Jansson on 1942 births in Leningrad

In a furtherresponse to the blog Friedrich Jansson tries to help Mattogno …, Jansson provides a source that, so he claims, "decisively" refutes my assumption that 3rd percentile female weights given in CDC Growth Charts, namely the charts Data Table of Infant Weight-for-age Charts and Data Table of Weight-for-age Charts (I only addressed the latter so far) are too high to represent the weights of a starved population.



Said assumption was based on the following sources, rendered in the blog Friedrich Jansson tries to help Mattogno …:

The comparative smallness of these differences suggests that the 3rd percentile does not represent the lowest range of what is considered underweight in children, as do the aforementioned pages whereby there are four underweight percentiles (the 1st to 4th). See also this page ("As a general rule of thumb, a typical, healthy child’s growth measurements fall between the 3rd and 97th percentiles. A child may fall below the 3rd percentile if they are genetically small-statured or severely malnourished.") and this one ("It is desirable that the child’s growth measurements fall between the 3rd and 97th percentiles. If a child has both low weight-for-age and height-for-age, their weight-for-length should at least be proportional (between the 3rd and 97th percentiles)."). A PDF available under this link contains a book chapter ("Use of Percentiles and Z -Scores in Anthropometry", by Youfa Wang and Hsin-Jen Chen) featuring a table (Table 2.2) based on the 1995 WHO growth reference, whereby the anthropometric measure or cut point for conditions indicating "chronic malnutrition" and "acute malnutrition, current malnutrition" in infants and children below ten years and "chronic malnutrition" in adolescents is below the 3rd percentile. Another source mentioning "less than the third percentile" as a criterion for malnutrition in children is Robert Markowitz MD, John B. Watkins MD and Christopher Duggan, MD, MPH, "Failure to Thrive: Malnutrition in the Pediatric Outpatient Setting", in: Christopher Duggan (MD.),John B. Watkins, W. Allan Walker, Nutrition in Pediatrics: Basic Science, Clinical Applications, pp. 479 ff. (excerpt viewable here).

The fact alone that Jansson bluntly dismisses these sources as not being "any serious argument" speaks volumes about my interlocutor's intellectual honesty. But the party gets much better, as Jansson provides a (to put it politely) highly selective reading of the source that is supposed to "decisively" refute my aforementioned assumptions.

The source in question is a paper on children born in the Leningrad State Pediatric Institute during 1942 (M.D. A.N. Antonov, "Children born during The Siege of Leningrad in 1942", in: The Journal of Pediatrics, March 1947, Volume 30, Issue 3, Pages 250–259; the article’s abstract is available on this page, where the whole article can be accessed against payment). The article addresses several aspects, namely height, weight, lack of vitality and other health problems as well as mortality among children born in the aforementioned institute (hereinafter called the "LSPI") from January to June and from July to December 1942. During the first of these periods (January to June 1942), 414 children were born in the LSPI; of these 23 (5.6 %) were stillbirths, 161 were born prematurely and 230 were born at term. Of the babies born at term, 21 (9 %) died soon after birth, while of the babies born prematurely 62 (30.8 %) were neonatal deaths. During the second of these periods (July to December 1942), 79 children were born in the LSPI; of these 2 (2.5 %) were stillbirths, 5 (6.5 %) were born prematurely and 72 were born at term. One of the babies born at term (1.4 %) and 3 of the babies born prematurely (60 %) were neonatal deaths. Antonov points out that

Premature births in the first half of 1942 reached the high proportion of 41.2 per cent; in the second half the proportion was only 6.5 per cent, which differs little from the normal rate. The proportion of stillbirths also was exceptionally high in the first half of the year (5.6 per cent) while in the second half it was 2.5 per cent, which is within normal limits as can be seen in Table II.

He then goes on to provide an explanation for the surprising normality of births in the second half of 1942 despite ongoing siege conditions, which I will address below.

The weights of 368 children born during the first semester of 1942 are given as follows in Antonov’s article:



The weighted average of these weights (assuming that "less than 2,000 Gm." means a range from 1,500 to 2,000 Gm. and "over 4,000 Gm." means a range from 4,000 to 4,500 Gm., and taking the median of all ranges) is about 2,512 grams. Jansson estimates a mean weight of 2.5 kg and points out that this is "between the 3rd and 5th percentiles (closer to the 5th percentile)" of weights at birth given in this table.

