"K Syndrome", the Disease that saved lives

In the heart of occupied Rome, on Tiber Island, one of the most extraordinary stories of resistance and humanity took place during the Second World War. "K Syndrome", a fictitious disease, was created by doctors at the Fatebenefratelli Hospital to protect Jews and others persecuted from roundups and deportations.

Under the pretext of a dangerously contagious epidemic, the Nazis were deceived, thus saving dozens of lives. On the occasion of Holocaust Remembrance Day, this interview leads us to the discovery of an "imaginary" epidemic that continues to inspire about the role of medicine and solidarity in times of crisis. We talked about it with Andrea Grignolio, professor of History of Medicine at UniSR.

K Syndrome

K Syndrome is the most "beautiful" epidemic in the history of medicine: it is an invention, a deception, which occurred on the Tiber Island, during the Nazi occupation, thanks to which "affected" people's lives were saved by this “very contagious disease”.

From the historical evidence we have, K Syndrome was characterized by cramps, convulsions, and finally asphyxia, a symptom profile very similar to tuberculosis. A central aspect relating to this disease is that it was unknown at the time which infectious agent was responsible, as was the case for some other infectious diseases in that same historical period. At the same time, it was presented as a highly contagious and lethal disease, so the sick lived in very strict isolation, an aspect that has always been associated with a high virulence index.

A historically interesting aspect is that the trigger point for K Syndrome was the Tiber Island which, from the 3rd century BC, was a health resort dedicated to Aesculapius, the Greek deity of medicine. Proof of this is that, even today, if you go to the Tiber Island you can find the caduceus, the famous staff of Aesculapius, with the coiled serpent, carved in marble. The hospital today is the well-known Fatebenefratelli in Rome.

The "inventor" of K Syndrome

The central figure is Giovanni Borromeo, an internist and expert in infectious diseases,  who had expressed a certain rejection of fascism. For this reason, the Polish priest F. Maurizio Bialek was called by the Prior of the Hospital Order of San Giovanni Calibita who managed the Fatebenefratelli, a sort of jurisdiction protected by the Vatican, which guaranteed him a certain margin of freedom.

It was he who invented this disease, I would say, for two reasons: on the one hand he offered significant, although not excessively obvious, resistance against fascism and its abuses; on the other hand he had been a student of the physiopathologist Marco Almagià, of Jewish religion, which probably made him more sensitive to anti-Semitic violence and discrimination.

Regarding the origin of the name, there are two versions, one more plain and evident and one more indirect, which however are not mutually exclusive.

The first is that K would come from the Koch bacillus responsible for tuberculosis (TB), a disease that affected the lungs and was very widespread at the time. In Italy, among other things, knowledge and attempts to cure TB were quite advanced. We remember, for example, Edoardo Maragliano, the first to propose a serotherapy based on passive immunity, or even Carlo Forlanini, who proposed a surgical therapy by inventing the pneumothorax to promote the healing of lung tissues affected by tuberculosis. The latter was known, widespread, dangerous and infectious and moreover had symptoms similar to those invented for the mysterious disease of the Tiber island, therefore it was decided to call it K Syndrome, by assimilation with the name of the discoverer, and of the responsible bacillus, of the tuberculosis.

A second version works by assonance with the terror of the time, i.e. with the two figures responsible for the Nazi violence and massacres that then weighed on the Peninsula. K could in fact be associated with the name of the Nazi authority that controlled Rome, i.e. the SS officer Kappler, who twenty days before the roundup had deceivedly confiscated the gold from the Roman Jewish community and who was then the responsible executor of the massacre of the Ardeatine pits, but also to the name of General Kesselring, commander in chief of the German forces in Italy. According to this version, the "Kesselring patients" were born in those tragic days to indicate patients fleeing from the Germans. It is not known whether in the hoax concocted by Borromeo the name chosen for the disease that could have plagued the Nazis during the roundup of the Rome ghetto there was also an ironic reference to the two senior German soldiers, it is certain that the "K Syndrome" had the advantage of being easily understandable to the ears of the SS.

Regardless of the origin of the name, as reported by Adriano Ossicini, an anti-fascist activist and young doctor employed by Borromeo, K Syndrome on patients' medical records was a way of indicating that the patient was not actually ill but was Jewish, which caused the Nazis to retreat with the same fear they instilled in others.

The "false patients"

Patients "affected" by K disease were housed in rooms with hermetically closed doors, covered and isolated, and were asked to cough hard to simulate the symptoms of the disease. At the same time, patients were attached to machines, there were drugs and solutions just as happened for the treatment of major infectious diseases.

Some historians hypothesize that just over a hundred patients were saved, although there is no certain data. For those unfamiliar with the Rome neighborhood that was the scene of this life-saving epidemic, it is worth remembering that the Jewish neighborhood is quite close to the Tiber Island and this contributed to Borromeo's plan. It is estimated that word spread starting from the roundup of 15-16 October 1943 and that, from then on, people secretly went to Fatebenefratelli to be admitted. The help of one of his collaborators, the doctor of Jewish origin Vittorio Emanuele Sacerdoti, nephew of the physiopathologist Marco Almagià, Borromeo's teacher, who worked at the Tiberina hospital under a false identity, was also fundamental.

Similar episodes throughout history

At least one case of a similar episode is known, which occurred in the Warsaw ghetto, another place unfortunately full of tragedies: two doctors invented a method to create false diagnostic signs of a typhus epidemic to block the compulsory recruitment of the workforce and deportations . It was a mimicked epidemic by inoculating, before the diagnostic test carried out by the Nazis, which was then the Weil Felix reaction, the same antigens that bind to the antibodies of subjects suffering from rat typhus or endemic typhus.

A lesson for the young and future doctors?

Can the example of men like Giovanni Borromeo be an inspiration for future doctors and young people in general? This is a very difficult question, to which I must answer by remembering that virtuous stories are a partially effective and non-resolving tool. Let me explain.

Cognitive-behavioural studies tell us that the population, and with it also medical students, is divided into at least 3 categories on these ethical issues: altruists (20%); those more oriented towards evidence of effectiveness, which we could define as rationalists (60%); and then those who are more individualistic (20%). For the former, these stories are effective, and confirm their natural tendency to be empathetic, but for the other two categories, these stories only have a positive effect in the immediate, short term.

If reevaluated over time, people demonstrate a return to their original attitude, or "nature". Therefore, insisting only on the use of narratives or tools coming from the arts, typical of a certain part of the Medical Humanities, to improve the sensitivity and human dimension of medicine, has weak effects. For this reason, we need to use other teaching forms, and in particular cognitive-behavioral tools, which go beyond stories.

This is not their only purpose, of course. Medical Humanities can also be useful for placing medical discoveries over time and demonstrating the developments in the ethical values ​​at play, the social dynamics and above all the evolution of the scientific method. This gives students a dynamic sense of the moment in history and science at which they begin their careers, which students generally do not reflect on. Talking about how paradigm shifts have occurred in the past, both in values ​​and in biomedical innovations, helps them understand the method of ethical and scientific progress: History remains a useful tool for projecting oneself with greater awareness towards the future.

Finally, I think that Medical Humanities help to understand the importance of the therapeutic alliance, contribute to the formation of values ​​and respect for the patient, alongside technical-scientific training, which however bases its training on technicalities. Conversely, today it does not exist, and perhaps cannot exist in general, a manual that improves the doctor-patient relationship or transmits values: this is a long journey that also has to do with pain and, sometimes, death and which requires empirical demonstration, as well as cognitive tools, of how this relationship can increase the effectiveness of therapies and patient care.

Interview by Dr. Federica La Russa, medical writer.