|OFFICE OF MEDICAL HISTORY AMEDD REGIMENT AMEDD MUSEUM|
HISTORY OF THE OFFICE OF MEDICAL HISTORY
Colonel Charles J. Farinacci, MC (Ret.)
POLITICAL AND MILITARY BACKGROUND
After World War I, the new republic of Austria was only a tiny remnant of the former Austro-Hungarian Empire. Badly disorganized and financially insecure, it would hardly have survived had it not been for the support of the League of Nations. The rise of the National Socialist party in Germany under Adolf Hitler had violent repercussions in Austria, and after several upheavals, the little country lost its independence and was absorbed into the greater German Reich by Hitler on 13 March 1938 (map 14). Its central administration was removed from Vienna to Berlin, and the Austrian people were subjected to regional and local governments composed of German and Austrian Nazis.
The political objectives for the ultimate occupation of Austria, as enunciated by the Allies in their Moscow Declaration of 1 November 1943, differed fundamentally from those for Germany since the European Advisory Commission was agreed "that Austria, the first free country to fall a victim to Hitlerite aggression, shall be liberated from German domination." The Allies regarded the 1938 annexation of Austria as null and void, and declared further that they wished to see reestablished a free and independent Austria, whose people would become both politically and economically secure.1
The European Advisory Commission was organized early in 1944 in London, with American, British, and Soviet delegates. In March 1945, the Commission was enlarged to admit France as the fourth power in the occupation of Austria. Each power was to have its own zone and share in the occupation of Vienna.
Early in 1945, the plans for Austrian occupation changed drastically because of the rapid weakening of the German Army in Germany. Indications were that the invasion of Austria would be effected more easily from the northwest (Germany) than from Italy, as had originally been planned. Accordingly, in mid-April 1945, the SHAEF (Supreme Headquarters, Allied Expeditionary Force) military government staff, although already fully occupied with its work in France, Belgium, and Germany, and having had no time to study the problem, took on the additional task of preparing
directives for Austria. Military government field detachment personnel from Italy were hurriedly assembled, reinforced, transferred to the European Civil Affairs Command, and sent to Austria.
This transfer of control at the last moment had many unfortunate effects upon military government in Austria. Although the tactical phase of military government should have ended on V-E Day, it was necessarily continued for a few weeks until early June 1945. The boundaries were based upon troop deployment rather than territorial lines. Consequently, since many Army divisions and all higher units were partly in Germany and partly in Austria, it was only natural that Austria should be treated initially as part of Germany and that the same policies and methods as had been prescribed for the Germans should be applied to the Austrians. Obviously, there were conflicts between these SHAEF directives and those which were being developed in the 15th Army Group Headquarters in Italy for use in
Austria when the command would pass from SHAEF to USFA (United States Forces in Austria). However, by the maintenance of close liaison between the military government teams in Austria and with the hearty cooperation of the SHAEF officers, these differences were resolved satisfactorily.
Early in May 1945, the U.S. element of Headquarters, 15th Army Group, commanded by Gen. Mark W. Clark, was selected for reorganization into Headquarters, USFA, and General Clark was designated as the U.S. Commissioner on the Allied Council. He remained in this capacity until succeeded by Lt. Gen. Geoffrey Keyes on 17 May 1947.
Late in June 1945, a joint British-French-American reconnaissance party entered Vienna to survey and discuss the situation with the Soviets, who had been in military control there since April. On the basis of the party's report, the European Advisory Commission in London concluded the agreements on control machinery for Austria and the occupation zones early in July (2 months after V-E Day).
On 6 July, command of the U.S. occupation forces in Austria passed from SHAEF to USFA; and in early August, Headquarters, USFA, moved from Italy to Salzburg, Austria. This transfer helped to accomplish three important things: the reassembling of the public health personnel of the U.S. element of the Allied Commission; the briefing of U.S. personnel who had been serving in Italy in military government capacities up to this time; and preparation of the Allied quadripartite operations on the national level after the establishment of USFA Headquarters in Vienna. Following a number of conferences with Soviet officials in Vienna, the British, French, and U.S. Headquarters moved there late in August; on 11 September 1945, the Allied Council held its first official quadripartite meeting (4 months after V-E Day).
The Four Power Declaration of 4 July 1945 stated that Austria had been restored to its 1937 (pre-Anschluss) frontiers; it was administratively divided into eight provinces and the city of Vienna. The same Allied agreement divided Austria into four occupation zones.
The Soviet zone included (1) the province of Burgenland (which had a common frontier with Hungary), (2) the province of Lower Austria (Vienna, which lies within it, received quadripartite occupation), and (3) that part of the province of Upper Austria (Mühlviertel) which lies on the north bank of the Danube River and shares a common frontier with Czechoslovakia and a small part of West Germany.
The U.S. zone consisted of (1) the province of Salzburg, and (2) that part of the province of Upper Austria lying on the south bank of the Danube River, both of which have common frontiers with West Germany.
The French zone, bordering on Switzerland and Italy, consisted of the provinces of Tirol and Vorarlberg.
The British zone included the provinces of Carinthia and Styria which have common frontiers with Italy and Yugoslavia (map 15).
