tion; and the symptoms tend to get worse.
Lederer rib; these include bossing of the skull, kyphoscolio-
proposes that thepersecution syndrome is psycho¬
logically caused. He distinguishes this syndrome
from the "K. Z.-syndrome" or concentration-camp
syndrome, which in spite of a superficial resem¬
blance, shows a different constellation and fre¬
quency of symptoms. The concentration-camp syn¬
drome, as described for example by Eitinger,3 is
postulated to be the result of organic changes in
the brain produced by mechanical and toxic in¬
juries as well as by starvation and exhaustion.
In classical German psychiatry, neurosis is not
an illness but a faulty reaction pattern due to con¬
stitutional weakness. As such, a neurosis is not
considered compensable, and this was the advice
given by court-appointed psychiatrists to the Ger¬
man courts. Nevertheless, it is a fact that the
courts themselves overthrew this rigid attitude by
ruling that even constitutionally based symptoms
are compensable, ". if it is evident that persecu¬
. .
tion experiences have made the predisposition
manifest, and if it is not certain that such symp¬
toms would have appeared in any case. ."2 This. . cate the need for further investigation if the lesion
attitude has been extended further by Eliasberg,4
who expresses the opinion that, where there is
doubt, one should accept claims if they appear war¬
ranted to common sense and can not be rejected
on valid reasons by medical science.
1. Archibald, H.C., and Tuddenham, R.D.: Persistent Stress Reaction
After Combat, Arch Gen Psychiat 12:475-481 (May) 1965.
2. Lederer, W.: Persecution and Compensation, Arch Gen Psychiat
12:464-474 (May) 1965.
3. Eitinger, L.: Pathology of Concentration Camp Syndrome, Arch Gen
Psychiat 5:371-379 (Oct) 1961.
4. Eliasberg, W.G.: Theory and Practice in Psychiatric Evaluation of
Restitution Cases, Israel Ann Psychiat 2:81-92 (April) 1964.
THE NEVOID BASAL CELL
CARCINOMA SYNDROME
The association of basal cell carcinoma, cysts of
the jaw, and abnormalities of the thoracic cage
was first appreciated by Howell and Caro, in 1959,1
although a syndrome was not delineated until a
year later.2 Since 1960, the combination has gen-
erally been called the "basal cell nevus syndrome."
The most recent of many apposite communications
appears in the April issue of the Archives of Pa-
thology,3 in which the investigators criticize the
term "basal cell nevus." Originally based on a
clinical misapprehension, the term leads to confu-
sion between tumors composed of basal cells and
those composed of nevus cells. The main presenting
sign of the syndrome is the appearance of multiple
basal cell carcinomas which are nevoid only by
virtue of their early appearance. Therefore, the
terminology, "nevoid basal cell carcinoma syn-
drome," would seem preferable.
Mere association of common signs and symptoms
\p=m-\inthis case basal cell carcinomas and bifid ribs\p=m-\
may lead to the introduction of false syndromes.
However, for this syndrome, the regularity of find¬
ings conclusively indicates a recognizable symptom
complex in which there may be additional changes
less common than the lesions of the skin, jaw, and
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sis, cerebral calcification, ovarian fibromas, hypo-
responsiveness to parathormone, and medulloblas-
toma. The familial nature of the syndrome has
been satisfactorily demonstrated, but varies with
the number of possible abnormalities considered.
For example, the current investigation is confined
to skin lesions and discloses a less impressive pat¬
tern of heredity than previously reported. No asso¬
ciation with is apparent, but the disease seems
sex
to be uncommon in Negroes.
Mason and colleagues were concerned with the
possibility of diagnosing the condition from routine
histologie slides. They found the results disappoint¬
ing; in the majority of cases it was impossible to
distinguish nevoid from other basal cell carcinomas.
The jaw cysts examined were compatible with a fol-
licular (dentigerous) origin. Ameloblastoma, which
has occasionally been reported, was not found in
their material. The authors conclude that the pa¬
thologist should raise the possibility of a nevoid
origin for a basal cell carcinoma and should indi¬
occurs in a young patient, if there is evidence of a
multiplicity of skin tumors, if the pattern is that
of superficial multicentricity, or if osteoid tissue is
present in the tumor.
