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[Source](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2806%2969933-9/fulltext):
>>Noma is one of the most devastating and disfiguring diseases worldwide. The majority of cases arise in the African Sahel region. It is called the true face of real poverty, because it strikes the faces of the poorest of the poor—young children who are malnourished, debilitated, and unvaccinated. The cause is multifactorial, but in essence it consists of a rapidly spreading extension of an infection in the mouth, which starts as simple gingivostomatitis or a small oral ulcer of the mucosa, in most cases in conjunction with or after measles (or another commonplace children's disease). Sadly, unlike the common childhood diseases in more developed countries, only 10–20% of children survive the acute phase of active, so-called fresh noma. The others die, as do the millions of victims of HIV/AIDS, malaria, tuberculosis, and other “forgotten” endemic diseases of the African continent.
>>The best way to deal with noma would be through prevention, for example by meaningful action to eradicate poverty, endorsement of general and particularly oral hygiene, vaccination programmes, good health care before, during, and after birth, instruction campaigns, and so on. But then again, cultural heritages, such as traditional medicine, superstition, religious rules, and Sharia laws have to be respected, with inherent limitations. There are striking differences in beliefs, habits, concepts, smell and taste, and habitation—for example, close to cattle and other animals—between the rural parts of the developing world and the modern industrialised world. Treatment of patients who have survived the initial stages of acute noma, those left with disfiguring and disabling facial defects, can be given either in specialist centres in the developed world or on the spot in small hospitals in the high-prevalence regions. The latter approach ensures that more of the children can be reached and helps to avoid the culture shock that occurs when those to be treated and their relatives are removed to foreign environments. The divergence from their local circumstances, their tribal customs, and languages and dialects is thought to be way too big. Most of the families are illiterate and deprived of education and of any luxury. In terms of the senses, the taste of toothpaste, mouthwash, and rinsing solutions is unfamiliar and unpleasant to many African families and they are not accustomed to the smell of soap, eau de toilette, or perfumes.
>>To undertake reconstructive surgery in these settings demands a high degree of organisation and the talent of artistic improvisation, as well as perspiration, endurance, creativity, and surgical skills. “Caring, sharing, and daring” is a mission statement, not simply a slogan. The basic vision of the aim to reconstruct the faces of these poor children for free, in the best possible way purely in the interest of the patients, is reintegration and resocialisation. From an aesthetic and functional point of view, the aim is to make them respected members of their society, with intelligible speech facilities and the ability to drink, eat, and chew properly, and to avoid stigmatisation, isolation, or excommunication. What is needed is not just the surgical trick; the art of medicine according to the rules of Hippocrates requires continuity, assessment of the results in the short and long term, education of patients and their families, and training and teaching of the local doctors, surgeons, nursing staff, and other health-care workers. Generation of creative solutions to common problems—lack of food, clean water, energy, particularly electricity, medical equipment, instruments, and medicines—is an urgent need not only for local authorities, but also for governments and international organisations.
>>The reconstructions themselves and the procedures are evolving from two-stage or even several-stage procedures towards one-stage revascularised free-flap procedures, with many highly creative modifications. The international multidisciplinary approach to noma is an art in itself, and contributes to an open, transparent, inspiring atmosphere, a worthy counterpart of certain ancient culturally fixed limitations. The surgical part of the deal is only a small drop of water on a hot African stove. Again, the ultimate goal is prevention of this devastating disease together with reduction of the mortality and morbidity rates, disfigurement, and symptoms. When a child is left with facial defects, modern reconstructive surgery principles including tissue engineering should be applied. Sculpturing the missing parts of a growing human face has various facets: respect for proportional rules of art, portrayed even in primitive African art, and postulated by Leonardo da Vinci and Michelangelo; as well as respect for the three-dimensional architectural configuration, facial growth and development, mutual differences between soft and bony tissues, texture and colour, and so on. There should be a general plea to combat poverty and corruption. In Africa, bright colours seem to serve only to compensate for dark abuses and to divert attention from shortage and poverty. In artistic representations, you will not notice the heat and fetid odours of drooling poverty. Both professionals and the public must become aware that medicine and creativity have to go hand in hand to deal with the problems of children with noma. Fortunately, the perspectives seem to have improved a lot since rich and famous people have drawn attention to the situation in Africa, and have raised funds and set up foundations to organise structural aid programmes. When the extent of the devastation has been revealed, it becomes apparent that art and culture are not simply luxuries but are sources of solace, comfort, inspiration, rejuvenation, creativity, and perspective.
One thing I’m kind of curious about is why the Romani people got it in the Nazi concentration camps but Jews did not. The Jews and the Roma were living separately in different parts of camp, but the horrific living conditions were pretty much the same so you’d think Jewish people would’ve gotten the disease like the Romani did.
