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You deleting my article on medical care in the Vilna Ghetto in March of 2018 saying it contained copyrighted material. I researched the article extensively, paraphrased (did not copy) information and cited sources throughout the article. I've been puzzled on how to get the article submitted but not rejected. Here is the article again to refresh your memory. (the citations don't seem to copy in this form, but there are a total of 33 footnotes). -Best Regards, Michaeldg
Medicine in the Vilna Ghetto
Between September 6, 1941 with the formation of the Vilna Ghetto by the German occupying forces in Vilna (now Vilnius Lithuania) and September 23, 1943 with the liquidation of the Ghetto, physicians, nurses and public health officials engaged in vigorous efforts to protect the health of the beleaguered Jews of the Vilna Ghetto. Through efforts in sanitation, nutrition, vaccination, protection of infants and children and a well developed Jewish Hospital and outpatient clinics, the medical community of Vilna was able to stave off the mass starvation and unchecked infectious epidemics that devastated Jewish Ghettos through much of Nazi Occupied Eastern Europe.
Historical Setting WWII started in September 1939 when Germany invaded Poland and occupied the Western half of Poland while Russia occupied the Eastern half which included Vilna (now known as Vilnius Lithuania). In the German occupied zone, including Warsaw, anti-Jewish measures were immediately instituted- Yellow stars, walking in the gutter, confiscation of business and in the Fall of 1940 the formation of the Warsaw Ghetto. Over 400,000 Jews were forced into a 1.3 square mile area and walled off from the rest of Warsaw’s population. Jews were crowded into congested apartment blocks, sleeping 7 to a room, and were given only 184 Kcal of food a day. There was no systems for sewage or garbage collection, people had no bathing facilities or hot water and as a result starvation and infectious epidemics were rampant. Starvation and infectious diseases- primarily Typhus, Typhoid and dysentery killed 93,000 of the ghetto’s inhabitants, an outcome that was very much in line with the Nazi’s plan to exterminate the Jewish people from Europe. This specter of horror under Nazi occupation was noted by the medical community of Vilna even while they were under Soviet control.
Pre-War Institutions in Vilna Vilna, often called the “Jerusalem of Lithuania” was center of Jewish culture and had some unique community attributes that would enable a more successful medical response to the Nazi policies than occurred in Warsaw and other Ghettos in Nazi occupied Eastern Europe. First they had a large, well educated medical community with 130 physicians practicing at two hospitals. Since Polish Universities excused the vast majority of Jewish students, they had been educated in medical schools across Europe. They ran two hospitals before the war, the Jewish Hospital and the Mishmeres Hoilim hospital for indigent Jewish patients. The Jewish Hospital was a premiere medical institution and in fact by the 1930s began to attract large numbers of gentile patients, so much so that in 1936, due to complaints from gentile institutions, the Mayor of Vilna restricted it to treat only Jewish patients. Vilna’ Jewish medical community had a tradition of public health efforts including an organization called TOZ formed after the mass starvation experienced during WWI which was devoted to the health of the Jewish population. They held clinic and were especially devoted to the health and nutrition of children. They published a lay journal called Folksgezund whose purpose was to educate the public regarding matters of public health. Its motto was “Fighting ignorance, filth and death, proclaiming cleanliness, light and health” . The Jewish doctors, having been excluded from gentile medical organizations due to the anti-semitism in Poland, formed a Jewish Medical Union whose chief was Elias Sedlis an obstetrician/gynecologist. Thus we see that before the war there were key institutions in place- hospitals, a public health community and a medical society which would help immensely with the unfathomable challenges that were to confront the Vilna Jewish community.
