An M.O.H. with second army

PUBLIC HEALTH, May, 1947 AN

M.O.H. W I T H S E C O N D A R M Y ~ By F. R. WALm~ON, M.D., D.P.H.,

Medical Q~cer of Health, Metropolitan Borough of Greenwich You will remember that in 1942, following representations from the Central Medical War Committee, some of us were released to the Services. Accordingly, I woke up disguised as a " Lieutenant on probation " at Boyce Barracks, Aldershot, on my 38th birthday in January, 1943. There were blisters on my heels, my arms showed tumor, tuber, and m u c h " dolor" (inoculation needles were reputed to be stored in the dust-bins) : in fact, a happy birthday ! I n January, 1944, having laboured at all parts of the military machine--I learned what A.C.I.s were, and the subtleties of difference between the salute one gave to a Field Officer and one's A . D . M . S . - - m y third " pip " went up. Normandy to Germany I n June, 1944, the tide of war deposited me with " rude and licentious soldiery " complete in " Christmas .tree" on the sands of Normandy. Speedy translation to hygiene duties followed an apparently unsuccessful venture as R.M.O., and, propter or post hoc, promotion to an acting majority and command of the Field Hygiene Section in the l l t h Armoured Division. T h e proud possessor of this Divisional sign basked in the reflected glory of its exploits. Anyway, Monty once shook hands with me in Holland because I wore it 1 T h e chap from whom the unit was taken over, an old campaigner, told me there was only one golden rule---" Whatever happens, never get off the ' Charley L o v e ' " (Centre Line or axis of advance of a mobile formation). Travelling with this Division the opportunity was afforded me of humble acquaintante with some truly great men of all ranks, too many of whom remain by the " Charley Love" between Normandy and the Baltic. I n retrospect, Normandy evokes poppy-spattered cornfields, orchards, and battered villages; dust, diarrhoea, mosquitoes, and refugees. O n this background there was (to my unmilitary mind) a clanking confusion of weird ironmongery and magnificent men on the move everywhere all the time. " Noises off" added to the general disharmony. A " brewed up " tank with its contents is a gruesome thing. Wounded boys and clusters of temporary graves saddened the heart. T h e Division rolled across France and Belgium after the Falaise Gap episode ; took Antwerp, where kisses and flowers welcomed the liberators and where some of us saw evidence of the methods of the gentle Gestapo at the notorious Fort Breendonck. T h e n on through poor battered Louvain, over the Albert and other canals, across Holland, to be held just short of the upper Maas in the third week of September. From now, until the Reichwald battle for the ground between the Maas and R h i n e in February, 1945, we held a length of river and canal and were relatively static. Twice the Bosehe got behind us, causing much personal alarm and despondency, though it didn't seem to worry the others unduly. Frost and snow, with very low temperatures, made things very trying, as we were in the open. For a time, in the early days, captured German rations were issued, as our supply lines still ran from the Normandy beaches, and " a m i n o " and " P O L " (petrol, oil and lubricant) came first. What the soldier had to say of the obscene liver sausage stuff was graphic and pithy. Occasional baths were available in towns behind the lines, and mobile bath units established showers in some of the villages near the river. Nevertheless, personal hygiene was very difficult, and it was due to D.D.T. that the troops were free.from lousiness. Conditions for the P.B.I. must have been at least as bad as their fathers faced in Flanders. An outbreak of in£eetive hepatitis was interesting because a Dutch doctor said that this was endemic in the river villages, though it could not be established that the Dutch differentiated it from Well's diri~ase. Some of the refugees seen at this period were in a bad state of malnutrition4:o, diphtheria was causing fatalities in adults, # An Address t ~ e Metropolitan Branch of the Society of M.O.H., October llth, 1941L

