VIII: ROLES OF PHYSICIANS AND NURSES IN THE “MEDICAL” EXPERIMENTS FOR MILITARY PURPOSES Professor Susan Benedict UT Health Science Center Houston, Texas, USA 77030 Susan.C.Benedict@uth.tmc.edu 001-‐713-‐500-‐2039 Purpose of the Module: To describe the role of physicians and nurses in experiments that were designed to increase the survival of the German troops. Suggested Readings: Hoedeman, P. (1991). The Dachau Experiments in Hitler or Hippocrates. Sussex: The Book Guild Ltd. Translated from the Dutch by Ralph de Rijke. Schmidt, U. (2007). Karl Brandt: The Nazi Doctor. London: Hambledon Continuum. Spitz, V. (2005). Doctors from Hell. Boulder, CO: Sentient Publications. Suggested Video: “Science and the Swastika”, part 2, available from www.historychannel.com. Objectives: 1. Describe the concentration camp environment. 2. Discuss the value of research in German medicine. 3. Analyze how the physicians were able to disregard the human rights of the research subjects. Discussion Questions: 1. Why did the Prussian Directive of 1931, as mentioned in Module 1, not prevent unethical experimentation? 2. Should the data from these experiments be used in contemporary research? Synopsis: Research in Nazi Germany As described in Module I, medical care and medical education in Germany were among the best in the world at the time the Nazi Party came to power in 1933. Medicine in prewar Germany was a showcase of academic, scholarly, and analytical pursuits.1 Research and academic medicine were highly valued. One of the most prestigious positions in Germany would be a professorship in medicine at one of the world-‐renowned universities. German medicine addressed the ethics of research on human subjects long before the Doctors’ Trial at Nuremberg and the derivation of the Nuremberg Code. In fact, in 1900, the Prussian Minister of Religious, Educational and Medical Affairs issued a Directive in response to discussions in Parliament, the courts, and the press about human experimentation. Much of this discussion was focused on experiments conducted by Professor Albert Neisser in 1892. These experiments consisted of inoculating healthy patients with serum from patients infected with syphilis in an attempt to prevent the disease. Some of the healthy patients contracted syphilis. Consent to participate in the study was not obtained from any of the subjects or their parents/guardians. The Prussian Directive forbade non-‐therapeutic research on minors or people who were incompetent and required consent of others as well as an explanation of any possible adverse consequences of participation.2 Despite the Prussian Directive of 1900, there were widespread allegations of unethical experiments during the 1920s. Alfons Stauder, a member of the Reich Health Office, described medical research in Germany in 1931: Naked cynicism; placing the lives of small children on the same level as those of experimental animals (rats), dubious experiments having no therapeutic purpose; science sailing under false colors; crimes against the health of defenseless children; lack of sensibility; mental and physical torture; martyrization of children in hospitals; the worse forms of charlatanism; disgustingly shameful abominations in the name of science run mad; horrors of the darkest middle ages, outstripping the infamous deeds of the inquisition and the hangman; social injustice; discrimination between the rich and the poor.3 Allegations of collusion between the hospitals and pharmaceutical manufacturers were made by Friedrich Müller in 1930 when he stated that medical pharmaceuticals were being “thrown onto the market and advertised” and hospitals were “working for the chemical industry and big business.”4 The deaths of 75 children from tuberculosis experiments were exposed by Dr. Julius Moses, a member of Parliament. As a result, guidelines for human experimentation were published in a Reich Circular entitled “Regulations on New Therapy and Human Experimentation”. In addition to being important at the time, this document was later cited at the Nuremberg Doctors’ Trial to verify that guidelines for human experimentation did, in fact, exist in Germany prior to World War II. This Reich Circular of 1931 contained almost all of the points of the subsequent Nuremberg Code.5 If the guidelines of the Reich Circular had been adhered to, the medical experiments of Nazi Germany would have be prohibited. The Reich Circular of 1931 contained these 14 points: 1. To exclude human experimentation or innovative therapy would hinder the development of progress in the diagnosis, treatment, and prevention of disease. The physician doing research must have responsibility for the life and health of any subject. 2. “Innovative therapy” is therapy with a purpose although its effects cannot be sufficiently evaluated on the basis of existing experience. 3. “Scientific experimentation” is interventions and treatment methods undertaken for research without a therapeutic purpose and whose effects and consequences cannot be sufficiently evaluated of the basis of existing experience. 4. Innovative therapy must be justified and performed in accordance with medical ethics. Adverse effects must be proportionate to the anticipated benefits. Innovative therapy must have been tested on animals when possible. 5. Innovative therapy may be carried out only with the unambiguously consent of the subject or his legal representative in the light of relevant information provided in advance. If consent is refused, innovative therapy may be done only if it constitutes an urgent procedure to preserve life or prevent serious damage to health and prior consent could not be obtained under the circumstances. 