As soon as World War Two breaks out, the nations
at war face an acute health care crisis, not
just in caring for the wounded, but also in
continuing to provide regular health care
on the home front when the war overwhelms
the already very basic health care systems.
This is On the Homefront, a sub-series of
World War Two in Real Time, I’m Anna Deinhard.
When millions of men start firing guns and
cannons, dropping bombs on each other and
on civilians, and overrunning territories
forcing millions to flee head over heels,
there will not only be a lot of dead people.
There will be even more injured people requiring
emergency care - few health care systems in
the world both now and in the past can handle
war without being stretched beyond their limits.
And it’s not just injuries, but also an
increase in disease that comes with war.
Now imagine what that means.
If you get sick, or hurt, you’ll likely
have to take care of yourself.
Or your parents, your children, grandparents,
a sibling, or a friend without any medical
knowledge will have to take care of you.
Home remedies are already the main way to
treat emergencies anyway, but now you have
to resort to these in a time of rationing
and a general lack of supplies.
Now, today I will focus mainly on the home
front in Germany and the Commonwealth countries,
who have been at war for two years now.
I will cover other parts of the world in future
episodes.
For these nations, for any nation, war means
a greater need for medicine, medical equipment,
doctors, and nurses, both on the battlefield
and on the home front.
The need for new resources gets even higher
when many people with medical training also
enlist and therefore leave their jobs.
And 1941 is a time when health care is not
a universal service anyway.
In places where there even is health care,
it is only in the last two decades after The
Great War that the creation of these health
care systems has picked up speed.
In fact, many people have little or no access
to professional health care at all.
For instance, in 1920s Italy there is a complete
lack of health insurances for poor people.
It is Mussolini’s regime that introduces
the first system of compulsory and additional
insurances in 1929 to moderate this social
disparity.
But they also use this progress to spread
their ideology.
Doctors who support the fascist government
have more influence, and get more benefits
during the redesign of the medical system.
They use medical practice for political purposes
by spreading ideas like- that illness or health
depends on the “kind of people” you are,
or interact with.
Similarly, the government's fight against
infectious diseases such as malaria, tuberculosis
and syphilis shifts from battling the germs
to targeting the carriers on ideological grounds.
Nazi Germany, too, connects ideology with
medicine.
They even start to eliminate people with hereditary
diseases by murdering them.
Like in Italy, the racist Nazi mythology impacts
health care negatively as the origins of disease
and health are confused.
But Germany also faces an increasing lack
of medical professionals due to the very nature
of their ideology.
Large swaths of the population, like women,
Jews, and political dissidents, are now forbidden
from practicing or even studying most disciplines
of medicine.
Many doctors flee the country, and Germany’s
loss becomes others’ gain.
Like in Australia where there is a severe
shortage of medical staff in the countryside.
Now European refugees, among others many German
Jewish doctors, gives some hope.
However, like in most parts of the British
Commonwealth in the 1930s, you have to have
British medical training to practice medicine
in Australia, or go through a complete retraining.
But, in 1939 the New South Wales Medical Practitioners
Act makes it possible for medical staff from
non-commonwealth countries to practice medicine
in some regions.
In Great Britain itself the situation in 1939
is still quite similar to the one in Italy
after World War One.
If someone needs a doctor or any medical treatment,
patients are generally expected to pay out
of their own pocket.
There is worker's health insurance, but that
only provides for the workers themselves,
not for their families.
It leaves poorer people largely without healthcare,
but there is change in the air.
Already before the Great War there is a vivid
debate about how to improve British Health
Care.
As the 1920s progress more and more people
get access to hospitals run by local authorities
and private interests, an approach originating
with the Poor Law.
By 1929 the Local Government Act empowers
and instructs local authorities to set up
services providing medical treatment for everyone.
For instance, on April 1st 1930, the London
County Council assumes responsibility for
around 140 hospitals, medical schools, and
other institutions after the abolition of
the Metropolitan Asylums Board.
By the time the war breaks out, this is the
largest public health care network in the
world.
But when Germany invades Poland the progress
takes a direction other than public health
care when the British nation focuses on the
emergency needs of war.
To ensure the availability of medical aid,
they cut up their cities into sectors.
Dangerous areas get first-aid stations and
casualty sorting centers, so that the seriously
wounded can be transported to safer areas
for a long-term treatment.
Remote sections are reserved for convalescence
and chronic patients.
Already in September 1939, many London patients
are evacuated to clear space for emergency
cases.
In Germany, preparations for war are running
at full speed.
But one thing the Nazis are not worried about
is a lack of medicine.
After all, even under the Nazis, Germany remains
the world's biggest exporter for pharmaceuticals.
With doctors and medical staff, it is a totally
different story.
OK, so even after driving away many doctors,
Germany still has one of the highest densities
of physicians per capita with 7 doctors for
every 10 000 civilians.
But now, one in three medical staff is drafted
to military service.
To some degree this is compensated by letting
medical students in their last year take a
doctor’s place where there are shortages.
That way they manage to mobilize 2.400 stop-gap
physicians.
Despite all these preparations, most countries
are unprepared for the drain of doctors and
medical supplies that the war immediately
creates.
