[Pages 140-153]

Everything that was considered until now as the holiest obligations of medicine – to care for the sick without paying attention to their race, to deal in the same way with all diseases, to help ill men everywhere and to ease their pain – all this is viewed by the National Socialists as sheer sentimental stuff which should be thrown away. The only matter of importance in their eyes is leading a war of annihilation against the less worthy – the incurable patients…If this line of thought will win the upper hand the German medical profession will lose its ethical norms…the physician will act as a killer, the doctor will become a murderer – Julius Moses, February 1932.[774] It is said of these patients: They are like an old machine which no longer runs, like an old horse which is hopelessly paralyzed, like a cow which no longer gives milk…We are not talking here about a machine, a horse, nor a cow…No, we are talking about men and women, our compatriots, our brothers and sisters. Poor unproductive people if you wish, but does this mean that they have lost their right to live? - Bishop Clemens August Graf von Galen[775]

On 9 October 1939, a meeting of the organisers of the “euthanasia” programme was held, at which a formula was presented by which the number of future potential Reich “euthanasia” victims could be calculated. The basis of the calculation was the ratio 1,000:10:5:1, meaning that for every 1,000 of the population, ten would require psychiatric treatment. Of those requiring treatment, five would receive this as in-patients, and one of those in-patients would fall within the scope of the programme. That is to say, one in every 1,000 of the population would be subject to “euthanasia”. Applying this ratio to the population of the Reich as a whole resulted in an aggregate figure of 65,000 -75,000 potential victims.^[776] This figure proved to be an under-estimate. In 1942, the statistician Edmund Brandt (one of many bureaucrats to find employment with the post-war West German government) prepared an analysis entitled “What has so far been accomplished by the various institutions in terms of disinfection?” The “institutions” were the six principle killing centres; “disinfection” was a code word for murder. By Brandt's calculations, between January 1940 and August 1941, when the killings were officially, although not actually suspended, precisely 70,273 patients had been liquidated by gassing. Brandt went on to calculate the savings made in food, clothing and accommodation on the assumption that those murdered had been allowed to survive for a further ten years. Based on the average daily needs for an institutional inmate, he estimated that the killing of these sick persons, incapable of labour – “useless mouths” in Nazi terminology – would yield precisely 885,439,800 Reichsmarks in savings by 1951.^[777] Setting purely fiscal considerations to one side, put another way it has been calculated that as many as 33 percent of the beds occupied by patients of mental institutions in 1939 had been made available through “euthanasia” for other use by the end of 1941.^[778]

In addition to those gassed, at least 20,000 further victims had been killed by the time of the “stop order” by means of lethal injection. In truth, despite a pause, the killing in various guises continued until the end of the war. Ludwig Sprauer, senior medical officer in Baden, and thus the official responsible for “euthanasia” in that state, testified that it continued uninterrupted from 1941, stating: “The persons killed in the course of this programme included not only those who were mentally sick but also those who suffered from arteriosclerosis, tuberculosis, cancer, and other ailments.”^[779] Had Sprauer been completely honest, he would have admitted that, if anything, following the pause, the killing was actually expanded to include the Gemeinschaftsfremde (`aliens to the community') as the Nazis labelled them – the maladjusted, sick foreign slave labourers, civilians suffering breakdown as a result of Allied air raids, and anybody else considered to be “useless.”^[780] A drafted but never implemented law of 1945 defined an “alien to the community” as “one whose personality and way of life renders him incapable of fulfilling the minimum demands of the national community through his own efforts, especially as a result of extraordinary defects in judgment or character.” Apart from those who were obviously criminal, encompassed within this definition were the rowdy, the drunken, beggars – in fact, anybody deemed by the state to be “anti-social.”^[781]

So far as children were concerned, the killing never stopped at all. At the Kelsterbach hospital alone, 68 children under the age of three died between 1943 and 1945. One Polish woman described how a man she assumed was a German physician, together with his assistants, had murdered children at Kelsterbach:

…They took the child of someone I knew, undressed it, and laid it on the table which stood in our room…As the child lay on the table he [the assumed physician] gave it an injection in the lower part of the spinal column, and then sucked out a white, transparent fluid, which looked like water…This process took about half an hour. During the process the child began to scream, but it was then held by the orderlies until it was quiet and had died.