157 and scabies and impetigo were rife among th~ cl~ildren. Refugees were: dusted with D.D~T. at control points 'before being sent back. Regimental Aid.Pogts: and Dressing'Stations were like civilian hospital out-patiefit departments. I can remember really laughingonly 0nee in Holland. • One day, calling on a unit in the slush, a"languid Hussar officer welcomed me to his watery command'p0st Wi~h, "Hello, Doe. Don't tell me you've come about our drains I " T h e Division was given its first rest out of the line when, after the Reichwatd battle, we went back to Belgium to comfortable rest billets at Louvain for three weeks. Back to the Rhine to cross the pontoon bridge at Weset completed by the Sappers on March 28th. The Rhine was unexpectedly unimpressive owing to the difficulty of approach, nursing' one's transport along, the necessity for keeping one eye or~ t h ~ pontoons and the o t h e r at the sky. Remaining interegt could be focussed on burning Wesel or swift waters.:; There were no turreted fairy castles or Rhine Maidens( T h e Field Hygiene Section, 27' strong, had up to this time produced ten casualties of sorts. T h e only fatal casualtY of, the eamp~iign occurred on March 30th. Belsen Camp Eleventh Armoured crossed the Weser after the first: ~ e k in April and we all said " Berlin or bust.". H~wever, instead of by-passing Hanover as expected, we seemed to face north halfway round, and, having seen the aerial:assault on 'the city. to the southward, were poised on the Allet~ rivgr ready for a dash to Ltmeburg and the Elbe. On April 12th, whilel the. usual assault crossing was being mounted and we of the~ rearguard stood and waited for the usual signal " Move,"Lstrango things were whispered. T h e Chief of Staff :of the Wehrmaehk. facing us was said to have crossed the line under :the white flag; to have stated that typhus had broken out in, his area, which included a large concentration camp; and offered to surrender the zone on certain conditions, Our people would know that i:he Germaris were making desperate efforts to stabilise a lind from the ~ Elbe, and that large troop movements were taking place from Denmark and" Schleswig. Too, an Arrnoured Division'sjob is to break through and keep going, not to mop up or occupy. On the morning of the 13th, having been called to H.Q., I was asked for an opinion as to the danger to the troops having to fight in a typhus areav I t could be said definitely that the danger was extremely slight. D.D.T.-impregnated shirts had been an issue since early in the campaign, every man had had a recent anti-typhus booster dose and D.D.T, (anti-louse powder Mark III) was a personal issue and well used. My briefing was to do what was possible to restrict the spread: of typhus. Two aerial photographs and available information were handed over. Somewhere near the ~;illago marked Belsen was a concentration camp with several thousand.eases of typhus, and internal hospital arrangements had broken down. A section of a Field Ambulance from t h e Airborne Division somewhere on the right would be brought up: to take charge of the medical side. I was given a paper stating ~ y authority. At first we were to precede the Infantry under the Red Cross. Needless to say, we took a poor view of this, as :our experience had taught us to put faith only in plenty of cover and none at. all in red crosses. We received further proof of our wisdom, if that were necessary, during the first week at Belsen, after we had moved out to the woods. A medical unit, newly arrived, harboured in the open close to where we were under cover. They spread their red cross on the ground. T h e following morning a couple of Bosche 'planes darted out of the cloud and machine-gunned them, causing five casualties. T o our relief it was finally decided to send us up well cushioned with tanks, and preparations were accordingly made. T h e trucks were " loaded to the gunnels" with D.D.T., soap and cresol, the Divisional R.A.S.C. as usual producing the goods. We took seven days' rations and lay forward with the tanks who were to belt up the edge of the area, depositing us at Belsen en route. We should have made it on the 14th, but unexpected opposition took a bit of winkling out, and so it was Sunday morning, the 15th, before we got on the road.

