Vapniarka, never forget

In 1942, a Jewish Romanian doctor was sent to a little-known Second World War concentration camp in what was then the German-occupied Romania and actual Ukraine.

In Vapniarka, he experienced the austere, horrendous, almost inhumane living conditions that he and his inmates were subjected to. Water was scarce, hygiene abominable, prisoners existed on a meager diet and under near freezing temperatures.

Nevertheless, a camp economy and social relations naturally blommed and Dr. Arthur Kessler described the spontaneous humane organization that surged inside and outside the camp with an almost mystical reverence in his never published memoirs – a camp physician.

“Life in the camp develops with timetable and division of labour. A guiding hand can be felt. It is not us nor any of our acquaintances. But it is there.”

“There was a system in everything. Without announcements or written proclamations. Each position had the right man, the most reliable, the most useful. Everyone had something to do, work outside the camp, camp duty, workshop, restaurant, wood distribution, parasite control and art work. Musical composition and practice of songs, but no idleness.”

“The importance of such occupation is unknown to anyone who hasn‘t been part of a helpless and hopeless mass. Give everyone the awareness to be doing something useful, approve or praise their actions and morale improves.”

 “Dignity and hope had to be sustained, so everyone got something to do. The point was not reeducate, but everyone had to become part of a system that helped all to preserve and survive, because if one is demoralized, this demoralizes those around him as well. In this spirit, life developed in the camp. It developed rapidly, so rapidly that one had to think of a guiding hand.”

Everything was difficult, had to be improvised and nothing could be wasted but “when humans are close together, then a community can develop which becomes more affectionate and solid. This works even under the most primitive conditions with level headed, firm characters and education, provided there is no degradation to most primitive needs.”

War and Peas

Sadly, conditions in Vapniarka became worse and eventually sank to that rock bottom situation, followed by the degradation Dr. Kessler much feared. By November, 1942, the Governor of Transnistria, complained to the Assembly of Ministers that he had experienced enough problems in supplying the army with food, “without having to also satisfy the needs of the Jewish Communist deportees interned in the camp.”

As such, upon recommendation from a Gestapo representative, the Romanians, drawing on stocks of animal feed abandoned by Soviet forces in 1941, started to provide the prisoners with a diet that consisted primarily of a fodder pea (Lathyrus sativus).

The daily rations typically consisted of 200 grams of bread (“barley bread with wet straw, real chaff. It is deeply split, it crumbles when cut, has a wide soapy strip at the bottom, but it is nevertheless bread”) 400 grams of fodder peas, 15 grams of salt, plus 500 grams of wood to fuel the stoves; occasionally, some oil, horse meat, or vegetables were also given.

 The grasspea soup was initially relished by the recipients as it was a good source of protein and provided nourishing meals after days of travel without sufficient food. They even drank the reddish water that the peas had been cooked in.

“The peas arrive. The flies are skimmed off. They are stiff and fall into the bucket by the heap. Everyone has their own system to consume the peas in order to minimize suffering. One takes more fluid, the other only the seeds and passes them through a tin with holes in the bottom. A third spits out the seed coats. In the end everyone is bloated to the same extent and all contribute to the stench of rotten eggs in the air. Then comes the urge to visit the latrine. Some don‘t make it there in time.”

Kessler, in charge of the infirmary, at first concerned with the deficient means at his disposal for treatment of boils on arms, carbuncles on necks, wound fingers and suppurated finger nails – the old companions of medieval war, started receiving some newcomers – cases with diarrhea, unbearable flatulence and some who had a chill on the bladder and were running day and night.

  Many complained about cramps in calf muscles, but others had cramps in arms, belly, face, stiffened necks and moaned in their sleep. Then, one day Dr. Moritz, his physician friend, comes and reports an old Ukrainian man with unusual gait. A few days later three more cases of spastic paraparesis are noted and then a mysterious epidemic began amongst the Ukrainians and Russians. These had been in the camp before the Romanian prisoners arrived and had eaten grasspea for a longer time. They walk stiffly, circle their legs awkwardly and tire quickly. Leg reflexes are acutely increased, tapping of the Achilles sinew causes the leg jump up, leaving it to twitch for a considerable time afterwards, the reflexes of the large toes show clearly that damage of certain tracts of the spinal cord had occurred.