Obviously not satisfied with this result, Jansson then argues that (for reasons I will address below) one should "separate out the effect of the increase in premature births" during the first half of 1942 and consider only the weights of babies born at term, which are rendered as follows in Antonov’s article:



Jansson points out that "the birth weights for the first half of 1942 lie slightly above the 10th percentile on the CDC data", while the birth weights for the second half of 1942 "are higher, roughly midway between the 10th and 25th percentiles for females and above the 25th percentile for males". He then makes a "correction" of these values to "include the influence of the normal rate of premature births", the results of this "correction" being "an average birth weight of 2743 g" during the first half of 1942 and "3127 g for boys and 2838 g for girls" in the second half of that year. Jansson’s triumphant conclusion is the following:

Thus, in the most severe portion of the famine, during the first half of 1942, once the impact of the prematurity rate is separated out, Leningrad birth weights were approximately on the level of the 10th percentile CDC birth weights. Including the high rate of prematurity, they were between the 4th and 5th percentiles. For the second half of 1942, when pregnancies that began after the onset of the siege were the norm, birth weights were between the 10th and 25th percentiles of the CDC birth weight data. Muehlenkamp’s assumption that CDC 3rd percentile female weights are too high to represent the weights of a starved population is decisively refuted in this case.

Except that Jansson wouldn’t be Jansson if he had not omitted crucial information included in his source and thereby twisted it to yield the results he desired.

Let’s start with the justifications he provides for not taking into consideration the weights of premature births in the first half of 1942. Jansson writes:

The prematurity rate increased dramatically in the first half of 1942, reaching 41.2%, and then fell to normal levels – 6.5% – in the second half of 1942. While this fall may be partially the result of improved food supply, at least among the pregnant population, the initial rise was also the result of premature births to women who became pregnant before food became scarce. This suggests that prematurity rates for a population under sustained food pressure are likely to return to somewhat normal levels. Therefore, for the purposes of inference to Polish Jewish populations, it would be desirable to separate out the effect of the increase in premature births. (Another reason to do this is the high mortality rate among premature births – 39% in 1942 at the institution discussed in the paper under discussion, and as high or higher at other institutions. As deaths fall out of the population to be studied, these premature births would have no impact on date for average weight.)

The second reason is just plain nonsense. When determining a population’s average weight at birth, one has to take into account all children born alive, including those who died soon after birth.

As to Jansson’s assumption that "prematurity rates for a population under sustained food pressure are likely to return to somewhat normal levels", this is also nonsense, but there’s more to it. Jansson omitted Antonov’s explanation of why the 79 births in the second half of 1942 were about normal as concerns stillbirth and prematurity rates, which is the following (emphasis added):

How did the seventy-nine women who entered the clinic in the second half of 1942 differ from the other women in Leningrad, so that they did not suffer from amenorrhea and were able to become• pregnant, and so that the proportions of stillbirths and of premature births among them were not above the normal? While the material is too limited for positive answer, there are reasons to believe that their nutrition was much better than that of the rest of the women in the city during that period. It was possible to ascertain that among these seventy-nine women, fourteen were employed in food industries (cooks, waitresses, and others), six were receiving military rations, seventeen were physicians, nurses, teachers, and members of other professions, fourteen were manual workers, and twenty-two were housewives. Had information been obtained about the occupations of the husbands of the twenty-two housewives, it would doubtless have strengthened further the assumption that the food of the women who bore children in the second half of 1942 was considerably better than that of the other women in the city. In any event, these seventy-nine women did not suffer from the hunger that was the lot of the others.

So the 79 women who gave birth in the second half of 1942 belonged to privileged sections of the city’s population who were fed much better than the average citizen, and this was, in Antonov’s opinion, the reason why they got pregnant in the first place, at a time when amenorrhea was prevalent among the city’s women. They were thus an exception to the rule and everything other than representative of the conditions among Leningrad’s female population at the time. Antonov’s observation reflects one of the sad (one might also say scandalous) realities of how Soviet authorities behaved towards the encircled city's population. Instead of the burden of severe food shortage being distributed equitably according to objective criteria (such as distinguishing between manual and mental workers), there was a majority of citizens who starved to death or barely managed to survive on quantitatively and qualitatively miserable rations and whatever at least unpalatable complements to the diet (such as leather straps, carpenter’s glue and paste from the tapestries) they turned to in their despair, while on the other hand there was a minority of privileged individuals, usually associated to state and party entities, who barely suffered from hunger or didn’t go hungry at all. Siege survivor Dimitri Likhachov, to give but one example, mentions the following case:

The windows of the refectory near the Museum of Anthropology and Ethnology were also nailed down. Here food was issued on special cards. Many employees got no cards and went here to lick the plates.

