The controversial Third Reich history of Hans Creutzfeldt: was he a supporter or just another adept of the “hand washing policy”?

ABSTRACT Creutzfeldt-Jakob disease (CJD) is a transmissible spongiform encephalopathy whose initial description is associated with two German authors, Alfons Maria Jakob and Hans Gerhard Creutzfeldt. As polemic as the issue about the Creutzfeldt’s merit in the first description of the disease, is his history during the Third Reich. Some evidence pointed to the idea that he was essentially against the Nazi ideology, though some did not. He was an official member of the SS, but his own wife was convicted by a Nazi court. Some authors have argued that Creutzfeldt helped save many patients during Aktion T4 operation, but, in fact, he could have done more. Even during the post-war period, he sent a letter to authorities reporting the name of a Nazi physician who worked as a medical reviewer at the euthanasia court, but he did not proceed any further when his letter initially failed to start an investigation.


INTRODUCTION
Walther Spielmeyer first used the term Creutzfeldt-Jakob disease (CJD) because two German neuropathologists had previously described the disease 1,2 . Alfons Maria Jakob described a series of six patients with spasticity and progressive dementia associated with neural degeneration in the early 1920s, as did Hans Gerhardt Creutzfeldt (Figure 1), who had independently published the case of a "not so" similar patient. Jakob credited Creutzfeldt for first describing the syndrome, without realizing he had also uncovered the new syndrome 2,3 . CJD is the usual eponym used, since Creutzfeldt certainly gave the earlier account. But, in view of Jakob's greatest contribution, many authors reasonably argued that the correct designation should be Jakob-Creutzfeldt disease 2,4,5 . One 5 had reported, in his own words, that: "Dr. Creutzfeldt after the II World War (WWII) told me that his case did not bear any resemblance to the cases described by Jakob". Particularly in Brazil, the use of "Jakob-Creutzfeldt Disease" is common, instead of CJD. It is also probably due to the prominent figure that doctor Jakob represented for Brazil. From May to July 1928, he gave a 20-lecture course in Rio de Janeiro on nervous pathology, as well as in São Paulo and Campinas 6,7 .
Moreover, both Jakob and Creutzfeldt had studied under Alois Alzheimer's supervision, in different units led by him. Creutzfeldt 2 in Breslau and Jakob in Munich 6 . In 1913, Creutzfeldt studied the clinical picture and pathological brain changes of a previously unknown disease in a patient at the Breslau University's Neurology Unit. His publication of a description of this disease in 1920 was considered by some researchers to be the first in the world's medical literature approximately a year before Jakob published his series 8 . Putting aside the controversy of the CJD name, unequivocally, it is easy to recognize that both authors are important historical figures in Neurology.
Dr. Jakob deceased in 1931, years before the arrival of the Third Reich. Dr. Creutzfeldt, on the other hand, lived throughout the Nazi era. Some data suggest that he was against the ideology 9,10,11 , with clear declarations that he disliked Nazi policies 9 . However, contradictory, he became a Patron Member of Heinrich Himmler's SS from 1932 to 1933 and had, at least, an ambivalent posture facing Nazism ideology and the Aktion T4 * euthanasia program 9,12,13,14 .

CREUTZFELDT'S BRIEF HISTORY
Creutzfeldt was born into a medical family in Harburg, a city annexed to Hamburg since 1937, on June 2 nd , 1885. In 1903, he was drafted into the German army and was stationed in Kiel 9 . Afterward, he attended the Medicine School of the University of Jena and the University of Rostock, receiving his doctorate in 1909 2 . In the following years until 1912, he sought adventure as a ship's surgeon, voyaging the Pacific Ocean, taking the opportunity to study local crafts, linguistics, and tropical plants 9 . After returning, he worked at the Neurological Institute in Frankfurt am Main and at the psychiatric-neurological clinics in Breslau, with professor Alzheimer, and then in Kiel, after in Berlin, and finally at the Deutsche Forschungsanstalt für Psychiatrie in Munich 9 .
During World War I (WWI), he was a German naval medical officer. He was deployed as a reserve medical officer and survived the sinking of the auxiliary cruiser SMS Greif ( Figure 2). After being captured, he was repatriated and served in the Imperial Navy until the end of the war in 1918 9 .
After WWI, Creutzfeldt worked with Spielmeyer in Munich and with Siemerling in Kiel 2 . He moved to the Charité Hospital in Berlin and, after 14 years, he returned to Kiel in 1938 to become Emeritus Professor and Director of the Psychiatric and Neurological Division 9,10 . Then, 1939 arrived and WWII began.