In Canada the shortage of doctors becomes
a real problem as many doctors, sometimes
all the physicians of an entire town, enlist.
The Canadian Medicine Association launches
an emergency research project of medical manpower
and starts working with the Department of
Defense to solve the problem.
Still, it will take until 1942 until the Canadian
Medical Procurement and Assignment Board is
founded, which takes up organizing the supply
of health resources.
In Great Britain, in 1940 the main problem
becomes loss of hospital space because of
Luftwaffe bombing.
In London for example, the St Thomas’s Hospital
loses 508 out of 682 beds in an air raid.
An eyewitness, who lives through a direct
hit of Queen Mary´s hospital in London on
the 7th of September 1940, describes the attack
in their diary: “In a moment, the bomb tore
through the three floors and finally burst
leaving a huge [sic!] crater which was immediately
filled by large masses of masonry and steel
girders twisted into all manner of fantastic
shapes, broken equipment and unfortunately
the bodies of six patients and two of the
nurses.”
In Germany the military continues to drain
the health care systems.
In the first year of war alone, 20 percent
of all beds of civilian hospitals are occupied
by or reserved for soldiers.
Additional hospitals are established to make
up for this, but they are poorly supplied
and therefore are only able to care for patients
with minor sicknesses.
Furthermore, the high hopes for an abundance
of medicine now become a pipe dream.
Many people working in the drug industry have
to go to war, so production of medicine drops
significantly.
Embargoes and blockades also force them to
ration medicines that need ingredients imported
from abroad, like iodine and quinine.
So, unexpectedly they now face a shortage,
forcing the Nazi regime to scramble just to
secure the supply of the most important drugs,
even for the war effort.
But there are some medical resources that
are still more common than ordinary creature
comforts.
For instance, cough drops that can substitute
for sweets for children.
And so, in the midst of the horror of war,
Germans now start hoarding medical products
that can be used to substitute at least one
of some other missing goods.
But that hardly solves the lack of proper
medical care, especially the lack of doctors.
Now, if you saw Indy’s and my episode about
women’s roles in the 1930s in our Between
Two Wars series, you will know that to satisfy
the war preparations, the Nazis have to dial
back their measures to relegate women to the
home already by 1938.
In medicine, the attempts to ban women from
academic professions has decreased the share
of female doctors from double digit percentages
in the early 30s to just eight percent, who
are allowed to continue working in limited
medical fields like pediatrics or gynecology.
But now the Nazis dial back in this area too,
and around 2000 female doctors are reinstated
and asked to fill in.
Women are even allowed to once again study
medical fields like surgery, from which they
have been banned since 1934.
But measures like that take time to have full
effect, so even with emergency stop gaps,
the number of doctors is only at 60 percent
of pre-war numbers.
If you are living outside of the bigger towns,
you might not even have a doctor to make a
first diagnosis but a nurse.
That is, if you have the possibility to get
to one at all.
Fewer physicians mean longer journeys and
even longer waiting times.
As soon as you have succeeded in getting hold
of a doctor, you might still only have up
to two minutes with them, because there is
an average of 100 patient calls per doctor
per day.
To make things worse, in 1941 a doctor gets
only two thirds of the already very tight
general rations that they would have gotten
in 1939.
So now house visits get very, very difficult,
thanks to strict rationing of gasoline.
And now in the summer of 1941, after the invasion
of the USSR a deeper medical crisis emerges.
The Nazis describe it with something of an
understatement saying that medical care and
supplies will “not be ideal everywhere.”
But this is a real turning point.
Already from the first day, casualties on
the Eastern Front are higher than expected.
Medical supplies are eaten up both on the
front, and as they get stuck in the endless
supply lines leading into the depths of Soviet
territory.
By the end of the year, the struggle to secure
enough hospital capacity for the civilian
population will simply be lost and there is
a rapid decline of medical provisions.
A situation made even worse as the British
will now bring the Blitz to Germany by bombing
their cities.
There, in Britain, the Blitz ended in May
and the health care system has been given
a chance to catch up, but the situation still
remains grim and just like in Germany many
people are dying for the lack of basic care.
And as the war now rages to the East it is
the population behind the front lines in the
Soviet Union that will face medical shortages.
I will get back to that in future episodes,
as I will try to cover health care on the
home fronts in Eastern Asia.
In any case, it’s a lot of suffering, and
one can easily lose faith in humanity.
But in that moment, we should remember one
thing.
After this war is over, the crisis facing
health care in many parts of the world in
1941 will be one of the main things that creates
a rapid rethinking of public health care,
especially here in Europe.
In Great Britain it will give birth to the
NHS, in Germany and many other parts of Europe
the tragedy of the war will contribute to
the reforms that will eventually lead to universal
health insurance, and health care systems
with the capacity for many, many more people
than before the war.
So if, now in 2020, you feel a scratchy cough
coming on, or one of your loved ones has come
down with COVID-19, remember that it was the
sacrifice of this generation that ensures
that you have a much better chance of getting
well again.
Now, it’s the contributions of the TimeGhost
Army that makes sure that our channels stay
healthy and alive.
Sign up for the TimeGhost Army on Patreon
or TimeGhost.tv - Make sure to subscribe,
and ring that bell.
Stay safe and take care of your health and
that of others.
