CHAPTER XIV
Austria
Colonel Charles J. Farinacci, MC (Ret.)
POLITICAL AND MILITARY BACKGROUND
After World War I, the new republic of Austria was only atiny remnant of the former Austro-Hungarian Empire. Badly disorganized andfinancially insecure, it would hardly have survived had it not been for thesupport of the League of Nations. The rise of the National Socialist party inGermany under Adolf Hitler had violent repercussions in Austria, and afterseveral upheavals, the little country lost its independence and was absorbedinto the greater German Reich by Hitler on 13 March 1938 (map 14). Its centraladministration was removed from Vienna to Berlin, and the Austrian people weresubjected to regional and local governments composed of German and AustrianNazis.
The political objectives for the ultimate occupation ofAustria, as enunciated by the Allies in their Moscow Declaration of 1 November1943, differed fundamentally from those for Germany since the European AdvisoryCommission was agreed "that Austria, the first free country to fall avictim to Hitlerite aggression, shall be liberated from German domination."The Allies regarded the 1938 annexation of Austria as null and void, anddeclared further that they wished to see reestablished a free and independentAustria, whose people would become both politically and economically secure.1
Allied Commission
The European Advisory Commission was organized early in 1944in London, with American, British, and Soviet delegates. In March 1945, theCommission was enlarged to admit France as the fourth power in the occupation ofAustria. Each power was to have its own zone and share in the occupation ofVienna.
Early in 1945, the plans for Austrian occupation changeddrastically because of the rapid weakening of the German Army in Germany.Indications were that the invasion of Austria would be effected more easily fromthe northwest (Germany) than from Italy, as had originally been planned.Accordingly, in mid-April 1945, the SHAEF (Supreme Headquarters, AlliedExpeditionary Force) military government staff, although already fully occupiedwith its work in France, Belgium, and Germany, and having had no time to studythe problem, took on the additional task of preparing
1SHAEF Provisional Handbook forMilitary Government in Austria, April 1945, p. 15.
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MAP 14.-Austria and adjacent countries from 1919to 13 March 1938.
directives for Austria. Military government field detachmentpersonnel from Italy were hurriedly assembled, reinforced, transferred to theEuropean Civil Affairs Command, and sent to Austria.
This transfer of control at the last moment had manyunfortunate effects upon military government in Austria. Although the tacticalphase of military government should have ended on V-E Day, it was necessarilycontinued for a few weeks until early June 1945. The boundaries were based upontroop deployment rather than territorial lines. Consequently, since many Armydivisions and all higher units were partly in Germany and partly in Austria, itwas only natural that Austria should be treated initially as part of Germany andthat the same policies and methods as had been prescribed for the Germans shouldbe applied to the Austrians. Obviously, there were conflicts between these SHAEFdirectives and those which were being developed in the 15th Army GroupHeadquarters in Italy for use in
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Austria when the command would pass from SHAEF to USFA(United States Forces in Austria). However, by the maintenance of close liaisonbetween the military government teams in Austria and with the hearty cooperationof the SHAEF officers, these differences were resolved satisfactorily.
Early in May 1945, the U.S. element of Headquarters, 15thArmy Group, commanded by Gen. Mark W. Clark, was selected for reorganizationinto Headquarters, USFA, and General Clark was designated as the U.S.Commissioner on the Allied Council. He remained in this capacity until succeededby Lt. Gen. Geoffrey Keyes on 17 May 1947.
Late in June 1945, a joint British-French-Americanreconnaissance party entered Vienna to survey and discuss the situation with theSoviets, who had been in military control there since April. On the basis of theparty's report, the European Advisory Commission in London concluded theagreements on control machinery for Austria and the occupation zones early inJuly (2 months after V-E Day).
On 6 July, command of the U.S. occupation forces in Austriapassed from SHAEF to USFA; and in early August, Headquarters, USFA, moved fromItaly to Salzburg, Austria. This transfer helped to accomplish three importantthings: the reassembling of the public health personnel of the U.S. element ofthe Allied Commission; the briefing of U.S. personnel who had been serving inItaly in military government capacities up to this time; and preparation of theAllied quadripartite operations on the national level after the establishment ofUSFA Headquarters in Vienna. Following a number of conferences with Sovietofficials in Vienna, the British, French, and U.S. Headquarters moved there latein August; on 11 September 1945, the Allied Council held its first officialquadripartite meeting (4 months after V-E Day).
Occupation Zones
The Four Power Declaration of 4 July 1945 stated that Austriahad been restored to its 1937 (pre-Anschluss) frontiers; it was administrativelydivided into eight provinces and the city of Vienna. The same Allied agreementdivided 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) thatpart of the province of Upper Austria (M?hlviertel) which lies on the northbank of the Danube River and shares a common frontier with Czechoslovakia and asmall 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 theDanube 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.
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The British zone included the provinces of Carinthia andStyria which have common frontiers with Italy and Yugoslavia (map 15).
National Elections
A provisional Austrian Government was established inApril-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 since1937 for a national parliament and (provincial) Land legislatures. A gratifying93 percent of the registered vote was cast. The resulting parliament consistedof 85 representatives of the Peoples Party (conservative), 76 Socialists, andfour Communists. Dr. Renner was elected Federal President and was installed inoffice on 20 December 1945.
