Clinical Reference / Dermatopathology: Practical & Conceptual / Jan – Mar 1995 | Vol. 1, No. 1 / Dermatology and Dermatopathology under the Swastika

Dermatology and Dermatopathology under the Swastika

Jan – Mar 1995 | Vol. 1, No. 1
Weyers, Wolfgang

Part 1. The Removal of Jews from the Universities

The year 1945, half a century ago, marked the end of one of the most terrible episodes in history: the Nazi dictatorship in Germany. Much has been said and written about this period in general, and about its implications for medicine in particular. The effects of the Nazi regime on dermatology and dermatopathology, however, have not been assessed comprehensively. That fact is staggering, considering the impact of those years on dermatology as a scientific discipline and a humanistic endeavor, not only in Germany but throughout the world. In Germany, dermatology was changed profoundly because most of its exemplars were Jewish or of Jewish descent. After Hitler came to power, they were dismissed from university and governmental positions and forced to emigrate. Some committed suicide; others, including Karl Herxheimer and Abraham Buschke, died in concentration camps. Consequent to these events, German dermatology, which had been premier at the beginning of the 20th century, lost its substance and its reputation. At the same time, German Jewish immigrants enriched dermatology in other countries, especially the United States, where those refugees soon acquired teaching posts, and even chairmanships, at universities.

Because of the impact of those years on the development of dermatology, a study of the circumstances that led to radical changes at German universities and to the infection of medicine with the mentality of National Socialism is warranted. Furthermore, it is important for contemporary dermatologists, dermatopathologists, and physicians of all kinds to learn about the fates of the men and women who were involved in these events, either as victims of the Nazis (e.g., Herxheimer, Buschke, Jessner, and Felix and Hermann Pinkus) or as supporters of them (e.g., Heinrich Adolf Gottron and Hans Reiter). Many of those names are still in daily use in connection with specific diseases or with diagnostic signs that are linked to them eponymically, e.g., Herxheimer phenomenon, scleredema of Buschke, Jessner’s lymphocytic infiltration, fibroepithelial tumor of Pinkus, Gottron’s papules, and Reiter’s disease. Who were the persons behind these eponyms, and how did they behave?

To date, only a very few articles have addressed these questions. Among them is a short review of the fates of Jewish dermatologists under the Nazis, published in 1983 in the American Journal of Dermatopathology, by the late Alfred Hollander. [1 ] Six years later, in the Journal of Investigative Dermatology, Karl Holubar and Klaus Wolff described the effects of mass emigration of German dermatologists on the development of dermatology in the United States. [2 ] Recently, studies in depth of the subject have been carried out by Albrecht Scholz and his colleagues at the University of Dresden. Scholz and Cathrin Schmidt described the fates of Jewish dermatologists dismissed from important academic positions in Germany and of their “Aryan” successors. [3,4 ]

The intention of this article is different: it seeks to provide information about those who suffered as a result of the rise of the swastika and those who profited by it, but it also endeavors to integrate those data into a picture of the time – a time in recent memory in which an ignorant band of thugs took control of one of the most cultivated nations in the world and in a matter of a few years brought it to their own base level. Lessons are still to be derived from critical analysis of those incomparably painful years, from which the world may never recover.

A major objective of the Nazis was to free Germany of Jews. In regard to medicine, this meant much more than simple reform of professional organizations and medical societies. The removal of Jews from the boards of societies and of journals was a first step, to be followed by the complete elimination of Jewish physicians from professional life in Germany. For this purpose, all kinds of measures were employed, no matter whether legal or not.

Even in the first days of Hitler’s dictatorship, before any anti-Jewish legislation had been enacted, squads of storm troopers (SA, “brown shirts”) went into hospitals, and even into operating rooms, surprised physicians, especially Jewish ones, at work, and arrested them. On open trucks, the captives were taken to the headquarters of the SA, where many were tortured and some were beaten to death. The storm troopers, largely hooligans of limited intelligence, relished humiliating respected citizens; for instance, Max Leffkowitz, an assistant medical director of the department of internal medicine at the Moabit Hospital in Berlin, was forced to crawl around on his hands and feet and bark like a dog. He also had to stand against a wall while SA men shot bullets around the contour of his body in the manner of knife-throwers in circuses.

The first victims of this deliberate policy were prominent Jews or well-known political opponents of the Nazis, particularly political opponents who were Jewish or of Jewish descent. Few physicians were socialists or communists; the Association of Socialistic Physicians, founded in 1924, had about 1,500 members in the entire German Reich, almost 200 of whom were living in Berlin. Many of those members were Jewish, and they were at special risk of being molested, e.g., Max Leffkowitz and Benno Chajes, a former member of the Prussian parliament and an authority in the field of occupational dermatoses who, in 1933, emigrated to Palestine, where he died in 1939.

Among the Jewish dermatologists who were known for their socialistic inclinations was Ernst Kromayer, the inventor of the “Kromayer’s lamp,” a small water-cooled mercury vapor lamp with a quartz window that produces ultraviolet radiation (Fig. 1). Kromayer was the first professor of dermatology at the University of Halle. In 1904, he moved to Berlin, where he opened a private skin clinic in a former factory building and enjoyed a flourishing private practice. Although Kromayer was wealthy and lived on an estate, he belonged to the circle that gathered around Rudolf Breitscheid, a member of the Reichstag and spokesman for foreign affairs of the Social Democratic Party. Breitscheid later was exterminated in the concentration camp at Buchenwald. Ernst Kromayer avoided this fate by committing suicide on May 6, 1933. By one dependable count, from January 1933 on as many as 5% of the Jewish physicians living in Germany during the Nazi period, i.e., several hundred of them, may have committed suicide.

