The small
step from
human being
to savage

Deported to Auschwitz from the Netherlands when he was in medical school, Louis J. Micheels wrote a book about his experience titled Dr. 117641. After the war, he immigrated to Westport, Conn., where he practiced psychiatry. He died in 2008, at 91.

Stealing bread was the worst crime anyone could commit, punished by often fatal beatings. Although in the hospital the debility of the victims precluded such retaliation, both staff and patients faithfully adhered to the edict that bread was a sacred possession. Ben, however, offered me his bread. That supposedly made accepting it legitimate, but it presented me with a terrible dilemma. I was very hungry most of the time and subject to the drive for self-preservation, a basic urge sanctioned among concentration camp prisoners. The step from human being to savage was but a small one. Yet those unable to avoid such a metamorphosis often could not survive. Therefore a close friendship took on enormous importance. Such a bond was essential as a protection against losing all traces of civilized behavior, and with them a true sense of hope and reason for survival. Although I did not feel such a bond with Ben, whom I did not know and who was barely alive, I could not take his food without an inner struggle. Even when he died a few days later and I did take a piece of bread I found under his mattress, I experienced a deep feeling of conflict.

Last medicine

Adina Blady Szwajger was a Jewish physician in the Warsaw Ghetto. Her memoir recounts her experiences as a pediatrician in the ghetto hospital. Szwajger escaped the ghetto in 1942 and survived in the resistance, then resumed her medical practice. She lived in Warsaw for the rest of her life. In this excerpt, she describes euthanizing patients with morphine as the Nazis close in on the hospital.

We went to the first floor where the families of staff were. And so that grey-haired lady smiled at me and stretched out her arm. The sister put on the clamp. And I injected the morphine into her vein. And then I saw a few more people who didn’t have the strength to move.

I asked Mira what we should do and she said: “Help them, surely.” So we helped them, too.

When I left the room, I held out my hand and got two large containers of morphine. I took the morphine upstairs...we took a spoon and went to the infants’ room. And just as, during those two years of real work in the hospital, I had bent over the little beds, so now I poured this last medicine in those tiny mouths. Only Dr. Margolis was with me. And downstairs there was screaming because...the Germans were already there, taking the sick from the wards to the cattle trucks.

A threat to the very life of the ghetto averted

Physician Elkhanan Elkes, head of the Judenrat in the Kovno Ghetto in Lithuania, went to great lengths, at great personal risk, to keep the ghetto Jews alive. Joel Elkes, his son, wrote the book Dr. Elkhanan Elkes of the Kovno Ghetto: A Son’s Holocaust Memoir after interviewing survivors of the ghetto who had known his father. Elkhanan Elkes died in Dachau in fall 1944.

Conditions in the ghetto favored the development of (typhoid) infection—crowding, hunger, open cesspools, etc. News of infection in the ghetto could have meant the instant destruction and burning of the ghetto just as the destruction and burning of the Infectious Diseases Hospital on October 4, 1941, had signified the Germans’ ruthless response to even the thought of contagious sickness among Jews.

A secret meeting, chaired by Dr. Elkes, was held. To his immense credit, Dr. Brauns (first name not given) undertook to control the infection. He did not report the existence of some known cases of typhus to the authorities. The disease was renamed “influenza,” and Dr. Brauns having obtained special allocations of food, soap, and nurses from the Council treated 70 cases; only three died, an extraordinarily low mortality for the condition. Neither the Lithuanians nor the Germans learned what had transpired. A threat to the very life of the ghetto had been averted.

Just to touch him…was horrible.

Of all the dilemmas faced by Jewish doctors in the Holocaust, one of the most troubling occurred when they were forced to weigh the ethics of treating Nazis. Elkhanan Elkes, a doctor and head of the Judenrat in the Kovno Ghetto in Lithuania, made the grueling decision to treat one of the most ruthless killers in the ghetto SS.

On July 16, 1943, SS Sergeant Major Schtitz asks Dr. Elkes to see him as a patient. Dr. Elkes examines him and prescribes medication. Afterwards Dr. Elkes (says), “This patient, whom destiny has forced me to check, is shocking in the extreme. Just to touch him—whose hands are covered with the blood of Jews—was horrible. Yet I suppose I did what I was meant to do. It may help to save lives.” Joel Elkes, the physician’s son, wrote the book Dr. Elkhanan Elkes of the Kovno Ghetto: A Son’s Holocaust Memoir after interviewing survivors of the ghetto who had known his father.

