Such a prospect finally became real in the summer of 1939. Already in May, as preparations for the war with Poland were under way, Hitler had set up administrative arrangements for the killing of mentally ill children under the aegis of the Reich Committee for Hereditary Health Matters, now renamed more precisely the Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses. A precedent, or excuse, was found in a petition to Hitler from the father of a baby boy who was born in February 1939 lacking a leg and part of an arm and suffering from convulsions. The father wanted the infant killed, but the Leipzig hospital doctor whom he had first approached had refused to do this because it would have opened him to prosecution for murder. Presented by the Chancellery of the Leader, his personal secretariat, with a dossier on the matter, Hitler ordered Brandt to visit Leipzig and kill the child himself after confirming the diagnosis and consulting with his medical colleagues there. Soon after, Brandt reported back to Hitler that he had got the local doctors to kill the infant on 25 July 1939. Hitler now formally asked Brandt, together with the head of the Leader’s’ Chancellery, to undertake active preparation of a major programme for killing mentally or physically handicapped children. Hitler’s personal physician, Theo Morell, who was closely involved in the planning process, suggested that the parents of the murdered children would prefer it if their death was reported as resulting from natural causes. As a final phase of the planning process, the head of the Leader’s Chancellery, Philipp Bouhler, a thirty-nine-year-old long-time Nazi who had built up the office over the years and gradually extended its influence into many of the areas of government touched on by the thousands of petitions addressed to Hitler that it was its job to deal with, invited fifteen to twenty doctors, many of them heads of psychiatric institutions, to a meeting to discuss the planned programme of killing. Although it was to begin with children, Hitler, Bormann, Lammers and Leonardo Conti, the head of the Party’s Health Office and ‘Reich Health Leader’ since the death of the Reich Doctors’ Leader Gerhard Wagner on 25 March 1939, decided that Conti should be commissioned with its extension to cover adults as well. Now that the decision had been made to kill the mentally ill and handicapped, a decree dated 31 August 1939 officially brought the programme of sterilizing them to an end in all but a few exceptional cases.
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The Leader’s Chancellery was from Hitler’s point of view the ideal location for the planning and implementation of the killing programme. His own personal office, it was neither subordinate to the Party, like the Party Chancellery, nor part of the civil service, like the Reich Chancellery, so it would be far easier to keep the deliberations over ‘euthanasia’ secret than it would have been had they taken place in the more formal bureaucratic setting of either of these other two institutions. Morell submitted to Hitler a memorandum on the possibility of formally legalizing the killing of the handicapped, and Hitler gave his personal approval to the idea. Under instructions from Bouhler’s office, the Ministry of Justice’s official Commission on the Reform of the Criminal Law prepared draft legislation removing penal sanctions from the killing of people suffering from incurable mental illness and confined to institutions. Lengthy discussions within the legal, medical and eugenic bureaucracies continued for many months as the draft was amended and refined. But for Hitler these seemingly endless deliberations were too slow and too pedantic. Like all the rest of the Commission’s drafts, the proposed legislation was eventually shelved.
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Impatient with these delays, Hitler acceded to pressure from Bouhler to transfer responsibility for the killings back from Conti to the Leader’s Chancellery, and signed an order in October 1939 charging Bouhler and Brandt ‘to extend the powers of doctors to be specified by name, so that sick people who by human estimation are incurable can, on the most critical assessment of the state of their illness, be granted a merciful death’. Although not a formal decree, this order effectively possessed the force of law in a polity where leading constitutional experts had long since been arguing that even Hitler’s verbal utterances were legally binding. As a precaution, none the less, the order was shown to Reich Justice Minister G̈rtner, to forestall any possible prosecutions; but apart from being made known to a few selected individuals involved in the programme, it was otherwise kept secret. To make clear that it was being introduced as a consequence of the heightened need to purify the German race imposed by the war, Hitler antedated it to 1 September 1939, the day the war broke out.
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By the time Hitler signed the order, the murder of adult patients was already under way in Poland; but it would not have begun there had the Regional Leaders in Pomerania, Danzig-West Prussia and East Prussia not been aware of the decisions already taken in Berlin. In Germany itself, the programme was initially directed at children. The secret Reich Committee for the Scientific Registering of Serious Hereditary and Congenital Illnesses, located in Bouhler’s Chancellery, ordered the compulsory registration of all ‘malformed’ newborn children on 18 August 1939.
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These included infants suffering from Down’s syndrome, microcephaly, the absence of a limb or deformities of the head or spine, cerebral palsy and similar conditions, and vaguely defined conditions such as ‘idiocy’. Doctors and midwives were paid two Reichsmarks for each case they reported to their superiors, who sent lists of the infants in question to a postal box number in Berlin, next to Bouhler’s office. Three doctors in the Leader’s Chancellery processed the reports. They then marked the registration forms with a + if the child was to be killed, and sent them on to the nearest public health office, which would then order the child’s admission to a paediatric clinic. To begin with, four such clinics were used, but many more were established later on, bringing the eventual total up to thirty.
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This whole process of registration, transport and killing was initially directed not at infants and children who were already in hospitals or care institutions, but at those who lived at home, with their parents. The parents were informed that the children would be well looked after, or even that removal to a specialist clinic held out the promise of a cure, or at least an improvement in their condition. Given the hereditarian bias of the diagnoses, a large proportion of the families were poor and ill-educated, and a good proportion of them were already stigmatized as ‘asocial’ or ‘hereditarily inferior’. Those who raised objections to the removal of their offspring from the family home were sometimes threatened with withdrawal of benefits if they did not comply. In any case, from March 1941 onwards, child allowances were no longer paid for handicapped children, and after September 1941 the children could be compulsorily removed from parents who refused to release them. In some institutions parents were banned from visiting their children with the excuse that this would make it more difficult for them to get used to their new surroundings; others found it difficult to visit in any case, since many of the centres were located in remote areas and far from easy to get to by public transport. Once admitted by the social and medical services, the children were put in special wards, away from the other patients. Most of the killing centres carried out their task by starving the children to death or administering overdoses of the sedative Luminal in their food. After a few days the children would develop breathing problems and eventually succumb to bronchitis or pneumonia. Sometimes the doctors left these diseases untreated, sometimes they finished the children off with lethal injections of morphine.
