[Pages 87-103]

When euthanasia was introduced, we welcomed it, because it was based on the ethical principle of sympathy and had humane considerations in its favour, of the same sort that the opponents of euthanasia claim for their own ideas. – Victor Brack[472] The handicapped and the mentally ill] were not killed for mercy. They were killed because they could no longer manufacture guns in return for the food they consumed; because beds in the German hospitals were needed for wounded soldiers; because their death was the ultimate logic of the National Socialist doctrine of promoting racial superiority and the survival of the physically fit. – Michael Straight[473] The tragedy is that the psychiatrists did not have to have an order. They acted on their own. They were not carrying out a death sentence pronounced by someone else. They were the legislators who laid down the rules for deciding who was to die; they were the administrators who worked out the procedures, provided the patients and places, and decided the methods of killing; they pronounced a sentence of life or death in every individual case; they were the executioners who carried out or - without being coerced to do so - surrendered their patients to be killed in other institutions; they supervised and often watched the slow deaths. – Fredric Wertham[474]

The formal commencement of the killing programme is generally considered to have been a meeting at the KdF on 9 October 1939 to initiate the registration of the inmates of all mental hospitals. Those present included Viktor Brack, Werner Blankenburg, Hans Hefelmannn, and Reinhold Vorberg.^[475] After operating from a number of different addresses, including the Columbus-Haus on Potsdamer Platz, a permanent headquarters for the new organization was established at Tiergartenstrasse 4 in Berlin in April 1940.^[476] The organization's code name, T4, was taken from this address. The premises, having been confiscated from their Jewish owners, were rented by the KdF under the name of the “Reich Work Group of Sanatoria and Nursing Homes” (Reichsarbeitsgemeinschaft Heil - und Pflegeanstalten: aka RAG). Other dummy organisations were set up under seemingly innocuous titles – the “Charitable Foundation for Institutional Care” (Gemeinnützige Stiftung für Anstaltspflege: aka Stiftung ), the “Charitable Society for the Transportation of the Sick Limited” (Gemeinnütziger Krankentransport GmbH: aka Gekrat), and the “Central Compensation Office for Sanatoria and Nursing Homes” (Zentralverrechnungsstelle Heil- und Pflegeanstalten: aka ZVST). These names were all intended to camouflage the true purpose of the plan.^[477] Despite the supposed secrecy, it should not be thought that T4 operated in a vacuum. The active co-operation of a number of different government departments and agencies was necessary for the new organization to function smoothly, in particular the Ministry of the Interior and its Department for the People's Health.^[478]

There was never an agreed division of authority between Bouhler and Brandt as the joint heads of T4. In fact, the “euthanasia” Aktion never had a clear cut modus operandi, as such. Not surprisingly, since the murder of the incapacitated had never been envisaged on this industrialized scale before, much was decided “on the hoof” as the programme progressed.^[479] In theory, Bouhler's principal role was the management and organisation of T4's affairs, but in practice the day-to-day administration of the operation was delegated to Hauptamt II (Main Office II) of the KdF, headed by Viktor Brack. It was the responsible agency for all aspects of the “euthanasia” and subsequent Aktion Reinhard policies.^[480] Brack's deputy was Werner Blankenburg; Hans Hefelmannn and Richard von Hegener, both suitably unqualified to occupy their positions, were the T4 executives responsible for children's “euthanasia”. Bouhler only participated when his authority was needed to intercede or negotiate with other branches of government. Apart from functioning as a link between T4 and the medical profession, it was Brandt's job to act as a conduit between Bouhler and Hitler and to keep Hitler informed “about medical matters which arose, or advise him (on medical matters) if these remained unclear to him.”^[481] Although nominally joint head of T4, Brandt was far too busy to become closely involved with the humdrum details of the organisation's activities. He was still Hitler's escort physician, accompanying the Führer on his travels, and there was his own surgical activity to occupy him. If Brandt was interested in matters such as the financing of T4 or the choice of killing centres, he disguised it well. It appears that he was happy to rely upon Bouhler to keep him informed of developments.^[482] For his part, Bouhler was prepared to leave the actual management of T4's affairs to Brack and his cohorts. Much like their master, it could be said that Bouhler and Brack only involved themselves in the “big” decisions; everything else could be left to others, although this in no way absolved either of them (or their master) from responsibility for T4's actions.

Martin Bormann was never directly involved in “euthanasia” matters. At the KdF it was considered that if he were, “euthanasia would not stop at mental patients.” Bormann was less than happy at being kept outside the inner circle of managers responsible for the programme, especially since his brother Albert worked for the KdF. In fact, all the KdF head office staff involved in “euthanasia” had other work commitments; they took the job on in addition to these other employments. Despite these distractions, the T4 personnel managed to remain thoroughly devoted to the business of murder.^[483] After they had been vetted by Brandt, Bouhler would arrange for new doctors to be signed up to carry out the actual killings. Since Brandt was responsible for all medical matters, it was he who also decided upon the appointment of the expert referees the programme required, as well as the killing method to be used.^[484] Most senior personnel were between thirty and forty years of age.^[485]There was no coercion so far as recruitment for the project was concerned. Individuals were simply asked if they were prepared to participate. Doctors were never ordered to kill psychiatric patients and handicapped children. Even assuming the broadest interpretation of Hitler's “euthanasia” dispensation, it was not a directive to kill, but simply empowered doctors to do so in “appropriate” circumstances.^[486] This was a question of choice, not command. However, all participants were required to confirm their understanding of the need to maintain absolute confidentiality. A number were informed that a “euthanasia” law existed, but could not be shown to them for the same reasons of secrecy. How many believed in the existence of such legislation (or wanted to believe it) is a matter of conjecture. Two documents discovered after the war at the Eglfing-Haar Hospital clearly indicate the nature of the oath to which accomplices (in this case nurses) were required to swear:

Obligation: To the Director of the Cure and Care Institute, Eglfing-Haar, Obermedizinalrat, Dr. Pfannmüller.

