Healing by Killing: Medicine in the Third Reich Course Outline Medicine in Germany during the Third Reich (1933- 1945) Eugenics: Healing by Killing in America and Germany Medicine after the Holocaust: From the Master Race to the Human Genome and Beyond. Contact Data Email your full name to: email@example.com Telephone numbers: 713-795-5750 (office) and 713661-6999 (home) Text, reading assignments, and contact information can be found at: files.me.com/sheldonrubenfeld/6j8669 Text for the Course Available Friday, 1/8/10, at UT Medical School Bookstore, 6431 Fannin, Room B600, 713-500-5861. Reading Assignments Class 2, 3- Healing by Killing: Medicine in the Third Reich (files.me.com/sheldonrubenfeld/nhjv63) AND Foreword, Introduction, Chs. 1-7, and Afterword in MATH Class 4, 5 – From Long Island to Auschwitz and Beyond (files.me.com/sheldonrubenfeld/ms4cpp) AND Chs. 7-10 and 16 in MATH Class 6, 7 – Chs. 11-15 and 17-20 in MATH Lectures given by these authors and others can be seen at UT Austin’s Schusterman Center for Jewish Studies: http://www.utexas.edu/cola/centers/scjs/medethics/lectures.php Part I. Medicine in Germany during the Third Reich (1933-1945) Sterilization Law Nuremberg Laws Child Euthanasia T4 Program Wild Euthanasia Operation 14f13 The Final Solution Medical Experiments Cover-up Sterilization Law Nazi: shorthand for Nationalsozialistische deutsche Arbeiter-Partei, National Socialist German Workers' Party, which was founded in 1919. Hitler democratically elected Chancellor of the Third Reich January 30, 1933 Law for the Prevention of Genetically Diseased Offspring (Sterilization Law) July 14, 1933 Sterilization Law Permits involuntary sterilization of anyone suffering from “genetically determined” illnesses: Feeblemindedness Deafness Blindness Severe Alcoholism Huntingdon’s Disease Schizophrenia Severe Malformations Insanity Sterilization Law All doctors required to register every case of genetic illness know to them with fines of up to 150RM for failure to register such a person. 181 Genetic Health Courts and Appellate Genetic Health Courts established in 1934 to administer the sterilization law. Each court was presided over by a lawyer and two doctors, one an expert on genetic pathology. Approximately 400,000 Germans sterilized between 1934 and 1939, primarily by BTL and vasectomy. Nuremberg Laws Three “Nuremberg Laws” were passed between September and November 1935. Reich Citizenship Law. Law for the Protection of German Blood and German Honor. Law for the Protection of the Genetic Health of the German People. Reich Citizenship Law Distinguished between “citizens” and “residents” including Jews and single women whose privileges were proscribed. Unmarried women were not considered citizens. Grounds for divorce included the inability of women to bear children. Sterilization and abortion for “healthy” German women was illegal. The quota of female students was fixed at 10 percent. Women were barred from professions and granted job security in official positions only after age 35. Law for the Protection of German Blood and German Honor Forbid marriage, sexual relations, and other acts between non-Jews and Jews (later non-Aryans). Defined “full-Jews” and “half-breeds. Couples must submit to medical examinations before marriage to see “if racial damage” might be involved. Genetically ill persons were permitted to marry other genetically ill persons, but only after being sterilized. Since it was feared many Jews had converted to Christianity, religion alone was no longer a reliable measure of one’s race. Only the use of physicians trained in genetics would ensure that racial policy was grounded in “a sound scientific basis.” Physicians were responsible for issuing certificates that one was “fit to marry.” These certificates were required in order to obtain a marriage license. Child Euthanasia The parent of infant Knauer, encouraged by the child’s grandmother, petitioned Hitler in order to bring about its death in the winter of 1938-1939. Infant Knauer was killed at the University of Leipzig pediatric clinic by lethal injection from Dr. Kohl while the nurses were taking a coffee break. Petitions to Hitler were handled by a subdepartment of the Kanzlei des Fuhrers (Chancellory of the Fuhrer or KdF) Child Euthanasia (contd) On August 18, 1939, the secret “Reich Committee for Hereditary Health Questions,” quickly renamed the “Reich Committee for the Scientific Registering of Serious hereditary and Congenital Illnesses,” introduced compulsory registration of all “malformed” newborn children. Doctors and midwives were given 28RM for the obligatory reporting of instances of idiocy and Down’s Syndrome; microcephaly; hydrocephaly; physical deformities such as the absence of a limb or late development of the head or spinal column; and forms of spastic paralysis. Child Euthanasia (contd) Information was eventually forwarded to the Reich Committee at a Berlin box number, which