“In December, our friend and comrade Solomowicz arrives. He walks uneasily, like the deceased old Ukrainian and the other still living victims. He continuously needs to go to the latrine, day and night. He can‘t hold his waters, doesn‘t sleep at night due to painful muscle cramps, he can‘t use his stiff legs, can‘t lift them nor spread them, he tries to walk but he staggers and falls. The next day a second and third arrive, then the number of the lame quickly rises above one hundred. The first are affected the most. After 3 days, Solomowicz is unable, even with crutches, to reach the latrine or bucket. His legs are spastic, they cross over when he attempts to walk (scissor gait), the leg reflexes are increased to a maximum, the large toes show reflexes that indicate damage to the pyramidal tracts. He needs care. The others are awkward, walk like ducks, waddle, require a broad track, circling their legs, fall, support themselves at the edge of windows, at tables, at columns, try with a stick and end up as nursing cases on the makeshift beds.”

Arthur Kessler and his inmates had no means of investigating the epidemic that was ravaging the camp other than pure and simple clinical observation and pattern seeking.

Ukrainians, Russians and Jews were affected but they heard of no cases amongst the guards or camp command. It couldn’t be the water, since everyone had been drinking it, nor could it be the bread. The distinguishing feature that separated the sickened from the others was the fodder pea diet. The lame amongst the Russians and Ukrainians had eaten that diet for some time and they were affected first. Amongst the Jews, the young, the most voracious eaters, the emaciated, those from prisons and penal camps, who devoured the leftovers, became the first victims of the epidemic. The longer and more plentiful one ate, the heavier the condition developed.

The peas themselves were the culprits. They were eating poison and would perish from it if something was not done. More than 70% of all inmates showed signs or prognostic symptoms of the disease.

A delegation of three physicians decided to go to the commanding officer on duty, Captain Buradescu. In a serious manner, Kessler described the desperate situation – hundreds of completely or partially paralyzed lame, helpless, with room temperatures below zero degrees Celsius, without a bed, bag of straw, blankets during the heavy Russian winter, terrible hunger, softened through unpalatable bread and occasional supplements of meat from a fallen horse. There were already 120 completely lame and another 1000 on their way. Cause was the toxic pea food. That diet had to be stopped immediately and another form of nutrition to be introduced. Medical help, medicines, transfer to hospitals for the most severe cases were immediately necessary.

Captain Buradescu listened calmly and briefly replied ―How do you know that we are interested in keeping you alive?

Neurolathyrism

Neurolathyrism is a neurodegenerative disorder caused by long-term (or subactute) consumption of the seeds of a plant coloquially known as grasspea and botanically called Lathyrus sativus from where the name of the disease comes from.

It is essentially a myelopathy, which means an injury to the spinal chord caused by a toxin present in the legume, which came to be identified as non-protein amino acid 3-N-Oxalyldiaminopropionic acid, shortly named beta-ODAP.

Beta-ODAP is chemically analog to the neurotransmitter glutamate and an agonist of the AMPA glutamate receptor. It competes positively with the neurotransmitter, binding to the neuroreceptors and by overstimulation or oxidative stress causes the death of pyramidal-tract neurons, which are responsible for the voluntary control of the musculature of the body.

The disease develops into muscular spasticity, paralysis, atrophy of the lower limbs and also bladder dysfunction. Occasionally there is a coarse tremor of the upper extremities. The condition is irreversible, but not progressive provided the ingestion of grass pea is interrupted. The treatment only symptomatic.

Neurolathyrism does not affect humans equally, it is prevalent in populations that make use of grasspea as its main or exclusive source of nutrition for prolonged periods of time.

The human body is able to metabolize and excrete beta-ODAP in physiological conditions, if part of a varied and regular diet, but in situations of drought and famine, severe malnutrition and deficiency of essential nutrients and vitamins (paticularly ascorbic acid – vitamin C and methionine), the excessive, frequent and prolonged consumption of grass pea triggers the neurological syndrome.

The highest incidence of neurolathyrism in history happened during the Second World War, with those prisoners of the camp of Vapniarka, when over 70% of the inmates were affected, as reported by Dr. Arthur Kessler’s memoirs. They developed the disease after being maintained on a daily diet of 400g of grass pea cooked in saltwater with 200g of barley bread. Prisoners who consumed less of the seeds (200g per day) did not develop it.

