Infectious diseases in the Auschwitz-Birkenau environment

In the criminally induced living conditions created for the prisoners of Auschwitz-Birkenau, those who were not killed straight on arrival were condemned to unimaginable torment – both physical and psychological – as well as to a sense of constant insecurity about their future, starvation, labour beyond their capacity, and to life in an utterly insanitary environment which fostered the spread of numerous infectious diseases. The deliberate exposure of prisoners to infectious diseases leading to endless outbreaks of epidemics, and eventually to the death of thousands of inmates, is one of the many crimes against humanity committed by Nazi Germany.

Epidemiology

The insanitary conditions in which the inmates of Auschwitz were forced to live should be seen as the root cause of the epidemics. The congestion of such a vast number of people in a small area can pose an epidemic threat in itself if the healthy and the sick, including the carriers of pathogenic microorganisms, are all crowded together. Conditions which foster the spread of pathogenic microorganisms combined with a large number of people susceptible to disease because of their low immunity, can easily lead to the outbreak of an epidemic. Under such circumstances, it is always essential to impose a stricter sanitary regime and raise the standards of hygiene. However, exactly the opposite approach was deliberately taken in Auschwitz.

Accommodation

Between 700 and 1,200 or even more prisoners were quartered in a brick block in the Stammlager (main camp). This block had a volume of 2,900 cu. m, which meant 2.5 to 4 cu. m per inmate. Initially, prisoners slept huddled together on the floor and stacked on their sides. It was not until 1941 that bunk beds started to be installed in the main camp.

The conditions were even worse in Birkenau, where over a thousand prisoners lived in wooden barracks intended to house 420 people. Each barrack was equipped with 28 three-storeyed bunk beds, and each of them was to sleep fifteen prisoners. So the “private” space allocated to a prisoner was 1.24 cu. m, though in theory it was supposed to be 3.12 cu. m.

The sleeping facilities in the brick barracks of Birkenau were three-tier bunks resembling shelves on a wooden base with vertical screens made of bricks separating them from each other. Each compartment was intended to sleep four prisoners but in reality slept about eight. When the weather was bad, the clay of the earthen floor would turn into mud, which was carried onto the bunks, where it combined with the straw and turned into a gungy substance which inmates had to sleep on. Later prisoners slept on straw mattresses, usually sharing a ragged blanket between three.

Clothing

The prisoners’ clothing offered no protection against bad weather conditions. It was rarely changed or washed, and even if it was taken to the laundry, inmates would often receive clothes which were still lice-infested. Their clogs chafed their feet and in winter gave no protection against frostbite.

Water

Initially in the main camp, one well had to cater for thousands of prisoners. Later washrooms were installed in the blocks over time, though water shortages still occurred. The water supply in Birkenau did not meet the needs of the camp right to the very end of its existence. The water was not properly purified, either. As Prof. Zunker observed in his report of July 26, 1941, the water in Auschwitz was not suitable either for drinking or even for a mouth wash. The shortage of water, especially hot water, and no soap after a day of hard labour in mud and dust, meant a disastrous decline in personal hygiene, filthy clothes, interiors, and bedding, which altogether helped infestations of insects and pathogenic microorganisms to spread.

Drainage and sewerage

By 1941, a network of sewers and drains had been installed in some of the blocks in the main camp. However, in most of them it only became operational towards the end of the War. No sewers were constructed in Birkenau at all. 3 latrine facilities had to serve 32 barracks. The time the inmates could spend in the latrines was strictly limited, and of course they had no toilet paper. Since most of the inmates suffered from diarrhoea, they would queue up for the latrine several times a day, risking harassment from the kapos.

Heating

The blocks in the main camp were equipped with stove heaters, while the wooden barracks in Birkenau had metal heaters with an outer casing of bricks and a brick chimney that ran lengthwise along the middle of the barrack. The barracks had dirt floors made of clay. The walls and roofs were not insulated. There were no windows, just a row of skylights running along the top of the barracks, just below the slightly raised double-pitched roof. There was always mud around the block during periods of rainy weather, and dust during the summer.

