■ imtm ill Aflk'a m Ifl: a,5 Mi il ;11 v lllfl MORALE DIVISION UNITED STATES STRATEGIC BOMBING SURVEY MEDICAL BRANCH REPORT THE EFFECT OF BOMBING ON HEALTH AND MEDICAL CARE IN GERMANY WAR DEPARTMENT WAS HINGTON, D. C. OCTOBER 30. 1945 PERSONNEL MR. FRANKLIN d’oLIER Chairman of the Survey MR. HENRY C. ALEXANDER Vice Chairman RENSIS LIKERT, PH.D. Director of Morale LT. COL. RICHARD L. MEILING, M.C. Chief, Morale Division Editor-in-Chief MAJOR CORTEZ F. ENLOE, JR., MEDICAL CORPS, AUS Chief, Medical Sciences Branch BOMBING RESEARCH ANALYSTS OF THE MEDICAL BRANCH LIEUTENANT COLONEL JOHN H. WATKINS, SANITARY CORPS, AUS HANS H. REESE, M.D. MADISON, WISCONSIN CAPTAIN FRANZ K. BAUER MEDICAL CORPS, AUS HERMANN K. ROSMANN, M.D. MADISON, WISCONSIN LIEUTENANT COMMANDER J. BENNETT NOLAN U.S. COAST GUARD (r) GEORGE A. WULP, M.D. HARTFORD, CONNECTICUT MAJOR HENRY J. RUGO MAJOR ROBERT H. NEWELL MEDICAL CORPS, AUS QUARTERMASTER CORPS, AUS CAPTAIN ASHER S. CHAPMAN MEDICAL CORPS, AUS CAPTAIN LAWRENCE S. FARRELL SANITARY CORPS, AUS T/3 LUDWIG BOETTIGHEIMER CAPTAIN PAUL J. HOUSER SANITARY CORPS, AUS T/4 SCOTT HITCHCOCK This report was written in compliance with the Presidential Directive of the 9th of September, 1944. The study of the health in Germany was made by a group of selected medical scientists under the auspices of the Secretary of War. The conclusions contained herein are the combined conclusions of this group and do not necessarily reflect those of other sections of the United States Strategic Bombing Survey. TABLE OF CONTENTS Page CHAPTER ONE—INTRODUCTION 1 CHAPTER TWO—CIVILIAN DEATHS FROM AIR ATTACKS 6 Summary 13 CHAPTER THREE—THE NATURE OF AIR RAID CASUALTIES 14 Mechanical causes 16 Heat 18 Carbon monoxide poisoning 24 Air blast 25 Dust inhalation 27 Drowning 27 Pre-existing organic disease 27 Poisoning by industrial gases 27 Phosphorus 28 Summary and conclusions 28 CHAPTER FOUR—COMMUNICABLE DISEASES AND OTHER DISORDERS 30 Communicable Diseases 30 Typhus Fever 30 Diphtheria 35 Scarlet fever 43 Whooping cough 43 Measles 55 Poliomyelitis—epidemic encephalitis—epidedemic meningitis 55 Influenza and pneumonia 63 Enteric fevers 63 Smallpox 73 Scabies—Weil’s disease—Other diseases 73 Why there were no epidemics 82 Tuberculosis 83 Summary 94 Venereal Diseases 94 Summary 98 TABLE OF CONTENTS (continued) Page Psychosomatic disorders 98 Gastrointestinal disorders 99 Endocrinologic disorders 99 Cardiovascular disorders 100 Dermatologic diseases 101 Vegetative symptomtology 101 Summary 101 Psychiatric disorders 101 Summary 105 CHAPTER FIVE—INDUSTRIAL HEALTH 106 Deaths and injuries due to aerial bombings 107 The sick rate 108 Industrial health and absenteeism 112 The foreign worker 115 Summary 116 CHAPTER SIX—VITAL STATISTICS 117 Selection of cities 117 Collection of data 118 Methods of analysis and presentation 119 Births 121 Mortality from all causes of death except those from air attacks 125 Infant mortality 126 Diseases of adult life 126 Suicide 148 Accidents 148 Effect of air attacks on mortality trends 148 Summary 158 CHAPTER SEVEN—MEDICAL PERSONNEL 159 Physicians 162 Germany’s national health administration 159 Dentists 164 Nurses 165 Women’s volunteer units 166 The general practitioner 166 The specialist 168 CHAPTER EIGHT—MEDICAL EDUCATION 169 The war and medical education 169 Effects of bombing on German universities 172 TABLE OF CONTENTS (continued) University of Munich 173 Page University of Wurzburg 175 University of Cologne 175 University of Frankfort-on-the-Main 177 University of Kiel 177 University of Hamburg 177 University of Leipzig 179 Conclusions 181 CHAPTER NINE—HOSPITALIZATION 182 Methods of the USSBS investigation 182 Hospital buildings in Germany 182 Prewar bed capacity of the hospitals 183 Medical and nursing personnel 186 Over-all measures for the defense of hospitals against air attack 187 Hospital air raid shelters 188 Wartime and auxiliary and emergency hospitals 202 The Brandt hospitals for air raid casualties 204 Effects of hospital evacuation: medical effects of individual and mass evacuations 210 Kinder Land Verschickung movement to send children to the country 214 Hospitals and hospital personnel 215 Hospital medical care 221 Hospital nutrition, medications, instruments 223 Summary and general conclusions 225 Maternal and infant care 225 CHAPTER TEN—ENVIRONMENTAL SANITATION 229 Water supplies 229 Emergency supplies 230 Emergency repairs 231 Protective measures 232 Physical damage 236 Frankfort 236 Augsburg 236 Karlsruhe 237 Munich 237 Cologne 238 Hamburg 238 Nuremberg 244 Stuttgart 245 Destruction of the Moehne Dam 245 Sewerage systems 250 Hamburg 251 Stuttgart 252 TABLE OF CONTENTS (continued) Ulm 252 Page Nuremberg 253 Cologne 253 Munich 253 Augsburg 255 Frankfort 255 Other effects of bomb damage to sewerage systems 255 Garbage—collection and disposal 257 Housing (light, heat, shelter) 260 Problems of decomposing bodies 261 Summary and Conclusions 262 CHAPTER ELEVEN—FOOD SUPPLY AND NUTRITION 264 Production 265 Organization of German food supply 264 Food processing 265 Fertilizer supply 266 Storage 271 Distribution 272 Ministry of food action against bombing 272 Food control and rationing system 273 Feeding during and after air raids 282 Nutritional quality of the national diet 284 Conclusions 290 CHAPTER TWELVE—MEDICAL SUPPLIES: DEVELOPMENT, PRODUCTION AND DISTRIBUTION. 294 The pharmaceutical industry 294 Knoll, A.G., Ludwigshafen 294 Pharmaceutical facilities of the I. G. Farbenindustrie, A. G 298 Biochemical Laboratories, Oppau Works 299 I. G. Farben, Hoechst 300 Behringwerke, Marburg 305 Bayer Laboratories, Elberfeld 305 Pharmaceutical manufacture at Leverkusen 306 C. H. Boehringer Sons, Hamburg 328 E. Merck, Darmstadt 329 Surgical dressings, supplies, and equipment 333 The government’s control organization 334 Counter-measures 335 The apothecary and drug rationing 336 New developments 337 Conclusions 338 APPENDICES 340 TABLES Number Page 1. Annual Case Incidence of Typhus Fever in Seven German Cities, 1938, 1940, 1942-44.... 31 2. Reported Cases of Typhus Fever in Magdeburg in 1943 and 1944 31 3. Annual Case Incidence of Diphtheria in Seven German Cities, 1938, 1940, 1942-44 34 4. Annual Mortality from Diphtheria in Thirteen German Cities, 1938, 1940, 1942-4 34 5. Annual Case Incidence of Scarlet Fever in Seven German Cities, 1938, 1940, 1942-44.... 42 6. Annual Mortality from Scarlet Fever in Thirteen German Cities, 1938, 1940, 1942-44 42 7. Annual Case Incidence of Whooping Cough in Seven German Cities, 1938, 1940, 1942-44. . 44 8. Annual Mortality from Whooping Cough in Thirteen German Cities, 1938, 1940, 1942-44. . 44 9. Annual Mortality from Measles in Thirteen Thirteen German Cities, 1938, 1940, 1942-44. . . 55 10. Annual Case Incidence of Poliomyelitis, Epidemic Meningitis and Epidemic Encephalitis in Seven German Cities, 1938, 1940, 1942-44 56 11. Annual Mortality from Influenza and Pneumonia in Thirteen German Cities,. 1938, 1940, 1942-44 62 12. Annual Case Incidence of Gastrointestinal Disease in Six German Cities, 1938, 1940, 1942-44 71 13. Annual Case Incidence of Typhoid Fever in Seven German Cities, 1938, 1940, 1942-44 71 14. Annual Case Incidence of Paratyphoid Fever in Six German Cities, 1938, 1940, 1942-44. . . 72 15. Annual Case Incidence of Dysentery in Six German Cities, 1938, 1940, 1942-44 72 16. Annual Case Incidence of Bacterial Food Poisoning in Six German Cities, 1938, 1940, 1942-44 72 17. Annual Case Incidence of Tuberculosis in Seven German Cities, 1938, 1940, 1942-44 85 18. Annual Mortality from Tuberculosis in Thirten German Cities, 1938, 1940, 1942-44 87 19. Cases of Venereal Diseases in Frankfort, 1939-42 96 20. Venereal Diseases in Hamburg, 1939-43 97 21. Annual Birth Rate in Thirteen German Cities 120 22. Annual Deaths from All Causes (except air raids) in Thirteen German Cities, 1938, 1940, 1942-44 121 23. Annual Infant Mortality in Thirteen German Cities 1938, 1940, 1942-44 125 24. Annual Mortality from Diabetes in Thirteen German Cities, 1938, 1940, 1942-44 136 25. Annual Mortality from Heart Disease in Thirteen German Cities, 1938, 1940, 1942-44 146 TABLES (continued) Number Page 26. Annual Mortality from Cerebral Hemorrhage in Thirteen German Cities, 1938, 1940, 1942-44 146 27. Annual Mortality from Old Age in Thirteen German Cities, 1938, 1940, 1942-44 147 28. Annual Suicide Mortality in Thirteen German Cities, 1938, 1940, 1942-44 147 29. Annual Mortality from Accidents in Thirteen German Cities, 1938, 1940, 1942-44 149 30. Summary of Air Raid Attacks 150 31. Summary of Changes in Mortality Rates Following Bombing 151 32. Medical Texts Authorized in 1944 171 32. Mortality and Physical Damage from Bombing in the Hospitals of Essen 215 34. Comparative Water Consumption in Greater Hamburg 239 35. Bacteriologic Condition of Drinking Water in Hamburg 244 36. Water Pumpage and Supplies Affected by Flooding Moehne and Ruhr Valleys 246 37. Effect of Moehne Raid on Water Works 248 38. Sewage and Water Associations Organized in Germany 252 39. Bomb Damage to Grain Mills 266 40. Consumption of Commercial Fertilizers 269 41. Degree of Self-Sufficiency of the Provinces 273 42. Scheme of Consumer Groups in the German System of Rationing of Foodstuffs, 1943-1945. 275 43. Supplementary Norms for Consumer Groups 284 45. Comparison of Recommended Dietary Allowances of United States and Germany 285 46. Daily Vitamin Supply During the Ration Periods No. 1-No. 9 (28 August 1939-5 May 1940), without vegetables 287 47. Vitamin Supply Through Vegetables During the Ration Periods No. 2- No. 10 (25 Sept. 1939-5 May 1940) 288 48. Weekly and Daily Vitamin Supply During the Ration Period No. 4 (20 November-17 December 1939), without vegetables 288 A 49. Products of I. G. Farben Hoechst 301 50. Receipts of Raw Pancreas at Hoechst 302 51. Production of Hoechst Leading Products 304 52. Sera and Vaccine Production at Marburg 306 A 53. Tablet, Ampule, and Vial Production at Leverkusen 328 ILLUSTRATIONS Figure Page 1. Total Deaths of Civilians from Air Raids on Germany 7 2. Monthly Summary of Air Raid Attacks on Duisburg 8 3. Bombing Experience and Mortality from Air Attacks on Thirteen German Cities 9 4. Typical Scene in Hamburg After Incendiary Raid 15 5. Dead Occupant of Air Raid Shelter 16 6. Death in Street from Effects of High Temperature 16 7. Example of Heat Victim 17 8. Effect of Dry Heat in a Group of Occupants in an Air Raid Shelter 17 9. Specimen of Lungs and Heart in a Case of Heat Death 18 10. Specimen of Brain and Lungs in a Case of Heat Death 18 11. Air Raid Victim in Street of Hamburg 19 12. Victim of Heat Rolled Over to Show Intact Skin on Chest and Abdomen 19 13. Body of a Young Woman, Heat Victim 20 14. Shelter Occupant. Advanced State of Cremation by Dry Heat 21 15. Shelter Occupant. Almost Completely Charred Body 21 16. Shelter Occupant. Advanced State of Charring 23 17. Another View of Victim Shown in Figure 5 23 18. Victims Succumbed to Carbon Monoxide in an Air Raid Shelter 23 19. The Bombing Experience and Case Incidence of Typhus Fever in Nine German Cities 32 20. The Bombing Experience and Case Incidence of Diphtheria in Nine German Cities 36 21. The Bombing Experience and Mortality from Diphtheria in Thirteen German Cities 38 22. The Bombing Experience and Case Incidence of Scarlet Fever in Nine German Cities 45 23. The Bombing Experience and Mortality from Scarlet Fever in Thirteen German Cities 47 24. The Bombing Experience and Case Incidence of Whooping Cough in Nine German Cities 50 25. The Bombing Experience and Mortality from Whooping Cough in Thirteen German Cities. . 52 26. The Bombing Experience and Mortality from Measles in Thirteen German Cities 57 27. The Bombing Experience and Case Incidence of Poliomyelitis in Nine German Cities 60 28. The Bombing Experience and Case Incidence of Epid. Encephalitis in Nine German Cities. ... 64 29. The Bombing Experience and Case Incidence of Epid. Meningitis in Nine German Cities 66 30. The Bombing Experience and Mortality from Influenza and Pneumonia in Thirteen German Cities 68 31. The Bombing Experience and Case Incidence of Typhoid Fever in Nine German Cities 74 32. The Bombing Experience and Case Incidence of Paratyphoid Fever in Nine German Cities. ... 76 33. The Bombing Experience and Case Incidence of Dysentery in Nine German Cities 78 34. The Bombing Experience and Case Incidence of Bacterial Food Poisoning in Nine German Cities 80 35. The Mortality Rate from Tuberculosis in Germany 84 ILLUSTRATIONS (continued) Figure Page 36. Cases and Deaths Due to Tuberculosis in Germany 86 37. Deaths from Tuberculosis in the Districts of Frankfort, Breslau, Stettin, Arnsberg and Schaben, by Age Groups 88 38. The Bombing Experience and Case Incidence of Tuberculosis in Nine German Cities 89 39. The Bombing Experience and Mortality from Tuberculosis in Thirteen German Cities 91 40. Percentage of the German Air Corps Admitted to Mental Institutions, 1942 and 1943 103 41. Average Weekly Sick Rate, 1938-1945, Krupp Industrial Plant, Essen 109 42. Percentage Disabled, by Age Groups, 1937-1943, Krupp, Essen 110 43. Annual Industries Patient Days Per 1,000 in Stuttgart 11l 44. The Bombing Experience and Birth Rate in Thirteen German Cities 122 45. The Bombing Experience and Mortality from All Causes of Death (Except Air Attacks) in Thirteen German Cities 127 46. The Bombing Experience and Infant Mortality in Thirteen German Cities 130 47. The Bombing Experience and Mortality from Diabetes in Thirteen German Cities 133 48. The Bombing Experience and Mortality from Heart Disease in Thirteen German Cities. .. . 137 49. The Bombing Experience and Mortality from Cerebral Hemorrhage in Thirteen German Cities 140 50. The Bombing Experience and Mortality from Old Age in Thirteen German Cities 143 51. The Bombing Experience and Mortality from Suicide in Thirteen German Cities 152 52. The Bombing Experience and Mortality from Accidents in Thirteen German Cities 155 53. Schematic Presentation of the German National Health Organization 161 54. Emergency Reserve of Active Physicians, 1943 162 A 55. Distribution of German Physicians in Autumn of 1944 164 56. Semester Strength of German National Medical Students, 1944-45 170 57. Air Raid Damage to First Medical Clinic, University of Munich. Front View 172 58. Air Raid Damage to First Medical Clinic, University of Munich 173 59. Air Raid Damage to Second Medical Clinic, University of Munich 174 60. Air Raid Damage to Children’s Clinic, University of Munich 174 61. Air Raid Damage to Eye Clinic, University of Munich 174 62. Air Raid Damage to Polyclinic Building, University of Munich 175 63. Air Raid Damage to Anatomy Building, University of Frankfort-on-the-Main 176 64. Air Raid Damage to Physiology Section, University of Frankfort-on-the-Main 176 65. Air Raid Damage to Surgical Section, University of Frankfort-on-the-Main 178 66. Damage to Surgical Clinic, University of Leipzig, by Air Raid of 4 December, 1943 178 67. Damage to Pharmacology Building, University of Leipzig, by Air Raid of 4 December, 1943 178 68. Damage to Children’s Clinic, University of Leipzig, by Air Raid of 4 December, 1943 179 69. Damage to Medical Clinic, University of Leipzig, by Air Raid of 4 December, 1943 179 70. Damage to Anatomy Building, University of Leipzig, by Air Raid of 4 December, 1943 180 71. Damage to Neuropsychiatric Clinic, University of Leipzig, by Air Raid of 4 December, 1943. . 180 72. Air Raid Damage to the Krupp Hospital 183 73. Proposed new home of the University of Berlin 184 74. Use of Beds in the Hospitals of Leipzig 185 ILLUSTRATIONS (continued) Figure Page 75. Air Raid Hospital Bunker, Gas Lock in Entrance Hall 187 76. Air Raid Hospital Bunker, Infants’ Ward 188 77. Air Raid Hospital Bunker, Children’s Ward 189 78. Plot Plan of a Typical Air Raid Hospital, Hamm in Westphalia 190 79. Elevation Plan of a Typical Air Raid Hospital, Hamm in Westphalia 190 A 80. Cross Section of a Typical Air Raid Hospital, Hamm in Westphalia 191 81. Longitudinal Section of a Typical Air Raid Hospital, Hamm in Westphalia 192 82. First Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 193 83. Second Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 194 84. Third Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 195 85. Fourth Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 196 86. Fifth Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 197 87. Sixth Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 198 88. Seventh Floor Plan of a Typical Air Raid Hospital, Hamm in Westphalia 199 89. Reenforced Basement Type of Air Raid Shelter, University of Munich 201 90. Bunker Hospital, Municipal Hospital, Nuremberg 202 91. Air Raid Hospital, Engine Room 203 92. Air Raid Hospital Bunker, Diet Kitchen 204 93. Air Raid Hospital Bunker, Four-Bed Ward 205 94. Hospital Bunker of the Subterranean Type, Frankfort-on-the-Main 205 95. Air Raid Hospital Bunker, Frankfort-on-the-Main, Engine Room and Power House 206 96. Plan of Subterranean Air Raid Hospital, Upper Floor, Frankfort-on-the-Main 207 97. Plan of Subterranean Air Raid Hospital, Lower Floor, Frankfort-on-the-Main 208 98. View of entrance to the Ludwigshafen Municipal Hospital 209 99. Air Raid Hospital Bunker, Operating Room, Frankfort-on-the-Main 210 100. Plot Plan, typical Brandt Hospital 211 101. Exterior View, Typical Brandt Hospital 212 102. Internal Medicine Clinic, Ludwigshafen 212 103. Ward Room, Brandt Hospital 213 104. Plot Plan, Municipal Hospital of Cologne, Showing Air Raid Damage 216 105. Plot Plan, Municipal Hospital, Munich, Showing Air Raid Damage 217 106. Plot Plan, City Hospital at Dortmund, Showing Air Raid Damage 218 107. Air Raid Damage to Hospital Building, Frankfort-on-the-Main 219 108. Obstetrics and Gynecology Building, Krupp Auxiliary Hospital 220 109. Air Raid Damage to Municipal Hospital, Essen 221 110. Insel Spital, Center of Old City, Nuremberg 222 111. Typical Ground Water Collecting System Showing Suction Line to Pump Pit 230 112. Typical Installation of Infiltration Gallery Pipe for Collecting Ground Water 230 113. Cross Section and Plan of Typical Installation for Collecting Ground V ater by Infiltration Galleries 230 114. Wine Cask Used for Emergency Water Storage 231 115. Emergency Water Supply Line Installed by Repair Team Following Air Raid 232 116. Emergency Pipe Line Laid on Air Raid Rubble 233 ILLUSTRATIONS (continued) Figure Page 117. Municipal Valved Distributor Hose Used Following Air Raid 233 118. Emergency Water Line; Spare Stub and Valve Used by Repair Team Following an Air Raid 234 119. Ration Stamps Used for Procurement of Pipe for Replacement of Damaged Water Lines and Sewers 234 120. Munich Infiltration Well House 235 121. Munich Infiltration Well—Interior 235 122. Interior of Underground Water Reservoir—Munich 236 123. “Scorched Earth” Destruction to Transportation and Water Supply Lines. Remains of Reichs- autobahn (Highway) Bridge 237 124. Wreckage of Pump Station—Cologne 237 125. Bomb Damage to 2.5 Million Gallon Reservoir—Cologne 238 126. Open Storage Tanks Built as Part of the Organized Air Raid Defense for Fire Fighting and Emergency Drinking Water Supply 239 127. Location Sketch of the Sources of Water Supply for the City of Hamburg 240 128. Broken Suction Line at Hamburg Pumping Station 241 129. Bomb Damaged Reservoir—Hamburg 241 130. Can Filling Station at Hydrant 242 131. Typical Damaged Steel Water Line 243 132. Emergency Water Line 244 133. Moehne Dam After Destruction in Bombing, May, 1943 247 134. Remains of Water Works at Neheim, May, 1943 247 135. Pumping Equipment Damaged by Flood—Neheim Water Works, May, 1943 249 136. Moehne Dam, Upstream Side, After Reconstruction 250 137. Cable With Hanging Grenade to Destroy Low Flying Planes and Prevent Skip Bombing 251 138. Moehne Dam. Nets Installed after Reconstruction to Prevent Floating Mines from Hitting Dam 253 139. Moehne Dam—Steel Nets Installed on the Downstream Side, to Prevent Bombs Dropped Vertically from Reaching Base of Dam 253 140. Sewage Disposal by Plain Settling and Sludge Digestion, Munich 254 141. Trunk Sewer Blown Open by Direct Hit 255 142. Damage Caused by Direct Bomb Hit on Trunk Sewer 256 143. Bomb Damaged Settling Tanks. Munich 256 144. Compressed Gas for Auto Fuel—Typical Installation 257 145. Typical German Garbage Cans 258 146. Hamburg after the Air Raids in July-August 1943 259 147. Flood Damaged Houses after Destruction of Moehne Dam, May, 1943 261 148. Organization of Food Control in Germany 264 A 149. Nitrogen Production in Greater Germany 267 150. Consumption of Fertilizer Nitrogen 268 151. Location of Grain Warehouses, Bavaria 270 152. Bread—Weekly Allowances 277 153. Fat—Weekly Allowances 278 ILLUSTRATIONS (continued) Figure Page 154. Meat and Meat Products—Weekly Allowances 279 155. Household Sugar—Weekly Allowances 280 156. Naehrmittel—Weekly Allowances 281 157. Food Ration Cards, Periods 65 to 74 282 A 158. Bunker Kitchen Plan 286 159. Calorie Consumption Graph, 55th Ration Period 289 160. Total Bombing Experience and Nutrition (Calories, Protein, Calcium) 290 A 161. Total Bombing Experience and Nutrition (Vitamin A, Thiamin, Riboflavin) 2908 162. Changes in Height and Weight—Elementary School Girls 290 C 163. Changes in Height and Weight—Elementary School Boys 290 D 164. Changes in Height and Weight—High School Girls 290E 165. Changes in Height and Weight—High School Boys 290F 166. Aerial Photograph of Ludwigshafen Marshaling Yards 295 167. Destruction of Knoll Plant 296 168. Sketch pf Damage to Knoll Plant 297 169. Destruction of Knoll Power House 298 170. Inside of Plant Area at Knoll 299 171. Insulin Production at Hoechst 302 172. Air View of Leverkusen, I. G. Farben 304 173. Atabrine Sales; Bayer Div., I. G. Farben 308 174. Plasmochine Sales; Bayer Div., I. G. Farben 309 175. Aspirin Sales; Bayer Div., I. G. Farben 310 176. Pyramidon Sales; Bayer Div., I. G. Farben 311 177. Eleudron Sales; Bayer Div., I. G. Farben 312 178. Sulfapyridine Sales; Bayer Div., I. G. Farben 313 179. Prontosil Sales; Bayer Div., I. G. Farben 314 180. Marfanil Sales; Bayer Div., I. G. Farben 315 181. Neosalvarsan Sales; Bayer Div., I. G. Farben 316 182. Typhus Vaccine Sales; Bayer Div., I. G. Farben 317 183. Diphtheria Serum Sales, Bayer Div., I. G. Farben 318 184. Vigantol Sales; Bayer Div., I. G. Farben 319 185. Betaxin Sales, Bayer Div., I. G. Farben 320 186. Novocaine Sales; Bayer Div., I. G. Farben 321 187. Insulin Sales; Bayer Div., I. G. Farben 322 188. Gardan Sales; Bayer Div., I. G. Farben 323 189. Rivanol Sales; Bayer Div., I. G. Farben 324 190. Kresival Sales; Bayer Div., I. G. Farben 325 191. Panflavin Sales; Bayer Div., I. G. Farben 326 192. Dolantin Sales; Bayer Div., I. G. Farben 326 193. Merck Plant, View of Damage 330 194. Sketch of Damage to Plant; E. Merck, Darmstadt 331 195. Merck Plant, Destruction to Research Laboratories 332 196. Air View of Kaiser Wilhelm Institute at Heidelberg 337 CHAPTER ONE INTRODUCTION MAJOR CORTEZ F. ENLOE. JR.. MEDICAL CORPS, AUS This is a report of the manner in which Allied air attacks on German cities and industries in- fluenced the health of that country. The informa- tion presented and the conclusions arrived at are the result of a health survey in Germany by a group of American scientists in medicine and re- lated subjects during the closing days of the Euro- pean war and for some months thereafter. There was no precedent for accomplishing the task to which we were assigned, for until this mis- sion was undertaken there had never been an evalu- ation of the effects of military operations on an enemy civilian population. This was an investiga- tion of an entirely new order. In the careful check they maintained on the reactions of the people dur- ing the war, the German government had not studied the effects of the strategic air offensive as distinct from the rigors of war as a whole. Simi- larly, the British took few steps in determining the effects of bombing of their own cities, although various individuals in Britain did make semi-official studies of what had happened to the people as a result of the raids by the Luftwaffe. We were, there- fore, working largely in the dark in an attempt to study the health of an enemy population as it was affected by the most potent weapon in total war, the air attack. In this investigation of the American, British, and French occupation zones of Germany we en- countered no evidence of Allied effort to break the health of the German people. Nevertheless, the bombing razed hospitals to the ground and created conditions which interfered with the maintenance of good health. In effect, the average inhabitant of the German cities was placed in the same position as the soldier on the battle field. The events in the air succeeded in greatly lowering the standard of health throughout Germany by destroying facilities for the maintenance of environmental sanitation, by creating the most acute conditions of over- crowding which have been encountered in the western world, by denying civilians hospital care and adequate drugs, and by changing three meals a day from an individual habit to an object of in- dividual ingenuity. This is not a sanitary report. The effects of bomb- ing on the health of a nation cannot be properly assessed within the limited scope of what is gen- erally considered a sanitary report, for sanitation is only one component of the health of a na- tion. Nor is it a compilation of vital statistics, for all the manifestations of bombing are not re- ducible to statistical analysis nor are they immedi- ately apparent in the way in which the destruction of some material object makes itself evident. It is, on the other hand, a study of every facet of Ger- man health, an analysis of the health aspects of the surroundings in which the German people lived, what they ate, how they were cared for medically, and how they were injured and died in the raids. All aspects of bombing cannot be reported here because they are not as yet readily discernible in their entirety. We feel that the effects of bombing of civilian populations are in many ways subtle, long-range effects. They are of such a nature as will largely determine the health of the German people for the coming generation. What can, there- fore, be accurately reported at this time are the changes in the health of the nation which were visible during the period of the field work. As the reader proceeds through this report he will soon understand that one of the greatest prob- lems was in determining just where the ordinary rigors of war ceased in their influence on the health of the German people and where bombing began to make itself evident. This was a harassing difficulty which finally compelled us to conclude that any investigation of the medical aspects of the air war must transcend the scope of what happened after each air raid and must, by the very nature of the problem involved, include many other fac- tors affecting the health of the country as a whole. Indeed it might be said that this became a study of the health of Germany during the war years with particular emphasis upon the manner in which it was influenced by the combined aerial offensive. In order to fortify ourselves with background 1 INTRODUCTION information in the period while waiting for the progress of the American and British armies to make target cities available for the field team, an effort was made to acquaint ourselves with the health problems which had arisen in England. We studied the activities of the medical services by the Ministry of Home Security, made visits to sev- eral emergency hospitals used for the evacuation of expectant mothers, and interviewed many British health authorities. For the information and guid- ance given us in forming our first impression of these problems, we wish to express our appreciation to Professor James Mackintosh of the London School of Hygiene and Tropical Medicine; Dr. Robert D. Gillespie, Psychiatrist at Nuffield House, Guy’s Hospital; Dr. Godhar and Dr. Kelly of the British Ministry of Health; and to Dr. Ripley Oddie, Mr. A. C. Henry, Mr. A. N. Edwards, and Mr. K. G. Gold, all prominent in the British pharmaceutical industry. In March and April of 1945, Lieutenant Colonel Meiling, a medical officer and chief of the Morale Division, was assigned to the Intelligence Task Forces (T-Force) of the Twelfth U. S. Army Group, and Major Enloe to the Intelligence Task Force of the Sixth Army Group. As members of these special units they were able to enter captured Ger- man cities with the initial assault forces under the auspices of Allied military intelligence groups. The material and information secured in these operations were later to prove of great value in the rapid exploitation of the German national health targets. This was found to be the most expe- ditious manner in which to locate civilian and mili- tary medical leaders in the days immediately fol- lowing German capitulation. The location of the authorities with a national picture of German health presented a considerable problem during the period of chaos and extreme apathy following the dissolution of the German government by the Allied powers. The medical group, consisting of four Army Medical Corps officers, a Coast Guard officer, three civilian physicians, two Sanitary Corps officers, one Quartermaster Corps officer, and two enlisted re- search analysts, was assembled for the first time in early May in London. The innumerable delays and complications resulting from travel restric- tions, priorities, military processing and adminis- tration had prevented the earlier arrival of all of this group in the theater of operations. Since we had neither sufficient time nor the per- mission of the Russian authorities to cover all of Germany prior to the deadline set for complet- ing the field work, it was decided to confine our city investigations to selected communities in the western zones of occupation. The localities were chosen from the sample of the Social Sciences Branch of the Morale Division on the basis of rela- tion of severity of bombing to the size of the city. The cities chosen were Stuttgart, Ulm, Augsburg, Munich, Nuremberg, Wurzburg, Karlsruhe, Pforz- heim, Ludwigshafen, Darmstadt, Frankfort, Kassel. Dortmund, Cologne, Essen, Hamm, Hamburg, and Kiel. For statistical data alone Bochum, Bremen, Duisberg, Duesseldorf, Muehlheim, and Solingen were also visited. In surveying the medical and health facilities of any given target area many informal inter- views were conducted with members of the profes- sional and administrative staffs of the various hos- pitals and, as far as they were available, with the former public health officials, police medi- cal inspectors, officials of the local and district medical organizations, and university authorities. Special provisions were made for interviewing ci- vilian and military health authorities and various ministers of the government, both national and state, in whom we were interested. As a rule these personages were found to be in the custody of the Allied occupying forces. Prisons, interrogation centers, bombed-out homes, offices and hospitals are not the most desirable locations for establish- ing mutual professional relationships. Fortunately the language of science is international so it was not always difficult to establish a spirit or atmos- phere of scientific and professional rapport dur- ing the interrogations and interviews. The medical group of the Morale Division possessed a distinct advantage in the very intimate personal knowledge of German medicine possessed by seven of its mem- bers who had at one time or another actually studied at the medical faculties at German and Austrian universities. Statistical data were obtained from official docu- ments and reports, with numerous spot checks be- ing accomplished at local, provincial and state levels. Every effort was made in the time allowed to secure classified medical and health reports and directives at all levels of the German govern- ment which would throw light upon the correlation between bombing and the health of the people bombed. Preliminary information indicated that the 2 INTRODUCTION famed winter sports country of Upper Bavaria had become the air raid shelter of Germany. This was the part of the country to which the women and children, the aged and infirm, in other words, the people whom the Nazis considered ‘'non-essential,’’ had fled to escape the air raids. It was also the hospital area of the German Army. It was believed that a study of such an influx into these rural areas which caused Garmisch to be as packed as a tenement district would provide information on the movement of large population groups which is perhaps one of the most pronounced sequelae of bombing. In order to ascertain the results of this mass migration on the health of the migrants and on the people of the villages to which they went, one phase of the survey included Kempten, Garmisch-Partenkirchen, Weilheim, Schongau, Bad Toelz, Rosenheim, Reichenau and Berchtesgaden. The routine followed in studying the rural evacua- tion areas of alpine Bavaria was the same as that employed in the study of the cities of Germany only on a smaller scale. Examination at the city level and at the evacua- tion areas provides the greater part of the founda- tion for the accounts given in the chapters to fol- low. The remainder was supplied by review of enemy records which we captured and by interroga- tion of officials at every level of the German hier- archy. Lieutenant Colonel Meiling accomplished the greatest share of the ground work in obtaining accounts of the experiences of the offices of the Commissar of Health, Professor Brandt, and of the German military authorities. Members of this branch were responsible for originally locating and capturing the files of the Reichs Commissar of Health, for discovering the hide-out of the secret archives of the German chemical industry, and for conducting the first interrogations of the Director of German Public Health, Dr. Leonardo Conti, and of the discoverer of sulfanilamide, Dr. Gerhard Domagk. Upon request of the counter-intelligence corps of the Twelfth Army Group, two members assisted in interrogations which led to a reconstruc- tion of Hitler’s medical history and the changes in his personality during the last years of the war. This report has been organized along the gen- eral lines of the Appraisal Lorm for Local Health Work, 1938 edition, published by the Committee on Administrative Practices of the American Public Health Association. It was felt, however, that a thorough investigation of the subjects mentioned in this Appraisal Lorm would not result in a com- plete survey such as was directed by the late Presi- dent Roosevelt in his letter to the Secretary of War, September 9, 1944. The President stated that, in his opinion, the survey should include an investigation of “the problems created in moving evacuees from a bombed city, the burden in the community to which the evacuees were moved, the complications caused in transportation, food distribution, medical attention. . . .” Therefore, in addition to the ordi- nary subjects it was decided to include an appraisal of the distribution of medical personnel, the changes in medical education, the fate of industries producing pharmaceuticals, surgical dressings and supplies, and to determine as far as possible the causes of death in air raid casualties. The second chapter is the result of an effort to determine as accurately as possible under the exist- ing circumstances just how many persons died in Germany in the air raids. The manner in which they died, whether through direct physical injury, from carbon monoxide, or through such interest- ing effects as inhalation of air of a temperature exceeding 500° L, has been discussed in Chapter Three. Chapter Lour is not strictly a statistical analysis of communicable diseases; it is this with the addition of the observations of prominent men throughout Germany on the effect of bombing on communicable diseases and other disorders. The other disorders include venereal diseases and con- ditions of a psychogenic nature. Many physicians in Germany and in England called this war, in which the civilian population was subject to attack, a “war of the vegetative neuroses.” It is unfor- tunate for our report that more precise statistical information was not available on the incidence of such afflictions as peptic ulcer and coronary disease. It is certain that if a yardstick had been applied to the frequency with which fear, the disruption of normal routine, and the psychologic upheaval ac- companying the chaos and sorrow and struggle for existence in a city under heavy bombing contrib- uted to the physical breakdown of the German population, we would have an index to one of the most important effects of bombing on a country’s ability to wage war. This is not evident from the discussion of industrial health in Chapter Live, nor is it apparent in the next chapter, number six, which is concerned with vital statistics. The fre- quency of suicides and the ratio of mortality from heart disease, cerebral hemorrhages, and perhaps old age may give only an indication of the role played by psychogenic disorders. 3 INTRODUCTION The medical care provided for the German ci- vilian population during the war is discussed in Chapters Seven, Eight and Nine. They also con- tribute to an understanding of the extent to which bombing influenced the health of the people. The detailed information presented on the hospitals of Germany (Chapter Nine) should prove of value in the future planning for the defense of the civilian population of the United States. The strik- ing contrast, evident in this chapter, between those cities with enough foresight to provide air raid hos- pitals in advance and those that awoke too late to the danger is an excellent example of the value of prior-planning in health protection. Interviews with top political and medical author- ities made it clear that the anticipation of bomb- ing caused Hitler to reorganize completely the top level of German health control and to establish the Office of Reichs Commissar for Health as the final arbiters between the demands of the civilian and the Armed Forces for medical care. This is the substance of Chapter Seven. Chapter Eight re- counts the fate of medical education in Germany during the past five years and describes the extent of the destruction of some of the institutions. This dissertation also emphasizes one of the long range effects of bombing. One of the great problems fac- ing the occupying authorities will be to find a suffi- cient number of German physicians who can keep the health of the country from deteriorating to the point where it becomes a burden and a danger to the Allied nations. The discussion of environmental sanitation in Chapter Ten points perhaps to the most important lessons of all to be learned from this undertak- ing. It makes it easier to understand why there were no epidemics in Germany during this war. When we state that there were no epidemics it is not implied that there were no discernible increases in certain contagious diseases or that they did not reach important proportions in some areas. Diph- theria in adults posed a real problem to the health authorities; typhoid also was encountered in one or two places, but there were no outbreaks of disease of such alarming proportions as might be described as major epidemics. Certainly the destruc- tion of the water and other sanitary facilities and the problems of living in these wilds of rubble created an ideal culture medium for the spread of contagious disease. But this did not occur. Nutrition and food supply are important pillars in the economy of any nation and especially in the economy of a nation at war. How the Germans organized their food distribution, how they ra- tioned their food, and how this system of produc- tion and distribution broke down under the impact of the Allied air attack are described in Chapter Eleven. The question of transportation plays an im- portant role in the discussion of production and distribution of medical supplies as described in Chapter Twelve. It was not possible to visit all of the pharmaceutical plants since some of them lay beyond the area of the jurisdiction of our creden- tials, nor could each of the surgical supply manu- facturing concerns be inspected. Nevertheless, we were fortunate enough to discover and to have for our study the complete files on medical research and drug supply of the Hitler government. From these and from the visits to all the important labor- atories in western Germany we were able to recon- struct a picture of the experience of these organiza- tions during the war. Members of the Medical Branch Team exploited every source of information in the time allowed. e were able to interrogate not only university professors, but also local health authorities and nutrition experts. The opinions of the top men in German public and military life were also sought. As a matter of interest in understanding the sources of information exploited a list of the more im- portant persons, though not all of the individuals interviewed and interrogated, is given in Appendix A. The Appendix also contains Lieutenant Colonel Meiling’s report on some aspects of the health ser- vices of the German Armed Forces which he was requested to make by the Military Effects Division of the Survey. The data on nutrition comprising Appendix C have been included for the reader who wishes to go further into an analysis of that sub- ject. The files containing hundreds of captured documents used as source material for this report may be examined at the War Department. Although attributing a subject to one author, as has been done here, is not a customary procedure in government reports, it was agreed that the na- ture of this document is such that it should con- form to the usual practice followed in medical literature. The fact that an investigator’s name appears above each chapter implies only that he was responsible for assembling data contained in that chapter. There is perhaps no one subject upon which information was not contributed by other members of the team. In fact, in guiding this group through Germany we endeavored to have every 4 INTRODUCTION analyst, excepting those responsible for nutrition and statistics, exploit at one time or another every type of target. The conclusions presented are not the final impressions of only one man but are to be regarded as the conclusions of the entire Medi- cal Branch. We have written the report on the effect of bombing on health and medical care in Germany as free from scientific jargon as possible so that it may accomplish its small part in the large mis- sion of the Strategic Bombing Survey. We believe that what has been set down will aid in understand- ing what happens to the health of a nation when the face of its cities is macerated by bombing. Al- though this is a description of the manner in which a thoroughly regimented nation reacted to air raids, we may learn from it how a democratic society can rise to a similar threat in the future. Others may arrive at conclusions which have escaped our attention. It seems difficult, however, to avoid the one outstanding fact which the study of these data defines, namely, that a people well trained in per- sonal hygiene, who, as one German puts it, know where the dangers to ill health lie, are the strongest bulwark against breakdown of public health when their cities have been destroyed by the enemy. 5 CHAPTER TWO CIVILIAN DEATHS FROM AIR ATTACKS T/4 SCOTT V. HITCHCOCK. MEDICAL DEPARTMENT, AUS LIEUTENANT COLONEL JOHN H. WATKINS. SANITARY CORPS. AUS control were, also, for the most part either anti- nazi or affiliated with the Nazi regime. In order to test the validity of local reports of aerial attacks it became desirable to compare the local information against the known aerial attacks as recorded by the Allied air forces. The city of Duisburg was chosen for this test. Information re- ceived from local authorities in Duisburg was very complete; the city, situated in the industrial Ruhr, was frequently and heavily bombed, and deaths were more numerous than average. The findings of this comparison are shown in the five panels of Figure 2. The top panel, giving the locally reported number of deaths per month from air raids, corresponded extremely well with the second panel showing the number of planes the Allied air forces reported sending against the city each month. Each peak in the number of planes bombing the city was reflected by a corre- sponding peak in the number of deaths reported by the local authorities. The third panel, giving the tons of bombs the air forces dropped, reflected faithfully the number of planes carrying those bombs. The local estimates on the number of bombs dropped are shown in the fourth panel. This followed very closely the air force record of tonnage dropped. The great peaks in the local fig- ures of bombs dropped on the city were caused by the local procedure of recording the number, not tonnage, of falling bombs. Therefore, in a raid where a great number of incendiary bombs, weigh- ing only a few pounds each, were used, the num- ber of bombs may have been great, while the bomb tonnage was low. The bottom panel gives a comparison between the number of attacks as recorded by the local au- thorities and by the air forces. In the main, these correspond. Such differences as do occur are per- haps largely accounted for by dissimilar ideas as to what constituted an attack. A group of bombers following an earlier group, after an elapsed time of an hour or two, might have been called another The most direct effect of bombing on health natu- rally would be the actual number of people killed. Therefore, the value of a complete and accurate recording of all deaths from air raids in German cities was recognized from the beginning of these investigations. The exact number killed by Allied bombs could not be determined and because of loss of records and the utter confusion of de- feat it is unlikely it will ever be known. An esti- mate, therefore is presented which we believe is sufficiently accurate to provide a basis for under- standing the relation between the tonnage of bombs delivered on a city and the number of peo- ple expected to be killed. Only one record of air raid mortality covering all of Germany was discovered by the medical sec- tion. This was a copy of a report by the German Statistical Office, Weimar Branch, which listed deaths due to aerial attacks by city and month, from October, 1940, through the end of 1944. Fig- ure 1 shows graphically the total number of deaths suffered by German civilians as a result of aerial attacks on Germany, as recorded by the German Statistical Office. The official German figures could not be accepted without ascertaining their reliability, not only be- cause of the possibility of deliberate falsification of air raid records, but also because of possible errors in the local system of recording deaths fol- lowing air raids, and in the transmission of those records to the point of central compilation and publication. Even if the report compiled by the German Statistical Office was assumed accurate and prepared in good faith, with no effort to con- ceal casualties, it was evident that it was a prelimi- nary or initial report, unrevised for later additions as more bodies were found under the rubble. It was believed that air raid casualty figures ob- tained from local police and statistical officials would prove reasonably reliable, as any basis for deliberate falsification had ended with the termina- tion of hostilities. Local authorities under Allied 6 Figure 1 TOTAL DEATHS OF CIVILIANS FROM AIR RAIDS ON GERMANY AS REPORTED TO THE GERMAN STATISTICAL OFFICE BY MONTHS. OCT 1940-DEC 1944 and separate attack by the local authorities, while the air force could have regarded it as a continua- tion of the earlier attack, or vice versa. Also, an air raid on an industrial plant or area just outside of a city’s corporate limits may have been called an attack on the city by one group and might not have been so regarded by the other. The two pages comprising Figure 3 illustrate the bombing experience and mortality from air at- tacks on thirteen German cities, by months, from October, 1942, to December, 1944. The air raid deaths were taken both from the German Statistical Office and local estimates, with those figures judged to be more correct for a particular city being used for that city. The monthly total bomb tonnage re- ported by all air forces on each city is represented by solid blocks. The deaths, represented by lines, are not shown as actual numbers but as monthly rates, computed on a monthly basis, per 1,000 population. Figure 3 shows that, in most cases, the death rate rose in proportion to the increase in tons of bombs dropped and to the number of consecutive months in which comparatively heavy raids were carried out. Seldom did a high death rate accom- pany a low bomb tonnage. One notable exception was Augsburg, where during the months of October and November, 1944, the death rates were fairly high although the tonnage of bombs was low. This led to the conclusion that in those two months either air raid shelters or bunkers were hit, or that the information received from the air forces as to the tonnage dropped on Augsburg was in error. Mulheim is shown as having had a considerable number of air raid deaths in April, 1943, and throughout the entire year of 1944, with no record of bombs released upon the city during those pe- riods. Again it appeared that the air raid reports from the air forces were in error, in that they failed to show Mulheim as a target. The region of the Ruhr is so continuously and densely popu- lated that Mulheim might easily have been bombed under the mistaken impression that it was another 7 Figure 2 MONTHLY SUMMARY OF AIR RAID ATTACKS ON DUISBURG COMBINED INFORMATION FROM AIR FORCE AND LOCAL REPORTS NUMBER OF DEATHS - LOCAL REPORTS 2,613 NUMBER OF PLANES -AIR FORCE RF PORTS TONNAGE OF BOMBS DROPPED "AIR FORCE REPORTS NUMBER OF BOMBS DROPPED - LOCAL REPORTS NUMBER OF ATTACKS 8 Figure 3 THE BOMBING EXPERIENCE AND MORTALITY FROM AIR ATTACKS ON THIRTEEN GERMAN CITIES MONTHLY DEATHS PER 1,000 POPULATION , MONTHLY BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES AUGSBURG BOCHUM NUMBER OF DEATHS PER 1,000 POPULATION BREMEM BOMB TONNAGE REPORTED DROPPED ON CITY COLOGNE DORTMUND DUISBURG DUSSELDORF Figure 3 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM AIR ATTACKS ON THIRTEEN GERMAN CITIES (CONTINUED) HAMBURG KIEL NUMBER OF DEATHS PER 1,000 POPULATION BOMB TONNAGE REPORTED DROPPED ON Cm MAGDEBURG MUL HEIM NUREMBERG SOLINGEN 10 CIVILIAN DEATHS FROM AIR ATTACKS city, with the latter city having been reported as the target of the attack. Cologne was an example of the manner in which the city procedure and governmental sys- tem frequently became inoperative under the ter- rific destruction and confusion of great aerial at- tacks. In October, 1944, a total of nearly 20.000 tons of bombs was released upon the city. Yet no deaths are shown for that month. Either records were destroyed or the city governmental machin- ery was unable to cope with such an onslaught and no records were kept of the great number of deaths occurring. A recording system had not as yet become operative two months later for, though bombings also occurred in the subsequent months of November and December, still no deaths were reported. Some cities, notably Hamburg and Kiel, ap- peared to have been taught safeguards and preven- tive measures from previous bombing attacks. In these two cities the death rate, in proportion to the tons of bombs dropped, appeared to decline in 1944. Conversely, Sol ingen seemed to have learned nothing from the bombing experience of its neigh- boring cities in the Ruhr. After escaping virtually unscathed prior to that time, comparatively moder- ate aerial attacks in November, 1944, caused one of the highest monthly death rates, per 1,000 popu- lation, suffered by any German city as shown in Figure 3. There were three months—August, 1943, March, 1944, and October, 1944—in which Nuremberg underwent raids of almost equal intensity. In the first and last of these the death rates were fairly high and almost identical. In the raid of March, 1944, the death rate was very low, being only about one-ninth as great as the other two. The most reasonable explanation of this appeared to lie in the location of the target area. Raids on targets located in urban or thickly populated areas naturally took a much greater toll of human life than did raids on railroad marshaling yards or factories situated in outlying or rural areas. Field teams of the Medical Branch were unable to secure complete figures on deaths from aerial at- tacks on all of the German cities visited. However, the figures obtained in certain cities were suffi- cient to form a basis of comparison with those from the German Statistical Office. From this com- parison, it was determined that the air raid deaths as given by the statistical office were reasonably accurate for the years 1940 through 1943, with one exception. This exception was the city of Ham- burg, for which the statistical office listed 34,324 dead from aerial attacks in July, 1943, the month of the great Allied attack on that city. All Ham- burg city officials and health authorities, inter- viewed in June, 1945, placed deaths in July, 1943, at a much greater number, their estimate ranging from 46,000 recovered dead with 10,000-12,000 bodies still under the rubble, to the total figure of 60,000 dead. These were not impromptu guesses by incompetent observers, but the reasoned analysis of officials best qualified to be familiar with the true picture. It was, therefore, deemed reasonable to add the figure of 20.000 additional dead in Hamburg for July, 1943, to the total as stated by the statistical office. With that addition, the air raid deaths ac- cepted from the statistical office were as follows: 1940 349 1941 2,785 1942 4,327 1943 103,271 1940-1943 110,732 The air raid deaths given by the statistical office for 1944 appeared to be low in respect to the great tonnage of bombs dropped on German cities in that year. Upon comparison with the known locally secured air raid deaths from several cities in 1944 a wide discrepancy with the statistical office listing was noted, not only in the monthly figures follow- ing very heavy raids, but also in the deaths given for those cities for the entire year. Therefore, some method of estimating deaths from aerial attacks during 1944 and 1945 had to be devised. Any method of estimation employed would have been, by its very nature, highly inaccurate and subject to criticism. Death from bombing attacks on cities followed no set pattern. The difficulty of estimating deaths by the tonnage of bombs dropped is illustrated by figures taken from the bombing experience of the city of Nuremberg. In March, 1944, 2,047 tons of bombs were released over the city with 60 casualties. Yet in November, 1944, 98 persons were killed as the result of raids total- ing only 190 tons. In Mulheim, during the months of October and November, 1944, 175 deaths re- sulted from a total of 17 tons of bombs, while in the other ten months of the year the local author- ities attributed 271 deaths to aerial attacks, al- though Allied air forces recorded no bombing at- tacks upon Mulheim during those ten months. However, in spite of the known weaknesses in 11 CIVILIAN DEATHS FROM AIR ATTACKS this manner of determining deaths, it was decided to base the deaths upon the tonnage of bombs dropped to arrive at the estimated air raid casual- ties for 1944 and 1945. The cities for which local air raid deaths were available were representative German cities and many of the great differences found in any one city were eliminated by compen- sating differences found in another. Any other type of estimation seemed to be even more inaccurate with less basis for justification of its use, than did the method determined upon. As it was believed that deaths from a given ton- nage of bombs were not consistent for all cities but varied with the size of the city, the following city population groups were established: 0-99,999, 100,- 000-249,999, 250,000-399,999, 400,000-499,999, and 500.000 and over. From the tabulation of air attacks on Europe, by city and date, by the Bth and 15th Army Air Forces and the Royal Air Force, a listing was made of the tons of bombs dropped in 1944 and in 1945 on individual German cities. These city totals were then added by population groups, giv- ing the total tonnage dropped in each year on each group of cities. There were thirteen cities for which the medical section had secured local records of air raid deaths, and at least two of these thirteen cities fell in each of the five population groups. From these local air raid death figures and from the bomb tonnage on these same cities the ratio between tons of bombs dropped and deaths resulting therefrom were established for each of the years 1944 and 1945, and for each of the population groups. The total bomb tonnage dropped upon each pop- ulation group was multiplied by the ratio (i.e., deaths per ton) for that group, giving the deaths in each group for each year. Adding the population groups for each year, the highly speculative re- sults of 201,000 deaths from air attacks in 1944 and 110.000 deaths from January 1, 1945, to the cessa- tion of hostilities were obtained. To these may be added the figure of 111,000 deaths during the years 1940-1943, to give a pre- liminary calculated estimate of 422,000 deaths in Germany from aerial attacks during the course of the war. To this other totals must, however, be added. All air raid death figures taken from the Ger- man Statistical Office, and those local figures upon which the estimates for 1944 and 1945 were based, were for the resident civilian German population only A true picture of the actual number killed by bombing should have included, in addition to the figure given above, foreigners, Jews, slave la- borers, displaced persons, members of the Wehr- macht and security police, and prisoners of war, all of whom were excluded from the figures given. These additions would have increased the estimate of 422,000 deaths to a considerably higher figure. The only deaths considered, including those upon which the above estimates were based, were re- corded deaths. If bodies were recovered and burial made without a certificate of death being signed and recorded those deaths were not included in the figures prepared by the local authorities. This undoubtedly was frequently the case in the latter part of 1944 and in 1945 when the great raids wiped out not only the city records, but tempo- rarily forced to a halt the normal functions of the city government. In addition, no estimate could be made of the great number of persons classed as missing. These figures were not secured from the local authorities, but it was known that in many cities great numbers of bodies were still under the debris. Local authorities in those cities which suffered great raids in the last eight to ten months of the war estimated that unrecovered, and there- fore, unrecorded, bodies easily totaled 25 per cent or more of the recovered and recorded deaths. From discussion with local authorities and after viewing the debris and rubble comprising the sole remains of great sections of many German cities, it was the opinion of the Medical Branch investi- gators and field team members that the figure of 25 per cent was very conservative. If so considered, the estimate of 77,750 missing in the years 1944 and 1945 would have given a total estimate of 499,- 750 German civilians killed by Allied air raids. This large number of missing persons was indica- tive of the utter chaos that prevailed in most Ger- man cities following the great aerial attacks. It is interesting to note that Professor Brandt, the Reichs Commissar for Health, when interrogated in an Allied prison camp in June, 1945, by a member of our team, stated that the Propaganda Ministry had estimated that 535.000 deaths had occurred from air raids. This estimate is inclusive of for- eigners, Jews, slave labor, police and members of the armed forces on leave. Weight is lent to the validity of our figures by these official estimates presented by Brandt, which did not come to our at- tention until after the completion of our own com- putations. 12 CIVILIAN DEATHS FROM AIR ATTACKS Summary No complete and accurate figures on German civilian air raid casualties, covering the entire pe- riod of the war, were available. Local reports of recorded deaths from aerial attacks were secured from a number of cities and proved to be compara- tively accurate. The report of the German Statis- tical Office, listing deaths by cities, was obtained and found to be generally correct for the years 1940 through 1943. Estimates of air raid deaths for 1944 and 1945 were prepared based upon the known tonnage of bombs dropped and the known locally recorded deaths per ton for sample cities graded by population size. The result yielded an estimated total of 422,000 deaths. It was further estimated that an additional number, approximat- ing 25 per cent of the known deaths in 1944 and 1945, were still unrecovered and unrecorded. With the addition of this estimate of 1944 and 1945 un- recorded deaths, the final estimation gave in round numbers a half million German civilians killed by Allied aerial attacks from the beginning of heavy bombing to the end of the European war. 13 CHAPTER THREE THE NATURE OF AIR RAID CASUALTIES CAPTAIN FRANZ K. BAUER. MEDICAL CORPS. AUS Until 1943 the only reports available to Ger- man governmental agencies on the causes of death came from police and medical inspectors in the health services of the bombed cities. Very few post- mortem examinations were performed in the early years of the war because all victims were taken to cemeteries where they were identified and buried as fast as feasible. The problem of the cause of death was apparently not considered of sufficient import- ance or magnitude to warrant special measures. Without well-laid plans and organization careful pathologic examinations of the bodies was extreme- ly difficult. Oftimes water and light failed. Also, the lack of any uniform system no doubt inhibited the personal initiative of the doctors entrusted with the establishment of accurate diagnoses, who as individuals were furthermore affected by the bombings of their home towns. Thus very soon such diagnoses as “anoxia,” “carbon dioxide poi- soning,” “tearing of the lungs,” and “asphyxiation" were made and, as fast-spreading rumors, assumed alarming proportions in not only the population at large but also among the medical profession.1 Despite these rumors it soon became apparent to leading pathologists that the air war was causing death in several different manners new to medi- cine. As the bombings became more intensive it was realized that only through systematic studies of the victims could more accurate knowledge of the causes of death be gained. Correct diagnoses and some attempt at collecting accurate statistics on the causes of death were not only of the utmost importance to medical science, but also had a prac- tical value in the problem of compensation for vic- tims without external injuries. In 1943 several important measures were taken to ensure correct diagnosis of persons killed in aerial bombings. First, the Reichs Ministry of the Interior ordered that all persons in whom the causes of death were not clear-cut were to be sub- jected to autopsy before an interment permit could be issued to the relatives. Second, the Luftgau (air district) physicians of the Luftwaffe were to ap- point and supervise commissions for the study of the causes of death in air raids, particularly for the clarification of hitherto unknown or unsus- pected causes of death. These commissions—or “examining troops,” as they were called—con- sisted of at least three members: a pathologist, a sanitary or industrial hygienist, and a medico- legal expert. These commissions could be tem- porarily augmented by all types of specialists, such as ophthalmologists, internists, toxicologists, surgeons, and, in fact, by any type of medical spe- cialist the permanent board might deem necessary for the solution of a particular problem. The ad- vantages of such a mixed commission over one consisting of police and health officers of one given community are obvious. The mixed commission was recruited from several cities in the respective Luftgau, and was to bring its work into the affected area from the outside without being personally affected by the catastrophe, according to a talk by Professor Rose, chief consultant in hygiene for the Air Ministry. The duties of the commissions were to clarify the causes of death by postmortem exam- inations, to study carefully the circumstances under which death or injury was produced, and to study the injured and uninjured survivors by fol- low-up visits to the hospitals and by eyewitness accounts. Professor Buechner, consultant to the Luftwaffe, estimates that from 20.000 to 30.000 autopsies were performed on air raid victims dur- ing the entire war. The central collection of reports was kept at the Institute of Aviation Medicine in Berlin and was, therefore, not available for inspection by the Med- ical Branch. The reports of the findings of these commissions were forwarded to the Air Ministry, where they were consolidated and published. The first of these reports2 was issued on October 30, 1944, and the second and last3 on January 24, 1945. In March, 1944, the Air Ministry issued seyeral pamphlets describing medical experiences in air raids but these, like the consolidated Luftgau re- ports, were not given to the public or the press. They were sent only to “cleared" medical authori- ties and to institutions. 14 THE NATURE OF AIR RAID CASUALTIES Before the establishment of the commissions a meeting was called by the inspector of sanitary and medical matters of the Luftwaffe to discuss the effects of the great incendiary raids on Ham- burg in July and August of 1943. The meeting took place in Jueterbog in December, 1943, and was attended by pathologists, medicolegal experts, pharmacologists, and physiologists, all of whom had had extensive experience with this problem. They concluded that the most prominent causes of death1 studied at the time were: (1). Causes of death from external injury: (a) Burial under rubble and debris and injury from flying fragments. (b) Secondary injuries through explosions (drowning, scalding, chemical burns, poisoning from by-products of ex- ploded bombs). (c) Burns. (d) Tetanus secondary to burns where no serum was given prophylactically. (2). Causes of death from internal injury: (a) Carbon monoxide poisoning in air raid shelters and occurring during res- cue work. (b) Effect of heat through conduction and radiation in the presence of very high temperatures. (c) Overheating over a prolonged period of time through temperatures which, normally, can be tolerated for short periods only. (d) Dust inhalation; blocking of the up- per respiratory passages and inhala- tion with damage to the small bronchi and alveoli. (e) Carbon monoxide poisoning from bursting gas mains (see also 1-b). (f) Sudden heart death through fright and exhaustion in cardiac patients. (g) Blast injuries in which external in- Figure 4. Typical scene in Hamburg after incendiary raid. Notice large amount of rubble and fires one week after the raid. Possibility of escape very slim. 15 THE NATURE OF AIR RAID CASUALTIES juries may be absent or which may be masked by external injuries. Several theories were refuted as being scientifi- cally unsound or unproven. The majority of au- thorities present at this conference expressed the belief that deaths from anoxia, from carbon diox- ide poisoning, from “gas poisoning” (i.e., “phos- phorus gas”), or from high-frequency air waves subsequent to explosions, had not been substan- tiated. The report of this conference stated that a satis- factory schematization was not always feasible in catastrophies of such magnitude as that which had occurred in Hamburg because several types of damage could occur in one individual at the same time. It also warned against taking reports from various cities too literally. For example, one city reported 20 per cent of all deaths in one air raid as unsolved, whereas a city nearby, hit in the same raid, reported only 1 per cent as unsolved. The reasons for such discrepancies were thought to be a lack of thorough examinations and the placing of too much reliance by the medical examiners on police reports. Up to September, 1943, 277 autopsies had been performed on air raid victims and had been studied extensively by examining commissions assigned to this project. The cases were chosen at random throughout Germany regardless of the types of bombs dropped. The effects of bomb fragments, of carbon monoxide poisoning, of heat, and of pre- existing organic disease (mainly cardiovascular) combined with the excitement and exertion were listed as etiologic factors in these air raid victims. The Hamburg raids in July and August, 1943, Figure 6. Man who succumbed from effects of high temper- ature in the street ivhile running to safety. Clothes were in- cinerated while shoes are intact. Position suggests effort to raise himself and keep going. provided a wealth of information and took first place in the attention of all German scientists work- ing on the subject of the causes of air raid deaths. They were the most carefully studied. The raids dominated the picture which existed at that time on the effects of bombings. A whole new field of medicolegal literature was opened and new terms coined. In the course of the air war, the causes of death were more and more differentiated. In The Medical Experiences of Air Raids4 of March 27, 1944, it was stated that besides mechanical injuries only heat and carbon monoxide poisoning were of sta- tistical importance, and that in large-scale fires, deaths resulting from heat and carbon monoxide poisoning can outnumber those from mechanical causes. Mechanical causes After studies and reports from other German cities became available it was evident that mechan- ical causes of death headed the list, as had been ex- pected. Direct hits by bombs and the action of bomb fragments, burial under rubble, and burns, all associated with shock, were the main causes of death of air raid victims throughout Germany. After the first excitement had quieted down and postmortem examinations were carried out more Figure 5. Occupant of air raid shelter found several days after raid. Death apparently came without struggle. 16 THE NATURE OF AIR RAID CASUALTIES various degrees, and when freed looked and felt well for hours or days. Then suddenly he went into clinical shock with low blood pressure and a rapid shallow pulse. The urinary output was dim- inished, and albumen and cylinders appeared in the urine. The patient died in anuria. Toxic sub- stances liberated from the damaged tissues were thought to be the cause for this syndrome. Other authors claimed that increased capillary permeabil- ity in the damaged tissues, leading to a decrease of the circulating blood volume, was the cause of this syndrome. Severe contusions with the typical decompres- sion shock syndrome occurred in practically all bombed cities. From estimates of the Luftgau phy- sicians, it can be stated that the mortality rate for this condition was about 90 per cent. The remain- der recovered without permanent damage. Kidney function returned to normal in a surprisingly short period of time. Dr. Karl Scriba, pathologist in Hamburg, published reports of 3 and saw 50 of these cases. All died despite vigorous measures, in- Figure 7. Example of a victim of heat. Position of hair shows clearly splitting and retraction of skin of skull and around orbits. Clothing practically intact. regularly, it was found that many persons without external injuries had died of internal hemorrhages, skull fractures, and fat embolisms. Injuries due to mechanical causes, fractures, dislocations, sprains, and contusions, were listed as typical of air raids. This proves that there is little reason to believe that air raid injuries to civilians are any different from those encountered in ordinary war medicine. As shown by the handing of the responsibility for this work to the Luftwaffe medical services, it is a problem requiring all the emergency equipment, organization, and supply facilities necessary on the battlefield. This is described in detail in the report of the Civilian Defense Division of the United States Strategic Bombing Survey. In the circumstances prevailing, shock must have played a tremendous role; just how much could not be stated. Rose quoted statistics from one hos- pital which gave shock as a cause of death in 12.6 per cent of all patients hospitalized from bombed areas. One aspect of delayed shock was described as “decompression shock” (Entlastungshollaps), It was observed in persons who had been freed from rubble under which they had been buried any- where from several minutes to many hours. A typ- ical victim suffered contusions of muscle tissue of Figure 8. Effect of dry heat in a group of occupants of an air raid shelter. Splitting of skin, scalp and around orbits. Clothing practically intact. 17 THE NATURE OF AIR RAID CASUALTIES eluding the liberal administration of whole blood, plasma, and vasoconstrictor drugs. All were feel- ing well and conscious when liberated from the rubble. Pathologic changes consisted of necroses in the damaged muscle tissue and the histologic picture of a myoglobin nephrosis with numerous myoglobin cylinders in the kidney tubules. Whether the cylinders were hemoglobin or myo- globin could not be ascertained. The whole symp- tom complex had been described in the war of 1914-1918 and the Tokyo earthquake of 1923.5 The treatments for fractures, dislocations, sprains, and contusions did not differ from the uni- versally accepted treatments for such conditions. Air raid first-aid posts were not set up to admin- ister anti-shock treatment except in occasional cases when Periston, a synthetic blood substitute produced as a by-product in the manufacture of butadiene, was given. There were no facilities for whole blood transfusions in any of the medical installations except hospitals, and plasma was used very little in Germany. Conjunctivitis resulting from dust and rubble particles occurred frequently and was treated with 1 per cent ammonium tartrate and boric acid. Per- forations of the eye happened relatively frequent- ly; if from metal fragments the victim was usually killed at the same time. Other causes were particles of glass, wood, and brick. Figure 10. Specimen of brain and lungs of a heat death vic- tim. Organs dry and hard. Note scale in centimeters. type of death or injury to be expected. An incen- diary attack, through the effects of heat (and car- bon monoxide), would cause more dead than wounded, whereas in high-explosive raids mechan- ical injuries would outnumber deaths.5 The crowd- ed conditions of a city, the height of apartment houses, the age of the dwellings—all these are contributory factors (Figure 4) towards the spread of fire and the outbreak of a panic. There is a dif- ference between peacetime fires and fires subse- quent to air raids but the difference is only quan- titative. Thus, 16.000 buildings were aflame at the same time in Hamburg in July, 1943. Furthermore, people rarely seek refuge in the basement if their house is on fire in peacetime. The effects of heat were classified as: (1) The effect of direct heat of short duration through conduction or radiation with production of burns proper. (2) The effect of high temperatures over long periods of time which did not immediately lead to protein coagulation but which caused a syndrome identical with that of heat stroke. Heat It can be stated that there is a definite relation- ship between the type of bomb dropped and the Figure 9. Specimen of lungs and heart in a case of heat death. Organs shrunk to a fraction of their normal size. Hard consistency. 18 THE NATURE OF AIR RAID CASUALTIES Figure 11. Another victim found in the streets of Hamburg after the incendiary raid of July 27/28, 1943; effect of heat. Note absence of clothing and presence of shoes. Figure 12. Victim of heat found lying on his stomach, rolled over on his back to show intact skin on chest and abdomen. Genitalia greatly swollen. Note extensive carbonization. The time at which injury from heat occurs varies with several factors such as the humidity of the air, the cessation of sweat production, and the amount of heat to which the body has been ex- posed. In humid air, heat stroke may occur at a temperature of 60° C. and does not need to be associated with subjective complaints. This ac- counts for the many bodies which were found dead in rooms from which escape would have been pos- sible, and which were in a position not suggestive of agony before death occurred (see Figure 5). Police engineers in Hamburg estimated that tem- peratures in the burning city blocks went as high as 800° C. (1472° F.). Literally hundreds of peo- ple were seen leaving shelters after the heat be- came intense. They ran across the street and were seen to collapse very slowly like people who were utterly exhausted. They could not get up (Dr. Hel- muth Baniecki of Hamburg). Many thus killed were found to be naked (Figure 6). Two explana- tions have been offered for this phenomenon: that flames spurted across the street with the speed of a tornado and consumed the victims’ clothing, singe- ing their skin, or that the intense heat made the clothes dissolve without actual fire. The shoes were usually the only covering left on the bodies. Most of these people were not burnt to ashes when recovered, but dry and shrunken, resembling mummies. In many the intense heat had caused the skin to burst and retract over typical areas such as the elbow, the knee, the scalp, and the orbit (Figures 7 and 8). Baniecki thought that the cause of death in these cases was shock. In approximately 80 autopsies he found all organs shrunken (Figures 9 and 10), showing venous stasis, with increased permeability of the small blood vessels. Damage to the chromatin in practically all the cells of the ab- dominal organs and the lungs also was seen, which this investigator attributed to the inhalation of superheated air. However, it has not been admitted that inhalation of superheated air was the actual cause of death. In The Medical Experiences of Air Raids5 of October 22, 1944, Professor Rose, chief consultant in hygiene to the Air Ministry, summarized the effects of heat. Besides immediate contact with flames, he wrote, the effect of heat through hot air as well as radiation of hot gases and from objects is of great importance. The main factor seems to be radiation. It is primarily the poorly clothed skin which is affected, whereby it and the sub- cutaneous tissues are damaged. This accounts for the severe heat changes in women who do not wear more than stockings on their legs or not even stock- ings. In many cases, when stockings were worn, they were not even singed although the skin and underlying structures were severely damaged. Radi- 19 THE NATURE OF AIR RAID CASUALTIES ation heat of over 225° C. can inflame clothes and air. Besides this local effect of heat, overburdening of the heat-regulating mechanisms of the body is important. This is brought about by a hindrance of the heat exchange between the body and the at- mosphere. Thus many air raid shelters which had been closed off by rubble produced an atmosphere intolerable to the occupants. Heat damage was seen in members of rescue squads who entered base- ments and air raid shelters where proper ventila- tion had not been available for some time but the disturbances encountered were insignificant. Some of these rescue workers complained of vertigo, drowsiness, and headaches which lasted a day or so. During escape from overheated shelters through burning city blocks, the danger was chiefly from radiated heat. The inhalation of hot air can cause severe damage to the respiratory passages such as ulcerous necroses of the mucous membranes. Whether this is a separate entity or the changes a part of a whole picture which lead to death is as yet unsolved. It should be kept in mind that the inhalation of dangerous gases or by-products of fires must be considered. The actual street temperatures in large-scale fires could only be estimated. The degree of tempera- tures produced in incendiary raids gave rise to a question from the office of Professor Karl Brandt, commissar for sanitary and health matters for Germany. Professor Schuetz, a physiologist of Muenster,0 answered from the Institute of Aviation Medicine: The question concerned is the effect on the human body of overheating to 41° C. (106° F.) for eight hours. The answer is: in the tissues in- creased temperature up to 50° C. is followed by death of all cells with subsequent vacuolization; higher temperatures are followed by shrinking and falling apart of the cells. According to Ludwig Aschoff, human cells die at 50° C., vesicles form in the tissues at 51° C., and hemolysis occurs at 60° C. Ganglionic cells are destroyed at 43° C. Animals die exposed to temperatures of from 60° to 100° C. in overheated rooms, usually in convul- sion, after a few minutes to half an hour. Professor Graeff, consulting pathologist to the Wehrhreis X (military defense area), in Hamburg, gave a very vivid description of the air raids on the night of July 27-28, 1943.7’8,9 The crowded conditions in a city of the size of Hamburg with its few parks and large squares, the height of the apartment houses, and the age of the dwellings are all contributory factors to the magnitude of the catastrophe. Soon after the sirens had sounded—a little before midnight on a clear night—the first bombs dropped. The warning was adequate for everyone to go to his shelter or bunker, and thereby evacuate the streets. High explosives and “air mines’’ destroyed houses, creating craters in streets and courtyards, ruining lighting and the power supply not only in the city at large but also in the individual blocks, and opening the gas and water mains (no gas escaped from the gas mains). In several bomb craters water accumulated from burst water mains ran into shelters and basements and thereby caused a great nuisance. At the same time incendiary bombs started fires which spread particularly in thickly inhabited parts of town in a very short period of time. Thus in several min- utes whole blocks were on fire and streets made impassable by flames. The heat increased rapidly and produced a wind which soon was of the power and strength of a typhoon. This typhoon first moved into the direction of the fires, later spreading in all directions. In the public squares and parks it broke trees, and burning branches shot through the air. Trees of all sizes were uprooted. The “fire- storm" broke down doors of houses and later the flames crept into the doorways and corridors. The “firestorm" looked like a blizzard of red snow- flakes. More scientifically, firestorm is a mass of fresh air which breaks into burning areas to re- place the superheated rising air. Figure 13. Body of a young woman; heat death. Induration of skin and underlying tissues. 20 THE NATURE OF AIR RAID CASUALTIES Figure 14. Shelter occupant. Advanced state of cremation by dry heat. Figure 15. Another shelter occupant. Almost completely charred body. The heat turned whole city blocks into a flaming hell. Those who were still in the streets or for some reason had to leave their homes crowded into a high bunker (a concrete tower shelter) or into a sub- terranean air raid shelter. Thus the number of peo- ple in shelters was doubled and tripled over the number considered safe. The first serious danger in houses which had not been hit and had withstood explosions nearby be- came apparent when the lights went out, the water stopped running, and cracks formed in the walls. Air raid wardens on the roofs were threatened by the “firestorm" and crumbling roofs. In many cases, windows and exits from shelters were blocked by rubble and thus the shelters were safe against fire. As the temperatures increased in the streets from the spread of large-scale fires many of the occupants of the air raid shelters realized the pre- cariousness of the situation, yet very few tried to escape into areas not endangered by fire. In the course of hours the air in the shelters became in- creasingly worse. Matches or candles did not burn. People lay on the floors because the air was better there and they could breathe easier. Some vomited and became incontinent. Some became Figure 16. Another example of a shelter occupant in ad- vanced state of charring. 21 THE NATURE OF AIR RAID CASUALTIES tired and quiet and went to sleep. In some shelters oxygen cylinders were available and produced better breathing conditions for at least a short period of time. Wherever the ventilators were still working they brought in hot smoky air instead of cool fresh air, so that they had to be turned off. Filters, when available, proved insufficient to keep out smoke. The apparent safety of many shelters and basements closed in by rubble was only tem- porary as the approaching fire increased heat and smoke. In others, detonations and explosions near- by increased the pressure downward and directed the storm against the basements. Thus the picture changed from hour to hour. Whoever was still able to make his own decision had one of two alternatives; to stay or escape. Many looked into the streets, saw that everything was on fire, decided they could not get through, and withdrew into the corners of the shelters. Some tried to get out of the burning areas, and for them it was a race with death among explosions, fire bombs, machine guns, and falling flak. Besides all this, flames spurted through the streets and the wind caught up with many and threw them to the ground. There were screams from victims all around. No eyewitness mentioned screams with pain. Many people were caught in the fire. Many stated that the air “just didn’t come anymore” and breathing became very difficult. Otherwise they did not feel anything, and the rest went on over those who had fallen. One man was observed to fall. He was about to pull himself up with his hands when flames were seen to envelop his back and he burned within five minutes without chang- ing his position. The dead usually lay with their faces toward the ground. Many were lying in rows. Only a very few who had fallen got up by their own effort or with the help of others and reached safety in the areas which had not been hit. Some found safety in the bottom of a bomb crater; others found death by drowning in other water-filled craters. Every possibility of escaping the “firestorm” be- hind rubble or remaining walls or corners was kept in mind. This was evident by the number of corpses found behind these ledges and corners. The same was true in open spaces where many sought safety behind tree stumps and parked cars. The only safe refuge in all this time was the water of the canals and the port. Most of those who got there were entirely exhausted. Fips, mouth and throat were dry. They were blistered on the nose and ears, on the hands and face, and their eyes burned with pain and could hardly be opened after having been exposed to so much smoke. Many collapsed, then lost consciousness and died. Many jumped into the water. Even here the heat was hardly bearable. They took blankets and handker- chiefs, soaked them in the water, and then protected their heads and the uncovered parts of their bodies with the wet cloths. But the water evaporated so quickly that this procedure had to be repeated every few minutes. It is striking that thirst was not a generalized symptom. Some victims could not take enough water, yet some who were in utmost danger of heat death denied a feeling of thirst. They did not seek water, although water was available, nor did they report that they sweated more than normally. Others, however, took off their sweat-soaked clothes as soon as they had reached areas safe from fire and excessive heat. Only a few generalizations could be made from the remarks of those who came to safety. In the first hours after they had successfully escaped, some complained of headaches and slight drowsi- ness. The desire for sleep was present in all and sleep very deep. After awakening there were no sequelae. In the meantime the burned-out houses caved in. The rubble and debris on the streets prevented many from escaping. The heat decreased slowly, but the main danger was past. Many of the bodies were lying in the streets half clothed or nude. The only covering that they always had on were their shoes (Figure II). The victims’ hair was often burned, but frequently preserved. A few hours after the start of the raid the corpses had a peculiar aspect; they seemed blown up, lying on their stomachs. The buttocks were enlarged and the male sex organs were swollen to the size of a child’s head (Figure 12). Occasionally the skin was broken and indurated in many places (Figure 13) and in the majority of cases was of a waxen color. The face was pale. This picture lasted only a few hours; after this time the bodies shrunk to small objects with hard brownish black skin and charring of different parts and frequently to ashes and com- plete disappearance (Figures 14, 15 and 16). At the same time fate had caught up with many of those in the shelters and the basements. In houses which had caved in through the effect of high ex- plosives or fires, the bodies were found covered with rubble. The air raid tower shelters and also 22 THE NATURE OF AIR RAID CASUALTIES the larger number of the subterranean shelters with- stood the explosions and fire. There was no doubt that in many a shelter, death had come to the oc- cupants without any one ever suspecting it. Several persons were sometimes found sitting or lying in the most natural position (Figure 17) ; others were sitting in groups as if talking to each other and some had slipped to the floor from chairs or found lying in a thick greasy black mass which was without a doubt melted fat tissue. The fat coagulated on the floors as the temperature de- creased. The head hair as a rule was unchanged or only slightly singed. The bodies were not bloated except for a few which were found floating in water which had seeped into the shelters from broken mains. All were shrunken so that the clothes appeared to be too large. Those bodies were called (“incendiary-bomb-shrunken bodies”) Bomben- brandschrumpfleichen. They were not always in one piece. Sleeves and trouser legs were frequently burned off and with them the limbs were burned to the bones. Frequently such bodies burned to a crisp weeks after death—apparently after oxygen had become available. In the same rooms with such bodies were found other more or less pre- served or shrunken corpses and also some which had fallen to ashes and could hardly be recognized. Many basements contained only bits of ashes and in these cases the number of casualties could only be estimated. Burns were seen in the living, as was to be ex- pected. Surprising to the Germans was the great increase in tetanus secondary to burns. Figures were not published or available at the time of the Medi- cal Branch survey but the problem was of sufficient Figure 17. Another view of victim shown in Figure 5. benches (Figure 18). The appearance of defense or escape movements could not be explained other than as death without premonition. In many shel- ters, however, bodies were found in a heap in front of the exit so that it must be concluded that escape was sometimes attempted. Many such public air raid shelters and base- ments were examined from about the eleventh day up to several months after the raid. Immediately following the raids the air was sometimes moist, seldom dry. At later dates, normal temperatures were prevalent. In most cases, the air was hot or warm and in some shelters even after weeks the heat was intolerable and breathing most difficult. As a rule, there was a strong, often nauseating odor of characteristic quality. The typical disagree- able odor of putrefied animal tissue was stronger than the odor of burnt flesh and fat. This typical odor helped experienced men to direct rescue work toward buried or hidden corpses. The odor in- creased in the course of weeks and was absent in shelters where only ashes were found. In the shelters bodies assumed various aspects corresponding to the circumstances under which death had set in. Nowhere were bodies found naked or without clothing as they were in the streets. The clothes, however, often showed burned-out holes which exposed the skin. Bodies were frequently Figure 18. Scene confronting rescue workers shown enter- ing air raid shelter some time after a raid. Victims succumbed to carbon monoxide. magnitude to warrant a directive from Professor Rostock to administer tetanus antitoxin to every case of burns. The fact that many burned victims were buried under caved-in houses and could not be evacuated to medical installations where they might have received tetanus antitoxin allowed for the optimum conditions for the development of 23 THE NATURE OF AIR RAID CASUALTIES tetanus. Tetanus immunizations were not given to the population at large. The treatment of burns varied throughout Ger- many. New drugs containing tannic acid deriva- tives,10 massive sterile pressure dressings, and ex- tensive debridement were all widely employed but without a definite over-all plan for the evaluation of the best method of treatment. No mention was made of injury from heat other than burns proper and without causing death. In personal interviews, opinions were expressed that all people in whom the previously described heat effect was found were dead, and that, therefore, the conclusion could be drawn that these changes had taken place dur- ing or after death. Blood substitutes were not used nearly as extensively as they are in the United States, and, in fact, the subject of the value of blood substitutes in the treatment of burns was to be worked out under sponsorship of the German National Research Council. Conjunctivitis as a result of smoke and radiated heat often occurred. No permanent after effects were observed and the standard treatment through- out Germany was a nursing treatment-—flushing the conjunctival sac with boric acid solution. In severe cases Biseptol Compositum (trade name of an oint- ment) was administered by physicians. A pamphlet was distributed to Luftgau physi- cians concerning expected injuries and their man- agement.11 Death attributable to carbon monoxide was also known to occur in the open. The additional strain of an attempt to escape from fire and heat was often the difference between life and death. That carbon monoxide will damage an already diseased heart muscle more than a normal one, is well known. That carbon monoxide is taken up in in- creased quantities when respiration is rapid is obvious. In a fire which developed after a raid on Wesermuende, of 210 corpses, 175 presented the picture of acute carbon monoxide poisoning. In Hamburg, 70 per cent of all casualties apart from those resulting from mechanical causes or burns were caused by carbon monoxide. According to Schoen,1 a concentration of 0.5 per cent carbon monoxide in the air can cause death after one hour. Even a concentration of 0.1 per cent may still produce symptoms. Sehoen also states that the old theory that one cannot die in a room where a flame can still burn is incorrect. The reason is that, as has been mentioned, the concentration of 4 per cent coal or lighting gas (corresponding to 0.5 per cent carbon monoxide) will lead to death after one hour, whereas explosion does not occur until a concentration of between 8 and 16 per cent is attained. Fumes from ordinary fires are said to contain 3 per cent of carbon monoxide gas, coal gas to contain 6 per cent carbon monoxide, gas from a high-explosive bomb 60 per cent to 70 per cent carbon monoxide.1 Qualitative and quantitative examinations for carbon monoxide were carried out in Hamburg and several other cities throughout Germany. A reliable laboratory test (Ponsold1) was reported to be: One drop of blood from a corpse is added to 50 cc of water. If this retains its red color, carbon monoxide hemoglobin is present. If not, the test should be regarded as negative for carbon monoxide. High temperatures will destroy carbon monoxide hemo- globin.* Putrefaction will not destroy carbon monoxide hemoglobin.f The conclusion as to the importance of carbon monoxide poisoning as a cause of death in incendiary raids on large German cities is plainly dependent on the validity of this statement concerning the presence of carbon monoxide in the blood at a considerable time after death. The conclusion arrived at by the German au- thorities was that there was a need for a good and Carbon monoxide poisoning Carbon monoxide as a major cause of death after aerial bombing was a possibility which few had expected before the war. It is now recognized as a typical “shelter or cellar death.” Like heat death it occurred in rooms the exits of which were blocked by rubble or fire. In such cases, the origin of the carbon monoxide was almost always incom- plete combustion. Also, in many instances, as much as 70 per cent of the gases liberated from an ex- ploded bomb was carbon monoxide. Carbon monoxide death assumed such an im- portance that the high command of the Luftwaffe issued an order to examining commissions to pro- cure statistical evidence of carbon monoxide poi- soning. In death resulting from burial in rubble, carbon monoxide poisoning was often the real cause of death. This is not surprising when it is kept in mind that many fires start when a house caves in, in bombing by incendiaries as well as by high explosives. * Graeff: Cited in reference 2. t K. Wenig: Reichsgesundheitsblatt, 19: 169; 1944, cited in reference 2. 24 THE NATURE OF AIR RAID CASUALTIES sensitive test for the detection of carbon monoxide in living and dead persons, because in the hands of most investigators the tests were unreliable in people who had been dead more than a few hours. The examination of splenic blood was suggested when it was impossible to test peripheral blood. Concentrations up to 95 per cent were found in many “shelter dead.” The fact that many shelters and basements could not be entered for many days after a raid made qualitative and quantitative ex- aminations for carbon monoxide unreliable or even impossible. The typical characteristic of car- bon monoxide deaths in aerial war is the so-called peaceful position of the bodies (Figure 18), which is suggestive of a complete lack of apprehension of danger. Rose1’5 stated that in aerial warfare different concentrations of carbon monoxide could not be found in one and the same room, as have been found, for instance, in the garage of the typical peacetime suicide. Two conclusions about death from this cause were arrived at and disseminated to everyone con- cerned in the treatment of aerial casualties: to keep in mind at all times the possibility of carbon monoxide poisoning even if the patient had been found in the open air; to give the unconscious vic- tim preference over a victim of physical injury. It has been known for a long time that small birds are particularly sensitive to carbon monoxide, and it was therefore recommended that they be taken into air raid shelters. This measure, however, did not prove very practical as the birds would not be quiet and peaceful during the raid and could not be watched for the excitement and subsequent drowsiness indicative of carbon monoxide poison- ing. The only thing to do, then, it was stated, would be to leave a burning building even if there was danger from other sources in the street. It should be kept in mind that the average gas mask or chemical warfare filters as used in ventilators do not keep out carbon monoxide. It was stressed at the conference in Jueterbog that the public should not be informed as to the danger of carbon monoxide originating in large- scale fires. In view of the inadequacy of preventive measures only unrest and even panic would be caused.1 were expected in large numbers because even after exposure to carbon monoxide for only a few hours extrapyramidal lesions are known to occur. How- ever, only occasional cases of permanent damage were seen up to the time of the Medical Branch survey. Just how many survivors from shelters and basements had sequelae resulting from carbon monoxide poisoning was not ascertained. Nor was it possible to obtain reports from pathologists as to the frequency of myocardial necroses, fatty de- generation of the liver and the kidneys, thromboses, and softening of the basal ganglia, all typical changes known to occur after carbon monoxide poisoning. In the absence of specific therapy for carbon monoxide poisoning uniform directives as to the management of this condition were not issued. But H. Desaga1 stressed the importance of prompt “heroic” treatment with large intravenous doses of analeptics, such as cardiazol, until the patient re- sponded to external stimuli. He warned against overlooking carbon monoxide poisoning in the presence of concomitant injuries. Air blast Air blast is caused by bombs containing a greater amount of explosive material than bombs which, when exploding, exert their effect on the human body by their fragments. Bombs containing a greater quantity of explosive material produced their damage through a blast wave of compressed air which was pushed ahead of the detonated gas in the form of a ball. In general, the Germans found that after an explosion of a bomb any human being nearby would be injured by fragments of the bomb and debris or be thrown by the air pres- sure, in which case he might suffer only external in- juries. Under certain circumstances, however, neither fully explained in Britain or Germany, air blast injuries can occur without external injuries. This type of damage, even with the heaviest bombs, occurred only within a radius of 30 meters. A good deal of experimental work had been done on the subject in Germany (see Desaga) .I>l2 The air blast wave attacks the body surface, but does not produce damage throughout the upper re- spiratory system as was suspected in England early in the war. It is a purely mechanical effect, and was compared with that of a faulty dive into the water when the chest and abdomen hit the water’s surface. Suction does not play a role in the pro- duction of air blast injuries, according to the Ger- man authorities. Because carbon monoxide poisoning is often not recognized, severe sequelae are frequently encoun- tered. Residual lesions in the central nervous sys- tem resulting from carbon monoxide poisoning 25 THE NATURE OF AIR RAID CASUALTIES In the air blast the most typical injury was found to be a single or bilateral perforation of the ear drum (when it had not been plugged as a pre- ventive measure). The most important injuries were those of the lungs. Massive hemorrhages into the alveoli and around the bronchi occurred. His- tologically, the damaged lung tissue was described as resembling red hepatization in lobar pneumonia. The lungs did not contain any air, and bloody foam was present in the bronchi and the trachea. Most of the damage was near the hi 1 urn, but it was also found near the heart and in the region of the lower lobes. The upper lobes were usually un- changed. In severe cases, the pleura was found to be torn in the direction of the ribs. Lung tears have been seen with such consequences as pneumo- thorax, hemothorax, and mediastinal emphysema as the result of a blast. The abdominal organs were very rarely damaged by air blast, and in order to avoid unnecessary laparotomies warnings were given of the possibility. In air blast casualties there was almost always unconsciousness of some duration, so that patients could not account for the circumstances leading to their injuries. The German authorities contend that air blast injuries may as a rule be excluded if the explosion occurred more than 30 meters away. Only under special circumstances air blast injuries were reported over a greater distance. Scriba described air blast injuries in the occu- pants of a shelter at the entrance of which a bomb exploded. The pressure wave shot through the tun- nel of the shelter, as it could not find another out- let. In March and April of 1945, Baniecki per- formed 39 autopsies on air blast victims who were found in Stollen (tunnels) about 40 to 50 meters long, dug into the ground. In each case the victim had been in such a tunnel when a bomb exploded near the entrance. The blast wave was transmitted into the tunnel and caused death to many occupants. Air embolism also occurred in air blast victims. The 39 autopsies just mentioned were done under field conditions with only a little water available, yet care was taken to open the thoracic cavity under water (urine was sometimes used) and in 18 cases the cause of death was found to be air embolism. In 15 cases the left ventricle was found to contain liquid blood and foam, and in 2 cases there was air in the right ventricle only. Numerous subdia- phragmatic and subpleural tears and hemorrhages were found. The air may be presumed to have en- tered from these tears. Conjunctival hemorrhages were found in half the cases. There were perfora- tions of the ear drums in about half the cases. Retinal hemorrhages were occasionally seen in people who presented other evidence of air blast injury. After regaining consciousness the injured per- sons usually complained of severe shortness of breath and of pain in the chest and abdomen ac- companied by precordial pain. The victims fre- quently stated that they could not move at all in the first thirty minutes or so. There was pain in their ears from ruptured drums. Deafness was ob- served in several instances. In slight cases middle ear deafness occurred. In severe cases the air wave transmitted pressure through the labyrinthic liquor on Corti's organ. This type of deafness may cover the entire range of hearing and was often seen with- out perforations of the drum. Zangemeister13 stressed the difference between damage to the ears subsequent to air blast and damage resulting from sound waves. Physically, the difference is only quantitative as the amplitude and frequency of air waves are different from those of sound waves; this is proved by the absence of perforated drums in ear damage from sound. Fur- thermore, in sound damage, the cochlear nerve is damaged almost exclusively in a range cor- responding to the frequency of the exciting sound wave. Air blast damage to the inner ear is a me- chanical damage and will not become better or worse, whereas damage from sound waves is called acoustic trauma and will improve after from two to ten weeks. Skull injuries, frequent in air blasts, can increase the damage to the ear. People who have been suffering from middle ear infections will be more vulnerable to air blast than others. Such cases, however, are yet to be studied. Those air blast victims who did not die recovered in a surprisingly short time. The pain in the chest and abdomen ceased and they were wide awake and in high spirits as early as twenty-four hours after the raid. Cardiac stimulants were no longer needed after twenty-four hours. Hemoptysis ended on the fourth or fifth day, and after six to eight days the patient was well clinically and roentgenologically. The majority of air blast injured could be dis- charged from hospitals after three to four weeks. No sequelae were seen in any, even in those very severely injured by air blast. There was no treatment for this syndrome except for bed rest and cardiovascular stimulants when in- dicated. It was advised even when minor or major 26 THE NATURE OF AIR RAID CASUALTIES surgical work had to be done that the air blast in- jured should for two reasons be admitted to medi- cal wards. The medical wards were less crowded after air raids than the surgical wards and the air blast injuries did present more of a medical prob- lem than anything else.12 In summary, it can be stated that air blast deaths and injuries were relatively infrequent because they affected, as a general rule, only those people who were in the open. Bombs which exploded near the entrance of an open tunnel or hallway caused damage through the pressure wave which was transmitted. Injuries to the ears, consisting of per- forated drums and damage to Corti’s organ result- ing in inner ear deafness, tearing of lung tissues with resulting air embolism, and conjunctival and retinal hemorrhages were the typical conditions oc- curring from air blast. ties, 1,194 people were drowned in the Ruhr Valley after the Moehne Dam had been bombed and blown up by the RAF on May 16-17, 1943. No other large- scale instances of drowning subsequent to air raids have been reported. Broken water mains permitted water to seep into shelters, basements, and bomb craters and caused death to the occupants of shel- ters and basements and people who had sought refuge in bomb craters (see report on the Hamburg raids8’ °). Pre-existing organic disease This kind of death is very frequent and consists of cardiac death and cerebral accident. Accurate figures could, of course, not be obtained as it is not known how many people in the population have more or less developed arteriosclerosis. The majority of cases in the reports of the examining commissions were attributed to fright and over- exertion when everyone was engaged in rescue work following the air raids. Dr. Wilhelm Stepp, Pro- fessor of Medicine at the University of Munich, described this as the “shelter death of the aged.” On many occasions they were surprised to find that when the “all clear" signal had sounded, older people did not get up to leave and had died quietly during the raid. However, sudden death was seen in younger people of thirty and older in whom coronary disease did not exist. Professor Siegmund, a pathologist of Muenster,15 described cases with undetermined cause of death in young people who were leaving their shelters and collapsed and died after the raids when fright could no longer play a role. In some of these people, it had to be assumed that carbon monoxide poisoning and the great ex- citement of a raid produced a cardiac arrest, a syn- drome which has not been explained satisfactorily. Dust inhalation The inhalation of dust was seldom found to be a cause of death in the air raids. According to the Medical Experiences in Air Raids14 of April 5, 1944, more than one thousand times the concentra- tion of particles in the air is required than is en- countered in the dustiest street or industrial plant to cause a closing off of the upper respiratory tract. In the case observed, the upper respiratory pas- sages down to the larynx were blocked with dust. Only small amounts of dust were able to enter the alveoli of the lung. Therefore, the disturb- ance of the gas exchange in the alveoli does not appear to play an important role in air raid deaths. In unconscious people who were lying face down in an accumulation of dust, a complete block- age of the respiratory passages did occur. After a very few breaths, they “drowned in dust. Profes- sor L. Singer, a pathologist of Munich, reported that after a raid was over and people left the shel- ters, the dust settled down on the city, and several cases of dust death were seen. He observed three cases where the larynx was filled with a pseudo- membranous mass of dust and mucous membrane. In cases without external injuries, dust was often found in the respiratory tract, but in most cases the real cause of death was something else, such as carbon monoxide poisoning. Poisoning by industrial gases Nitrose gas which is liberated in the explosion of dynamite and nitrocellulose, caused an occa- sional death. The pure poisoning with nitrose gas lead to pseudo-membranous changes in the respira- tory tract with edema of the lungs. Furthermore, methemoglobin was formed. Experimentally, the combination of carbon monoxide and nitrose gas is known to be a very lethal mixture. Only one-half the lethal dose of each gas is necessary to kill ani- mals experimentally (Wirth2). In these cases car- bon monoxide hemoglobin and methemoglobin can be shown to be present in the blood, but methemo- globin changes into nitrous oxide hemoglobin after Drowning Death from drowning can be expected in air raids near large bodies of water and dam facilities. For instance, according to public utilities authori- 27 THE NATURE OF AIR RAID CASUALTIES two hours, and resembles spectroscopically carbon monoxide hemoglobin. It can, therefore, be con- fused with the latter. Aldehydes were liberated after bombing of in- dustrial plants and were observed to cause irrita- tion to the mucous membranes. Akrolein, a gas which originates after heating or burning of glycerine and fats, was observed to pro- duce vertigo and drowsiness in isolated instances where factories processing meats, fats, oils, soaps, and varnish were hit. All of these gases produced irritation of the upper respiratory tract. A manuscript by Schoen2 of Goettingen described 44 clinically observed cases of poisoning by smoke and irritant gases. Of these 44-, 12 were unconscious; 6 were admitted with edema of the lungs and 3 died; 6 cases developed broncho-pneumonia, 2 with subsequent lung ab- cesses, and 1 of these died; in 5 cases an abnormal electrocardiogram as indicated by a particularly prolonged P-R interval, suggested myocardial dam- age. Summary and conclusions 1. Medical commissions working under the di- rection of the German Air Ministry studied all causes of death and injuries peculiar to aerial war- fare. They submitted their reports to the Air Minis- try in Berlin where periodic pamphlets were issued through which the medical profession was kept informed on developments. 