|Fig. 1: "We don't stand alone," a Nazi poster promoting eugenics. The shield says "Law for the Prevention of Offspring with Hereditary Disease". The surrounding flags represent countries that had, according to the Nazi government, enacted (left) or that were considering enacting (bottom and right) similar laws. (Source: Wikimedia Commons)|
X-rays have been used to reveal internal structures in the human body since the end of the nineteenth century. Exposed photographic plates afforded an internal view of body parts exposed between the plates and an X-ray source. Since 1973, X-ray computed tomography (CT) scans have made possible the generation of cross-sectional views of the body.  Medical diagnostic X-rays, as ionizing radiation, carry a small risk of cell damage and mutagenic effects, which is why X-ray technicians are careful to obey safety protocols that keep the X-ray machine operators from suffering cumulative overexposure. At higher strength and longer exposure, X-rays can have a destructive effect on human tissues. During World War II, Nazi scientists and technicians conducted human experimentation to find an unobtrusive means of using X-rays for sterilizing peoples who were not regarded as fit to reproduce.
As early as 1907, the Indiana state legislature passed a law permitting "involuntary asexualization." Mental illnesses, which included epilepsy, were the qualifying criteria.  Although a subsequent governor refused to enforce the 1907 law and it was overturned by the state supreme court, its promulgators developed a "Model Sterilization Act," designed to withstand constitutional challenges, which led to over thirty states passing laws allowing compulsory sterilization.  Norway and other Nordic countries saw the introduction of eugenics-oriented sterilization laws in the 1930s. Norway passed a sterilization law in 1934.  Sweden also funded the first government sponsored "eugenics institute" and enacted a forced sterilization law in the 1930s.  When the National Socialists (Nazis) came to power in Germany, they often cited the United States for justification and examples of eugenics laws. 
Hitler came to power in Germany as Chancellor on January 30, 1933.  In July of 1933, a more extensive and aggressive eugenics policy officially started with passage of the Hereditary Health Law (Erbgesundheitsgesetz), which listed five mental or neurological illnesses and four physical conditions, including alcoholism, as grounds for sterilization.  Doctors were required to report any patients who suffered from any of the nine conditions.  Sterilization would then be carried out by surgical means. A total of 400,000 people were sterilized by force by the end of World War II in 1945.  The poster in Fig. 1 appealed to Germans to support the law on the grounds that eugenics laws were already in place or under consideration other countries. Although other countries had, indeed, been "ahead" of Germany in compulsory sterilization laws, after the Nazis came to power the Hereditary Health Law was enforced to an extent and with a ferocity that has so far been unsurpassed. The remainder of this report, however, deals with sterilization experiments that were not approved by the Hereditary Health Law courts and which were carried out in Nazi concentration camps.
As Nazi Germany gained control over most of Europe during the war years, the aim of populating the newly-gained living space (Lebensraum) with Aryans and reducing the non-Aryan population came into conflict with the (slave) labor shortage during the war. As Viktor Brack, head of Hitler's Chancellery and a supporter of Nazi research into sterilization by radiation, reported to SS leader Heinrich Himmler in 1942, "Among 10 millions of Jews in Europe there are ... millions ... who are fit enough to work. These should be specially selected and preserved. This can, however, only be done if ... they are rendered incapable to propagate."
The usual surgical methods, according to Brack, were "out of the question because it takes too long and is too expensive." But Brack had a preferred suggestion for performing the sterilizations using "castration by X-rays." For obvious reasons, Himmler had a preference for sterilization methods that would be least apparent to the victims. In a 1941 letter to Himmler, Brack had earlier suggested a ruse of having victims fill out forms at a counter which concealed an X-ray apparatus, with which "20 installations would take care of 3,000 to 4,000 persons daily."  The difficulty was that, without extensive and obvious lead shielding, other body parts would also be affected, making detection on the part of the victims more likely. Based on his preliminary research, Brack suggested that "necessary local dosage for men is 500-600 r, for women 300-350 r, ... an irradiation period of 2 minutes for men, 3 minutes for women." [10,11]
A competing method was advocated by another Nazi sterilization researcher, Dr. Adolf Pokorny, who also wrote to Himmler in 1941, regarding Russian POWs, "The thought alone that the 3 million Bolsheviks ... could be sterilized so that they could be used as laborers but be prevented from reproduction, opens the most far-reaching perspectives."  Pokorny advocated use of injected drugs or poisons to effect sterilization.