The contrast between the privileged few and the starving many is illustrated by the picture on the right of the scan below, taken from Anna Reid’s book Leningrad. Tragedy of a City under Siege, 1941-44 ((2011 Bloomsbury Publishing Plc, London) and captioned «A "well-fed type" and a "dystrophic"; Ligovsky Prospect, December 1941»:



The 79 women who gave birth in the LSPI were obviously "well-fed" types, privileged people who ate regular meals on special cards instead of being reduced to licking the plates or trying to survive by other desperate methods such as those mentioned above.

This means that, instead of suggesting that "prematurity rates for a population under sustained food pressure are likely to return to somewhat normal levels", as Jansson would have it, they must not only be left out of any calculations aimed at establishing average birth weights among a starving population, but are also no justification for considering only the weight of babies born at term, as Jansson does.

It is inconceivable that Jansson, however sloppily he may have read his source, could have missed Antonov’s above-quoted explanation for the reasons why births in the second half of 1942 resembled normal circumstances, which contradicts his "return to somewhat normal levels" assumption. What clearly happened here was that Jansson deliberately omitted information that is not only unfavorable to his argument, but completely destroys it.

While I’m careful with accusing my interlocutor of lying (also because I have a healthy contempt for the baseless and dishonest or hysterical "lie" accusations he sends my way), I’d say that in this case the expression "lying by omission" is an accurate description of Jansson’s behavior.

This leaves us with the aforementioned average weight of ca. 2.5 kg for children born (at term or prematurely) in the LSPI between January and June 1942. This weight being above the 3rd percentile and close to the 5th percentile in this table, one might consider it enough to make Jansson’s point against my assumption that malnutrition, or at least severe malnourishment, is signaled by weights below the 3rd percentile. However, one should consider the following aspects:

1. The number of live births in the first half of 1942, as shown in Table II from Antonov’s article rendered below, was far below the number of live births in the same period of previous years, less than one-fifth of the number of live births between January and June 1941:



This although the pregnancy of the women who gave birth between January and June 1942 must in a great many cases have occurred before the beginning of the siege (a woman whose baby was born at term in January 1942 would have got pregnant in May 1941, and the corresponding months for February to June 1942 would be June, July, August, September, October and November 1941). While the siege of Leningrad started in September 1941, mortality in the city (mostly from lack of food) rose slowly in the following two months, to then take a dramatic leap in December 1941, as shown in the table below from Appendix II of Anna Reid’s aforementioned book about Leningrad.



The official figures in the above table are obviously considered too low by Reid, who writes that "the best estimate for the number of civilians who died during Leningrad’s first siege winter is around half a million" (Leningrad, page 231; Reid’s estimate of the siege’s overall death toll is about 750,000, which is lower than the estimates of Salisbury, Ganzenmüller and others). Nevertheless they show the trend in mortality, which, if taken as an indicator of the population’s health, suggests that women who got pregnant before or in the early stages of the siege spent much of their pregnancy still without feeling the full effects of acute malnourishment. If nevertheless the number of births in the first half of 1942 was only one-fifth of what it had been in the same period of 1941, this suggests that only the strongest, most resistant pregnant women managed to carry their pregnancy until birth, while weaker specimens either had natural abortions or died before giving birth. In other words, those women who managed to give birth in the first half of 1942 may already have been the survivors of a natural selection process, rather than representative specimens of the female population, and the weight of their babies, while being far lower than in normal times, may have been higher than that of average Leningrad women would have been if they had carried their pregnancy until birth.

