The National Socialist transformation of German medicine

How to cite: Pankowicz, A. The National Socialist transformation of German medicine. Bałuk-Ulewiczowa, T., trans. Medical Review – Auschwitz. Originally published as “Narodowosocjalistyczne przemiany medycyny niemieckiej.” Przegląd Lekarski – Oświęcim. 1982: 108–111.

Author

Andrzej Pankowicz, PhD, 1950–2011, professor of history at the Jagiellonian University of Kraków, social activist, member of the Independent Self-governing Trade Union “Solidarity” and of the Polish Red Cross.

The prevailing tendency in the research carried out hitherto on the history of German medicine under the Third Reich has been to examine the issue from the criminal aspect, or as an ethical and moral problem (Bayle; Bogusz and Wolter, 13–187; Mitscherlich and Mielke; Ternon and Helman, 1969 and 1971). I do not want to underrate the value of this approach, which shows the work of physicians subject to the conditions imposed by a totalitarian state eradicating the individual’s autonomy and humanity; yet I must emphasise that research oriented in this way leaves aside the mechanisms and structures constituting the essential features of the Nazi German health service. The changes which ensued in the organisation of the German health service after 1933 provide the key to the understanding of many of the negative phenomena characteristic of the practice of medicine which replaced the Hippocratic oath with a new, Nazi medical ethics. The changes that took place in the top echelons of the authorities of the institutions and organisations responsible for the activities of the civil and military health service in Germany and German-occupied countries constituted the crucial factor determining the new shape of the medical milieu.

The German system of medical treatment which worked until 1933 was created under the Second Reich. The Deutscher Ärztevereinsbund (German League of Physicians’ Associations) was established in 1873, and its members were the medical associations operating at the time in the diverse German countries. The Ärztevereinsbund was a democratic organisation, and its field of interests spanned the entire range of medical issues, public health and hygiene, including the care of persons suffering from chronic and irremediable conditions, both of the somatic and psychiatric kind. In 1881 legislation came into force for the establishment of a health insurance system which provided a large part of German society with guaranteed medical care. At this time German medical practitioners set up the Hartmann-Bund, a voluntary organisation whose aim was to defend the financial interests of the medical profession. It was also attuned to medical ethics, and established medical committees to investigate cases of alleged malpractice (see the Opening Statement of the Prosecution by Brigadier General Telford Taylor, 9 December 1946, TWC I, 56–57).

Apart from this self-governing system, there was also an Ärztekammer (Medical Chamber) independent of it, which represented the standpoint of the German government on all matters connected with medical treatment. Notwithstanding its semi-official character, this body, too, had democratically elected authorities, just like all the other medical organisations and associations. To complete the picture, I shall add that there were many associations which conducted scientific research, promoted medicine and disseminated medical information to the general public, organised continuous education and training programmes for medical professionals, published their own newspapers and journals, and pursued a wide range of relations with counterparts in other countries. Thanks to these contacts, the mass of German doctors enjoyed access to a large and usually full amount of information on issues which absorbed the attention of health service workers (TWC I, 56).

The two institutions which supervised the education, training, and work of medical professionals were the Ministry of Education and the Reichsgesundheitsamt (Health Office), which was attached to the Ministry of the Interior. Medical studies followed a similar course in German universities to the model generally used in most other European countries, and usually lasted for 5 to 6 years. Graduates were required to spend a year as an intern in a hospital or clinic, and on completion of their internship, they could start to practise in medicine. But before they could start treating patients on the national insurance system, they had to have spent at least two years’ service in general practice. The crowning achievement in every German physician’s medical education was the award of a degree of Doctor of Medicine from a European university (TWC I, 57).

When the Nazis came to power, the importance of the Nazionalsozialistischer Ärztebund (Union of National Socialist Physicians) rose. The organisation’s soul was Dr Leonardo Conti, a man absolutely committed to the Nazi cause since the age of 18 and an active participant in its anti-Semitic campaign (Ternon and Helman, 1971, 355 in the Polish edition). A special proscription list was compiled and in the early hours of 1 April 1933 members of the Union broke into the residences of physicians who held left-wing views or had a Jewish background and arrested them, taking them to the SA prison on Hedemannstrasse in Berlin. But before the arrestees arrived there, they were put through a variety of gruelling experiences: they were beaten, detainees who were elderly or in a poor state of health were forced to do “physical exercise,” and harassed in a number of other ways to diminish their physical and spiritual powers of resistance (TWC I, 57).

