by Cina, Joshua A. Perper, Stephen J. ; Cina, Joshua A. Perper, Stephen J.
A major role of the physicians in the concentration camps was in the so-called “selection” process. Upon arrival, the inmates were chased out of the J.A. Perper and S.J. Cina, When Doctors Kill: Who, Why, and How, 57
DOI 10.1007/978-1-4419-1369-2_7, © Springer Science+Business Media, LLC 2010
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wagons, greeted with cries of “Raus, Raus” (“Out, Out”), and harshly prodded and battered into “receiving lines” for medical review. Doctors in elegant SS
uniforms selected which prisoners should be immediately gassed and those who were to survive as slave laborers. As we have seen before, some doctors have the need to “play God” – these Nazi physicians were no exception. Older men, ill people and pregnant women were immediately killed, as were small children unless they were needed for “the advancement of science.” Some prisoners were selected for involuntary medical experimentation often culminating in death. The reviewing physician sorted the throng by flipping his hand; to the right meant
“death”, and to the left “temporary survival”. The selection was done casually with the screening doctors often smiling, joking or laughing. The more vicious doctors did not hesitate to brutalize some of the slower moving inmates. Some reports suggest that crying children were thrown alive into cremation fires during this screening procedure.
In the early stages of the War, physicians were responsible for turning on the gassing apparatus. These physicians were also supposed to witness the exterminations to assess the efficacy of the process. Once the bodies were removed from the chamber, German dentists extracted gold teeth from victims. Some of the victims’ bodies were stripped of their flesh with the skeletons submitted for anthropological studies to German universities. Many of these specimens were found in the university museums at the end of the War, before the local staff had a chance to dispose of them. In addition to the role they played in the concentration camps, Nazi physicians also participated in other progressively injurious or murderous programs including coercive sterilization, the killing of “impaired” children in hospitals, and the eradication of “defective” adults mostly from mental hospitals or institutions in special centers.
Coercive sterilization was done under the direction of the German Hereditary Health Courts. Men were forcibly vasectomized whereas women were initially sterilized by removal of their ovaries—sometimes with the uterus. Experiments on forced sterilization by radiation were performed on hundreds of women detained in concentration camps. By the end of the Nazi regime, over 200
Hereditary Health Courts (Erbgesundheitsgerichten) in which two of the three members were physicians were operating. Under their rulings, over 400,000
Germans had been sterilized including 200,000 deemed mentally deficient; 100,000 with mental illness; 60,000 epileptics; 10,000 alcoholics; 20,000 with body deformities; and others afflicted with Huntington’s chorea, hereditary blindness or deafness. The Nazis also considered Blacks inferior and despised their culture, including Black music and jazz. They decided to take action against people of color in the Rhineland. In 1937 some 400 children of mixed parentage were arrested and sterilized.
In the beginning of the so called “euthanasia” program, the Nazis were very careful to present to the German public only the most egregious cases of disability and deformity. This government response was marketed as a compassionate response to frantic pleas from parents wishing to put a suffering child out of his/her misery. In many of these cases, the pleas were either fabricated by the government 7 The Nazi Murders
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or were made after coercion. The actual child euthanasia program started with a family petition for the “mercy killing” (“Gnadentod”) of an infant by the name of Knauer. He had been born blind, mentally retarded, and with one or both legs and part of one arm missing. Hitler himself ordered the killing only after Karl Brandt, his personal physician, verified the accuracy of the facts and consulted with the treating physicians who approved euthanasia. Hitler granted the physicians assisting the government in this project immunity from prosecution.
