On the morning of 20 December 1946 a slim Polish woman in her late twenties walked into Courtroom 600 of the Nuremberg Justizpalast on a single wooden crutch, lifted herself into the witness box, and sat down to testify. Her name was Wladyslawa Karolewska. She had been arrested at the age of twenty-one in 1941 by the German police in Lublin as a member of the Polish underground and sent to the women’s concentration camp at Ravensbrück, in the woods north of Berlin. There, between July 1942 and August 1943, the camp doctors had performed three separate operations on her left leg: the first on 14 August 1942, in which a section of her tibia was removed and the wound deliberately infected with bacteria, glass, dirt and wood splinters; the second on 16 September 1942, in which the wound was reopened and her muscle was cut to study the spread of the infection; the third in early 1943, in which the bone was operated on again. The procedures were part of a research programme on the new sulfonamide antibiotic compounds, conducted to determine whether the drugs could save German soldiers wounded in the East. The subjects of the research had been Polish women selected from the camp’s political prisoner population. They were known among themselves as the Króliki, the Rabbits, the camp’s slang term for laboratory animals.
Karolewska had survived. Approximately seventy other women had undergone the experiments. Six had died on the operating table. Several others had died of the deliberately induced infections. Karolewska had been left with a permanent disability and had been smuggled out of Ravensbrück in 1944 by the Polish underground network operating within the camp. She had been brought to Nuremberg in December 1946 to give evidence at the trial of the men who had ordered the procedures. The case was United States v. Karl Brandt et al., the first of the twelve Subsequent Nuremberg Proceedings, formally the Doctors’ Trial. It opened on 9 December 1946 and ran until 20 August 1947. It put twenty-three defendants in the dock, twenty of them physicians. It produced the foundational document of modern medical research ethics, the Nuremberg Code. And it heard, on 20 December 1946, the testimony of Wladyslawa Karolewska on what had been done to her.
The defendants
The senior defendant was Karl Brandt, Hitler’s escorting physician and from 1942 the Reich Commissioner for Health and Sanitation, who had been one of the two co-administrators of the regime’s medical-killing programme that became known by its administrative cover name as Aktion T4 (after Tiergartenstraße 4, the Berlin office address). Brandt had been responsible, with Philipp Bouhler, for the killing of approximately 70,000 disabled Germans between October 1939 and August 1941 under the original T4 framework, and for the further informal continuation of the killings in hospitals and camps until the end of the war. He had not personally administered the experiments at the camps, but the prosecution argued that as the senior medical authority in the regime he had borne responsibility for the broader pattern of medical criminality.
The second senior figure was Karl Gebhardt, Himmler’s personal physician and the chief surgeon of the SS, who had run the bone, muscle and nerve transplantation experiments at Ravensbrück. Gebhardt had been the operating surgeon on Reinhard Heydrich after Heydrich had been mortally wounded by Czech assassins in May 1942 in Prague; he had failed to save Heydrich, despite Himmler’s despatch of him with the latest sulfonamide compound, and had subsequently launched the Ravensbrück experiments to vindicate his decision not to use the sulfonamides on Heydrich. The Ravensbrück experiments killed approximately a dozen Polish women and crippled approximately seventy others. Gebhardt’s defence was that the work had been authorised research and that the subjects had been condemned to death anyway. The court rejected the defence.
The third significant figure was Joachim Mrugowsky, the SS chief hygienist, who had supervised the typhus experiments at Buchenwald. The experiments had used Soviet POWs and other prisoners as test subjects for vaccines and for the deliberate transmission of typhus to maintain a viral stock. Approximately 600 prisoners had been deliberately infected; approximately 158 had died.
The fourth was Wolfram Sievers, who had not been a medical doctor but had run the SS Ahnenerbe research foundation and had administered the assembly of the Jewish skeleton collection at the Reich University of Strasbourg. Eighty-six Jewish prisoners had been selected at Auschwitz for the project, transported to the Natzweiler-Struthof concentration camp in Alsace, killed by Bickenbach gas, and prepared as anatomical specimens by the Strasbourg professor of anatomy August Hirt. The skeletons were intended to demonstrate, in Hirt’s racial-anatomical theory, the inferior racial characteristics of Jews. The bodies had not been fully prepared by the time French forces arrived at Strasbourg in November 1944; the partly defleshed corpses were still in Hirt’s laboratory. The prosecution had photographs of them.
