This catalogue documents and complements the exhibition at the historical site of the Charité in central Berlin inaugurated in 2017. Published in a German and an English edition, it details the history of the Charité during the times of National Socialism and documents doctors‘ questionable medical actions and medical crimes. Furthermore, it contains the perspectives and personal accounts of those affected, including victims of medical transgressions and medical scientists persecuted by the regime.
‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians’
‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted […]. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick.’ Leo Alexander, 1949
‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians’ The Charité in National Socialism and the Dangers of Modern Medicine
Judith Hahn (ed.)
Judith Hahn (ed.)
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‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians’ The Charité in National Socialism and the Dangers of Modern Medicine Catalogue to the exhibition Judith Hahn (ed.)
Berlin, 2020 Schwabe Verlag
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The building of the Charité’s Psychiatric and Nerve Clinic in which the exhibition takes place. 2019 | Photography | Psychiatric and Nerve Clinic of the Charité | Photograph: Wiebke Peitz/Charité.
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Foreword
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Preface
Contexts and approaches 11
Historical Approaches Thomas Beddies and Judith Hahn
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Areas of conflict and aporia in medicine Heinz-Peter Schmiedebach
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The Exhibition and the CharitĂŠ-Campus Berlin-Mitte Judith Hahn
Documentation of the exhibition 29
The perspective of the people concerned
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Actors and the crossing of medical borders
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Literature (selection) and Impressum
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Foreword
This publication documents an exhibition about the Charité during National Socialism (NS) and the dangers of modern medicine. The exhibition, as well as the catalogue, arose from the project ‘GeDenkOrt.Charité – Science and Social Responsibility’, by which Berlin university medicine meets its historical responsibility, deriving especially from its misconduct at the time of NS. In addition, present day issues are also reflected upon: the chances and risks of bio-medical science and practice are addressed in their ethical, social and cultural perspectives. Medical science crosses borders, that is its task. At the same time, however, human dignity and the respect for life must remain its highest demand. This double approach not only aims to look back and remember, but also strives to ensure historical knowledge is fruitful for current discourse. With this undertaking, the Charité seeks to establish a culture of continuous debate about the challenges and risk potentials in medicine and the sciences. The title of the exhibition ‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians’ reflects on a quote from the Austrian-American psychiatrist and neurologist Leo Alexander (1905-1985), who acted as an expert for the accusatory authority at the Nuremberg Doctors’ Trial and who tried to determine how medical crimes could have happened in NS times. Although there are great differences between current discussions in medicine and what happened then, the valid understanding remains that it needed only a ‘subtle shift’ for fatal developments to begin. This also makes it important to reassure, by permanent debate, a wide societal consensus on which actions are desirable and where there are dangers arising for the individual or for minorities. As an important research institution, the Charité has to face these questions to enable students and young physicians to perform science in a responsible way. When the exhibition was opened in November 2017, I was immediately asked about an exhibition catalogue. I supported it wholeheartedly from the outset and I am glad now that it has been realized in both a German and an English version. I hope it will help the project ‘GeDenkOrt.Charité – Science and Social Responsibility’ to gain a wide resonance.
