The Condition of Civilians in Western Europe at the Conclusion of the German Occupation

MAJOR CLOUSE: Gentlemen of the Empire Club of Canada and our audience of the air

Our meeting today will be somewhat unique in that our guest speaker has come equipped with a projector to show some pictures he took personally while with the army in Germany--which pictures he will use to illustrate certain features in his talk. However, may I say to those listening on the air--do not turn off your radio in the belief that this is to be a picture show, for that is not the case. There will be a few pictures only and Dr. McCreary will explain and describe each one for your better understanding.

The first step on a large scale to feed the people of occupied Europe came on April 30th, 1945, following a conference held the day before between Field Marshal Montgomery's Headquarters and the General Commanding the 25th German Army. It was agreed that the Swedish Red Cross would assume the responsibility of distribution of the rations and that day the Canadian Corps moved forward 240 lorries containing 100 tons of food and delivered it inside the German lines, under truce. The Dutch civilians handled the unloading with extreme difficulty as in their weakened condition, attributable to malnutrition, a man of normally excellent physique would collapse after a half hour of this manual labour. This will give some idea of the difficulties which followed as the necessity arose of not only feeding nearly fifty thousand Dutch civilians in the British area, but hundreds of thousands of released prisoners and others known as "misplaced personnel"--As the Allied Forces moved further into Germany. The need for those experienced in dietetics as well as in medicine was immediately indicated and at that point Dr. McCreary--an authority of international repute in dietetics--was sent forward to survey the situation, to report and (more important) to act, so that those suffering humans might secure the maximum in hunger relief and medical attention with a minimum loss of time.

Wing Comm. McCreary is a Graduate in Medicine of our own University of Toronto. Prior to joining the R.C.A.F. early in the war, he practised in Toronto. He served overseas in the Air Force until called to Supreme Allied Headquarters in 1945 to assume special duties in relation to the health of civilians in the occupied areas. His excellent work in this office merited the highest acclaim and the Dutch Government honoured him by making him an Officer of the Order of Orange-Nassau.

It is my pleasure to introduce

WING COMM. JOHN F. MCCREARY, M.D., who will tell us about "The Condition of Civilians in W. Europe at the Conclusion of the German Occupation".

WING. COMM. JOHN F. MCCREARY, M.D.: Mr. President, Gentlemen of the Empire Club: As has been stated, it was my very good fortune to be one of a group whose task it was to examine the civilians in Occupied Europe in an attempt to evaluate their state of health at the conclusion of the German Occupation.

We did most of our work in Western Holland, for reasons which I think will become clear during the course of this discussion. We had an opportunity of doing some work in the Brussels region of Belgium. We did no examinations whatever in France, so whatever I may have to say about that country will be based entirely upon reports of other groups doing the same work in that area.

We had an opportunity of visiting some of the concentration camps within Germany, and I should like to have a few words to say about these later on.

Now, it is obvious it would be ridiculous for me in the time at one's disposal this afternoon to attempt to describe all features of life under Nazi Occupation for the various population groups in Western Europe. One must select some particular aspect of the subject to discuss and I am going to discuss the question of food. How much food did these people actually get? How much harm did lack of food actually do to them?

It doesn't require any very lengthy consideration of the subject to realize that an area as large as Western Europe would have a good deal of variation in the degree of hardships occasioned by lack of food. The three main factors involved by lack of food under the Nazi regime were

(1) The amount of food which the Germans moved back into their own country for their own population.

(2) The shortage of manpower for planting and harvesting crops.

(3) And, by all odds most important, the breakdown in transport, particularly in the latter years of the war, which resulted in food being left in the areas where it was grown rather than being transported to the areas where it was ordinarily consumed. As a result of this last factor, the people in the agricultural areas of Western Europe probably were as well off as they had ever been. To be sure, they did not get the variety of food. It was impossible to import food with which to dilute their product but they certainly had plenty of food to eat and no nutritional problems developed in these areas.

If we leave out these last groups we find that three relatively clear cut grades of nutritional deficiencies existed in the population of Western Europe under the German occupation. The first was that that occurred in the large European centres, in France and Belgium, and it is with this group I should like to spend a little time at first. I am going to discuss Brussels largely because we had an opportunity of examining people in Brussels and because, more important, we had an opportunity of going through their Public Health records and knowing exactly what they did, what they had to eat in the way of legal rations and what illnesses were reported during the period when rations were at the most severe state.