2. Reports on casualties resulting from aerial bombings were kept by the municipal police de- partment. All reports were held secret, and no figures were given. The figures mentioned in this chapter were given by members of the various com- missions when interviewed. 3. It can be stated that there was a definite re- lationship between the type of bomb dropped, and the type of death or injury to be expected. An in- cendiary raid was expected to cause more dead than wounded, through the effects of heat and car- bon monoxide; in bombings with high explosives, mechanical injuries outnumbered deaths. 4. It should be kept in mind that season, geo- graphical location, and type of city bombed are very important factors in the evaluation of air raid casualties. German scientists found it impossible to get an accurate list of the causes of death in the order of their importance. The order in which the causes of death are listed in this chapter is only an approximation. 5. Direct hits, action of bomb fragments, and burial under rubble were listed as mechanical effects of air raids. The effects of heat in incendi- ary raids as well as high-explosives raids were the burns and very high temperatures to which the population were exposed. In all the cities visited carbon monoxide poisoning was regarded as the primary cause of death or injury, sometimes reach- ing to as much as 80 per cent of all incendiary raid casualties. Air blast was found to be a rela- tively infrequent cause of death and affected only people within a radius of 30 meters from the ex- plosion of a bomb. Perforation of the ear drums, inner ear deafness resulting from the effect of the pressure wave on Corti's organ, tearing of lung tis- sue with resulting air embolism, and hemorrhages in the eyes were described as typical of air blast. Dust inhalation was seen in occasional instances; drowning occurred in approximately 1,200 people after a dam in the Ruhr Valley had been blown up. Industrial gases accounted for an occasional death. Phosphorus Examining commissioners complained bitterly that not only laymen, but also doctors called every burn a phosphorus burn.5 It is stressed that a burn can be attributed to phosphorus only if it lights up in the dark or smells of phosphorus. Wounds resulting from phosphorus are very rare, and light- ing up in the dark can be caused by insignificant quantities of phosphorus which do not need to be dangerous. Rose5 stated that the psychologic effect of phosphorus bombs was far greater than any actual damage which they caused. Only the 30- pound incendiary bomb contained phosphorus. Al- though phosphorus burns were not infrequent and occurred in people who had come in contact with unexploded phosphorus canisters lying about in the streets and under the rubble and in fields, death through phosphorus alone was not observed. As incendiary agent the direct contact with an explod- ing incendiary bomb is a freak, and was never seen in Germany. No cases have been reported in which organic damage resulting from the absorption of phosphorus through the skin could be proved. No skin damage from phosphorus occurred where there was no burn at the same time. No cases of inges- tion of phosphorus with systematic after effects were observed. No eye injuries resulting from phos- phorus were seen, although directives were issued for the treatment of eye injuries caused by phos- phorus burns. 28 THE NATURE OF AIR RAID CASUALTIES REFERENCES 1. Tagungsbericht 9/44. Ueber eine wissenschafliche Besprechung am 13. und 14. Dezember 1943 bei der Sanitaets Versuchs —und Lehrabteilung der Luftwaffe in Jueterbog ueber aerztliche Luftschutzfragen. Publications on Aviation Medicine. Secret Document. Published by the Inspector of Sanitary and Medical Matters, German Air Force. 2. Beobachtungen and Befunde der aerztlichen Untersuchungsgruppen zur Erfassung neuartiger Personenschaeden nach Luftangriffen. Published by Supreme Command, German Air Force. No. 1. Saalow. October 30, 1944. 3. Beobachtungen und Befunde der aerztlichen Untersuchungsgruppen zur Erfassung neuartiger Personenschaeden nach Luftangriffen. Published by Supreme Command, German Air Forces. No. 2. Saalow. January 24, 1944. 4. Aerztliche Erfahrungen im Luftschutz. No. 1. Todesursachen bei Luftangriffen unter besonderer Beruecksichtigung von Flaechenbraenden. Published by the Reichs Minister for Air and the Chief, Sanitary and Medical Matters, German Air Force, in collaboration with the Reichs Minister of the Interior and the Reichs Leader of National Health. Berlin, March 27, 1944. 5. Aerztliche Erfahrungen im Luftschutz. No. 5. Todesursachen und gesundheitliche Cefahren im Luftkriege. Colonel Prof. Rose; Consultant Hygienist to the Chief, Sanitary and Medical Matters, German Air Force, Berlin, October 22, 1944. 6. Ueberhitzung des menschlichen Koerpers. Report to the Commissar of National Health from the Institute of Aviation Medicine. Berlin, June 15, 1944. 7. Pathologisch—Anatomische Erfahrungen bei Flaechenbraenden. Abbrev. Extract from a report to the meeting of consultants to the Armed Services at Hohenlychen. 1944. Unpublished Manuscript. 8. Tod durch Luftangriff. Prof. Dr. Siegfried Graeff, Hamburg. Unpublished Manuscript. Hamburg, 1945. 9. Die Nacht des Luftangriffes auf Hamburg vom 27/28 Juli 1943. Prof. Dr. Siegfried Graeff, Hamburg. Unpublished Manuscript. Hamburg, 1945. 10. Gerbstoff S 63 der Deutschen Hydrierwerke A. G. Chemnitz. A new drug for the treatment of bums. 11. Augenaerztliche Hinweise fuer die Yersorgung von Verletzten bei Luftangriffen. Reprinted from Klin. Monatsblaetter fuer Augenheilkunde, 1943. 12. Klinik und Therapie der Luftstossverletzungen unter Beruecksichtigung chirurgischer Massnahmen. Dr. H. Desaga. Unpublished Manuscript. To be published in Klinische Wochenschrift, 1944, p. 297. 13. Unsere Erfahrungen und Anschauungen ueber Luftstossverletzungen des Ohres und verwandte Fragen. Dr. H. E. Zangemeister, Hamburg. Unpublished Manuscript. 1945. 14. Aerztliche Erfahrungen im Luftschutz. No. 2. Die Staubwirkung. Berlin, 5 April 1944. 15. Pathologisch—Anatomische Untersuchungen an Todesfaellen nach Luftgriffen. Prof. Dr. Siegmund, Muenster. Unpublished Manuscript, 22 November 1944. 29 CHAPTER FOUR COMMUNICABLE DISEASES AND OTHER DISORDERS Air war against large crowded cities created con- ditions for which we had no precedent. In pre- paring to assess the influence of aerial bombing on the morbidity and mortality of many different dis- eases and disorders, the investigators who have written this chapter had to start from scratch in the truest sense of that expression. Training, ex- perience, and knowledge would lead one to expect a tremendous increase in communicable diseases to epidemiologic proportions when visualizing the de- struction of German cities, but there were no major epidemics. That the nervous strain of trying to keep somewhat of a normal life going amid such desolation would exhibit itself in an increase in the psychosomatic disorders was expected and was indeed found. Before the war the statement was frequently made that large-scale bombings would drive people mad. In England, R. D. Gillespie, the well-known psychiatrist of Guy’s Hospital, said that he and his colleagues held long discussions in the period after Chamberlain’s trip to Munich, to decide how to meet the tremendous incidence of psychiatric dis- orders anticipated once the Germans started bomb- ing London. Looking back on it in 1945 he added* “We might as well have saved our breath.’’ What happened in Germany under conditions even more trying for the individual is described in the final section of this chapter. COMMUNICABLE DISEASES CAPTAIN FRANZ K. BAUER, MEDICAL CORPS. AUS LIEUTENANT COLONEL JOHN H. WATKINS. SANITARY CORPS. AUS Disease is the third of the Lour Horsemen of the Apocalypse. In every war it has played a major role in the outcome of the conflict. Many factors arise in a wartime population to increase the in- cidence and mortality of disease. The aerial bomb- ing of civilian populations is new, except for the zeppelin raids in World War I, and it is the purpose of this chapter to attempt to indicate the effect of this factor upon disease and disease mor- tality. The assignment is not an easy one, for no epidemics arose in Germany during World War II of a degree in any sense comparable to such pre- vious wartime epidemics as that of influenza in 1918. Many of those which were recorded would have originated in the absence of a wartime regime. Usually the question to be answered was “Did bombing accentuate the incidence of the disease?” rather than “Did the epidemic occur because of the bombing?” Relationships are frequently in- volved; for example, the nutritional state of a population following bombing may be the precipi- tating cause of an outbreak of disease rather than the bombing itself. The results presented here are largely statistical in nature, reinforced wherever possible by the opinions of many reliable German medical authorities interviewed during the course of the survey. Typhus fever Typhus fever did not appear in German cities until foreign laborers had been imported and labor camps established. It is generally believed that the increased incidence of typhus in Germany during the war is attributable to the influx of foreign workers from those eastern countries where this disease is endemic. Foreign laborers were examined 30 COMMUNICABLE DISEASES Table 1. Annual Case Incidence of Typhus Fever in Seven German Cities in 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Bochum 0.00 0.00 0.00 1.22 1.11 Duisburg 0.00 0.00 0.00 0.00 0.00 Frankfort 0.00 0.00 0.00 0.38 5.72 Hamburg 0.00 0.00 0.06 0.81 0.98 Kiel 0.00 0.00 0.00 0.35 0.00 Magdeburg 0.00 0.00 1.16 0.89 39.28 Nuremberg 0.00 0.00 1.08 0.58 7.76 Combined Cities 0.00 0.00 0.23 0.65 5.51 (Rates per 100,000 population; annual basis) on two different occasions at the time they were imported, but the labor camps in which they were forced to live provided those conditions of over- crowding and insanitation under which typhus is spread. This is no doubt responsible for the appear- ance of epidemics among these individuals; and it is believed that the breaking down of the line of demarcation between forced laborers and German citizens caused by the air raids is responsible for the spread of typhus to the civilian population. No cases of typhus fever were reported in 1938 and 1940 among residents of the seven German cities listed in Table 1. In 1942 the case rate per 100,000 population in the combined group of cities was 0.23, in 1943, 0.65, and in 1944, 5.51. The high incidence in 1944 was accounted for by in- creased numbers of typhus cases in Frankfort on Main, Magdeburg, and Nuremberg. Until the heavy air attacks on Germany were started the in- cidence of the disease appeared to be sporadic and low. This is clearly indicated by Table 2 which lists the cases of typhus fever in Magdeburg during the years 1943 and 1944. In 1943, during which no air raids were made on the city, only 2 cases of typhus fever appeared among residents in spite of the fact that 98 cases occurred among displaced persons. In 1944, on the other hand, after the bombing in January, 8 cases of typhus fever appeared among the residents in April, the incidence rising to an epidemic number of 74 in May, and declining again to 4 cases in June as the war summer months approached. The charts of monthly air attacks and the monthly case incidence of typhus (Figure 19) show a relatively small amount of typhus occurring in the resident population of this group of cities, other than in Cologne and Magdeburg. Aside from Magdeburg the charts do not bring out the effect of bombing on typhus incidence, partly because of the small numbers involved, and partly because of Table 2. Reported Cases of Typhus Fever in Magdeburg in 1943 and 1944 Number of cases reported among Date Residents Displaced persons 1942 December 0 1 1943 January 0 5 February 2 46 March 0 43 April 0 1 October 0 0 1944 January 0 6 February 0 37 March 0 5 April 8 19 May 74 46 June 4 12 December 0 1 31 Figure 19 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF TYPHUS FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 32 Figure 19 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF TYPHUS FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 33 COMMUNICABLE DISEASES Table 3. Annual Case Incidence of Diphtheria in Seven German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis.) City 1938 1940 1942 1943 1944 Bochum 503.18 571.90 303.91 281.79 363.70 Duisburg 399.08 290.39 297.40 225.87 379.19 Frankfort 128.00 315.09 143.71 158.29 202.86 Hamburg 201.25 253.33 246.98 272.85 341.94 Kiel 206.81 109.32 441.68 229.27 237.42 Magdeburg 363.05 309.00 397.00 363.05 425.46 Nuremberg 321.44 208.89 366.62 476.97 562.95 Combined Cities 263.00 281.01 280.70 277.15 351.05 Table 4. Annual Mortality From Diphtheria in Thirteen German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis*.) City 1938 1940 1942 1943 1944 Augsburg 14.22 2.73 14.42 14.60 6.88(10) Bochum 15.61 22.60 10.42 13.46 19.27(10) Bremen 13.41 5.30 17.62 9.88 43.66(10) Cologne 8.47 11.86 6.76 17.07(5) 33.72(8) Dortmund 21.91 15.93 11.28 11.56 21.76(9) Duisburg 15.12 15.98 27.98 24.42 44.53(10) Duesseldorf 14.57 8.27 11.39 12.80(9) 24.47(7) Hamburg 7.68 17.54 14.21 21.41 23.55(10) Kiel 7.62 7.29 15.59 11.85 15.24(10) Magdeburg 13.10 10.25 12.49 13.93 19.83(10) Mulheim 5.17 17.32 11.19 17.48 14.94(10) Nuremberg 13.21 6.29 12.92 18.66 11.70(10) Sol ingen 8.46 1.50 4.86 8.61 18.26(10) Combined Cities 11.74 12.80 13.36 16.70 25.02(10) * All rates are computed on an annual basis. But in this and in following tables, wherever tire data used are for less than the complete year, the number of months actually included is indicated in parentheses. 34 COMMUNICABLE DISEASES the added factor of the size and location of foreign labor camps. It is interesting to note that the typhus fever reported in Frankfort, Magdeburg and Nuremberg occurred in the late spring and sum- mer months following periods of air attacks. German nationals were not immunized against typhus, for which Dr. Feonardo Conti, Chief of the German public health service, gave these reasons: “Germans are clean. They are never lousy. The primary danger of typhus arose from Russian and Polish workers who were brought into Germany during the war. They account for well over 90 per cent of all cases in Germany. We did not im- munize against typhus because I feel that this should be left to the discretion of the physician confronted with the problem. Furthermore, there was the danger of a reaction. It would also have required large amounts of vaccine and would have taken valuable time from the public health au- thorities, time which was to be spent more profita- bly in strengthening their control over the national public health. As a matter of fact, I would much rather take the risk with my control organization and, if I may say so, the absence of a typhus epi- demic shows that this was the proper approach. Generally speaking, only medical and nursing personnel in direct contact with typhus patients were immunized against the disease.” In summary, it can be stated that although typhus fever did not assume epidemic proportions of any magnitude, a relationship between aerial bombings and outbreaks in German nationals cannot be dis- puted. The bombings led to an increased interming- ling between Germans and foreigners by virtue of the fact that public shelters were shared by both groups alike and that evacuation could not be car- ried out separately for Germans and foreigners because of the disruption of transportation facili- ties. The decrease in cleanliness brought about by longer working hours and lack of soap must also be taken into account. who had received immunization within three years of the onset of the disease. The diphtheria rate went down all over Europe in 1942 and 1943. After the aerial bombings on Germany began the incidence of diphtheria went up rapidly, par- ticularly in 1944 as shown by the combined diph- theria case rates for the seven cities of Table 3. The case rates for 1938 and 1940 were 263.00 and 281.01, respectively, per 100,000 population; no significant change occurred in 1942 and 1943 but in 1944 the rate rose to 351.05. The increase did not occur in all seven cities, but in Hamburg, Kiel, Magdeburg, and Nuremberg. The mortality rates conform to the findings regarding case incidence (Table 4). The 1944 rate for all cities combined is twice the rates for either 1938 or 1940 and con- siderably higher than those for 1942 and 1943. In 1944 ten of the thirteen individual cities possessed higher rates than in 1938 or 1940. It is interesting to note that the total case and mortality rates indicate increased fatality. Com- puted from the total lines of Tables 3 and 4, the case fatality was: 1938 4.5 per cent 1940 4.6 per cent 1942 4.8 per cent 1943 6.0 per cent 1944 7.1 per cent The years 1938 and 1940 were selected as base years for the evaluation of the vital statistics for the years of the heavy air attacks, but a better selection of a base for the evaluation of communi- cable disease would have been an average of sev- eral prewar years. An epidemic of diphtheria did occur in Germany in 1937-38 and evidence in pos- session of the Medical Branch indicates that a high level of the disease persisted in 1940. The high rates of 1944, therefore, are all the more striking, in comparison with those of years in which the disease was excessively prevalent. Figures 20 and 21 give monthly trends of the case and mortality rates for cities in Germany, con- trasted with the monthly bomb tonnage of the air attacks upon each city. Some evidence does exist in these figures that incidence of the disease rose after periods of heavy bombing. In Bochum, Cologne, Dortmund, Duisburg, Hamburg, Kiel, and Nuremberg the rate in 1943 increased follow- ing the heavy air attacks of the summer months. A considerable part of the increases, however, is fal- lacious. Diphtheria case rates normally rise in the Diphtheria Diphtheria showed a marked increase in 1940 and 1941 (before the bombing of Germany began). This increase corresponded to the periodic increase in diphtheria which is known to occur in Europe every three to five years. By 1941 compulsory im- munization for children and voluntary immuniza- tion for adults against the disease had been insti- tuted by national decree, with the result that there was less diphtheria and of a more benign form. Further, no deaths were reported among patients 35 Figure 20 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF DIPHTHERIA IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 36 Figure 20 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF DIPHTHERIA MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES IN NINE GERMAN CITIES 37 Figure 21 THE BOMBING EXPERIENCE AND MORTALITY FROM DIPHTHERIA IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 38 Figure 21 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM DIPHTHERIA IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 39 Figure 21 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM DIPHTHERIA IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 40 COMMUNICABLE DISEASES autumn, and in the present instance the increase is accentuated by the fact that reporting was defec- tive in the early period following heavy air raids. However, the increase in Cologne, Hamburg, and Nuremberg is well above the incidence for the pre- vious year, and can hardly be attributed to factors other than those incurred during and following air attacks. Whether the increase was entirely the re- sult of conditions created by the air war could not be ascertained, as immediate records for accurate scientific studies on this subject were not prepared owing to lack of time and personnel. The opinion was expressed, however, by all those concerned with the problem, that an indirect effect of aerial warfare on the incidence and course of diphtheria could not be disputed. This opinion was categori- cally stated by Dr. Conti and other high-ranking physicians as well as by the municipal health offi- cers who were interviewed. The role which air war- fare played in the morbidity and mortality of diphtheria was explained as follows: By 1943, the German population was fatigued. The resistance of the people had been lowered ow- ing to poor living conditions and to constant cuts in their food rations. They had become careless: although a law had been passed early in the war providing that people ill with communicable dis- eases could go only to those bunkers and shelters which were designated for isolation, and if they were not near such a shelter or bunker they were to remain in their homes, the law was not always obeyed. For instance, a mother would not leave her sick child home and go to the bunker herself; she took the child along. Thus children ill with diphtheria were taken to bunkers and shelters where they spread the disease, particularly to adults who had not been immunized and were thus vulnerable to it. The changes in morbidity in diphtheria as com- pared with the picture of the disease as seen before the air war started were: 1. A higher incidence among adults. 2. A more malignant and rapid course. 3. A mortality which averaged 4.5 per cent for most of Germany, but in some places went up to 7 per cent. 4. Multiple and serious sequelae such as myo- cardial damage, paralyses of the soft palate, and polyneuritides. These polyneuritides were particularly resistant to therapy as were the other complications of diph- theria. Large doses of thiamin chloride were given without effect, and Professor Stepp of Munich, Germany’s leading expert on vitamins and nutri- tion, stated in a personal interview that the whole subject of complications was conditioned by the poor nutritional state of the patients. He did not think the virulence of Klebsiella diphtheriae had changed, a belief which was borne out by bacterio- logic studies. Additional causative or contributory factors were thought to be: 1. That too many people who suffered from “sore throats” did not seek medical attention. First of all, they were hard pressed and rushed, doctors were busy, and transportation off schedule, and, second, absenteeism was blazoned by the press and all state and Nazi party agencies as unpatriotic— so too many “sore throats” were allowed to go un- treated and to spread the pathogenic organism. 2. That compulsory immunizations caused an increased incidence in adults. Some public health men with somewhat old-fashioned conceptions of immunology (as Dr. W. Bolt of Cologne) claimed that many immunized children were carriers and infected nonimmunized adults. This was hotly de- nied by several well-qualified public health au- thorities. Thus Dr. Hans Eller, public health officer of Augsburg, showed that in his city the increase of diphtheria was noticeable but by no means alarming, nor were there any complications such as observed in other cities. The reason for this was thought to be that compulsory immunization against diphtheria was started in 1935 and that, therefore, active immunity of a considerable de- gree had been produced in the population of Augs- burg. The argument then, boils down to one con- clusion: immunization was started too late in most German cities. It was left to the individual public health officers in German cities to institute compulsory and volun- tary immunizations against diphtheria, and it was not until 1941 that all of Germany required com- pulsory immunization of school children. The rea- son for this rather unusual procedure in a country as rigidly organized as Germany, was given by Dr. Conti, the chief of the German public health service: “Immunization against diphtheria was instituted locally and encouraged by national propaganda. Other immunizations were left up to the individual physicians because it was felt that legislation in this respect would mean an encroachment upon the judgment and prerogatives of the individual doctor. 41 COMMUNICABLE DISEASES Table 5. Annual Case Incidence of Scarlet Fever in Seven German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Bochum 230.25 403.33 586.97 437.92 205.62 Duisburg 278.58 286.22 692.34 482.60 343.08 Frankfort 160.36 187.72 542.74 581.28 322.10 Hamburg 188.27 263.14 719.42 446.36 326.05 Kiel 262.12 322.13 753.11 465.51 374.77 Magdeburg 192.79 241.05 715.01 618.22 354.84 Nuremberg 169.13 140.44 393.81 635.86 462.71 Combined Cities 200.65 256.00 652.92 505.31 341.64 Table 6. Annual Mortality From Scarlet Fever in Thirteen German Cities in 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Augsburg 2.19 0.55 8.54 3.79 4.91(10) Bochum 1.91 6.46 9.45 9.79 4.65(10) Bremen 0.57 0.46 6.26 5.09 8.00(10) Cologne 3.26 3.00 6.76 6.40(5) 9.09(8) Dortmund 1.69 3.19 4.21 6.74 1.99(9) Duisburg 6.41 6.25 19.72 8.03 13.97(10) Duesseldorf 1.31 2.76 6.37 2.02(9) 5.43(7) Hamburg 0.71 2.01 11.42 8.19 3.87(10) Kiel 1.20 0.73 10.74 4.18 8.27(10) Magdeburg 1.22 2.05 9.58 9.78 7.83(10) Mulheim 0.74 5.77 13.43 11.65 2.30(10) Nuremberg 0.96 1.26 3.50 8.45 3.76(10) Solingen 7.30 7.75 2.15(10) Combined Cities 1.73 2.60 9.08 7.08 5.94(10) (Rates per 100,000 population, annual basis) 42 COMMUNICABLE DISEASES Our doctors did not desire to vaccinate everyone because of the danger of covering up the carriers. Furthermore, it is much better to rely upon careful and thorough public health controls than to de- pend upon immunizations which at best are un- certain. I believe that immunization should be re- sorted to only when we have determined definitely that a specific danger exists in a given area.” raid bunker of the Municipal Hospital in Nurem- berg: 53 newborn infants developed streptococcus infections such as otitis, mastoiditis, and pyoder- matosis. All this happened in one week and cost the lives of 14 infants. The reason for this was thought to be the airborne spread of pathogens from the emergency room where dirty bandages were unwrapped and dried before being sterilized and reused. It became apparent from these charts and from interviews with German physicians that scarlet fever and streptococcus infections were not a particular problem after the heavy air attacks set in. In contrast to the similar charts on diph- theria, scarlet fever rates rose again following the bombings only to the level attained before the months of the air attacks. Scarlet fever Germany experienced an epidemic of scarlet fever in 1941. Detailed data on mortality and case incidence for this year were not secured for the present study, but with the fact in mind it is ap- parent from the annual case incidence of Table 5 and the annual mortality figures of Table 6 that a high incidence of the disease still persisted in 1942 and 1943. For the seven cities of Table 5 the case incidence in 1940 was 256.00 per 100,000, while in 1942 it was 652.92 and in 1943, 505.31. The rate had fallen to 341.64 in 1944. A similar picture is shown for the annual mortality rates of Table 6, as well as for the case incidence rates of the individual cities. The mortality rates for the individual cities, shown in Table 6, are not as clear cut; for Augsburg, Bremen, Cologne, Duisburg, Duesseldorf, and Kiel the scarlet fever mortality rate in 1944 was higher than in 1943. Case incidence and mortality, by months, for the cities under discussion are given in Figures 22 and 23. The general conclusion to be read from these charts is that no relation existed between bombing attacks and the incidence of scarlet fever. Isolated instances, however, may be cited to show an in- crease in the disease after air attacks. In Munich, as a striking example, the number of reported cases before the air attacks averaged 20 a week. Since 1942 the weekly number of reported cases averaged 100. Reasons for this sharp rise were thought to be overcrowding in homes, at work, and in air raid shelters. The course of the disease was mild, very few complications were observed, and the mortality was low. The incidence of streptococcus infection was not well known, primarily because people did not seek medical attention for such “trivial” conditions, and second, because bacteriologic studies became more and more difficult as laboratory facilities, person- nel, and reagents became scarce with the increased destruction of cities. Of interest is one outbreak of streptococcus infection in the nursery in the air Whooping cough Mortality from whooping cough increased in 1943 and 1944, as did the complications from this condition. The reason for this increase in mor- tality was thought to be the frequent disorganiza- tion of home and hospital life, the disruption of heating facilities, and other factors resulting from aerial warfare. Thus infants and small children had to be moved from the wards to shelters or bunkers as often as two or three times daily, which practice led to an increase in the duration of the disease and in its complications. The year 1940 was epidemic for whooping cough in Germany, a fact responsible for the high case incidence rate for that year in the seven cities of Table 7, and the high 1940 mortality rate in the thirteen cities of Table 8. The case rates for 1942- 1944 were well below that of 377.40 for 1940 while the mortality rates of 4.18 and 4.27 for 1943 and 1944 are less than the epidemic rate for 1940 of 5.90, but greater than in the nonepidemic year of 1938 when the rate was 3.51. From the mor- tality table it is apparent that more whooping cough was encountered in Germany in 1943 and 1944 than the table of case incidence shows. Table 8 lists mortality figures for seven cities not in- cluded in the case incidence table, four of which, Augsburg, Bremen, Cologne, and Duesseldorf, show high rates of mortality from whooping cough. It is not apparent, however, that the disease increased in 1944 over 1943, Monthly air attack bomb tonnages are compared with monthly case rates of whooping cough in Figure 24 and with mortality rates in Figure 25. 43 COMMUNICABLE DISEASES Table 7. Annual Case Incidence of Whooping Cough in Seven German Cities in 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1940 1942 1943 1944 Bochum 244.45 128.99 93.37 25.98 Duisburg 451.80 127.38 246.75 164.01 Frankfort 446.42 177.81 66.14 Hamburg 321.97 127.89 145.59 182.99 Kiel 693.46 195.03 366.20 170.59 Magdeburg 344.44 308.52 124.46 Nuremberg 321.65 138.09 168.22 109.41 Combined Cities 377.40 159.87 193.61 140.95 Table 8. Annual Mortality From Whooping Cough in Thirteen German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Augsburg 3.83 2.73 4.27 11.90 2.95(10) Bochum 3.18 2.58 3.26 4.49 0.00(10) Bremen 2.57 6.68 1.62 5.39 6.91(10) Cologne 3.91 8.60 4.96 5.55(5) 0.97(8) Dortmund 4.31 1.87 1.72 0.72 1.57(9) Duisburg 2.52 12.97 4.26 9.00 3.06(10) Duesseldorf 5.79 11.39 2.51 6.06(9) 11.42(7) Hamburg 4.58 5.61 1.84 3.15 5.98(10) Kiel 1.60 3.28 2.08 2.09 2.61(10) Magdeburg 1.83 2.64 2.03 3.85 3.65(10) Mulheim 0.74 0.00 0.75 0.83 2.30(10) Nuremberg 0.96 3.52 1.08 2.04 2.92(10) Solingen 0.00 1.50 1.62 3.45 4.30(10) Combined Cities 3.51 5.90 2.50 4.18 4.27(10) 44 Figure 22 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF SCARLET FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100.000 POPULATION, ANNUAL BASIS MONTHLY total BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 45 Figure 22 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF SCARLET FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 46 Figure 23 THE BOMBING EXPERIENCE AND MORTALITY FROM SCARLET FEVER IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 47 Figure 23 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM SCARLET FEVER IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALI„ AIR FORCE 48 Figure 23 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM SCARLET FEVER IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES Figure 24 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF WHOOPING COUGH IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 50 Figure 24 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF WHOOPING COUGH IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 51 Figure 25 THE BOMBING EXPERIENCE AND MORTALITY FROM WHOOPING COUGH IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 52 Figure 25 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM WHOOPING COUGH IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 53 Figure 25 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM WHOOPING COUGH IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 54 COMMUNICABLE DISEASES Table 9. Annual Mortality From Measles in Thirteen German Cities in 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Augsburg 3.28 1.09 4.81 1.08 0.00(10) Bochum 1.27 4.20 2.28 0.82 0.66(10) Bremen 0.86 2.54 1.39 5.09 9.82(10) Cologne 3.52 2.22 1.38 0.43(5) 2.59(8) Dortmund 0.75 0.94 1.72 2.65 0.80(9) Duisburg 2.75 3.47 4.00 3.53 3.06(10) Duesseldorf 3.55 3.31 2.90 1.34(9) 6.00(7) Hamburg 0.48 0.71 1.31 1.48 0.82(10) Kiel 0.40 0.36 0.35 0.35 2.61(10) Magdeburg 1.83 0.88 1.45 1.48 1.04(10) Mulheim 2.22 1.44 3.73 3.33 0.00(10) Nuremberg 2.40 0.50 2.42 2.62 0.84(10) Solingen 0.00 0.00 1.62 1.72 3.22(10) Combined Cities 1.70 1.63 1.91 1.82 2.46(10) (Rates per 100,000 population; annual basis) No indication of any relationship between the intensity of air attacks and the level of whooping cough is given by these charts. the morbidity or the mortality of the disease and that it had not caused concern to practicing physi- cians and public health officers during the war. There was no marked increase in the complications attending measles. Measles The incidence of measles did not change mate- rially throughout Germany during the war. Spo- radic and explosive outbreaks occurred in various cities, whereas in other cities equally heavily bombed no change in the morbidity and mortality of the disease occurred. The data on mortality indicate that measles was not particularly preva- lent during the years of heavy air attacks. The rates per 100,000 of 1.70 and 1.63 in 1938 and 1940 rose only to 1.91 and 1.82 in 1942 and 1943 and to 2.46 in 1944 for the thirteen cities of Table 9. The rate for 1944 was high because of increased mortality from measles in Bremen, when the rate rose from 1.39 in 1942 to 9.82 in 1944, and in Duesseldorf where it increased from 1.34 in 1943 to 6.00 in 1944, Whatever relationship existed between bombing attacks and mortality in this disease can be seen in Figure 26. The German physicians interviewed regarding measles stated that aerial warfare had not changed Poliomyelitis—epidemic encephalitis— epidemic meningitis The air war could not be shown to have any effect on the morbidity and mortality of three dis- eases which in Germany presented a problem simi- lar to that encountered in the United States. In numerous personal interviews with private physi- cians and public health officers it was stated that poliomyelitis, encephalitis, and epidemic menin- gitis caused little concern during the war. It was stressed that diagnostic facilities were handicapped through the widespread destruction of transporta- tion facilities, and that the diagnoses reported were oftentimes unreliable. Poliomyelitis. The case incidence rates for polio- myelitis are only occasionally high for the cities of Table 10. The case rates for 1938 are higher, on the whole, than the subsequent years, 1938 being a year in which the disease was epidemic in Germany. 55 COMMUNICABLE DISEASES City 1938 1940 1942 1943 1944 1938 1940 1942 1943 1944 1938 1940 1942 1943 1944 Bochum 1.91 0.00 0.98 0.41 1.11 0.32 0.65 1.95 0.00 0.00 3.50 6.78 2.28 3.67 2.76 Duisburg 4.35 0.00 0.53 1.93 1.50 0.23 0.93 0.00 0.32 0.00 4.35 9.73 2.66 2.89 2.26 Frankfort 27.09 1.62 5.29 1.90 1.27 0.36 0.18 0.00 0.19 0.00 0.91 5.40 2.19 3.23 2.23 Hamburg 3.45 2.24 7.43 2.22 2.65 0.18 0.35 0.24 0.67 0.69 2.08 8.33 3.57 2.48 3.63 Kiel 1.20 10.20 0.35 3.14 1.48 0.80 0.73 0.00 1.39 1.48 Magdeburg 0.91 0.29 1.16 1.19 0.44 0.30 0.00 0.00 0.00 0.00 4.26 8.49 3.49 4.45 2.81 Nuremberg 12.25 3.27 2.15 1.46 11.29 0.00 0.00 0.54 0.87 0.71 6.97 4.03 5.92 3.50 2.21 Combined Cities 7.27 2.22 4.39 1.92 2.89 0.21 0.35 0.33 0.46 0.39 2.89 7.02 3.14 2.91 2.82 Epidemic Encephalitis Table 10. Annual Case Incidence of Poliomyelitis, Epidemic Meningitis, and Epidemic Encephalitis in Seven German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) Epidemic Meningitis Poliomyelitis 56 Figure 26 THE BOMBING EXPERIENCE AND MORTALITY FROM MEASLES IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 57 Figure 26 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM IN THIRTEEN GERMAN CITIES MEASLES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES DISEASE MORTALITY-/ 58 Figure 26 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM MEASLES f IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 59 Figure 27 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF POLIOMYELITIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 60 Figure 27 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF POLIOMYELITIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 61 COMMUNICABLE DISEASES Case incidence of this disease was high in Frank- fort and Hamburg in 1942 and in Nuremberg in 1944. Figure 27 does not show, however, any con- sistent relation between the disease and the months of air attacks. The July 1944 air attack on Ham- burg was followed by a heavy incidence of polio- myelitis, but the heavier bombings in 1943 and 1944 were followed by a normal incidence. The information obtained in interviews with leading public health men and practicing physi- cians in Germany was that poliomyelitis presented a similar problem in Germany to that in the United States. The highest incidence was found to be in September and October and in general from two to four weeks later than in the United States. The question of transmission of the virus through flies or water did not seem to take an important part in the epidemiologic considerations in Germany dur- ing the war. Epidemic encephalitis. The annual case inci- dence of epidemic encephalitis in 1938 and 1940 was 0.21 and 0.35 respectively for the six cities of Table 10. These rates were not exceeded in any excessive amount in 1942 to 1944. The case rates for epidemic encephalitis were somewhat higher in Hamburg and in Nuremberg for 1943 and 1944 than for the previous years. No relationship be- tween the monthly course of the disease and the occurrence of air attacks is shown in any of the charts of Figure 28. No information was obtained as to what agents were responsible for the disease referred to as en- cephalitis. Most physicians interviewed concerning this point stated that they had only seen occasional cases, and that diagnostic tests such as animal inoculations and neutralization tests as required for the confirmation of the diagnosis in the United States were not carried out in Germany except in rare instances where such facilities were imme- diately available and the physician particularly interested in the laboratory aspects of this disease entity. Epidemic meningitis. The period 1939-1941 was- one in which epidemic meningitis was epidemic in Table 11. Annual Mortality From Influenza and Pneumonia in Thirteen German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Augsburg 60.17 70.52 65.69 69.76 79.61(10) Bochum 116.56 93.65 99.02 75.03 110.30(10) Bremen 56.49 64.99 53.33 74.27 101.15(10) Cologne 80.89 115.84 97.78 115.22(5) 84.63(8) Dortmund 109.19 99.12 97.32 97.51 111.61(9) Duisburg 147.77 118.57 124.98 125.62 167.62(10) Duesseldorf 100.31 134.66 95.19 98.96(9) 86.51(7) Hamburg 84.31 126.46 104.29 95.78 81.78(10) Kiel 68.14 127.54 50.23 55.40 71.41(10) Magdeburg 85.28 68.83 72.60 73.20 81.43(10) Mulheim 124.06 105.35 118.66 107.35 112.64(10) Nuremberg 82.40 108.98 89.37 88.05 74.79(10) Solingen 121.20 123.00 90.81 65.47 74.13(10) Combined Cities 92.38 110.53 92.99 92.11 92.91(10) 62 COMMUNICABLE DISEASES Germany, so that the high case incidence rates of this disease given in Table 10 for 1940 are indica- tive of the degree of prevalence during an epi- demic year. The case rates for the period 1942- 1944 are again normal in comparison with rates for the year 1938. No evidence is given that epi- demic meningitis was a health problem during the years of heavy bombing. The monthly course of case incidence shown in Figure 29 shows no rela- tion between the incidence of the disease and the months or severity of air attacks. The problem of this disease was quite similar to the one in the United States. The disease did not seem to be feared as much as before the sulfona- mide era. Preventive measures were much the same before the war as during the war, and whatever outbreaks occurred were usually blamed on over- crowding. A number of the physicians and public health officers interviewed showed little concern about the disease and all stated that its morbidity and mortality had not changed during the time of aerial warfare against Germany, although living conditions had definitely changed, and crowding in shelters and homes had constituted a good pre- requisite for outbreaks of epidemic meningitis. on mortality from influenza and pneumonia, as shown by the monthly trends of Figure 30. In- creases in the rate following months of heavy at- tacks are shown for a number of cities, including Bremen, Hamburg, Nuremberg, and Solingen, but the increases are along the lines of normal seasonal expectation, and cannot, as here shown, be entirely attributed to the effects of air raids. A further study of the direct effect of air raids on mortality rates, eliminating the effect of seasonal variation, was carried out, the results of which are presented in Chapter Six. It was found there that mortality from influenza and pneumonia did show an in- crease after periods of air attacks. Enteric fevers The total case incidence of the gastrointestinal diseases—typhoid fever, paratyphoid fever, dys- entery, and bacterial food poisoning—is shown in Table 12 for six German cities. It is apparent that for the cities as a group the case incidence of these diseases did not rise during the years of heavy air attacks, in fact, the rates fell from 36.28 in 1942 to 21.30 in 1944. Case rates for the cities sepa- rately show years in which a high incidence oc- curred; in Bochum, for example, the rate was 51.38 in 1943 as compared with 14.00 in 1942 and 23.21 in 1944. However, no trend is evident for the four diagnostic groups taken together. Typhoid and paratyphoid caused little concern during the war. The German physicians said that whatever sporadic outbreaks did occur were usu- ally traced to foreign laborers who had polluted some source of water. Immunizations against ty- phoid and paratyphoid were voluntary (for which see Dr. Conti's explanation under the previous discussion of diphtheria). In view of the fact that in many towns the fire departments used raw, untreated sewage to fight fires which subsequently ran into the sources of drinking water, the ab- sence of epidemics is most surprising. But prior to the war Germany had established a most elabo- rate “typhoid carrier" control and placement system. Bacillary dysentery has always been fairly com- mon in Germany and has its seasonal high during the summer months. The pathogenic organisms in question were the Sonne and Kruse strains. The course of the disease was so mild that the patients were ill from four to five days only and often were able to go to work. There was rarely any blood in the stools and there were no deaths. In 1943 in Influenza and pneumonia Mortality from influenza and pneumonia was low during the years of concentrated air attacks (Table 11). The combined rates per 100.000 for the years 1942-1944, 92.99, 92.11, and 92.91 respec- tively, compare favorably with the rates for 1938 and 1940, which were 92.38 and 110.53. The rates for each of the cities lead to the same conclusion. Duisburg alone possessed an unduly high rate in 1944, 167.62; however, this rate was not greatly higher than that of 147.77 for the city in 1938. In numerous interviews it was brought out that no differentiation was made by the Germans be- tween bacterial and virus pneumonia, or as to the type of pneumococcus responsible for cases of pneumonia. It was emphasized that influenza per se rarely causes death, which is usually the result of a complicating bronchopneumonia. Diagnosis has always been left to the individual physician. Health officers did not require proof by laboratory tests before accepting the diagnosis. In addition to this long established practice, the disruption of trans- portation facilities and shortage of personnel, laboratory animals, and reagents made it difficult to establish accurate diagnoses. It is difficult to assess the effect of air attacks 63 Figure 28 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF EPIDEMIC ENCEPHALITIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 64 Figure 28 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF EPIDEMIC ENCEPHALITIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 65 Figure 29 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF EPIDEMIC MENINGITIS MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES IN NINE GERMAN CITIES Figure 29 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF EPIDEMIC MENINGITIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 67 Figure 30 THE BOMBING EXPERIENCE AND MORTALITY FROM INFLUENZA AND PNEUMONIA IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 68 Figure 30 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM INFLUENZA AND PNEUMONIA IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 69 Figure 30 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM INFLUENZA and PNEUMONIA IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 70 COMMUNICABLE DISEASES Table 12. Annual Case Incidence of Gastrointestinal Disease in Six German Cities in 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Bochum 15.93 16.46 14.00 51.38 23.21 Duisburg 21.31 26.87 81.27 64.57 37.24 Frankfort 19.45 21.08 18.05 21.85 5.09 Hamburg 29.66 44.77 35.62 25.10 17.17 Magdeburg 10.67 30.76 51.99 24.30 26.92 Nuremberg 15.86 34.74 26.38 25.37 34.23 Combined Cities 23.17 35.75 36.28 30.78 21.30 (Rates per 100,000 population; annual basis) Table 13. Annual Case Incidence of Typhoid Fever in Seven German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Bochum 3.82 4.84 4.23 14.68 10.50 Duisburg 4.58 2.78 3.46 10.60 1.50 Frankfort 3.27 0.72 7.66 1.71 1.59 Hamburg 3.10 1.24 2.26 2.75 3.43 Kiel 9.22 20.41 1.39 10.45 2.95 Magdeburg 2.44 1.76 4.07 2.37 5.74 Nuremberg 1.20 0.76 5.11 3.50 4.94 Combined Cities 3.47 2.92 3.65 4.77 3.83 many cities the incidence of this so-called E dysen- tery increased three-fold without a change in re- ported morbidity or mortality rates. Infractions against the rules for boiling water were blamed for this increased incidence. The annual case incidence of typhoid fever is given in Table 13. Nuremberg is the only city in which incidence of the disease appears to have risen during the air attack years. The other cities exhibit rates which are normal in comparison with those of 1938 and 1940 except for occasional years in certain cities, as in Bochum in 1943, Duisburg in 1943, Frankfort in 1942, and Kiel in 1943. The case incidence of paratyphoid fever (Table 14) was high in 1942 and 1943 for the cities as a group; however, the increase occurred only in Duisburg in 1942 and in Bochum in 1943. Case rates for the other cities are fairly normal, except in Nuremberg, where the rates rose from 0.29 in 1943 to 7.06 in 1944. The incidence of dysentery (Table 15) was higher among the cities of this set of tables than for the other three enteric diseases. The rates declined, however, during the heavy air attack years of 1942-1944. For individual cities, the reported num- ber of cases was high in Duisburg during these 71 COMMUNICABLE DISEASES Table 14. Annual Case Incidence of Paratyphoid Fever in Six German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Bochum 4.14 3.55 2.28 28.54 5.53 Duisburg 2.29 3.01 24.78 4.82 0.38 Frankfort 3.45 1.62 2.19 7.03 0.32 Hamburg 5.06 4.84 6.96 4.63 3.24 Magdeburg 1.22 1.76 2.03 1.78 1.32 Nuremberg 9.37 4.03 0.27 0.29 7.06 Combined Cities 4.56 3.67 6.53 6.09 2.97 Table 15. Annual Case Incidence of Dysentery in Six German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Bochum 5.10 8.07 7.49 7.75 6.63 Duisburg 5.73 12.74 50.37 38.23 32.73 Frankfort 12.73 12.43 5.65 13.11 2.54 Hamburg 20.96 37.80 25.98 17.32 9.32 Magdeburg 4.57 25.48 45.89 20.15 19.86 Nuremberg 5.29 29.19 19.92 19.83 16.94 Combined Cities 13.42 26.61 25.14 18.48 12.88 Table 16. Annual Case Incidence of Bacterial Food Poisoning in Six German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Bochum 2.87 0.00 0.00 0.41 0.55 Duisburg 8.71 8.34 2.66 10.92 2.63 Frankfort 0.00 6.31 2.55 0.00 0.64 Hamburg 0.54 0.89 0.42 0.40 1.18 Magdeburg 2.44 1.76 0.00 0.00 0.00 Nuremberg 0.00 0.76 1.08 1.75 5.29 Combined Cities 1.72 2.55 0.96 1.44 1.62 72 COMMUNICABLE DISEASES years, as compared with 1938 and 1940, and in Magdeburg in 1942. No mention of the pathogenic organisms in question was made by any German physician interviewed. A large bacterial food poisoning outbreak oc- curred in Duisburg in 1943 and another in Nurem- berg in 1944 (Table 16). Aside from these two instances of high incidence, cases of this diagnosis reported were normal in comparison with rates for 1938 and 1940. The monthly trends of case incidence of these diseases shown for German cities in Figures 31, 32, 33, and 34. The incidence of typhoid fever rose in Bochum and Cologne following air attacks in 1943, while the epidemic in Duisburg began three months after a series of heavy bombings on the city. The incidence of the disease does not ap- pear altered in any manner related to air raids in any of the other cities for which charts are pre- sented in Figure 31. Paratyphoid fever seemed to increase in a fashion more directly related to air attacks than did ty- phoid. Incidence of this disease was increased in Bochum, Cologne, and Frankfort during and fol- lowing months of heavy air raids. On the other hand, no increase in incidence was shown in the other cities, among* which were the badly damaged cities of Hamburg and Kiel (Figure 32). Dysentery also showed several striking increases in incidence following heavy bombing attacks. Of the nine cities included in Figure 33, only three, Dortmund, Kiel, and Nuremberg, showed no in- crease in dysentery after bombing attacks. How- ever, the fact that the increases came at about the same time of the year, and in a period of high expectancy of the disease impels us to state that the indicated rise in dysentery following air attacks is coincidental rather than as a result of the attacks. Figure 34, the last of the monthly trend charts, for bacterial food poisoning, demonstrates no par- ticular increase in reported cases of this diagnosis and certainly none associated with the bombings of the cities. It would appear then that except for occasional outbreaks of paratyphoid fever, gastro- intestinal disease was not altered in incidence dur- ing or following air raids on German cities. since 1874. The disease has been so rare that most physicians have never seen a case, and the same held true for the war years. Sporadic cases were observed among the foreign laborers, but most per- sons interviewed had seen no cases at all. Smallpox vaccination was the only compulsory vaccination in Germany. It was established by law for the entire Reich, whereas all other vaccinations and immunizations were left up to the individual provinces and states. (See Dr. Conti’s explanation given in the discussion of diphtheria.) It is of interest that in 1942 vaccinations against smallpox were discontinued upon instigation of the Reich Ministry of the Interior. In 1942 a tre- mendous increase in skin diseases, particularly furunculosis, was seen throughout Germany (see Chapter Five on Industrial Health), and it was be- lieved that children with vaccinia or vaccinoid reactions would be endangered by sitting in a crowded air raid shelter, and, on the other hand, that these lesions might spread pyogenic infec- tions among other children and among older peo- ple who were less resistant. No untoward effect was observed, and the rate of smallpox remained negligible. Scabies—Weil's Disease—Other Diseases In the bombed cities there was a great increase in scabies and head lice owing, no doubt, to over- crowding in the air raid shelters. The ease with which these conditions could be spread may be seen in the instance when the large underground shelter in Essen, built to accommodate 35,000 per- sons, was packed with 57,000 during one raid. In several cases it was reported that as many as one-third of a city’s population was burdened with scabies. These conditions were also prevalent among evacuated children because of the lack of soap. The comment on Weil’s disease (spirochaetal jaundice) secured in Hamburg is interesting. Be- fore the war, 50 per cent of all rats were infected. After the raids of 1943, very few cases of this dis- ease were encountered in the city, it is thought be- cause the rat population had been decimated by the bombings, or had left the city for safer areas. No evidence exists that plague, undulant fever, psittacosis, rabies, or anthrax showed any variation from the prewar normal, nor did German medical officials express any concern about these diseases. Smallpox Smallpox has been a reportable disease in Germany, and vaccination has been compulsory 73 Figure 31 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF TYPHOID FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 74 Figure 31 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF TYPHOID FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 75 Figure 32 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF PARATYPHOID FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 76 Figure 32 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF PARATYPHOID FEVER IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100.000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 77 Figure 33 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF DYSENTERY IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES Figure 33 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF DYSENTERY IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 79 Figure 34 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF BACTERIAL FOOD POISONING IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 80 Figure 34 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF BACTERIAL FOOD POISONING IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 81 COMMUNICABLE DISEASES Why there were no epidemics Major C. F. Enloe, Jr. Study of captured German documents and the bulletin of the public health service before going into Germany indicated that there had been no major epidemics in that country despite vast de- struction. At first this appeared inconceivable since the destroyed cities of Germany presented a classic culture media for the spread of contagious diseases to large sections of the population. Houses were down, water mains and sewers were ruptured in the same bomb craters, thousands of decaying bodies lay in the rubble, people lived in conditions of ex- treme overcrowding, and in some cases, all the es- sentials of public health service were lacking. Add to this the frequent reports of burning buildings having to be sprayed with sewage when the water system failed and the fire hoses had to cut into the stagnant sewers and one can see that we were somewhat incredulous when first informed there had been no epidemics in Germany after the raids. The preliminary surveys indicated that the ex- planation of this might prove the most interesting finding of this Branch for in it might lie the basis of maintaining good health under the worst condi- tions. Unfortunately, we were not able to arrive at a conclusion which seems entirely satisfactory. The average person’s proclivity of attributing that which he does not understand to luck is de- veloped to an extraordinary degree in the Germans. This habit seems to have guided many practitioners in answering our inquiries concerning the lack of epidemics for many of them could answer only that they were lucky. While luck may have played its part in saving the German people from epi- demics it seems that something more than fate or divine benevolence contributed to this phenomenon. Perhaps the most important safeguard from dis- ease was the personal habits of the Germans them- selves. They are well-known for their devotion to personal hygiene and their penchant for keeping their homes spotlessly clean and orderly. We visited some of the hovels and cellars in which they lived. It was surprising to see how neat and clean these places were kept in the midst of the ruins. The work of the Luftschutzbund (ARP) probably contributed greatly to the German civilians’ ability to ward off contagious disease, for they made lec- tures on personal hygiene an important part of their training for civilians. Every civilian was re- quired to attend a series of six lectures on first aid and personal hygiene once every three months. These continued through the war and gave the in- dividual a good idea of how to protect his health when all communal safeguards had broken down. Germany had a large well-organized public health service. As explained in Chapter Seven, this organization was enlightened and powerful—and by virtue of this was able to give the German civilians all the protection one could expect. Dr. Conti, the chief, said they operated on the prin- ciple of Robert Koch: to locate the area breeding disease, isolate it, and uncover the source of infec- tion. His contention that the public health service contributed greatly to the avoidance of epidemics appears well founded. Of course, one must keep in mind that the nature of the average German made their work easier and more effective than it might be in other countries. Being a docile individ- ual accustomed to taking orders, the German usu- ally obeyed to the letter regulations issued by the health officers after an air raid. When the health office and police said that rat extermination week would be carried out, it rarely, if ever occurred to a citizen not to conform. When signs were posted ordering the people to boil all their water after an air raid, they boiled their water. The combina- tion of a good public health service and a people who knew the value of personal hygiene and who rarely think of questioning anything their gov- ernment tells them, were a very nearly unbeatable bulwark against the spread of epidemic diseases. Having had a very high standard of health for many years, the Germans were relatively free from carriers of disease. This was not entirely true for diphtheria which has been occurring in epidemic form at cyclic periods for several decades but it does hold, according to most German scientists, for other contagious diseases. By the absence or at least their scarcity the danger of epidemics was reduced. It is true that during the last months of the war failures of the physicians to report communicable diseases were certainly more frequent. This has, no doubt, somewhat affected the statistics. Nevertheless, the personal investigations by members of the Medical Branch failed to reveal any variation in the incidence of contagious dis- eases which might alter these conclusions. We be- lieve that the air raids contributed somewhat to an increase in scarlet fever and other streptococcal infections and in paratyphoid fever, and they were largely responsible for the increase in the inci- dence of typhus fever, diphtheria, and scabies, and in the mortality from whooping cough. 82 COMMUNICABLE DISEASES TUBERCULOSIS GEORGE A. WULP, M.D., HARTFORD. CONNECTICUT LIEUTENANT COLONEL JOHN H. WATKINS. SANITARY CORPS. AUS An increased incidence of tuberculosis and an in- creased mortality from this disease is not new in war. The tuberculosis death rate, which had been declining since the turn of the century, rose sharply in Germany with the second year of World War I and continued to a peak in 1918. After a second smaller increase in 1923 at a time of great economic instability, the tuberculosis death rate fell gradually to 60 per 100,000 population in 1939. Since that year the rate has again increased; in 1943 it was 74 per 100,000 population. Figure 35 shows the trend of the disease from 1925 to 1943. Figure 36 is a graph of the number of cases and the deaths in Germany for the period 1940 through 1943. Com- plete numbers of cases and deaths and reliable pop- ulation data upon which to base 1944 rates for the country as a whole did not come into the posses- sion of the Medical Branch; however, the informa- tion which was obtained indicates that the increase in tuberculosis did not continue into 1944. For ex- ample, the new cases of tuberculosis reported for the first nine months of 1944 were 98,300 compared with 98,800 new cases in the same period of 1943. Deaths from tuberculosis, however, continued to rise; 47,100 were reported in the first three quar- ters of 1944 as compared with 42,100 in 1943. The increase shown in the first four years of World War II was not as great as the increase in the similar period for World War I. During World War I, the influenza epidemic was in large part responsible for a large number of deaths recorded as resulting from tuberculosis, a fact which does not permit us to compare the proportional increase during World War I with that of World War 11, A distribution of the incidence and mortality of tuberculosis by age groups was not available for Germany as a whole, however Figure 37 shows the distribution by age groups for the combined dis- tricts of Frankfort, Breslau, Stettin, Arnsburg, and Schwaben for October to January in the years 1941- 1942, 1942-1943, 1943-1944. The charts show an increase at all ages in the number of cases of pul- monary tuberculosis. The proportional increase was greatest for ages under 20 but a large and significant rise also occurred throughout the life span. The in- crease in deaths from other forms of the disease took place only at ages under 10 years. The annual case incidence of tuberculosis in seven cities is shown in Table 17. The combined rate for the seven cities of that table was 132.76 in 1938, and 141.98 in 1940; by 1942 the rate had risen to 171.05 and by 1944 to 207.60. The increase over 1938 and 1940 was general for the individual cities. The sharp rise in 1944 for the combined cities was largely owing to the heavy increase in Magde- burg for that year. Annual mortality rates for German cities for the same time period are given in Table 18. The death rate for the combined group of cities was 60.39 in 1938 and 66.76 in 1940. By 1942 the death rate had risen to 76.22 and continued to increase to 80.57 in 1944. The increase in mortality for the later bomb- ing years of the war is evident for all but two of the thirteen cities in the table; however, the pro- gressive rise in mortality during the three years 1942-1944 shown by the combined rates for the thir- teen cities is only apparent in one city, Augsburg. Other separate instances may be cited to corrobo- rate the fact of a national increase in the disease. In Darmstadt, for example, with a population of 114,000 before the war, 150 cases of open tubercu- losis were in hospital; with a population of 110,000 in June, 1945, the number of cases had risen to 323. In Munich the total number of open cases increased from 2,367 in 1939 to 4,114 in 1944. Stuttgart showed a similar increase and when the Medical Branch investigated the disease in May 1945, it was reliably reported that the municipal tuberculosis clinics had under observation 2.16 per cent of all the inhabitants of that city. In communities where statistics were not available, interviews with doc- tors and officials in the public health departments had to be relied upon. Without exception, such au- thorities reported an observed increase in the mor- bidity and mortality of tuberculosis which was di- rectly proportionate to the assembled data on the 83 Figure 35 THE MORTALITY RATE FROM TUBERCULOSIS IN GERMANY, 1925-1943 84 COMMUNICABLE DISEASES Reich as a whole. In an interview with Dr. Leonardo Conti, chief of the German public health service, the over-all increase in tuberculosis was again stressed. He pointed out the return of the incidence of this disease to the high rate recorded in the eco- nomic depression of 1933 when the Nazis came into power. Monthly trends of the case incidence and mortal- ity of tuberculosis compared with the bombing pat- terns are shown in Figures 38 and 39. Little or no indication is given in Figure 38 that an immediate rise in tuberculosis followed a siege of heavy air attacks. The same is true for the charts of mortality (Figure 39). If the increase from tuberculosis throughout the country is definitely associated with the air attacks, the development of the disease must have occured gradually and in association with other factors so that the particular effect of bomb- ing on the cause of the disease is hidden. It is not surprising that the mortality rate of the disease fails to show a direct rise following periods of air activ- ity, since the evacuation of tuberculosis patients to rural hospitals and sanatoriums, with no allocation of deaths back to the place of residence, prevented the inclusion of such deaths in the urban rates of tuberculosis mortality. What were some of the factors responsible for the increase in tuberculosis during the war? The answers to this question, collected from interviews with the German health minister and with hospital and local health department doctors throughout Germany, are remarkably consistent. One of the reasons is the fact that beginning in 1942 a national campaign under the auspices of the Roentgen Abteilung der Waffen SS, Roentgen Sturmband started a program for the fluroscopic ex- amination of every German citizen which turned up many new cases. According to Dr. Conti, some 15,- 000,000 people were examined. The system used was to fluoroscope whole communities at a time; inhabitants above preschool age reported to the ex- amining station, usually a school, on several con- secutive Sundays. For example, in Stuttgart, 98 per cent of the population were thus examined. In doubt- ful cases or in cases where there was obvious path- ology, roentgenograms were made. Such a mass screening of course brought to light many inactive and open cases which had hitherto been undetected and which, when reported, swelled the statistical total, especially for the years 1942 and 1943. This procedure could pick up only the cases of pulmonary tuberculosis and since there was also a known in- crease in extrapulmonary tuberculosis, this mass fluoroscopy campaign is not the only factor which must he considered in evaluating the over-all pic- ture. The second most commonly voiced cause was the poor nutritional state of the people as manifested by almost universal weight loss. Although there was little evidence of actual malnutrition or starvation (see Chapter Eleven), the lack of fats in the diet, and in the later years of the war a diet barely adequate in the amount of other foodstuffs, with a consequent lowering of caloric intake, would Table 17. Annual Case Incidence of Tuberculosis in Seven German Cities in 1938, 1940, 1942-43-44 (Rates per 100,000 population; annual basis) City 1938 1940 1942 1943 1944 Bochum 113.06 140.47 198.37 214.48 236.57 Duisburg 123.25 184.56 279.81 219.12 252.79 Frankfort 89.82 160.52 189.12 191.73 Hamburg 128.43 107.32 110.59 111.29 164.45 Kiel 207.62 173.46 218.59 331.36 260.31 Magdeburg 242.74 270.93 316.27 320.37 404.71 Nuremberg 100.18 86.07 114.13 105.25 111.53 Combined Cities 132.76 141.98 171.05 174.50 207.60 Figure 36 CASES AND DEATHS DUE TO TUBERCULOSIS REPORTED IN GREATER GERMANY, 1940-1943 86 COMMUNICABLE DISEASES Table 18. Annual Mortality From Tuberculosis in Thirteen German Cities in 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Augsburg 47.59 54.12 53.94 58.94 76.66 Bochum 70.70 93.65 114.01 108.46 112.96 Bremen 69.90 79.05 82.09 83:25 81.14 Cologne 61.35 69.45 79.03 111.81 89.17 Dortmund 66.11 80.01 87.38 81.86 119.12 Duisburg 71.48 78.04 108.19 104.42 124.41 Duesseldorf 59.40 56.40 65.45 77.76 72.90 Hamburg 56.15 58.83 66.83 61.01 66.90 Kiel 53.31 48.83 39.84 39.72 26.56 Magdeburg 56.95 55.36 80.16 81.80 79.34 Mulheim 57.60 56.29 55.22 46.60 49.43 Nuremberg 61.50 80.29 87.21 81.34 81.06 Solingen 43.69 56.25 71.35 68.92 81.65 Combined Cities 60.39 66.76 76.22 77.17 80.57 (Rates per 100,000 population; annual basis) tend toward a borderline nutritional state. This was especially true with young people who had to do harder work in factories and on farms than they were accustomed to. It is not surprising, therefore, to find it is in this group that the increase in tuber- culosis is most noticeable. Quiescent cases were not infrequently activated from this cause. No supple- ments to the normal food ration were granted to persons exhibiting a predisposition to tuberculosis. Indeed, no added food allowance was granted un- less a diagnosis of tuberculosis had actually been made and confirmed by the municipal tuberculosis clinic. The increase in deaths from other than pulmonary forms of tuberculosis at ages under 10 years, shown in Figure 37, indicates that an increase in bovine tuberculosis occurred among children. This increase was brought about by a breakdown in the sanitary precautions for the production and distribution of milk. Another factor frequently cited was the poor liv- ing conditions resulting from air raid damage: ex- posure to the elements, crowding in damaged houses and cellars, and lack of facilities for the main- tenance of good personal hygiene. The number of upper respiratory infections increased, and occa- sionally precipitated an active tuberculosis. The mental stress and strain of living under such cir- cumstances and the lack of sufficient rest because of the persistent night raids and alarms were also fre- quently given as contributing factors. The confusion caused by the disruption of civilian health controls following a heavy raid or a series of attacks made it extremely difficult for the au- thorities to exercise their tight control over the ac- tive cases of tuberculosis who were not hospitalized. There were both independent and mass migrations out of the cities, people moving from place to place within a city seeking shelter from bombed-out homes, and similar conditions which rendered it impossible for some time after an attack to trace down and locate again these dangerous carriers of disease. The most effective means of persuasion in bringing tuberculous individuals back to the tuber- culosis clinics was the authority granted them to issue supplemental food rations each week to the 87 Figure 37 DEATHS FROM TUBERCULOSIS IN THE DISTRICTS OF FRANKFORT, BRESLAU,STETTIN, ARNSBERG AND SCHABEN, BY AGE GROUPS OCT. TO JAN. 1941-42, 1942-43 AND 1943-44 88 Figure 38 THE BOMBING EXPERIENCE AND CASE INCIDENCE OF TUBERCULOSIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 89 Figure 38 (continued) THE BOMBING EXPERIENCE AND CASE INCIDENCE OF TUBERCULOSIS IN NINE GERMAN CITIES MONTHLY CASE RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 90 Figure 39 THE BOMBING EXPERIENCE AND MORTALITY FROM TUBERCULOSIS IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 91 Figure 39 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM TUBERCULOSIS IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 92 Figure 39 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM TUBERCULOSIS IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 93 COMMUNICABLE DISEASES identified tuberculous patients. Another problem which the air raids imposed was that of how to protect the uninfected population in the crowded shelters. Theoretically, a person ill with open tuber- culosis was prohibited from entering the public air raid shelters. Despite this they were often thrown into close contact with people in these shelters and in crowded living quarters, thus spreading their infection. Other cases were also lost track of when they were sent home because the sanatorium in which they were patients was taken over for an- other purpose and the records were closed or dis- carded. In addition to the increase in the actual number of cases, the general opinion among the physicians seemed to be that an increase in the number of cases of the more rapidly progressing exudatative type occurred. This was especially true among the Rus- sian laborers, who seem to have been particularly susceptible to the disease and therefore must be considered as contributing to its spread. The tuberculosis control program, in addition to the nation-wide program of fluoroscopy previously mentioned, included clinics which were established by Conti in each state and county under the direc- tion of the national health department. They con- sisted of a specialist (either part- or full-time), one or more nurses, and complete laboratory and roentgenologic equipment. Attached to these clinics were also several medical social workers for fol- low-up work with the patients in their homes. Ad- mission to a sanatorium depended Upon the recom- mendation of these clinics. Summary An increase occurred in the number of cases of tuberculosis reported in Germany after the outbreak of the war. Some of the causes for the increase which can be attributed indirectly to aerial bomb- ing are: crowding in air raid shelters, exposure to the elements, poor housing conditions resulting from the destruction of housing facilities, defective milk sanitation, increased nervous tension and nerv- ous fatigue, and loss of control over some patients who had to leave their homes or cities. Fluoroscopy of all German civilians was an attempt to control the expected increase in the tuberculosis case rate, but increasing pressure on the nation made the completion of this ambitious program impossible. Tuberculosis has been a serious problem to the health authorities in every country where war meant greatly lowered living standards, extreme overwork, and a governmentally regulated diet which has not yet proven adequate when rationing becomes severe. In England and Germany, two countries in which tuberculosis authorities were questioned, the war presented the ideal set of conditions optimum for the incubation and transmission of pulmonary tuber- culosis. There now appears sufficient evidence to warrant the conclusion that this new type of war- fare namely, the bombing of city areas for strate- gic purposes compounds the problem of tubercu- losis in wartime. The remarkable fact that tuberculosis or any other disease was not more prevalent can, according to Dr. Conti, be attributed to the general good health of the nation when the war started and to a well- organized national and local public health service. VENEREAL DISEASES HERMANN K. ROSMANN, M.D., MADISON. WISCONSIN Throughout the German Reich communicable diseases, occupational diseases, crippling conditions, and abortions are reportable. Reporting of venereal diseases, however, was never required. Nevertheless, the national law of February 18, 1927, which con- cerned the control of venereal diseases, under certain circumstances obligated the physician to report to the health department patients who either discon- tinue venereal disease treatment or observation, or who by reason of their occupation or personal con* duct especially endanger other individuals. To increase the efficiency of control, on Septem- ber 18, 1939, the Minister of the Interior ordered that in each case of confirmed venereal disease the source of infection must be investigated immediately and thoroughly. Health departments, venereal disease clinics, and physicians were obligated to fill in a special form which enabled the authorities to find 94 COMMUNICABLE DISEASES the person in question. Professional secrecy had to be strictly observed. Destitute patients were entitled to free treatment provided for by public means. On the other hand, severe punishment was in store for an infected person who knowingly spread a venereal disease. Paragraph 4 of the law refers to clandestine pros- titution and brothels and reads as follows: “Persons suspected of harboring and spreading venereal disease can be forced to submit a health certificate to the respective department of health." Persons be- longing to this category were defined as prostitutes, men and women promiscuous in their relationships, and, since September 18, 1939, waitresses, “taxi- girls,” etc. It is of some point here to review how the German authorities have tried to manage this difficult prob- lem. Until 1927 prostitution was officially sanctioned although legally forbidden. According to the Reich Criminal Code, it was a punishable offense for a woman to offer herself for indiscriminate sexual intercourse in return for money. Nevertheless, pros- titution was not prosecuted if the woman in question registered with the police and complied with the rules for her supervision. Brothels, although offi- cially forbidden, were tolerated. Regulation was ap- plied exclusively to women and only in so far as they derived the means for their support from prostitu- tion. The result was that an insignificant fraction of the promiscuous men and women became known. Women prostituting themselves were driven under- ground to become forever the tools of racketeers, and the transmission of venereal disease continued. General recognition of this absurd situation led, in 1927, to the revision of the obsolete statutes. The regulation of prostitution, with its system of periodic health examination, was abolished. In its place, a new nation-wide system of health service for the control of venereal disease was created. The new statutes made it a misdemeanor for anybody, man or woman, regardless of social position, publicly to solicit illicit sexual intercourse in a manner violating morals and decency. Commercialized fornication was prohibited in close proximity to schools and churches, in apartments where children were living, and in communities with fewer than 20,000 popula- tion. The operation of brothels and similar houses, such as the so-called “massage parlors,” and of special streets and red-light districts was forbidden. Police assisted the official health departments in operating the health service, and in the protective custody of people without shelter and of youths in danger of becoming delinquent. The Nazi regime, in the belief that these regulations contributed toward "immoral behavior," took countermeasures: they reintroduced weekly health examinations of known prostitutes and strengthened the powers of the police in supervising streets and restaurants for manifestations of immorality. That the red-light districts came back to life is revealed in the June 5, 1942, issue of a periodical called The Public Health Service; an article covering the subject of venereal disease reveals that in the city of Munich, a red-light district with 54 prostitutes was operating and the opening of a second one was planned for the near future. As to the city of Ham- burg, 70 prostitutes lived during the years 1942-1943 in certain buildings and streets especially controlled by the police who kept order and furnished necessary protection. I he important venereal disease clinics set up originally by the national insurance organization were suspended and taken over on March 31, 1943, by the municipal health departments. Their functions were carried on and consisted of: (1) free examina- tion, (2) investigation of the source of infection, (3) observation, control, and treatment of the patients, and (4) assumption of expenses. In addi- tion, elaborate pamphlets covering each of the vene- real diseases were handed to each patient. But, as prevention of the venereal diseases still proved to be the better policy, a widespread propa- ganda was initiated by education in public schools, by talks and lectures given to women’s societies, and through distribution of posters in public places. Furthermore, the Reich law of October 18, 1935, concerning the protection of racial health, required a health certificate for any person engaged to marry. Thus premarital serologic examination is implied although not required. Since 1940, concealment of a former syphilitic infection has been a valid reason for divorce. Health certificates have been required for wet nurses, infants attended by wet nurses, and children placed in foster homes. Prophylactics against venereal disease were allowed to be sold legally and a number of large cities distributed pro- phylactics free of charge through their first aid stations. Nation-wide surveys taken by the government in 1927, 1934, and 1940 revealed the prevalence of venereal disease. Based on the evaluation of the find- ings for the year 1927, a yearly admission rate of 400,000 newly infected cases was calculated, but by 1934 the number of fresh cases was reduced to 225,000, and at the end of the first war year, 1940, 95 COMMUNICABLE DISEASES the number was further reduced to 170,000 despite the rampages of the war.2 According to Conti, in the coming years it was planned to study the situation locally, including the cities of Munich, Frankfort, and Hamburg; later on a national survey was to complete the regional findings. In the October 11, 1941, issue of The Public Health Service, a lecture published by Dr. Keim, a high official in the public health service, listed the most important conclusions about venereal disease as: 1. The results in discovering the sources of vene- real diseases were still not too satisfactory despite the fact that compulsory reporting was resorted to. For instance, in Munich in the year 1940, 78 re- ported infection-spreading persons could not be found. In the year 1941, 99 such individuals could not be found. 2. In 1940, 90 persons were listed in Munich as possible infection carriers; in October, 1941, 471. 3. In October, 1941, 236 promiscuous individuals were under observation by the Munich health de- partment. In the year 1940, in Munich, 1,414 persons were examined as venereal disease contacts; 204 or 14.4 per cent of the diagnoses were positive on the first examination. 4. A national census conducted in Germany in June, 1940, revealed these figures, given as rates per 10,000 inhabitants: 20 per cent below the national average; the rate of venereal disease in women exceeded the national average by 20 per cent. Valuable information regarding venereal disease during the war years was given by the city health department of Munich on May 31, 1945. The report reads: The city health department performed in the last years approximately 10,000 examinations for venereal disease. New cases of gonorrhea stayed be- tween the yearly average of 700 to 800. Even during the war, the number was kept at the same level. The situation differs in regard to syphilis. During the years 1939 to 1942, the number of new infections remained the same but in 1943 new infections in- creased by 110 per cent. In 1944, another 60 per cent increase above the 110 per cent was noted. Special- ists in Munich interrogated by the city health depart- ment stated that all of them observed the sharp increase in syphilis. The conditions existing in the city of Frankfort regarding venereal disease are disclosed by the study of the reports of the sick benefit insurance ex- change which are shown in Table 19. The figures for syphilis starting in the year 1940 show a tremendous increase of 200 per cent for the year 1942. Taking 1939 as a base, gonorrhea and other venereal diseases went up approximately 88 per cent in 1940, increased 262 per cent by 1941, and dropped 154 per cent by 1942. In Hamburg, the health department had to face the same difficulty as in other cities for there was no law requiring registration of persons with venereal disease. Data could be obtained only by inquiry of the practicing physicians and clinics. The last sur- vey made in the summer of 1940 did not reveal any increase of venereal disease. In 1941, however, syphilis was on the march even though an increase New Cases New Cases Venereal Disease in Germany in Munich Syphilis in men 4.3 3.5 Syphilis in women 3.6 4.3 Gonorrhea in men 25.1 19.0 Gonorrhea in women 12.9 16.3 Soft chancre in men 0.5 0.6 Soft chancre in women 0.1 0.0 In Munich the rate of venereal disease in men was Table 19. Cases of Venereal Disease in Frankfort, 1939-1942 Year Members Venereal Disease Men W omen Total 1939 156,210 Gonorrhea and others 61 34 95 Syphilis 14 15 29 1940 157,906 Gonorrhea and others 32 147 179 Syphilis 16 17 33 1941 166,389 Gonorrhea and others 59 285 344 Syphilis 46 35 81 1942 161.058 Gonorrhea and others 39 202 241 Syphilis 41 49 90 COMMUNICABLE DISEASES Table 20. Venereal Disease Among Females in Hamburg 1939-43 From Ortskrankenkasse (municipal health insurance exchange). Year Average Female Members Syphilis Gonorrhea Total Annual Cases per 100,000 Members Total Annual Cases per 100,000 Members 1939 145,800 93 64 266 182 1940 150,500 102 68 282 187 1941 133,200 124 93 295 221 1942 147,600 181 123 293 199 1943 147,900 64 173 76 206 (1st quarter) • of 1.3 per cent was not alarming. Gonorrhea and other venereal diseases stayed at the same level. The year 1942 showed a further increase in syphilis and a further increase in gonorrhea and other venereal diseases. For 1943, the health department stated: The physicians agree that the venereal diseases are on the increase. Women suspected of venereal disease are more frequently found infected on examination. Through destruction of the houses in the red-light districts by bombing, the original number of prosti- tutes was reduced to about half (350) ; therefore, the frequency per day per prostitute increased from 20 to 30. Prices were low, ranging from 2.50 to 10 Reichsmarks. Visitors had plenty of money and the motive in many cases was the result of the “escape mechanism.” The restriction in the supply of con- doms meant a further increase in venereal disease. The figures tabulated by the Hamburg health depart- ment (Table 20) confirm the presumption that a positive connection exists between the number of frequentations and the number of infections by pros- titutes. Indications were that syphilis is on the in- crease; gonorrhea and the other venereal diseases also have increased, but only on a slighter scale. Unfortunately, the municipal health insurance ex- change stopped the assembling of statistics at the end of 1943. Statistics for the second and third quar- ters of 1943 are incomplete since the major attacks upon the city fell in this period, and therefore they were left out in the table. Dr. Conti, chief of the public health service, was eager to collect information on all of Germany for the year 1942. As the general practitioners and spe- cialists whom he asked for reports prior to this year were so overworked he approached this time the health departments, 70 per cent of which had ob- served an increase in venereal disease. The investiga- tion of rural districts made it clear that neither foreign labor nor Germans evacuated from bombed areas played any important role in spreading vene- real infections. The main sources of venereal disease in remote agricultural regions were the soldiers on furlough and the convalescent members of the armed services. Dr. Conti was confident that the control of venereal disease carried out by civilian and military authorities would be effective in controlling this spread. Unfortunately, Dr. Conti was unable to cite definite figures to support his statement. Of several physicians interviewed, Dr. Voight, chief of the health department, stated that venereal disease in- creased considerably in the last years despite the fact that statistical reports do not show higher figures in comparison to former years (venereal disease was not reportable). The marked difference between the increase in syphilis and the increase in gonorrhea can be ex- plained by the fact that gonorrhea still was con- sidered by a number of patients as a relatively harm- less disease and they resorted to self medication with sulfa drugs. Prostitutes and other promiscuous indi- viduals used sulfa medication as well. Treatment with arsphenamine was preferred for syphilis. Physicians in charge of health insurance found that their patients showed certain minor reac- tions, but the doctors of a large institution which took care of sailors could not confirm this observa- tion. Penicillin was not used for gonorrhea. The sulfonamides were used alone or in combination with artificial fever. 97 COMMUNICABLE DISEASES Summary Statistical information on the prevalence and trend of venereal disease in Germany and its rela- tionship to the effect of bombing is scant and fails to give an adequate picture of the situation. Al- though the diseases appear to have increased in in- cidence, many factors are at work to account for the increase aside from air attacks. In common with other countries, the state of the German popu- lation during wartime, with disrupted families, a desire for release and excitement with money no longer a restrictive factor is conducive to greater sexual promiscuity with its consequent toll in in- creased venereal diseases. Conditions created by air attacks may have played a part in this scheme but alone can hardly be held to account for an above-the-average incidence of these diseases. To control clandestine prostitution with its in- herent possibility of infection, even the totalitarian system was forced to reverse its original opinion and to sanction red-light districts in the larger towns. Beginning in 1941, syphilis increased alarmingly over the level of the year 1939, by 170 per cent in Munich, by 200 per cent in Frankfort, and by 100 per cent in Hamburg. In Munich gonorrhea and the other venereal diseases stayed at the same level during the war years. Frankfort reported an increase of 262 per cent and a slight increase was reported in Ham- burg over the 1939 level. PSYCHOSOMATIC DISORDERS CAPTAIN ASHER 5. CHAPMAN, MEDICAL CORPS. AUS Certain functional and organic diseases consid- ered in this section derive totally or in part from conditions which are generally considered to be an important factor in their production or aggrava- tion and which exert a psychic effect upon the in- dividual. Disorders such as bronchial asthma and hay fever, in which allergic factors play an impor- tant role, will not be included in this discussion. Diseases of purely neuropsychiatric nature are pre- sented in the final section of this chapter. There are several sources of information which form a basis for the subject under discussion. Sta- tistical data concerning psychosomatic diseases among the civilian population of Germany are meager because these diseases are not reportable. Furthermore, diagnostic errors inherent in the classi- fication of these diseases are great, and statistics compiled from the usual sources are therefore liable to error. The most important and reliable information was obtained from interviews with specialists in the par- ticular fields considered. Their opinions were formed on a basis of clinical observation in the hospitals, in the universities, and in private practice before the war and during the period of war and aerial bombing. For the most part, these informants are outstanding in their fields and internationally known in medical, circles. Certain statistical material regarding the inci- dence of the diseases under discussion was obtained from the records of the local offices of the govern- mental insurance exchanges (Ortskrankenkasse). Diagnostic error incurred in the compilation of these data is no doubt considerable; however, the outstanding variation in the incidence of diseases before and during the war about which this report is concerned, in many instances far outweighs the inherent error in the compilation of the data. These data correlated with and reinforced the expressed opinion of the medical specialists and other medical personnel who were interviewed. Circumstances of war and especially those condi- tions directly or indirectly existent incident to aerial bombardment produced a psychologic environment which can be considered ideally conducive to the production of psychosomatic disorders and for the aggravation of diseases which are influenced by emotional factors. Thus the German civilian was subjected to inter- mittent or almost constant threat of danger by air raids, not only a threat to himself but to his family and loved ones as well. If he escaped bodily injury or death he might find his home in ruins and the material gain of a lifetime lost. He often found it necessary to alter the accustomed pattern of his life. New and difficult problems confronted him and his 98 COMMUNICABLE DISEASES family. Frustration faced him at every turn. Fear, terror, anxiety, and grief beset him. Hope often was lost; resentment and undischarged hostility replaced the healthful course of productive enterprise as the reward of his efforts. It is evident the German civilian was placed in an environment considered ideal for the production of psychosomatic diseases. The disorders found or those which one would ex- pect to occur under these conditions are discussed in the following paragraphs. Mann of Cologne. Ulcer formations described, which were seen frequently since the onset of aerial bombardment, were characteristically, although not always, located in the stomach and usually in the cardia. Often there was acute ulceration of the duodenum on the anterior or posterior wall. The acute ulcers of the stomach were penetrating in type and extended deep into the muscular wall. They were large (frequently thumbnail in size or larger), and there was little or no scar tissue formation about them, indicating the acute nature of the lesion. Although some variance of opinion existed re- garding the incidence of complications in peptic ulcer during the war years, it is probably true, ac- cording to the opinion of competent surgeons, that there was an increase in perforation and hemorrhage of peptic ulcers. These complications have been re- ported to occur frequently during air raids. Analysis of cases suffering from the acute type of ulcer formation showed that gastric hyperacid- ity, such as is frequently found among patients suf- fering from chronic duodenal ulcer, usually was not present. Analysis of data from governmental insurance groups demonstrates an unmistakable increase in the incidence of ulcer patients during the war years and especially during periods in which the particu- lar areas were subjected to bombing. Furthermore, the areas which received little or no bombing showed little or no increase in the incidence of peptic ulcer. It is evident that the conditions brought about by war and especially by bombing contributed a psy- chologic factor to this increased incidence. Gastritis was considered by many to have in- creased during the years of war and especially during the periods of bombing. However, the term gastritis is used rather loosely and a diagnosis of gastritis is frequently difficult. No definite statement regarding this disease is warranted from the evi- dence at hand. Interrogation of German physicians concerning the incidence of ulcerative colitis was likewise in- conclusive. Again the question of a proper differ- ential diagnosis arose. No good evidence was gathered which would indicate that there was an increase in this disease during the war years. Gastrointestinal disorders There was a marked increase in the incidence of peptic ulcer among the German civilian population during the war years. It was noted particularly among young people, and the incidence was greater among women than is customarily encountered. The factor mainly responsible for this increase, according to Dr. Wilhelm Stepp, professor of in- ternal medicine at the University of Munich, was the tension and nervousness brought on by frequent air raids. Another factor considered to be opera- tive, according to Professor Alfred Schittenhelm of the University of Munich was a decrease in the pro- tein and fat content in the diet. However, most au- thorities interviewed agreed that the anxiety, ten- sion, and uncertainty brought about by the bomb- ings were the greatest factors in the increase of peptic ulcer. That such was the case was evident from the few cases of ulcer formation found in areas not subjected to air raids. The characteristic history given by patients with peptic ulcer during wartime has been described by Dr. Victor Hoffman:1 the onset often occurred sud- denly during an air raid alarm or the air raid itself in individuals who had not experienced any pre- vious gastrointestinal symptoms. A sense of pressure or burning in the epigastrium or left hypochon- drium occurred. Radiation of pain to the back or shoulder was often' present; abdominal pain oc- curred spasmodically, recurrently, or almost con- stantly. Nausea, belching, and vomiting were fre- quent. Intermeal pain, typical of peptic ulcer, may or may not have been present; however, food usu- ally gave relief. The course continued acutely for a period of eight days to three weeks at which time roentgenologic evidence of peptic ulcer usually could be demonstrated. From this evidence, it was apparent that these ulcers were very rapidly formed. Surgical and roentgenologic findings in these cases have been described by Professor G. E. Konjetzny of Hamburg and by Dr. Victor Hoff- Endocrinologic disorders Diseases of the thyroid gland, as the exopthalmic type of goiter or Graves’ disease, come first to mind in the consideration of endocrinologic diseases with 99 COMMUNICABLE DISEASES real disease rate. The relationship of these disorders to wartime conditions is not clear-cut. (See the sec- tion on venereal diseases in this chapter.) a probable psychologic etiology. It is commonly, considered that emotional and psychologic factors are at least a precipitating cause for this disease. The accumulation of data on this subject was of particular interest. The incidence of this disease is far less under normal conditions than that of peptic ulcer and coronary heart disease. Consequently, variations in the incidence are of small magnitude. The clinical experience of Professor Schitlenhelm has led him to the opinion that there was a definite and considerable increase in the incidence of Graves’ disease during the war years. Professor Stepp is in concurrence with this opinion, stating that the dis- ease increased threefold since 1939. Both are of the opinion that the environmental circumstances brought about by aerial bombardment were the outstanding precipitating factors, and the poor nu- tritional state of the population was a secondary factor. Frequently cases of acute crisis were pre- cipitated during the air raids. The course of the disease during the war years was extremely malig- nant. Analysis of the statistical data of the governmental insurance groups concerning the incidence of thyroid diseases is not conclusive. In most, but not all areas, the incidence was increased; hut because of the relatively low occurrence of this disease the increase was less spectacular than occurred in peptic ulcer. However, it was probable that a definite, moderate increase of Graves’ disease occurred during the war and that aerial bombardment was a primary factor in its production. Disorders of menstruation were extremely fre- quent. Dysmenorrhea, amenorrhea, and intermen- strual bleeding presented a major problem to the gynecologic clinics of Germany during the war years. Menarche (initial onset of menstruation) oc- curred later in life in girls during wartime. The marked increase in painful menstruation, amenor- rhea, and intermenstrual bleeding was associated particularly with bombing attacks, with the evacu- ation of patients to outlying areas, and with various types of heavy work to which many women were unaccustomed. Dr. Linzenmeier of Karlsruhe, Pro- fessor Eymer of Munich, Professor W. Heinemann of Hamburg, and others stated that the origin of these disorders was primarily and definitely psy- chic; and second, that they believed that certain nutritional factors contributed to their production. Psychic impotency among men was rare. On the contrary, increased sexual desire was present, as evidenced by a rise in prostitution and in the vene- Cardiovascular disorders Psychologic factors exert an important influence on the precipitation or aggravation of certain cardio- vascular diseases; because of this it was of interest to determine the effect of warfare and bombing upon the incidence of these diseases in Germany during a period when the population was under great psy- chologic and emotional stress. Functional arrhythmias were not greatly in- creased during the war years; neither was the so- called neurocirculatory asthenia syndrome reported to have been seen with any great frequency. The outstanding effect on the cardiovascular sys- tem resulting from wartime conditions and espe- cially bombing was a distinct rise in the incidence of coronary heart disease. Internists uniformly re- ported that this disorder increased during the war years and that it was associated with the situations brought on by bombing or by the threat of bomb- ing. The incidence of anginal pain among individ- uals who had previously suffered became greater during periods of air raids; likewise, anginal symp- toms occurred with greater frequency among people not previously affected. Many of these patients had no electrocardiographic evidence of coronary dis- ease. Severe anginal attacks were frequently pre- cipitated by air attacks. Coronary thrombosis occurred with increased fre- quency during periods of bombing, especially a fatal coronary thrombosis among men in their 30’s and older. This occurred so frequently it was called “the shelter death of the aged.” Professor Stepp of the University of Munich reported that many patients, and especially those in the younger age group, who had died a cardiac death that was par- ticularly associated with coronary symptoms, were found to have no morphologic evidence of arterio- sclerosis of the coronary arteries. Before the war, coronary insufficiency among younger men occurred infrequently; since the war it was frequently seen. Medical authorities concurred that circumstances brought about by air raids were a major factor in the production of coronary heart disease. Second- ary factors which were considered to influence the incidence of this disease were an increase in the use of tobacco, prolongation of the hours of work, and the everyday annoyances of life in a war-torn country. 