Food

Prisoners’ food rations did not cover even half of the daily caloric requirement for a person doing hard labour (ca. 1,900 kcal), the quality of the food was poor and contaminated with bacteria. Microbiological tests of food samples conducted at the SS Hygiene Institute confirmed the occurrence of colonic bacteria such as E. coli and proteus vulgaris.

Protracted starvation turned prisoners into a bag of bones within a few months. They lost their physical strength and mental faculties, by the terminal stage of hunger disease turning into shrivelled up, semi-conscious creatures known in the camp jargon as Muselmänner. The average life expectancy for prisoners on hard labour and only on camp rations was no more than 4 months.

In addition, the immunity of their emaciated bodies went down, and so they were susceptible to infections which they found harder and harder to get over. Prisoners with infectious diseases infected others because their bodies did not react to infection in the normal way.

On top of all this, prisoners had to share unwashed bowls and spoons (because there were not enough utensils to go round), and swarms of files infested the premises where the food was stored, cooked, and dispatched. Not surprisingly, infectious diseases of the digestive system proliferated.

The sanitary conditions in the camp, particularly in Birkenau, are best illustrated by the endless plague of insects, including fleas, lice, and bugs, as well as rats. In their statements, many survivors mentioned blankets teeming with hundreds of lice, swarms of fleas covering the walls and bedding like a black shroud, and rats as big as a cat cheekily scampering over the bunks or scavenging on corpses. It was a typical sight for prisoners, a view that encapsulated the tragic reality of Auschwitz-Birkenau.

The description of that dire imagery would not be complete without a mention of the very humid, malarial climate of the locality, swarming with mosquitoes breeding in numerous nearby pools of water, ponds, puddles, and bogs, both in the camp and in its immediate vicinity.

The extent of the SS authorities’ and doctors’ disregard for the impact of the insanitary conditions on prisoners’ health is best illustrated by the fact that no preventive measures such as vaccination, mass X-ray screening, isolating prisoners with infectious diseases, or disinfecting infected zones were ever introduced. Frequent death selections of sick inmates from the prisoners’ camp hospital spread anxiety for their future, which in turn made them dissimulate their true condition, particularly by trying to hide any symptoms of infectious diseases they may have had. Given such conditions, epidemics of various infectious diseases could and indeed did break out.

The most common infectious diseases in Auschwitz-Birkenau

Epidemic typhus

Epidemic typhus (typhus exanthematicus, German Fleckfieber) was the most common disease in these conditions, and also the deadliest of all the infectious diseases in Auschwitz-Birkenau. It is caused by Rickettsia prowazekii bacteria and transmitted by lice infected by a human host. The congestion and insanitary conditions in the camp helped the disease to spread on a scale which would have been impossible in normal circumstances.

The exact number of prisoners who contracted typhus cannot be determined. First of all, no medical records have survived from the camp hospitals. Secondly, even if these records had been preserved, it would be difficult to tell the records of those prisoners who actually contracted typhus from records with bogus data. Fabricating official medical records with entries of fake diagnoses for inmates who had simply been murdered was practised on a mass scale. Bogus records were also made by prisoner-doctors, who entered false diagnoses in patients’ medical records to save them from selection for the gas chamber.

I must also add that many sick prisoners dissimulated, fearing they would be sent to the prisoners’ hospital. However, we can at least make a rough estimate of the extent of the typhus epidemic in the camp on the basis of the documents which have come down to us, as well as from the statements made by prisoner-doctors.

One of the extant records is the register of the prisoners in Room 3 of Block 20 in the main camp, where inmates with infectious diseases were hospitalised. It was one of the three locations in the camp where typhus was treated. This document contains entries made between 12 March and 1 December 1942. A total of 1,792 patients were held there in that period, and 413 (23.04%) of them died. Case no. 645 was entered on 12 February 1942, and case no. 4812 was recorded on 30 November 1942, so 4,167 new cases of typhus were observed in nine and a half months. However, this is only the figure for cases confirmed by a serological test, and probably accounts for just half of the actual number of new cases.