At Brussels, as in other cities in Western Europe, there was plenty of food at the beginning of the German occupation: These people had seen war coming, they had built up stocks of food, and were relatively well off at that time. However, so energetic had the German army proven themselves in exporting food back to their own country that within a few months of the German occupation it was necessary to impose the first war time ration in the Brussels area. That first ration was a relatively generous one. It contained about 2200 calories as based on the 3000 calories which most of us eat in this country. It contained adequate amounts of fat and proteins and had it been maintained throughout the entire occupation there would have been no nutritional troubles of any sort. However it was not maintained so very long and within two months the ration was reduced.

Early in 1941 it was reduced again, and in July of 1941 it suffered a third reduction and finally in November of 1941 it reached the basal level which was maintained throughout the remainder of the German occupation. This vital ration was anything but generous. It provided 1200 calories as compared to our 3000. It provided by any set of standards an inadequate amount of proteins and fat.

What happened to the people of Brussels on this ration? Well, in order to try and answer that question I am going to quote to you from the Public Health records of that country for the blackest winter of all these people had to put in, the winter of 1941-42, and during that winter every single individual in Brussels was hungry. There simply wasn't enough food to fill their stomachs. Everybody lost weight, and the amount of weight lost depended in large part on the age of the individual. Newborn babies were born weighing within a fraction of an ounce of what they had weighed in the prewar years, despite the fact that their mothers might be 20%o under weight. Weight again was relatively normal the first year of life because milk was the main commodity in the diet and the milk was set aside for young infants. Then between one year and twelve and thirteen years of age, the discrepancy in the weight attained in the age group and those attained in the prewar period increased at 12 years of age the average little girl in Brussels in 1941 and 1942 weighed 15 pounds less than the average youngster did in the prewar years.

Then there was an unexplained trend back toward normal coincident with the onset of adolescence and puberty and between the ages of 12 to 17 years of age there was a trend back toward the normal weight. This is simply unexplained. They didn't receive any extra food during that period but it looks as though perhaps increased assimilation of food during that time. It was most marked in the case of the girls, and also noticeable in the case of the boys.

Then with that out of the way, the loss in weight gradually became more marked with advancing age until in the case of people of very obese in prewar years, the losses in weight are 75 to 100 pounds ordinarily.

Every single person in Brussels that winter was tired. Their basal metabolic rate according to studies made by their own scientists were about 12% lower than in prewar years. They needed more sleep, they required more rest, they simply could not produce the amount of work which they had formerly been able to produce in prewar years.

The incidence of infectious diseases rose rapidly, not, I am sure, directly as a result of the lack of food, but more particularly as a result of lack of shelter, lack of accommodation, inadequate clothing, overcrowding. In any event scarlet fever and diphtheria rates rose very markedly during the winter of 1941-42. Tuberculosis increased by 22% during that year.

What about deaths from starvation? That, after all, is the real measure of how serious a diet is? How many people died of starvation? A total of 6 people were reported to have died of starvation in this region during that year. All of them were social problems. All cared for alcohol or tobacco or other commodities than for food and they traded off ration coupons to obtain more of the particularly prized materials.

What of famine oedema? It is a condition consisting of swelling of the dependent parts of the body-the feet and the buttocks of the individual, due to a lack of protein in the blood plasma, a lack of protein brought on by the inadequate diet. Famine Oedema has been shown in this investigation as in previous investigations to precede death from starvation by a period of three to four months, following some radical change in the intake, so the incidence of famine oedema is a good way to measure the degree of inadequate diet.

There were 144 cases of famine oedema reported in the entire city of Brussels during the black winter of 1941-42. This probably does not represent the total number of cases but it certainly represents a very large percentage.

I think then one can summarize the condition of the people in the Brussels region by saying that during the black winter they were cold, they were hungry, they were tired, they lost weight, almost every one of them. They had a greater tendency toward developing infectious diseases but the danger of you or I or average individuals getting into serious nutritional difficulties as a result of the inadequate rations was very small indeed.

