Doctors Under Hitler

Michael H. Kater

• Publisher: The University of North Carolina Press
• Year: 2005
• ISBN:
  9780807876046
• Topic: History
• Subtopic: German History
• Index: History

"A brilliant attempt to explain the profound historical crisis into which medicine had plummeted during the Nazi period with the tried methods of social history.-- Historische Zeitschrift "The author has drawn from an extraordinary range of sources, and the weight of evidence he compiles will certainly give pause to anyone who still wants to believe that professionals kept their hands clean in this era of great and methodical crimes.-- Journal of Modern History "Kater's important book deserves close attention from historians of medicine and German historians alike.-- Isis
In this history of medicine and the medical profession in the Third Reich, Michael Kater examines the career patterns, educational training, professional organization, and political socialization of German physicians under Hitler. His discussion ranges widely, from doctors who participated in Nazi atrocities, to those who actively resisted the regime's perversion of healing, to the vast majority whose ideology and behavior fell somewhere between the two extremes. He also takes a chilling look at the post-Hitler medical establishment's problematic relationship to the Nazi past. -->

Chapter 1
Organizational and Socioeconomic Setting

1. Supply, Demand, and Deployment of Physicians

When the Third Reich was ushered in on January 30, 1933, it inherited a surplus of physicians from the republican era.¹ Even though published statistics on the number of medical doctors are inconsistent and spotty, it is now possible to reconstruct the picture. There were just over 48,000 independently practicing physicians in Germany by the end of 1931. This number had fallen to somewhat over 47,000 by 1934 but rose to more than 49,000 in 1937.² By a different count the number of physicians in Germany increased from somewhat over 52,000 in 1935 to above 55,000 in 1937, but the number of independently practicing ones declined from 38,000 to over 37,000, suggesting that more doctors were entering private employ and government services, as indeed they were.³

Yet another set of figures illustrates the transition in the supply of doctors from peacetime to wartime. The total number of German physicians jumped from over 59,000 just before World War II to nearly 76,000 in 1942, a gain of more than 25 percent, but the number of independently established practitioners rose only about 10 percent, from around 33,000 to just under 37,000.⁴ By this time, the general shortage of physicians was a much discussed national issue, with critical repercussions for the civilian population. For the period after 1942, the figures are very sparse. By spring of 1944, 79,462 doctors were said to exist, including 32,000 at the fronts.⁵

For the entire period of the Third Reich, there can be no doubt that the ratio of medical doctors per capita decreased. One public health insurance panel doctor was practicing for 1,344 medically insured patients in 1935, but this ratio slipped to 1 for 1,370 in 1936. In 1939, there were 1,432 health-insured and other (privately paying) patients for every doctor, compared to 1,380 in 1938 and 1,351 at the start of the regime. By July 1943, 2,543 civilians were looked after by one medical practitioner, and that figure was on the upswing as the war drew to a close.⁶

In February 1933, most German physicians greeted the new regime with high hopes, expecting it to redress anomalies left over from the health administration of the Weimar Republic. Third Reich officials, however, enacted new policies gradually. At the end of the Weimar Republic, young doctors straight out of medical school found it almost impossible to establish independent practices honored by the panel insurance fund system, which allowed only one new doctor per six hundred patients. The medical graduate was compelled to spend three years as an assistant physician (Assistenzarzf) in a hospital.⁷ These provisions were moderated slowly. The medical internship was shortened to one year (Medizinalpraktikum), but the doctor still had to spend two years as helper or deputy for an already established colleague. War veterans were given credit for a year’s practice of the two years spent as helper. After June 1935, three months of this preparatory period had to be in a country doctor’s office, in keeping with the regime’s “blood and soil” ideology. In summer 1939, with war in the offing and a pronounced scarcity of doctors, this long period of training after final university examinations was reduced.⁸

Under demographic pressures, the distribution ratio per capita was also altered. The limit of six hundred insurance fund patients per doctor, originally set to guarantee minimum earnings to a practitioner, was a reality only in Berlin, which had more doctors than anywhere else, and possibly Munich. Vast stretches of countryside, such as in East Prussia or Thuringia, had been understaffed by physicians even since republican times. As younger doctors attempted to establish themselves, they were to find that Nazi health administrators discouraged them from settling in the cities, exhorting them instead to move to rural areas. It became a policy to make certification of fund insurance doctors (Kassenzulassung) contingent on the candidates’ willingness to endure such regimentation.⁹ As of March 1, 1937, Berlin and Munich were declared special-permit territories.¹⁰ Eighteen months later the government promulgated an emergency decree allowing the regional health administrations to deploy physicians solely according to supply and demand. This measure was not implemented at the time, but it was premonitory of wartime practices and, to the wary, a signal of the imminent curtailment of the medical profession’s traditional freedoms.¹¹