I have been informed about the nature of my activity and my duties in the special department of the children's house of the Cure and Care Institute, Eglfing-Haar, where children of the [Reich] Committee for Scientific Approach to severe illness due to heredity and constitution are housed. I undertake to carry out my duties in this department according to the directions of my chief and I confirm that my attention has been called to the fact that the treatment of these children in this department is a matter of the [Reich] which has to be kept absolutely secret. I have been instructed that I have to keep strictest silence concerning all happenings of which I should become aware during the treatment of these children, and that any breach of this silence on my part will warrant the death penalty. I have given my word to maintain strictest silence and I shall adhere to this at all times and toward all people.

Eglfing 26 April 1941.

The second, similar document required the signature of a clerk, who was presumably not directly involved in the killing:

Obligation: I, the undersigned, have been obligated by handshake instead of by an oath, on the part of the director, to receive and to copy matters concerning the [Reich] which have to be kept secret. Such papers are of a special confidential nature. I herewith undertake to keep all papers which should become known to me under the heading “secret [Reich] matter” strictly secret, and never to give anyone knowledge of them without [a] specific order from the director of the institution, Dr. Pfannmüller. My attention has been called to the fact that if I should not keep this oath of secrecy, I will face penal prosecution by the Gestapo, and that I will have to count with the possibility of the death penalty if I should either carelessly or deliberately divulge matters which have become known to me as “secret [Reich] matters.^[487]

To a large degree, nepotism and personal contacts dictated recruitment to T4, with few of those approached declining an invitation to become involved. It was possible to refuse to participate, or to end one's participation, as some did. So far as is known, nobody was executed or sent to a concentration camp for declining to become a participant, or as a result of ceasing their involvement. Careers were not blighted as a consequence of such action.

All the non-medical T4 staff were initially interviewed by Brack or Blankenburg^[488]. The recruitment of Dieter Allers was typical of many. Conscripted by the Wehrmacht in 1939, Allers, a young lawyer, was posted to Poland. Blankenburg (an old SA comrade of Allers) met Allers' mother in the street one day in November 1940.^[489] On being informed by Aller's mother that her son was in the army, Blankenburg immediately offered him a job at the KdF and arranged for his discharge. In January 1941 Brack appointed Allers (in effect) managing director of T4.^[490] In a speech made by Brack to a conference on 23 April 1941, the parameters for participation in “euthanasia” were set out. “Find men with courage to implement”, and “nerves to endure”, Brack pronounced^[491]. The purpose of this meeting, organized by Brack and Werner Heyde, was to confirm to the leaders of the legal profession the existence of the “euthanasia” programme and to persuade them of its legality. There was no problem in convincing the assembly of lawyers, who willingly accepted that “every existing legal norm” was to be executed “according to the wishes of the Führer.”^[492] This unqualified endorsement of despotism simply confirmed that those functioning at any level within the programme shared an enthusiastic, sometimes fanatical belief in Nazi ideology, and a complete lack of any moral or ethical principles. It might be suggested that the two go hand in hand.

The majority of lower echelon staff recruited to the programme appear to have been of average intelligence. They had received a basic education, and lacked the talent, ambition, or desire to become members of the SS or the police. Their personal records and, where available, their post-war testimony, seem to indicate that they were surprised at being appointed to T4, although care should be taken in evaluating the evidence supplied personally by any of these functionaries. None had applied to join; they were ordered to do so and had no idea why, nor what they would be doing. They did not possess any immediately obvious murderous attributes; however, it may be supposed that those who chose them had excellent grounds for doing so. Most of these “ordinary men” were initially employed by T4 at jobs such as doormen, telephone operators or general handymen, and were gradually introduced into the actual killing process. There were, of course, exceptions to whom that killing came naturally, but in general the KdF, through Christian Wirth, bred a team of specialist murderers who could kill without any misgivings or, if they were concerned, managed to overcome their scruples and continued to kill anyway. The later dedicated slaughterers of European Jewry came predominantly from this “euthanasia” team of nondescript individuals in commonplace pre-T4 employment: chefs, carpenters, drivers, plumbers, photographers, and nurses.^[493] T4, and subsequently Aktion Reinhard, were the catalysts that transformed them into a collection of brutal and insensitive murderers and provided them with a status and a degree of power they could never have otherwise have hoped to attain. Neither should the financial benefits that they enjoyed, both in terms of salary and of theft, be overlooked, nor the considerable advantage of avoiding front-line military duty.

