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To: H-Eugenics@h-net.msu.edu H-NET BOOK REVIEW Published by H-German@h-net.msu.edu (October, 2005) Horst H. Freyhofer. _The Nuremberg Medical Trial: The Holocaust and the Origin of the Nuremberg Medical Code_. Studies in Modern European History Series. New York: Peter Lang, 2004. vi + 209 pp. Illustrations, notes, bibliography, index. $35.00 (paper), ISBN 0-8204-6797-9. Reviewed for H-German by Claire Sharman, Department of History, University of Southampton. Doctors on Trial After the International Military Tribunal at Nuremberg had tried and sentenced the Nazi leaders, the American Military Tribunal used the venue to put on a series of trials focusing on "major war criminals of the second rank." Under the auspices of Telford Taylor, twelve trials took place between 1946 and 1949, each focusing on a particular sector of criminal activity in the Third Reich. The first of these trials was concerned with trying twenty-three Nazi doctors and administrators for the horrific and often fatal experiments performed on concentration camp inmates. This is not the first English-language account of the Nuremberg Medical Trial (NMT), but it is the first to attempt both a legal and ethical analysis. In his introduction Freyhofer states, "The Nuremberg Medical Trial revealed what may have been one of the most gruesome chapters in the Holocaust. The defendants were brought to account for the tortuous murder and mutilation of thousands of human test subjects. Yet they tried to convince the court that these acts had been legally correct, medically necessary, and morally right.... Although their arguments were firmly dismissed by the tribunal, reading court records provides little comfort for anyone who would like to believe the case left no unanswered questions" (p. 2). Split into three broad sections, Freyhofer's book examines the road to Nuremberg, which includes several sections detailing the nature of the experiments conducted by those on trial; a legal analysis of the proceedings; and an ethical analysis of the trial. Experimentation on human subjects was not unknown in Western countries in the nineteenth and twentieth centuries, as the author makes clear in the first section. Commonly cited examples of this include the non-therapeutic experiments of Walter Reed on Cuban citizens and Joseph Goldberger's experiments with pellagra. Though experiments on human beings did decline in popularity after this, in part due to the increased reliability of animal testing, Freyhofer's gentle reminder that the Nazis did not invent the notion of experimenting on human beings is relevant. To say that Nazi doctors took this precedent several stages further is a serious understatement. In the aftermath of the First World War, Freyhofer argues that the doctrine of the primacy of the collective over the individual as well as the eugenics movement were instrumental in the subtle shift that had occurred in German society--and the German medical community--by 1933. Likening the Aryan race to an organic body in danger of being destroyed by the toxic cells that had infiltrated it, the National Socialists' "interchangeability of political and medical language . now marked public policy" (p. 23). The eugenic policies of the regime began with the compulsory sterilization of those suspected of being carriers of hereditary diseases, though this policy was later extended to cover social "undesirables" as well. Though this information is relevant to Freyhofer's study, it is worth pointing out that the author is not breaking new ground here. The evolution of Nazi eugenic policies has been covered by many scholars in works too numerous to mention here. Forced euthanasia of the mentally ill extended the eugenics program after the beginning of the war and was justified in terms of sacrificing the weak minority for the collective good. As Freyhofer points out, the policy dramatically reduced the number of individuals in hospitals and asylums, making beds available for injured soldiers. Freyhofer argues that the progress of the war was instrumental in the decision to begin experimenting on live human subjects. After the invasion of the USSR and the U.S. entry into the war, a long drawn-out conflict and the possibility of defeat seemed more likely, which led to the more urgent pursuit of research projects. The first experiments were conducted in early 1942 and were concerned with devising rescue techniques for pilots forced to bail out at high altitudes. Other projects followed within a matter of months and researchers discovered that they had a ready pool of test subjects--men and women interned in concentration camps. Freyhofer divides the medical experiments into six groups: rescue of fliers and sailors; treatment of war injuries; reconstructive surgery; controlling epidemics; biochemical warfare; and eugenics. The author then goes on to describe in some detail the nature of the experiments that were carried out on the unfortunate human guinea pigs. The often gruesome details need not detain us here, though the author provides a brief yet thorough survey of the methods used by various researchers and the often fatal outcomes for the subjects. Section 2 examines the