“Socialism is the Best Prophylaxis.” Medicine and Politics

Classic accounts about medicine and medical doctors in the GDR often repeated the statement made by Maxim Zetkin, a key figure in medicine in the early period: “Socialism is the best prophylaxis.” The sentence referred to prophylaxis not in its precise meaning of preventive care, but in a broader sense, suggesting that most health-care issues would ultimately be resolved by a socialist system. Zetkin’s dictum was extensively used as propaganda by East German media, writers, and intellectuals.Footnote ⁸ However, scholarship does not simply present an image of naive doctors thinking that socialism in and of itself would be capable of solving all health-care problems, nor is the system depicted as a “totalitarian” structure any longer. Indeed, as historian Markus Wahl wrote in a recent overview of health-care history in East Germany, the black-and-white approaches long ago gave way to “fifty shades of gray” resulting in “multi-layered, complex, and differentiated” approaches capable of capturing the “contradictions and diversity” of the socialist experience.Footnote ⁹ Similar arguments have been made in studies about the Eastern bloc. In relation to medicine, recent scholarship has pointed out how crucial experts were in the decision-making processes of socialist states, with pressing health-care challenges that only experts were able to solve. As such, the alleged totalitarian control of Communist Parties fades and gives way to a more nuanced understanding of power and governmentality in state socialism in which there was a space for cooperation between politicians and experts.Footnote ¹⁰

To address the interplay between experts and politicians in East Germany, scholarship has shown that there was an “alliance” between the medical intelligentsia and the SED.Footnote ¹¹ What this alliance meant in practice has received opposing descriptions oscillating between those conceiving of the medical experts as “servants of the state” and those emphasizing how the medical intelligentsia formed an independent “bastion,” mostly composed of conservative figures, capable of bargaining with the SED.Footnote ¹² Aligning with the latter interpretation, Markus Wahl argued that there was indeed “unity and solidarity amongst the medical intelligentsia, offering the opportunity to prevent ideological conditioning by the SED.”Footnote ¹³ Anna Sabine Ernst calculated that by the early 1960s only 13 percent of the university professors in medicine had SED membership. Most medical professors came instead from conservative milieus of pre-socialist Germany; furthermore, at that time 45 percent of the clinicians and 75 percent of the university professors of medicine had belonged to the Nazi Party.Footnote ¹⁴ The reasons Nazi doctors retained their influence in academic power in East Germany ranged from their usefulness to the state to their willing collaboration with the Ministry for State Security.Footnote ¹⁵ The overall presence of conservative doctors might explain the extraordinary fact that a socialist state like the GDR had two Christian democrats, members of the East German Christlich-Demokratische Union Deutschlands (Christian Democratic Union of Germany, CDU), as health-care ministers, first Luitpold Steidle (1950–1958) and later Max Sefrin (1958–1971). According to the historians Udo Schagen and Sabine Schleiermacher, the medical “conservative bastion” would not “accept a member of the SED” as a minister.Footnote ¹⁶

However, another stream of scholarship has highlighted that although medical experts retained a certain independence, they had no political power in the East German system. As Jutta Braun pointed out in her recent monograph, the health-care ministers were rather decorative figures and had practically no decision-making power.Footnote ¹⁷ This is factually true if we consider the striking fact that neither Steidle nor Sefrin, the health-care ministers, were present at the Politburo meetings where some of the most important health-care topics were discussed. Indeed, Kurt Hager announced that Sefrin would replace Steidle just in passing as a “last remark” at the end of one of the meetings, and there were neither reactions nor discussion from the experts.Footnote ¹⁸ This type of functioning has led Braun and others to underscore that the power lay in the SED members, namely in figures like Maxim Zetkin and Erwin Marcusson who were already members of the Kommunistische Partei Deutschlands (German Communist Party, KPD) in the interwar period and who, after the postwar takeover, led the Party’s health-care policies. Zetkin and Marcusson were medical doctors, but their influence came due to their position as Politburo members, which reinforces the SED-controlled character of the East German health-care system.