Fig. 1

Ernst Kromayer, (1862-1933)

Acts of illegality against Jews at the beginning of Hitler’s regime were claimed by the Nazis to be spontaneous outbreaks of anger of the German people, for which the Jews, as poisonous parasites of the nation, were themselves responsible. In truth, many Germans perceived the encroachments as irritating and disturbing, rather than justified. Attempts to intervene on behalf of Jews, however, were exceptional; altogether, the German population paid little heed to the phenomenon, and tried to either overlook or underemphasize illegal encroachments upon Jews. In any event, actual harassment of Jews was carried out not by the German people in general, as claimed by the Nazis, but almost exclusively by goon squads of the SA. In short, brutalities against Jews were not spontaneous at all; they were planned, initiated, and stopped by leaders of the Nazi party.

The most prominent example of this kind of officially sanctioned illegal terror occurred on April 1, 1933, the “day of the general boycott of Jews.” Storm troopers appeared in front of Jewish shops and molested people who wanted to enter them. They “informed” passers-by about Jews as usurers and escalators of prices, and demanded “Germans, protect yourselves, don’t buy from Jews” (Fig. 2). Those citizens who patronized the establishments of Jews were accused of being “traitors to their people.” Outside the offices of doctors, patients were warned menacingly about consulting Jewish physicians. Gynecologists and dermatologists, especially, were said to practice only for the sake of their own sexual excitement. Jewish physicians and lawyers in the public service were laid off; some were even arrested. Throughout Germany, Jews were taken into “protective custody” because of the ostensible offense of usury.

Fig. 2

“Germans! Strike back! Don’t buy from Jews!”

The impudence of the storm troopers reached such proportions that even the ultraconservative German president, von Hindenburg, was offended by it. As a former general, Hindenburg interfered specifically on behalf of Jews who were veterans of the World War. In a letter to Hitler, dated April 4, 1933, he wrote:

In the last few days, a series of incidents have been reported to me in which judges, lawyers and civil servants of the judiciary, who had been wounded in the war and who had unblemished records of military service, have been forcibly removed from their positions and are scheduled to be dismissed permanently simply because they are of Jewish origin. For me personally, revering those who have died in the war and grateful to those who survived and to the wounded who suffered, such treatment of Jewish war veterans in the civil service is altogether intolerable . If they were worthy to fight and bleed for Germany, then they should also be considered worthy to continue serving their fatherland in their professions.

Three days later, Hitler enacted the “Law for the Restoration of Professional Civil Service,” which enabled the government to eliminate, legally, Jews and political opponents from the civil service. Because of the good offices of von Hindenburg, the regulations excluded Jewish veterans of World War I and officials who had been employed before April 1, 1914.

Less than a week later, newspapers published lists of university professors who had been let go, and stated that “this, of course, is only a first, preliminary measure.” Within the next few months, most Jewish physicians who worked at public hospitals were fired. To maintain their regular medical services, administrators of hospitals were forced to utilize medical students in their stead. In Berlin, more than one third of all of the places available for assistant physicians were held by medical students who had not yet passed their examinations: 12 of 46 at the Urban hospital, 18 of 38 at the Moabit hospital, 31 of 52 at the Virchow hospital, and 47 of 84 at the Charite. In 1933, mortality rates for patients at hospitals in Germany rose by about 16%.

Among the Jewish physicians who lost their jobs as a consequence of Hitler’s edict were many prominent dermatologists, e.g., Abraham Buschke, who was director of the dermatology department at the Rudolf Virchow hospital in Berlin, and his assistant, Ludwig Löwenstein tumor,” a verrucous carcinoma on mucocutaneous surfaces thought to be caused by human papillomavirus (Fig. 3). Buschke continued to work in Berlin at the Jewish hospital until he was deported to the concentration camp at Theresienstadt, where he died of inanition in 1943. Ludwig Löwenstein left for the United States, where he joined the Skin and Cancer Unit of the New York University School of Medicine.

Fig. 3

Abraham Buschke (1868-1943)

Ernst Sklarz, a former assistant of Abraham Buschke, was consultant dermatologist at the Municipal Hospital of Berlin-Neukölln and director of dermatology of the new Polyclinic at the Alexanderplatz (Fig. 4). Because he was a Jew, he was dismissed in 1933 and, in 1936, he emigrated to Great Britain. The German medical degree was not accepted by British authorities, and Sklarz had to resume the study of medicine at the University of Wales. In 1937, he passed the British qualification examination and, within a year, was appointed postgraduate lecturer in dermatology at Blackfriars Hospital for Diseases of the Skin. Beginning in 1953, Sklarz became consultant dermatologist at New Cross General Hospital in London. When he retired at the end of 1962, his contributions were recognized by his appointment as honorary consultant to the Bermondsey and Southwark hospital group. Sklarz died in 1975.

Fig. 4

Ernst Sklarz (1894-1975)

Franz Blumenthal, who was acting chairman of dermatology at the Charite hospital in Berlin for three years following the death of Georg Arndt, departed for the United States in 1934, and was appointed professor of dermatology at the University of Michigan in Ann Arbor (Fig. 5). He died there in 1971 at the age of 93. Blumenthal contributed textbooks on radiotherapy of the skin and on contact allergy.

Fig. 5

Franz Blumenthal (1878-1971)

In Heidelberg, the old chairman of dermatology, Siegfried Bettmann, was dismissed because of his Jewish ancestry, despite the fact that he was a professed Lutheran.* Subsequently, Bettmann was granted permission to continue to work as a dermatologist until 1935, at which time he emigrated to Switzerland where he died shortly thereafter (Fig. 6). His son, a lawyer employed by the government, was terminated earlier, and, having seen storm troopers positioned in front of his father’s office, committed suicide in 1934.

