The permanent exhibition War by csgirla


									                                                                                                                                                              The Left Atrium

                           people, burning their homes and their          legal abortion at age 14 and now has                        ing home to his family or of remaining
                           land and using them as forced labour.          one child. We have seen a mother with                       at the clinic for support. As he leaves
                           The inhabitants of this border area can        severe asthma who, physically incapable                     the room, I am floored. Here is a young
                           be relatively well-to-do members of the        of farm work and having left the relative                   man dying of ignorance, for how could
                           political opposition, or illiterate farmers    security of the refugee camp, cannot                        he protect himself against this disease
                           lacking the most basic education and           feed her six children. We have also seen                    without knowing that it exists?
                           knowledge about health. Their medical          a 71-year-old man with a frozen shoul-                         I walk out into the sun — the per-
                           problems are diverse, ranging from the         der and a huge, inextinguishable smile.                     petual sun of the Thai–Burma border
                           psychological impacts of deprivation,              Wei Lai has finished her history and                    in mid November. The flowers are
                           fear and loneliness to the common              turns to me. Our patient has had a fever                    blooming and the medics are off to the
                           complaints of infectious diseases and          on and off for six months. He has lost                      soccer field as the work day winds to a
                           malnutrition to more “Western” ill-            much weight. His wife had a similar                         close. They will enjoy their game and
                           nesses like heart failure and COPD.            disease a while ago; as she deteriorated,                   return to play their guitars and sing
                           They come to this clinic because it of-        she left to live with her parents. He has                   popular songs into the evening. Teach-
                           fers free basic health care to a popula-       not heard from her since. At that time                      ing goes on in some classrooms, and in
                           tion that has no official status in their      he was not yet ill. He might never have                     another the clinic choir practises for
                           country of refuge. Thailand does not           heard of HIV and tuberculosis. At any                       Sunday’s service. A new father emerges
                           grant refugee status to most migrants,         rate, he cannot describe these diseases                     from from the clinic with a tightly
                           and therefore most of the people flee-         and has no knowledge of their sympto-                       swaddled baby in his arms.
                           ing across the border to find work or          matology, mode of transmission or
                           safety are illegal and have little access to   prognosis. He has no symptoms of tu-                        Eva Purkey
                           services of any kind. Thus this clinic,        berculosis anyway, and there is no                          Department of Family Medicine
                           now a multi-department quasi-hospital          treatment for HIV/AIDS on the                               Queen’s University
                           grown out of a small outpatient clinic         Thai–Burmese border.                                        Kingston, Ont.
                           founded fifteen years ago, serves as a             The young man climbs down from
                           safe haven for many.                           the examining table and takes his jacket.                   The author spent several months in
                              Our patient has been listening for          He gives me a weak smile. Wei Lai will                      2002–2003 working at the Mae Tao
                           many minutes now. As at home, some             take him to the inpatient department,                       clinic in Mae Sot, Thailand. Founded by
                           days are filled with joy and others with       where he will receive pretest coun-                         Dr. Cynthia Maung in 1988, the clinic
                           sorrow. Today we have seen a 16-year-          selling for HIV and will then be tested,                    provides essential services to a severely
                           old woman with malaria; married before         should he so wish. If the test result is                    disadvantaged target population of some
                           menarche at age 12, she had her first il-      positive, he will have the option of go-                    150 000 in the border area.

                           History of medicine

                           Unfit to live
                           T     he permanent exhibition War
                                 Against the Inferior: the History of
                           Nazi Medicine in Vienna at the Otto
                                                                             The exhibition documents not only
                                                                          what happened at the hospital but also
                                                                          how the doctrine of “racial hygiene”
                                                                                                                                      These transports continued until Au-
                                                                                                                                      gust 1941, when T4 ended because of
                                                                                                                                      public protest: for example, parents sent
                           Wagner Hospital of Vienna documents            evolved into the Holocaust. From 1938                       letters to Berlin and demonstrated in
                           the medical atrocities committed dur-          to 1941, under the eugenics program
                           ing the Nazi era. Now named after the          “Action T4” (short for the headquar-
                           Secessionist architect Otto Wagner,            ters’ street address in Berlin, 4 Tier-
                           who proposed the hospital’s spacious           gartenstrasse), medical authorities se-
                           layout and designed its church, the hos-       lected from medical institutions those
                           pital was called Am Steinhof when it           “unfit to live” (people with disabilities

                           opened in 1907. With 34 pavilions and          or mental illness) and those the Nazis
                           over 2000 beds, it was large and mod-          dubbed “asocial” (alcoholics, drug ad-
                           ern for its time. Mounted in 2002, the         dicts, homosexuals and anyone else
                                                                                                                      Debra Martens

                           exhibition reflects Austria’s long-            deemed to be a liability to society). In
                           overdue official acceptance of responsi-       July and August of 1940 alone, 3200 pa-
                           bility for its actions under Nazi ideol-       tients were sent from the Steinhof to                       Friedrich Zawrel remembers.
                           ogy between 1938 and 1945.                     Hartheim Castle near Linz to be gassed.