ORGANIZATION AND PLANNING FOR CIVIL PUBLIC HEALTH
Although a civil affairs unit for occupation of Austria wasauthorized by the combined chiefs of staff of the Allied Command on 8 January1944, it was not until 10 April that the actual organization of the"Austrian Country Unit" started its function. Civil Affairs planningfor Austria was based upon a SHAEF directive of 23 May 1944. The Austrian PublicHealth Section was thus organized and worked with the Germany Planning Sectionin the formulation of plans for the occupation of a liberated Austria. On 4January 1945, the Public Health Section in London became the Public HealthBranch of the Internal Affairs Division, USGCC/A (United States Group ControlCouncil (Austria)). This newly organized branch was composed of two officers,Maj. Edwin F. Daily, MC, chief of the Public Health Branch, and Capt. (laterMaj.) Paul X. Blattler, SnC, Sanitary Engineer. In March 1945, the Public HealthBranch, along with the other divisions of USGCC/A, established temporaryheadquarters at Caserta, Italy.
Public health planning and preparation during the stay ofUSGCC/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 adraft of Public Health (Austria) Policy directives. Close coordination wasmaintained with the MTOUSA (Mediterranean Theater of Operations, U.S. Army)Surgeon and G-5, particularly in regard to earmarking and allocating medicaland sanitary supplies and equipment for the United States Zone of Austria.2
With the realization that the German Reich would sooncapitulate, military government officers, in April 1945, were detached fromcivil affairs units of both the American Fifth Army and the British Eighth Armyand were hastily transported to Germany; there, they were assigned to thevarious military government teams of fast-moving Gen. George S. Patton's ThirdU.S. Army to function as Austrian Land and Kreis civil affairs teams undertactical command. The public health group of the USGCC/A,
2Blattler, Maj. Paul X., SnC, and Col.C. J. Farinacci, MC: Outline History of Public Health Activities Relating toMilitary Government of Austria (19 November 1945).
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MAP 15.-Allied Zones of Occupation in Austria, 22 April 1946.
except for some officers who were sent into Austria onspecial target missions, remained in Italy until 23 June, when the entire publichealth staff of the USGCC was assembled in Salzburg by the regional militarygovernment.
In early May, the two Land Military Government Public HealthSections had begun to function. In Land Salzburg, Lt. Col. (later Col.) RalphMarks, 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 theChief Public Health Officer. Colonel Farinacci and Lt. Col. (later Col.) JamesTobin, MC, had moved in with elements of the Third U.S. Army to establish thefirst Public Health Section of the Land Upper Austria Military Government Team.Until 1 August 1945, these two Land Military Government Public Health Sectionsin the U.S. zone of Austria operated independently.
Colonel Marks and Captain Blattler, while operating in LandSalzburg, concentrated on correcting sanitary conditions throughout the watersupply system. This included chlorination of various sources of supply followingreports of rising numbers of typhoid fever cases in and near the city ofSalzburg. Civilian laboratory facilities were utilized for chemical andbacteriologic analysis of drinking water. Equally alarming were the publichealth problems preoccupying Colonel Farinacci and his Public Health Section inLand Upper Austria. They were confronted with the spread of venereal disease,crowded housing conditions, shortages of many medical supplies and soap, and atyphus epidemic. The disease had spread from the German concentration camp atMauthausen, in June 1945, to exposed and ill
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inmates of nearby concentration camps. The laxity inpermitting such persons to cross the borders was discussed with the Austrianhealth authorities. Border control posts were established so that all personscoming 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 MilitaryGovernment was relieved from subservience to Corps and Divisional Commands. TheUSACA (formerly Regional Military Government) now cameunder the command of General Clark. By 1 September, USACA had established afunctional headquarters in Vienna. The Public Health Branch of Internal AffairsDivision gave all possible assistance to the Public HealthOffice of the Vienna Area Command, which was headed byMaj. Robert C. Hume, MC, in August 1945. He was replaced in early September byMaj. John F. Ellis, MC. Colonel Miles was in charge of the Military GovernmentPublic Health Section, USACA, from its activation in September 1945 until he wasrelieved by Colonel Farinacci on 21 September 1945.
Brig. Gen. Edgar E. Hume, a Medical Corps officer assigned toG-5, arrived in the city of Salzburg in September 1945 and became responsiblefor the Regional Military Government of the U.S. zone of Austria. Because of theisolated location of the Vienna Area Command, it was decided that itsheadquarters would be independent of General Hume's Group. The USACA was tobecome only a policymaking coordinating unit of USFA in its quadripartiteactivities and in its close liaison with the Austrian Public Health Section.
