Document 2qqpY1EVv5vZgnV1Qde04rD3L

20 CHAPTER 1 "The Number One Enemy of the State" The strength of German interest in cancer must be understood in light of the fact that Germany by the beginning of the twentieth century was a wealthy, highly industrialized nation with one of the highest cancer rates in the world. German labor unions and socialist parties had begun to emphasize occupational health and safety in the final decades of the previous century, an era of dra matic innovations in social medicine--including the world's most elaborate social welfare system, launched in 1883 in response to socialist demands. German medicine was powerful and politi cized, and Berlin was one of the world's strongest centers for medical research.34 Germany also had a strong "back to nature" (Lebensrefortn) movement that saw cancer as an unhealthy expres sion of the distance humans had traveled from their organic ori gins. Given that the insurance bureaucracy saw prevention as more cost-effective than curative medicine, it is perhaps not sur prising that Germans in the 1930s took steps to combat cancer. The kinds of cancers focused on must also be understood against the backdrop of Germany's unique professional, ideological, and technological history. Aniline dye cancer was discovered in Ger many in the 1890s, largely because Germany by this time was the world's leading producer of synthetic colorings.35 German profes sional societies were the first to establish informal standards for radiation protection,36 not just because X-rays were discovered in Germany, but also because the professional societies in that coun try were large and influential. Germans were early to perceive the cancer hazards of tar, asbestos, and radium, prompted by the strength of the union movement and the political parties rep resenting workers' interests. (Germany was the first nation to rec ognize lung cancer as a compensable occupational disease for uranium miners--in 1926--and by 1934 was the envy of American industrial toxicologists wanting to emulate its practice of closedsystem manufacture to prevent dye-related bladder cancer.)37 Ger mans formed organizations to combat alcohol and tobacco, be hueper s secret 21 cause these were seen as violating the organic integrity of the Ger man body--a concern that informed both the racial hygiene and Lebensrefortn (organic health) movement. Recognition of a steadily growing cancer incidence was one rea son German physicians launched the world's first state-supported anticancer agency, the Central Committee for Cancer Research and Cancer Combat (Zentralkomitee zur Erforschung und Bekampfung der Krebskrankheit), founded in 1900.38 Increasing cancer rates had been observed in Germany since the end of the nine teenth century, and by the 1920s these escalating rates had become a major scandal.39 Cancer surpassed tuberculosis as the nation's second-most common cause of death in 1928; cancer was declared "the number one enemy of the state" (Staatsfeind Nummer Eins), surpassing even the major form of heart attack.40 (All forms of heart attack combined, however, were still the number one cause of death.) A hundred thousand Germans died of cancer every year in the 1930s; another half a million lived and suffered with the dis ease.41 Germany by this time had one of the highest cancer rates in the world--owing to the longevity of its populace and its cancerinducing habits--and one of the most elaborate medical organiza tions struggling to deal with it. It also had a health-conscious polit ical party with unprecedented police powers allowing it to combat the growing threat. One of the more arresting features of the Nazi anticancer effort was its emphasis on prevention. Prevention fit with the Nazi ap proach to many other problems: racial hygiene, for example, was supposed to provide long-term care for the German germ plasm, by contrast with more traditional social or personal hygiene.42 The emphasis was not, of course, entirely new: socialist and communist physicians had long stressed prevention, and Nazi physicians could even cite Plato's admonishment that "care of the body" was better than the healing art, since "the former makes the latter su perfluous.''43 The Weimar period saw several important moves in this direction, reflected in the establishment of statistical offices, propaganda campaigns to stress early detection, and legislation to protect occupational health and safety. What was new in the Nazi