happened to be the nearest to the KdF. “Selections” were made by three expert referees, all physicians. Without actually seeing the children concerned, these men scrutinized the registration forms, marking them with a “+” if they wanted the child to die, a “-” if it was to live, and a “?” in the few cases requiring further consideration. Child Euthanasia (contd) The initiative to consign a child to specialist treatment at the expense of Reich Committee in its elite clinics sometimes came from the parents. Other parents were talked into parting with their child by their family doctor, or by public health or National Socialist People’s Welfare nurses. Parents were told that transport to one of these facilities was necessary to improve treatment for their child. Child Euthanasia (contd) The 28 institutions rapidly equipped with extermination facilities included some of Germany’s oldest and most highly respected hospitals. Methods of killing included injections of morphine, tablets, and gassing with cyanide or chemical warfare agents. Poisons were administered slowly so that the cause of death could be disguised as pneumonia, bronchitis, or some other complication induced by the injections. Children were often slowly starved or left without heat until they froze so that they died of “natural causes.” Child Euthanasia (contd) Parents were informed by a standardized letter, used at all institutions, that their child had died suddenly and unexpectedly of brain edema, appendicitis, or other fabricated causes. The parents were also informed that, owing to the danger of an epidemic, the body had to be cremated immediately. (See Swing Kids.) On July 12, 1941, all doctors, nurses, and medical personnel were ordered to register not just infants but all minors known to have crippling handicaps. Anyone failing to register such individuals could be fined up to 150RM or face imprisonment up to four weeks. Child Euthanasia (contd) More than 5,000 children were killed in this first phase of the German euthanasia program. Jewish children were originally excluded from this program on the grounds that they did not deserve the “merciful act.” In 1943, however, the program was broadened to include healthy children of unwanted races. Adult Euthanasia or “T-4” In a note written by Hitler on his personal notepaper in October of 1939, backdated to September 1, 1939 to coincide with the invasion of Poland and the start of World War II, he stated: “Reichleiter Bouhler and Dr med Brandt are charged with responsibility to extend the powers of specific doctors in such a way that, after the most careful assessment of their condition, those suffering from illnesses deemed to be incurable may be granted a mercy death.” Adult Euthanasia or “T-4” (contd) The team of three referees in the Children’s Euthanasia program, the “Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses,” was expanded. The adult euthanasia program was housed at an “aryanized” villa at Tiergartenstrasse 4 in Charlottenberg, so the codename became “Aktion T—4” or “T4”. Adult Euthanasia or “T-4” (contd) Three covert sub-bureaucracies were set up: Reich Working Party for Mental Asylums to register potential victims, deal with their effects, and oversee the registry offices to fake their cause of death. Community Patients’ Transport Service, Ltd. to transport patients from psychiatric hospitals to holding asylums and extermination centers. Community Foundation for the Care of Asylums to carry out the killings, run the buildings, acquire the gas, and recycle gold teeth and sold jewelry Adult Euthanasia or “T-4” (contd) October of 1939: toxicologists from the police forensic institute determined that patients were to be killed painlessly—“disinfected”—with carbon monoxide. Target figures were established from a calculation based on a ratio of 1000:10:5:1. This means that of 1,000 people, ten require psychiatric treatment, five require in-patient treatment, and one will be euthanized. Given the population of the Greater German Reich, it was expected that 6570,000 mental patients would be killed. Adult Euthanasia or “T-4” (contd) In the same month, the first euthanasia applications were sent to psychiatric institutions, where they were evaluated by 48 medical doctors. The application emphasized ability to work. For these services, the physicians received five pfennig per survey if they evaluated more than 3500 applications per month. From a total of 283, 000 applications, 75,00 were marked for death. Adult Euthanasia or “T-4” (contd) The first executions of adult mental patients were carried out during the military campaign against Poland on or about January 9, 1940. At the same time, physicians began developing techniques that could be used to destroy the entire mental patient population of Germany. Drs. Brandt, Bouhler, Conti (Reich Health Fuhrer), and Brack (head of the euthanasia program) met in the psychiatric hospital at Brandenberg