The darkest days of a caring profession

In the Third Reich, nurses went from caring for patients to killing them. Claire Sanders finds out why

The history of the Holocaust has become sanitised," says Linda Shields, holder of the foundation chair in nursing at Limerick University.

"Everyone knows about the gas chambers. But they were just one part of the horrors carried out in the name of racial purity. And while the role of doctors has been recognised, the role of nurses has largely been ignored."

Alison O'Donnell, a nursing lecturer at Queen Margaret University College in Edinburgh, spells out the scale - and intimacy - of nurses' involvement in the National Socialist eugenics programme: "Nurses cradled children in their arms while they administered lethal injections; nurses in concentration camps tried to calm prisoners as they led them to the gas chambers; nurses assisted doctors in their experiments on desperate men, women and children; and nurses reported colleagues who did not notify the authorities when a child with a handicap was born," she says.

In June, Limerick will hold the first conference to examine the role of nurses and midwives in the Third Reich. "Complicity and Compassion" will look at how nurses went from caring for patients to killing them, and it will unite the small group of academics in the field for the first time.

For organiser Shields and for O'Donnell, the conference represents a landmark in nursing research. "Nurses are at last being encouraged to carry out research for themselves and set their own agenda. As nurses, we have a moral obligation to face the darker side of nursing," Shields says.

The ethical issues it raises are as pertinent now as they were 60 years ago. "Nurses have traditionally been taught to care for patients and, in the past, were taught to obey doctors. Today, nurses are taught to think autonomously, but ethical issues remain," Shields says. "Death nurses in the US insert the intravenous lines for administering lethal injections to prisoners. Is this ethical?"

Shields' interest in the era began with a visit to the Imperial War Museum in London. "It has a permanent exhibition on the Holocaust that contains a film of a nurse in a white uniform tenderly leading an elderly naked man to the gas chambers," she says.

Shields is a paediatric nurse by training. She began to read about the role of nurses in killing children with learning difficulties. "Long before the death camps at Chelmno, Belzec, Sobibor and Treblinka were built, the Nazis were killing their own citizens. As the science of eugenics took hold, it became acceptable to kill those considered 'unfit for life'," she says.

"People with schizophrenia, depression and other mental illnesses were killed. Children with conditions such as cerebral palsy and Down's syndrome were killed. Towards the end of the war, badly wounded soldiers were also killed. The de-sensitised nurses carrying out these murders saw them as mercy killings."

As Hitler rose to power after the depression and collapse of the Weimar Republic, many nurses joined the Nazi Party to keep their jobs. "In 1938, the Nazis passed laws defining nursing practice," Shields says. "Alongside the normal duty of care was a reference to the need to keep the Aryan race pure."

As the war took its toll, the killing became more widespread and acceptable. "Children in schools were told to calculate how much it cost to keep the unfit alive compared with soldiers on the front," she says. As morphine supplies ran out, children and other unfit people were initially killed with phenobarbitone or starved. As starvation was considered inefficient, other methods were developed. Buses with blocked windows were designed and the passengers killed with carbon monoxide. "Nurses would give the patients little packed lunches to reassure them," Shields says. "These designs were the prototypes for later forms of mass killing."

In the 1980s, Hilde Steppe, a German nurse and historian, began to carry out research into nursing in the Third Reich. "Steppe interviewed German nurses," Shields says. "It was very hard to get them to talk. But what emerged was a picture of women who believed that they were being kind, who felt it was often more merciful to kill the unfit than to let them live.

Above all, the nurses felt they were obeying orders."

This notion of obedience is crucial to O'Donnell's work. She has studied the role of nurses in the Hadamar Asylum near Limburg an der Lahn in Germany. "When the Americans arrived in Hadamar in 1945, locals pointed them to the asylum on the hill. There they found mass graves and uncovered evidence of a euthanasia programme going back decades," O'Donnell says.

The transcripts of the 1945 trial of a male and female nurse reveal that they strongly believed that they were merely carrying out orders. "The chief male nurse, Heinrich Ruoff, was hanged," O'Donnell says. "The chief female nurse, Irmgard Huber, was sentenced to 25 years' hard labour."

A third nurse, Pauline Kneissler, who worked for a time at Hadamar, was tried separately, sentenced to three years' hard labour and released after a year. As well as working at Hadamar, Kneissler was also suspected of killing badly wounded German soldiers in hospitals on the Russian front.

"The transcripts of this trial reveal that the doctors found Kneissler to be an excellent nurse," O'Donnell says. "There were references to her abilities to obey orders that might have troubled another person. Her desensitisation was seen as an asset."

O'Donnell says that she initially found this complicity very hard to understand. "But it has to be seen in the context of the society. The epitome of a good German nurse was to be subservient," she says.

Both O'Donnell and Shields are keen to stress that the June conference will also include the stories of nurses who saved lives.

Susan Mayer of the North Central Bronx Hospital in New York will talk about Jewish nurse Luba Bielicka-Blum, director of the Nursing School of the Jewish Hospital in the Warsaw Ghetto. "Bielicka-Blum was an incredible woman who practised when ethics in nursing were rarely even discussed," Mayer says. She was one of the first students to graduate from the school of nursing, and became director when the Germans invaded. "The school was moved into the ghetto and continued to train nurses," Mayer says.

"Many desperate Jewish parents attempted to get their daughters into the school, although they were really too young, in the hope that this might provide a way for their daughters to survive. The school could have been liquidated at any second and continued to function in the ghetto with no drugs, no food and daily roundups."

Bielicka-Blum stayed in Poland throughout the war - turning away passports at one time that would have meant she could have left. She survived, although her husband, a resistance fighter, died.

O'Donnell argues that one of the key messages of the conference will be that nurses cannot divorce their working lives from the world around them.

"In her book Nursing in National-Socialist Germany , Steppe wrote: 'We should accept that nursing has always had a political dimension, and we must discuss our own societal position, reflect it and partake in decision-making.' Steppe died five years ago, but it is that message that I will be taking to the conference."

"Complicity and Compassion: The first international conference on nursing and midwifery in the Third Reich" will take place at Limerick University on June 10-11.

Details: http:///www.nursingthirdreich2004.com/

POLISH PERSPECTIVE

When Stefania Hoch heard about the Limerick conference, she was determined to attend. Now in her early 80s, she says it is crucial that nurses relate their testimony of life in occupied Poland. Hoch, who with fellow nurse Barbara Dobrowolska is representing the Polish Nursing Association at the conference, was born to a middle-class family in Warsaw in 1922.

The Germans banned apprenticeship training during the occupation. But the Warsaw School of Nursing remained open. The school gave Hoch a "complete professional and humanistic education. It shaped professional and social attitudes, basing them on Christian values".

Hoch worked at the Warsaw school during the occupation. "We faced random arrests, raids, prosecution and food rationing. The director did her best to look after the nurses. This meant supplying them with a daily lunch. If one of the students was arrested, she would do everything to get them released from prison."

During the Warsaw Uprising, Hoch worked as a nurse in a field hospital and then in a military camp. "There were Polish doctors - prisoners - who looked after the sick with great care in spite of the lack of medical supplies," she says.