Fig. 6

Siegfried Bettmann (1869-1939)

In Frankfurt, the chairman of dermatology, Oscar Gans, was kicked out on February 1, 1934 (Fig. 7). Gans was the most prominent dermatopathologist of his time, having written a two-volume revision of Unna’s textbook, Histopathology of the Diseases of the Skin. Gans’ text had been published in 1925 and 1928. After his dismissal as chairman, Gans went to Bombay, where he was engaged in a private practice of dermatology and conducted extensive studies of leprosy. In 1949, the University of Frankfurt recalled Gans to his previous position. Eleven years later, at the age of 72, Gans retired to Comano near Lugano, Switzerland. He died there at the age of 95.

Fig. 7

Oscar Gans (1888-1983)

Gans’ associate Franz Herrmann, also Jewish, was dismissed in 1933 and worked in a private practice until 1938 (Fig. 8). In the fall of 1938, he was one of the last Jews able to leave Germany. Herrmann initially went to London, where he worked at the Royal Northern Hospital. In 1940, he moved to New York City, joined the staff of the Skin and Cancer Unit of New York University, and was given charge of basic and laboratory research in dermatology. In 1959, Herrmann returned to Frankfurt to succeed his former teacher Oscar Gans as chairman of dermatology. He retired in 1969 and died in 1977. Herrmann was greatly respected for his work on the physiology of sweat glands and sebaceous glands.

Fig. 8

Franz Herrmann (1898-1977)

The director of dermatology at the Municipal Hospital of Nuremberg, Ernst Nathan, also emigrated to New York City, where he worked at the Skin and Cancer Unit of New York University. He died in 1981.

The ousting of their Jewish colleagues was tolerated quietly by the vast majority of Germans in academic life. Rare were efforts to prevent the dismissal of Jews, and those that were made were ineffective in the extreme. In Heidelberg, for example, the dean of medicine, Richard Siebeck, wrote a letter in April 1933 to the Reich’s Ministry of Education, in which he averred that even though it was necessary for academics to be “of German stock and German spirit,” it was evident that “German Jews take part in advances of science and that great medical personalities have emerged from their midst.” A few months later, Siebeck was removed as dean by the new rector of the university and nothing further was heard of his petition. Similar attempts were made in Düsseldorf, with equally futile results. In Marburg, the entire medical faculty intervened with the Ministry of Education on behalf of pediatrician Ernst Freudenberg, who was about to be terminated because his wife was Jewish, all to no avail.

In Breslau, the rector of the university asked the Reich’s Ministry of Education for permission to postpone the dismissal of Jewish lecturers in order to sustain the teaching program of the medical faculty. The situation for the Nazis was extraordinarily difficult in Breslau because of a long tradition of Jewish contributions to the university. Most of Breslau’s teachers of medicine were Jewish or of Jewish descent, and before the advent of the Nazis the skin clinic was decorated, as a matter of pride, with Stars of David. In spite of this heritage, the request by the university for a stay of punishment against the Jews was not acknowledged, let alone heeded. Within a few months, the medical faculty was forced to lose some of the most highly regarded dermatologists in the world. From being renowned in dermatology, it soon became unknown.

The first dermatologist to leave the University of Breslau was Rudolf Mayer, who was highly regarded for his work in chemotherapy and allergic contact dermatitis (Fig. 9). In January 1933, news of Hitler’s appointment as Chancellor of the German Reich reached him during a vacation in Czechoslovakia. Mayer foresaw how life would develop for Jews in Germany and called his chairman, Max Jessner, to submit his resignation. Although Jessner urged him to reconsider this decision, reminding him that a Prussian civil servant must fulfill his responsibilities and not act impetuously, Mayer never returned to Breslau. From Czechoslavakia he traveled to France, where he worked in Paris and Lyon until 1942. Subsequently, he went to Summit, New Jersey, in the United States, to become director of the microbiology laboratory of the Ciba Corporation. There he developed pyribenzamine, one of the first antihistamines. Mayer died in Washington, D.C., in 1962.

Fig. 9

Rudolf Leopold Mayer (1895-1962)

The next lecturer of dermatology to leave the University of Breslau was Wilhelm Siegmund Frei. Since 1929, Frei had also functioned as director of the dermatology department of Berlin-Spandau Municipal Hospital. In the spring of 1933, he was dismissed from his position in Berlin, and in April 1934, was struck from the register of teachers at the University of Breslau, retroactive to the day of the enactment of the Law for the Restoration of Professional Civil Service. Frei then left Germany for New York City, where he worked at Montefiore Hospital. He died in New York in January 1943, at age 57. Frei is remembered for the innovative work that now bears his name, the “Frei test” for lymphogranuloma venereum.

Walter Freudenthal had to leave the University of Breslau in 1934 (Fig. 10). He moved to London, where he was able to pursue his specialty of histopathology of the skin in the dermatology department of University College Hospital Medical School. In October 1945, Freudenthal became the first holder of a readership in dermatologic histology at the University of London and, in the next few years, he attracted many established dermatologists from England and abroad who sought to learn from him. Freudenthal was one of the most eminent dermatopathologists of his time. Several names of diseases that are still in common usage were introduced by him, e.g., keratoacanthoma and lichen amyloidosus. In 1926, he became the first to detail findings in solar keratosis. Together with Geoffrey Dowling, Freudenthal also provided the first description of Dowling-Degos’ disease, a reticulated pigmented anomaly of the flexures. Freudenthal died in London in 1952, at the age of 58.

