[MacCAT-T between Claim and Practice - Challenges of Assessing Capacity for Consent in Dementia]. / MacCAT-T zwischen Anspruch und Praxis ­ Herausforderungen bei der Beurteilung von Einwilligungsfähigkeit bei Demenz.

BACKGROUND: Consent is a prerequisite for medical diagnostic and therapeutic action. There is no standardised procedure for assessing the ability to give consent. The most widely used tool for structured assessment is the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). OBJECTIVES: People with dementia have impaired capacity to consent because of their disease. In order to answer the question to what extent structured assessment procedures can be usefully applied to people with dementia, we analyse the function, strengths and weaknesses of structured assessment procedures with a focus on the MacCAT-T and discuss suggestions for modification and further development of the tool. METHODS: Using the PubMed literature database, a systematic literature search and analysis was conducted on papers published since 2010, following PRISMA guidelines.Results Although the MacCAT-T is a valid and reliable tool, it cannot comprehensively address memory problems in people with dementia. It primarily measures cognitive functions. However, Decisions based on emotions, intuitions and values, are not captured by the MacCAT-T. Communicative limitations in people with dementia are not taken into account. CONCLUSIONS: It is recommended to provide information in simple language, written down and visualised for people with dementia. The development and elaboration of a graduated procedure for the examination of capacity to consent is indicated. The gradations of the scope and depth of the assessment to be determined should be based on the severity of the cognitive impairment, the benefit/risk ratio of the proposed medical intervention and the individual profile of affective functions and value-based imprints.

Artifical intelligence use in orthopedics: an ethical point of view.

Artificial intelligence (AI) is increasingly being utilized in orthopedics practice. Ethical concerns have arisen alongside marked improvements and widespread utilization of AI. Patient privacy, consent, data protection, cybersecurity, data safety and monitoring, bias, and accountability are some of the ethical concerns.

Highly varying concepts and capacities of forensic mental health services across the European Union.

Introduction: There is wide variation in the processes, structures and treatment models for dealing with mentally disordered offenders across the European Union. There is a serious lack of data on population levels of need, national service capacities, or treatment outcome. This prevents us from comparing the different management and treatment approaches internationally and from identifying models of good practice and indeed what represents financial efficiency, in a sector that is universally needed. Methods: From March 2019 till January 2020 we surveyed forensic psychiatric experts from each European Union Member State on basic concepts, service capacities and indicators for the prevalence and incidence of various forensic psychiatric system components. Each expert completed a detailed questionnaire for their respective country using the best available data. Results: Finally, 22 EU Member States and Switzerland participated in the survey. Due to the frequent lack of a clear definition of what represented a forensic psychiatric bed, exact numbers on bed availability across specialized forensic hospitals or wards, general psychiatric hospitals or prison medical wards were often unknown or could only be estimated in a number of countries. Population-based rates calculated from the survey data suggested a highly variable pattern of forensic psychiatric provision across Europe, ranging from 0.9 forensic psychiatric beds per 100,000 population in Italy to 23.3 in Belgium. Other key service characteristics were similarly heterogeneous. Discussion: Our results show that systems for detaining and treating mentally disordered offenders are highly diverse across European Union Member States. Systems appear to have been designed and reformed with insufficient evidence. Service designers, managers and health care planners in this field lack the most basic of information to describe their systems and analyse their outcomes. As a basic, minimum standardized national reporting systems must be implemented to inform regular EU wide forensic psychiatry reports as a prerequisite to allow the evaluation and comparison of the various systems to identify models of best practice, effectiveness and efficiency.

Artificial Intelligence in Reproductive Medicine - An Ethical Perspective.