                                                                                                CMAJ • SEPT. 14, 2004; 171 (6)                                              619
                Côté cœur

                front of hospitals, while nurses and         in 1951 and retracted
                members of the Catholic church spoke         charges against Gross. He
                out against the killings. By this time       returned to work at the
                over 18 000 patients had died at             Steinhof. Despite his
                Hartheim. The T4 medical experts             questionable past, Gross
                were then transferred to work at con-        became a leading neurol-
                centration camps, where they began           ogy specialist, earning
                weeding out the ill and unfit.               such rewards as the direc-
                    From 1940 to 1945, thirteen pavil-       torship of the Ludwig
                ions on the grounds of the hospital,         Boltzmann Institute for

                                                                                          Debra Martens
                emptied by the T4 murders, were used         Clinical Neurobiology,
                for a reformatory and a children’s           regular work as a court
                clinic, Spiegelgrund. The children at        psychiatrist, and even the
                Spiegelgrund included those selected         Austrian Cross of Honour        The child victims of Spiegelgrund.
                by T4 categories, as well as the children    for Science and the Arts
                of resistance fighters and communists.       in 1975. Throughout this period (until brary. Given the poor signage, visitors
                In Pavilion 17, doctors conducted ex-        1995), Gross used the preserved brains are unlikely to realize the exhibition is
                periments on children, particularly          of the children killed at Spiegelgrund as there. Nevertheless, many nurses,
                those with microcephaly, hydro-              the basis of his research.                   teachers and over 250 classes of stu-
                cephalus, rickets and tuberculosis. They         In 1976, as court psychiatrist, Gross dents have visited the exhibition since it
                were subjected to painful brain x-rays       was assigned the file of one of his for- opened in September 2002. Their visits
                (which involved withdrawing cere-            mer victims, Friedrich Zawrel. During have been enhanced by survivors who
                brospinal fluid and injecting air into the   the war, Zawrel had been at Spiegel- come to talk about Spiegelgrund and by
                brain cavity, for contrast), exposure to     grund as the “hardly reformable” son of lecturers from the Documentation
                cold and vaccine trials. They were then      an alcoholic communist. While there Centre of Austrian Resistance.
                sent to Pavilion 15 to die of malnutri-      he endured medical testing and nine             During my interview with Friedrich
                tion and infectious diseases, their resis-   months of solitary confinement in a Zawrel, accompanied by Wolfgang
                tance further weakened by sedatives. In      bare cell-like room, then escaped with Lamsa, one of the exhibition organiz-
                all, 789 children died; their brains and     the help of a nurse. After Zawrel con- ers and lecturers, we walked around
                parts of their spinal cords were re-         tacted the press about Gross, his story the grounds of the hospital. Zawrel
                moved and preserved for further study.       was taken up by an organization of doc- showed me the window of his cell
                    The director of the children’s clinic    tors who in 1979 exposed Gross’s role room in Pavilion 17. I asked, “What
                from 1942 to 1945, neurologist Ernst         in the killings of the children at do you think when you see that win-
                Illing, was sentenced to death in 1946       Spiegelgrund. Yet it was not until dow?” He paused, then smiled and an-
                for manslaughter. However, Dr. Hen-          twenty years later, after new evidence swered, “Joy. I feel joy because I have
                rich Gross, the senior doctor on duty in     had been found, that Gross was survived the war, I have survived
                Pavilion 15, was sentenced in 1950 by        charged with murder by the Viennese Hitler, Illing and Gross, I have sur-
                the Viennese People’s Court (a post-         District Court. The case never came to vived everything.” Thanks to survivors
                war tribunal) to only two years’ impris-     trial: charges were dropped in January such as Zawrel, Austria cannot forget
                onment for manslaughter; the Supreme         2000 on the grounds that Gross, aged its Nazi past. As Lamsa put it, “To tell
                Court of Austria rescinded the verdict       84, was suffering from dementia.             the truth now is not a political affair, it
                                                                 The story of Dr. Heinrich Gross is an affair of restoration, of memorial
                                                             and Friedrich Zawrel is only one of culture.” Let’s hope the hospital’s up-
                                                             many told through the exhibition at the coming centennial in 2007 provides
                                                             Otto Wagner Hospital. The inconclu- fresh incentive for Vienna to commit
                                                             sive nature of its outcome reveals Aus- itself to this exhibition on Nazi medi-
                                                             tria’s ambivalence about its Nazi past. cine, and to make it more accessible to
                                                             This ambivalence extends to the exhibi- all visitors.
                                                             tion itself, which suffers from modest
                                                             and unreliable funding from the city: Debra Martens
                                                             the display consists only of mounted Writer
                                                             copies of documents, news clippings, Vienna, Austria
Debra Martens

                                                             letters and explanatory text, with a few
                                                             captions in English. There are no More information about the
                 The Unfit to Live installation.             videos of survivors, for example, or exhibition is available at
                                                             original documents from the hospital li-

                620                                  JAMC • 14 SEPT. 2004; 171 (6)

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