Key words .
eugenics, genetics, Hitler, medical profession, public health, racism
Introduction
As a British South Asian, I have spent much of my personal and professional life dealing with issues of racism. I have become convinced that it is necessary to understand one’s enemy in order to combat him and was thus driven to read Hitler’s original writings. However, this paper was difficult to write: the content of Mein Kampf is disturbing, particularly to a person who I feel Hitler would have seen as inferior. The presence of the book in my home, and the process of drafting the article actually made me feel unclean. That said, my purpose here is to strengthen the anti-racism voice in medicine and science, and to help counter the rise of overt and covert racism, particularly in Europe, by bringing the writings of Hitler to a wider audience of health professionals. There is a danger that a few readers may be inspired by Hitler’s ideas, rather than shocked into anti-racism mode, but there seems to be no obvious way to counteract this problem except to acknowledge it.
No name is more closely associated with racism than that of Adolf Hitler yet, except in a cursory way, his writings are rarely referenced in the health disciplines such as medicine, epidemiology and public health, where the concepts of racism, race and ethnicity are of central importance (Bhopal, 1997, 1998). Arguably, Hitler has had the greatest impact on the concepts of race and ethnicity in history. His ideas, especially the ranking of ‘races’ and of ‘uber’ and ‘unter’ mensch (superior and inferior peoples), may have been derived but were given added strength and force by his writings. These concepts endure and have a life of their own, often being alluded to in discussions about treatment for infertility, and cloning. Many health professionals can draw upon their own experiences of colleagues who have adverse attitudes to those they regard as ‘defective’ or undeserving. Health professionals and researchers may warn of the dangers of racism in medicine by alluding to Hitler (as I have done), but few have read Hitler in his own words.
Hitler’s major written work is Mein Kampf (‘My Struggle’). The first volume was prepared while Hitler was imprisoned, and the second volume thereafter. While Mein Kampf was influenced by other sources, it represents a synthesis of Hitler’s core beliefs, among them that race was a central issue. Germany was, however, focused on race long before Hitler’s rise to power (see Box 1). Reading Hitler’s own words should increase our resolve to avoid future atrocities such as those perpetrated by the Nazis, abetted by the health professions, only 60 years ago.
In this essay my brief commentary puts Hitler’s words in contemporary context, but I try to let the words speak for themselves. The quotations come from Mein Kampf in the translation by RalphManheim (1992). The text can also be accessed freely on the internet: www.hitler.org/writings/Mein_Kampf. The phrasing may be offensive to modern readers, but has been reproduced as closely as is possible to the original. While Hitler’s views on race and health are mainly to be found in Chapter 11 (Volume 1) on Nation and Race, and in Chapter 2 (Volume 2) on The State, they are also scattered throughout the 628 pages of Mein Kampf. The quotations are reorganised by me under three headings, but the page number is given so the reader can read them in their original context. These quotations are a selection from a set created by me, and have been chosen to illustrate the theme.
Editors’ note 1. Stephen Frosh’s (2005) account of the relationship between the emergence of psychoanalysis and anti-Semitism highlights the degree to which the ideas expressed so clearly by Hitler permeate Western culture. Further, he shows (p. 94) how Jungian psychology at least began as an ‘Aryan’ alternative to Freud’s ideas. Similarly, we can find other current evidence of the deeper roots of race consciousness in the Eugenics movement started by Francis Galton and continued by the Galton Institute. However, I have been unable to locate any other accessible article on Nazi influences upon health thought, although there is extensive discussion on the internet about eugenics and ‘racial purity’. It may however be worth reflecting on the language used in debates around current research into genomics, despite the best efforts of authors such as Steven Rose and Steve Jones.
