THE SURVEY
After the Lean Years
Impressions of Food Conditions in Germany When Peace was Signed
By Jane Addams and Alice Hamilton
While we were in Zurich attending the International Congress of Women for Permanent Peace an invitation came to us to go into Germany with some members of the English and the American Society of Friends to discover how great was the need for food for the German children after the long years of hunger and to make arrangements for the distribution of such food and clothing as the Quakers had been able to collect. It may not be generally known that this society has been throughout the war laboring in the work of relief and reconstruction in France, Belgium, Russia and Poland, is now planning to extend its work to Germany and Austria and has in fact been sending supplies into both countries for several months. Dr. Hilda Clark and several other English Friends were planning their second journey into Austria but there were many delays before we were allowed to start into Germany. As we were waiting in London for the peace treaty to be signed we saw something of the campaign which the English people were carrying on for feeding the enemy countries with the rest of Central Europe. There was the Fight the Famine Fund, of which Lord Parmoor is president, the Feed the Children Fund, of which Mrs. Charles Roden Buxton is the leading spirit, the agitation led by the Women's International League, and many others, conducted with a freedom of speech in the Trafalgar square and Albert Hall meetings which was astounding to American ears.
The four English members of the Friends' Committee who traveled through the occupied region and entered Germany via Cologne, reached Berlin July 6; the three American members, Carolena Wood and ourselves, traveled from the Hague, crossing the border on the first civilian passports issued there after the war was technically over, and arrived in Berlin July 7. We were equipped with letters from Mr. Hoover to his various representatives in Germany cities. Dr. Aletta Jacobs, a Dutch physician who had been asked as a neutral to make observations on health conditions in Germany, was the fourth member of our party. Dr. Elizabeth Rotten of Berlin, who has been acting as the representative in Germany of the work of the English Friends and is also head of the Educational Committee of the German Association for the Promotion of the League of Nations, was naturally our guide and adviser.
We saw, of course, all classes of the population but from the very first we made a special effort to see as many children as possible, so that we might know the effect of long-continued underfeeding as registered in their growing bodies. In each city, therefore, sometimes under the guidance of the workers or patrons of private charities, sometimes under city physicians and other municipal officials, and sometimes with well-known professors or child specialists, we visited the créches, the child welfare clinics, the playgrounds and outdoor sanitaria, the homes for convalescent children, the hospitals, orphanages, and always several public kitchens and the homes of workers.
Our impressions crowded each other so fast that they merged into one, an impression of mass hunger as we had never imagined it, hunger of millions continued month after month for three years or more; combatted desperately by the doctors, the experimental chemists, the government authorities, the social workers, even more desperately perhaps by the mothers who were urged on by the primitive passion to save their children from starvation; but combatted largely in vain because the necessary weapons were not there. No specialist can fight tuberculosis with war flour and dried greens, nor can he keep alive a delicate old man on boiled turnips.
As nearly as we could learn up to the middle of 1916 the effects of the blockade were not severely felt, though people who worked among the poor knew that even then mothers of families were losing weight to an alarming degree and that the death-rate among the aged was increasing. Gradually, however, the important articles of diet -- meat, milk, animal fats, then vegetable fats, eggs, wheat flour, began to grow scarcer, and the various substitute foods were of low caloric value, so that as the year went on the diet grew very poor. In 1917 it reached the low point of one-third or less than one-third of the standard adopted by all civilized countries as the minimum for a working adult. Then in 1917 the potato crop failed and the terrible "turnip months" came, remembered with horror [page 2]
[image] Comparative quantities of soap per capita before the war and after 1917
in every city but most of all in Saxony where for weeks at a time there was literally nothing in the market but white turnips, the coarse kind known as "Swedes." Many people have acquired a permanent dyspepsia from that experience and for the old this diet was fatal. In Chemnitz the death-rate of those over sixty was only 166 in 10,000 inhabitants in 1914, but in 1917 it reached 430. The village schoolmaster in Barenstein, a little village in the Erzgebirge, told us that during those months in the morning session there would always be nine or ten children who would have to leave the room, vomit their breakfasts and stagger back to put their heads down on their desks and cry, too sick and miserable to sit up, much less learn their lessons. We were constantly told that the amount of school work required of the children has had to be lessened in order to meet their lowered vitality and that, owing to their absolute inability to do the work, many children of the poor in Germany have practically lost four years of school life out of their possible eight. The numbers of school children was greatly reduced by actual illness. In Halle, we were told by one of the school doctors that the school population had fallen off by one-half since the war began.
