Home Political science From Hunger to Malnutrition: The Political Economy of Scientific Knowledge in Europe, 1918-1960
Starvation, Malnutrition and Experimental Research in the Camps
Internment camps worked as large detention centres to confine selected groups of the population. In Germany, the Nazi regime established concentration camps after reaching power in 1933, and during World War II camps increased in size and number in many areas of Europe. Inmates came from every occupied country and others were transported from different areas. Early in 1942 the Wirtschafts- Verwaltungshauptamt, the Central Office for Economy and Administration of the SS, took control of the camps, and inmates were frequently worked to death as forced labourers in industrial production. They were also used for medical experimentation.
The German population grew rapidly in the 1920s and 1930s, as agricultural innovations led to increased food supplies, and medical progress together with better nutrition contributed to extending life expectancy and reducing mortality. During the Nazi rule, the German medical profession acted as an extension of the regime and the concept of Rassenhygiene, which was coined by Alfred Ploetz in 1895, became widespread with the new genetic theories, giving supposedly scientific support to the application of genetic laws and the natural selection of humans.
The racial hygiene programme was deployed once Hitler arrived in power on January 30, 1933. The Deutsche Arztevereinsbund and the Hartmannbund were placed under the control of the Reicharztefuhrer. Gerhardt Wagner was appointed to the post; he was already head of the Reich’s Physicians Chamber, the Association of German Health Insurance Physicians, the Office of Public Health, the National Socialist Physician’s League, the Office of Racial Policy, the Expert Committee for Public Health and the Office for Genealogical Research. A significant portion of German physicians participated in the racial hygiene programme, with 45 per cent of professionals joining the Nazi Party and becoming accessories to Nazism even before they began assisting in the camps’ experiments. From the early days, the Nazis set in motion a programme of medical intervention, including compulsive sterilisation that was made legal through the “Law for the Prevention of Genetically Diseased Offspring” (July, 1933). An individual could be sterilised if a genetic health court determined that he or she suffered from what was considered to be a genetic illness, such as schizophrenia, manic-depressive psychosis, syphilis or alcoholism. In May 1934 the former Bureau of Education for Population Policy and Racial Hygiene became the Office of Racial Policy, charged with bringing all education and training on population and race matters into line with Nazi ideology. In 1934 a total of 181 genetic health courts were established in
Germany, operating as part of the civil justice administration, composed of one lawyer and two doctors.67
The results of the sterilisation programme reveal the degree to which physicians participated from the very beginning in Nazi programmes. An estimated 400,000 persons were sterilised, 95 per cent before the outbreak of World War II. The majority of these sterilisations were done by surgical means, vasectomies for men and tubal ligations for women. In some instances experimental means such as chemical injections or radiation were used. Persons chosen for sterilisation had the right to appeal but almost all appeals were rejected. The so called feebleminded were almost frequently targeted (42.5% of the total number of procedures).68
After 1939 the sterilisation practices slowed down, with the euthanasia programme becoming one of the new priorities. It was grounded on two main assumptions: first, that human beings were not biologically equal; and second, that this inequality relieved the State of the duty to protect all citizens equally, so that the weak could be simply abandoned or sacrificed. Assisted death could be justified on medical and legal grounds, and also on utilitarian ones, freeing state and society from the burdens associated with caring for the incurable, the mentally ill, the feebleminded, the retarded, and the deformed.
The idea that the state should place a greater value on the healthy than on the sick was commonly accepted. Although the euthanasia programme was to be clandestine, its implementation required extensive cooperation from medical professionals. Doctors and midwives were put under pressure to report degenerative diseases, contributing to this medicalised form of killing.69 A Committee for the Scientific Treatment of Severe, Genetically Determined Illness started to administer an adult euthanasia programme in 1939. The war provided a smokescreen behind which the murders could take place. The euthanasia programme was named T4 and managed by a bureaucratic body consisting of 50 volunteer physicians headquartered in Berlin.70
The Working Committee for Hospital Care was the name that appeared on letterhead for official correspondence; The Charitable Foundation for Institutional Care, or Central Clearinghouse for Mental Hospitals, handled fiscal affairs; and the Non-Profit Transport Corporation and the Common    
Welfare Ambulance Service, Limited, moved patients from their care facilities to extermination centres.71
The programme involved most of the German psychiatric asylums, and questionnaires about the presence of genetic disease (schizophrenia, Down’s syndrome, Huntington’s chorea, and others) were sent to hospitals and homes for the chronically ill. Adults hospitalised for five or more years were checked as well. The first murders were carried out in Poland in January 1940, where 4,400 incurable mentally ill patients were shot.72 Injection was initially envisioned as the preferred means but it was soon substituted by carbon monoxide administered in special tiled gas chambers designed to resemble a shower room, complemented by crematoria ovens for burning the bodies. Initially six hospitals were chosen and outfitted with special gas chambers and crematoria. By August 1941 a total of 70,273 individuals had been murdered. The extermination camps were the end point in a graduated series of institutions designed to serve the goals of the Nazi programme of racial hygiene. The system of prison camps, which included forced-labour camps, prisoner-of-war camps, transit camps, concentration camps and extermination camps, thus completed the work begun in the ghettos and mental institutions.
