The Mentally and Physically
Handicapped: Victims of the Nazi Era
"sterilization Law" explained the importance of weeding out so-called
genetic defects from the total German gene pool:
Since the National Revolution public
opinion has become increasingly preoccupied with questions of demographic policy
and the continuing decline in the birthrate. However, it is not only the decline
in population which is a cause for serious concern but equally the increasingly
evident genetic composition of our people. Whereas the hereditarily healthy
families have for the most part adopted a policy of having only one or two
children, countless numbers of inferiors and those suffering from hereditary
conditions are reproducing unrestrainedly while their sick and asocial offspring
burden the community.
Some scientists and physicians opposed the involuntary aspect of the law
while others pointed to possible flaws. But the designation of specific
conditions as inherited, and the desire to eliminate such illnesses or handicaps
from the population, generally reflected the scientific and medical thinking of
the day in Germany and elsewhere.
Nazi Germany was not the first or only country to sterilize people
considered "abnormal." Before Hitler, the United States led the world in forced
sterilizations. Between 1907 and 1939, more than 30,000 people in twenty-nine
states were sterilized, many of them unknowingly or against their will, while
they were incarcerated in prisons or institutions for the mentally ill. Nearly
half the operations were carried out in California. Advocates of sterilization
policies in both Germany and the United States were influenced by eugenics. This
socio-biological theory took Charles Darwin's
principle of natural selection and applied it to society. Eugenicists believed
the human race could be improved by controlled breeding.
Still, no nation carried sterilization as far as Hitler's Germany. The
forced sterilizations began in January 1934, and altogether an estimated 300,000
to 400,000 people were sterilized under the law. A diagnosis of
"feeblemindedness" provided the grounds in the majority of cases, followed by
schizophrenia and epilepsy. The usual method of sterilization was vasectomy and
ligation of ovarian tubes of women. Irradiation (xrays or radium) was used in a
small number of cases. Several thousand people died as a result of the
operations, women disproportionately because of the greater risks of tubal
Most of the persons targeted by the law were patients in mental hospitals
and other institutions. The majority of those sterilized were between the ages
of twenty and forty, about equally divided between men and women. Most were
"Aryan" Germans. The "Sterilization Law" did not target so-called
racial groups, such as Jews and Gypsies, although Gypsies were sterilized as
deviant "asocials," as were some homosexuals. Also, about 500 teenagers of mixed
African and German parentage (the offspring of French colonial troops stationed
in the Rhineland in the early 1920s) were sterilized because of their race, by
secret order, outside the provisions of the law.
Although the "Sterilization Law" sometimes functioned
arbitrarily, the semblance of legality underpinning it was important to the Nazi
regime. More than 200 Hereditary Health Courts were set up across Germany and
later, annexed territories. Each was made up of two physicians and one district
judge. Doctors were required to register with these courts every known case of
hereditary illness. Appeals courts were also established, but few decisions were
ever reversed. Exemptions were sometimes given artists or other talented persons
afflicted with mental illnesses. The "Sterilization Law" was followed by the
Marriage Law of 1935, which required for all marriages proof that any offspring
from the union would not be afflicted with a disabling hereditary disease.