6. Innovative therapy must be examined with particular care where the subject is a child or a person younger than 18 years of age. 7. Exploitation of social hardship in order to use innovative therapy is incompatible with the principles of medical ethics. 8. Extreme caution should be used with innovative therapy involving microorganisms, especially live pathogenic. This therapy should be used only if it can be assumed to be relatively safe and similar benefits are unlikely to be achieved under other methods. 9. Innovative therapy may be carried out only be the physician in charge or by another physician acting in accordance with his instructions and responsibility. 10. A report of an innovative therapy must be made and include the purpose of the procedure, the justification, the way it was carried out, and a statement that the subject or his legal representative were provided, in advance, with all relevant information, and gave consent. If carried out without consent, as in #5, full details must be given. 11. The results on any innovative therapy may be published only in a manner respecting the subject’s dignity and respectful of the dictates of humanity. 12. Sections 4-‐11 of this document also apply to scientific experimentation. In addition, the following also apply: A. Experimentation shall be prohibited in all cases where consent has not been given. B. Experimentation involving human subjects shall be avoided if it can be replaced with animal studies. Experimentation involving human subjects may be carried out only after all data from animal studies and/or laboratory testing have been obtained and validity of the experiment has been obtained. Motiveless and unplanned experimentation involving human subjects shall obviously be prohibited. C. Experimentation upon children under the age of 18 years is prohibited if it in any way endangers the child or young person. D. Experimentation involving dying subjects is incompatible with the principles of medical ethics and shall therefore be prohibited. 13. While physicians, especially those in charge of hospitals, may be expected to be guided by a strong sense of responsibility toward their patients, they should at the same time not be denied the satisfying responsibility [verantwortungsfreudigkeit] of seeking new ways to protect or treat patients or alleviate their suffering where they are convinced by their experience that known methods are likely to fail. 14. Academic training courses should take every suitable opportunity to stress the physician’s special duties when carrying out a few form of therapy or a scientific experiment, as well as when publishing his results.6 In 1933, the Nazi Party passed legislation to protect animals. The laws stated that all operations or treatments that were associated with pain or injury, especially experiments involving the use of cold, heat, or infection, were prohibited and could be permitted only under exceptional circumstances.7 Had this law applied to humans, it would have rendered unlawful almost all of the Nazi experiments upon humans. It is within this culture and context that the experiments of the Nazi physicians and scientists must be viewed. This module will describe the experiments that used wartime as a rationale. Dr. Karl Brandt, the Reich Commisioner for Health and Sanitation,8 as the Reich’s head physician, played a significant role in the development of the experiments, just as he had in the euthanasia program. As seen in this Führer Decree of 28 July 1942, Brandt answered to no one but Hitler: I empower Prof. Dr. Karl Brandt, subordinate only to me personally and receiving his instructions directly from me, to carry out special tasks and negotiations to readjust the requirements for doctors, hospitals, medical supplies, etc., between the military and the civilian section of the health and medical services.9 Nutrition Experiments at Mauthausen Brandt’s first effort at experimentation related to the war effort had its origins in the huge loss of German troops in Stalingrad in early 1943.10 Brandt requested that “relevant nutritional experiments” could be carried out in concentration camps. Brandt’s request was turned down by the SS because no new information would be garnered and, additionally, because the nutritional condition and training of the troops would not be representative and the positive effects of the troops’ morale would not be present.11 However, seemingly without Brandt’s participation, nutritional experiments were carried out in Mauthausen concentration camp in the summer of 1943. There the SS fed 450 “healthy” prisoners Östliche Kostform [“Eastern Nutrition”], an artificial pâté made of cellulose refuse. Many of those prisoners suffered from severe gastrointestinal problems; however, the experiment was expanded to an additional 370 Mauthausen prisoners: 150 who were to receive the cellulose pâté and 220 prisoners as controls for another 6 months. In this experiment, 116 prisoners died.12 High-‐Altitude Experiments Dr. Sigmund Rasher was an ambitious young physician who aspired to become a professor. He married a woman who was close to Heinrich Himmler and this proximity to power fueled his ambitions.13 In 1939, he was drafted into the Luftwaffe’s [Air Force] Medical Research Center in Munich. It was there that he began his “research” career using animals as subjects. An opportunity came with the Battle of Britain and Germany’s inferiority in the air war. British aircraft were able to fly at much higher altitudes and, in addition, many German airmen had died in the cold seas of the English Channel. Professor Erich Hippke was tasked with solving the medical aspects of this inferiority