Artificial intelligence is steadily being integrated into all areas of medicine. In reproductive medicine, artificial intelligence methods can be utilized to improve the selection and prediction of sperm cells, oocytes, and embryos and to generate better predictive models for in vitro fertilization. The use of artificial intelligence in this field is justified by the suffering of persons or couples who wish to have children but are unable to conceive. However, research into the use of artificial intelligence in reproductive medicine is still in the early experimental stage and furthermore raises complex normative questions. There are ethical research challenges because evidence of the efficacy of certain pertinent systems is often lacking and because of the increased difficulty of ensuring informed consent on the part of the affected persons. Other ethically relevant issues include the potential risks for offspring and the difficulty of providing sufficient information. The opportunity to fulfill the desire to have children affects the welfare of patients and their reproductive autonomy. Ultimately, ensuring more accurate predictions and allowing physicians to devote more time to their patients will have a positive effect. Nevertheless, clinicians must be able to process patient data conscientiously. When using artificial intelligence, numerous actors are involved in making the diagnosis and deciding on the appropriate therapy, raising questions about who is ultimately responsible when mistakes occur. Questions of fairness arise with regard to resource allocation and cost reimbursement. Thus, before implementing artificial intelligence in clinical practice, it is necessary to critically examine the quantity and quality of the data used and to address issues of transparency. In the medium and long term, it would be necessary to confront the undesirable impact and social dynamics that may accompany the use of artificial intelligence in reproductive medicine.

[Franz Büchner's wartime hypoxia research and the Nobel Prize]. / Franz Büchners Hypoxieforschung aus der Kriegszeit und der Nobelpreis.

BACKGROUND: Between 1901 and 1953, a total of 5110 persons were nominated for the Nobel Prize in Physiology or Medicine. This time period spans both world wars and touches on the question of how the Nobel Committees dealt with German prize candidates. PURPOSE: The nominations of the German pathologist Franz Büchner for the Nobel Prize will be used to examine the extent to which it played a role in the awarding of the prize if some of the research results to be honoured were obtained during the National Socialist era. The article also presents an overview of all pathologists from Germany who were nominated for the Nobel Prize during the first half of the 20th century. MATERIALS AND METHODS: Data from the nomination archive in Stockholm as well as nomination letters and expert opinions of the Nobel Committee (Nobel Archive) were analysed. Franz Büchner's nomination is examined in more detail as an example, because the nominators justified their proposal with Büchner's publications traced here, that in part originated from the National Socialist era. RESULTS AND DISCUSSION: Franz Büchner was nominated by three German professors in 1963. Both areas for which he was to be awarded concerned his research on the influence of oxygen deficiency on the function and development of the human organism. In the end, Büchner's achievements were deemed not worthy of the Nobel Prize. His role as a military researcher during National Socialism and the knowledge of hypoxia acquired during this period do not seem to have had a negative impact on the Nobel Prize evaluation.

[Persecution, expulsion, annihilation. Neurologists in the NS era-For active remembrance]. / Verfolgung, Vertreibung, Vernichtung. Neurologinnen und Neurologen in der NS-Zeit ­ Für ein aktives Erinnern.

The German Neurological Society (DGN) has commissioned historical research related to the expulsion and murder of German-speaking neurologists during the National Socialism era (NS). Intended as an introduction to the following background essays and biographies in this special issue of Der Nervenarzt, this article summarizes the results and perspectives of medical historical research addressing the persecution of German physicians. Additionally, it shows how the current project of the DGN fits into the context of an interdisciplinary culture of commemoration by a confrontation with National Socialism. Of particular importance for the DGN is that it was founded as the successor to the Society of German Neurologists (GDN), which was dissolved in 1935. In the early stages of the NS era, the GDN was the professional home of numerous Jewish specialists and those labeled "Jewish" by NS law, who were expelled from Germany and (after the "Anschluss" of 1938) from Austria, deported to concentration camps or driven to suicide. With this in mind, "persecution", "expulsion", and "extermination" raise not only questions of collegiality, decency, and morality. Investigating and remembering this era also affects today's public image of the neurological specialist society and constitutes an important part of its culture of remembrance and its history politics.

[Legalized deprivation of rights: on the legal construction of dismissal and expulsion under National Socialism]. / Legalisierte Entrechtung: zur juristischen Konstruktion von Entlassung und Vertreibung im Nationalsozialismus.

