The German experiment: Health care without female or Jewish doctors☆
This article has been
cited by other articles in PMC.
Abstract
Jewish
and female doctors were not allowed to practice medicine in Germany
during Hitler’s rule from 1933 to 1945. Data about the consequences of
this on the health service are difficult to come by, but what
information can be gathered demonstrates a detrimental effect on the
nation’s health. These data, however, must be interpreted with
consideration to the morbidity and mortality from violence, death camps,
slave labor, and the privations of war. The article summarizes the
history of German health care during this period and also compares
Germany to other nations at that time.
Introduction
The
Third Reich (1933–1945), the period when Adolf Hitler was chancellor of
Germany, was a time of great violence, discrimination, and medical
upheaval. Data about the quality of the German health service are
difficult to come by, but what information can be gathered demonstrates a
detrimental effect on the country’s health. This is to be expected
during the war years, but may also represent the loss of so many trained
physicians (i.e. Jewish and female practitioners) who were not allowed
to practice during these years. This article will argue that preventing
women and Jews from practicing adversely affected Germany’s health.
Pre-Nazi period
Germany
had an advanced history concerning women’s rights. The first-ever
female doctor in Europe was a German woman named Frau Dorothea
Lepavin-Erxleben, who, in 1754, was admitted to the University of Halle
and graduated from the medical faculty by the favor of Frederick the
Great (Lovejoy, 1957).
Like most, if not all, early German female doctors, she became an
obstetrician. Queen Victoria of Britain, for example, was delivered by a
female German obstetrician named Dr. Charlotte von Siebald in 1819 (Lovejoy, 1957).
Women training to be doctors in Germany still faced a struggle,
however, and in 1869, female doctors could only practice in Germany if
their medical diplomas were from a different country. Women were not
admitted to medical schools in Germany until 1888 (Lovejoy, 1957), compared to 1849 in the United States, 1875 in France, 1876 in England, 1878 in The Netherlands, and 1882 in Spain.
Germany also led the way with social policies, including, in 1883, Otto von Bismarck’s state health insurance system (Berg and Cocks, 1997).
The move towards a social policy of health met with great criticism
from doctors, but also led to greater unification. In 1873, the National
Medical Association, DÄVB, was founded. This was largely a
Jewish-friendly organization, perhaps because so many of its members and
leading figures were Jewish (Berg and Cocks, 1997).
The
20th century led to greater recognition of both female and Jewish
medical practitioners. The First World War had been an opportunity for
female doctors to prove their skill manning hospital and research units
while their male colleagues signed up for active service. The First
World War also marked the first time Jewish male doctors received field
commissions, but, in general, Jewish doctors of both sexes had been
forced into less glamorous areas of medicine, such as internal medicine
and dermatology. These fields, however, were becoming highly developed,
perhaps under their influence. Still, Jews could not join university
medical faculties unless they converted (Berg and Cocks, 1997).
The
Wall Street crash of 1929 and resulting depression caused a collapse
across many developed countries. Germany was particularly affected, as
it was paying reparations after the Great War. Doctors suffered along
with all other professions; this helped foster anti-Semitism, as Jewish
doctors were academically influential in large metropolitan areas such
as Berlin, Frankfurt, and Hamburg (Berg and Cocks, 1997).
The national health insurance system meant that doctors had to wait to
fill vacancies in national services and could not start private
practices. This, with encouragement from the National Socialist Party
(Nazi Party), led to the formation of the National Socialist Medical
Association (NSDÄB) to rival the DÄVB. Initially, the NSDÄB was not a
powerful or influential organization, but things changed in 1933 when
Hitler rose to power. The Nazi Party ideals were also anti-feminist,
with rules as early as 1921 stating that no woman could have a position
or role in the Nazi Party. In 1933, there were 4,367 female German
doctors (Lovejoy, 1957), 587 of whom were Jewish (Hutton, 2001).
This can be compared to figures from France, a country of similar size,
where in 1928 only 556 women were practicing medicine in France across
all specialties (Lipinska and Thomas, 1930).
Jews represented 16% of doctors in Prussia and 25% of dermatologists in
Germany, which is equal to 566 total (compared to being less than 1% of
the population) (Yesudian et al., 2010). Another figure quoted is that, of the 2078 dermatologists in Germany in January 1933, 569 were Jewish dermatologists (Scholz and Eppinger, 1999).
Hitler’s rule in Germany
On
January 30, 1933, Adolf Hitler was elected Chancellor of the Reichstag,
the governing body of Germany. The Enabling Act was subsequently passed
in March 1933, effectively giving Hitler total power. Hitler then set
about with his programs of “social Darwinism” and “racial hygiene,”
which included the removal of all Jewish and female doctors from their
posts in April and June of 1933, often replacing them with medical
students (Weindling, 1989).
While female doctors might still be allowed to work in midwifery,
Jewish doctors could not work at all and many emigrated. After Hitler’s
ascension, most other medical practitioners decided to join the NSDÄB
(membership rose from 2,786 members in January 1933, to 11,000 members
in October 1933 and 42,000 members in 1942) (Weindling, 1989) and income for doctors rose from a rather poor 9,300 marks in 1933 to 15,000 marks in 1938 (Berg and Cocks, 1997).