The fifth was Viktor Brack, who had not personally conducted experiments but who had administered the T4 killing programme under Brandt and Bouhler and had subsequently transferred the personnel and the gas-chamber technology of T4 to Operation Reinhard, the killing centres at Bełżec, Sobibór and Treblinka. Brack was the institutional bridge between the T4 killings of disabled Germans and the operational killing centres of the Final Solution. The Hartheim, Sonnenstein, Bernburg, Brandenburg and Grafeneck killing centres in the Reich, where the T4 killings had been conducted, had supplied the operational template (the gas chamber disguised as a shower room, the false forward-rooms, the cremation ovens) and many of the personnel (Christian Wirth, Franz Stangl, Franz Reichleitner, Gottlieb Hering, Erich Bauer) for the death camps.
The experiments
The court heard evidence on the full range of the medical crimes. The high-altitude experiments at Dachau, conducted by Sigmund Rascher in collaboration with the Luftwaffe, had placed prisoners in low-pressure chambers to study the effects of decompression at altitudes between 7,000 and 21,000 metres. Eighty subjects had been used. Many had died. Rascher had filmed their deaths for analysis.
The freezing experiments at Dachau, also conducted by Rascher and his team between August 1942 and May 1943, had immersed prisoners in tanks of ice water to determine the rate at which body temperature dropped and the methods most effective at restoring it. Approximately 300 subjects had been used; approximately 90 had died on the operating table or shortly afterwards. The work had been justified to the Luftwaffe as relevant to the survival of pilots downed in the North Sea.
The seawater experiments at Dachau, conducted by Wilhelm Beiglböck in 1944, had given a series of forty Roma prisoners only chemically processed seawater to drink for periods of up to twelve days, to evaluate competing methods of making seawater drinkable. The subjects had been deprived of food entirely. Most had survived but had been left with substantial kidney damage.
The sulfonamide experiments at Ravensbrück were the experiments described by Karolewska. The bone and muscle transplantation experiments at Ravensbrück had used the same group of Polish women.
The typhus experiments at Buchenwald and Natzweiler had infected hundreds of prisoners with the Rickettsia bacterium that causes typhus, in support of vaccine research and to maintain a viral stock for transmission. Mortality at Buchenwald among the experimental subjects had been approximately a quarter.
The phosgene gas experiments, the mustard gas experiments, the malaria experiments, the hepatitis experiments, the bone marrow experiments, the X-ray sterilisation experiments, the chemical sterilisation experiments, all had taken place at one or other of the camps and had collectively killed several hundred prisoners and permanently injured several thousand more.
The Nuremberg Code
The judgment of 19 and 20 August 1947, delivered by the three-judge American military tribunal under Walter B. Beals as presiding judge, with Harold L. Sebring and Johnson T. Crawford, included as part of the section on the legality of medical experimentation a set of ten principles that came to be known as the Nuremberg Code. The principles had been drafted in part by the prosecution medical adviser Andrew C. Ivy and in part by the German psychiatrist Werner Leibbrand, working from earlier American Medical Association guidelines, prewar German guidelines on human experimentation that the Nazi regime had ignored, and the case the prosecution had built. The first and most important of the principles read:
The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.
The remaining nine principles set out further requirements: the experiment must be designed to yield results for the good of society; it must be based on prior animal experimentation; physical and mental suffering must be avoided; no experiment should be conducted where there is reason to believe that death or disabling injury will occur; the degree of risk must never exceed the importance of the problem to be solved; proper precautions must be taken; the experiment must be conducted only by scientifically qualified persons; the human subject must be at liberty to bring the experiment to an end at any time; the scientist in charge must be prepared to terminate the experiment if it is likely to result in injury, disability or death.
The Nuremberg Code is the foundation of every modern framework of human research ethics. The Declaration of Helsinki, adopted by the World Medical Association in 1964 and revised periodically since, is its direct descendant. The institutional review boards required by all modern medical research, the consent forms a patient signs before any clinical trial, the ethical review of pharmaceutical research, the standards applied in research grants by every national funding agency, all derive from the principles set out in the Doctors’ Trial judgment.
The verdicts
Of the twenty-three defendants, sixteen were convicted. Seven were sentenced to death: Karl Brandt, Karl Gebhardt, Joachim Mrugowsky, Wolfram Sievers, Viktor Brack, Rudolf Brandt (Himmler’s personal secretary, no relation to Karl), and Waldemar Hoven (the Buchenwald camp doctor). The seven were hanged at Landsberg prison on 2 June 1948.