For the 80,000 Jews of Vilna, the Holocaust began on June 22, 1942 with Hitler’s surprise attack on the Soviet Union. Vilna was captured within two days and measures against the Jews began immediately. All Jews had to wear identifying Yellow armbands or Stars, they were not allowed out of their homes except for designated hours, they were forced to walk in the gutter. They were frequently assaulted, robbed and beaten when they did venture out. Within a week the Germans began to capture young men and the community leaders who were transported to a secret killing ground in the forest of Ponary and shot into mass graves. A series of mass arrests, executions and deportations ensued over the summer and fall of 1941 during which 40,000 people were executed at the killing grounds of Ponar. The 40,000 remaining Jews were herded into a three square block area in the old Jewish Quarter on September 6th, 1941. The six streets of the Ghetto were walled off from the outside world and large sings were placed at the ghetto gates which read Attention! Danger of Contagion! As had occurred in Warsaw this sudden relocation into a cramped ghetto caused terrible congestion and overcrowding. The sanitary systems were immediately overwhelmed with latrines and outhouses meant for 30 people suddenly having to accommodate several hundred. Garbage began to pile up in courtyards and on streets attracting rats and pestilence. Food rations were were below subsistence levels, with only 640 Kcal per day allowed per resident. The combination of overcrowding, poor sanitation, inadequate food supplies and overwhelming stress all contributed to conditions that made the ghetto ripe for disease, epidemics, starvation and death. Once trapped in the ghetto, Jews who were working for a vital war industry were given “life certificates” which protected the worker, his wife and two children from death. Those without life certificates were regularly captured and taken to be killed at the execution grounds of Ponary. However, in the midst of this chaos and terror, the physicians in Vilna began to work on behalf of their patients and health of the community. Vilna’s physicians had seen what had occurred in the Warsaw ghetto the year before with it’s sweeping epidemics and mass starvation. Even before the formation of the Vilna ghetto on September 6, 1941, members of the Jewish Hospital medical staff and the Jewish Medical Union began to plan for how to respond the expected hardships they expected in the weeks ahead. The physicians organized themselves into four sections: The Sanitary Epidemiological section, the inpatient hospital, the outpatient ambulatory clinics and the Children’s School Medical Center. They devised the outlines of a ghetto health establishment with the following duties and structures :
Epidemiological prophylaxis Sanitary Inspection Bathhouses Laundries Disinfection (delousing) chambers Vaccination Stations Children’s Barbershop “Tea Houses” for providing hot water Garbage Removal Bureau Cleaning brigades School Medical Center Scabies Station Anti-insect brigades
Healing Inpatient Hospital Ambulatory Clinics Pharmacy
Child Care Pediatric clinic Milk Kitchen (for infants) Children’s Kitchen Daycare Center
When the ghetto was formed, one fortuitous occurrence was that the Jewish hospital fell within the walls of the ghetto and it’s entire medical staff of 130 doctors and nursing staff with their supplies and equipment remained intact. This remarkable stroke of fortune, which was at total variance from what occurred in other ghettos across Nazi Occupied Europe may have been due to the work of the head of the Jewish Hospital, Jacob Gens, an officer of the Lithuanian army who was later appointed to be the head of the Jewish Judenrat or governing council who had extensive ties with the gentile Lithuanian municipal government. The preservation of this institution and staff was a key factor in the Jewish medical communities ability to organize itself for the hardships that were coming.
The early ghetto created an ideal environment for contagious diseases. The outhouses quickly overflowed. This caused danger of dissentary and typhoid. The garbage bins filled and refuse began to pile up in courtyards and streets attracting rats, vermin and associated flea born diseases. The water pipes froze in unheated buildings making it impossible to bath, leading to lice infestations and the danger of Typhus. Within a week of the formation of the Ghetto the epidemiological section immediately got to work. They divided the ghetto into seven sanitation districts with each district being assigned a doctor and several nurses. They cooperated with the housing authority to begin a sanitation campaign. Each district had a housing Administrator and and assistant. Each district contained six or seven apartment buildings. Each building had a guard responsible for keeping the courtyards and public spaces clean and dirt free. Each floor of the building elected a Komendantin (woman in charge) who shouldered the responsibility for keeping the apartments clean and free of rubbish. The enforcement of proper sanitation was assigned to the ghetto police who formed a unit of Sanitary police who inspected each courtyard on a daily basis and each apartment flat once a month to certify that they were free of garbage and refuse. The ghetto sanitation police issued fines and even jail sentences for sanitation violations. Ghetto records show that in March 1942 the Sanitary police conducted 2407 courtyard inspections, 84 were found to be dirty and the owners issued fines. The same month 3996 flats were inspected and 324 were found to be dirty. Enterprises, especially those that served food were inspected. In December 1942 1380 businesses were inspected and 709 were issued $2,264 Reichsmarks in fines and 91 people were arrested for nonpayment of previous fines.
The issue of garbage was also addressed as quickly as possible. The Sanitary doctors learned that local farmers and peasants were interested in using refuge from the ghetto to feed to their pigs and to make compost for their fields. They were able to hire private wagons to haul garbage from the ghetto to give to waiting farmers at the ghetto gates. There was a communal celebration that was organized after the 1000 wagon of refuse was hauled out of the ghetto.