The woman's own child was then killed. She was instructed to take her child's body to the washroom, where she witnessed the corpses of approximately ten children. The oldest was no more than eighteen months of age.^[782]

Sources suggest that, taken together, the original estimate of a total of 160,000 victims of “euthanasia” now seems conservative. A figure of 200,000 appears to be minimal, with even double that number quoted by some historians.^[783] The more recent the research, the greater the evidence is uncovered of the true extent of the killing. In short, what had originally been conceived by the eugenicists as the extermination of the medically “incurable”, concluded with the murder of those who, for whatever reason, were either unable to contribute to the economic well being of the Reich, or were considered politically or racially undesirable. By 1942, “euthanasia” was considered an essential element in the modernization of mental institutions to the point where a planning review was able to predict that, in future, “with few exceptions, death by euthanasia will hardly be distinguishable from natural death. That is the goal to be striven for.”^[784]

It is dangerous to simply rely upon statistics without giving further consideration to their composition, but the decrease in the number of psychiatric patients in Berlin from 9,204 in 1939 to 1,807 in 1945 is surely indicative of the scale of the killing. Some Berlin patients had certainly been transferred to other institutions (often for liquidation), since by 1943 Wittenau was the only remaining public psychiatric institution in the city; others had undoubtedly died of natural causes, but there is significant evidence to indicate that an unknown number of patients were killed in Wittenau itself either by lethal doses of medication, starvation, or a combination of the two.^[785]

There were some in a position of authority who had the courage to object to this policy of state murder. Lothar Kreyssig was a judge in the province of Brandenburg who discovered that patients from the Brandenburg asylum were being murdered. In July 1940 he protested to Franz Gürtner, the Minister of Justice, deploring what were unquestionably illegal killings. After a confrontation with Roland Freisler, at that time a State Secretary, but later to become the notorious head of the Volksgericht, the People's Court, Kreyssig was informed by Gürtner that he would be compulsorily retired that December - which he was.^[786] Others were treated more harshly. The Protestant Pastor, Paul Gerhard Braune, submitted a memorandum to Lammers in 1940, in which he questioned how 2,019 people had died within a period of 43 days at Grafeneck,^[787] when the asylum only had a capacity of 100 beds. Braune was arrested by the Gestapo two months later for his troubles, but was released after three months imprisonment at Prinz-Albrecht- Strasse, the Berlin headquarters of the Gestapo, and survived the war.^[788]

The Nazi leadership remained nervous about public reaction to the programme. On 25 November 1940, Else von Löwis of Menar, a member of an aristocratic family, a committed Nazi, and a leader of the party's women's movement, sent a letter to her friend, the wife of Walter Buch, the presiding judge of the Nazi party court. Von Löwis asked the Buchs to inform Hitler of her concern that the killing of patients was straining the allegiance of the citizenry to National Socialism, writing:

Surely you know about the measures currently used by us to dispose of incurable mental patients. Still, you may not fully realize how it is accomplished and the vast scope of the undertaking, nor the terrible impression it leaves with the population! Here in Württemberg the tragedy takes place in Grafeneck, and this place has thus acquired an ominous reputation.

Events in Grafeneck and in other places had become common knowledge and thus were now a “public secret,” resulting in a “terrible feeling of insecurity”; people were asking, “What can one still believe? Where will this lead us and what will be its limits?” The population remained convinced that “the Führer obviously does not know about this,” but the party could lose the confidence of the people if it continued to deceive in this manner. A legal euthanasia law based upon the existing sterilisation law would be acceptable to the Volksgemeinschaft, but the present unlawful system was simply unsustainable.

Walter Buch forwarded this letter to Heinrich Himmler on 7 December 1940, pointing out that if the activities in Grafeneck could not remain secret and were causing such unrest, an alternative modus operandi must be put in place. On 19 December, Himmler replied to Buch:

Many thanks for your letter of 7 December 1940. I can inform you in confidence that the events that take place there are authorized by the Führer and are carried out by a panel of physicians.... The SS only assists with trucks, cars, and the like. I agree with you on one point. The process must be faulty if the matter has become as public as it appears.... I will immediately contact the office that has jurisdiction to point out these errors, and advise them to deactivate Grafeneck.

Himmler did exactly that. On the same day he received Buch's letter, he wrote to Viktor Brack, advising him to close Grafeneck:

As I have heard, there is great excitement in the Swabian Jura due to the institution Grafeneck. The populace recognizes the gray automobile of the SS, and thinks it knows what is happening under the constant smoke of the crematorium. What takes place there is a secret, and yet is no longer a secret. Thus the worst public mood has taken hold there, and in my opinion there remains only one option: discontinue the operation of the institution in this locality.^[789]

Brack heeded Himmler's suggestion. Grafeneck ceased operations on 13 December 1940.