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Berlin, September 2019, Prof. Dr. Karl Max Einhäupl Former Charité’s Chief Executive Officer and Patron of the project
FOREWORD
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Preface
Every application of medical knowledge, including the realization of scientific medical projects, inevitably touches upon questions of human dignity. In the double role of scientist and medical practitioner, physicians constantly face the responsibility to orientate their thinking and acting towards the rights of the individual and to take precautions against violating human dignity. The central concern of the project ‘GeDenkOrt.Charite – Science and Social Responsibility’ is to reinforce the awareness for an attitude towards human beings based on respect and responsibility in research, teaching and dealing with patients. This cooperative project between the Charité – Universitätsmedizin Berlin and the University of the Arts Berlin integrates historical approaches and elements of the medical humanities. With its presentation of information, discussion and the inclusion of art, it addresses not only a professional audience, but also the wider interested public. The exhibition documented in this volume was realized in 2017 as part of the aforementioned cooperative project. It is intended as a permanent source of information. With its selection of topics, the exhibition aims to facilitate knowledge and to stimulate thinking on questions of ethical limitations and dangers in modern medicine in a comprehensive way. Its focus is the Charité during National Socialism. In this time, many health professionals disdained the principles of medical thinking and acting to an extraordinary extent. However, the exhibition deliberately not only deals with clearly identifiable medical crimes, but also with questionable actions in grey areas and exploiting individual leeway. At two points the time horizon of the exhibition is widened: the question of dealing with human remains in the Charité’s anatomical collection dates back to colonial times; in highlighting the continuities of excluding people with venereal diseases, it looks back to the Imperial age. The exhibition approaches the topic of Charité during National Socialism from two angles. It opens with the perspective of the people affected; victims of medical practice, which clearly crossed ethical lines, as well as persecuted scientists and students speak in their own words. In addition, it presents scientific contexts and persons who acted in ways which possibly or definitely crossed medical lines. This part of the exhibition is mostly structured according to medical disciplines. Two chapters also deal with overarching aspects of the students’ and the university’s
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adaptation to the ‘Führer’ state. This catalogue documents the exhibition. Introductory contributions widen and explain the topic. These texts address contexts and approaches to the general topic of the Charité during National Socialism and the dangers of modern medicine in a more detailed manner than would be possible within the exhibition. The memorial path ‘REMEMBER’ (htpps://remember.charite.de), which has been installed parallel to the exhibition outside on the historical campus of the Charité, additionally allows an approximation to the themes by the means of art. The exhibition and catalogue are products of the project ‘GeDenkOrt.Charité – Science and Social Responsibility’. The exhibition was made possible by the support of the Freundeskreis der Charité e.V., the Stiftung Deutsche Klassenlotterie Berlin and the Friede Springer Stiftung. The Charité is thanked for adopting the project overall, for providing the unique exhibition space in its Psychiatric and Nerve Clinic, and for financing this catalogue in German and English. Special thanks are owed to Karl Max Einhäupl, who has continuously supported the project personally as CEO of the Charité – Universitätsmedizin Berlin. A heartfelt thank you to the Schwabe Verlag Berlin for the competent and constructive cooperation in realizing this catalogue. The exhibition was curated jointly by Laura Hottenrott and Judith Hahn. Its conceptualization and realization was fostered by a project group, in which the discussions of ideas and contents with Thomas Beddies, Heinz-Peter Schmiedebach and Thomas Schnalke were most fruitful. Gerda Fabert, as well as the colleagues from the Institute for the History of Medicine and Ethics in Medicine of the Charité – Susanne Doetz, Rainer Herrn, and Udo Schagen – contributed greatly to setting up this exhibition. They all deserve our special gratitude. We also thank all those who provided us with documents and allowed us to use their pictures. Hans Coppi has helped tremendously with writing the anatomy chapter focusing on the Anatomical Institute’s dealing with corpses from the place of execution in Berlin-Plötzensee.
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Berlin, August 2019, Dr. Judith Hahn Institute for the History of Medicine and Ethics in Medicine
PREFACE
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Location of the exhibition. View of the Charité’s Psychiatric and Nerve Clinic, c. 1910. around 1910 | Photography | Psychiatric and Nerve Clinic of the Charité | Reproduction IGM | Sign. 001499.
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Ground plan of the Psychiatric and Nerve Clinic, 1911. The exhibition is located on the ground floor of the clinic and extends through several hallways used as passageways (see indications in red). In developing and realizing the concept for the exhibition, it was necessary to respect the given spatial conditions of the historical building and its current use. 1911 | Ground plan | from: Die neue Psychiatrische und Nervenklinik in der CharitĂŠ Berlin, in: Zentralblatt der Bauverwaltung 31 (1911) Nr. 75, p. 464 | ZLB | Scan 2008 URN: https://nbn-resolving.de/urn:nbn:de:kobv:109-1-14267930
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CONTEXTS AND APPROACHES
Historical Approaches Thomas Beddies and Judith Hahn
Through space, objects and events this exhibition offers visitors historical access on three perspectives to enable an approach to its core topic: the Charité during National Socialism and the dangers of modern medicine.
