15 September 2010

Genetic Health Courts in Germany 1933-9

The science of eugenics in the early 20th century was based on a simple principle: If the most disabled citizens in society were not prevented from reproducing their genetic flaws in the next generation, society as a whole would be heavily burdened. This might sound bizarre to modern ears, but in societies where “national health” was allowed to take total precedence over “individual health”, it seemed perfectly acceptable.

A eugenic utopia in the Inter-War period was thought of as providing a very healthy environment for society, maximising the possibility of desirable genetic qualities and minimising the possibility of undesirable genetic qualities. If a eugenically sound society could be achieved, improvement of the social environment would be both inevitable and admirable. And the society would save a fortune in health care costs, at least for those people who needed to be cared for in asylums.

Such a utopia was desired in more than one country. I'll cite just two examples. By the 1930s, more than half the states in the USA had passed laws that authorised the sterilisation of "inmates of mental institutions, persons convicted more than one of sex crimes, those doomed to be feeble-minded by 10 tests, morally degenerate persons and epileptics." Sweden also had eugenics-based legislation enacted in 1934, primarily to prevent mental illness and disease in the general community. It is estimated that c60,000 Swedes were sterilised under the 1934 law, before the law was eventually overturned well after WW2.

But it was German race hygiene that had a more radical vision of a eugenic utopia than other countries, largely because the pre-1933 political climate in Germany was already hospitable to such ideas. Dr Franzblau noted that even before Hitler came to power, there were 23 chairs of racial hygiene in German Universities.
The assumption of power by the Nazis in 1933 made the implementation of eugenic legislation even better accepted. The new German legislation said: “Any person suffering from a hereditary disease may be rendered incapable of procreation by means of surgical sterilisation, if the experience of medical science shows that it is highly probable that his descendants would suffer from some serious physical or mental hereditary defect”.

The poster asked: Who would want to be responsible for these three handicapped children?

At no stage was the German policy anti-natal. The Nazi government paid for top quality research, designed and delivered public education campaigns, and introduced laws that aimed at eliminating alcohol, tobacco and syphilis from young couples. A vast public health scheme was developed and clinics were created to deal with the problems of child and maternal health. Abortion was banned. Getting married and having children wasn't just tolerated; it became a national duty for the racially fit.

More than that, it was emphasised that sterilisation should be seen as national liberation, not as an individual punishment. Advertising campaigns stressed that responsible young couples would naturally want to avoid bringing damaged babies into the world who would cost the state a fortune to sustain.

The German law clearly applied to each and every individual in the entire German population, presumably including members of the Nazi Party and the Hitler Youth! Thus its scope was much larger than the compulsory American sterilisation laws, which were most often applied only to inmates in psychiatric hospitals or prisons. And German practice differed from Swedish practice where, under Swedish law, no sterilisation would be carried out without the consent of the patient, or his/her parents.

There was another important difference. In Germany every undergraduate medical student was taught from films of feeble-minded, drooling and crippled children, and shown many films of sterilisation procedures. This was to familiarise them and involve them in the process, even before their medical careers started. In the USA and Sweden, only specialist practitioners were involved in the decision-making and in the surgical procedures.

Child candidates for compulsory sterilisation, waiting for the court's decision, 1934

A Law for the Prevention of Genetically Diseased Offspring via sterilisation became a German statute in July 1933. It demanded the compulsory sterilisation of any citizen who, in the opinion of a court, suffered from a list of specific disorders: congenital mental deficiency, schizophrenia, manic-depression, hereditary blindness or deafness, severe alcoholism, Huntington’s Chorea or hereditary physical deformities including epilepsy.

As the numbers of potential candidates for sterilisation grew and grew, it was feared that the ordinary court system would be clogged up with sterilisation cases. So a separate, dedicated court was established, to hurry cases through without the hassles of needing a qualified judge, trained lawyers and properly empanelled juries. Instead 200 Genetic Health Courts were established across Germany, with doctors inspecting the medical evidence and giving the final verdict. In total, these Genetic Health Courts ordered the compulsory sterilisation of just under 400,000 German children, teenagers and adults by the time war broke out in late 1939.

If the court decided that the person in question was to be sterilised, the decision could be appealed to a Higher Genetic Health Court where doctors and not judges also made all legally binding decisions. If the appeal failed, the sterilisation was to be carried out, with "the use of force being permissible".

One later amendment (1935) was very telling; it fined physicians who did not report patients who the doctors KNEW would qualify for sterilisation under the law. Teachers and kindergarten staff were encouraged to report their pupils for sterilisation, but were not fined if they failed to do so.

The UK tv series on Nazi Doctors (Oct 2009) reported three main outcomes, albeit unintended, that blighted The Genetic Health Courts programme:

1. The post-operative mortality and morbidity rates were higher than expected and were largely not reported. Bachrach recorded that as many as 5,000 patients died as a result of the surgery, most of them women.

2. The post-operative damage to the patients’ psychological health was much greater. This was true for all patients, of course. It was even more so for otherwise perfectly healthy people who would have loved to have had children, but were sterilised for a trivial reason eg distorted toes. Recently I saw the evidence given by elderly men and women who, sterilised in the 1930s, had been grief stricken all their lives.

