Nazi Medicine and Public Health Policy
By Robert N. Proctor
Professor of the history of science at Pennsylvania State University
It is poor scholarship and perhaps even dangerous to caricature the Nazis
as irrational or anti-science. What we have to look at more carefully is the
relationship between science and ideology at this time.
We often hear that the Nazis destroyed science and abandoned ethics.
Telford Taylor, in his opening statement at the Nuremberg "Doctors' Trial"
of 1946-7, claimed that Nazi doctors had turned Germany "into an infernal
combination of a lunatic asylum and a charnel house." "Neither science, nor
industry, nor the arts could flourish in such a foul medium," Taylor
asserted about the Third Reich. Taylor was not the first to suggest that
Nazism and the scientific spirit were fundamentally incompatible. Franz
Neumann, in his 1942 book Behemoth, had already posited "a most
profound conflict" between what he called the "magic character" of Nazi
propaganda and the "rational" processes of German industry, a conflict he
believed would culminate in an uprising on the part of engineers to combat
Hitler's irrationalist regime. Such an uprising, needless to say, never
materialized.
The problem with the "science vs. fascism" thesis is that it fails to take into
account the eagerness with which many scientists and physicians
embraced the Reich, and the many scientific disciplines which actually
flourished under the Nazis. Anyone who has ever examined a V-2 engine
will have few doubts about this, and there are numerous other examples.
During the Nazi era, German scientists and engineers either developed or
greatly improved television, jet-propelled aircraft (including the ejection
seat), guided missiles, electronic computers, the electron microscope,
atomic fission, data-processing technologies, pesticides, and, of course, the
world's first industrial murder complexes. The first magnetic tape
recording was of a speech by Hitler, and the nerve gases Sarin and Tabun
were Nazi inventions.
The story of science under German fascism is not, as conventional
wisdom would have it, only a narrative of suppression and survival; a
truthful account will explain how and why Nazi ideology promoted certain
areas of inquiry, and how projects and policies were championed or
disappeared because of political considerations.
In this article, I want to explore some of the obstacles that have hindered
our efforts to understand Nazi science and medicine. I will concentrate on
two myths: the myth of flawed science and the myth of abandoned ethics.
The Nazis, I shall suggest, supported many kinds of science, left politics
(as we often think of it) out of most, and did not abandon ethics. There
was an ethics of Nazi medical practice -- sometimes explicit, sometimes
not; often cruel, but sometimes not. This is important to understand if we
are not to perceive the German physicians who endorsed Nazism as
absolutely alien and otherworldly. The question of questions, after all, is
how did these men and women, who were convinced they were doing
good, come to commit crimes that we today regard as the embodiment of
evil?
Understanding the power of these myths -- of science destroyed and ethics
abandoned -- is important not just for setting the historical record straight,
but also for understanding why it has taken so long to come to grips with
Nazi medical crimes. And comprehending the Nazis' support for science
and medicine can also help us understand the appeal of Nazism within
German intellectual culture; this, in turn, might help us better discern how
fascism came to triumph in the first place.
Nazi Ideology and Anti-Tobacco Research
If you ask most experts when the first good evidence arose that tobacco
was a major cause of lung cancer, they will point to a series of
epidemiological studies by English and American researchers in the early
1950s. If you ask when a medical consensus on this question first arose,
they will most likely point to the 1964 Surgeon General's report, which
took a strong stand on this question, or a similar report by Britain's Royal
College of Physicians two years earlier.
