. Jasper Johns. Sotheby's, NY.

Walter Poller confirms that the Nazis continued to sterilize and castrate even in the camps. People with "schizophrenia, epilepsy, imbecility, insanity, those convicted of indecent assault were included," he notes, and "homosexuals were castrated as a matter of policy there."

"Useless Eaters"
The Nazi Murder of the Disabled

by Sandy O'Neill

Introductory Note

In 1999, together with the six candles representing the estimated six million Jews who perished in The Shoah, the annual ceremony of remembrance at the five-year-old US Holocaust Memorial Museum included the lighting of a candle in memory of the people with disabilities who perished. This was welcome progress.

When the Museum was being constructed just a few years ago, the inclusion of even part of the story of the disabled was a point of contention, as was the inclusion of the persecution of gays and lesbians and the Sinti and Roma peoples. While carrying out research there, I learned that the museum's presentation of information about what are alternately referred to as the Forgotten or Other victim groups continues to need improvement. In exhibits and in educational pamphlets, we are still referred to as "handicapped," a designation objectionable to many of us people with disabilities. Likewise, the pamphlets about Sinti and Roma people use the word "gypsy," and the pamphlet on the fate of gays and lesbians is emblazoned with the word "homosexual."

This institutional failure to grasp or attend to a changing lexicon disturbed me. On a more personal level, however, the Holocaust survivors who volunteer to share with visitors their stories of atrocities, deep personal loss and incredible survival expressed sincere interest in my work. They volunteer that they remember knowing or hearing about some of the evils inflicted on people with disabilities, but memory is faulty. They were young, after all, and maybe they heard about it afterward.

One quizzes her friend about whether she knew if a fellow survivor who had spent a long time in the camps had always had difficulties walking; was she sent there for being handicapped or for being a Jew, she wonders. We decide that there is no way to know anymore—so many people were so sick by the time they were liberated from the camps that they never regained good health. Some became disabled by reason of their incarceration.

This understandable confusion about the identity of victims makes me realize that horrid deaths and suffering are horrible for anybody, regardless of how we might "classify" them. But it also strengthens my resolve to draw distinctions, to clarify identities, for how else will the Forgotten victims, the Other, ever be known and remembered?

Although the Nazi torture and murder of millions of disabled Germans, Poles, and others is gaining increasing scholarly attention, it remains nearly unknown in popular perception. What follows is a small portion of my much larger investigation and analysis of how this happened.


Avoid the "excessive compassion and love of one's neighbor characteristic of past centuries," a German psychiatrist advised his colleagues.

In September 1939, Hitler signed a memo which directed physicians to "grant a mercy death to patients judged incurably sick, by critical medical examination" (Proctor, 177), a decree that authorized physicians to kill the "incurably ill." A large-scale organization was created that included review committees to decide who would be accorded a "mercy death." Germany labeled people with disabilities as "useless eaters" with "lives not worth living."

The mechanisms for mass murder were developed initially for the killing of men, women and children with disabilities. These methods, such as carbon monoxide poisoning and construction of "shower rooms" to allay suspicions, were later used upon Europe's Jewish population by many of the same personnel that had earlier decimated the disabled population.

The German government established an elaborate system of identifying, transporting, and murdering disabled people that involved three semi-independent corporations. The Foundation for the Care of Institutions in Public Interest handled the financial aspects of the program; the Reich Association of Sanatoriums and Nursing Homes developed selection criteria; finally, the Charitable Patient Transport Company operated patient transport (Gallagher, 27). The program as a whole is referred to as T4 or Aktion T-4, because the central headquarters was at 4 Tiergartenstrasse.

German doctors played a critical role in all aspects of this process. The medical community was the most enthusiastic supporter of Hitler. More than half of those in the medical profession were members of the Nazi party. Eighty percent of Germany's anthropologists joined the party, as well. Many of them who were also physicians ruled on whether disabling conditions were genetic. They also helped classify individuals as Aryan or non-Aryan (Proctor 1999). Many of those involved continued to deny that the sterilizations and murders were criminal, citing scientific theories of genetics. Many of the doctors involved returned to their practices after the war.

Questionnaires about all patients in long-term hospitals, sanitoriums, and asylum were completed and sent to the central office. By the middle of the 1930s these questionnaires were also sent to prisons, reform schools and concentration camps. The form included questions to determine whether the patient was "deserving of life." The decisions were again reviewed, generally by a department head of a medical department at a university (Gallagher, 66). Patients to be killed were transferred from mental institutions, hospitals, and nursing homes throughout Germany to "observation institutions." Groups of victims were gathered together before they were taken to one of six major killing centers.

While this and subsequent programs were conducted officially in secret, the regime could not have expected secrecy to last long, given the large numbers of people involved in everything from preparing questionnaires to driving buses to the killing centers. All institutions that housed patients were affected, including religious hospitals and asylums. Inmates of workhouses and prisons were also designated "deviant" and killed during this time.