As already mentioned, whilst given its self-serving nature it is always wise to approach any perpetrator testimony with a healthy degree of scepticism, Franz Stangl, later to become commandant of the death camps at Sobibor and Treblinka, provided some ostensibly plausible details concerning his recruitment to T4. He claimed to have received an order in November 1940, signed by Himmler, to report to the Stiftung (T4) in Berlin. Stangl was then a member of the Linz Gestapo. The motive he provided for his eventual willingness to transfer (conflict with a senior officer), appears improbable, and it seems reasonable to assume that he was selected by his superiors for good, if unknown, reasons. He had probably been an undercover member of the illegal pre-Anschluss Austrian Nazi party, and had rendered useful service; he was certainly not a man who was likely to disobey an order. In Berlin he was interviewed by Kriminalrat Paul Werner (an SS member who was also a fully certified detective), who explained that both Russia and America had a law permitting euthanasia for people who were “hopelessly insane or monstrously deformed.” It was now proposed that such a law was to be passed in Germany, but only very slowly after a great deal of “psychological preparation.” In the meantime, the “euthanasia” programme had already secretly begun. Although Stangl claimed to be horrified at this revelation, his sensibilities were soothed by the assertion that merely being asked to become involved in this operation was proof of the exceptional trust others had in him. Besides, all the killing would be done by doctors and nurses; he would only be responsible for law and order. The purportedly humanitarian Stangl - he claimed to have been reassured by Werner's comments concerning the intended careful medical vetting of patients, as well as the State's general concern for the wellbeing of the population and the fact that there was already a Russian and American euthanasia law in existence - then reported to Brack at Tiergartenstrasse 4. There he was instructed as to his specific duties and eventually posted to Hartheim.^[494] Allers confirmed that Stangl's job at Hartheim was the issuing of death certificates.^[495]

Even before the issue of the edict, the killing of Polish patients had begun in what were to become the incorporated territories of Danzig-West Prussia and the Warthegau, as well as that of German patients in Pomerania^[496] and East Prussia. When the Lauenberg mental hospital was dissolved in January 1940, the patients were transferred to another institution at Kosten, where they were housed overnight in an empty room. The following morning, as the nurses from Lauenberg who had accompanied the patients on their journey left, they saw soldiers in grey uniforms entering the hospital grounds. On waving to the soldiers, one nurse was invited to stay behind. She declined, replying that if she did she would be shot. Because they were so close to the Russian front, the nurse had been jokingly referring to the possibility of being caught up in any fighting, but when the party reached the railway station a military official asked to see the nurse who had spoken of shootings. She was only freed with great difficulty from what was in all probability a life-threatening situation by the intervention of the accompanying doctor and the senior nurse.^[497] The fate of the patients may be imagined.

The units involved in these early killings were the Wachsturmbann Eimann (Eimann commando), Einsatzkommando 16 and the Selbstschutz (a paramilitary organization of Volksdeutsche). On 22 September 1939, the Eimann commando began killing Polish patients in the mental hospital at Kocborowo, south of Danzig (Gdansk). In the following months, thousands of Polish mental patients from a number of mental hospitals were killed.^[498] Initially all executions had been by shooting, but in October, Dr Albert Widmann, chief chemist of the Kripo (Criminal Police) suggested the use of bottled carbon monoxide as a killing agent. In his post-war testimony, Widmann stated that he had been approached by Arthur Nebe, head of the Kripo, and asked if Widmann's department could supply large quantities of poison. When Widmann enquired: “To kill people?” Nebe replied, “No, to kill animals in human form, that is to say the mentally ill.”^[499] If true, it was a typically callous and cynical Nazi response. The first gas chambers were already being constructed at Grafeneck and Brandenburg in late November, by which time gassing experiments on mental patients utilizing both carbon monoxide and an agent similar to Zyklon B had already taken place at Fort VII in Posen (Poznan.)

By January 1940, Polish patients were being gassed, not in stationary gas chambers, but in mobile gas vans; bottled carbon monoxide was introduced into a sealed compartment at the rear of the vehicle. The first of these vans was operated by a commando headed by Herbert Lange, formerly the chief of staff of Naumann's Einsatzgruppe VI. Lange graduated from this relatively small-scale murder operation to become the first commandant of the Chelmno death camp.^[500]Throughout the last months of 1939 and the first months of 1940, Lange's commando travelled around the Warthegau in a van bearing a sign advertising Kaiser's Kaffeegeschäft (“Kaiser's Coffee Company”). The commando also journeyed to East Prussia, where in a period of less than three weeks more than 1,800 German and Polish patients were gassed, among them 1,558 victims from the surrounding region killed at Soldau between 21 May and 6 June 1940.^[501] It has been estimated that a total of 7,700 sick and handicapped patients fell victim to this early, experimental killing phase, in which up to seventy patients received a tranquilizing injection of morphine-scopolamine before being loaded into the gassing van.^[502] In total, between 1939 and 1944, a total of approximately 12,850 Polish psychiatric patients were killed.^[503]Following the invasion of the former Soviet Union in 1941, thousands of mentally ill patients were murdered in places such as Riga, Dvinsk, Aglona, Poltava, Mogilev, Kiev, and elsewhere. Both members of Einsatzgruppen and individual physicians participated in the killing.^[504] To quote a single example, Einsatzgruppe A shot 748 asylum inmates in Lithuania and Northern Russia since the patients had neither guards, nurses, nor food, and were considered a “danger to security.”^[505]

Lodz, now renamed Litzmannstadt after a First World War German general who had won a 1914 victory in the region, had been incorporated into the Reich as the principal city of the Warthegau. In March 1940, 40 Jewish patients were removed from the Lodz ghetto mental hospital and murdered in a nearby forest.^[506]A little more than a year later, a commission consisting of two German doctors and the head of the Lodz Judenrat, Chaim Rumkowski, visited the hospital again and compiled a list of some 72 patients, 12 of whom, it was claimed, had been cured. In fact it was agreed that five of the patients could be released. The remaining 67 men and women were first sedated with scopolamine injections, then on 29 July 1941 transferred in two batches to the forest for execution.^[507] It seems clear that these patients were murdered under the umbrella of the “euthanasia” programme, although by July 1941 the fact that they were Jewish was enough of itself to condemn them. Curious then, that it was felt necessary to go through the process of a medical inspection, and even more curious that five potential victims were spared and allowed to return to their home.