Fig. 10

Walter Freudenthal (1893-1952)

Hermann Pinkus, the son of the celebrated dermatologist, Felix Pinkus, was a young assistant at the department of dermatology in Breslau (Fig. 11). Because of his Jewish descent, he was dismissed in 1934. While his father, who was Jewish, and his mother, who was Christian, stayed in Germany until somewhat later, Hermann Pinkus, who was Christian, went to the United States, where he arrived as a refugee without money, work, or prospects. Through the help of Marion Sulzberger, Pinkus found a job in tissue culture as a research fellow at the University of Michigan in Ann Arbor. From this beginning he progressed, via a fellowship in dermatopathology at Wayne County General Hospital under Franz Blumenthal, to private practice of dermatology, to a part-time teaching post in the department of dermatology at Wayne State University in Detroit, to, in 1960, full-time professor and chairman of that department. He also operated a private dermatopathology laboratory in Monroe, Michigan (which later was joined by Amir Mehregan). Hermann Pinkus was one of the leading dermatopathologists in the world and perhaps the most reflective, imaginative one. Pinkus’ Guide to Dermatohistopathology, now in its fifth edition, became an appreciated resource. Pinkus identified the acrotrichium and the acrosyringium as distinct anatomic entities, and was the first to recognize several neoplasms as distinctive, e.g., eccrine poroma, premalignant fibroepithelial tumor, and trichodiscoma. In 1957, Pinkus described and named alopecia mucinosa. Pinkus was President of the Society for Investigative Dermatology in 1958, President of the American Society of Dermatopathology in 1964, and Vice President of the American Academy of Dermatology in 1970. He was the first recipient of the Founder’s Award of the American Society of Dermatopathology. Pinkus died in Monroe, Michigan, in 1985.

Fig. 11

Hermann Pinkus (1905-1985)

Stephen Epstein was chief of the Mycological Research Unit at the Skin Clinic of Breslau from 1929 to 1933, and chief of the units of radiology and allergy from 1933 to 1935 (Fig. 12). In December 1935, he left Germany for the United States, where he founded the Department of Dermatology at the Marshfield Clinic in Marshfield, Wisconsin. In 1946, he was appointed associate professor of dermatology at the University of Minnesota. Epstein wrote two books, Allergic Pruritus and An Atlas and Manual of Dermatology, published in 1952 and 1959, respectively. He also set forth the concept of photoallergic dermatitis. In 1960, Epstein was elected vice-president of the Society for Investigative Dermatology. He retired in 1965 and died in Madison, Wisconsin, in 1973.

Fig. 12

Stephan Epstein (1900-1973)

Curt Rosenthal, a Jewish neurologist at the University of Breslau, was co-describer of the Melkersson-Rosenthal syndrome, which consists, in its classic presentation, of a triad of facial paresis, scrotal tongue, and granulomatous cheilitis (Fig. 13). In 1933, his chairman applied for appointment of Rosenthal as extraordinary professor. For “racial reasons,” this request was rejected by the Prussian Ministry of Education, and Rosenthal’s employment at the University of Breslau was terminated. In the same year, Rosenthal emigrated to Switzerland, where he worked in meager economic conditions, first at the department of neurology of the University of Bern and later at a private sanatorium. Because of his uncertain professional status, Rosenthal contacted the “emergency organization of German scientists in foreign countries” (“Notgemeinschaft deutscher Wissenschaftler im Ausland”), seated in London, whose purpose it was to try to find positions for German scientists in exile. On his way to London, Rosenthal was run over by a car, and he died on April 4, 1937. His wife contended that “this tragic event possibly happened only because my husband, due to the uncertainty of our living conditions and the fight for our existence, was, at that time, emotionally and physically not in good shape.”

Fig. 13

Curt Rosenthal (1892-1937)

Because of exceptions inherent in the “Law for the Restoration of Professional Civil Service,” not all Jews qualified for dismissal immediately. In Breslau, this applied to the new chairman of the department of dermatology, Max Jessner (Fig. 14), and to his associate, Hans Biberstein (Fig. 15), both of whom had fought for Germany in World War I. The Nazis, however, were not hampered by legal restraints. In their view, it was “imperative for the new development of the medical faculty in Breslau, which was almost entirely jewified, that the last remnants of this jewification vanish, even if those involved are war veterans.”

Fig. 14

Max Jessner (1887-1978)

Fig. 15

Hans Biberstein (1889-1965)

The problem was solved easily: On May 17, 1934, one year after the “Law for the Restoration of Professional Civil Service” had been enacted, and even before von Hindenburg’s death, the exemption for Jewish veterans of the World War was revoked. Both Biberstein and Jessner were dismissed in the fall of 1934. Biberstein, who was well known for having developed immunotherapy for viral warts, worked subsequently at the Jewish hospital in Breslau, and, after five years, emigrated to the United States, where he became professor of dermatology at New York University and one of the most respected clinicians there. He died of acute congestive heart failure in 1965.

Max Jessner emigrated to Switzerland in 1935. Six years later, he moved to New York City, where, initially, he worked at the New York Postgraduate Medical School, and he later joined the teaching staff of the Skin and Cancer Unit of the New York University School of Medicine. After his retirement, Jessner returned to Switzerland, where he died at the age of 91. He was appreciated for his early studies of thorium X, which led to the first therapeutic application of radioactive isotopes in medicine, and for his description, in 1953, of lymphocytic infiltration of the skin.

Apart from Jews, the Nazis also dismissed political opponents, former members of the socialist and communist parties, and persons who did not endure quietly the measures enacted by the new rulers. In Bonn, this was the case for Erich Hoffmann, and in Tübingen for Paul Linser (Fig. 16), the old chairman of dermatology, who had introduced the use of sclerotherapy for varicose veins. In Munich, it happened to Leopold Ritter von Zumbusch, who had created there one of the most modern centers of dermatology in Europe and had been elected rector of the University of Munich (Fig. 17). Von Zumbusch is still remembered eponymically for his description, in 1907, of generalized pustular psoriasis.