By late 1938, only months before the preparations for war accelerated, the Nazi regime authorized mercy killings of babies born deformed or with brain damage. A Reich Committee for the Scientific Registration of Serious Hereditary and Congenital Diseases (Reichsausschuss zur wissenschaftlichen Erfassung von erb- und anlagebedingten schweren Leiden), was made responsible for monitoring the registration of all children under 3 years of age with any suspected “serious hereditary diseases” including a variety of mental and physical challenges. Midwives were required to make these reports at the time of birth and doctors were to report all such children up to the age of three on questionnaires of the Reich Health Ministry. The physicians staffing the euthanasia commission made their determination of “lebensunwertes leben” (life unworthy of life) solely on the basis of the questionnaire without examining the children or reviewing their medical records.
A red cross marked on the form indicated that that the child had to be killed, a blue one that it will be allowed to live. If the commission could not unanimously decide the fate of a child based on the questionnaire, the child was shipped to one of six psychiatric “euthanasia” sites including the Hadamar Psychiatric Clinic. While in the care of the Clinic, children were killed by either gradual starvation or by the administration of increasing doses of Luminal (phenobarbital – a type of sleeping pill). In the end, 70,000 German children thought to be abnormal were forcefully taken from their homes, institutionalized, and eventually killed. The parents were told by the doctors that their offspring died of natural conditions or of unavoidable complications of necessary surgical or medical therapy. The bodies were burned en mass and comingled ashes were sent to the families.
The Nazi serial murders soon snowballed and the “euthanasia” program was expanded to include inmates of psychiatric facilities, adult patients with severe neurological disorders and other “undesirables.” In October 1939, Hitler issued a decree increasing “the authority of certain physicians to …(identify) persons who, according to human judgment, are incurable … (and can) be accorded a mercy death.” Anyone who suffered from schizophrenia, manic-depressive disorder, epilepsy, senility, paralysis, syphilis, retardation, encephalitis, Huntington’s chorea, and other neurological conditions had to be reported to the Nazi Health Authorities.
The criminally insane and patients who had been institutionalized for 5 or more years were also on the hit list. Patients who did not have German citizenship or were not of German descent, including Jews, blacks, and Gypsies, were to be reported as well. Obviously, if you were not German, something had to be wrong with you. This seems curious since Hitler was Austrian.
By 1941, public outcry regarding the government’s euthanasia program (“Aktion T4”) had reached a fever pitch and Hitler suspended the program. Over 100,000
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men, women and children had been killed. The Nazis were no longer able to kill institutionalized patients with mass gassings. Drugs and starvation were used instead – it was much more discreet. Hitler still tried to influence the public view of euthanasia through a clever, emotionally charged movie entitled Ich Klage (I Accuse), which was shown in theatres all over Germany. It depicted the tribulations of a good and charitable physician and a loving husband whose wife suffered from disabling multiple sclerosis. The wife begged her husband to end her misery and help her to commit suicide and the husband reluctantly agreed. The husband was then charged with murder and he in turn accused the State of failing to help the disabled to die and thereby relieve their suffering. Obviously, the Nazis could not turn a blind eye to this poor fellow’s plight.
Why Did They Do It?
It is difficult to understand how normal human beings could have, would have, and did willingly take part in this orgy of medical mayhem and murder, particularly physicians who have taken an oath to do no harm. The Nazi doctors were no
t isolated psychopathic or sociopathic physicians but rather throngs of hundreds if not thousands of practicing doctors assimilated into the Nazi movement.
In her 1963 work “Eichman in Jerusalem,” Hannah Arrendt argued that the explanation is what she termed “the banality of evil.” Her theory suggests that great evils in history in general, and the Holocaust in particular, were not largely executed by fanatics or by sociopaths, but by ordinary people. Each small, human, cogwheel accepted the commands of the State as a matter of routine and complied with their instructions without much critical thinking. While such an attitude clearly facilitated some of the Nazi atrocities, it is not the sole explanation.
The metamorphosis of Germans doctors from healers to killers was a much more complex, multifaceted and gradual process, and an intrinsic outcome of very clever indoctrination of the German people by Hitler and his National-Socialist Nazi Party. Many German physicians were also strongly influenced by Hitler’s charisma.