One of the first concentration camps was Dachau, opened in 1933, just outside Munich. At first Dachau held only political opponents, such as Communists and Social Democrats, or those who had been sentenced in a court of law. But its population soon expanded to include Jews, homosexuals, Jehovah’s Witnesses, Gypsies, clergy and others who were denounced for making negative comments about the regime. The other concentration camps filled quickly as well. Meanwhile, the conquest of the East was bringing ever greater numbers of Jews and other “undesirables” into the boundaries of an expanding Reich.73
As this sort of medicalised killing was accepted and extended, the Nazi Reich faced new strains. Six extermination camps were constructed in Poland: Auschwitz-Birkenau, Treblinka, Belzec, Sobibor, Majdanek and Chelmno, all being operational since 1942.
“On 12 August 1942 Himmler instructed Oswald Pohl, Director of the SS Wirtschafts-Verwaltungshauptamp (WVHA), to organize experiments on nutrition in the concentration camps. The goal was to identify the cheapest method of supplying the minimal nutrition needed   
by active labourers in the camps”. Several diets, with and without nutritional supplements, were tested. The physician and chemist Ernst- Gtinther Schenck was appointed Nutrition Inspector and commissioned to assess the status of nutrition in the camps. Schenk spent the period of November 1942 to January 1943 visiting eight concentration and penal camps. He reported that the quality of food was good, including excellent vegetables, but that 20-30 per cent of the prisoners seemed, nevertheless, to be suffering from malnutrition.
Some dietary supplement, cheap and readily available was needed. Schenk suggested brewer’s yeast, which could be provided without taxing the civilian food supply. However, the WVHA favoured the implementation of another supplement, a mold-infused egg white available under the trade name Biosyn. In 1943 Biosyn was incorporated into a vegetable sausage that resembled common liverwurst in smell and taste, and the product was sent to the camps for initial tests on 100 prisoners. The sausages were alleged to have come from the cellulose and paper factory in Lenz, but camp rumours said they were actually made out of sewage sludge. The undernourished experimental subjects suffered from intestinal problems after eating the sausages, and 70 to 80 per cent of them became seriously ill. These dire results did not stop Pohl from continuing the experiments. He actually expanded their scope for three months between January to March 1944, including 100,000 prisoners in Dachau, Buchenwald and Sachsenhausen.
The results of these tests were among the reports presented in1944 at a conference held in Berlin, with the participation of experts in nutrition. The participants included the 1938 Nobel Prize winner for chemistry Richard Kuhn, Otto Flossner, Director of the Nutrition Physiology Department of the Reich’s Health Department, and Wilhelm Nonnenbruch, Professor of Medicine, among others. The vote was unanimous in favour of continuing the experiments.
Between December 1, 1943 and March 31, 1944, a series of experiments on nutrition were conducted in the Infirmary at Mathausen Concentration Camp. The objective of the experiments was to find the most beneficial form of nutrition for concentration camp inmates. For comparison purposes, three basic types of diet were established: type A, the so-called “eastern diet”; type B, a normal diet plus nutritive yeast; and type C, normal diet.
Type A or eastern diet consisted of vegetables and farinaceous food, served exclusively in the form of a thick soup without any meat or bread. Type B was the normal diet at the concentration camp, without any hard-labour rations but with an added 30 g of nutritive yeast per person, evenly mixed into the midday diet. The majority of the prisoners sought out for experiments consisted of invalids, cripples and those over 55 years of age. Only 30 per cent were strong, young individuals. Weakness was a common characteristic, which made the prisoners more susceptible to different types of illnesses. They worked in the weaving mill, located near the infirmary block. Their work was done while seated most of the time and was in general less exhausting, and so their caloric need was much lower than that needed by those doing hard work.
The clinical and laboratory experiments conducted in conjunction with nutrition tests were expected to give a picture of the influence of the respective forms of diet on the human body, especially on haematopoiesis or blood cell production, and on the circulatory and excretory systems. The experiments were also expected to cover the pathological changes that occurred. In addition, they were also expected to differentiate between the changes that could be attributed to the diet and those that were associated with pathogenic causes. Nevertheless, many practical difficulties arose: the emergence of acute enterocolitis and oedema, both affecting the weight curve in a different way. Other problems were related to haematological analysis, furunculosis and infections influencing the blood leukocyte formula.