That these physical privations should have an influence on juvenile crime is only to be expected. Ruth van der Leyden and other probation officers of the juvenile court in Berlin told us much of the increased criminality among the former pupils of the higher grade school. Those growing boys and girls who, owing to the shortage of labor during the long course of the war, undertook hard factory work, were simply unable to get enough to eat from the rationed supplies. From this root cause sprang many thefts of food, falsification of bread cards, house-breaking into bakeries and mills, stealing potatoes and turnips in the fields, taking part in the fraudulent handling of food in the hope that some would be given to them, and so on. In addition to hunger, many of these children, unable to bear any longer the anxiety of their mothers, stole food to take home, reckless of the consequences to themselves. Of course they often stole money from their parents, sold the clothing of their brothers and sisters or such household articles as they could pilfer. To quote Miss van der Leyden, "Children and youth from the most respectable families come before the court through their sheet inability to withstand the temptations to which they are so cruelly subjected." It has been said of these half-starved children that they well illustrate a saying of Rousseau's, "The body must have strength to obey the soul; the weaker the body the more it commands."
We were constantly reminded that the paucity of food does not only affect the poorer people; indeed many working people with relatives in the country from whom they could obtain food fared better than professional people and others who had no such connections. Often when asked a direct question, the professors in the clinics revealed the difficulty they had had in providing for their own families. One of them, who kindly invited us to his house, showed us two blooming children of seven and eight, but the little war baby of two years had stopped growing when she was weaned, and developed rickets. With the utmost care she has been cured to the point of being able to walk, but she is tiny, white and thin, a great contrast to the other children. Another professor who was taking us through a children's ward, admitted reluctantly that his daily food consists of a breakfast of black war coffee with bread and marmalade, no midday meal, and for supper soup and bread. He came back from the front to find that his wife had made a poor recovery from a serious operation and his two children were very much reduced, all for lack of proper food. He sent them to a seaside place on the Blatic, but there proved to be so little food there that he is obliged to save all he can to send food from Berlin.
Sometimes the tales of food shortage were touching. The editor of a large city newspaper told us that he had been able the night before to take home a bottle of milk and that his little girl, who met him at the door, had shouted joyously to her mother that peace had come. We asked if she had found the milk as delicious as she thought and he said: "Oh, she could only feast her eyes on it. That milk was for the little sick one, there was not enough for two." Again we were told by a mother that her little daughter had asked her if it was true that there were countries in the world where there was no war and where people could eat all they wanted. Perhaps it was these women who suffered most, these intelligent mothers who knew perfectly well how important proper feeding was and yet were unable to obtain the barest necessities for their children. One of them said to us that it was hardest at night after the children were in bed and one heard them crying and whimpering from hunger until they fell asleep and even after. She added, "I do not see how the women endured it who were obliged to sleep in the same room with their children and who could offer them no diversions in the evenings."
Many people kept conscientiously to the rationed food, though always at a risk to their health. We met one young girl of wealthy family who is reduced to such a pale ghost of her former self that her parents are greatly distrubed. She has a large Bible class of working girls and, as they are unable to buy extra food, she has refused to eat anything but the prescribed ration. Others found it simply impossible to keep this up. Obviously a woman who anxiously wonders whether the
[image] War shoes, made with wooden soles, woven paper uppers, and leather substitute toes and heels [page 3]
obligation to obey the law is as binding as her primitive obligation to preserve the health of her children, has taken the first step toward the illegal purchase of food. One woman who succumbed described her struggles: "My husband knew that I bought smuggled food for her children but he would never touch it himself. He died after a rather slight operation and I torment myself thinking that perhaps it was because he had no resistance left." Another said: "My old father would not let me give him smuggled food till he had lost more than forty pounds in weight and my friends were reproaching me with neglecting him. Then he yielded and he always referred to it as 'the time my conscience died!'"
There were many wealthy people who were able throughout the whole period of the war to secure an abundance of food for their families, but even if all the food in the country could have been secured by the government and fairly distributed, the lack of fats and albumens would still have been disastrously great.
There is a general impression in America that this suffering from lack of food is now a matter of the past, but in point of fact the armistice was followed by the cessation of sea-fishing through the complete blockading of the North Sea, the demobilization threw back on the cities thousands of soldiers whom they were unprepared to feed, the surrender of rolling stock demoralized transportation still further, and the armies of occupation took possession of regions which had formerly supplied several large cities. Thus Frankfurt am Main has lost its source of agricultural and dairy supplies to the French army.
Perhaps the best way to show the present state of things will be to describe some of the meals we saw in public and private institutions. We were in the kitchen of the great university hospital of Berlin, the Charité, at noon and saw the meal for 2,200 people. Since the revolution the hospital has had to adopt the Einheitsessen, that is, to give exactly the same food to everyone, from scrubwoman to head professor. We saw a tray of meat, about two and a half feet wide by 18 inches long, filled with chunks of lean beef, very stringy and full of bones, which had already been boiled for soup. This was for the 2,200 people. Of course they do not get it every day. The weekly allowance is 250 [grams] (8 ounces) but after the bone has been removed it is not more than 150, which would make the daily allowance just the legal weight of a letter.
