Antoni Makowski, MD, born 1910, Auschwitz‑Birkenau survivor (prisoner no. 131791), Buchenwald survivor.
Buna Monowitz (also called Auschwitz III) was the largest sub‑camp of the Auschwitz death camp. It was established in late October 1942 as a “labour camp” and initially had about 2,300 detainees. Their numbers gradually increased and from July 1944 never dropped below 10,000.
The prisoners had to work on the construction site of the Buna-Werke chemical plant, which was owned by the German company I.G. Farbenindustrie. All their tasks involved hard physical labour which was usually done outdoors, in all kinds of weather. Only very small groups of professionals did lighter work, sometimes indoors. The prisoners had inadequate clothing and no footwear to speak of, and starved on scanty food rations, which is why after a short period of backbreaking, exhausting drudgery their health deteriorated drastically, their immunity fell, and morbidity shot up.
As soon as the Monowitz camp was set up, medical care was provided in an outpatient infirmary and hospital, both housed in the Häftlingskrankenbau, dubbed the HKB or more often KB, which was a complex of wooden residential barracks. Initially, as in all other concentration camps, the SS administration did not intend to provide the internees with any medical treatment; on the contrary, the German policies thrived on the skyrocketing death rates. However, about mid‑1943 the situation changed, as the goal pursued from then on was to exploit slave labourers working for German industry for as long as possible. Therefore, the camp’s authorities first allowed prisoners to have access to medical treatment, and later even encouraged them to take advantage of a variety of medical services.
From September 1943 until January 1945, when the camp was evacuated, I was employed in the Monowitz camp hospital as a prisoner doctor (Häftlingsarzt). Previously, for an agonized two months, I had worked in Birkenau and Monowitz just like any other prisoner, in different Kommandos. In September 1943 the Monowitz hospital was housed in six barracks: one held the outpatient clinic and auxiliary units (such as the office, pharmacy, lab, physiotherapy room, and operating theatre), three were internal medicine wards, one was the surgical ward, and one was the infectious ward, which in practice treated diarrhoea. Throughout that period, my workplace was Internal Medicine Ward 1 (Interne I) in Block 19. It had four rooms: the staff room, postoperative patients’, Ward 1 proper, and German (Reichsdeutsche) patients’.
In this paper I would like to describe the functioning of the Internal Medicine Ward 1 in the Monowitz camp hospital and the problems faced by its doctors.1
Ward 1 had a capacity of 36 prisoner patients, as it had 18 bunk beds. The number of inpatients varied, but it was rare for patients not to have to be put up two in a bed. In the winter of 1943–44 the majority of bunks were occupied by two patients, and numbers went up to 70. Prisoners had to wear their shirts and underwear; they had straw mattresses and pillows filled with wood wool, and just one blanket for a bunk; there were no sheets or pillow cases.
At the beginning I was the only physician in the ward, having replaced Dr J. Silber, who had been transferred to outpatients. It was only in the spring of 1944 that another doctor, a Hungarian named Schönzweig, was admitted to the hospital as an inpatient and later illicitly employed there. In the autumn of 1944 we were joined by three more doctors, Hungarians Fischer and Weiner, and Spazierer, a Frenchman, formally also inpatients. Our helpers were Kurt Littwitz and A. Lindenbaum, two young prisoners with plenty of good will but no formal nursing training, so they had to be trained on the job. One of the male nurses, Otto Schuler, had to do day‑to‑day chores, keeping the premises clean and tidy and, most importantly, dispensing food rations to all the prisoners in the block, that is to the functionaries and the inpatients in all the rooms. Also, some convalescents and other patients who were not bedridden helped with the cleaning and caring for those seriously ill. All the general management tasks belonged to the block functionary. When I was employed in the camp hospital this position was held for a short time by Otto Kozdass, an Austrian, and subsequently by Hermann Leonhard, a German political prisoner. In July 1944 Leonhard was drafted into the army and then I had to reconcile the responsibilities of the block doctor and block functionary. As a rule the ward’s functionary prisoners did not interfere with the treatment.
Ward 1 took the most serious cases, and the majority were bedridden patients. Some were admitted to the hospital in the morning, following the preliminary examination by an SS doctor, but most arrived in the evening, after a hard day’s work and a return march to the camp. The most frequent problems were circulatory collapse, pneumonia (usually in its lobar form), effusive pleurisy and pleural empyema, acute arthritis, and acute muscle pain.