During the first two years of the war, the “euthanasia” programme in the Reich entered four distinctive but overlapping phases, relating sequentially to the killing of infants, adults, institutionalised Jews and concentration camp prisoners. Although during the first phase young mentally ill patients were gassed together with adults,^[508] 31 special wards were very quickly established in hospitals throughout the country^[509] for the murder of children.^[510] In time, this programme was extended from infants to older children, and in some cases even to teenagers. As is true of so many aspects of Nazi mass murder, it is impossible to be completely accurate regarding numbers of victims unless the perpetrators chose to record details of their activities and those records are still extant. Not all bodies of children were immediately cremated. As was to occur with adult victims, autopsies were sometimes conducted on children's corpses in the interests of “science” by doctors attempting to find causes for a child's disability. Autopsy activities of this kind on both adults and children provided experience for novice surgeons, who often received academic credit for their efforts.^[511]

It has been estimated that by the end of the war at least 6,000 children had been killed. The actual figure is almost certainly higher.^[512] In general, children were killed either by overdoses of medication, starvation, or a combination of the two. In the so-called “Luminal treatment” the sedative drug, sometimes mixed with Veronal, was administered orally, by injection, or rectally by enema. In some hospitals morphine-scopolamine was the killing agent of choice.^[513] The consequences of the “Luminal treatment ” were described in the following somewhat understated terms at the trial of Dr Fritz Kühnke:

During the deep sleep brought on by Luminal, the respiration of the patients became weaker and weaker. As a consequence of the continuous insufficient breathing, regularly, after two to five days of unconsciousness, an acute pneumonia developed itself, which again no longer caused any discomfort (or even pain) to the patients, who were fast asleep. For carefully considered reasons, this pneumonia, caused intentionally, was not medically treated, as it was not intended to be cured. On the contrary: according to the previously calculated plan, it should develop even further. For this reason it was deliberately not treated. Thus, the pneumonia developed in individual cases as desired and soon caused the pre-calculated and intended death.

Methods were frequently not quite so humane. At the Kaufbeuren asylum, a 14 year-old boy suffering no major mental or physical handicap, but knowing he had been singled out for killing, handed a photograph of himself inscribed “In Remembrance” to a nurse. The boy refused to drink his Luminal laced coffee. The drug was added to the boy's food; he refused to eat it. Then he was told he was suspected of having typhoid fever, and must receive an injection. When Luminal tablets were forced upon him, he spat them out. Finally the boy was held down by two men while a nurse injected him with morphia-scopolamine. The next day the boy was dead.^[514]

Ludwig Lehner, a visitor to the Reich Committee mental hospital at Eglfing-Haar, near Munich described the cynicism with which the director, Dr Hermann Pfannmüller, boasted of his system, openly admitting that among the children to be murdered were some who were not mentally ill. They were simply the children of Jewish parents.^[515] “No Jews are allowed in my institution!” Pfannmüller proudly declared. His technique was simple. Rations were gradually reduced and consisted of nothing other than vegetables boiled in water – no bread, fats, meat or carbohydrates. For adults, a slow lingering death would occur in about three months. The starvation process could be accelerated by mixing overdoses of sedatives in the inadequate food, or by lethal injections. It required much less time to kill children. Sometimes through starvation, latterly through overdoses of luminal or injections of morphine and scopolamine, they usually died in anything from three days to three weeks^[516] Nor was Pfannmüller alone in practising such methods, for the directors of other asylums were quick to take up what its creator, Valentin Faltlhauser of Kaufbeuren-Irsee, dubbed the Sonderkost or `E-Kost' diet.^[517]

Perhaps nothing illustrates the callous inhumanity of the children's “euthanasia” programme better than the case described by Götz Aly. Charlotte P., the wife of an SD officer found guilty of murder and rape by an SS court (for which he received a sentence of ten years imprisonment!), communicated with Himmler in order to thank him for his help in mitigating her husband's sentence. At the same time she took the opportunity to write of her four-year-old son: “He suffers from the effects of a severe cerebral infection. The doctors, especially Professor Bamberger at the university clinic, whom I visited at the recommendation of Gauleiter Erich Koch, are of the opinion that his illness is incurable. I hope, however, that I will be able to give my seriously-ill child significant relief one day.” Nine days later Koch wrote to Himmler: “I spoke quite openly with Frau P. about the case. She would be grateful if the child could be brought to one of your clinics and freed from his suffering.” Himmler responded immediately and passed the request to the KdF. Condemned by his own mother, Rudiger P. became one of the many victims of children's “euthanasia”.^[518]

The strategy for adult “euthanasia” was much more comprehensive than that which had been in place for children. The children's “euthanasia” three-man team of referees was expanded to encompass the new criteria through the willing recruitment of a number of eminent academics and asylum directors (Gutachter). The Interior Ministry had issued another decree on 21 September 1939, requiring medical facilities to complete questionnaires (Meldebogen) in respect of all patients who (a) suffered from an extensive list of medical conditions and were unable to work; or (b) had been institutionalized for more than five years; or (c) had been committed as criminally insane: or (d) were non-“Aryan”. As had been the case with children, whether or not an individual was to be condemned was initially decided by a panel of physicians.^[519] To overcome suspected “sabotage” of the system and a reluctance on the part of some doctors to complete the Meldebogen, T4 also employed roving “Doctors' Committees” (Ärztekommissionen) whose job it was to visit institutions and carry out instant selections.^[520] These committees were often hardly scientific. Dr Rudolph Boeckh, head physician of the asylum at Neuendettelsau, protested at the manner in which the medical commission had behaved at his establishment: “The commission did not examine one single patient out of the 1,800 concerned…They merely questioned the nursing staff, whose opinions were recorded on the forms…Cases were observed in which the opposite of the staff member's true statement was recorded on the questionnaire.”^[521] Others were prouder of their contribution. As a referee, Dr Josef Artur Schreck boasted of having conscientiously completed 15,000 forms within little more than a nine month period.^[522]Schreck sentenced about 8,000 of these patients to death.^[523] Paul Nitsche's “Doctor's Committee” registered over 900 patients in a single day, 843 of whom were subsequently gassed at Hadamar.^[524]