Later the number of typhus cases in that section of the camp fell. This was not due only to selection, i.e. the barbaric practice of exterminating sick inmates in the gas chamber (e.g. 746 typhus victims were killed on 29 August 1942) or with a phenol injection, but also from a certain improvement in the sanitary conditions in the main camp. Nonetheless, new cases of typhus still continued to occur until the very end of its operations. According to Dr Władysław Fejkiel, 10 to 15 thousand prisoners went down with typhus in the main camp between 1941 and 1944. While the typhus epidemic in the main camp fell in 1943, it continued to wreak havoc in Birkenau, which started operations in March 1942, when section BIb was established with several sectors for male prisoners. In August 1942, women prisoners were transferred to section BIa from 10 blocks separated off with a tall wall in the main camp. The female inmates were put in exceptionally insanitary conditions.

Sector BII in Birkenau, which was built in 1943–1944, had 6 sections, each marked with a letter of the alphabet.

Section BIIa was a quarantine camp for new male arrivals. BIIb was for Jews deported from the Theresienstadt ghetto, while Section BIIc, which was next to it, was for female Jewish deportees from Hungary. As of February 1943, a Roma community of approx. 21 thousand men, women, and children, was accommodated in BIIe. The Roma camp was wound up in an atrocity committed on 2 August 1944, when about 3 thousand of the remaining inmates were murdered in the gas chambers. Section BIId served as a men’s camp, while BIIf was a hospital for male prisoners.

Dr Otto Wolken, who worked at the dispensary of the BIIa section, secretly compiled and hid some notes which were later discovered. They include some fairly accurate statistics for his patients. 1,902 of the 4,023 prisoners admitted from his dispensary to the hospital in BIIf died. His figures are for the period from September 1943 to November 1944. A total of 582 cases of typhus were registered in that part of the camp alone.

The extent of the typhus epidemic was much wider in the Roma camp. It continued to rage there despite the barbaric gassing of 1,700 deportees on one of the first Roma transports in March 1943, when some of the new arrivals were found to be suffering from typhus; while another 1,035 sick inmates suspected of typhus were sent to the gas chambers on 25 May 1943, offering the best proof that the reason why the disease proliferated lay in the insanitary conditions. The epidemic did not diminish until late 1943, most probably because by then all the prisoners susceptible to infection (and the susceptibility rate for typhus was up to 70%) had already contracted the disease.

Out of the 5 hospital blocks in the Roma camp (Section BIIe), each with 400-600 patients, Blocks 32 and 26 were used for the treatment of prisoners with infectious diseases, while Block 24 served as a convalescence ward, mostly for those who survived typhus. During the epidemic, there were over 2 thousand patients in the hospital, most of them with typhus, which had a mortality rate of 30-40%. On the basis of this data, provided by prisoner-doctors working in that hospital, approximately 6–8 thousand inmates may be estimated to have contracted typhus in less than a year.

The situation was no better in the women’s section of Birkenau. The women were transferred to the newly erected barracks of Section BIa in August 1942. The mattresses they got at that time had neither been disinfected nor purged of insects, and were lice– and flea–ridden. Numerous cases of infectious diseases, primarily typhus, emerged within the next few days. From 800 to 1,000 prisoners were kept in 6 hospital barracks. In the autumn of 1942, an average of 100-200 women died every day, most of them of typhus. The epidemic peaked at the turn of 1943 and 1944. Almost all the barracks were full of prisoners with typhus. So the total number of cases in that part of the camp may be estimated at about 10 thousand.

The situation in the hospital of BIIf, the men’s section, was pretty much the same as in the other camp hospitals. An average of 100 – 200 prisoners died there every day, mainly of typhus or Durchfall (starvation diarrhoea). During successive waves of the typhus epidemic in Birkenau, there were 400 – 450 inmates suffering from the disease in the hospital barracks. The incidence of typhus did not fall until January and February 1944, as a result of criminal selections for the gas chambers and the “delousing campaign.” Considering the living conditions and the number of patients treated in the BIIf hospital, we may conclude that the number of typhus cases in that section was comparable to the figures for the women’s camp.

The data in the surviving records of the Waffen SS Hygiene Institute in Rajsko, currently preserved in the Archives of the Auschwitz-Birkenau State Museum, are for the period from 10 April 1943 to 14 May 1944 and give the impression of being scanty and not very helpful.