The elderly people fall easily

Born in Elberfeld, Germany, Philipp Manes and his wife were deported in 1942 to the Theresienstadt Ghetto, a stop on the way to Nazi death camps in the east. His account, As If It Were Life, was written as the Holocaust was unfolding.

Something always happens with 600 to 800 people gathered at the same place to receive food. The elderly people fall easily, sustaining both minor and more serious injuries. They may lose consciousness or cut themselves on broken crockery. There is one supreme law in the Theresienstadt Ghetto: take even the smallest injury seriously and seek treatment immediately. Vitamin deficiency, the monotonous, insufficient food the total lack of meat and food (after all, what good is one slice of sausage or meat to the body’s well-being?) affects the heating mechanism in humans. Someone who is organically healthy can manage on the amount of food rations. But the strength lost after illness is difficult to regain, even when the doctor does everything possible to help the patient get back on his feet. continue reading

The elderly people fall easily

Born in Elberfeld, Germany, Philipp Manes and his wife were deported in 1942 to the There sienstadt Ghetto, a stop on the way to Nazi death camps in the east. His account, As If It Were Life, was written as the Holocaust was unfolding.

Yet another danger threatened to bring severe hardship into the ghetto—lice and the dreadful fever, which brought back bad memories of Russia. At first, we laugh at the thought. What? We are civilized people. Lice? No, we are quite clean; we wash carefully, take care of ourselves, change our clothes, and take them off at night....The authorities in Theresienstadt worked tirelessly, as they usually did when there were big issues to resolve. The battle against the louse began.

Doctors who had been assigned to work only on this visited every house, barracks, and occupied space, unannounced. One had to undress. There was a full body search, including underwear, shirts, jackets. If anything was found the person had to go, with all his luggage, bedding, and mattress, to be deloused. Not only the person with the lice, but also the people in the neighboring beds had to walk the bitter path.

Among the Jews who survived the Nazi horror of Auschwitz was Gisella Perl, a gynecologist born in Transylvania in 1905. In interviews and in an unsparing memoir, Perl described her efforts to care for her fellow inmates when pregnancy among Jews was punishable by death. The doctor knew that at the Third Reich’s largest and most notorious concentration camp, the systematic execution of pregnant women was often preceded by grisly torture. To save lives, Perl, who the Jerusalem Post dubbed “the Angel of Auschwitz,” made choices that haunted her until her death in 1988, at 83.

Perl’s is one of 40 first-person accounts written by Jewish medical workers in concentration camps and ghettos and collected so far in an anthology-in-progress by Michael Grodin, a School of Public Health professor of health law, bioethics, and human rights. Grodin, founder of BU’s Project on Medicine & the Holocaust and a School of Medicine professor of sociomedical sciences and psychiatry, has been helped by researchers Rachelle Rubin (CAS’12) and Evelyn Liberman (CAS’12, SPH’13). The stuff of darkest nightmares, the texts shed light on a compelling facet of Holocaust studies—the ethical dilemmas faced by Jewish healers who struggled to save their own lives as well as the lives of fellow Jews. The material is, in Grodin’s word, overwhelming. But to read it is to understand that “there’s always the ability to make choices,” says Liberman.

“I worked on rescuers of Jews, on the righteous Gentiles, and I did some work on the perpetrators, the Nazi doctors,” says Grodin, who has been studying medicine in the Holocaust for three decades and has written or cowritten five books, including The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation, with George Annas, a William Fairfield Warren Distinguished Professor and chair of the SPH department of health law, bioethics, and human rights. “About seven years ago I said, ‘Where are the Jewish doctors?’”

With primary and secondary sources gathered from a wide range of testimonials as well as from archives of the United States Holocaust Memorial Museum, in Washington, D.C., and Yad Vashem, in Jerusalem, their story can now be told.

Grodin, a psychiatrist and a bioethicist, says the project goes beyond bearing witness, venturing deep into the moral belly of the beast, where self-preservation and altruism wrestle.

“It’s Sophie’s Choice, again and again,” Grodin says.

At Auschwitz, Perl refused to let the desperate nature of her surroundings defeat her. “It was up to me to save all the women at Camp C from this infernal fate,” she wrote, referring to a block that housed up to 30,000 women at a time. Perl taped up the expanding abdomens of some young women to hide their pregnancies and performed necessarily crude abor­tions on as many as 3,000, in the hope that the women’s survival would make possible the birth of more children.

