Letter to the Editor†

Ernst Rudin and Nazi Euthanasia: Another Stain onHis Career

To the Editor:

In Volume 67, Number 4 of the American Journal ofMedical Genetics (Neuropsychiatric Genetics) three ar-ticles by Zerbin-Rudin and Kendler [1996] and Kendlerand Zerbin-Rudin [1996a, 1996b] consider the scientificwork of Ernst Rudin, a famed German psychiatrist,while two editorials, by Gottesman and Bertelsen[1996] and by Weber [1996], discuss Rudin’s ideologyand political activities.

Although the central role played by Rudin in the en-actment of the Sterilization Law, which resulted in thesterilization of 350,000–400,000 people, is well known[Barondess 1996], the question of Rudin’s role in eu-genic euthanasia, a secret operation that was startedin 1939 in which physicians took the lives of more than70,000 patients with mental disorders or congenitalphysical defects [Burleigh, 1994], remains subject todifferent interpretations.

Regarding Rudin and euthanasia, Weber [1996]writes, . . . ‘‘Rudin was not directly involved in thepreparations for and execution of any murders in the‘T4 action’. . . Although Rudin did not generally sup-port euthanasia of adults, in a list of research topics ofimportance for the war effort that he prepared in Oc-tober 1942 he did stress the value of eliminating youngchildren of clearly inferior quality [Max Planck Insti-tute of Psychiatry, 1942]. Rudin did not explain thepractical consequences of this statement, but it wouldappear that he was willing to tolerate ‘euthanasia’ of atleast some handicapped children.’’ Weber continues:‘‘In May 1943, Rudin, Carl Schneider, Paul Nitsche andMax de Crinis presented a memorandum on the devel-opment of German psychiatry that mentioned ‘eutha-nasia’ as part of ‘therapeutic reform.’ This also showsthat Rudin tolerated ‘euthanasia’ after 1939.’’

I review in this letter evidence which shows that: (1)Rudin was close to the small circle of physicians thatplanned and implemented euthanasia, (2) the Associa-tion of German Neurologists and Psychiatrists, whichRudin chaired, received financial contributions from

T4, and (3) upon closer examination of the history andcontent of the May 1943 memorandum, it can be con-cluded that Rudin’s approval of euthanasia was conse-quential for decisions taken at the uppermost levels ofthe Third Reich.

Rudin is the first author of the memorandum men-tioned in Weber’s editorial. Rudin’s coauthors, in se-quence, are: Prof. Max de Crinis of Berlin, Prof. CarlSchneider of Heidelberg, Prof. Hans Heinze of Gorden(Prof. Heinze is missing from the list of co-authors inWeber’s letter) and Prof. Paul Nitsche of Berlin. Theassociation between Rudin and his co-authors in thememorandum is not circumstantial. Among other ex-tensive professional connections between the co-authors of the memorandum, Rudin was the chairmanof the Association of German Neurologists and Psy-chiatrists (Gessellschaft dutscher Neurologen und Psy-chiater), founded in 1935, and de Crinis, Nitsche, andSchneider were members of the executive committeeand advisory council of the association [Friedlander,1995]. Henry Friedlander in his book ‘‘The Origins ofNazi Genocide. From Euthanasia to the Final Solution’’[Friedlander, 1995] regarding the relationship betweenthe Association of German Neurologists and Psychia-trists and the T4, writes: ‘‘The association served as areservoir of talent and ideas for the euthanasia killingprogram; T4 provided financial subsidies for the asso-ciation, which in turn pledged ‘to do everything to ad-vance the work that is also of interest to party andstate.’ ’’ This is also addressed by Aly et al. [1994] whorefers to a letter in which Rudin thanks T4 for a con-tribution of 10,000 marks to the Society of GermanNeurologists and Psychiatrists [letter from Rudin,1941].

