Learning from history — experience of totalitarian regimes of the 20th century

1. Debates about eugenic sterilization

RNDr. et MUDr. Bohumil Sekla (1901–1987), at the time a lecturer at the Institute for National Eugenics, was among the first to report on eugenic sterilization measures in general during the 23rd meeting of the Association of Czech Medics in Prague on 11th December 1933.  At that time, supporters in the debate for the introduction of eugenic sterilization included psychiatrist doc. MUDr. Otakar Janota (1898–1969) and pathologist prof. MUDr. Kristián Hynek (1879–1960).  B. Sekla published a more detailed analysis the very next year, immediately after GzVeN had come into force.  He based his argument on the fact that “we are convinced today that both normal characteristics and certain particular defects and inferiorities have their origins in hereditary attributes, which their bearers continue to pass on to the population…

And we also know that we are not able to alter these hereditary traits by any external procedure, certainly not for the better.”  He considered the main problem, and justification for adopting sterilization measures, to be the effect of three interconnected factors: depopulation, differential fertility (i.e. the differing fertility rates among different social groups) and the ineffectiveness of natural selection, in other words inadequate counterselection.

Furthermore, he claimed, there was no dispute as to the fact that sterilization represented a “very profound interference in individuals’ rights and human destiny,”  yet he nevertheless expected to see the role of the state change in the future, bringing ever greater state interference in the individual sphere.  His eugenic reasoning is quite obvious from his harsh statement that “society as a whole has an obligation to take these [defective] individuals into account and take care of them. We cannot be rid of them at present. However whether it is possible to prevent their increase in the future is a different question.”

He considered the most feasible approach to be “to reduce the fertility of their [defective hereditary attributes’] carriers” and cited the USA as his main example.  In the author’s opinion as a geneticist, the desired aim of these measures was “the preservation of genetic hygiene” and these genes’ “regulation among the population”, that is a form of state-run “care” for the population’s gene pool.  Sekla particularly commended the German GzVeN law for its “perfect” formal aspect, and repeatedly voiced his conviction that eugenics must be very strictly separated from racial theories, which he stood consistently and unequivocally against.

It was in that same year that the debate about eugenic sterilization shifted into a somewhat higher gear. Against the backdrop of controversy in the press sparked by Bělehrádek’s article “Talenty a demokracie” , attention was drawn to key questions surrounding the use of the latest discoveries in genetics, in particular the democratic or anti-democratic nature of such usage and the possibility of political abuse.

Alongside philosopher doc. Josef Fischer (1891–1945) , whose work at the time was focused on a systematic study of the relationship between democracy and totalitarian regimes, the biologist and philosopher of science Prof. Emanuel Rádl (1873–1942)  contributed significantly to the debate, as did his former student, the same B. Sekla. Rádl’s commentary may be considered an interesting testament to the extent to which eugenics and its requirements were critically addressed at the time. In it, he declares eugenics to be a decidedly “modern science” and “the regulation of humankind according to the results of heredity” as “… a good programme, and we must not be offended if it leads to society interfering more and more in the affairs of individuals, on the grounds of social and health interests.”

Nevertheless, as a matter of principle, Rádl persistently pointed out what he saw to be the “fatalistic abuse” of the results of genetic research.  As for Sekla, he reacted with approval to Rádl’s recognition of the scientific status of eugenics, repeated its main mission as being to develop “a mass process of counter-selection resulting from the gradual rationalisation of human procreation,”  and at the same time urged that the main aim of the “progressively” oriented proponents of eugenics should be to prevent its abuse by the permeation of “waste products from the edge of objective science,”  by which he meant racial theories.  He also repeatedly stressed that he did not see any internal connection between eugenics and the “racial programme” in Germany”.