3. The reputation of doctors was accidentally destroyed. They changed from being seen as healers to being seen as policemen, judges and punishment-inflicters. Families no longer trusted their own doctors, if and when their children became ill with ordinary childhood diseases.

I personally would add another important outcome. Even within the moral context of the 1930s science of eugenics, terrible decisions were made by the Genetic Health Courts. Either knowledge of genetics was not yet adequate, or it was adequate but political policy-makers overrode the medical decisions. Many people were forcibly sterilised for conditions that we (now) know are not genetically based. And as the programme didn’t continue for enough decades, I also wonder if the geneticists had any idea about how recessive genes could skip generations.

Read Susan Bachrach “In the Name of Public Health: Nazi Racial Hygiene”, in New England Journal of Medicine, 29th July 2004. And see Science and the Swastika 2001,  an analysis of science and morality during the Third Reich, especially (for the purpose of this post) the practice of eugenics and euthanasia.


Anonymous said...

Obviously I don't support forced sterilization but it is worth pointing out that the issue of recessive genes is irrelevant. Even if the program only lasted short while the racial health of the nation would be improved by reducing the incidence of harmful genes (i.e., when recessive genes were expressed).

Hels said...

Thanks Anon. Good point. Although we don't believe in forced sterilisation now, there was a long time when serious scientists in most sophisticated nations believed that eugenics was a perfectly valid science.

Even so, the Genetic Health Courts made terrible errors. Even if you discount the problem of recessive genes not being visible for a couple of generations, people were sterilised for reasons that didn't always fit within the strictly limited list of diseases. And today, the list itself (congenital mental deficiency, schizophrenia, manic-depression, hereditary blindness or deafness, severe alcoholism, Huntington’s Chorea or hereditary physical deformities including epilepsy) looks highly suspect, from a hereditary point. of view.

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the foto fanatic said...

Human beings must be remarkably resilient, given what we have done to each other over millennia based on flawed beliefs and intolerance of differences.

ChrisJ said...

Now that the human genome project is done, probably none of us should be surprised to find ourselves on some or other list of "undesirables."

The world of perfection would be empty, except for the "perfection" of those in power.

Hermes said...

It wasn't just Germany of course, both the UK and USA had active societies - based on a sort of social Darwinism.

Hels said...

Photo, Chris and Hermes, thanks for all your comments.

I really would have understood the concerns of the various eugenics societies, had I lived during the first decades of the century. Everybody wants to give birth to healthy children who will be able to take their place in normal adult society.

Specifically my problems with the Genetic Health Courts in Germany from 1933-39 are:
1. The Nazis banned abortion, making motherhood compulsory, whether women wanted more babies or not.
2. Smoking, drinking and VD were indeed very destructive, but there are better ways of dealing with these problems
3. In the so-called courts, there was no criminal charge, no lawyers to defend the "patients", no judges to hear the evidence, and no appeal to a higher judge.
4. Voluntary sterilisation would be one thing; enforced sterilisation was a nightmare.
5. The doctors' knowledge about inherited disease states was not great, but the results couldn't be undone if they discovered that mistakes had been made.
6. Medicine became a tainted and politicised profession. Nobody wanted to allow their beloved children near a doctor, even if the children really did need medical care. And who can blame them.

An ideal for a healthy, caring society turned into a nightmare.

Mandy Southgate said...

Wow. What a fascinating article. I remember learning abut Eugenics in varsity but we were always taught that it was quackery. I did not realise the extent to which it was given creedance atthe time and passed into law.

Hels said...

Emm, *nod*
lots of nations brought in eugenic laws, each national programme taking a different legislative form: USA, Japan, China, Sweden, Norway, Germany etc. Finland, Denmark, Estonia, Iceland and Switzerland also had eugenics legislation, but I don't know the details of their laws at all.

And within each nation, there could be differences between the counties. In Canada, for example, only two provinces passed the Sexual Sterilisation Act: Alberta and British Columbia.

The use of sterilisation, especially mandatory sterilisation, was not necessarily a part of eugenics. I can imagine some nations simply keeping People With Harmful Genes away from marriage and reproduction (how? lock them up?). Or these days, testing every pregnancy for harmful genes and aborting only foetuses with catastrophic conditions.

Just as an aside, I wonder what Catholic countries did, instead of introducing eugenic legislation that would have been unacceptable to church teachings.

John Hopper said...

I suppose it just goes to show that a frightening combination of the sketchy use of science by politicians and the need to gain political and social control of a population is still with us today, whether that be the fight against obesity or eugenics.

P. M. Doolan said...

You are right to say that the Nazis banned abortion - but with an obvious exception. Abortion for non-Ayran women i.e. Jews and roma was not banned. Indeed the nazis encouraged abortions among the Jewish population and by 1938 had lifted all restrictions.

Hels said...

Mr Doolan, correct!

I think the Genetic Health Courts, the scientists and the doctors were only interested in the good genetic health of the German people. What non-citizens did was of little interest to them.

Hels said...


You may have seen the series called "Science and The Swastica" ten years ago. I have added it to the post now because of the two reasons you alluded to:
1. the sketchy use of science by politicians and, I would add, by doctors and
2. the need to gain political and social control of a population.

The film shows views that are in some ways VERY dated. But in some ways, the thinking is common today.