~S8 W e came to a point where Hungarian troops under arms, but wearing: white armlets, appeared on the left of the road, while our troops shot up pockets of Germans through the woods on our right. M y trucks were well in the rear of the column as a Medical Major and I in a jcep dodged along and finally turned out of the tank column into the gate, over which should have been hung " A b a n d o n all faith in man's humanity, ye w h o enter here." As the tank squadron clattered away there was comparative quiet, and we became conscious of a dismal wailing noise that was indescribably like lost souls. During the follow~ g days this became rivettcd unforgettably in one's mind. T h e S.S. guards were scowling and arrogant as we drove through the wire into the administrative compound and reported to my Colonel who was standing by his car near the gate leading to the lagers. I became suddenly conscious of a stench of corruption, and, through the wire, a milling mass of thousands of staggering, filthy, skeleton-like gnomes in ragged striped pyjamas. Their awful faces were mouthing squeaky sounds and showed no sign of being human. I thought I'd gone out of my mind. Suddenly there were shots. T h e guards had fired into the mass, and the tide of misery receded. One now realised that there were dirty bony bodies apparently scattered indiscriminately over the ground. T h a t was the first glimpse of Belsen in the bright sunshine of a Sunday afternoon. My experience as a medical man generally, and especially during the " blitz," had led me to think of myself as case-hardened. This, however, seemed to be unadulterated hell, or else I was in a crazy nightmare. The others left and I stood at the main gate waiting for the Section and transport to arrive. Tank troops clanked past, and occasional bursts of flame in the woods and odd crackles here and there, indicated the clearance of pockets. Gradually the noise of battle rolled away. Down a ride in the woods opposite came a body of German soldiers led by an officer carrying a large white flag. Occasionally they halted and the flag was given an extra wave, and as they reached the road they saw me on the other side and crossed over, apparently to surrender. The S.S. saw them and dashed out yelling, and, rounding the lot up, shepherded them into the camp. T h e Wehrmacht marched in with ~teath writ large on their faces. T h e trucks arrived and we went through the gates. T h e S.S. showed that they thought they would soon control the situation, and were not too co-operative. I was anxious, because the Gunners who were to take over had not arrived, nor had the Field Ambulance from the Airborne Division. We selected a hut from those used by the German troops who were subject to the truce arrangement. It seemed to me that if there were trouble they might side with us against the S,S. I set off to look over the ground and decide how best to start on the job of establishing the " cordon sanitaire." T h e sides of the pathways through the lagers were littered with naked corpses. In one of the women's compounds there was a heap of corpses about 50 yards long and some three feet high, and there were scores of others among the trees. T h e n I saw a most appallingly macabre sight--in and out among the trees, over and around the grotesque long-haired bodies on the ground, about a dozen ragged dirty children screamed and played happily at a sort of " follow m y leader" game. Unable to stand any more I turned to go back, and missed the way and found myself on what later turned x)ut to be the main pathway through the camp. Outside a cookhouse there was a mass of struggling subhumans. A squad of Hungarian soldiers m a y have been there to keep the queue in order; anyway, one of them would occasionally tap one of the skeletons with the butt of a rifle and add another body to those already down. S o m e sort of soup was apparently being dished out of a large container. T h e screaming crowd milled about waving bits of tins, and when one was lucky enough to get some soup, endeavoured to gulp it up at once. As often as not the others fell upon him, and the tin was knocked out of his hands and they fought for the scraps on the ground in a kind of desperate slow motion. Further along by a small reservoir in the ground there were emaciated caricatures of h u m a n beings getting water in bits of tin, and, having drunk their fill,carrying some of the filthy m u c k away. There were bodies on the ground, and some of

PUBLIC HEALTH, May, 1947 these were obviously dead, while others w h o could crawl no further were dying with tongues stuck out of a bony mask trying to call for water. Nearer to m y base I saw a straw dung=heap festooned with bodies. There were naked women's corpses in a crouching position. There were caricatures of what once were women, having diarrhoea and supporting themselves while doing so o n the dead bodies. Others were on their bellies stretching their arms below the rampart of corpses, filth and ordure, and bringing out something-possibly a potato. They could then be seen roughly scraping the excrement off and putting the " prize " to their mouths. Back at our hut a couple of Dutch internees, whose condition was not too bad, had been taken on as interpreters. A drill for the mass dusting of all w h o could walk was laid on to commence the following morning. It was n o w obvious that the problem was of a scale infinitely worse in all aspects than could be dreamed of or anticipated. W e could do nothing for tbe myriads of near-dead, and even the solitary aspect of hygiene, that of mass-dusting, which we were preparing to do, was far beyond th'c power of 16 m e n and myself. A n S.A.S. (Special Air Service) major drove up in a jeep and said he had come to find an intelligence m a n w h o had been dropped in Normandy on pre-D-day preparations and was known to be in Belsen. H e and his driver were dusted and drove off into the maelstrom. Miraculously, in about half an hour they returned with a dirty wizened man, w h o m w e deloused and fed on pap while he rested and got over the relief of being rescued. T h e S.A.S. officer,full of elan,~eemed to think it was quite ordinary to appear out of the blue and pull off what would be an unbelievably outside chance in the Beau Geste tradition. I would have liked to have got the story behind it all, but he said they had to be off, and was there anything they could do for us. I told him we did not m u c h like the look of the S.S., and that w e were worried about our chances for the night, so hc explained to the S.S. officerat the gate that he would be back in the morning, and that if w e were not " all present and correct" very unpleasant things would happen to all S.S. personnel. A n " Unter-offizier " from the G e r m a n troops came along, presented compliments and said their m e n would welcome the English soldiers to feed with them. They had " plenty food " he boasted. Through one of the Dutchmen he was told what they could do with it, and he went away disappointed. During the night the general wailing sound went on, very faint at times but, like the smell, always noticeable. Bursts of machine-gun fire and single shots could be heard intermittently. Early in the morning a dirty littleskeleton claimed sanctuary saying he was British. H e was deloused and given some pap and an old battle-dress to wear in place of a dirty bit of blanket which he wore as a shawl, and rags of striped pyjamas. This turned out to be Charles le Druillinec, the Jersey schoolmaster, and as far as I know, was the only Britisher to come out of Belsen alive, apart from the one found by the S.A.S. m a n the evening before. I met this m a n in Luneburg again in September, and, of course, did not recognise at firstthe hefty well-built m a n with a stick as the inarticulate scarecrow seen at Bclsen. H e had been nine days at the camp. At firstlight each morning he, and others still alive in the hut, threw out dead bodies. T h e n they spent the day tilllast light dragging corpses from the grounds to the pits, with three intervals, if lucky, for a quick soup issue. T h e n they were locked in the hut again with as m a n y more " new boys " as could literallybc squeezed in. There was no room to lie down, of course, or even to sit down, without the fear of being overlain by the dying. His weight in September was nearly back to h i s n o r m a l 190 lb., as compared with that of the liberation period of 95 lb. About 9 a.m. Brigadier Glyn Hughes, Head of Medical Services, and Tanks from Second Army arrived. I went o n a detailed inspection with him. Some of my men were getting a mobile filter on the job of producing some clean water for a pitiably small crowd of intm-nees. Others were on the dusting programme. Tanks were bearing guns on the S.S. quarters, and as more troops arrived they were disarmed. A mobile loudhailer was announcing in various languages that liberation was at hand. We now saw the insides of the wooden hutments and