I have become convinced, however, that there was an earlier and
overlooked consensus, a consensus within the German medical and
scientific community, that emerged during the Nazi period. The Nazis had a
powerful anti-tobacco movement, arguably the most powerful in the world
at that time. Tobacco was opposed by racial hygienists fearing the
corruption of the German "germ plasm" (i.e., genetic material), by
industrial hygienists fearing a reduction of people's capacity to work, by
nurses and midwives fearing harm to the "maternal organism." Tobacco
was said to be a "corrupting force in a rotting civilization that has become
lazy." The Nazis' anti-tobacco rhetoric drew from an earlier generation's
eugenics rhetoric and also reflected an ethic of bodily purity and zeal for
work. Tobacco use was attacked as an "epidemic," a "plague," as "dry
drunkenness," and as "lung masturbation"; tobacco and alcohol abuses
were "diseases of civilization" and "relics of a liberal lifestyle."
Anti-tobacco research flourished in the Third Reich. Animal experimental
work demonstrated that the tar extracted from cigarette smoke could cause
cancer; and physical chemists distilled tobacco tars to identify the
carcinogenic components. The editor of Germany's Monatsschrift für
Krebsbekämpfung (Monthly Anti-Cancer Journal) organized animal
experiments to test whether smoking causes lung cancer: rats were put into
a "gas chamber" and cigarette smoke was pumped in from the top (many
animals suffocated). Germans under the Nazis established ambitious tumor
registries, which included the first broad registries of cancer incidence, and
not just cancer mortality.
Third Reich scientists also performed extensive work in the area of
occupational carcinogenesis. Physicians documented the health hazards of
asbestos, and in 1943 Germany became the first nation to recognize lung
cancer and mesothelioma caused by asbestos inhalation as compensable
occupational illnesses. Nazi Germany also pioneered what we now call
experimental epidemiology: two striking papers -- a 1939 article by Franz
H. Müller of Cologne, and a 1943 paper by Eberhard Schairer and Erich
Schöniger of Jena -- presented the most convincing demonstrations up to
that time that cigarettes were a major cause of lung cancer. Let me say a
few words about these papers because they represent a different kind of
science than we are accustomed to associating with the Nazi era.
Franz H. Müller, a physician at Cologne's Bürgerhospital, analyzed the
smoking habits of 86 male lung cancer patients and compared them with
the habits of age-standardized "controls" not suffering from lung cancer.
His findings were clear-cut and striking: the lung cancer patients were
much more likely to be heavy smokers and much less likely to be
nonsmokers. Sixteen percent of the healthy group were nonsmokers,
compared with only 3.5 percent for the lung cancer group. The 86 lung
cancer patients smoked a total of 2,900 grams of tobacco per day, while
the 86 healthy men smoked only 1,250 grams. Müller concluded that
tobacco was not just "an important cause" of lung cancer, but also that "the
extraordinary rise in tobacco use" was "the single most important cause of
the rising incidence of lung cancer" in recent decades (emphasis in original).
Müller's work was taken one step further by Eberhard Schairer and Erich
Schöniger, physicians working at Jena's Institute for Tobacco Hazards
Research. The Jena scientists were well aware that German lung cancer
rates were on the rise, and that many of the nontobacco explanations of the
rise were flawed (the automotive exhaust theory, for example, failed to
explain the fact that rural rates were also rising). Schairer and Schöniger
drew attention to the fact that a heavy smoker could inhale as much as four
kilograms of tar over a lifetime, a frightening figure given Angel H. Roffo's
demonstration that animals painted with tobacco tars develop high rates of
cancer.
Closely following the method pioneered by Müller, Schairer and Schöniger
sent questionnaires to the relatives of 195 lung cancer victims, inquiring
into the smoking habits of the deceased. Going beyond Müller, however,
they sent an additional 555 questionnaires to the families of patients who
had died from other kinds of cancer -- the presumption being that smokers
would be more likely to develop certain kinds of cancer rather than others.