It was German physicians who were responsible for the implementation of Aktion T-4. All physicians were mandated to report patients who met selection criteria. The majority complied. The few who refused to go along were not punished, or killed, however. As a result of their genetic theories, the medical community was the driving force that selected, evaluated, judged and murdered the victims. Doctors on committees were paid ten pfennigs for each questionnaire they reviewed. Doctors could earn up to $70 in 1940 US dollars. An example is given of one doctor who maintained his regular duties while passing judgment on 2,058 patients in eighteen days (Gallagher 66). Hospital directors even made sure that they received gasoline coupons in return for volunteering their facilities as killing centers (Gallagher, 101). At least three hundred and fifty physicians participated in selecting and executing patients.

Gold teeth were removed from the bodies and sent to Berlin to be melted down (Gallagher, 74), and as the bodies piled up, the need for mass disposal prompted some centers to install conveyor belts to carry bodies to incineration chambers. For efficiency's sake, a reusable coffin was developed, with a trapdoor through which the body would fall (Gallagher, 7). Through the course of the war, doctors and scientists made various requests for specimens. Professor Julius Hallervorden—a world-renowned neuropathologist—used over six hundred brains of victims for his research in brain disease. He informed the killing centers of his needs, including how the brains should be selected, removed, preserved, and shipped (Gallagher, 76).

The killing programs were seen as representing scientific progress. Reports of psychiatrists who saw the murders as a "further development in psychiatry" include the professor of psychiatry who warned his colleagues to avoid the "excessive compassion and love of one's neighbor characteristic of past centuries" (Gallagher, 160). So many killings were carried out, however, that some doctors started to worry that they would run out of patients. One chief physician wrote, "And with mental patients being taken care of by euthanasia, who will wish to study psychiatry when it becomes so small a field?" (Gallagher, 33).

In a meeting held before Hitler's 1939 order, psychiatrists, professors, and other members of the medical community were informed of the program that was about to be initiated and were invited to participate. The members almost unanimously volunteered their services. Only one doctor who attended this session declined to participate (Gallagher, 30). Of the few doctors who did object, most did so because of concern about the legality of Hitler's order, not its ethical implications. Doctors even attempted to draft a euthanasia law to solidify the program's legal foundation (Proctor, 193). In a euthanasia trial in 1964, Dr. Hans Hefelmann, one of the chief physician at the T-4 program headquarters, testified that "no doctor was ever ordered to participate in the euthanasia program; they came of their own volition" (Proctor, 193).

A network of workers was required to drive the vans, dig graves, run the incinerators, clean the hospital wards, and process forms. Detailed lists were made of patients' belongings and double-checked when they got on the buses. Jobs in the T-4 program were considered desirable. School textbooks asked students to calculate the costs of maintaining people with disabilities (Proctor, 184), and the Nazi propaganda machine turned out "documentaries" and made popular movies extolling euthanasia of people with disabilities.

There are widespread reports that in 1941, a staff party was held at one center to celebrate the cremation of the ten-thousandth victim. After a body adorned with flags and a swastika was cremated, doctors and nurses danced to a polka band and drank beer.

Those judged "genetically inferior" included more and more categories of people. The term was not restricted to patients with supposed "genetic" diseases, but began to include those with epilepsy and retardation, for example. Doctors recommended and killed all patients with disabilities. One man who had lost his leg in an accident was approved for extermination (Gallagher, 24). Even the temporarily disabled were often murdered.

The existence and aim of the killing programs became widely known. The vans that transported patients to killing centers became a familiar sight. When they passed through town, children would call out, "There they go again for gassing" (Gallagher 168). The thick smog from the crematorium attached to the Hadamar killing institution was visible every day over the town (Gallagher, 168). There are widespread reports of people with disabilities resisting being put on the buses. In one case, people with disabilities organized to let neighboring villagers know that they expected to be killed. (Gallagher)

The T-4 program was officially suspended, partly in response to protests, in August of 1941, but the official goal for numbers killed for the initial stage of the program had been met by then. The children's murder campaign was never halted

II. Program for Murder of Disabled Infants and Children

The children's killing program continued even after the war had ended, until discovered by the Allies.

The Reich Committee for Scientific Research of Serious Illness of Hereditary and Protonic Origin was formed to implement a children's euthanasia program. On August 18, 1939 a decree signed by the Ministry of the Interior required all newborns and infants under the age of three to be reported when "serious hereditary diseases" were suspected. Such diseases included "deformities, paralysis, Down syndrome, deafness, and various others." (Gallagher, 96).