and he discussed the issues with two colleagues. Under Hippke’s supervision, experiments were begun at Munich and Rasher, who was assigned to the project, saw his opportunity.14 He wrote to Himmler in May 1941: I therefore ask this question in all seriousness: Could two or three professional criminals be made available for these experiments…The experiments, during which, of course, the test persons may die, will proceed with my collaboration. They are definitely of importance in high-‐altitude flight research, and cannot be conducted with monkeys, as has been tried, since monkeys react altogether differently. I have talked about this matter in strict confidence with the deputy air surgeon who will conduct these experiments, and he shares my views that the problems in question can be clarified only by way of experiments on human beings. (Feeble-‐minded persons might also be used as testing material).15 Himmler gave Rasher permission to select prisoners from Dachau, where a high-‐ altitude chamber was installed. Two hundred prisoners were selected with the promise that they’d be freed in return for their participation. In only one case was that promise kept. For 60 others, it was death. All suffered excruciatingly, as described by the prisoner-‐nurse Anton Pacholegg: I personally watched a prisoner through the screen of the low-‐pressure chamber who stood in the vacuum until his lungs burst. In the cabin, the prisoners went crazy, tearing their hair out in their attempts to relieve the pressure; some clawed their faces and heads open with frenzied nails. They beat their heads and hands on the walls and screamed for the pressure on the eardrums to be released. These cases usually ended in the death of the test subjects…16 In a report Rasher wrote in April 1942, and which was used as evidence in the case against him in the Doctors’ Trial at Nuremberg, he described the horrible suffering of a 37 year old Jewish prisoner during one of the experiments: The third experiment of this type took such an extraordinary course that I called an SS physician of the camp as witness, since I had worked on these experiments all by myself. It was a continuous experiment without oxygen at a height of 12 kilometers conducted on a 27 year old Jew in good general condition. Breathing continued up to 30 minutes. After 4 minutes the experimental subject began to perspire and wiggle his head, after 5 minutes cramps occurred, between 6 and 10 minutes breathing increased in speed and the experimental subject became unconscious; from 11 to 30 minutes breathing slowed down to three breaths per minute, finally stopping altogether. Severest cyanosis developed in between and foam appeared at the mouth. At 5 minute intervals electrocardiograms from three leads were written. After breathing had stopped Ekg (electrocardiogram) was continuously written until the action of the heart had come to a complete standstill. About ½ hour after breathing had stopped, dissection was started.17 Another report described how some subjects who had survived the experiments were then murdered so that autopsies could be performed: Some of the experimental subjects died during a continued high-‐altitude experiment; for instance, after one-‐half hour at a height of 12 kilometers. After the skull had been opened under water, an ample amount of air embolism was found in the brain vessels and, in part, free air in the brain ventricles. In order to find out whether the severe psychic and physicals, as mentioned under No. 3, are due to the formation of embolism, the following was done: After relative recuperation from such a parachute descending test had taken place, however before regaining consciousness, some experimental subjects were kept underwater until they died. When the skull and cavities of the breast and of the abdomen were opened under water, an enormous amount of air embolism was found in the vessels of the brain, the coronary vessels, and the vessels of the liver and the intestines.18 The subjects of these horrific experiments were not “professional criminals”. They were Jews who had been condemned for marriage or sexual relations with an Aryan woman.19 The high-‐altitude experiments concluded in August 1942.20 Freezing Experiments When Dr. Rasher concluded his high altitude experiments, his “research” career was far from over at Dachau. Serving as assistant to Dr. Georg August Weltz, a Lieutenant Colonel in the Medical Service of the Air Force and Chief of the Institute for Aviation Medicine in Munich,21 Rasher conducted the hypothermia experiments from about August 1942 until spring 1943.22 The topic of freezing experiments was first brought up to Himmler in July 1942 when Rasher and Dr. Hans Wolfgang Romberg, a member of the staff of the Department of Aviation Medicine, went to Berlin to deliver a report on the high-‐altitude experiments. At that time, according to Romberg, He [Himmler] also gave orders to effect preparations for cold-‐experiments and talked about popular methods of warming up near-‐drowned and frozen people. In particular, the story of a fisherwoman, who warmed her half-‐frozen husband up in bed seemed to please him…Himmler also took this opportunity to explain again that in this all-‐out war, concentration camp prisoners had to be used for medical experiments. He added that those who did not understand this, failed to understand the whole war; for it meant life or death for Germany.23 Himmler asked Romberg if he wanted to assist in the cold-‐experiments but he declined – and without consequence!24 The purpose for the freezing experiments was to determine the most effective way of warming German pilots who were forced to parachute