In explanation of our journey into Germany, it may be well to quote from a "minute" passed at a meeting held in Devonshire House, London, the central office of the Society of Friends, July fourth, 1919. "We are thankful to learn that the following members of the Religious Society of Friends are now proceeding to Germany under a deep sense of the need which exists for mutual friendly intercourse and fellowship between those who all belong to the same great human family and who have been separated during these sad years of war; namely,
"Marion C. Fox, Joan M. Fry, J. Thompson [Eliott] and Max Bellows from England, together with Carolena M. Wood from America, who is accompanied by Jane Addams and Dr. Alice Hamilton.
"Our friends are traveling on behalf of the Committee which has under its care the arrangements for sending 'Gifts of Love' to Germany in the form of food, clothes and other necessaries -- a work that is shared in, not only by the 'Emergency Committee for the Assistance of Germans, Austrians and Hungarians in Distress' and the 'Friends' War Victims Relief Committee,' but by many other persons not associated with Friends in Membership."
The four English members of the Committee, who traveled through the occupied region and entered Germany via Cologne, reached Berlin July 6th. The three American members, who traveled through Holland and crossed the border on the first civilian passports issued there since the signing of peace, arrived in Berlin July 7th. Dr. Aletta Jacobs, a Dutch physician who had been asked as a neutral to [page 2] make observations on health conditions in Germany, was the fourth member of the second party. Dr. [Elisabeth] Rotten, of Berlin, who has been acting as the representative in Germany of the work of the English Friends and is also head of the Educational Committee of the German Association for the Promotion of the League of Nations, was naturally our guide and advisor in making arrangements for the distribution of such assistance as we might be able to send from America.
Both the English and American members of the Committee attended a conference arranged by Dr. Rotten in the office of Dr. Albert Levy, head of the Centrale fur Privatfürsorge, an organization similar to our Associated Charities, in which various organizations responsible for the care and protection of children were represented. The decision was made to appoint a central committee, of which Dr. Levy, Dr. Rotten, [Siegmund] Schultze (the head of the Municipal Jugendfürsorge [Ant]) and Dr Alice [Salomon] (head of the Berlin School of Philanthropy) were to be members. Provision was made that in each place in which we should find unusual need, some one was to be selected who would serve as a member of the committee and aid in the distribution of supplies. Credits had already been established by the Society of Friends in America for $30,000, for which sum we were to secure through the office of the American Food Administration in Hamburg:
In addition to this, 25 tons of new clothing made by Friends in America was also to be disposed of. We realized that this was only an infinitesimal amount in the face of a great need, and very little compared with what the English Friends had been sending to Germany ever since the signing of the armistice, but we hoped it was only an earnest of what America would send later.
From the very first we made every effort to see as many children as possible, that we might know the effect of long-continued underfeeding as registered in their growing bodies. In each city therefore, sometimes under the guidance of the workers or patrons of private charities, sometimes under city physicians and other municipal officials, and sometimes with well known professors or child specialists, we visited the creches, the child welfare clinics, the playgrounds and outdoor sanitaria, the homes for convalescent children, the hospitals and orphanages, and always several public kitchens and the working people in their own homes.
After Berlin, the committee of eight divided into separate groups. The English Friends remained in Berlin, and later went to the industrial regions of the Ruhr valley, to the Erzgebirge. Dr. Jacobs, Dr. Hamilton and Jane Addams went into the industrial cities of Saxony, Leipzig, Halle and Chemnitz, where Mr Hoover had told them the need was unusually great. Later Dr Jacobs and Carolena Wood went to Breslau and to Silesian villages in the neighborhood; Dr Hamilton and Jane Addams, after seeing something of the villages in South Saxony, went to Frankfurt am Main. [page 4]
We received help and every possible courtesy in the carrying out of our plans. One Sunday morning in Leipzig three of us were accompanied by the Oberbürgermeister, the City Physician, and by the head, a woman, of the Jugendfürsorgeant. We visited with them a city home for delicate children where a distinguished orthopedist, Professor [Köllker], met us and demonstrated to us by means of his little patients the effects of prolonged hunger on rickets and tuberculosis. We visited also the City Orphanage and a Detention Home for dependent children. Of course at other times we made our own connections quite informally through old acquaintances in the philanthropic or medical field who showed us every hospitality and kindness. An unusual opportunity was occasionally given us to see a large number of children gathered together in connection with the sending of groups of city children to Switzerland and to Holland where they were to be the guests of kindly people who took them into their own homes. The children selected were not always tuberculous but were chosen because they were plainly suffering for lack of proper food which cannot be procured at present in Germany.
