restricted 
OFFICE OF STRATEGIC SERVICES 
Research and Analysis Branch 
H & A No, 1070 
HEALTH IN AXIS EUROPE 
6 October 1943 
If and when this study outlives its 
usefulness to you, please return it to: 
Oifice of Strategic Services 
DlreGtor RescarGh and Analysis Branch 
2oth and E Streets, N. V/, 
Washington, D. C, RESTRICTED 
TABLE OF CONTENTS 
Page 
Summary . . i v 
I, Introduction: General Conditions and Industrial Hazards,...! 
A. Plan of the Work 1 
B. Health Conditions in Industry 1 
1. General Conditions 1 
2. Industrial Accidents and Hazards., 4 
II, The Demand for Medical Personnel and Facilities Measured 
by the Incidence of Disease 6 
A. Epidemiology 6 
1. Venereal Diseases 6 
2, Gastrointestinal Diseases 8 
a. Typhoid and Paratyphoid Fever 
b. Dysentery 
c. Diseases of the Stomach 
5. Insect-borne Diseases 15 
a. Malaria 
b, Typhus 
4, Infectious Diseases 51 
a. Common Cold, Influenza, Pneumonia 
b. Whooping Cough 
, c. Diphtheria 
'.a d. Meningitis 
e. Scarlet Fever 
f. Jaundice 
g. Trachoma 
h. Smallpox 
‘ir i. Tuberculosis 
. Diseases Affecting Man and Animal 50 
a. Tularemia 
b. Trichinosis 
6. Miscellaneous Diseases 51 
a. Vitamin Deficiencies 
b. Caloric Deficiencies 
c. Alcohdlism, Nervous Disorders, Fatigue 
B, Food as a Cause of Disease 64 
1. Food Poisoning. 64 
2. Meat Inspection 66 
3. Control and Inspection of Dairy Products 67 
III. The Supply of Medical Personnel and Facilities.,., 69 
A. Quantity and Quality of Personnel 69 
1. Declining Number of Doctors 69 
2, Conditions of Medical Practice 71 
5. Collectivization of Medical Services,.,.,, 72 
4. Difficulties in Obtaining Medical Care,,.. 72 
5. Future Prospects 74 
6. Shortage of Nurses 74 
7. Conditions in Other European Countries..........74 
i ' 8. Decline in the Quality of Medical Personnel 77 
9. Dentists 79 
B. Quantity and Quality of Facilities...., 80 
1. Hospitals 80 
2. Recreational Travel arid Spas 8b 
5. Drugs and Medical Equipment, , 85 
a. The General Situation 
b. Cosmetics 
c. Medical Equipment/® RESTRICTED 
Page 
d. Drugs Acting Locally on the Skin and 
Mucous Membranes 
i. Glycerin 
ii, Tragacanth 
iii. Cocoa Butter 
iv. Lanolin and Vaseline 
v. Lard 
e. Germicides 
i. Borates 
li. Chlorine 
iii, Creosol 
iv. Iodine 
f. Drugs Used in the Therapy of Syphilis 
i. Bismuth 
ii. Arsenic 
g. Agar-agar 
h. Insulin 
i. Quinine 
j. Stimulants 
i. Camphor 
ii. Caffeine 
k. Radium 
l. Liver Extract 
m. Surgical Sutures 
n. Opium 
*. : • • • / *- 
Appendix I. Infant Mortality Rates 102 
Appendix II, Soap 103 
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SUMMARY 
1. Health conditions in 'German Europe have deterio- 
rated in consequence of such wartime conditions as internal 
migrations and other population movements, physical and 
mental strain, overwork, air-raid hazards and deterioration 
of nutritional standards. Medical personnel and facilities 
available for the civilian population have shrunk in quantity 
and quality. 
2, Systematic examinations of G-erman employees, carried 
out on a large scale by the Labor Front, have indicated that 
at least one-third of the examined "healthyn workers showed 
defects which at that time required medical attention. 
Working hours were reduced in the summer of 1943, Attempts 
are made at shortening the time required for the medical 
care of workers. New technologies have brought new industrial 
hazards and exposed the workers to undue strain. 
3. With reference to specific diseases, there is little 
evidence of a spread of venereal diseases in Germany. The 
legal measures designed to prevent such a spread have been 
further intensified during the war. Typhoid fever incidence 
has risen four-fold in G-ermany during the war even after 
allowance is made for the increase in population. Paratyphoid 
fever incidence has increased by nearly one-half. Dysentery 
has increased at an irregular rate; the case fatality rate of 
this disease has tripled. In the medical press much is made 
of the increase in stomach troubles and stomach and duodenal 
ulcers. There seems to have occurred a decrease of duodenal 
ulcers relative to stomach ulcers. 
4, The incidence of malaria has become more severe not 
only in malarial countries but also in G-ermany, Estimates 
of the number of malarial persons in Greece vary between 
1,500,000 and 2,500,000. 
5, Typhus has spread in Europe and though it is held 
under control at present, further deterioration of the 
standards of hygiene may be dangerous. During the first 
months of 1943 there has been a considerable increase in 
the number of cases reported from Bulgaria, Turkey, and 
Rumania, Mass production of anti-typhus vaccine has ap- 
parently not been achieved. 
6, The incidence of diphtheria has increased by one- 
half in Germany from 1939 to 1942, Vaccination continues to 
be voluntaryo Scarlet fever incidence increased by some 
100 percent in Germany from 1939 to 1942; protective vaccina- 
tions are applied only hesitantly and with doubtful success. 
7. Much is made of jaundice in intercepted letters and 
newspaper reports from the continent. 
8„ The reported incidence of trachoma has increased 
ten-fold in the expanding territory of the Reich, 
9, Apart from Turkey, there has been no spread of 
smallpox in Europe, Vaccination is compulsory in many 
countries# 
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10. Statements of German medical authorities indicate 
awareness of the impact of war conditions on the incidence 
of tuberculosis. In the expanding territory of Dermany, 
the incidence of tuberculosis of lungs and larynx has in- 
creased by 40 percent; the incidence of tuberculosis of the 
declined, and that of tuberculosis of other organs 
has increased by 100 percent. Much progress has been made 
in the detection of tuberculosis, 
11, Dermany seems to be well equipped with all vitamins 
except Vitamin A, There are organized campaigns for the 
distribution of vitamin preparations.. 
12. Famine oedema has been reported from Belgium and 
Greece but not from Germany, where it was observed during 
the First World War. 
» 
13, German medical journals contain articles on fatigue 
to a striking extent, Present discussions resemble closely 
the description of phenomena observed during the First World 
War. 
14, Meat from tubercular cattle is consumed in increas- 
ing proportions; the control of diseased cattle has been 
further relaxed. 
15, In view of increased requirements, it is of special 
importance to note the decline in the quantity and quality 
of medical personnel and facilities. In 1938, there was one 
doctor available for every 1,400 people in Dermany. Now one 
doctor must care for a number estimated between 2,400 and 
3,100. Doctors are overworked, and criteria in assessing 
health have been lowered. Medical services have become 
collectivized. Many newly admitted physicians are not 
properly qualified. Hospital facilities for civilians are 
scarce as a result of the requirements of the military. 
Recreational travel is restricted. 
16. In view of the size of the Denman and French produc- 
tion of. drugs, the drug situation is not extremely serious in 
Europe apart from certain specialties. Insulin is scarce and 
so are liver preparations, the production of which depends 
upon the importation of animal products, Quinine has been 
replaced by atabrine. It has been possible to expand the 
European production of morphine as a result of the increased 
utilization of poppy straw, 
17, Soap is in short supply and of poor quality. 
Synthetic fats have apparently not been used in soap produc- 
tion to an appreciable extent. 
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HEALTH IN AXIS EUROPE 
I. INTRODUCTION: GENERAL CONDITIONS AND -INDUSTRIAL HAZARDS 
A. Plan of the Work 
The data in the following pages are'chiefly from enemy 
sources. It is believed that information which depicts con- 
ditions unfavorable to the enemy is more valuable and carries 
more conviction if it originates from the enemy himself.1 
The present introductory-part consists of a general 
survey of such subjects as health conditions among industrial•. 
workers, consequent absenteeism, and wartime industrial hazards 
and accidents. Direct evidence pertaining to these condi- 
tions and their impact upon industrial productivity is not 
readily available. It has thus been necessary to collect 
material bearing*on the general and specific incidence of 
disease and the facilities and personnel available to cope 
with it. . . .. 
It is proposed, in the next section, to deal with the 
demand for medical-facilities and personnel. Owing to a 
number of which include Internal migrations and ot 
other population movements, physical;.and mental strain, over- 
work, air-raid hazards and deterioration of nutritional 
standards, this demand has greatly increased in wartime. The 
final section shows how the demand for. medical facilities is 
met by a supply which, for the same reasons, has shrunk in ' 
quantity and quality. - 
Though the area covered in the report is the European 
continent, main emphasis has been placed upon conditions in 
Germany. p-,.; 
B. Health Conditions in Industry 
1. General Conditions. Systematic examinations of 
employees which have been carried out on a large scale by 
the German Labor Front have indicated that at least one- 
third of the examined "healthy" workers showed defects- which 
at that time required medical treatment and attention. Tooth 
defects have the first place while foot defects follow. 
Every year about 100,000 workers become prematurely disabled 
average age of 34 years,- i.e. 12 years before they are 
eligible for old age insurance.- There are 2,000,000. such 
persobs in Germany,2 
A large proportion of the labor force is women. In 
1942, 47 percent of all mothers were reported to have been 
in employment. Figures for 1939 indicate that 40 percent of 
1 Figures and data for which no specific source is indicated 
in the report are taken from the various•official publications 
of the health offices and census bureaus of the various 
countries. 
2 Herbert Pirker, "Leistungsmedizlnisches Denken in der 
arztlichen Praxis," Wiener klinische Wochenschr.1 f t, 14 August 
1942, pp. 641 ff. ;— 
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the total female population was then gainfully employed, 
"Women in industry,1' it is said, "have now become a semi- 
permanent institution,.., Every woman, married or unmarried, 
has a vocation,,.. Marriage and birth result only in a 
temporary intermission of working conditions which are always 
dominated by the labor requirements of the. management. The 
latter does everything to reduce the interruption to the 
shortest possible time. Only such time as is essential for 
the health of mother and child is granted. Such conditions 
shorten the time of nursing and result in numerous maladies 
of the woman. Let us think only of the railroad and.bus 
trips and their effect upon a pregnant woman.... She views 
work and motherhood as competitors, one of which must be the 
loser,... The figures justify the assumption that the em- 
ployment- of women impedes the increase in the number of 
children.,.. With respect to men, the separation of work and 
private life is largely a matter of course; with respect to 
women, especially when they become older and attain greater 
maturity, such conditions often produce the effects of ’an 
inner disruption.,., A permanent effort beyond normal limits 
is like the.consumption of capital and reduces efficiency."1 
A general reduction of working hours was introduced in 
Germany in the summer of This was proceed by discus- 
sions of the adverse effects of unduly long hours on pro- 
duction. 5 The general registration for work duty,1 which was 
extended early in 1943, necessarily produces a lowering of 
the average stamina of workers. Employees drafted for work 
under the new regulations come from the ranks of the "normal 
consumers" who did not5 receive supplementary rations. Among 
them are bound to be many disabled and Weak persons, since 
the new registration embraces all men from 16 to 65 and all 
women from 17 to 45 unless they are working 48 hours a week. 
With reference to absenteeism, it is reported that 
absences because of sickness have increased so rapidly that 
a new rule was made in February 1943, specifying that doctors* 
certificates for absence from work could no longer be signed 
private physicians. In the future they would have to 
carry the signature of a factory or state physician. This 
had been preceded by decrees Issued in the spring of 1942 
which threatened workers, in case of unjustifiable absenteeism 
wi-th- the-forfeiture., of their accumulated rights to social 
insurance benefits $nd gave employers the right to withdraw 
suppiepehtdry ration-books from workers' with bad attendance 
raedrd©-. In- -the sdme line are decrees' Of 1942 which make 
the. exchange of information about the workers’ health mandatory 
1 Lampert, "Prauenarbeit und Muttertun," Wiener klinische 
Wochenschrlft, 10 July 1942, pp. 54l ff. 
2 OSS source, 18 May 1943, 
3 Frankfurter Zeitung, 1-2 May; 7 May 1943. Vera Pranke, 
Inside Germany Today," New Republic 108:852 ff (28 June 1943). 
4_ Decree of 27 January 1943. Frankfurter Zeitung, 29 January; 
23 February 1943; Per deutsche Volkswlrt, 2U February 1943. 
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upon the work-doctors (in the factory)-1- and the doctors . 
appointed by the sick funds and insurance.organizations. 
Moreover, the conclusion of an agreement was reported in 
December 1942 between the organization of the sick-funds 
physicians and the workers’ health authorities. According 
to this agreement the doctors of the sick funds will hold 
consulting hours in factories and workers be enabled to ob- 
tain medical care with minimization of loss of working hours 
and It is pointed out in the, German press that a 
regular consultation of a doctor at his office requires at 
least 3y hours* including waiting, commuting, washing and 
changing clothing, while consultation in the factory takes 
only half an hour,-^ 
In 1942 some firms had started the policy of granting 
so-called health bonuses for. workers with good attendance 
records. This policy was officially, discouraged. The rea- 
sons which were stated in a circular of the Minister of 
Labor were as follows4 • 
1. Such bonuses require consent of.,the wage authorities. 
2, Every employee has the duty not to be absent with- 
out good reason and this duty,exists without regard to any 
bonus. 
3. It is unjust to bestow favors.upon healthy people 
and to discriminate.against sick people. 
4,: If a bonus is granted, sick people may be induced 
to postpone the sick report* ’ 
1 The institution of the factory doctor is more fully dealt 
with In Section III, A, 2, below, on Conditions of Medical 
Practice, 
2 OSS #37520, 27 May 1943. DNB, 18 December 1942, 
3 Angrlff, 29 January 1943. ... ... 
4 Relchsarbeltsblatt, 1942, Part V, Number 2, pp. 45 ff. 
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In the German press, the average number of people who 
are absent from work because of sickness is reported as 
3 percent.1 
2, Industrial Accidents and Hazards. No recent figures 
of industrial accidents are available. For well-known rea- 
sons they must be high. The last report is.of 1938 and gives 
the number of accidents and Industrial diseases as 2,014,315. 
There was thus a daily average of 5*519 work accidents. New 
processes and the substitution of materials in short supply 
have undoubtedly caused an'increase in this figure. As early 
as 1939 the President of the Reich Health Office pointed out 
that the Four-Year Plan had greatly Increased industrial 
hazards: "In the newly constructed cellulose-wool factories, 
cases of Injury to workers incurred during the washing pro- 
cess with hydrogen sulphide have increased to a disturbing 
extent. The extraordinary increase in the use of light 
metals has given rise to a new problem in industrial hygiene 
in the form of what is called duraluminum sickness, a result 
of the deleterious effect of metal splinters on the tissues. 
The increased use of benzolated rubber solutions in newly 
created industries has resulted in frequent cases of benzol 
poisoning. New methods of combating grain parasites in 
large storage systems have resulted in cases of poisoning. 
The manufacture of artificial resinous substances and of 
so-called aurite glue led to cases of skin disease, .The lead 
and bronze alloy used as moulds for combustion engines has 
created a new source of Industrial poisoning," 
The President of the Reich Health Office then continues 
(in 1939): "The tremendous expansion in the volume of 
production. Impressively mirrored in production and em- 
ployment statistics, has created, in the fields of eco- 
nomics and of the care and systematic integration of 
our human labor power, new and difficult problems; these 
1 Deutsche Allgemelne Zeltung, 11 June 1943. - The private 
healths insurance companies paid the insured the folio-wing 
percentages of the premiums in the indicated years: 74 per- 
cent in 1939; 68.5 percent in 1940; 72.3 percent in 1941. - 
The following conditions are reported from an individual 
plant, a food enterprise with 200 employees. It should be 
emphasized, however, that three-fifths of the employees were 
women, that only a few were under 30 years, and the largest 
part between 40 and 50 years. Of these employees: 
22.5 percent had heart trouble of one sort or another, 
25.5 percent had had an operation in the past (cases less 
serious than appendicitis were not included), 
5.5 percent suffered from exophthalmic goiter, 
10.5 percent had a light hyperthyreosis, 
27.5 percent suffered from rheumatism, 
8.5 percent had had a tonsillectomy, 
13 percent had chronic tonsillitis, 
17.5 percent had extremely defective teeth, 
16 percent had chronic bronchitis and emphysema, 
6.5 percent suffered from tuberculosis, 
0,5 percent had extensive broncho-ekstasias, 
Among the women nutritional conditions were found to be better 
than among the men. Of 146 women, 90 were well fed while 56 
were partly in fair, partly in reduced conditions of nutrition. 
The corresponding figures for 54 men were 33 and 21, respec- 
tlvely. W, Henning, "Auswertung von Reihenuntersuchungen im 
Betrleb," Wiener klinische Wochenschrift, 14 August 1942, 
pp. 658 ffT : 
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have now reached such a point that they can no longer be 
solved without a diminution in the performance of the * 
individual worker and the Investment of the last reserves of 
labor power. The j.ncreased labor schedule is characterized 
by the emergence of inadequate performance..,. The extensive 
introduction of working shifts and the loosening up of the 
system of safeguarding labor hours, through overtime and 
Sunday work in many enterprises of State importance, are 
gradually creating conditions prejudicial to the health of 
the workers. This result of overwork also leads, in the 
opinion of medical circles, to a 'diminution of working 
capacity, and we are approaching the time when the increase 
of working capacity and the expansion of production will 
become the cry of the hour and the directive for further 
systematic development. We already hear from the medical 
profession expressions of concern regarding the decline in 
health conditions, and the frequent occurrence of general , 
nervous disturbances or of disorders of the digestive system, 
which are ascribed to the handling of new material. They 
raise the question whether the demands being made on the 
human working capacity have not in some cases exceeded the 
permissible limit." Thus spoke the President of the Reich 
Health Institute in the spring of 1939.1 
More recent information is indicative of many industrial 
hazards caused hy poisoning.2 Carbon monoxide poisoning is 
said to be most frequent, while Illness from the effects of 
motor spirit, motor-exhaust fumes, etc., takes second place. 
Fire-extinguisher and refrigerator plants expose the -workers 
to carbon-tetrachloride and methyl-bromide poisoning. In 
the production of explosives carbon monoxide and organic 
solvents are used. De-lousing., institutions have become 
numerous and the workers operating in such organizations are 
exposed to special risks, A broadcast of June 1942 referred 
to- the covering-up of the vent-pipes of furnaces in the Ruhr 
in order to ensure the blackout in the case of air raid 
alarms: "Unfortunately, the temperature has thereby, risen 
in the works and the workers are also affected by the fumes 
and the gases which are now prevented from escaping." 
1 Reiter, "Arbeitshyglene und Vierjahresplan," Reichsgesund- 
heltsblatt 14:332 (1939). ‘ , . 
2 K. Zipf, "Vergiftungen im Krlege," Deutsche medlzinlsche 
Wochenschrift, 1 May 1942, p* 472. 
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H. THE DEMAND FOR MEDICAL PERSONNEL AND FACILITIES MEASURED 
BY THE’INCIDENCE OF DISEASE 
In the following section the demand for medical facili- 
ties and personnel is Indicated by evidence of the prevalence 
of disease, by types, in Germany and the occupied countries. 
A. Epidemiology 
1. Venereal Diseases. "Venereal diseases continue to 
remain a wartime danger and the subject of worry," stated 
Dr. Leonardo Conti early in 1942.1 There are only few indi- . 
cations of a spread of venereal disease in Germany. The pre- 
war trend has been downward. The following figures are quoted 
by German authors:2 
192? 
■ 1934 
1940 
New o.ases of gonorrhea (thousands) 
279 
175 
161 
New cases of syphilis (thousands) 
75 
75 
54 
“R&tio of syphilis to gonorrhea (cases) 
1: 3.6 
1: 4.1 
1; 4.7 
New infections with venereal disease 
* per 10,000 persons: 
Men 
66.4 
a 
23.1 
Women 
25.1 
a 
12.9 
a. Not available 
Regional studies indicate primarily an increase in syph- 
ilis during wartime; the sulfonamide treatment of gonorrhea 
is said to have brought about amazing improvements.3,4 
The Draconian measures designed to prevent the spread of 
venereal diseases have been further intensified during the war. 
In the fall of 1940 it was provided that anyone with a vene- 
real disease in the infectious stage who is unable to pay for 
treatment should receive free treatment at public - expense. 
Other regulations were enacted at the same time. Instead of 
the law definitely stating that certain houses or blocks of 
1 Conti, "Die Bedentung der Wisspnschaft , insbesondere der 
kinderarztlichen, in der Gesundheit sfiihrung," Deutsche medl- 
z.inische Nochenschrlft,.16 January 1942, pp. 57 ff. 
2 B. Spiethoff and H. Gottschalk, "The Prevalence of Syphilis 
in Germany/' Medizinische Welt, 1942, pp, 112 ff. Reported, in 
Venereal Disease Information 24:100 ff. (March 1943). 
3 A. Rainer-Bielefeld, "Die Bekampfung der Geschlechtskrank- 
1m Kriege im gemischtwirtschaftlichen Bezirk," Der 
offentliche Gesundheitsdienst, 1942, No. 1, part B5 p.9. 
4 In an intercepted letter it is, however, pointed out that 
treatment of venereal disease is difficult for German civil- 
ians since the army gets all the chemicals. 
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houses in a street could not be used for prostitution, it vas 
provided that the health authority in regard to this law rest 
with the health department. Any health insurance physician 
(health Insurance is compulsory in Germany) may treat venereal 
diseases. He has to furnish an initial report, as well as a 
summary of the case at the end of treatment, to the health de- 
partment. All persons known to be sexually promiscuous are 
kept under strictest control and observation. It is suggested 
that examinations be made once a month or once every three 
months, depending on the habits of the person under observa- 
tion, and that observation by private physicians not be per- 
mitted ifthe person changes physicians more than twice a year. 
Each person who knows, or who under the circumstances should 
know, that he has a venereal disease must seek treatment and 
continue treatment without interruption until he is discharged 
by his physician. If necessary, he is forced to do so by the 
police. It is the physician’s duty to report to the health 
department all cases lapsing from treatment or refusing treat- 
ment for venereal disease. Every person (l) who knows, or who 
under the circumstances should know, that he has a venereal 
disease in the infectious stage, yet has sexual intercourse; 
(2) who deliberately opposes the regulations for the control 
of venereal diseases according to the law; (3) who makes avail- 
able substances for self-treatment for venereal diseases,.is 
punished with imprisonment for three years or a fine. Any 
physician who deliberately sends in an incorrect report to 
the health authorities in regard to the physical condition of 
a person or who deliberately permits a venereal disease to be 
spread is punished with imprisonment from one month to two 
years. All prostitutes in large cities are compelled to 
undergo a physical examination by a physician for skin and 
venereal diseases every seventh day. The physician reports 
his findings on a certificate for the health department and 
records the examination in the control book of the prostitute, 
by means of which the health authority-Is-'informed whether the 
prostitute is being examined regularly. If she fails to do so, 
compulsory measures are used., ..One physician who since 1938 
continued to issue certificates to the health department and 
to make entries in the control-books of prostitutes without 
having made examinations, yet charged the usual fee for his 
services, was sentenced to eight months imprisonment. His 
appeal to the Reich court was denied.1 
In 1942 the regulations were tightened further by the 
provision that physicians must in every case of"infection 
make investigations as to its source. In the past.they had 
simply been required to file a report with the health depart- 
ment if the patient was liable to endanger others or refused 
treatment.2 
As an article in a medical journal points out, the risk 
connected with salvarsan treatment has increased owing to a 
number of factors.3 It is stated that ill effects from 
1 "The Law for the Campaign against Venereal Diseases," 
Sozialhygiene der Qeschlechtskrankheiten, February 1941, as 
reported in Venereal Disease Information 22:228 (June 1941). 
2 Reichsgesundheit sblatt , 30 September 1942, p. 709. 
3 Erich Hoffmann-Bonn, "Uber Salvarsanohaden dm Kriege und 
ihre Verhiltung," Munchener medizinische Wochenschrift, 31 July 
1942, pp. 678 ff. 
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treatment by salvarsan, which had become extremely rare in 
peace-time and had almost disappeared owing to the exact ap- 
plication of the regulations laid down by the Reich Health 
Office, have sporadically become more apparent again in recent 
times. This is said probably to be the consequence of entrust- 
ing the treatment to inexperienced doctors, the.changed food 
situation, the Increased physical and mental burden, and the 
excessive strain to which doctors are subjected. 
In connection with the lack of evidence of any consider- 
able .increase in venereal diseases at the present time, it is 
well to remember that, contrary to the generally prevailing 
opinion, exicerts believe the actual increase in infections 
during the First World War was slight in Germany (from 20.4 
per thousand per year before the war to 20,5 during the war), 
while, following demobilization of the army after the war, 
there was a catastrophic increase in the Incidence of venereal 
diseases up to the years 1921-22.1 
At the present time, news from German-dominated Europe 
is more alarming than the reports concerning conditions in 
Germany. A Paris authority is reported to have stated in 
March 1943* that infections had trebled over the previous 
three years. Legislation was introduced in France which aims 
at preventing the spread of the diseases in accordance with 
the regulations prevailing in Germany.2 in Norway, which be- 
fore the war used to have only a few cases of gonorrhea and 
no syphilis at all, these diseases have now become more wide- 
spread owing to the growth of prostitution and other factors.3 
During the first six months of 1942, more cases of syphilis 
were reported in Oslo than in each of the- entire preceding 
years. Since most cases of syphilis prior to the war were 
acquired by Norwegian sailors in foreign ports, the situation 
is even more serious than the figures Indicate. The great 
majority of the Nor-wegian sailors today sail the Norwegian 
Merchant Fleet in Allied service under the direction of the 
Norwegian Government in London. 
2. Gastrointestinal. Diseases 
a. Typhoid and Paratyphoid Fever. There has been 
a large increase in typhoid and paratyphoid feyer in Germany, 
and a less pronounced increase in Italy. The rise was espe- 
cially striking in Germany in 1942. The following table in- 
dicates conditions in the expanding territory of Germany with 
respect to typhoid fever from 1936 through 1942: 
1 M. Schubert, "Venereal Diseases in War," Medizlnische Welt 
14:1037 ff. (October 1940). 
2 Transocean, 16 March 1943; Pariser Zeitung, 4 March 1943; 
Stefani, 2 March 1943; Journal of the American Medical Associa- 
tion 122:451(12 June 1945) ; 121:13Fo~(24 April 1943). 
3 Journal of the American Medical Association 122:239 (22 May 
•19437: 
4 Office of the Surgeon General of the Norwegian Public Health 
Service, Medical and Sanitary Data on Norway, Washington, D. 0., 
May 1943, CID 388477 P- 33. also OSS, CID 41102, 27 July 1943. 
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No . of 
0 
0 
Cases per ten 
Deaths per 
Year 
cases 
deaths 
thousand inhabitants 
hundred cases 
1936 
2,933 
333 
.44 
11 
1937 
3 5 081 
321 
.4C 
10 
1938 
2,957 
360 
.43 
12 
1939 
2,733 
353 
.39 
13 
1940 
9,163 
971 
1.0 
11 
1941 
7.723 
805 
.86 
10 
1942 
16,291 
1,622 
1.8 
10 
Typhoid fever incidence per ten thousand inhabitants has 
thus risen four-fold even though allowance is made for the in- 
crease in population and territory. The case-fatality rate 
has remained stationary. The cases in 1940 included 
in the Old Reich, 1,452 in the Alpine and Danube Gaue and 
the Sudetenland, 1,462 in the districts of Giechanov and 
Katovice, and 2,595 in Danzig-Westpreussen and Wartheland.l 
The situation with respect to paratyphoid fever is sim- 
ilar. The following table presents figures for this disease 
in the expanding territory of Germany from 1936 through 1942: 
Year 
No. of 
No. of 
Gases per ten 
Deaths per 
cases 
deaths 
thousand inhah it ant s 
hundred cases 
1936 
3,136 
110 
• 47 
4 
1937 
3,558 
107 
.52 
3 
1938 
3,296 
205 
.48 
6 
1939 
3,072 
112 
.44 
4 
1940 
4,197 
183 
,47 
4 
1941 
4,883 
156 
.54 
3 
1942 
6,076 
187 
. 68 
3 
The paratyphoid fever incidence per ten thousand inhabi- 
tants has thus increased by nearly one-half. Of the 4,883 
cases in 1941, 4,04y occurred in the Old Reich and 836 In the 
newly acquired eastern provinces. The increase in the inci- 
dence of both diseases is thus in no way exclusively indica- 
tive -of conditions in the new areas. 
Germans expecting to travel in the occupied sections of 
Eastern Europe, the Government-General, and foreign countries 
were advised in the spring of 1942 to obtain protective vac- 
cinations against typhoid, and paratyphoid fever before leaving. 
Vaccines are supplied from the Robert Koch Institute in Berlin 
or the Behring Works in Marburg.2 Early in 1943 all residents 
of the Government-General between the ages of 8 and 55 were 
made subject to an annual anti-typhoid vaccination.5 
In this as in other cases of contagious diseases, contact 
with the population of Eastern Europe has contributed much to 
1 In the Netherlands, deaths from typhoid and paratyphoid 
fevers increased from 21 during the first ten months of 1940 
to 51 in the same period of 1942. 
2 Mdnchenor Medizinische Wochenschrlff s 13 May 1942, p. 460. 
3 Decree of 20 January 1943.-, Reichsgesundheitshlatt , 1943, p. 163. 
(25443) RESTRICTED 
the spread in Germany. Over 800,000 Germans from Eastern 
Europe were resettled elsewhere after 1939.- It must be con- 
sidered that the degree of immunization is higher among these 
people than it is in Germany proper, and that migratory move- 
ments of the magnitude which have occurred in Europe cannot 
but affect the less Immune inhabitants. Among the migrants 
themselves, the change in environment may have contributed 
to the outbreak of the disease. In general, the strain of 
the work, of war conditions, and of malnutrition have les- 
sened the powers of resistance to infection. 
The severity of the war has been brought fully home to 
the Italian people only in recent time; it may be that the 
figures for Italy are not sufficiently recent to reflect the 
seriousness of the situation. Cases of typhoid and paratyphoid 
fever increased as follows; 
Year 
Number of Cases 
1937 
36,713 
1938 
41,824 
1939 
30.023 
1940 
30,328 
1941 
43.011 
1941 Jan. 
to October 30.782 
1942 " 
fl " 45.116 
In Greece, 289 cases of -typhoid were reported to the Min- 
istry of Hygiene in January 1943* and 170 in February. Dr, 
Papamarkou, Secretary General of the Ministry, has the im- 
pression that the number is rather large for the time of the 
year. The main cause is probably the bad water-supply. The 
Ministry of Hygiene supplies vaccine gratis to destitute 
persons.! According to recent reports, the occupation authori- 
ties have limited the consumption of water in Athens to the 
period from 6.00 a.m. to 2.00 p.m,^ 
The spread of typhoid in Northern Italy is evidenced by 
a report in a Swiss newspaper indicating that all the communes 
in the Canton Ticino along the Swiss-Italian frontier adopted 
strict precautionary measures against the dangers arising 
from the typhoid epidemic on the Italian side of the frontier.3 
In Hungary, the Inhabitants of Budapest were ordered to 
have themselves inoculated against typhoid in November 194,2; 
there were, however, 27 cases of typhoid in Budapest in April 
1943, and 11 cases of endemic typhoid fever were brought from 
the country to the Budapest hospitals during that month. Al- 
together there were 12,412 cases in 1942.4 
In Bulgaria, the Plovdiv municipal health service ap- 
pealed to all citizens, particularly those living in the 
1 From a report by Dr. Elsa Segerdahl Persson entitled "Con- 
tagious Diseases in Greece", dated Athens, 28 April 1943. 
CID 38151. 
2 Ephemeris. 17 July 1943. 
3 Democrats9 22 January 1943. 
4 Reggell Magyarorzag, 16 November 1942; Pester Lloyd, 7 May 
1943; Bern T. (P) #1583, 9 March 1943. 
(25443) RESTRICTED 
outskirts of the town, to be inoculated against typhoid. Owing 
to the use of water from uncontrolled sources, the possibility 
of a typhoid epidemic was said to exist in July 1943.^ 
In Yugoslavian communities orders were given in December 
1942, for a re-inoculation of the population,2 General Mihail- 
ovich’s chief of Medical Services states that 21,000 cases of 
typhoid occurred in 1942.7 
In Rumania, the population of Northern Bucovina and 
Bessarabia were urged to take precautions against typhoid.4 
There are similar reports from European regions nearer 
Germany proper,5 
German troops are reported to have little trouble with 
typhoid. It is said that all soldiers are issued pills which 
will render drinking water safe. Other pills are available 
which indicate whether the water is too badly infected to be 
sterilized.8 
The increased damage to which the territory of Germany 
proper has been exposed by air raids has led to a deterioration 
of drinking water and to local scarcities. In Hamburg,, the 
population was urged to boil water before use. There were 
also free anti-typhoid inoculations.7 Similar reports have 
arrived from Berlin,8 
It is stated that air raids have resulted in scarcity of 
drinking water and a breakdown in the sanitary system. As a 
result, many Berliners are said to have become ill from drink- 
ing liquids other than tap water. 
With respect to vaccinations, it is interesting to note 
that Professor Sergent, of the North African Pasteur Institute, 
has observed that the anti-typhoid vaccine used for the French 
Army during the campaign of 1939-40 did not prove useful in 
Southern Tunisia, This vaccine had been prepared by the Pasteur 
Institute of Paris. Professor Sergent holds that the Tunisian 
bacterium is particular to the country and that only vaccines 
made by the North African Pasteur Institute should be used in 
this territory,9 
1 Volya, 7 July 1943= BEW (P) 4729, 4 August 1943. 
2 Novo Vreme report from Nis; Granicar, 5 December 1942. 
3 OSS.source,20 June 1943. 
4 Radio Romania, 9 July 1943= 
5 Sender iyden, 23 December 1942. Areler Volkszeltung, 12 Sep- 
tember 1942. 
6 Intercepted letter from a Swiss doctor. OSS, CID, Censor 
Materials Summary No. 27, 1 May 1943, p. 28. 
7 Bern (P) #5483, 4 September 1943. 
8 OSS Source,, 2 September 1943 = 
9 OSS, CID 41395, 6 May 1943. 
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b. Dysentery. Cases of dysentery have increased 
considerably in Germany, as has the fatality rate of this 
disease. There has been no increase in Italy. 
The following table indicates conditions with respect 
to dysentery in the expanding territory of Germany from 1976 
through 1942: 
Year 
No. of 
No. of 
Cases per ten 
Deaths per 
oases 
deaths 
thousand inhabitants 
hundred cases 
1936 
4,816 
152 
.75 
3 
1957 
7.545 
177 
r.7 
2 
1958 
5,265 
174 
.79 
3 
1939 
6,190 
227 
• 91 
4 
1940 
24,438 
(12,790)al,497 
2.7 
6 
1941 
10,330 
( 8,641) 
a 672 
1.1 
7 
1942 
1 
15,148 
1,872 
1-7 
12 
a. Figures in parenthesis refer to the old territory of the 
■ Reich. 
As conditions deteriorate, a further increase .in the 
incidence of this disease' may be anticipated. It is to be 
remembered that there were no less than 69,000 cases of dy- 
sentery in Germany in 1917. As the war has progressed, the 
disease has become more severe. The fatality rate, which 
used to be between 2 and 7 per 100 cases, is now 12 per 100 
cases. 
