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Prof. Pfannenstiel - Modern war teaches hygiene

Posted: 23 May 2016, 21:19
by Scott

Prof. Dr. Wilhelm Pfannenstiel's 1944 lecture on wartime hygiene
- 2006 English translation by Fugazi for RODOH -


" Der moderne Krieg als Lehrmeister der Hygiene. "
(Modern War as a Master-Teacher of Hygiene.)

Pfannenstiel, Wilhelm, (1890-1982)

Publication: Oldenburg, Stalling,
Year: 1944

Description: 27 pages.
Language: German
Series: Bremer Beiträge zur Naturwissenschaft.; Bd. 8, Heft 2; Variation:
Bremer Beiträge zur Naturwissenschaft. ;; Bd. 8, Heft 2.
Accession No: OCLC: 14727956

~ University of Marburg

" Der moderne Krieg als Lehrmeister der Hygiene. "
(Modern War as a Master-Teacher of Hygiene.)
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The health science of hygiene has in both peace and war always the same national and social tasks. It should resolutely uncover every conceivable possibility and direct its entire strength towards keeping our armed services and the entire German folk healthy, so that their defense and performance capability is brought to the highest level.

Hygiene is still young as an independent branch of science. It is no coincidence that it was the soldierly Germany that created the first Hygiene teaching position, in the second half of the 19th century, in 1865. Its first occupant was Max von Pettenkoffer. In the introduction to his 1882- leased “Handbuch der Hygiene” Pettenkoffer declared that the scientific approach to this subject had first been taken up by the military. He saw this as a pleasing sign that his times “had correctly grasped the high economic value of health. The nature of the soldier might be proof that life is not the highest good, in that it falls to him to sacrifice his life for higher purposes, but nowhere is the value of health shown in such a bright light as by the Army, and especially in wars, where it often happens that many more lives are lost to diseases than to the enemy,

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and where armies equipped with the best weapons can lose their fighting effectiveness through poor care of their soldiers. As long as we live, health is one of life’s most valuable goods in all walks of life, and therefore the state has to care not only for the soldiers, but so far as possible for every law-abiding citizen.” This according to Pettenkoffer, who was born 125 years ago, on 3rd December 1818.

Hygiene is a preventive science. With watchful eye it observes everything that happens in the body of society and the circumstances in which we live. It seeks through its teaching to educate our people to healthier lifestyles and protect them from illness and premature death. War is in itself an enemy of hygiene. It is at the same time however – unwittingly – its hardest and best teacher. Like all of us, Hygiene is steeled by war, that requires it to double its efforts. Like us, it is in a constant struggle against the manifold injuries the enemy seeks to do us with weapons and deception.

Although war on the one hand often delays, or stops entirely, research projects that are certainly of great importance and that in peacetime would be carried out over extended periods, on the other hand it can give many research projects of military significance a powerful push forward. Some scientific breakthroughs would not have happened without war, some methods of protecting against illness never discovered, and some technical inventions in the health field never made.

I’d like to give you today a brief overview of the experiences and successes brought to the field of Hygiene by the influence of modern warfare, bringing out only the most significant from an extremely large field. You should realize that in truth

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every one of us is a beneficiary of the successes of this field of science, which as Defensive Hygiene has an effect not only on men of military age, but on the entire population. The public know little of the scientific work of Hygiene and its successes. After all, it’s not the individual person that Hygiene considers, but the entire community. The Hygienist helps no “grateful patient” back to health the way a Doctor does. However, Hygiene has kept far more people alive and healthy than a Doctor could ever hope to do. This applies above all to the struggle against epidemics.

The medieval diseases bubonic plague, smallpox, leprosy and cholera, that were often enough more decisive to a war’s outcome than luck with weapons until well into the 19th Century, have been completely defeated by Hygiene. Even their names are barely known to us today in Germany.

Bubonic plague alone claimed 26 million victims in Europe between 1346 and 1353. Even in later centuries it was so virulent in Marburg that the university had to close its doors on several occasions and hold lectures in emergency accommodation elsewhere.

Losses from smallpox were even greater, until the introduction of smallpox vaccinations. Today smallpox is knocking on Europe’s doors again. We read how people in famine-struck India, both natives and Europeans, are falling victim to smallpox in increasing numbers. The first cases of smallpox from the Middle East are seeping into Europe at the Greek-Turkish border. We’re locking it down.