Not all doctors were prepared to become part of the nefarious plan, although there was often a disquieting acceptance of the principle involved. When approached to become head of the children's “euthanasia” programme at Eglfing-Haar by the aforementioned Pfannmüller, Dr Friedrich Hölzel declined, writing: “It is one thing to approve of measures of the state with full conviction, and another to carry them out oneself in their final consequences. I am reminded of the difference which exists between a judge and an executioner.”^[525] But in general, the medical establishment was deeply implicated in the “euthanasia” programme, and many were indeed content to become willing executioners. Heinrich Bunke gave the following explanation for accepting the invitation to join T4 as a physician : “It provided the opportunity to collaborate with experienced professors, to do scientific work, and to complete my education [Ausbildung].”^[526]

One notable exception to this overwhelming complicity in murder should be noted. Heinrich Hermann, the Swiss born warden of the Wilhelmsdorf asylum for deaf mutes, wrote to his superior in August 1940:

I know the aim of this planned registration…I am simply convinced that the authorities are doing wrong in killing certain patients…by exterminating such a patient, or a member of the family or the asylum who is simply abnormal, we are acting against God's will…I am sorry, but we must obey God more than human beings. I am prepared to accept the consequences of my disobedience.^[527]

Men of principle, like Hermann, were fighting a losing battle. By the late 1930s, both the regional health departments as well as the office of general administrator at most psychiatric institutions had been taken over by Party officials, who used their political affiliation to browbeat those who remained non-political. The non-medical middle managers, often recruited from the police, were motivated by personal considerations of advancement and ideological commitment; they were the arbiters of life and death.^[528]

In total, some 200,000 Meldebogen were returned to T4 from various institutions. Tragically, some doctors interpreted the forms as an attempt to register suitably qualified patients for employment in the armaments industry. Hoping to save relatively healthy individuals from labour for which they were mentally unsuited, these doctors exaggerated the patient's disabilities, thereby unknowingly condemning them to death.^[529] Asylum patients with criminal records became doubly at risk as medical and sociological criteria were combined, with inmates of mental institutions held in preventive detention among the earliest victims of “euthanasia.”^[530] In late 1939, Dr Wilhelm Bender of the asylum at Berlin-Buch complained to the Main Health Office (Hauptgesundheitsamt - HGA) concerning the 100 criminals who were in his institution; they were both uncooperative and expensive to care for. “I request that you consider whether the institution could be freed of the unnecessary burden of these people,” he wrote. The Health Office procrastinated, but Bender found another way of resolving his problem. In June 1940 he wrote again to the HGA; there was no need to pursue the matter further, “since we can assume that it will be taken care of in the course of measures arranged by the Minister of the Interior for the methodical economization of the psychiatric institutions.”^[531] “Methodical economization” was coded language for “euthanasia”.

Upon receipt, the forms were distributed to the Gutachter, who were instructed by Brack to assess the cases in the harshest terms. If there was any doubt, the patient was to be registered for killing.^[532] When returned to Berlin, the Meldebogen were dispatched to the senior evaluators, the Obergutachter. Initially, there was only one such higher-ranking expert, Herbert Linden, head of the health department in the Ministry of the Interior. Although a doctor of medicine Linden was no psychiatrist, but that did not prevent him from assuming the responsibility for deciding matters of survival or quietus. He was only too eager to ensure that Brack's instructions were followed to the letter, even when he was himself no longer an Obergutachter. In a letter dated 26 July 1940 to the Oberpräsident of Hanover, who had queried the parameters to be applied when determining a patient's capacity for labour (those only capable of “mechanical work” were much more likely to be killed), Linden stated:

Regarding the general instructions as to how the questionnaires are to be filled in…I cannot agree to your proposed limitations on the notion of mechanical work. Too many rather than too few patients should be registered. Selection is to be made according to standard criteria. In case of doubt, the extent of the incapacity to work should be noted, this being a factor of great importance.^[533]

Werner Heyde quickly joined Linden, who after six months was succeeded by Paul Nitsche. There were thus never more than two Obergutachter to sit in judgement of more than 200,000 patients, over 70,000 of whom were gassed.^[534]

Unlike the children, who had been murdered in the main by lethal doses of medication or starvation, the much greater number of adults to be liquidated demanded a more efficient killing system. At Christmas 1939, Brack met with SS-Oberscharführer August Becker of the RSHA^[535] and explained to him that it was proposed to institute an adult “euthanasia” programme.^[536] After a variety of options had been considered, those responsible arrived at a suitably cheap and efficient method. Dr Richard von Hegener, chairman of the “Real Committee for the Scientific Approach to Severe Illness caused by Heredity and Constitution” and a member of the KdF testified:

Originally the killing of single incurable persons ... by injections or an overdose of sleeping pills was proposed. But this possibility ... was considered impracticable from the technical point of view ..., by the majority of the consulted doctors. Therefore it was proposed ... to kill the selected persons by some method simultaneously in a bigger group. After many consultations ... and having heard the chemist of the Reichskriminalpolizeiamt, it was decided to install a room in a number of conveniently located sanatoriums. The room would be filled with carbon monoxide gas...^[537]