I have made a statement you may find difficult to follow. I have stated that the ration was reduced to basal level in November of 1941, but the winter of 1941-42 was the most difficult period these people had to face: Why, if the ration remained at this low level throughout the remainder of the German occupation, did the condition of the people not continue to deteriorate, to reach lowest ebb at the time of the Allied liberation of the country?

That can be summed up in two words: black market and because the black market played such an important part in the feeding of people of Western Europe I would like to .say a word about it.

The black market sprang into being in order to satisfy two requirements. First, to increase the intake of food, and secondly, to increase the amount of money which the individuals had to buy food. The reason for that is this. When the Germans moved into Belgium they were paid very high salaries in Belgian funds. There was no reason why not. The Nazis controlled the printing presses and payed their men exceedingly high wages compared to the ordinary Belgian standard. When all the extra money reached the market it was inevitable that prices would spiral upwards very rapidly and of course among the scarcities was food and the price of food rose very rapidly indeed. To such a degree did this inflation extend that late in the winter of 1942 it became almost impossible to buy the 1200 legally available calories.

Had I been a high school teacher, let us say, living on the salary an average high school teacher would receive in this country, and had I four mouths to feed in this family, I would have been able to purchase the legally available food for my family only for a period of four days with the salary which I made in a month, so you see here was a completely impossible situation.

There was food in the country, not large quantities to be sure, but at least enough to keep people out of serious nutritional difficulties but they were unable to purchase it in many cases simply because they did not have the funds, so in response to this requirement the black market sprang into being. It became exceedingly expensive, so expensive that it involved every living individual above infancy and early childhood.

There were three different ways in which people became involved in the black market. A relatively small number became involved as one would say as wholesalers. They obtained by hook and crook, truck or other vehicles and went into the country and paid large prices and came back and sold to the retailers for many times what they had paid for it. A few were involved in this way. A great many were involved in the ensuing two ways. Many were involved as retailers. Not by any means all of the black market food in Brussels was sold through recognized retail channels. A great deal was sold through ordinary households. People would buy a little food for a large price and sell at a great deal higher price to friends and neighbours along the street. But the way in which you and I would have been involved in the black market had we lived in Brussels at that time was this. We would have done our week's work and then on our day off, we would have taken a bicycle--that was the only method of transport left-we would have taken some jewelry that had been in the family for some time or taken money and cycled out into the country and perhaps have bought what corresponds to 25 pounds of butter in this country and we would have paid a large price for the 25 pounds of butter. Then we would have gone back into Brussels, we would have kept 15 pounds of the butter and we would have sold the remaining 10 pounds for four or five or ten times what we paid for the whole purchase. In that way we not only increased our larder but also increased our income so we would be able to purchase illegally available food.

The black market assumed such proportions that beginning in the Spring of 1942, it had supplied to every man, woman and child in the Brussels area an average of approximately 1000 calories a day. It brought the consumption up from the 1200 calory level where they were in very serious nutritional difficulties, where they had deteriorated during the winter of 1941-42, up to the relatively safe level of 2200 to 2300 calories on which they steadily improved throughout the remainder of the German occupation. That was the reason why it was so difficult to find gross evidences of malnutrition in the cities and other urban centres in Western Europe at the time of the liberation.

That is the first type of malnutrition which occurred in Western Europe and I don't want anyone to think I was trying to minimize the discomforts that the people went through. Their hunger was very real, their loss of weight was very real. They spent a most uncomfortable time.

The second kind of malnutrition I would like to discuss occurred in Western Holland and I would like to say a few words about the food supply of Holland and the population of this country. As you know, it is an exceedingly small country. It represents a very tiny part of the size of the Province of Ontario. Its total population is somewhere in the neighbourhood of 7 to 7Y2 million people. Its people are not distributed evenly over the country available to them. The agricultural areas in the north, the northeast and the east, and the mixed manufacturing and agricultural areas in the south are relatively sparsely populated and the great bulk of the population are located together in the western part of the country in that area around the large cities, The Hague, Rotterdam, and Amsterdam.