A provisional Austrian Government was established in April-May 1945 under Russian supervision by a Social-Democrat, Dr. Karl Renner. On 25 November 1945, the Austrians held their first free and fair election since 1937 for a national parliament and (provincial) Land legislatures. A gratifying 93 percent of the registered vote was cast. The resulting parliament consisted of 85 representatives of the Peoples Party (conservative), 76 Socialists, and four Communists. Dr. Renner was elected Federal President and was installed in office on 20 December 1945.
ORGANIZATION AND PLANNING FOR CIVIL PUBLIC HEALTH
Although a civil affairs unit for occupation of Austria was authorized by the combined chiefs of staff of the Allied Command on 8 January 1944, it was not until 10 April that the actual organization of the "Austrian Country Unit" started its function. Civil Affairs planning for Austria was based upon a SHAEF directive of 23 May 1944. The Austrian Public Health Section was thus organized and worked with the Germany Planning Section in the formulation of plans for the occupation of a liberated Austria. On 4 January 1945, the Public Health Section in London became the Public Health Branch of the Internal Affairs Division, USGCC/A (United States Group Control Council (Austria)). This newly organized branch was composed of two officers, Maj. Edwin F. Daily, MC, chief of the Public Health Branch, and Capt. (later Maj.) Paul X. Blattler, SnC, Sanitary Engineer. In March 1945, the Public Health Branch, along with the other divisions of USGCC/A, established temporary headquarters at Caserta, Italy.
Public health planning and preparation during the stay of USGCC/A in Italy were under command of Lt. Col. (later Col.) Walter H. Miles, MC. The major work accomplished during that period was the preparation of a draft of Public Health (Austria) Policy directives. Close coordination was maintained with the MTOUSA (Mediterranean Theater of Operations, U.S. Army) Surgeon and G-5, particularly in regard to earmarking and allocating medical and sanitary supplies and equipment for the United States Zone of Austria.2
With the realization that the German Reich would soon capitulate, military government officers, in April 1945, were detached from civil affairs units of both the American Fifth Army and the British Eighth Army and were hastily transported to Germany; there, they were assigned to the various military government teams of fast-moving Gen. George S. Patton's Third U.S. Army to function as Austrian Land and Kreis civil affairs teams under tactical command. The public health group of the USGCC/A,
except for some officers who were sent into Austria on special target missions, remained in Italy until 23 June, when the entire public health staff of the USGCC was assembled in Salzburg by the regional military government.
In early May, the two Land Military Government Public Health Sections had begun to function. In Land Salzburg, Lt. Col. (later Col.) Ralph Marks, MC, was the chief of the Public Health Section with three assistants, while in Land Upper Austria, Col. Charles J. Farinacci, MC, was assigned as the Chief Public Health Officer. Colonel Farinacci and Lt. Col. (later Col.) James Tobin, MC, had moved in with elements of the Third U.S. Army to establish the first Public Health Section of the Land Upper Austria Military Government Team. Until 1 August 1945, these two Land Military Government Public Health Sections in the U.S. zone of Austria operated independently.
Colonel Marks and Captain Blattler, while operating in Land Salzburg, concentrated on correcting sanitary conditions throughout the water supply system. This included chlorination of various sources of supply following reports of rising numbers of typhoid fever cases in and near the city of Salzburg. Civilian laboratory facilities were utilized for chemical and bacteriologic analysis of drinking water. Equally alarming were the public health problems preoccupying Colonel Farinacci and his Public Health Section in Land Upper Austria. They were confronted with the spread of venereal disease, crowded housing conditions, shortages of many medical supplies and soap, and a typhus epidemic. The disease had spread from the German concentration camp at Mauthausen, in June 1945, to exposed and ill
inmates of nearby concentration camps. The laxity in permitting such persons to cross the borders was discussed with the Austrian health authorities. Border control posts were established so that all persons coming into the American Zone by rail, road, or water were dusted with DDT (fig. 67).
With the arrival of General Clark in late August 1945, the USACA (United States Allied Commission for Austria) became an integral part of Headquarters, USFA, and the Regional Military Government was relieved from subservience to Corps and Divisional Commands. The USACA (formerly Regional Military Government) now came under the command of General Clark. By 1 September, USACA had established a functional headquarters in Vienna. The Public Health Branch of Internal Affairs Division gave all possible assistance to the Public Health Office of the Vienna Area Command, which was headed by Maj. Robert C. Hume, MC, in August 1945. He was replaced in early September by Maj. John F. Ellis, MC. Colonel Miles was in charge of the Military Government Public Health Section, USACA, from its activation in September 1945 until he was relieved by Colonel Farinacci on 21 September 1945.
Brig. Gen. Edgar E. Hume, a Medical Corps officer assigned to G-5, arrived in the city of Salzburg in September 1945 and became responsible for the Regional Military Government of the U.S. zone of Austria. Because of the isolated location of the Vienna Area Command, it was decided that its headquarters would be independent of General Hume's Group. The USACA was to become only a policymaking coordinating unit of USFA in its quadripartite activities and in its close liaison with the Austrian Public Health Section.
SPECIAL PROBLEMS OF CIVIL PUBLIC HEALTH
Upon cessation of hostilities in the European theater in May 1945, a heavy burden of responsibility was assumed by the occupying forces in Austria. One of the most serious and urgent problems was the immediate safeguarding of public health and preventing the spread of epidemics. This was essentially a military operation under the quadripartite control of the United States, Great Britain, France, and Russia. Each nation assumed complete responsibility in its zone for the medical care, feeding, housing, and disposition of all displaced persons, refugees, victims from concentration camps, and prisoners of war.