Karl Brandt, the man charged with the responsibility for deciding such matters, was not initially enthusiastic about the use of carbon monoxide gas. It was not the “medical” solution he was looking for:

In my mind coal oxide [carbon monoxide] had never been an instrument of medicine. I myself had learned about it a few years ago and had experienced a little coal oxide poisoning when I was in a room where there was something wrong with the stove. Then I remembered that at that time when I went to the door, I had fallen out of the room without feeling anything and had simply passed out. So on reflection I thought that coal oxide death might be the most humane form of death. I did not come to this conclusion quickly, because it was clear to me that the moment I accepted this idea I would be bringing into being a wholly new medical concept. I thought very hard and earnestly about all this, in order to put my own conscience at rest.^[538]

Despite his earlier reservations, in time Brandt became inordinately proud of his contribution to mass murder: “This is just one case of a major leap being made in medical history,” he told his post-war interrogators.^[539]

With Brandt's conscience salved, and utilising Albert Widmann's expert advice as well as the experience gained at Posen, it was decided to employ bottled carbon monoxide in stationary gas chambers situated in six isolated killing centres – Grafeneck (operational January 1940 – December 1940), Brandenburg (January 1940 – September 1940), Bernburg (November 1940 – April 1943), Hadamar (January 1941 – August 1941), Hartheim (May 1940 –December 1944) and Pirna-Sonnenstein (June 1940 – September 1942).^[540] Only four of these sites were functioning at any given time. Each killing centre was assigned a code that was to be used in all telephone conversations and written communications with the T4 central offices: “A” was assigned to Grafeneck, “B” to Brandenburg, “C” to Hartheim, “D” to Sonnenstein, “Be” to Bernburg and “E” to Hadamar.

A report discovered after the war at Hartheim provided a total number of 70,273 victims for the six killing centres from inception to the issue of the so-called “stop” order in August 1941.^[541] This figure may be conservative. After a meeting with Bouhler on 31 January 1941, Goebbels noted in his diary: “Discussed with Bouhler the quiet liquidation of the mentally ill. 80,000 are gone. 60,000 still have to disappear.” It is certain that by then the programme had become more ambitious in scope. Following consultations between Brandt and Bouhler, it seems likely that the targeted number of victims had now been doubled.^[542] When the “stop” order was issued there were still hundreds of patients waiting in transit institutions for transportation to killing centres, which appears to indicate that the programme's objectives had by no means been achieved.^[543]

Within each of the killing centres two positions were paramount. The first, the physician-in-chief, was the individual responsible for the actual gassing of victims, the maintenance of their medical records and the decision regarding their supposed cause of death. He also served to maintain the pretence that the institution was just another hospital so far as outsiders were concerned. The second, the administrative supervisor, had responsibilities which included the security and documentation of the operation, and the efficient functioning of an incident-free killing procedure. At different times, and in different centres, either one of these individuals could be the dominant figure in the establishment's activities.^[544] Both types will be encountered in due course.

August Becker, who was a chemist by profession, collected the material necessary to conduct an experimental gassing at the former Brandenburg-Havel prison in December 1939 or January 1940, when 18-20 handicapped patients were gassed in a test which was decisive in arriving at the decision to use carbon monoxide gas as the killing agent for the “euthanasia” programme. It is impossible to state with certainty who attended the gassing demonstration, but there is testimony that the following persons were present: Hitler's two plenipotentiaries for “euthanasia”, Karl Brandt and Philipp Bouhler, as well as Leonardo Conti, the State Secretary for Health in the Ministry of the Interior. Also in attendance were Herbert Linden from the Ministry of the Interior and the KdF representatives Viktor Brack, Werner Blankenburg, Hans Hefelmannn, Reinhold Vorberg, Richard von Hegener, and Gerhard Bohne. Further, the T4 physicians Werner Heyde, Paul Nitsche, Irmfried Eberl, Horst Schumann, and Ernst Baumhard participated in the demonstration, as well as the KTI (Criminal Technology Institute) chemists Albert Widmann and August Becker.^[545] Finally, the Stuttgart police officer Christian Wirth, who was to play an essential role in Nazi killing operations, was also present during this first demonstration of systematic mass murder.

Watching through a peephole, Becker observed how very quickly “people toppled over, or lay on benches”– all without “scenes or commotions.”^[546] Becker noticed that Eberl had opened the gas container too quickly and the escaping gas made a hissing sound. Fearful that this noise “would make the victims uneasy,” Becker demonstrated how to open the valve slowly and quietly, and “thereafter the killing of the mental patients progressed without further incidents.”^[547] The gas chamber was quickly ventilated, then SS-men used special stretchers to mechanically push the corpses into the crematory ovens. Brack and Brandt both expressed their satisfaction with the test. 4-8 further inmates were administered lethal injections of curare and scopolamine, but when the poison had little immediate effect, these inmates were also gassed. The experiment was then repeated and considered a success. It was Becker who then delivered gas cylinders to the functioning killing centres and demonstrated how to operate the equipment.^[548]

Gekrat was created to ship the victims to the killing centres, with a fleet of buses (usually three at each killing centre) hired from the Reich Post Office.^[549] The Gekrat bus drivers were all SS-NCOs recruited from the concentration camps.^[550]The steel tanks or pressurised containers containing the gas were ordered by T4 through the Chemical Department of the KTI^[551] from Mannesmann Röhrenwerke, a manufacturer of tubes and piping in Buss-an-der-Saar. Ordered in batches of one hundred, each tank had a capacity of approximately six cubic metres of carbon monoxide. The gas itself was supplied by the Ludwigshafen plant of I G Farben (today Badische Anilinund Sodafabriken: BASF) to the KdF, which traded under the name “Jennerwein (Brack) and Brenner (Blankenburg)”.^[552] The use of code names was common for senior T4 staff.