Scholarship on the GDR has underscored this political component due to implicit or explicit comparisons with West Germany which, for instance, did not have a health-care ministry until 1960. Scholars compare the system of freelance doctors of the Federal Republic with the state-run East German system that forcefully integrated experts and medical professionals, who became part of a “paternalistic health care regime that tied comprehensive state care to fixed behavioral expectations.”Footnote ¹⁹ But a broader comparison shows that state-run centralized health-care systems were not unique to East Germany, nor even to the Eastern bloc. Scholarship addressing the creation of Great Britain’s National Health Service (NHS) has depicted a system of “mutual dependency” between medical experts and the state;Footnote ²⁰ Rudolf Klein called this the “politics of the double bed,” blurring the separation between politics and medicine.Footnote ²¹ After World War II, European states of all ideologies faced pressing health-care challenges; experts then acquired a central role, as their knowledge enabled them to solve problems that politicians could not resolve by themselves.Footnote ²² At the same time, unlike other experts, medical doctors are dependent on funding for technology and experiments, which in postwar Europe was provided by the increasingly interventionist states. The question of whether these experts were (civil) servants of the state is less compelling, as they were factually so in both Great Britain and East Germany. This “mutual dependency” shows that medicine and politics were interrelated, which does not overlook the fact that in East Germany the level of ideological surveillance and repression in medicine was higher than in democratic states.Footnote ²³

The main flaw of this argument is not the overemphasis on political control or repression, but rather the faulty syllogism that it is built on: the idea that if an ideologically driven state politically repressed some doctors, this somehow proves that the natural place of medicine should be separate from politics. The artificial separation between medicine and politics aligns, according to Mat Savelli, with the “popular tendency to understand science and medicine in Western Europe and North America as value-free, emerging in a climate void of ideology,”Footnote ²⁴ and by contrast socialist medicine as occupying a realm of ideological and political intervention that burdened its own development.

Savelli created a compelling theoretical framework for analyzing medicine in socialism. Investigating psychiatrists in Yugoslavia, Savelli distinguished between medical practices that were “socialist by design” and “socialist by default,” that is, those driven by a specifically socialist content and those which simply had “socialism as the backdrop.” Savelli made his case that psychiatry, a field that in socialism was heavily influenced by a Pavlovian approach, was socialist by design, leading to unsuccessful and problematic results. He argued that many, if not most, psychiatrists were only “socialist by default”; they worked within a socialist system but were part of the “broader evolution of the mental health care in the twentieth century.” Savelli does not understand “socialist by default” and “socialist by design” as irreconcilable opposites but as “interrelated, yet separate” phenomena.Footnote ²⁵ However, it is often difficult to delineate the border between the two, and historians often tend to highlight one or the other. As such, scholarship on East German medicine, especially when critically questioning totalitarianism theories, has opted for composing an image of a system that is implicitly only “socialist by default.” Following that line, many valuable studies have pointed out how organizational pragmatism was the leading principle in health care and medical expertise in the GDR. For a case study of pediatrics, for instance, Annette Hinz-Wessels showed that it was conservative doctors who occupied university chairs in postwar times. As a result, medicine in the GDR emerged as less totalitarian, not entirely controlled by the Party.Footnote ²⁶

Overemphasizing the concept of “socialist by default” might line up with the narrative of the “intelligentsia” versus the “Party”; this narrative is problematic. The concept of an “intelligentsia” has specific connotations. It is often associated with a long-lasting cultural capital derived from a post-gentry social class that, in countries like socialist Poland, retained its role as an autonomous elite able to shape culture, science, and politics.Footnote ²⁷ This argument can be applied to East Germany when considering the “conservative bastion” of university medical professors, who mostly came from “intelligentsia” milieus from the interwar period. However, the argument does not hold when considering the generational composition of the Politburo doctors: in the meetings, 80 percent of the experts were from a younger generation that lacked prewar prestige.Footnote ²⁸ In a study about the NHS, Rudolf Klein concluded that “the power of the medical profession derives not from its elite state but from its position as an organized group in a complex industry.”Footnote ²⁹ It could be similarly argued that the young generation of the Politburo doctors did not thrive within the system due to their inherited elite status, but rather due to their habitus and acquired scientific skills that were put to use by the East German state.

“Prophylaxis is the Best Socialism.” The Medical Habitus of the “Tenners” and the Construction of Socialism