Nuremberg Medical Trial from a legal point of view. Beginning with a brief examination of international law as it developed in the immediate aftermath of the Second World War, the NMT is neatly placed in its historical and legal context. Among those in the docket, certain individuals are conspicuous by their absence. Since the SS had been responsible for the concentration camps, it seemed logical that the head of this organization, Heinrich Himmler, together with its chief physician, Ernst Grawitz, were primarily responsible for the crimes committed inside the camps. Both individuals had, however, committed suicide at the end of the war, as had Leonardo Conti, the official for public health. The notorious Doctor Josef Mengele was in hiding. The group of defendants chosen to take part in the trial was therefore dependent on who was available to be tried. The main defendant in the trial was Karl Brandt, Gruppenführer in the SS and Hitler's personal physician. The next highest rank was held by Siegfried Handloser, Chief of the Medical Services of the Armed Forces. The positions held by these two defendants demanded that they carry responsibility for the crimes. The others in the dock had been more closely involved with the devising and carrying out of the medical experiments. Defendants were charged on four counts: conspiracy, war crimes, crimes against humanity and membership in a criminal organization. All defendants were charged under counts one, two and three, but only former members of the SS were charged under count four. As Freyhofer points out, the decision to charge all defendants with both war crimes and crimes against humanity was taken to prevent defendants from escaping punishment for war crimes by claiming that they were unaware of the nationality of their human subjects. When the victims were German nationals, their nationality was uncertain or they were stateless, the atrocities committed against them were still crimes because the victims were members of a persecuted political racial or religious group, and thus the crimes came under the charge of crimes against humanity. The defense tactics of the defendents are interesting. Like the members of the Nazi leadership tried at the International Military Tribunal, most presented themselves as mere followers of superior orders and most also claimed that they had understood their human subjects to be volunteers. Defendants also maintained that they had not broken, to the best of their knowledge, any existing German or international law. Freyhofer highlights the case of Kurt Blome, former Vice President of the Reich Chamber of Physicians, as particularly interesting here. Blome advanced the view (taken up by most of the defendants) that custom, not law, regulated medical research on human beings and that the custom of using prisoners in medical experiments had its origin in the United States, particularly in Goldberger's pellagra experiments. The prosecution did not attempt to deny his claim that medical ethics was largely a question of custom rather than law but argued that the parameters of these customs had long been established by the Hippocratic Oath, and that this principle had been grossly disregarded by many German doctors during the war. Interestingly, count one, the charge of conspiracy, although accepted by the tribunal in relation to war crimes and crimes against humanity, was dismissed as a "separate substantive offense." There were, therefore, no pronouncements on this first count. Fifteen defendants were found guilty of war crimes and crimes against humanity, of which seven were sentenced to death--as Freyhofer remarks, it is worthy of note that all of those sent to the gallows were members of the SS. Of the seven who were acquitted, not one had been an SS member. It is in the third section, on the ethical analysis of the trial, that Freyhofer is at his most engaging. A detailed examination of the ethical issues raised by the Nuremberg Medical Trial is, as he points out, long overdue. Much as the trial was concerned with punishing the guilty and securing justice for the victims, Freyhofer maintains that it was also "an attempt by the victorious Allies, mainly the United States, to affirm the existence of such a single and certain principle: namely the existence of inalienable human rights" (p. 111). The repeated attempts of the defense to argue that that the defendants' crimes were comparable to experiments carried out by Goldberger and others, were, the author argues, "misleading." Not only were the German experiments carried out on a far wider scale and with no respect for human life, but the German experiments also had at their core a manifest racial agenda. Those experimented on were abused, and if they did not die during the ministrations, were often dispatched to the gas chambers, in line with the genocidal policies of the National Socialists. To say that the defendants inflicted harm on their subjects is a gross understatement given the agonizing and often fatal procedures that these individuals were subjected to. However, the defendants all argued, in varying degrees, that their experiments were not contradictory to the principles laid down in the Hippocratic Oath. Collectivist medicine, where