One of the most feared diseases that the Sanitation police worked to prevent was Typhus. Typhus is a rickettsial disease carried by lice. It causes fever, rash and delirium due to meningoencephalitis. During WWI armies and civilians suffered hundreds of thousands of deaths from typhus due to unsanitary and crowded conditions. Typhus was rampant in the Warsaw ghetto and thus was a major concern for the ghetto doctors. The Sanitation department built two baths in the ghetto, these facilities were designed to allow a hot bath and delousing of clothing in the dressing rooms. Some of the residents were resistant to regular washing and thus the Judenrat then decreed that all ghetto residents must bathe once a month. This was enforced by a rule that decreed that a ration card would not be issued unless one produced certification that you had bathed in the previous month. This ingenious policy resulted in a 237% increase in the number of citizens registering for their monthly bath, totaling 18,026 bathers by December of 1942
The sanitary section also opened laundries and a disinfection chamber for helping to fight lice among the residents and to disinfect the clothes and mattresses of patients diagnosed with contagious diseases. In it’s first eight months of operation the disinfection chamber alone treated 86 thousand kilos of clothing and hundreds of mattresses.
The Sanitation-Epidemialogical section set up six “Teahouses” around the ghetto where ghetto residents could obtain hot water by the bucket for bathing, washing dishes and clothing and even making morning tea before work.
The doctors also set up vaccination stations giving typhoid, paratyphoid and cholera vaccines. These vaccines were mandatory for food handlers. Interestingly, the vaccines were supplied by the Germans who based on the catastrophic losses among their troops to infectious epidemics during WWI were fearful that an epidemic in the ghetto could spread into the German military formations. The Jewish physicians were appropriately cautious of the German supplied vaccines and tested each batch on dogs to make sure they were not poisonous.
They also set up scabies treatment stations and TB screening stations in the Ghetto. The scabies station treated over 2000 cases, giving out Williamson’s Salve as treatment. The TB station screened and treated primarily children and was able to prevent widespread TB epidemics in the ghetto.
Meanwhile the doctors and nurses of the Sanitation-Epidemialogical section engaged in a campaign of enlightenment and through propaganda, education and persuasion tried to get residents to maintain sanitary standards. They published a educational journal called “Folkesgezunt” (Folk Health) which contained articles on hygiene, nutrition and advice on care of children. They sponsored inter district cleanliness competitions with the doctors, nurses and residents of the winning district receiving prizes for their efforts. The doctors put on a play in the Ghetto Theatre entitled “The Open Trial of a Louse” with Dr. Lazar Epstein, the head of the Sanitary-Epidemiological Section playing the prosecutor, accusing the louse of sucking the blood of the population and spreading deadly diseases. The defense claimed that it was the crowded conditions in the ghetto to blame, not the louse. Expert witnesses were called to testify as to the relationship between lice and diseases such as typhus. In the end the louse was found guilty and sentenced to death by disinfection and public hygiene.
All these efforts had a miraculous effect, unlike the Warsaw and other Jewish ghettos in Nazi occupied Europe, there were virtually no infectious epidemics in the Vilna ghetto. According to ghetto survivor Mendel Balberyszki the sanitation efforts produced truly incredible results. “as someone who grew up in Vilna, I was familiar not just with every alley, but with every stone. Such cleanliness and tidiness as exhausted in the ghetto had not existed in peacetime”.
Prevention of Starvation was another area that the medical community assisted in. The Germans allowed less than subsistence rations to the Jewish residents of the ghetto. The Judenrat helped organize considerable food smuggling operations to bring food into the ghetto, including workers returning from workshops outside the ghetto, chimney sweeps who traveled over rooftops in and out of the ghetto and bands of children who would sneak in and out of the ghetto through small openings in the ghetto wall. There was a system of mutual assistance in which all working Jews donated 5% of their rations to those who could not work due to age or illness. There was a strong consensus that no one would starve in the ghetto. The Jews even refused to use the word starvation, referring instead to a malady labeled “ghetto weakness”. Physicians played a vital role in distributing food to those most in need. The Pediatrics department distributed milk and baby food for infants at “Milk kitchens” and also distributed food at schools and daycare centers. The adult outpatient clinics issued 30-60 food coupons a month for seriously malnourished patients while the school health center issued up to 120 coupons a month to children weakened by hunger.
Outside of the public health realm the medical community operated two vital institutions for the care of the sick: The Jewish Hospital and it associated Ambulatory clinics.