The objective was "to obtain possession of these abortions and destroy them as soon as possible after they had been brought into the world" (Gallagher, 97). Questionnaires were filled out and sent to a committee of physicians who used a "plus" symbol (+) to recommend "special treatment," meaning murder, or a "minus" symbol (-), which allowed the child to live. The children selected were transferred to one of twenty-eight official killing centers, the majority located in wings of existing hospitals.

These children's deaths were often slow and painful. Although infants were generally killed with a massive lethal injection, in many cases the poison was administered slowly over several days or weeks so that death could be attributed to pneumonia or similar complications (Proctor, 187). Other doctors preferred the painful approach of starvation, such as Dr. Hermann Pfannmuller who wanted his patients to die of "natural causes." There was popular support for the killing of children with disabilities. Several cases were reported of families who wanted to "rid themselves of the burden of having a defective child," and were openly supportive of infanticide (Proctor, 194).

Some parents who did object to "final medical assistance" for their children were allowed to take their babies home; hospitals had no authority to hold a baby against the parents' wishes (Gallagher, 102), but killing centers received letters from parents requesting that their child be killed. As early as 1920, a survey of the parents of 162 disabled children found that a large number favored death for their own children. One hundred nineteen said they would consent. Only four rejected euthanasia under any circumstance (Aly, et al, 30).

Parents and insurance companies were charged for the food, lodging and health care of the children even while they were being starved or had poison injected. In many cases, bills were continued after children were dead. As early as the fall of 1941, the child-killing program, initially limited to children under three, was expanded to include children up to the age of 17. While the adult program was supposedly halted, older children were simply rerouted through this program. The program to kill children was never halted, even for appearance's sake.

This program was also a bridge between definitions of disability and race. It was used to define children of mixed African-German heritage as inherently degenerate, for example, as a rationale for sterilizing them. Later, it was through this program that selected groups of mixed- heritage Jewish-German children were murdered.

III. The "Wild" Euthanasia Period

After T-4 was officially halted, local physicians murdered patients according to their personal standards.

During the prewar years and the first part of the War, the killing programs were defined by the same Nazi principles of organization that characterized the Reich's other endeavors. As the fortunes of war turned against Germany, the "logic" of the killing programs began to break down under the stress of competing national goals and their implementation grew inconsistent, a phenomenon that adds to the difficulty of historical analysis.

After T-4 was officially halted, for example, local physicians murdered their patients according to their own personal standards, and the SS officers who initially shot people with disabilities in areas taken over by the Reich were replaced with members of the medical profession using gas in vans. Viktor Brack, head of T-4's administration, insisted that "the syringe belongs in the hand of a physician" (Gallagher, 67).

Toward the end of the war, in April of 1942, orders were changed in the camps because of a shortage of workers for the Reich. Now only mentally ill and Jewish prisoners were to be 'selected." Other prisoners were to be kept at work. (Piper 1998:39) In some cases arrangements were made for prisoners confined to bed to work from there.

The children's killing program and the wild euthanasia murders continued even after the war had ended, until discovered by Allied troops. Polish and Russian workers who contracted tuberculosis were murdered, and Proctor (1999) discusses the starvation of inmates in asylums and hospitals. No one knows how many were starved; those "euthanized," i.e. gassed or injected, numbered 200,000 by his source (178).

The doctors' trial in the early Nuremberg cases tried individuals for these crimes. The legal opinion was that there was no way for international bodies to try Germans for killing other Germans.

IV. Some Conclusions

Despite the fact that information about the killing of the disabled is incorporated in numerous scholarly accounts, the public at large has little knowledge of this campaign of murder, its scope or its implications. Even researchers often remain misinformed about aspects of the Nazi's campaign, assuming, for example, that people with disabilities were not among those imprisoned and killed in the concentration camps. As I researched aspects of this question at the Unites States Holocaust Memorial Museum, the archivist who assisted me repeatedly stated that "handicapped" people were never in the camps.

People with disabilities were also part of the huge slave labor force necessary for running the Reich's wartime industries. This detail is overlooked in most of the literature, largely because scholars seem to have taken at face value the Nazi claim that people with disabilities had to be killed because they were sick, incurable and nonproductive.

The historical investigation of how people with disabilities were systematically murdered continues to be obscured by misinformation and errors of interpretation. The under- lying ableism of most historians needs to be addressed before we will have a clear and comprehensive account of what befell disabled people in the Third Reich and its ongoing implications for disability rights today.

© 2000 Sandy O'Neill


The foregoing account appears in slightly different form as part of Sandy O'Neill's Ph.D. dissertation, "First They Killed the 'Crazies' and 'Cripples': The Ableist Persecution and Murders of People with Disabilities by Nazi Germany 1933-45, An Anthropological Perspective." BENT is grateful for the opportunity to publish this excerpt.

Dr. O'Neill (SIMCHA@aol.com), a person with disabilities, lives in the San Francisco Bay Area and is a longtime social justice scholar and activist.



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BENT: A Journal of Cripgay Voices/November 2000