The tests were conducted during three periods. The nutrition experiments started on December 1, 1943 and completely ended on May 31, 1944. Further comparative experiments were performed until July 31, 1944, at which time a normal diet was prescribed to all prisoners. The numbers initially selected for the experiments were: group A, eastern diet, supplied to 150 prisoners; group B, normal diet plus yeast, supplied to 110 prisoners, and group C, normal diet, supplied to 110 prisoners. The total amount of inmates involved in the experiment was 370 prisoners.
By the end of the experimentation period - July 31, 1944 - the death toll came to 116 (31.35 per cent), the causes of death being diagnosed as follows:
The percentages of survivors were:
67% in group B 54% in group A 48% in group C
Through the clinical examinations and the hematologic, electrocardiographic and clinical evidence obtained while conducting the experiments, it was concluded that the most suitable diet was the normal diet plus yeast, and the most unsuitable the normal diet given to all prisoners in the concentration camps.
In general, the nutritional situation of inmates in internment camps during the war was a descent to hell. A report about the health condition of inmates in those institutions was published in the League of Nations Bulletin of the Health Organisation in 1944. The memorandum was received for publication in August 1943 and showed the clinical research completed over one year. According to the figures in the memorandum, internment camps investigated in the south of France harboured some 20,000 adolescents and adult internees in 1943. The published report focused on medical aspects related to the state of health of the confined population, excluding any reference to living conditions, human rights or internal rules that could incriminate authorities. The research was published as an anonymous report. The work done was justified for the scientific interest and experimental value of the observations, and the practical application of the results in communities suffering from famine. The names of the doctors participating in the research were suppressed, as well as those of the internees and any geographical references of the camps.
Between 1940 and 1943 the internment camps received a big influx of inmates, the number and composition of whom were variable. Internees showed amazing physical and moral resilience to the very negative health and nutritional conditions to which they were submitted. The situation changed completely 12 to 16 months after the internment of about 20,000 inmates. A first outbreak of famine disease had already occurred in spring 1941, but famine invaded the camps from August 1942 onwards.
The death rate continually increased, revealing, after a period of resistance, the deep exhaustion and extreme physiological destitution of the weakened organisms of the inmates. Men appeared to be much less resistant than women, teenagers and children. Private relief organisations drew up a plan of action, which found strong obstacles to its implementation, but was finally deployed with the help of large relief organisations and the goodwill of administrative authorities in the camps.
The plan comprised five main aspects: the examination of all internees from the point of view of their state of health and nutrition in order to spot inmates suffering from famine disease; the hospitalisation of famine patients in special huts for observation and treatment; the establishment of special dietetic kitchens under the joint responsibility of the relief organisations; emergency medical treatment consisting of dietetic products, vitamins, minerals and tonics, and segregation of threatened patients in a centre for prophylactic treatment separate from the camp. This medical relief intervention started in February 1942.
Internment camps became a large laboratory for clinical research on malnutrition and physical exhaustion under extreme circumstances. The medical programme included the screening all inmates in order to select those patients showing nutritional deficiency syndrome. A clinical and therapeutic study of the sick hospitalised in the quarters for cachectic patients followed. The food situation was analysed, all activities of the relief organisations coordinated, doctors gave medical instructions to be followed and finally a critical examination of the results took place.
In the course of a preliminary examination, all internees were weighed and measured, their pulse-rate and blood pressure recorded, as well as the main facts of their personal medical history. Patients were submitted to a simple medical examination and the results recorded on individual cards. A classification of the examined persons took place according to the following data: weight in relation to height; condition of the skin and subcutaneous tissue; muscular tone; station; cardiovascular system; oedema; and blood counts. Patients were divided into three main categories: cachectic, pre-cachectic and threatened.
Special infirmaries called cachectic quarters received those patients who suffered from extreme skeleton-like emaciation.
Many adults of medium height only weighed about 40 kg. Their physical condition was extremely impaired: dry skin, subicteric pallor, signs of cyanosis or haemolytic process and anaemia. Pre-cachectic patients displayed the same symptoms but to a lesser degree, and their general condition was not so seriously damaged. Threatened cases were in better shape, with a tendency to show symptoms of hunger oedema, some emaciation and weakness. Most of these patients were convalescing from typhoid fever, gastric or duodenal ulcer, tuberculosis and chronic uncompensated cardiac disease. Based on the quantitative results for a camp with a population of about 11,000 internees, of whom 9,000 were examined, 331 were classified as cachectic, 839 as precachectic and about 4,000 were under the label of threatened cases.
“These proportions, however, were not static. Famine disease, which developed like a virulent epidemic, constantly progressed in the camps. Every week systematic investigation discovered new pre-cachectic and threatened cases, as though the virulence of the pathogenic agent were far from spent”.80 From the first results of the screening work, it appeared that more than half the inmates were threatened by symptoms of famine disease. This research on camp inmates allowed the definition of clinical forms of famine:
Humid famine: the principal form being hunger oedema.
