Nazi murder of the sick in Erlangen: A terrible warning from history as the UK Parliament considers the Assisted Suicide Bill.

How much did the Church and the City know.  NB Church here means both Protestant and Catholic.  

This is a terrible warning from history as the UK Parliament considers the Assisted Suicide Bill.

The HuPflA (Hospital for the Disabled) in Erlangen played a central role in Nazi euthanasia. Thousands were murdered – in the heart of the city. Historians Karl-Heinz Leven and Sabrina Freund recount what was known, how the information was transported – and how the churches reacted.

The Institute for the History and Ethics of Medicine at the University of Erlangen-Nuremberg has researched the Nazi sick murders in the former Erlangen Sanatorium and Nursing Home (HuPflA). Editor Karl-Heinz Leven, Director of the Institute, and research associate Sabrina Freund also discuss the role of the churches.

What significance does the HuPflA have, or what role does it play, in the framework of the T4 Actions? Or was it more of an "intermediate institution" with a subordinate role?

Karl-Heinz Leven: Erlangen wasn't an "outstanding" location, but it was a very relevant one in this field of action. Many people became victims here because Erlangen played a central role for the surrounding area and the wider region as a collection point for the corresponding killing centers, to which the patients were then transported. Another special feature of Erlangen during the Nazi "euthanasia" campaign was that the buildings of the sanatorium and nursing home were located so close to the city. These were usually located in the outskirts of cities, but here they had one that was practically in the city center, which people walked past repeatedly.

If you walk past Maximiliansplatz today, you'll notice the memorial to those murdered under National Socialism in front of the building that houses the university's commercial directorate. Is it practically the last thing left of the former HuPfla?

Sabrina Freund: That was the former administration building. If you walk past it and all the way through the grounds, you'll see the remains of the north wing, which largely housed the university's psychiatric clinic. Later, two of the hunger stations, where the so-called "B-diet" was distributed, were also built in the basement. The area in front of it was built with a comb-like complex of buildings – a huge area. You often hear in eyewitness accounts that visitors could get lost there. The area was also enclosed by a wall, shielding it from the city.

Did the people of Erlangen know what was happening behind these walls?

Karl-Heinz Leven: Of course, one has to assume that some people knew something. But there are no direct eyewitness accounts. Another peculiarity of Erlangen is that the often-called "gray buses" of the GeKrat, a front company for the Nazis' ambulance service, didn't exist. The patients were transported to the killing centers on special trains. A correspondence between Director Wilhelm Einsle and the GeKrat (German Federal Office for the Investigation of the Death of the Jews) has been preserved, in which he learned that the patients had to be taken from the institution to the train station for the T4 transport. This is about a half-hour walk, and it runs right through the middle of the city.

Sabrina Freund: According to this correspondence, the transport also took place between 7:00 and 8:00 a.m. This means that some people must have noticed something on their way to work, for example. Our colleague Katrin Kasparek, who is researching the institution in Ansbach for the Middle Franconia district, quite by chance found an invoice for a local bus company in administrative files. We don't have such a document for Erlangen yet, but we can assume that it was organized similarly there. Many patients were probably sedated or physically unable to walk for half an hour.

Isn't it unusual that these transports were not discussed?

Karl-Heinz Leven: It shouldn't be surprising that no one spoke out about it directly, because it was a totalitarian regime in which concepts like freedom of speech or freedom of the press were foreign. Even journalists, clinical physicians, and those in the know didn't say anything, fearing for their positions, perhaps even their health or lives. The climate prevailed in which people exchanged views only occasionally. Voices against Nazi "euthanasia" were very rare, however, and almost unheard of in public. The Freiburg pathologist Franz Büchner was the only German doctor to speak out publicly against the murder of the sick in front of thousands of listeners, but in a manner so cryptic that one had to listen carefully.

Sabrina Freund: There's an example from Absberg near Gunzenhausen of the danger that could arise from a protest. A charitable institution there was closed because the district wasn't the sponsor, and the state therefore had no access to the patients. The population gathered there when the patients were transported to Erlangen and expressed negative views. Subsequent Nazi Party reports described attempts to identify the complainants. So, it was certainly dangerous.

Were the transports and admissions a constant occurrence, or did they fluctuate in frequency?

Karl-Heinz Leven: The radicalization of the measures coincided with the outbreak of the war. Society became increasingly militarized and geared toward war, and many aspects, such as the care of the mentally ill, were pushed into the background. The so-called "T4 Action," the centrally controlled murder of the institution's inmates, was carried out from autumn 1939 to summer 1941.

How did the churches deal with this knowledge?

