Michael Kater, "Doctors under Hitler", Chapel Hill: University of North Carolina Press, 1989.

This monograph is a sociohistorical study of the medical profession under the Third Reich and rests on the author’s previous work analyzing doctors and medicine from Wilhelm II to Hitler.  It draws upon documents in the Federal Archive of Koblenz and the Berlin Document Center.  Primary material was also drawn from the student archive in Würzburg and other regional West German archives.  He also drew on the papers of the former panel physicians’ association, the KVD, as well as the predominant professional journals and memoirs of physicians that lived beyond 1945.

 At the dawn of the Third Reich, in 1933, there was a surplus of physicians, inherited from the republican era.  These doctors were at first hopeful that the new regime would address issues left over from the health administration of the Weimar Republic, but their hopes were not fulfilled.  Under the republic medical graduates had to spend three years as an assistant in a hospital where they were poorly paid, and forbidden to seek other sources of income.  Establishing themselves as independent practitioners was almost impossible for a doctor straight out of medical school.  One of the complaints lodged by spokesmen for this group was that medical institutions should stop advertising junior positions for bachelors only.  They also emphasized that, after public school teachers, high school teachers, and jurists, they represented the fourth largest group of academically trained professionals born after 1900.

 But under the Third Reich, the medical profession became a microcosm of the larger Nazi sociopolitical system, governed by the Nazi leadership principle and redefined in National Socialist terms.  Physicians now had to present every private contractual arrangement to the Reich Physicians’ Chamber for approval, register with the Nazi medical agencies and keep them informed of any changes in their family status or medical qualifications.  They also had to report on their patients.  All serious cases of alcoholism, ‘incurable’ hereditary or congenital illness (i.e. imbecilism) and highly contagious diseases such as venereal disorders were recorded and reported to the appropriate authority.

 The doctors themselves were required to undergo continued training.  Partly this was to break down the distinction between general practitioners and medical specialists, but it was also to teach them National Socialist concepts of health and medicine.  The unpopularity of these courses was perhaps offset by another change in their profession implemented by the Nazi legislators, its redefinition.  By stating that the medical occupation was not a business, the Reich Physicians’ Chamber was able to exclude anyone who was not properly schooled or licensed.

 This did not do away with medical quacks, however, for the Nazi conception of medicine favored the lay element over ‘school’ medicine.  Instead they created a new class titled “physician of natural healing” open to anyone who could demonstrate the requisite ability.  Anyone in this group with extraordinary talent could enter a medical facility without the usual professional medical qualification, and could even receive a license as a doctor medici.  The Nazis further required that regular doctors had to assist registered lay healers at the latter’s request.

Under the Third Reich medicine became the preeminent academic discipline, with approximately 30 percent of all university faculty being composed of medical teachers by 1935.  Medical faculty also became dominant in university power politics.  Between 1933 and 1945 the percentage of medical faculty serving as rectors increased from 36 to 59 percent.  Along with this increase in power and significance there was the establishment of a new discipline that became a part of the medical curriculum after 1933, Rassenkunde or Rassenhygiene, race hygiene or eugenics.  This ‘science’ consisted of three parts: anthropological, sociological, and medical, and its goal was to improve the superior race, while eliminating the inferior ones.

Kater thus links the professionalization of medicine in the Third Reich with its corruption.  West German doctors saw these events as a struggle between the forces of freedom and democracy against the totalitarianism of the Nazi regime.  A battle which the latter eventually won.  East German doctors, on the other hand, saw these events as the result of a premeditated conspiracy between fascist-minded German doctors and Nazi political leaders.  Kater feels that the truth is somewhere in between, but that it lies closer to the East German perspective, than the West German one.

Treating the Disease vs Treating the Patient

While I was pursuing my History of Science studies at Notre Dame I took a seminar course on Medicine and Society.  My last two posts are from that class.  I came to hate that class and it was a large factor in my decision to drop out of the program, but I did learn some important lessons during it.  The crux of the message that the professor was trying to get across to us was the way that the medical profession dehumanizes the patient and ends up treating the disease, and not the human being.  If you want to see this message in a very disturbing but highly distilled form just watch the film "Wit" with Emma Thompson.

This lesson was reinforced for me this past week when I had to rush home to Ohio because my father was in the hospital.  He went in for something relatively minor but ended up in the hospital for a week being treated for another condition.  A condition that was due, in part, at least, to actions taken by the hospital staff in their treatment of his original issue.  I am not saying that the staff was malicious in their treatment, but they were aggressive and interventionist, so that rather than assuming that the change in his condition might be due to the drugs they had given him they kept chasing symptoms. It quickly became apparent that the treatment was reactive - x happened, so they did y, without ever really trying to understand the whole picture, the patient. In the end my father spent a week in the hospital and underwent a procedure that was probably not really necessary.