SPECIAL PROBLEMS OF CIVIL PUBLIC HEALTH
Upon cessation of hostilities in theEuropean theater in May 1945, a heavy burden of responsibility was assumed bythe occupying forces in Austria. One of the most serious and urgent problems wasthe immediate safeguarding of public health and preventingthe spread of epidemics. This was essentially a military operation under thequadripartite control of the United States, Great Britain,France, and Russia. Each nation assumed complete responsibility in its zone forthe 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 1945found the quadripartite powers somewhat unprepared for the complex public healthproblems which confronted them. In the first days of the occupation, the majortask facing the U.S. Army was that of halting, under conditions of extremefilth, malnutrition, and starvation, the spread of serious communicable diseasesby disease-infested victims of Nazi oppression among a civilian population thatwas both demoralized and confused. Land Upper Austria and, to a lesser degree,Land Salzburg, in the spring and summer of 1945 were fociof such problems. In addition to the indigenouspopulation,
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FIGURE67.-Border control post established toinsure that all persons entering the American Zone by rail, road, or water weredusted with DDT powder to control typhus.
estimated at somewhat more than 1 million inhabitants, therewere an estimated 700,000 displaced persons and refugees, including about 80,000concentration camp inmates of five large camps, 200,000 displaced Austrianrefugees, and 250,000 disarmed enemy forces (prisoners of war).
The "denazification" program, which involved thedismissal of public health officials belonging to certain categories of the NaziParty, was carried out in an orderly manner as soon as suitable replacementsbecame 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 Naziofficials were unavoidable.
Communicable Diseases
Reporting of communicable diseases had been satisfactoryuntil the invasion of Austria but was reestablished with considerable difficultyafter the invasion because of the poor postal service, lack of vitaltransportation for physicians and health officials, and the mass movement ofrefugees and displaced persons. The reporting of vital statistics throughSeptember 1945
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in the U.S. zone continued to be unsatisfactory. However, byNovember, the Provincial Government's nationwide reports of mild epidemicswere reasonably prompt, and control measures were instituted fairly early.Weekly reports of deaths from communicable diseases were received by LandMilitary Government Public Health Officers from the Austrian public healthauthorities. Each item on the report indicated whether or not the individualswere Austrian. Charts and graphs were made from these reports by the PublicHealth Branch of the USACA in Vienna.
The principal contagious diseases occurring among theindigenous population were typhus fever, the enteric group (typhoid,paratyphoid, and the dysenteries), diphtheria, venereal diseases, andtuberculosis.
Other complex problems, such as the huge hospitalization andtreatment problems of the total civil population, were aggressively pursued bythe U.S. Army Medical Department with the assistance of such medical units asevacuation hospitals and field ambulance units. In a few months, the crisis hadpassed and general conditions stabilized.
Typhus fever.-The most serious communicable diseaseencountered by displaced persons was typhus fever.3 Althoughlouseborne typhus was endemic in the area, the largest outbreaks occurred in theU.S. zone and were imported from outside sources. To prevent the importation oftyphus fever into the U.S. zone, border control dusting stations wereestablished at all important road, rail, and water entrance points. There, allindividuals entering the area were dusted with DDT powder. To indicate that thishad been accomplished, an entry was made on the identity card of each persondusted. The greatest number of typhus cases occurred among former concentrationcamp inmates in the vicinity of Linz in Upper Austria (fig. 68) during July,August, and September 1945. In Vienna and Salzburg, typhus arrived inmid-October with displaced persons from the Sternthal Camp in Yugoslavia.Isolated cases were reported in camp hospitals or civilian hospitals. Everyeffort was made to delouse contacts in displaced persons' camps and atshipping 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-
3Bayne-Jones, Stanhope: Typhus Fevers. In Medical Department, United States Army. Preventive Medicine in World War II. Volume VII. Communicable Diseases: Arthropodborne Diseases Other Than Malaria. Washington: U.S. Government Printing Office, 1964.
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FIGURE 68.-The power spray proved to be a quick and effective weapon against body lice. DDT is applied at displaced persons' camp in Linz, Austria, July 1945.
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-
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tions because Colonel Farinacci could procure the necessaryDDT supplies and dusting guns from the Third U.S. Army as a result of hispersonal 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 anepidemic which had been, at the onset, a serious threat because of the extensivelouse infestation. The United States of America Typhus Commission fully approvedthe interzonal use of all control items regardless of the source of thesupplies or the occupation area where they were ultimately used.5
Venereal diseases.-In the U.S. zones and the city ofVienna, venereal diseases were routinely reported for the first time in Austrianhistory when the venereal disease law of August 1945 was enacted. There was anupward trend in the rates for venereal diseases during the occupation period inthe U.S. zone.
During November 1945, the system of reporting venerealdisease in the Vienna Area Command had been greatly expedited. Companycommanders and the Provost Marshal, for the most part, were responsible forcontacting American troops.6 The Vienna City Department of PublicHealth aided them in this particular function by doing all work for civiliancontacts. The existence of venereal diseases in Vienna among the indigenouspopulation and military population was largely due to poor personal hygiene anda high incidence of promiscuity. Progress was made in establishing clinics andtraining public health casefinding teams.
There was a definite increase in syphilis in comparison togonorrhea during this period in the three U.S. zones of Land Upper Austria, LandSalzburg, and the city of Vienna.
The U.S. Army helped to reestablish free venereal diseasediagnostic and treatment clinics for civilians in its zones. Penicillin,furnished for the treatment of gonorrhea, helped to retard the spread ofvenereal disease. Other drugs and supplies were provided, administration wascarried out in the clinics supervised, and full publicity was given to the civilpopulation 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-
4Personal diary, Col. C. J. Farinacci, MC.
5Memorandum, Capt. Henry M. Lemon, MC, Field Headquarters, APO 757, for Brig. Gen. Stanhope Bayne-Jones, Director, USA Typhus Commission, 16 Feb. 1946, subject: Report of Typhus Control Survey in Austria 16 January to 4 February 1946.