The allowance of bread is 335 [grams] daily (11 ounces) but many of the sick cannot eat it, for it is made of meal ground very fine so as to retain all but 5 [percent] of the bran, which makes it irritating to a delicate stomach. Then they mix with the meal chopped dried greens and this makes the bread damp and liable to mould or sour in a few days. Yet if they cannot eat this there is no substitute. The allowance of white bread, made with the excessively dear American flour, is only one loaf a week for ten patients. Seafish stopped at the time of the armistice, rice, dried beans and peas are only beginning to come in, so the reliance has to be chiefly on green vegetables, of which the hospital is using ten times as much as before the war.
We saw the tuberculosis patients in the great wards for children -- where before the war physicians from all over the world came to study the methods of treatment -- fed with a soup of meal with dried greens and a little vegetable margarine.
"Something to Hope For"
In a créche in Frankfurt they were giving emaciated and rachitic children a dinner of meal soup made with a pound of margarine to 100 children and in the afternoon a meal consisting of a mug of German tea, made from dried leaves of strawberry and other plants, without milk and with only three-quarters of a pound of sugar to forty quarts of tea. In Leipzig, we visited a Landkolonie, a large playground in which 625 children from six to twelve years of age spend the day and are given a midday dinner. It consists of one pint of thin meal soup, to which had been added a little dried vegetable. Out of 190 children who were seated at one time in the dining room all except one were thin and anemic. The director made several announcements to the children -- a hike for the following day, which he carefully explained was not compulsory, the time when the prize would be awarded for the best garden, and so on. All of these were received with a curious sort of apathy by the listless children, but when he said that he hoped they would have milk in their soup tomorrow or the next day, the announcement was greeted by a shrill and spontaneous cheer. He turned to us with tears in his eyes. "I do not know where the milk is to come from," he said, "but one must give them something to hope for."
The meals for grown people we saw in the many food kitchens, some maintained by the city, some by private charity. In Leipzig one could get forty pfennigs two boiled dumplings of war meal with some dried pears which had been stewed with sugar. It was probably a little over one-third of what a [page 4] German would ordinarily eat at noon. The same was true of the meal served in Chemnitz, a soup of meal made with sauerkraut and potatoes and a little vegetable margarine. Both were more appetizing than the meals we saw served in Berlin, but scantier. However, in Berlin the price was a mark and a quarter or a half for meal soup, a dish of part dried and part fresh greens and potatoes, and sometimes a dessert of damp, grayish cake, which was so sticky and elastic one could draw it out like rubber, or aniline red jelly of a still stronger and more unappetizing consistency, both, of course, sweetened with [saccharin].
Food Rationing
It is needless to say that the lack of milk, butter, eggs, meat and fats is the serious side of the food shortage. Berlin's milk supply has fallen to a little over one-seventh of the normal, that of Chemnitz to less than one-eighth, of Frankfurt to less than one-twelfth. It is very strictly rationed to nursing mothers, children between one and four years and some of the sick. Children up to four get a pint a day, sometimes those up to a six may get half a pint. Open tuberculosis calls for one pint a day, closed tuberculosis for none. Acute nephritis entitles the patient to half a pint, but not chronic nephritis, and if there is hemorrhage a case of ulcer of the stomach may receive a pint a day. This is only, of course, when the supply is sufficient.
The crops of this year are already supplying Germans with fresh vegetables; the potato crop, so important for the poorer people especially, promises to be fairly good, and the bread will be much better in quality and cheaper when the rye crop is harvested. But it is impossible to restore a starved population to a normal condition on fresh vegetables and cereals. It is absolutely necessary to have fats and albuminous foods. Germany has no animal fats because of the loss of cattle and the lack of rich fodder for the cattle which still remain. She has always imported this fodder in the form of oil cake and palm kernels. Germany has no source of vegetable oils, no nuts, no cottonseed. Therefore, she must, if her people are to be saved from the effects of malnutrition, buy in foreign countries the oils, fat meats and milk which she cannot herself produce. There is also need of sugar for this year, since much of the sugar-beet land was sown to cereals. The important bacon, salt pork, suet, lard, butter, condensed milk, chocolate and cocoa will necessarily be very expensive and beyond the reach of the poor and even the moderately well-to-do class.
The effects of underfeeding are registered chiefly in the increased tuberculous rate at all ages, and in the increased death-rate among the old as is shown in Germany's statistics. During the third quarter of 1917, the deaths from tuberculosis had increased by 91 [percent] in women, only 40 [percent] in men. That same year the Prussian Home Office estimated the excess deaths among the old, those over 60 years, at 127,000, and among children under five at 50,000.
