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You have full access to this article via your institution. Download PDF INTRODUCTION In Nazi-era Vienna, pediatricians were both victims and perpetrators. A prior article discussed the

victims; this one will consider the perpetrators. Pediatrics was of central importance to the Nazis in implementing their “racially pure” society. Nazi pediatricians promoted the care of

“fit” Aryan children and identified “unfit” children whose lives were deemed unworthy.1 The concept of “racial hygiene” was fundamental to Nazi medical ethics.2 Twenty German university

institutes for racial hygiene were established before 1933. THE APPEAL OF NAZIISM TO PHYSICIANS Over 60 percent of non-Jewish Austrian physicians were members of the Nazi Party or one of its

supporting organizations, with 18 percent joining the SA “brownshirts” and 8 percent the elite SS. These were higher proportions than among any other occupation in Austria and greater than

Nazi membership among German doctors.3 The lure of Naziism for physicians may have arisen from pervasive antisemitism, added prestige, attraction to their role in promoting racial “purity,”

and creating more job opportunities by eliminating Jews from the profession.2 SYSTEMIC MURDER OF “UNFIT” CHILDREN In 1939, Hitler initiated the systemic killing of children with disabilities

in a program called “children’s euthanasia.”2 Doctors and midwives were commanded to report disabled children; these reports were reviewed by three experts—two pediatricians and a child

psychiatrist—who decided on either “treatment,” a euphemism for murder, or a period of observation to assess the child’s future prospects. Nazi pediatricians and collaborators played an

essential role in this program as referral sources, life-or-death decision-makers, and executioners. At least 5000 children and adolescents, mostly non-Jewish, were murdered in one of 30

killing centers throughout greater Germany. These wards were intermixed in psychiatric hospitals, pediatric clinics or long-term care homes, so most did not stand out as murder facilities.

The centers were directed by Nazi physicians, often pediatricians.4 Killings at the Spiegelgrund center in Vienna, adjacent to the Steinhof adult nursing home, started in August 1940. Slow,

painful deaths were initiated by intentional starvation or overdoses of barbiturates, and most children were diagnosed with pneumonia as their cause of death.5 The Spiegelgrund murders

became so well known, even abroad, that in the fall of 1941, the British Royal Air Force leafleted Vienna broadcasting the name of the hospital and director responsible for these systemic

killings: pediatrician Erwin Jekelius.6 By 1945, at least 789 children died there. (see Fig. 1) Many parents opposed their children’s murders, including nurse Anna Wödl, who made multiple

attempts to save her mentally disabled six-year-old son Alfred, including traveling to Berlin to appeal to the Reich director of the “euthanasia” program. When she desperately pleaded with

Dr. Jekelius, he threatened to call the Gestapo to arrest her.7 Alfred was murdered at Spiegelgrund on February 22, 1941. EXAMPLES OF NAZI PEDIATRICIANS AND THEIR SUPPORTERS * FRANZ

HAMBURGER (1874–1954) was appointed chair of pediatrics at the University of Vienna in 1930. He was a strong advocate of National Socialism from 1933 and joined the then-illegal Nazi Party

in 1934.8 In his hiring, firing and promotion decisions, Hamburger transformed the pediatric department into a Nazi stronghold. He advocated killing newborns with malformations, and

routinely sent children to Spiegelgrund for “euthanasia.” He referred one of the earliest victims on August 15, 1940: Viktor Stelzer, a one-year-old with seizures, muscle cramps and visual

impairment. Viktor died at Spiegelgrund several months later, supposedly of pneumonia.5 Hamburger was prominent as president of the German Association of Pediatrics, where he stated in 1939:

“A teacher of obstetrics, a teacher of pediatrics, internal medicine, or neurology has to be a true National Socialist. He has to be completely permeated with the foundations of National

Socialist life and health leadership.”6 Hamburger became professor emeritus in 1944. After the war, he never faced justice. * HANS ASPERGER (1906–1980), renowned for his autism research, was

a pan-German nationalist and Nazi sympathizer. Although he backed Nazi policies and joined several Nazi-affiliated organizations, Asperger did not join the Nazi party. He was hired by

Hamburger in 1931 and promoted to direct the pediatric clinic in 1935 ahead of more senior Jewish colleagues.1 He continued to praise Hamburger throughout his career, for decades after the

war.5 Asperger organized home visits to mothers and children by health teams who recorded information on chronic conditions, and many of these children were referred for “euthanasia.”

Asperger encouraged his colleagues to send “difficult cases” to Spiegelgrund and personally transferred at least 44 children for murder there. After the war, Asperger was given a clean slate

and remained director of the pediatric clinic. In 1957, he was appointed head of the university pediatric clinic in Innsbruck. He returned to Vienna as chair of pediatrics in 1962.6

Asperger was never punished for his activities under the Nazis. * ERWIN JEKELIUS (1905–1952), another Hamburger hire, killed thousands of adult psychiatric patients and disabled children as

the director of Steinhof and Spiegelgrund from 1940 to 1941.1 Jekelius had joined the then-illegal Nazi party in 1933. Before directing Spiegelgrund, he worked at the pediatric clinic with