Only the Roman Catholic Church, for doctrinal reasons, opposed the
sterilization program consistently; most German Protestant Churches accepted and
often cooperated with the policy. Popular films such as Das Erbe ("Inheritance")
helped build public support for government policies by stigmatizing the mentally
ill and the handicapped and highlighting the costs of care. School mathematics
books posed such questions as: "The construction of a lunatic asylum costs 6
million marks. How many houses at 15,000 marks each could have been built for
sterilization in Germany was the forerunner of the systematic killing of the
mentally ill and the handicapped. In October 1939, Hitler himself initiated a
decree which empowered physicians to grant a "mercy death" to "patients
considered incurable according to the best available human judgment of their
state of health." The intent of the so-called
"euthanasia" program, however, was not to relieve the suffering of the
chronically ill. The Nazi regime used the term as a euphemism: its aim was to
exterminate the mentally ill and the handicapped, thus "cleansing" the Aryan
race of persons considered genetically defective and a financial burden to
The idea of killing the incurably ill was posed well before 1939. In the
1920s, debate on this issue centered on a book coauthored by Alfred Hoche, a
noted psychiatrist, and Karl Binding, a prominent scholar of criminal law. They
argued that economic savings justified the killing of "useless lives" ("idiots"
and "congenitally crippled"). Economic deprivation during World War I provided
the context for this idea. During the war, patients in asylums had ranked low on
the list for rationing of food and medical supplies, and as a result, many died
from starvation or disease. More generally, the war undermined the value
attached to individual life and, combined with Germany's humiliating defeat, led
many nationalists to consider ways to regenerate the nation as a whole at the
expense of individual rights.
In 1935 Hitler stated privately that "in the event of war, [he] would take
up the question of euthanasia and enforce it" because "such a problem would be
more easily solved" during wartime. War would provide both a cover for killing
and a pretext--hospital beds and medical personnel would be freed up for the war
effort. The upheaval of war and the diminished value of human life during
wartime would also, Hitler believed, mute expected opposition. To make the
connection to the war explicit, Hitler's decree was backdated to September
1,1939, the day Germany invaded Poland.
Fearful of public reaction, the Nazi regime never
proposed a formal "euthanasia" law. Unlike the forced sterilizations, the
killing of patients in mental asylums and other institutions was carried out in
secrecy. The code name was "Operation T4," a reference to Tiergartenstrasse 4,
the address of the Berlin Chancellery offices where the program was
headquartered. Physicians, the most highly Nazified professional group in
Germany, were key to the success of "T4," since they organized and carried out
nearly, all aspects of the operation. One of Hitler's personal physicians, Dr.
Karl Brandt, headed the program, along with Hitler's Chancellery chief, Philip
Bouhler. T4 targeted adult patients in all government or church-run sanatoria
and nursing homes. These institutions were instructed by the Interior Ministry
to collect questionnaires about the state of health and capacity for work of all
their patients, ostensibly as part of a statistical survey.
The completed forms were, in turn, sent to expert
assessors physicians, usually psychiatrists, who made up "review commissions."
They marked each name with a "+," in red pencil, meaning death, or a "-"
in blue pencil, meaning life, or "?" for cases needing additional assessment.
These medical experts rarely examined any of the patients and made their
decisions from the questionnaires alone. At every step, the medical authorities
involved were usually expected to quickly process large numbers of forms.
The doomed were bused to killing centers in Germany and Austria walled-in
fortresses, mostly former psychiatric hospitals, castles and a former prison ---
at Hartheim, Sonnenstein, Grafeneck, Bernburg, Hadamar, and Brandenburg. In the
beginning, patients were killed by lethal injection. But by 1940, Hitler, on the
advice of Dr. Werner Heyde, suggested that carbon monoxide gas be used as the
preferred method of killing. Experimental gassings had first been carried out at
Brandenburg Prison in 1939. There, gas chambers were disguised as showers
complete with fake nozzles in order to deceive victims ---prototypes of the
killing centers' facilities built in occupied Poland later in the war.
Hadamar "euthanasia" center. In all likelihood the
smoke is from the crematoria.Hadamar, Germany, 1941
following procedures that would later be instituted in the extermination camps,
workers removed the corpses from the chambers, extracted gold teeth, then burned
large numbers of bodies together in crematoria. Urns filled with ashes were
prepared in the event the family of the deceased requested the remains.
Physicians using fake names prepared death certificates falsifying the cause of
death, and sent letters of condolences to relatives.
Meticulous records discovered after the war documented 70,273 deaths by
gassing at the six "euthanasia" centers between January 1940 and August 1941.