100 COMMUNICABLE DISEASES Statistical data from the records of the local in- surance exchanges showed definitely that the inci- dence of angina and other coronary disease in- creased during the periods when an area was sub- jected to heavy air attacks. Little or no increase in the incidence of hyper- tension or hypertensive heart disease was noted. However, several informants reported that a greater number of cases of hypotension were seen during the war. Hypotension tended to occur in patients 50 years of age or older. Possible causes were thought to be a nutritional deficiency or the excite- ment caused by air attacks. The incidence of cerebral hemorrhage was re- ported by some to have increased during periods of air raids, frequently occurring during an attack; however, this increase was not noted by all authori- ties who were interviewed. Peripheral vascular disorders were not common- ly noted to have increased during the war. In some instances it was felt that there was some increase in the incidence of Raynaud’s disease, or in its aggra- vation, which could be associated with bombing attacks. there was a moderate amount of insomnia. Anorexia was not an uncommon complaint. More frequently, patients suffered from diarrhea of neurogenic origin often requiring hospitalization. Dr. Meissner of the University Eye Clinic at Munich reported a definite increase in the incidence of glaucoma during the war, which he attributed to the nervous tension and excitement resulting from air raids. This state- ment was likewise corroborated in several large eye clinics in Germany and is furthermore reflected in the statistics of the governmental insurance ex- changes. Summary The circumstances associated with total war and especially the effects of aerial bombardment were influential factors in the increase of psychosomatic diseases in Germany. This was evidenced most by the greater number of cases of peptic ulcer, and more specifically, by the production of a characteristic ulcer, usually of the stomach rather than of the duo- denum, with the clinical onset rather acute and the ulcer large and penetrating in type. The increase in the incidence of coronary heart disease was particu- larly noticed among younger patients in whom arteriosclerosis was absent. However, in view of the tremendous exogenous stimuli which offered a fertile ground for the de- velopment of psychosomatic complaints, the rela- tive infrequency of the development of these dis- orders among the population is striking. Causes for the relative stability of the civilian population to psychologic trauma were not apparent to Medical Branch investigators. Constant indoctrination with propaganda may have been a factor. The initial and sweeping military successes evidenced by the ap- pearance of foreign goods and of slave laborers for work in factory and home, their expectation of win- ning the war, and the maintenance of a high level of morale may have been contributing factors. Dermatologic diseases Neurodermatitis was rather commonly seen in the skin clinics of Germany and its increase during the war was reported definitely to be associated with the tension and strain brought on by air raids. Urticaria and exzema also were said to increase in incidence or severity in association with air raids. Vegetative symptomatology Symptoms ordinarily associated with the auto- nomic nervous system were remarkably infrequent in their occurrence. It was reported that only occa- sionally did patients complain of excessive sweat- ing. Over prolonged periods of aerial bombard- ment some patients suffered from extreme fatigue- ability and “chronic nervous exhaustion”; likewise. PSYCHIATRIC DISORDERS HANS H. REESE. M.D., MADISON, WISCONSIN The objectives were to ascertain the effects of air warfare on Germany’s psychiatric institutions and on her facilities for diagnosing, treating, and com- mitting individuals with neuropsychiatric disorders and diseases. If possible, it was hoped to compute data on the mental health of Germany prior, during, and after the bombing attacks. To attain these objec- tives, psychiatric hospitals and clinics were visited, 101 COMMUNICABLE DISEASES and medical authorities, physicians in general prac- tice, and air raid protection police were interrogated on the problems that arose during the air attacks. To incorporate all these data into a condensed report is impossible and not desired, but a short introduc- tion may be helpful to familiarize the reader with the subject. University professors and superintendents of in- stitutions estimated that the war reduced the number of cases in mental institutions between 32 to 54 per cent. It is not possible to compute accurate data be- cause, late in 1944, the German government ordered the burning of all records relating to enforced ster- ilization, to mercy killings, and to population figures of psychiatric institutions. The Nazi government con- sidered that the chronic mentally ill, those with heritable physical and mental disorders and the in- capacitated senile population, were a liability to the nation. Therefore, by official regulation, institutions were deprived of enough physicians, food, drugs, and mechanical facilities for active therapy. Various stories were reported to the Medical Branch about the mercy killings, and the following paragraph is a synthesis of these stories. If in the psychiatric section of a city hospital or a university clinic a diagnosis of incurable mental dis- ease was made, the afflicted person was reported to the regional health office (Amtsarzt), which in turn requested a governmental commission to examine the official report, and, if necessary, ordered com- mitment of the patient to an institution of its selec- tion. His transport was conducted by SS police troops. Then the family was notified that, because of incurable mental disease, its member had been trans- ferred to such-and-such a place for care. After sev- eral days, however, the family received another notice, that the patient was seriously ill, and that an operation was imperative and he might die. Mercy killings were carried out in gas chambers by the use of carbon monoxide. On a specified date the family could call for the body or for the ashes in an urn and for their relative’s clothing. If the family did not keep this appointment, the urn was interred in the hospital cemetery, and the clothing was given to a public agency for distribution. In a final letter, the government expressed regrets, and an incor- porated death certificate related the cause of death. (Very often erroneous diagnoses were given, such as that the patient had died from a ruptured appen- dix or gallbladder, when in reality surgery had re- moved that organ years ago.) From the Medical Branch investigation of six uni- versity psychiatric clinics and eight state institu- tions and from discussion with a large number of urban and rural physicians, it is concluded that the air raids did not interfere directly with the manage- ment of the state institutions for mental diseases, for these reasons: they were located in rural areas or in sheltered regions and thus escaped damage or de- struction; they were self-supporting units from the standpoint of food, water, and lighting; and they suffered only indirectly from disruption of their transport system. The university psychiatric clinic and smaller hos- pitals of course suffered in proportion to the dam- age inflicted on the city in which they were located. If the university with its medical school was de- stroyed, the clinics for the care of nervous and men- tal diseases also suffered, as demonstrated by the illustrations accompanying the chapter on medical education. It is amazing indeed to hear that even in a com- pletely bombed-out psychiatric hospital, where in normal times little if any co-operation from the men- tally ill patients could be expected, no death or severe injuries occurred as the direct effect of the bombings. The knoAvn fact, that a psychiatric clinic or hospi- tal staff always encountered difficulties in the man- agement of disturbed or excitable patients, suggested inquiries at psychiatric clinics as to the effect of air raids on that difficult patient group. When the alarm signal was received in a psychiatric hospital sedation was ordered for all patients. The universal routine was that the excitable and uncontrollable patients received morphine and scopolamine and often slept through air raids unless physical damage to their wards necessitated moving them; the quiet and de- mented ones were guided to safety by the so-called herd instinct. No university psychiatric clinic had encountered insurmountable difficulties in rescuing its charges. The difficulties encountered depended upon the severity of the bomb damage inflicted and the number of patients to be removed. Verbal statements by leading psychiatrists to some important questions relating to mental disease are reported here. The questions were: What was the influence of the Allied bombings upon the mental health of the German population? Did air raids increase the number of psychiatric diseases? What was the most damaging effect of bombing attacks upon the population in the field of mental health and diseases? 102 COMMUNICABLE DISEASES Figure 40 MONTHLY RATE OF ADMISSION FOR NERVOUS 8 MENTAL DISEASES AMONG THE GERMAN AIR FORCE (1942-1943) PERCENTAGE OF THE PERSONNEL Did you observe an increase of psychiatric cases during the years 1940 to 1945? Professor Mueller of Leipzig voiced (May 16. 1945) the universal reply to a questionnaire that had been sent to specialists in the nervous and mental diseases, to universities, and to the medical directors of psychiatric institutions, that neither organic neurologic diseases nor psychiatric disorders can be attributed to, nor are they conditioned by, the air attacks. Fleeting reaction symptoms in the sense of neurohysteria were not uncommon after severe dam- aging attacks. There was no increase of psychiatric cases, he declared. Professor F. Knigge of Hamburg answered that there was no increase in psychoses or in acute psy- chotic episodes. Air raids were no longer a surprise to people, and therefore no panics nor so-called Katastrophenschocks were caused after the expe- riences of August, 1943. Professor M. Buerger-Prinz of Hamburg said that, in his experience, severe air raids will provoke en- dogenous depressions, either as a recurrent phase or as the initial clinical symptom complex of manic, depressive psychoses in older people. It is debatable if the psychotic manifestations which occurred in the change of life period are provoked by air raids. In five instances he observed that the severe depres- sions cleared up in the course of heavy bombings and that these people did a man’s job during the rescue work but relapsed into deep depressions after four to six weeks of apparently normal health. The majority of the depressed and melancholic patients remained in their stupor even with the greatest dan- gers from fire and crashing buildings about them. The increase of hysterical reaction types was mini- mal in the cities and almost absent in the Army. The shaker, the stuporous, the deaf-mute, the “shell shock patient" of World War I had not been seen as yet. Exogenous psychotic disorders as an ac- companiment of intoxication in infectious diseases were common; malaria often precipitated suhclinical psychotic tendencies into a long lasting psychosis. The leading authority in the field of psychiatry, Professor Bumke of Munich, had the following answer to the four questions: The university clinic with its 200 psychiatric and 100 neurologic patients had no air raid protection until in August, 1943, a provisory basement shelter 103 COMMUNICABLE DISEASES was constructed. The air raids of 1943 destroyed the serologic and neuropathologic laboratories and since 1943 paralyzed all work in these important departments. A direct bomb hit damaged the men’s building and collapsed the women’s chapel, but no lives were lost and no confusion or panic were en- countered. Sedation for the patients depended en- tirely upon the degree of mental disturbances. It was not necessary to use morphine and scopolamine for everybody. No entertainment for the patients was necessary during air raids, or while they were wait- ing in shelters. It is Burake’s opinion, that air war- fare or even severe air raids did not increase the ad- mission rate to his clinic, that air raids did not pro- voke latent dispositions into acute psychoses, that air raids did not increase psychoses in children, and that no manic phases as the direct result of bombing had been encountered. The increase in depressive states, especially in the involutional period of life, was negligible. However, a greater number of people suffering from nervous exhaustion, concomitant apathy, emotional lability, and depressed attitudes, and those who had attempted suicide, must be con- sidered “air raid victims,” and lack of sleep, lack of food, and never-ending worries about new raids con- tributed to the development of this more somatic than psychic fatigue syndrome with its weight loss and undernourishment. Bumke replied to a final question, “What was the most damaging effect of bombing upon your clinic and your patients?” with the following answers: 1. The physical destruction of the clinic with disruption of water, lighting, gas, and plumbing services interfered with medical supervision and treatment. 2. The disruption of all transportation facilities for physicians, for patients and their relatives, and a shortage of food and drugs created irritations and complaints. 3. The inability to repair the physical damages, and the tension caused by the never-ending but con- stantly altered emergency planning, taxed the patience of the staff. Bumke’s statements concerning nervous-mental diseases during the air raid years implies a rather stable incidence rate in the civilian population which equals the normal expectancy of peacetime. Figure 40, showing the percentage of the German Air Corps admitted to mental institutions in the years 1942 and 1943, is presented for the sole pur- pose of demonstrating a similar rather stable inci- dence rate in a large military group. Major hysterical disorders were a rarity in the Army as well as in the civilian population during the war years, according to Stockert, Villinger, Pette, Roeper, and Mikorey. They were not observed during air raids, nor did the wishful fixation neuro- sis to be evacuated to the country after a raid appear. The complicated and resistive psychoneuroses were much less frequent in the service groups and in civilians, in sharp contrast to the frequency of these disorders in prewar times among the German in- tellectuals. Hysterical manifestations in front of bunkers or air raid shelters or upon returning to bombed-out homes have been rare, but they did occur during severe air raids. Phobic obsessions in older children and in young women were present during the rush to air raid cellars or when crowding and noisy ex- citement blocked the entrances. Nervousness with irritability, steadily increasing fatigue leading to exhaustion, vegetative neurotic symptoms (which may be grouped under the generic term psycho- somatic disturbances), and the aviation anxiety, especially in children and in older people, may be attributed to bombing. In the collective psychiatric reports of 1942, the German Army sanitary inspector’s office challenges the opening of a special department for psychogenic disorders at the University of Munich and discour- ages other hospitals to follow what was believed to be an unnecessary and unwarranted separation of patients. This office stipulates directives for hysteria, for simulation, and for psychologic aggravation of organic diseases and requests that immediate therapy be given in qualified hospitals and states that under no circumstances should soldiers with hysterical signs be discharged from service. Diagnoses such as war neurosis, shell shock, or psychoneurosis should be avoided, to be replaced by adding the prefix psychogenic to the outstanding symptom (as psycho- genic gait disturbance). A short personality evalua- tion should follow the description of the causative factors which produced the disorder. Addiction to alcohol, to sedations, to pick-up drugs, or to narcotics did not increase. People smoked more, some excessively. However, the sense of moral responsibility was lessened, and tendencies toward petty criminality in people with excellent character records increased. Simulation and aggra- vation of illnesses were of no significance in the armed forces or in the home population. Juvenile delinquency with all the implications of that term, was a great concern to city and parental authority. 104 COMMUNICABLE DISEASES The formation of gangs and stealing by youngsters, especially after air raids, were severely punished, but according to police records, delinquency and looting never reached alarming proportions during the war years or after destructive air attacks. Psychopathic personalities, which caused severe disturbances as an effect of the ever-increasing air raids, will not be touched on, since there was no uniformity in the use of the term psychopathic per- sonality, and since no definite statements could be obtained. It is interesting to note that in a country so brutally ruled and crushed by the Gestapo, so frustrated by political accusators and defamers, so torn and demoralized from loyalty to its govern- merit, its leaders, and even to family members, not more systematized paranoid states with ideas of per- secution were registered. Summary Air raids did not aggravate illness or the loss of life in German neuropsychiatric hospitals. Air raids did not contribute directly to an in- crease in psychiatric disorders. Air raids only slightly influenced the course of affective emotional disorders. Air raids, however, did increase tension states, anxieties, and exhaustive states among the people, but not to an alarming degree. 105 CHAPTER FIVE INDUSTRIAL HEALTH CAPTAIN FRANZ K. BAUER, MEDICAL CORPS. AUS During the exploitation of targets by the Medi- cal Branch team it was possible to devote some attention to the problem of industrial health. In a country as highly industrialized as Germany, the health of industrial workers even in peacetime is of importance for the evaluation of the health state of a nation as a whole. If one, furthermore, takes into account the degree of industrialization during a total war when it was necessary to call on every available source of manpower and even to import foreign labor despite the obvious danger which such a measure carries with it from a politi- cal as well as sanitary standpoint, it can be seen that the health of the worker will reflect on the health of the nation. It is also of importance to note that Germany has had a widespread organi- zation for the safeguarding of industrial health ever since the end of the last century. Statistics and pertinent information were compiled and kept by German authorities in view of evaluating the state of health in industry. Although the main problem of the team was the study of German health as a whole, as many in- dustrial plants were visited as possible whenever they were in the vicinity of the city targets ex- ploited. It was attempted to obtain information from statistics and records kept by the plants and during interviews with managers and plant physi- cians. It must be stressed, however, that the heavy air attacks had destroyed many industrial plants and with them their recorded health statistics. Furthermore, the Germans had attempted to de- centralize their industries and to evacuate what- ever possible into areas comparatively safe from aerial attack. These areas were not visited by the Medical Branch team. This chapter is based on information obtained in several of the largest plants, such as the Krupp Industries in Essen, the M. A. N. Industries in Augsburg, the Messerschmitt aircraft factories in Augsburg, the I. G. chemical plants in Hoechst, Leverkusen, Ludwigshafen, and Elberfeld, and the Robert Bosch electrical works in Stuttgart. In ad- dition to these large establishments, a number of small plants were visited in or near the sample cities. Germany attempted to safeguard her industrial workers’ health by countless laws, decrees, and ordinances referable to industrial hygiene and health. Insurance against sickness and accidents applied virtually to every German worker and salaried employee. The latter’s income was not to exceed 3,600 RM. Family dependents of the insured were covered automatically although they did not qualify for the full services and benefits available to the insured. Legal responsibility for health services was di- vided between public agencies and social insur- ance organizations. In addition, voluntary health organizations were given a definite place in this structure, and party organizations exerted power- ful influence over administration of health service. With precautions against air raids and evacua- tion of victims exclusively in the hands of the government, the voluntary organizations lost their influence to a large extent during the period of aerial warfare against Germany. The public agencies vested with administrative powers and functions in the field of health service operated on a local, intermediate and a central level. In the local level, administrative responsi- bility was concentrated in the health departments which co-operated with public agencies active in related fields. Intermediate agencies were set up in government districts, provinces, or larger states, and were under medical administrators (Regier- ungsmedizinalraete). These men had supervisory powers over all local health activities. There was a division of the central government for sharing of responsibility for the health of the working population. The Ministry of Labor ad- ministered the social insurance or workers’ com- pensation and supervised the conduct of industrial hygiene. The compilation of statistics which is so important in detecting health trends among large working groups was prepared by the Reichs Sta- 106 INDUSTRIAL HEALTH tistical Office, a division of the Ministry of Eco- nomics which, among all other statistics, was in charge of the vital statistics for the entire Reich. The social insurance organizations played a most important role in the administrative struc- ture. Social insurance was administered by special bodies locally as well as centrally. Compulsory social insurance had developed legally since the 1880’s and provided compensation for sickness, ma- ternity care, accidents including permanent and temporary disability, old age, and death of the bread-winner due to sickness or accident. Sickness insurance was administered by local statutory bodies called Kranhenkassen consisting of state op- erated Ortskrankenkassen, Betriebskrankenkassen (operated by the individual plants), and Innungs- krankenkassen (operated by trade unions). In all cases the insured had free choice of a doctor. Voluntary health organizations including church and nondenominational organizations were inte- grated into the pattern of public agencies. The national socialist regime added a fourth to the three types of agencies previously described (local, intermediate, and central or national level) : the Main Party Office for National Health (Haupt- amt fuer Volksgesundheit) which was under the direction of the leader of German physicians (Dr. Leonardo Conti) and which had subdivisions at intermediate and local levels (Gauaemter und Kreisaemter), and the Main Party Office for Na- tional Welfare (Hauptamt fuer Volkswohlfahrt). Industry was covered by air raid protection in- surance as much as the civilian population. No major changes in the extremely detailed national plan were made. The socialization of health in- surance had been so thoroughly developed that the system was able to withstand the impact of the consequences of the aerial attacks on Germany. It was up to the factories and plants to procure shelters and other air raid protection measures through the co-operation of local and central agen- cies. In vital industries this was relatively easily accomplished through a priority system. Cities throughout Germany were given different numbers in this system. They were mostly dependent for their priority on vital industries in or near the cities. With high priority the cities (and indus- tries) were able to procure material and personnel from the Todt organization to construct shelters and bunkers (concrete tower shelters). For indus- tries less vital to the war effort, the construction program for air raid shelters lagged due to lack of manpower and increasing disruption of the transportation system subsequent to aerial attacks. As late as 1945 many factories had no, or inade- quate, shelters. Such factories were, among others, makers of surgical instruments, bandages, and other products not immediately connected with armaments and munitions industries. Deaths and injuries due to aerial bombings Casualties in war plants were about as frequent as they were for the population at large. The Ger- mans had expected more casualties in industry, particularly in the armament and munitions indus- try, by virtue of the fact that in aerial attacks on German cities these industrial plants constituted prime targets. According to information obtained, fewer and fewer people were killed at work as the aerial attacks on Germany increased in number and severity. Thus, at the Krupp industries in Essen 305 men were killed in 1943, against 291 in 1944 and 107 in 1945 up to the occupation of Essen by Allied Forces, although the attacks on these factories became so intense that they were forced to shut down most of their operations in late 1944. It should be kept in mind that there were more attacks on Essen as the war progressed, and that this decrease in the number of casualties was due to better air raid precautions, such as sending workers into air raid shelters as soon as plane formations were known to approach the area, which was contrary to the policy of 1943 of waiting until it was certain that the respective cities were the target (Robert Bosch Industries— Stuttgart; Messerschmitt Aircraft Industries—Augs- burg). According to the statements of managers and plant physicians interviewed, the number of dead and injured through aerial attack in industrial plants was not serious enough to stop production at any given time. This held true as long as key personnel was not killed or injured. The serious effect of such an incident is obvious as, for exam- ple, when at the pharmaceutical plant of E. Merck in Darmstadt one direct hit killed the entire bio- logic research staff (see Chapter Twelve). This plant from then on dispersed the workers in order to forestall a similar occurrence and to avoid crowding of members of one department into one air raid shelter. Other plants, according to the in- formation available to the Survey had no such provisions. The types of injuries due to direct violence en- 107 INDUSTRIAL HEALTH countered in bombed industrial establishments were similar to those seen among the population at large (see Chapter Three). Numerous instances occurred of irritation of the eyes through liberation of chemical gases such as aldehydes and akrolein, which were set free in the bombings of the respective plants. Such injuries were not noted among the population at large. No cases of permanent disability from gas effect were reported in the literature or in personal interviews. The care of casualties was undertaken in a simi- lar manner as for the general population: The plant physician usually acted as air raid physician, with a staff of nurses and lay attendants under him. The number of first aid posts distributed throughout the plants was usually increased as the air war against Germany progressed. At least one first aid post was designated in each plant for medical personnel. As soon as the alarm sounded, the medical personnel proceeded to the designated first aid post. The injured were evacuated as speedily as possible to either the plant hospital, if available, or to municipal hospitals in the cities nearby. Industrial establishments with high priority working for the war effort had no difficulty in retaining their physicians. Armaments industries were able to maintain the same doctor-patient ratio as in peacetime. This practice held true for all units working under directives of the Speer or- ganization. The same industries received priority for the purchase of medicaments. It was up to them to purchase drugs and bandages necessary for the care of the industrial workers. many which will give a more detailed picture of this phase. All Germans who were associated with indus- trial medicine emphasized that air raids caused sick rates to rise. In Hamburg the Blohm and Voss Company complained in their 1943 report that air raids had pushed their sick rate up to 5 per cent in August, September and October, and to 5.7 per cent in November. Reasons for this were “dis- turbances of health, shock and undisciplined be- havior of our employees. Inclement weather is a contributory factor.” The charts of the Krupp In- dustries in Essen show (Figure 41) how illness among the workers advanced to 9.5 per cent in 1944 after the heavy raids on that city. Officials of the Krupp Industries and of the public health department in Essen attributed this to an increase in the over-all emotional strain with heightened irritability and decrease in physical and emotional resistance; the resultant effect is demonstrable in the increase of the incidence of all illnesses and the prolongation of the period of treatment and recovery. The National Insurance Company’s re- ports of Augsburg show graphically that after aerial bombardments the sick rate advanced as high as 9 per cent in 1944, raising the expected annual seasonal peaks from 5 to 6 per cent; here, too, “shock, fright, neurogenic heart and stomach disorders and undisciplined and unpatriotic con- duct” were given as reasons. Industrial accidents were the main contributors to high percentage of compensation paid out (Fig- ures 42 and 43). At Krupp the total number of accidents decreased, and it was stated that the ratio between traffic and industrial accidents proper had changed; traffic accidents—to and from work, that is—showed an increase, whereas indus- trial accidents during work decreased due to better accident precautions and a vigorous educational program. In the statistics of other industrial estab- lishments this differentiation between traffic and in- dustrial accidents was rarely made. The National Socialist Party Office for National Health stated in its quarterly reports that accidents constituted the main cause of industrial illness. The shortage of manpower led to widespread employ- ment of foreign workers who were mostly untrained in the work to be done and in the principles of industrial hygiene and personal safety. Language difficulties were also an important factor in this re- spect. Although working hours were lengthened and as the younger age groups were drafted for mili- The sick rate Most insurance companies (Krankenkassen) com- piled statistics of diseases causing disability and re- quiring compensation, as well as data showing the duration of patient days. The majority of insurance companies discontinued this practice during the war because of the shortage of clerical help. Sta- tistics from different insurance organizations throughout Germany were compared and discussed with managers, plant physicians, public health men and expert consultants, and the findings and conclusions reached are thought to be valid for the entire industrial population of Germany. Other divisions of the Survey have gathered data on per- sonnel matters, including absenteeism and illness, in their examination of the war industries of Ger- 108 INDUSTRIAL HEALTH Figure 41 KRUPP INDUSTRIAL PLANT - ESSEN AVERAGE WEEKLY SICK RATE 1938-1945 tary service or compulsory labor service (women) the average age of the industrial employees be- came higher, the accident rate did not rise among German nationals due to the above mentioned pre- cautionary measures. It became higher among for- eigners before it was possible to acquaint them with the principles of industrial hygiene and per- sonal safety. Upper respiratory infections closely followed ac- cidents in the compensation data. The increase here was due to crowding in air raid shelters, in street cars and other public conveyances and in the homes. It should be kept in mind that not factories alone but entire cities which were large industrial centers were also principal targets of the attacks so that hundreds of thousands were made homeless. Whole families were forced to move in with other people and through this overcrowding the transmis- sion of droplet infections was enhanced. Added to this was the constant exposure during fire fighting and rescue work. Then, too, it was routine to start work in bombed plants as soon as possible even if the roof of such a plant had been shattered and re- pairs not begun. Workers were frequently exposed to rain and wind for days at their place of work and it is natural to expect an increase in upper respiratory infections. Armament plants reported a steady increase in gastro-intestinal disorders in all age groups. They were of a functional nature for the most part, a fact for which emotional irritability and poor nutri- tion were held largely responsible. Emotional in- stability following raids in which transportation facilities, water, gas and light service were affected, without which personal discomfort and hardship become acute, was always said to be the underlying factor for functional disorders involving the gastro- intestinal tract and cardiovascular system. Cardiovascular disorders increased throughout Germany during the war years and took an impor- tant place in the statistics of insurance companies. From Figure 42 it can be observed that heart dis- ease constituted 1.6 per cent of all disease groups in 1942 and 3.1 per cent in 1943 in one of Germany’s most important industries. From physicians it was learned that the increase was in functional disorders rather than organic disease, although the latter was more prevalent in the industrial worker as the war 109 Figure 42 KRUPP INDUSTRIES - ESSEN BREAKDOWN OF TOTAL NUMBER OF DISABLED IN VARIOUS DISEASE GROUPS 1937 - 1943 |BOMB CASUALTIES. 3OTHER DISEASES. | OTHER ACCIDENTS. 3 INDUSTRIAL ACCIDENTS. DISEASES. T1 TUBERCULOSIS. iIPULM.AND OTHER. ] DISEASES OF CIRCULATION. | HEART DISEASE. ] ARTHRITIS AND RHEUMATISM. |NERVOUS DISORDERS. |OTHER DISEASES OF I GASTRO-INTESTINAL TRACT. ] DISEASES OF 6ASTRO-INTESTINAL TRACT. |OTHER UPPER iRESPIRATORY DISEASES. |GRIPPE (NASOPHARYNGITIS.) Figure 43 PATIENT DAYS PER 1000 PER YEAR IN STUTTGART MALE FEMALE INDUSTRIAL HEALTH progressed in Germany by virtue of the fact that more and more physically fit persons were drafted into the armed services; thus the state of health of the German worker was worse. The part played by the nutritional status of the worker was the subject of much controversy among those interested in industrial health. There was much ado on the nationwide use of vitamin con- centrates for laborers and persons whose output was of prime importance to the total war effort. Re- search was done, for example, in the Medical Clinic of the University of Munich by Professer U ilhelm Stepp on the vitamin requirements in miners. Dr. Theodore Morrell, Hitler’s personal physician, was one of the great advocates of nationwide vitamin administration to all age groups. His reasoning was not always considered sound by scientists not only because he was, perhaps, the Fuehrer’s most in- timate associate but because he held large stocks in pharmaceutical houses producing vitamin prepara- tions. The fear of malnutrition was severely criti- cized in National Socialist Party publications. In the quarterly reports of the National Socialist Office for National Health, for example, it was stated that the continued “rumor-mongering about the scar- city of foods and the threatening famine was de- featism of the worst sort for it was “entirely un- founded.” It was stated in the same organ with authority and emphasis that enough wholesome food was available to cope with the demands of total war, that vitamin deficiencies were out of question, and that admitted weight loss of 10 to 15 pounds would not affect anybody. Rumors had spread, so this publication stated, that the loss of weight would ultimately lead to a lowered resis- tance and such a decrease in industrial output that the armaments industry was threatened. The loss of weight, it was explained, was due to the severe emo- tional strain of working and living under great hardship and the disruption of transportation be- cause of the Allied air raids rather than to any shortage of food for the worker. There was a marked increase in skin disorders. Interviews and an examination of statistics and pub- lications revealed that this increase was mainly due to pyogenic infections, particularly furuncu- losis. In the statistics of the National Insurance Company of Augsburg (Ortskrankenkasse), furun- culosis advanced in the list of disabling diseases from seventh place for men and seventeenth place for women in 1939, to fourth and sixth places, re- spectively, in 1943. At Krupp skin diseases con- stituted 6 per cent of all diseases listed in the plants’ chart of disabling conditions in 1941, whereas they constituted 9.6 per cent in 1943. The authorities with whom this subject was discussed stated that the lack of soap, which has never been the cheap and easy to get item in Europe that it is in the United States, contributed greatly to the prevalence of skin conditions. It was a vicious circle for it was repeatedly stated that as the work- ing conditions deteriorated soaps and wetting agents gradually vanished. Naturally this led to sharp in- creases in occupational dermatoses and the gen- eral uncleanliness among workers in many indus- tries was succeeded by acute flare-ups of such con- ditions as scabies. In some instances it was of such magnitude as to affect production materially. Gen- erally speaking, given a long period without the necessity for crowding into air raid shelters, an outbreak could be brought under control if medica- ments were available but they were not always. Not only was sulfur scarce but ointment bases and vehicles were frequently unobtainable for long pe- riods. Like the epidemiologists, the industrialists and hygienists repeatedly emphasized the average German’s penchant for personal cleanliness as the one factor that kept a bad hygienic situation from getting worse. Industrial health and absenteeism The causes of absenteeism attributable to air raids are given here as they were obtained in inter- views with German plant managers and physicians. It is not the purpose of this chapter to deal with absenteeism per se. Rather the question was dis- cussed during interviews with industrial physi- cians, public health authorities and others inter- ested in the workers’ health in order to discover whether there was a three-way correlation between bombing and industrial health and absenteeism. It was not possible to compile a list of the causes of absenteeism and to relate them to their effect on a given plant’s production. Nor was there an oppor- tunity to test the validity of the industrial vital statistics to determine to what extent workers ab- sented themselves from their jobs complaining of illness, when actually it was fear of being in the plant when it was attacked or a desire to clean up the rubble of their own homes. These are questions of morale and of many other ingredients of industrial absenteeism and they have been ade- quately explored in other reports by the Survey. Fear of bombings was experienced by everyone. 112 INDUSTRIAL HEALTH according to the persons interviewed. Numerous German citizens sought admission to hospitals for insignificant ailments in order to be evacuated to auxiliary hospitals in the country. Although evacua- tion was governed by the policies established by the government, a large number of workers at- tempted to go to the country either with their families or to join their evacuated children. The control was rigid, but many succeeded in finding ways and means to spend days and even weeks away from the endangered cities and justify their ab- sence on the basis of illness. A general irritability was evident soon after the bombings; loss of sleep due to alarms and rescue work, transportation difficulties, and stricter food rationing were all factors which induced people to absent themselves from work. Transportation be- came a major problem. At the Robert Bosch In- dustries in Stuttgart, to take one example, during the very heavy air raids in 1943 and 1944, only 30 per cent of the employees—both officials and laborers—were present for work in the first week after the raids. At the end of one week approxi- mately 50 per cent were present, and after four weeks 70 per cent to 80 per cent. In these figures are included the sick who contributed 15 per cent to the rate (5 per cent for the male, and about 20 per cent for the female employees). In most cases, transportation difficulties and preoccupation with personal affairs subsequent to bombings were given as reasons but the personnel director believed that very minor illnesses were used as excuses and may, therefore, render the statistics unreliable. Absenteeism was by no means widespread up to 1942. Living at that time was bearable, morale was high and the war was going well. By the end of 1942, however, many people decided that they had made enough money to buy the necessary com- modities which rationing permitted them, and that they were due a rest. They were resolved to take a rest either in their homes or in the country, and the only way to do this with compensation was to go to their plant doctor and be certified as to their need for sick leave. It was repeatedly stated that industrial physicians were rather lax in certifying workers who were not really sick, and that this practice spread rapidly despite warnings by the Government and the National Socialist Party to the workers that absenteeism meant defeatism, and defeatism was not far from treason. According to statements and publications from some insurance companies, the number of workers receiving sick leave with compensation soon reached the point where the insurance firms were no longer able to meet their financial obligations. At Frankfort on the Main the practice of granting these sick leaves became so widespread and the abuses so flagrant that the state authorities had to step in. Considerable correspondence developed be- tween the Gauleiter of Hessen, Sprenger, and the directors of the Frankfort branch of the National Insurance Company and other Frankfort insurance companies. The sick rate at that time exceeded 5 per cent of all workers, which was declared much too high by the companies. A physician of the medi- cal clinic of the University Hospital of Frankfort, Dr. W. Gutermuth, was called in to straighten out the situation. In his solution it was decided that the university hospital would assist the industrial physicians with all their diagnostic facilities in order to eliminate preventable absenteeism. By re- quiring a thorough physical examination supple- mented by laboratory tests many a malingerer and employees with minor ailments were discouraged from seeking a sick leave with compensation. Within three months the sick rate was below 3 per cent—a result considered spectacular at that time. This procedure attracted nationwide attention and Dr. Gutermuth was appointed plenipotentiary for medical problems in all war industries for the pur- pose of requiring more thorough examination and a stricter control of sick leave among war workers. German insurance companies had what was called a confidential medical expert service (Ver- trauensaerztlicher Dienst). Physicians, occasionally specialists, were appointed to pass on the plant doctor’s judgment as to whether a patient should be declared sick and receive compensation. In 1933, this Service had been overhauled when the Na- tional Socialists took over the German Government. Dr. Gutermuth directed his reorganization towards this consultant service. His reasons as given in a personal interview in 1945 were that most of these expert consultants had been appointed to their positions through political connections and were more or less corrupt (in the summer of 1945 a favorite explanation of most German authorities for everything). At the same time they were badly trained by virtue of the fact that they had been active in party organization and activities and “the two don’t go together.” In the beginning of Dr. Gutermuth’s period of term as plenipotentiary for medical problems in the war industry, the Expert Medical Consultant 113 INDUSTRIAL HEALTH Service prided itself on its success in reducing the sick rate and returning large percentages of “dis- abled” persons to work. The procedure followed was to call in those persons who had been declared sick and were about to receive compensation and examine them very carefully as to their state of health. However, Dr. Conti wrote a letter (July 7, 1943) to Dr. Walter, the Chief of the Expert Medi- cal Consultant Service, and pointed out that ac- cording to the reports of the Service 62 per cent of all persons declared sick by the plant physicians in 1939 were called in; in 1940, 75 per cent; in 1941, 76 per cent, and in 1942, 80 per cent. Yet the “disabled” returned to work include: in 1939, 14.2 per cent of the number considered unable to work by the industrial physicians; in 1940, 16.6 per cent; in 1941, 14.6 per cent; in 1942, 14.4 per cent. This means that, although the Expert Medical Consultant Service called in more and more em- ployees declared sick by the plant physicians, ap- proximately the same percentage of those who were sick were returned to work. It was deduced from this by Dr. Conti that it was neither malinger- ing nor was it laxity on the part of the physicians that the sick rate was high, for if it were the expert medical consultant service would have had more success in returning people to work. Dr. Conti in this letter attempted to explain the rise in the sick rate by “biologic” factors: During the war the healthiest and most resistant men were drafted, which led to a decrease in the general state of health among industrial workers as more and more older people and those with diseases of a chronic nature were employed or even made to work. Morbidity rates changed in many districts of Ger- many and for many disease. Thus, in Berlin, an epi- demic of bacillary dysentery occurred in October, 1942, and there was an increase of infectious hepa- titis. These are only examples listed by Dr. Conti in his attempt to explain the rise of the sick rate among war workers and to protect the German phy- sicians from the attack which Dr. Gutermuth had made on them. Gutermuth’s program was described to a member of the Medical Branch Team in a per- sonal interview in 1945. He had planned to recruit well-trained consultants for the insurance organiza- tions and to make the diagnostic facilities of all state institutions, such as university clinics, avail- able to the industrial physicians. Compulsory sick- ness insurance would have been broadened to in- clude earners making up to 7,200 RM yearly. No plant or industrial insurance companies were to have less than 5,000 members. Physicians from the Armed Forces were to be assigned to war in- dustries as plant or expert physicians on a full- time basis for a limited period of time or part- time to relieve the burden the bombing of war plants had placed upon industrial physicians. In brief, it can be stated that aerial attacks on Germany caused the sick rate in industrial establish- ments to rise. General irritability subsequent to bombings with disruption of public utilities and transportation facilities, overexertion due to rescue work and longer working hours with increase of dirt led not only to a decrease in the resistance of the individual to various diseases but also to a tendency to stay away from work without actual organic disease. The deterioration in workers’ health is directly related to bombing but the statis- tical up-swing of illness following raids is in part due to malingering and psychologic factors, which was soon recognized by the Germans. Improved and more thorough diagnostic pro- cedures were not the only steps taken to combat ab- senteeism. Expert medical consultants were required to make house calls, somewhat like a truant officer, to check on whether a person receiving illness com- pensation was actually following instructions. When the doctor found the “sick" worker in a pic- ture show or working in his garden instead of fol- lowing the regime prescribed, the worker could be fined by a loss of wages. Rigid Nazi control was exercised through representatives of the Party in the various plants. These representatives were sup plied with propaganda and with slogans and at- tempted to impress on workers through personal contact and distribution of pamphlets that they should be as brave and as willing to carry on, despite hardship and minor sickness, the same as the front-line soldier. Numerous inducements were offered to keep workers on the job. They consisted of food, liquor, tobacco, clothing, toys for their children, costume jewelry, free excursions and even vacations. This was handled through the Ministry of Munitions and War Industry and its Department of Social Care (Sozialbetreuung). The prerequisite was to meet the set individual production quota. The plant then was eligible to file application for bonuses in the form of the articles mentioned, if they were avail- able. It was stated that the output of foreign workers could be raised by 100 per cent by such items as three cigarettes for men and one comb for women. 114 INDUSTRIAL HEALTH This increased output did not last very long and most managers and supervisors promised cigarettes and toilet articles beforehand to lax workers in order to prolong the effect of the gift. The German Workers Front was instrumental in the distribution of vitamin concentrates, candy and similar items of inducement. They made it known to the industries that a certain amount of candy or vitamin concentrates was available. The plants then had to pay the makers of these items for the quantities received by the German Workers Front and distribute the items free of charge to the em- ployees. Thus, the employees gained the impression that the German Workers Front wras the one to which they owed these benefits. Language difficulties were an important factor in keeping them at work as they were easily able to exaggerate their complaints and ailments. In the opinion of seemingly responsible Germans, they were fairly easy to manage, particularly the Russians, Poles and Ukranians. They were given in- struction in the principles of industrial hygiene and health which occasionally included orientation in the vagaries of modern plumbing. As a result, no major epidemics developed among foreign workers. Naturally the Germans were careful to import only those slaves who were in robust physical con- dition. In order to retain the health status as high as possible—and to keep the foreign workers from being a burden to the already over-taxed physician —the foreigner who became permanently crippled or acquired some serious chronic disease was im- mediately returned to his home country. Thus for- eigners who developed tuberculosis or became preg- nant were immediately returned to their homelands and replacements procured. The notoriously clean Germans complained that foreign workers had no feeling for cleanliness; the workers of the East could be excused, but it is of in- terest to note that the Dutch were considered the worst in this respect. They sabotaged the program of personal hygiene in their barracks and permitted vermin to develop. Their behavior was considered a serious health hazard in an effort to complicate life for the Germans as much as possible. An effort was made to bring foreign physicians to Germany to care for their own nationals in the capacities of industrial physicians. Numerous in- ducements were offered such as private practice, nice homes and automobiles. This program met with partial success only in occasional instances* There were several hundred Ukranian physicians in Germany but they were considered poorly trained* Some French, Dutch, Belgian and Italian physicians went to Germany to practice, as did an occasional South American and Spanish physician, but the scheme soon collapsed of its own weight. Foreign laborers very frequently went to several physicians at the same time for the same ailment and drew food rations, drugs and compensation in a multiple of the permitted amount. This happened in several German cities and was given official pub- licity in the reports of various insurance companies and party publications. Self-mutilation was encountered occasionally in foreign workers and in some instances in Germans. Accurate figures are not available, but the matter The foreign worker Although no separate study was made on the efficiency and state of health of the foreign worker in comparison with the German national, the ques- tion was always brought up in interviews with managers, public health authorities and physicians when problems of industrial health and hygiene were discussed. The matter was given much atten- tion in the publications of the National Socialist Party Office for National Health in its quarterly re- ports. The statements made in this chapter were based on these publications and information ob- tained in numerous interviews from men who had close contact with foreign workers . It wras stated almost unanimously that with proper inducements and threats the output of the foreign worker, particularly the Russian, Ukranian and Pole, could be raised over the output of most German workers. It was explained in this connec- tion that foreign workers were in better physical condition than most German industrial workers by 1942 and 1943 because the Germans working in industrial plants were mostly replacements for healthy men and women who had been drafted for armed service or compulsory labor service. Yet the sick rate and the number of patient days lost from work were much higher among foreigners than among Germans, being double at times (Party Office for National Health, Robert Bosch Industries —Stuttgart, M.A.N. Industries—Augsburg and Nu- remberg). Foreign workers took advantage of the social insurance organization and were eligible for sickness and accident insurance. They could, go to physicians just like any German worker. They capitalized on every minor ailment and attempted to stay away from work as often as they could. 115 INDUSTRIAL HEALTH was deemed important enough to be brought up repeatedly in publications of the National Socialist Office for National Health. Thus, in the quarterly report of October, 1941, for Stuttgart it was stated that many men from the East had injected the juice of radishes into their urethras and produced a gon- orrheadike discharge. Several Polish women had treated their external genitalia with strong acids in order to simulate venereal disease in the hope of being sent back to their home countries. It was emphasized that the foreign worker capi- talized on any disease with which he was afflicted much more than the German in whom patriotism and national pride were still important factors. of concentration which accounted for a high acci- dent rate, traffic as well as industrial, and functional disorders; (2) production of unsanitary conditions of work which accounted for an increase in upper respiratory infections; (3) an increased need of soap due to longer working hours under poor hy- gienic conditions which accounted for an increase in pyogenic infections and scabies. Absenteeism because of ill health was on the increase subsequent to air raids, and measures were instituted to combat it. These measures were very rigorous and were partially successful. Although the physical condition and health of the foreign worker were better than those of the German industrial worker, the sick rate of the foreigners was higher than that of the Germans. Minor ailments were given the utmost attention by the foreigners and every attempt was made to be absent from work whenever possible. Summary Aerial bombardments had a direct effect on the health of the industrial worker in Germany. They were responsible for (1) irritability, fright and lack 116 CHAPTER SIX VITAL STATISTICS LIEUTENANT COLONEL JOHN H. WATKINS. SANITARY CORPS. AUS T/4 SCOTT V. HITCHCOCK. MEDICAL DEPARTMENT. AUS Through statistical analysis we have endeavored to show the trends of various health conditions in Germany and to discover their relation, if any, to the bombing of that country. Much of our work has been included in the study of communicable diseases and tuberculosis shown in Chapter Four. The present chapter, in addition to describing the methods employed, examines the birth rate, infant mortality, and mortality rates of death from all causes, suicides, diabetes, heart disease, cerebral hemorrhage, old age, and all types of accidents. It was obvious that a complete report of the effect of Allied bombing, as reflected in the vital statistics of Germany, was impossible; the time limit imposed on the activities of the Survey was alone sufficient to limit the study. The initial as- sumption that many record offices were destroyed with the records in them, which led the Medical Section to plan to collect only the bare essentials of population and mortality data, was confirmed during the later field work. It was recognized that all data collected had to be validated to assure that false reports had not been rendered by the Ger- mans with the hope of concealing the effects of Allied air attacks. Since the primary object of the study was con- cerned with the effects of air attacks, the major efforts of the Medical Branch in the collection of medical statistics were confined to individual cities in Germany rather than to the country as a whole. Case incidence and mortality rates for the entire country consists of data combined for all regions, bombed and unbombed, and were controlled by a variety of influences other than air attacks. Data for individual cities, consequently, were essential in order that variations in mortality or case rates could be examined in direct comparison with the specific bombing attacks which may have effected them. Allied air attacks on German cities over the period of air activity were not continuous, but each large city was subjected to raids, which must be considered from the present point of view as spo- radic in time. A city was attacked at one time for the purpose of eliminating a certain type of indus- try, again to destroy another industry, and still at other times to destroy the city as a whole. Repeated attacks occurred with no relation in time to the previous ones. Because of this, the effects of bomb- ings were only shown by weekly or monthly data so that an increase in mortality rates, for example, after a period of bombing could be compared with rates reported previous to the bombing. Selection of cities The selection of cities to be visited for collection of data on vital statistics was accomplished through the use of information on Allied air attacks, avail- able in the Morale Division. A chart was prepared for each city showing the number of planes desig- nating the city as a target, and the total tonnage of bombs dropped for each week through the period 1942 to April 1945. The resulting lime pattern of attacks was studied for the intensity and duration of attacks, and for the number of attacks which were followed by a non-bomhing period of several weeks. Approximately 25 cities were selected for which bombing attacks were sufficiently dispersed to reflect the influence of bombing on the com- munity vital statistics, if such occurred. The list of cities selected for field work was de- creased by the practical aspects of a field study of a country as large as Germany in the time allotted. Some of the cities originally selected, Berlin and Dresden, for example, were situated in Russian oc- cupied territory, to which the American teams were forbidden entry at the time the field study was made. It was soon learned that in most towns a complete compilation of the material desired would not be forthcoming. ‘kAlles verbrannt” and “Alles kaput’’ were all too familiar expressions. In some cities no information was available, or if so, could not be secured within a reasonable peripd of time. In other cities information on population data was lacking, which precluded the use of any mortality or morbidity information which had been obtained. 117 VITAL STATISTICS On the whole, the data on mortality submitted by the local officials checked with that published in the tables of the Reichsgesundheitsblatt. The popu- lation figures, however, seldom checked, so that it was impossible to use the Reichsgesundheitsblatt tables unless local data on population were secured to replace the population figures shown in the table. Upon completion of the field work, during which 23 cities were visited, selection of the cities began for which the information secured either from the local officials or from the Reichsgesundheitsblatt tabulations could be accepted. This examination was primarily for the purpose of securing reliable population bases from which rates of mortality and morbidity could be computed. Graphs were made of all population data submitted for each city. The births, deaths, number of attacking planes and the bomb tonnage were plotted on each graph, which were then examined for a consistent picture in the curves. All cases in which a population drop was shown were checked to ascertain first, if such a decrease was reflected in the total number of births and deaths, and second, if the air attacks indicated that it could reasonably have occurred through an exodus from the city. If such a consistent picture was not secured, the city was rejected for further analysis. If no local information on mortality was available, the city was also rejected, since the tabu- lations in the Reichsgesundheitsblatt for that city could not be checked. The result of this procedure was to leave 13 cities for which acceptable popula- tion and mortality data were at hand: These cities were representative of all cities in the southern, western and northern parts of Germany. Augsberg and Nuremberg are situated in southern and central Germany, while Bremen, Hamburg, Kiel, and Magdeburg are representative of north- ern Germany. Bremen, Hamburg, and Kiel were subject to heavy attacks because of their harbors. The remaining cities, Bochum, Cologne, Dortmund, Duisburg, Mulheim, and Solingen, are located in western Germany in the region of the Ruhr. Acceptable tabulations of the incidence of in- fectious disease were available for 8 of the 13 cities for which mortality data were utilized. These were: Bochum, Cologne, Dortmund, Duisburg, Hamburg, Kiel, Magdeburg, and Nuremberg. In addition, Frankfort was included in tabulations of infectious disease since acceptable population fig- ures were available in the absence of complete mortality data. Collection of data An examination of medical statistical reports available for the pre-war period showed that a comprehensive weekly tabulation of mortality sta tistics was available in the weekly Reichsgesund- heitsblatt. This table covered all cities over 100,000 in population, and gave immediate data on popula- tion, marriages, births, total deaths, and deaths by cause. Almost complete files of the Reichsgesund- heitsblatt up through the first month of 1945 existed in London. As a preliminary move the mor- tality tables were transferred to punch cards, and the data tabulated for each town. A major portion of the task of collecting mortality information was accomplished by this means, providing the tables could be validated. These tabulations by cities were taken to Germany for checking with data se- cured from local sources. In addition to mortality data, it was also planned to secure from local sources monthly tabulations on the incidence of infectious diseases, and of other important diseases. Monthly information on population was desired and as originally planned consisted in tabulations by sex and age groups. Early experience showed, however, that population data by such intimate sub-divisions could be secured rarely or not at all. Consequently, requests for population data were limited to monthly tabulations of the total resident population and all foreigners, Jews, and non-resi- dents. In order to clearly define the nature of the data, local officials were asked to submit popula- Population census of 1939 Augsburg 180,039 Bochum 305,469 Bremen 419,226 Cologne 768,352 Dortmund 537,865 Duisburg 433,530 Duesseldorf 535,753 Hamburg 1,698,388 Kiel 261,298 Magdeburg 329,824 Mulheim 136,828 Nuremberg 420,349 Solingen 140,453 Combined Cities 6.167.374 118 VITAL STATISTICS tion figures: (1) as estimated from births, deaths, and migration, and (2) as given by the count of the local ration cards. Four blank forms were prepared in German for distribution to local city officials with instructions as to how the forms should be filled out. These were tables on: (1) population, (2) births and deaths, (3) infectious disease, (4) other diseases. The data requested were: 1. Population. Monthly population of resi- dents and foreigners, Jews, and non-residents, esti- mated (a) by the customary procedure of adjust- ing the previous estimate by means of births, deaths, and migration, and (b) by counts of food ration cards. 2. Birth and deaths. The monthly number of live births, total deaths exclusive of air raid casual- ties, deaths under one year, deaths from tubercu- losis, pneumonia, diarrhea and enteritis under one year, typhoid fever, suicide, and air attacks. 3. Infectious disease. Monthly case incidence of diphtheria, scarlet fever, whooping cough, tuber- culosis, epidemic meningitis, epidemic encephalitis, poliomyelitis, trachoma, typhoid fever, paratyphoid fever, anthrax, rabies, psittacosis, undulant fever, typhus fever, syphilis and gonorrhea. 4. Other diseases. Monthly case incidence of wounded from air attacks, cancer, rheumatism, dia- betes, disease of the thyroid and parathroid, neu- rosis, psychosis, addiction, glaucoma, heart disease, arterial disease, influenza, pneumonia and bronchi- tis, stomach and duodenal ulcers, and kidney disease. The city officials were instructed to fill out one of the monthly tables for each of the years, 1938, 1940, 1942-1944, inclusive. The year 1938 was taken as the most recent pre-war year and 1940 as a war year during which air attacks on German cities were minimal. The list of infectious diseases requested in Form 3 was a standard one used in Germany for the transmission of periodic informa- tion to the Reichsgesundheitsamt. It was not ex- pected that Form 4 could be filled out completely, but instructions were given that as much of the table be prepared as possible. Forms 2, 3 and 4 were limited to statistics for German non-Jewish residents only, since prelimi- nary study had shown that only these data were adequately collected. Occasional records of mor- tality and case incidence for non-residents, for- eigners and Jews were encountered, but these were not considered reliable. The general plan of the field work was to have a member of the medical team surveying the city leave the forms with a responsible member of the civil government, either the Burgomeister, the Health Officer or the head of the Statistische Amt. This official was given several days in which to conform with the request, after which the team member called for the forms and discussed them with the official in charge. The plan was modified somewhat after the work began, in that the sta- tistical team was held responsible for the collec- tion of statistical information in each city. This change was made in order that a more thorough discussion of the submitted material could be made with the local officials, and first-hand conclusions regarding the validity of the information and of the tabulations from the Reichsgesundheitsblatt de- termined by those responsible for further analysis. Methods of analysis and presentation The monthly population data secured from each city consisted in local estimates for the first few years of the war, and of data compiled from the food ration cards for the later years. Where month- ly population figures computed by both methods were available, a large discrepancy was usually shown, the data from food cards being lower than that from the estimates made from births, deaths, and migration. It was believed that in the initial years of the war the estimates were accurate, but as air attacks occurred with greater frequency the migration from the city was too great to be ap- proximated, and no means was available to correct the factor with any precision. Consequently, in the later years of the war, the food ration cards had to be relied upon to yield population data repre- senting the number of persons in the city. A transi- tion period thus occurred after bombing took place for which the population data could only be esti- mated. During these periods, usually of several months duration, a straight line interpolation was made between the previous level of estimated popu- lation and the new level of food ration card popu- lation. The interpolations were checked against the population movement as reflected in the tabulation of births and deaths. The monthly population figures thus secured were used for the determination of computing fac- tors by which monthly numbers of deaths and cases of disease were multiplied to give monthly rates of natality and mortality on an annual basis. The birth rate and the death rates from all causes were 119 VITAL STATISTICS computed per thousand population. Specific death rates by cause and case incidence rates were com- puted per 100,000 population. Monthly figures on infant mortality were divided by the number of live births to yield an infant mortality rate per thousand live births. It was realized that this rate was inaccurate since the deaths of infants occurring within a given month were not all derived from the live births registered for that month. However, this is the most accurate figure obtainable since sufficient data were not available to compute rates by any other means. The results of these analyses on the acute com- municable diseases have been incorporated in the study of communicable disease. Data on tuber- culosis are included in the study of that disease. The analysis of births, all causes of deaths, infant mortality, mortality rates of non-communicable dis- ease, suicide and accidents are given in the present chapter. The general sequence of presentation has been a discussion of the annual case incidence and mortality rates, followed by the charts on monthly case or death rates as related to the air raids. The charts show individual mortality trends for thir- teen cities and case incidence trends for nine. The tables of annual mortality rates present those of the thirteen cities. However, for case incidence the cities comprising the table and its total show only six or seven of the nine presented in the monthly charts; two, Cologne and Dortmund, and occa- sionally a third were eliminated because the avail- able rates did not cover the five years for which data were available for the other cities of the ori- ginal nine. Annual rates have been considered in the present study as revealing changes which reflect all war- time influences taken together (air raids being but one of them) and year by year, their cumulative effect. The monthly charts, with the tonnage of bombs reported dropped on the city, show the rates in relation to the bombing, hence some idea of the bombing effect alone may be deduced from them. It will be noted that many gaps occur in the monthly rates; these in most instances follow an air raid, and are due to the destruction or disrup- tion of the local statistical office. After several Table 21, Annual Birth Rates in Thirteen German Cities, 1938, 1940, 1942-43-44 (Rates per 1,000 population, annual basis) City 1938 1940 1942 1943 1944 Augsburg 15.87 16.46 14.11 14.31 10.38(10) Bochum 16.74 17.39 13.88 10.95 9.97(10) Bremen 18.56 19.66 13.94 12.28 11.18(10) Cologne 16.21 17.84 11.79 15.69(5) 8.20(8) Dortmund 18.03 18.73 14.57 11.48 13.87(9) Duisburg 19.52 20.20 15.17 13.09 16.23(10) Duesseldorf 17.00 18.87 12.78 9.85(9) 8.43(7) Hamburg 16.26 17.54 14.34 12.65 12.64(10) Kiel 19.49 21.39 15.37 12.98 5.14(10) Magdeburg 16.13 17.15 14.57 14.72 13.03(10) Mulheim 15.68 17.11 13.48 9.67 12.07(10) Nuremberg 15.02 18.22 13.85 12.44 13.82(10) Sol ingen 11.27 13.61 11.78 10.70 12.47(10) Combined Cities 16.77 18.19 13.87 12.68 11.42(10) VITAL STATISTICS Table 22. Annual Mortality From All Causes of Death (Except Air Raids) in Thirteen German Cities, 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Ausburg 11.63 12.16 11.36 10.98 11.65(10) Bochum 10.11 10.73 10.37 11.29 12.93(10) Bremen 10.26 11.43 11.31 11.70 11.37(10) Cologne 11.15 12.73 11.91 14.84(5) 11.51(8) Dortmund 10.56 11.54 11.01 11.21 14.26(9) Duisburg 10.34 11.87 13.75 14.33 14.60(10) Duesseldorf 10.97 12.42 11.90 11.10(9) 11.87(7) Hamburg 11.64 13.36 12.29 11.09 13.10(10) Kiel 10.22 10.31 8.46 8.05 6.86(10) Magdeburg 11.92 12.13 11.68 11.83 15.47(10) Mulheim 9.61 10.51 13.49 12.77 10.24(10) Nuremberg 10.80 12.04 12.64 12.54 12.45(10) Solingen 10.74 12.17 12.63 12.79 13.45(10) Combined Cities 11.00 12.26 11.83 11.80 12.43(10) (Rates per 1,000 population, annual basis) weeks reports were resumed, but the data for the city during the bombing period were not made available in the Reichsgesundheitsblatt. The locally collected data on disease were more complete, and in most instances figures were rendered for all weeks, including {hose of the bombing. It is un- doubtedly true that the data for raid periods are defective, collected as it was by staffs of destroyed offices during a period when diagnosis and report- ing was unusually difficult. of 1939 being less abrupt than the increase for 1939 over 1938. The rate for the combined cities in 1942 was 13.87. It fell to 12.68 in 1943 and to 11.42 in 1944. In general the rates for the indi- vidual cities follow the same course. The excep- tions are largely those in which the rate for 1944 was higher than that for 1943, a condition brought about in large part because of evacuations from the cities following the air attacks of 1943. Programs of evacuation from large cities fea- tured the initial removal of pregnant mothers and those with babies and small children. The effect of this is clearly shown in Figure 44, where many of the monthly trends of birth rates are seen to drop sharply after periods of air attack. Properly, of course, the evacuation factor should have been taken care of by population adjustment, but this was not always possible. A second factor to be considered in the trend of the birth rate as effected by bombing is the fre- quency of miscarriages and abortions. Some evi- dence has come to hand that these mishaps of pregnancy increased during the period of heavy Births The birth rate in Germany began to rise in 1933 following the Nazi directed campaign for increased fertility. The upward swing continued until 1939, after which the rate declined. In 1941 the birth rate for the country as a whole was 18.6 per 1,000 population, compared with 20.4 at the peak year of 1939. Table 21 shows the annual birth rate for thir- teen German Cities. The 1940 rate for all cities, 18.19 per 1,000 population, was higher than in 1938 when it was 16.77, the decline from the peak 121 Figure 44 THE BOMBING EXPERIENCE AND BIRTH RATE IN THIRTEEN GERMAN CITIES MONTHLY BIRTH RATES PER 1,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 122 Figure 44 (continued) THE BOMBING EXPERIENCE AND BIRTH RATE IN THIRTEEN GERMAN CITIES MONTHLY BIRTH RATES PER 1,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 123 Figure 44 (concluded) THE BOMBING EXPERIENCE AND BIRTH RATE IN THIRTEEN GERMAN CITIES MONTHLY BIRTH RATES PER 1,000 POPULATION. ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 124 VITAL STATISTICS Table 23. Annual Infant Mortality in Thirteen German Cities, 1938, 1940, 1942-43-44 ( Rates per 1,000 population, annual basis) City 1938 1940 1942 1943 1944 Augsburg 60.65 78.41 80.97 89.19 89.96(10) Bochum 71.36 82.44 89.63 81.56 134.00(10) Bremen 47.05 47.37 52.72 59.76 97.98(10) Cologne 65.56 71.59 85.28 76.71(5) 134.84(8) Dortmund 64.19 57.53 67.58 82.44 97.03(9) Duisburg 77.21 89.90 134.00 114.41 137.17(10) Duesseldorf 72.74 94.91 68.60 74.87(9) 135.48(7) Hamburg 50.62 55.36 54.10 56.99 82.78(10) Kiel 54.48 44.29 59.51 49.41 120.24(10) Magdeburg 53.07 62.51 60.21 61.59 68.48(10) Mulheim 50.40 48.08 61.46 70.57 74.29(10) Nuremberg 41.09 48.61 59.65 67.24 68.02(10) Solingen 53.75 52.37 68.82 57.17 56.85(10) Combined Cities 58.83 64.29 69.12 68.79 96.79(10) air attacks. In Hamburg the number of miscarriages and abortions per 100 pregnancies rose between 1939 and 1944, as the following figures show: 1939 1940 1941 1942 1943 1944 This increase, even if a general one, is not great enough to account for the entire decline in the birth rate. The air attacks, then, had the effect of decreasing the birth rate in German cities largely through the evacuation of pregnant mothers to regions of greater safety. It is a statistical decrease, and signi- fies nothing as to the actual decrease in pregnancies throughout the country. Rural birth rates were not available to demonstrate an increase commensurate with the decline in the urban birth rate. Little doubt exists, however, that an actual decrease occurred in the rate for Germany as a whole. Mortality from all causes of death except those from air attacks Crude rates of death are ordinarily regarded as approximations of mortality forces since they are so easily effected by population differences. In the present study the death rate from all causes is to be taken as even less reliable since, as mentioned previously, the major changes in the monthly num- ber of deaths was utilized to assist in the determina- tion of the population figures from which rates were to be computed. This is a case of putting into the mill what is to be taken out and for this reason too much stress should not be laid upon changes in the all-cause mortality rate. The total mortality rate, exclusive of deaths from air raids, combined for the thirteen German cities is shown in Table 22. The table indicates that the crude death rate had risen during the war years, but that relatively little effect was demon- strated in increased mortality for the heavy bomb- ing years of 1942 to 1944 over that of 1940. The rate for 1944 was 12.43 per thousand which is only slightly above that for 1940, 12.26. The rates for 1942 and 1943 are both less than that for 1940. 125 VITAL STATISTICS The picture shown for the combined group is borne out by the data for individual cities. Pre-war year 1938 shows the lowest death rate, while those for 1942 to 1944, for the most part, show no marked deviation from the rates for 1940. A con- sistent increase during 1942-44 occurred in only five of the thirteen cities, four of which were lo- cated in the Ruhr, an area of exceptionally heavy bombing. The fifth city, Magdeburg, received only light air attacks until 1944. The monthly crude death rates for each of the thirteen cities, with the tonnage of bombs dropped, are shown in Figure 45. These curves clearly show that no substantial change in the level and trend of mortality occurred during 1942-43, as expressed by the data at our command. Inspection of the curves for the year 1943 does show that in several cities, Bochum, Dortmund, Duesseldorf. Hamburg, Mulheim, and Nuremberg, the mortality rate in- creased following months in which air attacks oc- curred. However comparison of the curves for 1943 with those for 1938 and 1940 indicates that the apparent increase is along the line of normal seasonal expectation. A later section of this chap- ter presents the results secured after the seasonal effect has been adjusted, and demonstrates that an actual increase occurred as an effect of the air attacks. a proportion of the infant deaths can properly be charged to the births occurring in that month. An evacuation of pregnant mothers and infants will effect the infant mortality rate in a manner gov- erned by the unknown ratio of pregnant mothers to infants for the previous months. Such an evacuation occurred in the cities under discussion here and its effects on the infant mortality rates cannot be judged. Diseases of adult life Diabetes: Annual mortality rates for diabetes in thirteen German cities are given in Table 24. In 1938 and 1940 rates for the cities combined are 23.32 and 21.51 respectively. Compared with these, the corresponding rates for the later years are low* being 16.84 in 1942 and 15.54 in 1944. In general, rates for the individual cities show a decreased mortality from this disease during the heavy bomb- ing years. The monthly trend of mortality from diabetes is shown in Figure 47 for the same cities. Fittle evi- dence is given that heavy air attacks had any effect on mortality from this disease. Occasional sharp increases following heavy bombings are shown as in Duisburg in 1942, for example, but these do not consistently occur to an extent that the level of mortality is raised significantly above that of the pre-bombing period. The effect of the breakdown in insulin supply discussed in Chapter Twelve which will probably make itself felt on the mor- tality rates of diabetes was not apparent when these data were collected. Heart Disease: In 1938 and 1940 the mortality rates per 100.000 for heart disease were 149.76 and 161.80 respectively for the combined group of thirteen German cities, Table 25. The correspond- ing rate for 1942 was 138.72; which rose to 145.10 in 1943 and to 164.49 in 1944. In spite of the fact that the level of mortality for the heavy bombing years was less than for 1938 and 1940, the progres- sive increase between 1940 and 1942 points to a definite increase in the later years of the war. This finding is consistent with the results shown in Table 25 for eight of the individual cities. The periods of heavy air attacks appear to have an accelerating effect on mortality from heart dis- ease, as indicated by the charts of Figure 48. In Bochum, for example, mortality rose shortly after the bombing periods in 1943. In Duisburg, the mor- tality rates rose after the raids of 1942 and again after those of 1943, and in Magdeburg immediately Infant mortality Annual infant mortality rates are shown in Table 23. The rate for the thirteen cities combined was 58.83 in 1938. It rose to 64.29 in 1940 and a little higher, 69.12 and 68.79 in 1942 and 1943. In 1944 the rate was 96.79. Except in Solingen the rate in 1944 was substantially increased over the previous years for all cities. Study of the monthly charts, Figure 46, shows that a gradual increase in the infant mortality rate may be detected except for the four cities Magdeburg, Mulheim. Nuremberg and Solingen on the third page of the figure. These are cities which were not attacked by air raids with the intensity devoted to other cities, especially in the earlier years of bombing. It appears, then, that increases in infant mortality were brought about more by the cumulative hardships of war-time than directly by air attacks. It should again be emphasized that the infant mortality rates are here subject to errors which may impair their accuracy and reliability. As men- tioned above, these rates were computed per 1,000 live births occurring in the same month. But only 126 Figure 45 THE BOMBING EXPERIENCE AND MORTALITY FROM ALL CAUSES OF DEATH (EXCEPT AIR ATTACKS) IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 1,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 127 Figure 45 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM ALL CAUSES OF DEATH (EXCEPT AIR ATTACKS) IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER ',OOO POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 128 Figure 45 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM ALL CAUSES OF DEATH (EXCEPT AIR ATTACKS) IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 1,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 129 Figure 46 THE BOMBING EXPERIENCE AND INFANT MORTALITY IN THIRTEEN GERMAN CITIES MONTHLY INFANT MORTALITY RATES PER 1000 LIVE BIRTHS .ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 130 Figure 46 (continued) THE BOMBING EXPERIENCE AND INFANT MORTALITY IN THIRTEEN GERMAN CITIES , MONTHLY INFANT MORTALITY RATES PER 1000 LIVE BIRTHS ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 131 Figure 46 (concluded) THE BOMBING EXPERIENCE AND INFANT MORTALITY IN THIRTEEN GERMAN CITIES MONTHLY INFANT MORTALITY RATES PER 1000 LIVE BIRTHS, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 132 Figure 47 THE BOMBING EXPERIENCE AND MORTALITY FROM DIABETES IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 133 Figure 47 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM DIABETES IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 134 Figure 47 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM DIABETES IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 135 VITAL STATISTICS Table 24. Annual Mortality From Diabetes in Thirteen German Cities, 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Augsburg 17.50 14.76 11.21 9.19 5.90(10) Bochum 23.25 20.02 14.33 15.90 8.64(10) Bremen 15.12 18.90 14.84 10.48 13.10(10) Cologne 30.35 29.71 20.41 22.19(5) 19.78(8) Dortmund 21.54 19.30 13.38 17.34 17.42(9) Duisburg 16.72 9.49 11.46 15.42 16.59(10) Duesseldorf 28.95 25.90 24.14 19.87(9) 22.85(7) Hamburg 22.51 19.26 15.28 11.88 13.59(10) Kiel 15.63 15.31 10.39 9.06 4.35(10) Magdeburg 32.59 38.95 23.52 17.78 19.31(10) Mulheim 30.28 20.93 16.42 10.82 26.44(10) Nuremberg 19.94 18.62 17.23 19.24 13.79(10) Solingen 23.96 31.50 34.87 42.21 30.08(10) Combined Cities 23.32 21.51 16.84 15.66 15.54(10) (Rates per 100,000 population, annual basis) following the first heavy air attack in January 1944. Other examples of increase following the bombing periods are less clear, being obscured by the seasonal rise. Cerebral Hemorrhage: Death from cerebral hemorrhage does not appear to have increased dur- ing the late war years 1942 to 1944. Mortality rates for this period are well below those for 1938 and 1940. In 1940 for example, the rate was 97.19 per 100,000 for the combined group of thirteen cities, 83.39 in 1942 and 82.81 in 1944. In five of the thirteen cities of Table 26, a progressive increase in mortality from cerebral hemorrhage occurred during 1942 to 1944; in general however, the magnitude of the rates in 1944 was less than in 1938 or 1940. Figure 49 shows monthly trends of mortality rates of cerebral hemorrhage compared with the frequency and severity of air attacks. No clear rela- tionship is shown except in Magdeburg where a sharp and definite increase occurred in 1944 fol- lowing the heavy air attacks in January. Old Age: Deaths classed as old age comprise all deaths of old persons dying without symptoms pointing to any other diagnosis as a cause; many of them are cases of sudden death. In the annual table of mortality from old age for our sample German cities (Table 27), the rate for the cities combined was highest in 1940, being 81.17 per 100,000 popu- lation; the rate for 1944, 80.07, is nearly as high, and shows a rise of 9 per 100,000 over 1943. No consistent trend in annual mortality from this cause is present among the rates of individual cities. The conclusion is evident that no general increase in mortality from old age occurred during the years 1942-1944 for the cities of Table 27. The trend of monthly mortality rates for old age is shown in Figure 50. While an increase during and following air attacks is shown for several cities, Bochum and Cologne, for example, the nor- mal high-winter fluctuation occurs at the same time to obscure the relation to the air attacks. A later analysis, adjusting for season, demonstrates a defi- nite increase in old age mortality following air attacks. 136 Figure 48 THE BOMBING EXPERIENCE AND MORTALITY FROM HEART DISEASE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 137 Figure 48 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM HEART DISEASE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 138 Figure 48 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM HEART DISEASE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 139 Figure 49 THE BOMBING EXPERIENCE AND MORTALITY FROM CEREBRAL HEMORRHAGE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100.000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY. ALL AIR FORCES 140 Figure 49 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM CEREBRAL HEMORRHAGE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION. ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES y-/ DUISBURG 141 Figure 49 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM CEREBRAL HEMORRHAGE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100.000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 142 Figure 50 THE BOMBING EXPERIENCE AND MORTALITY FROM OLD AGE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 143 Figure 50 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM OLD AGE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES TV-/ m i in 144 Figure 50 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM OLD AGE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES- 145 VITAL STATISTICS Table 25. Annual Mortality From Heart Disease in Thirteen German Cities, 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Augsburg 186.51 189.70 155.41 170.88 244.72(10) Bochum 117.52 92.68 89.25 100.71 152.16(10) Bremen 130.39 145.65 113.39 133.86 108.07(10) Cologne 199.15 221.00 203.43 252.63(5) 208.50(8) Dortmund 145.34 142.60 131.36 147.59 212.53(9) Duisburg 111.57 162.80 132.45 169.96 198.62(10) Duesseldorf 159.71 174.71 137.47 118.48(9) 161.03(7) Hamburg 131.88 146.54 119.92 97.93 116.11(10) Kiel 152.71 157.79 102.19 108.01 119.30(10) Magdeburg 167.82 164.02 126.91 156.48 220.79(10) Mulheim 94.52 96.70 141.79 166.43 168.97(10) Nuremberg 172.25 203.36 192.46 193.59 189.28(10) Sol ingen 202.23 156.75 210.01 223.12 233.12(10) Combined Cities 149.76 161.80 138.72 145.10 164.49(10) (Rates per 100,000 population, annual basis) Table 26. Annual Mortality From Cerebral Hemorrhage in Thirteen German Cities, 1938, 1940, 1942-43-44 (Rates per 100,000 population, annual basis) City 1938 1940 1942 1943 1944 Augsburg 108.30 106.06 82.24 86.52 104.18(10) Bochum 31.21 44.24 39.41 39.96 47.18(10) Bremen 119.54 128.13 88.58 91.34 66.95(10) Cologne 111.23 137.99 106.33 134.00(5) 95.98(8) Dortmund 83.91 38.79 30.21 28.65 37.19(9) Duisburg 61.86 15.52 23.98 26.67 37.98(10) Duesseldorf 129.08 140.72 112.95 113.43(9) 108.82(7) Hamburg 91.40 100.30 98.64 82.96 91.97(10) Kiel 97.39 75.43 60.97 58.43 54.43(10) Magdeburg 126.70 115.40 89.16 97.50 126.84(10) Mulheim 70.15 116.90 86.57 104.02 109.20(10) Nuremberg 102.58 116.02 108.21 104.96 103.62(10) Sol ingen 130.36 75.00 73.79 134.39 100.98(10) Combined Cities 96.83 97.19 .83.39 84.43 82.81(10) VITAL STATISTICS Table 27. Annual Mortality From Old Age in Thirteen German Cities, 1938, 1940, 1942-43-44 (Rates per 100,000 population, annual basis) City 1938 1940 1942 1943 1944 Augsburg 61.81 74.90 77.97 73.00 75.68(10) Bochum 81.21 100.11 119.87 134.56 102.33(10) Bremen 52.21 127.90 79.54 102.12 117.89(10) Cologne 27.09 37.27 30.20 40.11(5) 24.32(8) Dortmund 53.57 78.51 95.60 84.75 124.67(9) Duisburg 56.82 78.04 99.93 96.71 91.67(10) Duesseldorf 42.96 63.01 64.30 64.30(9) 73.44(7) Hamburg 90.21 99.53 67.19 51.95 57.53(10) Kiel 51.30 47.37 39.49 48.08 41.80(10) Magdeburg 70.36 91.38 104.26 106.69 176.95(10) Mulheim 94.52 73.60 80.60 77.39 79.31(10) Nuremberg 51.65 61.66 53.84 53.06 72.28(10) Solingen 69.76 117.75 167.84 145.59 146.11(10) Combined Cities 62.23 81.17 73.24 71.08 80.07(10) Table 28. Annual Mortality From Suicide in Thirteen German Cities, 1938, 1940, 1942-43-44 (Rates per 100,000 population, annual basis) City 1938 1940 1942 1943 1944 Augsburg 20.24 16.40 17.09 21.63 29.48(10) Bochum 14.33 13.89 8.14 13.05 15.28(10) Bremen 24.54 23.51 24.12 26.05 38.20(10) Cologne 17.45 13.68 15.86 9.39(5) 16.54(8) Dortmund 22.66 14.99 14.72 20.95 18.61(9) Duisburg 18.10 16.21 9.33 15.10 17.46(10) Duesseldorf 19.61 12.68 13.71 13.46(9) 21.23(7) Hamburg 41.56 30.12 32.23 35.71 37.49(10) Kiel 34.47 27.69 23.56 26.48 27.87(10) Magdeburg 31.98 31.63 23.81 23.41 38.63(10) Mulheim 14.03 19.48 6.72 18.31 10.34(10) Nuremberg 41.08 34.73 35.80 36.44 38.86(10) Solingen 23.25 19.50 12.97 16.37 25.78(10) Combined Cities 28.31 22.39 21.78 24.35 28.22(10) VITAL STATISTICS Suicide The suicide rate fell from 28.31 in 1938 to 22.39 in 1940 among the thirteen German cities included in Table 28. The rate remained about the same in 1942, rose slightly in 1943 and still more in 1944 to 28.22. This progressive increase in suicides was shown for eight of the individual cities, and was highest in Augsburg and Bremen. In Figure 51 the monthly suicide curve is shown in relation to the air attacks. Sharp increases in the mortality rate occur following many periods of bombing. In general, these appear following the first heavy attack on the cities as in Augsburg, Bochum, Bremen, Cologne, Hamburg and Magde- burg, for example. While it would appear from these data that suicides occur more frequently fol- lowing periods of air attacks than at times when the cities were free from bombing, the analysis of the next section shows that the increase is not statistically significant. This question will be taken up again in the following section of the present chapter. periods of air activity have been taken as the refer- ence point and overall mortality rates have been computed for a suitable number of weeks preced- ing the air attack and a similar period following the attack. The factor of seasonal change has been taken into account and adjusted before the actual comparison of the pre- and post-bombing raids. Mortality rates only have been dealt with since the data secured from the local sources on case inci- dence was on a monthly basis and did not lend themselves to this type of analysis. Method: The bombing charts, showing the weekly number of planes reporting the city as a target and the bomb tonnage dropped, were examined for each of the thirteen selected cities for which mor- tality data were available. Weekly periods of air attacks varying from one to sixteen weeks were selected which showed a period previous to the at- tack and a period subsequent to the attack during which the city was free of bombing. A total of 48 bombing periods was selected in this manner. The pre-bomhing and the post-bombing periods were not constant in length, hut varied according to the time period available for analysis; in no case, however, was either period less than four weeks, the maximum period being eight weeks. The weeks selected for the pre-hombing period were separated from the previous bombing attack made on the city by an interval of at least eight weeks. A sum- mary of the cities included, the bombing periods, and the weeks utilized for each attack is given in Table 30. For each of the periods of the separate bombing attacks, the weekly mortality data as given in the Reichsgesundheitsblatt were summed for all causes of death, infant mortality, and the following spe- cific causes: scarlet fever, whooping cough, diph- theria, measles, tuberculosis (all forms), pneu- monia and influenza, diabetes, cerebral hemorr- hage, heart disease, old age, suicide, and accidents. Each figure was multiplied by the appropriate con- stant to give the number of deaths on an annual basis, and rates were computed using for each period the population for the center of the time period. The seasonal fluctuation of mortality rates was a factor which had to be considered and elimi- nated. This was done by dividing each rate by a constant expressing the mortality rate for that period as a proportion of the average monthly mortality rate. The basic data utilized for this pur- pose were taken from monthly mortality indices for Germany and the Netherlands as given in Accidents In 1940 the annual mortality from accidents was 50.29 in the combined group of German cities. Table 29. The mortality rate did not change sub- stantially until 1944 when it arose to 58.06. This increase was shown for nine of the thirteen indi- vidual cities. Aside from this small increase in 1944, no definite trend in accidental death was noted. Figure 52, showing monthly trends of acci- dent mortality and bombing periods, indicates no relationship of the mortality to periods of air raids. Effect of air attacks on mortality trends Many charts have been presented in the preced- ing sections of this chapter and in the sections on communicable diseases and tuberculosis of Chapter Four to show the monthly trend of disease inci- dence and mortality as related to the tonnage of bombs dropped monthly on each of the various cities. These charts give a picture of the general relationship between the course of the disease and bombing, but in most instances the overall conclu- sions regarding the effect of air attacks on the rates are confused by their seasonal fluctuation, the lack of data for the months immediately following the severe air attacks, and the defective reporting so often occurring after these attacks. The present sec- tion deals with a more specific consideration of the problem. Here separate air attacks or continued 148 VITAL STATISTICS Table 29. Annual Mortality From Accidents i"n Thirteen German Cities, 1938, 1940, 1942-43-44 City 1938 1940 1942 1943 1944 Augsburg 22.97 30.61 35.78 30.82 41.28(10) Bochum 33.12 46.50 56.03 57.08 67.77(10) Bremen 50.50 47.47 41.74 44.32 43.30(10) Cologne 34.52 50.04 39.31 52.49(5) 50.26(8) Dortmund 45.33 59.77 54.30 58.27 87.86(9) Duisburg 44.67 65.54 70.35 71.33 80.32(10) Duesseldorf 48.94 64.30 47.30 45.44(9) 56.59(7) Hamburg 42.81 52.57 57.61 63.03 65.85(10) Kiel 42.48 43.73 40.53 33.45 35.27(10) Magdeburg 40.51 44.81 45.01 41.79 63.16(10) Mulheim 34.71 46.90 55.97 47.43 59.77(10) Nuremberg 36.52 29.45 38.49 40.52 36.77(10) Solingen 11.98 16.50 18.65 24.12 23.63(10) Combined Cities 40.53 50.29 49.56 52.19 58.06(10) (Rates per 100,000 population, annual basis) Priming’s Handbuch der Medizinischen Statistik, Yol. 2, 1931. Before being used, these indices were checked against quarterly data given in the Stat- ische Sonderbeilage of the Reichsgesundheitsblatl for the years 1937 and 1938. All rates were com- puted per 100,000 population except the infant mortality rates which were computed per 1,000 live births reported in the same period. After adjustment of the rates for seasonal changes, the rate for the pre-bombing period was subtracted from that of the post-bombing period. A tabulation of differences was prepared for the 48 air attacks. These data unfortunately do not in- clude bombing attacks made subsequent to Novem- ber, 1944, when the intensity of Allied assaults in- creased manifold, since mortality tabulations were not available after the end of 1944. The test of sig- nificance used was the “t” test described in Fisher’s “Statistical Methods for Research Workers, ' pp. 119-122, ninth ed., 1944. Results: A summary of the results of the analysis is given in Table 31 in which the mean differences are shown according to the destructive magnitude of the bombing period as measured by the weight of bombs dropped. The attacks have been divided into three groups: under 100 tons, 100 to 1,999 tons and 2,000 or more. This breakdown was es- sential. Small attacks appeared to have no effect on mortality rates while too often the largest raids were so damaging that the mortality recording sys- tem was either destroyed or its activities seriously impaired. Other breakdowns of the data were ex- amined to ascertain if a picture could be secured within other groupings of the attacks. The results were largely negative. Neither size of the initial or pre-bombing raid, geographical location of the city, or year yielded the effects other than those de- scribed in Table 31. The mortality rates which exhibited a definite and significant increase after bombing periods, for the tonnage group 100-1,999, were the following: 1. All Causes 2. Pneumonia and Influenza 3. Heart Disease 4. Old Age The all-cause mortality rate, it should be empha- 149 VITAL STATISTICS Table 30. Summary of Air Raid Attacks Selected for Study of Mortality Rates Town Initial Week of Periods* Pre- Post- Bombing Bombing Bombing Pre- Bombing Weeks in Period Post- Bombing Bombing Tonnage Dropped Augsburg 344 352 401 8 1 5 100 Augsburg 425 429 431 4 2 8 468 Bochum 306 314 315 8 1 4 112 Bochum 332 340 341 7 1 8 1505 Bremen 029 037 038 8 1 8 66 Bremen 149 203 208 6 5 8 175 Bremen 216 223 228 7 5 8 3028 Bremen 301 309 310 8 1 6 479 Bremen 334 341 342 7 1 4 970 Cologne 040 048 049 8 1 4 72 Cologne 151 207 223 8 16 8 2407 Cologne 234 242 243 8 1 7 672 Cologne 251 306 310 7 4 8 2593 Cologne 426 434 436 8 2 4 339 Dortmund 208 216 217 8 1 8 358 Dortmund 414 422 423 8 1 8 1890 Duisburg 017 022 023 4 1 8 52 Duisburg 039 047 048 8 1 5 64 Duisburg 221 229 233 8 4 4 2730 Duisburg 246 301 303 6 2 6 741 Duisburg 403 411 412 7 1 8 51 Duesseldorf 223 231 238 8 7 8 2216 Duesseldorf 430 436 438 6 2 5 657 Frankfort 227 235 238 8 3 8 989 Frankfort 307 315 316 8 1 8 1188 Frankfort 333 341 344 8 3 4 1520 Hamburg 029 037 038 8 1 5 77 Hamburg 150 203 204 5 1 8 184 Hamburg 223 231 232 8 1 8 1130 Hamburg 240 246 247 6 1 8 440 Hamburg 319 326 335 7 3 6 10,074 Hamburg 343 351 352 8 1 8 87 Hamburg 411 418 419 7 1 4 65 Kiel 034 042 043 8 1 8 80 Kiel 201 209 212 8 3 6 316 Kiel 234 242 243 7 1 7 633 Kiel 307 315 316 8 1 4 1535 Kiel 343 351 403 7 4 7 2632 Kiel 413 421 423 8 2 5 621 Magdeburg 316 324 325 8 1 8 61 Magdeburg 348 404 405 7 1 7 1489 Magdeburg 413 418 419 5 1 4 60 Mulheim 213 221 222 8 1 8 113 Nuremberg 227 235 236 8 1 8 292 Nuremberg 302 310 312 8 2 8 1204 Nuremberg 325 333 336 8 3 8 2034 Nuremberg 406 414 415 7 1 8 2047 Solingen 341 349 350 8 1 8 783 * The first digit indicates the year, and the last two digits the week of the year (week ending Saturday). For example, 344 is the 44th week in 1943. 150 VITAL STATISTICS Table 31. Summary of Changes in Mortality Rates Following Bombing Cause of Death Less than 100 Mean Increase in Mortality Rate after Attack Period Bomb Tonnage Dropped: 100-1,999 2,000 and over All Attacks All Causes 32.00 119.28** 44.89 68.50** Infant Mortality 9.01 —1.05 12.12 3.72 Tuberculosis —7.57 0.45 —16.86 —4.63 Pneumonia and Influenza 2.25 14.83* —6.67 7.91 Diphtheria 1.59 2.88 —2.98 1.48 Scarlet Fever —0.71 0.76 —4.15 —0.50 Whooping Cough —0.32 1.01 —1.50 0.23 Measles —0.29 0.03 0.84 0.11 Diabetes 0.31 1.73 0.48 1.17 Cerebral Hemorrhage —5.88 7.23 4.62 3.74 Heart Disease 1.53 12.11* —7.56 6.00 Old Age 5.72 14.74** —5.27 8.92 Suicide —0.71 2.20 5.02 2.06 Accidents —1.46 1.85 3.27 1.36 * Significant, p less than 0.05, greater than 0.01. ** Highly significant, p less than 0.01. sized, is exclusive of actual air-raid deaths. An in- crease in the death rate from pneumonia and influenza was no doubt to be anticipated as a de- velopment of the prolonged time spent in air raid shelters and the exposure to hardship following the attacks. Nor is it surprising that an increase in deaths from heart disease and old age occurred. Old persons, it may be presumed, are well taken care of during the period of bombing but are sub- ject to the stress of existence during and following the periods of attacks. The unusual strain of such times is undoubtedly sufficiently great to cause many old persons to weaken and succumb from the concomitant conditions usually described in the death report simply as heart disease or as old age. The results for the acute communicable disease are negative. It is to be remembered in this con- nection that the case incidence data, presented in the charts of Chapter Four, were not included in the present analysis. This fact is to be regretted, for case incidence data by weeks, so necessary for the present purpose, might have shown a more definite relation between the increase of these dis- eases and air attacks. It is hardly to be concluded that other mortality rates are not effected by bombing attacks, but rather that such rates based on information se- cured from badly bombed cities cannot be expected to reveal other than the most marked changes in disease mortality. The very effect of bombing in destroying records and in over-taxing the medical facilities of the city to an extent where the filling out of forms and certificates becomes a secondary matter, diminishes the accuracy of the basic data. Population movements following bombing attacks are of large magnitude and do not permit the cal- culation of rates by age and sex groups. If this were possible, greater changes in such specific mor- tality rates might possibly be shown. 151 Figure 51 THE BOMBING EXPERIENCE AND MORTALITY FROM SUICIDE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 152 Figure 51 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM SUICIDE IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 153 Figure 51 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM SUICIDE MONTHLY DEATH RATES PER 100,000 POPULATION. ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES IN THIRTEEN GERMAN CITIES 154 Figure 52 THE BOMBING EXPERIENCE AND MORTALITY FROM ACCIDENTS IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 155 Figure 52 (continued) THE BOMBING EXPERIENCE AND MORTALITY FROM ACCIDENTS IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES 156 Figure 52 (concluded) THE BOMBING EXPERIENCE AND MORTALITY FROM ACCIDENTS IN THIRTEEN GERMAN CITIES MONTHLY DEATH RATES PER 100,000 POPULATION, ANNUAL BASIS MONTHLY TOTAL BOMB TONNAGE REPORTED DROPPED ON CITY, ALL AIR FORCES, 157 VITAL STATISTICS A further explanation of the failure of other post-bombing disease mortality rates to show in- creases may lie in the placing of “air attack" on the death certificate as the cause of death rather than the disease itself. Many deaths have un- doubtedly been certified as due to the air raids when such would not actually have been the case had the individual not been suffering from the disease from which he actually died. No method is available to resolve the dilemma, so that the find- ings of a positive increase in disease following bombing had to be made despite the attribution of many deaths to bombing rather than to the disease involved. ysis for the acute communicable diseases and for tuberculosis are presented in Chapter Four. The birth rate for Germany, which was increas- ing up to 1939, fell consistently during the years of war. The birth rate of German cities decreased markedly following initiation of the heavy Allied bombings. It is not known to what extent the urban birth rate fell because of declining fertility, since a great part of the decrease occurred because of the evacuation of pregnant mothers from the cities to the country. No data were available as to the birth rate in the rural districts. Mortality from all causes of death, exclusive of the actual air raid deaths, increased with intensified aerial bombing. The infant mortality rate in- creased during the period of the war, but no evi- dence was available that the increase was directly related to the bombing attacks. This is not sur- prising in view of the evacuation of mothers and children from the areas in which heavy bombing had occurred or was likely to occur. With respect to the diseases of adult life, the mortality from diabetes and cerebral hemorrhage decreased dur- ing the war years and have no relation to bombing. Heart disease, on the other hand, was clearly re- lated to the periods of air attacks, mortality from this complex of diseases having risen following pe- riods of heavy air attacks. Deaths registered as due to old age likewise increased following periods of heavy bombing. While no clear cut evidence that the number of suicides rose after air attacks was secured, the suicide rate increased markedly fol- lowing several air attacks in a number of cities. The mortality from pneumonia and influenza increased during those periods after air attacks. Summary Investigations of the vital statistics of Germany were limited to those of cities since the Allied air attacks were directed in large part towards ur- ban territory. Published mortality data in the Reichsgesundheitsblatt were checked before using against material collected in German cities by the statistical team. Information on the case inci- dence of disease and on population was secured from local authorities in German cities. After the rejection of those cities for which the data se- cured were doubtful or quite incomplete, thir- teen cities remained for analysis. These were: Augsburg, Bochum, Bremen, Cologne, Dortmund, Duisburg, Duesseldorf, Hamburg, Kiel, Magde- burg, Mulheim, Nuremberg, and Soligen. Monthly and annual case incidence and mortality rates were computed for each. The monthly rates were studied with respect to the frequency and intensity of the Allied air attacks on each of the cities. The conclusions reached as a result of this anal- 158 CHAPTER SEVEN MEDICAL PERSONNEL HERMANN K. ROSMANN, M.D., MADISON, WISCONSIN An explanation of the availability of physicians, nurses, and other professional personnel is neces- sary to an understanding of the ability of the Ger- man medical profession to render complete medi- cal attention to the population of their country during the war. Looking back on the problems of procurement and assignment in the United States during the war when the medical profession was confronted only with the supply of additional medi- cal care for the Armed Forces, one can have some appreciation of the magnitude of the problem with which the German medical profession was faced when they had to cope with the steadily increasing Allied air attack. In this chapter an attempt is made to reconstruct a clear picture of the manner in which the government sought to locate physi- cians and nurses throughout Germany to meet the increased demand for medical care resulting from the air offensive. governmental agencies. With this move the Director of Public Health in the Ministry of the Interior was elevated to the position of Secretary of State in the Ministry. For the first time this influential position was occupied by a physician, Dr. A. Guett. A year later, in July, 1935, the entire public health ser- vice of the German nation was unified. hat then appeared to be a thoroughly central- ized national public health service was made even more influential by the changes in other aspects of the national government, as when, for example, in August, 1934, Hitler succeeded President von Hindenburg and thus became the supreme head of the government as well as the leader of the Na- tional Socialist Party. This unification of political party and government was immediately reflected throughout all levels of the state structure. As a re- sult, there arose in the state public health service a twin organization controlled by the Nazi Party that maintained right down through the health or- ganization structure to the municipal level a po- litical counterpart to each state office in the form of a party health authority. For example, in Ba- varia the state public health director (Ministerial Rat) functioned as a part of the State Ministry of the Interior. ithin the Gau, which is the political and geographical equivalent to a state, there was a director of medical services known as the Gau Arzt who held the additional position of chief of all the approved medical organizations in his area. Some of the higher authorities in the national health service and, in particular, Professor Karl Brandt, who was Reich Commissar for Health, and General Siegfried Handloser, the Director of Medi- cal Services of the Armed Forces, felt that this duplication of responsibility by the Nazi Party and the government in matters of public health was an important factor in what they stated to be inade- quate planning for the protection of the health of the civilian population to meet the combined bomber offensive of the Allies. The responsibility for many phases of national health was also shared by a number of federal departments other than the Ministry of the Interior. Germany's national health administration Lieutenant Colonel Richard L. Meiling The national medical and health organization of Germany was perhaps the most thorough, power- ful, closely knit body for the control of a nation's health that the world has seen. This organization, which actually was brought to completion under the Nazis, may be said to have originated with the public health law of 1874, which established the first national standards for smallpox vaccina- tion. Later, in 1900, another law was enacted which provided for a unified control of contagious diseases. In 1920, a national narcotic law was passed and between that time and the assumption of power by the Nazis in 1933 there was a gradual trend throughout Germany toward a vigorous and powerful public health program. Until the Nazis seized power, the medical and health organizations were centralized from the local offices up to the level of the states but they still lacked that co- hesion which would bring them together as a na- tional unit. In 1933, the first step toward establish- ing a strong central government of the Reich was the solidification of the national and the Prussian 159 MEDICAL PERSONNEL For example, the Ministry of Education was respon- sible for the selection and appointment (subject to Nazi Party approval, of course) of all members of medical faculties of the German universities; the Ministry of Labor supervised and controlled all health insurance and industrial compensation laws; Dr. Goebbels’ Propaganda Ministry controlled the conventions of medical and associated scientific bodies and the publication of medical journals and medical advertising as well as the operation of the health resorts; the Ministries of Commerce and Food had specific health responsibilities to be discharged in their management of the production, distribution, and control of food and food pro- ducts; the Ministry of Commerce, the Office of the Goering Four-Year Plan, and Albert Speer’s Min- istry of Munitions and War Production each had a voice in the production and allocation of critical raw materials in the industries producing pharma- ceutical and biologic products, and surgical and hospital supplies and equipment. The great con- struction organization known as the “Organization Todt” built all the hospitals, sanatoriums, labor- atories, and air raid hospital facilities which were constructed with federal funds. It is obvious from this then that, while there was tight central control of each phase of the German health organization, an extraordinary amount of co-operative spirit, insight, and understanding would have been required on the part of each bu- reaucrat in each of these separate sections of the public health organization to have given the entire structure that cohesion and integration which was necessary. Aside from this variegated structure for the protection of civilian health, the armed forces and the semimilitary political forces each had a medical service completely independent and more or less self-sustaining. These forces included the Army, the Navy, the Air Force, the Waffen SS, the Allgemeine SS, the Hitler Youth, the SA, the NSKK, the Organization Todt, the Arbeitsfront, the National Police, the Youth Labor Corps, and so on through the Nazi organization catalogue. To complicate further this complex structure there were the welfare agencies whose mission is often difficult to distinguish from that of the health organization. They were at least always intimately associated. These agencies were placed under the control of the Nazi Party shortly after 1933. Only three were permitted to continue: the Catholic Charities, the German Red Cross, and the National Socialist Public Welfare Fund (National Sozialis- tische Volkswohlfahrt or NSV). Although the ad- ministration and function of the German Red Cross were under the supervision of the Ministry of the Interior it was likewise under close political con- trol. The president of the Red Cross was an SS officer. Investigations revealed that the more impor- tant executive positions in the Red Cross were oc- cupied by SS officials. The Catholic Charities were forced to confine their work during the war years to the Catholic hospitals. The NSV was the organi- zation most favored by the state and in all cases was given the strongest financial backing and the greatest responsibility. For example, during any crisis, such as an air raid, the other agencies auto- matically came under the control of the NSV and had to take their orders from these political wel- fare workers. The Red Cross was usually respon- sible for the first aid attention and initial evacua- tion of the casualties while those features of welfare work which are most apparent to the recipient and which, therefore, could be relied upon to enhance the gratitude displayed toward the Nazi Party were reserved for the NSV. They made a great display of feeding and sheltering the homeless, supervising the mass evacuations, organizing the activities at the reception areas, and, with the Hitler Youth, guided the welfare and educational work of the evacuated school children. An additional aspect of this use of social welfare as a political instrument was in the manner in which all evacuees, including school children, air raid victims, and expectant mothers, were regarded as “guests of the Fuehrer,” and hence under party control. (See the section on maternal and infant care in Chapter Nine.) The impact of the general over-all hardships of the war and of aerial bombardment of the cities of Germany, in particular, upon this heterogeneous governmental and political hodgepodge, began to make itself felt in 1942. As the tempo of allied strategic bombing increased in 1942 the confusion resulting from the pull and strain of each of these organizations moving in a different direction with- out integration or control from above made resolu- tion of the national medical and health problem no longer escapable. On July 12, 1942, Hitler appointed Professor Karl Brandt (associate professor of surgery at the University of Berlin and personal physician to the Fuehrer) to be “General Commissar of the Fuehrer for all Military and Civilian Medicine and Health" (Generalkommissar des Fuehrers fuer das Sanitaets-und Gesundheitswesen). At the same time 160 Figure 53 SCHEMATIC PRESENTATION OF THE GERMAN NATIONAL MEDICAL AND HEALTH ORGANIZATION DURING THE CRITICAL WAR YEARS 1942-45 (NOTE:-THAT EACH AGENCY WAS HEADED BY A PHYSICIAN THAT PROF BRANDT WAS IN A POSITION TO RESOLVE DIFFERENCES BETWEEN THE CIVILIAN AND MILITARY SECTORS AND TO PROTECT THE NATIONAL INTERESTS OF BOTH--THAT EACH AGENCY RETAINED ITS SELF SUFFICIENCY) RESEARCH, SCIENCE AND MEDICAL EDUCATION (PROF. DR MED ROSTOCK) MILITARY SECTOR CIVILIAN SECTOR PHYSICIANS, PATIENTS AND HOSPITALS PHYSICIANS, PATIENTS AND HOSPITALS MEDICAL SERVICES OF THE PROF. DR MED. KARL BRANDT CIVILIAN MEDICAL AND (MAJ. GEN. DR. MED. HANDLOSER ARMED FORCES REICHS COMMISSAR OF THE FUEHRER FOR MILITARY AND CIVILIAN MEDICINE AND HEALTH HEALTH SERVICES (DR. MED, L. CONTI ARMY SS.SA.NSKK NAVY POLICE POLITICAL CIVIL GOVERNMENT* PARTY (MINISTRY OF INTERIOR) AIR FORCE ORGANIZATION —TOOT WAFFEN SS LABOR CORPS I.) PARTY MEDICAL AND I. PUBLIC HEALTH SERVICE ASSOCIATED ORGANIZATIONS 2. WELFARE AGENCIES (PHYSIANS, DENTISTS, 3 DRUGS, NARCOTICS 8 TECHNICIANS, DRUGGISTS, FOOD CONTROLS VETERI MARIANS,NURSES, 4. RED CROSS MATURE-HEALERS, 5. MEDICO-LEGAL FACILITCS HITLER YOUTH POLICIES PROGRAM MIDWIVES.) 