Fig. 16

Paul Linser (1871-1963)

Fig. 17

Leopold Ritter von Zumbusch (1874-1940)

Living in Munich, von Zumbusch was familiar with the National Socialist movement from its earliest days. In the 1920s, he had attended a meeting of the Nationalsozéalistische Deutsche Arbiter-Parte (NSDAP), had read Hitler’s clearly stated architectural plan, Mein Kampf, and had come to the conclusion that Hitler was a “lunatic.” When the “lunatic” ascended to power, von Zumbusch found himself in a thorny situation. He suddenly had to deal with people whom he despised and who wanted to take control of the university for which he, as rector, was responsible. The new Bavarian minister of culture, Hans Schemm, for instance, told professors of the University of Munich in 1933 that “from now on, it is no longer important for you to find out if something is true but if it corresponds to the spirit of the National Socialist revolution.” Schemm also criticized the university for having failed in its task to serve the community. Von Zumbusch’s response was sarcastic: his letter to the minister suggested that the latter was ignorant of the activities of the university because he was preoccupied by his own professional duties as an assistant in a military hospital and a teacher in an elementary school. Von Zumbusch also protested sharply against the progressive curtailment of the independence of the university. As a consequence, he was removed from his position as rector of the University of Munich in October 1933.

As chairman of the department of dermatology, von Zumbusch continued to resist interferences by the government. In contrast to most other chairman, he continued to employ foreign physicians and supported colleagues who were considered by the Nazis to be “politically unreliable.” His opposition to the regime, however, was unsuccessful in this regard, too. Despite energetic protests by von Zumbusch, several members of his staff were dismissed. Among them was his assistant, Rudolf Maximilian Bohnstedt, who was regarded by the Nazis as politically unreliable. Bohnstedt was denied academic promotion, had to leave the clinic in 1935, and worked in private practices in Dresden and Berlin until the end of the war. In 1948, Bohnstedt was appointed temporary chairman of dermatology in Marburg, and, only one year later, he assumed the same position at the University of Giessen, which he held until his retirement in 1969. Bohnstedt died in 1970 (Fig. 18).

Fig. 18

Rudolf Maximilian Bohnstedt (1900-1970)

The year 1935 was the last at the skin clinic of the University of Munich not only for Bohnstedt, but also for his chairman, Leopold Ritter von Zumbusch. The Nazis had thought initially that they could induce von Zumbusch, like so many others, to cooperate with them. When they realized that von Zumbusch would not adapt, they conspired to get rid of him. This they did by collecting damaging material against him, by smuggling into the skin clinic, in the role of a patient, a spy of the Gestapo, and by contacting assistant physicians with an eye on a career who were willing to pass on occasional political comments by von Zumbusch to the Gestapo.

On April 2, 1935, von Zumbusch was summoned for questioning by officials of the Nazi party and of the university, who confronted him with accusations of misdemeanors, some of which were true, but many of which were invented. Von Zumbusch was accused of having said that Hitler was a “stupid man,” of having responded to a cry of “Heil Hitler” in unison by patients of his clinic with the words “Don’t roar that loud,” and of not having enforced participation of employees of the university in rallies of the party. Furthermore, he was reproached with corruption, a charge based on such crimes as use of ointments of the clinic, without fee, for emolliation of his own hands, or use by him of towels of the state subsequent to his having examined his own private patients.

Von Zumbusch was forced to resign his chairmanship in October 1935. He spent the next few years on his private estate at Lake Chiemsee, close to Munich, devoting his time to his family, but also to discreet support of colleagues who, like himself, were viewed as subversive by the government. That only few colleagues maintained any contact with him was accepted readily by von Zumbusch, and even encouraged by him, because he did not want to drag others into his personal problems. On March 31, 1940, Leopold Ritter von Zumbusch, who also suffered from inoperable sarcoma of cardiac muscle, committed suicide. Only a single obituary was published in a German journal, and that was written by his disciple, Carl Moncorps, chairman of the department of dermatology in Münster. No mention was made of the circumstances that had led to the banishment of von Zumbusch. Nevertheless, publication of the obituary was perceived widely as a sign of extraordinary courage on the part of Moncorps. The funeral of von Zumbusch was not attended by a single official of the University of Munich. In his will, von Zumbusch requested that his tombstone carry his name alone, without academic titles, until it would be an honor again to be professor at a German university.

In similar vulgar manner, with calumny and aspersion on his character, the Nazis also removed the chairman of dermatology in Freiburg, Georg Alexander Rost (Fig. 19). Rost had been an active member of a democratic political party and, therefore, was regarded as “politically unreliable.” The Ministry of Education was informed that Rost’s hostile attitude had caused “considerable agitation among the students,” and that it might be necessary to take him into protective custody. According to a report by the National Socialist Union of Students, “Rost was a democrat and pacifist, it is known that Rost has derided and mocked at everything that was related to National Socialism.” It was also reported that Rost had asked two students who had attended a lecture about dermatology to remove their party badges because the swastika might be offensive to patients. Furthermore, Rost had to vindicate himself for having purchased for his clinic, a few years previously, the German flag of the Weimar Republic with the colors black, red, and gold. The National Socialists, like all rightwing parties of the Weimar Republic, hated that flag and accepted only the old colors of the German monarchy, black, white, and red. Finally, Rost even was accused by one of his own assistants of having molested nurses sexually, an accusation which, although refuted, nevertheless impaired his reputation.

