One of the darkest pages of the history of 20th Century, the eugenetic as a political strategy for forging the 'perfect' race is not just a dark heritage of the Nazi ideology: a dangerous potential still remains inherent in medicine more generally, as the Lancet argues. MD Patriarca, pathologist and novelist, explores a hugely relevant topic.
Are eugenic ideas still accredited within the scientific community?
di Carlo Patriarca
The Hippocratic oath has been the same for millennia, but the human and medical ability to convert therapy into killing remains. “Medicine during the Nazi period and the Shoah is not a matter of the distant past”, as recently stated by the medical journal the Lancet. “Historical evidence documents that the reasoning, values, and activities of health-care professionals and biomedical researchers in this context represented extreme manifestations of potential problems inherent in medicine more generally”. In the first decades of the 20th century, this ability was accentuated, when doctors who devoted themselves to the care of the community rather than the individual came across eugenic ideas.
Actually, the debate on environment and heredity was rich in interventions and fitted into the broader conflict of ideas and currents of thought triggered by eugenics, which emerged in England with Francis Galton in the last decades of the nineteenth century. Within the eugenic framework, conceived in the late positivist era as an instrument to strengthen the population and developed in the decades when “social Spencerism” was discussed in philosophical circles, both progressive and socialist-inspired demands were made, along with increasingly repressive demands for the defense of the "race" or, as it was preferred to say in Italy, the "stock". The contribution of doctors and biologists to the debate was enormous, and as is tragically well known, the responsibility of doctors in the eugenic programmes of the Third Reich also proved significant.
In the decades before the rise of Fascism in Italy and National Socialism in Germany, there was debate in educated circles about the artificial selection of the human species and the strengthening of "races", defined in the broadest sense by skin color and physical traits. After all, the risks of degeneration of family strains and inheritance of diseases were already discussed as early as in the 19th century with the alienist B.A. Morel.
The fascism financially and ideologicallisupported The Defence of the Race magazine (1938)
In Italy, however, at the beginning of the 20th century, doctors, hygienists and demographers have a more Lamarckian inclination to believe in the role of the environment in modifying genetic heritage. Accordingly, a "social medicine" was advocated and at most preventive measures were proposed against the diseases of the time.
The chapter is indeed very extensive and rich in positions that are very different in the world of culture outside medicine. But numerous clinicians also felt compelled to take a stand on this issue, more or less spontaneously, at a time when the role of the state in health planning was imposing itself, urban diseases were spreading and the sick veterans of the First World War needed to be helped physically and mentally. Debates about sterilisation and premarital certificates became common, and for a complete picture we refer to the essays by Claudia Mantovani and by Francesco Cassata.
In Europe (Switzerland, Denmark, Sweden, Norway, Finland, Estonia) and in the USA, laws were enacted for the (often voluntary) sterilisation of carriers of a range of diseases, as were laws on premarital certificates of absence of diseases considered hereditary in future spouses and their respective families; in Germany, a law on the forced sterilisation of psychiatric patients was in force from July 1933, immediately after Hitler came to power (in total, some 350.000 physical and/or psychiatric patients were sterilised), an eloquent prelude to the tragic developments that followed.
In Italy, on the other hand, there was an abundance of public intervention by doctors on these issues, but they hesitated only with recommendations on premarital visits and compulsory reporting (Unified Text of Health Laws of July 1934) of tuberculosis and venereal diseases among certain categories of workers (food industry workers, prostitutes, employees in crowded environments such as hotels, barracks, etc.).
The reasons why Italy stayed away from eugenically inspired birth control policies can be traced back to both the fascist regime and the Church. Fascism advocated expansive demographic policies (tax on celibacy, allowances for large families, etc.) in the belief that the "regeneration of the stock" would come from an increase in fertility, because "number is power”. For its part, the Church, far from an utilitarian vision of human life, was traditionally opposed to birth control, as set out in Pope Pio XI ‘1930 encyclical "Casti connubii" and supported with the usual energy by the Friar Minor Doctor Agostino Gemelli. Eventually, the idea spread even among clinicians that the environment, in conjunction with medicine, could have a curative effect on disease and that eugenic policies were therefore unnecessary. These were the decades of state intervention to combat the main infectious diseases such as tuberculosis and malaria: dozens of sanatoria were built in Italy and vast swamplands in Lazio, Polesine and Puglia were cleared of malaria.