6. VITAL STATISTICS 2) RACIAL MEDICAL 7. NATIONAL TBC 3.) PARTY ASSOC. OF 8. MEDICAL CURRICULA UNIVERSITY PROFESSORS AND LICENSING INDUSTRY AND BUSINESS ADMIRAL (RET) DR. MED. FIKENTSCHER) PHARMACEUTICALS ROENTGENOLOGICAL APPARATUS TEXTILES PRECISION INSTRUMENTS OPTICS HOSPITAL EQUIPMENT SURGICAL INSTRUMENTS I)MINISTRY OF LABOR RESPONSIBILITIES OF SOME OF THE OTHER CIVIL GOVERNMENT AGENCIES MEDICAL AND HEALTH INSURANCE INDUSTRIAL COMPENSATION SOCIAL SECURITY MEDICAL BENEFITS 2)MINISTRY OF PROPAGANDA MEDICAL PUBLICATIONS MEDICAL ADVERTISING MEDICAL PROFESSIONAL CONVENTIONS HEALTH RESORTS 3)MINISTRY OF EDUCATION MEDICAL FACULTIES DRAWN FROM A SKETCH PREPARED BY 4)MINISTRY OF FOOD AND AGRICULTURE FOOD,FOOD PRODUCTS PROF BRANDT. JUNE 18,1945 161 MEDICAL PERSONNEL Major General Handloser was appointed Director of Medical Services for all the armed forces and thus became responsible for the health of the Army, Navy, Air Force, SS, German Police, Youth Labor Corps, Organization Todt, and all semimilitary party organizations. It might be said that he was the military counterpart of Dr. Leonardo Conti, the head of the German public health service and the State Secretary for Civilian Health in the Ministry of the Interior. Brandt was the court of last appeal in resolving disagreements between the military and the civilian sectors of the German nation. During the early period of the war there was no co-ordination of the medical research being done by the military organizations, industry, universities, and government research organizations. In an at- tempt to channel all scientific research into one well-controlled direction Goering organized a group similar to the National Research Council in the United States and placed it under Professor Osen- berg. Professor Ferdinand Sauerbruch of the Uni- versity of Berlin was in charge of medical research within the Osenberg organization. This lasted un- til 1943 when the mounting air attacks on German cities began so to disorganize the established meth- ods of caring for civilian health that central con- trol for all health matters could no longer be avoided. (This is according to a statement by Brandt.) Hitler raised Brandt from a General Com- missar to a “Reichs Commissar,'’ or minister with- out portfolio. In so doing he made Brandt respon- sible for the co-ordination of all medical research and for the liaison between the drug, surgical sup- ply, and associated industries. This move also made Brandt the very top man in all matters, whether military or civilian, pertaining to the health of the Germans. When he was interrogated in June, 1945, Brandt said his basic policy was to maintain himself in a position of co-ordinator rather than controller, a most unique point of view for a commissar in a totalitarian government. He said it was his hope to resolve the complex problems affecting the medi- cal and health situation of the German nation by having physicians direct the responsible agencies. He felt that it would then be possible for these physicians to sit around the table and discuss as professional medical men any conflicts or problems which arose. He appointed Professor Paul Rostock to super- vise and direct the medical research and educational program of the nation. Admiral Fikentscher, the retired Director of Medical Services of the Ger- man Navy, became the co-ordinator for supply. The latter was responsible for monitoring not only the allocation of critical raw materials in the pharma- ceutical, optical, textile, and surgical supply indus- tries but he had also to see to it that manufactur- ers of these essential products were protected by the deferment from military services of a sufficient number of skilled technicians to assure the supply of finished goods. Fickentscher had his own prior- ities’ board to guide and control the division of available supplies between the military and civilian sides of the health organization. Brandt sketched this organization during the in- terrogation. It is from his statement that the ac- companying chart has been drawn ( Figure 53). Physicians From the beginning of the war until the sum- mer of 1942 neither the German Government nor the Nazi Party exercised any control over the re- quests or requirements of medical personnel from the Armed Forces. As a result, those responsible for the adequacy of physicians, nurses, and similar specialists to care for the health of civilians found themselves by the spring of 1942 confronted with a critical shortage of personnel. Records and inter- rogations of the Medical Branch indicate that this situation may be attributed to one or more of these causes: (1) The demand for physicians resulting from the increased number of air raid casualties occur- ring in German cities. (2) The redistribution of the civilian population through the air raid evacuation policies and, along this same line, the transportation of the more seri- ous air raid casualties to hospital centers outside the critical air raid zones contributing to the im- balance in the distribution of medical personnel. (3) The demands on German health services for supervision of sanitary and health conditions in the occupied countries. (4) The increased demands of the Armed Forces to replace losses sustained in the 1941-1942 Russian campaign (1.775 medical officers were reported killed on the Russian front during these years, and approximately 3,000 medical student cadet officers were also lost in this campaign). (5) The increased demand for physicians in the various industries engaged principally in the manu- facture of armaments. The abrupt demand for more medical care for 162 Figure 54 KEY TO DISTRICTS ) BADEN WITHOUT ALSACE ) BAVARIA ) BERLIN ) DANZIG-WEST PRUSSIA ) HAMBURG ) HESSEN-NASSAU I CARINTHIA ) KURHESSEN I MARK BRANDENBURG ) MECKLENBURG ) MOSELLELAND WITHOUT LUXEMBOURG I LOWER DANUBE I LOWER SAXONY I LOWER SILESIA I UPPER DANUBE I UPPER SILESIA I EAST PRUSSIA POMERANIA 1 RHINELAND SAXONY SAXONY-ANHALT i SALZBURG i SCHLESWIG-HOLSTEIN STYRIA SUDETEN LAND THURI NGIA TYROL AND VORARLBERG WARTHELAND WESTPHALI A —LI PPE WESTMARK WITHOUT LORRAINE VIENNA WUERTTEMBERG EMERGENCY RESERVE OF ACTIVE PHYSICIANS AS TO DISTRICTS STATUS OF 1/7/43 EMERGENCY RESERVE IN % OF THE NUMBER AVAILABLE FOR CIVILIAN CARE SURPLUS DISTRICTS WITH ABOVE AVERAGE SUPPLY DISTRICTS WITH AVERAGE SUPPLY DISTRICTS WITH SUPPLY BELOW AVERAGE DEFICIENT DISTRICTS 162 A MEDICAL PERSONNEL civilians when the air war was just starting brought to the attention of German health officials the dan- ger of the more or less uncontrolled induction of physicians into the Armed Forces. Conti at first at- tempted to establish a backlog of physicians to be used in the impending air raids by requesting the release of 2,000 men from the Armed Forces in late 1942. He received just half of the requested number. Subsequently, to stabilize the distribution of physicians an agreement was reached between Handloser and Conti whereby each time a practic- ing physician entered the Armed Forces, the latter were required to relinquish a similarly qualified in- dividual to the civilian sector. Any increase in the requirements for the Armed Forces was to be met by the immediate induction of all physically qual- ified medical students upon their graduation. The increased demand for the civilian side was met through the newly graduated women doctors, the counting of all doctors over 70 as “half-physicians” for the purpose of allocation and distribution, and the reinstatement of Jewish physicians into the practice of medicine. It is interesting to note that by 1943 all physicians of 50 per cent Jewish an- cestry were reinstated to full medical practice, and in the summer of 1944 when the air raid casualties increased in alarming proportions all physicians of 100 per cent Jewish ancestry were reinstated to full medical practice. Conti has stated that this exchange agreement was worked out smoothly, but there are indications that it was the inability of the military, which was trying to provide care for the wounded at the front, and the civilians, who were alarmed at the inade- quacy of the care given after the initial big scale raids, that precipitated Hitler's decision to name a health commissar for the nation. Brandt was made responsible to Hitler alone and his first mis- sion was to find medical personnel to meet both the military and the civilian needs of the nation. Dr. Leonardo Conti who, in addition to his gov- ernmental position in the Ministry of the Interior, was the party leader of all German physicians, but who had both political and governmental powers consistent only with those to be found in a totalitarian state, established a department within the National Chamber of Physicians (Reichs Aerz- tekammer) charged with the responsibility of the equitable distribution of .physicians throughout the nation to meet the civilian needs under the chang- ing conditions caused by aerial warfare. It was found necessary to provide approximately 2.824 physicians over and above the normal re- quirements to care for air raid casualties. To ac- complish this a reserve was set up. Figure 54 shows the source of these “extra physicians and is said to have been based upon the ratio of physi- cians to population and the expected danger of air attack. The basis was 1 physician to each 125 hos- pital patients (air raid casualties). When it was decided to divide the nation into four “zones of air raid danger" according to degree of severity of the anticipated allied aerial assault, additional phy- sicians were made available to the four zones in these proportions; Zone I—Zone of Hamburg, the Rhineland, and the Ruhr received an addition of 16 per cent. Zone 11—Berlin and Baden received an addi- tion of 12 per cent. Zone HI—Bavaria and Mosel land received an addition of 8 per cent. Zone IV—Danzig, Vienna, Thuringia received an addition of 4 per cent. These four critical air raid districts thus re- quired 2,088 additional physicians. This national plan provided roughly 1 doctor for each 6,670 civilians in towns or areas under 50,000 popula- tion and 1 doctor for each 3,333 civilians in towns of more than 50.000 population. The agricultural areas and the mountain areas received a prescribed percentage increase and the thirty German medical schools were authorized a total of 595 physicians to staff the full-time teaching and research posi- tions. In October, 1944, Handloser issued a directive that military health services, medical officers, facil- ities, and equipment were to be made available for the care of German civilians, particularly for the air raid casualties as well as for military personnel. This relieved the situation somewhat. Although there was considerable confusion resulting from so many people working at cross purposes in an effort to bring some order out of the chaos in the dis- tribution of physicians in Germany, in the end there appears to have been a reasonably equitable distribution of physicians in that nation. It is difficult to state categorically whether the plan of allocation and distribution had a delete- rious effect on the quality of medical care. As the interviews with physicians throughout the Ameri- can, French, and British occupied areas revealed, every physician in Germany had to do about twice as much work during the war as he did during 163 MEDICAL PERSONNEL peacetime. Add to this the extremely trying con- ditions under which he had to work, add such fac- tors as day and night air raids and alarms, fre- quently twenty-four hour tours of duty in air raid shelters, not to mention the inadequacy of medical supplies and the destruction of facilities and per- sonal losses (see Chapter Nine), and it is reason- able to assume that the quality of medical care was indeed lowered. There were older physicians at work as is shown by the fact that the average age of the German physician on the home front in 1942 was 58 years, but by January, 1945, the average age had increased to 62 years. In the Army, after October, 1944, medical officers who had reached the retirement age of 65 were retained in the service and were required to do the same amount of work under the same conditions as the younger men. There were 82,400 physicians in greater Germany in November, 1944, of which 33,000 were in the Armed Forces. If one includes the various semimilitary organizations with their independent medical services this last figure will be raised to approximately 47.000 for a popula- tion of 66,000,000 for Germany proper (see Figure 55). Perhaps the best proof of whether the Germans were satisfied with their ultimate solution of the problem of allocation and distribution of physi- cians can be had by comparing what they did during the war with what they planned to do in the postwar period. In 1943 a plan was prepared for the repopulation of Germany with the re- quired number of physicians during the years to follow the conclusion of hostilities. This was based upon physician losses and the increased civil- ian and military patient load which went hand in hand with the war and aerial bombardment of the German homeland. To provide 5,000 medical gradu- ates each year, 30,000 medical students were to attend medical school (two semesters each year, ten semesters in all), with a proposed ratio of two to one between men and women students. It was anticipated it would take twenty-five years follow- ing the cessation of hostilities to accomplish the ratio of 1 physician for each 1,000 inhabitants. Dentists Detailed information concerning the influence of the air war on the German civilian population with reference to the allocation and distribution of den- Figure 55 DISTRIBUTION OF GERMAN PHYSICIANS IN AUTUMN OF 1944 10.000 CIVILIAN MALE PHYSICIANS UNDER 50 l?; 000 CIVILIAN MALE PHYSICIANS OVER 50 [9,400 FEMALE PHYSICIANS 5,500 INCAPACITATED 8 ILL PHYSICIANS 15.000 IN PUBLIC HEALTH SERVICE 133.000 IN THE ARMED FORCES APPROXIMATE TOTAL 79,000 LETTER FROM REICHS COMMISSAR FOR HEALTH (PRANDT) NOVEMBER 16,1944. 164 MEDICAL PERSONNEL tists was not obtained during this survey. This should not lead to the conclusion that such prob- lems did not exist; no member of the dental profes- sion was available to the’Medical Branch of the USSBS. When the war started in 1939 there were some 20,000 dentists in Germany. At first those inducted were not commissioned as officers since there was no dental corps. In fact it was not until 1941 that the various medical services of the Armed Forces each established a separate dental corps. It is esti- mated that in 1942 approximately 8,000 dentists were Dental Corps officers in the Armed Forces. In addition, more than 3,000 German dentists were either line officers or enlisted men with combat or service elements. The term dentist is employed here in the same sense in which it is used in the United States (DDS) and not as it is used in Germany where dentist refers to the American equivalent of a den- tal technician or hygienist. pital beds. It was frequently stated that the hospi- tal authorities regarded themselves fortunate if even this ratio could be maintained. The actual statistical distribution of nurses was as follows: at the outbreak of the war there were approximately 5,500 Red Cross nurses assigned to the Armed Forces. This number had increased to 14.000 by January, 1945. Altogether there is said to have been approximately 40,000 Catholic nurs- ing sisters and 16,000 nurses drawn from Protestant organizations and from the Nazi Nurse Association. In Germany as a whole, according to Mrs. von Oertzen, Chief Nurse of the German Red Cross, there were 60,000 Catholic, 40,000 Protestant, and 40.000 Red Cross nurses, in addition to about 10.000 of the so-called “Brown Sisters." To this should be added the 30,000 nurses who were inde- pendent of any organizational control. The duration of nurses’ training was not short- ened during the war. An applicant could become a registered nurse either by taking the course pre- scribed by the Red Cross or by one of the sectarian groups or could be given credit for work as a nurse s aide. In the latter case after the completion of a year and a half of continuous work as a nurse’s aide any woman could receive three addi- tional months of academic work and become eli- gible to take the state examination. Those w-ho chose the somewhat longer route took the usual course of one and one-half years of academic studies and one year of practical work in a military or civilian hospital and then became eligible for the government examination for trained nurses. The personal and professional hardships en- countered by these women during the combined aerial offensive on the German.cities would be diffi- cult to overestimate. The first problem to confront the authorities was one of the personal health of the nurses working in the cities receiving the heavy assault. Mrs. von Oertzen declared there was a marked increase in tuberculosis and heart disease. This was attributed to the constant state of extreme fatigue resulting from having to work long hours and particularly to the extra physical exertion in- volved in moving patients from wards to air raid shelters and back to the wards each time there was an alert. This fatigue is said to have been respon- sible also for the fact that menstrual disturbances and secondary anemia became the rule rather than the exception. It was frequently accompanied by in- somnia and even well-developed neuroses. Nurses were required to live and work under very crowded Nurses The allocation and distribution of nursing per- sonnel in Germany did not present the same type of problems as did the physician personnel. Despite the emergency created by the war and the intensi- fication of this situation brought about by the in- jury to thousands of civilians in the air offensive it was not necessary for the German government to resort to the expediency of drafting nurses. That this was unnecessary may be attributed to the fact that the great majority of nurses in the Reich be- longed to such religious or state organizations as the Catholic or Protestant church orders, the Ger- man Red Cross, or the National Socialist Nurses Association. This last category was an organization which sprang up in the late 1930’s in nonsectarian hospitals. After 1939, all nurses’ training in the sectarian institutions was discontinued. Thus all student nurses training came under the Red Cross or the “Brown Sisters,” who, incidentally, were under the supervision of the NSV (see the discus- sion of Germany’s national health administration in the first section). Generally speaking, in the civilian institutions an effort was made at the beginning of the war to maintain a ratio of one nurse to every seven hospi- tal beds. By 1944, however, the losses among the nursing personnel and the increased military, civil- ian, and air defense demands upon their services had reduced this ratio to one nurse to twenty hos- 165 MEDICAL PERSONNEL conditions. Many of the air raid shelters had poor or inadequate ventilation systems; the illumination was not much better. The number actually killed or wounded has not been definitely established. Mrs. von Oertzen estimates, however, that during the last months of 1944 the Red Cross nurses suf- fered a casualty rate of 10 per cent as a result of the air raids and of this number 10 per cent wrere said to have been killed. Not only the work in the air raid shelters but the attempt to utilize small hotels, schools, and private homes as auxiliary hospitals placed an increased burden on the individual nurse because these substitutes often lacked the equipment and the architectural planning which made for efficient operation. Mrs. von Oertzen remarked that from the point of view of .the nurses the Ahtion Brandt hospitals were ideal in many respects. (See Chap- ter Nine for a description of these hospitals.) Perhaps the most difficult problem encountered in the actual rendering of nursing care was in the treatment of an excessive number of cases of burns. It was difficult to maintain the usual standards of cleanliness for the water supply in most of the hospital facilities w?as usually disrupted in or after most air raids. It was a laborious task to move the patients and to protect them from infection under the comparatively primitive conditions that existed, and the daily redressing of their wounds presented additional work. infrequently found operating a medical dispensary- in the evacuation and reception areas. In their work they performed all of the simpler types of nursing care. The general practitioner George A. Wulp, M.D. In describing some of the problems of the gen- eral practitioner in a country where every city is under violent air attack it is necessary to point out some of the factors governing his position in the profession as a whole. The general practitioner or Praktische Arzt in Germany includes the so-called family doctor and the insurance doctor. This group comprises a much smaller percentage of the total number of registered physicians than in the United States because there are proportionately more spe- cialists, more full-time hospital doctors, and more full-time or part-time Amtsaerzte or governmentally employed doctors in Germany. Of the general prac- titioners more than one half are insurance doctors, i.e., their entire income is derived from patients in a panel covered by sickness insurance. That this is so may readily be understood when it is realized that all wage earners of a certain income bracket must carry sickness insurance. (Sickness insurance is discussed in detail in Chapter Five on industrial health.) During the last years of the w7ar the total num- ber of general practitioners was a little more than half of what it had been before the war; there was proportionately a greater number of women physi- cians, as well as both men and women physicians of over 55 years of age. The greatest loss of course was in men up to 55 since this was the age group eligible for induction into the Armed Forces. In the last six months of the conflict general practi- tioners up to the age of 65 were being commis- sioned for front-line duty. During the last two years of the war the gen- eral practitioner w?as under the iron-clad control of the government. This control w?as exercised through the local medical society. It told him where he could get his equipment, what he could have, where he could practice, and even went so far as to move him from one section of the coun- try to the other. In many respects the civilian prac- titioner was no better off than the Army medical officer when it came to exercising his own profes- sional freedom. Dr. Conti, wTo was head of the German Medical Society (Reichsaerztekammer) in addition to being the head of the national public Women's volunteer units As an auxiliary service performing elementary nursing care the Germans organized a First Aid Women’s Volunteer Service which was comparable to the American Red Cross nurses’ aides. Members of this organization received twenty hours of first aid instruction and were usually employed in the dispensaries, in air raid shelters, and in other medi- cal facilities associated with civilian defense. If they desired, members of this group could com- plete forty-two hours of additional instruction (forty hours of which were in first aid and two of which were in “political indoctrination”) and they would then be permitted to take the examina- tion to become nurses’ aides. By 1945 the Women Volunteers of the Red Cross numbered approxi- mately 500,000. Nurses' aides were on a somewhat higher level than were the so-called “First Aid Women.” They were assigned to physicians in hospitals, air raid shelters, and industrial dispensaries, and were not 166 MEDICAL PERSONNEL health service, hoped with these rigid controls to distribute physicians as impartially as possible and still to maintain a physician to patient ratio of from 1 physician to every 2,000 to 4,000 in- habitants. These plans often needed revision dur- ing the last years of the war since it was frequent- ly necessary for Conti’s organization to send phy- sicians from the less critical areas to locations in which the civilian population was in greater need of them because the air raids had become more intense. These governmental regulations and the uncer- tainty they created in the minds of the doctors were the least of the general practitioner's difficul- ties during the war years. Every one of them had about again as much to do as formerly and, in ad- dition, had to do it under considerable handicaps, the direct and indirect effects of bombing being among them. Many physicians with whom the in- vestigators talked had had their homes and their offices, or both, bombed out not only once but sev- eral times; it was not unusual for a doctor and his family to live in one or two patched-up rooms in a cellar with very few facilities of any kind. If he had been fortunate enough to have evacuated his family to a safe place the doctor, living alone, did not have even these curtailed “comforts" of a home. If he had moved his family any distance away, it is more likely than not that he had had no word from them after the fall of 1944 when the Allies’ bombers went to work on the German communications and transportation systems. He probably had no assistant or office help and, in fact, there was little to make for peace of mind or to help relieve his increasing fatigue. Despite the fact that he worked long hours and had much traveling to do the physician received no supplementary food ration and his gasoline quota was in many instances too small for his needs. This was especially true in the country where the dis- tances were greater. Not a few doctors had to use wood-burning boilers for their cars. This added so much weight to the car that it often bogged down on the country roads. Others spent many hours a day walking or bicycling. These travel haz- ards were a particular hardship to the older men who had come back into practice and to those released from the Army for medical reasons. In the actual practice of their profession they were also hampered by many aggravating factors. Although the Ministry of Health tried to give the doctors more help (as nurses’ aides or volunteers) they were not infrequently without any office assis- tant. Laboratory facilities had been sharply cur- tailed so that such examinations as blood chemis- tries were done only on stated days, and much of the routine work that would ordinarily have been done in the doctor's office had to be eliminated for lack of reagents and time. When he wanted to pre- scribe for a patient it was frequently necessary for him to get in touch with the druggist (seldom by telephone) first to find out whether the required medication was available or whether he had to work out a substitute. Forms had to be filled out for insulin cards, extra rations, sick leaves, and so on down through the gamut of bureaucratic printing. Despite the fact that the general public had been asked to place requests for house calls early in the morning this was often impractical. Furthermore, the general practitioner’s day was often broken by the necessity of many hours of air raid work. The moment the first alarm sounded he had to go to his post in the shelter. The alarm might last all night. If the planes came over and went on to another city he had to be the pillar of courage for those huddled together. If they dropped their load on his city he had to care for the wounded and the dying until the job was done. This was the experience of every general practi- tioner interviewed in Germany. The general shortage of doctors being reflected in the shortage of specialists also, it became the task of the general practitioner to widen the scope of his work to include surgery, obstetrics, and other specialized types of practice. This tended toward an equalizing or leveling of all medical practice which under other circumstances might be a healthy development, but when the general practi- tioner had more than he could do at best, he had no time to improve his skill in special fields where he had become rusty. Toward the end of the war the general practi- tioner had become physically and nervously ex- hausted. He had done the work twice as many phy- sicians used to handle, going without vacations, sac- rificing home and family life, giving up study in his profession, going without many of his necessary professional “tools.” working almost constantly under adverse conditions-—and yet he did a good job. There were undoubtedly instances when a pa- tient’s illness became aggravated because a physi- cian could not see him soon enough, as for example in a case of ruptured peptic ulcers with no atten- tion for two days. But more frequently it was dis- 167 MEDICAL PERSONNEL closed that on the whole civilians had “adequate medical care,” the “shortage of doctors is not ap- parent,” “the situation is still bearable.” And a survey of the health of the German population does not indicate that the shortage of general practi- tioners had had too harmful an effect. adequately ventilated rooms were the specialists. Most of the doctors could stand up against this un- usual situation quite well, but slowly a sensation of increasing fatigue was noticed. On top of this strange professional life, all the usual hardships, like lack of sleep and permanent nervous tension, made their existence hard to bear. Lack of suffi- cient food was the main complaint in many in- stances, as even surgeons were not eligible for extra rations. Only after the great catastrophe in Ham- burg did doctors as well as other people residing in this district get supplementary food for a pe- riod of three months. In addition to all these phys- ical hardships, many specialists, very well ac- quainted with international professional and civil life, were greatly disturbed by the course of the war and by the faulty assumptions and doctrines of the Nazi regime. Nevertheless, they went on with their work and were very proficient despite having no holidays, no leisure, and being forced to do a double amount of work. Dr. Leonardo Conti, fully recognizing this situation, paid the highest tribute to the achieve- ments of his colleagues, and Dr. Handloser con- sidered the work of the German surgeons superb. The specialist The greatest burden of the strain of war was borne by the top specialists. The statistics reveal, for instance, that two thirds of division chiefs in in- ternal medicine and in surgery were called in to the Armed Forces. Specialists in private practice contributed their share as well; 960 of 2.090 in- ternists, 910 of 2,010 surgeons, 115 of 330 ortho- pedic surgeons had to serve the home front. Those who remained had to cope with often poorly educated and inexperienced assistants. The curtailment in gasoline and the insufficient quality of medical journals helped to make professional life difficult. Roentgenologists suffered under the loss of x-ray equipment, which was difficult to re- place, and repairs took an unduly long time. Since about 1942, a new era—the “bunkerlife”—started, and the physicians who had to spend most of their time under the influence of artificial light and in- 168 CHAPTER EIGHT MEDICAL EDUCATION HANS H. REESE. M.D., MADISON. WISCONSIN Medical education in Germany experienced many changes during the war but, except for the direct effect of the physical destruction of university buildings, hospitals, and clinics, few of these were related to bombing. Although continuing air raids raised new problems of patient care and treatment which had to be met by radical revisions of medical administration and of programs of medical care, these had to be accomplished with practising phy- sicians and medical officers rather than among students still engaged in acquiring the fundamentals of medicine. The destruction by air attack of uni- versities and medical schools in the later years of the war may have had little influence on the outcome of the conflict, but nevertheless it will be serious for German medicine of the future and the consequent effect on the health of the popu- lation of the country. Germany’s outstanding tradition in medicine and medical education began to deteriorate gradually during the turbulent twenties, a process which was greatly accelerated when the Nazis took over. The old eagerness for scientific knowledge and training declined; students of the new Reich entered medical school to secure the personal benefits of govern- ment support; their time was taken by interests other than the study of medicine. The Nazi disre- gard for professional and scientific matters crippled all medical training during the latter years of the regime. When asked the reason, Professor Brandt, the Reichs Commissar for Medical and Health Affairs, answered that in an authoritative type of government the old line street fighter natu- rally distrusted and disliked anything he could not understand, or which, because of background and education, he felt was above him. Political funds and party contributions were used in the selection and rating of students. Many outstanding teachers had been discharged for political reasons and re- placed by party stooges. Further, a unified study plan was instituted in 1938, stipulating educational requirements and minimal lecture program of twenty-five hours’ clinical study weekly throughout all universities in Germany. This attempted unity was designed to permit the forced transfer of stu- dents from overcrowded schools to less popular study centers with no interruption of studies. Hos- pitals approved for internships, residences and assistantships were supervised by regional deans in conjunction with the local medical societies. The war and medical education The history of medical education during the war was one of incessant conflict between the increas- ing manpower needs for the Armed Forces and the necessity of training physicians both for military service and for civilian practice. All students of medicine were called into service at the beginning of the war in 1939, but after the successful Polish campaign those who had completed at least one semester of medical study were permitted to re- turn to their studies. Although the enrolment gradu- ally increased from 17,000 in 1939 to 24,000 in 1941, and to 39,000 in 1944, the increase was in women students and in male Army students as- signed to medical training. The latter, after 1943, were for the most part members of “student com- panies" and received training in medicine at the same time they performed their military duties. They numbered 11,000 in 1941 and increased to 16,000 in 1944. The women students increased from 6,500 to 14,000 during these years, while male civilian students decreased from 5,700 in 1941 to 2,900 in 1944. The estimated annual replacement figure for the Medical Corps of the Army was placed at 3,000 for 1943. These were losses due to age, illness, accident, and death (including lives lost in combat). Re- placement had to come from the graduates of three military academies who numbered 117 in 1943, and from the graduating classes of the uni- versities, 1,550 in 1943, leaving a replacement defi- cit of 1,330 physicians. In an effort to fulfill these demands the tenth or last semester of study was canceled, and the students were assigned for the period to assistantships in city or field hospitals or, for a limited number, to postgraduate study. This step to lower professional training was considered 169 Figure 56 SEMESTER STRENGTH OF GERMAN NATIONAL MEDICAL STUDENTS WINTER SEMESTER 1944-1945 FROM THE FILES OF GENERAL ROSSTOCK-QFFICE OF THE REICHS’COMMISSAR FOR HEALTH 170 MEDICAL EDUCATION preferable to party demands that all medical schools be closed in 1943. However, the cancellation of the tenth semester proved to be only a temporary stop-gap. Late in 1943 an edict was issued closing the medical schools, the party officials maintaining that the sol- diers in the student companies were there to seek shelter from front line duty and the women to escape work in war industries. At this time 53 per cent of the men and 38 per cent of the women en- rolled in universities were studying medicine; tak- ing into account dentistry and veterinary medicine, more than 60 per cent of the total university en- rolment was engaged in the study of the medical sciences. At Berlin, for example, over 1,000 stu- dents were studying anatomy where only 300 had been registered in 1936. Lectures were thrice given; laboratory work was by demonstration. Professor Brandt pleaded with Goebhels, Speer, Conti, and the others responsible for the directive to eliminate medical education, to reconsider their actions in the light of what he termed a national catastrophe. As a result a compromise was reached whereby the fourth, ninth, and tenth semester students were ad- mitted to medical facilities during the winter semester of 1944-45, thus retaining approximately 18,000 of the original 39,000 enrolled. Figure 56 shows the 1944-45 enrolment by semesters and the changes resulting from this drastic draft of stu- dents for service. Little can be said for the quality of medical edu- cation during this period. Professor Brandt him- self stated that the medical students graduating since 1938 would never mature to be outstanding physicians, but believed they could be further trained so that “it will be safe to allow them to practise on their own.” In addition to the imposi- tion of purely military duties and the lack of chal- lenging responsibility under the military regime, the gravest interference with their studies occurred in the removal of libraries and the destruction of electric light and transportation systems. Lack of texts was another problem; a 1944 authorization for medical texts is shown in Table 32, but no evi- dence was found that the printing was actually carried out. Studies were frequently interrupted by air raids, by requests to help in devastated regions or to serve as “fire-watch” in university buildings at night. Table 32. Medical Texts Authorized in 1944 Priority Printing Approved by the Reichs Propaganda Ministry Number of Authorized separate copies Subject T exts Anatomy and embryology 11 67,750 Physiology, physical chemistry 10 53,900 Pathology 7 38,750 Hereditary medicine Bacteriology, hygiene, infectious 5 25,300 disease 10 30,625 Diagnosis (including X-ray) Therapy, pharmacology, phar- 4 24,925 macopoeia 7 53,350 Actinotherapy Internal medicine, including 5 12,100 tuberculosis 14 73,975 Pediatrics 6 20,550 Obstetrics and gynecology Surgery, including ortho- 9 35,600 pedics, urology, injuries Dermatology and venereal 13 52,950 disease 3 17,300 Ophthalmology 4 18,400 Ear, nose and throat Neurology, psychiatry, psy- 6 23,380 chology 8 40,950 History, terminology, ethics 6 51,700 Associated medical sciences 3 9,750 Dentistry 10 27,650 Total 141 678,905 The continued bombings resulted in an over- crowding in the still existing universities to a point where instruction was given only under severe diffi- culty. The medical curriculum was adjusted to practical and timely subjects with no opportun- ity for investigation or research. With the con- stantly increasing destruction, more and more uni- versities had to be closed with a consequent over- crowding in the remaining institutions until in March, 1945, all educational facilities had suc- cumbed to bombing. The lower grade and prepara- tory system had already been closed in the autumn of 1944. These enforced steps caused consternation among the people of Germany and produced a flood of comments and criticism in the press and in educational journals. 171 MEDICAL EDUCATION Figure 57. Air raid damage to First Medical Clinic, University of Munich. Front view. Effect of bombing on German universities The task of securing a detailed bombing survey of activities in German universities at the end of the war was difficult. Not only were faculties and student bodies scattered over the country, but more important was the utter destruction from frequent bombings and by fires of the institutions, the clinics, and laboratories of practically every uni- versity surveyed. For example, in the once spacious modern psychiatric clinic at Kiel not a single per- son was available for interrogation and discus- sions; in the bombed-out buildings once used for preclinical studies, collections of specimens, instru- ments, and books were strewn over the floors, or piled in burned-out basements. It was true that many records were wilfully destroyed upon the nihilistic orders of the government, and others were burned or severely damaged by fire and water as the result of the frequent air raids. On the other hand, precautionary measures had distributed many archives, documents and records into rural areas. These were not checked by us because of the limited allotted time and personnel. If several leads could have been followed, a considerable number 172 MEDICAL EDUCATION Figure 58. Air raid damage to First Medical Clinic, University of Munich. of libraries, collections of laboratory equipment, and other paraphernalia of medical research and teaching might have been uncovered. The following descriptions of the state of the universities visited in May and June, 1945, may, however, be considered fairly typical of the fate of medical schools located in the larger cities of Germany. It is proper to mention that the selection of these schools for survey was determined in Lon- don before field work was begun so that we were in no sense guided to these places as “examples" of destruction by persons desiring to place before us as devastating a picture as possible. University of Munich: Almost all of the inter- nationally known University of Munich was com- pletely destroyed; the once impressive administra- tion building is a shell. The anatomy, physiology, physiochemistry, hygiene and bacteriology, botany, zoology, and chemistry institutes were damaged severely in July, 1943, still more incapacitated in December, 1944, and transformed into ruins and rubble by an extremely devastating air raid by 600 planes of the Royal Air Force, striking at the city area on January 7, 1945. The surgical, internal medicine, pediatrics, eye, dental and outpatient clinics were severely damaged (Figures 57-62), Less extensive destruction occurred to oPstetrics and gynecology, neuropsychiatry, and dermato-urology clinics. In spite of this, medical training continued until March 17, 1945, although great difficulties were encountered. The enrolment of about 1,260 clinical students annually remained fairly constant to the winter semester of 1944-45. Much confusion reigned after each bombing attack, but co-opera- tive arrangements facilitated maintenance of teach- ing schedules in available lecture halls. Since parts of the damaged university buildings, especially roofs, could not be repaired, the upper floors in most clinics were unusable. The Dean and the faculty had worked out a directive for air raid measures and for procedures of transferring pa- tients which were well adapted to personnel, patient load and clinic facilities. Each university clinic was connected by special telephone lines with the city air protection office. Upon receiving the alarm signal, all patients and the most valuable instru- 173 MEDICAL EDUCATION Figure 59. Air raid damage to Second Medical Clinic, University of Munich Figure 61. Air raid damage to Eye Clinic, University of Munich. Figure 60. Air raid damage to Children s Clinic, University of Munich. 174 MEDICAL EDUCATION hereas in 1939 the children’s hospital had a bed capacity of 300, it was reduced by May, 1945, to only 80 beds. The reduction was due to an in- auguration of transfer measures of children to out- of-town emergency hospitals, leaving only infants and the acutely sick children at the hospital. Because of the air raids, the bed capacity of the university eye clinic was reduced from 200 to 40, the destruction of the roof and of one wing pre- venting all major surgery. The large number of perforated eye injuries due to splinters, glass and metal was surpassed by huge numbers of smoke injuries to eyes. Following the raid of December 15, 1943, more than 2,200 patients with severe “smoke irritation"’ of the eyes were treated within twenty- four hours. The university surgical clinic received a direct hit in December, 1944, and was severely damaged; however, the patient load had already been reduced from 220 to 100. The 100 patients were transferred from the burning and collapsed clinic at night into a spacious adjacent bunker with- out panic or confusion and without the loss of a single patient or staff member. This heavily rein- forced, concrete air raid cellar, with excellent sur- gical facilities, equipment and electric sterilization apparatus is presented in Figure 89 (see Chapter Nine). The clinic maintained an emergency hospital at Tegernsee, located in a castle. It offered satisfac- tory facilities for the care of surgical patients. Investigations during the later months of the war were conducted only on clinical projects, i.e., on pneumonia, on a type of lung disease termed “re- generative pulmonary hyperplasia.’* and on a hitherto unknown heart disorder, “fihrotic scarring in the heart of infants.” Scientific activities in the medical clinic were confined to routine work, ex- cept for studies in sprue and its pathogenic coli- mutation. University of Wurzburg: The University of W uerzburg, a charming old university located on the River Main with a history dating back to 1576, was severely damaged but less so among its medi- cal buildings. However, much destruction was seen in the Luitpold, the main university hospital with 800 beds and 60 doctors. Normal student life, lec- tures and war instructions stopped with the “hell- on-earth catastrophe” in the night of March 16, 1945, which destroyed over 300 beds, killed 12 patients and necessitated evacuation of the Luitpold University Hospital to its emergency hospitals. University of Cologne: The University of Co- logne was again a picture of utter destruction, with Figure 62. Air raid damage to Polyclinic Building, Univer- sity of Munich. ments were moved into the re-enforced basements. The air raid cellars for the university clinics were inadequate and remained mostly of the basement type, except for the surgical clinic. One farsighted member of the faculty, Professor Pfaundler, had built an air raid cellar in 1936 in the children’s clinic with room for 60 babies and 100 small chil- dren. Air raid attacks usually paralyzed the light- ing system and the water supply, at times for days. The greatest difficulties were encountered with toilet arrangements, since sand or peet closets and pots had to be used; the additional strain of disinfecting and carrying was noticeable among the already overworked nurses and attendants. The damage re- port system for each hospital after an air raid was very efficient. Within the entire medical campus not a single physician, nurse, attendant or patient was killed by bombing. However, indirect casualties did occur, especially among infants and small children or among older people who could not endure the frequent transports from wards into the damp, dusty raid cellars and the stay there for several hours and days. 175 MEDICAL EDUCATION Figure 63. Air raid damage to Anatomy Building, University of Frankfort-am-Main. Figure 64. Air raid damage to Physiology Section, University of Frankfort-am-Main. 176 MEDICAL EDUCATION only the administration building and parts of the surgical clinic intact. The shortage of teachers and assistants was greatly felt, because of the destruc- tion to the university hospital buildings and the tedious maintenance of the many scattered emer- gency hospitals in the country with only bicycles available for transportation. The various air at- tacks from October, 1943, to December, 1944, had disrupted teaching continuously with complete pa- ralysis of all academic activities by March 2, 1944. The large medical clinic had but 24 beds left, an additional 16 beds being shared with the neuro- psychiatric department. The latter was greatly dam- aged by direct hits in June, 1943, and received its final knockout in October, 1944. No research had been done in psychiatry since 1943; however, the surgical clinic carried out clinical investigations on gastric ulcer in relation to air raids. Cologne and the surrounding territory had no brain surgeon at the time of our visit, and with the ever increasing difficulties in travel and the transportation of pa- tients, a clear-cut result of air raids, no intervening brain surgery could be rendered except temporary relief measures to decrease intracranial pressure. No data are available as to the total number of stu- dents, as to lecture schedule changes or student ac- tivities. The University of Cologne and its medical school were considered by governmental authority a bombed-out and unusable university, in which no activities could be resumed during the war. The student body was transferred to less damaged uni- versities, but information on the percentage of transfers and to which universities could not be secured. University of Frankfort-on-the-Main: This uni- versity since the first world war one of the larger city universities of Germany, was located in close proximity to the railroad marshaling yards, the city power plant, and many industrial factories producing war materials. Consequently, the medical school and the city university hospitals suffered severe damage from the air attacks on these stra- tegic air targets. The anatomy, hygiene, pathology, and pharmacology sections were destroyed in 1943 and 1944 (Figure 63). The physiology and surgi- cal sections were severely damaged (Figures 64, 65) at the same time. The orthopedic hospital, which originally had 700 beds for the treatment of civilian orthopedic cases and an outpatient clinic for the Army, was completely demolished. One wing of the psychiatric hospital, built in 1930, was destroyed together with records pertaining to the effect of bombing upon psychiatric conditions. The modern X-ray clinic was partially destroyed, but continued to be used for administrative work and storage of X-ray equipment. The medical college was closed in February, 1945, at the end of the semester. Whatever was left of the buildings was converted to the care of pa- tients, and the staffs dealt with patients instead of with students. The library of the city-university hospitals was completely destroyed in October, 1944. However, certain publications and a quantity of books had been preserved. A subterranean air-raid hospital was built on the grounds of the medical center and is described in the chapter on hospitalization (see Chapter Nine). One of the largest in Germany, it permitted continuous operation of many hospital functions during air attacks, with its twelve operating rooms, extensive X-ray equipment, and obstetrical depart- ment. It was in full operation at the time of our visit, supplying badly needed hospital facilities. It will continue in use until the city hospital can be rebuilt but probably is too crowded to he of use for teaching purposes. University of Kiel: All of the buildings and in- stallations of the University of Kiel were com- pletely destroyed, the first institute of higher learn- ing to become a casualty to bombing. An early ministerial edict ordered its cessation as a func- tioning medical school. The student body was trans- ferred to the two less damaged universities at near- by Rostock and Greifswald. University of Hamburg: The medical facilities of the university are for the most part incorporated in the former city hospital, Eppendorf, located on the outskirts of the city. The pavilion system with 58 single pavilions, each accommodating 36 pa- tients with 4 patients in private rooms, offered good dispersal against air attacks. The admission stations for internal medicine, surgery, anatomy, and pa- thology are located in large two-floor buildings with modern equipment and construction facilities. The student body was never closely knitted as so commonly found in other medical schools, because it was a school for middle class students, who spent little time with social activities. Eppendorf, with a patient load of almost 3,000 patients, had only two spacious high bunkers. The auxiliary air raid cellars were enforced basements beneath pavilions or buildings. The various air attacks which cul- minated in the catastrophe of July 27, 1943, have 177 MEDICAL EDUCATION Figure 65. Air raid damage to Surgical Section, University of Frankfort-am-Main Figure 66. Damage to Surgical Clinic, University of Leipzig, by air raid of 4 December, 1943. Figure 67. Damage to Pharmacology Building, University of Leipzig, by air raid of 4 December, 1943. 178 MEDICAL EDUCATION Figure 68. Damage to Children s Clinic, University of Leip- zig, by air raid of 4 December, 1943. Figure 69. Damage to Medical Clinic, University of Leipzig, by air raid of 4 December, 1943. left marks on every hospital unit in the medical school. A large hospital staff at St. Georg assisted in the clinical teaching of the medical students. This 2,170 bed hospital had been reduced by air raids to less than 1,400 beds, and many depart- ments had to be removed to auxiliary hospitals by 1943. The severe bombing damage in April, 1945, suspended working facilities for several days, ne- cessitated the permanent removal of children and women suffering with nervous and mental diseases to out-of-town emergency stations, and limited the bed capacity to 768. Since St. Georg hospital played an important role in Hamburg’s medical life and in medical teaching it had received the same attention in re- gard to air protection as Eppendorf. A large spa- cious air raid bunker was completed in 1943 with a bed capacity of 32; it contained an excellent ven- tilating system and was well equipped for all sur- gical and delivery work. The medical director re- lated the enormous difficulties encountered during three rather severe bombings with from twelve to eighteen direct hits on burning buildings, and many more hits with fires everywhere from the catas- trophic bombing attack of April, 1945. No patients or personnel were lost although over two-thirds of the hospital was in flames. Practically all upper floors of twelve buildings were destroyed and burned out, with only one safe air raid bunker at their disposal. Working facilities are limited, since little repair work could be permitted in view of the extreme shortage of all building materials. In 1939, 643 clinical students were enrolled in the medical school, the number declining to 123 in the winter semester of 1944-45. The shortage of medical personnel, reduced by seven-tenths, with no replacement by internes or assistants, paralyzed research and only clinical investigations have been carried out since 1943. The pavilion system at Ep- pendorf made it feasible to carry on group teach- ing after the bombing havoc; however, with the final destruction of the larger lecture rooms, re- placement facilities were found in the pathology building until this building succumbed to repeated air bombing. The same story repeated itself, he... everything in the line of hospital equipment was short; no scientific treatment of metabolic and for most organic diseases could be carried out. The clinicians complained that the surgeons had better equipment, drugs and material, and could perform operations in safety with proper after-care. Surgical patients were much better protected in their special surgery bunkers than were the medical patients,, who had to be moved with each air raid or alarm into basements or collection cellars. At Hamburg’s medical school a hopeless attitude prevailed with regard to the future and progress of science in German universities. No information was available as to when teaching could be resumed. University of Leipzig: Although the University 179 MEDICAL EDUCATION Figure 70. Damage to Anatomy Building, University of Leipzig, by air raid of 4 December, 1943. Figure 71. Damage to Neuropsychiatric Clinic, University of Leipzig, by air raid of 4 December, 1943. of Leipzig was not included among the medical schools visited by our staff, reference to a compre- hensive air raid document obtained makes it pos- sible to give some detail on the damages inflicted by air raids upon the university. Leipzig, a university famous for five centuries, is the third largest uni- versity of Germany. Many outstanding scientists of international fame have been on the faculty. The important Karl Sudhoff Institute is here which housed a remarkable collection of documents on the history of medicine and science consisting of more than 35,000 books, 11,000 antique or his- torical medical instruments, and of more than 3,000 portraits of the world’s physicians. In the fall of 1942, the Education Department of the Min- istry of the Interior ordered that in view of ex- pected bomb raids the libraries of Leipzig, with their important and irreplaceable volumes, should be transferred to safe localities, preferably into near-by villages. The institute was bombed in Oc- tober, 1943, and severely damaged by direct hits on December 4, 1943, and again in February, 1944. The ultimate fate of the libraries was not known at the conclusion of the field work. Surprise air raids by the RAF in 1942 and in 1943 had destroyed many university and clinical buildings, but when 450 bombers blasted the town for twenty-five minutes on December 4, 1943, ruins and fire paralyzed all activities. The damage to the Sudhoff Institute from fire, destruction, and water on this “Katastrophen-night” was severe, hut the rescue work by the staff, by military students and by volunteers succeeded in transporting most of the Institute’s irreplaceable treasures to adjacent safety cellars without loss of life. The fire depart- ment and the heavy anti-flak artillery had been sent to the city of Berlin for emergency aid, thus making fire fighting and rescue work even more difficult. The women’s clinic received 126 incendiary and 14 phosphorous bombs; the orthopedic clinic over 200 incendiary bombs. With windows and doors blasted, with buildings in flame, the patients were removed quickly and marched in the bitter cold night, brilliantly illuminated by a burning campus, to their shelters. Pictures of the pre- clinical institutes, of clinics and of hospital build- ings demonstrate the bombing damage upon medi- cal installations as presented in Figures 66-70. A description of this air raid in which the uni- versity neuropsychiatric clinic was hit (Figure 71) is fairly typical of those reported from other clinics and is given as a specimen of such events: “W hen the night alarm sounded, we transported as usual all patients from the neuropsychiatric wards to the basement air raid cellar. Frequent preparatory exercises and constant education by lectures to patients and staff facilitated smooth transportation. The clinic is without an elevator. 180 MEDICAL EDUCATION therefore the majority of the paralyzed patients had to he carried on stretchers, and unruly psychotics had to be guided individually into the basement. When the last patients left the first floor, which was approximately five minutes after the alarm signal, the first bomb hits shook the clinic in its founda- tion and a direct hit laid the male wing of the clinic in ruin. V ithout consideration for their own safety or lives, nurses and some patients rescued the sick occupants amidst falling ceilings and beams. With everyone safely in the basement, it was found that the emergency exit doors could not be closed as they were covered or pushed open by debris. When the entire upper clinic started to burn, 180 mental and paralyzed patients had to be removed from the basement. There was no- where to take them, with all adjacent buildings in clouds of dark dust or on fire. The patients were carried or forced to march into an adjacent garden and bedded on piles of leaves. There was no water to fight fires or to quench thirst. To counteract the increasing restlessness of the groaning, freezing psychiatric patients, additional sedation by mor- phine and scopolamin injections was necessary. In the early morning hours the patients were trans- ferred to a rural school, including excited psy- choses, depressions, paretics and paralytics, after forty hours of agony in this open garden shelter. Except for the loss of one wounded demented pa- tient, no casualties had occurred.” help to bridge the shortage. The larger labora- tories employed technicians only, with their work confined to routine matters; only occasionally were specific research problems found to occupy people on full time. The dire need of medical assistants in the clinics was the cause of many complaints and led to such friction that a government directive had to be issued to regulate the allotted number of physicians to clinics according to the number of operations, beds and outpatients. This, however, failed to satisfy all needs and requests. The schools were finally ordered to submit six-month lists, giv- ing for each department the personnel by name, the number of outpatients, and the bed capacity so that continuous reallotment of available personnel could be made. The confusion in the universities was increas- ingly augmented by the air raids. Vast destruction to facilities and clinics, demands from the con- stantly increasing number of emergency hospitals in the country, the constant improvisation of lec- tures and demonstrations in the available halls on the campus or somewhere in the city, and increas- ing transportation difficulties caused students and teachers to become more and more fatigued and discouraged. To these burdens were added the de- pressing surroundings of destruction, inadequate repairs of bombed damaged buildings and clinics, the shortage of food, fuel, drugs, and bandages, and the ever present alertness and fear against new raids day and night. It is not a part of the post-war plans of the victorious Allied nations to keep the German peo- ple on a level where sickness cannot be cared for or physical health safeguarded. But until medical education can be developed again in Germany and the nation can produce her own supply of medical practitioners, nurses and public health workers, the facilities of the Allies will have to be called upon to render assistance. It seems evident that German students will have to be trained, in part at least, somewhere outside that country not only to main- tain reasonable medical care in Germany, but to augment the supply of instructors and professional teachers until medical education may again become able to supply the needs of the country. Conclusions The foregoing pages describe the physical losses endured by the medical schools of the German uni- versities, and enough has been said to indicate the extent of the devastation to these institutions. Higher education in Germany can no longer be carried on in the facilities now existing. The supply of physicians and allied technicians is low; an in- crease can hardly be expected for many years, until physical plants can be built in which medi- cal education can be pursued. The teaching staffs of all medical schools were decimated by 1941, and it was not unusual to find reductions from fourteen to four or fewer faculty members, with no internes, assistants or research 181 CHAPTER NINE HOSPITALIZATION GEORGE A. WULP. M.D., HARTFORD. CONNECTICUT This report covers the direct and indirect effects of bombing on hospitals and medical facilities. In total war, hospitals are not spared as experience in Germany and Great Britain has shown. Many large hospitals have been completely obliterated and their patients with them. In the large Krupp hospital at Essen, which was regarded as one of the most modern in Europe, every building was razed to the ground in a single raid. Over 85 of the 750 patients there at the time were killed. The scene left where this institution once stood is now as bleak as a painting by a surrealist (Figure 72). Many other hospitals in bombed countries have suffered a similar fate, as is simply demonstrated by the Warwickshire in Coventry, Guy’s Hospital in London, the clinics of the University of Munich, and the Insel Spital in Nuremberg (see Figure 110). Indeed, the opinion has been expressed that in total war the red cross on the brilliant white background is no longer a shield of safety on the roof of a hospital but a pinpoint for orienting pilots over a blackened city on a moonlit night. What occurs in a community, what was done when these institutions were destroyed or damaged, how they were protected, how well their vital services to the people were continued, is the substance of this report on the hospitals of Germany. cluded (1) number of beds available from 1938 to 1944 inclusive, and through April, 1945; (2) medical and nursing personnel for the same years; (3) type of hospital (special or general) and the number of patients in each department; (4) dates of air raids and the damage done to the buildings (using a blueprint if it was available) and the number of patients and personnel wounded or killed; (5) air raid precautions taken, including specially built shelters and reinforced cellars; and (6) the schemes for handling patients during air raids. In some of the smaller hospitals this statisti- cal data made up the entire report but in larger hospitals it was only part of a more complete sur- vey of the institution. The interviews with staff members were usually with one or more members of each department, the questions being formulated with a view to evaluat- ing the effect of air raids upon the patients, upon the incidence of various disease entities, and upon the medical aspects of the community as a whole. Where possible, nurses were also interviewed. Fol- lowing this, the hospital was inspected for a better understanding of the extent of the damage, the type of air raid shelter used, the method of han- dling of the patients, and similar problems. All of the information obtained from the various hos- pitals within a city was incorporated into a single report, entitled “Hospitals in The statistical data are available in the files of the USSBS in the ar Department. This chapter is a digest and summary of all of the reports on hospitals in the various areas visited. Methods of the USSBS investigation Sample cities were selected by qualified experts so that an accurate over-all picture could be ob- tained without having to take the time necessary to visit every city in Germany. More than a hundred hospitals in sixteen different sample cities were visited in addition to several smaller institutions in the evacuation areas. The usual procedure in arriving at a city was to secure the names of the larger hospitals, as a rule from the health depart- ment. Occasionally, the city hospital was visited directly and names of the other hospitals secured from physicians there. The superintendent was in- terviewed for statistical data which was supplied in some instances on the survey forms and in other instances in a typed report. This information in- Hospital buildings in Germany At the beginning of the present war there were few modern hospitals in Germany as Americans- know them. Many of the structures date back to the latter half of the last century. Only a few were completely constructed or enlarged as late as the 1920’5. The larger hospitals and especially those a part of the universities are built on the pavilion plan, i.e., usually a system of one-to three-story buildings in an enclosure, each building housing 182 HOSPITALIZATION Figure 72. Air raid damage to Krupp Hospital, Essen. This was one of the most modern installations in Europe and was completely destroyed in one raid. Hospital grounds were adjacent to main Krupp Works. a separate institute or clinic. Rarely were these buildings connected by passageways. What might he considered typical layouts of this type are shown in Figures 104, 105 and 106 (ground plans of pavilion-type hospitals showing bomb damage). Although considered antiquated by American con- cepts, those hospitals constructed on the pavilion plan were proven to have had a distinct advantage in modern warfare. Being dispersed and less in- timately integrated than our towering structures their whole system was not disrupted when one building was destroyed in an air raid, even though their total bed capacity might have been lowered. There are several reasons why hospital construc- tion had lagged in Germany but the main reason given by the Germans is war. They stated that preparation for and recovery from the first World War and preparation for the present conflict are probably the outstanding contributing factors. There is little evidence that the Nazis made much progress in remedying this situation. Elaborate plans were made such as the proposed new home of the medical school of the University of Berlin (Figure 73), but as one German put it, these were only plans for propaganda purposes, “the National Socialist regime laid emphasis on health and not on sickness.” With the extensive destruction of hos- pital facilities in the air war there appears to be little hope that the need for modern hospitals, which was critical even before the war, could be met for some time. Prewar bed capacity of the hospitals Because of the lack of new construction, the number of beds available for the civilian popula- tion was, according to most hospital superintend- 183 HOSPITALIZATION ents, barely adequate even in 1939. Exact figures were not obtainable. One statement by Professor Karl Brandt, in an interview with a Medical Branch investigator, gave the number as 350,000, of which 72,000 were for tuberculosis patients; another figure gave the number of general beds as 353,000 or 4.6 per 1,000 inhabitants and of total beds (all types) as 663,000, or slightly less than 9 per thousand inhabitants. By 1945, the number of individuals requiring hospital care had greatly increased to over 1,000,000 military and 500,000 civilian patients, according to Professor Brandt. By comparison, the rate in the United States, according to the American Medical Associa- tion, was 4.3 general hospital beds per 1,000 popu- latin in 1941. Before the war some effort was made to relieve this shortage by more discriminating control over hospital admissions and the duration of hospitaliza- tion. When the situation became critical, a great deal of attention was given in the literature to the subject of ways and means of reducing the patient days in hospitals1. The culmination of this emer- gency is marked by a decree from Public Health Division of the Ministry of the Interior in Febru- ary, 1945, which described the need for more hos- pital beds for civilians and ordered the use of every available space within hospitals for place- ment of extra beds. In some of the larger cities, the department of health had what was known as the Bettenachweis2 By this system the municipal health department maintained a daily listing of the number of available beds in each hospital in the city. This office thus became the central clear- inghouse for hospitalization and no patient could be admitted to a hospital in Hamburg (except for dire emergencies), without having been directed there by this central office. The attending physician would notify the clearinghouse and he would, in turn, be told he could send his patient to a certain facility. With such a simple procedure, the Ham- burg officials stated they were able to cushion the impact of destruction of hospital facilities during air raids. ithin the time available it was impossible to obtain figures on the rapidly shifting bed capacity of all of the hospitals in all the cities visited nor were accurate statistics available for Germany as a whole. Where figures were obtained (as for the sample hospitals of sample cities visited), it was often found that the number of beds available for civilians rapidly decreased as the bombing offensive against German cities was accelerated. In most hospitals, the daily census showed that 90 per cent Figure 73. Proposed new home of the Medical School of the University of Berlin. This 23 story medical center, patterned after American medical centers, ivas to house hospital wards, clinics, out-patient departments, laboratories, lecture halls, and quarters for staff and nurses. It was to be built near the Olympic Stadium. Construction was approved in 1938, but teas never started because of the war. 184 Figure 74 USE OF THE BEDS IN THE HOSPITALS OF LEIPZIG INCLUDING THE OUTSIDE ASSEMBLY CENTRES PERCENT OF TOTAL CAPACITY 1"6 COLLECTED IN ALL MUNICIPAL,UNIVERSITY AND OTHER PUBLIC INSTI TUTI ONS , BUT NOT THE PRIVATE INSTITUTIONS. 6“ INCLUDES WARDS I-5 AS WELL AS 18, NEUROLOGY, ORTHOPEDICS, GYNECOLOGY, EAR' THROAT' NOSE EYES, DERMATOLOGY. 185 HOSPITALIZATION or more of the beds were occupied. This is a higher percentage than is usual in peacetime and leaves very little leeway for emergencies (Figure 74). The main causes for this decrease in the number of beds were (1) destruction of hospital buildings by bombing; (2) the use of some civilian hospi- tals (all or in part) by the Wehrmacht; (3) the necessity of clearing beds from the upper floors of hospitals so as to minimize the danger to pa- tients from air attacks. The 1 oss of beds in any given area varied greatly with the severity of the air raids; for example, in Kassel and Hamburg, both badly damaged cities, the bed capacity in the latter part of 1944 and in 1945 was one-third to one-half of what it had been in 1939 and 1940; Cologne, another badly damaged city, had one-fifth the usual number of hospital beds available for civilians; Frankfort had more or less one-half available; and Hamm, Dortmund, and Essen showed little change in their ratios. There were other occasions (for example in Ham- burg, as a result of the great incendiary raids in July and August of 1943) when the available hos- pital beds were temporarily critically scarce. Be- cause of building destruction and difficulty in re- pairing this destruction the number of hospital beds remained low for some time. However, the situation gradually improved primarily as a result of moving the hospital facilities to undamaged or less dam- aged buildings. Furthermore, some of the lack of beds in the larger cities was compensated for by set- ting up auxiliary hospitals (Hilfskrankenhaeuser) and emergency hospitals (Ausweichskranken- haeuser). This phase is discussed in a succeeding section of this chapter. Another factor which has to be taken into con- sideration in discussing the bed population ratio is the evacuation of the civilian population from the larger cities to lower Germany and to country areas. For example, Cologne, which had a popula- tion of 770,000 before the war, had only 144,000 during the last months of the war; Essen decreased from around 604,000 to 294,000; Frankfort showed no noticeable change; but Hamburg’s population fell from 1,677,000 to 1.032.000. and Kassel from 210,000 to around 85,000. In many instances the drop in population in the larger cities was con- comitant with the destruction of hospitals. Conclusions. The over-all impression obtained was that (1) the number of beds available for civilian use in Germany was decreased as the di- rect result of bombing; (2) occasionally it was possible for the hospital to rebuild and, therefore, make more space available; (3) more generally, it was necessary to move part of the facilities out of town and re-establish the hospital in a new lo- cation (see the section on auxiliary hospitals in this chapter) ; (4) despite the decrease in the num- ber of beds as a result of the air war, hospital superintendents and doctors said that by decreas- ing the length of the patients’ stay in the hospital to a minimum, by hospitalizing only those patients who really needed hospital care, by establishing auxiliary and emergency hospitals, and by the de- crease in population in the large cities, the short- age of beds had not been acutely felt. Medical and nursing personnel The adequacy of the medical and nursing per- sonnel with which the hospitals were staffed varied greatly during the war years, varied in the differ- ent hospitals within the same city, and varied also from city to city. From interviews with hospital superintendents and physicians the Medical Branch received conflicting reports concerning the specific policy set up by the national government regard- ing the induction of permanent staff physicians into the armed services. The allocation of physicians in general (not only in hospitals) is discussed in another section of this report (Chapter Seven on the organization, distribution, and activities of medical personnel). All of the city hospitals had full-time physicians as did the university hospi- tals, which often functioned as the municipal hos- pital for the cities in which they were located. These two categories account for approximately 65 per cent or more of the hospital beds in Ger- many. (See also the reports of the various Ger- man hospital and health departments.) The insti- tutions with an entire staff of full-time doctors were more often affected by the loss of physicians to the armed services than were the hospitals de- pending upon private practitioners; the private hos- pitals more often lost doctors through displace- ment. The number of nurses in individual hospitals fluctuated less than the number of physicians and was occasionally found to have been higher during the war than preceding the war. This is largely ac- counted for by the fact that propoganda was effec- tive in persuading many more young women to take up nursing. The general feeling among hospital superinten- 186 HOSPITALIZATION Figure 75. Air raid hospital bunker. (Concrete air raid shelter). Gas lock in entrance hall to wards. Note ventilation openings above the door and electrical wiring on the wall. German sign on the right indicates that doorway is an emergency exit, and a passage to the surgical clinic. dents and doctors, especially the heads of various departments, may be summarized as follows: (1) The hospitals suffered a loss of medical per- sonnel varying from none to 40 per cent depending upon the location of the hospital, on the ages of the permanent personnel, and on similar variables. (2) The hospitals suffered more from the lack of quality in medical personnel than from the quan- tity of personnel. Many hospitals had inexperienced medical help such as recently graduated women or men or women physicians who had been out of practice for some time. (3) There was no acute lack of nurses. (4) By working longer hours and going without vacations, the hospital physicians were able to sup- ply fairly adequate medical care for their patients. (5) Hospitals which had suffered loss of beds through air raids were often able thus to maintain their doctor-patient ratio even though the actual number of physicians was lower than before the war. (6). Bombing had no direct effect upon the num- ber of physicians and nurses staffing the hospitals. Bombing did indirectly affect the professional staffs in that air raid casualties received in hospitals put an even greater load on their shoulders. It was often necessary for them to work with inferior assis- tants, but this cannot be attributed directly to the air attacks. Over-all measures for the defense of hospitals against air attack Early in the air war the various sections of Ger- many were classified into “zones of air raid dan- ger”, as they were called, and graded from one to four according to their anticipated danger from Allied air attack. The purpose of this was to estab- lish a basis for determining the extent of air raid 187 HOSPUAUZATION Figure 76. Air raid hospital bunker (concrete air raid shelter). Infants’ ward. Note arrangement of cribs. Towels are to pre- vent light shining in the infants’ eyes. precautions to be taken. These precautions were su- pervised and controlled by the chief of the medical service of the German Air Force (Chef des Sani- taetswesen der Luftwaffe). He issued specific direc- tives regarding allocation of materials for shelters and other defense measures to be taken to the air raid precautions chiefs in the air commands (Luft- gau Kommando) from where they were dissemi- nated to the institutions affected. These were fre- quently mere affirmations of the information and guidance given civilian hospitals by the Ministry of the Interior. The adequacy of the precautions taken by hos- pitals to protect their patients during air raids was found to have been directly associated with the rat- ing given their area when the zones of danger were originally established. The most extensive and thor- ough precautions were taken in the obvious zones of danger, such as the industrial districts of north- eastern Germany. Until the combined Allied air offensive got fully under way it was not expected that the bombers would reach southern Germany in force and by the time they did it was too late to take the elaborate precautions necessary for the protection of hospital facilities. In fact, until early in 1944, Bavaria was frequently referred to as the “Air Raid Cellar of the Fatherland." Hospital air raid shelters The air raid precautions which were suggested to hospitals by the Ministry of the Interior covered most eventualities, such as: when and where to build shelters, and what type; the best methods for supporting and reinforcing cellars; the neces- sity for supplying sufficient water in air raid shel- ters ; when to shut off the boilers; setting up an emergency operating room; arrangement of exits and entrances; when to bring patients into the shel- ters; and the conduct of doctors and nurses in the shelter.3 188 HOSPITALIZATION Figure 77. Air raid hospital bunker children s ward. Notice how close the beds are placed together, the use of double-decker bunks and the crowded washing facilities. The choice of shelters which were constructed, bunkers* or reinforced cellars, depended upon the danger zone in which the hospital was located. A typical hospital bunker of the tower type was from three to six stories high, square or rectangular in shape, and windowless. The walls were of re- inforced concrete and stone approximately 2.3 to 2.7 meters thick. The roof, also of reinforced con- crete, varied in thickness from 3 to 5 meters. These bunkers were usually connected to the hospital by several ramps and, in addition, there were also auxiliary underground passageways leading to the outside. The doors were double with a vestibule be- tween, the so-called “gas lock” (Figure 75). Each floor had a central corridor into which the rooms led. The patient room held from 6 to 8 patients, or twice that number if tier bunks were used. There was a small kitchen on each floor equipped only for washing dishes and keeping food warm. There were no cooking facilities in any of the air raid hos- pitals visited. As the accompanying charts show, each floor usually included such facilities as wash rooms, service rooms, and toilets. Mechanical equip- ment such as storage batteries, pumps, diesel en- gines for emergency lighting and water, the heat- ing systems, all these were situated in the under- ground floor of the tower-type bunkers. Not all bunkers had their own water supply, some of them having to rely solely on the city system. All of them did have their own stand-by lighting systems. The so-called “tower bunkers ordinarily had one story fully underground, one partially underground, and the balance above ground; the subterranean bunk- ers ordinarily had all floors except the top one underground. The actual size and bed capacity of these massive structures varied with the size of the * The German term Bunker was used to denote a type of shelter which was of permanent construction. It can be dis- tinguished from the improvised type built in cellars or by reinforcing ordinary buildings. Bunkers were of two types: underground and tower. 189 Figure 78 LEGEND - 1. AIR-RAID OPERATIONS BLOG. 2. MUNICIPAL HOSPITAL 3. KITCHEN LAUNDRY BLDG. U..-ISOLATION HOUSE 5. MORGUE 6. - BARRACKS PLOT PLAN SCALE IN FEET AIR-RAID HOSPITAL HAMM »" WESTPHALIA 190 Figure 79 FRONT ELEVATION SIDE E-LEVAHON Figure 80 A 1 R-RAID HOSPITAL HAMM »h W&STPHM\A OLD BUU-DING AIR RAID ADDITION CROSS SECTION 191 Figure 81 % JvtNTILATION INTAKE- AIR-RAID HOSPITAL HAMM ■« WESTPHALIA LONGITUDINM SECTION VENTILATION EXHAUST c n 1 SCALE IN EEET 192 Figure 82 RAMPWAY FOR CARb FIRST FLOOR AIR-RAID HOSPITAL HAMM i* WE-STPHALIA AIR-RAID HOSPITAL HAMM i* WE-STPHALIA 193 Figure 83 SECOND FLOOR AIR-RAID MQSPITAL HAMM ih WE-STPHAUA 194 Figure 84 THIRD FLOOR (SURGERY) AI R-RA.ID HOSPITAL HAMM »" WESTPHALIA 195 Figure 85 FOURTH FLOOR AIR-RAID RQSPITAL HAMM WESTPHALIA 196 Figure 86 FIFTH FLOOR AIR-RAID HQSPITAL HAMM WE-STPHAUA 197 Figure 87 SIXTH FLOOR (kitchen) AIR-RAID MO .SPITAI. HAMM w W &STPM ALIA 198 Figure 88 SEVENTH FLOOR Al R-RAID HOSPITAL MAM M >* WESTPMAUA 199 HOSPITALIZATION hospital of which they were a part. A few could accommodate as many as 300 bed patients but most were smaller, with a bed capacity of from 100 to 200 patients. Each section of the hospital usu- ally had its own floor with precedence being given to surgery, obstetrics and pediatrics in that order (Figure 76, 77). As a rule, there were complete operating rooms for surgery and gynecology. There were delivery rooms and emergency surgery rooms and in many instances the roentgenologic equip- ment of the hospital was located in this protected building. The equipment in these bunkers was as complete and modern as that to be found any- where. In other words, the typical bunker was a self-sufficient hospital, large enough to house all of the patients in its parent buildings who could not get themselves to shelter when the raids came. The details of the construction of the bunkers, such as the dimensions of the walls, the size of the bunker in relation to the size of the hospital, the construction of air-circulating apparatus, and all such pertinent information, was laid down in a guide of the Reichs Air Ministry (Luftfahrts Min- isterium) in 1944.4 A hospital constructed accord- ing to such lines was that at Hamm (Figures 78-88). These basic principles were relayed to the city architects through the air raid control system. The materials for the construction of these shelters and the construction itself was paid for by the state. Most of the hospitals in northern Germany had one or more of these bunkers, either of the tower or the subterranean type. In southern Germany, most of the hospitals depended upon reinforcing their cellars, (Figure 89), occasionally enlarging them first and making them bomb fragmentproof and shockproof. In the areas which were not con- sidered to justify a high air raid protection priority, most air raid precaution measures were left to the local authorities. An interesting improvisation was found in a hospital in urzburg where a subter- ranean wine cellar was converted into an air raid shelter complete with an operating room and all other facilities. Construction of the bunkers was begun as early as the summer of 1940 and progressed according to need. In some communities of the north, such as Hamburg, the local public health department started protecting hospitals by having them rein- force the ceilings, balconies, and cellars with con- crete, even before the national program was inaug- urated. All government-supported construction of air raid shelters stopped, however, on January 1, 1944, because of shortage of building materials. It should be noted that this preceded by many months the climax of the air attacks. Most of the air raid shelters in hospitals, whether of the bunker type or the cellar type, had emer- gency operating rooms and after air raids had be- come very frequent, these emergency operating rooms in the shelters were used constantly in pref- erence to those in the exposed buildings. The capac- ity of the air raid shelters was usually less than the total bed capacity of the hospital and was pri- marily for bedfast patients. All those patients who, because of the nature of their illness, could not readily help themselves were to have this fact stated on their temperature chart or, if no temperature chart was kept, on the name plate on the bed (this was the subject of a special decree). During the earlier phase of the air war, all bedfast patients (those either too sick to move themselves or whose illness was such that it made quick moving diffi- cult) were brought to the air raid shelters on the first alarm. As the air war intensified, the hospi- tals were ordered by the civilian defense leader to move such patients into the shelter each evening and have them taken back to the hospital again in the morning. Still later they were ordered to be kept in shelters all the time. The ambulatory pa- tients retired to shelters only when the alarm sounded. This moving of patients back and forth imposed terrific strain on the personnel who, how- ever, became quite proficient at the job. In a large hospital in Nuremberg, for example, all patients could he evacuated from the hospital building to the hunker (of the tower type, four stories high) in seven minutes (Figure 90). That particular hospital had a bed capacity of 160 beds. In most hospitals, especially the municipal hospitals, there were one or more doctors on duty for the reception of air raid victims twenty-four hours a day during the height of the air war. It was this doctor’s duty to help the patients within the hospitals and also to organize emergency teams for the treatment of casu- alties brought to the hospital with wounds resulting in the air raid. At the City Hospital at Dortmund, the assistant chief of the surgical department lived in the hospital for over two years and there set up three teams for the emergency treatment of air raid casualties; one for organizing and directing the pa- tients; another, usually a head surgeon with two assistants, to do the major operative work; and a third to handle minor injuries and give transfu- 200 HOSPITALIZATION in a central kitchen and had to he carried to the shelters through the open. A splendid example of an underground hospi- tal which was well conceived and organized was the subterranean section of the university hospital at Frankfort. Blueprints and photographs were made of this institution and are shown in Figures 93-97, inclusive. The subterranean section of the municipal hos- pital at Ludwigshafen (Figure 98), contained sev- eral features which are of interest. It was built in 1937 in the central courtyard of the hospital and provided space for 160 patients with a space allow- ance of 35 square feet per patient. The walls and roof are of reinforced concrete, feet thick. Atop the roof is a foot dirt fill. In water, lighting and heat the hospital is completely independent. The ventilation system is gasproofed and there are emergency stand-by units for all services. Power was received from three sources. Under normal conditions it came from the city facilities from which they had a number two priority, which is to say, that in an emergency the hospital was the first to receive power after the powerhouse it- self. If this power failed, it could cut in on the lines of the big I. G. Farben chemical plant. Should this also be cut off, the hospital was able to maintain low wattage illumination in the hall- ways with the diesel unit in the shelter. And, as a final safeguard, the walls of the operating, steriliz- ing, and instruments rooms were painted with flour- escent paint. The chief surgeon demonstrated this novel idea by extinguishing all the lights in the operating room. The light then given off by the walls and ceiling was fully adequate to permit the surgeon operating when all power failed to tie off the blood vessels and close and dress any wound or incision thus interrupted. The chief of staff stated that the room would remain light for as long as the electric lights themselves had been on. The patients in this underground section were usu- ally 4 to a cramped, low-ceilinged room, in double- decker beds. The acutely ill, including those with traction splints and pneumonia patients, remained in the subterranean section during their entire ill- ness. Other patients returned to their beds in the main hospital after each raid. In the dim light of this underground fortress the general psychologic atmosphere was unpleasant but the facilities pro- vided were sufficient for the essentials of medical care. No odors could be detected. It is interesting to note, as a side observation, Figure 89. Reinforced basement-type air raid shelter. Neu- ropsychiatric clinic. University of Munich. sions, infusions, and medications. This setup was fairly typical. Most bunkers were self-sufficient, in that they had an auxiliary water supply, usually from a well, to be used when the city water system was disrupted; an auxiliary power plant, usually diesel, for use when the city power was disrupted (Figure 91) ; a heating system; and an air circulating apparatus and so-called “tea kitchens” on each floor (Figure 92). Medical Branch representatives were told in many cities that, owing to the scarcity of fuel oil, the diesel engines could only be run part-time, so that in many instances, when it was necessary to de- pend upon the emergency equipment run by the diesel power, there might be many hours in the day when the hospital was without its facilities and could get no water, lighting, or heat. In most of the air raid shelters, members of the survey were struck by the lack of adequate facilities for feeding the patients, other than the small “tea kitchens." In one hospital (Nuremberg) all the food for the whole hospital and its two bunkers was prepared 201 HOSPITALIZATION Figure 90. Bunker hospital at Nuremberg showing connection to main building. The obstetrics and gynecology clinic on the left had been damaged by a bomb hitting in the courtyard, on the other side of the building. Appendage atop the five story windowless hospital is a fire watcher’s shelter. Walls, roof and floors are nine feet thick. that in some hospitals the facilities in the newly constructed bunkers were much more modern and efficient than were the facilities, especially the oper- ating rooms, in the hospitals themselves (Figure 99). On the other hand, those hospitals which had to resort to their own reinforced cellars as air raid shelters, often had to put up with dark, unhygienic, uncomfortable quarters. The degree of prepared- ness of the individual institution appeared to be a direct reflection on the amount of initiative and foresight displayed by the hospital’s chief of staff and superintendent, rather than of the force of the directives emanating from government quarters. The Ludwigshafen subterranean hospital was in- spected by a Medical Branch investigator while the area was under artillery fire and the threat of air attack was imminent. The crowding together of the patients must have made hospitalization extremely unpleasant. Despite this and despite the experience of being bedridden during an attack in the deep, dank, dimly lit cellars of these hospitals, that did not possess a formal air raid annex, patients and physicians reported that such an underground life was preferable to the patients to being sent to the emergency or to the Brandt hospitals where they would be separated entirely from their home com- munity. Wartime and auxiliary and emergency hospitals In order to have as few patients as possible re- maining in the larger hospitals subject to the dan- 202 HOSPITALIZATION Figure 91. Air raid hospital. Engine room for light, water and heat, municipal facilities were also available, but each air raid bunker had its own independent facilities, including sewage system. ger from air raids, and to compensate for the loss of beds resulting from the precautionary evacua- tion of patients from the upper floors of hospitals, the destruction of buildings by bombing, and the use of beds by the Army, two types of auxiliary hospitals were set up. These were the auxiliary hos- pitals proper (Hilfskrankenhaeuser) and the emer- gency hospitals (Ausweichskrankenhaeuser); each type of auxiliary hospital with its particular func- tion will be referred to hereafter as HKH or AWK. In the fall of 1939, the Reich Minister of the In- terior issued a directive ordering all cities to set up auxiliary hospitals, partially to compensate for the loss of beds taken over by the Wehrmacht. The basic standard set up for air raid cities of the first priority was one hospital bed for each 1,000 inhabi- tants. These auxiliary hospitals were usually lo- cated within the city limits but as far removed as possible from the center of the city and the indus- trial sections. In most instances they were under the control of the district administrator (Landes- rat) or the mayor. According to the routine pro- cedure the city would take over a school, pension, or small sanitarium, recondition it as much as pos- sible for use as a hospital, and lay in stocks of necessary supplies. The latter were drawn from the inventories of various hospitals in the community. Every effort was made to retain these auxiliaries as dependent adjuncts of the main hospitals. The pri- mary function of these HKH was of an emergency nature, i.e., they were to be prepared to take air raid casualties after initial treatment at a regular hospital or air raid first aid station. They also re- ceived a few Army casualties and “slave” laborers as ordinary admissions providing a sufficient num- ber of beds were kept available for use in catastro- phies. The number of these auxiliary institutions to be found in a given municipality was seldom that re- quired by the government’s decree. Like so many other accomplishments in the dire national emer- gency confronting these people, whether these hos- 203 HOSPITALIZATION versity hospital would have an AWK for each divi- sion, i.e., one for surgery, one for medicine, one for pediatrics, etc. While transportation to the AM K was at the hospitals’ expense, patients had to pay their own fare to their homes after dis- charge. The AWK were usually located in the open country or in villages as far removed as possible from targets of aerial attack. They were frequently 50 to 60 miles from the parent hospital and were in buildings such as castles, cloisters, pensions, ho- tels, and schools. Patients talked to stated that the light, airy, pleasant atmosphere provided a welcome relief from the depressing conditions in their home cities. (This opinion was contradicted by others, as seen in the following paragraph.) The staffs of these emergency hospitals were usually made up of assistant physicians from the main hospital. This is probably where most of the women physicians on hospital staffs were utilized in Germany during the war. Every effort was made to maintain intimate professional liaison with the chiefs of staffs at the main hospital but this was extremely difficult. Lack of gasoline and the pressure of overwork some- times severed the contact between the two facilities for months at a time. This lack of contact was re- peatedly referred to as one of the greatest handi- caps in the auxiliary hospital system. Patient reaction to being sent to hospitals de- veloped into a problem fundamental to this sys- tem. The reaction of hospitalized patients to evacua- tion to a distant city or even to a hospital in a near- by village was an important consideration in deter- mining the type and location of air raid hospitals. It was repeatedly asserted by hospital superintend- ents and staff physicians that patients resented being moved away from their communities and that worry over their families and their own intense loneliness —no visits were possible because transportation and communication was spotty and unreliable—caused impairment in the recovery of many patients in evacuation hospitals. As careful examination of the diagrams show, even in the best of air raid hospi- tals there was crowding. Most of these were visited after the war had ended when the constant threat of air attack had passed and patients could again be distributed as in normal times. Figure 92. Air raid hospital bunker, Frankfort on Main, typical compact diet kitchen. Note exterior installation of electrical facilities, and water and sewer pipes. Small general utilities closet in rear. Electrical stove on the right. Electrical refrigerator on the left. pitals were established beyond the danger area de- pended upon the ability of the responsible medical personnel. Some cities had an inadequate number while others, like Nuremberg, which had fifty aux- iliary hospitals, had small hospitals set up in schools and large houses. The emergency hospitals, on the other hand, were a function and a responsibility of the individual hospitals, and were staffed and supplied by the hospital solely for its own use. Their primary pur- pose was to relieve congestion in the parent hospi- tal. This was accomplished by sending to the AWK those patients who were readily transportable and those whose illness was such that they were likely to need hospital care for more than a week or ten days. Transportation, by a law promulgated in 1941, was accomplished by auto, truck, bus, or rail- road, usually, under the auspices of the German Red Cross. Army hospital trains were also made available in emergencies. Every large hospital, especially hospitals in the larger cities and con- gested areas, had one or more of these AM K's, and not infrequently a large general hospital or a uni- The Brandt hospitals for air raid casualties In addition to the HKH and the AWK discussed, there was still another type of auxiliary hospital, the so-called Sonderlage der Aktion Brandt or the special facilities of the Action Brandt. These 204 HOSPITALIZATION Figure 93. Air raid hospital bunker, four-bed ward. Notice proximity of beds which are placed end to end. Space between ibedside tables so small that nurse has to turn sideways. Figure 94. Hospital bunker of the subterranean type, Frankfort on Main. View showing well marked roof of the air raid hospital bunker. The bombed and fire gutted surgical pavilion of the university hospital is shown in the background. The small towers shown to the right, and left are principal air intakes; 25 such air intakes were provided. Officer in foreground is inspect- ing ventilator filter outlet. Construction of this two story 300 bed hospital bunker took 20 months. 