Rudin et al.’s memorandum was read on July 23,1943 by de Crinis and Nitsche in a meeting with KarlBrandt (Rudin was not present at the meeting) [Aly etal., 1994], who as head of the military and civilianhealth systems, had been charged by Hitler with theexecution of the euthanasia program. The euthanasiaprogram, which was started in 1939, had been formallysuspended due to public outcry in August 1941, unfor-tunately, only after a large majority of the patientswere already killed [Aly et al. 1994, p. 39]. The subjectof the meeting was the resumption of ‘‘centrally admin-istered’’ euthanasia [Aly et al., 1994], for which Rudinet al.’s memorandum served as background justifica-tion.

An English translation of the memorandum is avail-

*Correspondence to: Pablo V. Gejman M.D., Unit on MolecularClinical Investigation, Clinical Neurogenetics Branch, IRP, Na-tional Institute of Mental Health, Building 10, Room 4N320, 10Center DR MSC 1384, Bethesda, MD 20892-1384. E-mail:pgej@helix.nih.gov

Received 7 January 1997; Revised 18 April 1997

American Journal of Medical Genetics (Neuropsychiatric Genetics) 74:455–456 (1997)

© 1997 Wiley-Liss, Inc. †This article is a US Governmentwork and, as such, is in the public domain in the United States ofAmerica.

able from Aly et al. [1994]. The complete memorandum,whose title is ‘‘Gedanken und Anregungen betr. diekunftige Entwicklung der Psychiatrie’’ (Ideas and sug-gestions on the future of psychiatry) is available fromNational Archives II, Wash. D.C. (ref. BAK, 96 I/9,NAW, T1021, Roll 12, no. 126420). The memorandumstates, in part, ‘‘Above all, however, the psychiatrist inthe National Socialist state has fundamental responsi-bilities concerning methodical registration of and re-search on the genetic health of the German people, aswell as prevention of hereditary illnesses. Psychiatrymust not only take an active role in this, but musteducate the medical profession in general. The in-creased importance of the psychiatrist’s pathologicaland anatomical work, especially in light of genetic re-search and practice, should be emphasized in this con-text. The close relationship between neurology and psy-chiatry is becoming ever more apparent. In light of thefacts, we can no longer deny that these branches ofmedicine very much complement each other, and thatpsychiatrists require a strong neurological backgroundto the same extent that neurologists need good psychi-atric training. This should be stressed especially in theinterests of accomplishing medicine’s tasks in the areaof eugenics . . . Euthanasia measures will meet withmore general understanding and approval when it isassured and made public that in every case of psycho-logical illness, all possibilities are explored for curingor improving, either in their own vocations or in an-other form. That the latter is possible, and indeed with-out an unreasonable expenditure of resources andnursing personnel, has been shown by the last two de-cades of psychiatric treatment and research, and inparticular by many years of experience employing in-mates in agriculture. . . . Institutional psychiatrists areto be involved in the racial aspects of juvenile welfare,in criminal-biological treatment in certain districts andsimilar areas of activity.’’

Interestingly, although research is emphasized inthe memorandum, the possibility that an effectivetreatment could still be discovered did not affect theresolve of Rudin and his associates to urge the adoptionof euthanasia. As it happened, chlorpromazine enteredwidespread clinical use in the 1950s. Many of thechronically ill patients who were murdered might wellhave been discharged in a vastly improved state, hadthey been allowed to live. Parenthetically, in all prob-ability chronically ill patients from the families thatRudin used in his epidemiological research were mur-dered in the T4 euthanasia program. In a letter to me,Professor Benno Muller-Hill stated, in part, ‘‘A Germanwho was diagnosed ‘schizophrenic’ had to be sterilizedwithout exception. Equally, a person who was diag-nosed ‘schizophrenic’ and who was hospitalized for atleast five years had a strong chance to be murdered inthe euthanasia murders’’ [Muller-Hill, 1995].

