154 VOJENSKÉ ZDRAVOTNICKÉ LISTY ROČNÍK LXXIII, 2004, č. 4

ZAHRANIČNÍ PŘÍSPĚVKY

THE HEALTH SERVICE IN THE YEARS 1939−1945

Zdzisław Jezierski Faculty of Military Medicine, Medical University, Łodź,

In September 1939 the tary aspects and comprised among others jurisdic- were not able to throw back single-handed the tion, administration, culture and health care. aggression of and Stalin’s . Specialist services were created within the Home Therefore, the Commander-in-Chief and the Polish Army to fulfil these tasks properly. Health service State Government decided to continue the struggle included not only the Home Army soldiers but also against the aggressors in the foreign lands, together civilian population, which was deprived of medical with the allies. Late in September of the same year aid by the invaders (3). in France the Government of the Republic of Poland It should be emphasised that its organisers rea- with General Władysław Sikorski at the head was lised that the struggle they were preparing for would constituted. Under the General’s leadership also the be associated with the exposure of soldiers’ health Polish Armed Forces revived in France. It should be and life. They understood that if their soldiers were emphasised that the Polish Government in exile was convinced of getting quick medical aid in the case acknowledged to be legitimate and legal by the con- of injury their readiness for sacrifices and more em- temporary governments of anti-Nazi coalition states (1). phatic participation in fighting would be greater. This situation caused that also the Poles at home Therefore, the Home Army Commanders creating did not surrender to the aggressors. The September the regional underground net and groups defeat was treated as a lost campaign, not a lost war. were at the same time organising the health service Despite the terror and repressive measures applied as an integral element of these structures (3). by the invaders, the Polish nation did not cease The Home Army was formed basing on the or- fighting. In the face of the lack of possibility to ganisation of the pre-war army. At first, the attention oppose openly, the struggle was continued in was paid mainly to creation of regional organisational conspiracy that was organised spontaneously in all net. In the areas of pre-war provinces originated the regions of the country. It should be indicated that Home Army rings, whereas in administrative dis- from the start the Polish was tricts − regions and in civil parishes − localities. By characterised by a great dynamism of organisational the end of 1940, the Home Army organisational actions and enormous variety of fighting forms, structure was formed, comprising the whole territory both civilian and military. It resulted in the quick of pre-war Poland (4). development and strength of the Polish Underground It is interesting to note that in most regions health State (PPP) in the occupied country (2). service was created by the end of the year 1939, The office of the Delegate of the Government of before being organised in the Command-in-Chief. the Republic of Poland, performing executive func- The Sanitary Section in the Chief Headquarters was tions through local administration, was at the head. established only in the second part of 1940. It was It was supported by historical political groups, which the regions that played essential organisational role formed the nucleus of the Underground Parliament. in the process of the Home Army development. Their PPP had also at its command underground armed commanders were given a large scope of indepen- forces existing under the name of the Home Army dence. They appointed chiefs of divisions of the (AK) in which served citizens who identified them- regional health service. Their task was to create dis- selves with the Polish reasons of State, being the in- trict and regional departments of sanitary service on dependence strategy of the Republic’s Government the areas in their charge. in exile. There were many differences between individual The underground organisation was totally milita- regions, which affected efficacy of their organisa- rised and its aim was to prepare a victorious general tional efforts and concerned the invader’s policy, the uprising. Consequently, the Home Army became its number of its troops and police in the region and central link. Its real functions exceeded by far mili- attitude of local civilians providing protective and