Ca-ses in Italy were as follows: 
Year 
Number of Cases 
1937 
2,004 
1938 
1,997 
1939 
1,327 
1940 ' ' : 
1,725 
1941 •' ; ,7 ■ 
1,768 
1942, Jan. -May;' 
363 
1942, " • " 
?:i : 885 
As the figures for the'early part of 1942 indicate, there 
was a considerable increase during that year. 
Intercepted letters Indicate several cases of dysentery 
in Switzerland and Norway. 1 In the summer of 19473 a first- 
epidemic said to he connected with the mobilization of labor 
was reported from Roesvik in northern Norway. The number of 
cases was given as 50.2 This followed an outbreak in Oslo in 
1 OSS, CID, Censor Materials Summary Wo. 27, 1 May 1947, 
pp. 77 f f. 7 85 ff. 
2 Stock. (P) #2008, 70 June 1947. 
'(25443) RESTRICTED 
1942, where 104 cases of waterborne dysentery were reported 
in one week.l Late in 1942 the outbreak of an epidemic was 
reported at Rucar in the Muscel district of Rumania, where 
200 cases and seven deaths occurred. The number of new cases 
was said to be decreasing.2 
c, Diseases of the Stomach. In German medical 
literature of the last few years* much space is devoted to the 
description and discussion of wartime conditions and their 
impact upon the diseases of the stomach. As the various 
writers'invariably point out, there has been a universal in- 
crease in stomach and duodenal ulcers, A study which covers 
chiefly employees of the Krupp Works and their families con- 
tains the following figures; 
’ 
1937-38 
1938-39 
1939-40 
Index numbers of total 
stomach examinations 
(1937-58 - 100) 
100 
143 
132 
Index numbers of stomach 
and duodenal ulcers 
(1937-38 = 100) 
100 
143 
196 
Number of duodenal ulcers 
266 
409 
40? 
Number of scarred alterations 
of the duodenum 125 
179 
922 
Number of stomach ulcers 
58 
56 
154 
These figures indicate a relatively larger Increase of 
stomach ulcers than of duodenal ulcers.. Similar observations 
have been made in the Horst Wessel Hospital in Berlin. While 
the ratio of duodenal to stomach ulcers used to be 2 to 1 
among the patients of this hospital, it was 1 to 1 in October 
1942. The share of "all internal diseases" represented by 
gastritis and duodenal ulcer rose from 6.5 percent before the 
war to 16.2 percent at that date. 
A considerable increase in perforations of ulcers is 
reported in another study which was prepared by a Viennese 
physician. In his practice, such cases increased as follows: 
Year 
Numbers 
Percent of all operations 
1936 
16 
1.3 
1937 
18 
1.49 
1938 
19 
1.43 
1939 
23 
1.72 
19^0 
32 
2.54 
1 Office of the Surgeon General of the Norwegian Public 
Health Service, Medical and Sanitary Data on Norway, Washing- 
ton, D. C., May P. 30. GID '388577“ 
2 Universal. 18 November 1942. ouring 44 months before the outbreak of the war (l January 
1936 to. 1 September 1939) the number of perforations was 64 
and they amounted to 1.35 percent.of all operations; for 
16 months after the outbreak of the war the corresponding 
figures are 44 and 2.69 percent, respectively. 
The medical authorities draw the following conclusions 
from these trends sc- 
IV In wartime, a larger proportion of perforations of 
ulcers befalls men who have had no previous complaints. 
2. These and similar disturbances are not so much caused 
by nutritional deficiencies as by the overwork, nervousness, 
changes in the pattern of living, and tension which war en- 
tails. Also important are irregular food habits and long 
periods during which the stomach is empty. 
3. The increase in morbidity observed during the years 
preceding the war must be attributed in part to the growing 
burden of work. 
4. The reduction of such foods as eggs, milk, and fats 
seems to have caused the relapse of patients who have suffered 
from duodenal ulcers before. 
5. The decrease of duodenal ulcers relative to stomach 
ulcers may be due to the reduction of foods stimulating 
acidity of the stomach, such as coffee, spirits, certain 
spices, meat, and meat-concentrates . 
6. The food situation has caused an increase In ulcers 
not so much because of the change from fats and animal albumen 
to carbohydrates as main suppliers of calories, but possibly 
because of the consumption of dark bread, certain types of 
cabbage, and certain types of fats. This is especially true 
of participants in community feeding. 
Since the treatment required for these patients is ap- 
proximately one month, it is pointed out that the consider- 
able increase in "the army of people having a sick stomach" 
deserves attention not only for general hygienic■and medical 
reasons but because of its impact upon production. It is 
also said that a large number of patients vas in very poor 
condition and that in many cases the routine and quiet of 
hospitalization apparently contributed much to their recovery. 
It is interesting to note that none of the primary types 
of diet customarily prescribed in stomach-ulcer therapy in 
Germany is fully available at present: eggs and butter. 
1 Wilhelm Bruhl, "Die Behandlung des Ulcus und der Gastritis 
im Kriege," Klinische Wochenschrift, 24 October 1942, pp. 931 
ff.; Adalbert Slany, "Hhufung der Ulkusperforationen seit 
Kriegsbeginn," Wiener klinische Wochenschrift, 27 February 
1942, pp. lyi ff.; H. Rothep der Magen- und Zwolf- 
fingerdarmgeschwure im Kriege?" Deutsche medizinische Wochen- 
schrift, 25 July 1941, pp. 810 ff,; see also H. Wilhelm, 
Zentralblatt fur Chirurgie, 1941, p. 163;. F.W.Lapp, "Zur 
didtetlschen Behandlung chronischer Durchfallserkrankungen," 
Deutsche medizinische Wochenschrift, 13 November 1942, p. 1114. 
(2B443) RESTRICTED 
olive oil; and cream are all scarce. Owing to the difficulties 
of a permanent diet; doctors; it is pointed out; will be in- 
clined to operate more frequently in case of obstinate ulcers 
than before. 
Additional food rations for the sick are preferably 
granted to those useful in the war effort. A study1 of 5*000 
applications for such rations which were submitted in Berlin 
during the fourth quarter of.-1941, and which do not include 
applications of tubercular and diabetic persons, indicates that 
15.4 percent of them were refused and that 8© percent of 
the refusals concerned applications of persons over 45 years. 
In the higher age-groups, there was an absolute and relative 
increase in the number of refused applications. The proportion 
of working applicants to non-working applicants was about 2 to 
1; authorities regard a ratio of 7 to 1 as more desirable. 
Stomach disorders are also increasing in Italy; as in- 
dicated by the following figures. They refer to:non-spec ified 
"diseases of the digestive tract" and'are indicative of a con- 
siderable increase in morbidity. The figures are as follows: 
Year 
Number of -deaths -Deaths 1 
}dr 100,000 inhabitants 
1939 
10,778 
24.24 
1940 
12,951 
28.86 
1941 
14,053 
30,93 
3. Insect-borne Diseases. 
a. Malaria. Germany is not a malarial country and 
such increase in morbidity as has occurred may be ascribed 
largely to the newly acquired Eastern areas. The following 
table indicates conditions with respect to malaria in the 
expanding territory of Germany: 
Year 
Number 
Number 
Cases per ten 
Deaths per 
of cases 
of deaths 
thousand inhabitants 
hundred cases 
1939 
282 
4 
.041 
1.4 
19^0 
4.22 
3 
.047 
.71 
1941 
1,613 
3 
.18 
.19 
1942 
716 
3 
.079 
.42 
In 1941, morbidity increased four-fold,, but there was a 
considerable decline in the severity of the disease. In 1942; 
morbidity declined by 50 percent. In the German medical lit- 
erature it is pointed out that "in spite of the progress at- 
tained in preventing malaria, contact with the old foci of 
malaria in the Mediterranean and Eastern countries has pro- 
duced as was expected, a certain number of cases. Further- 
more; the immigration of foreign workers from malarial coun- 
tries brought numerous chronically sick people to the Reich... 
Among the prisoners of war; malaria is not unusual. Finally; 
the settlement of people from the Black Sea regions; Bessarabia 
and the Dobrudja introduced sick people into the old territory 
of the Reich as well as into the localities where they were 
1 ¥. Geroke, "Betrachtungen zur Kriegskrankenernahrung,11 
Deutsches Aerzteblatt, 15 November pp, 364 ff. 
(25443) RESTRICTED 
settled.111 It is also observed that the spread of malaria 
is not limited to tropical regions, and efforts are made at 
mosquito control in such central sections of Germany as the 
province of Brandenburg as well as in the eastern parts (East 
Upper Silesia).2 
The principal malarial countries of Europe are Italy, the 
Balkans, Russia and Poland. 
So far as Italy is concerned, a recent indicates 
that malaria is prevalent along the entire South coast of 
Calabria, through Blanca Novo, Branca Leone and Gatanzaro, 
up to Taranto, on a narrow shelf of flat land extending over 
an area from about 100 yards in width to a mile or so at the 
deeper deltas of rivers. Right behind the shore are dry, semi- 
arid hills. Cultivation is carried out in the highly malarious 
river bottoms. Two insect vectors of malaria breed on the 
coastal shelf in slightly brackish delta waters. A third 
mosquito is a stream breeder which prevails throughout the 
Near East in semi-arid country. It breeds in the gravel edge 
of running water for some distance up streams and rivers. 
The mosquitoes enter houses and tents freely and bite 
humans. The work of spreading paris green on breeding places 
in Southern Italy as well as in Sicily was well organized and 
well carried out by the Italian provincial malaria organiza- 
tions. These organizations have been trained by the Rocke- 
feller Foundation Malaria Experiment Station under the direc- 
tion of Professor A. Misslrol. Missirol is not a fascist and 
is able to recruit good workers, 
■ In Lucania malaria is not so well controlled owing to the 
ground being leveler from Siberi to Taranto. Puglie is much 
drier and what malaria there is is largely the result of ir- 
rigation. Brindisi and Bari are not malarious. Poggia, north 
of Bari, is the center of a cultivated plain which is malarious 
toward the coast as far north a.s Pescara beyond which there is 
no more malaria. 
The Campania is malarious except Naples and its environs. 
Most malaria is north of Naples, especially around Pormia, 
Terracini and the Pontine marshes, The north half above 
Pormia was under excellent ‘control at least as late as 1940. 
The same is true of the Roman Campania, which is potentially 
malarious. 
It is believed that members of the Italian armed forces 
have been diligently cared for during the malarious season 
in Southern Italy and Sicily, which starts in early July and 
may last to October. The barracks at Taranto are reported non- 
malarious. 
1 G. Rose, "Zeitgemasse Behandlung der Malaria durch den prak- 
tisohen Arzt," Deutsches Aerzteblatt, 1 June 1942, pp. 182 f f. 
2 Miinchener medizlnische Wochenschrift, 12 June 1942, p. 552; 
Hoffmann-Bielitz, 1,Der Stand der Malaria in Ostoberschlesien, 
inshesondere im Kreise Bielitz," Der offentliche Gesundheits- 
bi.ep.st, 1941, Part A, No, 17, p. 
3 Interview with Dr, Louis Hackett, 25 June 1943, OSS #37213. 
(25443) RESTRICTED 
Treatment for malaria is said to be so well-organized 
that after 1935 there was very little direct mortality from 
acute malaria, although there remained a good deal of chronic 
malaria which was probably a contributing factor in increasing 
the death rate. Every town had a government doctor who used 
to dispense free quinine, and in all the mosquito-breeding 
regions, drainage and the spreading of paris green were under- 
taken from four to five months each year, beginning in advance 
of the season each June, 
Hospitals worthy of the name are found only in provincial 
capitals or principal cities such as Reggio Calabria, Cosenza, 
Potenza, Taranto, Lecci, Bari, Brindisi, Foggia, Catanzaro. 
The size runs from about 50 beds at Catanzaro to several 
hundred in Bari, Medical facilities are said to be better 
than the nursing done* in these hospitals. 
.There are a few sanitoria in southern Italy which in 
the main have been used for the removal of children from 
danger areas. They are essentially summer camps with-a few 
cabins and tents. They are situated in the mountains on an 
upland plateau. As distances are short, such camps could 
easily be set up for soldiers if need arises. Local doctors 
generally know how to treat malaria. 
The shortage of quinine in Italy and elsewhere, and re- 
lated issues, are discussed below7. 
In Greece it is estimated that there are at present 
some 1,500,000 malarial persons.! Another source estimates 
the number as between 2,000,000 and 2,500,000,2 Reports indi- 
cate that malaria is rampant in Arcadia and that in certain 
villages all the inhabitants are suffering from the disease. 
It is suggested that in places where only 25 percent of the 
population was.suffering from malaria in 1942, the proportion 
may w7ell be 100 percent in 1943. Disease statistics are said 
to be available only for certain groups of the population, 
for example, school children in certain districts who undergo 
examinations. Mortality statistics were available for the 
whole country until the outbreak of the war. Since 1930 the 
Ministry of Hygiene and the Malaria Division of the School 
for Hygiene have systematically combated malaria, The; School 
for Hygiene was founded in 1930 by the Rockefeller Foundation 
and wTorked until 1937 under American leadership, and since 
1937 under Greek administration with support from Rockefeller- 
funds. The fight against mosquitoes was conducted by the 
Engineering division of the School for Hygiene, For the. 
treatment of persons suffering from malaria the Government 
quinine monopoly made quinine available cheaply or gratis. 
The campaign against malaria proved to be very successful but 
because of the shortage of medical supplies, paris green, 
transportation, etc. it was interrupted by the war. Malaria 
thus has increased enormously during the last few years. Espe- 
cially the tropical form, the most dangerous one, has spread 
1 MEW, Progress Report for Enemy Branch for Fortnight Ending 
6 March 1943. 
2 This and the following information is from a report by Dr, 
Elsa Segerdahl Persson, entitled "Contagious Diseases in Greece" 
and dated Athens, 28 April 1943. OSS, CID 38151, For a dis- 
cussion of the drug situation, see p. 96 of the present report. 
(25443) RESTRICTED 
rapidly. Macedonia and Epirus- were previously particularly 
bad malaria districts but now the disease has spread to areas 
where hitherto only a few or no cases at all occurred. 
In March 1942, reports from Yugoslavia! indicated the out- 
break of malaria in the district of Posavina (Bosnia). There 
were reported to be 150,000 cases. 
A rapid Increase was reported in Turkey in the spring and 
summer of 1945. ~ * 
The Stockholm press reported the following cases in Poland 
in 1945; 
1940 ' 1,949. 
1941 17,800 
Reports concerning malaria are most numerous from Bul- 
garia. In March 1945, the Minister of the Interior and the 
Minister of Education announced comprehensive programs con- 
cerning the campaign against this disease. Stagnant water 
was to be drained or disinfected, and a bonus paid for the 
destruction of mosquitoes. 
In general, it has been pointed out by a competent ob- 
server that the main danger rests with the possibility of 
having a new strain of the malaria parasite introduced in 
regions of countries which are already infected by another 
strain. The population may have acquired immunity against 
the local strain but is extremely receptive to any imported 
parasite. 
b. Typhus.2 The table on the following page, giving 
the number of cases of typhus fever in various European 
countries for recent years, indicates the spread of this 
disease.' 
Typhus is carried by lice and the spread of the disease 
is promoted by overcrowding in sleeping places-, ""lack of clean 
linen and changes of clothing, lack of soap and other facili- 
ties for bodily cleanliness. In regions of standing endemic 
typhus, hunger, excessive hardship, or other debilitating 
conditions may produce epidemics as well as a greater severity 
of the disease. 
As in 1914-18 and Immediately thereafter conditions 
in Poland were favorable to the spread of the disease as early 
as 1939. The number of ca’ses reported from December 1959, to 
June 1940, reached 5,976 in the district of Warsaw, of which 
1 The information for Yugoslavia, Poland, and Bulgaria is 
from MEW Progress Report of Enemy Branch for Fortnight Ending 
6 March 1945. For Bulgaria also Zona, 7/18 March; 27 May; 
20 June; 11 July 1945. For Turkey? OSS source, 7 May 1945. 
2 Parts of this section have been reproduced verbatim from 
Yves Biraud, "The Present Menace of Typhus Fever in Europe and 
the Means of Combating It," League of Nations, Health Organi- 
zation, Bulletin 10:1-64 (1945). Sep also MEW "Typhus in 
Europe," No. L l86/Z,„ dated 2 April 1942; a memorandum dated 
4 March 1942, Coordinator of Information, #15586. 
(25445) a. Deaths from typhus fever in Germany in the indicated years -were: .1938, 0; 1939, 0; 
1940, 95; 1941, 326.; ‘ • ’ • . 
h. The figure is for the first seven -weeks of the year only. 
c. Not available. . • • < ... . ■ 
d. The figure is for January through-May only. ; * 
e. The figure is for January through .March only. 
f. The figure is for .January through June only,*” 3 
g. All cases except one occurred in the. unoccupied zone. 
Table 1. NIMBEH 
OF REPORTED CASES 
OF TYPHUS 
FEVER IN 
BY 
COUNTRIES, 1939-1943 
Country 
1939 : 
1940 
1941 
1942. 
1943 
Germanya 
2 
556 
1969 
2043 
8oob 
77. Bulgaria 
108 
155 
284 
709 
1250d 
Yugoslavia 
404. , 
V ' 282 
c - 
c: 
■* 
117e 
Greece 
-■ ’ Ais • , 
43 
. G . 
> J c 
c 
Turkey 
; ;]I71 
533 
704 
427 
2593d , , 
Slovakia 
c 
■ .:;c 
■C :, 
0 c 
325f : 
Rumania 
' 9^2 
1403 
! 1827 
3999:- 
' • ■, 5585d 
Hungary 
57 
' 97 
652 
• 1 
00 
ro. 
-u 
658- 
Prance 
. v ", • 0 
1 
2 
' 230s ■ 
■ 2 
'Portugal 
27 
' c 
. 50 
1 
i 5<i 
Spain 
62 
• 14 
9560 
4144 
■ • 4o4d 
Lithuania 
;i ' .153-. 
• 115 
c 
c‘ 
c 
RESTRICTED nnbui-auvhi) 
1*746. were in the town properi During the corresponding half- 
year of 193fe; the number of cases had not e3tde£d6d 33 (with 
a. Single 'death) 
In the part of Poland now known as the Government General, 
cases of typhus rose as follows (according to a German medica.1 . 
writer) 
Year 
No. ot Cases 
1936 
740 
1957 
680 
1938 
700 
1939 
? 
1940 
7,900 
As this writer points out, the figure for 1940 should be 
doubled or trebled to take account of the cases which escaped 
notification. 
In the western part of Poland, now called Wartheland, 
typhus was extremely rare, and only some 40 cases were re- 
ported in 1938, This figure rose t<p 486 in 1940 and to 
1,241 in 1941. 
In the northern part of the Warsaw Voivodie, which is 
now annexed to Eastern Prussia to form, with part of the 
Bialystok Voivodie,. the district of Zich'enau (Ciechanow)j 
some dozens of cases were reported annually■before the war. 
There were 8 in 1940 and 550 in 1941. 
For the rest of Poland, no figures are Though 
conditions are disquieting, the spread of the disease falls- 
far short of the epidemic subsequent to the first World War 
of 1914-18, when, in the area which now represents the Govern- 
ment General, 44,000 cases were reported in 1919, 
Events in eastern Europe have led to an increase in 
typhus- in those regions, where the disease occurs in normal 
years sporadically in Bulgaria, Greece, and Yugoslavia. 
With reference to Greece it is reported that there were 
422 cases in Athens-Piraeus during the winter of 1942. Since 
the disease is greatly feared, it is believed that the oases 
have been reported relatively completely. One hundred and 
sixteen cases were reported in Salonica and vicinity during 
the winter of 1943. Otherwise there have been only isolated 
cases, epidemics mentioned were relatively mild with 
few deaths,3 
In Yugoslavia the disease is said to be spread by the 
partisan troops who have no facilities for changing their 
1 E, Zimmermann, ”Zur Epidemiologic des Fleckfiebers im Gen- 
erealgourvernement," Zeitschrift fur Hygiene und Infektlonskrank- 
helten 123:552, ff. (194277 ~” 
2 The Polish area annexed by the USSR had the following number 
of reported cases; 2579 in 1938; 2197 in the first six months 
of 1939. 
3 From a report by Dr. Elsa Segerdahl Persson entitled 
’’Contagious Diseases in Greece” and dated Athens, 28 April 
1943, OSS, CIP 38151. 
(25443) clothing and lack any sort of hygienic rules.1 Captured 
partisans reportedly state that scores of their fellows are 
dying daily.2 It is reported that the occupation authorities 
may be using the typhus scare to control population movements 
and combat partisan activities,3 It is interesting to note 
that this has also been reported with respect to the occupa- 
tion authorities in Poland. There they reportedly made use 
of the typhus scare in order to segregate the Jews and con- 
trol population movements as a means of preventing the leakage 
of military information.4 
Special attention should be paid to the figures for Turkey 
as indicated in Table I. The present Turkish epidemic is said 
to be the worst since 1905.5 
In Rumania, typhus was extremely rare in Transylvania; 
it was endemic in Bessarabia and Bukovina, and sporadic in 
the other provinces. In Transylvania, both in the part oc- 
cupied by the Rumanians and in that occupied by the Hungarians, 
typhus spread extensively in 1941. Supplementing the over- 
all figures given in Table I,., a slightly more detailed sur- 
vey is as follows; 
Rumania, 1912 
territory (before 
loss of territory 
Rumanian 
territory 
on January 1, 
Rumanian 
territory 
annexed by 
by annexation or 
1941 
USSR 
Year 
Invasion) 
1958 
2,254 
612 
1,617 
1939 
1,014 
491 
506 
19^0 
1378 
698 
734 
1941 
1,906 
1,045 
a 
1942, 
1st qu. 2,149 
943 
1.070 
a. Not available. - 
In 1942 and 1943 the disease increased rapidly. 
Figures for Bulgaria are likewise presented in Table 1, 
For the localization of the disease, the following data may 
be of help: 
t * ' 
Bulgaria, present , ... 
Bulgaria, 1919 
territory, including 
te-rritory, without 
Year 
annexations 
annexations 
1938 
• 91 
91 
1939 
129 
129 
1 OSS, GIE, #35939, 5 June 1943. 
Novo List, 16 May 1943. 
3 OSS, Bern (T .), 30 July 1942, #3515 (P). 
4 Ibid.- 
5 OSS source, 31 May 1943. 
(25443) - 
Bulgaria, present 
territory3 including 
Bulgaria, 1919 
territory, without 
Year 
annexations 
annexations 
1940 
127 
127 
1941 
302 
271 
19^2, 1st qu. 
332 
290 
As is evidenced in Table 1, the situation has deteriorated 
in recent months. Reports indicate that the campaign against 
the disease has been intensified and people are urged to 
greater cleanliness. If the exhortations are not effective, 
the authorities will have recourse to forcible de-lousing. 
In 1943, the incidence of typhus is reported to be double 
that of last year.l 
In 1941, and to a greater degree early in 1942, typhus 
appeared not only in Transylvania and in Sub-Carpathian 
-where typhus used to be endemo-sporadic, but in 
sporadic form in several parts of Hungary which had hitherto 
been free from the disease. The following figures are il- 
lustrative : 
Hungary, 
, Hungary , 
Territory 
Territory 
present ter-- 
former 
annexed from 
annexed from 
ritory (incl, 
territory 
Czechoslovakia 
Rumania 
annexations) 
Ibefore 
Year 
annexations) 
1938 5 
5 
17a 
0 
1939 57 
34 
23 
9a 
1940 93 
4 
89 
3a 
1941 621 
23 
226 
370 
1942 
1st, qu 377 
52 ' 
166 
158 
a. Approximate. 
The disease was reported to be rampant in the spring of 1943.3 
A similar spread of the disease also occurred in Germany 
during the later months of 1941. Outside those territories 
taken from Poland where the spread of typhus was particularly 
marked in 1940-41, no civilian cases of typhus were recorded 
in Germany in 1939 and only 6 cases were reported in 1940. 
In 1941 there occurred no less than nearly all of them 
during the months of November and December. During these 
two months, typhus occurred in no less than 44 administrative 
divisions out of the 74 of Greater Germany, The Incidence of 
cases was considerably greater in the east than in the central, 
western 'and southern parts of the country. During the first 
1 2cra, 13, 14, 16 January; 7, 14 March 1943. Borba, 18 
January 1943. Utro, 14 January 1943. Z.ora, 23 July 1943. 
Dnes, 16 July 1943. 
2 This territory belonged formerly to Czechoslovakia. 
3 OSS source, March 1943. 
(25443) RESTRICTED. 
two quarters of 1942, when 459 and 1,279 cases respectively 
were reported, the distribution was more uniform, foci occur- 
ring even in the north-western part of the country. 
The cases reported relate exclusively to civilians. In 
view of the traditional cleanliness of the German civilian 
population, the widespread and rapid distribution of typhus 
can be explained only by the existence of active foci of in- 
fection, either within the country among the military popu- 
lation, for which figures are not published (German and 
foreign troops and, in particular, Russian prisoners), or 
outside in Poland or in the theaters of operation in the USSR. 
During active military operations involving the move- 
ments and relief of many divisions and the transportation of 
hundreds of thousands of wounded, prisoners, and civilian 
workers, it must obviously be difficult to prevent the entry 
into Germany or Hungary of carriers of lice (and even carriers 
of the Rickettsia Itself) coming from the zone of operations 
where typhus is endemic. 
Reports from Germany emphasize the following factors as 
responsible for the spread of the disease in Germany and in 
the East: deterioration and insufficiency of food which 
lessen the power of resistance; Insufficient supply of clothing, 
which is not conducive to cleanliness and causes individual 
pieces of clothing to be worn for a long stretch of time; 
homelessness owing to the destruction of lodgings; greater 
density of inhabitants per lodging owing to the same cause; 
lack of soap and disinfectants. 
It is interesting to compare German morbidity figures 
(as presented in Table 1) with figures for the first World 
War of 1914-18. The total, including military cases, was 
then as follows: 
1914 1,675 
1915 ’ 49,099 
1916 '' 9^9 
1917 953 
1918 535 
1919 5,894 
1920 1,105 
1921 555 
1922 986 
1929 27 
1924 8 
1925 ; 5 
The fact of note in this connection is the relative smallness 
of the German civilian sector which was then affected by the 
disease. Not only did this sector largely consist of medical 
personnel, but other groups were much more prominent, especially 
prisoners of war. The figures were; 
Year 
German, civilians Foreign civilians 
Military Prisoners 
personnel of War 
1914 
8 
2 
4 1,661 
1915 
50 
4 
519 48,466 
1916 
22 
56 
42 223 
1917 
48- 
136 
89 82 
19x8 
145 
• 
131 
105 .174 
1919 
1,040 
a 
a a 
a. Not available. 
(25W5) RESTRICTED 
The figures for the present war, which count civilians 
only, are thus Indicative of a considerably larger number of 
typhus cases in German territory. The extent of the disease 
among prisoners of war can be judged from the fact that the 
number of doctors required for its treatment and prevention 
made it necessary to recall Jewish physicians, who were no 
longer allowed to practice their profession, and to send them 
to the prisoner of war camps to practice. 
The distribution of the cases in Germany is reported to 
show high incidence in industrial areas, a phenomenon which 
would ' be indicative- of the,:movement of .fopeagn . industrial 
labor from Eastern Europe to German industrial centers. Ninety- 
seven percent of the cases (first 9 months) are said to 
concern "nicht Volksdeutsche" (racially not'Germans). In 1939 
and nine cases occurred among the Germans who had been 
removed from the East. The mortality of the disease is said 
to be higher among Germans than among Poles, who have acquired 
a certain degree of immunization. Among the latter, the mor- 
tality is reported with only 5 to 6 percent in. 1933-40. 
Typhus is endemic not only in Eastern Poland and Bes- 
sarabia, the bases from which operations were directed against 
the USSR, but also in the territories of the Soviet Union it- 
self.l Figures :for years after 1937 are lacking for that 
country. Those available for the previous fifty years, how- 
ever, leave no doubt about the existence of typhus endemicity 
there. Moreover, the mass exodus of civilians during the Rus- 
sian retreat, their precarious settlement away from their homes, 
extensive military movements, and the hardships of the winter 
campaigns of 1941-42 and 1942-43 are powerful factors tending 
to aggravate the pre-existing typhus endemic. In areas where 
active operations take place, the systematic or accidental 
destruction of houses also plays its part, as it entails the 
crowding together of the remaining civilians and of the invad- 
ing armies in the few habitable buildings. The .possibilities 
of the spread of typhus among Germans and Russians in Russia 
differ greatly. It is, of course, practically Impossible to 
keep either German or Russian troops at the front absolutely 
free from lice, especially in winter. However, while the 
chances of the Rickettsia being brought to the Russian troops 
are doubtless greater, the German troops are practically all 
receptive to it, whereas some Russian troops,may be resistant 
on account of the immunity acquired in past years. 
In western Europe, the epidemic which, as indicated in 
Table 1, raged in Spain in and in the beginning of 
has now receded, ■ It does not seem to have been due to 
the importation of the virus from the outside but to a revival 
of endemo-sporadic- typhus, which had almost disappeared in the 
years preceding 1939• This revival must in part be ascribed 
1 During the First World War and in subsequent years typhus 
cases increased greatly in in■ Russia,! From an average 
of 15.0,000 a year before the war, the number of reported cases 
rose to 700,000 in 1918, and to 6,600,000 in 1-919* at which 
figure they remained in 1920. In 1921 the number declined to 
1,200,000. The actual number of cases during that period is 
reported as about 25,000,000, 1,e. nearly one-quarter of the 
population for which statistics were available. Other coun- 
tries with high morbidity during the Fihst World War are Serbia 
and Rumania. 
(25^3) RESTRICTED 
to the destitution engendered by the Civil War and the severe 
economic disturbances to which it gave rise. 
Repercussions of the food shortage caused a typhus 
hyperendemlo in North Africa which has abated to some extent 
only. The appearance of typhus in France is clearly due to 
this increase above the endemic rate. France had for many, 
years been quite free from typhus. The cases reported in 
recent time occurred in the central and southern part of 
that country, not only among individuals, arriving from North 
Africa but also among natives from those countries working 
in France. Apart from special cases, the disease did not . 
spread to the surrounding French population, since most of 
them were free from lice. The only secondary foci recorded 
occurred in the prisons of Marseilles, where obviously lice 
infestation was rife. The number of cases there far exceeded 
one hundred. 
There are sufficient indications of the apprehension 
with which the spread of typhus in Europe was regarded by 
the German authorities. In September 19395 the Minister of 
the Interior issued a circular largely dealing with disin- 
festation and measures to be taken by doctors for their personal 
security. No allusion was then made to any sort of prophylaxis 
by means of vaccination.1 Early in 1942- Dr. Leonardo Conti, 
the Reich Health Leader, made a statement to the effect that 
typhus had been brought into the Reich from the east, The 
disease had been suppressed at once but the highest degree 
of attention was still necessary.2 Germany then ceased 
publishing statistics on typhus and did not resume until 
early in 1943- In the meantime considerable effort had been 
made at preventing the spread of the disease. A centralized 
integration of all anti-typhus activities was established 
at Hitler’s headquarters under Dr.- Karl Brandt, Hitler’s 
representative in matters of public health.3 New typhus in- 
stitutes were established in Berlin (Director; Professor 
Hofmann),4 Riga (German Hygienic Institute for the Ostland), 
Kiev, Kherson,5 Cracow (Typhus Research Institute of the 
German High Command),£ and elsewhere. The establishment of 
a typhus hospital was reported from Leipzig.! According to 
Conti, a sanitary demarkation line was drawn in the Baltic 
States, over which no one might pass without•having been de- 
loused three times.3 The number of delousing facilities in 
1 Bulletin of Hygiene 16:425 (1941). 
2 Wiener klinlsche Wochenschrif 1, 20 February '1.942, p. 154; 
Deut sche inedlzlnische Wochenschrift, 24 April 1942, p. 434. 
3 OSS source, 24 February 1943. 
4 NPD, 1 June 1943. 
5 Transocean, 13 June 1943. 
6 Coordinator of Information, #13536, 4 March 1942, 
7 Reuter, 7 January 1942. 
3- Dagens.Nyheter, 24 January 1942. 
(25443) RESTRICTED 
the Eastl was'increased greatly and the population was ex- 
horted to make use of mobile hot-air chambers,2 Leaflets, 
illustrated advertisements, and exhibitions constantly draw 
the attention of the population in the east to the dangers 
of typhus and the methods of meeting it. A moving picture 
entitled "Fight against Typhus" was prepared and shown in 
Berlin cinema houses early in 1942. While the people are 
continually reminded about cleanliness, there is, as is dis- 
cussed elsewhere in this report, little soap, and hardly any 
of the special de-lousing ointments which used to be available 
before. In the summer of 1949* the production of louse-proof 
underwear was reported from Germany. This is supposed to kill 
lice and prevent them from penetrating. Whether it will be- 
come of great usefulness remains to be seen.3 
Protective vaccinations against typhus seem thus far 
have been limited to special groups. These are said to include 
French prisoners in German camps,4 the medical personnel at- 
tending to typhus hospitals and other facilities, the popula- 
tion of Athens,5 0f French of "about 80 percent of 
the population of Warsaw,"? "all persons between 2 and 80 
years in Presov (near Bratislava),"8 and "160,000 persons 
in Poland."9 Medical science has produced a considerable 
number of anti-typhus vaccines but thus far most of them 
cannot be made available on a mass production basis which 
would facilitate the vaccination of large populations. 
Weigl1s?0 vaccine is produced from artificially inoculated 
lice; one injection (three seem to be required) contains the 
intestinal contents of 90 to 173 lice. It goes without say- 
ing that the production of this vaccine in large numbers is, 
for all practical purposes, impossible. The Cracow-Lemberg . 
army institute, which seems to be the only German agency pro- 
ducing this vaccine, is said to employ approximately 500 
persons, and its output is reportedly sufficient for the 
1 The Swiss established similar facilities at their borders. 
Letter Extract, OSS, San Francisco Office, 7656, 28 July 1942. 
2 In Vilna alone there are said to be 60 de-lousing institu- 
tions. Stock T. 9 'September 1942, #2450 (P) . 
Frankfurter Zeitung, 28 July 1949. 
4 La Depeche Toulouse, 20 April 1949. 
5 Donauzeltung, 11 February 1949. 
6 OSS, CID Censor Materials Summary 27, 1 May 19495 PP. 58 ff. 
7 Krakauer Zeitung, 9 February 1949. 
8 Grenzbote, 24 November 1942. 
9 H, Hetsch, "Die Schutzimpfung gegeu Flecktyphus und die zu 
ihr verwendeten Impfstoffe," Medlzinische Klinlk, 1942, No, 13. 
10 Humor has it that Dr. ¥eigl, the famous Polish scientist, 
was executed by the Germans allegedly because he had made his 
services available to the Russians after the Germans had with- 
drawn. Upon their return he is said to have been killed. 