with August Becker, a chemist employed by the Reich Criminal Police Office to conduct the first largescale test of euthanasia. Becker wrote: Adult Euthanasia or “T-4” (contd) “I was ordered by Brack to participate in the first euthanasia trial run in the Hospital at Brandenburg, near Berlin. It was in the first part of January 1940 that I traveled to the hospital. Special apparatus had been constructed for this purpose at this hospital. A room, similar to a shower with tile floor, had been set up, approximately three by five meters and three meters high. There were benches around the edge of the room, and on the floor, about ten centimeters above the ground, there was a water pipe approximately one centimeter in diameter. In this tube there were small holes, from which the carbon monoxide gas flowed. The gas containers were outside the room and were already attached to one end of the pipe...In the hospital there were already two crematoria ovens ready to go, for burning the bodies. At the entrance to the room, constructed similar to that of an air-raid shelter, there was a square peep hole through which the behavior of the subjects could be observed. The first gassing was administered personally by Dr. Widmann. He operated the controls and regulated the flow of gas. He also instructed the hospital physicians Dr. Eberl and Dr. Baumhardt, who later took over the exterminations in Grafeneck and Hadamar...At this first gassing, approximately 18-20 people were led into the “showers” by the nursing staff. These people were required to undress in another room until they were completely naked. The doors were closed behind them. They entered the room quietly and showed no signs of anxiety. Dr. Widmann operated the gassing apparatus; I could observe through the peep hole that, after a minute, the people either fell down or lay on the benches. There was no great disturbance or commotion. After another five minutes, the room was cleared of gas. SS men specially designated for this purpose placed the dead on stretchers and brought them to the ovens...At the end of the experiment Victor Brack, who was of course also present (and whom I’d previously forgotten), addressed those in attendance. He appeared satisfied by the results of the experiment, and repeated once again that this operation should be carried out only by physicians, according to the motto: ‘The needle belongs in the hands of the doctor.’ Karl Brandt spoke after Brack, and stressed again that gassings should only be done by physicians. That is how things began in Brandenburg.” Adult Euthanasia or “T-4” (contd) Unlike the children’s “euthanasia” program, the T4 program, with its focus on adult chronic patients, involved virtually the entire German psychiatric community and related portions of the general medical community. There were six main killing centers: Grafeneck, 9,839 killed Jan-Dec 1940 Brandenburg, 9,772 killed Feb-Sept 1940 Bernburg, 8,601 killed Jan-Sept 1941 Hadamar, 10,072 killed Jan-Aug 1941 Hartheim, 18,269 killed May1940-1941 Sonnenstein, 13,720 killed June 1940-Aug 1941 Adult Euthanasia or “T-4” (contd) After the murder of 70,000 mental patients, the gassing stopped, in part because of public disquiet and protests of some churchmen, most notably Clemens Count von Galen, then bishop of Munster, in a sermon delivered on August 3, 1941, and possibly because 70,000 was the desired number. Faced with the choice between imprisoning prominent, highly admired protesters and ending the euthanasia program, Hitler apparently gave Brandt a verbal order on or about August 24, 1941 to end or at least “stall” Aktion T—4. Wild Euthanasia Widespread killing continued in a second phase, referred to as “wild euthanasia” in Nazi documents as doctors, encouraged if not directed by the regime, could now act on their own initiative concerning who would live or die. Patients were now not killed by gas but by neglect, starvation and drugs, the latter method in particular rendering the killing still more “medical.” At least another 70,000 patients are killed during the next four years. Operation 14f13 Spring 1941: T4 killings expanded to include concentration camp prisoners. This new killing enterprise was designated “Special Treatment 14f13.” “Special treatment” was the term prescribed for killing in the language regulations used by the SS (1 million man Schutzstaffel or Shield Squadron) and the police. The code “14f13” was the file number used by the Inspectorate of the Concentration Camps for the killing of prisoners in T4 centers. Operation 14f13 (contd) The selection of prisoners in the camps represented a close cooperation between T4 and the SS physicians. T4 physicians, in teams or alone, traveled to the camps to validate the pre-selections made by SS camp physicians. The physicians responsible for the administration of euthanasia operations in German hospitals were also responsible for formulating criteria and administering