into the North Sea.25 The tank for the cold-‐water experiments was built in Block 5 of Dachau. It tank measured 2mx2mx2m, holding 8,000 liters of ice cold water. Prisoners were forced to jump into the icy water fully outfitted as pilots and various methods were employed to warm them. Some of the researchers wanted to anesthetize the subjects; however, Rasher objected, saying that would affect the results of the experiment.26 In some of the experiments, the subjects were in the tank for 3 hours. In other experiments, the subjects had to stay outside in freezing weather with no clothing for 9 to 14 hours.27 Rasher made the following report in August 1942: Electrical measurements gave low temperature readings of 26.4C in the stomach and 26.5C in the rectum. Fatalities occurred only when the brain stem and the back of the head were also chilled….As soon as the temperature in those experiments reached 28C, the experimental subjects died invariably, despite all attempts at resuscitation.28 Various methods were attempted to re-‐warm the subjects with the most common being by a very hot bath. In September 1942, Himmler himself ordered rewarming by the warmth of other human beings to be tried. The researchers brought 4 female Gypsy prisoners from Ravensbrück concentration camp. Re-‐warming of the subjects was then attempted by placing each one between two naked women. Rasher described these cold-‐ experiments without anesthesia.29 Experiments without narcosis showed no essential differences in the course of cooling. Upon entry into the water, a severe cold shuddering appeared. The cooling of the neck and backof the head was felt as especially painful, but already after 5 to 10 minutes, a significant weakening of the pain sensation was observable. Rigor developed after this time in the same manner as under narcosis, likewise the tonic-‐clonic twitching. At this point, speech became difficult because the rigor also affected the speech musculature. Simultaneously with the rigor also affected the speech musculature with or without narcosis. It was reported that so to speak, an iron ring was placed about the chest. Objectively, already at the beginning of this breathing difficulty, a marked dilatation of the nostrils occurred. The expiration was prolonged and visibly difficult.30 It was during the winter of 1942-‐1943 that Rasher experimented with people placed outdoors without clothing. His report to Himmler included the following: Up to now, I have cooled off about 30 people stripped in the open air during nine to fourteen hours at 27 to 29 [degrees C]. After a time, corresponding to a trip of 1 hour, I put these subjects in a hot bath. Up to now, every single patient was completely warmed up within 1 hour at most, although some of them had their hands and feet frozen white.31 The prisoner-‐nurse Walter Neff, described these experiments: A prisoner was placed naked on a stretcher outside the barracks. This was in the evening. He was covered with a sheet, and every hour a bucket of cold water was poured over him. The test subject lay out in the open like this until the morning. The temperature of these test subjects was taken with a thermometer. Later, Dr. Rascher said it was a mistake to cover the subject with a sheet and to drench him with water. This caused the wrong effect since the air could not reach the test subject. In future, the test subjects must not be covered…I do not recall precisely, however, whether there were fatalities during these experiments and how many. I would like to state, without reservation, that about three victims lost their lives at this time.32 Rasher had some complaints about some of the conditions of his experiments. He hinted to Himmler that he’d like to move his on-‐ground freezing experiments to Auschwitz where the winters were much more severe and where he could conduct his experiments in outlying areas where other prisoners would not hear the victims’ screams in the night.34 Rasher also complained that one of the four Gypsy women sent from Ravensbrück to warm the freezing subjects with her naked body was too Nordic in appearance: My racial conscience is outraged by the prospect of exposing a girl to racially inferior concentration camp elements who is outwardly pure Nordic and who might be led on the right path by proper employment. For this reason, I decline to use this girl for my experimental purposes, and I have rendered an appropriate report to the Commandant of the camp and to the adjutant of the Reichsführer SS…35 The results of these freezing experiments were presented at a medical conference in Nuremberg in October 1942. The paper was titled “Prevention and Treatment of Freezing”. Weltz delivered a presentation entitled “Warming up after Freezing to the Danger Point” at the same conference. Thus it is clear that the cruel and inhumane experimentation of human prisoners of concentration camps was being done and was thought to be a source of academic achievement for the researchers.36 In February 1943, Rasher reported his re-‐warming results to Himmler. He reported that subjects who were placed in a bed with two naked women did not warm as quickly as those placed with one naked woman. Rasher concluded that this was because, with one naked woman, inhibitions were removed and the woman “nestled more intimately”. The two women warmed the subjects at about the same rate as subjects rewarmed by packing in blankets. The exception was four subjects who were able to have sexual intercourse. These subjects warmed at about the same rate as subjects rewarmed in a hot bath.37 The Sea Water Experiments It seems as though research had, with Rasher et al.’s experiments, caught on