Clinic buildings and the Charité Campus: authentic places The exhibition is installed in the Psychiatric and Nerve Clinic of the Charité, located on the historical campus of the Charité in Berlin Mitte. Today this clinic, opened in 1904, still serves as a location for scientific research, as well as for the treatment of psychiatric and neurologic patients. Thus, it is both a historical and contemporary venue of medical thinking and acting. At the time of its construction, the building was characterized by its spacious architecture. It followed the then modern programmatic concept to unite neurology and psychiatry under one roof. This explains the unusual structure of the building: the front part with the main entrance was reserved for neurology, the building at the rear for psychiatry. The two pavilions in the third row served as spaces for the separation of ‘agitated patients.’ Neurology and psychiatry were connected by a covered corridor divided into two elongated hallways. This division cut through the whole building complex from the front to the back and indicated separation by gender. On the left side, male patients were hospitalized and treated; on the right side, female patients. In addition, an exterior wall around the clinic premises isolated the clinical area from the surrounding grounds of the Charité. On the one hand, this segregation indicates the necessity at the time for security and protection from the ‘lunatics.’ On the other hand, it provided a sheltered clinic garden for the patients where they could move freely. Regarding its building structure the clinic building has remained unchanged to this day. With its overlapping historical and current use of facilities it can be seen and understood according to its patients’ use, but also as the workspace of physicians and scientists both then and now. As an authentic venue it invites us to reflect, for example, on the development of neurology and psychiatry as medical disciplines in regard to changes in dealing with patients. Different to memorial sites, which
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HISTORICAL APPROACHES
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Plans for the substantial renovation of the Charité originating in 1710. Between 1895 and 1917 the typical Charité building ensemble with its red brick stone facades was built. Former outline of the Charité premises with the existing buildings (left), plan for the location of the new buildings from 1895 (right). 1895 | Site plans | from: Die Neubauten der Königlichen Charité in Berlin, in Centralblatt der Bauverwaltung 17 (1897) Nr. 19, p. 206-207 | ZLB | Scan 2008 URN: https://nbn-resolving.de/urn:nbn:de: kobv:109-1-14083778
HISTORICAL APPROACHES
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View into the Radiation Lecture Theatre, 2016. This auditorium formerly belonged to the Second Women’s Clinic located in the Charité; then, after 1945, to the newly erected Tumour and Radiation Clinic. Because of its close proximity to the Berlin Wall, teaching was abandoned therein in 1961. The room was locked and has not been used since. In the future, it is planned to turn it into a visitor centre and a venue for events focusing on themes of the ‘GeDenkOrt.Charité – Science and Social Responsibility’. 2018 | Photography | Radiation Lecture Theatre | Photograph: Wolfgang Chodan.
were established for remembering patient murders in NS times in (former) sanatoria, this clinic is a location for performing current medical science and practice. Patients are examined here, tested and – for short periods – also treated. The clinic was never intended to serve for prolonged hospitalizations. As the case may be, patients were transferred to what were then known as mental homes. Therefore, clinical physicians at this clinic were only indirectly participating in patient murders during NS times. Charité physicians, however, did contribute directly in compulsory sterilizations on the basis of the ‘Law in the Prevention of Hereditary Offspring’ of 1933. They wrote hereditary-biological expertise and acted as assessors to the Hereditary Health Court. The exhibition addresses both aspects extensively. The Psychiatric and Nerve Clinic, located in the centre of the campus Berlin Mitte, is part of the historical Charité site. The whole complex, with its various clinic buildings erected around 1900, is a protected listed venue. Walking through the exhibition, one glimpses through the windows the neighbouring clinics on which the displays reflect. Views onto the delineation of the former Berlin Wall running directly next to the Charité allow an additional sense of historical localization. The close vicinity to the government quarter and other cultural institutions such as the Berlin Museum of Medical History of the Charite, the Berlin Museum of Natural History and the Hamburger Bahnhof, Museum of Contemporary Arts offers further links to the history of the Charité in its significance as one of Berlin’s oldest hospitals and as a prime research institution with a world-wide reputation. A graphical timeline in the exhibition provides specific explanations on this aspect.