It seemed to our guides, apparently, quite natural that we should be interested in the privations of these children irrespective of their nationality, as indeed they were themselves. In one hospital we found a Russian child being carefully cared for.
We entered Germany just one week after peace had been signed at Weimar, and food conditions were already changing for the [page 5] better, [although] most of the food shops and bakeries still had windows containing nothing but empty cans or biscuit boxes. An occasional display of American bacon would at once attract a crowd of adults as well as children, feasting their eyes on the unaccustomed sight of fate. The pale people we saw on the streets, especially in the industrial quarters, were very serious and quiet, and in the railroad stations there was a conspicuous lack of all that talk and family bustle which one associates with German travel. Even the children were quieter. For them the war had evidently been translated into a lack of milk and butter and chocolate. The editor of a large city newspaper told us that he had been able the night before to take home a bottle of milk and that his little girl, who met him at the door, shouted joyously to her mother that peace had come. We were told by a mother that her little girl had asked her if it was true that there were countries in the world where there was no war and where people could eat all they wanted to. Perhaps it was these mothers who suffered most, these intelligent women who knew perfectly well how important proper feeding was and who yet were unable to obtain the barest necessities for their children. One such mother said it was hardest at night after the children were in bed and one heard their crying and whimpering from hunger until they fell asleep and even after. She added, "I do not see how the women endured it who were obliged to be always in the same room with their children and could offer them no diversion." [page 6]
We found conscientious people everywhere who had scrupulously lived only [upon] the rationed food although it must be remembered that the ration represented only about one third of the caloric value considered normal. This restraint was [especially] observed by those [whose work] brought them continually in contact with the life of the poor, though it was by no means confined to them.
We were [entertained] in a beautiful country house where the [supper], served upon old silver by a butler, consisted of fresh vegetables and fruits from the garden and the after-dinner tea had been made by our host from dried strawberry and raspberry leaves and linden blossoms. On the other hand we were told that there had been a very general evasion of the food regulations and many people we met ruefully confessed that they had [compounded] with their [consciences] in the second year of the strict blockade. It is obvious that a mother who anxiously wonders whether she should net a higher value upon impartial obedience to the rationing regulations than upon her elementary duty to preserve the health of her children, had taken the first step toward [making] illicit purchases. "[My] husband knew that I bought smuggled food for the children, but he would touch none of it himself." ... "I bought what I could for my old father after he had lost forty pounds and looked so wretchedly that all my friends accused me of neglecting him. At first he would not take any of the illicit food, but at last he was driven to it, and he always refers to it as 'the time my conscience died.'"
Everyone we saw, men, women and children, had lost weight, [page 7] many of them to the point of emaciation. This loss of weight is very serious because it is a sign of lowered nutrition and consequently diminished resistance to infectious diseases, especially in the young. Wherever we saw children gathered together we were struck by the greyish pallor which has taken the place of the ruddy color formerly so characteristic of [those] blonde German children, and also by the thin necks and [wrists] and legs even where the face itself was fairly round in its [outline]. It is of course impossible to judge of emaciation in a child, unless very extreme, without stripping it, but in several places we were shown the children with their clothes off. The "[Luftbad]" in Frankfort does not take children [who] are really ill, but many of the naked boys we saw there were quite shockingly wasted.
We tried always to bear in [mind] the norm for German children, which is high, and to judge of the actual conditions we saw according to this standard. Recently the Metropolitan Life Insurance Company made a [study] of the weight and height of New York public school children and found that the children of German parentage stood at the top, outstripping those of English, Scotch and Scandinavian parentage, their nearest rivals. In normal times the children in Germany are probably even taller and sturdier than those of German parentage born in a new country. The contrast between the children as [one sees] them in Germany today and the children we were accustomed to see before the war is very striking, and when one can see them stripped there is no mistaking [page 8] the effects of the long starvation. The shoulder blades of the boys stand out like wings -- it is really almost a deformity; their ribs and their vertebrae can be counted, and their bony little arms and legs look still thinner because of the swollen joints which [rickets] causes so commonly. The narrow sunken chests bode ill for the future in a society where tuberculosis infection will certainly be widespread.