(25443) RESTRICTED 
treatment of 500 persons each month.1 ’ It is reported that 
160.000 persons in Poland were thus vaccinated; they are said 
to;. be immune for one to two years.2 There is also an insti- 
tute called "Working Union of the German Serum Institutes 
Ukraine", but it is not known what types of vaccine they pro- 
duce, 2a 
Cox's method, which is widely used in the United States, 
requires relatively large amounts' of egg-yolks.’ 60,000 
fertile eggs would theoretically be required to provide vac- 
cine for the treatment of 1,000,000 persons. Cox's method 
was introduced in Germany by Otto, Wohlrab, Gildemeister and 
Haagen. Gildemeister and Haagen regard Cox's method as more 
practical than Weigl's but are of the opinion that it can pro- 
duce only restricted amounts and accordingly cannot supply 
the material necessary for mass vaccination. It must be re- 
membered that the supply of fertile eggs is subject to seasonal 
fluctuations, . and also that, the vaccine is suitable only after- 
some time has been allowed to pass.3 However,,, productive fa- ■ 
cilities have been established in Lemberg under the auspices 
of the I.G.Farben (Behring Works, Marburg-Lahn) and in Frank- 
furt-Main by the State Institute for Experimental Therapeutics,4 
It seems that this vaccine was first used primarily for the 
vaccination of medical and sanitary personnel. Approximately 
1.000 of such persons are reported to have been vaccinated in 
1939-40 and 30,000 in 1940-42. Only 44 cases of typhus fever 
are said to have occurred among these people.5 In more recent 
times the use of this vaccine seems to have become more com- 
prehensive. Official provide for three inocula- 
tions of .5ec., .5cc., and l.Occ. of the vaccine which are 
to take place in periods of five days. If the environment 
is such that the danger of infection continues, the vaccina- 
tion has to" be repeated after one year. The amounts which 
are then given are .'5cc . and l.Occ. If,-necessary', a third 
1 Coordinator of Information, .#13586, 4 March 1942. 
2 H. Hetsch, ’’Die Schutzimpfung gegen Flecktyphus und die 
zu ihr verwendeten Impfstoffe," Medizinische Kllnik, 1942, 
No. 15; E, G. Dresel, ’'Helper die Epidemiologie des Fleck- 
typhus," Munchener medizinische Wochenschrift , 50. January 
1942, p. 113. 
2a Europa - Kahel, 6 August 1943. 
3 E. Gildemeister and E. Haagen, "Ueher die Zuchtung der- 
Rickettsia mooseri und der Rickettsia prowazeki im Dotter- . 
sack des Huhnereies und uber die Herstellung von Kultur- 
impfstoffen," Zentralblatt fur Bakteriologie, I, 148:257 ff. 
(1942). 
4 Zentralblatt fur die gesamte Hygiene, April 1943, vol, 51, 
pp. 68 ff.; Munchener fctedifinische Wochenschrift, 20 March 
1943, P. 276. 
5 R. Wohlrab, "Flecktyphusbekampfung im Generalgouvernement," 
Munchener medizinische Wochenschrift, 29 May 1942, p. 486. 
,6 Circular of 4 January 1943. Der offentliche Gesundheits- 
d.ienst. 1943, Part A, Wo. 7-8, p. 153. 
(25443) vaccination takes place in the following year. It consists 
of 1.0 cc. only. The same regulation Indicates that vaccine 
for medical personnel Is held in readiness at the Robert Koch 
Institute in Berlin, and lists as other suppliers the Behring 
Works of Marburg and the Serum Institute of Anhalt in Dessau. 
Mention Is also made o*f new producers which will have supplies 
available probably in the second quarter of 194-3. These new 
producers are the Serum Works of Saxony in Dresden, the 
Sobering A.G. of Berlin, and the Serum Works of Hamburg. This 
information, contained in a circular of the Minister of the 
Interior of the Reich of 4 January seems to indicate 
a shift from the previously preferred Weigl vaccine to that 
prepared after Cox’s method, which is also the vaccine gen- 
erally .produced in the United States. It seems that the out- 
put of Weigl’s vaccine has been even more disappointing than 
was anticipated. Moreover, the output of the Cracow-Lemberg 
army institute has in no way been reserved for the East, but 
has been used for the inoculation of German troops elsewhere. 
The German units in the African theater of war used anti- 
typhus vaccines of various kinds, including those prepared 
by the Pasteur Institutes of Paris and Tunis, Weigl’s vaccine 
prepared in Cracow-Lemberg, and vaccine supplied by the Insti- 
tute for Experimental Therapeutics of Frankfurt.! This is an 
innovation since the general army regulations of 23 April 1942 
contain references only to Weigl’s vaccine.2 There were in- 
dications of strained supplies.of anti-typhus vaccine for the 
German armed forces In Worth Africa. Most use seems to have 
been made of vaccines from the Cracow-Lemberg Institute and 
from the Pasteur Institute of Tunis. 
The vaccine preparations which have been mentioned so 
far do not consist of Rickettsia. One source reports that 
Germany continues exclusively to use killed vaccines while 
another that canned live bacteria are used by the 
Cracow Institute.3 In view .of the traditional aversion to 
the use of live bacteria not much credence should be given 
this information. 
Killed vaccine of the Durand-Giroud type is produced 
from mice lungs. White mice, particularly the so-called 
Swiss mice, are especially useful in the manufacture of this 
vaccine. Germany bought huge quantities of these mice from 
Switzerland in the early part of 1940 and paid for them in 
Swiss francs, an indication of the importance which Germany 
attributed to this transaction. Whether the mice were ac- 
tually used for the production of vaccine of the Durand- 
Giroud type is not certain, and a British report states that 
such was not the ca-se.4 Italy then made offers to the Swiss 
with the view of obtaining supplies of white mice but exporta- 
tion was finally forbidden by the Swiss Federal Council. There 
is a report that Dr. Mooser, the well-known Swiss scientist, 
produced killed vaccine of the Durand-Giroud type and that 
the whole output was reserved for the Swiss army and for Poland.5 
1 Circular of the Wehrmacht-Sanitatschef heim Oberbefehlshaber 
Tunesien, dated 12 February 1943. In files of OSS Library,. 
2 The same applies to the ’’Pleckfieber-Merkblatt fur Sanitatsof- 
fiziere," dated 15 February 1942, 
3 Journal of the American Medical Association 121:686 (2? Pebru- 
ary 1943). 
4 OSS source, 2 April 194-2.' 
5 OSS, CID, Censor Materials Summary 27, 1 May 1943. 
( or, ) RESTRICTED 
Elsewhere in Europe the stocks of available vaccines are 
being used up locally. The institutions producing-them are 
few. I Bucharest prepares a vaccine of the Durand-Giroud type 
for the array. The Pasteur Institute of Paris makes vaccine 
from rabbits1 lungs, probably according to Giroud*s latest 
methods.2 In September 1942, Germany requested 40 to 80 liters 
of lung emulsion from the Institute, an amount which would 
suffice.for 12-24,000 Vaccinations. One liter of this vaccine, 
an amount sufficient for about 300 vaccinations, can be ob- 
tained from a 4-lb. rabbit. It is interesting to note that 
this process of production is subject to the same drawback 
as others, that is, lack of material for mass production. 
Among German documents captured during the North African 
campaign there is a circular of a physician attached to an 
Army, dated 12 February 1943.5 which states: "Protective 
vaccination of all soldiers in Tunisia against typhus requires 
enormous amounts of vaccine. These amounts cannot be supplied 
from home. It is, therefore, necessary to have recourse to 
the vaccine of the Pasteur Institute of Paris. The Institute 
has readily placed at our disposal the available amount of 
vaccine, and will continue to produce it for the armed forces. 
Apart from this it is entrusted with the supply for the 
civilian population which likewise must be secured if the 
disease is to be fought efficiently. The vaccine is produced 
from killed rickettsia made from the lungs of artificially 
infected mice or rabbits. The need for these animals is 
large in view of the number required for the manufacture of 
vaccine. The war obviates the hinterland as a source of; 
rabbits. Therefore the armed forces themselves must under- 
take to provide rabbits for the Pasteur Institute. By array 
orders troops have been strictly forbidden to kill rabbits 
for food. The medical service will have the function of pur- 
chasing rabbits from the civilian population, especially of . 
the farms, and of transporting them to Tunis. The animals ... 
are to be bought by the.'medical personnel at the usual prices 
and sent to Tunis by the fastest route....The enterprise 
does not aim at producing a supply of rabbits at this time 
only, but is to be continued....No more than 50 percent of 
the available rabbits are to be purchased at one place in 
order to facilitate further breeding...." 
Spain makes live vaccine of the Laigret type which is 
produced from rat brain coated in egg-yolk or from mouse 
brain. Vaccine of Cox’s type is also produced by the Insti- 
tute for Military Hygiene, Madrid.4 There have been reports 
in 1942 that Spain had pressing need for an anti-typhus "serum" 
and that preparations did not meet the requirements.5 In 1942, 
the Spanish branch of an American automobile firm requested 
the shipment of a supply of Cox’s vaccine from the United 
Lack of vaccine was also reported from Hungary.? 
1 A shortage of vaccine is reported from Hungary. An insti- 
tute in Ungvar (Uzhorod) is engaged in the preparation of anti-1 
typhus serum. Deutsche medizinische Vochenschrift, 28 May 1943. 
2 Dr. Giroud has returned from Tunis to France. 
3 In files of OSS Library. . ... 
4 Zentralhlatt fur die gesamte Hygiene 51:68 ffV (.April 1943) 
5 OSS, CID, 27473* 27 January 1943. 
6 OSS, CID, Censor Materials Summary, No. 27, 1 May 1943, P'. 68. 
7 OSS source, March 1943. 
(25443) RESTRICTED 
The serum mentioned in the report from Spain is not used 
for the purpose of Immunization but designed for the treatment 
of existing cases of typhus. Up to the present time medical 
science has not been successful in developing a serum which 
may be injected into patients already affected with typhus* 
Research is being carried on in many parts of the world. In 
February 1943, the German medical press reported successful 
experiments in the treatment of serious typhus cases by blood 
transfusions from other typhus patients who have passed the 
crisis and are free from temperature. An evaluation of this 
report with special reference to the practical usefulness of 
the new method is not available at present.! 
In spite of this report, there is much skepticism in 
Germany concerning the extent to which vaccination proper can 
be made useful for large populations* A recent artlcle2 
points out that, in spite of what has been done with respect 
to the production of vaccines, "it is no personal pessimism 
but an indubitable fact that the goal of producing in suffi- 
cient quantity a typhus vaccine for the whole endangered mili- 
tary and civilian population can hardly be attained within a 
reasonable space of time, certainly not during the war. How- 
ever, new improvements in technology and the discovery of 
new methods may increase the quantity of vaccine available," 
The extent to which typhus will become a threat to a 
larger proportion of the population of Western Europe and 
Germany proper- depends largely upon the course which military 
events take. If infestation with lice is aggravated by such 
factors as hunger, disorganization of administrative powers, 
badly organized troop movements, conditions of extreme crowd- 
ing- in lodgings, homelessness and the like, a spread of the 
disease raay.be anticipated. A disorganized retreat of the 
German armies from the east would have a similar effect. 
1 Bern T, (P) #1346* 26 February 1943, 
2 Dr. Rose, ’’Fortschritte in der Bekampfung der Kleiderlaus, " 
Relchsgesundheitsblatt, 3 February 1943, pp. 53 ff. 
(2544^) RESTRICTED 
4. Infectious Diseases. 
a. Common Cold, Influenza, Pneumonia. There are 
no specific figures to show an increase of these diseases in 
Europe, but the shortage of fuel is occasionally referred to. 
Reduction of gas consumption in Germany as ordered in June 
1945, reduces the supply of. hot water,/* British prisoners of 
war complain about the apparent shortage of wood and coal in 
German camps,2 Adverse symptoms of 'exposure to cold, as re- 
ported from France and elsewhere are intensified if increased 
food supplies are: not-available,3 The destruction of window 
'panes Joy recent bombings and the Shortage of window glass 
must also be considered. According to announcements in Ger- 
many, the'plat5 ..and window glass industry had built up large 
stocks in order to be able to meet any However, 
recent announcements of Berlin city authorities state that 
only bedroom and sitting room windows will be given preference 
with respect to repair, and sitting room windows will only be 
repaired if the family uses the room or if it is occupied by 
air-raid..victinis,.... No other windows can be repaired until the 
panes have been replaced in all these rooms,5 Other reports 
indicate that windows in Berlin are covered with paper and 
cloth,6 The:German glass industry was not fully employed in 
the first years of the war. Then the demand increased and 
could be met owing to complete mechanization of plate and 
window glass production and the additional capacity of the 
Sudeten plants. Increased manpower requirements of the plate 
glas» industry will make themselves felt in other sectors of 
the economy!? ' 
In Italy a moderate increase in mortality caused by 
influenza and pneumonia has been observed in recent years. 
The figures are as follows: 
Number of deaths 
per 100,000 inhabitants 
Year 
Influenza 
Pneumonia 
1939 
. .18.68 
174.60 
1940 
18.00 
176.38 
1941 
19-71 
176.04 
There have thus far been no indications of an influenza 
epidemic as serious as that after the First World War, 
Authorities are inclined to regard such an epidemic as the 
greatest possible threat. Not much is known about the origin 
of this disease the incidence of which extended far beyond 
those countries in which resistance had been lowered by malnu- 
trition and the exigencies of war. 
1 Bern (P) #3689, 21 June 1943. 
2 Censor Materials Summary, No. 27, 1 May,1943,,p,.40.« 
3 F. Bezancon, address before the Academic de of 
Paris, Journal of the American Medical Association 117;63S 
( 23 .August 19.&1)', " r 1. " 11 L ■" ' tr 
# t . • j 
4 Transooean, 5 March 1943, 
5 Pagans Nyheter. 11 March 1943, 
6 OSS, CID 37528, 5 April 1943. 
7 Kolnische Zejtung, 25 June--1943, 
(25443) RESTRICTED 
In Norway, the average number of cases per year during 
the ten-year period from 1930 through 1939 was 6,657 for 
broncho-pneumonia and 5,025 for pneumonia crouposa. The 
figures were about the same in 1940, but in 1941 a marked 
Upward trend became evident, with 9,722 and 8,500 cases, 
respectively, reported. During'the first ten months of 
1942 the figures continued to rise and pneumonia crouposa 
in particular seems to have taken the lead, with 10,541 
cases- reported for the period,. The month of October was 
especially serious.l '.-" 
b. Whooping Gough* A temporary increase in 
whooping cough occurred in Germany in 1940 and 1941. After 
the incidence of the disease had returned almost to its 
previous level, there was a new increase in 1943, Figures 
for the expanding territory of the Reich are as follows: 
Cases Der 10,000 
Deaths per 
Year 
Cases 
Deaths 
inhabitants 
100 cases 
1939 - 
82.068 (78 ,941)b 
925 
11.8 
1.1 
1940 
133,479 (126,9947b 1,373 
14.8 
1.0 
1941 
107,543 '(93,694)b 
1,335 
11.9 
1.2 
1942 
87,960 
1,028 
9.8 
1.2 
1942 a 
32,010 
c 
c 
c 
1943 a 
73,319 
0 
c 
c 
a. First six months, 
b. Figures in parenthesis refer to the old territory of the 
Reich. 
c. Not available. 
In Italy, the disease declined from 1937 to 1939, but 
has since risen to the previous level, as the following table 
shows: 
Year 
Cas^es 
1937 
24,677 
1938 
19,003 
1939 
19,591 
1940 
22,096 
1941 
■ 24,203 
1942, Jan, 
* 
through May 
10,844 
c. Diphtheria. There was a striking increase in 
cases of diphtheria in Germany after the outbreak of the war 
and a further considerable increase in 1942. The' figures . 
for the expanding territory of the Reich are as follows 
1 Office of the Surgeon General of the Norwegian Public 
Health Service, Medical and Sanitary Data on Norway, 
Washington, D., C,, May 1943, GID 38847. 
2 During the first World War diphtheria cases rose from* 
117,821 in 1913 to 197,471 in 1916 and declined-thereafter. 
(25443) RESTRICTED 
Year 
Cases 
Deaths 
Cases per 10,000. 
inhabitants 
Deaths per 
100 cases 
1936 
149,973 
6,284 
22.0 
4 
1937 
146,733 
5,665 
21*7 
4 
1958 
149,627 
5,557 
21,8 
4 
1939 
143,585 
6,355 
20.6 
4 . 
1940 
174,052 
(I42,058)b 
8,500 
19.3 
5 
1941 
204,918 
(l73,052)b 
9,607 
22.8 
5 
1942 
289,863 
14,764 
31.2 
/ 
5 
1942 a 
121,602 
c 
c 
c 
1943 a 
124,007 
c 
G 
G 
a. First six months, 
b. Figures in parenthesis refer to the old territory of the 
Reich, 
c. Not available. 
Intercepted letters indicate that the disease has spread 
over the whole Reich and is the cause of particular anxiety 
everywhere. It is not limited to children. Schools have had 
to be closed and hospitals have been Diphtheria, 
together with dysentery, has been referred to as the worst 
menace on the Russian front, where the wounded were infected 
through open wounds,2 However, the principal causes of the 
spread of the disease in the Reich are decreased powers of 
resistance, population shifts and overcrowding. 
In March.1940, the Minister of the Interior recommended 
vaccination against diphtheria in areas where a spread of the 
disease was feared.3 He arranged for the exclusive employ- 
ment of vaccines controlled by the State and charged the 
Robert Koch Institute in Berlin with the collection and assess- 
ment of the results of the vaccinations. 
Vaccination has not been applied universally in Germany. 
Early in 1942 it was reiterated by the Reich Health Leader 
that the voluntary character of anti-diphtheria vaccinations 
would not be In March 1943, it was stated that 
production of 1,000-fold serum was possible only in limited 
amounts, while less concentrated serum, for example, 500- 
fold, was available in sufficient quantities,5 
1 OSS, CID, Censor Materials Summary No, 27, 1 Hay 1943, 
pp. 7 ff, 
2 Ibid,, p• 28,• 
3 Bulletin of Hygiene 16:425 (1941). 
4 L, Conti, ‘'Die Bedeutung der Wissenschaft, insbesondere 
der kinde.rarztlichen, in der G-esundheitsfhhrung,M Deutsche 
medlzinisohe Wochensohrift, 16 January 1942, p. 57, 
5 Wiener medizlnische Wochensohrift, 27 March 1943, p. 246. 
(25443) Among groups which have been vaccinated in recent years 
are youths who have to render one year of agricultural 
service; they are now to be vaccinated at the beginning of 
the "agricultural year" (Land.jahr) .1 Some 41,000 small 
children in have also been vaccinated, as well as 
95.>000 children in Dortmund,3 over 100,000 children in 
Cologne, 4 children up to 14 in Hamburg5, and Berlin,6 etc. 
Vaccination of young people seems to have been successful. 
Diphtheria cases in 1941 among the 41,000 Leipzig children 
who had been vaccinated in the fall of 1940 and spring of 
1941 were 1.1 per thousand among those who had been inoculated 
twice and 3.6 per thousand among those who had been inoculated 
once, as compared with 6.1 per thousand among children who had 
not been vaccinated. With growing age, vaccination produces 
undesirable reactions and by effects.? 
The increase in diphtheria is also noticeable in the 
Protectorate Bohemia-Moravia, Denmark, Netherlands, Portugal, 
Sweden, Switzerland, Norway, and elsewhere. 
In the Protectorate, figures for Bohemia increased from 
15.7 per 10,000 in the first quarter of 1941 to 28.9 in the 
corresponding quarter of 1942; the increase was less rapid 
in Moravia (from 17*5 to 22,7). This compares with an in- 
crease in morbidity for the Reich from 18.8 to 27.7. 
Mass vaccinations of children took place in Denmark8 
in 1942 and, among adults in Jutland, in 1943. The Jutland 
epidemic, which raged in 1943* was attributed to the consump-' 
tion of infected foodstuffs. The number of cases in Denmark 
increased from 917 in 1941 to.l,66l‘ in 1942. 
Mass vaccinations of children were also ordered for rural 
districts of France in 1943.9 In Hungary, protective ■;>-/ 
vaccinations■have" been compulsory for children from 2 to 7 
years bince ■ 1938 . jn Italy provided for the compulsory 
vaccination of children from 2 to. 10 years.?? Cases of 
1. Wiener klinlsche Wochenschrlft, 27 February 1942, p, 176. 
2. E. Hassler, "Ergebnisse der aktiven Diphtheric-Schutzimpfung 
in Leipzig," Munchener medlzinische Woohenschrlft, 10 April 
1942, -p. '342. 
3. Medlzinische K1 jnik:, 6 March 1'942 . « 
4., Medlzinische Kliniks 6 March 1942. 
5. Hamburger Fremdenblatt, 29 May 19^3- 
6. Frankfurter Zeitying, 7.August 1942. 
7. K. ¥. Klauberg, "Erfahrungen rait der aktiven Diphtheric- 
.schutzimpfung bei Erwachsenen," Deutsche medlzinische Woehen - 
schrlft, 1941, Wo. 45. 
8. Dagens Nyheter, 12 April 1943; Nationaltidende, 16 February, 
8 April: '1943. . . 
• ‘ l 
9. LfL Pebit Dauphinois 27 March, 28 April 1943. 
10. F, Faragq, "Die Kontrolle der Diphtheric-Immunitat mehrene 
Jahre nach der Schutzimpfung," Deutsche medlzinische Wochen- 
schrift, 6 February 1942, p. 137 
11. Bulletin of Hygiene 15:74 (1940); Journal of the American 
Medical Association 115:231 (20 July I9W) 
f 2544-5^ RESTRICTED 
diphtheria and croup were as follows: 
Year 
No. of Cases 
193? 
28,548 
1938 
27,417 
1939 
28,101 
1940 
26,218 
1941 
21,301 
1941, 
Jan.-May 
8,761 
1942, 
II • H 
8,777 
Diphtheria has- also made much headway in the Netherlands. 
An epidemic started in the fall 1942 and was still spreading 
in the spring of 1943,-.In 1942, the_number of cases was 
about ■ ten .times ’-higher than in 1957-59. Figures are as fol- 
lows : 
Year 
No, of Cases 
193? 
1,068 
1939 
1,273 
1940 
1,733 
1941 
5,434 
1942 
12,225 
The increase was smallest in those provinces where diphtheria 
has been prevailing for some time and the disease was most 
severe, in older -people. Vaccination has. been applied on an 
increasing scale.- In 1942, 394 of the 1,034-municipalities: 
had children under 14 years vaccinated. The serum is supplied 
by the Hijksseruminstituut.1 
In Sweden, if is planned to vac-cinate 1,500,000 children 
in Gases of diphtheria numbered 100 .in 1939 and 1,000 
in 1942.2 Switzerland reports lack of success of protective 
vaccinations in some districts*^ 
Reports from Norway4 indicate that the situation has 
deteriorated greatly under German occupation. Before the war, 
medical, science had fought diphtheria practically to a stand- 
still (without the use of prophylactic immunization) , and the 
number of cases reported until some months after the.German 
occupation rarely •- averaged more than 1C cases a month for the 
entire country. During the period from July 1940 to June‘1941, 
an average of 40 cases per month were reported. In July 1941, 
came ..the .second rise, and for the whole year of 1941 a total 
of 2609 ’cases were reported. During the first 10 months of 
1942, 5:,0.54 cases were reported. In normal, times, about 70 
percent of the cases occur in, rural districts and 30 percent 
in the cities. For diphtheria, a gradual process of reversion 
1- Nieuwe' Hotterdamsche Courant . 1 December 1042; Algeme'en 
Handolsblodt 1 December *1942; pe T1.1 d, 1 December 1942; Journal 
of the American Medical AssoclaEldh 11*9:1459; Dagblad van het 
gulden. 11 Hay 1943, ■ v ; ' - V 
2 News from Sweden. 13 January 1943. 
3 -E, Berger, "Preventive Schutzimnfup£e<n. 11 -Schwelzer medizinische 
Wochenschrift, 1942, No. 25. 
4 Office of the Surgeon General of the Norwegian Public Health 
Service, Medical and Sanitary. Data' on Norway♦ Washington, D. C, 
May 1943, GID 3684?', bp. 22 f f . 
(25443) RESTRICTED 
has taken place during the occupation. The percentage of 
cases of diphtheria occurring in city districts rose from 
34,9 percent in 1939 to 39,9 percent in 1940 ‘and 56.8 percent 
in 1941e If the normal distribution of the population is. 
taken into account, with 29 percent living.in cities and the 
rest in rural districts, this analysis indicates that the 
morbidity of diphtheria is about three times as high in the 
cities as in the rural districts. In 1942, the diphtheria: 
epidemic spread to the following districts in Norway: 
Aakra 
Faaberg 
Horten 
Skien 
Aamot 
G-jerpen 
Hell 
Stavanger 
Arendal 
G-j^vik 
Karra^y 
Trondheim 
Bamble 
G-rue ’ ; 
Krager^y 
tfstre Toten 
Bergen 
G-varv 
Liliehammcr 
Brandbu 
Haugesund” 
Mangor 
Brevik 
Herpya 
Notodden 
A number of cases also occurred in other districts in 
the provinces (fylker.) of f^stfold, Akershus, Hedmark, Horda- 
land, and Rogaland, The city of Stavanger had a very high 
incidence. 
It is stated that from a clinical-view the disease is 
not 'considered of the most malignant type. No bacteriological 
data are available. Though-physicians-in Norway launched,, 
health campaigns in order to educate -the public in the matter 
of precautionary measures, the Quisling authorities tried to, 
cover up the spread of the disease,, and Terbovcn prohibited 
official discussion of the state of health of the country 
which Mhad improved so marvelously,-under the new order." 
The local health'authorities introduced a number of 
measures to arrest the spread of the disease, which seems to 
be by far the.most important one in Norway during thp occupa- 
tion, Immunization was made more -or-less compulsory for 
school children in numerous localities., and a total ’of 15*900,1 • 
was vaccinated in 1942 alone. .Lack of toxoid delayed immuniza- 
tion for some time. ' Prophylaxis was resumed after toxoid was 
made available from Sweden and Denmark.. Among 15,000 immunized 
school children, only four.cases;of. mild diphtheria were ob- 
served, ■ , 
In view of the situation in Norway, members of Norwegian 
armed forces in England and Canada have been immunized against 
diphtheria. 
d. Meningitis. Meningitis,', an epidemic inflamma- 
tion of -the,-brain, has■ considerably inprcaaed.-in -Oe-rntan'y and'. 
Italy, It is also said to prevail in eastern Slovakia, the 
adjacent Hungarian districts, and the Garpatho-Ukrainian .area 
occupied by Hungary.1 Cases for Italy and (Germany are as 
f ollows: ■ ..... ■ 
Italy 
• , 8 
i, . ' • 
*, * 
Germany . : 
i 
Cases per 10,000 
Deaths per 
Year 
Ca.ses 
Gases 
Deaths 
inhabitants , ■ 
100 cases 
1937 
.1,057 
' 1,595 
■ , 851' 
■. „.. h. ■ ■ 
52 
1938 
1,27'6 .. 
1,790 r 
""861' 
♦ 26' 
48 
1939 
1,330 
5,120 
1,980 
.74 
39 
1 OSS, source, 5 June 1943, RESTRICTED 
Italy 
.Germany .. 
Cases per 10,000 
Deaths per 
Year 
Gases 
Cases 
Deaths 
inhabitant's 
100 oases 
1940 
2,783 
7,211 
2,089 
.80 
29 
1S41 
3,836 
4,767 
1,367 
.53 
29 
1942 
a 
. 2,754 
947 
.31 
34 
a. Not available. . "1 , • ,* ■ ’ 
The decline which occurred in Germany in 1942 can also 
be observed in Italy,,where the number of cases reported for . 
the period from January to May was 1,780 as compared with 
2,850 for the corresponding period of 1941, . 
■The severity of the disease has declined in Germany as 
is indicated in the fatality figures. 
Reports from Norway indicate the following increase in 
the number of reported cases: 
Year 
No. of Cases 
1939 
'28 
1940 
88 
1941 
490 
The rise started in the beginning of 1941 and culminated in 
the spring. The situation has later improved considerably, 
but the average number of cases: reported is still much higher . 
than before the war. 
e» Scarlet Fever. No disease has become more 
widespread in Germany in recent years than has scarlet fever. 
Figures for the expanding territory of the Reich are as fol- 
lows : 
Year 
Cases 
De 
aths 
Cases per 10,000 
inhabitants 
Deaths per 
100 cases 
1936 
124,570 
■ 993 
18.5 
1 
1937 
117,544 
829 
17.2 
' • 1 
1938 
114,243 
807 
16.6 
1 
1939 
129,495 
1,032 
18.5 
1 
1940 
159,597 
(l38,759)b 
1,700 
17,7 
1 
1941 
279,117 
( 247,744) b 
3,233 
31.0 
1 . ' 
1942 
.401,011 
4, 4p4 
44.6 
1 
1942 a 
219,676 * 
• 
c 
'C 
c 
1943 a 
185,920 . 
c 
'■ * c ■■ " ■ 
c 
a. Flr's.t-.'six months * 
b. Figures in parenthesis- refer to the old territory of the 
Reich, ■ ' 
c. Not .available. 
f * .. .. . 
1 During the first World War, scarlet fever cases' rose from 
104,420 in 1913 'to 149,537 in 1915 and declined since then. 
(2544-3) RESTRICTED 
Of the 160,000 cases in 1940, 128,000 were children under 15 
years.1 It seems that the disease has been most severe in 
adults. Protective vaccinations were applied only hesitantly 
and with doubtful success. The first mass vaccination in the 
Reich took place in the rural district of Bielefeld in the 
early part of the summer of 1942.0 Later such vaccinations 
were undertaken in Lueneburg,5 Vienna4 and elsewhere. The 
medical press, however, points out that vaccination does not 
offer certain protection.5 Of 17 sick children among people 
who had been resettled, 14 had been vaccinated before with 
Gabritschewsky1 s vaccine.5 It is said that, fatality had in— 
• creased though the over-all figure indicated in the preceding 
table does not express such increase.V A recent report in 
the German press states that, in cases of toxic scarlet 
fever, blood transfusions from other patients who have passed 
the crisis have brought good results.^ 
In German medical literature it is pointed out that a 
trend towards an increase in scarlet fever cases could be 
■ observed.since 1937 and that therefore the declining power 
of resistance under war conditions could not well be held 
responsible for the increase-(up to.1941). The importation 
of new •strains of bacteria is emphasized; these are brought 
by refugees and evacuated persons into territories whose 
population has not acquired immunity against these types. 
On the other hand, the immigrants may not be immune against 
the domestic type of bacteria.. The spread of the disease is 
said to be more advanced in cities than in the country. This 
■ is laid t.q poor housing conditions, requiring a large number 
of people to live in small lodgings, to the limitation of 
heating to one room, and t o blackouts which cause people to 
live close together.5 
In Bulgaria the outbreak of an epidemic was reported 
in the fall of 19420 Schools were, closed frpm November 
'.1942 to January 1943, and hospitals were overcrowded. 10 
.1 Reichsgesundheitsblatt, 7 April 1943. 
2 Deutsche- medizlnische. Wochenschrif t. 25 June 1942; 
Mflnchener medizlnische Wochenschrift, 31 July. 1942, p. 594; 
Medizlnische Kllnlk. 4 September 1942, p. . 8$4. 
3 Deutsche“medizlnische 'Wochenschrif11 15 January 1943, 
4 Neues. Wiener Tagblatt, 24 June 1943. 
5 E. Voeke, nErfahrungen mit dem Scharlachimpfstoff,n 
Deutsche medizlnische Wochenschrift t 1941, No. 45,. 
6 Konrad Hofer, nEine kleine Scharlachepideraie eines 
Umsledlerlagers unter kritischer Betrachtung der Scharlach- 
schut zlmpfung,11 Arc hi v fur Klnderhellklnde , Vol. 124, No. 4, 
1941. 
7 H. G, Huber, f,Der Scharlach in Chemnitz.n Monatsschrlft fur 
Klnderhellkunde, Vol. 90, No. 3-4, 1942. 
8 Bern T. (P) #1346, 26 February 1943. 
9 Erika Auener, ’’Der Scharlach im Landkrels Chemnitz im Jahre 
1941, ■' Medizlnische Kllnlk. 29 May 1942, pp. 510 , ff. 
10. Transocean, 19 October, 7 December 1942; Zora, 5, 7, 
November, Utro, 8 November 1942; Sofia Radio; 7 November 1942. 
(25443) RESTRICTED 
Denmark had 9,186 cases of scarlet .fever in 1941 and 14,302 
in 1942. Hospitals ."‘are badly crowded* Gases are often fol- 
lowed by complications.! A marked increase in the occurrence 
of the disease is reported from Norway, and it is stated that 
in 1942 there occurred the. most severe scarlet fever epidemic 
in 50 years8, There are also numerous reports of the disease 
in Sweden.3 In,Italy, no increase has been' observed.' Figures 
are as follows: - :' 
Year 
No. of Cases 
1937 
f. . • 
15,861 
1938 
13,629 
1939 
12,045 
1940 
10,792 
1941 
12,737 
1941, 
Jan.-May , 
4,415 
1942, 
H tl 
5,129 
f. Jaundice. Though much is made of jaundice in 
intercepted letters from Germany, and France,5 
exact over-all figures are not available. An increase in 
the number of cases is also reported from Norway.5 In the 
German press it is stated that “jaundice has occasionally 
been more frequently observed in recent times."? Censorship 
excerpts indicate that jaundice was, next to diphtheria and 
scarlet fever, the most widespread disease in Germany in 
1942 and early 1943, It appears to have occurred in epidemic' 
form and is reported from all regions of Germany, The German 
censor has on occasion regarded jaundice as serious enough to 
merit deletion of the word in letters. Some of the writers 
refer to this disease as a bother rather than a menace, and 
some believe that the soldiers have brought it from the 
front.8 With reference to the organism causing jaundice,, a 
circular of the medical■■ authorities,-of the German Army, 
dated 1 March 1942, states that it is unknown but that there 
is much evidence that it is a sort of virus whose ubiquitous 
existence seems to be certain.9 The disease is said to .spread 
1 Politiken, 20 December 1942; Nationaltldende . 16' December 
1942. ; -■ r- : ■ 
» T 
2 OSS, CID 41102, 2? July 1943. 
3 OSS,CID, Censor Materials Summary 27, 1 Hay 1943, p., 87. 
4 OSS, GID, Censor Materials Summary 27, 1 Hay 1943, pp. 78 f • 
5 Ibid,, -p. 63. ~ ~ ... • • >... 
6 Office of the Surgeon General of the Norwegian. Public Health 
Service, Medical and Sanitary.Data on"Norway, Washington D, C, 
May 1943, GID 38847, p. 25. : # 
7 Frankfurter Zeitung. 2 December 1942. r ' 
8 OSS, CID, Censor Materials Summary,27, 1 May 1943, pp, 7, 95. 
9 Germany, Oberkommando der; Wehrmacht. Sammelheft, . .1. 
Richtlinien und fur den Heeres-Sanit&tsdienst. 
Berlin, Reichsdruckerei, 1942. 
(25443) RESTRICTED 
from-man to man. and infections of persons in the zone of the 
.interior by soldiers on furlough are reported. Contact with 
■the virus through water or food; is held possible, but is 
said to be without general importance! 
g* Trachoma, This disease, which is endemic in 
some eastern parts’of Europe, has.increased greatly in 
Germany and the increase is not limited to the. newly acquired 
territories. Figures for the expanding territory of the Reich 
are presented in the following table: 
Year 
Cases 
Deaths 
Cases per 10,000 
.inhabitants 
Deaths per 
100 cases 
1936 
625 
0 
.084 
/ ■ 
0 
1937 
697 
0 
.10 
0 
1938 
533 
0 
.074 
0 
1939 
652 
0 
.092 
0 
1940 
5,586 
(2,979)a 0 
.62 
0 
1941 
9,196 
(2,770)a 0 
1.0 
0 
1942 
.. ■' ' ‘ 
8,564 
0 
) 
.95 
0 
a. Figures in parenthesis refer to the old territory of the 
Reicho 
East Prussia is the principal focus of the infection, which 
has been spread by returning Germans from Wolhynia, Galicia, 
Bessarabia and Lithuania* It is also found among Polish and 
Italian laborers. 
h. Smallpox, In Germany, an order of 22 January 
1940, fortified the law of anti-smallpox vaccination, which 
dates from 1874, and applied it to the whole territory of 
the Reich,2 As long as vaccines are produced, a spread of 
smallpox in.central Europe seems improbable® France, which 
before the war -used to have a few cases per year,, had 57 
cases in 1942, of which*44 were in the Seine department and 
13 in the unoccupied zone. There were only 2 cases in the 
first half of 1943. Recent reports from Paris indicate that 
the vaccination in schools is impeded by lack of paper (I).5 
1 ' Mo Schmidt > ’’Massnahmen zur Bekampfung des Trachoma,” 
* Deutsche medlzinische Uochenschrift 6?:760 (1941) ; W. 