In order to provide a deeper understanding of the mechanisms and background leading to the persecution and expulsion, particularly of physicians labelled as "Jewish" in Nazi Germany, this article outlines their gradual disenfranchisement, through laws and decrees in the years 1933-1939. As the publicly visible terror immediately after the Nazi takeover was rejected in large parts of society, the regime resorted early on to supposedly legal forms of exclusion. With the Law for the Restoration of the Professional Civil Service of 7 April 1933, "non-Aryan" (§â€¯3) and politically unreliable (§â€¯4) persons could be removed from office, if necessary, even without any further comment (§â€¯6). However, regulations for long-standing civil servants as well as the "front-line fighter privilege" reduced the desired effect, e.g. in university medicine in a way that was not intended by those in power. The Reich Citizenship Law of 1935, as part of the so-called Nuremberg Laws introduced the criterion of "German blood". This resulted in a second large wave of dismissals. Outside the universities, a plethora of further defamatory legal norms, from the regulation on the approval of physicians for activities with the health insurances and the Law on Honorary Appointments (both in 1933), the so-called Flag Decree (1937) and withdrawal of the approbation (1938), aimed at the gradual "elimination" of Jewish physicians, which for many of them ended in extermination in the Holocaust. This practice implemented over years was based on a jurisdiction devised especially for that purpose and in hindsight it has been perfectly defined as "legal injustice".

[The exclusion of "non-Aryan" scientists: universities, clinics and professional organizations]. / Der Ausschluss "nichtarischer" Wissenschaftler: Universitäten, Kliniken, Standesorganisationen.

With the implementation of the Law for the Restoration of the Professional Civil Service (1933), including the Third Implementation Decree (1934), the Regulation for Obtaining a Teaching License (1934) and the Law for the Dismissal and Transfer of University Teachers (1935), the National Socialist (NS) government created legislative instruments to ban university staff (from lecturers to full professors) labelled as Jewish or considered politically unwanted from teaching and research. Whereas around 20% of the staff at the universities were affected by these measures after 1933, at various medical faculties the figures reached 30-40% and at neurological departments and institutes sometimes up to 90%. Student Nazi activists played a significant role in expelling faculty members from office. As beneficiaries of the expulsions, young doctors often improved their career prospects and established professors remained silent out of political conviction, opportunism or fear. A (self) coordination (Gleichschaltung) with immediate or gradual exclusion of "non-Aryan" members and boards is documented for numerous medical organizations and associations (e.g. Deutscher Ärztevereinsbund, Hartmannbund, German Medical Women's Association, Association of Statutory Health Insurance Physicians) as well as for scientific academies (e.g. Leopoldina) and research societies (Kaiser Wilhelm Institutes, German Research Foundation). The NS-loyal Society of German Neurologists and Psychiatrists, which had been founded in 1935, tolerated "Jewish" members until 1938. As a whole, the picture that emerged from everyday medical (and neurological) practice is one of drastic changes that massively affected not only the lives of many doctors but also the moral standards in terms of patient care, teaching, research and collegiality.

[Context of the emigration of Jewish neurologists (1933-1939)]. / Rahmenbedingungen der Emigration jüdischer Neurologinnen und Neurologen (1933­1939).

This article focuses on the historical context of the emigration of "Jewish" doctors during the "Third Reich". The approximately 9000 Jewish physicians, who were still able to emigrate, represented 17% of the German medical profession in 1933. Around three quarters of them left the German Reich by 1939, mainly for the USA, Palestine and Great Britain. Initially, Jewish organizations fueled hopes of a temporary exile; however, in the wake of the events of 1938 ("Anschluss" of Austria, failure of the Evian Conference, establishment of the Central Office for Jewish Emigration headed by Adolf Eichmann in Vienna, maximization of economic plundering etc.) emigration via the intermediate step of forced emigration had turned into a life-saving flight. Scientists could appeal to special aid organizations for support. Among the best known are the Emergency Community of German Scientists Abroad initiated in Zurich, the Academic Assistance Council founded in England, from which originated the Society for the Protection of Science and Learning as well as the Emergency Committee in Aid of Displaced German Scholars created in New York. Their help was often subject to criteria, such as publication performance, scientific reputation and age. Promising researchers who were awarded a scholarship before 1933 could rely on a commitment from the Rockefeller Foundation. The historical analysis of options and motivations but also of restrictions and impediments affecting the decision-making process to emigrate, provides the basis for a retrospective approach to individual hardships and fates.