It is after the sixth year of life that the effects of underfeeding become increasingly evident, for there is not enough food to supply the needs of a growing child unless a good deal can be added by the purchase of smuggled goods. Already the schoolchildren of Leipzig average 2 to 4 cm. shorter than the pre-war average. In Frankfurt we were told that the average loss of weight for the younger children is 9 to 10 percent, for the older, 10 to 15 percent. And during this last year a loss in average height was becoming evident. In general the results of the blockade came to be felt in 1917, but people familiar with conditions among the poor saw in 1916 a change in the little children and in the mothers, which however became much more striking the following year. It certainly is fair to conclude that the shortage of food has been registered on the bodies of German women and children for a period of nearly three years, and of course it continues to register still.
From notes selected at random we find descriptions [page 9] such as the following: "A girl of 8 years, weighing 30 lbs., one of the same age weight 28 pounds, a third of 12 years weighing [46] pounds. These are not supposed to be ill, only in need of food and fresh air." That was in Frankfurt. In the notes taken in Halle we find mention of a child of three and a half, weighing 14 pounds; a 12 year old boy weighing 54 pounds; a girl of 11 weighing 50 pounds; and the following record of a four-year-old who had been under hospital care for malnutrition since February last. The miserably inadequate food is revealed in this child's history: "Weight in February 27 pounds; in March 25 pounds 8 ounces; in April 26 pounds 7 ounces; in May 25 pounds; in June 26 pounds 4 ounces."
In Leipzig, in Frankfurt, and in the little hill town of [Darstein?] in the Erzgebirge (on the Saxon side) we saw large crowds of children at school or in playgrounds, and always it was the rosy-cheeked, sturdy child who stood out in sharp contrast to the crowd. In the village schools in Bärenstein the teacher had the different classes pass slowly before us so that we could look closely at the children. They did not show the effects of underfeeding as strikingly as did the children of the cities, especially the Saxon cities, for in the country it is easier to eke out the rational food with extra vegetables or even a little milk than it is in the city, though the villages in the Erzgebirge are bleak and the soil is poor. Judging only from the looks of these school children as they filed past us, we estimated that about [page 10] 85 were in a fairly normal condition, but 120 were decidedly thinner and paler than normal. Of course this is a very superficial judgment, but it has some significance.
As a preliminary to understanding the food conditions of the children, early in our stay of five days in Berlin we went to the office of the central food control where we were met by Professor Schlesinger and Dr. Pfeiffer who gave us every facility for studying their method of food allotment and especially the distribution of milk to children. The supply of milk for Berlin in 1914 was 1,000,000 [liters]. There was a quick falling off in quantity in 1915 which continued till in the winter of 1918-19 it reached 150,000. Milk is given to children up to the age of four years at the rate of a pint a day, and in exceptional cases to delicate children up to the age of six; but at times there has been no milk even for the four-year-olds. Among the adults only the cases of open tuberculosis may have as much as a pint of milk and acute nephritis entitled the patient to half a pint, chronic nephritis to none. This latter is especially hard as patients with nephritis on a milk diet may recover. We met one well-to-do woman who spoke with the greatest bitterness of the death of her brother from nephritis, for whom she had been unable to get milk.
This fall in the milk supply is due chiefly to lack of rich fodder which Germany has always been obliged to import and without which her cows yield less than one third of the usual [page 11] amount. The city of Berlin has a herd of 7,000 cows, which are fed upon potato parings and vegetable trimmings carefully collected from householders every morning. If they could import oil cake for fodder, they could ration it to the peasants and thus control the milk of those peasants which now passes, in part at least, into the smuggling trade -- what the Germans call the "Schleichandel."
We found later in Chemnitz that the milk supply had fallen from 60,000 [liters] daily to 7000. This milk goes to infants and nursing mothers, and, according to the supply, to children up to the age of four. This is distributed by colored cards, one color for infants, another for little children, and so on. When the supply is low, one color is withdrawn, beginning with the older children, those over the advanced age of four years!
Frankfurt's former supply of milk was 220,000 [liters] daily, which has now fallen to 15,000. This does not promise to improve, since the hinterland from which Frankfurt has always drawn her supply of milk is now in the occupied territory and its produce is used by the French army.
The same office also rations the fat. The population in general is allowed to buy weekly 30 [grams] (1 ounce) of butter, 60 [grams] (2 ounces) of vegetable [margarine], 125 [grams] (4.2 ounces) of animal fats. This of course is only permission to buy, and many people cannot afford butter at 23 to 36 marks a pound, or American bacon at 12 to 16 marks a pound. We were told that [page 12] probably as much as sixty percent of the food in Germany passes into the [schleichandel] to well-to-do people at enormous prices, and that there is constant speculation in food cards. There is very little fat in the most that reaches the market from German sources, for the lack of fodder has made all cattle very thin.