well at Dachau. Citing the previous authorization to use prisoners as subjects, Professor Konrad Schrὅder sought Himmler’s permission to conduct experiments on making sea water drinkable. Meetings to discuss the problem were held in May 1944 and attended by representatives of the Navy, the Air Force, and I.G. Farben manufacturing company. It was agreed to conduct a series of experiments in which the subjects, who were to be fed only shipwreck emergency rations, were divided into four groups: (1) to receive no water at all, (2) to received ordinary sea water, (3) to receive sea water which was altered to remove the taste but not the salinity, and (4) to receive sea water which had the salt removed. Because it was recognized that the subjects were likely to die or, at least, suffer severe health problems, only subjects provided by Himmler himself could be used.38 Himmler decided that Gypsies would be the subjects.39 These subjects were recruited from Buchenwald concentration camp. Under the mistaken assumption that nothing could be worse than Buchewald, some volunteered.40 The Gypsies ranged in age from 16 to 49 years.41 Fritz Pillwein, a Viennese student who worked as a prisoner-‐nurse, described the sea-‐water experiments that took place in fall 1944: For the first three days the test subjects were given emergency marine rations, consisting of one tablet koka-‐kola, some dextropur and a few pieces of rusk, ten to twelve small pieces. In addition, from the first day to the last, the participants were issued salt water four to five times daily to the total quantity of a pint. The forty-‐four subjects were subdivided into five or six groups. Two groups received pure sea water, two other, pure sea water with an added salt preparation, the remaining group received distilled sea water without any additives. From the outset, daily blood specimens were drawn from the participants. With certain patients, weakness and especially thirst took such extreme forms that after only a few days, they could no longer leave their beds. In one case, I remember that the patient broke out into paroxysms of screaming. It happened frequently that these patients drank from the slop buckets of the orderlies, or in unobserved moments, drained water from the air-‐raid protection buckets in the hall. Some patients actually lapped up the water poured out on the floor for mopping. I had to weight the men taking part in the test every day, and noted that the daily loss of weight was up to two pounds.42 In addition to the agony of extreme thirst, the victims were also subjected to lumbar and liver punctures.43 Epidemic Jaundice Experiments The cause of epidemic hepatitis was a huge military concern. In September 1941 alone, there were 190,000 German soldiers with infectious hepatitis.44 In some units, up to 60% of the soldier were affected.45 During World War II, an estimated 10 million people had hepatitis. In fall 1941, some psychiatric patients in Breslau were infected with hepatitis without their consent.46 On April 30, 1943, Arnold Dohmen, a bacteriologist and military officer wrote to Brandt to convince him that studies were necessary to determine if infectious hepatitis was caused by a bacterium or a virus so that a vaccine could be developed.47 On June 16th, Himmler granted permission to use eight prisoners from Auschwitz who had been sentenced to death. He then specified that these eight be Jews from the Polish resistance movement. One week later, Dohmen was headed for Auschwitz and, on the following day, joined Josef Mengele on the selection ramp to select subjects for his study.48 Rather than selecting 8 prisoners from the Polish resisters, Dohman selected 18 Jewish prisoners who were between the ages of 9 and 22 years. On August 11th, 11 of the children, dressed in civilian clothes and accompanied by a guard, travelled by ordinary passenger train to Berlin and then on to Sachsenhausen concentration camp. In October 1943, the children were injected with hepatitis-‐infected material. Some received one injection whereas others received two or even three injections.49 The experiments stopped abruptly and without explanation in November 1943 when much of Dohmen’s research material was destroyed by allied bombers.50 Dohmen resumed his research at Sachsenhausen a year later, in September 1944. The 11 children were placed in isolation yet despite having high fevers, the children didn’t believe that Dohmen would harm them. Although some of the children had painful liver biopsies, none experienced long-‐term consequences.51 This latter statement is contradicted by Brandt who stated that some subjects died as a result of the experiments.52 The Malaria Experiments Like the high-‐altitude and freezing experiments, the malaria experiments were also conducted at Dachau, an enthusiastic venue for Nazi military experiments. The malaria experiments were carried out under the direction of Professor Dr. Claus Schilling in 1942-‐ 1944. 