[Late forced emigration without perspectives: Alfred Hauptmann and Adolf Wallenberg]. / Späte Zwangsemigration ohne Perspektive: Alfred Hauptmann und Adolf Wallenberg.

Archival documents and further biographical testimonies reveal that dismissal and expulsion on racist grounds also affected neurologists in leading clinical positions and at an advanced age. Alfred Hauptmann (1881-1948), full professor for neurology and psychiatry in Halle/Saale, member of the Leopoldina and discoverer of phenobarbitone treatment for epilepsy, emigrated first to Switzerland and then to the USA after the anti-Jewish pogroms in November 1938 and a subsequent "protective custody" imposed on him at the age of 58 years. Adolf Wallenberg (1862-1949), a self-made neurologist, described the syndrome later named after him in 1895. As a clinician he carried out research in the field of neuroanatomy until the National Socialists ousted him from his workplace in Danzig. At the age of 77 years, he emigrated to the USA via Great Britain, but did not manage to settle down again in his profession. For both physicians, neurology was their purpose in life, they felt patriotically attached to their home country and saw no future for themselves after their late forced emigration. Hauptmann is today commemorated by an award for experimental and clinical research on epilepsy, Wallenberg by the German Neurological Society award for outstanding achievements in the fields of cerebrovascular diseases, brain circulation and brain metabolism.

[Persecuted and forgotten? The neurologists Kurt Goldstein and Friedrich Heinrich Lewy]. / Verfolgt und vergessen? Die Neurologen Kurt Goldstein und Friedrich Heinrich Lewy.

This paper commemorates the careers and the scientific influence of the clinical neurologists Kurt Goldstein and Friedrich Heinrich Lewy including their forced migration in the mid-1930s. Goldstein (1878-1965) set up independent neurological departments in Frankfurt/Main and Berlin, adopting a decidedly holistic approach in medical care, research and teaching. He is therefore considered a co-founder of modern neuropsychology and neurorehabilitation. Goldstein came into the focus of the National Socialists as a Jew, socialist and adherent of psychotherapeutic methods. After a short incarceration he fled via Switzerland and Holland to the USA. Lewy (1885-1970) for his part specialized in neuropathological examinations and in 1912 quickly discovered the inclusion bodies in the cytoplasm of nerve cells named after him. As head of a neurological institute in Berlin with inpatient beds, he decided to leave Germany as early as 1933 and arrived after a stopover in England in the United States one year later. The biographies of the two highly innovative neurologists illustrate that career opportunities for doctors of Jewish descent were already clearly limited during the Weimar Republic and that they had to face anti-Semitic tendencies even after their arrival in the USA.

[Disparate lives: Ludwig Guttmann and Robert Wartenberg]. / Disparate Lebenswege: Ludwig Guttmann und Robert Wartenberg.

The neurologists Sir Ludwig Guttmann and Robert Wartenberg had a number of things in common, e.g., both enjoyed high international recognition for the clinical care they provided to paraplegics and for their contributions to the development of neurological diagnostics. Both were born before 1900. Both were classified as "Jewish" by the National Socialist regime because of their origins. Both had to flee from Germany in the 1930s but nevertheless did not appear to harbor any grudges after 1945; however, both also show differences even more than similarities. Guttmann (1899-1980) stood up for those persecuted, for instance during the November pogroms in 1938. After his late emigration, he soon found a new home in England. His skills in neurosurgery enabled him to convert a military hospital into the world's leading treatment center for spinal cord injuries. He was the founder of the Paralympic Games and received a knighthood from Queen Elizabeth II. In 1971 the German Neurological Society (DGN) awarded him with a late honorary membership during the presidency of the former SS captain Helmut Bauer. In contrast, Robert Wartenberg (1886-1956) found a new neurological home at the University of California in San Francisco and published numerous books, some of which also attracted attention in the German translation. On various occasions, he opposed the remembrance of National Socialist injustice and even justified the "concurrent research" in conjunction with "euthanasia".