Many of the deceptive practices that were later used in the death camps in Poland were first in evidence in the “euthanasia” programme. For example, at Hadamar, only minutes before they were taken to the gas chamber, the victims were given a stamped postcard on which to report to relatives a safe arrival at their destination.^[553] Apparently, it was Bouhler who suggested that the gas chamber at Brandenburg should be disguised as a shower room, a deception that was to become a common feature of Nazi killing centres. To enhance the chicanery some victims were even provided with soap and towels to take with them into the gas chamber.^[554] The man responsible for the construction of the gas chambers and crematoria at four of the killing centres^[555], Erwin Lambert, subsequently put his knowledge and experience to more extensive use at Sobibor and Treblinka.^[556]

With minor exceptions, a similar killing method applied at all of the centres. At his trial at Nuremberg, Viktor Brack had described the simple design of the gas chambers:

No special gas chambers were built. A room suitable in the planning of the hospital was used, a room attached to the reception ward.... That was made into a gas chamber. It was sealed, it was given special doors and windows, and then a few metres of gas pipe were laid, some kind of pipe with holes in it. Outside of this room there was a bottle, a compressed bottle, with the necessary apparatus, necessary instruments, a pressure gauge, etc.^[557]

The gas chambers were of a similar size - approximately 3 metres x 5 metres x 3 metres in height. Benches lined the walls, hiding a 3 centimetre perforated pipe that encircled the chamber.

On arrival, the patients undressed and were presented to a doctor, who briefly glanced at them without conducting any actual medical examination. This was considered necessary in order to establish that the prospective victim was indeed the person registered in the accompanying documentation, and that the appropriate authorization to murder the patient had been given by the Obergutachter. It was also required to confirm the individual's nationality, since only German citizens were to be victims. Any exceptions to the established criteria could be singled out at this stage, as indeed a very few individuals were. The immediate murder of these fortunate souls was then cancelled. The inspection also served to reassure the patients, whilst at the same time directing the staff towards finding possible fictitious causes of death. The patients were then marked on their backs with strips of adhesive paper or coloured pencil for future identification and photographed.^[558]

Usually in batches of anything of from 25 -50 at a time, the patients were told they were to enter an “inhalation room” for therapeutic reasons.^[559]  Troublesome or resistant patients were sedated or manhandled into the chamber by brute force. Initially, in accordance with orders from the KdF, the gassing apparatus was operated by the medical director at each “euthanasia” institution, who became known as the Vergasungsarzt (“gassing doctor”). In less than five minutes the victims were unconscious; within ten to fifteen minutes all were dead. A hiatus of about one hour ensued, following which the chamber was ventilated and the bodies removed to either the autopsy room or to the crematorium. Before cremation occurred, where considered appropriate the victim's body was looted. In a precursor of action that was to be practised on an industrial scale at the extermination camps, any gold-filled teeth or dental bridges were extracted from the corpse's mouth for smelting. In the autopsy room, organs, particularly brains, were removed from the corpses of previously noted patients considered to be of special interest. The brains were processed by the Kaiser-Wilhelm-Institute of Neurological Research in Berlin and the Kaiser-Wilhelm-Institute of Psychiatry in Munich (today the Max-Planck-Institutes).^[560]

As in the death camps which were to follow, disposing of the remains of the victims exceeded by far any problems arising in connection with the comparatively straightforward killing method employed. The killing centre crematoria had a restricted capacity. Following the burning of between two and eight bodies at any one time, the remaining bone fragments were crushed, and the ashes either forwarded to the deceased's next-of-kin, or simply discarded.^[561] Each killing centre had a so-called special registry office, from where a standard falsified death certificate and letter of condolence were sent to victim's next-of-kin. A list of causes that could explain a sudden natural death was available. Relatives were informed that it had been necessary to cremate the body for public health reasons; the ashes of the deceased were available upon request. Nazi functionaries and German bureaucrats were stereotypically precise and efficient when it came to keeping records about mass murder.^[562] Originals or copies of all paperwork generated by the killing programme were retained, including record books and lists for internal T4 use, correspondence with outsiders, and the medical records of the killed patients. To organize the paperwork, each killing centre kept a death book (Sterbebuch), sometimes known as the book of patients (Krankenbuch).^[563] However, in order to enhance the secrecy of the operation, files were exchanged between the various killing centres so that for example, the death certificates of many of those who had been murdered at Hartheim were issued by Brandenburg. Consequently even today a victim's place of death is often attributed to the incorrect killing centre.^[564]

Thinking that their lucky fellow inmates were being taken on an excursion, if at first some patients who were not on the list of transferees were disappointed at being left behind, they quickly realised that these were trips from which nobody returned. Consequently, subsequent transfers often resulted in traumatic scenes, as distressed patients clung to nursing staff they trusted and relied upon. On occasion patients were placed in strait-jackets or handcuffs before being loaded into the vans.^[565]