53 Eggs from the anopheles mosquito and malaria cultures were sent to Schilling at Dachua in 1942 and 1943 from the Robert Koch Institute in Berlin. Over 1,200 inmates of various nationalities were infected with malaria either by mosquitoes or injections of the glands of the mosquitoes. Among these victims were Catholic priests. After developing malaria, the victims were treated with a variety of medications. Many deaths occurred from neosalvarsan and pyramidon. Malaria itself caused the death of 30 subjects and another 300-‐400 died of complications of the experiments.54 Father Leo Miechalowski, who survived both the freezing experiments and the malaria experiments, testified at Nuremburg: …I was given malaria in such a manner that there were little cages with infected mosquitoes, and I had to put my hand on one of the little cages and a mosquito stung me, and afterwards I was still in the hospital for five weeks. However, for the time being no symptoms of the disease showed themselves. Somewhat later, I don’t exactly recall, two or three weeks, I had my first malaria attack. Such attacks recurred frequently, and several medicines were given to us for – against malaria. I was given such medicine as neo-‐salvasan. I was given two injections of quinine. On one occasion I was given atabrine, and the worst was that one time when I had an attack I was given so-‐called Perifere. I was given nine injections of that kind, one every hour, and after that every second day through the seventh injection. All of a sudden my heart felt like it was going to be torn out. I became insane. I completely lost my language-‐my ability to speak. This lasted until evening. In the evening a nurse arrived and wanted to give me the eighth injection. I was then able to speak, and I told the nurse about all of the complications I had had and that I did not want to receive the injection.55 Mustard Gas “Lost” Experiments The alleged purpose of the mustard gas experiments was to discover an effective treatment for soldiers burned by mustard gas, a chemical warfare agent also known as Lost. The experiments were carried out at Sachenshausen, Natzweiler and other concentration camps beginning as early as 1939.56 The subjects, who were non-‐German citizens such as Poles, Russians, Jews, and Gypsies, were inflicted with wounds and then the wounds were exposed to mustard gas. Other victims were forced to inhale it, drink it in liquid form, or have it injected.57 The mustard gas experiments that were carried out in the Natzweiler camp began in November 1942 and were supervised by Professor Dr. Hirt of the University of Strasbourg. Subjects included 220 Russian, Polish, Czech, and German inmates. Of these, approximately 50 died.58 The mustard gas experiments also were conducted at Neuengamme concentration camp, as described by a former inmate who worked in the hospital: …The prisoners were stripped completely naked. They came into the laboratory one after the other. Then I had to hold their arms and a drop of this fluid was rubbed on their arm ten cm. above their forearm. Then the people who had been treated accordingly had to stand waiting with their arms spread out. After about ten hours, maybe it was a bit longer, burn injuries began to cover their whole body. Their bodies were burnt in all of those places where fumes from this gas reached. Some of the people also went blind. The pain was so tremendous that one could hardly stand being near the victims. Then they were photographed each day; all of the injured parts of their bodies: i.e., each of their burnt areas. About on the fifth or sixth day we had our first death. At the time the dead were sent to Strasbourg, because there was no crematorium in the camp. The dead man was sent back and was “dissected” in the Ahbenerbe [SS research foundation]. His intestines, lungs and so forth were complete eaten away. Then, during the following several days, seven more people died.59 The Sulfanilamide Experiments Ravensbrück concentration camp is located just outside the beautiful resort town of Fürstenberg, Germany and is 55 miles from Berlin. It was constructed in 1939 and had a planned capacity of 6,000 to 8,000 female prisoners. Many nationalities were represented including Germans, Poles, and even Americans. By the end of the war, Ravensbrück’s population had increased to over 123,000 and as many as six women shared each bunk.60 Ravensbrück became the site of the sulfanilamide experiments. The purpose of the sulfanilamide experiments was to determine if the medication, sulfanilamide, would be effective in treating the wounds of soldiers. It had already been recognized in World War I that most soldiers did not die as a direct result of the wound sustained but rather died of infections of these wounds.61 In the winter of 1941-‐1942, there were especially heavy causalities of German soldiers on the Russian front from gas gangrene and the sulfanilamide experiments were done to determine if the drug would increase survival on the long transports to the base hospitals.62 Thus the question to be answered was whether the wounded should be treated surgically at field hospitals or should be treated with sulfanilamide and then transported to better equipped facilities. In addition to this wartime context, there was also the assignation of Reinhard Heydrich, Chief of the Reich Security Main Office. There was a charge that Heydrich’s life could perhaps have been saved had he received sulfanilamide. Hitler himself gave the order for the experiments.63 The initial experiments were conducted by Dr. Karl Gebhardt on 15 male criminals who were transferred from Sachsenhausen concentration camp to Ravensbrück. This first group of subjects consisted of criminals who had been sentenced to death but were to be pardoned if they survived the experiment. A second group of experimental subjects were 36 female prisoners of Ravensbrück who had been members of the Polish Resistance Movement and who, as a result, were sentenced to death. This group was divided into 3 groups of 12 subjects.64 The first group of 15 males was used to determine a mode of infection with various bacteria. Longitudinal incisions were made 10 cm. in length to expose the muscle and an ischemic zone was created by injecting adrenalin. Into this ischemic area was placed a gauze strip saturated with bacteria. Staphylococci, streptococci, para oedema malignum, bacteria