She wrote of the arrival of Yolanda, a poor former patient who had once sought the doctor’s help to conceive. Now, here was Yolanda, transported from Hungary, her belly swollen nearly to term. Perl delivered the baby—a boy—in secret, on the foul floor of the camp toilet, with her bare hands and without a drop of water. Then she put Yolanda in the hospital with pneumonia, not one of the illnesses, like typhus, that was punishable by death under camp edict. At first she hid the baby, whose cries would have brought certain death for him and his mother and would have put an end to Perl’s clandestine efforts to save as many pregnant women as possible. “Then I could hide him no longer,” she wrote. “I took the warm little body in my hands, kissed the smooth face…then strangled him and buried his body under a mountain of corpses waiting to be cremated.”

“It’s Sophie’s Choice, again and again,”
says Michael Grodin, founder of BU’s
Project on Medicine & the Holocaust.

Through all of this, Perl, who witnessed the infamous Josef Mengele shoving pregnant women into the Auschwitz crematoria, believed that she was doing what medicine was meant to do. She was offering comfort, and, she hoped, saving more lives than she was forced to sacrifice. Stripped of the tools of her trade, from surgical implements and medicine to soap and water, Perl cared for women who “did not know that they would have to pay with their lives, and the lives of their unborn children, for that last, tender night spent in the arms of their husbands.”

Grodin’s team has gathered other stories, from the unspeakably grim to some affording a rare morsel of consolation. In her search for firsthand accounts, Rubin scoured lists of victims and survivors, with thousands identified as doctors or dentists. It will never be known whether, or how, most of them practiced some form of their profession, but it is known how little they had to work with. In 1939 Poland, for example, the Nazis closed down Jewish-run pharmacies; in the Warsaw Ghetto, Jews raised money so the Judenrat, the Nazi-appointed Jewish authorities, could buy the nine ghetto pharmacies run by Polish Gentiles. But supplies were increasingly meager, and the few hospitals permitted to function did so as bleak parodies of their former selves, without heat, electricity, surgical tools, anesthesia, or sterilization equipment.

Moral Ambiguities

Grodin, whose beard and yarmulke befit a descendant of three generations of rabbis, is a perpetual student of the ravages of genocide. He cares for 10 Tibetan monks who are torture survivors, as well as refugees from Rwanda, Cambodia, and the Balkans. But his discovery 20 years ago of an English translation of the Nuremberg Nazi Doctors’ Trial set him on a course of inquiry that led to books about doctors as perpetrators, followed by an examination of such rescuers as the righteous Gentiles in Hitler’s Europe.

Rachelle Rubin’s grand­parents were Holocaust survivors.

He knew of a few primary sources, including doctors’ accounts that were found in urns in the ruins of the Warsaw Ghetto, destroyed by the Nazis after a quashed uprising in 1943. And with the help of Rubin and Liberman, who received grants from the University’s Undergraduate Research Opportunities Program, and funds from the United Nations, the U.S. Department of Health and Human Services Office of Refugee Resettlement, the Holocaust Memorial Museum, Yad Vashem, and other sources, he combed through archives and private collections to put together a manuscript, now in search of a publisher and tentatively titled Ethical Dilemmas of Jewish Physicians and Allied Health Professionals in the Ghettos and Camps During the Holocaust.

Perl’s story—how she went from bringing life into the world to taking life in the name of salvation—was riveting to Rubin, whose four grand­parents, all native Poles, were Holo­caust survivors. Both her paternal grandparents and her maternal grandfather were in Auschwitz, and her maternal grandmother, who lost all of her family but one sibling, was hidden from the Nazis by her Gentile nanny. Rubin hopes to combine a law degree with her undergraduate majors in international relations, political science, and Judaic studies and lend her voice to the cause of international justice.

“I’d been to the camps; I thought I could handle anything,” says Rubin, who grew up in Manhat­tan and visited Poland on a senior trip with her Jewish high school. On a fittingly gray day during that visit, she stood in the preserved rubble of the Auschwitz block that had housed her grandfather, who was liberated from Birkenau at age 17. Although he generally distrusted the camps’ Jewish doctors, some of whom believed they had to dance with the devil to help fellow Jews, he attributes his survival to a Jewish doctor. A man so hated that he was hanged by fellow Jews after the war, this doctor certified that the severely weakened young man was “fit to live” after taking pity on his brother, Rubin’s great-uncle, who managed to remain with his younger brother and protect him throughout their ordeal. The moral ambiguities of the story haunted Rubin as she unearthed similar accounts of doctors whose predicament left them a single and seemingly impossible goal: to do more good than harm. “They felt a responsibility because of their profession; that’s what I found interesting,” says Rubin. “For others it was just out of the goodness of their hearts, but the reason these people gave that care was because they were doctors,” she says. “That set them apart.”