The Politburo meetings with the doctors that started in 1958 summoned twenty-four of the main medical experts in East Germany. Four of them, 17 percent, came from a generation born between the 1890s and the 1900s. The remaining 83 percent, twenty out of twenty-four, came from a generation born between 1910 and 1920, referred to here as the “Tenners.” Scholarship on East Germany has highlighted the importance of generations. In a pioneering work, Catherine Epstein studied the “last revolutionaries,” those born at the turn of the century, like the medical doctor Erwin Marcusson (1899–76), who embodied the features of the Berufsrevolutionär (revolutionary professional). This generation shaped the birth of the GDR and conditioned its upcoming evolution.Footnote ³⁰ Dorothee Wierling and others studied the “Twenty-Niners,” those old enough to have seen the horrors of Nazism and the war, but too young to be actively involved in the conflict.Footnote ³¹ Unlike later generations, who were increasingly critical of the socialist system, the “Twenty-Niners” were the generation that sustained the GDR over its four decades because they received their university education in a socialist system and benefited from a quick upward mobility that made them more prone to be loyal to the system.Footnote ³² Indeed, in medicine there was quite a quick “structural change” of the profession as, according to Horst Spaar, by the 1960s more than half of the medical doctors had been socialized and received training in the GDR.Footnote ³³ At the time of the Politburo meetings in the late 1950s, the “Twenty-Niners” were still finishing or had just completed their PhDs, making them too young to be summoned by the SED to discuss politics and medicine at a high level. However, it is striking that only four of the twenty-four doctors were among the generation born around the turn of the century. This is even more surprising considering that Walter Ulbricht (born 1893), General Secretary of the SED, and Otto Grotewohl (born 1894), Chairman of the Council of Ministers, were their contemporaries, yet they chose to summon the “Tenners” rather than their contemporaries to discuss the most pressing health-care issues at the Politburo level. This challenges the narratives that emphasize either the centrality of the “conservative bastion” of doctors, who already held a strong position in pre-socialist Germany, or the political control of the “last revolutionaries,” both born around the turn of the century. The “Tenners” also benefited from the political relaxation that followed Stalin’s death. In April 1953, one month after Stalin died, medical doctors at a congress in Leipzig still felt compelled to praise the wonders of Soviet achievements, and protocols demanded strict adherence to Party directives.Footnote ³⁴ However, by the late 1950s, when the “Tenners” came to the forefront, as could be seen in the Politburo meetings, they enjoyed much greater leeway and were in a stronger position to challenge the Party.

The “Tenners” came from a generation with different life experiences and socialization, and they occupied a different position in East Germany after 1945. Mary Fulbrook has defined a “National Socialist generation” that encompasses people born between 1916 and 1925 and is marked by Nazi socialization and participation in the war.Footnote ³⁵ However, singling out this cohort is less useful for studying GDR medical experts, since those born in 1916 received a pre-socialist university education, either national socialist or abroad, but those born in or after 1925 mostly had their university training and education under socialist structures and therefore could be considered as the first offspring of the Regime, quite close to the “Twenty-Niners.” The “Tenners” did not receive medical training or university education under a socialist regime.Footnote ³⁶ Fifteen of the twenty “Tenners” who attended the Politburo meetings had a political past of leftist activism or opposition to the Nazi regime. The relationship between medicine and socialism was different for them than for the previous generation. With international experience and training in the latest medical breakthroughs, these experts became a valuable asset for socialism, which is why Politburo members predominantly relied on them rather than on previous generations. Unlike figures such as Maxim Zetkin or Erwin Marcusson, who were more invested in Party activities than in medicine and were not scholars but general Sozialhygieniker, most of the Politburo doctors were medical experts.

For the habitus of this generation, the medical vocation was parallel to their political beliefs; they did not naively believe that socialism would solve all the health-care problems, but rather that their skills as scholars would help construct socialism. These elements are present in the autobiographical accounts of some of the Politburo doctors. As Samuel Mitja Rapoport (1912–2004) recalled, speaking about his generation, “we endeavored to become effective in a country that was embarking on the path of the construction of socialism. And so, I turned down offers to work in capitalist countries.”Footnote ³⁷ Despite the propagandistic tone of this statement, the fact that some doctors in exile chose to install themselves in socialist Germany is empirically true. Kurt Scheidler (1914–2017) decided to move from the American to the Soviet occupation zone as there he could find “the opportunity to assert my medical and political views.”Footnote ³⁸ Postwar German medical doctors had greater power to decide than other nationalities, for they could go to the western occupation zones or to the neighboring German-speaking countries of Austria and Switzerland, to which some had prewar ties. This was the case for the pediatrician Eva Schmidt-Kolmer (1913–91), who was born, raised, and educated in Vienna, spent her exile in Switzerland and England, and landed in the Soviet occupation zone in 1946 to put forward her medical skills which, according to her, “for us communists […] it was customary and necessary.”Footnote ³⁹ In a similar vein, Rudolf Weber (1909–?) recalled that “after the war I did not go back to the Surgical University Hospital Erlangen in Bavaria, but to the Soviet occupation zone as my new home to help build a new order.”Footnote ⁴⁰