In September 1924, the first national congress on social eugenics was held in Milan, opened by Luigi Mangiagalli with these words: "Human selection will be the only remedy and the great effort of future generations" . Mangiagalli was referring to social measures that could realise the dream of improving the human species. In fact, there was much discussion about disease prevention (work environment, maternity and childhood, etc.), little about preventive eugenics as sterilisation, and nothing about selective eugenics in the sinister sense that the word later took on in Germany.
However, since immunity was believed to be transmitted, diseases could also exert their pathological influence on the chromosomes or, more realistically, bypass the placental barrier. For some doctors, neurologists and pathologists, hygienists and biologists the fear of the heritability of diseases surpassed any other consideration.
It is a fear that tests the limits of the "Latin way to eugenics", and at least in its intention to advocate sterilisation in the name of collective interests. Which diseases were of most concern? Syphilis, for good reason, but also tuberculosis, epilepsy, goitrous hypothyroidism, alcoholism and, in general - and more than any other because they were less known - mental illness. The fear of degeneracy did not stop there, however, and for many included antisocial behaviour and prostitution.
Eugenics heated up the debate among some doctors and psychologists in the late 1800s and early 1900s when it came to mental illness. In 1909, the psychiatrist Zuccarelli declared that "sterilisation should be extended to the severely feeble-minded". Fear of the hereditary nature of psychiatric diseases was high and proposals to sterilise patients were unsuccessfully introduced into parliament. Prominent doctors, first in the socialist and then in the anti-fascist movements, also took very firm positions, as in the case of Gaetano Pieraccini. He argued that "manic-depressive psychoses and early dementia (the old term for schizophrenia) have a high degree of heritability". The proposed solution to the problem was drastic, in a reality where asylums were overcrowded and the 1904 Act, which was in force for most of the the twentieth century, recommended the discharge of patients with so-called "quiet" mental illnesses. The mentally ill patient "leaves the asylum (...) and freely engages in procreation. Under these circumstances, discharge from the psychiatric hospital could be made conditional on sterilisation by X-rays, which was to be extended even to the examination of the lucidly insane”.
These views were in the minority, but certainly there was a widespread demand for a census of mentally ill individuals, including a family medical history, facilitated by the requirement in Rocco's 1930 Penal Code for hospitalised mentally ill individuals to be entered on the criminal register. Ultimately, the idea prevailed that the mentally ill should be kept, if not sterilised and free, at least fertile, but "incarcerated" on the basis of the legal principle of "social danger".
The manifesto of Italian racism (1938).
THE TRAGIC TURNS
The theme of psychiatry and heredity takes on shades that will later prove particularly dark when focused on Jewish communities. From a mixture of data and prejudices in which scientific, social and historical arguments are confused (where religious explanations, the character of the communities perceived as closed, the existence within them of some individuals with outstanding intellectual abilities, observations on the mercantile and urban vocation also find space), positions emerge at the turn of the nineteenth and twentieth centuries in France with Jean-Martin Charcot and in Germany with Emil Kraepelin that others - when a few decades later in Europe nationalism will dictate the law - will exploit to marginalize Jews. Two of the most important founders of modern neuropsychiatry, at a time when Jews were still quite well integrated into the city societies, express themselves in very clear terms. For Charcot, Jews are "especially prone to neurosis". For Kraepelin, "Jews are predisposed to mental illness much more than Germans. (...) in them, disorders that are generally attributed to hereditary degeneration are particularly pronounced."
