the third reich ( 19331945 ) , the period when adolf hitler was chancellor of germany , was a time of great violence , discrimination , and medical upheaval . data about the quality of the german health service are difficult to come by , but what information can be gathered demonstrates a detrimental effect on the country s health . this is to be expected during the war years , but may also represent the loss of so many trained physicians ( i.e. jewish and female practitioners ) who were not allowed to practice during these years . this article will argue that preventing women and jews from practicing adversely affected germany s health . the first - ever female doctor in europe was a german woman named frau dorothea lepavin - erxleben , who , in 1754 , was admitted to the university of halle and graduated from the medical faculty by the favor of frederick the great ( lovejoy , 1957 ) . like most , if not all , early german female doctors , she became an obstetrician . queen victoria of britain , for example , was delivered by a female german obstetrician named dr . women training to be doctors in germany still faced a struggle , however , and in 1869 , female doctors could only practice in germany if their medical diplomas were from a different country . women were not admitted to medical schools in germany until 1888 ( lovejoy , 1957 ) , compared to 1849 in the united states , 1875 in france , 1876 in england , 1878 in the netherlands , and 1882 in spain . germany also led the way with social policies , including , in 1883 , otto von bismarck s state health insurance system ( berg and cocks , 1997 ) . the move towards a social policy of health met with great criticism from doctors , but also led to greater unification . in 1873 , the national medical association , dvb , was founded . this was largely a jewish - friendly organization , perhaps because so many of its members and leading figures were jewish ( berg and cocks , 1997 ) . the first world war had been an opportunity for female doctors to prove their skill manning hospital and research units while their male colleagues signed up for active service . the first world war also marked the first time jewish male doctors received field commissions , but , in general , jewish doctors of both sexes had been forced into less glamorous areas of medicine , such as internal medicine and dermatology . still , jews could not join university medical faculties unless they converted ( berg and cocks , 1997 ) . the wall street crash of 1929 and resulting depression caused a collapse across many developed countries . doctors suffered along with all other professions ; this helped foster anti - semitism , as jewish doctors were academically influential in large metropolitan areas such as berlin , frankfurt , and hamburg ( berg and cocks , 1997 ) . the national health insurance system meant that doctors had to wait to fill vacancies in national services and could not start private practices . this , with encouragement from the national socialist party ( nazi party ) , led to the formation of the national socialist medical association ( nsdb ) to rival the dvb . initially , the nsdb was not a powerful or influential organization , but things changed in 1933 when hitler rose to power . the nazi party ideals were also anti - feminist , with rules as early as 1921 stating that no woman could have a position or role in the nazi party . in 1933 , there were 4,367 female german doctors ( lovejoy , 1957 ) , 587 of whom were jewish ( hutton , 2001 ) . this can be compared to figures from france , a country of similar size , where in 1928 only 556 women were practicing medicine in france across all specialties ( lipinska and thomas , 1930 ) . jews represented 16% of doctors in prussia and 25% of dermatologists in germany , which is equal to 566 total ( compared to being less than 1% of the population ) ( yesudian et al . , 2010 ) . another figure quoted is that , of the 2078 dermatologists in germany in january 1933 , 569 were jewish dermatologists ( scholz and eppinger , 1999 ) . on january 30 , 1933 , adolf hitler was elected chancellor of the reichstag , the governing body of germany . the enabling act was subsequently passed in march 1933 , effectively giving hitler total power . hitler then set about with his programs of  social darwinism  and  racial hygiene ,  which included the removal of all jewish and female doctors from their posts in april and june of 1933 , often replacing them with medical students ( weindling , 1989 ) . while female doctors might still be allowed to work in midwifery , jewish doctors could not work at all and many emigrated . after hitler s ascension , most other medical practitioners decided to join the nsdb ( membership rose from 2,786 members in january 1933 , to 11,000 members in october 1933 and 42,000 members in 1942 ) ( weindling , 1989 ) and income for doctors rose from a rather poor 9,300 marks in 1933 to 15,000 marks in 1938 ( berg and cocks , 1997 ) . in addition , in 1933 , women were dismissed from their positions as solicitors , civil servants , and other professional posts ; as of 1936 , women were no longer allowed to sit on juries ( nor be judges or prosecutors ) , as they were deemed to be ruled by their emotions . hitler s policies also featured eugenics , a term first proposed by francis galton , a cousin of charles darwin ( cuerda et al . , 2011 ) . eugenics was first implemented in the united states in the early 1900s , and is reportedly still occurring there via the sterilization of female prisoners ( johnson , 2014 ) . with the rise of nazism in 1933 , those chosen for sterilization included racial and ethnic groups such as blacks , gypsies , poles , and jews . one figure suggested that , of the 400,000 people who had been forcibly sterilized by 1945 , approximately 5,000 women died of either postoperative complications , as a result of their resistance to the procedure , or of subsequent suicide ( berg and cocks , 1997 ) . the surgeons , however , were being dubbed  masculine heroes of the scalpel .  