Historical Background

Social Darwinism, a concept based on the ideas of Charles Darwin, spread throughout Europe during the 19th century. It tried to define the workings of society in analogy to those of nature. The Aryan race was viewed as superior and its purification was seen as the only means to prevent the degeneration of society. Duke Gibenau, a Frenchman, postulated in the 1850s that the purity of races would be a determining factor in history. His ideas were taken up in both England and Germany. In 1883, Englishman Francis Galton coined the term "eugenics"; Alfred Ploetz, a German, first wrote about "race hygiene" in 1894. The basic idea of social Darwinism was that just as species fight for the survival of the fittest, peoples are in a constant process of competition that favors those who are genetically best equipped (Aryans). According to this theory, degeneration of a given people can be prevented by cultivating the optimal race (Aryans). Ernst Haeckel, a prominent proponent of social Darwinism, was the first to indirectly promote euthanasia for eugenic reasons: "It is the natural breeding process within the fight for survival that has produced the diversity of natural life and that determines the history of peoples; it is complemented by artificial breeding, for example the Spartans who submitted all new-born children to selection and killed all weaklings" [2]. Darwin's science had been misinterpreted to become the pseudoscience of social Darwinism, which in turn was perverted into the ideology of "race hygiene." The Nazis merely adopted these popular ideas, combined them with anti-Semitism, and used them for their own purposes [3]. The medical profession played an essential part in generating, popularizing, and implementing these theories; this resulted in the atrocities later revealed at the Nuremberg Trials [4].

Vienna before 1938

In the early part of the 20th century, the Faculty was the second largest medical school in German-speaking countries. At that time, much of the international medical literature was still published in German and the "Viennese School of Medicine" held a leading place in the hierarchy of medical excellence. No fewer than four Nobel prize winners of this era originated from within the Faculty: Robert Barany, Julius Wagner-Jauregg, Karl Landsteiner, and Otto Loewi. All but one died in exile; Loewi even had to transcribe his Nobel prize to the Third Reich to get permission to emigrate.

At the beginning of this century, the medical profession in Vienna was dominated by Jews; this was largely because, historically, medicine had been the only academic subject that Jews were allowed to take up (during the great plagues of the Middle Ages, doctoring was a risky business). Of the 4900 physicians practicing in Vienna in 1938, 3200 were of Jewish origin [5]. Thus, the proportion of Jews in medicine was greater in Vienna than in Germany, where it was about 20% [6]. The relationship between Viennese Jews and non-Jews had been relatively unproblematic until the late 19th century, when the ideas associated with social Darwinism began to spread and combine with overt anti-Semitism [7]. By the middle of the 1930s, "race hygiene," together with a political movement aimed at "uniting" Austria and Germany, had led to discrimination against Viennese Jews within the Faculty. This revived a long and infamous history of animosity: Viennese medical students were instructed not to attend courses held by Jews (much of the pressure created by the Nazi regime was brought about through students, who were generally taken with the new ideology), thus depriving Jews of income; even authorities like Landsteiner were hindered in acquiring top positions [7]. Academic promotion in general became more and more difficult for Jews to obtain. The "Society of German Doctors in Austria," a professional organization in favor of German (and Nazi) influences, grew and published lists of non-Aryan colleagues, lists that later provided some of the reference material for the events to follow. Because of this insidious change in climate, many Jewish colleagues emigrated well before 1938, and the seed of Nazism fell on fertile ground. The events that ensued must therefore not be seen as an "accident of history."

The Anschluss

After 11 March 1938, the date on which Hitler's troops marched into Austria and the Anschluss (the integration of Austria into Nazi Germany) was completed, the most drastic changes took place at an unprecedented speed. Almost immediately, 153 of the 197 members of the Faculty were sacked [8]; sources disagree slightly about the exact figures but agree as to the extent of the loss. The dean of the Faculty was replaced on 15 March with an outspoken Nazi, Professor Eduard Pernkopf. Later that month, Pernkopf sent a letter to all University staff: "To clarify whether you are of Aryan or non-Aryan descent you are asked to bring your parents' and grandparents' birth certificates to the dean's office no later than the end of April. Married individuals must also bring the documents of their wives." [9]. All professors had to give an oath of loyalty to Hitler, and by 24 March the minister responsible for the University of Vienna had ordered the Faculty to be "cleansed" of Jews and other unwanted persons. On 6 April, the "venia legendi" (license to teach at university) was withdrawn from all "suspects" and, at the beginning of May 1938, Pernkopf submitted to his superiors a list of those of his colleagues who had been unable to take the oath to Hitler [10]. The new law for the "restoration of professional civil servants" of 31 May 1938 left no doubt as to the professional future of those affected: "Jewish civil servants or individuals married to Jews cannot be civil servants ... (and) are to be transferred into retirement" [9]. Completion of this complex series of legislative and administrative changes and other events, which had taken some 3 years in Berlin and 5 years in Gottingen [11], was achieved within weeks in Vienna: the Faculty was "free" of Jews and other opponents to Nazism. Austria's long history of anti-Semitism, the pseudoscience of "race hygiene," the preparatory work of organizations like the "Society of German Doctors in Austria," the well-coordinated pressure from Nazi student organizations, and the experience gained during the "cleansing" of German faculties all may have contributed to the remarkably smooth and quick running of the operation.