The co-authors of Rudin’s memorandum were pro-foundly involved in the planning and implementationof the euthanasia program. Nitsche was tried by theAllies and executed for his role in medical crimes. BothMax de Crinis and Carl Schneider, for whom a judicialprocess had become inescapable, committed suicide in1945. Hans Heinze came to the attention of the au-

thorities in 1962. He alleged poor health which pre-vented his trial until his death in 1983 [Aly et al. 1994;Burleigh, 1994]. Additionally, Karl Brandt, to whomthe memorandum was submitted, was sentenced todeath at the Nuremberg Medical Trials and executed.On the other hand Rudin got a lenient sentence at hisdenazification trial. He was found guilty only at thelevel of Lesser Offender (level III) and, on appeal, Fol-lower (level IV) [Gottesman and Bertelsen, 1996].

The memorandum quoted states explicitly that Ru-din supported euthanasia. The allegations of financialand intellectual links between the Association of Ger-man Neurologists and Psychiatrists and the T4 pro-gram are particularly troublesome [Friedlander, 1995;Aly et al., 1994]. Furthermore, the May 1943 memo-randum appears to have contributed to the decision toresume the centrally administered euthanasia pro-gram in 1943.

Because of his advocacy of Nazi euthanasia and ofeugenic compulsory sterilization, I believe that Rudinbetrayed his Hippocratic Oath. If his research is to bereviewed in a historical article, the fundamental con-clusions he drew from his experiments and the impactof his actions on psychiatric patients, should not beignored.

ACKNOWLEDGMENTSI would like to thank Professor Benno Muller-Hill for

generously sharing valuable information with me andto Dr. Elliot Gershon for his useful comments on thisletter.

REFERENCESAly G, Chroust P, Pross C (1994): ‘‘Cleansing the Fatherland. Nazi Medi-

cine and Racial Hygiene.’’ Baltimore and London: The Johns HopkinsUniversity Press, pp. 39, 177, 194–202.

Barondess JA (1996): Medicine against society: Lessons from the ThirdReich. JAMA 276:1657–1661.

Burleigh M (1994): ‘‘Death and Deliverance. Euthanasia in Germany1900–1945.’’ Melbourne: Cambridge University Press, pp. 111, 160.

Friedlander H (1995): ‘‘The Origins of Nazi Genocide. From Euthanasia tothe Final Solution.’’ Chapel Hill and London: The University of NorthCarolina Press, p. 155.

Gottesman II, Bertelsen A (1996): Legacy of German psychiatric genetics:Hindsight is always 20/20. Am J Med Genet (Neuropsychiatr Genet)67:317–322.

Kendler KS, Zerbin-Rudin E (1996a): Abstract and review of ‘‘studien uberverebung und entstehung geistiger storungen. I. zur vererbung undneuentstehung der dementia praecox. (‘‘studies on the inheritance andorigin of mental illness: I. to the problem of the inheritance and pri-mary origin of dementia praecox’’). Am J Med Genet (NeuropsychiatrGenet) 67:338–342.

Kendler KS, Zerbin-Rudin E (1996b): Abstract and review of ‘‘zur erb-pathologie der schizophrenie’’ (contribution to the genetics of schizo-phrenia). Am J Med Genet (Neuropsychiatr Genet) 67:343–346.

Letter from Rudin, 17 July 1941, NAW,T 1021, Roll 12, no. 128174.Muller-Hill, B. Letter to Pablo V. Gejman, October 23, 1995.Weber MM (1996): Ernst Rudin, 1874–1952: A German psychiatrist and

geneticist. Am J Med Genet (Neuropsychiatr Genet) 67:323–331.Zerbin-Rudin E, Kendler KS (1996): Ernst Rudin (1874–1952) and his ge-

nealogic-dermographic department in Munich (1917–1986): An intro-duction to their family studies of schizophrenia. Am J Med Genet (Neu-ropsychiatr Genet) 67:332–337.

Pablo V. Gejman, M.D.*Unit on Molecular Clinical InvestigationClinical Neurogenetics BranchNational Institute of Mental Health, NIHBethesda, MD

456 Gejman