Leprosy was even in the Middle Ages almost rooted out by the ruthless isolation of the victims. The few hundred Lepers I was able to visit in Athens,

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the somewhat larger group of these incurably sick people isolated on the island of Spinalonga near Crete, finally the very few cases in Memel and the somewhat more numerous Lepers among the Lapps of Norway, Sweden and Finland constitute for the majority of the European population at the most a curiosity. The plutocracy of Athens satisfied their desire for charity through maintaining these ever-deteriorating human ruins, without granting them even the boon of an activity to occupy their time.

The infection method of Leprosy still offers some mysteries. Certainly the nasal mucus of those infected contains Leprosy bacteria and is highly infectious. But a particular sensitivity to infection seems to play a part in becoming infected with Leprosy. This is proved by an unusual case that occurred on the island of Spinalonga. A healthy woman wanted to accompany her Leprosy-infected husband into lifelong exile on the island. That was forbidden to her. So she made numerous cuts in her hands and brought these into contact with the leprous pus of her husband’s sores. As she now had to be regarded as infected, she was allowed onto the island. She outlived her husband there and in the course of the years another two leprous husbands she married and bore children with, without showing to this day any sign of the disease.

As regards Cholera, this claimed many lives right up to the end of the 19th Century. For example, the British Army of the Earl of Hastings fighting in India in 1817 lost 12,000 men to Cholera within 14 days. From 1817 to 1923, Cholera repeatedly migrated from India to Europe in 6 drives. In 1866, despite the short duration of the campaign, the Prussian Army lost 6427 men to illness, only 5235 were killed in action. Here too it was Cholera that claimed the most

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victims. In 1866, including both the Army and the civilian population, 119,212 Prussians died of Cholera and 106,441 Austrians. In the great Cholera epidemic in Hamburg in 1892, 6,000 out of 30,000 people infected died of the disease.

The reports that we have of the spread of infectious diseases during the Napoleonic Wars are shocking: “Due to the huge number of troops moving through Germany, their being billeted in the houses of the civilian population and due to the economic effects of the continental blockade, after 1800 the ground was well prepared for the spread of disease. Russian armies brought with them what was referred to as “War Typhus” – this included paratyphus, dysentery and similar illnesses, but most of all typhus – to eastern Germany. The French infected not just western Germany but the whole of western Europe including Spain with this “War Typhus.” Sweden also suffered terrible epidemics. Only England remained protected from the epidemics by virtue of being an island.

“The catastrophe suffered by the 500,000-man strong army of Napoleon in Russia was completely sealed by disease. Even during an advance featuring only one battle, four-fifths of the French fell, mostly the victims of disease. There were plenty of supplies in Moscow, and the soldiers recovered again. But as the remaining 80,000 men of the French Army withdrew along the infected supply routes following the burning of Moscow, they were almost completely wiped out by dysentery, typhus and spotted fever. By Smolensk the number of those left behind with dysentery and typhus had risen to 15,000. In Vilnius at that time 55,000 deaths were counted in 6 months.”

The gathering of troops outside Leipzig brought new severe disease outbreaks. A report from Reils

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to Freiherr von Stein described the terrible conditions, arising above all from the shortage of food and hospitals:

“Leipzig, October 1813. Your Excellency asked me to report my findings on the state of the aid stations of the allied armies on this side of the Elbe to you... . In Leipzig I found about 20,000 wounded and sick soldiers from all nations. The wildest imagination couldn’t create a picture of woe in such bold colours as I found here in reality before me… The wounded men lie either in dark holes in which even amphibians wouldn’t get enough oxygen, or in windowless schools and high-vaulted churches, in which the chill of the atmosphere grows as fast as their corruption diminishes. [Trans. note: had a hard time translating that: in dem Masse waechst, als ihre Verderbnis abnimmt.]

"They lie in these places like sardines in a tin, all still in the bloody wrappings in which they were brought from the heat of battle. Of 20,000 wounded, not a single one has received a shirt, sheet, blanket, straw mattress or bed. ...Those wounded who are unable to stand must defecate and urinate where they lie, and rot in their own filth. Barrels [Trans. note: Butts - could be troughs?] are set out for the use of those that can walk, but these overflow to all sides because they aren’t taken away and emptied. In the Petristrasse, one of these barrels stood next to another barrel just like it, which had the just-delivered midday soup in it. This placing together of food with human waste must necessarily arouse such nausea as only the grimmest hunger can manage to overcome. The most gruesome spectacle of this kind was offered by the Gewandhaus. The entrance [Trans. note: Perron] featured a row of these overflowing barrels, with their unpleasant contents slopping down the stairs. It proved impossible to penetrate this cascade and enter the building from the street...

