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Mentally and
Physically
Handicapped:
Victims of the
Nazi
Era
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Soon after Hitler took power, the Nazis formulated policy based on their vision of a biologically "pure" population, to create an "Aryan master race." The "Law for the prevention of Progeny with Hereditary Diseases," proclaimed July 14, 1933, forced the sterilization of all persons who suffered from diseases considered hereditary, such as mental illness (schizophrenia and manic depression), retardation ("congenital feeble-mindedness"), physical deformity, epilepsy, blindness, deafness, and severe alcoholism.
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Completed by physicians, this questionnaire was used by other "assessor" physicians to select patients who were killed in the "euthanasia" program.
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Dr. Eduard Brandt, a T-4 statistician, worked out the savings in foodstuffs and money realized from the "disinfection" (murder) of 70,273 "useless mouths" (persons) in the T-4 program.
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In 1934 this 19-year-old shop clerk, identified only as "Gerda D," was diagnosed as schizophrenic and sterilized at the Moabite Hospital. In 1939 she was repeatedly refused a marriage certificate because of her sterilization.
Karl-Bonhoeffer-Nervenklinik, Berlin, Germany
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Helene Lebel's story is told on one of the Museum ID cards distributed to visitors entering the Permanent Exhibition.
USHMM
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The Hadamar "euthanasia" center. In all likelihood the smoke is from the crematoria. Hadamar, Germany, 1941.
Diozesanarchiv Limburg
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Bishop of Munster, Clemens August Count von Galen, protested the T-4 killings in a sermon August 13, 1941. Thousands of copies were printed and circulated. Galen was not punished because Hitler did not want to clash openly with the Catholic Church.
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Buses operated by the T-4 transport company Gekrat, which conveyed victims to the "euthanasia" centers. Wiesbaden, Germany, 1941.
Hessisches Hauptstaatsarchiv Wiesbaden
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War crimes investigators question a nurse about the mass killings at the Hadamar "euthanasia" center. Hadamar, Germany, May 4, 1945.
National Archives, Washington, D.C.
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A physician displaying a patient at the Karl-Bonhoeffer psychiatric clinic. Berlin, Germany.
Karl-Bonhoeffer-Nervenklinik, Berlin, Germany.
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FORCED STERILIZATIONS
The "sterilization Law" explained the importance of weeding out so-called genetic defects from the total German gene pool:
Since the National Revolution public opinion has become increasingly
preoccupied with questions of demographic policy and the continuing
decline in the birthrate. However, it is not only the decline in population
which is a cause for serious concern but equally the increasingly evident
genetic composition of our people. Whereas the hereditarily healthy
families have for the most part adopted a policy of having only one
or two children, countless numbers of inferiors and those suffering
from hereditary conditions are reproducing unrestrainedly while their
sick and asocial offspring burden the community.
Some scientists and physicians opposed the involuntary
aspect of the law while others pointed to possible flaws. But the designation
of specific conditions as inherited, and the desire to eliminate such
illnesses or handicaps from the population, generally reflected the
scientific and medical thinking of the day in Germany and elsewhere.
Nazi Germany was not the first or only country to sterilize
people considered "abnormal." Before Hitler, the United States led the
world in forced sterilizations. Between 1907 and 1939, more than 30,000
people in twenty-nine states were sterilized, many of them unknowingly
or against their will, while they were incarcerated in prisons or institutions
for the mentally ill. Nearly half the operations were carried out in
California. Advocates of sterilization policies in both Germany and
the United States were influenced by eugenics. This sociobiological
theory took Charles Darwin's principle of natural selection and applied
it to society. Eugenicists believed the human race could be improved
by controlled breeding.
Still, no nation carried sterilization as far as Hitler's
Germany. The forced sterilizations began in January 1934, and altogether
an estimated 300,000 to 400,000 people were sterilized under the law.
A diagnosis of "feeblemindedness" provided the grounds in the majority
of cases, followed by schizophrenia and epilepsy. The usual method of
sterilization was vasectomy and ligation of ovarian tubes of women.
Irradiation (x-rays or radium) was used in a small number of cases.
Several thousand people died as a result of the operations, women
disproportionately because of the greater risks of tubal ligation.
Most of the persons targeted by the law were patients
in mental hospitals and other institutions. The majority of those sterilized
were between the ages of twenty and forty, about equally divided between
men and women. Most were "Aryan" Germans. The "Sterilization Law" did
not target socalled racial groups, such as Jews and Gypsies, although
Gypsies were sterilized as deviant "asocials," as were some homosexuals.