Prisoners’ blood samples were not always sent for a Weil-Felix test, which was only done if commissioned by an SS physician. Prisoner-doctors did not want serological confirmation for their diagnoses; quite on the contrary, they tried to conceal the real diagnoses. Originally, there were fourteen volumes of the Hauptbuch (main register) with records of the additional tests conducted by the SS Hygiene Institute, which was only established in March 1943, but only eight are extant today. If we count Weil-Felix titres of 1:400 or even 1:200 as testing positive in the epidemic conditions, we get a total of 1,818 positive tests recorded in those eight volumes (1,484 cases with a titre of 1:400 and 334 with a titre of 1:200). Even these highly underestimated figures reflect the vast scale of the typhus epidemic. When I was going through a random selection of the results for the samples sent in from Birkenau, I found that, for instance, the tests conducted on 19 May 1943 confirmed 64 cases, 31 cases were confirmed on 30 June 1943, and another 55 on 24 July 1943, even though this was not the peak of the epidemic in the camp.

On the basis of these calculations, we may assume that at least 20-25 thousand Birkenau prisoners contracted typhus. Combined with the figures for the main camp, this would amount to a total of 35-40 thousand cases. About 60 thousand prisoners were confined in Auschwitz in May 1943, and about 135 thousand in August 1944 (105 thousand registered and 30 thousand unregistered).

Infectious diarrhoea and Durchfall

Epidemics of orally transmitted diseases frequently broke out in conditions facilitating the spread of infections not only through skin contact with the filthy, lice-infested environment (as with typhus) but also of those disseminated in the food. According to Dr. Olbrycht, practically all of the time about 30% of the prisoners had diarrhoea. There were a number of causes of diarrhoea. The most common was diarrhoea induced by digestive disorders due to extreme emaciation and long-term hunger. Interestingly, tests conducted in the SS Hygiene Institute gave positive results for the Gram-negative Proteus bacteria. Starvation diarrhoea, known in the camp jargon as Durchfall, caused the largest number of deaths, even more than the death toll for typhus. For example, in Otto Wolken’s records for prisoners sick or deceased in the quarantine camp, 1,172 deaths were registered for 2,554 patients diagnosed with Durchfall in the BIIa hospital. All the other surviving documents show the exceptionally high prevalence of Durchfall and its very high mortality rate. Besides the typical starvation diarrhoea, there was also a wide range of infectious types of diarrhoea. Infectious diarrhoea was frequently contracted by prisoners shortly after their arrival in Auschwitz. Usually they caught one of the infectious types of diarrhoea, since the SS physician Johann Paul Kremer, who had diarrhoea several times within a short spell, called it “the Auschwitz disease” in his notes. Apart from prisoners with various types of non-specific diarrhoea, different from one another and difficult to determine aetiologically, there was also a large number of inmates suffering from specific diarrhoea transmitted through the alimentary tract.

Typhoid and paratyphoid

It is very difficult to determine (or even give a rough estimate for) the number of prisoners who suffered from typhoid. If we consider only the data in the extant volumes of the Rajsko Hygiene Institute, which have intermittent entries for samples tested between 10 April 1943 and 14 May 1944, and take titres of 1:400 and over as positive for Salmonella, and if we count only cases which gave negative Widal and Weil-Felix tests, we are still left with 347 cases of typhoid and eight of paratyphoid. Additionally, we get two stool samples which tested positive for typhoid and two for paratyphoid. The small number of positive tests for stool samples and the total lack of blood tests are striking, and probably due to the fact that the SS physicians and the SS Hygiene Institute in general were not interested in determining the actual number of cases nor in confirming the initial diagnoses. Moreover, the SS-men stationed in Auschwitz-Birkenau were vaccinated against typhoid.

In reality, the number of prisoners with typhoid must have been much, much higher, even in this short phase of the camp’s operations for which we have fragmentary records. The typhoid epidemic is confirmed in survivors’ statements. It is also mentioned in the diary of SS physician Johann Paul Kremer, who was stationed in Auschwitz. Conditions were right for the spread of typhoid in the hospital itself – not to mention other parts of the camp.