On the other hand, and despite political inclinations, medical expertise was in demand in East Germany; as such, and as part of a general phenomenon in the history of the GDR, this generation benefited from rapid advances in their professional careers.Footnote ⁴¹ This was the case of Rapoport himself, who spent his exile in the United States and decided in the early 1950s to move to East Germany where he was promised a prominent position from which to develop his specialty in medical biochemistry; Kurt Winter (1910–87), a medical doctor in the Spanish Civil War, after his exile in Sweden moved to Germany where he directed the Institute for Social Hygiene at the Humboldt University; and Helga Wittbrodt (1910–99), a participant in the German anti-Nazi resistance who was named director of the Berlin-Tempelhof hospital in 1946.Footnote ⁴² This window of opportunity was also open for doctors from this generation who were not leftists; in the Politburo meetings, 25 percent of the “Tenners” had a Nazi past. They had not enjoyed powerful positions in Nazi Germany, but were merely medical doctors in the Wehrmacht, as they were in their mid- to late-twenties during the war. After 1945, they did not have to undergo denazification; they were quickly integrated into the socialist state, where they thrived. Doctors with Nazi backgrounds from this generation did not mention their prewar and wartime activities in their memoirs or later writings, so it is difficult to know how much of a conflict their backgrounds created after 1945. However, when looking at the Politburo doctors’ political careers, they had an interest in the system that went beyond opportunism. One such doctor was Herbert Knabe (1918–2009), a Luftwaffe doctor who became an SED member and a co-founder of the Society for General Medicine of East Germany shortly after the war.Footnote ⁴³ But perhaps the most representative case is Michael Gehring (1918–69), a member of the Hitlerjugend and a Wehrmacht doctor on the Eastern Front, who enrolled in the SED in 1947 and forcefully defended socialist medicine. In 1958, as a result of the Politburo meetings, he became the deputy minister of health. The Central Committee appeared to trust this group despite their past; in the late 1960s, they selected Paul Steinbrück (1911–94), who had also come from a Nazi background but rapidly adopted a socialist approach, to give a speech taking stock of the changes made in health-care research and assistance. Steinbrück took credit for the successful eradication of tuberculosis, his area of expertise, and proclaimed that in the GDR “not only does science support the state, but the state also serves science.”Footnote ⁴⁴

After 1945, the “Tenners” shared a path shaped by their experiences and ideological commitments. This led them to develop a habitus that included support for the socialist system, aligning their professional roles with the broader political goals of East Germany during the early years of its socialist consolidation. Rapoport captured the generational experience present in the early years: “If I take an overview of this period from 1952 to 1960 in relation to the later development of the GDR […] I can see that all the essential foundations for this were laid during this period. Foundations that proved to be sustainable and promising for the future. Optimism, a fighting spirit, a sense of community and an epochal feeling, namely, to be involved in building the first socialist state in Germany inspired us and, through us, a future young generation.”Footnote ⁴⁵ However, this support was not solely political; it ran in parallel to the development of their expertise, which in some cases had a strong international recognition and reputation. Herbert Knabe was the co-founder of the International Society of Rural Medicine, and later the director of its European section; Karl-Heinz Mehlan (1916–2003) often published articles on contraception in international journals and was an activist and advisor to the international organization Planned Parenthood; Eva Schmidt-Kolmer was an international authority on childcare and participated in WHO symposiums even before East Germany became a member of the organization; virologist Konstantin Spies (1922–2005) was later part of the WHO executive board; Paul Steinbrück was a leader in tuberculosis research, organized international conferences, and later became part of WHO commissions on that subject; and Samuel Mitja Rapoport maintained his prewar links with Anglo-Saxon medicine and was widely read outside East Germany.Footnote ⁴⁶

Maxim Zetkin proclaimed that “socialism was the best prophylaxis”; in light of the expertise and the scientific performance of the generation of experts in the Politburo meetings, it seems more accurate to reverse the dictum and argue that for them prophylaxis, understood as health care, was the best socialism. Their expertise was a major asset in advancing the socialist project. For this generation, medical expertise and their trust in the socialist project—into which they had invested their faith and which had facilitated their successful careers—went hand in hand. Consequently, the supposed separation between medicine and politics proved entirely illusory. The Politburo meetings assisted the ascension of the “Tenners” as the main medical experts, as they were the majority of the reliable experts consulted by the Party. This was symbolically reflected in the replacement of Erwin Marcusson, born 1899, by Michael Gehring, born 1918, as the deputy minister of health, which was announced at the end of one of the Politburo meetings. However, although this generation quickly rose within the socialist system, this did not mean they were submissive to the Party. On the contrary, they often clashed with the Party to assert their views in the medical field.