[" no reservations against the dismissals": the expulsion of neuroscientists from Berlin]. / " keinerlei Bedenken gegen die Entlassungen": die Vertreibung von Neurowissenschaftlerinnen und Neurowissenschaftlern aus Berlin.

Before 1933 Berlin was considered a center of clinical neurology and neuroscientific research in the German Reich. Using a group biographical approach and drawing upon scattered secondary literature as well as upon various archival documents, this article provides an overview of 12 less well-known physicians and researchers who were forced into exile during the nationalsocialist (NS) era, primarily for racist reasons. Among those affected by NS persecution were Franz Kramer and Fredy Quadfasel (Charité), Ernst Haase, Carl Felix List, and Lipman Halpern (Moabit Hospital), Paul Schuster (Hufeland Hospital), and Clemens Ernst Benda (Augusta Hospital). Others who were forced to emigrate were Franz Josef Kallmann (Herzberge Sanatorium), Max Bielschowsky, and Hans Löwenbach (Kaiser Wilhelm Institute for Brain Research), Otto Maas (Berlin-Buch Clinic), and Kurt Löwenstein (Lankwitz). A total of 6 neurological departments at municipal hospitals were run by (in NS terminology) "non-Aryans" in 1933. With their expulsion, the existence of neurological treatment and training centers outside the university ended and did not resume until the 1960s.

[Radicalization and "forced emigration": the dismissal and expulsion of neuroscientists and neuropsychiatrists from Vienna]. / Radikalisierung und "forcierte Emigration": die Entlassung und Vertreibung von Neurowissenschaftlern und Neuropsychiatern aus Wien.

Austria's so-called annexation (Anschluss) to Germany from March 1938 was followed by the ousting of "Jewish" doctors out of Vienna which happened faster and with more brutality than in the "Old Reich". According to National Socialist (NS) criteria, 92% of the neurologists at Vienna University were understood as being "non-Aryan". Victims of these expulsions were prominent figures, such as the head of the Neurological Institute Otto Marburg (1874-1949), a renowned multiple sclerosis researcher, and his pupil Ern(e)st Spiegel (1895-1985), a pioneer of stereotaxis. Similar to Berlin, nonuniversity departments of neurology were run by doctors who served as professors at the university, e.g., Josef Gerstmann (1878-1967) and his assistant Ilya Mark Scheinker (1902-1954). While these four continued their careers in the USA, the founder of neuroradiology Arthur Schüller (1874-1957) was able to flee to Australia. Hans Hoff (1897-1969) was part of the small group of returning emigrants, who in 1950 was appointed as the chair of psychiatry and neurology. The fate of the neurologists Ernst Sträussler (1872-1959) and Erwin Stransky (1877-1962) appears to be exceptional: both were dismissed and banned from teaching and practicing, but being married to "Aryan" wives spared them further persecution. Overall, within a short period of time neurology in Vienna lost a large number of its highly respected clinicians and researchers. Some of them refined their ideas and innovations abroad after 1945.

["Impossible to be part of this system any longer": the expulsion of neuroscientists from Frankfurt am Main (1933-1939)]. / "Impossible to be part of this system any longer": die Vertreibung von Neurowissenschaftlerinnen und Neurowissenschaftlern aus Frankfurt am Main (1933­1939).

In the 1920s, the situation of neuropsychiatry in Frankfurt was characterized by the rivalry between two institutions (Edinger Institute and University Neurology Clinic), two subdisciplines (neurology and psychiatry), and the physicians Kurt Goldstein (1878-1965) and Karl Kleist (1879-1960). After the National Socialists' assumption of power, university neuropsychiatric institutions in Frankfurt showed the highest number of dismissed university teachers and personnel in the German Reich. In neurology and psychiatry alone the university lost almost 50% of the personnel. Among those persecuted on racist grounds was Leo Alexander (1905-1985), who carried out genetic studies before 1933, prepared the "Alexander Reports" on behalf of the Allies after the Second World War, and was one of the prosecution counselors in the Nuremberg Doctors' Trial. His colleague Walther Riese (1890-1976) fled via France also to the USA and dedicated himself to the historical and ethical principles of neurology. Alice Rosenstein (1898-1991) was the first woman to specialize in neuroradiology and neurosurgery. In contrast to her male colleagues who were also dismissed in 1933, she committed herself to psychiatry after her arrival in North America and belonged to the early campaigners for the rights of homosexuals. Ernst (1905-1965) and Berta (1906-1995) Scharrer finally left Germany because of the prevailing political climate in the country. They excelled as co-founders of neuroendocrinology and neuroimmunology on the other side of the Atlantic.