Younger doctors, many of whom were at the compulsory three-year waiting stage, harbored special grievances as the Third Reich began. Economically, they were badly off, for either as municipal employees, in a polyclinic, for example, or as state servants, perhaps in a university teaching hospital, they never earned more than 250 marks per month, a share of which was automatically deducted for room and board. If they decided to forgo the latter, they received no remuneration. These conditions prevented most young doctors, who usually underwent their professional licensure (Approbation) around the age of twenty-seven, from getting married and founding families, and their contracts allowed for their dismissal from their positions if they married even against such financial odds. Very few of their superiors, commonly well-entrenched medicine professors, tolerated or protected them. Customarily, no provisions existed for married doctors to be housed and fed in hospitals. Furthermore, these junior physicians were not entitled to more than four weeks of vacation per year at the most, and they were forbidden to undertake extracurricular medical activities to increase their incomes.¹²

Spokesmen for this group began early in the Third Reich to clamor for a change in this demeaning situation, arguing, more or less sincerely, on the basis of racial politics, that a nation that cut off its life stream by hampering biologically sound progenitors was mortgaging its future.¹³ Specifically, it was claimed that medical institutions should stop advertising junior positions for bachelors only, and it was emphasized that the physicians constituted, after public school teachers, high school teachers, and jurists, the fourth largest group of academically trained professionals of the younger generation, those born after December 31, 1900.¹⁴

Changes were slow in coming, however, because the interim periods young doctors spent serving in hospitals were essentially retained and the economic misfortunes these physicians had inherited from the late Weimar era would take several years to turn around. It was not until at least 1938 that the situation improved. The Nazi medical administrators, always mindful of the problems of youth and quick to seize a propagandistic opportunity, did what they could to help. Early in 1933, when salaried young doctors in Munich were infringed upon by their employers, the Reich Association of Employed Physicians interceded with Dr. Leonardo Conti, Prussia’s commissar of health and the Berlin executive of the National Socialist Physicians’ League (NS-Ärztebund). Although his jurisdiction stopped at the Prussian border, Conti assured the Bavarian rabble-rousers of his sympathy.¹⁵ A year later the Reich interior minister, who was responsible for health administration, officially encouraged the hospitals to hire married applicants with children.¹⁶ And as late at 1938 the Nazi-organized medicine sections at the universities (Reichsfachgruppen Medizin), which had the explicit support of the Reich physicians’ leader (Reichsärzteführer), compiled evidence on the economic plight of the young assistants, published it in part, and promised further action with the government.¹⁷

However gradually, the transition of younger physicians from salaried to independent positions improved to the extent that a growing number of doctors came to be needed in the Reich. The near-closure conditions of the late republic and the regional deployment directives of the authorities after 1933 slowly corrected the supply-and-demand imbalance until an equilibrium was attained. At this point, however, the forces of the marketplace again caused maladjustments resulting from an undersupply of doctors, which led to the chronic shortage at the end of World War II.

As happened at other levels of the German economy, the creation of new functions resulted in new posts to be occupied, a trend that was accelerated when mobilization for war began and the armed forces were reconstituted. In 1933, those seeking jobs still outnumbered the available job postings in the advertising sections of the professional journals.¹⁸ But as the incoming doctors found that if they were patient practices became available, as for example in East Prussia or in the seedier districts of a large city, and salaried positions, perhaps for postdoctoral specialist training, could be had without too much difficulty, those job want ads began to disappear.¹⁹ It would be a safe estimate that the turnaround occurred in 1935, after many Jewish colleagues had been forced out of competition, even though the general concern about a national dearth of doctors did not set in until 1939.²⁰

One indication of this new trend was the often advertised availability of new opportunities, some of them with agencies of state, such as consulting physician for the Reich insurance scheme, others with the Nazi party or its affiliates, such as in labor service camps or the SS. Industry, in concert with the German Labor Front (Deutsche Arbeitsfront—DAF), was hiring an increasing number of physicians.²¹ In addition, all three branches of the Wehrmacht—the army, the navy, and the Luftwaffe—actively courted young doctors for professional careers as Sanitätsoffiziere, especially after the Hossbach Protocol in November 1937, when the planning of aggressive war necessitated an ongoing mobilization.²²

Yet a third signal of better times for doctors was provided by the career development pattern of civil service physicians, the time-honored Amtsärzte. In 1934, the selection process for these moderately well-paid and tenured positions had been rigid, with candidates being required to possess good academic records, a certain amount of private field experience, and the ability to pass additional qualifying tests.²³ But as early as spring 1935, because more attractive options were available elsewhere, certain prerequisites for an Amtsarzt career were being lowered by compressing the special training curricula or by partially abolishing the examinations.²⁴ By 1939 the Reich’s health bureaucracy was seeking to employ not only Amtsärzte of the first order, full-time, regular officials, but also adjunct physicians and part-time ones, who would enjoy some of the statesanctioned privileges such as the title Medizinalrat, as well as being able to earn money in a private capacity.²⁵

With the beginning of the war in September 1939, the occupation of a medical official intermittently became somewhat more popular only because these specialists were less likely to be inducted into the Wehrmacht than were civilian physicians.²⁶ And indeed, in the war years the civilian health administration fought for retention of every member of its official staff on the home front and often with success.²⁷ But even though entrance requirements to the Amtsarzt office were further lowered and more perquisites were added, the job remained as unattractive to medical neophytes as before the war.²⁸ In ...