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medical infrastructure. The traditions of national up- dical care posts, which were managed by the medical risings existing among people in particular regions staff serving in the Home Army districts (6). of the Polish territory were associated with their In 1943 the Union of Revenge forces were trans- readiness to support the partisans’ fights and played formed into the Troops of Diversion Management an important role in organisation of the regional (). Then forest guerrilla bands started to form. health service. In both of these formations links of medical aid Only in , , and Lwow the were organised. Each of them, however, had its own chiefs of regional services were doctors-officers specific character of activities. from the sanitary regular service. In most regions The Kedyw Troops were appointed mainly from these functions were performed by doctors-officers among soldiers living and working in towns, so from reserve forces. All of them had taken part in they were of garrison character, whereas partisan the campaign of September of 1939. The experiences troops stayed all the time in the areas which pro- gathered then were very helpful in their work. The vided them with moderately adequate living con- Polish war of 1939 was the example of mobilisation ditions and helped in their activities. of wide community circles in helping people in need. The Kedyw sanitary authorities conducted pre- The qualified medical staff at that time was not able ventive actions. All soldiers of this organisation were to take care of thousands of sick and injured people. advised in primary health care. Nurses organised in The rapid increase in demand for medical help sur- the Women’s Military Service (WSK) functioning passed the possibilities of specialist institutions and since 1942 within the Home Army took constant their activity. Under these circumstances it was ne- care of the soldiers from their platoons. In the case cessary to include in work many people from out- of a disease they tried to help their colleagues ar- side medical service, mainly as auxiliary personnel. range medical visits at various specialists’ as well as First of all girls from the Polish Scouts’ Association, radiographic and follow-up examinations. Polish Red Cross and Women’s Military Training The best developed Kedyw troops were in the − previously trained in providing sanitary aid − were area of Warsaw. They used the medical service of engaged to it. These organisations were also the basic the Ujazdowski Hospital. This famous pre-war health source of gaining nursing and sanitary staff in the service institution of the Polish Army − despite trans- Home Army health service (5). ition to the status of civilian municipal hospital in The first years of Home Army were the time of 1940 − kept alive traditions of military organisation gradual development of organisational structures. throughout all the war years. Doctors − especially The process of development was regulated by orders of higher ranks − were addressed according to the and instructions of the Home Army Chief Headquar- military rank and the manager was called the ters. The order given in April 1942 played a special "commander". Most of the staff were pre-war doc- part in this respect. It distinguished 3 stages of the tors-officers from the Polish Army sanitary service. Home Army development, namely: period of con- Thus it was obvious that within this team con- spiracy, insurrection and reconstruction of the armed spiratorial life flourished. It manifested itself in forces. In each of these stages health service was set various forms − from gathering and distribution of to realise different tasks. dressing materials and drugs, through distribution In the period of conspiracy a special section of underground press, secret training of doctors and called the Union of Revenge was isolated from the nurses, to active participation of teams formed from Home Army to conduct military operations. It con- among them in combat actions and treatment of the sisted of small diversionary and combat troops that Home Army injured soldiers. In 1944 a few doctors were formed in particular regions. Most frequently went to other AK regions and districts to organise they numbered from a few to a dozen or so of well- field hospitals and first aid stations there. It should trained soldiers. There were neither doctors nor be added that the commander of hospital was at the stretcher-bearers among them. However, each of same time the chief of health service of the Home the participants of these groups was prepared to Army Chief Headquarters. Also the chief of Kedyw give the first aid and had a first aid kit. In the case sanitary authorities and sanitary chiefs of almost all of injury soldiers were obliged to take the victim districts of Warsaw Region came down from there (7). away during the retreat. In the second half of 1943, health service was The Union of Revenge soldiers prepared their created in Kedyw troops of many other regions and actions very carefully. The point was to have as in then developing partisan troops. They arose from small personnel casualties in its ranks as possible. joining the small AK diversionary and combat forces. The actions were short and lasted at the most several At that time the so-called uniting action, resulting hours from the assembly to the end. Few soldiers from the realisation of the Polish Armed Forces wounded in them were treated in conspiratorial me- Commander-in-Chief s order concerning the union of