The importance of a correct diagnosis lies in the
fact that the skin lesions and, to a lesser extent
the jaw lesions, are likely to recur throughout life.
Treatment of the skin tumors must consequently
be early and conservative, lest gross disfiguration
result. Note has also been made of the poor re¬
sponse of nevoid tumors to irradiation. The differ¬
entiation of the syndrome is, therefore, of practical
well academic
as as significance.
1. Howell, J.B., and Caro, M.R.: Basal Cell Nevus: Its Relationship
to Multiple Cutaneous Cancers and Associated Anomalies of Development,
Arch Derm 79:67-80 (Jan) 1959.
2. Gorlin, R.J., and Goltz, R.W.: Multiple Nevoid Basal Cell
Epithelioma, Jaw Cysts, and Bifid Rib: A Syndrome, New Eng J Med
262:908-912 (May 5) 1960.
3. Mason, J.K.; Helwig, E.B.; and Graham, J.H.: Pathology of Nevoid
Basal Cell Carcinoma Syndrome, Arch Path 79:401-408 (April) 1965.
KARL ERNST VON BAER (1792-1876)\p=m-\
COMPARATIVE EMBRYOLOGIST
Baer, doctor of medicine without a practice,
shifted his interest from gross anatomy to
comparative anatomy, but made his greatest con-
tribution in embryology. He described the noto-
chord, advanced the hypothesis of the germ layer,
recognized the similarity of the early stages of em-
bryonic development in related species, and was
the first to identify the mammalian ovum. He was
born near Piep, Estland (Estonia), was taught
reading and writing by a governess, mathematics
and mathematical geography by a private tutor in
languages, and music, general science, and botany
by a part-time general practitioner.1 Baer began
his study of medicine at the recently founded Uni-
versity of Dorpat, Estonia, over the wishes of his
parents who preferred one of the German schools.
Satisfied with the MD degree received at the age of
 22 but not with the clinical training, he turned to
Vienna, only to discover that he possessed a feeble
interest in bedside medicine. Whereupon he literally
wandered over the hills to W\l=u"\rzburg,where Dol-
linger was directing the research and teaching in
anatomy and embryology. The embryology of the
chick was Baer's assignment. Within a year he was
invited to Königsberg as prosector in anatomy.
However, before accepting this appointment, Baer
spent the winter in Berlin, still undecided whether
he should practice medicine. With the appointment
two years later as professor extraordinary, his life
work in the anatomical sciences was settled, and
the need to practice for a living vanished.
The ovum in the graafian vesicle of the dog was
recognized by Baer in the laboratory at Königsberg
in 1827. The discovery was anticipated since he was
convinced that the egg was responsible for the em¬
bryo. This assumption was contrary to the belief of
Haller, who postulated that the embryo existed in
an amorphous state in the graafian follicle and the
structure appeared only after the uterus was
reached. Baer's discovery was described in a letter
to the Imperial Academy of Sciences of St. Peters¬
burg, to which he had been elected a corresponding
member. It was prepared simultaneously in Latin
and in German and was published in Leipzig in
1827. The communication is an enthusiastic descrip¬
tion of the histology and physiology of the embryo,
with mention of the contributions of Cruikshank,
Prévost, Dumas, Wolff, and his onetime scientific
associate, Pander. Each had approached the dis¬
covery, but no one had made it.2
Led on more by inquisitiveness than by the hope of seeing
the ovules in the ovaries with the naked eye through all
the coverings of the Graafian vesicles, I opened a vesicle,
of which, as I said, I had raised the top with the edge of
a scalpel—so clearly did I see it distinguished from the
surrounding mucus—and placed it under the microscope. I
was astounded when I saw an ovule, already recognized
from the tubes, so plainly that a blind man could scarcely
deny it. It is truly remarkable and astonishing that a thing
so persistently and constantly sought and in all compendia
of physiology considered as inextricable, could be put be¬
fore the eyes with such facility.