As discussed above, The Jewish Hospital and its staff survived the formation of the ghetto intact. Much of its equipment had been confiscated by the Lithuanian Authorities but the medical staff was able to reconstitute these losses by pooling the doctors office equipment and buying supplies from the Aryan side of the ghetto. The hospital was headed by Dr. Elias Sedlis, a gynecologist and former head of the Jewish Medical Union. By mid 1942 the hospital had 192 beds divided into the following departments: Internal Medicine-77 Surgery-42 Urology-7 Pediatrics-25 Gynecology-12 TB ward-26 Infection/quarantine-3 The psychiatric department was eliminated after October 1941 by the Germans who took all the patients off the ward and executed them. Thereafter psychiatric patients (of whom there were few) were hidden among the general hospital population. Likewise patients with Typhus or Typhoid were obscured from German inspections under the guise that they had measles or scarlet fever or a benign febrile illness. The medical staff and patients alike were aware that in the Kovno Ghetto hospital the presence of patients with Typhus had been used as a pretext to the entire hospital patient population). Obstetrical patients presented a special difficulty. In February 1942 Vilna and other ghettos in the East were subject to a decree that forbade Jewish births- to be born was a crime punishable by death for both the infant and the mother. This decree was actively evaded by the hospital staff. Infants born shortly after the decree were given birth certificates registering them as having been born before the decree. Later on infants were kept in hiding until they were old enough to be discharge as children born before birth became illegal. Many women were willing to risk death as the fathers of the infants had been killed during the early mass executions from the summer and fall of 1941. The mothers desire care the memory of a lost husband or boyfriend motivated them to carry pregnancies to term in spite of the risk. Later on, larger numbers of pregnancies were voluntarily terminated and listed operations following miscarriage or hemorrhage. The hospital also served as a refuge for people without “Life Certificates” to hide posing as patients, most frequently on the surgical ward. The pediatric ward in particular protected children during killing actions in the ghetto. If the children’s parents survived the action they would reclaim them, newly orphaned children were placed in child care institutions. In all during its first year of operation under German occupation, the Jewish Hospital treated 4237 patients. The hospital Ambulatory Clinics were major providers of care with 25 physicians, six dentists, pharmacists and other support staff. During the first 11 months of existence, doctors saw 42,231 patients at the clinic and made 7,829 house calls. The dentists performed 25,125 dental visits and the Emergency Assistance team made 1,135 visits. A report from the emergency team for January to March 1942 shows 580 visits- 467 outside the clinic. The largest category involved wounds (39 patients), but fainting (35) and nerve attacks (15) were also seen. The Ambulatory clinic had a Children’s Consulting Room (the Kinder-Konsultatsye)that did preventive health exams, vaccinations, weighing and screening for tuberculosis. Extra milk and food were provided to children that fell ill. In it’s first year the Konsultatsye treated 5714 children at the clinic and made 1277 house calls. The nutritional status of children was a central concern and the Pediatric Division had two institutions to help with this vital area: The milk kitchen which supplied milk (when available) and baby food to infants and the Children’s Kitchen which provided a mid day meal to orphans and the ghettos poorest children. Once these institutions were established in early 1942, the health of children in the ghetto, especially the orphans, greatly improved. The Health Department’s report on the health status of residents of the Ghetto Children’s Home from August 1942 recalled that initially “The children’s health was very poor- lice, hunger, frostbite, wounds, rashes on their bodies and scalps all lead to considerable mortality, especially among the infants all of whom suffered from Whooping Cough”. With the arrival of the clinics and nutritional support the health of the orphaned children improved dramatically with the last death from natural causes being recorded in March of 1942. The Health department reported that “there are no more lice, the frostbite and scalp sores have healed. The little ones gain weight, the older ones do not gain, but neither do they lose any weight. Their food meets minimum caloric requirements. The children at the Home are fed four times a day”
Altogether the efforts of the medical community in Vilna had a remarkable effect on the population’s health- effectively thwarting the Nazi plan to kill off the Jewish population through disease and starvation. While the Warsaw ghetto had experienced a “natural” death rate of 107/1000 and the Lodz ghetto had a rate of 133/1000, the Vilna ghetto managed to keep their death rate down to 30/1000, only modestly higher than the pre-war death rate of 13/1000. Dr. Lazar Epstein, the head of the Sanitary Epidemiology Service estimated that with the public health, nutritional and medical programs in place, the Vilno ghetto could have continued for years, certainly up until Allied liberation which occurred in the summer of 1944. Tragically, their efforts were not allowed to continue to fruition. In the fall of 1943 the Nazi’s genocidal efforts were accelerated and all the Jewish ghettos of Nazi occupied Eastern Europe were ordered liquidated. The Vilna ghetto was liquidated on September 23, 1943 and it’s inhabitants either shot in the Ponary Forest killing grounds or shipped to slave labor camps in Estonia or death camps across Nazi occupied Europe. By war’s end, less than 2000 of Vilna’s 80,000 Jewish residents remained alive.
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