According to the regulations issued by the SS, a patient could not be hospitalized for more than three weeks. If the illness lasted longer, he was to be transferred to the main camp in Auschwitz or, following the decision of an SS doctor, to Birkenau, to be killed (we were fully aware of that). However, the actual periods of hospitalization differed widely. As my ward treated the most serious cases, the SS doctor hardly ever checked how long the patients were kept in, so the treatment could exceed three weeks. Yet the decisive factor was the number of patients that could be admitted. When there were very many seriously ill prisoners, I had to discharge convalescents in order to have some free bunks; alternatively, I transferred walking patients to Internal Medicine Ward 2. Sometimes discharged patients were relieved of their usual duties on the basis of a Schonung (special certificate) or, thanks to informal connections, assigned lighter tasks.
In some periods, especially in the winter of 1943–44, the mortality rate in the ward was high. It is difficult now to estimate the number of deaths, as no records have been preserved for Internal Medicine Ward 1.2 The main causes of death were pneumonia complications and circulatory collapse; an even more frequent cause, judging by the symptoms, was meningitis. The daily routine of the doctors and nurses in the ward was as follows: we woke up at about 6 o’clock and started work immediately after the morning toilet.3 The nurses took the temperatures, made the beds, and dispensed breakfast. The seriously ill had to be fed, which was usually done by the convalescents. The patients received their medication, other medical procedures followed, and we made sure that the ward was in good order. One of the nurses brought coffee from the hospital kitchen. This beverage, along with bread and other solid foods collected on the previous day, was then distributed to the patients in all the rooms. The daily ration was one and a half pints of soup, which contained vegetables and small amounts of margarine and meat, 250 grams of black bread, and other victuals, such as 20 grams of margarine / 30 grams of beetroot jam, or sausage / 50 grams of cheese, as well as two mugs of unsweetened chicory coffee.
The physicians did their morning rounds, examining the bedridden patients on their bunks, while those patients who felt better gathered at the table in the middle of the room. The doctors had to keep meticulous medical records in German on the reverse side of the temperature charts. Every two or three days new notes had to be added about the course of the illness, the treatment, and the recommended medication, even if the patient received none when none was available. The SS doctor was extremely particular about medical histories and woe betide a prisoner doctor found negligent of his duties. The morning was also the time of preparing death certificates for those who had passed away in the night and drafting discharge documents for those who were to leave the hospital the following day.
The morning medical procedures were intramuscular and hypodermic injections administered by the nurses, and intravenous injections administered by the doctors. Pleural taps were performed for diagnostic or therapeutic purposes (excess fluid was drained off and pleural cavities were rinsed). Several thoracenteses were carried out every day, using ordinary syringes and no suction apparatus, so they took a few hours. During that time a few new patients had to be admitted and instantly attended to. About 1 p.m. the patients and the personnel were given their midday meal. At this point our work became slightly more relaxed, but after a short rest both doctors and nurses had to resume their duties. At 6 p.m. supper was distributed and afterwards we observed an influx of very serious cases; sometimes examining them continued late into the night.
The new arrivals appeared in the ward freshly washed and in clean underwear, so we only had to provide all the medical help necessary. First an interview was conducted in order to diagnose the patient and establish his treatment plan, after he had been registered and had his medical history taken.
These initial steps were far from easy. The first obstacle was language, and it appeared during the interview. The official language in the camp was German, but very few prisoners could actually speak it. With its multinational community, Monowitz forced us to turn into polyglots to communicate with our patients. With prisoners of Slavonic origin, such as Slovaks, Czechs, Russians and, rarely, Serbs, some contact could be established using Polish, while German allowed for a passable conversation with the Germans, Austrians, some Hungarians, Dutchmen, and Norwegians. The Frenchmen, Belgians, and a few Italians had to make do with my rather imperfect French combined with their broken German. We had the greatest trouble communicating with the Greeks (as only some of them knew French), Italians, and especially those Hungarians who could only speak their mother tongue. Then we had to rely on the random help of untrustworthy interpreters. Alternatively, we could use the absolutely reliable communication by gestures.
Diagnostic procedures hinged upon the simplest methods, as practically no additional tests were available. Sometimes we could test the patients’ blood, urine, or spit, but the hospital lab did not give us many such opportunities. If we wanted to X‑ray a patient, we had to transport him to the main camp in Auschwitz, which was almost impossible to arrange. Therefore the diagnosis had to be based on a careful physical examination. I frequently resorted to diagnostic puncture of the pleural cavity when I suspected exudation.
