By cleverly using an historical microscope to focus on one area of German medicine --- the circumscribed fields of dermatology and dermatopathology --- Dr. Wolfgang Weyers helps us see how Nazi rule affected the medical profession as a whole as well as greater German Society. His intriguingly close inspection quite effectively brings this singular moment in time and history to life without the usual discussions of the most morbid aspects of that terrible era. We are enabled to "see the world in a grain of sand."(1)
Why are the changes in medicine under the rule of the Third Reich so historically relevant, and how can the events which unfolded in such a small field as German dermatology be of such paramount importance here? This is so because the Nazi regime regarded itself as the equivalent of physicians to the German people, as the Reich sought to cleanse the nation of its impurities and improve the general health and welfare of the State. The Jews were seen as the main threat to Germany's healthy recovery as a nation. Curiously enough, dermatology was more heavily represented by Jewish physicians than were most other fields of German medicine.
While many of the physicians discussed in this work will be recognized only by dermatologists, some of these historical "grains of sand" are now legion --- such as Moritz Kaposi, whose name has become irrevocably linked with one of the great plagues of the 20th century. Although this book will appeal primarily to physicians, and to dermatologists in particular, this well documented historical work should fill a significant niche in Holocaust literature.
While neither prejudice nor anti-semitism is unique to Germany, a unique concatenation of circumstances played itself out in that special time and place. For many reasons, anti-semitism had been prominent in Germany for many years. By the middle of the 19th century, two-thirds of those Jews who sought prestige in German-speaking countries, such as the poet, Heinrich Heine, had converted. For the majority of Jews who kept their faith, certain professions were more accessible than others --- medicine among them. In 1933-34, while Jews accounted for 0.8 percent of the German population, fully 16 percent of all German physicians were Jewish, 20 percent of all Jewish specialists were dermatologists, and 25 percent of all German dermatologists were Jews.
The medical profession, affording its practitioners a skill that permitted easy mobility, was attractive to a people whose history had taught them the value of such mobility --- but why were German Jews so attracted to dermatology? First of all, this field was not held in high esteem by many physicians. "Ugly" and malodorous skin diseases were shunned. Patients suffering from venereal diseases were deemed to be immoral, having only themselves to blame for their predicament. These latter conditions were not even covered by German health insurance.
Sons followed in their fathers' footsteps, making Jewish leadership in German dermatology a tradition by the first decade of the 20th century. Helping to cement this situation in place was the ironic fact that because of Jewish predominance in this field, Germans thought of dermatology as a Jewish specialty, and other German physicians tended to shy away from it. Names we know today such as Heinrich Auspitz, who described the pinpoint bleeding seen in psoriasis which still bears his name; Heinrich Koebner, who described the eponymic phenomenon of trauma-induced areas of certain skin diseases; Albert Neisser, who discovered the microbial cause of gonorrhea and who was the first to stain the organism of leprosy; Gerson Unna, whose boots are still used to treat those suffering from certain leg ulcers; and Moriz Kaposi are but a few such examples. "At the beginning of the twentieth century, Germany was the leader of the international dermatology community, a status achieved mainly through the work of its Jewish practitioners."(2) This was not to remain the case for long.
Germany was in dire economic straits after World War I, its economy in shambles. Complicating matters, Jewish immigrants from Russian pogroms had flocked to Germany at the end of the 19th century at the same time that German Jews had achieved extraordinary success in public life. They became convenient scapegoats. Dormant anti-semitism resurfaced in Germany as well as in other areas of Europe, but had special consequences in Germany. There, Jews came to be viewed as a distinct, inferior race and a threat to the German nation. The universal consequences of prejudice --- fear, envy and aggression --- took their toll on its Jews in spite of the fact that these people thought of themselves, first and foremost, as Germans. The biological model of "Social Darwinism" influenced the thinking of the Third Reich, and dermatology became a magnet for Nazi interest in, and influence over, medicine.
The politicization of German medicine began relatively modestly. Jewish department heads were forced to relinquish their positions to Aryan physicians. Fraternities and clubs closed their doors to the Jewish contingent. Lists of contributors to editorial boards were revised; the names of Jewish contributors vanished. The State implored patients not to seek treatment by any doctor who was not an Aryan.
German physicians were eager to "go along to get along" as the Reich helped them eliminate their competition. In 1926, their income was only slightly better than that of an average laborer. By 1929, it had dropped 48 percent, and by 1932, 72 percent of German doctors did not earn a livable wage. Allegedly 10 percent of all German physicians were starving. Making matters worse, there were many medical students in the pipeline. "Pure-blooded" German physicians benefitted professionally as well as financially from the New Order. They viewed themselves as instrumental to Germany's renaissance. It was to the advantage of the opportunists who arose during this time to join the power structure early; they were regarded as the most loyal to the cause, and reaped the greatest rewards.