Fraenkel, and earth were the infecting agents. However, the resulting infections were not severe enough to suit the researchers so six additional male subjects were infected with bacteria and wood shavings were added. Subjects were treated with various forms of sulfanilamide.65 Following these experiments on the males subjects, the females were similarly infected with the first group being infected with bacteria and wood fragments, the second group were infected with bacterial cultures and glass fragments, and the third group received bacterial cultures plus both wood and glass. There were no deaths from these experiments so Reich Physician SS Grawitz concluded that the experiments did not adequate replicate battlefield conditions. Thus a new series of experiments on 24 Polish female prisoners was designed. In this experiment, the blood circulation of the muscle was interrupted by tying off the muscles on either end. This experiment resulted in very severe infections. Five subjects died as a direct result and six were shot to death at a later time.66 Of those who died from the experiment, one died from tetanus, and the others from hemorrhage and gas gangrene.67 The post-‐operative care of the experimental subjects was entirely inadequate. Many of the subjects were given neither medicine nor morphine. They were given bandages from time to time when the doctors felt like it. Sometimes they waited 3 days, sometimes 4 days. There was a terrible odor of pus in the room. The girls were forced to help each other.68 In February 1945, there was an attempt to execute all of the experimental subjects. They were called to one block and told that they were being transferred to Gross-‐ Rosen concentration camp; however, these prisoners were aware that Gross-‐Rosen was already in the hands of the Allied Forces so they figured that they were going to be executed. They were able to avoid this by hiding which was possible due to the disorganization of Ravensbrück at that time.69 A number of the victims of these experiments survived and testified against the researchers in the Doctors’ Trial at Nuremberg as described in Module IX. Bone, Muscle and Nerve Regeneration, and Bone Transplantation Experiments These experiments were conducted on the same Ravensbrück concentration camp prisoners as were the sulfanilamide experiments and were to address battlefield wounds and subsequent disabilities. For the muscle regeneration experiments, a 5 cm incision was made on the outer aspect of the thigh and a piece of muscle was removed. Afterward a cast was applied. In one week, the incision was reopened and the area of the muscle surrounding the original excision was removed and again a cast was applied. One prisoner-‐physician who worked at Ravensbrück as a nurse secretly kept very detailed notes in the hope of one day being able to bear witness: As far as I know about thirteen prisoners were operated on several times, as a result of which two of them died. The muscle operations were very important. Certain muscles were hereby removed from the leg, which then became thin and weak. I never understood the point of these tests, neither was it clear to me what then happened to the muscles once they were removed. I don’t know whether they were taken to Hohenlychen. The experiments on the mentally defectives are another story. I can still remember two incidents very well. They amputated someone’s leg. The nurses took her to the operating room, and afterwards she did not return, but was brought to the special department to which the dead were normally transferred. Together with a friend, who also worked in the camp hospital, I went to have a look; we saw a corpse, from which one leg had been amputated, covered by a sheet. A little while later the nurses returned and, with no help from other prisoners, put the body into a coffin; this is how it was kept secret…Later, another mentally defective woman was taken in to the operating room; shortly thereafter Dr Fischer also went in. A little later he returned with a large parcel under his arm, the length of an arm, and he left for Hohenlychen by car. Shortly afterwards one of the prisoners came up to me and said: ‘Do you know what’s happened? They amputated her arm, together with the shoulder blade!’ I still remember these two incidents very well.70 In the instance of the shoulder amputation, the amputated part was transplanted onto a patient at Hohenlychen by Drs. Gebhardt, Schulze, and Stumpfegger.71 There were three kinds of bone experiments done at Ravensbrück: fractures, bone transplantation, and bone splints. In some instances small pieces of the fibula were removed and in others sections of the periosteum were also taken out. In the fracture experiments, the tibia was broken in several places and, on some of these prisoners, clamps were applied and on others no clamps were applied. Some prisoners had as many as six experimental surgeries performed on them.72 At least 10 whole limb amputations were carried out on mentally ill prisoners. In these cases, the legs were amputated at the hip joint or arms with shoulder blades were removed. Afterwards the victims, if still alive, were killed with injections of Evipan and the amputated limbs were taken to Hohenlychen.73 Many of the surviving young women who were the victims of these experiments formed a cohesive group at Ravensbrück. They were members of the Polish resistance thus had both ethnicity and politics in common. Many were university students. During the recuperation from their surgeries, which often took months, they were housed together in the Revier [hospital] and away from the other prisoners. They were referred to as “Kaninchen” [rabbits] by the entire camp. Perhaps it was because of their education and bonding that they had the nerve to present a petition to the Commandant of the camp stating that the surgeries violated all humanitarian principles and that they were being turned into “cripples”, their lives were being endangered, and that the surgeries were against their will. They all together took this written petition to the Lagerkommandant, an entire procession of cripples with bandaged legs, some walking on crutches. At that time there were in the block about 50 who had been operated; others were still lying in the Revier. They marched across the entire camp. Herr Lagerkommandant did not even take the trouble to come out to meet the crippled women, only sent out a female clerk, who explained, that there were to be no operations, that there are only hysteric inventions of the women folk, because those who had been summoned recently, were only supposed to have their temperatures taken. The Aufseherin [supervisor] spoke rather hesitatingly about hysterical inventions, due to the 50 bandaged legs in front of her… …For the time being, it seemed that it [the petition] had some meaning and the group felt stronger again.74 It seemed as if the experiments were finished by August 15, 1943 when word leaked out to the prisoners that the operating room was again being prepared. That evening the supervisor came with a list of 10 names but the women refused to go to the Revier. As a result, the entire block was closed for 3 days and 3 nights, without food, water, or fresh air. The 10 women were found and dragged to the punishment bunker where 5 of them were operated on just as they were, in dirty dresses, without any operating room, without nurses, in concrete prisoner cells which were damp and dirty.75 No one even bothered to remove their shoes.76 Incendiary Bomb Experiments The incendiary bomb experiments were carried out at Buchenwald concentration camp by Dr. Erwin Ding-‐Schuler in November 1943. The purpose was to test the effectiveness of a drug, R 17, and an ointment, echinacine, for the treatment of phosphorus burns. Five subjects were deliberately burned with ignited phosphorus from an incendiary bomb resulting in very severe pain and permanent injuries.77 The experiments were conducted by applying liquid phosphorus to the forearm and then igniting it. These experiments were conducted several times on the subjects. In some cases, the phosphorus, after it burned out, was wiped off with water and in other cases R 17 was applied at various intervals ranging from immediately to 30 minutes later.78 Conclusion The above synopsis describes some of the experiments which were documented at the Doctors’ Trial at Nuremberg. The consequences of these inhumane experiments to these physicians and scientists will be discussed in Module IX. References: 1. Grodin, M. (1992). “Historical Origins of the Nuremberg Code.” In The Nazi Doctors and the Nuremberg Code, edited by George J. Annas and Michael Grodin. New York: Oxford University Press, p. 128. 2. Ibid, p. 127. 3. Ibid, p. 128. 4. Ibid, p. 128-‐129. 5. Ibid, p. 129. 6. Reichsgesundheitblatt 11, No. 10, March 1931, 174-‐175. Published in the International Digest of Health Legislation 31 (1980), p. 408-‐411. Cited in Grodin, M. (1992). “Historical Origins of the Nuremberg Code.” In The Nazi Doctors and the Nuremberg Code, edited by George J. Annas and Michael Grodin. New York: Oxford University Press, p. 130-‐131. 7. Grodin, p. 132. 8. Trials of War Criminals before the Nuernberg Military Tribunals under Control Council Law No. 10 (1946-‐1949) , Vol. 1. Washington, DC: US Government Printing Office, p. 30. 9. Ibid, p. 82. 10. Schmidt, U. (2007). Karl Brandt: The Nazi Doctor. London: Hambledon Continuum, p. 261. 11. Ibid. 12. Ibid, p. 262. 13. Hoedeman, P. (1991). The Dachau Experiments in Hitler or Hippocrates. Sussex: The Book Guild Ltd. Translated from the Dutch by Ralph de Rijke, p.150. 14. Ibid, p. 151. 15. Ibid, p. 152. 16. Ibid, p. 156. 17. Trials, p. 39. 18. Trials, p. 40-‐41. 19. Trials, p. 40. 20. Spitz, V. (2005). Doctors from Hell. Boulder, CO: Sentient Publications, p. 65. 21. Trials, p. 9. 22. Trials, p. 41. 23. Hoedeman, p. 164. 24. Ibid. 25. Trials, p. 42. 26. Hoedeman, p. 165. 27. Trials, p. 42. 28. Ibid. 29. Trials, p. 43. 30. Ibid. 31. Ibid. 32. Hoedeman, p. 169. 33. Trials, p. 43. 34. Hoedeman, p. 169. 35. Ibid, p. 170-‐171. 36. Trials, p. 43. 37. Trials, p. 251. 38. Trials, p. 46. 39. Trials, p. 47. 40. Hoedeman, p. 179. 41. Spitz, p.157. 42. Trials, p. 180-‐181. 43. Trials, p. 427. 44. Schmidt, p. 265. 45. Trials, p. 494. 46. Schmidt, p. 265. 47. Ibid, p. 269. 48. Ibid, p. 271. 49. Ibid, p. 273. 50. Ibid. 51. Ibid, p. 275. 52. Trials, p. 495. 53. Trials, p. 283. 54. Trials, p. 44. 55. Spitz, p. 106-‐107. 56. Trials, p. 44 57. Schmidt, p. 285. 58. Spitz, p. 136. 59. Spitz, p. 136-‐137. 60. Benedict, S. (2003). “The Nadir of Nursing: Nurse-‐Perpetrators of the Ravensbrück Concentration Camp”. Nursing History Review, 11(2003), p. 130. 61. Trials, p. 364. 62. Spitz, p. 139. 63. Trials, p. 366. 64. Ibid, p. 367. 65. Ibid, p. 356-‐357. 66. Ibid, p. 357-‐358. 67. Ibid, p. 359. 68. Ibid, p. 360. 69. Ibid, p. 363. 70. Hoedeman, p. 58-‐59. 71. Trials, p. 395. 72. Ibid, p. 393-‐394. 73. Ibid, p. 405. 74. Póltawska, W. (1965). “Guinea Pigs” in the Ravensbrück Concentration Camp. In Przegląd Lekarski No. 1. International Auschwitz Committee (1971). Inhuman Medicine. In Anthology, vol.1, part 2, p. 142. 75. Ibid, p. 145. 76. Aroneau, E. (1996). Inside the Concentration Camps, translated by Thomas Whissen. Westport, CT: Praeger Publishers, p. 96. 77. Trials, p. 640. 78. Ibid, p. 649.