The rapid collapse of the German Army in Austria in May 1945 found the quadripartite powers somewhat unprepared for the complex public health problems which confronted them. In the first days of the occupation, the major task facing the U.S. Army was that of halting, under conditions of extreme filth, malnutrition, and starvation, the spread of serious communicable diseases by disease-infested victims of Nazi oppression among a civilian population that was both demoralized and confused. Land Upper Austria and, to a lesser degree, Land Salzburg, in the spring and summer of 1945 were foci of such problems. In addition to the indigenous population,
estimated at somewhat more than 1 million inhabitants, there were an estimated 700,000 displaced persons and refugees, including about 80,000 concentration camp inmates of five large camps, 200,000 displaced Austrian refugees, and 250,000 disarmed enemy forces (prisoners of war).
The "denazification" program, which involved the dismissal of public health officials belonging to certain categories of the Nazi Party, was carried out in an orderly manner as soon as suitable replacements became available. Trained replacements were difficult to obtain, however, especially where doctors were sorely in demand on the Bezirk or Kreis (county) level. In some instances, delays of several months in the removal of Nazi officials were unavoidable.
Reporting of communicable diseases had been satisfactory until the invasion of Austria but was reestablished with considerable difficulty after the invasion because of the poor postal service, lack of vital transportation for physicians and health officials, and the mass movement of refugees and displaced persons. The reporting of vital statistics through September 1945
in the U.S. zone continued to be unsatisfactory. However, by November, the Provincial Government's nationwide reports of mild epidemics were reasonably prompt, and control measures were instituted fairly early. Weekly reports of deaths from communicable diseases were received by Land Military Government Public Health Officers from the Austrian public health authorities. Each item on the report indicated whether or not the individuals were Austrian. Charts and graphs were made from these reports by the Public Health Branch of the USACA in Vienna.
The principal contagious diseases occurring among the indigenous population were typhus fever, the enteric group (typhoid, paratyphoid, and the dysenteries), diphtheria, venereal diseases, and tuberculosis.
Other complex problems, such as the huge hospitalization and treatment problems of the total civil population, were aggressively pursued by the U.S. Army Medical Department with the assistance of such medical units as evacuation hospitals and field ambulance units. In a few months, the crisis had passed and general conditions stabilized.
Typhus fever.-The most serious communicable disease encountered by displaced persons was typhus fever.3 Although louseborne typhus was endemic in the area, the largest outbreaks occurred in the U.S. zone and were imported from outside sources. To prevent the importation of typhus fever into the U.S. zone, border control dusting stations were established at all important road, rail, and water entrance points. There, all individuals entering the area were dusted with DDT powder. To indicate that this had been accomplished, an entry was made on the identity card of each person dusted. The greatest number of typhus cases occurred among former concentration camp inmates in the vicinity of Linz in Upper Austria (fig. 68) during July, August, and September 1945. In Vienna and Salzburg, typhus arrived in mid-October with displaced persons from the Sternthal Camp in Yugoslavia. Isolated cases were reported in camp hospitals or civilian hospitals. Every effort was made to delouse contacts in displaced persons' camps and at shipping points.
Because of the occurrence of secondary cases of typhus fever in Vienna, introduced by refugees from Yugoslavia during October and November 1945, the four Allies of the Vienna Inter-Allied Command became concerned and agreed unanimously to establish a cordon sanitaire around the city. A great deal of credit must go to Major Ellis, the Chief Public Health Officer of the U.S. element, Vienna Area Command, who was both diplomatic and persistent in pursing the U.S. Army goal in controlling the disease. Another important factor was the willingness of USACA to make available all the supplies and supervisory personnel. The other Allied powers merely gave their assent. In the winter of 1945, a total of 36 checkpoints were installed. Initially, the dusting teams, consisting of Viennese ci-
vilians and U.S. Army personnel, examined and dusted all persons entering the city.
Typhus fever outbreaks occurred in May 1945 among the liberated inmates of Camps Ebensee, Hoersching, Gunskirchen, and Mauthausen. Following the uncontrolled and unregulated liberation of inmates from these camps, the disease spread to crowded areas, including other camps and the indigenous population. This epidemic, which threatened so ominously, was controlled within 3 months. Because of the rigid controls established by U.S. Army authorities, not one soldier contracted the disease. In July 1945, when the Russians made no attempts to control the movement into the U.S. zone of individuals suffering from typhus fever, the Military Government Public Health Section in Land Upper Austria instituted the dusting of all persons who entered its area from the Russian and British zones.
The Land Upper Austrian Public Health Section in the U.S. zone was able to start its control program earlier than the other Public Health Sec-
tions because Colonel Farinacci could procure the necessary DDT supplies and dusting guns from the Third U.S. Army as a result of his personal visit to this Headquarters in May 1945.4
This establishment of a typhus control system in the U.S. zone of Austria and the city of Vienna helped to prevent the development of an epidemic which had been, at the onset, a serious threat because of the extensive louse infestation. The United States of America Typhus Commission fully approved the interzonal use of all control items regardless of the source of the supplies or the occupation area where they were ultimately used.5
Venereal diseases.-In the U.S. zones and the city of Vienna, venereal diseases were routinely reported for the first time in Austrian history when the venereal disease law of August 1945 was enacted. There was an upward trend in the rates for venereal diseases during the occupation period in the U.S. zone.