6Military Government, Austria. Report of the United States Commissioner, November 1945, No. 1, p. 14.
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cupation. In general, tuberculosis had appeared in alarmingrates in the urban centers.7
The U.S. Army Medical Service helped to reestablishdiagnostic and treatment centers in each of the three U.S. zones. Fewsanitariums or tuberculosis hospitals had been built during World War II by theGermans so that efforts at control were severely handicapped by the lack ofhospital beds.
Other communicable diseases-Diphtheria.During the period before January 1946, diphtheriaincreased sharply among the preschool and adult age groups in the U.S. occupiedzones. This was attributed to the breakdown in the immunization program duringthe war. In November 1945, the Austrian civil public health authoritiesundertook a mass diphtheria immunization program to protect the school childrenand preschool group (ages 12 years and younger). This program was carried out ona voluntary basis by the local authorities with the assistance of the U.S. ArmyMedical Department.
Enteric diseases. Of the three zones, the city of Viennashowed the highest incidence of enteric diseases. Previous epidemiologic studiesconducted by the Austrian health authorities revealed that 56 percent werecaused by contact infections, overcrowding, poor hygienic facilities among thepopulation, lack of control of carriers, and failure to trace contacts tocases.8
Typhoid fever. During the early months of the occupation,a high incidence of typhoid fever was reported, which was traceable to humancarriers and not directly to the food, water, or milk supplies. The lack oftrained personnel in the city health departments of each of the three U.S. zonesretarded the public health enterprise.9
Medical Supplies
By the end of 1945, the U.S. Army had released to theCivilian Medical Supply Pool in Vienna more than 40 tons of noncaptured medicalsupplies. To alleviate some of the bottlenecks in the awkward system ofdistribution, the U.S. Army contributed a total of 161.64 tons of medicalsupplies to the city of Vienna by the end of December 1945.10The U.S. Forces in Western Austria aided Land Salzburgby setting up collecting points for captured enemy material.
The U.S. Army made specific contributions of necessaryhospital equipment to the Austrian Provisional Government and providedassistance in transporting and distributing these critical items. Many privaterelief organizations helped by supplying such items as food, clothing, andmedical supplies.
Between September and November 1945, 50 CA (Civil Affairs) De-
7See footnote 6, p. 516.
8See page 50 of footnote 6, p. 516.
9See page 13 of footnote 6, p. 516.
10Military Government, Austria.Report of the United States Commissioner, December 1945, No. 2, p. 155.
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tachment Medical Units were requisitioned and distributed onthe 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 otherrequisitioned supplies including additional amounts of DDT and dusters,sulfonamide drugs, alcohol, ether, and biologicals.
The Austrian health officials were responsible fordistributing medical supplies to hospitals and other institutions under the LandMilitary Government. In Vienna, medical supplies from the American, British,French, and Russian Armies were pooled for the entire city.12 By theclose of 1945, adequate medical supplies for the U.S. occupied zone had becomeavailable.
Environmental Sanitation
Water and sewage.-Field environmentalsanitation inspections in the U.S. zone were accomplished by one qualifiedSanitary Engineer assigned to the Public Health Branch in Vienna. One of thebiggest 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 offunds.13 The cities of Salzburg, Linz, Steyr, and Vienna wereconfronted by many broken water mains caused by Allied bombing. Chlorinationsupplies were provided by the U.S. Army, and normal water and sewage systemswere restored in a few months in the major cities, except Vienna. The damage tothe water and sewerage systems in Vienna had been more extensive, and some areaswere 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 sewersdamaged by the Allied bombardment of Vienna had been repaired. The controlsewerage system of the city was regarded as reliable. Other work in the field ofsanitation included the supervision of refuse disposal and other generalsanitation problems, such as public baths and buildings. Stream pollution wasnot regarded as a problem by the Austrian health authorities.
Insect and rodent control.-Insect and rodent control wasleft almost entirely to private enterprise. Private firms were engaged by thecivil governments of Vienna, Salzburg, and Upper Austria to carry out ratextermination programs.
Refuse disposal-Disposalof refuseduring the early months presented a problem because of the shortage oftransportation and personnel required for removal and disposal. The methods ofstorage, removal, and disposal of refuse were considered satisfactory. Refuseand debris were used to fill in lowlands, swamps, and craters.
11See page 51 of footnote 6, p.516.
12See footnote 3, p. 514.
13Beckjord, Lt. Col. Philip R., MC:Preventive Medicine in Austria: A Post War Report, March 1950, p. 2.
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Nutrition
The serious nutritional state of the Austrian population canbe appreciated fully in light of the dietary trends that occurred from Januarythrough December 1945. Briefly, the history of food and nutrition passed throughthree separate economic phases: (1) under the economy of the Third German Reichfrom 1939 to April 1945; (2) under the occupation of the Soviet Army from Aprilto September 1945; and (3) during the quadripartite administration which beganin September 1945.