205 HOSPITALIZATION Figure 95. Air raid hospital bunker in Frankfort on Main. Engine room and underground power house. This was an emer- gency unit available if central or municipal power failed during or following an air raid. were the unique hospitals “strategically located " throughout Germany to care for air raid casualties for whom prolonged hospitalization was necessary. These hospitals were planned and constructed ac- cording to certain basic principles that would as- sure uniformity, economy, and. while doing away with the fortresslike nature of the air raid hospitals, would assure protection from bombings. Before he was made Reich commissar for health, Professor Karl Brandt came to the conclusion that not enough preparation was being made for the pro- tection of hospital patients from the effects of aerial war. This became very evident after the heavy raids on Emden in 1941. It was apparent that special measures would have to be taken in the north and northwestern areas of Germany where there was the greatest concentration of in- dustry and population. Therefore, in 1942, when Brandt took office, he started the organization of a group of German officials, the Aktion Brandt, whose mission was to be the construction of this network of hospitals. Besides Brandt and his two deputies in charge of the actual work, the group in- cluded Todt, the famous chief of war construc- tion for the Nazis, Reichsminister Albert Speer, who controlled the allocation of all materials, and an architect named Diestal to make the basic de- sign, Figure 100. The master plan they evolved provided for a semicircular main hall with wards extending from the outer circumference of this semicircle, prefer- ably facing south and with the windows primarily on the sunny side (Figures 101, 102). The entire unit was a one-story construction and conformed as much as was feasible to the contour of the land on which it was built. The floors and founda- tions were of concrete, and it was hoped that all the structures could be of poured concrete or ce- ment brick as they were planned as permanent in- stallations. However, as the war progressed and materials became more scarce, the construction had to be simplified, the superintendent of the hospi- tal at Eisenberg (which the American investiga- tors visited in a search for the secret files of Com- missar Brandt) stated that at one time a mill in Leipzig was commissioned to prefabricate these 206 Figure 96 SUBTERRANEAN AIR-RAID HOSPITAL FRANKFORT 0"/ main UPPFR FLOOR Figure 97 SUBTERRANEAN AIR-RAID HOSPITAL ERANKEORT ow/main LOWER F-LOOR HOSPITALIZATION moved from an unimportant town possessing good rail and highway communications. Upon inspection they appeared to be adequately staffed and some- what better equipped than the ordinary city hospi- tal. The location and surroundings provided a very satisfactory impression. The only criticism elicited from the patients and staff was that the patients felt lost and isolated so far away from their homes. Staff members and members of their families remarked that being stranded there, fam- ilies soon began to get on each other‘s nerves and the resulting difficulties affected the harmony among the professional staff. For administration, half of the Brandt hospitals were under the control of the central government. The remainder were controlled by the provinces in which they were located or the city they served, or the states shared the control with one of the two. It was originally planned that the central govern- ment would give all these hospitals to the various provinces but many difficulties arose that made this impractical. Perhaps the principal reason the government di- rectly administered half of the Brandt hospitals was that by such control it was enabled to main- tain a better balance of occupancy than might otherwise have been possible. It is known that in all those government-controlled hospitals the pa- tients were allocated to them by the Brandt office in Berlin. For example, when most of the hospi- tals in Trier were destroyed, several Brandt hos- pitals were notified that they would receive a cer- tain specified number of patients on a specific date. The notice given was usually not in excess of twenty-four hours and the respective hospitals would receive a hospital train of the patients allo- cated to them according to the vacancies in each of the different medical services reported in their daily telegram to Berlin. The initiative of evacua- tion of patients to the Brandt hospitals came from the local city health officer when he felt that the number of available hospital beds in his city was going below his minimum requirement. He would request a hospital train from the central health office of his district (Bezirk), which in turn would request the train from the Army. Each train was completely staffed with Army personnel despite the fact that the patients to be moved were civil- ians. Evacuation was organized by the allotment of a certain proportion of the space available to each hospital in the city. The cases were selected from among the surgical and chronically ill pa- Figure 98. View of the entrance to the subterranean section of the Ludwigshafen municipal hospital. hospitals “mail-order house’ style, but that a bomb dropped on this mill demonstrated the lack of wisdom in such a plan. There was a good deal of variation in these hos- pitals although they all conformed to the basic plans. Each was designed to provide for 800 pa- tients, but because of scarcity of equipment, a hos- pital was initially equipped to care for 500. hen the institutions were complete they were to pro- vide all the services of a general hospital at an anticipated cost of from 4,500 to 6000 Reichs- marks a bed. The handbook for architects and con- tractors and a set of the German government s blueprints of the fundamentals of design and con- struction were captured and may be inspected in the files of the USSBS at the War Department. As far as could he learned, forty-four of these hospitals were built of which only six were true to model design. They were centered in the areas of western Prussia, Westphalia, and the lower Rhine, but one was south of Frankfort. They were usually to be found in a dense wood several miles re- 209 HOSPITALIZATION Figure 99. Air raid hospital bunker, Frankfort on Main. Operating room. The operating rooms were connected by the hallway shown through the doorway in rear. This hallway provided access from all rooms, to the central sterilizing room. There was one scrub room for each operating room. tients at the discretion of the individual hospital director in filling his quota. The type of patients to be evacuated was restricted only insofar as to rule out infectious or contagious cases, and the anticipated duration of hospitalization was re- quired to be in excess of eight weeks. The patients were transported without cost to themselves, the charge being borne by the local health insurance exchange. cessity of maintaining a complete staff of surgical personnel near the scene of anticipated bombing attacks. The litter type of surgical cases were also retained in order to maintain an even distribution of patients, for most of these could be considered as ambulatory when it came time for them to seek the safety of air raid shelters. People suffering from infectious diseases (who could not, there- fore, be properly placed in the crowded shelters), all maternity cases, and hospitalized children were usually moved to the auxiliary institutions in the outlying districts immediately upon admission to the hospital near their homes. Just as in England, so it was in Germany that as food became more difficult to obtain in the cities, as the air war gradually turned from pre- cision targets to city areas, and as the impact of total war began to impress itself on the delicately balanced economy of large German cities, the trickle into the country of the women and the Effects of hospital evacuation; medical effects of individual and mass evacuations In the cities bearing the brunt of the aerial offen- sive the policy of evacuating the patients to the outlying hospitals (other than those evacuated by rail) made it possible to maintain surgical facil- ities and services and to take care of semiambula- tory medical cases in the established hospitals within the city for as long as bed space remained available. The evacuation system also met the ne- 210 Figure 100 ' TYPICAL BDANDT HOSPITAL WIMBEEN PLOT PLAN NOTE-: SHADED AREAS DENOTE SLOPING R.OOES. LEGEND u 1 MC'DICAL BABttACKS - 77 BEDS ErACH 231 2 SUBGICAL BABBACKS - 77 BE-D5 tACH ISA 3 GYNE-COLOGICAL BABBACKS - 50 BE-DS 50 A PE-DIATEIC BABBACKS - 50 BEDS 50 5A BC-CE-PTION 5 ADMINISTRATION B OISTBIBUTION OF- PATIE-NTS 6 OPEBATING DOOM BABBACKS-SUBGICAL 7 OPEBATING BOOM BABR AC KS-GYNECOLOGICAL 8 NUQSES' BESIDENCE- -9 DOCTOBS' BESIDENCE- -10 (k> kitchen; (H> heating plant;(l> laundbv 11 EMPLOYEES BESIDENCE 12 GABAGE- 5 POBTE-B'S HOUSE 13 E-LE-CTBICAL SUB-STATION U COAL SHUTE 15 SE-WAGE- SETTLING PIT 16 POND ~EOQ EIQE EXTINGUISHING 211 HOSPITALIZATION Figure 101. Exterior vieiv of a typical Brandt hospital. Barrack type. These expansion hospitals were built outside cities which were subjected to air raids. They were usually located in a wooded area. Figure 102. Internal medicine clinic at Ludwigshafen municipal hospital. First two stories were still in use despite the damage. 212 HOSPITALIZATION children, the aged and the infirm, became a great flow. By the end of the war, this migration from the cities had reached such proportions that the overcrowding in the hamlets, the villages, and the resort towns was as bad as what one would expect to find in a tenement district. This shift in popu- lation was such that the census of many German cities was reduced by one half and that of most country districts was doubled or tripled. This direct consequence of the Allied strategy to knock out Germany from the air, this break- ing-up of the German family, this dislocation with its certain, though not yet statistically apparent, impairment of the national health, was one of the severest hardships the average German had to face during the war. The location, administration, and organization of the evacuation areas is the subject of discussion in the report of the Civilian Defense Division of the USSBS. The writer is concerned here only with the effect this evacuation had on the health of the evacuees and the permanent residents. In short, it may be said that the people brought to the farm- ing communities the city diseases. From the crowded shelters and from the destroyed homes they brought scabies, tuberculosis, and diphtheria. None of these are recorded to have assumed the proportions of an epidemic in the evacuation areas but they were a constant source of worry to the physicians. The other problem in the evacuation area was that of providing adequate hospitalization and medical care. The greatest migration was into the resort region of Upper Bavaria, into the section of Greater Ger- many bounded by Munich, Constance, Innsbruck, and Salzburg. The total population of this area was approximately three times its peacetime norm. In the official migration which was arranged by the government but actually administered by the Nazi party welfare agency because of its propa- ganda value, those coming from a certain area in the Rhineland or Rhur or elsewhere in the north were dispatched to a specified area in the south. For example, the people of the Rhineland were Figure 103. Brandt hospital ward with eight patients. Note sunny, spacious atmosphere as compared with the air raid bunker type hospital. In European hospitals patient’s name goes on chart over head of bed, and fever chart is kept near foot of bed. 213 HOSPITALIZATION sent to the Lake Staremberg area south of Munich; Salzburg received the people from Westphalia, and so on. It should be remembered that this designa- tion of the place to which the individual citizen was sent was followed only if he participated in an official mass migration party. If the evacuation was wholly individual and independent of any party assistance, as most of them were, then the person went to near-by farmers, relatives, or resorts where they might be fortunate enough to find accommo- dations. The demand for hospital beds created by this in- flux of people into the rural areas was usually met by establishing small hospitals in available build- ings or by building a small additon to the local hospital. For example, in Garmisch-Partenkirchen, the bed capacity was increased from 106 to 270 beds; in Weilheim from 380 to 438 beds; and in Schongau from 103 to 198 beds. There was but one Brandt hospital in southern Germany and it was soon taken over by the Army. In traveling through these areas one is impressed by the apparent inattention of the national govern- ment to the health and medical care of these evac- uees. No one was permitted to leave his home city regardless of the severity of the bombing if he was old enough and physically able to do any type of work. In the lack of adequate medical care as demonstrated by the failure of the government to provide an increase in physicians and hospital beds which would even approximately correspond to the increase in population in the evacuation area, may be seen a demonstration of the Nazi ten- dency to regard such people as “nonessentials.” Some help was obtained from evacuated doc- tors, but, on the whole, the local medical profes- sion had to handle the situation. There were very few instances of deferment from military duty be- cause of the need for physicians in these areas re- ceiving evacuees. Our informants (doctors and offi- cials in the area) said that by working extra hours and by discharging patients from the hospitals a little sooner than they ordinarily might, and by seeing only the acutely sick people, they were able to handle the situation. schickung under the Nazi party evacuated children from whole areas in the north to the south. This movement included especially youngsters between the ages of 10 and 15 (Realschule and Gymnasium age) with their teachers, camp leaders, equipment, doctors, and so on. Schools were set up in the towns of Kochel, Bichl, Garmisch Partenkirchen, Toelz, and Tegernsee which served the district of Westphalia, the Rhineland, and Hamburg. In this way, education was not interrupted except for occasional periods of work on the farms which all of these youngsters had to do. The Nazi party wel- fare agency usually took over pensions or hotels for the purpose, set up one or two small hospi- tals with their own professional staffs, and, in many instances, allowed extra food rations. The children were examined before departing from their homes and were again examined upon their arrival at the evacuation area. No epidemics were reported, many of these youngsters gained weight, and their general health was good. There was no evidence that parents were forced to evacuate their children although many stated that the program was conducted along the lines of National Socialist volunteering in which any sug- gestion carried a sharp point. When the bombings began in some cities (Stuttgart, Essen, and others), the primary schools were closed in order to force parents to send their children into the country or with a KEY mission. The parents were allowed to visit them at periodic intervals and on rarer occa- sions, the children were allowed to visit their par- ents, provided the latter were in an evacuation area. Air raid shelters, auxiliary hospitals, emergency hospitals; conclusions: The establishment of auxiliary hospitals (HKH, AWK, and Brandt hospitals) was a direct outcome of the bombings that created an additional financial burden upon the communities and hospitals, and an added strain on their medical and nursing person- nel resulting from the scattering of patients. The construction of air raid shelters wras an added expense and the necessity of using them so constantly caused a strain upon the personnel and in many instances hindered the recovery of patients (see a following section of this chapter on the ef- fects of bombing on hospital medical care). How- ever, the efficient use of these facilities (air raid shelters, AWK, etc.) probably accounts for the ex- tremely low number of casualties among both pa- tients and personnel in hospitals (see the follow- ing section), Kinder Land Verschickung movement to send children to the country In order that children might be protected from the dangers of air raids, and also that they might continue their education (many schools in the north had been damaged), the Kinder Land Ver- 214 HOSPITALIZATION The Brandt hospitals were well equipped and generally satisfactory, but it was felt by many physicians that they were too far removed to be used efficiently. the city of Essen are presented in Table 33 as be- ing a fair representation of what happened. All statistics from the hospitals are in the USSBS file in the War Department. Hospitals and hospital personnel Casualties among hospital patients and person- nel. Despite the extensive damage to many of the hospitals in Germany the casualties among pa- tients, doctors, and other personnel was remark- ably low. There were many instances when half of a hospital was destroyed with only a negligible number of casualties to the patients. Even when hospital buildings suffered direct hits, no or few casualties resulted. Our informants were unani- mous in agreeing that this was attributable to keep- ing the patient load in hospitals at the number which could he taken care of in the shelters, to efficient (and semipermanent) use of air raid shel- ters, and to “luck.” In some instances, the patient casualties were the result of nonco-operation on the patient’s part, as, for example, when a psychotic patient refused to budge and there was no time to get help to move him; some doctors were killed because of a false sense of duty keeping them unnecessarily exposed (as at a hospital in Hamburg, where two women doctors remained out of the shelter and were killed) ; occasionally a nurse would be trapped in her sleeping quarters which were usually on an upper floor. On the opposite side of the ledger are the following examples of pure luck. In one of the hospitals at Augsburg, a child was thrown from its bed when a bomb exploded just outside the hospital walls and was tossed through a door- way and landed unharmed on another bed; in the Altona hospital at Hamburg, two patients had returned to their beds, the first to enter the build- ing after a raid, when an unexploded bomb was noticed embedded in the foundation. This went off before they could be warned and the two patients in their beds “slid" down the collapsing floor into the basement on their beds, with only a few scratches and bruises from falling debris. In an- other hospital at Hamburg, the Hafen Kranken- haus, which suffered severe damage in twenty raids, there were no patients killed or wounded and only two employees were killed and two wounded. In Stuttgart in a hospital which was totally destroyed in two raids, no patients were lost and only one doctor and two employees were killed. Data for Table 33. Mortality and Physical Damage from Bombing in the Hospitals of Essen Institution Total Damage Occupants Killed Shelters Available Staedtisches Serious 10 children Krankenhaus (1942) Yes Krupp (Lazarett Totally Unknown Strasse) Destroyed (85 estimated) No Krupp-Altenhof Moderate None Yes Lambertus- Recklinghausen Undamaged None No Huyssenstift Slight None Yes Elizabeth Krankenhaus One wing destroyed 1 Yes Franz-Sales Haus Serious 30 No Knappschaft-Stehle Slight None Yes Laurentius Hospital Slight None Yes Evangelisches-Stehle Slight None No Josepbs-Kupferdreh Slight None Yes Some hospitals, of course, were not so fortu- nate as Essen, but when the degree of destruction is seen it is amazing how few patients, doctors, nurses, and personnel were killed or injured. The figures collected were usually obtained from the hospital superintendent and were checked in interviews with doctors and nurses as well as with the local health departments. Damage to hospital buildings and facilities. Inasmuch as hospitals were not a direct target for air attack the degree of damage to them varied with the intensity and frequency of the bombing raids upon the cities and with the location of a hospital within the city, i.e., whether it was close to a railroad, a factory, or other military target. Most of the hospitals in the cities visited by the Survey investigators were damaged to some extent. In some only the windows were shattered or the roofs were torn away by blast concussion. Many received damage which was measured from moderate to severe, while some were completely de- stroyed by incendiary and high-explosive bombs. Where it was possible, a ground plan of the buildings showing the damage inflicted was se- 215 Figure 104 LEGEND DAMAGE- BY HIGH E-XPLOSIVtrS DAMAGE- BY F-IEE-S CITY HOSPITAL OP COLOGNE? (LINDE-NBUI2G) PLOT PLAN 216 Figure 105 EIGHT BANK OF THE ISAE SECTION OF THB CITY HOSPITAL OT MUNICH PLOT PLAN SYMBOLS TOTAL DAMAGEr- iLLIfj PARTIAL DAMAGE- HIGH EXPLOSIVE- BOMBS « MINE-5 W«4M*rgi‘«liiiiuiitc*aiilHiZi-. Iw-Mh-iml an- »im r IC<•lirl>ruiiin*i(«cul«'ri«- im«l • iii.m >niiiiii. |l.ninin‘ii Figure 111. Typical ground water collecting system show- ing suction line (Heberleitung) to pump pit. From Sierp (18). desirable unless proved necessary by frequent bac- teriologic examinations. When chlorination is em- ployed, only a minimal dosage (0.1 to 0.2 parts per million) is applied. No attempt is made to carry a chlorine residual in the distribution system. The various water department officials interviewed were proud of the fact that it was not necessary to treat the water supply under their supervision. Emergency supplies: Few German cities are de- pendent entirely on one source of water supply. Where wells are the only source of supply, the wells and pump stations are so spaced that damage to any one station or group of wells will not shut off the entire supply. Electric pumps are usually augmented by diesel or steam standby units. Only one city, Hamburg,5 was entirely without water for any length of time (three weeks) as a result of air raids. Power lines are connected in networks such that electricity is usually available by some route. Munich3 depends entirely on gravity flow, Figure 113. Cross section and plan of typical installation for collecting ground water by infiltration galleries (Sickerrohr) and method of augmenting supply by ”accumulation or filter basins” (FUterbecken). From report by Imhoff on the Ruhr Association, dated July, 1930. so power failure after bombings had no effect on its supply. By operation of pumping stations, even after 230 ENVIRONMENTAL SANITATION Figure 114. Wine cask used for emergency water storage. Placard on cask contains notice to boil water before using. numerous breaks occurred in the distribution sys- tem, water was often available at the basement taps for drinking. People were advised by radio and newspapers always to keep their bath tubs and all possible containers full of water. At Ulm6 arrange- ments were made with local breweries to store drinking water in large barrels and other con- tainers (Figure 114). The water was chlorinated immediately after the containers were filled, and samples of the stored water were examined fre- quently during the storage period. Tank trucks and wagons were used to furnish areas where the pub- lic supply had failed because of broken mains. These were filled from hydrants in undamaged sec- tions of the community or from emergency or exist- ing private and industrial wells. In areas where housing facilities were destroyed, but pressure ex- isted in water mains, emergency taps were installed in the mains and at fire hydrants (Figures 115 and 116). In Ulm(i street cisterns were filled with fire hose and emergency lines. Buckets were utilized to dip out the water to be used for drinking and cook- ing purposes. Either the people were advised to boil all drinking water from emergency sources or city officials provided chloride of lime to treat the water in tank trucks and stationary tanks. Due to the general shortage of chlorinated lime, boiling was the usual treatment recommended, except where poisoning by chemical warfare agents was sus- pected. In these cases sole dependence was placed on stored emergency supplies, as announced by leaflets (Ulm).° Emergency repairs: Various decrees, laws, and instructions were promulgated by the Reich Min- istry of the Interior, Chief Inspector for Water and Current, and other government agencies, which de- fined the responsibilities of water works officials and Air Raid Protection personnel in protecting water supplies and making emergency supplies available. In addition, the German Association of Gas and Water Experts published a comprehen- sive set of recommendations for the repair of air raid damage to water supplies. Briefly the scheme was as follows: The gas-water-supply economy 231 ENVIRONMENTAL SANITATION location of the hit. The wardens hurried to the spot and immediately closed the gate valves to stop water loss. After closing valves on all damaged lines, the warden returned to his post. The fore- man in charge of the “first aid" repair crew was notified and rushed to the scene with the necessary men and materials to repair the break if possible, or to provide emergency connections. As the in- tensity of air raids increased, immediate repairs became impossible while the night raids were in progress. The director of the distribution system then had to allocate repair crews according to im- portance. The larger water mains were repaired first, and smaller ones in accordance with area or industrial needs. For example, repairs to the system in an area near an industrial or private well were delayed until other areas with no water available for drinking or fire-fighting were supplied (Figures 117 and 118). The labor for repairs was provided mainly by prisoners of war and foreign laborers and the supervision by special repair foremen from the water department. Material, vehicles, and tools were decentralized into outlying districts to speed repairs and lessen the chance of large scale destruction of equipment during the raids. Although prohibited by law, Hamburg5 maintained a large reserve stock of pipe near the city. Material, valves, iron and steel pipe were purchased by cities under a ration stamp system (Figure 119). Cast iron appeared to be preferred for distribution mains, due to the ease and limit of fracture, usually two or three lengths. Steel pipe when hit by a high explosive bomb would twist and become distorted for a considerable distance, requiring extra labor for excavation and material for replacement (Nuremberg). 7 After mains were repaired, if other drinking water was available to the area, they were flushed until bacteriologic samples showed no B. coli, be- fore again being placed in service. If there was a general shortage of water (Cologne)8 the line was placed in service with only a short dirt flush out, and the public was advised to boil all drinking water until further notice. When chlorine was avail- able, as in Hamburg,5 Stuttgart.4 and Dortmund,0 the repaired mains were disinfected as a further protective measure against intestinal pathogens en- tering the distribution system. Protective measures: Aside from the steps taken to maintain an adequate potable water described in Figure 115. Emergency ivater supply line installed by re- pair team following air raid. group was entrusted with the supervision of pro- tective measures carried out by the manager of the water works in collaboration with the Commissar for Water W ays. All expenses for the installation of protective measures were borne by the water works except where special measures were necessary for protection beyond the water supply. The water economy authorities were responsible for investi- gating, identifying and registering all emergency sources of supply such as wells, cisterns, brooks, rivers or lakes. It was the duty of the local health department to judge whether these supplies could be used for drinking purposes and also to maintain careful observation of the main supply after damages had occurred. The organization for repair of damages was uniformly adopted in most of the cities. Pipe line wardens were located at or near air raid police headquarters. During a raid, as high explosive bombs hit on or near water mains the pipe line wardens were advised by the police of the exact 232 ENVIRONMENTAL SANITATION Figure 116. Emergency pipe line laid on air raid rubble, with hose connection and branch pipe. Note faucet welded directly into pipe. Figure 117. Multiple valued distributor hose used by water line wardens and repair teams following air raid. 233 ENVIRONMENTAL SANITATION Figure 118. Emergency water line—spare stub and valve used by repair team following an air raid. Note quick coup- ling device—annular rubber gasket used between sections. Line withstands a pressure of 150 pounds per square inch. Figure 119. Ration stamps used for procurement of iron and steel pipe (from Hamburg Water Department) for re- placement of damaged and destroyed water lines and sewers following air raids. The municipalities presented these stamps to the National War Allocation Board. the previous sections, which in themselves are pro- tective measures, certain other steps were taken, or were inherent, to protect the water supplies of Ger- many from air raid damage. The filtration plant (Gallenklinge) at Stuttgart was well camouflaged and protected by anti-aircraft guns. The collecting well house for the infiltration galleries of the Munich water supply was covered with camouflage nets (Figures 120 and 121). The main reservoir (Hochbehalter Deisendhofen) for Munich was a well constructed concrete underground structure covered with a natural landscape of trees and shrubs. Until going underground, one would never recognize the presence of this installation (Figure 122). The distribution systems in all cities visited were so constructed (looped) with interconnecting mains that water could be brought into any district from several directions. While this “looping” was de- signed primarily to prevent stagnation (dead ends) in areas of low water consumption, it was invalu- able as a protective measure against failure of sup- ply. Any one feeder main put out of service by a bomb hit could be easily by-passed and service maintained to other residential or industrial areas by means of the “loop'’ or “ring5' type of distribu- tion system. The use of the slow sand type of filter instead of the rapid sand type is an inherent protective mea- sure of importance. The rapid sand filter as used in numerous cities in the United States is of little value in water purification without chemicals for coagulation and disinfection. In case of shortage of these chemicals due to inadequate storage or lack of manufacturing or transportation facilities, which is an inevitable consequence of present-day war- fare against civilian population, a city depending on rapid sand filtration could not be supplied with a safe drinking water. During the last weeks of the war a definite shortage of chemicals existed in Ger- 234 ENVIRONMENTAL SANITATION Figure 120. Munich infiltration well house showing natural camouflage nets used to protect installation from air attacks. Figure 121. Munich infiltration well—interior. 235 ENVIRONMENTAL SANITATION 4,000 places; 2,000 of these breaks occurred on January 29, 1944, when 2,014 tons were dropped on the city by 814 planes of the Eighth Air Force. Two pump stations were hit, destroying the buildings, hut only one pump was hit and this was repaired within a few days. One reservoir of 3.7 million gal- lons capacity was hit and had to be isolated because of the damage. Although the supply of water was appreciably curtailed after the air attacks the en- tire city was without water on only one day, March 29, 1945, presumably because it was necessary to shut down in order to repair damage incurred dur- ing previous raids. By May 22 water pumpage had risen to 60 per cent of normal. Treatment for corrosion control was interrupted because of loss of chemicals by fire, inadequate transportation facilities and lack of electric power. Even the limited extent of chlorination had to be discontinued because of the unavailability of chlo- rine. City officials stated that the water had always been bacteriological ly satisfactory; nevertheless, the people were instructed to use only boiled water after air attacks. When breaks were repaired the pipe lines were flushed and disinfected with chlo- ride of lime until this material also became un- available. Augsburg:12 Source of supply: wells and infiltra- tion galleries from two fields located near the River Lech. One of these fields is located adjacent to the Messerschmitt airplane factory and suffered the consequences of being in the target area of an im- portant enemy war plant. Each field has a pumping station, the distribution mains being connected so that water can be supplied from either or both fields simultaneously. A storage reservoir of 42,200 gallons capacity located on high ground at the opposite side of the city floats on the system. The near-by communities of Goggingen and Haunstetten are also served by this supply. Total consump- tion for 1944 was 4,844 million gallons. The water works at Lobach (near the Messerschmitt plant) were damaged several times during 1944. On Feb- ruary 25 of that year, when 710 planes dropped 2,404 tons of bombs on the city and industrial area, one of the wells, the suction basin, pump and transformer house were destroyed. On March 16 another well was destroyed and pressure lines were damaged. Repairs to the pressure line were com- pleted within a short time. On April 13 the pressure line was again dam- aged but was repaired shortly afterward. On July 19 damage was incurred to the pressure main and Figure 122. Interior of underground water reservoir Munich. Capacity—lBs million gallons. Covered with arti- ficial landscaping to conceal its location and identiity. many, but this had little effect on the quality of the drinking water due to the use of slow sand filtra- tion for purification of polluted surface water. Increased personnel and laboratory facilities for collection and analysis of bacteriologic samples are an excellent protective measure. The Hygienic In- stitute in Hamburg attributed the freedom from water-borne epidemics to close supervision of water quality. Control of quality was aided by a new method for the detection of typhoid and paraty- phoid organisms in drinking water by combining the methods of diaphragm filtration and culture on bismuth-sulfide agar.10 Physical damage: Damage by bombing to the water works in Germany was extensive, as indicated by the following information obtained from several cities. Frankfort;n Source of supply: wells and springs for domestic use and a separate system for sprin- kling and fire protection utilizing river water. The latter has not been in operation since the raid of January 29, 1944. Treatment: 5 per cent treated with liquid chlorine, about 25 per cent treated for corrosion control by aeration and application of chemicals, and the remainder untreated. Consump- tion: between April, 1938, and March, 1939, 9,017 million gallons equivalent to 43 gallons per capita per day. Little damage was done to the water works until October 4, 1943, when the city area, industries and railroad yards were attacked by 482 aircraft carry- ing 1,446 tons of bombs. From this date to March 25, 1945, water mains and feed lines 3 inches to 40 inches in diameter were broken in approximately 236 ENVIRONMENTAL SANITATION lected in basins located near railroad yards at edge of the city which were under heavy attack by the Strategic Air Forces during the last phases of the war. Storage consists of a reservoir with a capacity of 800,000 gallons. The normal water consumption was from 6.5 to 7.5 million gallons per day. A total of approximately 400 breaks occurred in the distribution system as a result of bombing and artillery fire. Several of these were in the main distribution lines from the pumping station and were repaired by emergency crews immediately after the raids. Pipes were thoroughly flushed, but chlorine was not used as a disinfectant. The bac- terial quality was checked after breaks had oc- curred. The water was found to be free of pathogens and safe for consumption. Munich;3 Source of supply: wells and infiltra- tion galleries located in the foothills of the Alps about 30 kilometers (18 miles) south of the city. Flow is by gravity to reservoirs located near the southern edge of the city. During periods follow- ing damage to the gravity supply lines, shallow wells were constructed within the city. These wells were equipped with fire fighting pumps and the water was made available for drinking with the warning that it should be boiled before being con- sumed. In preparation for air raids, all privately owned wells were examined “from a hygienic point of view" and their owners were ordered to have neces- sary workmen and equipment on hand for deliver- ing water to designated areas. The German Army furnished about 100 water tanks while breweries supplied vats with a total capacity of 450,000 gal- lons. These were conveyed to stricken areas and re- Figure 123. “Scorched earth” destruction to transportation and water supply lines. Remains of Reichsautobahn (High- way) bridge over Mangfall river destroyed by the Germans after American troops had crossed. Broken water supply line to Munich lies under steel wreckage in foreground. connecting line bridges. These were also either tem- porarily or completely repaired within a short time. The works at Hochablass (other well field and pump station) were not severely damaged at any time. The distribution system within the city was dam- aged in about 300 places between February 25, 1944, and March 1, 1944. All breaks except about 25 which required extensive labor and materials were repaired by the early part of June. All pipe lines were thoroughly rinsed before being placed back in service. Emergency supplies consisted of connections to privately owned industrial wells of which there were many in this highly industrialized city, and distribution by trucks conveying tanks of water to stricken areas. Boiling of all water from private supplies was mandatory. Karlsruhe A3 Source of supply: well water col- Figure 124. Wreckage of pump station—Cologne. Direct hit during air raid. 237 ENVIRONMENTAL SANITATION filled by special water lorries consisting of city- owned watering carts, gasoline tank wagons, etc. A total of 7.1 million gallons was distributed in this manner, with a daily maximum of 300,000 gallons. Intact pipe lines also were tapped at various places. Warnings to boil all water not taken from pipe lines were announced by posters and the press. The air raids against the city area during July and August, 1944, when 9,500 tons of bombs were dropped, caused severe damage to the gravity feed lines and the distribution system. All five feed lines running into the city from mountain reservoirs were broken and the mains within the city were severed in approximately 850 places. The city was without an adequate supply of water for several days as a result of these raids. Total damages after the 37 raids in August, 1944, resulting from 9,063 tons of bombs dropped, caused 1,850 breaks in mains of which 62 were on lines from 20 inches to 48 inches in diameter. Repairs required a total of 6.5 miles of pipe and at times 400 workmen were im- ported from various industries, the Army, the Bavarian civil service, and military prison camps to restore the system. Two major supply lines were damaged in April, 1945, when the Reichsautobahn bridge over the Mangfall River was destroyed by the retreating German Army (Figure 123). Re- gardless of pleas on the part of water works officials to the Army officers to avoid damage to the piers near which 30 and 40 inch water lines were laid, the entire structure was destroyed. As a result, the water lines were cracked and water poured out at the rate of approximately one half million gallons per hour. The water system to Munich was thus seriously affected and it was estimated that the re- pair work would require several months since a temporary military road was constructed on the debris covering the damaged sections of pipe. Cologne:8 Source of supply: wells approximately 50 feet deep located in four scattered areas near the edges of the city. The supply is not usually chlorinated but equipment for emergency use was installed at two (Zugweg and Weiler) of the four pump stations, and one of these (Zugweg station) was in operation at the time of this visit. Normal water consumption was approximately 24 million gallons per day. Destruction of this city was so complete that the total number of breaks in water mains could not be estimated. Damages to the pump stations were as follows: Two of five steam pumps at the Zugweg station were destroyed on October 14, 1944 (Fig- Figure 125. Bomb damage to 2.5 million gallon reservoir— Cologne. ure 124), and on October 17 two of four boilers were destroyed. On December 18 one of the two reservoirs, having a capacity of 2.5 million gallons, was destroyed (Figure 125). The pump station at Weiler was put out of operation October 28, 1944, by the obstruction of a gas main supplying the gas engine driven pumps. By April 1, 1945, an electric pump had been installed which could sup- ply about one-third of the city’s normal demand of 250,000 gallons per hour. The supply of electricity to the water works was apparently always ample, although two 10,000 kilowatt turbines at the Zugweg station were de- stroyed. During one of the raids a dud bomb came to rest near the switch board. Had it exploded the electric pumps used to augment the steam pumps would have been put out of operation, resulting in a more serious water shortage than had occurred. Following several of the raids the damage was so severe that only a very limited amount of water could be supplied. On such occasions emergency sources consisting of various privately owned wells were placed in service hut these did not supply a sufficient quantity to meet normal demands. Auxil- iary water basins (Loeschteiche) located in various sections of the city were also available for emer- gency use in fire fighting (Figure 126). Preparatory to air raids the people were ad- vised to fill bath tubs and all other available con- tainers with water. Boiling of all water was recom- mended and the drinking of unboiled water was prohibited. Repaired mains and pipe lines were flushed but not disinfected before being placed back in service. Hamburg:5 Source of supply: sixteen scattered 238 ENVIRONMENTAL SANITATION Figure 126. Open storage tanks built as part of the organized air raid defenses for fire fighting and emergency drinking water supply. ground water works with a total of 450 wells (both deep and shallow) ; two purification plants consist- ing of sedimentation, rapid and slow sand filtration and continuous chlorination utilizing water from the Elbe River; one purification plant consisting of rapid and slow sand filtration and chlorination (0.2 parts per million excess) utilizing water from a lake at Grossensee (Figure 127). Water consump- tion in greater Hamburg before the famous fire raids and after these attacks is shown in Table 34 supplied by the Water Works Corporation. In an effort to minimize the effects of disruption of water supply, instructions were issued to em- ployees which were briefly as follows: During the attack, engines were to be kept going as long as possible; foremen and work shift in charge of boilers and engines were instructed to remain at their posts until bombs actually fell and were to stop the pumps when the main pressure failed be- cause of major breaks; the plant superintendent and other workers not essential to immediate emer- gency work were to proceed to air raid shelters. After the attack the first job was to determine the number and location of unexploded bombs in and about the work, and then to proceed to estimate the extent of damages and the amount of material and labor necessary for repairs, reporting these items to the municipal construction department. An application was also to be submitted to ARP headquarters for materials and assistance. Emer- gency labor groups consisting of foreigners and prisoners of war would then be organized for mak- ing the necessary repairs. Table 34. Comparative Water Consumption —Greater Hamburg Before the attacks • After the attacks July, 1943 Oct., 1944 Mar., 1945 MGD MGD MGD Consumption* 76.6 42.3 37.0f Loss from mains 7.9 39.7 17.2 Output 84.5 82.0 54.2 * Based on water meter readings t Corresponds to 30 gallons per capita per day including in- dustrial uses. 239 ENVIRONMENTAL SANITATION Figure 127 HYGIENIC INSTITUTE HANSEATIC CITY OF HAMBURG DIVISION 35T, WATER HYGIENE LEGEND • GROUND WATER WORKS ® SURFACE WATER WORKS A WATER TOWER ■ PUMP STATION LOCATION SKETCH OF THE SOURCES OF WATER SUPPLY FOR THE CITY OF HAMBURG During the air raids of July, 1943, severe dam- age was inflicted on the central pumping station at Rotenburgsort. Two engine houses including the pumping equipment were abolished and two boiler houses were damaged by collapse of a chimney. A workshop, warehouse, workers’ dwellings and recreation building were also destroyed by direct hits and fire. Several mains and pure water basins outside the buildings were also severely damaged (Figures 128 and 129). Some temporary repairs were completed immediately after the attacks but it was necessary to shut down the station for a period of about three weeks until engines and pumps could be put into working order. The treatment plant at Kaltehofe and the ground water works at Billbrook. Curslack, and Stellingen were also hit during these raids but damage was less severe and was repaired within a few months. Breaks in the distribution system totaled 847 feet of pipe rang- ing from 2 inches to 36 inches in diameter. Repeated attacks during the months between June and November, 1944, also resulted in damage to various supplies. At Kaltehofe, sedimentation tanks, filters and pipelines were hit; at Curslack, pipelines 240 ENVIRONMENTAL SANITATION Figure 128. Broken suction line (80" diameter) at Hamburg pumping station. Figure 129. Bomb damaged reservoir (5 million gallons capacity)— Hamburg. 241 ENVIRONMENTAL SANITATION Figure 130. Can filling station at hydrant. Civilian population with hand carts obtaining daily water supply were broken, and at the Rotenburgsort pumping station a pump and pure water main were dam- aged. This damage, however, was relatively minor in nature and, although breaks occurred in large diameter pipes, the repairs were completed within a short time so that the quantity of water distributed was not materially affected for any long period. Damage to pipe lines in the distribution system amounted to breaks in 1,650 lineal feet during the period July, 1943, to November, 1944, and further destruction in 1945 (January to April) amounted to breaks in approximately 975 feet, making a total of 3,475 lineal feet of pipe line damaged. During these emergencies at Hamburg, drinking water was supplied from about 100 wells con- structed by the Technical Emergency Corps, from privately owned wells in the community, and from surface sources which were treated with German Army purification equipment moved into the city for that purpose. Taps were installed on undam- aged parts of the system (Figure 130), and water from wells was delivered to afflicted areas by trucks, wagons and all other available means. Particular care was taken to test the water before approving its use and to assure that no contamination oc- curred during the transfer from mains, wells or purification equipment to the tanks in which it was conveyed to various points of distribution. Samples were taken periodically from all wells in the com- munity, some of which were made ready for use before the war. A card index was maintained show- ing the condition of each well so that its useful- ness could be judged at any time. Samples were also taken from points of low pressure on the dis- tribution mains as a check on back syphonage. Re- ports indicate that no objectionable conditions de- veloped, with the exception of a few cases of sludge (mostly ferric oxide) discharge caused by oscilla- tions in pressure. Booster pumps were installed at critical points on the system to provide pressure for fire protection. Repaired sections of pipe were thor- oughly flushed with water and chlorine solution, and the line was not put into service until it was found to be in a satisfactory bacteriologic condi- tion. Other than the one period after damage to the Rothenburgsort pumping station no serious short- ages of water developed. Water works officials at- tributed the successful operation of the system to 242 ENVIRONMENTAL SANITATION Figure 131. Typical damaged (8") steel water line. Note distortion. Result of direct bomb hit during air raid. the abundant reserve supply and to the fact that standbys were installed for all important pumps. The various sources of supply were so located and interconnected that many could be used to augment other damaged supplies. During the period of air attacks, the bacteriologic condition of the public water supply was under constant observation by frequent examination of samples was examined for total bacterial count the Hygienic Institute were examined once a day, but in 1945 the frequency was increased to four times daily at 0200, 0800, 1400 and 2000 hours. During the first half of the year a total of 236 samples were examined for total bacterial count and B. coli content. Of these examinations, 81 per cent were found to be bacterially satisfactory with an average count of less than 10 per milliliter, ex- cept in February when the count was 25 per mil- liliter and in March when the highest number of colon positive tubes was 32 per cent. These un- satisfactory conditions were attributed by Dr. Mueller of the Hygienic Institute to the increased air attacks mentioned previously which resulted in widespread damage to the water system. Samples were also taken at weekly intervals from thirty-three points on the distribution system. Of the 428 samples collected during the first six months of 1945, 26 per cent were unsatisfactory on the basis of B. coli in 100 milliliter quantities. The maximal number of unsatisfactory samples oc- curred during the months of March and June. These conditions were said to be due to increased bomb damage in March and extensive repair work to the system in June. Table 35 shows the bacteriologic condition of the water as indicated by samples collected during the past ten and one-half years. From this table it will be seen that contrary to the colon content, the average bacterial counts varied considerably. They remained below 10 up to the air attacks of 1940 and dropped to less than one per milliliter during the period 1940 to 1943 inclusive. The average for 1943 is particularly striking since the supply was disturbed consider- ably by bomb damage during that year. The B. coli content, however, was more definitely correlated with bomb damage. While the number of unsatis- factory samples during the period 1934 to 1943 was less than 10 per cent and at times less than 1 per cent, there was a definite increase to 16 per 243 ENVIRONMENTAL SANITATION cent during the year 1944 and to 19 per cent during the first six months of 1945. Because of this, peo- ple were warned by radio to boil all water used for drinking purposes, the warning being lifted in April when the B. coli content indicated an im- provement in the bacteriologic condition. Slight in- creases in B. coli content were observed after that time but they were attributed to repair work on the system and not considered dangerous. The relation- ship between bomb damage and water-borne disease rates, such as typhoid, paratyphoid, and dysentery, could not be established because the total number of intestinal disease cases remained at the usual level for this city (see Chapter Four). It was the conclusion of Dr. Mueller that “although the bomb- ing destruction of the Hamburg water supply, espe- cially during the last two years, has exerted an in- fluence on the potability of the water, it has not re- sulted in an increase in infectious disease trans- mitted by drinking water because the people were instructed in sanitary measures.” Nuremberg;7 Source of supply: three independ- ent waterworks, two of them utilizing surface Table 35. Bacteriologic Condition of Drinking Water at the Hygienic Institute Gorch Fock-Wall—Hamburg Year Total number of examinations Average bacterial count per milliliter Per cent of examinations positive for B. coli per 100 milli. 1934 364 8.7 9.2 1935 361 3.6 1.3 1936 359 3.5 3.6 1937 358 1.7 5.0 1938 354 1.1 2.0 1939 359 1.0 0.6 1940 355 1.1 1.3 1941 354 0.4 5.3 1942 364 0.3 0.6 1943 322 0.9 0.2 1944 371 22.5 16.7 1945 236 8.0 19.0 (Jan. to June) Figure 132. Emergency water line. Hastily laid across rubble following an air raid. ENVIRONMENTAL SANITATION water from the Veldensteiner wooded hill area and the third utilizing ground water from wells in the Pegnitz Valley. The surface supplies are untreated and are conveyed by gravity to the distribution sys- tem or to reservoirs floating on the system. The well water is pumped by electric power either directly into the system or to the elevated reservoirs. Emer- gency sources consisted of about 70 privately owned wells which generally produced a water of satis- factory bacterial quality. However, it was recom- mended that all water taken from these wells be boiled before using. The supply for the adjoining town of Furth was also used in emergencies after air raids. Distribution from these sources was by water carts which were registered by the town be- fore the air attacks began. These carts, 30 to 40 in number, provided means of transporting approxi- mately 105,000 gallons into the town daily when the normal supply was affected. Although no damage was reported to the wells, reservoir or pump stations, numerous breaks oc- curred in the distribution system (Figure 131) dur- ing the air raids so that only a portion of the town could be supplied from the main source. The num- ber of breaks was reported to have increased from approximately 150 in 1942 to more than 700 in 1945. A crew of 23 men was on twenty-four hour alert for shutting off house lines and damaged sec- tions of mains. A repair crew of about 500 men was also available for repairing the breaks and for laying temporary pipe lines to waterless areas (Figure 132). This crew was able to make the nec- essary repairs so that the supply was again normal within four to six weeks after each attack until the heavy raids of January, 1945. From that time until occupation of the town by American troops, fre- quent alarms and strafing attacks greatly hindered the repair work. It was estimated that approxi- mately 520 breaks were repaired up to January, 1945, but only about 220 since then. Particular care was taken to rinse thoroughly the repaired sections until samples indicated the water to be bacteriologically satisfactory. Stuttgart:4 Sources of supply; three main sources of supply include untreated water from the state owned Danube Valley near Niedestezingen ap- proximately 100 kilometers away; mixed well and surface water from the Neckar River treated by co- agulation, slow sand filtration and chlorination. Numerous small wrells located throughout the city and furnishing about 10 per cent of the supply were also connected to the system. Consumption varied from 15 million gallons during the winter to 37 million gallons during summer with an all time peak of 8,448 million gallons during the year 1944. Damages to the system totaled about 1,400 breaks, 200 of which were in large mains and 1,200 in smaller lines. By May 23, 1945, all except 25 breaks in the larger mains and about 300 in the smaller lines had been repaired. Pump stations, filter plants and reservoirs suffered minor damages but because of the plurality of sources the supply was never entirely interrupted. Water was conveyed to stricken areas by trucks and carts and the people were advised to boil all water used for drinking. Repaired distribution mains were thoroughly flushed and treated with chlorinated lime before placing into service. Samples from the system indicated no B. coli, and on only one occasion did the total bacterial count greatly exceed the average. Destruction of the Moehne Dam: The following report from the Hygienic Institute (Gelsenkirchen)2 describes damages to water works and the effect on the drinking water supply of the Ruhr District due to the flood caused by bombing of the Moehne Dam. In the early morning of May 17, 1943, the dam across the Moehne Valley was the target of an air attack. The wall was completely destroyed in its central part for a length of about 250 feet and to a depth of about 75 feet (Figure 133). Since the impounded basin was almost completely filled at the time, the water poured out through the hole in such quantities that a high water wave developed in the Moehne and Ruhr Valleys which reached a height of 30 feet and more in the narrow parts of the Moehne Valley. Even on the upper course of the Ruhr the high water wave was from 18 to 25 feet above the river in the first hours after the blast. In the lower course of the Ruhr at Baldeney Lake near Essen, about 75 miles below the dam, the wave receded to former high water levels and dropped further below the high water mark at the point where the Ruhr flows into the Rhine. The bulk of the water attained at first a velocity of 20 feet per second resulting in considerable damage in the Moehne and upper Ruhr Valleys. The worst damage occurred in the narrow parts of the valley, especially at places where the valley was restricted by structures such as plant buildings, bridges with adjoining road dams and dwellings. Cities suffering the worst damage were Neheim, Wickede and Froendenberg. The velocity of flow 245 ENVIRONMENTAL SANITATION was greatly increased in these cities by obstacles so that the destruction was considerably greater. The water flow approximated 300,000 cubic feet per second at the beginning of the flood. Before the catastrophe the total quantity of water supplied by the water works concerned amounted to about 265 million gallons per day. This supply dropped on May 17, 1943, the day of bombing, to approxi- mately 68.7 million gallons per day. The quantities of water pumped on succeeding days are shown in Table 36. Clearing and repairing the accumulation basins and replacing filter sand were major tasks; never- theless, the normal supply of water was resumed in a short time. This was principally due to the fact that the bottom and the banks of the Ruhr, which had become muddy and impermeable by polluted water, had been cleansed by the high water wave and the channel refilled by water com- ing from the subsoil through the river bottom. Ac- cording to former experiences, however, it was ex- pected that the river bottom might again be covered with slime after a relatively short time. Cleaning and repairing of the accumulation basins had, therefore, to be hastened. Rainfall was quite favor- ably distributed in the summer and fall of 1943, which helped considerably in maintaining an ade- quate supply. The following water works were completely de- stroyed by the break of the dam wall resulting in the flood: (1) The water works for the town section Ne- heim of the city Neheim-Huesten (Figures 134 and 135). (2) The newly established water works for the Russian camp in the town section Neheim of the city Neheim-Huesten. (3) . The water works in the slaughter house pas- ture for the town district Neheim of the city Ne- heim-Huesten. (4) The water works of the city Soest in Wickede on the Ruhr. (5) The works of the city of Herdecke. Especially heavy damage occurred also in the water work for Echthausen, which began operating as a new works in 1942. This was a part of the water works for the northern Westphalian coal dis- trict at Gelsenkirchen. Besides the clogging up of the accumulation basins already mentioned, much destruction resulted to the well installations and the power plant was destroyed. Similar damage oc- curred at the water works situated farther below in the valley, namely: (1) the water works of the city Hamm in Barmen; (2) the community water works for Froendenberg; (3) the water works of the city of Menden; (4) the water works of Lang- schede (water works for the northern Westphalian coal district), and (5) the works for the city of Dortmund. The Dortmund works were out of operation for two days. On the third day the distribution system was filled and pumping was resumed on the fourth day. The supply was then gradually increased from Table 36. Water Pumpage—Supplies Affected By Flooding Moehne and Ruhr Valleys Date Daily water pumpage Until May 16, 1943 on May 17 265.000,000 gls. 68,700,000 18 89,800,000 19 127,000,000 20 164,000,000 21 185,000,000 22 206,000,000 23 223,000,000 24 212,000,000 25 209,000,000 26 212,000,000 By June 8, 1943, the total water pumped rose to 250 million gallons per day and reached 265 mil- lion gallons per day on June 27, 1943. Most of the water works in the Ruhr Valley were flooded, resulting in considerable damage. Some of the plants had to be completely rebuilt. Others could not be placed into operation for several days, because of water damage to electrical equipment. Whirlpool holes and gravel deposits were formed in the stream valley. Accumulation basins having a capacity of about 7.5 million square feet, for aug- menting the ground water supply, were filled with mud so that the filter bottoms became practically impermeable. On May 17, 1943, after the bulk of the high water had run off, each water works began clean- up operations with their own laborers assisted by the fire police, technical emergency crew and spe- cial police units. 246 ENVIRONMENTAL SANITATION Figure 133. Moehne Dam. Water pouring thru breach resulting from direct bomb hit during air attack of May 17, 1943. Figure 134. Remains of water works at Neheim. Destroyed by the flood when the Moehne dam was destroyed by direct aerial bombardment—May, 1943. 247 ENVIRONMENTAL SANITATION Table 37. Effect of Moehne Raid on Water Works Pump Works Operations Stopped May 17,1943 Operations started again Date T ime Interruption Days Hours Former Moehne Flood Flood level level in meters Echthausen 0200 hrs. Aug. 23, ’43 0600 98 4 138 145 Froendenberg 0345 Aug. 2, ’43 0600 17 2 118 124 Langschede 0410 May 20, ’43 1935 3 15 114 120 Witten 1030 May 18, ’43 1700 1 6i/2 75 80 Horst 1720 May 17, ’43 2400 — 6i/2 55 61 Steele 2120 May 17, ’43 2230 — 1 55 59 20 to 80 per cent of normal. Operations at Lang- schede, which is the main supply for the district of Unna, were resumed within a few hours. The effect on the Ruhr water works supplying the northern Westphalian coal district Gelsenkirchen is shown in Table 37. The pump station supplying the city of Hagen was completely flooded, necessitating a complete shut down of the supply. The flood wave reached a height of 6 feet over the machine house, about 13 feet over the water supplying section, and about 7 feet over the rapid sand filter plant. Tremendous sludge masses, carried from the Hengsteysee, were deposited there. Sixty per cent of all the water de- mand had to be transferred from the Hasper Valley dam to the inner city district through an emergency line. Sections of the city situated on higher ground had to he supplied with water from water carts. Similar conditions existed in the water works situ- ated farther down the Ruhr. However, it should be emphasized that most of the water works could be- gin operation again within a few hours. The greatest difficulties in regard to the drinking water supply were naturally in the few cities where the water works had been completely destroyed. The water conveyed by the water works at Huesten and Hahhel was conducted into Neheim from Huesten. In addition large quantities of water were turned into the Neheim high reservoir from the Loermecke water works. In this way the city could be supplied with water in a few days. It must be noted that in all cases water supplied to Neheim was safe for drinking purposes. The second completely destroyed water works, for the city of Soest in Wickede on the Ruhr, had to discontinue the supply of drinking water even to the city. This city was supplied with water partly by an emergency pipe connection with the water works at Hamm, partly by the Loermecke water works, and by the old city plant in Soest. The old city well supply had to be treated with chlorine because of the objectionable bacteriologic condi- tion. It was necessary for a time to supply drinking water from private wells in most of the cities of the Ruhr district, especially in the city sections heavily damaged during the bombing attacks. These wells were tested for use as drinking before the catastrophe, but a single examination of well water, even though a negative result is obtained, cannot lead to the conclusion that the water is safe. Espe- cially in the Ruhr district continuous excavations and sink holes in the earth’s surface caused by mining operations must be taken into consideration. Therefore, upon our suggestion the individual city boards of health ordered signs to be put up at the wells warning the people to boil the water before drinking. Herdecke, which was suddenly cut off from the central water supply by the total destruc- tion of the pump station, was again being supplied with water within a short time. This was done by using the collecting well that remained practically undamaged. The water was taken from the collect- ing well in water carts, treated with chlorine, and conveyed to the various sections of the city. Several private wells also supplied water which was boiled before drinking. In general it must be noted that the exceptionally great efforts of technicians and sanitary engineers were successful in mastering these conditions. They 248 ENVIRONMENTAL SANITATION Figure 135. Pumping equipment damaged by flood—Neheim water works, May, 1943. used the strictest precautions and continuously watched over the water plants and emergency sup- plies. No epidemics of any kind were experienced which could be traced to this raid. Heavy damage to sewage treatment plants oc- curred in Neheim, Froendenberg and Witten. The treatment of sewage in the Ruhr district is of great importance in view of the fact that the river is a source of drinking water. Operation of the treat- ment plants was especially important when the ad- ditional water supply from the Moehne Valley Dam was cut off. Therefore, repair work on the sewerage plants was carried out immediately, so that Witten and Froendenberg were again ready for operation within a few weeks. In Neheim, in addition to the plant itself, the sewage collecting system and siphons under the Moehne were destroyed. As a result of the high water level, especially in the Moehne and upper Ruhr Valley, damage of great extent occurred to the water distribution sys- tern. Likewise, the river channel was changed in some places due to damage of the banks. At other places, especially at a sudden widening of the valley, heavy deposits of gravel have partially filled the channel, the greatest damage occurring in the Moehne Valley. Below the mouth of the Moehne the Ruhr was completely clogged by gravel for a length of about 500 meters. In addition decisive damage occurred to bridges and reservoirs. At the time of this survey, the dam had been re- paired but the level of impounded water was main- tained below normal to prevent a repetition of the flood damage should it again be destroyed (Fig- ure 136), and anti-aircraft guns were mounted in control towers. In addition cables with high ex- plosive grenades were hung above the dam as pro- tection against low-flying planes, and nets were in- stalled to prevent aerial bombs or water-borne tor- pedos from reaching the base of the dam (Figures 137, 138 and 139). 249 ENVIRONMENTAL SANITATION Figure 136. Moehne Dam, upstream side, after reconstruction. Water level maintained at halfway mark to reduce flood damage should dam be redestroyed. Sewerage systems For many years prior to the war, the problems of sewage disposal and prevention of steam pollution had been given considerable attention in Germany. As industry developed and certain areas became heavily populated, the objectionable conditions cre- ated by discharging raw or untreated sewage into streams became greatly amplified and in certain areas such as the Ruhr River Valley2 the condi- tions became definitely acute. In these areas the cities and towns were dependent upon rivers and smaller streams as sources of drinking water, either by taking it direct or by using it to replenish (through filter basins) the ground water from which the drinking water was drawn. Hence it was imperative that the stream water be maintained in as clean a condition as possible. Before the turn of the century it became evident that the laws prohibiting the discharge of sewage into water courses were definitely inadequate and that means other than law enforcement would have to be taken to correct unsatisfactory conditions. A few years later enabling acts were passed whereby cities and towns in certain defined districts could organize into “Sewage Water Associations” for the purpose of providing drinking water supplies and controlling conditions of stream pollution. These associations were given broad powers permitting them to require the construction of sewage treat- ment facilities and to maintain and operate the plants in such a manner that the streams would be satisfactory for use as public water supplies. Table 38 shows a list of the associations, date of organiza- tion, population and size of area served (Sierp14). It will be noted from this table that more than ten million persons are served by water supplies and sewage disposal facilities operated under the control of these associations. In addition, there are sewage treatment facilities installed for service to people living in unorganized areas, the total number of which is not known. Sewage treatment facilities in most cases con- 250 ENVIRONMENTAL SANITATION Figure 137. Cable with hanging grenades to destroy low flying planes and prevent skip bombing. Installed above Moehne dam after destruction by aerial bombardment May 17, 1943. sist of solid removal only, secondary treatment by filtration being employed only when the amount of dilution water in the receiving stream is exceed- ingly small. In some cases where careful control of the stream is necessary, overflow basins are installed on the outfall sewer so that the quantity of sewage discharged into the stream can be main- tained constant. These basins serve as storage space for the sewage during periods of daytime or heavy flow and are emptied during periods of night or low flow. Similarly, impounding reservoirs constructed on the stream for the purpose of maintaining a con- stant dry weather flow are used in some places as a means of sewage treatment. These reservoirs af- ford large quantities of dilution water containing dissolved oxygen which is necessary for complete stabilization of the sewage. The quantity of sewage discharged into these reservoirs is carefully con- trolled so as to prevent undue pollution. Since the organic material in the sewage stimulates the growth of vegetation and food for aquatic life, fish and ducks are often raised in these reservoirs for their food value. A sketch of the layout at Munich utilizing this system is shown in Figure 140. In rural areas, sewage is often discharged onto agricultural land as a source of fertilizer and mois- ture for agricultural products. The land is prepared for irrigation by the construction of trenches, and disposal is carefully regulated to prevent overflow into near-by water courses. Where disposal is by this method, “Irrigation Associations” have been organized to assume the responsibility of careful control. Sewerage and sewage disposal systems and dam- age thereto by bombing, as observed in several German cities, are as follows: Hamburgr> Sewage from this city is not treated except for mechanical coarse screening before dis- charge into the Elbe River. Several of the drainage areas were severely hit causing damages to the col- lecting system, lift stations, pressure lines and out- fall sewers. As a result of these damages and the subsequent clogging of pipes with debris and silt, 251 ENVIRONMENTAL SANITATION sewage backed up into residences and business establishments. In cases of damage to pressure lines or outfall sewers, the sewage was by-passed into road ditches or small tributaries to the Main River. This, of course, resulted in gross pollution to these small streams. Pump stations undamaged were sometimes shut down in an effort to save elec- tric power. The total number of breaks in the sys- tem is not known, hut it is probably safe to assume that they approached the number of recorded breaks in the water system, approximately 4,500. Stuttgart;4 Treatment in this city consists of rough screening and settling tanks with continu- ous sludge removal to heated digestion tanks. Di- gested sludge is run to drying beds, then sold as fertilizer. Treated effluent goes to the Neckar River. The gas produced in the digesting tanks is used as fuel for over-all plant operation, the remainder be- ing turned into the city gas system (approximately 8 per cent of the city supply) or compressed in cylinders for motor fuel. Raw sewage was some- times used in emergency for fighting fires. This oc- curred in the big fire raids in 1944 when fire de- partment pumpers shifted their intakes and sprayed large residential areas with sewage to hold back the fires. The health statistics show no marked in- crease in water-borne disease following this pro- cedure. Since April, 1943, the sewerage system suffered a reported 617 breaks. To May 23, 1945, 267 of these had been repaired, requiring 60,000 man days’ labor. The remaining 350 breaks will require an estimated 70,000 man days for repair- ing. The disposal plant suffered only minor dam- age by bombing. Ulm:G Disposal of sewage and waste water is by discharge into a network of canals which in turn discharges into the Danube River below the city. Street drainage, rain water, kitchen and lava- tory wastes are discharged into these canals without treatment, but sewage from toilet facilities is first settled in two compartment septic tanks located on the house sewer line. Damage to the sewers was ex- tensive, the total number of breaks being unknown as many lines were covered with debris. Although hit many times, the system was maintained in com- paratively good condition until December 17, 1944, and was especially hard hit during the raids of Feb- ruary and March, 1945. Most of the breaks could not be repaired during that time and as a result the system became clogged at many points with heavy accumulations of sludge and debris. These stop- pages caused sewage to back up into the deeper Table 38. Sewage-Water Associations Organized in Germany Name of association Date organized Population Size of area sq km. 1. Emscher Assn., Essen July 14, 1904 2,500.000 784 2. Sewerage Assn, for the Laisebach Area, Waldenberg Mar. 12, 1907 80.000 31 3. Sewerage Assn, in Moers on Left Rhine Bank Apr. 29, 1913 250,000 965 4. Ruhr Assn., Essen June 5, 1913 1,400,000 4500 5. Lippe Assn., Dortmund Jan. 19, 1926 500,000 2800 6. Niers Assn., Viersen July 22, 1927 470.000 1370 7. Schwarze Elster Assn., Rad Liebenwerda Apr, 28, 1928 300,000 3650 8. Wupper Assn., Wuppertal Jan. 8, 1930 680.000 620 9. Mulden Assn., Chemnitz Dec. 23, 1933 2,000,000 5500 10. Weisse Elster Assn., Leipzig July 23, 1934 1,960,000 5100 Total 10,140.000 25,320 ENVIRONMENTAL SANITATION so that they would no longer flow, or where resi- dences and other occupied buildings were without water under pressure for flushing plumbing fixtures, gross insanitary conditions sometimes prevailed. In some cases fecal matter was collected in buckets or pails and deposited into wagons or trucks to be hauled away and dumped into a stream or low, isolated area. In other cases, however, the people were forced to dump their wastes into shallow trenches on vacant lots or gardens. Accumulations were not always covered or otherwise given proper disposal and government officials anticipated an in- crease in fly-borne disease rates unless sewerage and water systems were restored promptly. Munich;3 The sewage collection system is the combined type (carrying sewage and storm water) with treatment facilities consisting of screening, Im- hoff type settling tanks and sludge drying beds. The gas produced by sludge digestion furnishes about 8 per cent of the city gas supply and the plant efllu- Figure 138. Moehne Dam. Nets installed after reconstruction to prevent floating mines from hitting dam. cellars of residences and mercantile establishments. Insanitary conditions were also created by the lack of sufficient water for flushing indoor toilets and other plumbing fixtures. At the largest hospital in Ulm, the water supply had been shut off for several months after the heavy raids during the forepart of March, 1945. Drinking water had to be brought in by buckets and the plumbing system could not be used. Fecal matter was dipped from toilet bowls and deposited into horse drawn wagons or trucks for periodic hauling away. Nuremberg:7 This city has five disposal plants, one of which is a plain septic tank, and four of the double chamber type, similar to the Imhoff tank used in the United States. No further treatment is given the sewage, tank effluents going to the Pegnitz River. Estimation of total broken sewer lines was impossible due to the large amount of rubble on many of the streets. Four of the treatment plants were not damaged but the fifth (North plant) was hit by aerial bombs and artillery shells causing severe damage. A gas holder was destroyed and the sludge mechanism put out of working order. It was estimated that complete repairs would require several months. Undiluted sewage was not used in fighting fires but water was used from a stream re- ceiving sewage from several small sewers. This water, however, was not heavily polluted. Cologne; 8 Damages here, exclusive of the central part of the city which was too badly damaged to appraise, consisted of 47 breaks in main trunk sewers (Figure 141) and 136 in important laterals. A new complete treatment plant had been con- structed but was destroyed by bombing before be- ing used. The old primary treatment plant was al- ready badly damaged and raw sewage was dis- charged directly into the Rhine River. Where sewers were blockaded by debris and mud Figure 139. Moehne Dam—Steel nets installed on the down- stream side, after reconstruction, to prevent bombs dropped vertically from reaching base of dam. 253 Figure 140 SEWAGE DISPOSAL BY PLAIN SETTLING 8 SLUDGE DIGESTION WITH DISCHARGE OF EFFLUENT INTO FISH PONDS AT MUNICH 254 ENVIRONMENTAL SANITATION approximately 26.5 MGD and only about 60 per cent was directed through the clarification plants. Because of unrepaired damage to collecting sewers, the remainder was diverted directly to the Main River through emergency outlets. Due to bomt damage of the main plant which destroyed fom sedimentation basins, pumps, sludge drains, power and light lines, tools and other equipment, ten of the fourteen sedimentation basins could be placed into makeshift operation only. This resulted in an estimated 50 per cent loss in efficiency of treatment. The other plants were not damaged and were in operation at the time of this visit. Damage to the sewage collecting system amounted to approximately 500 breaks during the air raids of 1943, 1944, and 1945; 150 of these were in the main collecting system which is laid at a depth of 13 to 20 feet, generally in ground water. Because of the difficulty in making repairs and the lack of labor and equipment, only about 50 of these breaks were repaired during 1944 and 1945. The other 100 breaks required a total of 52,000 days of labor and an additional 57,600 days of labor were required in repairing approximately 400 breaks in the smaller lateral sewers. Two of eight pumping stations were taken out of operation be- cause of damages to the pressure lines and two others because of electric power failure. By June 13, 1945, approximately one-half the total quan- tity of sewage from the city was being discharged without treatment into the Main River. Other effects of bomb damage to sewerage sys- tems: Aside from the amount of material and man hours required for the repair and reconstruction of sewers and disposal plants other effects of bombing include loss of fertilizer, resulting in lowered pro- duction of foodstuffs, and loss of gas production for plant operation and as a source of fuel for trucks and automobiles. According to Sierp,14 one kilogram (2.2 lbs.) of organic matter—sewage sludge—will produce about 875 liters (31 cu. ft.) of gas when digested at 45° C (113° F) ; 3.4 cubic meters (120 cu. ft.) of purified sewage gas has the fuel value of one gallon of gasoline. Sierp also states that under normal driving conditions an automobile with a 40 PS (39.5 horse power) engine will travel about 100 kilometers (62 miles) on 18 cubic meters of methane gas from sewage (Figure 144). The potential gas production from sewage is about 25 liters (0.9 cu. ft.) per man per day. Thus a sewage disposal plant serving a city of 100,000 Figure 141. Trunk sewer blown open by direct hit during air raid. Damaged water main at left. ent is discharged into a fish pond where fish are raised for food value (Figure 140). Prior to June, 1944, the sewage collection system was damaged in only 17 places but after this date increased aerial attacks and use of delayed fuse bombs caused heavier damages. Although the sewers were laid under 9 to 16 feet of cover, a total of 350 breaks were reported, often causing leaks into basements wherein people were forced to take shelter from the air raids. Because of the increased frequency in raids and the general shortage of labor and ma- terials, only 110 breaks had been repaired by the last of May (Figure 142). The treatment plant ■“Grosslappen” was heavily hit on July 11, 1944, when two of the sixteen settling tanks were de- stroyed and two others severely damaged (Figure 143). Temporary repairs were made soon after- ward so that the plant continued to operate at a reduced efficiency. Completion of permanent repairs would require an estimated 9 to 12 months. Augsburg:2 Treatment here consisted of screen- ing and Imhoff type settling tanks. No damage was reported to the plant but 94 breaks occurred in sewers, 30 being repaired by June 6, 1945. Frankfort:11 The sewage system comprises 605 km. (430 miles) of sewers and twelve primary treatment plants (settling and sludge digestion) ar- ranged as follows: one main plant serving 500,000 persons; one district plant serving 25,000 persons, and ten small plants serving from 50 to 4,000 per- sons. Before the war the quantity of sewage flow was approximately 33 million gallons per day. When observed in June, 1945, it had decreased to 255 ENVIRONMENTAL SANITATION Figure 142. Damage caused by direct bomb hit on trunk server during air raid—Munich Figure 143. Bomb damaged settling tanks—Munich sewage disposal plant. Sludge drying beds in rear. 256 ENVIRONMENTAL SANITATION Figure 144. Compressed gas for auto fuel—typical installation. Gas obtained from sewage disposal plants and gas works. could produce 2,500,000 liters (90,000 cu. ft.) of gas, with a fuel value equivalent to 735 gallons of gasoline. Destruction of sewers and disposal plants would thereby impair transportation, if the cities depended to any extent upon sewage gas to relieve this hard pressed transport system. Just how much effect destruction of these utilities had on fuel short- age is not known as the exact figures were not avail- able for the amount of sewage gases compressed for motor fuel. contents (Figure 145). The quantity of garbage per capita per year averages about 0.3 cubic meter (10 cu. ft.). Modern garbage trucks are of all metal- covered type construction, of about 10 cubic meters (350 cu. ft.) capacity. Some have an automatic mechanism for elevating and dumping garbage cans. Disposal of garbage is by incineration, bur- ial, or composting for use as fertilizer. Bombing and general war conditions interfered seriously with garbage collection and disposal. Dur- ing the last months of the war a shortage of man- power existed. The condition steadily became worse as trucks were confiscated for military uses or were destroyed in the raids. As gasoline became less and less available, trucks were equipped to run on gas from wood burners, or on gas com- pressed in cylinders. Gas plants were destroyed by bombing and artillery fire, eliminating this source of fuel for trucks. If horse-drawn carts were available they were used to the best advantage, but eventually the destruction of buildings and streets made collection impossible. Garbage cans were oh- Garbage—collection and disposal Garbage collection and disposal methods as ob- served in several German citiess’l2> 15>10 are as fol- lows : Heavy weight sheet metal garbage cans are fur- nished by the city to each residence and establish- ment. These cans have heavy hinged lids, some self closing, and hold approximately 25 gallons. They are sufficiently heavy in construction to pre- vent dogs from upsetting them. The tightly fitting lids also prevent access of flies and rodents to the 257 ENVIRONMENTAL SANITATION of Altona where it was left to city forces for deposi- tion on private or municipal garbage dumps. Accumulations of sludge from approximately 64.000 street gulley catch basins were also removed in this manner. This system of street cleaning was maintained regardless of the steadily reduced per- sonnel without essential disturbance until the big air attacks in July, 1943. It then became neces- sary to make fundamental changes to meet the in- adequacies. For weeks the street cleaning could only be ex- ecuted scantily because of the loss of personnel and vehicles, since a great number of the workers were over-age. In addition, the scarcity of vehicles be- came more pronounced and the fuel allotment was further reduced. Hence it was impossible to operate on a regular schedule of removing the garbage from the dumps and it was necessary to permit it to accumulate in heaps. On June 27, 1945, the situation began to improve with more workers, trucks and horse carriages be- coming available. Practically all accumulated gar- bage had been removed from the streets and the street cleaning program returned to normal. Garbage removal: At the beginning of the war house garbage was removed in the city proper and in the larger urban areas by means of special trucks. Garbage containers of 25 gallons were sup- plied by the government and were kept in the base- ment of the dwellings. For the removal, 85 special trucks and for the city district of Altona 12 elec- trical tractors were available. A total of 5,350,000 barrels of house garbage was removed, one half to the incinerators and the other half to various garbage dumps, situated in the outside districts of the city. Garbage was collected from houses twice a week. The full containers were carried out of the basements by a force of 400 robust workers who emptied them into trucks and then replaced empty containers. From the beginning of 1942, when numerous workers were drafted and bombings occurred, it was necessary to use hired foreign volunteers. Until the catastrophe of July, 1943, the removal of gar- bage was accomplished without difficulty. However, through enemy action 56 of the special garbage re- moval trucks, 77 per cent of the trucks on hand, were lost, the remaining 29 being ancient models of 1926. Thereafter until an improvised system of collection and removal could be organized, gar- bage was collected only in certain places where gross insanitary conditions prevailed. In other Figure 145. Typical German garbage cans. Property of the municipality. Note heavy construction with hinged, tightly fitting lids. served in Cologne with potato vines growing down the sides, indicating how long they had been stand- ing. When collection was re-established, garbage was often dumped in shell and bomb craters and covered with dirt and chloride of lime if it hap- pened to be available. When rats were reported, poison baits were set around the garbage dumps. The following report on street cleaning and gar- bage removal was obtained from the city of Ham- burg. The methods described are fairly typical for the cities visited. Street cleaning: At the beginning of the war there were about 750 men employed in street clean- ing. Main thoroughfares and streets with heavy traffic were cleaned once daily, residential streets two to three times weekly. The city area was di- vided into units, and the men assigned to each unit were responsible for the cleaning of their own districts. An annual total approximating 378.000 barrels of garbage was collected in carts and de- posited in subterranean dumps numbering about 440. The removal from these dumps was by tractor- trucks operated under contract by the regional freight railroad system, except in the city district 258 ENVIRONMENTAL SANITATION Figure 146. Hamburg after the air raids in July-August 1943, showing buildings gutted by fire. 259 ENVIRONMENTAL SANITATION places it was thrown among the ruins and debris of demolished buildings. Sometime later, 15 modern trucks were obtained and additional trucks were rented. Although the collection schedule was im- proved, new difficulties were encountered. The truck motors had to be readjusted to use a substitute fuel and even this was not available in sufficient quan- tities. This condition lasted until the end of the war, but by using prisoners of war and foreign workers, shortening the carting routes, creating new dumping places in the ruined areas and by using hand carts, oxen teams, and barges, the removal of house garbage beginning in January, 1944, amounted to from 190,000 to 200,000 barrels per month. The improvised dumps in the ruined areas were so arranged by the city administration of Hamburg to be far enough from occupied houses to prevent their being a nuisance or public health hazard. In order to protect the population from offensive smell and the plague of rats and flies, these places were continuously sprinkled with chlo- ride of lime and covered with earth. tion was made available to the administrations of bombed-out areas and, although well planned and organized according to statements from responsible Germans, they could not cope with the whole prob- lem. People had to stand in the open air, frequently in inclement weather, often improperly clothed, while waiting for trains or vehicles which were to evacuate them to safe areas. Many were crowded into waiting rooms, meeting places and halls with improper ventilation. Droplet infections were, therefore, enhanced, and upper respiratory infec- tions increased. V ashing facilities were often not available nor was a change of clothing; and to make matters worse, a national scarcity of soap was noticeable. The increase in pyogenic infections, par- ticularly furunculosis, among evacuees was at- tributed to these factors in several public health publications. These same publications also deplored the increase in scabies and head lice and stated that by far the largest percentage of cases was found in evacuees, particularly children, in whom the urge for cleanliness had not been sufficiently fostered. Periodic inspections of native and foreign labor camps were conducted by health department personnel. (Cassel) .15 Barracks were fumigated, clothing disinfected and inmates deloused when body or head lice were found. Through overcrowding in homes, contacts with tuberculosis patients and carriers of diphtheria and streptococci were greatly enhanced. This is held to have been the greatest single factor contributing to the increase in diphtheria described in Chapter Four. In contrast to the above-mentioned increase of diphtheria, upper respiratory infections, pyo- genic infections and scabies, was the absence of serious outbreaks of disease in those persons who had preferred to remain in their destroyed homes. Many families preferred to move into cellars and basements or even apartments which had been par- tially or almost completely damaged, instead of being evacuated to some other parts of Germany. They accomplished only the most urgent repairs, such as the replacement of broken window panes with plywood or paper. They were exposed to seep- ing sewage, and even seeping carbon monoxide from smouldering fires, or broken gas mains. Drink- ing water had to be carried from wells, street taps or wagon tanks, and although boiling of the water was recommended it is doubtful whether it was done in all cases. However, no serious outbreaks of enteric fevers ensued. Washing facilities were natu- rally very poor and contributed to the increase Housing flight, heat, shelterl The widespread destruction of dwellings led to several possibilities for the homeless: evacuating and moving in with neighbors, friends or relatives, or even inhabiting the destroyed dwellings as well as possible. The figures on percentages of dwellings destroyed vary in different towns, but the prob- lem was considered of tremendous magnitude by the Germans. To give examples: 85 per cent of inhabitable dwellings in Essen were destroyed and from 700,000 to 800.000 persons were made homeless after the heavy incendiary raids on Ham- burg in July and August 1943 (Figure 146). As a result of the Moehne Dam bombing, the following damage was reported by the Hygienic In- stitute (Gelsenkirchen) by the Hooding of the Ruhr Valley: houses completely destroyed—9s; dwell- ings slightly to heavily damaged—97l; farms slightly to heavily damaged—32; factories totally destroyed—-11; factories slightly to heavily dam- aged—ll4; farm land destroyed—7,ooo acres; farm land damaged—3,ooo acres; cattle lost— -5,700; pigs lost—625; railroad and street bridges destroyed—2s; bridges slightly to seriously dam- aged—21 (Figure 147). Various power plants were also heavily damaged. Evacuation of large sections of city groups, which is described in the report of the civilian Defense Division, was handled on a national level. Every possible means of transporta- 260 ENVIRONMENTAL SANITATION Figure 147. Flood damaged houses in Neheim after bomb destruction of Moehne Dam, May, 1943. in pyogenic infections which were generally ob- served throughout Germany during the war. Before the war most cities carried on energetic campaigns to eliminate rats and other rodents. Poi- son baits were made available to property owners with instructions for setting them out. In some places (Nuremberg) participation in these cam- paigns was made mandatory by police department ordnance. As a result, the rat population was quite effectively controlled so that rats were not numer- ous except in sewers, dumping grounds and similar places where waste food was abundant. After the air raids, however, when it became necessary to cur- tail regular schedules of garbage collection, the rat population began to increase. They became par- ticularly numerous in the bombed areas where food was scattered or garbage was dumped into the debris, and the ruins of buildings afforded excellent harborages. This is somewhat contradictory to the report from Hamburg where the absence of Weil’s disease was attributed to rats being driven out of the city by aerial bombings. In June, 1943, the problem was apparently serious enough to warrant the attention of national government officials as a decree was issued by the Reich Ministry of the In- terior ordering the destruction of rats by the civil- ian population (Nuremberg).7 Experts were sent to various cities to supervise the extermination of rats and other rodents. These eradication programs continued for a while until the lack of trained per- sonnel and poisons interfered. During 1944 and 1945 the shortage of workers and materials became acute in some of the cities. Consequently little work was being done and the rat population again in- creased. However, most city officials reported the situations not serious from the standpoint of disease transmission. Some even reported the population to be diminished after the air raids because many were killed or driven away by fires and explosions. Problems of decomposing bodies The layman in Germany apparently had great fear that the presence of dead bodies in the ruins presented a threat to his health. To combat this im- pression, Professor Hagen and Rose17 of the Ger- man Air Force expressed the opinion (Aug. 1943) that there was very little danger. This is the only official attitude which could be obtained. They based their opinions on the following observations and theories: 261 ENVIRONMENTAL SANITATION (1) The body is not a carrier of disease since putrefaction destroys any pathogen which may have been present. Furthermore the dead were usually in places uninhabited by the population for at least a few days after the bombing. Numerous cases were observed where people returned to live in houses under which corpses were known to be buried. But by that time putrefaction had progressed to a point where corpses could no longer be regarded as po- tential carriers of disease. (2) Although there was a possibility that the corpse might become a breeding place for flies, there usually were but few flies present in the area. Furthermore, the disease organism would have to be present before it could be carried by the fly. (3) It is not likely that human bodies would cause an increase in the rat population. The decay is usually in such an advanced state that the rats prefer other foods which are plentiful as a con- sequence of destruction. (4) The application of quicklime to bodies is not practical because it is objectionable from a moral and ethical viewpoint and has not been proved to be hygienically effective or absolutely necessary for reasons of sanitation. (5) No special sanitary measures are necessary in the removal or cleanup of charred bodies reduced to ashes. If moisture from decomposing bodies is present the remains should be cleaned with hypo- chlorite of lime solution, and the body sprinkled with dry hypochlorite of lime to prevent odors. (6) It is not necessary to treat the bodies with hypochlorite after burial; however, they should be covered with soil to a minimum depth of one meter. There is no danger of pollution to the ground water from bodies after burial. How far these measures were carried out is not known, but the general impression was gained that the bodies of those thought to be dead were not recovered until someone got around to it. Unlike the ruins in England, the cities of Germany present a picture just as they looked when the fires had died down after the raids. If a building collapsed on a family huddled in the cellar, it is safe to say they are still there unless the bodies could be re- covered without much time or effort. In Ulm laborers were observed recovering the bodies from a public shelter which had been hit two months previously. The authorities estimated that at the time of this survey, 10,000 bodies remained unre- covered in the ruins of the “dead quarter” of Ham- burg. Excepting one or two streets that had been cleared, this section appeared much the same as it must have when the fires subsided two years ago. In early summer, 1945, the most conservative cal- culated estimate was that 70,000 or 80,000 bodies were still decomposing in the ruins of German cities, and as yet there has been no satisfactory ex- planation why they have not presented a greater threat to good environmental sanitation than was apparent during the survey. Summary and conclusions Strategic bombing inflicted heavy damages upon the public water supply and waste disposal system of the cities selected as targets for aerial attack. In those places where residential or industrial areas were specific targets, water mains and sewer pipes were ripped open by the heavy bombs even though they were sometimes laid 20 feet below the ground surface. These damages resulted in heavy losses of water until the sections of mains could be shut off, and in seepage of sewage into bomb craters, cellars, wells or other depressions where it was a menace to the public health. In those places where the source of water supply was located near a factory* or other strategic target, heavy damages occurred to the pumping station resulting in a loss of water throughout the entire district. For ex- ample, the well field and pumping station at Augs- burg, located within a few hundred feet of an air- plane factory (Messerschmitt), was hit repeatedly when the factory was named as the specific target. Generally speaking, disease outbreaks which were definitely proved to be water borne or which could be traced to lack of sanitary facilities were amazingly low in number. Through an interview with Dr. W ilhelm Heine,10 Director of the Hygienic Institute, Ruhr Territory, it was learned that two epidemics of typhoid fever were reported for which improper conditions of water supply and sewage disposal were held responsible. One of these oc- curred in Bochum, a city of approximately 450,000 population located midway between Essen and Dortmund, date of onset about April 9, 1945. To date, July 2, 1945, the number of cases reached 450, with a mortality rate of 19 per cent. People resid- ing in the area were not vaccinated because of the lack of typhoid vaccine. Three possible causes for the epidemic were revealed: (1) eating meat slaughtered under insanitary conditions; (2) drink- ing polluted surface water, and (3) drinking ground water pumped in an emergency from a mine used as an air raid shelter having improper toilet facilities. 262 ENVIRONMENTAL SANITATION During the second epidemic 21 cases developed in the town of Buerhassel, 20 kilometers from Bochum. The cause was attributed to lack of toilet facilities in a coal mine shaft used as temporary living quarters by a girl who supposedly was a ty- phoid carrier. Water from this shaft, which showed evidence of fecal contamination, was also used as an emergency source of supply for the town. It is difficult to realize that other and more wide- spread epidemics did not occur. Certainly with such incidents as broken water mains and sewer lines lying side by side in bomb craters; with sewage overflowing into basements of dwellings and other buildings used as air raid shelters; with water puri- fication plants destroyed necessitating the drinking of water from sources of questionable quality; with sewage being used for fire fighting; with people bathing in polluted streams; with hospitals and other public institutions operating without water or sewerage; with fecal matter being dumped in gar- dens and vacant lots without adequate burial; with garbage and other refuse lying for days in the streets and amid the ruins of occupied residential districts, the situation was ripe for the development of disease into epidemic proportions. Obviously there had to be some control to prevent these conditions from getting out of hand, and it appears that the precautionary measures of care- fully selecting sources of emergency water supply; of observing them frequently; of flushing repaired mains thoroughly and disinfecting them when ma- terials were available; and above all of requiring the boiling of all drinking water were the chief fac- tors in preventing epidemics of water-borne dis- eases. On the other hand, in the closing days of the war, labor and materials for the repair of sanitary facilities were getting more and more difficult to obtain. Hence, with repeated aerial attacks it was becoming impossible to carry on uninterrupted pro- grams of adequate water supply, sewerage disposal and refuse collection, and many city officials were deeply concerned about the situation getting out of hand. It is, therefore, reasonable to believe, on the face of existing conditions, that disease would have be- come rampant had not the Germans been forced to surrender when they did. In any event, the dread of disease and the hardships imposed by the lack of sanitary facilities were hound to have a demoral- izing effect upon the civilian population. REFERENCES 1. Pamphlet—Trink und Brauchwasser, F. Sierp. Reprint from Handbuch der Lebensmittelchemie, Julius Springer, Berlin, 1939. Not on sale. 2. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Ruhr-Yerband, June, 1945. Unpublished. 3. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Munich, May, 1945. Unpublished. 4. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Stuttgart, May, 1945. Unpublished. 5. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Hamburg, June, 1945. Unpublished. 6. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Ulm, May, 1945. Unpublished. 7. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Nuremberg, June, 1945. Unpublished. 8. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Cologne, June, 1945. Unpublished. 9. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Dortmund, June, 1945. Unpublished. 10. Reports from the Institute for Hygiene of the Hanseatic City of Hamburg, “The Detection of Typhoid and Parathyroid in Surface and Waste Waters” and “Lactose-Fuchsine-Plate for Coli Detection in Drinking Water by Means of Membrane Filters,” by Dr. Gertrude Mueller, Staff Member. 11. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Frankfort, June, 1945. Unpublished. 12. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Augsburg, June, 1945. Unpublished. 13. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Karlsruhe, May, 1945. Unpublished. 14. Pamphlet—Hiiusliches und Stiidtisches Abwasser, F. Sierp. Reprint from Handbuch der Lebensmittelchemie, Julius Springer, Berlin, 1939. Not on sale. 15. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Cassel, June, 1945. Unpublished. 16. Sanitary Report, prepared for U.S. Strategic Bombing Survey by Department of Water-Sewage, Essen, June, 1945. Unpublished. 17. Danger of Epidemics Caused by Dead Bodies—Expert Opinion, by Professors Hagen and Rose, German Air Force, Hamburg, August 6, 1943. CHAPTER ELEVEN FOOD SUPPLY AND NUTRITION MAJOR HENRY J. RUGO, QUARTERMASTER CORPS. AUS The health of the German people was the basic factor upon which depended the ability of Ger- many to wage sustained war. The continuity and nutritional adequacy of Germany’s food supply constituted the foundation of this health. Although Germany’s agricultural economy was incapable of adequately feeding her own popula- tion without imports, she was able to withstand pro- longed blockade by war. The effect of blockade on the food supply was in large measure circumvented by the operation of the German system of supply control which, in turn, assured the continuity of Germany’s ultimate source of productive capacity. In consequence, the extent to which the Allied bomber offensive interfered with the German food supply system is a measure of its contribution to the defeat of Germany. This chapter is an evalua- tion of that contribution. A partial exposition of the structure and func- tion of the German system of food control will be included as a background by which the effects of bombing may be more clearly understood. Since the food supply embraces greatly dispersed and ramified elements, only the effect of bombing on the entire system will be reported. The detailed report on one or a few factories, for example, would be but a small fraction of the whole pic- ture. war. The latter, at the same time, was made sub- ordinate to the Ministerial Council for the Defense of the Reich. The two organizations, in addition to promoting agriculture in general, enforced the agri- cultural market regulations on production, sales and distribution of agricultural products, including retail sales and price control.4 To accomplish this the membership of the two bodies extended beyond the field of agriculture and included sections for the entire food economy: producers, distributors, workers and manufacturers of agricultural pro- ducts.1 The Food Estate was directed by the Reich Farm Leader, who was also the Minister of Food and Agriculture. It was subdivided into provincial, dis- trict and local farmers associations.2’ 3> 4 Through this complex organization the delivery of agricul- tural produce by the peasants on the land was con- trolled. Also under the Food Estate were Central Market- ing Associations ( Hauptvereinigungen) at the na- tional level to regulate and tax the movements of agricultural goods.2- 4 At the outbreak of the war there were in existence Central Marketing Associa- tions for grain and fodder, milk and fats, eggs, livestock, potatoes, sugar, garden products, vine- yard products, fish, brewery industry and con- fectionery. Under the Central Marketing Associa- tions at the national level there were correspond- ing agencies at the lower levels which usually coincided with the area of the farmers association. The activities of the Central Marketing Asso- ciations were limited to the realm of domestic trade. Foreign food trade was controlled by the Reich Offices (Reichsstellen).I,i Their duties in- cluded the regulation of tariffs, co-operation with domestic trade control and the storage and market- ing of imported foods. At the beginning of the war there were in existence Reich Offices for grain and fodder; animals and animal products; dairy products, fats and oils; eggs; and garden and vineyard products. Figure 148 translated from the original pre- Organization of German food supply From 1933 to 1945 the Reich Ministry of Food and Agriculture (Reichs Ministerium fuer Ernach- rung und Landwirtschaft) and the Reich Food Estate (Reichsnaehrstand) had charge of all agrar- ian policies in Germany.1 Their activities were divided, giving the Ministry of Food control over policy and administration and entrusting the Food Estate with the execution of agrarian policy.2’ 3 The detailed supervision of agricultural and food econ- omy procedure was handled mainly by the Food Estate and its branches.4 Although it originated as a self-administrative body, the Food Estate came under the jurisdiction of the Ministry during the 264 Figure 148 Organization of Food Control in Germany Tasks: Rationing and determin- ation of requirements according to rations Supply of requirements and adjustment of bal- ance between surplus and deficient areas Collection and shipment of supplies to wholesalers (import and export firms), manufacturers and retailers Regulation of the supplies and reserves Agencies at; National level; Reich Minister of Food and Agriculture Reich Farm Leader Central Market Associations (for grain, potatoes, cat- tle, milk, fat, eggs, etc.) In addition to th Of these, some we ing Associations; ations. The Reic ministrative depa ture to regulate the control of ag of storage of sto keting Associatio ese there are Reich Offices re set up in addition to the others in lieu of Central M h Offices were originally es rtments of the Ministry of F imports. Later they were al ricultural economy, especial cks, to the extent to which n existed. (Reichsstellen). Central Market- arketing Associ- tablished as ad- ood and Agricul- so charged with ly in the field no Central Mar- Provincial level; Provincial Food Office,, De pt. B Provincial Farm Leader, during the war; Provincial Food Office, Dept. A Provincial Marketing Asso- ciations (for grain, potatoes, cat- tle, milk, fat, eggs, etc.) District and city district level: District of Municipal Food Office, Dept. B District Farm Leader, during the war: District Food Office, Dept. A Local level; Local Farm Leader 1 1 ' v (Reich Foe >d Estate) Functions: Distribution of ration books and other ration permits to consumers Control of deliveries of the provinces, districts villages and individual producers in accordance with established require- ments Regulation of the distribu- tion to manufacturers and wholesalers, with simultan- eous consideration of reg- ional balances Acceptance of ration stamps from the dealer and exchange into re- tail ration permits authorizing purchase of additional merchandise from the wholesaler Proof of deliveries made Control of the distribution of all wholesale and retail ration permits Exchange of retail ra- tion permits into whole- sale permits authorizing purchase of merchandise from manufacturers or distributors Adjustment of balances between surplus and de- ficient areas in coop- eration with the Pro- vincial Marketing As- sociations FOOD SUPPLY AND NUTRITION pared by officials of the Reich Ministry of Food may serve to outline the structure and function of this complex organization more clearly.5 from 8 to 10 million tons of grain from east to west each year, not including Danzig and Posen. Industrialized centers in all parts of the country were dependent on the produce of widely dispersed areas for all their food supplies. Consequently, it is clear that all German civilians could be fed at a uniform level of adequacy during a war only by control of the country’s food supply at the na- tional level and by the continued operation of the transportation network of the country. Dr. Alfons Moritz, Head of Department II of the Reich Min- istry of Food and Agriculture, stated that for this reason the bombing of rail and inland water trans- portation facilities became such a serious threat to national uniformity in food distribution. Production Since Germany could not raise within her own boundaries sufficient food to supply her population adequately, self-sufficiency was a question of seri- ous national consequence long before the war.6, 7 Even prior to the advent of totalitarian rule many national officials labored on the problem of in- creasing the degree of self-sufficiency of Germany.8 With the inception of the Nazi regime, the meas- ures invoked to achieve this end became progres- sively harsher. The Goering Four-Year Plan was an example of the effort expended on this prob- lem. It is notable, however, that our observations after the war indicated no development of new basic ideas or policies. Rather the war had led only to more thorough exploitation of previously established principles. By the beginning of the war, Germany’s over-all self-sufficiency in food had reached a level of ap- proximately 83 per cent, on the peacetime basis of 2200-2400 calories per person per day, according to Hans-Joachim Riecke, State Secretary in the Reich Ministry of Food and Agriculture. In respect to some types of food, however, the situation was not satisfactory. For example, before the war she produced approximately 73 per cent of fish re- quirements, 12 per cent of corn, 50 per cent of leg- umes, and 60 per cent of fat within her own bound- aries. To attain even this supply of fat, great effort was expended in increasing the hectarage of land devoted to oil seed cultivation approximately forty- fold from 1933 to 1939.