These are views also shared in Italy, where Augusto Giannelli, chief and then director of the large Roman psychiatric hospital Santa Maria della Pietà, wrote in 1905 that "a neurasthenic trait runs through the whole race of Israelites". The Roman psychiatrist and the Milanese psychiatrist Andrea Verga speak of a higher statistical frequency of admissions to psychiatric hospitals among Jews. Phobias, obsessions and depressive states as well as frenasthenia are the terms that recur, while psychiatrists agree on the lower frequency of alcoholism compared to the general population. Enrico Morselli also agrees, adding that the reason lies in the "painful history of this scattered people on earth" These arguments are also echoed by Jewish scholars such as Cesare Lombroso and Edgardo Morpurgo, who, while condemning the creeping anti-Semitism and calling for greater integration of Jews, do not fail to point out the marked tendency towards neurosis that would affect Jewish communities.
The literature of the time also contains numerous references to an increased incidence of astigmatism, diabetes, arthritis and flat feet, which led to the true stereotype of the limping Jew, "Claudicatio intermittens" (a disease of the nervous system with a specific, albeit unknown, organic cause). In France, the (pseudo)scientific debate is particularly heated, and we find claims of an increased incidence of eczema, epilepsy and other diseases, often within the framework of a degenerative hereditary interpretation.
With the rise to power of fascism, things do not change at first, apart from a progressive affirmation of a new "Italic type", i.e. the idea of a strong and patriotic warrior, which is poorly compatible with the stereotype of the Jews and thus sets the stage for their later exclusion from the body of the nation. Finally, neurosis is a pathology of urbanised and democratic societies, and for the regime Italy must recover its rural roots.
For Kraepelin, "Jews are predisposed to mental illness much more than Germans. (...) in them, disorders that are generally attributed to hereditary degeneration are particularly pronounced."
As is well known, the racial demarcation of what is authentically Italian and what remains outside of it is completed by the new discipline of biotypology, founded by the endocrinologist and senator Nicola Pende. To this new constitutional discipline, Pende will dedicate manuals and articles that will be widely disseminated in other countries. For Pende, there is no doubt that races exist, they are a combination of biological and cultural data, which he calls the "spirit of the Italic race". For Pende, the "Mediterranean race" has its epicentre in Romanity and it is clearly distinguished from the Nordic races - individualistic, materialistic and animated by a purely biological racism - because of its strong sense of solidarity and its attachment to the land. Therefore, the Jews are definitely left out.
This is a different racism from the purely biological racism of Telesio Interlandi and his journal "The Defence of the Race", around which the adherents of the German line of racism rally and with which Nicola Pende will polemicise. But in any case, biotypology will be one of the reference points of the 1938 Manifesto degli scienziati razzisti, the "Manifesto of Race", signed and later rejected by Pende himself and by other doctors such as the psychiatrist Arturo Donaggio, among others. It is significant that a scientific society, the Italian Society of Psychiatry (SIP) led by Donaggio, approved the manifesto. A manifesto full of internal contradictions, as the historian of science Giorgio Israel noted, precisely because of the different souls of Italian racism, but anticipating and preparing the start of the racial laws and the beginning of the persecution of the Jews in Italy too by a few months. A persecution of rights soon turned into persecution of lives.
The horror of the deportations of the Jews and the uniqueness of the holocaust don’t allow us to neglect a lesser-known chapter that was confined to the border regions where eugenics was able to exercise its inhuman power and where pathological anatomy also played a role. The alliance with Germany established by the Steel Pact of 1939 paved the way for the Option in Südtirol or Option, through which the citizens of German-speaking South Tyrol were offered the opportunity to become Germans in every respect and to move to the Third Reich. This choice, which was officially accepted by the majority of the South Tyrolean population (almost 200,000 people), also opened a eugenetic wound in the border regions.
The issue is huge and formidable when placed within the eugenic project of oppressing mentally and physically disabled people who were mainly adults and therefore dangerously fertile as well as economically unproductive. It is estimated that between 250,000 and 300,000 lives were extinguished in this way. A project that began in Germany as part of "Aktion T4", so named after the Berlin address Tiergartenstrasse 4, the planning headquarters of the Nazi "euthanasia programme", in which doctors played a central role and where the first gas chambers were put into operation. The programme, which was contested by part of the German Church, was officially stopped in 1941; however the extermination, rather hidden and undisturbed, continued until the end of the wa.
