Into the Darkness : An Uncensored Report from Inside the Third Reich at War
by Lothrop Stoddard
Chapter 15: Socialized Health
“The treatment given a tuberculous patient is partly determined by his social worth. If he is a valuable citizen and his case is curable, no expense is spared. If he is adjudged incurable, he is kept comfortable, of course, but no special effort is made to prolong slightly an existence which will benefit neither the community nor himself. Germany can nourish only a certain amount of human life at a given time. We National Socialists are in duty bound to foster individuals of social and biological value.“
It was the official in charge of the Tuberculosis Section of the Public Health Service headquarters who spoke. He was an earnest young man with reflective eyes and a precise manner of speech. His was only one of many departments devoted to the combating of every notable Germanic ill, from cancer to flat feet. Here the myriad strands of a nationwide organization head up in a big building near Nollendorfplatz.
I had become accustomed to elaborate publicity methods in all the national headquarters of Governmental or Party institutions, but I think this one deserves the prize. The whole building was one series of exhibits, while the detailed educational literature was allinclusive. As usual, I was given a liberal sampling, sent next day to my hotel. They went to swell a collection of data which filled a handtrunk by the time I left Germany.
I have that public health literature spread out before me as I write. There are some twenty pamphlets, dealing with general or special topics, including a detailed bibliography of the best books available in the entire field. Some of the pamphlets are illustrated with cuts and diagrams. I note especially the one dealing with foot troubles, which contains a whole series of exercises. Then there are several singlesheet “dodgers.” Here is one entitled: Advice to Pregnant Women. This consists of a series of wood cuts. First, the things she should do: Spongebath on arising; take a quiet walk; wear proper clothes as indicated; brush her teeth before retiring; take a good sleep in a comfortable bed. Now the don’ts: heavy lifting; high reaching; bending long over the washtub; bending low to get into that bottom drawer; standing too long a time; drinking and smoking; wearing highheeled shoes; getting shaken up as on a motorcycle; finally, losing one’s temper. At the bottom of the sheet, proper articles of diet are visualized. Others in this pictorial series cover matters like Preparation for Motherhood, and Care of the Baby.
The pamphlets deal with all sorts of things. Here are several on specific diseases tuberculosis, cancer, foot troubles, infantile paralysis, venereal diseases, and so forth. There are several more on sex the best ages for begetting children; advice to parents on handling children during adolescence; advice to youths and maidens these last preaching strict morality, though from a patriotic rather than a religious basis. Lastly, there are a few miscellaneous topics, including diet, exercise, and avoidance of liquor and tobacco. All these are inexpensively gotten up for mass distribution.
Before I started on my tour of investigation, the general director, Dr. Eckhard, had given me a general background discussion, as Germans always do. He stated that the general theory and structure of the German public health system goes back to Bismarck’s day. The outstanding development under the Third Reich is thoroughgoing coordination of various departments and organizations. Structurally, therefore, no great changes have taken place except the establishment since 1933 of a complete system of cancer centers throughout Germany. It is in the spirit and tempo of the Public Health Service that we discover the vital difference between the present and former times. The Nazi attitude, subordinating the individual to the collective good, is well expressed in the remarks of Dr. Eckhard’s subordinate with which this chapter began.
Dr. Schramm, the eminent surgeon whom I met at my first dinnerparty in Berlin, undertook to continue my education in Public Health. One of the points he stressed was the good general level of health, due largely to the health insurance law by which even the poorest are assured full medical treatment. People are urged to seek medical advice periodically or for any worrisome symptom, and since it costs them nothing personally, they do it gladly. All medical men are legally bound to give a certain portion of their time to insured patients; patients have the right to choose the doctor or surgeon they wish to consult, and they even have the right to be sent to the private hospitals of such medical men, if he customarily sends his patients to those institutions. Dr. Schramm took me to the hospital of which he was chief surgeon. It was a fairly large private institution, with about 150 beds. Some wards were for insured patients. I spoke with several of them. They were all workingmen. Their health insurance allowed them up to one year’s hospitalization, with pocket money. After that, if not cured, I was told they were taken care of out of the public health funds indefinitely. Incidentally, Dr. Schramm informed me that cotton is so short in wartime Germany that absorbent cotton has become scarce. It is now saved for vital uses. Ordinary dressings are made of paper, and appear to serve quite well.
Another interesting point I learned was the progress made in the fight against venereal diseases. Anyone infected must at once consult a doctor, under heavy legal penalties. Since he or she can get free treatment and choose the doctor, they are glad to comply. Privacy for the case is assured by having the doctor send in a report to the health authorities bearing a number, the name and address of the patient remaining in his files. But if the patient does not come regularly or fails to comply with directions, the doctor discloses the patient’s identity and coercive measures are taken. Anyone spreading infection is punished by a sentence of at least six months in jail. This sentence is mandatory. Wealth and social position are of no avail. The result of all this is a sharp drop in social disease rates. Fresh syphilitic infections have become rare. There is still considerable gonorrhea, but much is hoped from the new treatment with sulfanilamide. The war has thus far not notably affected the situation. Soldiers are so well trained in prophylaxis and are subject to such heavy punishment for carelessness that there has been scant spread of venereal disease by them.