PUBLIC HEALTH~ May, 1947 the typhus huts, which differed from the others only because there were more corpses. There was a large open pit with hundreds of bodies (as we thought, until a smaller one dug during the week took five thousand corpses to fill). Kramer, the S.S. Camp Commandant, who had to accompany the party on the tour, still seemed a figure feared by the internees. He was, therefore, stripped to the waist and carted round on a jeep for all to see. There were, as later estimated, about 28 thousand women and 12,000 men, with varying degrees of life left in them at this period. Thirteen thousand corpses were buried from the ground and huts, and almost as many more died in the month after liberation. T h e general appearance was one of starvation, with typhus, enteric, dysentery and deficiency diseases superimposed, and the background was a collection of unfortunates from Europe and Asia. Until October, when I visited Stettin and Berlin, I did not see a thin or hungry German. I n September, .on my way back from Denmark, I was told that the people in the emergency hospital at Belsen were having bread baked from flour which had been found in store at the time the camp was uncovered. T h e state of supplies could not have accounted for the condition of these people. O n the morning of Tuesday, the 17th, at a conference, big decisions to meet the problem were made. T h e camp was to be evacuated of those still living, and the huts burned down. Twenty thousand hospital beds would be required, and the magnificent Panzer barracks near the village was therefore made a hospital area. I was sent to find the senior camp medical officer. He was among the S.S. men, and his name was Klein. He was taken along for interrogation, and later stood trial at Luneburg and was hanged. T h e R.A.S.C. got 20,000 rations up on the Monday, and the Sappers delivered water and quickly rigged up a temporary continuous supply. Field ambulances and a casualty clearing station arrived and towards the week-end patients were being admitted to the emergency hospital. I n the first days of confusion I saw several S.S. men knifed and one garrotted by mobs. A carelessly thrown cigarette end caused two deaths in a mob of Eastern devotees of My Lady Nicotine. On to Denmark

By the end of April, having served our purpose, we rolled away from Belsen. Having crossed the Elbe we caught 11th Armoured up as it took Lubeck, and celebrated VE Day on the Baltic in schnapps and champagne. O n May 9th the Division crossed the Kiel Canal to occupy the northern portion of Schleswig Holstein. Attached to an advance party to choose garrison billets, I went into Schleswig, a beautiful town nestling at the head of a long narrow inlet of the Baltic. Bemused HerrenfoLk and scowling armed Panzer Grenadiers were in the streets. We stopped at a classy-looking hotel; it was lunch time and the dining room was crowded with fat Bosche and well-dressed women ; waiters were floating round, and an air of peace and plenty seemed the order of the day. They were soon cleared out. Next morning we saw the reverse of the picture. Two Stalags outside the town contained Russian P.O.W.s dying from typhus and far gone in starvation --Belsens in miniature. From the problems consequent on control of repatriation of P.O.W.s, I was joyfully translated to Copenhagen to supervise the hygiene of British troops in Denmark. In this l a n d " flowing with milk and bacon and eggs," and relatively untouched by war, the comparatively few wearers of khaki were given the best in the way of hospitality. In September the transition from life in the "Paris of the N o r t h " to army rations once more, consequent on m y being posted back to Germany, was a bad blow ! From now until the Spring of 1946 I did odd jobs and roving commissions, which included some visits to Stettin on the Oder and to Berlin. These visits were not without exciting and educational aspects. T h e net result of accumulated experience has been to confirm my respect and admiration for the British soldier as a