On August 7, 1933, Rost was dismissed from his position as director of the skin clinic in Freiburg. A few months later, he moved to Berlin, where he opened a private practice of dermatology. He also edited the Zentralblatt für Haut- und Geschlechtskrankheiten, succeeding its former Jewish editor Oskar Spitz. The engagement of Rost by the Springer Publishing House met with fierce resistance by the new editors of the Archiv für Dermatologie and Syphilis, Walter Friboes, Ernst Heinrich Brill, and Karl Zieler. As a consequence, Rost’s name was not allowed to appear on the frontispiece of the Zentralblatt für Haut- und Geschlechtskrankheiten; for eleven years, the editor of that journal was anonymous. After the war, Rost became director of dermatology at the Berlin-Spandau Municipal Hospital. He died on July 1, 1970, at the age of 93.

Apart from Rost, several other renowned members of the skin clinic of Freiburg were dismissed, e.g., Berta Ottenstein, the first female lecturer of dermatology in Germany and the first and only woman member of the faculty of the University of Freiburg (Fig. 20). Ottenstein, a learned chemist, had acquired a reputation through numerous articles about the biochemistry of the skin. As a Jew, she had to leave the University of Freiburg in March 1933. Through the good offices of Stephan Rothman, she was able to continue her studies under Lajos Nekam in Budapest, and subsequently accepted an invitation by Hulusi Behcet to become director of the chemical laboratory of the skin clinic of Istanbul. From 1945 on, Berta Ottenstein worked at Harvard University, where she made important contributions to the pathogenesis of lipoidoses, especially Gaucher’s disease. She died in 1956.

A second Jewish lecturer at the skin clinic in Freiburg, Erich Uhlmann, was in charge of the radiology unit and had published a compendium on radiotherapy of the skin (Fig. 21). According to the “Law for the Restoration of Professional Civil Service,” Uhlmann had to be removed from his position. Georg Alexander Rost tried to prevent Uhlmann’s dismissal by qualifying him, in an appeal to the ministry, as “indispensable,” but the effort proved to be vain. Considering Rost’s extraordinary petition on his behalf, it seems almost incomprehensible that Uhlmann, only a few weeks later, began the campaign against Rost by denouncing him officially to the dean of the university. This denunciation was highly welcome to the Nazis, but it did not alter Uhlmann’s fate. Uhlmann was dismissed in July 1933. Like Berta Ottenstein, he emigrated to Turkey, where he worked at the skin clinic of the University of Istanbul. In 1938, Uhlmann moved to Chicago to become director of the department of radiologic therapy at Michael Reese Hospital. He died in Chicago in 1964, of metastatic carcinoma to the spine and brain.

Philipp Keller, Rost’s assistant medical director, was dismissed for political reasons: in the years of the Weimar Republic, he had been a member of the social democratic party, and this circumstance alone was sufficient to terminate his scientific career (Fig. 22). After large demonstrations and not so veiled threats by Nazi students, Keller had to leave the clinic in 1933. Subsequently, he opened a private practice in Aachen. After the war, Keller became director of the skin clinic of Aachen and was elected president of the German Society for the Fight against Venereal Diseases. He died at the age of 82 in 1973.

Alfred Marchionini (Fig. 23) was considered to be unreliable politically for two reasons: 1) he had been a member of the social democratic party, and 2) he had a wife of Jewish descent. Consequently, his appointment as extraordinary professor, which had been requested by the medical faculty of Freiburg University in December 1932, was never granted. Because Marchionini was the only lecturer of dermatology left at the University of Freiburg, however, he was allowed to continue to work there, but the chances for an academic career in National Socialist Germany were nil. When Alfred Stühmer was called to the chair at Freiburg to succeed Georg Alexander Rost, he specifically asked the rector of the university, the philosopher Martin Heidegger, about the prospects and perspectives of Marchionini. As Marchionini’s future chairman, Stühmer argued, he [Stühmer] would have to take on “the entire responsibility for his [Marchionini’s] further academic career.” Martin Heidegger answered on February 21, 1934, that “Mrs. Marchionini has a non-Aryan grandmother. As far as I know, there is no chance of his receiving a chair because of this fact.”

Figs. 19-23

Top to bottom, Georg Alexander Rost (1877-1970), Assistants of Rost at the Department of Dermatology of the University of Freiburg in 1933: Berta Ottenstein (1891-1956); Erich Uhlmann (1901-1964); Alfred Marchionini (1899-1965); Philipp Keller (1891-1973).

Nevertheless, Marchionini was not disqualified completely. According to a letter of the Reich’s Ministry of Sciences, Marchionini, “because of the not purely Aryan descent of his wife, was not acceptable for a permanent position in a university within the confines of the German Reich. However, as a respected scientist he could have a lasting positive effect on German causes as professor at a foreign university.” In 1938, Marchionini received a call to the University of Ankara and went there, with permission of the Reich’s government, as the new director of dermatology. Marchionini stayed in Turkey for ten years. After his return to Germany in 1948, he was chairman of the departments of dermatology in Hamburg and later in Munich.

By 1936, 458 physicians had been dismissed from German universities for racial or political reasons, among them 23 dermatologists. Dermatology was the specialty from which the largest percentage of chairmen of university departments were removed. In the first three years of the National Socialist regime, this fate struck about 30 Jewish chairmen in all branches of medicine, among them men of renown such as Siegfried Thannhauser, professor of internal medicine and designated dean of the University of Freiburg, Martin Hahn and Carl Prausnitz, professors of hygienics in Berlin and Breslau, the physiologists Rudolf Höber, Hans Winterstein, and Bruno Kisch, the ophthalmologist Alfred Bielschowsky, and the gynecologist Ludwig Fränkel, to mention only a few. Among the extraordinary professors were pediatricians Stefan Engel and Heinrich Finkelstein, radiologists Franz Groedel and Ludwig Halberstaedter, surgeons Rudolf Nissen and Eduard Melchior, and internists Rachel Hirsch and Georg Klemperer. By 1939, 45% of all academic positions at the universities had been filled by new appointees.