These are impressive numbers since during well-documented famine triggered epidemics in Ethiopia, only up to 6% of the population was affected.

An unfairly vilified crop

Lathyrus sativus is an important anual legume crop, resilient to weather adversities, pests and diseases and can be still considered a lifeline to entire populations during periods of drought and extreme lack of economic resources. When part of a minimally varied diet, the association between grass pea consumption and neurolathyrism is virtually non-existent.

During the Spanish Civil War it was used for several purposes, from animal feed, as supplement to cereals, to human consumption. In these regions, one of the most “healthy” and amazing custom for almost all village children until the 1960s was “corer los titos” (“running for grass peas”). The aim of the game was to slip into the neighbours’ grass pea fields and to eat the immature green seeds with the hope not to be caught by the owners.

Foods prepared from grass pea seeds are very tasty. They have been and are still popular in many European countries (e.g., Spain, France, Portugal, Italy, and Poland), in Africa (for instance, Ethiopia), and in South Asia (e.g., India, Bangladesh, and Nepal).

Must we keep Dr. Arthur Kessler’s words in mind, though: “provided there is no degradation to most primitive needs.”

WATCH OUT: Lathyrus sativus – the grasspea- is also named chickling pea and for this reason often confused with the edible and widely used chickpea (Cicer arietinum). Chickpea is not toxic and not associated with neurolathyrism.

Dear and glorious physician

It is arguable if the toxic potential of Lathyrus sativus was something previously known by the Governor of Transnistria, the Gestapo representatives or the camp authorities, but fact is that those prisoners only developed a preventable, disabling, irreversible neurological disease because they were submitted to life-threatening hunger, chronic malnutrition and excruciating living conditions while in the camp.

That benevolent “guiding hand” that inspired so many towards a collaborative, sustainable, affectionate organization had again its fingers smashed by the Holocaust’s hideous hammer – inhumanity.

This exchange between Kessler and Captain Buradescu brings up the pledge of the Third Geneva Convention relative to the treatment of prisoners of war and that would be completed and incremented with a fourth treaty in 1949, negotiated in the aftermath of the Second World War, establishing protections for the wounded, sick and civilians in and around war zones.

 “I explain to him that we are prisoners in a camp during war time, that we may possibly be destroyed through bombing raids or epidemics, but that it is against international law and the duty of a state to poison us on purpose.”- claimed a helpless doctor to the insensible, cynical ears of his designated captor.

What followed was the desperate struggle, the exceptional, heroic efforts of a group of inmate physicians and their assistants to prove that their patients, friends, relatives were being painfully poisoned and silently killed with the main miserable means received for their precarious subsistence.

“The appeals leave through all available direct and indirect channels. Those petitions and telegrams sent to the camp command for dispatch are returned 10 days later via the camp representatives marked with the comment ―return.”

“Meantime the situation in the camp worsens. In the large hall of the infirmary all makeshift beds are full and even the spaces between them are occupied. It is very cold. Around the small tin ovens sit those in circles who can still move, holding their hands to capture warmth above the heat radiating from the plate, legs jumping in continuous tremor. They support themselves with sticks while walking, fall and try again. Many new features appear. Blister on the toes, at heel and edge of foot, dark blisters which open up and become moist. The feet are pale, cold and insensitive. In some the discoloration has risen to the knee and the toes have become gangrenous. They contract fever, the feet turn blue, wounded and purulent. They suffered enormous pain and died from ascending gangrene. Others lost their toes and kept their legs. It was hellish, not a picture to be shown, hundreds of sick, lame, gangrenous legs, incontinence before the bins could be reached, bent postures due to muscle cramps in arms, back, abdomen and legs.”

An incredible, implausible network of help and assistance was formed outside and within the camp, and scarce smuggled food was given to the sick in order to keep them alive.

“From a thin shadow a normal human being can be regenerated. A useful person can be preserved for himself and his family. The majority of the peas returned to the kitchen, no strike, but abstinence to the extreme. Only towards the end of January did we receive bags of dried fruit and moldy potatoes normally destined for pig feed, instead of the fodder peas. Hunger replaced poison.”