1 April 1933 marked the beginning of the Nazi takeover of German medicine. Doctors who were known for the socialist or communist views, or who were Jewish, were thrown out of the public health service. In addition, Jews were expelled from all the professional organisations and learned societies in Germany. Initially, this ban did not apply to First World War veterans, but when the war broke out in 1939, Jewish doctors were deprived of all their rights to practise their profession and degraded to the rank of medical auxiliaries. A Star of David on a prescription put the patients of these doctors at risk of various forms of harassment in pharmacies and health centres. German “Aryan” doctors were subjected to continuous pressure to refuse to treat Jewish patients. Only a few non-Jewish doctors had the courage to defy the Nuremberg laws1 and treat Jewish patients. Special hospital wards were established for Jewish patients, but their purpose was not treatment as such, but extermination. The peak achievement of Conti’s policy was to impose a restriction on professional practice for foreign doctors or Mischlinge (persons of racially mixed descent), only to turn them all into staff forced to work for the German war industry a year later (TWC I, 58).

When the Nazis took power, Dr Arthur Julius Gütt was appointed head of the health department in the Reichsministerium des Innern (German Ministry of the Interior). One of the basic principles of his policy was the rejection of the concept of love of one’s neighbour with respect to persons who were “of lesser value racially” or “asocial,” which was done by drawing up and implementing a new Nazi system of ethics. The Nazi State was to look after the segment of society which was free of hereditary diseases and guaranteed the perpetuation of the “wholesome and racially pure national substance.”

In 1933–1936 Gütt implemented a far-reaching set of transformations of the health service to speed up the Nazification of this aspect of public affairs. This was an important move, because the doctors were envisaged to translate the Nazi theories into the language of medicine. All doctors in state appointments had to take an 18-month training course to learn the new tasks for the health service. During the course they were encouraged to join the Nazi Party. Prof. Ernst-Robert Grawitz, a member of the Nazi Party, was appointed head of the German Red Cross. All the physicians’ organisations operating hitherto except the Reichsärztekammer (Reich Chamber of Physicians) were closed down, and all practising physicians except for those in the military were required to join it. Conti directed the work of the Reichsärztekammer, and the overwhelming majority of its top management posts were held by members of the Nazi Party, usually Nazionalsozialistischer Ärztebund activists, appointed on the basis of political criteria, not for their professional qualifications. Their primary task was to foster Nazi Party, SS, and SA influence in all the units of the health service (TWC I, 59–60).


The RollerMarian Kołodziej. Photo by Piotr Markowski. Click to enlarge.

Newcomers to the medical profession had to attend a course of indoctrination in an institution called the Führerschule der Deutschen Ärzteschaft (German Physicians’ School of Leadership) at Alt-Rehse in Mecklenburg. The school was founded by Kurt Blome2 and thanks to to him its courses soon became obligatory. In practice young physicians were compelled to join the Nazi Party and make an active contribution to its operations and to the work of other Nazi organisations, which effectively precluded their prospects of enhancing their medical qualifications or conducting scientific research. Formally, there were no major changes in the university syllabus for Medicine after 1933, but in practice things were very different from the official description given in the German university handbooks. Candidates applying for Medicine had to prove they were of “Aryan” descent and join the Nationalsozialistischer Deutscher Studentenbund (National Socialist German Students’ League). Failure to master the Nazi racial theory and the Nuremberg laws was a serious obstacle to graduation. Many of the professors and other senior academics appointed after 1933 could not manage to reconcile their political duties with their academic work, and effectively neglected their academic tasks. A potential danger to the progress of the medical sciences in Germany came from the fact that a large part of the senior academics took a submissive attitude to the key Nazi figures (TWC I, 60).

The new situation had a dramatic effect on German psychiatry. There was a distinct fall in academic standards in this discipline, which along with the enforced indoctrination turned many medical students into practitioners of the policy of exterminating mental patients in order to ensure that the future generation of the German nation would be “wholesome.” A whole series of state-of-the art therapies which had been practised in Germany up to that time were relinquished or very substantially curtailed (for more on this see Ternon and Helman, 1971, 39–220 in the Polish edition).

