DEPARTMENT OF HEALTH & HUMAN SERVICES




                 November 13, 1981

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Public Health Service



Office of the Assistant Secretary
for Health
Washington DC 20201

Honorable Carl M. Levin
United States Senate
Washington, D. C. 20510

Dear Senator Levin:

I am sorry that the answer to your most recent letter cannot be as
complete as I would like to make it.  My files are in Philadelphia
locked up and I am here in Washington.

The enclosed copy of Alexander's article from the New England
Journal of Medicine provides some fragmentary documentation of
what he has told me much more extensively and which appear in his
collected papers donated to Tufts University.  I have highlighted
sentences here and there indicating the medical involvement in
the beginning process as well as some of the time relationships.

I do know that the list of those chosen for extermination was put
together over a long period of time and included not only the
mentally ill but also the feeble, the infirm, some tuberculosis
patients, some amputees from World War I, and a number of children
called "monsters."  The extermination process began some years before
Hitler's first-direct order for euthanasia was issued in September
1939.  How many of the 275,000 were already exterminated before the
order and how many after is not clear.

I do know from what Alexander has told me that the same green
psychiatric forms that were used to exterminate 'psychiatric'
patients before the order went out were used for a considerable
time after the order even though the reasons for extermination
shifted from 'mercy killings' to reasons of politics, ideology,
race, etc.

Also enclosed is a book review of Medical Holocausts with certain
pertinent passages highlighted.

Sincerely yours,

C; Everett Koop,-M. D.
Deputy Assistant Secretary
     for Health