Readers can access a succinct review by Silver (2003) on the central role of the medical profession – ‘the staunchest supporter of the Nazi regime’ – in the euthanasia of psychiatric patients, eugenics, race medicine, marriage laws, killing of children regarded as defective, experimentation in concentration camps and on prisoners, anti-Semitism, and the attack on academic standards. In his account he refers to some of the beneficial aspects of Nazi medicine, which include a strong public health movement based on lifestyle, understanding of the relation between cancer and smoking, occupational health and support of medical research. Currently there is some debate on the ethics of relying on papers based on experiments in concentration camps, but these were minor gains in relation to the evil. It can also be seen that Hitler built upon a rich legacy of racism in medicine and science, much of it developed in Germany. Silver states that Hitler incorporated ideas from the work of Baur, Fischer and Lenz (1921) in their standard text Outline of Human Genetics and Racial Hygiene and thus had ready-made policies for eugenics and the objective of creating an ‘Aryan’ state (see Box 2). However, in his work, there is a consistency of non-technical and rhetorical style that is clearly Hitler’s and not from any textbook.
Enlarge this image.Box 1 :Key events relevant to medical professions, race science and racism in Germany(extracted from text in Silver, 2003
Editors’ note 2: The direction of influence is also not always clear: Frosh demonstrates the expectation of the German Medical Society for Psychotherapy that ‘all its active members ... [will] have thoroughly read AdolfHitler’s fundamental book Mein Kampf ’ (Frosh, 2005, p. 109).
Hitler’s rise to power took advantage of the collapse of the economy in Germany following the First World War. Nonetheless, his ideas had an extremely broad appeal, and continue to be influential in right-wing circles (see Box 3). The economic, social and political circumstances that allowed Hitler’s policies to flourish could return.
Hitler on racial admixture
Race science flourished in Germany in the early 20th century. According to Silver (2003), Hitler’s policies were influenced by such work. Hitler drew his arguments against the sexual mixing of races from the natural world; for example ‘Such mating is contrary to the will of Nature for a higher breeding of all life’ (p. 258). His analogies refer repeatedly to animals. He believed that such mixed unions were deleterious, because they reduced the superior breed: ‘Any crossing of two beings not exactly the same level produces a mediumbetween the level of the two parents’ (p. 258). Hitler’s denigration of mating between human racial and ethnic groups, as if theywere different species,was scientifically wrong. Hitler’s idea that the offspring of unions of mixed race/ethnic group are inferior does not fit with modern evolutionary theory favouring outbreeding to inbreeding, or what gardeners refer to as ‘hybrid vigour’. To his way of thinking, however, there was only one superior race: ‘Everything we admire on this earth today – science and art, technology and inventions – is only the creative product of a few peoples and originally perhaps of one race’ (emphasis in original, p. 262). From such arguments he drew the inference of harm to his own ‘Aryan’ people from the mixing of peoples: ‘Historical experience offers countless proofs of this. It shows with terrifying clarity that in every mingling of Aryan blood with that of lower peoples the result was the end of the cultured people’ (p. 260), and ‘All great cultures of the past perish only because the originally creative race died out from blood poisoning’ (p. 262), and ‘Blood mixture and the resultant drop in the racial level is the sole cause of the dying out of old cultures ...’ (p. 269). A policy of enforced sterilisation was promoted, and Hitler perceived this in terms of racial warfare, for in his view the resulting ‘bastardisation’ resulting fromthe troops mating with German girls ruined the blood of the white race (p. 295).
Editors’ note 3: This philosophy led to the nearextermination of a small community of Afro-Germans, descended from French Senegalese troops who had lived in the Rhineland in the 1920s (El Tayeb, 2003).
The philosophy that Hitler promoted did not believe in equality of the races, but rather in the subordination of the inferior and weaker ‘... in accordance with the eternal will that dominates this universe’ (p. 348). He wrote, ‘... in a bastardised and niggerised [sic] world all the concepts of the humanly beautiful and sublime, as well as all ideas of an idealised future of our humanity, would be lost forever’ (p. 348). Hitler’s extreme language on mixing of the races marked the emotional foundations of his arguments, despite their being presented as ostensibly scientific.