Rohrschneider, '’’Das Tracho.ni in Cstpreusse-n, n Deutsche • 
medlzlnische Wochenschrift 67:758 (1941); S, Mielke, nDas 
. ;lraohom bei den Umsiedlern aus Bessarabien und Litauen und 
-seine moderns Behandlung,M Klinlsohe Wochenschriftt 7 March 
1942, p. 23,7. 
2 Bulletin of Hygiene » '16 :425 .. (1941). 
3 Des Documents, 1 Aoril 1943, 
• -u t ' . 
(25443) RESTRICTED 
The smallpox situation is serious in Turkey where an 
epidemic has broken out. Figures are as follows: 
Year 
No-., of Cases 
1939 
423 
1940 
139 
1942 
1,841 
1943, Jan,-Hay 
5,625 
In Yugoslavia an epidemic spread among the Moslem 
refugees in the Pljevlje in March 1943. There were then 
200 cases at least.1 General Mihailovich’s chief of 
medical services reports 28,000 cases of smallpox: for-the 
whole year of 1942.2 
Since vaccination against smallpox is compulsory in 
Greece, no cases have been reported. Vaccine is manufactured 
by the Government Laboratory for Smallpox and Rabies Vaccine 
(Director, Dr. Kaskas), Normally 100 calves per year are 
needed for the manufacture of the vaccine. At present, how- 
ever, permission has been received from the Italians for the 
purchase of only about half this number and as a result there 
is a. shortage of vaccine which can only be partly made good 
by the vaccine imported from Canada by the Red Cross,3 
i. Tuberculosis. Statements of German medical 
authorities indicate awareness of the impact of war conditions on 
the incidence of tuberculosis. Dr, Leonardo Conti, Reich Health 
Leader, refers to tuberculosis as the object of his greatest 
worry. He states that he is ’’aware of the fact that none :of the 
countries participating in the war will get off without an in- 
crease in tuberculosis morbidity and mortality. Exact figures 
are not available yet, but it is plain to the observant 
physician.” He asserts that the present (December 1941) in- 
crease is extremely small if compared with that of the First 
World War, New methods such as the intracutaneous test for 
detecting tuberculosis among small children and progress in 
the field of X-ray diagnosis have made much headway. ”Diag- 
nosis is excellent, therapeutics not quite so good. Tubercu- 
losis therapy is too much connected with the general condi- 
tions of living.” Of special importance is the need for good 
housing facilities.4 
■ An examination of morbidity and mortality indicates, how- 
ever, that the situation is considerably more serious than was 
intimated by Dr. Conti late in 1941, The following figures 
are for the territory of Germany as it expanded after 1939, 
1 Clas Crnogorca, 31 ‘ March 1943. 
2 OSS source, 20 June 1943. 
3 From a report by Dr. Elsa Seg.erdahl Persson entitled 
’’Contagious Disease in Greece11 and dated Athens, 28 Aoril 1943. 
OSS, GID 38151. 1 
4 Leonardo Conti, "Die Bedeutung der Wissenschaft, insbesondere 
der kinder$rztlichen, in der Gesundheitsfuhrung,” Deutsche 
medizinisohe Wochenschrlft, 16 January 1942, pp. 53 ff. 
(25443) RESTRICTED 
1939 
1940 
1941 
1942 
1942b 
194?b 
Tuberculosis of 
the lungs and 
larynx: 
Gases 
69,482 
98,062 
117,558 
126,965 
68,500 
71,515 
Deaths 
31,114 
42,989 
49,653 
53,999 
cl 
a 
Cases per ten 
thousand in- 
habitants 
10 
11 
13 
14 
a 
a 
Tuberculosis of 
the skin: 
Cases 
1,714 
1,667 
1,909 
1,837 
a 
a 
Cases per ten 
thousand in- 
habitants 
.25 
.19 
.21 
.20 
a 
a 
Tuberculosis of 
other organs 
Cases ,7 
6,366 
9,779 
15,512 
16,996 
f 
a 
a 
Deaths 
3,349 
4,867 
5,636 
6,101 
• a 
a 
Gases per,, ten 
thousand in- 
habitants 
.92 
1.1 
1.7 
1.9 
a 
a 
Deaths per hundred 
cases 
cl 
* 50 
36 
. 36 
a 
a 
a. Not available * 
b. First'six months. 
‘ There was thus a severe increase in cases of tubercu- 
losis of the lungs and larynx, no increase in tuberculosis 
of the skin, and a serious increase in tuberculosis of other 
.organs* The case fatality figures indicate that the new 
cases arc, not so frequently fatal as was the smaller number 
.of case’s' in the past. 
The increase in'tuberculosis of lungs and larynx 
(respiratory tuberculosis) is by no means a statistical 
consequence of the acquisition of new territories. Cases 
for phe old territory are as follows; 
Annual• 
First■ 
Second 
■Third 
Fourth 
Year 
* 
'"Total 
Quarter ' 
Quarter , 
■Quarter 
Quarter 
1935 
50,376 
15,649 
16.200 
18,186 
10,341 
1936 
50,727 
15,835 
16,095 
18,218 
10,579 
1937 
63,570 
16,881 
17,787 
15,034 
13,868 
1938 
60,420 
16,052 
- 16,441 
14,233 
13,594 
1939 
67,890 • 
19,431 
18,448 
15,816 
14,195 
1940 
73.267 
17,096 
21,778 
.17,514 
16,879 
1941 
82,043 
20,660 
24,155 
20,266 
16,962 
In"1941; there was thus a 34 percent Increase for the Old 
Reich in now cases of respiratory tuberculosis over the 
average of cases in 1935-3R. 
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In the large cities of Greater Germany, deaths from all 
forms of tuberculosis per 10,000 people we-re as follows*. 
1939 1940 1941 1942 
6.6 7.5 7.6 8.1 
Compared with the increase in deaths for the whole of 
Germany during the first World War, these figures are much 
smaller. The development then was as follows: 
M.Urnber of deaths from 
tuberculosis per 
Year 
10 ,000 people 
1913 
14 * 2 
1914 
. 14.3 
1915 
14*8 
1916 
16*2 
1917 
20.6 
1918 
23.0 
1919 
21.1 
1920 
15.4 
1921 
13 e 7 
With respect to the incidence *of the disease in various 
groups of the population, reports point out its spread among 
school chillienr-L It is also said that a further spread of 
the disease among the population of the newly acquired ter- 
ritories in the east must be anticipated owing to the in- 
creased economic activities and the influx of people from 
other parts of the Ro;icb, who are exposed to special danger.2 
Reports from other regions pen rt out that, while the number 
of new cases increased, the known cases did not deteriorate 
more than wa. causes which have contributed to the 
outbreak of new cases are overwork due bo war conditions, and 
conditions in air raid shelters rather, according to German 
statements,, than the deterioration of food conditions.? 
Progress in the detection of tuberculosis is due to the 
extensive use of mass radiography, a serial diagnosis by- 
means of miniature X-ray photographs by the Abren process. 
If films of 24x36 mm-, arc used* the price of each picture, 
including development y does not exceed 10 pf * In certain 
areas it is proposed to establish a register0 
by radiophotography of the whole population, but these pre- 
war plans could net be carried out so extensively as was 
intended* In 1939 more than 500.000 persons had already 
been examined in Mecklenberg* in addition. this method of 
diagnosis has been applied to various political and youth 
1 OSS, CID .27473, 27 January 1943. 
2 R, Hoffmann* ,?Neue Ergebnisse der Tuberkuloseforschung,H 
Med.isinj.53he Klinik, 11 September 1942, p. 878, 
5 E« Schroder and E, Hidden? "Beobachtungen liber den Einfluss 
des,Krpeges#auf den Ablauf der Lungentuberkulose,0 Der 
offentliche Gesundheitsdienst, Vol. 7, Part B, p, 128. (1941). 
' * 
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organizations, to school children, officials, workers in 
certain industries, etc. By this method, however, only 
preliminary surveys are possible; it is necessary further 
to investigate suspected cases fluoroscopically and radio- 
graphically #1 
The X-ray diagnosis in Mecklenburg resulted in the 
following findings: 1,25 percent of the cases showed active 
tuberculosis or suspicion of activity; .12 percent showed 
open tuberculosis,2 if later examinations(which covered 
95 percent of the population above 8 years in Westphalia and 
Wuerttemberg) are included, the percentage of cases suspect 
of active tuberculosis increases to 2=,53 for a total of 
nearly 5,000,000 examinations undertaken between September 
1938, and March 1942, Examination of nearly; 500,Q00f 
relocated Germans who had returned from Germany from various 
regions of eastern Europe indicated a percentage of 4.24 of 
suspects of active tuberculosis,3 Among 1,591 Polish 
laborers in Germany, 3,13 percent had active tuberculosis 
or were suspects and .78 percent had open tuberculosis.4 
The tuberculosis situation is more serious among the 
various foreign elements of the German labor force than it 
is among the Germans themselves. This may in part, and 
among specific groups of foreign workers, be indicative of 
poorer conditions of health in the countries of origin of 
the workers concerned. It may also indicate the neglect 
and ill-treatment to which,these groups have been exposed 
in Germany-s The following figures indicate the differences:^ 
Size of the 
Percent with 
tuberculosis 
Nationality ■ 
samole 
5 Ac tioe n . 
•'Non-■active . 
Poles 
2.. 641 
o 1 
* -U 
h 
Russians , 
1, ceo, 
3 3 6 
5 a 2 
Belgians 
631 ' 
5 v 
3*7 
Dutch 
445 
• . 1 v 5 
a 9 
Czech 
546 
2.6. 
2„0 
Flemings 
500 
3.7 
- 1.7 
French 
SCO 
4r C 
1.5 
Italians 
leo 
31 o 
3,8 
Hungarians 
3 57 
2 o 6 
4.5 
Spaniards 
loo 
3„0 
4.4 
Croatians 
1S5 
2o 4 
5.0 .. 
Estonians 
■ 105 
9 r o 
6.6 
1 Bulletin of lygiene 16:425 (1941). 
2 ;K1 Fi.rke, fiSrgebnisse der Reihendurchleuchtungen bei 
palnieohen ’Arbeitern und die Bedeutung f(ir den Tuberkulose- 
fursorgearzt, " Der off entliche G-esundheltsdienst. Vol. 7, 
Part i3. p, 220 TT94lT7~ 
3 W, M0 HA Weisswanger, RErgebni.sse der ersten 5 Millionen 
Volks rent genunter sue hunger, Hunchener medlzlnlsche Wochen- 
schrif t, ■ 6 November 1.942,, p« 961, 
4 K. Funke. "Srgebnisse der Reihendurchleuchtungen bei 
polnischen Arbeitern und die Bedeutung fHr den Tuberkulose- 
flirsorgearzt,per of f entliche Gesundheitsdlenst, Vol. 7, 
Part B, ,p.. 220 TI543X 7^ 
5 Ewald Wildau, ’’Lungen-und Herzkrankheiten bei ausl&ndischen 
Arbeitern verschiedener Nationality!,fl per off entliche Gesund- 
heitsdienst. Vol. 9, Part B, pp. 1 ff, (1943)• T~ 
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Another sample of 6,393 foreign workers who are not specified 
according to national origin indicates the following' per- 
centages for active and inactive tuberculosis:1 3,6| 3,3, 
This compares with ,08 and ,21 percent, respectively, for a 
s amp 1 e. of 10,500 Ge mans • 
The organized placement of tubercular persons in 
institutions, sanitoria, and special settlements seems to 
have been much disturbed owing to w^ar'conditions. It is 
objected that measures like this are now "very unpopular", 
and;that newly detected cases must wait three to four months 
ipstead of two to three weeks until they'are admitted to an 
institution. This produces psychological shocks, and "in •; 
the long period of Waiting the tubercular process may advance 
so quickly that under■'•certain circumstances it may change 
from a curable one to an incurable,"2 Much is also made of 
the poor housing conditions of people suffering from open- 
tuberculosis, a situation which is bound to deteriorate under 
the impact of recent air raids, -It is estimated that 25,000 
•persons affected with open tuberculosis live together with 
61,500 healthy persons in overcrowded lodgings. No 
systematic effort has as yet been made in the direction of 
removing the danger of such lodgings. There -are complaints 
about the lack of initiative and cooperation among the 
various authorities *3 
In view of the growing shortage of labor it is not 
surprising that much attention is being paid to the problem 
of utilizing the productive powers of tubercular people. 
Altogether there are 1,600,000 tubercular persons in Ger- 
of these, 4-500,000 suffer from open tuberculosis. Of 
the latter, only 100,000 receive treatment and 200,000 are 
not known as sick persons,4 On 9 June 1941, the Ministers 
of the Interior and :of Labor issued a circular which was 
designed to draw a larger number of tubercular persons into 
the labor force. Somewhat cynically this is referred to in 
Germany as "Labor therapeutics" (Arbeltstherapie)• In the 
press much is made of the 'labor reserves of the tubercular 
persons. It is even implied that the detection of their 
disease may be undesirable. Otherwise, it is said. 
1 Ewald Wildau, "Lungen-und Herzkrankheiten bei auslandischen 
Arbeitern verechie.dener National!tat," Per offentliche Gesund- 
heitsdienst, Vol, 9, Part B» pp. 1 ff. (1943)• 
2 Dr* Ickert, "Die Betreuung der Tuberkulosen wahrbnd der 
Wartezeit bis zur Einberufung in die Heilstatte,ff Deutsches 
Aerzteblatt, 15 September 1942, pp. 299 ff. - 
3 H* Br&uning, "Die Wohnungsnot der Offentuberkulosen," Der 
offentliche Gesundheitsdienst, 1941, Part B, p. 357, 
4 Dr, Marti neck,' "Geber den Arbeitseinsatz Lunge ntube.rkul os er, " 
Reichsarbeitsblatt, pt. 5, 25 May 1942, pp• 275 ff,| P, P, 
Schneider, "Gegenwarteprobleme der Tuberkulosebek&npfung," 
Wiener klinische Wochenschrlft, 9 October 1942, pp-. 817 ff,| 
K. Stalherm, ,rBetriebs£irz tliche Erfahruhgen in der Tuberkulose- 
bek&mpfung," Der oef fentliche Ge sundheitsdienst, 1941, Pt, B,.p. 
W. Ekhart, ,fTJnter welchen Bed ingunge n ist ein Tuberkuloser 
arbeitsfahig?" Wiener klinische Wochenschrift, 20 March 1942, 
pp, 221 ff. 
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mass radiography resulting in the detection of many cases 
would impair the economy.! The ministerial circular 
mentioned above reads as follows:2 
"The capability of tubercular persons to infect others 
is definitely limited. The coughing person with open 
pulmonary tuberculosis is dangerous only in a close environ- 
ment. If there is not much coughing and if he behaves in a 
disciplined manner, the open tubercular person represents, 
under.normal conditions of living.and working, practically 
a smaller danger for adults than the-one to which everybody 
is exposed in modern life. A separation of open tubercular 
persons is without exception necessary with respect to 
children, young persona, and other persons who cough much 
or are undisciplined. Measures at home or at work which go 
beyond this a*re unjustified and only likely to produce un- 
necessary fear of infection. They are even less justifiable 
because of the fact that the economy cannot do without the 
labor power of tubercular persons willing to work." 
Figures published in April 1942, indicate that about 
60 percent of all persons with open pulmonary tuberculosis 
and 80-90 percent of those with stationary tuberculosis were 
then employed, some in very unsuitable positions,^ 
I*n other parts of Europe complaints about a deteriora- 
tion of the situation are frequent. In Belgium, there has 
been the following increase in tuberculosis mortality per 
thousand deaths: 
Tuberculosis - of 
Tuberculosis 
Year 
respiratory organs 
of other organs 
1938 
40.3 , 
12.1 
1939 
38.2 
11.4 
1941 * 
52.9, 
14.1 
No figures'"were given for 1940 because-of the large number 
of deaths not•specified or vaguely defined owing to war 
conditions. Belgian''doctors are said to estimate that, in 
the lower-class and lower-middle-class groups, 80 percent 
of the children are in pre-tubercular condition,* The number 
of persons registered for extra rations allotted to tuberculars 
increased, from 1 December 1941 to 1 June 1942, from 69,000 
to 84,000, i.e*.by more than 20 percent* The proportion*of 
1 Kleler Zeitung, 1 July 1943* 
2 Zentralblatt fur die gesamte Hygiene, Yol. 49, p* 460, (25 
April' 1941ZTT ‘ T " ~ * 
3 Elisabeth Dehoff, "Tuberkulose: Konstitution und 
Arbeitseinsatz," Deutsches Tuberkuloaeblatt, April 1942, 
pp. 73 ff« ■ . 1 • r 
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tuberculars is much higher in the large cities than in the 
agricultural regions. This fact is referred to as a "severe 
warning to those who are systematically sabotaging the food 
supply of the large centres and, in particular, to the 
farmers who are not fulfilling their duty towards the com- 
munity." The proportion of tuberculars in the various 
provinces at the beginning of June 1942,' is shown in the fol- 
lowing table :1 
Province 
Gas 
es 
Brabant 
23,000 
(18,000 
in 
. Brussels 
alone) 
Antwerp 
15,055 
(10,000 
in 
. Antwerp 
alone) 
Liege 
12,037 
(8,506 
in 
Liege) 
Hainaut 
11,436 
(7,000 
in 
Charleroi 
and Mons) 
East Flanders 
7,212 
Namur 
6,816 
(5,518 
in 
Namur) 
West Flanders 
6,477 
Limbourg 
.4,230 
Luxembourg 
2,226 
In Bulgaria deaths from tuberculosis in all towns (ex- 
cept Dobrudja) increased from 1,772 in 1941 to 1,900 in 1942. 
The increase coincides with the rise in food prices.2 
In Denmark preparations were made in 1942 for protective 
vaccinations of school children. Vaccine of the Calmette type 
is prepared in the Serum Institute of Copenhagen. Vaccination 
seems to be given to young persons leaving school.0 There are 
said to be 6,000 tubercular persons in Denmark,4 . 
In France, tuberculosis has spread owing to the restric- 
tions which prevail in that country. The number of dangerous 
cases5 was estimated before the war as -550,000*. it is said 
to have risen to 1,000,000 by 1943. • Some reports emphasize the 
plight of the older people while others point out the dangers 
to children. Older people of from fifty to sixty years are 
said to have had relapses since their old lesions decalcify 
(owing to the lack of calcium, contained in milk, and lack of 
meat and fats-6) and release bacilli. According to other re-, 
ports, tuberculosis in Paris has doubled among children from 
six to eight and adolescents from eighteen to twenty-!ive.7 
1 LfL Nouveau Journal, 17, 18, October 1942, 
2 Dnevnlk. 5 July 1943. 
3 Deutsche medizinjsche Wochenschrlft1 24 April 1942, p. 434; 
Munchener medizinjsche Wochenschrlft, 9 October 1942, p. 884; 
National!idende♦ 14 May; 1945. 
4 Dageris, 23 July 1943. 
5. Sept-Jours» 10 January 1943. 
6 Sept-Jours, 10 January 1943, as reported in the Journal of 
.the~Americ8ErMedical Association 122:123 (6- May"1343)• 
7 Curieux Marcellin, 6 November 1942. 
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In the same city, deaths from pulmonary tuberculosis were 
20.4 percent and deaths from, other types of tuberculosis 
30.4 percent higher-, in the~ first half--of 1941 compared with 
the corresponding period of.1939, The departmental laboratory 
of the Qise, which does work for several dispensaries, reports 
the following increase of positive examinations ,of sputum for 
the tubercle bacillus:-1- ' ' ; ! 
Year ;• 
Positive results per 
one-thousand samples 
examined 
IS 38 
54.3 
1939 
- 
59.1 
1940 
. 
72.2 
1941 
> • 
211 
Medical authorities are inclined to distinguish between two 
types of tuberculosis which have developed in recent years 
the outbreak'.of one type is■.said to go back to the summer of 
1940 and to have been caused by fatigue and moral shock. This 
type is of a more polymorphic appearance and the prognosis is 
less grave* The other type is a bacillary bronchopneumonia 
with rapid evolution.. It started, in the beginning of 1941 and 
is,said to be chiefly due to food shortage. 
Intercepted reports from France indicate that tuberculosis, 
in general, assumes more malignant forms. Before the 'war there 
were many fibrous and quiescent forms were relatively 
curable in the sense that they were quite compatible with a 
long survival* At present tuberculosis is galloping and the 
mortality serious. New cases are rapid and malignant, though 
old ones which have been treated do not seem to develop much 
more quickly. Some of the cases of general consumption, 
terminate fatally in a few weeks. Caseous pneumonias develop 
_in a few days. The percentage of pleurisies is higher than 
usual. Food restrictions have a'great*deal to do with this. 
. Before the war, the .number of cases of tuberculosis in 1 
G-reece was estimated at -about 300,000. Available sanatorium 
beds totalled- 4,000 of which morp than half were in Athens. 
Only .in. Athens-Firaeus were there tuberculosis dispensaries. 
According to Dr, Hetallinos, the former head of the 
Soterias (Institution for the Treatment of Lung Diseases in 
Athens), tuberculosis has increased greatly since the war. 
Statistical data are lacking. Next to bad nutrition the 
great spread of malaria, which makes people ''susceptible to 1 
tuberculosis, is Regarded as one of the most important - causes. 
1 Marcel Moine, nUn danger.La tuberculose,H 
Bull, Agad. Med. Paris; III* ’125-1148450-(1941)', 
2 Dr. Ravina, address before a meeting of'the Societe 
medicale.des hdpitaux de Paris, J ournal of t he. American Medical 
Association 119:361 (23 Hay 194£j) , 
3 OSS, CID, Censor Materials Summary 27, 1 May 1943, pp. 58 ff• 
(25443) RESTRICTED 
With respect to available facilities and relief, it is stated 
that the capital has enjoyed much greater advantages than the 
provinces.t 
In Italy the number of‘deaths from tuberculosis has in- 
creased as follows; 
Number of 
Deaths per 100,000 
Year 
deaths 
inhabitants 
1939 
22,185 
49.89 
1940 
25,189 
56,12 
1941 
27*, 556 
60,74 
1941, Jan,-June 
1£;?72 
1942, " " 
17,371 
Much of the increase is said to be due to food . 
tions* To prevent tuberculosis from spreading children'are 
now X-rayed before being sent to holiday camps, 
In the Netherlands there are reports from'the Hague, 
indicating an increase*of persons registered with the tubercu- 
losis consultation office in that town* During the first nine 
months of 1942 their number was 13,514 as compared with 9,653 
in the corresponding period of 1941* Symptoms of the dis’ease 
were diagnosed in 3,740 persons, as compared with 2,913 in 
1941* In,Amsterdam, the tuberculosis death rate increased 
from 4*1 in 1939 to 6*1 in 1942* Throughout the country, 
deaths from tuberculosis increased from 3,272 during the first 
10 months of 1940 to 4,654 during the same period of 1942*5 
The increase of tuberculosis in Norway has resulted in 
systematic X-ray examinations which are- to start in October 
1943, and are designed to cover the whole population in two 
to three years* Attempts are also mad© at mass vaccinations 
on a voluntary basis* Sufficient vaccine is said to be 
available. The BG-G- vaccine, which is made at the Christian 
Michelsen!s Institute of Bergen, is employed according to the 
principles of the Scandinavian tuberculosis school.4 
In the former Polish territory now known as the Govern- 
ment G-eneral the number of tuberculosis cases is said to be 
three to five times higher than in the Reich,® In the former 
1 From a report by Dr. Elsa Segerdahl Persson entitled 
"Contagious Diseases in Greece,and dated Athens, 28 April 
1943. OSS, CID, 38151..,,. , 
2 OSS, CID, Censor Materials Summary;27/ 1 Hay 1943. 
3 Standa.ard. 1 January 1943; My-Dag, 3 March 1943, 
4 Dagens Nyheter, 5 February 1943; Office of the Surgeon 
General of the Norwegian Public Health Service. "Medical and 
Sanitary Data on Norway. Washington, D, C,, Hay 1943, CID 
38647, pp. 26 ff. 
5 DNB, 18 January 1943, 
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Czechoslovakian territory now known as the Protectorate there 
were 16,668 new oases of tuberculosis during the period from 
August 1941 to May 1942, In the ..Sudeten district of the Reich 
the number of new cases rose from 4,749 in 1940 to 5,352 in 
1941. Deaths rose from 1,376 to 1,866.1 
In the Baltic States artificial fog, which is produced 
during air raids, is said to have caused lung’ ailments.* 
In there has been a spread of the disease on 
account of the'war. -An extremely high morbidity is reported 
for units.of the Rumanian army. Many soldiers seem to have 
been sent home without treatment owing to the shortage of 
lung departments in hospitals. Altogether there are said to 
be 250-300,000 cases of open tuberculosis and accommodations 
for only 18,000.~- ‘ ... 
Studies are available indicating increased morbidity in 
Spain, - 
5, Diseases Affecting Han and Animal. 
a. Tularemia. Tularemia has been observed in „ 
Poland and Austria. It - is conveyed by rodents and especially 
by. hares* Its appearance in Austria in the winter of ,1,942 
was accompanied by numerous articles in the daily press and 
magazines*6 
6* Trichinosis* Reported cases of trichinosis have 
increased from none in G-ermany in 1936 to 1 in 1937, 20. in 
1938*, and 30 in 1939. It is now reported from the Warthegau 
as well as from Austria and Poland. Its sporadic appearance 
seems to be due to the consumption of bad pork as well as of 
badgers and foxes.6 It is likely that there are many more 
cases of trichinosis than are reported to the heal 
ties. ' -A ' - • 7 w:.. 
1 OSS, CID 41284, 9 August 1943:. . . " 
2 Handelstidnlngen. 8 September 1943, 
Timpul. 10 February 1943; Donauzeitung. 14 Julyl^’43, 
Dres* Ursu and Burabaoescu, "Tuberculosis Problems in Time of 
War ," Ardeadal Medical. Vol, 1', 1941, 
4 G-onzalez.de Vega and Gomez-Moreno, "Algunae observaciones 
epidemic ycllnicas sobre la Tuberculosis en la Provincia 
de Granada en la Pos.tguerra Espanola," Rev, Clin. 'Espanolo 
5:33-38, 15* April -1942s . • ■ T* 
5 QSS, CID 35939, A-6191,-5 June 1943. 
6 OSS, CID 35939,•A-6191, 5 June 1943. Lehmensick and 
Sendisaya, Zeitschrift fur Parasitenkuiide,' 1941. * „ • 
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6. Miscellaneous Diseases. * 
a. Vitamin Deficiencies. -.This report is not con- 
cerned -with nutrition proper. It will, however, point out 
some of the consequences of specific nutritional defects 
which have been, observed in Europe, as well as measures which 
have been undertaken in order to offset these deficiencies. 
Up until the war there was considerably less vitamin- 
consciousness in Europe than in the United States, As else- 
where, the war has been conducive to the promotion of know- 
ledge concerning vitamins. Such efforts at enlightening the 
public as have been made originated from public authorities 
or from labor organizations. It is these organizations which 
also handle the distribution of vitamins among the population 
in a planned and organized manner. Execution of the various 
programs requires a large personnel. 
An order by Hitler of 15 August 1941, established a 
Reich Institute for Vitamin Research and Testing (Reichsan- 
stalt fur Vitaminprufung und Vitaminforschung). For the 
time bfeing this Institute is located in temporary quarters 
in Leipzig until more elaborate facilities are available,! 
Germany seems to be well.equipped with all vitamins 
except Vitamin A (commonest commercial source is fish liver 
oil). This vitamin affects growth, skin, and the mucous 
membrane; lack of it causes night blindness and the tendency 
of wounds to suppurate. Since early in 1941, oleomargarine 
is enriched in Germany by a Vitamin A concentrate from liver 
oil of the blue whale, halibut and cod-fish. The concentrates 
are diluted with peanut oil and used in the following stand- 
ardized form: 10 Kg. concentrate per 1,000 Kg. fat (=1,250 
Kg. margarine).2 
In Sweden, margarine is enriched with Vitamin A in the 
form of carotin. The previous rate of 10 international units 
per gram was raised in 1943 to 12.5. Swedish margarine is 
also supposed to contain 10. international units of Vitamin A 
in the form of cod liver preparations, but owing to the 
existing shortage of that product it contains only 3.75 
international units of cod liver oil per gram for the time 
being. Thus, the total admixture of Vitamin A in Swedish 
household margarine is now 16.25 international units per 
gram \iP. 
There are reports from France which indicate that 
chocolate manufactured in Marseilles is enriched by the 
sedition of fish liver containing Vitamin A. The product is 
said to be distributed by the Secours National to children 
in tablets of 30 Gm,, containing 250,000 I. U, each.4 
1 NDZ, 28 December 194g; Reichsgesetzblatt, Ft. 1, 1941, 
p. 505; Herman Ertel, "liber■ den Aufbau der Reichsanstalt fur 
Vitaminprufung und Yitamlnforschung," Die Ernahrung 8:1 ff. 
(January 1943) 
2 H. Ertel, "DieMVitaminisierung der Margarine as Sicherhelts- 
faktor in der Ernahrung," Deutsche Fettwlrtschaft, 1941, 
No. 26. ' 
3 Stockholm, No. 123, 14 May 1943. 
4 Transocean, 23 March 1943; IDEffortt 24 March 1943. 
(25443) RESTRICTED 
Cod liver oil contains Vitamins A and D, Prance used to 
import all cod liver oil from abroad and is now cut off from 
foreign supplies. Attempts are made at domestic production.1 
In the Netherlands, cod liver oil is available only on medical 
prescription.2 Late in 1942 it was reported that the Belgian 
Red Cross had bought 13 tons of tuna liver oil, a substitute 
for cod liver oil, from‘a Spanish fish canning firm which had 
developed a large-scale production and export business.3 in 
Italy, cod liver oil is not available Nearly the entire 
supply used to be imported. Tuna liver oil is used in its 
Denmark, since February 1943, provides for the dis- 
tribution of cheap cod liver oil to children under 15 years 
of age,5 In Norway, school children are supplied with the 
oil, but supplies were reported to be running short owing to 
deliveries to Germany, In November 1942, it was reported 
that Germany had obtained 14,000 tons altogether from Norway 
since April 194l. Germany's optimum requirements of Vitamin 
A and D concentrates are estimated at 6,000,000,000,000 
international units of which 4,200,000,000,000 are supplied 3 
from Norway in the form of cod liver oil.7 Under the com- 
mercial agreement with Sweden of February 1943, Norway is to 
receive^lOO,000 kronor ($47,500) worth of cod liver oil from 
Sweden.^ 
With respect to foreign trade in Vitamin A preparations, 
the British Ministry of Economic Warfare is satisfied that 
there have been no exports of Vitamin A by Nestle's in Spain 
to Nestle's in France or Italy.0 However, other reports 
indicate that six to seven cases of vitaminized fish oil, 
each case containing ten tins of five Kilograms each, are 
shipped every day by air from Spanish Morocco to Seville and 
thence to Germany, A large number of cases also leave by 
small fishing boats, 16 The Spanish annual production of 
vitamin concentrates in the form of fish paste is estimated 
as 300 tons and the annual production of fish liver oil is 
said to be 4,700 Kilograms. About 80 percent of the fish 
liver oil and all of the vitamin concentrates are available 
1 Europa-Kabel, 27 August 1943. 
2 Nleuvsblad van het Noorden, 23 September 1942. 
3 OSS source, 12 December 1942, 
4 Europa-Kabel, 2? August 1943; OSS, CID, Censor Materials 
Summary 27, 1 May 1943, p. 49. 
5_ Nationalt-ldende, 3 December 1942; Berlingske Tidende, 
27 November 1942; Social-Demokraten, 12 and 29 December 1942; 
Krlsteligt Dagblad" 25 January 1543. 
6 Aftontldnlngen, 17 November 1942. 
7 OSS sources,29 January 1943. 
8 Ne¥S from Sweden, 3 March 1943. 
9 London .(p) A-457, 11 June 1943. 
10 OSS source, 14 April 1943. 
(25443) ’ RESTRICTED 
for export.-*- Portugal is reported to be an importer rather 
than an exporter of Vitamin A, as she has no facilities for 
extracting it,2 
With respect to Vitamin B, much is made in Germany of 
the -whole grain bread (Vollkornbrot), The germ and other 
components of the grain -which are contained in this bread 
have a content of Vitamin B-l, but it has been pointed out 
that the baking process may destroy the latter to some extent,2 
Lack of Vitamin B-6 is said to have caused seme cases of 
pellagra in Italy;4 however, the number of reported cases of 
this disease has declined constantly since 1939? This dis- 
ease is,also observed in Rumania and Spain; in the latter 
country a fatality of 62 percent of the observed cases has 
been reported. The situation is said to have been improved 
in recent times. Instead of pellagra there are no-w cases of 
lathyrisra, another deficiency disease, reported from Spain.5 
In Italy vitamin B-6 is also applied to counteract Leiner's 
disease -which is said to have made its appearance owing to 
malnutrition.0 In Bulgaria, the Directorate of Public 
Health attributes the spread of pellagra to the consumption 
of maize.7 In the Ostland, a vitamin and hormone factory 
has resumed activity and has commenced the production of „ 
Vitamin B from the yeast available there in great quantities.0 
Vitamin C is anti-scorbutic. It is more needed at 
certain ages and under certain conditions than otherwise. 
C-wing to food conditions, scurvy is reported from Belgium,9 
France, Norway,and other countries. A medical, inspection 
of children1 in Marseilles: showed that 66 percent of .those 
below the age of 18 had no Vitamin C in their blood,71 
Vitamin C is being widely distributed in Germany and recent 
• reports state that it has been possible to produce it from 
ordinary pine needles. -2 ■ in Italy it is made from citrus 
fruit„13 Since this vitamin is contained in potatoes, the 
large consumption of potatoes in Germany necessarily makes . 
some vitamin available to the population. 
1 OSS source, 9 April 1943. 
2 OSS source, 1 September 1943. 
3 C. Tropp, "Das Vollkornbrot und sein'Vitamin B-l Gehalt," 
Deutsche nedlzinische Wochenschrift, 1942, no, 10, 
4 OSS. CID, Censor Materials Summary 27., 1 May 1943? p. 42. 
5 Me dl in is che K1 inik2 January 1942, p. 19. 
6 OSS, CID, Censor Materials Summary 27, 1 May 1943* p. 42, 
7 Zora, 13 June 1943. 
8 Europa-Kabel, 6 August 1943.? , 
9 Journal of the American Medical Association 120:^48 
(17 October 1942J. ‘ ~~ , , ' 
10 Trots Alt, 9 October 1942. ■ r • . 
11 American Friends Service Committee, Bulletin, 13 April 1942. 
12 NPD, 31 March 1943. 
13 Europa-Kabel, 6 August 1943. 
(25443") RESTRIGTDD 
On 19 February 1940, the German Minister of the Interior 
issued a circular providing in some areas for the daily dis- 
tribution of a tablet of "Cebion sucre" from 1 May to 30 June 
1940, among all school children aged ten to fourteen. This 
preparation is manufactured by the firm of E. Merck of 
Darmstadt and is distributed in glass bottles. Each tablet 
contained 50 Mg, of ascorbic acid (pure Vitamin C) and beet' 
sugar. The age period of ten to fourteen ■was selected in 
order to place the children in a resistant state on attaining 
the age of puberty and, particularly, at the time when they 
leave school and begin to work. The selection of the areas 
was partly in accordance with medical statistics of the years 
following the First World War when scurvy was observed in 
Germany, and partly by taking account of the low Vitamin-C 
content of the diet in certain regions where the consumption 
of fruits and vegetables is low. Altogether more than 
60,000,000 of "Cebion sucre" tablets were used to treat 
1,600,000 school children in the large cities and industrial 
districts of the Rhineland, Saxony, Upper Silesia and 
Westphalia.1 
Since the results of the trial were regarded as success- 
ful, distribution of the tablets was repeated during the 
•winter of 1941-42 and extended to nurslings, pregnant women, 
nursing mothers and miners,2 The number of tablets distributed 
among.school children was then 186,000,000, Pregnant women 
were supplied with tablets containing a combination of 
"Cebion sucre" containing 50 Mg. of ascorbic acid and 50 Mg. 
of calcium (calculated as CaO). This was given beginning 
with the seventh month of pregnancy. Nurslings and nursing 
mothers were supplied with the original "Cebion 
tablets, with nursling and mother each receiving 30 tablets 
per month. If the child was exclusively nursed by the mother, 
only the latter was to receive the tablets. If necessary, 
the provision of the tablets for nurslings could be extended 
up to the completion of the second year. Altogether, 
1,750,000 mothers and nurslings are reported to have been 
supplied with a total of 264,000,000 tablets. Miners were to 
receive the same type of tablets. 
n A similar distribution of vitamin C in the form of 
"Cebion sucre'" was arranged in the winter of 1942-43.7 At 
that time, however, the content of ascorbic acid was reduced 
from 50 to 30 Mg. Whether this reduction was ordered because 
of increased demand of vitamins for the armed forces or for 
other reasons cannot be ascertained. In 1942 altogether 
4.000. persons are reported to, have been provided with 
4.50.0. daily doses of Vitamin C. 