°’10 Thus it is clear that since the production capacity of all land within the pre-1939 limits was strained to the utmost to attain even this degree of self-sufficiency, any fac- tor which decreased the yields per hectare was immediately reflected in the nutritional status of the population as a whole. The country could be fed at a reduced level by the produce raised within its own boundaries if food were perfectly controlled and evenly dis- tributed. However, in practice individual provinces were much less favorably situated in this respect.11 Western Germany, an area of relatively small and diversified farms, was critically dependent on the eastern provinces for its flour, grain, and potato supplies. Reich Minister of Food and Agriculture Herbert Backe stated that it was necessary to ship Food processing Of the many kinds of centralized food process- ing industries known in the United States, only a few played an important role in the food supply of German civilians.12’ 13>14 The principal ex- amples of these were grain milling, sugar produc- tion and refining, and the large bakeries of urban areas.6*15 The damage or destruction of these facilities, incidental to air attack on other indus- trial targets, seriously decreased their production capacity. At the request of the Medical Branch of the Survey, captured officials of the Ministry of Food prepared a report which summarized the effects of bombing on the food industry.16 In discussing- the processing industries these officials stated that of the total German grain milling output of 3,300,000 tons of rye and 4,000,000 tons of wheat per year, the bulk was centered near the river courses of the Elbe and the Rhine-Main with foci in Ham- burg, Berlin, Bremen, Duisburg, Cologne, Mann- heim, Ludwigshafen, Frankfort-on-the-Main, Mag- deburg and Dresden. The daily productive capacity of these mills was approximately 49,000 tons of grain. Aerial bombardment put out of action mills with a yearly output of 310,000 tons of rye and 1,400,000 tons of wheat or a daily productive ca- pacity of 10,500 tons for both types of grain. This damage corresponds to a reduction of 9 per cent of the rye output. 35 per cent of the wheat output, and 22 per cent of the daily production capacity of all German mills having a daily output of more than 500 tons each. In Table 39 the effects of bombing between the heavily bombed non-Russian zone and the lightly bombed Russian zone of Ger- many are shown clearly by a breakdown of the statistics.16 265 FOOD SUPPLY AND NUTRITION Table 39. Bomb Damage to Grain Mills Yearly Output Daily Rye Wheat Production Capacity T ons % Tons % Tons % Non-Russian Zone 250,000 21 1,300,000 49 9,500 38 Russian Zone 60,000 3 100,000 8 1,000 4 Of the oat and barley mills, which were cen- tered in Schleswig-Holstein, Oldenburg, and on the Rhine and Elbe River courses, bombing reduced the production capacity by 50,000 tons or 20 per cent of the total German production capacity for each type of grain. It was stated that the above figures apply only to large mills and include only that damage reported before the end of March, 1945, and that they should be increased by an un- known amount to include the damages to smaller mills and the effects of the bombing of late March and April. The report also stated that the effects of aerial attack on the alimentary paste industry, which is centered in southwest Germany and along the Rhine, were unknown because contact with these industries had been lost during the period of heaviest bombardment. Backe stated that bomb- ing destroyed all the grain mills in Berlin except the Osthafen Muehle, or more than 80 per cent of the daily production capacity. The center of the sugar industry, according to the report, was located in Saxony, Lower Saxony, Lower Silesia, Pomerania and the Rhineland. Fac- tories producing raw beet sugar were located al- most exclusively on the outskirts of the larger cities, in many cases at strategic rail traffic junc- tions, while pure sugar refineries were for the most part within the cities close to other industries. The damages to refineries, therefore, were considerably greater than those to raw sugar factories. Of the total yearly output of Alt-Reich refineries (800,000 tons), four plants producing 300,000 tons were destroyed. This corresponds to a decrease in pro- duction capacity of approximately 38 per cent. In the meat and meat products industries it was stated that bomb damage to slaughter houses and manufacturing establishments remained within rea- sonable limits. Due to the destruction of several important factories for artificial sausage casings, however, production of these had almost com- pletely ceased. The edible oil refining industry, comprising ap- proximately forty large and medium size mills, was centered on the lower Elbe, in Stettin, on the lower Rhine and in Central Germany. Altogether this industry is estimated to have had a pre-war total production capacity of about 600,000 tons of vegetable oils. The only information available on this industry was that air attack had caused pro- duction breakdowns of large magnitude and long duration. The Deutsche Fettsaeure Werke in W itten (Ruhr) had developed a process for producing 11,000 pounds of synthetic butter per day which was sold principally to hospitals for use in spe- cial diets. This rate of production was main- tained until the latter part of 1944, when bomb damage interfered with the operation of the plant and its supply of raw materials.17 In an interview by members of the Medical Branch, State Secretary for Food and Agriculture Hans-Joachim Riecke revealed that in all cases of bomb damage to food processing industries it appeared that hits were scored only as incidentals to attacks against other industrial targets or in area bombing. He further stated that Allied bombing had failed to attack a large sugar refinery even when it presented a readily accessible secondary target when a primary oil target nearby could not be bombed. As the intensity of aerial bombardment in- creased, Germany’s difficulties in maintaining its food processing industries also became more acute. Early attempts at partially protecting plants with blast walls were given up when experience showed them to be inadequate. In the later years of the war the only measures taken to offset the effect of bombing on these industries was to reconstruct plants (when possible) as they were destroyed and to transfer the load to other undamaged facilities. Fertilizer supply The dependence of land productivity on the availability of nitrogen fertilizers is indicated by the German experience that a decrease in produc- tion of 15 kg. of cereals per kilogram of nitro- gen was caused by an insufficient supply of nitro- 266 Figure 149 NITROGEN PRODUCTION IN GREATER GERMANY 1943-45 NITROGEN PRODUCTION- (0,000 TONS) 267 Figure 150 CONSUMPTION OF FERTILIZER NITROGEN GERMANY— 1942/45 fcy.fel EXPORT E23FERTILIZER USES-NEW GERMANY WtMb FERTILIZER USES-GERMANY, SEPT. 1939 NITROGEN-(000 TONS) FERTILIZER YEAR-JUNE I TO MAY 31 CALENDAR YEAR BASIS OF FEB. 1945. FOOD SUPPLY AND NUTRITION Table 40. Consumption of Commercial Fertilizers by German Agriculture Figures apply only to “Alt-Reich” territory or Germany without Austria, Poland, or Sudetenland. Years (June 1-May 31) Nitrogen (1000 T.N) Potassium (1000 T. K20) Phosphoric Acid (1000 T. P205) Calcium (1000 T.) 1938-39 718 1,256 762 2,963 1939-40 704 1,216 454 2,677 1940-41 675 1,366 351 3,280 1941-42 621 1,225 319 3,028 1942-43 506 1,348 340 3,372 1943-44 368 1,076 290 3,300* 1944-45 140* — 60* — * Estimated. gen.18 The trend of nitrogen production in Greater Germany (1943-45) and the consumption of fertil- izer nitrogen (1942-45) is indicated by Figures 149 and 150.19> 20 The information shown in these graphs is cor- roborated in a report dated December 6, 1944, signed by Reich Minister Backe and countersigned by Reich Minister for Armaments and War Produc- tion Speer.18 This report also stated that the agri- culture of Greater Germany (Alt-Reich, Austria and the Sudetengau) had at its disposal during the last pre-war fertilizer year 1938-39, 745,000 tons of nitrogen, i.e., 21.5 kg. per hectare; and during the fertilizer year 1943-44, 398,000 tons of nitrogen, i.e., 11.5 kg. per hectare. On the basis of a reduction in yield of 15 kg. of cereals per kilogram of nitrogen, this decrease of 10 kg. per hectare between the beginning of the war and 1943-44 is calculated to be equivalent to a loss of 150 kg. of cereals per hectare. The report also estimated that with the 192,000 tons planned for the use of agriculture in 1944-45 only 5 kg. would be available per hectare that year. This natu- rally would cause a further loss in yield. Later fig- ures of actual consumption for 1944-45 show that only 140,000 tons, or 3.6 kg. per hectare, were used on the land.10 Backe went on to state that estimates for the 1945 cereal crop, not including the eastern territories (Ostgebiete), indicated it would fall 9,100,000 metric tons below the average of the last peacetime years, or about 4,800,000 tons below the average of the war years. This was based upon calculated estimates and on certified and controlled statistics on the development of the crops for the most recent years. Additional data on the consumption of commer- cial fertilizers by German agriculture from 1938-39 to 1944-45 are given in Table 40 which was com- piled by officials of the Ministry of Food.16-21 In describing this the Germans attribute the decline in nitrogen consumption until 1940-41 primarily to the increased supply required by the newly oc- cupied territories in the east and west. From 1940 to 1943 the rising demand of the higher priority armaments industry for nitrogen was also increas- ingly detrimental to agriculture. After 1943-44, production losses increased daily so that in the production year 1944-45 at best only approximately 140,000 tons of nitrogen would have been available for agriculture. Most of these production losses were caused by the destruction of production plants, sources of power and transportation by air attacks. A detailed report on the extent of the destruction of nitrogen-producing facilities and its correlation with the bombing data is given in the Appendix to the Final Report of the Oil Division of the Sur- vey.'2- The German report further states that the ini- tial decline in phosphoric acid shown in Table 40 was the result of the loss of imports.lo Up to the year 1943-44 the losses in domestic production ca- pacity were still moderate, but in the second half of 1944 it declined rapidly on account of the increased damage caused by more intense aerial warfare. The relatively slight decline in potassium consumption after 1943-44 was caused primarily by progressive disorganization of transport by aerial bombard- ment. 269 Figure 151 Location of grain warehouses of the Bavarian Agricultural Association (Bayerische Warenvermittlung land- wirtschaftliche Genossenschaft) under the jurisdiction of the Pro- vincial Food Administration (Landesemaehrungsamt) of Bavaria, 270 FOOD SUPPLY AND NUTRITION In final analysis, aerial bombardment caused a diminution in agricultural productivity due to de- struction of fertilizer production capacity. Accord- ing to Dr. Karl A. Scheunert, President of the Reich Institute for Vitamin Assay and Research at Leip- zig (Reichs Institut fuer Vitamin Pruefung and Vitamin Forschung), this contributed directly to an increasingly sharper decline in the consumer’s daily food ration. vealed no damage, however. Under interrogation two operating engineers of this plant stated that the incendiary bombs which had fallen on the plant in February and July, 1944, had been extin- guished before they caused any damage. Manager Kruse of the Linde Kuehlhaus in Munich, stated that incendiary bombs in September, 1944, had destroyed 50 per cent of the entire 6,000 square meters of storage space of that warehouse. At the same time approximately 2,000,000 eggs, 400,000 kg. of butter, and 100,000 kg. of meat were dam- aged by the resulting fire which burned for eight days before it could be extinguished. Kruse estimated bomb destruction of the cold storage ca- pacities of Berlin and Hamburg, both principal centers of this industry, to be approximately 50 per cent, and that approximately 58 per cent of Leipzig’s capacity was destroyed. The increased use of cold storage intensified Germany’s dependence on transportation and on the continuity of the power supply. Aerial attack, as a result, not only decreased usable cold storage space as indicated above, but also seriously inter- fered with the operation of the remaining space by impeding shipments and damaging sources of power. Dr. K. Linge writing in the Zeitschrift fuer die gesamte Kaelteindustrie in 1944 while describing the air raid precautions considered necessary for cold storage plants implied that no special provi- sions had been made for protecting these plants against damage from air attacks.27 This was further corroborated by several officials of the Ministry of Food on individual interrogation. All German sources of information and personal inspection by members of the Medical Branch are in agreement that bomb damage to bulk stocks while extensive was not alone sufficient to upset the food economy structure.23’ 28 Estimates of the dam- age to stored foods in bulk warehouses prepared by specialists of the German Ministry of Food were as follows:10 Grain 220,000-250,000 tons Edible fats 23,000 tons Meat 6,000-7,000 tons Sugar 60,000 tons Sugar by-products for fodder 25,000 tons Canned vegetables 2,000,000-3,000,000 cans Canned fruit preserves approx. 1,000,000 cans Frozen fruits 5,000-7,000 tons Potatoes 25,000 tons Storage Storage is necessary in any food economy to eliminate the effect of seasonal variation in pro- duction. The war blockade increased Germany’s dependence on its storage facilities, especially for those foods in short supply. Air attack against this link in the chain of supply destroyed reserve food stocks and storage buildings and interrupted the necessary supply of power for cold storage.10 These losses and the uncertainty of further losses through enemy action demanded increased attention by Germany to the storage of food. In the Ministry of Food, this attention resulted in the increased decentralization of storage facilities and the construction of enlarged cold storage space.23 Decentralization of the bulk storage facil- ities in the area of the Provincial Food Offices of Bavaria is illustrated by the map in Figure 151.24)25 The dispersal of bulk storage facilities indicated in this map was augmented from time to time by the Ministry’s orders authorizing the issue of non-perishable foods, such as potatoes, to the final consumers weeks or months in advance of the normal rationing periods. Professor Rudolf Plank, Director of the Refrig- eration Institute in Karlsruhe (Kaeltetechnisches Institut der Technischen Hochschule Karlsruhe), and internationally known as the leading refrigera- tion engineer of Germany, estimated that aerial bombardment had destroyed 35 per cent of Ger- many’s total (approximately 460,000 square me- ters) cold storage capacity.20 He also stated that the large cold storage warehouse in Mannheim, Gebrueder Bender, G.m.b.H. Kuehlhaus Mann- heim, of approximately 6,000 square meters ca- pacity, had been completely destroyed by bombing. Interrogation of the manager of the Sueddeutsches Kuehlhaus in Stuttgart, Fraeulein Maria Krafft, re- vealed that incendiary bombs reduced the cold storage space of 2,500 square meters by 36 per cent in February, 1944. Personal inspection of the 2,300 square meter Kuelhaus und Eisfabrik Fried- rich Kremper, less than one-half mile away, re- 271 FOOD SUPPLY AND NUTRITION To the quantity stated above must be added the indeterminate quantities lost in the retail trade and enroute and the indirect losses caused by the communal feeding and ration-free distribution of food to bombed-out civilians. transport. That road transport could never replace the capacity of the normal carriers is readily ap- parent when one considers such bulk products as grain and potatoes, according to Fritz Siebert, of the Bavarian Ministry of Finance and Economics. Distribution The major task of the Ministry of Food was to direct the uniform distribution of bulk stocks and to continue an adequate supply of food to the final consumer. Immediately with the begin- ning of the war in September, 1939, an elaborate food rationing system was put into effect whereby the allowances of the principal foods were allo- cated to the individual civilian at four-week inter- vals.20 Further detail on the administration and operation of the system will be presented in the section entitled “Food Control and Rationing Sys- tem.” As the food available in any specific area was diminished through bomb destruction of food stocks, storage facilities and processing plants, the task of uniform distribution by the Ministry be- came more demanding. When the destruction of the transportation network out-distanced Ger- many’s capacity to reconstruct it, however, uni- form distribution became impossible by normal means and emergency measures were required. Eventually, even emergency measures were insuffi- cient to meet the additional burden of intensified bombardment. National control of the collection of food from surplus areas, its storage, its distribution to defi- cient areas and, through rationing, its consumption depended vitally on the communications network of the country. Experience showed that damage or destruction of transmission facilities and sources of power through air attack impeded this vital control in a given locality in proportion to the in- tensity and duration of the attack. It was the constantly reiterated opinion of all food officials that the bomb destruction of the transportation network was the largest single fac- tor contributing to the disruption of the food sup- ply. Bulk shipments which had been carried on in- land waterways were seriously impeded by the bombing of canals. Aerial attack against railway lines, bridges and terminal facilities caused wide- spread interruptions in service and destroyed roll- ing stock, freight enroute and handling facilities at terminals. These increasing disruptions made nec- essary a shift from canal and rail carriers to road Ministry of food action against bombing Consolidated reports of bomb damage to all parts of the food industry were received each morning by the food ministry. The reconstruction and renewed operation of the affected processing and storage facilities were based on these reports. At Goebbels’ order in 1942 an Interministerial Air War Damage Committee (Interministerieller Luftkriegsschaedenausschuss, or LKA) was formed to consolidate calls for assistance to the individual ministries from cities after air bombardment. The LKA comprised representatives of all ministries and was administered from an office in the Min- istry of Propaganda. Despite its early begin- ning, the first call to the LKA came only after the heavy raids on Hamburg July 24-August 3, 1943. The LKA was called upon to make avail- able emergency food supplies for communal feed- ing by a city which had been attacked only when the extent of damage made that city incapable of caring for itself or when neighboring cities or the respective provincial food office could not cope with the situation. After the LKA received a call for assistance, its members conferred to determine action to be taken. The food ministry representative on the committee then advised the Central Mar- keting Associations to give orders to the Provincial Marketing Associations. Necessary transportation for the shipment of food to bombed cities was re- quested from the rail and road transport ministries by the respective liaison official in the Ministry of Food. The size, composition and frequency of special food allowances to air raid victims were de- cided in each case by Ministerialdirektor Julius Claussen, head of Section B of Department II of the food ministry, on the basis of a point system he had established. The granting of special food rations was instituted after numerous requests from cities for more food, usually bread and butter. Special rations were also authorized by the Min- istry on the order of administrative superiors after special request. The food distributed as post-raid allowances belonged to the Reich Offices previously described or was on loan to the national govern- ment from commercial owners. Further action to counteract the effects of bomb- 272 FOOD SUPPLY AND NUTRITION ing was taken by the food ministry in its own operation when its offices were moved into rural areas to diminish their vulnerability to air at- tacks, as reported by Julius Claussen and Hans- Joachim Recke. Finally, in February, 1945, when transport had become so disrupted that uniform distribution of food was no longer possible, the basic national policy of food distribution was abandoned for a more expedient scheme. With this change in policy, the Ministry was forced to fall back on the ability of each province to produce all the food required by its own population. As previously mentioned, the agricultural characteristics of many of the provinces made individual province self-sufficiency an untenable thesis. Although it is based on the false premise that Germany was 100 per cent self- sufficient in food during the war, Table 41, de- rived from information prepared for the Medical Branch by officials of the Ministry of Food from agricultural production and consumption statistics, indicates the dangerous character of this step.30 A monthly summary31 of the damage to all sec- tors of the German economy was published by Department 111 of the Reich Statistical Office at Weimar, according to information obtained through Dr. Walther Engelmann. Specimens of these showed in great detail the number of horses, sheep, head of cattle killed, the number of barns, stables, and pieces of farm equipment and gave a complete pic- ture of the destruction in agriculture.32 Table 41. The Degree of Self-Sufficiency of the Provinces (in % of total requirementJ Vegetable Animal Total Pomerania 168 147 157 Mecklenburg 165 157 162 Saxony-Anhalt 161 108 137 Lower Saxony 146 143 144 Lower Silesia 144 111 126 Marienwerder 143 144 144 East Prussia 133 147 143 Bayreuth 114 135 129 Upper Silesia 112 88 97 Kurhessen 109 126 121 Thuringia 101 92 94 Kurmark 93 50 65 Bavaria 78 129 117 Moselle Province 75 93 87 Hessen-Nassau 71 68 69 Wurttemberg 58 118 100 Schleswig-Holstein 57 106 89 Westmark 56 40 46 Weser-Ems 55 144 127 Westphalia 50 83 72 Baden 48 78 68 Rhineland 47 39 41 Saxony 47 47 47 Eastern Germany (average) 133 98 113 VI estern Germany (average) 74 101 92 Food control and rationing system Administration: The structure and administra- tion of the Ministry of Food and Agriculture, like other German ministries, were highly complex in basic organization. In addition, it was penetrated with a Party control mechanism which paralleled the State organization.4 While there were many active Nazis in key positions at the ministry level, it appears that the political activities of this group were most evident at the lower levels where there was more intimate contact with the peasants. The section of the Ministry which was respon- sible for the entire food rationing program was called Department Two (Abteilung II). The chief of this department, Ministerialdirektor Alfons Moritz, was responsible directly to the Minister of Food and Agriculture Herbert Backe.2 Dr. Franz Wirz, consultant to the food ministry, contended that political relationships between the Ministry of Food and the Ministry of the Interior NOTES (1) Per capita food requirement is considered to be uniform for all provinces and equal to the average per capita production in Reich territory during the war years, i.e., Germany is assumed to be 100 per cent self-sufficient in all respects during the war. Therefore, the percentages stated indicate the self-sufficiency of the German provinces relative to each other only and do not give any indication of the adequacy with which the national nu- tritional requirements would be satisfied. (2) The food imports and food consumption of this period were not considered in this table. Imported fodder, however, appears as animal products in the food production. (3) Increased or decreased food production of the provinces compared to this food requirement approximately expresses food surplus and deficit. This is represented here in per cent of the food requirement of the provinces. Example: Pomerania produces 157 per cent of its total food requirements, i.e., it has a surplus of 57 per cent over its re- quirements. Of its requirements Saxony produces only 47 per cent, i.e., it must receive 53 per cent of its requirements from other provinces. 273 FOOD SUPPLY AND NUTRITION (4). Food production embraces market output plus self-supply by the farmers. This is measured by the “Grain Value” of the various products according to the following key: nutritional value. In establishing the ration allow- ances for any period, the food ministry merely calculated them from food stocks available. Working from eight to ten weeks in advance of each normal four-week ration period, the Min- istry based its calculations on a food balance sheet. A set of translated food balance sheets on a summarized yearly basis for the years 1938 to 1944 is reproduced in Appendix C-3.37, 38 On the asset side of the sheet were entered the amounts of criti- cal foods available for distribution. These were determined from the quantities on hand and due in as reported by the lower levels of the food con- trol system. The quantities required for consump- tion, based on the total population in each of the many consumer groups appeared as liabilities.39 From these calculations were determined the daily allowances of foods per individual in each con- sumer group. In Appendix C-4 are given the daily ration allowances for every fifth rationing period from the beginning to the fiftieth period and for all rationing periods from period 57 to 74.40 The only check on the nutritional value of the ration which was maintained by the Ministry of Food was the periodic calculation of its calorie, protein and fat content. The mineral and vitamin content of the ration was never determined by the Ministry. Copies of the calculated values for all consumer groups are included in Appendix C-4 on the sheets which show the daily ration allow- ances.40 These calculations were carried out by a statistician in the Ministry and were based on food composition tables compiled by a committee of technical experts. A perusal of these documents makes it apparent that ministerial officials even among themselves were inclined to make the ration appear to be of higher value than it actually was. A copy of the composition tables will be found in Appendix C-5.41 The only additional checks on the nutritional quality of the ration were made by one or the other of several nutrition experts at the request of the Ministry, when a reduction in allowances was contemplated. Since none of these experts was directly responsible for maintaining the quality of the ration, even their sporadically expressed opin- ions on the subject seldom made much difference in the food ration policy. On occasion other ex- perts made statements concerning the nutritional quality of the national diet either directly, or through the Ministry of the Interior, to the Min- istry of Food. In all such cases, however, it was the 100 kg. grain = 100 kg. grain value 100 kg. legumes = 120 “ 100 kg. oilseeds = 200 “ “ 100 kg. potatoes = 25 “ 100 kg. sugarbeets = 25 “ 1 ha. vegetable area = 4000 “ 100 kg. live cattle = 600 “ 100 kg. live sheep = 600 “ 100 kg. live pigs = 500 “ 100 kg. live poultry- = 600 “ 100 kg. eggs = 500 “ 100 kg. milk — 70 “ made it difficult if not impossible to utilize effec- tively the ability of the nutrition experts of the country. It is of note in this connection that Moritz stated that the Wehrmacht had solved the problem of maintaining the nutritional adequacy of the ra- tion much more effectively than the civilian sector because of its relative freedom from political in- fluence. He further stated that the Ministry did not include on its own staff any qualified nutrition- ists. Despite these serious difficulties, fortuitous circumstances appear to have staved off a more rapid deterioration of the nutritive value of the German civilian’s diet, in the opinion of Professor Benno Rleyer, University of Munich. When the food shortage eventually became critical, however, continued operation of the existing rationing policy brought incipient dietary deficiencies into sharper relief. Operation: For the purpose of establishing food ration allowances the civilian population of Ger- many was divided into a number of consumer groups according to age and occupation. The man- ner in which these varied with time is shown in Table 42.33 Farm workers and prisoners of war made up further categories, the latter varying as to the country of origin and the type of occupation.34 As reported by Paul Kaufmann (Stuttgart), Jews were nominally divided into consumer groups, de- pending upon age and occupation; but in all cases allowances soon decreased to the starvation level. That Jews did not actually starve in most cases was due only to gifts of food from non- Jewish friends.35 Special supplements were granted, in addition to the normal rations, to children and nursing and pregnant women on the basis of standards laid down by the national health organi- zation.36 The food allowances authorized for each con- sumer group were based on national dietary habits and on traditional methods of operation in the Ministry of Food rather than specifically on their 274 Table 42 Scheme of consumer groups 1939 - In the German (without system of rationing self-suppliers) of food stuffs Period*’) very heavy heavy long-and night Kormal Consumers Youths Children 1 Il-12 ic-m 6-10 3-6 | 0-3 workers ye: irs T ell X cl w w a JI groups 2 + + — + + 7 J 4- + + 4- + 2) + 4- k 4- + 4- 4- »o 4- 4* 3 + + 4- +u> +3> 4- 4- 6 + + 4- +U) + U) 4- 4- 4- 4- 7 + 4- 4- 4- 4- + + 4- 8 + 4- -5) + J 4- D/ 1) Period i - 5/28 - 9/24/39 ~ Ist ration period Period 5 = H/18/40 - 4/5/42 = ration neriod 11 2 = 9/25 -li/19/39 = 2-3 ""*' 6 = 4/6/42 - 10/13/14+ = 35-67 " * •' " 7 - 11/20/39 - 7/28/40 = 4-12 ration period '• 7 = 10/16/UU - U/g/45 = 68-73 “ « " 4 = 7/29/ mO - 11/17/40 = 13-16 »' " '* 8 = from 4/9/45 = from 74th " '» 2) for bread: 6-10, 10-14 years 3) 11 H 6-10 years 4) ” ” formal consumers over 20 years, youths 10-20 years 5) Eliminated because lack of raw materials and disruption of transportation made 24-hour work day impossible 6) To conserve paper and minimize work of staffs which had lost personnel to the armed forces 275 FOOD SUPPLY AND NUTRITION often exercised prerogative of the Ministry to ig- nore such opinions. Changes in ration allowances: Ration allow- ances were altered to conform to changes in the quantities of available food in accordance with the procedure outlined above. The gradual diminu- tion in the available food during the course of the war was reflected in reductions in the size of the allowances to the civilian population. A graphic representation of the weekly allowances of the prin- cipal rationed foods is given in Figures 152, 153, 154, 155 and 156 for all changes from Septem- ber, 1939, to the last functional ration period be- fore Allied occupation.42’43 All Ministry of Food officials interviewed were in agreement that the ultimate factor which caused reductions in the consumer’s allowances was a de- crease in the agricultural output. Of the many fac- tors contributing to such a decrease they listed the following in order of importance: (1) Loss of eastern agriculturally productive territories outside the Alt-Reich as the enemy ad- vanced. This loss was estimated to be approx- imately 10,000,000 tons of cereals.18 A large part of it was foodstuffs which had to be abandoned because bombing had disrupted transport. (2) Reduction in available fertilizers, espe- cially as sources of nitrogen, which accounted for a loss of approximately 9,100,000 tons of cereals.18 As shown above, this was due principally to dam- age to fertilizer manufacturing plants by aerial bombardment. (3) . Progressive decrease in fodder for meat ani- mals in favor of food for human use.44 This pol- icy was forced upon the Germans as the biologically uneconomical conversion of food by animals could no longer be afforded by their straitened agri- culture, as previously discussed. (4) Decrease in availability of farm machinery and replacement parts due to the over-all reduction in production and distribution caused, in part, by bomb damage to manufacturing plants and trans- port. (5) Decrease in manpower on the farms as the drain by the military services and by the recon- struction of bomb-damaged industry increased.45 (6) . Diminution in fuel for operating farm machinery due to air attack on production plants.22 In addition, the destruction of reserve food stocks, processing plants, storage facilities and the disruption of transportation by Allied bombard- ment also assisted in the reduction of the food ra- tion allowances. By November, 1944, the reduc- tion in rations, particularly for the normal con- sumer group, had reached a critical stage. By the beginning of 1945, the bomb destruction of the food supply system had attained such pro- portions that the Ministry of Food was forced to abandon its basic principles of rationing.46 Due to the delays innate in calculating new allowances and in distributing forms for the ration cards to the Provincial Food Offices, it was not until ra- tion period 74 (April 9 to April 29, 1945) that a new procedure was put into effect. At this time the earlier form of ration coupons, which stated the allowances of food in grams, were replaced by num- bered coupons which bore no statement of the weight allowances or, in most cases, of the types of food. A translated extract of the decree of the Ministry of Food which established this change is reproduced in Appendix C-246 In Figure 157 are reproduced samples of the ration cards authorized for the normal consumer group in period 65 (July 24 to Aug. 20, 1944) and for period 74 (April 9 to April 29, 1945) for comparison.47 The allow- ance in grams and the type of food authorized for each coupon in each area was made known to the public by announcement only a few days before the beginning of a new ration week. Through the use of the new system, the Ministry hoped to off- set its inability to forecast food stocks which had been forced upon it by the Allied bombing offen- sive. It was also hoped that the flexibility of the new system would make possible provincial differ- ences in the ration allowances as the local food situations required. The new system would have allowed an adequate food supply for the people in the provinces of surplus agricultural production. In provinces of less than 100 per cent self-sufficiency, however, it is obvious that unbearable shortages would soon have appeared. In addition, the disruption of com- munications by bombing made the collection of necessary statistics upon which to base national control almost impossible. Supplements to ration: The basic food ration allowances were supplemented in some instances by additional quantities of the principal foods and by vitamin concentrates. An elaborate schedule of special supplements existed, authorized for the sick by the Ministry of Food for each ration pe- riod, which recognized the special requirements of different diseases and distinguished between hos- pital patients, outpatients and those ill at home. 276 Figure 152 DEVELOPMENT OF FOOD RATION ALLOWANCES BREAD WEEKLY ALLOWANCES IN GRAMS RATION PERIODS FROM; 28/8/39- 24/9/39 (I) [[674/ 42 - 18/10/42 (sT]| 16/ 10/44- 4/2/45 (9) 25/9/39- 19/11/39 (2) 19/10/42' 30/5/43 (6) 5/2/45" 8/4/45 (10) 20/11/39- 28/7/42 (3)_ 31/5 /43 - 19/ 9/43 (7) FROM 9/ 4/45 (II) 29/7/42 - 5/4/42 (4)1120/9/43- 15/0/44 (8)| CHILDREN 3-6 YEARS 0"3 YEARS 6-10 YEARS ADOLESCENTS NORMAL CONSUMERS LONG ft NIGHT WORKERS HEAVY WORKERS VERY HEAVY WORKERS SELF- SUPPLIERS ( NORTH AND SOUTIT]~ X) - IN ADDITION TO THIS QUANTITY SUPPLEMENTS WERE TO BE ANNOUNCED WITHIN ONLY A FEW DAYS OF THE BEGINNING OF THE PERIOD. THESE SUPPLEMENTS WERE NOT UNIFORM FOR THE ENTIRE REICH, XX)' ALLOWANCES FOR THIS PERIOD UNKNOWN. 277 Figure 153 DEVELOPMENT OF FOOD RATION ALLOWANCES FAT WEEKLY ALLOWANCES IN GRAMS RATION PERIOD FROM'. 28/ 8 /39 -24/ 9/39 (11 1 / 1 1 /40 -17/11 /40 (6) 6/ 4/42'30/11 /42 (ll) 29 / 9/39 - 22/10/39 (2) 18/11 /40" 30/4 /4 1 (7) 1 /I2/42- 30/ 5 /43 (12) 23/10/39 " 1 9/1 1/39 (3) 1 / 5 / 4I- 31/10/41 (8) 31 / 5/43- 4 / 2/45 (13) 20/11 /39 '25/8 /40 (4) 1 /II / 41 - 4/1 / 42 (91 5 / 2/45- 8 / 4 / 4 5 (14) 26/ 8/40 * 31 /10/40 (5) 5 / 1 /42 ” 5/4/42 (10] FROM 9/4/45 0-3 YEARS CHILDREN 3-6 YEARS 6-14 YEARS ADOLESCENTS NORMAL CONSUMERS LONG 8 NIGHT WORKERS HEAVY WORKERS VERY HEAVY WORKERS SELF-SUPPLIERS (INCL. CHILDREN) X) IN ADDITION TO THIS QUANTITY SUPPLEMENTS COULD BE ANNOUNCED WITHIN ONLY A FEW DAYS OF THE BEGINNING OF THE PERIOD TO BE ISSUED AGAINST NUMBERED COUPONS. THESE SUPPLEMENTS WERE NOT NECESSARILY UNIFORM FOR THE ENTIRE REICH. XX) FAT ALLOWANCES FOR THESE GROUPS WERE, APPARENTLY, TO BE ANNOUNCED AT THE BEGINNING OF THE RATION PERIOD AGAINST NUMBERED COUPONS 3) ALLOWANCES FOR THIS PERIOD UNKNOWN 4) OF THIS 90 GRAMS MAY BE REPLACED BY 112.5 GMS. OF MEAT 5) OF THIS 40 GRAMS MAY BE REPLACED BY 50 GMS. OF MEAT 6) OF THIS 130 GRAMS MAY BE REPLACED BY 162.5 GMS. OF MEAT 278 Figure 154 DEVELOPMENT OF FOOD RATION ALLOWANCES MEAT a MEAT PRODUCTS RATION PERIODS FROM: 28/8 /39 - 24/9 /39 (I ) 25/9/39 - 19/11/39 (2 ) 20/11 /39 ~ 10/3/40 (3) I I /3 /40 - I /6/ 4 I (4) 2/6/41 - 5/4/42 (5) 6/4 /42 - 18/10/42 (6) 19/10/42 - 30/5/42 (7) 31 /5 /42 - 4/2/45 (8) 5/2/45- 8/4/45 JW~ FROM 9/4/45 (10) WEEKLY ALLOWANCES IN GRAMS ADOLESCENTS CHILDREN HEAVY WORKERS NORMAL CONSUMERS LONG aNIGHT WORKERS O- O o O ro O O 000 o ® o - °o° O ~ °l 1° ~1 m - MII II Ix, I 23456789 10 VERY HEAVY WORKERS 3ELF- SUPPLIERS X) MEAT ALLOWANCES WERE TO BE ANNOUNCED AT THE BEGINNING OF THE PERIOD FOR ISSUE AGAINST NUMBERED COUPONS. NO GUARANTEED UNIFORMITY FOR ENTIRE REICH. XX) ALLOWANCES FOR THIS PERIOD UNKNOWN, 3) INCREASE IN ALLOWANCE MAY BE OBTAINED AT THE EXPENSE OF THE FAT ALLOWANCE. SEE FAT CHART Figure 155 DEVELOPMENT OF FOOD RATION ALLOWANCES HOUSEHOLD SUGAR WEEKLY ALLOWANCES IN GRAMS RATION PERIODS FROM'- 28/8/39 ~ 24/9 /39 (l) 25/9/39 - 5/5 /40 (2) 6/5/40- 17/9/44 (3) 18/9/44- 4/2/45 (4) 5/2/45- 8/4/45 (5) FROM 9/4/45 (6) X) REDUCTION EQUALIZED BY INCREASE IN JAM RATION XX) SUGAR ALLOWANCES WERE TO BE ANNOUNCED AT THE BEGINNING OF THE RATION PERIOD TO BE ISSUED AGAINST NUMBERED COUPONS XX) ALLOWANCES FOR THIS PERIOD UNKNOWN JAM XX) JAM ALLOWANCES WERE TO BE ANNOUNCED AT THE BEGINNING OF THE RATION PERIOD TO BE ISSUED AGAINST NUMBERED COUPONS WEEKLY ALLOWANCES IN GRAMS RATION PERIODS FROM: 28/8/39 - 22/10/39 (I) I 6/4/42" 17/9/44 ~(6) 23/10/39- 5/ 5/40 (2) 18/9/44" 4/2/45 (7) 6/ 5/40 - 30/ 6 /40 (3) 5/2 /45" 8/4/45 (8) I / 7/40- 12 / I /41 (4) ITrOM 9/4/4 5 (9) 13/ 1/41 ■ 5/4/42 (5) l self j SUPPLIERS KINCL. CHILDREN) I SELF"SUPPLIERS (RECEIVE 17.5 KG. OF SUGAR PER YEAR WHICH CANCELS THEIR CLAIM TO 'JAM I I I IN ADDITION,ADOLESCENTS FROM 10 TO 18 RECEIVE EVERY 4 WEEKS /200G-JAM BEGINNING 16 OCTOBER 1944, ALTERNATELY I [I2SG-ARTIFICIAL HONEY 280 Figure 156 DEVELOPMENT OF FOOD RATION ALLOWANCES NAHRMITTEL WEEKLY ALLOWANCES IN GRAMS RATION PERIODS FROM! 28/8/39- 24/9/39 (I) 25/9/39-23/3/42 (2) 24/3/42- 5/4/42 (3) 6/4/42-31/5/42 (4) I /6/42- 12/11/44 (5) 13/11/44- 4/2/45 (6) 5/2/45 - 8/4/45 (7) FROM 9/4/4 5 {QJ_ SUPPLEMENTS FOR PREGNANT AND NURSING MOTHERS CHILDREN I) 0-3 YEARS 3-6 YEARS I) CHILDREN UP TO THE AGE OF 1 (/2 YEARS MAY DRAW 375 G. OF NAHRMITTEL WEEKLY INSTEAD OF 500 6. OF BREAD OR 375 G. OF FLOUR NORMAL CONSUMERS GRAIN SELF-SUPPLIERS OVER 6 YEARS UP TO 3 YEARS CHILDREN OVER 3 YEARS X) NAHRMITTEL ALLOWANCES WERE TO BE ANNOUNCED AT TH E BEGINNING OF THE RATION PERIOD TO BE ISSUED AGAINST NUMBERED COUPONS. XX) ALLOWANCES FOR THIS PERIOD UNKNOWN 281 FOOD SUPPLY AND NUTRITION Examples of the special allowances for patients are presented in Table 43.48 In general, the attending physician’s certificate was considered sufficient evi- dence for granting virtually any supplement within reason. On certificate by a physician, pregnant and nursing women could be authorized supplemental rations of l/ 2 liter of milk daily and 125 grams of butter weekly from the moment pregnancy was established until nine months after parturition. In addition, the Reich Midwife Association received from the Ministry of Food an allowance of roasted coffee, of which practising midwives could distrib- ute 20 grams as a stimulant to a woman in labor.36 The distribution of vitamin supplements to the normal ration for children and pregnant women, known as “Vitamin Aktion,” was carried out by the Ministry of the Interior.49- 50 This program be- gan in 1940 and was expanded in the winter of 1941-42. Vitamin C, in the form of lemon flavored sugar tablets containing 50 mg. (changed to 30 mg. in 1943) of synthetic 1-ascorbic acid, was issued daily to children through the schools for three winter months of the year from January to March or from February to April.51 The tablets dis- tributed to pregnant and lactating women by the local health offices contained calcium gluconate in addition.49 A liquid preparation consisting of an oil solution of crystalline vitamin D 2 was distrib- uted to all children in their first and second years by specially designated druggists at the direction of the local maternity clinics.52 The results of this program for both vitamins were presumed by one of its directors, Dr. Joseph Grunwald, to have been successful; but the evidence presented was based entirely on subjective observation of the rate of incidence of infectious diseases and the morale of children.49 The German Labor Front took upon itself the task of supplementing the diets of industrial and mine workers with vitamin tablets. Distribution of the tablets, which contained both vitamin and vitamin C, was made through the normal em- ployers.51 The Ministry of Food allocated the sugar required in the manufacture of the tablets. Technicians, trained and controlled by the Berlin office of the DAF, conducted standard analyses for the vitamin C level of the blood of the recipients in each sector and forwarded the results to Berlin.53 There, as reported by Drs. Stepp and Schroeder (First Medical Clinic, Munich), a con- stant check was maintained on these reports to determine the efficacy of the program and the re- suits, when positive, were published as propa- ganda in aid of the DAF. Feeding during and after air raids The task of feeding the population of any area under bombing attack was the responsibility of the National-Socialist Public Welfare Agency (Nazion- al-Sozialistische Volkswohlfa.hrt or NSV).54 Rela- tively small stocks of food were maintained by the NSV in or near all cities for use in emergency. In any city which had been attacked this organization made application for food supplies to its respec- tive Municipal Food Office. V hen the extent of damage seriously impeded municipal administra- tion or when the supplies requested were not avail- able within the city, application was made in suc- cession to the provincial and national levels of the food control administration. After an air attack, the NSV provided hot coffee to the population of a damaged area at the latest by the next morning. During the same afternoon a single dish meal (Eintopf) and additional hot coffee and bread were supplied at central locations. Further supply was provided by the distribution of ration-free and cost-free food to be prepared by the individual families.55 It devolved upon the NSV to restore normal supply of food of the area in accordance with the established rations within three days after the completion of the raid. Appendix C-l is a translated extract of the NSV report on its work during and after the great Hamburg air raid of July 24 to August 3, 1943.54 The food ministry specified the duties of all lower echelon offices in maintaining reserve stocks and in all cases directed shipments of adequate stocks to affected areas when necessary by the most expe- ditious means.56 Many cities were equipped with an extensive system of air raid bunkers for the protection of their populations. Apparently, however, according to information received from Drs. Geiger and Baurmann of the Alten Vincents Krankenhaus, Karlsruhe, no provisions were made for kitchen facilities within these bunkers at the time of their construction. As the intensity of the Allied bomber offensive increased, some cities planned the instal- lation of kitchens in their bunkers for the prepara- tion of food during and immediately after air at- tacks. In no city visited had these plans progressed beyond the paper stage. An example of this plan- ning by the municipal government of Stuttgart, of 282 Figure 157 Vfei&geievfarte Giiltig vom-24.7. bis 20.8.1944 21a[)rmi'tte(farte EA: , ‘jJJame: IBofmotf: - ) Strafje: ~r~ , Obnc 91amen$«ln(ragung ungiilfigl . i92icsf Obcrtragbacl ©orgfolfig aufbenwbrenl k c fonncn on 0(ellc ■ bon 100 g 3udcc bcjogcn merbcn: ; 125 g Munfffyonig obcr 125 g 3mfcr|lrui> ober 150 g Obftficub obec 200 g SDmcbflrup mi( 50#/o 3ucfcrgcbalf ober 400 g 9XifC9flru|> mif 25®/, SucfergebaU fur 'JHarmelabe (luafylrorifc 3ucfer) 92a me: 2Bof;nort: ©frajje: , Ol;nc Olamcndcinfragung ungiilfigl 92icf)f iibcrfragborl s}cr &Vrforgungdborod)ttgto fann jo £3utci(ung£pcriobe on t mob or 700 g Warmolabo (CbfUoufifuro, WaruMabo, ty'flaumonmud, Obflgoloo, niubonlraut [Oiiibonfaft] obor Cbfifrout) obcr 350 g bojiofjon. Womafi fcinor SBafyt ifl boim 35ojugc bon Warmolabo bor fur bio bo: trcffonbo boflimmto foihvdrte angobrad>tc 33oflcUfd>oin fur Wavmolabo mit bom Grfonabfd>nift, boim 35»*iugo bon purfor bor cntfpvcdjcnbc am obcron obor untoron SKanb bofinblki)o sofiollfd)oin fur Sudor obonfnlle mil bom (irfonabfdmitt nbjutronnon. Gin iVfloUfcboin obno Gcfonabfcf)nitt ifl iingultig. 3)io ®njefabfd;nitto finb jum 3}c,}iuio von 9)larmo(abo nut inncrljalb bonitto jobcrjoit bojogcn tvorbon. £sio 93cPoIIfdioino fur Warmolabo finb objugobon: 9lr. 03 ab 22. 9Wai, fpatoflond am 27. 9)fai 1944 „ 04 || 19.3uni „ „ 24.3uni1944 „ 05 „ 17.3u1i i, || 22.3u1i 1944 „ GO „ 14. Slugufl „ „ 19. Wugujl 1944 Focxi ration cards for the normal consumer group for #65 and #lh ration periods illustrating the change in rationing policy- instituted with the 7ljth period. Source of data; Files of the German Ministry of Food and the Food Office of the city of Heidelberg. FOOD SUPPLY AND NUTRITION Table 43. Rations for Patients I. Maximum Weekly Supplements for the 111 in Bed at Home:1) Bread and Flour 1800 gm. Butter 160 gm. Meat 500 gm. Naehrmittel 750 gm. Fat (with the exception of butter Eggs 7 each or in place thereof) 270 gm. Whole Milk 514 liters 11. Maximum Weekly Supplements for the Sick in Hospitals Entitled to Supplements: (in grams) Type of Food General Hospitals Sanitoriums for T ubercidosis Children’s Hospitals Medical personnel endangered by tuberculosis3 Flour 70 — 210 Meat 70 280 — — Butter 20 210 140 70 Margarine 40 70 35 — Lard — 70 — — Cheese 140 70 — — Naehrmittel 105 200 320 175 Jam 105 140 105 — Sugar 70 175 70 100 Eggs (each) 2.82 2.82 fl CO CN — Whole Milk (liters) 1.4 2.0 — — 111. Weekly Rations for Adult Patients in Hospitals Not Entitled to Supplements:4 Flour 1669 gm. Cheese 31 gm. Meat 250 gm. Jam 187 gm. Butter 94 gm. Sugar 219 gm. Margarine 31 gm. Eggs 1 each Lard 40 gm. Skimmed Fresh Milk liter Notes: (1) More than three of the above items were not authorized at any one time. In urgent cases exceptions to this rule as well as to the maximum quantities were granted. Statement was required on the doctor’s certificate of which ration cards were to be surrendered in return for supplements. During the stay in a hospital or sanitorium these supplements were not authorized. (2) Including normal rations. (3) In tuberculosis sanitoriums. (4) Special hospitals and institutions for cripples, chronic illnesses, mental cases, epileptics, etc. 283 FOOD SUPPLY AND NUTRITION which only one experimental installation had been made, is presented in Figure 158. As may be deduced from this highly condensed report on the measures adopted for emergency feeding, a heavy burden was added through this means to the already overtaxed transportation sys- tem, labor pool and food supply system by air attack. In all cases, however, there was no whole-hearted acceptance of these standards by German experts. In order to resolve differences of opinion on the subject of human nutritional requirements, the Ministry of Food called together in 1939 the com- mittee mentioned above. Among the members were appointed a nutrition expert, statisticians and rep- resentatives of the Ministry of Food and the Food Estate.41 In addition to the table of food composi- tion already mentioned, the committee established a table of reduced human nutritional requirements for calories, protein, fat and carbohydrates, which could be approximated under war conditions for use in the Ministry. These standards in complete form are shown in Table 44.59 Several of the offi- cials interviewed stated, however, that neither the table of composition nor the nutritional standards were used to the best purpose. These standards were used by the food min- istry as a rough check of the nutritional adequacy of any new group of ration allowances although they already represented an attenuated level of nutrition. Table 45 shows the calorie and protein requirements of the food ministry committee stand- ards compared with those of the National Re- search Council.00 Since the nutrition experts consulted by the Min- istry were chosen less for their professional com- petence than for their political affiliations, it was usually the less qualified, more politically active individuals who most frequently had the opportun- ity to state their opinions. An additional difficulty in this respect lay in the fact that the politically Nutritional quality of the national diet Standard of ration composition: Since the effec- tive standard of ration composition was weight of food rather than its nutritional value, it must be concluded that the physiologic value of the Ger- man diet was maintained largely by chance. This situation prevailed because of the absence of any unified and active body of thought in Germany concerning its significance. In lieu of unification and a directed policy, the many minor attempts served principally to divert the professionally qualified nutritionists from an effective course of action.58 Dr. Mahla, assistant to Professor Wirz, Schwab- inger Krankenhaus, Munich, stated that quite un- like the United States and England, Germany had no published and generally accepted standards for nutritional elements in the diet such as those of the National Research Council in the United States. Many of the individual German physiologists ac- cepted the National Research Council “Recom- mended Dietary Allowances” in the absence of any published standard in their own country; many others felt that these standards were too high.21 Table 44. Physiologic Norms for Consumer Groups (Daily requirements) Total Calories Fat (gms.) Protein (gms.) Carbohydrate ( gms.) Very heavy workers 4500 152 112 641 Heavy workers 3600 99 97 556 Normal consumers 2400 67 64 370 Children: 6-14 years 1900 53 53 292 10-14 “ 2050 56 56 319 6-10 “ 1750 50 49 265 0-6 1300 49 39 167 3-6 1400 50 41 187 Average of self-sup|)liers 3100 86 86 475 284 FOOD SUPPLY AND NUTRITION Table 45. Comparison of Recommended Dietary Allowances of United States and Germany Calories United States Germany Protein (gms.) United States Germany Very active 4500 4500 70 112 Moderately active 3000 3600 70 97 Sedentary 2500 2400 70 64 Children: 0-1 year 100/kg. 3.5/kg. 0-3 years 1200 38 1-3 “ 1200 40 3-6 “ 1400 41 4-6 “ 1600 50 0-6 “ 1300 39 7-9 “ 2200 60 6-10 “ 1750 49 6-14 “ 1900 53 10-12 “ 2500 70 10-14 “ 2050 56 powerful leader of the health services of the coun- try, Dr. Leonardo Conti, insisted that questions of nutritional adequacy of the diet belonged in the province of his organization. Thus, relative political position of individuals as well as government agencies convened to divert the best answers to a serious national problem. In addition to the lack of a nationally accepted nutritional standard for the diet, professional con- sciousness of the significance of mineral and vita- min requirements seemed far behind the level of the United States. It was the feeling of many medical men, including Major Reinhard Perwitzsch- sky, commanding officer of the Artilleriekaserne Hospital, Garmisch-Partenkirchen, that present day attention to the use of vitamins was a greatly overrated fad which would soon lose its apparent significance. In this type of professional matrix, where individual creativeness was discouraged and nationalized bodies were not established, it is clear that the best physiologic interest of the coun- try was not served. Furthermore, this lack of recognition constituted another point in the vul- nerability of Germany’s nutritional level to air at- tack since the supply of protective foods could be reduced below a critical level before it would be recognized.61’ 62 Analysis of diet: The relative adequacy with which the various consumer groups were supplied with food is shown by their calorie consumption in ration period 55 (October 18 to Nov. 14, 1943) as illustrated graphically in Figure 159.63 The values on which the graph is based were calculated by one of the nutrition consultants to the national health organization who was also in contact with the Ministry of Food, Professor Wirz of Munich, and his assistants Dr. Mahla and Dr. Mercedes Gaffron. They were further authenticated by sev- eral other sources, including works of the na- tional institute for research on food economy.64 As may be seen, the requirements of children and lactating women were exceeded at the expense of all other groups; an unusual development in the light of the stress rested on the industrial produc- tivity of the latter. On his own initiative the president of the Reich Institute for Vitamin Assay and Research in Leip- zig, Professor Scheunert, calculated the vitamin A, and C content of the German diet in the early years of the war. The results are shown in Tables 46, 47, 48.65 From these it may be seen that potatoes constituted the principal source of vitamin C and that approximately one-half of the vitamin A intake was consumed as vegetables which were never rationed. In these tables Vitamin C is given in milligrams and other factors are in inter- national units. On the basis of the daily allowances shown in 285 Figure 158 KITCHEN CONSTRUCTION PLATZ. PER S.A. A\R RAIP SHELTER ( STUTTGART) COOKING CAPACITY - \2OO PORTIONS FROM: MUNICIPAL CONSTRUCTION OFFICE STUTTGART MARCH 9. \°i*3 286 Table 46 Period Children 3-6 years Chil dren 6-10 years Children Normal 10 - lU years Consumers Heavy Workers Very Heavy Workers No. Dates AX) _ *) _«) C A Bl C A ®1 C A B1 C A Bl c A Bl c 1. 28 Aug. '39 - 2k Sept. 1758 515 70 1112 612 1U7 1112 698 117 1112 698 1U7 1112 1021 228 1198 1179 228 2. 25 Sept. - 22 Oct. 1655 538 57 1052 6to 10U 1052 7U2 10U 728 711 102 8lU 1123 15U gU6 125U 15U u. 20 Nov. - 17 Dec. 1846 386 32 15U0 399 uu 15U0 51U 6U 1058 U52 62 llUU 681 97 1178 732 97 5. 18 Dec. *39 - lU Jan. 'to 1713 4to 32 Ito? U97 **3 1U07 660 6U 927 598 62 1013 931 97 10U7 1055 97 6. 15 Jan. - 11 Pet. 1633 395 32 1329 U09 **3 1329 521 6U 8U5 U58 62 931 691 97 965 7U2 97 7. 12 Peh. - 10 Mar. 1457 458 28 1157 515 36 1157 678 5U 700 6U6 52 786 979 81 820 1102 81 g. 11 Mar. - 7 Apr. itos UI43 25 1188 U66 28 1188 629 U3 731 597 Ul 817 901 62 851 10 2U 62 9. 8 Apr. - 5 May 1801 Uto 22 IU92 U68 25 IU92 631 39 983 599 37 10 68 903 55 1103 1030 55 X) Vitamin A and Vitamin in international units xx) Vitamin C in milligrams The vitamin quantities listed above are increased by those which were added through vegetables (e.g. cabbage, carrots, salads, et.). It is impossible to figure these out exactly. They can only be calculated very roughly according to the quantities of vegetables sold in the Berlin market. Source: Translated from the original German manuscript of Prof. K.A. Scheunert, President of Heidi Institute for Vitamin Assay and Vitamin Research (Heichsanetalt fuer Vltamlnpruefung und Vltaminforschung), Leipzig, 5 July 19U5. Daily Vitamin Supply during the Ration Periods #1 - #9 (28 August 1939 - 5 Way I9I4O) . without vegetables 287 Table 47 VITAMIN SUPPLY THROUGH VEGETABLES DURING THE RATION PERIODS #2 - #lO (25 Sept., 1939 - 5 May, 19h0) gives a general view of the vitamin quantities which under equal distribution of vegetables would have been added to the figures shown in Period % loss in the kitchen Net Ration Ration (Grams) Weekly Supply Daily Supply # Date A B 1 C A B 1 C 2. 25 Sept.-22 Oct. 2h X21£ 9l*7 13021 1;21 57 i860 6o 8 3. 23 Oct. -19 Nov. it 121*5 9l*7 13021 1*21 57 i860 60 8 h. 20 Nov. -17 Dec. tt 1000 760 10li50 331* 1*5 H*9l* hi 6 5. 18 Dec. -ill Jan. it 1000 760 ioii5o 331* ii5 li*9l* hi 6 6. 15 Jan. -11 Feb* n 700 532 7315 231* 31 101*5 33 h 7. 12 Feb. -10 Mar. it 5oo 380 5225 167 22 71*6 26 3 8. 11 Mar. - 7 Apr. it 5oo 380 5225 167 22 71*6 26 3 9. 8 April - 5 May tt 5oo 380 5225 167 22 71*6 26 3 10. 6 May - 2 June it 600 1*56 6270 200 ) 27 895 28 h 288 Table 48 WEEKLY AND DAILY VITAMIN SUPPLY DUPING THE RATION PERIOD #U ( 20 November - 1J December 1939 ) WITHOUT VEGETABLES Loss in Foods the Children 0-3 yrs 5. Children 3-6 yrs. Children 6 - 1C yrs. Children 10-1*4 yrs. Normal Consumer Heavy Workers Very Heavy Workers Vitamin content I. Rationed kitchen Ration Net Ration Net Ration Net Ration Net Ration Net Ration Net Ration Net in 100 £ Ration A B 1 C Ration A B 1 c Ration A B 1 ( n Ration A B 1 C Ration A B 1 C Ration A B 1 C Ration A B 1 C A B 1 C (Grams) (Grams) (Grams) (Grams) (Grams) (Grams) (Grams) Cream Milk 0.5 5250 522*4 6791 1308 52 3500 3482 870 3*4 1750 17*42 2265 *436 17 1750 17^2 2265 63617 - - - - mm - - - - - — - — 130 25 1 Cheese 1 62.5 62 U75 \ 23 - 62.5 62 (1475 / 23 - 62.5 62 ((5?5 \ 23 - 62.5 62 (*475 ~ 62.5 62 (I475 ( ( i0 ( 23 ” 62.5 62 Jw< 23 - 62.5 62 jUTS* 23 - 575 25 - Curds 5 125 119 ( J < — 125 119 < ( - 125 119 ( - 125 119 (' ( - 125 119 125 119 - 125 119 - 500 25 mm Butter 2 15b.25 153 U59O - - 218.75 214 6*420 - - 212.5 208 62*40 - - 212.5 208 62*40 - - 175 171 5130 - - 175 171 5130 - - 175 171 5130 - 5000 - - Margarine 2 - - - - - - - - - - 78.12 - - - - 78.12 - - - - 78.75 - - - - 1*41.25 - - - - 203.75 - - - - - - - Lard 2 - - - - - - - - - - - - - - - — mm - - - *46.25 - - - - IO8.75 - - — - 390 _ — — — _ MS Meat 20 281.25 225 337 139 - 281.25 225 337 139 — 531.25 *425 637 263 - 531.25 **25 637 263 - 531.25 *425 637 263- 1031.25 825 1237 511 - 1231.25 985 1U77 610 - 150 62 - Eggs 2.2 lib 113 700 3s - lib 113 700 3s - 116 113 700 38 - 116 113 700 38 - 116 113 700 38- 116 113 700 38 - 116 H3 700 38 - 620 35 - Flour Rye and Bread 1 *412.5 *408 — I83 ** *412.5 *408 — I83 — 637.5 63! — 283 - 900 891 - *400 - 900 891 - *400 - 1*425 1*411 - 63*4 - 1800 1782 mm 801 — - **5 Wheat Flour 1 1*12.5 Uos - 97 - *412-5 nos - 97 - 637.5 631 - 151 - 900 891 - 213 - 900 891 - 213 - 1*425 1*411 - 33s - 1800 1782 - *427 - - 2*4 - Grains 1 275 272 - 351+ MO 275 272 - 355 - 150 1*48 - 192 - 150 1*48 - 192 - 150 1*48 - 192 - 150 1*48 - 192 - 150 1*48 mm 192 - - 130 mm Coffee Substitute 1 100 99 - - - 100 99 - - - 100 99 - mm - 100 99 - - 100 99 - - - 100 99 - - - 100 99 mm - - - - - Sugar 0.1 250 250 - - - 250 250 - - - 250 250 - - - 250 250 - - 250 250 - - - 250 250 - - - 250 250 - - - - - mm Sweets 0.1 31.25 31. 2 - - - 31.25 31.2 - - - 31.25 31.2 - - - 31.25 31.2 - - 31.25 31. 2 - - 31.25 31. 2 - - - 31.25 31. r\ c. — - - - - - Chocolate, Candy 0.1 2S 28 - - - 28 28 - - - 28 28 - M* - 28 28 - - 28 28 - - - 28 28 - - - 28 28 - - - - - - Cocoa 1 31.25 31 - - - 31.25 31 - - - 31.25 31 - - - 31.25 31 - - 31.25 31 - - - 31.25 31 - - - 31.25 31 - - - - - - Artificial honey 1 31.25 31 - - - 31.25 31 - - - 31.25 31 - - - 31.25 31 - - - 31.25 31 - - - 31. 25 31 - mm - 31.25 31 - - - - - - Marmalade 1 100 99 39 15 - 100 99 39 15 - 100 99 39 15 - 100 99 29 15 - , 100 _22_ 2_ 15 - 100 99 -J9- - 100 22_ . - 33- IJ mm 75 _2L mm Weekly: 12932 2157 52 12407 1719 3^ 1035b 1*401 17 10356 1*479 ib07 IT 6981 11*4*4 7581 1751 M* 7821 2105 Total Rationed: Daily: 16U7 308 7 1785 2*45 5 1679 200 2 229 2 997 lb 3 IO83 250 1117 301 II. Ration Free Skimmed milk 1 — — — - ~ - - — _ .. _ _ •• w 87 5 866 9 - 875 866 9 875 866 9 1 Fish 30 26.5 18.5 - 6 - 26.5 IS. 5 - 6 26.5 18. 5 - 6 - 26.5 18.5 - 6 - 26.5 18. 5 - 6 - 26. 5 18.5 - 6 - 26.5 IS.5 6 - - 30 - Bonbons, Cake 1 100 99 - - - 100 99 - - - 100 99 - - loo 99 - - 100 99 - - - 100 99 - - - 100 99 - - - - - - Potatoes 19 1000 810 - *405 97 2000 1620 - 810 19*4 3000 2*430 - 1215 292 *4500 36*45 - 1322 *437 14500 36*45 1822 *437 7000 5670 - 2835 680 7000 5670 - 2835 680 - 50 12 Fruit 5.75 600 571 *428 171 - 600 571 *428 171 - 600 571 *428 171 - 600 571 *428 171 - 600 571 *428 171 - 600 571 *428 171 - 600 570 *428 171 - 75 30 mm Beverages 1 - - - - - - - - - - - - - - - - - - 1200 - - - 1200 - - - - 1200 - - - - - - mm Weekly: *428 582 97 T2S 987 194 *428 1392 292 *428 1999 137 *428 2008 1437 *428 3021 bSO *428 3021 b80 Total Ration Free; Daily 6l 83 1*4 6l 1*41 27 6l 199 *42 6l 285 62 6l 289 62 6l *421 98 6l *431 98 Total Daily: 1908 391 21 18*46 3S6 32 15*40 399 *4*4 15*40 51*4 6*4 1058 *452 62 11*4*4 681 97 1178 732 98 FOOD SUPPLY AND NUTRITION part in Appendix C-4 and composition values from German and United States sources the relative con- sumption of the nutritive elements for the normal consumer and heavy worker groups was calculated for all ration periods.6(5’67, 68, 69 Calories, protein, calcium and vitamins A, IT and B2 for rationed foods only were considered. Vitamin C was omitted due to insufficient data on the quantities of vege- tables and potatoes in the diet. Graphs of the re- sults as related to bombing experience are shown in Figures 160 and 161.70-71 Values prior to period 60 (Mar. 6 to Apr. 2, 1944) were omitted from the graphs because they were of approxi- mately the same magnitudes as those shown for periods 60 to 65 (Mar. 6 to Aug. 20, 1944). It will he noted that the first large decline (approximately 10 per cent) at period 68 (October 16 to Novem- ber 12, 1944) and the later, sharper drop (ap- proximately 40 per cent) at period 71 (January 8 to February 4, 1945) clearly coincides with the peaks of Allied bomb tonnage dropped. With the steady increase of Allied bombing up to the end of the war and the collapse of the entire rationing structure it appears reasonable to assume that there was an extrapolated downward trend of all curves after period 73. The assumption that an earlier intensification of the bombing offensive against transport would have caused an earlier col- lapse of the German food economy appears to be justified by these curves and by statements of top Ministry officials. Effect of changes in ration allowances: Widely diverse opinions on the effect of the gradually di- minishing allowances of food were held by various nutrition experts and medical men in Germany. A general survey of these opinions and analysis of captured documents, however, indicates that: (1). The nutritional value of the average diet in Germany improved during the early course of the war because the system of price control tended to insure a more nutritious diet for the lower in- come groups by making food available at low cost. Figure 159 CALORIE CONSUMPTION OF EACH CONSUMER GROUP DURING THE 55TH RATION PERIOD FOOD SUPPLY AND NUTRITION In addition, the rationing program had the effect of making only the more nutritious foods available for consumption by all groups by limiting the possibilities of purchase. This parallels British war experience.72 (2) The gradual decrease in calories and pro- tein in the diet caused a reduction in body weight for all groups and a reduced rate of growth in school children, as shown in Figures 162, 163, 164, and 165 and in the quarterly health reports of Stuttgart.72' 73 (3) Deficiencies, principally in vitamins Bi and C and calcium, began to appear clinically after a prolonged period at subclinical level. There were also indications from the experimental results with dark adaptation tests and blood assays, reported by several German nutritionists, that the vitamin A level decreased significantly beginning in 1944.74> 75 (4) If the trend of ration allowances had con- tinued at the indicated rate, serious consequences to the entire population would undoubtedly have resulted from the diminishing supply of protective foods. (5) Sufficient official recognition of these con- sequences did not exist and they constituted a vul- nerable point in the German food economy. Every attempt was made to increase Germany’s self-sufficiency through a highly organized system of food production, storage and distribution and food rationing. The success of this delicately bal- anced, highly integrated organization was depend- ent upon the integrity of the German transporta- tion and communications system. Since the produc- tive capacity of all German land was strained to the utmost to attain even the degree of self-suffi- ciency which has been described in this report, any damage to the factors supporting this productivity obviously contributed to malnutrition in that coun- try. The bombing in which the German transporta- tion system was disrupted, and the air attacks in which sources of fertilizers, farm machinery, and fuel were destroyed, caused the ultimate break- down of the German food supply system. Disrup- tion of transport, in particular, made the uniform distribution of food to all areas impossible. It was not apparent that the Germans considered the vitamin and mineral content of foods in deter- mining the ration allowances of the people. Im- mediately with the beginning of the war, all the principal foods were rationed so that the lack of recognition of the importance of the vitamin and mineral content of this ration actually was an ad- ditional point of vulnerability for the German diet. With a food economy so vulnerable it is not surprising to have found that the basic food ra- tioning program was abandoned early in 1945 when the destruction of transport and communica- tions by the strategic air offensive attained major proportions. This necessitated falling hack on the inadequate system of regional self-supply. The de- struction of large food stocks, processing plants and cold storage plants by bombing also con- tributed to the general deterioration of the Ger- man food supply. There is ample evidence for the conclusion that as a result of the strategic air offensive, which was directed against all large cities, all types of trans- port and manufacturing plants, the nutritional de- mands for the continued health of the German people could not be met. Conclusions The total effect of strategic bombing on nutri- tion and food supply in Germany is the sum of the effects of this type of warfare on agricultural pro- duction, food processing, storage, and transporta- tion. It is not possible at this time to state exactly in what measure the curtailment of the national diet contributed to the ultimate defeat of Germany. The evidence available indicates, however, that it was an important factor. There is in any case no doubt that strategic bombing is the major element contributing to the present shortage of food in Germany. The food supply of Germany was intrinsically inadequate to meet the needs of the German popu- lation without dependence upon foreign imports. 290 Figure 160 TOTAL BOMBING EXPERIENCE S NUTRITION IN GERMANY NUTRITIONAL VALUES OF RATIONED FOODS ONLY MONTHLY TOTAL TONNAGE REPORTED DROPPED ON GERMANY, ALL AIR FORCES. Figure 161 TOTAL BOMBING EXPERIENCE B NUTRITION IN GERMANY NUTRITIONAL VALUES OF RATIONED FOODS ONLY MONTHLY TOTAL TONNAGE REPORTED DROPPED ON GERMANY, ALL AIR FORCES. Figure 162 CHANGES IN HEIGHT 8 WEIGHT OF STUTTGART ELEMENTARY SCHOOLGIRLS 1938/43 Figure 163 CHANGES IN HEIGHT a WEIGHT OF STUTTGART ELEMENTARY SCHOOL BOYS 1938/4 3 Figure 164 CHANGES IN HEIGHT a WEIGHT OF STUTTGART HIGH SCHOOL GIRLS 1938/43 Figure 165 CHANGES IN HEIGHT a WEIGHT OF STUTTGART HIGH SCHOOL BOYS 1938/43 FOOD SUPPLY AND NUTRITION REFERENCES 1. Nahrungsmittelversorgung in Bayern. Provincial Food Office of Bavaria. Munich, June 5, 1945. (Unpublished) 2. Organization Chart of the Reich Ministry of Food and Agriculture and Reich Food Estate. U. S. Group C.C., February 1, 1945, 3. Organization Chart German Food, Agriculture and Forestry Administration. U. S. Group C.C., October 10, 1944. 4. Report C-9; Administrative Machinery and Controls for Food and Agriculture in Germany during the war. Combined Working Party on European Food Supplies, London, January, 1945. 5. Organisation der Ernaehrungswirtschaft in Deutschland. Prepared for the Medical Branch by Ministerialdirektor Claussen, formerly of the Reich Ministry of Food and Agriculture, July, 1945. (Unpublished Chart) 6. Germany Basic Handbook. Economic Survey. Section B: Agriculture, Fisheries and the Food Industries. Foreign Office and Ministry of Economic Warfare, Economic Advisory Branch of Great Britain. London, September, 1944. 7. Germany Basic Handbook. Economic Survey. Section A: General Introduction. Foreign Office and Ministry of Economic Warfare, Economic Advisory Branch of Great Britain. London, November, 1944. 8. Un die Nahrungsfreiheit Europas. Herbert Backe, Wilhelm Goldmann, Publishers, Leipzig, 1942. 9. Die Landesbauernschaften in Zahlen, 2. Folge, 1938-1939. Administrative Office of the Reich Farm Leader, Reich- snaehrstand. Berlin, April, 1940. 10. Der neue Angriff auf die Fettluecke. LI. LI. Freudenberger, Zeitschrift fuer Gemeinschaftsverpflegung, Volume 19, Number 20, page 315, October, 1941. 11. Kriegsernaehrungswirtschaft. Dr. Heinz Dommaschk. Rembrandt-Publishers, and Deutsche Yerlags Company, Berlin. Volume I and Volume 11, November, 1944. 12. Germany Report upon Can Manufacture and Canning. F. E. Walch, Jr. Dewey and Almy Chemical Company, Cam- bridge, Mass., November, 1943. (Unpublished) 13. Food Processing and Canning in Germany. Gerard J. Bos, March 15, 1945. (Unpublished) 14. German Canning Industry. Capt. Bebout, Food and Agriculture Branch, U. S. Group C.C. (Unpublished) 15. Deutsches Reich Ruebenzucker Fabriken. P. van der Lleijden. London, April 17, 1945. (Unpublished) 16. Reports on German Food Economy, I. Getreide und Muehlen, 11. Kuehlhaeuser, HI. Milch- und Fettwirtschaft, IV. Fleischwirtschaft, V. Zuckerwirtschaft, VI. Obst- und Gemuesewirtschaft, VII. Kartoffelwirtschaft, VIII. Aenderung des Lebensmittelkartensystems, IX. Rationssaetze 67-75. Zuteilungsperiode, X. Entwicklung des Duengemittelverbrauchs. Prepared for Medical Branch by former officials of the Reich Ministry of Food and Agriculture, July 2,1945. (Unpublished) 17. Technical Report No. 144-45, The Manufacture of Synthetic Rubber. M. E. Spaght, U. S. Naval Technical Mission in Europe. July, 1945. 18. Report on the Supply of Nitrogen. Reich Minister of Food and Agriculture H. Backe and Reich Minister for Armaments and War Production Speer. Berlin, December 6, 1944. (Unpublished) Translation. 19. Stickstofferzeugung Grossdeutschlands. Graph prepared by Generalbevollmaechtigten fuer Sonderfragen der Chemischen Erzeugung. February, 1945. (Unpublished) 20. Tatsaechliche deutsche Stickstofferzeugung. Graph prepared by G. B. Chem. and Stickstoff Syndikat. June 19, 1945. (Unpublished) 21. Verbrauch der deutschen Landwirtschaft an Handelsduengemitteln. Prepared for the Medical Branch by Dr. Haefner, Reich Ministry of Food and Agriculture. June 15, 1945. (Unpublished) 22. Oil Division Final Report Appendix. Published by U. S. Strategic Bombing Survey. August 25, 1945. 23. Bericht ueber Nahrungsmittelnersorgung und Ernaehrung fuer die Jahre 1939/45. Prepared for the Medical Branch by the Provincial and Central Food Office, Hamburg. June 30, 1945. (Unpublished) 24. Map of the Province of Wurttemberg showing location of Food Storage Warehouses. Prepared by Provincial Food Office of Wurttemberg. Stuttgart, May 25, 1945. (Unpublished) 25. Map of Province of Bavaria showing location of Principal Grain Storage Warehouses. Prepared for Medical Branch by Provincial Food Office of Bavaria. Munich, July 4, 1945. (Unpublished) 26. Darstellung der belegten Flaechen in den privatwirtschaftlichen und den der Vorratwirtschaft dienenden gemeindlichen Kuehl- und Gefrierhaeusern Deutschlands nach den Ermittlungen der Fachgruppe Kuehlindustrie, 1944. Graph, Fachgruppe Kuehlindustrie der Wirtschaftsgruppe Lebensmittelindustrie, Berlin. January 24, 1945. 291 FOOD SUPPLY AND NUTRITION 27. Air Raid Precautions for Cold Storage Plants. Dr.-Ing. K. Linge. Zeitschrift fuer die gesamte Kaelte Industrie. 51: %: p. 12-14, Jan.-Feb., 1944. (Abstract) 28. Report on Food and Nutrition in the Province of Wurttemberg. Prepared for the Medical Branch by the Provincial Food Office, Stuttgart. May 22, 1945. (Unpublished) 29. Food Control in Germany. 1. Rationing of the Civilian Population. Report by Foreign Office and Ministry of Economic Warfare of Great Britain. London, February 15, 1945. 30. Ernaehrungswirtschaftliche Ueberschuesse und Zuschuesse der Landesbauernschaften. Dr. Haefner, June 15, 1945. (Un- published) 31. Abstract of Report on Reich Office of Statistics. U. S. Group C.C. May 21, 1945. 32. Die Taetigkeit der feindlichen Luftwaffe ueber dem Reicbsgebiet, August, 1944, September, 1944, October, 1944, November, 1944. Published by Reich Office of Statistics, Weimar. October 26-December 8, 1944. 33. Schema der Yerbrauchergruppen im deutschen System der Rationierung von Lebensmitteln, 1939-1945 (ohne Selbstver- sorger). Dr. Haefner, June 28, 1945. (Unpublished) 34. Versorgung der Ostarbeiter und sowjetischen Kriegsgefangenen, 1942-1945. Lebensmittelversorgung der Juden. Reports prepared for Medical Branch by Dr. Haefner, June 15, 1945. (Unpublished) 35. Nahrungsmittel und Ernaehrung. Report prepared for Medical Branch by Dr. Kessner, Chief of the Municipal Food Office, Stuttgart. May 21, 1945. (Unpublished) 36. Zulagen fuer werdende und stillende Muetter sowie Woechnerinnen. Dr. Haefner, July 1, 1945. (Unpublished) 37. Food Rationing Periods in Germany During the War Years 1939-1945. Table prepared by Medical Branch from German sources. New York, August, 1945. 38. Food Balance Sheets for Greater Germany, 1938/39 to 1943/44. Prepared by officials of the Reich Ministry of Food and Agriculture, June, 1945. (Unpublished) 39. Statistik der Yerbrauchergruppen und der Zuteilung an Lebensmitteln. 68. Zuteilungsperiode (16 Oktober bis 12 November 1944). Prepared in the Reich Office of Statistics at the request of the Reich Ministry of Food and Agriculture. Weimar, 1945. 40. Taeglicher Nabrungsverzehr. Dr. Haefner. Undated series of 73 pages. (Unpublished) 41. Naehrstoff- und Naehrwertgehalt von Lebensmitteln. Prepared by the Reich Office of Statistics in collaboration with the Reich Health Office. Johann Ambrosius Barth, Publishers. (Special supplement to the journal Die Ernaehrung.) Leipzig, 1943. 42. Development of Food Ration Allowances. Graphs prepared by Medical Branch from German sources. New York, Septem- ber, 1945. 43. Entwicklung der Rationssaetze. Prepared by Reich Ministry of Food and Agriculture. Undated series of 5 pages. (Un- published) 44. Die Verwertung der Bodenerzeugung und der Einfuhr. Graph prepared by Ernaehrungschaftliche Forschungsstelle, Berlin. Undated. 45. Repair of Pump-Damage at Dykes Draining-Installations and Agricultural Areas Hansestadt Hamburg. Prepared for the Medical Branch by the Municipal Sanitary Office, Hamburg. June 9, 1945. (Unpublished) 46. Durchfuehrung des Kartensystems fuer Lebensmittel fuer die 74. Zuteilungsperiode vom 2. bis 29. April 1945. Decree of the Reich Ministry of Food and Agriculture, Berlin. February 20, 1945. 47. Chart showing Ration Cards for Normal Consumers for Ration Periods 65 and 74. Prepared by Medical Branch from German copies. New York, August, 1945. 48. Zulagen fuer kranke und gebrechliche Personen. Dr. Haefner. June 15, 1945. (Unpublished) 49. Prophylaktische Vitaminaktionen 1940-1945. Prepared for Medical Branch by Dr. Joseph Grunwald, Assistant to State Secretary for Health Dr. Conti. July, 1945. (Unpublished) 50. Vitamin C Aktion. File of report and correspondence from the Main Party Office for National Health, Munich. 51. Report on Vitamin Assay of Cebionzucker and Vitamultin. E. Merck Company, Darmstadt. July 5, 1945. (Unpublished) 52. Die Vitamine A, B, C, D, E, K. E. Merck Company, Darmstadt, 1943. 53. 4. Vitamin Aktion (1944) der DAF- wissenschaftliche Auswertung—- Einberufung der technischen Hilfskraefte. Letter to Professor Stepp, Munich, from the German Labor Front, Berlin. November 2, 1943. (Unpublished) 54. NSV-Aktion in den Hamburger Grosskatastrophentagen von, 24 Juli bis 3 August 1943. Published by NSV Office, Hamburg. Undated. 292 FOOD SUPPLY AND NUTRITION 55. Sofortmassnahmen nach folgenschweren Luftangriffen. Letter to Councillors and Mayors of the Province from the Presi- dent of the Province of Moselleland. Koblenz, June 12, 1944. (Unpublished) 56. Einsatz des Handels nach Luftangriffen. Letter to all Provincial Food Offices from the Reichminister for Food and Agri- culture, Berlin. June 23, 1943. (Unpublished) 57. Kuecheneinbau, Luftschutzraum Platz der S.A., Stuttgart. Plan of air raid bunker kitchen designed by the Municipal Construction Office, Stuttgart. March 9, 1945. (Unpublished) 58. Produktionsumstellung beim Gemeinschaftswerk der DAF. Letter to the German Labor Front, Berlin, from Professor Stepp, Munich. June 18, 1943. (Unpublished) 59. Physiologische Norm der Verbrauchergruppen. Dr. Haefner. June 15, 1945. (Unpublished) 60. Recommended Dietary Allowances. Revised 1945. Reprint and Circular Series, No. 122, August, 1945, National Research Council, Washington, D. C. 61. Vitamin Bi —Versorgung Schaffung einer Aneurinreserve. Report to the Reich Ministry of the Interior, from Professor A. Scheunert, President of the Reich Institute for Vitamin Assay and Research, Leipzig. July 25, 1944. (Unpublished) 62. Massnahmen zur Sicherung der jetzt gefaehrdeten Versorgung mit Vitamin C. Ibid. March 24, 1944. 63. Physiologisches Kaloriensoll und Kalorienist (55. Kartenperiode) der einzelnen Verbrauchergruppen. Photostat of graph by Professor Wirz, Main Party Office for National Health, Munich. November, 1943. (Unpublished) 64. Ernaehrung in Deutschland und Europa im vierten Kriegsjahr. National Institute of Food Economy Research, Berlin. November 18, 1943. 65. Tabellen zur Vitamin versorgung der deutschen Bevoelkerung. Professor A. Scheunert, Leipzig. July, 1945. (Unpublished tables) 66. Vitamintabellen. Heft 8, Beihefte zur Zeitschrift Die Ernaehrung. 2nd Edition. Werner Droese und Herbert Bramsel. Johann Ambrosius Barth Publishers, Leipzig, 1943. 67. Nahrungsmitteltabelle. 14. Auflage. Dr. Hermann Schall. Johann Ambrosius Barth Publishers, Leipzig, 1942. 68. Nutritive Value of Common Foods. Table I. Nutritive Value of 100 Grams of Food E.P. National Research Council, Wash- ington, D. C. Committee on Food Composition of the Food and Nutrition Board. March 15, 1945. 69. Nutrient Values of European Foodstuffs During the War. Special report D 2, Combined Working Party on European Food Supplies, London. December, 1944. 70. Total Bombing Experience and Nutrition in Germany. Graphs prepared by Medical Branch. New York, September, 1945. 71. Total Bombing Tonnage Dropped on Germany from First Attack to V-E Day by Bth, 15th, 12th and 9th Air Force, Ist Tactical Air Force and RAF. Tabulating Service Branch. September, 1945. 72. Changes in Height and Weight of Stuttgart School Children. Col. Beckman, Bad Cannstatt Municipal Hospital. Undated. (Unpublished) 73. Vierteljahresberichte- H/1942, HI/1942, IV/1942, 1/43, H/1943, HI/1943. IV/1943. Prepared by Provincial Party Office for Public Health, Stuttgart. July 16, 1942-October 20, 1943. 74. Vorgehen bei Untersuchungen auf Vitamin A Mangel. Letter to the Institutes engaged in the program of investigation of the Supply of Germany from Professor Scheunert, Leipzig. April 20, 1945. (Unpublished) 75. Bestimmungen von Vitamin A und Carotin im Blutserum (in der Zeit vom 23.3. 22.4., 43). Report by Professor Stepp, Munich, to the President of the Reich Health Office, Berlin. Munich, April, 1943. (Unpublished) 293 CHAPTER TWELVE MEDICAL SUPPLIES DEVELOPMENT, PRODUCTION AND DISTRIBUTION MAJOR CORTEZ F. ENLOE, JR., MEDICAL CORPS, AUS A smoothly functioning, scientific medical sup- ply industry has become as important to the health of society as the number of hospitals and the availability of well-trained physicians. The quality of medical care which the people of a community enjoy is dependent, among other things, on the ability of manufacturers of drugs, dressings and surgical devices to produce and deliver their prod- ucts to the doctors serving the people. Our economy and our knowledge of disease and the human body have resulted in the discovery of therapeutic agents which the druggist can make neither satis- factorily nor economically. Thus for many years medical education has taken the presence of such drugs and supplies for granted with the result that when they are not at hand their absence is imme- diately reflected in the progress of the patient, usu- ally to his detriment. When Allied bombers pulverized plants of the German medical supply industry and wrecked the railroads of the Reich the whole complexion of medical care changed. The sulfonamides grew scarce, insulin became a treasured rarity, glandular extracts disappeared, and the plan to produce penicillin (the process was well known) had to be abandoned. The surgeon fared little better in the last year of the war when x-ray and similar equip- ment was usually unobtainable or destroyed, worn- out instruments could not be replaced, and a large part of the surgical dressings were made of paper or on occasion even of moss. The privations the war imposed upon the prac- tice of medicine were mostly the consequence of bombing. They did not appear until the last sum- mer of the European conflict because of the tight control which the national government had estab- lished over the allocation of raw materials and the distribution of medical supplies. This control re- mained firm to the end but in the last nine months the destruction of factories making pharmaceuti- cals, dressings, and instruments and the collapse of the system transporting them from the plants to the patient greatly lowered the caliber of medi- cal care in Germany. The pharmaceutical industry The drug industry was concentrated in Berlin, Hamburg, and the cities of the Ruhr and Rhineland. The textile industry providing the raw materials for the manufacture of surgical dressings was lo- cated primarily in Silesia, and the glass industry was for the most part in Thuringia. These geo- graphical factors proved to be important in decid- ing the idtimate effect the air war had on medical supplies. Such dispersal made this industry ex- tremely vulnerable to British and American attacks on rolling stock and canal shipping. The facilities were even more endangered by their location within the geographical areas for, with the exception of the plant for biologicals at Marburg and the large surgical dressing factory Scherrong at Tutlingen in Wurttemberg, the drug and surgical supply fac- tories were usually in an area occupied also by the important units of the armaments industry and other strategic targets. The laboratories and factories in Berlin and Silesia could not be visited. Rumors filtering out of the Russian area concerning Schering, William R. W arner, and other companies were not reliable and cannot therefore be properly included in this account of our investigation. This report concerns only that part of the industry located in the British, American and French areas of occupation. Knoll, A. G.f Ludwigshaten This firm was founded in 1886 with a capital of 5.400.000 RM. It was incorporated in 1887 and is considered to have been a major producer of stimulants, sedatives, and narcotics in Germany. The preparations include cardiazol (metrazol) a very strong stimulant used extensively in the Ger- man Armed Forces and mainly by the Luftwaffe in much the same manner as benzedrine is employed in the USAAF. Knoll also produced tanalbin, 294 MEDICAL SUPPLIES Figure 166. Ludivigshafen. Target evaluation photograph of marshalling yards shortly after raid in May 1944. Knoll plant is seen to be still, burning. Its location in the vicinity of the strategic rail net is readily apparent. a tannic acid albuminate employed by the ehr- macht in the treatment of diarrheal conditions; octinum, another widely used preparation devel- oped as a war substitute for atropine; as well as morphine, codeine, and barbiturates. The impor- tance of this organization to the German war effort is documented in a letter to the Reich’s Ministry for Armaments and Munitions dated June 22, 1944. This stated that entire sales to the Armed Forces amounted to: The plant was hit on May 27, 1944, September 5, 1944, and January 6, 1945. In the May raid, 295 B-17’s of the Eighth Air Force dropped 2,832 high explosive bombs (500 lb. each). The imme- diate interpretation report (No. K 2258 Head- quarters, Eighth Fighter Command) stated that buildings were observed on fire (Figure 166). No statement as to the severity of damage had been made. The raid of September 5, 1944, caused little damage to the plant but that on January 6, 1945, resulted in the complete destruction of 75 per cent of the facilities of the Knoll, A.G. This attack by 70 aircraft of the Eighth Air Force in which 205 tons of high explosive bombs were dropped was directed at the near-by marshaling yards. The power plant, administrative offices, tableting and coating departments, and the research laboratories suffered severe damage (Figures 167 and 168). All operations of the plant were discontinued for sev- eral weeks until machinery could be salvaged and moved into the basement of the main administra- tion building. When production was resumed, it could be carried out only on a very limited scale. Dr. Walter Sauerbeck, chief chemist of the com- pany and son-in-law of the owner, stated that limited production might have been resumed de- 1941 RM 3,078,760 1942 RM 4,295,539 1943 RM 3,032,784 1944 in the period between RM 1,054,487 Jan. 1 and May 31 Informants at Knoll estimated this to represent 50 per cent of the value of their entire production. The plant is located in the industrial district of Ludwigshafen adjacent to the main intersection of the north-south, east-west trunk lines of the rail- road serving that part of Germany (Figure 166). The lay-out consists of 57 buildings dispersed over an area of 75,000 square yards. They are modern and for the most part two-story buildings of re- enforced concrete. 295 MEDICAL SUPPLIES spite the material damage had it not been for the destruction of the plant power house (Figure 169). The loss of the steam plant caused the shutdown of all facilities except those which could be oper- ated with emergency power from the city lines and an auxiliary heating system. The main research laboratories of the Knoll organization were evacuated to Heidelberg late in the summer of 1944. This migration to the safety of Heidelberg seemed to be common practice for laboratories in that part of Germany. When the city was taken it was found to be a haven for many industrial scientists. Dr. Kraft, assistant di- rector of research for Knoll, was located there. He stated that the early raids in which only minor damage was done to the plant were sufficient to interrupt their investigations of penicillin. It is evident from correspondence taken from the files that this concern was regarded by the Speer Min- istry as one of the most important research organi- zations for penicillin in Germany. Kraft added that if it had not been for the repeated interrup- tions of his work by the air attacks he would have been able to begin supplying the German Army with penicillin by the spring of 1945. After January, 1945, Knoll was. forced to stop their supply of octinum, employed as one of the principal drugs in the treatment of burns in the German Army, and to curtail their supply of tan- albin and morphine. No shelters were provided in the factory grounds since most of the workers lived in the neighboring area and were assigned to public facilities in the vicinity of their homes. Early in 1944, the intensity of the air raids increased to such a degree that the management was granted the use of the three large shelters belonging to the German Railways. Dr. Werner Mothes, director of the plant, and Dr. Freese, production manager, estimated that each air raid alarm during working hours deprived them of 1600 man-hours of labor. There were 800 em- ployees in this plant, and since all of them left Figure 167. Knoll plant viewed from, grade crossing on western boundary of plant property. Power plant is to extreme right, center is chemical synthesis building. The granulating department and the towered building for fdling, packaging and storage of finished supplies is shown in the background. All buildings are severely damaged or completely destroyed, i.e., will have to be taken down to their foundations and entirely replaced. 296 Figure 168 LFGFND BUILDINGS 1 ADMINISTEATION 2 GEANULATIOHS COATING 3 CHEMICAL MANUEACTUCING 4 GEANULATIONS CHEMICAL LABOBATOBIES 5 BOILEB BOOM 6 TUEBINE- -7 COAL STOEAGt- S WAEEHOUSE 9 CHEMICAL INSTALLATIONS 10 EESEBVOIG 11 WAT EC WOBKS 12 BHELTEB EOUNDATIONS CIN CONSTEUCTION) 13 APPAEATUS STOEES 14 ANIMAL EXPEEIMENTS 15 POECELAIN WAEEHOUSE 16 SHE-D 17 WOEKEES BABBACKS 18 EIELD 19 INCOMPLETE- BUILDING 20 CAEPENTEG'S SHOP 21 MACHINE SHOP 22 FEINTING SHOP 23 MESS HALL 3 KITCHEN 24 BOX MAKING, EINISHING, STOBE- -25 GLASSWABE STOEEHOUSE 26 SHEDS 27 GABAGES 28 WOBKEBS BOOMS 29 STORES, PACKING, EILLING 30 TECHNICAL BUBEAU, LABOBATOBIES SYMBOLS AUt-A AEEE-CTED BY THE- BAID OF- JANUAEY 5,194.5 /WHICH STOPPED OPERATION OF- ENTIEE PLANT. HIGH EXPLOSIVE BOM 6 SKETCH SHOWING BOMB HITS ON KNOLL, A.G. PHARMACEUTICAL MANUFACTURER LUDWIG SHAPEN 297 MEDICAL SUPPLIES Figure 169. Looking north from main entrance to the plant shoiving total destruction of chemical synthesis, boiler and turbine buildings (buildings 3, 5, and 6in Figure 169). (Farden in look-out post (left foreground) was unhurt. their places of work on the first warning and did not return until all clear sounded, regardless of whether Ludwigshafen was hit, they were away from work from one and one-half to two hours. Only one worker, a fire watcher who remained in the plant, was killed during all the raids and eight others were injured (Figure 170). To minimize the effects of the air raids on the factory several measures were instituted which seriously hampered their ability to meet civilian demands and the commitments in medical supplies to the Armed Forces. It appears that the manage- ment was very reluctant to move the home office and the principal manufacturing unit to a safer area. It was obvious that Ludwigshafen would be the target of repeated bombings, but according to corespondence from the files it was decided that the advantages of keeping the home offices at the source of supply of labor outweighed the threat of total destruction. This was the attitude of most of the men in the pharmaceutical industry before the air war became intense. Many of them stated that they could understand the Allied attacks on war industries but felt themselves safe. Events proved this to have been a lack of understanding of total air war or an appreciation of the great margin for error in modern precision bombing technique. Plans were made too late to remove all produc- tion to a part of the country of less military value than Ludwigshafen. Following his trip to Berlin on January 24, 1945, Herr Arnsperger, a director of the company, reported that he was urged to take immediate steps to evacuate the essential parts of the plant to other towns of Germany in order to resume production and to meet commitments to the Wehrmacht. Economy of manufacture was no longer considered. The central office for the evacua- tion of manufacturing facilities urged the organiza- tion to move to Thuringia. It was stated that these moves would have been undertaken had not the military situation become acute. Sauerbeck asserted that had they moved in 1943 when the matter was first discussed the plant would have been saved. Pharmaceutical facilities of the I. G. Farbenindustrie, A. G. The drug manufacturing section of the I. G. Farben or “German Dye Trust is so entwined in 298 MEDICAL SUPPLIES Figure 170. View of destruction inside plant area. Granulating and coating building is to the left while rear of administration building is to the right. Most of damage visible here is from blast effect only. the other activities of this fabulous organization that it is almost impossible to trace the results of an air raid on one of the plants down to a finished pharmaceutical. When the giant chemical works at Ludwigshafen were hit, Leverkusen was deprived of acids necessary for their drug manufacture. When Leverkusen was hit, Elberfeld could no longer ob- tain sulfuric acid with which to make sulfonamides. In all this highly integrated system the serum plant at Marburg is the only quasi-independent unit. It was therefore impossible to study all the factors contributing to the final breakdown of the I. G. Farben pharmaceutical empire within the limits of our time and personnel. We have limited the ob- servations to those sections where the preponder- ance of manufacture was drugs. For a detailed evaluation of the big plants at Ludwigshafen and Leverkusen without which the I. G. would cease to function the reader is referred to the reports of the Oil, Chemical and Rubber Division of the Sur- vey. Since American and British airmen dropped but a negligible number of bombs on the pharma- ceutical laboratories of the I. G. Farben during the war the succeeding paragraphs are devoted to a description of the influence of bombings else- where on the ability of these units to supply essen- tial medications. Biochemical Laboratories, Oppau Works, I. G. Farben, Ludwigshafen The pharmaceutical division of this plant con- sisted of five buildings in open area between the two main sections of the principal plant. Dr. uertzler, the general manager at Ludwigshafen, stated that these laboratories played an insignifi- cant role in the entire operation. He had the im- pression that they had been permitted to operate as a fetish of the former chairman of the I. G. Farben. No documents were found to contradict this observation. W hen visited in March, the labora- tories had been totally destroyed, only one of the buildings being left even partially intact. What files could be located were examined and the im- pression was gained that the destruction would in no way influence the availability of essential medi- cal supplies to the Wehrmacht or the German ci- 299 MEDICAL SUPPLIES vilian population. The plant was still under shell fire and none of the scientists could be located for interrogation, and according to information ob- tained they had fled to the east bank of the Rhine. The files contained nothing of interest. The damage to the remainder of the I. G. plant, where most of the heavy chemicals for the German dye trust were produced, has been reported in de- tail by the Oil, Chemical and Rubber Division. Al- though also engaged in the manufacture of syn- thetic rubber, gasoline, 90 per cent hydrogen per- oxide and related chemicals for affiliated companies, and for the rest of Germany, a large number of products employed as basic ingredients in pharma- ceutical manufacturing were made at Ludwigshafen. These include 2,4 dichlorbenzoic acid for atabrine and polyvinylpyrrolidon or “kollidon,” the basic substance in the synthetic blood substitute “peris- ton.” When this plant was attacked and partially destroyed, the effect was felt by the entire pharma- ceutical industry in Europe and mainly by the other facilities of the I. G. Farben. tion injuring five men and destroying the work shop and building repair department. During the attack of the night of March 22-23, 1944, which was also directed at Frankfort, 3,000 incendiaries and 200 phosphorous bombs hit the plant. Wood working sheds and several small warehouses were burned but there was no significant inter- ruption of production. On February 10, 1945, two high explosives were dropped and on March 17 two low flying light bombers dropped three sticks of bombs on the plant resulting in minor damage to five buildings and killing two of the workers. While the extent of the damage inflicted on this unit of the I. G. Farben was insignificant and in no way interfered with their ability to produce, the strategic air offensive greatly affected the Hoechst plant through the destruction of German cities and chemical plants, and the disruption of rail and water transportation. The manner in which this was accomplished furnished a splendid example of the extent to which such indirect effects can cripple a large producer. Hoechst supplied 60 per cent of all insulin pro- duced in Germany. This represented 600,000,000 units during each peacetime year. The pancreas glands were supplied from slaughter houses in the cities of 150,000 population and over throughout Germany. The cities of central and southern Ger- many supplied most of the I.G.’s requirements while those in northern sections of the country sup- plied Sobering, A. G., the other large insulin manu- facturer. Purchases were made through brokers. The glands were shipped from the slaughter houses to Hoechst in special refrigerator cars making a scheduled circuit of the suppliers. Until 1942 calves were used as the primary source of pancreas, according to Professor C. L. Lautenschlaeger, general director of the plant. From that time on the meat situation became criti- cal causing a gradual shift to pork pancreas. Since the yield of a similar quality from porcine glands is but one fourth that of young beef the change caused a gradual decrease in the amount of insulin that could be extracted. An increased demand for insulin accompanied the minor curtailment caused by the shift in source of supply livestock. The greater demand followed the gradual change of the nation from one con- taining large amounts of fat and protein to one having a preponderance of carbohydrates. Such a shift naturally made it more difficult to manage the diabetics dietetically. The situation was recognized /. G. Farben, Hoechst This is a large rambling plant covering approxi- mately one square mile, engaged in the manufac- ture of pharmaceuticals and of chemicals of all types. The diversity of products is apparent from the lists in Table 49. No heavy air attacks were directed against this plant during the war. It is not listed as a target in the tabulation data. Nevertheless, Hoechst labora- tories were damaged slightly by several high ex- plosives and incendiaries. It is the impression of the informants there that these bombs were dropped only through error or from planes jettisoning their load after raids on near-by Frankfort. The plant was intact and operating when first visited three days after the city was captured. The few hits caused only minor damage which was quickly re- paired. Company records show that on June 30, 1940, several bombs dropped in series struck the administrative offices and caused a fire in one build- ing; a short unimportant interruption of work fol- lowed. One man was killed and one seriously wounded. On September 12, 1940, and May 6, 1941, minor damage was done by high explosives. On March 18, 1944, during a heavy attack on Frank- fort, one heavy high explosive bomb struck the silo containing stores of nitrate of lime. From 1,200 to 1,500 incendiaries and from 80 to 100 phosphorous bombs struck the northeastern sec- 300 Table 49. List of Products, I. G. Farben, Hoechst Indications given are those of enemy sources MEDICAL PREPARATIONS Anaesthesia Novalgin-Chinin... Anti pyrin Novocain Aspasan Novocain corbasil. . Cantan Ninhydrin Casbis Orasthin Citrin Orexin Cortenil } Corteniletten j Panflavin-Lozenges Trypaflvetten Disinfectant for mouth and throat Devegan Pantocain Dolantin Ebesal Pellidol salve Pellidol applicators Elityran Postonal Elityran K Preloban pituitary Emanal Priovit Ereton Pyramadon analgesic Erugon Gonad Racedrin Festal Rephrin Hemicellulase Revasa lozenges... Cardan Rivanol and throat Hemodal Hexophan Sajodin Hydronal Salvarsan Salvarsan natrium Myo-salvarsan Hypophysin Icoral Neo-salvarsan Iliren N eo-silbersalvarsan Solu-salvarsan Spirocid Impletol and caffein Insulin 1 Salyrgan Depot Insulin 1 Turbid Depot Insulin f Nativ Insulin ■> Clear Nitrous oxide Lacarnol Suprarenin the circulation Suprifen Lubisan Surfen Lutren Tonephin Lopion T onophosphan Melubrin Torantil Migraenin Trigemin Nosuprin Trypaflavin Novalgin T umenol-ammonia. antipyretic Varon SERA AND IMMUNIZING AGENTS Dysentery Polyfagin. ... Omnadin Gripcolm Drops Paragen respiratory infections Phytossan Monovalent..., Leukogen Trichophytin . . . Polyvalent preparation VETERINARY MEDICAL PREPARATIONS Allegan Tablets . .. Vermifuge and ruborant Methylenblue Med. “Bayer”) _. , ... Anaesthesin . . . Anesthetic Methylviolet Med. antiseptic Avomin .. .Vermifuge Natroletten . .Virus disinfectant Bovoflavin Salve . . . Disinfectant for coital infections Nemural . Vermifuge of cows and bulls Neosalvarsan Ciff Capsules , . . Vermifuge for horses Novalgin . .Analgesic and antispasmodic Congasin . . .For disease of cattle and horses caused Local anesthetic by Trypanosoma Congolense and Trypanosoma Vivax Orasthin “strong” . .Oxytocic from the posterior pituitary Derrophen ... For dermatobium infections of cattle Pantocaine ..Mucous membrane anesthetic Elityran . . .Thyroid preparation Pellidol Salve . .Epithelializing preparation Entozon .. .Chemotherapeutic antiseptic preparation Rephrin . .Racemic ephedrine & racemic Erugon .. . Testicular hormone preparation Rivanol suprarenine , . Chemotherapeutic Festal . . Pancreas enzyme preparation and hemicellulase Salyrgan .. Injectible Diuretic Hypophysin ... Pituitary preparation Suprarenin Igitol Powders and Pills. . . .. .Choleretics Tonophosphan Solution . Cardiovascular tonic Malix .. .Preparation from derris roots against Trypaflavin . .Chemotherapeutic antiseptic ectoparasites Trypanblue . .Specific for piroplasma species 301 MEDICAL SUPPLIES Figure 171 INSULIN PRODUCTION I. G. FARBEN, HOECHST LEGEND FIRST QUARTER SECOND QUARTER THIRD QUARTER FOURTH QUARTER as a national problem when Dr. Conti established an insulin control commission under the Aertze- hammer or National Chamber of Physicians. This group ordered all diabetics to be registered and de- clared that physicians must reduce the number of patients receiving insulin by one third through use of diet. To control this distribution of the extract they then issued insulin ration cards to the certified 200,000 diabetics in the country. The necessity for the rationing program is shown in Figure 171 by the fluctuation in output between 1945 and 1944. These data of the insulin produc- tion also reflect accurately the influence of bomb- ing on the ability of Hoechst to obtain the neces- sary satisfactory raw materials. The yield when compared with the amounts of raw glands obtained (Table 50) in indicative of the extent of deteriora- tion of glands and the drop in unit rate of recovery per kilogram of gland. The decrease in dead weight as well as the decrease in yield is the result of de- struction of slaughter houses in German cities and the disruption of refrigeration facilities and trans- portation. The drop to a negligible amount in 1945 is, according to Lautenschlaeger, attributable to the complete breakdown of transportation after the attacks by the Allied air forces in January, 1945. Table 50. Average Monthly Receipts of Pancreas by Hoechst District 1943 kg. % 1944 kg- % Baden-Wurttemberg 1,660 5.4 1,168 4 Bavaria 4,080 13 4,246 14.7 Berlin, Flensburg and Luebeck, Vienna 4,529 14.5 4,764 16.5 Alsace-Lorraine and Luxembourg 992 3.2 878 3.2 Frankfort Pfalz and Saar 1,679 5.4 2,223 7.7 Central Germany 2,979 9.4 1,850 6.4 Hannover-Hamburg 2,387 7.6 3,123 10.9 Rhineland-Westf. 