Deadly Medicine: Creating the Master Race A special exhibition In the late 1980s, when I first began working on the ethical issues raised by the involvement of Nazi medicine and science in the Holocaust, the US Holocaust Museum did not exist. In January of 1996, I had the honour of delivering a speech at the then 3-year-old museum. The topic I chose was the role of medicine in the Holocaust. I was also given a tour of the museum. While I was greatly impressed and moved by what I saw, I pointed out to my hosts, somewhat heatedly, that the permanent exhibition neglected the key role played by medicine and science. It is of no small import that a distinguishing feature of the Holocaust memorialised in the museum is the central role played by medicine and science in what was the pre-eminent scientific nation of the time. That lacuna has now been fully rectified with last month’s opening of the special exhibition, Deadly Medicine; the enthusiastic role of medicine and science in mass murder is now quite plainly on display. The exhibition carefully traces the evolution of thinking about eugenics and racial hygiene in Germany from the end of World War I to shortly after the conclusion of World War II. An amazing set of pictures, posters, films, charts, maps, books, instruments, masks, and paintings tells the incredible tale. Alfred Ploetz on the cover of Eugenik magazine Ploetz, a physician and economist, founded the German eugenics movement in 1905. The visitor sees the innocuous rise of eugenics in Weimar Germany as an adjunct to efforts at public-health reform. Germans eager for a rebirth after the disaster of the first World War eagerly seized on the hope extended by physicians, geneticists, psychiatrists, and anthropologists that using social Darwinism to guide public health was the vehicle for German regeneration. Soon, governmental exhortations to marry well and live virtuously were followed by the emergence of virulent bigotry against the costs to society imposed by those who could not or would not: the disabled, the mentally ill, the tubercular, prostitutes, and alcoholics. Hard on the heels of this intolerance of frailty and foolhardiness, as the Nazis tightened their grip on power, came the forced sterilisation of these groups as well as so-called racial misfits—the children of inter-racial liaisons in the border area between Germany and France, which was occupied by French troops from Africa during the 1920s. Dr von Verschuer, head of Kaiser Wilhelm Institute’s Department for Human Heredity, examines twins Verschuer, a physician and geneticist, examined many twins to study whether criminality, “feeble-mindedness”, tuberculosis, and cancer were inheritable. In 1927, he recommended forced sterilisation of the “mentally and morally subnormal”. He typified academics motivated by interest in Germany’s “national regeneration”. Murder soon replaced sterilisation as the public policy of choice for those who could not contribute healthy children or economic productivity to the state as killing multiplied in the insane asylums and in the notorious T4 programme that targeted the demented elderly. The slaughter then accelerated to unimaginable proportions as racism was added to the public-health drive to rid the Reich of the “threats” posed to its health and genetic purity by Jews, gypsies, homosexuals, and Slavs. Germany was not alone in its fascination with eugenics. The USA was well ahead of Germany by the early 1930s in its efforts to control the economic and social costs of mental illness and retardation through sterilisation. As the exhibition makes clear, Spain, Norway, Denmark, the Soviet Union, France, and the UK, among other nations, mixed public health and eugenics into their policies. It was the virulent racism that Hitler and the Nazis added to eugenics that created the events that led to the death camps. “Qualitative decline in the population . . . it will come to this if individuals with lesser value have four children and those of higher value have two” Nazi propaganda showing athlete shrinking and deformed man growing; intended to demonstrate the importance of preventing births among the “unfit” and achieving high birth rates among the “fit”. A number of features stand out about this exhibition. The fate of the staunchest Nazi eugenicists is carefully documented. Most fared well after the war, retaining high positions in German medicine and science. The horror of the killings is personalised through photos of specific individuals annotated with their names and histories. Susan Bachrach, the curator of Deadly Medicine, devised a system of identity cards that are issued to all visitors. Each card traces the fate of a real person who fell into the maw of the Nazi Holocaust. In ways such as this, she brings to life the stories of real, identifiable people. There are a few flaws in the exhibition. The complex story it tells, spanning 40 or so years, is made all the more so by being presented in the form of a maze, which seemed to confuse some of my fellow visitors. More substantively, not much is said about why doctors were the most enthusiastic participants in the Nazi genocide. We hear little about the ethical justifications that doctors and scientists had for their lethal actions. As the Nuremberg trial transcripts make clear, they had many of these, and it is important to realise that these were men who strongly believed in the rightness and righteousness of their actions. Nor is much offered in the way of an explanation of how so many vicious killers landed on their feet at the end of the war. My own hunch is that there were so many doctors and scientists involved in the Nazi crimes that to weed them all out would have left postwar Germany with hardly any at all, an intolerable situation in a nation reeling from starvation and decimation. Happily, Deadly Medicine’s few substantive flaws can be easily rectified by further reading and research after a visit. And I suspect that those who have the privilege of visiting this highly praiseworthy exhibition will be moved to do exactly that. Arthur Caplan Emanuel and Robert Hart Professor of Bioethics; Chair, Department of Medical Ethics; and Director, Center for Bioethics, University of Pennsylvania, PA, USA e-mail: caplan@mail.med.upenn.edu Used with permission from Arthur Caplan.