[" without a visible sign of protest or at least solidarity from colleagues": the expulsion of neuroscientists from Hamburg]. / " ohne ein sichtbares Zeichen des Protestes oder wenigstens der Solidarität der Kollegen": die Vertreibung von Neurowissenschaftlern aus Hamburg.

In Hamburg, the National Socialists' racially motivated exclusion principally hit neurologists from two institutions: the Eppendorf Neurological Clinic (director until 1934 Max Nonne) and the Psychiatric and Neurological Clinic of Friedrichsberg State Hospital (director Wilhelm Weygandt). The chief physician of the neurological department of Barmbek Hospital, Heinrich Embden (1871-1941), who had been trained by Nonne, emigrated to Brazil, whereas Friedrich Wohlwill (1881-1958), another Nonne pupil who had been a pathologist at St Georg since 1924, lived for many years in Lisbon, before he found a new scientific home at the Harvard Medical School. The cerebrospinal fluid researcher Victor Kafka (1881-1955), a Freemason and intermittent member of the Communist Party, was briefly in so-called protective custody (Schutzhaft) in Fuhlsbüttel then fled via Norway to Sweden. Hermann Josephy (1887-1960) and Walter R. Kirschbaum (1894-1982), both imprisoned in the Sachsenhausen concentration camp after the November pogroms in 1938, could successfully continue their professional careers in Chicago. Richard Loewenberg (1898-1954) first opted to continue his career in China, then changed his mind and also went to the USA after the Japanese invasion. With the exception of the latter all were full members of the Society of German Neurologists. The broad scope of their research work clearly illustrates that in addition to clinical core competence, former neurologists could intensively follow scientific interests in the neighboring disciplines of pathology, serology, and psychiatry.

["There are no worthy life opportunities from a human, professional or scientific viewpoint": expelled neurologists outside the centers of German-speaking neuroscience]. / "Weder menschlich noch beruflich, noch wissenschaftlich würdige Lebensmöglichkeiten": vertriebene Neurologen außerhalb der Zentren der deutschsprachigen Neurowissenschaft.

The persecution and expulsion of German-speaking neurologists were not limited to research centers, such as Berlin, Vienna, Frankfurt am Main and Hamburg. The exclusion from science, teaching and clinical care also occurred at other (university) sites. The different aspects and implementation of the exclusion are presented here exemplified by 10 physicians involved in neuroscience. These ranged from forced internal emigration (Georg Stertz/Kiel), racially motivated removal from office (Max Isserlin and Karl Neubürger/both Munich, Ernst Grünthal/Würzburg, Gabriel Steiner/Heidelberg, Rudolf Altschul and Francis Schiller/both Prague) to publicly staged denunciation and humiliation (Otto Löwenstein/Bonn). Furthermore, without being directly persecuted themselves, individual physicians reacted to the poisoned political and academic climate in that they either sooner or later left their homeland (Eduard Heinrich Krapf/Cologne, Hartwig Kuhlenbeck/Jena). The results and conclusions summarized in this article for university clinics and institutes represent only a narrow section of the neurological scene in 1933-1939; however, they emphasize how necessary an expansion of the historical research perspective is on the fate of neurologists at communal hospitals, in field practices and other professional areas.

["We have to get rid of the Jews, either way": victims of violence among the neuroscientists]. / "Mit den Juden muß so oder so Schluß gemacht werden": Gewaltopfer unter den Neurowissenschaftlerinnen und Neurowissenschaftlern.