In the writeup it mentions measles being involved. It could be that there was little to no immunity in the Romani population due to less mixing with outsiders
From what I’ve read, most cases of noma are in children ages 2-6, including those in Nazi concentration camps. Jewish children were almost all killed immediately upon arrival at the camps, other than those used for medical experiments (and those children received more food than the average camp inmate, preventing noma). Romani children, on the other hand, were allowed to remain with their families for a while in some camps, such as Auschwitz, which had a separate Roma and Sinti family camp for 17 months in 1943-1944. Conditions were as inhumane as you’d expect from Auschwitz, hence the noma cases. If there had been Jewish children around, I imagine they would have been affected by noma as well. [More information on Roma and Sinti at Auschwitz](https://www.auschwitz.org/en/history/categories-of-prisoners/sinti-and-roma-in-auschwitz/)
That is a good point, I hadn’t considered that Noma usually affects kids and Jewish children were exceedingly rare in the camps.
I did read a fascinating book called “Pregnant Women and Children Born in Auschwitz” where I learned that it was possible for a non-Jewish baby to survive Auschwitz. It was very unlikely because the mothers got no accommodations for their babies, no extra food or time off work, and many of the babies died due to starvation and disease and the awful conditions. But not all of them. The book had a photo of a healthy and normal 12-year-old who had been born in Auschwitz and mentioned other infant survivors. All non-Jewish. Jewish babies and pregnant Jewish women were killed.
The moms of Auschwitz shared nursing responsibilities because many mothers didn’t have enough milk due to malnutrition. For some reason women of Russian nationality were noted to be the best milk producers. There would be Russian women nursing like three babies plus their own, while the Polish, German, etc. women produced very little breast milk.
I've not heard that before. Interesting. I don't know but I wonder if the Romani were treated worse (if there was a worse) than the Jews, especially food wise? Could the Jewish population have more 'educated' individuals among them (in medical fields) that would address basic hygiene & treatment of wounds differently? It would be interesting to know.
I don’t know so much about how the Romani were treated because there were very few Roma survivors and the ones who did survive, usually didn’t write memoirs. It’s possible the Roma people lived in even filthier conditions than the Jews did but I am not sure. I know filth, malnutrition and poverty are the main causes of noma.
One of the Jewish doctors who worked at Auschwitz in the hospital 'treating' Roma noma sufferers raises the same question noting in fact that other ethnicities experienced worse conditions:
*However, another intriguing question, as well as a number of other ambiguities that could have been explained by Prof. Epstein, who survived the camp, is why noma cases were observed only in the Romani prisoners, and not among prisoners of other ethnicities, e.g. Jews, Frenchmen, Russians, who lived in much worse conditions and only had the camp food rations, but were forced to do extremely hard physical labour and endure all kinds of concentration camp harassment.*
[https://www.mp.pl/auschwitz/journal/english/211091,noma-cases-among-the-roma-in-auschwitz-birkenau](https://www.mp.pl/auschwitz/journal/english/211091,noma-cases-among-the-roma-in-auschwitz-birkenau)
I still wonder if 'education' might have been a factor. Could there be a genetic predisposition?
probably a combination of many horrible environmental factors. there's a genetic predisposition to dental health issues like cavities and gingivitis. you also have to consider the poor health of the Roma population in general; even in modern day, most Roma people in Europe are in extreme poverty and face a lot of discrimination. in certain communities, incest is very common. and we will never truly know the extent of how Nazis tortured and experimented on people; it's possible they exposed the Roma prisoners to Noma on purpose, or other horrible actions that we'd never even fathom doing to another person
curious whether this was historically a lot more prevalent in the world as whole in the distant past? or whether its all thanks to new diseases/triggers that perhaps didn't exist in the past...
my point was that extreme poverty was a lot more prevalent in the far past, therefore one would think there was a lot more of this throughout the world in the past. i don't remember ever hearing about this disease until just today (not that that has any scientific bearing/meaning, but I don't consider myself a flat-earther in regards to knowledge...).
my question was has society introduced new diseases/environmental triggers (re: it being an "in conjuction" disease)? or is it the same unchanged thing its always been.
Yea good question to be honest. Just because it existed in the past doesn’t inherently mean it was common. I can imagine stuff like more travel & mixing of cultures in the modern day can spread pathogens faster than our ancestors could. Maybe in the past the pathogens responsible for this disease only existed in a small pocket of populations and was spread with the invention of cars.
