CHAPTER ONE

The Nazi War on Cancer



By ROBERT N. PROCTOR



Princeton University Press

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Hueper's Secret





Of course! There is a great deal being done for cancer research in Germany. In every part of the Reich there are magnificent institutes, for which the Führer has provided large sums of money.

Adolf Butenandt, Germany's postwar president of the

Max Planck Gesellschaft, in a 1941 radio interview





On September 28, 1933, Dr. Wilhelm Hueper, chief pathologist at the University of Pennsylvania's Cancer Research Laboratory, wrote to the Nazi minister of culture, Bernhard Rust, inquiring into the possibility of an academic or hospital appointment in the new Germany. Hueper had emigrated to the United States in 1923, and we know from his unpublished autobiography that he had worn the swastika on his Freikorps helmet as early as 1919. Now, only months after the Machtergreifung (Nazi seizure of power), the young pathologist was petitioning Nazi authorities to allow him to return to Germany to restore his bonds to German culture ( deutsches Volks- und Kulturgut).

It is not always easy to distinguish between conviction and opportunism in such matters. And though the distinction may not be as crucial as we like to think, Hueper's apparent support for the Nazi regime (he ends his letter with an enthusiastic "Heil Hitler!") still comes as a shock to anyone unfamiliar with the political landscape of European cancer activism in the 1930s (see fig. 1.1). The story is a disturbing one, one that seems to violate some of our most cherished political prejudices. Hueper, after all, went on to become "the father of American occupational carcinogenesis," the man who tried to alert medical officials to the hazards of unventilated uranium mining, and the man who, more than any other, brought the cancer hazards of pollutants in our food, air, and water to scientific attention. Hueper was the guiding light behind the ominous cancer chapter in Rachel Carson's Silent Spring (titled "One in Every Four"), and it was Hueper who, only months before his death in 1979, was showered with honors for his work on occupational and environmental cancer.

How could the hero of Silent Spring have found hope in the Nazi movement? What were German fascists saying and doing about cancer that might have led a man such as Hueper to bet his future on the Thousand Year Reich?





TRIUMPHS OF THE INTELLECT





A great deal is known about science and medicine in the Nazi era. We know that while certain kinds of science were destroyed, others flourished. Sciences of an applied nature were especially encouraged, as were sciences that fit within the larger program of Nazi segregation and extermination. We know that physicians joined the Nazi party in very large numbers, that about 60 percent of all biologists joined the party, and that roughly 80 percent of all professors of anthropology—most of whom were physicians—were members. We know that the Nazi regime maintained a large medical surveillance capacity, as part of its program to "improve the strength of the German nation"; we know that there is a curious blend of the modem and the romantic in Nazi culture—a blend Jeffrey Herf has characterized as "reactionary modernism."

Part of our story has to be understood in light of the fact that Nazism took root in the world's most powerful scientific culture, boasting half of the world's Nobel Prizes and a sizable fraction of the world's patents. German science and medicine were the envy of the world, and it was to Germany—the "land of scholars and poets"—that many academic hopefuls flocked to cut their scientific teeth.

The Third Reich itself cannot be thought of as an icebound retreat into intellectual slumber: think of television, jet-propelled aircraft, guided missiles, electronic computers, the electron microscope, atomic fission, data processing, industrial murder factories, and racial research—all of which either were first developed in Nazi Germany or reached their high point at that time. (The recent sci-fi film Contact, based on Carl Sagan's novel, reminds us that the first television broadcast strong enough to escape the planet featured Hitler's speech at the opening of the 1936 Berlin Olympics.) There are innovations in the area of basic physics (nuclear fission, discovered by Otto Hahn and Lise Meitner in 1938), hormone and vitamin research, automotive engineering (the Volkswagen was supposed to be the "people's car"), pharmacology, and synthetic gasoline and rubber (I. G. Farben in 1942 controlled more than 90 percent of the world's synthetic rubber production). The nerve gas sarin and the chemical warfare agent tabun are both I. G. Farben inventions of Third Reich vintage—as is the opiate methadone, synthesized in 1941, and Demerol, created about this time with the name "pethidine."