In addition, in 1933, women were dismissed from their positions as
solicitors, civil servants, and other professional posts; as of 1936,
women were no longer allowed to sit on juries (nor be judges or
prosecutors), as they were deemed to be ruled by their emotions.
Hitler’s policies also featured eugenics, a term first proposed by Francis Galton, a cousin of Charles Darwin (Cuerda et al., 2011).
Eugenics was first implemented in the United States in the early 1900s,
and is reportedly still occurring there via the sterilization of female
prisoners (Johnson, 2014).
With the rise of Nazism in 1933, those chosen for sterilization
included racial and ethnic groups such as blacks, Gypsies, Poles, and
Jews. One figure suggested that, of the 400,000 people who had been
forcibly sterilized by 1945, approximately 5,000 women died of either
postoperative complications, as a result of their resistance to the
procedure, or of subsequent suicide (Berg and Cocks, 1997).
(Men were also being sterilized, but suffered fewer postoperative
complications.) The surgeons, however, were being dubbed “masculine
heroes of the scalpel.” In 1934, a doctor was required by law to
denounce any of his patients who were disabled (Berg and Cocks, 1997).
In 1935, the Blood Protection Law prohibited marriage and sexual
intercourse between Jews; later that year, the Marital Health Law
prohibited the marriage of a Jew (or a member of any other classified
unsavory group) to an Aryan (Berg and Cocks, 1997).
Abortion was either encouraged or refused depending on the woman’s
race/ethnicity, and a woman’s role in society was seen as purely
reproductive. One example of this is the “Lebensborn,” an initiative
where “racially pure” women were encouraged to procreate with Aryan men,
such as SS officers; the children would then be adopted out, while the
mothers continued in their duty to provide more members of the “master
race” (International Tracing Service, n.d.).
With
the advent of war in 1939, “Action T4” started in earnest, which was a
program to exterminate all mentally and physically handicapped and
chronically ill patients (Berg and Cocks, 1997).
Relatives, convents, and monasteries had to give up their charges.
Special children’s wards were created for the observation (and eventual
death, usually from starvation until they moved to faster methods) of
chronically ill children from the epileptic to the handicapped. Towards
the end of the Second World War, as German supplies became scarce, those
who had been kept in concentration camps or used as slave labor were
exterminated.
Morbidity and mortality figures have to
be interpreted amongst this setting of increased violence and
extermination programs. Not only were Jewish and female doctors
prevented from practicing medicine, but members of the German
intelligentsia, which included many physicians as well as politicians
and university staff, who refused to submit to Nazi doctrine also lost
their jobs. With the loss of a good proportion of experienced medical
practitioners, one would expect that the quality of the nation’s health
care would deteriorate.
The diphtheria death rate is
one indicator that medical care was suffering, as it shows 77,340 deaths
in 1933, increasing to 146,733 in 1937 (Weindling, 1989).
A doubling of the death rate in a pre-war Germany, which was ostensibly
flourishing under Hitler (if you were Aryan), suggests that good
propaganda underlay a very different reality of a healthcare system
bereft of experienced practitioners. Records also demonstrate increasing
trends in scarlet fever, spinal meningitis, infantile paralysis,
typhoid, and paratyphoid (Weindling, 1989). Hospital mortality figures rose by 16%5 and life expectancy declined but, again, whether this was due to violence or lack of medical care is difficult to extract (Gapminder, 2013). Research into the detection and treatment of sexually transmitted diseases stopped (Weindling, 1994).
Figures from one German dermatology center showed a tripling of cases
of syphilis, from 275 to 859, and gonorrhea cases increasing from 127 to
1675 between 1933 to 1938 and 1939 to 1945 (Kapp and Bondio, 2011).
Maternal mortality figures are not available for Germany until 1952,
when the maternal mortality rate per 100,000 was 184; compare this to
the rates of the United Kingdom (67 per 100,000) and the United States
(68 per 100,000) for the same year, which demonstrates that the German
health service still had not recovered by that point () (Gapminder, 2013).
Table 1
Historical Maternal Mortality Figures from Selected Developed Countries.
Country | Maternal mortality rate per 100,000
|
---|
1933 | 1945 | 1952 |
---|
Germany | N/A | N/A | 184 |
United States | 619 | 207 | 68 |
United Kingdom | 453 | 196 | 67 |
Sweden | 307 | 133 | 52 |
Netherlands | 317 | 194 | 76 |
Finland | 251 | 402 | 125 |
Belgium | 515 | 343 | 90 |
The
Jewish doctors who remained worked mainly amongst their own people.
Some did what they could to help their fellow Jews in the Warsaw ghetto
in 1940, while also providing useful research data. The Germans had
decided to exterminate the occupants of the Warsaw ghetto by starvation
by providing fewer than 800 calories a day to residents (Gratzer, 2005).
Dr. Milejokowksi and 5 out of 28 medical staff living in the ghetto
decided to record the effects of this starvation, understanding that
they would all die, but that the data they collected would mean that non omnis moriar (not everything of us will die) (Medawar and Pyke, 2001).