While the Government General and the Protectorate of 
Bohemia-Moravia were expressly excluded from these arrange- 
ments., a similar plan was said to be in preparation in the 
Netherlands in the spring of 1943.4 
1 Bulletin of Hygiene 16:431 (l94l). 
2 Munchener medlzlnlsche Wochenschrlft, 23' October 1942, p. 922. 
3 gelchsgesundheltsblatt. 16 December 1942, n. 891; NDZ, 
16 December 1942. 
4 Wleuws van den Dag, 8 March 1943. 
(25443) RESTRICTED 
During the past two years, the German Labor Front has 
also arranged for-'the distribution of vitamin preparations' • 
combining A, B, C, and D vitamins among heavy -workers,! The 
distribution takes place in spring® The preparation is 
called Vitamultln and has been compounded by a Professor 
Morell. It consists of grain germs, thiamin, ascorbic acid, 
calcium biphosphate, .sugar, and lemon. Ninety tablets are 
issued per head. The expenses of the program, whose execu- 
tion is entirely in the hands of * the labor organizations, are 
borne by the employers. It is reported that an extension of 
■the program to public employees "was not considered feasible 
owing to insufficient supplies, j 
With reference to foreign supplies, it has been reported 
that Germany imported 900 Kilograms of pure Vitamin C from 
Bulgaria in 1941.-5 Bulgaria produces this from rose hips. 
Other reports Indicate that Germany imported 370 tons of rose- 
hip flour from Bulgaria in 1940, 1,500 tons in 1941, and 
between 3., 000 and 4,000 tons in 1942.4 
Lack of Vitamin D causes rickets, decalcification of 
teeth and bones, and sometimes even spontaneous fractures. 
Vitamin D can be produced by irradiating relatively small 
amounts of fish oil. Early in 1943 it was reported that two 
German chemists, Dimroth and Stockstrom, had succeeded in 
producing a synthetic Vitamin D. It is not known whether 
synthetic production is practicable, however,5 
Since the campaign against rickets had failed to give 
the desired results in Germany, the Minister of the Interior, 
in a circular of 9 November 1939, made arrangements for free 
anti-rachitic prophylaxis for each Infant.° All infants were, 
from the third month on, to receive Vitamin D in the form of 
synthetic "Vigantol," as prepared by the firms of Bayer in 
Leverkusen and Merck in Darmstadt, A phial of Vigantol was 
to be given to each mother with instructions to give her 
child 5 drops of the preparation daily. At the end of two 
months a second phial was to be-supplied, A final examina- 
tion was to take place after the second phial had been given. 
If signs of rickets were detected, the child would be trans- 
ferred for treatment to the family or insurance doctor. One 
IC-cc. phial of "Vigantol" costs the health offices 80 pf. 
The health offices would also have the opportunity of using, 
as sources of Vitamin D, either Irradiated milk or cod liver 
oil. If possible standardized. Milk is irradiated in some 
German cities, for- example, Frankfurt .-on-the -Main. 7 
1 Munchener.medlzlnlsche ¥ochenschrift, 4 September 1942;. 
Klinlsche WocHenschrlft, 4~October 1941, p. 992. 
2 Die Ernahrung, 7;85 (1942).' 
5 Munchener medlzlnlsche Wochenschrift, 29 May 1942, p. 506. 
4 M. A. report, MID, 51539, 5 March 1945. 
5 Social Demokraten, 20 February 1945. 
6 Bulletin of Hygiene 16:451 (l94l). 
7 Frankfurter Zeitung, 8 January 1945. 
(25443) "RESTRICTED 
As a result of this prophylaxis, it is reported that 
rickets did not increase in volume in 1942. The program "was 
continued throughout the following year with the modification 
that the amount of Vitamin D was gradually Increased, Whether 
this was intended from the beginnings whether increased pro- 
duction of the preparation was conducive to greater liberality, 
or whether the original.amount proved too small cannot be 
ascertained. The Vitamin D ’content of Vlgantol, which had 
been 3 Mg.'per 10 ccm., was increased to 5 Mg. in 1941. An 
especially potent preparation, "Vlgantol Porte," which is 
used for shock therapy, ’’whs then' to contain 10 Mg. per 1 com, 
instead of 7.5 Mg. Late in 1942 the daily application, which 
then was 5 drops of "Vlgantol", was increased to 10 drops and 
the total supply was'lifted from 2 to 3 phials. It is not 
unlikely that the increase in the strength of the mixture and 
its increased application is indicative of greater need for 
offsetting the lack of Vitamin D in the food. Officially it 
was stated in Germany that the distinction between the early 
treatment of rickets and the prophylactic application of 
Vitamin D _is frequently not feasible on practical grounds and 
that therefore the prophylactic dose was to be made equal to 
the therapeutic one.l 
There are reports of rickets among Danish, and 
Belgian? children. In Prance, there have been complaints 
that, in some cases,, teeth are brittle as glass. In Denmark, 
an examination of Copenhagen children indicated that every 
seventh child had. rickets. 4 a vitamin program was started in 
1943. Children below the age of 15 years and pregnant women 
are given a preparation called "Vitaminol," which consists of 
50 percent Danish medicinal; cod liver oil and 50 percent 
carotin oil containing 1,000 Vitamin A units per gram, with 
an addition of Vitamin D-2 oil containing.150 units per gram. 
This preparation is sold upon the presentation of ration cards. 
Five coupons entitle the holder to buy one eighth of a liter 
of "Vitaminol" per month, at the price of 43 oere. Needy 
persons .may obtain it'free'. It is distributed through the 
ordinary commercial'channels.5. 
Vitamin E is contained in the whole grain bread produced 
in Germany which retains the germs., and other components of 
the grain. Lack of this vitamin brings about miscarriage 
and Premature births, the number of which is increasing 
rapidly in parts of Europe. 
b. Caloric Deficiencies. It is not proposed to 
deal here with the food shortage in Europe as such but rather 
1 Relc.hsgesundheitsblatt, 1943, No, 7, p. 92; Wiener medlzin- 
ische wochens 9 January' 1943, p. 38; Deutsche medlzin- 
ische Wochenschrift, 29 August 1941, p. 962. 
2 OSS, CID, Censor Materials Summary 27, 1 May 1943,. p. 57. 
3 Gazette de Lausanne, 20 January 1943. 
* ' " / ■ ’ . . . ..., I,.'.. . ' . ....... . . 
4 Krlsteligt Dagblad, 23,. January 1943. 
5 Berllngske Tidende, 26 January, 1943. 
(25443) RESTRICTED 
with some of its symptoms. The Agriculture and Standards of 
Living Section of this Office has prepared estimates , of the 
1942-43 nutritive value of average diets in various countries. 
These estimates are as follows (in calories); 
Germany 
2,784 
Netherlands 
2,461 
Italy 
2,619 
France 
2,431 
Denmark 
3,283 
Norway 
1,980 
Bulgaria 
3,120 
Belgium 
1,713 
Yugoslavia 
2,620 
Albania 
1,420 
These figures are considerably higher than those reported 
for Germany during the First World War.-*- In Frankfurt-on-the - 
Main, calories of rationed foods declined as follows: 
Year 
Caloric value of 
rationed foods 
Highest value 
Lowest value 
1915 
3100 
2750 
1916 
2750 
12 50 ■ 
1917 
1400 
700 
1918 
1900 
1400 
1919 
2000 
1400 
There was then a concomitant decrease in weight, as 
Illustrated by the especially striking case of inmates of 
institutions. Inmates of a German jail showed the following 
decline in average weight (in kilograms): 
1914, July 
67.5 
1915 
59-66 
1916 
56-59 
1917* September 
52-56 
Though the food situation in Germany proper seems to be 
much more favorable now in terms of calories, it goes without 
saying that calculation in. these terms must be supplemented 
by a qualitative appreciation of the foodstuffs available to 
the population. This point of view has found expression in 
strong terms in the volume on German nutrition during .the 
First World War, The- expert of the Carnegie Foundation 
stated that caloric calculation must operate within limits 
set by psychological considerations. "Man needs a differen- 
tiated diet.. He is not served by receiving only the calories 
needed for the maintenance of life. Bn cannot live from the 
’heat value of the utilized food' as a machine lives from 
coal.... The practical solution of the food problem is not 
concerned with the supply of necessary calories but with the 
supply for the hungry population of bread, meat, potatoes, 
fat, milk, eggs, and vegetables as they are needed for the 
dally diet."2 if emphasis is placed on specific foodstuffs 
rather than on quantities of calories, the' present situation 
seems much less favorable. ,v The normal consumer in Germany 
1 F. Bumm, ed,, Deutschlands Gesundheitsverhaltnlsse unter 
erfl Einfluss des Weltkrieges, Ft*. 1, Stuttgart, Deutsche Ver- 
lagsanstalt, 1928, p. 72. 
2_ A. Skalweit, Die deutsche Kriegsernahrungsvirtschaf t, 
Stuttgart, Deutsche Verlagsanstalt, 1927, p. 10. 
(25443) RESTRICTED 
receives only a -weekly ration of 9 ounces of meat, 8 ounces 
of sugar,, 7f ounce's o.f fat, very little milk and occasionally 
an egg. The difficulties -which have been encountered are 
illustrated in a recent, article, in the Voelkischer Beohachter, 
Vienna edition, of 1 November 1942, -which states that the 
Viennese health authorities -were then dealing -with 250,000 
complaints. Prom this the conclusion is dra-wn that, apart 
from the several thousand patients ’-who -were in hospitals at 
that time, 250,000 Viennese -were in poor health. This means 
that every seventh person suffered from;some ailment or 
other. The only effective treatment is additional food such 
as meat, rice, eggs, butter, fats, full milk, and coffee, 
all scarce. 
The fact that children grow thinner is implicitly ad- 
mitted in Germany, but complaints about this phenomenon are 
held unjustified because it is "a normal event between the 
ages of ten and fourteen."1 Other reports speak of the 
"accelerated" development of some school children which is 
contrasted with the "retarded" development of others. "In 
urban school classes of the ages from twelve to seventeen 
one gains the impression that the various ages were mixed. 
Some appear almost adult while others look and behave like 
children. But they all are of the same age."2 It is also 
admitted that men over sixty occasionally suffer, a consider- 
able loss of weight "because in normal times all groups of 
the population enjoyed good A study of Leipzig 
school children concludes that the acceleration of the rate 
of growth, which has been observed since 1918, has now 
apparently ceased. The increase in average height and 
weight is not as great as "before. The increase in the weight 
of the older students of secondary schools is said to be 
unsatisfactory.4 
The situation in other parts of Europe varies. Vague 
over-all estimates which are commonly, reported often depict 
the conditions in the cities and the plight of the least 
fortunate part of the population. A competent observer 
suggests ■ that losses from. 15 to 2-5 kilograms are the rule in 
Europe.- Even in Switzerland losses of weight are very fre- 
quent. In Belgium and France pregnant women rarely attain 
the increase in weight of at least five kilograms which they 
should show at the time of the delivery; the growth of 
children is impeded, and the energy and working capacity of 
the adults deteriorate. 
1 Frankfurter Zeitung, 6 June 1943. 
2 Munchener Neueste Nachrlchten, 19 May 1943. 
3 Dan Reich, 21 March 1943. 
4 Koch, "Langen und Ge-wichte der Leipzlger Kinder im Kriegsjahr 
194-1, " Der of fentliche ■ Gesundheltsdienst, 1941, Pt. A, p, 609, 
5 Raymond Gautier, "The Deterioration of Health on the Con- 
tinent from Epidemics and Pood Shortage," London,■Royal 
Institute of International Affairs, 1942. 
(25443) RESTRICTED 
In Prance, a recent study of the health of -workers in 
Toulouse Indicates an average loss of -weight of 10 to 20, 
sometimes 30, percent of the previous -weight, -with a con- 
comitant Increase in industrial accidents owing to reduced 
physical endurance. The reduction in muscular resistance 
caused an Increased number of hernias.1 In Belgium, adults 
are reported to have lost an average of one--fifth of their 
weight.2 in Yugoslavia, the average loss of weight is said 
to be from 6 to 10 Kilograms.2 In Finland, men are said to • 
have suffered an average loss of weight of about 6 to 7 
Kilograms compared with 5 Kilograms for women. The land- 
owners have presumably been able to maintain their weight,# 
In Norway, people are reported to have suffered an average 
loss of weight of 10 to 20 percent.5 
A Swedish labor union leader who visited in Oslo states 
that approximately one third of the school children have a 
loss of weight from 10 to 20 Kilograms. Another third has 
shown a loss from 2 to 10 Kilograms. The remaining third has 
shown insignificant loss, and, in certain cases, a moderate 
increase in weight. 0 
In 1942, Doctors Jean Girard, Pierre Louyot and Marcel 
Verdin reported to the Academie de MecLecine of Paris the 
results of a study of the conditions of ninety persons, mostly 
workmen, chauffeurs, engineers, unskilled laborers and fitters. 
These people had complained of a progressive weakness which 
appeared on awakening in the morning. Increased during the 
morning hours and decreased after lunch. The accompanying 
vertigo sometimes gave the feeling of a cerebral vacuum and 
compelled the. person to lean against 'something or sit down. 
This condition resulted in incapacity to work, and certain 
patients had to go to bed.' They suffered nocturnal per- 
spirations and became -very sensitive to cold, even during 
the. sutfimer. This state was accompanied by psychic depression 
and apathy. In several cases their families sought confine- 
ment to an asylum, , Arterial hypotension was present, loss 
of weight and paleness of the skin, without any relation to 
the figures for the hemoglobin of the red blood cells. All 
the syndromes can be ascribed to the present food shortage. 
Various tests produced the following findings: an increase 
in bleeding time; a hypoglycemia below .85 percent in 70 
percent of the patients; a hyposcorbemia in 70 percent of the 
patients, the Vitamin C being below 8 Mg.; a mononucleosis 
in 58 percent of the patients; eoslnophilla.in 53 percent of 
the patients; a slight anemia in 25 percent.i 
1 L®. Petit Journal, 22 March 1943. 
2 OSS source, 31 October 1942. 
3 OSS source, 20 June 1943. 
4 OSS source, 8 November 1941. 
5 Befn T. (p) #363, 16 January 1943. 
6 OSS, CID #41102, 27 July 1943. 
7 Dres. Jean Girard, Pierre. Louyot, and Marcel Verdin, 
report to the Academle de medecine de,Paris. Journal of the 
American Medical Association 120:386-87 (3 October 1942j. 
(25443) If people lose a great deal of weight in consequence of 
food deficiencies, there occurs a replacement of the body 
weight by accumulation of water. If this process continues, 
the so-called famine oedema makes its appearance. This 
pernicious disease is symptomatic of the lack of protein in 
the blood and its progress can be arrested by animal protein. 
This disease was observed in Germany during the First World 
War but is not indicated in present reports. It exists in 
and Greece,2 An article describing the conditions 
of forty-eight Belgian who suffered from this 
disease states that the protein osmotic pressure varied be- 
tween 12 and 35 Ora. In 77 percent of the cases an abnormally 
low percentage of assimilation was evident. Bradycardia was 
a frequent appearance. The lowest pulse-rate was thirty- 
eight. Diuresis usually set in once the patient was in the 
hospital. The protein osmotic pressure hardly changes after 
the oedema has disappeared, and relapse occurs frequently 
when the patients leave the hospital. It is stated that 
relapse could only be avoided if the food supply were improved. 
As during the First World War, it seems that the inmates of 
penal institutions, hospitals, and the like, suffer most from 
malnutrition. A report from Indicates that in the 
Gaustad Mental Institution cases of oedema occurred in the 
fall of 1942 among the debilitated schizophrenic patients. 
Of some fifty cases about fifteen died following gastro- 
enteritis. From Medical Division B of the State University 
Hospital there are reports of ten to fifteen cases among 
forty-five nurses of the division, suffering from poly- 
neuritis (pains in the extremities, changes in reflexes, 
asthenia). They were cured by the injection of Vitamin B. 
Prom a private clinic there are reports of eight cases of 
oedema and.polyneuritis among nine nurses. From other 
sources among privately practicing physicians there are 
reports of sporadic occurences of oedema of unknown cause, 
particularly among women. Thus from Draramen Hospital there 
are reports of certain cases of famine oedema with reduced 
serum protein. In February 1943, a professor of medicine 
was admitted to a hospital with a similar pathological pic- 
ture. In whatever way these pathological symptoms are 
classified (famine oedema, avitaminosis, hypovltami.no sis), 
the lack of fat is considered an essential etiological 
factor. 
According to an investigation undertaken in an Oslo 
factory in May and June 1942, the symptoms of malnutrition 
include the following;5 
1. Peeling of hunger to a smaller or greater degree. 
Many are hungry "all day," hungry "immediately after the 
meals, "always hungry," "sc hungry that I cannot work the 
last hours before dinner," 
1 R* Weekers, "Symptomes oculaires de I’oedeme de carence," 
Ophthalmologlea 103:81-8? (February 1942). 
2 Dr. Elsa Segerdahl Persson, OSS, CID 38151. { 
5 Bulletin de 11 academle Royale de mecleclne de Belgique, 1942, 
4 Office of the Surgeon General of the Norwegian Public 
Health Service, Medical and Sanitary Data on Norway, Washington, 
D. 0., May 1943, T." 18. CID 3BB4T. ” 
5 Office of the Surgeon General of the Norwegian Public 
Health Service, Medical and Sanitary Data on Norway, Washington. 
D. 0., May 1943."CID 388477 PpT"l? f. 
(25443) 
% RESTRICTED 
2. General weakness, tired feeling, reduced capacity 
for work, endurance, initiative and physical capacity, is 
claimed to a smaller or larger extent by about 80 percent. 
Several reports from the country indicate that this is a 
generally occurring phenomenon.- From one factory it was 
reported that the capacity.for work was reduced 45 percent, 
and it is stated that this decline is certainly not ex- 
clusively caused by sabotage. 
3. Increased tendency to sleep is claimed by as many 
as 60 percent. Many state that they are able to sleep in 
streetcars or buses on their way home, many plunge headlong 
into the bed as soon as the evening meal is consumed, while 
others indicate that they certainly have a stronger craving' 
for sleep but that they do not sleep more than before. The 
nervous strain evidently also contributes to disturb the 
sleep and render it restless. 
4. About 9-0 percent indicate that they feel cold much 
more easily than before. This is said to be a well-known 
symptom of caloric undernourishment. 
5. Frequent urination is a strikingly common symptom. 
It is found in about 70 percent of the cases examined. The 
majority must get up once or several times during the night. 
This has been attributed to the increased water content of 
the food (potatoes, vegetables, soups, porridge, etc.). 
It is of interest that these symptoms have been observed 
almost as frequently in Individuals who have retained their 
weight as in Individuals who show the most marked emaciation, 
- ■, : / • 1 ... . 
Nutritional experts state the following manifestations 
of the deficient food situation in Norway under the occupa- 
tional regime: 
1. Locally in the gastro-intestinal tract: 
a. An increase in pathological-anatomical-organic 
disease like gastro-duodenal ulcer, cancer, etc, has not been 
demonstrated with certainty. 
b. A considerable increase in functional gastric 
dyspepsia is probable. - 
c. A considerable- increase in diseases of the 
colon, from-'minor pains in the abdomen to fermentative 
dyspepsia and secondary colitis has been demonstrated with 
certainty. 
2. After absorption from the gastro-intestinal tract; 
a. Quantitative subcaloric feeding with emaciation 
hunger and reduced-working capacity is present. : 
b. Qualitatively deficient feeding-has. caused ;.an 
increase in B avitaminosis (Beri-Berl, Aribeflavinose. 
Pellagra). Avitarainosis (hemeralopia) and scurvy has been 
reported, but definite clinical evidence has been lacking in 
most cases. 
1 Rote the corresponding complaints of tiredness 'in Germany, 
PP. 63, 64, below. 
(25443) RESTRICTED 
a 
A marked increase in the number of cases of acute 
diarrhe:a is considered, to be the result of quantitatively 
and qualitatively deficient diet." While in normal years 
a sharp decline in the numbers of cases is observed during 
the winter months, no such decline occurred in 1940 and, 
from the month of August, the incidence continued to be high 
also in the winter months, with a reported 5,693 cases for 
the month of April, as compared to a normal number of .1,419 
cases in April 1940. The largest number of cases was ob- 
served in August 1941, with more than 14,000 cases, which is 
more than half of the total number of cases reported for the 
entire year of 1939. The last three months of 1941 showed 
a definite decrease, but the figures for January-October 1942, 
indicate another considerable rise. 
c. Alcoholism, nervous disorders, fatigue. There 
are no indications that alcoholism proper has made any headway 
during the war and the supply situation is undoubtedly 
responsible for this. During the First World there was 
a considerable decline of alcoholism in Germany. In Prussia, 
the proportion of patients admitted to institutions because 
of alcoholism declined from 10 percent of all admissions in 
1913 to 2 percent in 1918. 
During the First World War there occurred, on the other 
hand, a great increase■in the consumption of narcotic drugs. 
People became addicted to morphine and cocain after having 
had occasion to try it, and the opportunities of trying it 
increased because of the large number of wounded and the 
large number of health personnel who had access to drugs. 
Mental depression and the lack of variation and stimulation 
in the food supply increased the dependency upon these drugs. 
Between 1914 and 1918 the proportion of drug addicts doubled 
among the patients admitted to institutions in Prussia. 
In the present era of Ersatz it seems that people have 
recourse to dangerous drugs. Morphine and cocain are more 
difficult to obtain and people have become accustomed to less 
harmful insomnia powders, hypnotics, and the like. The con- 
sumption of barbiturates and other sedatives has‘increased 
sharply,2 especially during air raids. Such drugs are no 
longer available freely and can be procured only on pre- 
scription, + The apprehension of the authorities is reflected 
in the establishment of a Reich Institute for Fight Against 
Abuse of Narcotic Drugs (Reichsmeldestelle fuer Suchtglft- 
bekaerapfung) which is designed to prevent a development 
similar to that during the First World War.5 German,medical 
1 Medical aM Sanitary Data-on Norway, p. 36. • ' 
2 F. Bumm, ed., op. Pit., p. 266. 
2 ' Journal of the American Medical Association, 114:1385 (6 
April 1940), 119:1124 (1 August 1942). 
4 Bulletin of Hygiene 16:432 (l94l), 
5 Munchener medizinische Wochenschrift, 23 October 1942, 
p, 922. 
(25443) RESTRICTED 
journals still contain numerous articles on the abuse of 
pervitin.This drug, which is now placed on the narcotics 
list and is, no- longer freely available, used to be issued 
by the Army and Air Force for the purpose of stimulating and 
strengthening the power of endurance. It was widely used by 
the civilian population. Persons became addicted to it and 
undesirable effects such as hallucinations, insomnia, ex- 
haustion, and collapse appeared. 
Recent reports point out that air raids have produced 
specific nervous disorders (Luftmlnenpsychose) such as 
trembling, nerve irritation, and hysteria. At the siren’s 
sound many people are reported to have a 'feeling of suffoca- 
tion, heart pains and a feeling as if the whole body were 
heavy as lead,"2 
German medical Journals contain articles on fatigue to 
an extent which must be characterized as striking. Overwork, 
haste, and restlessness also cause many cases of insomnia. 
With respect to specific physiological consequences of 
psychic disorders, such items as premature births and stomach 
troubles are mentioned. 
It is interesting to reproduce synoptically parts of 
two papers on nervous disorders. The first refers to 
World War I and was written by Professor Bonhoeffer some 
later. The second is part of a recent article in the 
Muenchener medizlnlsche-Wochenschrlft. 
World War,. 1? : • World War 11^ 
"The.influence of the war "In a time of the highest 
upon the nervous system of the '-physical and intellectual 
population was most powerfully strain we observe a number bf 
expressed during the second half pathological phenomena which 
of 1916 and during 1917 and 1918. are in part novel, in part. 
1 H, Greving, "Psychopabholbgische und korperliche Vorgange 
Dei jahrelangem Pervitinmissbrauch," Nervenarzt 14:395 (194l); 
P, Wunderle, "Experimentalpsychologische Untersuchungen uber 
die Wirkung des Pervitin auf gelstige Leistungen," Archly fur 
Psychlatrie 113:504 (l94l); J. E. Staehelln, "Pervitin-Psychose," 
Z. Neur. 173:598 (1941); H. Druckrey, "Weekmittel,M Medlzlnische 
Klinik, 1941, p. 885; H, Auerwald and R. Briken, "Gefahren des 
Pervitinmissbrauches, " Medizlnlsche Veit, 1941, p, 897; P. 
Dittmar, "Pervitinsucht und akute Pervitinintoxikation," 
Deutsche medizlnlsche. Wochenschrlft, 13 March 1942, p. 266. 
Also OSS, GID, Censor Materials Summary 27, 1 May 1943, p. 30; 
OSS, CID 35939, A-6191, 5 June 1943. 
2 Stock. (P) #2051, 3 July 1943. ' ’ V ' 
3 Bumm, P., ed., Deutschlands Gesundheltsverhaltnisse unter 
dem Elnfluss des Weltkrieges, Pt. 1, Stuttgart, Deutsche 
Verlagsanstalt, 1928, p. 261, 
4 M. Hochreln and I. Schleicher, "Chronische Ermiidung als 
Krankheitsursache, 11 Munchener medizlnlsche Wochenschrlft, 
16 January 1942, p, 47. 
(25443) RELTKlOTEU 
On the subjective side, 
there were noted complaints 
about the growing difficulty 
and slowness in accomplishing 
intellectual and physical 
work; quick fatigue; diffi- 
culty in concentrating and 
in finding the right word. 
Objectively there was 
among many persons a certain 
restlessness and increased 
irritability; increased sug- 
gestibility; increased need 
for sleep, with the sleep 
often being restless and dis- 
turbed by dreams," 
however, so numerous in their 
appearance that we probably 
have to associate them with 
the rhythm of our time. What 
we have in mind are sick peo- 
ple of all social strata who 
have to perform lengthy tasks 
in responsible positions. 
Complaints about fatigue 
and general weakness are 
heard. Men, who always en- 
joyed the best health and 
displayed excellent ability, 
complain that they are unable 
to perform their previous 
work. There is a general 
heaviness of the body. After 
little strain they are easily 
tired. Frequently there are 
complaints of permanent tired- 
ness. This tiredness cannot 
be overcome by means of strain- 
ing all of their energy. To- 
gether with this feeling of 
weakness there is a deteriora- 
tion of the power of intel- 
lectual concentration. Often 
thoughts can be worked out 
only with great effort. Often 
there is a feeling’ of emptiness 
in the brain. At the same time 
the men suffer from an inner 
restlessness," 
The similarity of the symptoms is striking indeed. The 
restlessness, it is pointed out in the 1942 article, makes 
it difficult for the persons to accomplish work which requires 
some time. Often these symptoms are combined with complaints 
about a disturbance of the functions of specific organs such 
as the digestive apparatus, the circulation of the blood, the 
brain, etc. In the Leipzig clinic of the authors, stomach 
ulcers and Inflammations of the stomach increased from 695 to 
1190 cases; high blood-pressure from 657 to 957] especially 
prominent was the increase- in vague organic complaints 
(heart, stomach. Intestines, head, etc.) from 459 to 1790. 
"Relatively young persons, who had been on the peak of their 
Productive capacity, suddenly die from acute heart failure..,. 
Angina pectoris is extremely frequent,... The number of 
patients with vague complaints who previously used to be 
referred to as neurasthenics has grown very much.,,. Chronic 
fatigue represents the transition from health to sickness. 
the working man who collectively represents the labor and 
military strength of a people is not treated with care, if 
this high good of a people is utilized in a predatory manner, - 
then diseases appear which develop out of functional distur- 
bances and become serious organic changes,"! 
Food as a Cause of Disease 
Food Poisoning. The statistics of reportable diseases 
do not indicate a significant increase in ptomaine poisoning. 
1 ET;_ Hochreln and I. Schleicher, "Chronische Ermiidung als 
Krankheitsursache, " Mlinchener medizinlsche Wochenschrift, 
16jJanuary 1942, p. 
(25^3) RESTRICTED 
The following table presents the data for ptomaine poisoning 
in Germany from 1936 'through 1942. The figures cover the 
expanding territory of the Reich during the period. 
Year 
Number of 
Number of 
Cases per ten 
Deaths per 
cases 
deaths 
thousand 
Inhabitants 
hundred 
cases 
1936 
3,675 
77 
.55 
2 
1937 
2,354 
95 
.35 
4 
1938 
2.572 
90 
.38 
3 
1939 
2,063 
63 
.30 
3 
1940 
3,158 
121 - 
.35 
4 
1941 
2,255 
84 
.25 
4 
1942 
1,940 
83 
.22 
4 
With reference to the consumption of poisonous meat, 
there is, however, evidence that the figures do not reflect 
the true situation.-- There were 2,684 cases of meat poisoning 
in 1940 compared with 2,221 in 1941. Deaths due to meat 
poisoning declined from 84 to 10. It is, however, pointed out 
that "this favorable status has presumably been influenced by 
the fact that owing to war conditions all cases of meat poison- 
ing did not come to the knowledge of the authorities." As is 
pointed out in the article, cases of poisoning caused by meat 
resulting from forced slaughter (Notschlachtung) have Increased 
in absolute and relative terms. 
In German medical literature occasional references can 
be found to cases of poisoning due to the consumption of 
poisonous substances in place of fat,2 of late, such occur- 
rences seem to have become more numerous. Recently it was 
pointed out in the German press that oils for technical 
purposes of all kinds must not be used for the manufacture 
of food and for cooking. It is stated that they are a 
serious danger to health and that even the consumption of 
small quantities of fat mixtures containing technical oils 
may have serious consequences. People are urged not to use 
technical oils to prepare food or even to grease baking tins.-5 
In connection with the consumption of poisoned food it 
is interesting to note that the authorities in 1943 found it 
necessary to urge against the widespread application of 
artificial color to foodstuffs.4 it was pointed out that 
this practice must be reduced since medical authorities have 
expressed apprehension of the adverse effects upon the health 
of the population. > 
-I R. Meyer, "Zur Statistik der Fleischvergiftungen im Jahre 
1941, " Zeitschrift fur Fleisch- und Mllchhygiene, 15 October 
1942, pp. 11 ff. See also R. Meyer, nZur Statistik'"der 
Fleischvergiftungen im Jahre 1940," Zeitschrift fur Fleisch- 
und Mllchhygiene 51:301 ff., 318 ff / (1941). " 
2 P, Humpe, "Vergiftungen durch den Gebrauch eines "Fetter 
satz"-Stoffes (Orthotrikresylphosphat)," Miinohener medizinische 
Wochenschrift 1942:448, 
3 DNB, 30 June 1943. 
4 Relchsgesundheltsblatt, 3 February 1943,, p. 59. 
(25443) RESTRICTED 
Cases of food poisoning are not infrequently reported in 
the press of the German-dominated countries of Europe. How- 
ever, it is difficult to give statistical evidence of an 
Increase. In the absence of such evidence, it may be pointed 
out that organized efforts can occasionally be observed, 
which are designed to reduce the risks resulting from the 
consumption of dangerous foodstuffs. In April 1943, the 
Belgian Braille Association felt it its duty to draw 
attention to the dangers of drinking alcohol or liqueurs, 
the origin and composition of which are not expressly guaran- 
teed. This association pointed out that cases of blindness 
had come to its attention which had been caused by the con- 
sumption of adulterated liqueurs.! Other information from 
Belgium indicates that it is now permitted to sell certain 
sugar substitutes which were formerly regarded as injurious.2 
2. Meat Inspection. The standards governing the in- 
spection of meat have been much relaxed in Germany.5. Accord- 
ing to amendments to the meat-inspection legislation, it is 
no longer possible to certify meat as inferior merely because 
of tuberculosis. To certify such meat as inferior, other 
factors must be present -which have resulted in a "considerable 
decrease of the nutritional value of the meat," This ne¥ 
regulation has stimulated much criticism on the part of 
veterinarians. It is pointed out that a conscientious veter- 
inarian is now forced to feign the existence of such additional 
factors (as for example, wateriness) in order to certify meat 
from tuberculous animals as inferior. Such additional 
factors rarely are consequences of tuberculosis and. the 
statistical picture resulting from such practices becomes 
misleading. 
In view of these factors and other changes in the legal 
procedure governing meat inspection, a comparison of tuber- 
culous cattle statistics for the past few years is of limited 
value. The Swiss press reports that according to German 
agricultural papers 31 percent of all cattle in Germany are 
Infected with tuberculosis. At the Berlin slaughter houses, 
the largest of the Reich, seizures (certifications as to 
conditional suitability) because of fresh tuberculous in- 
fection of the blood were.: * * 2 
1 ’Le Soir, 6 April 1943. 
2 Ne^s from Belgium, 22 May 1943, p. 165. 
3 Dr. Gurgen, "Die Auswirkung der neuen Tuberkulosebeurtei- 
lung in der praktischen Flelschbeschau," Berliner und Munchener 
tierarztllche Vochenschrlft, 29 May 1942, ppV 173 ff.; Heine, 
Zur MVerwertung des bedingt tauglichen Rlndfleisches, " Deutsche 
tierarztllche Wochenschrift 1941 ;l87; E. Schurmann, r,Streifziige 
durch das neue Reichsflelschbeschaugesetz," Deutsche Schlacht- 
hofzeitung 41:315 ff., 329 ff. (1941): F. Schonberg, "Zur Minder- 
wertigkeitserklarung des ganzen Tlerkorpers bei ausgedehnter 
Tuberkulose," Deutsches Tierarztebjatt 8:101 f. (l94l); Alexander 
CerkownyJ, "Zur Fleischbeurteilung tuberkul8ser Schlachttiere," 
Zeitschrlft fflr Fleisch- und Mllchhyglene 52:217 ff. (1942); 
Dr, Scheers-Essen) "Ci'e Beurteilung der Tuberkulose nach dem 
neuen Pleischbeschaugesetz," Deutsche Schlachthofzeitung, vol. 
42, no. 8 (1942). *■ 
(25443) Year 
Confiscations per ten thousand cattle 
1939 
77.94 
1940 
19.16 
19^1 
60.33 
In the explanation of these figures, reference is made to 
changes in the law, improved methods of diagnosis, and 
decreased resistance to tuberculosis owing to difficulties 
in the supply of fodder. The relaxation of the treatment of 
such cattle finds its best illustration in the decline of the 
number of certifications as to inferiority of the meat be- 
cause of extensive tuberculosis and tuberculosis of the bones. 
