Noma cases among the Roma in Auschwitz-Birkenau

All I knew about the disease entity called “noma” (cancrum oris) was from textbooks I had read at medical school. Neither during my six years of medical practice before the war nor when I was working in the hospital in the main men’s camp in Auschwitz had I encountered a case of this infection or read publications on this topic.

It was only in 1943, when I was moved to work in the hospital in the Romani isolation camp in Auschwitz, that I came across patients suffering from noma.

I think it will be right to describe this disease before presenting my fragmentary observations concerning the noma cases in the concentration camp.

European encyclopaedias of medicine give only brief notes on noma, which shows that it has been a rare disease in Europe. On the basis of my observations made in the Romani camp where noma affected extremely emaciated, malnourished individuals, I concluded that this gangrenous disease must have been known in Asia where famine was very common.

In fact, I found a detailed clinical description of noma in a Vietnamese doctor’s paper (Phau-Dienth-Tuan). On the basis of his thorough hospital observations of 51 noma patients, this doctor reported that just as in Europe, in Vietnam noma was not contagious, and occurred almost always as a sequela to contagious diseases such as measles (63% of the cases), smallpox (6%), and other communicable diseases including malaria and typhoid fever (10%). 4% of the cases were not complications of infectious diseases.

On the other hand, in Madagascar noma hardly ever occurred in patients recovering from a contagious disease.

In Vietnam, noma affected children, usually aged 2–6. It has not been reported in babies before they got their milk teeth. The frequency of the infection was the same for girls and boys, but in Madagascar, the morbidity for girls was three times higher than for boys.

The Vietnamese doctor’s paper also says that most of the children suffering from noma came from poor families, constantly malnourished and living in extremely poor conditions, not familiar with the basic rules of hygiene. For instance, according to the Vietnamese folk beliefs, a person affected by measles should not be exposed to fresh air and water.

The development of noma was usually so rapid and fatal that the Vietnamese doctor described it as a disease that “bites like a galloping horse champs at the bit” (French qui ronge comme un cheval qui galope; Vietnamese Cam täu ma).

It was not until penicillin was applied to treat noma that patients started to recover, provided that penicillin (about 400 thousand units a day) and other medicaments (Vit. C + Vit. B gargarisme avec l’eau oxygénée, pulverisation Lucas‑Championniere Inject. cord. serum physiologique. Inj. serum antigangreneux) were given at the early stage of the disease.

This antibiotic treatment stopped necrotisation, while in cases of acute necrotising gingivitis a plastic operation for the removal of deformations could be conducted after the patient’s wounds had healed.

Unfortunately, there could be no question of such successful treatment of noma cases in the Romani camp in Auschwitz.

Before I describe the noma cases in the Romani camp I would like to say a word about the origins of this camp.

The Germans wanted to eliminate groups that were hard to discipline from their own nation and the nations they had conquered, so they decided to segregate the Romani, whom they regarded as a destructive factor. Consequently, in early 1943 they set up an isolation camp in Birkenau to which they moved Romani families from Poland, Czechoslovakia and Germany (about 15 thousand individuals).

The Romani were treated relatively mildly; they were not forced to work; no corporal punishment was used on them, they were not subject to extermination. Their families were allowed to stay together. Despite that, the Romani, who had been used to life in freedom, fell ill quite quickly in the camp, especially as they had to survive on the camp food rations. So at the beginning of 1943 the Germans set up a Romani hospital, in particular with a typhus ward. Later there were other contagious diseases: tuberculosis, typhoid fever, rubella, and malaria. Moreover, there were also cases of scabies, diarrhoea and extreme emaciation.

In the autumn of 1943 SS‑Untersturmführer Dr Josef Mengele was appointed SS chief physician of the Romani hospital. In November 1943, shortly after his appointment, one of the hospital barracks was opened for Mengele’s “scientific experiments,” which were carried out by prisoner Epstein, a professor of the University of Prague.

The experiments were conducted in Block 22. Patients with obvious symptoms of cachexia were moved to this barrack from the camp, and prisoners with scabies were also brought in to fill up the vacant beds. Patients in Block 22 were invariably worse off physically than those in other wards.

This block was divided into the following rooms, according to disease entities: I (several three‑storey beds, sleeping three a row) was full of patients suffering from scabies, each bed was separated by a curtain made from a blanket, II was for cachexia patients, and III was for noma patients.