There are many other examples. Nazi aeronautic engineers designed the first intercontinental ballistic missiles—never actually assembled—and it was Germans in the 1940s who built the first jet ejection seat. German engineers built the world's first autobahns, and the world's first magnetic tape recording is of a speech by Hitler. American military leaders knew that German scientists had not slept through the Hitler era, and after the war commissioned dozens of leading scholars to write book-length summaries of their fields, a veritable Encyclopedia Naziana with entries on everything from biophysics to tropical medicine. It is interesting what fields they chose to ignore: occupational health and antitobacco research, for example.

It is therefore surely not enough to say that the human inventive spirit was suppressed or even that it survived as "pockets of innovation" immune to Nazi influence. The story of science under German fascism must be more than a narrative of suppression and survival; we have to find out how and why Nazi ideology promoted certain areas of inquiry, how research was turned and twisted, how projects and policies came and went with the movement of political forces. If we find that certain sciences flourished, we then have to ask: What was science that it so easily adapted to fascist politics?

Little has been written on Nazi cancer research and policy, and there are interesting reasons for the neglect. Historians who have focused on Nazi medicine have tended to concentrate either on political and racial ideology, or on the complicity of physicians in Nazi campaigns of sterilization, segregation, and medicalized killing (e.g., the "euthanasia" operation). These deadly aspects of medicine under fascism are far better known than many other aspects—addiction or vitamin research, for example—that were also woven into Nazi ideology. Public health professionals have paid little attention, both because of the distance of history and because little might appear to be gained by pointing to Nazi success in fighting food dyes, tobacco, or occupational dust. The forgetfulness is especially strong in Germany itself, where the predictable ahistoricity of cancer researchers is compounded by their unstudied aversion toward anything that went on in the 1930s and 1940s. Nazism, for many Germans, is still a dirty word.

The topic is sobering, given that Nazi health activists may well have developed the most aggressive and successful cancer prevention program of the era. This should not be too surprising, since German cancer research—and medical research more generally—was the most advanced in the world by the time of the Machtergreifung (1933). German scientists were the first to discover skin cancers caused by coal tar distillates, and the first to show that uranium mining could cause lung cancer (both in the 1870s). Germans were the first to identify a bladder cancer hazard of aniline dye manufacture (in 1895), a lung cancer hazard from chromate manufacture (1911), and a skin cancer hazard of sunlight exposure (1894). German physicians were the first to diagnose an X-ray-induced cancer (in 1902) and the first to prove, by animal experimentation, that X-rays could cause leukemia (1906). They were even the first to suggest that domestic indoor radon might prove to be a health hazard, in 1907.

There are many other examples one can name—and in the interest of completeness (and at the risk of tedium), I shall continue. Johannes Müller in the 1830s pioneered the microscopic analysis of malignancies, identifying tumors as composed of cells, and Rudolf Virchow in Berlin in the 1860s developed the theory of cancer as caused by local "irritations." Germans were pioneers of cancer transplant research, and early in the development of the theory of dose-response latency (Latenzzeit). Germans were among the first to propose a major role for hormones in carcinogenesis and were early on aware of what is sometimes today called the "xenoestrogen hypothesis"—the idea that powerful petrochemical carcinogens such as methylcholanthrene may work by mimicking the body's natural hormones. It was a Munich pathologist (Max Borst) who first classified tumors according to their histogenesis, the method used today by the World Health Organization to classify cancers.