The fate of more than 5,000 children was instead decided in the depths of legislation and administration. The victims came under the Kindereuthanasie project, which started from the letter of a father (or a grandmother) who wrote to Hitler in 1939 asking that his child receive the Gnadentod, a "merciful killing". What was to be done with children and young people who suffered from incurable diseases and were carriers of a genetic heritage that was considered degenerate and dangerous? The children were "put to sleep". "Those selected for killing were prescribed very high doses of Luminal... They were spastic children..., they had polio..., they were idiots..., they could neither speaknor walk. As we say today, give them a sedative because they are restless. And with these sedatives... the child sleeps," says a doctor who was directly involved in the project. Over the years, many other children were suppressed with carbon monoxide or simply by malnutrition, others were subjected to unspeakable medical experiments. For these doctors, cure and eradication were not incompatible concepts: the aim was to cure society by eliminating carriers of defects that were considered hereditary or simply an unnecessary economic burden on healthy society. Thus, a utilitarian ethical concept prevailed, through which the subject became the object: those unworthy of life were made available to science and ultimately to humanity.
Victims of this project were also Italian children from South Tyrolean centres whose parents chose German citizenship, thus condemning them to death. In the medical records we read about children who are sometimes agitated and sometimes quiet, sometimes aphasic and apathetic, but occasionally interacting and talking, often incontinent, and with a clinical diagnosis of dementia precox or schizophrenia, sometimes microcephaly or epilepsy or outright idiocy. They were killed in the pediatrics department of Kaufbeuren. The pathological reports of the autopsies performed sometimes describe a normal brain picture, sometimes cerebellar or cerebral atrophy. Some cases of hydrocephalous are also reported. The deaths were attributed to bronchopneumonia, in about half of the cases to tuberculosis (in concentration camps the tuberculosis in children was sometimes the result of vaccination experiments with live bacilli).
None of the documents mention whether the pathologists refused to perform autopsies or whether there were toxicological investigations into the causes of death. One of them stated: "(Performing autopsies) allows one to soothe one's conscience, so to speak, especially because one is interested in finding out what is wrong with a person. What is happening here? Why is this child sick? What is the problem? Why is this child an imbecile? Why is it paralysed? This presented a high scientific interest, I must insist on this point.". The hypocrisy of this justification - which is itself absurd - is also revealed by the superficiality of the autopsy reports. These anatomo-pathologists played the role of willing and dull executors of autopsies on the victims.
A dismissed asylum.
In 2010, the German Society for Psychiatry and Psychotherapy (DGPPN) issued a very clear document of historical responsibility and an offer of apology from the psychiatrists of the Third Reich to the victims, which was incorporated into the society's statutes In his speech, the president of DGPPN said that “even until recently, there have been almost no qualms about using specimens taken from patients murdered during the Third Reich”. In recent years, the Italian Society of Psychiatry (SIP) has also reopened the debate on 1920s - 1940s psychiatry, eugenics and antisemitism, acknowledging racism and ideological support for the wars of the fascist regime.
However, the eugenic temptation does not cease with the end of World War II if sterilisation procedures for certain categories of patients continue in some countries, and in a more or less veiled form also in the second half of the 20th century. At the same time, however, the condemnation of these practises increased, also due to the progressive historical reworking of the decades of European dictatorships and the discovery of the exterminations committed.
Acknowledgements: the author is grateful to the Hirstorical Archiv. of the Bezirkskliniken Schwaben, Bezirkskrankenhaus, Kaufbeuren, Germany.
Moreover, the author is grateful to dr Andreas Conca, coauthor of a wider article on this subject recently published by Pathologica (https://www.pathologica.it/article/view/844),
where references of the present article are also reported.
© Rekh Magazine
Carlo Patriarca
MD Carlo Patriarca is currently the director of the Pathological Anatomy at the Azienda Ospedaliera Sant’Anna in Como, Italy. He also authored, as a novelist, three successful books - “Shock”, 2022; "The battlefield is the heart of men", 2013, and "The challenge", 2020 -, all published by Neri Pozza.