As pointed out before, such certificates are only, granted 
under the new regulations if the meat shows substantial 
additional-deficiencies. The figures (per 10,000 head of 
cattle,.Berlin slaughter houses) are as follows: 
Year 
Certifications ..per ten thousand cattle 
1939 
178.58 
1940 
127.31 
1941 
46.4 
Taking both sets of figures together, certifications of 
tuberculous meat declared from 146,4-7 in 1940 to 106.73 in 
1941. While in 19;.0 76 percent of tuberculous cattle was 
certified as inferior or conditionally suitable, only 56 
percent of tuberculous catble was so certified in 1941, 
In the case of hogs, figures indicating seizure because 
of acute miliary tuberculosis have increased. Taking the 
Berlin slaughter houses again, the following number of 
seizures occurred: 
Year 
Seizures 
average 1933-39 
2.09 per 10,000 
19;+0 
2,52 " ,r 
192n 
6.88 " 
The increase is attributed to better methods of diagnosis as 
well as to more frequent infections and decreased resistance 
ouing to the lack of albuminous feed and the considerable 
lengthening of the time of fattening. On the other hand, 
the total number of seizures of hogs declined from 12.88 in 
1940 to 6.88 in 1941 in view of relaxed standards. 
5. Control and Inspection of Dairy Products. There is 
considerable complaint about the quality of milk in Germany, 
Dr. Leonardo Conti, the chief of the Nazi health organiza- 
tion, has pointed out: "We can clearly notice that the 
pasteurization of the milk does not sufficiently prevent the 
bovine tuberculosis of small children,... More strongly than 
before we must start with the fight against tuberculosis at 
the cattle itself, Three months later, however, the 
Relchsgesundheitsblatt published an order providing for the 
termination of the organized procedure for the fight against 
1 Leonardo Conti, "Die Bedeutung der Wissenschaft, insbesondere 
der klnder&rztlichen, in der Gesundheitsffthrung," Deutsche 
medizinische Wochenschrlft, 16 January 1942, p. 57* 
(2 5443) bovine tuberculosis in its voluntary form,1 The killing of 
sick cattle by ord'er of the police is restricted, and the 
elimination of dairy cattle because of high probability of 
tuberculosis "-will be possible only in extremely rare cases. 
It is not intended to make any further amendments to these 
regulations during the -war,” No wonder that a few months 
later still a veterinarian complains: "The fight against 
tuberculosis of cattle has at present in no way advanced far 
enough to guarantee the population a supply of milk from 
healthy cows safely free from tuberculosis. Other bacteria, 
for example typhoid or coli bacteria, may be found in the 
milk."2 
Another veterinarian is apprehensive of the danger of 
technological developments which not always are compatible 
with the requirements of hygiene. This is especially pointed 
out with respect to the sterilization of milk.5 Food also 
gets spoiled In order to enable the seller to circumvent 
regulatory measures applying to food in normal conditions. 
A report from.Prance refers to the case of persons who delib- 
erately treated 18,000 Kg. of cheese until it aopeared to 
have gone mouldy,■in order to withdraw it from the ordinary 
market and to sell it at a high price on the black market.4 
1 Reichsgesundheitsblatt, 22 April 1942, p. 332, : 
2 ■ Dr, Catel, Deutsche tlerdrztliche Wochenschrift, 9 May 
1942, p. 2i5. ; . ' 
3 K. B. Bruggernann, "Milchwirtschaft und Milchhygiene," 
Berliner und Mdnchener tierdrztliche Wochenschrift, l6 
October pp.' 309 ff: 
4 Transocean, 16 January 1943. 
(25^3) RESTRICTED 
HI* THE SUPPLY OF MEDICAL FACILITIES 
This section treats the supply of medical facilities in- 
Germany and Axis Europe, particularly ‘ the decline in quantity 
and quality of personnel, the deterioration of hospital and 
recreational-travel facilities, and the relatively tight 
position with-respect to drugs and medical equipment. It should 
be borne in mind, while reviewing the evidences of the short 
supply of medical facilities, that the requirements have also 
risen sharply, as indicated in the previous section. 
A. Quantity and Quality of Personnel 
1* Declining Number of Doctors. The following 
compares the population of various areas of Germany and Axis 
Europe with the number of doctors theoretically available early 
in 1942; 
Territory 
Population 
Number of doctors 
Germany, including Austria, 
(thousands) 
Sudeten territory, Merael, 
Danzig, incorporated 
Polish territories, Eupen- 
Malmedy • • 
95,162 , 
76,98? 
Alsace-Lorraine 
1,906 
- - ,717 
Luxemburg 
301 
,180 
Protectorate Bohemia-Moravia 7,700 
*567 
Total ♦ • 
105,069 
78,447 
This tabulation indicates the number of doctors who would be 
available in peace-time. With the exception of 1,400 young 
doctors who were called to military service immediately upon 
the termination of their education, the tabulation gives no 
indication of the number of doctors who have been absorbed by 
the armed forces. On. the other hand, it includes approximately 
7,700 doctors who because of age or for other reasons were not 
practicing when the census was taken. Thus, 70,747 doctors 
were .available for the medical care of a population of 105,000,000 
as well as for medical service with the armed forces. 
An estimate of the number of doctors available for the civilian 
-population requires that we first estimate the number of doctors 
in armed service. The latter may then be subtracted from the 
total number of physicians, and the difference will be a rough 
approximation of the number of doctors available for the civilian 
population*^ 
1. E. van Kann, "Die Zahl der Aerste 1942'und ein Ruckblick bis 
1957," ' Deutsches Aorzteblatt, 15 September 1942, pp,300' ff, 
2. There are about 2,400 modical officers in Army, SS, Police and 
Labor Service, who are not included in ‘the preceding tabulation, 
and there are also the 1,400 young doctors who went into the armed 
forces without ever practising* The mst of the doctors who serve 
with the armed forces must bo estimated. 
(25443) In the United States the armed forces absorb approximately 
one fourth, or 45,000, of the 180,500 physicians listed in the 
American Medical Directory. This leaves 135,500 physicians for 
a population which, including the members of the armed forces, 
totals' 131,500,000, or, roughly, 1 physician for every 1,000 
civilians, 
In view of the size of the German military establishment 
and of the number of casualties, the number of doctors which 
the German armed forces have taken from the reservoir of 
doctors available for armed and civilian population must be 
considerable, and may not fall far short of the number of 
American doctors serving with the American armed forces. In 
the light of the reported employment of foreign doctors from 
the occupied countries, this number may be estimated at between 
30.000 and 40,000, but it may easily be higher.! On the basis 
of the minimum estimate of 30,000, this would leave for a total 
population (including the military) of 105,000,000 a total of 
43.000 doctors, while the maximum estimate of 40,000 would 
leave them with 33,000, This means that, compared with the 
United States where there is 1 physician for every 1,000 
civilians, in Germany there is only 1 doctor for every 2,000 
to 3,000 civilians (2,400 to 3,100, if no allowance is made for 
a reduction of the population by the men in the armed forces).2 
How does this compare with the ratio of doctors available 
for the German population in the pre-war era? In 1938 there 
were roughly 50,000 doctors in Germany proper with its popula- 
tion of 69,000,000. There was thus 1 doctor for every 1,400 
people. In other words; while in the pre-war era the ratio 
of doctors in Germany was considerably less favorable than it 
is even now in the United States,.the situation has deteriorated 
in war, and is now such that physicians must be under great 
strain. This is illustrated by a .large-body-of evidence, which, 
in turn, documents the decline in the quality of the medical 
personnel. 
1, In the fourth year of the First World War, there -were 26,000 
doctors with the German Army the strength of which then was 
8,000,000, This does nj)t include the medical personnel of the 
Wavy, Sanlt&tshericht uber das Deutsche Heer ira Weltkrlege 
1914-18, Vol. 3* The German military forces may now be 
in the neighborhood of 9*000,000. 
2. Estimates of the London Times as reported in the Journal of 
the American Medical Association 120:855 (l4 November 1942) in- 
dicate a ratio of 1 doctor for every 12-15,000 people. A ratio 
of 1 doctor for every 1-2,000 people is also said to have been 
calculated by an alleged expert of the Reich Chamber of Medical 
Practitioners in February 1942 (OSS, CID. 27473, 27 January 
A recent article in the Economist (nGermany!s Health," 6 Februaiu 
1943* PP. 180 f.) states that "less than one doctor is, on the 
average, available for every 10,000 of the civilian population," 
These estimates may be based upon a number of doctors reduced by 
those employed by the various organizations providing collecti- 
vized medical care. The estimates presented in the text Include 
these physicians, ... 
I i 
(25W3) RESTRICTED 
2, Conditions of .Medical Practice. The shortage o'f medical 
personnel finds expression in a greater preponderance of women 
doctors, whose number is 40 percent higher than in 1939, and in 
the undue proportion of doctors who practice notwithstanding their 
age. Swedish newspaper reports indicate that there are about 300 
doctors aged 80 and over and 5,000 aged 70 and over in practice in 
Germany,4 The Hamburger Fremdenblatt cites a 93-year-old eye- 
specialist, Dr, Karl Hauptmann, who has resumed practice in Kassel 
as locum tenens for a younger colleague,2 Dr. G-oebbels states that 
in some parts of the Reich one-third of the normal number of 
physicians performs more work than the normal complement did in 
peacetime,5 Most doctors are said to have twice as many patients 
as in normal times. One doctor frequently deals with from 100 to 
150 patients per day.4 The situation is well illustrated in 
intercepted letters from Germany, In a letter from Querscheid, a 
doctor complains that he has 120 appointments oer day,5 Apart 
from other work, a sur’geon in' Linz on the Danube performed 900' 
operations in six months, including 111 stomach, 26 gall stone, 
28 goitre and 300 appendicitis operationse6 No wounder that Dr, 
Conti, the Reich Health Leader, has set' a lower criterion in 
assessing health. He states: "These hard times must have their 
influence on medical advice, too. Peacetime usages must no longer 
apply today,"7 
In view of the growing scarcity of medical personnel, the 
authorities have made efforts to relieve physicians from certain 
routine jobs. The inspection of the state and communal health 
offices, which normally took place every three years, has been 
postponed until after the war,8 Officials are urged to be 
economical in their requests for medical examinations of the 
public,9 Women desirous of marrying a member of the armed forces 
no longer need a special medical certificate; that certifying to 
their general physical fitness for marriage suffices.40 The same 
rule applies to applicants' for marriage loans,11 
1, Sydsvenska Dagbladet. 23 May 1943, 
2, Hamburger Fremdenblatt. 10 January 1943. 
3, Das Reich; quoted in Bern T, (P) 14 January 1943 #307. 
4, OSS, CID 27473, 27 January 1943; Das Reich. 21 March 1943. 
5, Letter from 10 November 1942, Canadian Postal Censorship, 
Periodical Diary No. 22, 
6, Letter from 19 July 1942, Canadian Postal Censorship, Period- 
ical Diary No, 12, 
7* DNB, 22 February 1943. 
8. Munchener medizinische Wochenschrift. 13 March 1942,.p, 252, 
9. Reichsarbeitsblatt. Pt, V, 15 June 1942, pi 323 
Re ictus gesundheitsblatt. 16 September 1942, p. 673, 
10. Munchener medizinische Wochenschrift. 10 April 1942, p, 344, 
11. Deutsche medizinische Wochenschrift, 27 February 1942, 
(25443) RFLTRKJTFD 
3. Collectivization of Medical Services. These measures 
of rationalization are supplemented by the growing collectiviza- 
tion of medical services. Most important in this respect is 
-the-Increase ;in the provision of medical care in factories. The 
institution of the factory doctor!, it is pointed out, promotes 
economy in that workers can obtain medical care in the factory; , 
■no time is lost in visiting and waiting for the doctor, and 
absenteeism, loss of working hours and output are kept at a 
minimum, • On 31 December 1942, a total of 268 full-time and 
4,069 part-time ’’work doctors" were responsible for a total 
of 5*800 factories.. This is chiefly a wartime arrangement. 
The increase since the outbreak of the war has been 26l full- 
time and 3*080 part-time work doctors,. Part-time work doctors 
care for about 1,200 workers, while one full-time work doctor 
:is in charge of factories employing from 2,000 to 6,000 workers. 
Such doctors are especially useful in view of the strain under 
which the call for” increased output places all workers ■ and in 
•the face of increasing employment of women workers and partly 
disabled persons.* The quality of the medical care - provided 
by the work doctors is, however, a poor substitute for that 
provided by the family physician or, for that 'matter, the 
physician of the sick-funds, to which the overwhelming majority 
of German workers used to have recourse for medical attention. 
German newspapers praise the "efficiency" of the work doctors 
and it is said that one such physician handled 25,000 cases in 
a single year. 
Further evidence of the collectivization of medical care 
and the resulting economy-i-s the-large number of doctors em- 
ployed by numerous public and party organizations.2. The Nazi 
state is said to have established 1,100 health offices with 
12,600 doctors. Another 1,100 doctors are reported as working 
for the various labor authorities; another 670 are employed by 
the German Labor -Front. 3*000 doctors attend to the Hitler 
Youth. Venereal disease and tuberculosis are fought in 1,300 
special offices, and the "Mother and Child" organizations have 
63*000 advisory agencies. Thus a large proportion of physicians 
is attached to public or -semi-public bodies which provide med- 
ical care for collective entities; the number of doctors who 
remain available for individual medical care may be still smaller 
than was indicated by the overall ratio of available physicians 
and population given above, • • , 
4. Difficulties in Obtaining Medical Care. Free access 
to doctors is limited for the population at large and even more 
so for special unfortunate- groups. Persons who approach a phy- 
sician for medical care without good reason are now punished by 
the courts on the ground that their action .constitutes a public 
nuisance.3 Country people are requested in case of illness to go 
' 1. 22 February, 17 April 1943; DNB, 22 February 1943; 
Leipziger Neueste Nachrichten, 29 November 1942, 
2. Journal of the American Medical Association 122:239 (22, May 
. 1943); Das Reich, 4 April- .1943. According to another source,,' 
German physicians attached to the Labor Front examined 
workers, This would indicate a ratio of 1 doctor for every 
373,0*00 workers! Dr. Gobbels, in Das Reich, Bern T, (P) #307, 
14 January 1943. 
3. Wiener medizinische Wochenschrift, 23 January 1943, p. 76, 
(25W5) RESTRICTED 
first to the district nurse who if necessary will call a 
doctor.! Physicians are ordered not to allow direct contact 
with patients who have failed to report to the appropriate Ichor 
official before consulting a doctor.2 Some reports indicate that 
special permissions must be obtained before physicians may be 
called and that such permissions aro granted only to those persons 
who arc. valuable to tho war effort. Most pitiful is the plight 
of foreign workers. Tho Department for People’s Health in the 
Gauleitung pommorn writes:5 ’’Poles can only got leave for medical 
treatment in particularly serious eases. It is not suitable 
that. In view of the groat number of claims made upon pur doctors’ 
time, our comrades (Volksgonosson) should give way to Poles. 
Doctors must not pay unnecessary visits to poles and thus, as so 
often happens, withdraw important assistance from VoIksganossen. 
Every employer must, therefore, know'’ that only in the most urgent 
eases may doctors be called in for the Poles, and even then e re 
only at his disposal if tho doctor has nothing else to do. Poles 
may not be in the same waiting room' as German patient's, "but must 
wait apart and (if seen at all) will have special times in the 
week reserved for them*1,4 However, neglect of the health of 
special groups within the population is bound to affect tho 
health of the population at large, as is illustrated in Other 
parts of this report. Tho spread of diseases caused by such 
neglect is of considerable importanceparticularly in view of 
tho relative immunity of tho neglected part of the population, in 
this ease the Poles, and the greater sensitivity of the remainder. 
Doctors now are no longer occupied with tasks which in 
normal times were regarded as their normal function. An ever- 
■ worked physician proposes to permit nurses and technical 
assistants to administer intravenous injections and to bleed 
them, a. procedure which normally is frowned, upon by the law 
courts, and nodical■expertsAbout -75 percent -of all 'child- 
births arc'now attended by midwivos unaided by doctors.^ 
1. Bremer Nachrlchton, quoted in Journal of the /onericon Mcdica 1 
Association 119*1440 (22 August 1942# ]~ " 
{?■* Berliner Borsenzeitung, 16 February. .1943« 
3. 0-stsoo-So j. tdng und STto tfiner Gcno.ra 1 anzoi g-o-r, 1 ■ January-1942 • 
4.. In an intercepted lo.tto.r a doctor from Pomerania writes about 
* the ’Rforcig'n rabble’* he has to deal with: Polos, Lithuanians, 
Russians , Ukrainians , Czechs , French, Dutch, ’’Unfortunately,11 
he states, Mthe Gorman has not learned to- wield the ■ well-tried 
old slave-whip, and spoils the. rabble with X-ray examinations, 
ultraviolet rays, electric cardiograms and similar-aohiovoiilcnts 
of modern medicine. I cut things short with two unmistakable 
gestures: either that of shooting or that of hanging - it works 
quickly and empties the consultation room better -than a vacuum 
cleaner.11 OSS, CID 58626. 
5. R. ‘Goldliahri, ,rDurfoii Schwesto'm und Labor-ahtinnen intravonoso 
Blutentnahmon und Einspritzungen vornehnon?” Modizinischo Welt, 
1942, No. 1. 
6, DNB, 14 April 1943# 
(25443) RESTRICTED 
Radiographic examination of the population for tuberculosis 
has had to be restricted in view of personnel requirements*1 
The rules providing for the exclusive application of X-ray 
treatment by physicians have had to be relaxed.2 
5. Future Prospects* There are poor prospects for a speedy 
relief from the shortage"of medical personnel. The educational 
policies of the Nazi regime fit into the general pattern of 
preparation for a war of short duration. With all efforts 
concentrated on this aim, long-term considerations had to bo 
neglected® Correspondingly there occurred a sharp reduction in 
the number of high school and college students during the 
'thirties, illustrating the high valuation which was placed upon 
presently utilized manpower as compared with a training which 
would bear fruits only in the more remote future. The present 
increment of doctors is reported by Nazi authorities as 3,000 per 
yearS and this may just suffice to compensate for the natural, 
regularly occuring decrease* 
6. Shortage of Nurses. Among non-professional medical 
personnel there exists a severe shortage of nurses. According 
to an order of the Minister of the Interior of B July 1942, 
nurses and technical assistants and sub-assistants arc now 
allocated centrally by the health organization of the 'Reich to 
-the various institutions and places of employmenth1 The training 
period has been shortened:5 however, the Minister of the Interior 
found it necessary to make representations directed against undue 
curtailment of training and education in view of war conditions. 
It is also urged that nurses in hospitals be employed only for 
jobs which actually require nursing training and experience 
7• Conditions in Other European Countries. The supply of 
doctors In other parts of .Europe has shrunk to a similar-extent. 
There -is, first, the claim, which Germany has made upon foreign 
medical personnel and facilitios. Doctors in Denmark, Hungary, 
1. ' Dr. Bullcrdiok, "Die Aufgabcn dcs Amtsarztos in Kriogo,11 
Me dlz inis die Kllnik, 3 July 1942, pp • '"635 ff. 5 Munchoncr 
mcdizinischo Wochonschrift, 2 October 1942, p. 86Q* 
2• Wiener klinische Wochenschrift, 18 December 1942, p* 1019. 
3. Berliner Bo r s c nz o itung, 25 May 1942. 
4. Klinische Wochenschrift, 12 September 1942, p.„328. 
5. Frankfurter Seitung, 16 December 1942. 
r 1 —^ 
6. Roichsgesundhcitsblatt3 June 1942. 
7. Klinische Wochenschrift, 5 September 1942, p. 80*4# 
(25443) RESTRICTED. 
Rumania,. Yugoslavia and elsewhere arc' Urged to make their 
services available for the Gorman armed forces or to transfer 
their activities to Germany proper. Germany is said to have 
requested the services' of 3,000 Hungarian physicians.1 French 
public opinion is much upset by reports that French medical 
personnel is drafted into German service, this at a time when 
an. estimated 1,200 French physicians arc said to be still in 
Germany as prisoners of war. Germany is reported to have made 
numerous requests for a list of the staffs of all French hospitals, 
but up to the and of 1942 they arc said to have been ignored. 
Ukrainian doctors arc shipped to Germany to provide medical 
care for Ukrainian workers employed abroad.3 in Brussels Belgian ; 
doctors arc given lectures "enabling thorn to learn tho German 
medical terminology and to hoar about tho development of hygiene- 
in Germany*”4 Licenses permitting foreign medical personnel such 
as dentists, pharmacists, and midwivos to work in Germany were 
obtainable only under great difficulties in pre-war Germany; 
now they arc granted much more liberally.5 
Certain countries which, under German influence, had engaged 
upon a policy of racial discrimination in the matter of medical 
personnel, now amend this policy under the impact of war 
conditions • '.There seems to be a .sort of "cultural lag" in Franco 
whore foreign doctors were- forbidden to carry on their practices 
in 1940-41* This regulation does not seem.to hove boon-changed 
under' the impact of present needs.6 in Bulgaria the government 
has drafted tho Jewish physicians for service among tho rural 
population; they mrc Vpaid'by. the may not engage in 
private practice and may not become.members - of the-professional 
organization of Bulgarian doctors. '7 Germany herself has- mobilized 
the services of some- Jewish physicians who were still in Germany 
but were forbidden to practice0 They now administer to -'prisoners 
of war and: have.boon sent to tho aid of the districts affected by 
typhus fovorj8 in Hungary 300 Jewish doctors were ordered to. 
resume practice.9 
1* Journal of the American Medical Association 122:450(12 Juno 
194377“ 
2. Radio Paris* 12 April 1943; Radio Hennas* 12 July 1943; HEW* 
#55, 25 February 1943; MEW, # 61, 15 April 19430 
3. NPD, 28 July 1943.^ 
■ Brussolar Zoitung, 17 October 1942. 
5* Re i chs go sundho i t sb 1 at t, 1 July 1942, p. 494; Milne he ner 
medlzinischo 7 o c he n s c hr i f t, 25 September 1942, p. 846,. 
6,. Radio. Lyons, 10 Juno. 1943» 
7. Munchc-ner me diz ini sene / o c ho n sc Hr 1 ft,' '9 October 1942, p. 884 « 
8. OSS, CID, Censor Materials Summary 27, 1 May 1943, pA 18. 
9. OSS, CID 35939, 5 June 1943. 
(25445) RESTRICTED 
The shortage of doctors i.s further illustrated by the follow- 
ing information: Bulgaria has curtailed the medical curriculum 
and admits advanced medical, students to practice.1 In Croatia 
there are said to be only 1,500 physicians for a population of 
6-7,000,000-less doctors then were available in the old Croatia 
before the First World War.2 in France there is much complaint 
about the increase in medical fees; a doctor *s- visit was reported 
to cost 800 francs in 1942. Students are said to administer 
medical care to the inmates of concentration camps. To relieve 
the strain upon the medical profession the French government has 
experimented* like Germany, in tighter organization and collectivi- 
zation of medical services; however, the individualistic spirit 
of the population and especially among the medical profession 
had. proved an obstacle to such efforts .3 in Italy there is less 
complaint about a dwindling supply of doctors than about the 
difficulties under which their work proceeds in the face of 
greater demands and lack of medical supplies. For various reasons 
the complaints from Hungary are most numerous. The medical 
curriculum was reduced by one year. Many doctors a.re on 
military service; others have been called for work with the 
Germans. Reports indicating the moderate progress made in some 
regions to relieve the situation are Illustrative of extremely 
poor conditions. In Koloza county* for example, there were in 
April 1943, 23 panels with an average of 7,000 persons to each 
panel-doctor. During an earlier period of the war* the re was 
only one panel-doctor to every 14,000 persons. In other districts 
numerous communities are without medical care at all. Many 
positions normally.filled by medical officers seem to be 
In Norway the authorities released medical students 
from compulsory lab or since the continuation -of their studies was 
regarded as more Finally* there are complaints from 
'Yugoslavia, indicating that the Toslie district and the Miners’ 
Fund Hospital are without a regular physician, while the 
Domobranstvo physician is occupied with military duties and can- 
not look after the numerous sick.6 
In most countries there is a severe shortage of nurses. 
In some they have been drafted for work in Germama Complaints 
to this effect' are especially numerous.-.in.,Norway. ! Moreover,' 
there seems to have been an exodus among the "Germanic” element 
in the various European countries for nursing work in Germany. 
1. Neuos Wiener Tagblatt*.7 July 1942* 
2. Journal of the American Medical Association 118:1382(18 April 
1942TT ‘ " ' 
3. OSS* QID* Censor Materials Summary .27, 1, May 1943? pp• 63 ff. 
4. Journal of the American Medical As soc iation 122:450 (12 June 
1943J1 Reggeli Magyarors z ag * 6 April 1943. 
5. Svenska Dagblade t * 13 May 1943. 
6. Novi List * 16 March 1943* 
7. Arvotaren* 22 February 1943; Fritt Folk, 20 October 1942. 
(25445) Numerous reports indicate the employment of Belgian,1 Dutches 
and Rumanian either in the Reich or with German forces 
elsewhere in Europe, 
■ 80 Decline in the Quality of Medical Personnel, To the 
deterioration of medical care resultingfrom the decline in the 
number of doctors must be added the deterioration of the quality 
of the medical personnel* Factors responsible for this 
deterioration can be conveniently summarized under the following 
headings? elimination of qualified physicians and 'admission of 
unqualified physicians. The elimination of some 10,000 Jewish 
doctors has deprived the German medical profession of some of 
its best talent, while, on the other hand, the educational and 
ethical standards of the profession have' been gradually lowered. 
To consider only war measures proper; after the outbreak of 
hostilities in 1939 no less than 5,337 medical students, a 
number equal to 10 percent of the doctors then available, were 
prematurely admitted to practice without having to serve their 
year of hospital intern©ship, hit about the same time the medical 
curriculum was reduced from eleven to ten semesters, tho time 
required for taking the state examinations was drastically 
curtailed, and the year of hospital interne ship, which previously 
had to be served immediately after the state examination, was 
incorporated into the undergraduate schedule. The total reduction 
of the medical curriculum brought about by those measures has 
been estimated at two years. Subsequently the education of 
university students in general was further curtailed by introduc- 
ing the trimester in place of the semester, seeking to accomplish 
in two years what was formerly done in three. It was then that 
the.Berlin correspondent of the American Medical Association 
expressed his opinion that "the German medical curriculum is 
perhaps now shorter than that of any other country in the world. Tl5 
With the progress of tho war, educational -standards have 
continued to decline, A decree of the Minister of the Interior, 
referring to the re-examination of students who had failed 
to pass the examination tho first time, urged the "consideration 
of conditions imposed by the war©”8 
1. Vooruit, 7: February 1943; Volk on Staat, 21 July 1943; Le Pays 
Reel-, 6 April 1943; Transocean, 29 March, 5 April 1943, 
2. Algemeen Handelsbiad, 3 November 1942; Deutsche Seltung in den 
Niedor1undon, 8 March 1943. 
3. Universul, 13 September 1942. 
4. E. van Kann, "Die Zahl der Aorzte 1942 und Gin Ruckblick bis 
1937," Deutsches Aorzteblatt, 15 September 1942, pp. 300 ffe 
5. Journal of tho American Medical Association 112:401 (1939); 
113:2165 (9 December 1939);‘11371977 (25 November 1939); 114:675 
(24 February .1940); 114:1385 (6 April 1940); 114:675 (24 February • 
1940) . ■ ... . 
6. Klinische Wochenschrift,.. 7 AMaroh ,P. ♦ 04Q; 
(25443) Another attempt at.replenishing the medical profession 
with unsuitable material was undertaken in the spring of 1940, 
when a decree granted an amnesty to doctors, dentists, veterinary 
officers, and pharmacists who had been convicted for certain 
professional offenses committed before 1 September 1939* For 
doctors, the amnesty included the temporary or permanent 
prohibition of practice, except in cases where the doctor had * 
been found "unworthy of- exercising• the healing art.l 
.Reference must also bo made to the many favors which the 
regime has bestowed upon the so-called nature healers, a sort 
of quack whose professional activities were placed upon a 
legal basis in 1939. Since their number is in excess of 12,000, 
the harm which can be done by these people in the face of a 
dwindling•supply of regular physicans must not bo underrated. 
Still another sympton of the qualitative decline'in the 
medical profession is the nev/ intellectual orientation of a 
Nazi character and certain solf-imposbd limitations on medical 
authorities. Since October 1939, theses required to-obtain the 
title Doctor of Medicine must be submitted to a commission of 
the Party if they deal with subjects related to the direction, 
history, or organization of the National-Socialist movement. 
Moreover, Jewish authors may bo quoted only "if that is 
absolutely necessary for ’scientific exactitude; in such cases 
the fact that non-Aryans are quoted must always bo specified 
and their Works .must be placed in a special category in the 
index -,.of author s .cited.t?2 
Moreover, 'the'general.conditions under which the work of 
the physician.proceeds are not conducive to efficiency or 
individualized attention and care. All official strfoments, 
and promises to the contrary, the physician has become a public 
functionary with the attributes, standards, and predilections 
of a civil servant'. This trend, which w/as ushered in during 
the 1 twenties and Tthirties, has been enormously intensified 
during the war* In- 1943 members of the health services were 
ordered to wear insignia as. follows 
Physicians; the life rune in red; 
Dental surgeons; the life rune with a "Z" (Zahnarzt) in rod; 
Veterinary surgeons; the serpent in red; 1 
< pharmacists.; the familiar "A" (Apothoker) in rod; 
Midwives; the life rune with an "H" (Hobamrnc) in rod; 
Dentists; the life rune with a T,D" , .(.Dentist) .in .black'-; 
Health practitioners organized in the Federation of German 
Health Practitioners; the rune of this Federation in 
black; . * a a;, j ; 
Druggists; the druggistsT insignia in red. 
1 * Bulletin of Hygiene. 16.: 4:32,. (IS41) 
2. Bulletin of Hygiene 16"433 (1941) 
3. BBS, 18 February 1S43. 
(25445) RESTRICTED 
The jobs of doctors and dentists in Germany are'frozen in 
that no doctor or dentist may take up a new practice, change his 
employment, or terminate his- professional activity without the. 
consent of the authoritiesMoreover, the latter may compulsorily 
assign him to a different locality and to a now position if the 
conditions require such action,£ 
There has been a considerable decline in the standing of 
the medical profession in the countries under . German yoke, In- 
Athens, the Medical Society had boon forced by circumstances, 
among which the inflation of the drachma seems outstanding, to 
permit its members to accept' payment in kind,ran action for which 
it was reprimanded by the Minister of Health,3 in Prague a 
physician was taken into "protective custody" because ho certified 
that a worker "who was known for laziness" could not work "al- 
though he, was perfectly aware that the worker was in good health,"' 
9. Dentists . Many of the remarks pertaining to physicians 
apply to dentists as well. While defective teeth have first 
rank amopg the various medical defects of the working 
dentists are restrained, in the application of their care, They 
arc instructed only to make up dentures if a certain number of 
teeth are missing and if chewing is considerably impeded. 
Artificial teeth to remedy faults in appearance are strictly 
forbidden, and dentists have no time for other than absolutely 
essential troatmeht",0 At the same time, Weakness and emaciation 
of tho patients, have made the dentists1 work more difficult. 
An inhabitant, of Wupportal-Elberfold complains in an intercepted 
letter: "I am suffering from tooth-ache, my wisdom teeth arc 
troubling mo. hut no ono wants to extract them as it is a small 
operation and they told me our bodies wore no longer ablo to 
produce the necessary substances to make the socket holes close 
up again..."7 
At the same time dentists are kept busy with tasks which are 
regarded to be of military importance. In tho Bpring of 1943, 
an order was issued urging that tho teeth of all male juveniles 
1, Munchaner medizinischo Wochonschrift, 31 July 1942, p, 694; 
Roichsgesundheit.sblatt," 1942, p, Gl2 " 
2, Bullet in of Hygiene 16;433 (194IX; Re ichsgo sundhoitsblatt, 16 
September .p, 676; rIDZ 16 September 1942 (dentist s) , 
3, Medizinischo' Klinik, 6 November 1942, p.,1080, 
4, Dor ncuc Tag, 8 May 1943, 
5, Herbert Pirker, "Lcistungsmedizinischos Denkmv'ln"der 
'hr zt lichen Praxis," .Wiener klinischo Wochonschr if t14 August 
1942, pp. 641 ff. T * 
6, MEW Weekly Propaganda Extract Ho. 77, 24 July 1943; 
OSS, Born (P) #4270,'19 July 1943. 
7, PW/MEP/93493/43, 6 May 1943. 
(25443) RESTRICTED 
must be put in ord.er according to age groups, so that their teeth 
are in good condition v/hon they are called for the Labor Service 
or the armed forces. Actually, only the age 1927 group was 
ordered to sec a dentist and to undergo dental treatment if 
necessary. All dentists are under obligation to give such 
treatment. The Reich Leader of -Dental Surgeons and the Reich 
Leader of Dentists especially emphasize that these boys must be 
given preferential treatment before all other patients because 
of the military importance of this age group,1 
B. Quantity and Quality of Facilities 
1, Hospitals. German hospital facilities arc seriously 
short since so large a proportion of these facilities has boon 
placed at the disposal of the armed forces. While the quality 
of German hospital facilities had a great reputation in pre-war 
years, there were indications of a growing shortage as early as 
the * thirties. On the whole, however, Germany enjoyed a rather 
favorable ratio of hospital beds to population compared'with 
other countries. According to a number of calculations, the 
exactness of which it is impossible to ascertain in all cases, 
the ratio of hospital beds per 1,000 people is as follows in the 
various countries 
C ountry 
Beds per thousand people 
United States 
10 
Germany 
8.8 
N orway 
8.5 
Netherlands 
7.5 
G z echo Slovakia 
6 
Belgium and Luxembourg 
4.5 
Italy 
4 
Franco 
3 
Greece 
2 
Poland 
2 
Yugoslavia 
2 
At the end of 1939 there were 4,861 hospitals in Germany 
(including Momel territory and Ostmark; excluding'Saar, Sudeten 
territory and incorporated former polish territories)of 
those, 2,267 wore public, 1,519 free charitable, and 1,075 
private hospitals0 The number of beds was 662,996, compared with 
686,459 at the end of 1938, This decline was due to the taking 
over of some hospitals by the armed forces. Of those, 65 percent 
were in public, 29 percent in free charitable, and 6 percent in 
private hospitals. They wore used during 1939 by 6,413,340 
persons. 
1, NDZ, 20 April 1943; Frankfurt or Zoitung, 22 April 1943; 
VQlkischer Boobacliter , 23 ' April '1943. 
2, Inter “Allied Committee on Post-War Requirements, Report to 
allied Government s , App'ondix II, Allied Minimum Import s" 'Programme, 
1943, p, 110, Civil Affairs Handbook on Italy, Section 13, On 
Public Health and Sanitation, 1943, p, 19, 
3, !,Die Krankenanstalton im Jahro 1939," Wirtschaft und 
Statistic.. 21:453fDecember 1941) 
(25443) RESTRICTED 
The average number of days during which hospital bods wore 
in use increased as follows;- 
*• 
Utilization as Percent 
Year 
Number of days 
„ ; as, maximum use 
1936 
290.9 
79.5 
1937 
296.2 
81.1 
1938 
305.0 
83,6 
1939 
316.5 
86.7 • 
While available facilities increased, the number of patients 
increased at a. higher rate. With the outbreak of the war - ' 
conditions grew much worse. Though new facilities in schools, 
etc*, were made available, the .access of civilians to hospital 
facilities was necessarily curtailed and standards of hospital 
care had to be lowered. As in the field of public health in 
.general, measures of rationalization and collectivization which 
are designed to economize the .available facilities wore under- 
taken,! For example, in the city of Munich the -facilities’ of 22 
hospitals wore ;poolod in December. 1942; the hospitals-so. organized 
accept only patients assigned to them by a central bureau at 
'the city health office,2’ 
In general, hospitalization has been much restricted. As 
early as 1939, hospitals, were ordered to, reduce the number of 
maternity cases and to- advijtfo...patlents to lie • in- at home under . 
