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tional pamphlet for health administrators), BAB/NS 22/521.
RGAE f. 1562, s. ch., op. 329, d. 83, l. 1. The report also listed the fertility rates of republics

within the Soviet Union. Armenia had the highest fertility, followed by the Russian Federation,
Turkmenistan, Belorussia, Azerbaijan, Ukraine, and Tajikistan.
Pravda, January 1, 1936, 8.

Quoted in “Zabota o zdorov™e detei,” Gigiena i zdorov™e, no. 9 (1938): 1.

In practice, the Soviet government actually fostered national particularism. See Yuri Slezkine,

“The USSR as a Communal Apartment, or How a Socialist State Promoted Ethnic Particular-
ism,” Slavic Review 51, no. 1 (1992): 414“52; Terry Martin, The Af¬rmative Action Empire:
Nations and Nationalism in the Soviet Union, 1923“1939 (Ithaca, NY: Cornell University Press,
Utopian Biopolitics 97

Reproductive policies in both the Soviet Union and Nazi Germany were
largely administered through their respective health care systems, and for that
reason it is helpful to consider brie¬‚y the formation and structure of these
systems. As a largely rural, underdeveloped society, prerevolutionary Russia
had neither adequate medical facilities nor a centralized state health care sys-
tem. Medical care was primarily provided by locally based zemstvo physicians,
who, despite their lack of resources, aspired to provide free, universal health
care to Russia™s overwhelmingly peasant population. Following the October
Revolution, the Soviet government placed all medical care under centralized
state control. It founded the Commissariat of Health on July 11, 1918, empha-
sizing the need for coordinated state action to ¬ght epidemics, purify drinking
water, improve sanitation, and provide health care for “the broad mass of the
population.” While zemstvo doctors were initially hostile toward the Soviet
state, most came to see the Bolsheviks as allies in their efforts to establish free
and universal health care (and abolish private medicine), to prevent epidemics,
and to promote sanitary education. Some of them even joined the Bolshevik
Party and played a leading role building the Soviet health care system.36 The
structure of the Soviet health care system, then, re¬‚ected a number of currents
in the new Soviet state: the anticapitalism and statism of Bolshevik ideology,
the centralizing prerogative in the ¬ght against epidemics raging in the coun-
try, and zemstvo physicians™ belief in social medicine, with an emphasis on free
universal health care, preventive medicine, sanitation, and hygiene.37
Despite the initial ambition of Soviet health of¬cials and doctors to provide
free, universal health care, they lacked the resources to ful¬ll their goals. Under
the New Economic Policy of the 1920s, existing state clinics and hospitals
remained badly underfunded and plans to broaden health care went unreal-
ized. During the early 1930s, the Commissariat of Health expanded health
care in factories and prioritized the well-being of industrial workers, largely
neglecting the rest of the population. At the end of the 1930s, Soviet of¬cials
increased allocations for the health care of the general population, and in par-
ticular emphasized maternity care and the construction of children™s hospitals.
These priorities signaled a weakening of the productivist emphasis in state
health care and also re¬‚ected the pronatalist campaign in the period leading
up to the Second World War.38 Even given the considerable expansion of the
Soviet health care system during the Stalinist period, medical services overall
continued to be inadequate. Notwithstanding health of¬cials™ objective of pro-
viding comprehensive health care to the population, they were unable to over-
come the country™s prerevolutionary legacy of underdevelopment. During the

John F. Hutchinson, “Who Killed Cock Robin?: An Inquiry into the Death of Zemstvo

Medicine,” in Health and Society in Revolutionary Russia, eds. Susan Gross Solomon and
John F. Hutchinson (Bloomington: Indiana University Press, 1990), 4, 20.
Hutchinson concludes that the Commissariat of Health “owed much more to Russian precedent

and tradition than to Bolshevik ideology.” John F. Hutchinson, Politics and Public Health in
Revolutionary Russia, 1890“1918 (Baltimore: Johns Hopkins University Press, 1990), 202.
Chris Burton, “Medical Welfare during Late Stalinism: A Study of Doctors and the Soviet