Conclusions
Every animal which springs from the coition of male and
female is developed from an ovum, and none from a
simple, formative liquid.
The male semen acts through the membrane of the
ovum, which is pervious by no foramen, and in the ovum
it acts first on certain innate parts of the ovum.
All development proceeds from the center to the periph¬
ery. Therefore the central parts are formed before the
peripheral.
The same method of development occurs in all verte¬
brate animals, beginning at the spine.
In this critical communication Baer made refer¬
ence to germ-layers, suggested stages of develop¬
ment, and observed the first rudiment of the dorsal
spine, later called the chorda dorsalis or notochord.
Each of the structures was better defined and iden¬
tified in a two-volume treatise, Embryology of Ani¬
mals, the first volume appearing in 1828 and the
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second in 1837. The germ-layer theory espoused by
Baer included four layers, which were revised down¬
ward by Remak into the ectoderm, the endoderm,
and the mesoderm. The skin and nervous system
arose from the ectoderm; the notochord, the lining
of the gastrointestinal tract, and the digestive
organs from the endoderm; and the muscular,
skeletal, and excretory systems from the mesoderm/*
The first effect of impregnation is the progressive sepa¬
ration of the germ (ovum), the yolk and the membrane of
the yolk, when the germ begins to increase in size. During
the first hours the germ separates from the yolk, but ad¬
heres to the yolk membrane. The elevation of the
. .
germ-layer (Pander's kernel of the chick-embryo) follows .
the yolk-membrane, but it does not come completely clear
of it, but takes some of the yolk-substance with it. Soon
the center of this elevation is separated by a small amount
of fluid from the center of the germ. The germ becomes
thinner and firmer, and looks more like a sheet.
With the thickening of the germ the process of division
into two layers begins: into the upper, thinner, and firmer
membrane-like layer, and the lower, thicker, more granu-
lous and more friable layer. The beginning of the
.
separation probably corresponds with the first stage fol¬
. .
lowing impregnation. It is noticeable at the twelfth hour,
if the germ is carefully dissected under the microscope.
For better understanding I divided the development of
the chick embryo into three periods according to the stages
of circulation. The first period lasts about two days, until
the primary circulation is fully developed. The second
period lasts as long as the circulation through the vessels
of the yolk sac continues; that is three days, until the
vessels of the urinary sac are developed and begin to share
in the circulation. The third period lasts until birth or
until the pulmonary circulation appears. The fourth pe¬
riod begins with life outside the egg.
In the development of the skeletal tissue, an accumula¬
tion of the dark granules is seen, corresponding to the
axis of the embryo. The granules form a chain, the spine-
chain (chorda dorsalis).
As these important contributions were nearing
completion, Baer was troubled with inadequate
financial support for his researches and publica¬
tions. He had hoped for an academic post in Estonia
or in a prominent German university. A third
choice was an appointment in the Academy of
Petersburg, which he finally accepted in 1834.
Ample funds for construction and research were
made available, more time was planned for research,
and St. Petersburg was near his homeland. How¬
ever, his brilliant observations in embryology were
never systematically expanded. On the contrary,
the study of embryonic development was substan¬
tially abandoned. The remaining years were devoted
to the study of physical geography and anthropol¬
ogy, subjects taught by his tutor in Dorpat. Baer
traveled, became a recognized Russian geographer,
and accepted assignments for the government fisher¬
ies—but his great work was over. He taught and
lived in Russia until his death.
1. von Baer, K.E.: Life and Letters, Braunschweig: F. Vieweg and
Son, 1886.
2. von Baer, K.E.: "On the Genesis of the Ovum of Mammals and of
Man," Leipzig: L. Voss, 1827; trans. by C. D. O'Malley, Isis 47:117-153,
1956.
3. Baer, K.E.: Embryology of Animals, 2 vol, Z. Danilevicius, trans.
(excerpt), K\l=o"\nigsberg: G. Borntr\l=a"\ger,1828 and 1837.