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Michelle Landahl
Holocaust Journey
Engineering the Death of Lives Not Worth
Living: The Role of Medical Professionals in
Executing “The Final Solution”
13 February 2016
“Only a good person can be a good
physician.”
~Rudolf Ramm, leading Nazi medical ethicist
“Among all criminals and murderers, the most
dangerous type is the physician.”
~Miklos Nyiszli, pathologist to Dr. Josef Mengele
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Introduction
The Holocaust is arguably one of the most well-known and most evil events of human
history. After the horrors of Nazi Germany were brought to light, names like Hitler, Himmler,
and Mengele gained a permanent place of infamy in human history. After liberation, it became
clear that the murderous camps and ghettos established throughout Europe were engineered to
induce suffering from the moment of their inception. Prisoners lived in deplorable conditions
day-in and day-out until their eventual and systematic demise, and it is my belief that an
extensive knowledge of physiological and psychological mechanisms must have been required in
order for the nearly seamless extermination of millions to have occurred the way it did during the
Holocaust. Medical professionals must have played a significant role in the murder of those
millions, but exactly what role did they play in the planning and operation of the genocide, and
how did their insight influence the agony that occurred? My research has yielded results that
indicate the significant involvement of physicians throughout the killing process, even before the
establishment of the camps and up until the end of war.
Mental Hospitals and Sick Minds
The involvement of physicians in the deaths of those opposed by the Nazi regime actually
began before the formal start of World War II. The earliest murders took place in mental hospitals
throughout Nazi occupied countries, where a dangerous mentality had taken hold. For years, Hitler
and his associates and as well as many of his predecessors had been spewing propaganda relating
Darwin’s theories on the “survival of the fittest” to inferior members of society; toward the end of
the 1930’s, this idea began to take hold, and the “inferior” members of society were assigned
identities ("Auschwitz: Inside the Nazi State"). In addition to the Jewish “race,” they included
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homosexuals, the criminally insane, Communists, and those with mental and physical handicaps
(Baumslag 23). During discussions that took place during the summer and fall of 1939, Hitler
made it clear that it would be desirable to put an end to the “life unworthy of life,” referring
predominantly to the mentally and physically ill, although this definition expanded as the war
progressed (Kogon 14). A memo from the Interior Ministry dated 18 August 1939 required
midwives and physicians to report children born with deformities; those children were then taken
to so-called “special child groups,” where they were killed by injections of morphine or
scopolamine, by administering luminal, or by simply leaving them to die of starvation (Kogon 15).
Soon after this decree, Hitler began to select physicians who he believed would be willing
to assist him in his euthanasia goals. With the collaboration of Dr. Herbert Linden, the specialist
in affairs concerning the mentally ill, Hitler’s personal physician put together a list of numerous
leading German doctors who he considered suitable, on the basis of their opinions and their
professional qualifications, to take part in the proposed operation, and in October of 1939, Hitler
issued an order declaring that his appointees “are charged with the responsibility of extending the
authority of certain physicians, to be designated by name. These latter will be able to grant a mercy
death to patients considered incurable according to the best of human judgment.” (Kogon 16). Few
who were recruited refused the position, and with their compliance, the first euthanasia programs
were underway.
In order to determine which patients were going to be euthanized, a one-page questionnaire
was completed by a physician in the clinic in which the patients were housed, and the paper was
processed by two authorities (Caplan 43). One positive decision would warrant the death of the
patient. These “authorities” were compensated between 5 and 10 pfennings for their time, so each
one of their murderous decisions “cost about as much as a cigarette” (Caplan 44).
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When it came to actually killing the patient, many hospitals had already installed gas
chambers. The first experiments testing gases to kill took place in Brandenburg Hospital in January
of 1940, which were spectated by all of the euthanasia doctors (Muller-Hill 65). Viktor Brack,
head of the euthanasia operations in Germany, emphasized that the gassings “should be carried out
only by physicians” (Annas 7). A Nazi report filed in 1942, which some believe implies the
transition from gassing patients to gassing camp inmates, contained the following information
about the planning involved to make the executions run as smoothly as possible:
One of the essential requirements for carrying out euthanasia is that it should be as
unobtrusive as possible…in the first place, the surroundings should be unobtrusive…orders
for euthanasia must be given and executed entirely within the framework of the normal
activity of the ward. Thus, with few exceptions, it should be difficult to distinguish
euthanasia from a natural death. This is the goal towards which to strive. The fact that a
few active psychiatrists with progressive attitudes have been practicing medical euthanasia
in their hospitals and that today a hospital can carry out medical euthanasia without
attracting attention shows that this goal can be achieved (Caplan 69).
The physicians both evaluated and chose those patients who would be killed and supervised their
gassing, in a foreshadowing of the death camps (Lifton 302). Staffed by physicians, hospitals and
asylums used gas chambers disguised as showers, again “in a rehearsal for Auschwitz” (Lifton
301). The patients were even given towels and soap before being ushered off to their demise
(Kogon 26).