Simultaneously with these statements, a number of critical and, it must be said, far more sceptical comments were published in print. For example, in an analysis of the effects of GzVeN in Germany published in Peroutkova Přítomnost  it was primarily pointed out that there had been a suspiciously large increase  in the number of sterilizations carried out after the introduction of GzVeN. This led the author to conclude that in the context of the political regime in question, these were measures adopted to legalise “the prejudices of the national socialist doctrine”.  The article particularly highlighted the measures’ dangerous connection to health, unemployment and disability insurance: “Social measures such as sterilization cannot be evaluated alone. They must be seen in the light of everything else going on in the country.”  Another group opposed to the policy portrayed the negative medical experience gained during operations.  Meanwhile, further opinions in favour of the introduction of eugenic sterilization were also heard across the country.

In the autumn of that year, on 24th October 1935, the question of eugenic sterilization was the subject of a debate at a special meeting of the Czechoslovak Criminal Law Society in Prague. Its members discussed, as others had for example in Austria, under what circumstances the performance of sterilization for non-medical reasons would constitute grievous bodily harm to the individual’s health, and its legal implications. Alongside specialists in criminal law (A. Miřička, E. Lány and others), J. Bělehrádek attended the meeting on behalf of the Czechoslovak Eugenics Society (ČES).  With the exception of some criticism of castration, the meeting gave reasonable support to the introduction of eugenic sterilization in Czechoslovakia.

The following year, 1936, not only brought with it further discussions among the interested public  and reflections on the situation in Germany , but more importantly saw significant steps taken towards drawing up the Czechoslovak sterilization law. On 5th May 1936 the ČES held an extraordinary meeting in Prague, chaired by their longstanding member and economist Prof. Josef Drachovský (1876–1961), at which the introduction of eugenic sterilization in Czechoslovakia was the only topic for discussion.  The meeting was preceded by a survey, in which numerous medics, lawyers and economists from universities and government ministries participated.  Sterilization was found to be “effective” for certain indications, and its introduction “desirable”.

Its enactment in the law was unanimously recommended, with the establishment of a special committee (from ČES) “of experts, who would critically analyze the eugenic legislation currently in force in various countries, and taking our own circumstances into account prepare a draft bill, to be presented to the competent ministries and political circles”.  The members of this three-person committee were two eugenics medics, MUDr. Vladimír Bergauer (1898–1942)  and B. Sekla, and one lawyer JUDr. Jarmila Veselá (1899–1972). J. Veselá’s words from 1938: “Protection of the defective must not be allowed to go so far as to permit their procreation.”  could certainly serve well as a motto for the committee’s work.

It was K. Kadlec once again who gave what was probably the most concise criticism of eugenically motivated sterilization during 1936, when he included it among just five contemporary rationalization attempts that closely touched the foundations of human life, in The Rationalisation of Life,  a book that also served as a commentary on the second part of the 1930 papal encyclical Casti connubii.  Alongside arguments he had already presented in 1931, he looked at the situation in Germany following the implementation of GzVeN, and a more detailed analysis of the papal encyclical.  He divided sterilization interventions into private sterilizations, and those required by the law.

As before, he regarded sterilizations performed on the basis of eugenic indications to be an unjustifiable encroachment into human nature and interference in the individual’s human rights and bodily integrity, and he questioned its possible contribution to the common good.  He understood sterilization primarily as a punishment (like e.g. the death penalty) and was careful to point out its fundamental difference: “they [those affected by hereditary conditions] cannot be held responsible for their pathological condition; neither, therefore, can they be punished”.  Lastly, he once again highlighted the questionable effectiveness and economic benefit of these measures (bearing in mind the necessary increase in operational procedures) as well as the risk of their abuse.

The process of preparing the draft law, and the course of the debate during the remainder of 1936 and early 1937, is unclear from extant archival sources. What can be gleaned is that on 5th March 1937 a basic outline of the prepared act was put forward by ČES in the form of a “Memorandum on the Issue of Eugenic Sterilization”.  In this context, it is certainly interesting to note the coincidence with the release of the first Czech textbook of medical genetics, written by B. Sekla, which was published in 1937 under the title “Inheritance in nature and society” and in which the author reaffirmed his support for the introduction of eugenic sterilization in Czechoslovakia.  The memorandum was presented to the Ministry of Public Health and Physical Education (hereafter MVZd) on 21st June 1937.