Dr. Milejokowski and colleagues in the ghetto set about recording
clinical assessments, physiological readings, and data collected from
postmortems regarding the consequences of starvation (Gratzer, 2005).
Documentation stopped in 1942 when the remaining people were
transported to death camps (note that 43,000 people had already died at
this point), but almost one half of the reports were smuggled out and
entrusted to Professor Orlowski, the non-Jewish director of the
Department of Medicine of Warsaw University. The surviving reports were
published in English in the US in 1979 and were seen as an impressive
observation on the consequences of malnutrition (Gratzer, 2005).
Not
all Jewish doctors were persecuted. Eduard Bloch, an Austrian Jew, was
granted special protection and allowed to immigrate to the United States
in 1940 because he had cared for Hitler and his family during Hitler’s
childhood.
Refugees
In
1933, many Jews fled Germany before they were dismissed from their
positions, or worse. Within weeks of Hitler’s ascension, hundreds of
Jews had left. Britain was a welcoming destination for many, as it saw
the advantage and benefit of accepting so many skilled people,
especially in regards to medicine, physics, and chemistry. The United
Kingdom, therefore, set up the Academic Assistance Council (AAC), which
was tasked with finding these refugee scientists and physicians posts
and payment. U.S. policy was still largely anti-Semitic; as such, only
30 Jewish scientists and physicians fleeing Nazi Germany in 1933 were
admitted (Medawar and Pyke, 2001).
The United States remained prejudiced in this regard, never accepting
more than 100 Jewish academics in a year, the highest being only 97 in
1939 (most of those made up of physicians, as they had better
international contacts) (Medawar and Pyke, 2001).
Often, those who were allowed entry into the United States had already
been accepted into the United Kingdom (e.g., Edward Teller, known as the
father of the hydrogen bomb). In 1935, a U.S. envoy was sent to Britain
to tell the AAC that it could take no more academic refugees (Britain
ignored the request and continued to send Jewish academics to the United
States) (Medawar and Pyke, 2001).
Not
all of the United States was anti-Semitic; for example, Princeton
University donated 5% of all of their salaries to the AAC (Medawar and Pyke, 2001).
In the 1930s and 1940s, polls of the nation’s attitudes demonstrated
that 70% to 80% of the U.S. population opposed raising the quotas for
Jewish refugees (Medawar and Pyke, 2001).
In 1939, the Wagner–Rogers Bill was proposed, asking that 20,000
refugee children be allowed admittance into the United States, but it
was so unpopular that it failed to reach the floor of Congress. At the
same time, the already stretched Britain received 10,000 child refugees
as war began (known as the Kinder transport) (Medawar and Pyke, 2001).
Postwar
In
1945, the population of postwar Germany faced starvation and was
suffering from the destruction of its major cities, a displaced
population, and a defeated government. The Allies, comprising France,
United Kingdom, United States, and Russia, decided the fate of the
country, which was split between them. East Germany remained separate
until the fall of the Berlin Wall, while the United States and the
United Kingdom still maintain a military presence in what was once West
Germany. The splitting of Germany makes it difficult to compare German
health statistics pre- and postwar, as they were two very different
entities. Of the Jewish doctors who had not left Germany, most were dead
from suicide, starvation, violence, or the concentration camps. Using
Jewish dermatologists as an example, 50% had emigrated (with 107 going
to the United States), 10% died in concentration camps (including Karl
Herxheimer and Abraham Buschke), 10% died of natural causes, 2%
committed suicide, 4% survived and 24% remain unaccounted for (Burgdorf and Bickers, 2013, Eppinger et al., 2003).
German female doctors who remained started reclaiming for themselves a
position in medicine. Belatedly, in March 1950, the German Female
Doctors Association finally reacquired a legal footing and figures show
that of 64,104 doctors, 6,400 were women (Lovejoy, 1957).
Concluding comments
The
beginning of the 20th Century was a difficult time to practice medicine
as a woman or a Jew. The Nazi Party legalized prejudices (i.e.,
anti-Semitic and misogynistic) that reflected many people’s opinions at
that time. These opinions were not specific to Germany nor are they only
relevant to the past. The influx of so many talented people into
Britain and the United States represented a huge advance in academia and
medicine, and we still benefit from their discoveries and descendants
today. Those who remained made every effort to ensure that their work
would be remembered and that lessons were learned from the atrocities
inflicted upon them. The health care of Germany suffered as a
consequence of the loss of so many learned individuals, as evidenced by
the maternal mortality rates.
Doctors
have been political pawns for centuries, and Jewish doctors have been
expelled from their homelands on multiple occasions (e.g., the expulsion
of Jewish doctors from Malta in 1492). Recent conflicts have led to an
exodus of doctors and their families to safer regime; this includes
female doctors who are no longer allowed to practice in Islamic states.
One can never fully quantify the detrimental effects the loss of female
doctors have on the vulnerable groups they historically and religiously
care for.
Footnotes
☆Conflicts of interest: No funding was received for this work. The author is a co-editor of the International Journal of Women’s Dermatology.
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