Holocaust Memorial Day: The role of the medical profession

January 27 is ‘Holocaust Memorial Day’, the day to remember the victims of the Third Reich. So, please allow me to reproduce today a (slightly altered and shortened) paper that I published back in 1996 on the role of the German medical profession in the killing of millions:

On January 27, 1945, the concentration camp in Auschwitz was liberated by the Red Army. By May of the same year about 20 more such camps were discovered. Even today, it is hard to understand how so many terrible atrocities could have happened in a cultured country, and, more specifically, under the eyes of a medical profession that belonged to the world’s finest. Here I will try to explain how many of the worst infamies happened with the active help of Germany’s medical profession.

The pseudoscience of “race hygiene” had strong roots. In the second half of the 19th century, “Social Darwinism” had become increasingly popular throughout Europe. This theory assumed that, just as animal species fight for the survival of the fittest, whole nations struggle in a similar fashion. In this process of natural selection, the fittest nation would be the one that is genetically more pure than its neighbors.

Social Darwinism originated from France (Duke Gobinau), England (Francis Galton), and Germany alike. Its German proponents, however, were to expand it significantly: Alfred Ploetz coined the term “race hygiene” (Rassenhygiene) , Ernst Haeckel first considered selection by killing “weaklings,“’ and the physician Fritz Lenz finally formulated his theory of race inequality. Lenz’s works were read by Hitler during his prison sentence in Landsberg (1924 to 1925). They had a great influence on his race politics of the years to come.’ The ingredient of antisemitism had continually been added to “Social Darwinism” and the diabolic result turned out to be race hygiene.

As the word implies, it was essentially a medical issue. Throughout his credo Mein Kampf, Hitler refers to the Jewish race as a bacillus, a parasite, a disease. The propaganda of the Third Reich adopted these medical analogies. The “biological body of the German people” (Volkskoerper) was threatened. The healer was Hitler, who promised to eradicate this assault to the nation’s health once and for all. The Jewish question had been rendered a medical problem, the therapy of which was to be realized in places like Auschwitz and Dachau.

The medical profession promoted the belief that to cure individuals was one thing, but to heal the nation was incomparably more important. Owing to the popularity of Social Darwinism, a long history of antisemitism, and a powerful Nazi propaganda, the majority of the medical profession adopted the ideas of race hygiene. These were subsequently further perverted with applied racism.

Race hygiene had been initially developed by and was later entrusted to the German medical profession. There was shamefully little resistance from organized medicine, and many have wondered why. One answer is that critical peers who could have constituted opposition within the profession had been quickly eliminated. At the Medical Faculty of Vienna, for instance, some 80% of the faculty were dismissed within weeks of the German take-over. The most frequent reason for the dismissal of doctors at all levels was being of Jewish origin. Vacant posts were filled with new staff known not for their medical expertise but for political trustworthiness. Opposition from peers was thus minimal.

Forced sterilization was introduced in order to secure the freedom of the German nation from the threat of contamination by inferior (Jewish) blood. It was legalized through the “law for the prevention of genetically diseased offspring” (Gesetz zur Verhinderung erbkranken Nachwuchs) as early as July 1933, only 5 months after the Nazis came to power. The swift move was possible because of preparatory work performed during the Weimar Republic, much of which was contributed by the medical profession. The law provided that handicapped individuals were to be identified, examined by a jury of experts who had to write a report, and subsequently sterilized. For this purpose, some 200 Genetic Health Courts were instituted. These were empowered to order involuntary sterilization. An estimated 400,000 individuals became victims of these courts.

At this stage, physicians had assumed an executive position within the Nazi state as “delegated judges” and “guardians over the law.“’ When these medical experts’ reports were evaluated after the war, the overwhelming majority were found to be of unacceptable quality and almost all had recommended sterilization. Yet in the minds of leading proponents of race hygiene, the law did not go far enough but created human “ballast” and an economic burden that had to be eliminated by other means. Therefore, the concept of euthanasia was transformed from voluntary assisted death to involuntary, medically supervised killing.

The Nazi euthanasia program started in various specialized medicine departments in 1939. It was a delicate issue even by Nazi standards. Therefore, an attempt was made to keep it a secret. In theory, the program was aimed at eradicating children suffering from “idiocy, Down’s syndrome, hydrocephalus and other abnormalities.” In practice, however, it was sufficient for physicians to fill in the diagnosis “Jew” to effectively issue a death sentence.”

At the end of 1939, the program was extended to adults “unworthy of living.” It is estimated that more than 70,000 predominantly psychiatric patients fell victim to the program. Psychiatrists became concerned about whether there would be enough patients left to keep their specialty alive.” “Action T4” was the Berlin headquarters of the euthanasia program. It was run by approximately 50 volunteer physicians.

Questionnaires were sent to psychiatric and other hospitals urging the physicians in charge to name candidates for euthanasia. In some cases, the inducement was a financial reward. The victims were then transported to specialized centers where they were gassed or poisoned. Action T4 was therefore responsible for supervised murder. Its true significance, however, lies even beyond this horror.

Hitler himself formally discontinued the program on August 24, 1941, following increasing opposition from both the general population and the clergy. But action T4 turned out to be nothing less than a “pilot project” for the extinction of millions in the concentration camps. The T4 units had thus developed the technology for killing on an “industrial scale.” It was only with this technical know-how that the total extinction of all Jews of the expanding Reich could be anticipated. Most importantly, however, this truly monstrous task required medical know-how and reliability. Almost without exception, those physicians who had worked for T4 went on to take charge of what the Nazis called the Final Solution.

While action T4 had killed thousands, its offspring would eliminate millions under the trained guidance of doctors. The role the medical profession played in the atrocities of the Third Reich was therefore critical and essential. German physicians had been involved at all levels and stages. They had developed and accepted the pseudo-science of race hygiene. They were instrumental in developing it further into applied racism. They had evolved the know-how of mass extinction. Finally, they also performed outrageously cruel and criminal experiments under the guise of scientific inquiry.

The aim of generating pure Aryans had taken precedence over the most fundamental ethical issues in medicine. German doctors had betrayed all the ideals medicine had previously embraced and had become involved in criminal activities to an extent and degree that is unprecedented in the entire history of medicine.

Ironically German science suffered the most: 16 of the Jewish refugees were later awarded Nobel prizes. Many of the brightest Jewish figures, formerly involved in German medicine, made invaluable contributions to the healthcare of the United Kingdom, the United States, and other countries.

The memory of what happened during this period should fortify us against similar, future violations. Forced sterilization, and even ethnic cleansing, did not disappear from the world when 7 of the accused Germans were sentenced to death in the Nuremberg Doctor’s Tribunal. Such violations of humanity are a tragic reality even today. Understanding the greatest blot on the record of medicine could and should be a preventive measure. More importantly, perhaps, this story needs to be told and retold to honor those who became its victims.

(References can be found in the original paper)

PS

Personally, I do not need a ‘memorial day’ for remembering. I believe we must never forget.