Health System, 1945“1953” (Ph.D. diss., University of Chicago, 2000), 33“9.
David L. Hoffmann and Annette F. Timm

industrialization drive and the Second World War, the Soviet government chan-
neled most available resources to building steel mills and expanding military
production, while shortages of quali¬ed medical personnel and facilities con-
tinued. As we will discuss below, these de¬ciencies hampered of¬cial efforts to
entice women to have more children by providing maternity services and to use
medical personnel in a policing role to prevent women from having abortions.
Like the Soviets, Nazi politicians and propagandists considered health care
a key pillar of the new society. Unlike their Soviet counterparts, however, the
Nazis did not have to create entirely new structures of health care provision but
could impose their theories upon an already comprehensive and highly bureau-
cratized system. Beginning with the 1883 Bismarckian law on compulsory sick-
ness insurance for workers, which established the world™s ¬rst national health
care program, the scope of medical involvement in society had already been
dramatically increased.39 German citizens were the bene¬ciaries of the most
comprehensive and accessible health care system in the world. Indeed, one could
argue that by exposing doctors to the working classes for the ¬rst time, univer-
sal health insurance inspired medical ideas about in¬‚uencing health outcomes
on a mass scale. This almost universal system of health care was a structural
prerequisite for National Socialism™s intervention into reproductive health care,
though not without a substantial ideological and structural reorganization.
Soon after coming to power in 1933, the National Socialists set out to rad-
ically transform the system of health insurance funds.40 Capitalizing on the
discontent that had grown during the economically unstable Weimar years, the
Nazis set out to restructure the administration of health care entirely with the
goal of redirecting it toward “the healthy, enthusiastic, productive, military ¬t,
racially valuable German man of the future.”41 Personal needs, the right to
life, and individual bodily integrity were subordinated to the quest for “perfect
human material,” and all forms of self-government within insurance funds were
quashed.42 Soon after, extensive and ultimately fruitless efforts to integrate and
restructure Germany™s regionally diverse health care system began under the
auspices of the the Law for the Standardization of the Health Care System
(Gesetz uber die Vereinheitlichung des Gesundheitswesens) of July 3, 1934,
which sought to create a centralized health care administration while replacing
voluntary and government welfare agencies with new organizations devoted

For a synopsis, see Donald W. Light, “State, Profession, and Political Values,” in Political

Values and Health Care: The German Experience, ed. Donald W. Light and Alexander Schuller
(Cambridge, MA, and London: MIT Press, 1986), 3.
Extensive doctors™ strikes in the 1920s, declining medical bene¬ts during the in¬‚ationary period

and the depression, and in¬ghting among the administration (accused of mismanagement),
business circles, and doctors groups all contributed to a negative public attitude toward the
existing system.
A 1939 quote from the Nazi Minister of Labor, Seldte, cited in Peter Rosenberg, “The Origin and

the Development of Compulsory Health Insurance in Germany,” in Political Values and Health
Care: The German Experience, eds. Donald W. Light and Alexander Schuller (Cambridge, MA,
and London: MIT University Press, 1986), 119.
Utopian Biopolitics 99

to racial hygiene and the National Socialist Weltanschauung.43 This effort at
Gleichschaltung (synchronization) in the medical sphere created a new sys-
tem of state-run health bureaus and state-appointed medical administrators
to facilitate standardization across the Reich. A new focus on “genetic and
racial counseling” was to replace the Weimar tradition of linking health care
to economic productivity. The public health system was now to become the
“executive organ of National Socialist genetic health policy.”44
Complete federal unity in health care was never achieved, and battles
between state and communal medical administrations raged throughout the
Third Reich.45 Nevertheless, Arthur Gutt, Ministerial Director of the Volks-
gesundheit (people™s health) department of the Reich Ministry of the Interior,
continually praised the achievements of standardization and argued that it
had helped improve Germany™s genetic health (Erbgesundheit) while weeding
out those with genetic illnesses and inferiorities (Minderwertigkeiten).46 To
counteract the decline in genetic value (Erbwerte), Gutt created 742 regional
health of¬ces (Gesundheitsamter) across the country. But federal authorities

never had the resources to take control of the health of¬ces in large cities, who
continued to depend upon local administrative practices. Nevertheless, Nazi
medical reorganization imposed an administrative structure that aided in the
dissemination of racial ideas and created a bureaucracy for the elimination of
racially and genetically “inferior” individuals. Institutions that had originally
been set up in the Weimar Republic to help the chronically sick to improve their
standard of living and become reintegrated into society were now converted to
the purpose of weeding these undesirables out of the ranks of those deserving
government assistance.