the first phases of the destruction of the Jews and handicapped in Germany’s concentration camps. Operation 14f13 (contd) September of 1941: physicians conduct the first experiments using Zyklon B (hydrocyanic acid) to kill Russian prisoners of war at Auschwitz. Fall of 1941: gas chambers at psychiatric institutions in southern and eastern Germany were dismantled and shipped east, where they were reinstalled at Belzec, Majdanek, Auschwitz, Treblinka, and Sobibor. The same doctors, technicians, and nurses often followed their equipment. The Final Solution January of 1942: Himmler (SS leader) announces the policy of “Extermination Through Work” at the Wansee “Conference on the Final Solution of the Jewish Question.” The Final Solution (contd) Duties of SS Doctors in the concentration camps: Ramp “selections.” Camp “selections.” Accompany patients in Red Cross car to crematoria. Choose the appropriate number of pellets of gas. Observe through the hole how the people are dying. When the people were dead, order the opening of the gas chamber. Sign the form confirming that the people are dead and how long it took. Observe the extraction of teeth from the corpses. Healing by Killing: Medicine in the Third Reich Text for the Course Available Friday, 1/8/10, at UT Medical School Bookstore, 6431 Fannin, Room B600, 713-500-5861. Reading Assignments Class 2, 3- Healing by Killing: Medicine in the Third Reich (files.me.com/sheldonrubenfeld/nhjv63) AND Foreword, Introduction, Chs. 1-7, and Afterword in MATH Class 4, 5 – From Long Island to Auschwitz and Beyond (files.me.com/sheldonrubenfeld/ms4cpp) AND Chs. 7-10 and 16 in MATH Class 6, 7 – Chs. 11-15 and 17-20 in MATH Lectures given by these authors and others can be seen at UT Austin’s Schusterman Center for Jewish Studies: http://www.utexas.edu/cola/centers/scjs/medethics/lectures.php Course Outline Medicine in Germany during the Third Reich (1933- 1945) Eugenics: Healing by Killing in America and Germany Medicine after the Holocaust: From the Master Race to the Human Genome and Beyond. Part I. Medicine in Germany during the Third Reich (1933-1945) Sterilization Law Nuremberg Laws Child Euthanasia T4 Program Wild Euthanasia Operation 14f13 The Final Solution Medical Experiments Cover-up Medical Experiments (Vivien Spitz Doctors from Hell) High-altitude decompression “experiments” completed by Sigmund Rascher at Dachau. Deadly compression chamber for altitude experiments at Dachau Medical Experiments (contd) Mutilating “experiments” on women in Ravensbruck to test effectiveness of drugs against gunshot and other simulated battlefield injuries. May 1943: awards for results of Ravensbruck mutilating experiments given to researchers by German Orthopedic Society at Congress of Reich Physicians. Ravensbruck: infecting man-made wounds to test antibiotics Medical Experiments (contd) Hypothermia experiments begun by Dr. Rascher and University of Kiel Professors at Dachau. October 1942: data on hypothermia presented at annual meeting of Luftwaffe medical service in Nuremberg. There were 95 physicians in attendance. Should the results of any experiment be used? The results have already been used and we have all benefited from them. SS doctor Sigmund Rascher Dachau Experiment on Romani (Gypsy) victim re: potable seawater-Dachau Medical Experiments (contd) Josef Mengele, M.D. (with two doctoral degrees in anthropology and in genetic medicine) worked at Auschwitz as scientific assistant to Dr. Otmar von Verschuer, who proudly claimed that the dangers posed by Jews and Gypsies to the German people had been “eliminated through the racial-political measures of recent years.” Mengele sent “scientific” material to von Verschuer at the Kaiser Wilhelm Institutes, since renamed the Max Planck Institutes, the equivalent of our National Institutes of Health (NIH). Material secured by Mengele included eyes from murdered Gypsies, internal organs from murdered children, and sera from twins deliberately infected with typhoid. He was known as The Angel of Death. Victims of Dr. Mengele’s medical experiments at Auschwitz-Birkenau Summary of medicine during the Third Reich (1933-1945) More than 38,000 physicians, almost half of all doctors in Germany, had joined the Nazi party by war’s end. More than 7% of all physicians were members of the SS, compared with less than 0.5% of the general population. German physicians, nurses, other medical personnel, public health officials, and biomedical scientists accomplished the following: Summary (contd) More than 6,000,000 Jews selected and killed. 400,000 German patients selected and sterilized. 5,000 German children selected and euthanized. 