Hitler perceived North America as retaining its culture because it maintained its Germanic character with little racial mixture, in contrast to South America, which he proclaimed had lost this culture because of admixture. The conclusion to Mein Kampf is five short paragraphs. The fourth states: ‘A state which in this age of racial poisoning dedicates itself to the care of its best racial elements must some day become Lord of the earth’ (p. 628). This was a trumpet call for eugenics. The influence upon Hitler of the eugenics movement internationally, and particularly that in the USA, has recently been reviewed by Black (2003).
Hitler argued that in a racially pure Germany the herd instinct in times of danger and war would have been strong, and the Germans would have been enjoying world domination. Peace would have been supported by the ‘... victorious sword of a master people’ (p. 360). Fortunately, Hitler argued, there are still ‘... great unmixed stocks of Nordic-Germanic people who we may consider the most precious treasure for our future’ (p. 361).
Hitler on the superiority of the Aryan race, and the exploitation of inferior groups
Hitler attributed everything worthwhile in human culture to the Aryan. While stating that it was idle to argue which race started human culture, he then claimed that it was the Aryan, withoutwhom the ‘dark veils of an age without culture will again descend on this globe’ (p. 348). Hitler had difficulties in judging the contribution of his allies, the Japanese, where his mixing of politics with racial ideology was clear, but even then he gave the credit for the achievements of the Japanese to the Aryans. He attributed Japan’s present and previous rise to Aryan influences. The achievements of associates such as the Japanese were attributed as ‘culture bearing’ not ‘culture creating’ (p. 264). He predicted that in a few decades, the world of East Asia would be founded on the Hellenic spirit and German technology.
His thesis was that the contribution of Aryan people stimulated foreign people to achieve.When they reproduced with the Aryans, their new-found advances collapsed, with the degradation of the master race and the subjugated race alike. To quote: ‘The last visible trace of the former master people is often seen in the lighter skin colour which its blood left behind in the subjugated race ...’ (p. 265).
Hitler was frank that the superior races were exploiters. ‘Without this possibility of using lower human beings, the Aryan would never have been able to take his first steps towards his future culture ...’, he wrote (p. 267), and ‘It is certain that the first culture of humanity was based less on the tamed animals than on the use of lower human beings’ (p. 268). From this stand he argued for slavery as an essential and virtuous means of human progress of Aryans. He bolstered this argument by diminishing the worth of the inferior groups, e.g. ‘All who are not of good race in this world are chaff ’ (p. 269). He employed an argument that is still heard, that even such a state of slavery improved on the previous conditions enjoyed by such inferior races. In subjugating the lower races, Hitler wrote, ‘... perhaps he [the Aryan, my clarification] gave them a fate that was better than their previous so-called ‘freedom’ (p. 268).
In an unexpected turn, Hitler claimed that the Aryan was not necessarily the greatest in mental qualities but that he excelled in his ability to give his sciences to the community (Note: such gendered language was uncontested in that time). The Aryan sacrificed his own ego. Hitler called the attitude ‘Pflichterfu¨llung’ (fulfilment of duty, p. 271). It is hard, at first, to perceive why Hitler needed this argument of moral, as opposed to intellectual and physical, superiority of the Aryan, but it was used when Hitler attacked the Jewish people who he thought of as governed by the motive of self-preservation as opposed to the idealism of the Aryan. Hitler perceived the Jew as a threat to Aryan supremacy: ‘The mightiest counterpart to the Aryan is represented by the Jew’ (p. 272) and ‘Today he [the Jew, my clarification] passes as ‘‘smart’’ and this in a certain sense he has been at all times’ (p. 273). But his intelligence, said Hitler, was not the result of his own development, but of instruction from others. In this way Hitler reconciled the contradictions in his arguments and his observations on the smartness of the Jews, who despite centuries of anti-Semitism had succeeded in science and medicine in Germany
(Editors’ note 4: see also Frosh, 2005). The solidarity of Jewish people was explained as a primitive herd instinct for self-preservation. He denied art, especially architecture and music, as owing anything to Jews.