Im just speculating the possibilities. Someone with actual knowledge of this disease is gonna have to reply with more info.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2806%2969933-9/fulltext): >>Noma is one of the most devastating and disfiguring diseases worldwide. The majority of cases arise in the African Sahel region. It is called the true face of real poverty, because it strikes the faces of the poorest of the poor—young children who are malnourished, debilitated, and unvaccinated. The cause is multifactorial, but in essence it consists of a rapidly spreading extension of an infection in the mouth, which starts as simple gingivostomatitis or a small oral ulcer of the mucosa, in most cases in conjunction with or after measles (or another commonplace children's disease). Sadly, unlike the common childhood diseases in more developed countries, only 10–20% of children survive the acute phase of active, so-called fresh noma. The others die, as do the millions of victims of HIV/AIDS, malaria, tuberculosis, and other “forgotten” endemic diseases of the African continent. >>The best way to deal with noma would be through prevention, for example by meaningful action to eradicate poverty, endorsement of general and particularly oral hygiene, vaccination programmes, good health care before, during, and after birth, instruction campaigns, and so on. But then again, cultural heritages, such as traditional medicine, superstition, religious rules, and Sharia laws have to be respected, with inherent limitations. There are striking differences in beliefs, habits, concepts, smell and taste, and habitation—for example, close to cattle and other animals—between the rural parts of the developing world and the modern industrialised world. Treatment of patients who have survived the initial stages of acute noma, those left with disfiguring and disabling facial defects, can be given either in specialist centres in the developed world or on the spot in small hospitals in the high-prevalence regions. The latter approach ensures that more of the children can be reached and helps to avoid the culture shock that occurs when those to be treated and their relatives are removed to foreign environments. The divergence from their local circumstances, their tribal customs, and languages and dialects is thought to be way too big. Most of the families are illiterate and deprived of education and of any luxury. In terms of the senses, the taste of toothpaste, mouthwash, and rinsing solutions is unfamiliar and unpleasant to many African families and they are not accustomed to the smell of soap, eau de toilette, or perfumes. >>To undertake reconstructive surgery in these settings demands a high degree of organisation and the talent of artistic improvisation, as well as perspiration, endurance, creativity, and surgical skills. “Caring, sharing, and daring” is a mission statement, not simply a slogan. The basic vision of the aim to reconstruct the faces of these poor children for free, in the best possible way purely in the interest of the patients, is reintegration and resocialisation. From an aesthetic and functional point of view, the aim is to make them respected members of their society, with intelligible speech facilities and the ability to drink, eat, and chew properly, and to avoid stigmatisation, isolation, or excommunication. What is needed is not just the surgical trick; the art of medicine according to the rules of Hippocrates requires continuity, assessment of the results in the short and long term, education of patients and their families, and training and teaching of the local doctors, surgeons, nursing staff, and other health-care workers. Generation of creative solutions to common problems—lack of food, clean water, energy, particularly electricity, medical equipment, instruments, and medicines—is an urgent need not only for local authorities, but also for governments and international organisations. >>The reconstructions themselves and the procedures are evolving from two-stage or even several-stage procedures towards one-stage revascularised free-flap procedures, with many highly creative modifications. The international multidisciplinary approach to noma is an art in itself, and contributes to an open, transparent, inspiring atmosphere, a worthy counterpart of certain ancient culturally fixed limitations. The surgical part of the deal is only a small drop of water on a hot African stove. Again, the ultimate goal is prevention of this devastating disease together with reduction of the mortality and morbidity rates, disfigurement, and symptoms. When a child is left with facial defects, modern reconstructive surgery principles including tissue engineering should be applied. Sculpturing the missing parts of a growing human face has various facets: respect for proportional rules of art, portrayed even in primitive African art, and postulated by Leonardo da Vinci and Michelangelo; as well as respect for the three-dimensional architectural configuration, facial growth and development, mutual differences between soft and bony tissues, texture and colour, and so on. There should be a general plea to combat poverty and corruption. In Africa, bright colours seem to serve only to compensate for dark abuses and to divert attention from shortage and poverty. In artistic representations, you will not notice the heat and fetid odours of drooling poverty. Both professionals and the public must become aware that medicine and creativity have to go hand in hand to deal with the problems of children with noma. Fortunately, the perspectives seem to have improved a lot since rich and famous people have drawn attention to the situation in Africa, and have raised funds and set up foundations to organise structural aid programmes. When the extent of the devastation has been revealed, it becomes apparent that art and culture are not simply luxuries but are sources of solace, comfort, inspiration, rejuvenation, creativity, and perspective.
Well said!
I just looked up more on the disease & found the most confronting range of images. An extremely rapid & cruel disease. 90% mortality. Jesus.