Expert Jurisdiction in Relation to the Party and the Republikflucht

One of the issues that led to conflict was the Republikflucht. After the founding of the GDR in 1949, the East German socialist state faced numerous attempts by citizens to flee the country. These attempts were predominantly made by highly skilled professionals, including doctors, who sought better living conditions in other states, often West Germany, where they could earn higher salaries and enjoy a less-controlled professional life. The narratives about the Republikflucht have accurately described the poor working conditions and political grip over science that made many East German experts want to emigrate to Western countries. At the same time, both before and after the construction of the Berlin Wall, the secret services conducted surveillance of medical doctors who were suspected of intending to leave the country.Footnote ⁴⁷ The East German state could not afford to lose so much human capital, which was very much needed, in this case to build a proper health-care system. The 1958 communiqué had improved the working conditions of the medical doctors materially, in terms of better salaries and housing, and professionally, by making it easier to attend international conferences and have access to Western literature. However, the practical improvements were weak, and they neither alleviated the discontent nor decreased the Republikflucht.Footnote ⁴⁸ At the Politburo meetings between 1958 and 1960, the Republikflucht stood out as the most crucial problem.

Beyond the particularities of the case, how the medical experts treated the Republikflucht reflected their habitus and their relationship with the state and the Party. There was a stark contrast between what the “Tenners” said in the Politburo meetings and what they said about the same topic in other sources destined for a different audience. At a press conference with Western media in September 1958, the recently appointed deputy minister of health, Dr. Michael Gehring, dismissed Western criticisms and stated that the Federal Republic of Germany just wanted “to entice doctors to flee the country and mislead the population about the constantly worsening social situation.” That is, Gehring blamed West Germany for the manipulation spurring the Republikflucht.Footnote ⁴⁹ This position of unhesitating support for the Party line was maintained by some medical doctors in subsequent decades. In an unpublished memoir written in the late 1980s, Dr. Eva Schmidt-Kolmer expressed the following regarding the Republikflucht: “in 1958/61 the situation was at its worst […] exacerbated from year to year by the systematic and targeted poaching of qualified workers, who were lured to flee the country by all kinds of promises.” As she pointed out, “the Party and the government endeavored to overcome it” and they were partially successful. Yet, control of the situation was only achieved after August 13, 1961, when the Berlin Wall was erected. After that “we were finally free of the worst disruptions and provocations and the hemorrhaging of our economy and the brain drain and were able to redouble our efforts to complete the construction of socialism with redoubled vigor.”Footnote ⁵⁰ Both Schmidt-Kolmer and Gehring were seamlessly aligned with the position of the Party. Guided by the ethic of responsibility, they tried not to damage the socialist project publicly. However, during the Politburo meetings, they and other experts vehemently disagreed with the views of the Party and expressed opinions that radically contradicted their alignment with the Party in the public sphere.

In the opening intervention of a 1959 Politburo session, Werner Hering, who was the chief of the Central Committee Health Care department, and who was not a doctor, made it clear that “the opponent took advantage of the increased travel, conference visits, etc. to intensify ideological work among the members of the intelligentsia, and there was not enough counterweight from our side.” Hering elevated his alarmist tone and proclaimed that the “the enemy wants to carry out his work in such a way as to create unrest here.” The main question, however, was that “many doctors are fleeing the country, no one can stand it in the GDR […] You can read about the enemy’s plans in the Western press […] there is one case after another, we have lost professors in the GDR, the senior assistants are getting restless, the assistants too. In the future, we can expect an increased flight from the country by these very people.” Finally, he called on his listeners to “reckon with that,” which “only means countering the enemy’s work in our own offensive.”Footnote ⁵¹ His approach was clear; the problems related to health care—shortages of doctors, lack of materials and infrastructure, and professional complaints about health-care workers—were the fault of the Western enemy.