During November 1945, the system of reporting venereal disease in the Vienna Area Command had been greatly expedited. Company commanders and the Provost Marshal, for the most part, were responsible for contacting American troops.6 The Vienna City Department of Public Health aided them in this particular function by doing all work for civilian contacts. The existence of venereal diseases in Vienna among the indigenous population and military population was largely due to poor personal hygiene and a high incidence of promiscuity. Progress was made in establishing clinics and training public health casefinding teams.
There was a definite increase in syphilis in comparison to gonorrhea during this period in the three U.S. zones of Land Upper Austria, Land Salzburg, and the city of Vienna.
The U.S. Army helped to reestablish free venereal disease diagnostic and treatment clinics for civilians in its zones. Penicillin, furnished for the treatment of gonorrhea, helped to retard the spread of venereal disease. Other drugs and supplies were provided, administration was carried out in the clinics supervised, and full publicity was given to the civil population over the radio and in the local newspapers.
Tuberculosis.-Tuberculosis, like venereal disease, was an acute problem in the larger cities of Austria, and the conditions were worst in the city of Vienna. As of November 1945, approximately 26,000 known cases were registered with the Vienna Department of Public Health. From September to the end of December 1945, between 8,000 and 9,000 open active cases of tuberculosis in Vienna either were being given ambulatory treatment at the few tuberculosis sanitariums in the city or were not being treated at all. Upper Austria had a very high incidence during the early months of the oc-
cupation. In general, tuberculosis had appeared in alarming rates in the urban centers.7
The U.S. Army Medical Service helped to reestablish diagnostic and treatment centers in each of the three U.S. zones. Few sanitariums or tuberculosis hospitals had been built during World War II by the Germans so that efforts at control were severely handicapped by the lack of hospital beds.
Other communicable diseases-Diphtheria. During the period before January 1946, diphtheria increased sharply among the preschool and adult age groups in the U.S. occupied zones. This was attributed to the breakdown in the immunization program during the war. In November 1945, the Austrian civil public health authorities undertook a mass diphtheria immunization program to protect the school children and preschool group (ages 12 years and younger). This program was carried out on a voluntary basis by the local authorities with the assistance of the U.S. Army Medical Department.
Enteric diseases. Of the three zones, the city of Vienna showed the highest incidence of enteric diseases. Previous epidemiologic studies conducted by the Austrian health authorities revealed that 56 percent were caused by contact infections, overcrowding, poor hygienic facilities among the population, lack of control of carriers, and failure to trace contacts to cases.8
Typhoid fever. During the early months of the occupation, a high incidence of typhoid fever was reported, which was traceable to human carriers and not directly to the food, water, or milk supplies. The lack of trained personnel in the city health departments of each of the three U.S. zones retarded the public health enterprise.9
By the end of 1945, the U.S. Army had released to the Civilian Medical Supply Pool in Vienna more than 40 tons of noncaptured medical supplies. To alleviate some of the bottlenecks in the awkward system of distribution, the U.S. Army contributed a total of 161.64 tons of medical supplies to the city of Vienna by the end of December 1945.10The U.S. Forces in Western Austria aided Land Salzburg by setting up collecting points for captured enemy material.
The U.S. Army made specific contributions of necessary hospital equipment to the Austrian Provisional Government and provided assistance in transporting and distributing these critical items. Many private relief organizations helped by supplying such items as food, clothing, and medical supplies.
Between September and November 1945, 50 CA (Civil Affairs) De-
tachment Medical Units were requisitioned and distributed on the basis of need to the Austrian Health authorities in the cities of Linz, Salzburg, and Vienna.11 The three U.S. zones were provided with other requisitioned supplies including additional amounts of DDT and dusters, sulfonamide drugs, alcohol, ether, and biologicals.
The Austrian health officials were responsible for distributing medical supplies to hospitals and other institutions under the Land Military Government. In Vienna, medical supplies from the American, British, French, and Russian Armies were pooled for the entire city.12 By the close of 1945, adequate medical supplies for the U.S. occupied zone had become available.
Water and sewage.-Field environmental sanitation inspections in the U.S. zone were accomplished by one qualified Sanitary Engineer assigned to the Public Health Branch in Vienna. One of the biggest problems from the outset of the occupation was securing potable water. Public health officials in rural and village communities throughout the U.S. zone were unable to improve their water and sewage sanitation because of lack of funds.13 The cities of Salzburg, Linz, Steyr, and Vienna were confronted by many broken water mains caused by Allied bombing. Chlorination supplies were provided by the U.S. Army, and normal water and sewage systems were restored in a few months in the major cities, except Vienna. The damage to the water and sewerage systems in Vienna had been more extensive, and some areas were without normal water supply after the capture of the city by the Red Army.
By the end of December 1945, 962 of the 1,343 large sewers damaged by the Allied bombardment of Vienna had been repaired. The control sewerage system of the city was regarded as reliable. Other work in the field of sanitation included the supervision of refuse disposal and other general sanitation problems, such as public baths and buildings. Stream pollution was not regarded as a problem by the Austrian health authorities.