From January to April 1945, 1,500 calories were available tothe normal consumer. When Vienna fell, the city's food stocks were captured bythe Red Army, considered to be war booty, and sequestrated. Between 1 June and31 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 fourpowers in Vienna, with civilian authorities handling its distribution. A totalof 1,550 calories per normal consumer was authorized.14
The food situation in Land Upper Austria and Land Salzburgduring 1945 was somewhat different. The food distribution continued throughoutthe year in a relatively normal manner because the campaigns through theprovinces were rapid and war damage was insignificant. Indigenous supplies werenot confiscated; yet, in the large urban centers such as Linz and Salzburg, thesupplies were so short during the summer months of May through August that thecity dwellers subsisted on a dangerously low caloric intake. In July 1945, anutritional survey was conducted in Linz by the USFET (U.S. Forces, EuropeanTheater) Nutrition Team, composed of Dr. Charles S. Davidson, Consultant, Officeof 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 disarmedmilitary personnel, formerly prisoners of war, showed frank evidence ofstarvation, (2) the caloric intake of the civilians surveyed ranged from 801 to944 for normal consumers and 1,044 for heavy workers, (3) the authorized rationscale in effect on 10 July was 762 calories per normal consumer (this was raisedto 1,040 calories on 18 July), and (4) the ration allowance for displacedpersons 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, Chiefof OMGUS (Office of Military Government of Germany, United States) Public Healthand Welfare, along with the Nutrition Team and Colonel Farinacci, inspected bothprisoner-of-war camps and civilians in Linz, Austria.16 Oth-
14U.S. Forces in Austria, MilitaryGovernment, 22 Apr. 1946, p. 75.
15Letters, Maj. Harold L. Wilcke, SnC,Charles S. Davidson, M.D., and Pvt. Phillip J. Reiner, Headquarters, TwelfthArmy Group, to Surgeon, Headquarters, Twelfth Army Group, APO 655, 24 July 1945,subject: Nutritional Survey of the Population of Linz, Oberdonau, Austria.
16Davidson, C. S., Wilcke, H. L., and Reiner, P. J.: ANutritional Survey of Starvation in a Group of Young Men. J. Lab. & Clin.Med. 31: 721-734, July 1946.
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er than such isolated instances as occurred in Linz and inthe German prisoner-of-war camps, there was no period of acute distress and lackof subsistence issue in the U.S. military occupation zone.
Beginning in December 1945, the official ration authorized bythe U.S. military government in the two provinces was:17
Consumer | Calories |
Normal consumer | 1,550 |
Heavy workers | 3,000 |
Sick and hospitalized persons | 2,250 |
Pregnant and nursing women | 3,000 |
The U.S. Nutrition Office was established in the PublicHealth Branch, USACA, on 13 December 1945, with two officers of a four-mannutrition 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 asample population of 500 adults. The data for Vienna from this program revealedthat the sample population of 500 Austrian individuals compared favorably withthe existing nutritional standards adopted for the German population by theAllied Powers. A comparison of results from the December study with nutritionalsample surveys conducted in Vienna in September by the USFET Nutrition Teamrevealed that the data compiled by Captain Lewis and his group showed positiveand marked improvement in body weight. Further, the weight loss of the groupabove 40 years of age presented the most striking deviations. Lastly, thechildren up to 19 years of age showed a satisfactory state of weight.18
Routine nutrition surveys of the civilian populations ofVienna, Salzburg, and Linz were planned by the Nutrition Office for 1946. Othertypes of permanent operations of this group were special surveys of displacedpersons' camps, rural surveys, trouble areas, and routine 3-month surveys ofthe three principal cities in the U.S. zones.
During 1945, the U.S. Army nutritionists in each of theirareas undertook substantial food distribution for children, pregnant women,nursing mothers, and for the hospitalized. Not until April and December 1946 wasa supplementary food supply program for all of Austria carried on by UNRRA(United Nations Relief and Rehabilitation Administration) and UNICEF (UnitedNations Children's Fund).19
Other organizations assisting the U.S. Army in 1945 with anabundant food distribution program in Austria were the American Red Cross,
17See footnote 14, p. 519.
18Letter, Capt. Robert V. Lewis, MC,to Chief, Public Health Branch, U.S. Allied Control Commission, Austria, 14 Jan.1945, subject: Special Report on Analysis of Street Weighing in Vienna.
19Beckjord, Lt. Col. Philip R., MC:Nutrition in the U.S. Zone of Vienna and Austria, 1945-1949, November1949, p. 3.
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the National Catholic Welfare Conference, and the AmericanJoint Distribution Committee.
In general, the job of the U.S. Army nutrition officers wasto form teams and gather data on food consumption, height, and weight. TheseNutrition Teams also conducted physical and laboratory examinations of manythousands of individuals in the city of Vienna and the other U.S. zones.Eventually, Austrian personnel were trained to do the work under direction ofthe teams.
One of the many great contributions made by the U.S. ArmyNutrition Teams was that of determining the percentage incidence ofundernourishment, both within the general population and in each age group.
Veterinary Medicine
By May 1945, the Austrian civilian veterinary activities werebeing reestablished, and veterinarians were appointed at various politicallevels in the U.S. zones.20 Veterinary medical supplies wereobtained and distributed to various cities. The regional diagnostic laboratorywas reactivated in Salzburg.21
Throughout the U.S. zones, a sufficient number ofveterinarians were stationed to provide service satisfactory by prewar Austrianstandards. Several epidemics of anthrax and hog cholera were reported, andbiologicals, requested by the Austrians, were secured by air from U.S.stockpiles in Italy. When these epidemics were carefully investigated, noneproved as serious as first reported.