in 1934 , a doctor was required by law to denounce any of his patients who were disabled ( berg and cocks , 1997 ) . in 1935 , the blood protection law prohibited marriage and sexual intercourse between jews ; later that year , the marital health law prohibited the marriage of a jew ( or a member of any other classified unsavory group ) to an aryan ( berg and cocks , 1997 ) . abortion was either encouraged or refused depending on the woman s race / ethnicity , and a woman s role in society was seen as purely reproductive . one example of this is the  lebensborn ,  an initiative where  racially pure  women were encouraged to procreate with aryan men , such as ss officers ; the children would then be adopted out , while the mothers continued in their duty to provide more members of the  master race ( international tracing service , n.d . ) . with the advent of war in 1939 , action t4  started in earnest , which was a program to exterminate all mentally and physically handicapped and chronically ill patients ( berg and cocks , 1997 ) . special children s wards were created for the observation ( and eventual death , usually from starvation until they moved to faster methods ) of chronically ill children from the epileptic to the handicapped . towards the end of the second world war , as german supplies became scarce , those who had been kept in concentration camps or used as slave labor were exterminated . morbidity and mortality figures have to be interpreted amongst this setting of increased violence and extermination programs . not only were jewish and female doctors prevented from practicing medicine , but members of the german intelligentsia , which included many physicians as well as politicians and university staff , who refused to submit to nazi doctrine also lost their jobs . with the loss of a good proportion of experienced medical practitioners , one would expect that the quality of the nation s health care would deteriorate . the diphtheria death rate is one indicator that medical care was suffering , as it shows 77,340 deaths in 1933 , increasing to 146,733 in 1937 ( weindling , 1989 ) . a doubling of the death rate in a pre - war germany , which was ostensibly flourishing under hitler ( if you were aryan ) , suggests that good propaganda underlay a very different reality of a healthcare system bereft of experienced practitioners . records also demonstrate increasing trends in scarlet fever , spinal meningitis , infantile paralysis , typhoid , and paratyphoid ( weindling , 1989 ) . hospital mortality figures rose by 16% and life expectancy declined but , again , whether this was due to violence or lack of medical care is difficult to extract ( gapminder , 2013 ) . research into the detection and treatment of sexually transmitted diseases stopped ( weindling , 1994 ) . figures from one german dermatology center showed a tripling of cases of syphilis , from 275 to 859 , and gonorrhea cases increasing from 127 to 1675 between 1933 to 1938 and 1939 to 1945 ( kapp and bondio , 2011 ) . maternal mortality figures are not available for germany until 1952 , when the maternal mortality rate per 100,000 was 184 ; compare this to the rates of the united kingdom ( 67 per 100,000 ) and the united states ( 68 per 100,000 ) for the same year , which demonstrates that the german health service still had not recovered by that point ( table 1 ) ( gapminder , 2013 ) . some did what they could to help their fellow jews in the warsaw ghetto in 1940 , while also providing useful research data . the germans had decided to exterminate the occupants of the warsaw ghetto by starvation by providing fewer than 800 calories a day to residents ( gratzer , 2005 ) . dr . milejokowksi and 5 out of 28 medical staff living in the ghetto decided to record the effects of this starvation , understanding that they would all die , but that the data they collected would mean that non omnis moriar ( not everything of us will die ) ( medawar and pyke , 2001 ) . dr . milejokowski and colleagues in the ghetto set about recording clinical assessments , physiological readings , and data collected from postmortems regarding the consequences of starvation ( gratzer , 2005 ) . documentation stopped in 1942 when the remaining people were transported to death camps ( note that 43,000 people had already died at this point ) , but almost one half of the reports were smuggled out and entrusted to professor orlowski , the non - jewish director of the department of medicine of warsaw university . the surviving reports were published in english in the us in 1979 and were seen as an impressive observation on the consequences of malnutrition ( gratzer , 