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all military organisations of the Polish Underground The main period of AK activity was the year State within the Home Army, speeded up. In the 1944 when soldiers carried out the plan "Storm". course of this action effective forces of the Home The analysis of the types of wounds inflicted in the Army units considerably increased. The uniting "Storm" period showed that first of all they concerned formations had their own health service structures upper and lower limbs, abdominal cavity, chest and which merged with AK health service, submitting head. Most frequently they were bullet wounds, to the sanitary section of the Women’s Military perforating bullet wounds, lacerated wounds, wounds Service. In many districts the uniting process went caused by fragments of grenades, bullets from ma- smoothly because nurses from the Green Cross, serv- chine and rifle pistols or from small firearms. The ing in Peasants’ Battalions and also in the National wounds of limbs were often complicated with frac- Military Organisation or in Military Units of the tures and venous or arterial haemorrhages. Most of held their courses and train- abdominal cavity wounds ended with peritonitis. In ings in the same district hospitals as AK nurses (8). field conditions it was not always possible to carry The characteristic phenomenon in the activity of out laparotomy or deliver the injured to hospital. the partisan sanitary service was that its members Doctors were left only with words of comfort and had considerably more work with sick than injured morphine injections after which the injured stopped soldiers. These latter were most frequently turned complaining of pain and took their last sleep. over to conspiratorial dressing stations or field hos- pitals, while the sick were taken care of by unit Head injuries were often associated with com- nurses until the patients’ full recovery. plications in the form of cranial fracture or fracture Many diseases and ailments, resulting from their with dislocation, demanding immediate trephination. style of life, occurred among the soldiers from forest Such procedures were successfully performed in guerrilla bands. Pathological states as a result of field hospitals of AK partisan units. Chest perfora- nutrition deficiencies were a difficult problem to ting bullet wounds were − on the other hand − ac- solve. Almost all partisans for a shorter or longer companied by bleedings from mediastinal vessels period suffered from enteritis, food poisonings. Suf- or pneumothorax, which was very difficult to treat fering from scurvy was quite frequent. in field conditions. These injured were turned over to Sometimes tactical reasons compelled partisans stationary hospitals. to stop in hamlets affected with infectious diseases In the course of battles conducted in town that caused their spreading in many units. The main conditions, one of the most frequent wounds were infectious diseases occurring then most frequently burns of all grades, accompanied by depression and were: typhus fever, typhoid fever and dysentery. psychic (nervous) breakdowns (10). Typical ailments of soldiers from bush-and-forest In the autumn of 1944 diseases in AK units were guerrilla bands were skin diseases, especially scabies, a far bigger problem than wounds or incidence of difficult to control when there was a shortage of traumas. Many reports of the commanders of then appropriate treatment agents. Pediculosis was also re-created regiments and divisions testify to it. We common then. These diseases spread because of not can read in one of them: "...men without shoes, enough underwear, soap, disinfectants, no possibility underwear and clothes, they already have a cold, of having a bath and problems with maintaining 50% of the regiment soldiers are sick", whereas in necessary hygiene during constant marches. another one: "Only because of the flu many partisans The actions of AK partisan units were mainly went away to hide-outs in October, 1944 to take performed in areas with substantial forest and treatment. The flu was spreading in the regiment mountainous regions, wilderness, often economically alarmingly at that time." (11) poor. These conditions were beneficial to some The basic cause of these diseases was the season, respect because the invader had no possibility of prolonged stay in hard field conditions and shortage making use of their technical supremacy there. On of proper food that in conspiracy led to weakening the other hand, however, they created great difficulties of the biological energy even in partisans with longer for health service. The transport of the injured in practice. the hilly terrain caused them a lot of suffering and The shortage of medicines made epidemiologic was also strenuous for female sanitary sections. situation difficult in combat units at that time. Doc- The activity of the troops was facilitated due to tors from AK units and their commanders report it. the fact that Polish people considered AK soldiers They also point out that sacrifice and devotion of their protectors and friends and took care of the young people working in AK health service made injured, hid them, prepared lodgings where they up for the shortages in material supplies in forest could be treated safely, shared their belongings with units and also incomplete professional qualifications them and transported them on long distances (9). of the sanitary staff.