The list goes on: Germans were the first to utilize tissue stains as chemotherapeutic agents (in 1922), and were the first to inject thorotrast (thorium dioxide) into patients to improve the contrast in X-ray photographic plates (1928). German geneticists were the first to show that colon cancer could be inherited as a dominant trait, and it was a German zoologist—Theodor H. Boveri—who first proposed that chromosomal abnormalities might be responsible for the onset of malignancies (1902). Germany was the site of the first international congress of cancer research (Heidelberg and Frankfurt, in 1906) and the first country to establish a permanent journal devoted exclusively to cancer research. Germany pioneered the optical diagnosis of cancer, being home to the development of not just X-rays and the colposcope but also the rectal endoscope—a candlelit version of which was introduced in Frankfurt in 1807. German was arguably, at least for a time, the language of international cancer research: in 1915, for example, when Katsusaburo Yamagiwa and Koichi Ichikawa announced their experimental production of coal tar cancer in laboratory animals, they published it auf Deutsch. Germans were also apparently the first to suggest that secondhand tobacco smoke might be a cause of lung cancer—in 1928.

German scientists in the mid-1930s elaborated on this scientific base. The Reich Anticancer Committee (Reichsausschuss für Krebsbekämpfung) established in 1931 was enlarged, and an ambitious new journal, the Monatsschrift für Krebsbekämpfung (Monthly journal for the struggle against cancer), published by the notoriously antisemitic J. F. Lehmann publishing house, was launched in 1933 to coordinate the anticancer effort. More than a thousand medical doctoral theses explored cancer in one form or another in the twelve years of Nazi rule; only diseases of the blood attracted more attention. Cancer registries were established, including the first German registries to record cancer morbidity (incidence) and not just mortality (deaths). Efforts were made to strengthen prevention-oriented public health measures, including occupational safeguards, laws against the adulteration of food and drugs, bans on smoking, and programs to reduce the use of cancer-causing cosmetics, to name only a few.

Could Nazi anticancer measures have influenced postwar German cancer rates? The question is intriguing, given that Germany shows a fairly clear-cut decline in overall age-adjusted cancer mortality since the 1950s, when one would first expect the policies and practices of the 1930s to show up in cancer mortality and morbidity statistics. It is also possible, though, that measures taken with the goal of improving general health—the support for female athletics, for example, or the campaign to increase the consumption of whole-grain bread—may have had unintentional anticancer consequences. Other steps taken in consequence of Nazi goals may have had anticancer effects—the pronatalist movement, for example, which increased the number of women having babies and lowered the average age of conception—though the biggest factor of all may have been the war itself, as tobacco rationing and low-fat, near starvation diets became the order of the day, along with other "lifestyle" changes now known to reduce cancer risk.

How does one interpret such possibilities? Could one of the most murderous regimes in history actually have succeeded in lowering cancer rates for certain segments of its population? Who benefited from such policies and who suffered?





"THE NUMBER ONE ENEMY OF THE STATE"





The strength of German interest in cancer must be understood in light of the fact that Germany by the beginning of the twentieth century was a wealthy, highly industrialized nation with one of the highest cancer rates in the world. German labor unions and socialist parties had begun to emphasize occupational health and safety in the final decades of the previous century, an era of dramatic innovations in social medicine—including the world's most elaborate social welfare system, launched in 1883 in response to socialist demands. German medicine was powerful and politicized, and Berlin was one of the world's strongest centers for medical research. Germany also had a strong "back to nature" ( Lebensreform) movement that saw cancer as an unhealthy expression of the distance humans had traveled from their organic origins. Given that the insurance bureaucracy saw prevention as more cost-effective than curative medicine, it is perhaps not surprising that Germans in the 1930s took steps to combat cancer.

The kinds of cancers focused on must also be understood against the backdrop of Germany's unique professional, ideological, and technological history. Aniline dye cancer was discovered in Germany in the 1890s, largely because Germany by this time was the world's leading producer of synthetic colorings. German professional societies were the first to establish informal standards for radiation protection, not just because X-rays were discovered in Germany, but also because the professional societies in that country were large and influential. Germans were early to perceive the cancer hazards of tar, asbestos, and radium, prompted by the strength of the union movement and the political parties representing workers' interests. (Germany was the first nation to recognize lung cancer as a compensable occupational disease for uranium miners—in 1926—and by 1934 was the envy of American industrial toxicologists wanting to emulate its practice of closed-system manufacture to prevent dye-related bladder cancer.) Germans formed organizations to combat alcohol and tobacco, because these were seen as violating the organic integrity of the German body—a concern that informed both the racial hygiene and Lebensreform (organic health) movement.

