HISTORICAL ARTICLE

Xavier Riaud
Medical Ethics under a Totalitarian Regime: German Dentists and the Third Reich

Principles of ethics

After 133 days of long debates, the trial of twenty three Nazi doctors ended in Nuremberg on 21 August 1947 [1]. Seven of the doctors were sentenced to death, five to life imprisonment, two to 20 years imprisonment, two to 10 years imprisonment, and the remaining seven were discharged.  On the very eve of the announcements of the sentences, 10 essential principles that should in future govern every experiment with human beings were publicly announced by the Court of Nuremberg. Medical ethics was in its early stages. With this judgement the Court defined its fundamental principles.   

1. It is necessary to obtain the subject’s enlightened and voluntary consent without him or her being pressurised or being the victim of a hoax.
2. The experiment must lead to practical results for the sake of humanity.
3. The fundaments of the experiment must be based on previous experiments practised on animals as well as on the knowledge of the genesis of the illness itself.
4. The subject must not suffer or be hurt when the experiment is being carried out.
5. If there is a risk of death or disability for the subject, the experiment should not be carried out.
6. The risks during the experiment should not exceed the positive value of the medical problem that the experiment aims at solving.
7. During the experiment any possibility of causing injuries, disability or the subject’s death must be avoided.
8. Only competent and qualified people must carry out the experiment.
9. The subject is free to stop the experiment at any time.
10. The man of science can interrupt the experiment whenever he thinks that there is a potential risk for the subject.

Though there can be no question that the physicians sentenced in Nuremberg committed most evil acts, it is important to remember that they constituted a small minority. In Germany, under the Third Reich, about 350 active doctors out of a total of 90,000 committed medical crimes.  In 1939, out of 16,300 graduated dentists, not more than a hundred worked in concentration camps including those who were active in the of the administration of the camps [2].

Organisation of the dentistry in Germany before 1933 [3]

In 1930, there were 10,000 dentists, of whom 90% were members of the Association of Dentists of the Third Reich (12% were members of the NSDAP before 1933) [4]. Over 16% of them earned less than 3,000 Reichsmarks per year. The fee rates imposed by the funding organizations were 40% lower than those for private medical care. The dental surgeons (DS) received dental training at local universities. They were in competition with the clinics of the German government department dealing with health insurance, and with the dentists (D) who received a dental training in dental schools. Overall, there was a surplus in the number dental practitioners, resulting in ever lower wages. Academic dental clinics were spreading out across the country. Whereas the first one had opened in 1902, by 1931, 528 dental surgeons treated 6 million members of insurance companies in 126 academic dental clinics. 

From 1933

By 1933, each county and region was represented by a political representative. At the helm of this political apparatus was Ernstt Stück who became Reichzahnärzteführer (Chief dentist of the Reich) on October 2 of that year [5]. A year later (October 1,1934) Stück pronounced that every dentist working in private practice who wanted to receive payments from the funding organizations had to first complete an eight week ideological, military and professional training.  In 1935, the association of German dentists became the Order of German dentists.  The dentists adopted the regime’s policy of "aryanisation". Stück wrote: “Each dentist must become a national-socialist”:

Keiner ist unter uns, der nicht in unerschütterlicher Treue und blindem Gehorsam in dieser Stunde dem Führer folgen wollte, komme was da wolle!... Wo der deutsche Zahnarzt auch stehen mag, ... überall wird er sein Letztes hergeben, um dem Führer den Sieg erkämpfen zu helfen. Opfer und Entbehrungen mancher Art werden unausbleiblich sein. Sie werden als selbstverständlich zu erfüllende Pflicht ertragen werden.

Whatever happens, there is no one amongst us who is not ready to follow the Führer with an unshakeable trust and a blind allegiance.  No matter where a German dentist may find himself, he will do his utmost to help the Führer achieve victory.  Sacrifices and hardships of various kinds will be unavoidable.  They will be born with a self-evidential sense of duty.

During the first months of the war, 6,000 dentists enlisted in the army. In 1942, the two professional groups (dental surgeons and dentists) were united. The new association was taking the name of Dentists and Dental Surgeons Working Community. It aimed at solving the disaster of public health which was looming. On 12 April 1943 Stück ordained the necessity of dental checking and the systematic treatment of 16-year-old’s (born in 1927). In 1944, the same scheme was implemented for those born in 1928 and 1929 (all of whom were liable to enlist in the army).