Other faculties of the University were less strongly affected. Of 770 professors and 221 "Dozenten" (assistant professors), 322 (45%) were forced to leave, most of them within weeks after the German takeover [1]. The percentage of those in the Faculty who had to leave was significantly larger (78%) than in any other faculty of Vienna or indeed of any university in Europe. For most of the 118 persons evicted, the sole reasons for dismissal were Jewish origin or marriage to a Jewish partner [10] and only a few non-Jews lost their jobs for political reasons. Many were able to emigrate (111 of the 118); 66% of all Austrian physicians dismissed at that time went to the United States and 15% went to the United Kingdom [1]. A substantial number ("hundreds") of Austrian physicians, however, were deported and killed in concentration camps [12]; others committed suicide.

Little opposition was voiced by colleagues remaining in the Faculty [5]; the whole action was carried out without major disturbances and was obviously both well planned and enthusiastically supported. As early as July 1938, Pernkopf was able to send to the rector a list of suggestions about all replacements to fill the vacant posts. Reemployment was, of course, an urgent task: Four hundred ninety-one courses had been offered before the "clean-up"; only 259 were listed after it [10]. Medical care in general showed similar deficits. Before the Anschluss, more than 5000 physicians were practicing in Vienna; by 1942, the Figure haddecreased to 519 general practitioners and 211 specialists. The first anniversary of the above events was celebrated in a newspaper article by Professor Hans Eppinger: "Now that all disease has been eradicated, the Viennese School of Medicine can in future dedicate itself to its great task without inhibition" [13].

The Viennese Nazi Physicians (1938-1945)

Contrary to what one might assume, the vacant posts were filled not with German nationals but almost exclusively with Austrians and mostly with persons from the lower ranks of the Faculty [7]. All experts agree that the new appointments were made on political grounds rather than on the basis of competence. As a result, the quality of the Faculty was badly damaged; the episode represented nothing less than "the exodus of a medical school" [14]. Between 1938 and 1945, few innovations originated from this formerly thriving Faculty—the obligatory institution of a chair for "race hygiene" is not an exception to, but rather a confirmation of, this rule [9]. After 24 June 1939, the German medical legislation (Reichsarzteordnung) was fully applicable to the former Austria, now called "Ostmark." On 1 January 1940, a German law was implemented, according to which humans considered "unworthy of reproduction" were to be sterilized. In practice, however, sterilization had already been superseded by euthanasia [15], which was done mostly in psychiatric institutions; one of several infamous other sites was the University's pediatric hospital, where many children were killed [5]. A key person in the killings was Dr. Hans Bertha; he was awarded a professorship from the Faculty in 1945, shortly before the end of the war.

Other atrocities directly related to the Faculty were experiments done on human prisoners at Dachau; these experiments were led by Viennese professors Wilhelm Beigelbock and Hans Eppinger. Under Eppinger's directorship, Beigelbock was engaged in a project to find out how long humans could survive on seawater. The experiments entailed the torture of many Jews in Dachau [5]. Both professors were discussed during the Nuremberg Trials: Beigelbock was sentenced and Eppinger committed suicide. Pernkopf worked on the publication of an anatomic atlas, which contained material from children killed in a Viennese hospital. His Institute of Anatomy also used the corpses of executed persons for teaching purposes; part of this material is believed to be still in use at the University [10]. As in Germany, such atrocities were later "forgotten," "swept under the carpet," or justified by their medical (wartime) necessity.

How could such crimes have happened without significant opposition from peers [16]? The above facts provide the logical answer: no independent, critical peers were left. Those who remained in office turned a blind eye, were afraid, or converted to Nazism. This attitude is illustrated vividly by the following episode. In July 1939, Dr. J. Landmann suggested transferring the American Medical Association of Vienna from its traditional site to a new location in London. The Association was a well-established institution offering training to physicians, most of whom were from the United States. Landmann claimed that "a large number of former professors had been dismissed for political and racial reasons." This suggestion created outrage within the Faculty, where substantial incomes were earned through teaching for the Association. Therefore, 13 university teachers formulated an official reply: "The undersigned know of not one case of prosecution of a professor for his racial or religious adherence ... The truth is that Jews are no longer allowed to teach non-Jews ... By the removal of certain influences a trend of charlatanism ... was eliminated" [7]. The letter was signed by colleagues who did not belong to the inner circle of enthusiastic proponents of Nazism. Some of them, such as Professors Wolfgang Denk, Lorenz Bohler, and Ernst Lauda, had worldwide reputations.