“I took the warm body, kissed the smooth face, and strangled him...”

What, wonders Grodin, would he do in their situation? “The doctors who tried to do whatever they could were faced with horrible dilemmas,” he says. “Do you treat one and let the rest die, or divide up the medicine so the chances of everyone’s survival is diminished? Do you report a case of typhus to the Nazi authorities, in which case the person is killed, or do you keep quiet and risk the person’s infecting everyone? How do you deal with pain and suffering?” When, in the ghastly calculus of concentration camp triage, is it the healer’s role to hasten death?

In his firsthand account, Warsaw Ghetto doctor Mordechai Lensky wrote about doctors who gave up hope, using their access to drugs to commit suicide.

“People working on these accounts found it really important to document that most people tried to do the right thing,” says Liberman, whose grand­father was a Holocaust survivor. “The silver lining is that there are moral people under all circumstances.” And while most people are aware of the Holocaust’s toll in an academic sense, “there’s not the emotional component, especially as survivors pass away,” says Liberman, who is studying English and health law, bioethics, and human rights. She hopes the 250-page manuscript will provide that.

Reflecting Humanity and Hope

Most accounts reflect the experiences of doctors, but there are entries about dentists, who were often given more food and better living conditions and forced to extract gold fillings from the Jewish dead. Benjamin Jacobs, who wrote The Dentist of Auschwitz: A Memoir, told of his revulsion at having to strip gold from the gaping mouths of corpses, and of trying to help his family and other inmates by sharing his extra rations.

So clouded was the moral compass that even in the midst of the Nazi slaughter, observant Jews went to their rabbis to resolve important questions, such as whether it was permissible to risk one’s life to save others, as well as more mundane pleas, like whether eating nonkosher food was acceptable. The rabbis themselves often disagreed. In one response included in Grodin’s manuscript, Lithuanian Rabbi Ephraim Oshry cited a Talmud passage in which a man comes before the Rabbah, saying, “The governor of my town has ordered me, go and kill so and so, saying if you do not kill, I will kill you.” Rabbah replied, “Let him rather kill you, but you may not kill the other man. Who can say that your blood is redder than his?”

Evelyn Liberman has found “moral people under all circumstances.”

Discussing the dilemmas, Grodin says, “I can imagine how it felt…” and catches himself: “No. I can’t imagine.”

The anthology’s Warsaw Ghetto accounts reflect something Grodin cites as a key to survival: humanity and hope. The ghetto, where nearly half a million Jews were incarcerated, was established in the fall of 1940. Roughly 800 doctors attempted to meet the confounding medical needs resulting from starvation, poor sanitation, and lack of medicine, electricity, coal for heat, and clean water.

Pediatrician Adina Blady Szwajger, who died in 1993, wrote about how the Germans forced quarantine under the pretext of a typhus outbreak, with patients and staff locked inside the hospital without adequate beds or food. “It brought the entire staff together to form a tightly knit unit which nothing would be able to tear apart,” she wrote.

As transports of Jews arrived from all over Europe, and growing numbers suffered from starvation, typhus, and tuberculosis, the doctors became persuaded that there was something they could do, if not for their patients, then for future generations. They conducted research on starvation, “the hunger disease,” obtaining blood samples and keeping meticulous records that were hidden before the ghetto was destroyed.

One of the texts describes how a Dr. Eisner and his colleagues at the Czyste Hospital weighed the ethics of a medical study of the hunger disease, “some way to document the Nazi brutality and at the same time show the dedication of the Jewish physicians working in the War­saw Ghetto….If these atrocities could be documented by solid scientific observation…maybe the rest of the world would believe they actually happened.”

Warsaw Ghetto medical student Isaac Malanovsky is quoted: “For just as Jewish culture must survive, just as writers, composers, and artists must be encouraged to create out of this experience, so Jewish medical science, perhaps the pinnacle Jewish achievement, must also create out of this experience.”

Rabbis were asked if it was permissible to risk one’s life to save others.

“One of the things that allows people to survive is contact,” says Grodin. “The fact that the doctors could maintain optimism, even if it was a charade, relates to that spark. It’s that sense of humanness that I think is an incredibly important element. It was a way of maintaining sanity and a sense of self.”

The ghetto study was rigorous and well documented, and it remains one of the most extensive clinical studies of starvation ever reported. Grodin says the doctors rushed to finish it as a mass deportation order went into effect, with the Nazis relocating 5,000 Jews a day. Just after the study was completed, one of its chief authors committed suicide with his family.