THE AMBIVALENT RELATIONSHIP WITH NAZISM
During the years spent in Berlin and his subsequent time in Kiel, Creutzfeldt adopted a reserved but not completely hostile attitude to Nazism 9 . He was a registered candidate for the National Socialist German Doctors' Association, a paying member of the SS and Deputy Medical Assessor at the Berlin High Court of Hereditary Health 9 . However, he was one of just two members of Kiel's school of medicine who did not join the Nazi Party 10 . He was politically inconspicuous, with no emotional attachment to the ideology 9,13 . He also did not categorically reject compulsory sterilization in the reports he was required to produce and accepted that chronically ill patients who were unavoidably transferred to state hospitals for long-term treatment faced the threat of being sent to death camps for Aktion T4 9,14,15 (Chart 1). During WWII, as a Clinic Director in Kiel, of 605 patients transferred from Kiel, 135 were deported and 65 of these are known to having been murdered (the true figure is likely to be over 100) 9 . Nevertheless, Creutzfeldt claimed that he was "a decided opponent of the murder of the psychiatrically ill" 9,10,14 and one psychiatrist once declared that he was known to have attacked "euthanasia" during his lectures 10 , declaring that "They are murderers!"

The Aktion T4 operation was a postwar name for mass murder by involuntary euthanasia in Nazi Germany. 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 T4. Certain German physicians were authorized to select patients "deemed incurably sick, after most critical medical examination" and then administer them a "merciful death". "Merciful killings" referred to the systematic extermination of certain groups including the mentally ill, aged, disabled, and others. It was an Euthanasia Program, part of the Nazis' attempt to preserve the purity of the master race -in order to create a superior group of "Aryans," the Nazis needed to destroy all those with racial defects. By the end of 1940, almost 27,000 Germans had been killed as part of the program; by August 1941, more than 35,000 more had been exterminated. Aktion T4 was officially closed down on September 1, 1941, due to growing public pressure, including a sermon delivered by Bishop Clemens Galen in Muenster on August 3 rd . However, the Nazis secretly continued their "merciful killings" all the way up to the end of the war.
Source: Proctor 16 and Shoah Resource Center, the International School for Holocaust Studies 17 .
Heyde, was employed as a medical reviewer at the court. Interestingly, Creutzfeldt did not proceed any further when his letter initially failed to start an investigation into Heyde's case 9,12,13 . One year after, doctor Creutzfeldt retired and, on December 30 th , 1964, he died at the age of 80, after a longlasting disease 2,9 . It is difficult to consider that Creutzfedt was a clear adept of the Third Reich ideology. However, it is also nonsense to deny that some of his attitudes and passive behaviors put in check this belief. In general, his declared position seemed to be against the Third Reich, but some controversy has recently emerged, according to some authors 9,13,14,15 . Nevertheless, the actual question remains the same: Was he head-on against the Nazi ideology or was he merely another person who washed his hands? Only more historical research could shed light on this issue. His luck was that some Nazis thought him very eccentric or even "a little mad" 10 . However, it was not consistent with his lack of energy in the prevention of such murders 9 . Another event, which reinforced this idea, occurred when he put a great effort into reversing the conviction of a soldier in 1941/1942 who had deserted, which led to an avoidable death sentence 14,15 .
However, worth mentioning, is the fact that, during the war, bombing raids destroyed his home and clinic 11 . Besides, in 1943, a court sentenced his wife, Cläre, to four years in prison for spiteful and malicious remarks against the Third Reich 11 . Noteworthy, his son, Harald, defected from the German navy to join the Dutch underground resistance 12 .
Finally, another ambivalent event occurred years after WWII. In 1955, Creutzfeldt informed the President of the Court in Schleswig Holstein that the Nazi physician, Werner