12,302 39.5 10,061 35 Sudeten 627 2 598 2.6 Total 31,235 28,911 302 MEDICAL SUPPLIES Figure 172. Air view of southern section of I. G. Farben at Leverkusen taken by Royal Air Force in 1944. Arrow in lower left points to pharmaceutical division ivhere ampulling, granulating, tablet ing and packaging were done. Table 50, the average monthly receipts, shows a yearly purchase of 374,820 kg. of pancreas in 1943 and 346,932 kg. in 1944, or a decrease of 7.44 per cent. The production figures in Figure 171 show a drop from 433,000,000 units in 1943 to 377,000,000 units in 1944. This is equivalent to a drop in unit recovery from 1,230 units for each kilogram of the glandular material received in 1943 to 1,090 units in the 1944 raw glands. It is an 11 per cent reduction in yield. To make up for the growing deficit in insulin supply, Hoechst officials wanted to revert to di- oxyacetone, discovered by Van Noorden in 1921. It has been used in cases of acidosis and, they con- tended, will not raise the blood sugar although it is a sugar itself. Production difficulties, however, restrained them from starting manufacture. The effect of the reduced supply of insulin on the treatment of diabetes in Germany became steadily worse until early spring of 1945, when physicians in several cities stated that patients with diabetes not amenable to dietary control were dy- ing for lack of insulin. The rationing system did aid in reducing the demand by the required one third. All physicians were forced to report the number of patients under their care and to show that they had curtailed their use of insulin by one third. V hen this was presented they were then al- lowed to authorize insulin for their patients. Each case was reported to a commission of local physi- cians for approval. When the ration was granted the patient was given a card showing the number of units he could purchase monthly and was as- signed an apothecary for his supplies. The num- 303 MEDICAL SUPPLIES Table 51. Quarterly Production of Six Leading Products of Hoechst Plant of I. G. Farben 1-Ascorbic Acid Anaesthesin Novocain Pantocain Neosalvarsan Salyrgan* (in liters) (20% solJ 1939 1st Quarter 0.3t — — — l.lt 2127 2nd 66 0.3t — — — 0.4t 2273 3rd 66 0.2t 2.6t 0.5t O.lt 1.5t 1253 4th u 0.2t 6.4t 2.2t 0.2t l.Ot 1789 1940 1st u 0.25t 6.8t 2.7t 0.14t 1.9t 864 2nd u O.lt 9.8t 2.4t 0.13t 1.9t 432 3rd u 0.5t 8.7t 3.0t 0.13t 1.4t 864 4th u 0.2t 5.7l 1.5t 0.23t 1.3t 1242 1941 1st u O.lt 5.7t 0.8t 0.33t 1.4t 1026 2nd 66 0.04t 4.3t 0.8t O.llt 1.9t 648 3rd 66 0.28t 3.9t 3.It 0.37t 2.2t 551 4th 66 2.6t 7.8t 2.8t — 1.7t 432 1942 ■ 1st 66 2.8t 10.lt 1.8t 0.29t 0.6t 1080 2nd 66 2.4t 9.3t 1.8t 0.32t 1.3t 1134 3rd 66 3t 10.2t 3.3t — 2.5t 1404 4th 66 3.It 8.2t 2.3t 0.23t 2.2t 1944 1943 1st 66 3.3t 10.6t 3.2t — 2.It 1350 2nd 66 2.0t 7.2t 1.5t 0.36t 2.2t 1890 3rd 66 2.9t 11.5t 2.7t — 2.2t 1998 4th 66 2.4t 10.4t 2.It 0.17t 2.2t 1705 1944 1st. 66 3.0t 10.15t 2.17t 0.32t 1.98t 1440 2nd 66 2.49t 8.0t 2.16t 0.27t 2.It 2160 3rd 66 1.6t 11.6t 2.7t 0.43t 2.2t 1512 4th 66 O.lt 4.6t 2.14t 0.14t 1.8t 1872 1945 1st 66 — 1.7t l.lt — 0.4t — 2nd 66 — — — — — — * All figures in metric tons (2208 pounds avoirdupois) except Salyrgan 304 MEDICAL SUPPLIES her of ration units assigned the pharmacist was the basis of the amount the wholesaler was per- mitted to release. The system of control went no higher than the wholesaler and did not extend to the manufacturer who was exhorted by the govern- ment to maintain maximum production. The esti- mated capacity for each quarter was reported to the Berlin office of the national physicians’ asso- ciation who calculated the total ration accordingly. The chaotic conditions prevailing in the treat- ment of diabetes in the spring of 1945 clearly in- dicate that the system of rationing did not begin early enough and did not permit the accumulation of any reserve stocks against the day when Allied air power would wreck Germany’s transportation system. Vitamin C production at Hoechst did not show any marked drop until late summer of 1944. It could be traced directly to destruction of the large chemical plant at Ludwigshafen. The supply of potatoes employed for the extraction of sorbitol by the nickel reduction process became sporadic when increased amounts of potatoes had to be diverted for civilian consumption. Hoechst officials declared that all necessary supplies of ascorbic acid for the winter and spring of 1944-45 had been manufac- tured in the summer of 1944 so that shutdown in the late fall (shown in Table 51) was not imme- diately reflected in sales. Ascorbic acid is but one of the many examples of the indirect effects of bombing on this rambling, intact plant. The ammonia used was made at Lud- wigshafen and transported up the Rhine and the Main Rivers to Hoechst in an “ammonia” boat. When the ammonia boat was sunk supplies were interrupted. Acetanilid was made at the Knapsack plant outside Cologne until that plant was bombed out in 1942. From Leuna came dimethylether used in the production of barbiturates. The effect of this on the seven leading products (insulin given elsewhere) is shown in Table 51. The marked slump amounting to discontinuance of these items is an excellent example of how the bombing of key supply centers and transportation can all but end the production of a plant which is, in it- self, virtually untouched. cient to meet 85 per cent of the German domestic demand for biologicals. Despite the fact that on-the-spot inspection of this plant quickly revealed it was untouched by the air war and an investigation of the production data showed no changes from peacetime (Table 52), an examination of these facilities was something more than academic. The history of this plant in a country which was severely crippled by bombing emphasizes the most important factor for industrial- ists on the receiving end of a total war from the air. It is this: that in a large measure the ability of an industry not engaged primarily in armaments manufacture to withstand the impact of a strategic air offensive is directly related to its distance from an industrial center and the autonomy of its opera- tion. The biologicals plant of the I. G. Farben is located in a picturesque wooded valley a mile north of the old university city of Marburg. The town itself is of no strategic value except as a rail- head of secondary importance. This was lightly bombed in 1945 but the attack did not greatly affect the community and concerned the Behring- werk only by destroying a small warehouse of biologicals awaiting shipment at the freight sta- tion. Although there was little reason to expect a raid against the plant, the Behringwerk dispersed their essential supplies in twenty-three warehouses scattered throughout the farm country of Kur- hessen. These housed reserve stocks of feed, agar, petri dishes, ampules and other glassware. Accord- ing to Dr. Karl Demnitz, general director of the company, Professor Brandt, the Health Commissar, insisted upon this dispersal early in 1943. The Berlin authorities recognized the Behringwerk as the most vulnerable single target in their health defense. V ith but 20 per cent of their total output they were virtually the sole source of supply of sera and vaccines for the German Armed Forces. Neither the plant nor the area in which it was lo- cated was defended by anti-aircraft artillery or fighter interception. To have destroyed it would have been the most telling blow the Allies could have delivered against the health of the enemy Armed Forces and civilian population, if one may accept the opinion of German health authorities and the Behringwerk managers. Behringwerk, Marburg This is the unit of the I. G. Farben combine re- sponsible for the production of biologicals. Seventy per cent of the sera, vaccines and antitoxins pro- duced at the Behringwerk were for export trade. The remaining 30 per cent of the capacity is suffi- The Bayer Laboratories at Elberfeld The Bayer organization is the largest division of the I. G. Farben engaged in the manufacture of pharmaceuticals. This facility is one of the most 305 MEDICAL SUPPLIES important sources of vitamins, barbiturates, sulfo- namides, and anti-malarials. No tableting or ampul- ing is done at Elberfeld, all products being sent to Leverkusen for finishing. The laboratories are also important for their research division which is discussed in a later section of this chapter. The record of the Bayer laboratories during the war is the same in most essentials as that of the plant at Hoechst. It was not the target of any Allied attack, and the fluctuations in production which may be traced to air raids were the result of interference with delivery of essential ingredi- ents and absenteeism following raids on the city of Wuppertal-Elberfeld itself. When Wuppertal was hit by one of the war’s early area raids in May, 1943, the plant was forced to close for two weeks because of absenteeism. The Bayer buildings were hit by a few incendiaries but no damage was done. However, employees remained away from work to repair their houses, because of fear of new attacks, or because transportation in that Ruhr city had broken down. Dr. Clemens Luther, the production manager, said it was mid-July be- fore full production could be resumed. Throughout the war, Bayer was able to main- tain most of its production. The most marked fluctuations occurred in those products requiring raw materials made at Ludwigshafen and Lever- kusen. Periston is the product Professor Heinrich Hoerlein, the general manager, repeatedly referred to in discussing this subject. This synthetic blood substitute was discovered at Elberfeld during the war. It is produced from a by-product obtained in the manufacture of butadiene at Ludwigshafen. When production there was interrupted Bayer was no longer able to supply the German Armed Eorces with periston, which had largely replaced dried plasma and other blood substitutes. Ludwigshafen also furnished 2,4 dichlorbenzoic acid for atahrine manufacture. The synthetic gasoline plant at Leuna supplied dimethylether used in production of bar- biturates, thus attacks on these targets of greater strategic value immediately curtailed production at Elberfeld. here is, therefore, but a supplement to that report. Leverkusen was attacked repeatedly during the war but it was not until late summer, 1944, that the raids reached great intensity. In all the attacks, however, the large buildings housing the depart- ments for granulating, tableting, coating and fin- ishing the supplies from other plants did not suffer damage of any consequence (Figure 172). The destruction of chlorosulforic acid facilities in the winter of 1944 arrested the production of sulfonamides at Elberfeld. The sales of the twenty most important pharma- ceuticals of the I. G. Earben industries are shown in the charts in Figures 173 to 192 inclusive. Atabrine (Figure 173) sales increased from 7,400 kg. in 1939 to 101,800 kg. in 1943. In 1944 they dropped to 68,826 kg., the decrease being in export sales which is, in part, a reflection of the drop in production caused by failure of 2,4 di- chlorobenzoic acid and oxytriethylamino hydro- chloride to arrive from Hoechst. This, plus the damage from bombing to the Leverkusen plant as a whole, caused all production of atabrine to stop in November, 1944. A small amount of damage oc- curred to the roof and windows of the atabrine building from artillery fire but none from bombing. It is interesting to note that in 1944 sales to the Wehrmacht represented 83 per cent of total sales. Plasmochin s history (Figure 174) during the last years of the war is similar to that of atabrine. The steady decline in its use was checked in 1943 when export demands again increased. No aspirin (Figure 175) was sold to the Wehr- macht by the Bayer Division of the I. G. Earben. The 7 per cent decrease in 1944 is attributable to over-all damage to the Leverkusen plant and was reflected in a cut in exports. Pyramidon (Figure 176) sales did not begin to increase markedly until 1943 when 52.000 kg. were sold as compared with 29,000 kg. in 1942. The greatest proportionate in- crease was in exports which fell off again in 1944, while the civilian sales in Germany continued to increase. The production of sulfonamides (Figures 177- 180) fluctuated in much the same way as did the other preparations manufactured at Leverkusen. The normal monthly production of sulfathiazole was approximately 121/£> tons. The demand on the I. G. Earben was for tablets and an output of 20 tons a month was required. This capacity could never be reached. Indeed, in October, 1944, the heavy raids causing the general plant shutdown Pharmaceutical manufacture at Leverkusen Leverkusen like Ludwigshafen was important to the Allied air planners as a producer of chemicals employed in fuels, propellants, and explosives, not as a pharmaceutical plant. It has been sub- jected to a searching investigation by the Oil, Chemical, and Rubber Division. What is presented 306 Table 52. Quarterly Production of Most Important Sera and Vaccines Behringwerk at Marburg/Lahn, Division of I. G. Farben Amounts are given in liters SERA VACCINES Year Qtr. Diph* Tetanus* Gas Gangrene Typhoid Scarlet Fever Ery- sipelas Dysentery Coli Snake bite Meningo- coccus Diph. Scarlet Fever Typhoid Dysentery Quad- ruple Diph.- Scarlet “K” Diph.- Scarlet “E” Fowl Plague Typhus “E” Typhus “P” Cholera Plague Human Yatren Yatren** and Cultures 1939 I 5455 6338 1700 49 217 7422 1392 533 32 475 742 — — — — — — — — 683 1965 II 2980 5820 2342 36 234 6256 18 525 10 283 474 — — — — — — — — — — — 565 4018 III 5463 6536 3570 26 256 5174 1278 568 37 238 — — 2127 518 — — — — — — — — 580 1623 IV 5686 6537 3959 44 304 5461 359 381 66 486 — — 1283 630 — — — — — — — — 600 3127 Total 19584 25231 11571 155 1011 24313 3047 2007 145 1482 1216 — 3410 1148 — — — — — — — — 2428 10733 1940 I 5901 10927 6041 25 270 5045 548 521 4 437 453 — 1722 409 — — — — — < 445 2626 II 4901 15582 6109 42 291 4365 2223 644 42 515 604 — — 541 — — — — — — — — 285 3288 III 4080 10952 6273 — 326 4557 2138 1089 69 762 370 — — 1756 — — — — — — — — 420 2096 IV 2814 7513 3096 — 497 7140 1921 1136 56 715 155 — — — — — — — — — — — 115 2308 Total 17696 44974 21519 67 1384 21107 6830 3390 171 2429 1582 — 1722 2706 — — — — — — — — 1265 10318 1941 I 4758 6041 3032 — 526 11094 3028 1062 51 671 1289 — — — — — — .— — — — 363 1987 II 4468 4232 4264 — 566 10306 3383 771 107 608 923 — — 2366 — — — — — — 775 — 455 4941 III 5682 3513 6156 — 615 13395 3278 676 114 521 1570 — — 881 — — — — — — 4301 — 725 2386 IV . 8186 2591 5959 35 943 12844 4788 527 119 413 1343 — — — — — — — — — 2874 — 611 2713 Total 23094 16377 19411 35 2650 47639 14477 3036 391 2213 5125 — — 3247 — — — — — — 7950 — ' 2154 12027 1942 I 6671 2830 6087 31 1075 11733 5449 450 219 346 2321 — — 5882 — — — — — — 44 — 365 2497 II 6725 2678 5622 42 1417 10702 4973 550 180 298 2878 360 3285 4965 — — — — — — 45 — 355 4854 III 6657 2679 5672 59 1498 10246 6834 581 135 268 3476 560 1978 5052 — — — — 68 — — 1865 515 2707 IV 4475 3465 5976 83 1465 8595 4233 619 160 239 2593 466 — 2011 — — — — 125 — 3067 1011 1035 2794 Total 24528 11652 23357 215 5455 41276 21489 2200 694 1151 11268 1386 5263 17910 — — — — 193 — 3156 2876 2270 12852 1943 I 7233 3879 8343 62 1488 7719 5344 720 138 268 2421 529 — 6827 — 632 46 — 136 — — 254 755 2986 II 5219 4552 9941 53 680 6807 563 794 129 322 4447 774 1986 9625 — 2549 256 — 108 — — — 650 5892 III 5388 4345 11824 104 534 6768 808 1016 119 321 3835 1216 — 8351 1179 3158 495 — 406 — — 951 769 5602 IV 5783 4220 12073 62 441 7850 — 1119 92 324 3285 401 — 1400 6381 5243 46 — 478 — — — 1200 3234 Total 23623 16996 42181 281 3143 29144 6715 3649 478 1235 13988 2920 1986 26203 7560 11582 843 — 1128 — — 1205 3374 17714 1944 I 5288 4251 11241 62 459 6028 — 902 125 216 4525 170 — 15432 2407 3463 78 — 661 — — — 1250 4906 II 5422 3806 11265 65 439 9510 979 80 65 4054 320 — 6411 2336 4294 788 — 275 — — — 550 6731 III 7613 4343 10773 29 406 8594 803 72 60 3595 652 1416 4208 3672 2429 569 1124 770 484 — — 810 5421 IV 8138 4377 10355 — 307 11487 870 7 16 1692 — 4547 1500 — — 1109 1632 311 128 — — 990 6580 Total 26461 16777 43634 156 1611 35619 — 3554 284 357 13866 1142 5963 27551 8415 10186 2544 2756 2017 612 — — 3600 23638 serum is calculated on basis of 400 units per ccm and Tetanus serum on value of 600 units per ccm. * * Veterinary MEDICAL SUPPLIES reduced the output to 4 tons. None was pro- duced in November and only 3 tons in December. This is reflected in the sales shown in Figure 177. Sulfapyridine was first produced in 1940 (Figure 178). It was subjected to a 29 per cent decrease in 1944 due, in part, to the lack of demand by the Armed Forces. Prontosil also fell off, although the Armed Forces continued to use large amounts in 1944, as shown by Figure 179. The decrease here is the same as that for other sulfonamides. Marfanil, which was discovered in the research laboratories at Elberfeld and developed for use in anaerobic in- fections, reached its peak production in 1943 (Fig- ure 180). The 20 per cent decrease in 1944 was due to production difficulties at Elberfeld and some reduction in the requirements of the Armed Forces. Almost all production of sulfonamides was stopped in early 1945 because Leverkusen was dependent upon the chemical plants at Urdingen for aniline and at Ludwigshafen for ammonia. They were never able to re-establish effectively the sulfuric acid production after its destruction at Leverkusen in the winter of 1944 or to obtain adequate supplies of chlorosolfuric acid. Neosalvarsan sales did not change materially during the period between 1939 and 1944 (Figure 181) except in 1943 when export sales advanced from 2,600 kg. to 3,900 kg. The Armed Forces de- mands steadily increased toward the latter part of the war. Officials at the 1. G. Farben stated that in 1945 the demand of the Armed Forces increased 200 per cent. The sales of typhus vaccine and diphtheria serum (Figures 182, 183) are a reflection of the pro- duction figures shown in Table 52. In 1943 the de- mand for typhus vaccine increased nearly twenty- fold and almost doubled again in 1944 due to civil- ian and Armed Forces requirements. The sales of diphtheria serum in 1943-44, when compared to the amount sold in pre-war years, is a result of the great increase in diphtheria among the civilian population described in Chapter Four. The sale of vitamin preparations, vigantol (Fig- ure 184) and betaxin, increased steadily from 1939 to 1943. The greater part of the sales was to ci- vilian population, very little use of these being made by the Armed Forces. A 28 per cent drop in sales of vigantol occurred in 1944 due to the in- ability of Hoechst to obtain raw materials. Betaxin followed a similar trend showing a sharp decrease in 1944, most of which was taken up hy a decrease in exports, while civilian and Armed Forces sup- plies were maintained (Figure 185). Novocain, also a product of Hoechst, showed a steady decrease during the war years and only a slight drop in production in 1944 when it was still 93 per cent of the peak year of 1942 (Figure 186). Insulin sales follow closely production figures prepared hy Hoechst as shown in Figure 171. These sales (Figure 187) decreased by 19 per cent in 1944 over 1943, which is less of a reduction than that of production and probably is represented by the sale of stored material. The decrease demanded hy German Government health authorities was 33 per cent. The cause of the steady increase in de- mand from 1940 to 1943 is considered the result of changes in the national diet which have been described. The sales figures of gardan, rivanol, hresival, panflavin and dolantin appear in Figures 188-192. Leverkusen was also the principal source of supply in Europe for phenacetin and salicylic acid. The monthly average of 33 tons of phenacetin was reduced to 15 tons in October, 1944, and manufacture was discontinued entirely in Decem- ber of the same year. Eight tons were produced in the early months of 1945. Salicylic acid showed the same fluctuations, from 125 tons a month to zero in the winter of 1944-45. Both of these cut- backs were the over-all results of air raids on the plant. Among insecticides a water emulsion of DDT sold under the trade name Lauseto was the prin- cipal preparation. The average monthly weight of production was 70 tons, decreasing to 20 tons in November, 40 tons in December, 1944, and 25, 22, and 6 tons, respectively, in the first three months of 1945. Chloromethyl parachlorophenyl sulphone and par achloro phenyl sulphinate were two new insecticides being investigated. They were said to he more specific for insects and would not damage plants. Plant Report Number 37 of the Oil, Chemical and Rubber Division of the Bombing Survey pre- sents interesting data on the over-all production of tablets, ampules, and vials of all drugs at Leverkusen. According to this source, the plant had a capacity of 200,000,000 tablets a month. As has been stated, most of the products finished at Leverkusen came there from other plants so that some of the fluctuations in the production figures 307 Figure 173 ANNUAL SALES OF ATABRIN BAYER DIVISION, I. G. FARBEN, LEVERKUSEN. 1939-1944 ( [ CIVIL ARMED FORCES ■ <0 < cc o o _J a z < to 3 0 1 H 308 Figure 174 ANNUAL SALES OF PLASMOCHIN BAYER DIVISION, I. G. FARBEN, LEVERKUSEN. 1939-1944 □ CIVIL p-i-jjx'j ARMED FORCES EXPORT MM (O Z < a: e> o _j 2 o z < CO 3 o z »- 309 Figure 175 ANNUAL SALES OF ASPIRIN BAYER DIVISION, I. G. FARBEN, LEVERKUSEN. !939-f944 CIVIL EXPORT (0 2 Z < oc CO o _J 5 ! o z < CO 0 3 1 »- 310 Figure 176 ANNUAL SALES OF PYRAMIDON BAYER DIVISION, 1. G. FARBEN, LEVERKUSEN. !939-f944 CIVIL ARMED FORCES EXPORT <0 Z < tr o o _1 5 o z < CO 3 o X H 311 Figure 177 ANNUAL SALES OF ELEUDRON * BAYER DIVISION, I. 6. FARBEN, LEVERKUSEN. 1939-1944 CIVIL ARMED FORCES EXPORT POWDER THOUS. KILOGRAMS SOLUTION THOUSAND LITERS Figure 178 ANNUAL SALES OF SULFAPYRIDINE BAYER DIVISION, I. G. FARBEN, LEVERKUSEN. 1939-1944 CIVIL ARMED FORCES EXPORT THOUSAND KILOGRAMS 313 Figure 179 ANNUAL SALES OF PRONTOSIL' BAYER DIVISION, I. G. FARBEN, LEVERKUSEN 1939-1944 CIVIL ARMED FORCES EXPORT THOUS. KILOGRAMS THOUSAND LITERS Figure 180 ANNUAL SALES OF MARFANIL* BAYER DIVISION, I. G. FARBEN, LEVERKUSEN. 1939-1944 *NEW SULFONAMIDE-LIKE AGENT USED IN ANAEROBIC INFECTIONS CIVIL ARMED FORCES EXPORT THOUSAND KILOGRAMS 315 Figure 181 ANNUAL SALES OF NEOSALVARSAN BAYER DIVISION, 1. G. FARBEN, LEVERKUSEN. 1939-1944 C! VIL ARMED FORCES EXPORT 3E < cr o o _J V o z < , MANUFACTUBE 7 TE-CHNICAL SHOPS 8 INOEGANIC "SALTS 9 VITAMIN C PDODUCTION 10 ALKALOIDS PCODUCT lON 11 CE-AGE-NTS AND PUCE- CHEMICALS PRODUCTION 12 INORGANIC SALTS MF-GO. 13 WAREHOUSES FOQ FINISHED AND CAW STOCK PLOT PLAN SHOWING DAMAGE- TO THE" T. MEI2CK PLANT AT PAPMSTADT IN THE- PAID OF- DE~ CE-MEdEtD. 12,1944 SYMBOLS TOTAL DAMAGE- L:';Ti PARTIAL DAMAGt- 331 MEDICAL SUPPLIES workers shortly after the alarm was sounded. Never- theless, 50 workers were killed, among them the entire staff of the biologic research laboratories. It will be noted from the chart in Figure 194 prepared by Herr Jung, the production manager, that dam- age was widespread throughout the plant. Pipe lines and power lines, as well as sewage systems, were destroyed and considerable damage occurred to the buildings. The large warehouse with finished and raw stock (building 13, Figure 194) was com- pletely demolished with a loss of more than 200,000 kg. of packaged goods that had accumulated in the storehouse because of the inability to obtain railroad cars for shipment. Machinery was dam- aged in many places. The power house and trans- former station, however, remained intact except for some minor damage to the water purification plant. In conclusion the report states that with help from the outside most production could be resumed within a period of from one to two months. Any reconstruction of bomb damage to pharma- ceutical plants required first the approval by the Commanding General of the construction division of the military district. This was prepared and a copy of the damage report submitted to the main office of the Pharmacy Section of the Chemical In- dustries Division of the Armaments Ministry at Berlin. The Speer Ministry, therefore, had control over the rehabilitation of stricken pharmaceutical plants. However, as the report of December 12 from Merck shows, it was usually necessary to seek the intervention of the fuehrer for sanitary and health matters, Professor Brandt, before reconstruc- tion work would be sanctioned. The official report somewhat conflicts with the succeeding analysis of bomb damage as time af- forded an opportunity to assess the destruction more accurately. Reconsideration revealed that the most serious loss was in the alkaloid department which was very seriously damaged. It was here that eukodal, a morphine substitute used by the Wehrmacht, was produced. Production ceased after the raid. This was also the location of the extrac- tion facilities for other opiates from Papaver som- niferum. Thiamin hydrochloride facilities were seriously crippled when the refrigeration unit was destroyed, and no production was possible after December. In Figure 195. Biological laboratories at E. Merck, Darmstadt. 332 MEDICAL SUPPLIES the Merck process a temperature of 18° C is re- quired in the acet-amidine step of vitamin Bx syn- thesis, The facilities for making thiamin hydrochlo- ride were sufficiently damaged to end production. Merck was the largest manufacturer of this nutri- tional factor in Germany. Its destruction, however, would not be rapidly reflected in the health of the people since artificial reinforcement with vita- min Bx in bread is not required in Germany. All stocks of barbiturates were destroyed and it was estimated that with all required materials, six months’ time would be necessary to restore the apparatus for production. The damage to the rare chemicals department was assessed at 80 per cent. Merck was the sole source of many of the chemical reagents used in research and in industrial testing laboratories throughout Germany. The effect of the destruction of these facilities is therefore not proportionate in importance to their small percentage in Merck's total sales. Air raid precautions taken at the plant were very meagre. There were no large shelters for the work- ers and only a few scattered retreats called “Splitter Graben.” These were small, covered trenches or dug-outs, large enough to hold from 20 to 25 per- sons. Their sole protection was the earth around them and the 20 centimeters of thick layer of con- crete overhead. The only other shelters were those provided by the cellars of the reinforced concrete and brick buildings. There was room enough in these cellars for all the workers but there was little evidence of anything additional having been done to buttress up the floors above or to provide ventilation or emergency lighting. Conclusion: The raid of December 12, 1944, seriously crippled the chief source of chemical re- agents and vitamins in Germany. Little reconstruc- tion had been undertaken up to the time the Amer- ican troops arrived in April. It was estimated that as a result of this raid, Germany would have been deprived of a great source of the essential reagents and supplemental food factors for at least one year. The aerial photographs of the plant accompanying Interpretation Report SA 2986 do not show that the railroad network immediately adjoining the plant suffered any damage. difficulties of transportation were the more pro- nounced because many of the plants were making synthetic cloth which required large amounts of coal and coke. These plants were not in the Ruhr area but were located in Silesia which is far re- moved from the zones bearing the brunt of the aerial offensive. Apart from this there were manu- facturers of gauze bandages, adhesive tape and similar items in every large city in Germany. These items were produced from textile raw materials which had to come from a great distance, so that the moment transportation was interrupted their production had to be curtailed. One of the largest and most important manufac- turers of surgical dressings in Germany was the Scherrong Company at Tutlingen in Wurttemberg. In a small city some distance from the armaments industry they, like the plant making biologicals at Marburg, survived the war without serious damage. Oberstabsapotheker Paul Weiser, a member of Section 4, of the supply section in the office of General Handloser, stated that the destruction of small plants scattered throughout the cities of Ger- many and the lack of supply of essential textiles for surgical dressings caused the amount of finished material to fall from 20,000,000 meters in 1939 to 5,000,000 meters in December, 1944. This was such a reduction that various Army installations had to resort to moss for use as absorbent material on wounds. The moss was first washed, then sterilized and placed directly on the wound with a thin layer of gauze over it. As a less drastic measure, in 1944 supply houses were ordered to fill all orders for bandage with one half the amount in paper bandage and the remainder in cloth. In many instances, wholesalers reported that they were forced to fill orders with paper products alone as all other stocks were depleted. Surgeons were of the opinion that the paper bandage worked quite well on cases that were stationary, such as a leg under traction. The primary difficulty occurred in ambulatory cases in which paper had a tendency to slip and tear. Surgical instruments became increasingly diffi- cult to obtain as the air attack against German cities interfered with transportation to and from the numerous small plants operating throughout the country. In 1942 it was estimated that there were 4,000 different types of surgical instruments. These types were gradually reduced, by order of the Brandt office, until in August, 1944, there were less than 1,700 surgical instruments of all kinds. In January, 1945, only 200 types were allowed. Sev- Surgical dressings, supplies, and equipment The problem of supply and distribution of surgi- cal dressings is primarily one of transportation and secondarily a problem of coal supply. The 333 MEDICAL SUPPLIES eral of the authorities with whom this problem was discussed were of the opinion that curtailment came much too late and was not as drastic as it should have been. They seemed to think that surgeons would have been able to manage with very few instruments. They did not believe that as the situa- tion became critical surgeons should have been per- mitted the luxury of dozens of different types of instruments for each operation. Rationing of x-ray equipment was instituted in 1943, and manufacture was limited to three basic, simple models in August, 1944. The models were determined by the Brandt organization. The Speer Ministry allocated raw materials to manufacturers only for these models. Weiser, who was in charge of the supply of instruments and equipment to all the Armed Forces, stated that the drastic curtail- ment of surgical instruments and equipment which were finally unobtainable by January 1, 1945, was due to four causes which followed each other in succession and which ultimately led to the com- lete breakdown in the supply of essential equip- ment. These were (1) by 1943 the loss of the countries which the Germans had occupied reduced the quantities of essential ores and other raw mate- rial; (2) with the increasing tempo of the aerial offensives and the seriousness for the Germans of the ground situation, every manufacturer of medi- cal equipment was required to release one half of its specialized craftsmen for induction into the armed services in August, 1944; (3) this was fol- lowed by the Allied attacks on the German trans- portation system, and (4) the final breakdown at local sources came when the mass air attacks against city areas overwhelmed the defenses of Ger- man target cities. This occurred in the late fall and early winter of 1944-45 and had the effect of making the replacement of destroyed essential medi- cal equipment impossible. those industries supplying the civilian sector and the Armed Forces. From the beginning, the German Ministry of Armaments and Munitions contained one section devoted to allocating raw materials to the pharmaceutical industry. This was the “Spe- cialists’ Group Pharmacy” in the Chemical Divi- sion. Bandages and other types of surgical dress- ings were under the control of the textile group. The decentralization of the control of medical sup- plies in this Ministry went so far as to place oper- ating room lights under room fixtures and surgical appliances in the section dealing with musical .in- struments. There was no section in the Speer Min- istry where all the problems of medical supply were co-ordinated under one head. It was repeatedly stated that Brandt’s mission was difficult to fulfill because it was necessary to deal with so many different ministerial sections in the Speer organization, thus requiring endless conferences with each of the various departmental heads. They were necessary because Brandt was responsible for the ultimate supply of drugs, in- struments and other equipment. He was, therefore, determined that plants manufacturing such items should not be overlooked when the Speer Ministry distributed chemicals and other critical raw mate- rials. Figure 53 in Chapter Seven describes the close control he exercised in balancing the demands of the civilians and the military. In theory, it was the mission of Admiral Fikent- scher in the Brandt office to confer with the Speer group and then to estimate the potential supplies of all items which would be available for a given period. The estimated requirements of the military and of all civilian physicians in Germany were then presented to him by Conti and Handloser. In practice, however, there did not appear to be such clear-cut delineation, for the men of the Armed Forces worked directly with Speer, and Conti gained the impression that the civilians received only what was left over. Brandt made no direct distribution to military units, and except in cases where the Brandt Hospitals and the “Brandt Re- serve" were concerned, he issued no supplies to hospitals or individual cities. Under General Handloser the procurement and allotment of all medical supplies to the Army, Navy, and Air Forces were guided by Colonel Apothecary (Oberstabsapotheker ) Exo. His divi- sion was divided into a section for drugs (Sieke), bandages (Scriba), and equipment (Weiser). This The government's control organization It has been stated in a previous chapter that the anticipation of interference with the supply of essential medicaments, dressings, instruments and equipment was one of the important reasons for Hitler’s appointment of Brandt. The Brandt in- terview contains a conflicting explanation as to why he was appointed. It is, however, apparent that some co-ordinating office was necessary not only to allocate and control the distribution of medical care through the physician but to assist and guide 334 MEDICAL SUPPLIES office at the high command of the German Armed Forces received the estimates from the various sani- tary depots of the Army, Air Forces, Navy, SS, Todt Organization and the Labor Service. The re- quests were then examined and, when found justi- fied, approved. In each case the approved request had to be planned against the total allocations made to the military for each item of equipment. The civilian counterpart to Exo was Dr. Joseph Grunwald in Conti’s office of public health in the Ministry of Interior. One section of his division controlled all functions that were necessary for the supply of drugs, bandages, surgical dressings, in- struments and equipment to civilian facilities and to the population at large. It had no direct control over the pharmaceutical industry as this was re- tained by the Brandt organization. Furthermore, there was no such authority as is represented by the amended Food, Drug and Cosmetic Act in the United States for controlling the quality of medica- ments and the claims made for medical prepara- tions. The officials of the German public health ser- vice, including Dr. Conti, seldom were requested to participate in the discussions on allocations and received only what Brandt could persuade the Armed Forces not to take. The office of Admiral Fikentscher, the retired chief medical officer of the German Navy was or- ganized as follows: In the Conti organization, on the other hand, it was only in the supply of such items as were never required in volume over which they were able to exercise absolute control. These would in- clude operating tables, hospital beds, x-ray ma- chines and similar equipment. The latter offers a good example of the procedure followed. When x-ray equipment was destroyed in an air attack the physician or facility involved would first at- tempt to obtain a replacement through local pur- chases or from their ordinary sources of supply. \\ hen this failed a request was sent to Berlin. It first required the approval of the local medical association, whence it was sent to Grunwald’s office. The latter in turn forwarded the request to the "Deutsche Roentgen Gesellschaft for considera- tion. If in each instance it was justified, it was then forwarded to the manufacturer of the apparatus who would deliver the order if possible. The system of governmental control of medical supplies was developed in its final form only after the critical period of the air war had arrived. For some reason, which was not explained in all the interviews of German officials by members of this branch, the German drug, chemical and allied trades industry appears to have had a relatively free reign except in the allocation of raw materials until the intense phase of aerial attacks against the German homeland was reached. An air war of such magnitude was not anticipated. These officials repeatedly asserted that they organized too late to encourage the production of adequate reserves, to arrange the dispersal of sufficient stored material, and to institute the drug rationing and the simpli- fication of medical instruments, equipment and pharmaceuticals which finally became necessary. By this delay or lack of prior planning they were unable to withstand successfully the impact of the combined air offensive on the production and dis- tribution of these essentials to public health. Textiles Fikentscher Roentgenologic apparatus. .. .Fikentscher Pharmaceuticals Lupke Precision instruments and optics Geist Liaison with the military Hanstein Liaison with Speer (war production) Wanschure In the Armed Forces the system was better or- ganized and under stricter control than it was in the civilian sector. In the former, various medical supply depots would send their estimates to the chief of their branch of service. Fie would in turn forward them to HandloseFs office where the requi- sition would be approved and deducted from the master allotment before being sent to the main sanitary depots. This main depot for each of the several branches of service went through the same procedure of dividing up their allocation and gave the orders directly to the industry for supplies to be delivered to the unit depots throughout the country. Counter-measures Perhaps the most effective counter-measure in- stituted by the German Government was the so- called “Brandt Reserve Plan.” According to this, all companies engaged in the production, distribu- tion and sale of medical supplies were required to retain stockpiles on critical items. Manufacturing concerns were required to set aside an inventory representing a two months’ supply over and above their normal inventory when the plan was instituted 335 MEDICAL SUPPLIES in 1943. By the middle of 1944 this reserve was or- dered increased to a six months’ supply of all items which were, according to the directive, to be held in warehouses specified by Brandt. They were usu- ally located outside of cities and beyond the area of danger from air attack. Title to the goods remained in the manufacturer’s name. They became property of the government only when they were used, at which time the government reimbursed the manu- facturer. It could not be learned whether the gov- ernment considered paying interest on the frozen investment this represented. The items could be re- leased only upon authority of the office in Berlin as they were considered reserves to be held for raids classed as “catastrophies.” Members of the directorate of the I. G. Farben in discussing this Brandt reserve plan stated that in establishing it Brandt ignored the increased de- mands which had already been made on the phar- maceutical industry. He did not seem to consider how such a tremendous hulk of idle stock, which had to represent 50 per cent of their annual produc- tion over and above the normal inventory, could be manufactured. Manufacturers were able to comply partially with the scheme because the demands for other products from other European countries steadily decreased. Late in 1943, the I. G. discon- tinued all civilian supply for one month in order to force the wholesaler to squeeze out his holdings. This had the effect of further building up the so- called Brandt reserve. The wholesalers as well as each individual apoth- ecary in Germany were required to maintain a two months’ reserve of essential drugs, over and above their average normal inventory from 1935 to 1939. The wholesalers deposited their material in ware- houses in outlying districts. Apothecaries were per- mitted to retain their reserve in their own build- ings. For a city health officer to un-freeze such sup- plies he had to send an official declaration to Berlin stating that a catastrophe had occurred. If the de- mands for emergency medical supplies were large, it was customary for Brandt to send a representa- tive to the city to decide what supplies were neces- sary. Pharmaceuticals, surgical dressings and in- struments were then released. Occasionally this elaborate system did not function well in the com- munities. For example, in the July raids of 1943 on Hamburg city health officers were forced to call upon the medical supply depot of the German Navy at Wilhelmshafen for instruments and sur- gical dressings. Indeed, in some cities raids were of such magnitude that the Armed Forces were finally ordered to meet any demands made upon them by the civilian health authorities to satisfy the requirements in essential supplies after a heavy raid. The apothecary and drug rationing The system of rationing was extended to cover more and more pharmaceuticals until the spring of 1945 when 88 drugs and related items were on the restricted list. The plan was much the same as that governing the distribution of food; its pur- pose was to spread the thin reserves of the essential items over as wide an area as possible. With a few exceptions all chemicals and drugs used in druggists’ prescriptions were carefully con- trolled. Eight categories of substances were regu- lated: chemicals such as ether, theophyllin, and boric acid; drugs such as folia digitalis and jalap; ointment bases; fats and oils; suppository bases; ether oils; alcohol, sugar, balsam peru; and mis- cellaneous items such as petrolatum and benzine. To obtain these substances, the druggist had to submit his requirements to the local pharmacy con- trol board (a section of the Apothecary’s Cham- ber or Aerztekammer) every three months. His re- quests could not exceed his purchases for any quarter of 1938. These boards then consolidated their requirements and forwarded them to the district (Bezirks) board. The allotments of re- stricted substances were made to each district by the pharmacy section of the Speer Ministry on the basis of periodic estimates from the drug and chemicals industry. With his purchase orders to the wholesaler, the apothecary was required to submit a requisition from his rationing board. One such requisition was necessary for each drug which was then charged against the druggist’s allotment. Many apothecaries stated that only a fewT items were thus restricted and they were able to obtain most of their require- ments until late summer of 1944. Pharmaceutical specialties were not controlled by the government. No elaborate procedure was required by the pharmaceutical manufacturers who, for the most part, limited their wholesalers to the amounts of each item purchased in 1939. On criti- cally short items, such as glandular extracts, the wholesalers limited their sales to hospitals. Thus 336 MEDICAL SUPPLIES Figure 196. Kaiser Wilhelm Institute for Medical Research at Heidelberg. During the tear a building housing cyclotron teas added for study of atomic energy. the sale by manufacturers direct to physicians and hospitals was largely abandoned. Because of this and because of their ability to disperse large stocks and to serve an area after a raid, the officials of Reichelt, A.G. at Hamburg believe the wholesaler became more important in the economy of the drug industry. the country by ground forces delivered the coup de grace to all creative work in medicine. During the war, German laboratories succeeded in developing several therapeutic agents which, when they have been fully tested by American and British authorities, may prove of outstanding value in the future of medicine. These include a syn- thetic blood substitute which should materially reduce the cost of shock therapy, a chemothera- peutic agent of value in anaerobic infections, a synthetic oxytocic, a colorless anti-malarial agent claimed to exhibit the same therapeutic efficacy as atabrine. German progress in medicine was care- fully studied and much information was gained in every phase of medical investigations. However, a review of the nature and use of such new products does not come within the purview of this report. Two examples will furnish an accurate picture of what happened to research efforts in Germany under large scale bombing. They serve to make it obvious to the casual observer why medical prog- ress is impeded rather than stimulated by the events in a peoples’ war. New developments The air war did not greatly affect the progress of medical research until the last year of the Euro- pean conflict. In the period when Germany’s tide was running high and Allied planes were little more than a nuisance, the search for new thera- peutic measures continued at its peacetime pace. Many scientists were deferred from military duty, equipment was plentiful and of high quality, raw materials were available and the war was suffi- ciently remote from the homeland to afford the tranquility essential to scientific research. Early in 1944, with the advent of the air war all this changed. Research slowed to a snail’s pace in twelve months and, obviously, the overrunning of 337 MEDICAL SUPPLIES It is now clear that bombing is the reason Germany was found to be without penicillin. This type of warfare interfered with the development of sufficiently potent strains of molds and greatly delayed the assembly of data by the central re- search organization at Berlin. The files of Pro- fessor Rostock, chief coordinator of medical re- search for the Reich, knew, however, that by June, 1944, the Germans had learned enough of the char- acteristics of these strains to permit them to go into production on an experimental basis. More than this, however, was never attained. The German scientists with whom the matter of penicillin was discussed repeatedly referred to two points. First, they appeared surprised that the All ies had been able to withhold from scientific literature several essential details of information concerning this important discovery. Many of them also felt that present methods of manufacture were too cumbersome and complicated for production to he undertaken at the present state of knowledge. They believed that more time should elapse during which the problem of synthesis could be developed. They were reluctant to undertake the construction of such elaborate facilities as are presently required because of the constant threat that they would he destroyed overnight in an air raid. Penicillin was being manufactured on a laboratory scale at Hoechst, at Merck (Darmstadt) and in the labora- tory of Hitler’s private physician, Dr. Theodore Morrell. In passing, it is interesting to recall that during our interrogation of Dr. Erwin Giesing, who attended Hitler when his ear drums were punctured in the abortive plot of July, 1944, he stated that an independent analysis of the Morrell penicillin showed no antibacterial activity whatso- ever. Medical research was greatly impeded by the re- peated breakdowns in communications and the in- ability of pharmaceutcal concerns to maintain a steady supply of research materials. Difficulties of this sort were probably more responsible than any- thing else for the failure of Professor Richard Kuhn, Nobel prize winner and director of the Kaiser Wilhelm Institute for Medical Research at Heidelberg, to continue his work on new chemo- therapeutic substances. Before the breakdown of Germany’s transportation system Kuhn had made progress in the development of a sulphur, nitrogen, and metal free substance, for use in the treatment of all types of infections due to cocci and in those in which penicillin is presently indicated. This substance is 2,2' dioxybenzyl which, when halo- genated, forms a 2,2' dioxydibrombenzyl or “Sali- cil.” This preparation is being studied by Dr. Ger- hard Domagk. Work had to be abandoned on salicil in September, 1944. The destruction of laboratories and equipment, the breakdown of communication, which is neces- sary for the exchange of scientific information and materials, the induction into the Armed Forces of almost every available man for the last push of the German Army in late 1944, and the psycho- logical effect of the continuous air raids paralyzed medical research. Only two scientists were inter- viewed who were continuing clinical investigations. Conclusions From what has been reported it is apparent that the Germans established a well organized system for the control, manufacture, and distribution of essential medical supplies. The main error, and the one which may have been largely responsible for the ultimate breakdown of the system, was their delay in initiating the plan and their neglect in instituting drastic curtailment of the number and type of drugs, dressings, instruments and equip- ment permitted. The aerial war succeeded in seri- ously crippling many of the medical supply in- dustries. It was not sufficient to interfere seriously with the ability of these industries to produce essen- tial products. Transportation was the deciding fac- tor. The Brandt reserve plan was well conceived, but late. The manufacturers agreed, as did the whole- salers, that had they been given time to build up an inventory, they could have cushioned the effect of the air war on the health of the people. As it was, it appeared to be a stop-gap which in the end was inadequate. Attacks in which production facilities and ware- houses were damaged was one of the four reasons for the ultimate breakdown in the production and distribution of essential medical supplies to the German public. The three other contributing factors were the loss of sources of raw materials in foreign countries, the demand for manpower by the German ground forces which forced the drafting of skilled craftsmen, and the success of the Allied air attacks in the disruption of the distribution of supplies. The series of events related above forced Pro- fessor Brandt to inform Hitler on April 2, 1945, 338 MEDICAL SUPPLIES that 20 per cent of all essential medical supplies throughout Germany had been destroyed, that 40 per cent of those in stock were only partially dam- aged or intact and would last two months, and that the remainder would maintain the supply for four additional months if transportation could be re- stored. If these conditions could not be met, Brandt informed the Fuehrer, then the civilians and the Armed Forces could no longer be provided with even the barest essentials of medical attention. This succinct picture of the state of the German medical supply industry after the Allied Air raids was re- garded as evidence of a defeatist attitude. For ex- pressing it, Brandt was condemned to death. 339 APPENDICES This section contains tabular matter and other information not pertinent to an understanding of the effect of the air assaults on the health of Germany but which may be of interest to those wishing to study the subject further. APPENDIX A Individuals Interrogated APPENDIX B Bombing and the German Armed Forces APPENDIX C-J N.S.V. Action in Hamburg Catastrophe APPENDIX C-2 Rationing Regulation for Final War Period APPENDIX C=3 Food Stocks During War Years APPENDIX C 4 Daily Allowances of Rationed Foods APPENDIX C-5 Compilation of Nutritional Values appendix A INTERROGATIONS The following is a partial list of the more important persons interrogated by the Medical Branch team whose opinions were a major source of information. Dr. Adenauer, Lord Mayor of Cologne Dr. Aurnhammer, Pediatrician, Augsburg Mr. Bischoff, Architect, Brandt Hospital, Berlin Dr. Badin, Water Works, Dortmund Prof. Baniecki, Pathologist, University of Hamburg Prof. Bauer, Surgeon, University of Heidelberg Prof. Baur, Director, Hospital Schwabing, Munich Dr. Bauser, Water and Sewage Department, Stuttgart 340 appendix A Prof. Beckman, Internist, Stuttgart Prof. Beckerman, Internist, University of Hamburg Prof. Berg, Internist, University of Hamburg Prof. Beyle, N euro psychiatrist, University of Cologne Prof. Bingold, Internist, Nuremberg Prof. Bleyer, Nutritionist, Munich Prof. Blome, Deputy to the Leader of German Physicians, M unich Mr. Blucher, Director, Altona Hospital, Hamburg Dr. Boehm, Medical Director, Brandt Hospital, Wimmern near Dortmund Prof. Bothe, Chief of Atomic Research, Kaiser Wilhelm Institute, Heidelberg Prof. Brandt, General Commissar of German Health, Berlin Dr. Brueggemann, General Manager, I. G. Far ben, Leverkusen Prof. Brutt, Director, Hafen Hospital, Hamburg Prof. Buechner, Director of Institute of Aviation Medicine, F rank fort on the Main Prof. Buerger-Prinz, N euro psychiatrist. University of Hamburg Prof. Bumke, N euro psychiatrist. University of Munich Dr. Claussen, Chief of Division B, Reich Ministry of Food and Agriculture, Berlin Dr. Conti, Chief of the German Public Health Service and the German Physicians Association, Berlin Prof. Degwitz, Director of City Health Department, Hamburg Prof. Demnitz, Production Manager, I. G. Farben, Marburg Prof. Domagk, Nobel Prize W inner, /. G. Farben, Elberfeld Prof. Dommaschk, Chief of Rationing, Reich Ministry of Food and Agriculture Mr. Ebert, Director, Eppendorf Hospital, Hamburg Mr. Eggenstein, Director, Municipal Hospital, Hamm Dr. Eller, Chief of City Health Owce, Augsburg Prof. Engelhardt, Surgeon, Hospital Rechts der Isar, Munich Dr. Engler, Water and Sewage Department, Stuttgart Dr. Enders, Chief of the Physicians Association, Ulm Col. Erhard, Chief of Air Raid Matters, German Air Force Prof. Eyer, Director, German Army Typhus Commission, in Poland Mr. Eyermann, Director, Julius Hospital, W urzburg Prof. Eymer, Obstetrician and Gynecologist, University of Munich Prof. Fahr, Pathologist, University of Hamburg Dr. Fiehle, Lord Mayor of Munich Dr. Fischer, Personnel Manager, Robert Bosch Works, Stuttgart Prof. Fleck, N euro psychiatrist, Nuremberg Mr. Franz, Engineer, Ruhr Valley Association Prof. Frei, Surgeon, University of Munich Dr. Friedrich, Air Raid District Physician, Munich Dr. Fischer, Chief Pharmacist, City Hospital, Nuremberg: Dr. Ganzbauer, Obstetrician and Gynecologist, Nuremberg Dr. Gahliner, General Manager, Merck, Darmstadt Maj. Gen. Gebhardt, Surgeon General, SS. 341 appendix A Mr. Geist, Water and Sewage Department, Hamm Mr. Gerris, Water and Sewage Department, Hamm Dr. Giesing, Private Physician to Adolph Hitler Mr. Gimbel, Water and Sewage Department, Karlsruhe Maj. Gen. Goldbeck, Chief Medical Officer, German Air Force supporting German Army, 1940-43 Dr. Coeppel, Air Raid District Physician, Augsburg Dr. Goetz, Director of Marien Hospital, Stuttgart Prof. Graeff, Pathologist, University of Hamburg Dr. Grimminger, Director of Provincial Food Office of Wurttem- berg, Stuttgart Dr. Gulden, Epidemiologist, Health Office, Nuremberg Dr. Gutermuth, Plenipotentiary for Medical Matters in the Arma- ments and Munitions Industry, Frankfort on the Main Dr. Glockengiesser, Pathologist, University of Munich Dr. Haefner, Statistician, Reich Ministry of Food and Agri- culture Maj. Gen. Handloser, Director of Medical Services, German Armed Forces Mr. Hanik, Water and Sewage Department, Hamburg Mr. Hartman, Director, German Red Cross Mr. Hecht, Water and Sewage Department, W urzburg Dr. Hecht, Pharmacologist, 1. G. Farben, Elberfeld Dr. Heine, Hygienist, Ruhr Valley Association Prof. Heinemann, Obstetrician and Gynecologist, University of Hamburg Dr. Heiss, Director, Institute for Food Research, Munich Mr. Herpich, Water and Sewage Department, Munich Prof. Hoerlein, Director, I. G. Farben, Elberfeld Prof. Hoffmann, Dean of the Medical School, University of Cologne Prof, Hoffmeister, Surgeon, Hospital Rechts der Isar, Munich Dr. Holler, Water and Sewage Department, Cologne Dr. Hollweck, Epidemiologist, Health Office, Munich Prof. Hulser, Schwabing Hospital, Munich Dr. Harff, Consultant to General Rostock, Berlin Mr. Jarneke, Director, Barmbeck Hospital, Hamburg Mr. Jetter, Director, Municipal Hospital, Stuttgart—Bad Cannstatt Col. Joedicke, Chief of Staff to the Director of Medical Ser- vices, German Army. Mr. Juergen, Water and Sewage Department, Augsburg Dr. Jung, Production Manager, E. Merck, Darmstadt Mr. Kagel, Water and Sewage Department, Essen Dr. Kasper, Pediatrician, Nuremberg Prof. Kemmerer, Nymphenburg Hospital, Munich Prof. Kisskalt, Institute of Hygiene, University of Munich Prof. Konjetzny, Surgeon, University of Hamburg Dr. Kramann, Obstetrician and Gynecologist, University of F rank fort on the Main Dr. Kramer, Municipal Hospital, Frankfort on the Main 342 appendix A Prof. Kranz, Dentist, University of Munich Prof. Kroetz, Medical Director, Hospital Altona, Hamburg Prof. Kuhn, Director, Kaiser Wilhelm Institute, Heidelberg Prof. Lautenschlaeger, Director, /. G. Farben, Hoescht Major Leinung, Executive Officer for the Chief Medical Officer, German Air Force Mr. Lemke, Water and Sewage Department, Kassel Col. Lensch, former Chief of Staff for Air Raid Matters, German Air Forces Dr. Lempp, Director, City Health Department, Stuttgart Dr. Mann, General Director, I. G. Farben, Leverkusen Prof. Marx, Director, Luitpold Hospital, Wurzburg Prof. Meissner, Ophthalmologist, University of Munich Dr. Mertens, Director, I. G. Farben, Leverkusen Dr. Moritz, Chief of Department II in the German Ministry of Food and Agriculture Dr. Mueller, Water and Sewage Department, Hamburg Dr. Nachtigall, Hygienist, Hamburg Prof. Nauck, Director, Institute of Tropical Medicine, Hamburg Prof. Nonnenbruch, Internist, University of Frankfort on the Main Dr. Nuss, Water and Sewage Department, Darmstadt Dr. Oechsler, Director of Provincial Food Office of Baden, Karlsruhe Mr. Ostrop, Mayor of Dortmund Dr. Peters, Obstetrician and Gynecologist, Dortmund Prof. Pette, Neuropsychiatrist. University of Hamburg Mr. Pfeiffer-Detering, Water and Sewage Department, Nuremberg Dr. Pickert, SS Obersturmbannfuehrer, Stuttgart Prof. Pieper, Dentist, Munich Dr. Plank, Director, Kaeltetechnisches Institut, Karlsruhe Dr. Recke, Chief of Horticulture, Reich Ministry of Food and Agriculture Prof. Reinecke, Surgeon, University of Hamburg Dr. Reinhold, Representative of Physicians Association, Stuttgart Dr. Richard, Water and Sewage Department, Kassel Dr. Riecke, Secretary in the Reich Ministry of Food and Agriculture Prof. Riedschel, Pediatrician, University of Wurzburg Dr. Rimpau, Bacteriologist, Munich Dr. Roper, Representative of Physicians Association, Hamburg Prof. Rostock, Professor of Surgery and Dean of the Medical School, University of Berlin; Deputy for Sci- ence and Research in the Office of the General Commissar for German Health Field Marshal von Rundstedt, Supreme German Commander in the JFest Prof. Runge, Obstetrician and Gynecologist, University of Heidelberg Dr. Ruppold, Director, City Health Department, Dortmund Dr. Schaertz, Director, City Health Department, Munich Prof. Schaltenbrandt, N euro psychiatrist, Udiversity of Wurzburg Lt. Gen. Scheel, Gauleiter of Salzburg 343 appendix A Dr. Schefold, Director, City Health Department, Ulm Mr. Schenkenberger, Director, C. H. Boehringer Soehne, Hamburg Prof. Schennert, President, Institute for Vitamin Assay and Re- search, Leipzig Prof. Schilling, Malariologist, Concentration Camp Dachau Prof. Schindler, Nymphenburg, Munich Prof. Schittenhelm, Internist, University of Munich Prof. Schleicher, Nymphenburg Hospital, Munich Mr. Schlink, Director, Municipal Hospital, Dortmund Prof. Schmidt, Director, Behring Works, Marburg Brig. Gen. Schmidt, Director of Aviation Medicine, German Air Forces Dr. Schmucher, Municipal Hospital, Augsburg Mr. Schoenleber, Director, Municipal Hospital, Frankfort on the Main Prof. Schroeder, Internist, University of Munich Mrs. Schultz-Klink, Leader of German Women Major Siecke, Chief Drug Supply Branch, Brandt Office, Flensburg Dr. Spiedel, Leader of National Socialist Physicians, Wur- ttemberg Prof. Stepp, Internist, University of Munich Dr. Stratmann, Director, Personnel, Krupp Industries, Essen Dr. Tessmann, Manager, I. G. Farben, Leverkusen Miss Toenisson, Apothecary, Brandt Hospital, Eisenberg Mr. Tscherbring, General Director, Reichelt A. G. Hamburg Prof. Veiel, Medical Director, Municipal Hospital, Ulm Prof. Viele, Medimal Director, Krupp Industries, Essen Dr. Virbacher, Director, Municipal Hospital, Augsburg Prof. Voenckhaus, Internist, Dortmund Prof. Volhard, Internist, Unicersity of Frankfort of the Main Dr. Von Essen, Chief Health Officer, Cologne Mrs. Von Oertzen, Chief Nurse, German Red Cross Maj. Gen. Walter, Director of Medical Services, German Army Prof. Weese, Pharmacologist, I. G. Farben, Elberfeld Major Weiser, Pharmacist, Office of Medical Supply, German Armed Forces Dr. Winter, Public Health Officer, Stuttgart Prof. Wiskott, Dean, Medical School, University of Munich Prof. Wirz, Expert consultant to the National Socialist Party on Food, Munich Maj. Gen. W'uerfler, Chief of Staff to the Director of Medical Ser- vices, German Armed Forces Dr. Wuertzler, Director General, /. G. Farben, Ludwigshafen Prof. Zangemeister, Oto-Rhino-Laryngologist, University of Hamburg Dr. Zanglmayer, Internist, Augsburg Maj. Gen. Zeitler, Chief of Hospitals, Office of the Chief Medical Officer, German Air Force Dr. Zimdars, Consultant on Midwifery to Reich Health Leader Dr. Zundikuss, Director of Provincial Food Office of Bavaria, Munich Dr. Zutavern, Director, Knoll A. G., Ludwigshafen 344 appendix B ALLIED BOMBING AND THE GERMAN ARMED FORCES In mid-summer 1945 the Military Effects Divi- sion requested the Medical Branch to assemble what data it had relative to the effect of bombing on medical care in the German Armed Forces. This information which was supplemented by a number of interviews with high German military authorities was gathered in the following report submitted by Lt. Col. Richard L. Meiling, Chief of the Morale Division. Germans to have been much more severe and devastating than that experienced on the Russian Front. No defense was possible against the round- the-clock British and American low level attacks with heavy caliber weapons.1’2 During the Russian campaign the Germans suffered heavy casualties. Due to the very primitive conditions existing in that portion of Russia occupied by the Ger- mans, it was necessary to evacuate casualties to the homeland during the summer of 1942. At this same time, the homeland was just beginning to gird itself to resist the increased tempo of aerial attacks from the west. This resulted in both the civilian and mili- tary authorities competing for the available sani- tariums, hotels, schools and public buildings which might be converted to hospital use. This competi- tion extended to the demands for hospital equip- ment, supplies, pharmaceuticals, and even to the demands for available physicians and nurses. To control this impossible situation, Hitler desig- nated General Handloser Director of Medical Ser- vices of the German Armed Forces in July, 1942. Under the Armed Forces were included the Army, Navy, Air Force, SS, Labor Corps, Police, Hitler Youth, Organization Todt, and all the other semi- military organizations, each of which maintained an independent medical service. At this same time, Hitler appointed Professor Karl Brandt, associate professor of Surgery at the University of Berlin, “Reichs Commissar for Military and Civilian Health and Medicine. 5 In addition to the necessity of having a plenipotentiary direct the medical ad- ministration between the civilian and the military sectors someone was required who could restore the confidence of responsible German authorities in the medical services which were supposed to have been severely undermined because of the catastrophic losses on the Russian Front (1941-42) and the incompetent evacuation of wounded to the German homeland. Brandt's powers were unlimited and he was re- sponsible to Hitler alone. He was to coordinate on a national level all the civilian and military ques- tions pertaining to medicine or health concerning Medical services of the German Army lOKHI Prior to 1941, the German Army Medical Ser- vice was, like all other services, divided between the Administrative Section of the German Army General Staff (this included the Army Inspector- ates and the Army Reserve) and the German Field Army. The latter was composed of the tactical units in training in the homeland as well as all the tactical units in the combat zones. In January, 1941, Major General Handloser was appointed Director of Medical Services in the Ger- man General Staff and upon his recommendation the medical services of both the Administrative Section of the General Staff and of the German Field Army were consolidated in his office. General Handloser, while holding this dual position, re- tained the respective staffs of the two former posi- tions and these staffs continued throughout the remainder of the war to function as independent organizations under General Handloser and later under General Walter, who succeeded Handloser in August, 1944. Handloser was, in addition to his other duties, Director of Medical Services of the Armed Forces, which position he still held in May, 1945, on the cessation of hostilities.1 Aerial warfare During the Russian campaign in the winter of 1941-42 the German Ground Forces were first sub- jected to considerable amount of low level aerial strafing. This strafing proved a serious hazard to all combat troops and the medical services attached to them. The aerial strafing later inflicted by Allied airmen on the Western Front was stated by the 345 appendix B personnel, research, education, production, distri- bution, storage and requirements of medicine and associated supplies, instruments and equipment as well as the allocation of raw materials to the medical and associated industries. Brandt’s mission was declared successful by both Dr. Conti, head of the civilian medical sector and General Hand- loser, chief of the Armed Forces medical ser- vices.l, 3 pitals of the Armed Forces every three months and to make spot checks at more frequent intervals for the sole purpose of clearing them of all patients who might “possibly be used for some further military service although their wounds were not completely healed.’’1 Concurrent with these seemingly drastic mea- sures, the Germans developed the so-called stomach battalions, amputee battalions, eye battalions, etc., composed of personnel whose medical condition placed them in the specified grouping. Special medical service and dietary arrangements were in- corporated in the administrative direction of these units.l, 4 Patients and casualties According to Handloser, there were approxi- mately 5,000,000 wounded in the Armed Forces during the years 1939-1945. An additional 2,000,- 000 were missing and 2,030,000 were killed. Hand- loser stated that of the 2,000,000 missing approxi- mately 50 per cent must be considered dead. This is due in part to the fact that a number were re- ported missing following aerial bombing or straf- ing and because the Russians did not report prison- ers of war through the agencies of the International Red Cross. No record is available as to the actual number of Germans taken prisoner by the Russians. Prior to 1943, infantry weapons were the lead- ing cause of casualties. Artillery fire was second and aerial bombardment and strafing third. In the latter part of 1943, aerial strafing and bombard- ment shifted to first position, followed closely by artillery, and during 1944-45 aerial weapons (bom- bardment and strafing) were far ahead of either artillery or infantry weapons as a cause of casu- alties in the Wehrmacht.1 In 1940-41, the ratio of wounded to killed in the German Army was eight to one. By 1943, this had shifted to five to one, and during 1944 and 1945 the records revealed that for every three wounded one was killed. The military authorities attributed this shift entirely to the devastating ef- fect of aerial warfare. It must be remembered that in a great number of instances many were officially reported as missing who actually had been killed (destroyed or buried) by aerial bombardment.1 Beginning in 1943, a definite shift in the type of hospital patients was noted throughout the Armed Forces as a result of aerial warfare. The patients received severe and multiple type wounds which resulted in longer periods of hospitalization and convalescence. There was a decided reduction in the number of those who could be returned to either full or limited military duty. In 1944, this trend became so serious that special medi- cal commissions were established to visit all hos- Hospitals and medical installations The actual destruction of military hospitals was, according to the German medical authorities, purely coincidental with aerial warfare. The Ger- mans had the impression that the Air Forces of the Western powers did not respect the Geneva Convention insignia on hospital facilities, hospital trains, hospital ships, ambulances and field medi- cal installations.1*2 It is interesting to note that, in 1940, Hitler decreed that all Red Cross insignia were to be removed from military medical installa- tions and equipment. This decision was made upon the recommendation of the leaders of the German Air Force who felt that enemy aviators could use the Red Cross insignia for the purpose of locating large troop concentrations and military installa- tions. Early in 1944, as the result of questioning of both British and American aviators who fell into enemy hands as prisoners of war and because of the observed air policy of the Allies in the Mediterranean Combat Zone with respect to medi- cal installations adequately marked with the Red Cross insignia, Hitler again issued a decree order- ing all military medical installations to be re- marked with the conventional Red Cross insignia.2 Inasmuch as at this time the home front was be- ing subjected to severe bombings, the civilian authorities requested permission to place the Red Cross insignia upon the civilian medical installa- tions. The German military authorities objected to this procedure and the question was referred to the International Red Cross Agency at Geneva. This agency advised the Germans that the civilian medi- cal facilities should be marked with a large red square on a white field rather than with the red cross on a white field. 346 appendix B Although a great number of civilian and mili- tary hospital and medical installations were de- stroyed both in the combat zone and in Germany, the requisition of hotels, schools, etc., provided emergency hospital facilities. No reports or records were found to indicate that military patients could not be hospitalized due to lack of space. ments of the German General Staff for the defence of the homeland. Due to the political as well as military and inter- national complications which had developed dur- ing the initial phases of these negotiations, the Swiss government made a counter proposal. It proposed, for humanitarian reasons, to accept at any one time a total of 20,000 German military or civilian patients in Switzerland for hospital or convalescent care. According to General Handloser, the Swiss were to feed, house, and provide medical, surgical and rehabilitation services for these pa- tients. The political significance and the interna- tional negotiations involved so delayed the two plans that at the end of December, 1944, the mili- tary proposed the city of Constance (which was used for a similar purpose in 1914-1918), lo- cated on the Swiss-German border, as an “open city,” available for the mutual exchange of re- patriated prisoners of war between the Germans and the Allied powers (except Russia) and for the purpose of establishing military and civilian hos- pitals where patients would be free from the con- stant fear of aerial attacks. All the interested Ger- man military and civilian governmental agencies concerned agreed to the use of Constance. In January, 1945, final approval was requested of Hitler. This approval was not given. Whether the decision could actually be attributed to Hitler or to his political deputy, Bormann, could not be de- termined by the German military authorities. They were unanimous in their belief that the stated reason for the refusal, namely that Constance was on the Swiss border, was purely to cover the real reason, i.e., an international request would be an admission of defeatism and the success of the Allied air offensive. Negotiations were also under- taken through the International Red Cross and the Swedish Government for the establishment of Flensburg on the German-Danish border as an “open city. These negotiations likewise were un- successful probably because of fear of the brand “defeatism.” "Open cities" and proposed "open medical zones" In view of the destruction of hospitals from aerial bombardment throughout Germany and the terrific psychic trauma produced by continued air warfare upon combat patients who had been evacu- ated to the homeland for medical care and recuper- ation, General Handloser proposed a study to con- sider plans for the establishment of so-called ‘‘open medical cities'" or “open medical zones.” These, he thought, would be respected by the air forces of the Allied nations and not subjected to air attacks.1 General Sauerbruch, Professor of Surgery, Uni- versity of Berlin, aided in this study, as he was highly desirous of finding a city free of air at- tacks to which he could evacuate the amputee cases. Both Handloser and Sauerbruch were successful in presenting the problem to the Chiefs of Staff of the German Armed Forces, and received permis- sion to present the plan through the Military At- tache Division to the German Foreign Office. In the spring of 1944, the German Foreign Office, however, was extremely reluctant, for political rea- sons, to give full and open support to the idea of establishing “open cities" through international ne- gotiations. The Medical Services of the Armed Forces, the General Staff and the Foreign Office finally agreed to the selection of specific cities which were to provide a haven for hospitals, both military and civilian, and for the production and storage of certain critical and essential medical supplies. These cities or zones were to be free from all armament industry and military barracks and, as far as possible were to be in no way connected with rail or motor transportation centers. By August, 1944, the negotiations had developed sufficiently to permit contact with the Swiss legation at Berlin. The negotiations continued throughout the fall and winter months. By December the origi- nal 42 proposed German cities were reduced to 12 which could meet the conditions established for international negotiations with the United States and Britain as well as meet the strategic require- Medical supplies The Wehrmacht maintained medical supply de- pots in each of the various Army, Navy or Air Force districts. The German Field Armies also maintained medical supply depots within each Army and Army Group area. During the disastrous incendiary raids on Hamburg in July and August, 1943, one of the largest military medical supply 347 appendix B depots in Germany was completely destroyed. After this disaster and because of the increasing destruc- tion of other medical supply depots throughout Germany, orders were issued to all commands that medical depots and medical supply dumps of field armies should be dispersed into eight to fifteen separate units, depending on military circum- stances, and that each unit should contain at all times complete and identical stocks of supplies. It is evident that this program made a tremendous increased demand upon the pharmaceutical and medical industry and national stockpile.l, 5 This increase came at a time when the air raids on cities throughout Germany necessitated more medical supplies for civilian use. The key cities in the German pharmaceutical and medical supply in- dustry were being crippled by bombing. The tex- tile industry, the absorbent material industry, the glass industry and other associated industries were being damaged and in many cases destroyed by aerial bombardment. In addition to this, the roads, bridges and railroads, the rolling stock, the trucks as well as gasoline and oil dumps were being at- tacked and severely crippled. This resulted in acute shortages which became most noticeable in 1943 for both the civilian and military sectors of the German nation. It became increasingly difficult to provide ether, plaster of paris, serums, bandaging material and morphine after the fall of 1943. To conserve the dwindling supply of critical raw mate- rials, Professor Brandt, in 1943, reduced the pro- duction of approximately 30,000 various pharma- ceuticals to approximately 600 on the military sup- ply lists. At the same time the production of 40 different types of x-ray equipment was limited to nine, and 137 different types of hemostats were re- duced to six. Only Army field operating room tables were manufactured for both civilian and military hospitals. Brandt’s organization established similar controls over all production of medical, pharmaceutical and hospital supplies. Had the Allies destroyed the Behring Works at Marburg, the German people, both civilian and military, would have been without tetanus and diphtheria serums.l,5 With reference to shortages, Professor Brandt stated that all types of hypodermic needles, knives, scissors and bandages were the most ur- gently needed. Heart stimulants, narcotics, anal- gesics and anesthetics were the most critical items. An instance is cited of both military and civilian hospitals near Flensburg being entirely without anesthetics in May, 1945, a shortage which was due more to transport difficulties than to lack of pro- duction.4’ 6> 7 Textile manufacture was also hit. There were seven factories in Germany which produced ab- sorbent material. By the summer of 1944, six had been completely or partially destroyed by bombing. Those still in operation found it impossible to con- tinue production due to the lack of transportation required to supply raw materials and coal. In Oc- tober, 1944, the Armed Forces directed command- ing officers to send their troops into the forests to gather a specific type of moss to be dried and sterilized for use in the preparation of absorbent surgical pads. Paper bandages were introduced as early as 1940-41. The rewashing of cloth bandages was a standard procedure.5 The destruction of homes, hotels and hospitals and the increase in military and civilian patients made operating room and bed linen a very scare article by October, 1944. New hospitals were issued a total of only one set of linen per bed.0 In December, 1944, Brandt ordered the release of the six months’ reserve of medical supplies which had been set up earlier in the year. Further releases were made in January, February and March, 1945, when replacements were no longer produced. On April 2, 1945, Brandt personally ap- peared before Hitler in Berlin to inform him that more than 20 per cent of all essential medical items were totally depleted; that another 40 per cent of essential items would last two months, and that the remainder would last four months provided transportation could be restored, sufficient guards could be placed at the storage areas to prevent looting and to assure equitable distribution be- tween the Wehrmacht, SS, and civilians, and no additional requirements would be made upon ex- isting stocks. Hitler gave no reply and Brandt with- drew from the conference room, later to he arrested and condemned to death as a defeatist and a traitor.0 As to the effect of the Russian campaigns of 1941 and 1942 on the medical supply situation, Handloser believed that although the losses were severe there would have been no particular replace- ment problem had the Germans not been subjected to the combined bomber offensive which began in the summer of 1942.1 By 1944, the destruction of the production and storage facilities for medical supplies and equip- ment as well as the terrific toll of aerial warfare upon the German transportation system resulted in 348 appendix B establishing a so-called critical medical item list in the Armed Forces. This contained approximately 350 individual articles. Each medical installa- tion in the Armed Forces was assigned a monthly quota which could not be exceeded on monthly requisitions. A maximum of 60 days’ supply in these items was permitted as a stock on hand/’ After 1943 both the military and the civilian agencies had to submit their requisitions and re- quirements to a National Commission charged with establishing the requirements and distributing the available critical pharmaceutical and medical mate- rials to all agencies.s Several senior medical officers of the German Armed Forces stated that at no time prior to 1945 were they actually without essential items required to maintain the medical services of their particular units in the combat zone.2 They all admitted, how- ever, that they often received repeated complaints from the civilian home front as to acute shortages there. In February, 1945, the medical services were directed by the Chief of the Armed Forces not only to care for civilian patients on an equal basis with military patients, but also to share wherever pos- sible available medical supplies with civilian medi- cal installations. This order specifically stated that the Armed Forces would not receive deliveries from factories or warehouses of any medical supplies during the succeeding six months as all available supplies would be consigned to civilian need.1 fronting the medical evacuation services; that it was impossible after the Normandy campaign to move patients in the combat areas except at night, and that this was accomplished at considerable risk to the patients and attendants. The medical evacuation service was forced to use country roads, which caused increased delay in transport between the various medical installations. This, in addition to the rough roads, contributed greatly to the in- creased hardships of the patients and the higher mortality rates experienced in 1944-45 by the Ger- man medical services. Wherever possbile, trans- portation of patients by cargo and transport air- planes was accomplished (air evacuation of casu- alties was first undertaken in the Russian cam- paign), but in 1944 and 1945 lack of air superior- ity on the part of the Germans greatly interfered with such air service.2 Aerial bombardment was considered in the same light as artillery bombardment so far as the medi- cal services in the forward areas were concerned.2 However, the aerial bombardment of cities and the resulting destruction of hospitals and disruption and destruction of rail and motor transportation facilities had a severe effect on the maintenance of an adequate functioning medical service. It is estimated that in the first months of 1945 with more than 1,000.000 patients in German military hospitals inside Germany there were less than 10,000 “available beds.” At a time when rail transportation was receiving its most devastating aerial blows, when the roads were safe only at night for motor travel and when the available gasoline was at a very minimum, this meant that the various military hospitals were so crowded that they could never accept at any one time more than from 20 to 25 patients (less than one carload). By March, 1945, the medical regulating system was completely bogged down and it was no longer possible to distribute correctly diagnosed patients to the proper medical or surgical centers. The only way out from then on was to find a hospital bed for each military and civilian patient in any available location.1 Evacuation services in the army The German Army at divisional level used both animal-drawn and motor ambulances. At the level of army and army groups there was a medical regulating officer attached to the Transportation Corps to control the distribution and use of hos- pital trains. Within the communication zone, which for the Germans was the homeland, there were medical regulating officers attached to the staff of the Transportation Corps Officer with each rail- road directorate. The office of the Director of the Medical Services of the German Armed Forces re- ceived weekly reports as to available beds together with actual and anticipated patient loads accru- ing at all of the various fronts and in the military districts. These reports, submitted in code or by teletype apparatus, were broken down into vari- ous medical and surgical groupings. All the medical officers interviewed stated that aerial strafing was the most serious problem con- The German medical plan for the anticipated Allied invasion of the Continent German medical authorities cognizant of the staff plans for resisting the Allied invasion, pre- pared their medical plan in the early part of 1944. Due to the increasing intensity of aerial attacks upon north and northwest Germany and the Rhine- land, the destruction of the Rhine bridges by aerial 349 appendix B attacks and the overtaxed and partially paralyzed German rail transportation system, the military medical authorities decided to set up a so-called “hospital-basis” inside France. This “hospital- hasis” was to be “self-sufficient” and would evacu- ate only the most serious cases into the Black For- est region, southern Germany and Austria, by utiliz- ing transportation routes across the Rhine between Karlsruhe and Basle.l, 2 Forty thousand new hospital beds were requi- sitioned throughout the towns and cities of France in an area extending from Paris to the Swiss border and north as far as Strassburg. In addition to the 40,000 beds, the commanders of the hospital centers at Paris and at Brussels were ordered to maintain 28,000 “available” beds, to handle casu- alties during the initial six weeks of the campaign. The military commanders of Wurttemberg, Baden and Bavaria were ordered to maintain a reserve of 20,000 beds for the most severe casualties from the “hospital-basis” in France.l, 2 The increasing tempo of air warfare against the invasion coast and throughout France in April and May, 1944, had practically filled the 28,000 “avail- able” beds in the Paris and Brussels centers prior to the Normandy invasion in June, 1944.1> 4 The rapid progress of the campaigns on both Western and Eastern Fronts in the summer of 1944 forced the High Command to make a deci- sion to expend all available effort, equipment and personnel to remove military patients from the onrushing Russian forces and to abandon all mili- tary patients to Allied Forces west of the Rhine. This decision was apparently made not only be- cause of the recognized “humanitarian attitude” of the Western Allies, as stated by army medical offi- cers, hut it was also apparently the only possible military solution to the medical evacuation prob- lem. By this time the destruction of the Rhine bridges and the rail and motor transportation in the area between Germany and the western combat zone had become, according to Field Marshal von Kesselring, a “transportation desert.”l, 4 The medical plan for the “Bulge” in December, 1944, was handled entirely by a medical officer, Major General Haubenreiser, of von Rundstedt’s staff. No special plans were made for the antici- pated casualties in the office of the director of medical services of the German Army. authorities interviewed the most terrifying phase of aerial warfare as far as combat troops are con- cerned was aerial strafing with heavy caliber weapons. They stated that aerial bombardment had approximately the same morale and psychologic effect on the troops as an artillery barrage.1’4 While officers and enlisted men alike were con- cerned about their loved ones and their homes which they knew were being bombed, it was im- possible for them to discuss the matter with each other due to the constant threat of the political party informers scattered throughout the Armed Forces. That aerial bombardment did have a severe effect upon the morale of the troops is to be found in the following two incidents. After 1943, the names of towns or villages subjected to aerial bom- bardment were no longer listed in the official re- ports sent to the combat troops when their relatives were known to live in zones endangered by heavy air raids.8 In the fall of 1943, provisions were made for the dependents of military personnel to secure certification from the local police authorities as to casualties suffered within the family or property damage suffered by members of the immediate fam- ily. The police dispatched this report over military telegraph communications to the field forces. Mili- tary personnel receiving such a telegraphic notice (this was the first time that the German military communications were made available for personal wires) were granted furloughs to visit their homes as far as militarily feasible. This furlough was computed according to the following four pos- sibilities: (1) death within the immediate family; (2) serious injury within the immediate famly; (3) serious damage to the home of the immediate family, and (4) total destruction of the home of the immediate family.9 From five to fifteen days’ furlough was granted in each case. The reference to the so-called “war neurosis” which in the last war was described in various forms of stuttering, paralysis, tremors, as well as spastic disturbances of the stomach, bowel and bladder, is very difficult to find in the reports of the German Armed Forces medical services be- tween 1939 and 1945. As far as could be ascer- tained, Dr. Bumke, Professor of Psychiatry at the University of Munich, was in charge of the only section of a military hospital available for the so- called war neurotics. Professor Bumke stated in an interview that there was not a sufficient number of these war neuroses or hysterical patients to Morale of troops According to the German military medical 350 appendix C-1 maintain such a section of the military division of his hospital. The director of medical services of the Armed Forces issued instructions in 1942 stating that similar departments would not be established in military hospitals. Such patients were not to be isolated but should be hospitalized in the same facilities as provided for other military patients. According to the material found in the official documents of the consulting psychiatrists to the medical director of the Armed Forces, the diag- nosis of war neurosis, shell shock, combat fatigue and war hysteria was absolutely forbidden. In place of the above-mentioned diagnoses they used such terms as “psychogenic speech deformity” or “psychogenic muscle paralysis.” It must be recalled that release from military service had a definite effect on the standard of liv- ing of the individual German and it was far better as far as the food and housing were concerned to be a member of the Armed Forces than to be assigned to a labor battalion or similar organiza- tion. Medical officers could not release from active duty a patient who had developed a psychosis or neurosis in military service; they were required to recommend his placement at some duty station with the service elements. No attempt was made in this study to explain the low incident of the so-called psychogenic disorders as reported in the German Armed Forces, even among the personnel subjected to the heaviest artil- lery barrages and to the devastating effect of Allied aerial strafing and bombardment. REFERENCES USSBS Interviews 1. No. 75, Maj. Gen. Siegfried Handloser, July 27, 1945. 2. No. 76, Maj. Gen. Walter, July 20, 1945. 3. No. 82, Brig. Gen. Paul Wuerfler, June 29, 1945. 4. Col. Joedicke, July 20, 1945. 5. No. 46, Capt. Heinz Gluck, June 15, 1945. 6. No. 64, Prof. Karl Brandt, June 17-18, 1945. 7. No. 78, Walther Hartman, June 30, 1945. 8. No. 63, Brig. Gen. Hans Goldbeck, June 15, 1945. 9. No. 77, Maj. Gen. Schroeder, June 20, 1945. appendix C-1 Abstract of NSV Action in the GREAT HAMBURG CATASTROPHE (JULY 24 TO AUGUST 3, 1943) (NSV-Aktion in den Hamburger Grosskatastrophen+agen von 24 Juli bis 3 August, 1943) Food (p. 6) Though right after the all clear signal, in the middle of the night, preparations were made to use those cooking facilities and foodstuffs put down in the “G.K.”—plan, it was found that extremely high percentages of cooking placed and food raw materials were destroyed. The zone warehouse, too, with its great stores of food and textiles was severely damaged by fire. If in spite of all, it was possible to isolate the textile warehouse from the adjacent blazing food warehouse and in this way save it, this is due solely to the fearless action of a few co-workers. To care for the people in the particularly heavily hit districts 2 and 7 became urgently necessary. From the beginning on, the situation was aggravated due to the destruction of Kreisamt 7, and the further destruction of a number of Ortsgruppenaemter located in the Kreisaemter 7 and 2. In spite of this, in the course of the first day there was a relatively orderly distribution of almost 200,000 portions of hot and cold food by approximately 500 emergency kitchens and 160 distribution stations. 351 appendix C-l (p. 11) After the night 27-28 July, 1943, which in intensity far surpassed the one of 24-25 July, five large collecting centers were established. They were: on the Moorweide, in the City Park, on the Horner race-track, the Farmsener race-track, and in Billstedt. Immense crowds gathered there. It was the task of the City commandant to put to use all available forces and means. Up to the evening 1,200,000— among them evacuees, those who remained behind, policemen and members of the Armed Forces were fed. Among other things approximately 500,000 loaves of bread, 160,000 liters of whole milk, tens of thousands of bottles of beer, sodas and enormous quantities of coffee and tea in pitchers were dis- tributed. The collecting centers became large, well stocked warehouses. Huge staples of cheese, rows of barrels filled with butter, immense quantities of boxes of canned meat and fish and other food- stuffs made an impressive picture. There was nothing missing, even stocks of fruit, jam, cigarettes and ice cream were distributed. Food was procured through requisitions from the Landswirtschaftsamt. It arrived- by express from far away places, some of it was even confiscated. Mention must be made of huge stocks saved from destroyed warehouses. Preparation of hot food, however, became a still more difficult problem, since in those parts of the town that were bombed again and almost completely destroyed practically no cooking facilities ex- isted. More and more field kitchens of the Armed Forces had to be used, likewise five large kitchens, including one each of the Gauleitungen Ost-Hannover Mecklenburg and Schleswig-Holstein, (p. 12) The kitchen train Bavaria delivered food temporarily from Hagen in Westfalen. Particularly helpful, in ad- dition, were four food railroad trains. The food train that was in the station in Hannover was almost completely wrecked during that night. Only through uninterrupted work by its own crew, lasting several hours, was it possible to save the largest part of the train, and in this way approximately 18,000 liters of hot food could be prepared daily. Besides the procurement of insulated containers for the transportation to the food distribution places, it was difficult to obtain water and dishes. In addition, working girls, women and other help had to be obtained for peeling potatoes, cleaning vegetables, etc., etc. (p. 20) Special NSV figures. The following were distributed: From 25-27 July 1943 daily 200,000 portions each of hot and cold food. On 28 July 1,200,000 people ] , . , , , f , On 29 July 1,000.000 people J received cold and hot food On 30 July 800,000 people 1 , , , , , . , On 31 July 400,000 people j received cold and hot food From 25 July to 14 September 1943 the following items were distributed: 6.5 million portions cold food 6 million portions hot food 22 million y2 liters of beverages On 28 July alone 500,000 loaves of bread were given out. The following kitchen and cooking places were in operation from 25 July-14 September: 126 field kitchens (3 of the Armed Forces and 15 owned by the Zone) 5 big kitchens belonging to the Zone 3 railroad food trains and 340 emergency kitchen in place of business, restaurants, schools, etc. (p. 23) The carefully planned erection of decentralized emergency kitchens within the entire town was of no avail, because all of a sudden gas, water and electricity ceased to function. The feed- ing of the homeless as well as the entire population was of such decisive significance that the im- mediate removal from the interior of the town and the inclusion of large collecting stations became a necessity. If cold food is being procured, it appears advisable to deliver the goods if possible in 352 appendix C-2 smallest quantities or packed, i.e. canned meat and sausage in small cans, since these cans may be used as a hot dish if heated. Too many precautions for the serving of warm food cannot be taken, in order that food may be cooked and issued in sufficient vessels even when normal supply of electricity and water fails. (p. 24) Rooms should be kept available in temporary camps and places in which children may be sheltered, washed and fed. Midwives and nurses should be provided in these places. Baby food (canned milk, tea, zwieback, Naehrmittel, sugar), baby laundry (particularly diapers), bottles, nipples, sani- tary napkins and similar things must be at hand. appendix C-2 Minister for Food and Agriculture (Der Reichsminister fuer Berlin, February 20, 1945 Ernaehrung und Landwirtschaft) To The Provincial Governments The Prussian State Presidents provincial Food offices Through Channels to District Presidents and Corresponding Offices. REGULATION GOVERNING THE RATION SYSTEM FOR FOOD FOR THE 74TH RATION PERIOD FROM 2 APRIL-29 APRIL 1945 (WITH SUPPLEMENTS FOR THE 73rd RATION PERIOD) THIRD PART Orders and other regulations CHAPTER ONE Reorganization of Food Ration cards • Since it cannot be estimated with certainty to what extent food can be distributed to consumers, food ration cards will no longer show kind or quantity of food because of the present supply and transportation situation. The food to be distributed to consumers will be publicly announced. The Food Offices (Ernaehrungsaemter) are to announce before the beginning of each distribution period the food to be distributed in accordance with the orders given by me in conformity with available quantities. The retailer is directed to announce these quantities by displaying a poster in his windows. Con- 353 appendix C-2 cerning the possibilities of exchange of food, I refer to my publication of January 29, 1945, II B 1-500H, in which I gave the necessary authority to the Provincial Peasant Leaders (Laudesbauern- fuehrer). The food ration cards, therefore, comprise blank coupons identified solely by a number de- noting the respective distribution period, and with a consumer group mark, for instance, K for Kind (child). However, in order to avoid the announcement of small quantities required for eating in restaurants, the food ration cards contain coupons for bread and fat imprinted with the quantities 50 grams for bread and 5 grams for fat. The cards look like the samples enclosed. The further enclosure shows which coupons are provided for the uniform distribution of food for the entire Reich, which coupons are at the disposal of the Reichsminister for Economy for the distribution of soap products, and finally which coupons can be disposed of by the Food Offices (Landes- ernaehrungsaemter) for local distributions. The announcement of the quantities of food by the Food Offices makes it nec- essary further to simplify the ration card system. Basic and supplementary cards are therefore consolidated into collective cards. The classification of age groups has been simplified so that food ration cards are issued only for: Children up to 6 years (K) Children and adolescents from 6 to 18 years (JGD) Adults over 18 years (E) For partial self-suppliers and full self-suppliers, collective cards are also issued patterned on the principles applied to non-self-suppliers. The partial self-suppliers are also divided into three age groups, while the full self-suppliers receive cards only for children up to 6 years (K) and for consumers over 6 years. Besides, the full self-suppliers receive, in accordance with prevailing rules, bread rations, the quantities of which are also to be announced publicly. Enclosed is a sample of the new Reich bread card for self-suppliers. As far as the Reich milling cards are concerned, a separate decree will be issued. Likewise, for the issuance of the different kinds of food, further simplifica- tions are necessary. Regarding bread, the classification into zones and the differ- entiation between wheat and rye bread has been omitted beginning with the 74th ration period. The consumer, therefore, will receive only bread for his bread cou- pons, or, as far as provided, flour at the rate of 100:75; as far as fat is concerned, the differentiation into fat categories will be omitted. It is the responsibility of the retailer to distribute the available food supplies in a just and equitable manner. If wheat flour is available, it will be distributed against bread ration points first to the sick who are entitled to it in accordance with the decision of the local medical board, and then to small children. Lard, melted butter or salad oil are to be distributed, if available, against fat ration points at the rate of 100:80. Food coupons are valid only if attached to the food ration card. The food ration card contains a remark to that effect. My decree of 30 August 1944-11 B 1-68 regarding loose coupons of basic and supplementary ration cards is voided. Supplementary cards for long- and night-workers will be eliminated in the future. However, weekly supplementary cards are issued for heavy and very heavy workers, in accordance with the principles established for collective cards. The quantities to be distributed to these two groups are also to be announced publicly. The same applies to the AZ (foreign civilian workers), sample cards of which are included. Those fed communally receive principally the same rations as normal con- Appendix 1-3 (Anlagen 1-3) Appendix 17 (Anlage 17) Appendix 4-11 (Anlagen 4-11) Appendix 12 (Anlage 12) Appendix 14-16 (Anlagen 14-16 appendix C-2 sumers. Insofar as those communally fed should receive higher or lower rations, adjustments will be made by a special decree. The issuance of ration cards is simplified on similar lines. The clearing houses have to account for the coupons of the ration cards as to the quantities either printed or announced publicly; for instance, if a loose coupon has been designated for the purchase of bread, it passes as a bread ration point. But in the future, ration cards are to be issued only for flour, fat and Naehrmittel. Further subdivision of these foodstuffs is to be omitted. The retailers, on the basis of these cards, may purchase the required quantities from wholesalers. For the issuance of wholesale ration cards the same principles apply. To the extent that the card distribution centers are authorized to issue wholesale ration cards, they regulate the methods themselves. The distribution of potatoes will conform with existing regulations. The ra- tion coupons for whole milk and skimmed fresh milk remain valid for the 74th period, with the provision that children up to 6 years receive whole milk and non- self-suppliers over 6 years skimmed fresh milk. The whole milk ration for children up to 6 years has been fixed uniformly at liter daily. To compensate for the smaller quantities given to children under 3 years and the omission of whole milk for children between the ages of 6 and 14 years, increased fat rations will be issued. Order forms for whole milk and skimmed fresh milk are attached to the respective cards. Otherwise, the existing regulations remain valid. In order to avoid difficulties arising through the transportation of the mats for printing the food ration cards, I desist from producing them uniformly for the Reich. The Provincial Food Offices themselves are directed to print ration cards in accordance with the enclosed samples. The printing must be done in such a man- ner that the consumers receive the cards in time. Yellow paper (color No. 4) must be used for the collective food cards pertaining to the 74th Ration Period. The existing regulations remain valid for the printing of the other ration cards. Ac- cordingly, Reich bread cards for self-suppliers will be printed on green paper (color No. 30), Reich milling cards on green paper (color No. 30), supplementary cards for heavy and very heavy workers on brown paper (color No. 160), weekly cards for foreign civilian workers on dark yellow paper (color No. 22). I wish to point out that the rationing system must be maintained to insure equal distribution of food for the entire population. The chiefs of the Provincial Food Offices have been authorized by my circular of January 25, 1945-11/1-4018 g-M 291/45 to print the ration cards in case of emergency in a very simple man- ner, i.e. on ordinary paper of a different color, and if necessary, without water- marks. Due to the fact the 72nd and 73rd ration period had been extended to last an additional week, supplementary cards for heavy and very heavy workers as well as AZ cards, were issued only for the second, third and fourth week. Modi- fying my order of February 1, 1945-11 B 1-256, civilian foreign workers are to receive for the 73rd distribution period, in accordance with the mats sent out, four AZ weekly cards which are to last until April 8, 1945. SECOND PART Final Decisions The consumers are directed to turn in the order forms No. 74 for whole milk and skimmed fresh milk to the distributors during the week of March 26-31, 1945; if the Food Offices (Ernaehrungsaemter) do not limit the date to any one day of this week. The directives of this decree regarding the distribution for the period from Turning in of coupons. Validity. 355 appendix C-3 April 19, 1945, to April 29, 1945, will be enforced on April 9; the other orders, if nothing else has been decreed, immediately. It is directed that the Food Offices and card distribution centers be informed immediately by dispatching a copy of this decree. The decree will be published in the “Deutschen Reichsanzeiger.” Copies are enclosed. Charged with the conduct of affairs: (signed) Backe appendix C-3 FOOD STOCKS IN GERMANY DURING THE WAR YEARS Bread-Grain Balances for Greater Germany as of 1 Sept. 1939 (in 1000 T grain-value) Fiscal Tear 1.8. - 31.7. 1938/39 1939AO 191*0/1*1 191*1/1*2 191*2/1*3 191*3/1*1* A. Available quantities 1. Supply at the beginning on 1 Aug. Rye incl. flour 1750 3621* 3682 1017 632 829 Wheat 1550 2760 2501* 966 1*22 1*18 Total 3300 638I4 6186 1983 1051* 121*7 2. Harvest^ Rye 9701 9301 7091 8003 6222 6391 T«heat & Spelt 61*35 5597 1*558 1*799 1*025 1*888 Total 16136 11*898 1161*9 12802 1021*7 13279 3. Barley for Bread From harvest - - - - 1566 ICO 1*. Imports Rye incl. Flour Unmilled 11*6 31*1* 51*3 121*8 161*0 191*7 V/heat incl. Flour Unrailled 1016 1126 866 1781* 1911* 1930 Barley for Bread — _ — 38 Total 1162 H*70 ll* 09 3032 3592 3877 l.-U. Total Available Rye 11597 13269 11316 10268 814911 11167 Wheat 9001 91*83 7928 75U9 6361 7236 Barley - - - - l60l* 100 Total 20598 22752 1921*1* 17817 161*59 18503 B. Consumption 11211* 16566 17261 16763 15212 16368 C. Balance as of 31 July 63814. 6186 • 1983 1051| 121*7 2135 356 appendix C-3 Bread-Grain Consumption (in 1000 T grain-value) Fiscal Year 1.8. - 31.7. 1938/39 1939/UO 19I4O/U1 19U1/U2 19U2/U3 i9a3/aa !• Seed Rye 720 733 730 733 713 700 Wheat U30 U29 Ul5 U27 381 Uoo Total 1150 1162 nU5 1165 109^ 1100 2. Food consumption a) Bread Non self-suppliers 7U50 7829 7527 6718 6153 75802' Self-suppliers 2905 2798 260U 2579 2385 2U10 Armed Forces (incl. Naehrmittel) 1132 1785 2238 3070 3220 b) Naehrmittel w/o Armed Forces 350 #9 U30 530 U38 530 c) Substitute Coffee Rye So 188 195 121 15 60 a)-c) total Rye 553U 6901 72UO 7122 6007 7535 Wheat 5221 5505 #01 5073 U507 56U5 Barley - - - - 15U7 620 Total 107# 12U06 125U1 12195 12061 13800 2a)-c) in flour values Rye U300 5380 5330 6200 5660 7080 Wheat Ul60 U250 U170 U350 3980 U625 Barley - - - - 1270 515 Total 8U6O 9630 10000 10550 10810 12220 Index 1938/39 - 100 11U 118 125 125* 11*5 3. Deficient territories 12 308 1200 1305 1002 1115 U. Consumption a) Armed Forces 60 _ 263, N 11 b) Civilians 2297 2630 2375 1835^ 10 hh 353a) l.-ii. Total consumption Rye 7973 9587 10299 9636 7665 9522 Wheat 62U1 6979 6962 7127 59U3 6?U6 Barley - - - - l60ii 100 Total 1U21U 16566 17261 16763 15212 16368 as of 31 July 638U 6186 1983 105U 12U7 2335 1) Contained in consumption of Non-self suppliers. 2) Including 1;50,000 T in exchange for potatoes, 3) Including 50,000 T in exchange for potatoes. 1*) Consumption figures are based on official harvest results. Assuming that by enlarging the hectarage in 19i*l/l*2 the rye harvest rras higher by seme 300/500,000 T5 the actual consumption must have been higher by that amount. For 19h3/hh one can figure on an increased rye harvest of 600,000 T, and on an increased iiheat harvest of 1;00,000 T, totaling one million T, 357 appendix C-3 Meat Balances for Greater Germany, as of 1 Sept. 1939 (in 1000 T Dressed Meat) 1. Summary Fiscal Tear 1.9 - 31.8 1938/39 1939/Uo 19WU1 191*1/1*2 191*2/1*3 191*3/1*1* A. Available Quantities 1. Supplies at the begin- ning of the year. 2. Inland returns 111 2h 118 52 100 33^ a) industrial 2607 2320 1981* 1581* 1299 1336 b) house-slaughtering 687 669 601 $00 1*65 1*32 Total 3. Imports and deliveries 3291* of 2989 2585 2081* 1761* 1768 occupied territories. 