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Epidemics of infectious diseases − mainly of spiratorial Girl Guide movement. The majority of typhus fever and dysentery also occurred among them were arrested and repressed for their activity. AK weakened soldiers (12). During fights they were killed or injured similarly to The most dynamic development of the Home AK soldiers. Their service was not only performing Army occurred in 1944 when in the summer about their professional vocation but also the expression 350 000 soldiers served in conspiratorial armed for- of patriotic attitude in the struggle for independent mations. In the whole country they carried out in- Poland. dependence attacks under the name of the ''Storm'', which were conducted with vigour and fierceness. During this action the number of wounded soldiers Reference and also civil population increased significantly. In order to provide medical help for them the AK health 1. DAVIES, N. God’s playground. A , vol. service mobilised all its strengths and worked with II: 1795 to the present. Oxford, 1981. great devotion and heroism (13). 2. SALMONOWICZ, S. Polskie Państwo Podziemne. Z dzie- The "Storm'' action was initiated in January 1944 jów walki cywilnej 1939−1945. Warszawa, 1994. th 3. Polskie Siły Zbrojne w drugiej wojnie światowej, t. III: in by the 27 Volhynia Infantry Armia Krajowa, wyd. II, Warszawa−Londyn, 1999. consisting of more than 7 000 soldiers. Its health 4. Armia Krajowa. Szkic z dziejów Sił Zbrojnych Polskiego service was organised in accordance with the pre- Państwa Podziemnego. Warszawa, 1999. -war standards in the Polish Army and employed 5. Harcerki 1939−1945. Relacje − pamiętniki. Warszaw, 1985. 19 physicians, 28 stretcher-bearers and 75 field 6. STRZEMBOSZ, T. Oddziały szturmowe konspiracyjnej nurses (14). Warszawy 1939−1945. Warszaw, 1983. Fights for independence were carried out on a 7. WITKOWSKI, T. „Kedyw” okręgu warszawskiego Armii wide scale in the spring and summer of 1944 in the Krajowej w latach 1943−1944. Warszawa, 1984. region of Vilnus and Nowogródek. In July 1944 8. JEZIERSKI, Z. Kształcenie kadr medycznych w Armii Kra- one of the most crucial battles was the battle for jowej. Łódź, 2002. liberation of Vilnus conducted under the name of 9. BAYER, S. Służba zdrowia okupowanej Warszawy. War- szawa, 1982. ''The Sharp-Pointed Gate". Professor Michał Reicher, 10. Powstanie Warszawskie i medycyna. Wspomnienia lekarzy, pre-war Vice-Rector of Stefan Batory University in medyków i sanitariuszek z Powstania Warszawskiego, vol. Vilnus, having been appointed as Commander-in I-II, Warszawa, 2003. Chief of the Vilnus Region Health Service in the 11. Armia Krajowa w dokumentach, vol. IV, s. 192. Home Army, mobilised nearly all physicians in 12. ALEKSANDROWICZ, J. Kartki z dziennika doktora „Twar- this region to provide medical help during fights. dego”. Kraków, 1983, C. Sadowski, Pamiętnik doktora When the entered this territory the Soviet „Skiby”, Warszawa, 1990. security police arrested and repressed many medical 13. KOMOROWSKI-BÓR, T. Armia Podziemna. Londyn, 1952. professionals by sending them to labour camps in 14. FIJAŁKA, M. 27 Wołyńska Dywizja Piechoty AK. War- the interior of Russia (15). szawa, 1989. The greatest combat operation carried out within 15. KORAB-ŻEBRYK, R. Operacja Wileńska AK. Warszawa, 1988. the ''Storm'' action was the that 16. DAVIES, N. Europe. A history. , 1996, p. 1107−1108; lasted from 1 August to 3 October 1944. The majority JM. Ciechanowski, Powstanie Warszawskie. Warszawa, 1989. of the Warsaw population participated in it providing comprehensive help for AK soldiers. First of all it was a medical help. All hospitals in Warsaw admitted the wounded due to the fact that their medical Correspondence: Pulkownik Dr.med. Zdzislaw Jezierski personnel had joined the Home Army. Hundreds of Wydzial Wojskowo-Lekarski Universytetu girl-guides were trained to be field nurses. The Polish Medycznego w Łodźi Red Cross organised provisional hospitals in nearby ul. Jana Piwnika 9/25 towns and villages for the injured and delivered PL-93222, Łodź drugs and dressing materials to them (16). Poland There were no lists of people working in con- spiracy. Thus, it is difficult to present the amount of AK health service personnel. It is generally estimated that about 8000 physicians worked there (out of 12 thousands physicians before the war), 23 000 nurses and 20 000 field nurses derived mainly from the con- Received 30. 6. 2004