Dry famine: characterised by the absence of oedema; it was most common among Spaniards and Italians, showing dry and scaly skin.
Anaemic famine: blood examination and neurological symptoms “of considerable pathogenic and therapeutic interest”.
Circulatory famine: unstable blood pressure, hypotension, bradycardia showing heart suffering.
Neurological famine: ataxia, paresthesia, polyneuritis symptoms, mixture of Parkinsonian and ataxic symptoms.
Mental famine: patients showed a “fixed, lifeless and apathetic gaze”, confusion, prostration and extreme weakness.
The famine categories found in internment camps, with their physical and physiological symptoms, were carefully detailed in the published report. The determination of these clinical categories contributed to medical knowledge; they were also useful for prognosis and for the orientation of the treatment.
The genesis and evolution of the physical and mental impairment associated with the famine syndrome were followed carefully after the arrival of new internees in a normal state of nourishment. Those inmates were abruptly subjected to the camp fare. The deterioration of the general food supply and the growing destitution of the internees led to the appearance of the first symptoms of malnutrition at the end of 1942 “after a certain time-lag”. Careful clinical observation of the internees revealed that once signs of nutritional deficiency appeared they followed each other in a particular order. During the first three months of a deficient dietary, a heavy loss of weight took place, from eight to 15 kg per month. After that initial period the weight loss would decrease gradually from month to month. A gradual disappearance of the fatty tissue was observed and inguinal hernia was frequent. A general feeling of fatigue followed, accompanied by irritability and a change of the bodily complexion, which turned straw-coloured, lemon-yellow, or white; dry skin and fugitive oedema in the mornings, sometimes lasting for about ten minutes.
The headaches appeared later, sometimes accompanied by mental disorders, depression or excitement, excited reflexes, static disturbances and amenorrhea in women. Finally, giddiness and ankle-cramps appeared, oedema became permanent, showing a tendency to generalisation, and cardiac arrhythmia appeared. At this point impairment was so deep and global that if actions were not immediately taken, the outcome of famine disease was inevitably death. Malnutrition was not the only cause; restrictions on freedom of movement, the cold weather, unfavourable hygienic conditions, moral depression, in other words, the appalling living conditions could “only hasten this fatal development”.81
The medical research programme did not finish with the death of the patient; it also included a careful and detailed observation of the conditions under which the death had happened, something considered by the medical experts “very instructive from the pathogenic point of view”. The permanent impairment of physiological conditions finally led to a state of coma, which was followed after a more or less short interval, by death. Sometimes, patients were suddenly struck down and collapsed while walking, sometimes they died in their sleep.
Some patients passed away slowly, showing signs of progressive asthenia, or died from pre-existing or inter-current diseases. An autopsy was performed, which did not usually reveal anything macroscopically relevant, “apart from the occasional presence of cerebral oedema”.
The medical research programme was developed in two internment camps; mortality in January and February 1942 was:
Internment camps were equipped with technology to carry out clinical exploration: fluoroscopic examination, X-ray screening and blood analysis were applied to almost all of the inmates. Cases of pulmonary tuberculosis were detected, as well as cardiovascular disturbances such as heart enlargement and broncho-vascular inflammation, and the bones were extremely decalcified and demineralised, all such observations being typical of a deficiency condition. Clinical and X-ray screening detected endocrine disorders. Hyperthyroidism cases were rare but goitre was frequent; puberty was delayed in girls and a great deal of women over 15 and under 45 had amenorrhea. Adrenal alterations led to hypotension, hypoglycaemia and asthenia. Men suffered from alterations of spermatogenesis. Dysfunctions of the genital endocrine glands suggested pituitary disturbances. On the contrary, diabetic patients seemed to benefit from a deficient diet, as well as rheumatic and metabolic diseases.
Considered by medical researchers as an epidemic situation, the evolutionary curve showed, in a first phase, a progressive increase in morbidity, “consequent upon contamination, till it reaches a high level or a peak, and then falls again when a sufficiently large proportion of the population has acquired immunity, or when active measures effectively prevent the spread of the disease”. When the medical research was brought to an end, famine disease had not yet reached its peak in the camps. Every week the screening of the patients revealed new precachectic and threatened cases, for the causes of the famine were far from disappearing.