Berlin has a separate public office for providing food for the sick, where we saw many sick people waiting to be given cards entitling them to buy milk and white flour. This office is now caring for 210,000 people, although the permits are confined almost entirely to those suffering from tuberculosis, [rickets] or acute nephritis. Before the war it was estimated that about two [percent] of the population of Berlin would be sick at any one moment, now it is at least ten percent. The records in one room were especially pathetic. It contained the cards of those whose allowances had been revoked not because the given case no longer require food, but because so many new cases had come in that the list had to be revised in the interest of the most pressing need. Old people had to be sacrificed to the young, the incurable to the more hopeful. We were permitted to examine any cards which we chose to pull out of the cases.
We saw with our own eyes a striking demonstration of the insufficiency of food for the sick when we visited the kitchen of the great University hospital in Berlin, the Charité. There were 2,200 people in the institution to be fed, and since the Revolution the "[Einheitessen]" rule has been in force; i.e., exactly the same [page 13] food in kind and quantity is served to everyone connected with the hospital, from the scrub woman to the head professor. We were shown the supply of meat for one day. It consisted of lumps of very lean beef with much bone, already thoroughly boiled to make soup. It filled a tray about two and a half feet long by one and a half foot wide and about five inches deep. This was the meat allowance for 2200 people. But they do not get it every day. The weekly per capita allowance is 250 [grams], but after the bone has been removed it is only 150 [grams], which we were told would make a daily allowance just the legal weight of a letter! The bread allowance for the hospital is 335 [grams] daily, but many of the sick cannot eat this bread for it is made of [war] meal containing all but 5% of the bran with the addition of ground dried vegetables which renders it damp and liable to mold or ferment in a few days. There is only one loaf of white bread for ten patients weekly. They were using ten times as much green vegetables as formerly because they had no dried beans, peas or rice. For this week the supply of potatoes was only one pound per capita. There has been no fish since the armistice when the blockade provisions prohibited fishing in the North Sea. With this diet of unsatisfactory bread was served the inevitable marmalade made of vegetable [fiber], a minimum of fruit, the whole colored with aniline and sweetened with saccharine. It is obvious that such a diet is insufficient and that there is little chance of real recovery from sickness. The Director of the hospital was suffering [page 14] from a fracture of the hip which would not heal because his powers of recuperation were at so low an ebb from underfeeding.
As we went through other institutions we often had an opportunity to see the food served to the inmates. In the City Orphanage in Berlin children with rickets received for their noonday dinner a soup of war meal and dried vegetables with a few drops of vegetable [margarine] floating on the top. In a creche in Frankfurt for well children they were serving at noon a meal soup made with one pound of [margarine] for 100 children. In the afternoon the children were given a mug of German tea, made from dried leaves of strawberry and other plants, without milk and with only three quarters of a pound of sugar to 40 quarts of tea. Many of the children in the creche showed signs of rickets, and almost all of them, of malnutrition, save one small boy, conspicuous for his rosy cheeks, who had just returned from a visit to his grandmother in the country.
In Leipzig we visited a "Landkolonic," a large playground in which 625 children from 6 to 12 years of age spend the day and are given a midday dinner, consisting of one pint of meal soup to which had been added a little dried vegetable. Out of 190 children seated at one time in the dining room, all save one were pale and anemic. The director made several announcements to the children -- a hike for the following day (which he carefully explained was not compulsory), the time when the prize would be awarded for the best garden, and so forth. All of these announcements were received with a curious sort of apathy by the listless [page 15] children, but when he said that he hoped they would have milk in their soup tomorrow or the next day, the announcement was greeted by a shrill and spontaneous cheer. Here as everywhere the effect of food privation was more striking on the boys than on the girls. This was usually explained by the greater activity of the boys, although one professor regarded it as another evidence of the greater resistances of the female sex which has always been shown in the lower death rate of girl babies.
The "Luftbad" in Frankfurt is a very original mode of treatment for delicate children. The children in bathing suits -- on the boys' side they wear a very abridged form -- are kept in the sun and the open air for three hours a day, some of them playing, but others lying down according to the doctors' orders. The children used to be given a large glass of milk and all the bread and butter they wanted. Now the city allowance for them is half a pound of soup meal a month per capita to which the patrons add some fresh vegetables, but they have no fat. Many of the boys exhibited such extreme emaciation as to remind us of pictures of Indian famines, yet we were told that these children had greatly improved during their month of treatment in the Luftbad. Of course many of them brought bread carefully measured out by their mothers from the home allowance, for it would be illegal for the management of the Luftbad to secure an extra supply of bread. At another charming outdoor charity for little children, who are taken to spend each day in the woods, we again encountered the [page 16] afternoon tea without milk and so little sweetened that we were surprised the children were willing to drink it.