The concept of “Jewish disease” had a long pre-Nazi history. According to some so-called “experts”, a disproportionate Jewish tendency to suffer from certain sicknesses extended to anything from mental illness to myopia, glaucoma, diabetes, tuberculosis, gall, bladder, and kidney stones, rheumatism, and much else. As an indication of how ludicrous many of these judgements were, in a contrary opinion, Otmar Freiherr von Verschuer, head of the Frankfurt Institute for Racial Hygiene, actually considered Jews less susceptible to tuberculosis than non-Jews.^[790] However, for the Nazis, the image of the Jew as the bearer of disease was potent, indeed totemic. It provided the justification, if one were needed, for the ghettoisation of the Jews in the occupied countries of eastern Europe, ostensibly on eugenic rather than racial grounds, for as a Nazi newspaper in the Generalgouvernement^[791] stated: “The separation of the Germans from the Poles – and particularly from the Jews – is not merely a question of principle; it is also, at least as far as Warsaw is concerned, a hygienic necessity.”^[792] It was to become “a hygienic necessity” in many places other than Warsaw. Thus the reason given for the establishment of the Lodz ghetto was the alleged danger of the outbreak of epidemics.^[793]

The districts chosen to house the ghettos were inevitably situated in the most impoverished parts of cities and towns. The housing was dilapidated, often with no piped water or electricity. The number of people packed into a ghetto produced staggering levels of population density. In Warsaw, 30 percent of the population were forced to live in 2.4 percent of the city's area; the ghetto district occupied about 425 acres, of which 375 acres (approximately 152 hectares) was residential space. The Germans calculated a density of 6-7 people per room in the Warsaw Ghetto. According to calculations made after the war the density actually reached 9.2 people per room, while the population density of the ghetto as a whole rose to 128,000 per square kilometre.^[794] The allocated living space of the ghetto in the town of Checiny was fixed at 2-2.5 square metres per person.^[795] In the small ghetto of Odrzywol, 700 people lived in an area previously occupied by 5 families, so that between 12 and 30 people had to share a single small room. The intolerable population density, inadequate hygienic and sanitary facilities – in the Lodz Ghetto 95 percent of apartments had no sanitation, piped water or sewerage – almost complete lack of medical supplies, absence of fuel for heating, and starvation rations, combined to produce conditions in which sickness and epidemics were inevitable.^[796]

Lice plagued the ghetto population. In the Kutno Ghetto, which the Germans nicknamed Krepierlager (“Pegging out Camp”), between March and December 1941, 42 percent of all deaths were of typhus patients.^[797] The overall mortality rate during that period in Kutno was almost ten times the pre-war rate, for other contagious diseases were also commonplace.^[798] On 16 December 1941, Wilhelm Kube, Generalkommissar of Byelorussia pointed out that there were 22 epidemics prevalent in the country at that time. No serum was available for their treatment.^[799] In Nazi ideology the Jews had always been regarded as the bearers of disease. Now, because of conditions the Nazis had themselves created, this took on the nature of a self-fulfilling prophecy. Moreover, the deliberate creation of this appalling environment provided part of the rationale for the extermination of the ghettoised Jews. However, the precedent and method for doing so had been set much earlier.

Ludwig “Israel” Alexander was the only Jew listed on the Eglfing-Haar transport of twenty-five men destined for Grafeneck on 18 January 1940. After 1 January 1939, all male Jews were forced to take the second name “Israel”, and all Jewish women the second name “Sarah”. It is thus evident that Alexander was considered Jewish, as defined by the Nuremberg laws, and was therefore probably the first handicapped Jewish patient murdered in the gas chamber of a “euthanasia” killing centre.^[800] Initially no distinction had been made between Jewish and non-Jewish adult patients in the “euthanasia” programme, even though as early as 24 October 1939, a mere fifteen days after T4 had effectively commenced operations, Reich Health Leader Leonardo Conti ordered mental institutions to report to his office details of all Jewish inmates in their care.^[801] In a follow-up dated 15 April 1940, Herbert Linden required local health authorities to provide him with details of Jewish patients within their jurisdiction.^[802] On 30 August 1940, the Ministry of the Interior ordered that Jewish patients be separated from German inmates and placed in specified asylums, from where some were selected for gassing. At the end of that year, all remaining Jewish patients were incarcerated in a single asylum at Bendorf-Sayn prior to their murder. The director of the Munich hospital replied to a complaining relative in a letter: “The transfer (of the Jewish patients) has not only administrative reasons, but it makes sense in so far as many Aryan patients and nurses repeatedly refused to share the same hospital with Jewish patients.”^[803] By November 1942, Bendorf-Sayn could be closed. There were no longer any Jewish mental patients.^[804]