2005 ) . eduard bloch , an austrian jew , was granted special protection and allowed to immigrate to the united states in 1940 because he had cared for hitler and his family during hitler s childhood . in 1933 , many jews fled germany before they were dismissed from their positions , or worse . within weeks of hitler s britain was a welcoming destination for many , as it saw the advantage and benefit of accepting so many skilled people , especially in regards to medicine , physics , and chemistry . the united kingdom , therefore , set up the academic assistance council ( aac ) , which was tasked with finding these refugee scientists and physicians posts and payment . policy was still largely anti - semitic ; as such , only 30 jewish scientists and physicians fleeing nazi germany in 1933 were admitted ( medawar and pyke , 2001 ) . the united states remained prejudiced in this regard , never accepting more than 100 jewish academics in a year , the highest being only 97 in 1939 ( most of those made up of physicians , as they had better international contacts ) ( medawar and pyke , 2001 ) . often , those who were allowed entry into the united states had already been accepted into the united kingdom ( e.g. , edward teller , known as the father of the hydrogen bomb ) . in 1935 , a u.s . envoy was sent to britain to tell the aac that it could take no more academic refugees ( britain ignored the request and continued to send jewish academics to the united states ) ( medawar and pyke , 2001 ) . not all of the united states was anti - semitic ; for example , princeton university donated 5% of all of their salaries to the aac ( medawar and pyke , 2001 ) . in the 1930s and 1940s , polls of the nation population opposed raising the quotas for jewish refugees ( medawar and pyke , 2001 ) . in 1939 , the wagner rogers bill was proposed , asking that 20,000 refugee children be allowed admittance into the united states , but it was so unpopular that it failed to reach the floor of congress . at the same time , the already stretched britain received 10,000 child refugees as war began ( known as the kinder transport ) ( medawar and pyke , 2001 ) . in 1945 , the population of postwar germany faced starvation and was suffering from the destruction of its major cities , a displaced population , and a defeated government . the allies , comprising france , united kingdom , united states , and russia , decided the fate of the country , which was split between them . east germany remained separate until the fall of the berlin wall , while the united states and the united kingdom still maintain a military presence in what was once west germany . the splitting of germany makes it difficult to compare german health statistics pre- and postwar , as they were two very different entities . of the jewish doctors who had not left germany , most were dead from suicide , starvation , violence , or the concentration camps . using jewish dermatologists as an example , 50% had emigrated ( with 107 going to the united states ) , 10% died in concentration camps ( including karl herxheimer and abraham buschke ) , 10% died of natural causes , 2% committed suicide , 4% survived and 24% remain unaccounted for ( burgdorf and bickers , 2013 , eppinger et al . , 2003 ) . belatedly , in march 1950 , the german female doctors association finally reacquired a legal footing and figures show that of 64,104 doctors , 6,400 were women ( lovejoy , 1957 ) . the beginning of the 20th century was a difficult time to practice medicine as a woman or a jew . the nazi party legalized prejudices ( i.e. , anti - semitic and misogynistic ) that reflected many people s opinions at that time . these opinions were not specific to germany nor are they only relevant to the past . the influx of so many talented people into britain and the united states represented a huge advance in academia and medicine , and we still benefit from their discoveries and descendants today . those who remained made every effort to ensure that their work would be remembered and that lessons were learned from the atrocities inflicted upon them . the health care of germany suffered as a consequence of the loss of so many learned individuals , as evidenced by the maternal mortality rates . doctors have been political pawns for centuries , and jewish doctors have been expelled from their homelands on multiple occasions ( e.g. , the expulsion of jewish doctors from malta in 1492 ) . recent conflicts have led to an exodus of doctors and their families to safer regime ; this includes female doctors who are no longer allowed to practice in islamic states . one can never fully quantify the detrimental effects the loss of female doctors have on the vulnerable groups they historically and religiously care for .
jewish and female doctors were not allowed to practice medicine in germany during hitler s rule from 1933 to 1945 . 
 data about the consequences of this on the health service are difficult to come by , but what information can be gathered demonstrates a detrimental effect on the nation s health . these data , however , must be interpreted with consideration to the morbidity and mortality from violence , death camps , slave labor , and the privations of war . 
 the article summarizes the history of german health care during this period and also compares germany to other nations at that time .