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Bust of Robert Rössle. The bronze bust is situated in the Institute of Pathology of the Charité. 2017 | Photography | Portrait bust of Robert Rössle Reproduction | Photograph: Wolfgang Chodan.
Monument base in the foyer of the Psychiatric and Nerve Clinic. 2018 | Photography | Base of the monument for Carl Westphal | Photograph: Wolfgang Chodan.
Busts and bases removed. Note written by the Charité director of administration following the dismantling of the monuments of four scientists on the premises of the Charité, 1940. 1940 | Note | Note written by the Charité director of administration following the dismantling of the four monuments, 29.07.1940 | Reproduction | UA-HUB Sign. Akte Nr. 2744, Bl. 23.
HISTORICAL APPROACHES
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Busts and monuments: Objects of the Charité’s memorial culture For a long time, the Charité has cultivated a specific memorial culture. Following the tradition of scholarly monuments, physicians and scientists in the late 19th century began to honour esteemed teachers and colleagues – mostly at the end of their professional lives – in the form of portrait busts or paintings. Until today, monuments raised both inside and outside of the clinic buildings characterize the campus. As historical objects, however, these artefacts are more than just an aesthetic completion of the scenery. Looking closer they reveal their own history of, for instance, dynastic thinking, aesthetic preferences, interaction between colleagues and forging self-assurance in the academic field. Portrait busts were moved from time to time; some were altered, damaged or even disappeared completely. The Charité honoured a woman for the first time in 1996 with a monument to the physician Rachel Hirsch (1870-1953). During National Socialism, four portrait busts of Jewish scientists became objects of a retrospective ‘cleansing’ at the Charité. One consequence of this anti-Semitic ‘iconoclasm’ is still visible today: in a corner of the foyer of the Psychiatric and Nerve Clinic stands an empty monument base. The bronze bust of the psychiatrist and neurologist Carl Westphal (1833-1890), head of the clinic from 1869 until 1890, which it carried originally, is missing. In 1901, the monument had been placed outside, in front of the main entrance to the Psychiatric and Nerve Clinic, as a counterpart to the still existing monument for Westphal’s predecessor, Wilhelm Griesinger (1817-1868). In 1940, the Charité administration removed both the base and the bust. In the 1980s, the damaged base was rediscovered and placed at its present site in the clinic’s foyer. Explanatory labels convey its history and integrate it into the exhibition. It was an initiative of the director of the Charité Children’s Clinic, Georg Bessau (1884-1944), to remove this bust and three other similar monuments. In 1939 he urged a ‘review’ of the ‘non-Aryan’ origin of his predecessor, Eduard Henoch (1820-1910). Subsequently, the Charité’s head of administration had the monuments for Otto Lubarsch (1860-1933), Ludwig Traube (1818-1876), Carl Westphal and Eduard Henoch dismantled and, two years later, destroyed. In the light of National Socialism, the Charité today faces the question of how to deal with monuments of physicians who had been involved in dubious research at that time. Currently in debate, for example, is the memorialization of Robert Rössle (1876-1956), Director of the Institute of Pathology at the Charité from 1929 until 1949. In 1949, Rössle was awarded the GDR National Prize. In Berlin Buch a clinic and a street were named after him and a memorial bust of Rössle is placed inside the Institute of Pathology. Today, in accord with the current state of research, the actions of Rössle during NS times would not permit the honouring of his name. There are two further scientists after whom streets were named on the historical Charité campus in Berlin Mitte and whose honouring is currently in debate: the psychiatrist Karl Bonhoeffer (1868-1948) and the surgeon Ferdinand Sauerbruch (1875-1951). The exhibition includes information on the actions of these physicians in NS times.