In line with the preceding debates, it was declared a collective necessity to manage certain genetically determined diagnoses, when the “collective concern with the quality of future generations of our country’s population” was connected with quantitative considerations in so-called differential fertility.  Eugenic sterilization was appointed as the “most effective means” of achieving this goal, as “it is… the only safe obstacle to further reproduction,” other methods not being considered irreversible.  In terms of surgical procedures, vasoligature  and vasectomy  (for men) and salpingectomy  (for women) were proposed; sterilization using X-radiation was not considered suitable.

The memorandum further noted the necessity of legal regulation of the practice of sterilization for eugenic reasons; the adoption of a separate law was proposed as the most practical means.  Since at the time a doctor who carried out a sterilization operation for any non-medical reason could be criminally prosecuted for causing bodily harm, any possible law on eugenic sterilization would have to change this, by modifying the then § 152 of the Criminal Code.

The idea was that the disabled should put themselves forward for sterilization, or be nominated for sterilization either by their guardians, or by relevant “official institutions, who come into contact with this kind of person,” i.e. daily care, healthcare and social institutions.  The sterilization operation itself was always to be carried out with the consent of the individual him/herself or of their legal representative, or on the basis of an official medical, genetic-eugenic and administrative analysis of the case in question by a special committee.  Hence forced sterilization was not proposed.

It was recommended that a number of committees be set up, which would be centralized and each affiliated to the health department in one of the regional government offices.  Appeal against the committee’s decision was to be permitted, with the MVZd in Prague designated as the highest appeal authority.

Four diagnostic groups were specified in the Memorandum, as those to whom eugenic sterilization should apply, if the measure were to be introduced. These were originally:
1. hereditary feeble-mindedness;
2. severe hereditary nervous and mental disorders;
3. severe hereditary sensory defects;
4. certain severe hereditary physical defects.

Of all these eugenic indications, feeble-mindedness  (particularly in the sense of primary oligophrenia) took first place (largely owing to differential fertility), with a hereditary factor assumed in 75% of cases, and total incidence in the population estimated between 1 and 2% with a strong likelihood of increase.

The most significant conditions classed among the so-called severe nervous and mental disorders were Huntingdon’s disease and epilepsy.

Hereditary deafness and blindness were classified among the so-called hereditary sensory defects; the incidence of both these conditions in the population of the time was estimated around 0.1%, and there was no danger of an increase.

Lastly, the only condition clearly included among severe hereditary physical defects was cleft palate, otherwise the proponents of the Memorandum stated that medical knowledge at the time was insufficient to enable conclusive assessment of other conditions.

The 1936-37 Memorandum, it appears, constituted the most elaborate proposal ever written in for the introduction of eugenic sterilization in Czechoslovakia. It most likely never underwent further development, e.g. with numbered articles. Why so remains a question. It seems highly likely that opposition from MVZd representatives played a significant role; already in 1936, in connection with the effect of GzVeN on Czechoslovak nationals in Germany, they had firmly stated that the introduction of forced eugenic sterilization “… would be an intrusion into the personal freedom that is fundamentally guaranteed under the Constitution”.  Not even the publication of the most comprehensive and strongly argued work in favour of eugenic sterilization, by J. Veselá in 1938  was able to change the fact that, during the interwar period, eugenic sterilization measures were neither legalized nor implemented in Czechoslovakia. On the contrary, official proposals were developed for the introduction of new legislation to protect the feeble-minded.

The period of German occupation, on the other hand, together with the Second World War from 1939–45, are a different matter altogether, since from 1st January 1940 to 5th May 1945, the German GzVeN applied in the border territories annexed to Germany (i.e. the Reichsgau Sudetenland), or rather applied to the German population across the Protectorate.