The emphasis on the collective good and on racial health is an indication of the
centrality of eugenics in Nazi health care. Under the Nazis, eugenics became

The standard account of the struggles surrounding this law is: Alfons Labisch and Florian

Tennstedt, Der Weg zum “Gesetz uber die Vereinheitlichung des Gesundheitswesens,” vom 3.
Juli 1934: Entwicklungslinien und -momente des staatlichen und kommunalen Gesundheitswe-
sens in Deutschland (Dusseldorf: Akademie fur offentliches Gesundheitswesen, 1985). See also
¨ ¨ˆ
Norbert Frei, ed., Medizin und Gesundheitspolitik in der NS-Zeit (Munich: Oldenbourg, 1991).
Winfried Suß, “Gesundheitspolitik,” in Drei Wege deutscher Sozialstaatlichkeit: NS-Diktatur,

Bundesrepublik und DDR im Vergleich, ed. Hans Gunter Hockerts (Munich: Oldenbourg,
1998), 63.
Ursula Grell, “˜Gesundheit ist P¬‚icht™ “ Das offentliche Gesundheitswesen Berlins 1933“1939,”

in Totgeschwiegen 1933“1945: zur Geschichte der Wittenauer Heilstatten; seit 1957 Karl-
Bonhoeffer-Nervenklinik, 2nd ed., ed. Arbeitsgruppe zur Erforschung der Geschichte der Karl-
Bonhoeffer-Nervenklinik (Berlin: Hentrich, 1989), 52.
See for example, Ursula Grell, “Aufgaben der Gesundheitsamter im dritten Reich,” Archiv fur

¨ ¨
Bevolkerungswissenschaft (Volkskunde) und Bevolkerungspolitik 1 (1935): 280“1; and Arthur
Gutt, Der Aufbau des Gesundheitswesens im Dritten Reich, 4th rev. ed. (Berlin: Junker and
Dunnhaupt, 1938), 12.
Arthur Gutt, Die Rassenp¬‚ege im Dritten Reich (Hamburg: Hanseatische Verlaganstalt,

1940), 14.
David L. Hoffmann and Annette F. Timm

the guiding principle of medical practice, not just in the ¬eld of reproduction,
but in almost every medical specialty. Unlike socialist schools of thought on
eugenics, which had often stressed the need to prevent illnesses for humane
reasons, the guiding principle of Nazi eugenics was racial hygiene. Advocates of
Nazi racial hygiene (Rassenhygiene) were guided by the pessimistic assumption
that doctors had to be guardians of racial purity, turning their attention to
both internal (genetic) and external (racial) threats, if an almost inevitable
degeneration of the German Volk was to be avoided. Hereditary illnesses were
de¬ned more broadly and more ideologically than ever before.48 Nazis like
Arthur Gutt insisted, for instance, that racial hygiene and eugenics should target
not only physical features and de¬cits but also “mental and spiritual qualities
and with them character.” The purview of genetics was thus widened and
the links among eugenics, racism, and population policy were made explicit.
“Whoever recognizes genetic science,” Gutt insisted, “must necessarily embrace
not only the concept of race itself, but also the necessity of population and racial
policy.”49 It should also be noted that while National Socialist eugenics, like
Weimar eugenics, was mostly practiced in a Mendelian mode with an emphasis
on the immutability of genetic traits, Lamarckism and the idea that environment
might affect the germplasm crept in when it was ideologically convenient.50
Discussions about the need to protect men against venereal disease, for instance,
included the argument that these diseases might damage the male germ cell
(Keimzelle), and distinctions between congenital and genetic defects were often
It should not be surprising, of course, that Nazi eugenics did not maintain
strict scienti¬c standards. Race was generally de¬ned in genetic and biological
but also in spiritual terms. According to Gutt, racial purity, and society itself,
could be damaged through cultural mechanisms that destroy both the psycho-
logical and physical reproductive energies of the Volk. Gutt argued that only

For an overview see: Sheila Faith Weiss, “The Race Hygiene Movement in Germany 1904“

1945,” in The Wellborn Science: Eugenics in Germany, France, Brazil and Russia, ed. Mark B.
Adams (New York: Oxford University Press, 1990), 3“68.
Arthur Gutt, Bevolkerungs- und Rassenpolitik (Berlin: Industrieverlag Spaeth & Linde,

1936), 20.
Mendelian genetics, inspired by the mid-nineteenth-century writings of the monk Gregor

Mendel, holds that individuals inherit a set of unchanged units (now called genes) from both
parents. For any given pair of inherited units, only one will emerge as a trait in an individual.
(There will not, in other words, be a blending of traits.) But the parental trait that is not mani-
fested in the individual can still be passed on to that individual™s offspring. Mendel™s basic tenets
still form the foundation for our understanding of genetic transmission. Lamarckian genetics,
on the other hand, derived from the thinking of the French biologist Jean-Baptiste Lamarck
(1744“1824), hold that the environment can affect the genetic traits of an individual and that
these acquired traits can then be passed on to the next generation.


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