Survivor Anna Tytoniak described the hospital block in the following way:

Purulent, unwashed patients lay two a bed in their day shirts that were grey with dirt and full of fleas. They were covered with one blanket, and accommodated in a stuffy, stinking room. …

She continued with the following remarks:

All the nurses could do was to distribute the food and sometimes to provide a bed pan. There were around six of those pans per block of 800 patients. I don’t think they were ever washed and were covered with faeces.

Survivor Stanisław Kłodziński was a prisoner-doctor and member of the in-camp resistance movement who worked in Block No. 20, a hospital unit in the main camp. On 24 November 1942, Dr. Kłodziński wrote a kite (a secret message smuggled out by PWOK, a Polish organisation providing aid for concentration camp prisoners) reporting that ten inmates had typhoid, and thirty had paratyphoid.

Survivor Dr Otto Wolken, who worked in the dispensary of the Birkenau quarantine camp, made entries only for 14 cases of typhoid in his records. However, the medical board which examined survivors after liberation diagnosed 63 cases of typhoid. Considering the insanitary conditions in the camp and the lack of personal hygiene, we may assume that thousands of prisoners must have caught typhoid during their confinement in Auschwitz-Birkenau.

Dysentery

It is just as difficult to determine the number of dysentery cases, though clearly it must have been considerable. In the account of his work in the Birkenau women’s hospital in BIa, Julian Kiwała wrote that there were many cases of infectious dysentery. Dysentery was also reported by the doctors working in the Roma family camp hospital (BIIe). However, the disease was barely recognised as a problem in the SS Hygiene Institute records, with only twenty stool samples testing positive, 18 for Shigella flexneri and two for Shigella sonnei. These results are in one of the first volumes, which shows that little attention was paid to this disease later, particularly as regards sending stool samples for a bacteriological test.

So, although we cannot get even a rough estimate of the total number of dysentery cases, we should bear in mind that the incidence of dysentery is generally higher than of typhoid.

Malaria

The camp’s environs fostered malaria, and this combined with the complete want of measures to control the mosquito population led to the spread of malaria in the congested camp. It was particularly rife in Birkenau.

One of the women survivors recalled that for a certain period of time, a large number of malaria patients were accommodated in one of the hospital barracks. A similar situation occurred in the Roma camp. The overall number of cases must have been relatively high, since in the autumn of 1943 the SS authorities decided to compile a list of malaria patients. Dr. Władysław Fejkiel wrote of the anti-malaria campaign. Fearing that it would be yet another occasion for selections to the gas chambers, prisoner-doctors again made faked diagnoses to protect their patients. About 150 inmates either suspected of or diagnosed with malaria were in the hospital of the main camp at the time, though there were also some patients with other infectious diseases.

Fake diagnoses were also issued by the doctors in the Roma camp, as they were worried that the SS might want to play another dirty trick. It was not until much later that they discovered that the malaria patients had been transferred to Majdanek (KL Lublin), which was supposed to have a better climate. For instance, on 3 June 1943, 542 men and 302 women with malaria were transferred from Auschwitz to Majdanek. On 11 August 1944, after Majdanek had been liquidated, a group of 212 malaria patients were transferred from Auschwitz to Flossenbürg.

Dr Otto Wolken reported 44 cases treated for malaria and 5 malaria deaths in the Birkenau quarantine camp. A total of 41 positive blood tests for malaria parasites were registered in the first volumes of the SS Hygiene Institute records (10 April 1943 – 2 September 1943). When I was looking through a random selection of extant referral notices delivered to the SS Hygiene Institute from the camp hospitals, I found that six malaria cases were confirmed in the blood samples sent on 6 September 1943 from the Birkenau men’s hospital in BIIf, and that there was a list of nine confirmed malaria cases on the reverse of the notice dated 14 September 1943. 15 cases of malaria confirmed in this relatively short period of time implies that there were many cases of the disease.

Tuberculosis

Tuberculosis is a separate chapter in the list of diseases rampant in Auschwitz. TB was a chronic infectious disease and particularly debilitating in the conditions of Auschwitz. The Germans struggled resolutely to control tuberculosis – by killing those who contracted it. In 1941, SS physician Friedrich Entress issued an order that all prisoners diagnosed with TB were to be killed with a phenol injection. In 1942, a group of 200 TB patients who had been treated for three months in Block 20 were killed. A TB ward was established on the first floor of Block 20 in early 1943. The patients were frequently subjected to experimental treatment methods to test various “new” remedies. Nevertheless, the most seriously ill were murdered in the gas chambers or with a phenol jab. A total of 100 patients were in the TB ward of the main camp hospital in May 1943.

