Ringworm affair (Israel)
The ringworm affair refers to circumstances involving an alleged number of at least 20,000 Israeli individuals who were treated between 1948 and 1960 for tinea capitis (ringworm) with ionizing radiation to the head and neck area, the standard treatment at the time. The more likely figure, detailed here in the "Scientific findings" paragraph, is of some 15,000 patients. An estimated 200,000 children worldwide received X-ray treatment for tinea capitis in accordance with the standard Adamson-Kienbock procedure between 1910 and 1959, until griseofulvin, the first effective antifungal agent for ringworm, was introduced. The population suffering from the disease in Israel at the time was composed primarily of newly arrived immigrants, mostly from North Africa, as well as some from Middle East and elsewhere. This X-ray treatment for ringworm has been used around the world as early as 1897
Historical background - Ringworm in Israel and Jewish Communities
The scalp ringworm, also known as tinea capitis, mycosis, thrichophytia, and favus was one of the most common fungal diseases in children in the Jewish communities in Israel and abroad since the nineteenth century.
At the beginning of the twentieth century, Hadassah Medical Center in Jerusalem treated ringworm disease among the religious Jewish community in Jerusalem using irradiation and the disease almost disappeared.
With mass immigration in the 1940s and 1950s, many new cases of ringworm surfaced, primarily among immigrant children from Asia and North Africa due to crowded living conditions with deficient hygiene facilities. At this time, ringworm was still treated with irradiation, under the supervision of Hadassah Medical Center (Prof. Dostrovsky and Prof. Drukman).
The treatment regime increased the risk of cancerous and noncancerous growths of the head and neck area years later among a portion of the patients. A number of research groups in Israel and the world have followed patients who were irradiated as children, in order to examine this group's susceptibility to cancerous growths. In Israel, this study was led by Professor Baruch Modan who published an article in the prestigious medical journal The Lancet in 1974 in which Modan determined a strong causal linkage between irradiation of ringworm patients and the appearance of growths on the head and neck.
In light of Professor Modan's findings, legislation was passed in 1994 in Israel to provide compensation for damage to health resulting from exposure to such ringworm treatment. Compensation was available to patients (or their next of kin) treated with irradiation for ringworm between January 1, 1946 and December 31, 1960 and diagnosed with certain diseases as stipulated in the legislation. The law, however, placed the burden of proof on the claimant to submit factual evidence substantiating that they had received treatment – a proviso that generated public criticism.
The Ringworm Affair
A documentary film in Hebrew entitled "The Ringworm Children" (Yaldei Hagazezet), produced by the Dimona Communications Center and directed by Asher Nachmias and David Balchasan was released in 2003; the film received the Best Documentary Film Award at the Haifa International Film Festival and was featured as a documentary at the Israel Film Festival in Los Angeles in 2007. The documentary harshly attacked Israel's medical establishment in the 1950s, branding the episode "the ringworm children's holocaust" (shoat yaldei hagazezet). It also harshly criticized the compensation law and the politicians involved in its passage.
Treatment of ringworm patients is viewed by Mizrachi activists in Israel as the most salient example of injustices immigrants encountered in the 1950s as a result of shortcomings, negligence, paternalism or irresponsibility on the part of Israeli authorities in the reception and absorption in Israeli society of new immigrants.
It is claimed in the documentary that the X-ray radiation used on the children was thousands of times beyond the maximum recommended dose and it is suggested that the program was funded by the United States in order to test the effects of large radiation doses on humans. In fact, the treatment in Israel was the same as that used elsewhere in the world. The documented dosages given to the Israeli children were similar to (if not less than) those administered to about 2000 children treated for ringworm at New York University Hospital between 1940 and 1959. A study from the early 1950s found X-ray treatment effective in almost all cases of ringworm. The documentary alleges that 100,000 children were irradiated, and that 6,000 of them died shortly after receiving treatment. Many of the 'ringworm children' later developed cancer, and in 1994 the Knesset passed a law mandating the Israeli government to provide them with compensation.