The experts forcefully countered Hering. The pathologist Rudolf Baumann (1911–88) dismissed the role of propaganda from “the enemy” and instead highlighted that the discontent and the threat of fleeing came from “difficulties with professional development, which is not clear for many young doctors right now.”Footnote ⁵² Gerhard Misgeld (1913–91), also a pathologist, stated: “we have such a situation with regard to various professors, for example, who cannot get a flat in [East ]Berlin, for whom the situation then becomes so acute, so dangerous, that we are then faced with the situation that we lose them.”Footnote ⁵³ Most of the interventions underlined that the problem lay in the poor working conditions and defended a program of salary increases and more generous funding for scientific activities, including other international conferences, that would be reflected in the 1960 communiqué. The experts formulated this as a joint program; Schmidt-Kolmer asserted that these “scientific-political and health-political proposals are echoed by everyone, including the most conservative doctors.”Footnote ⁵⁴ The arguments anchored in expertise prevailed, but the doctors went further and even indicated that the Party was responsible for the situation. As Schmidt-Kolmer put it: “There are undoubtedly still a number of ideological dangerous elements in the situation, for example sectarian attitudes in the Party itself […] for instance the attitude of a comrade, who is also an employee in the Ministry of Health, who declared in her Party group that this whole salary regulation is the result of the blackmail of the non-Party doctors against the government. So, that’s one side we have to fight with, but comrades, these things are damaging us and the other side [the West] is becoming stronger.”Footnote ⁵⁵

Schmidt-Kolmer blamed the Party but argued from the perspective of a “comrade,” positioning herself within a quarrel among equals. Her aim was to improve the specific situation of medical doctors while also addressing broader questions about the relationship between experts and the state. Similarly, Rudolf Weber stated that “the underestimation of the work with the medical intelligentsia, which could also be described as sectarianism, is because our district leadership does not place emphasis on this task.” As experts within the system “we need the authority of the Party, but we also need the district leadership to be available to us,” that is, that the expert guidelines could be more consistently echoed in the health-care decision-making.Footnote ⁵⁶

The Party and the ideological struggle were important, yet to further advance in the construction of socialism it was necessary to avoid sectarianism. As psychiatrist Dietfried Müller-Hegemann (1910–89) argued: “I think we all agree about the way in which the social and ideological preconditions were set” but “the first thing we should do is better planning of science and research” and highlighted the “extraordinary activity is being developed by the non-Party professors of the faculty in the most diverse questions, be it the reorganization of the curricula or the question of the reorganization of the Charité.”Footnote ⁵⁷ Schmidt-Kolmer affirmed that the point at stake was “how we can contribute to the great tasks of the victory of socialism,” but asserted that it was to be accomplished scientifically; she further defended expert jurisdiction and argued that the joint program to improve conditions was based on “ideas [that] are so strong, they are so much in line with the doctors in their own field, in their own professional interests, that even conservative people could not close their minds to these things.”Footnote ⁵⁸ Central Committee representative Hering had to agree with the expert inputs and recognized not having “succeeded to a sufficient extent” in what applied to “salary regulations.” The 1960 communiqué, approved after the Politburo meetings, included salary increases, better funding conditions for scientific programs, and easier possibilities to travel abroad, which reflected most of the demands made by the experts.

Hering accepted that “there were several mistakes in the treatment of the medical intelligentsia due to the failure to heed their suggestions and criticisms.” However, he maintained his position and emphasized that the West was still encouraging Republikflucht. Talking about a specific case raised by one expert, Hering expressed that “he has left our country, simply left, there can be no discussion at all.” There should not be any benefits to “whoever goes against our country.”Footnote ⁵⁹ The experts unanimously countered this position. Schmidt-Kolmer stated that the Republikflucht had “decreased in recent months.” This was not factually true; in 1959, it was growing, but some doctors used the argument to frame the problem differently. The question was how to reverse the trend: to prevent medical doctors from fleeing and also to call for them to come back to East Germany. For that matter, some experts highlighted “increasing cases of doctors negotiating with the state authorities regarding a return.”Footnote ⁶⁰

Most doctors used a utilitarian argument, saying that East Germany needed as many doctors as possible to alleviate the health-care problems. Müller-Hegemann addressed the issue by posing a rhetorical question: “Do we actually give enough thought to the fact that citizens of our republic die every day or suffer serious health problems because there is a lack of medical care?”Footnote ⁶¹ Others argued similarly, aiming to put pressure on the Central Committee; Schmidt-Kolmer underscored the need to work on those cases where “we cannot return them to the GDR.” The hurdles to such returns included a legal one. The East German state had repressive legislation for those caught fleeing the country and also criminalized the act of defection. Punishments included confiscation of property; should individuals return, they could be barred from returning to their jobs and even face imprisonment. Before the critical situation and the shortage of doctors, the medical experts pressed the Politburo to act reasonably and support such returns. After the forceful discussion, the experts’ approach prevailed and it was agreed that there should not be any legal penalty to those who returned: “Regarding questions of the return of doctors and criminal law provisions, etc. It is not possible to repeal provisions in the passport law that are about this, but it is an optional provision and it depends on whether a corresponding criminal complaint is filed on the part of the public prosecutor’s office and the state organs. It is in our hands, and no criminal complaint will be filed, and the return will be supported from all sides.”Footnote ⁶²

The outcome of the Politburo meetings in this regard represents a victory for the doctors over the Party, as they succeeded in having most of their demands approved. However, this should not be interpreted as a triumph of science over politics but rather as an expansion of the experts’ jurisdiction within the East German state. Politics remained present in different forms throughout the meetings, making it difficult to draw a clear distinction between experts and politics.