2. Reichsgau Sudetenland 

The turbulent political events that would eventually result in the demise of the independent Czechoslovak state also brought about a fundamental change in conditions of medicine and public health administration in certain areas of the Czech lands, which had formed an organically evolving whole in these areas since at least the latter half of the 19th century.  A new situation emerged in the Czech border regions that were ceded to Germany, and amalgamated into the so-called Reichsgau Sudetenland, or connected with other German regions such as certain areas of Šumava and southern Moravia.

Meanwhile, right from the beginning of the crisis year of 1938, the position of the so-called Sudetendeutsche Partei [Sudeten German Party; hereafter SdP] became radicalised, when demands for political and ethnic “emancipation” of the so-called Sudeten German ethnic group [Sudetendeutsche Volksgruppe], for whom the SdP claimed to speak, were – among others – combined with demands for the adoption of uniform racial hygiene policies of the kind introduced in Germany.  Dr. Theodor Jilly (1901-?), a medical doctor from Jihlava who was at that time parliamentary deputy for the SdP, a member of the National Assembly’s health committee, and had been Heinlein’s commissioner for health issues since 1936, expressed this stance clearly and without a shadow of doubt from the beginning of the year : early in 1938 he declared that “ethnically” oriented doctors were particularly focused on initiatives to improve the “declining national and hereditary health of the Sudeten German people.” In his argument, he also refers to well-established racial hygiene theory, emphasising the unconditional “need to follow scientific findings”, in particular in the field of heredity studies, and so stating that this “care” provided by the Nazi state and in the name of its people is utterly essential:

“These findings oblige us to act … Awareness of the importance of hereditary health for the future of our people, our population problem, will likewise in future oblige the Sudeten German Party to do its duty for the people.”  He used similar ideological arguments, too, at the General Assembly of the umbrella organisation for German doctors in Czechoslovakia, the Reichsvereinigung der deutschen ärtzlichen Vereine, in June 1938, explaining with agility attitudes to the official German “hereditary health care” and “care for the race” among those Sudeten German doctors who had formed an independent group called Sudetendeutsche Ärzteschaft [Sudeten German Medics] as part of Henlein’s SdP in 1936.  In his speech, he spoke unambiguously in favour of the politicisation of the health sector, making no exception for the issue of “hereditary health”.

On the basis of racial hygiene arguments he then proceeded to cast aspersions on the existing health and, by extension, political system in Czechoslovakia, which he considered to be insufficiently “collectivist” under National Socialism: “This undoubtedly exaggerated personal hygiene and care for individuals [in Czechoslovakia], for which the whole society is responsible, was brought in at a time when births of hereditarily healthy children were continually declining and when it was already evident from scientific findings in heredity studies, that there are no methods for treating serious hereditary disorders.”

After the signing of the Munich Agreement on 29th September 1938 and the subsequent forced surrender of the Czech borderlands to Germany, the area’s health administration was also handed over to the newly created administrative authorities of the Reichsgau Sudetenland. To give just a general idea of what consequences secession had for the region’s healthcare, let us look at a few figures. According to the plan of Czech Lands at the time (i.e. not including regions assigned to the Moravo-Silesian Lands), secession resulted in the loss of forty out of the ninety-one hospitals that had fallen under its management pre-September 1938, and with them capacity to the tune of eight thousand nine hundred and twenty five hospital beds; in addition, the specialised medical institutions in Dobřany, Cvikov and Kostomlaty pod Milešovkou had to be handed over to the Germans.  The material value of these losses was estimated at the end of 1938 to be around five hundred and sixty million Czechoslovak crowns (Kč).

Additionally, an entirely new situation came about in Autumn 1938 as regards health administration: for the first time, it was taken out of the regional structures within which it had evolved over many decades and had to be given an entirely new framework, in particular at the lower administrative end, being no longer centred in Prague as previously, but in Liberec or, in some cases, Berlin.