Five drew long prison sentences: Hermann Becker-Freyseng (twenty years, the lowest end of the long sentences); Wilhelm Beiglböck (fifteen years); Hans Wolfgang Romberg (nineteen years); Helmut Poppendick (ten years); Oskar Schroeder (life, commuted by McCloy to fifteen years in 1951 and released the same year). Four drew shorter sentences. Seven were acquitted, in cases where the prosecution had been unable to establish the level of personal involvement the legal standard required.
The compromised aftermath
The clemency under McCloy in 1951 substantially reduced the prison sentences. Several of the convicted doctors went on to substantial postwar medical careers in West Germany. Hubertus Strughold, who had not been a defendant at the Doctors’ Trial but who had been an associate of the senior figures and had run the Luftwaffe Medical Research Institute, was recruited by the United States Air Force under Operation Paperclip and became, in his American postwar career, one of the founders of American aerospace medicine. He has the reputation in some quarters of being the father of American space medicine. The 2009 publication of further evidence on his wartime activities, by the historian Hugh G. Gallagher and others, has produced sustained reassessment of his postwar honours. Several have been rescinded.
The wider professional rehabilitation of the German medical profession after 1945 has been documented at length by Robert Jay Lifton, in The Nazi Doctors (1986), and by Paul Weindling. The German Medical Association did not formally apologise for the conduct of the profession under the Nazi regime until 2012. The apology came sixty-five years after the Doctors’ Trial verdict.
Karolewska after the trial
Wladyslawa Karolewska returned to Poland after her testimony at Nuremberg. She lived in Lublin and worked as a clerk for the rest of her life. She remained close to the other surviving Króliki and attended several reunions in Warsaw and at Ravensbrück over the following decades. She gave further testimony at the Frankfurt Auschwitz Trial in the 1960s and at the Düsseldorf Sobibór Trial in 1965 to 1966. She died in Lublin in 1990 at the age of seventy. The other surviving Króliki organised in their later years to obtain compensation from the West German government, which was paid in modest amounts in the 1950s under the bilateral agreement between Bonn and Warsaw. The compensation amounted, on average, to less than two thousand Deutschmarks per surviving woman. The figures had not been adjusted to reflect the costs of the medical treatment many of the women required for the rest of their lives.
What the trial established
The Doctors’ Trial was, by some measures, the most morally consequential of the twelve Subsequent Proceedings. It brought into court the most thoroughly trained, the most highly educated, and in some respects the most apparently respectable members of the regime’s professional class. It demonstrated that the killing had been carried out, in part, by men who had taken professional oaths to do exactly the opposite. It established that the principle of voluntary consent in medical research is not a matter of professional courtesy or institutional preference but a precondition of legitimate science. It produced, on the documentary record, the contrast between Karolewska on her single crutch and Brandt in his SS uniform, between the woman who had been operated on without anaesthetic in a research project to develop the drug that would save German soldiers and the doctor who had ordered the operation. The contrast, more than the principles or the convictions, was what the trial had shown. It is the substance of every framework of medical ethics that has come after.
See also
- Reinhard Heydrich
- Heinrich Himmler
- Franz Stangl
- People with Disabilities and the T4 Programme
- Soviet Prisoners of War
Sources
- Trials of War Criminals before the Nuernberg Military Tribunals, vols I and II (Doctors’ Trial), U.S. Government Printing Office, 1949 to 1950
- Robert Jay Lifton, The Nazi Doctors: Medical Killing and the Psychology of Genocide, Basic Books, 1986
- Paul Weindling, Nazi Medicine and the Nuremberg Trials: From Medical War Crimes to Informed Consent, Palgrave Macmillan, 2004
- Vivien Spitz, Doctors from Hell: The Horrific Account of Nazi Experiments on Humans, Sentient, 2005
- Wladyslawa Karolewska, testimony in the Doctors’ Trial, 20 December 1946, NMT vol I
- The Nuremberg Code (1947), reprinted in Trials of War Criminals before the Nuernberg Military Tribunals, vol II, p 181
- Henry Friedländer, The Origins of Nazi Genocide: From Euthanasia to the Final Solution, University of North Carolina Press, 1995
- Hugh G. Gallagher, By Trust Betrayed: Patients, Physicians, and the License to Kill in the Third Reich, Henry Holt, 1990