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"I close my report with the grisliest spectacle, one that chilled my limbs and paralysed my senses. I found in the open yard of the Buergerschule a mountain made of rubbish and corpses of my countrymen, lying naked and eaten by dogs and rats, as though they were evildoers and murderers.

"I appeal to your Excellency’s humanity, to your love to my King and his people, help our brave lads, help them quickly, a blood guilt clings to every wasted minute.”

We shouldn’t try to hide the fact that in this current war on the enemy side, eg in the hell that we made for the Poles in the encirclement at Kutno, the conditions in the Polish first aid stations weren’t much different.

Until the mid-19th Century, in all wars the losses caused by illnesses were on average 6 times as high as those caused by weapons. Only in the war of 1870/71, for the first time the history of the world, was the number dead through illness lower. It came to only half the number killed in action. In the World War 1914/18 the fatalities from illness were only a tenth of those caused by weapons.

The late Tropical Hygienist Muehlens said about this: “If there was any winner of the World War, it was the doctors and hygienists and their loyal assistant staff. By their efforts, they saved thousands upon thousands from illness and death through disease.”

In the World War, the German Army, and above all the German people, remained as good as completely protected from great epidemics. The reason for this astounding fact lies therein that already before the War, particularly through the scientific work of predominantly German researchers, particularly Robert Koch (whose 100th birthday we

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celebrated on 11 December 1943) and his students, the most important infection agents had been discovered, and their methods of transfer and the possibilities for fighting them identified. Then, thanks to the scientific work carried out in field experiments or in the infectious disease departments during the War, there was a whole series of further discoveries of infection agents and vectors. Paul Uhlenhuth, the winner of the first Behring Prize, found the infection agent for Weil’s disease, (a spirochete carried in water polluted with rat droppings, that can transfer to humans in the hot summer months). Weil’s Disease is keeping us busy again right now in southern France, where it was caught by soldiers who bathed in the rivers even though the local civilian population had warned them that swimming there in the hot season would make them sick. Further [to the discoveries made by WW1 - translator], it was also established that people could be infected with classical typhus or trench fever just through the faeces of infected clothing lice. Out of this grew the requirement to develop practical delousing stations, that act as a filter and certainly kept this war disease from spreading into the area of the Reich. Some researchers didn’t survive their study of Typhus, eg the Marburger student of Emil von Behring, Paul Roemer. The recognition that European relapsing fever, which is also carried by lice, could be cured by the same Salvarsan used against syphilis, saved the lives of thousands of Turkish soldiers, who were treated with this product by our current Tropical Hygienist, Prof. Dr Rodenwaldt, in the Military Medical Academy.

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A series of bacteria found in earth and faeces were also newly discovered in the First World War, that can cause gas gangrene and similar serious wound infections (when they get into open wounds). Here the war undoubtedly advanced bacteriological research. The knowledge achieved was of the greatest usefulness to the army.

However, there were still diseases and illnesses that man hadn’t mastered. The most important of these was dysentery, which would have to be called the “real war disease of the World War.” If anything, this increased rather than decreased during the war and maintained its high death rate. Amoebic dysentery also caused significant losses, which were so high among the British at Gallipoli that they contributed to the giving up of this Churchill-directed invasion.

Typhus and dysentery, along with sexually-transmitted diseases and malaria, are the diseases that also cause us the most trouble in the present war. In peacetime we didn’t need to fear the outbreak of great epidemics any more. But in that moment that we crossed the borders with our armies, we entered territories in which (as already in Poland) there was nothing to see of active preventative hygiene. The contact with the stuff of illness first took place here. And with the rising number of carriers of the bacteria or viruses that remain healthy, the diseases were brought into the pre-existing Reich territory.