A proper medical investigation team was sent to the camp, led by a neurologist who had been there earlier, accompanied by a second physician, dressed in the uniform of a captain, together with laboratory assistants, microscope, guinea pigs, mice and sterile containers. They finished their work, put down their masks and coats, packed up their liquor and urine samples for further investigations and left. The results were never received by the inmates.

With time reports on the association between famine and neurolathyrism began to arrive from the outside world, and finally the wind of change brought some hope and cheerfullness to desolated hearts.

“A few hundred of us, divided into three groups, are to leave camp Vapniarka and our destination is the ghetto of Oligopol. We take paralyzed people with us, but on average less than we are entitled to, because those who had been in work camps and prisons became afflicted to a much larger extent, and even those were retained in the camp.”

Kessler was able to set up a facility in the Transnitrian ghetto to care for the sick, using basic means. He also began to trade with the local farmers, exchanging his medical services, self-made soap and tinctures extracted from medicinal plants for food and other essentials. In comparison to what was described about the well-organized life in camp Vapniarka, the ghetto was even worse as it dehumanized the individual and enabled no social proximity and organization necessaries to counteract it.

He retired to Israel once the war had ended and there established a clinic to care for, study, and attempt to treat the numerous victims of neurolathyrism from Vapniarca, many of who had been also relocated in Israel.

It has been estimated that, in the twentieth century, more than a hundred thousand people worldwide were permanently paralyzed from eating grass pea. These numbers are alarming since they are directly proportional to poverty, deprivation and social exclusion, as we have seen.

In an ever spinning world, may the example and words of a compassionate, loving physician point to our true north.

 “When humans are close together, then a community can develop which becomes more affectionate and solid. This works even under the most primitive conditions with level headed, firm characters and education, provided there is no degradation to most primitive needs.”

Vapniarka, never forget.

References:

1- Ein Arzt im Lager – A camp physician. Excerpts of Arthur Kessler’s memoirs relating to the epidemic of neurolathyrism in camp Vapniarka, Transnistria. Translation by Dirk Enneking. Cassava Cyanide Diseases & Neurolathyrism Network News – Issue Number 25, June 2015.

2- Lambein, Fernand – Lathyrus sativus L. (grass pea) toxic plant or nutraceutical? Cassava Cyanide Diseases & Neurolathyrism Network News – Issue Number 25, June 2015.

3- Disorders of Upper and Lower Motor Neurons – Lathyrism – Joseph Jankovic MD, in Bradley and Daroff’s Neurology in Clinical Practice, 2022

4- Lambein F, Khan JK, Kuo YH, Campbell CG, Briggs CJ. Toxins in the seedlings of some varieties of grass pea (Lathyrus sativus). Nat Toxins. 1993;1(4):246-9. doi: 10.1002/nt.2620010408. PMID: 8167942.

5- Lambein, F., Travella, S., Kuo, YH. et al. Grass pea (Lathyrus sativus L.): orphan crop, nutraceutical or just plain food?. Planta 250, 821–838 (2019). https://doi.org/10.1007/s00425-018-03084-0

6- Vapniarka: a Romanian concentration camp. https://courses.bowdoin.edu/history-2203-fall-2020-bmalakoff/

7- Food-aid cereals to reduce neurolathyrism related to grass-pea preparations during famineGetahun, Haileyesus et al.The Lancet, Volume 362, Issue 9398, 1808 – 1810

8- Tan, Ruiyue & Xing, Geng-Yan & Zhou, Guang-Ming & Li, Feng-Min & Hu, Wen-Tao & Lambein, Fernand & Xiong, Junlan & Zhang, Sheng-Xiang & Kong, Hai-Yan & Zhu, Hao & Jiao, Cheng-Jin & Xiong, Youcai. (2017). Plant toxin β-ODAP activates integrin β1 and focal adhesion: A critical pathway to cause neurolathyrism. Scientific Reports. 7. 40677. 10.1038/srep40677.

9- Barone M., Tulumello R. (2020) Lathyrus sativus. Traditional Grass Pea-Based Foods. In: Lathyrus sativus and Nutrition. SpringerBriefs in Molecular Science. Springer, Cham. https://doi.org/10.1007/978-3-030-59091-8_2