The Nazi Hypothermia Experiments: Forbidden Data?

Abstract

One of the annual highlights of the Association of Anaesthetists' scientific programme is the Group of Anaesthetists in Training (GAT) conference. Most of the members of the Association, their formal training days long behind them, are ineligible to attend this particular event, but the Editor-in-Chief, along with the other Officers, is encouraged to show his face, and I was delighted to be able to go to this year's meeting in Portsmouth. As always, the quality of the scientific content was very high, and the organisers should be congratulated. The Pinkerton lecture is traditionally the highlight of the programme, and I found the exposition on immersion-related deaths and near-drowning, delivered by a senior naval doctor, both fascinating and informative. However, the speaker did strike one very disconcerting note, and it is this that led me to pen this editorial. In illustrating the effects of immersion in cold water upon body temperature and survival, he chose to cite the infamous experiments carried out by the Nazis upon inmates of the Dachau concentration camp. The relevant information was carried on two slides; the second of these, which seemed to be displayed for an inordinate length of time, listed the data relating to seven subjects – identified by ‘research number’– including time to death and lowest rectal temperature. The speaker did not preface his use of this material with any explanation of its origin, other than to briefly refer to the ‘‘data from Dachau’’. I was taken aback by this unexpected and unwelcome intrusion into an otherwise erudite presentation, but was even more surprised by the reaction of the audience to these slides. There was none. At the time, I put this down to a natural and creditable reluctance to offend a keynote speaker, but this optimistic view was dashed by the very next slide, which showed a photograph of a pig immersed in water, an experiment carried out in order to confirm the Dachau data. This slide was greeted by an audible sharp intake of breath from the audience, followed by a relieved exhalation when the speaker explained that the animal was anaesthetised, ‘‘otherwise I could never get it into the water’’. I do not know what can be deduced from this very depressing vignette. I would like to think that it did not reflect the perverse but creeping ideology that puts animal welfare above that of humans. Instead, I choose to believe that the true origins of the data shown by the speaker might have been lost on the relatively young audience and therefore take this opportunity to offer some information. The Nazi ideology was predicated on the concept of racial supremacy. At the top of the tree was the Aryan race; at the foot were the ‘untermenschen’: blacks, gypsies, homosexuals and Jews. In the obscene logic which emerged from this categorisation, such ‘subhumans’ were legitimate targets for extermination and, before their deaths, experimentation. A small number of German doctors who espoused the Nazi philosophy – some, like the infamous Joseph Mengele, highly regarded and well published – were recruited to carry out medical experiments on concentration camp inmates. In Auschwitz, Mengele worked with identical twins, trying to unravel how to genetically engineer a master race. Children were castrated, had limbs amputated, or their eyes injected with chemicals in an attempt to make them turn blue. One twin would be injected with typhus, then both would be killed and their organs compared. It is estimated that, out of around 1000 pairs of twins, only 200 survived [1]. In Cell 10 at Auschwitz, Clauberg investigated methods of efficient mass sterilisation of ‘untermenschen’; young women had caustic substances injected into their uteruses, causing internal sepsis and necrosis, while men underwent mass irradiation followed by castration so that the testes could be examined. Brandt and Sievers killed 112 Jews after carefully photographing and measuring them, then sent the bodies to the Reich University of Strasbourg in order to establish a skeleton collection [2]. These abominations were carried out in the name of racial purity. The doctor responsible for the hypothermia experiments, Sigmund Rascher, was working towards a more pragmatic purpose, the survival of Luftwaffe pilots who were shot down and had to bail out over the North Sea. Some 300 prisoners were immersed in ice-cold water, or strapped naked to a stretcher in the Polish winter, while rectal temperature, heart rate, level of consciousness and shivering were meticulously monitored and charted. Most were allowed to freeze to death; in some resuscitation by various methods was attempted, with active reheating in a warm bath proving the most effective. The results were presented at a medical conference in Berlin in 1942. Rascher was also responsible for placing 200 prisoners in a decompression chamber in an attempt to improve survival for pilots ejecting at high altitudes. He dissected some of the subjects’ brains while they still lived in order to demonstrate the formation of nitrogen bubbles in the cerebral blood vessels. Another military ‘experiment’– relating to survival when stranded at sea – was carried out by Eppinger, who forced 90 gypsies to drink only sea-water