World J Urol DOI 10.1007/s00345-013-1183-3

ORIGINAL ARTICLE

German urologists under national socialism Matthis Krischel

Received: 26 August 2013 / Accepted: 5 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013

Abstract Objectives The first full-time professorship for urology at a German university was established in 1937 and in 1942, a rare teaching qualification (Habilitation) for urology was granted, both at the prestigious Berlin University. At the same time, nearly a third of all physicians who worked in the field of urology were classified as ‘‘non-Aryan’’ according to Nazi race laws and were forced out of their profession and their homeland. Many of them committed suicide or, if they refused to flee, were murdered in concentration camps. German urologists also contributed to compulsory sterilization of men according to the ‘‘law for the prevention of hereditarily diseased offspring’’ between 1934 and 1945. Methods Historical sources on the history of urology in Nazi Germany were reviewed and analyzed. These include textbooks and medical journals from the 1930s and 1940s, as well as files from different state and university archives. Results For urologists, the changing political environment in Germany after 1933 offered possibilities to assert their personal and professional interests. Unfortunately, in many cases, moral principles were thrown overboard, and physicians advanced their own careers and the specialty of urology at the expense of their patients and their Jewish colleagues. Conclusion Under national socialism, German urologists backed Nazi health and race policies and in exchange M. Krischel (&) Institut fu¨r Geschichte, Theorie und Ethik der Medizin, Medizinische Fakulta¨t der RWTH Aachen, Wendlingweg 2, 52074 Aachen, Germany e-mail: [email protected] M. Krischel Institut fu¨r Geschichte, Theorie und Ethik der Medizin, Universita¨t Ulm, Frauensteige 6, 89075 Ulm, Germany

gained further professionalization for their specialty, including university positions and increased independence from surgery. Only in recent years has this chapter of German urology’s past become a topic of debate among members of the professional society. Keywords History of medicine  History of urology  National socialism  Germany  Eugenics  Anti-Semitism Introduction The historical study of medicine under national socialism has identified core areas of injustice, which are connected to broader Nazi health policy [1]. This health policy was informed by racism, a focus on public health instead of individual patients’ well-being and stark programs against individuals carrying allegedly hereditary diseases and disabilities [2]. Effects of these policies were experienced by all members of the medical community after the Nazis seized power in 1933 [3]. In this contribution, I will present the way in which they affected the specialty of urology. Among those injustices were the demotion and persecution of Jewish doctors [4] and a research focus on congenital diseases and sterilization of its carriers [5]. I will try to answer the questions why so many practitioners were complicit in these injustices and why it took so long to name the perpetrators and try to make amends to the victims. Expulsion of Jewish urologists In 1933, urology was the smallest of the nine recognized medical specialties in Germany, with about 1.7 % of

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physicians [4]. Of those 866 urologists, 28 % were classified as Jewish, according to Nazi race laws (Fig. 1). This is a significantly higher percentage than among physicians in general (16 %) [6] and second among specialists only to pediatricians [7]. Of the 209 men and women about whose fate we know, 129 emigrated, most to the USA (57), Palestine (27) and Britain (12). Of those who refused to leave their native country, 40 died in the years between 1933 and 1945, at least ten by suicide, 36 were deported to and all but one murdered at concentration camps, and only five survived in Germany [4] (Fig. 2). Three Jewish urologists from Berlin may serve as examples. All three had been well-respected physicians:

Leopold Casper and Alexander von Lichtenberg had been past presidents of the German Society of Urology, and Eugen Joseph had been associate professor of urology at the Berlin University. Casper was 74 years old in 1933 when he had to step down from all posts at the German

Fig. 3 Leopold Casper (1859–1959); image courtesy of the Archives of the German Society of Urology

Fig. 1 Number of urologists in Germany in 1933: 866; adapted from [4]

Fig. 2 Fate of those 241 Jewish urologists between 1933 and 1945; adapted from [4]

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Fig. 4 Alexander von Lichtenberg (1880–1949); image courtesy of the Archives of the German Society of Urology

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Fig. 6 Karl Heusch (1894–1986); image courtesy of the Archives of the German Society of Urology Fig. 5 Eugen Joseph (1879–1933); image courtesy of the Archives of the German Society of Urology

Society of Urology. When conditions got even worse, he fled to France and later to New York, where he spend his retirement (Fig. 3) [8]. Alexander von Lichtenberg was able to continue to work longer than most of his colleagues, because he was not employed at a public hospital, which dismissed all Jewish doctors as early as April 1933, but at a private Catholic hospital. When Jews were stripped of even their most basic civil rights, he fled to Hungary and then to Mexico, where he practiced medicine until his death in 1949 (Fig. 4) [9]. A particularly grim fate was that of Eugen Joseph, who had been head of the urology department at the Berlin University hospital’s surgical clinic since 1913 and associate professor of urology since 1921. After being stripped of both his clinical and teaching positions in 1933, he shot himself on Christmas Eve of that year (Fig. 5) [10].

Foundation of the Reichs-German Society of Urology The German Society of Urology that had existed since 1906 was in fact an Austrian–German association. This is indicated by the facts that until 1929, presidencies rotated between Austrians and Germans and congresses between Vienna and Berlin, the two centers of German-speaking urology. When Nazi race laws forced all German Jewish board members to resign in 1933, the law did not apply to

the citizens of Austria, which remained an independent country until 1938. Sharing the leadership of their professional association with Austrian Jewish members seemed impossible, so in 1935 German urologists founded the Reichs-German Society of Urology. Its secretary, Karl Heusch (Fig. 6), stated that the new association was ‘‘founded in the interest of public health and the specialty of urology.’’ This means that German urologists hoped that if they supported Nazi health policies, they would receive support to further professionalize their specialty and emancipate it from surgery [11] (Fig. 7).

