The National Socialist Medical Welfare State


The following is a talk given at the LRC Health and Wealth Conference in Foster City, California, December 2, 2006. Almost all the information in the talk, though not my libertarian theme, comes from two books by Robert Proctor: Racial Hygiene: Medicine Under the Nazis (Harvard, 1988) and The Nazi War on Cancer (Princeton, 1999).

Every society must answer a fundamental question about its medical system. Does each person control his own body? If he does, he has the right to decide what type of medical treatment he wants. If people do not own their own bodies, then medical policy need not respect individual decisions, and individuals can be ruthlessly cast aside for the supposed general welfare.

There is no doubt about how the Nazis answered our question. Paul Diepgen, the leading historian of medicine in the Third Reich and also during the preceding Weimar Republic, said in a book that appeared in 1938: "National Socialism means something fundamentally new for medical life. It has overcome an idea that was central to medicine of the recent past: the idea of the right to one’s own body." A key Nazi slogan was "The common good is higher than the individual good."

If individuals do not make the key medical decisions, who does? Inevitably, it is those who control the state. The Nazis denied that they subordinated everything to the state; in contrast to Italian fascism, their propaganda stressed the party rather than the state. But in practice, this did not matter. To them, the welfare of the German people, the Deutsche Volk, was the supreme good; and Hitler, as the Leader of the German people, claimed the right to be the final judge of what best promoted this. In his Berlin Sportspalast speech of January 30, 1941, he declared that he had a democratic mandate and had come to power legally. His will, and the decisions of his chosen subordinates, thus determined medical policy, as it did everything else of significance.

Our conference is concerned with alternative medicine, and so a question naturally arises: How did the Nazis view unorthodox medical systems? One might have expected them to be sympathetic. After all, the Nazi ideology claimed that modern society had become too dominated by urban values. Life was too technologized, and the Nazis said they wanted to return to peasant wisdom. A characteristic book of this period was the novelist and philosopher Erwin Guido Kolbenheyer’s The Philosophy of the Hunting Lodge. Wouldn’t people with such views have an affinity for therapies that promoted natural methods of healing and opposed laboratory medicine? Natural healing was very popular at the time. In November 1934, more than 270,000 people paid for treatment by natural healers, even though they could have received free treatment from government-paid physicians.

At first, the Nazis met our expectations. Gerhard Wagner, the head of the National Socialist Physicians’ League and Leader of German Medicine, favored a unification of standard and alternative medicine. The government provided funds for natural healers, as well as for standard medicine, and the Rudolf Hess Hospital in Dresden specialized in homeopathic medicine.

But, as always, when the state supports something, it takes control. Wagner made clear that alternative healers must be strictly regulated. One major practitioner of alternative medicine found out quickly what this meant. Albert Wolff, the editor of a leading journal of homeopathic medicine, wrote an editorial denouncing compulsory vaccination. (By the way, Herbert Spencer and George Bernard Shaw were also opponents of this practice.) Wolff was threatened with criminal action and his journal had to publish a statement by Wagner forbidding criticism of the government.

The standard doctors strongly opposed natural healing, and their opinion became more and more influential. Alternative medicine still had powerful supporters, including Rudolf Hess, the Deputy-Fhrer; Heinrich Himmler, head of the SS; and Julius Streicher, the editor of the anti-Semitic newspaper Der Strmer and Gauleiter of Franconia. (Streicher’s influence declined after 1940, and he was eventually put under house arrest.) By 1939, a law provided that no one could practice as a healer unless enrolled in a government approved program, and natural healers were gradually to be phased out

Matters became even worse for alternative doctors after Rudolf Hess’s flight to Britain in May 1941. Hess intended to contact the Duke of Hamilton, a leading Scottish peer, whom he somehow believed was an opponent of Winston Churchill. He hoped to negotiate a peace settlement between England and Germany. Some have speculated that Hitler approved Hess’s mission, but the Nazi leadership professed surprise and shock, denouncing Hess as insane. Joseph Goebbels, the Minister of Propaganda, strongly opposed those he termed medical quacks, and he used Hess’s flight to urge a crackdown on those who deviated from medical orthodoxy. Since Hess supported alternative medicine, the natural healers had to be punished when he came into disfavor. One of the speakers at our conference is an anthroposophical doctor, and he would not have fared very well under this order: among those arrested after Hess’s flight were anthroposophists. Here we see in action another characteristic of a statist regime. Groups can fall in and out of favor for arbitrary reasons, often with severe consequences for those who belong to them.

The Nazis had comprehensive plans for medicine. To carry out these plans, medicine received extensive funding; and medicine became one of the most popular subjects for university students. Of course, government funding meant government control. Jewish professors of medicine were dismissed. One exception was the Nobel Laureate Otto Warburg, who retained his position as head of the Kaiser Wilhelm Institute for Cell Physiology in Berlin through World War II. Often, they substituted for the ousted professors ideologues of their own stamp, such as experts in "racial hygiene."