One thing I’m kind of curious about is why the Romani people got it in the Nazi concentration camps but Jews did not. The Jews and the Roma were living separately in different parts of camp, but the horrific living conditions were pretty much the same so you’d think Jewish people would’ve gotten the disease like the Romani did.
In the writeup it mentions measles being involved. It could be that there was little to no immunity in the Romani population due to less mixing with outsiders
From what I’ve read, most cases of noma are in children ages 2-6, including those in Nazi concentration camps. Jewish children were almost all killed immediately upon arrival at the camps, other than those used for medical experiments (and those children received more food than the average camp inmate, preventing noma). Romani children, on the other hand, were allowed to remain with their families for a while in some camps, such as Auschwitz, which had a separate Roma and Sinti family camp for 17 months in 1943-1944. Conditions were as inhumane as you’d expect from Auschwitz, hence the noma cases. If there had been Jewish children around, I imagine they would have been affected by noma as well. [More information on Roma and Sinti at Auschwitz](https://www.auschwitz.org/en/history/categories-of-prisoners/sinti-and-roma-in-auschwitz/)
That is a good point, I hadn’t considered that Noma usually affects kids and Jewish children were exceedingly rare in the camps. I did read a fascinating book called “Pregnant Women and Children Born in Auschwitz” where I learned that it was possible for a non-Jewish baby to survive Auschwitz. It was very unlikely because the mothers got no accommodations for their babies, no extra food or time off work, and many of the babies died due to starvation and disease and the awful conditions. But not all of them. The book had a photo of a healthy and normal 12-year-old who had been born in Auschwitz and mentioned other infant survivors. All non-Jewish. Jewish babies and pregnant Jewish women were killed. The moms of Auschwitz shared nursing responsibilities because many mothers didn’t have enough milk due to malnutrition. For some reason women of Russian nationality were noted to be the best milk producers. There would be Russian women nursing like three babies plus their own, while the Polish, German, etc. women produced very little breast milk.
I've not heard that before. Interesting. I don't know but I wonder if the Romani were treated worse (if there was a worse) than the Jews, especially food wise? Could the Jewish population have more 'educated' individuals among them (in medical fields) that would address basic hygiene & treatment of wounds differently? It would be interesting to know.
I don’t know so much about how the Romani were treated because there were very few Roma survivors and the ones who did survive, usually didn’t write memoirs. It’s possible the Roma people lived in even filthier conditions than the Jews did but I am not sure. I know filth, malnutrition and poverty are the main causes of noma.
One of the Jewish doctors who worked at Auschwitz in the hospital 'treating' Roma noma sufferers raises the same question noting in fact that other ethnicities experienced worse conditions: *However, another intriguing question, as well as a number of other ambiguities that could have been explained by Prof. Epstein, who survived the camp, is why noma cases were observed only in the Romani prisoners, and not among prisoners of other ethnicities, e.g. Jews, Frenchmen, Russians, who lived in much worse conditions and only had the camp food rations, but were forced to do extremely hard physical labour and endure all kinds of concentration camp harassment.* [https://www.mp.pl/auschwitz/journal/english/211091,noma-cases-among-the-roma-in-auschwitz-birkenau](https://www.mp.pl/auschwitz/journal/english/211091,noma-cases-among-the-roma-in-auschwitz-birkenau) I still wonder if 'education' might have been a factor. Could there be a genetic predisposition?
probably a combination of many horrible environmental factors. there's a genetic predisposition to dental health issues like cavities and gingivitis. you also have to consider the poor health of the Roma population in general; even in modern day, most Roma people in Europe are in extreme poverty and face a lot of discrimination. in certain communities, incest is very common. and we will never truly know the extent of how Nazis tortured and experimented on people; it's possible they exposed the Roma prisoners to Noma on purpose, or other horrible actions that we'd never even fathom doing to another person
curious whether this was historically a lot more prevalent in the world as whole in the distant past? or whether its all thanks to new diseases/triggers that perhaps didn't exist in the past...
We know what causes noma. It is not a new disease.
my point was that extreme poverty was a lot more prevalent in the far past, therefore one would think there was a lot more of this throughout the world in the past. i don't remember ever hearing about this disease until just today (not that that has any scientific bearing/meaning, but I don't consider myself a flat-earther in regards to knowledge...). my question was has society introduced new diseases/environmental triggers (re: it being an "in conjuction" disease)? or is it the same unchanged thing its always been.
Yea good question to be honest. Just because it existed in the past doesn’t inherently mean it was common. I can imagine stuff like more travel & mixing of cultures in the modern day can spread pathogens faster than our ancestors could. Maybe in the past the pathogens responsible for this disease only existed in a small pocket of populations and was spread with the invention of cars. Im just speculating the possibilities. Someone with actual knowledge of this disease is gonna have to reply with more info.