Public health, hereditary diseases and compulsory sterilization This support of Nazi policies had different aspects. At the first meeting of the new association in 1936, Karl Heusch gave a speech titled ‘‘urology and public health,’’ in which he promised that strengthening the institutional position of urology in Germany, including the creation of professorships at medical schools and departments at hospitals, could provide ‘‘battalions of soldiers and workers for the fatherland and improve the value of the German people’’ [12 (translation by MK)]. At the same time, congenital diseases were perceived as the main threat to public health and medical research focused on them [13]. An example for this is a paper given at the same congress which focused on ‘‘Urological

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World J Urol Fig. 7 Letter by Karl Heusch to potential members; Archives of the German Society of Urology, no signature

Fig. 8 Hans Boeminghaus (1893–1979); image courtesy of the Archives of the German Society of Urology

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Development Disorders and Questions about Heredibility,’’ in which heredibility of conditions was demonstrated by means of pedigrees [14]. This focus on hereditary diseases as a threat to public health led, among other things, to a compulsory sterilization law in Germany. Similar laws, which targeted people with psychiatric and physical conditions, existed in a number of countries at the time, including many states of the USA. When the German sterilization law took effect in 1934, hereditary health courts were installed in which physicians and jurists decided who was unfit to procreate [15]. Another law that allowed castration of sexual offenders and homosexuals was passed around the same time. These new laws led to a surge of publications that dealt with surgical sterilization and castration in medical journals. A leading textbook on the subject was coauthored by the urologist Hans Boeminghaus (Fig. 8) [16]. Up to 350,000 people were sterilized and up to 3,000 castrated in Nazi Germany [15], [17].

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Fig. 9 Otto Ringleb (1875–1946); image courtesy of the Archives of the German Society of Urology

Personal benefits and the development of urology as a medical specialty Reviewing this involvement, the following questions arise: Why did the majority of German urologists—at least of those who were not forced out of the profession—go along with these injustices? And why is there no recorded case of outspoken criticism during the Nazi era, and only a few in postwar Germany? The answer comes in two parts: Many German doctors actually were convinced Nazis, including the majority of leaders in the field of urology. Many of them, like Hans Boeminghaus and Karl Heusch, were early members of the Nazi party; others, like the first president of the Reichs-German Society of Urology, were members of the SS [18]. It is safe to assume that they were anti-Semites and thought of people with hereditary diseases as a cancer to body politic that needed to be purged. In return for their loyalty to the regime, which was in fact stronger than in some other specialties, urologists were rewarded. The same year that Otto Ringleb (Fig. 9) joined the uniformed SS, he was granted the first full professorship of urology in Germany, and in 1942, his pupil Karl Heusch received his Habilitation, an essential prerequisite for a professorship. A number of independent urological departments at German hospitals were founded during the 1930s and staffed with Nazi supporters. The foundation of the uro-surgical clinic at Berlin-Westend Hospital in 1939 with Hans

Fig. 10 Outline of the history of the German Society of Urology (1958), created from instruction by Karl Heusch; image courtesy of the Archives of the German Society of Urology

Boeminghaus as its founding director is an example of this trend. Coming to terms with the past After the end of the Second World War, German urologists, like most Germans, were looking for a way back to normalcy. The German Society of Urology met under the presidency of Hans Boeminghaus in 1948 and the same men who had been the leaders of the Reichs-German society took its leadership and continued to preside over congresses. Of the 129 Jewish urologists who had emigrated, only two returned to Germany, not enough to start a discussion about the association’s past wrongdoings. When German urology celebrated its 50th anniversary in 1957, it was Karl Heusch who depicted the Reichs-German society as a branch on the tree of German urology [19] (Fig. 10). This interpretation of history remained dominant until after the deaths of all involved in the 1980s [20]. Later, in the wake of a growing interest in the history of medicine in Nazi Germany, urologists started to question their professional association’s past. In a volume commemorating the 100th anniversary of the association, the Nazi era was identified as a dark time in its history that

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needed to be explored [21]. In the wake of this decision, a series of articles have appeared in the association’s scholarly journal, and in 2011, a two-volume book was published to commemorate those victimized [22] and try to explain why so many joined in the injustices [23]. While this book does not mark the end of the exploration of this historical period, it is an important milestone in the recognition of past injustices and a reminder lest we forget.

Conclusion Under national socialism, German urologists backed Nazi health and race policies and in exchange gained further professionalization for their specialty, including university positions and increased independence from surgery. This can be explained as an exchange of resources between the domains of medicine and politics, in which both sides exchanged favors to their mutual advantages [24]. At the same time, leading German urologists in the 1930s and 1940s did not take their patients or Jewish colleagues’ well-being into consideration. Institutional and personal continuities meant that in the immediate post-war era, the professional society’s past was not reflected critically. Only in recent years has this chapter of German urology’s past become a topic of interest and debate among members of the German Society of Urology. Acknowledgments The author would like to gratefully acknowledge the material and immaterial support provided by the German Society of Urology for research on the history of urology in Nazi Germany. This article is based on a paper presented at the 2012 American Urological Association annual meeting, which was made possible by a travel grant from the German Academic Exchange Service, and for which the author subsequently received the AUA Earl Nation Retrospectoscope Award. For these reasons, he would also like to thank the German Academic Exchange Service and the American Urological Association.

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German urologists under national socialism.

The first full-time professorship for urology at a German university was established in 1937 and in 1942, a rare teaching qualification (Habilitation)...
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