(This total included up to 5,000 Jews; all Jewish mental patients were killed
regardless of their ability to work or the seriousness of their illness.) A
detailed report also recorded the estimated savings from the killing of
The secrecy surrounding the T4 program broke down quickly. Some staff
members were indiscreet while drinking in local pubs after work. Despite
precautions, errors were made: hairpins turned up in urns sent to relatives of
male victims; the cause of death was listed as appendicitis when the patient had
the appendix removed years before. The town of Hadamar school pupils called the
gray transport buses "killing crates" and threatened each other with the taunt,
"You'll end up in the Hadamar ovens!" The thick smoke from the incinerator was
said to be visible every day over Hadamar (where, in midsummer 1941, the staff
celebrated the cremation of their 10,000th patient with beer and wine served in
A handful of church leaders, notably the
Roman Catholic Bishop of Münster, Clemens August Count
von Galen, local judges, and parents of victims protested the killings. One
judge, Lothar Kreyssig, instituted criminal proceedings against Bouhler for
murder; Kreyssig was prematurely retired. A few physicians protested. Karl
Bonhöffer, a leading psychiatrist, and his son Dietrich, a Protestant minister
who actively opposed the regime, urged church groups to pressure church-run
institutions not to release their patients to T4 authorities.
In response to such pressures, Hitler ordered a halt to Operation T4 on
August 24, 1941. Gas chambers from some of the euthanasia killing centers were
dismantled and shipped to extermination camps in occupied Poland. In late 1941
and 1942, they were rebuilt and used for the "final solution to the Jewish
question." Similarly redeployed from T4 were future extermination camp
commandants Christian Wirth, Franz Stangl, Franz Reichleitner, the doctor
Irmfried Eberl, as well as about 100 others -- doctors, male nurses, and clerks,
who applied their skills in 'Treblinka, Belzec, and Sobibor.
The "euthanasia" killings continued, however, under a different,
decentralized form. Hitler's regime continued to send to physicians and the
general public the message that mental patients were "useless eaters" and life
unworthy of life." In 1941, the film Ich klage an ("I accuse") in which a
professor kills his incurably ill wife, was viewed by 18 million people. Doctors
were encouraged to decide on their own who should live or die, Killing became
part of hospital routine as infants, children, and adults were put to death by
starvation, poisoning, and injections. Killings even continued in some of
Germany's mental asylums, such as Kaufbeuren, weeks after Allied troops had
occupied surrounding areas.
Between the middle of 1941 and the winter of 1944-45, in a program known
under code "14f13," experienced psychiatrists from the T4 operation were sent to
concentration camps to weed out prisoners too ill to work. After superficial
medical screenings, designated inmates Jews, Gypsies, Russians, Poles, Germans,
and others were sent to those euthanasia centers where gas chambers still had
not been dismantled, at Bernburg and Hartheim, where they were gassed. At least
20,000 people are believed to have died under the 14f13 program.
Outside of Germany, thousands of mental patients in the occupied
territories of Poland, Russia, and East Prussia were also killed by the
Einsatzgruppen squads (SS and special police units) that followed in the wake of
the invading German army. Between September 29 and November 1, 1939, these units
shot about 3,700 mental patients in asylums in the region of Bromberg, Poland.
In December 1939 and January 1940, SS units gassed 1,558 patients from Polish
asylums in specially adapted gas vans, in order to make room for military and SS
barracks. Although regular army units did not officially participate in such
"cleansing" actions as general policy, some instances of their involvement have
In all, between 200,000 and 250,000 mentally and physically handicapped
persons were murdered from 1939 to 1945 under the T4 and other "euthanasia"
programs. The magnitude of these crimes and the extent to which they prefigured
the "final solution" continue to be studied. Further, in an age of genetic
engineering and renewed controversy over mercy killings of the incurably ill,
ethical and moral issues of concern to physicians, scientists, and lay persons
alike remain vital.
The text of this
web page was originally published by the United States Holocaust Memorial Museum
as a pamphlet titled "Handicapped".
United States Holocaust Memorial Museum,
100 Raoul Walenberg Place SW,
Washington D.C. 20024-2150.