In 1929, Hitler had appealed directly to German physicians to assist him in his campaign of “racial hygiene” and in response, a group of 40 German doctors formed the Nationalist Socialist Physician League to support the Nazi racial policy designed to “purify” the medical establishment. Almost 2,790 physicians, 6% of the entire medical profession, joined the League well before Hitler came to power.
Hitler’s appeals also prompted many physicians to join the Nazi Party. Between 1924 and 1944, the physicians’ membership in Hitler’s National Socialist Party was threefold that of the general German population, with most of the supporters being young physicians below 40. Like moths attracted to a burning light, many German physicians blindly followed the Nazi myths and practices. Those that did not march to the tune of the State could well become a future “patient” of the regime.
Duty
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Duty
The enthusiasm with which the Nazis carried out their onerous tasks in the extermination camps varied from bland indifference to undisguised pride. Although it was not uncommon for newly assigned doctors to be upset by the skeletonized appearance of starving inmates and mounds of murdered victims ready for cremation, in time most were capable of efficiently carrying out their duties (although some resorted to heavy drinking). The small number who complained that they were unable to carry out their assignment were re-educated about their duty as “medical soldiers”
and the need to unquestioningly follow the instructions of their beloved Fuehrer.
Many other doctors fulfilled their duty with maximal devotion looking forward to every new arrival of victims. Some displayed unusual cruelty towards the inmates, especially doctors with innate narcissistic or sadistic personality traits. Such was the case of Dr. Joseph Mengele, a Bavarian physician who became the “Angel of Death.”
In 1945 Mengele was stationed at the Auschwitz–Birkenau concentration camps where numerous Poles, homosexuals, Soviets, Jews, and Romanians met horrible and untimely deaths. Mengele would inspect incoming camp prisoners and assign them to work, experimentation, or the gas chambers. He believed fanatically in the Social Darwinism of Nazi racism and generally carried out his odious duties in a very obsessive fashion, usually with marked indifference to the suffering around him. He made a special point of greeting every load of incoming prisoners, as he wanted to be sure that he was not going to miss sets of twin prisoners up on which he was always burning to experiment. Mengele apparently enjoyed the dramatic contrast between his elegant officer’s clothing and the dirty rags worn by most prisoners. Psychiatrists who have studied Mengele have asserted that this infatuation was a marker of a narcissistic personality with sexual gratification overtones.
Even Mengele, however, displayed short-lived flashes of humane behavior, a phenomenon known as doubling. For example, Mengele had a protégé among the Gypsy camp inmates, a young boy, who he provided with better food and clothing.
Despite this apparent kindness, on the night when he was ordered to exterminate all the Gypsies in the camp, Mengele himself relentlessly hunted for the boy throughout the camp and personally saw to it that he was gassed with the rest of the prisoners.
After the war Mengele fled to South America (Paraguay and Brazil) where he eventually died by drowning decades after the War. Despite the insinuations made in
“The Boys from Brazil” movie, there is no firm evidence to suggest that after Mengele relocated to South America he attempted to clone Hitler. However, it should be noted that in a 2009 book entitled “Mengele: an Angel of Death in South America”
an Argentine historian argued that Mengele’s activities after the War were the explanation for the high proportion of twins in the tiny Brazilian town of Candido Godoi.
Further, although the natives resembled their neighboring South Americans, most of the twins were blond-haired and blue-eyed. The residents of the town apparently reported that Mengele made repeated visits there in the early 1960s. He first claimed 62
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to be a veterinarian but then offered free medical treatment to women, providing them with unidentified elixirs and pills and taking blood samples.
Shortly after the end of the war, a small group of Nazi physicians were brought before an Allied tribunal at Nurenburg and tried for war crimes including human medical experimentation. Some were sentenced to death by hanging, some to long prison terms, and a few were acquitted. In truth, a very small number of culpable German physicians were brought to justice and most escaped punishment. Many esteemed physicians from reputable German universities had collaborated shamelessly with the Nazi authorities and had received organs, tissue and skeletons of the murdered camp victims which they used in their research. Despite the advances made in the name of science, they could not justify the atrocities committed and an indelible mark of Cain was emblazoned on the body of German Medicine.