They have singularly poor agricultural land. Nearly all is reclaimed land, useful for crops for forage, but completely inadequate for market gardening. The great bulk of the Netherlands under ordinary circumstances obtained food from two sources. A fair amount was imported from other countries, some from as far away as Canada. Secondly, they obtained the food grown in the agricultural areas of the old country by a rather involved system of transport. First of all their excellent railway system which transported the more perishable foods from the agricultural areas to the area where it was required, Secondly, and far more important, their canal, system and their barges on which they moved the great bulk of the food from the areas in the northeastern part of the country. I think the people of western Holland probably tightened their belts a little more rapidly and severely than did the other people of Western Europe, at the time of the German occupation, because immediately the Germans came in, their imports from outside were cut off. Nevertheless they managed to put in four relatively comfortable years, a little worse off than people in the Brussels area. The people certainly lost weight but the black market flourished and they were able to get by without any serious evidence of malnutrition.

Then suddenly in the Fall of 1944 the situation deteriorated very rapidly indeed because of two factors. The first was a change in the attitude of the occupying Germans. Apparently the Germans when they realized that the Allies had conquered most of France and most of Belgium decided they could not possibly hold on to the remaining parts of Western Europe which they then held, and that their best chance was to withdraw to the borders of their own country, taking with them all the materials which might conceivably assist them in withstanding siege within their own land. So they took with them from Holland everything that might possibly assist in this regard. They took food, manufacturing machinery, but the most important thing of all from the point of view of the Dutch, was their barges. The canal system had been taking quite a beating from the Germans and they took as many of the Dutch barges back as they could lay their hands on.

As a result, fairly quickly, in the Fall of 1944, the barge traffic in the Dutch canals fell off very markedly indeed and the main manner of transporting food from agricultural areas to the large urban centres was removed.

Then, very suddenly and very dramatically the second blow hit Holland. You all remember the ill-fated airborne attempted invasion at Arnheim. I think September 12, 1944 on the day the invasion attempt occurred the B.B.C. broadcast to the Dutch people asking them to sabotage their railways so the Germans would not have the benefit of their railway system in defending Holland. And to such good measure did the Dutch accede to this request that within a period of 12 hours the Dutch railways ceased functioning. The people went underground, and the railways stopped immediately. The Germans attempted to take them over during the ensuing weeks, but the sabotage continued and in the face of many incidents and much loss of life, the Germans gave up.

But if they were not going to use them they were going to see that the Dutch were not going to use them for some time so the railways were relieved of their electrification devices and they stripped the roads of every moveable part. So you have the large population group in the west of Holland suddenly without any means of obtaining the food supply on which they relied which was grown in the northeast part of the country.

As a result of these two facts, there was a sudden precipitation from the legal ration available from somewhere in the neighborhood of 1100 calories down to about 500 or 600 calories. No nation can be maintained on a ration containing only 500 or 600 calories. Sheer starvation stares them in the face in a very short space of time.

The Dutch Government and the people themselves took every possible steps to increase the intake of food. Some of the methods are worth mentioning. In the first place practically every Dutch family with true canniness had tucked away in their cellar or dug deep in their garden a store of emergency food for just such a time as this. Some fell back on private stocks of food.

Secondly, they made tremendous use of fundamental teaching and brought in the best medical and dietetic people in the country in an attempt to augment their meagre stores of food with others not usually eaten but edible products which added calories and nutrients in the soup in the kitchen. So extensive did the use of communal kitchens become that in one large centre in western Holland during that bad winter, over 90 per cent of the people in the city had one meal at least in the communal kitchen.

Thirdly, they made extensive use of materials that would not ordinarily be used for human consumption. The main product with which we relate Holland is the bulb. The bulbs which were grown in western Holland graced the table in that winter of 1945 instead of the garden. Sugar beets were quite prominent in the western part of the country and were eaten by human beings that winter steadily instead of by animals.

And, finally, and most important of all, the people themselves tried to conduct individual searches for food and the roads of western Holland in that cold winter of 1945 were literally covered with people on bicycles trying to make the last trip up to the northeast part of the country to obtain a little bit of additional food for their families.

The people were tired. They were not fit to make long journeys. Their clothing was not adequate. No clothing had been made in Holland from the time the Germans came into the country four years before. You can imagine how ill equipped they were to withstand the cold winter. Their bicycles were very bad indeed.