for up to 12 days, half of whom had their water pre-treated to disguise the taste. Eye-witnesses speak of his victims licking the floor after it had been mopped in a vain attempt to quench their thirst before they died. These are but a few examples of the horrors carried out in the name of science in the death camps. Readers who wish to know more are directed to the Simon Wiesenthal Center's website, where well-researched descriptions of these and other Nazi atrocities can be found [3]. The ethical implications of using data which have been derived from such sources are manifold, and have been the subject of considerable discussion. The widely-held view that unethically-acquired data should never be used is bolstered by the understandable concern that experiments conducted by doctors who were so corrupted as to fall under the thrall of Nazi ideology might be scientifically flawed as well as morally repugnant. In addition, the results and conclusions arising from the experiments may have been skewed by political imperatives. Rascher, in transmitting his findings on hypothermia to his superior, Heinrich Himmler, reported that death occurred in 53–100 minutes after immersion; later examination of his laboratory notes by Leo Alexander, Psychiatric Consultant to the Chief Counsel for War Crimes at the Nuremberg Doctors’ Trial, revealed that death actually took longer, from 80 minutes to 5–6 hours [4]. However, even if the experiments were carried out without scientific flaw and reported accurately, the results from a population of severely malnourished and disease-ridden prisoners are most unlikely to be applicable to the average victim of a drowning accident. The scientific validity and utility of such data must, clearly, be questionable at best. But this is really something of a moral side-step. Even if the data were of the highest quality, its provenance should surely put it out of bounds to the ethical scientist. In making use of these results we are offering a veneer of respectability – however thin – to doctors who have violated in the most extreme way imaginable the essence of their calling. And medicine itself is demeaned. Henry K Beecher of Harvard Medical School, the first Professor of Anaesthesia in the United States and the second in the world, considered that, while suppression of the data would result in a specific and localised loss of information, ‘‘this loss, it seems, would be less important than the far reaching moral loss to medicine if the data were to be published [5]’’. Some would argue that, if some general good can come of the most evil acts, then those who suffered and died might not have done so entirely in vain. The benefit derived by society could be regarded as an intangible memorial to the victims of Nazism. Most commentators who espouse this view would, nonetheless, restrict this use of the data to those circumstances where the benefit derived would be life-saving and near-certain, circumstances that rarely pertain in the world of medical research. Even then, presentation of the data would have to be prefaced with explanations of how they were derived, in order that those who were unaware of the provenance could see them in their moral context and judge for themselves. When it comes to publication, editors have in recent years universally steered clear of allowing the hypothermia results – widely regarded as the most potentially useful of the Nazi data – to see the light of day. Even in the 1980s, Robert Pozos, Director of the Hypothermia Laboratory at the University of Minnesota, made a strong argument to use the data in potentially life-saving research, but was flatly refused permission to publish by Arnold Relman, the then editor of the New England Journal of Medicine [6, 7]. Baruch Cohen, a Californian lawyer and Holocaust researcher, argues that ‘‘although use of the Nazi data might benefit some lives, a larger bioethical problem arises. By conferring a scientific martyrdom on the victims, it would tend to make them our retrospective guinea pigs, and we, their retrospective torturers’’ [8]. It is this intimation of complicity, however peripheral, that probably stays the hand of the modern ethical researcher tempted to make use of such data. The perverted doctors who tortured their victims were eventually brought to book at Nuremberg in 1945, where sixteen were found guilty of crimes against humanity and seven executed. Sigmund Rascher, the doctor responsible for the hypothermia experiments, was not among them. He had been put to death in 1945 for violating strict Nazi genetic purity laws when he and his wife, who was unable to conceive, illegally adopted two children who were not from sufficiently Aryan stock. Simon Wiesenthal, tireless Nazi hunter and Holocaust educator, received an honorary knighthood this year at the age of 95 in recognition of his ‘‘lifetime of service to humanity’’. The 1964 Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects was a direct response to the Nazi experiments, and was the forerunner of the codes of ethics which now inform and control the activities of all medical researchers. This enduring power for good is the true legacy of the people who were slowly frozen to death in Dachau 62 years ago.

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