Insect and rodent control.-Insect and rodent control was left almost entirely to private enterprise. Private firms were engaged by the civil governments of Vienna, Salzburg, and Upper Austria to carry out rat extermination programs.
Refuse disposal-Disposalof refuse during the early months presented a problem because of the shortage of transportation and personnel required for removal and disposal. The methods of storage, removal, and disposal of refuse were considered satisfactory. Refuse and debris were used to fill in lowlands, swamps, and craters.
The serious nutritional state of the Austrian population can be appreciated fully in light of the dietary trends that occurred from January through December 1945. Briefly, the history of food and nutrition passed through three separate economic phases: (1) under the economy of the Third German Reich from 1939 to April 1945; (2) under the occupation of the Soviet Army from April to September 1945; and (3) during the quadripartite administration which began in September 1945.
From January to April 1945, 1,500 calories were available to the normal consumer. When Vienna fell, the city's food stocks were captured by the Red Army, considered to be war booty, and sequestrated. Between 1 June and 31 August 1945, the normal Viennese consumer was authorized about 850 calories. At the beginning of October 1945, pooling of the food was begun by the four powers in Vienna, with civilian authorities handling its distribution. A total of 1,550 calories per normal consumer was authorized.14
The food situation in Land Upper Austria and Land Salzburg during 1945 was somewhat different. The food distribution continued throughout the year in a relatively normal manner because the campaigns through the provinces were rapid and war damage was insignificant. Indigenous supplies were not confiscated; yet, in the large urban centers such as Linz and Salzburg, the supplies were so short during the summer months of May through August that the city dwellers subsisted on a dangerously low caloric intake. In July 1945, a nutritional survey was conducted in Linz by the USFET (U.S. Forces, European Theater) Nutrition Team, composed of Dr. Charles S. Davidson, Consultant, Office of the Surgeon General; Maj. Harold L. Wilcke, SnC, Nutrition Officer; and Pvt. Phillip J. Reiner, Technician. A cross section study of the civilian population, displaced persons, and prisoners of war disclosed that (1) German disarmed military personnel, formerly prisoners of war, showed frank evidence of starvation, (2) the caloric intake of the civilians surveyed ranged from 801 to 944 for normal consumers and 1,044 for heavy workers, (3) the authorized ration scale in effect on 10 July was 762 calories per normal consumer (this was raised to 1,040 calories on 18 July), and (4) the ration allowance for displaced persons in effect on 18 July provided 2,000 calories (and 84 grams of protein) per person.15
Furthermore, on 24 July, Maj. Gen. Morrison C. Stayer, Chief of OMGUS (Office of Military Government of Germany, United States) Public Health and Welfare, along with the Nutrition Team and Colonel Farinacci, inspected both prisoner-of-war camps and civilians in Linz, Austria.16 Oth-
er than such isolated instances as occurred in Linz and in the German prisoner-of-war camps, there was no period of acute distress and lack of subsistence issue in the U.S. military occupation zone.
Beginning in December 1945, the official ration authorized by the U.S. military government in the two provinces was:17
The U.S. Nutrition Office was established in the Public Health Branch, USACA, on 13 December 1945, with two officers of a four-man nutrition team reporting for duty. During the remainder of December, Capt. Robert V. Lewis, MC, and his Nutrition Team devoted their time to planning, organizing, and factfinding on food, policy, and execution on the highest level.
During December, Major Ellis, Chief, Public Health Branch, Vienna Area Command, established a much needed street weighing program with a sample population of 500 adults. The data for Vienna from this program revealed that the sample population of 500 Austrian individuals compared favorably with the existing nutritional standards adopted for the German population by the Allied Powers. A comparison of results from the December study with nutritional sample surveys conducted in Vienna in September by the USFET Nutrition Team revealed that the data compiled by Captain Lewis and his group showed positive and marked improvement in body weight. Further, the weight loss of the group above 40 years of age presented the most striking deviations. Lastly, the children up to 19 years of age showed a satisfactory state of weight.18
Routine nutrition surveys of the civilian populations of Vienna, Salzburg, and Linz were planned by the Nutrition Office for 1946. Other types of permanent operations of this group were special surveys of displaced persons' camps, rural surveys, trouble areas, and routine 3-month surveys of the three principal cities in the U.S. zones.
During 1945, the U.S. Army nutritionists in each of their areas undertook substantial food distribution for children, pregnant women, nursing mothers, and for the hospitalized. Not until April and December 1946 was a supplementary food supply program for all of Austria carried on by UNRRA (United Nations Relief and Rehabilitation Administration) and UNICEF (United Nations Children's Fund).19
Other organizations assisting the U.S. Army in 1945 with an abundant food distribution program in Austria were the American Red Cross,
the National Catholic Welfare Conference, and the American Joint Distribution Committee.
In general, the job of the U.S. Army nutrition officers was to form teams and gather data on food consumption, height, and weight. These Nutrition Teams also conducted physical and laboratory examinations of many thousands of individuals in the city of Vienna and the other U.S. zones. Eventually, Austrian personnel were trained to do the work under direction of the teams.