200,000 German adults selected and euthanized. Only 15% of patients in German mental hospitals at the start of World War II survive. Cruel, and murderous medical experiments on thousands of concentration camp inmates. Cover-up None of the following ringleaders of the Nazi program of “Applied Biology” were prosecuted and the many thousands of other involved physicians continued to practice, teach, or do research or administrative work after the war: Dr. Eugen Fischer Dr. Julius Hallervorden Dr. Fritz Lenz Dr. Ernest Rüdin Dr. Otto Von Verschuer Dr. Ernst Wenzler Cover-up (contd) West German physician organizations actively covered up the crimes of their members. Respected German bioscientists, like Nobel Laureate Adolf Butenandt, falsely disclaimed knowledge of the crimes of their fellow bioscientists. Americans were more interested in securing German scientists (before the Russians secured them) than in prosecuting them. Cover-up (contd) “Houston, we have a problem.” Wernher von Braun, who according to a NASA website, was “without doubt, the greatest rocket scientist in history.” Wernher von Braun worked for the Nazis at Peenemünde from 1937-1945 and developed and realized 6,000 V-2 missiles, of which 3,000 were launched against Europe, especially London, in the last year of World War II. Dock at Nuremberg Doctors’ Trial Gen. Telford Taylor’s Indictment Cover-up (contd) Nuremberg Doctor’s Trial: 23 physicians, administrators, and bioscientists tried for war crimes and crimes against humanity. Sixteen found guilty. Seven sentenced to death and executed on June 2, 1948. Sentencing of Dr. Karl Brandt Cover-up (contd) The 10 point Nuremberg Code, developed at the trial, deals exclusively with medical research: The voluntary consent of the human subject is absolutely essential. During the course of the experiment the human subject should be at liberty to bring the experiment to an end if he has reached the physical or mental state where continuation of the experiment seems to him to be impossible. The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury. Cover-up (contd) Euthanasia was the fulcrum for the Holocaust: once German physicians killed their own citizens because they considered their “lives not worth living,” they would have no qualms about experimenting upon and killing Jews, Gypsies, blacks, communists, homosexuals and others they considered subhuman. By dealing primarily with the medical experiments and not the sterilization, euthanasia, and murder of millions of people, was the Nuremberg Doctors’ Trial, inadvertently, part of the cover-up? Cover-up (contd) Nazi defense attorneys raised difficult ethical questions Arthur Caplan on bioethics: It if often presumed, if only tacitly, by those who teach bioethics that those who know what is ethical will not behave in immoral ways. What is the point of doing bioethics, of teaching courses on ethics to medical, nursing, and public health students if the vilest and most horrendous of deeds and policies can be justified by moral reasons? Bioethics has been speechless in the face of the crimes of Nazi doctors and biomedical scientists precisely because so many of these doctors and scientists believed they were doing what was morally right to do. Cover-up (contd) Gerhard Rose Koch Institute of Tropical Medicine in Berlin. Initially opposed performing potentially lethal experiments to create a vaccine for typhus on camp inmates. He came to believe that it made no sense not to risk the lives of 100 or 200 men in pursuit of a vaccine when 1,000 men a day were dying of typhus on the Eastern front. Justifying the sacrifice of the few to benefit the majority is a position that must be taken seriously as a moral argument. Cover-up (contd) There has been a deafening silence among bioethicists about medicine during the Third Reich. According to Volker Roelcke, three myths have contributed to the deafening silence: 1. Medical atrocities were committed by a few incompetent and fervent Nazi doctors and were the result of irrational ideologies imposed from above by Nazi politicians on apolitical physicians. Cover-up (contd) 2. The programs of mass sterilizations and patient killings were the expression of an ideology that had little or nothing to do with contemporary state of the art medical reasoning and practice. 3. The activities of eugenically motivated medical geneticists and medical scientists experimenting on humans in concentration camps had nothing to do with science, but were rather the expression of racial ideology or even individual perversion disguised as science and, therefore, better termed “pseudoscience.” Cover-up (contd) Arthur Caplan: It is comforting to believe that health care professionals from the nation that was the world’s leader in medicine at the time, who had pledged an oath to “do no harm,” could not conduct brutal, often lethal, experiments upon innocent persons in concentration camps. It is comforting to think that it is not possible to defend wound research on the living in moral terms. It is comforting to think that anyone who espouses racist, eugenic ideas cannot be a competent, introspective physician or scientist. Nazi medical crimes show that each of these beliefs is false.