Asperger.6 After a falling out with Hitler in 1941 due to an affair with his sister Paula Hitler, Jekelius was sent to the Eastern front, where, after the war, he was arrested, tried and

sentenced to 25 years imprisonment by the Soviets. Jekelius died in a Moscow prison in 1952. Vienna psychiatrist Viktor Frankl called him “the devil in a white coat,”6 and “the only man I

ever encountered in my whole life whom I would dare to call a Mephistophelean being, a satanic figure.”5 * ELMAR TÜRK (1907–2005) conducted horrific experiments on children at the University

pediatric clinic. In 1941–1942, he intentionally infected five children with tuberculosis, three after receiving the Bacille Calmette-Guérin vaccine and two controls. All five were sent to

Spiegelgrund, where they died or were intentionally killed to provide post-mortem specimens.8 In another study, he withheld vitamin D prophylaxis from 15 babies until 13 developed rickets,

even though the importance of this treatment had already been established. Türk also injected staphylococcal bacteria or a placebo in 218 children in the pediatric clinic, as many as 15

injections in each child’s back, with no benefit to the subjects. Elmar Türk received no punishment and practiced pediatrics through the 1990s, continuing to proudly refer to his Nazi

experiments.5 * MARIANNE TÜRK (1914–2003), of unknown relation to Elmar, assisted in the murder of children at Spiegelgrund. She was tried in Vienna after the war and sentenced to ten years

in prison, but three years later she was declared unfit for incarceration and was pardoned in 1952 by the president of Austria. Her doctorate and practice certification were returned in

1957, but she declined to resume medical practice.3 THE TRAGIC LEGACY OF VIENNA PEDIATRICS Few Nazi pediatric perpetrators were brought to justice, and of those convicted, most received

early pardons. Many physicians tainted by Nazi ties avoided punishment and soon returned to practice. Body parts of Spiegelgrund victims continued to be used in research for decades after

the war.5 Conditions at Steinhof and Spiegelgrund remained dismal for years after 1945, and most staff who participated in killing patients remained employed. The “devaluation, exclusion and

neglect” of those with disabilities continued in Austria through the 1980s.9 Only in the 1990s did Vienna’s academic medical establishment begin to acknowledge its complicity with National

Socialism.10,11 In 2018, on the eightieth anniversary of the _Anschluss_, the Medical University of Vienna (successor of the University of Vienna Medical School) belatedly sponsored its

first international symposium on the role of Vienna’s physicians in supporting Nazi policies.12 Since 1997, Austria’s National Fund for Victims of National Socialism has offered “gesture

payments” of €5,087.10 each to Holocaust victims, including descendants of Spiegelgrund victims, not intended as compensation but as a symbolic acknowledgment of the injustices suffered.13

CONCLUSIONS AND LESSONS FOR TODAY Nazi pediatricians and their allies took advantage of career opportunities afforded by the removal of their Jewish colleagues, conducted unethical

experimentation and participated in killing children with disabilities. Few were punished. Do any factors that attracted physicians to Nazi ideology persist today? Some current concerns

include professional demoralization, economic insecurity, the drive for career advancement, the need to belong and conform, and the search for quick fixes to existential problems.14 Using

demeaning language when referring to patients and other forms of dehumanization continue to be prevalent.15,16 In addition, medical staff still commonly use racial identifiers as proxy

biological markers.17,18 The current international upswing of xenophobia, right-wing populism, antisemitism and other forms of racism is also of concern. What lessons may help us confront

these societal challenges? Nazi physicians believed that those with physical and mental disabilities were unworthy of living. Will we support the universal inherent worth of every person and

actively call out those who use dehumanizing language and/or behavior toward patients with marginal identities or lack of insurance? Nazi actions were generally “legal,” according to their

laws. Will we actively oppose legal and institutional racism? Are we prepared to practice civil disobedience when confronting unjust laws and policies affecting our patients?19 Nazi racial

hygiene concepts were inspired by American racism.2 Will we accept race as a social construct, work to eliminate race-based medicine,17 and stop including it at the start of case

presentations?18 In considering these questions, those who value an antiracist, just and equitable society can learn valuable lessons from the tragic legacy of pediatrics in Vienna under

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FUNDING Funding The author received no outside funding for this research. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Pediatrics, Atrium Health, Charlotte, NC, USA Daniel R.

Neuspiel Authors * Daniel R. Neuspiel View author publications You can also search for this author inPubMed Google Scholar CONTRIBUTIONS D.R.N. is the sole author of this manuscript and has

not used any sources other than those listed as references. He has not submitted this manuscript to any other journal for publication. CORRESPONDING AUTHOR Correspondence to Daniel R.

Neuspiel. ETHICS DECLARATIONS COMPETING INTERESTS D.R.N. reports no conflicts of interest regarding this research. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral

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governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Neuspiel, D.R. Pediatricians in Nazi Vienna, part 2: the

perpetrators. _Pediatr Res_ 95, 403–405 (2024). https://doi.org/10.1038/s41390-023-02802-z Download citation * Received: 08 May 2023 * Revised: 15 July 2023 * Accepted: 15 August 2023 *

Published: 02 September 2023 * Issue Date: January 2024 * DOI: https://doi.org/10.1038/s41390-023-02802-z SHARE THIS ARTICLE Anyone you share the following link with will be able to read

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