Questionnaires were also sent to 700 male residents of Jena to determine
the smoking habits among a population apparently free of cancer. The
results were clear: among the 109 lung cancer cases for which usable data
were obtained, only three were nonsmokers, a far lower proportion than
among the population as a whole (about 3 percent, vs. 16 percent for the
noncancer controls). The smokers were not necessarily "cancer prone,"
because when cancers other than lung cancer were looked at -- stomach
cancer, for example-- smokers were found to be no more likely to
succumb than nonsmokers. Schairer and Schöniger's conclusion: smoking
was very likely a major cause of lung cancer. The results were of the
"highest" statistical significance, though the investigators did not have the
mathematical tools to quantify that level of significance. A 1994
re-evaluation of Schairer and Schöniger's study showed that the probability
that the results could have come about by chance was less than one in 10
million.
The Significance of Nazi Tobacco-Use Research
How should we interpret such studies? How can we explain the fact that
Nazi Germany was home to the world's foremost tobacco-cancer
epidemiology and the world's strongest cancer prevention policy? Do we
say that "pockets of innovation" existed in Nazi Germany, resistant to
ideological influence? What if we find, on closer inspection, that
Germany's anti-tobacco research flourished not in spite of the Nazis, but in
large part because of the Nazis? And would it then be appropriate, from a
moral point of view, to cite such research in scientific studies today?
I ask this last question partly because the two tobacco studies I have just
discussed have, in fact, been repeatedly cited by postwar scientific
researchers, though rarely with any mention of the social context within
which they were carried out. There is never any mention, for example, of
the fact that the founding director of Schöniger and Schairer's Institute
was Karl Astel, Rector of the University of Jena, a vicious racial hygienist,
and an SS officer. One never hears that the grant application for the
Institute was written by Gauleiter Fritz Sauckel, chief organizer of
Germany's system of forced labor and a man hanged after the war for
crimes against humanity (most leaders of Nazi Germany's anti-tobacco
movement were silenced in one way or another after 1945). No mention is
ever made of the fact that funding for Astel's Institute, and therefore for
Schairer and Schöniger's study, came from a gift of 100,000 Reichsmarks
from the Führer-- himself an ardent anti-smoking activist. It is clear to
anyone who follows the money trail and the research interests that Schairer
and Schöniger's study would not have been undertaken had it not been for
Hitler's anti-tobacco sentiments and those of his like-minded underlings.
Hitler once even attributed the rise of German fascism to his quitting
smoking: the young artist-architect had smoked a couple of packs a day
until 1919, when he threw his cigarettes into the Danube and never reached
for them again.
Again, how should we interpret such Nazi-era papers? How should we
judge the fact that Nazi ideology in this case (and there are others) appears
not to have hindered research, but actually to have promoted it?
In drawing attention to such questions, my intention is not to be
provocative, or to argue that "something good" came from the Nazi regime.
I have no desire to rescue the honor of the Nazi regime, or to "balance the
historical record" for balance's sake. You cannot balance genocide with a
few flashy studies or a dazzling V-2 engine. I should also say that I have
little sympathy for those who argue that republishing the results of brutal
Nazi medical experiments is a way to ensure that the victims of such
experiments "did not die" in vain. They did die in vain, and a well-designed
life jacket or Apollo spacecraft is no compensation.
I raise the questions I do about Nazism and science because it is poor
scholarship and perhaps even dangerous to caricature the Nazis as irrational
or anti-science. What we have to look at more carefully is the relationship
between science and ideology at this time. It is not the case, for example,
that the papers on tobacco epidemiology I have mentioned were
uninfluenced by Nazi ideology. The Reich's anti-tobacco program was
motivated by Nazi ideals of bodily purity and racial hygiene: there was a
kind of "homeopathic paranoia" pervading Nazi ideology that led many of
its adherents to believe that tiny, corrosive elements were insinuating
themselves into "the German body," sapping its strength, causing harm.
Appreciating this helps us understand how Nazi science/ideologues could
declare that tobacco tar, lead, mercury, asbestos -- and Jews -- all posed a
threat to the Nordic race. It also may help us better understand why so
many doctors were supporters of Hitler's regime.
The Moral Failure of German Medicine
The complicity of German physicians in the Nazis' crimes against humanity
is a well-established historical fact. Explaining that fact is far more difficult.