The Nazis believed that medical research had been too abstract. They proposed instead to concentrate on more practical measures. They emphasized prevention of illness, as well as cure. Cancer was an especially important area of concern, and the Nazis addressed this illness in their characteristic language. War had to be waged against "Jewish" or "Bolshevist" cancer cells.

But there was more to the Nazi campaign against cancer than odd rhetoric. Massive surveys took place to determine the incidence of cancer, and these proved very useful for later research. Many of the health campaigns we see today have precedents in Nazi policy. Women over thirty were urged to undergo screenings for cancer, and advertising campaigns warned against the dangers of tobacco. Just as today, regulations forbade smoking in certain public places and jobs. And, just as with us, smoking could not be banned completely: smoking was too popular, and the tobacco companies were too powerful.

Many people think that before the 1950s, the evidence that linked smoking and lung cancer was just anecdotal, but in fact a member of the Nazi party, Franz Mueller, established the link in his 1939 dissertation. The research that showed the dangers of asbestos also took place in the Nazi period. Robert Proctor has written an excellent book, The Nazi War on Cancer, which gives full particulars on Nazi research.

The Nazi health campaigns were by no means confined to cancer. People were urged to eat whole grain bread instead of white bread, and there were demands for a final solution for the bread problem. Another campaign urged people to eat vegetables. Hitler had become a vegetarian in 1931, although, like Bernard Shaw, he was not of the strict observance. (Some people have speculated that Richard Wagner, to whose music and writings he was devoted, influenced Hitler here.) But there was no attempt to ban meat altogether. Most of the Nazis were not vegetarians, and such a ban could in any case never have been effective.

Robert Ley, the head of the Labor Front, urged workers to drink tea instead of their traditional beer. His anti-alcohol campaign, though, suffered from the fact that he himself was a notorious drunk who sometimes delivered public speeches while under the influence.

Nazi medical policy of course had a more sinister side than I have so far described. If individuals do not own their own bodies, then people have no right to reproduce. The good of the German Volk, as determined by the ruling authorities, would govern who could have children. A law of October 1933 provided for the sterilization of persons with certain conditions, including feeblemindedness, schizophrenia, manic-depression, epilepsy, blindness, deafness, and alcoholism. Genetic courts could judge people with these conditions. These consisted of two doctors and a lawyer. Eminent scientists, including Eugen Fischer, who coined the word "genetics" in 1926, served on the tribunals. People could appeal the verdict of the genetics court, but few appeals were successful. About 4000 people per year were sterilized, mostly for feeblemindedness; the total number of people sterilized under this law was about 400,000. Rudolf Ramm, a leading National Socialist medical expert, said that those sterilized were making a sacrifice "in the interests of the good of the Volk."

Here I think we must avoid a mistake. It is easy to say that such a policy could only take place in a dictatorship: a Western democracy could never do such a thing. Quite the contrary, sterilization was very popular in the United States. Twenty-nine states had laws allowing compulsory sterilization, beginning with Indiana in 1907. Oliver Wendell Holmes found these laws constitutional in Buck v. Bell (1927). He declared, "three generations of imbeciles are enough." In fact, the Nazis modeled their policy on the American laws. They were influenced by American racial theorists and eugenicists, such as Lothrop Stoddard. He later visited Germany and described the genetic courts in his book Into the Darkness. European nations such as Denmark also had sterilization laws. Once a nation abandons self-ownership, individual welfare must indeed bow to the general good. The National Socialists carried out more consistently than others an idea that was widespread.

After World War II began on September 3, 1939, the Nazis extended the basic premise of their medical and health policy even further. Demands on resources drastically increase during a war. People who are severely mentally ill use valuable resources but do not contribute to the welfare of the Volk. (The historian Goetz Aly has written extensively on the use of this argument in Nazi racial policy.) If they have no rights to their own bodies, the government is free to get rid of them. They, like everyone else, are viewed as means to an end and not as persons with inherent worth. Hitler issued a secret order that allowed the mentally ill to be killed. Another policy called for killing mentally defective and handicapped children. About 5000 children were killed, and about 65—70,000 mentally ill people were gassed. National Socialist experts estimated that out of every 1,000 people, 10 would need psychiatric treatment. About 5 of this group would need continuous treatment, and 1 would need to be killed.

The program could not be kept fully secret, and people protested against it. These included Bishop (later Cardinal) Klemens von Galen, the "Lion of Muenster," who denounced the killings from the pulpit. As a result of these protests, Hitler ordered the gassing program ended in August 1941, but many of the mentally ill continued to be killed throughout the war, many by lethal injection.

National Socialist medical policy thus offers an excellent case study of what happens if a nation embraces the slogan that the common good is higher than the individual good. Exactly the same mentality can be found today in those, such as Judge Richard Posner and John Yoo, who defend torture if this would promote national security. Once more we have the premise that the rights of individuals must bow before what the government deems best for all. Let us hope that those loyal to freedom will be able to overcome this dangerous view, both in medicine and elsewhere.

December 14, 2006