Letter Re: Three Abstracts on Public Health in Ghettos During the WWII Holocaust

In light of the recent shooting by a Nazi whacko in Washington at the Holocaust Museum, I think it is important that we remember the victims and impact of a totalitarian government deliberately starving, looting, and otherwise dehumanizing its citizens. (The articles were published in Hebrew but the following abstracts are in English) – Yorrie in Pennsylvania (a retired physician)

Clinical Manifestations of "Hunger Disease" Among Children in the Ghettos During the Holocaust
Hercshlag-Elkayam O, Even L, Shasha SM.
Western Galilee Hospital, Nahariya, Israel.

The harsh life in the ghettos were characterized by overcrowding, shortage of supplies (e.g. money, sanitation, medications), poor personal hygiene, inclement weather and exhaustion. Under these conditions, morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with a high mortality rate. The dominant feature was hunger. Daily caloric allowance was 300-800, and in extreme cases (i.e. Warsaw ghetto) it was only 200 calories. The food was lacking important nutrients (e.g. vitamins, trace elements) leading to protean clinical expression, starvation and death. The clinical manifestations of starvation were referred to as "the Hunger Disease", which became the subject of research by the medical doctors in the ghettos, mainly in the Warsaw ghetto in which a thorough documentation and research were performed. The first victims of hunger were children. First they failed to thrive physically and later mentally. Like their elders, they lost weight, but later growth stopped and their developmental milestones were lost with the loss of curiosity and motivation to play. The mortality rate among babies and infants was 100%, as was described by the ghetto doctors: "when the elder children got sick, the small ones were already dead…". In the last weeks of the ghettos there were no children seen in the streets. In this article the environmental conditions and daily life of children in the ghettos are reviewed, and the manifestations of "Hunger Disease" among them is scrutinized.
[Harefuah. 2003 May;142(5):345-9]

Morbidity in the Ghettos During the Holocaust
Shasha, SM.
Western Galilee Hospital, Nahariya.

The environmental conditions and daily life in the ghettos of Europe during the holocaust are reviewed, and their effect on morbidity in different ghettos is scrutinized in an attempt to construct a typical morbidity profile. The outstanding characteristics were: crowding, shortage of basic necessities (such as food, clothing and medications), harsh environmental and sanitary conditions, inclement weather, poor personal hygiene, chronic undernutrition and malnutrition, physical and mental exhaustion. Morbidity was mainly due to infectious diseases, both endemic and epidemic outbreaks with high mortality, and high infestation rates of lice and other parasites. The dominant feature was "hunger disease" with its protean clinical expressions, endocine pathology, growth and development retardation in children, and amenorrhea and infertility among women of child-bearing age. Polyuria, nocturia and increased frequency of bowel movement were common. The typical presentation of a ghetto dweller was of extreme emaciation (a loss of up to 50% body weight); muscle weakness and skeletal abnormalities; pale, dry skin with excoriations; pedal edema; anxiety and nervousness; often goiter in children. Most of the inhabitants had some, or all, of those signs and symptoms (there were times when more than half the population was sick). This syndrome complex was termed "Ghetto Sickness" or "Ghetto Fatigue" (ghetto schwachkeit).
[Harefuah. 2002 Apr;141(4):364-8, 409, 408]

Medicine in the Ghettos During the Holocaust
Shasha, SM.
Western Galilee Hospital, Nahariya.

The Health systems in several ghettos in Europe during the holocaust were studied in an attempt to construct a typical structural profile. The medical system in a typical ghetto consisted of a department of public health (sanitation) that belonged to the Yudenrat, several hospitals, outpatient clinics, first aid stations and physicians in the labor groups. The structure of the system in several ghettos is discussed and the functions of the various units in the prevention of epidemics, and health education are reviewed. Also described is the medical research that was carried out in the ghettos, emphasizing the work on "Hunger Disease" in the Warsaw ghetto, as well as the heroic endeavor to establish a clandestine medical school in the Warsaw ghetto during the holocaust
[Harefuah. 2002 Apr;141(4):318-23, 412]