During one of the ward rounds, the hospital doctors, Prof. Epstein and a dermatologist, Dr Weisskopf (another Czech), showed us a few patients who had deformities in the soft tissues of the cheek. These were cases of noma. There were about 30 places for noma patients. They slept in the three‑storey beds: small children (over two) on the lowest level, women and girls on the middle level, and men and boys on the top level. Considering the camp conditions, they had relatively spacious beds.

As none of my fellow Polish doctors who were prisoners worked in this block, I cannot describe all the details of the stages of the noma cases and their treatment. I can only say what I observed during my rounds with Dr Mengele.

As I have already mentioned, most of the noma patients in Block 22 were suffering from cachexia (extreme debilitation) and stomatitis ulcerosa (inflammation of the mouth and lips with oral ulceration).

From what I managed to observe, the disease had the following stages: initially the inflammation of the oral cavity had a characteristic odour, then intraoral ulcers appeared; within a few days the necrotizing infection had reached the outer side of the cheeks, usually at the level of the gums and molars, and a bluish discoloration of the skin indicated the underlying necrosis, which was visible through a small hole in the already sloughed skin. The steady outflow of the necrotizing substance gave off such a specific stench that it was possible to diagnose noma from the smell. The gangrene expanded rapidly, covering a larger and larger part of the cheek, and as a result, the teeth, gums and alveolar bone were exposed. I saw noma cases in which the lesion in the soft tissues extended from the zygomatic bone to the neck.

The sight of extremely emaciated patients, skin and bones, as we say, with stinking open holes in the cheek shocked even us, “veteran” prisoners.

Most of the noma patients were children, about 80% of the total number, I suppose (I do not recall an epidemic of measles; there was definitely no smallpox epidemic). Several men aged around 20 and diagnosed with noma were sent to the dental infirmary in the main camp for treatment. The results of the therapy were good. Bacteriological tests of the noma microflora showed the presence of spirochetes in symbiosis with spindle‑shaped bacilli, as well as other microbes.

Most of the noma patients treated in the Romani camp died. Admittedly, I remember that Prof. Epstein showed us several children whose necrotisation had been stopped, but I do not recollect seeing them later among healthy prisoners. The treatment for noma the Romani patients were given, as far as I can remember from the general insights given by Prof. Epstein, consisted of sulphonamides such as Cibazol and Prontosil, and vitamins, especially vitamin C; in addition, some kind of paste, probably talc with Prontosil, was applied locally. For a certain time during the experiments involving noma patients, Mengele ordered a nutritious diet for them. It included boiled and fried meat, butter, milk, vegetables as well as good bread. The food rations were varied and contained high‑calorie products. I should add that by order of Lagerarzt [Head SS physician—translator’s note] Mengele, some of the noma patients had the normal camp food rations but received pharmacological treatment. Incidentally, Dr Mengele sent typical noma cases to Block 21 or Block 28 in the main camp (Auschwitz I), where prisoner Vladimir Zlamal, who was an artist, painted watercolour portraits of their faces.

The research on noma lasted from autumn 1943 to June 1944, i.e. until the dissolution of the hospital in the Romani camp, which was closed down soon afterwards (we know that that 5 thousand Romani prisoners were killed in the gas chambers and the remaining Romani were sent to other concentration camps).

We often wondered why research on noma was being done in our camp hospital, and we tried to find out from our fellow medical practitioner Weisskopf, whom most prisoners liked. One day he lifted the veil of mystery and said that the research on noma was being conducted on the Romani probably because cases of similar illnesses were occurring among the Wehrmacht soldiers after the Stalingrad defeat.

However, another intriguing question, as well as a number of other ambiguities that could have been explained by Prof. Epstein, who survived the camp, is why noma cases were observed only in the Romani prisoners, and not among prisoners of other ethnicities, e.g. Jews, Frenchmen, Russians, who lived in much worse conditions and only had the camp food rations, but were forced to do extremely hard physical labour and endure all kinds of concentration camp harassment.

For those interested, below I provide some foreign publications on noma. For example, the Yugoslavian periodical Vojnosanitetski Pregled for April 1960 contains a paper on reconstructive plastic surgery following noma; the British Oral Surgery, vol. IX, No. 10, October 1956, pp. 1076–1079, contains S. Stark’s paper “Noma or gangrenous stomatitis; report of case.”

Translated from original article: Szymański, T. Noma (rak wodny) w obozie cygańskim Oświęcim-Brzezinka. Przegląd Lekarski – Oświęcim, 1962.