2. The weight at birth was not necessarily a predictor of continuing weight development even among the children born at term that didn’t die in the LSPI, a fact that Jansson also conveniently omits. In fact their weight dropped after birth, as shown in Table IV from Antonov’s article:



Antonov adds the following after this table:

The loss of weight lasted three days or Jess in only 11.2 per cent of the children; in 88.8 per cent it lasted more than three days. Many of the children were discharged without any established tendency toward further gain in weight. On the average, the loss of weight continued for six days instead of three to four days; the average loss was 273 Gm., 9.7 per cent of the original weight.

Not being a doctor, I don’t know what the implications of a child having "no established tendency toward further gain in weight" upon release were, but my guess is that such child was expected to either become severely underweight or die after release from the clinic.

3. It is doubtful whether weight at birth is a predictor of continuing weight development at all under precarious food conditions. Antonov quotes foreign and Russian research, also not mentioned by Jansson, which suggests that a child’s birth at weight, while negatively affected by the mother’s severe malnourishment, may on the other hand be positively affected by the fact that the fetus draws resources from its mother while it is the womb. The following information is of particular interest in this respect:

According to Shkarin,4 the proportion of babies with birth weights above the average (more than 4,000 Gm.) was lower in 1919 than in 1913, while the proportion with very small birth weights (below 2,300 Gm.) was higher. Lurie and Belugin5 found that with insufficient diet there was a slight decrease in birth weight, in 1919 the average birth weight was 160 Gm. less than in 1915. According to Troitzkaia, 6 the average birth weight in 1919 was 200 Gm. less than in 1914. This did not prevent either Troitzkaia or Lurie and Belugin from reaching the conclusion that the fetus receives from the mother's body everything it needs for its development, regardless of the nourishment received by the mother from the outside, that, in other words, the fetus behaves like a parasite.

(Emphasis added.)

Antonov also mentions at least one source that "rejects the theory that the fetus is a parasite", but in the last paragraph states that "we do not contradict the prevailing opinion that the fetus behaves like a parasite in the mother's body":

While, in general, we do not contradict the prevailing opinion that the fetus behaves like a parasite in the mother's body, we can say on the basis of our material that the condition of the host, the mother's body, is of great consequence to the fetus, and that severe quantitative and qualitative hunger of the mother decidedly affects the development of the fetus and the vitality of the newborn child.

If, as was the prevailing opinion among Russian pediatric doctors at the time according to Antonov, the fetus enjoys "parasite" benefits while in the mother’s womb that help its development despite the mother’s weakened condition, these benefits cease to exist once the baby is born, especially as the baby (a phenomenon mentioned earlier out by Antonov) will not be able to draw sufficient milk from its mother:

In 1918, on the basis of many observations of the effect of hunger on lactation in women, we came to the following conclusions:3 (1) in spite of hunger, the mammary gland secretes milk if there is sufficient physiologic stimulation, that is, the capacity for breast feeding remains; (2) the quantity of milk, however, decreases; and (3) the duration of the lactation period becomes shorter. These circumstances were observed also during the siege of Leningrad, 1941 to 1943, with the difference that the mother's incapacity to produce sufficient milk was greater.

The extent and duration of the physiologic loss of weight and the rapidity of restoration to the initial weight depend mainly upon food conditions, that is, on the quantity of the mother's milk to some extent they probably depend also upon the strength with which the child sucks, that is, on his general vigor. Most of the children born late in 1941 and in the first half of 1942 of severely exhausted mothers had very low vitality. The mothers as a rule had very little milk, and many babies had to be fed, even in the first few days of their lives, on artificial mixtures prepared from milk substitutes because there was no cow's milk.

4. Last but not least, births in Leningrad occurred among a population that, according to the 1906 Jewish encyclopedia’s article "STATURE: Jews Compared with Non-Jews, must have been comparatively taller (and accordingly heavier) than the Jews of Poland and Galicia at the time, a trend that presumably continued over the next decades. One reads in the mentioned article that

As will be noticed from the figures in Table 2, showing the average height of Jews as compared with that of the non-Jewish inhabitants in eastern Europe, the stature of the former corresponds to a great extent with that of their Gentile neighbors. Wherever the latter are tall, the Jews also are tall, and vice versa. Thus in Galicia and Poland, where the indigenous Polish population is short of stature, measuring 162 to 163 cm. on the average, the shortest Jews are found. In Little Russia and South Russia, where the Gentiles are characterized by their superior height, measuring 165 to 167 cm. on the average, the Jews also are comparatively tall, averaging 163 to 167 cm. The same is true of the Jews in Rumania, Bukowina, etc.