In each city except Halle we visited public kitchens to which men and women of the working class come to buy cooked food, either taking it home or eating it on the premises. We visited six of these in Berlin, two in Leipzig, one in Chemnitz, and one in Frankfurt. In Berlin a meal could be bought for a mark and a quarter or a mark and a half. For this they received a soup of meal and dried vegetables, then a dish of boiled greens -- part fresh and part dried -- and another dish of dried cabbage or potatoes, and for desert -- to quote from notes taken on the ... 10,000 boiled dumplings made of war meal and eaten with dried pears that had been stewed with sugar. For two dumplings they paid forty-five pfennigs. In Chemnitz forty pfennigs bought a pint and a half of soup made of [sauerkraut] and potatoes, with a fairly generous allowance of margarine. This last is a municipal enterprise, as is a kitchen we visited in Frankfurt where school children are served their midday meal, the most nearly adequate one we saw. They were given one or two quarts, as they chose, of a thick soup of potatoes, carrots and noodles. This was made in a central kitchen and distributed through many centers. The food in these Berlin kitchens seemed sufficient in quantity but poor in nutrition and very tasteless, while in Chemnitz and Leipzig the quality was better and more attractive and the quantity was very insufficient! The children in Frankfurt [page 17] had to eat a harmfully large quantity of soup in order to satisfy their hunger. Of course no one knows better than the Germans themselves the harmfulness of this bulky diet, so poor in nutritive qualities. German scientists have made every possible effort to get at new sources of fat. Every bone is saved that it may be crushed, and the fat extracted from the marrow. They have taken the germs from the rye kernel for the sake of the trace of fat. They even collect the fats from the dish water of the great hotels.
We were constantly reminded that the paucity of food does not affect only the poorer people. We were told that many working people with relatives in the country from whom they might obtain food, fared better than professional people and others who had no such connections. Often when asked a direct question, the professors in the clinics revealed the difficulty they had had in providing for their own families. One famous physician said that he had never during the blockade and up to the present had meat more than once a week. The wife of a great biologist said that many a morning when she had faced an empty larder she would go out in one direction, her husband in another ... professor who was taking us through the children's ward admitted rather reluctantly that his breakfast consists of black war coffee with bread and marmalade, that he eats no midday meal, and a supper of soup and bread. He had come back from the front to find that his wife had made a poor recovery from a serious operation and that his two children were very much reduced, all for lack of proper food. He sent them to [page 18] a seaside place on the Baltic, but there proved to be so little food there that he is obliged to save all he can to send them food from Berlin. Another of our guides who kindly invited us to his house showed us two blooming children of seven and eleven, but the little war baby of two years had stopped growing when she was weaned and developed rickets. With the utmost care she is now able to walk, but is still tiny, white and thin, a great contrast to the other two children.
It was in Saxony especially that they spoke with horror of the "time of turnips" when for three of four months the entire population had almost nothing to eat except white turnips. Many grown people have acquired a permanent dyspepsia from that experience and it was of course impossible for many of the children to digest such food. The village schoolmaster in Bärenstein told us that in the course of each morning nine or ten children would leave the room, [vomit] their breakfast, and stagger back too miserable and sick to hold up their hands, much less to study their lessons. We were constantly told that the amount of school work required of the children had to be lessened in order to meet their lowered vitality and that owing to their absolute inability to do the school work many children of the poor in Germany have practically lost four years of school out of their possible eight. The number of school children was greatly reduced also by actual ... [page 19]
Ruth von der [Leyen] and other probation officers of the Juvenile Court of Berlin told us much of the increased criminality among the former pupils of the higher grade schools, -- the growing boys and girls who, owing to the shortage of labor during the long course of the war, undertook hard factory work and were simply unable to get enough to eat from the rationed supplies. From this root cause sprang many thefts of food, falsification of bread cards, housebreaking into bakeries and mills, stealing potatoes and turnips in the fields, taking part of the fraudulent ... of food in the hope that some would be given to them, etc. In addition to hunger, many of these children, unable to bear any longer the anxiety of their mothers, stole food to take home, reckless of the consequences to themselves. Of course they often stole money from their parents, sold the clothing of their brothers and sisters or such household articles as they could pilfer. To quote Miss von der [Leyen]: "Children and youth from the most respectable families come before the court through their sheer inability to withstand the temptations to which the blockade so cruelly subjects them." It has been said of these half starved children that they well illustrate a saying of Rousseau's: "The body must have strength to obey the soul; the weaker the body, the more it commands."