The revolution at the universities instigated by the Nazis affected not only faculty but also students. The National Socialist Union of Students was much more active and radical than its counterpart, the National Socialist Union of Lecturers. At many universities, Jewish professors had to stop teaching, long before they were dismissed, because their lectures were disrupted by rowdy Nazi students. Nazi students also were particularly active propagandists on behalf of new anti-Semitic regulations. In Giessen, for example, the National Socialist Union of Students proclaimed, in leaflets and newspapers, that “Giessen does not want Jews.” All over Germany, a numerus clausus for Jews was demanded by the local student organizations of the party. This claim was aimed at medicine especially, not only because of the well-known inclination of Jews to medicine, but also because of a marked overall increase in the number of medical students during the last years of the Weimar Republic. From the summer of 1926 to the winter of 1932-33, the percentage of medical students within the universities rose from 13 to 26.2. Hence, in the view of the Nazis and their supporters, Jewish students came to occupy places that “Aryans” aspired to, an intolerable situation that had to be terminated. On April 25, 1933, shortly after enactment of the “Law for the Restoration of Professional Civil Service,” a numerus clausus was established that limited the percentage of Jews at the universities to the percentage of Jews in the general population. This numerus clausus, however, hid the real intention of the Nazis, appealing as it did to the instincts of the masses. The true objective was total exclusion of Jews from higher education and university life in Germany.

Within a few weeks after the Nazis assumed power, life changed dramatically for Jewish students and for students of Jewish descent. Fellow students suddenly excluded and provoked them, and professors discriminated against them in examinations. Suddenly the “Führer” was being glorified by famous scientists, who previously had mocked the Nazis, e.g., Robert Feulgen, who is known for the development of the Feulgen stain, a method for demonstrating chromatin and desoxyribonucleic acid. Feulgen, professor of physiological chemistry in Giessen, declared loudly and proudly that he would “throw everybody out of the lecture who does not support the Führer totally” (Fig. 24).

Fig. 24

Robert Feulgen (1884-1955).

Jewish students had to tolerate all kinds of humiliation. Some were attacked physically and were forced to return their student identification cards. “Aryan” students behaved hostilely to fellow Jewish students who were receiving financial assistance, in the hope of inheriting grants that had been awarded to them. Even before any government or university regulation had been handed down, “Aryan” students insisted that Jews pursue their studies in separate groups, as in a ghetto. At several universities, Jewish students were not allowed to enter the campus. The medical faculty of the University of Munich announced in February 1933 that “the Jewish students of medicine are advised, in their own best interest and in the interest of maintenance of peace and order in the lecture halls, to take their seats only after the lectures have begun. The first rows are reserved for other medical students. In case this well-meant advice is not heeded, we will be forced to resort to stricter measures.”

In Giessen, a newly enrolled Jewish student received a letter from a member of the faculty that read as follows: “Nothing stands in the way of pursuit of your studies in Giessen. Nevertheless, I consider it my duty to call to your attention that especially at our small university with its accordingly small tightly knit study groups, your participation as a non-Aryan might be much more difficult than at a middle-sized or large university.”

According to a decree that was issued on October 20, 1933, non-Aryan students of medicine and dentistry were excluded from “national duties” that were demanded as prerequisites for admission to examinations; most of them thus were deprived of the chance to complete their studies. Graduates who wanted to submit their dissertations to acquire the degree of “doctor of medicine” were informed that they would be denied diplomas. In 1934, these regulations were relaxed somewhat, when it was stated that Jewish medical candidates who made clear their intentions to move abroad would be eligible to receive their doctorates if they renounced their German citizenship. German-Jewish students were in a quandary: so long as they remained in the Reich, it was legally impossible for them to lose their citizenship, but, at the same time, they could not receive their degrees; if they wished to emigrate to take jobs abroad, they had to have their doctorates in hand as a prerequisite for a post, yet this was denied them inside the borders of Germany.

Because of this situation, the University of Basel offered Jewish graduates of German medical schools the opportunity to have their dissertations accepted there and to promote them officially if the dissertations were found to be satisfactory. One of those who accepted this offer gladly was Rudolf Baer, who 30 years later became chairman of the department of dermatology at New York University School of Medicine (Fig. 25). In 1934, after having passed the examination in Basel, Baer emigrated to the United States. Born in Strasbourg, which had been German before the First World War but was French after the war, Baer was allowed to enter the United States in the French contingent for immigration. At that time, the German quota for immigration already had been exceeded, and Germans usually had to wait for years to receive permission to immigrate to the United States.

Fig. 25

Rudolf Baer (born 1910)

Baer was one of the last Jewish medical students to have graduated in Germany. By the end of 1934, the number of Jewish medical students in Germany had declined from more than 2,000 to 263. By the spring of 1935, Jewish students had been completely excluded from matriculation and from sitting for examinations.

The radical changes at the universities, however, were not the only stroke against Jewish or politically unreliable physicians in Germany. For the majority of them, a decree that was issued by the German Ministry of Labor on April 22, 1933, was far more daunting. According to this edict, “the practice of insurance panel doctors of non-Aryan descent and doctors who have been active in communistic causes is now terminated. New admissions of such physicians to practice in the scope of health insurance will not happen any more.”