It is hard challenging the medical profession when you are a patient, they are so authoritative, and when there is something wrong you get swept up into their treatment course and it takes over your life.  I saw this myself when I was undergoing treatment for breast cancer.  I tried hard to be an informed patient and question the treatment but there was one week in which I had a CAT scan, a PET scan and two biopsies.  Everything checked out as fine, but that week was quite an ordeal, both physically and emotionally.  My oncologist's conclusion after all of that was that if you did tests and scans you will always find something that is odd, and if you let yourself, you will chase these oddities for quite some time before concluding that while odd, they are not dangerous or unhealthy.  My oncologist now uses me as a poster child for not doing more than is necessary.  He still feels bad about putting me through that ordeal. 

There is a lot of debate going on right now about how to fix the health care system.  Well, one of the things they should do is treat the patient, not the disease.  One of the hardest things about being a doctor is the process of diagnosis (this is actually a place where expert systems could be useful) and rather than being thoughtful or logical about ordering tests they just order a whole suite of them.  It is as if they are throwing a whole bunch of darts at a dart board in the dark, hoping that one of them hits the target.  That is simply not a rational or cost effective approach to treatment.  It isn't good for society and it isn't good for the patient.

Demographics

Fertility, Class and Gender in Britain 1860-1940   
    Simon Szreter, Cambridge University Press, 1996

In the early part of the 20th century there was a growing awareness of a declining birthrate in the industrialized nations.  In Austro-Hungary and France the birth rate in some rural areas had begun to decline substantially during the 18th century, with similar declines taking place among the aristocratic and bourgeois groups as early as the 17th century.  In 1945 a theory of demographic transition was published.  It proposed three stages of demographic development: an initial pre-industrial stage of high birth rates and high death rates, an industrial phase of high birth rates and declining death rates (leading to substantial population growth) and a post-industrial phase of low birth rates and low death rates.

This theory was based upon a single case, that of Britain.  It utilized the findings of the 1911 census, which analyzed the fertility patterns of the British population from 1851-1911 and the newly released study conducted for the Royal Commission on Population that covered the period 1901-1946.  The 1911 census used what has become known as the professional model of social classification in which all male occupations are assigned to one of five grades (professional upper and middle class, intermediate, skilled workers, intermediate, unskilled workers).  The 1911 census analysis found that the higher the social class, the earlier and more rigorously it controlled its fertility.

This classification scheme was based upon three assumptions: 1) the occupation of the male head of household was the best way to classify families; 2) a primary division existed between the higher-status non-manual occupations (they were more professional) and the lower-status manual occupations (assessed according to skill) and 3) the fact that a single hierarchical social grading system was a valid classification scheme.  It should be noted that this scheme excludes women and their labor, both paid and unpaid.  It should also be noted that those living off private means, and thus listing no personal occupation, were classified alongside paupers in a residual category, labeled the unproductive class.

In 1869 Francis Galton published Heredity Genius in which he examined the families of ‘eminent men’ in England in an effort to determine the heritability of both mental and physical qualities.  He went on to coin the term eugenics in 1884.  By the end of the 19th century there was widespread concern that modern society was reversing evolution, leading to the degeneration of the English people.  This was partly driven by an increase in the recorded rates of lunacy from 2.26/10,000 in 1807 to 29.26/10,000 in 1890, (Mathew Thomson, The Problem of Mental Deficiency: Eugenics, Democracy and Social Policy in Britain c. 1870-1959).  By the first decade of the 20th century mental defectives became defined as the central eugenic threat facing the nation.  Greater social awareness plus universal education led to the growing realization of the presence of mentally deficient people in the population.  This heightened awareness coincided with growing fears about the fitness of the population.  In 1907 the Eugenics Education Society was formed.

During the period 1875-1883, the Anthropometric Committee of the British Association for the Advancement of Science provided an hereditary basis for the professional model.  The professional model thus acquired the status of an empirically tested theory.  Despite the fact that it was based upon unexamined social conventions it had been turned into a naturalistic theory of British society’s essential structure.

In the beginning of the 20th century an environmentalist counter movement emerged opposing the ideas of the eugenicists that the poor were poor because of the way they were, rather than because of social or environmental factors.  At the forefront of this movement were the Fabians who, although they shared a nationalistic interpretation of social Darwinism with the hereditarian biometricians, did not agree with them as to the causes or the appropriate political means to achieve the optimal nation.  They held that poverty was not the manifestation of inherited biological deficiencies but rather that the environment was responsible for the moral and material degradation of the working man.

The Anatomy Act

Death, Dissection and the Destitute
by Ruth Richardson, Penguin Books, 1988, 426 pp., appendices, notes, bibliography, index.


In 1518, the College of Physicians was founded to improve the state of medical knowledge in England, but improvements were hampered by one very simple fact: the lack of human bodies for dissection.  In 1540, the companies of Barbers and Surgeons were united by Royal Charter and Henry VIII granted them the rights to the bodies of four hanged felons per year.  Charles II increased that number to six.  But these dissections were ostensibly public affairs and were part of the sentence inflicted upon the criminals.  Thus, from the start, dissection was seen in the public eye as a punishment for criminals and as a defilement of the corpse, not as a means of gaining medical knowledge.

This shortfall in supply was made up by one very simple solution, robbing graves.  This was done either by disinterring freshly buried corpses, or by waylaying the bodies before they were buried.  Work houses, charity hospitals and asylums were favorite sources as their occupants were poor, indigent or had no relatives to claim their bodies.  The supplying of anatomists and surgeons with bodies sometimes involved the collusion of grave diggers, sextons, administrators at the facilities mentioned, undertakers and even clergy.