Himmler was so interested in the kinds of sterilization described above that he funded two "competing" experimental research programs; one looking into use of radiation for sterilization, the other exploring various poisons to see how to use them to sterilize the labor force without killing the labor. Aside from providing staff, funds, and equipment, Himmler arranged and authorized "medical" experiments to be carried out on unwilling victims from the concentration camps.  Himmler kept two files about sterilization research; one for chemical sterilization and one for X-ray sterilization. 
Dr. Carl Clauberg's Research on Chemicals for Sterilization: Dr. Clauberg was a professor of gynecology who progressed in his career from treating infertility among German mothers to working on techniques for inducing infertility, experimenting on prisoners assigned to "Clauberg's block" in Auschwitz. Clauberg also used X-rays, but only as a means of initially confirming the effects of his injections and tracing them over time.  Estimates of the number of women sterilized in experiments at Clauberg's block range "from seven hundred to 'several thousand'," many of whom did not survive the experiments. 
Dr. Horst Schumann's Research on X-Ray Sterilization: Dr. Schumann did not have any particular qualifications for medical research. His duties prior to his research into sterilization involved the direction of killing centers and selection of victims.  By 1942, the doctor and his assistants were at work on X-ray sterilization experiments at Block 30 in Birkenau.  In these experiments, men and women had their reproductive areas exposed to a five to eight minute dose of X-rays. Depending on the intensity of the dose, this resulted in external burns or worse. Following exposure, some of the women and men underwent operations to remove reproductive organs for evaluation. Ovaries and testicles were removed and examined.  The men also were subject to other brutalizing medical procedures involving semen extraction.  Many of the victims died from complications following the surgeries. The survivors were not as likely as others to survive assignment to work details in their weakened condition. Roughly one thousand male and female prisoners were subjected to X-ray sterilization with about two hundred of them undergoing follow-up extractive surgery. 
Some of the German officials who had been apprehended after the war were put on trial at Nuernberg, charged with war crimes. One of the trials dealt with lapses of medical ethics and human experimentation. Sterilization experiments were included in charges against the defendants at the medical trial, as subsection (I) out of subsections (A) through (L) of counts two and three for "War Crimes and Crimes against Humanity."  In his closing statement, the prosecutor, Telford Taylor, observed that "It is the most fundamental tenet of medical ethics and human decency that the subjects volunteer for the experiment after being informed of its nature and hazards."  Viktor Brack was among the defendants. He, and seven other of the defendants, were executed on June 2, 1948. 
Most of the victims did not survive the war. For those who did survive, the United States and Germany reached an agreement to provide a five billion dollar fund for "slave laborers and victims of medical experiments." One victim, Simon Rozenkier, states that he was repeatedly injected by Dr. Horst Schumann who, according to Rozenkier, had by then seen the limitations of X-ray sterilization and was subsequently using injections. Rozenkier received $8,000 from the compensation fund. He sued in 2003 for a larger settlement, but, per the US and German agreement, the State Department was recommending dismissal of the case "if there were any valid legal grounds to do so." 
It is tempting to analyze the rationalizations of the Nazi doctors and assert that our own society would, in light of these historical examples, never allow our doctors to follow a path that violates the Hippocratic Oath. It is important to keep in mind however, that the Nazi doctors maintained at trial, in an end-justifies-the-means argument, that they were serving the greater good. There are respected members of our own society who advocate measures not so far removed in principle from the German Hereditary Health Law. In 1970, William Shockley, a Nobel Prize winning physicist, suggested bribing the "intellectually inferior" to agree to sterilization.  Had Dr. Schumann attempted his sterilization experiments in 2017, advances in computer-controlled radiation treatments would have provided a closer approximation to the controlled tissue destruction he was after. As our medical technology advances, the job of preventing it from outstripping the ethics of its potential becomes more difficult.
© Genevieve Payzer. The author grants permission to copy, distribute and display this work in unaltered form, with attribution to the author, for noncommercial purposes only. All other rights, including commercial rights, are reserved to the author.
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