One of the therapeutic factors in the healing process, and a fairly significant one, was hospitalization as such. The patient was allowed to stay in a warm bed; his temporary living conditions, given that we were in a concentration camp, were tolerable; he could enjoy relative peace and calm, take advantage of medical care, get enough rest and sleep.
Obviously, the most serious cases should have received pharmacological treatment, which was irreplaceable, while our resources were more than modest.
The officially allocated medication reached the Monowitz hospital via the main pharmacy in Auschwitz. We received aspirin, Schmerztabletten (painkillers), Calcium lacticum tablets, Infusum fol. Digitalis (apparently a digoxin preparation, probably containing other ingredients), and medicinal white clay. We also got other drugs that were needed to treat pneumonia, such as Prontosil, Sulphatiazole, Solvochin and Solvochin-Calcium (quinine preparations in ampoules), Cardiazol and Pandigal syrup, herbs for expectorant infusions, and the antiseptics Rivanol and Mercurochrome.
The second source of medicines for the ward was the sorting warehouse of Auschwitz, which was called Kanada in the prisoners’ jargon. New arrivals in Auschwitz had to give away all their clothes and other belongings, which were then sorted in this warehouse in Birkenau. Medicines obtained in this way came from various countries and numerous producers, and differed in efficiency too. The Monowitz hospital received a few suitcases packed full of them on several occasions, which to some extent helped to meet the needs. Kanada was our chief source of extra Sulphatiazole, much in demand, and Eleudron and Ultraseptyl, respectively its German and Hungarian equivalents. Another important source was the hospital lab, which provided us with some medications, such as sol. calcii chlorati and sol. glucosae, used for injections, which never brought about any complications.
This account might suggest that Ward 1 in the Monowitz camp hospital was able to offer efficient, comprehensive pharmacology to patients with both the basic and the most serious health problems. However, such a conclusion would be absolutely wrong. The officially allocated medicines were scant, while other resources were insufficient to meet the enormous demand. The only substance that I had in plenty was glucose, which was produced in the hospital lab.
When treating seriously ill prisoners, for instance those with pneumonia, I often faced a great dilemma: which men should take a particular medicine. For instance, there were ten of them with pneumonia, and my assignment for the day was 20 tablets of sulphonamides, 3 ampoules of Solvochin and another 3 of Solvochin‑Calcium. I never knew what the next day might bring. So was it better to give each of them a smaller dose of the medicine, but then the treatment would have been ineffective in all the cases, or was it right to provide intense, efficient treatment just to a few patients? If so, who should I have chosen? It was not easy to solve such a medical and ethical problem. Other prisoner doctors advised I should be using sulphonamides mainly to treat younger internees: if they recovered from their serious illness, they would stand a better chance to survive the camp. Older men, even if they recuperated, would still have to face so much horror during their internment that their prospects of survival would definitely be worse.
Other patients received Solvochin injections, all those running a temperature were given Inf. Digitalis or Pandigal, and all the patients with pneumonia got intravenous injections of glucose every day. I had to administer dozens of these injections every day, often to patients in the upper bunk, which I had to climb up to, with a torch between my teeth in order to get some light. Yet the effort proved beneficial in the process of healing and though the injections were given just because we were unable to treat the cause, they undoubtedly had a good psychotherapeutic effect.
I remember a patient (G.M., camp number 144338)4 with lobar pneumonia and, what was worse, a congenital heart defect. Two weeks after a nine‑day spell of fever and a crisis, when his temperature had come down, he had a relapse. There were no medicines, so no intensive treatment was possible and he received a Digitalis preparation and intravenous glucose injections. He went through the full course of the illness again. When he was a convalescent, he thanked me warmly for the successful treatment: he thought he had been cured only thanks to my efforts. In my opinion, what was more important was the strangely inexhaustible resilience of his body, or the healing power of Nature, vis medicatrix naturae, given that we were in a concentration camp. My “treatment” probably only kept up his spirits.
Circulatory collapse, usually brought about by general exhaustion and hypothermia, was treated with warm baths and hot water bottles, giving patients hot drinks, glucose injections, [medicinal doses of] strychnine, when it was available, and Cardiazol orally. This usually proved effective.