We must therefore as a first line of defence, seek to prevent contact with the foreign illnesses through prophylactic hygienic measures. As well as that, we have to keep our soldiers and the entire medical personnel as far as possible free of the disease-causing agents, so that the fewest possible losses through illness are suffered. It’s impossible to calculate how many million freshly-wounded soldiers’ lives have been saved just by preventive

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serum injections against tetanus. Today we have vaccines that by their injection (eg, on joining the Wehrmacht) most likely will make the soldiers resistant to Tetanus their whole lives. This war has also brought about great advances in the creation of vaccines against typhus and dysentery. Vaccines against typhus have been developed from louse digestive systems, chicken eggs and the lungs of rabbits and mice, and manufactured in huge quantities in big newly- built institutes, eg in Krakau and Lemberg. Those vaccinated may not be protected against falling ill from typhus, but are fairly well protected against dying from it. The cases of other types of typhus occasionally observed in southern Greece that, like the so-called “Murine” typhus, carried in the faeces of rats or their parasites, or the so-called “Tick Typhus” carried by the brown dog tick, are transferred to humans, are despite a high fever much less dangerous than the “classical” louse typhus. Here people are best protected by banning the troops assigned to these areas from keeping dogs, which can also transfer other tropical diseases to humans.

German medical research is also on the way to developing equally effective vaccines against dysentery. By far the most important thing in the fight against dysentery is the effective disposal of human waste, and ensuring that flies don’t get any opportunity to transfer the dysentery bacilli from human faeces to food. This must above all

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be taken into account when building latrines. The East African campaign brought us the in this respect extremely useful smoke latrine, and the present war the Bohrlochlatrine, which pretty much rules out transfer of illness from faeces. [Trans. note: “A Bohrlochlatrine was essentially a pit bored in the ground measuring 1 meter wide and 3 meters deep. Quicklime was normally added periodically to help break down the waste material. A base slab usually of wood with built in squatting hole and lid covered the top and usually the top of the latrine was built up to prevent surface water from entering. As long as the hole remain less than 2/3 filled, it provided for adequate sanitary conditions by preventing flies from carrying fecal matter to food and water sources. Once a latrine of this type was 2/3s filled, it was closed and a new one sunk.” Definition courtesy of Tommy303 on Axis History Forum.]

We also have effective new vaccines available against the plague, which is endemic east of Rostov and in the Caucasus. This war has also brought us new information regarding the epidemiology of the plague, which is carried by the parasites of rodents (not only rats but also mice) and transferred by these intermediaries to humans. This information has proved its worth as our troops entered plague-infected areas. So far not one soldier has fallen ill with the plague.

The vaccinations carried out across the whole Wehrmacht have almost completely removed the threat of typhus, paratyphus and cholera for our soldiers. Thanks to progress in the area of war hygiene we hardly need to fear these diseases of the uncivilized at all. However tularemia, a disease of rodents first recorded in the Californian county of Tulare, which is related to the plague and like it is carried over to people by the rodents’ parasites, has made the acquaintance of no small number of our soldiers (particularly early in the year, when the stacks [Trans. note: Mieten] are opened and the countless mice that have wintered over in there flood out). Fortunately tularemia is, unlike the plague, a harmless disease.

On the other hand, we’re still in a great struggle against the so-called diseases of civilization, above all the flu, which in 1918 claimed 20 million victims worldwide, but also against diphtheria, scarlet fever, cerebral meningitis and

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polio, that occasionally spring up in larger or smaller epidemics, particularly among the recruits in training.

This war fought in the farthest-flung areas of Europe and in Africa has already brought us new discoveries about foreign diseases almost unknown in the areas of the Reich, including how to protect against them. For example, we’ve been able to substantially improve our equipment for combating various tropical diseases, in particular malaria, in recent times.

I’d like to discuss the experience we’ve acquired during this war in protecting against malaria a little more closely. After the sandfly fever whose virus is carried by small, so-called “Aderlassmucken” (phlebotomes) and causes – even if only for a few days at a time – the most days lost through illness among the troops, malaria is the most common and most serious of the illness in the southeast region, which I visited recently. Just how heavily the civilian population there is infected with malaria, thereby providing the carrier mosquitoes the opportunity to infect themselves with the virus, is shown by findings of the so-called Spleen Index and the rate of parasite infection among 100 children from each of a number of malaria-infected villages. I was able to establish for myself that in the Wardarebene villages in Macedonia often over 80 out of 100 examined children had greatly enlarged spleens, showing that they’d survived a case of malaria, and in many cases parasites could still be found in their blood. The degree of infection of an area established by these annually-repeated investigations determines the intensity of the necessary sanitation measures.