Also, about 500 teenagers of mixed African and German parentage (the
offspring of French colonial troops stationed in the Rhineland in the
early 1920s) were sterilized because of their race, by secret order,
outside the provisions of the law.
Although the "Sterilization Law" sometimes functioned
arbitrarily, the semblance of legality underpinning it was important
to the Nazi regime. More than 200 Hereditary Health Courts were set
up across Germany and later, annexed territories. Each was made up of
two physicians and one district judge. Doctors were required to register
with these courts every known case of hereditary illness. Appeals courts
were also established, but few decisions were ever reversed. Exemptions
were sometimes given artists or other talented persons afflicted with
mental illnesses. The "Sterilization Law" was followed by the Marriage
Law of 1935, which required for all marriages proof that any offspring
from the union would not be afflicted with a disabling hereditary disease.
Only the Roman Catholic Church, for doctrinal reasons,
opposed the sterilization program consistently; most German Protestant
churches accepted and often cooperated with the policy. Popular films
such as Das Erbe ("Inheritance") helped build public support for government
policies by stigmatizing the mentally ill and the handicapped and highlighting
the costs of care. School mathematics books posed such questions as:
"The construction of a lunatic asylum costs 6 million marks. How many
houses at 15,000 marks each could have been built for that amount?"
"EUTHANASIA" KILLINGS
Forced sterilization in Germany was the forerunner of the systematic killing of the mentally ill and the handicapped. In October 1939, Hitler himself initiated a decree which empowered physicians to grant a "mercy
death" to "patients considered incurable according to the best available
human judgment of their state of health." The intent of the socalled
"euthanasia" program, however, was not to relieve the suffering of the
chronically ill. The Nazi regime used the term as a euphemism: its aim
was to exterminate the mentally ill and the handicapped, thus "cleansing"
the "Aryan" race of persons considered genetically defective
and a financial burden to society.
The idea of killing the incurably ill was posed well
before 1939. In the 1920s, debate on this issue centered on a book coauthored
by Alfred Hoche, a noted psychiatrist, and Karl Binding, a prominent
scholar of criminal law. They argued that economic savings justified
the killing of "useless lives" ("idiots" and "congenitally crippled").
Economic deprivation during World War I provided the context for this
idea. During the war, patients in asylums had ranked low on the list
for rationing of food and medical supplies, and as a result, many died
from starvation or disease. More generally, the war undermined the value
attached to individual life and, combined with Germany's humiliating
defeat, led many nationalists to consider ways to regenerate the nation
as a whole at the expense of individual rights.
In 1935 Hitler stated privately that "in the event of
war, [he] would take up the question of euthanasia and enforce it" because
"such a problem would be more easily solved" during wartime. War would
provide both a cover for killing and a pretext--hospital beds and medical
personnel would be freed up for the war effort. The upheaval of war
and the diminished value of human life during wartime would also, Hitler
believed, mute expected opposition. To make the connection to the war
explicit, Hitler's decree was backdated to September 1, 1939, the day
Germany invaded Poland.
Fearful of public reaction, the Nazi regime never proposed a formal "euthanasia" law. Unlike the forced sterilizations, the killing of patients in mental asylums and other institutions was carried out in secrecy. The code
name was "Operation T4," a reference to Tiergartenstrasse 4, the address
of the Berlin Chancellery offices where the program was headquartered.
Physicians, the most highly Nazified professional group in Germany, were key to the success of "T-4," since they organized and carried out nearly, all aspects of the operation. One of Hitler's personal physicians, Dr. Karl
Brandt, headed the program, along with Hitler's Chancellery chief, Philip
Bouhler. T-4 targeted adult patients in all government or church-run
sanatoria and nursing homes. These institutions were instructed by the
Interior Ministry to collect questionnaires about the state of health
and capacity for work of all their patients, ostensibly as part of a
statistical survey.
The completed forms were, in turn, sent to expert assessors
physicians, usually psychiatrists, who made up "review commissions."
They marked each name with a "+," in red pencil, meaning death, or a
"" in blue pencil, meaning life, or "?" for cases needing additional
assessment. These medical experts rarely examined any of the patients
and made their decisions from the questionnaires alone. At every step,
the medical authorities involved were usually expected to quickly process
large numbers of forms.
The doomed were bused to killing centers in Germany
and Austria walled-in fortresses, mostly former psychiatric hospitals,
castles, and a former prison at Hartheim, Sonnenstein, Grafeneck,
Bernburg, Hadamar, and Brandenburg. In the beginning, patients were
killed by lethal injection. But by 1940, Hitler, on the advice of Dr.