290 1*63 5 A 662 7i*l 673 Total at hand 369$ 3U76 32U7 2798 2605 2)*7l* of -which industrial B. Consumption 1. Self-suppliers from 3008 2807 2U6L1 2298 211*0 20l*2 home slaughterings 2. Non self-suppliers and 687 669 601 500 1*6$ 1*32 other civilian needs. 2981* 2077 189U 1386 1257 1125^1 3» Armed Forces 589 637 750 802 7273) Consumption within Germany 1*. Deficient Territories 3671 3335 3132 2636 23 63 62 252U 1*8. 2281*. 35 Total Consumption C. Stocks at the end 3671 3358 3195 2698 2572 2319 of the year 2h 118 52 100 33 155 1) =Dead weight, plus chargeable part of the intestines, minus killing losses, shrink- age and raw fat deliveries. 2) regard to changes of stocks of self-suppliers* 3) =lncl. 16,000 T canned which were already delivered for the VI. War Year. li) =of which deliveries to fat econony, issuance of appr. 76,000 T meat in lieu of fat* 358 appendix C-3 For Greater Germany, as of 1 Sept. 15*39 (in 1000 T Meat) Meat Balances 2. Meat Yield from Slaughtering of Domestic Livestock. Fiscal Year (1.9 - 31*3) 1938/39 1939/1*0 191*0/hi 191*1/1*2 191*2/1*3 191*3/1*1* a. Slaughterings of German live stock per 1000 head Pigs industrial 15011* 15132 10265 6957 3670 6073 home-slaughterings 10027 981*0 91*10 881*0 7805 6712 Total Pigs 250U1 21*972 19675 15797 111*75 12785 Ca ttle 14,89 3781* 1*088 3698 3569 2683 Calves 5651* 6001 6356 6512 6276 6239 Total Cattle 1011*3 9785 101*1*1* 10210 981*5 8922 Sheep 2257 161*1 1706 1320 1167 H89 Horses 168 162 228 161* 11*2 168 b. Average dead-freight in kg per head Pigs industrial 102 96 95 92 98 96 horne-slaughterings 111* 113 106 91* 99 107 Total Pigs 107 103 100 93 99 Cattle 252 21*7 21*2 231 218 229 Calves 1*2 39 36 35 33 32 Sheep 21* 21* 23 23 23 23 Horses 262 258 253 233 229 223 c. Returns from slaughterings of German animals in 1000 T dead-weight Pork industrial 1529 1253 978 638 358 581 home-slaughterings niii 1111 99 8 831 773 716 Total 2670 2561* 1976 11*69 1131 1297 Beef 1133 933 991 851* 779 615 Veal 235 236 229 226 208 203 Mutton 55 38 39 30 27 27 Horsemeat 10* 1*2 58 38 32 37 Total 1*137 3813 3293 2617 2177 2179 of which industrial 2996 2702 2295 1786 liiOl* 11*61* d. Returns from slaughterings of German animals in 1000 T of dressed meat Pork industrial 1269 U96 812 530 30i* 500 hcme-slaughterings 687 669 601 500 1*65 *32 Total 1956 1865 1013 1030 769 932 Beef 1038 856 908 790 71*6 589 Veal 220 220 212 2n 201 197 Mutton 55 38 39 30 27 27 Horsemeat 15 11* 20 13 n 13 Venison 10 10 10 10 10 10 Total 329* 2989 2) 2585 2) 2081* 1761* 1768 of which industrial 2607 2320 2) 1981* 2) 1581* 1299 1336 1) Dead-weight, incl. chargeable part of intestines; minus killing losses, shrinkage and raw-fat delivery. 2) September 1939 to May 19Ul without horseraeat, since not rationed. 359 appendix C-3 Fat Balances of Greater Germany* as of 1 Sept. 1939 (in 1000 T Commercial Fat) Fiscal Year 1.8 - 31.7 1939/1*0 i9Uo/ia 1910/1*2 19lt2A3 19l;3/U A. Available Quantities 1. On hand 1 August a) Butter and melted butter as butter fat. 28 82 65 Uh 96 b) Slaughter fat (as raw fat) 23 U2 12 6 18 c) Margarine-raw materials 576 361 2UU 170 112 Total supplies 627 U85 321 220 226 2. German production a) Butter 681 686 685 710 682 b) Slaughter fat (as raw fat)Uli3 37U 299 228 2U1 c) Tallow 30 39 38 36 25 d) Oil harvest as margarine 25 20 no 67 273 e) Meat fat - - - - 35 Total Domestic Production 1179 1119 1132 loll 1256 3. Imports a) Butter 12U 121 88 lU8 139 b) Slaughter fat (as raw fat) 57 26 12 U 1 c) Margarine-raw materials 265 233 159 223 63 Total Imports hU6 380 259 375 203 Available quantities total a) Butter 833 889 838 902 917 b) Slaughter fat $23 hh2 323 238 260 c) Margarine 896 653 55i U96 U73 d) Meat fat - - - - 35 Total Available 2252 1981i 1712 163 6 1685 B. Consumption a) Butter 75l 82U 79k 806 852 b) Slaughter fat (in raw fat)U8l U30 317 220 2h 6 c) Margarine $3$ U09 381 38U 36U d) Meat fat - - - - 31 Total Consumption 1767 1663 1*492 IJ4IO 1*4.93 360 appendix C-3 Fat Consumption (in 1000 T Commercial Fat) Fiscal Year (1.8 - 31.7) 193 9Ao 19h0/hl 19JOA2 19U2/U3 19k3/Uh 1. Civilian Population on cards and ration coupons a) Butter 5U6 585 513 U88 528 b) Margarine 355 287 287 2U3 211 c) Slaughter fat (as raw fat) 191 1U8 85 29 51 b) Meat fat - - - - 16 Civilian Population Total 1092 1020 855 760 806 2. Self-Suppliers a) Butter 158 163 160 160 157 b) Slaughter Fat (as raw fat) 255 2U5 209 18U* 177 Self-Suppliers Total .103 Uo8 369 3Uli 33U 3* Armed Forces a) Butter Uo 63 95 136 13U b) Margarine 29 21 33 uu 59 c) Slaughter Fat (as raw fat) 35 35 21 6 lU d) Meat fat - - - - 9 Armed Forces Total ioU 119 A9 186 216 h. Deficient Territories a) Butter 7 13 26 22 22 b) Margarine 29 56 61 67 56 c) Slaughter fat - 2 2 1 l d) Meat fat - - - - 6 Deficient Territories Total 36 71 89 90 85 5. Technical Sector Margarine-Raw Materials 122 U5 - 30 33 6. Loss through enemy action - - - - 2> 19 7. Total Consumption a) Butter 751 82U 79U 80 6 8^2 b) Margarine 535 U09 381 38U 36U c) Slaughter fat (as raw fat) U8l U30 317 220 2U6 d) Meat fat - - - - 31 Total Consumption Total 1767 1663 1U92 1U10 1U93 Index 100 9h 8U 80 8U Total Consumption of Food in Reich 1609 15U7 A03 1290 1356 Index 100 96 87 80 85 1) Less subsidy territories and 5* Technical Sector 2) Contained in civilian r.nr.snmnti nn. 361 appendix C-3 Potato-Balance of Greater Germany as of 1 Sept. 1939 (in 1000 T) Fiscal Year 1.7 - 30.6. 1938/39 1939/40 1940/41 1941/42 1942/43 194^44 A. Available Quantities 1. Harvests 55983 56273 57447 47690 54423 29500 la. Estimated increased harvests - - - - - 3000 2, Imports a) of the Reich 136 514 475 596 1300 750 b) of the Armed Forces from occupied territories 422 1310 2320 1970 Total available Quantity 56119 56787 58344 49596 58043 45220 Index 1938/39 r IOC 100 101 104 88 103 81 B. Consumptior. 1. Shrinkage 4800 6600 5700 4800 4350 3400 2, Seed 7000 6900 6800 6800 7000 6800 3. Potatoes (for eating) 14000 16000 19422 21310 26320 22470 Index 1938/39 r 100 100 114 140 152 188 157 of which a)self-suppliers 7000 8000 9000 9500 9500 130001' 8000 b)non self-suppliers 7000 7250 8700 9300 10700 c)Armed Forces total of which 1722 2610 3820 3770 cl)Armed Forces in Reich 750 1300 1300 1500 1800 c2)Armed Forces in occupied terri- tories 750 422 1310 2320 1970 4. Distilleries 2416 2044 1949 994 1150 400 5. Starch-industry 1576 1400 1200 1000 1350 430. 6, Drying-industry 978 655 905 625 1215 22 f 7# Fruit-starch & baking powder 100 100 100 100 100 20 8, Deliveries to deficient terri- tories 28 16 680 538 1227 524 Total consumption 30898 33715 36756 36167 42712 34269 C. Fodder 1. Fresh potatoes (Remmant) 25221 23072 21588 13129 15331 10951 2, Potato-flakes (Raw potato-value 1:4) 922 560 500 200 500 160 Fodder total 26143 23632 22088 13629 18831 11111 (Raw potato value) Number of pigs (Sept.) 26200 29034 25114 22229 18142 18561 T potatoes per pig 1.0 0.81 0.88 0.62 0.86 0.60 1) Probably including considerable (Quantities for smaller animals. 2) Without dehydrated potatoes, which are contained in eating-potatoes. 362 appendix C-3 Sutrar-Balance s — ~ , of Greater Germany as of 1 Sept. 1939 (in 1000 T) Fiscal Year 1.10.-30.9. 1939/10 191+0/1+1 191+1/1+2 191+2/1+3 191+3/1+1+ A# Available quantities 1. on hand 1 Oct. 162 202 211+ 96 265 2. German production 2051 2061 1778 2022 1900 3. Imports 287 389 1+1+3 S72 390 Total Stock B. Consumption 2p0C 2652 21+35 2690 2555 1. Sugar for civilian consumption 1166 911 969 939 915 2. Jam 100 205 200 197 205 3. Sugar for Armed Forces 175 160 200 209 220 Edible Sugar Total 1+. Industrial consumption H+l+1 1266 1369 1369 131+0 a) Civilian soli 581+ . h7h .. 51+2 1+92 b) Armed Forces 11+0 ll+O D iso n 170 160 5. Glycerine (Armed Forces') 5 5 5 12 20 6. Sugar for preserves 36 7i+ - 72 36 7. Christmas Supplement - 10 - 13 18 8. Cultivation premiums - 6 6 7 7 9. Exports 152 328 317 213 217 10. Losses (ca 1$) 20 20 18 20 13 21 782) 11. Losses by bombing - - - 26 Total consumption 2298 21+38 2339 21+25 2386 of which in Reich territory (without exports) 211+6 2110 2022 2212 2169 Index 1939/1+0 = 100 100 98 91+ 103 C. Balance on 30 Sept. 202 2H+ 96 265 169 1) ■ estimated. 2) r inc. Fiihrerpaketaktion (3>) and additional untraceable consumption. 363 appendix C-3 Industrial Sugar Consumption (in 1000 T) Fiscal Year (1,10 - 30.9) 1939/UO 19ii0/iil 191H/U2 19ii2/ii3 19h3/hh 1. Sugar Goods of which; civilian needs - - nii 109 61 Armed Forces - - 76 119 113 artificial honey (civ .) - - 39 39 39 Total 253 269 229 267 213 2. Horticulture 183 221 210 228 2U1 3* Brewing industry 10 18 28 56 51 li. Bee sugar 3h 39 23 30 33 5. Viticulture lil 2U li2 26 27 6* Milk and fat economy Hi 8 12 13 20 7. Fish 0 0 0 0 0 8* Distilleries 8 13 7 5 3 9. German Apothecaries Assn. 3 3 3 3 3 10. Bread industry 3 li 3 li 3 !!• Specialist Groups, Physic- al Hygiene, Chemistry, Optics 1 1 1 1 1 12* Naehrmittel industry 8 8 9 10 10 13. Meat industry 1 1 1 1 1 Hi. Tobacco industry li 5 li 5 3 15. Pharmaceuticals 8 8 9 9 9 16. Confectioners Hi 22 16 18 Hi 17. Bakers 51 75 Uo U5 33 18. Inns 25 30 Hi 20 10 19. All others 30 30 20 25 25 Consumption incl. incorporated Eastern and Western territories 691 779 671 766 701 1% for Eastern and Western territories ii8 55 hi 5U 50 Consumption in Reich territory as of 1 Sept. 1939 6Ui 72li 62li 712 652 of which; Civilian % HiO % HiO 150 5U2 li92 Armed Forces 170 160 1) estimated. 364 appendix C-4 DAILY ALLOWANCES OF RATIONED FOODS IN GERMANY FROM 1939 TO 1945 1. Ration Period fron - 9/2U, 1939 Daily Allowance in Grains 5. Ratioi Period frtm 12/18/1939 - VWISIiO Daily Allowance in Grans Very Long Normal Adolos- Children Heavy Heavy and Con- cents 10-lU 6-10 3-6 0=3 '.Yorkers Workers night suncrs 31-13 yrs. yrs. yrs. yrs. ’.Yorkers yrs. 1 2 3 it 5 6 7 8 9 ' Bread Sane as in peace-tines - flour Sane as in peace- times Flour supplement for southern Germany - Naohrmittel 21.lt 21.lt - 21.U 21.U 21.U 21.lt 21,It 21.lt Sugar Uo hO - Uo Uo UO N Uo Uo Uo Jam 16 16 - 16 16 16 16 16 16 Artificial Honey Meat - products 170 100 - 100 100 100 100 100 100 Fats - total 98.6 ua.6 _ U8.6 lt8.6 ltQ.6 U3.6 li3.5 ltd.6 of which butter 12.9 12.9 - 12.9 12.9 12.9 12.9 12.9 12.9 Margarine h2.9 17.9 - 17.9 17.9 ** 17.9 17.9 17.9 17.9 slaughter-fats U2.9 17.9 17.9 17.9 17.9 17.9 17.9 17.9 Whole milk (kgri) 200 200 - 200 200 200 200 700 700 Cheese u.ii ll.lt - n .u n.U n.ii 11.u ii.u ll.U or Quarg 22.9 22.9 - 22.9 22.9 22.9 22.9 22.9 22.9 Coffee substitute 9 9 - 9 9 9 9 9 9 Cocoa nix powder Eggs Nutritional Content of the Daily Consumption including Ration-free Foods Physiological Nom Total Calories U500 3600 - - - - — - - Total protein 112 97 - - - - . - - Total fat 152 99 - - - - - - - Very Long Normal Adolcs- Children Heavy Workers Heavy Workers and night Workers Con- sumers cents lii-18 yjs- 10-1U yrs. 6-10 yrs. ><> yrs. o-3 yrs. i 2 3 i* 5 6 7 B 9 Bread s flour Flour Supplement for southern Ger- many 685.7 S1U.3 26.8 5U2.9 1*07.1 26.8 1*28.6 321.lt 26.8 31*2.9 257.1 26.8 31*2.9 257.1 26.8 31*2.9 257.1 26.8 21*2.9 182.1 26*8 157.1 H7.9 157.1 -117.9 26.8 Naehrmittel 21.U 21.lt 21.1* 21.lt 21.1* 21.1* 21.1* 39.2 39.3 Sugar 35.7 35.7 35.7 35.7 35.7 35.7 35.7 35.7 35.7 Jam m.3 11*.3 ll*.3 U*.3 11* .3 21.U 21.1* 11* .3 1U.3 Artificial Honey - - - - - luS U.5 1*.S U.S Meat - products 175.? 11*7.3 90,2 75.9 7 5.9 75.9 IS .9 1*0.2 U0.2 Fats - total 105>«3 of which batter 20.5 Margarine 29.1 slaughter-fats 55*7 56.3 20.5 20.2 15.5 la. 2 20,5 lil.l 6.6 38.1* 20.5 11.3 6.6 38J* 20.5 11.3 6.6 37.0 25.9 11.1 37.0 25.9 11.1 26.8 26.8 17.9 17.9 Whole milk (Kg*l) - - - - - 250 250 5oo 750 Cheese 6.7 6.7 6.7 6.7 6.7 6.7 6.7 6.7 6.7 or Quarg 13.U 13.1* 13.1* 13.1* 13.1* 13.1* 13.lt 13.1* 13 .U Coffee Substitute Ut.3 11*.3 Ut.3 U*.3 Ut.3 Ui.3 U*.3 Ui.3 Ui.3 Cocoa mix powder - - - - - U.S 1*.S U.S U.5 Errs 5.9 5.9 5.9 5.9 5.9 5.9 5.9 .5.9 5.9 Nutritional Content of the Daily Consumption Including Ration-free Foods Total Calories U216 Grams protein 108.8 Grams fat 122.6 Physiological Norm Total Calories U500 Total protein 112 Total fat 152 Difference from Norm Total Calories -28U Total protein - 3*2 Total fat - 29.U Total % of Norm Calories 9h% Protein 97% Fat 81* 31*22 92.9 71.7 3600 97 99 -178 - It.l - 27.3 95* 96$ 72$ 1.1 .11 III psS 231*3 60.0 1*6.5 21*00 61* 67 - 57 - It.O - 20.5 98$ 9li$ 69$ 231*3 60.0 1*6.5 21*00 . 61* 67 -57 - l*.o - 20.5 98$ 9U$ 69$ 2330 63.1* 52.5 2050 56 56 280 7.1* - 3.5 1U*$ 113$ 9lt$ 2078 56.2 51.1* 1750 1*9 50 326 7.2 1.1* 119$ 115$ 103$ 1689 1783 UB.8 57.5 1*6.8 U7.6 11*00 1200 111 38 50 U7 289 583 7.8 19.5 - 3.2 0.6 121$ U*9$ 119$ 151$ 9l*$ 101$ 10. Ration Period from 5/6 - 6/2, 19U0 Daily Allowance in Grams 15. Ration Period from 9/23 - 10/20, 19U0 Daily Allowance in Grams Very Long Normal Adoles- hildren Heavy Workers Heavy Workers and night Workers Con- sumers cents 1U-18 yrs. is-Tir yrs. 6-10 yrs. 1-6 yrs. 0-3 yrs. Bread 685.7 5U2.9 108.6 3U2.9 3U2.9 3U2.9 210.9 157.1 157.1 = flour 5Ut.3 U07.1 321.lt 257.1 257.1 257.1 182.1 117.9 117.9 Flour supplement 26.8 26.8 26.8 26.8 26.8 26.8 26.8 26.8 26.8 for southern Ger- many Naehnnittel 21.1* 21.lt 21.It 21.lt 21.1* 21.1* 21.1* 39.2 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam 21.lt 21.lt 21.1* 21.1* 21.1* 28.5 28.5 21.1* 21.lt Artificial Honey - - - - - It .5 lt.5 lt.5 lt.5 Meat - products 171.lt Ut2.9 85.7 71.U 71.1* 71.lt 71.lt 35.7 35.7 Fats - total 105.3 56.2 10.2 38.It 38.It 37.1 37.1 26,8 17.9 of which butter 20.5 20.5 20.5 20.5 26.0 26.0 26.0 26.8 17.9 butter or Margarine - - 31t.S - - - - - - Margarine 29.0 20.1 - 11.2 11.2 11.1 11.1 - - slaughter-fat 55*8 15.6 - - - - - - - lard - 6.7 6.7 6.7 “ “ “ Whole milk (Kg=l) - - - - - 250 250 5oo 750 Cheese 8.9 8.9 8.9 8.9 6.9 8.9 8.9 8.9 8.9 or Qoare 17.9 17.9 17.9 17.9 17.9 17.9 17.9 17.9 17.9 Coffee Substitute Ut.3 Ut.3 Ut.3 Ut.3 Ut.3 Ut.3 Ut.3 Ut.3 Ut.3 Cocoa mix powder - - - - - 2.2 2.2 2.2 2.2 Eras 22.1* 22.lt 22.lt 22 .It 22.lt 22.1* 22.1* 22.1* 22.1* Nutritional Content of the Daily Consumption including Ration-free Foods Total Calories 1068 3106 2610 231t7 2387 2310 2091 1701 1795 Grams protein 113.2 9U.5 69.2 61.1 61.1 63.9 56.7 lt9.3 57.9 Grams fat 107. li 67.lt 50.7 ltlt.5 ltlt.5 52.5 51.U U6.8 lt7.6 Physiological Norm Total Calories 1*500 3600 _ 2lt00 2lt00 2050 1750 11*00 1200 Grams protein 112 97 - 61t 61t 56 1*9 lo 38 Grams fat 152 99 - 67 67 56 5o 50 1*7 Difference from Nona Total Calories -332 -186 - 53 - 53 292 310 301 595 Grams protein 1.2 - 2.5 - - 2.9 - 2.9 7.9 7.7 8.3 19.9 Grains fat - ltlt.6 - 31.6 - - 22.5 - 22.5 - 3.5 1.1* - 3.2 0.6 Total * of Norn Total Calories 93? 95? . 98? 98? Hi** 119? 121* 150? Protein 101* 982 - 95? 95? 1H*2 115? 120* 152? Fat 71? 66? “ 66? 66? 9lt? 1032 9lt? 101* Very Long Normal Adoles- Children Heavy Workers Heavy Workers and night Workers Con- sumers cents lii-18 yrs. 10-li* yrs. 6-10 yrs. >6 yrs. 0-3 yrs. Broad 66U.3 521.U U07.1 321.lt 371.lt 371.lt 2lt2.9 157.1 157.1 - flour U96.9 391.1 30S.lt 210.1 278.5 182.1 182.1 117.9 117.9 Flour supplement 26.8 26.8 26.8 26.8 26.8 26.8 26.8 26.8 26.8 for southern Ger- many Naehrmittol 21.U 21.lt 21.lt 21.lt 21.lt 21.lt 21.lt 39.3 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam 21.1l 21.lt 21.lt 21.lt 21.lt 28.5 28.5 21.U 21.U Artificial Honey - - - - - U.5 U.5 U.5 U.5 Meat - products 171.U 1U2.9 85.7 71.lt 71.lt 70.lt 71.U 35.7 35.7 Fats - total 105.5 56.3 10.3 38.5 38.5 37.9 37.9 26.8 17.9 of which butter 25.1 25.1 25.1 25.1 25.1 26.8 26.8 26,6 17.9 fritter or Margarine U9.7 ltO.7 - 31.8 31.8 37.9 37.9 26.8 17.9 Margarine - 9.5 - - - - - - slaughter-fat - - 6.7 - - - _ - _ lard 55.8 15.6 6.7 6.7 - Whole milk (Kg£L) - - - - - 250 250 5oo 7So Cheese 8.9 8.9 8,9 8.9 8.9 8.9 8.9 8.9 8.9 Coffee Substitute Ui.3 Ht.3 lit.3 llt.3 llt.3 llt.3 1U.3 1U.3 1U.3 Cocoa mix powder - , - - - - 2.2 2.2 2.2 2.2 Eggs 9.8 9.8 9.8 9.8 9.8 9.8 9.8 9.8 9.8 Nutritidnal Content of the Daily Consumption, including Ration-free Foods Total Calories 1018 3365 2539 2296 2351 . 2097 170U 1797 Grams protein 112.0 95.2 66.5 59.8 62.2 _ 57.1 U9.9 58.0 Grams fat 107. li 67.lt U9.2 ltlt.5 ltlt.3 _ 51.6 U6.9 U7.8 Physiological Nora Total Calories liSoo 3600 2lt00 1750 1UOO 1200 Grams protein 112 97 - 61t - U9 Ul 38 Grams fat 152 99 - 67 - • 50 So U7 Difference from Nora Total Calories -302 235 -loll _ . 3U7 303 590 Grams protein 0.0 3.8 - It.2 - - 8.6 8.9 20.5 Grams fat UU.6 31.6 - 22.5 - - l.S - 3.1 0.8 Total % of Nora Total Calories 92? 9h% _ 95? . _ 119? 122% iSo? Protein 100% 96? - 93? - - 116? 120% 156? Fat nt 67? 66? - - 103? 9U? 102? 365 appendix C-4 20. Ration Period from 2/10 - 3/9, 19l*l Daily Allowances in Grans 30. Ration Period from 17.11. - Ui.12.19Ul Daily Allowances in grams Very Long Normal Adoles- Children Heavy Workers Heavy Workers and KiCht Workers Con- sumers cents Il*-18 10-11* yrs. 6-10 yrs. 3-o yrs. o-3 yrs. 1 2 , 3 1* 6 i 8 9 Bread - Flour bbli.J 1*96.9 521.1* 391.1 U07-1 30 5. It 321.1* 21*1.1 371.lt 278.5 371.8 278.5 21*2.9 182.1 157.1 117.9 Ib'M 117.9 Flour Supplement for Southern Germany 26.8 26.8 26.8 26.8 26.8 - 26.8 26.8 26.8 Naehrmittel 21.1* 21.1* 21.1* 21.1* 21.1* 21.1* 21.1* 39.3 39.3 Sugar 32.2 33.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam 25.0 25.0 25.o 25.0 25.0 32.2 32.2 25.0 25.0 Artificial Honey - - - - - It. 5 It-5 It. 5 It. 5 Meat -products 171. It 182.9 85.7 71.1* 71.1* 71.1* 71.1* 35-7 35.7 Total fats of which butter margarine slaughter fats 105.5 20.1 29.6 55.8 55.3 20.1 20.6 15.6 1*1.3 20.1 11*. 5 6.7 38.5 20.1 11.7 6.7 1*2.9 20.1 16.1 6.7 37.9 26.8 11.1 37.9 26.8 11.1 26.8 26.8 17.9 17.9 Whole milk (KG=1) - - - - - 250 250 500 750 Cheese 6.7 6.7 6.7 6.7 6.7 6.7 6.7 6.7 6.7 Quarg It. 5 It. 5 It. 5 It. 5 It. 5 It.5 It. 5 li. 5 It. 5 Coffee substitute ll*.3 lit. 3 11*. 3 Ut. 3 lit. 3 ll*.3 Ht.3 11*. 3 lit.3 Cocoa nix powder - - - - - 2.2 2.2 2.2 2.2 Eggs 3.9 3.9 3.9 3.9 3.9 3.9 3-9 3.5 3.9 Nutritional Value of the Daily Consumption Including Ration Free Foods Total calories Grams protein Grams fat lil20 lll.lt 106.8 3367 92.6 66.8 2SU. 65.9 It8.6 2298 59.2 U3.9 2391 61.8 hi.9 2557 72.3 51t.9 2099 1705 55.5 lt8 51.0 lt6 1799 8 57.lt It U7.2 Physiological Norm Total calories 1*500 Grams protein 112 Grans fat 152 3600 97 99 2lt00 6it '67 2050 56 56 1750 It9 50 11*00 1*1 5o 1200 38 1*7 Difference from Norm Total calories -330 Grams protein -0,6 Grams fat -1*5«2 -233 -t>. It -32.2 102 -It. 8 -23.1 31t9 305 599 .1:1 Total % of Norm Total Calories protein fat 91* 99% 70* 9lt* 96* 67* 96* 93* 66* 125* 129* 98* 120* 115* 102* 122* 119* 93* i5o* 151* 100* Very Heavy Long Normal Adoles- Children Heavy Workers Workers and Night Workers Con- sumers cents 6-lh yrs. 3-6 yrs. 0-3 yrs. 1 2 3 u V b 7 Bread2) = flour 66U.3 1*96.9 521. U 391.1 U07.1 305. U 321.U 21*1.1 371. U 278.5 2 U2.9 182.1 1 117.9 Flour supplement for Southern Germahy 17.9 17.9 17.9 17.9 17.9 17.9 17.9 Naehrmittel 21.U 21.1* 21.U 21.U 21. U 21.U 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 or Sugar 25.0 16.1 25.0 16.1 25.0 16.1 • 25.0 16.1 25.0 16.1 32.2 25.0 16.12+7.IK 16.1 Artificial honey - - - - - U.S U.5 Meat, -products 11*2.9 HI*.3 85.7 57.1 57.1 57.1 35.7 Total fat of which butter Margarine Slaughter fat 105.1* 17.9 33.9 53.6 56.2 17.9 21*.9 13.1* 1*1.2 17.9 13.8 U.S 38.U 17.9 16.0 U.S 1*2.8 22.3 16.0 U.S 37.9 26.8 26.8 26.8 11.1 - 17.9 17.9 Whole milk (kp>l)S) - - - - - 250 Soo . 750 Cheese U.S U.S U.S U.S U.S U.S U.S Quarg U.S U.S U.S U.S U.S U.S U.S Coffee substitute U*.3 1U.3 1U.3 1U.3 1U.3 1U.3 lU.'S Cocoa Mix Powder - - - - - 2.2 2.2 Eggs 3.9 3.9 3.9 3.9 3.9 3.9 3.9 I. Rations Total-calories Qrams-protein drams-fat 3018 83.6 10U.2 Nutritional Value of the Daily Consumption. 2271 1830 15U8 1710 1512 138U 65.3 51.7 Ul.l 1*5.3 Uo.l UoJ* 6U.2 U8.7 1*2.7 U7.0 1*9.9 1*6.3 1U76 1*8.8 1*6.9 II.Total-consumption Total-calories Grama-protein Grams-fat U023 3276 109.1* 9l.l 106.0 66.0 2835 77.5 50.5 2319 61.7 UU.5 26UO 69.7 U8.8 —H b b 1921 58.U U7.U 1) - U) see Vierwochensaetze. 5) pregnant and lactating women, post-partun patients and special professions receive 500 g whole milk, sick persona up to 7$0 g whole milk. 35. Ration Period from 6.U. - 3.5.19U2 Daily Allowances in Grams 25- Ration Period fron 30.6. - 27.7.19U1 Daily Allowances in grams Very Heavy Long Normal Adoles- Children Heavy Workers Workers Night Workers Con- sumers cento U*-18 yrs. 10-11* yrs. 6-10 yrc. yrs. Bread*-) s flour 628.6 U70.2 185.7 36U.3 371-1. 278.5 285.7 21U.3 371.U2) 278.5 371.U 278.5 21*2.9 182.1 171.2 128.5 128.2 96.3 Kaehrmittel 21-U 21. 1* 21.1* 21.1* 21.1* 21.U 21.1* 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam or Sugar 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 32.2 32.2 12.5Z+7.1M. 25.0 12.5 25.0 12.5 Artificial honey - - - - - u.s u.s u.s U.S Meat, -products 121.1* 85.7 6U.3 U2.8 5o.o 5o.o So.o 21.U 21.1* Total fats of which butter Margarine Slaughter fat 82.2 17.9 26,h 37.9 U3.8 17.9 11*.7 11.2 32.1* 17.9 12.2 2.3 29.6 17.9 9.U 2.3 33.U 22,3 13.8 2.3 37.9 29.0 8.9 37.9 29.0 8.9 26.8 26.8 17.9 17.9 Whole Bilk (kg= 1) - - - - - 250 250 500 750 Cheese 6.7 6.7 6.7 6.7 6.7 6.7 6.7 6.7 6.7 Quarg u.s It.5 U.5 U.S U.S u.s U.S U.S U.S Coffee substitute 11.2 11.2 11.2 11.2 11.2 11.2 11.2 11.2 - Cocoa mix powder - - - - - 2.2 2.2 2.2 2.2 Eggs 11.8 11.8 11.8 11.8 11.8 11.8 11.8 11.8 11.8 Potatoes 357.1 357.1 357.1 357.1 357.1 357.1 357.1 357.1 3S7.1 Rations Total calories Grams fat Grama protein of which animal Grams carbohydrate 3061 9U.7 77.6 27.3 1.53.3 2329 55.1. 62.3 21.8 379.2 Nutritional Content 1912 1635 1929 Ul.U 35.3 Mi.2 51.5 U2.0 U9.U 18.6 15.5 16.6 319.7 275.1 320.1 2062 U9.6 53.8 20.5 335.3 17U0 1576 1562 U8.5 Ul.7 Uo.6 U5.0 UU.o 51. 20.5 25.2 33. 271.5 2U3.7 2U1. Total Available Total calories Grams fat Grams protein of which animal Grams carbohydrate 35U2 105.9 89.9 33.6 533.5 2775 63.6 7U.3 27.8 U57.9 231.2 1.8.6 63.2 21..5 393.5 2052 U2.S 53.3 21.2 350.3 2U28 52.6 61.U 22.U U12.7 2507 57.8 6U.8 26.3 U16.2 2178 1959 1958 56.6 U9.0 U7. 55.8 53.6 61. 26.3 30.8 39. 350.9 313.6 310.8 Vierwochensaetze 3)pregnant and lactating women, post-partum patients and special professions receive $00 g whole milk, sick persons up to 750 g whole milk. — Heavy long Normal Adolcs- Heavy Workers Workers Night iVorkors Con- sumers cents 6-TJS yrs. 3-6 yrs. 0-3 yrs. Bread 66H.3 521.1 107.1 321.1 371.1 212.93} 157.1 = flour 196.9 391.1 305.1 211.1 278.5 182.I3) flour supplement for Southern Germany 17.9 17.9 17.9 17.9 17.9 17.9 17.9 Naehrmittel 21.U 21J* 21 Ji 21.1 21.!* 21.!* 39.3 Sugar 32.2 32,2 32.2 32.2 32.2 32.2 32.2 Jam 25.0 25.0 25.0 •25.0 25.0 32 2 25.0 or Sugar 16.1 16.1. 16,1 16.1 16.1 l6.1Zf7.E 16.1 Artificial Honey - - - - - 1.5 1.5 Heat, -products 112.9 111.3 85.7 57.1 57.1 57.1 35.7 Total fats 105. 1 56.2 Ul-2 38.1 12.8 37.9 26.8 of which Butter 22.3 22,3 22.3 22.3 2U.5 29.0 26.9 Margarine 29.5 20.5 U.l 11.6 13.6 Slaughter Fat 53.6 13.li 1.5 1.5 1.5 - - Whole Milk (kg -1) - - - - - 250 500 750 Cheese 8.9 8.9 8.9 8.9 8.9 8.9 8.9 Quarg 1.5 li.S 1.5 1.5 1.5 1.5 1.5 Coffee Substitute 11.3 li.3 11.3 11.3 11.3 11.3 11.3 Cocoa mix powder - - - - - 2.2 2.2 Eggs 11.7 11.7 11.7 11.7 11.7 11.7 11.7 Nutritional Value I Rations Total-caloriee 3099 2352 of the Gaily Consumption 1911 1629 1790 1593 1165 1557 Orams-protein 05.9 66.6 51.0 13.1 17.6 U2.3 Grams-fat 105.6 65.6 19.9 11.1 18.1 51.3 17.7 18L3 II.Total-consumption Total-calories UlOU 3357 2916 2100 2728 2207 19l0 orams-protein 111.7 92.U 79.8 61.0 72.0 59.1 52.3 Grams-fat 107 .1 67.1 51.7 15.9 50.2 53.1 18.5 19 4 Notes: 1-7 see Vierwochensaetae. 366 appendix C-4 liO. Ration Period from 2U/8 - 20/10, 1982 Daily Allowances in Grams. Us. Ration Period from U.l. - 7.2.1?1*3 Daily Allowances in Gratis Tiiy Long Nonnal Adoles- Children Heavy Workers Heavy Workers and Night Workers Con- sumers cents lli-18 10-11* yrs. 6-10 yrs. yrs. 0-3 yrs. i 2 i U 5 6 7 8 9 Bread*) = flour 623.8 MO. 2 1*85.7 368.3 371.U 278.5 255.7 211*. 3 371.U2) 278.5 371. U 278.5 21*2.9 182.1 171. 120. 128.2 96.3 Naehrmittel 21. k 21. U 21. h 21. I* 21. Ii 21. 1* 21.It 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam or Sugar 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 32.2 32.2 12.5Z/7.LM. 25.0 12.5 25.0 12.5 Artificial honey - - - - - u.s U.S U.S U.5 Meat - products 121.ll 85.7 6U.3 U2.3 50.0 So.o So.o 21.1* 21.U Total fats of which Butter Margarine Slaughter fat 82.2 17.9 28.6 35.7 U3.8 17.9 17.0 32. h 17.9 lli. 5 29.5 17.9 11.6 38.1* 22.3 16.1 37.9 26.8 11.1 37.9 26.8 11.1 26.8 26.8 17.9 17.9 Whole milk (KO-lp) - - - - - 250 250 5oo 750 Cheese u.s u.s u.s U.5 u.s U.S u.s U.5 U.5 Quarg U.S u.s u.s u.s u.s U.5 u.s U.5 U.5 Coffee substitute 11.2 11.2 11.2 11.2 11.2 11.2 11.2 11.2 - Cocoa mix powder - - - - - - 2.2 2.2 2.2 Eggs 5.9 5.9 5.9 5.9 5.9 5.9 5.9 5.9 5.9 Potatoes 6U2.9 6U2.9 6U2.9 6U2.9 6U2.9 6U2.9 6U2.9 6U2.9 6U2.9 Nutritional Content Ration Total calories Grams fat " protein of which animal Grams carbohydrate 3268 9U.U 82.9 28.0 Ii99*6 2536 5U.9 67.6 22.U U2S. 5 2119 U0.8 56.0 17.0 366.1 18U2 3U.8 U7.8 16.1 321. U 2135 U3.5 51*. 7 17.2 366.lt 2272 U9.U 59.1 21.1 381.5 1950 U3.3 50.3 21.1 317.7 1735 1792 Ul.U U9.3 U9.3 56.0 25.6 3U.1 290.0 287.7 Total Available Total calories Grams fat " protein of which animal Crams carbohydrate 3621 105.6 92.5 3U.3 532.1 285U 63.1 76.9 ’8.3 U67.5 21*21 1*8.6 65.8 22.9 1*15.8 2131 ia.8 56.1* 318:1 2506 51.9 6U.0 uS:S 2637 57.6 67.U u&I 2308 56. U 59.U 3&I 2130 2129 U0.7 27.1 58.1 65.5 3&s m Notes: 1.) See Vierwochensaelze 2. See Vierwochensaetze 3. Pregnant and lactating women, post-partum ceive 500g whole milk, sick persons up to patients and spe 750 g whole milfc cial professions re- Very Heavy Long Normal Adolas- Children Heavy Workers Workers and Night Worker;-. Con- sumers cents lb-13 10-1U yrs. 6-10 3-6 0-3 yro. 1 i 3 b 6 — s— 9 = flour 66b.3 b96.9 521 .b 391.1 b07.1 305 .b 321.b 2bl.i 371.b2J 273,5 371.b 278.5 21*2.9 102.1 171.2 128.5 157.1 117.9 Naehrmittel 21. I* 21 .b aJi 21.1* 21 .b 21 .b 21 .b 28.6 39.3 Sugar 32. 2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam or Sugar 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 32.2 32.2 12.5ZA7.1'J. 25.0 12.5 25.0 12.5 Artificial honey - - - - - b.S b.5 b.S b.S Meat, -products 135.7 100.0 78.6 So.o 57.1 57.1 57.1 23.6 28.6 Total fats of which butter Butter fat*1' Margarine Slaughter fat 82.2 17.9 b.S 2b.1 35.7 b3.3 17.9 b.S 12.5 8.9 32 Ji 17.9 U.5 10.0 29.6 17.9 U.5 7.2 38.b 2.3 b.S 11.6 37.9 29.0 8.9 37.9 29.0 8.9 26.8 26.8 17.9 17.9 Whole milk (kg-lp) - - - - - 250 250 5oo 750 Cheese b.S b.S b.S b.S b.S b.S b.S b.S b.S Quarg b.S b.S b.S b.S b.S b.S b.S b.S b.S Coffee substitute 8.9 8.9 8.9 8.9 8.9 8.9 8.9 8.9 . Cocoa mix powder - - - - 2.2 2.2 2.2 2.2 Eggs - - - - - . . _ _ Potatoes 571.b 57l.b 571. b 571.b 571.b 571 .b 571. b 571.b 571 .b Ration Total calories 3351 2615 Grams fat 95,1* 56,0 Grams protein 85*8 70J* of which animal 27,1 21,3 Grams carbohydrate 5lli*2 i*39«9 Nutritional Content 2191 1909 211b 2250 bl.9 35.0 b3.b b9.1 59.6 b9.6 5b.2 59.6 l8,b Ib.b 15 .b 19.b 380.6 3b5.9 372.3 377.5 1920 b8.0 b9.8 19.3 SIS.3 1765 bl.l b9.7 23.7 206.1 18bb bo.2 59.3 32.2 290.3 Total available Total calories ,370b 2933 2b93 21?8 Grams fat 106.6 6b.2 U9.1 U2.0 Grams protein 9S.li 79.7 68.6 58.3 of which animal 33.b 27.3 jq.i Grams carbohydrate 566.7 b90.9 I13O.3 393.b 2b85 2615 51.3 57.3 63.5 67.9 21.2 25.2 . b37.2 bbl.3 2285 56.1 58.9 25.1 376.0 2109 bS.b 57.5 29.3 3b7.6 2181 b7.0 67.1 37.8 359.8 i>ee Vierwochensaetze. 3) Pregnant and lactating women, whole milk, sick persons up patients and special professions receive 500 e 0 730 e whole milk. 6 57* Ration Period from 13/12, 19U3- 9/l> 19UU Daily Allowances in Grams 50. Ration Period from 31*5* - 27.6.19U3 Daily Allowances in Grama Very Long Normal Adoles- Children Heavy Workers Heavy ’.Yorkers and Night ’Yorkers Con- sumers cents 1U-13 10-1 u yrs. yrs. 3-6 yrs. 0-3 yrs. Bread* - flour 1 2 3 U 5 .. 6 7 a 5 605:3 516.9 TKT U09.8 UU6.U 33U.8 3U6.U 259.8 396.U2) 297.2 396. U 297.2 285.7 21U.2 196.2 1U7.2 182.1 136.6 Naehrraittel 21. U 21.U 21. U 21.U 21.U 21.U 21. 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32 2 32.2 Jan or Sugar 25.0 12.5 29.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 32.2 12.5f7 32. .Ill 25.0 12.5 25.0 12.5 Artificial honey -■ - - - U.5 U.5 U.5 u.s Meat, - products 121.U 85.7 6U.3 35.7 1*2.9 1*2.9 1*2. 1U.3 1U.3 Total fats of which butter butter-fat slaughter fat 8U.0 17.9 U.l 2U.1 2.2 35.7 U5.5 17.9 U.l 12.5 2.2 8.8 31*.2 17.9 U.l 10.0 2.2 31.u 17.9 U.l 7.2 2.2 U0.2 2U.5 U.l 7.2 U.5 39.7 26.3 13.U 39.7 26.3 13.U 28.6 28.6 19.7 19.7 JIhole milk (KO-1) - - - - . - 250 250 500 750 Cheese U.5 U.S U.S U.5 U.5 U.5 U.5 U.5 U.5 Quarg U.5 U.5 u.s U.5 U.S U.5 U.5 U.5 U.S Coffee substitute 8.9 8.9 8.9 8,9 8.9 8.9 8.9 8.9 - Cocoa mix powder ?) - - - - 2.2 2. 2.2 2.2 Eggs 1.9 1.9 1.9 1.9 1.9 1.9 1. 1.9 1.9 Potatoes 595 595 595 595 595 595 595 595 595 Nutritional Content Ration Total calories 3513 Grams fat 98.9 Grams protein 85. U of which animal 25*3 Crams carbohydrate 5U8.U Total available Total calories 3866 Grams fat 110.1 Grans protein 95»0 of which animal 31,6 Grams carbohydrate 600,9 2778 59.5 70.1 19.8 1*73.7 3096 67.7 79.1* 25.8 521*. 7 239U U5.5 61.0 16.6 U21.8 2596 52.8 70.0 22.5 U17.5 2071 38.5 1*9.3 12.5 370.3 2360 1*5.5 58.0 18.2 1*17.8 2295 U7.0 53.7 13.5 U00.7 2666 55. U 63.0 19.3 U65.6 21*31 52.6 58.1 17.U 1*15.9 2795 60.8 67.U 23.2 U79.6 2155 51.6 50.6 17.U 358. U 2513 59.7 59.7 21.2 U10.6 19U6 2025 UU.8 U3.9 U8.U 58-0 21.6 30.0 323.1 337.7 2290 2362 52.1 50.7 57.2 66.8 27.U 35.9 385.6 398.7 1) 2th,7, See Vierwochensaetze. 3) pregnant and lactating women, post-partun patients and special professions receive 500 z whole milk, sick persons up to 750 g whole milk Very Heavy Long Normal Adolos Children Heavy Workers Workers and Night Workers Consumers cents 1U-18 TT.s>_ lo-iir yrs. 6-10 yrs. yrs. yrs. i 2 3 6 5 6 7 9 Breid1' ■ flour 675.0 506.2 532.1 399.1 u.7.8 313.6 332.1 382.1 269.1 286.5 382.1 286.5 253.6 190.1 181.9 135.S 167.8 125.9 Kaehmittel 21.U 21.U 21. U 21 .U 21.U 21 .U 21.U 26.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam or Sugar 25.0 12.5 25.0 12.5 25.0 12:5 25.0 12.5 25.0 12.5 32.2 32.2 12.5Z.47.1M 25.0 12.5 25.0 12.5 Artificial honey - - - - - 6.5 6.5 6.5 6.5 Meat,- products 121.U 85.7 66.3 35.7 62.9 62,9 62.9 1U.3 16.3 Total fata of which butter Oil1" nargarina Slaughter fat 8U.0 19.7 U.5 2U.1 35.7 65.6 19.7 U.5 12.5 8.9 3U.2 19.7 U.5 10.0 31.6 19.7 6.5 7.2 U0.3 2U.2 U.5 11.6 39.7 26.3 13.6 39.7 26.3 13.6 26.6 28.6 19.7 19.7 Whol* Bilk (kg» 1) - - - - 250 250 500 750 Cheese 6.5 U.5 6.5 6.5 6.5 6.5 6.5 6.5 6.5 QBATg U.5 U.5 6.5 6.5 6.5 6.5 6.5 6.5 6.5 Coffee substitute 8.9 8.9 8.9 8.9 8.9 8.9 8.9 8.9 - Cocoa mix powder - - - - - 2.2 2.2 2.2 2.2 Beg" '5.9 5.9 5 A 5.9 5.9 5.9 5.9 5.9 5.9 Potatoes 500 5oo 5oo 5oo 500 500 500 500 500 Nutritional Content Eations Total calories Grans fat Grams protein of which animal Grams carbohydrate Total available Total calories Grams fat Grams protein of which animal Grams carbohydrate 3318 96.0 81.0 27.2 506.5 3671 107.2 93.6 33.5 559.0 2583 56.6 67.7 21.8 U31.S 2901 6U.8 77.0 27.8 682.8 2166 62.7 57.9 18.6 372.6 2666 69.9 66.9 26.5 622.3 1876 2062 35.6 63.9 67.9 51.6 16.5 15.6 228.6 353.9 2165 2653 62.6 52.3 55.6 60,7 20.2 21.6 275.9 618.3 2217 1896 69.5 68.6 56.7 67.9 19.6 19.6 369.1 302.6 2582 2256 57.7 56.5 66.0 57.0 25.2 25.2 632.8 366.6 1731 61.7 66.8 23.6 278.0 2075 69.0 55.6 29.2 339.5 1810 60.9 56.6 32.3 290.7 2167 67.7 65.2 37.9 351.7 1, 2, U) See Vierwodhensaetze. 3) pregnant and lactating women, post-parturn patients and special professions receive $00g whole milk, sick persons up to 75>Og whole milk. 367 appendix C-4 Very Long Normal Adoles- Children Heavy Workers Heavy Workers Night Workers Con- sumers cents 1U-18 10-lU yrs. 6-10 yrs. yrs. 0-3 yrs. 1 2 3 U 5 6 ? B 9 lr?Iour' 9.3 516.9 to. 8 U46.I4 33U.8 386.8 259.8 3I46.I1 297.2 396.1 297.2 285.7 21U.2 196.2 187.2 182.1 136.6 Naehrmittel 21. ii 21. h 21. U 21.1* 21.14 21.14 21.U 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jan or Sugar 25.0 12.5 25.0 12.5 * 25.0 12.5 25.0 12.5 25.0 12.5 32.2 32.2 12.5Zf7 LM. 25.0 25.0 12.5 12.5 Artificial Honey - - - - - 8.5 8.5 8.5 8.5 Meat, - products 130.3 98.6 73.2 88.6 51.8 82.9 82.9 18.3 18.3 Total fats of which butter margarine oil slaughter fat 79.9 17.9 2U.1 2.2 35.7 Ui.U 17.9 12.5 2.2 ■8.8 30.1 17.9 10.0 2.2 27.3 17.9 7.2 2.2 36.1 25.5 7.2 14.5 39.7 26.3 13.14 39.7 26.3 13.U 28.6 19.7 28.6 19.7 Whole milk (KG-1) - - - - - 250 250 500 750 Cheese a. 5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Quarg 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Coffee substitute 8.9 8.9 8.9 6.9 8.9 B.9 8.9 8.9 Cocoa mix powder - - - - 2.2 2.2 2.2 2.2 Eggs Potatoes 5oo 5oo 5oo 5oo 500 500 500 5co Soo Nutritional Content Ration Total calories 3291 Grams fat 93.1 Grams protein 82.9 of which animal 26.2 Grans carbohydrate 507*8 Total available Total calories 36Ui Grams fat 10l*.3 Grams protein 92.5 of which animal 32.5 Grans carbohydrate 560.3 2556 53.7 67.6 20.7 833.1 2878 161.9 76.9 26.7 888.1 2172 39.8 58.5 17.6 381.2 2878 87.0 67.9 23.5 830.9 I8li9 32.7 16.8 13.14 329.7 2138 19.7 67.5 19.1 337.2 2053 81.2 51.1 18.8 335.2 2828 89.6 55.5 20.2 820.1 2190 88.8 58.8 17.0 370.8 2563 52.6 60.8 22.8 838.1 1922 1713 1792 17.8 80.6 39.7 86.9 88.7 58.3 17.8 21.6 30.1 312.9 277.6 292.2 2280 2087 2129 55.5 87.9 86.5 56.0 53.5 63.1 23.2 27.2 32.7 375.1 339.1 353.2 1) 2,h,7* See Vierwochensaetze. 3) pregnant and lactating women, post-partum patients and special professions receive 500 g whole milk, sick persons up to 750 g whole milk. 58. Ration Period from 10/1 - 6/2, 19U* Daily Allowances in Grams Very Heavy Long Normal Ad ole s- Children Heavy Workers Workers and Night Workers Con- sumers cents lo-iu yrs. 6-10 yrs. yrs. 0-3 yrs. 1 2 ) U 5 6 i “8 9 Bread 639,3 SU6.U Ut6.lt 3U6.U 396.U2) 396.U 285.7 196.2 182.1 — flour 516.9 U09.8 33U.8 259.8 297.2 297.2 21U.2 1U7.2 136.6 Naehrmittel 21.1; 21.1; 21.lt 21.1* 21.U 21.U 21.il 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jan 25.0 25.0 25.0 25.0 25.0 32.2 32.2 25.0 25.0 or Sugar 12.5 12-5 12.5 12.5 12.5 12.52+7.111 12.5 12.5 Artificial Honey - - - - - U.S u.s U.S U.S Meat products 130.3 9U.6 73.2 UU.6 51.8 U2.9 12.9 1U.3 1U.3 Total fats 79.9 ia.u 30.1 27.3 36.1 39.7 39.7 28,6 19.7 of which butterx ' Butter fat '* 13.1; 13.lt 13 .It 13 .U 20.0 21.6 21.8 2U.1 IS.2 - - - - - U.S u.s U.S U.S Margarine 2U.1 12.5 10.0 7.2 7.2 13 .U 13 .U oil U) 2.2 2.2 2.2 2.2 U6 Slaughter fat 110.2 13.3 it.S u.s U.S - - - - Whole milk 3) (kg-1) - - - - - 250 250 Soo 750 Cheese li.S It.s it.s u.s u.s U.S u.s U.S U.S Quarg u.s It .5 u.s u.s u.s U.S U.S U.S U.S Coffee Substitute 8.9 8.9 8.9 8.9 8.9 8.9 8.9 8.9 - Cocoa mix powder - - - - - 2.2 2.2 2.2 2.2 Eggs 3.9 3.9 3.9 3-9 3.9 3.9 3.9 3.9 3.9 Potatoes 6) 500 500 Soo 500 500 5oo Soo 500 500 Nations Total Calories 3302 2567 Nutritional Content 2103 I860 206U 220U 1928 1729 1798 Grans fat 9U.3 Sit .9 la.o 33.9 U2.U U3.7 U7.7 U0.9 £o.o " protein 83.2 67.9 58.8 1*7.1 51.U 5U.8 U7.3 U5.0 5U.6 of which animal 26.5 21.0 17.8 13.7 m.7 17.6 17.6 21.9 30 .U Grans carbohydrate 507.7 lt33.0 331.1 329.6 355.1 370.U 312.9 277.5 292.1 Total Available. Total Calories 3655 2885 2U85 21U9 2U3S 2569 2206 2073 2135 Grans Fat 105.5 63.1 U8.2 U0.9 50.8 56.9 55.6 U8.2 U6.8 n Protein 92.8 77.2 67.3 55.8 60.7 61*.1 56 .U S1.8 63 .U of which animal 32.3 27.0 23.7 19 .U 20.5 23.U 23.U 27.5 36.0 Grams carbohydrate 560,2 itSit.o U30.8 377.1 U20.0 U3U,1 375.1 339.0 353.1 Notes: 1,2,1: and 7) See Vienrochonsaetze. 3) Pregnant and lactating women post-parturn patients and special profee- sions receive 500 g whole milk, sick persons up to 750 g whole milk. 59. Ration Period from 7.2. - 5.3.19hh Daily Allowances in Grams 60-Ration Period from 6.3. - 2.U.19UU Dally allowances in Grams 61. Ration Period from 3. - 30.U.19UU. Daily Allowances in Grams Very Heavy Heavy Workers Long and Normal Son- Adoles cents Children Workers Night Workers suaers 10-lii yrs- 6-10 yrs. 3-6 yrs. 0-3 yrs. 1 2 3 8 5 „ 6 7 8 9 Bread 639.3 586.U 886.8 386.8 396.U 396,8 285.7 196.2 182.1 - flour 516.9 809.8 338.8 259.8 297.2 297.2 218.2 187.2 136.6 Naehrmittel 21.8 21.8 21.8 21.8 21.8 21.8 21.8 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam 25.0 25.0 25.0 25.0 25.0 32.2 32.2 25.0 25.0 or Sugar 12.5 12.5 12.5 12.5 12.5 12.5Z/1M 12.5 12.5 Artificial honey - - - - - 8.5 8.5 8.5 8.5 Moat - products 121.8 85.7 68.3 35.7 82.9 82.9 82.9 18.3 18.3 Total fats eit.o 85.6 38.2 31.8 80.2 39.7 39.7 28.6 19.7 of which Butter,*. Butter fat ' X3.U 13.8 13.8 13.8 20.0 21.8 21.8 2U.1 15.2 h.l U.l 8.1 U.l 8.1 8.5 8.5 8.5 8.5 Margarine 28.1 12.5 10.0 7.2 7.1 13.8 13.8 Oil 8) 2.2 2.2 2.2 2.2 8.5 Slaughter fat 80.2 13.8 8.5 8.5 8.5 8.5 - Whole Ullk (kg-1) 3) - - - - - 250. 250. Soo. 750 Cheese 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Quarg 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 , Coffee Substitute 8.9 8.9 B.9 8.9 8.9 8.9 8.9 8.9 - Cocoa mix powder - - - - - 2.2 2.2 2.2 2.2 Eggs 11.8 n.8 11.8 11.8 11.8 11.8 11.8 11.8 11.8 Potatoes 6) 5oo 5oo 5oo 500 Soo 5oo 500 500- 5oo Nutritional Content Rations Total calories 3333 2595 2212 1996 2091 2222 1988 1738 1909 Grams fat 95.8 56.6 83.0 35.9 88.3 89.5 88.7 81.8 8i.l " protein 75.7 61.9 53.1 83.1 U7.1 51.6 85.1 88.7 52.9 of which animal 26.2 20.8 17.7 13.6 18.7 18.5 18.5 22.9 31.3 Total Available Total calories 3686 2913 1518 2285 2862 2587 2302 2078 2Ui6 Grams fat 107.0 68.8 50.2 82.9 52.7 57.7 56.8 89.1 87.9 " protein 85.8 71.2 62.1 51.8 56.8 60.9 58.2 53.5 61.7 of which animal 32.5 26.8 23.6 19.3 20.5 28.3 28.3 28.5 31.9 Very heavy Long Normal Adoles Children Heavy Workers Workers and Night Workers Con- sumers centa 11**18 j™. _ 10-11* Yr.s 6-10 yrs. yra. 0-3 yrs. 1 £ 3 i* 5 6 i “5 9 Bread a flour 589.3 516.9 566.6 609.3 666.6 336.3 366.6 259.8 396.I*2) 396.1* 297.2 297.2 235.7 216.2 196.2 167.2 182.1 136.6 Naehraittel 21.6 21.6 21.6 21.6 21.1* 21.6 21.6 26.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam or Sugar 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 25.0 12.5 32.2 32.2 12.5Z47.1M. 25.0 12.5 25.0 12.5 Artificial honey - - - - - u.s 6.5 U.S U.S Meat, -products 121.6 85.7 66-3 35.7 62.9 62.9 62.9 IU.3 1U.3 Total fata of which Ixitter Butterfat 5) Margarine Oil 1*) Slaughter fat 86.0 15.7 6.7 21.5 2.21 38.(7 65.6 15.7 6.7 9.9 2.2 11.2 36.2 15.7 6.7 7.6 2.2 2.3 31.6 15.7 6.7 6.5 2.2 2.3 60.2 22.3 8.9 6.5 2.2 2.3 39.8 26.1 6.7 8.9 39.8 26.1 6.7 8.9 28.6 2U.1 U.S 19.7 15.2 U.S Whole milk (kg -1) 3) - - - - - 250 250 500 75o Cheese 6.5 6.5 U.S 65 6.5 6.5 U.S U.S U.S Quarg 6.5 6.5 6.5 6.5 6.5 6.5 6.5 U.S U.S Coffee substitute 8.9 8.9 8.9 8.9 8.9 8.9 8.9 8.9 . Cocoa nix powder 7) - - - - - 2.2 2.2 2.2 2.2 Eggs 15.7 15.7 15-7 15.7 15.7 15.7 15.7 15.7 15.7 Potatoes &) Soo 5oo 500 Soo 5oo 500 500 Nutritional Content Total calories 3339 2599 2216 2001 2096 2228 1950 1760 1815 Grans fat 96.2 56.8 U3.2 36.1 66.6 1,9.9 69.1 1,2.3 61.6 < , l6A 62-1 53.3 1,3.1. 1,7.1. 51.9 US.U 1,5.1 S3U of which animal 26,6 21.1 18.O 13.9 15.0 18.9 18.9 23.3 11 7 Total available <■ Total calories 3692 2917 2518 2290 2667 2593 2308 2081, 2152 Grams fat 10M 65.0 50.6 63.1 52.8 58.1 57.2 1.9.6 1,8.1, Grams protein 85.8 71.li 62.3 52.1 56.7 61.2 56.5 53.9 62 1 of iblch animal 32.9 27.1 23.9 19.6 20.8 26.7 26.7 28.9 37*3 Non Self Suppliers receive as an average; Ration 2061 Calories, Ul.6 g Fat, 1*7.3 g of which 17.3 g animal. Total available 2371 Calories, 1*8.9 g Fat, 56.1 g Protein, of which 21*.6 g animal. Notes: See Viorwochensaetze. 368 appendix C-4 62. Ration Period from 1. - 28.5.19U* Daily Allowances in Grams 63. Nation Period from 29«5*-25*6.191*1* Daily allowances in grams ' Very Heavy Workers Heavy Workers Long and Night Workers Normal Con- sumers Adoles- cents 1U-18 Children 10-1i* yrs. JT yrs. yrs. yrs. i 2 3 li 5 6 1 J 689.3 5U6.U 1*1*6.1* 3U6.U 396,UZ) 396.U 285.7 196.2 182.1 ■ flour 516.9 U09.8 33U.8 259.8 297.2 297.2 211.2 1U7-2 136.6 Naehrmittel 21.U 21.1* 21.1* 21.1* 21.1* 21.1* 21.1* 28.6 39.3 Sugsr 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 25.0 25.0 25.0 25.0- 25.0 32.2 32.2 25.0 25.0 or Sugar 12.5 12.5 12.5 12.5 12.5 12.52+7.Ik 12.5 12.5 Artificial honey - - - - - U.S u.s U.S U.S Meat, -products 121 .U 85.7 6U.3 35.7 U2.9 U2.9 U2.9 1U.3 1 U.3 Total fata 98.0 US.6 3U.2 31.3 U0.1 39.7 39.7 28.6 19.7 of which butter 17.9 17.9 17.9 17.9 2U.5 21*.1 21*.1 21*.1 15.2 Margarine 21.5 9.9 7.U U.S U.S 3.9 8.9 - - Oil 2.2 2.2 2.2 2.2 2.2 - — — — Slaughter fat 35.7 8.9 - - - - . - - - Meat fat 6.7 6.7 6.7 6.7 8.9 6.7 6.7 U.S U.S Whole silk (kg = 1) 3) - - - - 250 250 500 750 Cheese u.s u.s u.s U.S U.S u.s u.s U.S U.S (juerg U.S u.s u.s u.s U.S u.s u.s u.s U.S Coffee substitute 8.9 8.9 6.9 8.9 8,9 8.9 8.9 8.9 - Cocoa mix poirder 5) - - - - - 2.2 2.2 2.2 2.2 sgg» 13.8 13.8 13.8 13.8 13.8 13.8 13,8 13.8 13.8 Potatoes 500 500 500 500 500 500 500 500 Nutritional Content Rations Total calories 332U 258U 2198 1983 207U 2212 193U 1729 180U Grams fat 93. U 5U.1 U0.U 33.3 U1.9 1*7.2 U6.U 1*1.1 UO.U Grams protein 76.U 62.U 53.6 U3.7 U7.8 52.1 U5.6 U5.2 S3.U of which animal 26.9 21.U 18.3 U*-2 15.U 19.1 19.1 23 .U 31.8 Total available Total calories 3671. 2899 2500 2272 2UUS 2577 2292 2073 2lUl Grama fat 506.6 62,3 U7.6 uo.3 50.3 55.U 5U.5 U8.U U7.2 Grams protein 86.0 51.7 62.6 52 .U 57.1 61. U 5U.7 5U.0 62.2 of which animal 33.7 27 .U 2U.2 19.9 21.2 2U.9 2U.9 29.0 37.U Son-Self Suppliers receive as in average: Ration 201*0 Calories, 37$ g Fat, 1*0.2 g Protein, of *iich 17.5 animal 2355 Calories, 1*6.3g Fat, 56.3 g Protein, of which 22.8 Motes see Vierwochensaetze. Very Heavy Heavy Workers Long and Nomal Con- Adoles- cents Children Workers Night Workers sumers lO-HT yrs. 6=icr yrs. >6 yrs. 0-3 yrs. 1 2 3 8 5 6 7 8 Bread ji flour 689.5 516.9 51*6.1* 1*09.8 886,8 338.8 31*6.1* 259.8 396.8 2 297.2 396 .1* 287.2 285.7 218.2 196.2 187.2 182.1 136.6 Naehrmittel 21.8 21.8 21.8 21.8 21.1* 21.8 21.8 28.6 39.3 Sugar 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 32.2 Jam or Sugar 25.0 12.5 25.0 12.5 25.0 TL.l 25.0 12.5 25.0 12.5 32.2 32.2 12.5247.1M 25.0 12.5 25.0 12.5 Artificial honey - - - - - 8.5 8.5 8.5 8.5 Meat - products 121.8 85.7 61*.3 35.7 82.9 82.9 82.9 18.3 li*.3 Total fats of which Butter Margarine Oil U) Slaughter fat Meat fat 88.0 21.9 20.5 2.2 17.9 21.5 1*5.6 21.9 8.9 2.2 8.1 1*.5 38.2 21.9 6.5 2.2 3.6 80.1 21.9 3.6 2.2 3.6 39.7 30.7 3.6 2.2 3.6 39.7 37.2 8.9 3.6 39.7 27.2 8.9 3.6 28.6 25.0 3.6 19.7 16.1 3.6 Whole Milk 3) - - - - - 250 250 Soo 750 Cheese 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Quarg 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Coffee Substitute 0©coa ndx powder $ 8.9 8.9 8.9 8.9 8.9 8.9 2.2 8.9 2.2 8.9 2.2 2.2 Eggs 13.8 13.8 13.8 13.8 13.8 13.8 13.8 13.8 13.8 Potatoes 6) 500 Soo Soo 500 500 500 5oo 500 5oo Nutritional Content Total Calories 3266 2573 2203 1988 2088 2217 1939 1730 Grams fat 88.2 Sk.l 81.9 35.0 85.3 88.9 88.1 S.3 protein 77.1 62.S 53.1, 1,3.5 t,je 5, „ ... . ,, . 27-6 a*s “-1 »■» S3 “9 §3 Total Calories 3619 2891 2505 2277 2855 2582 2297 2078 Grans fat 99.8 62.3 89.1 82.0 51.7 57.1 56.2 88.6 " protein 86.3 71.3 62.8 52.2 56.8 61.2 58.5 53.9 of *lch animal 33.9 27-5 28.0 19.7 20.9 28.7 28.7 28.1 The Non Self Suppliers receive as an average: Nation 2053 Calories, 38.5 g Fat, 87.6 g Protein, of which 17.8 g Aotal available 2357 Calories, 87*6 g Fat, 56.3 g Protein, of which 22.9 g 1807 80.5 53.3 31.7 2188 87.3 62 J. 37.33 animal. animal. Notes see Vierwochensaetze. TSy— Heavy Seavy Workers Long Normal Con Adoles- cents Children Workers Night Workers aimers 10-li* 7T3. o-IO yrs. yrs. 0-3 jrrs. 1 2 ” 3 8 6 b 7 8 9 Bread D 689.5 586.8 886.8 386.8 396.8 2 396.8 285.7 196.2 182.1 s flour 516.9 809.8 338.6 259.8 297.2 297.2 218.2 187.2 136.6 Haehmittel 21.8 ZL.il 21.8 21.1* 21.U 21.8 21.8 28.6 39.3 Sugar 32*2 32.2 32.2 32.2 32.2 32*2 32.2 32.2 32.2 J am. 25.0 25.0 25.0 25.0 25.0 32.2 32.2 25.0 25.0 or Sugar 12.5 12.5 12.5 12.5 12.5 12.5Z67.1U 12.5 12.5 Artificial honey - - - - 8.5 8.5 8.5 8.5 Meat-product* 121.8 85.7 68.3 35.7 82.9 82.9 82.9 18.3 18.3 Total fata 88.0 85.6 38.2 31.3 Uo.i 39.7 39.7 28.6 19.7 of which Butter 21.9 21.9 21.9 21.9 30.7 30.8 30.8 28.6 19.7 Margarine 28.1 12.5 10.0 7.2 7.2 8.9 8.9 - — Oil 8) 2*2 2.2 2.2 2.2 — — Slaughter fat 35.7 8.9 “ - - * “ Whole Milk 3) - - - - - 250 250 Soo 75o Cheese I».5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Qaarg It.S 8.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Coffee Substitute 8.9 8.9 8.9 8.9 8.9 • 8.9 8.9 8.9 - Cocoa mix powder 5) - - - - - 2.2 2.2 2.2 2.2 Kggo 7.9 7.9 7.9 7.9 7.9 7.9 7.9 7.9 8.9 Potatoes 6) Soo 5oo Soo 500 Soo 500 500 5oo _S2Q Rations Total Calories Nutritional Content 3329 2589 2206 1990 2086 2221 1983 1738 1809 Grass fat 95.3 56.0 82.3 35.2 83.5 89.3 88.5 81.6 1*0.8 Grams protein 76.1 62.2 53.8 83.8 87.8 51.9 85.8 85.1 53.3 of idiich animal 26.6 21.1 18.0 13.9 15.0 18.9 18.9 23.3 31.7 Total Arailable Total Calories 2682 2907 2508 2279 2858 2586 2310 2078 2185 Grams fat 106.5 68.2 89.5 1*2.2 51.9 57.5 56.6 88.9 87.6 ■ protein 85.8 71.5 62.8 52.1 56.7 61.2 58.5 53.9 62.1 of which animal 32.9 27.1 23.9 19.6 20.8 28.7 28.7 28.9 37.3 Notes: see Vierwochensaetze 61*. Ration period from 25*6. - 23.7.19U* Dally Allowances In Grams Vary Long Normal Adoles- Children Heavy Workers Heavy Corners Night ■ 6 7 9 Bread - flour 689.5 516.9 516.1* 1*09.8 116.1 331.8 316,1 259.8 396.1* 297.2 396,1* 297.2 28$.7 211*.2 196.2 117.2 182.1 136.6 Naehnnittel 21.h ZL.U a.i 21.1 21.1* 21.1* 21.1* 28.6 39.3 Sugar 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31.2 Jan or Sugar 26.8 13.1 26.8 13.1 26.8 13.14 26.8 13. U 26.8 13.1i 31.0 31.0 13.lZ47.lU. 26.8 13.1 26.8 13.1 Artificial honey - - - - - 1.5 1.5 1.5 1.5 Meat - products 121.li 85.7 61.3 35.7 12.9 12.9 12.9 11.3 11.3 Total fats 8I*.0 of which Butter . -—,_17.9 margarine*1) 26*8 slaughter fat 30.li meat fat 5) 8.9 15.6 17.9 11.3 1.1 8.9. 31.2 17.9 11.8 i.5 31.3 17.9 8.9 i.s 10.1 26.8 8.9 1.5 10.1 26.8 8.9 i.5 10.1 26.8 8.9 i.s 26.6 21.1 i.s 19.7 25.2 i.5 Whole Milk - - - - - 250 250 Soo 750 Cheese 1.5 1.5 1.5 1.5 1.5 1.5 1.5 1,5 1.5 Quarg lt.5 lt.5 1.5 1.5 1.5 l.S 1.5 1.5 1.5 Coffee Substitute 8.9 8.9 8.9 8.9 8.9 8.9 8.9 8.9 - Eggs Potatoes 6) 500 Soo 5oo *00 500 5oo 5oo 5oo Soo Nutritional Rations Total Calories 3301 2583 2167 Grams fat 92,6 53,5 1*0.7 " protein 7U.5 60.6 51.8 of which animal 25,0 19.5 16,U Total Available Total Calories 365I* 2861 2lt89 Grams fat 103.8 61.7 67,9 n protein 8U.2 69.9 60.8 of which animal 31,2 25,5 22.3 The Non Self Supplies receive aa an average Ration 1975 Calories, 38.9 Total Available 2285 Calories, 1*8.2 Content 1862 2068 2197 1919 1707 1782 33.6 11.8 17.9 17.1 39.9 39.2 11.8 15.7 19.9 13.1 13.1 51.3 12.3 13.3 17.2 17.2 a.6 30.0 2151 2139 2562 2277 2051 2119 10.6 50.2 56.1 55.2 17.2 16.0 50.5 55.0 59.2 52.5 51.9 60.1 18.0 19.1 23.0 23.0 27.2 35.6 g Fat, 15.7 Protein, of which animal 15.7- g Fat, 54.3 g Protein, of which animal 21.1. Notes* See Vierwachensaetze, 68. Ration Bsriod from 16.10. - 12.11.19UU Daily Allowances in Grams 69 Ration Period from 13.11 - 10.12. 191*1* Daily Allowances in Grams Very Heavy Long Normal Adoles- Children Heavy Workers Workers and Night Workers Con- sumers lli—18 yrs- 10-Ilf yrs. 6-10 yrs. yrs. 0-3 yrs. 1 2 3 u 5 6 7 0 Bread = flour 6U6.5 U8U.9 517.9 358.1: UU6.U 33U.8 317.9 233.1* 396.U 297.2 396.1* 297.2 285.7 2m.2 182.1 136.6 167.9 125.9 Naehrmittel 21.U 21.1* 21.1* 21.1* 21.1* 21.U 21.1* 28.6 39.3 Sugar 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31-2 - 31.2 Jan or Sugar 26.8 13.1* 26.8 13. U 26.3 13.U 26.8 13.1* 3U.0 3U.0 U.UZ+7.1 M. 3l*.0 13.1* 26.8 13.1* 26.8 13.1* Artificial Honey - - - - - - U.S U.S U.S Heat -products 121.1: 85.7 6U.3 35.7 U2.9 U2.9 U2.9 1U.3 U*.3 Total Fats of which Butter Margarine Slaughter-fat Meat fat 2) 1*) Meat and fat 6U.0 13. U 26.8 30.U 8.9 U.5 US.6 13.1: lb.3 U.U 8.9 U.S 3U.2 U.U 11.8 U.S U.S 31.3 U.U 8.9 U.S U.S UO.l 22.3 8.9 U.S U.S UO.l 22.3 8.9 uTs U.S UO.l 22.3 6.9 U.S U.S 23.6 19.6 U.S U.S 19.7 15.2 U.S \Sliole Ittlk 3) - - - - - 250 2S0 5oo 750 Cheese U.S U.S U.S U.S U.S U.S U.5 U.S U.S Quarg U.S U.S U.S U.S U.S U.S U.S U.S U.S Coffee Substitute 8.9 s.u s.u s.u s.u s.u s.u s.u - Eggs - Potatoes 5) U23.6 U28.6 U26.6 1:28.6 U28.6 U23.6 U28.6 U28.6 U23.6 Nutritional Content Rations Total Calories 3122 2U2U 2117 1721 2017 2111! 1650 1601 1692 Grams fat 89.9 50.8 38.3 30.9 39.1: 65.1; UU.7 37.U 38.0 " protein 72.0 59.0 51.8 UO.l U5.9 1:9.8 1:3.5 1:2.1: 1:9.2 of which animal 26.2 20.7 17.6 13.5 1U.6 18.5 18.5 22.9 30.0 Total Available Total Calories 3U7S 271:2 21:19 2010 2388 2U79 2208 19US 2029 Orams Fat 101.1 59.0 US-5 37-9 1:7.8 53.7 52.8 1:1:.7 U5.7 " Protein 81.7 68.3 60.8 1:8.8 55.2 59.1 52.6 51.2 58.0 of which animal 32.5 26.7 23.5 19.2 20.1: 21:.3 2U.3 23.5 35.6 The Mon Self Supplies receive as an average: Ration: 1861 Calorie., 36.5 g Fat, UU.3 g Protein, of vhich animal 16.5. Total Available 2159 Calorie?, 1:3-8 g Fat, 53,7 g Protein, of which animal 22.3. hlotes; See Vierwochensaetze Very Heavy Workers Heavy Workers Long and Night Workers Normal Con- sumers Adoles cents Children io-iir yrs. 6-10 yrs* 3-6 yrs. 0-3 yrs. _. 3 1 1* 5 7 9 1) Bread 686.5 517.9 ltlt6.lt 317 .9 396.8 396.8 285.7 162.1 167.9 -flour 888.9 358.lt 33U.8 238.8 297.2 297.2 216.2 836.6 125.9 Naehmittel 19.6 19.6 19.6 19.6 19.6 19.6 19.6 25.8 37.5 Sugar 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31.2 Jam 26.8 26.8 26.8 26.8 26.8 26.8 38.0 26.6 26.8 or Sugar 13.U 13.lt 13.lt 13.8 13.8 13.82/7.lit. 13.8 Artificial honey -- - - - 8.5 8.5 8.5 8.5 8.5 lie at - products 121.6 85.7 68.3 35.7 82.9 82.9 82.9 18.3 18.3 Total fate 8U.0 lt5.6 lli.2 31.3 8o.l 8o.i 8o.i 26.6 19.7 of which Butter 13.lt 13.lt 13.8 13. U 22.3 22.3 22.3 19.6 15.2 Margarine 26.8 Ht.3 11.8 8.9 8.9 8.9 8.9 - - Slaughter fat 30.U u.u - - - - - - - Meat fat 2) 8.9 8.9 8.5 8.5 8.5 8.5 t.5 8.5 8 .5 Meat and fatal*) U«5 U.5 8.5 8.5 8.5 8.5 8.5 8.5 - Whole liilk 3) - - - - 250 250 500 750 Cheese 2.2 2.2 2.2 2 • 2 2 .2 2.2 2.2 2.2 2.2 Meat instead of cheese 8.9 8.9 8.9 8.9 8.9 8.9 8.9 6.9 8.9 Quarg 8.5 lt.5 8.5 8.5 8.5 8.5 8.5 8.5 8.5 Coffee substitute 8.9 S.It 5.8 5.8 5.8 5.8 5.8 5.8 - Eggs 3.9 3.9 3.9 3.9 3.9 3.9 3.9 3.9 3-9 Potatoes 828.6 828,6 1:28.6 828.6 828.6 628.6 828.6 826.6 828.6 Nutritional Content Rations Total calories 3133 21:35 2128 1732 202: 2120 1861 1612 1706 Grass fat 91.lt 52.3 39.8 32.8 80.9 87.0 :6.2 38.6 80.8 " protein 72.8 59.8 52.6 80.9 86.8 50.7 t8.3 83.2 50.8 of which animal 27.1 21.7 18.6 18.8 15.5 19.8 L9.8 23.8 30.9 Total Available Total calories 3U86 2753 21:30 202] 2398 2865 2219 1956 2083 Grans fat 102.6 60.5 87.0 39.8 89.3 55.2 58.3 66.1 67.2 " protein 82.5 69.1 61.6 89.6 56.1 60.0 53.8 52.0 58.9 of which animal 33.1: 27.7 26.5 20.1 21.3 25.2 25.2 29.8 36.5 The Non Self Suppliers receive as an average: Ration 185a Calories. 38.3 g Fat, 65-3 g Protein , of which 17. 7 g animal. Total Available 217U Caloreis, U5«U g Fat, 58.2 Protein of which 26.9 animal. Notes: See Vierwochensaetze 370 appendix C-4 70. Ration period from 11.12.1966 - 7a.1965 Daily Allowances in Grams Very Heavy Heavy Workers Long and Normal Con- Adoles- cents Children Workers Night Workers sumors 10-11* yrs. 6-10 yrs. 3-6 yrs. 0-3 yrs. 1 2 3 u 5 6 7 8 9 Bread ~ flour 6U6.5 UBU.9 517.9 358.1* UU6.U 33U.8 317.9 238.U 396,1; 297.2 396.1* 287.2 285.7 211*. 2 182.1 136.6 167.9 125.9 Naehrmittel 19.6 19.6 19.6 19.6 19.6 19.6 19.6 26.8 37.5 Sugar 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31.2 31.2 Jan or Sugar 26.6 13.li 26,8 13.U 26.8 13.1* 26,8 13 .U 3U.0 3U.0 13.1*247.1 H. 3U.0 13.U 26.8 13.U 26.8 13.U Artificial honey - - - - - - U-5 U-5 U.S Meat - products 121.li 85.7 6U.3 35.7 1*2.9 U2.9 U2.9 1U.3 1U.3 Total fats 81*.0 of which Butter 13.1* Margarine 26*8 Slaughter fat 30,1* Meat fat 2) 8.9 Meat and fats 1*) 1*«5 1*5.6 13.1* U».3 lt.li 8.9 U.5 3U.2 13.1* U.S U.5 U.5 31.3 13.U 8.9 U.5 U.5 1*0.1 22.3 8.9 U.5 U.5 U0.1 22.3 8.9 U.5 U.S U0.1 22.3 8.9 U.5 U.5 28v6 19.6 U.5 U.5 19.7 15.2 U.5 Whole Milk 3) - - - - - 250 250 Soo 750 Cheese li .5 U.5 U.S U.S U.5 U.5 U.5 U.S U.S Quarg U.5 u.s U.5 u.s U.5 U.S U.5 U.5 U.5 Coffee Substitute 8.9 5.U s.u S.U S.U s.u s.u S.U - Potatoes 5) U28.6 U28.6 1*28.6 U28.6 1*28.6 U28.6 1*28.6 U28.6 1*28.6 Eggs - Nutritional Content Rations Total calories Grains fat " protein of which animal 3139 2lilil 213U 1738 91.6 52.5 liO.O 32.6 73.6 60.6 li3.1i ia.7 27.9 22.1i 19-3 15.2 203U UU.1 U7.S 16.3 2131 1867 U7.2 U6.U 51.U U5.1 20.2 20.2 1618 39.0 U3.9 2U.6 1710 1*0.6 50.9 31.9 Total Available Total calories Grams fat " protein of which animal 31*92 2759 21*36 2027 102.8 60.7 1*7.2 39.6 83.3 69.9 62.1* SO.U 3ll.2 28.1i 25.2 20.9 21*05 1*9.5 56,8 22.1 2U96 2225 55.U 5U.5 60.7 56.2 26.0 26,0 1962 1*6.3 52.7 30.2 2017 U7.U 59.7 37.5 The Non Self Suppliers receive Ration 1851* Calories, Total available 2183 Calories, s an average; 30*3 g Fat, 1*5.3 g Protein, of which 18,9 g animal, 1*5*7 g Fat, 55*3 g Protein, of which 2l*,3 g animal. Notes see Vierwochensaetze, Very Heavy Workers Heavy Workers Long and Night Workers Normal Con- sumers Adoles- cents Children 10-lit 75s* 6-10 y™* 3-6 <5-3 1 2 3 U 5 6 7 a 9 Bread 6b6.S 517.9 UIt6.lt 317.9 396.b 396.b 285.7 182.1 167.0 = flour b8b.9 358 .b 33b.8 238. b 297.2 297.2 2U*.2 136.6 12S.9 Naehrmittel 19.6 19.6 19.6- 19.6 19.6 19.6 19.6 26.6 37.S Sugar 31.2 3132 31.2 31.2 31.2 31.2 31.2 31.2 31.2' Jan 26.8 26.8 26.8 26.8 26.8 26.8 3b.O 26.8 26.8 or Sugajr 13.U 13 .b 13.b 13.b 13.b 13.b 13.bZ*7.1H 13 b 13 *b Artificial honey - - - - b.S b.S b.S b.S b.S Meat - products 121.ll 85.7 6b.3 35.7 b2.9 b2.9 b2.9 lb.3 lb.3 Total fats 8b.0 bS.6 3b.2 31.b bO.3 b0.3 bO .3 28.6 19.7 of which Butter 13.b 13 .b 13.b 13.b 22.3 22.3 22.3 19.6 15.2 Margarine 22.3 9,8 7.3 b.S b.S b.S b.S - - Slaughter fat 3b.9 8.9 b.S b.S b.S b.S b.S — — Meat fat 2) 8.9 8.9 b.S b.S b.S b.S b.S b.S b.S Meat and fats U) U.5 b.S b.S b.S b.S b.S b.S b. 5 " Whole unit 3) - - - - - 250 250 Soo 750 Cheese b.S b.S b.S b.S b.S b.S b.S b.S b.S Quarg b.S b.S b.S b.S b.S b.S b.S b.S b.S Coffee Substitute 8.9 S.b S.b S.b S.b S.b S.b S.b - 6) Potatoes 5) b26.6 b28.6 b26.6 1*26.6 b28.6 b28.6 b28.6 b28.6 b28.6 Nutritional Content Rations Total Calories 312b 2b23 2116 1721 2012 2109 18S0 1595 1689 Grains fat 90.6 51.3 38.9 31.6 1*0.1 1*6.2 bS.ii 37.3 38.9 Grams protein 72.0 58.9 51.7 bO.l b6.0 b9.9 b3.S b2.3 b9.2 of which animal 26.3 20.8 17.7 13.6 lb.7 18.6 18.6 22.9 30.2 Total Available Total Calories 3b77 27bl 2bl8 2010 2383 2b?b , 2208 1939 2026 Grams fat 101.8 59.5 1*6,1 33.6 b8.S Sb.b 53.5 bb.6 b5.7 Grams protein 81.7 63.2 60.7 18.8 55.3 59.2 52.6 51.1 58.0 of which animal 32.6 26.8 23.6 19.3 20.5 2b.b 2b.b 28.5 35.8 The Non Self Suppliers receive as a n average: Ration 1836 Calorie s, 37.2 g Fat, U3»7 g Protein, of which 16,1 g animal. Total available 2156 Calories, Uh,3 g Fat, 52.6 Protein, of which 23.3 g animal. Notes see Vierwochensaetze. 71, Ration Period from 8.1. - U.2.19U5 Daily Allowances in Grams 72, Ration Period from 5,2. - 8.3. 1965 1) Daily Allowances in Grams 73. Ration Period from 8.3. - 8.6. 1965 6) " Very Long Normal Adoles- Children Heavy Workers Heavy Workers and Night Workers Con- sumers cents 1U-18 10-1U yrs. 6-10 3-6 yrs. 0-3 yrs. 1 2 3 U 5 6 7 8 9 Bread ■flour 57U.7 U31.2 U60.U 3U5.3 396.9 297.6 282.6 211.9 352.U 26U.U 352.U 26U.U 253.9 190. u 161.9 1U9.3 121.8 112.0 Naehrraittel 17. U 17.U 17. u 17.U 17.U 17.U 17.U 23.9 33.3 Sugar 27.8 27.a 27.8 27.8 27.8 27.3 27.8 27.8 27.8 Jam or Sugar 23.9 12.0 23.9 12.0 23.9 12.0 23.9 12.0 30.2 15.1 30.2 15.1 30.2 15.1 23.9 23.9 12.0 12.0 Artificial Honey - - - - - - U.O U.o U.o ileat - products 107.9 76.1 57.1 31.7 38.2 38.2 38.2 12.- 12.7 Total fats of which butter margarine slaughter fat meat fat meat, fats 80.8 11.9 19.8 31.0 10.2 7.9 U6.8 11.9 8.8 8.0 10.2 7.9 35.5 11.9 6.6 U.O 5.1 7.9 32.9 11.9 U.O U.O 5.1 7.9 U0.8 19.8 U.O U.O 5.1 7.9 U0.8 19.8 u.o U.o 5.1 7.9 U0.8 19.8 U.o U.o 5.1 7.9 30.U 19.0 17.U 13.9 5.1 5.1 7.9 - 7/hole milk 223 223 223 UU5 667 Cheese 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.C 2.0 Quarg u.o U.O U.O U.O U.o U.o U.o U.o U.O Coffee substitute 7.2 U.O U.O U.O U.o U.o U.O U.O - Potatoes Sggs 1) The 72nd and 73rd ration periods together were 'extended to cover 9 weeks, instead of the normal 8 weeks. Correction for this extension has been made in the figures above# 1) Figures are based on the publication of the Reich Ministry for Food and Agriculture; "Lebensmittelmengen auf Kartengrundlage J.n der 72. Zuteilungsperiode U.3. 19U5 It. Erlass des RMf EuL. vom 20.12.UU - II B 1 - 72." vom 5.2 . bis Very Long Normal Adoles- Children Heavy Workers Heavy Workers Night Workers Con- sumers cents 1U-18 10-1U yrs. 6-10 yrs. yrs. o-3 yrs. 1 2 3 U 5 6 7 8 9 Bread- flour SU2.9 U07.2 1*28.6 321.5 365.1 273.8 250.8 188.1 320.6 2U0.5 320.6 2U0.5 238.2 178.7 1U6.0 1U9.3 109.5 112.0 Naehrmittel 8.7 8.7 8.7 8.7 8.7 8.7 8.7 17.U 26.1 Sugar 27.8 27.8 27.9 27.8 27.8 27.8 27.8 27.8 27.8 Jam or Sugar 23.9 12.0 23.9 12.0 23.9 12.0 23.9 12.0 30.2 15.1 30.2 15.1 30.2 15.1 23.9 23.9 12.0 12.0 Artificial Honey - - - - • - - U.O ll.o U.o Meat, - products 101.9 76.1 57.1 31.7 38.2 38.2 38.2 12." 12.7 Total fats 70.7 36.6 26.5 23.8 31.7 31.7 31.7 21.U 13.U Whole milk 223 223 223 uus 667 Cheese U.O U.O U.O U.O U.O U.O U.O U.O U.o Quarg U.O U.o h.o U.O U.O U.o U.o U.o U.o Coffee Substitute U.o h.O h.O U.O U.o u.o U.o U.o U.o 1) The 72nd and 73rd ration periods together were extended to cover 9 weeks, instead of the normal 8 weeks. Correction for this extension has been made in the figures above• 1) Figures are based on lists prepared by officials and Agriculture at Walburg, Hessen, on 2 July 19U5. of the Reich Ministry for Food Frequently during the last few periods foods were issued, e.g. meat in lieu of fat, cheese items is not considered in the above figures. alternate to those originally announced or Naehrmittel. This substitution of Daily Allowances in Grams 371 appendix C-5 COMPILATION OF NUTRITIONAL VALUES EXPLANATION OF TABLES This compilation of nutritional values applies to foods of the customary type and quality of pre- war days (1939). It comprises three parts, namely the values for foods at the consumer level, foods at the wholesale level and the values of pure substances. Part I shows the content of foods, as far as nutritive value is concerned, with occasional con- siderations as to the waste which exists in foods at the consumer level. These values apply to foods in such state and form as the consumer has at his disposal to fill his needs. The values contained in this part are therefore based on calculations relating to foods in the form in which they reach the kitchen of the consumer from the retailer or market place. Part 111 contains the pure substance values of the raw product values contained in Part I and 11. These are values given for each hundred grams of edible substance free of waste and loss. From these pure substance values the values for raw products contained in Part I and II have been calculated in such a way that the waste quotas (Table I) or the loss quotas (Table II) were always deducted from the pure substance values. The pure substance values were included primarily for use in scientific re- search. The practical significance of the pure substance values is confined to calculations on merchan- dise free of waste. In order to calculate the calorie values of the individual nutritive substances, the following values were used: 1 gram protein = 4.1 cal 1 gram fat = 9.3 cal 1 gram carbohydrates ==4.l cal 1 gram lemon (fruit) acid = 3.4 cal. 1 gram other organic acid = 4.1 cal. 1 gram extract taken from beer = 4.1 cal. 1 gram extract taken from wine = 3.4 cal The content of alcohol has not been considered in the calculation of the calorie values, as accord- ing to an authoritative statement of the Kaiser Wilhelm Institute for Work Physiology in Dortmund, alcohol is no energy producer in respect to muscle work and it plays only a small part in metabolism in a state of rest. The book by Koenig must still be considered as a main source for the analysis employed, since more up to date analyses can only be made on a limited scale. These were chiefly contributed by the nutri- tion physiology and chemical department of the Reich Health Office. The values of the individual foodstuffs are taken in part in the form as given in the above men- tioned sources, in part they are given as average values calculated from analyses contained in the sources. These average analyses are calculated as simple arithmetical means from the individual analy- ses at hand. As far as the values contained in the surveys are expressly designated as average values only group averages are concerned. These values given for a whole group of foods (for instance, cheeses) were calculated from values for individual types of merchandise (for instance, fat cheese, half fat cheese, etc.) as a rule as weighted average values. The calculations included consideration of the contribution of the individual type of foods in the total consumption of the respective groups of food, just prior to the war. 372 appendix C-5 Betl)cfte 5 m £ettfd)nft ,/Bk Crtmfynmg" Zeitsdirift fur das gesamte Ernahrungswesen in Forsdmng, Lehre und Praxis Herausgegeben von der Deutsdien Gesellsdiaft fur Ernahrungsforsdiung in Verbindung mit dem Reidisgesundheitsamt und der Reidisarbeitsgemeinschaft fiir Volksernahrung President und Vorsitzender Prof. Dr. HANS REITER, BERLIN REDAKTION: PROF. DR. MED. O. FLOSSNER RERUN Dlrektor beim Relchsgesundheltsamt OBERREGIERUNGSRAT DR. AGR. H. ERTEL BERLIN Reichsministerlum des Innern, Geschaftsfiihrer derßelchsarbeitsgemeinsdiaft fiirVolksernahrung Heft 11 Baljtftoflv unt» Ualjtnjertgdjalt oon Icbcnsnnttdn Bearbeitet im Statistiscben Reidisamt in Verbindung mit dem Reidisgesundheitsamt 19 4 3 VERLAG VON JOHANN AMBROSIUS BARTH / LEIPZIG 373 appendix C-5 TeU I Seite Teil II Seite Teil III Seite Sonstiges Mehl (einschl. Starkemehl 11 26 41 e) Nahrmittol und ahnliche industrielle Erzeugnisse 12 26 41 f) Getreidekaffee 12 26 41 2. Brot und Backwarep 12 — 41 a) Brot 12 — 41 b) Backwaren 12 — 42 3. Teigwaren. 13 26 42 4. Zucker und Zuckerwaren, Honig 13 26 42 a) Zucker und Sirup 13 26 42 b) Hartzuckerwaren (Bonbons) 13 26 42 c) Honig 13' 26 42 5. Kartoffeln 13 27 42 6. Hiilsenfriichte, getrooknet.: 13 27 43 7. Gemiise 14 27 43 a) Gemiise, frisch 14 27 43 1. Deutsche Erzeugung — 27 — 2. Einfuhrware — 28 — b) Gemiisedauerware 15 29 44 8. Obst und Siidfriichte 15 30 44 a) Frischobst 15 30 44 b) Siidfriichte 16 30 45 o) Hartschalenobst 16 31 45 d) Obstdauerware 16 31 45 Getrocknetes Obst 16 31 45 Obstkonserven 16 31 46 Obstkraut 16 31 46 Marmelade 16 31 46 9. Kakao und Kakaoerzeugnisse 17 31 46 10. Alkoholische Getranke 17 32 47 a) Bier 17 32 47 b) Traubenwein 17 32 47 o) Obstwein 18 33 47 d) Schaumwein 18 33 48 e) Branntwein 18 33 48 11. Alkoholfreie Getranke 19 33 48 a) Fruchtsafte, Fruchtsirup 19 33 48 b) SuBmoste 19 33 48 o) Sonstige 19 — — Saohverzeichnis Systematischea Inhaltsverzeichnis Erlauterungen zu den Tabellen Teil I; Verbraucherstufe Teil II: GroBhandelsstufe Teil III: Reinsub'stanztabelle Seite ... 4 ... 20 Teil Teil Teil I II III Seite Seite Seite I. Tierische Nahrungs- und GenuBmitte! 4 20 34 1. Fleisch und Fleischwaren 4 20 34 a) Frisches Fleisch von Schlachttieren 4 20 34 b) Innereien, Schlachtfette und Schlachtabgange 5 20 35 c) Fleisch- und Wurstwaren 6 20 36 d) Wild (ohne Wildgefliigel) 7 21 36 e) Gefliigel 7 21 36 f) Wildgefliigel 7 21 36 2. Fische und Fischwaren 7 21 37 (jj a) Fische, frisch, stadtischer Verbrauch 7 21 37 •<1 b) Seefische, frisch 7 21 37 c) SiiBwasserfische 7 22 37 d) Fischdauerwaren 7 22 37 e) Schaltiere 8 22 38 f) Fischsalate 8 — 38 3. Eier und Eiererzeugnisse 8 22 38 a) Analysenwerte je 100 g 8 22 38 b) Analysenwerte je Ei 8 23 38 4. Milch und Milcherzeugnisse 8 23 38 a) Milch und dergleichen 8 23 38 b) Butter und Butterschmalz 9 24 39 c) Kkse und Quark 9 24 39 II. Tierische und pflanzliohe Fette, gemischte Lebensmittel 10 24 39 1. Fette und Ole 10 24 39 2. Suppenpraparate, Wiirzen und Hefe 10 24 39 III. Pflanzliohe Nahrungs- und GenuBmittel 10 25 40 1. Getreide und Mixhlenerzeugnisse 10 25 40 a) Ganzes Korn 25 40 b) Geschkltes Korn 10 25 40 c) GrieB, Grutze 10 25 40 dj Mehl 10 25 40 Roggen- und Weizenmehl 10 25 40 Neue Sorten 11 25 40 Alte Sorten 11 - 40 Systematisches Inhaltsverzeichnis appendix C-5 Nahrungsmittel Der genieCbare Ten von 100 g Rohware enthalt Beriicks EiweiB g Fett g Kohle- hydrate g Kalorien Abfall % Kalbfleisch1) mit Knochen Klasse I2) 17,8 6,9 0,4 139 10,5 Klasse II2) 16,1 7,2 0,3 134 18,5 Klasse III2) 14,3 7.6 0,3 131 26,5 Klasse IV2) 9,8 2,7 0,2 66 50,0 i. D.2) 16,1 6,9 0,2 131 18,7 i. D.3) 17,2 7,4 0,2 140 13,0 Rind- und Kalbfleisch mit Knochen i- D.2) 16,3 7,7 0,3 140 17,3 i. D.3) 17,4 8,1 0,3 148 12,6 Schaffleisch Fleisch vom fetten Tier4) i. D.2) 13,6 17,5 0,2 219 20,3 i. D.3) 14,1 18,2 0,2 228 17,4 Klasse I (Riicken)2) 15,1 23,6 0,2 283 12,0 Klasse I (Keule)2) 14,2 22,1 0,2 265 17,5 Klasse II2) 11,7 27,1 0,2 301 19,0 Klasse III2) 12,4 17,8 0,1 215 26,0 i. I).2) 13,2 21,4 0,2 254 20,3 i. D.3) 13,6 22,1 0,2 262 17,4 Pferdefleisch Lende 21,2 1,2 0,9 100 — mit Knochen6) 20,4 2,3 0,9 109 5 Ziegenfleisch mit Knochen i. D.2) 16,1 3,4 0,4 99 22,0 i. I).3) 17,6 3,7 0,4 108 15,0 Kaninchen mit Knochen, bratfertig 19,0 7,0 — 142 12,3 Ziegen- und Kaninchenfleisch mit Knochen, i. D.3) 17,9 5.4 0,3 125 13,5 b) Innereien und Schlachtfetto Innereien i. D.6) 15,9 4,8 1.0 114 9,5 Herz, frisch, vom Rind odcr Kalb 14,9 8,5 0,3 141 15.4 Leber, frisch, vom Rind oder Kalb 19,6 3,6 3,3 127 1,4 Leber, frisch, vom Schwein 19,2 5,2 2,5 137 1.4 Klasse I: Keule, Nierenbraten; Klasse III: Hals, Brust, Bauch; Klasse II: Riicken, Kamm, Bug; Klasse IV: Kopf, Fiiße. 2) Ohne den Nahrwert der eingewachsenen, auskochbaren Knochen. 3) Einschließlich des Nahrwertes der eingewachsenen, auskochbaren Knochen. 4) Klasse I: Riicken, Keule; Klasse III: Brust, Bauch, Hals, Kopf. Klasse II: Bug; 5) Kein Nahrwert auskochbarer Knochen. 6) Durchschnjtt der wichtigsten Arten. I. Tierische Nahrungs- und Genußmittel Toil I: Verbraucherstufe (Fortsctzung) Nahrungsmittel Der genieBbare Teil von 100 g Rohware enthalt Beriicks. Abfall % EiweiB g Fett g Kohle- hydrate g Kalorien I. Tierische Nahnuigs- und GenuBmittel 1. Fleisch und Fleischwaren a) Frisches Fleisch von Schlachttieren Fleisch i. D.*) 4) *) Gesamtbevolkerung 13,5 16,6 0,2 211 22,7 Stadtischer Verbrauch 14,3 15,0 0,2 199 20,4 Landlicher Verbrauch 12,5 18,4 0,2 223 25,8 Schweinefleisch mit Knochen Fleisch vom fetten Tier3): Klasse I (ohne Schinken)4) 15,6 21,3 0,3 263 11,0 Klasse I Schinken4) 10,1 13,7 0,2 170 42,5 Klasse II4) 12,6 27,2 0,3 306 16,0 Klasse III4) 10,9 20,7 0,2 238 32,0 Klasse IV4) 5,7 18,6 0,1 196 55,0 i. D.4) 11,0 20,1 0,2 233 31,4 i. D.1) 11,3 20,6 0,2 238 29,8 Rindfleisch mit Knochen mager4) 17,4 3,0 0,5 101 15,6 mittelfett4) 16,7 6,6 0,3 131 16,0 fett4) 14,4 15,4 0,2 203 20,4 i. D.4) 16,3 7,9 0,3 142 17,0 i. D.1) 17,4 8,3 0,3 150 12,5 Fleisch vom fetten Tier4)6) : Klasse I 19,1 12,5 0,4 196 4,5 Klasse II 15,5 16,6 0,3 219 15,5 Klasse III 12,5 20,3 0,2 241 24,1 Klasse IV 11,6 11,3 0,2 154 37,5 Hackfleisch 15,3 8,7 0,4 145 - *) Hier wie im folgenden vgl. die Erlauterungen. 1) Einschließlich dea Nahrwertes der eingewachsenen, auskochbaren Knochen ohne Innereien, 2) Sehweine-, Bind-, Kalb-, Schaf-, Pferde-, Ziegen-, Kaninchenfleisch und Gefliigel im ge- wogenen Durchschnitt des Verbrauchs. 8) Klasse I: Riicken, Kotelett, Schinken; Klasse III: Bauch; Klasse II: Kamm, Vorderschinken, Brust; Klasse IV: Kopf, Beine. 4) Ohne den Nahrwert der eingewachsenen, auskochbaren Knochen. 6) Klasse I: Rinderbraten, Blume, Eck- , Klasse III: Fehlrippe, Kamm, Qucrrippe, schwanzstiick, Mittelschwanzstilck; Brustkern; Klasse II: Unterschwanzstiiok, Bug, Mittel- Klasse IV: Querrippe, Hessen, Dimming, brust; Teill: Verbraucherstufe Teil I: Verbraucherstufe 375 appendix C-5 Nahrungamittel von Der genieBbare Teil 100 g Rohware enthfllt Berlicka. Abfall 7. EiweiB g Fett g Kohle- hydrate g Kalorien d) Wild i. D. (ohne Wildgefliigel) 18,6 1,7 0,4 94 14,4 Hirach, Keule (mit Knochen) 18,1 3,4 0,5 109 12,5 Reh (mit Knochen) 17,7 1,6 0,3 89 16,0 Wildschwein, Keule (mit Knochen) 18,9 2,1 0,4 99 12,5 Hase (mit Knochen) 19,6 0,9 0,4 91 15,0 e) Gefliigel i. D 15,3 13,1 — 185 17,6 Cans, Mittel 11,0 34,5 — 366 22,2 Huhn, bratfertig 17,0 4,0 — 107 15,5 Ente, Hauatier 18,0 4,0 — 111 13,5 Taube, bratfertig 16,6 0,8 0,4 77 25,0 f) Wildgefliigel Faaan 12,9 1,1 0,2 64 42,1 Feldhuhn, Rebhuhn 14,3 0,8 0,3 67 41,2 Wildente 12,1 1,7 0,3 67 46,7 2. Fisohe und Fischwaren a) Fisohe, friach, atftdtiacherVerbrauch See- und SuBwaaaerfiache i. D 8.7 1.3 - 48 51,5 b) Seefische, frisch Ganze Fisohe, i. D. des atadt. Verbrauchs 8,8 1,2 47 51,2 Aal (FIuBaal) 9,3 20,9 — 233 24,0 Heilbutt 15,1 0,2 — 64 26,2 Hering 8,3 3,5 — 67 53,5 Kabeljau 8,3 0,1 — 35 54,0 Knurrhahn 10,6 1,4 — 56 43,4 Lengfisch 16,6 0,2 — 70 7,7 Makrele 11,2 2,9 — 73 43,6 Petermann 11,4 1,4 — 60 34,2 Rotbarsch 10,9 0,5 — 49 41,0 Rotzunge 11,9 0,1 — 50 31,5 Schellfisch 9,5 0,2 — 41 48,5 Scholle 11,1 0,5 — 50 37,1 Seelachs 14,2 0,3 — 61 25,8 Thunfisch 14,6 0,3 — 63 43,6 Wittling 13,6 0,2 — 58 20,9 c) SuBwasaerfische i. D 7,3 2,4 — 52 57,1 FluBbarsch 7,0 0,3 31 63,0 Hecht 10,2 0,3 — 45 45,0 Karpfen 7,5 4,4 _ 72 55,0 Plbtze, Rotauge 7,6 0,5 — 36 55,0 Schleie 6,6 0,1 — 28 63,0 d) Fischdauerwaren i. D 14,3 10,5 0,5 158 31,5 Gerauoherter Fisoh i. D 14,1 9,1 142 33,8 Aal 13,2 22,4 0.2 263 26,5 Buckling 13,7 9,9 — 148 37,0 I. Tierische Nahrungs- und GenuCmittel Teil I: Verbraucherstufe (Fortsetzung) von Der genieflbare Teil 100 g Rohware enthalt Beriicks. Nahrungsmittel EiweiB g Fett g Kohle- hydrate g Kalorien Abfall V. Niere, frisch, vom Rind oder Kalb 18,4 4,5 0.4 119 Lunge, frisch, vom Rind oder Kalb 12,9 2,1 0,5 74 15,4 Milz, frisch, vom Rind oder Kalb 16,9 4,0 1,0 111 5,0 Zunge, frisch, vom Rind oder Kalb 14,2 15,9 0,1 207 9,8 Him, frisch, vom Kalb 8,5 8,1 — 110 6,7 Jus (Bratensaft, geliert) 2,5 9,0 — 94 — Knochenmark, frisch 3,2 89,9 — 849 — Knochen 0,2 6,3 — 59 93,0 Schlachtfette Fettgewebe, frisch, vom Rind 1,2 89,0 — 833 — Fettgewebe, frisch, vom Schwein 1,3 92,0 — 861 — c) Fleisch- und Wurstwaren Schweinefleisch, gerauchert (Geselchtes) i. D. mit Knochen1) 20,8 27,8 — 344 9,2 mit Knochen2) 20,9 27,9 — 345 8,7 Ochsenfleisch, gerauchert 27,1 13,4 — 236 — Pferdefleisch, gerauchert 31,8 6,5 0,9 195 — Schinken, gerauchert 21,9 21,9 — 293 12,4 Speck, gerkuchert und gesalzen 9,0 72,8 — 714 — Speck, durchwachsen 14,0 51,0 — 632 — Gefrierfleisch 15,8 7,7 0,3 138 19,8 Mettwurst 19,4 42,8 — 478 2,0 Rindfleischwurst 20,1 32,2 — 382 2,0 Salami 27,2 47,4 — 552 2,0 Schinkenwurst 12,6 33,7 2,5 375 2,0 Zervelatwurst 21,8 46,0 0,1 518 2,0 Rohwurst i. D 21,2 44,5 0.1 501 2,0 Leberwurst 6,9 19,5 0,3 211 2,0 Blutwurst 13,9 43,6 0,2 463 2,0 Frische Leberwurst 12,6 24,6 11,8 329 2,0 Frische Blutwurst 9,8 9,8 19,6 212 2,0 Frische Wurst i. D 10,7 14,1 17,3 246 2,0 Kochwurst i. D 8,8 24,2 2,0 269 2,0 Jagdwurst 16,2 25,8 — 302 2,0 Briihwurst i. D 15,2 25,8 — 302 2,0 Wiener Wiirstcben 12,4 13,6 — 177 1,0 Frankfurter Wurstchen 12,4 38,7 0,6 413 1,0 Wiirstchen i. D 12,4 13,9 —- 180 1,0 Siilzwurst 22,6 22,3 — 300 2,0 Wurst i. D 14,0 27,8 0,9 320 1,8 Rindfleisch in Buchsen 19,2 12,4 1,2 199 — Gulasch in Biichaen 19,2 11,0 2,7 192 — Corned beef 22,3 6,5 — 152 6,2 Fleischkonserven i. D 20,2 10,0 1,3 181 1,6 Fleisch und Fleischwaren i. D 15,3 20,8 0,6 259 11,3 Fleischsalat 20,8 3,3 0,5 118 — l) Ohne den Nahrwert der eingewachsenen, auskochbaren Knochen. *) EinachlieClich des Nahrwertes der eingewachsenen, auskochbaren Knochen. Teil I: Verbraucherstufe Teil I: Verbraucherstufe (Fortsetzung) 376 appendix C-5 Nahrungsmittel von Der genieCbare Teil 100 g Rohware enthalt Beriicks. EiweiC g Fett g Kohle- hydrate g Kalorien Abfall V. Vollmilch, 2,8% Fettgehalt 3,4 2,8 4,8 60 _ Vollmilch, 2,9% Fettgehalt 3,4 2,9 4,8 61 — Vollmilch, 3,0% Fettgehalt 3,4 3,0 4,8 62 — Vollmilch, 3,2% Fettgehalt 3,4 3,2 4,8 63 — Vollmilch, 3,3% Fettgehalt 3,4 3,3 4,8 64 — Vollmilch, 3,4% Fettgehalt 3,4 3,4 4,8 65 — Vollmilch, 3,5% Fettgehalt 3,4 3,5 4,8 66 — Vollmilch, 3,6% Fettgehalt 3,4 3,6 4,8 67 Vollmilch, 3,7% Fettgehalt 3,4 3,7 4,8 68 Vollmilch, 3,8% Fettgehalt 3,4 3,8 4,8 69 —. Vollmilch, 3,9% Fettgehalt Entrahmte Frischmilch (Magermilch), 0,1% 3.4 3,9 4,8 70 Fettgehalt 3,7 0,1 4,8 36 — Buttermilch, 0,5% Fettgehalt Trookenerzeugnisse: 3,7 0,5 3,7 35 Vollmilohpulver Pulver aus entrahmter Milch (Magermilch- 25,2 26,8 37,0 504 — pulver) 33,5 1.6 60,0 357 — Milei W 30,7 0,3 51,0 338 Milei G 34,0 1,4 52,1 366 Rahm, Sahne: Kaffeerahm 3,5 10,0 4,0 124 Schlagrahm, 30% Fettgehalt 2,7 30,0 3,0 302 — Kondenaierte Milch (Vollmilch ohne Zucker) . 8,0 9,3 10,9 164 Ziegenmilch 3,6 3,9 4,7 70 — b) Butter und Butterschmalz Butter i. D 0,9 80,0 0,9 751 __ Butterschmalz c) Kfise und Quark Fettgehalt i. T. °/« Kftse i. D 0,1 99,8 0,1 929 29,3 20,3 2,5 319 4,6 Doppelrahmkase 60 19,3 37,3 1.4 432 1,5 Rahmkase 50 23,0 30,3 1,8 383 6.3 Vollfettkftse1) 45 25,6 26,6. 2,1 361 5,9 Fettk&se1) 40 26,3 23,6 2,5 338 5,5 Dreiviertelfettk&se1) 30 31,8 17,5 2,6 304 5,6 Halbfettkftse 20 36,2 9,9 3,0 253 4,2 Viertelfettkftse 10 36,5 4,2 3,2 202 4,8 Magerkftse weniger als 10 Quark, frisch 37,1 2,8. 3,8 192 4,8 aus abgerahmter Milch mit 0,8% Fettgehalt der Rohware aus entrahmter Frischmilch mit 0,1% Fett- 17,2 1,2 4,0 98 — gehalt der Rohware 17,6 0,1 4.1 1 90 — I. Tierisohe Nahrunge- und GenuCmittel Teil I: Yerbraucherstule (Fortsetzung) l) Die Werte umfassen Hartkaee, halbfesten Schnittkiae und Streichkkae, Nahrungemittel Der genieCbare Teil yon 100 g Rohware enthftlt Berflck* Abfall V. EiweiB g Fett g Kohle- hydrate g Kalorien Makrele 14,8 10,0 164 31,0 Seelaoha 18,9 1,0 — 87 14,8 Sprotten 10,0 11,6 — 148 42,0 Marinaden i. D 16,4 11,3 0,8 172 23,9 Biamarokhering 12,6 8,4 0,8 133 45,8 Marinierter Bering 14,4 11,2 0,6 166 23,6 Rollmope 19,3 14,4 0,9 217 2,4 Fiaohkonaerven i. D 14,5 10,0 0,7 155 33,0 Bering in Gelee 10,2 8,7 0,4 124 44,0 Aal in Gelee 9,4 9,0 0,3 123 47,9 Glaardinen 18,8 11,2 1.0 186 21,5 Salahering 14,0 11,4 0,9 167 31,7 Stookfitoh 55,5 1,8 — 244 32,2 Klippfiaoh 29,5 1.0 — 130 31,5 SaUfiaoh, Laberdan 16,6 0,8 — 76 31,8 e) Sohaltiere Krabben mit Schalen 7,5 0,6 1,1 41 62,4 Mieamuscheln mit Sohalen 4,5 0,7 1.1 30 49,3 f) Fischsalate Heringsealat 6,6 6,3 17,6 149 — Fischsalat 13,8 1.3 0,7 72 3. Eier und Eiererzeugnisse a) Analysenwerte je 100 g Biihnerei 12,3 10,7 0,5 162 12,7 EiweiB (Eiklar) 12,8 0,3 0,7 58 — Eigelb (Eidotter) 16,1 31,7 0.3 362 — Trockenei (Vollei) 43,2 40,9 2,0 566 — Trockeneiweifi 73,4 0,3 4,0 320 — Trockeneigelb 35,1 53,2 1,0 643 — Entenei 11,1 13,0 0,3 168 12,9 b) Analyeenwerte je Stiick Biihnerei der Kinase B = 57 g i. D.1) 7,0 &.1 0,3 87 12,7 Entenei im durchachn. Gewicht yon 69,8 g.... 6,6 7,8 0,2 100 12,9 4. Milch und Miloherzeugnisse a) Milch u. dgl. Kuhmilch: Vollmilch, 3,1% Fettgehalt, durchschnitt- liche Trinkmilch 3,4 3,1 4,8 62 — Vollmilch, 2,7% Fettgehalt 3,4 2,7 4,8 59 — *) Nadi den Ermittlungen der Reichastelle fttr Eier beeteht ein Eider Klaase B im Dorchschnitt aus 7,3 g Schale, 19,1 g Eidotter, 30,6 g Eikl&r. Tell I: Verbrauoherstufe Toil I: Yerbraucherstule (Fortsetzung) 377 appendix C-5 Nahrungsmittel von Der geniefibare Teil 100 g Rohware enthftlt Beriicks. EiweiC g Fett g Kohle- hydrate g Kalorien Abfall V. im einzelnen neue Sorten Roggenmehl Type 997 (Ausmahlung etwa 0—75%) 6,9 1,1 76,3 351 Roggenmehl Type 1150 (Ausmahlung etwa 0—80%) '• 7,7 1,3 74,6 349 Roggenmehl Type 1370 (KommiCmehl, Aus- mahlung etwa 0—85%) 8,0 1,4 73,9 349 Roggenbackschrot, Roggenvollkornschrot Type 1800 (Ausmahlung etwa 0—94 bzw. 98°/0) .. 9.0 1,5 72,1 346 Roggenmehl i. D. einschliefilich Backschrot.... 7,9 1.3 74,2 349 Roggenmehl i. D. ohne Backschrot 7,5 1,2 74,9 349 Weizenmehl Type 812 (Ausmahlung etwa 0—78%) 10,6 1,6 72,3 354 Weizenmehl Type 1050 (Ausmahlung etwa 0—83%) 10,9 1,7 71,1 352 Weizenbackschrot, Weizenvollkornschrot Type 1700 (Ausmahlung etwa 0—94 bzw. 98%) . 12,6 1,9 68,2 349 Weizenmehl i. D. einschlieClich Backschrot.... 11,3 1.7 70,5 351 Weizenmehl i. D. ohne Backschrot 10,7 1,7 71,7 354 — alte Sorten Roggenmehl 1—30%, feinstes 6.9 0,6 75,7 340 Roggenmehl 30—60%, zweites 9.7 1,2 67,5 328 Roggenmehl 60—65%, drittes 12,8 2,2 60,9 323 Roggenmehl 65—70%, Nachmehl 14,6 2,4 58,7 323 Roggenmehl 70—95%, Kleie 15,5 3,2 29,4 214 — Weizenmehl 1—30%, feinstes 11,6 0,9 71,5 349 Weizenmehl 30—70%, zweites 13,3 2,2 69,8 361 Weizenmehl 70—75%, drittes 17,1 3,5 61,2 354 Weizenmehl 75—80%, Naehmehl 17,9 4,0 50,3 316 — Sonstiges Mehl Buchweizeumehl 8,3 2,1 74,6 359 Grunkernmehl, Dinkelmehl 8,9 1,8 76,3 366 Kartoffelstarkemehl, Kartoffelsago, DPM (Deutsches Puddingmehl) 0,9 0,1 80,7 335 Kartoffelwalzmohl 6,7 0,2 80,0 357 Maismehl 9,6 3,1 71,7 362 Maisstftrkemehl 0,5 83,0 342 Reisstarkemehl 0,8 — 85,2 353 Sojamehl, entfettet 52,2 1.2 29,9 348 Sojamehl, Vollsojamehl 42,5 19,9 24,3 459 Sufllupinenmehl aus gelben, geschalten SiiB- lupinen 65,6 6,6 23,0 384 Weizenst&rkemehl 1,1 0,2 84,1 351 — Belh. 11 rur Zeltschrlft „Dle ErnShrung“ 2 11. Tierieche und pflanzliche Fette / HE. Pflanzliohe Nahrungs- und Genußmittel Teil I: Yerbraucherstule (Fortsetzung) Nahrungamittel von Der genieBbare Teil 100 g Rohware enthftlt BerOcka. EiweiB g Fett g Kohle- hydrate g Kalorien Abfall Vo II. Tierische und pflanzllche Fette, gemischte Lebensmlttel 1. Fette1) und Ole Kunatapeiaef ett — 99,0 — 921 — Lebertran — 99,7 — 927 — Margarine 0,5 80,0 0,4 748 — Rindertalg, auagelassen 0,5 99,2 — 925 — Schweineachmalz 0,3 99,4 — 926 — Speiaeol Unvermiaohtes Pflanzenfett (Kokosfett, Palmin, — 99,5 — 925 — Nuasa u. dgl.) 2. Suppenpraparate, Wtirzer 99,8 und H jfe 928 Hefe, friach, gepreBt 16,2 1,3 5,5 101 — Hefeextrakt i. D 48,32) — 193 — N&hrhefe 52,0 3,0 25,7 346 — Suppenwiirfel, Suppentafeln u. dgl. i. D 13,7 8,2 54,5 356 — Suppenwiirze i. D 30,52) — — 122 — Fruchtauppen (Pulver) 2,3 0,3 s) 80,2 341 — SiiBe Suppen (Pulver) 10,9 1,6 74,1 363 — SoBenwiirfel, SoBenpulver III. Pflanzllche Nahni] 1. Getreide und M) a) Ganzea Korn4) 11,0 ngs- und ihlenerz 9,2 GenuCni eugniaae 64,3 ittel 353 b) Geachkltea Korn Reia (Kochreia, poliert) 7,9 0,5 77,8 356 — Geratengrnupen 11,8 2,7 74,5 379 — Hafermehl (Flocken) 14,4 6,8 66,5 395 — Buchweizen 10,2 1,9 71,7 363 — Hirae (Riapenhirae) 10,5 4,3 68,2 363 — c) GrieB, Grtitze WeizengrieB Type 450 (Ausmahlung 0—57°/0) 9,4 1,0 74,6 354 — MaiagrieB 8,8 1,1 78,0 366 — Hafergriltze 13,4 5,9 67,0 385 — Buchweizengriitze d) Mehl 10,6 1,5 70,1 345 Roggen- und Weizenmebl im volksw. D. einacbliefllicb Backacbrot 9,6 1,5 72,4 350 — im volkaw. D. ohne Backacbrot 9.1 1,4 73,3 351 — r) Butter und Butterachmalz a.,,Milch und Milcherzeugniaae“; Rinderfett, Schweinefett, roh (Fettgewebe, friach) a. ,,Schlachtfette“. s) Organiache Subatanz. •) AuBerdem 2,4 g Fruchtakure. *) Siehe Teil II und III. Teill: Verbraucheretufe Teil I: Yerbraucherstule (Fortsetzungj 378 appendix C-5 Der genieCbare Teil von 100 g Rohware enthftlt Beriicks. Nahrungsmittel EiweiO g Pett g Kohle- hydrate g Kalorien Abfall V. 3. Teif Makkaroni, Nudeln, Suppeneinlagen waren 9,6 1,0 76,9 360 Eier-Makk&roni, Eier-Nudeln usw. mit 4 Ei- dottern auf 1 kg WeizengrieQ 10,6 2,9 73,0 370 Eier-Makkaroni, Eier-Nudeln usw. mit 2,5 Ei- dottern auf 1 kg WeizengrieQ (seit Detember 1935 flbliche Eierteigware) 10,2 2.2 74,1 366 _ 4. Zucker nnd Zuc a) Zucker und Sirup Rtlbenzucker, Kochzucker kerware n, Honi 8 99,8 409 Speisesirup1) 9,6 — 64,6 303 — b) Hartzuckerwaren (Bonbons) i. D 0,6 0,1 94,3 390 — Pruchtbonbons , 0,3 0,1 96,9 399 Karamellen, ungefilllt — — 94,3 387 — Bonbons, bessere 1,6 0,2 91,9 385 — Bonbons, gewohnliche 0.7 0,2 93,9 390 — c) Honig Bienenhonig 0,4 81,0 334 Kunsthonig, Invertzuckersirup 0,2 — 73,6 302 — 6. Kart Kartoffeln mit Schalen; gekocht gesch&It jffeln 1.8 0.2 18,6 86 11,0 ungekocht geschalt 1,6 0.2 16,7 72 25,0 Durchschnitt (Stidtischer Ver- brauch)*) 1,6 0,2 17,1 79 18,0 Durchschnitt (Gesamt- bevolkeruBg) 1.5 0.2 16,3 75 21.9 ohne Schalen 2,0 0,2 20,9 96 Trockenkartoffeln 7,6 0,3 77,1 360 — 6. Htilsenfrtichte, getro Hulsenfriichte, reif getrocknet, i. D.*) 24,7 cknet 1,9 52,2 333 Linsen 26,0 1,9 52,8 341 Erbscn, gelbe, ungeschklt 23,4 1,9 52,7 330 — Erbsen, gelbe, gesch< 26,0 2,0 57,0 359 — Ackerbohnen (Puff-, Putter-, Sau-, Pferde- bohnen), ungeschalt 25,7 1.7 47,3 315 Gartenbohnen (weiQe Bohnen, Veits-, Speck-, Buschbohnen), ungeschalt 23,7 2,0 56,1 346 Kichererbsen 22,6 5,1 66,1 370 — Kichererbsen, gerostet 24,8 6,1 58,0 396 — 111. Pflanzliche Nahrungs- und GenuCmittel Teil I: Yerbraucherstule (Fortsetzung) *) Siehe auch Kunsthonig. *) Lftndlicher Verbrauch = Kartoffeln mit Scbalen, ungekocht geschalt. *) Nach deutacher Verbrauchsgewohnheit. Nahrungsmittel Der genieCbare Teil von 100 g Rohware enthalt Berticks. Eiweifi g Fett g Kohle- hydrate g Kalbrien Abfall V. e) Nahrmittel und ahnliche indnstrielle Erzeugnisse Nahrmittel i. D.1) 9,2 1.9 74,9 362 Kindernahrmittel i. D 17,1 5,6 69,9 409 Kindernahrmittel auf Getreidebasis i. D 17,4 4,5 73,2 413 Kindernahrmittel auf Milchbasis i. D 14,7 16,5 39,8 368 Puddingpulyer i. D 6,1 1,7 80,4 366 — f) Getreidekaffee i. D 6,5 1,4 30,1 163 87,6 100 com KaffeeaufguC 0,15 2,51 11 — 2. Brot und a) Brot, i. D Backwa 7,2 ren 1,0 50,6 246 Boggenbrot aus R-Mehl Type 997 6,8 0,8 53,3 251 Roggenbrot aus R-Mehl Type 1150 6,4 1,0 52,2 250 Roggenbrot aus R-Mehl Type 1370 (KommiB- brot) 6,6 1,0 51,7 248 Boggenschrotbrot und Roggenvollkornbrot aus Roggenbackschrot bz w. Roggenvollkornschrot ,- Type 1800 7,4 1,1 50,4 247 Boggenmischbrot aus 80% R-Mehl Type 997 und 20% W-Mehl Type 812 6,3 0,9 52,9 251 Weizenbrot aus W-Mehl Type 812 8,2 1,2 48,6 244 Weizenbrot aus W-Mehl Type 1050 8,5 1,2 47,8 242 Weizenschrotbrot bzw. Weizenvollkornbrot aus Weizenbackschrot bzw. Weizenvollkornschrot Type 1700 9,7 1.4 46,7 240 Weizenmischbrot aus 50% W-Mehl Type 812 und 50% R-Mehl Type 997 6,9 1,0 60,1 243 Rnackebrot 11,4 1,8 78,6 386 b) Backwaren Weizenkleingeback (ohne Milch) aus W-Mehl Type 812 9,6 1,4 68,3 291 Weizenkleingeback (ohne Milch) aus W-Mehl ' 'Type 1050 9,9 1,4 67,2 288 Weizenzwieback, gewohnlich 9,9 6.2 78,2 410 Butterkeks (10,4 kg Weizenmehl, 1,2 kg But- ter, 1,6 kg Zucker, 3,2 Liter Vollmilch) 9,1 9,3 70,2 412 Stollen (Milch, Mehl, Eier, Zucker, Butter, Rosinen) 8,3 19,0 47,1 404 Lebkuchen, Niirnberger 9,0 4,3 80,4 407 — Apfelkuchen (300 g Mehl, 130 g Zucker, 130 g Butter, 1 Ei, 50 g Mandeln, 640 g Apfel).... 4,5 12,1 36,6 282 Honigkuohen 5,3 0,8 73,3 330 — ,) Gewogener Durchechnitt aus GrieC, Graupen und Griitze, Haferflocken, Qrflakem-, Maii- gt&rkemehl, Kartoffelsago, Teigwaren und Reis. Teil I: Verbrauoherstufe Teil I: Yerbraucherstule (Fortsetzung) 379 appendix C-5 Der genieCbare Teil Nah rungsmittel yon 101 g Rohware enthalt Beriicks, Abfall EiweiB Fett Erucht- Kohle Kalorien saure hydrate g g g g To 9. Kakao und Kakaoerze ugnisse Kakaopulver 18,0 14,0 51,0 413 Speiseschokolade 6,9 26,0 62,0 525 Pralinen i. D 5,1 16,2 69,7 457 Dessertpralinen 3,6 12,4 74,8 437 Schokoladepralinen 6,6 20,0 64,7 478 Nahrungs- Der geniefibare Teil yon 100 g Rohware enthalt Spezif. Gewicht tmd GenuCmittel EiweiB Kohle- hy- drate1) Al- kohol2) Ex- trakt3) Kalorien g g g g 10. Alkoholisc le Getranke a) Bier Stammwiirzegehalt 12,0% 0,4 3,8 4,5 20 b)'Trauhenwein WeiB- und Rotwein, deutscher, i. D. 0,9963 — 0,1 7,6 2,3 8 WeiBwein, deutscher, i. D 0,9965 0,1 7,5 2,3 8 WeiBwein, Altreich, i. D 0,9964 — 0,1 7,6 2,3 8 Baden 0,9964 — 0,1 6,8 2,0 7 ElsaB 0,9961 — 0,1 6,5 1,9 7 Franken 0,9972 — 0,1 7,0 2,2 8 Hessen 0,9958 — 0,1 7,9 2,2 8 Lothringen 0,9968 — 0,1 6,5 2,1 8 Mosel und Saar 0,9963 — 0.2 7,4 2,3 9 Nahe 0,9953 — 0,2 8,2 2,3 9 Niederdonau 0,9950 — — 7,9 2,2 7 Pfalz 0,9946 — 0,1 8,6 2.3 8 0,9960 0,9977 0,1 0,2 7,4 8,1 2,2 2,9 8 11 Rhein- und Maingau — Steiermark 0,9994 — — 8,4 3,1 11 Wiirttemberg 0,9983 — — 6,6 2,0 7 *) Bei Wein und Branntwein geben die Zahlen den Zuckergehalt an. 2) Der Alkoholgehalt ist bei der Berechnung der Kalorien nicht beriicksichtigt. Slehe. die Erlauterungen S. 2. 3) Bei Wein zuckerfreier Extrakt. 4) Im Extrakt enthalten. 111. Pflanzliche Nahrungs- und GenuCmittel Teil I: Yerbraucherstule (Fortsetzung) Nahrungsmittel Der genieBbare Teil von 100 g Rohware enth< Beriicks. EiweiB g Fett g Frucht- saure g Kohle- hydrate g Kalorien Abfall % b) Siidfriiohte, ganzeFriiohte, i. D.1) 0,7 1,6 10,8 53 31,8 Ananas 0,3 — 0,4 8,8 39 37,0 Apfelsinen, Orangen 0,6 — 0,96 9,0 43 29,0 Bananen 0.9 — 0,26 15,5 68 12,0 Feigen 1,4 — — 17,5 77 — Grape fruit (Pampelmuse) 0,6 — 4.0 3,4 30 27,0 Johannisbrot 5,3 — 1,0 63,9 293 7,4 Mandarinen 0,5 — 0,9 5,4 27 36,8 Zitronen c) Hartschalenobst 0,6 5,9 2,3 32 35,7 Nvisse und Mandeln i. D., handels- iibliche Ware 9,7 30,6 — 6,1 349 47,2 Niisse mit Schalen, lufttrocken, i. D. 7,4 26,1 — 4,7 292 56,7 Edelkastanien,mitSchalen,lufttrocken 9,0 6,0 — 57,7 328 17,0 Haselmisse mit Schalen (lufttrocken) 8,7 31,3 — 3,6 341 50,0 Haselniisae ohne Schalen, trockene Hand el aware 17,4 62,6 — 7,2 682 — Mandeln, suB, ohne Schalen, trockene Handelsware 21,4 53,2 — 13,2 637 — Mandeln mit Schalen (lufttrocken) .. 12,0 29,9 — 7,4 358 43,8 Paraniisse mit Schalen (lufttrocken).. 7,8 33,9 — 1,9 355 50,0 Walniisse mit Schalen (lufttrocken).. 6,7 23,5 — 5,2 267 60,0 d) Obstdauerware Getrooknetea Obst i. D.1) 1,9 0,9 1,6 60,3 269 5,6 Apfel mit Kernen 1.4 0,8 3,51 55,4 252 — Birnen mit Kernen 2,2 0,7 1,0 58,9 260 — Aprikosen mit Kernen 3,6 0,4 2,4 51,7 239 4,0 Aprikoaen ohne Kerne 3,8 0,4 2,5 53,9 249 — Pflaumen mit Kernen 1,9 0,5 1,72 51,4 230 13,8 Rosinen, Sultaninen, Malagatrauben 1,6 1,2 1,52 66,2 295 — Korinthen 2,8 1,3 1,14 77,3 344 — Feigen 3,3 1,3 1,05 58,8 270 — Datteln mit Kernen 1,9 — 0,6 72,4 307 1,3 Obstkonserven i. D 0,5 0.33 — 20,9 91 — Apfelkompott 0,4 — — 23,2 97 — Birnen in Zucker 0,3 0,18 — 18,4 78 — Zwetachgen in Zucker 0,5 0,52 — 23,3 102 — Kirschen in Zucker 0,6 0,45 — 17,6 79 — Mirabellen in Zucker 0,5 0,59 — 22,0 98 — Obstkraut Apfelkraut, rheinisch 0,8 — 1,86 67,0 286 — Marmelade i. D 0,7 — 1,09 65,2 274 — Apfelmarmelade 0,4 — 0,71 57,5 240 — Erdbeermarmelade 0,6 — 0,75 68,2 285 — Himbeermarmelade 1,1 — 1,26 68,5 290 — Johanniabeermarmelade 0,6 — 1,61 65,3 275 — Pflaumen-Zwetschgenmarmelade.... *) Durchschnitt der wichtigaten Art 0,8 en. 1,14 66,6 280 Teil I: Verbraucherstufe Teil I: Yerbraucherstule (Fortsetzung) 380 appendix C-5 Nahrungs- und Genuflmittel Spezif. Gewicht Der genieCbare Teil von 100 g Rohware enthalt EiweiC g Frucht- saure g Kohle- hy- drate1) g AI- kohol2) g Ex- trakt8) g Kalorien 11. Alkoholfreie Getranke a) Fruchtsafte, Frucht- sirup Himbeersaft (Himbeersirup) — 0,15 0,69 68,9 , 285 Zitronensaft — 0,36 6,70 2,98 — — 36 b) SiiBmoste Apfelsaft, unvergoren, ohne Zuckerzusatz — 0,3 1,0 15,0 66 Traubensaft, unvergoren, ohne Zuckerzusatz — 0,7 1,0 19,9 — — 8« c) Sonstige Brausepulver 15,9<) 67,75) _ ],1«) 342 Fleisohbriihe 0,8 — 0,6 — 1.0’) 15 111. Pflanzliche Nahrungs- und Genußmittel Teil I: Verbraucherstufe (Fortsetzung) *) Siehe Fußnote 1 S. 17. 2) Siehe Fußnote 2 S. 17. s) Siehe Fußnote 3 S. 17. 4) Zitronensaure. 8) Saccharose. •) Atherisches 01. 7) Fett. Nahrungs- Spezif. Gewicht Der geniefibare Teil von 100 g Rohware enthii.lt und GenuBmittel EiweiB g Kohle- hy- drate *) g Al- kohol2) g Ex- trakt3) g Kaloriea Rotwein, deutscher, i. D 0,9966 0,1 8.1 2,5 9 Rotwein, Altreich, i. D 0,9965 — 0,1 8,5 2,6 9 Ahr 0,9957 — 0,2 9,5 2,9 11 Baden 0,9968 — 0,1 7,6 2,5 9 ElaaC 0,9973 — 0,1 7,2 2,4 9 Lothringen 0,9972 — 0,1 6,3 2,1 8 Niederdonau * 0,9958 — — 8,7 2,6 9 Rheinhessen 0,9957 — 0,2 8,8 2,6 10 Rheingau 0,9960 — 0,1 9,3 2,8 10 Wiirttemberg 0,9983 — 0,05 7.1 2,2 8 Rotwein, auslandischer Bordeaux 0,9958 0,2 8,2 2,4 9 Bulgarien 0,9943 — 0,1 9.1 2,4 9 Italien 0,9952 — 0,1 9,8 2.7 10 Siidtirol 0,9934 — 0,15 9,1 2,2 8 SiiBwein Malaga 1,0749 17,0 11,7 20,6 140 Marsala 1,0047 — 3,2 15,1 6,4 35 Portwein, rot 1,0217 — 7,6 15,5 9,5 63 Sberry 0,9932 — 2,4 16,2 4,1 24 Wermutwein, italienisch 1,0159 — 10,1 12,1 12,8 85 c) Obstwein Apfelwein, Altreich 1,0019 0,2 5,1 2,5 9 Apfelwein, Steiermark 1,0054 — 0,9 4,4 3,2 15 Johannisbeerwein, siiC 1,0115 — 7,3 11,0 9,4 62 d) Schaumwein Deutscher u. franzos. i. D 1,0146 - 5,9 9,8 7,8 51 e) Branntwein Rum Trinkbrantwein, gewohnlicher - - - 31,4s) - - (Kartoffel, Korn) — — — 26,4*) — — Weinbrand (Kognak) — — — 31,4s) — — Weingeist 100 Vol.-°/0 100,0 “ Tell I: Verbrauoherstufe Teil I: Yerbraucherstule (Fortsetzung) *) Siehe Fußnote 1 S. 17. 2) Siehe Fußnote 2 S. 17. 3) Siehe Fußnote 3 S. 17. 4) 32 Vol.-%. 6) 38Vol 381 appendix C-5 100 g genieBbare Substanz enthalten Nahrungsmittel EiweiQ g Rett g Kohle- hydrate g Kalorien Kalbfleisch1) Klasae I 19,9 7,7 0,4 166 Klasae II 19,8 8,8 0.4 166 Klasae III 19,3 10,4 0.4 178 Klasae IV 19,6 6,4 0,4 132 i. D 19,7 8,6 0,4 161 Rind- und Kalbfleisch i. D. ohne Knochen 19,7 9,4 0,4 170 Schaffleisch’) Klasee I 17,2 26,8 0.3 321 Klasae II 14,4 33,6 0,2 372 Klasae III 16,4 24,0 0,2 291 i. D 16,6 26,7 0,2 317 Pferdefleisch ohne Knochen 21,6 2,6 0,9 116 Lende 21,2 1.2 0,9 100 Ziegenfleisch, ohne Knochen 20,7 4,3 0.6 127 Kaninchenfleisch, ohne Knochen 21,0 8,0 — 161 Ziegen- und Kaninchenfleisch, ohne Knochen, i. D. 20,7 6,2 0,3 144 b) Innereien, Schlachtfette und Schlaoht- abg&nge Innereien i. D.s) 17,6 6,3 1.1 126 Herz, frisch, vom Rind oder Kalb 17,6 10,0 0,4 167 Leber, frisch, vom Rind oder Kalb 19,9 3,7 3,3 130 Leber, frisch, vom Schwein 19,5 6.3 2,6 139 Niere, frisch, vom Rind oder Kalb 18,4 4,6 0,4 119 Lunge, frisch, vom Rind oder Kalb 16,2 2,6 0,6 88 Milz, frisch, vom Rind oder Kalb 17,8 4,2 U 117 Zunge, frisch, vom Rind oder Kalb 16,8 17,7 0,1 230 Him, frisch, vom Kalb 9.0 8,6 — 117 Jus (Bratensaft, geliert) 2,6 9.0 — 94 Knochenmark, frisch 3.2 89,9 — 849 Schlachtfette Fettgewebe, frisch, vom Rind • 1,2 89,0 — 833 Fettgewebe, frisch, vom Schwein • 1.3 92,0 — 861 Schlachtabg&nge Blut vom Schwein 18,4 0,1 0.1 77 Blut vom Rind 18,7 0,1 0,1 78 Blut vom Kalb - 14,6 0,1 0,3 62 Schweineschwarte 35,3 3,8 — 180 *) KJasse I: Keule, Nierenbraten; Klasae III; Hals, Brust, Bauch; Klasae II: Rucken, Kamm, Bug; Klasae IV: Kopf, FiiBe. s) Klasse I: Rucken, Keule; Klasae III: Brust, Bauch, Hals, Kopf. Klasae II: Bug; *) Durchschnitt der wichtigsten Arten. I. Tierisohe Nahrungs- und Genußmittel Teil III: Reinsubstanztabelle (Fortsetzung) Teil III: Reinsubstanztabelle Teil III: Reinsubstanztabelle 100 g genieBbare Substanz enthalten Nahrungsmittel EiweiB g Fett g Kohle hydrate g Kalorien I. Tlerische Nahrungs- und GenuCmittel 1. Fleisch und Fleischwaren ft) Frisches Fleisch von Schlachttieren (ohne Innereien) Fleisch i. D.1) Gesamtbevolkerung 17,5 21,5 0,3 273 Stftdtischer Verbrauch 18,0 18,8 0,3 250 Lfindlicher Verbrauch 16,8 24,8 0,3 301 Schweinefleisch, ohne Knochen vom, fetten Tier*) Klasae I 17,5 23,9 0,3 295 Kiasse II 15,0 32,4 0,3 364 Klasse III 10,0 30,5 0,3 350 Kiasse IV 12,6 41,2 0.2 436 i. D 16,0 29,3 0,3 339 Rindfleisch mager 20,6 3,5 0,6 120 mittelfett 19,9 7,8 0,4 156 fett 18,1 19,4 0,3 255 i. D 19,7 9,6 0,4 172 Fleisch vom fetten Tier5) Klasae I 19,5 13,1 0,5 204 Klaaae 11 18,0 19,7 0,4 253 Klasae III 16,5 26,7 0,3 317 Klaase IV 18,5 18,1 0,4 246 Hackfleisch 15,3 8,7 0,4 145 ') Schweine-, Rind-, Kalb-, Schaf-, Pferde-, Ziegen-, Kaninchenfleisch und Gefliigel im ge- wogenen Durchschnitt des Verbrauchs. *) Kiasse I: Riicken, Kotelett, Schinken; Kiasse III: Bauch; Kiasse II: Kamm, Vorderschinken, Brust; Kiasse IV: Kopf, Seine. 5) Kiasse I: Rinderbraten, Blume, Eck- Kiasse III: Fehlrippe, Kamm, Querrippe, schwanzstck., Mittelschwanzstck. Brustkern; Kiasse II: Unterschwanzstiick, Bug, Kiasse IV: Querrippenstiick, Hessen, Dlinnung Mittelbrust; 382 appendix C-5 100 g genieBbare Substanz enthalten Nahrungsmittel EiweiB g Fett g Kohle- hydrate g Kalorien 2. Fische und F a) Fische, frisch, stadtischer Verbrauch See- und SuBwasserfische i. D ischwaren | 18,0 2,7 99 b) Seefjsohe, frisch Ganze Fische, i. D. des stadtisohen Verbrauchs 18,0 2,5 97 Aal (FluBaal) 12,2 27,5 — 306 Heilbutt 20,4 0,3 86 Hering 17,9 7,6 — 144 Kabeljau 18,1 0,2 — 76 Knurrhahn 18,8 2,4 99 Lengfisch 18,0 0,2 — 76 Makrele 19,8 5,2 130 Petermann 17,3 2,1 90 Rotbarsch 18,5 0,9 83 Rotzunge 17,4 0,2 — 73 Sohellfisoh 18,4 0,4 79 Scholle 17,7 0,8 80 Seelaohs 19,1 0,4 82 Thunfisch 25,8 0,6 111 Wittling 17,2 0,2 — 72 c) SuBwasserfische i. D 17,1 5,7 — 123 Fluflbarsch 18,9 0,8 85 Hecht 18,4 0,5 — 80 Karpfen 16,7 9,8 — 160 Plotze, Rotauge 16,9 1,1 — 80 Schleie 17,8 0,3 — 76 d) Fischdauerwaren i. D 20,9 15,3 0,8 231 GerSucherter Fiseh i. D 21,3 13,7 215 Aal 18,0 30,5 0,3 359 Buckling 21,7 15,7 — 235 Makrele 21,4 14,5 — 223 Seelachs 22,2 1,2 — 102 Sprotten 17,2 19,8 — 255 Marinaden i. D 20,2 14,8 1,1 225 Bismarckhering 23,2 15,5 1,5 245 Marinierter Hering 18,8 14,7 0,8 217 Rollmops 19,8 14,8 0,9 223 Fischkonserven i. D 21,6 14,9 1,0 231 Hering in Gelee 18,2 15,5 0,7 222 Aal in Gelee 18,0 17,2 0,5 236 Glsardinen 23,9 14,3 1,3 236 Salzhering (Pokelhering) 20,5 16,7 1,3 245 Stockfisch 81,9 2,7 — 361 Klippfisoh 43,1 1,5 — 191 Salzfisoh, Laberdan 24,4 1,1 — 110 I. Tierische Nahrungs- und Genußmittel Teil III: Reinsubstanztabelle (Fortsetzung) 100 g genieflbare Substanz enthalten Nahrungsmittel EiweiC g Fett g Kohle- hydrate g Kalorien c) Fleisoh* und Wurstwaren Schweinefleisoh, gerauchert (Geselchtes) i. D. ... 22,9 30,6 — 378 Ochsenfleisch, gerauchert 27,1 13,4 — 236 Pferdefleisch, gerauchert 31,8 6,5 0,9 195 Schinken, gerauchert 25,0 25,0 — 335 Speck, gerauchert und gesalzen 9,0 72,8 — 714 Speck, durchwachsen 14,0 51,0 — 532 Mettwurst 19,8 43,7 — 488 Rindfleischwurst 20,5 32,9 — 390 Salami 27,8 48,4 — 564 Sohinkenwurat 12,9 34,4 2,5 383 Zervelatwurst 22,2 46,9 0,1 528 Rohwurst i. D 21,6 45,4 0,1 511 Leberwurst 7,0 19,9 0,3 215 Blutwurst 14,2 44,5 0,2 473 Frische Leberwurst 12,9 25,1 12,0 338 Frische Blutwurst 10,0 10,0 20,0 216 Frische Wurst i. D 10,9 14,4 17,7 251 Kochwurst i. D 9,0 24,7 2,0 275 Jagdwurst 15,5 26,3 — 308 Briihwurst i. D 15,5 26,3 — 308 Wiener Wurstchen 12,5 13,7 — 179 Frankfurter Wurstchen 12,5 39,1 0,6 417 Wurstchen i. D 12,5 14,0 — 181 Siilzwurst 22,6 22,3 — 300 Wurst i. D 14,3 28,3 0,9 326 Rindfleisch in Biichsen 19,2 12,4 1,2 199 Gulasch in Biichsen 19,2 11,0 2,7 192 Corned beef 23,8 6,9 — 162 Fleischkonserven i. D 20,7 10,1 1,3 184 Fleisch und Fleisohwaren i. D 17,2 23,5 0,6 292 Fleischsalat 20,8 3,3 0,5 118 d) Wild i. D. (ohne Wildgefliigel) 21,7 2,0 0,5 110 Hirsch, Keule 20,7 3,9 0,6 124 Reh 20,8 1,9 0,4 105 Wildschwein, Keule 21,6 2,4 0,5 113 Base ■ 23,1 U 0,5 107 e) Gefliigel i. D 18,6 15,9 — 224 Gans, Mittel 14,1 44,3 — 470 Huhn, bratfertig 20,1 4,7 — 126 Ente, Haustier 20,8 4,6 — 128 Taube, bratfertig 22,1 U 0,5 103 f) Wildgefliigel Fasan 22,3 1,9 0,4 111 Feldhuhn, Rebhuhn 24,3 1,4 0,5 115 Wildente 22,7 3,1 0,5 124 Teillll: Reinsubstanztabelle Teil III: Reinsubstanztabelle (Fortsetzung) 383 appendix C-5 100 g genieBbare Substanz enthalten Nahrungsmittel EiweiB g Fett g Kohle- hydrate g Kalorien Rahm, Sahne: Kaffeorahm 3,5 10,0 4,0 124 Schlagrahm, 30°/0 Fettgehalt 2,7 30,0 3,0 302 Kondensierte Milch (Vollmilch ohne Zucker) 8,0 9,3 10,9 164 Ziegenmilch 3,6 3,9 4,7 70 b) Butter und Butterschmalz Butter i. D 0,9 80,0 0,9 751 Butterschmalz 0,1 99,8 0,1 929 c) KS.se und Quark Fettgehalt i. T. % KSse i. D 30,7 21,1 2,6 333 DoppelrahmkSse 60 19,6 37,8 1,4 438 Rahmkase 50 24,3 32,0 1,9 405 VollfettkSse1) 45 27,2 28,3 2,2 384 Fettkase1) 40 27,8 25,0 2,6 357 Dreiviertelfettkase1) 30 33,7 18,6 2,8 323 Halbfettkase 20 37,8 10,3 3,1 263 Viertelfettkase 10 38,4 4,4 3,4 212 Magerkase weniger als 10 39,0 2,7 4,0 201 Quark, frisch r* aus abgerahmter Milch mit 0,8°/0 Fettgehalt der Rohware 17,2 1,2 4,0 98 aus entrahmter Frisohmilch mit 0,l°/0 Fett- gehalt der Rohware 17,6 0,1 4,1 90 II. Tierlsche mid pflanzliche Fette, gemischte Lebensmittel 1. Fette und Ole4) Kunstspeisefett — 99,0 — 921 Lebertran — 99,7 — 927 Margarine 0,5 80,0 0,4 748 Rindertalg, ausgelassen 0,5 99,2 — 925 Schweineschmalz 0,3 99,4 — 926 Speiseol Unvermischtes Pflanzenfett (Kokosfett, Palmin, — 99,5 — 925 Nussa u. dgl.) 2. SuppenprSparate, V Jiirzen un 99,8 d Hefe 928 Hefe, frisch, gepreBt 16,2 1,3 5,5 101 Hefeextrakt i. D 48,32) — — 193 NShrhefe 52,0 3,0 25,7 346 Suppenwiirfel, Suppentafeln u. dgl. i. D 13,7 8,2 54,5 366 Suppenwiirze i. D 30,52) — — 122 Fruchtsuppen (Pulver) 2,3 0,3* 80,2 349 SiiBe Suppen (Pulver) 10,9 1,6 74,1 363 SoBenwtirfel, SoBenpulver 11,0 9,2 54,3 353 1) Die Werte umfassen Hartkase, halbfesten SchnittkSse und StreichkSse. 2) Organische Substanz. 3) AuBerdem 2,4 g FruchtsSure. 4) Butter und Butterschmalz siehe ,,Milch und Milcherzeugnisse"; Rinderfett, Schweinefett, roh (Fettgewebe, frisch) siehe „Schlachtfette“ 11. Tierisohe und pflanzliche Fette, gemisohte Lebensmittel Teil III: Reinsubstanztabelle (Fortsetzung) Teillll: Reinsubstanztabelle Teil III: Reinsubstanztabelle (Fortsetzung) Nahrungsmittel 100 g g EiweiB g eniefibare Fett g iubstanz en Kohle- hydrate g thalten Kalorien e) Schaltiere Krabben mit Schalen 15,8 1,3 2,3 86 Miesmuscheln mit Schalen 8,9 1,4 2,2 59 f) Fischsalate Heringssalat 6,6 5,3 17,6 149 Fischsalat 13,8 1,3 0,7 72 3. Eier nnd Eiererzeugnisse a) Analysenwerte je 100 g Huhnerei 14,1 12,3 0,6 175 EiweiB (Eiklar) 12,8 0,3 0,7 58 Eigelb (Eidotter) 16,1 31,7 0,3 362 Trockenei (Vollei) 43,2 40,9 2,0 566 TrookeneiweiB 73,4 0,3 4,0 320 Trockeneigelb 35,1 53,2 1,0 643 Entenei 12,8 15,0 0,3 193 b) Analysenwerte je Stuck Hiibnerei der KJasse B = 57 g i. D.1) 8,0 7,0 0,3 99 Entenei im durchschn. Gewicht von 59,8 g 7,6 9,0 0,2 116 4. Milch und Milcherzeugnisse a) Milch u. dgl. Kuhmilch: Vollmilch, 2,7°/0 Fettgehalt 3,4 2,7 4,8 59 Vollmilch, 2,8% Fettgehalt 3,4 2,8 4,8 60 Vollmilch, 2,9% Fettgehalt 3,4 2,9 4,8 61 Vollmilch, 3,0% Fettgehalt 3,4 3,0 4,8 62 Vollmilch, 3,1 % Fettgehalt2) 3,4 3,1 4.8 62 Vollmilch, 3,2% Fettgehalt 3,4 3,2 4,8 63 Vollmilch, 3,3% Fettgehalt3) 3,4 3,3 4.8 64 Vollmilch, 3,4% Fettgehalt 3,4 3,4 4,8 65 Vollmilch, 3,5% Fettgehalt 3,4 3,5 4,8 66 Vollmilch, 3,6% Fettgehalt 3,4 3,6 4,8 67 Vollmilch, 3,7% Fettgehalt 3,4 3,7 4,8 68 Vollmilch, 3,8% Fettgehalt 3,4 3,8 4,8 69 Vollmilch, 3,9% Fettgehalt 3,4 3,9 4,8 70 Entrahmte Frischmilch (Magermilch) 0,l%Fett- gehalt 3.7 0,1 4,8 36 Buttermilch, 0,5% Fettgehalt 3,7 0,5 3,7 35 Trockenerzeugnisse: Vollmilchpulver 25,2 26,8 37,0 504 Pulver aus entrahmter Milch (Magermilch- pulver) 33,5 1,6 50,0 357 Milei W 30,7 0,3 51,0 338 Milei G 34,0 1,4 52,1 366 M Each den Ermittlungen der Reichsstelle fur Eier besteht 'em Ei der Klasse B im Durch- schnitt aus 7,3 g Schale, 19,1 g Eidotter, 30,6 g Eiklar. 2) Durchschnittlicher Fettgehalt der von den Molkereien gelieferten Trinkmilch. 3) Durchschnittlicher Fettgehalt der an die Molkereien gelieferten Milch. 384 appendix C-5 100 g genieBbare Substanz enthalten Nahrungsmittel EiweiB g Fett g Kohle- hydrate g Kalorien Weizenmehl 1—30°/o> feinstes 11,6 0,9 71,5 349 Weizenmehl 30—-70%, zweites 13,3 2,2 69,8 361 Weizenmehl 70—75 °/0, drittes 17,1 3,5 61,2 354 Weizenmehl 75—80°/0, Nachmehl Sonstiges Mehl 17,9 4.0 50,3 316 Buchweizenmehl 8,3 2,1 74,6 359 Griinkernmehl, Dinkel Kartoffelstarkemehl, Kartoffelsago, DPM (Dent- 8,9 1,8 76,3 366 sohes Puddingmehl) 0,9 0,1 80,7 335 Kartoffelwalzmehl 6,7 0,2 80,0 357 Maismehl 9,6 3,1 71,7 362 Maisstarkemehl 0,5 — 83,0 342 Reisstarkemehl 0,8 — 85,2 353 Sojamehl, entfettet 62,2 1,2 29,9 348 Sojamehl, Vollsojamehl SiiBlupinenmehl aus gelben, geschalten SuB- 42,5 19,9 24,3 459 lupinen 55,6 6,6 23,0 384 Weizenstarkemehl e) Nahrmitfcel u. a. industrielle Erzeug- nisse 1,1 0,2 84,1 351 Nahrmittel i. D.1) 9,2 1,9 74,9 362 Kindernahrmittel i. I) 17,1 5,6 69,9 409 Kindernahrmittel auf Getreidebasis 17,4 4,5 73,2 413 Kindernahrmittel auf Milchbasis 14,7 15,5 39,8 368 Puddingpulver i. D 5,1 1,7 80,4 366 f) Getreidekaffee i. D 10,4 2,3 48,3 262 100 com KaffeeaufguB 2. Brot und Ba 0,15 ckwaren 2,51 11 a) Brot i. D 7,2 1,0 50,5 246 Roggenbrot aus R-Mehl Type 997 5,8 0,8 53,3 251 Roggenbrot aus R-Mehl Type 1150 6,4 1,0 52,2 250 Roggenbrot aus R-Mehl Type 1370 (KommiBbrot) Roggenschrotbrot und Roggenvollkornbrot aus Roggenbackschrot bzw. Roggenvollkornschrot 6,6 1,0 51,7 248 Type 1800 Roggenmischbrot aus 80% R-Mehl Type 997 und 7,4 1,1 50,4 247 20% W-Mehl Type 812 6,3 0,9 52,9 251 Weizenbrot aus W-Mehl Type 812 8,2 1,2 48,6 244 Weizenbrot aus W-Mehl Type 1050 Weizenschrotbrot bzw. Weizenvollkornbrot aus Weizenbackschrot bzw. Weizenvollkornschrot 8,5 1,2 47,8 242 Type 1700 9,7 1,4 45,7 240 x) Gewogener Durchschnitt aus GrieB, Graupen starkemehl, Kartoffelsago, Teigwaren und Reis. und Griitze, Haferflocken, Griinkern-, Mais- 111- Pflanzliche Nahrungs- und Genußmittel Teil III: Reinsubstanztabelle (Fortsetzung) Teil III: Reinsubstanztabelle Teil III: Reinsubstanztabelle (Fortsetzung) 100 g genieBbare Subatanz enthalten Nahrungsmittel EiweiB g Fett g Kohle- hydrate g Kalorie III. Pflanzliche Nahrung 1. Getreide und Miih a) Ganzes Korn Roggen s- und Ge lenerzeug 11,2 nuBmittel niase 1,6 69,1 344 Weizen 12,0 1,8 68,7 348 Hafer 10,3 5,3 59,7 336 Gerate 9,7 2,0 68,5 339 Maia 9,4 4,1 69,4 361 Buohweizen 11,4 2,7 58,8 313 Hirae (Riapenhirse) 10,6 3,9 61,1 330 b) Gesohaltes Korn Reia (Kochreia, poliert) 7,9 0,5 77,8 356 Geratengraupen 11,8 2,7 74,5 379 Hafermehl (Flocken) 14,4 6,8 66,5 395 Buohweizen 10,2 1,9 71,7 353 Hirae (Riapenhirse) 10,5 4,3 68,2 363- o) GrieB, Griitze WeizengrieB Type 450 (Auamahlung 0—57%) .... 9,4 1,0 74,6 354 MaiagrieB 8,8 1,1 78,0 366 Hafergrutze 13,4 5,9 67,0 385 Buchweizengriitze 10,6 1,5 70,1 345 d) Mehl Roggen- und Weizenmehl im volkaw. D. einachl. Backachrot 9,6 1,5 72,4 350 im volkaw. D. ohne Backachrot 9,1 1,4 73,3 351 im einzelnen: neue Sorten Roggenmehl Type 997 (Ausmahl. etwa 0—75°/0) 6,9 1,1 76,3 351 Roggenmehl Type 1150 (Ausmahl. etwa 0—80%) 7,7 1,3 74,5 349 Roggenmehl Type 1370 (KommiBraehl, Auamah- lung etwa 0—85%) 8,0 1,4 73,9 349 Roggenbackschrot, Roggenvollkornschrot Type 1800 (Auamahlung etwa 0—94 bzw. 98%) 9,0 1.5 72,1 346 Roggenmehl i. D. einachl'. Backachrot 7,9 1,3 74,2 349 Roggenmehl i. D. ohne Backachrot 7,5 1,2 74,9 349 Weizenmehl Type 812 (Ausmahl. etwa 0—78%) 10,5 1,6 72,3 354 Weizenmehl Type 1050 (Ausmahl. etwa 0—83%) 10,9 1,7 71,1 352 Weizenbackschrot, Weizenvollkornschrot Type 1700 (Auamahlung etwa 0—-94 bzw. 98%).... 12,6 1,9 68,2 349 Weizenmehl i. D. einachl. Backachrot 11,3 1,7 70,5 351 Weizenmehl i. D. ohne Backachrot 10,7 1,7 71,7 354 alte Sorten Roggenmehl 1—30%, feinstes 5,9 0,6 75,7 340 Roggenmehl 30—60%, zweitea 9,7 1,2 67,5 328 Roggenmehl 60—65%, drittes 12,8 2,2 60,9 323 Roggenmehl 65—70%, Nachmehl 14,6 2.4 58,7 323 Roggenmehl 70—95%, Kleie 15,5 3,2 29,4 214 385 appendix C-5 111. Pflanzliche Nahrungs- und Genuflmittel Teil III: Reinsubstanztabelle (Fortsetzung) ' 100 g genieBbare Substanz fenthalten Nahrungsmittel j EiweiB L 8 . . Fett g Kohle- hydrate g Kalorien 6. Hiilsenfruchte Hiilsenfruchte, reif, getrocknet, i. D 24,7 1 1,9 52,2 333 Linsen 26,0 1,9 52,8 341 Erbsen, gelbe, ungeschalt 23,4 1.9 52,7 330 Erbsen, gelbe, geschalt Ackerbohnen (Puff-, Putter-, Sau-, Pferdebohr.en) 26,0 ; 2,o 57,0 359 ungeschalt Gartenbohnen (weiBe Bohnen, Veits-, Speck-, 25,7 1,7 47,3 315 Buschbohnen), ungeschalt 23,7 I 2,0 56,1 346 JCichcrerbscn 22,6 1 5,1 56,1 370 Kichererbscn, gerostet 7. Gemfi 24,8 se , 6,1 | 58,0 396 a) Gemusc, frisch, i. D. (einschl. Pilze) 1,7 1 0,3 5,0 30 Artischocken 2,0 0,1 7,6 40 Blumenkohl, Karfiol 2,4 0,3 4,5 31 Champignons 4,9 0,2 3,6 37 Chicor6e 1,9 0,2 8.5 45 Chinakohl 1,5 0,3 0,9 13 Eierfrucht (Aubergine) 1,3 0,2 4,8 27 Endiviensalat 2,0 0,1 2,3 19 Erbsen (Schoten) 6,5 0,5 12,5 83 Eskariol 1,4 0,1 2,5 17 Eenchel 2,6 0,2 11,2 58 Plaschenkiirbis 1,0 0,4 2,2 17 Gelbe Rube, groCe Mohrriibe 1,2 0,3 9,1 45 Griine Bohnen 2.6 0,2 6,4 39 Griinkohl, Kohl, Winterkohl Gurken, mittelgroB, ungeschalt (I Stiick = 170 4,9 0,9 10,2 70 bis 190 g) 0,8 0,3 1,4 12 Karotte, kleine (friihe) Mohrrube 1,0 0,2 8,1 39 Kohlrabi (Oberkohlrabi) 2.5 0.1 5,8 35 Kohlrube (Brasaica napus) 1,4 0,1 7,5 37 Kopfsalat 1,5 0,3 2.0 17 Kurbis Lauchporree 1,1 0,1 6,5 32 ganze Pflanze 2,4 0,4 5,5 36 Knollcn 2,8 0,3 6,5 41 Blatter 2,1 0,4 4,6 31 Mairiibe 1,2 0,3 3,9 24 Mais (Kolbenmais) 9,4 4,1 69,4 361 Melonen 0,8 0,1 6,4 30 Morchel (Speise-) 3,4 0,4 4,5 36 Paprika (ganze Frucht) 15,7 12,5 34,3 321 Petersilie 3,7 0,7 7,4 52 Pfifferling, Eierschwamm 2,6 0,4 3,8 30 Portulak, Bunzelkraut U 0,2 0,9 10 Puffbohnen, Pferdebohnen 6,7 0,4 4,2 48 Radiesohen 1,3 0,2 3,8 23 Rettich 1,9 0,1 8,4 43 Rhabarber Beih. 11 zur Zeitschrift „Die Ernahrung“ 0,5 0,09 3,1 4 16 100 g genieBbare Subatanz enthalten Nahrungsmittel EiweiB g Fett g Kohle- hydrate g Kalorien Weizenmischbrot aus 50°/o W-Mehl Type 812 und 60% R-Mehl Type 997 b) Backwaren 6,9 1,0 50,1 243 Weizenkleingeback (ohne Milch) aus W-Mehl Type 812 Weizenkleingeback (ohne Milch) aus W-Mehl 9,6 1,4 58,3 291 Type 1050 9,9 1,4 57,2 288 Knackebrot 11,4 1,8 78,6 386 Weizenzwieback, gewohnlich Butterkeks (10,4 kg Weizenmehl, 1,2 kg Butter, 9,9 5,2 78,2 410 1,6 kg Zucker, 3,2 Liter Vollmiloh) Stollen (Milch, Mehl, Eier, Zucker, Butter, 9,1 9,3 70,2 412 Rosinen) 8,3 19,0 47,1 404 Lebkuchen, Niirnberger Apfelkuchen (300 g Mehl, 130 g Zucker, 130 g 9,0 4,3 80,4 407 Butter, 1 Ei, 50 g Mandeln, 640 g Apfel) 4,5 12,1 36,6 282 Honigkuchen 3. Teigwa 5,3 ren 0,8 73,3 330 Makkaroni, Nudeln, Suppeneinlagen Eier-Makkaroni, Eier-Nudeln uaw. mit 4 Ei- 9,6 1,0 75,9 360 dottern auf 1 kg WeizengrieB Eier-Makkaroni, Eier-Nudeln usw. mit 2,5 Ei- dottern auf 1 kg WeizengrieB (seit Dezember 10,6 2,9 73,0 370 1935 iibliche Eierteigware) 4. Zucker und Zucke 10,2 rwaren, I 2,2 onig 74,1 366 a) Zucker und Sirup Riibenzucker, Kochzucker — — 99,8 409 Speisesirup1) 9,5 — 64,5 303 b) Hartzuckerwaren (Bonbons) i. D. 0,6 0,1 94,3 390 Fruchtbonbons 0,3 0,1 96,9 399 Karamellen, ungefiillt — — 94,3 387 Bonbons, bessere 1,6 0,2 91,9 385 Bonbons, gewohnliche 0,7 0,2 93,9 390 c) Honig Bienenhonig 0,4 — 81,0 334 Kunsthonig, Invertzuckersirup 5. Kartof 0,2 eln 73,5 302 Kartoffeln, ohne Sohalen, i. D 1 2,0 0,2 20,9 96 Trockenkartoffeln 1) Siehe auch Kunsthonig. 7,6 0,3 77,1 350 Teil III: Reinsubstanztabelle Teil HI: Reinsubstanztabelle (Fortsetzung) 386 appendix C-5 Nahrungs- 100 g genieBbare Substanz enthalten und UenuBmittel Spezif. Gewicht EiweiB g Kohle-1) hydrate g Alko- hoi8) g Ex- trakt8) g Kalorien 10. A1 a) Bier Stammwurzegehalt 12,0% roholisc he Qetr 0,4 inke -*) 3,8 4,5 20 b) Traubenwein WeiB- und Rotwein, deutscher, i. D. 0,9966 0,1 7,6 2,3 8 WeiBwein, deutscher, i. D 0,9965 — 0,1 7,5 2,3 8 WeiBwein, Altreich, i. D 0,9964 — 0,1 7,6 2.3 8 Baden 0,9964 — 0,1 6,8 2,0 7 ElsaB 0,9961 — 0,1 6,5 1,9 7 Franken 0,9972 — 0,1 7,0 2,2 8 Hessen 0,9958 — 0,1 7,9 2,2 8 Lothringen 0,9968 — 0,1 6,5 2,1 8 Mosel und Saar 0,9963 — 0,2 7,4 2,3 9 Nahe 0,9953 — 0,2 8,2 2,3 9 Niederdonau 0,9950 — — 7,9 2,2 7 Pfalz 0,9946 — 0,1 8,6 2,3 8 Rheinhessen 0,9960 — 0,1 7.4 2,2 8 Rhein- und Maingau 0,9977 — 0,2 8,1 2.9 11 Steiermark 0,9994 — — 8,4 3,1 11 Wurttemberg 0,9983 — — 6,6 2,0 7 Rotwein, deutscher, i. D 0,9966 — 0,1 8,1 2,5 9 Rotwein, Altreich, i. D 0,9965 — 0,1 8,6 2,6 9 Ahr 0,9957 — 0,2 9,5 2,9 11 Baden 0,9968 — 0,1 7,6 2,5 9 ElsaB 0,9973 — 0,1 7,2 2,4 9 Lothringen 0,9972 — 0,1 6,3 2,1 8 Niederdonau 0,9958 — 8,7 2,6 9 Rheinhessen 0,9957 • 0,2 8,8 2,6 10 Rheingau 0,9960 — 0,1 9,3 2,8 10 Wurttemberg 0,9983 — 0,05 7,1 2,2 8 Rotwein, auslandischer Bordeaux 0,9958 0,2 8,2 2,4 9 Bulgarien 0,9943 — 0,1 9,1 2,4 9 Italian 0,9952 — 0,1 9,8 2.7 10 Siidtirol 0,9934 — 0,15 9,1 2,2 8 StiBwein: Malaga 1,0749 17,0 11,7 20,6 140 Marsala 1,0047 — 3,2 15,1 6,4 35 Portwein, rot 1,0217 — 7,6 15,5 9.5 63 Sherry 0,9932 — 2,4 16,2 4,1 24 Wermutwein, italienisch 1,0159 — 10,1 12,1 12,8 86 c) Obstwein Apfelwein, Altreich 1,0019 0,2 5,1 2,5 9 Apfelwein, Steiermark 1,0054 — 0,9 4,4 3,2 15 Johannisbeerwein, suB 1,0115 — 7,3 11,0 9,4 62 1) Bei Wein und Branntwein geben die Zahlen den Zuckergehalt an. a) Der Alkoholgehalt ist bei der Berechnung der Kalorien nicht beriicksichtigt. Siehe die ErJauterungen S. 2. 8) Bei Wein und Branntwein zuckerfreier Extrakt. 4) Siehe Extrakt. 111. Pflanzliohe Nahrungs- und Genufimittel Teil III: Beinsabstanztabelle (Fortsetzung) 100 g genieflbare Substanz enthalten Nahrungsmittel Eiweifi g Fett g Frucht- saure g Kohle- hydrate g Kalorien Aprikosen 3,8 0,4 2,5 53,9 249 Pflaumen 2,2 0,6 2,00 59,6 266 Rosinen, Sultaninen, Malagatrauben 1,6 1,2 1,52 66,2 295 Korinthen 2,8 1.3 U4 77,3 344 Feigen 3,3 1,3 1,05 58,8 270 Datteln mit Kernen, getrocknet 1.9 — 0,6 73,4 311 Obstkonserven i. D 0,5 0,33 20,9 91 Apfelkompott 0,4 — — 23,2 97 Birnen'in Zucker 0,3 0,18 — 18,4 78 Zwetschgen in Zucker 0,5 0,52 — 23,3 102 Kirschen in Zucker 0,6 0,45 17,6 79 Mirabellen in Zucker 0,6 0,59 — 22,0 98 Obstkraut Apfelkraut, rheinisch 0,8 - 1,86 67,0 286 Marmelade i. D 0,7 1,09 65,2 274 Apfelmarmelade 0,4 0,71 57,5 240 Erdbeermarmelade 0,6 — 0,75 68,2 285 Himbeermarmelade U — 1,26 68,6 290 Johamiisbeermarmelade 0,5 — 1,61 65,3 275 Pflaumen-Zwetschgenmarmelade 0,8 — 1,14 66,6 280 100 g genieObare Substanz enthalten Nahrungsmittel EiweiC g Fett g Kohle- hydrate g Kalorien Wasser + Asche + Rohfa»er+ Theo- bromin 9. Kakao und Kakaoerzeugnisse Kakaomasse 11,0 55,0 25,0 660 1.61) Kakabpulver 18,0 14,0 51,0 413 — SpeiseBohokolade 6,9 26,0 62,0 525 5,0 Pralinen i. D 5.1 16,2 69,7 457 — Deasertpralinen 3,6 12,4 74,8 437 — Sohokoladepralinen *) Theobromin. 6,6 20,0 64,7 478 Teiini: Reinsubstanztabelle Teil III: Reinsubstanztabolle (Fortsetzung) 387 appendix C-5 TeilHl: Reinsubatanzt abelle Kahrungs- 100 g genieBbare Substanz enthalten und GenuBmittel Spezif. Gewicht Kohle-1) hydrate g Alko- hol*) g Ex- trakt*) g Kalorier d) Schaumwein Deutscher und franzosischer i. D 1,0146 5,9 9,8 7,8 51 e) Branntwein Rum — — 31,45) — — Trinkbraimtwein, gewohnlicher (Kartoffel, Korn) _ _ 26,44) Weinbrand (Kognak) — — 31,46) — — Weingeist 100Vol.-°/0 — — 100,0 — — Teil HI: Reinsubstanztabelle (Fortsetzung) Nahrunga- 100 g geniefibare Subatanz enthalten und GenuBmittel EiweiB g Frucht- aaure g Kohle- hydrate g Kalorien 11. Alkoholfreie Getrknke a) Fruchtsafte, Fruchtsirup Himbeeraaft (Himboorairup) 0,15 0,69 68,9 285 Zitronensaft 0,36 6,70 2,98 36 b) SiiBmoate Apfelsaft, unvergoren, ohne Zuokerzusatz 0,3 1,0 15,0 66 Traubensaft, unvergoren, ohne Zuckerzusatz 0,7 1,0 19,9 88 *) Siehe Fußnote 1 S. 47. 2) Siehe Fußnote 2 S. 47. 3) Siehe Fußnote 3 S. 47. 4) 32 Vol.-%. 5) 38 Vol.-%. 388