The total number of days lost through malaria infection among the troops fighting in the Balkans is still considerable. However, in the First World War, the number of days lost through malaria

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was far higher. For example, among the German units stationed in Turkey the rate of infection was six times that of today. Of the three kinds of malaria, cases in the Balkans are made up of malaria tertiana in about two-thirds of cases, and malaria tropica in about one-third. Apart from isolated cases in Dalmatia and on Crete, malaria quartana is not to be observed in the south-east region.

South of the 43rd parallel, which connects Dubrovnik on the Adriatic with Burgas on the Black Sea, malaria tropica is endemic due to the increasing warmth. Crete is well-known to lie far south of the African coast in the region of Algiers and Tunis. The sexual development of the tropical variety of the malaria- carrying mosquitoes, which are known as anopheles, or pest, requires higher outside temperatures than is the case with malaria tertiana. In the northern parts of the south-east region, cases of tropica occur only when brought up from the south, without causing great epidemics.

The latest research has shown that there are very significant differences in the course of the illness and its ability to be influenced by treatment between the two types of malaria. The tertiana parasites seem to be capable of going through so-called endothelium stages that resist the influence of all our medication. They only cause the outbreak of fever when they come out of this endothelium stage into the blood, and can then be fought with Atebrin and Plamochin, these excellent German pharmaceutical products specifically developed to treat malaria. This is why someone infected with this illness doesn’t necessarily suffer fever outbreak after a particular incubation period, but often only in the next spring, at a time when no mosquitoes are swarming at all. The relationship of the

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early summer to the late spring infections is about 1:1. We can now explain why there are malaria outbreaks in the Balkans throughout the year. During the swarming time of the anopheles in the malaria-infected areas though, it’s hard to establish whether individual infections are new infections, late manifestations or relapses.

Because malaria tropica doesn’t seem to go through endothelium stages, this in itself much more dangerous form of malaria is therapeutically much more treatable. Our wonderful German medicines have largely taken the horror out of malaria tropica, which caused countless deaths of soldiers in earlier wars.

The aim of the fight against malaria must be to interrupt the life cycle, that goes from being stung by an infected mosquito and the development of the malaria illness, to the taking in of the malarial virus again by non-infected mosquitoes, which can then infect other people.

In the struggle against larvae and mosquitoes as most important measure, in which the new chemicals from I.G. Farbenindustrie A.G. have replaced the previously-used larvae poison Schweinfurter Gruen and has been sprayed over wetlands in the East (including from specially modified aeroplanes) with great success, as well as in our developments in mechanical protection against mosquito bites, and finally in preventive pharmaceutical treatment, this war has already again been an excellent teacher. Even though preventive pharmaceutical treatment by itself can never guarantee that an individual in a heavily infested area won’t lose his operational readiness long-term through malaria, it still seems that a conscientiously-followed preventive course of Atebrin medication can see to it that

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the whole fighting unit isn’t struck down at once and combat operations forcibly interrupted, as it was with the outbreak of Dengue fever, carried in from the Orient 15 years ago, that infected almost the whole population of Athens and brought all traffic of all kinds to a halt, both on land and water, because the fever victims couldn’t stand or walk for three weeks due to heavy joint pain. In earlier campaigns in the Balkans and the Orient, eg in the Crusades, such catastrophes actually occurred, caused not at all by Dengue fever but simply by malaria, so that the troops coming out of malaria-infested areas, without any contact with the enemy to speak of, were defeated by the disease and had to give up the war. We no longer have to fear such an outcome, now that every man deployed in the Southeast swallows his prescribed dose of Atebrin daily. The experience gained in the First World War and being gained right now, as well as the new scientific knowledge achieved between the wars in the field of Geo-medicine, put us in the position of being able to keep the infection rate among troops well equipped for the tropics in the Southeast regions that are home to this disease, well within acceptable limits, as long as the proven preventive measures are conscientiously followed.

Other illnesses appearing again in the war present medical science with research problems still to be solved. This goes above all for a disease increasing in any case, hepatitis epidemica or infectiosa, a liver infection mostly associated with jaundice, which (beginning in late autumn) through the winter months troubles people all over Europe, as well as for the so-often appearing

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stomach ulcers and for the mysterious loss of teeth sometimes suffered by our soldiers in the far north, without vitamin C deficiency seeming to have anything to do with it. A special study commission, also including our Marburger Professor for Dentistry, Prof. Dr Fliege, is working right now to make clear what’s happening here. However, thanks to the constantly increasing discoveries in the field of disease prevention that modern warfare has brought about, casualties occurring in the Wehrmacht through disease have become vanishingly small compared to the victims of the ever-increasing destructive power of weaponry, now even among the civilian population.