It is not clear why Hitler denied that Jews were a religious community, while he insisted that they were a race. It seems that he needed the concept of race to justify racism. The Talmud in his view promoted a practical and profitable life, which should have commended itself to him. The Jewish doctrine of Mosaic descent kept the blood of Jews pure, a policy which Hitler extolled for Germans but decried in the Jews. He denied their Germanification because ‘Race, however, does not lie in the language, but exclusively in the blood, which no one knows better than the Jew’ (p. 283), and ‘He poisons the blood of others, but preserves his own’ (p. 272).
Editors’ note 5: It should be noted also that such a belief in ‘the Jewish blood’ was also referred to frequently in the novels of the British Prime Minister Disraeli, himself of Jewish origin.
The supposedly scientific basis for racial difference was, however, mostly discarded for open hostility. His lengthy analysis of the evolution of Jewish communities denied them any decent motive. His hatred can be seen throughout his writings in the use of such terms as rats, apes, beasts, wolves, parasite, spongers, liars, bloodsuckers, vampires, or poodles, when discussing Jewish people.
Hitler blamed all the ills of his nation, even the poverty following industrialisation, on Jews. Jewish involvement in trade unions was seen as part of a plot for exploitation and subjugation of others. He saw this as a plot favouring both the hegemony of international capital and the triumph of Marxism (even if these might normally be seen as opposing philosophies). He wrote, ‘If we pass all the causes of the German collapse in review, the ultimate and most decisive remains the failure to recognise the racial problem and especially the Jewish menace’ (p. 296). In relation to the First World War, Hitler contended that the inner enemy was not recognised. The argument led to the call for the creation of ‘A German State of the German Nation’ (p. 296) to free the German blood of its vices and redeem it from the foreign virus, which was spread by racial mixing or what he described as the Jewish problem. The stage was thus set for the ‘Final Solution’ and the programme to eradicate Jews and others from German society.
Hitler on the creation of a superior society and the role of medicine
Only 600 years are required, Hitler said, to achieve a recovery. All that German society needed to do was prevent the physically degenerate and mentally sick from procreating and to promote fertility of the healthiest bearers of the nationality. To achieve the blessing of a highly bred racial stock, the state must not leave matters to chance. Hitler’s ideas for the creation of a superior society were explicitly founded on discrimination, based particularly on racism but also on perceived superiority on other grounds. ‘A folkish state must therefore begin by raising marriage from the level of a continuous defilement of the race, and give it the consecration of an institution which is called up to produce images of the Lord and not monstrosities halfway between man and ape’, said Hitler (pp. 365–6). He deplored the fact that ‘In this ... society, the prevention of the procreative faculty in sufferers from syphilis, tuberculosis, hereditary diseases, cripples, and cretins is a crime ...’ (p. 366) and proclaimed that a People’s (a better translation of Volkisch) state must put race at centre stage and ensure that ... ‘only the healthy beget children’ (p. 367). The medical profession was seen as the torchbearer for this policy. Hitler declared that the country ‘... must put the most modern medical men in the service of this knowledge’ who in turn ‘... must declare unfit for propagation all who are in any way visibly sick or who have inherited a disease ...’. Childbearing was extolled and the state should ‘... take care that the fertility of the healthy woman is not limited by the financial irresponsibility of a state regime ...’ (all p. 367).
Racial commissions would be required to issue settlement certificates in newly acquired territories, after the individual’s racial purity was established. On citizenship, Hitler argued that racial factors were not given sufficient importance, and deplored the fact that (at least in theory) ‘Even the Zulu Kaffir can become a German’. He praised the United States of America for refusing immigration to the sick and those from some races (as embodied in their 1921 and 1924 Immigration Acts). The ‘folkish’ people’s state that he planned was to have citizens, subjects and foreigners. The citizen was to be privileged and of German nationality. He was to be the lord of the Reich. Those born in Germany but not of German nationality were to be subjects. Hitler proposed that evaluation of race be done on individuals using blood tests because ‘... the blood components, though equal in their broad outlines, are, in particular cases, subject to thousands of the finest differentiations’ (p. 402).