Recognition of a steadily growing cancer incidence was one reason German physicians launched the world's first state-supported anticancer agency, the Central Committee for Cancer Research and Cancer Combat (Zentralkomitee zur Erforschung und Bekämpfung der Krebskrankheit), founded in 1900. Increasing cancer rates had been observed in Germany since the end of the nineteenth century, and by the 1920s these escalating rates had become a major scandal. Cancer surpassed tuberculosis as the nation's second-most common cause of death in 1928; cancer was declared "the number one enemy of the state" (Staatsfeind Nummer Eins), surpassing even the major form of heart attack. (All forms of heart attack combined, however, were still the number one cause of death.) A hundred thousand Germans died of cancer every year in the 1930s; another half a million lived and suffered with the disease. Germany by this time had one of the highest cancer rates in the world—owing to the longevity of its populace and its cancer-inducing habits—and one of the most elaborate medical organizations struggling to deal with it. It also had a health-conscious political party with unprecedented police powers allowing it to combat the growing threat.

One of the more arresting features of the Nazi anticancer effort was its emphasis on prevention. Prevention fit with the Nazi approach to many other problems: racial hygiene, for example, was supposed to provide long-term care for the German germ plasm, by contrast with more traditional social or personal hygiene. The emphasis was not, of course, entirely new: socialist and communist physicians had long stressed prevention, and Nazi physicians could even cite Plato's admonishment that "care of the body" was better than the healing art, since "the former makes the latter superfluous." The Weimar period saw several important moves in this direction, reflected in the establishment of statistical offices, propaganda campaigns to stress early detection, and legislation to protect occupational health and safety. What was new in the Nazi period were augmented police and legislative powers to implement broad preventive measures, and the much-touted "political will" to deploy those powers to strengthen the health of the nation.





ERWIN LIEK AND THE IDEOLOGY OF PREVENTION





The Danzig surgeon Erwin Liek (1878-1935) was one of the more vocal heralds of the Nazi approach to cancer. Liek is a complex and fascinating person whom we shall reencounter in our discussion of Nazi food fashions (see chapter 5). He is widely reviled today as the "father of Nazi medicine"; yet he was also a cosmopolitan world traveler who managed to publish kind words of praise for Freud as late as 1934. In his thirty-year professional career he produced writings on a broad range of topics—including a stirring attack on overzealous human experimentation—but he was best known for his critique of the "spiritual crisis" of modern medicine, medicine enervated by specialization, bureaucratization, and scientization, warped by greed and myopia but also by its failure to appreciate the natural capacity of the body to heal itself. Liek was a hands-on practitioner but also something of a romantic, yearning after simpler times when science was not the be-all and end-all of medicine, when the doctor-patient relationship was (purportedly) intimate and sacred. As founding editor of Hippokrates, a magazine of general health interest with strong ties to homeopathy and the natural foods movement, he helped to usher in a broader and more holistic medicine of the sort embraced by many Nazi leaders—medical men like Kurt Klare, Karl Kötschau, Walter Schultze, and Ernst Günther Schenck, but also high-placed politicos like Heinrich Himmler, Julius Streicher, Rudolf Hess, and even Hitler himself.

Liek is difficult to pigeonhole, however, and his attitude toward Nazism was, at least for a time, ambivalent. He never joined the party but was nonetheless apparently offered—prior to 1933 and by Hitler himself—the position of Reich Physicians' Führer (eventually assumed by his admirer, Gerhard Wagner; Liek's failing health precluded his appointment). By 1933 he was clearer in his praise for the Nazi movement. In an essay that year titled The World of the Physician, he applauded Hitler for "destroying Marxism, rejecting the delusions of equality (Gleichheitswahn), defeating the party system, silencing the do-nothing chitchat parliament ( Schwatzparlament), unifying the German people, reducing unemployment," and much else. Nazism represented the "dawn of freedom" (Aufbruch zur Freiheit) and the cleansing of Germany's "Augean stables."