The decision-making bodies for the newly formed Reichsgau Sudetenland health authorities were the health department (Ia) of the so-called Reich Governor’s Office [Reichsstatthalter; hereafter RG], representing the position of state authorities, and the so-called office for the people’s health [Gauamt für Volksgesundheit], representing the NSDAP [Nazi] party line. Between 1938–45, MUDr. Karl Feitenhansl (1891–1951) served both as head of the Ia department and of the regional office, and was chief doctor for the Reichsgau Sudetenland.

There were then three health departments subordinate to the RG, within the so-called District Government President’s Office [Regierungspräsidenten] located in Karlovy Vary, Ústí nad Labem and Opava. Lastly, at the lowest level, new so-called State Health Offices [Staatliche Gesundheitsämter; SHO], were established according to the Reich model, as branches of the relevant provincial council offices [Landräte], i.e. city health departments.

This brief and far from exhaustive overview of the management and administration of healthcare is essential in order to give a clear picture of the framework within which GzVeN was introduced in the Reichsgau Sudetenland, and on the basis of which compulsory sterilizations for selected groups within the local population were first legalized and subsequently implemented in practice.

Although the first formal discussions on the subject of introducing GzVeN in the Reichsgau Sudetenland had already taken place in Berlin in mid-August 1939, the experience of its introduction in the newly established Eastern March (Austria) on 15th January 1939 and the on-going process of creating new administrative structures in the Sudetenland were the reason why, in October 1939, it was decided that GzVeN, inclusive of all six executive regulations, which significantly modified and supplemented it, would enter into force in the Reichsgau Sudetenland only on 1st January 1940, as indeed it did.

The basic requirements for its introduction were suitable medical facilities and personnel to carry out potential sterilization procedures, and the establishment of a system of hereditary health courts (trial and appellate courts). Simultaneously the groundwork was laid for the creation of a hereditary biological inventory [Erbbiologische Bestandaufnahme], in other words an extensive medical and genealogical register.

The first list of suitable medical (hospital) facilities was drawn up by the RG office at the beginning of February 1940. It listed hospital facilities appointed to carry out sterilization procedures in accordance with GzVeN, in particular as specified in art. 5 of the executive regulation of GzVeN dated 5th December 1933.  The list also recorded each facility’s capacity to carry out such procedures by three different methods: surgically, using X-ray or using radiotherapy.

The staffing and capacity of each medical facility or department, together with information about their consultants and specialists, were also taken into account. After two months in correspondence with the various Regierungspräsidenten, a list of twenty-one hospitals and thirty-two doctors who were to implement the decisions of the hereditary health courts was drawn up (see Overview 1). We may of course presume that before the end of the war the list would have undergone a number of changes, both in terms of institutions and of their personnel. In any case, the share of such operations taken on by each of the individual facilities (clinics) remains unclear, especially in the cases of Dobřany near Plzeň and Opava.

As for the so-called hereditary health courts [Erbgesundheitsgerichte], the trial courts were, just as in Germany, affiliated with the Local Courts [Amtsgerichte] and in the Reichsgau Sudetenland sixteen of these were established in total. These courts were located in Ústí nad Labem, Česká Lípa, Most, Cheb, Stříbro, Frývaldov, Karlovy Vary, Chomutov, Liberec, Žatec, Teplice-Šanov, Trutnov, Varnsdorf, Litoměřice, Nový Jičín and Opava.

Only one so-called high court for hereditary health [Erbgesundheitsobergericht], in other words appeals court, was established in the Reichsgau Sudetenland, at the Higher Regional Court [Vrchní zemský soud] in Litoměřice. The names of both the judges at these courts and the doctors who acted as medical assessors are known.  A description of the decision making process in the cases of a number of institutional patients is contained for example in the testimony given by the director of the Opava clinic, Dr. Karl Girschek (1898–1992) , who was one of the few doctors investigated and tried after the war for carrying out forced sterilizations:

“Upon diagnosis of a hereditary disease at the institute I was, as its director, required to complete a report (Antrag) for the sterilization of the individual concerned to the ‘Erbgesundheitsgericht’, which I did. ‘Erbgesundheitsgericht’ consisted of one judge, an official doctor and a general practitioner. This court then decided whether the individual was to be sterilized, or whether sterilization was declined. If the court established that the individual must be subjected to sterilization, the individual themself or their relative could lodge an appeal against the decision. The matter was then handed over to a higher authority, the ‘Obererbgesundheitsgericht,’ against whose decision there was no further possibility of appeal.