In response to enquiries from the families of a number of Jewish patients who had actually been gassed in Brandenburg, Gekrat replied that the victims had been sent to an asylum in Chelm (sometimes referred to as either “Chelm II”, “Cholm”, or Cholm II), in the Lublin District of Poland. Notices containing fictitious dates of death were mailed from Chelm in order to add to the deception. Aktion Cholm, as it was known, proved particularly lucrative for T4, since it was not only possible to collect the gold teeth and jewellery of the deceased, but also their hospital fees, which continued to be received for some months after the actual date of death.^[805]

Following a decision of the Ministry of the Interior in early 1941, all Jews in German hospitals were ordered to be exterminated.^[806] From that year German Jewish patients were sent to the Generalgouvernement, and there either shot or killed in gas vans, although from the time of Hitler's decision in the autumn of that year to deport German Jews en masse, these killings did not form part of Aktion T4, but rather of the so-called “Final Solution.” By the summer of 1940, the medical condition of Jewish patients had already become irrelevant. They were being killed simply because they were both Jewish and a patient.^[807] Very shortly, one of those qualifications also disappeared. Selected members of the staff of T4 began killing Jews of all nationalities on a gigantic scale in the Polish death camps solely because they were Jews.

By the early summer of 1941 the “euthanasia” genie was out of the bottle. An undated letter to the Reich Minister of Justice quoted at the Nuremberg Medical Trial read:

I have a schizophren[i]c son in [a] Württembergian mental institution. I am shocked about the following absolutely reliable information.

Since some weeks, insane persons are being taken from the institutions allegedly on the grounds of military evacuation. The directors of the institutions are enjoined to absolute secrecy. Shortly afterwards the relatives are informed that the sick person has died of encephalitis. The ashes are available if so desired. This is plain murder just as in the concentration camps. This measure uniformly emanates from the SS in Berlin. The institutions dare not inform the authorities. Inquire at once at Rottenmuenster, Schassenried, Winzertal, all in Würtemberg. Have the lists of two months ago examined and submitted to you, check upon the inmates who are there now and ask where the missing persons went to. For seven years now this gang of murderers defiled the German name. If my son is murdered, woe! I shall take care that these crimes will be published in all foreign newspapers. The SS may deny it as they always do. I shall demand prosecution by the public prosecutor.

I cannot give my name nor the institution where my son is, otherwise I, too, won't live much longer. Heil Hitler Oberregierungsrat N.^[808]

Knowledge of the “euthanasia” programme had become widespread, in part because the killings were taking place on German or Austrian soil. Visiting a lady doctor friend who had founded a private clinic in Pirna in 1937, Victor Klemperer noted her remarks in a diary entry of 21 May 1941:

Sonnenstein has long ceased to be a regional mental asylum. The SS is in charge. They have built a special crematorium. Those who are not wanted are taken up in a kind of police van. People here call it “the whispering coach”. Afterwards the relatives receive the urn. Recently one family here received two urns at once.^[809]

In the town of Absberg, the SD reported, citizens had actually resisted the removal of the disabled inmates from the home at Ottilien.^[810] Still, not everybody objected. The murder of handicapped children appears to have received broad public support across the country, and it is suggested that the liquidation of mentally sick adults was not entirely unpopular.^[811] Where there were objections, the Nazis were quick to learn the lesson. Future killing centres would be established far away, where possible in isolated areas. Meanwhile, awareness by any sector of the general population, however small, of what had been from the beginning a Staatsgeheimnis (state secret) rang alarm bells, as Himmler's reaction over Grafeneck illustrated. Aware of such growing public disquiet, and in the wake of explicit sermons preached by a number of churchmen, in particular the Roman Catholic Bishop Clemens August Graf von Galen of Münster, on 24 August 1941 Hitler ordered the suspension of adult “euthanasia”, at the same time threatening post-war revenge on the bishop for his audacity.^[812] Von Galen had certainly pulled no punches, saying:

Do you, do I have a right to live only as long as we are productive, as long as long as others recognize us as being productive? If the principle is established and applied that “unproductive fellow citizens” can be killed, woe to all of us when we grow old and feeble! If it becomes permissible to kill unproductive people, woe to the invalids who invested and sacrificed and lost their energies and sound bones during their working careers. If unproductive fellow citizens can be eliminated by force, woe to our brave soldiers who return to their homeland severely injured, as cripples, as invalids. Once it becomes legal for people to kill “unproductive” fellow citizens - even if for at presently only our poor defenceless mentally ill are concerned – then the basis is laid for murder of all unproductive people, the incurable, the invalids of war and work, of all of us when we become old and feeble.^[813]