There is little evidence of overt antisemitism in Liek's many published works, but there are oblique insinuations that are hard to misinterpret—his assault on analytic laboratory methods, for example. Even his attack on human experimentation has an antisemitic resonance, given the degree to which "Jewish excesses" in this area had been publicized. (In the most notorious case, the dermatologist Albert Neisser in 1895 had injected young prostitutes—the youngest being only ten—with a syphilis serum, hoping to confer immunity; many instead contracted a full-blown case of the disease, prompting a widespread debate on the ethics of human experimentation and the world's stiffest restrictions against experimental abuse—Prussia's famous 1900 Code.) We know that he privately lamented the "jewification" (Verjüdung) of German medicine—in letters to his close friend and publisher, Julius F. Lehmann, for example—blaming Jews for overvaluing exactitude and for bringing a certain superficiality and "showmanship" into science. Liek became friends with the Munich-based Lehmann, Germany's leading medical publisher and an ardent Nazi, after Lehmann printed his first and most successful book, Der Arzt und seine Sendung (1926), which went through many editions and sold more than a hundred thousand copies (mostly after 1933). Liek professed to sympathize with the publisher's concern for "the frightening influence of the Jews" in medicine; he agreed that the "Jewish-dominated Weimar Republic" was an era of "spiritual poverty," and hoped that the nation's new leaders would resurrect German honor, morality, and selflessness. Liek's wife later praised him as an "early struggler for Nazi ideals." He might more properly be described as a kind of medical Nietzsche, Germany's Frederick Hoffman, if not its Rachel Carson (for his critique of environmental degradation).

Liek wrote two books on cancer. In his 1932 volume on "The Spread, Prevention, and Control of Cancer," the Danzig surgeon argued that cancer was a disease of civilization, a "cultural disease" whose incidence was on the rise. A natural way of life was the best protection: "the simpler and more natural one's way of life, the rarer is cancer." Liek endorsed the view that cancer was rare among the primitive races of the world, a view dating back at least to the 1840s and subsequently upheld by people like Frederick Hoffman, the American insurance agent, and Vilhjalmur Stefansson, the Arctic explorer. Lick was convinced that the growth of cancer could be traced to things like arsenic pesticides, artificial fertilizers, excessive smoking and drinking, and sexual promiscuity. People were getting too many X-rays, and stress from the rapid pace of modern life was weakening our overall bodily resistance, making us vulnerable to cancer.

Faulty nutrition, in Liek's view, was the single most important cause of cancer. Japan's high rate of stomach cancer, for example, must have something to do with their consumption of "enormous quantities" of spicy foods, compounded by their infrequent consumption of meat. In Germany, the pumping of massive quantities of petrochemical preservatives and colorings into foods must play a role. Vegetables, Lick complained, were too often "greened" with copper sulfate (one hundred milligrams per kilogram was the legal limit in his day), while sugar was routinely "blued" with a dye known as "ultramarine" (a sulfated sodium aluminum silicate—later replaced by the coal tar derivative indanthrene). Bread was regularly bleached with benzoyl peroxide after many of the natural vitamins and fibers found in traditional whole-grain breads had been destroyed by overprocessing. All of these things, in Liek's view, contributed to the cancer burden.

In his second book on this topic—The Struggle against Cancer, published in 1934 Lick admitted exaggerations on the part of some food critics. He did not believe, for example, that aluminum pans were a cause of cancer (a near-hysterical fear in the late 1920s), and he questioned whether the dangers of lead or mercury had been exaggerated (fears of poisoning from dental fillings had already begun to be raised). He also corrected certain errors in his 1932 book—that raw sugar was superior to refined, for example, and that the most common "blueing" agent of sugar was a coal tar derivative (the coal tar product was introduced later). The larger point was still valid, however, he maintained: cancer could be prevented. If lifestyle degradations were behind the increase, then lifestyle changes could reverse the trend. What was needed was a reorientation of medicine from cure and care to prevention: Fürsorge and Nachsorge (comfort and care) were to be complemented by an increased attention to Vorsorge (taking precautions).

