Forty-four pencil drawings on the backsides of a shop order book are all that remain of the life of Wilhelm Werner. But his artistic response to the forced sterilisation programme he underwent in Nazi Germany, a bundle of leaves flimsily held together in a worn leather cover, is receiving growing recognition in the art world almost eight decades after his death.

The detailed sketches, like scenes from a puppet show, are believed to be the only works of art by one of the 400,000 people who suffered forced sterilisation under the Nazis’ programme to eliminate “undesirables”.

The sketch book is to be the focal point of a major permanent collection of so-called outsider art – at the Prinzhorn gallery in Heidelberg, southern Germany from May.

“These drawings are immensely precious both historically and artistically,” says Thomas Röske, art historian and director of the Prinzhorn, which owns Werner’s drawings in its collection of 6,000 works by patients of psychiatric institutions, dating back to 1840 and the largest of its kind in the world.

“Most work produced by patients was destroyed during the Nazi period,” he says.

Facebook Twitter Pinterest Pencil drawing by Werner. Photograph: Prinzhorn gallery

That Werner’s works survived, he believes, is nothing short of a miracle. “There are some writings and poems of patients from this era but as far as we know no drawings.”

An administrator at the Werneck asylum in southern Germany where Werner spent most of his life saved the book, regularly showing it to friends, and when he died several years ago his family sold it to the Prinzhorn.

Marc Steene, director of Outside In, a UK-based charity that aims to provide a platform for artists largely excluded from the art world because of health, disability or social reasons, encountered Werner’s works for the first time three years ago during a research residency at the Prinzhorn.

“There’s an awful normality to Werner’s drawings,” he says. “They are a potent mix of what was happening to him and what he created out of that. He is like the director of his own awful play.” He included two sketches in a show he curated at the Lightbox in Woking, The Outside and the Inside. The works of Werner have a particular poignancy, he says, viewed in the context of the many pieces of art by institutionalised artists that are often destroyed.

Facebook Twitter Pinterest Pencil drawing by Werner. Photograph: Prinzhorn gallery

“I worked at a care centre in Brighton 30 years ago where I was struck by the artistic intuition and talent of those who came there. When I went back to get some of the works framed, I was told they had been pulped,” Steene says. “The reality is that most works produced by people in similar situations ends up in landfill sites, deemed worthless.”

Röske says that many medical files from before and during the Nazi era document the fact that patients often worked artistically. “Typical are comments by doctors in their notes, that say: ‘he or she makes nice drawings’,” he says. “But the thought of keeping them was rarely considered worthwhile.”

Werner’s drawings are all that remain of his existence. It is only due to strict German bureaucracy that the scantest of details about his life are known.

Born on 18 September 1898, he was without a profession, unmarried, Catholic and diagnosed with idiocy. Analysis of his drawings suggest he was probably left-handed. But there is no birth certificate, no photograph and his medical file has been lost, probably destroyed. There is only the registration number HHSTAW Abt.631a, Nr 1645, assigned to him at the age of 42, when he was in a group of 143 people – mainly women – who were transported to Pirna Sonnenstein asylum near Dresden on 6 October, 1940 and murdered in its gas chambers as part of the Nazis’ “Action T4” extermination programme.

Facebook Twitter Pinterest Pencil drawing by Werner. Photograph: Prinzhorn gallery

Röske’s attempts to discover more about Werner took him back to the town of Nordheim am Main, where he had lived with his mother in the poorhouse. Residents there still remembered talk of the boy who was “not right in the head”, and who was forbidden to play with younger children, he says.

“But we have found nothing to back up the diagnosis of idiocy,” Röske added. “That would mean a mental age of two to four, whereas we have here someone who was able to write (some of the drawings are annotated), who had an imagination and developed an individual way of telling his story. It’s clear that drawing was his world and he had developed a style and had inhabited that world for a long time.”

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The drawings show scenes from the clinic, including meetings between doctors and nurses. Round clowns depict the patients as they undergo surgery or juggle testicles. The nurses smoke, with swastika bands around their arms as they handle the patients’ testicles. Twice, Werner refers to a Dr Weinzierl. Hans Weinzierl was head surgeon in a hospital in Schweinfurt where compulsory sterilisations were carried out, even though there is no evidence that he was involved. Although the artist’s sympathy is clearly with the patients, the pictures are often ambiguous, Röske says, with “the authority figures exuding an air of matter-of-fact authority”.

Werner also depicts sterilisation as a literal castration, Röske says, whereas the Law for the Prevention of Genetically Diseased Offspring only stipulated that patients should be made infertile. “But he seems to have understandably viewed the surgery as a brutal emasculation,” Röske says, “hence his frequent use of the motif of removed testicles and drawings of the sterilisation instruments, as he imagined them.”

In arguably his most striking drawing, entitled The Triumph of Sterelation (as he referred to sterilisation), Röske says it is still not clear to him if Werner was “maybe being sarcastic or trying to develop a humouristic fantasy about suffering for a ‘good cause’”.

The drawing shows inmates of the clinic being transported on a bus decorated with swastika flags while on its roof a nurse displays two testicles on a plate. “He might well have been aware of the propaganda vehicles that drove through Nazi Germany advertising the party’s slogans and could well have been referencing them,” Röske says.

On the inside of the book cover, Werner refers to himself as an “orator of the people” and a “theatre director”.

Steene says: “It’s rather wonderful. He knew that he was speaking up for so many back then. He’s still doing so now.”