, the care of a In view of the difficulty of obtaining.' 
medical attendance, refusal of hospitalization often spoils, 
.refusal .of; medical care, ' Doctors now attend only 25 percent hi 
.of -.ill chlldbirtlis, - * S’ ■ • ■; ■ . • - 
The extent- ef t he ’ crowded, condit ions is, iliustr-, Tied. by the 
greatly increased-time lag in :.a.dmis.3ion.’to hospitals and •, .... 
sanitaria, A Gorman doctor complains that 11 the creation of new 
sahit or ia’bods in the 1: st few years has ,;in ;no way been increased 
in accordance with'the improved methods pf recognizing . 
tuberculosis,n Ho states', that . the patients who in previous .. .. 
years had to wait 2 t o 3’ -weeks :must now remain without.. ' r' . 
ho sp it a 1 i z at i on for of period ranging from 3 to 4 months,0.'. 
...The absorption; of hospital .facilities by; the armed forces 
scorns to have progressed farther in ’ certain; c it ies than in: others . 
Reports indicate that Vienna, Munich and Breslau have- become.' 
centers of such activity*6" It--Is also said that. 170*,000: G-erman 
1, OSS, CID, Censor Materials Summary #27, 1 May 1943, dp, 19, 
25-27i 
2, Wiener modlzinischo Wochonschrift, 16 .January 1943, p, 5S, 
3, Bulletin of Hygiene 16;433 • (1941), , , 
4, DHB, 14 April 1943. ' : .. , . •.. ■ : 
5, Dr, Ickcrt, nDie Betreuung dor 'fubbrkulpsen-'w^rond--dor 
Wartozo.it bis zur Einberufung in die HoilstHtto,!l Dbut'schos 
Aorztoblatt, 15 September 1942,.pp. 299 ff, 
6, Nya Dagligt Allohanda, 27 April 1943; Magyar Nemzot, 5 May 
!943, “ ' ~^ 
(25443) RESTRICTED 
wounded are nursed in Hungary, but the Hungarian authorities have 
denied this.l There have also been reports of the evacuation of 
hospitals in Bohemia-Moravia to make room'for wounded from the 
Eastern front,2 
Complaints about the deterioration’ of hospital care are 
numerous. There are said to be premature discharges, patients in' 
excess of hospital,beds, and inclination to resort to amputations, 
lack of sufficient medical and nursing personnel, and poor food. 
Furthermore, the lack of equipment has caused a deterioration of 
hygienic standards and medical care. Linen is short and bed sheets 
are not changed so often as before; there is lack of gauze for 
bandages and surgical laundry is sharply economized, (Specific 
shortages are more fully discussed in the section of this report 
dealing with medical equipment,) 
There is much evidence that hospital conditions, in absolute 
terms, are in a state of even greater deterioration in the G-erman- 
dominated countries. People in France are said to be eager to 
enter hospitals in order to relieve their domestic shortage ,of 
fuel and food. However, waiting lists have been established in 
Paris and admission takes one or .two months,3 On the other hand, 
there is evidence that food conditions in hospitals, may be poor, 
and some people are said to be unwilling td go to hospitals where 
they have to surrender their food cards. Interminable formal- 
ities are said to be required to have them returned on leaving 
the hospital. It has also been reported that the director of the 
sanitorium for the French clergy turned to the Italian clergy for 
food shipments, without which the patients would have had to be 
discharged. It is also reoorted that in sanito'ria providing for 
patients affected with tuberculosis the lahge-scale dismissal of 
patients is considered since the latter cannot be provided with 
sufficient food as required by the change in climatic conditions. 
All Paris hospitals are said to suffer from enormous trans- 
portation difficulties. There ' are only a few ambulances', and 
patients are brought to the hospital by the police first-aid. 
For the return journey patients are carried in a group ambulance 
and dropped at their respective destinations. 
In the same city, the German authorities have requisitioned 
the Beaujon, Lariboisiere and La Pitie^hospitals with a total of 
3,280 beds. Thanks to temporary hospitals, however, Paris still 
has 36,800 beds for a population estimated at 4,200,000,4 Llsewhert 
in France • it, become necessary to .open to* paying patients hos- 
pitals- and almshouses (hospices) which .were formerly reserved for- 
th©’needy; it is not ■ clear where’ the- poor will now be .accommodated,5 
1, DNB9 June 1943. 
2, Radio. Maroc, 25 January 1945... . , . 
3, Paris Bhir. 12, 16 February 1943. 
4, Curioux Marcellin. 6 November 1942. 
5, Radio Paris, 21 April 19431: 
(25443) RESTRICTED 
From Italy it, is reported that " a great number of people 
refuse to enter hospitals because they are so badly fed there. 
The lack of accommodations seems ~tp be worst in Norway, where 
patients have been turned out of hospitals,' Because of large-scale 
requisitioning of facilities by the Germans, increasing use has 
been made of makeshift arrangements' in schools and, similar places.2 
Since so many facilities have been seized by the Germans, hospitals 
are very crowded and beds have been Placed in conference rooms 
and corridors. At the Oslo Public Hospital (Ulleval) the second 
section has how 183 beds compared to the normal number of 158; the 
third section has 224 beds as compared to its normal number of 
188, In Trondheim, a city of 50,000 inhabitants, whose hospitals 
take care of the surrounding districts with 200,000 inhabitants, 
there used to be three hospitals with 750 beds. At present, only 
350 beds are available for the Norwegian population. The largest 
hospital had to be moved'and its different sections are now located 
at four different places, in former old people’s homes and similar 
buildings around the city. The demand for beds is Very large and 
the length of time a patient spends in bed has been decreased. 
One patient operated on for appendicitis is said to hate had. to 
get up after two days in bed.3 Scarlatina patients are no longer 
received by hospitals'in Oslo, They must be isolated at home. It 
is stressed that this provision applies to Norwegian workers on 
German constructions. If the German authorities order Norwegian 
workers infected by scarlatina to be removed, they must be sent 
home immediately, even if their home is located in another province. 
This, in turn, facilitates the spread of diseases elsewhere,4 
Hospital conditions are so bad that the Swedish and Danish Red 
Cross have made arrangements for the establishment of facilities 
in Norway, The Swedish Red Cross plans the'founding of a hospital 
for about 150 Norwegian civilians near Oslo,7 while the Danish 
Red Cross intends to furnish a hospital with 100. beds.6 
2, Recreational Travel-..and Spak. Facilities in spas and. 
watering places have likewise been . seriously curtailed, as has 
all sorts of travel for reasons of health. The spas of Piest1 
any and Pyrmont seem to be reserved for wounded soldiers9 and 
so are many facilities in Baden-Baden, Wildbad, and other resorts.7 
1. OSS, CID, Censor Materials Summary 27, 1 May 1943, p. 43,- 
2. Svenska Dagbladet 6 July 1942; 10 April 1943; Nya Dagligt 
allehanda. 4 February 1943, 
3. CID 41102, 27 July 1943 (Report of a Swedish Labor Union 
Leader from a visit in Norway), 
4. Dagens Nyheter f 21 July 1943, 
5. Stockholms Tidningen. 23 August 1943, 
6. Aftontidningen . 10 August 1943. : 
7. Berliner Borsenzoitung. 9 August 1942; Slovak , 2.6 May 1946, 
(25445) RESTRICTED 
There are no facilities for the foreign travel of sick persons 
except those suffering from tuberculosis and rheumatism. The 
latter may apply to central agencies and be assigned to a foreign 
sanitorium in case* of urgent need.1 
Recreational travel is rationed in that persons desirous 
of obtaining admission tp hotels, etc., must present their 
clothing ration card, upon which the trip is entered. Exceptions 
are made for. mothers with children up to three years, pregnant 
women, persons who have been exposed to bomb damage, and sickly 
people from regions especially exposed to air raids. In theso_ 
cases certificates issued by the public or party authorities must 
be presented,2 
According to a decree of 9 January 1943, reservations for 
hotel and related, facilities werfe accepted, provided that the * 
facilities would hot be needed for a front soldier on furlough 
or other person requiring preferential treatment, 'In the case 
of such need, the' reservation could be invalidated, but not 
later than two weeks before the first day of the planned 
vacation. Thus it could be expected that hotel facilities 
would be available if no information to the contrary was received 
two weeks before the start of the vacation. In July 1943, these 
arrangements had to be changed in view of the dispersion of the 
population due to air raids and the requirements of persons de- 
housed by bombing,0 Since that time the availability of 
facilities for which reservation has been made and accepted can 
no longer be taken for granted. People are requested to make • 
inquiry with the hotel shortly bef.ore leaving for the vacation, 
A medical certificate to be.issued on a special form 
which sets up strict requirements is needed for' all spas In the 
narrower sense of the term. Holders of such certificates are 
entitled to preferred treatment and obtain facilities in ■ 
preference to other persons,4 ‘ ■ 
While recrpational travel is thus not facilitated on the 
supply side, ’the! restrictions on tho vacations of employees 
. whidh were introduced■after the outbreak, of the war have been 
lifted, and rationalization an-dicollectivization have made as 
. much headway as in other fields of public health. Collective 
travel is required/for recreational purposes, and is sponsored 
by the Labor Front, the Reich Health Insurance Organization and 
other agencies. In addition, the tax authorities encourage the 
granting of contributions on the part of the employers for : 
vacation purposes by. exempting such payments from the income and 
wage tax. The vacation leave in private industry for 1943 was 
set at a maximum of fourteen days for workers ’born; after 1 April 
1894, and at a maximum of twenty days for workers born before 
that time. The determination of the,leave periods does not imply 
that loaves actually will be taken. Early in 1943.. it was * , 
announced that loaves for 1942 which had not boon taken would.not 
bo forfeited until 1 October 1943,5 ' .. . 
1, Reichsgesundheit sblatt, 17 June 19.4.2-j p. 462. 
2, Frankfurter Zeitung; 11 March 1943. 
3, Frankfurter Zeitung 51,July 1943. 
4, Frankfurter Zeitung, 11 March 1943, 
5, Volkischcr Boobachter, 1,_24 April 1943; Der Deutsche 
Volkswirt, 2 October 1942. 
(25443) RESTRICTED 
In 1943'arrangements were made for vacations of the 
"Ostarbeitor,” i , e ,, workers from Poland or Russia,1 Though 
the regulations aro vague in that they only state the possibility 
of a vacation leave for these people, the measure itsolf seems 
to be' indicative of a progressive deterioration of health among 
the concerned groups. The regulations provide that Russian or 
Polish workers may be given a paid vacation of one week in 
Germany if they are in the second year of employment and if they 
have proved efficient and loyal, Special vacation camps aro to 
be established for them. In the third or fourth year of 
employment they may bo sent home every year for two weeks plus' 
travel time. The"faro to the boundary is paid by the employer, 
while the Reich contributes the fare from the boundary to the 
home town. The extent to which these potentialities are being p 
transformed into actualities is not certain. The health of the 9 
workers may be such that the maintenance of their working power, 
makes vacations imperative and that they aro therefore actually 
given vacations. ,.r. 
3, Drugs and Medical Equipment. a, The General Situatio; , 
Shortages oi’ drugs in various European countries are,' due to the ’ 
.cessation of imports of various materials and to economies in 
manp owe r and ot her resources re quired by t ho war. In sp it e of 
the shortage of -packing material, bottles, and similar articles, 
there is still much inter-continental trade,' This fact is not 
surprising in view of the size of the German production of drugs, 
Germany was the loading exporter of medicinal preparations in 
the world, and its' share in world trade in these articles used 
to bo between 33 and 39 percent. Franco had third’rank among.- 
the exporters 'of drugs, exceeded only by the United Kingdom, 
It is thus understandable that the drug situation in Europe yi 
is by no means extremely serious apart from certain 
the lack of which will bo felt only by a relatively- few people.2 
Excessive hoarding of medicaments has occurred- everywhere, 
and prices have- gone up substantially, Shortages occur oven in 
neutral countries? the Swiss pharmacists’ journal .contains a ■ . ; 
section devoted to the barter of scarce- products, Germany is 
reported to have increased her stocks substantially from material 
captured at Dunkirk, These stocks are said to bo so large -that y 
they are still in use. There has boon'much standardization ofs 
<7 
drugs and the introduction of new preparations has boon stopped,- 
Advertising has boon severely Many drugs-, are. sold 
only by If a proscription cannot bo supplied, 
the druggist may, within certain limitations, substitute another 
preparation for it,6 Containers must .generally bo•returned.- 
1. Frankfurtor Zoitung,:2 August 1943, 
2, G, Banzerj '’Arznoivcrsorgung 1m Kr logo.,11 Deutsche modiziniscl ■- 
Wochonschr .1 ft, 1942, Ho'. i0;v‘ 
3. Frankfurter Zoitung, 21 February 1943, 
4, Gerhard Karber, ’’Dio Nouregelung dor Worbung* auf deni Gcbieto 
dcs Heilwesons,” Die Ern&hrung 7?136 ff. (1942); Reichsgesund- • 
heitsblatt 17 Juno 1942 , p. 467; Klinlsche. Hochonschrift, 1942, 
pp. 120/ 784, ■ . 
5* VIIoner klinisch/- ■Jochcnschrift, 24 -1.942 
6. Deutsches Acrztoblatt,- 1 November 1942, p, 33"'; Wiener 
modizlnische Wochcnschrif‘1, 16 January 1943, RESTRICTED 
In Germany, statements of the authorities are generally 
reassuring. The situation is, however, well illustrated in a 
circular issued by the surgeon of the 314 th Infantry Regiment 
on 2 March 1943. This unit 'was then in North Africa, but there 
■were no specific transportation difficulties. The circular reads 
as follows ; "All physicians are directed to apply the greatest 
economy in the use of bandages and medicaments. Bandages must 
be washed and reused. This applies especially to elastic 
bandages. If new elastic bandages are requisitioned, the old 
ones must be turned in. Under no conditions may splints be 
thrown away; the padding is to be removed and the splints used 
again. Gauze and cotton wool must also be used very economic- 
ally, and the greatest economy is required in the use .of 
adhesive tape. Owing to the tight raw material situation, we 
have the greatest difficulties in obtaining these supplies. 
Often it suffices to use adhesive tape half the width of the 
roll,. Drugs of any kind may be given only in really urgent 
cases. Only as much ife to be dispensed as is actually used by 
the men. Under no conditions should soldiers be allowed to 
carry with them drugs prescribed some time in the past,"l 
The Frankfurter Zeltung, in the summer of 1942, dealt 
with the shortage of medicines in a generally reassuring 
"But even so, certain tensions are inevitable," the paper admits, 
"and it cannot be denied that we shall have to adapt ourselves 
in certain ways, in some cases accept substitutes, and make the 
sale of more preparations subject to a doctor’s prescription." 
As the article points out, laxatives are especially in short 
supply owing to the cessation of imports of raw materials.. 
Constipation may also have increased owing to dietary conditions. 
There is, furthermore, the factor of- increased purchasing power 
as well as the desire of the population to buy invigorating 
drugs and vitamin preparations.. As the paper states, the in- 
creased demand for sedatives and barbiturates "borders on 
addiction. " At about the same time. Das Reich.,discussed 
conditions in one large Berlin chemist's shop.2 When the shop 
opens after the lunch hour at 3 p.m., there is a queue of 30 
people and a similar number are waiting until the shop closes. 
Only a small proportion of the prospective customers have 
prescriptions. They ask for anodynes, grape-sugar preparations, 
malt preparations, tonics, vitamin preparations etc,, which 
they think will make up for "imaginary" shortcomings of 
nutrition or compensate the actual or Imaginary 'consequences of 
some affliction caused by the present conditions. Many of the 
articles are not available. If by chance some food preparation 
can be- had in limited quantity, customers return two or three 
times in order to hoard the precious article. Of the'3,000 
people who visit the shop-every day, only 1,000 actually buy. 
The average turnover of the shop has more than doubled. This 
has happened in the face of a decline in personnel. Instead 
of six dispensers there are now only two. 
The production of medicinal herbs ha’s been greatly 
stimulated in Europe owing to the shortage-of various drugs. 
The collection of these.plants is organized by the authorities in 
!♦ In files of OSS library, 
2» Journal of the American Medical Association- 119;l440 22.August 
1942. 
3, 13 September 1942. _ . .. ... -■ 
(25443) RESTRICTED 
many localities and th,e„ cultivated areas have generally Increased. 
Exports from certain countries, such as Bulgaria, have risen to 
a considerable extent. 
The following is a more detailed survey of various 
medicinal articles which are in short supply.. Soap, vitamins, 
anti-typhus and other vaccines are dealt with elsewhere in this 
report. 
b. Cosmetics. A decree of 30 July 1942, limited the 
manufacture of cosmetics to those enterprises which had 
continuously been in business since 1938.-- Early in 1943 the 
production of perfumes, cosmetics, artificial brine, salts, 
bath salts and other bath accessories was prohibited altogether.^ 
c. Medical Equipment. There are numerous complaints 
about^the decline in the quality of surgical instruments and 
the tight supply situation,3 it is reported' to be difficult 
even to have surgical instruments sharpened. In order to 
economize in steel, only the blades of surgical instruments are 
now said to be made of that-metal the remainder being made■from . 
aluminum. Italy is reported to use a new chromium-plated 
plastic Instead of steel. The substitute has proved unsatis- 
factory, as it discolors easily and,rusts after the instruments 
have oeen boiled. In view of the general shortage it is not 
'surprising that in June 1943, the production of medical 
instruments in Germany was ordered to be maintained. Industries, 
engaged in this branch of manufacture are forbidden to lower 
their output by accepting orders outside their field, even- 
orders for military untensils,.^ 
Concerning electrical medical equipment, Swiss importers 
complain about the quality of small electrical bulbs for 
surgical Instruments and of X-ray tubes. They are obtainable,, 
only with great difficulty in Germany and do not last nearly 
so long as before the war.5 in 1942 enterprises producing.- 
electrical medical equipment were instructed by the authorities 
concerning priorities in the, use of their .capacity. ., Repair 
and maintenance hold the first.rank .and are followed by 
replacements. New installations are to be made only if •-•'they do 
not exclusively serve a regular peacetime need but - are capable 
of being fully utilized in wartime also.° in July 1943, all 
1. Reichsgesundheitablatt, 14 October 1942, p, 749, 
2. Bern T. (p)#1838, 22 March 1943. 
3. OSS, CID, Censor Materials Summary 27/1 May 1943* pp. 29, 
43, 81. : 
4. Munchener neueste Nachrichten. 26-27 June 1945, 
5. OSS, CID, Censor Materials Summary 27, 1 May, 1943, p, 8l. 
6. Kllnlsche Wochenschrlft, 10 October. 1942, p. 916. 
(25443) RESTRICTED 
doctors, dental surgeons, dentists and healers using X-ray 
equipment were 'required to register it with the authorities of 
the Reich Defense Commissary. Manufacturers and dealers were 
exempted from this order. Subsequent changes In the possession 
of the equipment also had to be reported. This measure is 
indicative of a growing shortage of such equipment and shows 
that the authorities were preparing themselves for the alloca- 
tion of available installations according to the most urgent 
need. The order expressly pointed out that equipment and X-ray 
tubes which were not in current use were also to be reported.-1- 
The supply of optical implements seems to have been 
Curtailed, though some supplies of optical goods are still 
available for export. It was reported in April 1943 that 
Bulgaria' is to receive optical,Instruments and apparatus to the 
total value of 22 million levas for the: observatory at the 
Sofia University.2 (wo air-raid damage seems to have been 
inflicted on the Zeiss Works in Wetzlar as yet -) 
There has been much standardization in' the field of 
medical glass articles and more bottles are recovered now than 
in the past.. Many articles of tubular and flat glass are no 
longer produced.3 The size of the paper labels on bottles 
has been reduced to save paper.4 a circular of the. health 
authorities published in May 1942, mentions that the procurement 
of glass articles required by the veterinary authorities has 
been difficult for some time.5 
Rubber gloves are no longer available in Italy, where 
surgeons use cotton gloves for operations. Switzerland is said 
to be in the possession of a sizable stock of American rubber 
gloves. Germany uses gloves made from synthetic rubber. These 
gloves are inferior in that they cannot be exposed to paraffin, 
fat, or alcohol; they tend to stick and are not uniformly 
elastic. They are, however, more resistant to benzine than rubber 
gloves.6 
Paper bandages of low quality are. widely used. In view 
of the shortage of adhesive plaster, bandages are.occasionally 
fastened directly to the■skin by glue. Army surgeons are 
requested to economize in adhesive tape, using if possible only 
half of the normal width by cutting the tape into two parts. 
Cotton wool and gauze are very scarce and bandages have to be 
washed and reused. Paper bedsheets have replaced linen in 
military-hospitals. Sheets can thus be changed more often.f 
1. Frankfurter Zeitung, 2 August 1943. 
2. Nachrlchten fur den Aussenhandel, 28 April 1943. ■ 
3. Relchsgesundheitsblatt, 14 October'"1942, p. 730. 
4. Stuttgarter N.S.Kurler, 2 July 1943. 
5. Relchsgesundheltsblatt, 27 May 194.-3, p. 421„ .v, 
6. E. Bolland, "Wie erhalte ich mein Instruraentarium lange Zeit 
gebrauchsf ertig?!i Wiener kllnische Wochenschrift, 31 July 1942, 
f.; OSS, CID, Censor Materials Summary-27, 1 May pp. 
43,8l. 
7. OSS, CID, Censor Materials Summary 2J, 1 May 1943s pp. 28, 43, 
66, 81. 
(25W3) RESTRICTED 
Artificial teeth are now said.to be made from rosin, as 
porcelain factories are working for the armament industry,1 
d. Drugs- Acting Locally oh the Skin and Mucous Membranes. 
i. Glycerin» For.medical, purposes,.glycerin is used as a 
protective coating of,irritated or abraded tissue (demulcent) or as 
an agent for softening the skin (emollient). Besides medical uses, 
there are numerous other civilian uses of glycerin. In wartime, 
however, this preparation, ‘goes into the manufacture of nitro- 
glycerin, dynamite, cordite, and other explosives. It is thus 
understandable that shortages of medicinal glycerin are. reported 
from. Germany and that none is said to be available in Bulgaria.2 
Though glycerin is extensively employed as a vehicle fpr many drugs 
applied, to the skin, it is not a preparation to which extreme 
importance can be attributed, 
ii, Gum tragacanth is the. dried gummy 
exudation of a shrub which grows in Asia Minor, Iran, and British 
India, This gum is used for industrial, medicinal and confection- 
ery purposes. Medicinally it serves as a demulcent in pharmaceu- 
tical preparations, as an emulsifier and excipient for pills as 
well as a base for skin medications. At present Germany has to 
satisfy her requirements for tragacanth. entirely from stocks and 
from the small quantities which she can import from Turkey, The 
stockpile must have been considerable in view of greatly increased 
Imports during the late thirties compared with earlier years.. 
In metric tons, German imports of MTragantgummil, were as follows: 
1926 
1929 
1930 
1936 
1937 
1938 
Imports 
574 
950 
1,062 
2,055 
1,587 
1,401 
Exports 
252 
250 
'311. 
'■ 280 
’ 380 
' 243 
Apparent, consumption 
322 
700 
■ 751 
1,775 
■ 1,207- 
1,158 
The bulk.of German pre-war imports came from British India; 
which supplied about 70 percent;- the rest f rom Iran and Turkey, 
Germany has continuously shown interest in- supplies from Turkey 
and has been.successful .in obtaining this commodity under the 
various Glodius agreements,,./ Annual. Turkish production however, 
is. only in the neighborhood, of 200 tons. Judging from the. second 
Glodius agreement of ■October 19419 Germany was interested in buy- 
ing tragacanth up.to the;amount of Lt 100,000. This would-, 
represent an amount estimated slightly in excess of 200 tons. 
Satisfactory substitutes for tragacanth are other gums, .;: 
starches, and pectin, which can be produced from sugar beets, 
other vegetable roots, and tree barks, Basic materials for these 
substitutes are plentiful in practically all countries but require 
expenditures in equipment and labor to produce commercial 
quartitles,. Deficiencies of tragacanth in' Germany thus entail 
additional employment of scarce resources. 
1, Sydsvenska.. '20 July 1943., .......v J. 
2, Reichsgesundheitsblattf 20 January 1943; OSS, CID, Censor 
Materials Summary 27, .1 May 1943, p, 96, 
3, BEW, axis Supplies of Tragacanth, .21 August 1942; files, 
of U.S.T Department ..of Commerce, 
(25445) RESTRICTED 
iii* Cocoa Butter» Cocoa butter is a vegetable oil 
product which acts .as;•.emollient.. ‘ Germany 'now has to rely on 
stored supplies. Under storage conditions the acidity of cocoa 
butter increases. New pharmaceutic regulations issued by the 
German authorities permit', the use of such butt er'-in modification 
of the standard of the pharmacopoeia. A substitute product, 
postonal, which is created by the polymerization of ethyls> is 
widely used, d , 
iv. Lanolin and Vaseline. Lanolin and vaseline are 
used for their local action on the'skin. ■Lanolin is extracted, . 
wool fat, while, vaseline is solid petrolatum. Petrolatum is a 
common ointment base and,, is also employed as an emollient and 
lubricant. Shortage•of vaseline or lanolin is reported from 
Germany, Italy, Holland, Belgium, and Bulgaria,- A German sub- 
stitute material is composed of paraffine and synthetic ' 
hydrocarbon of the modern fuel industry. In Germany, -white 
vaseline may-only be used for preparations for eye treatment.^ 
v. Lard. Lard as a foundation for ointments has 
been replaced by hardened walnut oil and oils obtained ffom 
the seeds of fir and pine ..cones• 
e. Germicides. i. BoratesOver 90 percent of. the 
world supply of boron; materials is produced in the‘United States. 
Boric acid is used as a germicide and mild disinfectant in medical 
practice, but can be replaced by numerous substitutes, Germany 
curtailed the use. of boron derivatives as early as in 1959.^ 
It is not believed that this was accompanied by. adverse effects 
upon health, 
ii. Chlorine. Chlorine arrests putrefaction and . 
destroys the accompanying odors. Apart from other medical uses, 
it is of great value as a sterilizer of water. Though Germany 
has supplies of this material, the'need for it is believed ,to. . 
have increased markedly owing to-war requirements and air-raid 
damage. In the summer of 1945 it was reported that Germany 
had made attempts to-obtain chlorine from Sweden. These attempts 
seem to have been unsuccessful. It is believed that British • 
bombings of German chlorine factories have caused some'damage Z1 
It has been estimated that German Europe-uses about. 15,000 
metric tons of chlorine for water purification. 
Till, Cresol» There are indications of a shortage of 
this disinfectant in Germany. 
1. Reichsgesundheitsblatt, 20 January 1945; Journal of the 
American Medical Association 114:69 (6 January 1940), r 
2. Walter Kern and Theodor (4Cordes, "Entersuchungen uber 
Handelsvaselinen," Archly fur Pharmazie. 18 January 1945, pp. 25 
ff.; Reichsgcsundheitsblatt . 20 January 1945; Bulletin de 11 ordre 
des pharmaciens, 7 March 1945; CSS, CID, Censor Materials Summary 
27, 1 May 1945, pp, 45, 96. 
5. Bulletin of Hygiene 16:452 (1941) , 
4. Social Demokraten, 16 August 1945. 
(25445) RESTRICTED 
iv. Iodine. Iodine is one of the oldest of the 
various antiseptics and is -widely employed owing to Its 
efficiency and. economy. The bulk of the -world supply of iodine 
is a by-product of the.nitrate' Industry in Chile, Of 
continental-European countries, France and Norway used to 
contribute relatively small amounts to the world output. Germany 
used to depend on foreign sources for all of its iodine re- 
quirements. Though waste iodine from all possible sources is 
being recovered, most of this is employed principally for 
industrial' purposes, especially photography. Medical consumption 
of iodine is much restricted and various substitutes have been 
developed, including a new bromine preparation. In view of the 
availability of so large a number of highly efficient sub- 
stitutes, including raercurochrome, the situation is far from 
N 
In greater detail, the economy measures introduced in 
Germany include the following :2- In December 1939, the iodine 
content of tincture of iodine was reduced to an amount not in 
excess' of 5 percent. Wholesale druggists were required to report 
their stocks. Pharmacists were instructed to. use .Iodine and its 
compounds only on medical prescriptions, ■ and' each prescription 
was made valid for one purchase drily. If a doctor required, the 
10-percent tincture of iodine of the: pharmacopoeia, hep had-, to 
indicate this on the prescription. 
It is likely that thd supply situation‘subsequently im- 
proved, since the requirement of a prescription for purchases 
was -lifted.3 This may have resulted from the receipt of French 
stock. Concerning other European -countries, reports from 
Belgium, Hungary, and Italy indicate that no iodine is available 
there.4 Switzerland has gradually replaced it by the various 
substitutes which are available.5 In the Netherlandsthe 
iodizatlon of the drinking water, usual in various localities, 
had to be terminated. In its place, an iodizatlon of bread was 
to take place ,6“ . ' . 
1. -H. Kruger -Martins, "Hautdesinf ektion , 1m Kriege,'' Medizinische. 
Kllnlk, p. 1082. ■ . ' ; 
2. Bulletin of Hygiene 16:432 (194.1) 
3. Gerhard Karber, "Neurgelung der Werbung auf dem Gebiete des ■ 
Heilswesens,M Die Ernahrung, Vol.7, 1942,, p. 139. 
4. OSS, CID, Censor Materials Summary 27, 1 May 1943, pp. 29, 43, 
31, 96; Bulletin de 1’ordre des pharmaciens, 21 March 1943, p. 88, 
5. "Succedanes de la teinture d'iode," Bulletin du service federal 
de 1'hygiene* publique, Tune 1942. 
6. Medizinische Klinik, 5 June 1942, p, 552. 
(25445) RESTRICTED 
Recent reports from Italy indicate that the Salsomaggiore Hot 
Springs, Italy’s chief source of mineral iodine, have become 
sanded up because of lack of cleansing. Two new wells are being 
bored, which must go to a depth of not less than 1,000 metres- 
before suitable hot springs can be reached*! 
f, Drugs Used in the Therapy of Syphilis, ■ i, Bismuth 
is of value in the treatment of syphilis and for other medical 
purposes. The bulk of world output is produced in the United 
States and Latin America. Of the European countries, Spain, 
Yugoslavia, Sweden, Belgium, France, and'Germany produced 
relatively small amounts. Since the war, Germany and Italy have 
probably obtained small supplies of bismuth from Spain and Sweden, 
and the fall of France may have yielded some larger stocks of the 
metal. Control over Yugoslavia gave Germany the Trepca lead 
mines and their by-product bismuth,,. Intercepted material 
indicates that there are shortages of bismuth in France, Norway 
and the Netherlands.2 
ii. Arsenic. Arsphenamine, popularly called "SOS”, is 
said to'be difficult to obtain'from Germany for export because 
arsenic, its component element, is used for numerous war-essential 
purposes,3 There are-no reports of shortages in Germany itself. 
g. Agar-Agar. Agar-agar is a. dried mucilaginous 
substance obtained from various species of seaweed. This .material 
is of great value in laboratory work since it serves as a nutrient 
medium for the growth of bacteria. Before the war, Japan was 
almost the exclusive producer of agar-agar, the United States 
supplying 2 percent of world requirements. At present, production 
is carried on in the United States on a larger scale, in New 
Zealand and in England. Experts.believe that climatic factors 
prevent its production on the continent of Europe. The European 
Axis is thus without supplies of .Agar-agar, Various substitutes 
have been developed which, however, are not satisfactory in work 
with certain Agar-agar is washed and re-used to achieve 
economy, but this method is not satisfactory in certain respects. 
In Norway, the Fishery Experimental Station of Bergen .is studying 
the utilization of seaweed, which is available in great quantities 
on the coast, and it is possible that technologies for the 
production of agar-agar may be developed in -the course of these 
.investigations.5 
f . , •• 
1. Ministry of Economic Warfare,. Weekly Propaganda Extract, #72 
19 June 1943. 
2, OSS,' CID, Censor Materials Summary 27, 1 May 1945, pp. 65,87. 
5. Ibid,, P, 81. 
4. W, Zimmermann, "Demonstration neuer Nahrbodeh als Ersatz fur 
Agar," Zentralbatt fur Bakteriologie. 'Pt.1, 1959, Vcl. 144, 
Supplement, -op, So^-TO*. 
5, Europa-Kabel. 6 August 1943, \ 
(25445) RESTRICTED 
h. Insulin. Shortages of insulin are reported from 
virtually all European countries. Insulin is produced from 
animal pancreas: which used to be imported in large amounts from 
South America, Insulin production requires enormous quantities 
of these glands, 80-100,000 animals supply 10,000 lbs. of glands, 
■and these, in turn, suffice for the production of 1 lb. of insulin 
which is composed of 9,000,000 international units. United States 
monthly requirements, including exports, are 400,000,000 inter- 
national units. During the earlier part of the war, Italy'is 
reported to have been able to build up a stock of insulin of South 
American origin while the L.A.T.I. air line was still operating. 
This stock was apparently running low in 1943 and exports have 
been forbidden.1 
■ The reports from the various countries which indicate 
shortages of drugs in many cases expressly refer to insulin. This 
is true of Rumania, Belgium, Bulgaria, France/ Hungary, Switzer- 
land, G-ermany, and the Netherlands. The actual or planned 
establishment of new productive facilities is reported from Italy 
(Biochemical Institute of Milan),2 Bulgaria, and Hungary, Ration- 
ing of insulin is taking place in Rumania, Bulgaria, ■■the Nether- 
lands, and G-ermany, Difficulties in the treatment of diabetic 
persons are reported from France, the Netherlandsand elsewhere,0 
The disease is often aggravated because of the food situation, which 
does not permit an adequate diet for diabetic persons or ’a diet 
which would offset the decline in insulin intake. In Germany, 
©f facial thought pertaining to this situation is normally in- 
termingled with considerations concerning the exploitation of the 
working power of diabetic An expert states that "All 
of us have experienced losses in weight during the'course of the 
war, after we had experienced with rare exceptions, some over- 
weight, Even if many persons have' become somewhat subnormal in 
their weight, this in itself entails no great damage and will 
quickly be regained. Concerning diabetic Persons: male diabetics 
who are employed have on-the average a weight of 2,7 Kg, below 
normal. This is certainly not alarming, X mentioned before that 
diabetic persons are. that group of the Population which is in the-, 
most unfavorable position." The same author "states that 91 percent 
of all male diabetics are employed and that 20 percent of these 
are heavy workers,0 Another authority, a Viennese doctor, points 
out the following disadvantage.? of normal food rations for 
1. HEW,'48, 7 January 1943, 
2. Hedizinlscne Klinik. 5-June 1942, p, 549. 
3. Nows from Belgium. 24 April 1943, p. 132; Universal, 28' Marc.h 
1943; K. F. Minoli,. "Food-.Rationing and Mortality in Paris, 1940-41; 
Hilbank Memorial Fund quarterly 20’• 213-20.. (.July 1942) ; NacMrichten " 
fur den Ausscnhandel. 8 January 1943; Het Nationale Dagblad. 24 
February 1943; Bulletin de 11 ordre des ■ ghariaa-ciJns . 7 March' 1943; 
HEW, #61, 8 April 1943; OBS, CID, Censor Materials.Summary,27, 1 
May 1943, pp, 43, 65, 81. 
'4, K, Oberdisse and A, Fleckenstein, "Der Eihflus-s- der Kriegserna- 
hrung auf den Diabetes mellitus," Deutsche medizinische Wochen- 
schrift, 17 July 1942, pp. 717 ff. 