This killing within the confines of hospitals went on for nearly two years, and before the
dust settled, an estimated 300,000 patients were murdered (Muller-Hill 70). In the fall of 1941, the
gas chambers at many psychiatric hospitals were dismantled and shipped east, where they were
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reinstalled at Majdanek, Auschwitz, and Treblinka (Annas 224). The same doctors, technicians,
and nurses often followed the equipment, meaning that the same medical professionals working in
hospitals across the country were now running the gas chambers within the death camps
("Auschwitz: Inside the Nazi State"). In this sense, “there was a continuity in both theory and
practice between the destruction of lives not worth living in Germany’s mental hospitals and the
destruction of Germany’s ethnic and social minorities” (Annas 224).
Designing Death
When it came to the camps and ghettos themselves, it is clear that serious planning went
into every aspect of the Holocaust, from manipulating the social climate under the Nazi regime
to the living conditions within the camps themselves. The infamous “special treatment” of the
Jews “was organized by public health officials, physicians, nurses, administrators, and lawyers”
(Proctor 35). Physicians devised and promoted the claim that the very presence of Jews
endangered German families and troops, and this propaganda was distributed through scientific
journals (Muller-Hill 21). Public health became an instrument of Nazi ideology. After the Nazi
takeover of the German government, the National Department of Public Health was dissolved
and replaced by an “expert council” on public health, and by 1941, “Nazi doctors, nurses, and
public health officials were receptive to the final solution as a way out of the self-induced public
health dilemma” (Muller-Hill 22). Jews were blamed not only for the economic problems within
Germany but also for disease, branded “a breeding ground for typhus-filled lice,” and this fear
permeated German society (Müller-Hill 15).
The camps and ghettos themselves were also largely designed by physicians and other
medical professionals. In fact, many believe that it “was the Nazi doctors who initiated pressure
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on high-ranking Nazi officials to progress swiftly to ghettoization” (Gutman 24). By the 1940s,
Nazi scientists were extremely knowledgeable. Physicians recognized the importance of a diet
high in fruit and fiber, and in the early war years managed to enact a law requiring every bakery
to produce whole grain bread (Caplan 37). They were also well-versed in disease pathology. At
the time of the War, typhus was rampant in society, and physicians knew it would be even more
so when a large group of people were confined in a small space with poor sanitary conditions.
The way the small, squalid ghettos were created “made the outbreak of epidemics inevitable”
(Fertig 35). Quarantine coupled with the pernicious unsanitary conditions craftily devised by the
German authority resulted in the spread of disease. In the Warsaw ghetto, 500,000 Jews were
crammed into about 100 acres of land, meaning that if every inch of land was used and every
person was equally distributed, each person had less than 9 square feet to themselves (Fertig 54).
Over 25,000 died in the Warsaw ghetto due to conditions alone (Fertig 55). In the Dvinsk ghetto
in Latvia, 16,000 people were confined to the ghetto, but only 100 survived a four month
quarantine (Baumslag 57). Were these conditions created by neglect and apathy to human
suffering, or by sinister and murderous planning? Testimony at the Nuremberg trials claimed that
there “was no doubt that the German medical authorities and their collaborators knew that they
were deliberately exposing the Jews to a typhus-rich environment” (Baumslag 56). The
technologies of typhus eradication and repulsive conditions used first within the ghettos and later
in the camps “were murderous by design and thinly camouflaged genocidal intentions” (Lifton
67).
Physicians continued to use their knowledge about the human body to facilitate
concentration camp functioning as well. They could make determinations on who could
withstand a beating and be made an example of, and who could not (Gutman 54). They
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determined that a diet consisting of 600 calories could sustain a person and 1100 could sustain a
worker on the brink of death but provide him with enough strength to work, so diets meeting
those needs were given to those who were still valuable to the Nazi regime in some way
(Gutman 62). The others were plucked from the herd by physicians and escorted to their death at
the hands of other doctors, those who had turned their backs on the Hippocratic Oath that they
had sworn to uphold.
Executing the Executions
Prior to the establishment of Auschwitz and other death camps, the Nazis had developed
“a policy of killing within medical channels, decided by medical means and carried out by
doctors and their assistants” (Baumslag 28). This idea was continued when it came to genocide
in the camps. In 1941, Heinrich Himmler issued an order that medical boards should visit all
concentration camps to sort out all those prisoners who were unfit for work, ill, or psychopaths
(Communists) (Caplan 68). Himmler recognized the special role of physicians in this regard; he
understood the power of the faith that people put in doctors and their belief that physicians meant
only to heal and never to harm. This trust was knowingly manipulated and abused throughout the
course of the war. In the years that followed Humbler’s declaration, the Nazis continued to
capitalize on the general public’s faith in physicians. On March 9, 1943, the Reichsfuhrer of the
SS issued an order that only physicians trained in anthropology could perform selections at
concentration camps (McKale 72). These appointed physicians knowingly determined who
would live and who would die on a daily basis.