It has seemed best to treat the specific results of the food blockade, the loss of weight, increase of tuberculosis, and other diseases, under separate heads, as follows: [page 20]
TUBERCULOSIS: -- On our first evening in Berlin, Professor Kayserling, one of the foremost German authorities on tuberculosis, came to our hotel and gave us a brief outline of the terrible results of the prolonged food blockade as shown in the increase of tuberculosis in German cities. Country districts apparently have suffered less. He began by saying that in 1900 at the International Congress for Tuberculosis in London, statistics were shown covering the previous 30 years of tuberculosis in London and in Berlin, and the English and Germans were agreed in predicting that if the same rate of progress in the control of this disease could be maintained in the future, some forty years more would see its practical extinction, in those two countries. Now all the progress of years has been swept away and Germany is back at the point she had reached in the eighties before Koch's discovery of the tubercle bacillus revolutionized all our ideas about the disease and led to modern methods of control. That the increased rate is due to lack of food and not to the other incidents of war is shown by the slight rise before the tightened blockade and the rapid rise after it. In 1914 the deaths from tuberculosis in German cities of over 15,000 inhabitants was 40,374. By 1916 it had risen only to 48,779, but by 1917 it was 67,860, and for the first half of 1918 it was 67,860. Since tuberculosis is not a disease that kills quickly, Professor Kayserling expects that the rate for the last half of 1918 and that for 1919 will prove to be still higher. It must also be remembered that the number of people in the susceptible ages was decidedly diminished by the loss of young men who had fallen in the war. [page 21]
The almost complete lack of fats, including cod liver oil -- the first installment of which reached Germany through Dr. Rotten in May of this year -- makes it impossible to strengthen the body against infection or help it combat infection after it has taken place. Matters were still worse after the armistice, when the demobilized soldiers suddenly returned to the cities to share in the scanty food supply at the same time that transportation became more demoralized than ever because of the surrender of rolling stock. So striking has been the effect of partial starvation on tuberculosis among all classes that Kayserling says [German] physicians are beginning to say that tuberculosis should be regarded primarily not as an infectious disease but as a disease of nutrition, to be controlled much more by feeding than by preventing infection.
A few days later we had the opportunity to visit Kayserling's dispensary (Poliklinik) for tuberculous children of the middle class. He allowed us to interview the mothers who brought their children for examination and to find out what the little things had to eat. The answer was almost always the same. For breakfast "ersatz," coffee without milk or sugar, bread, and usually but not always marmalade made with saccharin for sugar. One lucky child had had a bit of lard on his bread that morning. For dinner at noon, soup made of a war meal and dried vegetables, sometimes potatoes, and rarely beans. Supper was a repetition of breakfast. If the child was under four years, he was receiving a pint of milk a day, and this was true for part of the time for the six-year-olds, but [page 22] after six years the allowance stopped. One girl of eleven, who looked about eight, was discovered to be tuberculous. She was getting a little meat once a week, no butter, no eggs nor milk. Kayserling gave the mother an order for a pint of milk daily, but it will cost her a mark and a half each time, and will constitute the only possible change in the child's diet which, even with this addition, will be too [meager] for a healthy child, to say nothing of one whose hope of life lies in a generous allowance of animal fats.