It has been suggested that this ostensible cessation was not so much caused by the protests of a few churchmen and others^[814], but rather because the T4 personnel were now required to practice their killing technique on a vastly greater scale as part of Aktion Reinhard.^[815] Considered by his contemporaries to be a man of no great intellect, nor prior to his revelatory sermon one overly endowed with moral courage, Von Galen's condemnation of “euthanasia” occurred in the last of three sermons delivered by him in summer 1941 on the subject of Nazi outrages. Following a conversation in early June of that year with the Dominican priest, Odilo Braun, in the course of which Braun revealed the extent of state seizure of church assets, von Galen's principal motivation for his condemnation of the regime appears to have been not so much the murder of the incapacitated, but rather his concern that Catholic institutions in Germany were threatened with the prospect of excision.^[816] The Gestapo were seizing church properties and hounding priests in Münster, and it was these acts that convinced von Galen to voice his alarm.^[817]

An even simpler reason for the official halt may have been that the envisaged target figure of victims had been reached, although that seems unlikely in the light of the increase in the number of potential victims believed to have been agreed by Bouhler and Brandt in January 1941.^[818] It seems likely that there was no single motivation for the “stop order”, but simply a combination of all of the factors mentioned. Whatever the reasoning, children's “euthanasia”, Sonderbehandlung 14f13, and the so-called “wild euthanasia” of adults in hospitals continued. In fact, the suspension should more accurately be called a pause for reorganization.^[819]Indeed, it is certain that more victims of “euthanasia” perished after the official order to cease than had been killed before it was issued.^[820] Thereafter, gas chambers at the killing centres functioned on a greatly reduced scale, but thousands of patients were murdered by means of lethal drugs or starvation at mental hospitals like Eichberg, Meserlitz-Oberwald, Kaufbeuren and many others.^[821] What occurred was in reality not a cessation, but rather a change of direction and method. That the “stop order” came as a surprise to the “euthanasia” perpetrators is indicated by the report of a Bavarian planning commission in October 1942, which indicated that the previous year's target figures for patient mortality had not been achieved because they had been suggested “on the assumption that the Operation [that is “euthanasia”] would continue”. Such assumptions had not been limited to Bavaria.^[822]

With Paul Nitsche and Herbert Linden the driving forces behind a resumption of “euthanasia”, albeit in an amended form, in September 1942 Linden's superior, Fritz Cropp, issued a directive to the institutions under his control. In view of the overcrowding in certain hospitals because of bombing raids, he asked for details of the mentally ill who were “eligible for transfer” to asylums in less dangerous regions. The coded message was clearly understood by those to whom it was directed; “euthanasia” was back on the agenda.^[823] In this second phase of “euthanasia”, murder became decentralised. No longer were there to be just a handful of killing centres, each equipped with a gas chamber in which a number of individuals could simultaneously be annihilated. For the purpose of Sonderbehandlung 14f13, the gas chambers at Bernburg and Sonnenstein remained operational for a short time, that at Hartheim for somewhat longer. Elsewhere, killing of the undesirable was now to be on an individual basis, be simpler in method, and occur at institutions throughout the Reich.

With the reorganization, it was no longer just those deemed medically “inferior” who became the target of T4. Linden busily compiled the registration of those considered socially unacceptable.^[824] Thus the list of those earmarked for elimination was actually expanded. In a “Manual of Hereditary Diseases” published in 1942, Hans Heinze listed those unfit for marriage and therefore reproduction: prostitutes, vagrants, professional criminals, pimps, paupers, swindlers, cheats, frauds, confidence tricksters, “hysterical scoundrels” (whatever that may have meant), “incorrigible and active confirmed homosexuals”, and “incorrigible shirkers” – amongst others.^[825] Compulsory sterilisation was urgently required for “antisocial and recidivist criminal psychopaths whose hereditary deviance can be inferred from their genealogy.” Within the context of Nazi racial hygiene, “psychopath” meant not just those who fell within the psychiatric definition of the term, but individuals who were simply nonconformists – “aliens to the community”, as described earlier. Ominously, Heinze added: “We hope that after the war, the fight against or extermination of subhumanity through purposeful measures will take its honoured place as a further great deed beside those already accomplished.”^[826]