In the search to find a way to quickly and effectively kill mass numbers of people, an
experiment was conducted at Auschwitz on September 3, 1941, using the gas prussic (HCN)
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acid, known commercially as Zyklon B ("Auschwitz: Zyklon B”). Eight-hundred and fifty
people were gassed, and the Nazis had discovered a successful method of mass murder, although
there was some delay between its discovery and its application due to its expense and the Nazis
desire for their murderous intentions to remain low-profile (Kogon 89).
From the spring of 1942 until the fall of 1944, the operation designed to annihilate
European Jews functioned almost flawlessly as trains poured in from Nazi occupied countries
and European satellites of the Third Reich (Fertig 6). At this point, Nazi doctors, using
knowledge gained through intelligence and/or experimentation, were prepared to utilize
numerous methods of murder to complete their genocidal goals. Benzine, gasoline, hydrogen
peroxide, epivan, prussic acid, chloroform, and air were all substances injected into the veins of
victims to achieve death (Caplan 98). Of these methods, phenol injected directly into the heart
was discovered to be the most “inexpensive, easy to use, and effective method” (Caplan 9).
When enough Jews had been transported to the camps, however, Zyklon B and carbon monoxide
from diesel engines became the method of choice to kill the most people per day. It took victims
up to 20 minutes to succumb to the cell-stopping effects of Zyklon B and potentially 2 to 3 hours
to suffocate by diesel engine fumes (“Auschwitz: Zyklon B”).
By 1942, three major extermination centers were operating – one in Belzec (at its peak
murdering 15,000 per day), another in Sobibor (20,000 per day), and a third in Treblinka which
could gas 25,000 persons per day (Weindling 45). Kurt Gerstein, a German chemical engineer in
charge of the technical disinfection with highly toxic gasses, testified that the system was
organized to cause the minimum resistance and to utilize as few staff members as possible:
“You just have to breathe very deeply, that strengthens the lungs, inhaling is a means of
preventing contagious disease. It’s a good disinfection.” They were packed into the gas
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chambers, and the doors were shut. Exhaust fumes from a diesel engine filled the room.
SS doctors and others watched through specially constructed peepholes on the door of the
gas chamber. Metal grids covered the peepholes so that the people inside could not try to
break it to get air (Gutman 62).
Testimonies such as this one were later used against those proclaiming their innocence or lack of
knowledge or involvement in the murders; prosecutors could use their own incriminating words
against them.
In smaller camps and ghettos where gas chambers were not cost-effective, both portable
and stationary gas vans were employed (Kogon 53). Prisoners could be discreetly loaded in the
back, suffocated with carbon monoxide fumes delivered through a specially designed ventilation
system, and then transported to a secret dumping ground to risk anyone discovering the bodies
(Kogon 52). This allowed the Nazis to kill numerous people quickly and then simply drive away,
leaving no evidence behind.
Physicians played a role even after death; once the screaming from the chambers ceased,
dentists were sent in to hammer out the gold teeth, bridges, and crowns of the victims (Gutman
63). These gas chambers were designed to be innocuous; the Nazis exploited expectations of
routine delousing using prussic acid, and gardens were even planted outside of the chambers to
give the illusion of a bathhouse (Gutman 64). After the war, it became clear that “doctors were
actively involved in all aspects of the façade” ("The Doctors Trial: The Medical Case of the
Subsequent Nuremberg Proceedings").
Physicians were also responsible for supervising their medical technicians trained in the
use of Zyklon B for gassing. They “brought the Zyklon to the gas chambers in Red Cross luxury
cars, saw that disinfectors were protected with gas masks, and were responsible for declaring the
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disinfected dead” ("Auschwitz: Zyklon B”). They even provided technical expertise for the most
cost-effective method of destroying bodies (Baumslag 47). Although many medical professionals
professed their innocence after the end of the war, their involvement was clear from
documentation as well as eye-witness testimony; the blood of nearly 11 million people was
predominantly on their hands.
Conclusion
World War II ended in 1945 soon after the United States’s involvement. In an attempt to
evade capture and discovery from the impending Russian front, many of the concentration camps
were either razed or evacuated, with the Nazis forcing inmates on death marches through the
brutally cold countryside. They could not run forever. When all was said and done, the Jewish
death toll alone was conservatively estimated at 800,000 from ghettoization, 1.4 million from
shootings, and 2.9 million murdered in the camps ("The Nazi Doctors"). From there, the world
was left to pick up the pieces. The Nuremberg Trials brought some perpetrators to justice, but
many escaped to other countries, and others were merely protected through anonymity. To this
day, the identity of many of the physicians who engineered this historic genocide remains
unknown. If we cannot put a face to their crimes, let us not let their deeds be omitted from
history as well. We must face what they have done in order to better understand where medicine
went mad during this dark time in history. The only conclusion and closure we may gain from
this is if we use this awareness to make sure that something like this happens “Never again.”
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Bibliography
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This is an article published by the reputable Public Broadcasting Service detailing the
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The Nizkor Project is an internet-based organization dedicated to Holocaust victims and
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