After the outbreak of the Second World War, the civilian health service continued to be eclipsed by its military counterpart, especially by the constantly expanding SS medical institutions and organisations. In the conditions of a country waging total war, the militarisation and Nazification of the health service compelled the German government to introduce a series of measures to integrate the system of management in its health service. On 28 July 1942 Hitler issued a decree appointing Prof. Siegfried Handloser chief of the German armed forces medical services. Handloser had been Heeressanitätsinspekteur (army sanitary inspector) up to that time, in charge of the army’s health service; now his duties included the coordination of the medical services in all the different kinds of forces, the Waffen SS, and in all the health care organisations and units under the authority of the Wehrmacht. As the official spokesman of all the military physicians, Handloser was authorised to represent the German military in all matters handled by the civil authorities concerning the health service and medical research. He was to manage the Waffen SS health service, working with its medical inspector. Conti, the head of the civil health service, was an undersecretary in the Reichsministerium des Innern, and was responsible for the health service. Hitler’s decree also gave special powers to Prof. Karl Brandt, the Reich Commissioner of Sanitation and Health. Brandt’s duties were to implement and coordinate Hitler’s plans relating to the health service and to keep Hitler informed about the work of the various branches of the German health service (Reichsgesetzblatt 1942, I. 515).

On 5 September 1943, Brandt was made chief of all the medical research institutions and the industrial units connected with the production of medicines, medical equipment, and dressings, as well as of the institutions engaged in the distribution of these products (Reichsgesetzblatt 1943, I. 533).

The next phase in Brandt’s rise in the German health service, and also in his personal influence on Hitler and other prominent Nazis, started on 25 August 1944, when Hitler issued another decree appointing him Commissioner of Sanitation and Health. This promotion made him a member of Germany’s supreme authorities, empowered to issue orders concerning a wide range of medical matters to the state administrative authorities, the authorities of the Nazi Party, and the German armed forces (Reichsgesetzblatt 1944, I. 185).

An earlier decree, issued by Hitler on 7 August 1944, reorganised the German military health service. On the grounds of this decree, as of September 1944 Handloser ceased to be the inspector of the military health service, but retained his post as head of the Wehrmacht’s medical service. Previously he had held the two offices jointly, but their separation was intended to help him focus his attention on matters which were fundamental for the proper operation of the military health service. A set of instructions issued on the same day by the Oberkommando der Wehrmacht (High Command of the Armed Forces) appointed Handloser head of all the state medical research institutes, schools of medicine, and other entities associated with medical matters and under the authority of the Wehrmacht or Waffen SS (TWC I, 84–87, Document NO-227). Handloser was now in charge of the military medical academy, the institutes in Lemberg3 and Krakau4 under the authority of the Oberkommando der Wehrmacht, the St. Johann medical school, and the Berlin and Munich institutes for aviation medicine (TWC II, 184–185).

The SS and police force health service started to expand after 1936, when Prof. Grawitz, who was also the chairman of the German Red Cross, was put in charge of it. Dr Helmut Poppendick, the head of the medical service of the SS Rasse- und Siedlungshauptamt (SS Race and Settlement Main Office), was appointed head of the personnel department in Grawitz’s office. The SS Main Economic and Administrative Office (Wirtschafts- und Verwaltungshauptamt SS), which was directed by Oswald Pohl, had its own health and hygiene service, which was run by Dr Enno Lolling, who was responsible for the medical services in the concentration camps, and this aspect of his work, though formally subject to the authority of the SS chief physician, in practice operated as an independent branch of the German health service (Ternon and Helman, 1969; 53–58 in the Polish edition; reviewed by Gutt).

Ahnenerbe (“ancestral heritage”), an association for the study of the anthropology and cultural history of the “Nordic race,” was accorded a special place in this system. It also conducted a wide range of publishing activities. The basic source of its funds were donations (TWC I, 88–90, Documents N0-303 and N0-422).

On 9 June 1942, Hitler issued a decree founding yet another institution, the Reichsforschungsrat (German Research Council). Its task was to draw up a set of guidelines to help German medicine provide the best possible service for the needs of Germany’s war effort. The Research Council worked with the Reichsministerium für Wissenschaft, Erziehung und Volksbildung (Reich Ministry of Science, Education, and Culture) to coordinate research projects and implement their results as soon as possible. Its funds came from the national budget and private donations. The Research Council’s field of interests encompassed matters relating to German medicine and pharmacy (Reichsgesetzblatt 1942, I. 389).

This complex system of offices and institutions concerned with medical affairs constituted a well-knit network due to the fact that many of the senior management posts were in the hands of the same, small group of individuals, who held key appointments in the state administrative system and in the Nazi Party, SA, and SS political setup. The high level of complexity helped them carry out the criminal purposes for which they wanted to enlist a select group of German physicians.