5. Dr, G-reiff, " Zuckerkrankheit und Arbeit seinsatz, " Reichsarbeits- 
blatt. Pt. II, 5 November 1942, -or). 563 ff. 
( 2 0 443) RESTRICTED. 
diabetics ; normal food rations contain albumen principally in 
animal form; diabetic persons should receive it in vegetable 
form. The rations do not contain enough fat on the one hand and 
too many carbohydrates on the other. "A basic diet for diabetic 
persons can thus not be composed exclusively of the. food rations. 
For this reason the diabetics receive additional food, which 
originally•was quite ample but now has been reduced,... It is 
apparent that'the prescription of a diet encounters certain 
difficulties," In view of this situation, the expert recommends 
offsetting the food deficiency by increasing the insulin intake 
and by giving insulin to a.larger number of patients.! 
However, the supply situation has been such that the 
authorities had to take recourse to exactly opposite measures. 
Regulations were issued in the spring of 1942 for a sort of 
census of diabetic persons, with prescriptions of Insulin 
centrally collected. This was done in order to ascertain' re- 
quirements and to prevent people from obtaining more insulin by 
using the prescriptions of more than one physician. 'On the basis 
of this material, ration cards were issued,2 The results of this 
investigation are decribed in the following circular of the 
Reich Health Leader, which was issued on 12 November 1942: "The 
Insulin ration cards which have been issued on the basis of 
applications by physicians have resulted in a total demand for 
insulin essentially in excess of the previous consumption. 
Investigations indicate that.Insulin was requested in many cases, 
for diabetics who do not require it and that higher amounts- were 
prescribed than- necessary'. In order to meet the really essential 
need for insulin, it is necessary that doctors apply- the same. 
strict standard in their requests for new insulin cards as in 
prescribing additional food rations for sick people, . The supply 
for- diabetics is-assured if all doctors impose upon themselves 
the necessary responsible limitation on insulin prescriptions." 
In prescribing insulin, doctors must apply the following 
principles: no, insulin for light cases of diabetes; a reduced 
amount in-other cases; no insulin for other dieases. Random 
investigations of the applications are made to assure that these 
principles are applied.3 
Before the war, Denmark and the Netherlands, were among the 
principal- countries producing insulin. Some 90 percent of the 
Danish production used to be exported. Danish production of the 
Novo factory, which used to export to 45 countries in previous 
years, is reported to be hampered by lack of raw materials. The 
European market/ on the other hand, has increased to such an extent 
uhat uhe demand cannot be met, 'r In the Netherlands, the Organon 
1. ¥. Palta, "¥ie be handle ich die Zuckerkrankheitzeitgemlss?" 
wiener klinlscho Wochenschrlft, .20- February 1942, p. 152. 
2. Klinlscho Nochenschrift, 30 May -1942, p. 512. : 
5- Relchsgesundhe.lt sblat't, 13 January 1943, p,. l4„ 
19^B~1;Lf:l0r —--- 1 March 1943, Europa-Kabel,- 27 August- 
(25443) RESTRICTED 
factory was one of the worlds largest producers of glandular 
preparations of all kinds. At least 60 percent of its pancreas 
used -to be imported, in the main from South America and to some 
small extent from North'America. In 1958, this factory took 285 
tons of pancreas glands, which yielded roughly 5-400,000,000 
international units of insulin. In 1939 and 1940 the facilities 
were .enlarged and the present capacity . may be 50-60 percent 
higher. The annual prewar consumption of insulin in the Nether- 
lands has been estimated as 240,000,000 international units, 
to which Organon contributed 200,000,000 units. The rest was 
supplied by imports and one other small Dutch factory. Present 
minimum requirements for the Netherlands have been estimated, 
as 12,000,000 international units per month as compared .with 
20,000,000 before the war.- Dutch production is said to be only 
6-7,000,000 per month. This corresponds to ah estimated pre- 
war production of 40 tons of glands or 60,000,000 units of 
insulin per year. According to one source, practically all 
of the insulin is produced by Organon, Other reports indicate 
a greatly increased production by Organon, but there is- unanimity 
about lack of insulin in Holland proper. There is said to be 
no evidence of exports to Germany,! 
It is hot known to what extent the collection of nanereas 
glands in' Europe is impeded by the consumption of the glands 
as food and to what extent it is organized for the purpose of 
..insulin production. In Cracow, for example, the administration 
•of the Government General has founded the Bacutil Corporation 
which is -designed to function as a central'- agency for the 
marketing of animal by-products. This’ company is collecting 
rand marketing the intestines, gall bladders, stomachs, and 
glands important for medical;preparations, as well-as other, 
offal from'the slaughter houses'of the,Government General, 
In Norway the Fishery-Experimental Station of Bergen Is 
investigating, the possibility of obtaining insulin from the. 
organs of the. codfish,8 The Bulgarian, government now exports y 
panepeas glands' only to countries which are' willing to supply 
insulin in Preparations are ;;also made for the domestic 
production of insulin by the Buichina Corporation near Momina- 
Banja in the district -:of Ichtiman,4 'Rumania is engaged in 
similar efforts and has sent a deputation for the purchase, of 
the equipment of-an insulin factory in the Netherlands or in 
Denmark,5 • ' ” ' Vi. 
1, MEW, #61', 15 April 1943. 
2, Eurooa-Kabel . 6 August 1945. * >v v .;>■.• 
3, Zpra, 5 January 1945. 
4, 3ukarester Tageblatt. 15 March 1943; Eurooa-Kabel. 6 August 
1943. . : ' ' * "" J 
5, Bukarester Tageblatt, 3 February;- 6 June 1943. 
(25443) RESTRICTED 
i. Quinine . Quinine ,is; the chief alkaloid of cinchona; 
the bark of the- cinchona tree, which is cultivated in Java, India, 
Ceylon, and certain regions of South America. Before the war, 
more than 90 percent of quinine 'originated from trees grown in 
Java. The principal use of quinine is in the treatment of malaria./- 
It is also applied in gynecology, as a prophylactic against grippe, 
as an analgetic, and in the treatment of general infections. 
It is believed that Germany has obtained small amounts of 
quinine by blockade running during the war, though the quantity of 
these supplies is uncertain.1. Total stocks in Axis Eurooe in May 
1940 have been estimated as 275 tons of.actual or extractable 
quinine salts. • The pre-war requirements of this area were about 
2lQ.. tons per annum including (or 190 tons per annum excluding) 
French North Africa. On this basis there was enough quinine in 
German Europe to supply, needs for about 17 months, i0eo, until 
the- later part of- 1941. The various campaigns in malarial 
districts have, however, placed the available supplies under much 
strainM 
The lack of quinine is not much felt in Germany, which'is not 
malarial, but to a greater extent in Italjr, Spain, Bulgaria, 
Yugoslavia, Greece, Turkey., and Portugal.4’ However, the production 
of synthetic anti-malariala like Atebrin and Plasmochin has made 
much headway in recent years. Since their production is concen- 
trated' in Germany., malarial countries in Europe 'are dependent upon 
exports from Germany. ..France and Italy are also producers of 
synthetic anti-malarials. 
was originally a Bayer .product, ..'■According to. 
Professor Sergent of the North African Pasteur Institute, no ■ 
French' equivalent was available until Professor Roux, the director 
of the .Paris.;,; Institute. Pasteur,. obtained'the formula.' The French 
product, an exact equivalent, is called Quinacine, and made by the 
Usines de Rhone. Another French malarial remedy, Stovaine, has 
been invented by Professor Fourneau. Professor Sergent has• 
suggested obtaining quinine by cutting down, trees after five years 
instead of removing the bark after 20 years,5 ,, 
Atabrine is chiefly used as a remedy for malarial persons in 
Greece. The Red Cross had in April 1943 a supply of about 5,2 
million atabrine tablets and 30 .million'more were ordered from 
Canada, For a treatment which, however, must be repeated often, . 
15 atabrine tablets are said to be needed. In order to make ..the 
campaign effective, 20 million additional tablets are reported 
to be needed. For the chronic cases., about 2,000,000 plasmochin 
tablets are said to be needed, of which 300,000 were at hand in the 
spring of 1943. Moreover, quinine :-is necessary.for special pur-., 
poses. The Red Cross has about 300,000 quinine tablets.6 
1. ’MEW, 7 May 1945, P-79. MEW #67, 27'May 1945. 
2. MEW, 17 March 1941, • • : • , ' , ...." 
3. Zora. 7, 18, March, 1943; Proinos. TVnos. 9 July 1942; OSS, 
Censor ■ Mate rial.6'Summary 27, 1 1943, pp»,49* 68, 70,. 74, 96, 
4. See Dr. Rose, ’’Malariaprophylaxe mit Atebrin, ihre Doslerung 
und angeblichen Komplikationen n Deutsche medlzinische Wochen--- 
schrift, 28 November p. 130?. 
5. OSS, CID 41395, 6 May 1943. 
6. From a report by Dr. Elsa SegerdahlPerss.on entitled 11 Contagious 
Diseases in G-reece" and dated Athens, 28 April 1943. OSS, CID 38151. RESTRICTED 
In Germany herself, various economy measures have been 
applied which are designed to reduce the civilian consumption of 
quinine helow normal. According to a decree of the Minister of 
the Interior of 15 March 1941, quinine and its compounds are 
dispensed only on a doctor's prescription. Doctors must not 
prescribe it as a prophylactic against grippe or as an 
analgetic. It is to be replaced by sulphonamides in the treat- 
ment of broncho-pneumonia, and by pyramidon in the treatment of 
genera.! infections where it has sometimes been used to bring 
down temperature. Where necessary, it may still be prescribed 
in the treatment of malaria and in gynecology.4 
The German position has undoubtedly been strengthened by 
the seizure of the considerable -stocks which were available in 
the occupied countries, especially in the Netherlands. There 
are reports of German deliveries to Italy and Bulgaria, but 
other reports indicate the difficult supply situation in these 
countries. 
j. Stimulants. i. Camphor. Natural camphor is 
obtained from the wood and bark of a tree growing chiefly in- 
Japan and Formosa. Camphor is used as a liniment as well as a 
stimulant of the circulatory and respiratory systems. Though 
the continent of Europe is short of natural camphor, this 
deficiency is not serious in view of the limited usefulness of 
the.product and in view of the fact that it can be produced 
synthetically. Shortages are reported from Holland and Belgium. 
ii. Caffeine.. Caffeine, another stimulant, is re- 
ported to be short in. 'Estonia, where its content had to be 
'decreased in certain medicinal preparations.' It is also short 
in Holland and Hungary.2 Reports from Prance indicate that 
synthetic caffeine can now be manufactured on a large ‘scale 
after long laboratory research work. The price is much higher 
than genuine caffeine.3 
k. Radium. About 85 percent of the world radium out- 
put is employed for medical purposes. The Belgian Congo 
provides 90 percent of the world supply of uranium, the ore. 
from which radium is extracted. .*■■■ Extraction 'bakes place in 
Canada and at Oo-len, -near Antwerp. The Belgian refinery fell 
into German hands in 1940, Though there have been no, shipments 
of ore from the Belgian Congo, Germany is said to be in the 
possession of sufficient quantities of radium.• 
• la 4lVGr Extract. The value of a liver diet in the 
treatment of pernicious .anemia was discovered only recently. 
The various liver extracts require extremely large numbers of; 
animal livers and the supply situation in Europe is thus very 
Deutsche modizinlsche Wochenschrift 67:446 (l8 April" 1941) .• 
ohXefn5eP -942k P. 1130; Kllnis.che Wochenschrift. 7 March 1942 
?alp40; 9 May 19^2* p. 444; RelGh.3gesundheitsbl8.tt, lo December 
2. Bern T. (p) #1698, 15 March 1945. 
9* Pet:?-t Dauphlnois. 11 August 1945. . 
7'Auj^rfl^—1-anzelger*16 July 19*S; S«£2: £££21 Belgium. 
(25445) RESTRICTED 
similar to that in the case or insulin, in Germany, liver 
extracts, used to be produced by I. G. Farben and much reliance 
was placed on liver imports from the Argentine. It Is very 
difficult to replace these preparations, which might bo more 
needed now than they wore in the past owing to the various 
food deficiencies. 
Since 1939, liver preparations have been available in 
Germany only on prescription,! In 1942 it was decreed that liver 
was no longer to be used for the manufacture of preparations 
to be taken orally but only for preparations for injections 
in the treatment of pernicious anemia,2 
m. Surgical Certain 'varieties of animal 
casings lamb casings, -in particular) may be used for the 
production of catgut for surglca;! sutures» Although 
some, kinds of fibers, particularly cotton, silk, and nylon, may 
also be used as sutures, those produced from natural casings 
have unmistakable advantages since animal casings are absorbed 
into the blood stream and there is a .smaller chance of Infection 
when such casings are used. Moreover, the use of substitute 
fibers requires a special technique on the part of the surgeon. 
Germany has always been a large importer of casings. In 
1938, for instance, German imports of animal casings totalled 
19,311 metric tons, of which 3,317 tons came from Great Britain 
and With the loss of imports from Russia, Great 
Britain, and,"to some extent, from Argentina, and with the 
decline of livestock in many European countries, Turkish 
supplies have taken on greater significance than before the war. 
Orders were also placed with Swiss firms importing catgut and 
other raw materials for supplies to be used "supposedly for the 
production of strings for musical instruments.”4 At the Russian 
front in the winter of 1941, the Germans were using silk as well 
as catgut, but the quality of the latter was lower since it 
was not, always of a uniform thickness or at a uniform tension. 5 
In view of the heavy .German demand for lamb casings in 
Turkey, arrangements were made by the Allies for purchasing as 
much of the 1943 production as could be obtained. These 
arrangements were successful and by the end of September 1943, 
no typo of lamb casing suitable for surgical sutures was 
available to the Axis. 
German annual catgut requirement's have been estimated as 
200.000 Kg. In 1941 Germany imported 12,500 Kg. of dried raw 
catgut from Spain, which has an annual production of about 
23.000 Kg. In 1942 exports to Germany rose to 13,400 Kg, 
During the same years Portugal imported 4,800 and 5,100 Kg., 
respectively, from Spain, It was- believed that these imports 
would be shipped to Germany. In 1943 Portugal placed an embargo 
1. Bulletin of Hygiene 16:432 (1941). - • ■ ... 
2. Wiener mediziniecho Wochenschrlft. 9 January .19.43, p. 38, 
3. BEW, Memorandum, 20 April 1943, Bl-6-257, 
4. OSS Sources, 8 March 1943. 
5. OSS, CID, Censor Materials Summary 27, 1 May 1943, pp. 29, 43. 
(25443) RESTRICTED 
on the exportation of catgut, thereby depriving the enemy of an 
important source of supply. 
Official Spanish figures for exports of silkworm gut are 
(in Kg.): 
Country 
19U 
19^2 
Germany 
0 
J84 
France 
265 
1,575 
Italy 
76 
84 
United States 
2,04? 
5,088 
United Kingdom 
957 
1,254 
■Total 
5,W 
6,454 
It Is believed that German purchases, ■which -were confined to 
surgical grades of silkworm gut, were in excess of the official 
figures. The 1942 Spanish production was estimated as 7,660 
pounds and was said to be one of the lowest on record. Normal 
output averages 25,000 pounds, producing 90,000,000 of strands, 
of which 20 percent are suitable for surgical purposes." Germany 
normally bought 6 percent of Spanish production, concentrating 
on the finest surgical grades. Since the start of the war, 
German pruchascs have trebled. 
n. Opium. Goodman and.Gilman, in their Pharmacological 
Basis of Therapeutics, aptly express the importance of opium' as 
follows.* "If it were necessary to restrict the choice of drugs 
to a very few, the great majority of physicians would place the 
■opium alkaloids, particularly morphine, at the head of the. list. 
Morphine is unequalled as an analgesic and its indispensable 
employment in medicine and surgery is well defined.n Morphine 
is contained in raw opium in varying proportions, and although 
raw opium with a morphine content of less 'than 12 percent :is, not 
normally used in the manufacture of morphine, fluctuations of 
the morphine content must be taken into account, in the evaluation 
of raw opium statistics. Morphine is not only produced from 
raw opium but also from poppy straw. The extraction of morphine 
from poppy straw is a comparatively recent development with 
possibilities limited only by necessary economies concerning land 
and labor. 
Intercepted letters and related material occasionally 
indicate shortages of morphine and other opiates in Europe 
(Norway, Holland, France, Switzerland, etc,).! There is.little 
such evidence from Germany:proper, except a circular of 16 
November 1942, which states that doses of codeine and 
ethylmorphtne can not be sold more than once against the same 
prescription,2 Official figures of Belgian and Danish stocks 
arc slightly in excess of the stated requirements of these r- a 
countries.3 In June 1942, German field lazarotts had presumably 
1. OSS,' CID, Censor Materials Summary 27,1 May 1943, pn. 81, 87; 
Journal of the American Medical Association 116:1470 (29 March 1Q4l 
llB 1942)7 ~~ 
2 . Dor- ooff ontliche Gcsundheitsdienst Ft. AV 1945. p. 154, 
3. League of Nations, Estimated World Retirements of Dangerous 
Drugs in 1943, Supplement, 31 JulyT9437“' ~~ 
(25443) RESTRICTED 
no restrictions on the use of anaesthetics. The use of narcotics1 
is reported to have been prohibited in the treatment of Russian 
prisoners of war, while reportedly it is freely used for French 
and English prisoners. There is, however, a report indicating 
that opium derivatives could not bo obtained by German field units 
in North Africa,1 
The statistical evidence is rather ambiguous.2 Axis stocks 
of opium on 1 January 1940 are generally estimated as between 
270 and 277 tons. Subsequent production and imports during 1940, 
1941 and 1942 are estimated as between 370 and 485 tons. The 
resulting total supplies in 1940-42 of 647 to 755 tons would 
haye been absorbed, by an Axis consumption in 1940-42 of from 
536 to 600 tons. According to these estimates this would have 
left stocks amounting to 111 to 178 tons on 1 January 1943. la- 
conjunction with imports estimated as between 45 and 58 tons, these 
stocks would have carried the Axis through the year 1943. This 
calculation of Axis supplies for 1943 -is exclusive of 1943 Europear 
production, which will become available in the fall and early 
winter. 
Apart from the production of synthetic substitutes for opium 
(demerol, dolantin, etc.), which has made much headway since 
the war, the production of morphine from poppy straw has grown 
in importance. Before the war, this process contributed the 
equivalent of at least 24 tons of opium in Europe per year., 
Extension of the acreage would make Axis Europe independent of 
opium imports from abroad, and there is little doubt that much 
has been done in this direction. As earlier experiments have 
shown, popples can be grown as far north as Sweden and-England, 
Before the war, the yield of poppy straw per acre varied between 
.75 and 1 tons. The yield of mophlne per ton of poppy straw 
is 1 to 2 Kilograms, In the spring of 3.943* Denmark started.. the 
cultivation of 120 acres.3 According to Danish newspaper■reports, 
domestic morphine requirements in Denmark could be*met if about 
1,500 acres of poppies were Slovakia harvested in 
1942 7*000 acres or 2,150 tons of straw. Hungarian production 
rose in 1942 to 2,775 Kilograms or the equivalent of 20 to 30 
tons of raw opium. This was produced from 1,600 tons of poppy 
straw, an amount which normally would not have been productive 
of so largo a quantity of morphine. There has thus been a 
considerable improvement in the technique of production. Though 
more extensive information is lacking, there is little doubt that 
the Axis, if it so desires, can expand'the production of poppy ■ 
straw at will. The production of straw is considerably less labor- 
consuming than the production of raw Opium, and progress has been 
made in the establishment of manufacturing plants for processing 
the straw and extracting the morphine. 
1. MEW #60, 12 April 1943, P-64. 
f; * Materials Inventory of the ..European Axis, 8 January 1943; 
Preclusive Purchase of.Opium in Turkey, 18 February iQby- 
Memorandum dated 15 April 1943, B1-64-3A. - '■ . ; 
3• Wiener medizinische Wochenschrift9 6 February 1943, p, 1]4, 
Politiken, 27 November 1942. 
(25443) RESTRICTED 
It is difficult to calculate Axis requirements under 
war conditions. In a report prepared by the International 
Narcotics Bureau it is estimated that Axis requirements during 
the war have increased from 50 to 100 percent and probably closer 
to 100 percent. Axis consumption before the war has been 
estimated as slightly in excess of 100 tons of raw opium. In 
spite of the increase in production from poppy’straw, Germany 
has continued to press for the continuation of opium imports 
from Turkey and recent Turkish reports indicate that Turkey 
is not willing to reserve the whole of the crop for the 
Allies. Even though production from poppy straw has been 
expanded and can be increased still more, experts believe that 
Allied purchases of Turkish opium- may be defensible in view 
of resulting dislocations in the Axis economy and in view of 
the postwar needs for opium. 
(25443) 
i RESTRICTED 
APPENDIX I: INFANT MORTALITY RATES 
The following table present's a compilation of Infant 
mortality rates in various countries: 
Year 
Germanya 
Protectorate 
Italy 
France*3 
Netherlands 
Belgium 
1958 
62 
Bohemia-Moravia 
c 
106 
66 
37 ' 
73 
1939 
62 
95 
,97 
63 
34 
74 
1940 
65 
94 
103 
91 
40 
85 
1941 
64 
99 
115 
73 
44 
84 
1942 
70 
98 
c 
70 
40 
84 
a. Territory of 1937 including Austria, Sudeten districts, 
Danzig and Memel, 
b. 1939 ff,: excluding Alsace-Lorraine. 
c. Not available. 
1 In the United States the infant mortality rate was 40 in 1942, 
(25443) RESTRICTED 
APPENDIX II: SOAP 
The following table gives estimates of the pre-war con- 
sumption of soap and of the consumption in 1941 and 1942 in 
various European countries. Estimate's are expressed in kilo- 
grams per person and per year.^ 
Country 
Soap ■ 
consumption 
Consumption of 
Pre-war 
Nov.., 
April, 
fat contained in soap 
1941 
1042 
Pre-war 
United Kingdom 
10.1 
10.1 
7.5- 
b 
Germany. 
7,25 
5 • 0 
a 3.78 
b 
Prance 
9,6 
1.J3 
■ 1.2 
5,6 
Italy 
4.6 
1.8 
1.2 
b 
Spain 
1.8 
1.8 
c 
b 
Poland 
1.8 
b 
d 
i;8 
Hungary 
2.6 
2.0 
d 
b 
Rumania 
1.7 
b 
d 
b 
Belgium 
11.5 
2.5 
e 
4.6 
-Holland 
10.7 
4.0 
CO 
• 
i—1 
4.5 
Portugal 
. : 2,7 
b 
b 
Greece 
1.6 
b 
f 
2,5 
Sweden 
8.75 
6.1 
6.0 , 
h 
Switzerland. 
. 5.8' 
b 
b 
b 
Denmark 
10.6 
2,2, 
5 e 
b 
Norway 
6,6 
b 
1.8 
4.0 : 
Austria . 
V ■ 5.1 
b 
b 
b 
..Protact prate 
and Slovakia 
. 4.25 
■ rb 
d 
2.6 
Finland 
. 3.4 
2.0 
1.5 
r b •' - 
Bulgaria 
1,-35 
b: 
d- 
b 
Yugoslavia 
1.1 , 
b • 
d 
1.1 
a. Rough estimate. • M • 
b. Not available, - ‘-'J 
c. Scarce., 
d. Very scarce, 
e. Official ration unchanged. Bad distribution. 
In addition to the figures reproduced above and those 
given in the following pages, allowance must be made for. 
home production of soap, which varies from country to country, 
and for which more exact data are not available. It is not 
believed that such production is of much importance in the : 
urbanized parts of we stern r Europe., 
The soap shortage, the degree of which varies in dif- 
ferent European countries, is a contributory cause of various 
diseases. It has contributed to the spread of....lice and thus 
to the spread of typhus fever in regions which are normally 
not affected to any appreciable degree by this -disease,’ Skin 
diseases as eczema, scabies, and Impetigo have become •-wide- 
spread, especially among the lower-income groups. 
I MEW, 6 November 1942, The last column is from Inter tAMied 
Committee on Post-War Requirements, Report to Allied Govern- , 
ments, Appendix II, Allied Minimum Imports Programme, 1943, p. 27* 
(25443) RESTRICTED ' 
Soap is manufactured from, fats and oils which are split 
into fatty acids and glycerine by the action of an alkali, 
usually lye of sodium or potassium* The latter combines with 
the fatty acids, which are the principal ingredients of soap, 
■and frees the glycerine. The availability of soap is thus 
largely determined by available fat and oil supplies. In 
1936 Germany used about 14 percent of her consumption of fats 
and oils for soap, compared with 20 percent in the United 
States in In view of the German fat situation, it is 
thus understandable that soap should become scarce early in 
the war. The growing reliance, .upon domestic fats and oils 
was accompanied by the tendency to curtail the proportion of 
fats and oils used for soap production. As early as 1937 a 
leading German expert had stated in an address before the 
German Society for Pat Research that ’’present conditions re- 
quire the allocation of .all available fat for nutritional 
purposes. No edible fat for industry I, Paint technology and 
soap manufacturing must look for a different raw-material 
basis."2 
Before the outbreak of the war ••new technologies .had been 
devised which were designed to reduce the consumption of fat 
for s.oap manufacturing or to produce economy in soap consump- 
tion, thereby reducing the consumption of fat. The fatty 
acids contained in soap are composed of groups of acids (C00H) 
which form lime salt, which in turn is. not easily soluble. To 
reduce the concomitant loss of soap (fat), the I. G. Parben 
and the Boehme Corporation of Chemnitz, have produced soaps 
(Igepon and Pewa) which .do not contain the carboxyl group 
(C00H) but substances of the sulfo group (HSOg). Igepal, 
another I. G. Parben product, does not contain any salt-form- 
ing 'groups (G00H or SO3H) at all, but many hydroxyl groups 
(OH). Still other washing preparations are made from lignin- 
sulfon acids, a waste product of sulfite cellulose manufactur- 
ing plants. These preparations have,hhowever, a very dark 
color. Much was made in Germany of the oxydation of paraffin 
to fatty acids for soap manufacturing purposes. ■ This process, 
which in the last analysis produces soap from, coal, had been 
studied by the I. G. Parben since 1921, and in 1S28 a few .tons 
of the product had been delivered to soap manufacturers for 
testing purposes. The results are said to have been excellent, 
but at that time foreign fat was available at prices which were 
low enough to prevent the utilization of the substitute prod- 
uct . The latter was not used until the introduction of the 
Pour-Year Plan, which also promoted the production of liquid 
fuels from coal,. Paraffin Is a by-product of liquid fuel pro- 
duced in this manner. Patty acids are produced from paraffin 
by the Deutsche Pettsaeure Works in Witten, Ruhr,'* and the fat- 
ty acids are used in the soap production of the Maerklsche 
Seifenindustrie. Production is said to consist of soft soap, 
laundry soap, soap powder, and some toilet soap. Pieces of 
the latter carry, .the inscription ”Seife aus Kohle” (Soap from 
Coal). Such soap has been sold at retail since 1937. In 1942 
it was reported that a new, product, similar to Igepon, was 
manufactured by I. G. Parben from new sulphonate detergents 
made from brown coal. The name of the new product is Mersol.^ 
1 Karl Brandt, Fats and Oils'in the War, Stanford University, 
1943, p, 3, 
2 See Max Hessenland, Deutschlands Kampf um seine Rchstoffe, 
Munich, Lehmann, 1939, 3d ed., pp, 36 ff„ _ 
3 MEW #17, 6 April 1942. 
(25443) RESTRICTED 
Already included in products- rationed under the circular 
of 29 August 1939, on ”vital'needs of the,German people,” soap 
was subject to a special order of the Tints Office of 26 October 
1939,This order introduced a soap card giving the right to 
one piece of soap and one packet of washing soda and 150 Gm. 
of soft soap or 100 Gm. of hard household soap per month; and 
one tube of shaving soap every four months-. Children up to 
eight years were given an additional monthly allowance of 500 
Gm. of soap powder or two packets of washing soda or 120 Gm, 
of soap flake,s. Children under two years received, in addition, 
100 Gm. of toilet soap. Persons suffering from skin diseases 
(confirmed by a medical certificate) and medical and nursing 
staffs could obtain a supplement of 500 Gm. of soap powder and 
100 Gm. of toilet soap. In addition, persons engaged in dirty 
trades received a supplement of up to three pieces of soap 
monthly. While rations were subject only to slight.modifications 
in the course of the subsequent years., the quality of the prod- 
ucts deteriorated- to a striking degree. The soap is said to 
consist of some sort of clay .and barely lathers; other observers 
speak- of ”solid sand bars.” The fat content of the household 
or toilet soap was reduced from 50 percent in 1941 to 18 percent 
in 1941-1942 and 12.5 percent in the early part of 1943, with a 
corresponding increase in the mineral content consisting of 
impure chalk, carbon dioxide, calcium oxide, alumina, silica 
and traces of magnesia.2 
The extent to which the production of this soap of poor, 
quality drains the German fat reserve is not easily determined 
in view of the uncertainty concerning the extent of the use of 
synthetic.fats of the nature described above. Frequent exam- 
ination of German soap samples have not revealed the use of 
synthetic fats in any appreciable number of cases,.. This has 
been ascribed to the German desire to economize in the produc- 
tion of liquid fuel by-products in order: bo maximize the pro- 
duction of the fuels themselves. On the other hand, uncorrobo- 
rated reports from the summer of 1943 point out., that Germany 
is now using synthetic fats successfully in soap manufacturing 
and that the new standard soap made from synthetic fiats has a 
fat content of 78 In the summer of 1942 the produc- 
tion of fatty acids from paraffin was: given as 60,000 tons. 
Based on official soap rations and- the analyses of soap . 
samples which have boon undertaken abroad, the total fat needs 
for soap production have been estimated as 45,000 tons for 
1942, Since rations have not changed, this estimate may well 
hold true also for 1943. It is based upon the following cal- 
culations: 
Population 
Soap product 
Ration ■ 
Soap 
consumed.. Pa 
t con- 
P 
or person 
r ten 
t(tons} 
80,000,000 
Standard Soap 
1.08 Kg. 
86,400 
tons (18/bf at) 
15,552 
u !t Powder 
2,70 Kg, 
226,000 
tons (13$f at},. 
29,320 
Total 
fat 
44,872 
1 Bulletin of Hygiene 16:432 (1941). 
MEW, #31, 9 November 1942, etc. 
APHQ, Weekly Summary of World Events, No. 23, 002424. 
4 MEW #121, June 1942. 
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If to this are added the fat needs of the occupied territories, 
the total figure increases to 97,000 tons on the basis of an 
average ration of 1.5 Kg., a population of 196,000,000, an 
avera :e fat content of soap estimated as 18 percent, and the 
resulting'fat requirements of 52,264 tons. Much of the re- 
quired 97,000 tons of fat for .soap manufacture are provided 
by waste and fats recovered from oil and fat refineries and 
hardening plants, slaughter houses, restaurants, hotels, and 
even domestic drain water. 
The general situation is most unfavorable to the main- 
tenance of proper health and hygiene, the more so since hot 
water is rationed in numerous In the summer of 
1942 the operations of commercial laundries were placed under 
considerable strain by a'decree prohibiting the manufacture 
of machinery for making laundry soap and candles and cutting 
off the supplies of felt canvas and other textiles needed by 
There is much complaint about the spread of skin 
diseases in Germany. Though the authorities are not inclined 
to state in plain words that the decline in the quantity and 
quality of soap must be held responsible for this, it goes 
without saying that the cure of such diseases becomes more 
difficult if the standards of hygiene decline. The ’’alarming 
Increase” in eczema is ascribed in Germany to nervous disor- 
ders and and the growing number of cases of bolls 
among miners is attributed, tentatively, to specific condi- 
tions of work, vitamin deficiencies and the like. It is 
pointed out that miners have shown less Resistance to this 
disease than the rest of the. population. 
In Denmark domestic soap production is reported to have 
increased in 1942 compared with 1941, since domestic oilseed 
crops could'be utilized and regular soda imports from Germany 
were continued. However, the Copenhagen Municipal Hospital, 
which handles 80 percent of the cases of skin diseases among 
the population of the capital, treated 10,000 skin disease 
cases in 1942. Before the war only two cases of persons with 
body lice were treated annually, but during January 1943, 162 
cases were treated,13 In December 1942, two men were arrested 
in Copenhagen for having produced, and sold about 500,000 so- 
called ”shampoo powders” made from ordinary kitchen scrubbing 
powder, in some cases with the addition of some soap flakes. 
Analysis of the powders indicated that their application might 
cause eczema.6 
In Prance the soap ration allowed was 3 ounces in May 1943 
with a maximum fat content of 20 percent. There is much com- 
plaint of a shortage of caustic soda which is taken by Germany 
from Prance and reexported, in part, to Italy, Impe.tigo is 
said to-prevail and cases -of-scabies to have increased many 
times. In 1941 a Paris hospital•treated 60,567 scabies cases 
compared with a pre-war average of 4,500-5,000, 
. 1 Bern (P) #5209, 25 August 1943 (Munich), 
2 MEW, 24 July 1942; 1 September 1942. 
3 Karl Braun, ’’Ursachen .der Hautfunktionsstorungen,11 Fette 
und Selfen. May 1942, pp. 359 ff, 
4 Deutsche Bergwerksze1tung, 14 May 1943. 
5- Fyns . Tldende, 28 March 1943. 
6 Polltlken, 6 December 1942, 
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In Italy the shortage of soap is such as to yield re- 
oorts normally incredible. An American citizen of Italian 
origin, who studied medicine in Naples, stated that nin the 
summer of 1942, students (subject included) of the surgical 
department of the university manufactured soap from fat ob- 
tained from cadavers at the morgue.Italy relied upon 
German Imports of caustic soda in 1942 and 1943/" 
Stocks of this commodity have increased in Portugal ow- 
ing to the lack of vegetable oils for soap manufacture. 
Impetigo is said to prevail in Norway and the weekly 
cases of scabies in Oslo hospitals are now from 30 to 80 as 
compared with 0 before the war. For the whole country, the 
number of cases reported prior to the war varied between 450 
in 1930 and 11,108 in 1939. During the first 10 months of 
1942 a total of 26,574 cases was reported. Reports indicate 
that practically all German prisons and concentration camps 
are infested with scabies. The closing down of public baths 
in the cities aggravates the situation further, since hot 
water for bathing is no longer provided by apartment houses. 
In the city of Oslo all but one of the public baths were 
closed owing to the lack of fuel in the month of October 
1942, and have been closed ever Soap is so scarce in 
Norway that the patrons of barbershops must bring their own 
supply along. - 
Recent reports from Turkey indicate that several small 
factories, encouraged by the Axis, are engaged in making soap 
from spoiled hazelnuts. In the summer of 1943, 140,000 Kilo- 
gram of soap of excellent quality was said to be available for 
export to the Axis. The Allies have considered preclusive 
purchase of these stocks. 
A recent report from Hungary indicates that the discovery 
of earth saturated with oil in Transylvania has given rise to 
the production of a soap substitute called Montmarillonit. 
This is said to be sold everywhere for a price somewhat, less 
than regular soap. Allegedly it is almost as good as the 
natural product. In the process of production the oily earth 
is dried, ground and cleaned. It is then scented with per- 
fume. Germany has shown great interest in the product arid a 
Gorman export concern was established in Budapest.^ 
1 OSS., Survey of Foreign Exports, CID 00535, 30 June 1943. 
2 MEW, Intelligence Weekly, 15 April 1943. 
3 Office o£ the Surgeon General of the Norwegian Public 
Health Service, Medical and Sanitary Data on Norway, Washington, 
D. C., May 1943, CID 3§847, pp. 34 f. 
4 Sydsvenska, 4 August 1943. 
5 CSS, CID 42939, 12 September 1943.