The article mentions "Little Russia and South Russia", but there’s no reason why inhabitants of northern Russia should not have been equally tall or even taller.

To sum up, consideration 1 above calls in question whether an average birth weight of 2.5 kg under starvation conditions was representative of Leningrad’s average female population at the time, rather than a natural selection of particularly strong and resistant specimens. Considerations 2 and 3 suggest that weight at birth cannot, under continuing precarious food conditions, be considered a predictor of further weight development, namely that children with birth weights closer to the 5th than to the 3rd percentile may have seen their weights reduced to or below the 3rd percentile in the following weeks, months and years, if they survived. Consideration 4 suggests that data about the birth weight of Leningrad children born under starvation conditions cannot be projected onto Polish Jewish children born under similar conditions (to the extent that there were any), due to substantial differences in average height and accordingly weight of the relevant population.

The conclusion from the above is that, contrary to what he would like to believe (or to what he would like his readers to believe), Jansson has not refuted my assumption that 3rd percentile female weights given in CDC Growth Charts are too high to represent the weights of a starved population, namely a starved Jewish population in Poland during 1942. The only thing Jansson has achieved with his exercise is to again put his intellectual dishonesty on display, by showing that he is willing to distort his own source by omitting crucial information from such source that contradicts his argument.

As to Jansson’s closing remark that my assumptions on weights of Jewish children and adults in 1942 Poland "rest on no weight-data whatsoever", my comment is that I consider the data mentioned in the blogs Friedrich Jansson tries to help Mattogno … and Just when I thought I had seen all of Jansson’s fits … - namely Baron Otmar von Verschuer’s 1938 article, the aforementioned Jewish encyclopedia article, the "Gewichtstabelle nach BMI and evidence to the severe malnutrition/starvation of Polish ghetto Jews in 1942 - to form a pretty good database in support of my assumptions, and what is more, one that hasn’t been distorted the way Jansson distorted his Leningrad source where it didn’t fit his argument.

I would like to end this blog with a quote from Antonov’s article explaining the reasons (or some of the reasons) for the high mortality among children born in the first half of 1942, especially premature births. While not related to the refutation of Jansson’s article, it provides further insight into the plight of an urban population caught between Nazi Germany’s endeavor to eradicate it (which German historian Ganzenmüller called A Quite Genocide) and the callousness, corruption and incompetence of its own government;

In the beginning of the war the Department for the Newborn consisted of 120 beds and was• situated on the third floor of the obstetric-gynecologic building. During air raids the babies were taken by elevator to the basement, where an air-raid shelter was specially equipped for them. Late in the fall of 1941, damage to the central heating plant forced the obstetric department to move, with reduced facilities, to other quarters which could be heated by stoves. The Department for the Newborn was placed in a ward of fifteen to twenty beds, which was heated by a brick stove with a pipe connected to a window. The stove was too small to heat the ward adequately; it smoked often, arid there was not enough wood. The temperature in the ward was usually very low, often 50° F.; in the fourth week of January, 1942, it went down to 40° F. The physicians and nurses worked in their overcoats (over which they wore white coats) and in felt boots. Medical examination of the infants and changing of diapers brought danger of chilling. The same danger threatened in the corridor and in the mothers' ward, where the infants were taken for feeding and where the temperature was lower still. The situation was made worse by the insufficiency of heaters, the impossibility of repairing damaged heaters, and the insufficiency of hot water (the water system was not working; water could be heated only on the stoves in the wards). It is not surprising that during that time many newborn infants died from such diseases as scleredema, sclerema, and pneumonia. It should be added that of the children born at home the majority were brought to the clinic severely chilled.

The large number of premature births, the congenital debility of many babies born at term but with low weight, and poor conditions of care and feeding, all explain the high neonatal mortality at the end of 1941 and in 1942. Under these difficult conditions, the staff of the Department for the Newborn, Dr. R. M. Levis and the nurses, themselves in a condition of advanced alimentary dystrophy, did everything they could to preserve the lives of the newborn babies; but, unfortunately, many things did not depend upon their good will and devotion.

I thank Jansson not only for giving me another chance to expose his mendacity and the fallaciousness of his arguments, but also for having brought this very interesting source to my attention.