159 fighting man, a nurse or as a n ambassador. He seems to be able to assume the required'role when the situaflon demands it, and cannot be excelled ~by anybody at any' of i~iem. On a bright day in April, 1946, I was in a iDakh~a at about 3,000 feet belting for Blighty. Below us in cldar isunshine lay the Hague, and in the flat drab surround w't,s a delightful patchwork of bright colours made by the tulip.fi$1ds in bloom. Without regret, those of us on the way to " demob." gave the receding Continent a " Soldier's Farewell." SEVENTY

YEARS OF PUBLIC HEALTH SUSSEX R U R A L D I S T R I C T * By Emc WARn, M.R.C.S., L.R.C.P., D.P.H.

IN

A

Medical Officer of Health, Borough of Arundd~ 'and Chiehester and Midhurst Rural Districts I propose to review some of the aspects o f public health in the Rural District of Midhurst, as described and recorded !ha the Annual Reports of the various medical officers' of health who served the district since the year 1876. T h e Midhurst Rural Dibtrict"iS situated in the north-west comer of the County of West Sussex, b e i n g b6t¥1ered on the north by Surrey a n d in the west by Hampshire .and having an area of some 67,000 acres. • It is almost wholly rural i n character, the only town being Midhurst itself which has a present-day population of 3,500. T h e d i s t r i c t is hilly, t l ~ e ~ t i t h ' i D o w n s separating it from the Chichester coastal plain, whilst further high ground is found in the northern half of'the district. T h e staple industry is agriculture. The districtl is particularly suitable for a review of this kind because lth6re has been no significant change in its boundaries during the last 70 years, and only little fluctuation in the population. It is therefore possible to compare the vital statistics of the various years with much accuracy. T h e first available report is that for 'the year 1878, the Mid~;., hurst Rural Sanitary Authority having joined the Combinei~ ' Sanitary District of West Sussex in March of that year and thus secured the services of'Dr. Charles Keller, M.D.,F.R:c.~P:~ as Medical Officer of Health.: :Dr. Kelly, it may be noted, as~ well as holding the appointment of Medical Officer o f HAal/'~ to the Combined District, was also Professor o f Hygiene'. at King's College, London. T h u s the small rural districts v f West Sussex have had the services Of a Medical Officer dmploydd wholetime in public health for over 70 years. D r . Kelly held officeuntll 1903, the combined district gradually increasing iff size until it included the greater part of the county of WesS Sussex. Dr. Kelly's successor was,Dr. A. G. R. Cameron, who held office ,until 1912, :when the: original Combined District.~was split up and Midhurst.was included in a new Northern Corn2 blued District which was formed of all the Sanitary Distri~t~ lying to the north of,the So/tth:D6wns. Dr. S. Child XCas appointed to the new Northern 'Cbrnbined, District~attd: heFd' office until 1986. I n addition to his appointment as M.O'.H~ he acted as Assistant School Medical Officer to the C o u n t F Education Committee, a similar arrangement still being in forcel Vital Statisties of the Period

T h e population of t h e Midhtirst Sanitary District at th~ census of 1841 was 13,325t T hi~y years later it was 13~051I There was a gradual rise t6 15,283~in 1911, :about Thick 1eve1, it remained until the outbre/~:of the 1939-45 war, whem,it~ was gradually swollen by evacuees to 18,740 in 1941. Since then it has fallen and is now estimated at 15,520, whioh is withir~ 1,600 of that of 1881.(see Table I). A study of the birth and death rates during the last 70 years is of,g~eat interest (see Table I I ) . I n the five-year period 1 8 7 ~ i the average birth rate.was~ 30.52 per 1,000 population by 1900 it ha'd fa!len to 2A 44.- T h e fall continued with little interthipti'ort~to 1940 when ttxe rate was 10.44. Slight increases were recordediin 1942 and t943, b u t the fall recommenced i~ 1944 and tl~e figure for 1945'was 13.92. Whilst the birth rate * Presidential Addres~ ~to~the Southern Branch of the Society ~04

M, O; Of H,,January 13th, 1947,