Public Mental Health Practices in Germany
Sterilization and Execution of Patients Suffering from Nervous or Mental Diesase
Leo Alexander, Major, M.C., AUS
CIOS Item 24
Combined Intelligence Objectives Sub-Committee
A. Sterilization of Patients Suffering From Nervous or Mental Disease
Sterlization of the mentally ill in germany was based on laws making compulsory sterilization mandatory in cases of hereidtary disease, including hereditary mental diesease. The law of 25 July 1933, as enacted by Hitler's government, and its amendment of 7 December 1933, defined hereditary disease as including: congential mental deficiency, schizophrenia, manic-depressive insanity, hereditary epilepsy, Huntington's Chorea, hereditary blindness, hereditary deafness, and severe hereditary physical malformation. In severe alcholism sterilization was at the discretion of the "courts of hereditary health" ("Erbgesundheitsgerichte"), which were in charge of the encorcement of the steriliztaion law. Voluntary sterilization of people with herditary disease was discouraged in Germany on theoretical grounds. Rüdin expressed the nature of that objection in a a discussion at the Population Congress, held by the international union for the scientific investigation of population problems in Paris on 1 August 1937. He stated: "The main demand of the gentlemen and and ladies who took part in this discussion is the voluntary character of sterilization. The great and decisive objection against voluntary sterilization is and remains the counter-selection which would be crated by it, and which therefore is the opposite of what we want."
Despite the exaggerated hopes concerning the eugenic effects of compulsory sterilization, which were constantly kept alive by the agitation of Dr. Rüdin and his associates, the practice of sterilization nevertheless fell gradually into disuse in Nazi Germany, as inexorably as it had fallen into disuse in those American Sates which had enacted sterilizattion laws long before the arrival of the Nazis to power in Germany. The main reason advanced for this change in practical policy in Germany (the sterilization law remained on the statute books, but its enforcement "fell asleep") by neuropsychiatrists in pos2ton of authority whom I questioned was that it had been realized since shortly before the war that most insane do not descend from other insane, and therefore, according to studies by Essen-Moeller, only 3% of the insane in the next generation could be eliminated by sterilizing the insane of the present generation; and while those tainted with schizophrenia could thus be eliminated from a given family group within 9 generations, these same strains were bound to die out anyway within 12 generations, because of the diminshed marriage rate and propagation rate of schizophrenia. This was exactly the view taken several years before, namely in 1935, by a committee of the American Neurological Association of which I was a member, the findings of which were published in book form (A.Myerson, J.B Ayer, T.J.Putnam, L.Alexander, and C.Keeler: Eugenical Sterilization: A Reorientation of the Problem. MacMillan New York, 1936).
1. Information Received from Professor Dr.O. Bumke in Munich
Professor Bumke stated on 7 June 1945 that he and many other psychiatrists, with the sole exception of the Nazi hotheads among the psychiatrists, never really cooperated witht he sterilization law. "The incidence of schizophrenia had greatly diminished in Germany, because we no longer made that diagnosis. Instead, we invented the "schizoid reaction", which did not call for sterilization. Similarly, we made the diagnosis "reactive depression" instead of "manic depressive insanity". We have sabotaged the law. Finally, sterilization fell gradually into disuse even officiallly, especially since 1943".
2. Information Received From Professor Dr. Karl Kleist in Frankfurt a.M.
Professor Kleist stated on 10 June 1945 "I never thought much of the sterilization law. Its justification in the manic-depressive group was always questionable, to say the least. Apart from the fact that the whole setup as it was organized implied an unnecessary expenditure, it was medically unsound because it discredited the patient as a human being and it discredited his whole family. I had an extensive practice as an expert in sterilization cases, especially in cases of appeal to the higher courts of hereditary health ("Erbgesundheitsobergerichte"), and I have always tried to protect the patients from sterilization. The only instances in which I regarded sterilization as justified was in Huntingtons choreas, in severe mental deficiency, and in severe cases of epilepsy".