The men who plied this trade were called resurrectionists.  Grave robbing was not a crime, per se, since the body was not considered property.  While a man could be hung for poaching, he would not be hung for stealing a dead body, unless he also stole the personal effects of the corpse.  It was a lucrative business and it is perhaps not entirely surprising that at some point some one would see the advantage of using the anatomists as a means of disposing of murder victims.  The most celebrated case was that of Burke and Hare in Edinburgh.

Mrs. Hare was the owner of a cheap lodging house in which an elderly man died while still owing her money.  To pay off this debt, Burke and Hare sold him to an anatomist for £7.10s.  When another lodger fell very ill, Burke and Hare eased him on his way and sold his body for £10.  In all they killed 16 people before they were discovered, and introduced a new verb into the English vocabulary: to burke.  Burke was hung and dissected on 28 January 1829, Hare turned King’s evidence and was spared, and the anatomist to whom they sold the bodies, Knox, was never charged.

The first Anatomy Bill (Bill for preventing the Unlawful Disinterment of Human Bodies, and for Regulating Schools of Anatomy) was submitted to Parliament by Henry Warburton on 12 March 1829.  It did not pass, partly because of its length, the fact that it used the word dissection and because it obviously singled out the poor as the primary source of bodies.  In 1831 Bishop and Williams, the London Burkers, were discovered.  They had been supplying bodies to schools for some time when they decided to help matters along.  They confessed to killing three people before their trial, although on the eve of their execution on 5 December 1831, Williams supposedly confessed that the number was closer to sixty.

Warburton introduced his second Anatomy Bill ten days after their execution.  This one was called simply A Bill for Regulating Schools of Anatomy, and the word dissection had been replaced with the phrase anatomical examination.  It was shorter than his previous bill and though it still targeted the poor, it did not do so directly.  It merely said that unless you or your executor or other lawful party expressly forbid it, your body was liable to undergo anatomical examination.  It was eventually passed, but it did little to increase the supply of legitimate bodies.  For the most part it simply cut out the middle man of the resurrectionist.

In this book, Ruth Richardson has given us a detailed social and political history of the events leading up to and surrounding the Anatomy Act using numerous primary sources including government documents, official reports, pamphlets and newspapers.  She links it with a general change in attitudes towards the poor, culminating in the New Poor Laws, and stigmatizing poverty by connecting their deaths with a fate that had previously been reserved for criminals.  She claims that it also lead to a societal fear among the poor of the pauper’s funeral, helping to spur the growth of burial clubs and friendly societies.  In addition, the connection of work houses as suppliers of anatomists lead to a general mistrust of these institutions.  Other factors that are mentioned are the corruption and nepotism of the Royal College of Surgeons, the establishment of the Lancet by Thomas Wakley as a means of promulgating medical knowledge and as a vehicle for medical reform and the role of the Benthamites in the passing of the Anatomy Act itself.

David Noble - America by Design

A neo-Mumfordian, Noble enlists science in the conspiracy of Big Money in taking over the world and turning us all into parts of their machine, whose sole motives are profit and power.

C. Hamlin & P. Shepard - Deep Disagreement in U.S. Agriculture

As we watch policy debates, and technology debates, and all the debates on environmental issues, the question arises: how can we ever hope to resolve all of these differences?  How can we ever find a solution that will satisfy all the parties concerned?  This book presents a method for doing just that.

By creating a neutral ground, and translating between the various interest groups in a disagreement, academics can enable a rational dialogue between the parties concerned that might actually lead to mutual understanding and maybe even a solution.

Bruno Latour, Aramis

When a technology fails, how do we explain what happened?  How do we understand what happened?  In Aramis Latour uncovers the multiple narratives that underlie failure, and perhaps, by implication, success.

Among the themes that he addresses are the sexuality of technology.  Latour wants to refute the idea that the theory of evolution can be applied to scientific progress, which assumes that later technology is an improvement over earlier technology and that it better meets/serves the needs of “the environment” (i.e., humanity).

He also advocates heterogeneous engineering in which major social questions concerning the spirit of the age or the century and “properly” technological questions are blended into a single discourse.  This leads to the notion of translation, in which a global problem is transformed into a local problem through a chain of intermediaries that are not “logical” in the formal sense.

In addition, in order for a project to succeed, an engineer has to stimulate interest and convince the public.  They must market innovation and technology.  All of which leads to the question: is technological reality rational?  Consumers, like technology, are invented, displaced, and translated through chains of interest.

He recommends two kinds of charts to help understand technology: sociograms, which chart human interests and translations; and technograms, which chart nonhuman interests and translations.  Both people and technology (human and nonhuman actors) are alike in that just as you have to compromise when dealing with a number of people, so you have to compromise when integrating any new technology.

But one of the problems of an innovative project is that the number of actors that needs to be taken into account are not known from the beginning.  If you don’t have enough actors, the project loses reality, if you have too many actors, the project becomes over-complicated and will probably fail.