One of the many great contributions made by the U.S. Army Nutrition Teams was that of determining the percentage incidence of undernourishment, both within the general population and in each age group.
By May 1945, the Austrian civilian veterinary activities were being reestablished, and veterinarians were appointed at various political levels in the U.S. zones.20 Veterinary medical supplies were obtained and distributed to various cities. The regional diagnostic laboratory was reactivated in Salzburg.21
Throughout the U.S. zones, a sufficient number of veterinarians were stationed to provide service satisfactory by prewar Austrian standards. Several epidemics of anthrax and hog cholera were reported, and biologicals, requested by the Austrians, were secured by air from U.S. stockpiles in Italy. When these epidemics were carefully investigated, none proved as serious as first reported.
Manufacture of veterinarian biologicals was started in plants near Salzburg and Vienna. Food and meat inspections were considered unsatisfactory in Salzburg, Linz, and Vienna, according to U.S. Army standards, and the local authorities repeatedly were instructed concerning improvement of these inspections.22
Milk sanitation-Inspection of the Austrian dairies within the U.S. zone revealed that the Austrians had a good working knowledge of milk sanitation. However, they did not have sufficient reserve equipment to continue their methods of pasteurization satisfactorily should existing plant equipment break down.
Animal diseases.-The most important animal diseases were the foot-and-mouth disease in cattle, scabies in horses, and erysipelas and poliomyelitis in swine. Of these, scabies and poliomyelitis were brought on by war conditions.
All abattoirs throughout the U.S. zones were under U.S. Army veterinary supervision. One laboratory which diagnosed animal diseases was in
operation in Salzburg; this laboratory also started producing swine erysipelas serum and brucella vaccine.23
Medical Care and Related Services
During the first 3 months of military government in Austria, it was evident that there was a minimum of physicians, nurses, dentists, ancillary services, and hospital facilities to care for the Austrian civilian population in the three U.S. zones.
During the winter of 1945, increasing illnesses and epidemics traceable to malnutrition overtaxed the Austrian Medical Service. Problems of communication and transportation often prevented patients from reaching their physicians, or physicians from visiting their patients.
Initially, Corps surgeons were responsible for medical and hospital care of displaced persons and for the proper sanitation of their camps (fig. 69). Later, the Surgeon, USFA, was given this responsibility, which he then delegated to his Division surgeons. Elements of two medical battalions were assigned to Land Salzburg and Land Upper Austria to assist the Austrian authorities in providing these services. In most instances, professional service for displaced persons was provided by physicians and nurses who were themselves displaced persons.
The U.S. Army abolished the Nazi medical organization in the U.S. zone. The new Austrian Red Cross helped considerably in reestablishing its ambulance service in Land Upper Austria and Land Salzburg. Confiscated German ambulances were transferred by military government public health officers from Salzburg to Vienna.
Hospital dispensaries under the care of displaced medical personnel were established in all displaced persons' camps located in Vienna (U.S. zone), Linz, Wels, and Salzburg.
Maternal and Child Health Program
At the onset of the occupation in postwar Austria, prenatal advice to mothers, well-baby clinics, and care of the preschool and the school child remained divided between public health and public welfare agencies.
The welfare workers were given increasing responsibility in these matters. While the medical aspect of the prenatal and well-baby clinics was under the jurisdiction of the Austrian health officials, the material aspects, including furnishing food, clothing, and medical supplies, were handled by welfare agencies.
The health of the school children remained the responsibility of educational authorities. School physicians were appointed by the local school officials, and, often, the county health officer obtained the appointment.
Maternal and child health care progressed in Austria and continued to remain the responsibility of the Land (State) officials. Because of the history of socialized medicine in the country and the support provided by the
Catholic Church and other charities, remarkable contributions to the health of mothers and children were evident by the end of December 1945.
According to Lt. Col. Philip R. Beckjord, MC, "* * * from the standpoint of effort and organization, and in view of the small size and general poverty of the land, the maternal and child health program of modern Austria compares more than favorably with the great Western democracies."24
Relationship Between USACA Public Health and the Austrian Medical Schools
Many well-trained specialists resided in the U.S. zone of Austria, especially in Vienna. The University of Vienna and the Allgemeines Krankenhaus (fig. 70) were well staffed by such notables as Prof. Dr. Chiari, chairman of the Department of Pathology; Prof. Dr. Artz, chairman of the Department of Dermatology and Syphilology; Prof. Dr. Lauda, chairman of Internal Medicine; and Prof. Dr. Wolfgang Denk, dean of the Medical Faculty. The other major cities, Linz and Salzburg, were similarly well supplied with medical and dental specialists. The University of Vienna had a heavy enrollment during the winter session of 1945, and all the clinics were well attended. Despite the preoccupation of the USACA Public Health Section with the immediate problem of the quadripartite meetings, Allied problems of control of contagious diseases, and other matters, it did concern itself with aiding and encouraging the University to reestablish itself as an international medical center. The Public Health Section solicited the
Armed Forces medical units for donations of medical journals to the University, and encouraged and arranged for American military medical officers to attend short courses there. In addition, the University was aided in its campaign to reestablish its former relationships with American universities and with the Rockefeller Foundation. Foreign speakers were encouraged to appear before the Austrian medical profession. Considering the many difficulties placed in their paths by the disasters of war and with their nation's occupation by four victorious powers, physicians, dentists, and veterinarians cooperated wholeheartedly in carrying out the military government public health programs. However, they were uneasy over the denazification program because, as more than one physician stated, "Who wasn't a Nazi?"