Dr. Kleist was then asked whether he knew the total annual figures of those sterilized for neuropsychiatric reasons in Germany. He stated that the overall figures were not divulged and that he therefore did not know them; the statistics were in the hands of special medical officials. The neuropsyciatrist in charge of patient merely proposed sterilization and they frequently never learned themselves whether their proposal was carried out or not after the case came before the court of hereditary health. In the early years after the law had been passed, there was a great wave of proposals for sterilization, and masses of patients were brought before the courts of hereditary health. These courts were not thorough and passed practically everyone brought before them. If the patient or his relatives objected, they could appeal to a higher court. Dr. Kleist himself served on such a higher court ("Erbgesundheitsobergericht"). As a member of this court, Dr. Kleist always urged caution and reserve. Gradually, sterilization fell fairly generally into disuse; the only one in Germany who remained enthusiastic was Rüdin.
The practical procedure in neuropsychiatric hospitals was as follows; after the admission of a patient a report had to be made whether he was suspect of hereditary mental or nervous disease. If this suspicion became verified in the course of further observation, a proposal for sterilization had to be submitted to the court of hereditary health. From then on the matter was in the hands of the courts, which were then to order the performance of sterilization at a special surgical sterilization center.
Dr. Kleist submitted statistics as to the number of proposals for sterilization made by his clinic (Table 1). Compared to the total number of admission, the incidence of proposed sterilizations was never high or significant at his clinic; it fell off sharply at the beginning of the war, and proposals for sterilization ceased completely since the budget year of 1942/43 (which begins in Germany 1 April 1942). Dr. Kleist felt that in addition to general and theoretical considerations, the shortage of physicians and surgeons during the war was an additional factor in making the sterilization law fall into disuse in Germany during the war.
3. Information Received from Dr. Wilhelm Möckel, Director of the Heil-und Pflegeanstalt (State Hospital for the Insane) in Wiesloch near Heidelberg
Dr. Möckel stated that the practice of sterilization gradually became dormant, and that since the beginning of the war this state of affairs was encouraged by higher authorities. He supplied statistics from his hospital which indicated a gradual decline of the practice of sterilization (Table 2). The average bed capacity of his hospital was 1,640. Since the war, however, only 517 of these beds were occupied by civilian insane. The remainder of the beds were occupied as follows: 350 beds as a convalescent center for chronic cases of physical illness attached to the medical clinic of the University of Heidelberg, a varying amount of 30-400 beds for chronic cases of physical illness from the City Hospital of Mannheim; 1,290 beds were occupied by a military hospital (Lazarett), which included a neuropsychiatric division. The entire military section was under the direction of Oberstabsarzt Dr. Schwenninger.
In addition to sterilization, eugenics were to be safeguard by a special "law of matrimonial health" (Ehe- Gesundheitsgesetz"). This law prohibited marriage for people who had been sterilized, for people who had been under guardianship because of mental incompetence and for severe psychopaths and syphilitics.
4. Information Received at the Psychiatric Clinic of the University of Heidelberg
In the absence of the director of the clinic, Professor Dr. Carl Schneider, who fled upon the occupation of Heidelberg by the American army, I had a talk with the acting director, Stabsarzt Dr. Hans Joachim Rauch. He stated that Professor Schneider had been a great scientific supporter of the sterilization law. It was strictly carried out in all cases in which there was hereditary mental disease, such as schizophrenia, manic depressive insanity, feeble-mindedness or epilepsy. Dr. Rauch stated that he did not know the number of patients sterilized in Heidelberg, but that this information could be obtained at the Staatliche Gesundheitsamt in Heidelberg, Bergheimerstrasse 12.
The new psychiatric clinic in Heidelberg had 225 beds in peace-time. During war there were 149 civilian beds and 80-100 military beds. The number of total annual admissions were in peace-time 1,500. During war there were annually 1,300 civilian and 800-1,000 military admissions.
Sterilization was initiated up to the beginning of the war by a proposal to the Court of Hereditary Health. Later a mere notification of the State Health Office was sufficient. These authorities then decided what should be done.
Dr. Rauch stated that the killing of patients suffering from mental or nervous diseases was entirely non-official and that he did not know anything about it beyond the fact that it had been done.
Faculty of Humanities, Languages and Social Science