Hunger, along with other diseases and extreme overcrowding, was among the dominant experiences of Jews confined to the Warsaw Ghetto.  Official food ration cards failed to ensure even the biological minimum of existence.  According to Jewish Council statistics from 1941,  exhaustion due to hunger was the most frequently diagnosed cause of death.  The worst situation was in the refugee shelters, where death due to starvation took its daily toll.

Chronic starvation caused conditions previously unknown to medicine. In the extreme conditions of the ghetto, when effective help to the sick and dying was practically impossible, Jewish doctors decided to use the terrible laboratory, of which they themselves became a part, for the benefit of medicine and future generations. They wanted to turn the helplessness they faced every day into action.  "People with no tomorrow, with the last effort of will and brain, have decided to make a modest contribution for tomorrow" - reads in the introduction to the post-war publication of the results of their research.

The initiative to conduct comprehensive clinical research on the effects of extreme hunger on the human body came from the chairman of the Departments of Health and Hospitality of the Jewish Council, dr Izrael Milejkowski. The patronage was taken by the chairman of the Judenrat, Adam Czerniaków, and the chairman of the Economic Council, Abraham Gepner.  The work was subsidised by "Joint".  Thanks to that support, it was possible to purchase the missing laboratory equipment.

In November 1941, the Organisational Committee was established, the members of which, apart from dr Milejkowski, were the director of "Czyste" Hospital, Józef Stein, the director of the Bersohn and Bauman Children's Hospital, dr Anna Braude-Hellerowa, dr Emil Apfelbaum and dr Julian Filiederbaum, who became the scientific director of the entire project.  The actual clinical trials began in February 1942.

The patients usually came from among those dying of starvation in refugee points and quarantines, which, contrary to appearances, was not easy.  This is because they had to represent "pure" cases of the starvation disease, without additional conditions or complications.  They were placed in special hospital rooms, where they were observed and subjected to various medical tests and treatments.  Attention was paid to physiological and biochemical changes in the body due to prolonged starvation. In "Czyste" hospital, in the ward managed by dr Apfelbaum, studies were conducted on adult patients (20-40 years old), and in Bersohn and Bauman Children's Hospital - on children from 6 to 12 years old.  The team of doctors that took part in the studies on the hunger disease consisted of more than 20 people.  Obviously, the Germans were not aware of the conducted research.

The tragedy related to the studies on hunger disease was that it could not be used to save the health and life of the sick. Paradoxically, the full picture of the effects of the disease, supplementing clinical observations, was obtained only after an autopsy of the deceased patient.  Almost 500 such autopsies were performed.  What the research could offer the patients was to prolong their lives.  In the hospital, they received nutrition of up to 1,100 kcal, which they would have been deprived of at the refugee points.

The progress of the research was discussed at monthly seminars convened by dr Milejkowski.  The preliminary results of the project were presented at a meeting attended by Adam Czerniaków on 6 July 1942.  The great liquidation of the Warsaw Ghetto, which began several days later, interrupted the clinical research and caused the break-up of the research team. Some of its members died in the gas chambers in Treblinka.

In October 1942, in the residual ghetto, the members of the scientific team who survived the action began to prepare typescripts of scientific articles. Dr Milejkowski, who was killed during another action organised by the Germans in January 1943, managed to write a foreword to a planned scientific publication.

In the spring of that year, as the final liquidation of the ghetto was expected, the preparation of materials for publication was accelerated.  Before the outbreak of the April Uprising, one copy of the typescript was hidden in the Jewish cemetery. The second typescript was handed over to prof.  dr Witold Orłowski. The eminent physician, called the father of Polish internal medicine, whose students were, among others, dr Apfelbaum and dr Fliederbaum, had already conducted research on hunger disease.  Following the request of  prof. Orłowski, his son Tadeusz, a student of the clandestine Faculty of Medicine at the University of Warsaw (an outstanding doctor-transplantologist later on), hid the manuscript at the Hospital of the Infant Jesu.  That copy, found after the war, became the basis for the publication of the results of the research. The second copy, hidden in the cemetery, got lost.

The work "Hunger Disease. Clinical research on hunger performed in the Warsaw Ghetto in 1942" was published in 1946 in Warsaw by the Joint American Distribution Committee under the scientific editorship of dr Emil Apfelbaum. He was one of the few members of the research team who survived the war but died just before the book was published.  The work consists of six chapters: "Pathological anatomy of hunger disease", "Observations of starving patients", "Clinical picture of starvation in children", "Clinical studies on the pathology of the circulatory system in starvation cachexia", "Blood picture in starvation", and "Eye disorders in chronic starvation". The death of the authors prevented the production of four additional planned chapters, which were to deal with studies of bone marrow, skin, blood coagulation in starvation and anatomical studies of hunger disease in children.

The pioneering research conducted by the doctors from the Warsaw Ghetto has no equivalent in world medicine. Already in 1946,  a French translation of The Warsaw Ghetto Hunger Study was published. The English edition was not published until 1979.

Krzysztof Persak

References

• Ciesielska M., Lekarze getta warszawskiego, Warszawa 2017.
• Hunger Disease: Studies by the Jewish Physicians in the Warsaw Ghetto, ed. M. Winnick, New York 1979.
• Janczewska M., Badania nad głodem w getcie warszawskim – problemy etyczne, "Zagłada Żydów. Studia i Materiały”
• Massry S.G., Smogorzewski M., The Hunger Disease of the Warsaw Ghetto, "American Journal of Nephrology” 2002; 22: 197–201.
• Szarota T., Jak zabija głód, "Gazeta Wyborcza” – "Duży Format”, 17 II 2009.
• Tushnet L., The Uses of Adversity: Studies of Starvation in the Warsaw, New York and London 1966.