Werner Heyde, suggested that carbon monoxide gas be used as the preferred
method of killing. Experimental gassings had first been carried out
at Brandenburg Prison in 1939. There, gas chambers were disguised as
showers complete with fake nozzles in order to deceive victims prototypes
of the killing centers' facilities built in occupied Poland later in
the war.
Again, following procedures that would later be instituted
in the extermination camps, workers removed the corpses from the chambers,
extracted gold teeth, then burned large numbers of bodies together in
crematoria. Urns filled with ashes were prepared in the event the family
of the deceased requested the remains. Physicians using fake names prepared
death certificates falsifying the cause of death, and sent letters of
condolences to relatives.
Meticulous records discovered after the war documented
70,273 deaths by gassing at the six "euthanasia" centers between January
1940 and August 1941. (This total included up to 5,000 Jews; all Jewish
mental patients were killed regardless of their ability to work or the
seriousness of their illness.) A detailed report also recorded the estimated
savings from the killing of institutionalized patients.
The secrecy surrounding the T-4 program broke down
quickly. Some staff members were indiscreet while drinking in local
pubs after work. Despite precautions, errors were made: hairpins turned
up in urns sent to relatives of male victims; the cause of death was
listed as appendicitis when the patient had the appendix removed years
before. The town of Hadamar school pupils called the gray transport
buses "killing crates" and threatened each other with the taunt, "You'll
end up in the Hadamar ovens!" The thick smoke from the incinerator was
said to be visible every day over Hadamar (where, in midsummer 1941,
the staff celebrated the cremation of their 10,000th patient with beer
and wine served in the crematorium).
A handful of church leaders, notably the Bishop of
Münster, Clemens August Count von Galen, local judges, and parents of
victims protested the killings. One judge, Lothar Kreyssig, instituted
criminal proceedings against Bouhler for murder; Kreyssig was prematurely
retired. A few physicians protested. Karl Bonhöffer, a leading psychiatrist,
and his son Dietrich, a Protestant minister who actively opposed the regime, urged church groups to pressure church-run institutions not to release their patients to T-4 authorities.
In response to such pressures, Hitler ordered a halt
to Operation T-4 on August 24, 1941. Gas chambers from some of the "euthanasia" killing centers were dismantled and shipped to extermination camps in
occupied Poland. In late 1941 and 1942, they were rebuilt and used for
the "final solution to the Jewish question." Similarly redeployed from
T-4 were future extermination camp commandants Christian Wirth, Franz
Stangl, Franz Reichleitner, the doctor Irmfried Eberl, as well as about
100 others - doctors, male nurses, and clerks, who applied their skills
in Treblinka, Belzec, and Sobibor.
The "euthanasia" killings continued, however, under
a different, decentralized form. Hitler's regime continued to send to
physicians and the general public the message that mental patients were
"useless eaters" and life unworthy of life." In 1941, the film Ich klage
an ("I accuse") in which a professor kills his incurably ill wife, was
viewed by 18 million people. Doctors were encouraged to decide on their
own who should live or die, Killing became part of hospital routine
as infants, children, and adults were put to death by starvation, poisoning,
and injections. Killings even continued in some of Germany's mental
asylums, such as Kaufbeuren, weeks after Allied troops had occupied
surrounding areas.
Between the middle of 1941 and the winter of 1944-45,
in a program known under code "14f13," experienced psychiatrists from
the T-4 operation were sent to concentration camps to weed out prisoners
too ill to work. After superficial medical screenings, designated inmates
Jews, Gypsies, Russians, Poles, Germans, and others were sent to those
"euthanasia" centers where gas chambers still had not been
dismantled, at Bernburg and Hartheim, where they were gassed. At least
20,000 people are believed to have died under the 14f13 program.
Outside of Germany, thousands of mental patients in
the occupied territories of Poland, Russia, and East Prussia were also
killed by the Einsatzgruppen squads (SS and special police units) that
followed in the wake of the invading German army. Between
September 29 and November 1, 1939, these units shot about 3,700 mental
patients in asylums in the region of Bromberg, Poland. In December 1939
and January 1940, SS units gassed 1,558 patients from Polish asylums
in specially adapted gas vans, in order to make room for military and
SS barracks. Although regular army units did not officially participate
in such "cleansing" actions as general policy, some instances of their
involvement have been documented.
In all, between 200,000 and 250,000 mentally and physically
handicapped persons were murdered from 1939 to 1945 under the T-4 and
other "euthanasia" programs. The magnitude of these crimes and the extent
to which they prefigured the "Final Solution" continue to be studied.
Further, in an age of genetic engineering and renewed controversy over
mercy killings of the incurably ill, ethical and moral issues of concern
to physicians, scientists, and lay persons alike remain vital.
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