measuremerts that it is not possible to estimate accurately the actual amounts of Thorotrast deposited, but it has been calculnted that with a dose of 75 ml the radiation dose to liver is between 700 and 15,000 r over a period of 50 yr. For this same period the total radiation dose in bone marrow may be approximates 350 r. Of the total dose to the reticuloendothelial system liver receives from 71 to 73%, spleen from 7 to 17%, and bone marrow from 6 to 10%. One characteristic injury frequertly observed is the formation of granulomas (thorotrastomas) within the reticuloendothelial system thnt, depending on their location, can cause tracheal or esophageal stenosis, fistulas, vocal cord paralysis, or cerebral hypoxia.more » Blood changes, such as thrombocytopenla, slight leucopenia, appearance of large monocytes, and a relative aplastic myelodepressant effect, often appear. Liver thmors have been reported often, but in the patients studied here none were observed. One major late effect is appearance of fibrosis of the supportive tissue of the reticuloendothelial system that is often followed by damage to the tissue parenchyma. Many angiographic studies were performed with Thorotrast during the last war, and many patierts with injuries from this agent will probably be observed in the years coming. (BBB)« less

The clinical experiences in 125 patients, both as to immediate and late effect, with a new antacid “Mucotin” (aluminum hydroxide, magnesium trisilicate and gastric mucin mixture) are discussed in the light of recent ideas as to ulcer prevention and ulcer treatment. This substance led to rapid clinical improvement during the stage of exacerbation and also apparently prolonged the pain-free intervals, having a recurrence rate of 15 to 18% in 12 to 24 months respectively. Two case histories are presented as demonstrating the rapid healing in gastric ulcer. The possible basis for the beneficial effect of this substance is discussed.

SummaryThe number of nucleated cells and the proportion of colony-forming units (CFU) were estimated in the femoral marrow of (C57Bl × C3H)F1 male mice aged 20 months or more, and of mice of the same age surviving a mid-lethal dose of x-rays delivered when young adults. Both total cellularity and CFU's were found to be decreased by previous irradiation compared with controls of comparable age. These parameters were also found to be slightly age-dependent in normal mice but not those that had been irradiated. Particular attention was paid to the histopathology of haemopoietic organs of the ageing mice; donor animals in which reticular tissue tumours were found, even in early stages, were excluded. Results are discussed mainly in terms of residual radiation injury.

The EEG and the behavior of actively sensitized animals were compared during the anaphylactic reaction provoked with low, intraperitoneal shock doses of either horse serum or recrystallized egg albumin. It was found that the recording of the electrical cortical activity does not provide a good index of the anaphylactic reaction; however, it has been shown that a group of animals can indeed have severe abnormalities in their EEG when subjected to a challenging dose with only minor signs of behavioral disturbance. The abnormalities in the cortical activity have been interpreted as an isolated partial symptom of the anaphylactic reaction. Another extreme group of animals showed the classical anaphylactic response with only a late effect on the EEG, secondary to the impairment of respiration and the systemic circulation. Other animals occupied an intermediate position or did not respond to the challenge. Further details will be presented elsewhere in the future. 1

Glucose tolerance tests were performed in a group of patients in a mental hospital who had been treated with insulin shock and in a matched control group. Five out of 31 (16%) patients in the insulin-treated group and 1 out of 22 (5%) controls had “diabetic” blood sugar curves. Median blood sugar values were significantly higher at 60 minutes and later in the insulin-treated group, as were mean blood sugar values when the “diabetic” patients were excluded. Small amounts of plasma insulin-binding antibody were found in two insulin-treated patients. In the absence of any other clear-cut explanation, it is suggested that in some patients massive doses of insulin by injection may leave diminished tissue responsiveness to insulin as a long-term after-effect.

In relation to the papers of Drs. Dobbing, Bass and Galli, I would like to report some clinical observations made in Poland after the Second World War on Jewish and Polish children who, unfortunately, were born or brought up in German ghettos or concentration camps.

A group of 90 Indonesian children whose nutritional status has been studied over a two year period from 1957 to 1959 were again examined in 1964. The children of the malnourished group were smaller and in poorer physical condition than those of the healthy group.The I. Q. lowest values were found in the children who had been malnourished and had shown clinical signs of vitamin A deficiency during the 2-4 year age period, the highest in those who had never been diagnosed as malnourished.No similar relation between EEG results and nutritional condition was found. However, the ERG recordings had shown that in the 5-9 year old group there was a lower response in children with low serum vitamin A.The dietary study showed a low food intake with deficiency of protein, particularly animal protein, and vitamin A. For vitamin A alone of the major nutrients, the intake of the children was much lower than that of the mothers.The persistence over a period of years of signs of malnutrition in children who had suffered malnutrition and especially in those where malnutrition was combined with vitamin A deficiency is indicative, but not conclusive, of a late effect of early damage.