Manufacture of veterinarian biologicals was started in plantsnear Salzburg and Vienna. Food and meat inspections were consideredunsatisfactory in Salzburg, Linz, and Vienna, according to U.S. Army standards,and the local authorities repeatedly were instructed concerning improvement ofthese inspections.22
Milk sanitation-Inspection of theAustrian dairies within the U.S. zone revealed that the Austrians had a goodworking knowledge of milk sanitation. However, they did not have sufficientreserve equipment to continue their methods of pasteurization satisfactorilyshould existing plant equipment break down.
Animal diseases.-The most important animal diseases werethe foot-and-mouth disease in cattle, scabies in horses, and erysipelas andpoliomyelitis in swine. Of these, scabies and poliomyelitis were brought on bywar conditions.
All abattoirs throughout the U.S. zones were under U.S. Armyveterinary supervision. One laboratory which diagnosed animal diseases was in
20See footnote 2, p. 510.
21Medical Department, United StatesArmy. Veterinary Service in World War II. Washington: U.S. Government Printing Office, 1961, pp. 471-472.
22Report, Maj. E. F. Daily, MC,subject: Civil Public Health History, European Theater of Operations, Austria,undated, pp. 8-9.
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operation in Salzburg; this laboratory also started producingswine 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 civilianpopulation in the three U.S. zones.
During the winter of 1945, increasing illnesses andepidemics traceable to malnutrition overtaxed the Austrian Medical Service.Problems of communication and transportation often prevented patients fromreaching their physicians, or physicians from visiting their patients.
Initially, Corps surgeons were responsible for medical andhospital care of displaced persons and for the proper sanitation of their camps(fig. 69). Later, the Surgeon, USFA, was given this responsibility, which hethen delegated to his Division surgeons. Elements of two medical battalions wereassigned to Land Salzburg and Land Upper Austria to assist the Austrianauthorities in providing these services. In most instances, professional servicefor displaced persons was provided by physicians and nurses who were themselvesdisplaced persons.
The U.S. Army abolished the Nazi medical organization in theU.S. zone. The new Austrian Red Cross helped considerably in reestablishing itsambulance service in Land Upper Austria and Land Salzburg. Confiscated Germanambulances were transferred by military government public health officers fromSalzburg to Vienna.
Hospital dispensaries under the care of displaced medicalpersonnel 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, prenataladvice to mothers, well-baby clinics, and care of the preschool and the schoolchild remained divided between public health and public welfare agencies.
The welfare workers were given increasing responsibility inthese matters. While the medical aspect of the prenatal and well-baby clinicswas under the jurisdiction of the Austrian health officials, the materialaspects, including furnishing food, clothing, and medical supplies, were handledby welfare agencies.
The health of the school children remained the responsibilityof educational authorities. School physicians were appointed by the local schoolofficials, and, often, the county health officer obtained the appointment.
Maternal and child health care progressed in Austria andcontinued to remain the responsibility of the Land (State) officials. Because ofthe history of socialized medicine in the country and the support provided bythe
23See footnote 2, p. 510.
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FIGURE69.-Liquid spraying of bedding, onemeasure taken to improve sanitation at displaced persons' camps, isaccomplished in a camp near Linz, Austria, July 1945.
Catholic Church and other charities, remarkable contributionsto 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 andchild health program of modern Austria compares more than favorably with thegreat Western democracies."24
Relationship Between USACA Public Health and the Austrian Medical Schools
Many well-trained specialists resided in the U.S. zone ofAustria, especially in Vienna. The University of Vienna and the AllgemeinesKrankenhaus (fig. 70) were well staffed by such notables as Prof. Dr. Chiari,chairman of the Department of Pathology; Prof. Dr. Artz, chairman of theDepartment of Dermatology and Syphilology; Prof. Dr. Lauda, chairman of InternalMedicine; and Prof. Dr. Wolfgang Denk, dean of the Medical Faculty. The othermajor cities, Linz and Salzburg, were similarly well supplied with medical anddental specialists. The University of Vienna had a heavy enrollment during thewinter session of 1945, and all the clinics were well attended. Despite thepreoccupation of the USACA Public Health Section with the immediate problem ofthe quadripartite meetings, Allied problems of control of contagious diseases,and other matters, it did concern itself with aiding and encouraging theUniversity to reestablish itself as an international medical center. The PublicHealth Section solicited the
24See page 4 of footnote 13, p. 518.
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FIGURE 70.-The Allgemeines Krankenhaus (general hospital), Vienna, affiliated with the University of Vienna Medical School.
Armed Forces medical units for donations of medical journalsto the University, and encouraged and arranged for American military medicalofficers to attend short courses there. In addition, the University was aided inits campaign to reestablish its former relationships with American universitiesand with the Rockefeller Foundation. Foreign speakers were encouraged to appearbefore the Austrian medical profession. Considering the many difficulties placedin their paths by the disasters of war and with their nation's occupation byfour victorious powers, physicians, dentists, and veterinarians cooperatedwholeheartedly in carrying out the military government public health programs.However, they were uneasy over the denazification program because, as more thanone physician stated, "Who wasn't a Nazi?"