Kayserling, one of Germany's foremost tuberculosis specialists, told us that the fight of almost forty years against tuberculosis was lost. The Germans date their anti-tuberculosis campaign from about 1882 when Koch discovered the bacillus. Since then their rate had fallen from over 30 per 10,000 of the population to less than 14. In the first half of 1918 it was already over 30 and is still rising and will continue to rise for some years. Nor does the death-rate tell all the story. In Berlin the infection rate among babies -- shown by the von Pirquet test -- has increased threefold, the rate of tuberculous sickness among little children, fivefold. These children will not all die. Many will live on to puberty and then fall prey to the disease, or if they are able to resist that period of strain, they will succumb during the twenties, under the strain of childbearing or heavy work. For the whole period of this generation, tuberculosis will claim a greatly increased number of victims and how far the health of the children of these war children will affected, nobody can say.
Not only is the number of the tuberculous increased but the form of the disease is changed and German hospitals are now filled with varieties of the disease which used to be regarded as medical curiosities. We saw most pitiful cases among the children, multiple bone tuberculosis with fistulas, multiple joint tuberculosis, the slow, boring ulcers of the face called lupus, great masses of tuberculous glands such as we never saw in America, and that great rarity in civilized countries, caseating pulmonary tuberculosis in little children. Kayserling said that the hunger blockade had shown that tuberculosis is a disease to be combatted chiefly by nutrition, not by the prevention of infection, and that by long starvation it is possible to break down racial immunity, if indeed there be such a thing. The forms of tuberculosis now common in Germany were formerly seen almost entirely among primitive peoples and it was supposed that the acquired resistance of civilized races made such things impossible, but that is now an exploded belief.
There is no space to do more than mention some of the other results of the long underfeeding of women, children and old people. "Galloping consumption," fatal in four to sixteen weeks, used to be very rare; now it is almost the rule in young adults who develop tuberculosis after a decided loss of weight. Gastro-intestinal diseases of all kinds have, of course, greatly increased, especially ulceration. Rickets among children is enormously prevalent, scurvy less so, and the war oedema -- which seems to be caused by an exclusively carbohydrate diet -- has been brought under control and is hardly to be found except in isolated spots. The blockade of soap and soap fats has brought about not only an increase of skin diseases especially among babies, but an increase of puerperal fever among women in childbed, from the lack of clean linen and the difficulty of securing personal cleanliness for the woman and the midwife. A further and more serious effect has been the gradual accumulation of household filth, which is shown by the fact that there are now in Berlin about 100,000 lice-infected houses and the municipality can see now way to get them cleaned unless they can provide cheap and abundant soap for the people. As typhus has smouldered in Berlin for months there is a very bad outlook for the city when once the cold autumn weather lights it up again in these vermin-filled houses.
In common gratitude we feel we must not close without referring to the fine spirit of courtesy with which the Germans received us. Doctors, nurses, men and women who are working against tuberculosis, to keep babies alive, to keep children healthy, to prevent youthful crime and foster education, these people are way past the point of bitterness. What they are facing is the shipwreck of a nation and they realize that if help does not come quickly and abundantly this generation in Germany is largely doomed to early death or a handicapped life. For what Germany needs is more food for her children than normal children need, and more publicly care for her sick than she had before the war, more research, more experts. What she faces is a dearth of food and a crippling of all her institutions of relief and of learning.
The first cod liver oil, so terribly needed, reached Berlin this last May, a gift of the English Friends. The American Friends allowed our little group, Carolena Wood -- herself a Friend -- and ourselves to arrange for the purchase [page 5] of $30,000 worth of condensed and dried milk, which seemed to us the most urgent need after we very reluctantly gave up cod liver oil. We left behind us a committee with headquarters in Berlin, consisting of Dr. Artur Levy, of the associated charities of Berlin, Dr. Elizabeth Rotten, who has been in cooperation with the English Friends throughout the war, Dr. Alice Salomon, the head of the school of philanthropy, Dr. Sigmund Schultze, head of the city [Jugendfürsorge] Amt, and other experts in relief work, to take charge of the distribution of this food and if possible later consignments. In Frankfurt the committee is represented by the head of the associated charities, in Leipzig by the head of the child welfare agencies, in Halle by the well-known Swiss scientist, Professor Abderhalden, in Breslau by the Oberburgermeister, and so on. We had repeated interviews with all these people and are convinced that the supplies that are sent in will be distributed with the utmost efficiency by men and women conversant with the situation and experienced in modern methods of relief. All of the money contributed will be sent to the Committee of American Friends in Philadelphia and will be expended in this country for food and medical supplies, both of these to be purchased and shipped most advantageously through the cooperation of Mr. Hoover.
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