Eighty years ago, deep inside a Warsaw ghetto cemetery, Israel Milejkowski gathered fellow physicians with whom he co-authored a clandestine “hunger disease” study.
“What can I tell you, my beloved colleagues and companions in misery. You are a part of all of us,” said Milejkowski, a member of the ghetto’s Jewish Council and the head of its health department.
During the previous summer, many of the secret group’s 23 members had been “resettled,” a German euphemism for murder in the gas chambers of Treblinka.
“Slavery, hunger, deportation, those death figures in our ghetto were also your legacy. And you, by your work, could give the henchman the answer ‘Non omnis moriar,’ [I shall not wholly die],” said Milejkowski, whose specialities were dermatology and venereology.
Most of the physicians were highly regarded heads of hospitals or university departments. Shortly after Milejkowski placed his foreword atop the group’s six surviving manuscripts, the precious documents were smuggled into “Aryan” Warsaw and buried in a hospital cemetery.
Unearthed after the war, the manuscripts made their way to the American Joint Distribution Committee, which compiled them into a book initially published in French. One of 1,000 copies sent abroad was mailed to Tufts University in Massachusetts, where it was put in a file more than seven decades ago.
Last year, Tufts University’s copy of the book — published as “The Disease of Starvation: Clinical Research on Starvation in the Warsaw Ghetto in 1942” — was rediscovered in campus archives by assistant professor Merry Fitzpatrick.
With expertise in the role of famine in conflict zones, Fitzpatrick had been looking for extreme examples of starvation when she came across the crumbling book.
Study criteria implemented by the ghetto physicians included that patients have no other illnesses than “hunger disease.” One group of patients was children aged 6 to 12, and another was adults aged 20 to 40. In total, 100 patients were enrolled in the study.
After patients were confirmed to have “hunger disease,” observations were made in areas including metabolic systems, blood morphology, cardiovascular output, etc.
Some of the research overturned assumptions held in medicine, including the role of vitamins compared to minerals in malnourishment, while other pioneering research could have prevented the sudden death of many starved survivors who were “re-fed” too quickly after Liberation.
‘The most widespread disease’
Officially, German rations allowed each ghetto inmate 180 daily calories, or less than one-tenth of the daily calories needed to remain healthy. Unofficially, the ghetto’s children made herculean efforts to smuggle food into the open-air prison, thereby mitigating the famine for some inmates.
Imprisonment in the ghetto was intended to be a slow-motion death sentence for hundreds of thousands of Jews. The starvation study physicians understood this German strategy before beginning their research.
“The Disease of Starvation” includes dozens of research charts and data sets, while also making space for graphic photographs of patients starving to death.
In one photo, physician Anna Braude-Heller, director of the Berson and Bauman Jewish Children’s Hospital, is seen examining a starving child. Braude-Heller — whose hospital hosted some of the research — is wearing a white physician’s coat and a forlorn expression.
In some ways, “The Disease of Starvation” was a medical version of the so-called “Oneg Shabbat Archive,” a vast collection of primary sources about life in the Warsaw ghetto, buried in 1943 and retrieved after the war.
Milejkowski was interviewed by “Oneg Shabbat” volunteers, wrote Warsaw ghetto historian Samuel Kassow, but there is no evidence Milejkowski knew about the larger documentation project, which was also clandestine.
“Jewish physicians and professors are conducting scientific investigations,” wrote “Oneg Shabbat” founder Emanuel Ringelblum in his diary on June 26, 1942.
“One of the most interesting subjects is hunger. Interesting because it is the most widespread disease in the ghetto,” wrote Ringelblum.
‘Death stares into my room’
In framing the research compiled in “The Disease of Starvation,” Milejkowski said the first phase of the study was conducted between February 1942 and that summer. During this period, life in the ghetto was marked by “mass starvation.”
The study’s second half started with the summer 1942 deportations and was characterized by “mass death,” wrote Milejkowski.
“It is also not surprising that with the second period, work on the starvation [study] was interrupted: hospitals, workshops were destroyed, and most importantly, scientific medical work — human material — was destroyed,” wrote Milejkowski.
In his foreword to the manuscript, Milejkowski wrote about his anguish watching the ghetto population starve against the backdrop of mass “resettlement” actions, which most Jews understood to mean death.
“The torture of words, I have never felt it as strongly as now when I have to write an introduction to this work,” wrote Milejkowski, who was likely murdered at the death camp Treblinka in 1943.
“I hold my pen in my hand and death stares into my room,” wrote Milejkowski. “It looks through the black windows of sad empty houses of deserted streets littered with vandalized and burglarized possessions.”
‘A major building block’
Imprisonment in the ghetto afforded the physicians an unasked-for — and unprecedented — opportunity to conduct research that would outlast them.
In one discovery, the physicians demonstrated the body’s extreme “adaptation for vitamins.” Despite being starved, patients maintained relatively normal levels of vitamins by the bones “mining” themselves for those elements.
In another finding, physicians determined the body will shut down the immune system before other systems during starvation. Tuberculosis was rampant in the ghetto, but children stopped testing positive for antibodies, because their bodies had deprioritized creating immune responses.
According to medical experts, the research into immune responses in emaciated children has relevance for HIV prevention. There were also findings for ocular science, micronutrition, and bone health.
One metabolic and circulatory finding that could have saved thousands of lives was about the importance of not “re-feeding” emaciated people too quickly.
After Liberation, the rapid “re-feeding” of emaciated people led to the failure of already weakened circulatory systems and — in tens of thousands of cases — heart failure and death within 72 hours of being fed.
“Some of the findings were lost, but what remains is still the most extensive investigation of starvation ever carried out,” wrote physician and nutrition professor Myron Winick in 1979.
“The physicians described the clinical findings in such detail that their description remains the clearest to date,” wrote Winick, who published a book about the Warsaw ghetto physicians.
“[The study] remains a major building block in our understanding of the effects of severe malnutrition on both adults and children. But it is more than that. It is a glimpse into the character of some of the physicians in the Warsaw ghetto,” wrote Winick.
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