The gender divide showed important features. Compared with men, women were affected after a time lag of ten months. Keeping this fact in mind, the increasing number of women affected by the deficiency syndrome in July 1942 was a clear expression of the general impairment of the overall situation. The medical experts did not take into consideration any external or social aspects such as the intensity of physical work, which could contribute to explaining this situation. On the contrary, they argued that “[...] the fact that the calorie requirements of women are 20% lower than those of men, and the slowing-up of metabolism due to amenorrhea, explain in part why they have been more resistant to famine than men. It appears that in the end their resistance broke down in its turn, and that the prognosis in the case of women became less favourable than it had previously been”.84
On the other hand, climate conditions seemed to have a strong influence over evolution and survival. The chances of saving a patient were greater during milder seasons than in wintertime. The cold weather had a weakening influence because calorie losses and existing vascular and nervous disorders were aggravated. Patients who died in winter did so as much from the cold as from famine. On the contrary, a warm temperature had positive effects over oedema. The medical report found that those patients suffering from neurological and mental forms of famine had the most negative prognosis, as well as the appearance of abundant diarrhoea, which is a cause of dehydration, demineralisation and bad assimilation of nutrients and vitamins.
Some signs indicated a fatal prognosis. The inability of patients to stand on their feet for a few minutes was most serious. Medical experts found it indispensable to prescribe strict and complete rest if those patients were to be protected from sudden death. Also, pronounced atrophy and extreme emaciation accompanied cachexia, and, a as a general rule, patients already suffering from other diseases got worse due to famine.
The medical research experts responded to famine disease as if it were not a social problem provoked by living conditions at the internment camps but a sort of epidemic with a purely medical and scientific perspective. The possibilities of cure depended upon age, the season of the year, the early establishment of treatment and the extent of the therapeutic action undertaken. They were explicit; “[...] an incurable condition (apart from terminal coma) does not exist. Notwithstanding a remarkable loss of weight, profound asthenia and a very serious general condition, it was found possible, through persevering an energetic treatment, to save individuals considered to be irrevocably lost”. With treatment being based on a substantial diet rich in fats and proteins and on hypertonic injections of glucose, the medical research found that patients who had been considered hopeless cases were saved. They had been suffering from generalised oedema, ascites, pleural effusion, myocarditis, hemorrhagic purpura and losing as much as 55% of their physiological weight. Segregation of severe cases was considered to be an indispensable therapeutic factor, especially for those suffering from mental disorders.
One of the experimental targets of the research project was to assess the exact role played by vitamin deficiency in famine disease. However, the exact participation of it in clinical signs and physical deterioration was impossible to ascertain. Obviously, the experts discovered the consequences of a deficient calorie intake easily - emaciation, loss of weight and disappearance of fat-but clinical examination did not enable them to assess specific signs resulting from the lack of any definite vitamin. “Moreover, the vitamin requirements of the human body can vary and be subject at the same time to individual factors and to endogenous influences, which govern the absorption and utilisation of the vitamins consumed”. They talked about clinical symptoms related to vitamins C, D, A, nicotinamide and decalcification.
Indeed, it was obvious that the appalling physical condition of the internees was due to the inadequacy of their diet, both from the viewpoint of quantity and quality. A simple comparison between the indispensable elements of a normal diet and the one served to the inmates of the camps provided blatant conclusions. Famine disease was considered the consequence of a chronic quantitative and qualitative deficiency in the diet.
The experts calculated that about 15 to 20% of the theoretical energy value of nutrients in the diet was in reality lost, and therefore the actual value of the daily ration per person was not 1,188 calories but around 950 calories a day on average. As we analysed in previous chapters, in 1942 a great deal of experimental and clinical research on nutrition had established solid patterns regarding the necessary intake of calories for health. In addition, numerous technical reports and articles were available about the consequences of shortages and malnutrition during the Great War, from 1914 to 1918. The situation was considered to be
critical when the daily protein intake fell to 40-50 g per day, the fats intake to 20-30 g, and the daily calorie value between 1,400 and 1,800.
The daily protein ration in the internment camps was no more than 30 to 40 g of foodstuffs that were almost exclusively of vegetal origin and the fats intake was 8 to 10 g a day, which in no case allowed the protein balance to be maintained. When the protein ration and the calorie intake fell simultaneously below the physiological minimum, it was not only the nitrogen balance that was disrupted; the elimination of proteins was also abnormally increased. Cachexia cannot be overcome, even by giving large amounts of fats and carbohydrates, and the weight cannot rise if the minimum requirement of proteins is not supplied. Instead of one gramme of protein per kilo of body weight, defined as necessary by nutritionists, the diet only provided 48 g of vegetal protein. A continual nitrogen deficit followed, which, even though it amounted to only 9 g a day, represented for these internees 3,300 g of protein in the course of a year, a serious impairment of the muscles and other organs being the consequence. The same vegetables were served for weeks on end. Besides, they were badly cooked and inadequately stored for too long. A significant number of inmates suffered from intestinal disorders, and defective absorption was yet another factor of vitamin deficiency, even though the intake was adequate.
