Book Review

Death of Medicine in Nazi Germany: Dermatology and dermatopathology under the swastika

N Engl J Med 1999; 340:1931June 17, 1999

Article

Death of Medicine in Nazi Germany: Dermatology and dermatopathology under the swastika
By Wolfgang Weyers, with A. Bernard Ackerman. 442 pp., illustrated. Lanham, Md., Madison Books, 1998. $49.95. ISBN: 1-56833-121-5

How could the Holocaust have occurred? How could the seemingly sophisticated German society of the Weimar Republic permit the rise of the National Socialist Party? How could the new Nazi government nearly destroy the country's medical system in the name of racial purity?

An increasing number of treatises, symposiums, and books have attempted to address these issues. This book succinctly presents the frightening accounts of the destruction of German Jewry from the point of view of the physician and, more particularly, the dermatologist. Antisemitism, a word introduced in 1873, has always existed; it has been more overt at some times than at others. Because Jews were often denied entrance to many professions and occupations, and because of the Jewish tradition of helping others, Jews became physicians in disproportionate numbers.

Although Jews accounted for only 0.8 percent of the residents in Germany in 1933, at least 16 percent of German physicians were Jewish. Once the Jewish physician graduated from medical school, he, or rarely she, would often experience difficulty in obtaining a hospital appointment at non-Jewish institutions — hence the development of Jewish hospitals. Many Jewish physicians were barred from selecting the more popular — and more financially rewarding — medical and surgical fields. Because dermatology was not held in high regard by the medical establishment, the specialty was available to Jewish physicians. In 1934, a quarter of all dermatologists in Germany were Jewish.

Weyers's documentary account takes the reader through a “Who's Who” of medicine in the 19th and 20th centuries. Many luminaries, such as Ernst Kromayer (inventor of the Kromayer lamp) and Eugen Galewsky (who was responsible for introducing anthralin in the treatment of psoriasis), were Jewish, and others, such as Franz Herrmann (known for his research on the physiology of sweat glands) and Hermann Pinkus (an expert in the field of dermatopathology), were Christian but of Jewish ancestry. Some were converts, like Fritz Juliusberg (who was responsible for describing pityriasis lichenoides chronica), who had disavowed Judaism. Theodor Grüneberg, a member of the Nazi party, was appalled to find that one of his own great-grandparents had been Jewish.

Many directors of university and hospital departments were replaced by followers of the party. Some of the Nazi physicians were lacking in academic qualifications, whereas others had some scientific background, such as Heinrich Adolf Gottron (who first identified Gottron's papules). There were also the German professors who stood up to the regime and lost their posts. Leopold Ritter von Zumbusch (who first described pustular psoriasis) was fired as rector of the University of Munich and then as director of dermatology at the university.

Within six years, Jews went from being full German citizens with economic opportunities to outcasts subjected to the lowest degradation. Imagine an educated society devoting energy to defining who was Jewish, but not according to whether people practiced the religion or whether their mothers or fathers considered themselves Jewish.

The Mischlinge (persons of mixed race), as such persons were considered, would also be ostracized, even if they and their parents had always been Christian. (Jeremy Noakes. “The Development of Nazi Policy towards the German–Jewish `Mischlinge' 1933–1945.” New York, Leo Baeck Institute Yearbook, 1989, xxxiv:291-354.) There were also rules when only one grandparent was an observant Jew.

Like many other intellectual German dermatologists of the late 20th century, including the late Albin Proppe of Kiel, Karl Holubar of Vienna, and Albrecht Scholtz of Dresden, Weyers is haunted by the past: “How do I behave and how should I behave? When is it right and essential for me to uphold my personal convictions and inviolate standards, and when is it necessary to compromise for the greater good? At what point do compromises become concessions, and I become a wholly different person?”

This book should be required reading, because it recalls the tragedy of German medicine during a time when prejudices and hatred overcame reason, let alone the Hippocratic oath. These same evil forces are still with us, only now their methods are called “ethnic cleansing.”

Lawrence Charles Parish, M.D.
Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107