1945: A New Beginning?

After the end of the war, a law condemning the former Nazi physicians was anticipated but never materialized. It was estimated that the law would have affected most Austrian physicians, which might be the obvious reason for its nonappearance. Of the 200 teaching staff of the Faculty, only 19 were thought not to be burdened by a Nazi past [10]. At the same time, there was a severe shortage of medical tuition and care [12]. In the winter term of 1945-1946, the Faculty had only 40 teachers. To ease this situation, committees were formed to pardon those who were desperately needed and who had "not indulged in life-threatening experiments on living beings ..." [10]. In this way, most of those who had taken over for Jewish colleagues in 1938 stayed on—even those with records of overt misconduct. Pernkopf, after being imprisoned by the Allies during an attempt to escape, was allowed to finish his anatomic atlas. Only a few months after the end of the war, physicians were permitted to practice, providing that they had submitted a statement confirming that they had not done wrong; this statement had to be accompanied by a letter from the head of their department emphasizing that their work was essential [10]. While Professors Karl Lindner and Ernst Lauda were deans, no fewer than 10 dismissed colleagues were reinstated. After 1950, even those who had indisputably committed atrocities were reinstated. Hans Bertha, for example, reobtained a professorship in 1954 and later became head of psychiatry at the University of Graz, Austria [10]. Prosecution of criminal behavior within medicine was "totally insufficient" and remained so [10]. Many of those who had exposed themselves to Nazism went on to make high-powered careers. Professor W. Denk, for instance, became a rector of the University in 1948 and an unsuccessful candidate for presidency of state in 1957. This office was later taken by Kurt Waldheim, also burdened with a "forgotten" Nazi past; Denk became the first post-war president of the prestigious "Society of Doctors in Vienna," which had been abolished in 1938 and had re-opened on 19 October 1945.

At no point did Austrian officials invite back those physicians who had been thrown out in 1938. On the contrary, the new president of the Austrian Medical Association, Dr. Alexander Hartwich, wrote to key addresses in London and New York discouraging the emigrants from returning. He reasoned that there were "no Jews left to treat," that there was "a shortage of housing and work," and that the Nazi physicians were "unlikely to leave their posts." Thus, in 1955, only 6 former members of the Faculty had returned [10]. The sterreichische rztezeitung, official organ of the Austrian Medical Association, published a 2-page paper [9] in 1988 to commemorate the 50th anniversary of the events of 1938. They stated that "... of the many University teachers exiled from their home country, only few felt the desire to come back to Vienna following the collapse of the Nazi regime ..."

Hundreds of Austrian physicians had died in concentration camps [12, 17]. Those who had the courage to return were generally given no help at all in restarting their lives [12]. Even as late as 1950, some had not regained their private housing, their professional premises, or their licenses to practice [12]. Official rehabilitation of the victims was marked predominantly by its nonexistence [5].

This sequence of events was similar in many ways to that at German medical institutions [4]: preparatory groundwork laid by proponents of "race hygiene"; dismissal of Jewish physicians; substitution of suboptimal Nazi replacements; lack of meaningful opposition by remaining colleagues; and persistence in office of Nazi apologists in postwar times. Yet, there were also substantial differences: the damage done in Vienna was more destructive, and few attempts have been made to come to terms with it.

Comment

The above facts were compiled as objectively as possible from the few records that are available. I consciously and cautiously abstained from interpretation. Some brief comments, however, are inevitable.

Why bring all this back? Is it not better to let these things rest? For several reasons, I think the episode needs to be reported. The fact that so many Nazi physicians remained in office after the war has unavoidable, strong implications for this formerly leading medical school. A loss of this magnitude (78%) is difficult to recover even within two or three generations, and the persistence of the "old spirit" (not necessarily Nazism per se but the idea of making a university career on the basis of factors other than quality of work) must be meaningful for many generations to come. More importantly, perhaps, this story has to be told and retold to honor those who were victims. Their heroic deeds should not be lost in history but must be irremovably secured in it [17].

We seem to live in a time of a most unfortunate revival of Nazi ideology, both in Vienna and elsewhere [18]. At present, few signs suggest that the medical profession has a disproportionate part in this. The historic role played by the profession in the Third Reich, however, is indisputable: "Had the profession taken a strong stand. it is conceivable that the entire idea ... of genocide would not have taken place" [19]. The tragedy might have been avoided but for the active leadership of the medical profession [20]. We must, therefore, remind ourselves of what has happened in order to fortify our resistance against its happening again—in Vienna or anywhere else.

Author's Note: I would like to briefly describe my background and identity. I was born in 1948 in Germany and am not Jewish. In 1990, I took over the Chair of Physical Medicine and Rehabilitation at the Faculty. During my time in office, I gradually became aware of the above events and started researching them as best I could. Even though I had a permanent position in Vienna, I left in 1993 to take another chair at Exeter University in the United Kingdom. The reasons for this decision were largely unrelated to the story told above.