Book Review

Courage under Siege: Starvation, Disease, and Death in the Warsaw Ghetto

N Engl J Med 1993; 328:1428May 13, 1993

Article

Courage under Siege: Starvation, Disease, and Death in the Warsaw Ghetto
By Charles G. Roland. 352 pp., illustrated. New York, Oxford University Press, 1992. $25. ISBN: 0-19-506285-X

It is difficult to imagine a more dreadful existence than that faced by the half-million Jews imprisoned in the Warsaw ghetto from 1940 to 1943. Under the pretext of a quarantine (for typhus), Nazi authorities ordered walls to be erected around the ghetto, sealing it off from the outside world. Thirty percent of the population of Warsaw was confined to just over 2 percent of the city's land mass. Deprived of food, fuel, and often water, people began to freeze and to starve, even as trainloads of Jews from other parts of Europe were forced into the ghetto. In a space of about two years, 50,000 to 100,000 people died of starvation, and nearly as many died of infectious diseases such as tuberculosis and typhus. Most of those who remained as of July 1942 were deported to the death camp at Treblinka, where they were gassed and their bodies burned. Only a few thousand of the original inhabitants remained alive after the famous uprising of April and May 1943, the others having fallen prey to Hitler's coldly calculated Final Solution.

Parts of this story have been told before, but Charles Roland, a medical historian at McMaster University in Hamilton, Ontario, is the first to present a book-length account of the medical and health history of the ghetto under Nazi rule. The personalized vignettes are moving. Desperate for protein, starving families ate stockyard refuse or coagulated horse blood mixed with salt and pepper. Dentists removed gold from their patients' teeth, so their owners could buy food or shelter. Families often concealed their dead, so as not to lose a relative's food rations (amounting to about 200 calories per person per day). Medical institutions continued to function, though by very different rules: doctors were periodically ordered to select some fraction of their patients for deportation, and euthanasia (by morphine injection) became a common practice as physicians sought to save their patients from a more miserable death at Treblinka.

Even those who managed to escape from the ghetto usually perished or suffered to avoid detection. Roland tells of one woman who, hiding in an attic, gave birth without uttering a sound as Germans searched the floors below. The story is not entirely grim; a remarkable chapter describes how physicians inside the ghetto established a clandestine medical school that operated for 15 months until the destruction of the ghetto in the spring of 1943. Another chapter recounts how several Jewish physicians used the extremity of the situation to study the physiology of starvation.

The author sometimes introduces superfluous truisms: sexuality was “affected negatively by ghetto life,” the slow starvation in the ghetto “affected significantly” the inmates' metabolism, and so forth. One might quibble with whether the Holocaust really is “the least understandable event since the Creation,” and there is no evidence for Roland's assertion that the Japanese as a race have a heritable predisposition to gastric cancer. More might also have been said about the part played by German physicians in the administration of the ghetto. These are minor flaws, though, in what is altogether an admirably well documented and thorough exploration of how people lived and died in one of our century's most notorious horrors.

Robert N. Proctor, M.D.
Princeton University, Princeton, NJ 08544