The multiple powers which these people exercised, in a system of double, or sometimes even triple duties mutually superimposed one on top of another, did not encourage these individuals to develop a sense of responsibility for the decisions they made. In many cases it reduced these high officials to the role of a mindless cog in a machine that carried out orders for which only their superiors were responsible. An examination of the way the German health service was Nazified gives a new vista of the relatively small group of physicians whose names are familiar to all historians of the concentration camps. If we consider the fact that there were between 80 and 100 thousand medical practitioners in Germany at the time, this group is indeed small. Yet what is striking about it is the fact that a large number of the German Lagerärzte (concentration camp doctors) and researchers conducting pseudo-medical experiments held prominent offices in the Nazi health service. It was not heartlessness or the want of medical ethics that made many of these doctors engage in criminal activities, but the fact that they were brainwashed with the new Nazi morality, in which the Hippocratic oath was repudiated and replaced with contempt for the infirm, the weak, and foreigners, in favour of the physical and mental health of the citizens of a future, thousand-year German Reich.

Translated from original article: Andrzej Pankowicz, “Narodowosocjalistyczne przemiany medycyny niemieckiej.” Przegląd Lekarski – Oświęcim, 1982.

Notes

  1. The Nuremberg laws – Anti-Semitic and racist legislation which came into force in Nazi Germany in 1935.
  2. The institution was pioneered by Hans Deuschl; Kurt Blome was the only one of its associates to appear before the Nuremberg Tribunal, so most probably Pankowicz’s information comes from his testimony.
  3. Now Lviv, Ukraine
  4. The German name of Kraków (Poland)
All notes courtesy of Teresa Bałuk-Ulewiczowa.

References

  1. Bayle, François. Croix gammée contre caducée. Les expériences humaines en Allemagne pendant la deuxieme guerre mondiale. Neustadt: Centre de L'Imprimerie Nationale; 1950.
  2. Bogusz, Józef, and Wolter, Władysław. “Wyrok wraz z uzasadnieniem Amerykańskiego Trybunału Wojskowego Nr 1 w Norymberdze w procesie lekarzy hitlerowskich z dnia 19–20 VIII 1947 r.”[Polish translation of the Nuremberg Tribunal’s verdict in the Doctors’ Trial, with introductions by Józef Bogusz and Władysław Wolter]. Biuletyn Głównej Komisji Badania Zbrodni Hitlerowskich w Polsce; 1970: XX, 13—187.
  3. Gutt, Romuald Wiesław. “Autorzy belgijscy o medycynie SS.” Przegląd Lekarski – Oświęcim. 1974: 238–240.
  4. Mitscherlich, Alexander, and Mielke, Fred. Nieludzka medycyna. Warsaw: Państwowy Zakład Wydawnictw Lekarskich; 1963. Polish translation of Medizin ohne Menschlichkeit (first German edition, Heidelberg: Lambert Schneider, 1947; English translation, Doctors of Infamy: The Story of the Nazi Medical Crimes, New York: Henry Schuman, 1949).
  5. Reichsgesetzblatt 1942, I; 1943, I; and 1944, I.
  6. Ternon, Yves, and Helman, Socrate. Histoire de la médecine SS ou le mythe du racisme biologique. Tournai: Casterman; 1969. Polish edition: Historia medycyny SS, czyli mit rasizmu biologicznego. Mieczysław Kowalski (trans.). Warsaw: Państwowy Zakład Wydawnictw Lekarskich; 1973.
  7. Ternon, Yves, and Helman, Socrate. Le massacre des alienés. Des théoriciens nazis aux practiciens SS. Paris: Casterman; 1971. Polish edition: Eksterminacja chorych psychicznie w III Rzeszy: od teoretyków narodowosocjalistycznych do praktyków z SS. Ewa Baumritter (trans.). Warsaw: Państwowy Zakład Wydawnictw Lekarskich; 1974.
  8. TWC—Trials of War Criminals before the Nuernberg Military Tribunals under Control Council Law No. 10. Nuremberg, October 1946–April 1949. 1949: U.S. Government Printing Office. Vols. I and II: “The Medical Case.” Online: https://www.loc.gov/rr/frd/Military_Law/pdf/NT_war-criminals_Vol-I.pdf https://www.loc.gov/rr/frd/Military_Law/pdf/NT_war-criminals_Vol-II.pdf (Accessed 27 Dec. 2019)

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