the few are sacrificed for the supposed greater good of the many, was an extension of Social Darwinism. As Freyhofer points out, according to some interpretations, this interpretation was not necessarily incompatible with Hippocratic traditions. According to this reading, in times of crisis, those who were a liability to the collective good should either be forced to contribute to society or be removed from it. Contribution could include being the subject of experimentation; removal being euthanasia. Freyhofer points out that the Hippocratic Oath as we understand it had certainly evolved considerably since its conception in ancient Greece. Modern technology too had rendered the oath out of date on some issues: "Since the mid-nineteenth century its injunction against inflicting willful harm was frequently violated when the introduction of the germ theory of disease tempted a growing number of researchers to perform nontherapeutic experiments on patients" (p. 124). All those in the dock placed the collective good of the community above the welfare of individual subjects and most also refused to accept individual responsibility, preferring to place blame for their crimes on the state, at least "in a legal and ethical sense" (p. 130). Freyhofer also tackles the contentious issue of the ethics of using data gathered during the concentration experiments, as a basis for further medical research. In his opening speech, at the beginning of the trial, Telford Taylor had maintained that these "experiments revealed nothing which civilised medicine can use" (p. 161). While this statement neatly sidestepped a moral dilemma, it was not entirely correct. Freyhofer points out that while some data gathered by the Nazi doctors was of little use, bad ethics do not necessarily facilitate bad science. The U.S Armed Forces availed itself of numerous pieces of Nazi data, including the results of hypothermia experiments and investigations into aviation medicine. In addition, several Nazi scientists forged second careers in the United States, most notably SS Major Wernher von Braun, who became a key figure in the space program. More worryingly, a significant proportion of the scientifically useful data gathered during the Nazi experiments has become readily available in the medical community through papers and books that make no reference to the deplorable way in which it was gathered. Additionally, many of those involved in experimenting on human subjects continued to practice medicine after the war, several publishing their Nazi era publications with only a few changes to the vocabulary. How then, should the medical community deal with this quandary? On the one hand, as the author acknowledges, using the data suggests giving some retroactive justification to the Nazi experimenters. Ignoring it, however, risks withholding possible help from patients. Freyhofer believes the answer lies in continued debate: "Encouraging greater participation by all members of the medical community, preferably including actual and suspected offenders, and society at large, would likely produce a wider consensus on how to handle data questionably or criminally obtained" (p. 159). But his sympathies clearly lie with victims' groups rather than the medical profession. The Nuremberg Medical Code and the legacy of the Nuremberg Medical Trial are referred to throughout this work, but the Code itself is only examined in the epilogue. One feels the work would have been improved had it been the subject of greater scrutiny, but this is a minor annoyance. Freyhofer's work is solidly based on court documents and archival records. The central issues of the work are the proceedings of the trial rather than the personalities in the docket and works of autobiography or reminiscence are accordingly avoided. While little of the work is truly novel, the end result is a focused monograph that gives a much needed overview of the Nuremberg Medical Trial and the ethical issues surrounding it. Notes . Studies of the ethics of extermination have been produced before, however. See particularly Michael Burleigh, _Ethics and Extermination: Reflections on Nazi Genocide_ (Cambridge: Cambridge University Press, 1997). . Two scholars in particular have examined this issue in detail. See Paul Weindling, _Health, Race and German Politics between National Unification and Nazism 1870-1945_ (Cambridge: Cambridge University Press, 1989); and Michael Burleigh, _Death and Deliverance: Euthanasia in Germany c.1900-1945_ (Cambridge: Cambridge University Press, 1994). Purchasing through these links helps support H-Net: http://www.powells.com/cgi-bin/partner?partner_id=28081&cgi=product&isbn=0820467979 http://www.amazon.com/exec/obidos/ASIN/0820467979/hnetreview-20?dev-t=mason-wrapper%26camp=2025%26link_code=xm2 http://service.bfast.com/bfast/click?bfmid=2181&sourceid=41034484&bfpid=0820467979&bfmtype=book Copyright � 2005 by H-Net, all rights reserved. H-Net permits the redistribution and reprinting of this work for nonprofit, educational purposes, with full and accurate attribution to the author, web location, date of publication, originating list, and H-Net: Humanities & Social Sciences Online. 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