Even the approach of the modern Doctor to Hygiene has undergone change through the present war. While in the wars of the Middle Ages and early modern times into the 19th Century, the feldscher or surgeon mainly took care of the wounded and preventive medical care of the troops was almost completely nonexistent, today every military doctor has become a Hygienist. The military doctor is responsible for the health care of the men entrusted to him in every aspect. He must constantly oversee their accommodation and camps, their food supply including drinking water, and much more. Like the factory doctor with the worker, the military doctor should know and be able to judge the capability and performance of every single one of the soldiers entrusted to him. All unnecessary losses must be avoided, and among the unnecessary losses are without doubt those occurring through incorrect application of equipment, inappropriate equipment and poor nutrition, as well as avoidable illnesses and diseases.

When at the beginning of the War of 1870/71 30,000 men, that’s the strength of an Army Corps of the time,

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fell completely out of combat with foot problems, just because of inappropriate footwear; when the French Army, which wasn’t vaccinated against smallpox, lost 75 times as many soldiers to smallpox as the vaccinated German Army; when in the World War cholera caused among the non-vaccinated troops of the Austrian Army, which at the time rejected vaccinations, from the beginning of the war to the end of July 1915, when they began vaccinating, 29,939 infections of which 8850 victims died, and of whom hundreds in northeast Hungary were simply thrown onto the railway tracks from the fully overcrowded trains during the frantic retreat from the Russians; when the Serbian Army already by the end of September 1914 had 12,000 cases of cholera with 200-300 dying of it daily; when through poor organization the development of the large areas of agricultural land that had become accessible in the course of the war in eastern Europe by 1917/18 was unsuccessful and starvation struck our population, with all its consequences, eg a three-fold increase in tuberculosis: all these were failures in Hygienic armament that should have been avoided. We have learned our lessons from these failures.

In this war we’re very differently armed, and are constantly working to improve that armament. In the field of Food Hygiene the war has again presented us with completely new tasks. The winning of good drinking water from any available, even very dirty water source, possible with the help of the Army drinking water preparer. The process removes all silt and slime and filters out finer silt and bacteria including their spores. Intestinal diseases and intentional pollution of the water, eg with anthrax spores, can be secured against using the easily-transported Army water preparer. It has an output of

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2000 liters of good drinking water per hour, while the Tornister filter can still remove bacteria from 300-400 litres of water per hour.

As concerns the production of concentrated biologically valuable food and preserves, this war has created completely new processes. These have become even more necessary, as unlike in earlier times, the combat troops in enemy territory today can’t feed themselves from the food supplies available there, in fact more often they have to bring their entire food supply with them. It’s obviously due to a shortage of transport tonnage that the Anglo-Americans can’t do the same themselves, otherwise there wouldn’t be such hunger in India, Africa, southern Italy, the Middle East, in almost every area occupied by their troops. Moltke said once that a war is already lost with the first cannon shot, if the preparations for a good and sufficient food supply for the soldiers haven’t been made. I believe that our troops, now in their fifth year of war, can’t complain about poor rations on any front – apart from emergencies that enemy activity can occasionally create. We even go to the trouble to see that familiar German food is also provided in enemy territory so far as possible. However, that’s often only possible through the issue of conserved German food. So I managed, through years of work together with a master baker in Marburg and paper manufacturer in Minden, to produce a conserved bread that differs from the usual mess hall bread at most through its particularly grainy flavour, and that can remain fresh and flavoursome through years and days in its paper wrapper, even under tropical conditions – without even the slightest change in its Vitamin B content. The freezing and drying

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processes have also undergone unforeseen progress in the war. In this the war was everywhere a teacher.

Progress in technology has added new, special tasks to the general tasks of military hygiene. Our new weapons, aircraft, submarines, tanks, as well as modern methods of warfare, which unlike in earlier times hardly take geographical, climate or weather conditions into account, force our soldiers to fight under circumstances that at first appear unbearable. When, despite that, success is achieved through training and skillful exploitation of every possible measure in overcoming seemingly impossible problems and, even under completely unaccustomed conditions, health and performance can be fully maintained, this is in good measure due to the untiring work carried out in the laboratories and teaching rooms of the homeland as well as the practical experience of the Front.