Karl-Heinz Leven: Prussian Protestantism had a leaning toward the Nazi state. Catholicism, through its ties to Rome, had another authority besides the Führer that was far superior to it: Pope Pius XII. He had previously served as ambassador to Berlin and behaved diplomatically toward the German Reich. There was a concordat between the Holy See and the Nazi regime that regulated the Catholic Church's scope of influence in Germany. This also concerned Catholic religious education in schools. This means that the Vatican had a very strong interest in reaching an agreement with the German Reich and maintaining peaceful relations.

The book also mentions the chaplains of the institutions. What kind of people were they?

Sabrina Freund: These weren't clergy employed by the institution, but rather the pastors of the respective parishes. Next to the administration building is the Catholic Church of the Sacred Heart. Their pastor was the Catholic chaplain of the institution, because he was also in close proximity. Eugen Buck and Wilhelm Berger, for example, were ordinary pastors of their parishes and primarily held services in the institution. A pastor was practically also an official during this time. The clergy, of course, also knew what was happening in the institution; they saw the people starving to death.

Karl-Heinz Leven: But again: actual resistance was very dangerous under National Socialism. And the examples we know of mostly ended with the guillotine. Pastors were also sent to concentration camps, although no bishop died there.

Were there at least the voices of individual clergy who spoke out against this injustice?

Karl-Heinz Leven: One example is Clemens August Graf von Galen, then Bishop of Münster, a stronghold of Catholicism. In August 1941, he publicly preached from the pulpit of St. Lamberti Church against Nazi "euthanasia" and called it a "murder campaign." This was unique, because he described the campaign for what it truly was, thus turning the regime against itself. Nevertheless, they didn't dare attack him at first; the authorities had saved that for the time "after the final victory." They knew that if they took von Galen out of Münster, they would risk a public reaction, which the regime did not want, because they wanted to carry out the killings of the sick as a secret operation.

A secret operation, but with many thousands of accomplices?

Karl-Heinz Leven: That, too, is a strange fact, since the staff of the various organizations involved alone already comprised many hundreds of people, and the operation therefore couldn't remain secret. It was nevertheless carried out unofficially, as the killings actually violated the applicable law of the Nazi state.

What do you mean by that?

Karl-Heinz Leven: The murders of the sick were not based on a law, but on a Führer order, actually a letter of authorization. Those involved were led to believe that the measures were legally protected; the Führer's will was, so to speak, above the law. But there was no law, and therefore it could not be discussed openly, even to those who supported such killings. Only rarely was "euthanasia" mentioned in internal correspondence; instead, code terms such as "special treatment" or "children's special ward" were used, since even under National Socialism, killing—even on request—was a criminal offense. The Führer's letter of authorization was not circulated; only three copies existed, of which one has survived. Justice Minister Franz Gürtner received a copy following a complaint. Although Gürtner was a jurist loyal to the Nazis, he nevertheless maintained a professional code of conduct: If a death sentence was passed, it had to be based on law. Killing people without a legal basis wasn't in his interest.

And were the judges satisfied with this authorization from the Führer?

Karl-Heinz Leven: Ostensibly, yes. Except for Judge Lothar Kreyssig. In 1941, he inquired at the Ministry of Justice in Berlin, as he was becoming skeptical about the frequent deaths among his legal wards. The infamous Roland Freisler, then State Secretary in the Ministry of Justice, replied that Philipp Bouhler, Hitler's right-hand man and head of the Führer's Chancellery, was responsible. Freisler even recommended that Kreyssig report Bouhler for murder. Kreyssig then followed up with Justice Minister Gürtner, who noted on the authorization letter: "Handed over to me by Bouhler on August 27, 1941." At that point, "Aktion T4" had already been running for two years. Kreyssig countered that this basis and measures were unacceptable to him as a lawyer. Gürtner, however, believed that the Führer was above the law and that, as Minister of Justice, the letter was sufficient for him. This document also shows how the regime operated and that there were "competing hierarchies" and rival endeavors. Ultimately, a "euthanasia" law, which would have required publication, never came into being. Hitler shied away from this.

Starvation diets, malaria treatments, and long-term baths are measures or treatments explained in the book that took place regularly. That all sounds inhumane today. Were the medical profession, including the nursing staff, actually convinced that these things served some kind of therapeutic purpose, or was everyone aware that this was pure harassment?