Col. Thair Rich, MC, Surgeon, USFA, a vigorous proponent ofimproving the relations between the U.S. Army and the University of Vienna, madegreat progress in promoting clinic attendance by American Army medical officers.Maj. Gen. E. A. Noyes, Surgeon of USFET, was sympathetic and helped theUSFA-USACA's program of aid to the University.
By the middle of 1947, the refresher courses conducted by theUniversity of Vienna were well established. An average of 10 U.S. Army medicalofficers attended each 6-week refresher course, which consisted of internal
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medicine, hematology, electrocardiography, surgery,dermatology, and pathology. Each officer was responsible for the payment of histuition. Since money was worth little, a barter system was set up and manyofficers paid their tuition with Care Parcels. Upon completion of the 6-weekrefresher training, each graduate received a diploma from the Medical Faculty ofthe University, certifying his successful completion of the training.25
Relationship With Austrian Public Health Authorities
Although the personal relationships with the Austrian publichealth officials were extremely cordial and the Austrians appeared anxious toimprove their services, the U.S. military government public health officersfrequently were disappointed at the slow progress being made. At times,personnel in the higher echelons of USACA apparently did not understandAustrian health problems; they were more concerned (and justifiably so) with theserious problem of coping with inter-Allied and Soviet politics. Sometimes, theslow progress resulted from the apparent inertia of the Austrian public healthofficials themselves, who were reluctant to change the status quo because of theunsettled political balance of power, and who feared dismissal from theirgovernment positions by their political overlords. Sometimes, the lack ofprogress was aggravated by the inability of the quadripartite public healthgroup to agree as to what was best for the Austrians (since each of the fourpowers had its own idea, and each probably had its own selfish motive). At othertimes, the very structure of this newly formed Austrian Government preventedaction. For example, the Land (State) public health sections were not under thedirect rule of the Austrian Central Federal Government Department of PublicHealth; therefore, the Land health authorities in the U.S. zone and as inthe other occupation zones were not compelled to carry out the CentralGovernment directives unless their governor (Landesdirektor) accepted theCentral Government's ruling. In other instances, a lack of funds was adeterrent since Austria was financially insolvent after the collapse of theGerman Reich.
During the early months of the occupation, as the Austrianpublic health officials realized the sincere desire of the U.S. militarygovernment public health officers to assist them in reestablishing their healthservices upon a sound progressive basis, their cooperation was excellent.However, there were delays, sometimes from lack of communication with the Landand Bezirk public health officials. Another serious handicap was theinsufficient number of automobiles to transport Austrian health personnel (atboth Land and national levels) so that either adequate supervision of publichealth activities and prompt investigation of alleged disease outbreaks had tobe delayed or vehicles had to be borrowed from the military government.
25Personal communication, Col. Ralph Marks, MC (Ret.), whoattended such a course during the period 2 June-12 July 1947.
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SUMMARY
A SHAEF directive, issued on 23 May 1944, was the basis forCivil Affairs/Military Government Public Health Planning for Austria. Thisdirective was the culmination of many months of planning, coordination, andorganization of the Allied Civil Public Health Organization for Austria by theChief of Staff to the Supreme Allied Commander.
Throughout the remainder of 1944 and the early months of 1945and, finally, with the capitulation of the Third German Reich in May 1945, theCivil Affairs Planning Group for Austria was developing a functionalorganizational structure. This military government public health organization,which had its inception in England, carried out its policies and programsthrough the able assistance of its public health specialists, who served withEuropean Civil Affairs Detachments in Italy and, later, with military governmentteams in Northwest Europe.
Of the remaining key U.S. Army public health officers who hadnot rotated to the United States for separation from the service following theItalian campaign, a few became the hard core of the several public healthsections in the U.S. zone of Austria.
Among the first public health specialists to arrive inAustria were those assigned to interim military government teams with GeneralPatton's Third U.S. Army. Some officers were assigned to Land (State) andKreis (County) in Land Salzburg and Land Upper Austria while others later joinedthe Vienna Area Command Public Health Section and the military public healthsections of the U.S. Allied Commission Headquarters, USFA, under the command ofGeneral Clark. These officers engaged in the task of advising, revitalizing, andassisting the Austrian public health authorities and the other related agenciesin the regrowth and redevelopment of their local public health facilities.
Civil public health problems confronting the specialists inthe U.S. zone were varied and complex. They assisted the Land and Kreisofficials in dealing with such chronic special public health problems ashousing, feeding, medical care, and disposition of displaced persons, refugees,victims from concentration camps, and prisoners of war. They also assistedAustrian public health officials in the control and prevention of communicablediseases, logistic and materiel support, maternal and child health,hospitalization, reporting of communicable diseases, medical supplies, treatmentof prostitutes, public health education, and the reestablishment of the health,medical, and paramedical agencies, and long term health programs such asdiphtheria and tuberculosis control. Still another important function of theMilitary Government Public Health Section of USACA was that of acting with theAllied Commission Quadripartite Health Working Party under the new AlliedControl Agreement.
In general, the relationship of U.S. public health personnelassigned to the various military sections of the U.S. occupation zone withAustrian
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public health officials was based on cordiality and mutualprofessional respect in the multiplicity of tasks which confronted them all. TheU.S. personnel soon realized that many central government directives andrecommended public health programs could not be implemented because of limitedfunds.