Patients with exudative pleurisy, the real cause of which was tuberculosis but never diagnosed as such,5 were given aspirin, whenever we had it, and intravenous injections of calcium chloratum. Also, I tried to procure additional food rations for them: a portion of soup or bread left when a prisoner died or was unconscious. Sometimes I had to remove fluid from the pleural cavity; this procedure was repeated weekly or every few days with the same patient.
Pleural empyema was a frequent problem, sometimes occurring as a complication following pneumonia. The pleural cavity then had to be punctured and rinsed with Rivanol solution. For arthritis and acute muscle pain I administered 2–3 tablets of aspirin a day, which was too small a dose, but our resources were slim and we had to keep some of the daily ration for these patients. We also applied diaphoretic treatments, for instance, patients took light baths in a Lichtkasten (a chest fitted with light bulbs).
The effects of such treatments, perforce inadequate, were various.
The sulphonamide treatment of lobar pneumonia tended to be spectacularly successful—initially. The patient’s temperature came down in two days and he did not run a fever for another couple of days. At that point we stopped administering Cibazol, as we could afford to give him up to 20 tablets, while the average dose needed was 50–60 tablets. So after about a week his temperature shot up to 40 degrees [40oC = 104oF] , and on day 9–11, when the crisis and profuse sweating came, it dropped again. Such patients did not have the typical symptoms in the lungs, and usually there were no complications. Those who were treated with Solvochin had a slightly less severe course of pneumonia, as manifest in the respiratory sounds, and they expectorated less. However, they were ill longer and had pleural complications. The most tragic fate awaited those for whom there was not even enough Solvochin. The majority of them were emaciated and their immunity was low, so the course of the illness was extremely severe. After a week or two they developed cerebral complications. Recoveries, such as the one I have described above, were rare.
I would now like to recall some of the more unusual and memorable cases I came across.
A teenager6 was admitted to hospital with a persistent high fever of 39oC [102,2oF]. No other symptoms were observed. We could suspect typhus, but there were no other indications for it in his general condition. After a week the enigma was solved: his buttocks were red and swollen, with pus under the skin. The boy had been beaten by a Kapo at work, a few days before being admitted, and now the haematomas were festering. He recovered as soon as his abscesses were drained.
M.W., camp number 135701, a boy of 17, ran a very high temperature for a long period (in the winter of 1943–44) following pneumonia. I suspected pleural exudation, but could not identify its location although I examined him thoroughly. After some time, when the amount of exudate increased and I could hear dull percussion sounds within a four‑centimetre radius in the right axillary line, I punctured the pleura towards the interlobar cavity, where finally I located the purulent exudation. The punctures were repeated every three or four days, and the cavity was rinsed with Rivanol. The patient’s condition and mood improved and his temperature came down. Yet the interlobar empyema was still there. One day the boy suddenly coughed up and expectorated about a pint of pus, which was evacuated via a bronchus. From that time on there was no more excess fluid in the pleura and no more punctures were performed. The boy’s condition quickly improved, which was facilitated by his feeding well on victuals generously sent in by his family. We discharged the young man and made sure he was employed in a different Kommando, doing lighter work. Having survived the camp, in 1953 he managed to find me in Warsaw. When he was examined after the war, TB lesions in the lungs and thickenings in the pleura were found, but apart from that his condition was fine and he is [as of 1969] in relatively good health.
J.B., camp number 119205, a nineteen‑year‑old student from Warsaw, had bilateral exudative pleurisy, most probably as a result of developing TB. I gave him all the treatments I had, salicylates, extra doses of which were sent in by his family, as well as calcium, and punctured the pleura to remove the fluid. He stayed in hospital for a long time, probably a few months, enjoying relatively good living conditions. Every two or three days his relatives posted a large parcel with nutritious foods, so he was well nourished. Yet the treatment was all in vain and the fluid kept accumulating. Gradually, the boy deteriorated more and more and died with symptoms of meningitis, which must have been caused by miliary tuberculosis.
J.W., an E-Häftling aged 187, who had not been in Monowitz for long, convalescing after a regular course of pneumonia. He had polyphagia: he simply wolfed down his food. Although my colleagues and I procured additional rations for him and generously shared the victuals we received in parcels from our families, he never seemed to have had enough and even resorted to stealing other prisoners’ food. One of the French doctors, an experienced practitioner, recommended homeopathic doses of iodine in a weak solution. After a few days’ treatment, the boy’s excessive appetite was suddenly back to normal. I was unable to make sense of his condition then, and I still can’t understand it now.