Hitler believed that leadership must be in the hands of those who possessed the best minds, and these were, in his philosophy, the racially most pure and Aryan. He considered it a sin that a Negro might become a lawyer, ‘... it is criminal lunacy to keep on drilling a born half-ape until people think they have made a lawyer out of him, while millions of members of the highest culture-race must remain in entirely unworthy positions; ... while Hottentots and Zulu Kaffirs are trained for intellectual professions’ (p. 391). Despite these views, Hitler wanted the state to be a meritocracy, picking the most capable people.
Conclusion
Hitler’s views were published in Mein Kampf to widespread acclaim and support. By 1939 the book had sold 5 200 000 copies and had been translated into 11 languages, acting as an inspiration to most of the German public, and the medical profession especially (Silver, 2003). Hitler built his case upon the language and arguments of current science albeit, in retrospect, poor science. If the modern world were free of racism, nationalism and other forces leading to inequality and cruelty, there would be no reason to read Hitler’s views. Sadly, this is not the case, and there are many signs that racism as a component of right-wing political policy is making a come-back, as witnessed in recent simmering racial tension in parts of England, the Netherlands and France including the desecration of Jewish cemeteries. The dangers of escalation are shown by the atrocities in Bosnia, Rwanda and Darfur, to cite but a few recent examples. Echoes of Hitler’s views are abundant in the mainstream media and particularly in correspondence columns of newspapers. They appear in arguments based upon the need to increase the cultural cohesion of society, the danger of diluting national traits by immigration, and subtle versions of the concepts of cultural and racial superiority. Casual scanning of the internet will reveal thousands of pages dedicated to ‘biological racism’, socio-biology and eugenics.
There is evidence, worldwide, that racism is being controlled, but it is far from eradicated. Immigration is currently a major political issue in all industrialised nations, and the medical profession is often drawn into these debates. One particular concern is the role of health screening as a component of immigration control. At the time of writing, the Conservative Party election manifesto explicitly states that health screening will be introduced as part of immigration control. The truism that those who forget history are bound to repeat it is one that applies to racism. Hitler’s goal of creating a superior society is shared by most political leaders, and many of his means, including appeals to nationalism, control of occupational opportunities and reproduction, and immigration control, are components of the political armamentarium worldwide. Eugenics in its open form, in the past promoted by scientists and leading thinkers, is currently out of favour, but its return is a likely accompaniment of the genomic revolution. Only open racism remains offside in mainstream politics but it is lurking in the fringes. Subtle forms of racism, including institutional racism, are widespread and based on deep-held beliefs or embedded in ‘taken for granted’ reasoning (Bhopal, 1997, 1998; Modood et al, 1997).
Reading Hitler’s views will surely stimulate health professionals worldwide, including medical scientists and doctors, to combat racism. They should ensure their professional and learned societies have constitutions and policies that will empower them to resist, rather than assist as in Nazi Germany, the emergence of future racist states. Hitler’s words and legacy remind us of the massive historical and contemporary importance of racism to public health and medical care.
Acknowledgment
I thankDrSonjaHunt,DrColin Fishbacher,DrParamjit Gill, Professor Aziz Sheikh and ProfessorMark Johnson, and members of the editorial board of Diversity in Health and Social Care, for helpful comments on an earlier draft, and Mrs Hazel King and Ms Tori Hastie for secretarial support. I am also thankful to the editors for their notes. I am solely responsible for the remaining contents of this paper.
CONFLICTS OF INTEREST
I have nothing to declare, except perhaps my ethnic origin which is British Indian.
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Raj Bhopal CBE MD MPH Bruce; John Usher Professor of Public Health; Public Health Sciences Section; Division of Community Health Sciences; University of Edinburgh; Scotland; UK
Bruce and John Usher Professor of Public Health, Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Scotland, UK
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