Medical researchers then made a comparison with the food situation of a large industrial town near the camps, in collaboration with the Nutrition Section of the Regional Hygiene Institute. Quantitative data for February 1941 showed that the average for different social groups was 1,737 calories for adults and 1,565 calories for teenagers. The lowest figures accepted by physiologists were 1,600 calories for male adults, 1,400 for women and 1,400 for adolescents. At the end of 1941 figures were similar: for the least favoured group, 1,764 calories per male adult, 1,509 per female adult and 1,614 per teenager.
Based on these figures, the experts compared the food situation in the town to that of other German towns in 1917. As for the food situation in the camps, the ration average was not unlike that in Madrid towards the end of the siege, during the civil war, when the ration was 852 calories (it was 1,514 calories at the beginning of the siege). From the comparative study, medical experts concluded that the ration supplied to the internees in the camps was 40% to 50% lower than that of the civilian population of the nearby industrial town, which was itself seriously affected by a food shortage. They predicted that the epidemic of famine disease would persist in the camps and that the efforts of the organisations to combat the situation by supplying additional nourishment and intensive drug therapy would remain ineffective under the existing conditions. It was urgent to raise the ration in all the camps to the level of the civilian population.
Relief organisations made considerable efforts by sending supplementary foodstuffs to the camps but, according to the medical report, failure was due to the insufficient food rations given to the internees. When the relief organisations discovered that famine disease was spreading in the internment camps, they intensified their efforts; several kitchens were installed especially designed to feed cachectic patients, who received a daily ration of between 2,200 to 2,500 calories, with an appreciable improvement in the quality. Relief organisations sought to procure a nourishing diet, scientifically calculated and adapted to patients in a state of advanced cachexia. On the other hand, to stop the famine epidemic, they supplied an ever-growing number of threatened patients with food supplements in the form of pea or rice soups, pasta, pearl barley or dried or fresh fruit, accounting for 250 to 400 calories.
It is impossible in the present study to give an adequate idea of the immense effort exerted by the organisations engaged in relief work, the flexibility of their action and the spirit of cooperation animating them. Some inkling of it may be given by the fact that in less than a week there were numerous developments: the kitchens were installed; a detailed card-index was prepared and kept up-to-date containing the follow-up observations concerning patients cared for by each organisation; most of the necessary foodstuffs were purchased in the Balkans, Turkey, Portugal and Spain, and others were dispatched from the two Americas; storehouses were built; and a great deal of work was done in connection with the handling and storing of the supplies. When we add that, in addition to these material arrangements, many necessary negotiations were undertaken with the authorities on behalf of the internees either in general or in individual cases, a fair idea is given of the impressive work carried out jointly on behalf of the internees by a dozen international and national relief organisations.89
The work of the organisations covered between 65 and 70% of the internees in the camp. In June 1942 a total of 1,958 rations a day were distributed among 2,750 inmates in one large camp. Specific actions were taken in the maternity section, where the weight of the newborn infants shifted from an average of 2.1 to 2.5 kg in 1941, and from 2.9 to 3.1 kg in 1942 and 1943. No infant mortality rates appeared in the medical report.
Some sort of drug therapy was also implemented, depending on the various clinical forms of famine. Patients suffering from dry famine were supplemented with tonics, drugs containing amino-acids, stimulants, vitamins and phosphorus-containing products. In those affected by humid famine, diuretics were added to the above, and for patients suffering neurological and mental famine, brewers’ yeast, glucose and aneurin were added. In cases of anaemia, iron extracts and vitamins were administered. The effects of a wide range of drugs was evaluated: brewers’ yeast, calcium, glucose, iron, insulin, coramin, vitamins A, B, C, D and E, nicotinamide, hepatogastric extract, wheat germ, ortedrin, pervitin, and sulphonamides. The medical treatment was accompanied by rest, and there was segregation for permanent care and systematic supervision in the case of cachectic and pre-cachectic patients.
According to the evaluation of the medical experts, dietary and drug treatment had completely changed the appearance and condition of the patients. There was a rapid decline in mortality once relief had been well organised. During the last two weeks of April 1942 an increase in weight was recorded in 32 out of 100 cachectic patients in one camp, 20 patients remained in a stable condition, there was weight loss owing to a decrease in fluid (oedema) in 40 cases, and a real loss of weight in eight patients. In the first two weeks of May the number of cachectic patients who gained weight was 60.4%. But after the medical programme of intervention and the two months of therapeutic experience, the cachectic and pre-cachectic patients who returned to everyday life at the camp relapsed because they were still exposed to the same pathogenic factor: famine. According to the experts working on the relief programme:
The inadequacy and the irregularities of the rations effectively supplied to the inmates by the administrative authorities of the camps made it definitely impossible to save them. Those who were saved from the consequences of famine, at the cost of great effort on the part of the relief organisations in supplying supplements of food, would thus still have a suspended sentence of death, unless the camp authorities supplied them with a more or less adequate basic ration, this basic ratio remaining the prime factor in the problem of saving famine-disease patients. When all is said and done, the obligation to solve this problem rested with the authorities responsible for the internment of the inmates of the camps.