One of the most stirring docu­ments in the anthology is a letter by the physician Elkhanan Elkes to his children, who had been sent to safety in England. Elkes was head of the Judenrat of Kovno Ghetto, in Lithuania, which was divided into concentration camps and handed to the SS in the fall of 1943. “I am writing this at an hour when many desperate souls…are camping on my doorstep, imploring us for help. My strength is ebbing. There is a desert inside me. My soul is scorched. I am naked and empty. There are not words in my mouth.”

Elkes was eventually transported to a subcamp of Dachau, where he was placed in charge of what was called, with cruel irony, the camp hospital. He died in the fall of 1944 after a hunger strike, having refused to participate in the camp “selections.” True to his medical oath, even as the moral universe was turned upside down, Elkes, first and always, did no harm. ■

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On 27 May 2012 at 2:48 PM, Ester A. Malke (ENG’75) wrote:

I am a Jew. My two uncles - good doctors - refused to leave Minsk ghetto to treat Jew-haters partisans in order to care for Jews in ghetto. (Yes, dear, Jew-haters partisans who would shout a Jew, running away from ghetto outright - immediately).

They probably would survive the war. So I wish all Holocost deniers and emerging Nazi's. Let you get what we've got during WWII. Don't forget, 6,000,000 were exterminated, but 12,000,000 of Germans were killed by troops and bombings.

On 23 April 2012 at 3:29 PM, Gail Smith (COM’13) wrote:

While I am not of Jewish heritage, and have not met any Holocaust survivors personally, as one of Jehovah's Witnesses, I grew up learning about the suffering and persecution inflicted by the Nazis on both the Jewish community and members of my own faith. To me, the statement that “there’s always the ability to make choices,” despite the most unimaginably horrific circumstances, speaks volumes about that human ability toward “free will” within each of us. As my mother impressed upon me the importance of understanding and remembering this atrocity, I would be very interested in speaking with a Holocaust survivor, or one of their family members.

On 30 March 2012 at 11:05 AM, Rosemary Dreyer wrote:

What an incredibly powerful article. I look forward to reading the book. The horrors experienced cannot be fully imagined, but what light shines from those who lived with integrity during this nightmare.

On 29 March 2012 at 6:32 PM, Jack Kelley (CAS’66) wrote:

This article was both enlightening and confirmed the inhuman nature of the Nazi regime. Since graduation from BU in the mid60s I have interacted frequently with German scientists and physicians. Two experiences stick out in my mind. Firstly many professional Germans still deny the severity and scope of the Holocaust. Secondly given an opportunity the bellicose German culture would re-emerge and seek to dominate the world again. It's no accident that the U.S. Army still maintains high visibility in that country but this might not last forever.

On 12 March 2012 at 2:31 PM, Jessica (CAS’12) wrote:

I have to say, this article is haunting. I've read books about Nazi doctors ("Ordinary Men" and "Hitler's Willing Executioners" to be precise, although they're not exclusively about doctors) and the existence of Jewish doctors in the camps never occurred to me. I can't even comprehend the ethical conundrum Ms. Perl must have encountered, although it does make me think of many medical ethics problems that doctors encounter today, such as with euthanasia and other controversial practices. This article was captivating and eye-opening, and now I want to do more research into this topic as well.

On 8 March 2012 at 9:10 PM, Lyle Smith (SDM/GSDM’15) wrote:

Hello, I believe my mom sent a comment earlier. Dr. Perla actually delivered my mother in the New York. My grandfather was a dentist in the holocaust and I have heard many stories about him saving lives, removing gold fillings, and splitting his rations similar to the stories above. I am now in the BU dental school and a large influence on my choice for this profession was my grandfather (who I never met, but he did survive). My nana who is still alive today has told me many stories and if you would like to speak to me or someone in my family about anything we can do to help please feel free to ask me.

On 8 March 2012 at 1:59 PM, Mitch Cohen (COM’59) wrote:

I always think that the horrors of the holocaust that I have just finished reading will be the end of the stories of the hurt. It never ends. It just never ends.

On 8 March 2012 at 11:40 AM, Arleen Smith wrote:

My son is an alumni & I picked up the latest issue of Bostonia. My parents are Holocaust Surivors, so the article "First Do No Harm" caught my attention. I was thrilled to see Dr. Gisella's Perl's submission, especially as she was my mother's doctor in NYC and actually delivered me & was then my doctor as well. My father also practiced as a dentist in Auschwitz, working on Nazi officers as well as being responsible for extracting gold teeth from corpses. My mother is still alive and living in South Florida.

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