Ethic of Responsibility and Censorship

In parallel to the quarrel in which experts pressed the Politburo to relax and improve the conditions for non-Party doctors and those who fled the country, some of these experts put ideology center stage and pushed for the censorship of one medical colleague, the physician Rudolf Neubert. Neubert (1898–92) had a Nazi background as a medical doctor but refurbished his past and became a very popular and widely read expert in marriage and child-related medical topics.Footnote ⁶³ The attempt to censor one of his books, which was ultimately unsuccessful, had peculiarities that further illuminate the intellectual stance of the socialist experts and their position in relation to the Party. The publication that the experts sought to censor was Principles of Social Hygiene, a general textbook intended for medical students that summarized key findings and the latest principles of medicine and health care. The book did not introduce much novelty nor contain reactionary content. It was dismissive of Pavlov’s methods, to which it devoted little space, but overall, it presented a scientifically compelling approach. At the same time, it upheld the egalitarian perspective—both in terms of gender and social class—that was characteristic of East German medicine.Footnote ⁶⁴

In the first years of East Germany, censorship of medical writings affected mostly publishing houses and books, but it lacked a fixed procedure.Footnote ⁶⁵ Regarding medical journals, some scholars have asserted that censorship had mostly to do with removing “Nazi and militaristic” content, but also avoiding criticism of the health-care conditions in the GDR and underscoring the socialist project.Footnote ⁶⁶ However, censorship in journals was rare, although it existed,Footnote ⁶⁷ and journals, conferences, and academic writings widely cited non-socialist authors and often directly criticized measures taken and wrong approaches, including by Soviet medical experts.Footnote ⁶⁸

During one Politburo meeting the medical doctor Kurt Winter approached the Central Committee representative Kurt Hager on a question “of great importance.” According to Winter, “the major publishing houses that publish medical literature here are all nationally owned” but “working together does not work at all” because “now, for example, comrade Neubert has published a third book on social hygiene, contrary to the advice of all the social hygienists.” He questioned the publication; Hager replied, “So, Neubert’s book should not be published at all?” Winter responded plainly: “No, it should not appear.” As a justification, Winter asserted that the publication “in and of itself would not be a bad thing if it did not have an ideological effect that threatens all of our work, because what’s in this book is not true.”Footnote ⁶⁹

The disposition to censor the publication expressed by Winter was shared by fellow doctors present at the meeting, as is reflected by the “exalted reactions” recorded in the Politburo proceedings. To Hager, the demand came as somewhat of a surprise; Hager half-jokingly expressed that the success of the works by Neubert and the publication of his third book about social hygiene was “possible because you have not written a better one yet!” This was received with noises and gestures of disapproval by the experts. In response, Hager went further, asking “Why should a scientist be unable to express himself?”Footnote ⁷⁰

The crucial factor that pushed the experts to question the book was the fact that given Neubert’s enormous popularity, the book would reach a general audience that included students and lay people.Footnote ⁷¹ The doctors were not calling to censor a scholarly publication, but a general one. As a medical doctor said during the discussion, the “book will certainly circulate among students, which would torpedo all our efforts.”Footnote ⁷² What concerned the experts, as expressed by Winter, was: “It publishes the entire 1934 law with all the racial clauses in full. About Pavlov’s teaching, it says: ‘Well, Pavlov said what prophylaxis is; but you cannot make anything of that!’—and this continues throughout the book. How is this possible? I do not understand it.”Footnote ⁷³

