aktion t4 aktion t4 aktion t4 (german, pronounced ) was a campaign of mass murder by involuntary euthanasia in nazi germany. the term was first used in post-war trials against doctors who had been involved in the killings. the name t4 is an abbreviation of tiergartenstraße 4, a street address of the chancellery department set up in early 1940, in the berlin borough of tiergarten, which recruited and paid personnel associated with aktion t4. certain german physicians were authorised to select patients "deemed incurably sick, after most critical medical examination" and then administer to them a "mercy death" (gnadentod). in october 1939, adolf hitler signed a "euthanasia note", backdated to 1 september 1939, which authorised his physician karl brandt and reichsleiter philipp bouhler to begin the killing. aktion t4hitler's order for aktion t4also known ast4 programlocationgerman-occupied europedateseptember 1939 – 1945incident typeforced euthanasiaperpetratorsssparticipantspsychiatric hospitalsvictims275,000–300,000 the killings took place from september 1939 until the end of the war in 1945; from 275,000 to 300,000 people were killed in psychiatric hospitals in germany and austria, occupied poland and the protectorate of bohemia and moravia (now the czech republic). the number of victims was originally recorded as 70,273 but this number has been increased by the discovery of victims listed in the archives of the former east germany. about half of those killed were taken from church-run asylums, often with the approval of the protestant or catholic authorities of the institutions. the holy see announced on 2 december 1940 that the policy was contrary to divine law and that "the direct killing of an innocent person because of mental or physical defects is not allowed" but the declaration was not upheld by all catholic authorities in germany. in the summer of 1941, protests were led in germany by the bishop of münster, clemens von galen, whose intervention led to "the strongest, most explicit and most widespread protest movement against any policy since the beginning of the third reich", according to richard j. evans. several reasons have been suggested for the killings, including eugenics, racial hygiene, and saving money. physicians in german and austrian asylums continued many of the practices of aktion t4 until the defeat of germany in 1945, in spite of its official cessation in august 1941. the informal continuation of the policy led to 93,521 "beds emptied" by the end of 1941. technology developed under aktion t4, particularly the use of lethal gas on large numbers of people, was taken over by the medical division of the reich interior ministry, along with the personnel of aktion t4, who participated in mass murder of jewish people. the programme was authorised by hitler but the killings have since come to be viewed as murders in germany. the number of people killed was about 200,000 in germany and austria, with about 100,000 victims in other european countries. following the war, a number of the perpetrators were tried and convicted for murder and crimes against humanity. background at the beginning of the twentieth century, the sterilisation of people carrying what were considered to be hereditary defects and in some cases those exhibiting what was thought to be hereditary "antisocial" behaviour, was a respectable field of medicine. canada, denmark, switzerland and the us had passed laws enabling coerced sterilisation. studies conducted in the 1920s ranked germany as a country that was unusually reluctant to introduce sterilisation legislation. in his book mein kampf (1924), hitler wrote that one day racial hygiene "will appear as a deed greater than the most victorious wars of our present bourgeois era". in july 1933, the "law for the prevention of hereditarily diseased offspring" prescribed compulsory sterilisation for people with conditions thought to be hereditary, such as schizophrenia, epilepsy, huntington's chorea and "imbecility". sterilisation was also legalised for chronic alcoholism and other forms of social deviance. the law was administered by the interior ministry under wilhelm frick through special hereditary health courts (erbgesundheitsgerichte), which examined the inmates of nursing homes, asylums, prisons, aged-care homes and special schools, to select those to be sterilised. it is estimated that 360,000 people were sterilised under this law between 1933 and 1939. the policy and research agenda of racial hygiene and eugenics were promoted by emil kraepelin. the eugenic sterilisation of persons diagnosed with (and viewed as predisposed to) schizophrenia was advocated by eugen bleuler, who presumed racial deterioration because of "mental and physical cripples" in his textbook of psychiatry, the more severely burdened should not propagate themselves... if we do nothing but make mental and physical cripples capable of propagating themselves, and the healthy stocks have to limit the number of their children because so much has to be done for the maintenance of others, if natural selection is generally suppressed, then unless we will get new measures our race must rapidly deteriorate. within the nazi administration, the idea of including in the programme people with physical disabilities had to be expressed carefully, because the reich minister of propaganda, joseph goebbels, had a deformed right leg. after 1937, the acute shortage of labour in germany arising from rearmament, meant that anyone capable of work was deemed to be "useful", exempted from the law and the rate of sterilisation declined. the term aktion t4 is a post-war coining; contemporary german terms included euthanasie (euthanasia) and gnadentod (merciful death). the t4 programme stemmed from the nazi party policy of "racial hygiene", a belief that the german people needed to be cleansed of racial enemies, which included anyone confined to a mental health facility and people with simple physical disabilities. new insulin shock treatments were used by german psychiatrists to find out if patients with schizophrenia were curable. implementation nsdap reichsleiter philipp bouhler, head of the t4 programme karl brandt, doctor to hitler and hans lammers, the head of the reich chancellery, testified after the war that hitler had told them as early as 1933—when the sterilisation law was passed—that he favoured the killing of the incurably ill but recognised that public opinion would not accept this. in 1935, hitler told the leader of reich doctors, gerhard wagner, that the question could not be taken up in peacetime; "such a