Therefore, the documentary alleged, the campaign against North African immigrants to Israel – prior to or following their arrival - was only part of an international phenomenon whose scope is still being uncovered.
Research conducted by medical historian Professor Shifra Shvarts in the first decade of the twenty first century casts the Israeli ringworm narrative in an entirely new context.
Shvarts followed a handful of parenthetical references to international organizations in Israeli primary documents, uncovering a wealth of archival material in Hadassah archives, United Nations archives and subsequently in the archives of a growing list of countries. This material showed that mass treatment of ringworm in Israel was founded on treatment protocols designed and administered decades earlier. During the years 1921–1938, there was a campaign among Jews in Eastern Europe (i.e. among Ashkenazi Jews) in the course of which some 27,000 East European children were irradiated in an identical fashion – in part to allow their families to emigrate, since ringworm was grounds for exclusion in the United States and elsewhere.
The campaign carried out on Mizrachi children from the Mediterranean region was based on this European campaign. The organizers were convinced that the European campaign had been crowned with success in treating ringworm and therefore they sought to enable the Jews of Morocco to benefit from the same. Since most of the Jewish children who had been irradiated in Eastern Europe perished in the Holocaust, there was no way of knowing the ramifications of such treatment
A key figure in formulation and organization of the ringworm campaign among the Jewish community in North Africa was Professor Moshe Prywes who would later become president of Ben-Gurion University and the founding dean of BGU's Medical School. Prywes traveled to North Africa in 1947 and following his findings there, formulated a comprehensive program for eradicating contagious diseases among those planning to immigrate to Israel. The program was called T.T.T., for the three leading diseases the program would address: Tinea (Ringworm), Trachoma and Tuberculosis.
Parallel to irradiation for ringworm carried out during the 1950s in the State of Israel, irradiation for ringworm was also carried out among thousands of Yugoslavian children (some 94,000), in Portugal (30,000), Syria (7,000). and about 4,600 children were irradiated for the disease between the years 1922-1958 in just one hospital in London.
The primary agent behind these ringworm eradication operations was UNICEF, which even assisted in the purchase of X-ray machines for this purpose. It even supplied the two X-ray machines that operated in the immigrant intake and processing facility for immigrants in Israel – Sha'ar Ha'aliyah south of Haifa. With the development of the drug griseofulvin for treating ringworm, UNICEF, as part of its policy devoted to eradicating contagious diseases among mothers and children, began funding the supply of the drug to all countries with a high incidence of ringworm.
There is a question of how many children of Moroccan origin actually suffered health issues as a result of X-ray ringworm treatment in childhood. One encounters wild estimates (for example, in the aforementioned documentary film) claiming there were a hundred thousand persons or more. Others go even farther: a non-profit organization, established in 1999 to organize former patients and to ensure their compensation, goes so far as to put the number of Mizrachi children irradiated at 200,000. In fact, a more accurate assessment can be extrapolated from reliable statistical data in the historic record. In Dr. Yaron Tzur's work on Moroccan Jewry between the years 1940–1954 – Kihilah K'ruah (A Community Torn-Asunder), demographic data found by the author regarding the Moroccan Jewish population shows the numbers must have been much more modest. A 1947 Moroccan census, even after adjustments, show there were at most 240,000 Jews in Morocco at the time. The work is a comprehensive study, filled with archival material, correspondence of key figures, reports of Israel emissaries and a rich bibliography that includes a list of all points of settlement in which Jews resided in Morocco, down to those with just a few families. Up until 1956, data shows 80,000 Jews emigrated from Morocco. Therefore, the maximum number of child immigrants within the age range that ringworm attacks could not exceed 20,000 to 25,000. If one assumes that not all the children in that age group had ringworm, there is no logical statistic basis for assuming that any more than about 10,000 to 15,000 underwent irradiation. The Israel Ministry of Health has the files of 10,000 individuals; they are, apparently, the total number of individuals irradiated of all ethnic origins.
