Pulmonary Medicine and its Institutions During National Socialism

Abstract

When the National Socialists came to power in 1933, a complete paradigm shift took place in the health policy under the principle "Public interest ahead of self-interest". In the early years there was an intense discussion about whether tuberculosis (TB) is more caused by heredity or by infection. Finally, the arguments of leading TB specialists were accepted that TB is predominantly an infectious disease. In 1939, the year Germany started World War II, TB mortality was at its lowest, with only a few countries having lower rates. TB mortality increased in all areas during the war, both in the civilian population and in the Wehrmacht, as well as in prisoners of war, foreign forced laborers and concentration camps. Incapable TB patients were considered biological and social "ballast". They were worthless for the "national community" and had to be socially excluded. Thus one could refuse them the "marriage loan" introduced in the summer 1933, forbid starting from 1935 also the marriage. From 1938 on, TB-patients with open TB, who showed themselves unreasonable, could be compulsorily isolated as "asocial" by public health physicians - mostly pulmonary specialists. There, under prison conditions and with limited food, most patients fell victim to TB in a short time. Especially inhuman was the handling of prisoners in the concentration camps, where the disease was very common. Thousands of people were killed prematurely through deliberate neglect, starvation, abuse for medical experiments, or simply murdered. TB mortality increased by 160 - 240 % compared to pre-war levels. With the support of the victorious Allied powers, the TB control system was restructured and the institutions such as DGP and DZK were re-established. In the following years, the TB situation improved slowly, in the FRG initially slightly faster than in the GDR.