Following a meeting held in September 1942, Otto Thierack, the Minister of Justice, noted:

With regard to extermination of antisocial lives, Dr Goebbels' point of view is that all Jews and Gypsies, Poles who have served prison sentences of around 3-4 years, and Czechs or Germans who have been sentenced to death, life in prison, or preventive detention should be exterminated. The best idea is extermination through work.^[827]

A secretary confirmed the new categories of potential victims when she testified in 1946: “I was assigned by the Foundation [Stiftung] to duty in the Rummelsburg workhouse. Here files were prepared that would process the so-called antisocial elements for extermination.”^[828]

By October 1942, two doctors were already visiting German mental hospitals for the purpose of evaluating inmates with criminal records, with particular reference to the patient's capacity for work. These found “no longer [in] need [of] treatment in mental institutions and [who] are capable of working”, had “KZ” marked on their records, meaning recommendation for the transfer of the individual to a concentration camp (KZ). Such patients were listed by the Ministry of Justice and placed “at the disposal of the police for accommodation in police labour and disciplinary camps”, in reality meaning “for liquidation through labour”. This led to a rather odd conflict of interests, for while Himmler and the SS intended to use those capable of labour by working them to death, the directors of mental institutions wished to retain the very same individuals alive and resident for the purpose of the asylum's own productivity. After much negotiation, the Ministry of Justice were forced to retract; they issued a new directive, excepting “from delivery to the police…those employed in important work either within or outside the mental hospitals, whom it is either impossible or inexpedient to replace with other workers.” Shortly thereafter, Herbert Linden was able to inform asylum directors that the decision now rested with them whether to send a patient to a concentration camp for extermination through labour, to a killing centre for death by other means, or to retain them for work at the institution.^[829]

Karl Brandt, the pioneer of “euthanasia” and T4, was appointed plenipotentiary for medicine and health (Bevollmächtigter für das Sanitäts- und Gesundheitswesen) in July 1942, and granted additional powers by Hitler in September 1943. Brandt thus became the central medical authority of the Reich, responsible in particular for the allocation of hospital beds and other medical resources.^[830] There is some evidence that Brandt received Hitler's approval in summer 1943 to begin a second phase of “euthanasia”. In post-war testimony, Nitsche stated that in August 1943 he had “managed to obtain Hitler's expressed approval, through the mediation of Professor Brand[t], to authorise certain responsible physicians to perform euthanasia in individual cases by means of drugs.” Although by this stage Brandt had become a major player in his own right in the chaotic Nazi government, and had “the unlimited trust of the Führer”, it is highly unlikely that he would have issued such an authorization without first obtaining Hitler's consent, or even perhaps his specific instructions.^[831] Albert Widmann, the chief chemist of the Kripo,^[832] who had recommended the use of bottled carbon monoxide in the gas chambers of the killing centres, now became responsible for the delivery of lethal pharmaceutical substances to various T4 related institutions, which in turn distributed them to an unknown number of mental hospitals. As the end of the war neared and it became increasingly difficult to obtain drugs, some physicians relied upon simple injections of air or gasoline to kill their victims.^[833]

Together with Linden, Brandt created a programme codenamed Aktion Brandt, under the auspices of which mentally disabled patients were evacuated from mental institutions in areas vulnerable to Allied air raids, purportedly for the patients' protection. In fact, in many cases the evacuees were eventually transported to killing centres for elimination.^[834] Under the umbrella of Aktion Brandt, in early 1943 several hundred patients were deported from hospitals in the Rhineland to asylums in the Generalgouvernement for killing. Within eighteen months all were dead.^[835] In April 1943, Brandt informed Conti that he had visited north-west Germany. He considered that a “large scale plan for the supply of hospital beds, etc is necessary.” And who did Brandt intend to turn to for aid in instituting this plan? “The organisation which has helped us in the registration of the cure and nursing homes through the Chancellery of the Führer [that is, T4]…Herr Blankenburg will also collaborate in this.”^[836]

The reason given for the removal of patients was to allegedly create room in hospitals for civilian casualties of the Allied bombing offensive and wounded Wehrmacht soldiers.^[837] The reality was that this was simply another manifestation of “euthanasia”, one which extended the concept of killing the unwanted “useless eaters”, originally limited to specific categories of the community, into an instrument of unrestricted population control.^[838] For example, in addition to the inmates of old-age homes in Hamburg sent to Meseritz-Obrawalde following the air raids of July 1943, between 22 June and 7 August, 349 mentally ill women of that city were transported to Hadamar for killing. About 20 percent of them had literally lost their minds as a result of the firestorm that had raged through Hamburg as a result of “Operation Gomorrah.”^[839] Ample evidence of their fate is provided by the correspondence passing between the victims' relatives and the killing centre. One son enquiring after his 77 year-old mother was informed by Hadamar: “Frau K. was so frail she had to be kept in bed constantly. Rapid degeneration began several days before her death. A weak heart in addition to this caused her death.”^[840]

