Medical Ethics in Germany Before 1933

Stricter Guidelines and More Protections Than the Nuremberg Code

Sep 10, 2009

The Nuremberg Code (1947) is considered the starting point for human experimentation ethics, but strict guidelines and medical regulations existed in Germany before 1933.

The crimes perpetrated by National Socialist (Nazi) physicians from 1933 to 1945 raised numerous issues concerning medical ethics. On August 19, 1947, the Military Tribunal felt it necessary not only to render a final verdict, but also to set forth “certain basic principles [that] must be observed in order to satisfy moral, ethical and legal concepts.” The resulting Nuremberg Code (1947) is generally considered the first document to suggest limitations on human experimentation. In reality, Germany had adopted strict guidelines and medical regulations for human research before 1933.

In 1890, the German physician Robert Koch (1843–1910) discovered tuberculin and claimed that it was a possible cure for tuberculosis (TB). As was customary at the time, tuberculin was tested in prison populations without the consent of the prisoners.

Tuberculin, however, was ineffective as a cure for TB. In response, the Prussian Minister of the Interior issued a directive in January 1891, which declared that the use of tuberculin on prisoners was authorized only if

The Prussian directive was explicit that tuberculin was never to be used “against the will of the sick person.” At that time, no other civilized nation went so far to protect prison inmates as did Germany.

Prisoners were not the only vulnerable population to be exploited in the name of medicine. Beginning in 1892, a dermatologist named Albert Neisser (1855–1916) became interested in serology as a way to immunize healthy people against disease.

Neisser was aware that eight young women (four children and four adults) had been hospitalized in a local infirmary for other illnesses. Without their consent, he injected all eight women with syphilis and observed their reactions over a four-year period. When four of the women contracted syphilis, Neisser claimed his vaccination did not work and refused to admit that his experiment was responsible. Instead, he said that the women were prostitutes who had acquired syphilis in their line of work.

Neisser published his results in 1898, and the medical community praised his efforts. However, when a liberal newspaper published the story of Neisser's experiments in early 1899, the public was outraged.

In March 1900, the Prussian House of Representatives and the local public prosecutor opened investigations into the case. According to Lafleur et al (2007), Neisser claimed that he could have fooled the young women into giving their consent, because “nothing is easier than to use friendly prodding to convince a person with no expertise to assent to just about anything.” Instead, he decided that their consent was unnecessary, as the women were incapable of understanding enough about his experiment to approve or to disapprove.

Although Neisser was fined a small sum of money, the Prussian government decided further public protection was needed. On December 29, 1900, the Prussian Minister of Religious, Educational and Medical Affairs issued the second broad government directive concerning human experimentation. The directive specifically prohibited “medical intervention for purposes other than diagnosis, therapy and immunization” if any of the following three conditions applied to a proposed subject:

Unfortunately, the directive was not legally binding throughout Germany, and physicians continued to experiment on unwilling subjects with disastrous results.

In 1930, a physician by the name of Julius Moses disclosed that 75 children had died in Lubeck, Germany, as a result of TB vaccination experiments. Dr. Moses began a public campaign for stricter guidelines on human experimentation.

In 1931, the German Republic issued the Reichsrundschreiben (“Regulations on New Therapy and Human Experimentation”). The new regulations were enforced by the German Health Department and allowed human experimentation only after animal testing had exceeded its usefulness. As stated in Guideline 5, “New Therapy may only be initiated after first being tested in animal experimentation, where this is at all possible.”

For its time, the regulations were extraordinary. According to Sass (1983), the Reichsrundschreiben anticipated modern ethical restrictions later contained in the Nuremberg Code, including risk-benefit analysis, informed consent, and detailed documentation of all experiments. Unlike the Nuremberg Code, however, the regulations expressly forbade experimentation on certain specific vulnerable populations such as children or dying persons.

From the date of publication on February 28, 1931, the regulations were legally binding in Germany and had to be signed by every physician before entering practice. When the Nazi Party assumed power in 1933, the regulations were retained and stayed in effect until the end of World War II in 1945.

Sadly, the regulations designed to protect humans from unnecessary experimentation actually led to more abuses. As German physicians were restricted from experimenting on animals, they turned to human subjects who the Nazis decided were undesirable: political prisoners, the mentally ill, and Jews. Ironically, the man responsible (Dr. Moses) for the new German regulations was Jewish.

Lafleur WR, Bohme G, Shimazono S. (Eds.) 2007. Dark Medicine: Rationalizing Unethical Medical Research. Bloomington and Indianapolis: Indiana University Press.

Prussian Minister of the Interior. 1891. Ministerial-Blatt fur die gesamte innere Verwaltung in den Koniglich Preubischen Staaten. 52:27. (English translation: Official regulations as to tuberculin in Germany and Italy. JAMA. 16:492.)

Sass H-M. 1983. Reichsrundschreiben 1931: pre-Nuremberg German regulations concerning new therapy and human experimentation. J Med Philos. 8:99–111.

The copyright of the article Medical Ethics in Germany Before 1933 in Scientific Ethics is owned by Jeffrey Willett. Permission to republish Medical Ethics in Germany Before 1933 in print or online must be granted by the author in writing.