The organisation of military dentistry before and during the war

On 14 March 1935 the Luftwaffe was created [6]. There were to be 100 dental surgeons per aerial region. The important garrisons had five to six dental surgeons and 25 to 30 dental technicians.  A mobile dental clinic was worth 250,000 Reichsmarks. On 18 June 1935, the Kriegsmarine (German navy) was created. In 1940, some dental surgeons were enlisted in the navy and trained in the Baltic Sea. On 24 June 1937 the Werhmacht received secret directives to get them ready for imminent final commitments [7]. In 1941, the dental surgeons were out-fitted with portable equipment to enable treatment at the front lines. In 1942 dental consulting rooms were created at important troop transits points. Some 40 to 50 patients were treated daily [8]. A reserve group consisting of 50-60 dentists, called the Zahnärztliche Einsatzabteilung der Waffen-SS 500 (Military SS Dental Squadron) was permanently stationed in Prague. If needed, dentists from this unit would be sent to the units at the front.

Dentists and anti-Semitism

From 1933, Reinrassigkeit (purity of the race) became the ideological doctrine of a unified profession. The Arische Abstammung (aryanisation of race) was an essential criterion for qualification as a dentist. In April of 1933 a law was passed forbidding Jewish dentists to practise for the funding organizations. On 17 January 1939 the 8^th order concerning the Reich citizenship law was passed. Jewish dental surgeons were no longer allowed to practise. From then on, the only dental treatment the German population received was from Aryan Germans. On 1 January 1934, there were 1,064 Jewish practitioners among the 11,332 dental surgeons.  By 1 January 1938, only 579 of the Jewish dental surgeons remained, reducing to 372 by 1 January 1939. 

The T4 operation and dental surgeon’s involvement in euthanasia for mentally insane and physically handicapped people 

T4 was the code name given to the secret euthanasia program, named after its head quarters at Tiergartenstraβe #4 in Berlin [9]. Everything was highly structured. The SS intervened at every level of the organisation but did not manage it. Absolute secrecy was compulsory. In 1933, the law on sterilization was promulgated. In 1935 the Minister of Justice, Dr Gürtner [10], published a penal code which forbade euthanasia, except for those who were at the end of their lives. By 1939, all the country’s endeavours were devoted to the war effort. Hitler’s calculation that some 350 billion Reichsmarks were being spent on providing care to the disabled was one of the factors leading to his signing of the secret decree on euthanasia on September 1 1939 .On 1 October it was backdated and became a war measure, which made it indisputable. This decree ended up in Dr Gürtner’s office in August 1940. In January 1940 the first gas chamber was tested in Brandenburg. According to the Nuremberg Court, the T4 Operation caused 200,000 deaths. German dentists were involved in this crime in three different ways. 

a) Indoctrination and Publication

In the 1930s, racial health became a compulsory lecture topic for all medical and dental students [11]. In 1933, the dental literature produced 15 articles on this topic, followed by 45 more in 1935 --not to mention 70 articles of political propaganda [12]. Books on the subject were also published, containing racially motivated claims such as this one from "Neue Grundlagen der Rassenforschung" (New Foundations of Racial Research):

Die mehr in der waagerechten mahlenden Kaubewegungen des nordischen Menschen lassen das Kauen bei geschlossenem Mund erfolgen, die pressenden also mehr senkrechten des andersrassischen Menschen neigen aber wie beim Tier mehr dazu, den Mund bei den Kaubewegungen jeweils zu öffnen und so zu schmatzen...

 

Die Eckzähne überragen ihre Nachbarn beim nordischen Gebiβ nicht. Bei anderer Rasse finden wir häufig starke Breite und Spreizung der Zahnwurzeln, mitunter auch eine groβe Zahl oder mehr Teilungen derselben. Die Eckzähne überragen da häufig die anderen, wie auch beim Tiere; überhaupt sind die Zähne entsprechend der schiefen Vorschnauzigkeit länger, mehr abgerundet und dick...»

Amongst the Northern man, the chewing movements which grind and which are horizontally oriented allow him to chew with a closed mouth; while amongst a man of a different race, as amongst the animals, the movements which compress, and which are, therefore, more perpendicular, compel the mouth to open when chewing, and consequently to smack.