Col. Thair Rich, MC, Surgeon, USFA, a vigorous proponent of improving the relations between the U.S. Army and the University of Vienna, made great progress in promoting clinic attendance by American Army medical officers. Maj. Gen. E. A. Noyes, Surgeon of USFET, was sympathetic and helped the USFA-USACA's program of aid to the University.
By the middle of 1947, the refresher courses conducted by the University of Vienna were well established. An average of 10 U.S. Army medical officers attended each 6-week refresher course, which consisted of internal
medicine, hematology, electrocardiography, surgery, dermatology, and pathology. Each officer was responsible for the payment of his tuition. Since money was worth little, a barter system was set up and many officers paid their tuition with Care Parcels. Upon completion of the 6-week refresher training, each graduate received a diploma from the Medical Faculty of the University, certifying his successful completion of the training.25
Relationship With Austrian Public Health Authorities
Although the personal relationships with the Austrian public health officials were extremely cordial and the Austrians appeared anxious to improve their services, the U.S. military government public health officers frequently were disappointed at the slow progress being made. At times, personnel in the higher echelons of USACA apparently did not understand Austrian health problems; they were more concerned (and justifiably so) with the serious problem of coping with inter-Allied and Soviet politics. Sometimes, the slow progress resulted from the apparent inertia of the Austrian public health officials themselves, who were reluctant to change the status quo because of the unsettled political balance of power, and who feared dismissal from their government positions by their political overlords. Sometimes, the lack of progress was aggravated by the inability of the quadripartite public health group to agree as to what was best for the Austrians (since each of the four powers had its own idea, and each probably had its own selfish motive). At other times, the very structure of this newly formed Austrian Government prevented action. For example, the Land (State) public health sections were not under the direct rule of the Austrian Central Federal Government Department of Public Health; therefore, the Land health authorities in the U.S. zone and as in the other occupation zones were not compelled to carry out the Central Government directives unless their governor (Landesdirektor) accepted the Central Government's ruling. In other instances, a lack of funds was a deterrent since Austria was financially insolvent after the collapse of the German Reich.
During the early months of the occupation, as the Austrian public health officials realized the sincere desire of the U.S. military government public health officers to assist them in reestablishing their health services upon a sound progressive basis, their cooperation was excellent. However, there were delays, sometimes from lack of communication with the Land and Bezirk public health officials. Another serious handicap was the insufficient number of automobiles to transport Austrian health personnel (at both Land and national levels) so that either adequate supervision of public health activities and prompt investigation of alleged disease outbreaks had to be delayed or vehicles had to be borrowed from the military government.
A SHAEF directive, issued on 23 May 1944, was the basis for Civil Affairs/Military Government Public Health Planning for Austria. This directive was the culmination of many months of planning, coordination, and organization of the Allied Civil Public Health Organization for Austria by the Chief of Staff to the Supreme Allied Commander.
Throughout the remainder of 1944 and the early months of 1945 and, finally, with the capitulation of the Third German Reich in May 1945, the Civil Affairs Planning Group for Austria was developing a functional organizational structure. This military government public health organization, which had its inception in England, carried out its policies and programs through the able assistance of its public health specialists, who served with European Civil Affairs Detachments in Italy and, later, with military government teams in Northwest Europe.
Of the remaining key U.S. Army public health officers who had not rotated to the United States for separation from the service following the Italian campaign, a few became the hard core of the several public health sections in the U.S. zone of Austria.
Among the first public health specialists to arrive in Austria were those assigned to interim military government teams with General Patton's Third U.S. Army. Some officers were assigned to Land (State) and Kreis (County) in Land Salzburg and Land Upper Austria while others later joined the Vienna Area Command Public Health Section and the military public health sections of the U.S. Allied Commission Headquarters, USFA, under the command of General Clark. These officers engaged in the task of advising, revitalizing, and assisting the Austrian public health authorities and the other related agencies in the regrowth and redevelopment of their local public health facilities.
Civil public health problems confronting the specialists in the U.S. zone were varied and complex. They assisted the Land and Kreis officials in dealing with such chronic special public health problems as housing, feeding, medical care, and disposition of displaced persons, refugees, victims from concentration camps, and prisoners of war. They also assisted Austrian public health officials in the control and prevention of communicable diseases, logistic and materiel support, maternal and child health, hospitalization, reporting of communicable diseases, medical supplies, treatment of prostitutes, public health education, and the reestablishment of the health, medical, and paramedical agencies, and long term health programs such as diphtheria and tuberculosis control. Still another important function of the Military Government Public Health Section of USACA was that of acting with the Allied Commission Quadripartite Health Working Party under the new Allied Control Agreement.
In general, the relationship of U.S. public health personnel assigned to the various military sections of the U.S. occupation zone with Austrian
public health officials was based on cordiality and mutual professional respect in the multiplicity of tasks which confronted them all. The U.S. personnel soon realized that many central government directives and recommended public health programs could not be implemented because of limited funds.
By the end of December 1945, the general health of the Austrian population, as measured by vital statistics, communicable disease and nutritional analysis, and a study of hygiene and environmental sanitation, had greatly improved.