Many of the mothers in this clinic looked so emaciated that one could not help believing that scanty as their rations were, they took only part for themselves and gave the rest to the children. One specially wretched-looking woman said she was the mother of six children, one of whom had recently died of tuberculosis and she had brought a little daughter to be examined for the same disease. As all her children were over six years of age, they had no milk except the half pint which was allotted to her because she is suffering from a serious form of nephritis. "And how much of that goes into your stomach?" Professor Kayserling asked. The woman only shrugged her shoulders. At the end we asked him what he could do for these cases, and he answered: "Almost nothing. I see the conditions and I know how they should be dealt with, but I cannot put my knowledge to use. I cannot work without the tools of my trade." While in former years Kayserling used to see about fifty cases of bone tuberculosis in children in the course of a year, now he sees as many in a month. [page 23]
We heard still more about tuberculosis in the great hospital of Charité, connected with the University, when we visited Professor Czerny's wards there. Fully half of all the children here are tuberculous, a condition which they attribute first to increased infection because so many mothers have contracted tuberculosis through overwork and underfeeding and so many fathers have come back from the front tuberculous, and, second, to the loss of resistance in the children's bodies because of starvation for fats. The men in charge in this hospital and in the Kaiser and Kaiserin Friedrich Spital for Children told us that they feel sure the effects of the hunger blockade will be apparent throughout the lifetime of this generation and perhaps longer. These effects cannot be rightly estimated by simply looking at death records. Most of the children infected with tuberculosis will not die now; the majority do not as yet even show signs of the disease. But each coming year for twenty years will show a far higher rate of sickness and death from tuberculosis than Germany has known for decades, because the seeds of the disease which have fastened themselves on these weakened children will do their work later on, perhaps in puberty when resistance is always lowered, perhaps in the twenties under the strain of childbearing or of industrial life. Nor is it only tuberculosis which will have increased; all infectious diseases will meet with a lessoned resistance, all overstrain and hard work will do a greater injury, and even the children of these war children may be below the normal standard. [page 24]
In the wards of tuberculous children we saw varieties of the disease which used to be regarded as medical curiosities, so extreme as to be seen only in primitive peoples with no racial immunity to the disease. Germany's racial immunity, if there really be such a thing, was destroyed by the blockade, and now in her hospitals one can see the most terrible forms of this infection, and not as exceptional cases but fairly common. Not only in the Charité, where one expects to see picked cases, but in the hospitals of Halle, Leipzig, and Frankfurt we saw children with enormously developed tuberculosis of several bones at once, with involvement of both lungs and cavity formation such as ordinarily occurs only in grown people. There were tiny children with tuberculosis of the breast bone, of the bones of the skull, even of the bones of the upper jaw with involvement of the eye socket, and many cases of the formerly rare tuberculosis of the skin, lupus. There was added tragedy in the impotence of the physicians, who while equipped with all that science has discovered in this field and so entirely capable of dealing with each case in the best possible way, could only struggle with makeshifts and look on at their own failures because without nourishing food the fight against this disease must be a losing one. Yet if only food could be procured these child cases of bone and gland tuberculosis could be made to improve amazingly.
While at the Charité we went to Kraus's wards for tuberculous adults, and were received by his assistant, Professor Leschke, [page 25] who showed us cases of the new form of this disease in adults. Before the war the [so-called] galloping consumption was a great rarity in Germany, now they are having an enormous mortality in young adults after an illness of only one to four months. It appears in those who have lost many pounds in weight. As it is impossible to give them the abundant fats they need, they go rapidly down hill, having apparently lost all resistance to the disease. This rapid consumption is greatly on the increase, and probably will continue at a high figure for several years. Nor is it confined to hospital patients, it is common among the well-to-do. Dr. Leschke had at that time no less than thirty cases in his own private practice.
The city orphanage in Berlin, which is really a home for dependent children whether actually orphans or not, is not supposed to take any but healthy children, but it is impossible now to reject the tuberculous and rachitic, for they are too numerous. It has long been the rule here to give the Pirquet skin test to the children, to determine the presence of tuberculous infection. Before the war this test was positive for 10 percent of the two-year-olds, now it is positive in 30 percent; but while infection has increased threefold, actual illness has increased fivefold, as shown by the number of cases of skin, gland, bone and pulmonary tuberculosis. In Halle there is ten times as much skin tuberculosis as before the war, and in Frankfurt they showed us cases of pulmonary tuberculosis in babies, something hardly ever seen in other countries. The curve of tuberculosis, or rather of mortality from this disease, [page 26] in the city of Chemnitz, shows clearly the influence of the intensified blockade, for while there is little increase in the first two and a half years of war, there is a sudden rise in 1917 and a still greater rise in 1918.
INCREASE OF OTHER DISEASES:
Probably the increase of tuberculosis is the most serious single result of the food blockade, but there are other diseases also which have shown a startling rise in numbers and in severity. Among children, rickets -- formerly almost confined to the very poor or to the inmates of private orphanages -- has become widespread in every class of society. With the softening and bending of the bones goes an abnormal fragility, so that fracture occurs almost spontaneously after the slightest violence. If a child stumbles and falls to the floor, he may break a leg or a collar bone, even a hip. If the mother lifts a child by its arm, she may break one of the arm bones. We saw a three-year-old boy in bed with his second broken leg.