Those who had retained their bicycles for the most part had no tires or they had rope wrapped around the rims and on these rickety conveyances and inadequate clothing, thousands and thousands of people made the trip on the windswept cold roads to obtain food and not by any means all of them were able to make the trip. A great many broke down on the way and emergency hospitals sprang up in churches and schools and private dwellings along the main highways to look after the people to bring them in to give additional food for a period of two to three days and send them on their way.

I should think almost every family in western Holland has one member, in many cases many members, who made one or more trips to eastern parts of the country to obtain extra food for their family for that winter. The amount of food brought back was sometimes pitifully small--sometimes five pounds of barley or ten pounds of meat.

As a result of this, encouraged by the Government and worked out by themselves, the Dutch were able to increase the intake of food up to somewhere around 1100 to 1500 calories, depending on the part of the country involved. During the months of January, February and March, this represented about the average intake of food available to the individual inhabiting western Holland.

They then suffered a further setback. Some of the measures they were taking to increase food were shortlived and couldn't continue for very long. For instance, their own personal source of foods were very rapidly used up, once they started to delve into them. The sugar beets and bulbs formed a prominent part of the diet during the first months but didn't last long when everybody started to eat them. They were soon over.

Perhaps, most important of all, the Germans put a ban on the myriads of people who had started cycling from one part of the country to another, and this precipitated a further drop in the number of calories available to the population in western Holland and it fell to somewhere in the neighborhood of 400 calories. Fortunately that didn't last long. That was only about six weeks before the Germans surrendered. Had it lasted longer, it would have been very serious indeed.

As it was, let us think for a moment which was the result of the inadequate diet on the population of western Holland. Everything I have said about the people in Brussels was certainly true to a much greater degree in western Holland. They were hungry, they were cold, they didn't receive enough food to keep comfortable, they lost weight in every age group to a much greater degree than in Brussels. The incidence of infectious disease rose alarmingly and in communities whose public health record before the war was excellent. As far as deaths from starvation were concerned, from the basis of Public Health reports, it looks as though 1200 people in western Holland lost their lives as the result.

Now, the average individual was not affected. Most of the 10,000 people belonged to three well defined groups. The first group was the very aged population. The people too old to get out and rummage around and try to obtain additional food. The second group was the very poor population. The very poor people had nothing to give, nothing with which to buy the additional food for their families. The picture (slide shown) shows a little girl who looks about ten or eleven years old but actually is 17 years of age. She does not represent in any sense what the average Dutch child at 17 years of age looks like. Actually this sort of picture was confined to those areas where very poor sections of the population were to be found. So the very poor were the second group to be involved in the most severe of the symptoms as the result of the lack of food.

The final group to be involved were the occupants of institutions. The people who lived in sanitoriums, or mental hospitals. The Germans, as you know, had no great zeal for carrying on the life of a mental person so the person living in mental institutions had the greatest difficulty in obtaining even the legal amount of food available and these people deteriorated very rapidly, to such a degree that the deaths that occurred of the 10,000 people that died of starvation in western Holland, were for the most part in that group.

How many cases of famine oedema occurred in western Holland? Well, on the basis of the examinations we did it looks as though a quarter of a million people had famine oedema at the time the Germans left the country. That figure was supported by further work the Dutch did themselves. They set up outpatient departments in various places throughout the country to treat the famine oedema cases and they found the incidence of famine oedema in the group of persons that turned up to be treated, was somewhere in the neighborhood of 23,000 so it looked as though there were in the neighborhood of 200,000 to 250,000 who were suffering from famine oedema and were within a period of three or four months from death by starvation at the conclusion of the German Occupation.

I would like to sum up what occurred in Western Holland in just a few words. The people there were singularly uncomfortable, singularly badly off. They were within a very short time, indeed, of a major catastrophe.

The next slide shows a chart which indicates that in an old peoples home in Amsterdam there were 650 occupants, and in the month of January, among the 650 occupants there were no cases of famine oedema. The incidence of famine oedema among these occupants rose rapidly until in May of 1945 there were 235 of the total number who were suffering from famine oedema. They were doomed to death in a few months unless the ration was changed.