Neurologists as victims of National Socialist extermination policies have been rarely addressed as a special group in historical research. On the basis of archival documents and biographical literature, this essay presents 9 exemplary fates of a group of victims of violence whose number and structure so far cannot be estimated. These neurologists died in the ghettos of Lwów (e.g. Lucja Frey) and Theresienstadt (Alexander Spitzer/Vienna), were murdered in the concentration or extermination camps of Mauthausen (e.g. Raphael Weichbrodt/Frankfurt, Hans Pollnow/Berlin) and Auschwitz (e.g. Otto Sittig/Prague), or were executed in the East (e.g. Arthur Simons/Berlin). Others whose attempts to emigrate failed or whose deportation was imminent, chose to commit suicide. This group included the neuroserologist Felix Plaut (Munich), the encephalitis researcher Felix Stern (Göttingen), and presumably Fritz Chotzen (Breslau). In all these cases it was an eponym or a relationship to university medicine that prompted the investigations; however, the fate of innumerable colleagues employed in communal departments and medical practices remains unknown to date. Future studies will have to undertake a deeper look at the suffering of neuroscientists who perished in the Holocaust.

[Persecution, expulsion and extermination of German-speaking neurologists during the NS era: attempt at an assessment]. / Verfolgung, Vertreibung und Vernichtung deutschsprachiger Neurologinnen und Neurologen während der NS-Zeit: Versuch einer Bewertung.

Some 90 years after the beginning of the Nazi regime, the German Neurological Society (DGN) commissioned an investigation into the extent to which persecution, expulsion and extermination during the "Third Reich" also affected neurologists. In total, the biographies of 61 mostly Jewish physicians and scientists, of whom more than 70% were members of the neurological association of the time, could be analyzed. Most of them emigrated, a few remained in Germany or Austria despite persecution, and nine died in the Holocaust or by suicide. The racistically motivated expulsion affected all age groups, especially those who were 30-60 years old in "middle" positions. In close connection with Nazi legislation, three waves of emigration can be distinguished (1933-1934, 1935-1937, 1938-1939) and the clearly preferred destination country was the USA (64.7%). Younger age, knowledge of a universal language, reliable family and academic connections as well as internationally recognized publications, could make it easier to start a career in the country of exile. It was not uncommon for those who were involved in neurological fields before emigration to turn to basic science or psychiatry afterwards. The general "brain-drain"/"brain gain" hypothesis must be expanded by analyses on the biographical microlevel in order to illustrate the difficulties emigrants encountered when trying to start a new career and to publicize a sometimes unsuccessful acculturation. Not a single neurologist returned to Germany and, as far as can be assessed, any compensation, if at all was low. The critical assessment of the racistically motivated persecution between 1933 and 1945 can today be an occasion for the DGN and its members to reflect on collegiality as a value as well as to become more aware of structurally related discrimination and injustice and to counteract it in a timely manner.

Historical review: the German Neurological Society and its honorary members (1952-1982).

BACKGROUND: As part of a larger project commissioned by the German Neurological Society (DGN), this paper focuses on the DGN's German and Austrian honorary members. In particular, the question of whether former membership in the National Socialist German Workers' Party (NSDAP) or other Nazi organizations was an obstacle to becoming an honorary member in the years 1952-1982, and whether victims of the Nazi regime were also considered for honorary membership. RESULTS: From the early 1950s to the early 1980s, the DGN awarded honorary membership to 55 individuals. Of these, 27 were German or Austrian citizens who were physicians during the Nazi era, and 17 of the 27 (63%) were members of the NSDAP, Storm Troopers (SA), or Schutzstaffel (SS). In the early postwar period, honorary membership was much less frequently awarded to former Nazi Party members than in the years around 1980. Sir Ludwig Guttmann, the only neurologist forced to emigrate, received his honorary membership in 1971. Brief biographies of Hans Jacob, Gustav Bodechtel, Karl Kleist, and Ludwig Guttmann outline exemplary careers and life histories, in addition to highlighting key issues such as concurrent research on "euthanasia" victims, denazification procedures, forced emigration, and the contemporary mindset in the Federal Republic of Germany. CONCLUSIONS: Apparently, a "Nazi past" did not play a decisive role in the selection process for honorary members within the DGN until at least the 1980s. Aside from Guttmann, no other neuroscientist expelled from Germany was honored. With these practices, the Society marginalized its Jewish colleagues for a second time.