The medical records kept by Otto Wolken have entries for 569 TB deaths in the quarantine camp (BIIa) and 541 registered TB cases. Around 63% were for recently contracted TB. The mortality rate which may be calculated on the basis of these statistics was over 50%.

In 1944, once the number of typhus cases in Birkenau fell, TB patients made up the majority in the men’s hospital, filling two barracks with a capacity of 130-140 patients. Mortality was very high, with 5-10 deaths registered every day. Prisoners with TB constituted a considerable group of those who survived to the day of liberation.

Such a large number of tuberculosis cases inside the concentration camp was of course due to the dreadful conditions in which prisoners had to live. Their long-term starvation, which made their immunity drop, and no causal treatment, fully account for the high death rate for TB.

Diphtheria

Although diphtheria is usually regarded as a children’s disease, it also occurred in Auschwitz. Diphtheria was even confirmed in the records of the SS Hygiene Institute’s bacteriology tests.

In 1943, for instance, ten diphtheria cases were diagnosed on 8-10 August, nine cases on 26-28 October, and six cases on 1-2 November. Most probably, they were instances of pharyngeal diphtheria. Two cases of diphtheria were reported in a secret message smuggled out by the resistance movement on 24 November 1942.

Otto Wolken’s records list 18 cases of successful diphtheria treatment, and eight deaths due to this disease. The referral notices sent with samples for a bacteriology test to the SS Hygiene Institute which I looked through contain only sporadic data for diphtheria.

These records show that most of the confirmed diphtheria cases were diagnosed on the basis of pharyngeal smears taken in the SS hospital. However, this was no doubt due to the fact that the medical care given to SS-men was far better than what was available to prisoners, rather than to the real frequency of occurrence of diphtheria. In the light of other surviving records, it appears that the diphtheria epidemic in Auschwitz-Birkenau was endemic because of the low susceptibility of adults to this particular disease.

Erysipelas and other purulent skin diseases

With a water shortage and no antiseptics, minor skin injuries and poor protection from external factors due to inadequate clothing and footwear served as open doors for pyogenic microorganisms. Many prisoners developed purulent changes in the form of abscesses, phlegmons, furuncles, purulent sores, or even gangrene. In these conditions, erysipelas was rife. The report smuggled out by the in-camp resistance movement on 24 November 1942 mentions 90 cases of this disease.

Otto Wolken’s records speak of 47 erysipelas cases, and 467 streptococcal and staphylococcal skin infections. Erysipelas must have been a common disease in the camp, since many survivors recalled situations when someone’s face suddenly swelled up and went red. Many continued working despite developing this condition. Such descriptions probably relate to facial erysipelas. The large number of purulent skin diseases in the camp is confirmed by an extant volume from a surgical dispensary which has records of over a thousand surgeries for purulent skin diseases.

Scabies

Scabies was one of the most common diseases plaguing prisoners, which is not at all surprising if we consider the sanitary conditions in the camp. The general muck helped skin infections to spread through contact, though of course no blame can be attributed to inmates. Psorous skin changes, frequently infected with pyogenic microorganisms, proliferated, along with changes caused by pediculosis, or bites by fleas, bugs, mosquitoes, and flies. In the main camp the scabies epidemic abated in 1943, when there was a slight improvement in the sanitary conditions. In Birkenau, on the other hand, where the situation was very bad until the end of the camp’s operations, scabies continued to rage right up to the day of liberation.

The scale of the scabies epidemic is aptly illustrated by a camp pharmacy note dated 16 June 1942, which includes a request for anti-scabies ointment. A total of 200 kg of that medicine was ordered for the main camp. Incidentally, Mitigal, a very effective medication for scabies, was a highly valued item bartered on the black market in the camp.

This article gives an overview only of the most common infectious diseases contracted by Auschwitz-Birkenau prisoners. There are still many other illnesses which should but cannot be properly described for lack of relevant data.