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The Nuremberg Doctors’ Trial: a historical event with consequences The medical profession is obligated to healing. In contradiction to this core aim stands the historical fact that physicians, especially in NS times, harmed and even killed patients and probands. Twenty-three medical professionals and
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During the Nuremberg Doctors’ Trial 1946-7. The neurologist, psychiatrist and psychoanalyst Leo Alexander, expert for the American accusatory authority, with the witness and survivor of concentration camp-based human experiments, Maria Broel Plater (1913-2005), 1946. Alexander had received his MD at the Berlin university in 1927 and had emigrated to the US in 1933. In World War II he served with the US air force. He contributed substantially to formulating the ‘Nuremberg codex’ of medical experiments. 1946 | Photography | The expert Leo Alexander and the witness Maria Broel Plater at the Nuremberg Doctors’ Trial, 20.12.1946 | USHMM | Sign. 81969.
high-ranking healthcare representatives were accused in the Nuremberg Doctors’ Trial in 1946-7 to have been directly, that is, personally or indirectly responsible for such actions. During the trial it became clear that the culprits were not ‘lunatics’ or sadists. In most cases they were top (military) medical representatives frequently teaching as professors at universities. They had gained a reputation as respected experts in their fields with longstanding scientific experience. Seven of the culprits were members of the Berlin Medical Faculty. How could medical crimes such as experiments in concentration camps and patient murders (‘euthanasia’) have occurred? The expert of the accusatory authority at the Nuremberg Doctors’ Trial, Leo Alexander (1905-1985), provided an answer to this question at an early stage of the proceedings. The neurologist, psychiatrist and psychoanalyst carried out extensive interviews with the culprits
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during the process of the court trial. His dictum of 1949, presented as the introductory statement to this exhibition, offers the visitor one attempt at explanation. It serves, simultaneously, as the title of the exhibition: ‘The beginnings at first were merely a subtle shift in emphasis in the basic attitude of the physicians. It started with the acceptance of the attitude, basic in the euthanasia movement, that there is such a thing as life not worthy to be lived. This attitude in its early stages concerned itself merely with the severely and chronically sick. Gradually the sphere of those to be included in this category was enlarged to encompass the socially unproductive, the ideologically unwanted, the racially unwanted and finally all non-Germans. But it is important to realize that the infinitely small wedged-in lever from which this entire trend of mind received its impetus was the attitude toward the nonrehabilitable sick.’ The Nuremberg Doctors’ Trial marked the starting point of dealing more intensively with medicine during National Socialism. While wider historical research of this topic only took off in the 1980s – after a long phase of denial within the medical profession, as well as in the general public – Alexander Mitscherlich (1908-1982) and Fred Mielke (1922-1959) provided a lasting contribution with their trial documentation of 1947. With the ‘Nuremberg Codex’, an establishment of basic medical ethical values, the trial had consequences for the wording of the Professional Code of Physicians in Germany which remains in effect today. Reflecting on physician misconduct, which became apparent during the trial, the ‘Nuremberg Codex’ defined anew, under which conditions research on humans could be exerted in an honourable and reliable way. Its contents – most prominently the claim for gaining an ‘informed consent’ (an informed agreement of the proband) – were accepted as medical ethical principles in the ‘Declaration of Geneva’ by the World Medical Association in 1948 and in the ‘Declaration of Helsinki’ in 1964. The Nuremberg Doctors’ Trial serves as a central event and lead into the exhibition, from which one can look back into what happened in NS times. In addition, it acts as a prompt to reflect on current dangers within modern medicine, since medical science continuously expands its knowledge, including the use of animal testing and studies on humans. The spectrum of diagnostic and therapeutic interventions is ever increasing. Medical actors, therefore, always face the questions anew: how can responsible medical and scientific actions respect human dignity? What is permissible? What is the desired outcome – individually and socially? When and where are the rights of the probands and the patients in danger?
Literature • https://denkmaeler.charite.de • Alexander Mitscherlich, Fred Mielke, Das Diktat der Menschenverachtung, Heidelberg 1947. • Heinz-Peter Schmiedebach, Psychiatrie im Nationalsozialismus an der Charité und in Berlin (Hefte zur Geschichte der Charité – Universitätsmedizin Berlin, 6), Berlin 2018.