From reports submitted to UNICEF by the Israeli Ministry of Health and published in the medical news, it was stated that the number of children treated with irradiation in Israel between 1948–1959 was approximately 15,000. Testimony exists that shows that children of Eastern European origin who were suspected of having ringworm were also irradiated. It is hard to know their numbers but they most likely numbered a few thousand. According to Giora Leshem, who was Professor Modan's statistical partner in his 1974 study (based on the Cancer Registry), it seems that the number of Moroccans who were irradiated was in the vicinity of 15,000 children.
- Shore RE, Moseson M, Xue X, Tse Y, Harley N, Pasternack BS (April 2002). "Skin cancer after X-ray treatment for scalp ringworm". Radiat. Res. 157 (4): 410–8. doi:10.1667/0033-7587(2002)157[0410:SCAXRT]2.0.CO;2. ISSN 0033-7587. PMID 11893243.
- Sadetzki S, Chetrit A, Freedman L, Stovall M, Modan B, Novikov I (April 2005). "Long-term follow-up for brain tumor development after childhood exposure to ionizing radiation for tinea capitis". Radiat. Res. 163 (4): 424–32. doi:10.1667/RR3329. PMID 15799699.
- Rosenthal r. :"perspectives in ringworm of the scalp", Arch. Dermatol, vol 9, p 431-448 (1947)
- Dostrovsky, Ringworm in Jerusalem’s Schools, Education ( Ha'Chinuch, Hebrew) , 9(1926) (p. 98.).
- Modan B, Baidatz D, Mart H, Steinitz R, Levin SG (February 1974). "Radiation-induced head and neck tumours". Lancet 1 (7852): 277–9. doi:10.1016/S0140-6736(74)92592-6. PMID 4130470.
- "THE RINGWORM CHILDREN (20th Anniversary Israel Film Festival)". israelfilmfestival.com.[dead link]
- "The Ringworm Children (FANDANGO)". fandango.com.[dead link]
- Israel Insider - Ringworm and Radiation
- 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. (Page 166)
- Albert R.A. :"Follow-up study of patients treated by X-ray for tinea capitis", A.J.P.H. ,vol 56, p 2114-2220 (1966)
- Hornblum, Allen. Acres of Skin: Human Experiments at Holmesburg Prison (2nd Edition). Routledge, 1998 (Page 152)
- "חוק לפיצוי נפגעי גזזת, התשנ"ד-1994".
- Shvarts S., "Israel Health Policy and the Ringworm Case 1948–1959: New Findings - New Context" The 25th Association of Israel Studies Conference, Beer Sheva, June 2009
- Shvarts S., Romem P., Romem I., Shani M. (2009). "The Forgotten Ringworm Campaign of OSE-TOZ in Poland, Harefua". Journal of the Israel Medical Federation 48 (4): 125–9. PDF (Hebrew)
- Prywes Moshe, Prisoner of Hope, Zmora-Bitan-Modan, Jerusalem 1995 (178–190)
- Grin E.I. :"Epidemiology and control of tinea capitis in Yugoslavia", Trans St. Johns Hosp. Dermatol, vol 47, p 109-122(1961)
- Shvarts S, Sevo G, Tasic M, Shani M, Sadetzki S (August 2010). "The tinea capitis campaign in Serbia in the 1950s". Lancet Infect Dis 10 (8): 571–6. doi:10.1016/S1473-3099(10)70107-9. PMID 20670904.
- Ignjatovic B. [Mycotic diseases in Serbia (Tinea Capitis): Modern Campaign on their eradication.] Antimycotic Campaign in Serbia. [Library of the Institute of Hygiene of the People's Republic of Serbia.] Belgrade; 1959;1–91. (In Serbian with English summary).
- Shanks S. C. :"X-ray epilation of the scalp at Goldie Leigh Hospital Woolwich (1922-1958),Brit. J. of Derm., vol 79, p 237-238 (1967)
- UNICEF Archives, CF/HST/MON/1989-003.
- see www.health.gov.il/pages/default.asp?maincat(PageId=4136&catId=768&=78 )