Why were German doctors such avid fans of fascism? Why did nearly half
of all German physicians join the Nazi party?
I don't think it was the tirades of Julius Streicher in Der Stürmer that
attracted their interest, but rather the promises of Nazi leaders to solve
Germany's problems medically, surgically. The Nazi state was supposed to
be a hygienic state; Nazism was supposed to be "applied biology" (Fritz
Lenz coined this phrase in 1931). Hitler was celebrated as the "great
doctor" of German society and as the "Robert Koch of politics" (Koch was
a nineteenth century pioneer in studying the bacterial origin of diseases).
The seductive power of National Socialism for many physicians lay in its
promise to cleanse German society of its corrupting elements -- not just
communism and Jews, but also metallic lead and addictive tobacco, along
with homosexuality and the "burdensome" mentally ill.
The relation of science and politics in Nazi Germany was therefore more
complex than most people like to think. Part of the misunderstanding, I
would suggest, lies in the widely accepted belief that when science is
politicized, "real" science inevitably suffers: the freedom of scientists is
abrogated, distorting biases are introduced into research, minds are closed,
avenues of inquiry are blocked. In many areas of science, of course, that is
indeed what happened in Nazi Germany; one thinks of the fate of Einstein's
relativity theory, for example. But in other areas -- e.g., many areas of
public health -- that was not the case at all.
Biology was another field that thrived. Ute Deichmann in her book,
Biologists Under Hitler (Harvard University Press, 1996), shows that the
majority of biologists in the Thirties and early Forties joined the Nazi party;
but it was still quite possible for non-Nazi biologists to obtain grants from
the Deutsche Forschungsgemeinschaft, Germany's leading scientific grant
agency. Not only possible but easy: Deichmann discovered that there was
no correlation at all between a researcher receiving a grant and whether
that researcher belonged to the Nazi party. I would argue that biology
prospered under the Nazis because it was so integral to their worldview.
Apart from the reasons I have already discussed, there is the fact that
Nazism placed a much higher value on nature than on nurture in the
development of human talents and disabilities.
I am not sure I would agree with Deichmann that scientists in the Third
Reich were more independent of the regime than we usually think.
Independent research flourished in many fields but it was, after all, also in
the Nazi state's interest to cultivate a strong scientific community, at least
in certain disciplines. What is clearly wrong about the autonomy thesis,
applied to science and medicine as a whole, is that many professionals did
not retreat into the purely technical. It took a lot of medical enthusiasm to
forcibly sterilize 350,000 Germans, to "euthanize" 70,000 people with
physical or mental handicaps in gas chambers. (The latter figure is only for
the period from January 1940 to August 1941; even more than that were
killed in the informal euthanasia program launched after this time.) And
there were the medical crimes committed in the concentration and death
camps. Among doctors, there were far more volunteers than victims, more
partisans than pawns.
There is nothing inherently evil about physicians working and cooperating
with their government. The moral failure of the German medical profession
was its willingness to collaborate with the Nazi state, its willingness to
serve Nazi values. There is nothing wrong with physicians working to
preserve the health of a larger community; that, after all, is the essence of
responsible public health. What differentiated National Socialist public
health from genuine public health in a reasonably civilized society was the
exclusive nature of what the Nazis considered "the community." Nazi
values excluded Jews and others deemed racially or genetically unfit from
the völkisch community. It bears repeating: Most German physicians in the
Reich failed to challenge the rotten substance of Nazi values, the
murderous directions of Nazi initiatives.