Summary 1.A case is reported of basal-cell epithelioma of the nose and cheek, proven at 18 years, starting from a burn in infancy. Ineffectually treated for eight years with heavy irradiation elsewhere, the patient was under the writer's personal observation and care for nineteen years, with apparent elimination by excision on four occasions, and with three reconstructions of the nose and cheek, the last being eight and a half years ago with no signs of reappearance. Reappearance of tumour was believed to be a new malignant growth as a late effect of irradiation. 2.Irradiation may (a) cure the disease, (b) imprison tumour cells that may later become active, or (c) stimulate tissues to neoplastic growth. Tissue that has been irradiated is more difficult to cure and more difficult to repair. 3.In a large majority of instances adequate surgical excision followed by plastic surgical repair is preferable to treatment by irradiation, as the excised tissue can be examined for adequacy of margin, and there will be no sequel˦ of irradiation, such as discomfort to the patient, damage to the tissues, and stimulus of neoplastic activity. 4.If surgery is used in malignancy of the face the excision should be sufficiently wide at the first attack to remove all of the tumour. This should be checked by localised specimens and a competent pathologist. 5.Immediate reconstruction may be started at the operation of excision if the diseased area is small, does not involve structures that cannot be readily repaired, and has not been previously treated, particularly by irradiation. 6.Where the tumour is possibly scattered over a considerable area, has been previously unsuccessfully treated, particularly by irradiation, where skeletal structures and the nasal and oral cavities are involved, and where there is a question of adequacy of excision, coverage of the defect by thick tissues should be delayed until adequate time has elapsed to warrant a definitive reconstruction. Thin skin grafts may be applied to close over the defects in the interim so that these areas can be under observation for the appearance of any neoplastic growth. 7.The surgeon who makes the repair should be the surgeon who excises the diseased tissue, provided he has the training and ability to do both. He should be safer because he can afford to be adequately radical. With his choice of possible pre-excisional procedures, the immediate application of flaps and free skin grafts, he may speed repair, avoid discomfort for the patient, and facilitate later reconstruction. 8.It is not always possible to have the foresight to anticipate all eventualities in complicated cases.

The late effect of adrenalin on the white blood picture is a complex problem. One assumes that this effect for instances regarding the eosinophil cells in the blood may be indirect and we don’t know which cell adrenalin attack primarily. It is known that the presence of the adrenal cortex is not necessary for the adrenalineosinopenia when cortisone is available by other means.

SummaryAlloxan, injected into pigeons in a single dose of 60 to 125 mg/kg (less than one-half of the diabetogenic dose) sometimes causes a marked elevation of the blood uric acid level and a deposition of sodium urate in the tissues. A conspicuous atrophy of the musculature is observed as a late effect in pigeons which recover from the acute stage of alloxan poisoning. Among several compounds, related to alloxan, only dialuric acid was found to possess a similar effect.

RADIATION therapy about the eye is being employed by an increasing number of practitioners in an expanding category of conditions. It is only to be expected that an increase in the late complications of irradiation will be experienced. Radiation cataract, the commonest late complication, is known to every ophthalmologist. Its clinical and pathological characteristics have received a great deal of attention. In like manner, late skin changes and effects on bone growth are wellknown and easily recognized sequelae. The purpose of this paper is to report a less common late effect of application of radiation to the globe which presents a striking clinical appearance, namely, focal scleral necrosis. So far as could be determined, this sequela has not previously been described. PRESENTATION OF CASES Case 1. —J. G., a white man aged 38, had had a squamous-cell carcinoma of the right lower lid treated 18 years earlier with radium, 400

Practically all clinical and statistical studies of silicosis have been made on groups of men still employed in dusty trades. From these studies the conclusion has been reached that, while there is a great variation in individuals in the length of exposure necessary to produce clinical and roentgenographic evidence of the disease, it is rare for it to develop in men who have not been at the work for many years. Watkins-Pitchford 1 found that the average duration of exposure in the South African mines before the appearance of symptoms was 9.6 years. Tatersall 2 found that in hard rock coal miners it was slightly more than ten years. From statistics of this nature compiled from groups of men still employed in the trade, one cannot say what is the late effect of short exposures. They give no information as to what happens to men who, having been exposed for

Accidental exposure of people of Rongelap Island to radioactive fallout and particularly to radioactive iodines in the fallout has resulted in the development of thyroid abnormalities in 21 of 67 of these people, 3 with malignant lesions, 16 with benign adenomatous nodules, and 2 with atrophy of the gland with hypothyroidism. The preponderance of lesions occurred in children exposed at less than 10 years of age who had received a greater thyroid exposure. Growth retardation associated with hypothyroid tendency was noted in some children who appear to be responding favorably to thyroid hormone medication. Thyroidectomy, partial to complete, has been carried out on 18 patients. Risk for thyroid cancer from radioactive iodine exposure in this group does not appear to be very different from that reported following x-irradiation.

Recently, in this journal, Brinkley and Haybittle (1969) suggested from the analysis of their data that total doses of 700 R to 1,000 R were responsible for an increased incidence of cancer in the pelvis five years or more after treatment. The basis for calculating the expected number of deaths was taken from the registration at the Cambridge Cancer Registration Bureau.