Professional organizations of physicians had to compile lists of colleagues to whom this decree applied, and they did this in a flippant way, especially in regard to accusations of communist activity. Many insurance panel doctors who were excluded by their own professional organizations were reaccepted by the Ministry of Labor (of 1,377 appeals submitted in the first months by the professional organizations, 550 were accepted). Furthermore, the decree did not affect Jewish insurance panel doctors who had seen front-line duty in World War I or who had established their practices before August 1, 1914. These “Hindenburg” clauses for exemption, adopted from the “Law for the Restoration of Professional Civil Service,” were fulfilled by many more insurance panel doctors than by physicians in the civil service, the reason being that insurance panel doctors, on average, were older than their colleagues in hospitals and in other public institutions. In some cities, including Munich and Stuttgart, relatively few Jewish doctors were affected; in Berlin, with its large Jewish population, more than half of the insurance panel doctors still were Jewish by 1935. Nevertheless, the lists of physicians excluded were long; by early 1934, more than 2,000 physicians could no longer work in the scope of health insurance, and thus they lost their bases of economic income entirely (Fig. 26).

Fig. 26

List in a Munich newspaper of medical practices that had been closed. Most of the names sound Jewish.

The situation deteriorated further subsequent to a decree issued by the Reichsführer of physicians, Dr. Gerhard Wagner, who, on August 10, 1933, forbade any cooperation between “Aryan” and “non-Aryan” physicians, including references, substitutions, and practices that were combined. Until then, linked practices were not rare. Karl Linser, for instance, after the war chairman of dermatology in Leipzig, practiced with Eugen Galewsky in Dresden. Karl Linser was “Aryan,” Eugen Galewsky (Fig. 27) was Jewish. When their union was forced to be dissolved, they informed their patients through the newspaper that this separation had been undertaken in friendly fashion. Because of this advertisement, Karl Linser was arrested for one day (Fig. 28).

Fig. 27

Eugen Galewsky (1864-1935)

Fig. 28

Karl Kinser (1895-1976)

Eugen Galewsky continued to work in Dresden until he died of a heart attack in 1935. In the last two years of his life, he was defamed as a “liquor Jew” because his father had operated a liquor factory. Galewsky was among the most prominent dermatologists in Germany. He and Joseph Jadassohn had been the first assistants of Albert Neisser in Breslau. Galewsky was known for having introduced cignolin (anthralin) for treatment of psoriasis in 1916.

When Hitler assumed power in January 1933, Galewsky was already 68 years of age. He had established his practice as early as 1891 and, therefore, was not affected by the new regulations concerning Jewish insurance panel doctors. As a highly esteemed specialist, he also had many private patients, which made him relatively independent of public health insurances. The situation of most of his younger colleagues was less favorable. When affected by the new governmental regulations, they lost most of their poorer patients, who were unable to pay bills without the aid of insurance. The numbers of private patients available to them also declined steadily because “Aryan” patients were put under intense pressure by governmental institutions and by employers who forbade their employees to visit Jewish physicians. Medical certificates were accepted only if they had been issued by “Aryans.” Patients who still attended their former Jewish doctors were threatened by storm troopers, as exemplified by a letter of a Special Agent of the Highest SA-command in Nuremberg that stated:

I came to know that you are under medical treatment of a Jew. But German citizens should attend only German physicians. The Jew is not a German. It shall also serve for your information that you receive your public benefits from the German people and not from the Jewish people, who only enjoy hospitality in Germany. I hope that this instruction will suffice to enable you to act as a German in the future. I shall conscientiously oversee the success or failure of my admonition and warning. In the case of non-observance, we will have to deal with this affair in a different manner. Heil Hitler!

As a consequence of such friendly, gracious, and gentle advice, Jewish physicians were forced out of practice. Even non-Jewish physicians who had Jewish-sounding names were in trouble, for example, Dr. Seeliger, an ophthalmologist in Munich, who placed ads in newspapers in an attempt to make clear to his patients his purely “Aryan” lineage. “Aryan” descent also could be indicated by a sign at the entrance of a practice that displayed the swastika and the words “Deutscher Arzt” (“German physician”) (Fig. 29).

Fig. 29

Deutscher Artz [German physician]

*The term “Jew” was used by the Nazis, without regard to religious belief, for anybody who had Jewish parents or grandparents. Therefore, many citizens who did not consider themselves to be Jewish at all were suddenly designated “Jews”. Among dermatologists, some , like Abraham Buschke, were observant Jews, while others, like Siegfried Bettmann, were professed Christians. In this chronicle, the latter are referred to as being “of Jewish descent.” However, the religious and cultural inclinations of many dermatologists who were classified as “Jews” by the Nazis are not known.

(For a comprehensive list of references, please contact the author.) From the Center of Dermatology and Andrology, Justus-Liebig-University, Gaffuystr. 14, 35385 Giessen, Germany. This article is one chapter of a book to be published under the same title.

References

1. Hollander A. The tribulations of Jewish dermatologists under the Nazi regime. Am J Dermatopathol 1983; 5: 19-26.

2. Holubar K, Wolff K. The genesis of American investigative dermatology from its root in Europe. J Invest Dermatol 1989; 92: 14S-21S.

3. Scholz A, Schmidt C. Decline of German dermatovenereology under the Nazi regime. Int J Dermatol 1993; 32: 71-4.

4. Schmidt C. Dermato-Venerologie im Nationalsozialismus – Die Neuordnung des Fachgebietes durch personelle Veränderungen im akademischen Bereich, in den Fachgesellschaften and Herausgeberkollegien der Fachzeitschriften. Dissertation zur Erlangung des Doktors eines Wissenschaftszweiges (Dr. med.) vorgelegt dem Wissenschaftlichen Rat der Medizinischen Akademie “Carl Gustav Carus,” Dresden, 1990.