In March 1941, Bouhler and Brack issued guidelines concerning the assessment of those to be considered “hereditarily ill.” These instructions stated, inter alia, that (a) all those who were unproductive were to be liquidated, not simply those considered to be “life unworthy of life” ; (b) war veterans who had distinguished themselves at the front or had been decorated were to be excluded (which category was in the event frequently disregarded.) Other ex-servicemen were to be included in the programme, with doubtful cases referred to Brack for a decision; (c) geriatric cases were to be evaluated with the greatest care, and action taken only in extreme circumstances (for example cases of criminal or “asocial” behaviour.) Again, Brack was to be the final arbiter; and (d) only Reich Germans were to be considered for inclusion in the programme.^[566]

In the early phase of T4, victims were taken by Gekrat from the institutions to which they had been committed directly to a designated killing centre. However, in order to improve efficiency and at the same time disguise the murderous activity by making it more difficult for family and friends to track the whereabouts of inmates, from April-May 1940 patients were first transferred to so-called Zwischenanstalten, (“intermediary institutions”), assembly points where for several weeks they awaited onward transportation to their final destination. For example, in the province of Hessen-Nassau there were five such dedicated mental homes serving as feeder stations for Hadamar – Scheuern, Weilmünster, Herborn, Kalmenhof-Idstein, and Eichberg.^[567] A typical example of the kind of notification sent by the director of an intermediate institution, in this case Kalmenhof, to the next-of-kin following the transfer of the victim to Hadamar for gassing, read:

By Order of the Reich Defence Commissioner, your sister…was transferred on 25 July 1941 by the Charitable Society for the Transportation of the Sick [that is Gekrat]…to another institution whose name and address are not known to me. The receiving institution will send you a corresponding communication. I would ask you to abstain from further inquiries until this notice is received.

If, however, you receive no notification from the receiving institution within fourteen days, I would recommend that you make inquiries with the Charitable Society for the Transportation of the Sick…”^[568]

This delay between initial transportation and ultimate murder also provided a lacuna sufficient to enable any administrative errors to be corrected. At the same time, schedules sent to individual mental institutions containing details of the number of patients to be killed were inflated by about 25 percent, so that a list might contain 94 names, but only 65 individuals were to actually be transported. Thus the director of the asylum became not just an executor of the orders of others; he became part of the decision making process, able to remove patients from the list at his own discretion.^[569] In certain respects, this can be seen as a precursor of the `selections' which were to become so commonplace with the expansion of genocide.

Although the programme had officially been concluded in August 1941, in reality “euthanasia” never ceased, but simply continued by alternative means. Over time, the process was polished and refined and a degree of sophistication added, so that by 1944 Hans-Joachim Becker^[570] of the Central Clearing Office for Mental institutions, the administrative and financial heart of T4, was able to issue precise instructions to hospitals regarding the manner in which relatives were to be notified of a patient's admission, as well as the procedure to be followed if a patient was to be discharged. Concerned relatives were to be notified by mail of a significant deterioration in a patient's condition; should a patient die, a telegram was to be immediately sent to the closest relatives stating the deceased was to be buried in either the institution's or a local cemetery. In order to allow relatives to attend, the funeral should occur no earlier than four days after the date of death. The property of the deceased, including clothing and underclothing, was to be forwarded to their relatives. Objects of minor value were also permitted to be sent to the next-of-kin. However, “where objects of real value are included in the estate, I am to be consulted as to whether they should be claimed to partially cover costs.”^[571]

In 1939 there had been approximately 300,000 mental patients in greater Germany. By 1946 there were 40,000. Not all of these individuals fell victim to “euthanasia”; hundreds of thousands of civilians died from a variety of other causes during the Second World War. But there can be no doubt that a significant number of those who perished did so at the hands of the medical killers.^[572] Evidence of this exists in both the minutes and the private notes of a meeting of the German Association of Cities held in April 1940, a convocation of local authority representatives including the mayors of all major cities, where the principal speaker was Viktor Brack. Having estimated that 30-40 percent of sanatoria and nursing home inmates were “asocial elements or unworthy of life”, he was explicit about the putative benefits of “euthanasia”:

In the many mental institutions in the Reich there are an infinite number of incurably ill patients of all kinds who are completely useless to humanity; in fact they are nothing but a burden, their care creates endless expense, and there is no possibility that these people will ever become healthy or useful members of human society. They vegetate like animals, and are antisocial people unworthy of living…they only take nourishment away from other, healthy people, and often need two to three times as much care. Other people must be protected from these people.

If, however, we must already make preparations for healthy people, then it is all the more necessary to first eliminate these beings, even if only to better maintain curable patients in mental hospitals. The space that would thus become free is needed for all sorts of things important to the war effort: military hospitals, regular hospitals, and auxiliary hospitals.

And how was this to be achieved? Brack continued:

Thus…incurable patients…must be packed into very primitive special asylums…nothing must be done to maintain these seriously ill patients; on the contrary, everything must be done in order to have them die as quickly as possible…It would be best if those involved were to be placed in very bad barracks where they could contract pneumonia; in other words, accelerate their death rather than artificially maintaining them.

In these “primitive lodgings…mortality will naturally be substantially greater, especially in time of war.” Brack then went on to detail the methodology to be followed regarding the disposal of corpses, the notification to the next-of-kin of the deceased, and who was to be responsible for the costs involved. In addition to the possibility of protest by the churches, concern was expressed regarding the reaction of the populace if this proposal became common knowledge. It was for these reasons that the programme would be conducted under conditions of the utmost secrecy, with cremation the preferred method of disposal of the victim's bodies.^[573] Although the notes and minutes were circumspect concerning method with no mention of gas chambers, neither document was a verbatim transcript, and it is a moot point whether such matters were discussed. In any event it may be regarded as certain that those present knew exactly what any coded message about desired “increases in mortality” meant.

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