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Heinrich Ruoff, a nurse at the Hadamar Mental Institution, Germany, was convicted of murdering hundreds of innocent civilians and sentenced to death at the Hadamar Mass Murder trial, held in the American Occupation Zone at Weisbaden, Germany.

During the Third Reich, home care nurses reported disabled Germans to the authorities for euthanasia because it was part of the job. Pediatric nurses earned bonuses for killing hospitalized children by slow starvation or poison. Others visited wine cellars to celebrate every 50th murder.

Yet that was years before World War II and the mass exterminations of the Holocaust.

Even so, at this nadir of modern-day nursing, some nurses risked everything to provide crumbs of food or comfort, a blanket, another day’s life, or a chance for freedom.

Nurse historians and ethicists say it’s critical to understand that some nurses embraced cruelty while others renounced it.

Physicians have extensively researched and reported atrocities by their profession, and now nurses are doing the same.

These historians interview nurses, former patients, and citizens. They read postwar trial transcripts. And they work with researchers, reviewing thousands of German nurses’ and physicians’ meticulous records and documenting everything from the mundane to murder.

In June, they shared their findings at the first international conference on nursing and midwifery in the Third Reich.

“A nurse has moral authority everywhere, or he or she shouldn’t be a nurse,” says Susan Benedict, CRNA, DSN, FAAN, professor in the College of Nursing, Medical University of South Carolina, Charleston. “Nurses who participated in euthanasia and medical experimentation set aside their individual moral authority and acquiesced to the will of the state.”

Before the war, Germany used euthanasia programs, gas chambers, and crematoria in psychiatric facilities to rid society of “useless eaters” and release them from a “life unworth living.” Children’s math problems calculated costs to keep the mentally ill and other “useless eaters” alive. Nurses helped gather, transport, and escort disabled Germans into the chambers. Eventually, these facilities became the models for the mass extermination of groups including Jews, gays, Roma, the elderly, and prisoners of war.

Gradual move toward the horrific

“We have to understand the continuum and how one set of circumstances segued to the next,” Benedict says. “Germany admired sterilization laws first passed in the United States in the 1930s and used them as a prototype for sterilizing anyone with a hereditary disease. ... [I]n 1939, they decided psychiatric patients and others should not only not reproduce, but be killed as ‘useless eaters,’ even though these patients were forced to work. Nurses and doctors bought into it and influenced others.” Nurses even helped set up gas chambers in concentration camps for the “Final Solution.”

“Nurses fell in line with belief in the state,” Benedict says. Some even swore allegiance to Hitler as part of their nursing oath at graduation. They also pledged eternal silence — and to the disappointment of researchers, it’s an oath some still maintain.

In concentration camps, according to their own records, German nurses participated in medical experiments on living people. Official Nazi correspondence report how they injected botulism and other dangerous organisms into surgical incisions, rubbed in glass and sawdust, then applied plaster casts to prevent “disturbance” of the infected sites while comparing the efficacy of potential antibiotics with untreated control subjects. Among other atrocities, they slowly froze patients to death to see what temperature they could tolerate.

“Nurses were not forced to participate in euthanasia,” Benedict says. “The worst that happened was one nurse was sent to work in the laundry. Relative to killing people, that demotion was not bad. After 60 years, nobody was discovered to have been sent to concentration camps or punished for doing anything to aid patients. One nurse brought children toys and cookies, which was used in her defense.”