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In Germany, paediatrics evolved at the end of the 19th century in an atmosphere of social Darwinism and nationalism which paved the way towards elimination of handicapped infants. As nearly all infant specialists were Jews, with their persecution this topic disappeared from academic medicine.
Killing handicapped children was organised in Hitler's Chancellery from 1939, targeting infants with idiocy and mongolism, micro- or hydrocephaly, malformed limbs, head, or spine, and palsies. A system of reporting and rating such infants was established, leading to their admission to one of thirty ‘Special Children's Departments’. There, sedatives were applied in a dose depressing respiration which led to a slow death disguised as natural. A hundred physicians were directly involved in killing, and many more including eminent paediatricians in reporting infants.
After the war, court trials were initiated, but usually discontinued. Physicians involved in murdering children continued to teach and to conduct research on the victims' brains. Their textbooks were republished and conveyed little compassion for the weak, malformed, and handicapped. There was widespread unwillingness to keep preterm infants alive. When from 1960 artificial ventilation of neonates became possible, opposition against it persisted in Germany. In 1970, Germany's infant mortality rate was 23.4—rank 17 among 22 OECD states, and in 1980 fewer than ten neonatal intensive care units existed, located near the delivery room. Despising the weak was an enduring legacy of Nazism that may have delayed the introduction of neonatology in Germany.
As the killing of mentally ill adults in Nazi Germany has been thoroughly described,1 the systematic murder of handicapped children took longer to reveal: it was done more secretly; documents were destroyed upon the regime's collapse, German courts prosecuted child killing half-heartedly and testimony of the accused played down the crime. After the war, the paediatricians, nurses and midwives involved united …
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