At the end of the medical report, a postscript was added. The changes in the military and political situation in Europe, characterised by the advance of allied troops and the consequent Nazi retreat, enabled the humanitarian experts’ group to lift the veil of anonymity, giving some information about the camps. The “Health Commission” of the “Co-ordination Committee for Relief in Camps” consisted of: Rene Zimmer, representing the Unitarian Service Committee of the United States; Maurice Dubois, member of the Swiss Red Cross and Children’s Relief (Secours aux Infants); and Joseph Weill, of the O.S.E. Union (Jewish health organisation). The camps in which the observations were recorded were situated in the south of France and, more particularly, in the Eastern Pyrenees. They were set up in 1939 and 1940, first of all to accommodate Spanish refugees, under the name of Centres d’hebergement, and then, during the first part of the world war, to receive “enemy aliens”. From July 1940 these camps were mainly filled with Jews of various nationalities. During the second half of 1942 tens of thousands of them were deportees from camps in Poland. The camps designated by the letters “G” and “R” in the medical report were those at Gurs and Rivesaltes. The town and its food rations have been indicated for purposes of comparison with those of camps in Marseille. The charitable organisations that took part in the provision of relief for the internees were: Aide aux Emigres, the Swiss section of the International Migration Service, Geneva; The Confederation of Swiss Jewish Communities; The Joint Relief Committee of the International Red Cross; The Ecumenical Council, Geneva; The O.S.E. Union (Jewish Health organisation), Geneva; Schweizerischer Aerzte verein (Swiss medical union), Zurich; Secours Suisse aux enfants, Geneva; The Society of Friends, United States; The Swiss Red Cross; and The Unitarian Service Committee, United States. Consignments of medicines were supplied free of charge by the following manufacturers of pharmaceutical products in Basle: C. Boehringer & Co., C.I.B.A., Geigy; and Sandoz.
Following the pattern of internment camps and the excellent conditions they offered to investigate the effects of malnutrition on human health, at the beginning of 1945 the American physiologist Ancel Keys, head of the Laboratory for Physiological Hygiene at Minnesota University, initiated a series of experiments on starvation with a group of volunteers. The experiments were implemented by a research group headed by Keys and composed of doctors Henry Longstreet Taylor, Josef Brozek, Austin Henschel and Harold Guetzkow. As a previous stage, researchers travelled around the country in order to choose a significant group of volunteers for the human research experiment on nutrition deprivation. They interviewed a long series of volunteers, performed a medical examination and asked the men about their health, taking as a key factor their psychological balance. They also reviewed the Selective Service health record of each candidate. Men whose weight varied greatly from the norm were dismissed, as well as husbands. Keys considered that married life interfered with the maintenance of control conditions in the experiment.
Main requirements were enjoying good physical and mental health, measured according to a clinical tool: the Minnesota Multiphasic Personality Inventory (MMPI), published in 1943. Keys’ goal was to analyse scientifically the effects of prolonged hunger on the impairment of health and bodily functions. He originally wanted 40 men in the study, but could only select 36 volunteers who met the minimum requirements. The loss of a man would represent an almost three per cent loss in the study’s total data, something which would also reduce the statistical reliability of every test ran because of the small sample size. J. Brozek acted as the psychotherapist. Volunteers received extensive information about the experiment: they were instructed about body functions, changes to be expected both in organic and psychological aspects, patterns of behaviour, living conditions and the organisation and length of the research programme. Under difficult circumstances, the participants took frequent advantage of the rule that allowed them black coffee and water in unlimited quantities, an opportunity to put something in their mouths and stomachs.
They were submitted to frequent and systematic medical exploration. Increasing the intake of water resulted in polyuria of transparent colourless urine per day, as coffee and water consumption soared. If patients experienced any exceptional or unexpected changes, they were to inform the research team. Obviously, as the time went on, the reactions among the guinea pig group were plural. One of the participants waited weeks before telling any of the scientists that his urine appeared to be changing colour. As the days passed, his urine darkened and he was eventually obliged to report the problem to the staff: he was actually urinating blood. Keys wrote that the problem was “of obscure aetiology”. It was the 18th week of starvation and Keys was forced to drop another man from the experiment. The affected man stayed to help in the kitchen until the end of the experiment. Like other guinea pigs, within a few days of normal meals, all symptoms, mental and physical, disappeared, but Keys thought the blood in urine somehow represented a personal failure, not a direct result from starvation.