For example, the need for ever-stronger growing performance in flight operations brought a new science into being, which because of its preventative character is tightly bound to Hygiene: Flight Medicine. Germany is leading the world in this field. One sign of that is that even enemy countries are using our flight medicine textbooks for their training. In all German technical colleges, flight medicine (for which I’m the teaching specialist in Marburg) is a compulsory subject. Aircraft technology is constantly making progress. The aircraft are reaching ever-greater heights and speeds, despite increased bomb or cargo capacities. Today we can already predict that the time isn’t far off when we’ll be able to safely fly through the stratosphere and reach flight speeds that match the speed of sound.

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If the technical improvements are subject to physical limits, eg the maneuverability of our fighters at high speed, the physiological limitations of human capability are a lot narrower. For example, the capability of our aircraft to suddenly pull out of a dive, and the forces generated by aerobatics, which air warfare often demands, have reached such a level that making full use of them would generate centrifugal forces that would kill the aircraft’s occupants. Aeronautical medical research has already taught us how to bear sudden deceleration forces that can raise our body weight 20-fold in a moment, through proper posture [? Trans. note: zweckmaessige Haltung] and other measures.

At an acceleration of 7 ‘g’, a 7-fold increase in body weight, gravitational forces make the blood as heavy as iron. At 20 ‘g’ the weight of a man increases from 85kg to 1700kg. And yet we’ve succeeded in getting men to bear not only this but even stronger accelerative forces, without damage to their health. It’s clear that these kind of experiments, which can be carried out not only in aircraft but also in purpose-built centrifuges, are of great value for maintaining the health and performance of our dive bomber crews, paratroopers and airborne troops. We’ve also made great progress in dealing with the effects of altitude, with its triple dangers of low air pressure, oxygen shortage and cold. In compression chambers we can research these factors alone or together in their effects on animals and people. The human centrifuge for the study

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of the effects of acceleration complements the modern compression chamber with climate control apparatus for laboratory research of altitude effects.

Through systematic training, which apart from the compression chamber can include breath training, sport and above all long periods spent on high mountains, individual members of the German Nanga-Parbat Expedition were able to endure low air pressures without artificial oxygen supply, that correspond to an altitude of 10,000 meters. That is far higher than the highest mountains on Earth, for which successful climbing attempts, even without oxygen tanks, are only a matter of time. Apart from the compression chamber, the effects of oxygen shortage can also be studied by breathing an oxygen-nitrogen mixture, in which the oxygen can be regulated to match different altitudes. For example, we’re conducting experiments at the Marburg Hygienic Institute that have the aim of increasing the altitude capability, ie the ability of untrained people to cope with oxygen shortage using medication already proven to be effective using animal testing, eg Vitamin B and C.

Finally, as regards the effects of cold, which our aircrews are exposed to in flight at the great heights demanded by fighter defence, and also our soldiers operating in the far north and in the Soviet winter, the great master teacher War has brought us likewise completely new knowledge. We can stay healthy and capable of working at degrees of cold that would in earlier times have made any form of combat impossible. Heated flight suits and winter combat clothing for the Wehrmacht and Waffen-SS is continually improved on the basis of practical experience and are even now being developed further. To rescue someone from

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freezing to death, it was earlier believed victims must be warmed only very slowly and carefully. This incorrect assumption cost some soldiers their lives. The results of animal testing, which have been proved in practice with people, have shown that in these cases only the quickest application of high levels of warmth will save lives.

At the other end of the scale, medical science has also found methods to cope with high levels of heat, as experienced in tanks, sometimes in U-Boats and for extended periods when fighting in hot countries, without damaging health or combat ability. Through appropriate measures, particularly regarding nutrition, it’s possible today to obtain nearly the same performance even in the Tropics as in our temperate climate.

I could easily provide more examples that show us in how many respects the war has brought progress in preventive medicine and accident prevention. For every weapon a corresponding hygiene has been developed. Next to the air weapon hygiene we can already speak of a U-Boat weapon hygiene. The sanitary arrangements inside our mighty fortress installations that protect Europe from enemy invasion have also experienced constant improvements, which keep their occupying troops healthy even during enemy attack.