The rationale for censorship is not clear-cut. While the 1934 law contained racial clauses, the book highlighted these as things to avoid and actively criticized Nazi medical practices. The real issue seemed to be its dismissive tone toward Pavlov. East Germany had “an intense but brief love affair with Pavlov,” which permeated their general approaches to medicine and was the translation of Soviet influence.Footnote ⁷⁴ However, when it came to actual East German medical practices like “sleep therapy” or painless childbirth, Pavlov’s methods were either underused or abandoned after the late 1950s and early 1960s, as they were not effective.Footnote ⁷⁵ Yet, Pavlov’s general theory continued to influence textbooks, even though it was increasingly questioned by the East German experts’ research and practice. Medical experts had the responsibility to defend the general socialist approach to medicine in public because, as put by Winter, “after years of ideological struggle in our field, we have achieved certain results” that the book was partially calling into question.Footnote ⁷⁶ The ethic of responsibility is well reflected in a statement by Rudolf Baumann, who also supported censoring the book: “There are tendencies, especially based on the Politburo communiqué and subsequent statements, that we must consider, namely, the idea that we can now write freely, conduct research freely, and publish anything. But we need to find a balance. If we are confident that no controversy will arise, we can allow some ideologically questionable content. However, if we are unsure, we risk publishing misleading material with lasting effects.”Footnote ⁷⁷

This specific example does not indicate a general will among the experts to censor their medical colleagues. In East German medical academic culture, authors from all the ideologies, including those from capitalist countries, were constantly read and referenced. Yet, the narrower the circulation, the freer the expression, and as such scholarly publications might contain multiple allusions to any kind of approach, but for books, especially those intended for a general audience, the ideological component was stronger. Medical experts discussed subjects freely within their academic field, but they tried to maintain a distinctive socialist approach in the public sphere. Winter explained this principle to Hager: “I want to clarify that for you. Comrade Neubert can express himself in every question; but he should only write a textbook when the comrades collectively have really discussed it. It is not so easy to publish a textbook for students in a field that plays an ideologically important role, namely medicine.”Footnote ⁷⁸

Hager, who expressed reluctance to censor the book, realized the importance of the question. In his response, he extended a claim to censor the book and further to strengthen the control of the “state secretariat” on the books published in the field of medicine. The medical experts wanted to take advantage of a state intervention on a specific matter, but their question backfired; Hager suggested that “the state secretariat is responsible for what is taught at the universities” and should therefore more carefully monitor any books published.Footnote ⁷⁹ This intervention annoyed the medical doctors, but their annoyance was initially expressed in a calm comment from Winter, who suggested that “the commission should not be burdened with this.” Hager replied, “Don’t talk nonsense! Excuse me if I say so crudely but published books need the confirmation of the state secretariat.” Then the experts shouted in unison, “That’s news to us! We didn’t know that!” and “That’s a mistake!”Footnote ⁸⁰ That point of friction illustrates how the medical habitus of socialist experts had the responsibility to defend East German medicine, but this did not mean absolute submission to the Party. Although all the parts in the discussion defended socialist medicine, in that particular discussion the task of the experts emerged as a distinctive field separated from the Party lines.

As the discussion closed, one of the experts reinforced “one should not restrict the scientific discussion—that would be quite wrong—but where ready-made doctrines for the education of our offspring are published, a certain standard of ideological and professional conditions are required.”Footnote ⁸¹ Medical experts indeed called for checks in the field but done by themselves and not by the state secretariat, whose intervention “should only apply to a small selection of textbooks.” They wanted Hager to enhance their control through “better coordination with the state-owned publishing houses”; that is, they wanted to expand their room to maneuver.Footnote ⁸² They did not succeed, and Rudolf Neubert’s books and influence only grew over time.Footnote ⁸³ Indeed, the discussion showed how slippery the terrain was and how in some areas the experts were more dependent on the state than vice versa and that their claims for control could eventually backfire and result in the state having more control. However, censorship in East Germany did not grow over time.Footnote ⁸⁴

The “Tenner” generation of medical experts continued to express their loyalty to the system and state through their “ethic of responsibility.” There were individuals, such as Müller-Hegemann, for whom the contradictions within the system became overwhelming. Faced with these tensions, he eventually left East Germany and rejected socialism.Footnote ⁸⁵ However, the rest of the medical experts in the Politburo meetings retained their influential position over time. While they used the ethic of responsibility to justify the censorship of a medical colleague, they applied it to themselves as well. The heated discussions at Politburo meetings and their quarrels with the Party were presented as unproblematic, as seen in Schmidt-Kolmer’s memoirs. Referring to Hager, she expressed the outcome of the Politburo meetings as: “The development and consolidation phase in medicine and health care, which took place despite the Republikflucht, culminated in the health conference held in Weimar in February 1960. There, comrade Kurt Hager took stock of the situation and, after an in-depth discussion, adopted a prospective plan for the medical sciences […] developed with contributions from more than 800 scientists and employees from a wide range of health care institutions.”Footnote ⁸⁶ This ethic of responsibility illustrates how crucial it was for the “Tenners” to defend the political project of socialist East Germany.