When Adolf Hitler gained the seat of power in 1933, problems for Jewish physicians accelerated. Sections of the German Consti-tution, along with civil rights, were suspended. Weyers makes the point that, "According to Martin Bormann, the secretary of Adolf Hitler, 'the Fuhrer holds the cleaning of the medical profession far more important than, for example, that of the bureaucracy, since in his opinion the duty of the physician is or should be one of racial leadership.' "(3) Two new government organizations were created which exerted totalitarian control over doctors: the German Panel Fund Physicians Union, which subsumed all doctors working in public health, and the Reich's Chamber of Physicians, in which membership was mandatory for every practicing German doctor. Curiously, although the State took control of the personal as well as the professional life of every practicing physician, first by persuasion and later by force, doctors did not clearly perceive the new restrictions on their freedoms --- at least not initially.
German medicine paid a high price for its "de-Jewification." Because race and politics rather than merit and ability were responsible for promotions, less than competent people often found themselves in positions of power and responsibility while Jewish doctors were removed from boards and committees. The quality of German dermatology --- indeed, medicine as a whole --- began to decline. By 1933, mortality rates for hospitalized patients had risen by 16 percent.
The forces which came to bear on German medicine exerted changes in its ethics; this was of seminal importance to the creation of the horrors which soon came to pass. First the infirm or insane were sterilized. Then they were eliminated. Then the conceptual boundaries of those who were "inferior" were expanded. And all the while physicians, as willing accomplices, played key roles in the human drama which was unfolding. Hitler, a veritable chameleon who told each audience what it needed to hear, was an expert politician. His regime exerted control over public perception as well as thought, using euphemisms to hide the true nature of its crimes, planning actions in quite deliberately measured steps, even indoctri-nating German youth as early as possible to try to guaranty victory. Eventually, only oral orders were given, in an attempt to cover up reality.
German society, long used to acquiescence to authority, faced with economic hardship and fear of not cooperating with the power structure and coupled with a massive public education effort to convince Germans they were the master race, succumbed to the basest aspects of human nature.
[T]he medical profession in general, with its many Jewish members, was more severely affected than most other fields by the rise of the Nazis. In no other medical specialty was this as true as in dermatology. Within a short period of time, most of the leading German dermatologists were fired and forced to emigrate. Of 2,078 dermatologists living in Germany in 1933, 566 were Jewish. The fate of about two-thirds of German Jewish dermatologists is known: 248 emigrated, most of them to the United States [my own former department head, Rudolph Baer, among them]; fifteen survived within the confines of Nazi Germany; fifty-eight died in Germany, at least ten of them through suicide; and at least sixty-one dermatologists shared the fate of most other European Jews - - death in a concentration camp.(4)
In his introduction, Dr. Weyers states, "Given the current estrangement of medicine from its ethical roots, it is not hard to imagine that under similar circumstances, the average physician of today might behave even worse than the physicians in the Third Reich."(5) Unfortunately, in spite of the admonition of the philosopher, George Santayana, history does repeat itself all too often. Perhaps this book will help today's physicians essay to preserve their oaths --- whether to Maimonides or Hippocrates --- as they, too, grapple with forces which would mold them into servants of the state instead of advocates for their individual patients. This well researched and thoughtful work can serve to help all of us ensure that the worst examples of human behavior of time present and time past are not repeated in time future.
1. Blake W. Auguries of Innocence. The Portable Blake. The Viking Press, 1966, p. 150.
2. Weyers W. Death of Medicine In Nazi Germany. Lippincott Raven Publishers, 1998, p. 1.
3. Ibid., p. 45.
4. Ibid., p. 4.
5. Ibid, Introduction, pp. xvii-xviii.
Reviewed by Joseph M. Scherzer, MD
Dr. Scherzer is a dermatologist in Scottsdale, Arizona, and president-elect of the AAPS. His address is 10900 N. Scottsdale Road, Suite 502, Scottsdale, AZ 85254.
Originally published in the Medical Sentinel 1999;4(2):73-74. Copyright © 1999 Association of American Physicians and Surgeons (AAPS).
(Death of Medicine in Nazi Germany by Wolfgang Weyers, MD. 442 pp., $50.00, ISBN 0-7817-1714-0, Lippincott-Raven Publishers, Philadelphia, PA, 1998.)