The truth about the end of these deportees was revealed by the testimony of a surviving ex-patient of Meseritz-Obrawalde:

I recall a transport from Berlin of patients who had suffered severe shock as a result of air raids on Berlin. These patients were not even distributed among the various houses, but instead were brought directly from the train to the hospital, where they were killed the same day.^[841]

Other mentally impaired evacuees were sent to hospitals such as Eichberg and Kaufbeuren, where they were either starved to death or killed with lethal injections or overdoses of medication.^[842] It was not now quotas to be fulfilled, as had been the case in the first phase of T4, but rather individuals who were to be killed on the basis of “need.” As the bombing raids increased in intensity, space had to be created for the treatment of those considered to be essential for the prosecution of the ongoing conflict. Total war precluded the use of hospital beds for any considered unlikely to again become economically productive, namely the aged and the infirm^[843], so that following an air raid on Bremen on 26 November 1943, most of the patients of a bombed hospital in that city were transferred to Meseritz-Obrawalde. By 2 February 1944 the great majority of them were dead.^[844]

It has been estimated that between 1941 and 1944, some 35,000 patients were deported from various mental institutions to other more remote asylums, where many thousands were murdered.^[845] Some died because of questions of explication. Nazism had so corrupted the German language that it was no longer possible to be certain of the meaning of certain words. If patients were to be “evacuated”, was the expression to be taken literally or was some more sinister objective implied? Those responsible for interpreting such orders were often uncertain of what was required of them, and sometimes chose the more extreme option, even when this had not been the original intention.^[846]

The initial phase of the killing system had been largely devoted to the elimination of supposedly “worthless life”. The official conclusion of the application of “euthanasia” to the handicapped in August 1941 shifted the emphasis of the programme to the marginalized members of society – those “antisocial” elements listed so extensively by Heinze in the “Manual of Hereditary Diseases” mentioned earlier.^[847] From 1943, all of those considered to be unproductive were exterminated in order to make room for others who could be nursed back to health and work, or whose lives were judged to be of greater worth. The sick and “antisocial” of all kinds were murdered wherever and whenever their removal provided essential hospital space and medical supplies for the healing of those deemed likely to be of future value to the state.^[848] Thus, following the destruction of the University of Kiel in 1944, 700 patients of the mental hospital in Schleswig were transferred to Meseritz-Obrawalde for killing, in order to make room for the Kiel university students.^[849] As their friends and family disappeared, elderly individuals were terrified by the prospect of becoming inmates of geriatric homes or sanatoria. Even a visit to the doctor became a feared ordeal.^[850]

In August 1943, the majority of the administrative staff of T4 was moved from Berlin to the new central office which had been established at Hartheim.^[851] At the same time, Blankenburg, who by that time had succeeded Brack, reorganised T4 into three departments. Department I under Nitsche was responsible for the identification and examination of patients; department II headed by Gerhardt Siebert oversaw the place and time of the actual killings; and Friedrich Lorent was in charge of department III, which took care of the organisation's finances.^[852]

Starting one month later, barrack-like structures either were, or were intended to be, erected within the grounds of at least 32 mental institutions. It was proposed that defined categories of patients would be held in these barracks for treatment, thereby making room in the hospitals themselves for others more likely to respond to medical care. The barracks, with their three tiered bunk-beds, bore an obvious similarity to the structures evident in concentration camps. The standard of treatment meted out to patients confined within them can be imagined. Only one addition was necessary to complete the parallel, and in the summer of 1944, Linden, who had been responsible for the planning and financing of this entire scheme, authorised the construction of crematoria in German mental hospitals.^[853]

Future intentions were made abundantly clear in a planning report of July 1942 by the T4 Gutachter, Robert Müller, following an inspection of mental institutions in Baden:

…In implementing the contemplated euthanasia law, we cannot allow asylums to attain the reputation of institutions of death – in other words, asylums in which death awaits those transferred there. One of the basic conditions for implementing euthanasia is that it be as inconspicuous as possible. This means first of all an inconspicuous milieu…There we can accommodate incurable, chronic, or far advanced cases for which euthanasia has been or will be decided upon…These establishments and the general conditions for euthanasia cases must be indistinguishable from traditional nursing institutions. Euthanasia directives and their implementation must remain completely integrated into normal asylum routine. Thus, with few exceptions, euthanasia deaths will be all but indistinguishable from natural deaths. That is what we strive for…^[854]