But modern warfare has brought new teachings not just for our armed forces, but for our whole population. Although in earlier times the work of war was carried out mainly by soldiers, this century has introduced total war. Even in the First World War 1914/18, 10% of the total population of Germany, 20% of the male population and 35% (ie more than a third) of all German men

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over the age of 20 were under arms. Today all citizens, even the women, and youths of both sexes, are active participants. Almost the entire population is working with all its strength to achieve the victory that will secure us a lasting peace.

We can’t allow ourselves to begin working on military hygiene only when war has already broken out. Rather, it has its tasks to carry out in peacetime that are as important as any other form of armament. Frederick the Great once said “Setting everyone in the right place means double advantage from all.” In the carefully-worked-out medical examinations to establish suitability for military service in the Waffen-SS and the three arms of the Wehrmacht, results have been achieved that benefit the entire population. I’ll mention here only the medical examination of lungs and hearts of the workforce by the X-Ray Unit of the Waffen-SS, through which many a beginning Tuberculosis or heart disease was uncovered and able to be treated in time. The total war that we’re fighting for the life of Germany and therefore the future of Europe, demands the application of every individual in the place where his abilities and education promise the best performance.

The physical examinations, not only in health terms but also racial/genetic, have been widened during the course of the war to cover able and gifted youth of both sexes and all walks of life. So, during the war, Reich Genetic Selection Camps [Reichsausleselager] were created by the Reich Youth Leadership [Reichsjugendfuehrung] together with the DAF, in which continuous examinations of all gifted working youths, more recently also returned war invalids, are carried out in a process developed by me in combination with the SS-Aufnahmeuntersuchung

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and proven many times over.

The war forces us not only to carry out military service medical examinations, but to subject the entire German youth to such fitness tests. The protection of the health of the entire working population requires the prevention of much sorrow and sickness, and through that to protect social welfare, which is particularly stressed by the effects of war, from avoidable extra tasks.

Modern war also makes us conscious not least how decisively important all health-related measures are for defensive capability. Military service brings to a conclusion the pre-military education carried out by the Hitler Youth and SA. The making of a soldier is, as thousandfold experience teaches, absolutely and closely tied to a strengthening of his health that no school in the world would be able to achieve. No one can doubt that military training is even in the spiritual sense health-promoting. After all, the soldier is trained up to what we might call the “complete guy.” Therein see we Germans the physical, psychological and spiritual, ie character-wise, highly-developed person, the ideal type worthy of striving towards, such as the Greeks described with the words kalos kagathos, ie well-formed both on the inside and the outside.

The Front and the work in support of it forms such complete guys. It is they, the ones who set their lives on the line for Germany, who must be protected from every avoidable harm that war brings with it. In earlier times, war always brought with it those other two riders of the Apocalypse: Pestilence and Famine. Hygiene has to a large extent banished both. We can confidently assert that the health care of our armed services, and our whole German people,

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even in this fifth year of war, is unmatched in the entire world, thanks to the continual successful disease prevention measures as well as the planning of food distribution by the National Socialist state. The [science of] Hygiene can take pride in having significantly assisted the state in these successes, true to the concept of its old master, Pettenkofer.

We fight today for our existence, for the future of our children, which will only be secure when we create for ourselves a place in the world that our creative nature, our high performance and our position as the best and largest people of Europe warrants. We know today that even after victory has been achieved, this people will only be able to achieve ever-greater cultural creativity if it avoids allowing its spectacular performance to run down its health. If the National Socialist state can succeed in maintaining work performance and health care through bringing the natural rhythm of effort and relaxation into balance, the victorious German people will be not only the strongest, but also the happiest people on Earth.

And what is valid for the entire population is also valid for the individual. Each of us, whether active in the violent struggle of the front or deployed on the home front, has the sacred duty to everything to keep himself healthy and fit for work, and to avoid everything that might damage his health. For this reason he must concern himself with the results of hygiene research as much as the state does. The liberal view, that it must be left to the individual how he lives his life, is even less valid in the present time, as we simply can’t afford to allow the unavoidable victims of war to be increased by avoidable victims of unhealthy lifestyles.

If we want to keep our German people healthy and after the victory bring them to new achievements and growth, we mustn’t restrict ourselves to healing the countless wounds that the war has brought us and will yet bring, but instead prevent anything that can damage our physical and psychological health and through that hinder our work and the reconstruction of Germany. The healthier and the quicker this can be achieved, the less vulnerable we’ll be in the future, and the more secure will be the fruits of our victory.