Combating infectious diseases and treatment methods

The camp hospitals had a very limited therapeutic potential. Diseases that manifested themselves through diarrhoea were usually treated with kaolin (bolus alba) and charcoal which was acquired from wood burned in the block’s stove. Incidentally, Ernst-Robert Grawitz, chief physician of the SS Hygiene Institute in Berlin, issued guidelines for the treatment of diseases of the digestive system. He claimed that the first and best treatment was the application of laxatives.

Antibiotics, which are an aetiologically effective way to treat infectious diseases, were not available (and still not widely known) during the War and the German occupation of Poland. The want of specific medicines for causal treatment (except for a very limited range of sulphonamides) gave rise to an understandable fear of infectious diseases. No wonder, then, that the conditions which helped diseases to spread on a mass scale seemed even more menacing and terrifying.

How could you treat typhus in such an environment?

Apart from the lack of specific causal medicines, the camp hospitals struggled with a shortage of simple, familiar medications for symptomatic treatment, for instance those used for cardiovascular diseases. With such vast numbers of sick inmates, the sparse amounts of medicine, most of it smuggled into the camp, could be distributed only to some of the patients. What difficult choices the prisoner-doctors had to make, deciding who should get the medicine. Patients who recovered from typhus recovered their appetite. They were so emaciated by the disease that they needed extra food to save them for going down with hunger disease.

Malaria was combated with quinine, of course only if it was available in the camp. Erysipelas, pneumonia, and purulent diseases were treated with Prontosil and Cibaral, mostly smuggled in via the resistance network.

Odo Bujwid’s bacteriology lab in Kraków regularly used the underground services of the resistance movement to send in typhus vaccine for prisoners. However, there was never enough to vaccinate a large number of inmates. Those who contracted TB and the Muselmänner with starvation diarrhoea were in a completely hopeless situation. Typhus did its damndest – its death toll was enormous despite the efforts and dedication of the prisoner-doctors.

In these circumstances, with such a dearth of medicines for the treatment of infectious disease, prophylaxis and effective prevention took on a special significance. But if there were any measures in Auschwitz to prevent infectious diseases, they existed only on paper – in the paperwork for the medical reports. In reality, not much effort was made to improve the sanitary conditions in Birkenau, where the majority of prisoners were detained. In 1943, the situation in the main camp (Auschwitz I) improved, but only slightly. There was no prophylaxis at all in the form of vaccinating prisoners, neither was there any mass X-ray screening in the entire time of the camp’s operations (as I have said before). This of course was due to the criminal aim of the concentration camp system – genocide and a meticulously conducted policy of mass murder. That is why infectious diseases were “combated” with phenol jabs and mass selections for the gas chamber. These methods were applied to eradicate the pathogenic microorganisms and the infected victim in one blow. Therefore, many prisoners tried to avoid being sent to the camp hospital. Later on, another method – “delousing” – was introduced to combat typhus. The procedure involved disinfection of the premises where prisoners spent about 17 hours of the day. Stripped naked and soaked to the bone, starving and harassed, they were kept waiting out of doors for hours until the “delousing” was over. Many of the physically exhausted and diseased prisoners died in the process.

The in-camp arrangements for prisoners’ baths and the procedure itself, for example in Birkenau, was a ridiculous parody. One of the women survivors recalled such a “bath” during a cold spell. All the prisoners from the block had to immerse in just a single barrel of water, one at a time. Dr Mengele designed a bizarre method of combating scabies in the Roma camp. He ordered the construction of two water tanks. One was had a solution of sodium thiosulphate, and the other had a solution of hydrochloric acid. Inmates were forced to strip, dive into the first tank and then into the second one. The sulphur released in the process was expected to have an anti-scabies effect. Many prisoners subjected to this procedure during the winter season would later come down with other illnesses.

Prisoners with severe infectious diseases like typhus and TB were not the only ones SS physicians sentenced to death by a phenol injection or in the gas chamber. Otto Wolken recalled that Jewish children diagnosed with scarlet fever, or even suspected of it, were murdered in the gas chambers. Two prisoners with dysentery were killed in this way at an early stage of the Roma camp. During selections in the prisoners’ hospital, the SS physicians would first pick out prisoners with infectious diseases, primarily typhus and TB, and sentence them to death by phenol jab or send them to the gas chamber. So this notorious practice must have been perceived in Auschwitz as a means to combat infectious diseases.