Liek was well aware that powerful financial interests would resist efforts to remove carcinogens from the environment—suppliers of alcohol, food products, and pharmaceuticals, for example, who made it their business to convince the public that beer was food, that tin cans were a convenience, and that Brand X toothpaste would fight cavities. He pointed out that resistance was to be expected from such companies; he also pointed out, though, that new political winds were blowing which might change all this. (He doesn't actually mention Nazism, but that is clearly implied). It had taken ten years for his critique of surgery to be taken seriously, he says, but his cancer complaints were likely to gain a sympathetic hearing sooner. Universities (e.g., the University of Vienna) were establishing cancer clinics featuring dietary therapeutics, and cancer journals (e.g., the Zeitschrift für Krebsforschung) were recommending nutritional expertise as a requirement for directors of German cancer clinics. Germans were preparing, he says, to move from "care for the individual" to "cancer prevention on a large scale—for the entire people."

Liek's was not the only voice from the political right-of-center advocating prevention. A broad range of Nazi officials—from Gauleiter Julius Streicher to Reich Health Führer Leonardo Conti—championed a renewed focus on preventive medicine. The Monatsschrift für Krebsbekämpfung adopted the motto: "The earlier a tumor is treated, the better the likelihood of a cure." The Zeitschrift für Krebsforschung announced that "prevention is the best therapy." The ideology of prevention merged with the ideology of "one for all and all for one" (Gemeinnutz geht vor Eigennutz) that was yet another hallmark of Nazi thought: as one anti-tobacco activist put it, nicotine damages not just the individual but the population as a whole.

Cancer prevention also fit with the Nazi emphasis on nature and natural modes of living. Hitler, we should recall, was a vegetarian and did not smoke or drink; nor would he allow anyone else to do so in his presence—excepting the occasional woman. (As already noted: Benito Mussolini of Italy and Generalissimo Franco of Spain were also nonsmokers, a point not lost in Nazi health propaganda; attention was also drawn to the fact that Roosevelt and Stalin smoked cigarettes, while Churchill smoked cigars.). Vegetarianism got a boost: more than one writer for Hippokrates revived Friedrich Beneke's nineteenth-century recommendation that cancer patients adopt a vegetarian diet. Karl Kötschau, professor of "organic medicine" at Jena since 1934 and chief spokesman for the natural healing movement, launched a tirade against the lead arsenate pesticides used on wine grapes, and Weimar-era worries over the health effects of lead from water pipes and toothpaste tubes were revived. Efforts were made to control food additives and to limit the oversalting of prepared foods.

This emphasis on a return to nature led to some curious alliances. German Seventh-Day Adventists with their theology of health reform endorsed the regime in the summer of 1933, rejoicing in the fact that the nation was now in the hands of a man "who has his office from the hand of God, and who knows himself to be responsible to Him. As an anti-alcoholic, non-smoker, and vegetarian, he is closer to our own view of health reform than anybody else." The Adventist stress on temperance and healthful living seemed to fit with the new swing of things, though their aversion to pork must have raised some eyebrows. The sect was banned on November 26, 1933, and it took some clever politicking by its leader, Hulda Jost, to produce a reversal.

Homeopaths likewise joined with Nazi enthusiasts to argue that mercury could cause memory loss and that arsenic could cause depression. The homeopathic stress on the potency of rare (or absent!) trace elements fit well with the idea that powerful bodily disturbances were likely to come from our surrounding ourselves with exotic substances like mercury, lead, and arsenic. The idea of prevention fit well with this notion that health could be restored by avoiding exposure to rare but powerful agents corroding the German Volksköper.

(Continues...)