problem could be more smoothly and easily carried out in war". he wrote that he intended to "radically solve" the problem of the mental asylums in such an event. aktion t4 began with a "trial" case in late 1938. hitler instructed brandt to evaluate a petition sent by two parents for the "mercy killing" of their son who was blind and had physical and developmental disabilities. the child, born near leipzig and eventually identified as gerhard kretschmar, was killed in july 1939. hitler instructed brandt to proceed in the same manner in all similar cases. on 18 august 1939, three weeks after the killing of the boy, the reich committee for the scientific registering of hereditary and congenital illnesses was established to register sick children or newborns identified as defective. the secret killing of infants began in 1939 and increased after the war started; by 1941, more than 5,000 children had been killed. hitler was in favour of killing those whom he judged to be lebensunwertes leben ('life unworthy of life'). a few months before the "euthanasia" decree, in a 1939 conference with leonardo conti, reich health leader and state secretary for health in the interior ministry, and hans lammers, chief of the reich chancellery, hitler gave as examples the mentally ill who he said could only be "bedded on sawdust or sand" because they "perpetually dirtied themselves" and "put their own excrement into their mouths". this issue, according to the nazi regime, assumed a new urgency in wartime. after the invasion of poland, hermann pfannmüller (head of the state hospital near munich) said it is unbearable to me that the flower of our youth must lose their lives at the front, so that that feeble-minded and asocial element can have a secure existence in the asylum. pfannmüller advocated killing by a gradual decrease of food, which he believed was more merciful than poison injections. karl brandt, hitler's personal doctor and organiser of aktion t4 the german eugenics movement had an extreme wing even before the nazis came to power. as early as 1920, alfred hoche and karl binding advocated killing people whose lives were "unworthy of life" (lebensunwertes leben). darwinism was interpreted by them as justification of the demand for "beneficial" genes and eradication of the "harmful" ones. robert lifton wrote, "the argument went that the best young men died in war, causing a loss to the volk of the best genes. the genes of those who did not fight (the worst genes) then proliferated freely, accelerating biological and cultural degeneration". the advocacy of eugenics in germany gained ground after 1930, when the depression was used to excuse cuts in funding to state mental hospitals, creating squalor and overcrowding. many german eugenicists were nationalists and antisemites, who embraced the nazi regime with enthusiasm. many were appointed to positions in the health ministry and german research institutes. their ideas were gradually adopted by the majority of the german medical profession, from which jewish and communist doctors were soon purged. during the 1930s, the nazi party had carried out a campaign of propaganda in favour of euthanasia. the national socialist racial and political office (nsrpa) produced leaflets, posters and short films to be shown in cinemas, pointing out to germans the cost of maintaining asylums for the incurably ill and insane. these films included the inheritance (das erbe, 1935), the victim of the past (opfer der vergangenheit, 1937), which was given a major première in berlin and was shown in all german cinemas, and i accuse (ich klage an, 1941) which was based on a novel by hellmuth unger, a consultant for "child euthanasia". killing of children schönbrunn psychiatric hospital, 1934 (photo by ss photographer friedrich franz bauer) in mid-1939, hitler authorised the creation of the reich committee for the scientific registering of serious hereditary and congenital illnesses (reichsausschuss zur wissenschaftlichen erfassung erb- und anlagebedingter schwerer leiden) led by his physician, karl brandt, administered by herbert linden of the interior ministry, leader of german red cross reichsarzt ss und polizei ernst-robert grawitz and ss-oberführer viktor brack. brandt and bouhler were authorised to approve applications to kill children in relevant circumstances, though bouhler left the details to subordinates such as brack and sa-oberführer werner blankenburg. extermination centres were established at six existing psychiatric hospitals: bernburg, brandenburg, grafeneck, hadamar, hartheim, and sonnenstein. one thousand children under the age of 17 were killed at the institutions am spiegelgrund and gugging in austria. they played a crucial role in developments leading to the holocaust. as a related aspect of the "medical" and scientific basis of this programme, the nazi doctors took thousands of brains from 'euthanasia' victims for research. viktor brack, organiser of the t4 programme from august 1939, the interior ministry registered children with disabilities, requiring doctors and midwives to report all cases of newborns with severe disabilities; the 'guardian' consent element soon disappeared. those to be killed were identified as "all children under three years of age in whom any of the following 'serious hereditary diseases' were 'suspected': idiocy and down syndrome (especially when associated with blindness and deafness); microcephaly; hydrocephaly; malformations of all kinds, especially of limbs, head, and spinal column; and paralysis, including spastic conditions". the reports were assessed by a panel of medical experts, of whom three were required to give their approval before a child could be killed. the ministry used deceit when dealing with parents or guardians, particularly in catholic areas, where parents were generally uncooperative. parents were told that their children were being sent to "special sections", where they would receive improved treatment. the children sent to these centres were kept for "assessment" for a few weeks and then killed by injection of toxic chemicals, typically phenol; their deaths were recorded as "pneumonia". autopsies were usually performed and brain samples were taken to be used for "medical research". post mortem examinations apparently helped to ease the consciences of many of those involved, giving them the feeling that there was a genuine medical purpose to the killings. the most notorious of these institutions in austria was am spiegelgrund, where from 1940 to 1945, 789 children were killed by lethal injection, gas poisoning and physical abuse.