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Areas of conflict and aporia in medicine Heinz-Peter Schmiedebach
The subtitle of the exhibition points to the ‘dangers in modern medicine’; in the foyer of the Psychiatric and Nerve Clinic of the Charité, visitors find short texts specifically addressing this topic. They describe areas of conflict and irresolvable contrarieties (aporia), which are inherent in modern medicine and from which health risks arise. Since these issues existed in National Socialism times as well as today, addressing them offers a systematic access to the historical contexts presented in the exhibition. In addition, this may stimulate thinking on current developments in medicine. In the course of the 19th century a modern system of science developed. Medicine as a human life science relied increasingly on (natural) scientific knowledge regarding its methods as well as its objectives. Being part of the modern system of science, medicine since then has been progressively confronted with tensions and structural contradictions generating continuous risks of slipping into medical and scientific practices which would be harmful to people. During National Socialism, external political conditions – as well as the internal constitution of the medical profession – provided sufficient grounds for medical actors to take a one-sided position in following the thinking and aims of selective and ‘eradicating’ politics, which neglected the patient’s wellbeing. These basic areas of conflict and aporia still form – as immanent conditions in medicine – a permanent challenge for any medicine in terms of responsibility, since medicine in modern society cannot, like all science, be shaped and developed independently from politics. Science and politics are not separated systems but form a complex relation of mutual interaction. Although freedom of research concerning political prerequisites and restrictions is crucial for the self-perception of modern science, the relationship between science and politics constitutes, rather, a form of mutual dependency. Mitchell G. Ash has described this entanglement as an exchange of resources. Politics provide science with power and money. Science in return presents politics with expert knowledge to reason, justify and evaluate political actions. Thus, science can also act as a source of legitimation for political activity. This mutual relationship also applies to the human life sciences, which investigate the individual in his or her biosocial conditions. Michel Foucault understood this intertwining of human life sciences and politics as ‘biopolitics’. This term
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AREAS OF CONFLICT AND APORIA IN MEDICINE
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refers to the power strategies which are generated with the help of science. These strategies are not aimed at the individual, but at the population in general or the ‘Volk’, that is, on the regulation of one or more biological parameter in a population, such as steering the birth rate, the age-demographic or the levels of physical and psychological health. With the help of techniques developed by modern sciences, biological processes appear to be controllable to a growing extent. During National Socialism, these biopolitical interactions prevalent in modern societies became effective in a dominant way as it was thought that many social questions could be answered with the help of biological interventions (sterilization, for example). The six areas of conflicts and dangers in medicine, which are addressed below, are on the one hand immanent to medicine itself and its research practice. On the other hand, they also result from the structures of science as a system and its biopolitical interactions.
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The ethical aporia (Toellner) and the collision of duties Medicine pursues the constant improvement of therapies to reduce or eliminate, for instance, the unpleasant or damaging side effects of drugs. In doing so, it relies on human experiments in clinical studies. This has created an ethical aporia, which Richard Toellner has described thus: it is unethical to carry out a therapy which has not been proven scientifically as safe and effective; however, it is also unethical to test the effectivity scientifically, since this testing could cause damage to the proband. The collision of duties is inevitable. The norms of physician and scientific acting either exclude or restrict each other. Since this conflict is irresolvable, special agreements are necessary, such as ethical declarations or bilateral contracts and so on, which cannot abandon the risk of damage completely, but can at least minimize it. Addressing this aporia in teaching and professional acting can contribute to sensitization, which reduces dangers in research and practice. Medical science and destruction There is a universal problem in medicine concerning interventions in therapy: healing is often inseparably connected with the destruction of body tissue. In performing an amputation to save a life, for example, it is not only the amputated extremity which is destroyed, bodily integrity is also affected. In an antibiotic ‘fight’ against aggressive intruders, the application of drugs aims at the destruction of bacteria; necessary microorganisms are frequently killed too. A similar problem features in cancer therapy, when not only carcinomatous cells are hit, but also regular cells which are functionally necessary. In this respect, Viktor von Weizsäcker spoke of an order of destruction in 1933 and 1947. Using metaphors of fighting and war without critical reflexion and implementing such perspectives in a habitual implicitness of medical acting fosters the danger of furthering attitudes towards being accustomed to destruction in its multiple forms of appearance by following an approach to which there seems to be apparently no alternative. To break up this process of familiarization and to raise awareness of alternatives, it would be advantageous if medicine could develop its own regulative measures so that such regulations do not have to be applied to medicine externally (ethics, religion), which might aggravate its acceptance amongst physicians under certain conditions.
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