In July 1949, the New England Journal of Medicine published “Medical Science Under Dictatorship,” a disturbing paper written by Leo Alexander, MD. Dr. Alexander, a psychiatrist, was the Chief American Medical Consultant at the Nuremberg war crimes trials. His report detailed and analyzed the process by which the German medical profession became a willing and unquestioning collaborator with the Nazi regime. How could this happen? How could a profession dedicated, since antiquity, to healing, to easing suffering—a profession of caring and compassion—a profession respected and revered by the people—be transformed into a hideous corps of scientific killers, enforcing the will of a brutal dictatorship? This is a question that has troubled many historians, humanitarians, and just plain thoughtful people. Dr. Alexander tried to answer this question. In addition, he pointed to disturbing trends in medical practice in mid-century America. Nearly 50 years have gone by since the publication of Leo Alexander’s paper. But as you will soon understand, Dr. Alexander’s report is, unfortunately, more relevant to Americans today than it was when it first appeared.

Dr. Alexander tells us that, even before the Nazi takeover of Germany, a subtle “attitude shift” was taking place among German physicians and psychiatrists. By the late 1920s, the idea of sterilizing and “euthanizing” those who were chronically ill and consequently physically or socially unfit became an increasingly legitimate proposal within medical and public policy discussions. Alexander states, “By 1936, extermination of the physically or socially unfit was so openly accepted that its practice was mentioned incidentally in an article published in an official German medical journal.”

A cultural shift was quietly taking place among the lay population as well, as policy makers and members of the intelligentsia promoted sterilization and euthanasia. A popular movie in 1930s Germany Accuse, made a compelling case for euthanasia. In the film, a doctor kills his wife, suffering from multiple sclerosis to the accompaniment of soft piano music played by a sympathetic colleague in an adjoining room. A widely used high school mathematics text, “Mathematics in the Service of National Political Education,” asked how many new housing units could be built, and how many marriage-allowance loans could be given to newly wedded couples for the amount of money it cost the state to care for “the crippled, the criminal, and the insane.”

From these beginnings it was no great leap to a discourse on eugenics and the “purification” of German society. By 1939, the Nazi government made euthanasia official state policy. Two agencies were established to carry out the killings in an efficient manner: the “Reich’s Work Committee of Institutions for Cure and Care” dealt with adults, and the “Reich’s Committee for Scientific Approach to Severe Illness Due to Heredity and Constitution” dealt with children. Separate organizations were set up to transport patients to killing centers and to collect the cost of killing the victim from next of kin, who were told the victim died of natural causes.

What began as a government “mercy killing” program soon expanded to extermination of those with epilepsy, psychosis, depression, Parkinsonism, infantile paralysis, multiple sclerosis, and senility. Eventually, those simply unable to work and considered non-rehabilitable were killed. The technical arrangements, methods and training of the killer personnel were under the direction of a committee of physicians headed by Dr. Karl Brandt. Most were killed by gassing. At first, carbon monoxide was used. Later, “Zykion B,” a form of cyanide was the agent of choice. Victims were herded into phony showers and told they were going to be cleansed with antiseptic. The doors were locked and the gas pumped into the chamber. Medical scientists were then given body parts from the corpses to further their medical research. One neuropathologist, Dr. Hallervorden, obtained 500 brains from the killing centers for the insane. In a grisly account of the callous, detached way medical researchers competed for parts to study, Dr. Alexander says of the victims, “All but their squeal was utilized.”