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A teacher taken on a tour of the killing ward at the Eglfing-Haar asylum in the autumn of 1939 later testified that the director, Hermann Pfannm̈ller, a long-time Nazi and an advocate of involuntary euthanasia for many years, told him openly that he preferred to let the children die naturally rather than killing them by injections, because this might arouse hostile comment abroad if news of it ever got out:
As he spoke these words, [Pfannm̈ller] and a nurse from the ward pulled a child from its crib. Displaying the child like a dead rabbit, he pontificated with the air of a connoisseur and a cynical smirk something like this: ‘With this one, for example, it will still take two to three days.’ I can still clearly visualize the spectacle of this fat and smirking man with the whimpering skeleton in his fleshy hand, surrounded by other starving children. Furthermore, the murderer then pointed out that they did not suddenly withdraw food, but instead slowly reduced rations.
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The programme continued for much of the rest of the war along similar lines, killing an estimated 5,000 children in total. Gradually, the upper age limit for removal and murder was raised, first to eight, then to twelve, and finally to sixteen. In practice some were even older. Many of these children and adolescents suffered from little more than developmental difficulties of one kind or another.
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A large number of health officials and doctors were involved in the scheme, whose nature and purpose thus became widely known in the medical profession. Few of them objected. Even those who did, and refused to take part, did not put forward any criticisms on grounds of principle. For many years, and not merely since 1933, the medical profession, particularly in the field of psychiatry, had been convinced that it was legitimate to identify a minority of the handicapped as living a ‘life unworthy of life’, and that it was necessary to remove them from the chain of heredity if all the many measures taken to improve the health of the German race under the Third Reich were not to be frustrated. Virtually the entire medical profession had been actively involved in the sterilization programme, and from here it was but a short step in the minds of many to involuntary euthanasia. Their views were well represented by an article that appeared in the leading German physicians’ journal in 1942 on ‘The New German Physician’, arguing that it was the task of the medical profession, particularly in wartime, when so many of Germany’s best and bravest were dying on the battlefield, ‘to come to terms with counter-selection in their own people’. ‘Infant mortality,’ it went on, ‘is a process of selection, and in the majority of cases it affects the constitutionally inferior.’ It was the doctors’ task to restore this balance of nature to its original form. Without the killing of the incurable, the healing of the maj ority of the sick and the improvement of the nation’s health would be impossible. Many of those doctors involved spoke with pride of their work even after the war, maintaining that they had been contributing to human progress.
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III
Hitler’s retrospective ‘euthanasia’ order of October 1939, putting a pseudo-legal gloss on a decision already taken at the end of July, applied not only to children but also to adults in hospitals and similar institutions. Planning for this extension of the killing programme also began before the war. The programme, codenamed ‘Action T-4’ after the address of the Leader’s Chancellery, Tiergartenstrasse 4, from where it was run, was put into the hands of a senior official in the Chancellery, Viktor Brack. Born in 1904, and so in his mid-thirties, Brack, the son of a doctor, was a trained agronomist who had run the estate attached to his father’s sanatorium. He joined the Nazi Party and the SS in 1929, and benefited from the fact that his father knew Heinrich Himmler and had delivered one of his children. In the early 1930s he frequently acted as Himmler’s driver, before being appointed adjutant and then chief of staff to Bouhler and moving with him to Berlin. Brack was another enthusiast for involuntary euthanasia, declaring after the war that it was based on humane considerations. Such considerations were not powerful enough at the time to overcome his awareness that what he was doing might be regarded as tantamount to murder, so he used the pseudonym ‘Jennerwein’ when he dealt with the killing programme, just as his deputy, Werner Blankenburg, who succeeded him in 1942 when Brack went off to fight at the front, also disguised his identity (with the pseudonym ‘Brenner’).
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Brack soon created a whole bureaucracy to administer Action T-4, including front organizations with harmless-sounding names to run the registration, transport, personnel and financial sides of the operation. He put Dr Werner Heyde in charge of the medical side of the programme.
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Born in 1902, Heyde had fought in a Free Corps unit in Estonia before taking up his medical studies, graduating in 1926. He clearly enjoyed strong connections with the far right, and in 1933 it was Heyde whom Himmler had asked to carry out a psychological assessment of the later commandant of Dachau concentration camp, Theodor Eicke, after the latter’s violent quarrel with the Regional Leader of the Palatinate, Josef B̈rckel, who had committed him to an asylum. Heyde’s positive assessment had gratified Himmler, whose backing he now enjoyed. Following this encounter, Heyde had joined the Nazi Party in May 1933. He became an SS officer in 1936. During the 1930s Heyde had acted as an expert medical referee in sterilization cases and he also carried out assessments of concentration camp inmates. Appointed to the staff of Ẅrzburg University in 1932, he became an adviser to the Gestapo in psychiatric matters, lectured on hereditary diseases (or those that were supposedly hereditary) and headed the local branch of the Racial-Political Office of the Nazi Party. In 1939 he became a full professor at the university. Here was an example, then, of a medical man who had built his career in the most ideological areas of Nazi medicine rather than in a more conventional manner. He seemed ideally suited to administer the killing programme.
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