Healing by Killing: Medicine in the Third Reich

Healing by Killing: Medicine in the
Third Reich
Course Outline
 Medicine in Germany during the Third Reich (1933-
 Eugenics: Healing by Killing in America and
 Medicine after the Holocaust: From the Master
Race to the Human Genome and Beyond.
Contact Data
 Email your full name to:
[email protected]
 Telephone numbers: 713-795-5750 (office) and 713661-6999 (home)
 Text, reading assignments, and contact information
can be found at:
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
 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:
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:
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
 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
 Genetically ill persons were permitted to marry
other genetically ill persons, but only after being
 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
 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
 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
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
 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
 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
 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:
Course Outline
 Medicine in Germany during the Third Reich (1933-
 Eugenics: Healing by Killing in America and
 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
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
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
 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
 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.
 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
 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,
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
 Initially opposed performing potentially lethal
experiments to create a vaccine for typhus on camp
 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
Cover-up (contd)
 There has been a deafening silence among
bioethicists about medicine during the Third
 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
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.

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