Like the euthanasia crimes of [Fascism], the murder of tuberculosis patients in special facilities had a long backstory. As early as the 1920s, lung specialists and other experts responsible for treating tuberculosis paved the way for decisions and actions under [the Third Reich].

Ultimately the decisions of the 1920s culminated in the comprehensive monitoring of tuberculosis patients, their forced transfer to such special facilities and finally their killing through deliberate neglect, including inadequate nutrition. What is more, by constructing the tuberculosis patients as ‘deviant sociopaths’, these experts helped engender social norms that encouraged their exclusion, which prepared the ground for more radical actions under [German Fascism].⁷

[…]

The First World War was also a positive reference point for some doctors whose thinking was particularly radical. They learnt that the situation of war and crisis favoured those social developments that they advocated. A striking example is provided by Berthold Kihn. In 1932 the psychiatrist and later director of the special facility for ‘deviant’ tuberculosis patients in Stadtroda published a paper in the Allgemeine Zeitschrift für Psychiatrie, a major psychiatric journal.

Shortages during the First World War had also had their good side, Kihn proposed: the Hunger Years ‘truly cleaned out things among inmates of insane asylums’, an allusion to the nearly 70,000 psychiatric patients who starved to death in German health facilities between 1914 and 1918.²⁸ The naval blockade by the Entente Powers had led to major supply bottlenecks in the German Reich, which had most affected the weakest members of society.

Government food officials and facility directors had calculated that supplies for the ‘insane’ should be diverted in times of emergency to social groups regarded as more important. Belinda Davis, among others, has studied the hierarchy in the food supply: the military were at the top, followed by population groups important to the war effort, such as industrial workers; at the very bottom were the ‘useless’ inmates of prisons and other penal institutions²⁹

Thus, as Davis shows, there was a sharp divide between ‘food for the strong’ and ‘food for the weak’. Here was much more than a philosophy, well before the [Fascist] takeover of power, that was based on a differential valuation of human life. Such considerations, I contend, ultimately led to the actions of a relatively small group of lung doctors and psychiatrists who rapidly rose to leading positions and, like Kihn, after 1933 organized and implemented the forced incarceration of tuberculosis patients.

[…]

We do not know precisely how many tuberculosis patients lost their lives to negligent care and patient murder. The special facilities did not maintain separate statistics for deliberate deaths and, additionally, there are large gaps in the available records. We can, however, estimate those figures. Through the files preserved from Karthaus, for example, we know that of the 391 persons with tuberculosis committed to that special facility between 1939 and 1945, about 20 per cent died.

While that figure includes instances where the patients died of tuberculosis, this number suggested a death rate much higher than the peacetime death rate among psychiatric inmates. According to official medical statistics, prior to the First World War and in the interwar period the annual mortality rate for those admitted for psychiatric reasons was 7 to 8 per cent.⁹⁹

We therefore have reason to conclude that between 1933 and 1945, a considerable proportion of forcibly interned persons with tuberculosis died as the result of deliberate starvation. If we assume 12 per cent excess mortality, then of the approximately 30,000 patients interned in the special facilities, up to 4,000 would have died as a result of the conditions of their detention rather than from their disease.

(Emphasis added. Note the continuities between the Weimar Republic and the Third Reich.)