I spent an instructive morning visiting an accident and out patient clinic, to see how that aspect of public health was handled. This clinic was maintained for workingmen; all of them, of course, insured. The approach was not prepossessing. It was on the fourth floor of a dingy warehouselike building, and was reached by a freight elevator. Once inside, however, I was astonished at the completeness and modernity of the equipment. XRay and Roentgen Ray machines, sun and violetray lamps, mechanical and hand massage, uptodate operatingroom everything seemed to be there. An American woman, the wife of a bone specialist, who accompanied me, was frankly astounded at what we saw. She knew about such matters, and she told me that she had never seen anything professionally finer at home. Perhaps the most significant point was the cheapness with which the clinic was conducted. I was shown the costsheets, and found that the average charge made for patients to their associations was less than one dollar per day.
Another important aspect of public health is housing. The officials concerned with this phase showed me several new developments, from inexpensive workingmen’s apartments, through single and doublehouse settlements, to uppermiddle class “model villages,” all on the outskirts of Berlin. However, I wasn’t satisfied with what was officially shown me, surmising that everything would be the best of its kind. So I got a foreign journalist who knew about such matters to steer me around the poorest quarters. I was on the hunt for slums.
My colleague told me I wouldn’t find anything very bad, because Berlin had no real slums, as most countries reckon them. But he promised to show me the worst there were, and we spent the greater part of a day poking about. Our starting point was Alexanderplatz, formerly a very tough district and a Communist stronghold. Today, it is a humdrum traffic and shopping center. The worst section nearby has been almost entirely rebuilt with municipal apartment houses for workingmen. They are plainly and simply built, and the rents are very cheap. The heart of this extensive development is Horst Wessel Platz, named after the famous Nazi hero and martyr who was murdered by Communists in an old tenement (now torn down) which faced the present square.
After that we radiated in easterly segments; some of the oldest tenement sections drab and dreary, especially in the gray light of a cloudy autumn day. But none of them were rundown, and no dirt or rubbish was to be seen. My colleague informed me that the Nazi Government has forced landowners to clean up and repair even the oldest tenements. This was originally started as part of a compulsory “makework” program during the early years of the Nazi regime. In some tenement courtyards I saw small, shed like buildings (somewhat like the “alley dwellings” of Washington, D. C.) which once had evidently been lived in. However, such structures have all been condemned as living quarters. So are all cellar tenements. The general impression I got from these workingmen’s quarters was that of a rather low average standard of living, yet above the squalor line.
The nearest to slumlike conditions I discovered was in and about the Grenadierstrasse. There the very poorest class lives, including many foreigners and a considerable number of Jews. The tenements look sordid, with few clean curtains or flowers in the windows, as was the case nearly everywhere else. Many of the passersby looked as sordid as their abodes. The Jews, understandably, had a fear ridden, sullen air. I tried to find out whether ghetto conditions existed, in the sense that Jews were concentrated in certain tenements. Apparently this is not the case. In one tenement, where I saw nothing but Jews about, I asked a postwoman just going in to deliver mail if this were a purely Jewish place. With the frank callousness one so often encounters, she answered disdainfully:
“Ach, nein. Jews, Gypsies, all sorts of trash live here!“
Germany’s coldly efficient system of public health is strikingly shown by the scientifically notable sanitary job it has done in Poland. Although none of us foreign journalists were allowed to visit the Polish zone, I was fortunate in having a long conversation with almost the only foreigner who was permitted to go there. This man was Dr. Junod, a Swiss and a high official of the International Red Cross. Dr. Junod is an expert judge of sanitary conditions, with many years of service in the Red Cross and long experience in the Ethiopian and Spanish Civil wars. He visited Warsaw, Poland’s shattered capital city, about mid November.
He told me that what the German health authorities had done to Warsaw since its capture in late September was a miracle of scientific efficiency. Though the houses were still largely in ruins, the streets were immaculate he did not see even bits of waste paper blowing about. The water and lighting systems had been restored and the population generally inoculated against typhoid. The prostitutes had been listed and were carefully examined at frequent intervals. Most striking of all, the urban masses, habitually filthy and verminous, had been deloused wholesale. The delousing stations parted a man from his clothes, both going through different cleansing processes. These were so nicely synchronized that the naked individual usually met his garments at the other end both clean and freed from local inhabitants. The clothes were dry, since they had been subjected to a blast of hot air which desiccated them almost immediately.
About the more important aspects of the lives of the people through whose city those unlittered streets ran, I was able to gather little.
Nevertheless, the result of this intensive health campaign was an utter transformation of public hygiene in the short space of two months. Thereby a great peril had been averted. Sanitary conditions immediately following the German conquest were so bad that, unless heroic measures had been speedily taken, mass epidemics would have been inevitable. This would have endangered not only German occupied Poland but Germany itself. If such epidemics had spread into the Reich, the consequences might have been catastrophic, for the habitually cleanly Germans have no such partial immunity to filth diseases such as typhus as the Poles have acquired through having been chronically exposed to them. It was clearly not for the Poles, therefore, but for the benefit of the invaders that this miracle of sanitary science had been invoked.