In a Northern man’s jaw, the canines are not taller than the other teeth.  Amongst other races, we often find wider dental roots with gaps in between, as well as a frequent number of divided roots. Among them, the canines are generally taller than the other teeth, as is true among animals; corresponding with the snout-like shape of the jaw, the teeth are generally longer, rounder and larger.

There were also presumably scientific dental doctoral theses produced. For example, Gottfried Burstedt presented a thesis in Münster in 1940, entitled "Zahn- und Kieferanomalien bei Schwachsinnigen (Untersuchungen bei den Pfleglingen der « Heil- und Pflegeanstalt Wittekindshof » bei Bad Oeynhausen)" (Anomalies of teeth and jaws amongst the mentally ill (Research on patients in the mental institution of Wittekindshof near Bad Oeynhausen).  The second one was presented by Hermann Nienhaus in 1940: "Anomalien der Zähne und Kiefer als Hilfsmittel bei der Diagnose des angeborenen Schwachsinnes" (Anomalies of teeth and jaws as diagnostic tools in congenital mental retardation) [13]. Here is an extract from the latter:

Wenn ich zum Schluß der Arbeit die an anderen Heil- und Pflegeanstalten durchgeführten Untersuchungen mit meinem eigenen vergleiche, so muß ich in vielen Fällen eine auffallende Übereinstimmung der Ergebnisse feststellen. Aufgrund meiner Untersuchungen möchte ich jedoch besonders hinweisen auf das häufige Vorkommen des hohen Gaumens und der prognathie bei Schwachsinnigen. Ich hoffe so, mit meiner Arbeit einen bescheidenen Beitrag zu Aufkläurung über den Wert körperlicher Merkmale bei der Diagnosestellung des angeborenen Schwachsinniges geliefert zu haben. Da es in Deutschland zur gerechtfertigten Ausführung des Sterilisationsgesetzes einer exakten Diagnosestellung der Erbkrankheiten, wozu auch der angeborene Schwachsinn gehört, bedarf, so wäre gerade die Zuhilfenahme zuverlässiger körperlicher Merkmale sehr wertvoll, die dem Gutachter seiner verantwortungsvolle Aufgabe erleichtern könnten.

If I compare my experiments with those of others, carried out in other clinics and long term care institutions, I notice a striking similarity between the results in many instances. However, based on my experiments, I wish to point out in particular the frequent presence of a high palate and prognatism among the mentally disabled. I hope that my work has somewhat contributed to the exposition of the value of physical characteristics in diagnosing hereditary mental illness.  Here in Germany the just implementation of the law on sterilization requires a precise diagnosis of hereditary illnesses, to which congenital mental disability belongs as well; hence reliable physical characteristics would be a valuable tool, that could ease the specialist’s heavy burden in executing his responsibilities properly.

 b) Assessments of the patients with cleft palate for the purpose of sterilization

Sterilization was allowed for certain classes of cleft palate patients, as evidenced by an article published in 1935 in Zahnärztliche Mitteilungen [14]:

Das Erbgesundheitsamt in Rostock hat die Unfruchtbarmachung nach dem Gesetz vom 14. Juli 1933 in einem Falle von Hasenscharte für berechtigt angesehen und dazu ausgeführt: N. habe zwei Kinder gezeugt, die ebenso wie er eine Hasenscharte haben; ein Kind besitze einen Wolfsrachen; dieselben Miβbildungen waren auch bei einem verstorbenen Kind festzustellen. N. müsse daher als erbkrank im Sinne des §1 des Gesetzes zur Verhütung erbkranken Nachwuchses bezeichnet werden; seine Unfruchtbarmachung sei geboten

According to the law of July 14^th 1933, the Hereditary Health Office of Rostock has considered sterilization justified in the case of cleft lip and added: N. fathered two children who have a cleft lip like he does; one child has cleft palate; the same malformations were present in a dead child. In accordance with article 1 of the Law on Prevention of Offspring Affected by Hereditary Illness, N. must be identified as the carrier of a hereditary illness; his sterilization is ordered.