If the court decided that sterilization of the individual was to be performed, the court itself appointed the doctor who was to carry out the operation and that doctor received a direct order from the court that had considered the case for the individual’s sterilization. The sterilization of the individual was then carried out and the whole matter was concluded.”  In complicated cases, the courts would call for expert opinions from certain clinics and institutes of the Medical Faculty at the German Charles University [Deutsche Karls-Universität] in Prague, which despite being located in the Protectorate was connected with the dealings of the hereditary health and sterilization courts in the Reichsgau Sudetenland.

Even though GzVeN only applied to residents of the Reichsgau Sudetenland of German citizenship, in certain cases Czech nationals were evidently also made to undergo sterilization.

Furthermore, there is evidence that in a number of cases sterilization was demanded in the Reichsgau Sudetenland for explicitly racial reasons. In February 1943, for example, the Opava Regierungspräsidenten informed the RG in Liberec that in the Opava district there were “several gypsy families [Zigeunerfamilien], among whom is a woman, who is a gypsy and was recently sterilized. She has had six children with a German man [Deutschblütige], of whom the eldest two are approaching sexual maturity. I have been asked whether a first-generation gypsy half-breed can be sterilized.”

In terms of the total number of individuals in the Reichsgau Sudetenland who were sterilized on the basis of the GzVeN law between 1940–45, further research would be needed to establish this. It can be assumed that numbers may have varied quite widely from district to district. In the case of the clinic in Dobřany, for example, Dr. Neonila Lutschinger stated when detained after the war that “… it happened [among patients at the facility] fairly often that sterilization measures were performed on men and women according to the Reich laws, at the Cheb hospital. There were a few hundred such cases.”  Partial data are currently available, based on annual reports from the time (see Overview 2). It is nonetheless necessary to mention a few matters in relation to this overview: 1. The overview only contains data taken from annual statements that were sent by individual institutions in each district to the RG offices, and hence to the Reich’s Ministry of the Interior (Reichsministerium des Innern) in Berlin.

As can be seen, these statements have only survived for the years 1940 (not including the district of Karlovy Vary), 1942 and 1943. In addition to the annual statements, regular summaries, usually compiled for quarterly or shorter periods, have also been preserved. The surviving materials are, however, far from complete, and so do not enable us to retrospectively reconstruct the content of the missing annual statements (1941, 1944 and 1945). 2. As for the numbers of sterilization procedures themselves, the table here shows only those procedures carried out under the “hereditary health care” measures, and not those performed on the basis of other medical indications. The figures do, however, only reflect the total number of proposals submitted to and considered before the hereditary health courts. The overwhelming majority of these resulted in surgical operation. 3. For completeness, the number of abortions made under the “hereditary health care” measures is also listed.

Lastly, as for the so-called hereditary biological inventory, it was based on the 6th executive regulation to GzVeN dated 23rd December 1936, and an unpublished ruling by the Reich Ministry of Justice (Reichsministerium der Justiz) on 27th March 1939, and was supposed to begin first of all with institutional patients.  Incidentally, it coincided with the construction of so-called advice centres for genetic and racial care [Beratungsstellen für Erb- und Rassenpflege] at the various SHOs. In the Reichsgau Sudetenland the head office for the hereditary biological inventory was located at the Opava institute and its sole manager was the aforementioned K. Girschek.

The article was first published in “The human rights of the disabled, the terminally ill and the dying, in the context of the Nazi „Euthanasia“ programme”, René Milfait (ed.).

Translated by Anna M. Barton