Medical experiments related to infectious diseases

The medical experiments conducted in Auschwitz may be divided into three categories:

1) Wilful infection of healthy prisoners by injecting them with blood samples from inmates suffering from typhus,

2) testing the effectiveness of “new” typhus vaccines,

3) tests of unidentified substances (codenamed B1012, B1034 etc.) intended for use to treat typhoid, typhus, TB, or scarlet fever.

The experiments were conducted without the consent of the prisoners involved. The aim of the first type was to determine the infectious timeline of typhus and reduce the period a patient had to stay in quarantine after recovering from the disease. These tests resulted in shortening of the isolation period from three months to one month.

The tests on prospective typhus vaccines not only proved entirely futile, but actually brought on the disease. The codenamed substances Bayer’s agent Dr Helmut Vetter applied in the experiment did not turn out to be of much use and, as a matter of fact, often led to various side effects.

The experimental administration of certain substances to treat TB also gave disappointing results. According to Dr Tondos, who observed the procedure, patients involved in the tests vomited bile, and lost weight and their appetite.

Emil Kaschub, a physician and Feldwebel (sergeant) representing the Wehrmacht’s high command, also conducted experiments involving the wilful bringing about of skin infections. Photos of the patients used as guinea pigs for this test have been preserved and are currently in the Auschwitz-Birkenau State Museum.

All these deplorable facts are evidence of how SS physicians repudiated the principles of medical ethics, and served as useful instruments in selections for the gas chamber and the administration of lethal phenol injections, instead of providing medical care for patients.

A review of the morbidity rate for selected infectious diseases

If we now use the estimates for the infectious diseases presented above to calculate Auschwitz morbidity rates and compare them with peacetime data, we will get enormous differences in the figures.

A total of 3,566 cases of typhus registered in Poland for 1938 gives a morbidity rate of 11.2 per 100,000 inhabitants. For a comparison, for 405,000 registered Auschwitz prisoners there were approximately 40,000 cases of typhus, which gives an average of 10,000 cases per annum. This figure gives an estimate of the morbidity rate for typhus in Auschwitz-Birkenau, implying that in Auschwitz-Birkenau it was a thousand times the figure for the entire territory of Poland in 1938. So the claim that typhus decimated inmates is perfectly justified. These calculations can be supplemented with the 1947 data, when the morbidity rate in Poland was just 2.2, and dropped to 1.0 and lower in the following years. The mortality rate for typhus in Poland amounted to 0.6 in 1938 and fell to nil or nearly nil in the post-war years.

The estimates of 2,000-4,000 cases of typhoid which we made above for all the registered prisoners, many of whom were in fact promptly transferred to other camps, would amount for a morbidity rate of 500-1,000 per million. In 1938, the morbidity rate for typhoid was 45.5, and around 20.0 during the 1950s. The death rate for typhoid was 3.8 in 1938 and 3.3 in 1951.

The estimated number of malaria cases amounted to approximately one thousand. It must be emphasised, however, that only 316 malaria cases were reported in Poland in 1938, which gives a 0.9 morbidity rate, while the Auschwitz-Birkenau rate would be about 250 cases per 100,000 individuals. Nowadays, there are hardly any malaria cases reported in Poland and the current morbidity rate is nought.

Even this very small set of figures gives a good illustration of the scale of the unimaginable and incomprehensible atrocities Germany committed in Auschwitz-Birkenau, the largest and most sinister platform for mass murder in human history.

The original text was submitted for a Polish nationwide contest held by the Polish Medical Society for articles on medicine in German-occupied Poland during the Second World War. This article was acknowledged with an award conferred on 10 May 1970.

Author’s note: This version of the article includes amendments and supplements suggested by Irena Strzelecka, M.A., on 23 May 2010, and by Dr Franciszek Piper on 24 May 2010, 27 October 2015, and 23 March 2021.

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Translated from original article: Ptaszkowski, Karol. “Choroby zakazne w warunkach obozu koncentracyjnego Auschwitz-Birkenau”.