There were, of course, physicians who did not collaborate, who retreated
to the laboratory or the bedside while eschewing the Nazi regime's medical
dogmas and its use of doctors to implement various heinous policies. It is
surely fair to say that far too few of these "apolitical" physicians raised
their voices to protest the Nazis' exploitation of their profession. The
science historian Herbert Mehrtens has a nice name to describe these
scientists or doctors: "irresponsible purity." The expression is apt, because
it challenges the conventional wisdom that "pure" science and medicine are
invariably laudable, and politicized science and medicine are inevitably
immoral. In fact, the purity of silence embraced by a large fraction of
physicians in the Third Reich was a great moral failing. These doctors did
not take a sufficient interest in the life and death dealings of their
colleagues. Doctors in Nazi Germany were not sufficiently politicized -- if
by politicized we mean appreciating the larger political and ethical context
of their particular professional practice. Nazi medical evils represent a
failure of moral and social responsibility. More should have spoken out
against the regime, more should have resisted.
The Fallacy of Abandoned Ethics
It is just as misguided to believe that scientists who cooperated with the
Nazis were bereft of ethics as to believe the Nazis were intrinsically hostile
to science. There was an ethic of Nazi medical practice, and it should be
examined and understood.
We often hear that the Nazis abandoned ethics. A recent Israeli film on the
euthanasia operation claims that the overzealous scientific curiosity of Nazi
doctors led them "to abandon all moral sense in the pursuit of medical
knowledge." The image created is of an unfettered quest for knowledge, a
kind of scientific fanaticism, or science practiced without limits.
It might be hard to believe, but there were, in fact, ethical standards that
governed medical research and the practice of medicine in the Third Reich.
Medical students took courses on medical ethics; medical textbooks in Nazi
Germany discussed medical ethics. There was a great deal of attention
given to the obligations of physicians to society, the state, and sometimes
even to the individual. Nazi medical philosophers were critical of the ideal
of value-free science, which was often equated with useless ivory-tower
liberal -- or Jewish -- "science for its own sake." Science was supposed to
be "for the people," though not of course for all people: Science was
supposed to be at the service of the German Volk, the healthy and
productive white races of Europe. Nazi medical ethics was underpinned by
sexist paternalism, Nordic supremacy, cleanliness, punctuality, orderliness,
unquestioned obedience to authority, and public and environmental health.
It tended to emphasize preventive medicine, cost efficiency, the natural
lifestyle, and the superiority of the productive worker. Clearly, Nazi
medicine was imbued with ethical principles -- some admirable, some
despicable.
One sees evidence of these principles in Nazi public health practice. Nazi
health officials cleaned up water supplies and removed lead and mercury
from consumer products. Doctors were urged to counsel patients against
tobacco use, to maintain the efficiency of workers, safeguard public and
genetic health, and ensure the best possible medical care for every pregnant
woman and newborns judged "genetically fit." There were debates about
medical malpractice -- whether, for example, natural healers were to be
barred from treating cancer patients (they eventually were) -- and the limits
of medical confidentiality and medical disclosure. A 1943 article in a leading
German cancer journal cited the "demands of medical ethics" to inform
patients of the severity of their diseases, and in at least one case a physician
was prosecuted for failing to inform a woman she had cancer (physicians
protested the ruling in print).
Ethical norms were implicit even in the most horrific experimental practices
in the camps. How else does one explain the fact that "healthy" German
citizens were never experimented on? Those subjected to experimental
violence were invariably people judged less than fully human in the Nazi
scale of values. Jews and Gypsies were considered "diseased races,"
tumors in the German body politic. Nazi medical crimes simply don't make
sense without this conception of healthy and diseased races, lives worthy
and unworthy of living.
The doctors infamous today for brutalizing prisoners at Buchenwald or
Dachau were not morally blind or devoid of the power of moral reflection.
Acknowledging this, however, does not excuse the behavior of these
physicians; on the contrary, it is crucial if we are to condemn them for
their ethical transgressions. Possessing a sense of morality means one is
not a lunatic. Nazi legal philosophy tended to blur the distinction between
insanity and criminality, but it is a distinction we must keep clear. The Nazi
doctors were not madmen; that is why we must work so hard to
understand the origins of Nazism if we are to have any success in
preventing its resurgence.
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