I should like to go on and say a few words about Concentration. Camps. The concentration camp I would like particularly to speak about is Belsen. As you know, Belsen is a political concentration camp, a place where the Nazis put people who did not adhere to the Nazi ideals in their own country or in Occupied countries. They were people whom the Nazis feared had sufficient influence in their own countries that they might do a good deal of harm to the Nazi cause. These people were by no means the riffraff in the country. They were brought to places like the Belsen Concentration Camp and there interned. Belsen was situated in a relatively uninhabited part of Germany. It was a large camp in terms of the amount of acreage it covered. It was barbed wire enclosed, of course, and inside the barbed wire were dozens of huts similar to the 35 man huts we used in our Services, but instead of 35 men in each hut, the Germans put anywhere between 200 and 600 people in each of these dwellings. These people were fed always in the same way--twice a day--a large tureen of watery potato soup which was pushed in through the open door at either end of the hut. Every individual was equipped with a tin mug and it was his own responsibility how much of this material he obtained before it ran out. The people able to survive long periods in the Belsen Concentration Camp were people with tremendous will to win through and tremendous physical endurance to fight their way up to the soup tureen and obtain three or four cupfulls. This was at the expense of their fellows, because after they were there a few days nobody thought of anything else or anybody else and in that way some of them retained their physical well being.

When the Army went into the Concentration Camp nobody had any idea how many had been there. The Germans asked for a 48 hour truce. They stated that they wanted to mend the fences. The typhus epidemic raging inside the camp would not extend to the surrounding territory, and also to bury the dead.

They did neither of these things but they did destroy every record available in the Camp of who the occupants were. It turned out later that there were something like 50,000 in the camp at the time the British Army entered.

For the purpose of simplicity I am going to try to divide the people into three main groups. The first group and those best off were people either in the camp for a long period of time and who had tremendous physical endurance and who had been able to maintain their physical and mental state on the inadequate food which they had received, those people required only a little special feeding for a relatively few days or weeks and were able to go back home.

The second group, unfortunately also quite large, were a group of people who had deteriorated physically but not so far that they could not be returned on the Bengal Famine mixture which was fed to most of the occupants of the camp and was made of skimmed milk powder, flour and sugar and is a singularly easy thing for people not eating to be able to digest.

The second group were those able to take that, and keep it down, and gradually gain strength. Unfortunately, they had been so disturbed mentally by so long a period in the camp that their mental return was far from as rapid as their physical return. When we saw the people in the camp they were lower in any sense of the word than any domestic animal one could imagine. They had lost their ability to see. They had of course no idea what their names were. They had no idea where they came from. They didn't know how long they had been there. They were simply mute. They were people whose only noise was a high pitched cry. There were thousands of these people and they represented the most disturbing sight to be seen in the Belsen Concentration Camp.

It looked for a long time as if there was absolutely no hope of any return to normal of this group. However, a very short time ago Sir Drummond was over in this country from England and he had been back to some of the places where the people were being treated a few months ago and he said that after about a year of treatment with good food and quiet surroundings, when these people had long since been returned to their prewar physical state, they began to get a glimmer of normal intelligence. As soon as the glimmer began to return very rapidly they returned toward normal and the great bulk of the people by that time had been discharged back to their own homes, knowing where they came from and knowing their families and taking up their prewar status in life again.

The third group was the group that was too far gone to take even the Bengal Famine Mixture. The group who as soon as they attempted to take any food lost it almost immediately. Most of these people died in the month following the taking over of the camp by the Allies.

May I have the next slide? This reveals one of the common graves of which you have seen many pictures in the newspapers. This represents the number of people picked up one morning who had died in one night during the month after the Allies had taken over, people for whom absolutely nothing could be done.

We have often heard the expression, "skin and bones". That expression didn't mean very much to me until one actually had an opportunity of seeing these people who had died in the Belsen Concentration Camp but it actually is true. People do deteriorate until there is nothing left but skin and bone and some of the people shown in the common grave are in that state.

Now, Gentlemen, I have talked long enough. I have tried to describe today three different degrees of malnutrition which prevail in Western Europe. The first was a relatively mild one which condition had every discomfort of loss of weight but it did not entail any severe danger of loss of life or severe illness as a result of lack of food. The second, that which occurred in Western Holland was very much more severe than the first. It entailed a great deal of discomfort and incurred at the conclusion a great danger of loss of life. I think we can say by only a few weeks was a very serious catastrophe missed in Western Holland. The third had to do with the concentration camps and that meant complete and utter tragedy for every individual who was involved. Thank you very much.