It is only recently that evidence has emerged of human experiments being conducted on psychiatric patients, for example the Schaltenbrand experiments in 1940 at the Werneck psychiatric hospital, in which Professor Georg Schaltenbrand injected chronically mentally ill patients intradernally and cisternally with spinal fluid from apes, the latter having been previously injected with spinal fluid from multiple sclerosis patients.^[855] There is also an increasing body of evidence emerging of the involvement of the pharmaceutical industry (I.G. Farben) in the testing of drugs on patients.^[856]

As conditions of wartime life in Germany inexorably deteriorated, the potential victims of Nazi eugenic and racial policies (to all intents and purposes the two had long since ceased to be distinguishable) were no longer solely Jews and the inmates of asylums. In November 1942, Kurt Blome, Deputy Reich Physician's Führer wrote to Arthur Greiser, Gauleiter of the Warthegau, concerning tubercular Poles of the region governed by the latter. Earlier Greiser had written to Himmler advocating a “radical procedure” for the resolution of the problem. Everybody understood what the coded “radical procedure” implied, but Blome was rather more circumspect than others in his response:

Since some time ago the Führer halted the programme in the mental institutions, it occurs to me that he may not regard “special treatment” of the hopelessly sick as politically feasible at the moment. In the case of the euthanasia programme, German citizens afflicted with hereditary diseases were involved. This time it would be infected members of a subjugated nation. There can be no question that the proposed method represents the simplest and most radical solution. If there were assurances of complete secrecy, all reservations, regardless of the reason, could be withdrawn. But I regard such secrecy as downright impossible.

Rather than gassing, Blome proposed “strict quarantine and institutionalization of all infectious, hopeless tubercular patients. This solution would tend to make the patients die off fairly rapidly. The necessary inclusion of Polish physicians and nurses would to some extent rob such institutions of the character of death camps.” In other words, murder by alternative means. The following month Himmler instructed Greiser “to select a suitable area into which incurable tubercular patients can be sent.” Whether such a scheme was implemented is unknown.^[857] Blome was one of those acquitted at the Nuremberg Medical Trial, allegedly in return for providing the Americans with details of his research into biological and chemical warfare, regarding which subject he had probably had practical experience. Whilst admitting that he was a convinced Nazi, and approving of “euthanasia” in principle, Blome claimed to have been opposed to Aktion T4 on the grounds that Hitler's 1939 authorisation was of dubious legality.^[858] It was an assertion impossible to refute, and one that appeared to sit comfortably with the Nuremberg Tribunal, who in any event had only the haziest notion of the legality or otherwise of Hitler's dicta.^[859]

Presumably having exhausted the list of other helpless victims and with the war already clearly lost, in November 1944 the Ministry of Justice were considering killing the unattractive:

During various visits to the penitentiaries, prisoners have always been observed who – because of their bodily characteristics – hardly deserve the designation human; they look like miscarriages of hell. Such prisoners should be photographed. It is planned that they too shall be eliminated. Crime and punishment are irrelevant. Only such photographs should be submitted that clearly show the deformity.^[860]

It would be reassuring to think that the killing of patients ceased with the end of the war. Regrettably, that was not the case, for thousands perished from the effects of starvation and neglect in the months that followed the termination of hostilities. Heinz Faulstich was one of the first psychiatrists to document the results of murder by starvation. He proposed a minimum number of 20,000 deaths due to malnourishment in the post-war period alone. It is impossible to obtain precise figures, as so many of the asylums and institutions destroyed data and relevant documentation, but some statistics are indicative. On 28 April 1945, the day of liberation, the mental institution at Teupitz accommodated 600 inmates. By the end of October 1945, their number had been reduced to 54. At Grossschweidnitz, 1,012 inmates died in May 1945 alone. The mortality rate at a variety of hospitals is also revealing. At Altscherbitz it was 36·5 percent in 1945, rising to 38 percent in 1947. At Zwiefalten it was 46·5 percent in 1945, double that of 1944. At Ueckermünde, the rate rose to 55 percent in 1945. At Bernburg/Saale, it doubled in 1945. At the Düsseldorf- Grafenberg institution, between 1946 and 1947 the rate was 55 percent, and even as late as 1948/49 was still 30 percent.^[861]

So much for a “stop order”.

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