Karl-Heinz Leven: You have to differentiate. "Starvation diet" is not, in fact, a medical procedure, but rather a code term for a method of killing patients in a slow and painful manner. This procedure during the so-called "decentralized euthanasia" was regulated by a state decree in the Bavarian Ministry of the Interior after the discontinuation of "Aktion T4." Some of the treatment methods mentioned may sound cruel from today's perspective, but they were innovative psychiatric procedures. Julius Wagner-Jauregg received the Nobel Prize in Medicine in 1927 for his malaria therapy for "progressive paralysis," a sequela of syphilis. This Austrian physician developed the procedure by inducing an artificial fever through the injection of malaria parasites. This "cure" suddenly made the late forms of syphilis treatable. Among the treatment methods, electroconvulsive therapy, which was only invented in the 1930s, must also be mentioned. This involved exposing the head to a strong electrical voltage. The fact that these procedures were also ruthless back then, that the therapy was applied not three times but 20 times, and that people also died as a result, is another question. But the forms of therapy were not paramedical; that was "state of the art."

Sabrina Freund: I believe that some people genuinely felt they were doing something meaningful because medicine was understood differently back then, as the focus was on the "national body," and the goal was to heal the "national body." This is also the background of eugenics, or "racial hygiene," as it was called in Germany. However, there were, of course, some witnesses during the trials who testified that they had only been involved to prevent something worse from happening or to sabotage the measures. But for that to happen, one would have to have been aware of the implementation of the measures. It's hard to imagine that employees of the institution knew nothing about it. But many of those involved and accomplices weren't exceptional sadists who enjoyed torturing people. That doesn't make things any better, of course; they were often cool, rational people, especially in leadership positions.

Which perhaps also explains why the patient files were very well documented and preserved, rather than the events being concealed?

Sabrina Freund: Exactly. Registration forms were sent from all institutions to the T4 headquarters in Berlin, Tiergartenstrasse 4. A form was completed for each patient in a sanatorium and nursing home, including information on religion, ability to work, diagnosis, and other criteria. At the bottom of the form was a boxed box. There, the assessors, such as university psychiatrists, noted a plus or minus. The plus sign represented killing. Behind this lies an ideology that had already taken root in the 1920s and dealt with the "extermination of life unworthy of life." This is the title of a pamphlet that—under the influence of the First World War—was distributed to the medical profession and the general public. The war represented a turning point in the radicalization of these ideas. In view of the economic crisis, the large number of young war casualties, and inflation, people could no longer afford to feed the sick in the institutions. Under National Socialism, this ideology was integrated into state ideology and found compliant minds in medicine for practical implementation.

So why was "Aktion T4" stopped in 1941?

Sabrina Freund: By the summer of 1941, a certain target had been reached: approximately 70,000 killings. They then moved on to so-called "decentralized euthanasia." During this regionally organized phase, patients were killed in the institutions themselves with starvation diets, systematic neglect, or overdoses of medication; they were no longer sent to the killing centers. The war against the Soviet Union also began in the summer of 1941. The personnel and knowledge required to carry out mass murder, to use a somewhat macabre term, were relocated eastward for the Holocaust. There is a personnel, structural, and material continuity from the extermination of the sick to the extermination of the Jews.

Karl-Heinz Leven: Furthermore, it had now leaked out, even to relatives, that terrible things were happening in the institutions. False death certificates were being issued, and death certificates were being exchanged with other killing centers. Sometimes, in very small villages, several families received a death notice on the same day. Or, in the case of children, it was stated that they had died of old age because the causes of death had been fabricated. At some point, this got out and was no longer a secret operation. This led to resentment. In the immediate vicinity of the killing centers, people could smell the smoke from the crematoriums.

Moreover, more and more relatives rebelled. In contrast to the Holocaust, the resentment was also greater because these killings could, in principle, affect anyone—including "Aryans": a demented grandmother, a deaf child, or a disabled veteran from the First World War.

You have now published the first of two volumes examining the history of euthanasia in Erlangen. Are you pioneers?

Sabrina Freund: No. The earliest engagement with the topic occurred immediately after the war. Initial attempts to address it quickly petered out. It wasn't until the 1980s that a critical examination of "euthanasia" began. So, it took an entire generation. We titled the first volume "Event and History," and the second deals with its reception.

Why should we still engage with this topic today?

Sabrina Freund: Our work is intended to make people think about the role that science plays in society, even in the present day. We need to think about how we deal with science in our own time. Is there political influence on medicine today? There was an extreme version of health policy in the Third Reich, but what about the alliance between the state and medicine today?

Karl-Heinz Leven: Today, thank God, we are very far removed from the totalitarianism of the Nazi era; nevertheless, we must always be vigilant with regard to developments in society, politics and science. Medicine, with its paramount importance in the modern age, has proven to be susceptible to ideologies.

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