The Austrian Public Health Services were reestablished on the pre-Anschluss basis in the three areas of the U.S. zone of Austria. Many experienced official physicians (Amtsärzte) who had embraced the German Nazi ideology were caught up in the U.S. denazification program with the result that many of them had to be removed from office. Trained replacements were difficult to find, especially on the Bezirk level.
Reporting of communicable disease was irregular due to transportation and communication problems. Beginning in November 1945, for the first time, the Renner Provisional Government began collecting morbidity statistics on a nationwide basis. By the end of December, communicable diseases among the indigenous population had dropped considerably. Typhus fever was no longer the problem it had been during the early part of the occupation. Typhus control measures to protect the city of Vienna were in operation; within the city, all the Bezirks were covered, and a cordon sanitaire operated effectively on the city's perimeter. With the gradual improvement of living conditions in Vienna, the incidence of dysentery decreased. The enteric diseases, diphtheria, and tuberculosis had been of relatively high incidence. Venereal diseases were being reported routinely for the first time in Austrian history.
Medical supplies were available in adequate amounts within the two Lands of the U.S. occupation zone. However, in the U.S. zone of Vienna, the supplies were limited, and distribution had to be restricted so that supplies were issued chiefly to hospitals and other public institutions. Retail pharmacies could not be stocked since there was no control over the sales of drugs.
Routine nutritional surveys of the civilian populations of Linz, Salzburg, and the U.S. zone of Vienna were conducted by the military government health officers, beginning in September 1945. It was evident from the onset of the occupation that the greater need for nutritional improvement would be in the larger cities such as Vienna. The rural communities of Upper Austria and Land Salzburg were more often able to supplement their rations with sufficient food for proper maintenance of life without calling for additional amounts. The city of Vienna, on the other hand, was in dire straits during the period between the capture of the city and the arrival of the U.S. Army.
By the end of December 1945, the nutritional survey conducted by the
American and British elements in Vienna failed to reveal any specific nutritional diseases although the studies did show definite weight loss as the most striking nutritional deficiency. In addition, the Viennese diet was deficient in both protein and vitamins, and approximately 82 percent of the diet was made up of carbohydrates. On several occasions, hunger edema had been reported within the U.S. zone of Vienna. Upon investigation, in all instances it was found that the persons involved were elderly people, and the edema was the result of organic diseases, not hunger. These patients required special rations, which were unobtainable except by a diagnosis of hunger edema.26
By the end of December 1945, the Central Austrian Government Health Department, in close liaison with the U.S. Public Health staff throughout the U.S. zone, was gradually assuming more responsibility in the civil public health activities of its people.
During 1946-47, following the Austrian national elections, the newly formed Austrian Coalition Government was beset by the divergent aims of the four powers. The British, French, and U.S. elements, on one hand, were extremely anxious to "nurse this newborn baby" along, to protect it from undue criticism, and to encourage it by suggestion rather than by authority. On the other hand, the Soviets, who were bitterly disappointed at the very poor showing of their Austrian Communist Party in the election, appeared determined to impede the progress of the Coalition Government and to discredit it in the eyes of the Austrian people, with the hope of turning them toward the Communist Party. The policy of the quadripartite Public Health Working Party became one of control which allowed the Austrian Government freedom of action and, at the same time, insured its adherence to the general policies under which the Allied Commission in Austria functioned.
Quadripartite Public Health Working Party meetings, which had been held since September 1945, continued. One public health officer from each of the four occupying powers attended these meetings. They discussed and reached agreement on public health laws concerning the control of venereal disease, examination of food handlers, control of narcotics, and control of diphtheria. Attempts to convince the Austrian public health authorities that they should have compulsory immunization failed. Consequently, although the program was well publicized and vaccine was supplied free by the U.S. Army, the program fell far short of the desired goal.
The Public Health Branch continued to give immeasurable help to the Austrians in the form of earnest advice and good will, and millions of dollars in the form of medical, dental, veterinarian, hospital, and laboratory supplies and equipment. This help was given unselfishly and willingly to produce a stable Austrian public health organization which would be economically and professionally sound. The Public Health Branch, USACA, at the end of 1947, was still concerned with long term matters, such as raising the
standards of the nursing profession, reestablishing and developing the pharmaceutical industry of Austria, revising the public health laws, strengthening the Central Austrian Health Department, and further "denazifying" the medical, dental, and veterinary professions.
Certain general principles were followed: Austrian laws and regulations took priority unless the health of U.S. forces was likely to be jeopardized; the imposition of sudden radical changes was avoided; only the most undesirable Nazi officials were removed from office; and care was taken not to abuse military authority, so that government could proceed on a humanitarian, honorable, and just basis. The Branch was seriously handicapped by lack of specially trained personnel, which was attributed largely to the "point system of rotation." The British, in contrast, had sufficient numbers of civil public health administrators to carry out their obligations.
The fact that Austria is today a stable, self-sufficient, recognized non-Communist government is the best conclusive evidence that the entire USACA, including the Public Health Branch, and its British and French counterparts, was successful in its efforts to strengthen this struggling nation which had been crippled by the first World War, battered by the Hitler conquest of 1938, and almost smothered by the defeat of the German Reich in 1945.