In the orthopedic wards of the Charité, 90 percent of all the children are rachitic, and even in detention homes and creches and orphanages rickets are now common. Forty-one percent of all the children in the Leipzig home for delicate children are rachitic. We saw innumerable instances of this disease of malnutrition coming on after the first year, in children who were fairly normal till they were weaned or till they began to require more fatty and proteid food than could be given them. There were children of two, three, four [page 27] and even six and seven years, who had learned to walk and then gradually lost the ability to so much as stand alone. The orthopedists operate on bowed legs or knock knees and obtain their usual good results, but the food that would make the straightened bones strong is lacking, and so little by little the bending returns and the surgeon's work is all undone.
Infantile scurvy is frequent, from lack of milk and eggs, and we saw instances of profound [anemia] in tiny children, a very rare thing in most countries. These were children who had been given food very poor in iron, war meal, potatoes, marmalade ... we read so much appeared in children who had been kept on a diet of carbohydrates only, and in Berlin it was confined to certain religious orphanages where it was very prevalent. In one of them all the children, 150 in number, were dropsical. That state of things has been corrected.
We saw many cases of emaciation in children and babies so extreme that it was hard to believe the condition was caused by hunger alone and not generalized tuberculosis, yet such was the case. In a creche in the industrial town of [Neukölln], near Berlin, there were 14 babies in one room. Five were normal, nine markedly undernourished, and one of these five were emaciated. None of them were tuberculous. In a Leipzig creche, out of 39 babies only 11 were normal in development, the remaining 28 showed in varying degree the effects of lack of food, emaciation, [rickets] or both together. [page 28]
The food blockade also was a soap blockade, and this has had very great influence over certain diseases, notably skin diseases and the fever of childbed. The lack of soap to cleanse the person of the patient, to wash her linen, and to cleanse the hands of the midwife, is apparently the cause of a sudden rise in the mortality from puerperal fever which has occurred in Germany in the last two years. Children have been the greatest sufferers from the skin diseases resulting from lack of soap; babies, of course most of all. We were shown their scalded little bodies, their heads covered with scales, the bleeding surfaces in the folds of groins and arms. The treatment for such a condition is very insufficient, for Germany has absolutely no medicinal oils, no Vaseline or other bland ointment to soften the scales and assist in the healing process. For soap there is still only the heavy slab of chalky material which is very irritating to delicate skin; and to wash inflamed eyes there is no absorbent cotton, only tissue paper. The ... to a dangerous point. There was a little child in one of the wards in Halle whose body was covered so thickly with scars that it was impossible to find a square inch of skin that had escaped. This was a case of furunculosis, or multiple boils, so severe that it had been necessary to make 80 or 90 incisions to let out the suppuration.* [page 29]
As for the effect of the hunger blockade on the aged, we heard a great deal, but perhaps the curves of mortality shown to us in Chemnitz will tell the tale as well as anything. The year 1917, when the great rise in the number of deaths is seen, was the year of the "turnip months" when for three or four months there was almost nothing to eat in Saxony but turnips, and the old people could not digest such food. [page 30]
Many times of course we were asked about the war, and we encountered a state of mind which can be described only as pure bewilderment. We were asked in perfect faith, "Why does all the world feel justified in hating us? What have we done? Why are we considered so different from other people?" It was easy to repeat the well known charges; but to them the invasion of Belgium had been reported as a military necessity in a righteous war of self defense; they had never heard of the Bryce report, and of the deportations from Lille and Belgium they had heard but the vaguest rumors. Whereas the continuation of the food blockade during the months after the armistice, when they had seen their children and old people sicken and die, had been to them the height of cruelty not to be explained by the well worn phrase "It is war!" Apparently it was impossible to make clear to them the rough justice in the Entente's demand for 140,000 [milk] cows to replace those which five years before had been driven out of France and Belgium. What was to be gained by starving more children now that the war was over? -- they asked.
The "Pacifists" whom we met, as those were called who had urged that Germany trust to the generosity of the Entente and to negotiations based on the fourteen points, were at the moment of our visit under the harshest possible criticism, even from their fellow citizens who acknowledged that it had been impossible to continue the war. Much remains to be done in the way of interpretation [page 31] and honest discussion before even a beginning of mutual understanding can be made.
[at the bottom of page 28] * A very serious effect of the lack of soap is the increase of body parasites. In Berlin, we were told, there are now as many as 100,000 houses infested with lice. Typhus is endemic in Berlin since the war, and unless these houses can be rid of lice before the cold weather comes on, an epidemic of typhus is inevitable.
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