By the end of December 1945, the general health of theAustrian population, as measured by vital statistics, communicable disease andnutritional analysis, and a study of hygiene and environmental sanitation, hadgreatly improved.
The Austrian Public Health Services were reestablished on thepre-Anschluss basis in the three areas of the U.S. zone of Austria. Manyexperienced official physicians (Amts?rzte) who had embraced the German Naziideology were caught up in the U.S. denazification program with the result thatmany of them had to be removed from office. Trained replacements were difficultto find, especially on the Bezirk level.
Reporting of communicable disease was irregular due totransportation and communication problems. Beginning in November 1945, for thefirst time, the Renner Provisional Government began collecting morbiditystatistics on a nationwide basis. By the end of December, communicable diseasesamong the indigenous population had dropped considerably. Typhus fever was nolonger the problem it had been during the early part of the occupation. Typhuscontrol measures to protect the city of Vienna were in operation; within thecity, all the Bezirks were covered, and a cordon sanitaire operated effectivelyon the city's perimeter. With the gradual improvement of living conditions inVienna, the incidence of dysentery decreased. The enteric diseases, diphtheria,and tuberculosis had been of relatively high incidence. Venereal diseases werebeing reported routinely for the first time in Austrian history.
Medical supplies were available in adequate amounts withinthe 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 thatsupplies were issued chiefly to hospitals and other public institutions. Retailpharmacies could not be stocked since there was no control over the sales ofdrugs.
Routine nutritional surveys of the civilian populations ofLinz, Salzburg, and the U.S. zone of Vienna were conducted by the militarygovernment health officers, beginning in September 1945. It was evident from theonset of the occupation that the greater need for nutritional improvement wouldbe in the larger cities such as Vienna. The rural communities of Upper Austriaand Land Salzburg were more often able to supplement their rations withsufficient food for proper maintenance of life without calling for additionalamounts. The city of Vienna, on the other hand, was in dire straits during theperiod between the capture of the city and the arrival of the U.S. Army.
By the end of December 1945, the nutritional survey conductedby the
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American and British elements in Vienna failed to reveal anyspecific nutritional diseases although the studies did show definite weight lossas the most striking nutritional deficiency. In addition, the Viennese diet wasdeficient in both protein and vitamins, and approximately 82 percent of the dietwas made up of carbohydrates. On several occasions, hunger edema had beenreported within the U.S. zone of Vienna. Upon investigation, in all instances itwas found that the persons involved were elderly people, and the edema was theresult 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 GovernmentHealth Department, in close liaison with the U.S. Public Health staff throughoutthe U.S. zone, was gradually assuming more responsibility in the civil publichealth activities of its people.
During 1946-47, following the Austrian national elections,the newly formed Austrian Coalition Government was beset by the divergent aimsof the four powers. The British, French, and U.S. elements, on one hand, wereextremely anxious to "nurse this newborn baby" along, to protect itfrom undue criticism, and to encourage it by suggestion rather than byauthority. On the other hand, the Soviets, who were bitterly disappointed at thevery poor showing of their Austrian Communist Party in the election, appeareddetermined to impede the progress of the Coalition Government and to discreditit in the eyes of the Austrian people, with the hope of turning them toward theCommunist Party. The policy of the quadripartite Public Health Working Partybecame one of control which allowed the Austrian Government freedom of actionand, at the same time, insured its adherence to the general policies under whichthe Allied Commission in Austria functioned.
Quadripartite Public Health Working Party meetings, which hadbeen held since September 1945, continued. One public health officer from eachof the four occupying powers attended these meetings. They discussed and reachedagreement 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 shouldhave compulsory immunization failed. Consequently, although the program was wellpublicized and vaccine was supplied free by the U.S. Army, the program fell farshort of the desired goal.
The Public Health Branch continued to give immeasurable helpto the Austrians in the form of earnest advice and good will, and millions ofdollars in the form of medical, dental, veterinarian, hospital, and laboratorysupplies and equipment. This help was given unselfishly and willingly to producea stable Austrian public health organization which would be economically andprofessionally sound. The Public Health Branch, USACA, at the end of 1947, wasstill concerned with long term matters, such as raising the
26See footnote 2, p. 510.
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standards of the nursing profession, reestablishing anddeveloping the pharmaceutical industry of Austria, revising the public healthlaws, strengthening the Central Austrian Health Department, and further"denazifying" the medical, dental, and veterinary professions.
Certain general principles were followed: Austrian laws andregulations took priority unless the health of U.S. forces was likely to bejeopardized; the imposition of sudden radical changes was avoided; only the mostundesirable Nazi officials were removed from office; and care was taken not toabuse military authority, so that government could proceed on a humanitarian,honorable, and just basis. The Branch was seriously handicapped by lack ofspecially trained personnel, which was attributed largely to the "pointsystem of rotation." The British, in contrast, had sufficient numbers ofcivil 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 theentire USACA, including the Public Health Branch, and its British and Frenchcounterparts, was successful in its efforts to strengthen this struggling nationwhich had been crippled by the first World War, battered by the Hitler conquestof 1938, and almost smothered by the defeat of the German Reich in 1945.