One of the conditions that we knew it was safer not to diagnose was tuberculosis. A prisoner diagnosed with TB was likely to be selected by the SS and killed.
I remember a locksmith aged about thirty from Warsaw (E.N., camp number 131730)8 with a prolonged sub‑febrile temperature following pneumonia. On auscultation, you could hear crackles in the apex of both lungs. Diagnostically, the picture was clear, especially as Mycobacterium tuberculosis was found in his spit. A less obvious issue was how to help him and at the same time decrease the probability of other prisoners getting infected. We reached an agreement with Dr Budziaszek, the hospital supervisor, to have the prisoner employed in the nearby workshop, and he survived in a relatively good shape, until the evacuation of the camp in January 1945. I do not know what became of him later.
Similarly, one of the doctors (C.J., camp number 31070) with a knee condition caused by joint tuberculosis was officially diagnosed with rheumatic joint inflammation. He took sun baths and light baths with a quartz lamp, and received extra food in parcels from his family. His knee was not put in plaster, because any SS physician would have realized what the real diagnosis was. I kept this patient in hospital for five months, but had to discharge him after he had accidentally attracted the attention of an SS doctor. So I arranged for him to work as a clerk in another hospital ward.
Internal Medicine Ward 1 took in prisoners with acute conditions, and hardly any chronically ill patients, so the SS doctors and nurses did not carry out selections there. They rarely turned up, and if they did, it was usually just to take a look at the medical histories, check the rooms for cleanliness, and engage us in pseudo‑medical talks about treatment methods. So I felt fairly free to run the place in my own way, and even to hospitalize people for longer than the regulations permitted.
In January 1945 all the prisoners, myself including, were forcibly evacuated to Germany (Makowski 1967: 212). The seriously ill were left behind in Monowitz and their fate has been described by Dr Czesław W. Jaworski.
My work as a doctor, regardless of the specifics of life in the concentration camp, resembled regular medical practice, though it was very intensive and exhausted me both physically and mentally. I was occupied all day long and for several hours at night, because besides performing my duties in the ward I also assisted at operations, giving general or spinal anaesthesia. Thanks to my employment in the camp hospital, I was able to forget, at least partly and occasionally, about the realities of the camp and to find satisfaction in making myself useful and sometimes proving to be effective. I suppose it was my work, during which my contact with the SS men was infrequent, that helped me to survive the camp without much damage to my mental health. After the war I met several other survivors, my former patients, who managed to hold it out with some help from me, which I find immensely gratifying.
Translated from original article: Makowski, A. I oddział wewnętrzny szpitala obozu koncentracyjnego Buna‑Monowice. Przegląd Lekarski – Oświęcim, 1969.
1. For a long time it has been suggested, and rightly so, that a monographic study is needed of all the hospital wards in Auschwitz‑Birkenau. However, the topic cannot be treated comprehensively until we have the results of more focused research available for each of the wards (editors’ note).
2. The estimated number of deaths in all the hospital wards in December 1943 and January 1944 was between 12 and 14 per day. Most of those prisoners died in Internal Ward 1.
3. The medical personnel and the patients did not have to attend the general roll call in the morning.
4. Thanks to the information provided by the Auschwitz-Birkenau State Museum, we know that G.M. arrived in the camp on 31 August 1943 with an RSHA transport from the Jewish ghetto in Białystok. He is in the records of the Monowitz camp hospital for the period from 15 October 1943 to 26 February 1944. We don’t know what happened to him later. This article gives only prisoners’ initials and camp numbers if identified.
5. If an SS physician learned that a prisoner had TB, he would “select” him to be killed in the gas chamber or with a phenol injection (translator’s note).
6. I had not managed to find any reliable personal data for this prisoner before the article went to print.
7. Erziehungs-Häftling. The Erziehungskompanie was a special penal Kommando for prisoners who had committed misdemeanours or minor offences. It was not as heavy as the Strafkommando.
8. He was deported to Auschwitz from Radom and arrived in the camp on 29 July 1943. He is in the Monowitz camp hospital records for the period between 10 and 16 June 1944.
References1. Makowski, A. Wspomnienia lekarza z obozów koncentracyjnych w Monowicach, Buchenwaldzie i Zwieberge‑Langensteinie. Przegląd Lekarski – Oświęcim. 1967: 212.
2. Jaworski, C. W. Wspomnienia z Oświęcimia. In Apel skazanych. Warszawa: Pax; 1967.