During the experiment, body temperatures decreased from the normal 98.6°F to an average of 95.8°F and in one of the more striking changes, the average heart rate slowed from an average of 55 beats per minute in control to 35 beats per minute, the bodies trying to conserve every calorie. The lowest recorded pulse rate was a startling 28 beats per minute. Participants saw their weight loss begin to stabilise around the 20th week of starvation. Unlike a couple of them, their stalled weight losses were entirely explicable and did not put them under suspicion of cheating. A few of them were suffering from oedema. Keys considered this the chief stigmata of starvation. Oedema was caused by retained water and occurred chiefly in the ankles and knees, but also in the face; some cases adopted extreme forms.
While oedema had traditionally been linked to famine, the causes were obscure, as it was a conspicuous symptom of starvation. Keys devoted a chapter to oedema in his final study, where he analysed different explanations. One theory considered it as a cause of increased pressure inside the capillary vessels, pushing fluid from the blood vessels into the interstitial space between cells. Another explanation attributed it to increased permeability in the capillaries. Oedema complicated weight calculations due to the water retention.
In the 20th week of the experiment, on June 22, 1945, the guinea pigs received the visit of a young army sergeant, whose testimony translated the starvation experiment to the German concentration camps.
I was captured in December during the Jerry breakthrough in Belgium. I weighed 190 pounds when they captured us. I was fat, friends! Anyway, the first thing the Krauts did was take our boots and our socks - I do not know if this was to keep us from escaping, or because they needed the boots and socks. Probably both. Then they marched us for four days in just our galoshes. That was entirely without food. Finally, they gave us a loaf of bread for every four men. I wanted to save a little piece of mine for later, but I couldn’t. I ate all of my share right then and there. Then they loaded us into boxcars, and we took another four-day trip locked up like cattle. At the end of that, we hiked three miles up a mountain to Bad Orb Prison Camp. There we got our first hot meal- a bowl of grass soup. Most days after that, a smudge of margarine, and some kind of tea. That was it. I was there a hundred days and lost fifty pounds. So, I guess the reason I’m telling you all this is that I also used to hide food under my pillow and stare at pictures of
bread like they were pinups of Betty Grable - I recognize your deviant behaviour. So how about it - are you fellows ready to eat? You’ll have to forgive my table manners, though. I’ve been a guest of the Nazis - the bastards.95
On July 20, 1945, the final week of starvation, a military visitor and Army major visited Keys’ Laboratory of physiological hygiene. He was Marvin Corlette, a doctor who had seen first-hand the starving victims of the Nazi concentration camps. He was also the chief of the Civilian Nutrition Branch of the Army’s Medical Corps, owing all the credentials and the experience to rigorously evaluate the starvation experiment.
Keys showed Major Corlette the barracks... and their array of testing equipment. Corlette was more eager to get to the men. Keys watched from across the room as the major talked to them, took notes, and examined their swollen ankles. Key’s wasn’t about to ask this young major his opinion, but he listened closely to the major’s questions and comments in an attempt to discern his frame of mind. Did he think that Keys had accurately recreated concentration camp-style famine? Or did he think the whole experiment was a circus, a dangerous, indulgent exercise in scientific showmanship? Major Corlette was civil and cheerful, but he left the laboratory without sharing his conclusions.
Keys got a letter from the major dated August 18, summarising his visit to the lab. After describing the clinical symptoms of the guinea pig group he concluded: “Except for the absence of filth and secondary skin infections in the experimental subjects, it appears that the fundamental clinical pattern of partial starvation as we observed in Europe has been duplicated”.97
A specific aspect of the experiment was the assessment of the influence of hunger on sensorial perception. Hungry people were said to be more sensitive, but Keys found it difficult to believe that hunger really improved hearing and sight; he therefore devised a series of laboratory tests to examine sensorial perception and reactions. The most meaningful results were those regarding hearing improvement by a full standard deviation that apparently demonstrated that hunger sharpened hearing. On the other hand, the intellectual capacity of the men in the study was largely unaffected by hunger.
July 28, 1945, had been announced from the beginning of the experiment as the last day of the starvation phase:
Ibidem, pp. 141-143.
The thirty-two men who made it to the rehabilitation phase were in many ways different than the men who had shown up at Memorial Stadium in November of 1944. They were smaller - they had dropped from an average of 152.7 pounds to 115.6 pounds, an average weight loss of 24.29 per cent. They were shorter too - the average man had lost about a third of a centimetre in height. Their total blood volume had been reduced by almost 500 cubic centimetres. The heart that pumped that blood had shrink by 17 per cent. More significant, and more difficult for Keys to measure, their world had shrunk. The men had come to Minnesota to be part of a global mission to help all of humanity. Now they didn’t care about starving refugees... Now their world consisted only of the South Tower of Memorial Stadium and the food line at Shevlin Hall.
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