In the same article, Prof Astel added: Die Anfrage, ob sich ein 27 jähriger Mann, der mit offenem Gaumen und Oberlippenspalte behaftet ist, fortpflanzen soll, kann eindeutig mit «nein» beantwortet werden... Offener Gaumen und Oberlippenspalte zählen zu den schweren erblichen Miβbildungen, deren Träger nach dem Gesetz... unfruchtbar gemacht werden können. Also Stellung der Anfrage auf Sterilisierung durch den Erbkranken oder durch den Kreizarzt. The question whether a 27 year old man, who has an open palate and a cleft of the upper lip, should procreate, can be answered categorical with “no”...  An open palate and cleft of the upper lip are amongst the most serious hereditary deformities... and those affected by these conditions can be sterilized according to the law. So the request for sterilization should be made by the patient or the local physician. Like all medical professionals, a dentist had a legal duty to denounce anyone affected by a congenital deformity [15]. c) The extraction of dead people’s dental gold A dental consulting room was established in each large concentration camp. The camp surgeon general would be in charge of the SS dentists [16]. On 23 September the Reichsführer, Heinrich Himmler, ordered SS doctors to take out gold teeth from corpses and from living people whose teeth “could not be cured” [17] The first decree, promulgated as part of the T4 Operation, initially was not consistently implemented on the detainees of the concentration camps. Himmler enacted the systematic removal of gold teeth with a second decree passed on 23 December 1942. This decision was one of the direct outcomes of the implementation of the Final Solution. The huge deficit of currencies to purchase raw materials motivated its implementation. In 1940, the dentist Wiktor Scholz defended his PhD thesis at Strzelin, in Lower Silesia [18]. It is entitled "Über die Möglichkeit der Wiederverwendung des Goldes im Munde des Toten" (On the feasibility of the re-using the gold from the mouths of the deceased).  Scholz considered the gold from dead people’s crowns and false teeth indispensable resources for the Third Reich. To qualify this practice he affirmed: “In this context, it is not an end but rather a beginning.” Therefore the removed gold served to finance the operation [19].

“About the possibility of reusing gold coming from the mouth of the dead”. Doctoral dissertation to obtain the title of Doctor in Dentistry of the Silesian  Medical University  Friedrich-Wilhelm in Breslau, defended by Viktor Scholzs, dentist in Breslau. Printer: Printing house Paul Schwarzer, Strehlen, 1940. (Panstwowe Muzeum Auschwitz-Birkenau, Oswiecim, Pologne, 2003.

Post-War Convictions of Concentration Camp Dentists

Out of 100 dentists involved in the concentration camps, historical accounts of only 60 of them have been traced. To my knowledge, only seven dentists were ultimately convicted.

Prof Dr. Hugo Blaschke was in charge of dental treatments for the SS, the Police and the Gestapo. [20] He was also the appointed dentist for leading figures such as Hitler, Eva Braun, Bormann, Goering and some others.  His dental prostheses helped to identify Hitler’s, Eva Braun’s and Bormann’s charred bodies (Bormann died in Berlin in the last bombings of the town). Blaschke was found guilty of the exploitation of dental gold extracted from dead detainees’ mouths in the concentration camps, and was sentenced to 10 years imprisonment for war crimes and crimes against humanity.

Dr Hermann Pook was not only found guilty of the extraction of dental gold from dead prisoners‘ mouths, but also for the introduction of statistics on the amount of gold extracted. He was sentenced to 10 years imprisonment for crimes against humanity and membership in a criminal organisation. He only served 5 years and 9 months in jail. After he was released, he practised dentistry again in Northern Germany where he died in 1983.

Dr Willy Frank, a dentist at Auschwitz, was involved in the selection of prisoner convoys from the camp to the gas chambers. He was sentenced to seven years imprisonment for crimes against humanity and war crimes.  During his imprisonment he abandoned dentistry.

Dr Karl-Heinz Tauber [21], also at Auschwitz, was sentenced to 6 years imprisonment after he was found guilty of mass killings. He died on 15 June 1961.

Dr Karl Philipp Teodor Schütz spent more than 3 months in jail for his involvement in crimes at the Lublin-Majdanek extermination camp [22]. The director of the Memorial of the camp was unable to provide further information and details of Schütz.

Dr Walter Sonntag was sentenced to death and executed on 17 September 1948 for crimes he committed at Ravensbrück’s camp [23].

Conclusions