Preservation of the Race
Many Germans physicians of the 1930s were strong supporters of eugenics.
This branch of science has as its goal the improvement of the human race through manipulation of genetic hereditary traits. It discourages the propagation of negative hereditary traits (negative eugenics) and encourages propagation of positive traits (positive eugenics). The term was coined in 1865 by Sir Francis Galton in a social application of his cousin Charles Darwin’s On the Origin of Species. On the face of it, eugenics seems to be a well-intentioned and beneficial philosophy to humankind.
In modern times, it has played a formative role in pre-natal testing and screening, genetic counseling and molecular correction of genetic diseases. Unfortunately, the Nazis used eugenics as a model for coercive state-sponsored discrimination, forced sterilization of persons with disabilities and/or genetic defects (real or conveniently assumed), the killing of disabled or institutionalized people and, in some cases, outright genocide of populations perceived as inferior or undesirable. Malignant eugenics and pseudo-eugenics practices were at the very heart of Nazism.
In an 1895 book entitled “Das Recht auf den Tod” (the Right to Death) Adolf Jost argued that the State should have the ultimate authority to decide who should live and who should die since it has the responsibility of efficiently handling the society’s resources “in order to keep the social organism alive and healthy.” He argued that the State already exercised such rights in war, when throngs of individuals are sent to die for the good of the State. Jost advocated that for the collective good, the State’s right to decide death should be extended to peacetime and that the euthanasia of the disabled is not an act of cruelty but of mercy. Though morally repugnant, similar arguments are currently being made by some extremists who are trying to figure out how to deal with millions of aging “baby-boomers.”
In 1920 Karl Binding, a law professor from the University of Leipzig, and Alfred Hoche, a professor of psychiatry at the University of Freiburg, authored
“Die Freigabe der Vernichtung lebensunwerten Lebens” (The Permission to Preservation of the Race
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Destroy Life Unworthy of Life). The authors included in the category “unworthy life” not only the incurably sick but large segments of the mentally ill, the feebleminded, and retarded or deformed children. They claimed that the termination of life unworthy of life is “purely a healing treatment” and a “healing work.” Many German physicians accepted such argumentation as being rational and ethically justified. As early as 1922, the popular writer Ernst Mann (a pseudonym of Gerhardt Hoffman) defended direct medical killing commenting that illness is “a disgrace to be managed by health control” and that “misery can only be removed from the world by painless extermination of the miserable!” Mann wrote that, “all the weaklings and the sick must be exterminated” and suggested to the Reichstag that anybody who was a burden on society and unable to contribute to it should die. After all, if they weren’t exterminated, they would be miserable anyway.
He argued that a combined plan of eugenics and euthanasia would bring about a triple benefit for Germany:
1. It would be seen as an act of mercy by society in general;
2. It would improve the stock of the Aryan race and;
3. It would be financially sound for the State.
His euthanasia extremism was also evident in his book “Moral der Kraft”
(The Morality of Strength) in which he advocated that war veterans should commit suicide in order to reduce public welfare costs. In 1936, Gerhardt Wagner, the head of the Nazi Health System and of the Reich’s Physicians Chamber to which all physicians were mandated to belong, held informal discussions about killing “idiotic children” and “mentally ill” people. The group also advocated producing propaganda films for the German audiences emphasizing the humanity of such an approach. He also identified as the task of his Public Health Office “the promotion and perfection of the health of the German people … to ensure that the people realize the full potential of their racial and genetic endowment.” An influential manual by Dr. Rudolf Ramm of the University of Berlin proposed that each doctor was to no longer be merely a caretaker of the sick but to become a “cultivator of the genes,” a “physician to the Volk,” and a “biological soldier.”